FY1988 12/15/1987oannp 1. Rotbage
BRANCH OFFICE CLERK OF THE CIRCUIT COURT BRANCH OFFICE
3117 OVERSEAS HIGHWAY MONROE COUNTY P.O. BOX 379
MARATHON, FLORIDA 33050 500 WHITEHEAD STREET PLANTATION KEY, FLORIDA 33070
TEL. (305) 743-9036 KEY WEST, FLORIDA 33040 TEL. (305) 852.9253
TEL. (305) 294-4641
December 18, 1987
David P. Rice, Ph.D., Executive Director
Guidance Clinic of the Middle Keys, Inc.
11399 Overseas Highway
Marathon, Florida 33050
Dear Dr. Rice:
At a Regular Meeting in formal session on
December 18, 1987, the Board of County Commissioners adopted
Resolution No. 469-1987 authorizing the Mayor/Chairman of
the Board to execute an Agreement for Baker Act Matching
Funds by and between the Board and the Guidance Clinic of
the Middle Keys, Inc, concerning funding for Fiscal Year
1987-88.
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 Of
Enclosures
cc: Mayor E. Lytton
County Attorney
County Administrator
Finance Department
Ly' y e
AGREEMENT FOR BAKER ACT MATCHING FUNDS
THIS AGREEMENT, made this /Jitl day of ,DCeepal r- 1987, 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 $145,964.00 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 Six
Thousand Four Hundred Ninety One Dollars ($36,491.00) during the period
beginning October 1, 1987, and ending September 30, 1988.
(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 conditions 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, 1988 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
4
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)
At t e s t : DANNY L. KOLHAGE, Clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
GUIDANCE CLINIC OF THE MIDDLE
KEYS, INC.
Pr6sio nt/Board of Directors
By "
Executive Director