Item C26
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: March 19.2003
Bulk Item: Yes [8J No D
Division: ManaQement Services
Department: Administrative Services
AGENDA ITEM WORDING: Approval of late invoice from Rural Health Network of
Monroe County in the amount of $5.823.70 for the period from Oct. 1 2001 throuQh
Sept. 30, 2002; approval of resolution to transfer funds from reserves to cover this
expense and pay it in current fiscal year; approval of amendment to current year
contract to increase it by this amount; and waiver of contract requirement that final
invoice must be received within sixty days after contract termination date.
ITEM BACKGROUND: This invoice was received more than sixty days after the
termination date of the contract. A COpy of a letter from Dr. Mark Szurek. Executive
Director, explaininQ the circumstances. is attached. Balance remaininQ in this cost
center as of September 30.2002 is $14.050.22.
PREVIOUS RELEVANT BOCC ACTION: Approval of fundinQ as part of FY 2002 budoet
process; approval of contract at October 2002 BOCC meetinQ; approval of fundinQ and
contracts in previous years.
CONTRACT/AGREEMENT CHANGES: ChanQes to amount and inclusion of
reimbursement for expenses from FY 2002.
STAFF RECOMMENDATION: Approval
TOTAL COST: $5.823.70
COST TO COUNTY: $5,823.70
REVENUE PRODUCING: Yes D No [8J
BUDGETED: Yes [8J No D
SOURCE OF FUNDS: General Revenue
AMOUNT PER MONTH
YEAR
APPROVED BY: COUNTY ATTY [8J OMB/PURCHASING [8J RISK MANAGEMENT [8J
DIVISION DIRECTOR APPROVAL: -&~ tl ~d .._~
/ Sheila A. Barker
DOCUMENTATION: INCLUDED: [8J TO FOllOW: D NOT REQUIRED: D
DISPOSITION: AGENDA ITEM #: ~
3052953660 CLERK OF COURT
Rural I BBCEIVED DEe 0
Health . 6 2002
Network of Monroe CountY,. Flotida, Inc.
P.O. Box 4966, Key West, Aoridn 33041-4966
PAGE 02
Monroe County Board of County Commissioners
Finance Department
i~~t~~";";04O RECEIVED n:R 14 lllO3 REtEwa~ .. : ::.Jl
No....,,,", 2.... 2002 ~ ~ t 4JQ3 ~
The rollowing is. sWJUDlt)/ of tho ""paIS" fir tho KidC~ ~~ N_ork or~~' Florida,
Inc. REQUEST## 3. fYl{,V~ ~
CHECK# PA YEE REASON ? -zu AMOUNT
Please see aUacbed Matrix
A. Total
B. Total PriQr Payments
C. Total Requested
D. Total Cootract A.moupt
Balance ofContrad
$13, 700.22~ -tZ\r
$ 6,299.78 . ~
$13,700.22
$20,000.00
0.00
I certify that the above checks have been submitted to the vendors as noted and that the expcnse:s are accurate
and in agrcement with thc records of this organization. Furthermore:, these expenses arc in compliance with this
orge.nization's contract with the Monroe County Board of County Commissioners and will not be submitted for
reimbursement to ~~ funding source.
. .
If,... ~
Mark L. S~ Ph.D.
Executive Director
~. 6 'lS~3 .-=to f
I
l' '^I yp.U\+ .
Attachments
Grant Matrix
Payroll Summaries
Paystub Details
- ... .
c-...- 'j TJ ..DDlII,all
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....... ....
r~ ..~......... .....,~,..
I
Zbyl!1M!5:.~~ tome~~jkb~
.. -
SWORN AND SUBSCRI
presented as identificatioa:
Adtninistration. Comnuai1y Outreach Director. finance Director. or Health Services Director'
VoXCE 305-Z93-7570: FAX 305-Z93-7573
Refurals 1/888-381-8770: Medi-Van 305-797-4104; Rur-ol Heal1h at Ruth Ivins Clinic 305-Z89-3748
Dq....tInoWafBHS<
Jaaarca .
. Adawidr.attnft
3052953660
CLERK OF COURT
PAGE 03
Rural ~ 10 7'1'BI1J ofSenice iD Molll'Oe CoIIDJr
Heahh 1993-2009
'Network of Monroe County, Florida. Inc.
P.o. Box-l988. Key War. Florida 3~CMl-l9G8
RECEIVED J:F.B 1 4 2~n~
February 13, 2003
Ms. Tina Boan
Monroe County Government
530 Whitehead St.
Key West, FL 33040
Dear Ms. Boan:
This letter ~ submitted in reference to funds allocated by Monroe County to the
Rural Health Networ1c.'s KidCare outreach project, in FY 01-02. On behalf of the
our organization, I can attI5t that...
... aU fuel consumed by virtue of travt!l by Mr. Keith Douglass was used
exclusively for KidCare outreaeh services...
.__ all internet access functions utilized by Mr. Douglass were exclusively
peDuaaled for KidCare outreach functions and busineSS, and...
'.' all copy Inilchine functions utilized by Mr. Douglass were performed
exclusively fw KidCare outreach business only.
It is lIlY hope and inient that this Jettel' will substantiate and validate the work
Mr. Douglass has completed on behalf of I<idCare outreach services in Monroe
County, with the su~ and ~ of c~unty funds.
Thank you for your assistance.
Sincerely, /~
JJt.~
Mal'k Ph.D.
~Ie J.)bIe3pdar. Presi t & CEO .
,....... CaaIdy
. ....ao
L ~ PbJ).
xc. Mr. Dan Smith. RHNMC finance MaI13ger
~ ~ 0aIruda. or Semc:a
"f01CE !06-ZN-7S70: ax 306-103-""
s.liL1 Dfa/DfC-;'fOICE lION17~; PAX 105411~
....~--t
03/05/2003 09:55 3052953660
.. .."~.' ~ ;pi ~~1\
~.:": . '-. ' ::., l;_\':" f' '~~.~_;'. .
CLERK OF COURT
PAGE 04
KID CARE
~
BAROMETER ADVERTISING
ADVERTISING
HEAL ni INSURANCE
PAYROLL TAXES
SANDS COPIER SERVICES
KEYS CONNECT KID CARE WEB SITE
GENERAl.. EXPENSES
88.00
2,358.00
1,190.60
637.50
819.50
258.65
KID CARE VEHICLE FUEL
KC FUEL
KC FUEL
KC FUEL
KC FUEL
KC FUEL
KC FUEL
KC FUEL
KC FUEL
KC FUEL
KC FUEl.
KC FUEL
KC FUEL
PO BOX
CAR SERVICE
POSTAGE DOH
OFFICE DEPOT
OFACE DEPOT
POSTAGE QTRL REPT
OFFICE DEPOT
OFFICE DEPOT
16.25
23.58
23.39
21.84-
19.85
22.01
20.12
17.00
24.96 ;
23.27 i
22.01
21.55 ;
17.92 i
32.QO !
28.161
18.25
13.25
18.54.. .
1.52
29.99
58.99
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Rural Health Network Effective Date: 10/1/02
Expiration Date: 9/30103
Contract Purpose/Description: Amendment to contract with Rural Health Network to provide
administration and promotional activities related to the Florida KidCare program in Monroe
County.
Contract Manager: David P. Owens
(Name)
4482
(Ext. )
OMB/Grants Mgt.
(Department)
for BOCC meeting on 03/19/03
Agenda Deadline: 03/05/03
CONTRACT COSTS
Total Dollar Value of Contract: $25,823.70 Current Year Portion: $25,823.70
Budgeted? Yes X No Account Codes: 001-03211-530340
Grant: $0.00
County Match: $0.00
Estimated Ongoing Costs: $0.00
(Not included in dollar value above)
ADDITIONAL COSTS
For:
(ego Maintenance, utilities, ianitorial, salaries, etc.)
CONTRACT REVIEW
Date In
Changes
Needed Reviewer
YesD NoD .
YesDNog W.&-L-
:::~::~ f7~~V
Date Out
Division Director
Risk Management 3/7/03
3/--;(OJ
3/7/03
:J,h~ J
O.M.B./Purchasing
County Attorney 3151 C 3
Comments:
OMB Form Revised 9/11/95 MCP #2
CONTRACT AMENDMENT
This amendment to agreement is made and entered into this day of
, 2003, between the BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, hereinafter referred to as "COUNTY" and The Rural Health
Network of Monroe County, hereinafter referred to as "PROVIDER."
WHEREAS, COUNTY and PROVIDER entered into an agreement on October 17,2001
for the purpose of providing OUTREACH AND PROMOTIONAL ACTIVITIES FOR THE Florida
Kid Care Program, and,
WHEREAS, COUNTY and PROVIDER entered into an agreement on October 16, 2002
for the same purposes, and,
WHEREAS, PROVIDER has submitted an invoice for fiscal year 2002 expenses after
the sixty-day deadline established in the contract, and,
WHEREAS, COUNTY wishes to amend the agreement dated October 16, 2002 to
allow for the payment of the invoice submitted after the sixty-day deadline,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is
agreed as follows:
1. Article One of the agreement entered into on October 16, 2002 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 of the Board as
to providing outreach and promotional activities related to the Florida Kid Care
Program in Monroe County, Florida, shall pay to the Provider the sum of TWENTY-
FIVE THOUSAND, EIGHT-HUNDRED, TWENTY-THREE AND 70/100 DOLLARS
($25,823.70) for fiscal year 2002-2003. This will include FIVE-THOUSAND, EIGHT-
HUNDRED, TWENTY-THREE AND 70/100 ($5,823.70) of expenses incurred during the
fiscal year beginning October 1, 2001 and ending September 30, 2002, for which an
invoice was submitted after the sixty-day limit.
2. All other provisions of the agreement dated October 16, 2002 not inconsistent
herewith shall remain in full force and effect.
Deputy Clerk
Mayor/Chairman
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IN WITNESS WHEREOF, the parties hereto have caused these presents to be
executed as of the day and year first written above.
(SEAL)
ATrEST: DANNY L. KOLHAGE, CLERK
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
By
RURAL HEALTH NETWORK OF MONROE
COUNTY, INC.
Federal ID No.
Witness
By
Witness
Executive Director
AGREEMENT
Rural Health Network of Monroe County, Florida, Inc.
This Agreement is made and entered into this day of
, 2002, between the BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and
RURAL HEALTH NETWORK OF MONROE COUNTY, FLORIDA, INC., hereinafter
referred to as "Provider."
WHEREAS, the Provider is a not-for-profit corporation established for the
provision of health-related services to the disadvantaged citizens of Monroe County,
and
WHEREAS, it is a legitimate public purpose to provide outreach and
promotional activities for the Florida Kid Care Program 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 of
the Board as to providing outreach and promotional activities related to the Florida
Kid Care Program in Monroe County, Florida, shall pay to the Provider the sum of
TWENTY-THOUSAND AND NO/100 DOLLARS ($20,000.00) for fiscal year 2002-
2003.
2. TERM. This Agreement shall commence on October 1, 2002, and
terminate September 30, 2003, unless earlier terminated pursuant to other
provisions herein.
3. PAYMENT. Payment will be paid periodically, but no more frequently
than monthly as hereinafter set forth. Reimbursement requests will be submitted
to the Board via the Clerk's Finance Office. The County shall only reimburse,
subject to the funded amounts below, those reimbursable expenses which are
reviewed and approved as complying with Florida Statutes 112.061 and Attachment
A - Expense Reimbursement Requirements. Evidence of payment by the Provider
shall be in the form of a letter, summarizing the expenses, with supporting
documentation attached. The letter should contain a certification statement as well
as a notary stamp and signature. An example of a reimbursement request cover
letter is included as Attachment B.
After the Clerk of the Board examines and approves the request for
reimbursement, the Board shall reimburse the Provider. However, the total of said
reimbursement expense payments in the aggregate sum shall not exceed the total
amount shown in paragraph one during the term of this agreement.
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 providing outreach and promotional activities
related to the Florida Kid Care Program in Monroe County, Florida.
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 and
representatives. In the event of an audit exception, the 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.
7. INDEPENDENT CONTRACTOR. At all times and for all purposes
hereunder, the Provider is an independent contractor and not an employee of the
Board. No statement contained in this agreement shall be construed so as to find
the Provider or any of its employees, contractors, servants or agents to be
employees of the Board.
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. COMPLIANCE WITH COUNTY GUIDELINES. The Provider must
demonstrate and sustain compliance with:
(a) SOl(c)(3) Registration;
(b) Board of Directors of five or more;
(c) Annual election of Officers and Directors;
(d) Annual provision of annual report to County;
(e) Corporate Bylaws;
(f) Corporate Policies and Procedures Manual;
(g) Hiring policies for all staff;
(h) Cooperate with County monitoring visits; and
(i) Semi-annual performance reports to be presented to County.
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. 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.
12. NO ASSIGNMENT. The Provider shall not assign this agreement
except in writing and with the prior written approval of the Board, which approval
shall be subject to such conditions and provisions as the Board may deem
necessary. This agreement shall be incorporated by reference into any assignment
and any assignee shall comply with all of the provisions herein. Unless expressly
provided for therein, such approval shall in no manner or event be deemed to
impose any obligation upon the Board in addition to the total agreed upon
reimbursement amount for the services of the Provider.
13. 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.
14. 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.
15. 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
Gato Building
1100 Simonton Street
Key West, FL 33040
and
Monroe County Attorney
PO Box 1026
Key West, FL 33041
For Provider
Mark L. Szurek
Executive Director
Rural Health Network of Monroe County
Post Office Box 4966
Key West, FL 33041-4966
16. 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.
17. NON-WAIVER. Any waiver of any breach of covenants herein
contained to be kept and performed by the Provider shall not be deemed or
considered as a continuing waiver and shall not operate to bar or prevent the Board
from declaring a forfeiture for any succeeding breach, either of the same conditions
or covenants or otherwise.
18. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be
continued at a level sufficient to allow for continued reimbursement of expenditures
for services specified herein, this agreement may be terminated immediately at the
option of the Board by written notice of termination delivered to the Provider. The
Board shall not be obligated to pay for any services or goods provided by the
Provider after the Provider has received written notice of termination, unless
otherwise required by law.
19. 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.
20. 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
By
Deputy Clerk
Mayor/Chairman
Witness
RURAL HEALTH NETWORK OF
MONROE COUNTY, FLORIDA, INC.
(Federal ID No. )
By
Witness
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 reimbursement. Inter-company allocations are not
considered reimbursable expenditures unless appropriate payroll journals for the charging
department are attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is
needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or
hourly rate, total hours worked, withholding information and 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 included.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are
not allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement.
The log must define the date, number of copies made, source document, purpose, and
recipient. A reasonable fee for copy expenses will be allowable. For vendor services, the
vendor invoice and a sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc.
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 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
(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 2002
by who is personally known to me.
Notary Public
Notary Stamp
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:
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 signing) in the space provided above on this
day of
,19_.
NOTARY PUBLIC
My commission expires:
OMB - MCP FORM #4
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 public 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 of 36 months from the date of being
placed on the convicted vendor list."
Rural
Heal th
Network of Monroe County, Florida, Inc.
P.o. Box 4966, Key West, Florida 33041-4966
December 19, 2002
Mr. Dave Owens
Grants Administrator
Monroe County Government
1100 Simonton St.
Key West, FL 33040
Dear Mr. Owens:
The Rural Health Network of Monroe County, FL, Inc requests a special exception be granted to our
previous fiscal year's budget allocation (01-02), for KidCare outreach. We were unable to provide all
invoices in a timely manner for reimbursement purposes and subsequently still require those
reimbursements to cover our actualized costs. We ask that through appropriate authorization, that
you please overlook our tardiness and allow RHNMC to obtain these unclaimed and remaining
funds.
The reason for our tardiness is reflective of an internal control problem. The employee responsible
for collections of invoices, invoice processing and oversight failed to complete his assigned tasks in a
timely manner. We have since corrected this situation by the replacement of this employee with a
more responsible fiscal agent. I would also offer that our current record for this fiscal year now
reflects these internal changes, as your office has received all current invoices within a reasonable
time for processing.
Your consideration of this request is deeply appreciated.
7'y,
Mark L. zurek, Ph.D.
Executive Director
Administration, Community Outreach Director, Finance Director, or Health Services Director
VOICE 305-293-7570; FAX 305-293-7573
Referrals 1/888-381-8770; Medi-Van 305-797-4104; Rural Health at Ruth Ivins Clinic 305-289-3748
Healthy Kids/KidCare Director-VOICE 305-517-9002; FAX 305-517-9004
www.ruralhealth-floridakeys.org
OMB/Grants
Resolution No.
- 2003
A RESOLUTION CONCERNING THE TRANSFER OF FUNDS
WHEREAS, it is necessary for the Board of County Commissioners of Monroe County,
Florida, to make budgeted transfers in the Monroe County Budget for the Fiscal Year
2003, therefore,
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, that there shall be transfers of amounts previously
set up in the Monroe County Budget for the Fiscal Year 2003, as hereinafter set forth to
and from the following accounts:
Fund #001 - General Fund
From: 001-5900-85500-590990 Other Uses
Cost Center # 85500 - Reserves 001
For the Amount: $14,050.22
To: 001-5690-03211-530340 Contractual Services
Cost Center # 03211 - Rural Health Network of Monroe County
BE IT FURTHER RESOLVED BY SAID BOARD, that the Clerk of said Board, upon
receipt of the above, is hereby authorized and directed to make the necessary changes of
said items, as set forth above.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting of said Board held on the 19th day of March AD 2003.
Mayor Spehar
Mayor Pro Tern Nelson
Commissioner McCoy
Commissioner Neugent
Commissioner Rice
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By:
Mayor/Chairman
(Seal)
Attest: DANNY L. KOLHAGE, Clerk
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