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BRANCH OFFICE CLERK OF THE CIRCUIT COURT BRANCH OFFICE
3117 OVERSEAS HIGHWAY MONROE COUNTY P.O. BOX 379
MARATHON, FLORIDA 33050 600 WHITEHEAD STREET PLANTATION KEY, FLORIDA 33070
TEL. (305) 743-9036 KEY WEST, FLORIDA 33040 TEL. (305) 852.9253
TEL. (305) 294-4641
M E M O R A N D U M
To: George Harper,
ACA/Management Services
From: Rosalie L. Connolly, Deputy Clerk
Subject: Resolution No. 767-1989
Date: December 26, 1989
On December 13, 1989, the Board of County Commissioners adopted
Resolution No. 767-1989 authorizing execution of an Agreement
for Baker Act Matching Funds between the Board and the Guidance
Clinic of the Upper Keys, Inc. concerning funding for Fiscal`Year
Attached are two certified copies of the subject Resolution and
two duplicate originals of the Agreement, all of which have now
been executed and sealed on behalf of the County. One set of
documents should be sent to the Clinic and the other set kept in
your proper departmental records.
Rosalie L. Con ly
Deputy Clerk
Attachments
cc: County Attorney
County Administrator
Finance Director
File
i
AGREEMENT FOR BAKER ACT MATCHING FUNDS
THIS AGREEMENT, made this 13th day of December ,
1989, 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 agree as follows:
(1) The Board shall reimburse the Clinic twenty-five
percent (25%) of total $57,040.00 expenditures for Baker Act
hospital, physician, and crisis stabilization services, as billed
to the Clinic on state approved Baker Act Billing Forms (HRS
1005) for clients qualifying for such services under applicable
state and federal regulations and eligibility determination
procedures. This cost shall not exceed a total reimbursement of
Fourteen Thousand Two Hundred Sixty Dollars ($14,260.00) during
the period beginning October 1, 1989, and ending September 30,
1990.
(2) The Clinic shall 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, in order
to comply with regulations safeguarding the patient's right to
confidentiality, copies of individual client bills shall not be
available for inspection by the Board for reimbursement purposes.
Copies of individual client bills shall be kept on file in the
Clinic business office and shall be made available under con-
trolled conditions to qualified auditors for audit purposes. The
Clinic shall also provide the Board all Baker Act statistical
data normally available to the Clinic and make an annual report
to the Board of the expenditure of County funds for the above
specified purposes.
(3) This agreement shall terminate at 11:59 P.M., September
30, 1910 and the Board shall not be liable under the terms of
this agreement for any liability incurred after the time of
termination; 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 reimbursement 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.
r
(4) The Clinic shall indemnify Monroe County for all claims
of any sort that arise from the use of this funding. In this
respect, the Clinic shall hold Monroe County harmless and assume
all responsibility for any claims or damages resulting from the
use of this funding during the time wherein the funding
continues.
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 writ-
ten.
(Seal)
Attest:DAT� 1`7 x ":-
er
Wit esses
BOARD OF COUNTY COMMISSIONERS
OF MONRO-CWNTY, FLORIDA
By
ayor airman
GUIDANCE CLINIC OF THE UPPER
KEYS, INC.
siaent/ isoara or `Directors
_r f-
By
1j<9_
xecutive erector
APMIOVED AS TO FORM
AND LEGAL SUFFICIENCY.
13Y
A ,ern^y s Office
2