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Item F1 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: Sept. 15. 2004 Division: Management Services Bulk Item: Yes No XX Department: Administrative Services AGENDA ITEM WORDING: Approval of contract amendment with Guidance Clinic of the Middle Keys to provide additional funds through remainder of FY04 for Baker Act Transportation program, and resolution to transfer funds from fund 102 reserves to cover. ITEM BACKGROUND: Additional funds are needed because of an unanticipated 31 % increase in trips experienced in FY04, and increase in fuel costs. PREVIOUS RELEVANT BOCC ACTION: Monroe County has previously contracted with the Guidance Clinic of the Middle Keys for the past several years to provide Baker Act Transportation. CONTRACT/AGREEMENT CHANGES: Increase current contract amount for Baker Act Transportation component from $94,307 to $115,844, an increase of $21,537 in funding. STAFF RECOMMENDATIONS: approval TOTAL COST: $772.501.00 (new contract total) BUDGETED: Yes No XX COST TO COUNTY: $772.501.00 (increase of21.537.00) SOURCE OF FUNDS: road and bridge fund REVENUE PRODUCING: Yes NoXX AMOUNTPERMONTH_ Year APPROVED BY: County Atty _ OMB/purch,az in., _ . ,.RiSk M. ,a...nageme,nt_ /) I~;;< Jh ~~, /[E<.~etL (? (:7?ZLKt/L/' Sheila A. Barker DIVISION DIRECTOR APPROVAL: DOCUMENTATION: Included XX To Follow Not Required DISPOSITION: AGENDA ITEM # F 1- Revised 1/03 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract # Contract with: Guidance Clinic ofthe Effective Date: 1 0/01103 Middle Keys Expiration Date: 9/3 0/04 Contract Purpose/Description: amendment to portion of contract that provides funding for Baker Act transportation services in Monroe County. Contract Manager: David P. Owens (Name) 4482 (Ext.) OMB/Grants (Department) for BOCC meeting on 09/15/04 Agenda Deadline: 08/31/04 CONTRACT COSTS Total Dollar Value of Contract: $ 772.50 1. 00 Current Year Portion: $ 772.501.00 Budgeted? Yes~ No 0 Account Codes: 001-01501-530340-_-528.019.00 Grant: $0.00 102-01507-530340-_-115.844.00 County Match: $_ 102-04542-530340-_-42351.00 101-68607-530340-_-86.287.00 ADDITIONAL COSTS Estimated Ongoing Costs: $_/yr For: (Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.) CONTRACT REVIEW O.M.B.lPurchasing Changes Date Out Date In Needed ,0' Re~ie~ /J ) /) y -, 1-/ Y esD No~0/LLt.iJ4..- LA. U cL.c.J.ej!/L./ ~o I q.~.lX{ YesD NoEl ~. ~) "'~ }irm:f2. qh"i W YesDNo~ 'l/JJJj -2/J01( YesD NO~ #'1 Division Director Risk Management County Attorney Comments:_ OMB Form Revised 9/11/95 MCP #2 09/02/2004 13:33 FAX 3052896158 GCMK 14I 0011001 GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. 3000 41sT STREET, OCEAN MARATHON, FL 33050 (v) 305/289-6150 / (f) 305/289-6158 www.gcmk.org September 2, 2004 Mr. James L. Roberts Monroe County Administrator. 1100 Simonton Street Key West, FL 33040 Re: Agenda Items for the September meeting of the Board of County Commissioners-Requests for additional funds for Baker Act Transportation Dear Mr. Roberts: The Guidance Clinic of the Middle Keys requests additional funding in the amount of $21,537 for Fiscal Year 2004 and $25.410 for Fiscal Year 2005. The additional funds are needed in Fiscal Year 2004 because: 1. The number of trips for the first 10 months of this year has increased by more than 30% over the same period last year. 2. Fuel costs have increased 30% since October 2003. Our initial request for Fiscal Year 2005 was for the same amount as the original FY 04 Contract: $94,307. We are asking that the funding be increased for FY 05 because we expect the utilization and fuel costs to remain at current levels. Additional documentation regarding costs is included in the agenda item request. Thank you for your consideration in this matter Sincerely, Q~~ ~~~ ~~i~ T. Pipher, MA Vice President of Operations Partially funded by the Florida Department of Children & Families, District 11 ~'CUHiLDRiN 121 .. JAM."'ES The Guidance Clinic of the Middle Keys requests a contract amendment for Fiscal year 2004 to increase the amount for Baker Act Transportation. The additional funds are needed because: 1. The number of trips increased by 31 % over last fiscal year. 2. Gasoline costs have increased by 30% since October 2004. Detail of costs appears below. The additional funds requested represent an increase of 23% over the current contract amount. The projection for this fiscal year is based on actual information through July 2004. GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. Baker Act Transportation Expenses County Fiscal Year: October through September FY04 Projection FY03 Actual Trips 422 322 ExDenses Drivers $77,590 $52,305 Vehicle Costs Insurance Fuel Repairs Licenses & Other subtotal 7,864 3,385 2,588 37 13,874 6,590 2,125 5,069 405 14,190 Other Costs Coordination Telephone/Pagers Other subtotal 23,076 26,792 1,293 946 11 74 24,380 27,812 115,844 94,307 94.307 94.307 $21,537 Total Expenses Current County Contract Additional Funds Needed Management Services Resolution No. - 2004 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 2004, 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 2004 as, hereinafter set forth to and from the following accounts: Fund #102 - Road and Bridge Fund From: 102--5630-85504-590990 Other Uses Cost Center # 85504 - Reserves, Fund 102 For the Amount: $21,537.00 To: 102-5630-01507-530340 Contractual Services Cost Center # Guidance Clinic of the Middle Keys - Baker Act Transportation BE IT FURTHER RESOLVED BY SAID BOARD, that the Clerk of said Board, upon receipt ofthe 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 15th day of September AD 2004. Mayor Nelson Mayor Pro Tem Rice Commissioner McCoy Commissioner Neugent Commissioner Spehar BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: Mayor/Chairman (Seal) Attest: DANNY L. KOLHAGE, Clerk ,.....,.~..,._c., (/ZJ' CONTRACT AMENDMENT This amendment to agreement is made and entered into this day of September, 2004, between the BOARD OF COUNTY COMMISSIONERS OF MONORE COUNTY, FLORIDA, hereinafter referred to as "COUNTY" and the Guidance Clinic of the Middle Keys, Inc., hereinafter referred to as "PROVIDER." WHEREAS, COUNTY and PROVIDER entered into an agreement on October 15, 2003 for the purpose of providing Baker Act transportation services, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: 1. Article 1 and article 1.d. of the agreement shall be amended to read: 1. AMOUNT OF AGREEMENT. The Board, inconsideration 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 service, non-Baker Act mental health and substance abuse treatment. This cost shall not exceed a total reimbursement of SEVEN HUNDRED SEVENTY-TWO THQUSAND, FIVE HUNDRED, ONE, AND NO/100 DOLLARS ($772,501.00), during the fiscal year 2003-04, payable as follows: d) Pay to the Provider the sum of ONE HUNDRED FIFTEEN THOUSAND, EIGHT HUNDRED, FORTY-FOUR AND NO/100 DOLLARS ($115,844.00) for Baker Act transportation. 2. All other provisions of the agreement dated October 15, 2003, 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. KOHLAGE, CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By By Deputy Clerk Mayor/Chairman Guidance Clinic of the Middle Keys, Inc. FederallD No. 59-1458324 Witness By Witness, '." ~'.. ~'~"~;":/./.,~., _._ S;, -,,;;t. V . .,..~,(.~"...,._ (/~.) , . .> ,,': · ?/l/t-~y AGREEMENT A-fA - This Agreement is made and entered into this . b day of CJlC--I. ,2003, 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 2003-2004, 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 stabilization services, as billed by the Provider, for clients qualifying fOf such services under aoplicable 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 FIFTY THOUSAND, NINE-HUNDRED, SIXTY-FOUR, AND NO/IOO DOLLARS (S750,964.00), during the fiscal year 2003-2004, payable as follows: a) Pay to the Provider the sum of FORTY-TWO THOUSAND, THREE-HUNDRED, FIFTY- ONE, AND NO/100 DOLLARS ($42,351.00) for Community Transportation Coordinator services. b) Pay to the Provider the sum of FIVE-HUNDRED TWENTY-EIGHT THOUSAND, NINETEEN, AND NO/lOO DOLLARS ($528,019.00) for Baker Act Inpatient, Residential Detox, and Mental Health/Substance Outpatient counseling services and community mental health and substance abuse services. c) Pay to the Provider the sum of EIGHTY-SIX THOUSAND, TWO-HUNDRED EIGHTY- SEVEN, AND NO/lOO DOLLARS ($86,287.00) for residential treatment services, including detoxification, long-term substance abuse treatment,. and long-term psychiatric treatment services. d) Pay to the provider the sum of NINETY-FOUR THOUSAND, THREE HUNDRED, SEVEN, AND NO/lOO DOLLARS ($94,307.00) for Baker Act transportation. 2. TERM. This Agreement shall commence on October 1, 2003, and terminate September 30, 2004, 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 Article 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 Provider's 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 Oerk: 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 shalt 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 shalt 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 (induding 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, general liability and professional liability 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 of the Board, which approval shall be subject to such conditions and provisions as the Board 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 Boa rd: David P. Owens, Grants Administrator 1100 Simonton Street 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, Ine. 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 or 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 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. 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. BOAR~~ COU~[f_ ~OMMISSIONERS OF M~~/J=O~, ~aV By Mayor/Chairman GUIDANCE CUNIC OF THE MIDDLE KEYS, INC. (Federal ID No. _ ) i ire. ct/b ~&L. / \ President ~} By By 'J 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 st3tement verifying th€ acC'..Jracy and authentidty 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 or~ered, 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 induded in the contract). contributions. depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non-suffident check charges, penalties and fines. ATTACHMENT B ORGANIZATION LETTERH EAD 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 Drior 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 2003 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. SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY. FLORIDA ETHICS CLAUSE (}v.'f)A-NC6 WNIC t2f';7I& IVlI/?PtE.~k"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 an d 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 pai~ or employee. f (signAre) Date: Ii:> /I~ a3 I I STATE OF F(aTlclc, COUNTY OF N O'V'\ (~e.- PERSONALLY APPEARED BEFORE ME, the undersigned authority, ~.b{ ~ C. ~f Se...-t 1 who, after first being sworn by me, affixed his/her _ '" ~Ir- signature (name of individual signing) in the space provided above on this I~ O~Jc)b.u- day of , 20 03 . -~,~~ NOTARY PUBUC My commission expires: rJ..j J1! ~ c 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." BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: Sept. 15.2004 Division: Management Services Bulk Item: Yes No XX Department: Administrative Services AGENDA ITEM WORDING: Approval of contract amendment with Guidance Clinic of the Middle Keys to provide additional funds through remainder of FY04 for Baker Act Transportation program, and resolution to transfer funds from fund 102 reserves to cover. ITEM BACKGROUND: Additional funds are needed because of an unanticipated 31 % increase in trips experienced in FY04, and increase in fuel costs. PREVIOUS RELEVANT BOCC ACTION: Monroe County has previously contracted with the Guidance Clinic of the Middle Keys for the past several years to provide Baker Act Transportation. CONTRACT/AGREEMENT CHANGES: Increase current contract amount for Baker Act Transportation component from $94,307 to $115,844, an increase of $21,537 in funding. STAFF RECOMMENDATIONS: approval TOTAL COST: $772.501.00 (new contract total) BUDGETED: Yes No XX COST TO COUNTY: $772.501.00 (increase of21.537.00) SOURCE OF FUNDS: road and bridge fund REVENUE PRODUCING: Yes NoXX AMOUNTPERMONTH_ Year APPROVED BY: County Atty _ OMB/purCh, aSi~J?~ ~isk ~anagement -:- yl/U~~L {(.(~J~{/(___'/ Sheila A. Barker DIVISION DIRECTOR APPROVAL: DOCUMENTATION: Included XX To Follow Not Required_ AGENDAITEM#~ DISPOSITION: Revised 1/03 AGENDA ITEM WITH LATE DOCUMENTATION DIVISION Manaqement Services DEPARTMENT Administrative Services SUBJECT Approval of contact amendment with Guidance Clinic of the Middle Keys to provide additional funds through remainder of FY04 for Baker Act Transportation program, and resolution to transfer funds from fund 102 reserves to cover. DATE ITEM WILL BE AVAILABLE: 09/08/04