FY1996 10/18/1995BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
y
coulf" •tom
"Xlavannp 'L. Iftotbage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
M E M O R A N D U M
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
To: James L. Roberts, County Administrator
From: Isabel C. DeSantis, Deputy Clerk_Q,(-1==�
Date: November 20, 1995
As you know, at the October 18, 1995 meeting, the Board granted
approval and authorized execution of the following Human Service
Organization Agreements for FY 1996:
1. Guidance Clinic of the Middle Keys, Inc., in the amount of
$501,266.
2. Florida Keys Children's Shelter, Inc., in the amount of
$26,695.
At the November 21, 1995 meeting, the Board granted approval and
authorized execution of the following Agreements:
1. Florida Keys Youth Club, in an amount not to exceed $30,000.
2. Big Brothers -Big Sisters of Monroe County, in the amount of
$21,010.
Attached hereto are duplicate originals of the above documents
above for return to the Providers.
Should you have any questions concerning this matter, please do
not hesitate to contact me.
cc: County Attorney
Finance
X
AGREEMENT
This Agreement is made and entered into this 18thday of October , 1995, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or "County," and the GUIDANCE CLINIC OF THE MIDDLE KEYS, INC., hereinafter referred to as
"Provider."
q nl
WHEREAS, the Board and the Provider desire to enter into an agreement wherein th"oard,
contracts for services from the Provider for the rendering of mental health services to the citizens of-'
,j
the Middle Keys, Monroe County, Florida, and i
co =
WHEREAS, the Board is vested and charged with certain duties and responsibilities relating " o
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 Middle Keys, and
WHEREAS, it is proper and fitting to enter into an agreement for services to be rendered in the
forthcoming fiscal year 1995-96, now, therefore,
follows:
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
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, shall
reimburse the Provider for a portion of the Provider's expenditures for Baker Act hospital, physician
and crisis stabilization services, as billed by the Provider, for clients qualifying for such services under
applicable state and federal regulations and eligibility determination procedures, and for Baker Act
transportation services, non -Baker Act mental health services and substance abuse treatment. This
cost shall not exceed a total reimbursement of Five Hundred One Thousand Two Hundred Sixty-six
Dollars ($501,266.00), during the fiscal year 1995-96, payable as follows:
A. Pay to the Provider the sum of Three Hundred Nineteen Thousand One Hundred Forty-
nine Dollars ($319,149.00) for Baker Act hospital, physician and crisis stabilization services.
B. Pay to the Provider the sum of Thirty-seven Thousand Three Hundred Eighty-six Dollars
($37,386.00) for the providing of transportation of patients in Monroe County to treatment facilities.
C. Pay to the Provider the sum of Forty-seven Thousand Seven Hundred Eighty Dollars
($47,780.00) for rendering counseling services.
D. Pay to the Provider the sum of Ninety-six Thousand Nine Hundred Fifty-one Dollars
($96,951.00) for substance abuse treatment services.
2. TERM. This Agreement shall commence on October 1, 1995, and terminate
September 30, 1996, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act Billing
Summary Forms, 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 $501,266 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 Middle Keys,
Monroe County, Florida. The Provider shall provide these services in compliance with Florida Statutes
Chapter 394.
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
2
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
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.
3
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. 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
4
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
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: For Provider:
Monroe County Attorney Dr. David Rice, Executive Director
310 Fleming Street Guidance Clinic of the Middle Keys, Inc.
Key West, Florida 33040 3000 41 st Street
Marathon, Florida 33050
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.
E
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
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
respect to such subject matter between the Provider and the Board.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of
the day and year first written above.
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
By. ,bC . CL
Deputy Clk
Witness
guidanc2
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
11
By cz�
May/Chairman
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
(Federal ID No.-!5q-1-L46S�R; � )
By
ire 'tor ,
By
President
Ist 1,611611l.,
WORKERS' COMPENSATION
INSURANCE REQUIREN11EXI'S
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
GUIDANCE CLINIC OF
THE,UPPER KEYS, INC.
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 and the company or companies must maintain a minimum rating of A -VI, as
assigned by the A.M. Best Company. '
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 find, 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.
Administralivc lrntnxikm W C3 1
#4709.1 83
Aixil 22. 199.1
1m 1'riii(mg
C'ENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
EN
MON110E (,OUNTY, FLORIDA
AND
GUIDANCE CLINIC OF THE.UPPER KEYS, INC.
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 Iniury Liability
• Expanded Definition of Property Damage
The minimum limits acceptable snail be:
$1,000,000 Combined Single Limit (CSL)
If split limits arc 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 ailed on or after the cirective date of this contract.
In addition, the period for which claims may be reported should extend Ibr 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.
Adminimm ivc Iminiclim GI-3 1
1/4709.1 56
April 22. 1991
Irt IYiNing
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRAC'I'
13E rwEEN
NIONROE COUNTY, FLORIDA
AND
GUIDANCE CLINIC OF
THE UPPER KEYS, INC.
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor,
ptior 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-Owncd, and lured 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.
Adminidralivc lininklion VI-3
1
1/4709.1 77
April 22. 1993
Ial 1'rilAmr;
MEDICAL 1111OF1;SSIONA1, LIABILITY
INSURANCE: la QUIREMEXI'S
FO 12
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
GUIDANCE CLINIC OF
THE UPPER KEYS, INC.
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.
'File minimum limits of liability shall be:
$1,000,000 per Occurrence/$3,000,000 Aggregate
If coverage is provided on a claims made basis, an extended claims reporting; period of four (4)
years will be required.
AJmini-irelivc Didniction MEW 1
1/4709.1 66
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 fopm 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
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 County officer or employee.
(signature)
Date -
STATE OF
COUNTY OF , oYi re e
Subscribed and sworn to (or affirmed) before
me on I'IdV. A(date) by
111-34 ��'�( �, �h . [7. ( name of off cant) .
He/She is personally known to me or has produced
ersovv�(�y ki+�ow►�, as identification.
( type of identification)
NOTARY PUBLIC
-,PR' PUB OFFICIAL NOTARY SEAL
DEBRA L DUBOIS
1=c �� * COMMISSION NUMB& 3
CC417387 s
9� ' MY COMMISSION EXP.
MCP # 4 REV. 2 / 9 2 °f pL°� OEC. 2 1998
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 anc. ''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.
Teiefax, 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 to the County contract is required for reimbursement.
For overnight or express deliveries, the original vendor invoice must be included.
Reproductions, copies, etc.:
1
A log of copy expenses as it relates to the County contract is required for r( mbursoment. 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 Reim, ,rsement of
Travel Expenses. Credit card statements are not acceptable documentation fc,r r :rn. irsement.
Airfare reimbursement requires the original passenger receipt portion of the ainune ; icket. A
travel itinerary is appreciated to facilitate the audit trail.
Auto rental reimbursement requires the original vendor invoice. Fuel pur:.hases should be
documented with original paid receipts.
Original taxi receipts should be provided. However, reasonable fares will be reimbrre cd without
receipts. Taxis are not reimbursed if taken to arrive at a departure point: for ex.-. *ale, taking a
taxi from one's residence to the airport for a business trip is not reimbursable.
Original toll receipts 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
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.:
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
WPSI\PROCEDUR\EXP REIM
ATTACHMENT B
I IUMAN SERVICE ORGANIZATION LETTERf IEAD
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 Amount
101
A Company
rent
$xxxx.xx
102
B Company
utilities
$xxxx.x c
103
D Company
phones
$xxxx.xx
104
Person A
payroll
$xx, x.xx
105
Person B
payroll
$Xh CX.Xx
(A) Total
(B) Total prioripayments
(C) Total requested and paid (A + B)
(D) Total contract amount
Balance of contract (D - C)
$xxxx.xx
$xxxx.xx
`Axxx.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.
lks&ive Director
Attachments (supporting documentation)
Sworn and subscribed before me this AV day of n" 1995
"OL
tiPRY PUB OFFICIAL NOTARY SEA2 Tr`/Q COMMIDEBRASSION
L DUBOIS
NUMB
y *COMMISSION NUMBER
CC417387
MY COMMISSION EXP.
Notary Public �f�OrFV°�` 8 Stamp