FY1997 10/16/199639annp I. Roljagt
BRANCH OFFICE CLERK OF THE CIRCUIT COURT
3117 OVERSEAS HIGHWAY MONROE COUNTY
MARATHON, FLORIDA 33050 500 WHITEHEAD STREET
TEL (305) 289-6027 KEY WEST, FLORIDA 33040
FAX (305) 289-1745 TEL. (305) 292-3550
FAX (305) 295-3660
MEMORANDUM
TO: Peter Horton, Director
Division of Community Services
FROM: Ruth Ann Jantzen, Deputy Clerk
DATE: December 30, 1996
BRANCH OFFICE
88820 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,
File
w/o document
AGREEMENT
th
This Agreement is made and entered into this 1 G day of 0 C-t 1996, 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."
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 Middle 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 Middle Keys, and = *-
WHEREAS, it is proper and fitting to enter into an agreement for service. O( be rfAderftd in the
forthcoming fiscal year 1996-97, now, therefore, o
IN CONSIDERATION of the mutual promises and covenants contained -herein, -pis agYeed as
follows: N
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 1996-97, 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, 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. 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. 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.
2
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
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
3
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. 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
4
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
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.
5
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
subject matter between the Provider and the Board.
IN W1�, S WHEREOF, the parties hereto have caused these presents to be executed as of
the day and 7LKOLHAGE,
irst written above.
A CLERK
Witness
6
Witne
guidanc2
BOARD OF COUNTY COMMISSIONERS
OF MONROEwCOOUNTY, FLORIDA
-�
�Y J
By
Mayor/Ch an
GUIDANCE CLINIC OF THE MIDDL KEYS, INC.
(Federal ID No. S9 - /1/SFl32 J )
By
Director
By—�_-I'�, U
President
APPROVED AS TO FO M
4AND AL SUFFICIE
BY
ANN A. N
6 DAT
"A person or affiliate who has been placed on the conv, a conviction for public entity crimeicted vendor list following
may not submit a bid on a contract to provide
any goods or services to a public entity, may riot submit a bid on a contract with a
Public entity for the construction or repair of public buity may not be awarded or
lding or public work ma
not submit bids on leases of real property to public entiy
Perform work as a contractor, supplier, subcontractor, or consultant under a contract
with any public entity, and may not transact business with an
), public of the threshold amount provided in Section 287.017, for CATEGORY TWO foress
a period of 36 months from the date of being placed on the convicted vendor list."
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
ETHICS CLAUSE
Mr)NROF. COUNTY, FLORIDA
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 formeZr Coun y o ficer or employee.
1
(signature)
STATE OF
COUNTY OF
_GTE
Y1/i C V-u•Q-
Date : //- 7 - 941
Subscribed and sworn to (or affirmed) before
me on 1OA'1lgtc (date) by
( name of of f iant) .
He/She is personally known to me or has produced
(type of identification)
MCP#4 REV. 2/92
as identification.
NOTIRY PUBLIC
SPRY P(/e OFFICIAL NOTARY SEAL
_ T,n DEBRA L DUBOIS
1� * COMMISSION NUMBER
C C417387
MY COMMISSION EXP.
�r`�OF 1`70�o DEC. 2 1998
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
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.
h3l-*14a
Administration Instruction
#4709.2 67
1996 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
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.
WC3
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 fine items on the reimbursable expense request 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 organizatiods 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 an;::Jability 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 to- the County contract is required for reimbursement.
For overnight or express deliveries, the original vendor invoice must be included.
Reproductions, copies, etc.:
A log of copy expenses as it relates to the County contract is required for r( imbursement. The
log must define the date, number of copies made, source document, purpo:ce, 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;- •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 reimbi 1 rsed 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 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.:
4
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 merges
fundraising
contributions
capital outlay expenditures (unless specifically included in the contract)
depreciation expenses (unless specifically included in the contract)
SGRIFFITHS
WP51 \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
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
$xx cx.xx
(A)
Total
�xxxx.xx
(B)
Total prio?payments
$xxxx.xx
e
(C)
Total requested and paid (A + B)
$xxxx.xx
(D)
Total contract amount
Oxxxx.XX
Balance of contract (D - C)
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
Guidance Clinic of the Middle Keys
FY 1996-97
20. Complete Attachment B Salary Data Form
Attached
21. Please give a one paragraph description of the agency program for which you are requesting funding.
See #2.
22. What need or problem in this community does this program address? Includeyour target
population?
Emotional disorders and mental illness occur at nearly constant rates in human
populations worldwide; a discussion of the fine points of the epidemiology of emotional
disorders is well beyond the scope of this application, but at any given time, between four
and seven per cent of the population suffers from an emotional or mental disorder that
impairs to some degree their ability to meet social or functional expectations. The twenty
years of operation at the Guidance Clinic suggest that persons in Monroe County do not
differ from other populations in the prevalence of mental disorders. While poverty is a
mild predictor of mental disorder, mental disorders do not respect ethnicity, religion,
economic status or moral character. The Guidance Clinic consequently has developed a
strong tradition of serving a broad cross section of the community with a focus on
individual needs.
Some disorders are self resolving, others resolve best with appropriate treatment and
attention to safety, others require life long support and monitoring in order for those
individuals to be able to be able to function at all effectively. The Guidance Clinic thus
provides care directed toward individual treatment needs based on diagnosis, severity of
the disorder, functional abilities, and client preferences.
Substance abuse disorders also occur at predictable rates in human populations but are
more likely to be mediated by social and economic factors. At any given time in the
United States, between five and ten per cent of the adult population uses alcohol or drugs
to an extent that interferes with fulfilling social or functional expectations. No definitive
survey of Monroe County's substance use and abuse patterns has been conducted, but the
Guidance Clinic serves approximately 600 persons per year with substance abuse disorders
requiring treatment of various intensities.
Guidance Clinic of the Middle Keys
FY 1996-97
2. Explain specifically howyour agency plans to use the moneyyou are requesting, i.e. rent, salaries,
expansion of services or service area or general agency operations.
The Guidance Clinic of the Middle Keys will use county funds in four program areas:
1. Substance abuse services: these include inpatient detoxification services,
assessment, outpatient counseling, outpatient medical, and the residential Keys to
Recovery program.
• Amount requested: $101,799
2. Mental health services: these include assessment, outpatient services, outpatient
medical, and Heron House (under contract)
• Amount requested: $50,169
3. Baker Act services: the Guidance Clinic's Crisis Stabilization Unit (CSU) is a
Baker Act receiving facility and provides crisis stabilization and treatment services
to persons in sufficient emotional distress as to require acute care to assure their
safety and that of others.
• Amount requested: $335,106
4. Baker Act transportation: these funds enable the Clinic to provide secure
transportation throughout the county for persons needing admission to the CSU.
• Amount requested: $39,255
Total Request: $526,329.00
3. Ifyour funding request is greater than lastyear, explain in detail what the increase is expected to buy.
The figures in #2 above include a 5% increase ($25,063) over the 95-96 funding level for
a cost of living adjustment to maintain current service levels.
3
s
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.
0
Pl7R HH''SING-IiEFT. ID:'042924 5 1
CERTIFICATE OF INSURANCE
DEC 26 ' 96 10:41 No . 003 F . ii 1
LUmpany Name
NATIONAL INDEMNITY COMPANY OF THE SV
3024 Harney Street • Omaha, Nebraska 68131.3580
-- - �� i& ivvi an insurance policy and does not amend, extend or alter the coverage afforded by the policies -listed herein
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 ,s subJeci to all the terms, exclusions and conditions of such policies which may
substantially limit Coverage. Where reference is made to an Aggregate Limit, those limits are Company's maximum iiab lity under the Policy for the
entire policy period regardless of the number of insureds, claimants or occurrences
NAME OF INSURED GUIDANCE CLINIC
P.O. ADDRESS 3000 T ST 0
POLILY NUMBER
74AP123122
THE MIDDLE KEYS
MARATHON, FL
KINDS OF INSURANCE
Date 7/10/96
COMMERCIAL GENERAL LIABILITY
Q Occurrence form 0 Claims -Made Form
Coverages
❑ Premises operations
El Producti/Completed Operations
0 Other (Specify)
General Aggregate Limit
Products -Completed Operations Aggregate Limit
Personal b Advertising Injury Limit
Each Occurrence Limit
Fire Damage Limit (Any One fire)
Medical Expense Limit (Any One Person)
Aggregate Limit on Claims Expenses
AUTOMOBILE LIABILITY
50
LIMITS
EFFECTIVE EXPIRES
Risk .N�ar it, ,:r LOSS L: ntrai
S
S
S
DATE ,
S
Bodily Injury
Each Person
$ 00
Each Accident
S 1 , 000,
Property Damage
Each Accident
S 10_0 000.
Bodily Injury and Property Damage Combined Single Limit S
GARAGE LIABILITY
Bodily Injury and Property Damage Auto Only
Other than Auto
Combined Single Limit
S
S
Aggregate Limit
S
Garagekeepers Insurance
Q Legal Liability
S
❑ Direct Excess
S
❑ Direct Primary
$
EXCESS LIABILITY
❑ Automobile ❑ General Liability
Name of Primary Insurer:
Primary Limits
Excess Limits
General Aggregate Limit
❑ Aggregate Limit Inclusive of Claims Expenses
Workers Compensation
Employer's Liability
Other
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES
PER POLICY SCHEDULE
IF7R;sK ra
— n _ 17 01
- so
YES
3/21/96 3/21/97
i
THIS CERTIFICATE REPLACES AND SUPERSEDE THE ONE DONE ON
i
S
S
$ Statutory Limits
S
In the event of any material change in or cancellation of said policies, the COMPANY intends to, but is not obligated to, notify the party to whom
this Certificate is addressed of such change or cancellation, and COMPANY undertakes no responsibility by reason of any failure to do sic.
This Certificate issued to: AND ADDITIONAL INSURED -
MONROE COUNTY & MONROE COUNTY
FL 33040 By SWETT INSURANCE GERS
' _ Title
M•tOAi(4/9f) rC _ " e• `� NOTE TO AGENT - Mail Copy to Home Office Immed77
iately
PQRCHHSIN5-DEPT. ID:3052`924515
DEC '26'96 10:41 No03 P.0�
SUR
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION
Poe & Brown Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
220 South Ridgewood Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED 13Y THE 1301.15�[ES BELOW.
Daytona Beach, FL 32115
COMPANIES AFFORDING COVERAGE
COMPANY
ARISCORP
INSURED
Guidance Clinic of the Middle
3000 419t Ocean Street
COMPANY
Marathon, FL 33050
OOMPANY
COMPANY
d6i Wks,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS'LIED TO THE INSURED NAMED ABOVE FOR T-W POL16Y PERIOD
INDICATED. NOTWITHSTANowa ANY RECIVIREMISNT, TEAM OfI CONDITION OF ANY CONTRACT OR OTHER IDOOLIMENT WITH RESPECT To WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEANN 19 SUBJECT To ALL THE
=LUSIONS AND CONDITIONS OF SUCH pOLICIE9, LIMITS SHOWN MAY HAV BEEN REDUCED BY PAID CLAIMS, TtRM
CLAIMS MADE OCCUR
FIRE DAMAGE (Any one prj)
s
AUTOMOBILE
IJAGILITY
ANYAUTO
APPROVED BY RISK MANtr-jMF.NT
COMBINED SINOLE LIMIT
ALL OWN E D AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BY
DATE
BODILYINJURY
(Per person)
BODILY INJURY
(Par acoldeml)
PROPERTY DAMAGE
OAKACIE LIABILITY
ANYAUTO
R,
AUTO ONLY -EA ACCIDENT
$
OTHER THAN A��10 ONLY -
AGGREGATE
LVOEIIISLIAWLITY
EACH OCCURRENCE
AGGREGATE
UMBAELLAFORM
OTHER THAN UMBRELLA FORM
IIMPLOYERV LIABILITY
OFFICERS ARE; R EXOL
$1,000,000
EACH ACCIDENT
DISEASE -EACH EMPLOYEE ISI
r 000 10 0 0
OTHER
10 DAY NOTICE OF CANCELLATION WILL BE GIVEN FOR NON-PAYMENT OF PREMIUM.
SHOULD ANY OF THE ABOVE DESCRIBED POUOIVG ISE! OANCELLI! D BEFORE THE
MONROE COUNTY
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
RISK MANAGEMENT DEPT
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAME 0 TO THE LEFT,
PUBLIC SERVICE BUILDING
5100 COLLEGE ROAD
ACOI!b 2'"'
fUT IFAAI LURE TO MAIL SUCH NOT CE SHALL I" 1 10 OB LIOATION OR LIAB I UrY
AF_ -ANY KIND UPON THE DQ JPAU.V"j�. A -- RIEPREI�EN TIVES.
RYATInN 1993
F'I_WCHA`:IIN(3-DEFT . III : 3Ci'_y2451
„ A ORE
_ _ ..5
J.J. NEGLEY ASSOCIATES, INC.
388 POMPTON AVE, P.O. BOX 206
CEDAR GROVE, NJ 07009
(201) 239-9107 FAX; 239-6241
INSURED
The Guidance Clinic of the
Middle Keys, Inc.
3000 - 41st Street Ocean
Marathon, Florida 33050
DEC 26'96
ONLY AND CONFERS -NO
HOLDER. THIS CEIMPIcAi
10 : 42 PJo .003 P .1_1.>
DATE (mmiDoNy) .
7 2 9 6
18 A MATTER OF INFORMATICqW
INTO UPON THE CEMlFICA*
,DEB NOT AMEND, EXTEND OR
DED BY THE POUCIE$ BELOW,
COMPANY
A Scottsdale Insurance Co
COMPANY
Received
COMPANY Risk mrxit,Loss colt ,;i
C '/
COMPANY -`�—
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENISSUED TO THE INSURED NAMED ABOVE FOA''rHE POLICY PERTOD
INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE INUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEAEJN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYFE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCYEOVATION LIMITS
DA
TV MIDD/YY) DATE (MM/DDIM
GENERAL UABIIJTY
X
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NONI.OYVNED AUTpg
OARA(E LIASIUTY
ANY AUTO
Mom LIABILITY
LJMIWH1A FORM
OTHFA THAN LIMIMM-LA FORM
WOWAYIS COMPENSATION AND
EMPLOYEIS' LIABILITY
THEPROPRETCW_ 17 INCL
CiS2p7pp0
APPROk'F..0 By RISK M0,.
- VIA U_
-�— -- -
6/30/96
r.rIkIrNT
(P
.- '� (�
..__.__ U)
6/30/97
__
r'x �r-
ORAL AGGREGATE
81,000,000
PR4OLICT8 - COMP/OP App
all-000, 000
PER9oNAL11ADVINU
$1 000000
e*zHOOmnv Nw
S1 000 000
FWMWAM! Yoft&w)
S 100,000
MED EV (Aft ww POMM)
S 1,000
E
gCpOpM�SWM9INQI.EUMIT
SMWwLY INJUAY
aoddeno
>j
PROPERTY DAMAGE'
AUTO ONLY • EA ACCIDENT
E
s
OTHER THAN AUTO ONLY:
EACHADOWNT
S
AGOREOATE
PAOM OCCURRENCE
i
S
AGGREGATE
a
0. EACH AOOIWNT =
EL DISEASE - POI ICY LIMIT Ii _
EL DISEASE - LA EMPLOYEt< I L
Professional I
$1,000,p00 Aggregate
A Liability CLS322414 6/30/96 6/30/97 $1,000,000 Ea. Claim
IESCRIPTION OF O►ERATION*A=ATWNIJYENICLFS/SPEML InMa
Certificate Holder is added as Additional Insured, but only with respect to
operations of the Named- Insured
SHOULD ANY OF THE ABOVE DMIuBED ro=Ea BE CANCELLED BEFORE THE
Monroe County of Commissioners EXPIRATION DATE THEREOF, THE ISSUING COMPANY WLLL ENDEAVOR TO MAIL
Its Employees & Officials 3-0— DAYS WNTTEN NOTICE TO TH■ CERTIPICATT HC"FR NAMED TO TILC LEFT,
5100 College Road BUT FAILU4 TO�W SUCH NOTICE SNiLLL IY E NO O� ON OR LUUIILTY
Key West, Florida OF ANY NIN N THE COMPANV&j1 waENTa al i6tRasENTATnrEs.
PUI R-CHH'�:'ING-DEFT .
: LUSS "
ID:3052924515
LIE 26 ' 9F-1
10 : 4 31 hdo . 00' F . (=i4
MONROE COUNTY. FLORIDA
Request For Waiver
of
Insurance Requiremenog
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Rcquirentents. be Waived or snodiftcxd on the following contract.
Contractor: Guidance Clinic of tho Middle xo 1 Tnr
Contract for: .provision of mantal health gPryti rP5
Address of Contractor: .3000 41 st Street Ocean
Marathon, FL 3305o
Phone: 305/743-949I
Scope of Work: Dgl ivery of i UROX-J,AU aut ari ent mental heal t;h
and. s1 ,4tianrP ahltQe moryi r,eg
Rcason for Waiver:
Signature of Contractor:
Risk Management
Date
Request walypr of the Q0DJQ00/$3,D()D QOOr-equirement.
for Professional and General Liability. Currently,
Snd fnor.. LhP-.ni Rt 90+ xe z+i ►.-red'7.,.ini c- has - cn rri ed•�•.
$1,000,000/$1,000,000 Professional and General
LiRhi.7;ry 1 v�trAnr.P__ �T-he- r-nor of. $-3'X00..1.1D04$3,W0,000
i8 U/�. f
County Administrator appwl:
Approved: ,
Date:
Board of County Commissioners append:
Mccting Date:
Not Approved
Not Approved:
Approved: Not Approved:
WAIVER