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FY1997 10/16/1996w • BRANCH OFFICE 3117 OVERSEAS HIGHWAY MARATHON, FLORIDA 33050 TEL (305) 289-6027 FAX (305) 289 -1745 Amp 1. RotbAge CLERK OF THE CIRCUIT COURT MONROE COUNTY 500 WHITEHEAD STREET KEY WEST, FLORIDA 33040 TEL. (305) 292 -3550 FAX (305) 295 -3660 BRANCH OFFICE 88820 OVERSEAS HIGHWAY PLANTA71ON KEY, FLORIDA 33070 TEL (305) 852.7145 FAX (305) SM -7146 MEMORANDUM TO: James Roberts County Administrator FROM: Ruth Ann Jantzen, Deputy Clerk DATE: November 14, 1996 On October 16, 19%, the Board of County Commissioners granted approval and authorized execution of the following documents between Monroe County and the following FY 97 Human Service Providers: Agreement between Monroe County and Monroe Association of Retarded Citizens, in the amount of $30,695.00. Agreement between Monroe County and Hospice of the Florida Keys, Inc., in the amount of $50,000.00. Also approved at the October 16th meeting was authorization to execute FY 1997 youth club agreements including an Agreement between Monroe County and Florida Keys Youth Club, in the amount of $30,000.00. Enclosed please find a fully executed duplicate original of each of the above Agreements for return to your providers. If you have any questions regarding the above, please do not hesitate to contact this office. Enclosure cc: County Attorney Fi anance File . t IF AGREEMENT This Agreement is made and entered into this /Gr day of CIOAG f 1996, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and HOSPICE OF THE FLORIDA KEYS, INC., hereinafter referred to as - 'M �d - "Provider." i 0 WHEREAS, the Board and the Provider desire to enter into an agreement waereir� !J Board contracts for services from the Provider in providing the medical, psychological, phys y , W C -/ and social needs of terminally ill persons and their families and to mobilize other F�mm@ity resources to meet such needs for the citizens of Monroe County, and WHEREAS, such services have been provided by the Provider in the past and have been invaluable to the citizens of Monroe County, and WHEREAS, such services will promote independence and home care for terminally ill persons, and WHEREAS, the Board recognizes the public purpose to be met by an agreement for services to be rendered in fiscal year 1996 -97, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: 1. AMOUNT OF AGREEMENT. The Board, in consideration of the Provider substantially and satisfactorily performing and carrying out the duties of the Board as to rendering services to the citizens of Monroe County, in matters of health and education in regard to the care of terminally ill persons, shall pay to the Provider the sum of Fifty Thousand Dollars ($50,000.00) for fiscal year 1996 -97. 2. TERM. This Agreement shall commence on October 1, 1996, and terminate September 30, 1997, unless earlier terminated pursuant to other provisions herein. 3. PAYMENT. Payment will be paid periodically, but no more frequently than monthly as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Florida Statutes 112.061 and Attachment A - Expense Reimbursement Requirements. Evidence of payment by the Provider shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a certification statement as well as a notary stamp and signature. An example of a reimbursement request cover letter is included as Attachment B. After the Clerk of the Board examines and approves the request for reimbursement, the Board shall reimburse the Provider. However, the total of said reimbursement expense payments in the aggregate sum shall not exceed the total amount of $50,000.00 during the term of this agreement. 4. SCOPE OF SERVICES. The Provider, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and carry out the duties of the Board in providing the medical, psychological, physical and social needs of terminally ill persons and their families and shall mobilize other community resources to meet such needs for the citizens of Monroe County, Florida. Said services shall include, but are not limited to, those services described in Provider's Details of Specific Program for Which Funding is Requested, attached hereto as Exhibit C and incorporated herein. 5. RECORDS. The Provider shall maintain appropriate records to insure a proper accounting of all funds and expenditures, and shall provide a clear financial audit trail to allow for full accountability of funds received from said Board. Access to these records shall be provided during weekdays, 8 a.m. to 5 p.m., upon request of the Board, the State of Florida, or authorized agents and representatives of the Board or State. The Provider shall be responsible for repayment of any and all audit exceptions which are identified by the Auditor General of the State of Florida, the Clerk of Court for Monroe 2 County, an independent auditor, or their agents and representatives. In the event of an audit exception, the current fiscal year contract amount or subsequent fiscal year contract amounts shall be offset by the amount of the audit exception. In the event this agreement is not renewed or continued in subsequent years through new or amended contracts, the Provider shall be billed by the Board for the amount of the audit exception and the Provider shall promptly repay any audit exception. b. INDEMNIFICATION AND HOLD HARMLESS. The Provider covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Provider occasioned by the negligence, errors, or other wrongful act or omission of the Provider's employees, agents, or volunteers. 7. INDEPENDENT CONTRACTOR. At all and for all purposes hereunder, the Provider is an independent contractor and not an employee of the Board. No statement contained in this agreement shall be construed so as to find the Provider or any of its employees, contractors, servants or agents to be employees of the Board. 8. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the Provider shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the Provider. 9. PROFESSIONAL RESPONSIBILITY AND LICENSING. The Provider shall assure that all professionals have current and appropriate professional licenses and professional liability 3 insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and /or federal certification and /or licensure of the Provider's program and staff. 10. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and /or reimbursement of services shall be amended by an agreement amendment, which must be approved in writing by the Board. 11. NO ASSIGNMENT. The Provider shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the Provider. 12. NON - DISCRIMINATION. The Provider shall not discriminate against any person on the basis race, creed, color, national origin, sex or sexual orientation, age, physical handicap, or any other characteristic or aspect which is not job - related in its recruiting, hiring, promoting, terminating or any other area affecting employment under this agreement. At all times, the Provider shall comply with all applicable laws and regulations with regard to employing the most qualified person(s) for positions under this agreement. The Provider shall not discriminate against any person on the basis of race, creed, color, national origin, sex or sexual orientation, age, physical handicap, financial status or any characteristic or aspect in its providing of services. 13. AUTHORIZED SIGNATURES. The signatory for the Provider below, certifies and warrants that: (a) The Provider's name in this agreement is the full name as designated in its corporate charter, if a corporation, or the full name under which the Provider is authorized to do business in the State of Florida. (b) He or she is empowered to act and contract for the Provider; and 4 (c) This agreement has been approved by the Board of Directors of the Provider if the Provider is a corporation. 14. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand - delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the other party as follows: For Board: Monroe County Attorney 310 Fleming Street Key West, FL 33040 For Provider: Liz Kem, President Hospice of the Florida Keys, Inc. 1319 William Street Key West, Florida 33040 Louis LaTorre, Social Services Director and Public Service Building 5100 College Road Key West, FL 33040 15. CONSENT TO JURISDICTION. This agreement shall be construed by and governed under the laws of the State of Florida and venue for any action arising under this agreement shall be in Monroe County, Florida. 16. NON - WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the Provider shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. 17. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the Provider. The Board shall not be obligated to pay for any services or goods provided by the Provider after the Provider has received written notice of termination, unless otherwise required by law. 5 18. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. 19. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the Provider and the Board. of the (SEAL) ATTEST: CLERK . � • �� W&WM �'-7&w&o I / witness Witness conshospice BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: Mayor /Chairmct HOSPICE OF THE FLORIDA KEYS, INC. (Federal ID No. .SJ!— - ?'F 8 ) A � By v � ExerUive Director APPROVED AS TO FOR AND LE AL SUFFICIE BY NNE A. U ON 5 � DATE p IN WITRE.SS *iIEREOF, the parties hereto have caused these presents to be executed as IaY:cTr first tten above. R PUB LIC ENTITY CRIME FORM - STATEMENT Any person submitting a bid or proposal in response to this invitation must execute the enclosed Form PUR 7068, SWORN STATEMENT UNDER SECTION 287.133(3) (A), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES, including proper check(s), in the space(s) provided, and enclose it with his bid or proposal on behalf of dealers or suppliers who will ship commodities and received payment from the resulting contract, it is your responsibility to see that copy(s) of the form are executed by them and are included with your bid or proposal. Corrections to the form will not be allowed after the bid or proposal opening time and date. Failure to complete this form in every detail and submit it with your bid or proposal will result in immediate disqualification of your bid or proposal. a SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE /J �`�i�� <<" ���' �t"/r► G warrant s that he/it has not employed retained or otherwise had act on his /its behalf any former County office,; or employee in violation of Section 2 of Ordinance No. 10 -1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10 -1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee. All (signature) Date: STATE OF COUNTY OF Subscribed and sworn to (or affirmed) before me on (date) by —_ /I ! Z 4" ey (name of affiant) . He /She is personally known to me. d 110T RY PUBLIC iz ru 454u96 EXPIRTS: July 21, 1999 MCPJ4 REV. 2/92 0 1 1 1 - """ ",""" tended Thru Notary Public Undenmiters "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." ATTACHMENT A Expense Reimbursement Requirements This document is intended to provide "basic" guidelines to Human Service Organizations, county travellers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from Florida Statute 112.061, which is attached for reference. A cover letter summarizing the major line items on the reimbursable expense -equest should also contain a certified statement such as: I certify that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners. Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all- inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to Stephanie Griffiths at 305- 292 -3528. Payroll: A certified statement verifying the accuracy and authenticity of the payroll expenses. If a Payroll Journal is provided, it should include: Payroll Journal dates employee name, salary, or hourly rate hours worked during the payroll journal dates withholdings where appropriate check number and check amount If a Payroll Journal is not provided the following must be listed: check number, date, payee, check amount support for applicable payroll taxes Original vendor invoices must be submitted for Worker's Compensation anc> :;ability insurance coverage. Telephone expenses: A user log of pertinent information must be remitted: the party called, the caller, the telephone number, the date, and the purpose of the call must be identified. Telefax, fax, etc.: A fax log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Supplies, services, etc.: For supplies or services ordered the County requires the original vendor invoice. Rents, leases, etc.: A copy of the rental agreement or lease is required. Deposits and advance p:.yments will not be allowable expenses. Postage, overnight deliveries, courier, etc.: A log of all postage expenses as it relates to the County contract is required for reimbursement. For overnight or express deliveries, the original vendor invoice must be included. Reproductions, copies, etc.: I A log of copy expenses as it relates to the County contract is required for r( imbursement. The log must define the date, number of copies made, source document, purpoe, and - ecipient. A reasonable fee for copy expenses will be allowable. For vendor services, the original vendor invoice is required and a sample of the finished product. Travel expenses: please refer to Florida Statute 112.061. Travel expenses must be submitted on a State of Florida Voucher for Reim. , lrsement of Travel Expenses. Credit card statements are not acceptable documentation for r• ;m. irsement. Airfare reimbursement requires the original passenger receipt portion of the airline � i cket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the original vendor invoice. Fuel purchases should be documented with original paid receipts. Original taxi receipts should be provided. However, reasonable fares will be reimbl ' rsed without receipts. Taxis are not reimbursed if taken to arrive at a departure point: for exal. ole, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Original toll receipts should be provided. However, reasonable tolls will be reimbursed without receipts. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. Lodging reimbursement requires a detail listing of charges. The original lodging invoice must be submitted. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls (see previous guidelines) are not allowable expenses. Per diem lodging expenses may apply. Again, refer to Florida Statute 112.061. Meal reimbursement is breakfast at $3.00, lunch at $6.00, and dinner at $12.00. Meal guidelines are that travel must begin prior to 6 am for breakfast reimbursement, before noon and end after 2pm for lunch reimbursement, and before 6pm and end after 8 pm for dinner reimbursement. Mileage reimbursement is calculated at 20 cents per mile for personal auto mileage while on i county business. Effective October 1, 1994, mileage will be reimbursed at 25 cents per mile. An odometer reading must be included on the state travel voucher for vicinity travel. A mileage map is attached for reference to allowable miles from various Florida destinations. Mileage is not allowed from a residence or office to a point of departure: for example, driving from one's home to the airport for a business trip is not a reimbursable expense. Data processing, PC time, etc.: I The original vendor invoice is required for reimbursement. Intercompany allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department (see Payroll above) are attached and certified. The following expenses are not allowable for reimbursement: penalties and fines non - sufficient check charges fundraising contributions capital outlay expenditures (unless specifically included in the contract) depreciation expenses (unless specifically included in the contract) SGRIFFITHS WP5I\PROCEDUR\ENP REIM ATTACHMENT B HUMAN SERVICE ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, Florida 33040 (Date) The following is a summary of the expenses for (Human Service Organization name ) for the time period of to Check # Pavee Reason Amount 101 A Company rent $ xxxx.xx 102 B Company utilities $ xxxx.xx 103 D Company phones $ xxxx.xx 104 Person A payroll $xx--x.xx 105 Person B payroll $xx �cx.xx (A) Total I SXXXX.XX (B) Total priorpayments $xxxx.xx r (C) Total requested and paid (A + B) $xxxx.xx (D) Total contract amount �xxxx.xx Balance of contract (D - C) I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any of her funding source. Executive Director Attachments (supporting documentation) Sworn and subscribed before me this — day of 199_. Notary Public Notary Stamp EXHIBIT 20 Details of specific Program for which Funding is Requested 21. Please give a one paragraph description of the agency program for which you are requesting funding. The priority thrust of this organization is to provide top quality, cost effective, sensitive services to residents of Monroe county who have life limiting illnesses. This funding request is for monetary support to assist the agency in caring for indigent residents who are terminally ill. With hospice care, most people can live their lives to the fullest and remain in their own places of residences through death. This approach, which comprehensively addresses and provides care relating to physical, social, emotional and spiritual needs, offers Monroe county families and friends the opportunity to remain together. To conclude there is no place like home. This organization does everything possible to make this a pleasant, safe and practical reality. Also, with strong supportive services made available by this applicant, programs (such as those for bereavement) continue for families well after a loved ones death. This type of specialized care is important to not only surviving family members and friends, but to the entire community. With assistance during the grieving process, people get on with their lives as productive, intact citizens. EXHIBIT 21 Details of Specific Program for which Funding is Requested 22. what need or problem in this community does this program address? Include your target population. Services for the terminally ill are targeted toward an anticipated 793 deaths of Monroe County residents for FY X96 -97 (estimated per figures given in a report by the Agency for Health care Administration, "Hospice Programs & Medicare Certified Home Health Agencies", 2/2/96). Particular attention is paid to several diagnoses which exceed the national norm by Monroe County (AIDS and several forms of cancer). other target populations include those with various forms of heart disease, stroke and infectious diseases such as pneumonia and influenza. EXHIBIT 22 Details of Specific Program for Which Funding is Requested 23. What data supports this need. Attach copies of any relevant documents or cite report. The program for which this applicant is requesting funding is included or implied in various priorities, as identified by HRS and the Health and Human Services Board for 11B (from the Needs Assessment and Strategic Plan Update - Monroe County, 1996). These priorities are as follows: 1. Control Disease. While this applicant is a direct care provider to those terminally ill, it's mission also includes education and supportive services (particularly to those with AIDS or cancer). 2. Reduce Substance Abuse. Assisting and supporting families dealing with grief, directly helps in limiting or eliminating problems with substance abuse. 3,4,5.Children will grow up in permanent families free from abuse and neglect. Persons with mental illnesses will be integrated into the community. Reduce teen pregnancy. Again, with supportive, professional services readily available during one of the most stressful periods of ones life (impending /actual loss of a loved one), the above potential problem areas will be greatly reduced. 8,9. Disabled adults and the elderly will be protected and maintained in their communities. vulnerable persons with developmental disabilities will be protected and will have productive lives. These two priorities are perhaps the most obvious reasons which support rationale for this applicants fundraising. All efforts are made to prevent institutionalization and to enable terminally ill people to remain at home in their community. Again, family members and significant others who also fit into the categories of disabled and elderly will be supported to be independent and self efficient to the extent possible. 10,11. Persons will possess economic self - sufficiency. Reduce infant mortality. With supportive and preventive services rendered to family members and significant others, along with care for the dying person, both of these potential problem areas are reduced or prevented. The other document which supports the need for services to the terminally ill and their families is the "1996 - Health Data SourceBook," South FL - District 11, published by The Health Council of South Florida. EXHIBIT 23 Details of Specific Program for Which Funding is Requested 24. Where is this program being offered? List all sites and hours of operation. This applicant offers services throughout Monroe County, 24 hours /day, 7 days /week, from three locations: 1319 William Street (MM 0.25) Key West, FL 33040 305/294 -8812 6799 Overseas Highway, #5 (MM 50) Marathon, FL 33050 305/743 -9048 92001 U.S. #1, (MM 92.1) Tavernier, FL 33070 305/852 -7887 In addition to services being offered during the organizations regular office hours (8 am - 5 pm), a minimum of three on -call registered nurses are available for direct care between closing time and opening time. Services are provided 24 hours /day (every day, including weekends and holidays).