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06/01/1983f AGREEMENT THIS AGREEMENT, made and entered into this lst day of June , 1983,by and between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, a body corporate and politic existing under the laws of the State of Florida, hereinafter called the SPONSOR, and FISHERMEN'S HOSPITAL, INC., Marathon, Florida, a Florida corporation not for profit herinafter called the HOSPITAL. WITNESSETH: WHEREAS, the SPONSOR desires to utilize the food preparation facilities of the HOSPITAL for the purpose of providing meals for Senior Citizens parti- cipating in the Older Americans Act Title III-C, Nutrition Program in Marathon and the HOSPITAL is willing to provide for said services upon the terms and conditions of this Agreement, NOW, THEREFORE, the parties hereby agree and undertake as follows: I The HOSPITAL hereby agrees to furnish meals, in accordance with Attach- ments "A" and "B" of this agreement and at the prices therein specified, to senior citizens participating in the Older Americans Act Title III-C, Nutrition Program, such meals to be furnished at the Marathon site. II The SPONSOR agrees to reimburse the HOSPITAL for meals served according to the aforesaid schedule, payment to be made to the HOSPITAL no more than thirty (30) days after receipt by the SPONSOR of the HOSPITAL'S claim. Claims for reimbursement shall be rendered as promptly as practicable after the loth day in each month. III The meals to be provided by the HOSPITAL pursuant to this Agreement are to be in accordance with Attachments "A" and "B" hereto. The HOSPITAL may, upon request of the SPONSOR, make substitutions for the items on the regular menus. IV Meals will be provided on the days shown in Attachment "A". It is agreed that the individual service institution for whom the SPONSOR is responsible will by 2:00 p.m. the day prior to food service or in the case of Mondays on Fridays notify the HOSPITAL'S Food Service Director of the number of meals I needed for the next day, except, if the SPONSOR does not notify the HOSPITAL by 2:00 p.m. as aforesaid, the maximum number of meals shown on Attachment "A" hereto shall be prepared and charged for by the HOSPITAL and paid for by the SPONSOR. It is agreed and understood that the number of meals which the HOSPITAL is obligated to provide shall not exceed 25% above the maximum estimated number. If the SPONSOR desires to have the HOSPITAL provide additional meals, the HOSPITAL shall be notified accordingly in advance, in which event the HOSPITAL may, but shall not be obligated to, furnish such additional meals. U The SPONSOR hereby agrees to indemnify and hold harmless the HOSPITAL from and against any and all liability which may at any time be asserted or claimed by any person, natural or otherwise, arising out of or in connection with the performance by the HOSPITAL pursuant to this Agreement or in connection with the purposes thereof, and that liability insurance be provided to effectuate the purposes herein stated, except in case of food poisoning or contamination, at which time responsibility shall be determined. VI If additional services are requested by the SPONSOR, the parties shall mutually negotiate for the additional services, including cost of providing same to be paid to the HOSPITAL. VII The obligations of the SPONSOR under this Agreement are subject to the availability of funds lawfully appropriated annually for its purpose by Monroe County, Florida, and on the availability of funds through contract or grant programs. VIII A reasonable effort will be made by the HOSPITAL to provide meals and the SPONSOR will be given thirty (30) days notice if meals are not provided. IX This Agreement shall continue in effect to an including the 31st day of August, 1983, at which time the HOSPITAL'S obligations hereunder shall cease. - 3 - This Agreement may be terminated by either party by giving written notice to the other party of its intention so to do thirty (30) days prior to said termination. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date first above written. BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA 9 By ! Mayo /Chairman (Seal) Attest: &� ��►►tt MPH W. R�b�aT ��.� i� Nr M 6 6 Clerk FISHERMEN'S HOSPITAL, INC. B;��k C%✓�- spital Administrator (Seal) Attest: Secretary of Corporation ATTACHMENT "A" (Annexed to and made a part of Agreement terminating August 31, 1983, between the Board of County Commissioners of Monroe County, Florida, and Fishermen's Hospital, Inc.) Relative to Fishermen's Hospital, Inc., providing lunches for the aged at the Marathon Nutrition Site the following items are agreed to: 1. Food will be prepared at Fishermen's Hospital and transferred in bulk by the Sponsor to the serving site. Food will be served using disposable ware provided by the Sponsor. Transfer pans will be provided by the Sponsor and sterilized by the Hospital. 2. All food prepared by the Hospital will meet temperature standards as defined in Attachment "B", section C.3 (Minimum Service Standards. Food Preparation.). 3. Food safety requirements as defined in Attachment "B", section CA (Minimum Service Standards. Food Safety.) will be met by the Hospital. 4. Food service facilities will provide proof of sanitation inspection performed within previous six months; and the Sponsor will periodically inspect the sanitary conditions of food preparation, packaging and storage areas. 5. Meals will be provided daily, Monday through Friday, during the period June 13 through August 26, 1983, except on Monday, July 4, 1983. 6. Meals provided will be charged at a rate of $3.25 per meal. 7. Menus will be planned by the Hospital's dietician. Menus will be planned with consideration of special needs of elderly, ethnic and regional dietary preferences, food item variation, seasonal availability of foods and available equipment for food preparation. Each meal served must provide at least one-third of the Recommended Dietary Allowance. Menus will be approved by the State (HRS) Nutrition Consultant. The minimum menu pattern to be followed for senior sitizens is specified in Attachment "B", section C.1 (Minimum Service Standards. Meal Planning.). 8. Special meals for dietetic or medical purposes cannot be prepared due to the limited number of daily meals to be prepared by the Hospital. 9. The minimum number of meals will be eighteen (18) and the maximum will be twenty-five (25) daily unless both parties agree to an increase or decrease. 10. If food does not meet proper specifications, the Sponsor will not be required to pay. 11. Meals to be delivered to homes will be dished at the serving site by Sponsor personnel and delivered by the Sponsor. 12. The responsibility for the care and maintenance of the serving site is that of the Sponsor. 13. Fishermen's Hospital financial records will be open to the Sponsor for audit purposes; and information concerning labor and raw food costs, insurance coverage, bonding, food cost changes will be available to the Sponsor for reporting purposes. 14. The Sponsor has authorized the Nutrition Program to operate 250 days per year. Through mutual agreement by both Sponsor and Hospital, the operation of the site can be discontinued at any time and for any length of time. March 31, 1981 ATTACHMENT "B" (Page One of Seven) H RSM 140-1 Appendix B CONGREGATE MEALS A. DEFINITION OF SERVICE. A con- gregate meal is a hot or other appropriate nutritionally balanced meal that meets one-third of the current daily Recom- mended Dietary Allowances (RDA) served in a strategically located center to older persons. B. GOAL OF SERVICE. To provide eligible persons, particularly those in greatest social and economic need, with low cost, nutritionally sound meals served in strategically located centers such as schools, churches, community centers, senior centers, and other public or private facilities where they can obtain other social and rehabilitative services. Besides promoting better health among the older segment of the population through improved• nutrition, such a pro- gram is aimed at reducing the isolation of old age and offering older persons the op- portunity to live their remaining years in dignity. C.MINIMUM SERVICE STANDARDS. 1. MEAL PLANNING. (a) Meal service should be planned so that food is available for at least one- half hour after serving time begins to enable individuals who may not arrive at a specific time to participate in the meal. (b) The special needs of the elderly must be considered in all menu planning, food selection, and meal preparation. (c) Menus must be: (1) Planned in advance for a minimum of four weeks in a format pro- vided by the Program Office. (2) Certified in writing as pro- viding a minimum of one-third of the cur- rent Recommended Dietary Allowances (RDA) established by the Food and Nutri- tion Board of the National Academy of Sciences - National Research Council by the dietitian or nutritionist whose ser- vices are utilized by the project. (3) Submitted for review and ap- proval by the AAA Nutrition Consultant at least four weeks prior to use for nutri- tional adequacy and inclusion of USDA donated food, if applicable. Menus must be transmitted to the AAA to arrive on the first of the month four weeks prior to their anticipated use.- An approved cycle menu may not be repeated for more than six months. a. Revisions may be required by the AAA's Nutrition Consultant based upon the review. Appropriate comments will be returned to service providers. Copies of corrected menus must be resubmitted to the AAA within one week of receipt of comments. (4) Dated and posted in a con- spicuous location in each congregate meal site as well as the preparation area. (5) Filed, as served, for a period of one year both by service provider and the AAA for purposes of audit. (6) Adhered to, subject to seasonal availability of food items, as well as availability of USDA donated foods, if applicable. Substitutions for the approved menu must be minimal and ap- proved prior to use by the Provider. A list that includes the date of substitution, the original menu item, and the substitution made must be submitted to the AAA at the end of each month. (7) Planned with consideration for the following: a. Special needs of the elder. ly, such as the restricted use of sugar, salt and saturated fats. b. Religious, ethnic, cultural and regional dietary practices or Appendix B for HRS11 140-1 HRSM 140-1 t (Page Two of Seven) March 31, 1981 preferences of the participants, if reasonable and feasible. c. Food items within the meat, vegetable, fruit, and dessert groups shall be varied within the week and not repeated on the same days of con- secutive weeks. d. Variety of food and prepara- tion methods including color, combina- tions, texture, size, shape, taste and ap- pearance. foods. e. Seasonal availability of f. Available equipment for food preparation. (d) Each meal served must provide at least one-third of the Recommended Dietary Allowances. Therefore, the following meal pattern requirements are established: (1) MEAT OR MEAT ALTERNATE GROUP. Three ounces of cooked, edible portion of meat, fish, fowl, eggs or cheese. An equivalent amount of meat alternates, individually or in combination, may be used occasionally for variety. Meat alternates include cooked dried beans, peas, lentils, nuts or nut butter. Alternates for the protein in one ounce of cooked lean meat include: a. One-fourth cup cottage cheese. b. One ounce cheddar cheese. c. One egg. d. One-half cup cooked dried beans, peas or lentils. (Garbanzos, lima beans, black-eyed peas, pinto beans; red beans, etc.) butter. e. Two tablespoons peanut (2) VEGETABLE AND FRUIT GROUP. Two different one half cup serv- ings (four ounces drained weight): a. One-half cup serving of a vitamin A rich food shall be served a a-z minimum of three times per week. A vitamin A rich food is defined as a single food serving that provides a minimum of one-third of the RDA for that nutrient, or a combination of no more than two one-half cup servings at the same meal which together provide at least one-third of the RDA for that nutrient. b. One-half cup serving of a vitamin C rich food must be served daily. A vitamin C rich food is defined as a single food serving that provides a minimum of one -third -of the RDA for that nutrient, or a combination of no more than two one-half cup servings at the same meal which together provide at least one-third of the RDA for that nutrient. Vitamin C rich foods include raw or cooked citrus fruits or juices, tomatoes, melons, berries, dark green leafy vegetables, etc. Fortified full strength juices are defined as "fruit juices that are 100 percent natural juice with vitamin C added." Partial strength or simulated fruit juices or drinks, even when fortified, may not count as vitamin C sources. c. It is noted that: 1. Rice, spaghetti, macaroni and noodles are not vegetables but "bread alternates". Potatoes, sweet potatoes and yams are considered vegetables. 2. Vegetable soup may be used to fulfill one portion of the vegetable and fruit requirement if the soup contains at least one-half cup of vegetables per serving of soup. 3. Dried peas, beans, or lentils may be used to fulfill the fruit and vegetable requirement. However; if used to fulfill this requirement they cannot simultaneously fulfill the protein requirement. 4. Congealed salad may be used to fulfill one portion of the vegetable and fruit requirement if the salad C ATTACHMENT "B" March 31, 1981 contains at least one-half cup of vegetables or fruit per serving of the salad. 5. Fruit used as a dessert may not be counted toward the required two servings of vegetables and fruits. (3) BREAD OR BREAD ALTER- NATE GROUP. a. One serving whole grain or enriched bread, biscuits, muffins, rolls, sandwich buns, cornbread or other hot breads. b. Bread alternates may in- clude enriched or whole grain cereals or cereal products such as spaghetti, macaroni, dumplings, pancakes, waffles and tortillas. c. When available and ap- propriate (e.g., ethnic preferences) yams, plantains, and sweet potatoes may be substituted for the bread requirement. However, when used to fulfill the bread requirement, they cannot be simultaneously used to fulfill the vegetable and fruit requirement. d. Whenever possible, enrich- ed or whole grain flour or meal should be used in place of unenriched flour or meal. (4) BUTTER OR FORTIFIED MARGARINE. One teaspoon. (5) DESSERT GROUP. One half cup serving. All fruits and simple desserts such as puddings, gelatin desserts, ice cream, ice milk and sherbet may be used. Cake, pie, cookies and similar foods are also included but should be limited in use. (6) MILK GROUP. a. Eight ounces of fortified whole, skim, low fat milk and buttermilk or the calcium equivalent. b. All milk and fluid milk pro- ducts for drinking purposes shall be pur- chased and served in the individual con- tainer in which they were packaged at the B•3 (Page Three of Seven) HRSM 140.1 milk plant, or shall be served from an ap- proved bulk milk dispenser of sanitary design, construction, and operation. C. If a cultural or ethnic preference precludes the acceptance of milk with the meal, the following may be substituted for eight ounces of milk. 1. One and one-half cups cotta cheese. z 2. One and one-half ounc American cheese. 3. One and one-half cups ice milk ice cream. 4. One and one-half cups custard. 5. One cup yogurt. (e) Coffee, tea, decaffeinated beverages, soft drinks, and fruit flavored drinks may be used, but not as a substitute for milk. (f) Vitamins or mineral sup- plements may not be provided with Title III-C funds. (g) Nutrition service providers shall provide special menus, where feasi- ble and appropriate, to meet the par- ticular dietary needs arising from the health requirements, religious beliefs, or ethnic backgrounds of eligible in- dividuals. (1) Menus for modified diets may be provided for health reasons. (2) A written or documented oral order must be on record for each in- dividual on a modified diet, and the order must be reviewed annually with the par- ticipant's physician. (3) Modified or therapeutic menus must be planned and prepared under the supervision of a registered dietitian. (4) A current diet manual, ap- proved by the PDAA Nutrition Consultant, must be used as the basis for therapeutic or modified menu planning. (5) In determining feasibility and appropriateness, the provider must use ge es - or ATTACHMENT "B" HRSM 140-1 (Page Four of Seven), March 31, 1981 the following criteria: a. Whether there are suffi- cient numbers of persons who need the special menus to make their provision practical. b. Whether the food and skills necessary to prepare the special menus are available in the planning and service area. 2. FOOD PROCUREMENT. (a) All food procurement must be transacted in accord with policies and procedures set forth in HRSM 55-1 and "Federal Food Services Contract Provi- sions" herein. (b) All foods procured shall be of good quality and shall be obtained from sources which conform to Federal, State and local regulatory standards for quali- ty, sanitation, and safety. Food from. unlabeled rusty, leaking, broken con- tainers or cans with side seam dents, rim dents or swells shall not be used. 3. FOOD PREPARATION. (a) When nutrition service is designed to serve meals at more than one congregate meal site, efforts should be made to have all meals prepared at one facility and then delivered to the various sites. For the most economical delivery of meals, the duplication in staffing and equipping food preparation facilities at more than one congregate meal site should be minimized. (b) State and local fire, health, sanitation and safety regulations ap- plicable to the particular type of food preparation and meals delivery system used by the provider must be adhered to in all stages of food service operations. (c) All staff working in the prepara- tion of food must be under the supervi- sion of a person who will insure the ap- plication of hygienic techniques and practices in food handling, preparation and service. This supervisory person shall a-4 consult with the provider's nutrition con- sultant. (d) Tested quantity recipes, ad- justed to yield the number of servings needed, must be used to achieve the con- sistent and desirable quality and quantity of meals. (e) All foods must be prepared and served in a manner to preserve optimum flavor and appearance, while retaining nutrients and food value. (f) Hot food must be served at a minimum of 1400F. Neutral foods should be served at a neutral temperature. Cold food must be served at a maximum of 40 OF. (g) More than one meal per day may be provided. if a second meal is pro- vided, the combination of the two meals must provide at least two-thirds of the RDA if these are to be reported as two meal service -units. 4. FOOD SAFETY. (a) All foods used in a nutrition ser- vice must meet standards of quality, sanitation and safety applying to foods that are processed commercially and pur- chased by the Provider. (b) No food prepared, frozen or canned in the home may be used in meals provided by a service financed through Ti- tle III-C. (c) Only commercially processed, frozen or canned food, or approved by the USDA and the FDA, may be used. 5. USDA FOOD ASSISTANCE. Con- gregate meals programs shall take such steps as necessary to assure that max- imum numbers of older persons within the service area benefit from the USDA food assistance program. Each recipient of an award shall: (a) Provide the opportunity for, and assist all nutrition participants who desire food stamps to apply for such assistance. ATTACHMENT "B" March 31, 1981 (Page Five of Seven) HRSM 140-1 (b) Provide the opportunity for in- dividuals receiving meals to use food stamps as their contribution toward the cost of the meal by having the Provider certified for receipt of food stamps. (c) After the Provider is certified for receipt of food stamps, it must take steps to assure that all provisions related to the use and handling of food stamps (as prescribed by USDA) will be met. 6. UTILIZATION OF EXISTING RESOURCES. (a) A service provider must make every effort to utilize the existing social service resources provided by agencies such as health and mental health, public assistance, Medicaid, social services, food and agriculture agencies to provide the supporting services. (b) Such efforts shall include joint planning, sharing of information, and negotiation of agreements for joint fun- ding and operation of programs for the elderly. 7. ELIGIBILITY. Eligible individuals are those persons who are aged 60 or over and the spouses of such individuals. 8. TARGET POPULATION. Nutrition services under the Older Americans Act should be reserved for those individuals in the target population who have been identified as being in greatest economic or social need. Factors which should be considered in establishing priority in- clude those older persons who: IY (a) Cannot afford to eat adequate- (b) Lack the skills or knowledge to select and prepare nourishing and well- balanced meals; (c) Have limited mobility which may impair their capacity to shop and cook for themselves; or (4) Have feedings of rejection and loneliness which destroy the incentive necessary to prepare and eat a meal alone. B-5 9. NUTRITION CONSULTATION. (a) A minimum of eight hours of consultation per month by a registered dietitian or other qualified person who has been approved by the AAA Nutrition Consultant is required for each Title III-C Nutrition Provider. A resume for the Nutri- tion Consultant must be included in the service provider application or submitted when there is a new person hired in this - position. (b) The Nutrition Consultant must be either a provider employee or an in- dependent consultant hired by the pro- ject (paid or in -kind). (c) Minimum responsibilities of the Nutrition Consultant must include: (1) Monitoring of food service to include measurement of food temperatures and portion sizes, assess- ment of food quality, and adherence to contract specifications. (2) Staff training in areas of nutrition, food service management, and sanitation. (3) Assessment of participants' satisfaction and preference. (4) Menu review and approval. (d) Individual diet counseling with participants, if provided, should be done only by persons with approved training in therapeutic diets. 10. FOOD SERVICE CONTRACT PROVISIONS. (a) Food service contracts are defined as contracts for the purchase of meals or portions of meals or for food preparation. (b) All service providers must adhere to all standards set forth herein, in HRSM 140.1, HRSM 55-1 and HRSM 115-1 in preparing contracts. (c) Written specifications for food service contracts must be approved by the AAA prior to solicitation of bids for such contracts by the Title III-C grantees. ATTACHMENT "B" (Page Six of Severe). HRSM 140-1 March 31, 1981 (d) Competitive bidding for food service contracts must be conducted a minimum of every two years. The con- tracts must not be signed for longer than one year but may be extended for an addi- tional year as a "continuation clause" if included and both parties are agreeable to terms and conditions. (e) Specifications for bids and terms and conditions of the proposed contracts must establish methods or responsibilities for each of the following: - (1) DELIVERY. a. Transportation: trucks, vans. b. Delivery sites: number and location. c. Delivery schedule. 1. Number of days each week. 2. Hour of delivery for each site. d. Type of containers for bulk food delivery. e. Type of containers for in- dividual service. f. Return of containers. 1. How and by whom. 2. Condition (washed„ sterilized, etc.) (2) MENUS. a. Written by whom. b. Approved by whom. c. Compliance with Title III-C meal pattern and other standards re- quired herein. d. Menus submitted to project director at least five weeks in advance of service. e. Approval of substitution on menus. (3) SANITATION. a. Compliance with Federal, State and local regulations. b. Food preparation facility in- spection within previous six months. c. Delivery standards. 1. Temperature maintenance. B-6 2. Sanitary conditions. d. Inspection of food prepara- tion, packaging and storage areas by the project. (4) FOOD. a. Number of meals. 1. Provision for flexibility. 2. Time limits for ordering amounts of food. 3. Dispositon of unconsumed meals. b. Cost schedule. c. Food purchased by whom. d. Food provided - entree, vegetable, fruit, milk, dessert, juice, salad, beverage, cream (or substitute), condiments, butter or margarine. e. Storage and handling of USDA donated foods. f. If food does not meet proper specifications, the project will not be re- quired to pay. g. If the caterer fails to deliver a meal or any portion of a meal, the pro- ject will procure food from other sources at the caterer's expense. (5) MISCELLANEOUS SUP- PLIES. Napkins, table coverings, home - delivered meal containers, paper towels, table service (plates, cups glasses, silver- ware). (6) ADMINISTRATION. a. Sales tax exemption. b. Caterer's financial records open for audit purposes. C. Supply information for nutrition reporting on: 1. Labor costs. 2. Raw food costs. d. Insurance coverage. e. Bonding. f. Food cost changes. g. Termination of contract agreement. h. Dates and times of contract payments, to contractor. i. Approval by PDAA. L " ATTACHMENT "B" (Page Seven of Seven) March 31, 1981 HRSM 140-1 Cj. Holidays and days when meals are not to be served. k. Training of site personnel. (f) All proposed food service con- tracts with profit -making organizations must be submitted for prior approval by the Area Agency. 11. NON-DISCRIMINATION ON THE BASIS OF HANDICAP. Access to benefits and services for handicapped par- ticipants will be assured pursuant to Sec- tion 504 of the Rehabilitation Act of 1973 (45 C F R 84). 12. INSURANCE. It is strongly recom- mended that service providers have ade- quate liability insurance coverage, in- cluding product liability. 13. RECRUITMENT. Service pro- viders will provide, subject to their merit systems, a preference to persons aged 60 or over for any staff positions (full or part- time), whether paid or volunteer.