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07/07/1993 AgreementBRANCH OFFICE 3117 OVERSEAS HIGHWAY MARATHON, FLORIDA 33050 TEL. (305) 289-6027 M GOUNTYC O % O P 0 19OE COUNiV.4yO. ;Dannp 1. Rotbage . 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 TO: Division of Management Services c/o County Administrator Q� FROM: Isabel C. DeSantis, Deputy Clerk DATE: August 11, 1993 BRANCH OFFICE 88820 OVERSEAS HIGHWAY PLANTATION KEY, FLORIDA 33070 TEL. (305) 852-7145 On July 7, 1993, the Board adopted Resolution No. 296-1993, authorizing execution of an Agreement between Monroe County and the Guidance Clinic of the Middle Keys, Inc., in the amount of $221,800.001 to provide alcohol and drug abuse treatment as specified by HRS in Contract #KH383 between Monroe County and HRS. Attached hereto is a duplicate original of the subject Agreement executed and sealed by all parties involved which should be returned to the Guidance Clinic. Should you have any questions concerning the above, please do not hesitate to contact me. cc: County Attorney Finance Risk Management '-File w/o document c 1 A G R E E M E N T THIS AGREEMENT, made this day of 1993, between the Board of County Commissioners of Monroe County, Florida, ("Board") and the Guidance Clinic of the Middle Keys, Inc., ("Clinic"); WHEREAS, the Board has entered into a grant agreement, No. KH383, with the State of Florida Department of Health and Rehabilitative Services (HRS); and WHEREAS, the Grant Agreement requires the Board to sub -contract with Clinic for outpatient treatment at the Central Intake Unit of no more than 96 clients, and detoxification services for adults referred by the CIU for in -patient treatment; now, therefore, IN CONSIDERATION of the promises made each to the other, the Board and the Clinic agree as follows: 1. AMOUNT OF AGREEMENT AND PAYMENT. The Board shall reimburse the Clinic for services rendered under HRS''`Gramt Agreement No. KH383, incorporated herein by refereice, an -amount not to exceed a total of Two Hundred Twenty -One Thousand -:Eight Hundred Dollars ($221,800), during the term of th1s agreement. Payment shall be made upon submission of invoices .suppoit-ed ,by documentation of services rendered, in compliance with -,Grant Agreement No. KH383 and Monroe County Department of Finance requirements. 2. TERM. This Agreement shall commence on the date executed by both parties and terminate June 30, 1994, unless earlier terminated pursuant to other provisions herein. 3. SCOPE OF SERVICES. The Clinic, for the consideration named, shall provide those services described in Grant Agreement No. KH383, Exhibit B-I, Service Descriptions Outpatient Services and Detoxification. 4. RECORDS. The Clinic 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 K 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, HRS, the State of Florida, or authorized agents and representatives of the Board, HRS or State. The Clinic 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 Clinic shall be billed by the Board for the amount of the audit exception and the Clinic shall promptly repay any audit exception. 5. INDEMNIFICATION AND HOLD HARMLESS. The Clinic 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 rendered under this agreement by the Clinic or any of its agents, employees, officers, subcontractors, in any tier, occasioned by the negligence, errors, or other wrongful act or omission of the Clinic or its subcontractors in any tier, their employees or agents. In the event the completion of services (to include the work of others) is delayed or suspended as a result of Clinic's failure to purchase or maintain the required insurance, the Clinic shall indemnify the Board from any and all increased expenses resulting from such delay. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. 6. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the Clinic is an independent contractor and not an employee of the Board. No statement contained in this 2 agreement shall be construed so as to find the Clinic or any of its employees, contractors, servants or agents to be employees of the Board. 7. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the Clinic shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provisions of, such services, including those now in effect and hereinafter adopted and those applicable to services under this Agreement and contained in Exhibit B hereto. Any violation of said statutes, ordinances, rules or 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 Clinic. 8. PROFESSIONAL RESPONSIBILITY AND LICENSING. The Clinic 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 Clinic's program and staff. 9. INSURANCE. The Clinic shall obtain, prior to the commencement of work governed by this agreement, at Clinic's own expense, that insurance specified in any attached insurance schedules which are made a part of this agreement. The Clinic will also insure that all subcontractors, in any tier, have obtained the insurance as specified in the attached schedules or be covered by Clinic's insurance. The Clinic will not be reimbursed for any work commenced prior to coverage with required insurance. The Clinic will not be reimbursed for any services governed by this contract until satisfactory evidence of the required insurance has been furnished to the Board via either Monroe County's certificate of insurance or a certified copy of the actual insurance policy. Delays in the commencement of work, resulting from the failure of Clinic to provide satisfactory evidence of the required insurance, shall not extend deadlines specified in this agreement and any penalties and failure to perform assessments shall be imposed as if the work commenced on 3 the specified date and time, except for Clinic's failure to provide satisfactory evidence. The Clinic and any subcontractors shall maintain the required insurance throughout the entire term of this agreement and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced. Delays in the completion of the work resulting from the failure of Clinic to maintain the required insurance shall not extend deadlines specified in the agreement and any penalties and failure to perform assessments shall be imposed as if the work commenced on the specified date and time, except for Clinic's failure to maintain the required insurance. The Board, at its sole option, has the right to request a certified copy of any or all insurance policies required by this agreement. If a certificate of insurance is provided, the County -prepared form must be used. "Accord Forms" are not acceptable. 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 Clinic's and subcontractor's insurance shall not be construed as relieving the Clinic or subcontractor from any liability or obligation assumed under this agreement or imposed by law. 10. MODIFICATIONS AND AMENDMENTS. Any and all modifica- tions of the services and/or reimbursement of services shall be amended by an agreement amendment, which must be approved in writing by the Board. 11. NO ASSIGNMENT. The Clinic 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 4 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 Clinic. 12. NON-DISCRIMINATION. The Clinic shall not discriminate against any person on the basis of 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 Clinic shall comply with all applicable laws and regulations with regard to employing the most qualified person(s) for positions under this agreement. The Clinic 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 other characteristic or aspect in its providing of services. 13. AUTHORIZED SIGNATORY. The signatory for the Clinic, below, certifies and warrants that: (a) The Clinic'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 Clinic is authorized to do business in the State of Florida; (b) He or she is empowered to act and contract for the Clinic; and (c) This agreement has been approved by the Board of Directors of the Clinic, if the Clinic is a corporation. 14. 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: Mary Broske Monroe County Grant Management Director 5100 College Road Public Service Building Key West, Florida 33040 and 5 Monroe County Attorney 310 Fleming St., Rm. 29 Key West, Florida 33040 For Clinic: Dr. David Rice Executive Director Guidance Clinic of Middle Keys, Inc. 3000 41st Street, Ocean Marathon, Florida 33050 15. 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. 16. NON -WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the Clinic 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. 17. 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 at the option of the Board by providing written notice of termination to the Clinic. The Board shall make every reasonable effort to provide said notice at least thirty (30) days prior to the effective date of said terminiation, and shall not be obligated to pay for any services or goods provided by the Clinic after the effective date of termination, unless otherwise required by law. 18. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, as accounted for by line -item billing to County for specific purchases, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. (Chapters 255 and 274, F.S.). 19. 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 0 with respect to such subject matter between the Clinic 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 Signed, Sealed and Delivered In Our Presence: IN 71AN.._ I 'J OaA4Q —Witness coniiiguidance BOARD OF COUNTY COMMISSIONERS OF MO COUNTY, FLORIDA By !lam`?.��,, Mayor/Chairman GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. By By APPROVED AS TO FC'!" .1 AND AL SUFnCIEN^ . Fy Heys t'ice 1 r_,3 — 7 SUB -GRANT AGREEMENT - EXHIBIT B CONTRACT ATTACHMENT: COMPLIANCE WITH LAW WHEREAS, all persons are subject to and must abide by all applicable local, state and federal laws; and WHEREAS, federal and state funding -require inclusion in contracts of provisions for compliance with specified laws; now, therefore, the parties to the contract of which this document is a part agree as follows: The contractor shall comply with all laws to the extent applicable to the operations of contractor, including but not limited to: 1. The National Environmental Policy Act of 1969 (42 USC 54321, et seq.) and 24 CFR, Part 58; 2. Executive Order 11988, Flood Plain Management; 3. Executive Order 11990, Protection of Wetlands; 4. The Endangered Species Act of 1973, as amended (16 USC §1531, et seq.); 5. The Fish and Wildlife Coordination Act of 1958, as amended (16 USC §661, et seq.); 6. The Wild and Scenic Rivers Act of 1968, as amended (16 USC §1271,--etr_seq.) ; 7. The Safe Drinking Water Act of 1974, as amended (42 USC §300f, et seq.); 8. Section 401(f) of the Lead -Based Paint Poisoning Prevention Act, as amended (42 USC §4831(b), et seq.); 9. The Clean Air Act of 1970, as amended (421 11SC §7401, et seq.); 10. The Federal Water Pollution Control Act of 1972, as amended (33 USC §1251, et seq.); 11. The Clean Water Act of 1977 (Public Law 95-217); 12. The Solid Waste Disposal Act, as amended by the Re- source Conservation and Recovery Act of 1975 (42 USC §6901, et seq.); 13. Noise Abatement and Control: Departmental Policy Implementation Responsibilities and Standards, 24 CFR Part 51, Subpart B; 14. Flood Disaster Protection Act of 1973 (PL 93-234); 15. Protection of Historic and Cultural Properties under HUD Programs, 24 CFR, Part 59; 16. Coastal Zone Management Act of 1972 (PL 92-583); 17. Executive Order 11593, "Protection and Enhancement of the Cultural Environment"; 18. Architectural and Construction Standards; 19. Architectural Barriers Act of 1968 (42 USC §4151); 20. Executive Order 11296, relating to Evaluation of Flood Hazards; 21. Executive Order 11288, relating to the Prevention, Control and Abatement of Water Pollution; 22. Cost -Effective Energy Conservation Standards, 24 CFR, Fart 39; 23. Section 8 Existing Housing Quality Standards, 24 CFR, Part 882; 24. Section 319 of Public Law 101-121, as provided in the "Governmentwide Guidance for New Restrictions on Lobbying; Interim Final Guidance" published in the December 20, 1989, Federal Register, which prohibits recipients--ref„federal contracts or grants from using appropriated funds for lobbying in connection with a grant or contract, and requires that each person who requests or receives a federal contract or grant, and their subrecipients, disclose lobbying undertaken with non-federal funds; 25. Executive Order 11246; 26. Procurement requirements for Counties under Chapters 255, 274 and 287, Florida Statutes; and 27. Americans with Disabilities Act. - L _ Y 7/ 4/93 SUB —GRANT AGREE&ENT EXHIBIT A STATE OF FLORIDA Contract No. KH383 DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES STANDARD CONTRACT THIS CONTRACT is entered Into between the State of Florida, Department of Health and Rehabilitative Services, hereinafter referred to as the "department% and BOARD OF COUNTY COMMISSIONERS, COUNTY OFMONROE THE PARTIES AGREE: hereinafter referred to as the "provider". THE PROVIDER AGREES: A.To provide services according to the conditlons specified In Attachment(s) I B.Federal Laws and Regulations 1. If this contract contains federal funds, the provider shall comply with the provisions of 45 CFR, Part 74, and/or 45 CFR, Part 92, and other applicable regulations as specified in Attachment _..L__, 2. If this contract contains federal funds and is over $100,000, the provider shall comply with all applicable standards, orders, or regulations Issued under Section 306 of the Clean Air Act, as amended (42 U.S.C. 1857(h) et seq.), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368 et seq.), Executive Order 11738, and Environmental Protection Agency regulations (40 CFR Part 15). The provider shall report any violations of the above to the department. 3.If this contract contains federal funding in excess of $100,000, the provider must, prior to contract execution, complete the &rtffication Regarding Lobbying form, Attachment If a Disclosure of Lobbying Activities form,— tar and Form LLL, is required, It may be obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager. C.Audtts and Records 1. To maintain books, records, and documents (Including electronic storage media) in accordance with genera)ly accepted accounting procedures and practices which sufficiently and property reflect all revenues and expenditures of funds provided by the department under this contract. 2. To assure that these records shall be subject at all reasonable times to inspection, review, or audit by state personnel and other personnel duly authorized, by the department, as well as by federal personnel. 3. To maintain and file with the department such progress, fiscal and inventory reports as specified in Attachment _ I , and other reports as the department may require within the period of this contract. Such reporting requirements must be reasonable given the scope and purpose of this contract. 4. To provide a financial and compliance audit to the department as specified In Attachment II and to ensure that all related party transact bns are disclosed to the auditor. Additional audit requirements are specified in Attachment I, Special Provisions, Section D 5. To Include these aforementioned audit and record keeping requirements In all approved subcontracts and assignments. D.Retention of Records 1. To retain all client records, financial records, supporting documents, statistical records, and an other documents (including electronic storage medl.1 pertinent to this contract for a period of five (5) years after termination of this contract, or N an audit has been Initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. 2. Persons duly authorized by the department and federal auditors, pursuant to 45 CFR, Part 92.36(i)(10), shall have full access to and the right to examine any of said records and documents during said retention period or as long as records are retained, whichever Is later. E. Monitoring 1. To Iprovide reports as specifled in Attachment . These reports will be used for monitoring progress or performance of the contractual services as specified In Attachment I 2. To permit persons duly authorized by the department to Inspect any records, papers, documents, facilities, goods and services of the provider which are relevant to this contract, and/or Interview any clients and employees of the provider to be assured of satisfactory Performance of the terms and conditions of this contract. Following such Inspection the department will deliver to the provider a list of its comments with regard to the manner In which said goods or services are being provided. The provider will rectify all noted deficiencies provided by the department within the specified period of time set forth in the comments or provide the. department with a reasonable and acceptable Justification for not correcting the noted shortcomings. The provider's failure to correct or justify within a reasonable time as specified by the department may result In the withholding of payments, being deemed In breach or default, or termination of this contract. "I - F. Indemnification If the provider is a state agency or subdivision as defined In section 768.28, Florida Statutes, only No. 2 below is applicable. Other than state agencies or subdivisions refer only to No. 1. 1. The provider agrees to be liable for all claims, suits, judgments, or damages, including court costs and attorney's fees, arising out of the negligent or intentional acts or omissions of the provider, and its agents, subcontractors, and employees, in the course of the operation of this contract. Further, the provider agrees to Indemnify the department against all claims, suits, judgments, or damages, Including court costs and attorney's fees, arising out of the negligent or Intentional acts or omissions of the provider, and its agents, subcontractors, and employees, in the course of the operation of this contract. Also, the provider agrees to defend the department, upon receiving timely written notification from the department, against all claims, suits, judgments, or damages, including costs and attorney's fees, arising out of the negligent or Intentional acts or omissions of the provider and its agents, subcontractors, and employees, in the course of the operation of this contract. Where the provider and the department commit joint negligent acts, the provider shall not be liable for nor have any -obligation to defend the department with respect to that part of the joint negligent act committed by the department. In no event shall the provider be liable for or have any obligation to defend the department against such claims, suits, judgements, or damages, including costs and attorney's fees, arising out of the sole negligent acts of the department. 2. Any provider who is a state agency or subdivision, as" defined in section 768.28, Florida Statutes, agrees to be fully responsible for its negligent acts or omissions or Intentional tortious acts which result in claims or suits against the department, and agrees to be liable for any damages proximately caused by said acts or omissions. Nothing herein is Intended to serve as a waiver of sovereign Immunity by any provider to which sovereign Immunity applies. Nothing herein shall be construed as consent by a state agency or subdivision of the State of Florida to be sued by third parties in any matter arising out of any contract. The provider agrees that it is an Independent contractor of the department and not an agent or employee. G.Insurance 1. To provide adequate liability Insurance coverage on a comprehensive basis and to hold such liability Insurance at all times during the existence of this contract. The provider accepts full responsibility for Identifying and determining the type(s) and extent of liability Insurance necessary to provide reasonable financial protections for the provider and the clients to be served under this contract. Upon the execution of this contract, the provider shall furnish the department written verification supporting both the determination and existence of such Insurance coverage. Such coverage may be provided by a self -Insurance program established and operating under the laws of the State of Florida. The department reserves the right to require additional Insurance as specified in Attachment I where appropriate. 2. If the provider is a state agency or subdivision as defined by section 768.28, Florida . Statutes, the provider shall furnish the department, upon request, written verification of liability protection in accordance with section 768.28, Florida Statutes. Nothing herein shall be construed to extend any party's liability beyond that provided in section 768.28, Florida Statutes. H.Safeguarding Information Not to use or disclose any Information concerning a recipient of services under this contract for any purpose not In conformity with the state regulations and federal regulations (45 CFR, Part 205.50), except upon written consent of the recipient, or his responsible parent or guardian when authorized by law. I. Client Information To submit management, program, and client Identifiable data, as specified by the department In Attachment I J. Assignments and Subcontracts 1. To neither assign the responsibility of this contract to another party nor subcontract for any of the work contemplated under this contract without prior written approval of the department. No such approval by the department of any assignment or subcontract shall be deemed in any event or in any manner to provide for the incurrence of any obligation of the department In addition to the total dollar amount agreed upon in this contract. All such assignments or subcontracts shall be subject to the conditions of this contract (except Section I, Paragraph 0.1.) and to any conditions of approval that the department shall deem necessary. 2. Unless otherwise stated In the contract between the provider and subcontractor, payments made by the provider to the subcontractor must be within seven (7) working days after receipt of full or partial payments from the department in accordance with section 287.0585, Florida Statutes. Failure to pay within seven (7) working days will result in a penalty charged against the provider and paid to the subcontractor in the amount of one-half of one (1) percent of the amount due, per day from the expiration of the period allowed herein for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15) percent of the outstanding balance due. K.Financial Reports To provide financial reports to the department as specified in Attachment i 2 � M. ` I • ' 8 6. Provider will submit monthly reports describing the progress achieved using the format provided by the Center for Substance Abuse Treatment (CSAT) (Exhibit - C-I) to the HRS/ADM Project Manager. A -report schedule attached shows �• due dates (Exhibit - D). Providers who have been awarded a contract for more than. one type of service are required to submit monthly reports separately for each type of service. 7. Plans to subcontract` program activities must be approved by the CSAT Project Officer in advance. 8. By 90 days after an award is obligated -to a provider, each provider will: achieve 75 percent --utilization per month for awarded slot; maintain 85 percent complete clinical records for all persons admitted. For detoxification, this includes an admission physical, results of required laboratory and follow-up referrals as indicated. For post-detoxifica tion services, this includes an individualized treat ment plan, drug history, psychosocial evaluation and - progress notes. -:Discharge records must include a discharge plan providing for continuity of care•for relapse prevention and follow-up. Failure to achieve--these-goals may result in - withholding of funds due to the provider. 9. _By 150 days after an.award is obligated.to a provider, each provider will: achieve 85-percent utilization per month { for -awarded slot; maintain. 95 percent complete clinical records for all persons admitted. For detoxification, this includes an admission physical, results of required laboratory and follow-up referrals as -indicated. For post -detoxification services, this includes an individualized treatment plan, drug history, psychosocial evaluation and progress notes. Discharge records must include a discharge plan providing for continuity of care for relapse prevention and follow-up. Failure to achieve these goals may result -in withholding of funds and/or the cancellation of the contract. 9 10. None of the Federal funds provided under this agreement shall be used to provide individuals with hy- podermic needles or syringes so that such individuals may use illegal drugs, unless the Surgeon General of the United States determines that a demonstration needle exchange pro- gram would be effective in reducing drug abuse and the risk that the public will become infected with the etiologic agent for acquired immune deficiency syndrome. 11. The provider will cooperate with the CSAT Project Officer in determining the effects of this project on the target population and jurisdiction. This may include an as- sessment of program operations and the provision of informa- tion concerning Me nature and evolution of the substance abuse problem in the jurisdiction. C. Method of Payment: 1. Payment Clauses a. Payment: This is a cost reimbursement contract. The department shall reimburse the provider for allowable expenditures incurred pursuant to the terms of the contract for a total dollar amount not to exceed $_ 3 2 Z 5"o subject to the availability of funds. b. Inpatient hospital substance abuse programs will not be permitted, except in the case (a) such treatment is a medical necessity for the individual involved, and the indi- vidual cannot be effectively treated in a community based, nonhospital, residential treatment program; or (b) such a treatment is provided at a rate that is financially compara- ble to that being provided in a community based, nonhospi- tal, residential treatment service. If such circumstances occur, the daily rate for payment provided to the hospital for providing the services cannot exceed the comparable daily rate provided by a residential treatment program. c. Funds may not be used to purchase or improve land, purchase, construct or permanently improve (other than re- modeling or minor renovations) any building or other facil- ity, or purchase special major medical equipment. (Trailers are considered temporary dwelling units and not fall under this provision). d. Costs covered by the Robert T. Stafford Disaster Relief and Emergency Assistance (Public Law 93-288, as amended) including mental health services, facility alter- ations and major renovations will -not be reimbursed. Under no circumstances, may funds provided under this announcement 10 be used to meet local cost sharing requirements for facility alterations and renovations funded by FEMA. Further, these funds cannot be used to pay costs covered by commercial in- surance carriers. e. Funds cannot be used to supplant current funding for existing treatment services and related activities. f. Expenditures must be for services specified in Ex- hibit - B, Service Description as given in Exhibit B-I and be in accordance with the line -item budget given in Exhibit - A, the Budget Narrative in Exhibit A -Band Personnel Details in Exhibit -A -II. g. Providers should collect first and third party re- imbursement for allowable services whenever possible. All revenues must be deducted from the amount of reimbursement requested monthly. h. Providers who - have been awarded a contract for more than one type of service are required to submit reim- bursement requests separately for each type of service. i. The department may, if funds are available, re- lease more than the monthly pro rata share of the contract amount only for onetime nonrecurring expenditures, provided the terms which specify month(s) and amount(s) to be re- quested are included as part of this contract. Requests may be made in writing along with the supporting documentation for this purpose (Exhibit - F). J. Invoice Requirements: (1) The provider may request a monthly advance for each of the first two months of the contract period based on anticipated cash needs. The amount of request for those periods, will be the lesser of either the pro, rats share of the contract balance or the actual amount expended and require no documentation. All reimbursement requests for the third through the twelfth month shall be based on the submission of monthly actual expenditure reports (Exhibit-C). Charges on the invoice must be accompanied by copies of supporting documentation. Administrative costs as shown in Exhibit - A do not require supporting documentation. 11 Payment Schedule Month- Type of Request July Advance August Advance September Reimbursement October Reimbursement November Reimbursement December Reimbursement January Reimbursement February Reimburigment March Reimbursement April Reimbursement May Reimbursement June Reimbursement Final Inv. Final Expenditure Report Based_ on Submittal Date -.-Anticipated Cash Needs July 1 Anticipated Cash Needs August 1 July Actual Expenditure Sept. 1 August Actual Expenditure Oct. 1 Sept. Actual Expenditure Nov. 1 Oct. Actual Expenditure Dec. 1 Nov. Actual Expenditure Jan. 1 Dec. Actual Expenditure Feb. 1 Jan. -Actual Expenditure Mar. 1 Feb. Actual Expenditure Apr. 1 Mar. Actual Expenditure May. 1 Apr. Actual Expenditure June. 1 May Actual Expenditure Date(s) June Actual Expenditure specified in contract Note: Reimbursement request must be submitted for each month even if the reimbursement request is zero due to the two advance payments received at the beginning of the con- tract. (2) Payment of an invoice may be authorized only for allowable expenditures which are in accord with the lim- its specified on the approved line -item budget, Exhibit A and the Budget Narrative, Exhibit A-1. Exhibits A and A-1 may be modified only -through amendment to -this contract ini- tiated by written request which includes justification sup- porting the need for modification. Such modifications. can- not be made retroactive from the execution date of the amendment back to the execution date of the contract. 2. Supporting Documentation Requirements a. Personnel. Expenditures will be supported by pay- roll records and employee time sheets. b. Building Occupancy. Where this is a charge sup- ported by an allocation plan, the plan will serve as docu- mentation of this expenditure. In all other cases actual receipts or paid invoices are required. . o s 6. 12 C. Professional Services Fees on a Time/Rate Basis. The invoice must have attached a general statement of the services being provided under this line item. The time pe- riod covered by the invoice as well as the hourly rate times the number of hours worked must be given separately for each professional. Supporting documentation which details the hours represented on the.invoice must be included. Such documentation should include time sheets or a time log. d. Postage and Reproduction Expenses. Purchases made from outside vendors must be supported by paid invoices and/or receipts. Purchases for all inhouse postage (e.g., postage meter) and reproduction expenses must be supported by usage logs or similar documentation. e. Operating Supplies and Expenses. Receipts or paid invoices are required for all expenses (e.g., office supplies, long distance telephone calls, etc.) paid for with this contract's funds. f. Travel. For all travel expenses, HRS travel voucher, form C-676 (State of Florida Voucher for Reimburse- ment of Traveling Expenses) must be submitted. Original re- ceipts for expenses incurred during officially authorized travel, including those for items such as car rental and air transportation, parking and lodging, and tolls and fares are required for reimbursement. Section 287.058(1) (b), Florida Statutes, v requires that bills. for any travel expense --shall be submitted in accordance with section 112.061, Florida Statutes,.. governing payments by the State for traveling ex- penses. HRSR 40-1 (Official Travel of HRS Employees and Non -employees) provides further explanation, clarification and instruction regarding the reimbursement of traveling ex- penses necessarily incurred during the performance of offi- cial State business g.-- Conference Travel: Prior approval is required in accordance with section .112.061, Florida Statutes, and must be certified on form C-676C (State of Florida Authorization to incur Travel Expense) with a copy of the program or -agenda.of the.conference.attached. Reimbursement is in ac- cordance with travel above. See HRSR 40-1 for further ex- planation, clarification and instruction. h. All other Expenditures: All other expenditures require receipts or paid invoices. 13 i. Non -expendable Property (Capital Expenditures): Rules set forth in Chapter 10E-14.007-010, F.A.C. shall govern any purchases of non -expendable property. However, for purposes of this Cooperative Agreement, all capital items over $500 will revert to the State at the end of the contract period. D. Special Provisions: 1. The department will support the provider in the event of State or Federal disallowance of any expenditures which have been made pursuant to written approval of the de- partment. Notwithstanding the foregoing, the department's obligation to pay the provider for expenses made under the Hurricane Andrew Disaster Relief Assistance for Substance Abuse Treatment ftoperative agreement is limited to those items ultimately determined allowable by Substance Abuse and Mental Health Services Administration (SAMHSA) and which the department is reimbursed by the grantor. 2. Coordination of HIV/AIDS services in HRS District 11, Dade and Monroe counties, is facilitated by consortia of providers, as required by the federal "Emergency Relief Act of 1990", commonly referred to as "Ryan White". These consortia are two: 1) HIV Planning Council of Metro -Dade County, which provides oversight and coordination for services funded by Title 1 of Ryan White. Support for this consortium is provided by the Health Council of South Florida. 2) South Florida AIDS Consortium, which provides oversight and coordination for services funded by Title 2 of Ryan White. Support for this consortium is provi ded by the South Florida AIDS Network of Jackson Memorial Hospital. These consortia meet on a monthly basis, relying on strong committee structure to develop and implement service sys- tems. As a condition of this contract, agency representa- tives will participate in consortium activities. 3. The maximum term of treatment for residential care is 60 days for Level 1 and 120 days for Level 2. However, outpatient has no maximum time limit. Intensive Out- pa- tient) has an eight week limit. All intakes, with rare exceptions, must be'made by the Central Intake Unit (CIU). In the event a client is seen directly by a provider and that provider feels an ex- _ ception is warranted, permission -to directly admit must be obtained from the CIU. 14 a) b) c) In those cases: the relevant patient data is provided to the Central Intake Unit within 24 hours of admission. the required screenings, assessments and physical examination are completed within 48 hours of admission, and_ any such admission is subject to monitoring with 14 days to verify the appropriateness of the level of care. 4. This cooperative agreement will be subject to the Department of Health and Human Services generic regulations concerning the administration of cooperative agreements, as set forth in 45 CFR Part 92. Cooperative agreements must also be administered in accordance with the PHS Grants Pol- icy Statement (Rev. October 1, 1990). 5. None of the Federal funds awarded in this cooperative agreement may be used to pay the salary of an individual at a rate in excess of $125,000 per year. 6. Programs must be adapted to local needs including special ethnic, cultural, language and geographic considera- tions, and service delivery is required to be culturally competent. 7. Providers have an obligation to report their cen- sus to the the Centralized Resource & Referral (CRR) agency daily by telephone or through the Management Information System (MIS), when operational. 8. The contractors cannot discriminate against people who tested positive for HIV. 9. Provider must be licensed and certified to provide the types of services for which it is contracted to provide. 10. "Confidentiality of Alcohol and Drug Abuse Patient Records" regulations (42 CFR Part 2) are applicable to any information about alcohol and other substance abuse patients obtained by a "program" (42 CFR 2.11). This means that all patient records are confidential and may only be disclosed and used in accordance with 42 CFR Part 2. 11. Any entity receiving amounts from this Cooperative Agreement for operating a program of treatment for substance abuse are (1) to, directly or through arrangements with other public or nonprofit private entities, routinely make available TB services to each individual receiving treatment for such abuse; and (2) in the case of an individual in need 15 of such treatment who is denied admission to the program an! the -.basis of lack of capacity of the program, to refer t1ker individual to.another provider of TB services. 12.._Any provider must make available to individua,Ils: early intervention services for HIV/STD disease at the sites: at which the individuals are undergoing such treatment. Such services will be undertaken voluntarily by, and with the informed consent of, the individual and undergoing such services will not be required as a condition of receiving treatment services for substance abuse or other services. 13. All programs should attempt to focus on admissiGms for persons who are first time alcohol and substance abuse treatment admissifns, or individuals who have relapsed after a period of one year or more of stable abstinence. 14. All clients will receive a discharge plan at the time they are discharged from a program. 15. The provider will establish procedures throes which applicants for and recipients of services may present grievances about the operation of the services being provided under this contract. The provider will advise persons of their right to appeal a denial or exclusion from the program, of failure to take account of an indi'vidual's choice of service and of the right to a fair hearing to the final governing authority of the agency. 16.- Clients recommended for treatment by the CIU may not be rejected by the agency to which they are referred. E. Required Report: 1. A final expenditure report, Exhibit - E, is to be submitted no later than 45 days following expiration of the contract. 2. Providers who have been awarded a contract for more than one type of service are required to submit the fi- nal -expenditure report separately for each type of service. Furthermore, all the financial and other documents should be clearly identifiable per service program and kept separately in order to facilitate an efficient audit review. /6 ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A AGENCY: MONROE COUNTY CONTRACT # KH 383 REVISION # BUDGET PERIOD: 6/21/1993 TO 6/20/1994 TYPE OF SERVICE CENTRAL INTAKE UNIT TOTAL -----------------------------------(SUBCONTRACTED-�--------------------- 1. Personnel: a. Salaries b. Fringes - Total Personnel: 2. Expenses: a. Building Occupancy 4 b. Professional Services c. Travel d. Equipment Costs e. Medical and Pharmacy - f . Subcontracted -Services $86,987.00 $86,987.00 g. Insurance h. Operating Supplies/Expenses i. Food Services J. Other Total Expenses: - $86,987.00 $86,087.00 Total Personnel/Expenses: 3. Administrative Costs 4. Capital Expenses GRAND TOTAL: $86 , 987.00 f __ $86,987_00=__ l7 ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A :assas=sssssasssasasasasssaasasaasssass:ssssssssassassaasssssasssssssss AGENCY: MONROE COUNTY /Guidance Clinic of CONTRACT # KH 383 MidleBUDGET PERIOD: 6/20/1993.toe6/21/1994eys Inc REVISION s-a-ss=sao==o=__====ss=ssaaaasaos,,=s3sasaaasass:ssaaaasa=aassaasssssasss TYPE OF SERVICE CENTRAL INTAKE UNIT (SUBCONTRACT) ---- ------------------------ TOTAL 1 ------------------------------------------- Personnel: a. b. Salaries Fringes $ 8,539 3,477 Total Personnel: 12,016 ` 12,016 .2. Expenses: a. b. Building Occupancy 3,353 Professional Services 5,652 C. Travel d. Equipment Costs 680 e. f. Medical and Pharmacy Subcontracted 1,600 39,659 Services (Janitorial, exterminator, etc.) g• Insurance ' h• i. Operating Supplies/Expenses Food 6s1 1,681 58 J. Services Other 2,373 Total Expenses: 55,656 55,656 Total Personnel/Expenses: --- 3. Administrative Costs 67,672 67,672 ( 19.676% ) 13,315 13,315 4• Capital Expenses GRAND TOTAL: 6,000 6,000 $ 86,987 $ 86,987 sssssassssssss tAhlbiT A - 1 • LINE ITEM BUDGET NARRATIVE • GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. CENTRAL INTAKE UNIT PERSONNEL Salaries Program Director Discharge Planner $1, 2 6 9 substance Abuse Tech. 624 4,624 056 Nurse - RN Records Clerk 2,184 184 406 Total Salaries 8,539 Fringe Benefits social Security 653 633 Pension Health Insurance 512 1, 930 Workmen's Compensation 7 Florida Unemployment 1 Total Fringe Benefits 31477 Total personnel 12,016 EXPENSES Building Occupancy Utilities Repairs & Maintenance 2,457 555 Janitorial & Household Supplies 341 Professional Services Medical Coverage Linen Services 4,519 Audit 383 383 Travel 680 Food 2,373 Medical And Pharmacy Medicine & Medical Supplies Lab & Testing Fees (1) Pharmac Consultant 38 674 �138 Personal Items 126 Insurance Comprehensive Professional Liability 481 200 0 EXHIBIT A - 1 LINE ITEM BUDGET NARRATIVE GUIDANCE CLINIC OF THE MIDDLE KEYS, INC CENTRAL INTAKE UNIT Operating Supplies and Expenses Office Supplies Educational = 235 Postage 141 Telephone 202 Printing 687 License Fees 72 Data processing 22 Administration (2) 299 13,315 Renovations Computer Equipment Total Expenses ;Grand Total Average Cost per Day 6,000 1,600 74,971 $861987 $238.32 FOOTNOTES: (1) Lab and testing fees are determined on administering Tuberculin PPD skin teat to approximately 858 datox admissions It is estimated that approximately 219 (25%) of those tested will result as positive. Once identified, the will receive x-ray and sputum testing. Theocovtvisstatus determinednas outline below: X-ray testing 6$64.90 x 219 Throat Cultures @$92.10 X 219 14,214 Skin testing @55.00 x 858 20,170 4,290 (2) Administration expense in all three Programs incl Of the administrative staff which comprises the Chiefucosts. Executive Department. Officer, RiRickManager, Clinical Director and the Accounting 1z.:t u ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A AGENCY: MONROE COUNTY CONTRACT # KH 383 REVISION # BUDGET PERIOD: 6/21/93 to 6/20/94 TYPE OF SERVICE OUTPATIENT SERVICES ----------------------------------------------------------------------- (SUBCONTRACTED) TOTAL 1. Personnel: a. Salaries b. Fringes Total.Personnel: 2. Expenses: a. Building Occupancy b. Professional Services c . Travel d. Equipment Costs e. Medical.and Pharmacy f . Subcontracted Services $42,813.00 $42,813.00 g. Insurance h. Operating Supplies/Expenses i. Food -.Services J. Other TotalExpenses: _ _ $42,813.00 - $42,813.00 Total Personnel/Expenses: 3. Administrative Costs C ) $ 4. Capital Expenses GRAND TOTAL: $42,813_00 ___ $42,813_00== ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A AGsa=sasssssassessssssssssssssssssaassssasssssssssssssssasssssssssssasssss ENCY: MONROE COUNTY /Guidance Clinic of the Middle Keys, Inc, CONTRACT # KH 383 BUDGET PERIOD: 6/21/1993 to 6/20/1994 REVISION # ==asaaaaas=s=a=asasaaaaassasaassasasassassssssassssssasassssassasssssass TYPE OF SERVICE OUTPATIENT SERVICES -------__ _----- (SUBCONTRACT) TOTAL ------------------------ 1. Personnel: ---------------------- a. Salaries $ b. Fringes 27,650 7,978 Total Personnel: 2 • Expenses:. . , ' 35,628 35,628 a. Building Occupancy b. Professional Services 983 C. Travel 250 d. Equipment Costs 100 e• f• Medical and Pharmacy Subcontracted Services g• (Janitorial, exterminator, etc.) Insurance h• i• Operating Supplies/Expenses Food 714 459 J. Services Other Total Expenses: 2,506 2,506 Total Personnel/Expenses: 38,134 38,134 3• Administrative Costs ( 12.270% ) 4• Capital Expenses 4,679 4,679 GRAND TOTAL: 421813 42,813 ssssssssssssss 01 GUIDANCE CLYNIC OF THE MIDDLE KEYS, INC. OUTPATIENT SERVICE PERSONNEL Salaries Substance Abuse Counselor Receptionist $27, 650 650 Total Salaries 27,650 Fringe Benefits Social Security Pension 21115 Health Insurance 1,659 Workmen's Compensation 3,898 Florida Unemployment 210 96 Total Fringe Benefits 7,978 Total Personnel - 35,628 Building Occupancy Utilities Repairs & Maintenance 728 Janitorial & Household Supplies 165 90 Professional Services Audit 250 Travel 100 Insurance Comprehensive Professional Liability 142 P, 572 Operating supplies and Expenses Office Supplies Educational. 43 Postage 77 Telephone 37 Printing 127 Data Processing 15 Administration 160 4,679 Total Expenses • 7,185 Grand Total $42,813 Average Cost Per Hour $41.81 2 Z Z3 ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A AGENCY: MONROE COUNTY CONTRACT # KH383 REVISION # BUDGET PERIOD: 6/21/1983 to 6/20/1983 TYPE OF SERVICE DETOXIFICATION (SUBCONTRACTED) TOTAL ----------------- --------------------------------------------------- 1. Personnel: a. Salaries b. Fringes Total Personnel: 2. Expenses: a. Building Occupancy b. Professional Services c. Travel d. Equipment Costs e. Medical and Pharmacy f . Subcontracted Services $92,000.00 $92,000.00 g. Insurance h. Operating Supplies/Expenses i. Food Services J. Other Total Expenses: $92,000.00 $921000.00 Total Personnel/Expenses: 3. Administrative Costs 4. Capital Expenses GRAND TOTAL: $92,000.00 $92,000.00 Y�� ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER -FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A asas�aassssssasssasssassassasss:assssasssssssssssssssssssssssssssssssss AGENCY: MONROE COUNTY/Guidance Clinic of thCONTRACT # KH 383 Middle Keys, Inc. REVISION # BUDGET PERIOD: 6/21/1993 to 6/20/199* s===assassssssaasassassasssassasasssssassasssasssasasssssssssasssssssss TYPE -OF -SERVICE -DETOXIFICATION (SUBCONTRACT)----------- 1 -----------. TOTAL Personnel: ------- a - Salaries b. Fringes Total Personnel: 2.. Expenses a. Building Occupancy b. Professional Services C. Travel d. Equipment Costs e. Medical and -Pharmacy f. Subcontracted Services (Janitorial, exterminator, etc.) ; g• Insurance_ h• Operating Supplies/Expenses i• Food Services J. Other Total -Expenses: Total Personnel/Expenses: 3• Administrative Costs - ( 19.798% ) 4• Capital Expenses GRAND TOTAL: 24,343 6,791 31,134 6,707 11,304 1,360 2,145 1,362 18,038 4,746 45,662 76,796 15,204 92,000 31,134 45,662 76,796 15,204 92,000 sasses:sssssss : r+nnlnl'1' A - 1 LINE ITEM BUDGET NARRATIVE • GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. DETOXIFICATION PERSONNEL Salaries Program Director. $2,961 Discharge Planner 1,456 Substance Abuse Tech, 13420 Nurse - RN 460 Records Clerk 5,946 946 Total Salaries 24,343 Fringe Benefits Social Security Pension 1,862 Bealth Insurance 1,46 2,373 Workmen's compensation Florida Unemployment 779 779 316 Total Fringe Benefits 61791 Total Personnel 31,134 Building Occupancy Utilities Repairs & Maintenance 4r915 Janitorial & Household Supplies 1,110 682 Professional Services Medical Coverage Linen Services 9,038 Audit 766 15 0D Travel 1,360 Food 4,746 Medical And pharmacy Medicine & Medical Supplies Lab & Testing Fees 697 Pharmacy Consultant 920 Personal Items 276 252 Insurance Comprehensive Professional Liability 962 400 Operating Supplies and Expenses Office Supplies Educational 470 Postage 282' Telephone 404 1,374 2 �" EXHIBIT A — 1 LINE ITEM BUDGET NARRATIVE 2 �j { t GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. DETOXIFICATIO14 Printing 144 License Fees 44 Data Processing 598 Client Transportation �4,722 Administration 15,204 Total Expenses 60,866 Grand Total $92,000 Average cost Per Day $126.03 d 27 5 ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A AGENCY: MONROE COUNTY CONTRACT # KH 383 BUDGET PERIOD: 6/21/93 to 6/20/94 REVISION # TYPE OF SERVICE - RESIDENTIAL LEVEL I -(SUBCONTRACTED) TOTAL ----------------------------------------------------------------------- 1. Personnel: a. Salaries b. Fringes Total Personnel: 2. Expenses: a. Building Occupancy b. Professional Services c. Travel d. Equipment Costs e. Medical and Pharmacy f . Subcontracted Services $160,450.00 $160,450.00 g. Insurance h. Operating Supplies/Expenses i. Food Services J. Other TotalExpenses:-- $160,450.00 $160,450.00 Total Personnel/Expenses: 3. Administrative Costs i 6.232% ) . 10,000.00 10,000.00 4. Capital Expenses GRAND TOTAL: 170.,450.00 170 �450.00 ---==--==--== ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A 219 AGENaa=x=ssssaaasaaxxasasasasssaxxaaaaassaasasssasssssssassassssssssssssssss CY: MONROE COUNTY /Life Center FoundatiorCONTRACT # KH 383 BUDGET PERIOD: 6/21/93 to 6/20/94 REVISION # =-cxaxa==s==aa=xxaaaaxaaaaaasaaaaassaaaasasasssssasaasassassa3axsasssxs TYPE OF SERVICE RESIDENTIAL LEVEL 1 (SUBCONTRACT) TOTAL ------------------ ----- ---------------------------- 1. Personnel: ""'--------------- a. b. Salaries Fringes $ 69,500 15,985 Total Personnel: 85,485 ` 85,485 .2. Expenses: a. b. Building Occupancy Professional Services 42,610 C. d. Travel Equipment Costs 3,075 e. Medical and Pharmacy 2,100 f. Subcontracted Services 9. (Janitorial, exterminator, etc.) Insurance h. i. Operating Supplies/Expenses 1,2 0 Food Services 8,260 J. Other 161640 1,080 Total Expenses: 74,965 74,965 Total Personnel/Expenses: 160,450 160,450 3. Administrative Costs 4• Capital Expenses GRAND TOTAL: 160,450 160,450 ssssssssssssss EXHIBIT A - 1 LINE ITEM BUDGET NARRATIVE LIFE CENTER FOUNDATION RESIDENTIAL LEVEL I PERSONNEL Salaries Project Director (70% FTE) $24,500 Counselor (1) 27,000 Clerical (1) 18,000 Total Salaries 691500 Fringe Benefits Social Security (7.65%) 5,317 Health Insurance (10.85%) 7,541 Workman's Compensation (3.2%) 2,224 Florida Unemployment (1.3%) 903 Total Fringe Benefits 15,985 Total Personnel 85,485 EXPENSES Building Occupancy Building Rental 30,000 Utilities 4,200 Repairs & Maintenance 5,790 Janitorial & Household Supplies 2,620 Equipment Costs Equipment Rental 630 Equipment Repair & Maintenance 1,470 Travel 3,075 Client Hygiene 11080 Client Food 16,640 Insurance 1,200 Operating Supplies/Expenses Office Supplies 1,040 Automobile Repair & Maintenance 4,060 License & Permits 160 Telephone, FAX 3,000 Total Expenses 74,965 Sub Total $160,450 ADMINISTRATION Administration _0_ Grand Total $- 160,,450 EXHIBIT - B DETAILS OF SERVICES PROVIDED NAME OF PROVIDER ACENCYr . MONROE COUNTY 3©. CONTRACT M CONTRACT PERIODS 6/2 t193 '6/l ao e TYPE OF SERVICE i 0 OF BEDS i #OFBED I COST PER I NOF SLOTS ( COST PER I TOTAL I S ( BED DAY I ( SLOT ( COST 1 �ussssassssssssssss asassssssssssssssasssasssssssssssssssssss:sssssssss*asssssssasssasssssssssrnl OUTPATIENT ( .. ............................................................•---...............................I I I ( 1,024 ( 41.81 ( 42,813 I INTENSIVE - OUT PATIENT ( ( I I ( I .................................................................•----------........................_......._............1 kESIDENTIAL LEVEL 1 I •......----•---.......i 10 1 3.650 .............i........_........---......._...i...............i.. I 46.70 I ( I J 7p::450 1 .......:... RESIDENTIAL LEVEL2 .........................................................................................................................( CHILD CARE ....• I ( I .................I...............--•--•---................---------............_.................................1 DETOXIFICATION ! ---------------•--_..........-.-.......-----•----.....................-----......-----.-........----•... 2 ( 730 ( 126.03 I ( 1 92 000 1 _------1.......) RESOURCE i REFERRAL I I - I ( I ( ( CENTRAL• INTAKE....._.....i.....i ---.....I .. ...............1----------._...!-•--86,9871 ................................................................•------•-----•----...-•------------•----.............I 3 6 5•----I 238.32 ADOLESCENT RECEIVING ( ..-...SCR...E I I I I -•............................ STD ENING._•-- I ..............................................................................•---................................... ...........•----........----._............---..............••............... ( = I I I I GRAND TOTAL: I $392,250. _ M 0 fD G `d n 0 f1 Cf N I N !• 0 r N rA N Mtn mroH. 0~n NNN N^orvrxs , w w ps w I 0 ►� N a N• O 4 � r ' t E i • m W O � � N oC►O010�N O �OV1N� .r C+ •o. �� O 3 2. ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT EXHIBIT B - I SERVICE DESCRIPTION CENTRAL INTAKE UNIT Agency Name: MONROE COUNTY GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. Adds= 3000 41st Street, Ocean, Marathon, FL Director/Coordinator: David P. Rice, Ph.D., Chief Executive Officer SusHor Phone Number: (305) 743an949in, Program Director Days/Hours of Operation: 24 hours, 365 days per year Bed Capacity: Population Groups Served: Adults in need of substance abuse services as a result of Hurricane Andrew Staffing - $ of FTE's Providing Direct Care: .48 Intake Referral Agreements: Intake referrals may be accepted from any of the following: (1) Substance Abuse Providers (2) Community Mental Health Centers (3) Acute Care Hospitals (4) Primary Care Centers (5) Private Medical & Mental Health Providers (6) Law Enforcement or Court Officials (7) Community Health.Teams (Outreach Disaster Response) Residential Stay: At the discretion of the medical staff the minimum stay at the CIU can be from 48 to 96 hours for the purpose of intake, receiving and assessment for level of care including completion of infectious disease screening. SERVICES: Screening =_ Assessment: Medical history and physical examination Drug and psychosocial screening Mental status Assessments (e.g., Addiction Severity Index) TB/HIV/STD (see below) Infectious Disease:, Screening for HIV, TB and STDs Pre and post-test counseling and risk reduction Must have network established for X-Ray and throat culture for those that test positive for TB Isolation area for clients that test positive for TB External referrals for TB treatment TB infection control designs Modifications to air handling and lighting systems as may be needed Outreach: To identify persons in need of substance abuse treatment and to network with the Community Health Teams (Outreach disaster response). SERVICES TO SPECIAL POPULATION: Pregnant Women: It -is essential that services provided at the CIU also include counseling on the effects of alcohol and drug use on the fetus, as well as referrals for prenatal care. Methadone: While at the CIU, .clients needing methadone treatment will need to be transported to a methadone treatment center for dosage. Each individual who requests and is in need of treatment for injection drug abuse should be admitted to a program not later than 14 days after making the request for admission to such a program, or 120 days after the date of such a request, if no such program has the capacity to admit the individual on the date of such request and if interim services are made available to the individual not later than 48 hours after such request. r Capacity Utilization Management System:,._ Substance Abuse Treatment Programs participating in this project will -report to the CIU the vacancies available for --clients on the waiting list so that they can enter programs at the earliest.opportunity. The CIU will establish a waiting list management program which provides systematic reporting of treatment demand. External --Referrals: Based on findings at CIU, referrals will be made for the level of care necessary as follows: Detoxification - Inpatient hospital detoxification which is to be used only when there is a significant concomitant medical problem or the use of barbituates. - Directly into rehab: residential, intensive outpatient or outpatient. SERVICE DOCUMENTATION: Service Ticket: a)- Name of service � _b)_. Program. ---Adult or'child 18 & under c) Client name and identification number d) Service date AUDIT DOCUMENTATION: " Client Medical Record: a)_ Name Of service b) Client name and identification number c) Service date TOTAL BUDGET s . +' 3 - ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT EXHIBIT - B - I SERVICE DESCRIPTION OUTPATIENT SERVICES (A separate sheet must be completed for each location) Agency Name: MONROE COUNTY Address: 3000ANCE 41st St ICLINC Oce nOF H,E arathon,KEYS FL INC Director/Coordinator: David P. Rice, Ph.D., Chief Executive Officer Deborah Harrison, Ph.D., Clinical Director Phone Number: (305) 743-9491 Days/Hours of Operation: 8:30 AM to 5 PM, Monday through Friday Average Length of Treatment: 2 months #Of Clients to be Served During the Term of Contract: 9 Population Groups Served: Adults with substabce abuse diagnosis Staffing - # of FTEIs etc. : (One Counselor to no more than 35 clients.) Treatment Regimen: Minimum of one individual session of one hour per week and one group session of 1 hour per week. Description of Services To be Provided: Capacity Utilization Management System: Substance Abuse Treatment Programs participating in this project will report to the CIU the vacancies available for clients on the waiting list so that they can enter programs at the earliest opportunity. Participating Substance Abuse Treatment Programs for adolescents within the area will report to the ARF the vacancies available for clients on the waiting list so that they can enter programs at the earliest opportunity. SERVICE DOCUMENTATION: Service 'Ticket: a) Name of Service b) Client Name and Identification Number c) Service Date. AUDIT DOCUMENTATION: Client Medical Record: a) Name of service b) Client Name and Identification Number c) Service Date TOTAL BUDGET: 'T 7 g13 36 ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT'COOPERATIVE AGREEMENT EXHIBIT - B - I SERVICE DESCRIPTION DETOXIFICATION Agency Name: MONROE COUNTY GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. Address: 3000 41st St., Ocean, Marathon, FL Director/Coordinator: David P. Rice, Ph.D. , Chief Susan Horn, Program Director ExecutWe Officer Phone Number: (305) 743-9491 Bed Capacity: 2 Population Groups Served: Adults referred by Central Intake Unit Staffing - # of FTE's Providing Direct Care:1.43 Residential Stav Up to 5 - 10 days of detoxification using the medical and/or non -medical model of treatment. Description of Services To be Provided: Capacity Utilization Management System: -- Substance Abuse Treatment Programs participating in this project will report to the CIU the vacancies available for clients -on the waiting list so that they can enter programs at the earliest opportunity. Participating Substance Abuse Treatment Programs for adolescents within the area will report to the ARF the vacancies available for clients-on.the waiting list so that they can enter programs at the earliest opportunity. 0 SERVICE DOCUMENTATION: Service Ticket: a) :Name of Service b) Program :adult or children c) Client Name and Identification Number d) Service Date AUDIT DOCUMENTATION: Client Medical Record: a) Name of . Service b) Client Name and Identification Number c) Service Date TOTAL BUDGET: ;-72, 00© ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT EXHIBIT - B - I SERVICE DESCRIPTION RESIDENTIAL LEVEL I Agency Name: MONROE COUNTY Address: LIFE CENTER FOUNDATION, INC. 610 Elizabeth Street, Key West, FL 33040 Director/Coordinator: William W. Irby, Director Phone Number: (305) 292-1774 Bed Capacity: / O Population Groups Served: Individuals recovering from addictions, substance abuse, w o reside in Monroe County, FL, as referred by CIU Staffing - # of FTE's Providing Direct Care:l Residential Stay: Maximum of 60 days in residential care. Description of Services To be Provided: Capacity Utilization Management System: Substance Abuse Treatment Programs participating in this project will report to the CIU the vacancies available for clients on the waiting list so that they can enter programs at the earliest opportunity. Participating Substance Abuse Treatment programs for adolescents within the area will report to the ARF the vacancies available for clients on the waiting list so that they can enter programs at the earliest opportunity. Lj SERVICE DOCUMENTATION: Service Ticket: 0 Name of Service b)..Client Name and Identification Number c) Service Date ' AUDIT DOCUMENTATION: Client Medical Record: a) Name of Service b) Client Name and Identification Number c) Service Date CJ U46- TOTAL BUDGET: s AK© AA /0 OO O (i R4 V 7o TAL : 70, Z150 ��1 C1 ��jj �0y �O " V 1� N • Y O off' ggl0l(A�• V 8° 0 " " m i s C O 0 a tm < wig c CA 40 p< CI 5�1> I p 8z �• 9;�� I W � 01 C� w_c 1 g ; m z o �m m o N w w M N w N M M w: M N to N N °x�s >,03ml F. ° T �8 �ptl t I I 1 1 1 i 1 1 tool It t t 1 I 1I 1 H�� t >_ z 1 1 Q r N M w M N M M M M » M> M N M M M Q � I z z ° b> ° za Cow nd 6Kas°v in O C n%�c y II z o C ii O x n EXHIBIT C-1 HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT MONTHLY PROGRESS REPORTS SUGGESTED FORMAT - Monthly Progress Reports should contain concise summaries of project progress and impediments. Reports should be prepared by each provider. I. Narrative Each Provider shall provide a narrative summary, not to exceed 5-6 pages, describing the activities undertaken over the monthly period for which the report is being filed. To the extent possible, documentation in support of the accomplishments described in the narrative section should be included in -the form of an appendix. The narrative should include the following information at a minimum: A. Description of the target population(s). Where available, the target population should be described in terms of age, race,,gender, and socioeconomic status. please note the proportion of female patients who are pregnant or postpartum women. B. Describe the drug use patterns of the target population(s). C. Describe key objectives for the quarter, as set forth in the contract, together with a brief description of actual accomplishments achieved against these objectives during the same period. Also, include utilization statistics. The completeness of the medical records will be monitored by HRS staff. Be sure to include at least the following information at a minimum: 1. The date, term, and volume of award for provider agreements or contracts with the State Drug Treatment Agency. cal _ i 2. Describe new staff hired during the period -according to date of hire, job title, name, and salary. Indicate whether each staff member is employed full-time, part-time, o . on a contractual basis. 3. List the date, term and cost of any new leases entered into during the reporting period. 4. Describe cost and scope of alterations and renovations begun during the reporting period. 5. Describe subcontracts initiated during the reporting period, and provide supporting documentation. 6. Describe the extent to which linkages with FEMA, Civil Defense, health, human service, criminal Justice, education and vocational agencies or programs have been established. Attach memoranda of understanding or letters attesting to these linkages in an appendix. 7. 'If applicable, describe any increase in the number and type of patients served. 8. Describe the development.of new patient outreach, intake, referral and tracking systems, together with any other treatment enhancements implemented during the reporting period. 9. Describe implementation of quality assurance methods. 10. Describe the extent of any personnel or organizational changes occurring during the reporting period. 11. Highlight any significant impediments, delays or barriers, and describe how thesedifficultieswere overcome - (or still exist), as well as the need for any State, CSAT, or consultant technical assistance. Obligation and Expenditure Summary In chart form,, and for each line in the approved budget for the Provider, provide the dollar amounts of contract monies actually obligated and expended during the reporting period (and a cumulative total for the present and prior reporting periods). --See attached -sample form. (Attachment '--C)- ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW -_CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT EXHIBIT - D Required Reports for CSAT Substance Abuse Treatment Cooperative Agreement Reports Due Date Copies * Budget Detail with Budget- Narrative As needed for amendments 1 * Details of Services Provided As needed for amendments 1 * Monthly Expenditure Report and Reimbursement Request As per the along with back-upq - Schedule in ATTACHMENT - I, documentation C•j. (Pages 8-9) 1 * Monthly Progress Report P 30 days after, the end of each month of service 2 * Final Expenditure Report P for CSAT Substance Abuse - No later than Treatment Cooperative 45 days following Agreement (Exhibit - E) expiration of Contract. i 2 ' ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT FINAL EXPENDITURE REPORT EXHIBIT - E AGENCY._____________________________________aaaa:====_________--___________ CONTRACT # BUDGET PERIOD:REVISION # TYPE OF SERVICE BUDGETED EXPENDED BALANCE AMOUNT TO DATE - Personnel. --------------------------------------------------- a. Salaries b. Fringes Total Personnel: ' 2. Expenses: a. Building Occupancy b. -Professional Services c. Travel d. Equipment Costs e. Medical and Pharmacy f. Subcontracted Services (Janitorial, exterminator, etc.) g. Insurance h. Operating Supplies/Expenses i. Food Services J. Other Total Expenses: Total Personnel/Expenses: 3. Administrative Costs 4. Capital Expenses GRAND TOTAL: xaa==aaams ss:=axxsx= sxasx=x=== 0 SPECIAL REQUEST EXHIBIT - F CONTRACT # ONE-TIME NON -RECURRING EXPENDITURE ADVANCE Pursuant to Attachment I, paragraph C.l.j. of the attached FY 93-94 contract, we are requesting more than the monthly pro-rata share of the contract only, for one-time non- recurring expenditures. ' This request is for the month of , 1993 in the excess amount -of $ to be used for the purpose of --------------------------- PROGRAM --------------------------- SIGNATURE --------------------------- TITLE A --------------------------- DATE M FINANCIAL AND COMPLIANCE AUDITS ATTACHMENT — l4 This attachment is applicable, if the provider or grantee, hereinafter referred to as provider, is any government entity, = nonprofit organization, or for -profit organization. PART 1: SINGLE AUDIT This part is applicable. if.the provider is a local government entity or nonprofit organization and receives a total of 525,000. or more from the department during its fiscal year. The provider has "received" funds when it has obtained cash ,front the department or when it has incurred expenses which will be reimbursed by the department. The provider agrees to have an annual financial and c current Government Auditin Standards ("Yellow Book )�ispsued a audit performed by independent auditors in accordance with the " by the Comptroller General of the United States. Local governments shall comply with Office of Management and Bud et OMB Circular A-128 Audits of State and opt overtments. Nonprofit providers receiving federal funds passed through the department shalt comply with the audit requirements contained in OMB Circular A-133 Audits of institutions of Higher Learning and Other N rofit ins itutions, except as modified herein. Such audits shall cover the entire organization for the organization's fiscal year, not to exceed 12 months, The scope of the audit performed shall include the financial audit requirements of the "Yellow Book and must include reports contrcl and compliance_- The audit re " port shall include a schedule of`financisl assistance that discloses each state contract by number. An audit performed by the Auditor General shall satisfy the requirements of this attachment. Compliance findings related to contracts with the department shall be based on the contract requirements Including rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation any showing whether or not matching requirements were -met. All questioned costs and liabilities due to the calculated and fully disclosed in the audit report with reference to the department contract involved. These requirements is not expand the scope of the audit as prescribed by the "Yeitvv-V65i_ " department shall be equ ements do If the provider has received any funds from a grants report(s) in accordance with the rules of the Auditor aGeneral,aids achaptera10.600, and r ndicateer ion thelt os ubmiite ocompliance assistance which contracts are funded from state grants and aids appropriations. financial Copies of the financial and compliance audit report, management letter, and all other correspondence, audits performed by indepe�ent auditors, other than the Auditor General, shall be suhnitted120fdays after the the provider's fiscal days related to Year, unless otherwise required by Florida Statutes, to the following: end of A. Office of Audit and Quality Control Services 1347 Winewood Boulevard, Building 5, Room 116 a Tallahassee, Florida 32399-0700- B• Contract Manager for the department C- 'Submit to this address only those reports prepared in accordance with ome Circular A-133: Federal Audit Clearinghouse U.S,_Bureau of the Census Jeffersonville, Indiana 47132 ' 0• Submit to this address only se reports prepared in accordance with the rules of the Auditor General, chapter 10.600 Jim Dwyer Office of the Auditor General P- 0. Box 1735 Tallahassee, Florida 32302 The provider shall ensure that audit workingoc f- five papers are made available to the department, or its designee, '� the date the audit report is issued, unless rxtended in writing g upon request for a 07/cl�g3 3 by the department. SPECIAL REQUEST EXHIBIT - F CONTRACT # ONE-TIME NON -RECURRING EXPENDITURE ADVANCE Pursuant to Attachment I, paragraph C.l.j. of the attached FY 93-94 contract, we are requesting more than the monthly pro-rata share of the contract only for one-time non- recurring expenditures. ' This request is for the month of , 1993 in the excess amount -of $ to be used for the purpose of --------------------------- PROGRAM --------------------------- SIGNATURE --------------------------- TITLE a --------------------------- DATE `j J FINANCIAL AND COMPLIANCE AUDITS ATTACHMENT -- I- This attachment is applicable, if the provider or grantee, hereinafter referred to as provider, is any government entit, nonprofit organization, or for -profit organization. -y PART 1: SINGLE AUDIT This part is applicable if the provider is a local government entity or nonprofit organization and receives a total of 525,000 or more from the department during its_fiscat year. The provider has "received" funds when it has obtained cash •from the department or when it has incurred expenses which will be reimbursed by the department. The provider agrees to have an annual financial and c current Government Auditing Standards ("Yellow Book") oissued a audit performed by Independent auditors in accordance with the " by the Comptroller General of the United States. Local governments shall comply with Office of Mana ement and Bud et OMB Circular A-128 Audits of State and oea Governments. Nonprofit providers receiving federal funds passed through the department shall c requirementsit in OMB Circular A-133 Audits of institutions of Hi her Learnin and Other N roffitllnstihutions dexcep es modified herein, Such audits shall cover the entire organization for the organizations fiscal year, not to exceed 1e months. The scope of the audit performed shall include the financial audit requirements of the "Yellow Book," and must contrcl and compliance. The audit report shalt include a schedule of financial assistance that discloses eachstats tecontract by number. An audit performed by the Auditor General shall satisfy the requirements of this attachment. Compliance findings related to contracts with the department shall be based on the contract requirements, including a rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a e any shoring whether or not matching requirements were met. All amputation and calculated and fully disclosed in the audit report with referencett questioned eodepartment acontract bilities �olved. to Thesdepae shall be not expand the scope of the audit as prescribed " requirements do by the Yeltop'Bo6A:" If the provider has received any a fords from grants and aids appropriation; the provider will also submit a compliance report(s) in accordance with the rules of the Auditor General, chapter 10.600, and indicate on the schedule of financial assistance which contracts are funded from state grants and aids appropriations. Copies of the financial and compliance audit report, management letter, and all other correspondence, audits performed by independent auditors, other than the Auditor General, shall be submittedithin120fdays after the end of the providers fiscal any, related to year, unless otherwise required by Florida Statutes, to the following: A. Office of Audit and Quality Control Services 1317 Winewood Boulevard, Building 5, Room 116 i Tallahassee, Florida 32399-0700 S. Contract Manager for the department C• Submit to this address only those reports prepared in accordance with OMB Circular A-133: Federal Audit Clearinghouse U.S. Bureau of the Census Jeffersonville, Indiana 47132 ' D• Submit to this address only those reports prepared in accordance with the rules of the Auditor General, chapter 10.600: Jim Dwyer Office of the Auditor General P- 0. Box 1735 Tallahassee, Florida 32302 The provider shall ensure that audit working papers are made available to the department or its designee, upon rcqtrest for a period Of_five years fron the date the audit report is issued, unless rxtended in writing b •07/G1/93 y the department. •"' �� PART 11: GRANTS AND AIDS AUDIT/ATTESTATION 4 This part is applicable if the provider is awarded funds from a grants and aids appropriation, and is either (1) a local government entity or nonprofit organization receiving a total of less than S25,000 from the department during its fiscal year or (2) a for -profit organization receiving any amount from the department. The provider has "received" funds when it has obtained cash from the department or when it has incurred expenses which will be reimbursed by the department. - If the amount received from grants and aids appropriation awards exceeds S100,000, the provider agrees to have an audit performed by an independent certified public accountant and submit a compliance re port(sinthe Auditor General, chapter 10.600. The audit report shall include a schedule of financial'assistanceance thatwith disclosestheules eachostate contract by number and.i•ridicates which contracts are funded from state grants and -aids appropriations. Compliance findings related to contracts with the department shall be based on the contract requirements, including any rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation showing whether or not matching requirements were met. All questioned costs and liabilities due to the department shall be calculated and fully disclosed in the audit report with reference to the department contract involved. If the amount received from grants and aids appropriation awards exceeds $25,000, but does not exceed S100,000, the provider may have an audit as described above or have a statement prepared by an independent certified public accountant which attests that the provider has complied with the provisions of all contracts funded by a grants and aids appropriation. If the amount received from grants and aids appropriation awards does not exceed $25,000, the provider will have the head of the entity or organization attest, under penalties of perjury, athe organization has P y' tht 9 complied with the provisions of all contracts funded by a grants and aids appropriation: - Copies of the audit report and all other correspondence, if any,. related to audits performed by the inde the attestation statement, shall be submitted within 120 days after the provider's fiscal year end to the frollowingttor, or A. Office of Audit and Quality Control Services 1317 Winewood Boulevard, Building.5, Room 116 Tallahassee, Florida 32399-0700 B. Contract Manager for the department C. Jim Dwyer Office of the Auditor General P. 0. Box 1735 Tallahassee, Florida 32302 The i provder shall ensure that audit workin Period five g Papers are made available to the department, or its designee, upon request for a years from the date the audit report is issued, unless extended in writing by the department. PART III: NO AUDIT REQUIREMENT This part is applicable if the provider is not awarded funds from a grants and aids appropriation, and is either (1) a local government entity or nonprofit organization receiving a total of less than S25,000 from the department during or (2) a for -profit organization receiving any amount from the obtained cash from the an department. The provider has "received" funds whenit department or when it has incurred expenses which will be reimbursed by the department. The provider has no audit or attestation statement required by this attachment. 07/01/93 N T 7AC H /'RCN T- /// July 11 1991 CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS. GRANTS LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an ,_ employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or w- attempting to influence an officer or employee of any agency, a member of congress, an officer, or employee of congress, or an employee of a member of "congress in connection.with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission`of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less th,-+rR•)$IQ.�,Q00 and not more than $100, 000 for each such failur J � --- _ Siayr4ure AA London Monroe County Board June 16, 1993 Date KH-383 :.ndi iCL:l J:_�_,lication or Con-'ac:. of County -Commissioners, 500 Whitehead St.,Key West, FL O c_ rcani::atio:: 6 � l� � -- � ATTEST: DANNY L. KOLHAGE, CLERK ao o v.nec ncnr.• BY - Dep ty Clerk A-wo.iy's -5-p SUB -GRANT AGREEMENT EXHIBIT B CONTRACT ATTACHMENT: COMPLIANCE WITH LAW WHEREAS, all persons are subject to and must abide by all applicable local, state and federal laws; and WHEREAS, federal and state funding require inclusion in centracts of provisions for compliance with specified laws; now, therefore, the parties to the contract -of -which this document is a part agree as follows: The contractor shall comply with all laws to the extent applicable to the operations of contractor, including but not limited to: i. The National Environmental Policy Act of 1969 (42 USC §4321, et seq.) and 24 CFR, Part 58; 2. Executive Order 11988, Flood Plain Management; 3. Executive Order 11990, Protection of Wetlands; 4. The Endangered Species Act of 1973, as amended (16 USC §1531, et seq.); 5. The Fish and Wildlife Coordination Act of 1958, as amended (1'6 USC §661, et seq.); 6. The Wild and Scenic Rivers Act of 1968, as amended (16 USC §1271, et seq.); 7. The Safe Drinking Water Act of 1974, as amended (42 USC §300f, et seq.); 8. Section 401(f) of the Lead -Based Paint Poisoning Prevention Act, as amended (42 USC 54831(b), et seq.); 9. The Clean Air Act of 1970, as amended (42 USC 57401, et seq.); 10. The Federal Water Pollution Control Act of 1972, as amended (33 USC §1251, et seq.); 11. The Clean Water Act of 1977 (Public Law 95-217); 12. The Solid Waste Disposal Act, as amended by the Re- source Conservation and Recovery Act of 1975 (42 USC §6901, et seq.); 13. Noise Abatement and Control: Departmental Policy Implementation Responsibilities and Standards, 24 CFR Part 51, Subpart B; 14. Flood Disaster Protection Act of 1973 (PL 93-234); 15. Protection of Historic and Cultural Properties under HUD Programs, 24 CFR, Part 59; 16. Coastal Zone Management Act of 1972 (PL 92-583); 17. Executive Order 11593, "Protection and Enhancement of the Cultural Environment"; 18. Architectural and Construction Standards; 19. Architectural Barriers Act of 1968 (42 USC §4151); 20. Executive Order 11296, relating to Evaluation of Flood Hazards; 21. Executive Order 1128£, relating to the Prevention, Control and Abatement of Water Pollution; 22. Cost -Effective Energy Conservation Standards, 24 CFR, Part 39; 23. Section 8 Existing Housing Quality Standards, 24 CFR, Part 882; 24. Section 319 of Public Iaw 101-121, as provided in the "Governnentwide Guidance for New Restrictions on Lobbying;.Interim Final Guidance" published in the December 20, 1989, Federal Register, which prohibits recipients of federal contracts or grants from using appropriated ---funds for lobbying in connection with a grant or contract, and requires that each person who requests or receives a federal contract or grant, and their subrecipients, disclose lobbying undertaken with rion-federal funds; 25. Executive Order 11246; 26. Procurement requirements for Counties under Chapters 255, 274 and 287, Florida Statutes; and 27. Americans with Disabilities Act. Alxil 22. 1'M.l INI Nmina MONROE COUNTY, FLORIDA INSURANCE GUIDE TO CONTRACT ADMINISTRATION General Insurance Requirements for Suppliers of Goods or Servicei As a pre -requisite of the work governed, or the goods supplied under this contract (including the pre-sta*,ing of personnel and material), the Vendor shall obtain, at his/her own expense, insurance as specified in any attached schedules, which arc made part of this contract. The Vendor will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the Vendor. As an alternative, the Vendor may require all Subcontractors to obtain insurance consistent with the attached schedules. The Vendor will not be permitted to commence work governed by this contract (including pre - staging of personnel and material) until satisfactory evidence of the required insurancc has been furnished to the County as spccificd below. Delays in the commencement of work, resulting from the failure of the Vendor to provide satisfactory evidence of the required insurance, shall not extend deadlines spccificd in this contract and any penalties and failure to perform assessments shall be imposed as if the work commenced on the spccificd date and time, except for the Vendor's failure to provide satisfactory evidence. The Vendor shall maintain the required insurance throughout the entire tern of this contract and any extensions spccificd in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurancc has been reinstated or replaced. Delays In the completion of work resulting From the failure oft lie Vendor to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the Vendor's failure to maintain the required insurance. The Vendor shall provide, to the County, as satisfactory evidence of the required insurance, either: • Certificate of Insurance or • A Certified copy of the actual insurance policy. The County, at its sole option, has the riglit to request a certified copy of any or all insurance policies required by this contract. 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 County by the insurer. The acceptance and/or approval of -the Vendor's insurance shall not be construed as relieving the Vendor from any liability or obligation assumed under this contract or imposed by law. AdmiaWAlve kwuwim 04709.1 r 17 Alxil22, 199:1 1x1 !'diking WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT' BETWEEN MONROE COUNTY, FLORIDA AND _GUIDANCE CLINIC OF THE MIDbLE 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: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 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 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. Administrative In 6wiae WC2 N�7tM.1 82 Al"A 22, 1"3 Ix1 PriiMinll GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT 13E'1'WEEN MONROE COUNTY, FLORIDA AND _ariTUANCE r TjQTC OF THE MIDDLE 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 Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $500,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $250,000 per Person 3500,000 per Occurrence $ 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims tiled on or after the eftcctive dace 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. Adminislrnlive k*nKikm GL2 #4709.1 55 • A0122. 19M • IY1 Priltiev VEHICLE LIABILITY INSURANCE REQUIREMENTS Foil CONTRACT BE'I•WEEN MONROE COUNTY, FLORIDA AND GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. Recognizing lhat the work governed by this contract requires the use or vehicles, the Contractor, prior to the commencement orwork, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the lire orthc contract and includc, as a minimum, liability covcragc for, • Owned, Non -Owned, and Hired Vehicles • The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSI.) If split limits are provided, the minimum limits acceptable shall be: $ 100,000 per Person 5300,000 per Occurrence $ 50,000 Property Damage The Monroe County Board orCounty Conimissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. Adminiximlivo Ingnmicm VL2 04709.1 76 April 22, 1993 Ix1 Priming 0 PROFESSIONAL LIABILITY INSURANCE, REQUIREMENTS FOR CONTRAC71' BUIVEEN MONROIl; COUNTY, FLORIDA AND GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. Recognizin4 that the work governed by this contract involves the furnishing of advice or services of n professional nature, the Contractor shall purchase nerd maintain, throughout the life of the contract, Professional Liability Insuralrce which will respond to damages resulting from any claim arising out of the performance ofrrofessional services or any error or omission of the Contractor arising out of work governed by this contract. The minimum limits of liability shall be: $500,000 per Occurrence/$1,000,000 Aggregate AdnNnixrrnlivc 1tWnK1km PIW2 04709.1 73