06/20/2012 AgreementDANNY L. KOLHA GE
CLERK OF THE CIRCUIT COURT
DATE: June 21, 2012
TO: Sheryl Graham, Director
Social Services Department
ATTN: Dotti Albury,
In Home Services
FROM. • Pamela G. Hanc k D. C.
At the June 20, 2012, Board of County Commissioner's meeting, the Board granted
approval and authorized execution of the following:
Item C8 Alzheimer's Disease Initiative (ADI) Contract KZ1297 between the Alliance for Aging,
Inc. (Area Agency on Aging) and the Monroe County Board of County Commissioners (Social
Services /In -Home Services, for Fiscal Year 7/1/2012 through 06/30/2013.
Item C9 Community Care for Disabled Adults (CCDA) Contract KG069 between the Florida
Department of Children & Families and the Monroe County Board of County Commissioners
(Social Services /In -Home Services, for Fiscal Year 7/1/2012 through 06/30/2013.
Item C10 Community Care for the Elderly (CCE) Contract KC1271 between the Alliance for
Aging, Inc. (Area Agency on Aging) and the Monroe County Board of County Commissioners
(Social Services /In -Home Services, for Fiscal Year 7/1/2012 through 06/30/2013.
Item C 11 Home Care for the Elderly (HCE) Contract KH 1272 between the Alliance for Aging,
Inc. (Area Agency on Aging) and the Monroe County Board of County Commissioners (Social
Services /In -Home Services, for Fiscal Year 7/1/2012 through 06/30/2013.
Enclosed are five duplicate originals of each of the above - mentioned, executed on behalf
of Monroe County, for your handling. Please be sure to return two fully executed originals for
the Clerk and the Finance Department. Should you have any questions, please do not hesitate to
contact our office.
cc: County Attorney
Finance
File ✓
Contract No. KG069
CFDA No.
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES STANDARD CONTRACT
Client ® Non - Client ❑
THIS CONTRACT is entered into between the Florida Department of Children and Families, hereinafter referred to as the "Department" and Monroe
County hereinafter referred to as the "Provider ". The Department and Provider agree as follows:
1. Purpose. The Department is engaging the Provider for the purpose of providing Community Care for Disabled Adults Services, as further described
in Attachment I hereto. The Provider shall perform all tasks and provide units of deliverables, including reports, findings, and drafts, as specified in this
contract. These deliverables must be received and accepted by the contract manager in writing prior to payment, subject to subsequent audit and review
and to the satisfaction of the Department.
2. Effective and Ending Dates. This contract shall begin on July 1, 2012, or on the date on which the contract has been signed by the last party
required to sign it, whichever is later. It shall end at midnight, Eastern time, on June 30, 2014.
3. Payment for Services. The Department shall pay for contracted services according to the terms and conditions of this contract of an amount not to
exceed $163,466.00, or the rate schedule, subject to the availability of funds and satisfactory performance of all terms by the Provider. The State of
Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. Any costs or services paid
for under any other contract or from any other source are not eligible for payment under this contract
4. Contract Document. The Provider shall provide services in accordance with the terms and conditions specified in this contract including its
attachments, I & II and Exhibits A, B, C & D, and any exhibits referenced in said attachments, together with any documents incorporated by reference,
which contain all the terms and conditions agreed upon by the parties. The definitions found in the Standard Contract Definitions, located at
http: / /www.dcf.state.fl.us /admin/ contracts / docs /GlossaryofContractTerms,pdf are incorporated into and made a part of this Contract. The PUR 1000 Form
(10/06 version) is hereby incorporated into and made a part of this Contract. Sections 1.d., 2 -4, 6, 8 -13, 19, 22, 23, 27, 31, and 35 of the PUR 1000 Form
are not applicable to this contract. In the event of any conflict between the PUR 1000 Form and any other terms or conditions of this contract, such other
terms or conditions shall take precedence over the PUR 1000 Form.
5. Compliance with Statutes, Rules and. Regulations. In performing its obligations under this Contract, the Provider shall without exception be aware
of any compliance with State and Federal laws, rules and regulations relating to its performance under this Contract, including but not limited to those
described in Section 34 of this Contract.
6. Inspections and Corrective Action. The Provider shall permit all persons who are duly authorized by the Department to inspect and copy any
records, papers, documents, facilities, goods and services of the Provider which are relevant to this contract, and to interview any clients, employees and
subcontractor employees of the Provider to assure the Department of the satisfactory performance of the terms and conditions of this contract. Following
such review, the Department will deliver to the Provider a written report of its findings, and may direct the development, by the Provider, of a corrective
action plan where appropriate. The Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan. This provision will not
limit the Department's termination rights under Section 30.
7. Independent Contractor, Subcontracting and Assignments.
a. In performing its obligations under this contract, the Provider shall at all times be acting in the capacity of an independent contractor and not as
an officer, employee, or agent of the State of Florida, except where the Provider is a state agency. Neither the Provider nor any of its agents,
employees, subcontractors or assignees shall represent to others that it is an agent of or has the authority to bind the Department by virtue of this
Contract, unless specifically authorized in writing to do so. This contract does not create any right in any individual to state retirement, leave benefits
or any other benefits of state employees as a result of performing the duties or obligations of this contract.
b. The Provider shall take such actions as may be necessary to ensure that it and each subcontractor of the Provider will be deemed to be an
independent contractor and will not be considered or permitted to be an officer, employee, or agent of the State of Florida. The Department will not
furnish services of support (e.g., office space, office supplies, telephone service, secretarial or clerical support) to the Provider, or its subcontractor or
assignee, unless specifically agreed to by the Department in this contract. All deductions for social security, withholding taxes, income taxes,
contributions to unemployment compensation funds and all necessary insurance for the Provider, the Provider's officers, employees, agents,
subcontractors, or assignees shall be the sole responsibility of the Provider.
c. The Provider shall not assign the responsibility for this contract to another party without prior written approval of the Department, upon the
Department's sole determination that such assignment will not adversely affect the public interest; however, in no event may the Provider assign or
enter into any transaction having the effect of assigning or transferring any right to receive payment under this contract which right is not conditioned
on full and faithful performance of the Provider's duties hereunder. Any sublicense, assignment, or transfer otherwise occurring without prior approval
of the Department shall be null and void. The Provider shall not subcontract for any of the work contemplated under this contract without prior written
approval of the Department, which shall not be unreasonably withheld.
d. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under this contract to
another governmental agency in the State of Florida or to a provider of the Department's selection, upon giving prior written notice to the Provider. In
the event the State of Florida approves transfer of the Provider's obligations, the Provider remains responsible for all work performed and all
expenses incurred in connection with the contract. This contract shall remain binding upon the lawful successors in interest of the Provider and the
Department.
e. To the extent permitted by Florida Law, and in compliance with Section 7.c., the Provider is responsible for all work performed and for all
commodities produced pursuant to this contract whether actually furnished by the Provider or by its subcontractors. Any subcontracts shall be
evidenced by a written document. The Provider further agrees that the Department shall not be liable to the subcontractor in any way or for any
reason relating to this Contract.
f. The Provider shall include, in all subcontracts (at any tier) the substance of all clauses contained in this Standard Contract that mention or
describe subcontract compliance.
g. To the extent that a subcontract provides for payment after Provider's receipt of payment from the Department, the Provider shall make
payments to any subcontractor within 7 working days after receipt of full or partial payments from the Department in accordance with section
287.0585, F.S., unless otherwise stated in the contract between the Provider and subcontractor. Failure to pay within seven (7) working days will
CF Standard Contract 05/2012 1 Contract KG069
result in a penalty that shall be charged against the Provider and paid by the Provider to the subcontractor in the amount of one -half of one percent
(.005) of the amount due per day from the expiration of the period allowed for payment. Such penalty shall be in addition to actual payments owed
and shall not exceed fifteen (15 %) percent of the outstanding balance due.
8. Provider Liability and Indemnity. The Provider shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall
fully indemnify, defend, and hold harmless the State and the Department, and their officers, agents, and employees, from suits, actions, damages, claims
and costs of every name and description, including attorneys' fees:
a. arising out of or by reason of the execution of this contract or arising from or relating to any alleged act or omission by the Provider, its agents,
employees, partners, or subcontractors in relation to this agreement provided; however, that this indemnity shall not include that portion of any loss or
damages proximately caused by the negligent act or omission of the Department. This indemnity specifically precludes compensation of the Provider
for any obligations of any kind to any person, paid or unpaid, incurred as a result of a culpable act or omission of the Provider, its agents, employees
or subcontractors.
b. arising from or relating to violation or infringement of a trademark, copyright, patent, trade secret or intellectual property right associated with a
service or product of the Provider; provided, however, that the foregoing obligation shall not apply to Department's misuse or modification of
Provider's products or a Department's operation or use of Provider's products in a manner not contemplated by the contract. If any product is the
subject of an infringement suit or claim or in the Provider's opinion is likely to become the subject of such a suit or claim, the Provider may at its sole
expense procure for the Department the right to continue using the product or to modify it to become non - infringing. If the Provider is not reasonably
able to modify or otherwise secure the Department the right to continue using the product, the Provider shall, without limiting the Department's
remedies at law for breach or nonperformance, remove the product and provide a fully - licensed replacement to the Department's satisfaction. The
Department shall not be liable for any royalties. The Provider's indemnification for violation or infringement of a trademark, copyright, patent, trade
secret or intellectual property right shall encompass all such items used or accessed by the Provider, its officers, agents or subcontractors in the
performance of this contract or delivered to the Department for the use of the Department, its employees, agents or contractors.
c. arising from or relating to Provider's claim that a record contains trade secret information that is exempt from disclosure or the scope of the
Provider's redaction of the record, as provided for under Section 27.c., including litigation initiated by the Department.
The Provider's inability to evaluate liability or its evaluation of liability shall not excuse its duty to defend and indemnify after receipt of notice. Only an
adjudication or judgment after the highest appeal is exhausted finding the Department negligent shall excuse the Provider of performance under this
provision, in which case the Department shall have no obligation to reimburse the Provider for the cost of its defense. If the Provider is an agency or
subdivision of the State, its obligation to indemnify, defend and hold harmless the Department shall be to the extent permitted by section 768.28, F.S. or
other applicable law, and without waiving the limits of sovereign immunity.
9. Insurance. The Provider shall maintain continuous adequate liability insurance coverage during the existence of this contract and any renewal(s) and
extension(s) thereof. With the exception of a state agency or subdivision as defined by subsection 768.28(2), F.S., by execution 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
protections for the Provider and the clients to be served under this contract. The limits of coverage under each policy maintained by the Provider do not
limit the Provider's liability and obligations under this contract. Upon the execution of this contract, the Provider shall furnish the Department 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 Department reserves the right to require additional insurance as specified in this
contract.
10. Notice of Legal Actions. The Provider shall notify the Department of legal actions taken against them or potential actions such as lawsuits, related
to services provided through this contract or that may impact the Provider's ability to deliver the contractual services, or adversely impact the Department.
The Department's contract manager will be notified within 10 days of Provider becoming aware of such actions or from the day of the legal filing, whichever
comes first.
11. Client Risk Prevention. If services to clients are to be provided under this contract, the Provider and any subcontractors shall, in accordance with
the client risk prevention system, report those reportable situations listed in CFOP 215 -6 in the manner prescribed in CFOP 215 -6. The Provider shall
immediately report any knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse
Hotline on the statewide toll -free telephone number (1- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the
Provider and its employees.
12. Emergency Preparedness Plan. If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the
Provider shall, within 30 days of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include
provisions for records protection, alternative accommodations for clients in substitute care, supplies, and a recovery plan that will allow the Provider to
continue functioning in compliance with the executed contract in the event of an actual emergency.
a. For the purpose of disaster planning, the term supervision includes the responsibility of the Department, or its contracted agents to ensure the
safety, permanency and well -being of a child who is under the jurisdiction of a dependency court. Children may remain in their homes, be placed in a
non - licensed relative /non- relative home, or be placed in a licensed foster care setting.
b. The Department agrees to respond in writing within 30 days of receipt of the plan accepting, rejecting, or requesting modifications. In the event
of an emergency, the Department may exercise oversight authority over such Provider in order to assure implementation of agreed emergency relief
provisions.
c. An updated emergency preparedness plan shall be submitted by the Provider no later than 12 months following the acceptance of an original
plan or acceptance of an updated plan. The Department agrees to respond in writing within 30 days of receipt of the updated plan, accepting,
rejecting, or requesting modification to the plan.
13. Intellectual Property. It is agreed that all intellectual property, inventions, written or electronically created materials, including manuals,
presentations, films, or other copyrightable materials, arising in relation to Provider's performance under this contract, and the performance of all of its
officers, agents and subcontractors in relation to this contract, are works for hire for the benefit of the Department, fully compensated for by the contract
amount, and that neither the Provider nor any of its officers, agents nor subcontractors may claim any interest in any intellectual property rights accruing
under or in connection with the performance of this contract. It is specifically agreed that the Department shall have exclusive rights to all data processing
software falling within the terms of section 119.084, F.S., which arises or is developed in the course of or as a result of work or services performed under
this contract, or in anyway connected herewith. Notwithstanding the foregoing provision, if the Provider is a university and a member of the State
University System of Florida, then section 1004.23, F.S., shall apply.
CF Standard Contract 0512012 2 Contract KG069
a. If the Provider uses or delivers to the Department for its use or the use of its employees, agents or contractors, any design, device, or materials
covered by letters, patent, or copyright, it is mutually agreed and understood that, except as to those items specifically listed in the Special Provisions
of Attachment I as having specific limitations, the compensation paid pursuant to this contract includes all royalties or costs arising from the use of
such design, device, or materials in any way involved in the work contemplated by this contract. For purposes of this provision, the term "use" shall
include use by the Provider during the term of this Contract and use by the Department its employees, agents or contractors during the tern of this
Contract and perpetually thereafter.
b. All applicable subcontracts shall include a provision that the Federal awarding agency reserves all patent rights with respect to any discovery or
invention that arises or is developed in the course of or under the subcontract. Notwithstanding the foregoing provision, if the Provider or one of its
subcontractors is a university and a member of the State University System of Florida, then section 1004.23, F.S., shall apply, but the Department
shall retain a perpetual, fully -paid, nonexclusive license for its use and the use of its contractors of any resulting patented, copyrighted or trademarked
work products.
14. Real Property. Any state funds provided for the purchase of or improvements to real property are contingent upon the Provider granting to the state
a security interest in the property at least to the amount of the state funds provided for at least five (5) years from the date of purchase or the completion of
the improvements or as further required by law. As a condition of receipt of state funding for this purpose, the Provider agrees that, if it disposes of the
property before the Department's interest is vacated, the Provider will refund the proportionate share of the state's initial investment, as adjusted by
depreciation.
15. Publicity. Without limitation, the Provider and its employees, agents, and representatives will not, without prior Departmental written consent in each
instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State
affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the Provider has been approved
or endorsed by the State, or refer to the existence of this contract in press releases, advertising or materials distributed to the Provider's prospective
customers.
16. Sponsorship. As required by section 286.25, F.S., if the Provider is a non - governmental 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 (Provider's name) and the State of Florida, Department of Children and Families ". If the sponsorship reference is in written material,
the words "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization.
17. Employee Gifts. The Provider agrees that it will not offer to give or give any gift to any Department employee. As part of the consideration for this
contract, the parties intend that this provision will survive the contract for a period of two years. In addition to any other remedies available to the
Department, any violation of this provision will result in referral of the Provider's name and description of the violation of this term to the Department of
Management Services for the potential inclusion of the Provider's name on the suspended vendors list for an appropriate period. The Provider will ensure
that its subcontractors, if any, comply with these provisions.
18. Official Payee and Party Representatives
a. The Provider name, as shown on page 1 of this contract, and
mailing address of the official payee to whom the payment shall be
made is:
Name: Monroe County
Address: 500 Whitehead Street
City: Key West State:FL Zip Code:33040
Phone: 305 - 294 -4641
ext:
b. The name of the contact person and address, telephone, and e-
mail address where financial and administrative records are
maintained is:
Name: Kim Wilkes
Address: 1100 Simonton Street
City: Key West State:FL Zip Code:33040
Phone: 305 - 292 -4588
ext:
e -mail: wilkes -kim @monroecounty -fl.gov
c. The name, address, telephone number and e-mail address of the
contract manager for the Department for this contract is:
Name: Theresa Phelan
Address: 111112 Street
City: Key West State: FL Zip Code: 33040
Phone: 305 -292 -6810
ext:
e -mail: trixie_phelan @dcf.state.fl.us
d. The name, address, telephone number and e-mail of the
representative of the Provider responsible for administration of the
program under this contract is:
Name: Sheryl Graham
Address: 1100 Simonton Street
City: Key West State:FL Zip Code:33040
Phone: 305 - 292 -4510
ext:
e-mail:graham-sheryl@monroecounty-fl.gov
Upon change of representatives (names, addresses, telephone numbers or e-mail addresses) by either party, notice shall be provided in writing to the
other party and the notification attached to the originals of this contract.
19. Invoices. The Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre -audit and
post- audit. Where itemized payment for travel expenses is permitted in this contract, the Provider shall submit bills for any travel expenses in accordance
with section 112.061, F.S., or at such lower rates as may be provided in this Contract.
20. Final Invoice. The final invoice for payment shall be submitted to the Department no more than 45 days after the contract ends or is terminated. If
the Provider fails to do so, all rights to payment are forfeited and the Department will not honor any requests submitted after the aforesaid time period.
Any payment due under the terms of this contract may be withheld until all reports due from the Provider and necessary adjustments thereto, have been
approved by the Department.
21. Financial Consequences. If the Provider fails to meet the minimum level of service or performance identified in this contract, or that is customary for
the industry, the Department will apply financial consequences commensurate with the deficiency. Financial consequences may include but are not limited
to refusing payment, withholding payments until deficiency is cured, tendering only partial payments, applying liquidated damages to the extent that this
contract so provides, imposition of penalties per Section 29, termination of contract per Section 30 and requisition of services from an alternate source.
CF Standard Contract 05/2012 3 Contract KG069
Any payment made in reliance on the Provider's evidence of performance, which evidence is subsequently determined to be erroneous, will be
immediately due as an overpayment in accordance with Section 22, to the extent of such error.
22. Overpayments. The Provider shall return to the Department any overpayments due to unearned funds or funds disallowed that were disbursed to
the Provider by the Department and any interest attributable to such funds pursuant to the terms and conditions of this contract. In the event that the
Provider or its independent auditor discovers that an overpayment has been made, the Provider shall repay said overpayment immediately without prior
notification from the Department. In the event that the Department first discovers an overpayment has been made, the contract manager, on behalf of the
Department, will notify the Provider by letter of such findings. Should repayment not be made forthwith, the Provider will be charged interest at the lawful
rate of interest on the outstanding balance after Department notification or Provider discovery. Payments made for services subsequently determined by
the Department to not be in full compliance with contract requirements shall be deemed overpayments. The Department shall have the right to offset or
deduct from any amount due under this Contract at any time any amount due to the Department from the Provider under any other contract or agreement.
23. Payment on Invoices. Pursuant to section 215.422, F.S., the Department has five (5) working days to inspect and approve goods and services,
unless the bid specifications, purchase order, or this contract specify otherwise. With the exception of payments to health care providers for hospital,
medical, or other health care services, if payment is not available within forty (40) days, measured from the latter of the date a properly completed invoice
is received by the Department or the goods or services are received, inspected, and approved, a separate interest penalty set by the Chief Financial
Officer pursuant to section 55.03, F.S., will be due and payable in addition to the invoice amount. Payments to health care providers for hospital, medical,
or other health care services, shall be made not more than thirty-five (35) days from the date eligibility for payment is determined. Financial penalties will
be calculated at the daily interest rate of .03333 %. Invoices returned to a Provider due to preparation errors will result in a non - interest bearing payment
delay. Interest penalties less than one (1) dollar will not be paid unless the Provider requests payment. Payment shall be made only upon written
acceptance by the Department and shall remain subject to subsequent audit or review to confirm contract compliance.
24. Vendor Ombudsman. A Vendor Ombudsman has been established within the Department of Financial Services. The duties of this office are found
in section 215.422, F.S., which include disseminating information relative to prompt payment and assisting vendors in receiving their payments in a timely
manner from a state agency. The Vendor Ombudsman may be contacted at (850) 413 -5516.
25. Records, Retention, Audits, Inspections and Investigations.
a. The Provider shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all income and
expenditures of funds provided by the Department under this contract.
b. Retention of all client records, financial records, supporting documents, statistical records, and any other documents (including electronic.
storage media) pertinent to this contract shall be maintained by the Provider during the term of this contract and retained for a period of six (6) years
after completion of the contract or longer when required by law. In the event an audit is required under this contract, records shall be retained for a
minimum period of six (6) years after the audit report is issued or until resolution of any audit findings or litigation based on the terms of this contract,
at no additional cost to the Department.
c. Upon demand, at no additional cost to the Department, the Provider will facilitate the duplication and transfer of any records or documents
during the required retention period in Section 25.b.
d. These records shall be made available at all reasonable times for inspection, review, copying, or audit by Federal, State, or other personnel duly
authorized by the Department.
e. At all reasonable times for as long as records are maintained, persons duly authorized by the Department and Federal auditors, pursuant to 45
CFR, section 92.36(i)(10), shall be allowed full access to and the right to examine any of the Provider's contracts and related records and documents,
regardless of the form in which kept.
f. A financial and compliance audit shall be provided to the Department as specified in this contract and in Attachment Il.
g. The Provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by The Office
of the Inspector General (section 20.055, F.S.).
h. No record may be withheld nor may the Provider attempt to limit the scope of any of the foregoing inspections, reviews, copying, transfers or
audits based on any claim that any record is exempt from public inspection or is confidential, proprietary or trade secret in nature.
26. Public Records. The Provider shall allow public access to all documents, papers, letters, or other public records as defined in subsection
119.011(12), F.S. as prescribed by subsection 119.07(1) F.S., made or received by the Provider in conjunction with this contract except that public records
which are made confidential by law must be protected from disclosure. It is expressly understood that the Provider's failure to comply with this provision
shall constitute an immediate breach of contract for which the Department may unilaterally terminate the contract.
a. Unless exempted by law, all public records are subject to public inspection and copying under Florida's Public Records Law, Chapter 119, F.S.
Any claim by Provider of trade secret (proprietary) confidentiality for any information contained in Provider's documents (reports, deliverables or
workpapers, etc., in paper or electronic form) submitted in connection with this contract will be waived, unless the claimed confidential information is
submitted in accordance with Section 26.b.
b. The Provider must clearly label any portion of the documents, data, or records submitted that it considers exempt from public inspection or
disclosure pursuant to Florida's Public Records Law as trade secret. The labeling will include a justification citing specific statutes and facts that
authorize exemption of the information from public disclosure. If different exemptions are claimed to be applicable to different portions of the
protected information, the Provider shall include information correlating the nature of the claims to the particular protected information.
c. The Department, when required to comply with a public records request including documents submitted by the Provider, may require the
Provider to expeditiously submit redacted copies of documents marked as trade secret in accordance with Section 26.b. Accompanying the
submission shall be an updated version of the justification under Section 26.b, correlated specifically to redacted information, either confirming that
the statutory and factual basis originally asserted remain unchanged or indicating any changes affecting the basis for the asserted exemption from
public inspection or disclosure. The redacted copy must exclude or obliterate only those exact portions that are claimed to be trade secret. If the
Provider fails to promptly submit a redacted copy, the Department is authorized to produce the records sought without any redaction of proprietary or
trade secret information.
d. The Provider shall be responsible for defending its claim that each and every portion of the redactions of trade secret information are exempt
from inspection and copying under Florida's Public Records Law.
CF Standard Contract 05/2012 4 Contract KG069
27. Client Information. The Provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose
prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized
by law.
28. Data Security. The Provider shall comply with the following data security requirements:
a. An appropriately skilled individual shall be identified by the Provider to function as its Data Security Officer. The Data Security Officer shall act
as the liaison to the Department's security staff and will maintain an appropriate level of data security for the information the Provider is collecting or
using in the performance of this contract. An appropriate level of security includes approving and tracking all Provider employees that request or
have access to any Departmental data system or information. The Data Security Officer will ensure that user access to the data system or information
has been removed from all terminated Provider employees.
b. The Provider shall provide the latest Departmental security awareness training to its staff and subcontractors who have access to departmental
information.
c. All Provider employees who have access to departmental information shall comply with, and be provided a copy of CFOP 50 -2, and shall sign
the DCF Security Agreement form CF 0114 annually. A copy of CF 0114 may be obtained from the contract manager.
d. The Provider shall make every effort to protect and avoid unauthorized release of any personal or confidential information by ensuring both data
and storage devices are encrypted as prescribed in CFOP 50 -2. If encryption of these devices is not possible, then the Provider shall assure that
unencrypted personal and confidential departmental data will not be stored on unencrypted storage devices. The Provider shall require the same of
all subcontractors.
e. The Provider agrees to notify the contract manager as soon as possible, but no later than five (5) business days following the determination of
any breach or potential breach of personal and confidential departmental data. The Provider shall require the same notification requirements of all
subcontractors.
f. The Provider shall at its own cost provide notice to affected parties no later than 45 days following the determination of any potential breach of
personal or confidential departmental data as provided in section 817.5681, F.S. The Provider shall require the same notification requirements of all
subcontractors. The Provider shall also at its own cost implement measures deemed appropriate by the Department to avoid or mitigate potential
injury to any person due to a breach or potential breach of personal and confidential departmental data.
29. Financial Penalties for Failure to Take Corrective Action.
a. In accordance with the provisions of section 402.73(1), F.S., and Rule 65-29.001. F.A.C., corrective action plans may be required for
noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make
acceptable progress on such corrective action plans.
b. The increments of penalty imposition that shall apply, unless the Department determines that extenuating circumstances exist, shall be based
upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The
penalty, if imposed, shall not exceed ten percent (10 %) of the total contract payments during the period in which the corrective action plan has not
been implemented or in which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct
effect on client health and safety shall result in the imposition of a ten percent (10 %) penalty of the total contract payments during the period in which
the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made.
c. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of a five
percent (5 %) penalty. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two percent
(2 %) penalty.
d. The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the Department may
deduct the amount of the penalty from invoices submitted by the Provider.
30. The following termination provisions apply to this Contract:
a. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days notice in writing to the other party
unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that
provides verification of delivery or by hand delivery to the Contract Manager or the representative of the Provider responsible for administration of the
program.
b. In the event funds for payment pursuant to this contract become unavailable, the Department may terminate this contract upon no less than
twenty-four (24) hours notice in writing to the Provider. Said notice shall be sent by U.S. Postal Service or any expedited delivery service that
provides verification of delivery. The Department shall be the final authority as to the availability and adequacy of funds. In the event of termination
of this contract, the Provider will be compensated for any work satisfactorily completed.
c. In the event the Provider fails to fully comply with the terms and conditions of this contract, the Department may terminate the contract upon no
less than twenty-four (24) hours (excluding Saturday, Sunday, and Holidays) notice in writing to the Provider after Provider's failure to fully cure such
noncompliance within the time specified in a written notice of noncompliance issued by the Department specifying the nature of the noncompliance
and the actions required to cure such noncompliance. In addition, the Department may employ the default provisions in Rule 60A- 1.006(3), F.A.C.,
but is not required to do so in order to terminate the contract. The Department's failure to demand performance of any provision of this contract shall
not be deemed a waiver of such performance. The Department's waiver of any one breach of any provision of this contract shall not be deemed to be
a waiver of any other breach and neither event shall be construed to be a modification of the terms and conditions of this contract. The provisions
herein do not limit the Department's right to remedies at law or in equity.
d. Failure to have performed any contractual obligations under any other contract with the Department in a manner satisfactory to the Department
will be a sufficient cause for termination. To be terminated as a Provider under this provision, the Provider must have: (1) previously failed to
satisfactorily perform in a contract with the Department, been notified by the Department of the unsatisfactory performance, and failed to correct the
unsatisfactory performance to the satisfaction of the Department; or (2) had a contract terminated by the Department for cause. Termination shall be
upon no less than twenty -four (24) hours notice in writing to the Provider.
CF Standard Contract 05/2012 5 Contract KG069
31. Dispute Resolution. Any dispute concerning performance of the contract or payment hereunder shall be decided by the Department's contract
manager, who shall reduce the decision to writing and provide a copy to the Provider. The decision shall be final and conclusive unless within twenty -one
(21) calendar days from the date of receipt of the contract manager's decision, the Provider delivers to the contract manager a petition for alternative
dispute resolution. After receipt of a petition for alternative dispute resolution the Department and the Provider shall attempt to amicably resolve the
dispute through negotiations. Timely delivery of a petition for alternative dispute resolution and completion of the negotiation process shall be a condition
precedent to any legal action by the Provider concerning this Contract. After timely delivery of a petition for alternative dispute resolution, the parties may
employ any dispute resolution procedures described in the Attachment I or other attachment, or mutually agree to an alternative binding or nonbinding
dispute resolution process, the terms of which shall be reduced to writing and executed by both parties. Completion of such agreed process shall be
deemed to satisfy the requirement for completion of the negotiation process. This provision shall not limit the parties' rights of termination under Section
30.
32. Other Terms
a. Any notice that is required under this contract shall be in writing, and sent by U.S. Postal Service or any expedited delivery service that provides
verification of delivery or by hand delivery. Said notice shall be sent to the representative of the Provider responsible for administration of the
program, to the designated address contained in this contract.
b. This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance
with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in
any action regarding this contract and venue shall be in Leon County, Florida.
c. Articles which are the subject of or are required to carry out this contract shall be purchased from Prison Rehabilitative Industries and Diversified
Enterprises, Inc., (PRIDE) identified under Chapter 946, F.S., in the same manner and under the procedures set forth in subsections 946.515(2) and
(4), F.S. For purposes of this contract, the Provider shall be deemed to be substituted for the Department insofar as dealings with PRIDE. This
clause is not applicable to subcontractors unless otherwise required by law. An abbreviated list of products /services available from PRIDE may be
obtained by contacting PRIDE, (800) 643 -8459.
d. The Provider shall procure any recycled products or materials, which are the subject of or are required to carry out this contract, in accordance
with the provisions of sections 403.7065, F.S.
e. The Department is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the Department has
expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the majority of the Department's
providers will either be accredited, have a plan to meet national accreditation standards, or will initiate a plan within a reasonable period of time.
f. The Department of Economic Opportunity and Workforce Florida: The Provider understands that the Department, the Department of Economic
Opportunity, and Workforce Florida, Inc., have jointly implemented an initiative to empower recipients in the Temporary Assistance to Needy Families
Program to enter and remain in gainful employment. The Department encourages Provider participation with the Department of Economic
Opportunity and Workforce Florida.
g. Transitioning Young Adults: The Provider understands the Department's interest in assisting young adults aging out of the dependency system.
The Department encourages Provider participation with the local Community -Based Care Lead Agency Independent Living Program to offer gainful
employment to youth in foster care and young adults transitioning from the foster care system.
h. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous
communications, representations, or agreements, either verbal or written between the parties.
i. If any term or provision of this contract is legally determined unlawful or unenforceable, the remainder of the contract shall remain in full force
and effect and such term or provision shall be stricken.
j. Survival of terms. The parties agree that, unless a provision of this Standard Contract, its attachments or incorporated documents expressly
states otherwise as to itself or a named provision, all provisions of this contract concerning obligations of the Provider and remedies available to the
Department are intended to survive the "ending date" or an earlier termination of this contract. The Provider's performance pursuant to such
surviving provisions shall be without further payment, as the contract payments received during the term of this contract are consideration for such
performance.
k. In the event of a conflict between the provisions of the documents, the documents shall be interpreted in the following order of precedence:
L Attachment I and other attachments, if any;
ii. Any documents incorporated into any attachment by reference;
iii. This Standard Contract;
iv. Any documents incorporated into this Standard Contract by reference.
33. Modifications. Modifications of provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both
parties. 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 Department's operating budget.
34. Additional Requirements of Law, Regulation and Funding Source. As provided in Section 5 of this contract, the Provider is required to comply
with the following requirements, as applicable to its performance under this contract. Provider acknowledges that it is independently responsible for
investigating and complying with all State and Federal laws, rules and regulations relating to its performance under this contract and that the below is only
a sample of the State and Federal laws, rules and regulations that may govern its performance under this contract.
a. Federal Law
i. If this contract contains federal funds, the Provider shall comply with the provisions of federal law and regulations including, but not limited
to, 45 Code of Federal Regulations (CFR), Part 74, 45 CFR, Part 92, and other applicable regulations.
CF Standard Contract 05/2012 6 Contract KG069
ii. If this contract contains $10,000 or more of federal funds, the Provider shall comply with Executive Order 11246, Equal Employment
Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation 41 CFR, Part 60 and
45 CFR, Part 92, if applicable.
iii. If this contract contains over $100,000 of federal funds, the Provider shall comply with all applicable standards, orders, or regulations
issued under section 306 of the Clean Air Act, as amended (42 United States Code (U.S.C.) 7401 et seq.), section 508 of the Federal Water
Pollution Control Act, as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, as amended and where applicable, and Environmental
Protection Agency regulations (40 CFR, Part 30). The Provider shall report any violations of the above to the Department.
iv. No federal funds received in connection with this contract may be used by the Provider, or agent acting for the Provider, or subcontractor to
influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of
$100,000, the Provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment NIA. 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, prior to payment under this contract.
V. If this contract contains federal funds and provides services to children up to age 18, the Provider shall comply with the Pro - Children Act of
1994 (20 U.S.C. 6081). Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000
for each violation or the imposition of an administrative compliance order on the responsible entity, or both.
vi. Unauthorized aliens shall not be employed. The Department shall consider the employment of unauthorized aliens a violation of section
274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324 a) and section 101 of the Immigration Reform and Control Act of 1986. Such
violation shall be cause for unilateral cancellation of this contract by the Department. Pursuant to Executive Order 11-02 signed on January 4,
2011, the Provider will use the E- verify system established by the U.S. Department of Homeland Security to verify the employment eligibility of
its employees and the subcontractors' employees performing under this contract.
b. Civil Rights Requirements. In accordance with Title VII of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, or the
Florida Civil Rights Act of 1992, as applicable the Provider shall not discriminate against any employee (or applicant for employment) in the
performance of this contract because of race, color, religion, sex, national origin, disability, age, or marital status. Further, the Provider agrees not to
discriminate against any applicant, client, or employee in service delivery or benefits in connection with any of its programs and activities in
accordance with 45 CFR 80, 83, 84, 90, and 91, Title VI of the Civil Rights Act of 1964, or the Florida Civil Rights Act of 1992, as applicable and
CFOP 60 -16. These requirements shall apply to all contractors, subcontractors, subgrantees or others with whom -it arranges to provide services or
benefits to clients or employees in connection with its programs and activities. The Provider shall complete the Civil Rights Compliance Checklist, CF
Form 946 in accordance with CFOP 60 -16 and 45 CFR 80. This is required of all Providers that have fifteen (15) or more employees.
c. Use of Funds for Lobbying Prohibited. The Provider shall comply with the provisions of sections 11.062 and 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a state agency.
d. Public Entity Crime and Discriminatory Contractors Pursuant to sections 287.133 and 287.134, F.S., the following restrictions are placed on
the ability of persons placed on the convicted vendor list or the discriminatory vendor list. When a person or affiliate has been placed on the
convicted vendor list following a conviction for a public entity crime, or an entity or affiliate has been placed on the discriminatory vendor list, such
person, entity or affiliate may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a
bid, proposal, or reply on a contract with a public entity for the construction or the repair of a public building or public work; may not submit bids,
proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or
consultant under a contract with any public entity; and may not transact business with any public entity; provided, however, that the prohibition on
persons or affiliates placed on the convicted vendor shall be limited to business in excess of the threshold amount provided in section 287.017, F.S.,
for CATEGORY TWO for a period of thirty-six (36) months from the date of being placed on the convicted vendor list.
e. Health Insurance Portability and Accountability Act .The Provider shall, where applicable, comply with the Health Insurance Portability and
Accountability Act (42 U. S. C. 1320d.) as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164).
f. Whistlebiower's Act Requirements. In accordance with subsection 112.3187(2), F.S., the Provider and its subcontractors shall not retaliate
against an employee for reporting violations of law, rule, or regulation that creates substantial and specific danger to the public's health, safety, or
welfare to an appropriate agency. Furthermore, agencies or independent contractors shall not retaliate against any person who discloses information
to an appropriate agency alleging improper use of governmental office, gross waste of funds, or any other abuse or gross neglect of duty on the part
of an agency, public officer, or employee. The Provider and any subcontractor shall inform its employees that they and other persons may file a
complaint with the Office of Chief Inspector General, Agency Inspector General, the Florida Commission on Human Relations or the Whistle- blower's
Hotline number at 1- 800 - 543 -5353.
g. Support to the Deaf or Hard -of- Hearing
i. The Provider and its subcontractors, where direct services are provided, shall comply with section 504 of the Rehabilitation Act of 1973, 29
U.S.C. 794, as implemented by 45 C.F.R. Part 84 (hereinafter referred to as Section 504), the Americans with Disabilities Act of 1990, 42 U.S.C.
12131, as implemented by 28 C.F.R. Part 35 (hereinafter referred to as ADA), and the Children and Families Operating Instruction (CFOP) 60-
10, Chapter 4, entitled "Auxiliary Aids and Services for the Deaf or Hard -of- Hearing."
ii. If the Provider or any of its subcontractors employs 15 or more employees, the Provider shall designate a Single- Point -of- Contact (one per
firm) to ensure effective communication with deaf or hard -of- hearing customers or companions in accordance with Section 504, the ADA, and
CFOP 60 -10, Chapter 4. The name and contact information for the Provider's Single- Point -of- Contact shall be furnished to the Department's
grant or contract manager within 14 calendar days of the effective date of this requirement.
iii. The Provider shall, within 30 days of the effective date of this requirement, contractually require that its subcontractors comply with Section
504, the ADA, and CFOP 60 -10, Chapter 4. A Single- Point -of- Contact shall be required for each subcontractor that employs 15 or more
employees. This Single- Point -of- Contact will ensure effective communication with deaf or hard -of- hearing customers or companions in
accordance with Section 504 and the ADA and coordinate activities and reports with the Provider's Single- Point -of- Contact.
iv. The Single- Point -of- Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points
associated with compliance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. Further, employees of providers and its subcontractors
with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60 -10, Chapter
4. This attestation shall be maintained in the employee's personnel file.
CF Standard Contract 0512012 7 Contract KG069
iv. The Single- Point -of- Contact shall ensure that employees are aware of the requirements, roles & responsibilities, and contact points
associated with compliance with Section 504, the ADA, and CFOP 60 -10, Chapter 4. Further, employees of providers and its subcontractors
with 15 or more employees shall attest in writing that they are familiar with the requirements of Section 504, the ADA, and CFOP 60 -10, Chapter
4. This attestation shall be maintained in the employee's personnel file.
V. The Provider's Single- Point -of- Contact will ensure that conspicuous Notices which provide information about the availability of appropriate
auxiliary aids and services at no -cost to the deaf or hard -of- hearing customers or companions are posted near where people enter or are
admitted within the agent locations. Such Notices must be posted immediately by providers and subcontractors. The approved Notice can be
downloaded through the Internet at: http: / /www.dcf. state. fl .us /admin /ig /civiIrights.shtmI
vi. The Provider and its subcontractors shall document the customer's or companion's preferred method of communication and any requested
auxiliary aids /services provided in the customer's record. Documentation, with supporting justification, must also be made if any request was not
honored. The Provider shall submit compliance reports monthly, by the 5"' business day following the reporting month, to the Department's
grant or contract manager. The Provider shall distribute Customer Feedback forms to customers or companions, and provide assistance in
completing the forms as requested by the customer or companion.
vii. If customers or companions are referred to other agencies, the Provider must ensure that the receiving agency is notified of the customer's
or companion's preferred method communication and any auxiliary aids /service needs.
The Department requires each contract/subcontract provider agency's direct service employees to complete Effective Communication Online (as
requested of all Department employees) and sign the Attestation of Understanding. Direct service employees will also print their certificate of
completion, attach it to their Attestation of Understanding, and maintain them in their personnel file.
By signing this contract, the parties agree that they have read and agree to the entire contract, as described in Section 4.
IN WITNESS THEREOF, the parties hereto have caused this 32 page contract to be executed by their undersigned officials as duly authorized.
PROVIDER: Monroe County
Signature:
Print/Type
Name: David P. Rice
Title: Mayor Title:
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Signature:
Print/Type - -- ——
Name: Esther Jacobo
Date: I Z 11 Date:
STATE AGENCY 29 alT FLAIR CODE:
Federal Tax ID # (or SSN): 59- 6000749 Provider Fiscal Year Ending Date: 09/30
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DEPUTY CLEPy
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Southern REgion Managing Director
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CF Standard Contract 05/2012 8 Contract KG069
07/01 /2012
ATTACHMENT I
A. Services to be Provided
1. Definition of Terms
a. Contract Terms
Community Care for Disabled Adults
Contract terms used in this document can be found in the Florida Department
of Children and Families Operating Procedure (CFOP) 75 -2, Glossary of
Terms, which is available at the following website:
http: / /www.dcf.state.fl.us /admin/ contracts /docs /GlossaryofContractTerms pdf
b. Program or Service Specific Terms
(1) Activities of Daily Living - Basic activities performed in the course of
daily living, such as dressing, bathing, grooming, eating, using a commode
or urinal, and ambulating around one's own home.
(2) Client - Any person ages 18 through 59 having one (1) or more permanent
physical or mental limitations that restrict the person's ability to perform
normal activities of daily living, and impede the person's capacity to live
independently or with relatives or friends without the provision of
community -based services.
(3) Medicaid Institutional Care Program (MICP) - A program designs to
provide primary, acute, and long -term care services at capitated federally
matched rates to Medicaid recipients who are determined eligible for a
nursing home level of care.
(4) Nursing home - Any facility that provides nursing services as defined in
Chapter 464, Florida Statutes, and which is licensed in accordance with
Chapter 400, Florida Statutes.
(5) Outcomes - Quantitative indicators that can be used by the Department to
objectively measure a Provider's performance toward a stated goal.
(6) Outputs - Process measures of the quantity of services delivered, clients
served, or similar units completed.
(7) Performance Measures - Quantitative indicators, outcomes and outputs,
that can be used by the Department to objectively measure a provider's
performance.
(8) Service Providers - Private, for - profit, nonprofit or local government
agencies designated to provide coordination of care for eligible clients.
Monroe County 9 KG069
07/01/2012 Community Care for Disabled Adults
Service providers can be case management providers, direct service
providers, or both.
2. General Description
a. General Statement. The Community Care for Disabled Adults (CCDA)
Program is designed to assist disabled adults, age eighteen (18) through fifty -
nine (59), in utilizing available community and personal resources enabling
them to remain in their own homes, and preventing their premature or
inappropriate institutionalization.
b. Authority. Sections 410.601 - 410.606, Florida Statutes, Chapter 65C -2,
Florida Administrative Code, and the annual appropriations act, with any
proviso language or instructions to the Department, constitute the legal basis
for services to be delivered through the CCDA program.
C. Scope of Service. Services will be for eligible adults in Monroe County.
d. Major Program Goal. Under this contract, the CCDA program provides link
to community -based services that are designed to prevent inappropriate
institutionalization of disabled adults.
3. Clients to be Served.
a. General Description
Adults with disabilities, age eighteen (18) through fifty -nine (59), who are no
longer eligible to receive children's services, and are too young to qualify for
community and home -based services for the elderly, may be served under the
provisions of this contract.
b. Client Eligibility
(1) Applicants must have one or more permanent physical or mental
limitations, that restrict the ability to perform normal activities of daily
living, as determined through the initial functional assessment and medical
documentation of disability. Determination of a permanent disability must
be established and evidenced in one of the following manners:
(a) An applicant may present a check, award letter, or other proof showing
receipt of Social Security Disability Income, or some other disability
payment (e.g., Worker's Compensation); or
(b) An applicant may present a written statement from a licensed
physician, licensed nurse practitioner, or mental health professional,
which meets the Region's criteria for evidence of a disability. This
Monroe Countv 10 ti(;069
07/01/2012 Community Care for Disabled Adults
written statement must, at a minimum, include the applicant's
diagnosis, prognosis, a broad explanation of level of functioning, and
the interpretation of need for services based on identified functional
barriers caused by the applicant's disabling condition.
(2) Applicants must have an individual income at or below the prevailing
MICP eligibility standard in order to receive free CCDA services.
(3) Applicants with incomes above the standard will be assessed a fee for a
share of the costs, or may be required to provide volunteer services in lieu
of payment.
C. Client Determination
(1) Clients will be assessed for eligibility determination, and prioritized for
services by Department case management staff, in accordance with
subsection 410.604 (2), Florida Statutes.
(2) The Department will make the final determination of client eligibility.
d. Contract Limits
(1) The total annual cost estimated or actual, for an individual receiving
CCDA services, shall not exceed the average, annual general revenue
portion of a Medicaid nursing home bed within the Regional area.
(2) Clients must not be receiving comparable services from any other entity.
In order to prevent duplication of services, client files must contain
documentation verifying that all comparable community services and
funding sources have been explored and exhausted.
(3) To the extent that funds are available, the Provider will receive referrals
for clients on whom the Department's Human Service Counselors have
completed an Adult Services Screening for Consideration for Community
Based Programs.
B. Manner of Service Provision
1. Service Tasks
a. Task List
(1) Service providers will ensure that appropriate community -based services
are provided to clients in a manner designed to meet the client's changing
needs, to assist the client in avoiding or reducing unnecessary dependence on
the delivered service(s), and to increase the client's self- reliance.
Monroe County
1 1 KG069
07/01/2012
Community Care for Disabled Adults
(2) The following tasks shall be performed under this contract: Case
Management to be performed by Provider staff: Personal Care and
Homemaker services to be performed by subcontracted vendor: and
Home Delivered Meals to be purchased through subcontract and
delivered by Provider staff.
(3) Details of services to be provided under this contract and the negotiated
parameters of those services are included in the descriptions and minimum
requirements for each service task listed in CFOP 140 -8, Community Care
for Disabled Adults Operating Procedures.
(4) Each Regional CCDA program must include case management services
and at least one other community service.
b. Task Limits
The following task limits apply only to the services specified above.
(1) Personal Care services will not substitute for the care usually provided by
a registered nurse, licensed practical nurse, therapist, or home health aide.
The personal care aide will not change sterile dressings, irrigate body
cavities, administer medications, or perform other activities prohibited by
Chapter 59A -8, Florida Administrative Code.
(2) Homemaker service time does not include time spent in transit to and from
the client's place of residence except when providing shopping assistance,
performing errands or other tasks on behalf of a client.
(3) Several restrictions apply to persons providing Homemaker service
activities. Persons providing services must not:
(a) engage in work that is not specified in the referral from the case
manager;
(b) accept gifts or lend or borrow money from clients;
(c) handle client money, unless authorized in writing by a supervisor or
case manager (documented in the personnel file) and unless bonded or
insured by the employer;
(d) transport clients, unless authorized in writing by a supervisor or case
manager.
(4) The parameters of service delivery, by type of service, are detailed in
CFOP 140 -8, Community Care for Disabled Adults Operating Procedures.
Monroe County 12 KG069
07/01/2012
2. Staffing Requirements
a. Staffing Levels
Community Care for Disabled Adults
(1) The Provider will meet the minimum staffing requirements for each
service, as specified in CFOP 140 -8, Community Care for Disabled Adults
Operating Procedures.
(2) The Provider will notify the Department, in writing, within thirty calendar
(30) days whenever the Provider is unable, or expects to be unable to
provide the required quality or quantity of service due to staff turnovers or
shortages.
b. Professional Qualifications
The Provider will ensure that staff meets the professional qualifications for
each service, as specified in CFOP 140 -8, Community Care for Disabled
Adults Operating Procedures.
Staffing Changes
The Provider agrees to notify the Department's contract manager within two
(2) working days if a key administrative position (e.g., executive director)
becomes vacant. Planned staffing changes that may affect service delivery, as
stipulated in this contract, must be presented in writing to the contract
manager for approval at least ten (10) working days prior to the
implementation of the change.
d. Subcontractors
This contract allows the Provider to subcontract for the provision of the
following services under this contract: Personal Care, Homemaker and
Home Delivered Meals. All subcontracting is subject to the provisions of
Section 7 of the Standard Contract. The subcontractor at any tier level must
comply with the E -Verify clause as subject to the same requirements as the
prime contractor. The Provider may not subcontract services not listed.
3. Service Location and Equipment
a. Service Delivery Location and Times
(1) CCDA services may be delivered in the client's home or on -site at a
facility, as negotiated by the Department and the Provider.
(2) Facilities delivering on -site services to clients shall pass an annual
inspection by the local environmental health and fire authorities.
Monroe County 13 KG069
07/01/2012
Community Care for Disabled Adults
(3) Service Providers will meet the minimum service location and time
requirements as specified in CFOP 140 -8, Community Care for Disabled
Adults Operating Procedures.
(4) Services for this contract will be delivered at the following locations and
times:
SERVICE
LOCATION
TIMES
Case Management
Client's Home
As Needed
Personal Care
Client's Home
As Needed
Homemaker
Client's Home
As Needed
Home Delivered Meals
I Client's Home
As Needed
b. Changes in Location
The Provider must notify the Department of changes in the location of service
delivery. Once the service delivery location is agreed upon, any proposed
change must be presented in writing to the contract manager for approval, ten
(10) working days prior to implementation of that proposed change. In the
event of an emergency, temporary changes in location may necessitate waiver
of this designated standard by the Region's program office. Such a waiver
will take into consideration the continuity, safety, and welfare of the
Department's clients, and is at the Department's sole discretion.
C. Equipment
The Provider is responsible for supplying, at its own expense, all equipment
necessary to perform under, conduct and complete the contract, including but
not limited to computers, telephones, copier and fax machines, including
supplies and maintenance as well as needed office supplies.
4. Deliverables
a. Service Units
A service unit is an appropriate, distinct amount of given service, which may
include, but is not limited to, an hour of direct service delivery; a meal; an
episode of travel; or a twenty -four (24) hour period of Emergency Alert
Response maintenance, as defined in CFOP 140 -8, Community Care for
Disabled Adults Operating Procedures. All service units, as well as their
description and costs, are listed in CFOP 140 -8, Community Care for
Disabled Adults Operating Procedures.
Monroe Countv 14 KGI169
07/01/2012
(1) Client Records (all clients)
Providers shall maintain information on each client served by this
contract, which includes the following:
(a) documentation of the client by name or unique identifier;
(d) current documentation of eligibility for services;
(e) dates of service provision and delivery;
Community Care for Disabled Adults
b. Records and Documentation
(d) information documenting the client's need to receive services;
(e) the number of service units provided; and
(f) all other forms or records necessary for program operation and
reporting, as set forth by the Department.
(2) Case Management Client records.
Case management agency individual client files shall contain the
following:
(a) a completed client assessment (no more than one (1) year old);
(b) a care plan (no more than one (1) year old);
(c) a release of information form;
(f) a copy of a completed Adult Services Information System (ASIS)
form;
(e) documentation of the client's age, disability, and income;
(f) a completed and scored copy of the Adult Services Screening for
Consideration for Community Based Services; and
(g) a case narrative.
(3) Providers must ensure that all client records accurately match the invoices
submitted for payment. Records must cross reference to each invoice for
payment.
Monroe County 15 KG069
07101/2012
Community Care for Disabled Adults
(4) Providers must maintain documentation necessary to facilitate monitoring
and evaluation by the Department.
(5) The Case Management Provider must maintain documentation in the
client's file that all comparable community services and funding sources
have been explored and exhausted before using CCDA funding.
C. Reports
Report Title
Reporting
Report Date
Number
DCF Office addresses
Frequency
Due
of copies
to receive report
due
Monthly
Monthly
By the 15` of
One
Contract Manager
Cumulative
the month
Summary
immediately
Report
following the
report period
Monthly
Monthly
By the 15` of
One
Contract Manager
Performance
the month
Date Report
immediately
following the
report period
Emergency
Annually
Within 30
One
Contract Manager
Preparedness
days of
Plan
contract
execution
and annually
by July 1
Reporting requirements for this contract include:
(1) Exhibit A, Monthly Cumulative Summary Report and Exhibit B,
Monthly Performance Data Report. Regions will negotiate with the
Provider on specific submission requirement criteria for these reports.
(2) In the event of early termination of this contract, the Provider will submit
the final Monthly Cumulative Summary Report within forty -five (45) days
after the contract is terminated.
Monroe County 16 KG069
07/01/2012
Community Care for Disabled Adults
(3) Acceptance of Reports. Where the contract requires the delivery of
reports to the Department, mere receipt by the Department shall not be
construed to mean or imply acceptance of those reports. It is specifically
intended by the parties that acceptance in writing of required reports shall
constitute a separate act. The Department reserves the right to reject
reports as incomplete, inadequate, or unacceptable according to the
parameters set forth in the contract. The Department, at its option, may
allow additional time within which the Provider may remedy the
objections noted by the Department or the opportunity to complete, make
adequate, or acceptable, or declare the resulting contract to be in default.
5. Performance Specifications
a. Performance Measures
(1) 98% of adults with disabilities receiving services will not be placed in a
nursing home.
(2) 100% of clients served through this contract will be provided case
management services and at least one other CCDA service.
b. Description of Performance Measurement Terms
Placed: The result of an assessment of an individual who is no longer able to
remain in his present place of residence. (To place a client involves
preparation for and follow up of moving a client into a more restrictive
alternative living environment).
C. Performance Evaluation Methodology
Measuring Outcomes. The Department will measure the outcomes found in
paragraph B.5.a. above as follows:
(1) The outcome measurement contained in paragraph B.5.a. (1) above will be
calculated by dividing the total, fiscal year -to -date number of clients in the
Community Care for Disabled Adults program not transferred to a nursing
home, by the total, fiscal year -to -date number of clients in the Community
Care for Disabled Adults program.
(2) The outcome measurement contained in paragraph B.5.a. (2) above will be
calculated by dividing the total number of clients served through this
contract that received case management and at least one other CCDA
service, by the total number of clients served through this contract.
d. By execution of this contract the Provider hereby acknowledges and agrees
that its performance under the contract must meet the standards set forth
Monroe County 17 KC069
07/01/2012
Community Care for Disabled Adults
above and will be bound by the conditions set forth in this contract. If the
Provider fails to meet these standards, the Department, at its exclusive option,
may allow up to six months for the Provider to achieve compliance with the
standards. If the Department affords the Provider an opportunity to achieve
compliance and the Provider fails to achieve compliance within the specified
time frame, the Department must cancel the contract in the absence of any
extenuating or mitigating circumstances. The determination of the
extenuating or mitigating circumstances is the exclusive determination of the
Department.
6. Provider Responsibilities
a. All Providers Unique Activities
Health Insurance Portability and Accountability Act. If required by 45
CFR Parts 160, 162, and 164, the following provisions shall apply [45 CFR
164.504(e)(2)(ii)]:
(1) The Provider hereby agrees not to use or disclose protected health
information (PHI) except as permitted or required by this contract, state or
federal law.
(2) The Provider agrees to use appropriate safeguards to prevent use or
disclosure of PHI other than as provided for by this contract or applicable
law.
(3) The Provider agrees to report to the Department any use or disclosure of
the information not provided for by this contract or applicable law.
(4) The Provider hereby assures the Department that if any PHI received from
the Department, or received by the Provider on the Department's behalf, is
furnished to Provider's subcontractors or agents in the performance of
tasks required by this contract, that those subcontractors or agents must
first have agreed to the same restrictions and conditions that apply to the
Provider with respect to such information.
(5) The Provider agrees to make PHI available in accordance with 45 C.F.R.
164.524.
(6) The Provider agrees to make PHI available for amendment and to
incorporate any amendments to PHI in accordance with 45 C.F.R.
164.526.
(7) The Provider agrees to make available the information required to provide
an accounting of disclosures in accordance with 45 C.F.R. 164.528.
Monroe Countv 18 KG069
07/01/2012
Community Care for Disabled Adults
(8) The Provider agrees to make its internal practices, books and records
relating to the use and disclosure of PHI received from the Department or
created or received by the Provider on behalf of the Department available
for purposes of determining the Provider's compliance with these
assurances.
(9) The Provider agrees that at the termination of this contract, if feasible and
where not inconsistent with other provisions of this contract concerning
record retention, it will return or destroy all PHI received from the
Department or received by the Provider on behalf of the Department, that
the Provider still maintains regardless of form. If not feasible, the
protections of this contract are hereby extended to that PHI which may
then be used only for such purposes as make the return or destruction
infeasible.
(10)A violation or breach of any of these assurances shall constitute a material
breach of this contract.
b. Direct Service Provider Unique Activities
(1) The Provider will be required to use volunteers to the fullest extent
feasible in the provision of services and program operations. The Provider
is required to train, supervise, and appropriately support all volunteers
with insurance coverage.
(2) The Provider will maintain an accurate and current active caseload list.
(3) The Provider will maintain a current monthly billing ledger of all Provider
claims submitted to the case management agency or Adult Services local
office, including all corrected claims and adjustments to claims for
services that were delivered to consumers being served through this
contract.
(4) The Provider will notify the case management agency or Adult Services
local office of all service terminations, service increase requests and
monthly expenditure trends with regards to the terns of this contract.
(5) The Provider will explain to each individual requesting consideration for
CCDA services that the program maintains a centralized Waiting List on
which the individual will be placed according to his or her score received
through an Adult Services Screening conducted by an Adult Services
counselor.
(6) The Provider shall provide to individuals requesting services a contact
name and phone number to the nearest Adult Services Region Office.
Monroe Countv 19 KC069
07/01/2012
Community Care for Disabled Adults
C. Case Management Provider Unique Activities
(1) The case management Provider will accept all referrals through the Adult
Services Regional Program Office.
(2) The case management Provider will complete ongoing face -to -face
assessments on all pre- screened individuals referred by the Adult Services
Regional Program Office for service consideration and program
application, using the Adult Services Client Assessment, CF -AA 3019.
(3) The case management Provider will maintain an accurate and current
active caseload list.
(4) The CCDA case management Provider will maintain a current monthly
billing ledger of all Provider claims submitted to the agency or the local
Adult Services office, including all corrected claims and adjustments to
claims for services that were delivered to consumers being served through
this contract.
(5) The CCDA case management agency will notify the local Adult Services
office of all service terminations. In addition, requests for service
increases shall be submitted to the Department using Exhibit C, Request
for Approval of CCDA Care Plan Services Increase.
(6) The case management Provider will explain to each individual requesting
consideration for CCDA services that the program maintains a centralized
Waiting List on which the individual will be placed according to his or her
score received through an Adult Services Screening.
(7) The case management Provider shall provide to individuals requesting
services a contact name and phone number to the nearest Adult Services
Region Office.
d. Coordination with Other Providers/ Entities
The case management Provider must coordinate, as necessary, with the
Agency for Persons with Disabilities, the Department of Children and
Families, the Department of Education, the Department of Health, and the
Florida Statewide Advocacy Council, to serve those clients who are eligible
for services through two (2) or more service delivery continuums.
Monroe Countv 20 KG069
07/01/2012
7. Departmental Responsibilities
a. Department Obligations
Community Care for Disabled Adults
(1) The Department will supply all new Providers with a copy of the
Community Care for Disabled Adults Operating Procedures, CFOP
140 -8.
(2) The Department will provide CCDA technical assistance to the
Provider, relative to the negotiated terms of this contract and
instructions for submission of required data.
b. Department Determinations
Should a dispute arise, the Department will make the final determination
as to whether the contract terms are being fulfilled according to the
contract specifications.
c. Monitoring Requirements
The Provider will be monitored in accordance with existing Departmental
procedures (CFOP 75 -8).
C. Method of Payment
1. Payment Clause
a. This is a fixed price (unit cost) contract. The Department shall pay the Provider
for the delivery of service units provided in accordance with the terms of this
contract, for a dollar amount not to exceed $163,466.00, subject to the availability
of funds, as follows:
Fiscal
Year 2012 -2013
$81,733.00
Fiscal
Year 2013 -2014
$81,733.00
b. The Department agrees to pay for the service units at the unit price(s) and limits
listed below:
Service
Service
Unit
Unit Rate
Case Management
Hour
550.48
Personal Care
Hour
$25.28
Homemaking
Hour
521.79
Home Delivered Meals
Meal
S 6.30
Monroe Countv 21 KC069
07/01/2012 Community Care for Disabled Adults
d. The Provider's annual dollar match for this contract is $9,081.00 and may be cash
or in kind resources.
2. Invoice Requirements
The Provider shall request payment through submission of a properly completed
Monthly Request for Payment and Expenditure Report, Exhibit D, within 15 days
following the end of the month for which payment is being requested. The Provider shall
submit to the contract manager an original Monthly Request for Payment and
Expenditure Report, Exhibit D, and no copies, along with supporting documentation.
Payment due under this contract will be withheld until the Department has confirmed
delivery of negotiated services.
Payments may be authorized only for service units on the invoice which are in
accordance with the above list and other terms and conditions of this contract. The
service units for which payment is requested may not either by themselves, or
cumulatively by totaling service units on previous invoices, exceed the total number of
units authorized by this contract.
3. Supporting Documentation
a. It is expressly understood by the Provider that any payment due the Provider
under the terms of this contract may be withheld pending the receipt and approval
by the Department of all financial and program reports due from the Provider as a
part of this contract and any adjustments thereto. Requests for payment, which
cannot be documented with supporting evidence, will be returned to the Provider
upon inspection by the Department.
b. The Provider must maintain records documenting the total number of recipients
and names (or unique identifiers) of recipients to whom services were provided
and the dates the services were provided so that an audit trail documenting service
provision can be maintained.
D. Special Provisions
1. Fees
a. The Case Management Provider will collect fees for services provided according
to Rule 65C- 2.007, Florida Administrative Code.
b. No fees shall be assessed other than those established by the Department. Fees
collected in compliance with the Department directives will be reinvested in a
manner prescribed by the Department.
Monroe County 22 KC,069
07/01/2012 Community Care for Disabled ,adults
2. MyFloridaMarketPlace Transaction Fee
This contract is exempt from the MyFloridaMarketPlace Transaction Fee in
accordance with Chapter 60A- 1.032(1) (e), Florida Administrative Code.
3. Mandatory Reporting Requirements
The Provider and any subcontractor must comply with and inform its employees of
the following mandatory reporting requirements. Each employee of the Provider, and
of any subcontractor, providing services in connection with this contract who has any
knowledge of a reportable incident shall report such incident as follows: 1) reportable
incidents that may involve an immediate or impending impact on the health or safety
of a client shall be immediately reported to the contract manager; and 2) other
reportable incidents shall be reported to the Department's Office of Inspector General
by completing a Notification/Investigation Request (form CF 1934) and emailing the
request to the Office of Inspector General at ig; complaints(ddcf. state. fl.us The
Provider and subcontractor may also mail the completed form to the Office of
Inspector General, 1317 Winewood Boulevard, Building 5, 2 °d Floor, Tallahassee,
Florida, 32399 -0700; or via fax at (850) 488 -1428. A reportable incident is defined in
CFOP 180 -4, which can be obtained from the contract manager
4. Employment Eligibility Verification
a. Definitions. As used in this clause —
(1) "Employee assigned to the contract" means all persons employed during the
contract term by the Provider to perform work pursuant to this contract within the
United States and its territories, and all persons (including subcontractors)
assigned by the Provider to perform work pursuant to this contract
(2) "Subcontract" means any contract entered into by a subcontractor to furnish
supplies or services for performance of a prime contract. It includes but is not
limited to purchase orders, and changes or modifications to purchase orders.
(3) "Subcontractor" means any supplier, distributor, vendor, or firm that furnishes
supplies or services to or for a prime contract recipient or another subcontractor.
b. Enrollment and verification requirements.
(1) The Provider shall —
(a) Enroll as a Provider in the E -Verify program within 30 calendar days
of contract award;
(b) Within 90 calendar days of enrollment in the E- Verify program, begin
to use E- Verify to initiate verification of employment eligibility. All new
employees assigned by the Provider /subcontractor to perform work
Monroe County 23 KC069
07/0t/2012 Community Care for Disabled Adults
pursuant to the contract with the Department shall be verified as
employment eligible within 3 business days after the date of hire; and
(2) The Provider shall comply, for the period of performance of this contract, with
the requirement of the E -Verify program enrollment.
(a) The Department of Homeland Security (DHS) or the Social Security
Administration (SSA) may terminate the Provider's enrollment and deny
access to the E -Verify system in accordance with the terms of the
enrollment. In such case, the Provider will be referred to a DHS or SSA
suspension or debarment official.
(b) During the period between termination of the enrollment and a
decision by the suspension or debarment official whether to suspend or
debar, the Provider is excused from its obligations under paragraph (b) of
this clause. If the suspension or debarment official determines not to
suspend or debar the Provider then the Provider must reenroll in E- Verify.
(3) Information on registration for and use of the E -Verify program can be
obtained via the Internet at the Department of Homeland Security Web site:
http: / /ww /E- Verify .
(4) The Provider is not required by this clause to perform additional employment
verification using E -Verify for any employee whose employment eligibility was
previously verified by the Provider through the E -Verify program.
(5) Employees assigned to and performing work pursuant to this contract prior to
February 04, 2011 do not require employment eligibility verification through E-
veri fy.
(6) Evidence of the use of the E- Verify system will be maintained in the
employee's personnel file.
(7) The Provider shall include the requirements of this clause, including this
paragraph (7) (appropriately modified for identification of the parties), in each
subcontract.
E. List of Exhibits
1. Exhibit A, CCDA Monthly Cumulative Summary Report
2. Exhibit B, Monthly Performance Measures Report
3. Exhibit C, Request for Approval of CCDA Care Plan Services Increase
4. Exhibit D, Monthly Request for Payment and Expenditure Report
Monroe County 24 KG069
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MONTHLY PERFORMANCE DATA REPORT
CONTRACT #
CCDA PROVIDER
REPORTING MONTH
# Active CCDA Clients / this month
# CCDA Clients / YTD
# Active CCDA Case Management Clients
# Clients Placed in Nursing Home / this month
Clients placed in Nursing Homes / this month
Active Case Management Clients / this month
Prepared by Date
Exhibit B
26 KG069
Exhibit C
' Request for Approval of CCDA Care Plan Services Increase
Part I: Recipient Information
Name: Last name, first name, middle name or initial
Date of birth:
Social security number:
Medicaid /Medicare Medical assistance number:
Current Address:
Address where services will be received:
County:
County:
Status (Transfer /Existing):
Describe reason for service funding increase.
If individual is a transfer, indicate originating district/agency:
An Adult Services client reassessment was completed on
by and
If individual is an existing consumer with your agency,
respective revised care plan revisions made on
indicate current monthly authorized units of service by
by , to
service type(s):
reflect that this Recipient is justifiably in need of increased
Service(s) based on (check all situations which apply):
❑ Failing Support System
❑ Decrease in Functional Capacity
❑ Rapidly Deteriorating Health
Medicaid waiver eligibility date:
Provider Information
Agency name:
Agency contact person:
Agency address:
Phone:
Fax:
E -mail address:
Part II: Summary of Recipient's Presenting Situation. (Refer to form instructions for details about the type of information
required here. Use the space below or include attachment.)
Part III: Proposed New Service Request. (Please indicate the new care plan services being requested and the corresponding,
anticipated service start dates.
Service Anticipated start date Service Anticipated start date
27 KG069
Part IV: Specific Description of Proposed New Service(s) As Tailored To Meet Recipient's Need. (Refer to the form
instructions for details about the type of information required here. Use the space below or include attachment.)
Part V: Cost Detail for Proposed New Care Plan Service(s).
A. Attach a Cost Detail page for each service requested in Part III. Each Cost Detail page should reflect the total
annual cost of serving the consumer for that service type.
Part VI: Care Plan Modification of Number of Service Units. The Budget Entity Team will not consider authorization to
increase service unit quantity of an authorized service on a Recipient's care plan for any of the following documented
reasons unless this section is accurately and fully completed.
[To justify unit service rates, please present comparative information: unit rate quotes from a minimum of three other service
agencies providing this same service within a ten mile radius; reasons for choosing this specific vendor; a statement attesting to the
fact that selected vendor is a sole source provider of this service in this geographic area, etc. Attach information as necessary (e.g.,
agency administrative costs, your agency salary scale, etc.). Refer to the form instructions.]
❑ Failing Support System: List proposed add -on number of monthly service units by service component with annualized
service costs projected to safely maintain Recipient at home and to ameliorate this risk factor.
❑ Decrease in Functional Capacity: List proposed add -on number of monthly service units by service component with
annualized service costs projected to safely maintain Recipient at home and to ameliorate this risk factor.
❑ Rapidly Deteriorating Health: List care plan add -on number of monthly service units by service component with
annualized service costs projected to safely maintain Recipient at home and to ameliorate this risk factor.
Part VII. Signatures. (Please note: Final approval of all requests for Care Plan increases rest with the Budget Entity Team.
Providers will receive an Award Letter from the Budget Entity Team (or one of its members) when the plan has been approved.)
Provider Agency: (Signature indicates that the information presented in this Request for Care Plan Services
Date:
Increase and attachments are accurate and complete.)
Recipient/Representative: (Signature indicates that the Recipient /Representative has reviewed the Request for
Date:
Care Plan Services Increase and attachments.)
District/Regional Program Staff: (Signature indicates that the district /regional program staff and provider have
Date:
agreed upon the services to be funded.)
District/Regional Adult Services Program Director: (Signature indicates district /regional approval of the Service
Date:
Funding Plan.)
28 KG069
o
DEPARTMENT OF CHILDREN AND FAMILIES
ADULT SERVICES OFFICE
MONTHLY REQUEST FOR PAYMENT AND EXPENDITURE REPORT
PROVIDER FED. ID #
NAME AND MAILING ADDRESS OF PAYEE: CONTRACT AMNT.:
REIMBURSEMENT YTD.:
CONTRACT BALANCE:_
DATE:
CONTRACT #:
PERIOD OF SERVICE PROVISION:
NAME OF SERVICE
OR DESCRIPTION OF MATERIALS
UNITS/
QUANTITY
AMOUNT PER UNIT/
EPISODE
TOTAL AMOUNT
DUE
TOTAL MATCH REQUIRED
FOR CONTRACT:
THIS MNTH. YTD.
TOTAL
PAYMENT
REQUESTED
�i; iii« + K F + ■
LOCAL CASH MATCH
LOCAL IN -KIND
TOTAL DEDUCTIONS
REMAINING MATCH BALANCE
kJ
SIGNITURE OF PREPARE
APPROVED BY
DATE COMPLETED
TITLE
CHILDREN AND FAMILIES USE ONLY
DATE INVOICE RECEIVED
APPROVED BY: DA
29
KG069
7 0
ATTACHMENT II
The administration of resources awarded by the Department of Children & Families to the provider may be
subject to audits as described in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A -133 and Section 215.97,
F.S., as revised, the department may monitor or conduct oversight reviews to evaluate compliance with
contract, management and programmatic requirements. Such monitoring or other oversight procedures
may include, but not be limited to, on -site visits by department staff, limited scope audits as defined by
OMB Circular A -133, as revised, or other procedures. By entering into this agreement, the recipient agrees
to comply and cooperate with any monitoring procedures deemed appropriate by the department. In the
event the department determines that a limited scope audit of the recipient is appropriate, the recipient
agrees to comply with any additional instructions provided by the department regarding such audit. The
recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits
deemed necessary by the department's inspector general, the state's Chief Financial Officer or the Auditor
General.
AUDITS
PART I: FEDERAL REQUIREMENTS
This part is applicable if the recipient is a State or local government or a non - profit organization as defined
in OMB Circular A -133, as revised.
In the event the recipient expends 5500,000 or more in Federal awards during its fiscal year, the recipient
must have a single or program - specific audit conducted in accordance with the provisions of OMB Circular
A -133, as revised. The recipient agrees to provide a copy of the single audit to the Department's Single
Audit Unit and its contract manager. In the event the recipient expends less than $500,000 in Federal
awards during its fiscal year, the recipient agrees to provide certification to the Department's Single Audit
Unit and its contract manager that a single audit was not required. In determining the Federal awards
expended during its fiscal year, the recipient shall consider all sources of Federal awards, including Federal
resources received from the Department of Children & Families, Federal government (direct), other state
agencies, and other non -state entities. The determination of amounts of Federal awards expended should be
in accordance with guidelines established by OMB Circular A -133, as revised. An audit of the recipient
conducted by the Auditor General in accordance with the provisions of OMB Circular A -133, as revised,
will meet the requirements of this part. In connection with the above audit requirements, the recipient shall
fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-
133, as revised.
The schedule of expenditures should disclose the expenditures by contract number for each contract with
the department in effect during the audit period. The financial statements should disclose whether or not
the matching requirement was met for each applicable contract. All questioned costs and liabilities due the
department shall be fully disclosed in the audit report package with reference to the specific contract
number.
Single Audit Information for Recipients of Recovery Act Funds:
(a) To maximize the transparency and accountability of funds authorized under the American Recovery and
Reinvestment Act of 2009 (Pub. L. 111-5) (Recovery Act) as required by Congress and in accordance with
2 CFR 215.21 "Uniform Administrative Requirements for Grants and Agreements" and OMB Circular A-
30
Y . ; s
102 Common Rules provisions, recipients agree to maintain records that identify adequately the source and
application of Recovery Act funds. OMB Circular A -102 is available at
http://wNvw.whitehouse.gov/omb/circulars/a102/aIO2.html.
(b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A -133,
"Audits of States, Local Governments, and Non -Profit Organizations," recipients agree to separately
identify the expenditures for Federal awards under the Recovery Act on the Schedule of Expenditures of
Federal Awards (SEFA) and the Data Collection Form (SF —SAC) required by OMB Circular A -133. OMB
Circular A -133 is available at http: / /www.whitehouse.gov /omb /circulars /al33 /al33.html. This shall be
accomplished by identifying expenditures for Federal awards made under the Recovery Act separately on
the SEFA, and as separate rows under Item 9 of Part III on the SF —SAC by CFDA number, and inclusion of
the prefix "ARRA -" in identifying the name of the Federal program on the SEFA and
as the first characters in Item 9d of Part III on the SF —SAC.
(c) Recipients agree to separately identify to each subrecipient, and document at the time of subaward and
at the time of disbursement of funds, the Federal award number, CFDA number, and amount of Recovery
Act funds. When a recipient awards Recovery Act funds for an existing program, the information furnished
to subrecipients shall distinguish the subawards of incremental Recovery Act funds from
regular subawards under the existing program.
(d) Recipients agree to require their subrecipients to include on their SEFA information to specifically
identify Recovery Act funding similar to the requirements for the recipient SEFA described above. This
information is needed to allow the recipient to properly monitor subrecipient expenditure of ARRA funds
as well as oversight by the Federal awarding agencies, Offices of Inspector General and the Government
Accountability Office.
PART II: STATE REQUIREMENTS
This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2), Florida Statutes.
In the event the recipient expends $500,000 or more in state financial assistance during its fiscal year, the
recipient must have a State single or project - specific audit conducted in accordance with Section 215.97,
Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local
governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General. The
recipient agrees to provide a copy of the single audit to the Department's Single Audit Unit and its contract
manager. In the event the recipient expends less than $500,000 in State financial assistance during its fiscal
year, the recipient agrees to provide certification to the Department's Single Audit Unit and its contract
manager that a single audit was not required. In determining the state financial assistance expended
during its fiscal year, the recipient shall consider all sources of state financial assistance, including state
financial assistance received from the Department of Children & Families, other state agencies, and other
nonstate entities. State financial assistance does not include Federal direct or pass- through awards and
resources received by a nonstate entity for Federal program matching requirements.
In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure
that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes
submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters
10.550 or 10.650, Rules of the Auditor General.
The schedule of expenditures should disclose the expenditures by contract number for each contract with
the department in effect during the audit period. The financial statements should disclose whether or not
the matching requirement was met for each applicable contract. All questioned costs and liabilities due the
department shall be fully disclosed in the audit report package with reference to the specific contract
number.
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t 4 • i
PART III: REPORT SUBMISSION
Any reports, management letters, or other information required to be submitted to the department pursuant
to this agreement shall be submitted within 180 days after the end of the provider's fiscal year or within 30
days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following
unless otherwise required by Florida Statutes:
A. Contract manager for this contract (1 copy)
B. Department of Children & Families ( 1 electronic copy and management letter, if issued )
Office of the Inspector General
Single Audit Unit
Building 5, Room 237
1317 Winewood Boulevard
Tallahassee, FL 32399 -0700
Email address: single audit adcf. state. fl. us
C. Reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and
required by Part I of this agreement shall be submitted, when required by Section .320(d), OMB
Circular A -133, as revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse
using the Federal Audit Clearinghouse's Internet Data Entry System at:
littp://Iiarvester.ceiisus.�.zov/fac/collect/ddeindex.html
and other Federal agencies and pass - through entities in accordance with Sections .320(e) and (f),
OMB Circular A -133, as revised.
D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf
of the recipient directly to the following address:
Auditor General
Local Government Audits /342
Claude Pepper Building, Room 401
1 l 1 West Madison Street
Tallahassee, Florida 32399 -1450
Email address: tlaudgen_localgovt &aud. state. fl. us
Providers, when submitting audit report packages to the department for audits done in accordance with
OMB Circular A -133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for- profit
organizations), Rules of the Auditor General, should include, when available, correspondence from the
auditor indicating the date the audit report package was delivered to them. When such correspondence is
not available, the date that the audit report package was delivered by the auditor to the provider must be
indicated in correspondence submitted to the department in accordance with Chapter 10.558(3) or Chapter
10.657(2), Rules of the Auditor General.
PART IV: RECORD RETENTION
The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement
for a period of six years from the date the audit report is issued and shall allow the department or its
designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient
shall ensure that audit working papers are made available to the department or its designee, Chief Financial
Officer or Auditor General upon request for a period of three years from the date the audit report is issued,
unless extended in writing by the department.
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