FY1987 01/06/1987BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 743-9036
wannp 'oifjage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
5W WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (306) 294-4641
January 9, 1987
David P. Rice, Ph.D., 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
TEL. (305) 852.9253
At a Regular Meeting in formal session on January 6,
1987, the Board of County Commissioners adopted Resolution
No. 044-1987 authorizing the Mayor and Chairman of the Board
to execute an'Agreement for Baker Act Mataching Funds by and
between the Board and the Guidance Clinic of the Middle
Keys, Inc. concerning funding for Fiscal Year 1986-87.
Enclosed herewith is a certified copy of the sub-
ject Resolution and a fully -executed copy of the Agreement.
Very truly yours,
Danny L. Kolhage
Clerk of Circuit Court
and ex officio Clerk to
Board of County Commissioners
by:
Rosalie L. onnolly
Deputy Clerk
Enclosures
cc: County Attorney
Finance Department
W.,'`i1e
AGREEMENT FOR BAKER ACT MATCHING FUNDS
THIS AGREEMENT, made this 1_&k day of�y�1., 19871
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 $129,524.00 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 Thirty Two Thousand Three
Hundred Eighty One Dollars ($32,381.00) during the period beginning
October 1, 1986, and ending September 30, 1987.
(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 reim-
bursement 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, 1987
and the Board shall not be liable under the terms of this agreement
for any liability incurred after the time of termination; 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 reimbursement 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 j)ANNY L. i<G� t'�� Clerk
,VANA�- -
&. L. E I iot4
Witnesses
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA j
By y,
r ayor/Chairman
GUIDANCE CLINIC OF THE MIDDLE
KEYS, INC.
By
P esident/Board of Directors
By
xecutive Dire or
M
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