Item C18 •
BOARD OF COUNTY COMMISSIONERS
County of Monroe
1 Mayor Sylvia J.Murphy,District 5
- � A Mayor Pro Tern Dann L.Kolha e,District I
The Florida Keys N) ) y y g
r Michelle Coldiron,District 2
Heather Carruthers,District 3
David Rice,District 4
Commissioner David P.Rice
9400 Overseas Hwy., Suite 210 •
Florida Keys Marathon Airport Main Terminal
Marathon, FL 33050
Boccdis4@monroecounty-fl.gov
305-289-6000
Interoffice Memorandum
Date: October 10,2019
To: Kevin Madok, Clerk of the Court
County Clerk's Office
From: Commissioner David Rice,District 4
RE: NOTICE OF VOTING CONFLICT
Per Florida Statute 112.3143,I hereby disclose by written memorandum that I will
abstain from the vote on certain issues brought before the Monroe County Board of
Commissioners with entities with which I am involved.
I will abstain from the vote on issues concerning the following entities:
Guidance Care Center,Inc., a private,not-for-profit entity,which receives some of its
operational funding from the County, as I currently sit on the Board of Directors of the
Guidance Care Center. I am also a member of the Board of the Historic Florida Keys
Foundation,Inc.
At the October 16,2019 BOCC meeting,I abstained from the vote on item(s):
#C1, C15, C17, C18, C20
Copy of agenda item listing from the Revised Agenda for each of the referenced item(s)is included for
documentation.
ATT:• State Form 8B Memorandum of Voting Conflict for County,Municipal,and Other Local Elected
Officers
FORM 8B MEMORANDUM OF VOTING CONFLICT FOR
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
LAST NAME—FIRST NAME—MIDDLE NAME NAME OF BOARD,COUNCIL,C MMISSION,AUTHORI 0 COMMITTEE
(ZLCE DAVID PA YAVt enonrva-Coo,i- , Ovarl e Comm(ssroo
MAILING ADDRESS THE BOARD,COUNCIL,COMMISr�ION,AUTHORITY OR COMMITTEE ON
9 33 m o C.(!s 1-a I c (-EL Ln • WHICH I SERVE IS A UNIT F: (j
CITY II u COUNTY 0 CITY COUNTY 0 OTHER LOCALAGENCY
(�alra--ko n Ma n rO¢— NAAMME OF POLITICAL SUBDIVISI N:
DATE ON WHICH VOTE OCCURRED ' " '�IT�aQ- �U n
MY POSITION IS:
)iCELECTI E ❑ APPOINTIVE
WHO MUST FILE FORM 8B
This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council,
commission, authority, or committee. It applies to members of advisory and non-advisory bodies who are presented with a voting conflict of
interest under Section 112.3143, Florida Statutes.
Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending
on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before
completing and filing the form.
INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which
would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on
a measure which would inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained
(including the parent, subsidiary, or sibling organization of a principal by which he or she is retained);to the special private gain or loss of a
relative;or to the special private gain or loss of a business associate.Commissioners of community redevelopment agencies(CRAs) under
Sec. 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one-acre, one-vote basis are not prohibited
from voting in that capacity.
For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law,
mother-in-law, son-in-law, and daughter-in-law.A"business associate" means any person or entity engaged in or carrying on a business
enterprise with the officer as a partner,joint venturer, coowner of property, or corporate shareholder(where the shares of the corporation
are not listed on any national or regional stock exchange).
* * * * * * * * * * * * * *
ELECTED OFFICERS:
In addition to abstaining from voting in the situations described above, you must disclose the conflict:
PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are
abstaining from voting; and
WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the
minutes of the meeting,who should incorporate the form in the minutes.
* * * * * * * * * * * * * * * *
APPOINTED OFFICERS:
Although you must abstain from voting in the situations described above, you are not prohibited by Section 112.3143 from otherwise
participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision,
whether orally or in writing and whether made by you or at your direction.
IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
TAKEN:
• You must complete and file this form (before making any attempt to influence the decision)with the person responsible for recording the
minutes of the meeting,who will incorporate the form in the minutes. (Continued on page 2)
CE FORM 8B-EFF.11/2013 PAGE 1
Adopted by reference in Rule 34-7.010(1)(f),F.A.C.
APPOINTED OFFICERS (continued)
• A copy of the form must be provided immediately to the other members of the agency.
• The form must be read publicly at the next meeting after the form is filed.
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
• You must disclose orally the nature of your conflict in the measure before participating.
• You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of
-the
meeting,who must incorporate the form in the minutes.A copy of the form must be provided immediately to the other members of the
agency, and the form must be read publicly at the next meeting after the form is filed.
DISCLOSURE OF LOCAL OFFICER'S INTEREST_ / •
I, David P- A(alp , hereby disclose that on 9 /1 i(c ,20 1,
(a)A measure came or will come before my agency which (check one or more)
inured to my special private gain or loss;
inured to the special gain or loss of my business associate, • ;
inured to the special gain or loss of my relative,
inured to the special gain or loss of ,by
whom I am retained;or
inured to the special gain or loss of ,which
is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me.
aohe measure before my agency and the nature of my conflicting interest in the measure is as follows:
I currently sit on the Board of Directors of the Guidance Care Center,Inc.
I am also a member of the Board of the Historic Florida Keys Foundation, Inc.
SEE ATTACHED AGENDA ITEM SUMMARY
�► � CA- C(s, CA-7
If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer,
who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way
as to provide the public with notice of the conflict.
D(.'4o1 /2 2D1 /
Date Filed Signature
NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE
CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT,
REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A
CIVIL PENALTY NOT TO EXCEED $10,000.
CE FORM 88-EFF. 11/2013 PAGE 2
Adopted by reference in Rule 34-7.010(1)(f),FA.C.
C.18
t, BOARD OF COUNTY COMMISSIONERS
County of Monroe Mayor Sylvia Murphy,District 5
The Florida.Keys � � �l'U � Mayor Pro Tern Danny Kolhage,District 1
�pw° Michelle Coldiron,District 2
Heather Carruthers,District 3
David Rice,District 4
County Commission Meeting
October 16, 2019
Agenda Item Number: C.18
Agenda Item Summary #6143
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Janet Gunderson (305) 292-4470
Bulk
AGENDA ITEM WORDING: Approval of Agreement with Guidance/Care Center for the
Community Transportation for Disadvantaged (CTD) program in the amount of$41,225 and Baker
Act Transportation service program in the amount of$165,000 for Fiscal Year 2020.
ITEM BACKGROUND: The County annually provides the required local match for transportation
services for the disadvantaged and Baker Act. The FY2020 required local match for the Community
Transportation for Disadvantaged program is $41,225 and Baker Act Transportation funding request
is $165,000.
PREVIOUS RELEVANT BOCC ACTION: The budgets for Community Transportation for the
Disadvantaged (CTD) and Baker Act transportation services were approved by the BOCC on
September 18, 2019 during the adoption of the final Monroe County Operating Budget for Fiscal
Year 2020.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Contract - GCC - Transporation (Baker& CTD) FY2020
FINANCIAL IMPACT:
Effective Date: 10/01/2019
Expiration Date: 09/30/2020
Total Dollar Value of Contract: $206,225
Total Cost to County: $206,225
Packet Pg. 500
C.18
Current Year Portion: $206,225
Budgeted: $206,225
Source of Funds: 001
CPI: N/A
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in above dollar amounts: N/A
Revenue Producing: N/A If yes, amount:
Grant: N/A
County Match: N/A
Insurance Required: N/A
Additional Details: N/A
10/16/19 001-045903 - GCC BAKER ACT TRNSP $165,000.00
10/16/19 001-01509 - MIDDLE KEYS GUIDANCE CLI $41,225.00
Community Transportation for Disadvantaged
Total: $206,225.00
REVIEWED BY:
Tina Boan Completed 10/01/2019 3:29 PM
Christine Limbert Completed 10/01/2019 4:23 PM
Maria Slavik Completed 10/01/2019 6:08 PM
Kathy Peters Completed 10/01/2019 6:08 PM
Board of County Commissioners Pending 10/16/2019 9:00 AM
Packet Pg. 501
AGREEMENT
This Agreement is made and entered into this 16th day of October 2019, between the BOARD
OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or
"County," and Guidance/Care Center, Inc., a Florida 501(c)(3) not-for-profit corporation, hereinafter
referred to as "PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established to provide transportation
services to the citizens of Monroe County, and
WHEREAS, it is a legitimate public purpose to provide transportation services to the residents
of Monroe County, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows:
FUNDING
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and providing services, shall reimburse the PROVIDER for providing
transportation services as billed by the PROVIDER for clients qualifying for such services under
applicable state and federal regulations and eligibility determination procedures. The cost shall not
exceed a total reimbursement of TWO HUNDRED SIX THOUSAND TWO HUNDRED TWENTY-FIVE
DOLLARS ($206,225.00), during the fiscal year 2020, payable as follows:
a) The sum of ONE HUNDRED SIXTY-FIVE THOUSAND DOLLARS ($165,000.00) for Baker
Act/Marchman Act transportation services pursuant to Chapter 394, Florida Statutes; and
b) The sum of FORTY-ONE THOUSAND TWO HUNDRED TWENTY-FIVE DOLLARS ($41,225.00),
for Community Transportation Coordinator-related transportation services to residents of Monroe
County.
2. TERM. This Agreement shall commence on October 1, 2019, and terminate September
30, 2020, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment for Baker Act and Marchman Act transportation services shall be
made according to the rate schedule set forth in Attachment D and in accordance with Attachment A,
as applicable, subject to the maximum amounts set forth in Paragraph 1. a. above. Billing Summary
Forms, certified monthly financial and service load reports will be made available to the Board to
validate the delivery of services under this contract. The monthly financial report is due in the office
of the Clerk of the Board no later than the 15th day of the following month. After the Clerk of the
Board pre-audits the certified report, the Board shall reimburse the Provider for its monthly
expenses. However, the total of said monthly payments in the aggregate sum shall not exceed the
total amount shown in Paragraph 1, above, during the term of this agreement and are subject to
examination, approval and audit by the Clerk. To preserve client confidentiality required by law,
copies of individual client bills and records shall not be available to the Board for reimbursement
purposes but shall be made available only under controlled conditions to qualified auditors for audit
purposes. The organization's final invoice must be received within thirty days after the termination
date of this contract shown in Paragraph 2 above.
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.
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,
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 1
1
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. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds
provided under this agreement, shall become the property of Monroe County and shall be accounted
for pursuant to statutory requirements. Funding under this agreement shall not be used to purchase
capital assets.
RECORDKEEPING
6. RECORDS AND RIGHT TO AUDIT. PROVIDER shall maintain all books, records, and
documents directly pertinent to performance under this Agreement in accordance with generally
accepted accounting principles consistently applied. Each party to this Agreement or their
authorized representatives shall have reasonable and timely access to such records of each other
party to this Agreement for public records purposes during the term of the Agreement and for four
years following the termination of this Agreement. If an auditor employed by the County or Clerk
determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not
authorized by this Agreement, the PROVIDER shall repay the monies together with interest
calculated pursuant to Sec. 55.03, F.S., running from the date the monies were paid to PROVIDER.
Right to Audit. Availability of Records. The records of the parties to this Agreement relating to the
Project, which shall include but not be limited to accounting records (hard copy, as well as computer
readable data if it can be made available; general ledger entries detailing cash and if applicable
trade discounts earned, insurance rebates and dividends; any other supporting evidence deemed
necessary by County or the Monroe County Office of the Clerk of Court and Comptroller (hereinafter
referred to as "County Clerk") to substantiate charges related to this agreement, and all other
agreements, sources of information and matters that may in County's or the County Clerk's
reasonable judgment have any bearing on or pertain to any matters, rights, duties or obligations
under or covered by any contract document (all foregoing hereinafter referred to as "Records") shall
be open to inspection and subject to audit and/or reproduction by County's representative and/or
agents or the County Clerk. County or County Clerk may also conduct verifications such as, but not
limited to, counting employees at the job site, witnessing the distribution of payroll, verifying payroll
computations, overhead computations, observing vendor and supplier payments, miscellaneous
allocations, special charges, verifying information and amounts through interviews and written
confirmations with employees, Subcontractors, suppliers, and contractor's representatives. The
County Clerk possesses the independent authority to conduct an audit of Records, assets, and
activities relating to this Project. The right to audit provisions survives the termination of expiration
of this Agreement.
In addition, if PROVIDER is required to provide an audit as set forth in in Section 8(e) below, the
audit shall be prepared by an independent certified public accountant (CPA) with a current license, in
good standing with the Florida State Board of Accountancy.
7. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and
inspection of, all documents, papers, letters or other materials in its possession or under its control
subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and
PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally
cancel this Agreement upon violation of this provision by PROVIDER. This provision shall survive any
termination or expiration of the contract. The PROVIDER is encouraged to consult with its advisors
about Florida Public Records Law in order to comply with this provision.
Pursuant to F.S. 119.0701 and the terms and conditions of this contract, the PROVIDER is required
to:
1) Keep and maintain public records that would be required by the County to
perform the service.
Guidance Care Center—Transportation:Baker Act and CTD FY20,-page 2
2
2) Upon receipt from the County's custodian of records, provide the County with a
copy of the requested records or allow the records to be inspected or copied
within a reasonable time at a cost that does not exceed the cost provided in
this chapter or as otherwise provided by law.
3) Ensure that public records that are exempt or confidential and exempt from
public records disclosure requirements are not disclosed except as authorized
by law for the duration of the contract term and following completion of the
contract if the PROVIDER does not transfer the records to the County.
4) Upon completion of the contract, transfer, at no cost, to the County all public
records in possession of the PROVIDER or keep and maintain public records
that would be required by the County to perform the service. If the PROVIDER
transfers all public records to the County upon completion of the contract, the
PROVIDER shall destroy any duplicate public records that are exempt or
confidential and exempt from public records disclosure requirements. If the
PROVIDER keeps and maintains public records upon completion of the contract,
the PROVIDER shall meet all applicable requirements for retaining public
records. All records stored electronically must be provided to the County, upon
request from the County's custodian of records, in a format that is compatible
with the information technology systems of the County.
5) A request to inspect or copy public records relating to a County contract must
be made directly to the County, but if the County does not possess the
requested records, the County shall immediately notify the PROVIDER of the
request, and the PROVIDER must provide the records to the County or allow
the records to be inspected or copied within a reasonable time.
If the PROVIDER does not comply with the County's request for records, the County shall enforce the
public records contract provisions in accordance with the contract, notwithstanding the County's
option and right to unilaterally cancel this contract upon violation of this provision by the PROVIDER.
A PROVIDER who fails to provide the public records to the County or pursuant to a valid public
records request within a reasonable time may be subject to penalties under section119.10, Florida
Statutes.
The PROVIDER shall not transfer custody, release, alter, destroy or otherwise dispose of any public
records unless or otherwise provided in this provision or as otherwise provided by law.
IF THE PROVIDER HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER
119, FLORIDA STATUTES, TO THE PROVIDER'S DUTY TO PROVIDE PUBLIC
RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC
RECORDS, BRIAN BRADLEY AT PHONE# 305-292-3470 BRADLEY-
BRIAN@MONROECOUNTY-FL.GOV, MONROE COUNTY ATTORNEY'S OFFICE 1111
12T" Street, SUITE 408, KEY WEST, FL 33040.
S. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the
County the following (items (a)-(j) must be provided prior to the payment of any invoices):
(a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status;
(b) Proof of registration with the Florida Department of Agriculture, as required by Florida Statute
496.405, and the Florida Department of State, as require by Florida Statute 617.01201, or
proof of exemption from registration as per Florida Statute 496.406.
(c) List of the Organization's Board of Directors of which there must be at least 5 and for each
board member please indicate when elected to serve and the length of term of service;
(d) Evidence of annual election of Officers and Directors;
(e) Unqualified audited financial statements from the most recent fiscal year for all organizations
that expend $150,000 a year or more; if qualified, include a statement of deficiencies with
Guidance Care Center—Transportation:Baker Act and CTD FY20,-page 3
3
corrective actions recommended/taken; audit shall be prepared by an independent certified
public accountant (CPA) with a current license, in good standing with the Florida State Board
of Accountancy. If the PROVIDER receives $100,000 or more in grant funding from the
County:
a. The CPA that prepares the audit must also be a member of the
American Institute of Certified Public Accountants (AICPA);
b. The CPA must maintain malpractice insurance covering the audit
services provided and
c. The County shall be considered an "intended recipient" of said audit.
(f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules;
(g) Organization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
(h) Organization's Policies and Procedures Manual which must include hiring policies for all staff,
drug and alcohol-free workplace provisions, and equal employment opportunity provisions;
(i) Specific description or list of services to be provided under this contract with this grant (see
Attachment C);
(j) Annual Performance Report describing services rendered during the most recently completed
grant period (to be furnished within 30 days after the contract end date.) The performance
report shall include statistical information regarding the types and frequencies of services
provided, a profile of clients (including residency) and numbers served, and outcomes
achieved (see Attachment H);
(k) Cooperation with County monitoring visits that the County may request during the contract
year; and
(1) Other reasonable reports and information related to compliance with applicable laws, contract
provisions and the scope of services that the County may request during the contract year.
RESPONSIBILITIES
9. SCOPE OF SERVICES. The Provider, for the consideration named, covenants and agrees
with the Board to substantially and satisfactorily perform and carry out the duties of the Board in
rendering counsel in the matter of mental health and guidance to the citizens of the Monroe County,
Florida. The Provider shall provide Baker Act transportation services in compliance with Florida
Statutes Chapter 394. Baker Act and Marchman Act transportation services which are covered
under this agreement may be subcontracted but are subject to the rates set forth in Attachment D,
and the limitations above. The subcontractor shall be subject to all of the conditions of this contract,
including but not limited to insurance and hold-harmless requirements, as is the Provider.
10. ACCESS TO FUELING FACILITIES. The County shall provide access to the Provider's
vehicles at all County fueling facilities. The County shall grant the Provider a license for the use of
the real property and its improvements for each fueling site.
The Provider agrees that only those individuals authorized by the County to use the fueling
sites designated in this agreement shall have twenty-four-hour access to said sites, and that they
shall either be maintained open or access otherwise provided to them by a uniform key system on
such a twenty-four-hour basis.
The County shall bill the Provider for fueling and other related services and materials utilized
by the Provider at the fueling sites within the County's immediate control and as previously set forth
in this agreement. Said billing by the County to the Provider shall include an administrative
surcharge, as adopted by the Monroe County Board of County Commissioners annually, for
processing, servicing, and handling. The Provider shall reimburse the County within thirty (30) days
of the date of issuance of the bill.
Access to the Fuel Sentry System shall be provided by an electronic memory key, which shall
be issued by the County to all authorized designated users of the fueling sites, and as contemplated
by this Agreement. For purposes of uniformity, the Monroe County Fleet Management Department
shall be responsible for establishing a uniform electronic key system for use by both the County and
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 4
4
the Provider under this agreement and shall establish and maintain policies and procedures for
identification, control, and distribution of all keys issued.
11. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event
any cause of action or administrative proceeding is initiated or defended by any party relative to the
enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable
attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award against the non-
prevailing party, and shall include attorney's fees, courts costs, investigative, and out-of-pocket
expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this
Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary
procedures required by the circuit court of Monroe County.
12. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement
shall bind and inure to the benefit of the County and PROVIDER and their respective legal
representatives, successors, and assigns.
13. CODE OF ETHICS. County agrees that officers and employees of the County recognize
and will be required to comply with the standards of conduct for public officers and employees as
delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or
acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public
position, conflicting employment or contractual relationship; and disclosure or use of certain
information.
14. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect to
itself, it has neither employed nor retained any company or person, other than a bona fide employee
working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any
person, company, corporation, individual, or firm, other than a bona fide employee working solely
for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting
from the award or making of this Agreement. For the breach or violation of the provision, the
PROVIDER agrees that the County shall have the right to terminate this Agreement without liability
and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee,
commission, percentage, gift, or consideration.
15. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee, agent or instrumentality of the Board.
No statement contained in this agreement shall be construed so as to find the PROVIDER or any of
its employees, contractors, servants or agents to be employees of the Board.
COMPLIANCE ISSUES
16. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the
PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating
the provision of such services, including those now in effect and hereinafter adopted. Any violation
of said statutes, ordinances, rules and regulations shall constitute a material breach of this
agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
17. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure
that all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state
and/or federal certification and/or licensure of the PROVIDER'S program and staff.
18. NON-DISCRIMINATION. The 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.
The COUNTY and PROVIDER agree to comply with all Federal and Florida statutes, and all local
ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1)
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 5
5
Title VII of the Civil Rights Act of 1964 (PL 88-352), which prohibits discrimination in employment on
the basis of race, color, religion, sex, and national origin; 2) Title IX of the Education Amendment of
1972, as amended (20 USC §§ 1681-1683, and 1685-1686), which prohibits discrimination on the
basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC § 794), which
prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as
amended (42 USC §§ 6101-6107), which prohibits discrimination on the basis of age; 5) The Drug
Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on
the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis
of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, §§ 523 and 527 (42 USC
§§ 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 §§ 3601 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 §§ 12101), as amended from time to time, relating to nondiscrimination in
employment on the basis of disability; 10) Monroe County Code Chapter 14, Article II, which
prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual
orientation, gender identity or expression, familial status or age; and 11) any other
nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or
the subject matter of, this Agreement.
AMENDMENTS, CHANGES, AND DISPUTES
19. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services
and/or reimbursement of services shall be accomplished by an amendment, which must be approved
in writing by the COUNTY.
20. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree
that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions
between representatives of each of the parties. The PROVIDER and County staff shall try to resolve
the claim or dispute with meet and confer sessions to be commenced within 30 days of the dispute
or claim. If the issue or issues are still not resolved to the satisfaction of the parties, then any party
shall have the right to seek such relief or remedy as may be provided by this agreement or by
Florida law. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit
Court, 161" Judicial Circuit, Monroe County, Florida.
21. COOPERATION. In the event any administrative or legal proceeding is instituted
against either party relating to the formation, execution, performance, or breach of this Agreement,
County and PROVIDER agree to participate, to the extent required by the other party, in all
proceedings, hearings, processes, meetings, and other activities related to the substance of this
Agreement or provision of the services under this Agreement. County and PROVIDER specifically
agree that no party to this Agreement shall be required to enter into any arbitration proceedings
related to this Agreement.
ASSURANCES
22. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently
has any interest, and shall not acquire any interest, which would conflict in any manner or degree
with its performance under this Agreement, and that only interest of each is to perform and receive
benefits as recited in this Agreement.
23. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing
and with the prior written approval of the Board, which approval shall be subject to such conditions
and provisions as the Board may deem necessary. This agreement shall be incorporated by
reference into any assignment and any assignee shall comply with all of the provisions herein.
Unless expressly provided for therein, such approval shall in no manner or event be deemed to
impose any obligation upon the Board in addition to the total agreed upon reimbursement amount
for the services of the PROVIDER.
Guidance Care Center—Transportation:Baker Act and CTD FY20,-page 6
6
24. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida
Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of
any commercial liability insurance coverage, self-insurance coverage, or local government liability
insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability
coverage, nor shall any contract entered into by the County be required to contain any provision for
waiver.
25. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug-
Free Workplace Statement.
26. AUTHORITY. Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all necessary County and
corporate action, as required by law.
INDEMNIFICATION AND INSURANCE
27. INDEMNIFICATION, HOLD HARMLESS AND INSURANCE REQUIREMENT. The
PROVIDER covenants and agrees to indemnify and hold harmless Monroe County Board of County
Commissioners from any and all claims and causes of action for medical malpractice, medical
negligence, bodily injury (including death), personal injury, and property damage (including property
owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees)
which arise out of, in connection with, or by reason of services provided by the PROVIDER
occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S
employees, agents, or volunteers.
Insurance Reauirement Limits
Worker's Compensation Statutory Limits
Employer Liability $1,000,000 Each Accident
General Liability $1,000,000 Each Occurrence
$3,000,000 General Aggregate
Vehicle Liability
(Owned, hired and
Non- owned Vehicles) $1,000,000 Combined Limit
All insurers shall have an A.M. Best rating of VI or better and shall be licensed to do business in the
state of Florida. The Certificate of Insurance shall include Monroe County as Certificate Holder.
28. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability,
exemptions from laws, ordinances, and rules and pensions and relief, disability, workers'
compensation, and other benefits which apply to the activity of officers, agents, or employees of any
public agents or employees of the County, when performing their respective functions under this
Agreement within the territorial limits of the County shall apply to the same degree and extent to
the performance of such functions and duties of such officers, agents, volunteers, or employees
outside the territorial limits of the County.
29. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be
deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe
County in his or her individual capacity, and no member, officer, agent or employee of Monroe
County shall be liable personally on this Agreement or be subject to any personal liability or
accountability by reason of the execution of this Agreement.
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 7
7
30. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional or
Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any
participating entity from any obligation or responsibility imposed upon the entity by law except to
the extent of actual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
31. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon
the terms, or any of them, of this Agreement to enforce or attempt to enforce any third-party claim
or entitlement to or benefit of any service or program contemplated hereunder, and the County and
the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of
either shall have the authority to inform, counsel, or otherwise indicate that any particular individual
or group of individuals, entity or entities, have entitlements or benefits under this Agreement
separate and apart, inferior to, or superior to the community in general or for the purposes
contemplated in this Agreement.
GENERAL
32. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of
counterparts, each of which shall be regarded as an original, all of which taken together shall
constitute one and the same instrument and any of the parties hereto may execute this Agreement
by signing any such counterpart.
33. NOTICE. Any notice required or permitted under this agreement shall be in writing and
hand-delivered or mailed, postage pre-paid, by certified mail, return receipt requested, to the other
party as follows:
For Board:
Grants Administrator and Monroe County Attorney
1100 Simonton Street PO Box 1026
Key West, FL 33040 Key West, FL 33041
For PROVIDER
Sharon Crippen, Senior Vice President
Guidance/Care Center
1205 Fourth Street
Key West, FL 33040
Copies of all default notices, notices of breach, termination, legal claim, or indemnity copied
to:
WestCare Foundation, Inc.
Attn: Executive Vice President
1711 Whitney Mesa Drive
Henderson, Nevada 89014
34. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement
shall be governed by and construed in accordance with the laws of the State of Florida applicable to
contracts made and to be performed entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie
in the appropriate court or before the appropriate administrative body in Monroe County, Florida.
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 8
8
The County and PROVIDER agree that, in the event of conflicting interpretations of the terms
or a term of this Agreement by or between any of them the issue shall be submitted to mediation
prior to the institution of any other administrative or legal proceeding.
35. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept and
performed by the PROVIDER shall not be deemed or considered as a continuing waiver and shall not
operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach, either of
the same conditions or covenants or otherwise.
36. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or
the application thereof to any circumstance or person) shall be declared invalid or unenforceable to
any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and
provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant,
condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent
permitted by law unless the enforcement of the remaining terms, covenants, conditions and
provisions of this Agreement would prevent the accomplishment of the original intent of this
Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken
provision with a valid provision that comes as close as possible to the intent of the stricken
provision.
38. 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
purpose of this Agreement. Any conditions imposed as a result of funding that effect the Scope of
Services will be provided to each party.
37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the PROVIDER and the Board.
[THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW]
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 9
9
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day
and year first written above.
BOARD OF COUNTY Coh4mISSD]NERS
(SEAL) [>FMONRDECOUNTY, FLORIDA
^ ' REVINy4AOO�
ATTEST: , CLERK
By
By_ Mayor/Chairman
Deputy Clerk
Guidance/Care Center, lnc., n Florida
5O1(c)(3) not-for-profit corporation
3Z \
(Federal IDNo,By
,
Witnyef
Director
Witness Guidance/Care Center, Inc., a Florida
501(c)(3) not-for-profit corporation
Guidance Care Center-nanvpom,mm:Baker Act and oToFYo0;page 10
10
ATTACHMENT A
EXPENSE REIMBURSEMENT REQUIREMENTS
This document is intended to provide basic guidelines to Human Service and Community-Based
Organizations, county travelers, and contractual parties who have reimbursable expenses associated
with Monroe County business. These guidelines, as they relate to travel, are from the Monroe
County Code of Ordinances and State laws and regulations.
A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense
request needs to also contain the following notarized certified statement:
"I certify that the above checks have been submitted to the vendors as noted and that the
attached expenses are accurate and in agreement with the records of this organization.
Furthermore, these expenses are in compliance with this organization's contract with the Monroe
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source."
Invoices should be billed to the contracting agency. Third party payments will not be considered for
reimbursement. Remember, the expense should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all-inclusive. The Clerk's Finance Department reserves the
right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines should be directed to 305-292-3534.
Data Processing, PC Time, etc.
The vendor invoice is required for reimbursement. Inter-company allocations are not considered
reimbursable expenditures unless appropriate payroll journals for the charging department are
attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a
Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total
hours worked, withholding information and paid payroll taxes, check number and check amount. If
a Payroll Journal is not provided, the following information must be provided: pay period, check
amount, check number, date, payee, and support for applicable paid payroll taxes.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for reimbursement.
For overnight or express deliveries, the vendor invoice must be included.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not
allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The log
must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc.
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 11
11
A fax log is required. The log must define the sender, the intended recipient, the date, the number
called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the
telephone number, the date, and the purpose of the call.
Travel and Meal Expenses
Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel
Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with
Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not
acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the
agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the
airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement
requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not
reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's residence to
the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel
expense at the destination. Airport parking during a business trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must
be registered and paid for by traveler. The County will only reimburse the actual room and related
bed tax. Room service, movies, and personal telephone calls are not allowable expenses.
Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading
must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a
residence or office to a point of departure. For example, driving from one's home to the airport for a
business trip is not a reimbursable expense.
Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS,
AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel
must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch
reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement.
Non-allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 12
12
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)
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
This instrument was acknowledged before me this day of (month), (year),
by (name of officer or agent, title or officer or agent) of
(name of entity).
Personally Known
Produced Identification: Type of ID and Number on ID
(Seal)
Signature of Notary
Name
of Notary (Typed, Stamped or Printed)
Notary Public, State of
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 13
13
ATTACHMENT C
Specific description and list of services to be provided under this contract:
Baker Act/Marchman Act transportation services and Community Transportation Coordinator related
services.
Guidance Care Center—Transportation:Baker Act and CTD FY20,-page 14
14
ATTACHMENT D
Copy of the Sub-Contract for Baker Act transportation services and proof of automobile insurance.
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 15
15
WESTCARE
VEN20R SE RVICE AGREEMENT
THIS VENDOR SERVICE AGREEMENT (the "Agreement"') is effective as of this 1" day of..
October, 2019 ("Effective Date") betweenGuidance/Care Center, Inc. a Florida not-for-profit
corporation (" IestCare") and Caribbean Transfers, Inc. dba Key Lime Taxi ("Vendor"),
Vendor and WestCare collectively hereafter the "Parties" and individually the `Party", The
.Parties agree as follows:
1. Services to be Performed, Vendor will provide the services set forth on Exhibit A
("Services), which exhibit is attached hereto and incorporated herein by and throntgh this
reference,
2. Term. This agreement shall commence on the Effective bate and shall expire on
September 30, 220 ("Ternnn"). Foregoing notwithstanding, either party may terminate
this Agreement at any time, with or without cause, upon not less than twenty (20) days
written notice to the other party. If either Marty breaches the obligations set forth in this
Agreement,the non-breaching Party may teir ninate this Agreement upon not less than five
( ) days prior written notice and retain its right to all damages caused by the breach
(unless otherwise provided herein.) and subsequent termination. Upon expiration or
termination of this agreement, neither party shall have any further obligation hereunder
except for (i) obligations due and owing which arose prior to the date of termination, and
(ii) obligations, promises or covenants contained herein which expressly extend beyond
the term of this agreement,
3. Performance Standards. Vendor shall comply with all applicable laws, codes,
ordnances, and regulations of the Unites States and the State. of Florida., additionally, and
without limiting the foregoing, Vendor shall tale all commercially reasonable care in the
delivery of Services under this Agreement,
. Compensation. In fall consideration for the performance of the Services set forth in
Section 1, including for any nights granted or relinquished by the Vendor under this
.Agreement, WestCare shall pay Vendor the rate set forth in Exhibit B based on the
specific Service(s) provided pursuant to this Agreement ("Fee Rate""). Services provided
pursuant to this Agreement are to be documented and invoiced by Vendor in writing at the
end of each calendar:month of service. All written invoices are due by the last day of the
month for that month's service. Compensation shall be payable on the last day of the
following calendar month following WestCare's receipt and acceptance of Vendor's
written accurate invoice. Vendor acknowledges and agrees that, except as provided in
this Section or as otherwise set forth in Exhibit ll , it shall not be entitled to, and
estCare shall not be obligated to pay, any monies or other compensation for the Services
provided and rights granted under this Agreement,
wCocc vsA
Pap r of 14
16
5. Intentionally Deleted.
6. Confidential Information, Both parties hereto shall treat as confidential all information
relating to either party's operations or the general business affairs or any of the operations
or general business affairs of the party (including the party's parent, affiliate or subsidiary
companies) which the other party may observe or which may be disclosed as a result of
the party's performance under this MOO. Neither party shall not disclose any
information, including without limitation any information contained in this MOU, to third
parties or use any such information for any purpose other than the performance under this
MOM, without the prior written consent of the other party. Additionally, the Parties agree
to abide by all State and Federal laws, rules and regulations, HTPAA and 42 C.F.R., Part
2. Both parties agree not to divulge any information concerning any individual client to
any unauthorized person or agency without the written consent of the client and
participant. This Section 6 shall survive the termination of the Agreement.
7. Indemnification. Vendor shall indemnify, defend and hold WestCarc (including without
limitation WestCare's affiliates, subsidiaries' officers, directors, employees,
representatives, independent contractors and agents) harmless for, from and against any
and all losses, expenses, costs, liabilities, damages, claims, suits and demands (including
without limitation attorney's fees and costs) arising from or attributable to the acts or
omissions of Vendor (including but not limited to Vendor's officers, directors, employees,
representatives, sub-contractors, and agents).
8, Insurance. Vendor shall be solely responsible, at Vendor's sole, cost and expense, for
maintaining its own liability insurance, including any workers compensation insurance
required under applicable law. At no time shall WestCare be liable for any insurance
obligation of Vendor.
9, Representations and Warranties. Vendor hereby represents, covenants and warrants to
WestCare as a material part of the consideration for WestCare agreeing to enter into the
Agreement, as follows: (i) Vendor is a corporation, duly organized and validly existing
under the law; (il) the execution of this Agreement has been duly authorized by all
necessary corporate action on behalf of Vendor; and (iii) Vendor has obtained and
currently holds all licenses, permits and approvals of all governmental authorities
necessary or appropriate to perform Vendor's obligations under the this Agreement.
10. Intellectual Property. Neither party to this Agreement shall be deemed to be granted
any right, title or interest in or to the trademarks, trade names, service marks, copyrights,
patents or other intellectual property of the other Party. WestCare and Vendor expressly
acknowledge and agree that neither party is granted under this Agreement the right to use,
refer to or incorporate in any materials, including without limitation marketing materials,
the name, logos, trademarks, or copyrights of the other Party,
11. Intentionally Omitted.
GCC VSA
Page 2 of 14
17
12. Notice. Any notices to either party under this Agreement shall be in writing and delivered
by hand or sent by nationally recognized messenger service, or by registered or certified
mail, return receipt requested, to the address set forth herein or to such other address as
that party may hereafter designate by notice. Notice shall be effective when received,
which shall be no greater than one (1) business day after being sent by a nationally
recognized messenger service or three (3) days after being sent by mail.
If to West are: Guidance/Care Center, Inc.
Attn: Maureen Dunleavy
3000 41" Street Ocean
Marathon, Florida 33050
with a copies of any legal notice, notice of demand, notice of breach, demand for
indemnity, claim, assertion of damage or notice of default to:
WestCarc Foundation, Inc.
Attn: Executive Vice President
1711 Whitney Mesa Drive
Henderson, Nevada 89014
If to Vendor: Caribbean Transfers, Inc. dba Key Lime Taxi
Attn: Margaret Scholl
30886 Hammock Drive
Big Pine Key, FL 33043
13. Miscellaneous.
(a) Time is of the essence of this Agreement,
(b) This Agreement, together with all documents incorporated herein by reference, if
any, constitutes the entire agreement between the Parties. There are no terms,
conditions or provisions, either oral or written between the parties other than those
contained in this Agreement,
(c) No amendment to this Agreement shall be enforceable, unless in writing and
signed by the Parties,
(d) Whenever the context may require, any pronouns used in this Agreement shall
include the corresponding masculine, feminine or neuter forms, and the singular
form of nouns and pronouns shall include the plural and vice versa. Captions
contained in this Agreement are inserted only as a matter of convenience and in no
way define, limit, extend or describe the scope of this Agreement or of any
provision herein.
(e) This Agreement may be executed in one or more counterparts, each of which shall
be deemed an original, but all of which shall constitute one and the same
GCCVSA
Page 3 of 14
18
agreement. Any such counterpart signature pages may be attached to the body of
one agreement to form a complete integrated whole..
Any to or provision of this Agreement which now or hereafter is declared
contrary to any law, order, ordinance, requirement ruling or regulation of ally
governmental authority, whether federal, state or local, whether now in force or
enacted or promulgated in the future, or which is otherwise invalid, shall be
deemed stricken from this Agreement without impairing the validity of the
remainder of this,Agreement.
(g) This Agreement shall be governed by and construed in accordance with the law of
the State of Florida. The venue for any dispute arising under this Agreement shall
be a court of competent jurisdiction in Monroe County, State of Florida,
(h) Neither Party hereto shall be entitled to recover special damages in the -nature of
lost profits or consequential damages,
(i) The Parties to this Agreement are acting as independent contractors and
independent employers. Nothing contained in this Agreement shall create or be
construed as creating a partnership, joint venture or agency relationship between
the parties, Neither Party shall have the authority to bind the other Party in any
respect.
In the event of any action or proceeding to compel compliance with, or with
respect to any breach of this Agreement, the prevailing party shall be entitled to
recover all reasonable costs and reasonable expenses of such action or proceeding
including without limitation its reasonable attorneys' fees and costs incurred in
connection therewith regardless of whether any formal legal action is commenced
or whether such fees and costs are incurred at or in connection with trial or
appellate proceedings.
(k) Vendor shall perform all of the Services under,this Agreement in compliance with
all applicable federal, state and local laws, ordinances, rules, regulations, codes or
orders.
(1) Any failure by either Party at any time, to enforce or require the other Party's
compliance with any of the, terms and conditions of this Agreement shall not
constitute a waiver of such terms and conditions in any way, or the right of the
non-defaulting party at any time to avail itself of any and all rernedies it may have
for any breach of said terms and conditions including without limitation any right
to terminate this Agreement, The remedies of the parties provided for in this
Agreement shall be cumulative with all other remedies that either Party may have
against the other party at law or in equity.
(m) All of the covenants and agreements contained in this Agreement shall be
extended to and be binding upon the successors and assigns of the Parties,.
OCC VSA
Page 4 of 14
19
(n) Neither Party may assign this Agreement in whole or in part or assign, pledge or
otherwise transfer either party's obligations hereunder except with the prior
written consent of the non-assigning party, which consent shall not be
unreasonably withheld.
(o) The Vendor shall not subcontract any portion of the Services contemplated by this
Agreement without the prior written consent of West Care, which consent may be
given or withheld in WestCare's sole and absolute discretion,
(Signature Page to follow)
GCC V8A
Page 5 io r 14
20
SIGNATURE TAT
IN WITNESSWVHERE T+, the parties, by their duly authorized representatives, have executed
this Service Agreement as of the Effective Day noted alcove.
"Westcal-e" "Vendor"
GUIDANCE/CARE CNN rE R,INC. CARIBBEAN °T°RANSFERS, INC. DBA KE,v Twit
a Florida 501c3 no -for p ofit corporation TAM,
B
Nam' : Ciai I iierirn Name:
Its: Deputy COO Its:. C Q
Date; /s_.� �� 2019 Date;k ����..� 2019
Gcc VSA
Page 6 of 14
21
Exhibit A
Services
GCC will supply Vendor with two Ford Crown Victoria vehicles
—Ford � �..,. ...
(White) n/a -door- donation KW—Baker
2 1C1 Crown 2FABP7BVOAXI.1 953 cage from B 4 Act
Victoria IICS3
Ford Donation n .
r/a 4-door` TAW—Barer
2011 Crown
2F BP7BV6B 113 7 cage from BA5 act
Victoria MCSC
Maintenance specifications: one vehicle to be stations at the GCC ley West office and
the other in Marathon at GCC headquarters. GCC will pay for the fuel and maintenance of
the two vehicles used for Barer Act and Marchman Act transportation. Vendor will
complete daily inspections each time the vehicles are driven as noted on the inspection
farms which will be submitted to GCC with trip verification. GCC will coordinate the
maintenance for both vehicles above.
(ACC will maintain insurance on bath of the vehicles. Vendor will be named as an
"additional insured" for these two cars. All Vendor drivers operating GCC vehicles will
hold a minim-am of a Class B Florida giver's License and be approved for GCC
insurance coverage by the Transportation Coordinator. Upon execution of this agreement,
Vendor will fax/email to CCC's Transportation Coordinator a current list of drivers—
including a copy of the driver's license and social security number for each driver—for
approval to operate GCC vehicles, prior to adding a driver, Vendor will fax or email to
CCC's Transportation Coordinator, or designee, a copy of the driver's license, social
security number and signed"Request for Check of Driving Record"' form. GCC will
initiate procedures to add the driver to GCC vehicle insurance Vendor cannot use the
driver for BA MA transports until it has received written notification that the driver has
been added to the GCC insurance coverage.
All drivers and escorts are required to have a background screen, a minimum 3-year clean
driving record and submit to drug screen. Additionally, Vendor will fax a copy of picture
identification and social security number for each driver and escort to CCC's
Transportation Coordinator or designee. Vendor cannot use the escort for BANG
transports until it has received written notification that the escort has been approved by
GCC. All BA/MA approved drivers must read and sign the acknowledgement of reading
and receiving, attached hereto as Attachment ] Transportation protocol.
occ vsA
Page 7 of 14
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• Vendor will report and document accidents involving GCC vehicles and incidents
involving clients to the proper authorities and immediately thereafter contact the site
director at GCC. Following an accident, GCC Vehicle Incident Protocol must be followed,
A Vehicle Incident Kit, attached hereto as Attachment 4,, has been provided for each
vehicle with instructions. Additionally, anyone involved in an accident with a GCC
vehicle MUST BE DRUG TESTED as soon as possible following the incident. Drug
testing forms are included in the lit,
• Any citations received while driving a GCC vehicle will be the responsibility of the
driver. Refusal or failure to accept responsibility for citations may result in removal of
driving privileges.
• All drivers will be required to complete an orientation and verbal de-escalation,training
within 30 days of approval to drive. GCC will provide details for accessing the training.
All BA/MA approved drivers must read and sign the acknowledgement of completing the
assigned training, attached hereto as'Attachment 5.
• Vendor will follow the transportation protocol and complete the documentation provided
as Attachment 1-3 herein.
• Vendor, upon approval of drivers, will issue an identification badge,
GCC VSA
Page 8 of 14
23
Exhibit B
Compensation
Pursuant to the terms and conditions set forth in this Agreement, and pursuant to the invoice
requirement set forth in Section 4 herein, West are shall pay Vendor the following fee structure
established for the Term of the Agreement:
I)bc-r ,�,i",k C
Estimated#
Client Pickup Point Client Drop-off Point -,Elanjess Payment
Ro
Key West Key West $115
Marathon Marathon $115
450 Key West Marathon $145
Marathon Key West $145
Marathon Key Largo $145
ley Lark Marathon $145
40 Marathon Miami-Dade County $385
Key Largo Miami-Dade County $385
40 Key West Miami-Dade County $385
GCS Preauthorization Requiredfor All Trips Below
*Approval for below fees will be granted only when the Marathon BA/MA vehicle is engaged
wifli another BA/ ? .trip,that Eoulq_pjecIudc another picker Lwithin_a reasonable period of time
Estimated# Car Client PFclku_F 'Client Drop-off Elanj-ess-Payment
Roundtrips Location Point Point —
,5 Key West Marathon & North Marathon $145
Key West Marathon $145
5 Marathon
2 Key West Marathon &North Key Largo $225
3 Key West Marathon &North I Miami-Dade CoyE_ $385
GCC Preauthorization Re qir d gar:ill Trips Below
Estimated 4 Client Pickup Point Client Drop-off Point ..-Elani-esspayment
Rol Ln trips -
They Largo Avon Park (Area) $770
Marathon Avon Park (Area) $770
Key West Avon Park (Area) $770
Key Largo Up-State (McClenny Area) $1,200
Marathon Up-State (McClenny Area) $1,200
Wiest yp-Mate ( I ergy area}
_$12 00
Timely payment for services rendered is endured by adherence to the following invoicing
procedures.
Vendor will submit one-statement/invoice per month pursuant to the procedure set forth in
Section 4 herein to the attention of the GCC Marathon Site Director,
GCC VSA
Page 9 of 14
24
Attachment 1
Guidance/Care Center Transportation Protocol:
The Transportation of Baker Act and arch art Act Clients
(See Attached)
OCC VSA
Pap 10 of 14
25
..........
Attachment 2
Transportation Record and Payment Authorization Sheet
(See Attached)
GCC VSA
Page I I of 14
26
Affachment 3
Statement
(See Attached)
GCC VSA
Page 12 of 14
27
..............
Attachment 4
Vehicle Incident Kit
(See Attached)
GCCVSA
Page 13 of 14
28
Attachment 5
De-Escalation Training Acknowledgement Form
(See Attached)
GCC VSA
Page 14 of 14
29
GUIDANCE/CARE CENTER, INC.
BA/ MA DRIVER TRAINING ACKNOWLEDGEMENT
I acknowledge I have completed GUIDANCE / CARE CENTER'S BA MA DRIVER
ORIENTATION including:
a De-Escalation
* Proper completion of trip documentation(trip sheets)
o Pre-trip vehicle inspections and reporting
0 Incident Reporting
* Accident Reporting
* Citations
0 Driver Protocols
o Professionalism
Date
i�fltato r Date
15n"n I ted-11 Name .........
30
..........................
ATTACHMENT 1
GUIDANCE /CARE CENTER TRANSPORTATION PROTOCOL:
THE TRANSPORTATION OF BAKER ACT AND MARCH MAN ACT C 3LIENTS
A. Client Related Rules:
1 Confidentially of a client and client related information shall be maintained at all
times.
Z Each client shall be treated with respect and dignity at all times.
3. No information with client information shall leave the clinic unless part of a client
transfer packet to a designated facility. (No driverlescort shall maintain a personal
copy of the Transportation Record and Payment Authorization Sheet.)
4. Client transportation within Monroe County may be conducted with a driver and an
escort when deemed appropriate or necessary.
5. A female client requires a female escort or a female driver.
& A client must be observed for any unusual behaviors including hurting self/others or
sudden medical conditions. Respond to a medical emergency by calling 911, If a
client is violent during transport and poses a threat to safety, stop the vehicle and
call 911. Notify the Nurse on Duty of any unusual situation at (305) 434-7660 ext.
31123
7. At the time of pick up for a Baker Act or Marchman Act client, a driver must obtain
the Baker Act or Marchman Act paper work from the Pick Up facility. If the original
paper work is not available the driver must immediately report this information to the
GI CC Nurse on Duty for further instructions.
8, Only one client may be transported at a time
9. a client may only be transported in the back seat of the vehicle
10. A parent is not allowed to travel in the Baker Act vehicle with a Baker Oct or
Marchman Act minor.
When a parent or other responsible party reports he/she plans to follow the
Baker Act vehicle, the Baker Act driver advises the parent/party that our
primary responsibility is to the child and ensuring the safety of the child
therefore following our vehicle as a method of direction is not encouraged.
11. Dri'vers, Escorts and Clients are not to smoke in the car at any firne,,
12. Clients are not to be placed in handcuffs or any type of restraints for any reason by a
driver or escort— or to be placed in the vehicle by others (i.e. Law Enforcement) in
handcuffs or any type of restraints
13. A client's movement is not to be impeded with any physical restraint unless directed
by a nurse/MD/law enforcement officer,
14, If a client must use a public facility, the client must be escorted to the restroonn and
the driver must remain outside the restroom door until the client leaves the restroom.
The driver will remain in conversation with client while the client is in the restroom.
THIS SHOULD HAPPEN ONLY UNDER MOST EXTREME CIRCUMSTANCES.
15. A client shall not be left alone in the vehicle during the trip for any reason,
16. A client shall be under the observation of the driver or escort at all times during the
transport.
17. Client is encouraged to use restroom facilities prior to departure, If the trip is
Rvsd/ind 9.2019
31
generated from Key West and a stop is required, G/CC may be used for that
purpose,
18. A client may not use aluminum/metal cans. Items for drinking shall be provided onily
in a plastic container,
19. Clients may not have any metal utensils, glass or other hard products such as
pencils or pens.
M A client may not shop during a stop. All efforts should be made to avoid stops. If a
stop is required, it should, be short and without delay.
B. Coordination of Transportation Rules:
1. Transportation arrangements for Baker Act and Marchma n Act clients are under the
direction of the Unit Nurse on Duty/G/CC per contractual arrangement Caribbean
Transfers, Inc. No other agency is authorized to contact Caribbean Transfers, Inc.
directly for transportation,
2. Final decision for a driver to transport is made by the nurse on duty. The nurse may
request a BAL be conducted or send a drivers/escort home if he/she has a concern.
3. A driver shall not be permitted or required to drive more than 12 hours in any one 24-
hour period, or drive after having been on duty for 16 hours in any one 24-hour period,
4. All trips will be made within the approved fee structure.
5. All trips will be made using the closest vehicle and the shortest distance unless
preauthorization is obtained from the Unit Nurse on Duty at the /CC.
6. Clients may be picked up at only approved locations. The G/CC Nurse on Duty will
communicate the pick up location. Approved locations will include:
a. Hospitals
b. Detention Facility
c. Schools
d. Anchors Away
e. Any G/CC site
f. Or otherwise authorized by the G/GC IP Unit Coordinator
7. De Poo-Hiospitak Pick-up / drop-off is located in the rear next to the handicap parking.
G—Pon arrival, call the nurse's station directly from the vehicle at 305-294-5531 x8330.
Hospital staff will escort the client to/from the building,
8. Pick-up / drop-off is at the ER entrance. Upon arrival, call 305-294-5531 x3202.
a. Hospital staff will escort the client to/from the building,
9. At G/CC: Use the telephone call box next to the elevator.,
10.At G/CC, staff members shall place the client in the vehicle for departure and will assist
the client from the vehicle at time of arrival.
11.The facility responsible for the departing client for a trip longer than 2 hours shall
provide a brown bag snack. All minors shall be supplied with a snack for any trip over I
hour.
12.When a driver reports a client is too dangerous to transport, the nurse on duty shall
work with the Sheriffs department to transport the client
13.If a client absconds at time of or during transport, immediately contact 911 and report
the information to the G/CC Nurse on Duty. Do not go after the client.
14.Neither Drivers nor Escorts are permitted to physically restrain a client,
Rvsd/md 9,2019
-2 -
32
15."Jail Hold" clients from the Monroe County Detention Facility shall be picked tp; from the
Sallyport area only. To access the Saliyport area, the driver must drive the car within 1
foot of the Sallyport entrance. If the door does not open, the escort Must Use the
speaker mounted on the wall next to the Sally port entrance to request entrance. Once
inside, Detention Facility staff will bring the client to the car. When the client is inside the
car and the doors are locked, the Sallyport area exit doors will open.
16.The driver/escort must determine from the Pick Up facility if the client has been
searched and encourage staff to conduct a search prior to transport. If the client is not
searched prior to transport, the driver must communicate this information to the Duty
Staff Member prior to opening the client door at the Designation point,
17.Driver/escort MUST respond to the pick up point within a maximum time-frame of I
hour and 15 minutes.
C. Reimbursement relate d rules
1. All cancelled and otherwise diverted trips, will be reported on the Transportation
Record and Payment Authorization Sheet,
2. Transportation Record and Payment Authorization Sheets and a Statement of
services rendered will be faxed to the IP Unit Coordinator on the first and sixteenth
of each month.
3. G/CC does not reimburse Vendor for cancelled trips. Compensation to the
drivers/escorts for cancelled trips is at the discretion of Vendor.
4. If the driver arrives without the Baker or Marchman Act paperwork, Vendor will
obtain the paper work without charge to the G/CC.
0. Dress Code
1. Drivers must wear their Vendor issued ID badge at all times
2, All, clothing worn by the driver must be clean and in good condition, and the driver must
have good standards of personal hygiene. As a minimum standard, drivers should wear
trousers and a shirt which has a full body and sleeves. Knee length shorts may be worn,
3. Footwear for all drivers shall fit around the heel and toe of the foot. Sneakers are
acceptable,
4. The following are deemed to be unacceptable: (a) Clothing that is not kept In a clean
condition, free from holes and rips. (b) Words or graphics on any clothing that is of an
offensive or suggestive nature or which might offend, (c) Drivers not having either the
top or bottom half of their bodies suitably clothed. (d) The wearing of hoods or other
clothing that obscures the drivers vision or their identity
I acknowledge I have received: and read the above BA/MA Transportation Protocol,
Driver/Escort Signature Date
Printed Name
Rvsd/md 9.2019
3 -
33
ATTACHMENT 2
GUIDANCEICARE CENTER
300041 ST ST. Ocean:
Marathon, FL 33050
Voice 0 mx 0 e Fax305-434-9040
TRANSPORTATION REC T AUTHORIZATION SHEET
Transportation Type: c Baker Act o Marchman Act
Date: Client Name:
DOB:,--Time Called: Time of Pick p:
Time of Drop Off: Time van returned to Duty:
Vehicle: vehicle Mar vehicle
j
Place of Pick
(Where did you pick yap the Client: Facility elCity
Authorized Staff Signature at Rick lip Facility:
Time.
i
{
f Destination:
(Where did you take the Client: Facility Name/City)
I
Authorized Staff Signature at Designation Facility:
Time:
(Staff member accepting client)
Driver Name:
Escort Name:
Beginning Miles: Pick Up Miles:
Drop Miles: Ending Miles:
... .r.. ...._.-- ____--_. _. ._.__. _...,.n...m. _..._. _.:_,-__ _.-,___. -_______________ _. ..._._.. ..... _.._m.. ...___._m. .-..-...__ ..w_............. .._._
FOR
! C USE ONLY:
Amount to be paid:
Unit Director Signature:
_.._
\\westca re.localldfs redirection$\FL-GCC\maureen.kempaft Documents\Contracts\Transportation\Attachment 2-auth sheet V A Baker Act.doc
RVSDO912
34
Attachment 2
Transportation Record and P'nyment Authorization Sheet
(See Attached)
GCC VSA
Page I I of 14
35
.............111--l-............................. ............
GUIDANCE / CARE INC
p
DRIVERESCORT APPLICATIONT FOR CHECK OF DRIVING RECORD
DRIVER APPLICATION =ESCORT APPLICATION
""""DRIVER APPLICANTS MIDST SUBMIT A COPY OF THEIR DRIVER LICENSE WITH THIS APPLICATION"""'
I HEREBY AUTHORIZE GUIDANCE / CARE CENTER, INC. to obtain a report of my driving
record as needed to evaluate my job application. The report may be procured by HRH of
Orlando and may include an assessment of ray insyurability under the company's insurance
coverage. By signing this disclosure, i hereby authorize the company to pocure such report
and additional reports about me on an annualy basis, or as it deems appropriate, to evaluate
my ongoing insurability.
Panne of Applicant:
Driver's License Number:
Social Security Number:
Date of Birth:
Signature of Applicant
Date Signe&
Phone Number:
*******DRIVER APPLICANTS MUST SUSMITA COPY OF THEIR DRIVER LICENSE WITH THIS APPLICATION*"""
CC Authorization Signature:
Printed
Date:
36
GUIDANCE / CARE CENTERp INC
BA / MA DRIVER APPROVAL
TO- J
Please add the folio v' driver to thtApgLqved rist.
APPROVAL DATE:
NAME:
PHONE:
Vendor will contact the driver and advise of the pay rate per trip,
and determine, if necessary, the hours the driver is available.
This information wi to dispatchers and the dr r will
be added to the call list.
THE DRIVER ABOVE IS AUTHORIZED TO DRIVE THE
KEY WEST OR MARATHON BAKER VEHICLE
GCC Authorization Signature:
PRINTED NAME:
DATE:
37
i
Vehicle Incident Kilt
'r
Contents:
Vehicle ] Protocol i
Vehiclei t Report Fonn
Vehicle Incident- Passenger/Witness Statement Forms*
IncidentVehicle Traffic
Disposable Ca
.
*Number2 Pens
of StatementForms Required is to equal vehicle passenger capacity
peas ah additional two for other witnesses.
rivers are responsible for making sure this kit is complete at all times.
38
Vehicle Incident Protocol and "Pepqrd ng-lig!ia
(Vehicle Incident Kit Copy)
DO IMMEDIA.TE :
I. Immediately after the incident, examine and question persons for bodily injury and they
examine vehicle for damage.
2. If there is an accident involving another vehicle or if persons involved require iflunediate
medical attention, call 911 or 3 11 accordingly.
3. If involved persons do not report injury, ap tliori ties stilt neq�t.!tLbc politactedL and, a police
—
Eq pot ° r�e�;ted. If the request for a police report is declined.,the reason and dispatcher name
and badge number need to be noted.
4. After authorities have been called, your supervisor:needs to be called.
DO NOT:
1. DO NOT admit fault if you are truly not at fault.
2, DO NOT leave the scene of an accident.
3, DO NOT drive the vehicle if you feel it is-unsafe.
4. DO NOT drive the vehicle if you feel physically incapable of driving safely.
S. DO NOT discuss the-incident with anyone other than lav;, enforcement authorities, your
supervisors, or a claims a4juster from York Claims Service Inc.
GATHER WORMATION &_Q0TAPLUTE ULCTQENT REPORT:
L An incident will be defined as any occurrence that resulted in dainage to the vehicle and/or
injury to any person. Damage to a vehicle will be defined as anything that resulted in the
property not being left in the same condition as before the incident.
2. Locate and complete the Vehicle Incident Fonn, complete all the information requested
regarding incident and parties involved and take photos ofdaniage with camera provided.
3. All passengers and other available witnesses, if applicable, need to complete the statement
form.
4. After police report has been completed (if it was not declined), persons have been cared for
if injury occurred), and vehicle is operation at, retm.-n to the office.
5. Any and all vehicle incidents must also be reported electronically upon return to the office
by attending supervisor by transfeiring information from Vehicle Incident Form. The
incident report.will be completed online by logging into the Westcare Intranet at
6. An additional einail must also be sent by the attending supervisor to the,following
management staff stulunarizing the incident and action taken; Program Director/Coordinator,
Area Director and/or Vice President, and Michael Lavin, Sr. VP of Operations
7, Supervisor will await further instructions by Program Director/Coordinator and/or Area
Dire ctorNice President and Michael Lavin, Sr, VP of Operations.
MANDATORY DRUG TEST
The driver of tie vehicle involved.MUST immediately take a drug test upon completion of the
Vehicle Incident Report or The driver's supervisor will provide the documents needed for
the designated laboratory.
ApprDved by Senior Management 712009
39
Page I of 3
Westca,re'Velflelc ItLeident &I)OH FOM
This form is to be completed.by driver immediately after a vehicle incident, when all persons involved have
been checked for inj-ury and provided medical attention(if applicable), and while all parties are still present.
Basic Information.
Incident Date and Time:
Incident Location:
Were Authorities called? Yes/No
If no,explain why? --------------------
If yes,was a police report request granted?Yes/No
If yes, list police report number and attending of.ficer name:
If no,list reason why it was declined?
Dispatcher Name and Badge Number:
Was citation issued? Yes or No If yes, to whom: ......
Westeare Vehicle Information:
Year/Make/Model.
VIN: plates State:
Desetiption of Damage: ..............
Please take pictures of damage with disposable camera provided.in Vehicle Incident Kit,
Driver Information;
Driver Nye and Job'ritte-
giver License Number: State:
Involved Par ill.
Year/Make/Model:
Role in Incident:
Description of Damage:
Please take pictures of damage with disposable camera provided in Vehicle Incident Kit,
Insurance Company. Claims
Policy License State:
Driver Name: Phone;
Injured?Yes orNo If yes, explain: -------___-----------
Passenger I Name: Licemse# State:
Inju red?Yes err No If yes, explain: -------
40
Page 2 of
Passenger 2 Name. _. License _ �. . M, w_ .. _. ta . ._ ..—
lraj red s or No If yes, explain:. ,._ —.
Passenger 3 Name: P ._. _.._. . ,. w . ..,...... ._,w......License
njured?Yes car o If yes,explain:
(Attach shect if more passengers present,
Inv O!V0 1111rt 2..,
Ycw/Mako/a cadel:
Role in Incident:
Descriptionof Damage,
Please tale pictwes of daina e with disposable camera provided in Vehicle 1heident Kit,
InsuranceCompany: .� . _ _ laisras Phone to., .....,wmp
._...
Policy#
Driver algae: Pbone:
Injured"'? Yes or No If° es, explain' �..�.__._..._
Passenger 1 aye: _ . ...._..... .,.. ._ License 4__...__. . ........ _ State: ...._
Injured? Yes or No If yes,explain: .
Passenger 2 Name: License State:
-
Injured?Yes or No If yes, explain: _.m....__....��_._......
Passenger 3 Name:_..------ License#� State:
Injured?Yes or No If yes,explain:
h sheet if more parties valved)
Passe ,gra Present W Westcare hicl :
All passengers must complete aVehicle Incident Passenger Statement Panne,
t Staff or Client
Injured? Yes or No
If Yes, explain:
2. Staff or Client
Name: � ��._ w..� .. _.._�...,. ry 7 . _,� Injured?Yes or No
If Yes,explain.,
. Staff or Client
Name: Injured? "des or No
if Yes, explain:
4, Staff or Client
Name: hijrared?Yes or No
If Yes,explain:
41
Page 3 of 3
. Staff or Client
arrne: Injured? "es or No
If Yes, explain:
Staff or Client
amea Injured? Yes or, No
If Yes, explain:
7. Staff or Client
Name: Injured?Yes or No
If Yes, explain; _, ....,.... _. _._.�_W....
, Staff or Client
Name: _._.._......_ .. hiivared? Yes or No
If Yes, eaplaiiim ........
(Attach sheet if more passengers present)
Was this a prevent6le incident? Yesur No
Explain why or why not:
I con rni the information provided in this report is as accurate to iiiy knowledge and as thorough as passible,
Name. Signature: -_
his report inust be sere to the attending supervisor as promptly as possible. Attending supervisor inust complete and
,submit an electronic incident repeat via the Westcare Intranet and email,management.
"The Driver of the Westcaro vehicle must take a.drug test, as required by cargpany policy,iaram diatel after the vehicle
incident and attending supervisor needs to know the time ofcompletion.
Approved by Senior lit'ana enient 712009
42
Westeare Vehicle Incident pasE2gg2rnyit ess Statement Form
Name-,
Arc you Westeare Staff, a Westcaro Client, or Other?
Ale you a Driver,Passenger or Other Witness?.--.---
If Other Witness,please list Contact Information.
Adckess:
City: t® Zip
Phone: ......
Incident Date aiid Time:
Incident Location.
Westcare Vehicle Make/Model
Description of Incidentffi ire nt.
Are you iiqjured?Yes or No
If yes,please explain:
I was offered medical evaluation: Yes or No
If yes,I.Accepted or Declined Signature:
I ceilify that the abo-kre information is as accurate to my knowledge and as thorough as possible.
Date
This form will be forwarded to attending supervisor to be part of the Vehicle Incident Report.
Tliai-Jc you for your cooperation.
Approved by Senior Management 712009
S.L'
43
Wes are Vehicle Incident
Name:
Are you Westearo Staff,a Westcave Client, or Other? ............
Are you a Driver, Passenger or Other Witness?
If Other Witness,please list Contact Information.
Address:
st: zip
Phone:
Incident Date and Time:
Incident Location:
WestcareVeldcle'Make/Model. ,,
Description of Inciden-t/Event:
.......... —-----
Are you injured? Yes or No
If yes,please explahu
I was offered medical evaluation: Yes or No
If yes,I.- Accepted or Declined Signature:
I certify that the above information is as accurate to my knowledge and as thorough as possible.
Signature Date
This for will be forwarded to attending supervisor to be part of the Vehicle Incident Report.
Thwik you for your cooperation.
Approved by Senior Management 712009
44
We9teare Vehicle Incident PassmTi�ss tst .gt M1�prr I.
Name:
Are you westeare Staff,a Westeare Client,or Other?
Me you a Driver, Passenger or Other Witness?
If OthLer Witness,please list Contact Infurmation:
Address: .
City.
Phone-
Incident Date and 'rime:
Incident Location: ----—-
Westcare Vebicle,Malce/Mcdeh
Description of Inc ident/E vent:
Are you injured? Yes or No
If yes,please explain: --------,---
I was offered medical evaluation: Yes or No
If yes,1: Accepted oT Declined Signature:
I certify that the dbove infbimation is as accurate to my knowledge and as thorough as possible.
ioate
Date
This form will be forwarded to attendi ng suporvisor to be pail of 1e Vehicle hicident Report,
Thank you for your cooperation,
Approved by Senior Management 712009
S,L.
45
West t Form
Narne-
Are yo stcare Staff, a Westeare Client,or Othcr?---..--'
Are you a Driver,Passenger or Other Witness?
if Other Witness,please list Contact Information:
Address:
City- St: zip
Phone:
Incident Date and'rimc:
Incident Location: .A,
Westcare Vehicle Make/Model:
Description of Incident/Event:
Are you injured? Yes or No
If yes,please explain: ............
I was offered inedical evaluation: Yes or No
If yes,1: Accepted or Declined Signature:
I certify that the above information is as accurate to my knowledge and as thorough as possible.
Signature Date
This form will be forwarded to attending supervisor to be part of the Vehicle Incident Report.
Thank you for your cooperation.
Approved by Senior Maria gement 712009
L
46
N
M
V;
Traffic Di2omms W+E
r
Inter'section
P
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Highway/street
d
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47
Additional fie t for more Information
48 Approved by Senior Managornent 7/2009
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r � !- „I x,r. � ,✓ r7 „�.rrr ,l,i �r f 9J �,v,, .✓l, ,, =fr ,, , „,,, r 1. , rl ,Y„ f, l� /r
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„ltr r ✓ fu7 4 i, d4/J r/fh�F'x -r;,Jr, � i �, f v r� r- ' r rti E � r r✓`W Yrl�',�,P,i 1,Jr�r r'jir`f/','r G 1JI Ir
;f/J/lu{ ,!�horEfr yv �fA Yt ! rrf llf'jf � , ";P M 4" � i�,. A 1 ✓ ,r rfr t r�rJ / r r ,r': f F�,
Caribbean Transfers, Inc.
30886 Hammock k r.
Big Pine Keys FIL 33043
T ;
Lisa ar iniak- Site [director
Guidance/Care Center
000 41 at t. Ocean
Marathon, FL 33050
The following is a breakdown of trips FROM TO
DATE FROM TO FEE
SUBMITTED BY DATE
50
® 1 Page 1 of 2
CERTIFICATE LIABILITY INSURANCE 07/03/2019
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 INSURR(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy( )must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION 18 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 andorsomen s.
PRODUCER ZURrACT
E:
Willis of Florida, lac. PHONE 1-877-945-7378 FAx No. 1-8813-467-2376
c/o 26 Century Blvd L
P.O. sax 305191 crtifioa ewiilis.com
Nashville, TH 372305191 USA INSU AFFORDINGCOVERAGE NAIC r
INS A: Allied World Surplus linos Xnatzrance Compa 24319
INSURED INSURE
B: Ilemkohirm Hathaway Rometate Inaurance Cam 20044
Guidance/Care Guidance/Care Center, Inc.
PO Box 94738 INS C:
Las Vegas, NV 891934738 USA INSURER D:
INSURER E:
INSURER F,
COVERAGES CERTIFICATE NUMBER:W11965825 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,
EUP
1N5 TYPE OF IN NUMBEMR LIMITS
X COMMERCIAL GENERAL LIABILITY EACHI7CCURRENCE S 1,000,000
u CLAIMS-MADE X OCCUR ¢"ORIA ZZTORN ul-
PF S 1,000,000
20,000
A 5008-0078-00 07/01/2019 07/01/2020�PEDt7(>y 1,000,000
GEN L AGGREGATEpCTSMPICW AGG Sm 3,000,000
LIMIT APPLIES PER
3,000,000
PRO-
POLICY JECT i X L 4 rvrv.
OTHER: S
AUTOMOBILELUIBILI7Y LIMIT S 1,000,000
X ANY AUTO OILY INJURY(Per person) 3
A "OWNED SCHEDULED Y 5091-0193-00 07/01/2019 07/01/2020 BODILY INJURY(Par ) $
AUTOS ONLY AUTOS
HIRED . , NON-OWNED
AUTOS ONLYAUTOS ONLY
SS _.,. . .
UMBRELLA LIMB X a EACH OCCURRENCE S , , D
A � ��OGCUR ,�.
2 000 00
X,EXCESSLGIB -,'"/ E 5090-0223-00 07/Ol/2019 07/03/2020 AGGREGATE11/11111-1-1 S 2,000,OpD
DE TH X R 7 NTION�10,000 f
WORKERS PENSATION X R H._.
SAND EMPLOYERS'LIABILITY _ A r
B ANYPROPRIETORIPARTHEWEXECUTIVE YIN E.L.EACHAOCIDENT S 1,000,000
OFFICEWMEMBEREXCLUDED7 No NIA 010197 02/26/2019 02/26/2020
(Mandatory In NH) 11 EL DISEASE FA EMPLOYE E S
,Otl0,000
yy �.,,..m_ nm, ."..... ,�.,
DESC�RIPTIONOFQP RATK3N below , EL_DISEASE-POLICYLIMIT, S 1,000,000
HRAWAYMY
A Professional Idah. 5088-0876-00 „07/01/2019''07/Ol/2020 Each Occurrence $1,000,000
Aggzvqata $3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddlOonal Remarka Schedule,maybe amehad Itmom space to r nlred)
SEE ATTACKZD
AM 8YR1 �p
BY
CERTIFICATE HOLDER CELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, N0710E WILL Be DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Mnroe County Board of County Commissioners AUTHORIZEDREPRESENTATIVE
Attn: Risk 14anagam=t
1100 sinuontons t
Fay blast, PL 33040
19 2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
sx m: 10299640 RkTmy 1269537
51
AGENCY CUSTOMER ID:
Lac#:
ACOROO ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMED INSURED
Willie of Florida, Inc. Quidanae/Care Center„ Inc.
PO Box 94738
POUCYNUMBER Las Vegas, NV 891934738 USA
See Page 1
CARRIER NAIC CODE
See Page 1 See Page 1 EFFECTIVE DATE:See Page 1
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance
Monroe County Board of County Commissioners is Additional Insured under the General Liability and Automobile Liability
as required by written contract.
INSURER AFFORDING COVERMM. Allied World Surplus Lines Insurance Company NAIC4: 24319
POLICY NUMBER: 5088-0878-00 EFF DATE: 07/01/2019 Exp DATE: 07/01/2020
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Abuse G Molestation Per Occurrence $1,000,000
Aggregate $3,000,000
ACORD 101 (2008101) ®2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SR ID: 18199640 BATcB: 1269537 CERT: W11965825
52
ATTACHMENT E
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following
oservices to conviction
public
public entity crime may not submit a bid on a contract to provide any g of a
entity, may not submit a bid on a contract mi ith a bids on entityses of realfor tpropertyrtotpubl�r en ity, may
public building or public work, may not lier, subcontractor, or CONTRACTOR under
not be awarded or perform work as a CONTRACTOR, supp ' ublic entity in excess of
a contract with any public entity, and may not transact business with any p
the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months
from the date of being placed on the convicted vendor list."
U4,et � (Respondent's name) nor
I have read the above and state that neither
any Affiliate has been placed on the convicted vendor list within the las
t 36 months.
(Signature)
Date: Loth
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
� �. ���'� �� � - (Year),
y °f (month),
This instrument was acknpwedged before me this name of officer or agent, title or officer or agent) of
by
i' � i "t (name of entity).
411 Personally Known
Produced Identification: Type of ID and Number on ID
(Seal)
,are " Notary=hnn
a ,,, � o y r'" ", , ,.._•
MaryaMy co5 Signi� re of Notaryow Expire
AI
Name of otary(Typed, Stamped or Printed)
Notary Public, State of
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 16
ATTACHMENT F
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
(Company)
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former
County officer or employee In violation of Section 2 of Ordinance No. 010-1990 or any County officer
or employee In violation of Section 3 of Ordinance No, 010-1990. For breach or violation of this
provision the County rnay, in its discretion, terminate this Agreement without liability and may also,
in its discretion, deduct from the Agreen"ient or purchase price, or otherwise recover, the full arnount
of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
................
(Signature)
Date:
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
LA 1A z
This instrument was acknowledged before me this ,
_day of (month), 224 (year)
y
b (name of officer or agent, title or officer or agent) of
(name of entity).
-Personally Known
Produced Identification: Type of ID and Number on ID
(Seal) Notary Public State of Florida
MaryanneL Johnson
my Comm wion GG 175345
ear E.pir.,01/15/2022
Sigr1t re of Notary
to
..........
Prirlte
Name of Lary(Type'd, Ante
Name of
Notary Public, State of-2 u- AL/Ld_l
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 17
54
ATTACHMENT G
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Business)
1. publish a statement notifying employees that the Unlawful manufacture, distribution,
dispensing, possession, Or Use of a controlled substance is prohiblted In the workplace and
specifying the actions that will be taken against employees for violations of such proNbitlom
2, Inform employees about the dangers of drug abuse in t-.t-ie workplace, the business' policy of
rTiaintaining a drug-free workplace, any available drUg counseling, rehabilitation, and
employee assistance programs, and the penalties that may be Imposed Upon employees for
drug abuse violations,
3. Give each employee engaged in providing the commodities or contractual services that are
under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of
working on the commodities or contractual services that are under bid, the employee will
abide by the terms of the statement and will notify the employer of any conviction of, or plea,
of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any
controlled substance law of the United States 01' any state, for a violation occurring, In the
workplace no later than five (5) days after such conviction.
5. impose a sanction on or require the satisfactory participation in a drug abuse assistance or
rehabilitation program If such Is available In the employee's community, or any employee
who is so convicted. o maintain a drug-free workplace through
6. Make a good faith effort to continue t
implementation of this section.
As the person authorized to sign the statement,- certify that this firm complies fully with the above
requirements.
(Signature)
Date:
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
This instrument was acknowledged before me this _L_day ofrr� (montil), (year),
by 9 4 f (name of officer or agent, title or officer or agent) of
((name of entity),
nam
Personally Known
-Produced Identification" f
�,P(� Q N Q po",__ Ze
Me
(Seal) I My re otary
E
Pt
Name of No ar, (Typed, Stamped or Printed)
Notary Public, State of J" 11-rLs.....
J.,-L-
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 18
55
ATTACHMENT H
FY2020 Annual Performance Report
(For year October 1, 2019—September 30, 2020)
Agency Name
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Pointof Contact (.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 FY2020 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.
, ,WO/iiiii,
A �
2. What were the measurable outcomes (including numbers) accomplished in FY2020? 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
FY2020; and/or 200%; and/or another standard used by your organization?
4. Were all the awarded funds used in FY2020? If not, please explain.
5. What is the number of FTEs working on the program(s) funded by the award in FY2020?
6. Were the awarded funds used as match in FY2020? If so, please list matching sources.
Guidance Care Center—Transportation:Baker Act and CTD FY20;page 19
56
7. What area of Monroe County did you serve in FY2020?
8. How many total FTEs in your organization?
9. Volunteers: hours of program service were contributed by volunteers in FY2020.
10. What was the CEO/Executive Director (or highest paid title) compensation in FY2020? (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 FY2020 IRS Form 990. If
your FY2020 IRS Form 990 is not yet prepared, please provide an estimate for the following
questions.
12. What were your organization's total expenses in FY2020?
13. What was your organization's total revenue in FY2020?
14. What was the organization's total in grants and contracts for FY2020?
15. What was the organization's total donations and in-kind (fundraising) in FY2020?
16. What percentage of your expenses are program service expenses' versus management and general
expenses2 in FY2020 as reported on your IRS Form 990?
'Program service expenses are defined as expenses needed to run your programs.
2Management and general expenses encompass expenses such as human resources,salaries of those not working directly with
programs, legal services,accounting services, insurance expenses,office management,auditing,and other centralized services.
Guidance Care Center-Transportation:Baker Act and CTD FY20;page 20
57