Item C08
~/
'J~~
Louis LaTorre, Senior Director
Social Services/tabt
Revised 2/95
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 6/14-15/00
DIVISION: COMMUNITY SERVICES
BULK ITEM: YES X
NO
DEPARTMENT: SOCIAL SERVICES
AGENDA ITEM WORDING: APPROVAL OF AMENDMENT 0001 TO 99-00 COMMUNITY CARE
FOR DISABLED ADULTS CONTRACT #KG-026 BETWEEN THE STATE OF
FLORIDA/DEPARTMENT OF CHILDREN & FAMILIES AND MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS/ MONROE COUNTY SOCIAL SERVICES (MONROE COUNTY IN
HOME SERVICE PROGRAM, THE CASE MANAGEMENT AGENCY).
ITEM BACKGROUND: The purpose of this amendment is to extend Contract #KG-026 for an
additional three months (July 1, 1999 through September 30,2000) and provided additional funds of
$27,925.89 to cover the three month extension.
PREVIOUS RELEVANT BOCC ACTION:
Approved
STAFF RECOMMENDATION: Approval
TOTAL COST: $139,639.12
BUDGETED: YES X NO
COST TO COUNTY: $12,412,59
REVENUE PRODUCING:
YES NOx.. AMT.PER MONTH
YEAR
APPROVED BY: COUNTY ATTY...X- 0
TO FOLLOW__ NOTIRE~a_
AGENDA ITEM#:~
DIVISION DIRECTOR APPROVAL:
DOCUMENTATION: INCLUDED X
DISPOSITION:
AGENDA DOC
TABT
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #KG-026 Amendment 0001
Contract with:State of Florida/Department Effective Date:Julv L 1999
of Children & Families
Expiration Date:Seotember 30.2000
Contract Purpose/Description:Aooroval of Amendment 000 I to 99-00 Community Care for
Disabled Adults Contract #KG-026 to extend this contract for an additional three months and
provided additional funds of $27,925.89 to cover the extension.
/'r/
Contract Manager:Louis La Torre/tabtf~ 4572
),/ -
(Name) " (Ext.)
Social Services
(Department)
for BOCC meeting on 6/14-15/00
Agenda Deadline: 5/31/00
131 (;, 31./2- CONTRACT COSTS
I
Total Dollar Value of Contract: $139.629.12 Current Year Portion: $N/A
Budgeted?Yes~ NoD Account Codes: IzS- (01537- -S-3()C/Cj(J- t-S9767
Grant: $-l39,629.1~ /37, to;3 q, I z... NA-_ __
County Match: $12,412.59 I'S, $/S.57 NA-_ _ _
NA-___
ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes Date Out
Needed~irYr\ () /./
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R~fJanagement 5~ as-COy esD No~ tD , 6-d5-o:)
o~./pur~ng ~Zs/DO YesDNo0 ~ 5/'W~
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Date In
I, .
CONTRACT #KG026
AMENDMENT #0001
THIS AMENDMENT, entered into between the State of Florida, Department of Children
and Families, hereinafter referred to as the "department", and Monroe County In Home Services,
hereinafter referred to as the "provider", amends contract KG026.
I. Standard Contract, Section II, paragraph A. is hereby amended to read:
To pay for contracted services according to the conditions of Attachment I in an amount not to
exceed $139,639.12, subject to the availability of funds. The State of Florida's performance and
obligation to pay under this contract is contingent upon an annual appropriation by the Legislature.
The costs of services paid under any other contract or from any other source are not eligible for
reimbursement under this contract.
2. Standard Contract, Section III, paragraph A. is hereby amended to read:
This contract shall begin on July 1, 1999, or the date on which the contract has been signed,
whichever is later. It shall end on September 30, 2000.
3. Attachment I, Section B. Manner of Service Provision, paragraph S.d. is hereby amended to read:
d, The contract period is defined as July 1, 1999 through September 30, 2000.
4. Attachment I, Section C. Method of Payment, paragraph 2. is hereby amended to read:
2. The total dollar amount ofthis contract is $139,639.12, The department shall make
payment to the provider for a total dollar amount not to exceed $139,639.12, which is 90%
of the total cost and only subject to the availability of funds.
5. Attachment I, Section C. Method of Payment, paragraph 3. is hereby amended to include the
correct, negotiated rates:
4. The department shall make payment to the provider for provision of services up to a
maximum number of units of service and at the rates stated below:
SERVICE UNIT UNIT RATE MAX # UNITS TO MAX # CLIENTS
MEASURE BE DELIVERED TO BE SERVED
Case Management One Hour $42.3926 1050 Hours 50
Homemaking One Hour $24.6583 1625 Hours 30
Home Delivered Meals One Meal $3.7068 11222 Meals 40
Personal Care One Hour $23.3971 450 Hours 20
Chore One Hour $22,5409 130 Hours 20
Medical Equipment N/A N/A N/A N/A
Respite N/A N/A N/A N/A
CONTRACT #KG026
. ""'"
AMENDMENT #0001
6. Attachment I, Section c., paragraph 6. is hereby amended to read:
6. The provider match for this contract is $15,515.57. Case management and/or
transportation may be exempt from this requirement at the discretion of each district.
7. This amendment shall begin on June 30, 2000, or the date on which the amendment has been
signed by both parties, whichever is later.
8. All provisions in the contract and any attachments thereto in conflict with this amendment shall be
and are hereby changed to conform with the amendment.
9. All provisions not in conflict with this amendment are still in effect and are to be performed at the
level specified in the contract.
10. This amendment and all its attachments are hereby made a part of this contract.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their
officials thereunto duly authorized.
PROVIDER:
MONROE COUNTY IN HOME SERVICES
STATE OF FLORIDA
DEPARTMENT OF CHILDREN
AND FAMILIES
SIGNED
BY:
SIGNED
BY:
NAME:
Shirley Freeman
NAME: Charles M. Auslander
TITLE:
Mayor
TITLE: District Administrator
DATE
DATE
FEDERAL ID NUMBER: 596000749029
CFDA No.
., f 1.04
Grants and Aids XX
'.
,~
, Clientl8l Non-Client 0
Multi-DistrictO
.....-...
STATE OF FLORIDA
DEPARTMENT OF CHILDREN AN~ FAMIUES
5T ANDARD CONTRACT,
THIS CONTRACT is entered into between the State of Florida. Department of Children and Families, hereinafter referred
to as the "department," and Monroe County In Home Services
hereinafter referred to as the "provider."
I. THE PROVIDER AGREES:
A. Attachment I
To provide services in accordance with the conditions specified in Attachment I.
B. Requirements of Section 287.058, FS
To provide units of deliverables, including reports, findings, and drafts, as specified in Attachment I, to be received and
accepted bY'the contract manager prior to payment. To comply with the criteria and the final date by which such criteria
must be met for completion of this contract as specified in Section III, Paragraph A of this contract To submit bills for
fees or oth~r compensation for services or expenses in sufficient detail for a proper pre-audit and post-audit thereof. :
YVhere.appllcable, to submit bills for any travel expenses in accordance with section 112.061, FS. The department may,
If specified in Attachment I, establish rates lower than the maximum provided in section 112.061, FS. To allow public
acc~ss to all documents, papers, letters, or other materials subject to the provisions of Chapter 119, FS, made or
~~celv~d by tJ:l~ provider in conjunction with this contract. It is expressly understood that the provider's refusal to comply
With thiS prOVISion shall constitute an immediate breach of contract.
C. Governing Law
1. State of Florida Law
a. That this contract is executed and entered into in the State of Rorida, and shall be construed, performed, and
enforced. in al~ respects in accordance with the laws, rules, and regulations of the State of Florida. Each party shall
perform Its obligations herein in accordance with the terms and conditions of the contract.
b. . That it understands that the department, the Department of Labor and Employment Security. and the WAGES
prowam State Board of Directors have jointly implemented WAGES, an initiative to empower recipients in the Temporary
~sslstance To Needy Families Program to enter and remain in gainful employment Employment of WAGES participants
IS a mutually ~eneficial goal for the provider and the department in that it provides qualified entry level employees needed
by many prOViders and provides substantial savings to the citizens of Florida.
2. Federal Law
a. That if this contract contains federal funds. the provider shall comply with the provisions of 45 CFR, Part 74, and/or
45 CFR, Pa~ 92,. and other applicable regulations as spe~ified in Attachment I.. ..
b. Th~t If thiS contract contains federal funds and IS over $100,000, the prOVider shall comply With all applicable
stan~ards. orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 U.S.C. 7401 et seq.),
sectIon ~08 of the Federal Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.), Executive Order 11738,
and EnVironmental Protection Agency, regulations (40 CFR Part 30). The provider shall report any violations of the above
to the department. ,
c. . That ~o federal funds received in connection with this contract may be used by the provider. or agent acting for the
provl~er, to Influence legislation or appropriations pending before the Congress or any State legislature. If this contr~ct
contaln~ federal funding in excess of $100,000, the provider must, prior to contract execution, complete the Certification
Regardll:1g Lobbying form, Attachment 1L-. If a Disclosure of lobbying Activities form, Standard Form LLL is required,
it may be obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying
form must be completed and returned to the contract manager.
,d.. Thc~t un.authorized aliens shall not be employed. The department shall consider the employment of unauthorized
, aliens a VIOJ'!it10n of section 274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324 a)., Such violation shall be
cause for Unilateral cancellation of this contract by the department '
e. That if this contract contains $10,000 or more of federal funds, the provider shall comply with Executive Order
11246, Equal Employment Opportunity as amended by Executive Order 11375, and as supplemented in Department of
Labor regulat!on ~ 1 CFR, Part 60. [45CFR, Part 92] .
f. T~at If thiS contract contains federal funds and provides services to children up to age 18, the prOVider shall
compl~ With tJ:te Pro-Children Act of 1994. Public Law 103-227. Failure to comply with the provisions of the law may
resu~t.1n t~e Imposition of a civil monetaJy penalty of up to $1.000 for each violation and/or the imposition of an
admInistrative compliance ord~r on the responsible entity. This clause is applicable to all approved subcontracts.
1 CONTRACT# j(f02~
CF STDCTJF 12/98
" D. Audits, Records, and Reel. ,.:>> Retention
1. To establish and maintain books, records, and documents (including electronic storage media) in accordance with
generally accepted accounting procedures and practices which sufficiently and properfy reflect all revenues and
expenditures of funds provided by the department under this contract, , .
2. To retain all client records, financial records, supporting documents,statistical records, and any other documents
(in~luding electronic storage media) pertinent to this contradb" a period of five (5) years after termination of the contract,
or If,an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be
retained until resolution of the audit findings or any litigation which may be based on the terms of this contract
3., Upon completion or termination of the contrad and at the request of the department, the provider will cooperate
with the department to facilitate the duplication and transfer of any said records or documents during the required
retention periOd as specified in Section I, Paragraph 0.2. above.
4. To assure that these records shall be subjed at all reasonable times to inspection, review, copying, or audit by
Federal, State, or other personnel duly authorized by the department
5. . At all reasonable times for as long as records are retained, persons duly authorized by the department and Federal
audl!ors, pursuant to 45 CFR, Part 92.36(i)(10), shall be allowed full access to and the right to examine any of the
provider's contract and related records and documents, regardless of the form in which kept
6. To provide a financial and compliance audit to the department as specified in Attachment I1L- and to ensure that
all related party transactions are disclosed to the auditor.
7., To include the aforementioned audit and record keeping requirements in all approved subcontracts and
assignments.
E. Monitoring by the Department
To ~ermit persons duly authorized by the department to inspect any records, papers, documents, facilities, goods, and
services of the provider which are relevant to this contract, and to interview any clients and employees of the provider to
assure ,the department of the satisfactory performance of the terms and conditions of this contract Following such
evaluation the department will deliver to the provider a written report of its findings and will include written
recommendations with regard to the provider's performance of the terms and conditions of this contract The provider will
.correct all noted deficiencies identified by the department within the specified period of time set forth in the
. recommendations. The provider's failure to correct noted deficiencies may, at the sole and exclusive discretion of the
d~partment, result in anyone or'any combination of the following: (1) the provider being deemed in breach or default of
thiS contract; (2) the withholding of payments to the provider by the department; and (3) the termination of this contract
for cause. .
F. Indemnification
NOTE: Paragraph I.F.1. and 2. are not applicable to contJacts executed between state agencies or subdivisions, as
defined in subsection 768,28(2), FS.
1. To be liable for and indemnify, defend, and hold the department and all of its officers, agents, and employees
ha~mless from all claims, suits, judgments,. or damages, including attorneys' fees and costs, arising out of any act,
actions, neglect, or omissions by the provider, its agents, or employees during the performance or operation ~f this
~ontra~t or any subsequent modifications thereof, whether direct or indirect, and whether to any person or tangible or
intangible property, .
2.. That, its i~ability to evaluate its liability or its evaluation of liability shall not excuse the provider's duty to defend an.d
to Indemn.lfy Within seven (7) days after notice by the department by certified mail. After the highest appeal taken ~s
exh~u.sted, only an adjudication or judgment specifically finding the provider not liable shall excuse performance of thiS
prOVISion. The provider shall pay all costs and fees, including attorneys' fees related to these obligations and t~eir
enforcemen~ by the department The department's failure to notify the provider of a claim shall not release the proVIder
of these dutIes. The provider shall not be liable for the sole negligent acts of the department. .
G. Insurance
~o prov.id,e adequate liability insurance coverage on a comprehensive basis and to hold such liability insurance at all
times d,uryng the existence of this contract and any renewaJ(s} and extension(s) of it. Upon execution of this con!r':l~t,
unle:ss It,lS, a state agency or subdivision as defined by subsection 768.28(2), FS, the provider accepts full responslbll~ty
for Ide~tlfylng and determining the type(s) and extent of liability insurance necessary to provide reasonable finanCial
prot~ctions for the provider and the clients to be served under this contract. Upon the execution of this contract, the
prOVider shall furnish the department written verification supporting both the determination and existence of such
Insurance coverage, Such coverage may be provided by a self-insurance program established and operating un~er t~e
laY'S of the State of Florida. The department reserves the right to require additional insurance as speCified In
Attachment J.
2
CONTRACT # t. fO 2 C:,
" ll;;'~
''H. Safeguarding Information
Not to use or disclose any information concerning a recipieJ1t of services under this contract for any purpose not in
conformity with state regulations and Federal law or regulatiaos (45 CFR, Part 205.50), except upon written consent of
the recipient, or the responsible parent or guardian when authorized by law. .
I. Assignments and Subcontracts
1. To. neither assign the responsibility for this contract. to another party nor subcontract for any of the work
c,?ntemplated under this contract without prior written approval of the department which shall not be unreasonably
Withheld, Any sublicense, assignment or transfer otherwise occurring shall be null and void.
2. To be responsible for all work performed and all expenses incurred with the project If the department permits the
provider to sUbcC?ntract all or part of the work contemplated under this contract, including entering into subcontracts with
ve~dors for services and commodities, it is understood by the provider that all such subcontract arrangements shall be
eVidenced by a written document subject to prior review and comment by the department Such review of the written
subc,?ntract document by the department will be limited to a determination of w~ether, or not s~bcontracting is
perm,l~slble, wh,ether the offered subcontractor is acceptable In the department, and the inclUSion of applicable terms and
condItions of thiS contract. The provider further agrees that the department shall not be liable to the subcontractor for any
expenses or liabilities incurred under the subcontract and the provider shall be solely liable to the subcontractor for all
expense,s and liabilities incurred under the subcontract The provider, at its expense, will defend the department against
such claims, .
3. That the State of Florida shall at all times be entitled to assign or transfer its rights, duties, or obligations under this
contract to another governmental agency in the State of Aorida, upon giving prior written notice to the erovider. In the
event the State of Florida approves transfer of the provider's obligations, the provider remains responSible for all work
pe~ormed and all expenses incurred in connection with the contract In addition, this contract shall bind the successors,
assigns, and legal representatives of the provider and of any legal entity that succeeds to the obligations of the State of
Flonda, "
4. To make payments to the subcontractor within seven (7) working days after receipt of full or partial payments f~om
the department In accordance with section 287.0585, FS, unless otherwise stated in the contract between the prOVider
an~ subcontractor. Failure to pay within seven (7) working days will result in a penalty charged against the pro,,:"lde:r and
paid to ,the subcontractor in the amount of one-half of one (1} percent of the amount due per day from the expiratIon of
the perrod allowed herein for payment. Such penalty shall be in addition to actual payments owed and shall not exceed
fifteen (15) percent of the outstanding balance due. .
J. Return of Funds
To return to the department any overpayments due to unearned funds or funds disallowed pursuant to the terms of ~his
c~ntract that were disbursed to the provider by the department In the event that the provider or its independent auditor
dl.scovers . that ~n overpayment has been made, the provider shall repay said overpayment within 40 calendar days
Without pnor notification from the department. In the event that the department first discovers an overpaymen~ has ,been
made, the department will notify the provider by letter of such a finding. Should repayment not be made In a tImely
manner, the department will charge interest of one (1) percent per month compounded on the outstanding balance after
40 calendar days after the date of notification or discovery.
K. Client Risk Prevention and Incident Reporting
1. That if. services to clients will be provided under this contract, the provider and any subcontractors shall, in
accor~anc~ With the client risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner
prescnbe,d./n C~OP 215-6 or district operating procedures.
2. , To Immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged per~on,
or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96ABUSE). As reqUired
by Chapters 39 and 415, FS, this is binding upon both the provider and its employees.
L. Transportation Disadvantaged
To comply with the, provisions of Chapter 427, FS, and Chapter 41-2, FAC, if clients are to be transported under this
contract: The prOVider shall submit to the department the reports required pursuant to Volume 10, Chapter 27, DCF
Accountmg Procedures Manual.
M. Purchasing
'. 1. ~o purcha~e articles which are the subject of or are required to carry out this contract from Prison Rehabilitative
Industnes and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, FS, in the same manner and under the
procedures. set forth in subsections 946.515(2) and (4), FS. For purposes of this contract, the provider shall be deemed
to,be substituted for the department insofar as dealings with PRIDE. This clause is not applicable to subcontractors
unless, otherwise required by law. An abbreviated list of products/services available from PRIDE may be obtained by
contactmg PRIDE, (850) 487-3774.
2. To pro~ure any prOducts or materials which are the stIbject of, or are required to carry out this contract, in
accordance With the provisions of sections 403.7065, and 287.045, FS.
3
CONTRACT # /t...(;() 26
II 11::1::1
N. Civil Rights Requirements
1. Not to discriminate against any employee in the performance of this contract, or against any applicant for
employment, because of age, race, creed, color, disability, national origin,. or sex. The provider further assur.e~ that all
contractors, .subcontractors, subgrantees, or others with whom it arranges to provide services or benefits to pa~~lpants or
employees In connection with any of its programs and activities are not discriminating against those participants or
emploY!'les because of age, race, creed, color, disability, national origin, or sex. This is binding upon the provider
emplOYing fifteen (15) or more individuals.
2., ,To Co~plete the Civil Rights Compliance Questionnaire., HRS Forms 946 A and B, in acccrdance with HRSM 220-2.
ThiS IS applicable if services are directly provided to clients and if 15 or more individuals are employed.
O. Independent Capacity of the Contractor
1. To be solely liable for the performance of all tasks contemplated by this contract which are not the exclusive
responsibility of the department. . '.
2. . To ~ct in the capacity of an independent contractor and not as an officer, employee, or agent of the State of
F!onda, except where the provider is a state agency. The provider shall no.t represent to others that it has the authority to
bind the,gepartment unless specifically authorized in writing to do so. In addition to the provider, this is also applicable to
the prOVider's officers, agents, employees, subcontractors, or assignees, in performance of this contract. .
3. E?,cept where the provider is a state agency, neither the provider, its officers, agents, employees, subcontractors,
nor assignees are entitled to state retirement or state leave benefits, or to any other compensation of state employment
as a result of performing the duties and obligations of this contract.
4., To take such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be
an Independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the
State of Florida. .
5. ~he department will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial
or clencal support) to the provider, or its subcontractor or assignee, unless justified by the provider and agreed to in
advance by the department in Attachment I.
6. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation
,fun~s, and all necessary insurance for the provider, the provider's officers, employees, agents, subcontractors, or
assignees shall be the responsibility of the provider.
P. Sponsorship . ,
As requir~d by section 286.25, FS, if the provider isa nongovernmental organization which sponsors a program fln.anced
wd hOllyb<?r In part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertiSing, or
escr! Ing the sj:)onsorship of the program state: "Sponsored by (provider's name) and the State of Flonda, Department
Ocfh91dhlldren and Families.' If the sponsorship reference is in wntten material, the words "State of Florida, Department of
I ren and Families" shall appear in the same size letters or type as the name of the organization.
Q. . Final Invoice
To ~ubmit the final invoice for payment to the department no more than ~ days after the contract ends or is
terminated. If ,the provider fails to do so, all rights to payment are forfeited and the department will not hon~r any
req,uests submitted after the aforesaid time period. Any payment due under the terms of this contract may be Withheld
until all reports due from the provider and necessary adjustments thereto have been approved by the department.
R. Use Of Funds For Lobbying Prohibited
To comply" with the provisions of sections 11.062 and 216.347, FS, which prohibit the expenditure of contract funds for
the:purpose of lobbying the Legislature, judicial branch, or a state agency.
S.Public Entity Crime
P~rsuant to section 287.133, FS, the following restrictions are placed on the ability of persons convicted of public entity
cnme~ to transac:t ~usiness with the department: When a person or affiliate has been placed on the convicted vendor list
follo~lng a convlc:tlon for a public entity crime, he/she may not submit a bid on a contract to provide any go~ds or
sefV~ces:!o ,a pUblic entity, may not submit a bid on a contract with a public entity for the construction or the repair of a
public bUilding or public work, may not submit bids on leases of real property to a public entity, may not be awarded or
perform wo~ as a c~ntractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not
, transact bUSiness With any public entity in excess of the threshold amount provided in section 287.017, FS, for
' CATEGORY TWO for a periOd of 36 months from the date of being placed on the convicted vendor list.
T. Patents, Copyrights, and Royalties
1:: If any discc;)Very or invention arises or is developed in the course or as a result of work or services performed under
thiS contract, or In anyway connected herewith, the provider shall refer the discovery or invention to the department to be
referred to the Department of State to determine whether patent protection will be sought in the name of the State of
FlOrIda. Any and all patent rights accruing under or in connection with the performance of this contract are hereby
reserved to the State of Florida.
4
CONTRACT # It G- 0 2~
1111~~
'2. t I'n the event that any books, ,..dnuals, films, or other copyrightable materia~ are produced, the provider shall notify
the Department of State. Any and all copyrights accruing under or in connection with. the performance under this
contract are hereby reserved to the State of Florida .
~. " The provider, without exception, shall indemnify and save harmless the State of ~Iorida and its employees from
!Iablh~ of any nature or kind, including cost and expenses for or on account of any .copynghted,patent~, O!' unpatented
Inventl~n, process, or article manufactured by the provider. The provider has no habilly when such daim IS solely and
ex~luslv~ly due to the Department of State's alteration of the article. The State of Florida will provide p~mpt written
~otlfic?tlon of claim of cOPyright or patent infringement. Further, if such claim is made oris pending, the ~rovider ~ay, at
Its optl~n and expense, procure for the Department of State, the right to continue use of, replace, or modify the article to
render It non-infringing. If the provider uses any design, device, or materials covered by fetters, patent, or copyright, it is
mutually agreed and understood without exception that the bid prices shall include all royalties or costs arising from the
use of such design, device, or materials in any way involved in the work.
U, Requirements of Section 20.19, F.S.
That the. department shall file a lien against the property where facilities are located which have been constru~ted or
subst~ntl~II'y renovated, in whole or in part, through the use of state funds; However,' the department is not required to
~le a hen If the amount of state funds does not exceed $25,000 or 10 percent of the contract amount, whichever amount
IS less. As a condition of receipt of state funding for this purpose, the provider agrees that, if it disposes of the property
~efore the department s interest is vacated, the provider will refund the proportionate share of the state s initial
Investment, as adjusted by depreciation.
1/. THE DEPARTMENT AGREES:
A. Contract Amount
To pay for. contracted services according to the conditions of Attachment I in an amount not to exceed.
$111.713.30. ,subject to the availability of funds. The State of Florida's performance and obligation to pay under
thiS contract IS contingent upon an annual appropriation by the Legislature. Any costs or services paid for under any
other contract or from any other source are not eligible for payment under this contract
.8. Contract Payment
Pursuant to ~ection 215.422, FS,' the departmenfhas five (5) working days to inspect and approve goods and services,
unless the bid specifications, purchase order,' or this contract specifies otherwise. With the exception of payments to
health care providers for hospital, medical, or other health care services,' if payment is not available within 40 d~ys,
measur~d frof!! the latter of the date a properly completed invoice is received by the department or the goo.ds or services
a~e received, Inspected, and approved, a separate interest penalty set by the Comptroller pursuant to section .55:03, FS,
Will be due and payable in addition to the invoice amount. To obtain the applicable interest rate, contact the dl~tnct fiscal
office/contract administrator. Payments to health care providers for hospital, medical, or other health care services, shall
be made ,no~ more than 35 days from the date eligibility for payment is determined. Financial penalties will ~ecalculated
at the dally Interest rate of .03333%. Invoices returned to a vendor due to preparation errors will result In a payment
delay, Interest penalties less than one dollarwill not be enforced unless the vendor requests payment.
C. Vendor Ombudsman
!' Y~ndor. Ombudsman has been established within the Department of Banking and Finance. The duties of this
individual include acting as an advocate for vendors who may be experiencing problems in obtaining timely payment(s)
fro~ a state agency. The Vendor Ombudsman may be contacted at (850) 488-2924 or 1-800-848-3792, the State of
Flonda Comptroller's Hotline.
III. THE PROVIDER AND DEPARTMENT MUTUALLY AGREE:
A. Effective and Ending Dates
This contract shall begin on July 1, 1999 or on the date on which the contract has been signed by
b~th parties, whichever is later. It shall end on June 30, 2000
B. Termination: At Will, Because of Lack of Funds, or For Breach or Failure to Satisfactorily Perform Prior
Agreement
1. " This contract may be terminated by either party without cause upon no less than thirty (30) calendar d<3:Ys notice in
wn~Ing to the ot~er p.arty unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be
d~lIvered by certified mail, return receipt requested, or in person with proof of delivery. .
2. In the event funds to finance this contract become unavailable, the department may terminate the contract ~pon no
less ,than twenty-four,(24) hours notice in writing to the provider. Said notice shall be delive~ed by certified r:na I I.. . return
receIpt requested, or In person with proof of delivery. The department shall be the final aUthonty as to the availability and
ad~quacy ,of funds. In the event of termination of this contract, the provider will be compensated for any work
satlsfactonly completed prior to notification of termination.
5
CONTRACT # f( f'& 26
1/1/99
,3. 'This contract may be termin J for the provider's non-performance upor,' jess than tWenty-four (24) hours notice
in writing to the provider. If applicaole. the department may employ the default provisions in Chapter 60A-1.006 (3), FAC.
Waiver of breach of any provisions of this contract shall Dot be deemed to be a waiver of any other breach and sh~1I not
be construed to be a modification of the terms of this contract. The provisions herein do not limit the department's nght to
remedies at law or in equity. .
4. Failure to have performed any contractual obligations with the d~partment in a manner satisfactory to the
department will be a sufficient cause for termination. To be terminated as a provider under this provision, the provider
must have: (1) previously faj,fed to satisfactorily p~rform in a contract ~th the department, been notifi.ed by the
department of the unsatisfactory performance, and failed to amed the unsatisfactory performance to the satisfaction of
the department; or (2) had a contract terminated by the department for cause.
C. Renegotiation or Modification
Mb odificatipns of provisions of this contract shall only be valid when they have bE;!en reduced to .writing and duly signed by.
,oth parties. The rate of payment and the totaf dollar amount may be adjusted retroactively fo reflect pnce level
Incbreases and, char:l~es.in the (ate of payment wh~n these have been established through the appropriations process and
su sequently IdentlfTed In the department's operating budget
D. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
1. The provider. name, as shown on,page 1 of this 3. The name. address, and telephone n~mber of th.e
cthontract, and maIling address of the official payee to whom contract manager for the department for thiS contract IS:
e payment shall be made is:
Monroe County In Home Services
5100 COlleqe Road
Key West, FL 33040
Theresa Phelan
Department of Children and Families
1111 12th Street #301
Key West FL 33040
305/292-6810
2. The na.me of the contact person and street address 4. The name, address, and telephone number of the
y.'here finanCial and administratiVe records are maintained representative of the provider respon~ible for
IS: administration of the program under this contract IS:
Deloris Simpson Deloris Simpson
Monroe County In Home Services' Monroe County In Home Services
5100 Colleqe Road 5100 Colleqe Road, Key West, FL 33040
Key West. FL 33040 305/292-4588
5. ,~pon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
wntl~g to the other party and the notification attached to the originals of this' contract
E. All Terms and Conditions Included
This contract and its attachments as' referenced, I, II, II and Exhibits A, B & C
co~tai~ all the terms and conditions agreed upon by the parties. There are no provisions, terms, condit.ion~, or
obligatIons, other than those contained herein, and this contract shall supersede all previous commUnlCatlon~,
representatl<?ns, or agreements, either wrbal or written between the parties. If any term or provision of the contract IS
found to be Illegal or unenforceable the remainder of the contract shall remain in full force and effect and such term or
provision shall be stricken. ' .
The parties have read the !!ntire eo '. t inc tJS.lve of all its attachments, as referenced in Paragraph III.E. above,
and understand each section an ~tajJh,;':\
I NffiVVIT, NESS THEREOF, the pa .~> ", have ca\~ed this ~ page contract to be executed by their undersigned
o ICla s as duly authonzed. I.. , . .
PROVIDER: (SEAl.l I~"'!, ".. .' ,: ': " STATE OF FLORIDA
ATT~ST: J. · ,~:t.r'.' ,
Monroe Coun In Home Service ~ ~l/:1 E, a /( DEPARTMENT OF CHILDREN AND FAMILIES
SIGN~D BY: ,." '0- 1'.: ^'> "'GNED BY: . ~ ~
: NAME: Wilhelmina Harvey NAME: Sara B. Herald
TITLE: Mayor ,.' ".._': 4l~ f\ .. ~ \ '\. "
- -~~~ ~ ,-
.- .. .. ..;"..........
. .. .." ...."
.. .. .. ". .. .. .
.. .." ..
".:::~
..~
',': :: :': : \ : :: : :'
\: TITLE:
DATE:
~r Administrator
. qct
DATE: / -~/_ 99
STATE AGENCY 29 DIGIT SAMAS CODE:
Federal EID # (or SSN): F596000740029
APPROVED AS TO FORM
~AND GAL SUFFIC '
· UUON
Z/., "") . ...., T:i6
Provider Fiscal Year Ending Date: --.QL I ~
APPiU)';t:lJ AS TO FORM
Al'iD LEGAL SUFFICIENCY
~ G.('4.lq~
i~d~"":~.'" nidr~~t ....e:l::! Ll'unseJ
6
CONTRACT #
Ker02(o
I .
,07/01/99
Community Care f-- Uisabled Adults
Fixed Price
Adult Services
/< 6-0.2 0
ATTACHMENT I
A. Services to be Provided
The provider's approved application or program proposal for Community Care for Disabled Adults
Funds is incorporated herein by reference. In the event of a conflict between the approved
application or program proposal and this Attachment I, the provisions 'of this Attachment I Will
prevail.
. 1. Definition of Terms
a. Contract Terms
(1) State Fiscal Year - July 1st through June 30th.
(2) Invoice - A standardized form utilized by the provider to request payment on a
monthly basis.
(3) Exhibit - An attachment to an Attachment I or any other contract attachment
(4) Fixed Price - Method of payment used when the provider is paid a pre-determined
price for each unit of service delivered.
(5) Rate Contracts - A contract between the department and an individual or an
organization that establishes a rate of payment for a specified unit of service.
b. Program or Service Specific Terms
(1) Activities of Daily Living (ADL's)- basic activities performed in the course of daily
living, such as dressing, bathing, grooming, eating, toileting, and ambulating around
one's own home.
(2) Community Care for Disabled Adults (CCDA) Program - a program designed to
assist disabled adults 18 through 59 years of age in utilizing available community and
personal resources to help them remain in their homes and prevent their premature or
inappropriate institutionalization. These adults must have one or more permanent
physical or mental limitations that restrict their ability to perform normal activities of
daily living as determined by an initial functional assessment and documentation of
disability.
(3) Contract Manager - an individual designated by the contract signer to be responsible
. for the success of the contract in addition to his other duties.
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GA08
f)7/0 1/99
Community Care r Disabled Adults
Fixed Price
Adult Services
(4) Medicaid Institutional Care Program - Medicaid .eligible indivicJua1s determined
eligible for a nursing home level of care are provided primary, acute and long-term
care services at capitated federally-matched arrangements.
(5) See the INSTRUCTIONAL GUIDE, SECTION D, Glossary of Approved Community
Care for Disabled Adults Services, or those terms as specified in HRSM 140-8,
CCDA Program Manual, Appendix B, both incorporated herein by reference.
2.. General Description
a. General Statement
Service providers will ensure that appropriate community-based services (duration,
frequency, scope per the client's care plan and the HRSM 140-8, CCDA Program Manual)
are provided to clients in a manner developed to meet the client's changing needs, to assist
the client in avoiding or reducing unnecessary dependence on the delivered service(s), and
to increase the client's self-reliance.
b. Authority
Sections 410.6'01-606, Florida Statutes (F.S.), Chapter 65C-2, Florida Administrative Code
(F.A.C.), and the annual appropriations act with any proviso or instructions to the
department constitute the legal basis for services to be delivered through the Community
Care for Disabled Adults program.
c. Scope of Service
Services will be targeted toward eligible adults aged 18 through 59 years in Monroe
County .
d. Major Program Goal .
The provision of community-based services through this contract are to prevent unnecessary
institutionalization of disabled adults.
. 3. Clients to be Served
a. General Description
Adults with disabilities, 18 through 59 years of age, no longer eligible to receive children's
serVices, yet too young to qualify for community and home based services to the elderly.
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"
D7/01/99
Community Care Disabled Adults
Fixed Price
Adult Services
b. Client Eligibility
(1) Must be 18 through 59 years of age.
(2) Must have one or more permanent physical or mental limitations which restrict the
ability to perform normal activities of daily living as determined through the initial
functional assessment and medical documentation of disability. Disability, per
HRSM 140-8, CCDA Program Manual, must be established in one of two ways: a)
the case manager may see a check, awards letter; or other evidence which proves that
the applicant receive's Social Security Disability 'Or some other disability payment (e.g.
Worker's Compensation); or, b) the applicant may have a written statement from a
licensed physician, licensed nurse practitioner, or a mental health professional which
meets the district's criteria as evidence of the applicant's disability. This statement
must, at minimum, include the applicant's diagnosis, prognosis, a broad statement
about the applicant's level of functioning, and the author's interpretation of need for
this program's services based on identified functional barriers caused by the
applicant's disabling condition.
(3) Applicant must have an individual income at or below the prevailing Medicaid
Institutio:nal Care Program (ICP) eligibility standard in order to receive non-fee
assessed CCDA services. Clients with incomes above the ICP standard will be
assessed for a share of the costs, or may be required to provide volunteer services in
lieu of payment.
(4) Applicants for Community Care for Disabled Adults services will be assessed for
eligibility and prioritized for services by district or provider case management staff in
accordance with subsection 410.604 (2), F.S.
c. Client Determination
(1) Client must not be receiving comparable services from any other entity in order to
prevent duplication of effort.
(2) Documentation must be contained in the client's file that all comparable existing
community services and funding sources have been explored and exhausted.
(3) Determination of eligibility for this program will remain with the department.
(4) Should a dispute over eligibility determination arise, final determination will be made
by the department's contract manager.
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9
GA08
'7/01/99
Community Care l Disabled Adults
Fixed Price
Adult Services
d. Contract Limits
(1) The total annual cost, estimated or actual, for an individual receiving Community
Care for Disabled Adults services, shall not exceed the annual general revenue portion
of a Medicaid nursing home bed within the district area.
(2) The provider shall deliver services only to those persons who meet program eligibility
criteria and only to the extentthe funds are available.
B. Manner of Service Provision
1. Service Tasks
a. Task List
(1) TIlls contract will render the following checked [X] Community Care for Disabled
Adults services:
[ ]Adult Day Care
[X]Personal Care
[X]Homemaker
[ ]Interpreter
[X] Chore
[ ]Escort
[X]Case Management
[ ]Home Health Aide
[ ]Home Nursing
[ ]Transportation
[X] Respite
[ ]Emergency Alert Response
[ ]Group Activity Therapy
[X]Home Delivered Meals
[ ]Medical Therapeutic Services
[ ]Physical and Mental Exams
[X]Medical Equipment/Supplies
(2) A description and minimum requirements for scope of service for each of these services
may be found in the INSTRUCTIONAL GUIDE, SECTION D, or as specified in
HRSM 140-8, CCDA Program Manual, both incorporated herein by reference.
The provider may render additional services, as found in Section D of the
INSTRUCTIONAL GUIDE and as specified in HRSM 140-8, by submitting a written
request, accompanied by a budget revision, to the department contract manager.
b. Task Limits
(1) Each district Community Care for Disabled Adults program shall include case
management services and at least one other community service.
(2) Respite care may be provided for up to 240 hours per consumer per calendar year
depending upon individual need. The service may be extended up to 360 hours as
recommended by the case manager with documented approval placed in the case
narrative by their immediate supervisor.
Revised 5/24/99
10
GAOS
. .
O~IO 1/99
Community Care f !>isabled Adults
Fixed Price
Adult Services
(3) Personal Care services will not subStitute for the care usually provided by a registered
or practical nurse, therapist, or home health aide. The personal' care aide WILL NOT
change sterile dressings, irrigate body cavities, administer medications, or perform
any other activities prohibited by Chapter 59A-8, F.A.C.
(4) Homemaker service time DOES NOT include time spent in transit to and from the
client's place of residence except when providing shopping assistance, performing
errands or other tasks on behalf of the client. The following restrictions apply to
persons providing ho~emaker activities: must NOT engage in work that is not
specified in the homemaker assignment; must NOT accept gifts from clients; must
NOT lend or borrow money or articles from clients; must NOT handle money unless
authorized in their personnel file by a supervisor or case manager AND unless bonded
or insured by employer; and, must NOT transport the client unless authorized by a
supervisor or case manager.
(5) The parameters of service delivery, by service, are detailed in the INSTRUCTIONAL
GUIDE, SECTION D, or as specified in HRSM 140-8, CCDA Program Manual, both
. incorporated herein by reference.
2. Staffing Requirements
a. Staffing Levels
(1) The provider will notify the deparbnent within thirty days whenever the provider is
unable, or appears to be unable, to provide the required quality or quantity of service
due to staffmg inadequacies.
(2) The provider will meet the minimum staffing requirements per service definition as
found in the INSTRUCTIONAL GUIDE, SECTION D, or as specified in HRSM 140-
8, CCDA Program Manual, both incorporated herein by reference.
b. Professional Qualification
See the INSTRUCTIONAL GUIDE, SECTION D, or as specified in HRSM 140-8, CCDA
Program Manual, both incorporated herein by reference.
c. Staffing Changes
The provider agrees to notify the department's contract manager within two working days if
an administrative position (e.g., executive director, contract contact person, or project
director) becomes vacant. Planned staffing changes which may affect program objectives,
as stipulated in this contract, must be presented in writing to the contract manager for
approval at least two weeks prior to the implementation of the change.
Revised 5/24/99
II
GA08
.Q7/01/99
j
Community Care / Disabled Adults
Fixed Price
Adult Services
d. Subcontractors
The provider must monitor the subcontractor once (on-site) during the contract period and
provide the requested technical assistance to all subcontractors as needed. Copies of reports
of those monitoring visits will be submitted to the department in a format and within the
time frames set and approved by the department. The provider must monitor all
subcontracts at least once during the contract period.
.3.. Service Location & Equipmept
a. Service Delivery Location and Time
(1) Community Care for Disabled Adults services may be delivered in the client's home
or on-site at a facility as negotiated by the department and the provider.
(2) Facilities delivering on-site services to Community Care for Disabled Adults
consumers, shall pass an annual inspection by the local environmental health and fire
authorities.
(3) Service providers will meet the minimum service location and time requirements as
specified in the INSTRUCTIONAL GUIDE, SECTION D, or as specified in HRSM
140-8, CCDA Program Manual, both incorporated herein by reference.
(4) Services for this contract will be delivered at the following location(s) and times:
SERVICE
Case Management
Personal Care
Homemaking
Home Delivered Meals
Chore Service
Respite
Medical Equipment/Supplies
LOCATION
Client's Home
Client's Home
Client's Home
Client's Home
Client's Home
Client's Home
Client's Home
b. Changes in Location
TIMES
As Needed
As Needed
As Needed
As Needed
As Needed
As Needed
As Needed
Location of service delivery must be negotiated and must be included in either the
provider's Application or in the Attachment 1. Once the service delivery location is agreed
upon, any proposed change must be presented in writing to the contract manager for
approval prior to implementation of that proposed change. In the event of an emergency,
temporary changes in location may necessitate waiver by the district program office of this
designated standard. Such a waiver will take into consideration the continuity, safety and
welfare of the department's clients, and is in the department's sole discretion.
Revised 5/24/99
12
GA08
97/01199
Community Care ~ Uisabled Adults
Fixed Price
Adult Services
c. Equipment
(1) The equipment required to perform the contracted services must be agreed upon by
the provider and department during the negotiation process. Any changes to.that
negotiated requestmust be presented in writing to the contract manager for approval
10 days prior to implementation of the proposed change.. This is to ensure uniformity,
safety, and quality of service to the department's clients.
(2) All equipment acquir~ under this contract must be inventoried annually by the
provider and such inventory made available within seven days upon provider receipt
of written request by the contract manager.
4. Deliverables
a. Service Units
A service unit is an appropriate, distinct amount of a given service. It may include, but is
not llinited to: an hour or quarter hour of direct service delivery; a meal; an episode of
travel; or, a 24 hour period of Emergency Alert Response maintenance: Each Community
Care for Disabled Adults service unit is defined in the INS1RUCTIONAL GUIDE,
SECTION D, or as specified In HRSM 140-8, CCDA Program Manual, both incorporated
herein by reference. .
b. Reports
(1) Reporting will be as set forth in Community Care for Disabled Adults Policy
Clearance No. 009 in the INS1RUCTIONAL GUIDE, SECTION A, which provides
information on the forms to be submitted in accordance with policy, and HRSM 140-
8, CCDA Program Manual, all incorporated herein by reference.
(2) Reporting requirements for this fixed price contract include Monthly Summary
Reports and Quarterly Cumulative Summary Reports. Monthly Summary Reports are
due once a month from the provider to the district office, as negotiated. Quarterly
Cumulative Summary Reports (3 Month Cumulative Swnmary Reports due October
30th, 6 Month Cumulative Summmy Reports due February 15th, 9 Month Cumulative
Summary Reports due April 30th, and 12 Month Cumulative Summary Reports due
August 15th) are also required of the provider.
(3) The provider of case management services agrees to submit to the department
management program data including client identifiable data in accordance with
negotiated instructions provided by the department.
Revised 5/24/99
13
GA08
07/01199
Community Care.' Disabled Adults
Fixed Price
Adult Services
(4) The provider agrees to submit to the department contract manager an original signed
Security Agreement Form (CF-114) (Exhibit A) for all required personnel no later
than thirty (30) days following the execution of the contract or thirty (30) days from
the date of employment. All personnel who require access to sensitive data must sign
the Security Agreement Form prior to receiving access to the data
c. Records and Documentation
(I) The contents of the cl~ent file are: a completed client assessment not more than one
year old; a care plan not more than one year old;' a release of information form; a copy
of a completed Client Information System (CIS) form; documentation of the client's
age; disability and income; a copy of the referral/intake form; and, a case narrative
section.
(2) A [mal report will be submitted to the department by the provider within forty (40)
days after the contract ends or is terminated. This report is to be completed on the
form supplied by the department, identifying total units of service and total payment
. 'received. In the event of an overpayment resulting from revised units of service for
the contract period being reported, these monies must be returned to the Department
with the ~al report.
(3) The provider must maintaiti a current record on each individual in the program
including: current documentation of eligibility for services; identifying information
about the recipient and need to receive the service; service delivery date; and all other
forms or records necessary for program operation and reporting as set forth in HRSM
140-8, CCDA Program Manual. This must track to each invoice for payment.
(4) Documentation must be contained in the client's file that all comparable existing
community services and funding sources have been explored and exhausted.
(5) Maintain records documenting the clients by name or unique identifier, to whom
services are provided, the number of units provided and the dates of service
provision, whIch must match the invoice for payment.
(6) Resolution offmal questions regarding records will be the department's
responsibility .
(7) The provider must maintain documentation necessary to facilitate monitoring and
evaluation by the department as described in paragraph B.5.c.
Revised 5/24/99
14
GA08
,0,7/01/99
Cemmunity Care i: Disabled Adults
Fixed Price
. Adult Services
5. Performance Specifications
a. Outcomes and Outputs (performance Measures)
(1) 99 % of individuals served will not fie placed in a nursing home.
(2) 50 eligible individuals will be served through this contract.
(3) Providers of home an~ community-based services shall conduct individual satisfaction
surveys on a negotiated random sampling of the. clients they are serving with CCDA
services, using the survey instrument developed by the department's Office of
Standards and Evaluation. Surveys will be delivered in a number that will ensure a
35% client response. The provider must achieve a 95% client satisfaction with
services received.
.' b. Standards Definitions
(1) "individuals served" - refers to cliems who received case management or any of the
other services offered and funded through the Community Care for Disabled Adults
program 4uring the fiscal.year being evaluated.
(2) "eligible individuals" - refers to tmse individuals who meet client eligibility criteria
under paragraph A.3.b. of this attadJment.
(3) "placed" - refers to the act of assessing an individual no longer able to remain in their
present place of residence and prepsration for and follow-up of moving that individual
into a more restrictive alternative IRing environment.
(4) "nursing home" - refers to any facility licensed under Chapter 400, F.S., which
provides services or acts as may be rendered, directly or indirectly, to and in behalf of
a person by individuals licensed in this state to perform selected acts, including the
administration of treatments and medications, in the care of the ill, injured, or infirm
and the promotion of wellness, maintenance of health, and prevention of illness of
others.
(5) "will be served" - refers to those idcmi:fied, eligible individuals who will receive case
management or a negotiated service of this contract.
c. Monitoring and Evaluation Methodolomr
(1) By execution of this contract the provider hereby acknowledges and agrees that its
. performance under the contract must meet the standards set forth above and will be
bound by the conditions set forth bdow. If the provider fails to meet these standards,
Revised 5/24/99
IS
GA08
07/01/99
Community Care'" Disabled Adults
Fixed Price
Adult Services
the department, at its exclusive option, may allow up to six months :for the provider to
achieve compliance with the standards. If the department affoIds the provider an
opportunity to achieve compliance, and the provider fails to achieve compliance
within the specified time frame, the department will terminate the contract in the
absence of any extenuating or mitigating circumstances. The determination of the
extenuating or mitigating circumstances is the exclusive determination of the
department.
(2) The department reseryes the right to monitor on.;.site without prior announcement to
the provider. Monitoring shall generally be conducted as set forth in Exhibit C.
(3) District II's Office of Contract Compliance ("Contract Compliance') may select to
perform an on-site administrative and programmatic monitoring during the contract
period. At a minimum, an annual desk review will be performed which will be
accomplished by a combination of the review of reports or other documentation
submitted by the provider, input from service recipients and others and visits to the
site of service delivery for programmatic review.
For on-site monitoring, a random discovery sample of open and closed files will be
taken for review. This sample may be increased to a raridom statistical sample
depending on the results of our review. The number of files reviewed will be
contingent upon the population size of the services rendered. To facilitate the
sampling process, upon Contract Compliance's request, the provider shall submit a
universal events listing of all services provided under the contract prior to the
monitoring. Detailed instructions will be provided prior to the monitoring visit.
A report outlining the department's findings during the on-site monitoring win be
submitted to the provider within 30 days of concluding filed work with an exit
conference. The provider agrees to respond and submit a corrective action plan, if
necessary, within 30 days of receiving the department's monitoring report.
(4) The performance standard in paragraph B.5.a.(1), above, win be measured by
determining the ratio of the number of persons served to the number of persons placed
in a nursing home during the contract period.
(5) The performance standard in paragraph B.5.a(3), above, will be performed by the
provider. Survey forms will be hand delivered with a seIf- addressed, stamped return
envelope to each client to be surveyed. Those clients requiring special assistance to
complete the survey, are permitted to seek such assistance from a friend or family
member. Clients may not receive such assistance from the contracted provider staff.
CCDA case managers (both contracted and departmental) are to give the clients the
. instructional guide directions necessary to complete and return the survey form.
Revised 5/24/99
16
GA08
07/01/99
Community Care" Disabled Adults'
Fixed Price
Adult Services
(6) The performance standard in paragraph B.5.a.(3),above, will b~,applied only to the
percentage of completed satisfaction surveys received by the provider. Providers are
to leave the completed, returned surveys sealed, and in a negotiated place for case
manager retrieval. Case managers are to collect all completed, sealed surveys and
return them to the district office where district program specialists for the CCDA
program will rate and score survey results to determine each provider's percentage of
measure achieved. The rating process of this standard will be the rating process
established by the Office of Standards and Evaluation for this instrument and will be
completed by the district office program represeritative forthe CCDA program.
d. Performance Definitions
The contract period is defined as July 1, 1999 through June 30, 2000.
6. Provider Responsibilities
a. Provider Unique Activities
In addition to the approved application or program proposal, the provider will be required to
use volunteers to the fullest extent feasible in the provision of services and program
operations, and train, supervise, and appropriately support those volunteers with insurance
coverage. .
b. Coordination With Other ProviderslEntities
(1) The case management provider must coordinate as necessary with the Vocational
Rehabilitation Division of the Department of Labor and Employment Securities, the
Developmental Services Office of the Department of Children and Families, the
Department of Education, the Department of Health, and the Human Rights Advocacy
Committee serving. those clients who are eligible for services through two or more
service delivery continuums.
(2) All providers must comply with local environmental health and fire authorities'
annual inspections.
7. Departmental Responsibilities
a. Department Obligations
(1) The department will supply all new providers with a copy of: HRSM 140-8, CCDA
Program Manual; Policy Clearance 009; and, the INSTRUCTIONAL GUIDE.
Revised 5/24/99
17
GA08
"
67/01/99
Community Care { Disabled Adults
Fixed Price
Adult Senrkes
(2) The department will provide Community Care for Disabled Ad~lts technical
assistance to the provider, relative to the negotiated terms of this contract and supply
providers with instructions for submission of required data.
b. Department Determinations
Should a dispute arise, the department will make the final determination as to whether or
not the contract terms are being fulfilled according to the contract specifications.
C. Method of Payment
1. This is a Fixed Price contract.
2. 'The total dollar amount of this contract is $11 1,713.30. The department shall make payment to
the provider for a dollar amount not to exceed $11 1,713.00, which is 90% of the total cost, and
. 'only subject to the availability of funds.
3. The department shall make payment to the provider for provision of services up to a maximum
number of units of service and at the rates stated below:
Service Unit Unit Rate Max. # Units Max.#
Measure to be Clients
Delivered to be Served
Case Management One Hour $45.7533 825 50
Homemaking One Hour $25.3532 1300 30
Home Delivered Meals .. One Meal $3.2912 9400 40
Personal Care One Hour $23.5613 320 20
Chore One Hour $23.0046 110 20
Medical Equipment/Supplies N/A N/A $1,426.94 2
. Respite One Hour $20.7199 . 195 2
The provider may render additional services, as found in Section D of the INSTRUCTIONAL
GUIDE and as specified in HRSM 140-8, by submitting a written request, accompanied by a
budget revision, to the department contract manager.
4. The provider shall request payment through SIlbmission of a properly completed invoice
(Exhibit B) within 15 days following the completion of all terms and conditions for the
delivery of service under this contract. If the provider fails to do so, all right to payment is
Revised 5/24/99
11
GA08
07JO 1/99
Community Care ft lisabled Adults
Fixed Price
Adult Services
forfeited, and the department will not honor any requests submitted after ~he aforesaid time
period. Payment due under this contract will be withheld until the final product has been
approved by the department. Replication of the form via data processing equipment is
permissible; replications must include all data elements included on the departmental form.
5. The provider shall submit to the contract manager an original invoice, Exhibit B, along with
supporting documentation, for payment on a monthly basis. The due date for these invoices is
the 15th day of the month following the month being reported.
6. The provider's dollar match for this contract is $12,412.59. Case management and/or
transportation services may be exempt from match requirement at the discretion of each district.
7. It is expressly understood by the provider that any payment due the provider under the terms of
this contract may be withheld pending the receipt and approval by the department of all
financial and program reports due from the provider as a part of this contract and any
. adjustments thereto.
8. The provider must maintain records documenting the clients, by name or unique identifier, to
whom services are provided, the number of units provided and the dates of service provision.
The records must track to. each invoice for payment. Requests for payment which cannot be
documented with supporting evidence will be returned to the provider upon inspection by'the
department.
D. Special Provisions
I. State Laws and Regulations
a. The provider will comply with the applicable provisions of Chapter 410,. F ~S.
b. The provider will comply with the.applicab.le provisions of Chapter 65C-2, F.A.C.
c. The provider will comply with the applicable provisions of HRSM 140-8, CCDA Program
Manual, and any other applicable guidelines or criteria established by the department.
2. Fees
a. The provider will collect fees for services provided according to 65C-2.007, F.A.C.
b. No fees shall be assessed other than those set by the department. Fees collected in
compliance with departmental directives will be disposed of in a manner prescribed by the
. department.
Revised 5/24/99
19
GA08
"
~"/01l99
Community Care ;" Disabled Adults
Fixed Price
Adult Services
3. Human Rights Advocacy Committee Clause
The provider agrees to allow properly identified members of the HRAC access. to the facility
and/or agency and the right to communicate with any client being served, as wen as staff or
volunteers who serve them in accordance with subsections 402. 165(8)(a) and (b),.F.S.
Members of the committee shall be free to examine all records pertaining to any case unless
legal prohibition exists to prevent disclosure of those records.
4. The provider agrees that any donations received will be used to enhance or expand program
. activities.
5. In accordance with HRS Regulation 0-221-1, Civil Rights, Accessibility of Meetings to
Handicapped Persons, any meeting, conference, workshop, hearing, training session, seminar or
other similar functions sponsored by this department, either as sole sponsor or in conjunction
'with other agencies, whether such functions are open to the public, designed for department
staff, or limited by invitation, must be scheduled in an accessible facility. This includes any
. . ,training done through contracts.
6. The department may renegotiate the contract with the provider if service utilization falls below
90 percent.
7. Information Tec~ology Resources. All contract providers must adhere to the department's
procedures and standards when purchasing Information Technology Resources (ITR) as part of
this contract if these resources will revert to the department at the conclusion of the contract.
ITR are data processing hardware, services, supplies, maintenance, training, personnel and
facilities. The provider agrees to secure prior written approval through the contract manager
from the district Management Systems director for the purchase of any ITR. The provider will
not be reimbursed for any purchases made prior to this written approval.
8. Venue for any court action pertaining to this contract shall be Monroe County.
9: The provider will make available to Children and Families District XI zip code data on where
their service recipients reside as well as certain other client identifying information as
requested. This information will be used to facilitate department impact zone planning.
10. Provider proposal is hereby incorporated by reference for programmatic assurance of service
provision. This proposal will be part of the contract manager's file.
11. Funds provided by the Department under this contract shall not be used by Not For Profit
'. Corporations to make loans to their employees, officers, directors and/or subcontractors.
Violation of this provision shall be considered a breach of contract, the termiIllnion of this
c~:mtract shall be in accordance with the Standard Contract, Section III, Paragraph B,
subsection 3. A loan is defined as any advancement of money for which the repayment period
extends beyond the next scheduled pay period.
Revised 5f24/99
20
GA08
.'
1.)7/01/99
Community Care' Disabled Adults
Fixed Price
Adult Services
12. MORALS CLAUSE
The Provider understands that performance under this contract involves the expenditure of
public funds from both the state and federal governments, and that the acceptance of such funds
obligates the Provider to perform its services in accordance with the highest standards of ethical
and moral conduct. Public funds may not be used for purposes of lobbying, or for political
contributions, or for any expense related to such activities, pursuant to Section I R of the
Standard Contract of this contract. The Provider understands that the Department is a public
agency which is m~dated to conduct business in the sunshine, pursuant to Florida Law, and
. that all issues relating to the business of the Department arid the Provider are public record and
subject to full disclosure. The Provider understands that attempting to exercise undue influence
on the Department and its employees to allow deviation or variance from the terms of this
contract other than negotiated, publicly disclosed amendment, is prohibited by the State of
Florida, pursuant to Section ill C of the Standard Contract. The Provider's conduct is subject
to all state and federal laws governing the conduct of entities engaged in the business of
providing services to government
13. YEAR 2000 COMPLIANCE WARRANTY (EXISTING HARDWARE AND SOFTWARE)
The Provider shall warrant that their existing hardware and software shall not experience
abnormal ending and/or produce invalid or incorrect results in the operation of the business of
the State after the turn of the century. In the event of any recognition, calculation, or indication
of century proble~s related to the Year 2000, the Provider shall warrant that they will make all
code adjustments necessary at no cost to the State in order to ensure that the code and databases
are "Year 2000 Compliant". The warranty shall be in effect until December 31, 2000 or one
year after system reconfiguration, which ever is later.
Year 2000 compliant: "Year 2000 compliance" means that information resources meet the
following criteria and/or perform as described.
1. Data structures (databases, data filed, etc.) provide 4-digit data century
recognition. Example: "1996" provides "data century recognition", "96 does not.
2. Stored data contains date century recognition, including, but not limited to, data stored in
databases and hardware/device internal system dates.
3. Calculations and program logic accommodate both same century and multi-century formulas
and data values. Calculations and logic include, but are not limited to, sort algorithms, calendar
generations, event recognition, and all processing actions that use or produce data values.
4. Interfaces (to and from other systems or organization) prevent non-compliant dates and data
from entering or exiting any state system.
5. User interfaces-(i.e. screens, reports, etc.) accurately show 4-digit years (if critical to
busmess functions.) ,
6. Year 2000 is correctly treated as a leap year within all calculation and calendar logic.
Revised 5/24/99
21
GA08
/)7/01199
Community Care! lisabled Adults
Fixed Price
Adult Services
14. YEAR 2000 COMPLIANCE WARRANTY (NEW HARDWARE AND, SOFTWARE
PURCHASES)
For purposes of this Year 2000 warranty, the term "Product'~ shall include software, firmware,
microcode, hardware and embedded chip technology. .
Provider warrants that the Product is Year 2000 Compliant All versions of the Product offered
by the Provider and purchased by the State, for which Provider is obligated to provide
maintenance service are, and in the future, will be, Year 2000 Compliant. Year 2000
. Compliant means the Product will include the ability to: cOnsistently handle date information
before, during, and after Janmiry 1, 2000, including accepting date input, providing date output,
and processing dates; function before, during and after January 1,2000, without the need for
program changes caused by the advent of the new century; properly handle all date related
information before and following Jan. 1, 2001, including but not limited to accurate and reliable
performance in processing date and date rel3fed data, including calculating, comparing and
sequencing; properly process any and all date calculations before, on and after the leap year
: date of February 29, 2000 and store and provide output of date information in ways that are
unambiguous as to century.
The duration of this warranty and the remedies available to the State for breach of this warranty
shall be defmed in.. and subject to, the terms and limitations of any general warranty provisions
of this contract, provided that notwithstanding any provision to the contrary in such warranty
provision(s), or in the absence of any such warranty provision(s), defects in the Product with
regard to Year 2000 Compliance, if any, will be corrected by Provider at Provider's cost within
a timefrarrie mutually agreed upon with the State. Provider cannot be held responsible for
errors resulting from devices or systems external to this contract which are permitted to directly
access any database provided under this Agreement and overwrite Product date fields or from
the users improper integration of non-Year 2000 Compliant systems. Nothing in this warranty
shall be construed to limit any rights or remedies the State may otherwise have under this
contract with respect to defects other than Year 2000 performance.
15. YEAR 2000 REMEDY CLAUSE
In the event of any decrease in product functionality related to time and date related codes and
internal subroutines that impede the hardware or software programs from operating beyond the
Millennium Date Change, Licensors and Pro~ders or Licensors products, agree to immediately
make required corrections to restore hardware and software programs to the same level of
functionality as warranted herein at no charge to the licensee, and without interruption to the
ongoing business of the licensee, time being afthe essence. .
16. RESELLERS
All products bid under this bid/contract will be Year 2000 compliant. Year 2000 Compliant
m~ans the Product will include the ability to: consistently handle date information before,
during, and after January 1,2000, including accepting date input, providing date output, and
processing dates; function before, during and after January 1,2000, without the need for
Revised 5/24/99
22
GA08
,,0.7/01/99
,--
Community Care " Disabled Adults
Fixed Price
Adult Services
program changes caused by the advent of the new century; properly handle all date related
information before and following Jan. 1, 200I~ including but not limited to accurate and reliable
performance in processing date and date related data, including calculating, comparing and
sequencing; properly process any and all date calculations before, on and after the leap year
date of February 29, 2000 and store and provide output of date information in ways that are
unambiguous as to century. Resellers may provide a "pass through warranty" from the
manufacturer/software developer, which meets all the warranty requirements by the State, and
which shall include all other warranties provided by the manufacturer or software developer.
. Reseller shall be responsible f~r warranty assurance, assistance, enforcement and any other
actions or remediation, required to satisfy warranty requirements.
17. EMERGENCY PLAN
The provider shall be responsible for the care, maintenance and, if necessary, the relocation of
'clients during any natural disaster or period of civil unrest. The provider shall submit its
emergency plan to the Department for approval at the time of submission of the agency's
.. proposal and must be updated on a yearly basis. In case of evacuation, the emergency plan
must identify the method of evacuation, the address of the emergency or shelter facility to be
utilized cind the method of notification of the Department of the evacuation.
18. INCIDENT REPORT
All providers will be required to document reportable incidents, as set forth in HSRS 215-6,
paragraph 3, in the following manner:
a. The provider must fill out an incident report for each incident occurring during
the administration of its program.
b. A copy of the incident report must be placed in a central file marked "Incident
Reports," a copy also must be placed. in the client file for every client involved
in the incident and/or in the personnel file of every employee involved in the
incident. The provider must immediately forward a copy of the incident report to
the contract manager for the Department. The contract manager shall then be
responsible for dissemination of the incident report to the program office.
c. If the incident report is an emergency in that the provider is aware that the
health, safety or welfare of any person has been threatened or may be in
imminent danger, the provider shall make telephonic contact with the
department program office immediately and follow up with the written incident
report in accordance with paragraph b.
19.. All references to "Department of Children and Families", "Department of Health and
Rehabilitative Services" and "HRS", here and throughout the contract, shall be construed as the
Department of Children and Family Services.
Revised 5/24/99
23
GADS
l~(('HILDREN
'V & FAMILIES
EXHIBIT A
I<~(}z~
SECURITY AGREEMENT FORM
The Department of Children and Families has authorized you:
Employee's Name/Organization
to have access to sensitive data through the use of computer-related media (e.g. printed
reports, microfiche, system inquiry, on-line update, or any magnetic media).
Compu'ter crimes are a violation of the department's disciplinary standards and, in addition to
departmental discipline, the commission of computer crimes may result in felony criminal
charges. The Florida Computer Crimes Act, Chapter 815, Florida Statutes, addresses the
unauthorized modification, destruction, disclosure, or taking of information resources.
, .
· I have read the'above statements and have been provided a copy ofthe Computer
Related Crimes Act, Chapter 815, F.S.
· By my signature, I acknowledge that I have received, read and understand Chapter
815, F.S., and have received any necessary clarification from my supervisor.
I un~e.rstand that a security violation may result in criminal prosecution according to the
provIsions of Chapter 815, F.S., and may also result in disciplinary action against me according
to the provisions in the Employee Handbook.
The minimum security requirements are:
'. Personal passwords are not to be disclosed.
.. Information is not to be obtained for my own or another person's personal use.
Print Employee Name
Signature of Employee
Date
. Print Supervisor Name
Signature of Supervisor
Date
CF 114, JF 12/96
Distribution of Copies: Personnel File/Contract File
Security File
Employee
)t..(
,F---
,
.,
Exhibit B
,If. ~O 261
DEPARTMENT OF CHILDREN AND FAMILIES
OFFICE OF FAMILY SAFTEY
MONTHLY REQUEST FOR PAYMENT AND EXPENDITURE REPORT
PROVIDER FED. 10 #
NAME AND MAILING ADDRESS OF PAYEE:
CONTRACT AMNT.:
REIMBURSEMENT YTD,:_
CONTRACT BAlANCE:
DATE:
CONTRACT#:
PERIOD OF SERVICE PROVISION:
" NAME OF SERVICE UNITSI AMOUNT PER UNITI TOTAL AMOUNT
OR DESCRIPTION OF MATERIALS QUANTITY EPISODE DUE
TOTAL
TOTAL MATCH REQUIRED PAYMENT
FOR CONTRACT: REQUESTED
THIS MNTH. YTD.
LOCAL CASH MATCH
LOCAL IN-KIND
TOTAL DEDUCTIONS
REMAINING MATCH BALANCE
SIGNATURE OF PREPARER
APPROVED BY
DATE COMPLETED
TITLE
"IF THIS INVOICI! IS FOR A F1XEO PRICI! CONTRACT, THE REQUEST FOR PAYMeNT~BE DETERMINED
BY DMDING THE lENGTH OF THE CONTRACT INTO THE CONTRAC'lED AMOlJHT (EX.412.llOClAUOCATIONI DMDED IJ't
12 MoI(n.tS [THe lENGTH OF THE CONTRACT]-'1.COCl PAYMENT REQUEST) OH A COST~ c:afTRACT
THE PAYMENT REQUEST WILL BE THE MOmHL Y REQUEST EXPENsE.
DATE INV. RCD,
APPROVED BY:
CHILDREN AND FAMILIES USE ONLY
DATE
[ORG
EO
OBJ
DESC.
AMNT.
IOCA
FIUSERSIPDFSAJAASHAREI
PANZARonNV.
j5'
. ,
7/1/99
t
Comrnuni;"- ;are for Disabled Adults
EXHIBITC
K &-tJ 2(P
To Program Specific Model Attachments ..: GA07 and GA08
Through on-site visits and client interviews, the District Program Office and Contract
Management will assess the quality and quantity of services being provided by a project.
The following areas will be reviewed:
(1) procedures used in program statistical record keeping;
(2) quality of services and adherence to established standards;
(3) effectiveness of methods of service delivery system;
(4) fiscal record keeping and proper use offunds;
(5) accomplishment of objectives; and,
.c 6) adherence to established procedure for reporting requirements and guidelines to
. Client Information System (CIS) in accordance with HRSP50-10.
Frequencv of Monitoring
(1) 30-90 Dav Visit. This visit is required for a new CCDA service provider as well as a
new oroiect director of a CCDA project. This visit should be made 30-90 days after the
employment of a new project director, regardless of contract amount.
(2) Annual Visit. The annual visit should be made between the ninth and eleventh
months of the funding period.
(3) Soecial Visit. These annOlinced or unannounced visits can be made at any time
during the funding period. It should be used to follow-up on any problem found while
conducting a regular semi-annual visit, especially if the problem required immediate
: follow-up and/or a formal corrective action plan.
Guidelines for Monitoring CCDA Providers
In preparation of the monitoring visit, the monitor should review any follow-up on
corrective action reports, the service provider application, advisory councilor board
meeting minutes, any correspondence identifying technical assistance needs, status of
required reports, and fiscal status of the project if not covered during fiscal monitoring.
Exhibit C
).~
7/1/99
Communt- ~are for Disabled Adults
Monitoring Reoort FonnatfI'"'Imeframes
All monitoring reports should be written and forwarded to the president of the provider's
board/corporation (or project director's supervisor) with a copy to the project director
within 20 working days after the visit. A copy of the report should be sent to PDAA
within 20 working days after the visit. The fonowing format should be observed:'.'
(1) Project name and address, funding period and funding source;
(2) Purpose of visit (initial or refunding), imd date;,
(3) Names and titles of participants;
(4) Narrative description of the visit to include matters to be followed up at time
of next visit;
(5) Instructions for a corrective action plan, if necessary;
(6) Narrative description of the exit interview;
(6) Monitor's name, signature, and date of report.
Tooics for Discussion During the Visit.
(1) Conditions of Contract: review contracts for special conditions and track
'progress in meeting deadlines.
(2) F ollow-uo of oroblems identified in last report.
(3) Soecial concerns of the project director and DPOAA.
(4) Year-to-date Obiective(s) Achievements and Comments. Compare output
reports with state objectives; discuss provider's method for capturing
statistical data (units of service and unduplicated counts); discuss quality of
service provided; measure objective achievements in terms of percentage of
funding period completed and allow 5% over/under achievement; determine
reasons for over/under achievement and corrective action; determine objective
impact on budget (creation of surplus or deficit situation); determine need for
objective or budget revision. The administrative monitoring checklistand
Chapter 6 ofHRSM 55-5 can be used as references.
Exhibit C
~7
7/1/99
t'
Commun(- ~are for Disabled Adults
(5) Attendance. Leave and Travel. Review records for accuracy and approval by
appropriate staff; determine appropriateness ofleave and travel recording;
determine whether leave accrued and taken is in line with project policies and
approved budget; review back-up documentation of travel vouchers.. (Not
required for fixed rate contracts):
(6) Personnel. Review personnel policies and interview personnel; review
completeness and timeliness of evaluation; determine if there is ajob
description for each position; review staff changes and documentation of those
changes; determine rate of staff tmnover; check positions/salaries against
grant application. (Not required for fixed rate contracts).
(7) Fire. Health. and Safety Standards. Review appropriate reports from proper
authorities for dates and deficiencies noted; examine fire extinguisher tags;
and discuss handicapped accessibility for fire or other emergencies.
(8) Training. Compare training schedule and log of stafllvolunteers
(accomplished to date) with scheduled training in grant application; assess
.' resources provider as used to provide identified training needs (e.g., are efforts
coordinated with other agencies?); attend training sessions provided by
project; and, interview personnel and volunteers about training needs.
(9) Coordination of Services.- Discuss project coordination services with other
service agencies (e.g., does the provider attend mteragency meetings and visit
pther agencies as time permits?); review grant application for coordination
indicators; and review programmatic reports to'determine coordination
through meetings, staffing, and written agreements.
(10) Technical AssistaD.ce. (TA) Review any provider requests for TA and TA
provided; discuss any current need for T A.
(11) Status of Client Information Forms. Review Client Information Forms and
Daily Service Logs (if appropriate) for accuracy; discuss error rate and
methods for ,improvement; and compare manual client unduplicated count
with CIS count.
(12) Compliance with the Civil Rights Act and Affirmative Action. Review
recruitment documents and advertisements; discuss methods used to comply
with Title vn or the Civil Rights Act of 1964; and interview staff for staff
compliance indicators. Determine if the service provider has a written
affirmative action policy and review new staff hired to assure compliance;
determine if the service provider's policy meets the intention of the law;
interview minority staff members; and discuss progress made in implementing
the affirmative action plan. (Required once a year)
Exhibit C
;J-f
7/1/99
---
Commun ':are for Disabled Adults
(13) Compliance with Section 504 of the Rehabilitation Act of1973:
Handicapped Accessibility and with the Americans with Disabilities Act.
Check the physical facility to ensure that handicapped peIzwH:an enter and
use the buildings (wheelchair ramps, rails, etc.); review assurances in grant
application; discuss methods to correct any areas which are used by clients
and staff which are non-accessible; and discuss project's policy for hiriiig of
handicapped.
(14) Evaluation of Reporting Procedures. Review reports on file prior to
monitoring visit; discuss timeliness, accuracy, and completeness of reports
submitted by providers; and discuss-any corrections need~ by provider and
method to be used for corrections. .
(15) Confidentiality. Discuss methods to ensure confidentiality; check applicable
files and drawers for security; and discuss ways clients are made aware of
confidentiality rights according to 45 CFR 431.306.
(16) Local Match. (Cash and In-Kind). Review fiscal reports and receipts to
.' ascertain accuracy of local match; compare percentage to date to confirm
sufficiency to match state funds received; review compliance with contract;
identify any problem areas and discuss methods to solve; check accuracy of
donor foims and appropriate signatures; and review match to be generated
from a source later iri the funding period (if app~opriate).
(17) In-Kind Voucher SYstem. Detemrine if project has used approved in-kind
match sources; track backup documents/vouchers for compliance with
approved procedures, grant application, and budget; and track allowance to
budget for accuracy ~
(18) Contributions. Check accuracy of contribution recordin~ logging,
depositing, and staff involved in this process; discuss confidentiality of
contribution system; assure that clients are aware of their right to contribute or
not to contribute (posters, envelope, etc.); and assure that all employees
authorized t~ handle money are bonded.
(19) Participants Interviews. Discuss, with a variety of participants, the quality
of service(s); determine what services are actually received as compared to
client file information (if appropriate); if survey. forms are used for client
. feedback, check the percentage of clients who complete them without help
from project staffand check percentage offorms returned by mail against
number sent out; and visit clients in their homes, if appropriate, to ascertain
above. A home-delivered meals route should be ridden at least annually to
check temperatures of home delivered meals, validate participant eligibility,
obtain participant input, etc.
Exhibit C
d.-t
.
..
7/1/99
,,'
\
.~
Commwf- 2are for Disabled Adults
(20) Advisory Council. When applicable, review minutes of advisory council
meetings; attend advisory council meetings to di~cuss their evaluation of
services; examine methods by which client feedback is obtained; discuss with
council members their roles and responsibilities, and compare to
responsibilities outlined in the approved application.
Refundinl! Visits
All refunding monitoring reports should contain a statement that the project is/is not
recommended for refunding and the reasons. stated.
'3..tJ
Exhibit C
CERTIFICATION REGARDING LOBBYING Attachment 'JL.--
r' ~ .. .
CERTIFICATION FOR CONT.....~CTS, GRANTS, LOANS AND COOtJERATIVE
AGREEMENTS
The undersigned certifies, to the best of his or her Imowfedge and belief, that:. ___.
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or an employee of any agency,
a member of congress, an officer or employee of congress, or an employee of a member of
congress in connection with the awarding of any federal contract, the making of any federal
grant, the making of any federal loan, the entering into of any cooperative agreement; and the
extension, continuation, renewal, amendment, or modification of any federal contract, grant,
loan, or cooperative agreement. '
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a member of
congre~s, an officer or employee of congress, or an employee of a member of congress in
connection with this federal contract, grant, loan. or cooperative agreement, the undersigned
shall complete and submit Standard Form-LLL. -Disclosure Form to Report Lobbying," in
accorqance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans and cooperative agreements) and that all subrecipients shall certify and
disclose accordingly. ' .
This ce~ification is a material representation of fact upon which reliance was placed when this
transactlon.was made or entered into. Submission of this certification is a prerequisite for making
or. entering into this transaction imposed by section 1352. Trtle 31, U.S. Code. Any person who
falls to file the required certification shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
., ~~22Q~L~
S;/~'/99
Date
Signature
James Roberts
I( G- 0 2 G
Na,me o~ Authorized Individual
Application or Contract Number
Monroe County Board of County Commissioners
Name o,f Organization
. .
JF 03/96
Address of Organization Page _
5100 College Road - Public Service Building Key West FL 33040
3(
'.
I. ~ I
ATTACHMENT III
(
If. G- () 2 G
FINANCIAL AND COMPLIANCE AUDIT
This attachment is applicable if the provider is cmy State or local government entity,
nonprofit organization, or for-profit organizatioJl1. For State or local government entities,
a Single Audit performed by the Auditor General shall satisfy the requirements of this
attachment. If the provider does not meet any of the requirements below, no audit is
required by this attachment.
PART I: FEDERAL AUDIT REQUIREMENTS
Thi,s part is applicable if the provider is a State or local government entity, or nonprofit
organization, and expends a total of$300,000 Clrmore in Federal Awards passed through
the department during its fiscal year. The detennination of when a provider has
"expended" Federal Awards is based on when the activity related to the award occurs.
The provider shall comply with the audit requirements contained in OMB Circular A-
133, Audits of States, Local Governments, and Non-Profit Organizations, except as
modified herein. The determination of amounts of Federal awards expended should be in
accordance with the guidelines established by OMB Circular A-133, as revised. The
provider is responsible for the procurement of an independent auditor to conduct the audit
required by this part. The provider is required to- follow the auditor procurement
standards specified in' section .305, OMB Circmar A-133, as revised.
The provider shall fulfill the requirements relative to auditee responsibilities, financial
statements, audit findings follow-up, and report submission as provided in sections .300,
.310, .315, and .320 ofOMB Circular A-B3, as revised. This includes, but is not limited
to, preparation of financial statements, a schedule of expenditures of Federal awards, a
summary schedule of prior audit findings, and a corrective action plan. Such audits shall
cover the entire organization for the organization's fiscal year. The reporting package,
shall include a schedule that discloses the amount of expenditures by contract number for
each contract with the department in effect during the audit period.
Compliance findings related to contracts with the, department shall be based on the
contract requirements, including any rules, regulations, or statutes referenced in the
contract. The financial statements shall disclose whether or not the matching requirement
was met for each applicable contract. All questioned costs and liabilities due to the
department shall be fully disclosed in the audit report with reference to the department
contract involved.
07/01199
'l;2
(
PARTII: DEPARTMENT AUDIT REQUIREMENTS
This part is applicable if the provider is a nonprofit organization that receives, during its
fiscal year, a total of$100,000 or more in non-federal funds from the department which
was not paid from a rate contract based on a set State or area-wide fixed rate for service.--
The provider agrees to have an annual financial audit performed by independent auditors
in accordance with the current Government Auditing Standards issued by the Comptroller
General of the United States. Such audits shall cover the entire organization for the
organization's fiscal year. The scope of the audit performed shall cover the financial
statements and include a report on internal control and compliance. The reporting
. package shall include a schedulet~at discloses the amount of receipts by contract number
for each contract with the department in effect during the audit period.
Compliance findings related to contracts with the department shall be based on the
comract requirements, including any rules, regulations, or statutes referenced in the
contract. The financial statements shall disclose whether or not the matching requirement
was met for each applicable contract. All questioned costs and liabilities due to the
department shall be fully disclosed in the audit report with reference to the department
contract involved.
PART III: STATE AUDIT REQUIREMENTS
In the event that the provider receives more than $25,000 from a Grants and Aids
Appropriation in its fiscal year, the provider must have a limited scope audit conducted in
accordance with section 216.349, Florida Statutes, and Chapter 10.600, Rules of the
Auditor General. In determining the Grants and Aids Appropriations received in its fiscal
year, the provider shall consider aggregate Grants and Aids Appropriations received
directly from all State agencies, including Grants and Aids Appropriations received from
the department. The audit report must include an auditor's examination attestation report,
management assertion report (alternatively, management's assertion may be included in the
management representation letter), and a Schedule of State Financial Assistance. The
auditor's examination attestation report must indicate whether management's assertion as.
to compliance with the contract terms and conditions pertaining to the allowability of costs
is fairly stated, in all material respects.
In the event that the provider receives Grants and Aids Appropriations totaling $25,000 or
,less in its fiscal year, the head of the provider's organization must provide a written
attestation, under penalty of perjury, that the provider has complied with the allowable
cost provisions of the Grants and Aids Appropriation funded contract. The provider shall
have an audit, or submit an attestation statement, in accordance with section 216.349,
Florida Statutes. The report shall cover the provider's fiscal year. The audit report shall
. include a schedule of financial assistance which discloses each State contract by number
and indicates which contract funds are from State Grants and Aids Appropriations. The
provider has "received" funds when it has obtained cash from the department.
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PART IV: SUBMISSION OF REPORTS
For any of the above requirements, copies of the audit report and any management letter
by the independent auditors, or attestation statement, required by this attachment shall be
submitted within 180 days after the end of the provider's fiscal year or within 30 days of--
the recipient's receipt of the audit report, whichever occurs first, directly to each of the
following, unless otherwise required by Florida Statutes:
A. Financial Management, Audit Services Unit
Building 2, Room 401
1317 Winewood Boulevard
Tallahassee, Florida: 32399-0700
B. Contract manager for this contract
C. Submit to this address only those reports
required by OMB Circular A-l33:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, Indiana 47132
D. Submit to this address only those audits
or attestation statements required by
section 216.349, Florida Statutes:
Jim Dwyer
State of Florida Auditor General
P.O. Box 1735
Tallahassee, Florida 32302-1735
PART V: RECORD RETENTION
. The provider shall ensure that audit working papers are made available to the department,
or its designee, upon request for a period of five years from the date the audit report is
issued, unless extended in writing by the department.
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