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SY2017-2018 1st Amendment 06/20/2018 Kevin Madok, CPA a . C ' 's ' ' , " Clerk of the Circuit Court& Comptroller-Monroe County, Florida DATE: December 20, 2018 TO: Sheryl Graham, Director Social Services VIA: Kim Wilkes Wean FROM: Pamela G. Hance 410 I.C. SUBJECT: June 20th&August 15"'BOCC Meetings Enclosed are three duplicate originals of each of the following for your handling: June 20, 2018 C31 Annual Agreement between Tranquility Bay Adult Day Care and Monroe County Social Services to provide Facility-Based Respite Services to elderly and disabled citizens residing throughout Monroe County in an amount not to exceed$50,000.00 for the period of July 1, 2018 throughJune 30, 2019. C32 1st Amendment to Agreement#TB 17-18 between Tranquility Bay Adult Day Care and Monroe County Board of County Commissioners/Monroe County Social Services to provide Facility-Based respite and Caregiver Services to elderly and/or disabled Monroe County residents and to increase the "not to exceed amount"from $50,000.00 to $80,000.00 for the contract period ending June 30, 2018. August 15, 2018 C25 Rescinding of Item C30 from June 20, 2018, BOCC Agenda and granted approval and authorized execution of the Annual Agreement between Tranquility Bay Adult Day Care of Marathon CORP., and Monroe County Social Services to provide Facility-Based Respite Services to elderly and disabled citizens residing throughout Monroe County in an amount not to exceed $30,000.00 for the period of July 1, 2018 throughJune 30, 2019. I'm returning Item C30 to you without the Mayor's signature as there is no Anther action needed. Should you have any questions,please feel free to contact me at ext. 3550. Thank you. cc: County Attorney _ Finance File KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070 305-294-4641 305-289-6027 305-852-7145 305-852-7145 e � r OGNAL AMENDMENT#1 TO AGREEMENT TB #17/18 THIS AMENDMENT is made and entered into this 20th day of June, 2018 by and between MONROE COUNTY, FLORIDA,/Monroe County Social Services a political subdivision of the State of Florida (hereinafter called the "Owner" or "County"), and Tranquility Bay Adult Day Care. (Contractor). WHEREAS, on the 21'day of June 2017 the County and Tranquility Bay Adult Day Care entered into an agreement(hereafter"original agreement")to provide Facility-Based Respite Services;and WHEREAS, the original agreement was within the County Administrator's purchasing authority and was executed by the County Administrator for a total contract amount of$50,000; and WHEREAS, the County has received additional funding that will allow for Facility- Based Respite Services prompting an amendment to the agreement with Tranquility Bay Adult Day Care that exceeds the County Administrator's purchasing authority and requires Board Of County Commissioners approval; NOW THEREFORE, in consideration of the mutual covenants and provisions contained herein, the parties agree as follows: That the parties hereto, for the consideration hereinafter set forth,mutually agree as follow: SECTION 1. Article 3 of the original agreement dated June 21, 2017, is hereby amended to read as follows: 3. PAYMENTS TO THE CONTRACTOR A. Payments to the Contractor for services rendered pursuant to this Agreement shall not exceed a total of Eighty Thousand dollars ($80,000). The Contractor shall submit to the County a weekly invoice, with supporting documentation acceptable to the Clerk. Acceptability to the Clerk is based on generally accepted accounting principles and such laws, rules, and regulations as may govern the Clerk's disbursement of funds. B. Upon Monroe County's receipt and thorough review and processing of said invoices,Monroe County Clerk's Office shall submit payment to the Contractor in accordance with the Florida Prompt Payment Act. SECTION 2. All other provisions of the original agreement dated June 21, 2017 not inconsistent herewith, shall remain in full force and effect. 1 IN WITNESS WHEREOF the parties hereto have executed this Agreement on the day and date first written above in four (4) counterparts, each of which shall, without proof or accounting for the other counterparts,be deemed an original contract. Tranquility Bay Adult Day Care Monroe County Social Services Oscar Hernandez,President David Rice,Mayor By: 1 By: P Date: 6/mo0/Z6/ 8 Date: zar zo 1 if AVT.ciA,---, � �Y ,� FTj"�w 1 `5 0 /i d\\ , ,\fir\n, i -i ,,, \� off, i,L�Sf i . P pis 'YYdii �FFy' �j i /�� �_ N�OE COU ..,-c��v yF'f' VED PFDR ASSiS UfVTY ATT77 Date 1 3 IV CD r-,- 1 Cl sic), o Q . p Q �. c • -71 c: 2 ACCP EP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ka.....---- 12/17/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Liliana Ortiz NAME: Sunflowers Insurance Group Inc. (a/C.No.Ext): 305-553-4949 NE FAX No). 305-553-4958 11401 SW 40 ST#311 AIL ADDRESS: sunflowersins@live.com INSURER(S)AFFORDING COVERAGE NAIC# Miami FL 33165 _INSURER A: AMTRUST NORTH AMERICA INSURED INSURERB: AMTRUST NORTH AMERICA TRANQUILITY BAY ADULT DAY CARE INSURER C: 100360 OVERSEAS HIGHWAY INSURER D: SUITE#6,7,8 INSURER E: Key Largo FL 33037 INSURERF: COVE AGES CERTIFICATE NUMBER: I REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP/Y LIMITS LTR INSD WVD, POLICY NUMBER .IMM/DDYYY) (MM/DD/YYYY) K COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS-MADE K OCCUR DAMAGESORENc 100 000.00 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000.00 A Y NPP1008905-00 02/26/2018 02/26/2019 PERSONAL 8,ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 3,000,000.00 K POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 3,000,000.00 OTHER: Professional Liability $ Included AUTOMOBILE LIABILITY Oa MaBcINeDINGLELIMIT $ 500,000.00 ANY AUTO BODILY INJURY(Per person) $ AWNED AUTOS ONLY K AUT SCHEDOSULED NCA1008906-00 02/26/2018 02/26/2019 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLALIAB _ OCCUR -I-•-t! EM �' EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE eY 'I7ISK LPL AGGREGATE $ DED RETENTION$ $ 'T WORKERS COMPENSATION t PER OTH- ANDEMPLOYERS'LIABILITY Y/Nr`` r -� — _ STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE WAIVER W/ YES.._- E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 l N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Abuse&Molestation Included • $300,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Monroe County Board of County Commissioners is listed as an additional. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County ACCORDANCE WITH THE POLICY PROVISIONS. Board of County Commissioners AUTHORIZED REPRESENTATIVE 1100 Simonton St.Key West,FL 33040 I -`kr. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD , - TRANQUILITY BAY ADULT DAY CARE 100360 OVERSEAS HWY SUITE 6,7,8 KEY LARGO FL 33037 PH: 305 440-2398 FAX 305 440-2399 August 21, 2018 To: Monroe County Social Services My name is Oscar Hernandez and I am the owner of Tranquility Bay Adult Iay Care. I have researched and reviewed the laws of Chapter 440, Fl rida Statutes and am fully aware of the state requirements for employ rs to carry Workers Compensation Insurance. By signing below, attest under penalty of perjury, that as of 8/01/18,Tranquility Bay Adult Day Care is exempt from Workers Compensation insurance requirement. I will contact Monroe County Social Services with my WorkerJIs Compensation Insurance policy information should I become non-exempt over the coming year. Feel free to contact me should you have any questions or concerns. i Sin a ely, OS R HERNANDEZ Pres'dent I Nov 071812:38p p.1 TRANQUILITY BAY ADULT DAY CARE 100360 OVERSEAS HWY SUITE 6,7,8 KEY LARGO FL 33037 PH: 305 440-2398 FAX 305 440-2399 November 7, 2018 To: Monroe County Social Services My name is Oscar gferna ez and I am the owner air uilf a Add¢Dam are. I have researched and reviewed the laws of Chapter 440,Florida Statutes and am fully aware of the state requirements for employers to carry Workers Compensation Insurance. By signing below,I attest under penalty ofperjury, Bay�hdult Da Care is exempt from ork Wtorkers Compensatio ins ce requirement. I wilt contact IO_KL) COIGN , insurance th my Workers Compensation Insurance policy information should be become non- exempt over the coming year. Feel free to co ct me should you have any questions or concerns. Sincerely, OSCAR HERNANDEZ • President State of 2 - A County of iMonf©� day of �� do hereby confirm that on this 0 Se f_f1 y �63 appearedo before me in person who executed the preceding document; wn to be the person(s) Notary Public in and for the State of_ t My commission expires • `^:%,. LISAL.MILLER MY COMMISSION#GG 080345 co EMPIRES:June 15,2021 ye%;fit•.• Bonded Thu Notary Public Underwriters a/ et RL/O AO(V Aiy .r � TT p .31 - JIMMY PATRONIS 44, CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** NON-CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law_ EFFECTIVE DATE: 11/6/2018 EXPIRATION DATE: 11/5/2020 PERSON: OSCAR HERNANDEZ EMAIL: MRAISEL5@AOLCOM FEIN: 454896661 BUSINESS NAME AND ADDRESS: TRANQUILITY BAY ADULT DAY CARE CORP 100360 OVERSEAS HWY SUITE 6,7,8 KEY LARGO, FL 33037 SCOPE OF BUSINESS OR TRADE: College: Professional College: All Other Employees&Clerical Employees IMPORTANT:Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this within the section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply exempt p and certif icates ates of election eto be exempts or trade ted on the shall be subject to revocation it,,at any of election to be time me after the fit Pursuant to ling of the noticter e or the issuance of the election ertificate,the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. 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