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01/20/1993 IF • r $ . Contract No. KG -351 1993 OLDER AMERICANS ACT ADVANCE /COST REIMBURSEMENT CONTRACT • THIS CONTRACT is entered into between the Alliance for Aging, Inc., herein referred to as the Alliance, and Monroe County Board of Commissioners, hereinafter referred to as the "provider ". I. Provider Responsibilities A. Services to be Rendered: �- w The approved Service Provider application eor A lder Americans Act funds for January 1, 1993 to Decemberri3=1,` 199=8 and any revisions thereto approved by the Alliance are inCodrpbratpd-by 'reference as part of this legal agreement between the Miia cn e 4Tjd the provider and prescribe the services to be refia0i05 by the provider. _ ' c , , 3 rn o • B. Manner of Service Provision: ; ,, c.o The services will be provided in a manner consistent with and described in the provider's approved application for Older Americans Act funds and HRSM 140 -1 and HRSM 55 -1. In the event these manuals are revised, the contract will incorporate any such revisions and the provider will be given a copy of the revisions. C. Federal Laws and Regulations: 1. The provider shall comply with the provisions of 45 CFR, Part 74, and /or 45 CFR, Part 92, and other applicable regulations. 2. The provider shall comply with the provisions of the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA) code, 29 CFR, Part 1910.1030. 3. The provider shall comply with all applicable standards, orders, or regulations issued under Section 306 of the Clean Air Act, as amended (42 U.S.C. 1857 (h) et seq.), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368 et seq.), Executive Order 11738, and Environmental Protection Agency regulation (40 CFR Part 15). The provider shall report any violations of the above to the Alliance. 4. The provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment I. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may be obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager no more than 10 days after contract execution. D. Audits and Records: The Provider Agrees: 1. To maintain books, records, and documents (including electronic storage media) in accordance with accepted accounting procedures and practices which sufficiently and properly reflect • all revenues and expenditures of funds provided by the Alliance under this contract. 2. To assure that these records shall be subject at all reasonable times to inspection, review, audit, copy, or removal from premises by state personnel and other personnel duly authorized by the Alliance, as well as by federal personnel. 3. To maintain and file with the Alliance such progress, fiscal and other reports as the Alliance may require within the period of this contract. Such reporting requirements 'must be reasonable given the scope and purpose of this contract. 4. To submit management, program, and client identifiable data, as specified by the Department of Elder Affairs per the Management Information System policies. 5. To provide a financial and compliance audit to the ' Alliance as specified in Attachment II and to ensure that all related party transactions are disclosed to the auditor. 6. To include these aforementioned audit and record keeping requirements in all approved subcontracts and assignments. E. Retention of Records: The Provider Agrees: 1. To retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract for a period of five (5) years after termination of this contract, or if an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. 2. Persons duly authorized by the Alliance and federal auditors, pursuant to 45 CFR, Part 74.24 (a), (b), and (d), and 92.42(e) (1) and (2)shall have full access to and the right to examine any of said records and documents during said retention period or as long as records are retained, whichever is later. - 2 - F. Monitoring: The Provider Agrees: 1. To provide progress reports, including data reporting requirements as specified by the Alliance. These reports will be used for monitoring progress or performance of the contractual services as specified in the Service Provider Grant Application. • 2. To permit persons duly authorized by the Alliance to inspect any records, . papers, documents, facilities, goods and . services of the provider, which are relevant to this contract, and /or interview any clients and employees of the provider to be assured of satisfactory performance of the terms and conditions of . this contract. Following such inspection the Alliance will deliver to the provider a list of its comments with regard to the manner in which said goods or services are being provided. The provider will rectify all noted deficiencies provided by the Alliance within the ,specified period of time set forth in the comments, or provide the Alliance with a reasonable and acceptable justification for not correcting the noted shortcomings. The provider's failure to correct or justify within a reasonable time as specified by the Alliance may result in the withholding of payments, being deemed in breach or default, or termination of this contract. G. Indemnification: The Provider Agrees: Pursuant to F.S. 768.28 and subject to the limitations therein, to be liable for all claims, suits, judgments, or damages, including court costs and attorney's fees, arising out of the negligent or intentional acts or omissions of the provider, and its agents, subcontractors, and employees, in the course of the operation of this contract. Further, the provider agrees to indemnify the Alliance against all claims, suits, judgments, or damages, including court costs and attorney's fees, arising out of the negligent or intentional acts or omissions of the provider, and its agents, subcontractors, and employees, in the course of the operation of this contract. Also, the provider agrees to defend the Alliance, upon receiving timely written notification from the Alliance, against all claims, suits, judgments, or damages, including court costs and attorney's fees, arising out of the negligent or intentional acts or omissions of the provider and its agents, subcontractors, and employees, in the course of the operation of this contract. Where the provider and the Alliance commit joint negligent acts, the provider shall not be liable for nor have any obligation to defend the Alliance. In no event shall the provider be liable for or have any obligation to defend the Alliance against such claims, suits, judgments, or damages, including court costs and attorney's fees, arising out of the sole negligent acts of the Alliance. - 3 - • H. Insurance and Bonding: The Provider Agrees: 1. To provide adequate liability insurance coverage on a comprehensive basis and to hold such liability insurance at all times during the existence of this contract. The provider accepts full responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protection for the provider and the clients to be served under this contract. Upon the execution of this contract, the provider shall furnish the Alliance written verification supporting both the determination and existence of such insurance coverage. Such coverage may be provided by a self- insurance program established and operating under the laws of the State of Florida. The Alliance reserves the right to specify additional insurance requirements where appropriate. 2. To furnish an insurance bond from a responsible ,commercial insurance company covering all officers, directors, - employees and agents of the provider authorized to handle funds received or disbursed under this contract in an amount commensurate with the funds handled; the degree of risk as determined by the insurance company and consistent with good business practice. I. Safeguarding Information: The Provider Agrees: Not to use or disclose any information concerning a recipient of services under this contract for any purpose for any purpose not in conformity with the state regulations and federal regulations (45 CFR, Part 205.50), except upon written consent of the recipient, or the custodial parent or legal guardian of the recipient, as authorized by law. J. Assignments and Subcontracts: The Provider Agrees: To neither assign the responsibility of this contract to another party nor subcontract for any of the work contemplated under this contract without prior written approval of the Alliance. No such approval by the Alliance of any assignment or subcontract shall be deemed in any event or in any manner to provide for the occurrence of any obligation of the Alliance in addition to the total dollar amount agreed upon in this contract. All such assignments or subcontracts shall be subject to the conditions of this contract and to any conditions of approval that the Alliance shall deem necessary. K. Return of Funds To return to the Alliance any overpayments due to unearned funds or funds disallowed pursuant to the terms of this contract that were disbursed to the provider by the Alliance. The provider shall return any overpayment to the Alliance within twenty (20) calendar days after either discovery by the provider, or notification by the Alliance, of the overpayment. In the event - 4 - that the provider or its independent auditors discover an overpayment has been made, the provider shall repay said overpayment within twenty (20) calendar days without prior notification from the Alliance. In the event that the Alliance first discovers an overpayment has been made, the Alliance will notify the provider by letter of such a finding. Should repayment not be made in a timely manner, the Alliance will charge interest of one (1) percent per month compounded on the outstanding balance after twenty (20) calendar days after the date of notification or • discovery. L. Abuse, Neglect and Exploitation Reporting: The Provider Agrees: 1. In compliance with Chapter 415, F.S., an employee of the provider who knows, or has reasonable cause to suspect, that a child, aged person or disabled adult is or has been abused, neglected, or exploited, shall immediately report such knowledge or ,suspicion to the central abuse registry and tracking system of the Department of Health and Rehabilitative Services on the single statewide toll free telephone number (1- 800- 96ABUSE). 2. To treat as TOP PRIORITY any clients determined to be victims of abuse, neglect or exploitation by the Department of Health and Rehabilitative Services. M. Transportation Disadvantaged: The Provider Agrees: If clients are to be transported under this contract, the provider will subcontract with a designated Community Transportation Coordinator, in accordance with the provisions of Chapter 427, Florida Statutes, and Rule Chapter 41 -2, Florida Administrative Code. N. Procurement of Products or Materials with Recycled Content: The Provider Agrees: That any products or materials which are the subject of, or are required to carry out this contract shall be procured in accordance with the provisions of Section 403.7065, Florida Statutes. O. Civil Rights Certification: The provider gives this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DOEA forms 101 A and B, if services are provided to clients and if fifteen (15) or more persons are employed. - 5 - The Provider Assures that it will comply with: 1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq., which prohibits discrimination on the basis of race, color, or national origin in programs and activities receiving or benefiting from federal financial assistance. • 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal - financial assistance. 3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age'Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. Section 654 of the Omnibus Budget Reconciliation Act of 1981, as amended, 42 U.S.C. 9849, which prohibits discrimination on the basis of race, creed, color, national origin, sex, handicap, political affiliation or beliefs in programs and activities receiving or benefiting from federal financial assistance. 6. The Americans with Disabilities Act of 1990, 42 USC 12101, et. seq., which prohibits discrimination against, and provides equal opportunities for individuals with disabilities, in employment, public services, and public accommodations. 7. All regulations, guidelines, and standards as are now or may be lawfully adopted under the above statutes. 8. The provider further assures that all contractors, subcontractors, subgrantees, or others with whom it arranges to provide services will comply with the above laws and regulations. P. Requirements of Section 287.058, Florida Statutes: The Provider Agrees: - 6 - 1. To submit bills for fees or other compensation for services or expenses in sufficient detail for a proper pre -audit and post -audit thereof. 2. Where applicable, to submit bills for any travel expenses in accordance with Section 112.061, Florida Statutes. • 3. To provide units of deliverables, including reports, findings, and drafts as specified in-this contract to be received and accepted by the contract manager prior to payment. 4. To comply with the criteria and final date by which • such criteria must be met for completion of this contract as • specified in Section III, Paragraph A.2 of this contract. 5. To allow public access to all documents, papers, letters, or other materials subject to the provisions of Chapter 119, Florida Statutes, and made or received by the provider in . conjunction with this contract. Q. Withholdings and Other Benefits: The provider is responsible for Social Security and Income Tax withholdings. R. Sponsorship: 1. As required in Section 286.25, Florida Statutes, if the provider is a nongovernmental organization which sponsors a program financed wholly or in part by state funds, including any funds obtained through this contract, it shall in publicizing, advertising or describing the sponsorship of the program, state: "Sponsored by Monroe County Board of Commissioners PROVIDER and the State of Florida, Department of Elder Affairs." If the sponsorship reference is in written material, the words "the State of Florida, Department of Elder Affairs," shall appear in the same size letters and type as the name of the organization. 2. The contract manager's written approval is required prior to the provider's use of the name of the Department of Elder Affairs and the Alliance for solicitation of funds. S. Final Invoice and Expenditure Report: The Provider Agrees: 1. To submit a final invoice for payment to the Alliance no more than fifty (50) days after the contract ends or is terminated. If the provider fails to do so, all rights to payment are forfeited and the Alliance will not honor any requests submitted after the aforesaid period. Any payment due under the terms of this contract may be withheld until all reports due from - 7 - • the provider, and necessary adjustments thereto, have been approved by the Alliance. 2. To submit a final expenditure report to the Alliance within fifty (50) days after the contract ends or is terminated, on a form provided by the Alliance, identifying total payment received. T. Use of Funds For Lobbying.Prohibited: The Provider Agrees: To comply with the provisions of Section 216.347, Florida Statutes, which prohibits the expenditures of contract funds for the purpose of lobbying the Legislature or a state agency. II. Alliance Responsibilities A. Contract Amount To pay for contracted services according to the conditions of this contract in an amount not to exceed $465,549.00. Subject to the availability of funds, the Alliance will reimburse no more than a total dollar amount of $465,549.00 for expenditures made in accordance with the approved budget for Older Americans Act, Attachment III to this contract. The Alliance's performance and obligation to pay under this contract is contingent upon the availability of funds to the Alliance through its contract with the Department of Elder Affairs. The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. B. Contract Payment: Pursuant to Section 215.422, Florida Statutes, upon receipt of goods and services, the Alliance has five (5) working days to inspect and approve the goods and services, unless the bid specifications, purchase order or contract specifies otherwise. The voucher authorizing payment of an invoice submitted to the Alliance shall be filed with the Department of Elder Affairs not later than twenty (20) days after the receipt of the invoice and receipt, inspection and approval of the goods or services, except that in the case of a bona fide dispute the voucher shall contain a statement of the dispute and authorize payment only in the amount not disputed. Such approval is for the purpose of authorizing payments and does not constitute a final approval of services purchased under this contract. The date on which an invoice is deemed received is the date on which a proper invoice is first received at the place designated by the Alliance. A payment is deemed to be issued on the first working day that payment is available for delivery or mailing to the provider. If a warrant in payment of an invoice is not issued within forty (40) days, or thirty -five days for health care providers as defined in Rule Chapter 3A -24, Florida Administrative Code, after the receipt of the invoice and receipt, inspection, and approval of the goods and services, the Alliance shall pay to the provider, in addition to the amount of the invoice, interest at a rate of one - 8 - (1) percent per month calculated on a daily basis on the unpaid balance from the expiration of such forty (40) day period, or thirty -five (35) day period for health care providers as defined in Rule Chapter 3A -24, Florida Administrative Code, until such time that the warrant is issued to the provider. The temporary unavailability of funds to make a. timely payment due for goods or services does not relieve the Alliance from this obligation to pay interest penalties. • C. Vendor Ombudsman: A Vendor Ombudsman has been established within the Department of Banking and Finance. The duties of this individual include acting as an advocate for vendors who may be experiencing - problems in obtaining timely payment(s) from a state agency. The Vendor Ombudsman may be contacted at (904) 488 -2924 or by calling the State Comptroller's Hotline, 1- 800 - 848 -3792. III. Provider and Alliance Mutual Responsibilities A. Effective Date: 1. This contract shall begin on January 1, 1993 or on the date on which the contract has been signed by both parties, whichever is later. 2. This contract shall end on December 31, 1993. B. Method of Payment: 1. Payment shall be on an advance and reimbursement basis in accordance with HRSM 55 -1 and Attachment IV, Advance and Reimbursement Schedule, except that the forms used shall be those approved by the Alliance. All requests for payments will be made using forms approved by the Alliance. Expenditure reports will be submitted to support requests for payment, using forms approved by the Alliance. Duplication or replication of forms via data processing equipment is permissible; replications must include all data elements included on Alliance forms. 2. The provider may request a monthly advance for up to two months of the initial contract period in accordance with HRSM 55 -1 and Attachment IV. All payment requests for the remaining months shall be based on the submission of actual expenditure reports beginning with the first month of the contract in accordance with HRSM 55 -1. All advance payments are subject to the availability of funds. 3. The provider may request extraordinary cash in addition to the above advance requests in accordance with information contained in HRSM 55 -1 and Attachment IV to this contract. 4. Subject to the annual approval of the request for waiver of the provisions of 216.181(14) (a) F. S. by the State Comptroller's Office, all interest earned on the advance of federal funds my be retained by the provider for the purpose of expanding service provision in accordance with HRSM 55 -1, paragraph 4 -14. - 9 - Interest earned on federal funds must be used during the contract period earned or the subsequent contract period. All interest earned on advance of general revenue funds and federal funds must be reported on DOEA Form 105. Interest on the advance of general revenue is to be returned to the Alliance on a monthly basis. 5. Any payment due under the terms of this contract may be withheld pending the receipt and approval by the Alliance of all financial and programmatic reports due from the provider and any adjustments thereto. 6. All monies which have been paid to the provider which have not been used to retire outstanding obligations of the contract being closed out must be refunded to the Alliance along • with the closeout package which is due within fifty (50) days after the contract period ending date. 7. Financial Reports: The provider agrees to provide ,an accurate, complete and current disclosure of the financial results of this contract as follows: a. To submit all requests for payment and expenditure " reports according to the format, schedule and requirements specified by the Alliance. b. All invoices and reports shall be submitted to the contract manager for the Alliance at the following location: 9500 South Dadeland Blvd., Suite 400, Miami, FL 33156. c. To submit a complete and accurate DOEA Form 110, annual Service Cost Report to the contract manager within sixty (60) calendar days of December 31st. d. The completed Older Americans Act Annual Report is due to the contract manager on or by October 1, 1993. C. Termination: 1. Termination at Will: This contract may be terminated by either party upon no less than thirty (30) calendar days notice, without cause unless a lesser time is mutually agreed upon by both parties, in writing. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. 2. Termination Because of Lack of Funds In the event funds to finance this contract become unavailable, the Alliance may terminate the contract upon no less that twenty -four (24) hours notice in writing to the provider. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The Alliance shall be the final authority as to the availability of funds. - 10 - 3. Termination for Breach Unless the provider's breach is waived by the Alliance in writing, the Alliance may, by written notice to the provider, terminate this contract upon no less than twenty -four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. If applicable, the Alliance may employ the default provisions in Chapter 13A- 1.006(4), Florida Administrative Code. Waiver of breach of any provisions 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 this contract. The . provisions herein do not limit the Alliance's right to remedies at law or to damages. D. Suspension: 1. The Alliance may, for reasonable cause, temporarily suspend the use of funds by a provider pending corrective action, or pending a decision to terminate the award. Reasonable cause is such cause as would compel a reasonable person to suspend the use of funds pursuant to this contract; it includes, but is not limited to, the provider's failure to permit inspection of records, or to provide reports, or to'rectify deficiencies noted by the Alliance within the time specified by the Alliance, or to utilize funds as agreed in this contract, or such other cause as might constitute breach of any of the terms of this contract. 2. The Alliance may prohibit the provider from receiving further payments and may prohibit the provider from incurring additional obligations of funds. The suspension may apply to any part, or all of the provider's obligations. 3. To suspend operations of the provider, the Alliance will notify the provider in writing by Certified Mail of: the action to be taken; the reason(s) for such action; and the conditions of the suspension. The notification will also indicate what corrective actions(s) are necessary to remove the suspension. E. Notice and Contact The name and address of the contract manager for the Alliance for this contract is: John L. Stokesberry 9500 South Dadeland Blvd., Suite 400 Miami, FL 33156 The name and address of the representative of the provider responsible for administration of the program under this contract is: Louis LaTorre 1315 Whitehead Street Key West, FL 33040 In the event that different representatives are designated by either party after execution of this contract, notice of the name - 11 - • and address of the new representative will be rendered in writing to the other party and said notification attached to originals of this contract. F. Renegotiation or Modification 1. Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly signed. The parties agree to renegotiate this contract if federal and /or state revisions of any applicable laws, or regulations make changes in this contract necessary. 2. The rate of payment and the total dollar amount may . be adjusted retroactively to reflect price level increases and • changes in the rate of payment when these have been established through the appropriations process and subsequently identified in the operating budget of the Department of Elder Affairs. G. Special Provisions: 1. Match: Total provider match for this contract period will be at least $51,727.00. The provider's contribution will be made in the form of cash and /or in -kind resources. By the end of the sixth month of the contract period matching amounts provided must be in proper proportion to the Older Americans Act Funds expended. At the end of the contract period, all Older Americans Act Funds expended must be properly matched. 2. Non - Expendable Property: a. Nonexpendable property is defined as tangible property of a nonconsumable nature that has acquisition cost of $500 or more per unit, and an expected useful life of at least one year; and hardback bound books that are not circulated to students or the general public, the value or cost of which is $100 or more. Hardback books with a value or cost of $25 or more should be classified as an OCO expenditure only if they are circulated to students or to the general public. b. All such property, purchased under this contract shall be listed on the property records of the provider. Said listing shall include a description of the property, model number, manufacturer's serial number, funding source, information needed to calculate the federal and /state share, date of acquisition, unit cost, property inventory number and information on the location, use and condition, transfer, replacement or disposition of the property. c. All such property, purchased under this contract, shall be inventoried annually, and an inventory report shall be submitted to the Alliance along with the final expenditure report. A report of nonexpendable property shall be submitted to the - 12 - • Alliance along with the expenditure report for the period in which it was purchased. d. Title (ownership) to all nonexpendable property acquired with funds from this contract shall be vested in the Department of Elder Affairs upon completion or termination of the contract. e. Disposition of non - expendable property and unused supplies for a currently funded and /or terminated provider or service providers will be in accordance with instructions from the Alliance. f. A formal contract amendment is required prior to the purchase of any item of non - expendable property not specifically included in the approved Service Provider Application. g. Information Technology Resources The provider must adhere to the Department of Elder Affairs procedures and standards when purchasing Information Technology Resources (ITR) as part of this contract. ITR are data processing hardware, software, services, supplies, maintenance, training, personnel and facilities. The provider agrees to secure prior written approval from the Department of Elder Affairs Management Systems Director through the contract manager for the purchase of any ITR. The provider will not be reimbursed for any purchases made prior to this written approval. 3. Subcontracts: Approval by the Alliance of the 1993 Service Provider Grant Application shall constitute approval of the provider subcontracts if the subcontracts follow the service and funding information identified in the grant application. The provider must submit all contracts for services under the 1993 grant application to the Alliance for prior approval when the proposed subcontractor is a profit making organization. 4. Older Americans Act Funds: The provider and the Alliance agree to perform the services of this contract in accordance with all federal, state and local laws, rules, regulations and policies that pertain to Older Americans's Act funds. 5. Fees for Services: The provider assures that Older Americans Act paid staff will not assess nor collect fees from eligible clients for older Americans Act funded services. Fees for services not paid for with Older Americans Act funds may be charged of those persons who are able to pay for the cost of services. 6. Carry Forward Funds: - 13 - • t Federal fiscal year funding provided in this contract is subject to substitution by prior year's carry forward funds in accordance with procedures identified in Section 4 -15, HRSM 55 -1 or other procedures determined by the Department of Elder Affairs. The Alliance has the authority to re -award current year funds in excess of five percent which are deobligated by this process. This provision excludes senior center carry forward funds. 7. Copyright Clause: • • Where activities supported by this contract produce original writing, sound recordings, pictorial reproductions, drawings or other graphic representation and works of any similar nature, the Department of Elder Affairs has the right to use, duplicate and disclose such materials in whole or part, in any manner, for any purpose whatsoever and to have others acting on behalf of the Department of Elder Affairs to do so. If the materials so developed are subject to copyright, trademark, patent, then legal title and every right, interest, claim or demand of any kind in and to any patent, trademark, copyright, or application for the same, will vest in the State of . Florida, Department of State, for the exclusive use and benefit of the state. Pursuant to Section 286.021, Florida Statutes (1987), no person, firm or corporation, including parties to this contract, shall be entitled to use the copyright, patent or trademark without the prior written consent of the Department of State. 8. Grievance and Fair Hearings Procedures: The provider will utilize the fair hearing system outlined in 10A- 11.07(e) F.A.C. through which clients served by the provider under this contract may present a request for a fair hearing. 9. Investigation of Allegations: Any report that implies criminal intent on the part of a service provider agency and referred to the state attorney will be sent to the Department of Elder Affairs. The Alliance must investigate allegations regarding falsification of client information, service records, payment requests, and other related information. 10. Amendment and Changes: a. Budget changes and /or adjustments shall be made according to the provisions of HRSM 55 -1. b. Changes in the approved Service Provider Application for Older Americans Act funds not affecting the total contract amount are valid only when submitted in writing and approved by the Alliance and provider. - 14 - • c. Any reduction or increase in total contract amount must be authorized through a contract amendment. d. Either party may request negotiation to adjust the total amount of this contract. If this request is made by either party, the other party will be required to re- negotiate the total amount of this contract although these re- negotiations may not result in an adjustment, if the justification does not warrant it. • H. Name, Mailing and Street Address of Payee: 1. The name (provider name as shown on Page 1 of this contract) and mailing address of the official payee to whom the payment shall be made: Monroe County Board of Commissioners 1315 Whitehead Street Key West, FL 33040 • 2. The name of the contact person and street address where financial and administrative records are maintained: Louis LaTorre 1315 Whitehead Street Key West, FL 33040 I. All Terms and Conditions Included: This contract and its attachments as referenced, Attachment I: Certification Regarding Lobbying Attachment II: Financial and Compliance Audits Attachment III: Budget Attachment IV: Advance /Reimbursement Schedule Attachment V: Special Contract Provisions Attachment VI: Service Provider Application contain all the terms and conditions agreed upon by the parties. - 15 - • i IN WITNESS THEREOF, the parties hereto have caused this 22 page contract to be executed by their undersigned officials as duly authorized. PROVIDER: • -a,. Alliance for Aging for Dade and Monroe Counties Monro =L•' nt .a • o - ._, Toners ' � SIG BY: SIGNED BY(L, g _ N.* . Jack London NAME: JohrY / L. Stokesberry TITLE: Mayor TITLE: Executive Director DATED AS OF: t- a. O " al 3 DATED AS OF: , FEDERAL ID NUMBER: A ST: D KOL GE PROVIDER FISCAL YEAR ENDING DATE: December 31, 1992 APPROVED AS TO Fr r? • - GAL SUFFICIENT By 4 Data ✓ _ — 16 - a ATTACHMENT I CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENT The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or•on • behalf of the undersigned, to any person for influencing or attempting . to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal grant, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil pen. aL,not less than $10,000 and not more than $100,000 for each such fa' e. ' ‘;;;;:!";;4e de ''''s c�• ° t3 40 - ignature Date Jack London KG -351 Name of Authorized Individual Application or Contract Number Monroe County Board of Commissioners ATTEST: DANNY L. KOLHAGE 1315 Whitehead Street Key West, FL 33040 , LLLC • ' Q. 4 4 4 r ,,p) Name and Address of Organization DOEA 103 APPROvFD AS T'? F ^r'M By • _ Date _____4Xj3e1 9°l - 17 - { ATTACHMENT II • FINANCIAL AND COMPLIANCE AUDITS This attachment is applicable, if the provider or grantee hereinafter referred to as provider, is any local government entity, nonprofit organization, or for - profit organization. PART I: SINGLE AUDIT This part is applicable if the provider is a local government entity or nonprofit organization and receives a total of $25,000 or more from the Alliance during its fiscal year. The provider has "received" funds when it has obtained cash from the Alliance or when it has . • incurred expenses which will be reimbursed by the Alliance. The provider agrees to have an annual financial and . compliance audit performed by independent auditors in accordance with the current Government Auditing Standards ( "Yellow Book ") issued by the Comptroller General of the United States. Local governments shall comply with Office of Management and Budget (OMB) Circular A -128, Audits of State and Local Governments. Nonprofit providers receiving federal funds passed through the Alliance shall comply with the audit requirements contained in OMB Circular A -133 , Audits of Institutions of Higher Learning and Other Nonprofit Institutions, except as modified herein. Such audits shall cover the entire organization for the organization's fiscal year, not to exceed 12 months. The scope of the audit performed shall include the financial audit requirements of the "Yellow Book ", and must include reports on internal control and compliance. The audit re P p report shall include a schedule of financial assistance that discloses each state contract by number. An audit performed by the Auditor General shall satisfy the requirements of this attachment. Compliance findings related to contracts with the Alliance shall be based on the contract requirements, including any rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation showing whether or not matching requirements were met. All questioned costs and liabilities due to the Alliance shall be calculated and fully disclosed in the audit report with reference to the Alliance contract involved. These requirements do not expand the scope of the audit as prescribed by the "Yellow Book ". If the provider has received any funds from a grants and aids appropriation, the provider will also submit a compliance reports(s) in accordance with the rules of the Auditor General, chapter 10.600, and indicate on the schedule of financial assistance which contracts are funded from state grants and aids appropriations. Copies of the financial and compliance audit report, management letter, and all other correspondence, if any, related to audits performed by independent auditors, other than the Auditor General, shall be submitted within 180 days after the end of the provider's fiscal year, unless otherwise required by Florida Statutes, to the following: A. Contract Manager for the Alliance John L. Stokesberry Executive Director Alliance for Aging, Inc. 9500 South Dadeland Boulevard, Suite 400 Miami, FL 33156 B. Submit to this address only those reports prepared in accordance with OMB Circular A- 133: Federal Audit Clearinghouse U.S. Bureau of the Census Jeffersonville, Indiana 47132 C. Submit to this address only those reports prepared in accordance with the rules of the Auditor General, chapter 10.600: Jim Dwyer Office of the Auditor General P.O. Box 1735 Tallahassee, Florida 32302 The provider shall ensure that audit working papers are made available to the Alliance, or its designee, upon request for a period of five years from the date the audit report is issued, unless extended in writing by the Alliance. DOEA -104A 9/30/92 — 1.8 — • • PART 11 : GRANTS AND AIDS AUDIT /ATTESTATION This part is applicable if the provider is awarded funds from a grants and aid appropriation, and is either (1) a local government entity or nonprofit organization receiving a total of less than $25,000 from the Alliance during its fiscal year or (2) a for - profit organization receiving any amount from the Alliance. The provider has "received" funds when it has obtained cash from the Alliance or when it has incurred expenses which will be reimbursed by the Alliance. If the amount received from grants and aids appropriation awards exceeds $100,000, the provider agrees to have an audit performed by an independent certified public accountant and submit a compliance report(s) in accordance with the rules of the Auditor General, chapter 10.600. The audit report shall include a schedule of financial ,assistance that discloses each state contract by number and indicates which contracts are funded from state grants and aids appropriations. Compliance findings related to contracts with the Alliance shall be based on the contract requirements, including any rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation showing whether or not matching requirements were met. All questioned costs and liabilities due to the Alliance shall be calculated and • fully disclosed in the audit report with reference to the Alliance contract involved. If the amount received from grants and aids appropriation awards exceeds $25,000, but does not exceed $100,000, the provider may have an audit as described above or have a statement prepared by an independent certified public accountant which attests that the provider has complied with the provisions of all contracts funded by a grants and aids appropriation. If the amount received from grants and aids appropriation awards does not exceed $25,000, the provider will have the head of the entity or organization attest, under penalties of perjury, that the organization has complied with the provisions of all contracts funded by a grants and aids appropriation. Copies of the audit report and all other correspondence, if any, related to audits performed by the independent auditor, or the attestation statement, shall be submitted within 180 days after the provider's fiscal year end to the following: A. Contract Manager for the Alliance John L. Stokesberry Executive Director Alliance for Aging, Inc. 9500 South Dadeland Boulevard, Suite 400 Miami, FL 33156 B. Jim Dwyer Office of the Auditor General P.O. Box 1735 Tallahassee, Florida 32302 The provider shall ensure that audit working papers are_made available to the Alliance, or its designee, upon request for a period of five years from the date the audit report is issued, unless extended in writing by the Alliance. PART III: NO AUDIT REQUIREMENT This part is applicable if the provider is not awarded funds from a grants and aids appropriation, and is either (1) a local government entity or nonprofit organization receiving a total of less than $25,000 from the Alliance during its fiscal year or (2) a for - profit organization receiving any amount from the Alliance. The provider has "received" funds when it has obtained cash from the Alliance or when it has incurred expenses which will be reimbursed by the Alliance. The provider has no audit or attestation statement required by this attachment. DOEA -1048 9/30/92 • • — 19 — - 411111111111111111 -11111111111111111 i • s, ..,,, x i. • •■1 RI • r4 IT • O - CO O O er 0 O O O O : O O O O O O 0 M N O 0 0 n n r- M co) r) co e 1 en to •-4 r1 r) O co 0o o n H • ' H at o 0 0 N CO . • .f H ri N N N ri • 41} V} V} V} V} V} V) th V} V} V} Vr ilk V} V} IA V} V} . . ' N r1 0 0 0 0 0 r) 0 N 0 CO O CO n 1-1 0 a1 N • co H O 0 ri 10 tp . k0 U in co •41 r1 W M 0 N O e n 0 0 N r1 0 N 0 Ca H •1 N • er to co co l'' O 1D Op to Q H a1 n H N I-1 to 1-i ,-1 N r•1 D • V) V} V} V} V} » t!} VI V} V} (1} Vr V} V} V} V) V} . H M H p4 • r♦ A 1 N tL) 0 N 0 0 ri 0 at 0 0 e)' e1' N N 0 '.0 W C.) 01 to N tf) N to In er a1 ri CO O d' th H H H t0 0 01 I's er u1 er .4 tf 0 K1 0 N r1 H H • • • • N � H U) r1 r'1 d o • co r{ N 0 r1 01 V N ri r-1 rOi N ("1 rN ri -4 1 in in in V} in in V} . in VI V} V} V} v} V} V} V>' V1' V} 0 . 1 C N Q 1 H 04 W to (l co N O t O O O O ri O d' M N 0 N 0 M er M W H 0 rt 0 N 0 o 0 •:), r•1 ttl W ' 0 N 4 g 1-1 N N e1' In 111 Q'. 0 H G '-4 N r1 d' H a1 0 0 r1 LO ri CI A !n N N N N N H r1 rO•c • o g y r v! in v} VI v} V} VI V} 0 0 0 V} V} V} yr V} V} ' M at U _ - Q► rl W • C) to N 'd ' 4 o N - 4 • ro V) • C) r id U cal) 0 N 4) 0 cd o •,./ D U U H u�i p4 + b4 a) iv 4► >~ • v w 'Pi 0 v) Q 0 a) Z CD 0 w 0 b 4-1 d c V 'r H '0 O b k 0 o 0 0 •� g 0) ) 4) 'd m > w Z 0 o 1 ••• a • IZI , (3 4) ° � a 0 ,t } w .. > =� ro a) a 0 4) 4 4 '0 0 0 0 4) W N 0 4) .. a E4 w U a N X u) 0 H E-1 as E�1 4 Z 4 a w H >4 4 • , • ATTACHMENT IV CONTRACT REPORT CALENDAR ADVANCE BASIS CONTRACT • TITLE III Submit to State on Report or Before Number Month Based On Date 1 January Advance* January 1 2 February Advance* January 5 3 March January Expenditure Report February 5 4 April February Expenditure Report March 5 5 May March Expenditure Report April 5 6, June April Expenditure Report May 5 7 July May Expenditure Report June 5 8 August June Expenditure Report July 5 9 September July Expenditure Report August 5 10 October August Expenditure Report September 5 11 November September Expenditure Report October 5 12 December October Expenditure Report November 5 13 November Expenditure Report December 5 14 December Expenditure Report January 5 15 Final Payment Request February 21 16 Final Closeout Package February 21 Legend: * Advance based on projected cash need. Submission of expenditure reports may or may not generate a payment request. If the closeout package reflects funds due back to the Alliance, payment is to accompany the report. - 21 - s • ATTACHMENT V SPECIAL CONTRACT PROVISIONS 1. All service providers agree to submit to the Alliance on an annual basis, and no later than March 31 a disaster preparedness plan which will include as a minimum, the following: • a. Activities undertaken to educate clients and the community regarding disaster preparedness and the needs of the elderly. .F b. Activities undertaken to identify the special needs of clients and how these will be met in the event of a disaster. c. Activities undertaken to participate with local, municipal and county agencies to assist in the development of local disaster preparedness plans which include the special needs of the elderly. d. Specific plans developed for the continuation and /or suspension and resumption of service in the event of a disaster. v:\cm \dk \oaa\KG351MC.CON 5 k - 22 - AREA AGENCY ON AGING FOR DADE & MONROE COUNTIES EMERGENCY CERTIFICATION FOR RETROACTIVE PAYMENT ALLIANCE RE: 1993 Older Americans Act Contract # KG -351 For AGING BACKGROUND: I nc. Prior to signoff, all contracts must be approved at a regularly scheduled meeting of the Monroe County OFFICERS Board of Commissioners. ROSEBUD FOSTER, R.N., Ed. D. Presiders The 1993 OAA contract was scheduled to be discussed MELVIN LEVITT, Esquire at . the Commission's last scheduled meeting of 1992 Secretory (in December) . The meeting was canceled. As a CARLOS NOBLE result, Monroe County's Older Americans Act contract Treasurer for 1993 was not able to be executed until BOARD MEMBERS February 18, 1993. HON. MATILDE AGUIRRE OSCAR BATSMAN JUSTIFICATION: ROSLYN BERRIN FRANK CASTANEDA Monroe County's Department of Social Service is the HON. A. EARL NIICKCOPPOLAHEAL sole provider of Older Americans Act services in HENRYFIALLO Monroe County. Since January 1st, the following CHARLES A. FRANKENHOFF services have been provided to eligible clients WIFREDO GORT without an executed contract: HON. CARRIE P. MEEK GENEVA MILLER _ WILLIS N. MURRAY Titl III-B: Title IIIC -2: ELLENOPPENHEIMER Information Home Delivered Meals JEAN JONES PERDUE. M.D. Referral CAROL RENICK Transportation. CARLOS SABATER, C.P.A. JOSE T. SANCHEZ, M.D. RODNEYTHAXTON,Esquire Title IIIC -1: Title III -D: MARTIN URRA Congregate Meals Home Health Aide HENRIETTA WATERS Nutrition Education J.A. ZISKIND. Esquire Outreach EXECUTIVE DIRECTOR JOHN L. STOKESBERRY CERTIFICATION: I hereby find that this situation constitutes an emergency thereby justifying that payment be made on the contract between the Alliance for Aging and the Monroe County Board of Commissioners retroactive to January 1, 1993. ALLIANCE FOR AGING lA BY: �O' /, NAME: John L. Stokesberry Or TITLE: Executive Director DATE: 9 //S 93 v: \rm \dk \mcemerg.doc 9500 South Dadeland Blvd. • Suite 400 • Miami, Florida 33156 • (305) 670 -6500 Fax (305) 670 -6516 "An Equal Opportunity Employer" COMMITMENT OF IN -KIND (F CONTRIBUTION OF SERVICES BY STAFF OF SERVICE PROVIDER OR STAFF • MEMBERS _ • �. . OF OTHER ORGANIZATION; TO: Monroe County Older Americans' Transportation Program • . • - (name oz provider agency). . - .- . FROM: MDnr e County Board of County Commissioners • = L _ . • (donor name) • • - 1315 Whitehead Street Kev West Monroe •(street address) . (city) . (county) • • The below described persoral services are committed for use by your project for the period January 1,1992 to December 1. .499 2 _ (from) , . (unti.l) Description of Positions ' • . Hourly Rate or . Value to • -Position Title - Annual Salary #Hrs. Worked Project* !! 1) Transportation Director $ 32140.42 ,,, i d $ 3, 360 • 2) - - -- Admin. Assistant 19,921.95 194 2,197.00 . -3) Area c.:oord. (Marathon) 29 , 270.00 • 139.8 . 1, 998.00 . — tee l word. 4) Area ord. (Plantation, 25,173.72 140_A1 1,698.00 5) --- =-- . —. • Total $ • * Value to project = (# of hours provided) x (Hourly rate of • Annual Salary). 2080 . . It is certified that the time devoted to the project will be . perforated during normal working hours. • These services are not included as contributions for any other federally assisted program or any federal contract'and are not• ••!' borne by the•federal government directly or indirectly under any federal grant or contract except as provided for under (cit_ a h authorizing federal reculation or law). , Monroe County Board of County Commissioners Donor Donor Signature • • ft Post /. ll Date . l (S Attest: DANNY L. KOLHAGE, Clerk • . _ .Ntaftedite‘AL4A__ 4 `r...�, . • n •.. • { Availability Of Documents The undersigned hereby gives full assurance that the following documents are maintained in the administrative office • of the provider agency and will be filed in such a manner as to ensure ready access for inspection by. the DOEA, AAA or its designees) at any time. The agency will furnish copies of these documents to the AAA Contract Manager upon request for maintenance in the AAA. • 1. Current Board Roster. • 2. Site List (Congregate Meal Providers Only) 3. Articles of Incorporation 4. Corporate By -Laws • 5. Advisory Council By -Laws and Membership. 6. Corporate Fee Documentation 7. Insurance Coverage Verification • • 8. Bonding Verification • 9. ' Staffing Plan a. Position Description b. Pay Plan • c. Orc}anizational Chart • d. Executive Director Resume 10. Personnel Policies Manual 11. Financial Procedures Manual 12. Functional Procedures Manual 13. Affirmative Action Plan 14. Interagency Agreements 1 15. Equipment Inventory J 16. Program Income and Contributions System 17. Catering and Other Subcontracts Certified By Authorized Agency Official: I hereby certify that the documents identified above currently exist and are properly maintained in the administration office of this agency. Assurance is given that the Area Agency on Aging or its designee(s) will be given immediately access to these documen , upon request. x . %�% • -�.y�� _ 'lCr -• Name: Jack London ate: / -d 0 -9J Title: Mayor (Seal) Attest: DANNY L. KOLHAGE, Clerk 44 aA 24) • •j ` f SECTION 504 ASSURANCE (H_A.NDICA ?PED) I DEPARTMENT OF HEALTH AND HUMAN SERVICES ASSURANCE OF COMPLIANCE WITH SECTION 504 OF THE REHABILITATION ACT OF 1973, AB AMENDED . the undersigned (hereinafter called the "recipient" HEREBY AGREES THAT it will comply with Section 504 of the Rehabilitation. Act of • 1973, as amended (29 U.S.C. 794), all requirements imposed by the applicable HHS regulation (45 C.F.R. Part 84), and all guidelines. - and interpretations issued pursuant thereto. . Pursuant to 84.5(a) of the regulation [45 C.F.R. 84(a)], the recipient gives this Assurance in consideration of,and for.the _ purpose of obtaining any and all federal grants, loans; contracts, (except procurement contracts and contracts of insurance or guaranty), property, discounts, or other federal financial assistance extended by the Department of Health and Human Services . after the date.of the Assurance, including payments or other assistance made after such .date on applications for federal financial assistance that were approved before such date. The recipient recognizes and agrees that such federal financial assistance will be extended in reliance on the representations and agreements made in his Assurance and that the United States will have the right to enforce this Assurance through lawful means. . This Assurance is binding on the recipient, its successors, transferees, and assignees, and the person or persons whose . signatures appear below are authorized to sign this Assurance cn behalf of the recipient. )This Assurance obligates the recipient for the period during whit: federal financial assistance is extended to it by the Department of Health and Human Services or provided for in 84.5(b) of the regulation (45 C.F.R. 84.5(b)). The recipient: • a. (X) employs fewer than fifteen persons; b. ( ) employs fifteen or more persons and pursuant to 84.7(a) of the regulation (45 C.P.R. 84.7(a)), has designated the following person(s) to coordinate its efforts to comply with the HHS,regulation:. ' Na^e of Designee (s) Monroe County Board of County Commissioners Recipient: Street Address: 310 Fleming Street City: Key West State: Florida Zip: 33040 IRS Employer I.D. Number: 03- 00021 -0354 Signature .. Title of Authorized Official: X�.-7 Date: 1 20 Title• ayor I certify that the above information is complete and correct to the l ') best of my knowledge. - (Seal)' Attest: DANNY L. KOLHAGE, C rkJ /�' • n4ak_41.4‘....,_,4:14,4„,r2tbfr ____ i • OAA TITLE III GENERAL ASSURANCES 45 CFR 1321 subcart D - Service Requirements 1321.65 Responsibilities of Service Providers under Area Plans. Service•Providers assure that they will: 1321.65 (a) Provide the Area Agency on Aging, in a timely • • . manner, statistical and other information Which the Area Agency . on Aging requires in order to meet its planning, coordination, evaluation and reporting requirements established by the State under 1321.13. • 1321.65 (b) Specify how the provider intends to satisfy the service needs of low- income minority individuals in the area served in at least the•proportion to the number of low- income . • .. minority older persons in the population served by the provider. : 1321.65 (c) Provide recipients with an opportunity to contribute to the cost of the service as provided in 1321.67. 1321.65 (d) With the consent of the older person, or his or her • representative, bring to the attention of appropriate officials for follow -up, conditions or circumstances which place the older person, or the household of the older person, in imminent danger. 1321.65 (e) Where feasible and appropriate, make arrangements 1 for the availability of services to older persons in weather J related emergencies. 1321.65 (f) Assist participants in taking advantage of benefits under other programs. 1321.65 (g) Assure that all services funded under this part, (of 45 CFR 1321), are coordinated with other appropriate services in the community, and that thasa service do not constitute an unnecessary duplication of services provided by other sources. , '' • Provider Na..: Monroe County Board of County Commissioners Address: 310 Fleming Street Key West, Florida 33040 I.D. Number: 03- 00021 -0354 Signature o Authorised Official: X _-, DATE: i'•20 X73 . Titl - Mayor 1 eel) J ) Attest: DANNY L. KOLHAGE, Cl J2 zd - �� . • CIVIL RIGHTS ASSURANCE 111 • l ,. ASSURANCE OF COMPLIANCE WITH THr DEPARTMHNT OF HEALTH AND HUMAN SERVICES REGULATION UNDER 1 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 • Monroe County Board of County Commissioners , ( ( "Applicant ") •r.EREBY AGREES THAT it will comply with Title VI of the Civil Rights Act of 1964 (P.L. 88 -352) and all requirements imposed by . or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 80) issued pursuant to the title, tp • the end that, in accordance with Title VI of that Act and Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department; and HEREBY GIVES ASSURANCE THAT it will immediately • • take any measures necessary to effectuate this.agreement. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the • Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar service or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. In all other cases, this assurance • J shall obligate the Applicant for the period during which the Federal financial assistance is extended to it by the Department. THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts, property, discounts or other Federal financial assistance extended after the • date hereof to the Applicant by the Department, including installment payments after such date on account of the applications for Federal financial assistance which were approved before such date. The Applicant recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in this assurance, and that the United States shall have the right to seek judicial . enforcement of this assurance. This assurance is binding on the Applicant, it's successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign t ' assurance on behalf of the Applicant. le � `'y'Z� i Date: 1_2 _ ?3 . T e : Mayor Signature and Title of Authorized Official (Seal) _:.> Attest: DANNY L. KOLHAGE, Cler rJ i • Commitment of Cash Donation • E Agency Name: Monroe County Board of County Commissioners Donor Identification: • Name Jack London Street Rt. 2 Box 674B - .Alamo Building - Suite B • City Summerland Key State' Zip 33042 305- 294 -4641 Phone • • • • Authorized Representative: Amount/ • • Total Amount �. . Payments Payment 119_454.79 1 = � Contribution Period 79,754.79 01/01/93 - 12/31/93 Special Conditions: • • Donor Certification: l l I hereby certify intent to make the cash donation set t forth above for use in the specified program to use during the program's upcoming funding period. This cash is not included as contribution for any other State or Federal assisted or any Federal contract and is not borne by the Federal Government directly under any Federal grant or contract. 7 • ature of Donor or Representative { (Date) (Seal) Attest: DANNY L. KOLHAGE, Clerk s � 1 -,,' ��i SERVICE PROVIDER • SUMMARY INFORMATION PAGE 1. PROVIDER INFORMATION 2. GOVERNING BOARD CHAIR: Executive Director: (Name /Address /Phone) Jack London Louis LaTorre Rt. 2 Box 674B -Alamo Building . Summerland - Key, F1. 33042 • a. Name of Grantee Agency Monroe Co..Board of County Comm Legal Name of Agency: . Monroe County Board of County Commissioners 3 • ADVISORY COUNCIL CHAIR: (if applicable) • Mailing Address: (Name /Address /Phone)• 310 Fleming Street N/A • Key West, FL 33040 • Telephone: (305) •294 - 4641 5. TYPE OF AGENCY/ • 4. PROVIDER STAFF RESOURCES: ORGANIZATION: • Private . Publicg UNPAID STAFF IPAID Full Part Private for Profit STAFF — SCEP [OAA TITLE V] 6.PROPOSED PERIOD OF FUNDING Positions Assigned: Total 12 9 01/01/93 - 12/31/93 • Age 60+ 3 1 • Female 2 3 Total Budgeted Minority 5 4 [X] Continuati [ ] New Applicant • Volunteer Hours: Handicap 0 0 on 7. FUNDS REQUESTED: [ x ] OAA Title IIIB X [ x ] OAA Title IIIC -1 [ 3 OAA Title IIID [ ] USDA [ x ] OAA Title IIIC -2 t • 8. SERVICE AREA: (x ) Entire County Selected Communities of the County. Specify: Monroe Count • • • 9. ADDRESS FOR PAYMENT CHECKS ITEM #: [X ] #i [ ] #2 10. CERTIFICATION BY AUTHORIZED AGENCY OFFICER: I hereby certify that the contents of this document are true, accurate and complete statements. I acknowledge that intentional misrepresent- tion or falsification may result in the teri of financia a assistance. 1 if ,_ Name- •Jack London �" i___ ....3._.______—... Title: Mayor. ' 1 (Seal) Attest: DANNY L. KOLHAGE, Clerk 1 I sat&Z.C.4&42.r.41) • r