Item C17 BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: December-I 1, 2013 Division: Monroe County Health Department
Bulk Item: Yes x No — Staff Contact: Robert Eadie 809-5610
AGENDA ITEM WORDING:
Approval of Amendment I to the agreement between the Monroe County BOCC and the Monroe
.County Health Department for the provision of immunization services.
ITEM BACKGROUND:
This item was previously approved on the October agenda. The population to be served has been
updated.
PREVIOUS RELEVANT BOCC ACTION:
This agreement was previously approved on the October meeting agenda for the provision of
immunization services.
CONTRACT/AGREEMENT CHANGES:
Monroe County Health Department has outlined the population to be served in the scope of services.
The description is as follows: The population to be served under this agreement is individuals
400% or less of the Federal Poverty Guidelines as outlined by the Department of Health and
Human Services. Persons at or under 400% of the Federal Poverty Guideline will be covered
under this agreement and will not incur a cost for immunization services.
STAFF RECOMMENDATIONS:
Approval.
TOTAL COST:_ $226,640.00 INDIRECT COST: BUDGETED: Yes X No
COST TO COUNTY: $226,640.00 SOURCE OF FUNDS:
REVENUE PRODUCING: Yes— No AMOUNT PER MONTH Year
APPROVED BY: County AttN(!�� OMB/Purchasing Risk Management
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM#
Revised 1/09
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: Monroe County Health Effective Date: .10/01/13
Q�tpartrn e�nt
Expiration Date: 9Z30/14
Contract Campaign,
including TDaP, flu and HPV vaccines, 1.0 FTE and a media campaign, for residents in
Monroe. County. The amended contract includes population to be served. The following
wording has been added under scone of services The,,population to be served under this
agreement is individuals 400% or less of the Federal Poverty Guidelines as outlined by the
DepartmentPersons.. at or under 400% of the Federal
Poverty .ment and will not incur a cost for
immunization services.
Contract Manager: Laura deLoach- 4482 OMB/Grants
Hartle
(Name) (Ext.) (Department)
for BOCC meeting on 12LL1L2013 Agenda Deadline: 1IL2512013
CONTRACT COSTS
Total Dollar Value of Contract: $226,640.00 Current Year Portion: $226640.00
Budgeted? Yes® No ❑ Account Codes: 001- 04599 -530340-
Grant: $0.00
County Match: $_
ADDITIONAL COSTS
Estimated Ongoing Costs: $__Jyr For:
(Not included in dollar value above) (e.g. maintenance, utilities, janitorial, salaries,
etc.)
CONTRACT REVIEW
Changes Date Out
Date In Needed Reviewer
Division Director Yes R No❑
Risk Management YesEl NoEJ-V
O.M.B,/Purchasin Yes❑ Now
9
County Attorney Yes❑ NoK
Comments:
OMB Form Revised 9/11/95 MCP #2
AMENDMENT 1 TO INTERLOCAL AGREEMENT
WITH MONROE COUNTY HEALTH DEPARTMENT
THIS AMENDMENT is made and entered into this day of , 2013,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA,
hereinafter referred to as "Board" or "County," and the Monroe County Health
Department, hereinafter referred to as "MCHD" or"PROVIDER."
WHEREAS, the PROVIDER is an agency of the State of Florida and pursuant
to Chapter 154.01(1), F.S., provides for the promotion of the public's health, the
control and eradication of preventable diseases, and the provision of primary health
for special populations, and
WHEREAS, it is a legitimate public purpose to provide immunizations and
other communicable disease control services pursuant to Chapter 154.01(2)(b) F.S.,
for persons in Monroe County; and
WHEREAS, the County and the MCHD entered into a interlocal agreement on
October 16, 2013 for performance of services related to the Adult Immunization
Campaign; and
WHEREAS, the population to be served under this agreement should be
specified in the scope of services as persons at or under 400% of the Federal
Poverty Guideline, now,therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein,
it is agreed as follows:
1. The SCOPE OF SERVICES shall be amendment to read as follows:
10. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants
and agrees with the Board to substantially and satisfactorily perform and provide
the services outlined in Attachment C to residents of Monroe County, Florida. The
population to be served under this agreement is individuals 400% or less of the
Federal Poverty Guidelines as outlined by the Department of Health and Human
Services. Persons at or under 400% of the Federal Poverty Guideline will be
covered under this agreement and will not incur a cost for immunization services.
2. Force and Effect. In all other respects the Contract dated October 16, 2013
remains in full force and effect.
In WITNESS WHEREOF each party hereto has caused this contract to be executed by
its duly authorized representative.
(SEAL) BOARD OF COUNTY COMMISSIONERS
ATTEST: AMY HEAVILIN, CLERK OF MONROE COUNTY, FLORIDA
By By_
Deputy Clerk Mayor/Chairman
Monroe County Health Department
(Federal ID No.59-3502843)
Witness
By
Witness
MONROE COUNTY ATTORNEY
APPROVED AS TO FORW
CHRIST��NEM, L�IMBE
ASSISTANT COUN TY AT'rORNEY
Date
INTERLOCAL AGREEMENT
MONROE COUNTY HEALTH DEPARTMENT
THIS INTERLOCAL AGREEMENT is made and entered into this 16th day of October, 2013,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter
referred to as "Board" or "County," and the Monroe County Health Department, hereinafter
referred to as "MCHD" or"PROVIDER."
WHEREAS, the PROVIDER is an agency of the State of Florida and pursuant to Chapter
154.01(1), F.S., provides for the promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health for special populations, and
WHEREAS, it is a legitimate public purpose to provide immunizations and other
communicable disease control services pursuant to Chapter 154.01(2)(b) F.S., for persons in
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 carrying out the duties of the Board as to providing
an Adult Immunization Campaign for persons in Monroe County, Florida, shall pay to the
PROVIDER the sum of TWO HUNDRED AND TWENTY SIX THOUSAND AND SIX HUNDRED AND
FORTY DOLLARS ($226,640.00) for fiscal year 2013-2014.
2. TERM. This Agreement shall commence on October 1, 2013, and terminate September
30, 2014, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be made periodically, but no more frequently than monthly,
as hereinafter set forth. Reimbursement requests will be submitted to the Board via the Clerk's
Finance Office. Included with each request will be a corresponding Activity Report indicating the
vaccine type, quantity purchased and number of doses administered. The County shall only
reimburse, subject to the funded amounts in Attachment C, 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 as Attachment B. The organization's
final invoice must be received within thirty days after the termination date of this contract shown
in Article 2 above.
After the Clerk of the Board examines and approves the request for reimbursement, the
Board shall reimburse the PROVIDER. However, the total of said reimbursement expense
payments in the aggregate sum shall not exceed the total amount shown in Article 1, above,
during the term of this agreement.
4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a
level sufficient to allow for continued reimbursement of expenditures for services specified herein,
this agreement may be terminated immediately at the option of the Board by written notice of
termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services
or goods provided by the PROVIDER after the PROVIDER has received written notice of
termination, unless otherwise required by law.
S. CLAIMS FOR FEDERAL OR STATE AID. PROVIDER and County agree that each shall
be, and is, empowered to apply for, seek, and obtain federal and state funds to further the
ILA-MCHD Adult Immunization Campaign-FY14;page 1
. .
purpose of this Agreement; provided that all applications, requests, grant proposals, and funding
solicitations shall be approved by each party prior to submission.
6. 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 tostatutory requirements.
RECORDKEEPING
7. 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 ur 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, FS, running from the date the monies were paid to PROVIDER.
S. 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 inconjunction with this Agreement; and the County shall have the right to
unilaterally cancel this Agreement upon violation of this provision by PROVIDER.
9- COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the
County the following:
(a) 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;
(b) Cooperation with County monitoring visits that the County may request during the contract
year; and
(c) 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
10, SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and provide the services outlined
in Attachment Cto residents ofMonroe County, Florida.
11. 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.
12~ CODE OF ETHICS. County agrees that officers and employees of the County
recognize and will be required to comply with the standards of conduct for public officers and
employees as delineated in Section 112.]1], 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 ofcertain information.
/LA'MCHDAdult ImmunizabonCampaigm-FY/4;page
^ .
13. 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 m bona fide
employee working solely for it, any fee, commission, percentage, gift, or other consideration
contingent upon or resulting from the award or making of this Agreement. For the breach or
violation of the provision, the PROVIDER agrees that the County shall have the right to terminate
this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise
recover, the full amount of such fee, commission, percentage, gift, or consideration.
14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee of the Board. No statement
contained in this agreement shall be construed so as to find the PROVIDER or any of its
employees, contractors, servants or agents to be employees of the Board,
COMPLIANCE ISSUES
15. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the
PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining in 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 tothe PROVIDER.
16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure
that all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state
and/or federal certification and/or |icensure of the PROVIDER'S program and staff.
17. NON-DISCRIMINATION. County and PROVIDER agree that there will be no
discrimination against any person, and it is expressly understood that upon a determination by a
court of competent jurisdiction that discrimination has occurred, this Agreement automatically
terminates without any further action on the part of any party, effective the date of the court
order. County or PROVIDER agree to comply with all Federal and Florida statutes, and all local
ordinances, as applicable, relating to nondiscrirninabon. These include but are not limited to: 1)
Title VI of the Civil Rights Act of 1964 (PL 88-]52) which prohibits discrimination on the basis o'
race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended /20
(�U� ss. 1581-1683, 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 prohibit'
discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42
{�U� ss. 6101-6107) which prohibits discrimination on the basis of age; 5\ The [}rug Abuse Office
and Treatment Act of 1972 (PL92-255), 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 (PL91-616), as amended, relating to nondiscrimination on the basis of
alcohol abuse or alcoholism; 7) The Public Hcm|Lh Service Act of 1912, ss. 523 and 527 (42 U5C
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 e to time, relating to
nondiscrimination on the basis of disability; 10\ 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
6LA'MCHD Adult Immunization Campa{gn-pY/4;page 3
^ .
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.
19. 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. If no resolution can be agreed upon
within ]O days after the first meet and confer session, the issue or issues shall be discussed at a
public meeting of the Board of County Commissioners, If the issue or issues are still not resolved
to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy
as may be provided by this Agreement or by Florida law.
20. 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
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 perform
and receive benefits as recited in this Agreement.
22. 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 subiect 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.
23. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.20,
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 o 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. AlTESl[AlFIKDN& 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
26. INDEMNIFICATION AND HOLD HARMLESS. To the extent permitted by law, and
as limited by Section 768.28, F.S., the PROVIDER covenants and agrees to indemnify and hold
harmless Monroe County Board of County Commissioners from any and all claims for 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
/LA'M*HD Adult Immuniza8onCampa/gn-FY,4;page
.
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,
27. 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
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.
28. NO PERSONAL LIABILITY. No covenant or agreement contained herein sha|l 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.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation o[ Constitutional
or Statutory Duties. This Agreement isnot intended to, nor shall it be construed as, relieving any
participating entity from any obligation orresponsibility imposed upon the entity by law except to
the extent ofactual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
30. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled tnrely
upon the terms of this Agreement to enforce or attempt to enforce any third-party claim or
entitlement to or benefit ofany service or program contemplated hereunder, and the County and
the PROVIDER agree that neither the County nor the PROVIDER orany 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
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 asfollows:
EoI Board:
Grants Administrator and Monroe County Attorney
11DO Simonton Street PO Box 1026
Key West, FL33O4O Key West, FL33O41
For PROVIDER
Robert Ead(e, Administrator
Monroe County Health Department
1100S|rnonton Street
Key West, FL 33040
/LA'MCHD Adult ImmunizahonCampa/gn-FY/4;page
.
305-803-5610
305-809-5629FAX
33~ GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This
Agreement shall be governed by and construed in accordance with the |avvo of the State of Florida
applicable to contracts made and to be performed entirely in the Staie.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will
lie in the appropriate court Or before the appropriate administrative body in Monroe County,
Florida,
The County and PROVIDER agree that, in the event of conflicting interpretations of the
terms or a term of this Agreement by or between any of them the issue shall be submitted to
mediation prior to the institution of any other administrative or legal proceeding.
34. NON-WAIVER. Any waiver of any breach of covenants herein 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.
35, SEVERAK8ILITY. 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 |avv unless the enforcement of the remaining terms, covenants,
conditions and provisions of this Agreement would prevent the accomplishment of the original
intent Vf this Agreement. The County and PROVIDER agree to reform the Agreement to replace
any stricken provision with a valid provision that comes as dose as possible to the intent of the
stricken provision.
36. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the PROVIDER and the Board.
[THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TOFOLLOW]
/LA'/w[HDAdult Immunization Canpaign-FY/4;page o
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as
and year first written above.
' t E BOARD OF COUNTY COMMISSIONERS
Y HEAVILIN, CLERK OF MONROE COUNTY, FLORIDA
Prr�r �r
B
De uty Cler Mayor/Chairma
yfy Monroe County Health Department
(Federal ID No. 5'9—gSo'gFg3 )
Wi ness
r
By
Witness
MONROE COUNTY ATTORNEY
/1A,PPROVED AS TO FORM:
CHRISTINE M. LIMBERT-BARROWS
ASSISTANT COUNTY ATTORNEY
Date IQJ I tI A
ILA-MCHD Adult immunization Campaign-FY14;page 7
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 b] 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 organizahon'm 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 to3O5-292-]534.
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 orhourly rate, total
hours worked, withholding information and paid payroll taxes, check number and check amount.
If 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 ofcopies 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.
ILA-MCHD Adult Immunization Campaigm'Fv/4;page
Telefax, Fax, etc.
Afax 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 besubmitted 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. Atnnvd itinerary is appreciated tn 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. Hoorn
must be registered and paid for bytraveler. 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 beatthe rate established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY nf the Monroe County Code ofOrdinances. 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
fora business trip is not reimbursable expense.
Meal reimbursement shall beatthe rates established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code ofOrdinances. 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 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.
ILA-MCHDAdult Immunization Campa(gn-FY/4;page 9
ATTACHMENT 8
ORGANIZATION
LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
5OO Whitehead Street
Key West, FL33O4O
Date
The following is a summary of the expenses for ( ) for the time period
of______ to______.
Check # Payee Reason Amount
101 Company Rent $ X,XXX.XX
102 Company Utilities X%X.XX
104 Employee P/R endingU5/14/O1 XXX.XX
185 Employee P/R ending O5/28/01 X (X.XX
(A) Total
(B) Total prior payments $ X,XXX.XX
(C) Tota( requested and paid (Af B) $ X,XXX.XX
([}) Tota} contract amount $ X/XXX.XX
Balance of contract (U-C)
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 ZO by
who |Gpersonally known to me.
Notary Public Notary Stamp
ILA-/NChD Adult Immunization Campaign'FY,v;page /o
ATTACHMENT C
Services to be provided:
ADULT IMMUNIZATION CAMPAIGN
Item Detail Total Cost
TDaP Vaccine 600 doses $ 20,100
Flu Vaccine 1,200 doses 10,800
HPV Vaccine 900 doses 117,900
(Oty 300 x 3 dose series)
RN Specialist 1.0 FTE Salary & Benefits 63,840
Media Mixed Media Campaign 14,000
Total $ 226,640
ILA-MCHD Adult Immunization Campaign-FY14;page 11
` ~
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 o[ 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 contractor, supplier, subcontractor, or consultant 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 207.017, for CATEGORY TWO for a period of 36
months from the date of being placed on the convicted vendor list."
ILA'MC*D Adult Immunization Cmnpaign-FY/o;page /2
. ~
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
M0NROE COUNTY, FLORIDA
ET7H�IXCSLA.7U .
warrants that he/it has not employed, retained or
otherwise h�d act on his/its—behalf any former County officer or employee in violation of Section 2
of Ordinance No. 10-1990 or any County officer or employee in violation of Section 3 of Ordinance
No. 10-1990. For breach or violation of this provision the County may, in its discretion, terminate
this contract without liability and may also, in its discretion, deduct from the contract 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.
(sign re)
Date:—
STATE0F
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, affixed his/her
signature (name ofindividual signing) in the space provided above on this day of
20__�=�
My commission expires:
Expires January 13,2014
OMB - MCP FORM #4
uA-MKJHD Adult Immunization Campaign-FY/4;paDe 13
. .
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Business)
1. Publishes statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of controlled substance is prohibited in the workplace and
specifying the actions that will be taken against employees for violations of such prohibition,
2. Informs employees about the dangers of drug abuse in the workplace, the business's 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. Gives each employee engaged in providing the commodities orcontractual services that are
under bid a copy of the statement specified in subsection /1\.
4. In the statement specified in subsection (1), notifies the employees that, as 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
no|o contendere to, any violation of Chapter 893 (Florida Statutes) orofany controlled substance
|avv of the United States or any state, for a violation occurring in the workplace no later than five
(5) days after such conviction.
5. Imposes sanction on, or require the satisfactory participation in drug abuse assistance ur
rehabilitation program if such is available in the employee's community, or any employee who is
so convicted,
G. Makes good faith effort to continue hn maintain adrug-frae 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.
STATE OF 71
(Signature 0 dent)
COUNTY OF u
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
~ who, after first being sworn by me, (name of
/no|v/oua{ signing) affixed his/her signature in the space provided above on this
d of
20 \��.
My commission expires:
6LA'MCHDxdult Immunization Compa(gn'FY/4;page /4