01/20/1993 IF •
r $ .
Contract No. KG -351
1993 OLDER AMERICANS ACT ADVANCE /COST REIMBURSEMENT CONTRACT
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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
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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.
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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.
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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.
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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
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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.
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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.
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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:
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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.
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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
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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
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(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.
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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.
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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.
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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
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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
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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:
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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.
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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 —
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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