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FY1997 10/19/1996BRANCH OFFICE 3117 OVERSEAS HIGHWAY MARATHON, FLORIDA 33050 TEL (305) 289-6027 FAX (305) 2WI745 0annp 1. Rotjagc CLERK OF THE CIRCUIT COURT MONROE COUNTY SW WHITEHEAD STREET KEY WEST, FLORIDA 33040 TEL. (305) 292-3550 FAX (305) 295-3660 MEMORANDUM TO: Peter Horton, Director Division of Community Services FROM: Ruth Ann Jantzen, Deputy Clerk i0i DATE: December 30, 1996 BRANCH OFFICE W= OVERSEAS HIGHWAY PLANTATION KEY, FLORIDA 33070 TEL (305) 852-7145 FAX (305) 852-7146 On October 16, 1996, the Board of County Commissioners granted approval and authorized execution of Fiscal Year 1997 Human Service Providers, including the Guidance Clinic of the Upper Keys, Inc., in the amount of $87,859.00;and the Guidance Clinic of the Middle Keys, Inc., in the amount of $501,266.00. Enclosed please find a fully executed duplicate original of each of the above Agreements for return to your providers. If you have any questions concerning the above, please do not hesitate to contact me. cc: County Attorney Finance County Administrator, w/o document File AGREEMENT This Agreement is made and entered into this //� day of 0� 741996, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and the GUIDANCE CLINIC OF THE UPPER KEYS, INC., hereinafter referred to as "Provider." WHEREAS, the Board and the Provider desire to enter into an agreement wherein the Board contracts for services from the Provider for the rendering of mental health services to the citizens of the Upper Keys, Monroe County, Florida, and WHEREAS, the Board is vested and charged with certain duties and responsibilities relating to the mental health and guidance of the citizens of Monroe County, and WHEREAS, such services have been rendered by the Provider in the past and have been invaluable to the citizens of the Upper Keys, and WHEREAS, it is proper and fitting to enter into an agreement for services to be �dered in the forthcoming fiscal year 1996-97, now, therefore,' r mo n --r- r. IN CONSIDERATION of the mutual promises and covenants contained :herein is agreed as follows: N cl: 1. AMOUNT OF AGREEMENT. The Board, in consideration of 'the Provider substantially and satisfactorily performing and carrying out the duties and obligations of the Board, as to rendering mental health counsel to the citizens of the Upper Keys, Monroe County, Florida, shall pay to the Provider the sum of Eighty-seven Thousand Eight Hundred Fifty-nine Dollars ($87,859.00) for fiscal year 1996-97. 2. TERM. This Agreement shall commence on October 1, 1996, and terminate September 30, 1997, unless earlier terminated pursuant to other provisions herein. 3. PAYMENT. Payment will be paid monthly as hereinafter set forth. Certified monthly financial and service load reports will be made available to the Board to validate the delivery of services under this contract. The monthly financial report is due in the office of the Clerk of the Board no later than the 15th day of the following month. After the Clerk of the Board pre -audits the certified report, the Board shall reimburse the Provider for its monthly expenses. However, the total of said monthly payments in the aggregate sum shall not exceed the total amount of $87,859.00 during the term of this agreement. To preserve client confidentiality required by law, copies of individual client bills and records shall not be available to the Board for reimbursement purposes but shall be made available only under controlled conditions to qualified auditors for audit purposes. 4. SCOPE OF SERVICES. The Provider, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and carry out the duties of the Board in rendering counsel in the matter of mental health and guidance to the citizens of the Upper Keys, Monroe County, Florida. The Provider shall provide these services in compliance with Florida Statutes Chapter 394. Said services shall include, but are not limited to, those services described in Provider's Details of Specific Program for Which Funding is Requested, attached hereto as Exhibit C and incorporated herein. 5. RECORDS. The Provider shall maintain appropriate records to insure a proper accounting of all funds and expenditures, and shall provide a clear financial audit trail to allow for full accountability of funds received from said Board. Access to these records shall be provided during weekdays, 8 a.m. to 5 p.m., upon request of the Board, the State of Florida, or authorized agents and representatives of the Board or State. The Provider shall be responsible for repayment of any and all audit exceptions which are identified by the Auditor General of the State of Florida, the Clerk of Court for Monroe County, an independent auditor, or their agents and representatives. In the event of an audit exception, the current fiscal year contract amount or subsequent fiscal year contract amounts shall be offset by the amount of the audit exception. In the event this agreement is not renewed or continued in subsequent years through new or amended contracts, the Provider shall be billed by the Board for the amount of the audit exception and the Provider shall promptly repay any audit exception. 6. 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 2 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. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. 7. INDEPENDENT CONTRACTOR. At all 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. 8. 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. 9. 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. 10. INSURANCE. As a pre -requisite of the services supplied under this contract, the Provider shall obtain, at its own expense, insurance as specified in any attached schedules, which are made part of this agreement. The Provider shall maintain the required insurance throughout the entire term of this agreement. Failure to comply with this provision may result in immediate suspension of all work until the required insurance has been reinstated or replaced. The Provider shall provide, to the County, as satisfactory evidence of the required insurance, either a certificate of insurance or a certified copy of the actual insurance policy. 3 The Board, at its sole option, has the right to request a certified copy of any or all insurance policies required by this agreement. All insurance policies must specify that they are not subject to cancellation, non -renewal, material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the Board by the insurer. The acceptance and/or approval of the Provider's insurance shall not be construed as relieving the Provider from any liability or obligation assumed under this agreement or imposed by law. The Monroe County Board of County Commissioners, its employees and officials shall be included as "additional insureds" on all policies, except for Worker's Compensation. Any deviations from these general insurance requirements must be requested in writing on the County -prepared form entitled "Request for Waiver or Modification of Insurance Requirements" and approved by Monroe County Risk Management. 11. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be amended by an agreement amendment, which must be approved in writing by the Board. 12. 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. 13. NON-DISCRIMINATION. The Provider shall not discriminate against any person on the basis race, creed, color, national origin, sex or sexual orientation, age, physical handicap, or any other characteristic or aspect which is not job -related in its recruiting, hiring, promoting, terminating or any other area affecting employment under this agreement. At all times, the Provider shall comply with all applicable laws and regulations with regard to employing the most qualified 2 person(s) for positions under this agreement. The Provider shall not discriminate against any person on the basis of race, creed, color, national origin, sex or sexual orientation, age, physical handicap, financial status or any characteristic or aspect in its providing of services. 14. AUTHORIZED SIGNATURES. The signatory for the Provider below, certifies and warrants that: (a) The Provider's name in this agreement is the full name as designated in its corporate charter, if a corporation, or the full name under which the Provider is authorized to do business in the State of Florida. (b) He or she is empowered to act and contract for the Provider, and (c) This agreement has been approved by the Board of Directors of the Provider if the Provider is a corporation. 15. 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: Monroe County Attorney 310 Fleming Street, upstairs Key West, Florida 33040 For Provider: Richard Matthews Executive Director Guidance Clinic of the Upper Keys, Inc. P. O. Box 363 Tavernier, Florida 33070 16. CONSENT TO JURISDICTION. This agreement shall be construed by and governed under the laws of the State of Florida and venue for any action arising under this agreement shall be in Monroe County, Florida. 17. 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. 18. 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 5 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. 19. 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. 20. 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 ect matter between the Provider and the Board. EREOF, the parties hereto have caused these presents to be executed as of above. (SEAL) ATTEST: DA L. KOLHAGE, CLERK Witness n Witness BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By Mayor/airman GUIDANCE CLINIC OF THE UPPER KEYS, INC. (Federal ID No. ) 1 B, Director By President guidanc3 APPROVED AS TO FOR AND L SUFFICIE BY UZA NE A. U ON DATE 1.1 PUBLIC ENTITY CRIME FORM - STATEMENT Any person submitting a bid or proposal in response to this invitation must execute the enclosed Form PUR 7068, SWORN STATEMENT UNDER SECTION 287.133(3) (A), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES, including proper check(s), in the space(s) provided, and enclose it with his bid or proposal on behalf of dealers or suppliers who will ship commodities and received payment from the resulting contract, it is your responsibility to see that copy(s) of the form are executed by them and are included with your bid or proposal. Corrections to the form will not be allowed after the bid or proposal opening time and date. Failure to complete this form in every detail and submit it with your bid or proposal will result in immediate disqualification of your bid or proposal. SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE Richard Matthews, Ph.D warrants that he/it has not employed, retained or otherwise had act on his/its behalf any formet 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 unty officer or employee. ( sign/atu e ) Date: J/-mS 96 STATE OF Florida COUNTY OF Monroe Subscribed and sworn to (or affirmed) before me on 11/5/96 (date) by Richard Matthews (name of affiant). \/She is personally known to me or has produced License as identification. (type of identification) MCP#4 REV. 2/92 NOTARY PUBLIC #" Barbara L. ::�•AV;=; Martln =* *= MY COMMISSION III CCM7321 EXPIRES '+ June 13, 2000 $ ,h BONDED TNRU TROY FAIN INSURANCE, INC. " "A person or affiliate who has been placed on the convicted vendor list foliow- a conviction for public entity crime may not submit a bid on a contract any goods or services to a publito provide c 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 an y public in of the threshold amount provided in Section 287.017, for CATEGORYtity TWO foress a period of 36 months from the date of being placed on the convicted vendor list." 1996 Edition GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: • Premises Operations • Products and Completed Operations • Blanket Contractual Liability • Personal Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $1,000,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $ 500,000 per Person $ 1,000,000 per Occurrence $ 100,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. GL3 Administration Instruction #4709.2 55 19% Edition VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: • Owned, Non -Owned, and Hired Vehicles The minimum limits acceptable shall be: $1,000,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $ 500,000 per Person $1,000,000 per Occurrence $ 100,000 Property Damage The Monroe County Board'of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. VL3 Administration Instruction #4709.2 82 1996 Edition MEDICAL PROFESSIONAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract involves the providing of professional medical treatment, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to the rendering of, or failure to render medical professional services under this contract. The minimum limits of liability shall be: $500,000 per Occurrence/$1,000,000 Aggregate If coverage is provided on a claims made basis, an extended claims reporting period of four (4) years will be required. MED2 Administration Instruction #4709.2 67 1996 Edition WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $1,000,000 Bodily Injury by Accident $1,000,000 Bodily Injury by Disease, policy limits $1,000,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self - insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. �9j Administration Instruction #4709.2 89 ATTACHMENT A Expense Reimbursement Requirements This document is intended to provide "basic" guidelines to Human Service Organizations, county travellers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from Florida Statute 112.061, which is attached for reference. A cover letter summarizing the major line items on the reimbursable expense -equest should also contain a certified statement such as: I certify 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. 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 Stephanie Griffiths at 305-292-3528. Payroll: A certified statement verifying the accuracy and authenticity of the payroll expenses. If a Payroll Journal is provided, it should include: Payroll Journal dates employee name, salary, or hourly rate hours worked during the payroll journal dates withholdings where appropriate check number and check amount If a Payroll Journal is not provided the following must be listed: check number, date, payee, check amount support for applicable payroll taxes Original vendor invoices must be submitted for Worker's Compensation am. :;ability insurance coverage. Telephone expenses: A user log of pertinent information must be remitted: the party called, the caller, the telephone number, the date, and the purpose of the call must be identified. 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. Supplies, services, etc.: For supplies or services ordered the County requires the original vendor invoice. Rents, leases, etc.: A copy of the rental agreement or lease is required. Deposits and advance p.;yments will not be allowable expenses. Postage, overnight deliveries, courier, etc.: A log of all postage expenses as it relates for the County contract is required for reimbursement. For overnight or express deliveries, the original vendor invoice must be included. 11 Reproductions, copies, etc.: I A log of copy expenses as it relates to the County contract is required for rc ►mbursement. The log must define the date, number of copies made, source document, purpo::e, and -ecipient. A reasonable fee for copy expenses will be allowable. For vendor services, the original vendor invoice is required and a sample of the finished product. Travel expenses: please refer to Florida Statute 112.061. Travel expenses must be submitted on a State of Florida Voucher for Reims •irsement of Travel Expenses. Credit card statements are not acceptable documentation for r, .m. irsement. 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 original vendor invoice. Fuel purchases should be documented with original paid receipts. Original taxi receipts should be provided. However, reasonable fares will be reimbursed without receipts. Taxis are not reimbursed if taken to arrive at a departure point: for ex2l_ ole, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Original toll receipt., should be provided. However, reasonable tolls will be reimbursed without receipts. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. Lodging reimbursement requires a detail listing of charges. The original lodging invoice must be submitted. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls (see previous guidelines) are not allowable expenses. Per diem lodging expenses may apply. Again, refer to Florida Statute 112.061. Meal reimbursement is breakfast at $3.00, lunch at $6.00, and dinner at $12.00. Meal guidelines are that travel must begin prior to 6 am for breakfast reimbursement, before noon and end after 2pm for lunch reimbursement, and before 6pm and end after 8 pm for dinner reimbursement. Mileage reimbursement is calculated at 20 cents per mile for personal auto mileage while on i county business. Effective October 1, 1994, mileage will be reimbursed at 25 cents per mile. An odometer reading must be included on the state travel voucher for vicinity travel. A mileage map is attached for reference to allowable miles from various Florida destinations. 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. Data processing, PC time, etc.: i The original vendor invoice is required for reimbursement. Intercompany allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department (see Payroll above) are attached and certified. The following expenses are not allowable for reimbursement: penalties and fines non -sufficient check charges fundraising contributions capital outlay expenditures (unless specifically included in the contract) depreciation expenses (unless specifically included in the contract) SGRIFFITHS WP5I\PROCEDUR\EXP REIM ATTACHMENT B HUMAN SERVICE ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, Florida 33040 (Date) The following is a summary of the expenses for (Human Service Organization_ name) for the time period of to Check # Payee Reason 101 A Company 102 B Company 103 D Company 104 Person A 105 Person B (A) Total , (B) Total prior'jpayments f (C) Total requested and paid (A + B) (D) Total contract amount Balance of contract (D - C) Amount rent $xxxx.xx utilities $xx.<x.x.,c phones $xxxx.xx payroll $xx--x.xx payroll $xx tx.xx � xxxx , xx $xxxx.xx $xxxx.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 and subscribed before me this _ day of 199_ Notary Public Notary Stamp 21. Please give a one paragraph description of the agency program for which you are requesting funding. The program is requesting operating expenses for the Mental Health and substance abuse programs. These dollars are the shortfall between the dollars generated through ADM and fees for service. 22. What need or problem in this community does this program address? Include your target population. The chronically mentally ill and substance abusing population both adults and children. 23. What data supports this need. Attach copies of any relevant documents or CITE Report. Attached. 24. Where is this program being offered? List all sites and hours of operation. 92140 O/! Highway 8:30a.m. thru 5:30 p.m. M-F Emergency Services 24 hours per day. 90290 Overseas Highway 8:30 a.m. thru 5:30 p.m. M-F 25. What measurable changes do you plan to accomplish this next fiscal year? The program hopes to establish in conjuction w/ADM and Medicaid, at least one Specializec Therpeutic Foster Home in Monroe County. 5. PURC:HH ,1t1G-DEFT . ID : 13052`` 24515 DEC 26 ' 96 10 : 44 hJo . 003 F.01 The Johnsons Insµrance Agency 89015 Overseas Highway Tavernier FL 33070 305-852-9247 INSURED _ - e Guidance Clinic of the per Ke Is, Inc. Boxi3 3 THIS CERTIFICATE IS IbbUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ---POLICIES BELOW. ....4............................................ -----•---........ COMPANIES AFFORDING COVERAGE -cOMPAur A USA`&G v I M, +�'AR�� . A�cN ---------------}Lr�F_C;_�f?-R------ �5��.--I---------------- COMPANY Q G COMPANY :;AI E L� -/d --yr(� r J . imvern er FL 33070 ( COMPANY titi��tif.R: N/A YE$ .• %- 0 > COVERAGES<iee�ieaeiseeeee:eeesaseeea�=■��ssrcc�vcCF:tracaci��=■eeeppRycr��iee�e�eseeeee=eeeer_==ese.a=ceaeaee�a�eeeaertxs�FFc¢ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 13SUE0 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE -POLICIES -DESCRIBED HEREIN IS SUBJECT TO •---ALL-THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFf POLICY EXP LIMITS LTR DATE MM/DD/YY) DATE(MM/DD/YY) _....---------•-------------------.--._.----------.........------•---------__._... .__.I ... ------ _.-----------_- AI GENERAL LIABILITY IX) COMMERCIAL GEN LIABILITY C I CLAIMS MAOE [Xj OCC. [ I OWNERS'S & CONTRACTOR'S PROTECTIVE I I [ ) AUTOMOBILE LIABILITY IX I ANY AUTO I I ALL OWNED AUTOS [ I SCHEDULED AUTOS ( I HIRED AUTOS [ j NON -OWNED AUTOS [ I [ I GARAGE LIABILITY [ I ANY AUTO EXCESS LIABILITY [ I UMBRELLA FORM I I OTHER THAN UMBRELLA FORM WORKERS COMP. AND EMP. LIAR. THE PROPRIETOR/PARTNERS/ EXECUTIVE OFFICERS ARE: [ j INCL. ( I EXCL. IMP30047068704 IMP30047068704 R. 07/01/96 07/01/96 ............ a ----- - _lire -. I 37/01/97 )7/01/97 GENERAL AGGREGATE 1, 000 000 PROD-COMP/OP AGG. 11 , 0 0 0, 0 0 01 PERS. & ADV. INJURY EACH OCCURRENCE FIRE DAMAGE (ANY ONE FIRE) MED. EXPENSE (ANY ONE PERSON) COMB. SINGLE LIMIT BODILY INJURY (PER PERSON) DOILY INJURY (PER ACCIDENT) PROPERTY DAMAGE AUTO ONLY (EA ACC) OTHER / AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE ]STATUTORY LIMITS EACH ACCIDENT DISEASE-POL. LIMIT b1SEASE-EACH EMP. I 1 0 0 0 1 0 0 C 50,000 5,000 1,000,000 -------------- --- MOTHER.........................I------------------------------^---•-----j------------- ....... .__._..------------------ e' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS -------- - ------ ------------------ --------- ..-._._.----..--.-----. .iealth care facilities -clinics dispensaries or infirlp aries- -reatin out -patients only no regular bed/board facilit�e k*Certificate Holder is also listed on the policy as Additional Insured** > CERTIFICATE HOLDER<=eeeeaeeieeaa�ee�eccc�e:cecsccav==as> MONCO-3 1 Monroe County Kayy Miller 5100 College Road Kev West FL 33040 ACORD 25-S (3/93) c-e_- ! F-14,dipr CANCELLATION<==am/aae*mumaammmummuemm■eMeng eeeeee■ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR -LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. ------------------------ --=-----G,------------a--------.. - AUTHORIZED REPRESENTATIVE Ti'1R �7nhT�tanna Tnc��r�r�rre T.-.o r..si i sF-U-RCHasSIING-DEFT. ID:305''2 i2a515 DEC 26'96 10:45 Nu.00 1 F.06 A. W. CERTIFICATL.. OF LIABILITY... INSURANCE. _DATE (M Dom) L1 P RODUCER -` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1A ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR POE & BROWN INC ALTER THE_.COVERAGE AFFORDED BY IHEPOLIOJ $. B t,QW,. PO BOX 2412 COMPANIES AFFORDING COVERAGE DAYTONA BEACH FL 32113-2412 COMAPANIRISCORP Insurance Coigpany INSURED 26207 y4 COMPANY APPROITD BY RISK MANAGEMENT GUIDANCE CLINIC OF THE UPPER KEYS g 9Y PO BOX 363 COMPANY j TAVERNIER FL 33070-0363 C DATE. 1 �fe"pe- ---- coMDANY k V',! J R: N 'A YES`�•/, COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE: INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, T44E INSURANCE AFFOROED BY THE POLICI[C DC^CRIDCD I ICRCIN 13 3UDJECT TO ALL THE TERMS, EXCLUSIONS AND CONDMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. o LTYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO POLICY NUMBER POLICY EFFECTIVE DATE (LWjoDM) POLICY EXPRATION LIMITS DATE (MMIDDlYY) Q.ENERAL AGGREGATE S PRODUCTS --GOMPCOP AGO S Q.�RSONAj A,ARV INJURY $ EACH OCCURRENCE S FIRE DAMAGE (Any one fire) S MEO EXP (Mv one COMBINED SINGLE LIMIT S BODILY INJURY S (Per person) BODILY INJURY (Per ow nt) PROPERTY OAMAOE $ AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: EACH ACCIDENT f - - • -_.--. -•- --._. . - __ . _ ---- A0GRE ATE. . SXCRSS LIABILITY EACH OCCURRENCE f UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM - - - f WORKERS COMPENSATION AND WC STATU- OTH- - EMPLOYERS' LIABILITY TORY LIMITS ER EL EACH ACCIDENT $100 k p ETNERS/EXECUTIVE 1NOi 26207 07 / 01 �96 U7 /01 / 97 _@A DISEASE _POLICY LIMIT. 000 k I OFFtC RSARE: EXCL l -,-•• — 1`S QYEL0.0___.. —{i-- DESCRIPTION OF OPERATIONWLOCATIONSNEHICLES+SPECIAL ITEMS CERTIFICATE HOLDER - — --- ----- MONROE CNTY RISK MGMT 5100 COLLEGE ROAD KEY WEST FL 33040 ACORD 25-8 (1/95)��.� c� CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL � 1� DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY. KIND UPON. THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /",7/<- lcq/_ 0 ACORD CORPORATION 1988 FURCHA IPdG - DEFT . I : 30J2924515 DEC 26 ' 96 10 : 46 Ida .003 F . U Acuount Number: FL GU I D 36 Dat,. 1/ 2 0/ 9 6 Initials: MF CERTIFICATE OF INSURANCE American Home Assurance Company c/o: American Professional Agency, lnc.�pi' 95 Broadway, Amityville, NY 11701 This is to certify that the insurance policies specified below have been issued by the company indicated above to the Insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named Insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGES) :. f vi ; BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Insured: �� kimxfidiaaledck>tK>�>: GUIDANCE CLINIC OP THE UPPER KEYS, INC. P.O. BOX 363 TAVERNIER, FL 33070 APPRD "RISK k'WfCq+ENY 8Y. a� /G _ CGarle Kam, e DATE Occupation or Business: SOCIAL SERVICE AGENCY Location of Operations: (if different than address listed above) Type of Work Covered: PROF. MENTAL HEALTH COUNSELING BLANKET COVERAGE Policy Effective Expiration Limits of Coverages Number Date Date Liability PROFESSIONAL/ 1,000,000 LIABILITY SSA-6904713 10/01/96 10/01/97 1,000,000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS POLICY AND HE OR SHi SHALLACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Claim History: Comments: This Certificate Issued to: Name: MONROE COUNTY RISK MNGT. Address: ATTN : KAY MILLER 5100 COLLEGE ROAD KEY WEST, FL 33040 e'c : s o c i.�-� Sam d� cats OFN bz Authorized Representative PUF:CHHS-ING-DEFT. ID:30529245)15 DEC 26'96 10:46 No.00.) F>.0 . .. lt�.iatiaw 4191199� IK l'�i�wa l MUNR K courm. 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