Item C09
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: January 16. 2002
Bulk Item: Yes cgJ No 0
Division: Administrative Services
Department: Grants Administration
AGENDA ITEM WORDING: Approval of amendment to contract with Guidance Clinic of
the Middle Keys to increase fundino for community transportation coordinator services
by forty-thousand dollars ($40.000,00) and transfer from road and bridoe fund to cover
this increase.
ITEM BACKGROUND: Amendment made necessary by approval of reouest for
increased fundino.
PREVIOUS RELEVANT BOCC ACTION: Approval of re~uest for increase in fundino of
$41.000.00 for FY01 January 2001 meetino; approval of reouest for increase in fundinq
in $40.000.00 for FY02 at Dec. 2001 meetino.
CONTRACT/AGREEMENT CHANGES: chanoe in amount
:,
STAFF RECOMMENDATION: Approval
TOTAL COST: $40.000.00
COST TO COUNTY: $40.000.00
REVENUE PRODUCING: Yes 0 No cgJ AMOUNT PER MONTH
YEAR /
APPROVED BY: COUNTY ATTY 0 OMBlPURCHASI~RISK MANAGEMENT 0vJ.If.- '
DIVISIONDIRECTORAPPROV!},Jp~.-!l _--
. James L. Roberts
BUDGETED: Yes 0 No cgJ
DOCUMENTATION: INCLUDED: fZI TO FOllOW: L NOT REQUIRED: 0
DISPOSITION: AGENDA ITEM #: /~C /'
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Guidance Clinic of the
Middle Keys
Effective Date: 10/1/01
Expiration Date: 9/30/02
Contract Purpose/Description: Approval of amendment to contract with Guidance Clinic of the
Middle Keys, increasing amount for community transportation coordinator services by
$40,000.00, and total contract from $679,221.00 to $719,221.00.
Contract Manager: David P. Owens
(Name)
4482
(Ext. )
OMB/Grants Mgt.
(Department)
for BOCC meeting on 1/16/02
Agenda Deadline: 1/2/02
CONTRACT COSTS
Total Dollar Value of Contract: $719,221.00 Current Year Portion: $719,221.00
Budgeted? Yes No X Account Codes: 102-04542-530340
(transfer also going to this
meetint)
Grant: $0.00
County Match: $0.00
:"
Estimated Ongoing Costs: $0.00
(Not included in dollar value above)
ADDITIONAL COSTS
For:
(eg. Maintenance, utilities, ianitorial, salaries, etc.)
CONTRACT REVIEW
County Attorney
Changes Date Out
Date In Needed ,__ ~
1- ).-~ YesD NoEl/~'l -.. /-)..~
11"':.\OL..-YesONo~l'(A)~~~ 1\z..\IIL-
I z')ZS10l YesD No~- I ztzzlOI
t2{z.,? YesD No~ 1l11.-7fi I
Division Director
Risk Management
O.M.B./Purchasing
Comments:
OMB Form Revised 9/11/95 MCP #2
CONTRACT AMENDMENT
This amendment to agreement is made and entered into this day of
, 2002, between the BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, hereinafter referred to as "COUNTY" and the Guidance Clinic
of the Middle Keys, hereinafter referred to as "PROVIDER."
WHEREAS, COUNTY and PROVIDER entered into an agreement on October 17, 2001
for the purpose of providing Community Transportation Coordinator services,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is
agreed as follows:
1. Article 1 and article 1. a. of the agreement shall be amended to read:
1. AMOUNT OF AGREEMENT. The Board, in consideration of the
Provider substantially and satisfactorily performing and carrying out the
duties and obligations of the Board, shall reimburse the Provider for a portion
of the Provider's expenditures for Baker Act hospital, physician and crisis
stabilization services, as billed by the Provider, for clients qualifying for such
services under applicable state and federal regulations and eligibility
determination procedures, and for Baker Act transportation services, non-
Baker Act mental health services and substance abuse treatment. This cost
shall not exceed a total reimbursement of SEVEN HUNDRED NINETEEN
THOUSAND, TWO-HUNDRED, TWENTY-ONE, AND NO/l00 DOLLARS
($719,221.00), during the fisc~1 year 2001-2002, payable as follows:
a) Pay to the Provider the sum of FIFTY-SIX-THOUSAND, THREE-
HUNDRED, EIGHTY AND NO/l00 DOLLARS ($56,380.00) for Community
Transportation Coordinator services.
2. All other provisions of the agreement dated October 17. 2001 not inconsistent
herewith shall remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed
as of the day and year first written above.
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
u.;
I-
<(
a
By
Deputy Clerk
By
Mayor/Chairman
Guidance Clinic of the Middle Keys, Inc.
FederallD No.
Witness
Witness
By
Executive Director
Board of County Commissioners
Agenda Item Summary
Meeting Date: December 19, 2001
Bulk Item: Yes. No C
Division: Board of County Commissioners
Department: George R. Neugent
AGENDA ITEM WORDING:
Approval by the board for an increase of $40,000 for the Transportation Disadvantaged
program fadlitated by the Guidance Clinic of the Middle Keys..
ITEM BACKGROUND: .~~
Last year the BOCC, on a unanimous vote, approved an inaease of $40,000 to
accommodate inaeased expense ~st to the Guidance Cinic of the Middle Keys as CTC
and provider of services for TranspOrtation Disadvantaged program. However, due to an
oversight by the GCMK it failed to be added to the budget - the GCMK is humbly
requesting the additional funds be reinstated.
PREVIOUS RELEVANT DOCC ACTION:
,
.~
.
..""
CONTRACT I AGREEMENT CHANGES:
STAFF RECOMMENDATIONS:
TOTAL COST:
BUDGETED: YES. NO C
COST TO COUNTY: $
REVENUE PRODUONG: YES C NO C AMT PER MONTH: - YEAR:
APPROVED BY: COUNlY ATIY C OMS/PURCHASING C RISK MANAGEMENT C
APPROV~~/: ,e. kL.~ ~
EORGE R.~
DISTRICT II
DOCUMENTATION: INCLUDED. TO FOLLOW [J NOT REQUIRED [J
DISPosmON:
AGENDA ITEM #
./ -L-~
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
3000 41sT STREET, OCEAN
MARATHON, FL 33050
(v) 305/289-6150 I (f) 305/289-6158
November 12, 2001
Honorable George Neug~nt
Mayor Monroe County
25 Ships Way
Big Pine Key, FL 33043
\,
"
Dear Mayor Neugent:
I am writing to request the assistance of the'Monroe County Soard of County
Commissioners to correct an error t~t was made by our staff while developing our
county budget request. ...
~-;-
In November of last year, the Commission increased their participation in the
Transportation Disadvantaged program by the sum of $40,000. While preparing this
year's budget the $40,000 contract amendment that was signed in January 2001 was
not noted and consequently not included in this year's total.
I would like to request that thjs item be added to the SOCC Agenda on November 21 5t
for discussion and resolution.
Thank you for your assistance.
Sincerely,
~!J~1t.
Chief Executive Officer
Partially funded by the Florida Department of Children & Families. District 11
~'cHi':DRiH
121 &. FAMILIES
AGREEMENT
This Agreement is made and entered into this day of , 2001,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter
referred to as "Board" or "County," and the GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.,
hereinafter referred to as "Provider."
WHEREAS, the Board and the Provider desire to enter into an agreement wherein the
Board contracts for services from the Provider for the rendering of mental health services to the
citizens of the Middle Keys, Monroe County, Florida, and
WHEREAS, the Board is vested and charged with certain duties and responsibilities relating
to the mental health and guidance of the citizens of Monroe County, and
WHEREAS, such services have been rendered by the Provider in the past and have been
invaluable to the citizens of the Middle Keys, and
WHEREAS, it is proper and fitting to enter into an agreement for services to be rendered in
the forthcoming fiscal year 2001-2002, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed
as follows:
1. AMOUNT OF AGREEMENT. The Board, in consideration of the Provider
substantially and satisfactorily performing and carrying out the duties and obligations of the
Board, shall reimburse the Provider for a portion of the Provider's expenditures for Baker Act
hospital, physician and crisis stabilizatioo services, as billed by the Provider, for clients qualifyi,ng
for such services under applicable sta'fe and federal regulations and eligibility determination
procedures, and for Baker Act transportation services, non-Baker Act mental health services and
substance abuse treatment. This cost shall not exceed a total reimbursement of SIX HUNDRED
SEVENTY-NINE-THOUSAND, TWO-HUNDRED, TWENTY-ONE, AND NO/100 DOLLARS
($679,221.00), during the fiscal year 2001-2002, payable as follows:
a) Pay to the Provider the sum of SIXTEEN-THOUSAND, THREE-HUNDRED, EIGHTY
AND NO/100 DOLLARS ($16,380.00) for Community Transportation Coordinator services.
b) Pay to the Provider the sum of FOUR-HUNDRED, NINETY-NINE-THOUSAND, FIVE-
HUNDRED, FIFTY-EIGHT, AND NO/100 DOLLARS ($499,558.00) for Baker Act Inpatient,
Residential Detox, and Mental Health/Substance Outpatient counseling services.
c) Pay to the Provider the sum of EIGHTY-SIX-THOUSAND, TWO-HUNDRED, EIGHTY-
SEVEN, AND NO/100 DOLLARS ($86,287.00) for The Keys to Recovery Program substance abuse
treatment services.
d) Pay to the provider the sum of SEVENTY-SIX-THOUSAND, NINE HUNDRED NINETY-
SIX, AND NO/100 DOLLARS ($76,996.00) for Baker Act transportation.
2. TERM. This Agreement shall commence on October 1, 2001, and terminate
September 30, 2002, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be paid monthly as hereinafter set forth. Baker Act
Billing Summary Forms, certified monthly financial and service load reports will be made available
to the Board to validate the delivery of services under this contract. The monthly financial report
is due in the office of the Clerk of the Board no later than the 15th day of the following month.
Payment for Baker Act and Marchman Act transportation services shall be made according to the
rate schedule set forth in Attachment 0, subject to the maximum amounts set forth in Paragraph
1. d. above, After the Clerk of the Board pre-audits the certified report, the Board shall
reimburse the Provider for its monthly expenses. However, the total of said monthly payments in
the aggregate sum shall not exceed the total amount shown in Arti<;:le 1, above, during the term
of this agreement, To preserve client confidentiality required by law, copies of individual client
bills and records shall not be available to the Board for reimbursement purposes but shall be
made available only under controlled conditions to qualified auditors for audit purposes. The
organization's final invoice must be received within sixty days after the termination date of this
contract shown in Article 2 above.
4. SCOPE OF SERVICES. The Provider, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and carry out the duties of the
Board in rendering counsel in the matter of mental health and guidance to the citizens of the
Middle Keys, Monroe County, Florida. The Provider shall provide these services in compliance with
Florida Statutes Chapter 394, Said services shall include, but are not limited to, those services
described in Provider1s Details of Specific Program for Which Funding is Requested, attached
hereto as Exhibit C and incorporated herein. Baker Act and Marchman Act transportation services
which are covered under this agreement may be subcontracted, but are subject to the rates set
forth in Attachment D, and the limitations above. The subcontractor shall be subject to all of the
conditions of this contract, including but not limited to insurance and hold-harmless requirements,
as is the Provider.
5. RECORDS. The Provider shall maintain appropriate records to insure a proper
accounting of all funds and expenditures, and shall provide a clear financial audit trail to allow for
full accountability of funds received from said Board. Access to these records shall be provided
during weekdays, 8 a.m. to 5 p.m., upon request of the Board, the State of Florida, or authorized
agents and representatives of the Board or State.
The Provider shall be responsible for repayment of any and all audit exceptions which are
identified by the Auditor General of the State of Florida, the Clerk of Court for Monroe County, an
independent auditor, or their agents an~ representatives. In the event of an audit exception, ~he
current fiscal year contract amount or subsequent fiscal year contract amounts shall be offset by
the amount of the audit exception. In the event this agreement is not renewed or continued in
subsequent years through new or amended contracts, the Provider shall be billed by the Board for
the amount of the audit exception and the Provider shall promptly repay any audit exception.
6. INDEMNIFICATION AND HOLD HARMLESS. The Provider covenants and agrees
to indemnify and hold harmless Monroe County Board of County Commissioners from any and all
claims for bodily injury (including death), personal injury, and property damage (including
property owned by Monroe County) and any other losses, damages, and expenses (including
attorney's fees) which arise out of, in connection with, or by reason of services provided by the
Provider occasioned by the negligence, errors, or other wrongful act or omission of the Provider's
employees, agents or volunteers. The extent of liability is in no way limited to, reduced, or
lessened by the insurance requirements contained elsewhere within this agreement.
7. INDEPENDENT CONTRACTOR. At all and for all purposes hereunder, the
Provider is an independent contractor and not an employee of the Board. No statement contained
in this agreement shall be construed so as to find the Provider or any of its employees,
contractors, servants or agents to be employees of the Board.
8. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement,
the Provider shall abide by all statutes, ordinances, rules and regulations pertaining to or
regulating the provision of such services, including those now in effect and hereinafter adopted.
Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach
of this agreement and shall entitle the Board to terminate this contract immediately upon delivery
of written notice of termination to the Provider,
9.
COUNTY:
COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the
(a) evidence of the organization's SOl(c)(3) status;
(b) a list of the organization's Board of Directors of which there must be five or more;
(c) evidence of annual election of Officers and Directors;
(d) an annual audited financial report;
(e) a copy the organization's Corporate Bylaws, which must address the organization's
mission, board and membership composition, election of officers, and so on;
(f) a copy of the organization's Corporate Policies and Procedures Manual which must include
hiring policies for all staff, drug and alcohol free workplace provisions, equal employment
opportunity provisions, and so on;
(g) cooperation with County monitoring visits;
(h) semi-annual performance reports. These reports should include performance
measurements which will demonstrate the level of accomplishment of goals for which funding
has been provided.
(i) other reasonable reports and information related to compliance with applicable laws,
contract provisions and the scope of services that the County may from time to time request.
10. PROFESSIONAL RESPONSIBILITY AND LICENSING. The Provider shall assure
that all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state
and/or federal certification and/or licensure of the Provider's program and staff.
11. INSURANCE.As a pre-requisite of the services supplied under this contract, the
Provider shall obtain, at its own expense, insurance to cover its activities.
12. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services
and/or reimbursement of services shall be amended by an agreement amendment, which must be
approved in writing by the Board.
13. NO ASSIGNMENT. The Provider shall not assign this agreement except in writing
and with the prior written approval 0( the Board, which approval shall be subject to such
conditions and provisions as the Boarct. may deem necessary. Baker Act and Marchman ACt
transportation services may be subcontracted, as set forth in Paragraph 4, above. This agreement
shall be incorporated by reference into any assignment and any assignee shall comply with all of
the provisions herein. Unless expressly provided for therein, such approval shall in no manner or
event be deemed to impose any obligation upon the Board in addition to the total agreed upon
reimbursement amount for the services of the Provider.
14. NON-DISCRIMINATION. The Provider shall not discriminate against any person
on the basis race, creed, color, national origin, sex or sexual orientation, age, physical handicap,
or any other characteristic or aspect which is not job-related in its recruiting, hiring, promoting,
terminating or any other area affecting employment under this agreement. At all times, the
Provider shall comply with all applicable laws and regulations with regard to employing the most
qualified person(s) for positions under this agreement. The Provider shall not discriminate
against any person on the basis of race, creed, color, national origin, sex or sexual orientation,
age, physical handicap, financial status or any characteristic or aspect in its providing of services.
15. AUTHORIZED SIGNATURES, The signatory for the Provider below, certifies and
warrants that:
(a) The Provider's name in this agreement is the full name as designated in its
corporate charter, if a corporation, or the full name under which the Provider is authorized to do
business in the State of Florida.
(b) He or she is empowered to act and contract for the Provider; and
(c) This agreement has been approved by the Board of Directors of the Provider if the
Provider is a corporation.
16. NOTICE. Any notice required or permitted under this agreement shall be in writing
and hand-delivered or mailed, postage pre-paid, by certified mail, return receipt requested, to the
other party as follows:
For Board:
David P. Owens, Grants Administrator
Public Service Building
5100 College Road
Key West, FL 33040
and
Monroe County Attorney
PO Box 1026
Key West, FL 33041
For Provider:
Dr. David Rice, Executive Director
Guidance Clinic of the Middle Keys, Inc.
3000 41st Street
Marathon, Florida 33050
17. CONSENT TO JURISDICTION. This agreement shall be construed by and
governed under the laws of the State of Florida and venue for any action arising under this
agreement shall be in Monroe County, Florida.
18. NON-WAIVER. Any waiver of any breach of covenants herein contained to be
kept and performed by the Provider shall not be deemed or considered as a continuing waiver and
shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding
breach, either of the same conditions o'r covenants or otherwise.
19. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued
at a level sufficient to allow for continued reimbursement of expenditures for services specified
herein, this agreement may be terminated immediately at the option of the Board by written
notice of termination delivered to the Ptovider. The Board shall not be obligated to pay for any
services or goods provided by the Proeider after the Provider has received written notice "'of
termination, unless otherwise required by law.
20. PURCHASE OF PROPERTY. All property, whether real or personal, purchased
with funds provided under this agreement, shall become the property of Monroe County and shall
be accounted for pursuant to statutory requirements.
21. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the Provider and the Board.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as
of the day and year first written above.
(SEAL)
ATTEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
Deputy Clerk
By
Mayor/Chairman
GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
(Federal ID No. )
By
Director
By
President
ATTACHMENT A
EXPENSE REIMBURSEMENT REQUIREMENTS
This document is intended to provide basic guidelines to Human Service Organizations, county
travelers, and contractual parties who have reimbursable expenses associated with Monroe
County business. These guidelines, as they relate to travel, are from Florida Statute 112,061.
A cover letter summarizing the major line items on the reimbursable expense request needs to
also contain a notarized certified statement such as:
"I certify that the attached expenses are accurate and in agreement with the records of
this organization. Furthermore, these expenses are in compliance with this organization's
contract with the Monroe County Board of County Commissioners."
Invoices should be billed to the contracting agency. Third party payments will not be considered
for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines should be directed to 305-292-3534.
Data Processing, PC Time, etc. :~,
The vendor invoice is required for reimbu1"sement. Inter-company allocations are not considered
reimbursable expenditures unless appropriate payroll journals for the charging department are
attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If
a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate,
total hours worked, withholding information and payroll taxes, check number and check amount.
If a Payroll Journal is not provided, the following information must be provided: check amount,
check number, date, payee, support for applicable payroll taxes.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for reimbursement.
For overnight or express deliveries, the vendor invoice must be incluged.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not
allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the
number called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the
telephone number, the date, and the purpose of the call.
Travel Expenses
Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel
Expenses. Travel must be submitted in accordance with Florida Statute 112.061. Credit card
statements are not acceptable documentation for reimbursement. If attending a conference or
meeting a copy of the agenda is needed, Airfare reimbursement requires the original passenger
receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail.
Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented
with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example,
taking a taxi from one's residence to the airport for a business trip is not reimbursable. Parking is
considered a reimbursable travel expense at the destination. Airport parking during a business
trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room
must be registered and paid for by traveler. The County will only reimburse the actual room and
related bed tax. Room service, movies, and personal telephone calls are not allowable expenses.
Meal reimbursement is: breakfast at $3.00, lunch at $6.00, and dinner at $12.00. Meal
guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon
and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner
..l ,:,,-:
reimbursement. .
Mileage reimbursement is calculated at .29 cents per mile for personal auto mileage while on
County business. An odometer reading must be included on the state travel voucher for vicinity
travel. Mileage is not allowed from a residence or office to a point of departure. For example,
driving form one's home to the airport for a business trip is not a reimbursable expense.
Non-allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
ATTACHMENT B
ORGANIZATION
LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, FL 33040
Date
The following is a summary of the expenses for ( Organization name) for the time period
of to
Check # Payee Reason ' Amount
101 Company A Rent $ X,XXX.XX
102 Company B Utilities XXX.XX
104 Employee A P/R ending 05/14/01 XXX.XX
105 Employee B P/R ending OS/28/01 XXX.XX
(A) Total $ X.XXX.XX
,
'If, ~.:
'l ~..,;
(B) Total prior payments $ X,XXX.XX
(C) Total requested and paid (A + B) $ X,XXX.XX
(D) Total contract amount $ X,XXX.XX
Balance of contract (D-C) $ X.XXX.XX
I certify that the above checks have been submitted to the vendors as noted and that
the expenses are accurate and in agreement with the records of this organization.
Furthermore, these expenses are in compliance with this organizations_ contract with
the Monroe County Board of County Commissioners and will not be submitted for
reimbursement to any other funding source.
Executive Director
Attachments (supporting documentation)
Sworn to and subscribed before me this _ day of 2001
by who is personally known to me.
Notary Public
Notary Stamp
ATTACHMENT C
Baker Act inpatient services, residential detoxification services, mental health and
substance abuse outpatient services, Baker Act vehicles, Keys to Recovery residential
substance abuse treatment, and community transportation coordination.
,
.,
.~
;;a-.~
~.:
FROM GUIDANCE CLINIC MIDDLE KE\'S
PHONE NO. 305 289 6170
Oct. 03 2001 02:45PM P2
A-fi- ,1:>
GUIDANCE CLINIC OF THE MIDDLE KEYS,INC,
3000 41 ST 5TR!ET. OCEAN
MARATHON. FL 33050
(v) 3051289-6160! (f) 305l289-e 158
SetJtember 19, 2001
Oarren Guttman
800 Catherine Street
Key West, Florida 33040
Ref: Letter of Agreement
o..r Mr. Guttman:
The Guidance Clink: of the Middle Keys. Inc. (GCMK). will CQntract with Jeearica Inc.. to
provide transportation for Baker Act and Marchman Act clients from Key Weat to
Marathon or Miami. The effective, time period for this agreement will be from
October 1. 2001 through SeptemrJ.r 30, 2002.
QCMK will aupply a 1993 Ford Crown Vletorla for the tranaportation of c1iems. GCMK
will pay for the fuel and maintenance of the vehicle,
J;k".;-
C: ~:
GCMK wilt maintain ineuranee on the vehicle. and JeGsrica Inc. win 8upply GCMK a llet
of drtvenl who witt operate the vehi~e. The 1ist wilJ furnish the driver'e license number.'
dm of birth, and oocial security number. GCMK wilt ryn driver's license checke on an
drivers and will determine efigibiflty to drive under the guidelines of GCMK'a ineuranee
carrier. No one hired by Jessrica Inc. may drive the GCMK vehicle witl'laut prior
approval by the GCMK Transportation Coordinator.
GCMK WIll aupply Je8srica lnc.;wilt\ a beeper and cell phone. The on-ean driver witt
haYe the beeper and cell phone. Drivers wiD be dispatched by the on-duty nurse at
GCMK. 'A driver must r.pond 10 the pl<:kup locaf,on within 30 mll'lUtes fram the time of
being dispatched by GCMK. -
A rate structure will be as follows:
pednatlon
Local trips within Key West area
Kay Weet to Marathon
Key West to Key Largo
Kay West to Miami
Ildm
escort
S 25.00
$ 15.00
$125.00
$ 175.00
$ 25.00
$ 75.00
$ 125.00
S 175.00
~""""~M"OI
eMIL."""
Paltlllll\t tUndIId by 1Ite Florida Oe~l of Cl1ldl8n & ...m..... Dlelricll11 " ~ILln
td ~: ~ teBG 68 'Fo'eW
'ON X\:I.::l
:~
FPcr'1 GU !DANCE CLl N I C ~1 I DDLE KE'(S
PHONE NO. 305 289 6170
Oct. 03 2001 02:46PM P3
.
. -~
m \he; ~t that the Key W..t Car is requested to make a pIck up Qutslde the
jurisdiction of Key West, the charges that apply to the rate of the destfnatlon are:
Marathon to Key West
Marathon to Marathon
Marathon to Key Largo
Kay largo to Key Largo
Key largo to Marathon
Key l.at;o to Key West
Kay Largo to Miami
$ 75.00
$ 75.00
$ 125.00
$ 125.00
$ 125.00
$ 126.00
S 175.00
$ 75.00
$ 75.00
$ 125.00
$ 125.00
$125.00
$ 125.00
$ 175.00
Jenric:a Inc. will supply a female driver or escort tQ accomp~ny any female client that Is
bH1g trw.porWd under thll agreement
Jessrlca Inc. win report and document accidents or incidents InvoMng a client to GCMK
-::::~ ;.~~ha'b.enco_~
~ Ph.C.. CEO :~ Darren Guttman
Guidance Clinic of the Middle Keyi, Inc. Jessrica Inc.
q//9/6/ 7-:2?-o/
Date' , Date
~-:.
c;'cHiiiiiM
IDeftllllY ~ndIIclllY the 'lorta. QeDerunenl at C"i~ & 'amifta, DIstr1ct " ~. IAMI"fl
2d ~:2Q tOO2 6a ."~U
'ON XI::l.:l
:\.l~.;l
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list
following a conviction for public entity crime may not submit a bid on a
contract to provide any goods or services to a public entity, may not submit
a bid on a contract with a public entity for the construction or repair of a
public building or pu~lic work, may not submit bids on leases of real
property to public entity, may not be awarded or perform work as a
contractor, supplier, subcontractor, or consultant under a contract with any
public. entity, and may not transact business with any public entity in excess
of the threshold amount provided in Section 287.017, for CATEGORY
TWO for a period of36 months from the date of being placed on the
convicted vendor list."
;\
.:.\
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1.:,:-;
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY. FLORIDA
ETHICS CLAUSE
warrants that he/it has not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or employee.
(signature)
.\
'"
Date:
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0.-;
STATE OF
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, affixed his/her
signature (name of individual signmg) in the space provided above on this
day of
.19_.
NOTARY PUBLIC
My commission expires:
OMB - MCP FORM #4