11/14/1990AMENDMENT # 1
THIS AMENDMENT, entered into between the Monroe County Board of County
Commissioners of Monroe County, Florida, as the governing body of the County
exercising supervision and control over Monroe County In Home Services, the
Community Care for the Elderly (CCE) and Community Care for Disabled Adults
(CCDA), Lead Agency for Monroe County, hereinafter referred to as the Lead
Agency, and Florida Health Nursing Services, Inc. hereinafter referred to
as Florida Health, amends the contract for 1989-90 as the second year option
agreed upon in that contract.
1. Page 4, Item 3 - A is hereby amended to read:
This contract shall commence on July 1, 1990 and *hall LO
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continue until June 30, 1991. o
2. This amendment shall begin on July 1, 1990. r, = c o
All provisions in the contract and any attachments thereto in2onfiict m :-D
CD
with this amendment shall be and are hereby changed to confortl�t;thi�j
amendment. c � r- n
All provisions not in conflict with this amendment are still I -A 'ef �gct gild
are to be performed at the level specified in the contract ardDher6Vy N
amended to conform with this amendment. G
This amendment and all its attachments are hereby made a part of the
contract.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment as
of this a day of 1990.
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS - MONROE COUNTY..
FLORIDA
r
BY:
MAYOR/CHAIRMAN OF THE BOARD OF
COUNTY COMMISSIONERS OF MONROE
COUNTY, FLORIDA.
DATE: '/-, 0/ 90
(SEAL)
ATTEST: DANNY L. KOHLAGE, CLERK
BY: P
CLERK
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A.^VD LEC:AL Bile
oly A orn^
FLORIDA HEALTH NURSING SERVICES, INC.
BY: /YliLL � 0"z
TSU A R
r
DATE:
(SEAL)
ATTEST:e
BY..
NOTARY PUBLIC STATE OF FLORIDA
MY COMMISSION EXP.'APR.20,1992
BONDED THRU GENERAL INS. UND.
,• }, r} SWORN STATEMENT UNDER SECTION 287.133(3)(a),
FLORIDA STATUTES ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER
AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted with Bid, Proposal or Contract No.
for MONROE COUNTY BOARD OF COUNTY COMMISSIONERS/IN HOME SERVICES
2. This sworn statement is submitted by FLORIDA HEALTH NURSING SERVICES, INC.
[name of entity submitting sworn statement]
whose business address is 715 Palermo Avenue
Coral Gables, Florida 33134 and
(if applicable) its Federal Employer Identification Number (MIN) is 5 9— 2 3 9 8 9 7 0
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
statement: .)
3. My name is JOBYNA L. OKELL and my relationship to the
[please print name of individual signing]
entity named above is TREASURER x
4. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes,
means a violation of any state or• federal law by a person with respect to and directly related to the
transaction of business with any public entity or with an agency or political subdivision of any other
state or with the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any other state
or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
5. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes,
means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of
guilt, in any federal or state trial court of record relating to charges brought by indictment or
information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty
or nolo contendere.
6. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes. means:
1. A predecessor or successor of a person convicted of a public entity crime: or
2. An entity under the control of any natural person who is active in the management of the
entity and Who has been convicted of a public entity crime. The term "affiliate" includes those
officers, directors, executives, partners, shareholders, employees, members, and agents who are active
in the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not for fair
market value under an arm's length agreement, shall be a prima facie case that one person controls
another person. A person who knowingly enters into a joint venture with a person who has been
convicted of a public entity crime in Florida during the preceding 36 months shall be considered an
affiliate.
7. i understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes. means any
natural person or entity organized under the laws of any state or of the United States with the legal
power to enter into a binding contract and which bids or applies to bid on contracts for the provision
of goods or services let by a public entity, or which otherwise transacts or applies to transact business
with a public entity. The term "person" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents who are active in management of an entity.
8. Based on information and belief, the statement which I have marked below is true in relation to the
entity submitting this sworn statement. [Please indicate which statement applies.]
Neither the entity submitting this sworn statement, nor any officers, directors, executives, ` f.
partners, shareholders, employees, members, or agents who are active in management of the entity, !
nor anv affiliate of the entity have been charged with and convicted of a public entity crime -
subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of the officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in management of
the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, _ 1989, AM [Please indicate which additional statement applies.]
There has been a proceeding concerning the conviction before a hearing- officer of
the State of Florida, Division of Administrative Hearings. The final order entered by the
hearing officer did not place the person or affiliate on the convicted vendor list. [Please
attach a copy of the final order.]
The person or affiliate was placed on the convicted vendor list. There has been a
subsequent proceeding before a hearing officer of the State of Florida, Division of
Administrative Hearings. The final order entered by the hearing officer determined that it
was in the public interest to remove the person or affiliate from the convicted vendor list.
[Please attach a copy of the final order.]
The person or affiliate has not been placed on the convicted vendor list. [Please
describe any action taken by or pending with the Department of General Services.]
61 ignature]
Date: �� �� % % ��
STATE OF FLORIDA
COUNTY OF /" "- '
PERSONALLY APPEARED BEFORE ME, the undersigned autUority,
.TnRYNA T.- nyF.LL. who, after first being sworn by me, affixed his/her signature
[name of individual signing]
in the space provided above on this day T 19�.
PUBLP.
My commission expires:
NOTARY PUBLIC STATE OF FLORIDA
NY COMMISSION EXP. APR.20,1992
BONDED THRU GENERAL INS. UND.
For: t PUR 7068 (Rev. 11/89)