FY1987 01/20/1987=i
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 743-9036
� annp1. ot�jage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 294-4641
January 26, 1987
Richard Matthews, Ph.D., Executive Director
Guidance Clinic of the Upper Keys, Inc.
Post Office Box 363
Tavernier, Florida 33070
Dear Sir:
BRANCH OFFICE
P.O. BOX 379
PLANTATION KEY, FLORIDA 33070
TEL. 1305) 852.9253
At a Regular Meeting in formal session on January 20,
1987, the Board of County Commissioners adopted Resolution
No. 061-1987 authorizing the Mayor and Chairman of the Board
of County Commissioners of Monroe County to execute an
Agreement for Baker Act Matching Funds by and between the
Board and the Guidance Clinic of the Upper Keys, Inc. con-
cerning funding for Fiscal Year 1986-87.
Enclosed herewith is a certified copy of the sub-
ject Resolution and a fully -executed copy of the Agreement.
Very truly yours,
Danny L. Kolhage
Clerk of Circuit Court
and ex officio Clerk to
Board of County Commissioners
by:
Rosalie L. onnolly
Deputy Clerk
Enclosures
cc: County Attorney
�fFFiinance Department
e
AGREEMENT FOR BAKER ACT MATCHING FUNDS
THIS AGREEMENT, made this .24 day of , 198�j, by
and between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY,
FLORIDA, hereinafter referred to as "BOARD", and the GUIDANCE
CLINIC OF THE UPPER KEYS, INC., hereinafter referred to as
"CLINIC",
For and in consideration of the mutual covenants made
herein, the parties hereby agree as follows:
(1) The Board agrees to reimburse the Clinic twenty-five
percent (25%) of total $29,952.00 expenditures for Baker Act
hospital, physician, and crisis stabilization services, as billed`
to the Clinic on state approved Baker Act Billing Forms (HRS 346)
for clients qualifying for such services under applicable state
and federal regulations and eligibility determination procedures.
This cost is not to exceed a total reimbursement of Seven
Thousand Four Hundred Eighty-eight dollars ($7,488.00) during the
period beginning October 1, 1986, and ending September 30, 1987.
(2) The Clinic agrees to provide to the Board on a regular
basis a copy of the Baker Act Summary Billing Form from which
reimbursement due the Clinic can be calculated; however, copies
of individual client bills will not be available for inspections
by the Board for reimbursement purposes in order to comply with
regulations safeguarding the patient's right to confidentiality.
Copies of individual client bills are kept on file in the Clinic
business office and will be made available under controlled
condition to qualified auditors for audit purposes. The Clinic
further agrees to provide the Board any Baker Act statistical
data normally available to the Clinic and to make an annual
report to the Board of the expenditure of County funds for the
above specified purposes.
This agreement shall terminate at 11:59 P.M., September 30,
1987 and the Board shall not be liable under the terms of this
agreement for any liability incurred after the time of termina-
tion; however, the Board shall be liable for outstanding costs
incurred prior to the termination of this agreement provided the
Clinic submits to the Board the required Baker Act Summary
Billing Form within three (3) weeks of the date of termination of
this agreement, provided, however, that the maximum of reimburse-
ment specified above is not exceeded. This agreement may also be
terminated by either party upon thirty (30) days written notice
delivered by certified mail to the party receiving notice of
termination.
County warrants or checks written for reimbursement to the
Clinic shall be made payable to the Guidance Clinic of the Upper
Keys, Inc.
IN WITNESS WHEREOF, the BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, has caused these presents to be signed in
its name by its Chairman, Board of County Commissioners, and the
Clerk of the Board of County Commissioners, and the Guidance
Clinic of the Upper Keys, Inc., has caused these presents to be
signed in its name by its President/Board of Directors and
Executive Director all as of the day and year first above
written.
(Seal)
Attest: D.,D.Clerk
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1,
�A_�.
Witnesses ,
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By SSS 7
or Chairman ,� a
GUIDANCE CLINIC OF THE UPPER
KEYS, INC.
;)
residetit/Board ot Directors
By i
Executive Di ector
APPfPVED AS TO FORM
ANY GAL SUFFIVEi!CY
2 Attorneys Offire