FY2018 10/18/2017KEVIN MADOK, CPA
MONROE COUNTY CLERK OF THE CIRCUIT COURT & COMPTROLLER
DATE: November 27, 2017
TO: Janet Herbener
Senior Grant & Finance Analyst
FROM: Painela G. Hancoc&,C.
SUBJECT: October 18th BOCC Meeting
Attaclied are electronic copies of the following (Item 1338) Fiscal Year 2018 contracts with
non- profit orgimizations:
A.H. of Monroe County, Inc., in the amouIIt of $0,000.00
Anchors Aweigh Club, Inc., in the unount of $20,000.00
Autism Society of the Keys, Inc., in the amount of' $30,000.00
Grace Jones Community Center, Inc., in the amount of $55,000.00
Star of (lie Sea Foundation, Inc., in the amount of $100,000.00
Hospice of" Florida Keys, Inc., in the aunount of $190,000.00
Womankind, Inc., in the amount. of' $140,000.00
Should you have any questions, please feel Tree to contact me at ext. 3130. Thank you.
cc: County Attorney
Finance
File
AGREEMENT
This Agreement Is made and - entered into this 18th day of October, 2017, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA,. hereinafter referred to as
"Board" or "County," and Hospice of Florida Keys, Inc., hereinafter referred to as "PROVIDER."
WHEREAS, the PROVIDER Is a not- for -profit corporation established for the provision. of
home health and hospice care services,. and
WHEREAS, It is a legitimate public purpose to provide facilities and services related to
home health and hospice care, now, therefore,
IN CONSIDERATION of the mutual promises .and covenants contained. hereln, .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 ofthe Board -as to providing facilities and:
.services for home health and hospice care for disadvantaged and medlcally -needy persons living
In Monroe County, Florida, shall pay to the PROVIDER the sum of ONE HUNDRED NINETY
THOUSAND AND NO /100 DOLLARS ($190,oco.00) for. fiscal year 2017 -2018.
2. TERM. This Agreement shall commence on October 1, 2017, and terminate September
30, 2018, 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 certlfication.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.
S. 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.
c0n&WWov1w- VNA -FY98: page 1
RECORDKEEPING
6. RECORDS. PROVIDER shall maintain all books, records, and documents directly
pertinent to performance under this Agreement in accordance with genera IIy..accepted .accounting
principles consistently applied. Each party to this greement. or their authorized representatives
shall have reasonable and timely access to such records 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 8(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.
7. PUiBLIC 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, rand made or recelved
.by the County and PROVIDER In: conjunction with this Agreement; and the County shall have the
rightto unilaterally cancel this Agreement upon vlolation of this provision -by PROVIDER.
S. COMPLIANCE: WITH COUNTY 'GUIDELINES. The PROVIDER must furnish to the
County:the following (items (a) -(j) -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 496.406.
(c) List of the Organization's Board of- Directors of which there must be at least 5 and for each
board member piease.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 statements, 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; 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. -If the PROVIDER receives $100,000 or more In
grant funding from the County: i
a. The CPA that prepares the. audit must also be a member of the
American Institute of Certified Public Accountants (AICPA); i
b. The CPA must .rhaintaln malpractice .Insurance covering. the audit
services. provided and
c. 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;
(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;
(1) Specific description or list of - services to be provided under this contract with this grant
(see Attachment Q;
(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
confradt Hospxe.VNA -FYra; page 2
frequencies of services provided, a profile of clients (including resldency): 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
9. SCOPE OF SERVICES. The PROVIDER,. for the . conslderation- 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.
10. 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..
11. BINDING EFFECT. The terms, covenants, conditions, and provisions of this
Agreement shall bind and Inure to the beneflt -of the County and PROVIDER and their respective
legal representatives, successors, and assigns.
12. 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.- refatlonship; and disclosure or .
use of certain Information.
13. NO-SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in.respect
to )tself, 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.
14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, -the
PROVIDER is an Independent contractor and not an employee of the - Board. No statement
contained In this agreement shall be construed so as to find the PROVIDER or any of its
employees, contractors, servants or agents to. be employees of the Board.
COMPLIANCE ISSUES
15. 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 shalt constitute. a material breach of
conftd -HaVke VNA -Frfs page 3
this agreement and shall = entitle the Board "to terminate this contract immediately- upon delivery of
written notice of termination to the PROVIDER:
16. 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.
17. 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 These include, but are not limited to: 1).
Title VI of the Civil Rights Act of 1964. (PL 88 -352) which prohlbits 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. Discriminatlon: 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 (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.confidentlality 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) Monroe County Code Chapter 13; Article VI,
which prohibits discrimination on the basis -of race, color, sex, religion, national origin; ancestry,
sexual orientation, gender identity or expression,. familial status or age; 111 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
18.. 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.
ig. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and .PROVIDER
agree that all disputes and disagreements, shall be attempted, to be resolved meet.and confer I
sessions between representatives of each of the. parties: The. PROVIDER-and County staff shall ,try
to resolve the claim or dispute with meet. and confer sessions to be commenced within _15 days of
the dispute or claim. 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. Any claims or dispute that the.- parties - cannot :resolve :shall be
decided by the Circuit Court, 16"' Judicial- Circuit, Monroe County, Florida. i
20. COOPERATION. In- the. event any administrative or legal proceeding is :Instituted
against either party relating to the formation, execution, or breach of this
Agreement, County and PROVIDER agree to participate, to the extent required by the other party,
In all proceedings, hearings, processes, meetings, and other activities related to the substance of
this Agreement or provision of the services under this Agreement: County and. PROVIDER -
specifically agree that no party to this Agreement shall be required to enter (nto any arbitration
proceedings related to this Agreement.
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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:
30. 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 entitles, 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
31. EXECUTION IN COUNTERPARTS.. Thls: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.
32., NOTICE. Any notice required or permitted under this agreement shall be in writing
and hand - delivered or mailed,: postage pre -paid, by certified mall, 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
Gayle Mattson, President
Hospice of the Florida Keys, Inc.
1319 William St.
Key West, FL 33040
305 =294 -8812
305- 294 -9348 FAX
33. GOVERNING LAW, VENUE, .INTERPRETATION, COSTS, AND FEES. This
Agreement shall be governed by and construed in accordance with the laws of the State of Florida
applicable to contracts made and to be performed .entirely in the State.
In the event that any cause of action' or administrative proceeding. Is instituted for - the
enforcement or Interpretation of this Agreement, the County and PROVIDER agree that venue -will
lie In the appropriate. court or before the appropriate administrative :body In: Monroe County;
Florida.
The County and .PROVIDER agree that, in the event of conflicting interpretations of the
terms or a term of this Agreement. by or between any of them the Issue -shall be submitted to
mediation prior to the. institution of any other administrative or legal proceeding.'
.34.. NON - WAIVER. Any waiver of any breach of covenants herein contalned to be kept
and performed -by the PROVIDER shall not be deemed or considered as a continuing and
Contract NoVke VNA -PY18; page 6
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.
35, 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 Areement, 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.
36. 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]
Confect Hospka VNA -FY18: Page 7
WHEREOF,. the parties hereto. have caused these presents to be executed as
first written above.
BOARD OF COUNTY COMMISSIONERS
'N a MADOK, CLERK OF MONROE COUNTY FLORIDA
,
By
Deputy Clerk I Mayor /Chalrman
Hospice Florida Keys,_Inc.
Witness (Federal ID No. 51 - a-
By
Witnesso Phler Executive Officer
MONROE COUNTY ATTORNEY
/�_, �OV AS TO FORM:
.BSI (? i [i7 TINE LIMBERT- BARROWS
ASSISTANT COUNTY ATTORNEY
DATE:
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ATTACHMENT A .
EXPENSE (REIMBURSEMENT REQUIREMENTS
This document :is intended to provide basic guidelines to_ Human.Service and Community -Based
Organizations; county travelers, and, contractual parties who have reimbursable expenses
associated with Monroe County business. These guidelines, as they relate to travel, are from the
Monroe County Code of' Ordinances and State laws and regulations.
A cover letter (see Attachment B): summarizing the major line Items on the reimbursable expense:
request needs to also contain the following - notarized certified statement: -
"I certify that the above checks- have -been submitted to the vendors as noted and that the
attached expenses are accurate and In agreement with the.records.of this organization.
Furthermore, these expenses are in compliance with this organization's contract with -the Monroe
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source."
Invoices should be billed to -the: contracting agency. Third party- payments will not be considered.
for reimbursement. Remember, the expense should be paid -prior to requesting a reimbursement.
Only current. charges will be. considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all- inclusive.. The Clerk's Finance. Department, reserves
the right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines. should. be directed to 305 - 292 -3534.
Data Processing, PC Time, etc.
The vendor Invoice is required for reimbursement. Inter - company allocations are not considered
reimbursable expenditures unless appropriate payroll journals -for the charging department are
attached and certified.
Payroll
A certified statement verifying the accuracy and.authentldty of the payroll expense is needed. If
a Payroll Journal is provided, It should. include:. dates, employee name; salary 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 requl red- 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.
Aaog 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.
Confta- Hospice VNA -fyf 8; 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 purposed 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 Ordinances and State 1aws 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- aldlne 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.relmburse 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 vlclnity travel. Mileage is not allowed 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 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.ln the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non - sufficient check charges,
penalties and fines. i
CCOW- Hospice VNA- FY16,' 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.- (Oraanization name T 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_ XX.Kx
(B) Total prior payments $ X,XXX.XX
(C) Total requested and paid (k+ 8) $ X,XXX:XX
(D) Total contract amount $ X,XXX:XX
Balance of contract (D -C) $ X_XXX-XX
I certify that the above checks have been submitted to the vendors_ as- noted. and that the
expenses are accurate and in - agreement with the records of this organization.. Furthermore,:
these expenses are In compliance with this organization's contract with the Monroe County Board
of County. Commissioners and .will not be submitted for reimbursement to 'any other funding
source. .
Executive Director
Attachments (supporting documentation)
S orn to and subscribed bee re me this day of _l.l.�y 2d by �,r/
Is oa�l ko to
Notary P I c Not !`Rakf SAN BURCH
ra
Notary Public tale of Florida
My Comm. Expires Oct 26, 2018
Commission # FF 137561
rY� PO,,�
%° .. :°`'� 8aided Thrarph National Notary Assn.
Confract- hospice VIVA- FY18, page Y 1
ATTACHMENT C
Specific description or list of services to be provided under this contract:
Funds will be utilized to offset expenses for non - refundable home health, palliative,. and hospice care
services and programs provided to the citizens of Monroe - County, as well as health care expenses
related to uninsured and underinsured residents such as, but not limited to:
Professional licensed medical physicians that will be providing care to: residents
Profession clinical staff, nurses, aides, social workers and clergy providing care.
Non - reimbursable expenses associated with ambulatory transportation: of patients to include expenses
associated with evacuating patients pre and post natural disaster procedures.
Funds will be used to off-set the cost for medical equipment, supplies, medications. patients:receive that .
are not fully reimbursed.
Expenses associated with all community education and support outreach services such as:
1. Palliative care
2. Advance care planning support and guidance -
3. Bereavement and cancer support group programs to include our new No-One -Dies Alone
program.
4. Annual memorial ceremonies held throughout Monroe. County.
5. Expenses associated with volunteer services.& programs such as Music & Memory and pet
therapy
6. Non- reimbursable expenses association.with social services /clergy support for families for a
period of 1 year as dictated by the federal government.
foot Note:
2016 Cost of Services:
Reimbursed Amount:
Home Health Patients:
Palliative /Private Duty:
Hospice Patients:
$5,501,834.35
$3,750,425.45
708
52
240
Contract- Hospice VNA -FY18; 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
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 � 1 Respondent's name) nor
any. Affiliate has been: placed on the convicted vendor list within the last 36 months:
(Signature)
Date:
STATE OF:
COUNTY OF:.
Subscribed and wom to (or affirm ) before me on . a i f /
(date) by (name of affiant). - He /She i �nally
know to me or has produced (type of identification) as
identification.
�.
BEVERLY ELSTON BURCH
:
Notary Public - Stale of Florida
My Comm. Expires Oct 26, 2016_
Commission # FF 137561
OF F ; ,
BdnM Through National Notary Assn.
NOTARY PUBLIC
My Commission Expires: (f/
0. •OP8,
Contract Hospice HNA -FY18, page 13
ATTACHMENT E
SWORN. STATEMENT UNDER ORDINANCE NO..010 - 1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
r
"..,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 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."
�J
(Signature)
Date:.
STATE OF:
COUNTY OF: M
Subscribed and to (or affirmed) before me on O(OP 7
(date) by I r la (name of affrant). He /She is (personally
kno to me or has produced (type of
identification) as identification.
HLARLY ENSIGN BUNCH _
Notary Public - State of Florida NOTAR PUBLIC
"� a My Comm. Expires Oct 26, 2018 AJ
F.�$; Commission N, FF 137561
Bonded TkW0 Nuional Notary Assn.. My Commission Expires: lY V
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned: vendor in accordance with Florida Statute 287.08:7 Hereby certifies: that:
(Name of Business)
1. :Publish a. statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a .controlled substance is prohibited in the workplace and
specifying the.actions that will be taken against employees for violations of such .prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, - the business' policy of
maintaining a drug- free workplace -any available drug counseling, rehabilitation, and employee
assistance programs,. and the. penalties that may be imposed upon - employees for drug abuse
violations.
3. Give each employee engaged in providing the commodities or contractual services that are
underbid 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 pies of guilty
- or nolo : contendere to, any violation of Chapter 993 (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, (.,certify that -this firm complies fully with the above
requirements.
Sub rib an s m to (or affirmed) before me on OJ6 & (date) by
(55h (name of affiant). He/She is ersonally known -to me
or h produced 01 (ty of i en cation) as
.(Signature)
Date:
STATE OF: Florda
COUNTY OF:
BEVERLY ELSTON BURCH
Notary Public - State of Florida
3 ^ My Comm. Expires Oct 26.2018
commission # FF 137561
,•�" "• Bonded Throto N alional Mary Assn.
Contract- Hospice VNA- FYI 8,• page 15
NOTARY PUBLIC n !� /,,
My Commission Expires: V'Ur .0(016
ATTACHMENT G
FY18 Annual Performance Report
(For year October 1, 2017—September 30, 2018)
Agency Name
POC
Phone/Email
Grant Amount
Per Section 8 of your contract, it is required that you fill out the entire form and answer every
question.
Narrative on the FY18 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
Services Target Population target population served in FY18
Unduplicated Clients Served
2. What were the measurable outcomes (including numbers) accomplished in FY18? 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 FY18; and/or 200%; and/or another standard used by your organization?
4. Were all the awarded funds used in FY18? If not, please explain.
5. What is the number of FTEs working on the program(s) funded by the award in FY18?
Contract-Hospice VNA-FY18:page 16
6. Were the awarded funds used as match in FY18? If so, please list matching sources.
7. What area of Monroe County did you serve in FY18?
8. How many total FTEs in your organization?
9. Volunteers: hours of program service were contributed by volunteers in FY18.
10. What was the CEO /Executive Director (or highest paid title) compensation in FY18? (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 FY18 IRS Form 990. If
your FY18 IRS Form 990 is not yet prepared, please provide an estimate for the following
questions.
12. What were your organization's total expenses in FY18?
13. What was your organization's total revenue in FY18?
14. What was the organization's total in grants and contracts for FY18?
15. What was the organization's total donations and in -kind (fundraising) in FY18?
16. What percentage of your expenses are program service expenses versus management and general
expenses in FY18 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 - Hospice VNA -FY18; page 17