Miscellaneous BOARD OF COUNTY COMMISSIONERS
=-- MAYOR Keith Douglass, District 4
; Mayor pro tem Jack London, District 2
COUNTY O MONROE .�- I I: 4 1 W Harvey, District 1
KEY WEST FLORIDA 33040 ' sly Shirley Freeman, District 3
�3os� 294-4641 ' Mary Kay Reich, District 5
4 `+.r . �• :was
Social Services Nutrition Program ",, . 4 4.; •
5100 College Road, Wing 111 " •
Key West, FL 33040
(305) 292 -4522 ��
(305) 292 -4517 FAX '
January 20, 1998
Isabel DeSantis
Deputy Clerk
Monroe County Clerk's Office
500 Whitehead Street
Key West, Fla. 33040
Dear Ms. DeSantis
Enclosed please find a fully executed original copy of the 1998 OAA contract KG -851
between Monroe County and the Alliance for Aging, Inc.
Enclosed also are copies of the Certificate of insurance and Civil Rights Questionnaire
(DOEA Form 101), requested by the Alliance.
Should further documentation be needed, please let me know.
Sincerely,
Ramonita Garrido, Director
Monroe County Nutrition Program
enc.
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST
ALLIANCE FOR
Program/Facility Name County AAA AGING FOR DADE
MONROE COUNTY NUTRITION PROGRAM MONROE & MONROE COUNTIES.
Address
5100 COLLEGE ROAD Completed By RAMONITA GARRIDO PUBLIC SERVICE BLDG. WING III PROGRAM DIRECTOR
City, State, Zip Code KEY WEST, FLORIDA 33040 Date 1/15/98 Telephone
(305) 292 -4523
READ THE REVERSE SIDE FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU IN THE COMPLETION OF THIS FORM.
PART I. 1. Briefly describe the geographic area served by the program /facility and the type of service provided: PROVIDES
CONGREGATE, HOME DELIVERED MEALS, INFORMATION & REFERRAL WITHIN A RURAL
COUNTY, CONSISTING OF A STRIP OF SMALL TSLANT)S CONNECTED BY A MATN
HIGHWAY.
Z. POPULATION OF AREA SERVED. Source of data: 1990 CENSUS
Total # % White % Black % Hispanic % Other % Female
78,024 80 6 12 2 48
3. STAFF CURRENTLY EMPLOYED. Effective date: 12/31/97
Total # % White % Black % Hispanic % Other % Female % Handicap
9 34 23 34 12 78 12
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date: 12/31/97
Total # % White % Black % Hispanic % Other % Female % Handicap % Over 40 Yrs.
573 60 _15_ _.13 _2— 70 70 100
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE. N/A
Total # % White % Black % Hispanic % Other % Female % Handicap
PART II. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? If NA or NO, explain. N Y YES NO
7. Compare staff composition to the population. Are staff representative of the ❑ NA YES NO
population? If NA or NO, explain.
8. Compare the client composition to the population. Are race and sex characteristics NA YES NO
representative of the population? If NA or NO, explain. ❑ KJ ❑
9. Are eligibility requirements for services applied to clients and applicants without NA YES NO
regard to race, color, national origin, sex, age, religion or handicap? ❑ 121 ❑
If NA or NO, explain.
10. Are all benefits, services and facilities available to applicants and participants in NA YES NO
an equally effective manner regardless of race, sex, color, age, national origin, ❑ III 0
religion or handicap? If NA or NO, explain.
11. For in- patient services, are room assignments made without regard to race, color, NA Y NO
national origin or handicap? If NA or NO, explain.
Copies to Contract File and Provider Page 1 of 2
DOEA Form 101 -A, Jan 92
PART II. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
12. Is the program /facility accessible to non - English speaking clients? NA NO
❑ A YES
If NA or NO, explain. IN 0
13. Are employees, applicants and participants informed of their protection against NA YES NO
discrimination? If YES, how? Verbal Written Poster ❑ Cil
If NA or NO, explain.
14. Give the number and current status of any discrimination complaints regarding NA NUMBER
services or employment filed against the program /facility.
15. Is the program/facility physically accessible to mobility, hearing and sight impaired NA YES NO
individuals? If NA or NO, explain.
PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES N/A
16. Has a self - evaluation been conducted to identify any barriers to serving handicapped YES NO
individuals, and to make any necessary modifications? If NO, explain. ❑ ❑
17. Is there an established grievance procedure that incorporates due process into YES NO
the resolution of complaints? If NO, explain. ❑ ❑
18. Has a person been designated to coordinate Section 504 compliance activities? Y a
If NO, explain.
19. Do recruitment and notification materials advise applicants, employees and YES NO
participants of nondiscrimination on the basis of handicap? If NO, explain. ❑ ❑
20. Are auxiliary aids available to assure accessibility of services to hearing and YES NO
sight impaired individuals? If NO, explain. ❑ ❑
PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000 OR MORE. N /A
21. Do you have a written affirmative action program? If NO, explain. YES NO
❑ ❑
DOEA USE ONLY
Reviewed by
In Compliance: Yes ❑ No* ❑
Program Office
*Notice of Corrective Action Sent _ /_/_
Date Telephone
Response Due _ /_ /_
On -Site ❑ Desk Review ❑ Response Received _ /_ /_
Page 2 of 2
DOEA Form 101 -A, Jan 92
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST p p
Program/Facility Name m aN R o 6 co UN T y County 0 AAA ` I anc a •te r
�N- t-kDI'1►E SEg117�CtS rn01UR PI r, /111 ■tint
Sapp Co 1 1 efe, kc P By C � r v f sop
Address Completed B O t —
UJ TN 6
City, State, Zip Code W L S T FL- L 3 S D y D Date Telephone , 2q z
KEY �j
READ THE REVERSE SIDE FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU IN THE COMPLETION OF THIS FORM.
PART I. 1. Briefly describe the geographic area served by the program/facility and the type of service provided:
2. POPULATION OF AREA SERVED. Source of data:
Total # % White % Black % Hispanic % Other % Female
43. STAFF CURRENTLY EMPLOYED. Effective date: 12411 tell
/00
# � to % Black % Hispanic Other ! � Female 6 Handicap
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date: 12431 l qi
Total # % 'te % Black % Hispanic % Other % Female % Handicap % Over 40 Yrs.
/too a 1L4 C, :3 % , __2_ 100
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total # % White % Black % Hispanic % Other % Female % Handicap
PART II. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? If NA or NO, explain. NA YES NO
❑ ❑ ❑
7. Compare staff composition to the population. Are staff representative of the NA YES NO
population? If NA or NO, explain. ❑ ❑ ❑
8. Compare the client composition to the population. Are race and sex characteristics NA YES NO
representative of the population? If NA or NO, explain. ❑ ❑ ❑
9. Are eligibility requirements for services applied to clients and applicants without NA YES NO
regard to race, color, national origin, sex, age, religion or handicap? ❑ ❑ ❑
If NA or NO, explain.
10. Are all benefits, services and facilities available to applicants and participants in NA YES NO
an equally effective manner regardless of race, sex, color, age, national origin, ❑ ❑ ❑
religion or handicap? If NA or NO, explain.
11. For in- patient services, are room assignments made without regard to race, color, NA YES NO
national origin or handicap? If NA or NO, explain. ❑ ❑ ❑
Copies to Contract File and Provider Page 1 of 2
DOEA Form 101 -A, Jan 92 S
'PART II. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
12. Is the program/facility accessible to non - English speaking clients? N Y NO
If NA or NO, explain. NO
13. Are employees, applicants and participants informed of their protection against N❑A 0 S ❑
discrimination? If YES, how? Verbal Written Poster
If NA or NO, explain.
14. Give the number and current status of any discrimination complaints regarding NA NUMBER
services or employment filed against the program/facility.
15. Is the program/facility physically accessible to mobility, hearing and sight impaired NA YES NO
individuals? If NA or NO, explain. ❑ ❑ ❑
PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES
16. Has a self - evaluation been conducted to identify any barriers to serving handicapped Y NO
individuals, individuals, and to make any necessary modifications? If NO, explain.
17. Is there an established grievance procedure that incorporates due process into YES NO
the resolution of complaints? If NO, explain. ❑ ❑
18. Has a person been designated to coordinate Section 504 compliance activities? Y NO
If NO, explain.
19. Do recruitment and notification materials advise applicants, employees and YES NO
participants of nondiscrimination on the basis of handicap? If NO, explain. ❑ ❑
20. Are auxiliary aids available to assure accessibility of services to hearing and YES NO
sight impaired individuals? If NO, explain. ❑ ❑
PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000 OR MORE.
21. Do you have a written affirmative action program? If NO, explain. YES NO
❑ ❑
DOEA USE ONLY
Reviewed by In Compliance: Yes 0 No* 0
Program Office *Notice of Corrective Action Sent _ /_ /_
Date Telephone _ /_ /_
Response Due
Response Received — / —/—
On -Site 0 Desk Review ❑ Page 2 of 2
DOEA Form 101 -A, Jan 92
CERTIFICATE OF COVERAGE •
•
Certificate Holder Administrator Issue Date 1116198 NT
ALLIANCE FOR AGING, INC. Florida League of Cities, Inc.
9500 SOUTH DADELAND BOULEVARD, STE 400 Public Risk Services
MIAMI, FL 33156 P.O. Box 530065
Orlando, Florida 32853 -0065
COVERAGES , .
MS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO TIE DESIGNATED RIMIER FOR THE COVERAGE PERIOD INDICATE°. NOTWITISTANONG ANY REUV•REMIEN I.
TERM OA ca 0I11ON OF ANY HEREIN 1
CONTRACT SUMO! OR TO OTHER THE TERMS. WITH RESPECT
PEC AND NICliHI CONDITIONS CERTIMCATE MAY OE
AGREEMENT. S OR MAY PERTAIN. THE COVERAGE AFFORDED eY THE
COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST .
AGREEMENT NUMBER: EMIT 386 I COVERAGE PERIOD: FROM 1011197 1 COVERAGE PERIOD: TO 9/30/98 12:00 Midnight Standard Time
TYPE OF COVERAGE - LIABILITY TYPE OF COVERAGE • PROPERTY
General Liability 0 Buidings •
0 Basic Form
® Comprehensive General Liability, Bodily Injury. Properly �Spe14a1 Form
Damage and Personal Injury
® Errors and Omissions Liability ❑Personal Property
® Employee Benefits Program Administration Liability 0 Bask Form
® Medical Attendants'IMedieal Desoto's' Malpractice LiabiOy 0Speaal Form
® Broad Form Property Damage DAgreed Amount
El Law Enforcement Liability ❑ mod Ill $
® Underground, Explosion & Collapse Hazard Coinsurance %
❑ DBlanlud
0Spaafic
Limits of Liability Re Iacertlent Cost
5100.000 Each Person or 'Combined Single Limn P
5200,000 Each Occurrence .
EJActuat Cash Value
Deducted* 5 0 Miscellaneous
I:Illbnd Marine
Automob8e Liability .
DElaatronic Data Processing
•
® AS owned Autos (Priv. Pass.) 0BOnd
® All owned Autos (Other than Pm. Pass.)
® Hired Aules Limits of Liability on FIN with Administrator
® Non Owned Autos .
Omits of LIablUty
$100,000 Each Person or • Combined Sing* Limit
5200,000 Each Occurrence
Deductible $
Automobile/Equipment • Deductible
0Phys cal Damage $ Comprehensive • Auto $ COlisbn • Auto $ Miscellaneous Equipment
Other
•The limit of lability A 55,000,000 (Combined Single Limit) Bodily Injury and/or Properly Damage each occurrence in excess of a self•insured retention of
5100,000.Thes time Is solely for any lability resulting from entry of a claims bill pursuant to Section 768.28(5) Florida Statutes or liability imposed pursuant
to Federal Law or actions outside the Stale of Ronda.
Description of OperatioralLocadonJNehlciesSSP0Clal Items
RE: Contract KG-851 *_
•
•
THIS CERTIFICATE IS ISSUED As MUTTER OF NFORISAION ONLY AND CONFERS 140 RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER TIM COVERAGE AFFORDED SY THE AGREEMENT AI ME. E.
0ESGNATED 14141414014 CANCELLATIONS
SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT SE CANCELLED BEFORE THE
EXPIRATION GATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS
DONNA PEREZ WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED ABOVE, BUT FAILURE TO 14Ae
SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
RISK MANAGEMENT PROGRAM. ITS AGENTS OR REPRESENTATIVES.
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
5100 COLLEGE ROAD
KEY WEST FL 33040 —..%0 l
AUTHORIZED REPRESENT*
ANT-CERT (WNW
t
, Fea 1998 Agenc oon A A for Dade and Monroe Counties
Louis LaTorre, Executive Director .GEIVEO
A `A��� January 12 Monroe County Social Services
1F or 5100 College Road - Wing III
AGING, Key West, FL 33040 •�! 14.E
Inc.
M ocuoe Gax►tf
SUBJECT: CONTRACT KG -8514
Dear Louie:
OFFICERS,
Enclosed please find an executed copy of your 1998 OAA contract with the
WILLIS N. M L RR.A1' Alliance which awards your agency a total of $404,070 to provide the following:
President
RA_ IONA FRISCHNAN, Ed.D. SERVICE UNITS CLIENTS TOTAL AWARD
\ ire President Information 1,824 1,824 $ 6,289
c*.Ia1. MARY KAY REICH Referral 1,824 1,824 $ 5,638
E—retar Homemaker(III -D) 1,261 30 $ 28,764
Congregate Meals 22,000 200 $166,841
ROBERT EBERST Nutrition Ed. (C -1) 180 100 $ 6,642
Treasurer Outreach (C -1) 100 100 $ 9,770
Di � i� 1)i.�� P��T PRr ]D ES T Home Del. Meals 36,000 200 $175,628
Nutrition Ed. (C -2) 12 200 $ 4,498
C ARLOS NOBLE $404,070
This will be a unit cost contract and you will be reimbursed at the following rates
O_ARD MEMBERS up to the total amount awarded under each service category as follows:
ALBERT AFTER91AN
DONALD E. BAKER. Es SERVICE REIMBURSEMENT RATE
ROSLY ` 5ERR1N Information $ 3.447916
oNCH i T. BRETOS Referral $ 3.091008
CAROLINA CALDERIN
] 1I EL F1z1EDMA Homemaker (III -D) $ 22.810467
CHARLES GRAY Congregate Meals $ 7.583681
HON. ROBERT B. II\GRAM Nutrition Ed. (C -1) $ 36.90
NORMA LEMBERG Outreach (C -1) $ 97.70
BEN3SMINLEON
GENEVA MILLER Home Del. Meals $ 4.878555
JEAN JONES PERDUE, M.D. Nutrition Ed. (C -2) $374.833333
JULIA PRANSCHKE
'∎1 a RTIN URRA
.R. FREEMAN ; T �i 7 CHE Prior to the release of any contract funds, we will need you to provide us with
L. GEORGE YAP a Certificate of Insurance showing the extent of your liability coverage. We shall
also need a completed copy of the Civil Rights Questionnaire (DOEA Form 101).
A bl . s k copy with instructions is enclosed.
EXECUTIVE DIRECTOR
ioH \ L. STOKESBERRY, M.Ed. If you hay - any questions please call me at (305) 670 -6500, Ext. 223.
Sincerel ,
'0
Pedro Jove
Director of Administration
Enc.
)500 South Dadeland Boulevard, Suite 400, Miami, Florida 33156, Tel .(305) 670 - 6500, Suncom 455_6600
Fax (305) 670 - 6516, TDD (305) 670-7721