07th Amendment 04/15/2015AMY NEAVILIN, CPA
CLERK OF CIRCUIT COURT &COMPTROLLER
MONROE COUNTY, FLORIDA
DATE: June 8, 2015
TO: Beth Leto, Assistant Director
Public Works Division
ATTN: Alice Steryou
FROM: Amy Heavilin,
Clerk of the Circuit Court
At the April 15, 2015 Board of County Commissioner's meeting the Board granted approval and
execution of Item C5 renewal and seventh addendum to contract with Humane Animal Care Coalition,
Inc. (HACC) to operate the Key Largo Animal Shelter and provide animal control services from Mile
Marker 70 through Mile Marker 112 including Ocean Reef and the Village of Islamorada.
Enclosed is a duplicate original of the above mentioned executed on behalf of Monroe County for your
handling. Should you have any questions, please feel free to contact me.
cc: County Attorney
Finance
File ✓
500 Whitehead Street Suite 101, PO Box 1980, Key West FL 33040 Phone: 305-295-3130 Fax: 305-295-3663
3117 Overseas Highway, Marathon, FL 33050 Phone: 305-289-6027 Fax: 305-289-6025
88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852-7145 Fax: 305-852-7146
RENEWAL AND SEVENTH ADDENDUM TO CONTRACT
BETWEEN HUMANE ANIMAL CARE COALITION, INC.
AND MONROE COUNTY DATED APRIL 18, 2007
This Renewal and Seventh Addendum to the Agreement dated April 18, 2007 is entered into this 20th
day of May, 2015, between Humane Animal Care Coalition, Inc., a Florida non-profit corporation,
("CONTRACTOR") and Monroe County ("COUNTY").
WHEREAS, the parties entered into an agreement on April 18, 2007; as amended on August 15, 2007,
May 19, 2010, September 21, 2011, September 21, 2012, April 16, 2014 and February 18, 2015; and
WHERAS, Section IV of the agreement between the parties provides the COUNTY with the option to
renew the agreement after June 30, 2015, for one additional five-year period; and
WHEREAS, the CONTRACTOR has requested a renewal of the agreement; and
WHEREAS, in order to clarify that the reimbursement amount to CONTRACTOR is not to exceed the total
sum of the contract and to ensure that reimbursement request are timely received by the COUNTY,
language under Section II in the agreement is being amended; and
WHEREAS, in order to ensure that the CONTRACTOR's Policies and Procedures adequately address
procedures for CONTRACTOR's staff, the language in Section III SCOPE OF SERVICES, A., paragraph 7 of
the agreement is being revised to allow the County to review and request revisions as needed; and
WHEREAS, in order to provide additional training to CONTRACTOR as may be requested and required by
the County, language is being added to the Contract to allow for such training; and
WHEREAS, in order to clarify obligations and responsibilities relating to animal control investigations,
language under Section III, paragraph B. subsection 9 of the agreement is being amended to require the
CONTRACTOR to contact law enforcement and/or the Monroe County State Attorney's office when
warranted; and
WHEREAS, in order to include and update Pet Friendly Shelter Operations as Exhibit "D" to the
Agreement and to require the Contractor to assist Monroe County Emergency Management in volunteer
recruitment, language in Section III, paragraph F. of the Agreement is being revised; and
WHEREAS, for clarification Section IV is being revised to reflect that the Consumer Price Index (CPI)
adjustment shall be calculated using the CPI for the recent 12 months ending in December of each year;
and
WHEREAS, in order to avoid request for retroactive CPI adjustments, language is being revised in Section
IV of the agreement to require CONTRACTOR to request CPI adjustments no later than January 31; and
WHEREAS, in order to clarify that the County is an "intended recipient" of all audits, language in Section
XIX of the Agreement is being revised; and
1
WHEREAS, pursuant to F.S. 119.0701, language is being added to the Section XX of the agreement to
include public record law requirements;
NOW THEREFORE, in consideration of the mutual promises and considerations, the parties
agree to amend the contract as follows:
1. In accordance with Section IV of the Agreement, the County hereby exercises its option to
renew the Agreement for one additional five-year period. The renewal term shall be
effective July 1, 2015 and end at 12:00 midnight on June 30, 2020.
2. Section II AMOUNT OF AGREEMENT/AVAILBILITY OF FUNDS shall be amended to add the
following language:
The total compensation paid to the Contractor for its services under this agreement shall
not exceed the total contract sum as stated above. Reimbursement requests shall be
received no later than 15 days after the end of the month.
3. Section III SCOPE OF SERVICES, A. paragraph 7. POLICIES AND PROCEDURES MANUAL: shall
be amended to add the following:
The County may review and request revisions to the Policies and Procedures Manual as
needed.
4. Section III SCOPE OF SERVICES, B. ENFORCEMENT SERVICES, Paragraph 1. shall be amended
to add the following:
The Contractor shall attend additional training as required by the County. If there is a cost
involved with the training, the County will pay directly for such cost or reimburse for such cost
separate from and not counting against the Contractor's monthly reimbursement amount.
5. Section III SCOPE OF SERVICES, B. ENFORCEMENT SERVICES, Paragraph 9. shall be amended
to read as follows:
9. Investigating all reports of violation of local ordinances, state statutes and other rules and
regulations relating to animal control and, when warranted by the facts, contact law
enforcement and/or Monroe County State Attorney's Office to consult on Contractor's
investigation, and potential criminal investigations and/or prosecution; issue citations
(resolution No. 290-2010 and animal control citation form attached hereto in Exhibit "G3";
and or prosecute all persons charged with violation of said ordinances and regulations,
which includes representing Monroe County in court proceedings when required. Further
upon termination of this agreement, the Contractor shall complete all cases originated by
Contractor including representing the County in court if necessary.
6. Section III SCOPE OF SERVICES, paragraph F. PETS IN SHELTERS shall be amended to read as
follows:
F. PETS IN SHELTERS: Contractor shall provide the services designated for the
Supporting Agencies/Animal Control outlined in the Monroe County Emergency
f
Management Pet Friendly Shelter Operations Plan (See Exhibit "D"). Furthermore,
the Contractor shall assist Monroe County Emergency Management in recruiting
shelter workers from their volunteers to assist with the care of shelterees' pets
7. Section IV RENEWAL shall be amended to read as follows:
The contract amount agreed to herein may be adjusted annually in accordance with the
percentage change in the Consumer Price Index (CPI) for all urban consumers (CPI-U) for the
most recent 12 months ending in December of each year. The Contractor shall request
annual CPI adjustments no later than January 315Y of each year for the upcoming contract
period. Failure to timely request annual CPI adjustment will result in waiver of CPI
adjustment for that year.
8. Section XIX shall be amended to add the following language:
The County is an "intended recipient" of the audits required by this agreement. The CPA
performing said audits shall provide the audits to the County as an intended recipient of the
audit.
9. Section XX Public Record shall be amended to add the following language:
Pursuant to Florida Statute §119.0701, Contractor and its subcontractors shall comply with
all public records laws of the State of Florida, including but not limited to:
(a) Keep and maintain public records that ordinarily and necessarily would be required by
Monroe County in the performance of this Agreement.
(b) Provide the public with access to public records on the same terms and conditions that
Monroe County would provide the records and at a cost that does not exceed the cost
provided in Florida Statutes, Chapter 119 or as otherwise provided by law.
(c) Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost, to Monroe
County all public records in possession of the contractor upon termination of this
Agreement and destroy any duplicate public records that are exempt or confidential and
exempt from public records disclosure requirements. All records stored electronically must
be provided to Monroe County in a format that is compatible with the information
technology systems of Monroe County.
The County shall have the right to unilaterally cancel this Agreement upon violation of this
provision by Contractor.
10. The remaining terms of the contract dated April 18, 2007, as amended, and not inconsistent
herewith, shall remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Renewal and seventh addendum
to the Agreement as of the date first written above.
3
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By:
Clerk
Attest:
By: �.�
WITNESS
Print Name: L , o12 qaY Ae&
By:
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BOARD OF COUNTY COMMISSIONERS
O ONROE COU, FL
By:
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CONTRACTOR
By: -, i�stw�
Humane Animal Care Coalition, Inc.
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Title
MONROE C,DJ,,'TY r,TTORNEY
70 FORM:
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CHRISTIN 1 . !.,10FRT-BARROWS
ASSISTANT (',)!-; + "' TORNEY
MONROE COUNTY
EMERGENCY MANAGEMENT
PET FRIENDLY SHELTER
OPERATIONS PLAN
EXHIBIT "D"
Pet Friendly Shelter 3.25.15
I. INTRODUCTION
Purpose
The purpose of this plan is to provide standard operating procedures for operation of
the following Primary Shelters as a pet friendly evacuation shelters.
• Key West High School — #4-124 & 4-125 (Boys & Girls Locker Rooms)
• Sugarloaf School — #3-123 & 1-123 (Boys & Girls Locker Room)
• Marathon High School — #611(Boys & Girls Locker Room)
• Coral Shores High School - # 2-004A, 2-110A, 2-1108 (Boys Locker Room)
Scope
Overall management, coordination, prioritization and identification of services and
assets needed to support humans and domestic animals being housed together in a
shelter during an emergency or disaster.
II. POLICIES
Authorities
In performing the functions outlined in this operations plan county and municipal
agencies are governed by the authorities of Public Law 93- 288, as amended, FS§
252, FS § 768.13 and other rules and regulations governing this agency.
III. AGENCY ROLES AND RESPONSIBILITIES
List of Agencies:
Primary Agencies (To be contacted only by MCEM):
Monroe County Emergency Management Department
(305)289-6418
Monroe County Public Works
(305)289-4560
Monroe County School District
(305)293-1400
Monroe County Fire Rescue
(305)289-6088
Support Agencies:
Florida Keys SPCA
(305)294-4857
Safe Harbor Animal Rescue of the Keys, Inc. (SHARK)
(305)743-4800
Humane Animal Care Coalition, Inc.
(305) 51-0088
Monroe County Sheriff's Office
(305)296-2424
Florida Fish and Wildlife Commission
(305)289-2320
University of Florida Extension Services
(305)292-4501
City of Key West Police Department
(305)809-1011
Key Colony Beach Police Department
(305)743-5380
Florida Highway Patrol
(305)289-2383
Pet Friendly Shelter 3.25.15 2
i
Assignment of Responsibilities:
Primary Agency
Monroe County Emergency Management is designated as the lead agency and is
responsible for duties under the Emergency Support Function (ESF) 17, as well as the
following:
• Function as the County's representative and liaison with the Emergency
Operations Center (EOC) for activities and responsibilities carried out by other
support agencies.
• Notify the primary and supporting agencies identified in this plan and implement
all or portions of it.
• Notify, activate and mobilize agencies assigned to the designated pet friendly
shelter locations.
• Coordinate and direct supporting agency actions.
• Provide emergency supplies for animal care.
• Provide and coordinate shelter managers and staff to operate the designated pet
friendly shelters.
• Coordinate the intake and placement of shelterees and their pets at the designated
pet friendly shelters.
• Provide emergency supplies for animal care.
• Coordinate requests for support and additional resources from primary and
supporting agencies and other partner ESFs represented in the EOC.
• Continue to update and refine this plan based on After Action Reports (AARs)
and lessons learned from real world response activation.
Support Agencies
Support agencies are responsible for the following:
• Notification, activation and mobilization of personnel and equipment, when
requested
• Designate and assign people for staffing all facilities as required.
• Provide support for the pets of special needs clients during an evacuation.
• Provide representation when requested by the primary agency of this PFSP
• Coordinate all actions of the support agency with the primary agency when
performing the assigned mission of this plan
• Identify all personnel and resource requirements to preform assigned missions in
excess of the support agencies' capabilities
Pet Friendly Shelter 3.25.15 3
Response Requirements
Federal and State assistance to this plan is provided under Public Law 93-288 and
F.S. § Chapter 252. The primary and support agencies of this plan must anticipate
being as self-sufficient as possible during the first 72 hours following an event.
Resource Coordination
This plan will provide human/animal assistance through its primary and support
agencies in coordination with other ESFs to support its missions. This plan will
allocate available resources to each mission based upon priorities identified by the
EOC. Relative to human/animal shelter matters. If animal assistance resources are
locally unavailable, the ESF will directly request assistance from its corresponding
ESF at the State EOC.
All other ESF's will coordinate with the ESF 17 representatives at EOC when
requesting emergency support or disaster assistance. If a conflict of priorities
develops, this ESF will work directly with the EOC's Operations Chief to resolve the
conflict.
Recovery Operations
Although this annex addresses recovery activities of the agencies associated with this
ESF, EOC is responsible for coordinating all recovery activities to provide animal
services to the County, as required. Therefore, recovery operations of this ESF will be
initiated commensurate with emergency priorities within the County and based on the
availability of resources.
Operating Facilities
Pet Friendly Shelter Teams:
Shelter teams will serve to augment the general shelter staffing, focus on the care of
for pets in the shelter and will consist of one Animal Enforcement Officer (AEO) and
two volunteers identified prior to event. The rest of the shelter support team will be
made up of volunteers from the individuals sheltering within the facility. The Team
will be stationed at the assigned Primary Staging Area.
Contractors:
Contractors providing animal services to Monroe County will provide shelter staffing
and ESF 17 staffing if requested by the County EOC.
Note: Monroe County understands that staffing will be stretched during times of
emergency and will work with the Contractor to address the issue in advance.
Pet Friendly Shelter 3.25.15 4
Volunteers:
Volunteers will primarily be used to assist Animal Enforcement Officer (AEO) in the
care of pets at the shelter but in the event that an AEO is not available, will serve as
the lead staff for animal care in the shelter. A volunteer may be an individual who is
affiliated with an existing animal volunteer group or a member of the community,
provided they meet the following criteria:
■ Be a Monroe County resident.
■ Be 18 years old or older and in good physical condition.
■ Have current picture identification.
■ Have the knowledge and skills to perform basic animal care at shelter facility
■ Be able to write legibly and provide the shelter manager with a report of hours
worked and general tasks performed
Pet Friendly Shelter Team Duties include:
• Logging in animals and owners.
• Checking the registration log for completed forms.
• Sorting animals to group kinds/types.
• Reviewing shelter rules and regulations with evacuees.
• Verifying vaccination records.
• Inspection of animal restraint equipment (cages, pens, collars, leashes)
• Providing support agencies with number of registered animals.
• Identify all animal medications brought into the shelter and insure they are in
controlled location.
• Issue identification tags and wrist bands for people/carriers/cages and animals.
• Issue cleaning supplies to evacuees as needed and available.
• Placing protective barrier between cages and the floor of the shelter.
Pet Friendly Shelter Team Maintenance Activities include:
In April of every year, check supplies in the Shelter Hurricane Kit
o Order any supplies needed.
o Prepare intake logs and forms.
o Walk through all designated pet friendly shelters to document/photograph
conditions and note any damages.
IV. EMERGENCY MANAGEMENT CENTER LEVELS OF ACTIVATION
In the event of an emergency this plan will follow the MCEM Levels of Activation
(1-3). The Monroe County Shelter Coordinator will assess the potential severity and
extent of the areas impacted by the event and will determine the appropriate pet
friendly shelter locations. In the event of a large scale disaster there may be multiple
shelters assigned.
Pet Friendly Shelter 3.25.15 5
Pet -Friendly Shelter Preparations:
Level 3 — Monitoring
1. Review emergency procedures.
2. Review and update organizational plans.
3. Contact support agencies.
4. Identify designated pet friendly shelter facilities.
5. Notify Pet Friendly Shelter Managers and assign duties accordingly.
6. Notify Pet Friendly Shelter Team members and direct them to prepare vehicles
and equipment.
Level 2 - Partial Activation
Danger is probable within 24 to 36 hours. Staff is briefed and municipal and county
coordination is established. Emergency Information Hotline is activated.
1. All Pet Friendly Shelter Team members are put on stand-by.
2. Pet Friendly Shelter Team members are briefed by Monroe County Shelter
Coordinator with regards to the designated pet friendly shelter locations,
assignments and given a report time.
3. Supply shelters with needed provisions (i.e. dog food, cat food, water, etc.) and
provide resource access to Pet Friendly Shelter Team members.
4. Notify volunteers to remain on stand-by.
Level 1— Full Activation
Danger is probable within 12 to 24 hours. Shelters will be opened to the general
public and operations will begin.
1. Activate and mobilize Pet Friendly Shelter Team members.
2. Shelters will be opened to evacuees and in -processing will begin.
3. Initiate registration of animals.
4. Review rules and regulations with pet owners.
5. Verify vaccination records of incoming animals.
6. Inspection of animal restraint equipment (cages, collars, leashes, etc.)
7. Issue identification tags.
8. Provide Shelter Manager with number of animal owners and pets.
Pet Friendly Shelter 3.25.15 6
Post Event
Damage assessment is conducted, appropriately noted and conveyed to the Shelter
Manager.
Following the direction of the County EOC, the Shelter Manager will direct the Pet
Friendly Shelter Team members to begin to deactivate the shelter by:
• Verifying the all clear has been given by EOC.
• Checking registration log as people leave.
• Prepare area for Public Works to clean and disinfect animal areas of the shelter.
• Returning moved items to proper place (once area cleansed).
IV DISASTER SUPPLIES/ EQUIPMENT IN -COUNTY PET -FRIENDLY
SHELTERS
_Laptop computer/printer
_First aid kits
_Nylon leashes
_Fire extinguishers
_Animal stretcher
_Pet carriers
_Portable radios
_Rubber boots
_Leather gloves
_Clipboards
_Waterless hand cleaner,
_Blankets
disposable towelettes, and
Catch -poles and nets
paper towels
Newspapers
_Standard tool kit for minor repairs
_Absorbent materials (such
Bolt cutters
as cat litter)
Nylon rope
_Flashlight with battery supply
_Radios with extra batteries
_Plastic carcass bags
_Supply of animal information forms
_Manual can openers
_Ball point pens and felt markers
_Duct tape
ID bands, tags, or collars
_Camera, film, and batteries
_Air filtration masksibandanas
_ Disposal litter pans
Pooper Scoopers
_Waste disposal containers,
2 each (20 gal)
_Leashes
_Cleaning supplies, bleach,
_800 MHz radio w/charger
sanifect, buckets, rubber gloves,
_Chairs/ cots
garbage can liners, brooms,
hoses, paper towels, antibacterial soap
_Office supplies.
_Food, dry dog, dry cat, canned dog, canned cat
_Bottled water.
_Log forms, intake cards, ID
tags
Pet Friendly Shelter 3.25.15 7
APPENDIX
OF
FORMS
Pet Friendly Shelter 3.25.15
HOLD HARMLESS AGREEMENT
Pet Friendly Shelter 3.25.15
HOLD HARMLESS AGREEMENT
I understand and agree that this pet registration form is not a sheltering contract and that there is no
contractual, legal or equitable right to sheltering at the Monroe County Animal Shelter (MCAS) arising
from completion and submission of registration documents or otherwise. I hereby agree to hold
harmless all persons, organizations, corporations, or government agencies involved in the care and
sheltering of my family, my pet(s) and myself at the MCAS and agree to waive any claim against such
persons, organizations, corporations or government agencies involved in the care and sheltering of
my family, my pet(s) and myself at the MCAS. I further agree to indemnify any persons or entities,
organizations, corporations or government agencies which have suffered any loss, damage, or claim
related in any way to the care and sheltering of my animal(s) at the MCAS. I also agree to undertake
the defense of any claim against the County or other governmental agencies, organizations, or
individuals arising out of the sheltering of a pet at the MCAS.
I have read and accept the above. ❑
Print Name
Date
Signature
Pet Friendly Shelter 3.25.15 10
ANIMAL SHELTER REGISTRATION
Pet Friendly Shelter 3.25.15 11
Date: Pet Control Number:
M
Pet Registration Form
Shelter: Key West ❑ Sugarloaf ❑ Marathon ❑ Coral Shores ❑
Name of
Pet Owner:
Home Address:
Home Phone: Work Phone:
Email Address:
Pets:
Name Age M/F Spayed Breed
Neutered
Immunization records: YES ❑ NO ❑
Pet Medications or Dietary Medications or DietarvSu[mlements:
Condition Medication/Dietary Supplement
Color/Markings
How is it administered?
The information above will be provided to the animal handler for scheduling medication administration.
CAGE YES
FOOD YES
FOODMATER BOWLS YES
Pet picked up by:
NO
NO
NO
Date:
Initials
Page 1 of 1
Pet Friendly Shelter 3.25.15 12
PET CONTROL NUMBER LOG
Shelter: Key West ❑ Sugarloaf ❑ Marathon ❑ Coral Shores❑
INCIDENT: DATE:
PC Number OWNER NAME PET NAME
Pet Friendly Shelter 3.25.15 13
THIS PAGE INTENTIONALLY LEFT BLANK
Pet Friendly Shelter 3.25.15 14
PET OWNER SHELTER AGREEMENT
Pet Friendly Shelter 3.25.15 15
AGREEMENT
I, (the owner of the pet(s) listed on the registration form)
understand that an emergency exists and that special arrangements have been made to allow my family
and pet(s) to remain together in this shelter facility. I understand and agree to abide by the pet care
rules contained in this agreement and have explained them to any other family member accompanying
my pet(s) and me.
RULES:
1. My pet(s) will remain contained in its approved carrier except at scheduled times. During scheduled
relief times, my pet(s) will be properly confined with leash, harness or muzzle (if necessary).
Scheduled times will be strictly adhered to.
2. 1 agree to supply food and bowls for food and water.
3. 1 certify that my pet(s) is current on rabies and all other vaccinations recommended
4. 1 will maintain proper identification on my pet(s) and its carrier at all times.
5. 1 will permit qualified animal shelter personnel/vet to administer medical care should it become
necessary.
6. I acknowledge that my failure to follow these rules may result in the removal of my pet(s) to another
location. I further understand that if my pet(s) becomes unruly, aggressive, shows signs of
contagious disease, is infested by parasites (fleas, ticks, lice, etc.) or begins showing signs of
stress related conditions, it may be removed to a more appropriate location. I understand that any
decision concerning the care and welfare of my pet(s) and the shelter population as a whole are
within the sole discretion of the shelter manager, whose decision is final.
7. 1 further understand that any damage caused by my pet(s) will be my responsibility.
I certify that my pet(s) has no previous history of aggressive behavior and has not been diagnosed
with any contagious disease for which it has not received successful treatment.
I hereby agree and hold harmless all persons, organizations, corporations, or government
agencies involved in the care and sheltering of my animal(s). I further agree to indemnify any
persons or entities which may have suffered any loss or damage as a result of the care and
sheltering of my animal(s).
SIGNED
PRINTED NAME DATE
Pet Friendly Shelter 3.25.15 16
Pet -Friendly Hurricane Evacuation Center (PHEC)
Registration Guidelines
Pre -Registration
Part 1
All residents living in the qualified areas must pre -register their families and their center acceptable
pets (a maximum of three). An adult who will be sheltering at the Pet -Friendly Hurricane Evacuation
Center (PHEC) with his or her pet(s) can call the Monroe County Emergency Management at (305)
299-6018 to receive an application packet by mail, or the applicant can complete the online packet
and mail it to the address provided. Required information will include:
• Name of each family member sheltering at the Center.
• Home address.
• Daytime phone number.
• Evening phone number.
• Cellular phone number.
• Name of pet(s).
• Description of pet(s) including gender/breed/coloring and weight
• Medical history of pet including all current medication.
• Description of carrier/cage.
Part 2
Monroe County Emergency Management will mail a registration packet which includes:
• A tentative acceptance letter.
• Part 2 of the application which must be:
• completed in its entirety.
• notarized.
Part 3
Applicants must return the following items to be eligible for acceptance into the PHEC:
• Part 2 of the application, completed and notarized.
• A photocopy of the most recent utility bill that reflects the home address provided on the
application.
• A picture of each pet being registered (minimum size of Xx 5").
• A photocopy of a picture identification of the adult registering/sheltering at the PHEC.
Acceptable forms of identification are:
• State of Florida Driver's License
• Current United States Passport
• State of Florida Identification
Page 1 of 8
Pet Friendly Shelter 3.25.15 17
Pet -Friendly Hurricane Evacuation Center (PHEC)
Application: Part 1
Complete Name of
Adult Applicant: _
Home Address:
Home Phone: Work Phone:
Email Address:
Family Members (first and last name, if different from above):
1 age:
2 age:
3 age:
4 age:
Pets:
Name
Age M/F Spayed Breed Color/Markings
Neutered
Pet Medications or Dietary Supplements:
Condition Medication/Dietary Supplement
How is it administered?
The information above will be provided to the animal handler for scheduling medication administration.
Crate/Cage info:
Animal type Material Dimensions Access Panel Location
Page 2 of 8
Pet Friendly Shelter 3.25.15 18
Pet -Friendly Hurricane Evacuation Center (PHEC)
Application: Part 2
Instructions
I agree to read all information and follow all instructions as detailed on this registration form. I
understand that failure to do so will preclude my and/or my family's, and my pet's(s') acceptance.
At the end of each paragraph or section there is a box that must be checked acknowledging that
you read, understood, and agree to abide by the provisions therein. This form must be completed
in its entirety, notarized, and returned by mail to:
Pet -Friendly Shelter Application
c/o Monroe County Emergency Management
490 63`d Street
Marathon, Florida 33050
This form must be signed and dated by an adult who is reporting to the PHEC for sheltering. It is the
responsibility of the registrant to assure receipt of this form by the Monroe County Emergency
Management. This may be done by calling (305)289-6018.
I have read and accept the above. ❑
The information that I provided during my registration is accurate and complete. I understand that
only those family members and pets pre -registered are allowed into the PHEC.
I have read and accept the above. ❑
I agree to notify Monroe County Emergency Management as soon as possible of any changes in my
registrant status. I understand that any changes, additions or deletions, either of persons or animals,
must be made prior to a hurricane warning being issued for any one storm.
I have read and accept the above. ❑
I understand that to gain entrance into the shelter I must reside in one of the mandatory evacuation
zones. If my residence changes to an area outside a mandatory evacuation zone, or if I am no longer
residing in a home that has been deemed unsafe by Monroe County, I understand that I (and my
family and pet(s)) will no longer be eligible for sheltering at the PHEC.
I have read and accept the above. ❑
I understand that to gain entrance into the PHEC. I must arrive at the PHEC with all items outlined in
the tentative acceptance letter that accompanied this form.
I have read and accept the above. ❑
Page 3of8
Pet Friendly Shelter 3.25.15 19
Application: Part 2 (continued)
My animal(s) are in good health. I understand that even though pre -registered, if my pet(s) is deemed
a health or safety risk to any person or animal, entrance will be denied. This includes flea or tick
infestation or any active parasitic or fungal infection such as ringworm or mange. I agree to my pet
being examined by qualified animal shelter personnel to determine its fitness for entry. I understand
and agree that at all times, regardless of compliance with all requirements, Monroe County still
retains sole discretion in accepting persons and pets to the PHEC.
I have read and accept the above.
My pet(s) will be current on all required vaccinations as noted on the acceptance letter. I will provide
proof of all required vaccinations at check -in as well as current rabies tag(s) as required. I understand
that failure to provide these items will preclude entrance into the shelter.
I have read and accept the above. ❑
I understand and agree that at least one (1) adult family member will reside in the shelter with the
pet(s) at all times and that if at any time my pet(s) is(are) left in the shelter without at least one (1)
adult family member that the animal(s) is then considered abandoned and will be immediately
surrendered to
I have read and accept the above.
I understand and agree that if for any reason my animal is left behind, it is thereby considered
abandoned and I will be responsible for any and all fees, fines, or monetary remittance payable to
under their adoption, reunification, or euthanasia policy.
I have read and accept the above.
I understand and agree that upon entrance to the PHEC access to the animal(s) is limited and will be
allowed contingent upon the needs of the animals, staff, or PHEC staff.
I have read and accept the above. ❑
I understand that the feeding, replenishing of water, and removal of waste materials from the cage is
the responsibility of the adult family member. Immediately upon request of PHEC staff to report to the
animal area, I will do so and perform any feeding, watering, or waste removal necessary.
I have read and accept the above. ❑
Page 4 of 8
Pet Friendly Shelter 3.25.15 20
I understand and agree that this PHEC registration program is not a sheltering contract and that there
is no contractual, legal or equitable right to sheltering at the PHEC arising from completion and
submission of registration documents or otherwise. I hereby agree to hold harmless all persons,
organizations, corporations, or government agencies involved in the care and sheltering of my family,
my pet(s) and myself at the PHEC and agree to waive any claim against such persons, organizations,
corporations or government agencies involved in the care and sheltering of my family, my pet(s) and
myself at the PHEC. I further agree to indemnify any persons or entities, organizations, corporations
or government agencies which have suffered any loss, damage, or claim related in any way to the
care and sheltering of my animal(s) at the PHEC. I also agree to undertake the defense of any claim
against the County or other governmental agencies, organizations, or individuals arising out of the
sheltering of a pet at the PHEC.
I have read and accept the above. ❑
Print Name Signature
Date
Stamp seal here
Notary Public
Date
Page 5 of 8
Pet Friendly Shelter 3.25.15 21
Pet -Friendly Hurricane Evacuation Center (PHEC)
Tentative Acceptance Letter
Dear Applicant:
This letter serves to acknowledge receipt of Part 1 of your application for the Monroe County Pet -
Friendly Hurricane Evacuation Center (PHEC). For the registration process to be complete, you must
fill out and return Part 2 of the application and return it to:
Pet -Friendly Shelter Application
c/o Monroe County Emergency Management
490 63`d Street, Suite 150
Marathon, FL 33050
Failure to return the form negates your application and hurricane evacuation center eligibility. It is
your responsibility to contact the Monroe County Emergency Management at (305)289-6018 to
assure that the form was received and that your registration is complete.
This PHEC is the first of its kind in Monroe County and we are working to assure a successful
operation. However, the success of this pet -friendly hurricane evacuation center depends upon you.
On Part 2 of the application you acknowledged and agreed to certain provisions regarding shelter
management. You are expected to abide by these provisions. Any infraction can result in your
removal from the registration database and denial of use of the PHEC for current and future storms.
You should understand that this letter, your application, or your compliance with all PHEC
requirements do not constitute a binding commitment or contract that you and your pets will be
accepted at the PHEC. The purpose of this application process is to facilitate the accommodation of
applicants. However, everyone should understand that even if they comply with all application
requirements and receive this letter, there is no guarantee or contractual commitment that you and
your pets will be accepted at the PHEC.
If you live in one of the County's hurricane evacuation zones, mobile homes, or in a structure that has
been deemed unsafe by the County, you must monitor the hurricane event and listen for the
mandatory evacuation order. Upon issuance of a mandatory evacuation order for your area, you
should report to the PHEC with all of the items listed in this letter. It is important to note that opening
of this shelter is at the sole discretion of Monroe County and that you need to have a contingency
plan for yourself and your pet(s) if this shelter is not opened for any reason, or if you and your pet are
not accepted in the PHEC.
Upon arrival at the PHEC, all animals will be examined by a qualified shelter personnel / licensed
veterinarian. The veterinarian will only examine the animal and will not vaccinate or offer medical
treatment. This examination will determine if the animal presents a health or safety risk to any human
or other animal. All proof of vaccinations must be presented at this time. Any animal deemed a risk to
humans or other animals, due to illness or behavioral problems, will not be allowed to enter. It is
imperative that your animal is clean, healthy, and that all vaccinations are up to date. It is within the
County's sole discretion to determine whether any pet will be accepted at the PHEC.
Page 6 of 8
Pet Friendly Shelter 3.25.15 22
Items you must bring to the PHEC:
• Valid photo identification and recent utility bill showing current address for adult registrant
• Proof of all current required vaccinations for each pre -registered pet (list appears on page)
• All personal hygiene items, medications, and bedding supplies for each member of your family
• A three (3) day supply of non-perishable food and water for each member of your family and each
pet; any medications for each pet.
• Appropriate bowls or dishes for each pet's food and water.
• Appropriate crate/cage for each pet; bedding (specifications are below).
• A sheet or other covering material for each crate to reduce the visual stimuli of the animal.
• A secure collar and sturdy leash for each dog.
Although we do not list numeric specifications for the size of any one crate or cage, the following
criteria apply for dogs and cats:
Housing must be large enough to allow the animal to stand, turn around, and fully recline. It should be
constructed of wire or heavy plastic and must be well ventilated. Crates/cages excessive in size and
exercise pens are not allowed. Smaller dogs and cats may be housed together as a species as long
as they are fully socialized and the provisions for movement are met for each animal.
All dogs must have the following current vaccinations
Rabies
Distemper/Parvo
Bordetella
Coronavirus
All cats must have the following current vaccinations:
Rabies
Feline Leukemia
Rhinotracheitis
Calicivirus
Panleukopenia (distemper)
Ferrets: Housing for ferrets must allow ample room for movement, constructed of wire or heavy
plastic, and allow for the appropriate bedding material without spillage. Up to three (3) ferrets may be
housed together as long as they are fully socialized and the provisions for movement are met for
each animal.
All ferrets must have the following current vaccinations:
Rabies
Distemper
Page 7 of 8
Pet Friendly Shelter 3.25.15 23
Small mammals: Housing for small mammals (gerbils, guinea pigs, hamsters, mice, rabbits, rats) that
provides space for ample movement. Cages must be chew -proof, such as wire or plastic, and have a
base deep enough to hold appropriate bedding. Small mammals normally housed together may stay
together as long as the aforementioned provisions for movement are met for each animal.
Birds: Cages must allow for adequate movement, minimal flight and be fully ventilated. Up to three (3)
birds may be housed together as long as they are fully socialized. Food and water dishes must be
easily accessible and not require the opening of main access. Covers need to be provided to deter
noise and reduce stress.
Thank you for pre -registering your family and pets. Please review all of the criteria listed in this packet
before submitting and address any questions to Emergency Management at 305-289-6018.
Sincerely,
Irene Toner
Director
Monroe County Emergency Management
Pet Friendly Shelter 3.25.15 24
PET SHELTER VOLUNTEER FORMS
Pet Friendly Shelter 03/27/2015 25
Monroe County Emergency Management Department
Pet -Friendly Shelter Team NAME:
490 63'd Street Suite 150
Marathon, FL 33050
(305)289-6018
The information in the box below is filled out the first time you volunteer. Then, each time you return, enter on the back side of this log your time
in and time out. It is very important that these procedures are followed so that MCEMD can properly acknowledge volunteers for the work they
have done, and to keep our internal records current. If you have any questions about the log, those working in the volunteer sign -in area will be
glad to help you.
TODAY'S DATE:
ADDRESS:
STREET:
CITY / STATE / ZIP CODE:
HOME PHONE#
NAME OF EMERGENCY CONTACT PERSON
HAVE YOU COMPLETED THE MONROE COUNTY SHELTER MANAGER TRAINING? ❑ YES ❑ NO
IS THIS THE FIRST TIME YOU HAVE VOLUNTEERED WITH MCEMD? ❑ YES ❑ NO
PLEASE NOTE: IT IS RECOMENDED THAT PET -SHELTER VOLUNTEERS ARE CURRENT ON THEIR TETANUS
VACCINATION BEFORE THEY CAN START WORKING!
CHECK WHICH OF THE FOLLOWING VACCINATIONS YOU ARE UP-TO-DATE ON:
❑ TETANUS (DATE ) ❑ HEPATITIS A (DATE ) ❑ RABIES PRE -EXPOSURE (DATE )
HAVE YOU COMPLETED THE MONROE COUNTY VOLUNTEER REGISTRATION FORM? ❑ YES ❑ NO
IF NO, VOLUNTEERS MUST COMPLETE THIS FORM BEFORE JOINING THE TEAM.
DO YOU HAVE A CURRENT PICTURE I.D.? ❑ YES ❑ NO
NAME OF EMERGENCY CONTACT PERSON RELATIONSHIP OF EMERGENCY CONTACT PERSON
HOME PHONE NUMBER OF EMERGENCY CONTACT PERSON
CHART USE ONLY
❑ VOL APP ❑ CTY FORM 1 ❑ EMG ❑ PICT LD 1 ❑ CERT ❑ LTR ❑ TS ❑ WS INFO
CONT
Pet Friendly Shelter 03/27/2015 26
MCEMD Daily Volunteer Log
EVENT:
SIGN -IN LOG TALLY SHEET
► VOLUNTEER'S NAME:
N SUMMARY OF VOLUNTEER HOURS N
► START DATE:
► TOTAL DAYS:
► FINAL DATE:
/ TOTAL HOURS:
INSTRUCTIONS: ON THE FIRST LINE IN COLUMN "A" FILL IN
THE DATE AND YOUR TIME IN AND TIME OUT, AND THEN
TOTAL YOUR HOURS FOR THAT DAY. CONTINUE TO DO THIS
FOR EACH DAY THAT YOU VOLUNTEER. IF YOU REACH THE
BOTTOM LINE OF COLUMN "A" CALCULATE YOUR SUB-
TOTAL AND THEN CONTINUE KEEPING TRACK OF YOUR TIME
IN COLUMN "B." WHEN YOU ARE DONE VOLUNTEERING
WRITE IN YOUR TOTAL HOURS AND MINUTES AT THE
BOTTOM OF COLUMN "B."
Pet Friendly Shelter 03/27/2015 27
MCEMD VOLUNTEER REGISTRATION
By completing this form, you are registering as a volunteer with Monroe County Emergency Management Department.
DATE
LOCATION OF DISASTER
NAME
SSN
ADDRESS
DRIVERS LIC # / STATE
CITY/ STATE / ZIP CODE
HOME PHONE WORK PHONE PAGER CELL
CONTACT RELATIONSHIP
ADDRESS
PHONE CELL
DO YOU HAVE HEALTH CARRIER POLICY NUMBER
INSURANCE? ❑ NO ❑ YES
DO YOU HAVE A CURRENT
TETANUS VACCINATION? ❑ NO ❑
YES
IF NOT, YOU MUST GET ONE. PROOF OF THE VACCINATION WILL BE NEEDED PRIOR
TO ALLOWING YOU TO VOLUNTEER
IF YES. DATE OF LAST TETANUS VACCINATION?
ARE YOU ON LONG TERM
MEDICATIONS?
❑ NO ❑ YES IF YES, TYPE
DO YOU HAVE ANY MEDICAL CONDITIONS THAT HCAS SHOULD BE AWARE OF IN
THE EVENT OF AN EMERGENCY? ❑ NO ❑ YES IF YES, EXPLAIN
DO YOU HAVE ANY MEDICAL ARE YOU ALLERGIC TO ANY ANIMALS? ARE YOU AFRAID OF ANY ANIMALS?
ALLERGIES? ❑ NO ❑ YES IF YES, ❑ NO ❑ YES IF YES, TYPE ❑ NO ❑ YES IF YES, TYPE
EXPLAIN
❑ DOGS ❑ CATS ❑ HORSES ❑ DONKEYS ❑ CATTLE ❑ SHEEP ❑ GOATS ❑ PIGS
❑ BIRDS ❑ REPTILES -TYPE ❑ WILDLIFE -TYPE
❑ EXOTIC ANIMALS -TYPE
WHAT PREVIOUS ANIMAL RELATED EXPERIENCE DO YOU HAVE? DOES ANY OF YOUR EXPERIENCE INCLUDE HELPING
ANIMALS DURING A DISASTER?
Pet Friendly Shelter 03/27/2015 28
SHELTER PHONE LOG
FOR
SHELTER MANAGER USE ONLY
Pet Friendly Shelter 03/27/2015 29
LOCATION
PHONE LOG
TODAY'S DATE Page _ of
TIME YOUR NAME FROM FOR COMMENTS ACTION REQUIRED FOLLOW-UP
(NAMEINUMBER) (NAME/NUMBER) COMPLETED
Pet Friendly Shelter 3.23.11 24
IV '
SHELTER SUPPLY REQUEST FORM - FOR SHELTER MANAGER ONLY
Pet Friendly Shelter 3.23.11 25 [Type text]
THIS PAGE INTENTIONALLY LEFT BLANK
Pet Friendly Shelter 03/27/2015 27
24
SUPPLY REQUEST FORM
LOCATION TODAY'S DATE Page _ of
REQUESTED BY
#
ITEM DESCRIPTION
AND COMMENTS
PURCHASE
AUTHORIZED
IF NEEDED
SOURCE
RECEIVED BY
REC'D DATE/
TIME
COST
Pet Friendly Shelter 3.23.11 26