FY2016 10/21/2015 •
AGREEMENT
This Agreement is made and entered into this 21st day of October, 2015, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or "County," and Burton Memorial United Methodist Church, hereinafter referred to as
"PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of a
food pantry for disadvantaged persons, and
WHEREAS, it is a legitimate public purpose to provide facilities and services for the provision
of a food pantry and meals for disadvantaged persons of Monroe County, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows:
FUNDING
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and carrying out the duties of the Board as to providing facilities and
services for provision of a food pantry for disadvantaged persons of Monroe County, Florida, shall
pay to the PROVIDER the sum of TEN THOUSAND AND NO/100 DOLLARS ($10,000.00) for fiscal
year 2015-2016.
2. TERM. This Agreement shall commence on October 1, 2015, and terminate September
30, 2016, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be made periodically, but no more frequently than monthly,
as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's
Finance Office. The County shall only reimburse, subject to the funded amounts below, those
reimbursable expenses which are reviewed and approved as complying with Monroe County Code
of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement
Requirements. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing
the expenses, with supporting documentation attached. The letter should contain a notarized
certification statement. An example of a reimbursement request cover letter is included as
Attachment B. The organization's final invoice must be received within thirty days after the
termination date of this contract shown in Article 2 above.
After the Clerk of the Board examines and approves the request for reimbursement, the
Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments
in the aggregate sum shall not exceed the total amount shown in Article 1, above, during the term
of this agreement.
4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a
level sufficient to allow for continued reimbursement of expenditures for services specified herein,
this agreement may be terminated immediately at the option of the Board by written notice of
termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services
or goods provided by the PROVIDER after the PROVIDER has received written notice of termination,
unless otherwise required by law.
5. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall
be, and is, empowered to apply for, seek, and obtain federal and state funds to further the purpose
of this Agreement; provided that all applications, requests, grant proposals, and funding
solicitations shall be approved by each party prior to submission.
Contract-Burton Memorial-FY16;page 1
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6. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with
funds provided under this agreement, shall become the property of Monroe County and shall be
accounted for pursuant to statutory requirements.
RECORDKEEPING
7. RECORDS. PROVIDER shall maintain all books, records, and documents directly
pertinent to performance under this Agreement in accordance with generally accepted accounting
principles consistently applied. Each party to this Agreement or their authorized representatives
shall have reasonable and timely access to such records of each other party to this Agreement for
public records purposes during the term of the Agreement and for four years following the
termination of this Agreement. If an auditor employed by the County or Clerk determines that
monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by
this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant .
to Sec. 55.03, FS, running from the date the monies were paid to PROVIDER.
In addition, if PROVIDER is required to provide an audit as set forth in in Section 9(d) below, the
audit shall be prepared by an independent certified public accountant (CPA) with a current license,
in good standing with the Florida State Board of Accountancy, and maintain malpractice insurance
covering the audit services provided. If the PROVIDER receives $100,000 or more in grant funding
from the County, the CPA must also be a member of the American Institute of Certified Public
Accountant (AICPA). The County shall be considered an "intended recipient" of said audit.
8. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access
to, and inspection of, all documents, papers, letters or other materials in its possession or under
its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the
County and PROVIDER in conjunction with this Agreement; and the County shall have the right to
unilaterally cancel this Agreement upon violation of this provision by PROVIDER.
9. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the
County the following (items A-I must be provided prior to the payment of any invoices):
(a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status;
(b) List of the Organization's Board of Directors of which there must be at least 5 and for each
board member please indicate when elected to serve and the length of term of service;
(c) Evidence of annual election of Officers and Directors;
(d) Unqualified audited financial statement from the most recent fiscal year for all organizations
that expend $150,000 a year or more; if qualified, include a statement of deficiencies with
corrective actions recommended/taken;
(e) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules;
(f) Organization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
(g) Organization's Policies and Procedures Manual which must include hiring policies for all staff,
drug and alcohol free workplace provisions, and equal employment opportunity provisions;
(h) Specific description or list of services to be provided under this contract with this grant (see
Attachment C);
(i) Annual Performance Report describing services rendered during the most recently completed
grant period (to be furnished within 30 days after the contract end date.) The performance
report shall include statistical information regarding the types and frequencies of services
provided, a profile of clients (including residency) and numbers served, and outcomes
achieved (see Attachment G);
(j) Cooperation with County monitoring visits that the County may request during the contract
year; and
(k) Other reasonable reports and information related to compliance with applicable laws,
contract provisions and the scope of services that the County may request during the
contract year.
Contract-Burton Memorial-FY16;page 2
.
RESPONSIBILITIES
10. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and provide the services outlined
in Attachment C to residents of Monroe County, Florida.
11. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event
any cause of action or administrative proceeding is initiated or defended by any party relative to
the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to
reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award
against the non-prevailing party, and shall include attorney's fees, courts costs, investigative, and
out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted
pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and
usual and customary procedures required by the circuit court of Monroe County.
12. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement
shall bind and inure to the benefit of the County and PROVIDER and their respective legal
representatives, successors, and assigns.
13. CODE OF ETHICS. County agrees that officers and employees of the County recognize
and will be required to comply with the standards of conduct for public officers and employees as
delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or
acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public
position, conflicting employment or contractual relationship; and disclosure or use of certain
information.
14. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect
to itself, it has neither employed nor retained any company or person, other than a bona fide
employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed
to pay any person, company, corporation, individual, or firm, other than a bona fide employee
working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon
or resulting from the award or making of this Agreement. For the breach or violation of the
provision, the PROVIDER.agrees that the County shall have the right to terminate this Agreement
without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full
amount of such fee, commission, percentage, gift, or consideration.
15. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee of the Board. No statement contained
in this agreement shall be construed so as to find the PROVIDER or any of its employees,
contractors, servants or agents to be employees of the Board.
COMPLIANCE ISSUES
16. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the
PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating
the provision of such services, including those now in effect and hereinafter adopted. Any violation
of said statutes, ordinances, rules and regulations shall constitute a material breach of this
agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
Contract-Burton Memorial-FY16;page 3
17. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure
that all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state
and/or federal certification and/or licensure of the PROVIDER'S program and staff.
18. NON-DISCRIMINATION. County and PROVIDER agree that there will be no
discrimination against any person, and it is expressly understood that upon a determination by a
court of competent jurisdiction that discrimination has occurred, this Agreement automatically
terminates without any further action on the part of any party, effective the date of the court order.
County or PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances,
as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the
Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or
national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-
1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the
Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis
of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which
prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972
(PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970
(PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ee-3), as
amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the
Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale,
rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201
Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability;
10) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the
parties to, or the subject matter of, this Agreement.
AMENDMENTS, CHANGES, AND DISPUTES
19. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services
and/or reimbursement of services shall be accomplished by an amendment, which must be
approved in writing by the County.
20. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree
that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions
between representatives of each of the parties. If no resolution can be agreed upon within 30 days
after the first meet and confer session, the issue or issues shall be discussed at a public meeting of
the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction
of the parties, then any party shall have the right to seek such relief or remedy as may be provided
by this Agreement or by Florida law.
21. COOPERATION. In the event any administrative or legal proceeding is instituted
against either party relating to the formation, execution, performance, or breach of this Agreement,
County and PROVIDER agree to participate, to the extent required by the other party, in all
proceedings, hearings, processes, meetings, and other activities related to the substance of this
Agreement or provision of the services under this Agreement. County and PROVIDER specifically
agree that no party to this Agreement shall be required to enter into any arbitration proceedings
related to this Agreement.
ASSURANCES
22. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently
has any interest, and shall not acquire any interest, which would conflict in any manner or degree
Contract-Burton Memorial-FY16;page 4
with its performance under this Agreement, and that only interest of each is to perform and receive
benefits as recited in this Agreement.
23. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing
and with the prior written approval of the Board, which approval shall be subject to such conditions
and provisions as the Board may deem necessary. This agreement shall be incorporated by
reference into any assignment and any assignee shall comply with all of the provisions herein.
Unless expressly provided for therein, such approval shall in no manner or event be deemed to
impose any obligation upon the Board in addition to the total agreed upon reimbursement amount
for the services of the PROVIDER.
24. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida
Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition
of any commercial liability insurance coverage, self-insurance coverage, or local government
liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability
coverage, nor shall any contract entered into by the County be required to contain any provision
for waiver.
25. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug-
Free Workplace Statement.
26. AUTHORITY. Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all necessary County
and corporate action, as required by law.
INDEMNITY ISSUES
27. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees
to indemnify and hold harmless Monroe County Board of County Commissioners from any and all
claims for bodily injury (including death), personal injury, and property damage (including property
owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees)
which arise out of, in connection with, or by reason of services provided by the PROVIDER
occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S
employees, agents, or volunteers.
28. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability,
exemptions from laws, ordinances, and rules and pensions and relief, disability, workers'
compensation, and other benefits which apply to the activity of officers, agents, or employees of
any public agents or employees of the County, when performing their respective functions under
this Agreement within the territorial limits of the County shall apply to the same degree and extent
to the performance of such functions and duties of such officers, agents, volunteers, or employees
outside the territorial limits of the County.
29. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be
deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe
County in his or her individual capacity, and no member, officer, agent or employee of Monroe
County shall be liable personally on this Agreement or be subject to any personal liability or
accountability by reason of the execution of this Agreement.
30. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any
participating entity from any obligation or responsibility imposed upon the entity by law except to
the extent of actual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
Contract-Burton Memorial-FY16,;page 5
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
31. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon
the terms of this Agreement to enforce or attempt to enforce any third-party claim or entitlement
to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER
agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall
have the authority to inform, counsel, or otherwise indicate that any particular individual or group
of individuals, entity or entities, have entitlements or benefits under this Agreement separate and
apart, inferior to, or superior to the community in general or for the purposes contemplated in this
Agreement.
GENERAL
32. Execution in Counterparts. This Agreement may be executed in any number of
counterparts, each of which shall be regarded as an original, all of which taken together shall
constitute one and the same instrument and any of the parties hereto may execute this Agreement
by signing any such counterpart.
33. NOTICE. Any notice required or permitted under this agreement shall be in writing
and hand-delivered or mailed, postage pre-paid, by certified mail, return receipt requested, to the
other party as follows:
For Board:
Grants Administrator and Monroe County Attorney
1100 Simonton Street PO Box 1026
Key West, FL 33040 Key West, FL 33041
For PROVIDER
Kerry Foote
Burton Memorial United Methodist Church
93001 Overseas Hwy.
Tavernier, FL 33070
305-852-2581
305-852-4917 FAX
34. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This
Agreement shall be governed by and construed in accordance with the laws of the State of Florida
applicable to contracts made and to be performed entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will
lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida.
The County and PROVIDER agree that, in the event of conflicting interpretations of the terms
or a term of this Agreement by or between any of them the issue shall be submitted to mediation
prior to the institution of any other administrative or legal proceeding.
35. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept
and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and
shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach,
either of the same conditions or covenants or otherwise.
36. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or
the application thereof to any circumstance or person) shall be declared invalid or unenforceable to
any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and
Contract-Burton Memorial-FY16;page 6
'provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant,
condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent
permitted by law unless the enforcement of the remaining terms, covenants, conditions and
provisions of this Agreement would prevent the accomplishment of the original intent of this
Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken
provision with a valid provision that comes as close as possible to the intent of the stricken
provision.
37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the PROVIDER and the Board.
[THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW]
•
Contract-Burton Memorial-FY16;page 7
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of
the d. and year first written above.
BOARD OF COUNTY COMMISSIONERS
AVILIN, CLERK OF MONROE COUNTY, FLORIDA
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Contract-Burton Memorial-FY16;page 8
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ATTACHMENT A
EXPENSE REIMBURSEMENT REQUIREMENTS
This document is intended to provide basic guidelines to Human Service and Community-Based
Organizations, county travelers, and contractual parties who have reimbursable expenses
associated with Monroe County business. These guidelines, as they relate to travel, are from the
Monroe County Code of Ordinances and State laws and regulations.
A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense
request needs to also contain the following notarized certified statement:
"I certify that the above checks have been submitted to the vendors as noted and that the
attached expenses are accurate and in agreement with the records of this organization.
Furthermore, these expenses are in compliance with this organization's contract with the Monroe
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source."
Invoices should be billed to the contracting agency. Third party payments will not be considered
for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines should be directed to 305-292-3534.
Data Processing, PC Time, etc.
The vendor invoice is required for reimbursement. Inter-company allocations are not considered
reimbursable expenditures unless appropriate payroll journals for the charging department are
attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If
a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total
hours worked, withholding information and paid payroll taxes, check number and check amount.
If a Payroll Journal is not provided, the following information must be provided: pay period, check
amount, check number, date, payee, and support for applicable paid payroll taxes.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for reimbursement.
For overnight or express deliveries, the vendor invoice must be included.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not
allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Contract-Burton Memorial-FY16;page 9
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the
number called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the
telephone number, the date, and the purpose of the call.
Travel and Meal Expenses
Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel
Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with
Monroe County Code of Ordinances and State laws and regulations. Credit card statements are
not acceptable documentation for reimbursement. If attending a conference or meeting, a copy
of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of
the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental
reimbursement requires the vendor invoice. Fuel purchases should be documented with paid
receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a
taxi from one's residence to the airport for a business trip is not reimbursable. Parking is
considered a reimbursable travel expense at the destination. Airport parking during a business
trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room
must be registered and paid for by traveler. The County will only reimburse the actual room and
related bed tax. Room service, movies, and personal telephone calls are not allowable expenses.
Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading
must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a
residence or office to a point of departure. For example, driving from one's home to the airport
for a business trip is not a reimbursable expense.
Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state
that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2
p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement.
Non-allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
Contract-Burton Memorial-FY16;page 10
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ATTACHMENT B
ORGANIZATION
LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, FL 33040
Date
The following is a summary of the expenses for (Organization name) for the time period
of to .
Check # Payee Reason Amount
101 Company A Rent $ X,XXX.XX
102 Company B Utilities XXX.XX
104 Employee A P/R ending 05/14/01 XXX.XX
105 Employee B P/R ending 05/28/01 XXX.XX
(A) Total $ X,XXX.XX
(B) Total prior payments $ X,XXX.XX
(C) Total requested and paid (A + B) $ X,XXX.XX
(D) Total contract amount $ X,XXX.XX
Balance of contract (D-C) $ X,XXX.XX
I certify that the above checks have been submitted to the vendors as noted and that the
expenses are accurate and in agreement with the records of this organization. Furthermore,
these expenses are in compliance with this organization's contract with the Monroe County Board
of County Commissioners and will not be submitted for reimbursement to any other funding
source.
Executive Director
Attachments (supporting documentation)
Sworn to and subscribed before me this day of 20
by who is personally known to me.
Notary Public Notary Stamp
Contract-Burton Memorial-FY16;page 11
•
Attachment C
Services to be provided:
Burton Memorial United Methodist Church provides Methodist worship services and related
ministries. We also provide worship space to The Coptic Church,which is not affiliated with the
United Methodist organization. We provide two types of food services for the needy: a Food
Pantry that serves the upper keys and a free prepared community dinner(God's Kitchen)on
Thursday nights. We also have a child development center. We host space for many
organizations such as Boy Scouts and the Fire Fighter's Union. We have a designated
community peace park, and we sponsor youth activities in the Keys, such as the baseball team
coached by Pastor Kerry Foote and other volunteers. As our mission statements begin"We are
an uncommon church for conunon people offering a love of neighbor without boundaries"We
live strive to live those words by meeting the needs of our community.
The specific services to be funded by this request are the supply of hot meals and groceries to
people in need in the upper keys community. This year, our goal is to solicit, collect, organize,
store, and distribute approximately 150,000 pounds of groceries and personal hygiene items and-
prepare and serve about 3000 meals from our Church in Tavernier Florida.
•
ATTACHMENT D
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a conviction for public
entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may
not submit a bid on a contract with a public entity for the construction or repair of a public building or
public work, may not submit bids on leases of real property to public entity, may not be awarded or
perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under a contract with
any public entity, and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being
placed on the convicted vendor list."
I have read the above and state that neither (Respondent's name) nor any
Affiliate has been placed on the convicted vendor ist t in the last 36 months.
z(g ature
Date: I
STATE OF: Z' ' `-O.
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COUNTY OF: MNI2Oc.
Subscribed and sworn to r affirmed before me on Z0 S
( ) OC.COEFQ
(date) by C �� OT& (name of affiant). He/She is ersonall known
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to me or has produced (type of identification) as
identification.
C-/e) N ARY PUBLIC
My Commission Expires: JUGIUENIrce2 231201
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TIFFANY L.KATZ
�%`' Commission#EE 221875
J.,•off Expires November 23,2016
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Contract-Burton Memorial-FY16;page 13
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
(Company)
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former
County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or
employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this provision
the County may, in its discretion, terminate this Agreement without liability and may also, in its
discretion, deduct from the Agreement or purchase price, or otherwise recover, the full ount of any
fee, commission, percentage, gift, or consideration paid to the for, er County officer - /employee."
Si atur
Date: /O / -7 / 15
STATE OF: 41IO1�
COUNTY OF: II/l.t*Q-CAE
Subscribed and sworn to (or affirmed) before me on VCi1 /J ZO IS
(date) by !L'C Q.Q y r. (name of affiant). He/She is personally
known to me or has produced (type of
identification) as identification.
TA Y PUBLIC to
My Commission Expires: AIO V 2? 2d 1
�` e0.1t' TIFFANYL.KATZ
Commission#EE 221875
Expires November23 2016
Banded Thor Troy Fain Insurance BUOJB5-7019
Contract-Burton Memorial-FY16;page 14
1 .
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the workplace and specifying the
actions that will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business' policy of
maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee
assistance programs, and the penalties that may be imposed upon employees for drug abuse
violations.
3. Give each employee engaged in providing the commodities or contractual services that are
under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of working
on the commodities or contractual services that are under bid, the employee will abide by the
terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo
contendere to, any violation of Chapter 893(Florida Statutes)or of any controlled substance law
of the United States or any state, for a violation occurring in the workplace no later than five (5)
days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or
rehabilitation program if such is available in the employee's community, or any employee who
is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through implementation
of this section.
As the person authorized to sign the statement, I certify that this,fir complies full ith he above
requirements.
gnature)
Date: v /L U 15
STATE OF: C-OQ\C
COUNTY OF: I ' 16N � C
Su scribed and sworn to (or affirmed) before me n E r ( - � —) 12 iC (date) by
i 2y Oat T? (na of . ). He/St- i personally known tj or
has produced (ty.: �� - •n) as identification.
ye AM'
NO A'41/
My Commission xpiredJQli Zi 20 i(o
:;er:�ia,;•.. TIFFANY L.KATZ
= Commission#EE 221875
Expires November 23,2016
,of„°�``�, BonQeilhm Troy Fan Insurance 800-385-7019
Contract-Burton Memorial-FY16;page 15
•
ATTACHMENT G
FY16 Annual Performance Report
(for year October 1, 2015—September 30, 2016)
•
Agency._Name..........._.... -._.._.........._............._..__....__.....__.
POC
Phone/Email _.____.._._._.._........_
Grant Amount
Per Section 9 of your contract, it is required that you fill out the entire form and answer
every question.
Narrative on the FY16 Performance (i.e. successes, challenges, etc):
Questions:
1 . Please list services and client information below for the program/activities funded by the
Monroe County award.
Services Target Population # of persons in target Total # of clients
population served in FY16
Unduplicated Clients Served
2. What were the measurable outcomes (including numbers) accomplished in FY16? Please
base these outcomes on the services you identified in Question #1.
3. What number and percentage of your clients/participants were at or below the federal
poverty level in FY16; and/or 200%; and/or another standard used by your organization?
4. Were all the awarded funds used in FY16? If not, please explain.
5. What is the number of FTEs working on the program(s) funded by the award in FY16?
6. Were the awarded funds used as match in FY16? If so, please list matching sources.
Contract-Burton Memorial-FY16;page 16
p
7. What area of Monroe County did you serve in FY16?
8. How many total FTEs in your organization?
9. Volunteers: hours of program service were contributed by volunteers in FY16.
10.What was the CEO/Executive Director (or highest paid title) compensation in FY16?
(Please breakdown between salary and benefits.)
11.What is your organization's fiscal year?
For the following questions, please use the number as reported on your FY16 IRS Form
990. If your FY16 IRS Form 990 is not yet prepared, please estimate for now, and re-
submit revised when you have the final numbers.
12.What were your organization's total expenses in FY16?
13.What was your organization's total revenue in FY16?
14. What was the organization's total in grants and contracts for FY16?
15. What was the organization's total donations and in-kind (fundraising) in FY16?
16.What percentage of your expenses are program service expenses versus management and
general expenses in FY16 as reported on your IRS Form 990?
(Program service expenses are defined as expenses needed to run your programs.
Management and general expenses encompass expenses such as fundraising, human
resources, salaries of those not working directly with programs, legal services, accounting
services,.insurance expenses, office management, auditing, and other centralized services.)
Contract-Burton Memorial-FY16;page 17