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Item D19 , BOARD OF COUNTY COMMISSIONERSCoun County Of Monroe Mayor Michelle Coldiron,District 2 The Florida Keys Mayor Pro Tern David Rice,District 4 y r Craig Cates,District 1 Eddie Martinez,District 3 Holly Merrill Raschein,District 5 INTEROFFICE MEMORANDUM TO: Kevin Madok, Clerk of the Court FROM: Mayor Michelle Coldiron DATE: October 18, 2021 SUBJECT: NOTICE OF VOTING CONFLICT Per Florida Statute 112.3143, I hereby disclose by written memorandum that I will abstain from the vote on certain issues brought before the Monroe County Board of County Commissioners with entities with which I am involved. I will abstain from the vote on issues concerning the following entities: Gary's Plumbing and Fire,Inc.,as I have a personal relationship with owner Gary Centonze and Florida Keys Area Health Education Center(AHEC)because I am a member of the Board. At the October 20,2021, BOCC meeting,I will abstain from voting on items #D. 9 and D. 19 A copy of both agenda items from the Revised Agenda for each of the referenced items is included for documentation. Att: State Form 8B Memorandum of Voting Conflict for County,Municipal,and other Local Elected Officers Michelle Coldiron, Mayor FORM 8B MEMORANDUM OF VOTING CONFLICT FOR COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS LAST NAME-FIRST NAME-MIDDLE NAME NAME OF BOARD,COUNCIL,COMMISSION,AUTHORITY,OR COMMrTTEE Coldiron Michelle, Ann Monroe County Board of County Commissioners MAILINGADDRESS THE BOARD,COUNCII,COMMISSION,AUTHOR"OR COMMITTEE ON 243 Key Deer Blvd. WHICH I SERVE IS A UNIT OF: Big Pine Key Monroe NAME OF POLITICAL SUBDIVISION: District 2 ONTE ON WHICH VOTE OCCURRED W ELECTIVE 0 APPOINTIVE 10/20/2021 WHO MUST FILE FORM 813 This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112.3143. Florida Statutes. Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this noason, please pay dose attention tmthe instructions on this form before completing and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112'3143" FLORIDA STATUTES Apereon holding elective orappointive county, municipa|, or other local public office MUST ABSTAIN from voting on measure which would inure tohis or her special private gain or loss.Each elected cv appointed local officer also MUST ABSTAIN from knowingly voting on a maeamwrevvh(oh would inure to the special gain or loss of principal -odher than a government agency) by whom he or she is retained (including �u��n�dhe�a;emt. �ub�i�i�� or�b||nguqgmn�a%ionofap� w n��U�� hichheormheisetoined):kotheepeoial private gain or loss mfa relative;or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies(CRAs)under Sec. 163.356 or 183.357. F.S., and officers of independent special tax districts elected on a onm'acna, one-vote basis are not prohibited from voting in that capacity. For purposes of this |amv e "relative" includes only the officer's father, mother, yon, daughter, husband, wife, brother, sister, father-in-law, mother-in-law, son-in'| .^ and daughhepin'|a°^A"business associate" means any person or entity engaged in or carrying on e business enterprise with the officer as a partner,joint venturer, com*ner of property, or corporate shareholder (where the shares of the corporation are not listed on any national or regional stock exchange). ELECTED OFFICERS: In addition to abstaining from voting in the situations described above,you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting;and WITHIN 15 O/#S AFTER THE VOTE OCCURS by completing and filing this fnmn with the person responsible for recording the minutes of the meeting,who should incorporate the form in the minutes. APPOINTED OFFICERS: Although you must abstain from voting in the situations described ebove, you are not prohibited by Section 112.3143from otherwise participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction. IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TOTHE MEETING AT WHICH THE VOTE WILL 8E TAKEN: ^ You must complete and file this forrin (before making any attempt to influence the decision)with the person responsible for recording the minutes of the meeting,who will incorporate the form in the minutes. (Continued on page 2) APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency. • The form must be read publicly at the next meeting after the form is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: • You must disclose orally the nature of your conflict in the measure before participating. • You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the meeting„who must incorporate the form in the minutes.A copy of the form must be provided immediately to the other members of the agency, and the form must be read publicly at the next meeting after the form is filed. DISCLOSURE OF LOCAL OFFICER'S INTEREST I Michelle Coldiron , hereby disclose that on October 20 120 21 (a)A measure came or will come before my agency which(check one or more) inured to my special private gain or loss; inured to the special gain or loss of my business associate, inured to the special gain or loss of my relative, inured to the special gain or loss of - by whom I am retained;or inured to the special gain or loss of - which is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me. (b; The measure before my agency and the nature of my conflicting interest in the measure is as follows: I have a personal relationship with Gary Centonze,owner of Gary's Plumbing and Fire,Inc. I serve on the Florida Keys Area Health Education Center Board. At the October 20,2021,Board of County Commissioners meeting,I will abstain from the vote on item(s): #D.9 Approval to award bid and enter into an Agreement with Gary's Plumbing and Fire,Inc.,for Full Maintenance Fire Protection Services at County facilities with an annual amount not to exceed$70,000.00.Funding is Ad Valorem. #D. 19 Approval of Fiscal Year 2022 contracts with local non-profit human service organizations(HSO)funded by the Board of County Commissioners through recommendations of the Human Services Advisory Board(HSAB)as per attached spreadsheet totaling $2,050,000. If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer, who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way as to provide the public with notice of the conflict. Date Filed Signature NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $10,000. CE FORM 813-EFF.11/2013 PAGE 2 Adopted by reference in Rule 34-7.010(1)(0,F.A.C. County of onroe BOARD OF COUNTY COMMISSIONERS Mayor Michelle Coldiron,District 2 The Florida Keys Mayor Pro Tern David Rice,District 4 Craig Cates,District l Eddie Martinez,District 3 Holly Raschein,District 5 DAVID P.RICE,COMMISSIONER 9400 Overseas Highway, Suite 210 Marathon Airport Terminal Building Marathon,FL 33050 O 305.289.6000 E boccdis4@monroecounty-fl.gov Interoffice Memorandum Date: October 13,2021 To: Kevin Madok, Clerk of the Court County Clerk's Office From: Commissioner David Rice, District 4 r �' -- RE: NOTICE OF VOTING CONFLICT Per Florida Statute 112.3143, I hereby disclose by written memorandum that I will abstain from the vote on certain issues brought before the Monroe County Board of Commissioners with entities with which I am involved. I will abstain from the vote on issues concerning the following entities: Guidance Care Center,Inc., a private, not-for-profit entity, which receives some of its operational funding from the County, as I currently sit on the Board of Directors of the Guidance Care Center. I am also a member of the Board of the Historic Florida Keys Foundation,Inc. At the October 20,2021 BOCC meeting,I will abstain from the vote on item(s): #D17,D19,D22,D23 Copy of agenda item listing from the Revised Agenda for each of the referenced items)is included for documentation. ATT.• State Form 8B Memorandum of Voting Conflict for County,Municipal,and Other Local Elected Officers FORM 813 MEMORANDUM OF VOTING CONFLICT FOR C I U OUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS LAST NAME—FIRST NAME—MIDDLE NAME NAME OF BOARD COUNCIL,C MMISSION,AUTHORI ,OA COMMITTEE ML('ZZ C_E Piq 1 01 4 MAILING ADDRESS THE BOARD,COUNCIL,COMMIdION.AUTHORITY OR COMMITTEE ON Ln WHICH I SERVE ISAUNIT F CITY_ Q CITY OUN TY Q OTHER LOCALAGENCY COUNTY NAME OFPOLITCAI UBDVISI N: Mortr-n— -0(2 V 11 DATE ON WHICH VOTE OCCURRED MO t)V F _L MY POSITION IS: >CELECTkV C3 APPOINTIVE WHO MUST FILE FORM 813 This form is for use by any person serving at:-the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112,3143, Florida Statutes Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position- For this reason, please pay close attention to the instructions on this form before completing and filing the form INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on a measure which would inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained (including the parent, subsidiary, or sibling organization of a principal by which he or she is retained)-to the special private gain or loss of a relative, or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies(CRAB)under Sec. 163.356 or 163,357, F.S., and officers of independent special tax districts elected on a one-acre, one-vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law, mother-in-law, son-in-law, and daughter-in-law- 4"business associate" means any person or entity engaged in or carrying on a business enterprise with the officer as a partner,joint venturer, coowner of property, or corporate shareholder(where the shares of the corporation are not listed on any national or regional stock exchange) ELECTED OFFICERS: In addition to abstaining from voting in the situations described above, you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting, and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the minutes of the meeting, who should incorporate the form in the minutes, APPOINTED OFFICERS: Although you must abstain from voting in the situations described above, you are not prohibited by Secti6n,112.3143 from otherwise participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction, IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE TAKEN: • You must complete and file this form(before making any attempt to influence the decision)with the person responsible for recording the minutes of the meeting, who will incorporate the form in the minutes (Continued on page 2) CE FORM 813-EFF. 11/2013 PAGE I Adopted by reference in Rule 34-7 010(1)(fl. F.A,C APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency, • The form must be read publicly at.the next meeting after the forrn is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: • You must disclose orally the nature of your conflict in the measure before participating. • You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of-the meeting,who must incorporate the form in the minutes.A copy of the form must be provided immediately to the other members of the I agency, and the form must be read publicly at the next meeting after the form is filed. DISCLOSURE OF LOCAL OFFICER'S INTEREST T, DaVd 0 C� _ hereby disclose that on _NA�J�-� 2-4 20 2 (a)A measure came or will come before my agency which (check one or more) Aff P I inured to my special private gain or loss-, inured to the special gain or loss of my business associate, inured to the special gain or loss of my relative, inured to the special gain or-loss of by whom I am retained;or inured to the special gain or loss of _ ,which s is the parent subsidiary,or sibling organization or subsidiary of a principal which has retained me. 0(b) he measure before my agency and the nature of my conflicting interest in the measure is as follows: I currently sit on the Board of Directors of the Guidance Care Center, Inc. I am also a member of the Board of the Historic Florida Keys Foundation, Inc. SEE ATTACHED AGENDA ITEM SUMMARY ,D 17 � 0 D ZZ p 2-3 If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer, who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way as to provide the public with notice of the conflict.. Date Filed Signature NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112,317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $10,000. CE FORM 6B-EFF. 11/2013 PAGE 2 Adopted by reference in Rule 34-7 010(1)(0,F.A.0 D.19 i�` County of Monroe �y,4 ' ?, "tr, BOARD OF COUNTY COMMISSIONERS Mayor Michelle Coldiron,District 2 �1 nff `_ll Mayor Pro Tem David Rice,District 4 -Ile Florida.Keys Craig Cates,District 1 Eddie Martinez,District 3 w � Holly Merrill Raschein,District 5 County Commission Meeting October 203, 2021 Agenda Item Number: D.19 Agenda Item Summary #9820 BULK ITEM: Yes DEPARTMENT: Budget and Finance TIME APPROXIMATE: STAFF CONTACT: Janet Gunderson (305) 292-4470 NA AGENDA ITEM WORDING: Approval of Fiscal Year 2022 contracts with local non-profit human service organizations (HSO) funded by the Board of County Commissioners through recommendations of the Human Services Advisory Board (HSAB) as per attached spreadsheet totaling $2,050,000. ITEM BACKGROUND: The Human Services Advisory Board (HSAB) met on June 2, 2021 and made funding recommendations to the BOCC. Attached are the funding recommendations for FY2022 (October 1, 2021 — September 30, 2022). In order to reduce the vast quantity of paperwork, we request your approval of the agreements as outlined on the attached spreadsheet, wherein the organization name, description of service, funding amount recommended by the HSAB, fund, cost center, account number and service dates are provided for your information. PREVIOUS RELEVANT BOCC ACTION: The budget($2,050,000) for the HSAB was approved by the BOCC on September 15, 2021, during the adoption of the final Operating Budget for Fiscal Year 2022. This is a $10,000 increase over the FY2021 budget. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval DOCUMENTATION: FY2022 HSAB Contract Template FY2022 Funding Recommendations FINANCIAL IMPACT: Effective Date: 10/01/2021 Expiration Date: 09/30/2022 Packet Pg.625 D.19 Total Dollar Value of Contract: $2,050,000 Total Cost to County: $2,050,000 (FY2022) Current Year Portion: FY2022 = $2,050,000 Budgeted: Yes Source of Funds: 001 CPI: No Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: No If yes, amount: N/A Grant: No County Match: No Insurance Required: No Additional Details: 10/20/21 001-03232 MARC $200,000.00 10/20/21 001-03236 WESLEY HOUSE $157,500.00 10/20/21 001-03215 WOMANKIND $155,000.00 10/20/21 001-03235 FL KEYS CHIL,DRENS SHELTE $150,000.00 10/20/21 001-03239 FL KEYS AREA $130,000.00 10/20/21 001-03206 FL KEYS OUTREACH COALITI $110,000.00 10/20/21 001-03214 SAMUEL'S HOUSE $105,000.00 10/20/21 001-03241 - BOYS AND GIRLS $100,000.00 10/20/21 001-03246 STAR OF THE SEA FOUNDATI $100,000.00 10/20/21 001-03225 AIDS HELP $95,000.00 10/20/21 001-03201 - DOMESTIC ABUSE SHELTER $80,000.00 10/20/21 001-03242 FL KEYS HEALTHY START $80,000.00 10/20/21 001-03224 GRACE JONES $70,000.00 10/20/21 001-03226 GOOD HEALTH $60,000.00 10/20/21 001-03205 LITERACY VOLS OF AMERICA $60,000.00 10/20/21 001-03253 HEART OF THE KEYS YTH CT $50,000.00 10/20/21 001-03262 KEYS TO BE THE CHANGE $50,000.00 10/20/21 NEW COST CENTER ADDED $40,000.00 Autism Society of the Keys 10/20/21 001-03259 - THE HERON $40,000.00 10/20/21 001-03247 INDEPENDENCE CAY $30,000.00 10/20/21 001-03243 KEYS AREA INTERDENOMINAT $30,000.00 10/20/21 001-03260 KIDS COME FIRST-FL KEYS $30,000.00 10/20/21 NEW COST CENTER ADDED $25,000.00 A Positive Step 10/20/21 NEW COST CENTER ADDED $25,000.00 MNLAG/Kreative Kids 10/20/21 001-03261 VOICES FOR FL KEYS CHILD $17,000.00 10/20/21 001-03255 ANCHORS AWEIGH $15,000.00 10/20/21 001-03256 BURTON MEMORIAL UMC $15,000.00 10/20/21 NEW COST CENTER ADDED $15,000.00 Packet Pg.626 D.19 Special Olympics 10/20/21 NEW COST CENTER ADDED $10,500.00 Big Pine UMC 10/20/21 NEW COST CENTER ADDED $5,000.00 Dr. Jose Sanchez Liions Eye Clinic Total: $2,050,000.00 REVIEWED BY: Christine Limbert Completed 10/04/2021 10:16 AM Tina Boan Completed 10/04/2021 3:11 PM Maria Slavik Completed 10/04/2021 3:37 PM Liz Yongue Completed 10/05/2021 8:50 AM Board of County Commissioners Pending 10/20/2021 9:00 AM Packet Pg.627 D.19.a AGREEMENT This Agreement is made and entered into this 201" day of October 2021, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board" or "County," and Organization, hereinafter referred to as "PROVIDER." WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of service, and WHEREAS, it is a legitimate public purpose to provide (description of service), now, therefore, IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as follows: FUNDING CD cv 1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially >- and satisfactorily performing and providing services for persons living in Monroe County, Florida, as provided for in this Agreement, shall pay to the PROVIDER the sum of dollar amount NO/100 DOLLARS ($ .00) for fiscal year 2022. ca 2. TERM. This Agreement shall commence on October 1, 2021, and terminate September 30, 2022, unless earlier terminated pursuant to other provisions herein. 3. PAYMENT. Payment will be made periodically, no less than quarterly but no more frequently than monthly, as hereinafter set forth. Reimbursement requests shall include items paid by the PROVIDER within 120 days of payment by the PROVIDER. Reimbursement requests will be submitted to the Board via the Clerk's Finance Office. Reimbursement request and supporting documentation must be acceptable to the Clerk. Acceptability to the Clerk is based on generally accepted accounting principles and such laws, rules and regulations as may govern the Clerk's disbursal of funds. The County shall only reimburse, subject to the funded amounts below, those reimbursable expenses which are reviewed and approved as complying with Monroe County Code ca of Ordinances, State laws and regulations 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 Clerk's Finance Office may accept Reimbursement Requests electronically, but only when submitted and formatted in a PDF file with cover letter and attachments together in one (1) file.) The PROVIDER agrees to submit hard copies of Reimbursement Request and supporting documentation upon request. The letter should contain a notarized certification statement. An example of a reimbursement request cover letter is included as Attachment B. The organization's final invoice must be received within thirty days after the termination date of this contract shown in Article 2 above. 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 Article 1, above, during the term of this agreement. 4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a level sufficient to allow for continued reimbursement of expenditures for services specified herein, 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. Contract-Organization Name-FY22;page 1 Packet Pg.628 D.19.a S. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with funds provided under this agreement, shall become the property of Monroe County and shall be accounted for pursuant to statutory requirements. Funding under this agreement shall not be used to purchase capital assets. RECORDKEEPING 6. RECORDS AND RIGHT TO AUDIT. PROVIDER shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Records shall be retained for a period of ten (10) years from the termination of this agreement. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for seven (7) years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not authorized by this Agreement, or were wrongfully retained by the PROVIDER, the PROVIDER shall repay the monies together with interest calculated pursuant to Sec. 55.03, Florida Statutes, running from the date the monies were paid by the COUNTY. ILL >' Right to Audit. Availability of Records. The records of the parties to this Agreement relating to the Project, which shall include but not be limited to accounting records (hard copy, as well as computer readable data if it can be made available; subcontract files (including proposals of ca successful and unsuccessful bidders, bid recaps, bidding instructions, bidders list, etc.); original estimates; estimating work sheets; correspondence; change order files (including documentation covering negotiated settlements); back charge logs and supporting documentation; general ledger entries detailing cash and if applicable trade discounts earned, insurance rebates and dividends, any other supporting evidence deemed necessary by County or the Monroe County Office of the Clerk of Court and Comptroller (hereinafter referred to as "County Clerk") to substantiate charges related to this agreement, and all other agreements, sources of information and matters that may in County's or the County Clerk's reasonable judgment have any bearing on or pertain to any matters, rights, duties or obligations under or covered by any contract document (all foregoing hereinafter referred to as "Records") shall be open to inspection and subject to audit and/or reproduction by County's representative and/or agents or the County Clerk. County or County ca Clerk may also conduct verifications such as, but not limited to, counting employees at the job site, witnessing the distribution of payroll, verifying payroll computations, overhead computations, observing vendor and supplier payments, miscellaneous allocations, special charges, verifying information and amounts through interviews and written confirmations with employees, Subcontractors, suppliers, and contractors' representatives. All records shall be kept for ten (10) years after Final Completion of the Project. The County Clerk possesses the independent authority to conduct an audit of Records, assets, and activities relating to this Project. If any auditor employed by the Monroe County or County Clerk determines that monies paid to Contractor pursuant to this Agreement were spent for purposes not authorized by this Agreement, the Contractor shall repay the monies together with interest calculated pursuant to Section 55.03, F.S., running form the date, the monies were paid to Contractor. The right to audit provisions survives the termination of expiration of this Agreement. In addition, if PROVIDER is required to provide an audit as set forth in in Section 8(e) below, the audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. 7. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access to, and inspection of, all documents, papers, letters, or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and PROVIDER in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by PROVIDER. Contract-Organization Name-FY22;page 2 Packet Pg.629 D.19.a 8. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the County the following (items (a)-(j) must be provided prior to the payment of any invoices): (a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status; (b) Proof of registration with the Florida Department of Agriculture, as required by Florida Statute 496.405, and the Florida Department of State, as require by Florida Statute 617.01201, or proof of exemption from registration as per Florida Statute 496.406. (c) List of the Organization's Board of Directors of which there must be at least 5 and for each board member please indicate when elected to serve and the length of term of service; (d) Evidence of annual election of Officers and Directors/Directors At-Large or bi-annual election of Officers and Directors/Directors At-Large as applicable; (e) Unqualified audited financial statements from the most recent fiscal year for all organizations that expend $150,000 a year or more; if qualified, include a statement of deficiencies with corrective actions recommended/taken; audit shall be prepared by an independent certified public accountant (CPA) with a current license, in good standing with the Florida State Board of Accountancy. If the PROVIDER receives $100,000 or more in grant funding from the County: a. The CPA that prepares the audit must also be a member of the American Institute of Certified Public Accountants (AICPA); b. The CPA must maintain malpractice insurance covering the audit services provided and c. The County shall be considered an "intended recipient" of said audit. (f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; (g) Organization's Corporate Bylaws, which must include the organization's mission, board and membership composition, and process for election of officers; (h) Organization's Policies and Procedures Manual which must include hiring policies for all staff, drug and alcohol-free workplace provisions, and equal employment opportunity provisions, (i) Specific description or list of services to be provided under this contract with this grant (see Attachment C); 2 (j) Annual Performance Report describing services rendered during the most recently completed grant period (to be furnished within 30 days after the contract end date.) The performance report shall include statistical information regarding the types and frequencies of services ca provided, a profile of clients (including residency) and numbers served, and outcomes achieved (see Attachment G); (k) Cooperation with County monitoring visits that the County may request during the contract year; and (1) Other reasonable reports and information related to compliance with applicable laws, contract provisions and the scope of services that the County may request during the contract year. RESPONSIBILITIES 9. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants, and agrees with the Board to substantially and satisfactorily perform and provide the services outlined in Attachment C to residents of Monroe County, Florida. 10. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award against the non-prevailing party, and shall include attorney's fees, courts costs, investigative, and out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. Contract-Organization Name-FY22;page 3 Packet Pg.630 D.19.a 11. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and PROVIDER and their respective legal representatives, successors, and assigns. 12. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 13. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the ca 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. COMPLIANCE ISSUES IS. 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 2 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 ca written notice of termination to the PROVIDER. 16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure CD 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. 17. NON-DISCRIMINATION. The COUNTY and PROVIDER agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The COUNTY and PROVIDER agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VII of the Civil Rights Act of 1964 (PL 88-352), which prohibits discrimination in employment on the basis of race, color, religion, sex, and national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC §§ 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC § 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC §§ 6101-6107), which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, §§ 523 and Contract-Organization Name-FY22;page 4 Packet Pg.631 D.19.a 527 (42 USC §§ 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC §§ 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC §§ 12101), as amended from time to time, relating to nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 14, Article II, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. AMENDMENTS, CHANGES, AND DISPUTES 18. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services and/or reimbursement of services shall be accomplished by an amendment, which must be approved in writing by the County. cv cv 19. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. The PROVIDER and County staff shall try to resolve the claim or dispute with meet and confer sessions to be commenced within 30 days of the dispute or claim. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as may be provided by this agreement or by Florida law. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit Court, 161" Judicial Circuit, Monroe County, Florida. 20. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and PROVIDER agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and PROVIDER specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. ca ASSURANCES 21. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 22. 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. 23. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. Contract-Organization Name-FY22;page 5 Packet Pg.632 D.19.a 24. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- Free Workplace Statement. 2S. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. INDEMNITY ISSUES 26. 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 and causes of action for medical malpractice, medical negligence, bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the PROVIDER occasioned by the negligence, errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers. 27. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 28. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. c U 29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional ca or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 30. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon the terms of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. GENERAL 31. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. Contract-Organization Name-FY22;page 6 Packet Pg.633 D.19.a 32. NOTICE. Any notice required or permitted under this agreement shall be in writing and hand-delivered or mailed, postage pre-paid, by certified mail, return receipt requested, to the other party as follows: For Board: Grants Administrator and Monroe County Attorney 1100 Simonton Street PO Box 1026 Key West, FL 33040 Key West, FL 33041 For PROVIDER Signing Official, Title Organization Street address City, ST Zip Code (Area Code) Phone Number Email Address: cv 33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This >" Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the ca enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and PROVIDER agree that, in the event of conflicting interpretations of the terms 0) or a term of this Agreement by or between any of them the issue shall be submitted to mediation 0. prior to the institution of any other administrative or legal proceeding. 34. 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. 3S. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. 36. CLAIMS FOR FEDERAL OR STATE AID: PROVIDER and COUNTY agree that each shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the purpose of this Agreement. Any conditions imposed as a result of funding that effect the Scope of Services will be provided to each party. 37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the parties hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between the PROVIDER and the Board. [THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW] Contract-Organization Name-FY22;page 7 Packet Pg.634 D.19.a IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of the day and year first written above. (SEAL) BOARD OF COUNTY COMMISSIONERS ATTEST: KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA By By As Deputy Clerk Mayor/Chairman Organization Name cv cv (Federal ID No. ) Witness By Witness Chief Executive Officer c U cv cv cv Contract-Organization Name-FY22;page 8 Packet Pg.635 D.19.a ATTACHMENT A EXPENSE REIMBURSEMENT REQUIREMENTS This document is intended to provide basic guidelines to Human Service and Community-Based Organizations, county travelers, and contractual parties who have reimbursable expenses associated with Monroe County business. These guidelines, as they relate to travel, are from the Monroe County Code of Ordinances and State laws and regulations. NEW: Provide docurnentation of number of clients servers and explanation of measurable outcomes described in Q.29, of the FY2022 application submitted to the HSAB, that were achieved during the billing period. For reir b rser ent of Payroll and/or fees for services, the Provider shall provide supporting docurnentation to substantiate that the work performed was for services as set forth in Attachment hr ent Cy (sign-in log from clients server, a detailed work log with services rendered and client(s) server for that time period as indicated above) cv cv A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense request needs to also contain the following notarized certified statement: "I certify that the above checks have been submitted to the vendors as noted and that the attached expenses are accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe ca County Board of County Commissioners and will not be submitted for reimbursement to any other funding source." The notary public is subject to the provisions of Chapter 117, Florida Statutes, must use a certificate in substantially the following form in notarizing a tangible or an electronic record. TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) State of 0 U County of The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online cv notarization, this _day of (month), (year), by cv (name of officer or agent, title of officer or agent) of U_ (name of entity). Personally Known 0 Produced Identification: Type of ID and Number on ID_ _ (SEAL) Signature of Notary Name of Notary (Typed, Stamped or Printed) Notary Public, State of 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. Contract-Organization Name-FY22;page 9 Packet Pg.636 D.19.a Reimbursement requests will be monitored in accordance with the level of detail in the contract. This document should not be considered all-inclusive. The Clerk's Finance Department reserves the right to review reimbursement requests on an individual basis. Any questions regarding these guidelines should be directed to 305-292-3534. Data Processing, PC Time, etc. The vendor invoice is required for reimbursement. Inter-company allocations are not considered reimbursable expenditures unless appropriate payroll journals for the charging department are attached and certified. Payroll A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total hours worked, withholding information and paid payroll taxes, check number and check amount. If a Payroll Journal is not provided, the following information must be provided: pay period, check amount, check number, date, payee, and support for applicable paid payroll taxes. I EPayroll N and/or fees for services requests for reir b rser ent shall include the supporting docurnentation as detailed above. The Clerk may request further docurnentation to verify and substantiate that the payment request for payroll and/or fees for services relates to the services provided as set forth in Attachment C. Postage, Overnight Deliveries, Courier, etc. ca 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. 2 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 ca sample of the finished product are required. Supplies, Services, etc. For supplies or services ordered, a vendor invoice is required. C44 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 and Meal Expenses Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's Contract-Organization Name-FY22;page 10 Packet Pg.637 D.19.a residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable travel expense at the destination. Airport parking during a business trip is not. A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must be registered and paid for by traveler. The County will only reimburse the actual room and related bed tax. Room service, movies, and personal telephone calls are not allowable expenses. Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a residence or office to a point of departure. For example, driving from one's home to the airport for a business trip is not a reimbursable expense. Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement. Non-allowable Expenses The following expenses are not allowable for reimbursement: capital outlay expenditures (unless specifically included in the contract), contributions, depreciation expenses (unless specifically included in the contract), entertainment expenses, fundraising, non-sufficient check charges, penalties and fines. c U cv cv cv Contract-Organization Name-FY22;page 11 Packet Pg.638 D.19.a 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 CD 104 Employee A P/R ending 05/14/01 XXX.XX N 105 Employee B P/R ending 05/28/01 XXX.XX (A) Total X.XXX.XX (B) Total prior payments $ X,XXX.XX (C) Total requested and paid (A + B) $ X,XXX.XX (D) Total contract amount $ X,XXX.XX Balance of contract (D-C) $ X,XXX.XX I certify that the above checks have been submitted to the vendors as noted and that the expenses are 0 accurate and in agreement with the records of this organization. Furthermore, these expenses are in compliance with this organization's contract with the Monroe County Board of County Commissioners and will not be submitted for reimbursement to any other funding source. 0 U Chief Executive Officer Attachments (supporting documentation) TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) N cv State of County of The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online notarization, this _day of (month), (year), by (name of officer or agent, title of officer or agent) of (name of entity). Personally Known Produced Identification: Type of ID and Number on ID_ (SEAL) Signature of Notary Name of Notary (Typed, Stamped or Printed) Notary Public, State of Contract-Organization Name-FY22;page 12 Packet Pg.639 D.19.a ATTACHMENT C Specific description and list of services to be provided under this contract: Measurable Outcomes Include: (HSAB Application Q.29) Budget Categories Include: (HSAB Application Q.36) cv cv cv c cv cv cv Contract-Organization Name-FY22;page 13 Packet Pg.640 D.19.a ATTACHMENT D 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 CONTRACTOR 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." I have read the above and state that neither (Respondent's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Date: 0 U TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) CD cv State of U_ County of m The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online notarization, this _day of (month), (year), by (name of officer or agent, title of officer or agent) of (name of entity). Personally Known Produced Identification: Type of ID and Number on ID_ (SEAL) Signature of Notary Name of Notary (Typed, Stamped or Printed) Notary Public, State of Contract-Organization Name-FY22;page 14 Packet Pg.641 D.19.a ATTACHMENT E SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE (Company) "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, cV in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount `V of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee." (Signature) Date: -- 0 U TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) cv State of CD cv County of m The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online notarization, this _day of (month), (year), by (name of officer or agent, title of officer or agent) of (name of entity). Personally Known Produced Identification: Type of ID and Number on ID_ (SEAL) Signature of Notary Name of Notary (Typed, Stamped or Printed) Notary Public, State of Contract-Organization Name-FY22;page 15 Packet Pg.642 D.19.a ATTACHMENT F DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: (Name of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are >_ under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of ca any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. (Signature) Date: cV cv cv TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) �- State of County of The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online notarization, this _day of (month), (year), by (name of officer or agent, title of officer or agent) of (name of entity). Personally Known Produced Identification: Type of ID and Number on ID_ (SEAL) Signature of Notary Name of Notary (Typed, Stamped or Printed) Notary Public, State of Contract-Organization Name-FY22;page 16 Packet Pg.643 D.19.a ATTACHMENT G FY2022 Annual Performance Report For year October 1, 2021 —September 30, 2022 (Report Deadline: October 31, 2022) lAgency Name -i-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Point of Contact (POCK ----------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------i Phone/Email ------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Grant Amount N Per Section 8 of your contract, it is required that you fill out the entire form and answer every question. �- Narrative on the FY2022 Performance (i.e. successes, challenges, etc.): Questions: 1. Please list services and client information below for the program/activities funded by the Monroe County award. .. U 0 L) fps! ` .,,)}�Ss� y -,�i '\1ts t is};<'�, 1}4 i} }s is�s'�{s t�sJl\s ,5�s?is�'i 1ll,i ls�ity)�,t, ,7^i 11 s {i�`1?�1 1 s is\l `�t,�� i:.ti. �� ,,, {1tsgS�}i}�lsilj}S1tj 11� j1\Ir(iij�}��1s\�1\i}1�� ,ss�"il}s� yi\�1�i1�?)yj�1)�s}��`it N 2. What were the measurable outcomes (including numbers) accomplished in FY2022? Please base these outcomes on the services you identified in Question#1. 3. What number and percentage of your clients/participants were at or below the federal poverty level in FY2022; and/or 200%; and/or another standard used by your organization? 4. What area of Monroe County did you serve in FY2022? 5. During FY2022, how many months did you provide program services to (Q.1) clients? 6. How many total FTEs in your organization? 7. How many FTEs worked on the program(s) funded by the FY2022 HSAB award? 8. Volunteers: hours of program service were contributed by volunteers in FY2022. Contract-Organization Name-FY22;page 17 Packet Pg.644 D.19.a FY2022 HSAB FINANCIAL REPORT 9. Were all the awarded funds used in FY2022? a. If no, please explain: 10. Allocation of FY2022 Award; HSAB Award Amount = $ Program Expense Administrative Expense Budget Category Dollar`Amount Dollar Amount Salaries $0 $0 Fringe $0 $0 FICA $0 $0- Independent Contractors $0 $0 Office Supplies, Telephone, Postage $0 $0 Utilities $0 $0 Insurance $0 $0 Repair& Maintenance $0 $0 ca Travel/Transportation $0 $0 Rent/Association Dues $0 $0 Client Service/Describe: $0 $0 Client Service/Describe: $0 $0 Client Service/Describe: $0 $0 Client Service/Describe: $0 $0 Other Expense/Describe: $0 $0 ca Other Expense/Describe: $0 $0 Other Expense/Describe: $0 $0 cv Other Expense/Describe: $0 $0CD 11. Compensation Detail: Include all persons who receive compensation from the FY2022 HSAB funding (including Independent Contractors) Employee Name Type of Work Hrs.Worked Total Charges (FName, Last Initial) Title Performed in Program on Program to Program $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (Note:If you need more space,you may add additional lines or an addendum.) Contract-Organization Name-FY22;page 18 Packet Pg.645 D.19.a 12. Did the HSAB funding you received in FY2022 serve as required match for a portion or all funding awarded by another granting agency? If yes, please provide details below: Amount of Name of Grantor Amount Grantor Type: Grant Type: Match % HSAB that Required Match Awarded by Federal, Competitive or Required Funding Funding Grantor*** State, Non-Competitive by the served as Local or Grantor Required Foundation Match ***Enter the Amount Awarded by the Grantor regardless of whether HSAB provided 100%of the Required Match. For the following questions, please use the number as reported on your FY2022 IRS Form 990. If your FY2022 IRS Form 990 is not yet prepared, please provide an estimate for the following questions. CD cv 13. What is your organization's fiscal year? 14. What were your organization's total expenses in FY2022? 15. What was your organization's total revenue in FY2022? -- 16. What was the organization's total in grants and contracts for FY2022? 17. What was the organization's total donations/fundraising and in-kind in FY2022? a. Cash Donations/Fundraising: b. In-kind Donations/Fundraising: 18. What percentage of your expenses are program service expenses' versus management and general expenses2 in FY2022 as reported on your IRS Form 990? CD cv 19. Additional Comments, Questions and/or Suggestions: .. Email the Annual Performance Report to the Grants Coordinator for Monme County '.Program service expenses are defined as expenses needed to run your programs. 2Management and general expenses encompass expenses such as human resources,salaries of those not working directly with programs, legal services, accounting services, insurance expenses,office management,auditing,and other centralized services. Contract-Organization Name-FY22;page 19 Packet Pg.646 D.19.b FY2022 HSAB Fundin or Recommendations FY22 Applicants Scope of Service Amount Fund Cost Service Account Awarded Center Dates A Positive Step of New October 1, 2021 Monroe County Provision of a Fatherhood Initiative program $25,000 001 Awardee 530340 September 30, 20 Provide facilities and services for a RN- A.H. of Monroe County October 1, 2021 (AHI) Intensive Case Management within a home $95,000 001 03225 530340 September 30, 20 and community setting. Anchors Aweigh Club Provide facilities and services for substance $15 000 001 03255 530340 October 1, 2021 abuse services. September 30, 20 Autism Society of the Provide facilities and services to children and $40,000 001 03263 530340 October 1, 2021 Keys families affected by autism. September 30, 20 CD Provision of a program to repair and restore >_ storm-damaged owner occupied houses in LL Big Pine United New October 1, 2021 Methodist Church the Lower Keys and to maintain and upgrade $10,500 001 Awardee 530340 September 30, 20 homes where the stresses of personal economic and health issues are evident. LL Provide facilities and services for activities Boys &Girls Club for the wholesome development of youths' $100 000 001 03241 530340 October 1, 2021 personal, social, physical, and emotional September 30, 20 '✓ growth. Burton Memorial United Methodist Provide facilities and services for provision of $15,000 001 03256 530340 October 1, 2021 Church Domestic Abuse Provide facilities and services for comprehensive services for individuals and October 1, 2021 U Shelter of the Florida $80 000 001 03201 530340 0) Keys families experiencing domestic and sexual September 30, 20 abuse. Provide facilities and services for free or low- Dr. Jose Sanchez New October 1, 2021 Lions Eye Clinic cost eye exams and glasses for $5,000 001 Awardee 530340 September 30, 20 LL disadvantaged persons. CD Florida Keys Area Provide facilities and services related to N Health Education health-related services for children and $130,000 001 03239 530340 October 1, 2021 >_September 30, 20 LL Center(AHEC) health education. Florida Keys Provide facilities and services for shelter and $150,000 001 03235 530340 October 1, 2021 Children's Shelter counseling to youth and families. September 30, 20 Florida Keys Healthy Provide facilities and services for financial October 1, 2021 Start Coalition assistance with pre-natal care for uninsured $80,000 001 03242 530340 September 30, 20 and under-insured pregnant women. Provide facilities and services such as Florida Keys Outreach shelter, transitional housing, case $110 000 001 03206 530340 October 1, 2021 Coalition (FKOC) management and referrals for homeless September 30, 20 individuals and families. Provide facilities and services for health care October 1, 2021 Good Health Clinic for disadvantaged persons living in Monroe $60,000 001 03226 530340 September 30, 20 County. Grace Jones Day Care Provide facilities and services related to October 1, 2021 Center provision of educational and nutritional $70,000 001 03224 530340 September 30, 20__ services to disadvantaged children. U:ABudget and Finance\Grants\BOCC_H SAB_H SO Grants\FY 22\FY22 HSAB BOCC Activity\FY20 Packet'Pg.647 D.19.b FY2022 HSAB Fundin or Recommendations FY22 Applicants Scope of Service Amount Fund Cost Service Account Awarded Center Dates Guidance/Care Center Provide facilities and services such as mental October 1, 2021 -The Heron,Assisted health support, transportation and $40,000 001 03259 530340 September 30, 20 Living Facility Program supervision. Heart of the Provide facilities and services for activities Keys/Marathon for the wholesome development of youths' $50 October 1, 2021 Recreation Center personal, social, physical, and emotional 000 001 03253 530340 September 30, 20 growth. Provide facilities and services related to Independence Cay provision of a community soup kitchen, $30 000 001 03247 530340 October 1, 2021 transitional housing program and referrals to September 30, 20 _ support services for homeless persons. N N N Keys Area Provide facilities and services for supportive >' Interdenominational services for disadvantaged persons living in $30,000 001 03243 530340 October 1, 2021 September 30, 20 Resources (KAIR) Monroe County. Provide facilities and services for youth such as the provision of violence and substance October 1, 2021 Keys to Be the Change abuse prevention, academic and mentoring $50,000 001 03262 530340 September 30, 20 activities,youth leadership and other programs. Provide facilities and services for Kids Come First in the October 1, 2021 Florida Keys disadvantaged children such as the provision $30,000 001 03260 530340 September 30, 20 of clothing, school supplies, and other items. Literacy Volunteers of Provide facilities and services for literacy October 1 2021 America training. $60,000 001 03205 530340 September 30, 20 W Marathon New Life New October 1, 2021 Assembly of Provide childcare for disadvantaged families. $25,000 001 530340 God/Kreative Kids Awardee September 30, 20 N Monroe Association of CD N ReMARCable Citizens Provide facilities and services for mentally $200 000 001 03232 530340 October 1, 2021 N Inc. (MARC) retarded citizens. September 30, 20 Samuel's House Provide facilities and services for women and $105 000 001 03214 530340 October 1, 2021 children's housing and support. September 30, 20 Provision of health programs, fitness Special Olympics of activities, sports, and non-competitive $15 000 001 New 530340 October 1, 2021 programs for persons with intellectual or Awardee September 30, 20 developmental disabilities Star of the Sea Provide facilities and services related to October 1, 2021 Foundation provision of a certified food pantry for $100,000 001 03246 530340 September 30, 20 disadvantaged persons. Provide facilities and services for the Voices for Florida Keys provision of safe and supportive foster $17 000 001 03261 530340 October 1, 2021 Children environments to meet the needs of foster September 30, 20 children. Wesley House Family October 1, 2021 Services Provide facilities and services for child care. $157,500 001 03236 530340 September 30, 20 U:ABudget and Finance\Grants\BOCC_H SAB_H SO Grants\FY 22\FY22 HSAB BOCC Activity\FY20 Packet'Pg.648 D.19.b FY2022 HSAB Fundin or Recommendations FY22 Applicants Scope of Service Amount Fund Cost Service Account Awarded Center Dates Womankind Provide facilities and services for health care $155 000 001 03215 530340 October 1, 2021 for women. September 30, 20 Total $2,050,000 cv cv cv 0 0 cv cv CD cv U U:ABudget and Finance\Grants\BOCC_H SAB_H SO Grants\FY 22\FY22 HSAB BOCC Activity\FY20 Packet'Pg.649