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12/22/1993 AgreementBRANCH OFFICE 3117 OVERSEAS HIGHWAY MARATHON, FLORIDA 33050 TEL. (305) 289-6027 wannp 1. Ralbage 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 Attn: Mary Broske, Director Grants Management FROM: Isabel C. DeSantis, Deputy Clerk oJ' DATE: January 25, 1994 BRANCH OFFICE 8$820 OVERSEAS HIGHWAY PLANTATION KEY, FLORIDA 33070 TEL. (305) 852-7145 On December 22, 1993, the Board granted approval and authorized execution of a Contract in the amount of $133,708.34 by and between Monroe County and the Guidance Clinic of the Middle Keys, Inc., to provide Residential Level One Services as required in Health and Rehabilitative Services Contract #KH383. Inasmuch as Mary Broske will be following -through on this matter, she has been provided with three duplicate originals of the subject Contract executed by all parties. One set of documents are for her departmental records, one for David Rice, Chief Executive Officer of the Guidance Clinic of the Middle Keys, Inc., and one for the State of Florida Department of Health and Rehabilitative Services. Should you have any questions concerning the above, please do not hesitate to contact me. cc: County Attorney County Administrator w/o doc. Finance Director Aile t 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 Residential Level One Services 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 Grant Agreement No. KH383, incorporated herein by reference, an amount not to exceed a total of One Hundred Thirty -Three Thousand, Seven Hundred Eight and 34/100 Dollars ($133,708.34), during the term of this agreement. Payment shall be made upon submission of invoices supported 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 December 16, 1993 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 D��4s Residential Level t t Il.,) One Services. 4. RECORDS. The Clinic shall maintain appropriate records to insure a proper accountingrpfZal7 eNpdsp nd expenditures, and shall provide a clear financial audit trail to allow for full accountability of funds received from said Board. Access to these records shall be provided during weekdays, 8 a.m, to 5 p.m., upon request of the Board, 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 r r i 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. B. 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 C: only when expressed in writing and daily signed by the parties. IN WITNESS WHEREOF, the parties to this Agreement have caused their names to be affixed hereto by the proper officers thereof for the purposes herein expressed at _Ae,y l/i%S/ , Monroe County, Florida, on the day and year first written above. (SEAL) ATTEST: DANNY L. KOLHAGE, CLERK By �aj Deputy r BOARD OF COUNTY COMMISSIONERS OF MONR COUNTY, FLORIDA By yor/unairman THE GUIDANCE CLINIC OF THE MIDDLE KEYS, IN y/17 B y Witness IG46t Execittive Officer Y APPROVED AS TO FOP O LEG SlJFF 7 m April 22. 197.1 Im 1'rinling WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND GUIDANCE CLINIC OF THE MIDDLE 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 I?mployers' Liability Insurance with limits of not less than: $500,000 Bo( ily 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 Leiter 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 Incrniciicm WC2 1147Q7.1 82 April 22. 199-1 Isl 1'riouing GI:NrRAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND GUIDANCE CLINIC 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 $500,000 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 filed on or after the effective dale of ibis contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance ol'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. Adminimrntivc lrwnooHm Ci l.2 1/4709.1 55 April 22. 1993 r%1"11rin1inl; VEHICLE LIABILITY INSURANCE, REQUIREMENTS FOR CONTRACT BE VEEN MONROE COUNTY, FLORIDA AND GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. Recognizing that the work governed by this contract requires the use ofvchicles, the Contractor, prior to the comrtrencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: Owned, Non -Owned, and I lived 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 $300,000 per Occurrence $ 50,000 Property Damage The Monroe County Board of County Conunissioncrs shall be named as Additional Insured on all policies issued to satisfy the above requirements. Adminisirnliwe Iminifiion VL2 IM709.I 76 e ,a April 22. 1993 1sl Printing PROFESSIONAL LiAmu'I'Y INSURANCE, REQUIREMENTS FOR CONTRAC"1' BEIVEEN MONROE COUNTY, FLORIDA AND GUIDANCE CLINIC OF THE MIDDLE KEYS, INC Recognizing that the work governed by This contract involves the furnishing of advice or services of a professional nature, the Conlractor shall purchase and maintain, tlu-oughout the life of the contract, Professional Liability Insurance which will respond to damages resulting from any claim arising out of the pet of professional 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 Adminisiralivc liviniclion PR02 #4709.1 73 SUB —GRANT AGREE:% I;NT EXHIBI^1 A f STATE OF FLORIDA Contract No. KH383 r DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES STANDARD CONTRACT THIS CONTRACT is entered Into between the State of Florida, Department of Health and Rehabllitatty Service: hereinafter referred to as the department , and BOARD OF COUi4TY COMMISSIONERS, COUNTY. OFMONROE THE PARTIES AGREE: hereinafter referred to as the 'provider. I. THE PROVIDER AGREES: A. To provide services according to the conditions 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 &rtificatlon Regarding Lobbying form, Attachment If a Disclosure of Lobbying Activities form, to and Form " 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.Audlts and Records 1. To maintain books, records, and documents (Including electronic storage media) in accordance with generally 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 financlal and compliance audit to the department as specified In Attachment U anc to ensure that all related party transa' ct o s arc disclosed to the auditor. Additional audit requirement; 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.Retentlon of Records 1. To retain all client records, financial records, supporting documents, statistical records, and an Y other documents (including electronic storage media pertinent to this contract for a period of five 5 ) after termination of this contract, or V an audit years been Initiated and audit flndings 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 E as long as records are retained, whichever is later. E. Monitoring 1. To Iprovide reports as specified 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 G 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 (allure 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. F.lridem`nification 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 tortlous 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-insurar .program established and operating under the laws the State of Florida. The department reserves the ric to require additional Insurance as specified Attachment I where appropriate. 2. If the provider is a state agency or subdivision defined by section 768.28, Florida Statutes, t provider shall furnish the department, upon re ue written verification of liability protection in accordan with section 768.28, Florida Statutes. Nothing here shall be construed to extend any party's Ilabil beyond that provided in section 768.28, Flork r Statutes. H.Safeguarding Information Not to use or disclose any information concerning recipient of services under this contract for any purw not In conformity with the state regulations and fader regulations (45 CFR, Part 205.50), except upon writte consent of the recipient, or his responsible parent c guardian when authorized by law. I. Client Information To submit management, program, and client Identifiab data, as specified by the department in Attachmer I J. Assignments and Subcontracts 1. To neither assign the responsibility of this contract t another party nor subcontract for any of the wor 1 contemplated under this contract without prior wrote approval of the department. No such approval by th department of any assignment or subcontract shall b deemed In any event or In any mariner to provide fc the Incurrence of any obligation of the department 1: addition to the total dollar amount agreed upon in thi contract. All such assignments or subcontracts sha be subject to the conditions of this contract (excep, Section I, Paragraph 0.1.) and to any conditions c 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 payment: from the department In accordance with sectlo 287.0585, Florida Statutes. Failure to pay within sever (7) working days will result in a penalty charges against the provider and paid to the subcontractor it the amount of one-half of one (1) percent of the amount due, per day from the expiration of the perlocr allowed herein for payment. Such penalty shall be Ir 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 Ret* of•Funds' 1. To return to the department any overpayments due to unearned funds or funds disallowed pursuant to the terms of this contract that were disbursed to the provider by the department. The provider shall return any overpayment to the department within forty (40) calendar days after either discovery by the provider, or notification by,the department, of the overpayment. In the event that the provider or its Independent auditor discovers an overpayment has been made, the provider shall repay said overpayment within forty (40) calendar days without prior notification from the department. In the event that the department first discovers an overpayment has been made, the department will notify the provider by letter of such a finding. Should• repayment not be made In a timely manner, the department will charge Interest of one (1) percent per month compounded on the outstanding balance after forty (40) calendar days after the date of notification or discovery. 2. For state universities, should repayment not be made within forty (40) calendar days after the date of notification, the department will notify the State Comptroller's Office who will then enact a transfer -of the amounts owed from the state university's account to the account of HRS. M. Incident Reporting 1. Client Risk Prevention If services to clients will be provided under this contract, the provider and any subcontractors shall, In accordance with the client risk prevention system, report those reportable situations listed in HRSR 215-6, Paragraph 5. in the manner prescribed In HRSR 215-6 or district operating procedures. 2. Abuse, Neglect and Exploitation Reporting In compliance with Chapter 415, Florida Statutes, an employee of the provider who knows, or has reasonable cause to suspect, that a child, aged person or disabled adult is or has been abused, neglected, or exploited, shall immediately report such knowledge or suspicion to the central abuse registry and tracking system of the department on the single statewide toll - free telephone number (1-800-96ABUSE). N.Transportation Disadvantaged If clients are to be transported under this contract, the Provider will comply with the provisions of Chapter 427, Florida Statutes, and Rule Chapter 41-2. Florida Administrative Code. The provider shall submit to the department the reports required pursuant to Volume 10, Chapter 27, HRS Accounting Procedures Manual. 0-Purchasing I. PRIDE It Is expressly understood and agreed that any articles which are the subject of, or are required to carry out this contract shall be purchased from Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE) Identified under Chapter 946. Florida Statutes, in the same manner and under the procedures set forth In subsections 946.515(2) and (4), Florida Statutes. For purposes of this contract, the person, firm, or other business entity carrying out the provisions of this contract shall be deemed to be substituted for the department insofar as dealings with PRIDE. This clause Is not applicable to any subcontractors, unless otherwise required by law. An abbreviated list of products/services available from PRIDE may be obtained by contacting PRIDE's Tallahassee branch office at (904) 487-3774 or SunCom 277-9774. 2. Procurement of Products or Materials with Recycled Content Additionally, it Is expressly understood and agreed that any products or materials which are the subject of, or are required to carry out this contract shall be procured in accordance with the provisions of section 403.7065, Florida Statutes. P. Civil Rights Requirements 1. Provider Assurance The provider assures that it will comply with: a. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq., which prohibits discrimination on the basis of race, color, or national origin. b. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap. C. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex d. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age. e. Section 654 of the Omnibus Budget Reconciliation Act of 1981, as amended, 42 U.S.C. 9a49, which Prohibits discrimination on the basis of race, creed, color, national origin, sex, handicap, political affiliation or beliefs. f. The Americans with Disabilities Act of 1990. P.L 101- 336, which prohibits discrimination on the basis of dlsabillty and requires reasonable accommodation for persons with disabilities. g. All regulations, guidelines, and standards as are now or may be lawfully adopted under the above statutes. The provider agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from funds provided through this contract, and that it is binding - upon the provider, its successors. transferees, and assignees for the period during. which services are provided. The provider further assures that all contractors. 3 /. :: J subcontrbctors, subgrantees, or others with whom it arranges to provide services or benefits to participants or employees In connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. 2. Compliance Ouestionnaire In accordance with HRSM 220-2, the provider agrees to complete the Civil Rights Compliance Questionnaire, HRS Forms 946 A and B, if services are provided to clients and If 15 or more people are employed. O.Requirements of Section 287.058, Florida Statutes 1. To submit bills for fees or other compensation for services or expenses in sufficient detail for a proper pre -audit and post -audit thereof. 2. Where applicable, to submit bills for any travel expenses In accordance with section 112.061, Florida Statutes. The department may, when specified In Attachment I - establish rates lower than the maximum prov in section 112.061. Florida Statutes. 3. To provide units of delfverabies, including reports, findings, and drafts as specified in Attachmnt I , to be received and accept y t e contract manager prior to payment. 4. To comply with the criteria and final date by which such criteria must be met for completion of this contract as specified in Section III, Paragraph A.2. of this contract. S. To allow public access to all documents, papers, letters, or other materials subject to the provisions of Chapter 119, Florida Statutes, and made or received by the provider in conjunction with this contract. It Is expressly understood that substantial evidence of the provider's refusal to comply with this provision shall constitute a breach of contract. R. Withholdings and Other Benerds 1. The provider is responsible for Social Security and Income Tax withholdings. 2. The provider is not entitled to state retirement or leave benefits except where the provider Is a state agency. 3. Unless justified by the provider and agreed to by the department in Attachment I, Section D , the department will not furnish services of suppo (e.g., office space, office supplies, telephone service, secretarial, or clerical support) normally available to career service employees. S. Sponsorship As required by section 286.25, Florida Statutes, If the provider is a nongovernmental organization which sponsors a program financed wholly or in part by state 4 funds, Including any funds obtained through th contract, it shall, in publicizing, advertising or describin the sponsorship of the program, state: 'Sponsored C —BOARD QLLO TY COMM_TSSTONER COUNTY OF MONROE PROVIDER and the State of Florida,- Department of Health arx Rehabilitative Services'. If the sponsorship reference Is i. written material, the words 'State of Florida, Departmnr of Health and Rehabilitative Services' shall appear in th same size letters or type as the name of the organization. T. Discounted Invoices To allow a N A percent discount on selectee Invoices which are paid In less than N/A days. Tht provider must clearly mark any Invo oe wn t e discoun If It is to be allowed. The provider may submit Invoice: with or without the negotiated discount terms. The department shall comply with subsection 215.422(4) Florida Statutes, If a discounted Invoice Is offered. U. Final Invoice The provider must submit the final invoice for payment tc the department no more than 45 days' after the contract ends or Is terminated; ii' a provider fails to do so, all right to payment is forfeited and the department will not honor any requests submitted after the aforesaic time period. Any payment due under the terms of this contract may be withheld until all reports due from the provider and necessary adjustments thereto have been approved by the department. V. Use Of Funds For Lobbying Prohibited To comply with the provisions of section 216.347, Florida Statutes, which prohibits the expenditure of contract funds for the purpose of lobbying the Legislature or a state agency. 11. THE DEPARTMENT AGREES: A. Contract Amount ' ' To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $ 392 250 , subject to the availability of !, fun s.I he tate o on a s performance and obligation to pay under this contract Is contingent upon an annual I appropriation by the Legislature. The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract, B. Contract Payment Pursuant to section 215.422, Florida Statutes, the voucher authorizing payment of an invoice submitted to the department shall be filed with the State Comptroller not later than twenty (20) days from the latter of the date a proper Invoice Is received or receipt, Inspection and 3 approval of the goods or services, except that in the case I of a bona fife dispute the voucher shall contain a statement of the dispute and authorize payment only in the amount not disputed. The date on which an Invoice is e deemed received Is the date on which a proper Invoice Is E first receNod at the place designated by the department.'!, Invoices which have to be returned to a vendor because of vendor preparation errors will result In a delay in the payment. The invoice payment requirements do not start until a property completed Invoice, as defined In Rule Chapter 3A-24, Florida Administrative Code, is provided to the department. Approval and inspection of goods or services shall take no longer than five (5) working days unless the b(d specifications, purchase order or contract specffles otherwise. Such approval Is for the purpose of authorizing payments and does not constitute a final approval of services purchased under this contract. A payment Is deemed to be Issued on the first working day that payment Is available for delivery or mailing to the provider. If a warrant in payment of an Invoice is not Issued within forty (40) days, or thirty-five (35) days for health care providers as defined in Rule Chapter 3A-24, Florida Administrative Code, after the receipt of the Invoice and receipt, inspection, and approval of the goods and services, the department shall pay to the provider, in addition to the amount of the invoice, interest at a rate of one -(1) percent per month calculated on a daily basis on the unpaid balance from the expiration of such forty (40) day period, or thirty-five (35) day period for health care providers as defined in Rule Chapter 3A-24, Florida 'Administrative Code, until such time that the warrant is issued to the provider. The temporary unavailability of funds to make a -timely payment due for goods or services does not relieve the department from this obligation to pay Interest penalties. .Vendor Ombudsman A Vendor Ombudsman has been established within the Department of Banking and Finance. The duties of this Individual inchi de acting as an advocate for vendors who may be experiencing problems in obtaining timely payment(s) from a state agency. The Vendor Ombudsman may be contacted at (904) 488-2924 or by calling the State Comptroller's Hotline, 1-800-848-3792. II. THE PROVIDER AND DEPARTMENT MUTUALLY AGREE: L Effective Date 1. This contract shall begin on June •21. 1993 or on the date on which the contract has been signed by both parties, whichever is later. 2. This contract shall end on June 20, 1994 3.Termination 1. Termination at Will This contract may be terminated by either party upon no less than thirty (30) calendar days notice, without cause, unless a lesser time Is mutually agreed upon by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. 2. Termination Because of Lack of Funds In the event funds to finance this contract become unavailable, the department may terminate the contract upon no less than twenty-four (24) hours notice In writing to the provider. Said notice shall be delivered by certified mall, return receipt requested, or In person with proof of delivery. The department shall be the final authority as to the availability adfunds. 3. Termination for Breach Unless the provider's breach Is waived by the department In writing, the department may. by written notice to the provider, terminate this comact upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or In person with proof of delivery. If applicable, the department may employ the default provisions In Chapter 13A-1.006(4), Florida Administrative Code. Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this contract. The provisions herein do not limit the department's right to remedies at law or to damages. C.Notice and Contact 1. The name, address and telephone number of the contract manager for the department for this contract Is: JAMES J. VENGALIL 401 N.W. 2nd Ave., Miami, Fl. 33128 2. The name, address and telephone number of the representative of the provider responsible for administration of the program under this contract Is: MARY BROSKE_ Grants -Management Department -)IUU College Romu, 0.1. Key West, FL 33040- (305) 292-4515 3.In the. event that different representatives are designated by either party after execution of this contract, notice of the name and address of the new representative will be rendered in writing to the other party and said notification attached to orbinals of this contract. D.Renegottation or Modification 1. Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly signed. The parties agree to renegotiate this contract If federal and/or state revisions of any applicable laws, or regulations make changes In this contract necessary. 2. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently identftiod in the department's operating budget. A Contract No KH 383 E. Name, Mailing and Street Address of Payee 1. The name (provider name as shown on page t of this contract) and malling address of the off clal payee to whom the payment shall be made: BOARD OF COUNTY COMMISSIONERS COUNTY OF MONROE 5100 College Road, S.I. KEY WEST, FL 33040 2. The name of the contact person and street address where financial and administrative records are maintained:' NARY BR05KE GRANTS 'MANAGEMENT DEPARTMENT 5100 COLLEGE ROAD, S . T _ KEY WEST, FL 33040, _ (305) 292-4515 F. All Terms and Conditions Included This contract and its attachments as referer, ( Attachment I - Edibits A-F Attwh ent II - Financial & CoTliance Audit Attachment III - Certification regarding lobbyir contain aff the terms and condakm agreed upon } parties. P oV£ S T(? F^ NO EGA ' F�:��^ By Mornoys O=9 Date IN WITNESS THEREOF, the parties hereto have caused this rit% page contract to be executed by their underslgr officials as duly authorized. PROVIDER BOARD OF COUNTY COMMISSIONERS COUNTY OF MANRDE SIGNED BY: NAME:Jvrcje' London TITLE: Mayor/Chairman DATE: June 16, 1993 STATE OF FLORIDA, DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ,SIGNED BY: 4 �+ NAME: Anita M. '4 TITLE:Jtnr District Administrator DATE: FEDERAL ID NUMBER (or SS Number for an individual): VF11571165inn1 STATE AGENCY 29 DIGIT SAMAS CODE: ----------------------------- PROVIDER FISCAL YEAR ENDING DATE: 06/30/1994 CONTRACT IS NOT VALID UNTIL SIGNED AND DATED BY BOTH PARTIES ATTEST: DANNY L. KOLHAGE, CLERK By De ty rk ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES ATTACHMENT I A. Services to be Provided: The provider agrees to provide alcohol and other drag-' abuse outreach, intervention and treatment services to their clients in the South Florida area, particularly those individuals whose substance abuse •and subsequent behavioral conditions were exacerbated by or resulted from Hurricame Andrew. These services are specifically mentioned in Exhibit - B and B - 1. _.. , B..,•_ - Manner of Service Provision: 1. The provider will comply with Chapter 394, Part 4 and Chapter 397 of Florida Statutes and Chapters 10 a 14.002, .010, .014, .017. of Florida Administrative Code and pages 3-7 through 3-37 of the HRS Guide to performance contracting for Alcohol, Drug Abuse and Mental Health Services. 2. Provider will screen each patient at the point of original admission for HIV, STDs, and TB. Documentation will be included in patient record. 3. Provider will work towards the ultimate goal of effective case. management 'and- treatment services so as to effect a continuum of care for the target population; initi.--- ated with detoxification, followed by intensive outpatient, day treatment, residential or supportive outpatient as is individually appropriate, provision of relapse prevention services and for a small proportion, readmission following relapse for pharmacologic maintenance. 4. Provider -will expand outpatient and pharmacologic maintenance service as necessary to implement a continuum of care. - 5. The provider will coordinate, as relevant, with the Center -for Substance Abuse Prevention's (CSAP) high risk ­ youth activities, including Community Partnership Agencies, High Risk Youth Programs, the Urban Youth Campaign, Teen Drinking Prevention Programs as well as other relevant prevention and media efforts to help grass roots activities that are directed toward prevention of further increases in drug use among younger age groups. In particular, activi- ties pursuant to this cooperative Agreement should'be coor- .dinated with CSAP funded activities that are being initiated' ....in south Dade in response to the devastation and, after ef- fects of Hurricane Andrew. 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 provider, each provider will: an award is obligated -to a 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: ii 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 Ithese 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 progr m operations and the provision of informa- tion concerning Effe 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 $ ��y�T2�-- 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-I�and 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: i� (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. rata 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 sup porting pporting 11 Payment Schedule Month- Type of Request July Advance August Advance September Reimbursement October Reimbursement November Reimbursement December Reimbursement January Reimbursement February Reimburiment March Reimbursement April Reimbursement May Reimbursement June Reimbursement 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 Final Inv. Final - May Actual Expenditure Date(s) Expenditure June Actual Expenditure specified Report 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. not be made retroactive can - 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. 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,pimilar 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,, 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 accordance with.section 112.061, Florida Statutes, and emust be certified on form C-676C (State of Florida Authorization to incur Travel Expense) with a copy of the prram 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 199011, 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 Tor 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 cidmit must 'be obtained from the CIU. 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. ii 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 14 15 of such treatment who is denied admission to the program ma' the .basis of lack of capacity of the program, to refer the.. individual to.another provider of TB services. 12._ Any provider must make available to individuals; 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 admissiow for persons who are first time alcohol and substance abuse treatment admissifts, 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 through 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: 0 1. A final expenditure report, Exhibit - E,, is to be submitted.no later than 45 days following expiration of the contract. T 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 --------------------- GENCY: MONROE COUNTY CONTRACT # KH 383 BUDGET PERIOD: REVISION # 6/21/1993 TO 6/20/1994' -------------------------- YPE OF SERVICE -------------- --- CENTRAL INTAKE UNIT -------------- (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 $86,987.00 $86,987.00 g. Insurance h. Operating Supplies/Expenses i. Food Services J. Other Total Expenses: $86,987.00 $86,987.00 Total Personnel/Expenses: 3. Administrative Costs c ) 4. Capital Expenses GRAND TOTAL: __4 $86,987.00 r ALCOHOL,. DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A ===a=aasaaasaassoaaasaaasaaaa=aoaaassaaassassasssssssassaasssse3sasssssss AGENCY: MONROE COUNTY /Guidance Clinic of CONTRACT # KH 383 Middle BUDGET PERIOD: 6/20/1993.toe6/21/1994eys Inc REVISION # =====aaaa-==-===a=oa=aaaaaaaaazaa3aaaassaaaarsoaaasaasaaaaa3sas=a=ssaasaa TYPE —OF SERVICE CENTRAL INTAKE UNIT (SUBCONTRACT) ------------------ 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 (Janitorial, exterminator, etc.) g. Insurance h. Operating Supplies/Expenses i. Food Services J. Other Total Expenses: Total Personnel/Expenses: 3. Administrative Costs ( 19.676% ) 4. Capital Expenses GRAND TOTAL: $ 8,539 3,477 12,016 3,353 5,652 680 1,600 39,659 681 1,658 2,373 55,656 67,672 13,315 6,000 $ 86,987 12,016 55,656 67,672 13,315 6,000 • • $ 86, 987 ssnseumssnssmn 1 LAhibil' A - 1 LINE ITEM BUDGET NARRATIVE GUIDANCE CLINIC OF THE MIDDLE KEYS, INC: CENTRAL INTAKE UNIT PERSONNEL Salaries Program Director Discharge Planner $1,269 Substance Abuse Tech. 624 4,056 Nurse - RN Records Clerk 21184 406 Total Salaries 8,539 Fringe Benefits Social Security 653 Pension Health Insurance 512 1,930 Workmen's Compensation 1 27271 Florida Unemployment Total Fringe Benefits 31477 Total personnel 12,016 EXPENSES Building Occupancy Utilities Repairs & Maintenance 2,457 555 Janitorial & Household Supplies 341 Professional Services Medical Coverage Linen Services 4,519 Audit 383 383 750 Travel, ' ' 680 Food 2,373 Medical And Pharmacy Medicine & Medical Supplies Lab & Testing Fees (1) 721 Pharmacy Consultant 38,674 Personal Items 138 138 Insurance Comprehensive Professional Liability 481 200 • lS EXHIBIT A - 1 LINE ITEM BUDGET NARRATIVE l GUIDANCE CLINIC OF THE MIDDLE KEYS, INC ' CENTRAL INTAKE UNIT - - Operating Stipplie$ - Office Supplies and Expenses Educational. 235 Postage 141 Telephone 202 Printing 687 License Fees 72 Data Prooessing 22 Administration (2) 299 13,315 Renovations Computer Equipment 61000 1,600 Total Expenses Grand Total 74,971 $86,987 Average Cost per Day $238.32 FOOTNOTES: (1) Lab and testing fees are determined on ad Tuberculin PPD skin test to approx. ministering It is estimated that approximately 29 tely 858 d®tox admissions. result as positive. pproxinaately 219 (25$) of those tested will will receive x-ray andnsputumce ntesting.ified thThaoco®tve status clients outline below: is determined as ..X-ray testing 6$64.90 x 219 Throat Cultures 1$92.10 X 219 14,214 Skin testing Q$5.00 x 858 20,170 of) Administration -expense in all 4�290 the administrative staff which comprises the Chief 8 Programs includes costs Officer, Rick Manager, Clinical Director and the c o utive Department. A counting o 9- ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A 20 AGENCY: MONROE COUNTY CONTRACT # KH 383 BUDGET PERIOD: REVISION # 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 g. Insurance h. Operating Supplies/Expenses i. Food.Services J. Other Total'Expenses: _ Total Personnel/Expenses: 3. Administrative Costs 4. Capital Expenses GRAND TOTAL: i $42,813.00 $42,813.00 $42,813.00 $42,813.00 $42,813_00 ___ $42i813_00=_ 2-1 ALCOHOL, DRUG ABUSE AND MENTAL, HEALTH SERVICES HURRICANE ANDREW - CENTER -FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A sansasssHaasaaassaasssaassssasasaaasaaaasasssssssasssssassssssssssasssss AGENCY: MONROE COUNTY /Guidance Clinic of the Middle Keys, Inc, CONTRACT # KH 383 BUDGET PERIOD: 6/21/1993 to 6/20/1994 REVISION a-aaoaaoa'==aa===aasasssoaaasa_saaaaasassssasssaaaaaasiaasas=aaasssass TYPE OF SERVICE OUTPATIENT SERVICES (SUBCONTRACT) TOTAL 1. Personnel:------------------------------- • b• a aries Fringes $ 27,650 7,978 Total Personnel: .Z• Expenses:- ' 35,6.28 35,628 a• b• Building Occupancy Professional Services 983 c• Travel 250 d• Equipmgnt Costs 100 e• Medical and Pharmacy •f• Subcontracted Services g• (Janitorial, exterminator, etc•) Insurance h• i• Operating Supplies/Expenses 714 Food Services 459 459 J. Other Total Expenses: 2,506 2,506 Total Personnel/Expenses: 38,134 3• Administrative Costs ' 38,134 ( 12.270% ) 4• Capital Expenses 4,679 4,679 GRAND TOTAL: 42,813 42,813 sssssssssssaiss ,,,•.,. GUIDANCE CLINIC OF THE MIDDLE KEYS, INC-. OUTPATIENT SERVICE PERSONNEL Salaries Substance Abuse Counselor Receptionist $27,000 650 Total Salaries ' _ Fringe Benefits 27, 650 Social Security Pension 2,115 Health Insurance 1,659 Workmen's Compensation Florida 3,898 Unemployment 210 96 Total Fringe Benefits Total Personnel 7,978 - Building Occupancy 35,628 Utilities Repairs & Maintenance 728 Janitorial & Household Supplies 165 Professional Services 90 Audit Travel 250 Insurance 100 Comprehensive Professional Liability 142 Operating Supplies and Expenses 572 Office Supplies. Educational 43 Postage 77 Telephone 37 Printing 127 Data Processing 15 Administration 160 4,679 Total Expenses ' Grand Total 7,185 Average Cost per Hour $42,813 $41.81 ' 2Z 23 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 BUDGET PERIOD: 6/21/1983 to 6/20/1983 REVISION # ..TYPE OF_______________________________________________________ aria== •• SERVICE DETOXIFICATION - (SUBCONTRACTED) 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 g. Insurance h. Operating Supplies/Expenses i. Food Services J. Other Total Expenses: Total Personnel/Expenses: 3. Administrative Costs ( i 4. Capital Expenses GRAND TOTAL: $92,000.00 $92,000.00 $92,000.00 .$92,000.00 <3- f-�--- $92,000.00 $92,000.00 • 1 rt, 2� ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER -FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A a=a.aaaaasaaaassaassasasasaaaaaaaasssassassaasssssaassaasasssasssssssssF AGENCY: MONROE COUNTY/Guidance Clinic of thCONTRACT # KH 383 Middle Keys, Inc. REVISION # BUDGET PERIOD: 6/21/1993 to 6/20/199* aoo=asa=aasssaaasaaxaaaaasaaa=aaassaaaassasssasssasassssassaaaaasssssssx TYPE -OF -SERVICE -DETOXIFICATION (SUBCONTRACT) 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.) 9• Insurance... h• Operating supplies/Expenses i• Food Services J- Other Total Expenses: Total Personnel/Expenses: 39 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 31,134 45,662 45,662 76,796 76,796 15,204 15,204 92,000 e 92,000 sssssassssssss t, ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER -FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A a=a.aaaaasaaaassaassasasasaaaaaaaasssassassaasssssaassaasasssasssssssssF AGENCY: MONROE COUNTY/Guidance Clinic of thCONTRACT # KH 383 Middle Keys, Inc. REVISION # BUDGET PERIOD: 6/21/1993 to 6/20/199* aoo=asa=aasssaaasaaxaaaaasaaa=aaassaaaassasssasssasassssassaaaaasssssssx TYPE -OF -SERVICE -DETOXIFICATION (SUBCONTRACT) 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.) 9• Insurance... h• Operating supplies/Expenses i• Food Services J- Other Total Expenses: Total Personnel/Expenses: 39 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 31,134 45,662 45,662 76,796 76,796 15,204 15,204 92,000 e 92,000 sssssassssssss t, • a-.aaa LIj L A. !1 — 1 LINE ITEM BUDGET NARRATIVE ' GUIDANCE CLINXC OF THIS MIDDLE KEYS, INC. DETOXIFICATION PERSONNEL salaries Program Director. Discharge Planner $2,961 Substance Abuse Tech. Nurse - RN 1,456 13,520 Records Clerk 5,460 946 Total Salaries 24,343 Fringe Benefits Social Security Pension 1,86Z Health Insurance 1,461 Workmen,$ Compensation 2r373 Florida Unemployment 779 316 Total Fringe Benefits 6,791 Total Personnel 31,134 Building Occupancy Utilities Repairs & Maintenance 4,915 Janitorial & Household Supplies 1, 110 110 682 Professional Services Medical Coverage Linen Services 9,038 Audit 766 ison 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 a 282 Telephone 404 1,374 2 5' EXHIBIT A - 1 LINE ITEM -BUDGET NARRATIVE GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. DETOXIFICATIOI7 printing License Fees 144 Data Processing 44 Client Transportation, 598 Administration• 14,722 15,204 Total Expenses 60,866 Grand Total $92,000 Average Cost Per Day $126.03 r 1 27 ALCOHOL, DRUG'ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUASTANCE 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 - Total Expenses:- $160,450.00 $160,450.00 Total Personnel/Expenses: 3. Administrative Costs 6.232$ ) 10,000.00 10,000.00 4• Capital Expenses GRAND TOTAL: -_170__450 _00 -- 170i450 00 2 9 ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR TREATMENT SUBSTANCE ABUSE COOPERATIVE AGREEMENT LINE ITEM BUDGET EXHIBIT - A =aaa=aasa=asaaa=asasaaasssaaa=aaaassaasa,asaassssasassssasssssszass:sssss AGENCY: MONROE COUNTY /Life Center FoundatiorCONTRACT BUDGET PERIOD: 6/21/93 to 6/20/94 REVISION # KH 383 ====aaa-a-a=zsaaa=aaa===a==asaaasasssasa3aasaasaaaaassaaaas TYPE OF SERVICE RESIDENTIAL ----------LEVEL ------------------ .---"----- 1(SUBCONTRACT) 1. Personnel: --------------- nnel: --------- TOTAL a• Salaries b• Fringes $ 69,500 15,985 Total Personnel: •Z• Expenses: 85,485 85,485 a• Building Occupancy b• Professional Services 42,610 c• Travel d• Equipment Costs 3,075 e• Medical and Pharmacy f• 2,100 Subcontracted Services (Janitorial, exterminator, etc.) 9• Insurance h• Operating supplies/Expenses i• Food 1,200 Services j• Other 8,260 16,640 1,080 Total Expenses: . Total Personnel/Expenses; 74,965 74,965 3• Administrative Costs 160,450 �- 160,450 ( ) 4• Capital Expenses -0- GRAND TOTAL: .160, 450 160,450 • s..=.sss...:s. EXHIBIT A - 1 LINE ITEM BUDGET NARRATIVE LIFE CENTER FOUNDATION RESIDENTIAL LEVEL I PERSONNEL Salaries Project Director (70% FTE) Counselor (1) Clerical (1) Total Salaries Fringe Benefits Social Security (7.65%) Health Insurance (10.85%) Workman's Compensation (3.2%) Florida Unemployment (1.3%) Total Fringe Benefits Total Personnel EXPENSES Building Occupancy Building Rental Utilities Repairs & Maintenance Janitorial & Household Supplies Equipment Costs Equipment Rental Equipment Repair & Maintenance Travel Client Hygiene Client Food Insurance Operating Supplies/Expenses Office Supplies Automobile Repair & Maintenance License & Permits Telephone, FAX - Total Expenses Sub Total ADMINISTRATION Administration Grand Total $24,500 27,000 18,000 69;500 5,317 7,541 2,224 903 15,985 85,485 30,000 4,200 5,790 2,620 630 1,470 3,075 1,080 16,640 1,200 1,040 4,060 160 3,000 74,965 $160,450 $' 160-01450 - I EXHIBIT - B - DETAILS OF SERVICES PROVIDED CONTRACT M NAVE of PROVIDER AGENCYr_MONROE COUNTY CONTRACT PERIOD: 6/2t193/2c TYPE OF SERVICE I OF BEDS I #OF BED I COST PER I #OF SLOTS ( COST PER I TOTAL �•••■■s■■■■:a■■s■ss.::�su�■■�■:■s:■:�ss■s■■■■ssa■u■■■�:■s■■:ussss:a■.■■,:us■.aassss■■■ DAYS I BED DAY I I SLOT I CAST OUT PATIENT ........................................... ..............i...-••-----•-..i...............i..........._...i............. 1,024 ( 41.81 I -E 4 2 81- INTENSIVE..............................OUPATIENT I I kESIDENTIALLEVEL i .......................... 1 •••••••••.•••••••••••-••-.•- ..............................1 .......... 3,650 ..............i...............i....---••------i---.......---..i.............. I 46.70 ' 7 0 , 4_S C RESIDENTIALLEVEL 2 I .......................................... I CHILD CARE ................................. I I ........................................................ DETOXIFICATION...........!.. 2 I ...................................... 1 ............................................................................ 730 1 2 6.0 3 0 C RESOURCE i REFERRAL .._......_..i.............. . ...... . CENTRAL INTAKE .............................365 -...i ...---..I.....3.............2386 5 3 2.................................................... ........-••............................................: , 8 7 ADOLESCENT RECEIVING I ....................................................... I .. . I I STD SCREENING I ..................... I ..............:................................I.............. I I I GRAND TOTALS ........................................................... ................... ................. : $392,250. ...... co mob N ' v 01 o . - C9 its • w . o o c N w W o i ON vh %o cn 00 N 41O0►0%N O 1 - 0 ID d' 0rt Mb'to N N tnn(yDrn� u �. n - NN" N` 0 N T It � r N O crt '~ s a rt fD ' rt tM" N• ON aR >R � 1 da OD 3Z ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES . HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT EXHIBIT SERVICE DESCRIPTION ' CENTRAL INTAKE UNIT Agency Names MONROE COUNTY GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. Address:. 3000. 41st Street, Ocean, Marathon, FL Director/Coordinator: David P. Rice, Ph.D., Chief Executive OfficerSus' Hor Phone Number: (305) 743an9491n' Program Director Days/Hours of Operation: 24 hours, 365 days per year Bed Capacity: P02ulation Groups Served: Adults in need of substance abuse serviced 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 i (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 the CIU also include counselingontheat 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. 3tl 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 Tickets- a)- Name of service . Program-. --_Adult- or- child 18 & under C) Client name and identification number d) Service date AUDIT DOCUMENTATIONS Client Medical Record: a) Name of service b) Client name and identification number c) Service date TOTAL BUDGET: �� S 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 GUIDANCE CLINIC OF THE MIDDLE KEYS, INC Address: 3000 41st St., Ocean, Marathon, FL Director/Coordinator: David P. Rice Ph.D ive Of f Deborah Harrison, Ph.D., Clinical tDirecctorce; 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: 96 Population Groups Served: Adults with substabce abuse diagnosis Staffing - # of FTE's etc. : (One Counselor to no more than i35 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. :. 3 6' SERVICE DOCUMENTATION: Service Ticket: a)' 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: $ )7 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 Address. GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. 3000 41st St., Ocean, Marathon, FL Director/Coordinator: David P. Rice, Ph.D. , Chief Susan Horn, Program Director Executitre Officer, Phone Number: (305) 74379491 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 Utii ization Management System: Substance Abuse Treatment iPrograms inin this project will report to the CIU the vacanciestavailable 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) 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: q 2 OO u 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: Phone Number:liam (305)�292b1774irector Bed Capacity: / O Po ulation Grou s'Served: Individuals recovering from addictions, su s ance abuse, who rest a in Monroe County, FL, as referred by CIs Staffing - # of FTEIs providing Direct Care:1 Residential Stay: Maximum of 60 days in residential care. Description of Services To be Provided: Capacity Utilization Management System: Substance Abuse Treatment Programs this project will report participating in to the CIU the vacancies available for clients on the waiting list so that they can enter Programs at the earliest opportunity. Participating Substance adolescents Abuse Treatment programs for 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 c) Service ` Identification Number Date ' AUDIT DOCUMENTATION: Client Medical Record: a) Name of Service b) Client Name and c) Service Date Identification Number s U46- TOTAL BUDGET: /9�n7N• /O 000 ���ND 7'o TAL : / 70, �'50 �►qI y aa�o m C n > O o e « v w M • u » rn p C A 1 9� O Hum � A °> o; s p co too in g-4 >� yv IIp��yg n� q QOK to I I m A'tCsfO rA > ZCZ .n I y e {�• to '.� O O j j I I p^ riot 70 C Z 1 ' I to 40 40- A m M H 03 -� IV «66" « » » « Z n » « �' p O O to C I��0��� O ' } f x �0 0 �K O _ Q Z m o Z EXHIBIT C-1 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. 3 . 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. 3w 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 these difficulties were overcome (or still exist),, as well as the need for any State, CSATr or consultant technical assistance. II. 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 - � ALCOHOL, DRUG ABUSE AND MENTAL HEALTH -SERVICES .HURRICANE ANDREW -..CENiER 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 Details of Services Provided As needed for amendments Monthly Expenditure Report and Reimbursement As per the Request along with back-up Schedule in documentation ATTACHMENT C.jt (Pages 8-9) 1 Monthly Progress Report 30 days after, the end of each month of service 2 Final Expenditure Report for CSAT Substance No later than Abuse Treatment Cooperative 45 days following Agreement (Exhibit E) expiration of Contract. 2 w ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT COOPERATIVE AGREEMENT FINAL EXPENDITURE REPORT EXHIBIT - E ---•-a.ao=aaa3==a.aaa---- AGENCY: CONTRACT # BUDGET PERIOD: REVISION # TYPE OF SERVICE----------------------===a--=aaaaaas=aasaaa==o ===a= BUDGETED EXPENDED BALANCE AMOUNT TO DATE 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 (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: aaaaaaaaQQ aaaaaamma aaa=aaaa= SPECIAL REQUEST EXHIBIT - F CONTRACT # 1c N 3�3 ONE-TIME NON -RECURRING EXPENDITURE ADVANCE Pursuant to Attachment I, paragraph C.1.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 amountof$ to be used for the purpose of --------------------------- PROG n /� 1�:-+ lj SIGNATURE --------------------------- TITLE; - ---------------------------- DATE • Zs FINANCIAL AND COMPLIANCE AUDITS ATTACHMENT This attachment is applicable, if the provider or grantee, hereinafter referred to as, is a nonprofit organization, or for -profit organization. _ any goverment entity, PART 1: SINGLE AUDiT This part,is applicable•if.the provider is, a local government entityor 125,000, or more from the department during its fiscal nonprofit organization and receives a total of the department or when it has incurred expenses which will be reimbursed year. The provider has „received" funds when it has obtained cash f` :. by the department. The provider agrees to have an annual financial and c current Government Ato have Standards �• ompliance audit performed by independent auditors in accordance with r governments shall c < Yellow Book'•) issued by the Comptrollercomply General of the United States. Loco( Nonprofit ement and Bud et OMB Circular A-12B Audits of State end providers receiving federal funds passed through the de in CMB Circular A-133 Audits of institutions of Hi her learnin and Other NInstitutions OCre Governments. partment shall comply with the audit r Such audits shall cover the entire organization for the Le anization s fiscal ear, requirements eontaitt roftt ins t uttons, except the audit per shall include the financial audit requirements of the Yellow Book Ont . modified scope here q Y , not to exceed 12 months- The scope of { contrcl aft nd compliance..._The audit -report ~ by rwrbe�, port shall include a schedule of*finaneial assistance n hatdiscloses marts on intern An audit performed by the Auditor General shall satisfy the r each state contra requirements of this attachment. Compliance findings related to contracts with the department shall be based rules, regulations, or statutes referenced in the contract, on the contract requirements showing whether or not statuterequirements inhere applicable, the audit re � i�la Com any calculated and fully disclosedgin theauditwere reportawith reference to the department contractport shall include a eamputatfor t. All questioned costs and liabilities due to the not expand the scope of the audit asdepartment shall bel prescribed by the "Yeti „ involved. These requirements } t>w'ff6aK: It the provider has received any funds from a grants and aids appropriation; the report(s) in accordance with the rules of the Auditor General, chapter 10.600 and assistance which contracts are funded from state provider will also submit a compliance indicate on the schedule of financial grants and aids appropriations. Copies of the financial and compliance audit re audits performed b i report, management letter, and all other cornea the providers fiscal Year, auditors, other than the Auditor correspondence, if year, unless otherwise r General, shall be submitted within 120 te, related to required by Florida Statutes, to the following: days after the end A. Office of Audit and Quality Control Services •1317 Vinewood Boulevard, Building ?. Room 116 Tallahassee j Florida 32399-07p0' B. '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 Jeffersonvil(e, Diana 47132 - D• 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 ptrioa ensure that audit working of years from the date the audit report iseis made dedavailable to the department, or its de .07jG1/.^3 lea„ rxtended in wittin signce, upon requrst for 9 by the department. a . PART � LAC tII: AND AIDS AUD1T ATTESTATION phis part is applicable if the provider is awarded funds from a grants and aids appropriation, local I government entity or nonprofit organization receiving a total of less than S25,000 from the department duningther(its afiscal or (2) a for -profit organization receiving any amount from the department. The provider has 11received-1 funds when it ha R 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 hav performed by an independent certified public accountant and submit a c e an audit with the Auditor General, chapter 10.600. The audit report shall include a schedule aofefinanccial'assistance in accorda hnce at disclosesrules each o: contract by number and t1dicates which contracts are funded from state grants and aids appropriations. Compliance findings related to contracts with the de rules, regulations, or statutes referenced in the contract. Where apprtment shall be licablesed ,' the audit the areport shalt ct requirements, including arty showing whether or not matching requirements were met. All l ineltxie a e calculated and fully disclosed in the audit re questioned costs and liabilities emputati due to the department shall port with reference to the department contract involved. If the amount received from grants and aids appropriation awards exceeds 525,000, but does not exceed 5100,000, the provi may have an audit as described above or have a statement prepared by an independent certified that the provider has complied with the provisions of all contracts funded public accountant which attj, .. 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 he the entity or organization attest, under penalties of perjury, that the organization has contracts funded b a ad Y grants and aids appropriation. complied with the provisions of r Copies of the audit report and all other correspondence, if an •- the attestation statement, shall be submitted within 120 days afterthefiscaits l by the independent auditor, � year end to the following: A. Office of Audit and Quality Control Services 1317 Uinewood 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 provider shall ensure that audit working+i Period provider er S Papers are made available to the department years from the date the audit report is issued or its designee, upon r . unless extended in writingegoist fo' by the department. PART III: NO AUDIT REQUIREMENT This part is applicable if the provider is not awarded funds from a grants and government entity or nonprofit organization receiving a total of less than !25 000 ends appropriation, and is either or (2) a for -profit organization receiving an (1) a loc�� Obtained cash from the de y amount from the department. from the department during its fiscal y { department or when it has incurred ex The provider has "receivedN <i expenses which will be funds when it has reimbursed by the department. The provider has no audit or attestation statement required by this attachment, 07/01/93 T 7,9C y/J76-1V T- July 1, 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 -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 $7400 and not more than $100,000 for each such failur -- Sic ure �r, _June 16, 1993 Date J London KH-383 o� 1:uthozlzed Tncit•:d 1 , ica; ion or Con :."Cz 1;u=bc_ Monroe County Board of County Commissioners, 500 Whitehead St., Key West FL ATTEST: DANNY L. KOLHAGE, CLERK • APR V -D AS O F7^' B ECI S . rc - ..Y. Y r;. Dep ty Clerk A..nuy'so,.5ce 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 §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 (16 USC §661, et seq.); 6. The Wild and Scenic Rivers Act of 1968, as amended (16 USC § 1271 , --et- _sec.) ; 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 (42 USC §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 95-1-17); 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 Floo! Hazards; 21. Executive Order 11288, 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 cf Public Law 101-121, as provided ir. the "Governmentwide 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 non-federal funds; 25. Executive Order 112-46; 26. Procurement requirements for Counties under Chapters 2559 274 and 1-87, Florida Statutes; and 17. Americans with Disabilities Act. - L _