FY2011 10/20/2010DANNY L. KOLHA GE
CLERK OF THE CIRCUIT COURT
DATE: October 28, 2010
TO: Lisa Tennyson
Grants Management
i
FROM: Pamela G. Hancock 13. C.
At the October 20, 2010, Board of County Commissioner's meeting the Board granted
approval of Contracts with Nonprofit Service Organizations funded by the County Commission
for Fiscal Year 2011. These organizations do not apply to the Human Services Advisory Board;
they are funded directly by the Board of County Commissioners as budget line items: AIDS
Help, Inc., in the amount of $20,000; American Red Cross of Greater Miami and the Keys, in the
amount of $5,000; Boys and Girls Club, Inc., in the amount of $36,554 of which $1,554 comes
from the Clerk's Drug Abuse Trust Fund; Domestic Abuse Shelter, in the amount of $20,000;
Easter Seals Florida, Inc., in the amount of $11,200; Florida Keys Area Health Education Center,
Inc., in the amount of $35,000; Florida Keys Children's Shelter, Inc., in the amount of $146,000;
Florida Keys Healthy Start Coalition, Inc., in the amount of $5,000; Florida Keys Outreach
Coalition, Inc., in the amount of $30,000; Good Health Clinic, Inc., in the amount of $40,000;
Grace Jones Day Care Center, in the amount of $30,000; Guidance Clinic/Care Center, in the
amount of $1,082,770 of which $22,250 comes from the Clerk's Drug Abuse Trust Fund;
Helpline, Inc., in the amount of $4,000; Hospice of the Florida Keys, Inc., in the amount of
$145,000; Independence Cay, in the amount of $15,000; Keys Area Interdenominational
Resources, in the amount of $15,000; Literacy Volunteers of America - Monroe County, Inc., in
the amount of $4,000; Monroe Association for Retarded Citizens (MARC), in the amount of
$145,000; Monroe County Education Foundation, Inc., - Keys Center, in the amount of $57,000;
Rural Health Network of Monroe County, Florida, Inc., in the amount of $333,600; Samuel's
House, Inc., in the amount of $75,000; Star of the Sea Foundation, in the amount of $30,000;
United States Fellowship of Florida, Inc., d/b/a Heron and Peacock Programs, in the amount of
$45,000; Wesley House Family Services, Inc., in the amount of $126,000; Womankind, Inc., in
the amount of $70,000.
Enclosed are two copies of each of the above -mentioned for your handling. The
American Red Cross of Greater Miami and Florida Keys Area Health Education Center, Inc. did
have two originally signed agreements - I have returned those. Should you have any questions
please do not hesitate to contact this office.
cc: County Attorney - via compact disc
Finane - via compact disc
File
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AGREEMENT
This Agreement is made and entered into this 20th day of October, 2010,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA,
hereinafter referred to as "Board" or "County," and Womankind, Inc., hereinafter
referred to as "PROVIDER."
WHEREAS, the PROVIDER is a not -for -profit corporation established for the
provision of women's health care, and
WHEREAS, it is a legitimate public purpose to provide facilities and services
related to women's health care, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is
agreed as follows:
FUNDING
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER
substantially and satisfactorily performing and carrying out the duties of the Board as to
providing facilities and services for women's health care for persons living in Monroe
County, Florida, shall pay to the PROVIDER the sum of SEVENTY THOUSAND AND NO/100
DOLLARS ($70,000.00) for fiscal year 2010-2011.
2. TERM. This Agreement shall commence on October 1, 2010, and terminate
September 30, 2011, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be made periodically, but no more frequently than
monthly, as hereinafter set forth. Reimbursement requests will be submitted to the
Board via the Clerk's Finance Office. The COUNTY shall only reimburse, subject to the
funded amounts below, those reimbursable expenses which are reviewed and approved
as complying with Monroe County Code of Ordinances, State laws and regulations and
Attachment A - Expense Reimbursement Requirements. Evidence of payment by the
PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting
documentation attached. The letter should contain a notarized certification statement.
An example of a reimbursement request cover letter is included as Attachment B. The
organization's final invoice must be received within thirty days after the termination date
of this contract shown in Article 2 above.
After the Clerk of the Board examines and approves the request for
reimbursement, the Board shall reimburse the PROVIDER. However, the total of said
reimbursement expense payments in the aggregate sum shall not exceed the total
amount shown in Article 1, above, during the term of this agreement.
4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be
continued at a level sufficient to allow for continued reimbursement of expenditures for
services specified herein, this agreement may be terminated immediately at the option
of the Board by written notice of termination delivered to the PROVIDER. The Board
shall not be obligated to pay for any services or goods provided by the PROVIDER after
the PROVIDER has received written notice of termination, unless otherwise required by
law.
S. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each
shall be, and is, empowered to apply for, seek, and obtain federal and state funds to
further the purpose of this Agreement; provided that all applications, requests, grant
proposals, and funding solicitations shall be approved by each party prior to submission.
6. PURCHASE OF PROPERTY. All property, whether real or personal, purchased
with funds provided under this agreement, shall become the property of Monroe County
and shall be accounted for pursuant to statutory requirements.
RECORDKEEPING
7. RECORDS. PROVIDER shall maintain all books, records, and documents
directly pertinent to performance under this Agreement in accordance with generally
accepted accounting principles consistently applied. Each party to this Agreement or
their authorized representatives shall have reasonable and timely access to such records
of each other party to this Agreement for public records purposes during the term of the
Agreement and for four years following the termination of this Agreement. If an auditor
employed by the County or Clerk determines that monies paid to PROVIDER pursuant to
this Agreement were spent for purposes not authorized by this Agreement, the
PROVIDER shall repay the monies together with interest calculated pursuant to Sec.
55.03, FS, running from the date the monies were paid to PROVIDER.
S. PUBLIC ACCESS. The County and PROVIDER shall allow and permit
reasonable access to, and inspection of, all documents, papers, letters or other
materials in its possession or under its control subject to the provisions of Chapter 119,
Florida Statutes, and made or received by the County and PROVIDER in conjunction with
this Agreement; and the County shall have the right to unilaterally cancel this
Agreement upon violation of this provision by PROVIDER.
9. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the
COUNTY the following (items A -I must be provided prior to the payment of any
invoices) :
(a) IRS Letter of Determination indicating 501(c)(3) status;
(b) List of the Organization's Board of Directors of which there must be five or more;
for each board member please indicate when elected to serve and the length of
term of service;
(c) Evidence of annual election of Officers and Directors;
(d) Unqualified audited financial statement from most recent fiscal year for all
organizations that expend $150,000 a year or more; if qualified, include a
statement of deficiencies with corrective actions recommended/taken;
(e) IRS Form 990 from most recent fiscal year for all organizations;
(f) Organization's Corporate Bylaws, which must include the organization's mission,
board and membership composition, and process for election of officers;
(g) Organization's Policies and Procedures Manual which must include hiring policies
for all staff, drug and alcohol free workplace provisions, and equal employment
opportunity provisions;
(h) Specific description or list of services to be provided under this contract with this
grant (see Attachment C);
(i) Initial Performance Report describing services provided during the prior fiscal year.
The performance reports shall include statistical information regarding the types
and frequencies of services provided, a profile of clients (including residency) and
numbers served, and outcomes achieved.
(j) Final Performance Report describing services rendered during the current grant
period (to be furnished within 30 days after the contract end date.) The
performance reports shall include statistical information regarding the types and
frequencies of services provided, a profile of clients (including residency) and
numbers served, and outcomes achieved.
(k) Cooperation with County monitoring visits that the County may request during the
contract year; and
(1) Other reasonable reports and information related to compliance with applicable
laws, contract provisions and the scope of services that the County may request
during the contract year.
RESPONSIBILITIES
10. SCOPE OF SERVICES. The PROVIDER, for the consideration named,
covenants and agrees with the Board to substantially and satisfactorily perform and
provide the services outlined in Attachment C to residents of Monroe County, Florida.
11. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the
event any cause of action or administrative proceeding is initiated or defended by any
party relative to the enforcement or interpretation of this Agreement, the prevailing
party shall be entitled to reasonable attorney's fees, court costs, investigative, and out-
of-pocket expenses, as an award against the non -prevailing party, and shall include
attorney's fees, courts costs, investigative, and out-of-pocket expenses in appellate
proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement
shall be in accordance with the Florida Rules of Civil Procedure and usual and customary
procedures required by the circuit court of Monroe County.
12. BINDING EFFECT. The terms, covenants, conditions, and provisions of this
Agreement shall bind and inure to the benefit of the County and PROVIDER and their
respective legal representatives, successors, and assigns.
13. CODE OF ETHICS. County agrees that officers and employees of the County
recognize and will be required to comply with the standards of conduct for public officers
and employees as delineated in Section 112.313, Florida Statutes, regarding, but not
limited to, solicitation or acceptance of gifts; doing business with one's agency;
unauthorized compensation; misuse of public position, conflicting employment or
contractual relationship; and disclosure or use of certain information.
14. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in
respect to itself, it has neither employed nor retained any company or person, other
than a bona fide employee working solely for it, to solicit or secure this Agreement and
that it has not paid or agreed to pay any person, company, corporation, individual, or
firm, other than a bona fide employee working solely for it, any fee, commission,
percentage, gift, or other consideration contingent upon or resulting from the award or
making of this Agreement. For the breach or violation of the provision, the PROVIDER
agrees that the County shall have the right to terminate this Agreement without liability
and, at its discretion, to offset from monies owed, or otherwise recover, the full amount
of such fee, commission, percentage, gift, or consideration.
15. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder,
the PROVIDER is an independent contractor and not an employee of the Board. No
statement contained in this agreement shall be construed so as to find the PROVIDER or
any of its employees, contractors, servants or agents to be employees of the Board.
COMPLIANCE ISSUES
16. COMPLIANCE WITH LAW. In providing all services pursuant to this
agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations
pertaining to or regulating the provision of such services, including those now in effect
and hereinafter adopted. Any violation of said statutes, ordinances, rules and
regulations shall constitute a material breach of this agreement and shall entitle the
Board to terminate this contract immediately upon delivery of written notice of
termination to the PROVIDER.
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17. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall
assure that all professionals have current and appropriate professional licenses and
professional liability insurance coverage. Funding by the Board is contingent upon
retention of appropriate local, state and/or federal certification and/or licensure of the
PROVIDER'S program and staff.
18. NON-DISCRIMINATION. County and PROVIDER agree that there will be no
discrimination against any person, and it is expressly understood that upon a
determination by a court of competent jurisdiction that discrimination has occurred, this
Agreement automatically terminates without any further action on the part of any party,
effective the date of the court order. County or PROVIDER agree to comply with all
Federal and Florida statutes, and all local ordinances, as applicable, relating to
nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights
Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or
national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC
ss. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3)
Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which
prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of
1975, as amended (42 USC ss. 6101-6107) which prohibits discrimination on the basis
of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended,
relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol
Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-
616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss.
690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug
abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.),
as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9)
The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended
from time to time, relating to nondiscrimination on the basis of disability; 10) Any
other nondiscrimination provisions in any Federal or state statutes which may apply to
the parties to, or the subject matter of, this Agreement.
AMENDMENTS, CHANGES, AND DISPUTES
19. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the
services and/or reimbursement of services shall be accomplished by an amendment,
which must be approved in writing by the COUNTY.
20. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER
agree that all disputes and disagreements shall be attempted to be resolved by meet
and confer sessions between representatives of each of the parties. If no resolution can
be agreed upon within 30 days after the first meet and confer session, the issue or
issues shall be discussed at a public meeting of the Board of County Commissioners. If
the issue or issues are still not resolved to the satisfaction of the parties, then any party
shall have the right to seek such relief or remedy as may be provided by this Agreement
or by Florida law.
21. COOPERATION. In the event any administrative or legal proceeding is
instituted against either party relating to the formation, execution, performance, or
breach of this Agreement, County and PROVIDER agree to participate, to the extent
required by the other party, in all proceedings, hearings, processes, meetings, and other
activities related to the substance of this Agreement or provision of the services under
this Agreement. County and PROVIDER specifically agree that no party to this
Agreement shall be required to enter into any arbitration proceedings related to this
Agreement.
ASSURANCES
22. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither
presently has any interest, and shall not acquire any interest, which would conflict in any
manner or degree with its performance under this Agreement, and that only interest of
each is to perform and receive benefits as recited in this Agreement.
23. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in
writing and with the prior written approval of the Board, which approval shall be subject to
such conditions and provisions as the Board may deem necessary. This agreement
shall be incorporated by reference into any assignment and any assignee shall comply
with all of the provisions herein. Unless expressly provided for therein, such approval
shall in no manner or event be deemed to impose any obligation upon the Board in
addition to the total agreed upon reimbursement amount for the services of the
PROVIDER.
24. NON -WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28,
Florida Statutes, the participation of the County and the PROVIDER in this Agreement
and the acquisition of any commercial liability insurance coverage, self-insurance
coverage, or local government liability insurance pool coverage shall not be deemed a
waiver of immunity to the extent of liability coverage, nor shall any contract entered into
by the County be required to contain any provision for waiver.
2S. ATTESTATIONS. PROVIDER agrees to execute such documents as the County
may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement,
and a Drug -Free Workplace Statement.
26. AUTHORITY. Each party represents and warrants to the other that the
execution, delivery and performance of this Agreement have been duly authorized by all
necessary County and corporate action, as required by law.
INDEMNITY ISSUES
27. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and
agrees to indemnify and hold harmless Monroe County Board of County Commissioners
from any and all claims for bodily injury (including death), personal injury, and property
damage (including property owned by Monroe County) and any other losses, damages,
and expenses (including attorney's fees) which arise out of, in connection with, or by
reason of services provided by the PROVIDER occasioned by the negligence, errors, or
other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers.
28. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from
liability, exemptions from laws, ordinances, and rules and pensions and relief, disability,
workers' compensation, and other benefits which apply to the activity of officers, agents,
or employees of any public agents or employees of the County, when performing their
respective functions under this Agreement within the territorial limits of the County shall
apply to the same degree and extent to the performance of such functions and duties of
such officers, agents, volunteers, or employees outside the territorial limits of the
County.
29. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall
be deemed to be a covenant or agreement of any member, officer, agent or employee
of Monroe County in his or her individual capacity, and no member, officer, agent or
employee of Monroe County shall be liable personally on this Agreement or be subject
to any personal liability or accountability by reason of the execution of this Agreement.
30. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non -Delegation of
Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be
construed as, relieving any participating entity from any obligation or responsibility
imposed upon the entity by law except to the extent of actual and timely performance
thereof by any participating entity, in which case the performance may be offered in
satisfaction of the obligation or responsibility. Further, this Agreement is not intended
to, nor shall it be construed as, authorizing the delegation of the constitutional or
statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
31. NON -RELIANCE BY NON-PARTIES. No person or entity shall be entitled to
rely upon the terms of this Agreement to enforce or attempt to enforce any third -party
claim or entitlement to or benefit of any service or program contemplated hereunder,
and the County and the PROVIDER agree that neither the County nor the PROVIDER or
any agent, officer, or employee of either shall have the authority to inform, counsel, or
otherwise indicate that any particular individual or group of individuals, entity or entities,
have entitlements or benefits under this Agreement separate and apart, inferior to, or
superior to the community in general or for the purposes contemplated in this
Agreement.
Cc] 4:14114
32. Execution in Counterparts. This Agreement may be executed in any number
of counterparts, each of which shall be regarded as an original, all of which taken
together shall constitute one and the same instrument and any of the parties hereto
may execute this Agreement by signing any such counterpart.
33. NOTICE. Any notice required or permitted under this agreement shall be in
writing and hand -delivered or mailed, postage pre -paid, by certified mail, return receipt
requested, to the other party as follows:
For Board:
Grants Administrator and
1100 Simonton Street
Key West, FL 33040
For PROVIDER
Kim Romano, Executive Director
Womankind, Inc.
3142 Northside Dr., Suite 101
Key West, FL 33040
305-294-4004
305-294-6043 FAX
Monroe County Attorney
PO Box 1026
Key West, FL 33041
34. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This
Agreement shall be governed by and construed in accordance with the laws of the State
of Florida applicable to contracts made and to be performed entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for
the enforcement or interpretation of this Agreement, the County and PROVIDER agree
that venue will lie in the appropriate court or before the appropriate administrative body
in Monroe County, Florida.
The County and PROVIDER agree that, in the event of conflicting interpretations
of the terms or a term of this Agreement by or between any of them the issue shall be
submitted to mediation prior to the institution of any other administrative or legal
proceeding.
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35. NON -WAIVER. Any waiver of any breach of covenants herein contained to be
kept and performed by the PROVIDER shall not be deemed or considered as a
continuing waiver and shall not operate to bar or prevent the Board from declaring a
forfeiture for any succeeding breach, either of the same conditions or covenants or
otherwise.
36. SEVERABILITY. If any term, covenant, condition or provision of this
Agreement (or the application thereof to any circumstance or person) shall be declared
invalid or unenforceable to any extent by a court of competent jurisdiction, the
remaining terms, covenants, conditions and provisions of this Agreement, shall not be
affected thereby; and each remaining term, covenant, condition and provision of this
Agreement shall be valid and shall be enforceable to the fullest extent permitted by law
unless the enforcement of the remaining terms, covenants, conditions and provisions of
this Agreement would prevent the accomplishment of the original intent of this
Agreement. The County and PROVIDER agree to reform the Agreement to replace any
stricken provision with a valid provision that comes as close as possible to the intent of
the stricken provision.
37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of
the parties hereto with respect to the subject matter hereof and supersedes any and all
prior agreements with respect to such subject matter between the PROVIDER and the
Board.
[THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW]
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ESS WHEREOF, the parties hereto have caused these presents to be
the day and year first written above.
tS
' L. KOLHAGE, CLERK
Deputy Clerk
Witness
v
Witness
BOARD OF COUNTY
OF MONROE COUNTY, FLORIDA
By
Mayor/Chairman
Womankind, Inc.
(Federal ID No. 65-100-3208)
By C,�JV�
President
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ATTACHMENT A
Expense Reimbursement Requirements
This document is intended to provide basic guidelines to Human Service and
Community -Based Organizations, county travelers, and contractual parties who have
reimbursable expenses associated with Monroe County business. These guidelines, as
they relate to travel, are from the Monroe County Code of Ordinances and State laws
and regulations.
A cover letter (see Attachment B) summarizing the major line items on the reimbursable
expense request needs to also contain the following notarized certified statement:
"I certify that the above checks have been submitted to the vendors as noted and
that the attached expenses are accurate and in agreement with the records of this
organization. Furthermore, these expenses are in compliance with this organization's
contract with the Monroe County Board of County Commissioners and will not be
submitted for reimbursement to any other funding source."
Invoices should be billed to the contracting agency. Third party payments will not be
considered for reimbursement. Remember, the expense should be paid prior to
requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the
contract. This document should not be considered all-inclusive. The Clerk's Finance
Department reserves the right to review reimbursement requests on an individual basis.
Any questions regarding these guidelines should be directed to 305-292-3534.
Data Processing, PC Time, etc.
The vendor invoice is required for reimbursement. Inter -company allocations are not
considered reimbursable expenditures unless appropriate payroll journals for the
charging department are attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is
needed. If a Payroll Journal is provided, it should include: dates, employee name,
salary or hourly rate, total hours worked, withholding information and payroll taxes,
check number and check amount. If a Payroll Journal is not provided, the following
information must be provided: pay period, check amount, check number, date, payee,
support for applicable payroll taxes.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for
reimbursement. For overnight or express deliveries, the vendor invoice must be
included.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments
are not allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for
reimbursement. The log must define the date, number of copies made, source
document, purpose, and recipient. A reasonable fee for copy expenses will be
allowable. For vendor services, the vendor invoice and a sample of the finished product
are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date,
the number called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the
caller, the telephone number, the date, and the purpose of the call.
Travel and Meal Expenses
Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of
Travel Expenses. Travel reimbursement requests must be submitted and will be paid in
accordance with Monroe County Code of Ordinances and State laws and regulations.
Credit card statements are not acceptable documentation for reimbursement. If
attending a conference or meeting a copy of the agenda is needed. Airfare
reimbursement requires the original passenger receipt portion of the airline ticket. A
travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement
requires the vendor invoice. Fuel purchases should be documented with paid receipts.
Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a
taxi from one's residence to the airport for a business trip is not reimbursable. Parking
is considered a reimbursable travel expense at the destination. Airport parking during a
business trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero
Room must be registered and paid for by traveler. The County will only reimburse the
actual room and related bed tax. Room service, movies, and personal telephone calls
are not allowable expenses.
Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER
DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An
odometer reading must be included on the state travel voucher for vicinity travel.
Mileage is not allowed from a residence or office to a point of departure. For example,
driving from one's home to the airport for a business trip is not a reimbursable
expense.
Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER
DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal
guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement,
before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end
after 8 p.m. for dinner reimbursement.
Non -allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay
expenditures (unless specifically included in the contract), contributions, depreciation
expenses (unless specifically included in the contract), entertainment expenses,
fundraising, non -sufficient check charges, penalties and fines.
1n41,4 4 .r.,..• ..s..o 4n
ATTACHMENT B
ORGANIZATION
LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, FL 33040
Date
The following is a summary of the expenses for ( Organization name) for the time
period of to
Check #
Payee
Reason
101
Company A
Rent
102
Company B
Utilities
104
Employee A
P/R ending 05/14/01
XXX.XX
105
Employee B
P/R ending 05/28/01
XXX.XX
(A) Total
(B) Total prior payments
(C) Total requested and paid (A + B)
(D) Total contract amount
Balance of contract (D-C)
Amount
$ X,XXX.XX
XXX.XX
$ X'XXX.XX
$ X,XXX.XX
$ X,XXX.XX
$ X,XXX.XX
$ X,XXX.XX
I certify that the above checks have been submitted to the vendors as noted and that
the expenses are accurate and in agreement with the records of this organization.
Furthermore, these expenses are in compliance with this organization's contract with the
Monroe County Board of County Commissioners and will not be submitted for
reimbursement to any other funding source.
Executive Director
Attachments (supporting documentation)
Sworn to and subscribed before me this day of 200_
by who is personally known to me.
Notary Public
Notary Stamp
WVY` 7Mn_14 * - - 44
ATTACHMENT C
Services to be provided:
(Insert a description of your organization including a list of the services that will be provided by
your organization under this contract.)
WomanKind, inc. is a health care center that provides individualized and prevention -
focused primary and gynecologic medical care to women of all ages, ethnicity, sexual
orientation and socioeconomic level. A sliding scale allows women who are uninsured or
underinsured and/or low income in Monroe County to receive health care.
Services provided with funding from Monroe County include but are not limited to:
• Medical services and procedures
• ARNP-provided care
• Hispanic outreach and translation.
BOCC Contract 2010-11; page 12
PUBLIC ENTITY CRIME STATEMENT
"A 'person or affiliate who has been placed on the convicted vendor list following a
conviction for public entity crime may not submit a bid on a contract to provide any
goods or services to a public entity, may not submit a bid on a contract with a public
entity for the construction or repair of a public building or public work, may not submit
bids on leases of real property to public entity, may not be awarded or perform work as
a contractor, supplier, subcontractor, or consultant under a contract with any public entity,
and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the
date of being placed on the convicted vendor list."
Gnr'e' (`—f -4 7/N/L44 rl • noun -VZ
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUS
1XjM1�261AO warrants that he/it has not employed, retained or
otherwise Aad act on his/its behalf any former County officer or employee in violation of
Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its
discretion, deduct from the contract or purchase price, or otherwise recover, the full
amount of any fee, commission, percentage, gift, or consideration paid to the former
County officer or employee. --------.
(s19Aatu r
Date: 04 I i )01 0
STATE OF F 6 V l d a
COUNTY OF Y I M Mr
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Kim
y� / o YY ric who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this day
of
My commission expires:
OMB - MCP FORM #4
O ARY PUBLIC
KERR Y S. HADO
Honorpvbft. SW 01 FWW
MV Cow Ex0M j*n 13. 201
CO M IUW 0 DD 620325
9aid�d Through ►�'� Nar1► �'
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
A
(Name of Business)
1. Publishes a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is prohibited in the
workplace and specifying the actions that will be taken against employees for violations
of such prohibition.
2. Informs employees about the dangers of drug abuse in the workplace, the
business's policy of maintaining a drug -free workplace, any available drug counseling,
rehabilitation, and employee assistance programs, and the penalties that may be
imposed upon employees for drug abuse violations.
3. Gives each employee engaged in providing the commodities or contractual services
that are under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notifies the employees that, as a
condition of working on the commodities or contractual services that are under bid, the
employee will abide by the terms of the statement and will notify the employer of any
conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893
(Florida Statutes) or of any controlled substance law of the United States or any state,
for a violation occurring in the workplace no later than five (5) days after such conviction.
5. Imposes a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's community, or
any employee who is so convicted.
6. Makes a good faith effort to continue to maintain a drug -free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with
the above requirements.
) j rm
STATE OF G f' I d GL
(S nl to a 6f tlkespondeA�'
COUNTY OF rcLf c�_ ( ) :�01 v
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Il 1tY, Amon 0 who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
1 _S - day of� 60kLer , 2014-0.
NOTARY PUBLIC
My commission expires: 143 /1
1(20''1
KERR S. HAM
Notary PUW - Shts of FWW
MY CarWWW EXO M Jan 1S. Z011
Comn�olon / 00 VM5
7lr0*11 10-NoWyAan