07/03/1987C O N T R A C T
THIS CONTRACT entered into on this first day of July, 1987, between the 1
Board of County Commissioners of Monroe County FLorida as the governing 2
body of the County exercising supervision and control over Monroe County 3
In -Home Services, the Community Care for the Elderly (CCE) and Community 4
Care for Disabled ADults (CCDA) Lead Agency for Monroe County, hereinafter 5
referred to as the Lead Agency, and FLorida Health Nursing Services, Inc., 6
hereinafter referred to as Florida Health, for the provision of nursing 7
services to qualified individuals within Monroe County in accordance 8
with the Community Care for the ELderly (CCE) program guidelines and 9
Community Care for Disabled Adults (CCDA) program guidelines promulgated 10
by the State of Florida Department of Health and Rehabilitative Services 11
and the District XI Area Agency on Aging. 12
The Parties agree:
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1. Florida Health will do
the following:
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A. Make home visits
to CCE and CCDA clients
for initial
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and follow-up review
as assigned by the
Lead Agency. Such
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visits shall be made
by and the services
provided hereunder
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shall be rendered by
a Registered Nurse
in accordance with
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HRS manual 140-4, Community Care for the
Elderly Program
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and HRS manual 140-8,
Community Care for
Disabled Adults
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Program. 21
B. Complete a CCE/CCDA Care Plan and/or Re-evaluation Form 22
as indicated by the Lead Agency for each client visit made. 23
C. Deliver to the
Lead Agency office those
forms completed
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for clients visits
as designated
by the Lead
Agency, no later
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than the fifteenth
and thirtieth
day of each
month.
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D. Complete accurate monthly mileage reimbursement request 27
forms for submission to the Lead Agency no later than the 28
last work day of the month. 29
E. Comply with all Federal and State laws, rules and 30
regulations including, but not limited to the following: 31
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1. All applicable standards, criteria and guidelines 1
of the Community Care for the Elderly Program, Community 2
Care for Disabled Adults Program, and any other applicable 3
guidelines or criteria established by the Department of 4
Health and Rehabilitative Services, State of Florida, 5
Area Agency on Aging or any other applicable Federal or 6
State Agency. 7
2. All applicable statutes, rules, regulations, guidelines 8
and Executive Orders pertaining to civil rights and equal 9
employment opportunity. 10
It is expressly understood that upon receipt of substantial evidence of any 11
violation of these laws, rules and regulations, the Lead Agency shall have 12
the right to terminate this contract immediately. 13
F. Provide Insurance. Florida Health shall maintain Professional 14
Liability Insurance or make adequate provision through an approved 15
insurance program. Said 'insurance shall specifically address 16
liability coverage for contractural agreements for services. 17
Florida Health shall provide the Lead Agency with written proof of 18
insurance coverage prior to commencement of this agreement. 19
G. Provide Indemnification. Florida Health agrees to fully 20
indemnify and shall hold the Lead Agency and Monroe County harmless 21
from any claims, suits, judgements, damages, costs, and reasonable 22
attorneys fees in connection therewith caused by reasons of and 23
predicated upon any liability of Florida Health for its negligent 24
acts or intentional acts of either omission or commission in the 25
performance of the nursing services contemplated herein. In no 26
way does this indemnification seek to relieve or indemnify the 27
Lead Agency from its own acts of negligence. 28
H. Safeguard Information. Florida Health shall not use or 29
disclose any information concerning a recipient of services 30
under this contract for any purpose not in conformity with the 31
Federal and State laws or regulations except on written consent 32
of the recipient or their responsible parent or guardian when 33
authorized by law. 34
Page 2 of'5
I. Maintain records in accordance with standard and accepted
audit procedures adequate for proper audit or program
activities and to make same available to the Lead Agency or
its duly authorized representatives.
2. The Lead Agency agrees to do the following:
A. Pay Florida Health on a "fee for service" basis the
sum of Fifteen dollars ($15.00) for each initial visit
and Ten dollars and Fifty cents ($10.50) for each sixty
day follow-up (review) visit, during which services are
provided to said client, as assigned by the Lead Agency.
No fee will be paid in the event that a client is not
available when FLorida Health visits the home. Payment will
be made on a monthly basis the last day of each month and
upon validation of the statement of service on a form
prescribed by the Lead Agency.
B. Provide the appropriate CCE and CCDA forms to be completed
by Florida Health.
C. Provide a weekly assignment sheet listing the clients
to be visited.
D. Reimburse Florida Health for reasonable mileage traveled
in making client visits on the basis of 200, per mile. Mileage
reimbursement will be included in the monthly payment. No
payment for mileage will be made in the event a client is not
available when Florida Health visits the home.
3. Florida Health together with the Lead Agency jointly agree
as follows:
A. This contract shall commence on July 1, 1987 and shall
terminate on June 30, 1988.
B. The total number of clients to be served under this
agreement shall not exceed 336 CCE elderly and CCDA disabled
clients. The total number of visits to be made by Florida
Health shall not exceed 168 per month. The total amount of
money payable hereunder shall not exceed $1,890.00 per month.
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C. The contract provisions herein may be terminated for
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the following causes:
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1. Suspension for reasonable cause. The Lead Agency
3
may for any reasonable cause, including but not limited
4
to, failure to comply with the reporting requirements
5
provided herein, temporarily suspend Florida Health
6
pending corrective action or pending decision to
7
terminate this contract. Said Florida Health will
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not be entitled to payment of any fee for service
9
until it fully complies with all requirements including
10
the reporting requirements provided herein. The Lead
11
Agency may, for reasonable cause, prohibit Florida
12
Health from receiving further assignments and from
13
incurring additional obligation of payments pending
14
corrective action or pending a decision to terminate
15
this contract.
16
In order to terminate or suspend this contract, the
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Lead Agency must notify Florida Health in writing
18
of the action to be taken, the reasons for such action,
19
and the conditions of the suspension or termination.
20
Said notice shall be afforded ten (10) days prior to
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any action being taken pursuant to this provision.
22
The notification will also indicate what corrective
23
actions are necessary to remove the suspension and
24
will stipulate a reasonable time period to correct
25
these actions.
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2. Termination/reduction due to lack of funds. In
27
the event funds to finance this contract become
28
unavailable or are reduced, the Lead Agency may reduce
29
or terminate the contract upon no less than twenty-four
30
hours notice in writing to Florida Health. The final
31
determination as to the availability of funds is to be
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made exclusively by the Lead Agency.
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Page 4 of 5
F '
3. Termination for breach. The Lead Agency and Florida
Health agree that this contract may be terminated upon
evidence of any violation of this agreement, including
but not limited to, violation of any Federal or State law,
rule or regulation. Such termination shall be effective
immediately upon written notice delivered to Florida Health.
A waiver of breach under any provision 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 the contract.
D. In the event of the termination of this contract for any
reason, Florida Health shall furnish to the Lead Agency such
reports, records, files and audit materials as may be requested
based upon work completed under the provisions of -the contract.
E. Client shall be accepted for provision of services only by
the Lead Agency.
IN WITNESS WHEREOF, the parties hereto have caused this contract to be
executed by the undersigned.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
BY:
Eugene R. Lytton, Sr.
Typed Name
TITLE: Mayor/Chairman of Board
DATE: 11— 3 "g!
ATTEST: a'
ti �.iCr
FLORIDA HEALTH NURSING
SERVICES, INC.
BY:
Jobyna Okell
Typed Name
TITLE: Administrator/Treasurer
DATE: 10/29/87
\'ATTEST: 7i
APPF01f. .QS T FORPf
AP,!D A Via_ ° rUFr �rir ;n`9!
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Page 5 of 5
� � q
Brown and Brown, Inc.
Serving You Since 1939
November 2, 1987
Ms Gwen Rodriguez, Project Director
Monroe County In Home Service
Wing III, Public Service Building
Key West, FL 33040
RE: FLorida Health Nursing Services, Inc.
Dear Ms Rodriguez:
P.O. Drawer 1712
Daytona Beach, Florida 32015
904/252-9601
I am enclosing a Certificate of Insurance for Florida Health Nursing Services, Inc.
This certificate shows Monroe County as an additional insured on the policy. This
will provide coverage for both.Monroe County and Florida Health Nursing Services, Inc.
in the event that you both are named in a suit.
This endorsement provides protection for your interest in any work that our -insured
does for you.
If you have any questions please don't hesitate contacting me at 1-800-342-9426.
Since ly ,
He' Juttner
VC i nt Service
resentative
Daytona Beach • Boynton Beach • Cape Coral • Coconut Creek • Delray Beach • Fort Myers Beach • Jacksonville
Miami • North Fort Myers • Orlando • Port Charlotte • Sanibel • Tampa • West Palm Beach
ISSUE DATE (MM/DDNY)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Brown & Brown, Inc.
P.O. 1Drawer 1712
COMPANIES AFFORDING COVERAGE
Daytona Beach,FL 32015
LEOTTERNY A Interstate Fire & Casualty
COMPANY
1 LETTER B
INSURED
Florida Health Nursing Services, Inc.
ETTERNY C
1510 Venera Avenue
COMPAN V D
, LETTER
Coral Gables FL 33146 I
�
COMPANY E
LETTER
•
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EF�ECTVE
DATE (MM/DD/l'Y)
POLICY EXPIRATION
DATE (MM/DDNY)
LIABILITY LIMITS IN THOUSANDS
EACH
OCCURRENCE
AGGREGATE
GENERAL
LIABILITY
A
COMPREHENSIVE FORM
PREMISES/OPERATIONS
80-1093088
( 8/19/87
0/19/88
BODILY
INJURY
$
$
X
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
I
PROPERTY
DAMAGE
$
$
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BI & PD
COMBINED
$1 , 000
_
$ 1,000
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
PERSONAL INJURY
$
AUTOMOBILE
LIABILITY
ANY AUTO
Ko y
:PEP
PEP PERSON)
$
ALL OWNED AUTOS (PRIV. PASS.)
OTHER THAN
ALL OWNED AUTOS PRIV. PASS. )
BODILY
N URY
)PER ACCIDENT)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY
DAMAGE
$
GARAGE LIABILITY
91 8 PD
COMBINED
$
EXCESS
LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
BI & PD
COMBINED
$
$
WORKERS' COMPENSATION
STATUTORY
AND
$ (EACH ACCIDENT)
$ (DISEASE -POLICY LIMIT)
EMPLOYERS' LIABILITY
$ (DISEASE -EACH EMPLOYEE)
OTHER
A
Prof. Liability
80-1093088
8/19/87
0/19/88
1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Monroe County is added as an additional insured onto this policy
Monroe Qounty In Home Service: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
Wing III, Public Service Building MAIL 4DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Key West, FL 33040 LEA, BUTFAILUR O MAILS NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KINDD�I THE CQ'PANY_ATS AGENTS OR REPRESENTATIVES.
I. - GENERAL AMENDMENT ENDORSEMENT NO: 5
THE POLICY TO WHICH THIS ENDORSEMENT IS ATTACHED IS HEREBY AMENDED AS FOLLOWS:
In consideration of an additional premium of $500.00, it is
agreed that the following entity is added as an additional.
Named Insured: plus $15.00 Tax
Monroe County In -Home Services
SURPLUS LINES AGENT, EDWARD J. WOJCHICK
LIC. # 009.30-8590.05
4763 S. CONWAY RD.. SUITE B
ORLA,NDO, FL 32812
PROD. AGT. BrOtm Brown
CITY Daytona
THE INSURANCE IS ISSUED PURSUANT TO THE
FLORIDA SURPLUS LINES LAW. i ERSONS .NSURED
BY SURPLUS LINES CARRIERS 00 NOT HIVE THE
PROTECTION CF THE FLLRIDA INSURANCE
C.! RA';iY "CT TO -,HE EXTENT 0: ANI 10(;NT OF
R COrERY FOR TK 13LICATION OF : N Ii;; L)Ii CNi
I.N.:CLNSED 1.1-URER.
E"* 151-87 Filed 4th Qt. 1987
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
ANNUAL PREMIUM I DUE AT ENDORSEMENT Additional Premium Return Premium
EFFECTIVE DATE
INSTALLMENT PREMIUM PAYMENTS
Date Due Prior Installments REVISED INSTALLMENTS
$ $ is $
$ $ S $
ENDORSEMENT TOTAL PREMIUM $ J S
n INTERSTATE FIRE & CASUALTY COMPANY
Attached to and forming part of Policy No. 8 0 -1_ 0 9 3 p 8 S CH ICAGO INSURANCE COMPANY
Florida Health Nursing Services, IC.
IZsued to INTERSTATE INDEMNITY COMPANY,
Effective
11-2-87 By , . ,a 4eJd 1 C/
h-�
IIG 9-35 (1182)
INSURED
S