06/16/1993Contract No. RH383
7/ 1-/s3 1 ,
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
STANDARD CONTRACT
THIS CONTRACT is entered into between the State of Florida, Department of Health and Rehabilitative Services,
hereinafter referred to as the "department% and BOARD OF COUNTY COMMISSIONERS, COUNTY OFMONROE
, hereinafter referred to as the "provider".
THE PARTIES AGREE:
I. THE PROVIDER AGREES:
A.To provide services according to the conditions specified
In Attachment(s) I
B.Federal Laws and Regulations
1. If this contract contains federal funds, the provider
shall comply with the provisions of 45 CFR, Part 74,
and/or 45 CFR, Part 92, and other applicable
regulations as specified In Attachment I
2. If this contract contains federal funds and is over
$100,000, the provider shall comply with all applicable
standards, orders, or regulations Issued under Section
306 of the Clean Air Act, as amended (42 U.S.C.
1857(h) et seq.), Section 508 of the Clean Water Act,
as amended (33 U.S.C. 1368 et seq.), Executive Order
11738, and Environmental Protection Agency
regulations (40 CFR Part 15). The provider shall report
any violations of the above to the department.
3. If this contract contains federal funding in excess of
$100,000, the provider must, prior to contract
execution, complete the &rtification Regarding
Lobbying form, Attachment . If a Disclosure
of Lobbying Activities form-,-S-ta-55-rd Form LLL, Is
required, it may be obtained from the contract
manager. All disclosure forms as required by the
Certification Regarding Lobbying form must be
completed and returned to the contract manager.
C.Audlts and Records
1. To maintain books, records, and documents (Including
electronic storage media) in accordance with generally
accepted accounting procedures and practices which
sufficiently and properly reflect all revenues and
expenditures of funds provided by the department
under this contract.
2. To assure that these records shall be subject at all
reasonable times to inspection, review, or audit by
state personnel and other personnel duly authorized
by the department, as well as by federal personnel.
3. To maintain and file with the department such
progress, fiscal and inventory reports as specified in
Attachment I , and other reports as the
department may require within the period of this
contract. Such reporting requirements must be
reasonable given the scope and purpose of this
contract.
4. To provide a financial and compliance audit to the
department as specified In Attachment II and
to ensure that all related parry transactions are
disclosed to the auditor. Additional audit requirements
are specified In Attachment 1, Special Provisions,
Section D
5. To include these aforementioned audit and record
keeping requirements In all approved subcontracts and
assignments.
D. Retention of Records
1. To retain all client records, financial _ records,
supporting documents, =tistical raords,_'Ind any
other documents (includlQ electrorilb'stor media)
pertinent to this contract �rce peri° of fiveS years
after termination of this contract, an audit has
been Initiated and audit. findings .I- ve not been
resolved at the end of fivC5), years, tthe records shall
be retained until resolutio"f the audit findings:
2. Persons duly authorized b the depart{{��ent and federal
auditors, pursuant to 45 R, Part $� 36(i)(10), shall
have full access to and the right to examine any of said
records and documents during said retention period or
as long as records are retained, whichever is later.
E. Monitoring
1. To Iprovide reports as specified in Attachment
These reports will be used for monitoring
progress or performance of the contractual services as
specified in Attachment I
2. To permit persons duly authorized by the department
to Inspect any records, papers, documents, facilities,
goods and services of the provider which are relevant
to this contract, and/or Interview any clients and
employees of the provider to be assured of satisfactory
performance of the terms and conditions of this
contract Following such inspection the department
will deliver to the provider a list of its comments with
regard to the manner in which said goods or services
are being provided. The provider will rectify all noted
deficiencies provided by the department within the
specified period of time set forth in the comments or
provide the. department with a reasonable and
acceptable justification for not correcting the noted
shortcomings. The provider's failure to correct or
justify within a reasonable time as specified by the
department may result in the withholding of payments,
being deemed in breach or default, or termination of
this contract.
i/i/bJ
F. Indemnification
If the provider is a state agency or subdivision as defined
In section 768.28, Florida Statutes, only No. 2 below is
applicable. Other than state agencies or subdivisions
refer only to No. 1.
1. The provider agrees to be liable for all claims, suits,
judgments, or damages, including court costs and
attorney's fees, arising out of the negligent or
Intentional acts or omissions of the provider, and its
agents, subcontractors, and employees, in the course
of the operation of this contract. Further, the provider
agrees to Indemnify the department against all claims,
suits, judgments, or damages, Including court costs
and attorney's fees, arising out of the negligent or
intentional acts or omissions of the provider, and its
agents, subcontractors, and employees, in the course
of the operation of this contract. Also, the provider
agrees to defend the department, upon receiving
timely written notification from the department, against
all claims, suits, judgments, or damages, including
costs and attorney's fees, arising out of the negligent
or intentional acts or omissions of the provider and its
agents, subcontractors, and employees, in the course
of the operation of this contract. Where the provider
and the department commit joint negligent acts, the
provider shall not be liable for nor have any obligation
to defend the department with respect to that part of
the joint negligent act committed by the department.
In no event shall the provider be liable for or have any
obligation to defend the department against such
claims, suits, judgements, or damages, including costs
and attorney's fees, arising out of the sole negligent
acts of the department.
2. Any provider who is a state agency or subdivision, as
defined in section 768.28, Florida Statutes, agrees to
be fully responsible for its negligent acts or omissions
or intentional tortious acts which result in claims or
suits against the department, and agrees to be liable
for any damages proximately caused by said acts or
omissions. Nothing herein Is intended to serve as a
waiver of sovereign Immunity by any provider to which
sovereign immunity applies. Nothing herein shall be
construed as consent by a state agency or subdivision
of the State of Florida to be sued by third parties in any
matter arising out of any contract. The provider agrees
that it is an independent contractor of the department
and not an agent or employee.
G.Insurance
1. To provide adequate liability Insurance coverage on a
comprehensive basis and to hold such liability
insurance at all times during the existence of this
contract. The provider accepts full responsibility for
Identifying and determining the type(s) and extent of
liability Insurance necessary to provide reasonable
financial protections for the provider and the clients to
be served under this contract. Upon the execution of
this contract, the provider shall furnish the department
written verification supporting both the determination
and existence of such insurance coverage. Such
coverage may be provided by a self-insurance
program established and operating under the laws of
the State of Florida. The department reserves the right
to require additional Insurance as specified in
Attachment I where appropriate.
2. If the provider Is a state agency or subdivision as
defined by section 768.28, Florida Statutes, the
provider shall furnish the department, upon request,
written verification of liability protection in accordance
with section 768,28, Florida Statutes. Nothing herein
shall be construed to extend any parry's liability
beyond that provided in section 768,28, Florida
Statutes.
H.Safeguarding Information
Not to use or disclose any information concerning a
recipient of services under this contract for any purpose
not In conformity with the state regulations and federal
regulations (45 CFR, Part 205.50), except upon written
consent of the recipient, or his responsible parent or
guardian when authorized by law.
1. Client Information
To submit management, program, and client identifiable
data, as specified . by the department in Attachment
I
J. As'signments and Subcontracts
1. To neither assign the responsibility of this contract to
another party nor subcontract for any of the work
contemplated under this contract without prior written
approval of the department. No such approval by the
department of any assignment or subcontract shall be
deemed in any event or in any manner to provide for
the incurrence of any obligation of the department in
addition to the total dollar amount agreed upon in this
contract. All such assignments or subcontracts shall
be subject to the conditions of this contract (except
Section I, Paragraph 0.1.) and to any conditions of
approval that the department shall deem necessary.
2. Unless otherwise stated in the contract between the
provider and subcontractor, payments made by the
provider to the subcontractor must be within seven (7)
working days after receipt of full or partial payments
from the department in accordance with section
287.0585, Florida Statutes. Failure to pay within seven
(7) working days will result in a penalty charged
against the provider and paid to the subcontractor in
the amount of one-half of one (1) percent of the
amount due, per day from the expiration of the period
allowed herein for payment. Such penalty shall be in
addition to actual payments owed and shall not exceed
fifteen (15) percent of the outstanding balance due.
K.Financial Reports
To provide financial reports to the department as
spebi ied In Attachment I
2
1f.1/*0 .
L Return of Funds
1. To return to the department any overpayments due to
unearned funds or funds disallowed pursuant to the
terms of this contract that were disbursed to the
provider by the department. The provider shall return
any overpayment to the department within forty (40)
calendar days after either discovery by the provider, or
notification by the department, of the overpayment. in
the event that the provider or its Independent auditor
discovers an overpayment has been made, the
provider shall repay said overpayment within forty (40)
calendar days without prior notification from the
department. In the event that the department first
discovers an overpayment has been made, the
department will notify the provider by letter of such a
finding. Should- repayment not be made in a timel
manner, the department will charge Interest of one (1�
percent per month compounded on the outstanding
balance after forty (40) calendar days after the date of
notification or discovery.
2. For state universities, should repayment not be made
within forty (40) calendar days after the date of
notification, the department will notify the State
Comptroller's Office who will then enact a transfer- of
the amounts owed from the state university's account
to the account of HRS.
M. Incident Reporting
1. Client Risk Prevention
If services to clients will be provided under this
contract, the provider and any subcontractors shall, in
accordance with the client risk prevention system,
report those reportable situations listed In
HRSR 215-6, Paragraph 5, in the manner prescribed In
HRSR 215-6 or district operating procedures.
2. Abuse, Neglect and Exploitation Reporting
In compliance with Chapter 415, Florida Statutes, an
employee of the provider who knows, or has
reasonable cause to suspect, that a child, aged person
or disabled adult is or has been abused, neglected, or
exploited, shall immediately report such knowledge or
suspicion to the central abuse registry and tracking
system of the department on the single statewide toll -
free telephone number (1-600-96ABUSE).
N.Transportation Disadvantaged
If clients are to be transported under this contract, the
provider will comply with the provisions of Chapter 427,
Florida Statutes, and Rule Chapter 41-2, Florida
Administrative Code. The provider shall submit to the
department the reports required pursuant to Volume 10,
Chapter 27, HRS Accounting Procedures Manual.
O.Purchasing
1. PRIDE
It is expressly understood and agreed that any articles
which are the subject of, or are required to carry out
this contract shall be purchased from Prison
Rehabilitative Industries and Diversified Enterprises,
Inc. (PRIDE) identified under Chapter 946, Florida
Statutes, in the same manner and under the
procedures set forth In subsections 946.515(2) and (4),
Florida Statutes. For purposes of this contract, the
person, firm, or other business entity carrying out the
provisions of this contract shall be deemed to be
substituted for the department insofar as dealings with
PRIDE. This clause is not applicable to any
subcontractors, unless otherwise required by law. An
abbreviated list of products/services available from
PRIDE may be obtained by contacting PRIDE's
Tallahassee branch office at (904) 487-3774 or
SunCom 277-3774.
2. Procurement of Products or Materials with
Recycled Content
Additionally, it is expressly understood and agreed that
any products or materials which are the subject of, or
are required to carry out this contract shall be
procured in accordance with the provisions of
section 403.7065, Florida Statutes.
P. Civil Rights Requirements
1. Provider Assurance
The provider assures that it will comply with:
a. Tide VI of the Civil Rights Act of 1964, as amended,
42 U.S.C. 2000d et seq., which prohibits
discrimination on the basis of race, color, or national
origin.
b. Section 504 of the Rehabilitation Act of 1973, as
amended, 29 U.S.C. 794, which prohibits
discrimination on the basis of handicap.
c. Tide IX of the Education Amendments of 1972, as
amended, 20 U.S.C.1681 et seq., which prohibits
discrimination on the basis of sex.
d. The Age Discrimination Act of 1975, as amended, 42
U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age.
e. Section 654 of the Omnibus Budget Reconciliation
Act of 1981, as amended, 42 U.S.C. 9849, which
prohibits discrimination on the basis of race, creed,
color, national origin, sex, handicap, political
affiliation or beliefs.
f. The Americans with Disabilities Act of 1990, P.L 101-
336, which prohibits discrimination on the basis of
disability and requires reasonable accommodation
for persons with disabilities.
g. All regulations, guidelines, and standards as are now
or may be lawfully adopted under the above
statutes.
The provider agrees that compliance with this
assurance constitutes a condition of continued
receipt of or benefit from funds provided through
this contract, and that it is binding upon the
provider, its successors, transferees, and assignees
for the period during which services are provided.
The provider further assures that all contractors,
subcontractors, subgrantees, or others with whom It
arranges to provide services or benefits to
participants or employees in connection with any of
its programs and activities are not discriminating
against those participants or employees in violation
of the above statutes, regulations, guidelines, and
standards.
2. Compliance Questionnaire
In accordance with HRSM 220-2, the provider agrees
to complete the Civil Rights Compliance Questionnaire,
HRS Forms 946 A and B, if services are provided to
clients and If 15 or more people are employed.
Q.Requirements of Section 287.058, Florida Statutes
1. To submit bills for fees or other compensation for
services or expenses in sufficient detail for a proper
pre -audit and post -audit thereof.
2. Where applicable, to submit bills for any travel
expenses in accordance with section 112.061, Florida
Statutes. The department may, when specified in
Attachment I establish rates lower than the
maximum provided in section 112.061, Florida
Statutes.
3. To provide units of deliverables, including reports,
findings, and drafts as specified in
At t I , to be received and
cepy the contract manager prior to payment.
4. To comply with the criteria and final date by which
such criteria must be met for completion of this
contract as specified in Section III, Paragraph A.2. of
this contract.
5. To allow public access to all documents, papers,
letters, or other materials subject to the provisions of
Chapter 119, Florida Statutes, and made or received
by the provider in conjunction with this contract. It is
expressly understood that substantial evidence of the
provider's refusal to comply with this provision shall
constitute a breach of contract.
R. Withholdings and Other Benefits
1. The provider is responsible for Social Security and
Income Tax withholdings.
2. The provider is not entitled to state retirement or leave
benefits except where the provider is a state agency.
3. Unless justified by the provider and agreed to by the
department in Attachment I, Section D , the
department will not furnish services of support (e.g.,
office space, office supplies, telephone service,
secretarial, or clerical support) normally available to
career service employees.
S. Sponsorship
As required by section 286.25, Florida Statutes, If the
provider is a nongovernmental organization which
sponsors a program financed wholly or in part by state
funds, Including any funds obtained through this
contract, it shall, in publicizing, advertising or describing
the sponsorship of the program, state: "Sponsored by
_DQARD (1F COUNTY CQ�TccTnNFRS
COUNTY OF MONROE
PROVIDER
and the State of Florida, Department of Health and
Rehabilitative Services'. If the sponsorship reference is in
written material, the words "State of Florida, Department
of Health and Rehabilitative Services' shall appear in the
same size letters or type as the name of the organization.
T. Discounted Invoices
To allow a _N/A percent discount on selected
Invoices whic are pa In less than N/A days. The
provider must clearly mark any invo oe w t e discount
K it Is to be allowed. The provider may submit Invoices
with or without the negotiated discount terms. The
department shall comply with subsection 215.422(4),
Florida Statutes, if a discounted Invoice is offered.
U. Final Invoice
The provider must submit the final invoice for payment to
the department no more than 45 days' after the
contract ends or is terminated; 9 the provider fails to do
so, all right to payment is forfeited and the department
will not honor any requests submitted after the aforesaid
time period. Any payment due under the terms of this
contract may be withheld until all reports due from the
provider and necessary adjustments thereto have been
approved by the department.
V. Use Of Funds For Lobbying Prohibited
To comply with the provisions of section 216.347, Florida
Statutes, which prohibits the expenditure of contract
funds for the purpose of lobbying the Legislature or a
state agency.
I1. THE DEPARTMENT AGREES:
A. Contract Amount
To pay for contracted services according to the
conditions of Attachment I in an amount not to exceed
$ 392,250 , subject to the availability of
funds. The State of FU05's performance and obligation
to pay under this contract Is contingent upon an annual
appropriation by the Legislature. The costs of services
paid under any other contract or from any other source
are not eligible for reimbursement under this contract.
B. Contract Payment
Pursuant to section 215.422, Florida Statutes, the
voucher authorizing payment of an invoice submitted to
the department shall be filed with the State Comptroller
not later than twenty (20) days from the latter of the date
a proper invoice Is received or recelpt, inspection and
approval of the goods or services, except that in the case
of a bona fide dispute the voucher shall contain a
statement of the dispute and authorize payment only in
the amount not disputed. The date on which an Invoice is
deemed received is the date on which a proper invoice is
first received at the place designated by the department.
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7%1193
Invoices which have to be returned to a vendor because
of vendor preparation errors will result in a delay in the
payment. The invoice payment requirements do not start
until a properly completed Invoice, as defined in Rule
Chapter 3A-24, Florida Administrative Code, Is provided
to the department. Approval and Inspection of goods or
services shall take no longer than five (5) working days
unless the bid specifications, purchase order or contract
specifies otherwise. Such approval is for the purpose of
authorizing payments and does not constitute a final
approval of services purchased under this contract. A
payment is deemed to be Issued on the first working day
that payment is available for delivery or malling to the
provider. If a warrant in payment of an invoice Is not
Issued within forty (40) days, or thirty-five (35) days for
health care providers as defined in Rule Chapter 3A-24,
Florida Administrative Code, after the receipt of the
Invoice and receipt, Inspection, and approval of the
goods and services, the department shall pay to the
provider, In addition to the amount of the invoice, interest
at a rate of one (1) percent per month calculated on a
daily basis on the unpaid balance from the expiration of
such forty (40) day period, or thirty-five (35) day period
for health care providers as defined In Rule
Chapter 3A-24, Florida Administrative Code, until such
time that the warrant is issued to the provider. The
temporary unavailability of funds to make a timely
payment due for goods or services does not relieve the
department from this obligation to pay Interest penalties.
C.Vendor Ombudsman
A Vendor Ombudsman has been established within the
Department of Banking and Finance. The duties of this
individual include acting as an advocate for vendors who
may be experiencing problems in obtaining timely
payment(s) from a state agency. The Vendor
Ombudsman may be contacted at (904) 488-2924 or by
calling the State Comptrollees Hotline, 14300-848-3792.
11. THE PROVIDER AND DEPARTMENT MUTUALLY
AGREE:
L Effective Date
1. This contract shall begin on June •21•, 1993
or on the date on which the contract has been signed
by both parties, whichever is later.
2. This contract shall end on
June 20, 1994
3. Termination
1. Termination at Will
This contract may be terminated by either party upon
no less than thirty (30) calendar days notice, without
cause, unless a lesser time Is mutually agreed upon by
both parties. Said notice shall be delivered by certified
mail, return receipt requested, or In person with proof
of delivery.
2. Termination Because of Lack of Funds
In the event funds to finance this contract become
unavailable, the department may terminate the
contract upon no less than twenty-four (24) hours
notice in writing to the provider. Said notice shall be
delivered by certified mail, return receipt requested, or
in person with proof of delivery. The department shall
be the final authority as to the availability of funds.
3. Termination for Breach
Unless the provider's breach is waived by the
department In writing, the department may, by written
notice to the provider, terminate this contract upon no
less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt
requested, or In person with proof of delivery. If
applicable, the department may employ the default
provisions In Chapter 13A-1.006(4), Florida
Administrative Code. Waiver of breach of any
provisions of this contract shall not be deemed to be a
waiver of any other breach and shall not be construed
to be a modification of the terms of this contract. The
provisions herein do not limit the department's right to
remedies at law or to damages.
C.Notice and Contact
1. The name, address and telephone number of the
contract manager for the department for this contract
Is:
JAMES J. VENGALIL
401 N.W. 2nd Ave., Miami, Fl. 33128
2. The name, address and telephone number of the
representative of the provider responsible for
administration of the program under this contract is:
MARY BROSKE_
Grants Management Department
5100 College Koad, b.i.
Key West, FL 33040
(305) 292-4515
3.In the. event that different representatives are
designated by either party after execution of this
contract, notice of the name and address of the new
representative will be rendered In writing to the other
party and said notification attached to originals of this
contract.
D.Renegotiation or Modification
1. Modificatkxts of provisions of this contract shall only
be valid when they have been reduced to writing and
duly signed. The parties agree to renegotiate this
contract If federal and/or state revisions of any
applicable laws, or regulations make changes in this
contract necessary.
2. The rate of payment and the total dollar amount may
be adjusted retroactively to reflect price level Increases
and changes in the rate of payment when these have
been established through the appropriations process
and subsequently identified in the department's
operating budget.
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Contract No.KH 383
E. Name, Mailing and Street Address of Payee 1 this
1. The name (provider name as shown on page of
contract) and malling address of the official payee to
whom the payment shall be made:
BOARD OF COUNTY COMMISSIONERS
COUNTY OF MONROE
5100 College Roa S I
KEY WEST, FL 33040
2. The name of the contact Person and street address
where financial and administrative records are
maintained:
NLARY BR SKr
GRANTS MANAGEMENT DEPARTMENT
5100 COLLEGE ROAD S T
KEY WEST, FL 33040,
(305) 292-4515
F. All Terms and Conditions included
This contract and Its attachments as referenced,
f Attachment I - Exhibits A-F
Attachment II - F~irar al & Cmpliance Audit
Attwlment III - Certification re� lobbying
contain aU Me terms and agr upon y the
parties.
jNOtEGA
STOP-7
FF .J. 1'
ByAttorneys Oifias
Date
IN WITNESS THEREOF, the parties hereto have caused this pale contract to be executed by their undersigned
officials as duly authorized.
PROVIDER
BOARD OF COUNTY COMMISSIONERS
COUNTY OF NUNROE
SIGNED BY:
NAME: JpCV London
TITLE: Valor/Chairman
DATE:
June 16, 1993
FEDERAL ID NUMBER (or SS Number for an individual):
STATE AGENCY 29 DIGIT SAMAS CODE:
STATE OF FLORIDA, DEPARTMENT OF
HEALTH AND REHABILITATIVE SERVICES
NAME:
TITLE: District Adm nistrator
DATE:
---------------------------
PROVIDER FISCAL YEAR ENDING DATE: 06/30/1994
CONTRACT IS NOT VAUD UNTIL SIGNED AND DATED BY
BOTH PARTIES
ATTEST: DANNY L. KOLHAGE, CLERK
By d
D uty C rk
A
7
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
ATTACHMENT I
A. Services to be Provided:
The provider agrees to provide alcohol and other drug
abuse outreach, intervention and treatmentservices
to
their
clients in the South Florida area, particularly those
individuals whose substance abuse and subsequent behavioral
conditions were exacerbated by or resulted from Hurricane
Andrew. These services are specifically mentioned in
Exhibit - B and B - 1.
B. Manner of Service Provision:
1. The provider will comply with Chapter 394, Part 4
and Chapter 397 of Florida Statutes and Chapters 10 E-
14.002, .010, .014, .017 of Florida Administrative Code and
pages 3-7 through 3-37 of the HRS Guide to performance
contracting for Alcohol, Drug Abuse and Mental Health
Services.
2. Provider will screen each patient at the point of
original admission for HIV, STDs, and TB. Documentation
will be included in patient record.
3. Provider will work towards the ultimate goal of
effective case management and treatment services so as to
effect a continuum of care for the target population; initi-
ated with detoxification, followed by intensive outpatient,
day treatment, residential or supportive outpatient as is
individually appropriate, provision of relapse prevention
services and for a small proportion, readmission following
relapse for pharmacologic maintenance.
4. Provider will expand outpatient and pharmacologic
maintenance service as necessary to implement a continuum of
care.
5. The provider will coordinate, as relevant, with
the Center for Substance Abuse Prevention's (CSAP) high risk
youth activities, including Community Partnership Agencies,
High Risk Youth Programs, the Urban Youth Campaign, Teen
Drinking Prevention Programs as well as other relevant
prevention and media efforts to help grass roots activities
that are directed toward prevention of further increases in
drug use among younger age groups. In particular, activi-
ties pursuant to this cooperative Agreement should be coor-
dinated with CSAP funded activities that are being initiated
in south Dade in response to the devastation and after ef-
fects of Hurricane Andrew.
8
6. Provider will submit monthly reports describing the
progress achieved using the format provided by the Center
for Substance Abuse Treatment (CSAT) (Exhibit - C-I) to the
HRS/ADM Project Manager. A report schedule attached shows
due dates (Exhibit - D). Providers who have been awarded a
contract for more than one type of service are required to
submit monthly reports separately for each type of service.
7. Plans to subcontract program activities must be
approved by the CSAT Project Officer in advance.
8. By 90 days after an award is obligated to a
provider, each provider will:
achieve 75 percent utilization per month for
awarded slot;
maintain 85 percent complete clinical records for all
persons admitted. For detoxification, this includes an
admission physical, results of required laboratory and
follow-up referrals as indicated. For post-detoxifica
tion services, this includes an individualized treat
ment plan, drug history, psychosocial evaluation and
progress notes. Discharge records must include a
discharge plan providing for continuity of care for
relapse prevention and follow-up.
Failure to achieve these goals may result in
withholding of funds due to the provider.
9. By 150 days after an award is obligated to a
provider, each provider will:
achieve 85 percent utilization per month
for awarded slot;
maintain 95 percent complete clinical records for
all persons admitted. For detoxification, this
includes an admission physical, results of
required laboratory and follow-up referrals as
indicated. For post -detoxification services,
this includes an individualized treatment plan,
drug history, psychosocial evaluation and progress
notes. Discharge records must include a discharge
plan providing for continuity of care for relapse
prevention and follow-up.
Failure to achieve these goals may result in
withholding of funds and/or the cancellation of
the contract.
E
10. None of the Federal funds provided under this
agreement shall be used to provide individuals with hy-
podermic needles or syringes so that such individuals may
use illegal drugs, unless the Surgeon General of the United
States determines that a demonstration needle exchange pro-
gram would be effective in reducing drug abuse and the
risk that the public will become infected with the etiologic
agent for acquired immune deficiency syndrome.
11. The provider will cooperate with the CSAT Project
Officer in determining the effects of this project on the
target population and jurisdiction. This may include an as-
sessment of progrtLm operations and the provision of informa-
tion concerning �'ie nature and evolution of the substance
abuse problem in the jurisdiction.
C. Method of Payment:
1. Payment Clauses
a. Payment: This is a cost reimbursement contract.
The department shall reimburse the provider for allowable
expenditures incurred pursuant to the terms of the contract
for a total dollar amount not to exceed $c32 050
subject to the availability of funds.
b. Inpatient hospital substance abuse programs will
not be permitted, except in the case (a) such treatment is a
medical necessity for the individual involved, and the indi-
vidual cannot be effectively treated in a community based,
nonhospital, residential treatment program; or (b) such a
treatment is provided at a rate that is financially compara-
ble to that being provided in a community based, nonhospi-
tal, residential treatment service. If such circumstances
occur, the daily rate for payment provided to the hospital
for providing the services cannot exceed the comparable
daily rate provided by a residential treatment program.
C. Funds may not be used to purchase or improve land,
purchase, construct or permanently improve (other than re-
modeling or minor renovations) any building or other facil-
ity, or purchase special major medical equipment. (Trailers
are considered temporary dwelling units and not fall under
this provision).
d. Costs covered by the Robert T. Stafford Disaster
Relief and Emergency Assistance (Public Law 93-288, as
amended) including mental health services, facility alter-
ations and major renovations will -not be reimbursed. Under
no circumstances, may funds provided under this announcement
10
be used to meet local cost sharing requirements for facility
alterations and renovations funded by FEMA. Further, these
funds cannot be used to pay costs covered by commercial in-
surance carriers.
e. Funds cannot be used to supplant current funding
for existing treatment services and related activities.
f. Expenditures must be for services specified in Ex-
hibit - B, Service Description as given in Exhibit B-I and
be in accordance with the line -item budget given in Exhibit -
A, the Budget Narrative in Exhibit A-Itand Personnel Details
in Exhibit -A -II.
g. Providers should collect first and third party re-
imbursement for allowable services whenever possible. All
revenues must be deducted from the amount of reimbursement
requested monthly.
h. Providers who have been awarded a contract for
more than one type of service are required to submit reim-
bursement requests separately for each type of service.
i. The department may, if funds are available, re-
lease more than the monthly pro rata share of the contract
amount only for onetime nonrecurring expenditures, provided
the terms which specify month(s) and amount(s) to be re-
quested are included as part of this contract. Requests may
be made in writing along with the supporting documentation
for this purpose (Exhibit - F).
j. Invoice Requirements:
(1) The provider may request a monthly advance
for each of the first two months of the contract period
based on anticipated cash needs. The amount of request for
those periods -will be the lesser of either the pro. rata
share of the contract balance or the actual amount expended
and require no documentation. All reimbursement requests
for the third through the twelfth month shall be based on
the submission of monthly actual, expenditure reports
(Exhibit-C). Charges on the invoice must be accompanied by
copies of supporting documentation. Administrative costs as
shown in Exhibit - A do not require supporting
documentation.
11
Month
July
August
September
October
November
December
January
February
March
April
May
June
Payment Schedule
Type of
Request
Advance
Advance
Reimbursement
Reimbursement
Reimbursement
Reimbursement
Reimbursement
Reimburpment
Reimbursement
Reimbursement
Reimbursement
Reimbursement
Based on
Submittal
Date
Anticipated Cash Needs July 1
Anticipated Cash Needs August
July Actual Expenditure Sept. 1
August Actual Expenditure Oct. 1
Sept. Actual Expenditure Nov. 1
Oct. Actual Expenditure Dec. 1
Nov. Actual Expenditure Jan. 1
Dec. Actual Expenditure Feb. 1
Jan. Actual Expenditure Mar. 1
Feb. Actual Expenditure Apr. 1
Mar. Actual Expenditure May. 1
Apr. Actual Expenditure June. 1
Final Inv. Final May Actual Expenditure Date(s)
Expenditure June Actual Expenditure specified
Report in contract
Note:
Reimbursement request must be submitted for each
month even if the reimbursement request is zero due to the
two advance payments received at the beginning of the con-
tract.
(2) Payment of an invoice may be authorized only
for allowable expenditures which are in accord with the lim-
its specified on the approved line -item budget, Exhibit A
and the Budget Narrative, Exhibit A-1. Exhibits A and A-1
may be modified only through amendment to this contract ini-
tiated by written request which includes justification sup-
porting the need for modification. Such modifications..can-
not be made retroactive from the execution date of the
amendment back to the execution date of the contract.
2. Supporting Documentation Requirements
a. Personnel. Expenditures will be supported by pay-
roll records and employee time sheets.
b. Building Occupancy. Where this is a charge sup-
ported by an allocation plan, the plan will serve as docu-
mentation of this expenditure. In all other cases actual
receipts or paid invoices are required.
12
C. Professional Services Fees on a Time/Rate Basis.
The invoice must have attached a general statement of the
services being provided under this line item. The time pe-
riod covered by the invoice as well as the hourly rate times
the number of hours worked must be given separately for each
professional. Supporting documentation which details the
hours represented on the invoice must be included. Such
documentation should include time sheets or a time log.
d. Postage and Reproduction Expenses. Purchases made
from outside vendors must be supported by paid invoices
and/or receipts. Purchases for all inhouse postage (e.g.,
postage meter) and reproduction expenses must be supported
by usage logs or similar documentation.
e. Operating Supplies and Expenses. Receipts or
paid invoices are required for all expenses (e.g., office
supplies, long distance telephone calls, etc.) paid for with
this contract's funds.
f. Travel. For all travel expenses, HRS travel
voucher, form C-676 (State of Florida Voucher for Reimburse-
ment of Traveling Expenses) must be submitted. Original re-
ceipts for expenses incurred during officially authorized
travel, including those for items such as car rental and air
transportation, parking and lodging, and tolls and fares are
required for reimbursement. Section 287.058(1) (b), Florida
Statutes, requires that bills for any travel expense shall
be submitted in accordance with section 112.061, Florida
Statutes, governing payments by the State for traveling ex-
penses. HRSR 40-1 (Official Travel of HRS Employees and
Non -employees) provides further explanation, clarification
and instruction regarding the reimbursement of traveling ex-
penses necessarily incurred during the performance of offi-
cial State business.
g. Conference Travel: Prior approval is required in
accordance with section 112.061, Florida Statutes, and must
be certified on form C-676C (State of Florida Authorization
to incur Travel Expense) with a copy of the program or
agenda of the conference attached. Reimbursement is in ac-
cordance with travel above. See HRSR 40-1 for further ex-
planation, clarification and instruction.
h. All other Expenditures: All other expenditures
require receipts or paid invoices.
13
i. Non -expendable Property (Capital Expenditures):
A C. shall
Rules set forth in Chapter 10E-14.007-010, F• However,
govern any purchases of non -expendable property.
for purposes of this Cooperative Agreement, all capital
items over $500 will revert to the State at the end of the
contract period.
D. Special Provisions:
1. The department will support the provider in the
event of State or Federal disallowance of any expenditures
which have been made pursuant to written approval of the de-
partment. Notwithstanding the foregoing, the department's
obligation to pay the provider for expenses made under the
Hurricane Andrew Disaster Relief Assistance for Substance
Abuse Treatment &operative agreement is limited to those
items ultimately determined allowable by Substance Abuse and
Mental Health Services Administration (SAMHSA) and which the
department is reimbursed by the grantor.
2. Coordination of HIV/AIDS services in HRS District
11, Dade and Monroe counties, is facilitated by consortia of
providers, as required by the federal "Emergency Relief Act
of 1990"1 commonly referred to as "Ryan White".
These consortia are two:
1) HIV Planning Council of Metro -Dade County, which
provides oversight and coordination for services funded
by Title 1 of Ryan White. Support for this consortium
is provided by the Health Council of South Florida.
2) South Florida AIDS Consortium, which provides
oversight and coordination for services funded by Title
2 of Ryan White. Support for this consortium is provi
ded by the South Florida AIDS Network of Jackson
Memorial Hospital.
These consortia meet on a monthly basis, relying on strong
committee structure to develop and implement service sys-
tems. As a condition of this contract, agency representa-
tives will participate in consortium activities.
3. The maximum term of treatment for residential care
is 60 days for Level 1 and 120 days for Level 2. However,
outpatient has no maximum time limit. Intensive Out- pa-
tient) has an eight week limit.
All intakes, with rare exceptions, must be made by
the Central Intake Unit (CIU). In the event a client is
seen directly by a provider and that provider feels an ex-
ception is warranted, permission - to directly admit must be
obtained from the CIU.
14
In those cases:
a) the relevant patient data is provided to the
Central Intake Unit within 24 hours of admission.
b) the required screenings,
examination are completed
admission, and
c) any such admission is
14 days to verify the
of care.
assessments and physical
within 48 hours of
subject to monitoring with
appropriateness of the level
4. This cooperative agreement will be subject to the
Department of Health and Human Services generic regulations
concerning the administration of cooperative agreements, as
set forth in 45 CFR Part 92. Cooperative agreements must
also be administered in accordance with the PHS Grants Pol-
icy Statement (Rev. October 1, 1990).
5. None of the Federal funds awarded in this
cooperative agreement may be used to pay the salary of an
individual at a rate in excess of $125,000 per year.
6. Programs must be adapted to local needs including
special ethnic, cultural, language and geographic considera-
tions, and service delivery is required to be culturally
competent.
7. Providers have an obligation to report their cen-
sus to the the Centralized Resource & Referral (CRR) agency
daily by telephone or through the Management Information
System (MIS), when operational.
8. The contractors cannot discriminate against people
who tested positive for HIV.
9. Provider must be licensed and certified to provide
the types of services for which it is contracted to provide.
10. "Confidentiality of Alcohol and Drug Abuse Patient
Records" regulations (42 CFR Part 2) are applicable to any
information about alcohol and other substance abuse patients
obtained by a "program" (42 CFR 2.11). This means that all
patient records are confidential and may only be disclosed
and used in accordance with 42 CFR Part 2.
11. Any entity receiving amounts from this Cooperative
Agreement for operating a program of treatment for substance
abuse are (1) to, directly or through arrangements with
other public or nonprofit private entities, routinely make
available TB services to each individual receiving treatment
for such abuse; and (2) in the case of an individual in need
15
of such treatment who is denied admission to the program on
the basis of lack of capacity of the program, to refer the
individual to another provider of TB services.
12. Any provider must make available to individuals
early intervention services for HIV/STD disease at the sites
at which the individuals are undergoing such treatment.
Such services will be undertaken voluntarily by,
and with
the informed consent of, the individual and undergoing such
services will not be required as a condition of receiving
treatment services for substance abuse or other services.
13. All programs should attempt to focus on admissions
for persons who are first time alcohol and substance abuse
treatment admissifns, or individuals who have relapsed after
a period of one year or more of stable abstinence.
14. All clients will receive a discharge plan at the
time they are discharged from a program.
15. The provider will establish procedures through
which applicants for and recipients of services may present
grievances about the operation of the services being
provided under this contract. The provider will advise
persons of their right to appeal a denial or exclusion from
the program, of failure to take account of an individual's
choice of service and of the right to a fair hearing to the
final governing authority of the agency.
16. Clients recommended for treatment by the CIU may
not be rejected by the agency to which they are referred.
E. Required Report:
1. A final expenditure report, Exhibit - E, is to be
submitted no later than 45 days following expiration of the
contract.
2. Providers who have been awarded a contract for
more than one type of service are required to submit the fi-
nal expenditure report separately for each type of service.
Furthermore, all the financial and other documents should be
clearly identifiable per service program and kept separately
in order to facilitate an efficient audit review.
4
/6
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
AGENCY: MONROE COUNTY CONTRACT # KH 383
REVISION #
BUDGET PERIOD: 6/21/1993 TO 6/20/1994
----------------------------
TYPE OF SERVICE CENTRAL INTAKE UNIT (SUBCONTRACTED TOTAL
-------------------------------------------- ----------------.....
-----
1. Personnel:
a. Salaries
b. Fringes
Total Personnel:
2. Expenses:
a. Building Occupancy
b. Professional Services
c. Travel
d. Equipment Costs
e. Medical and Pharmacy
f. Subcontracted Services
g. Insurance
h. Operating Supplies/Expenses
i. Food Services
J. other
Total Expenses:
Total Personnel/Expenses:
3. Administrative Costs
4. Capital Expenses
GRAND TOTAL:
$86,987.00 $86,987.00
$86,987.00 $86,987.00
$86,987.00 $86,987.00
/7
ALCOHOL,. DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
sassasasssssssssssssssssssssssaaassssa:sassssssssssssssssssssasssssssss
AGENCY: MONROE COUNTY /Guidance Clinic of CONTRACT # KH 383
the Middle Keys Inc REVISION #
BUDGET PERIOD: 6/20/1993 ,to 6/21/1994
aosaxaxaaaasa3sasaaaasaassaasasaa�ssassasssassssssssssaassass:sasssaasss
TYPE OF SERVICE CENTRAL INTAKE UNIT ,(SUBCONTRACT) TOTAL
1. Personnel:
a. Salaries $ 8,539
b. Fringes 3,477
Total Personnel: 12,016 12,016
9 `
,2. Expenses:
a.
Building Occupancy,
3,353
b.
Professional Services
5,652
c.
Travel
680
d.
Equipment Costs
1,600
e.
Medical and Pharmacy
39,659
f.
Subcontracted Services
(Janitorial, exterminator, etc.)
g.
Insurance
681
h.
Operating Supplies/Expenses
1,658
i.
Food Services
2,373
J.
Other
Total Expenses:
55,656
55,656
Total Personnel/Expenses:
67,672
67,672
3.
Administrative Costs
13,315
13,315
( 19.676% )
4.
Capital Expenses
6,000
6,000
GRAND TOTAL:
$ 86,987
$ 86,987
sssssossssssss
.
EXHIBIT A - 1
LINE ITEM BUDGET NARRATIVE
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
CENTRAL INTAKE UNIT
PERSONNEL
Salaries
Program Director $1,269
Discharge Planner 624
Substance Abuse Tech. 41056
Nurse - RN 21184
Records Clerk 406
Total Salaries 8,539
Fringe Benefits
Social Security
653
Pension
312
Health Insurance
1,930
Workmen's Compensation
271
Florida Unemployment
ill
Total Fringe Benefits
3,477
Total Personnel
12,016
EXPENSES
Building Occupancy
Utilities
21457
Repairs & Maintenance
555
Janitorial & Household Supplies
341
Professional Services
Medical Coverage
4,519
Linen Services
383
Audit
730
Travel, 680
Food 2,373
Medical And Pharmacy
Medicine & Medical Supplies 721
Lab & Testing Fees (1) 36,674
Pharmacy Consultant 138
Personal Items 126
Insurance
Comprehensive 481
Professional Liability 200
f
I
EXHIBIT A - 1
LINE ITEM BUDGET NARRATIVE
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC
CENTRAL INTAKE UNIT
Operating Supplies and Expenses
Office Supplies 235
Educational 141
Postage 202
Telephone 687
Printing 72
License Bees 22
Data processing 299
Administration (2) 13,315
Renovations 61000
Computer Equipment 11600
Total Expenses 74,971
Grand Total $86,987
Average Cost per Day $238.32
FOOTNOTES:
(1) Lab and testing fees are determined on administering
Tuberculin PPD skin test to approximately 858 detox admissions.
It is estimated that approximately 219 (25t) of those tested will
result as positive. Once identified, the positive status clients
will receive x-ray and sputum testing. The cost is determined as
outline below:
X-ray testing 1$64.90 x 219
Throat Cultures $$92.10 X 219
Skin testing 185.00 x 858
14,214
20,170
4,290
(2) Administration expense in all three programs includes costs
of the administrative staff which comprises the Chief Executive
Officer, Rick Manager, Clinical Director and the Accounting
Department.
s
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
----- ------------- ----- ----------
AGENCY : MONROE COUNTY CONTRACT # KH 383
REVISION #
BUDGET PERIOD: 6/21/93 to 6/20/94
TYPE OF SERVICE OUTPATIENT SERVICES (SUBCONTRACTED) TOTAL
1. Personnel:
a. Salaries
b. Fringes
Total Personnel:
2. Expenses:
a. Building Occupancy
b. Professional Services
c. Travel
d. Equipment Costs
e. Medical and Pharmacy
f . Subcontracted Services $42,813.00 $42,813.00
g. Insurance
h. Operating Supplies/Expenses
i.• Food Services
J. Other -
Total Expenses: 1 $42,813.00 $42,813.00
Total Personnel/Expenses:
3. Administrative Costs
4. Capital Expenses
GRAND TOTAL: $42,813.00 =__ $42 813.00
---L=====__
.
21
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
saasssssssasssssssssssassssssasasssssssssssss:sssssssssssssssasssssssss
AGENCY: MONROE COUNTY /Guidance Clinic of CONTRACT # KH 383
the Middle Keys, Inc. REVISION #
BUDGET PERIOD: 6/21/1993 to 6/20/1994
ssasasssssassaassaasssassss:saessassasaasas:sss:sssssssassssssasssssss:s
TYPE OF SERVICE OUTPATIENT SERVICES (SUBCONTRACT) TOTAL
1. Personnel:
a.
Salaries
$ 27,650
b.
Fringes
7,978
Total Personnel:
35,6-28 35,628
,2.
Expenses:- '
a.
Building Occupancy
983
b.
Professional Services
250
c.
Travel
100
d.
Equipment Costs
e.
Medical and Pharmacy
f.
Subcontracted Services
(Janitorial, exterminator, etc.)
g.
Insurance
714
h.
Operating Supplies/Expenses
459
i.
Food Services
J.
other
Total Expenses: 2,506 2,506
Total Personnel/Expenses: 38,134 38,134
3. Administrative Costs
( 12.270% ) 4,679 4,679
4. Capital Expenses
GRAND TOTAL' 42,813 42,813
ss
.
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
2 2-
OUTPATIENT SERVICE
PERSONNEL
Salaries
Substance Abuse Counselor
Receptionist
Total Salaries
Fringe Benefits
Social Security
Pension
Health Insurance
Workmen's Compensation
Florida Unemployment
Total Fringe Benefits
Total Personnel
Building Occupancy
Utilities
Repairs & Maintenance
Janitorial & Household Supplies
Professional Services
Audit
Travel
Insurance
Comprehensive
Professional Liability
r
Operating Supplies and Expenses
Office Supplies
Educational
Postage
Telephone
Printing
Data Processing
Administration
Total Expenses
Grand Total
Average Cost Per Sour
$27,000
650
27,650
2,115
10659
3,898
210
96
7,978
35,628
728
165
90
250
100
142
572
43
77
37
127
15
160
41679
7,185
$42,813
$41.81
23
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
AGENCY: MONROE COUNTY CONTRACT # KH383
REVISION #
BUDGET PERIOD: 6/21/1983 to 6/20/1983
TYPE OF SERVICE DETOXIFICATION (SUBCONTRACTED) TOTAL
1. Personnel:
a. Salaries
b. Fringes
Total Personnel:
2. Expenses:
a. Building Occupancy
b. Professional Services
c. Travel
d. Equipment Costs
e. Medical and Pharmacy
f . Subcontracted Services $92 , 000.00 $92 , 000.00
g. Insurance
h. Operating Supplies/Expenses
i. Food Services
J. Other
Total Expenses: $92 , 000.00 . $92 , 000.00
Total Personnel/Expenses:
3. Administrative Costs
4. Capital Expenses
GRAND TOTAL: $ 92 , 000.00 $ 9 2 , 000.00
2�
s
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
saasssssssassassssssssassssasasaaasssossssssssssssssassasssssssssssssss
AGENCY: MONROE COUNTY/Guidance Clinic of thCONTRACT # KH 383
Middle Keys, Inc. REVISION #
BUDGET PERIOD: 6/21/1993 to 6/20/199*
a=aaaasaaassaassssasasaasasaaasssssssasassssssssssssssassssssssasssssss
TYPE OF SERVICE DETOXIFICATION (SUBCONTRACT) TOTAL
-----------------------------------------------------------------------
1. Personnel:
a. Salaries $ 24,343
b. Fringes 6,791
Total Personnel: 31,134
.2. Expenses:
a.
Building Occupancy
6,707
b.
Professional Services
11,304
c.
Travel
1,360
d.
Equipment Costs
e.
Medical and Pharmacy
2,145
f.
Subcontracted Services
(Janitorial, exterminator, etc.)
g.
Insurance
1,362
h.
Operating Supplies/Expenses
18,038
i.
Food Services
4,746
J.
Other
Total Expenses: 45,662
Total Personnel/Expenses: 76,796
3. Administrative Costs
( '19.798% 15,204
4. Capital Expenses
GRAND TOTAL: 92,000
31,134
45,662
76,796
15,204
92,000
ssssssssssssss
.
EXHIBIT A - 1
LINE ITEM BUDGET NARRATIVE
GUIDANCE CLINXC OF THE MIDDLE KEYS, INC.
DETOXIFICATION
PERSONNEL
Salaries
Program Director -
Discharge Planner
Substance Abuse Tech.
Nurse - RN
Records Clerk
Total Salaries
Fringe Benefits
Social Security
Pension
eealth Insurance
Workmen's Compensation
Florida Unemployment
Total Fringe Benefits
Total Personnel
Suildinq Occupancy
utilities
Repairs & Maintenance
Janitorial & Household Supplies
Professional Services
Medical Coverage
Linen Services
Audit
Travel
r
Food
Medical And Pharmacy
Medicine & Medical Supplies
Lab & Testing Fees
Pharmacy Consultant
Personal Items
Insurance
Comprehensive
Professional Liability
Operating Supplies and Expenses
Office Supplies
Educational
Postage
Telephone
$2,961
1,456
13,520
5,460
946
24,343
11862
1,461
2,373
779
316
6,791
31,134
4,915
1,110
682
9,038
766
15 OD
1,360
4,746
697
920
276
252
962
400
470
282
404
1074
s
EXHIBIT A
LINE ITEM BUDGET NARRATIVE 2-6
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
DETOXIFICATION
Printing 144
License rees 44
Data Processing 598
Client Transportation 14,722
Administration 15,204
Total Expenses 60,866
Grand Total $92,000
Average Cost Per Day $126.03
,2-7
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
AGENCY: MONROE COUNTY CONTRACT # KH 383
REVISION #
BUDGET PERIOD: 6/21/93 to 6/20/94
TYPE OF SERVICE RESIDENTIAL LEVEL I (SUBCONTRACTED) TOTAL
1. Personnel:
a. Salaries
b. Fringes
Total Personnel:
2. Expenses:
a.
Building Occupancy
b.
Professional Services
c.
Travel
d.
Equipment Costs
e.
Medical and Pharmacy
f .
Subcontracted Services
$160,450.00
$160,450.00
g.
Insurance
h.
Operating Supplies/Expenses
i.
Food Services
J.
Other
Total Expenses:
$160,450.00
$160,450.00
Total Personnel/Expenses:
3.
Administrative Costs
( 6.232% )
10,000.00
10,000.00
4.
Capital Expenses
GRAND TOTAL:
170.,4.50.00
170 450.00
.
i
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
LINE ITEM BUDGET
EXHIBIT - A
saasasssssssaasssssssasssssssasasasasassassssssssss:ssassssssassssss:ss
AGENCY: MONROE COUNTY /Life Center Found atiorCONTRACT # KH 383
BUDGET PERIOD: 6/21/93 to 6/20/94REVISION #
===xsaae:sxaaaexeasaesassassseasae:oaeaaaaass:sssas::sasses:aeeessssses
TYPE OF SERVICE RESIDENTIAL LEVEL 1 (SUBCONTRACT) TOTAL
-----------------------------------------------------------------------
1. Personnel:
a. Salaries $ 69,500
b. Fringes 15,985
Total Personnel: 85,485 85,485
.2. Expenses:
a.
Building Occupancy
42,610
b.
Professional Services
c.
Travel
3,075
d.
Equipment Costs
2,100
e.
Medical and Pharmacy
f.
Subcontracted Services
(Janitorial, exterminator, etc.)
g.
h.
Insurance
Operating Supplies/Expenses
1,200
8,260
i.
Food Services
1
J.
Other
1,0
,08 0
Total Expenses: 74,965 74,965
Total Personnel/Expenses: 160,450 160,450
3. Administrative Costs
4. Capital Expenses
GRAND TOTAL: -160,450 160, 450
sssssassssssss
.
EXHIBIT A - 1
LINE ITEM BUDGET NARRATIVE
LIFE CENTER FOUNDATION
RESIDENTIAL LEVEL I
PERSONNEL
Salaries
Project Director (70% FTE) $24,500
Counselor (1) 27,000
Clerical (1) 18,000
Total Salaries 69;500
Fringe Benefits
Social Security (7.65%) 5,317
Health Insurance (10.85%) 7,541
Workman's Compensation (3.2%) 2,224
Florida Unemployment (1.3%) 903
Total Fringe Benefits 15,985
Total Personnel 85,485
EXPENSES
Building Occupancy
Building Rental 30,000
Utilities 4,200
Repairs & Maintenance 5,790
Janitorial & Household Supplies 2,620
Equipment Costs
Equipment Rental 630
Equipment Repair & Maintenance 1,470
Travel 3,075
Client Hygiene 11080
Client Food 16,640
Insurance 1,200
Operating Supplies/Expenses
Office Supplies 1,040
Automobile Repair & Maintenance 4,060
License & Permits 160
Telephone, FAX 3,000
Total Expenses 74,965
Sub Total $160,450
ADMINISTRATION
Administration -0-
Grand Total $ 160,450
A
so -
EXHIBIT - B
DETAILS OF SERVICES PROVIDED
NAME OF PROVIDER AGENCYr . MONROE COUNTY
CONTRACT N /k N 383
CONTRACT PERIOD: (, l2 t/ 9 3 4 �/2-o19y
TYPE OF SERVICE (
E OF BEDS
( #OF BED
I COST PER
I NOF SLOTS I COST PER
I TOTAL I
I
I DAYS
( BED DAY
I ( SLOT
I COST I
,�,,,..�
.s:ssss..sssssss.s
sss::==ss:..ss:ssssssss...sssssssssss
I
OUT PATIENT (
I
I
I 1,024 ( 41.81
I 42,813 I
-•-----•--••....................................................•----........---...................a........._...........)
INTENSIVE • OUT PATIENT I
I
I
I I ................
I
... I
..... ............................
11ESiDENTiAI LEVEL 1 (
...........
10
..........................................................
13,650
I 46.70
.....--•------....•----•
................
:17-. �p '4 5 0
_ .I
RESIDENTIAL LEVEL 2 1
1
.-----...........................
1
1 1
....................................
1
I
....................................................
CHILD CARE I
I
.......I
I
..............................................................
I I
I I
....................................................
............ON i
2
( 730
I 126.03
..
II
..............................I
. 92, 000
RESOURCE i REFERRAL I
I
I
I I
I I
.............................................
.................................................................
,.......... I
CENTRAL INTAKE I
1
1 365
1 238.32
1 1
1 86,987 I
..-------•--•----....-•---•
.............................................................•-----.........&.................
I
ADOLESCENT RECEIVING I
I
I
I I
I I
....----••..............................................................:..•-----------•--.............._................I
STD SCREENING I
I
I
( 1
1 I
GRAND TOTAL: $392 , 250
MUNKUL I..UUIV I T T
4
I
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32
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
EXHIBIT - B - I
SERVICE DESCRIPTION
CENTRAL INTAKE UNIT
Agency Names MONROE COUNTY
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
Address: 3000, 41st Street, Ocean, Marathon, FL
Director/Coordinator: David P. Rice, Ph.D., Chief Executive Officer
Susan Horn, Program Director
Phone Number: (305) 743- 9491
Days/Hours of Operation: 24 hours, 365 days per year
Bed Capacity:
Population Groups Served: Adults in need of substance abuse services
as a result of Hurricane Andrew
Staffing - # of FTE's Providing Direct Care: .48
Intake Referral Agreements: Intake referrals may be
accepted from any of the following:
(1) Substance Abuse Providers
(2) Community Mental Health Centers
(3) Acute Care Hospitals
(4) Primary Care Centers
(5) Private Medical & Mental Health Providers
(6) Law Enforcement or Court Officials
(7) Community Health.Teams (Outreach Disaster
Response)
Residential Stay: At the discretion of the medical staff the
minimum stay at the CIU can be from 48 to 96 hours for the
purpose of intake, receiving and assessment for level of
care including completion of infectious disease screening.
Is
33
SERVICESs
Screening a
Assessment:
Infectious
Disease:
Medical history and physical examination
Drug and psychosocial screening
Mental status
Assessments (e.g., Addiction Severity Index)
TB/HIV/STD (see below)
Screening for HIV, TB and STDs
Pre and post-test counseling and risk
reduction
Must have network established for X-Ray and
throat culture for those that test positive
for TB
Isolation area for clients that test positive
for TB
External referrals for TB treatment
TB infection control designs
Modifications to air handling and lighting
systems as may be needed
Outreach: To identify persons in need of substance
abuse treatment and to network with the
Community Health Teams (Outreach disaster
response).
SERVICES TO SPECIAL POPULATION:
Pregnant
Women: It is essential that services provided at
the CIU also include counseling on the
effects of alcohol and drug use on the
fetus, as well as referrals for prenatal
care.
Methadone: While at the CIU, clients needing methadone
treatment will need to be transported to a
methadone treatment center for dosage. Each
individual who requests and is in need of
treatment for injection drug abuse should be
admitted to a program not later than 14 days
after making the request for admission to
such a program, or 120 days after the date of
such a request, if no such program has the
capacity to admit the individual on the date
of such request and if interim services are
made available to the individual not later
than 48 hours after such request.
n
Capacity Utilization Manaaement Svstem:
Substance Abuse Treatment Programs
participating in this project will report to the CIU the
vacancies available for clients on the waiting list so that
they can enter programs at the earliest opportunity.
The CIU will establish a waiting list
management program which provides systematic reporting of
treatment demand.
External Referrals: Based on findings at CIU, referrals
will be made for the level of care necessary as follows:
Detoxification
Inpatient hospital detoxification which is to
be used only when there is a significant
concomitant medical problem or the use of
barbituates.
Directly into rehab: residential, intensive
outpatient or outpatient.
SERVICE DOCUMENTATION:
Service Ticket:
a)- Name of service
b) Program - Adult or child 18 & under
c) Client name and identification number
d) Service date
AUDIT DOCUMENTATION:
Client Medical Records
a) Name of service
b) Client name and identification number
c) Service date
TOTAL BUDGET: S
3-
5-ALCOHOL,
, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
"EXHIBIT - B - I
SERVICE DESCRIPTION
OUTPATIENT SERVICES
(A separate sheet must be completed for each location)
Agency Name: MONROE COUNTY
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC
Address: 3000 41st St., Ocean, Marathon, FL
Director/Coordinator: David P. Rice, Ph.D., Chief Executive Officer
Deborah Harrison, Ph.D., Clinical Director
Phone Number: (305) 743-9491
Days/Hours of Operation: 8:30 AM to 5 PM, Monday through Friday
Average Length of Treatment: 2 months
#Of Clients to be Served ��
During the Term of Contract:
Population Groups Served: Adults with substabce abuse diagnosis
Staffing - # of FTE's etc. :
(One Counselor to no more than
35 clients.)
Treatment Regimen: Minimum of one individual session of one
hour per week and one group session of 1 hour per week.
Description of Services
To be Provided:
Capacity Utilization Management System:
Substance Abuse Treatment Programs participating in
this project will report to the CIU the vacancies available
for clients on the waiting list so that they can enter
programs at the earliest opportunity.
Participating Substance Abuse Treatment Programs for
adolescents within the area will report to the ARF the
vacancies available for clients on the waiting list so that
they can enter programs at the earliest opportunity.
36
SERVICE DOCUMENTATION: +
Service Ticket:
a).. -.Name of Service
b) Client Name and Identification Number
c) Service Date
AUDIT DOCUMENTATION:
Client Medical Record:
a) Name of service
b) Client Name and Identification Number
c) Service Date
TOTAL BUDGET: S 7 �i g13
37
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
EXHIBIT - B - I
SERVICE DESCRIPTION
DETOXIFICATION
Agency Name: MONROE COUNTY
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
Address: 3000 41st St., Ocean, Marathon, FL
Director/Coordinator: David P. Rice, Ph.D., Chief Executive Officer
Susan Horn, Program Director
Phone Number: (305) 743-9491
Bed Capacity: 2
Population Groups Served: Adults referred by Central Intake Unit
Staffing - # of FTE's Providing Direct Care:1.43
Residential Stay: Up to 5 - 10 days of detoxification
using the medical and/or non -medical model of treatment.
Description of Services
To be Provided:
Capacity Utilization Management System:
Substance Abuse Treatment Programs participating in
this project will report to the CIU the vacancies available
for clients on the waiting list so that they can enter
programs at the earliest opportunity.
Participating Substance Abuse Treatment Programs for
adolescents within the area will report to the ARF the
vacancies available for clients on the waiting list so that
they can enter programs at the earliest opportunity.
SERVICE DOCUMENTATION:
Service Ticket:
a),_Name of Service
b) Program :adult or children
c) Client Name and Identification Number
d) Service Date
AUDIT DOCUMENTATION:
Client Medical Record:
a) Name of Service
b) Client Name and Identification Number
c) Service Date
TOTAL BUDGET: s 91 2 D OO
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
EXHIBIT - B - I
SERVICE DESCRIPTION
RESIDENTIAL LEVEL I
Agency Name: MONROE COUNTY
Address: LIFE CENTER FOUNDATION, INC.
610 Elizabeth Street, Key West, FL 33040
Director/Coordinator:
William W. Irby, Director
Phone Number: (305) 292-1774
Bed Capacity: / Q
Population Groups Served: Individuals recovering from addictions,
substance abuse, w o reside in Monroe County, FL, as referred by CIU
Staffing - # of FTE's Providing Direct Care:l
Residential Stay: Maximum of 60 days in
residential care.
-Description of Services
To be Provided:
Capacity Utilization Management System:
Substance Abuse Treatment Programs participating in
this project will report to the CIU the vacancies available
for clients on the waiting list so that they can enter
programs at the earliest opportunity.
Participating Substance Abuse Treatment programs for
adolescents within the area will report to the ARF the
vacancies available for clients on the waiting list so that
they can enter programs at the earliest opportunity.
SERVICE DOCUMENTATION: _
Service Ticket:
a} Name of Service
b)- Client Name and Identification Number
c) Service Date
AUDIT DOCUMENTATION:
Client Medical Record:
a) Name of Service
b) Client Name and Identification Number
c) Service Date
TOTAL BUDGET:
RA/*t4-
CiQfIHID To TAL
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0 0 0
/ 70,950
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EXHIBIT C-1 '
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE TREATMENT
COOPERATIVE AGREEMENT
MONTHLY PROGRESS REPORTS
SUGGESTED FORMAT
Monthly Progress Reports should contain concise summaries of
project progress and impediments. Reports should be
prepared by each provider.
I. Narrative
Each Provider shall provide a narrative summary,
not to exceed 5-6 pages, describing the activities
undertaken over the monthly period for which the
report is being filed. To the extent possible,
documentation in support of the accomplishments
described in the narrative section should be
included in the form of an appendix. The
narrative should include the following information
at a minimum:
A. Description of the target population(s).
- Where available, the target population
should be described in terms of age,
race, gender, and socioeconomic status.
please note the proportion of female
patients who are pregnant or postpartum
women.
B. Describe the drug use patterns of the
target population(s).
C. Describe key objectives for the quarter,
as set forth in the contract, together
with a brief description of actual
accomplishments achieved against these
objectives during the same period. Also,
include utilization statistics. The
completeness of the medical records will
be monitored by HRS staff. Be sure to
include at least the following
information at a minimum:
1. The date, term, and volume of award
for provider agreements or contracts
with the State Drug Treatment
Agency.
Z13
z'
2. Describe new staff hired during the
period according to date of hire,
job title, name, and salary.
Indicate whether each staff member
is employed full-time, part-time, o
on a contractual basis.
3. List the date, term and cost of any
new leases entered into during the
reporting period.
4. Describe cost and scope of
alterations and renovations begun
during the reporting period.
5. Describe subcontracts initiated
during the reporting period, and
provide supporting documentation.
6. Describe the extent to which
linkages with FEMA, Civil Defense,
health, human service, criminal
Justice, education and vocational
agencies or programs have been
established. Attach memoranda of
understanding or letters attesting
to these linkages in an appendix.
7. If applicable, describe any increase
in the number and type of patients
served.
8. Describe the development of new
patient outreach, intake, referral
and tracking systems, together with
any other treatment enhancements
implemented during the reporting
period.
9. Describe implementation of quality
assurance methods.
10. Describe the extent of any personnel
or organizational changes occurring
during the reporting period.
11. Highlight any significant
impediments, delgys or barriers, and
describe how these difficulties were
overcome (or still exist), as well
as the need for any State, CSAT, or
consultant technical assistance.
II. Obligation and Expenditure Summa
In chart form, and for each line in the approved
budget for the Provider, provide the dollar amounts of
contract monies actually obligated and expended during the
reporting period (and a cumulative total for the present and
prior reporting periods).
--See attached sample form. (Attachment - C)
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
EXHIBIT - D
Required Reports for CSAT Substance Abuse Treatment
Cooperative Agreement
Reports Due Date Copies
* Budget Detail with Budget As needed for
Narrative amendments 1
* Details of Services Provided As needed for
amendments 1
* Monthly Expenditure Report
and Reimbursement Request
along with back-up
documentation
* Monthly Progress Report
* Final Expenditure Report
for CSAT Substance Abuse
Treatment Cooperative
Agreement (Exhibit - E)
As per the
Schedule in
ATTACHMENT - I,
C.J. (Pages 8-9) 1
30 days after
the end of each
month of service 2
No later than
45 days following
expiration of
Contract. 2
ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES
HURRICANE ANDREW - CENTER FOR SUBSTANCE ABUSE
TREATMENT COOPERATIVE AGREEMENT
FINAL EXPENDITURE REPORT
EXHIBIT - E
AGENCY: CONTRACT #
REVISION #
BUDGET PERIOD:
TYPE OF SERVICE BUDGETED EXPENDED BALANCE
AMOUNT TO DATE
1. Personnel:
a. Salaries
b. Fringes
Total Personnel:
2. Expenses:
a. Building Occupancy
b. -Professional Services
C. Travel
d. Equipment Costs
e. Medical and Pharmacy
f. Subcontracted Services
(Janitorial, exterminator, etc.)
g. Insurance
h. Operating Supplies/Expenses
i. Food Services
j. Other
Total Expenses:
Total Personnel/Expenses:
3. Administrative Costs
4. Capital Expenses
GRAND TOTAL:
x==s==sass soxssssss ssssc=____
0
ZJ7
SPECIAL REQUEST _
EXHIBIT - F
CONTRACT #
ONE-TIME NON -RECURRING EXPENDITURE ADVANCE
Pursuant to Attachment I, paragraph C.1-j. of the attached
FY 93-94 contract, we are requesting more than the monthly
pro-rata share of the contract only for one-time non-
recurring expenditures.
This request is for the month of , 1993
in the excess amount of $ to be used
for the purpose of
---------------------------
PROGRAM
---------------------------
SIGNATURE
---------------------------
TITLE
---------------------------
DATE
�• ♦ _ /
FINANCIAL AND COMPLIANCE AUDITS
ATTACHMENT_
This attachment is applicable, if the provider or grantee, hereinafter referred to as provider, is any government entit
nonprofit organization, or for -profit organization. y,
PART 1: SINGLE AUDIT
This part is applicable- if the provider is a local government entity or nonprofit organization and receives a total of
$25,000_ or more from the department during its fiscal year. The provider has "received" funds when it has obtained cashfromthe department or when it has incurred expenses which wilt be reimbursed by the department.
The provider agrees to have an annual financial and compliance audit performed by inde current Government Auditing Standards ("Yellow Book") issued pendent auditors in accordance with the
by the Comptroller General of the United Statess.. Local
governments shall comply with Office of Mana ement and Bud et OMB Circular A-128 Audits of State andLocal Governments.
Nonprofit providers receiving federal funds passed through the department shall comply with the audit requirements contained
in OMB Circular A-133 Audits of Institutions of Hi her Learning and Other Nonprofit Ins itutions, except as modified he
nrein.
12 months. The scope re
Such audits shall cover the entire organization for the organization
s fiscal year, not to exceed
the audit performed shalt include the financial audit requirements of the "Yellow Book," and must of
include reports on internal
control and compliance. The audit report shall include a schedule of financial assistance that discloses each state contract
by number. An audit performed by the Auditor General shall satisfy the requirements of this attachment.
Compliance findings related to contracts with the department shall be based on the contract requirements, including any
rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation
showing whether or not matching requirements were met. All questioned costs and liabilities due to the department shall be
calculated and fully disclosed in the audit report with reference to the department contract involved. These requirements do
not expand the scope of the audit as prescribed by the "Yettuw-radt-11
If the provider has received any funds from a grants and aids appropriation the
prvider
comptiance
report s) in accordance with the rules of the Auditor General, chapter 10.600, andindicateion theoschedutleaof financial
assistance which contracts are funded from state grants and aids appropriations.
Copies of the financial and compliance audit report, management letter, and all other correspondence,
any
audits performed by independent auditors, other than the Auditor General, shall be submitted hin120fdays,
aftertthetend of
the provider's fiscal year, unless otherwise required by Florida Statutes, to the following:
A. Office of Audit and Quality Control Services
1317 Winewood Boulevard, Building 5, Room 116
Tallahassee, Florida 32399-0700
B. Contract Manager for the department
C. Submit to this address only those reports prepared in accordance with OMB Circular A-133:
Federal Audit Clearinghouse
U.S. Bureau of the Census
Jeffersonville, Indiana 47132
D. submit to this address only those reports prepared in accordance with the rules of the
Auditor General, chapter 10.600:
Jim Dwyer
Office of the Auditor General
P. 0. Box 1735
Tallahassee, Florida 32302
The provider shall ensure that audit working papers are made available to the department,
period of five years from the date the audit report is issued, unless extended in writingby its desi nee
9 upon request for a
07/Ct/43
y the department.
j97
SPECIAL REQUEST
EXHIBIT - F
CONTRACT #
ONE-TIME NON -RECURRING EXPENDITURE ADVANCE
Pursuant to Attachment I, paragraph C.l.j. of the attached
FY 93-94 contract, we are requesting more than the monthly
pro-rata share of the contract only for one-time non-
recurring expenditures. '
This request is for the month of , 1993
in the excess amount of $ to be used
for the purpose of
---------------------------
PROGRAM
---------------------------
SIGNATURE
---------------------------
TITLE
---------------------------
DATE
' Zi D
FINANCIAL AND COMPLIANCE AUDITS
ATTACHMENT_
This attachment is applicable, if the provider or grantee, hereinafter referred to as provider, is any government entity,
nonprofit organization, or for -profit organization.
PART I: SINGLE AUDIT
This part is applicable if the provider is a local government entity or nonprofit organization and receives a.total of
$25,000 or more from th.e,'department during its fiscal year. The provider has "received" funds when it has obtained cash from
the department or when it has incurred expenses which will be reimbursed by the department.
The provider agrees to have an annual financial and compliance audit performed by independent auditors in accordance with the
current Government Auditing Standards ("Yellow Book") issued by the Comptroller General of the United States. Local
governments shall comply with Office of Management and Budget OMB Circular A-128 Audits of State and Local Governments.
Nonprofit providers receiving federal funds passed through the department shall citlt
th the airements contained
in OMB circular A-133 Audits of Institutions of Hi her Learnin and Other Nonprofit Insitutions,�it excepptas modified herein.
Such audits shall over the entire organization for the organization's fiscal year, not to exceed 12 months. The scope of
the audit performed shall include the financial audit requirements of the "Yellow Book," and must include reports on internal
control and compliance. The audit report shalt include a schedule of financial assistance that discloses each state contract
by number. An audit performed by the Auditor General shall satisfy the requirements of this attachment.
Compliance findings related to contracts with the department shalt be based on the contract requirements, including any
rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation
showing whether or not matching requirements were met. All questioned costs and liabilities due to the department shall be
calculated and fully disclosed in the audit report with reference to the department contract involved. These requirements do
not expand the scope of the audit as prescribed by the "YettmrB-6ai(:"
If the provider has received any funds from a grants and aids a
report(s)ppropriation, the provider will also submit a compliance
in accordance with the rules of the Auditor General, chapter 10.600, and indicate on the schedule of financial
assistance which contracts are funded from state grants and aids appropriations.
Copies of the financial and compliance audit report, management letter, and all other correspondence, if any, related to
audits performed by independent auditors, other than the Auditor General, shall be submitted within 120 days after the end of
the provider's fiscal year, unless otherwise required by Florida Statutes, to the following:
A. Office of Audit and Quality Control Services
1317 Vinewood Boulevard, Building 5, Room 116
Tallahassee, Florida 32399-0700
e. Contract Manager for the department
C- Submit to this address only those reports prepared in accordance with OMB Circular A-133:
Federal Audit Clearinghouse
U.S. Bureau of the Census
Jeffersonville, Indiana 47132
D. Submit to this address only those reports prepared in accordance with the rules of the
Auditor General, chapter 10.600:
Jim Dwyer
Office of the Auditor General
P• 0. Box 1735
Tallahassee, Florida 32302
The provider shall enure that audit working papers are made available to the de
7/01� of_five years from the date the audit report is issued, unless extended in writing by its designee, upon request for a
G7/G1�g3 g y the department.
PART 11: GRANTS AND AIDS AUDIT/ATTESTATION
This part is applicable if the provider is awarded funds from a grants and aids appropriation, and is either (1) a local
government entity or nonprofit organization receiving a total of less than S25,000 from the department during its fiscal year
or (2) a for -profit organization receiving any amount from the department. The provider has "received" funds when it has
obtained cash from the department or when it has incurred expenses which will be reimbursed by the department.
If the amount received from grants and aids appropriation awards exceeds S100,000, the provider agrees to have an audit
performed by an independent certified public accountant and submit a compliance report(s) in accordance with the rules of the
Auditor General, chapter 10.600. The audit report shall include a schedule of financial assistance that discloses each state
contract by number and i.rldicates which contracts are funded from state grants and -aids appropriations.
Compliance findings related to contracts with the department shall be based on the contract requirements, including any
rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation
showing whether or not matching requirements were met. All questioned costs and liabilities due to the department shall be
calculated and fully disclosed in the audit report with reference to the department contract involved.
If the amount received from grants and aids appropriation awards exceeds S25,000, but does not exceed S100,000, the provider
may have an audit as described above or have a statement prepared by an independent certified public accountant which attests
that the provider has complied with the provisions of all contracts funded by a grants and aids appropriation.
If the amount received from grants and aids appropriation awards does not exceed $25,000, the provider will have the head of
the entity or organization attest, under penalties of perjury, that the organization has complied with the provisions of all
contracts funded by a grants and aids appropriation.
Copies of the audit report and all other correspondence, if any, related to audits performed by the independent auditor, or
the attestation statement, shall be submitted within 120 days after the provider's fiscal year end to the following:
A. Office of Audit and Quality Control Services
1317 Winewood Boulevard, Building.5, Room 116
Tallahassee, Florida 32399-0700
B. Contract Manager for the department
C. Jim Dwyer
Office of the Auditor General
P. 0. Box 1735
Tallahassee, Florida 32302
The provider shall ensure that audit working papers are made available to the department, or its designee, upon request for a
period of five years from the date the audit report is issued, unless extended in writing by the department.
PART III: NO AUDIT REQUIREMENT
This part is applicable if the provider is not awarded funds from a grants and aids appropriation, and is either (1) a local
government entity or nonprofit organization receiving a total of less than $25,000 from the department during its fiscal year
or (2) a for -profit organization receiving any amount from the department. The provider has "received" funds when it has
obtained cash from the department or when it has incurred expenses which will be reimbursed by the department.
The provider has no audit or attestation statement required by this attachment.
07/01/93
,#9 T TAC H RCN 7'- ///
July 1, 1991
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS. GRANTS 7.oA1"IS AND COOPERATIVE
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge
and belief, that:
(1) No federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or an
employee of any agency, a member of congress, an officer or
employee of congress, or an employee of a member of congress
in connection with the awarding of any federal contract, the
making of any federal grant, the making of any federal loan,
the entering into of any cooperative agreement, and the
extension, continuation, renewal, anendment, or modification
of any federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than federal appropriated funds have been
paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any
agency, a member of congress, an officer or employee of
congress, or an employee of a member of"congress in
connection with this federal contract, grant, loan, or
cooperative agreement, the undersigned shall- complete and
submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this
certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans and cooperative
agreements) and that all subrecipients shall certify and
disclose accordingly.
This certification is a material.representation of fact upon
which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by section
1352, Title 31, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil penalty of not
less than 10,000 and not more than $100,000 for each such
failur
,tune 16 1993
sign �Date
London KH-
31C2-tJ on C'_" CC. r a c z
Monroe County Board of County Commissioners, 500 Whitehead St., Key West, FL
ATTEST: DANNY L. KOLHAGE, CLERK R v DAS oFor,�
E. L S IC Y.
By �:' -
A ;;; yS o,:res
D puty C rk c.