FY2017 12/14/2016 KEVIN MADOK, CPA
MONROE COUNTY CLERK OF THE CIRCUIT COURT & COMPTROLLER
DATE: January 11, 2017
TO: Janet Herbener, Sr. Grant & Finance Analyst
FROM: Pamela G. HancoOk I eputy Clerk
SUBJECT: December 14th BOCC Meeting
Attached is a duplicate original of Item C15 Agreement with Domestic Abuse Shelter, Inc.
for FY17 Human Service Organization.
Should you have any questions, please feel free to contact me at ext. 3130. Thank you.
cc: County Attorney
Finance
File
AGREEMENT
• This Agreement is made and entered into this 14th day of December, 2016, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or "County," and Domestic Abuse Shelter, Inc., hereinafter referred to as "PROVIDER."
WHEREAS, the PROVIDER is a not - for - profit corporation established for the provision of
comprehensive services for individuals and families experiencing domestic and sexual abuse, and
WHEREAS, it is a legitimate public purpose to provide facilities and services for the
provision of comprehensive services for individuals and families experiencing domestic and sexual
abuse, 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 comprehensive services for individuals and families experiencing
domestic and sexual abuse in Monroe County, Florida, shall pay to the PROVIDER the sum of
THIRTY THOUSAND AND NO /100 DOLLARS ($30,000.00) for fiscal year 2016 -2017.
2. TERM. This Agreement shall commence on November 3, 2016, and terminate
September 30, 2017, 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-Domestic Abuse Shelter -FY17; page 1
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(e) 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 -3 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) Proof of registration with the Florida Department of Agriculture as required by Florida
Statute 496.405 and the Florida Department of State as require by Florida Statute
617.01201 or proof of exemption from registration as per Florida Stature 496.406.
(c) 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;
(d) Evidence of annual election of Officers and Directors;
(e) 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;
1. If the PROVIDER receives $100,000 or more in grant funding from the County
an audit shall be prepared by an independent certified public accountant (CPA):
a. The CPA must have a current license, in good standing with the Florida
State Board of Accountancy
b. The CPA must be a member of the American Institute of Certified Public
Accountant (AICPA);
c. The CPA must maintain malpractice insurance covering the audit services
provided and
d. The County shall be considered an "intended recipient" of said audit."
(f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules;
(g) Organization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
Contract- Domestic Abuse Shelter- FY17,; page 2
(h) 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;
(i) Specific description or list of services to be provided under this contract with this grant
(see Attachment C);
(j) 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);
(k) Cooperation with County monitoring visits that the County may request during the contract
year; and
(I) 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.
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.
Contract-Domestic Abuse Shelter-FY1 7; page 3
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.
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. AD]UDICATION 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,
Contract - Domestic Abuse Shelter -FY17 page 4
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 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
Contract - Domestic Abuse Shelter- FY17,; page 5
•
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
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
Jennifer Powell, President
Domestic Abuse Shelter, Inc.
P 0 Box 522696
Marathon Shores, FL 33052
305- 743 -5452 PHONE
305 -289 -1589 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.
Contract- Domestic Abuse Shelter -FY17; page 6
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 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 - Domestic Abuse Shelter -FY17 page 7
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as
d to and year first written above. 11N
f OF 7 ...i. ; M de - BOARD OF COUNTY COMMISSIONERS
�,L , `�- 4 , CLERK
MONROE COUNTY, FLORIDA
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Deputy Clerk Mayor /Chairman
Domestic Abuse Shelter, Inc.
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Contract - Domestic Abuse Shelter -FY17; page 8
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- Domestic Abuse Shelter -FY17 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 - Domestic Abuse Shelter -FY17 page 10
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.
Chief Executive Officer
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 - Domestic Abuse Shelter -FY17; page 11
ATTACHMENT C
Services to be provided:
(Insert a description of your organization including a list of the services that will be provided by
your organization under this contract.)
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Contract - Domestic Abuse Shelter- FY17,; page 12
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 Ji E. -t + - (Respondent's name) � ( p nor
any Affiliate has been placed on the convicted vendor list within the last 36 months.
A
(sg'ature
D-- i I 08 /4,
STATE OF: rl coQn
COUNTY OF: ROMItOC,
Subscribed arid sworn to (or affirmed) before me on (((z ( 1
(date) by \J]U E/U F L IOC(EL1_ (name of affiant). He /She is personally
known to me or has produced FLO1Z DA 'Y - 5 . (type of identification) as
identification.
p p
UY
� • DEBORAH J MORELLI (
1 t ' , 3 .1 Notary Public - state of Florida ► NOTARY PUBLIC
Commission / FF 978897 1
' My Comm. Expires Apr 5. 2020 My Commission Expires:
Contract - Domestic Abuse Shelter -FY17; page 13
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990
' MONROE COUNTY, FLORIDA
ETHICS CLAUSE
u - ID V (NAXr.,j C- N 4ceir" i C.- -
(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 amount of
any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
ii
:ture) 0
D. 11 i
STATE OF: FL6(
COUNTY OF: 4 Oh) 12 C
Subscribed and sworn to (or affirmed) before me on (I 1 2E ( L
(date) by J �=kw i - ""DG--- (name of of ant). He /She is personally
known to me or has produced FwP� � D vS � C CNS� (type of
identification) as identification.
..................6.6,0„,,s„........„.„,,, 1 0
I "Or:q. DEBORAH J MORELLI
0 "L Notary Public - State of Florida ■ NOTARY PUBLIC I.
I 4N Vs.,
, , i Commission # FF 978897 I
I °•.' �a�tV My Comm. Expires Apr 5, 2020 My Commission Expires:
Contract - Domestic Abuse Shelter -FY17; page 14
ATTACHMENT F
. DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
Domestic Abuse Shelter, Inc.
(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 firm complies fully with the above
requirements.
,, ,` / cip..„),Q_QQ ,
(Sie :ture),
Da e: t L 7,-)--W r
Y'
STATE OF: fi--0 O A
COUNTY OF: MOI.Ia2 E
Sub cribed and worn to (or affirmed) before me on fI /Z81 �. (date) by
l
\1 ∎1 N I F 4 tci t- (name of affiant). He/She is personally known to me
or has produced FWOLOA DaiVGn -S Lico (type of identification) as
identi is tin r I n i
` '•; DEBORAH J MORELLI NOTABLIC
. Notary Public State of Florida
RY _ Commission # FF 978697
'•',;; r• My Comm. Expires Apr 5.2020 My Commission Expires:
Contract - Domestic Abuse Shelter -FY17; page 15
ATTACHMENT G
FY17 Annual Performance Report
(For year October 1, 2016—September 30, 2017)
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 FY17 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.
# of persons in Total #of clients served
Services Target Population target population in FY17
Unduplicated Clients Served
2. What were the measurable outcomes (including numbers) accomplished in FY17? 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 FY17; and/or 200%; and/or another standard used by your organization?
4. Were all the awarded funds used in FY17? If not, please explain.
5. What is the number of FTEs working on the program(s) funded by the award in FY17?
Contract-Domestic Abuse Shelter-FY17,page 16
6. Were the awarded funds used as match in FY17? If so, please list matching sources.
7. What area of Monroe County did you serve in FY17?
8. How many total FTEs in your organization?
9. Volunteers: hours of program service were contributed by volunteers in FY17.
10. What was the CEO /Executive Director (or highest paid title) compensation in FY17? (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 FY17 IRS Form 990. If
your FY17 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 FY17?
13. What was your organization's total revenue in FY17?
14. What was the organization's total in grants and contracts for FY17?
15. What was the organization's total donations and in -kind (fundraising) in FY17?
16. What percentage of your expenses are program service expenses versus management and general
expenses in FY17 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 - Domestic Abuse Shelter -FY17; page 17