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Item C14M C ounty of f Monroe ELj » °o � BOARD OF COUNTY COMMISSIONERS /� � Mayor David Rice, District 4 Th e Florida Keys Mayor Pro Tem Sylvia J. Murphy, District 5 Danny L. Kolhage, District 1 George Neugent, District 2 Heather Carruthers, District 3 County Commission Meeting January 17, 2018 Agenda Item Number: C.14 Agenda Item Summary #3729 BULK ITEM: Yes DEPARTMENT: Budget and Finance TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292 -4482 No AGENDA ITEM WORDING: Approval of FY18 Clerk's Drug Abuse Trust Fund agreements, totaling $58,696. Agreements are with Florida Keys Children's Shelter ($15,110), Key Bridge ($6,500) and Samuel's House ($37,086) for Substance Abuse Treatment and Prevention programs. The Substance Abuse Policy Advisory Board ( SAPAB) recommended the programs to be funded by the Clerk's Drug Abuse Trust Fund. ITEM BACKGROUND: The Substance Abuse Policy Advisory Board ( SAPAB) met on November 27, 2017 to discuss the distribution of the Florida Department of Law Enforcement Byrne Memorial JAG funds and the Clerk's Drug Abuse Trust Fund based upon applications received. The following recommendations were made by the SAPAB in regards to the Drug Abuse Trust Fund: Florida Keys Children's Shelter - $15,110; Key Bridge - $6,500, and Samuel's House - $37,086. PREVIOUS RELEVANT BOCC ACTION: For FY17 the BOCC approved the allocation of $45,000 from the Clerk's Drug Abuse Trust Fund. For FYI the SAPAB recommended an allocation of $58,696 in funding. CONTRACT /AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval DOCUMENTATION: Samuel's House _ FYI 8 DATF Agreement Children's Shelter_ FYI 8 DATF Agreement Contract -Key Bridge CDATF FY18 FINANCIAL IMPACT: Effective Date: 10/01/2017 Expiration Date: 09/30/2018 Total Dollar Value of Contract: $15,110 (FKCS); $6,500 (Key Bridge); $37,086 (Samuel's House) Total Cost to County: $58,696 = $15,110, $6,500, $37,086 Current Year Portion: $58,696 Budgeted: Yes Source of Funds: 164 — Clerk's Drug Abuse Trust Fund CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: No Grant: No County Match: No Insurance Required: No Additional Details: N/A If yes, amount: N/A 01/17/18 164 -04569 -DRUG ABUSE TRUST $37,086.00 Samuel's House 01/17/18 164 -04569 -DRUG ABUSE TRUST $15,110.00 Florida Keys Children's Shelter 01/17/18 164 -04569 -DRUG ABUSE TRUST $6,500.00 Key Bridge Total: $58,696.00 REVIEWED BY: Tina Boan Skipped 12/22/2017 10:08 AM Christine Limbert Skipped 12/29/2017 4:22 PM Cynthia Hall Completed 12/31/2017 10:34 AM Maria Slavik Completed 01/02/2018 7:27 AM Kathy Peters Completed 01/02/2018 9:14 AM Board of County Commissioners Pending 01/17/2018 9:00 AM &AGREEMENT This Agreement is made and entered into this 17 day of January, 2018, between the BOARD OF COUNTY COMMISSIONERS OF MONK COUNTY, FLORIDA, hereinafter referred to as 'Board" or 'County," and Samuel's House, Inc., hereinafter referred to as "PROVIDER." WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of women and children's housing and support services, and WHEREAS, it is a legitimate public purpose to provide substance abuse treatment and relapse prevention and education activities, now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: DA Tr Contrast Samuel's House FY18; Page I I RECORDKEEPING DA TF Contract Samuels flouse FYI 8; Page 12 (k) Cooperation with County monitorling visits that the County may request during the contract year; and (1) Other reasonable reports and information related to compliance with applicable laws, contract provision s and the scope of services that the County may request during the contract year. 16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and/or federal certification and/or licensure of the PROVIDER'S program and staff. AMENDMENTS, CHANGES, AND DISPUTES 18. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the COUNTY. DATF Contract. Samuel's House FPS; Page[ 4 21® 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 per and receive benefits as recited in this Agreement. ® 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. 24. ATTESTATION& 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, 25. 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 28. 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. DA TF Contract: Samuel's House FY18; Page 15 31. 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. ® NOTICE. Any notice required or permitted under this agreement shall be in writing and hand-delivered or mailed, postage pre-paid, by certified mail, return receipt requested, to the other party as follows: For Board Grants Administrator and Monroe County Attorney 1100 Simonton Street PO Box 1026 Key West, FL 33040 Key West, FL 33041 330 GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding, DA TF Contract. Samuels House FYI 8; Page 16 ® 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. 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] DA TF Contract: Samuel's House FY18; Page 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above, (SEAL) ATTEST: KEVIN MAD OK, CLERK E BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA M Mayor/Chairman Samuel's House, Inc (Federal ID No�::—: ---------- I-,......- ------------ By Executive Director DA TE Contract: Samuel's House MY Page j 8 ATTACHMENT A Expense Reimbursement Requirements This document is intended to provide basic guidelines to Human Service and Community- Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: 'I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement. Only current charges will be considered, no previous balances. Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all-inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305-292-3534. Data Processing, PC Time, etc® The vendor invoice is required for reimbursement. Inter-company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed, if a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, support for applicable paid payroll taxes. Postage, Overnight Deliveries, Courier, etc® A Ion of all postage expenses as: they relate to the County contract Is required for reimbursement For ;vernigkt or express deliveries, the vendor invoice M ' Ust be inclosed, Rents, Leases, etc. A copy of the rental or lease agreement is required. Deposits and advance payments are not allowable expenses. 1 ATF 'attract: Samuel's IssuseFY18 Page 9 Tellefax, 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. ATTACHMENT B ORGANIZATION LETTERHEAD Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, FL 33040 EM The following is a summary of the expenses for ( Organization name) for the time period of A� -- ----------- --- Check # Payee Reason Amount 101 Company A Rent $ X 102 Company B Utilities XXXXX 104 Employee A RIR ending 05/14/01 XXXXX 105 Employee B P/R ending 05/28/01 XX_XXX (A) Total L& MM (5) Total prior payments $ X (C) Total requested and paid (A + B) $ X (D) Total contract amount $ X Balance of contract (D-C) L&MM 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 _m..... _ 20_ by who is personally known to me. Notary Public Notary Stamp DATF Contract: Samuel's house FY18; Page 11 ATTACHMENT C Our Mission is "to provide housing in a nurturing environment for homeless women, women with children, men with children and intact families and to provide them with care coordination beneficial to their physical, mental, emotional and spiritual well-being." ovi a women, men ana intact families with care coordination to access all appropriam r.ervices/resources to help them become self-sufficient. Specifically, funds received from the FY2018 Drug Abuse Trust Fund will be used for The Mary Spottswood Women's Center Emergency Shelter in order to provide the following services Provide a full-time position of a Court Mandated Criminal / Substance Abuse Case Manager, released from jail or prison and/or referred from the Key West Police Department, Monroe County Sheriffs Office and probation officers as a condition of their client's release. Services include but are not limited to: Shelter, employment assistance, permanent housing search assistance, food, clothing, substance abuse counseling, drug recovery support services, administer drug and alcohol tests, refer clients to services, monitor client progress, assist clients with developments of individualized Plan of Action and maintain contact with judicial offices, Monroe Coun Sheriff's Off Key West Police Department and probation officers on behalf of the client I DATF Contract: Samuel's House P(18; page 12 ATTACHMENT D PUBLIC ENTITY CRIME STATEMENT STATE OF: COUNTY OF: ............. Subscribed and sworn to (or affirmed) before me on . ........... -------- (date) by . .... ... . (name of affiant). He/She is personally MW identification. . ......... NOTARY PUBLIC My Commission Expires: 4 ?Bt post STOVER My COMMISSIONS FF93683 EXPRES Docmft DA 77 Contract Samuel's House FYI 8; Page 113 ATTACHMENT E SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS USE (Company) (Signature) Date: ---./ -------------------- STATE OF: ..................... .. . ................ 717MMI j N N V N Subscribed and sworn to (or affirmed) before me on wwwwwwwwv (date) by", (name of afflant). He/She is personally known to me dr"hae NOTARY PUBLIC zmw�� KIM ST L i c M My CHMNI�RSK) N y COMMISSIO # FPS36837 man 11 201 EXPIRES DOOPTOW 'S3 = OVER 0 84 Pu?)32"154 DATF Contract: Samuel's House FYIS; Page 14 ATTACHMENT F DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that. As the person authorized to sign the statement, requirements. NN , Subscribed and .,,.sworn,, to (or affin before me on or has produced - .. . ....... identification. (name of affi ant). DATr Contract. Samuel's House FY18; Page 15 My Commission Expires: KIM STOVER My COMMISSION # FP93Swj EXPIRES rep�eevun v 11 2010 ATTACHMENT A 2. What were the measurable outcomes (including numbers) accomplished in FY18? Please base these outcomes on the services you identified in Question All. woulliwanaffiRymirem DA TF Contracl: Samuel's Rowe FYIS; Page 116 1. Please list services and client information below for the program/activities funded by the Monroe County award. 5. What is the number of FTEs working on the program( s) funded by the award in FY18? 6. Were the awarded funds used as match in FY1 8? If so, please list matching sources, 7. What area of Monroe County did you serve in FY1 8? 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 transfer.) 11. What is your organization's fiscal year? For the following questions, please use the number as reported on your FY1 Form 990. If your FYI Form 990 is not yet prepared, please provide an estimate for the following questions. 12. What were your organization's total expenses in FYI 8? your IRS �or 990? (Program service expenses are defined as expenses needed to run yourprognairs. Management and general expenses encompass expenses such as londiseding, human resources, salaries of those not working directly with programs, legal services, accounting services, insurance expenses, office management, auditing, and other centralized services.) DA TF Contract: Samuel's House 1I Page 1 17 AGREEMENT DA TF Contract: Florida Keys Children's Shelter FYI 8, Page I 1 RECORDKEEPING DATF Contract: Florida Keys Children's Shelter FY18,- Pagel 2 (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. 14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the PROVIDER is an independent contractor and not an employee of the Board. No statemenl 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. 15. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, t PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulati the provision of such services, including those now in effect and hereinafter adopted. A violation of said statutes, ordinances, rules and regulations shall constitute a material breach this agreement and shall entitle the Board to terminate this contract immediately upon delivery written notice of termination to the PI-2.OVIDEP.. DATF Contract: Florida Keys Children's Shelter FY18 Page 13 16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure that all professionals have current and appropriate professional licenses and professional liability insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state and/or federal certification and/or licensure of the PROVIDER'S program and staff. ! 141NOM4101. ... W I , , , , 18. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the servir'm and/or reimbursement of services shall be accomplished by an amendment, which must approved in writing by the COUNTY. DA TF Contract: Florida Keys Children's Shelter FYI 8; Page 14 28. 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. 1 M IT 80 1. SUNNI 1 9 1 -- 94 141 DA TF Contract: Florida Keys Children's Shelter FY18; Page 1 5 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. 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. 32. 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 ■ follows: For Board: Grants Administrator and Monroe County Attorney 1100 Simonton Street PO Box 1026 Key West, FL 33040 Key West, FL 33041 For PROVIDER Ben Kernmer, Co-CEO Florida Keys Children's Shelter, Inc. 73 High Point Road Tavernier, FL 33070 (305) 852-4246 33. GO Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. 34. NON-WAIVER. Any waiver of any breach of covenants herein contained to be ke and performed by the PROVIDER shall not be deemed or considered as a continuing waiver a chall not operate to bar or prevent the Board from declaring a forfeiture for any succeedii breach, either of the same conditions or covenants or otherwise. I DA TF Contract: Florida Keys Children's Shelter FY18; Page 16 MINN.- 111171MININNOW0 a gpi emst — - . I �ggIff �L# �U-TRWAWA-M-affy., DA 7'F Contract: Florida Keys Children's Shelter FYI 8; Page 1 7 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed of the day and year first written above. -2 Eza7mrm Witness Witness 191001932 m Ill 11 111111;M11 iiiiiiij ' 1111 UP i W RV (Federal ID N o .-57—egfk) 5-3`2(0) BVZ Executive Director DATr Contract: Florida Kays Children's Shelter FY18; Pagel 8 ATTACHMENT A Expense Reimbursement Requirements This document is intended to provide basic guidelines to Human Service and Community- Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." Invoices should be billed to the contracting agency. Third party payments will not be considered for reimbursement, Remember, the expense should be paid prior to requesting a reimbursement. 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 considereri reimbursable expenditures unless appropriate payroll journals for the charging department are ;wtt,2cWed 4*4 certifie4. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If 2 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 imount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, 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 ? sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. DA TF Contract: Florida Keys Children's Shelter FYI 8. Page I 1 0 ATTACHMENT B Monroe County Board of County Commissioners Finance Department 500 Whitehead Street Key West, Fl- 33040 mm ORGANIZATION LETTERHEAD M u- M -0 al as L) 00 The following is a summary of the expenses for ( Organization name) for the time period of to Check # Payee ME1111111111101111 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 RID ending 05/28/01 XXXXX (A) Total 1Z.Z4&M (B) Total prior payments $ X (C) Total requested and paid (A + B) $ X (D) Total contract amount $ X Balance of contract (D-C) ILM&MU 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 MERMEH= Sworn to and subscribed before me this - day of.. 2_ who is personally known to me. Notary Public Notary Stamp DATF Contract: Florida Keys Children s Shelter FY18; Page H ATTACHMENT C WEIMM=1 FAII - TIN -4VAP-jalk Isla] M Mr. *SL"'T - C-#7ATeIfCdr'TTTF#T( 2n■ authority figures. The All StarSThl program aims to offer participants an experience where positive lifestyle values are learned from their instructors and classmates, including perceptions of problem behaviors, and the importance of maintaining commitments. 207- aMl DATF Contract: Florida Keys Children's Shelter FY1 8; Page 1 12 F-A ignature) MM STATE OF: /t mm COUNTYOF: q)onea Subscribed and sworn to (or affirmed) before me on , (dgteLb ee Al fWX y C'tj CAM --t _Lnown to - �ie • has produced ntification. if * R Notary Public Staft of Florida Patricia K Murray tj My Commission FF 142333 ExpliviloarOW018 EEfj 1: Uk-H 3 1G=Mr0MMrjM NOTAR' MMZMM�� 114 TF Contract: Florida Keys Children's Shelter FYI 8 Page 113 =goW I] z I NA g Ml :4 1 91--� -P�Mnd- �fcs CA Jdari he-llcl- I (Company) --- .7 ------- r) ignatue Wc- Date: STATE OF: f- /4)1- f COUNTY OF' W pn�� I Subscribed and sworn to (or affirmed) before me on 4,� /6 (date) b (name of affiant). j known to A�mr has produced identification) as identification. 4 e K NNII� ry Public State of Florida Patricia K Murray MY COlumbelon FF 142333 4' �� F R I #' i ` i� DA TF Contract.• Florida Keys Children's Shelter FYI 8. Page 1 14 ATTACHMENT F 1 1111�11�1� III (Name of Business) As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. -SSRfn re) STATE OF: COUNTYOF: r - - - - - - - - - - - - DA IF Contract: Florida Keys Children's Shelter FYI S- Page 115 ATTACHMENT G Per Section 8 of your contract, it is required that you fill out the entire form and answer every question. Rm !� III I III I IIIIII!!IIII III SIR 111 '1111 111, ffiir*17�- 611151" F-Val DATFContract: Florida Keys Children's Shelter FYI Page 116 1. Please list services and client information below for the program/activities funded by the Monroe County award. M��I= 030�� your FY18 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. I I i '' I I I • I I UIE1121111=1 � 1 111 � 1 l � i! I I I 1 1 l � I � � 1 1 l I [112 MI-E(MITOEMOMWA ". 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.) DATFContract.- Florida Keys Children's Shelter FYI 8; Page 17 FAC10:1 7n s, Ag s r ti 'e Fj - 1 .7 e n tel ed i rd'u �l i -_� 17" d a'�' 10' J a nj .3 r' be',Weei .'!ic ECAP, ?_,'F CCD l C0F " (DF M(.D -JRCL C:C FL')R;DlA, re`C-rnelj tom' aS - d ' c r "!:C L r "V. g rid K o, v R ri c' Q e. .'r c. c - c i n a " -p 7 7 -red -c a ' P F. 0 y ' I I;'3 R L c es s,eL 'c)r I.•Ie Of �:reven: o 1 3 1': r- a t i-i It A-,7 - renta' hea ' tro.. are is a L'L;tima p'.itiliC ._Mprj�� Lo pro cd-p 15ijl I - a trearrnen and mert:: f'ee.Rh treatment, navv pro and coverla7tv; 7r.n.,- it 3s fullc.v's: FUNDING I. AMOUNT OF AGREEMENT. T " F3: a r d , i r) C� T7 S: d t �71 : , 1 I f _ ' ! u . P P. 0.'v': L:l E P. s, _j L) S',� -1 t: 43 . a 7 c s�q t sf a :' 0 r• 1-C any. :t r0'- i '," i r q fjc- 1 i ti e. P, F:. nd 5 e r-..- C e S f U 7 p E 7S 0 -) 4 I r , 4.7"rc)e County, F s lal pay tl PPC ),,r: D E p. -1 of SIX - H& - ,J5A%D r F _ , Vr E HU* 1:1 F E" r i rj D '-)-' LA P. f,-- fi !;Col y 7 J!� MC0.7 n., Lh;_ _ e i r 2(j 18, n _ 'I -� r st 1) C o 1 : f A i - s c r, 5 rC a 1 6 f.j ncle h d v the (� -rk :�-r!.j � At) i. F:k 7 j F lyr d, 2. TERM. 7 A7roompn �lhq rj 'lct.n,ter I l and - - lF!te Sep 3. PAYMENT. Paymer vo: I -je madii. per la,j s C b!.j 0 'r' fr e q i. - en na t f - o - I + a ri L-t�wL:r.c. e� fo,-'l. via th•c' Z"t ce_ - he Sha on;v reim'C subjoct 'T'. )x e expensas F,re e and ./,.:6 h "lOn CCL I*y' State !3 .jr j rH9i..l5ti-7r5 and - irne. - it A Lci Peimit u -4 se rr � - t :DEP. siall -0.2 in fhe fn-n- o a l�_LLt:r, 5IJ77a,rzn 1: h c c.ypu.plSr'.. v -)u d 7n.9 e'er _1 cm An ar of m rcr4--ust -zo er C-tte'' ri, - 'I :j F . , or , j , � A .r7emi: 5- 7ic "rUci f.ria iro. c;! - )e vjitrin- th ,, days dfLcr the After the Clc-r c,' ;L B.7,3rr Fx;�.mires an i:jprovi7F - . - ie " n- - - t - , - 30 % rr thu FRO". �O oo - P e �oa• 1Df sai. pa' In tF'C- 3.ggr 5'm 5ral r UL CXCi!V` ti'_IE tl7tul 8TOJI'l ',hOW n 4r-ucIc :r b o y d-irirn the tcrr D' 7. aqreer•e•l.t 4. AVAILABILITY OF FUNDS. if cbrr.ined ; r i:a-if Li `: c n -, - i L c- ij 3 j eve Su"I (_Lmt - o for c - i'i7_)_rse7en - o' cx:, -jrF'5 fi:,• , srelc "jez . at '�C L o' the Board 6.0ritten - lati:° ::f 9t:l77 celivc LO - PPZ 7i�- E.r:6rd shall F OC 7 ^iigatal tD For , on'; 4dF-i-,6.: Or zc prrvv de-d t.' . the after `fie PPC-VIDER. has A ri Cwl o r u r , r i r i ci -. r] - 1 r i-, - i . e ss L h e rv. i ; c r E r: i. j i - p .1 1 - c . A . S. PURCHASE OF PROPERTY. A I -vFeflher - ?=al cir pumcT vl jrd-�' - nis agrc-f-m- 5, t:,ecnn:N -)rr7 e -, I 7ril- ""gill he 3CcOurtez fo- to st4t_itcjr req, ji- -1 - - .- I RECORDKEEPING 6. RECORDS. FR.0 s-all mairtair zi LiFLc7 np•nrer.- •`ci cie-fo--T'a- u Llh-c A^t'e.e[- ill v,ith 3rjp;Pf Fach p?r to Lh :a Agrepme7rt o the 5,131 have reasr.3-2! blu iird i Cc e`_•5 '(. s.cl-i - cr-L ,, rds c)f cltrie- matt-.. IL:; - . - lin purposecl Ji,ring fine :crn , 1 1 1 tr Aq aid to- fc, yf=ars fici —iu of Aqrc-ement I' :it :jud - n - � b the Cojr•` nr Clergy `etern-irlus L,'-l.gt r)c;d - ,C, PROl.'IElER ',, -,-ii-s A.greemen vevE? cpe.-it t pu nc,t ai. .-rizec "r- PPC'4`1'LDER s�all rup�-,,- ' mcries -lo,2et' \-"i irN-rpF�7 L I t-J Scc. FS, rijil-inq f;c Lh,t da tl mc N pair I! i5 - equired Cc prov;(Ri min al.- as se, `'D•th in i•i D.1 i S:'cm) 7. PUBLIC ACCESS. The ar PRO"."IDER. 51-1.=j a ; Ov.. j -! C. 7, P r m I -, I' c- a 5, - 1 - 1 a L - Lccc .:jf, 31 d2-EL MF pa-erts, ItAtcrs or c nnattrial-_: irl ;ts pcT.:;C-« 0 u•t itF ro-itrc)l siu to thc of C�'Iap.'er L2 Flo StatL•tes.. mUCC. E a ?: i- this Aqreerr-e .3-c ': r i a 1 1" , t1 ri I -,, t c r a i I -.., c -i r e. I , 115 A g --2 e r -lL. -- t u r u n .- i -, I - i t -1 -1 c) f i f, o r o bv S. COMPLIANCE WITH COUNTY GUIDELINES. 7`'c- PRO' r7LF; L i' v t ! - e ru i I L) - r e .7 5 (.5 :'j r - 1 L S P :, r u - v - i r J e 1 F) r - j - t ci t - - �- a p , t-1 p. ^ t cl f ,g - y I -., fc I � C G ' -ia: u , i j �;U:DE57AR. ]il[ ind Ljlul,'Cji'�,l 5 f IDt ; C- g I S 1: r a' ri - i h-o " - 1 th E F. CI- d a D e pa - 1 T r i i! r r l: i I t L r e, a s r �� r 1, j; - f7 7 D - i ii 5�atute 4-46.4-,t -.jr-d the -Flan�a De--artr•icvh of StFit e.- 85 by R,7,ri�-a 5 *,3--tL 7 d 2 rJ 2 of exemption f- rn rcg i:,t r�lh )n as :et• F D-da Sl7&ij 49-,406 •-f A thc- rnij he at lc35t and bo i - re, - rbe , p ird u - - i elec�c-d LO ! UrVP 73rd the lel'gth 0' Lii!r•`r r7f 5eF : E',-'i fen-ze c" a r.jz 01 e--ti on of C ff c�r a c i d I i rFr,,D.rs Unq ua I I fi e J a j U i t E? '4 "1 - F, rl C:,=1 S *,a I c - r u r i t !, f-r t I-, - C) 17- n sca v,, fn .91 "I crl 7 Jtic-r-. nm=it t7-xFc[-d m vea.r cir rr•iOrC C U -_ I( J L U Zef;C.Cri•JJV.s correcti've s! all :c - i , -'upender - It i /.-tri c] c:.jrren* iicerisc, it cjood slig-ij .17 ,-oitk - F i:ird.D SCZ!'u E•,-. o' Ac c U -- I t,2 I' L' . 'f the r r . i q -- a r - rr)r7 '.. : 3. c C P A t h a ` p - - pa r F' L I - u an i 7 IJ St a 1 5C. L tG e r 71 e M t C- f ID A: Iori rl I -I - ti-;tr-. c f i-Q rti 'i ('d Pi J.-) .0 A.CCIDIJ r- La n-. l!.A 'CPA': b. 7 CZIA rnl-GL nnairh:ir rna !- e —, C7pe I �.UL jr 7 The C ,hal -7e - iterded rccipiert 7f 5 +5 lj 3 u e j -nd f: r'in 9"-K r1 r7 c,F:r recel I VQ�:r Filth all ?ttaLh,ti :d • Q mu, irclude c7)rqa[ Z - .1 Ur i missic Poli^ies a•,c Proced:.res '1;qrij,a v. M.-St 71:11,1dC hI r, 7 r7-1 c e _ „ r -ill StL!'F, drlj-� .971' alcol 'rep vonrm::D aCe and c4q p - t m I jQl Qm p o. p r r p 0V S 0 S p E-zi f c 7 e5cr p!.c, 01 7f 5e S Lul L)t: �Ied L n er uln - a :t ti i s e e Attach - hen - C 9 r -i a n r-ma n ce R c e 5 ri b i nq -s t� -s r e, nd e r e c d -j ri r-,Q khe da ater c7rrrac end T. T g' 0 ?� r i uu i � L e , n,7' .- i e ca: 71 fO:"7 a ' i Cl r) r e c � 7 i r i� a I r D'.` 1 C!e C..r -9 p r r f nI S I;: - I L d i r 1 cls i -~:e r 'I a I ii n . i m 7,F s�r and rm'i—mc-, :' F:r4 tt r A Coop o;it." 13 r n 0*-ic rp.,-sn-iahle repcir rci - jviSicjns 3 �t 7, rf c.c. tract -.,, e , r RESPONSIBILITIES T-CilitL�ril'g -hat :hf= Cc11Jlt ruLLUeSt it,rinq t11 ccv relate . t app l c-. : ) C , the sLc:L� -,.f tlaC tl CCU--t 9. SCO O SE 77 p P PC r,' R, fo - ''' cc) •- c: i di e r.q: :, `ia nn c. d, c o v Fri a r ts 3 r ij u, ov '. 7le 80a per`crm ar -- ie sern, L AaC! m-RT-t to - esli.ceri - :s 20. ATTORNEY'S FEES AND COSTS. - htr tha- it tl- al cause :'f QcLior' :J- =Cl7in,�� -Ircceed -i; s ni o- d.c`cr-cj-.-�t1 th° u in 0" tH Arj the �-C� -1,-, s�)11: ne e CCS rvest ,g.]*IVU, jr-d LC8 'lit 771f2 par- - Y nr-d F:h-: : ircludc Cc-urt,'; ard OL' nf-pocke explerises in appe, ate ), " i r3 t i ^. r :Drc�ceed rigs - i - ir , tFnd ' 9711 --on dLLtud - o th :; Ag s`'all _'e Ill vi: the Hor da Ru ps, CD` C P li-d ,s-ja . L:jstomFir ]rn.r:edurcS h- 'he LC)U7t 0` 11 BINDING EFFECT. 71' co r r Aq�ee !3 bind and ir - r-, t[ L'Lref - --f t`-C- y' oa PF:CV a -- icir e 'Q!5 r - s, aiL r- P5. i e p r tn�c .. L L! L s, j ccesso i 12. CODE OF ETHICS. ofce-, a-:L (:77,71,7!',',eeS reco,;ri-e. a id h-oic :�,L req�.Jrc-G ',C3 1:10111rdy v _ Lhe star of c;,.nd:jr7t "or I- - ern D ea r 2 S C, I i F' 6'Ptef7, : Section 11'. ;ard 7 '7iteC e n lb -, t no 1 Ce o` g itts cd nq 7 1 si nes.s v) it omit! a cel J 1`3 JI'l LTI :e Cl C7-7,7 :)e r sa� c�-i or d,sc osLrc u 13. NO SOLICITATION/ PAYMENT. - he Couity PRr,)`, va brat, in res:XIC', try e 1 1 C i s nil t hp - F- m c. I - ,yed r) r r in t a - n e .�' a n y : '1 ; L� j r o - p e rs c r o t c r t h- i m 9 b D a f , c l C, v. 1; 51 e y o-r se Ii, r 2t Lho !',7.5 'rit :D3 rj wr - a r p t r n r 1:0 7 P-B r p: �i n i r d; d if 1 -i a Ur fl rm , �D - -) c r e. h n -) a fj � P2 f- . 7 - -V - - i, a n , . ...... r K i r g s:: I e:y or IL ar� C0.7MI55ii:ii'i, -ic-ccr C d`•'3* o 7c.r ipon ur r fro * .`:E' i:'A'a or rn3k n.; o th s A.]reefn�T-L = or " :-:.r U c.'.iuri 0' the ' PRCV.'11DER af;rec�s t! the shD hove the te, LL:rmir:tF7 i r E:c rm f 7 t v; i t b i I i I t S C � i G L rc t 0 n ffS e [ rT u r • i rm o - J e 5 j T ,: t. , e -o. I - rz the fail 87C1Ijlt 0' "l'[_'h fEer comini_<si• n. gilt. , jr 14. INDEPENDENT CONTRACTOR. A� .91. •rc, urd fu -II PRCV'C- Ll C o F: t Fterlflrl this aryee I be oD-1str 5f) a - o "Ind PR.r_ z: is Crp LTVae-s, sere ant; D aq AS fW be , :I tle Bcarc, COMPLIANCE ISSUES 15. COMPLIANCE WITH LAW. 1 : : rovid-ng F, Se P. k_ �S [)L1 ',o Lf-j Q tl PROVI'CIEP 5lha.. aL)iC t.1 a i 5fatj e S , .J r L i n a i c e - 5 . F e S a i d r uQ . I a f i r r 5 F e rt a i rl , l fD- _eQLL;2 LiT sj-7h sen, C-eq, irlr "1Dsc '!2v.' i7 effeCt an nerejma`tr a rj 2 r-tef7, A. I Y o a 0 n o sa - kj 5 a i t e c) %, i 7 F, n,7. - IS S"all CC � : a ur; es, ri.eS a rE'q a C :1 F I t rea I_, 1 1:1 and slal' urit 'Ic. - -r- P,,71a L . „' t. 'Cl - latf , ': 5 ir7 y- I tt t i r- r-) I r . j P C', . 1 [ - j E p. P Z 16. PROFESSIONAL RESPONSIBILITY AND LICENSING. - ! , c PR.C%`l_'E ;iali "mot a 1 CLr7-i2 Lriff as ipm p.-cfessic--al liccris-u!Ei ":nd p-r..fesci• cral Iabil :lLy- Isli F_jr `;y rm- �ciard 5 C0'1t11 rEltE?r`17-071 cl ra:Dprl:i_ rDCQ'r StE:r ,.,,r - - isi . 'n :Z'S - am - ,qm and s �c��_ura' cur' 'i.LijLiwi a-1 ,r '.ce -j y e �R.0% ;. 17. NON-DISCRIMINATION. it - d PP.�10.1'IDEP. aqree thc.i L it is r2ypr , _�ly i_n.:erc;t t ha t . �l . 0 0 1 �j - 0 n a � r L U r T `l i r cl n a tra,' cisc. nn �ia5 cf:f:i_j-T I .. gr rlr•rlhe 3CUun cw p.kr :if any par'•: effec�,vc ,�i rf :tr- n the 7c cr- L L(J_p /iirh all `ede-a arid FIL)ridj anc, a lc:cal as rc a',nq t, r, rc)ndiscr Triese - ich-de. hj,jt are ric: milte._ tc.: ! of * rQ ClVil '� af 1964 :'PL 88-252,' vr7ich prcjlh..'� 7!; i. : L:.r - bpF; of 0 o- na onal orig n.: 2,1 Titlt IX ':if t•E Er.rJnarl A nerldrl'1? It 0' L-72, i:s nmei :ei- a 69 5 1 r'c h p n h; i ts d !;C - i rn; na t c - i cj n s f± y e C- 5C14 of tilt iRci�jbij:- J o< D= 2973., aS s. v'mch dis.mr ', l L - )as.s o" rEndizzaps, 41 - h(-, � i�,iscr7i7a Ac of 1915, as amen - ded (41_� 6", �,.7': icr vc.r I bits di sc nat.n r7.r the tasis of age; 7 D Abise C.ffik:c reatme, Ac nlf i .,PL 2 255':, .c nc n driuq ao,se; lb) 7 Alb_j-st' P R e ha b i' , a t i a n A C' u 4 1 0 PL q 1 -' "' c, zj F5 ar7erided, 1 ' rig tL nndi5rrimi7ctic.f Dr'l : (7) alccli'i:;i abuse '.r 7,1 711e PLbl;C HL,'alLh AC Of Ss '_ 3 5:7 421 jl_'lL ss. 6L'I'lr �i - T , e nd - :711,i�l-_' . c-.7% - elatl - ig: t ic Fla.' eri* 7 - ne r.fits A.L:L L); I . 9 11 S r :' r S "� `� - 1 r rel a ti r a - c - 1 C+i iJ s.Lr i f i . <j i - the sa e, renta [, ti ii,] i .i r n` hc)ijsi rii? ; 9 7 hc 44.mer. ca S v..rh C sa 1 ! 1 es Ct '� r 1 7- L D 2 " 4 7 IJ 5. 121)1 rflL!' [ :mended frcm .me t:;. L! relati7i;, tci - orldis , -'r Dn -- ir, h, 'l disa:D t•lon Cc-unt.,- Chaztc 13r Ar c vl .10•iL'l P d:s::rim: l'i . ''IL Ll j ;,- Ur racvl 7-c-lo se.x, -__ 9 r j - "r 5'iCeStrv. x j Lf ;ende de u exp fa arly LILI'lu- scri7 7atiar r - i iy -: erera i: ir s',D vnif7lh r7av a:)� `0 t h '7e 5_ibJEC* nlL�Ucr ':.f, "iq A�;reemert AMENDMENTS, CHANGES, AND DISPUTES 18. MODIFICATIONS AND AMENDMENTS- An y an al' r - c) cl i `,,749 t ci - 1 5 iD f i e c v i c t- arri, rC-irlbu 7f 5e S'1311 DC �L.L(J S7e b a^ .�j ":.J i r i v, - - : n ; 7 t h F� �r_- U u r.j —)'. 19. AD3UDICATION OF DISPUTES OR DISAGREEMENTS. Z11 and S'iall L)L cttemp ec be by le .9 , c c _o r ' , Li e cl L� j - t c �5, 7 P R ED 'V' C) [: P, a T' d C 0 L J - 1 t F. , f of Lh. p i star' sha I - . - y rn res", , the c - ft'! nr riF:r..1te ri'cct ard ',c oc cumrmt7 with n c the I-Splu'r- ro cl,;im. if - .' - ie ir-slie 3.` l Ssu. --i ijre sti I no Lu sati5factiair 0" th pa t i es, 'h(--i ring 7,ar-ry rig-it tr.' Jru �v - 1 - is Juree 7 A7 c'.,aims I .-ir dispu.c `nat tre. 7 Lari-iot I L) r - ac �lrjr d,5, cc b•.y t Caur IG"' f �'71 1 i t r t•lcri . CL2Lr , 20. COOPERATION. :r crl dumiri5tra,i Or oyll [;rnreeijiri- s rpr Y 7 ela --1 9 tO Ch lc: c-: - ,eff. - rmamce, u a FF-CV':DEP ri�ree V^ :7,articipa'e C [ho extP r - re f7 j i - i e n - - i r- y ., n a i p: �_C, L-r-' i r! g - 1 r ri r q s, ;D c. c c ss.Q S, - r e, e. -. m q s.. .9 1 [ C) t h L: r El ct i i t iF I c- I a tvd Lu L Q S - b 7 c e 1:1 rh T. A17 - ccr t C." ":TcjV F; clan re' tl ridF, i rt:er er y L Splel:lCall', � 1 7Frf "iqr n. lrj th-s A Shia Liu rU�:U. �rtc b 'ra' nn r .- , i i i' u rj nv a r 7a a - erg tc� 'Is Ar�ri ,em-er-t, ASSURANCES 21. COVENANT OF NO INTEREST. ,njn anc PP.C Pre - 1L!� uny in' erec; grid [ L:Lqjire ar,- ' , ir e.f y, CI o-LiLi d c�, .7,fl-C7 IF -)r �:eg "N' - I - s ..nder tlIS.Agrcuj1 Arid tha cinly each 15 tO f:-Ur a r i l re C e v u :D C; - C2 ` " s r1s rp c -prl I ri r1l I s .4 c r ce [ L. r. t. 22. NO ASSI(3NMENT, Tho 5`1311 ", ,c't ass.a this a4 -ee. cx ir. \.rig - sha : tic sJbj�c - c sLc,"i •5-C as the BC.a 'ray recessai T'no, �iq,7ee7en sha ! bli' Wi�h cll rf the [,r 5 o i s ' e T cm I r Jr14'�c, express: - rovizcd for �7 app ,hai r S�;Ch I no ma 2r e bo mpose an ob ga':c)n :.jF :he' l3c in edd;. an to the tiotal zj.grr'er: _LJ ? ammiclurit 'or tl•u t rvice.5 c-f the ppC, 23. NON-WAIVER OF IMMUNITY. - nstand ig :he 2 E., Fir.)rlda S_a_-JteSr the of thLn c �41f,: ` PR•0% irl acqi-ismar c" aiy , iumrme - cial Bali r ns_ C CIV e ra 0 C , S c I T S ij - a 7 C e : c ., L r 2 L: c (.1 r m c r b [ i t,pr 151.rarice poi: 2D'-'Cfr11Qe Sl ['10' :�C JL�L'171-V.d n va ver - :f 11 L tr .7e uxtur:' of ietilit clove ri2r sha i Ar con C in h the Cou•!L �P. - e,7,i.j !"ell - cl 24. ATTESTATIONS. PROVIDER rq-ees Co CXi2CLLE' S,j7lh doc:xrcits )s tHp Cajr.t •e2SCria�Iy e, tc ric u j Piblic. crlti-• _ � St3tor'1 PH a7 Eth'cs SaA!_T'pn and 3 D__Lr_I =iL_ - dCC Staterne-t, 25. AUTHORITY. Eac sart-., cprcLc and 'va"tar::s 'Ll the 'ntlhe! -- lat :.It d• I'. _r•' 31C plu�cr .If *1IS Agruemert h t cu iiij6h - .rjLec b a and co Fiction, •BS `CCU tYy INDEMNITY ISSUES 26. INDEMNIFICATION AND HOLD HARMLESS. The PP( j Yl/1'_"ER. alv grid aicr_'i2_< -ri •izui a- h anrr.IOSG * v1Zr7 , 7 , F '.%ny 134,a%. u C:,-. - I r 1 j I �� S� O�Crs [,,:, I a[ r , r - - a rT;Li iii ra.jsc-:, of actic)ti fa- Tier IC,5. ma �rzj�tia�, mrz.�jca;l 7 0gli , yOi•cu. 7,.ri- riJL7•,,' 1; - 1:11-ding telcl; COJ7 V) a r [):_ n'y' m CiSsCs.. a expti nc! '.j 7, 1 r q t:y'.P� lf "i ov 1, ch t�r 5�_ Liu' ) ri l _e �t-nn .0- d - h y the errs, r, CI ri f' vorompf.jl act 0 7)f : em_ 1:es - ts,, cr a 27. PRIVILEGES AND IMMUNITIES. All of the luges an- - 1 -- T , u !il_ ;! �rnm liqti e x p 7 p n s fr 0'r , r:'A'S, 07-t i r ? n c -i r: r--j I eF; I r j -- ' r' •�; uri:i :) r d - ei e', ri i bi I. beneflts o.1 to t, 3ct accriti 7T e1 Vit',' :J Off 7,erS L7n c a. cr eT cye.e5 z7f -- ic when per�cirryiirg f ^eir - '-nc - iD-,s 'A' J1 'I - . - Ip j1pp .7 le �J7. cl a to the 1er'L,rr .7f s.-Cri Tu: a7d cr r C 7 D! 0"y'eC' , C1 lj *_ i ;: L -..-I -e t e r- - I t.1, t'j a' I i; r i, :s � t - e I - L ty. 28. NO PERSONAL LIABILITY. `Vc co ;:.:� dFr �inrl;ined rc-riin d -° 7 0 d - 0 Y0 ! Cc ve - 1 a r ` n. - a g r P2 e r Pr - , - ci ' a n r c m b e 7, ci 'f c t� a �i u r L 0 F C' 7 C:'V tf� 0 clua ca Fl+r 7C. off c7e qquir , .r er cf 'Inr �e Lkl:c per - J - i tl Agreement ur LJE! 54JbjeC_, any p-7 liabilry c d - C o J 7 t a 'D - i I ty L7'y' r P r i So - 1 iD -1 e Q k eC. j f i 7. r- ^f l-jS , 29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: %ni-l•�eleq cr g C. E? r) r. n I r t e Ind e d a - i1 s - 1 a 1: T' St c- c- as I i e v nq - sed ipun -,Lie 3'• ' Cxc�' exL(--n- FJ- ZlEtUa Pn,l purfarr-ijrcc :hnrecf b aly larticipa'ing C' L2_SQ tttE� per'c imce m r 1 :ajt s" rti nn of the abl I gUti L E: r recpiD.jsl L :-y r . _Lrtic �, , th, . • ' Are.k-.mF-rr is rc ir'eridc 'L mnr rha I it the delpop-, on q- tke F -I' o• al Lir SLL tu-c -.,' C_' J_ eS 13r tht- C�:'L'lt ',', cx - cl I L pL:! fted e Flo - I � �2 cc.ns' • it n -t At ije , c c.2 sL 30. NON-RELIANCE BY NON-PARTIES. pws:1-: u7 e^tity SI all , I I .. t c co p_ I r t e. , r el rjon 'ife turf IS of t`iis Acre.e.mer -CI C)r Ar lp. M pr t et ury th C n C'm t o c) r s e re r : - cl - P a r; s c : I' -E: p - c-, ra -n r ci t e tr a 1 , �:d �- c r u- Lj r it e I I t I U C r J t E: n d ti l e' Ln -- y' n or i e Fl CVl C) E P. a' a ri - y - a g t, er. 0 V ( -`1c a j t h o r i 'y , c I r r c e r r :'c : n d i 7p t� Gar_ C-113' ❑r cif I-CI VIdl-21S, C (17 e have On' L lt?me-.ts or beriefits rc c r -iuw. s=,j.irate ard a_-art, nfcrnr m, or 5:.1cerior [o Lhc cc'771j'�I,y' .11 ge"er,�' o .`::r r .::r tre 11 thiS kglQE?Mf7�1k. GENERAL 31. EXECUTION IN COUNTERPARTS- T- 'TJ'y hP. eVC-I:.te�l cl coir',cr epc v jcf - i sf ij I :jc E?cia iec' as an iDr gria . ad n' vhir" C07 (,7e 977, sa-i!e 1ftr.jre an, 31y 01 thi? Fier - e5 I'erccl r ay ex'- ciu*e th Agree - ren , tc sigri rig a 32. NOTICE. Any n�j,,:e rc-Cij -ed G. puvitl fc r; i..nde t� ] Sh,q, :C- in v,riti"'u and 0 at is '4�7:7istf a n d - I' Ori Strei�7 P0' 5ox 0 4 E "J"- Kc"' 6%'0SL, :- I- 5 11 a 112' St I Kcy klhlrqr, F' 7F- 33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. - r.;s r+ rccmcrt F:ha.. he �jc J zmd i r 0 L L Q 71J Z3 r C 1P v% in r ri t: i a v. s o 1: h t7 5; r 7 t t- :;1 F I i MFide a"C to :jL pp. - r m,a—d en 5t everl th a' iiry ' Y Of DlCtiOn Or prc m3 s ':�iLitu fo- tj-it 3f th 15 thgt Ve v.il! 0 p - i z3 `t7 7 ^• I_: I --I b %( � re the a -. F) ric, D I I a tC a u 71 i r st ra e b cl Tv L - rr C ' - e I -!' c Cc'.u and FR-0'�,`IZER lqreC -IC-r -f C-'r C - 1� ne77Ietath.4 tt`P te or L Ler L7) 4.gro - Hti ':�SUe, 5 - mt -I y n "red • rjri p7c- - 0 tt'e - 15titIj',C a rl of rmv othe.- Dr Iegal 34. NON-WAIVER. An 'waiver of ar` nreac"i cif co +L_: be 7,.E -rTne.d :yy tf pr C,vq[)EP, sl�-all net be ceem-.�: 2 curs J�_e� as 2 i - mr - ri and - Q Shia . nc Joel ate to Ll . u �e a ca rd 4 rcirr, deC 2 r(.1-fUil t Lj-+' fD i5 r -11 �lljcc ee: I b re a c " .. either L) t.ri e m� - r ' e L u) r) d :7. o n 5 � - C,.a ,r ^ a ri :s or ot h t—vo i se . 35. SEVERABILITY. 1 iiry term, cr.vr-r-an clocicitiov cir p-�:.-,rj -- le apQ c._ tf 'o ar or persn ,'l shal cr2LIL:red rvpli`7 i exturL by J cuu-t rjf cc .m C-teri ji-'r SdIcticr, V rc, mjiming tprmc, - -is Agreemert, -stall ic.t 2 • RIC f=_aZh tt 1 1 - 1 ; 1 lc . o . 4 . T r ?rld Dro olr *",i� Agreeimpr" Thal :De vallr7 arld S :;c tc -,I - idlest peri L) aV, LJ-11-PS� tl ierfcrcerileri Lif t!'u rumijivirg Ter_ 'S, Cf [:L_J'ciU 'rs ard p. s o-is "It 7715 Aqreere vo if �rt_vc rL CjC,,:r,) M7,dirl -.f n7u.-i; r)f th-, Agreemer-. — re ard PROVIDEP agree 6 ci ref-c the t7, �mmv ;trlc.-�en prc. cr. Q . .. J j d 170,nleS 3s osc r Jn POZ�Slzl£= h7) t' I e rr c: ": e -I r,• .. I -, 1 c. I -. . 36. ENT AGREEMENT. 7' agruLt,'I:!Tll the eri.';rc- acrec.-r-ow, of `hp rle'etc) with ress-sect to Lhe �:ijbj;,lcl r7lDte lere and SL PL'rse%lPs r5rly ig7f: =,Il ancir - esoezt - o su � t :lF...O'VlDEFZ !nd •' Board. qreeriers u:�h r rT S�Ai,'_ LEFT BLAI- K oNo'.'_H SICr,'A77DRY ?A.GE — C - "__`LLrYVki I b TN d'd'ITN E S S V E P. he Fla r e s I u r if_[] L o �lav e 1 j se If � b :i r e. 5e. In - S � C, :� C E) x j �e.ij jf e '.19',- a n 2 '' / r' i — i 1: .-1 ri tt e r a LQ - E SEA i '77S, R "' IF ElO.A'-•.D OF CIDLIN tOMIV.-SS'CINFRS OF �-IONRCE rL10-RIDA B . Fla y vr ; ` C ha - - r a - i 17 t 17 I d LL U) CU co co LL LL L) cu bb ATTACHMENT A Expense Reimbursement Requirements 7hi5 dC'Cum�2nt is ^ -e ^ded to basic aL:icelines to HLjr^an S?r +r.ce 5 Co^,rnuniry'- 5ased 3rga - -zat - ens, r�,;; ^�� t -- ccntra� -u2. par'ies +,ho have 'ci n , v4 rsa-' e exren5es asso'clated with %Icnroti C_c);. r)t - y 7�'LJSiness. These gu do into: a; -h ey reiate -ci tra'.el, a -e F_cm -ho '•lonrc,e cunt'f Code 'o= Cird- nanrr,� an'd State la and r�'gulctiG .. A Lf3vi_- IcLter ' seti Attach - r e n- B,I z • I_ t•;r - ra j - 7,r ne iterr orl th rcirTlhlJ ex:�?rSc need; 70 8.150 CIX - 1 -3 '1 rtl f'2' 0A rl' 'ti]ri -e.I c e r =led 5 -a -e r'c•-1:: - I Jfer�i fy th;y- the? � t'I,i'Jr _f'.(r k� plc,': _ beei-i :U h: rn Ittf, -ci the : ct'r_r,-i� US n .-t a -i r7 i:re riri .irate , lid ^. .7C]ri_Cf'lf_rt 1YItr' -n!'. "PC ^•I'll`, i,1 • II_ L jr' - L-: "err - lore. :',c`Sf'. fix ;ernes are Ir, cc'n - ipI ar -cc k t i5 '.;r , 2atior'S co "trcL: /oth the h'r,nrce C0LJ•'h',' SO : Of C,Ln -'y' nr -t '3? sJbmi - -C F: r rcir-ih.Jr }errient'I ari'y cti fJr r nr_l:r _• � te Lrr." - II "'L) L es S:I: L :d be --i'.P.d t4 -`le rcci; iL, c qL:f 4 Th „ mart, c'0 ^sidere (i for r•,,,hl,� 5er�err ReI'I� rl c:r tht! PXpe.nse Srl - 1,d tie riaiC : rior t : - F ^I l.:r?5- 1^ a I' e lrlbu - sui - 1f;I';. J11'; ciJrren- s z)L mrisi"?ered, nc' -,rcoc'us ha 1-1,F -- ?.r_InlbIJrSCr'}Cr't - L'cu ?S',5 '.VI'' C'e "[r11 -'J'L' "1 L.cczrCf:n -, - c- •1"7) 'Ile le'- Or d?:-i].. :'1 `he I_lintl'a T'li; rt,: ^I- :-r.en' sh^cIC rat :e 1cll,s', 71 c C13 Firanon Dep }en' res'e ^:es the f:r �- 'ii I'f_':I�+•� "�i'r'� rS� .Tr?n' rr'i'� eSCS c'f arl II''[]:'NICLJr�. h X515, Ar.'y gL�_S'_:Uris 7^:?qi:3ril 1, ; sia de n_5 s ~ou cJ he .:irprte?rl tr, 3C , 5 -2p 2 -2574. Data Processing, PC Time, etc. in +-e I`: 'FCIJI - &d 'C'r rC?II I-IJ- SerriFrt_ ='e r''r1- Lninsizcrf:ll ex e C_'. U';If'SS J Lr. - IaIS `;.r t''e :- rarijir^ a<<ach - ed aI ce ?ioo. - - Payroll 1. CC'ri tC Ll 'iy :elf?. t cc:Jracy of - Id 8.U:': f.:r'�iC:if' +� ilr -1e ��'� rL' ! C:•;�.iC;rI�E IS reeded. .f F PF'i f ill JIDU- al s 2)r-a'y' dM, it SrI. L ll1 irdudi - y ' 'uLu, 'r1' 3[' CJ , I o - Yee i_r t �G f� r.�'yr I .a:•, �, cf'I rl.Jrri ,er .9 ^I:l check 8.r7c'i,n`. I` 3 Pa'y'r;, .:c).irr:a Is n'at r lue 1rc', Ided psi F ci.f ?c:k r:r71r;l:rlt ':heck nJr c:1<nii, r'Fyee• sla0pci^ 'cr d�ralir.�h:e oai� �3'� roll `�xf s. Postage, Overnight Deliveries, Courier, etc. .4 c_ ea:pe - lses 3S - "U''i - f: 8. -f? tr., -r'F -i i:_lf "t'J :c'r',[ic7`t !S req,iirt7-l- fr,r rCir-1L),— j7ser'"ii'r` F0� CJ'rf'.r ilyh: c'r ex :res_ dc' '�Lr:E'S, :.ne ' + , en'dc'r IrVOIL - 1:' - f - USt "]r' ini j7ei . Rents, Leases, etc. A :rp'y' Cf the rent,) ^r e,y5e rF q i J:rer. _ _•J�'I' ^ f •'I:•� a - f: '1.",t ui1C�d:�h7 C' 4at:]f`rSc'�. Reproductions, Copies, etc. n iii4� f 1 =i i r'% f ):tic'nSf 4 �_ `ne'i rC ,;'C tC .'lz C'a Jr. -'v .. ;r •'.r•y' t rr_L'u ~ `nr e rCll "IL''J' Stir i�"t- Tn - ,'� r'ULt dC•ir''e, p �a`r, rl_11'.oc' r]1 cr'piP� rn.3:nF :r1IJ "crc C'CJrnc'.nt, ( "- 1r��rJsr 8. rec!p•erl-, A c 7�rJrI J i ri£ f r ^ ,r'y A.X7CFSC= Will Vii: 4'ir�hlN, 1 [I" '�r; 6r Sf'-r•JICe.S, - - je 'VI -"ILur r 7e 3 j c'f Lfic r -1 isr' ed prod L, c- a rte• - CCU -:Id. Supplies, Services, etc. r �r 07 5E'71) �-1`.�F'r'rf�, a rt'i_IJIrI_L:- Telefax, Fax, etc. A fix IL-.g is rPkji.;rer1 I _. Tle cig r'7LS. L:P -- le rec p en, "re "'JI"r tre J __!E frol rig 'Jic rd e.. Telephone Expenses A ..Ise c �Ier nc ^t r7for mijs LIe f'ernitt:. 1ric the par the Le1eP410—le '_ILr:ibu- "E? ' I cite, and :he pjp c) I. Travel and Meal Expenses r,: u I c x p P. 7 re. c; r11 - .s, L ci L L u c; c r a St F 1: e of F'I:i -, I -j a Vrj j --- h (-- 7 f 7: r RE - r C) , t Sc- - T , L' ri - C, f T -a:a. must be 13LO '"Pd ar;LJ I/, :;I Dc- �)3;d r. i1c-C:C'JrI,1jrCe vth ��f (rrtraicos -ird S tat(" J'.VF; an'� _A dC'-'UPtiz-h R, - 0C7i.J - re1t8t1C , r fcj, attryi�jf a �.,7 r 7C C, I is needec- A1 rumbursemeri f •ic o-i -,,qssc-t C7 - C::Ql P C)r 771i- P.irire - cke*. A * tirr-.rFr is ap.pf , Ll 1 - , - ie auccit :ra I- - F-T - tF., re.mb-irsernerr rk'Lu - il:� - , - le v'en,cx W',II'01LC:_ F.JL!l `)Jrchases sl rDjl� ao, c,'r)c ,jr k pall p*s. Tax's Pre nnr reimbu it tikp 71 aI at a Jupi pID n-,: f'Dt e�:ai__1P1Lr a- L.r-:i "um o-ie > rce t ic nn, reimL'iu'SaLl1& P�rkirq is zC.rF; dt-rrar: -9 expe-se at dcs- - I�tiar, .4 pLr pcIJriq Jur ig a 7f 7ha IS '&qLir !(J Uri hhe ri cc�. Biil�rce cue mL:s bi] 7 F-rc). LIB' rug !;T.Prc and rl rci by The , V 7,7-C7 aj,' re _rud L)uLJ L P se'vlzze, tn vics, ijml re al'e - ,Dt a eace S ,all De at "IC? 7,37i! P5,a:D1 5'1f: A;,71_ Xxv', T�.A'Lo" P V ArJL t' 'Innrc "., Cc)u(. uf Ar ucfo re, -- i: - : I 1 bu n:1k.cJed c)ri the sCaLt %I-I v - i i l - y lrr.r(✓L "lile8ge is 1'0, 'rcj .3 - E�F'Icje - 17e :1 cI'fr:e uL a P".) - it a� de:,qr F or c.'KLr•1p1c-., d ni'] "r'i:irn .Jr - Ir -r 7e `1:1 tl D 1, 1A• r c r - I L u - i, L r - i e r. t a V: L' .j t us ti SM 15 h e iJ LI - . s. - .4 R 7 C L E L. P D I E t-di � A%D M:LEA".':It =1 0LICY u the VC CC CocJe. f C rl:jide. 'Ie� "J: li� 7 t r F e I - rust t i2 r i m r t l t ?.RI. fo - b - e ii k f a s. 11 1 e I m tI 1-i r 3 c 1 1 c r t, 1 ) a ff7j re r, :i c: j q ft e - - 7 f l]' I I - j , ) : : h r c I I u E = m e 7 a ri -c I c ) - u 6 r.1 e[ a Lt L r -m _T'b rs e m e ri Non-allowable Expenses 7"t fL)11L)v.-irg PXPe-_ISeS al'e - IL;t !.10'A'a7 e fC1` r'C Ca p 'a - L' L t I:J e? P C - 1 C I t U - (:- L ri e. 7is : I n:lLderJ it t1-v Dri cxp)eisF� . i ric _c( 1 -- 1 e ccr Lr �L um ;7, rier C fi-j dra Si r g , ri.� r - Y -r f c en cm:rzk c rqe:-, pemql- es af 7,r 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 DATF Contract: Key Bridge FY18; Page 111 ATTACHMENT C c;.,,-, c f'p-;c ard iist cf ser. tic. :e ' ' C2VLrJClL] T c p rc v i d c t he s a I a ry for o n c. rvl a.St i? r's � o. v p I --- I c.f n p d CI; n I a r t c f .9 ci I i t .9 t e t o h e e k h c u rs " Rt f r a r-, i r) 9 Yo F u L u i t- " g ra n t ; Fo r e -i v e n i I e 5 in N'c n ro e Co unt , ; from 0 c t o L o r 20:7 LhTuu�h 30, 2023. ATTACHMENT D PUBLIC ENTITY CRIME STATEMENT A pe-svr or aff Iiate w, .Q has - -een paced an the convicted vendo• ist fo lo,%1in; a conviction for z;'ubl y Clrti' ' cr me rra rot submit a bid -)r• a con -act any gcf:�cs or a 2Lbli^ :i Iti:V, - r, ay not subm a big on a zontract With a public entity far the construct; on or repair . a pjzIIC bu Id r - q c' public work, may no: subrrr bids or. ieas�s of real property to p -Gblic entity rra.y no: be awarder a., �er'cc`rn work as a CCNTRACTOP suppler, subcontractor, or CCNTPACTOR under a C;Dntrar_- n any pubiic ontity. an may rot transact bus ress hi'h ar, %r put l:c entity in excess of the *+ res c 2ri p r ov I d eci in Section 2. 8, 21?, `a• CATE3,') 7, far a periac o months frcrt, tree ca.te cf be p aced ; n the convicted 'vnndo st.' - c c tr -� ++� i I navy r_ad the abov and �:a., tl Wei. er� f4�� ' Reszcr :den: s namei nor an•y Affi ia:e ras been a•aced on „nv co wicted •4 list within U-e Est 36 - n ' Worths. r ' I:S 'ure Date. r 3 S — AT_7 0= r, Subscribed and sw3rr to �;or r, rrnedi before me cr rate; by ` I I �C r •! ' o (namc of affiant) He She is cersonail, kr�owrl to me cr has prowueev ;tr of iderlff cation; as identi` ca NOTARY PUELICC My Commissi -ar. Expires: / �r --�C�• , P. I ATTACHMENT E SWORN STATEMENT UNDER ORDINANCE N0, 010 -1990 MONROE COUNTY, FLORIDA ETiiCS CLAUSE Corn�an;,� ova -a its 'hat he �t has not employed, retained or othn ^MiSn had act on ni&her behalf any `c-met Coun�y cffiicer c err p.oree i r via late on of Section 2 of Ord inan e N i2. 0j 1 - 1 �9 0 c any C-un� cfficer or employee in vio aticr o' Sect on u cf 0 -d canoe No. 010 -1990. =or brnuon Dr vio atiarr o - -i's , `.hF ';,o; nt may. in i -s discre terminate 1 .7i5 Agree±rent wi:,ncut lia"illt,; and may alsD in Is dis:rollor, ded:�.vt from the Agreerren' o- puronase pr[::e, o othermse reco:e t - lo r -jll a7 oun' o` any fee. ccrnmission percentage �3 t, or conside paid to t�e forcer ;,eau ^ty of car r employee ' f (Signature; Cate. T47 F= OF f, Subscrio�� +�� and sorr. to ;o a�`r -neb; before rnL cr � �,_ _ C •I da'e; dy i L I r L,. iL c - �� ; name of aIf ant; . f- e S l - e is pe-sc nail; known -c me or has prz ucery = L ;type of idertif cation; as [dentificatio D �R lt'ti %ly Comrn.ssion Ex. -ireS: ATTACHMENT F E] R ['G -FREE: NVO RKPL.'1C E FORM The unde frame of Business i cor in accordance with Florida Statuto 257.087 hereby certf•es t "at: Publish a s.aterrer' ncti�ying er7p,oyees - rat the Jrla'nrFUl nlanufaoture, istribu•.!on eispensing, pcssnssicr, or use of a con: - o! ed sucstaricze is proribi'e'-I ir, tr e ,vorkpla:e and speoiiyiry she ac ions teat wi be taken aga i n 5 ernp ayaes fcr vi catiois cf such P-ori bitian 2. Irfcrtr employees about ,! v dangers of i„rag abuse in the Avkplace. the business po icy ^f ^trin',ainirg a drug -free Workplace. am; a�4ailable druo counsel ng- rehac lktatio and errplV,ree ass.s'arce programs, a ^ the oeral' es ,.nat may be imposed upcn emaica nes fo- dr;.rg abuse -.r: ofations. ? ; 're each errplc�yee engaged in p-ovidir.g the ccmmod: ties or ecrtraclual se^v,c�es that are ;;roar bf.o a copy cf the staternert spec.fied in subsection ; i. 4 17 'he sta'erren' scec;fied �r subsection ;' i, rotiry' the errp oyees tha'. as a condition. of , working on'ne :-orrrnod ties or cur ser. that are under d id. tte ern.lo will abide oy 'ne terms of tl'e statement and will nctify� :he ern loyer of ar.r carr,, o=. or plez, oI 9L;i t; or rr nc'o cortendere to any Rio atior. of ; apter 893 i,C icrfua Statutes;i or of any control•ed sVlts .3w cf the �nited Slates c any sate, for a vic'atic�n occurring -n the v;orkz lace r.o late- 4nar ft've ;S;i cloys ate such ccr.vr :t i or. �5 ITpose a sa nctlCr on, or reaui -e the satisfactor : ar' c patio) .r, a drug abase assistance or •ehabif tat on pro ,"ram f such :s avaiiable in Ire employee's ccmmunty, or any emp oyee who s S cor.I. o'�d. 6. [Take a good faith E?ffpr` to continue to mainta n a drug -free Ao-kplacc `fi^rcayr; - .rn.p erren-ation c'f th!s section As : ^e po authorizes 'v s.gn the statement. I ce - ;fy that tfi i� ccmpl ;es fully ',v,t:, the 3 "o :c r�ou�rerrnnts. r L -` ;5igr,atu`e; Date. STS=, 7 E v'r: CCUr4TY CF' Sucscr bed and to for aff rmed;! before rr cr has pr�burd f r� :��nt�ficaticr., re o` affiar.ti f~e S" is pe- sona :l -y k-towr to rr.e fi1pe of ident fcat on; as i NCTA.RY PUB_I" -- — V uorrm ssion 1= xcires c- ATTACHMENT G FY18 Annual Performance Report (For year October 1, 2017 — September 30, 2018) Agency Name POC Phone /Email Grant Amount Per Section 8 of your contract, it is required that you fill out the entire form and answer every question. Narrative on the FY18 Performance (i.e. successes, challenges, etc): Questions: 1. Please list services and client information below for the program /activities funded by the Monroe County award. Services Target Population # 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. DATF Contract: Key Bridge FY18; Page 116 5. What is the number of FTEs working on the program(s) funded by the award in FY18? 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.) DATF Contract: Key Bridge FY18; Page 117