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Item C22County of Monroe The Florida Keys Mayor David Rice 9400 Overseas Highway Suite 210 Marathon International Airport Terminal Marathon, FL 33050 305.289.6000 Boccdis4@monroecouniy-fl.gov monroecounty -fl.gov BOARD OF COUNTY COMMISSIONERS Mayor David Rice, District 4 1 2 ' Mayor Pro Tem Sylvia J. Murphy, District 5 Danny L. Kolhage, District 1 George Neugent, District 2 Heather Carruthers, District 3 Interoffice Memorandum Date: December 7, 2017 To: Kevin Madok, Clerk of the Court County Clerk's Office From: Commissioner David Rice, District 4 RE: NOTICE OF VOTING CONFLICT Per Florida Statute 1123143, I hereby disclose by written memorandum that I will abstain from the vote on certain issues brought before the Monroe County Board of Commissioners with entities with which I am involved. I will abstain from the vote on issues concerning the following entities: Guidance Care Center, Inc., a private, not - for - profit entity, which receives some of its operational funding from the County, as I currently sit on the Board of Directors of the Guidance Care Center. I am also a member of the Board of the Historic Florida Keys Foundation, Inc. At the December 13, 2017 BOCC meeting, I will abstain from the vote on item(s): #08, C21, C22, E8, & S4 Copy of agenda item listing from the Revised Agenda for each of the referenced item(s) is included for documentation. ATT. State Form 8B Memorandum of Voting Conflict for County, Municipal, and Other Local Elected Officers t FORM 813 MEMORANDUM OF VOTING CONFLICT FOR COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS LAST NAME —FIRST NAME — MIDDLE NAME �1-CE D�} D PA — NAME OF BOARD, COUNCIL, C MMISSION, AUTHORI 0 COMMITTEE lYlorl�Ua�'oun C,oar-� o` �dmfy) �sro� MAILING ADDRESS - 6 b • THE BOARD, COUNCIL, COMMI - ION, AUTHORITY OR COMMITTEE ON WHICH -I -SERVE IS A -UN9a F.- -- ❑ CITY O ❑ UNTY Y OTHER LOCALAGENCY CITY , COUNTY (MD In � I ► + NAME of POLITICAL SUBDIVISI N: mo n rroa 6u n DATE ON WHICH VOTE OCCURRED MY POSITION IS: ELECTIVE ❑ APPOINTIVE WHO MUST FILE FORM 86 This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies to members of advisory and non - advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before completing and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on a measure which would-inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained (including the parent, subsidiary, or sibling organization of a principal by which he or she is retained); to the special private gain or loss of a relative; or to the special private gain loss of a business associate. Commissioners of community redevelopment agencies (CRAB) under Sec. 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one -acre, one -vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father -in -law, mother -in -law, son -in -law, and daughter- in-I'aw. A "business associate" means any person of entity engaged in or carrying on a business enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder (where the shares of the corporation are not listed on any national or regional stock exchange). ELECTED OFFICERS: In addition to abstaining from voting in the situations described above, you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting; and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the minutes of the meeting, who should incorporate the form in the minutes. APPOINTED OFFICERS: Although you must abstain from voting in the situations described above, you are not prohibited by Section 112.3143 from otherwise participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction. TAKEN: • You must complete and file this form (before making any attempt to influence the decision) with the person responsible for recording the minutes of the meeting, who will incorporate the form in the minutes. (Continued on page 2) CE FORM 8B - EFF. 11/2013 PAGE 1 Adopted by reference in Rule 34- 7.010(1)(f), F.A.C. APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency. • The form must - be read publicly at the next meeting after the form is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: • You must disclose orally the nature of your conflict in the measure before participating. • You must complete the form and file it.within 15 days after the vote occurs with the person responsible for recording the minutes of #lie meeting, who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the agency, and the form must be read publicly at the next meeting after the form is filed. � I I DISCLOSURE OF LOCAL OFFICER'S INTEREST I, .Da V; Q 1 y 1( 0.C-- , hereby disclose that on 4 3e- c qS L Q , 20 (a) A measure came or will come before my agency which (check one or more) Af li - inured to my special private gain or loss; inured to the special gain or loss of my business associate, inured to the special gain or loss of my relative, ; inured to the special gain or loss of by whom I am retained; or inured to the special gain or loss of which is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me. 9(b) he measure before my agency and the nature of my conflicting interest in the measure is as follows: I currently sit on the Board of Directors of the Guidance Care Center, Inc. I am also a member of the Board of the Historic Florida Keys Foundation, Inc. SEE ATTACHED AGENDA ITEM SUMMARY C Z i 0-2-2- Ste{ ' Cr - � j or e�a- t S If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer, who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way as to provide the public with notice of the conflict. r (� 2C Lm !fir 7 2c) 1 7 - - — - Date Filed f Signature - NOTIG €: -UND €R P-ROVISIONS-O€--FLORIDA-STAT-UT-ES-§1-1- 2:31 =7 - -A- FAILURE -TO- MAKE- AN- Y- REQU-I RED- DISC-L-O-SI-}RE -- CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR 'EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $10,000. CE FORM 86 - EFF. 11/2013 PAGE 2 Adopted by reference in Rule 34- 7.010(1)(fl, F.A.C. C oun t y of Monr ELj » °o � i� G�, � BOARD OF COUNTY COMMISSIONERS � Mayor David Rice, District 4 The Florida Ke s lv ', y f i I w; \ Mayor Pro Tern Sylvia J. Murphy, District 5 ; ,= _ :' j Danny L. Kolhage, District 1 George Neugent, District 2 Heather Carruthers, District 3 County Commission Meeting December 13, 2017 Agenda Item Number: C.22 Agenda Item Summary #3686 BULK ITEM: Yes DEPARTMENT: Budget and Finance TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292 -4482 Bulk AGENDA ITEM WORDING: Approval of Agreement with Guidance /Care Center for the Community Transportation for Disadvantaged (CDT) program in the amount of $38,685 and Baker Act Transportation service program in the amount of $160,000 for Fiscal Year 2018. ITEM BACKGROUND: The FY2018 funding for the required local match, $38,685, for the Community Transportation for Disadvantaged program decreased approximately 22 %. The Baker Act Transportation funding request increased from $145,000 (FY2017) to $160,000 (FY2018) PREVIOUS RELEVANT BOCC ACTION: The FYI funded amounts were included in the County budget process. Annually the County has provided the required local matching funds for Baker Act Transportation services. CONTRACT /AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval DOCUMENTATION: Agreement -GCC - Transporation (Baker and CTD) FYI FINANCIAL IMPACT: Effective Date: 10/01/2017 Expiration Date: 09/30/2017 Total Dollar Value of Contract: $198,685 Total Cost to County: $198,685 Current Year Portion: $198,685 Budgeted: Yes Source of Funds: Ad Valorem CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A Grant: N/A County Match: N/A Insurance Required: N/A Additional Details: N/A If yes, amount: 12/13/17 001 - 045903 • GCC BAKER ACT TRNSP 12/13/17 001 -01509 • MIDDLE KEYS GUIDANCE CLI Community Transportation for Disadvantaged Total: REVIEWED BY: Tina Boan Christine Limbert Maria Slavik Kathy Peters Board of County Commissioners Skipped Completed Completed Completed Pending $160,000.00 $38,685.00 $198,685.00 11/28/2017 4:41 PM 11/28/2017 4:46 PM 11/28/2017 4:55 PM 11/28/2017 5:38 PM 12/13/2017 9:00 AM AGREEMENT This Agreement is made and entered into this 13 day of December, 2017, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "BOARD" or "COUNTY," and the Guidance /Care Center, hereinafter referred to as °PROVIDER." WHEREAS, the PROVIDER is a not - for - profit corporation established to provide transportation services to the citizens of Monroe County, and WHEREAS, it is a legitimate public purpose to provide transportation services to the residents of Monroe County, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING 1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially and satisfactorily performing and providing services, shall reimburse the PROVIDER for providing transportation services as billed by the PROVIDER for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures. The cost shall not exceed a total reimbursement of ONE HUNDRED NINETY -TWO THOUSAND THREE HUNDRED FIFTY -FIVE DOLLARS ($198,685.00), during the fiscal year 2017 -2018, payable as follows: a) the sum of ONE HUNDRED SIXTY THOUSAND DOLLARS ($160,000.00) for Baker Act transportation services pursuant to Chapter 394, Florida Statutes; and b) the sum of THIRTY -EIGHT THOUSAND SIX HUNDRED EIGHTY -FIVE DOLLARS ($38,685.00), for Community Transportation Coordinator - related transportation services to residents of >_ Monroe County. U. 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 for Baker Act and Marchman Act transportation services shall be made according to the rate schedule set forth in Attachment D, subject to the maximum amounts set forth in Paragraph 1. a. above. Billing Summary Forms, certified monthly financial and service load reports will be made available to the Board to validate the delivery of services under this contract. The monthly financial report is due in the office of the Clerk of the Board no later than the 15th day of the following month. After the Clerk of the Board pre- audits the certified report, the Board shall reimburse the Provider for its monthly expenses. However, the total of said monthly payments in the aggregate sum shall not exceed the total amount shown in Paragraph 1, above, during the term of this agreement. To preserve client confidentiality required by law, copies of individual client bills and records shall not be available to the Board for reimbursement purposes but shall be made available only under controlled conditions to qualified auditors for audit purposes. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Paragraph 2 above. Payment will be made periodically, but no more frequently than monthly, as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a letter, summarizing the expenses, with supporting documentation attached. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included Guidance Care Center — Transportation: BakerAct and CTD FY18; page 1 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 Paragraph 1, above, during the term of this agreement. 4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, this agreement may be terminated immediately at the option of the Board by written notice of termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services or goods provided by the PROVIDER after the PROVIDER has received written notice of termination, unless otherwise required by law. 5. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. RECORDKEEPING 6. RECORDS. PROVIDER shall maintain all books, records, and documents directly (3 pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by this Agreement, the PROVIDER shall repay the monies together with interest calculated pursuant >_ to Sec. 55.03, F.S., 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. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. Pursuant to F.S. 119.0701, PROVIDER and its subcontractors shall comply with all public records laws of the State of Florida, including but not limited to: (a) Keep and maintain public records that ordinarily and necessarily would be required by Monroe County in order to perform the service. (b) Provide the public with access to public records on the terms and conditions that Monroe County would provide the records and at a cost that does not exceed the cost provided in Florida Statutes, Chapter 119 or as otherwise provided by law. (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (d) Meet all requirements for retaining public records and transfer, at no cost, to Monroe County all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure Guidance Care Center — Transportation: BakerAct and CTD FY18; page 2 requirements. All records stored electronically must be provided to Monroe County in a format that is compatible with the information technology systems of Monroe County. 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 contract provisions and the scope of services that the County may request during the y contract year. c RESPONSIBILITIES 9. SCOPE OF SERVICES. The Provider, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and carry out the duties of the Board in rendering counsel in the matter of mental health and guidance to the citizens of the Monroe County, Florida. The Provider shall provide Baker Act transportation services in compliance with Florida Statutes Chapter 394. Baker Act and Marchman Act transportation services which are covered under this agreement may be subcontracted, but are subject to the rates set forth in Attachment D, and the limitations above. The subcontractor shall be subject to all of the conditions of this contract, including but not limited to insurance and hold - harmless requirements, as is the Provider. Guidance Care Center — Transportation: BakerAct and CTD FY18; page 3 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 Statute 496.406. (c) List of the Organization's Board of Directors of which there must be at least 5 and for each � board member please indicate when elected to serve and the length of term of service; (d) Evidence of annual election of Officers and Directors; (e) Unqualified audited financial 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 E grant funding from the County: E a. The CPA that prepares the audit must also be a member of the E American Institute of Certified Public Accountants (AICPA); U b. The CPA must maintain 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; ca (i) Specific description or list of services to be provided under this contract with this grant (see Attachment C); (j) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers 2 served, and outcomes achieved (see Attachment H); (k) Cooperation with County monitoring visits that the County may request during the contract to year; and (1) 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 y contract year. c RESPONSIBILITIES 9. SCOPE OF SERVICES. The Provider, for the consideration named, covenants and agrees with the Board to substantially and satisfactorily perform and carry out the duties of the Board in rendering counsel in the matter of mental health and guidance to the citizens of the Monroe County, Florida. The Provider shall provide Baker Act transportation services in compliance with Florida Statutes Chapter 394. Baker Act and Marchman Act transportation services which are covered under this agreement may be subcontracted, but are subject to the rates set forth in Attachment D, and the limitations above. The subcontractor shall be subject to all of the conditions of this contract, including but not limited to insurance and hold - harmless requirements, as is the Provider. Guidance Care Center — Transportation: BakerAct and CTD FY18; page 3 10. ACCESS TO FUELING FACILITIES. The County shall provide access to the Provider's vehicles at all County fueling facilities. The County shall grant the Provider a license for the use of the real property and its improvements for each fueling site. The Provider agrees that only those individuals authorized by the County to use the fueling sites designated in this agreement shall have twenty -four hour access to said sites, and that they shall either be maintained open or access otherwise provided to them by a uniform key system on such a twenty -four hour basis. The County shall bill the Provider for fueling and other related services and materials utilized by the Provider at the fueling sites within the County's immediate control and as previously set forth in this agreement. Said billing by the County to the Provider shall include an administrative surcharge, as adopted by the Monroe County Board of County Commissioners annually, for processing, servicing, and handling. The Provider shall reimburse the County within thirty (30) days of the date of issuance of the bill. Access to the Fuel Sentry System shall be provided by an electronic memory key, which shall be issued by the County to all authorized designated users of the fueling sites, and as contemplated by this Agreement. For purposes of uniformity, the Monroe County Fleet Management Department shall be responsible for establishing a uniform electronic key system for use by both the County and the Provider under this agreement, and shall establish and maintain policies and procedures for identification, control, and distribution of all keys issued. 11. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out -of- pocket expenses, as an award against the non - prevailing party, and shall include attorney's fees, courts costs, investigative, and out -of- pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. ca 12. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 13. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 14. NO SOLICITATION/ PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 15. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee, agent or instrumentality of the Guidance Care Center — Transportation: BakerAct and CTD FY18; page 4 Board. No statement contained in this agreement shall be construed so as to find the PROVIDER or any of its employees, contractors, servants or agents to be employees of the Board. COMPLIANCE ISSUES 16. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating the provision of such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the PROVIDER. 17. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and /or federal certification and /or licensure of the PROVIDER'S program and staff. 18. NON - DISCRIMINATION. County and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88 -352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681 -1683, and 1685 - 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101 -6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd -3 and 290ee -3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) 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; 11) any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. AMENDMENTS, CHANGES, AND DISPUTES 19. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and /or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the COUNTY. 20. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. 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 Guidance Care Center — Transportation: BakerAct and CTD FY18; page 5 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. 21. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ASSURANCES 22. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 23. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing and with the prior written approval of the Board, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed upon reimbursement amount for the services of the PROVIDER. 24. NON - WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self- insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the U. extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. ca 25. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug - Free Workplace Statement. 26. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 27. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims and causes of action for medical malpractice, medical negligence, bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 28. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under Guidance Care Center — Transportation: BakerAct and CTD FY18; page 6 this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 29. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 30. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non - Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 31. NON - RELIANCE BY NON - PARTIES. No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third - party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 32. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 33. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand - delivered or mailed, postage pre -paid, by certified mail, return receipt requested, to the other party as follows: For Board: Grants Administrator and 1100 Simonton Street Key West, FL 33040 For PROVIDER Frank Rabbito, Senior Vice President Guidance /Care Center Inc. 1205 Fourth Street Key West, Florida 33040 Monroe County Attorney PO Box 1026 Key West, FL 33041 34. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will Guidance Care Center — Transportation: BakerAct and CTD FY18; page 7 lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 35. NON - WAIVER. Any waiver of any breach of covenants herein contained to be kept and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of the same conditions or covenants or otherwise. 36. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. 37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] U. Guidance Care Center — Transportation: BakerAct and CTD FY18; page 8 C.22.a IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year First written above. (SEAL) BOARD OF COUNTY COMMISSIONERS ATTEST: KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA By Clerk - ItneS� 3 W ICf ess 01 ZA Mayor/Chairman GUIDANCE /CARE CENTER (Federal ID No. B Y _ director Guidance/Care Center Co r U_ Guidance Care Center— Transportation: Baker Act and C rD FYI 8; page 9 Packet P9. 910 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. 00 Data Processing, PC Time, etc. >_ The vendor invoice is required for reimbursement. Inter - company allocations are not considered U. reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. ca Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. r_ If a Payroll Journal is not provided, the following information must be provided: pay period, check 2 amount, check number, date, payee, and support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. � For overnight or express deliveries, the vendor invoice must be included. y Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. E Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number of copies made, source document, purpose, and recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. Guidance Care Center — Transportation: BakerAct and CTD FY18; page 10 Telefax, Fax, etc. A fax log is required. The log must define the sender, the intended recipient, the date, the number called, and the reason for sending the fax. Telephone Expenses A user log of pertinent information must be remitted including: the party called, the caller, the telephone number, the date, and the purpose of the call. Travel and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are � not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business E trip is not. E A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room 0 must be registered and paid for by traveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a residence or office to a point of departure. For example, driving from one's home to the airport >_ for a business trip is not a reimbursable expense. U. 0 Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement. Non - allowable Expenses C: The following expenses are not allowable for reimbursement: capital outlay expenditures (unless 2 specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non - sufficient check charges, penalties and fines. c E E Guidance Care Center — Transportation: BakerAct and CTD FY18; page 11 ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 Date The following is a summary of the expenses for ( Organization name for the time period of to Check # Payee Reason Amount 101 Company A Rent $ X 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 (B) Total prior payments $ X (C) Total requested and paid (A + B) $ X (D) Total contract amount $ X Balance of contract (D -C) X 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 sou rce. Executive Director Attachments (supporting documentation) Sworn to and subscribed before me this day of 20 who is personally known to me. Notary Public Notary Stamp by Guidance Care Center — Transportation: BakerAct and CTD FY18; page 12 ATTACHMENT C Services to be provided: Baker Act /Marchman Act transportation services and Community Transportation Coordinator related services. Guidance Care Center — Transportation: BakerAct and CTD FY18; page 13 Copy of the Sub - Contract for Baker Act transportation services. See attached. ATTACHMENT D Guidance Care Center — Transportation: BakerAct and CTD FY18; page 14 ATTACHMENT D .a WESTCARE VENDOR SERVICE AGREEMENT THIS VENDOR SERVICE AGREEMENT (the "Agreement ") is effecti ve as of th is I day of October, 2017 ( "Effective Date ") between Guidance/ Care Center, Inc., a Florida 501 c3 not- for - profit corporation ( "WestCare ") and Elanjess, LLC, a limited IiabiIity company ( "Vendor "} Vendor and WestCare collectively hereafter the "Patties" and individually the "Party ". The Parties agree as follows: 1. Services to be Performed. Vendor will provide the services set forth on Exhibit A ( "Services), which exhibit is attached hereto and incorporated herein by and through this reference, 2. Term. This Agreement shall commence on the Effective Date and shall expire on September Q 30, 2018 (" Term "). Foregoing notwithstanding, either patty may terminate this Agreement at any time, with or without cause, upon not less than thirty (30) days written notice to the other party. If either Party breaches the obligations set forth in this Agreement, the non - °0 breaching Party may terminate this Agreement upon not less than five co (5) Days prior written notice and retain its right to all damages caused by the breach (unless U_ otherwise provided herein) and subsequent termination. Upon expiration or telnination of o this agreement, neither patty shall have any further obligation hereunder except for (i) v obligations due and owing which arose prior to the date of termination, and M (ii) Obligations, promises or covenants contained herein which expressly extend beyond L the tehi of this agreement, c' 3. Performance Standards. Vendor shall comply with all applicable laws, cod es, ordnances, and regulations of the Unites States and the State of Florida. Additionally, and without limiting the foregoing, Vendor shall take all commercially reasonable care in the delivery of Services under this Agreement. 4. Compensation. In full consideration for the perfo Imance of the Services set forth in Section 1, including for any rights granted or relinquished by the Vendor under this Agreement, WestCare shall pay Vendor the rate set forth in Exhibit A based on the specific Service(s) provided pursuant to this Agreement ( "Fee Rate "). Services provided pursuant to this Agreement are to be documented and invoiced by Vendor in writing at the end of each calendar month of service. All written invoices are due by the last day of the month for that month's service. Compensation shall be payable on the fifteenth (15) of the following calendar month following WestCare's receipt and acceptance of Vendor's written accurate invoice. Vendor acknowledges and agrees that, except as provided in this Section or as otherwise set forth in Exhibit A, it shall not be entitled to, and WU VSA Packet Pg. 97176 C.22.a WestCare shall not be obligated to pay, any monies or other compensation for the Services provided and rights granted under this Agreement. 5. Intentionally Deleted. b. Confidential Information, Both parties hereto shall treat as confidential all information relating to either party's operations or the general business affairs or any of the operations or general business affairs of the party (including the party's parent, affiliate or subsidiary companies) which the other party may observe or which may be disclosed as a result of the patty's performance under this MOO. Neither patty shall not disclose any information, including without limitation any information contained in this MOU, to third parties or use any such information for any purpose other than the performance under this MOU, without the prior written consent of the other patty. AdditionaIIy, the Patties agree to abide by all State and Federal laws, rules and regulations, H1PAA and 42 CY.R., Part 2. Both parties agree not to divulge any information concerning any individual client to any unauthorized person or agency without the written consent of tl ;e client and participant. This Section 6 shall survive the termination of the Agreement. 7. Indemnification. Vendor shall indemnify, defend and hold WestCare (including without limitation WestCare's affiliates, subsidiaries' officers, directors, employees, representatives, independent contractors and agents) harmless for, from and against any ° 0 and all losses, expenses, costs, liabilities, damages, claims, suits and demands (including CO without limitation attorney's fees and costs) arising from or attributable to the acts or omissions of Vendor (including but not limited to Vendor's officers, directors, employees, o representatives, sub- contractors and agents). & 1nsuranee. Vendor shall be solely responsible, at Vendor's sole cost and expense, for maintaining its own liability insurance, including any workers compensation insurance required under applicable law. At no time shall WestCare be liable for any insurance obligation of Vendor. 9. Representations and Warranties. Vendor hereby represents, covenants and warrants to WestCare as a material patt of the consideration for WestCare agreeing to enter into the Agreement, as follows: (i) Vendor is a corporation, duly organized and validly existing under the law; (ii) the execution of this Agreement has been duly authorized by all necessary corporate action on behalf of Vendor; and (iii) Vendor has obtained and currently holds all licenses, permits and approvals of all goveriunental authorities necessary or appropriate to perform Vendor's obligations under the this Agreement. 10. Intellectual Property. Neither party to this Agreement shall be deemed to be granted any right, title or interest in or to the trademarks, trade names, service marls, copyrights, patents or other intellectual prope lty of the other Party. WestCare acid Vendor expressly acknowledge and agree that neither party is granted under this Agreement the right to use, refer to or incorporate in any materials, including without limitation marketing materials, the name, logos, trademarks, or copyrights of the other Patty. WC V5A 1'age 2 n f 7 Packet P9. 117 C.22.a IL Intentionally Omitted. 12. Notice. Any notices to either party under this Agreement shall be in writing and delivered by hand or sent by nationally recognized messenger service, or by registered or certified mail, return receipt requested, to the address set forth herein or to such other address as that party may hereafter designate by notice. Notice shall be effective when received, which shall be no greater than one (1) business day after being sent by a nationally recognized messenger service or three (3) days after being sent by mail. If to WestCare: Guidance/ Care Center, Inc. Attn: Anne Romance 3000 41 `! Street Ocean Marathon, FL 33050 with a copies of any legal notice, notice of demand, notice of breach, demand for indemnity, claim, assertion of damage or notice of default to: WestCare Foundation, Inc. Attn: General Counsel 1711 Whitney Mesa Drive Henderson, Nevada 89014 co If to Vendor: Elanjess, LLC Attn: Lee Connell 800 14` Street Key West, FL 33040 M 13. Miscellaneous. (a) Time is of the essence of this Agreement. (b) This Agreement, together with all documents incorporated herein by reference, if any, constitutes the entire agreement between the Parties. There are no terms, conditions or provisions, either oral or written between the parties other than those contained in this Agreement. (c) No amendment to this Agreement shall be enforceable, unless in writing and signed by the Parties. (d) Whenever the context may require, any pronouns used in this Agreement shall include the corresponding masculine, feminine or neuter forms, and the singular form of nouns and pronouns shall include the plural and vice versa. Captions contained in this Agreement are inselied only as a matter of convenience and in no way define, limit, extend or describe the scope of this Agreement or of any provision herein. WC V5A Page 3 of Packet P9. 918 C.22.a (c) This Agreement may be executed in one or more counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same agreement. Any such counterpart signature pages may be attached to the body of one agreement to fO lm a complete integrated whole. (f) Any term or provision of this Agreement which now or hereafter is declared contrary to any law, order, ordinance, requirement ruling or regulation of any gove lrnnental authority, whether federal, state or local, whether now in force or enacted or promulgated in the future, or which is otherwise invalid, shall be deemed stricken from this Agreement without impairing the validity of the remainder ofthis Agreement. (g) This Agreement shall be governed by and construed in accordance with the law of the State of Florida. The venue for any dispute arising under this Agreement shall be a court of competent jurisdiction in Miami -Dade County, State of Florida. (h) Neither Party hereto shall be entitled to recover special damages in the nature of lost profits or consequential damages. (i) The Parties to this Agreement arc acting as independent contractors and Qj independent employers. Nothing contained in this Agreement shall create or be m construed as creating a partnership, joint venture or agency relationship between CO r the parties. Neither Party shall have the authority to bind the other Party in any respect. G) In the event of any action or proceeding to compel compliance with, or with respect to any breach of this Agreement, the prevailing party shall be entitled to recover all reasonable costs and reasonable expenses of such action or proceeding incILiding without limitation its reasonable attorneys' fees and costs incurred in connection therewith regardless of whether any formal legal action is commenced or whether such fees and costs are incurred at or in connection with trial or appellate proceedings. (k) Vendor sliall perftll m all of the Services under this Agreement in compliance with all applicable federal, state and local laws, ordinances, rules, regulations, codes or orders. (l) Any failure by either Party at any time, to enforce or require the other Party's compliance with any of the terms and conditions of this Agreement shall not constitute a waiver of such terms and conditions in any way, or the right of the non - defaulting party at any time to avail itself of any and all remedies it may have for any breach of said terms and conditions including without limitation any right to terminate this Agreement. The remedies of the parties provided for in this Agreement shall be cumulative with all other remedies that either Party may have against the other party at law or in equity. wC V5.4 Page d of 7 Packet P9. 919 C.22.a (rn} All of the covenants and agreements contained in this Agreement shall be extended to and be binding upon the successors and assigns of the Parties. Neither Party may assign this Agreement in whole or in part or assign, pledge or otherwise transfer either party's obligations hereunder except with the prior written consent of the non- assigning party, which consent shall not be unreasonably withheld. (o) The Vendor shall not subcontract any portion of the Services contemplated by this Agreement without the prior written consent of WestCare, which consent may be given or withheld in WestCare's sole and absolute discretion. (Signature Page to follow) CO r LL WC VSA Page 5 of Packet P9. 920 C.22.a Rim motimmulm IN WITNESS WHf :REOF, the Parties, by their duly authorized representatives, have executed this Service Agreement as of the Effective Day noted above. e W estCa re G['€DANCE/ CARL£ CF�TER. a Florida 5010 tint - f l or - profit corporati(m By: 9�—� Name: Sharon Crippen Its: Senior Vice President Date:_- kO! /e -m -&J Z ,2017 H Vender" El- ANJFSS LLC, a limited fiah company Name: AMY 1 EE 6 a.v y le W Its: Yr(:e- Pg1- c. -n Date, 'Za .2017 CO r U- IL i t'ti:1 Paw {. 411 ' Packet Pg. 921 C.22.a m a� r it i M services N_ (5cc Amiched) o 0 m r- 0 CL N _ L H 7, a-� 7 E E O U U a L QI Y m Co r LL U M r_ m L QI Y (a _ L ^ O ^ CL N _ L 1 7 U U C7 d E m L _ m E U t4 a-� a-� a WC VSA E'age 7 07 Packet Pg. 922 C.22.a GICC su ooly Elaniess with two Ford Crown Victo vehicle Maintenance specifications; one to be stationed in Key West at an Elanjess location and the other in Marathon at GICC headquarters, GICC wilt pay for the fuel and maintenance of the two vehicles used for Baker Act and March rnan Act transportation. Eta njesswill coordinate the maintenancefor the CrownVictoria bcated in Key West. invoices for routine maintenance (labor and parts) on the Crown Victoria will be forwarded quarterly to GICC's Transportation Coordinator for payment. Elanjess will not charge an extra fee for coordinating the maintenance of the vehicle. Elanjess must obtain prior approval from the GICC Transportation Coordinator to initiate major vehicle repairs. GICC will coordinate the maintenance for the Crown Victoria located in Marathon. GICC wiil maintain insurance on both of the vehicles. Elanjess will also be named as an E "additional insured" for these two cars. All Elanjess drivers operating GICC vehicles will hold o a minimum of a Class E Florida Driver's License and be approved for GICC insurance 0 coverage by the Transportation Coordinator. Upon execution of this agreement, Elanjess will fax /email to GICC's Transportation Coordinator a current list of drivers - including a copy of a L the driver's license and social security number for each driver - for approval to operate GICC Y vehicles. Prior to adding a driver, Elanjess will fax or email to G /CC's Transportation m_ Coordinator or designee a copy of the driver's license, social security number and signed CO "Request for Check of Driving Record" form of the person. GICC will initiate procedures to add the driver to GICC vehicle insurance.Elanjess cannot use the driver for BAiMA transports until it has received written notification that the driver has been added to the G /CC insurance ° coverage. Packet Pg. 923 ortl {41' iitel ViN Donator from 2007 Croton Victoria 2FAFP71W97W'34976 4 -door - c aq e MOSO BA4 KW Baker Ac; Ford VIN Donaton from 2006 Crowr. Victoria FAFP71 WX6X128 "48 k -ciir -cage MCSO BA5 NA-Baker Act Maintenance specifications; one to be stationed in Key West at an Elanjess location and the other in Marathon at GICC headquarters, GICC wilt pay for the fuel and maintenance of the two vehicles used for Baker Act and March rnan Act transportation. Eta njesswill coordinate the maintenancefor the CrownVictoria bcated in Key West. invoices for routine maintenance (labor and parts) on the Crown Victoria will be forwarded quarterly to GICC's Transportation Coordinator for payment. Elanjess will not charge an extra fee for coordinating the maintenance of the vehicle. Elanjess must obtain prior approval from the GICC Transportation Coordinator to initiate major vehicle repairs. GICC will coordinate the maintenance for the Crown Victoria located in Marathon. GICC wiil maintain insurance on both of the vehicles. Elanjess will also be named as an E "additional insured" for these two cars. All Elanjess drivers operating GICC vehicles will hold o a minimum of a Class E Florida Driver's License and be approved for GICC insurance 0 coverage by the Transportation Coordinator. Upon execution of this agreement, Elanjess will fax /email to GICC's Transportation Coordinator a current list of drivers - including a copy of a L the driver's license and social security number for each driver - for approval to operate GICC Y vehicles. Prior to adding a driver, Elanjess will fax or email to G /CC's Transportation m_ Coordinator or designee a copy of the driver's license, social security number and signed CO "Request for Check of Driving Record" form of the person. GICC will initiate procedures to add the driver to GICC vehicle insurance.Elanjess cannot use the driver for BAiMA transports until it has received written notification that the driver has been added to the G /CC insurance ° coverage. Packet Pg. 923 C.22.a All drivers are required to have at minimum 3 -year clean driving record. Additionally, Elanjess will fax a copy of picture identification and social security number for each escort to GICC's Transportation Coordinator or designee. Elanjess cannot use the escort for BAIMA transports until it has received written notification that the escort has been approved by GICC. All 13A/MA approved drivers must read and sign the acknowledgement of reading and receiving (Attachment 1) Transportation Protocol. Elanjess will report and document accidents involving GICC vehicles and incidents involving clients to the proper authorities and immediately thereafter contact GICC. Following an accident, GCC Vehicle Incident protocol must be followed. A Vehicle Incident Kit (Attachment 4) has been provided for each vehicle with instructions. Additionally, anyone involved in an accident with a GCC vehicle MUST BE DRUG TESTED as soon as possible following the incident. Drug testing forms are included in the kit. Any citations received while driving a GCC vehicle will be the responsibility of the driver. Refusal or failure to accept responsibility for citations may result in removal of driving privileges. All drivers will be required to complete a verbal de- escalation training within 34 days of approval to drive. GCC will provide details for accessing the training which will be available on line. All BAIMA approved drivers must read and sign the acknowledgement of completing the assigned training (Attachment 5). Elanjess will follow the transportation protocol and complete the documentation provided as Attachment 1 -3 herein. Elanjess, upon approval of drivers, will issue an identification badge. The following fee Estimated 9 Roundtrips* structure is establi for Client Pickuo Point the period of the agreement: Elanjess Ciient Drop -off Point Pavment Key West Key West $115 Marathon Marathon $115 450 Key West iviaratrion 4)1.1+0 Marathon Key West $145 Marathon Key Largo $145 Kev Larao Marathon $145 40 Marathon Miami -Dade County $385 Miami -Dade Countv K La rao_ _ Miami- Dade_County _ $38 40 Kev West Mia mi -Dade Countv $385 GCC Preauthorization Required for All Trips Below *Approval for belowfees will be granted only when the Marathon BA/MA vehicle is engaged v, i b l2tbdr BA/UMriothat wo 00dwiluftailoot her pickup within a reasonab €e pe io tijvvs # Roundtrips Location Point Client DePoo -off Point Payment 5 Key West Marathon & North Marathon $145 5 Marathon Key West Marathon $145 2 Key West Marathon & North Key Largo $225 3 Key West Marathon & North Miami -Dade Countv $3 85 CO U_ Rvt;Wrvwd. f1id 0916 2 Packet Pg. 924 C.22.a GICC Preauthorization Required for All Trips Below Estimated Elanjess # Roundtrips* Client Pickup Point Client Dro12 -off Point Payment Key Largo Avon Park (Area) $774 1 Marathon Avon Park (Area) $770 Key West Avon Park (Area) $770 Key Largo Up -State (McClenny Area) $1,200 1 Marathon Up -State (McClenny Area) $1,200 Key West Up -State (McClenny Area) $1,200 Timely payment for services rendered is ensured by adherence to the following invoicing a procedures: _ Elanjess will submit one state mentslinvoice per rnonth, within 5 business days after the end of the billing period. Elanjess will include required documentation with each statement invoice. - Elanjess statern e nts/i n voice s for BA/MA trips will be submitted to the attention of E G /CC Inpatient Unit Coordinator, 0 GICC's Inpatient Unt CoordinatorwiII review state menthnvoice, mediate any discrepancies with Elanjess, and forward approved invoice to GICC Finance Q Department. Elanjess will submit vehicle maintenance bills for the KW car quarterly to the m Transportation Coordinator CO GICC will mail payment to Etanjess within 14working days (Finance Department) upon receipt of statement 'invoice by the Inpatient Unit Coordinator. U_ Attachments: 1. GICC Transportation Protocol 2. GICC Transportation Record and Payment Authorization Sheet 3. Statement 4. Vehicle Incident Kit 5. De- escalation attestation Packet Pg. 925 C.22.a ATTACHMENT 1 GUIDANCE /CARE CENTER TRANSPORTATION PROTOCOL: THE TRANSPORTATION OF BAKER ACT AND MARC HMAN ACT CLIENTS A. Client Related Rules: 1. Confidentially of a client and client related information shall be maintained at all times. 2. Each client shall be treated with respect and dignity at all times. 3. No information with client information shall leave the clinic unless part of a client transfer packet to a designated facility. (No driver /escort shall maintain a personas copy of the Transportation Record and Payment Authorization Sheet.) 4. Client transportation within Monroe County may be conducted with a driver and an escort. 5. Client transportation outside of Monroe County must be made with one driver and 0 one escort. ad 6. A client must be observed for any unusual behaviors including hurting self /others or a sudden medical conditions. Respond to a medical emergency by calling 911. L Otherwise, contact the nurse at the transferring (pick -up) facility for consultation. 7. At the time of pick up for a Baker Act or Marchman Act client, a driver must obtain the original Baker Act or Marchman Act paper work from the Pick Up facility. If the co r original paper work is not available the driver must immediately report this information to the G /CC Nurse on Duty for further instructions. o 8. A female client requires a female escort or a female driver. 9. A parent is not allowed to travel in the Baker Act vehicle with a Baker Act or Marchman Act minor. When a parent or other responsible party reports he/she plans to follow the Baker Act vehicle, the BakerAct driver advises the parent /party that our primary responsibility is to the child and ensuring the safety of the child therefore following our vehicle as a method of direction is not encouraged. 10. Only one client may be transported at a time in the Baker Act vehicle. 11. Drivers, Escorts and Clients are not to smoke in the car at any time. 12. Clients are not to be placed in handcuffs or any type of restraints for any reason by a driver or escort — or to be placed in the vehicle by others (i.e. Law Enforcement) in handcuffs or any type of restraints 13. A client's movement is not to be impeded with any physical restraint unless directed by nurse /MD /law enforcement officer. 14. If a client is violent during transport and poses a threat to safety, stop the vehicle and call 911, than notify the Nurse on Duty of the situation at (305) 434 -7660 ext. 31123 15. A client shall not be left alone in the vehicle during the trip for any reason. 16. A client shall be under the observation of the driver or escort at all times during the transport. 17. Client is encouraged to use restroom facilities prior to departure. If the trip is generated from Key West and a stop is required, the G /CC may be used for that purpose. Packet Pg. 926 C.22.a 18. A client may not use aluminum or metal cans. Items for drinking shall be provided only in a plastic container. 19. Clients may not have any metal utensils, glass or other hard products such as pencils or pens. 20. A client may not shop during a stop. All efforts should be made to avoid stops. If a stop is required, R should be short and without delay. 21. If a client must use a public facility, the client must be escorted to the restroom and the driver must remain outside the restroom door until the client leaves the restroom. The driver will remain in conversation with client while the client is in the restroom. B. CoordinationofTransportation Rules: 1. Transportation arrangements for Baker Act and Marchman Act clients are under the direction of the Unit Nurse on Duty GICC per contractual arrangement Elanjess LLC. 12. When a driver reports a client is too dangerous to transport, the nurse on duty shall work with the Sheriff's department to transport the client 13. If a client absconds at time of or during transport, immediately report the information to the GICC Nurse on Duty. Do not go after the client. 14. Neither Drivers nor Escorts are permitted to physically restrain a client. 15. "Jail Hold" clients from the Monroe County Detention Facility shall be picked up from Rvsdllfn 9.2016 -2- Packet Pg. 927 No other agency is authorized to contact Elanjess directly for transportation. c 2. Final decision for a driver to transport is made by the nurse on duty. The nurse may L) request a BAL be conducted or send a drivers escort home if he/she has a concern. w 3. "A driver shall not be permitted or required to drive more than 12 hours in any one a 24 -hour period, or drive after having been on duty for 16 hours in any one 24 -hour Y period. " m 4. All trips will be made within the approved fee structure. 5. CO All trips will be made using the closest vehicle and the shortest distance unless preauthorization is obtained from the Unit Nurse on Duty at the GICC. U_ 6. Clients may be picked up at only approved locations. The GICC Nurse on Duty will o communicate the pick -up location. Approved locations will include: 0 Hospitals, Detention Facility M Mental Health Clinics, Anchor Away L With a G /CC staff member 9r otherwise authorized by the G /CC I Unit Coordinator m 7. Depoo Hospital . Pick -up I drop -off is now located in the rear next to the handicap parking. Upon arrival, call the nurse's station directly from the vehicle at 305 -294- 5531 x8330. Hospital staff will escort the client to /from the building. 8. Pick -up /drop -off is atthe ER entrance. Upon arrival, call 305- 294 -5531 x3202. _ Hospital staff will escort the client to /from the building. 9. At GICC: Use the telephone call box next to the elevator. 10. At G /CC, staff members shall place the client in the vehicle for departure and will assist the client from the vehicle at time of arrival - 11. The facility responsible for the departing client for a trip longer than 2 hours shall provide a brown bag snack, All minors shall be supplied with a snack for any trip over 1 hour. 12. When a driver reports a client is too dangerous to transport, the nurse on duty shall work with the Sheriff's department to transport the client 13. If a client absconds at time of or during transport, immediately report the information to the GICC Nurse on Duty. Do not go after the client. 14. Neither Drivers nor Escorts are permitted to physically restrain a client. 15. "Jail Hold" clients from the Monroe County Detention Facility shall be picked up from Rvsdllfn 9.2016 -2- Packet Pg. 927 C.22.a the Sallyport area only. To access the Sallyport area, the driver must drive the car within 1 foot of the Sallyport entrance. If the door does not open, the escort must use the speaker mounted on the wall next to the Sallyport entrance to request entrance. Once inside, Detention Facility staff will tiring the client to the car. When the client is inside the car and the doors are locked, the Sallyport area exit doors will open. 15. The driver /escort must determine from the Pick Up facility If the client has been searched and encourage staff to conduct a search prior to transport. If the client is not searched prior to transport, the driver must communicate this Information to the Duty Staff Member prior to opening the client door at the Designation point. 17. Driver /escort MUST respond to the pick up point within a maximum time -frame of 1 hour and 15-m inutes. C. Reimbursement related rules 1. All cancelled and otherwise diverted trips will be reported on the Transportation c Record and Payment Authorization Sheet. U 2. Transportation Record and Payment Authorization Sheets and a Statement of w services rendered will be faxed to the IP Unit Coordinator on the first and sixteenth a of each month. 3. GICC does not reimburse Elanjess for cancelled trips. Compensation to the m drivers /escorts for cancelled trips is at the discretion of Elanjess, co 4. If the driver arrives without the original Baker or Marchman Act paperwork, Elanjess will obtain the paper work without charge to the GICC. U- D. Other 1. Drivers must wear their Elanjess issued ID badge at all times I acknowledge I have received and read the above BAIMA Transportation Protocol. Driver /Escort Signature Printed Name Date Rvs{i/Ifii7 9.2016 -3 - Packet Pg. 928 F. I I &TQ M E I LTA I WL w GUIDANCE/CARE CENTER 3000 41 ST. Ocean Marathon, FL 33050 Voice 305-434-7660 • Fax 305-434-9040 TRANSPORTATION RECORD AND PAYMENT AUTHORIZATION SHEET Transportation Type: ❑ Baker Act ❑ Marchman Act Date: Client Name DOB- 0 Time Called: Time of Pick Up: Time of Drop Off: Time van returned to Duty: E E Vehicle: KW vehicle Mar vehicle 0 0 Place of Pick Up (Where did you pick up the Client: Facility Name/City) Co Authorized Staff Signature at Pick Up Facility: Time: U_ Destination: [Where did you take the Client: Facility Name/City) Authorized Staff Signature at Designation Facility: Time: (Staff member accepting client) Driver Name: Escort Name: Beginning Miles: Pick Up Miles: Drop Off Miles: Ending Miles: E ----------------------- ------- 1 FOR G/CC USE ONLY- Amount to be paid: Unit Director Signature: ------------------------ ----------------------------------------------- ------------------------------------------------------------------------------- -------- ......... ftestca re - I o c ali F i lesXF L- GCOG Iob al S h a re%Tra ns p orl atio n\Bake r Act\ 16-17 ela njessN 16-17 Attachment 2 - a u [h she et -do c Packet P9. 97297] RVS00912 C.22.a Attachment 3 Statement Date: Eianjess LLC 84014th Street Key West, Florida 33640 Inpatient Unit Coordinator Guidance /Care Center 3000 41 st St. Ocean Marathon, FL 33054 Re: Baker Act and Marchman Act transportation Thefollowi ng is a break down for trips from to Date Name Pick Up Cast Vehicle Designation 1 ? 3 7 TOTAL Elan}ess LLC Representative Signature GICC Finance Director or Designee Signature co r LL tlwestcare .tocallFilesTL- GCCi0iatrat 5harelTransportationMaker A016 -17 eIanjessl16 -47 Attachment 3 - 6tatement for EIanj es. doc Rvsd: 16l103VWd:0914 Packet P9. 330 Attachment 4 C.22.a Vehicle Incident Kit Contents: Vehicle Incident- Protocol and Reporting Policy Vehicle Incident Report Form CO U- Vehicle Incident- Passenger /Witness Statement Forms* U Vehicle Incident Traffic Diagram M Disposable Camera 12 Pens *Number of Statement Forms Required is to equal vehicle passenger capacity plus an additional two for other witnesses. * * Drivers are responsible for Making sure this kit is complete at all times. Packet Pg. 331 C.22.a Vehicle Incident Protocol and Reporting Polic (Vehicle Incident Kit Copy) DO IMMEDIATELY: I. Immediately after the incident, examine and question persons for bodily injury and then examine vehicle for damage. 2. If there is an accident involving another vehicle or if persons involved require immediate medical attention. call 911 or 311 accordingly. 3. If involved persons do not report injury, authorities still need to be contacted and a police report re quested. If the request for police report is declined, the reason and dispatcher name and badge number need to be noted. 4. After authorities have been called, your supervisor needs to be called. DO NOT: 1. DO NOT admit fault if you are truly not at fault. 2. DO NOT leave the scene of an accident. 3. DO NOT drive the vehicle if you feel it is unsafe. 4. DO NOT drive the vehicle if you feel physically incapable of driving safely. 5. DO NOT discuss the .incident with anyone other than law enforcement authorities, your supervisors, or a claims adjuster from York CIainns Service Inc. co r GATI IF:R INFORMATION &COMI "LE - l'I I N C I D ENT R EPORT: >_ I . An incident will lie defined as any occurrence that resulted in damage to the vehicle and/or injury to any person. Damage to a vehicle will be dened as anything that resulted in the v fi property not being left in the same condition as before the incident. M 2, Locate and complete the Vehicle Incident Form, complete all the information requested M L regarding incident and parties involved and take photos of damage with camera provided. 3. All passengers and other available witnesses, if applicable, need to complete the statement m form. 4. After police report has been completed (if it was not declined), persons have been cared for a (if injury occurred), and vehicle is operational, return to the office. n S. Any and all vehicle incidents must also be reported electronically upon return to the office by attending supervisor by transferring; information from Vehicle Incident Form. The incident report will be completed online by logging into the Westcare Intranet at v hens / /sectire.w estcare.com/intra/. c? 5. An additional ernail must also be sent by the attending supervisor to the following management staff summarizing the incident and action taken; Program Director /Coordinator, E Area Director and/or Vice President, and Michael Lavin, Sr. VP of Operations. a 7. Supervisor will await further instructions by Program Director/Coordinator and/or Area Q DirectorNice President and Michael Lavin, Sr. VP of Operations. MANDATORY DRUG TEST The driver of the vehicle involved MUST immediately take a drug test upon completion of the Vehicle Incident Report Form. The driver's supervisor will provide the documents needed for the designated laboratory. Approver/ F ! Senior Mcmagemetit 712009 Packet P9. 932 C.22.a Westcare Vehicle I nci dent Report Form gage l of 3 This form is to be completed by driver immediately after a vehicle incident, when all persons involved have been checked for injury and provided medical attention (if applicable), and while all parties are still present, Basic Information: Incident Date and Time: Incident Location, Were Authorities called? Yes 1 No If no, explain why`? If yes, was a police report request granted? Yes 1 No If yes, list police report number and attending officer name: If no, list reason why it was declined? Dispatcher Name and Badge Number: Was citation issued`? Yes or No If yes, to wham: Westeare Vehicle Information CO r Year /Make/Model: LL VIM: - Plates: state: a Description of Damage: v M PIease take pictures of damage with disposable camera provided in 'Vehicle Incident Kit, C Driver Information Driver Name and Job'ritle: Driver L icense Number: State: Involved Party 1: Year /Make /Model: Role in h}cident: Description of Damage: _ Please take pictures of damage with disposable camera provided in Vehicle Incident l"Lit, insurance Company: Claims Phone: Policy # License; # Driver Name: Phone: Injured? Yes or No If'yes, explain: Passenger I Name: _ License �# _— Injured? Yes or No If yes, explain: State: State: Packet P9. 933 C.22.a Passenger 2 .Name: Injured? Yes or No If yes, explain: Passenger 3 Name: Injured? Yes or No If yes, explain: (Attach sheet ifniare passengers present) Involved Party 2 Yearimake /Model: Role in Incident: License 4 Page 2 of 3 State: State: Description of Dainage: Please take pictures of damage with disposable camcxa provided in Vehicle Incident [fit, Insurance Company: _ _ Claims Phone:_ Policy # License # — Driver Name: Phone: Injured? Yes or No If Yes, explain: _.. Passenger 1 Narue: License # Injured? Yes or No If yes, explain: - -�� -- Passenger 2 Name: _ License 4 Injured? Yes or No If yes, explain: Injured? Yes or No If yes, explain: __ (Attach sheet if more parties involved) Passengers Present in Wes_t_care Vehicle All passengers must complete a Vehicle Incident Passenger Statement Form. 1. Staff or Client Name: Injured? Yes or No If Yes, explain: 2. Staff or Client Name: Injured? Yes or No If Yes, ex plain: License # State: State: 3, Staff or Client U Name: Injured? Yes or No Q If Yes, explain: ----- -- _ —�- 4. Staff or Client Name: Injured? Yes or No If Yes, explain; _ Packet P9. 334 State: State: CO U_ C.22.a 5, Staff or CIient Name: If Yes, explain: _. G, 4(afl' of Cliciu Name; If Yes, explaiva; 7. Staff or Client Name: If Yes, explain: 8. Staff or Client Name: If Yes, explain: (Attach sheet if more passengers present} Detailed Explanation of7ncident: Injured? Yes or No Injured? Yes or No Was this a preventable incident? Yes or No Explain why or why not: I confirm the iatformation provided in this report is as accurate to my knowledge aid as thorough as possible Name: Signature: *This report nimt be sent to the attending supervisor as promptly as possible. Attending supervisor must con tplete and svbrnit an electronic inoident report via (fie Westcare lnttarnet and cmaiI intenngatinent. * *The Driver ortlae Westcnre vehicle naust take, a drug fast, as required by company policy, immediately after the vehicle incident and attending supervisor needs to know the time ofcompletion. Approved by Senior Alanagemens 712009 Injured? Yes or No Injured'? Yes or No Page 3 of 3 CO r LL Packet P9. 935 C.22.a Westcare Vehicle Incident Passenger/Witness Statement Form Name: Are you Westcare Staff, a Westcare Client, or Other`? Are you a Driver, Passenger or Dtlhcr Witness? If Othex Witness, please list Contact Information: Address: City: Phone: - -. - -- Incident Date and Time: Inciden[ Location: Westcare Vehicle Makc/ModeI: Description of Incident/Event: !ip -- I Are you injured? Yes or No If yes, please explain: _.._.. I was offered medical evaluation: Yes or No If yes, I: Accepted or Declined Signature: I certify that the above information is as accurate to my knowledge mid as thorough as possible. Signature Date This Form will be furwarded to attending supervisor to be part of the Vehicle Incidunt Report. 'l. - h ank you for your cooperation. Approved by Senior Manugenwit 712009 S L. CO r LL Packet P9. 936 C.22.a Westeare Vehicle Incident Pas%en er(WitneKy Statement Form Name: Are you Westeare Staff, a Westeare Client, or Other?, Are you a Drive, l' ISSer1gel () ()lheT WiLICS'Sr If Other Witness, please list Contact Information: Address: City: St: _Zip Phone: { Incident Date and Time: Incident Location: Westeare Vehicle Make/Model: co Description of Incident/Event: U_ Are you injured? Yes or No If yes, please explain: I was offered medical evaluation: Yes or No If yes, 1: Accepted or Declined Signature: I certify that the above information is as accurate to my knowledge and as thorough as possible. Signature Date 'Phis form will be forwarded to attending supervisor to be part of the Vehicle Incident Report. Thank you for your cooperation. Jpproved by Seneor Managenmw 712009 5. G. Packet P9. 937 C.22.a Westeare Vehicle Inelclent Passer werlWitness Statement Form Name: Are you Westcarc Staff, a Westcare Client, or Other? Are you a Driver, Passenger or Other Witness? If Other Witness, please list Contact Information: Address: City: St: ,_ -- lip Phone: — Incident Date and Time: Incident Location: Westeare Vehicle MakelModel: Description of Incident/Event: Are you .injured? Yes or No If yes, please explain: I was offered tnedical evaluation: Yes or No If yes, I: Accepted or Declined Signature: I certify that the above information is as accurate to my knowledge and as thorough as possible. co r U- N Signature Date This fonn will be forwarded to attending supervisor to be part of the Vehicle Incident Report. Thank you for your cooperation. t Approved by So for Management 712009 S L. Packet P9. 938 C.22.a Westcare Vehicle Incident Passenar /Witness Statement Form Name: Are you Westcare Staff, a Westcare Client, or Other? Are you a Driver, Passenger or Other Witness? If Other Witness, please list Contact Information: Address: City: St: Phone: (� - Incident Date and Time: Incident Location: Westcare Vehicle Make/Model: Description of Incident/Event: Are you injured? Yes or No If yes, please explain: I was offered medical evaluation: Yes or No If yes, I: Accepted or Declined Signature: I certify that the above information is as accurate to my knowledge and as thorough its possible Signature Date This form will be Forwarded to attending supervisor to be pail of the Vehicle Incident Report. Thank you for your cooperation. 'Lip co LL Approved by Senior Management 712009 SL Packet P9. 939 Additional Sheet for More Taf6imation CO LL Approved by Senior Mrinugement 7120OS; 1 9 , I Packet P9. 940 C.22.a Traffic Diagrams tntersectian Highway /Street 3 3 �4 N W#t!t s co r U- ��'� Packet Pg. 941 C.22.a Attachment 5 GUIDANCEICARE CENTER, INC. 300041 ST STREET, OCEAN !MARATHON, FL 33050 (v) 3051434 - 13000 7'660 1(f) 3051434 -9040 I acknowledge I have completed DE-ESCALATION TRAINING http: / /www.bing. com /videos/ search?g =De+ Escalation+ Training +Video& &view= detait &mid =AC9 FB1689A985EE5E794AC9FB1689A985EE5E794 &FOR[M= VROGAR Driver /Escort Signature Printed Name Date co r LL Packet Pg. 942 C.22.a ATTACHMENT E PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work., may not submit bids on leases of real property to public entity, may not be awarded or perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." I have read the above and state that neither h Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the laonths. I - 1 ( ignature) Date: 4 I STATE OF: �06� COUNTY OF: l I tww— CRA Subscribed and sworn to or affirmed) before me on t7�x� 41 2+" -7 (date) by (name of affiant). Sh is personally known a or has produced (type of identification) as identification. mt, a Q-,A� NOTARY PUBLIC My Commission Expires: CAROL A. f7QCD Notary PublIC - Stat My Comm. Expires J Commission 8 FF co LL Guidance Care Centar— Transpottation: Baker Act and CTD FY18; page 15 Packet Pg. 943 C.22.a ATTACHMENT F SWORN STATEMENT UNDER ORDINANCE NO. 0 10- 1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE G� L d c, cc— C C4 Gf 1 V�- t (Company) "...warrants that he /it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 0 10- 199 0 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." V V I (Signature) Date: i A Lj is STATE OF: _ COUNTY OF: ff Wo -b Subscribed and sworn to (or affirmed) before me on Pa. GV (date) by n! (name of affiant). He4 k me o r has produced identification) as identification. CAROL A. OOCHOW f r" Notary Pub% - State of Florlda My Comm. Exp lies Jun 7. 2018 Cumrnlssio,t # FF 104258 (type of NOTARY PUBLIC My Commission Expires: co r U- Guidance Care Canter — Transportation: Baker Act and CTS FY16; page 16 Packet Pg. 944 C.22.a ATTACHMENT G DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: (Name of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business` policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. (Signature) Date: !/ STATE OF: r-nd.a COUNTY OF: MO 6& Subscribed and sw o f or affirmed) before me fi ll ra j, or has produced identification. (name on 1w - 4- P] -� (date) by of affiant }. Hel h is personally known tom ty t e ntification} as Lbk� NOTARY PUBLIC My Commission Expires: co U_ Guidance Care Center — Transportation: Baker Act and CTS FY 18; page 17 Packet Pg- 945 " ` Y' ' CAROB_ A. I]OCHOW Notary Public State Florida - of My Comm. Expires .tun 1, 2018 Commisslon # FF 104258 (name on 1w - 4- P] -� (date) by of affiant }. Hel h is personally known tom ty t e ntification} as Lbk� NOTARY PUBLIC My Commission Expires: co U_ Guidance Care Center — Transportation: Baker Act and CTS FY 18; page 17 Packet Pg- 945 ATTACHMENT H 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. Services Target Po ulation # of persons in target population Total # of clients 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? I Guidance Care Center — Transportation: BakerAct and CTD FY18, page 18 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.) Guidance Care Center — Transportation: BakerAct and CTD FY18, page 19