FY1985 12/14/1984b
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{ BRANCH OFFICE
1 3117 OVERSEAS IGHWAY
MARATHON, LORIDA 33050
TEL (30S) 74 9036
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RECORDER,
COLLECTOR.OF DELINQUENT TAXES
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1. Rotbage
CLERK OF THE CIRCUIT COURT
16TH JUDICIAL CIRCUIT
MONROE COUNTY
500 WHITEHEAD STREET
KE 'WEST, FLORIDA 33040
TEL. (305) 294-4641
December 27, 1984
Or David P. Rice, Executive Director
Guidance Clinic of the Middle Keys, Inc.
11399 Overseas Highway
Marathon, Florida 33050
Dear Dr. Rice:
BRANCH OFFICE
P.O. BOX 379
PLANTATION KEY, FLORIDA 33070 j
TEL. (305) 852-9253
COUNTY CLERK
COUNTY AUDITOR
The Board of County Commissioners at a regular
meeting in formal session on December 14, 1984 adopted
Resolution No. 362-1984 authorizing the Chairman of the
1 Board of County Commissioners of Monroe County, Florida, to
approve and execute an Agreement for Baker Act Matching
Funds by and between the Guidance Clinic of the Middle Keys,
Inc. and the Board of County C issioners of Monroe County,
Florida. Enclosed is a certif copy of this Resolution
for your records. Also enclose Is a copy of this Agreement
which has now been fullly execut'd on behalf of Monroe
County.
very truly yours,
Danny L. Kolhage
Clerk of Circuit Court
and ex officio Clerk
Board of County Commissioners
by:
15 eputy C 1 e r
OLK/rls
Enclosures
cc: Lucien Proby, County Attorney w/copy
Finance Department w/copy for file in your possession
VFl 1 e
I
AGREEMENT FOR BAKER ACT MATCHING FUNDS
THIS AGREEMENT, made this 14th day of December 1284,by
and between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY,
FLORIDA, hereinafter referred to as "BOARD", and the Guidance
Clinic of the Middle Keys, Inc., hereinafter referred to as
"CLINIC",
For and in consideration of the mutual covenants made
herein, the parties hereby agree as follows:
(1) The Board agrees to reimburse the Clinic twenty-five
percent (25%) of total Clinic expenditures for Baker Act
hospital, physician, and crisis stabilization services, as billed
to the Clinic on state approved Baker Act Billing Forms (HRS 346)
for clients qualifying for such services under applicable state
and federal regulations and eligibility determination procedures.
This cost is not to exceed a total reimbursement of Twenty-four
thousand, four hundred eighty-four dollars and twenty-five cents
($24,484.25) during the period beginning October 1, 1984, and
ending September 30, 1985.
(2) The Clinic agrees to provide to the Board on a regular
basis a copy of the Baker Act Summary Billing Form from which
reimbursement due the Clinic can be calculated; however, copies
of individual client bills will not be available for inspections
by the Board for reimbursement purposes in order to comply with
regulations safeguarding the patient's right to confidentiality.
Copies of individual client bills are kept on file in the Clinic
business office and will be made available under controlled
condition to qualified auditors for audit purposes. The Clinic
further agrees to provide the Board any Baker Act statistical
data normally available to the Clinic and to make an annual
report to the Board of the expenditure of County funds for the
above specified purposes.
This agreement shall terminate at 11:59 P.M., September 30,
1985 and the Board shall not be liable under the terms of this
agreement for any liability incurred after the time of termina-
tion; however, the Board shall be liable for outstanding costs
incurred prior to the termination of this agreement provided the
Clinic submits to the Board the required Baker Act Summary
Billing Form within three (3) weeks of the date of termination of
this agreement, provided, however, that the maximum of reimburse-
ment specified above is not exceeded. This agreement may also be
terminated by either party upon thirty (30) days written notice
delivered by certified mail to the party receiving notice of
termination.
County warrants or checks written for reimbursement to the
Clinic shall be made payable to the Guidance Clinic of the Middle
Keys, Inc.
IN WITNESS WHEREOF, the BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, has caused these presents to be signed in
its name by its Chairman, Board of County Commissioners, and the
Clerk of the Board of County Commissioners, and the Guidance
Clinic of the Middle Keys, Inc., has caused these presents to be
signed in its name by its President/Board of Directors and
Executive Director all as of the day and year first above
written.
(Seal)
Attest: DANNY L. KCLHAGE, Clerk
f
er
Witnesses
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
Mayor/Chairman
GU
KE
By
rectors
By
xecutive Directft
AS 70 FORM
2 OF IQ ,Q
Attorneys Office
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