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FY2018 12/13/2017C ,-, Kevin Madok, CPA Clerk of the Circuit Court & Comptroller — Monroe County, Florida DATE: December 26, 2017 TO: Janet Herbener Senior Grant & Finance Analyst FROM: Pamela G. Hancock, D.C. SUBJECT: December 13' BOCC Meetings Attached are electronic copies of the following the following items for your handling: C18 Amendment to an Agreement with Guidance /Care Center to extend the Fiscal Year 2017 Residential Substance Abuse Grant Agreement period through December 31, 2017. C21 Amendments to Agreements with Guidance /Care Center to extend the grant period for the Fiscal Year 2017 FDLE Byrne /JAG grants, Women's Jail program & Heron program, through December 31, 2017. C22 Agreement with Guidance /Care Center for the Community Transportation for Disadvantaged (CDT) program in the amount of $38,685.00 and Baker Act Transportation service program in the amount of $160,000.00 for Fiscal Year 2018. Should you have any questions, please feel free to contact me at ext. 3550. Thank you. cc: County Attorney Finance File KEY WEST 500 Whitehead Street Key West, Florida 33040 305 - 294 -4641 MARATHON 3117 Overseas Highway Marathon, Florida 33050 305 - 289 -6027 PLANTATION KEY 88820 Overseas Highway Plantation Key, Florida 33070 305 - 852 -7145 PK/ROTH BUILDING 50 High Point Road Plantation Key, Florida 33070 305 - 852 -7145 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 /Ca.re 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. 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: Baker Act 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 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: Baker Act 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 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 grant funding from the County: a. The CPA that prepares the audit must also be a member of the American Institute of Certified Public Accountants (AICPA); 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; (i) Specific description or list of services to be provided under this contract with this grant (see Attachment C); (j) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services provided, a profile of clients (including residency) and numbers served, and outcomes achieved (see Attachment H); (k) Cooperation with County monitoring visits that the County may request during the contract 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 contract year. 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. 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: Baker Act 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 Can: Center — Transportation: Baker Act 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 extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 25. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug - Free Workplace Statement. 26. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 27. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from ,any and all claims 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 Can: 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 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] Guidance Care Center — Transportation: Baker Act and CTD FY18; page 8 =.' o-II e c r. '�, o ATTEST: y .. 3 WHEREOF, the parties hereto have caused these presents to be executed as r first written above. OK, CLERK r Witif6ss BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA B a e a M r /Chairman GUIDANCE /CARECENTER (Federal ID No. 5Q 1 q5 - &3 By Wt)_ ' � Director Guidance /Care Center __j :Z� r -. - r n C - ) 177 . - 'C M;V N C - 3 = rn C> C-) -- - p,` "`� a. . - Dpi• MONROE COUNTY ATTORNEY AP ROVED AS TO FgPM / I _n `n rn C") G C YNTHIA L. HALL ASSISTANT COUNTY ATTORNEY Date i Guidance Care Center - Transportation: Baker Act and CTD FY18; page 9 ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community -Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will, be monitored in accordance with the level of detail in the contract. This document should not be considered all- inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305 - 292 -3534. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter - company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, and support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc. A log of all postage expenses as they relate to the County contract is required for reimbursement. For overnight or express deliveries, the vendor invoice must be included. Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. Reproductions, Copies, etc. A log of copy expenses as they relate to the County contract is required for reimbursement. The log must define the date, number of copies made, source document, purpose, and recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. 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 trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must be registered and paid for by traveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a residence or office to a point of departure. For example, driving from one's home to the airport for a business trip is not a reimbursable expense.. Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement. Non - allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non - sufficient check charges, penalties and fines. 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,XXX.XX 102 Company B Utilities XXX.XX 104 Employee A P/R ending 05/14/01 XXX.XX 105 Employee B P/R ending 05/28/01 XXX.XX (A) Total X.XXX.XX (B) Total prior payments $ X,XXX.XX (C) Total requested and paid (A + B) $ X,XXX.XX (D) Total contract amount $ X,XXX.XX Balance of contract (D -C) X.XXX.XX I certify that the above checks have been submitted to the vendors as noted and that the expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. Executive Director Attachments (supporting documentation) Sworn to and subscribed before me this day of 20_ by who is personally known to me. Notary Public Notary Stamp Guidance Care Center — Transportation: Baker Act and CTD FY18; page 12 ATTACHMENT C Services to be provided: Baker Act /Marchman Act transportation services and Community Transportation Coordinator related services. Guidance Can: Center — Transportation: Baker Act and CTD FY18; page 13 ATTACHMENT D Copy of the Sub - Contract for Baker Act transportation services. See attached. Guidance Care Center — Transportation: Baker Act and CTD FY18; page 14 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 D W 11 41/ (Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 Vnonths. ( ignatur / e) / O Date: i l STATE OF: W6 COUNTY OF: rntmrw Subscribed and sworn to or affirmed) before me on b "l (date) by Y `�U (name of affiant). H Sh is personally,, known me or has produced (type of identification) as identification. a NOTARY PUBLIC My Commission Expire ;`- CAROL A. DOCHOW Notary Public - State of Florida `itr o�c My Comm. Expires Jun 7, 2018 Commission # FF 104268 Guidance Care Center — Transportation: Baker Act and CTD FY18; page 15 ATTACHMENT F SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE C�vi d c� -rlc�- Ict4e- Ctl___Vkr I A- c „ (Company) "...warrants that he /it has not employed, retained or otherwise had act on his /her behalf any former County officer or employee in violation of Section 2 of Ordinance No_ 010 -1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010 -1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee." �D I ( Signatur Date: l STATE OF: �"Ull IQ COUNTY OF: M ►r _& Subscribed and sworn to (or affirmed) before me on Pm - 4 UJ (date) by u�i.�ii 1 ' UC/� (name of affiant). He� per song known to me or has produced identification) as identification. (type of a CAROL A. DOCHOW Notary Public - State of Florida My Comm. Expires Jun 7 2018 NOTARY PUBLIC Commission # FF 104268 My Commission Expires: Guidance Care Center — Transportation: Baker Act and CTD FY18; page 16 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. 1� (Signature) Date: !/ STATE OF: r� w � dA COUNTY OF:Y Subsc ibed ands rn o (or affirmed) before me on • -+ �� (date) by �LU) (name of affiant). Hei h is personally known tom, or has produced ty [d ent ication) as identification. % F S M CAROL A. DOCH OW : Notary Public _ State of Florida My Comm. Expires Jun 7, 2018 Commission # FF 104268 f• NOTARY PUBLIC My Commission Expires: Guidance Care Center — Transportation: BakerAct and CTD FY18; page 17 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: 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? Guidance Care Center — Transportation: BakerAct and CTD FY18, page 18 1. Please list services and client information below for the program /activities funded by the Monroe County award. 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 Can; Center — Transportation: Baker Act and CTD FY18; page 19 f :ter -�► W EST CA RE VENDOR SERVICE AGREEMENT THIS VENDOR SERVICE AGREEMENT (the "Agreement's is effective as of this 1 day of October, 2017 ( "Effective Date ") between Guidance/ Care Center, Inc., a Florida 501c3 not - for- profit corporation ( "WestCare ") and Elanjess, LLC, a limited liability 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 30, 2018 ( "Tenn "). 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- breaching Party may terminate this Agreement upon not less than five (5) Days prior written notice and retain its right to all damages caused by the breach (unless otherwise provided herein) and subsequent termination. Upon expiration or teinination of this agreement, neither patty shall have any further obligation hereunder except for (i) obligations due and owing which arose prior to the date of termination, and (ii) Obligations, promises or covenants contained herein which expressly extend beyond the tein of this agreement. 3. Performance Standards. Vendor shall comply with all applicable laws, c o d e s, 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 lmance 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 ('Tee 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 WC VSA Page I of 7 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. 6. 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 MOU. 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. Additionally, the Patties agree to abide by all State and Federal laws, rules and regulations, HIPAA and 42 C.F.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 the 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 and all losses, expenses, costs, liabilities, damages, claims, suits and demands (including 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, representatives, sub- contractors and agents). 8. Insurance. Vendor shall be solely responsible, at 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 governmental 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 1ty of the other Party. WestCare and 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 VSA Page 2 of 7 11. 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 41S 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 If to Vendor: Elanjess, LLC Attn: Lee Connell 800 14 Street Key West, FL 33040 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 inseled 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 VSA Page 3 of 7 (e) 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 goveinnental 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 j urisdiction 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 are acting as independent contractors and independent employers. Nothing contained in this Agreement shall create or be construed as creating a partnership, joint venture or agency relationship between 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 including 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 shall perfOlm all of the Services under this Agreement in compliance with all applicable federal, state and local laws, ordinances, rules, regulations, codes or orders. (1) 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 VSA Pege 4 of 7 (m) 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. (n) 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) WC VSA Page 5 of7 IN WITNESS WHEREOF, the Parties, by their duly authorized representatives, have executed. this Sw&e Agreement as of le Effwdve Day noted above. "WestCaw GUIDANCE/ CARE CENTER, INC. a Florida SOW not - for -profit corporation BY: Name: Sharon Crippen Its: Senior Vice President Dater ,2017 HVendor" ELANASS LLC, a limited liability company f3. - d its: 1ri« tOeec A>m. r Date: 414re "BeXi X0 ,2017 %%'C vsA POge 6 or7 Services (See Attached) WC VSA Page 7 of7 i f• G /CCwill supply Elan' esswith two _Ford Crown Victoria vehicle: Maintenance specifications; one to be stationed in Key West at an Elanjess location and the other in Marathon at G /CC headquarters. G /CC will pay-for the fuel and maintenance of the two vehicles used for Baker Act and Marchman Act transportation. Elanjesswill coordinate.the maintenance forthe Crown Victoria located in t Key West. Invoices for routine maintenance (labor and parts) on the Crown Victoria will be forwarded quarterly to G /CC'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 G /CC Transportation Coordinator to initiate major vehicle repairs. G /CC will. coordinate the maintenance for the Crown Victoria located in Marathon. G /CC will maintain insurance on both of the vehicles. Elanjess will also be named as an "additional insured" for these two cars. All Elanjess drivers operating G /CC vehicles will hold a minimum of a Class E Florida Drivers License and be approved for G /CC insurance coverage by the Transportation Coordinator. Upon execution of this agreement, Elanjess will fax/email to G /CC's Transportation Coordinator a current list of drivers - including a copy of the driver's license and social security number for each driver - for approval to operate G /CC vehicles. Prior to adding a driver, Elanjess will fax or email to G /CC's Transportation Coordinator or designee a copy of the driver's license, social security number and signed "Request for Check of Driving Record" form of the person. G /CC will initiate procedures to add the driver to G /CC vehicle insurance.Elanjess cannot use the driver for BAIMA transports until t has received written notification that the driver has been added to the G /CC insurance coverage. Ford (White) VIN Donation from 2007 Crown Victoria 2FAFP71W97W134976 4- door -ca a MCSO BA4 KW_BakerAct Ford VIN Donation from 2006 , Crown Victoria . FAFP71WX6X128148 4- diir-cage MCSO BA5 MA_BakerAct Maintenance specifications; one to be stationed in Key West at an Elanjess location and the other in Marathon at G /CC headquarters. G /CC will pay-for the fuel and maintenance of the two vehicles used for Baker Act and Marchman Act transportation. Elanjesswill coordinate.the maintenance forthe Crown Victoria located in t Key West. Invoices for routine maintenance (labor and parts) on the Crown Victoria will be forwarded quarterly to G /CC'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 G /CC Transportation Coordinator to initiate major vehicle repairs. G /CC will. coordinate the maintenance for the Crown Victoria located in Marathon. G /CC will maintain insurance on both of the vehicles. Elanjess will also be named as an "additional insured" for these two cars. All Elanjess drivers operating G /CC vehicles will hold a minimum of a Class E Florida Drivers License and be approved for G /CC insurance coverage by the Transportation Coordinator. Upon execution of this agreement, Elanjess will fax/email to G /CC's Transportation Coordinator a current list of drivers - including a copy of the driver's license and social security number for each driver - for approval to operate G /CC vehicles. Prior to adding a driver, Elanjess will fax or email to G /CC's Transportation Coordinator or designee a copy of the driver's license, social security number and signed "Request for Check of Driving Record" form of the person. G /CC will initiate procedures to add the driver to G /CC vehicle insurance.Elanjess cannot use the driver for BAIMA transports until t has received written notification that the driver has been added to the G /CC insurance coverage. 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 G /CC'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 G /CC. All BA/MA approved drivers must read and sign the acknowledgement of reading and receiving (Attachment 1) Transportation Protocol. Elanjess will report and document accidents involving G /CC vehicles and incidents involving clients to the proper authorities and immediately thereafter contact G /CC. 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 30 days of approval to drive. GCC will provide details for accessing the training which will be available online. 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. 1 ne Touowmg Tee siruciure is es>:agn TorTne penoo oTine agreement: Estimated Elanjess # Roundtrips* Client Pickuo Point Client Drop-off Point Pavment Key West Key West $115 Marathon Marathon $115 450 Key West iviarainon ;14a Marathon Key West $145 Marathon Key Largo $145 Kev Larao Marathon $145 40 Marathon Miami -Dade County $385 Kev Larao Miami -Dade County $385 40 Kev West Miami -Dade County $385 GCC Preauthorization Required for All Trips Below *Approvalfor belowfeeswill be granted onlywhen the Marathon BA/MAvehicle isengaged v tdnetbdrBA/ I0Artriothatwo( O. d& glpfta> potherpickupwithina io tlfevs # Roundtrips Location Point I Client DePoo -off Point Payment 5 Key West Marathon & North Marathon $145 5 Marathon Key West Marathon $145 2 Key West Marathon & North Key Cargo $225 3 Key West Marathon & North Miami -Dade Countv $385 Rvl; Wrvwd. M rl 0916 -2- G /CC Preauthorization Required forAll Trips Below Estimated Elanjess # Roundtrips" Client Pickup Point Client Dro12 -off Point Payment Key Largo Avon Park (Area) $770 1 Marathon Avon Park (Area) $770 Key West Avon Park (Area) $770 Key Largo Up -State (McClennyArea) $1,200 1 Marathon Up -State (McClenny Area) $1,200 Key West Up -State (McClennyArea) $1,200 Timely payment for services rendered is ensured by adherence to the following invoicing procedures: Elanjess will submit one statements /invoice per month, within 5 business days after the end of the billing period. Elanjess will include required documentation with each statement invoice. Elanjess statements /invoices for BA/MA trips will be submitted to.the attention of G /CC Inpatient Unit Coordinator. • G /CC's Inpatient Unit Coordinator will review statement/ nvoice, mediate any discrepancies with Elanjess, and forward approved invoice to G /CC Finance Department. Elanjess will submit vehicle maintenance bills for the KW car quarterly to the Transportation Coordinator • G /CC will mail payment to Elanjess within 14working days (Finance Department) upon receipt of statement invoice by the Inpatient Unit Coordinator. Attachments: 1. G /CC Transportation Protocol 2. G /CC Transportation Record and Payment Authorization Sheet 3. Statement 4. Vehicle Incident Kit 5. De- escalation attestation ATTACHMENT 1 GUIDANCE /CARE CENTER TRANSPORTATION PROTOCOL: THE TRANSPORTATION OF BAKER ACTAND MARCHMAN 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 personal 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 one escort. 6. A client must be observed for any unusual behaviors including hurting self /others or sudden medical conditions. Respond to a medical emergency by calling 911. 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 paperwork from the Pick Up facility. If the original paper work is not available the driver must immediately report this information to the G /CC Nurse on Duty for further instructions. 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 Baker Act 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. 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, it 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. Coordination of Transportation Rules: 1. Transportation arrangements for BakerAct and Marchman Act clients are under the direction of the Unit Nurse on Duty G /CC per contractual arrangement Elanjess LLC. No other agency is authorized to contact Elanjess directly for transportation. 2. Final decision for a driver to transport is made by the nurse on duty. The nurse may request a BAL be conducted or send a drivers escort home if he /she has a concern. 3. "A driver shall not be permitted or required to drive more than 12 hours in any one 24 -hour period, or drive after having been on duty for 16 hours in any one 24 -hour period. " 4. All trips will be made within the approved fee structure. 5. 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 G /CC. 6. Clients may be picked up at only approved locations. The G /CC Nurse on Duty will communicate the pick -up location. Approved. locations will include: Hospitals, Detention Facility Mental Health Clinics, Anchor Away With a G /CC staff member Or otherwise authorized by the G /CC IP Unit Coordinator 7. Depoo Hospital : Pick -up / 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 I drop -off is at the ER entrance. Upon arrival, call 305 - 294 -5531 x3202. Hospital staff will escort the client to /from the building. 9. At G /CC: 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 Sheriffs department to transport the client 13. If a client absconds at time of or during transport, immediately report the information to the G1CC 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 Rvsd /lfin 9.2016 -2- 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 bring the client to the car. When the client is inside the car and the doors are locked, the Sallyport area exit doors will open. 16. 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. f 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 Record and Payment Authorization Sheet. 2. Transportation Record and Payment Authorization Sheets and a Statement of services rendered will be faxed to the IP Unit Coordinator on the first and sixteenth of each month. 3. G /CC does not reimburse Elanjess for cancelled trips. Compensation to the drivers /escorts for cancelled trips is at the discretion of Elanjess. 4. If the driver arrives without the original Baker or Marchman Act paperwork, Elanjess will obtain the paper work without charge to the G /CC. D. Other 1. Drivers must wear their Elanjess issued ID badge at all times I acknowledge I have received and read the above BA/MA Transportation Protocol.. Driver /Escort Signature Printed Name Date Rvsd /lfm 9.2016 -3- z , i ATTACHMENT2 GUIDANCE /CARE CENTER 3000 41 ST. Ocean Marathon, Fi. 33050 Voice 305. 434 -7660 • Fax 305 -434 -9040 Date: ❑ Baker Act ❑ Marchman Act Client Name: DOB.: Time Called! Time of Pick Up: Time of Drop Off: Time van returned to Duty: Vehicle: KW vehicle Mar vehicle Place of Pick Up: (Where did you pick up the Client: Facility Name /City) Authorized Staff Sig_ nature at Pick Up Facility: Time 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: Transportation Type: TRANSPORTATION RECORD AND PAYMENT AUTHORIZATION SHEET Pick Up Miles: Beginning Miles: Drop :Off .Miles: FOR G /CC USE ONLY: Amount to be paid: Unit Director Signature: Ending Miles: \ \westcare.local\Flles \FL -GCC \Global Share\ Transportation \BakerAct \10- 17elanjess \78-17 Attachment 2- aulhshest.doc RVSD0912 Attachment 3 Statement Dater Elanjess LLC 80014th Street Key West, Florida 33040 Inpatient Unit Coordinator Guidance /Care Center 3000 41 st St. Ocean Marathon, FL 33050 Re: Baker Act and Marchman Act transportation The following is a breakdown for trips from to De . ® © ®® Elanjess LLC Representative Signature G /CC Finance Director or Designee Signature llwestcare.locallFiiesTL- GCC%Global SharelTransportationlBakerAct116 47eianjess17647 Attachment 3-Statement for Elanjes.doc Rvsd:10 /101VWd:0914 Attachment 4 i r Vehicle Incident Kit Contents: Vehicle Incident- Protocol and Reporting Policy Vehicle Incident Report Form Vehicle Incident- Passenger /Witness Statement Forms* Vehicle Incident Traffic Diagram 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. Vehicle Incident Protocol and Reportin P�v_ (Vehicle Incident Kit Copy) DO.IMMEDIATELY: 1. 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 le quested. If the request for p olice 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: I. DO NOT admit fault ifyou 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 ifyou feel physically incapable of driving safely. S. DO NOT discuss the .incident with anyone other than law enforcement authorities, your supervisors, or a claims adjuster from York Claims Service Inc. GATHER INFORMATION & COMPLETE INCIDENT R EPORT: 1. An incident will be defined as any occurrence that resulted in damage to the vehicle and/or injury to any person. Damage to a vehicle will be defined as anything that resulted in the property not being left in the same condition as before the incident. 2. Locate and complete the Vehicle Incident Form, complete all the information requested 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 form. 4. After police report has been completed (if it was not declined), persons have been cared for (if injury occurred), and vehicle is operational, return to the office. 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 btMs .: / /secure.w estcare.com/intra/. 6. An additional email must also be sent by the attending supervisor to the following management staff summarizing the incident and action taken; Program Director /Coordinator, Area Director and /or Vice President, and Michael Lavin, Sr. VP of Operations. 7. Supervisor will await further instructions by Program Director /Coordinator and/or Area Director/Vice 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. Approved 1 I Senior Management 72009 Pagel of 3 Westeare Vehicle'Incident Report Form 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 / No If no; explain why? If yes, was a police report request granted? Yes / 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 whom; Westeare Vehicle Information Year/Make/Model: VIM. State: Description of Damage: Please take pictures of damage with disposable camera provided in Vehicle Incident Kit. Driver Information Driver Name and Job 'Title: Driver License Number: State: ]involved Party 1: Year/Make/Model: Role in Incident: Description of Damage: - Please take pictures of damage with disposable camera provided in Vehicle Incident Kit. Insurance Company: Claims Phone; Policy # License # State: Driver Name: Phone: Injured? Yes or No If yes, explain: Passenger 1 Name: License #. State: Injured? Yes or No If yes, explain: Page 2 of 3 Passenger 2 Name: License # State: Injured? Yes or No If yes, explain: Passenger 3 Name: License # State: Injured? Yes or No If yes, explain: (Attach sheet if more passengers present) Involved Party 2• YearlMakelModel: Role in Incident: Description of Damage: Please take pictures of damage with disposable camera provided in Vehicle Incident Kit. Insurance Company: CIaims Phone: All passengers must complete a Vehicle Incident Passenger Statement Form. Policy # License # State: Driver Name: Phone: Injured? Yes or No If Yes, explain: I Name: Passenger 1 Name. License # State: Injured? Yes or No If yes, explain: Name: Injured? Yes or No If Yes, explain: Passenger 2 Name: License # State: Injured? Yes or No If yes, explain: Injured? Yes or No If. Yes, explain: Passenger 3 Name: — License # State: Injured? Yes or No If yes, explain: _ (Attach sheet if more parties involved) Passengers Present in West 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 I Name: Injured? Yes or No j If Yes, explain: 3. Stag or Client Name: Injured? Yes or No If Yes, explain: 4. Staff or Client Name: Injured? Yes or No If. Yes, explain: i i Detailed U xnlanation of Incident Was this a preventable incident? Yes or No Explain why or why not: I confirm the information provided in this report is as accurate to my knowledge and as thorough as possible, Name: Signature• *This report must be sent to the attending supervisor as promptly as possible. Attending supervisor must complete and submit an electronic incident report via the Westcare Intranet and email management. * *The Driver of the Westoare vehicle must lake a dreg test, as required by company policy, immediately after the vehicle incident and attending supervisor needs to know the time of completion. Approved by Senior Management 712009 Page 3 of 3 S, Staff or Client Name: Injured? Yes or No f If Yes, expo' 6. Staff or Client Name: Injured? Yes or No If Yes, explain: 7. Staff or Client i Name: Injured? Yes or No If Yes, explain: 8. Staff or Client Name: Injured? Yes or No _ i� If Yes, explain: (Attach sheet if more passengers present) Detailed U xnlanation of Incident Was this a preventable incident? Yes or No Explain why or why not: I confirm the information provided in this report is as accurate to my knowledge and as thorough as possible, Name: Signature• *This report must be sent to the attending supervisor as promptly as possible. Attending supervisor must complete and submit an electronic incident report via the Westcare Intranet and email management. * *The Driver of the Westoare vehicle must lake a dreg test, as required by company policy, immediately after the vehicle incident and attending supervisor needs to know the time of completion. Approved by Senior Management 712009 Westeare Vehicle Incident Passenger/Witness Statement Form Name, Are you Westeare Staff, a Westeare Client, or Other? Are you a Driver, Passenger or Other Witness? If Other Witness, please list Contact Information: Address: City St: Zip Phone: (' ) - incident Date and Time: Incident Location: Westcare Vehicle Make/ModeI: 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 as possible. Signature llate This form will be forwarded to attending supervisor to be part of the Vehicle incident Report. Ihank you for your cooperation. Approved by Senlor Management 712009 SL Westeare Vehicle.Incident Passenge /Witness Form Nance: Are you Westcare Staff, a Westeare 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: Westeare Vehicle Make/Model: Zip 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 eer* that the above information is as accurate to my knowledge and as thorough as possible. Signature - Date This form will be'forwarded to attending supervisor to be part of the Vehicle IncidentRepork Thank you for your cooperation. Approved by Senior Management 712009 S L. Westeare Vehicle Incident Passenaec/Witness.Statement Form Name:_ Are you Westoare Staff, a Westcare Client, or Other? Are you a Driver, Passenger or Other Witness? If Other Witness, please list Contact Information: Address: City: St: Zip 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, 1: Accepted or Declined Signature: I certify that the above information is as accurate to my knowledge and as thorough as possible. Signature Date This form will be forwarded to attending supervisor to be part of the Vehicle Incident Report. Thank you for your cooperation. �r Approved. by Senior Management 712009 S. L. �i r. Westcare Vehicle incident Passenger /Witaess;Statement'rorin I 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: zip Phone; Incident Date and Time: Incident Location: Westcare Vehicle Makelmodel: Description of Incident/Event: Are you injured? Yes or No If yes, please explain: I was offered medical evaluation: Yes or No I: If yes,. I: Accepted or Declined Signature: I certify that the above information is as accurate to my knowledge and as thorough as possible. Signature Date This form will be forwarded to attending supervisor to be part of the Vehicle Incident Report. Thank you for your cooperation. f; Approved by Senior Management 712009 S L. Additional Sheet for More Infonnation I I i. Approved by Senior Management 7/2009 a: 0 Cs I-3 d rQ Attachment 5 GUIDANCE/CARE CENTER, INC. 3000 41ST STREET, OCEAN MARATHON, FL 33050 (v) 305/434 -9900 - 7660 / (i 3051434 -9040 I acknowledge I have completed DE-ESCALATION TRAINING http: / /www. bind. com/ videos / search ?a =De +Escalation +Training +Video& &view = detail &mid =AC9 FB 1689A985EE5E794AC9FB1689A985EE5E794 &FORM = VRDGAR Driver /Escort Signature Date Printed Name