Item D23 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.23'
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CountCounty ��Monroe. ,y, ? "tr, BOARD OF COUNTY COMMISSIONERS
y M T� \�1a� Mayor Michelle Coldiron,District 2
�1 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.23
Agenda Item Summary #9326
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Janet Gunderson (305) 292-4470
No
AGENDA ITEM WORDING: Approval of FY22 Clerk's Drug Abuse Trust Fund agreements,
totaling $55,000. Agreements are with Florida Keys Children's Shelter ($9,187.64), Literacy
Volunteers of America ($14,955.56), Florida Keys Outreach Coalition ($4,865.11), Guidance/Care
Center, Heron ($19,911.45) and Keys to Be the Change ($6,080.24) for Substance Abuse Treatment
and Prevention programs. The Substance Abuse Policy Advisory Board (SAPAB)recommended the
programs to be funded by the Clerk's Drug Abuse Trust Fund.
ITEM BACKGROUND: The Substance Abuse Policy Advisory Board (SAPAB) met on May 7,
2021, to discuss the distribution the Florida Department of Law Enforcement Byrne Memorial JAG
funds and the Clerk's Drug Abuse Trust Fund based upon applications received.
PREVIOUS RELEVANT BOCC ACTION: Last year (10/21/2020, Agenda Item C.24) BOCC
approved the recommendation of the SAPAB and allocation of $56,822.00 from the Clerk's Drug
Abuse Trust Fund.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Contract- Children's Shelter CDATF FY22
Contract- Keys to Be the Change CDATF FY22
Contract- FKOC CDATF FY22
Contract- GCC - Heron CDATF FY22
Contract- LVA CDATF FY22
FINANCIAL IMPACT:
Effective Date: October 1, 2021
Expiration Date: September 30, 2022
Packet Pg.707
D.23'
Total Dollar Value of Contract: $55,000.00
Total Cost to County: $55,000.00
Current Year Portion: $55,000.00
Budgeted: Yes
Source of Funds: 164— Clerk's Drug Abuse Trust Fund
CPI: N/A
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in above dollar amounts: N/A
Revenue Producing: No If yes, amount:
Grant: No.
County Match: No.
Insurance Required: No
Additional Details:
10/20/21 164-04569 DRUG ABUSE TRUST $19,911.45
G/CC - The Heron
10/20/21 164-04569 DRUG ABUSE TRUST $6,080.24
Keys to Be the Change
10/20/21 164-04569 DRUG ABUSE TRUST $4,865.11
FKOC
10/20/21 NEW COST CENTER ADDED $14,955.56
Literacy Volunteers of America
10/20/21 164-04569 - DRUG ABUSE TRUST $9,187.64
Children's Shelter
Total: $55,000.00
REVIEWED BY:
Christine Limbert Completed 10/05/2021 10:33 AM
Tina Boan Completed 10/05/2021 11:42 AM
Maria Slavik Completed 10/05/2021 11:55 AM
Liz Yongue Completed 10/05/2021 12:33 PM
Board of County Commissioners Pending 10/20/2021 9:00 AM
Packet Pg.708
D23.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 Florida Keys Children's Shelter, Inc., hereinafter referred to as "PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of
providing shelter and offering various programs for vulnerable children, and
WHEREAS, it is a legitimate public purpose to provide shelter and offer programs for
vulnerable children and adolescents who present at risk for substance use, aggressive/violent
behavior, and/or premature sexual activity, now, therefore,
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IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows:
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FUNDING
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and providing a program for the prevention of risky behaviors and
help build a positive future for children and adolescents in Monroe County, Florida, shall pay to the
PROVIDER the sum of NINE THOUSAND, ONE HUNDRED EIGHTY-SEVEN AND 64/100 DOLLARS
($9,187.64) for fiscal year 2022, as recommended by the Substance Abuse Policy Advisory Board
and funded by the Clerk's Drug Abuse Trust Fund. `CD
V
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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 U_
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 y
reimbursable expenses which are reviewed and approved as complying with Monroe County Code
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
DATF Contract:Florida Keys Children's Shelter FY22 Page I 1
Packet Pg.709
D23.a
or goods provided by the PROVIDER after the PROVIDER has received written notice of termination,
unless otherwise required by law.
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 2
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 y
from the date the monies were paid by the COUNTY.
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 >-
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
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
DATF Contract:Florida Keys Children's Shelter FY22 Page 12 Packet Pg.710
D23.a
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.
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; 2
(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:
JA
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);
(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 v,
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
DATF Contract:Florida Keys Children's Shelter FY22 Page 13 Packet Pg.711
D23.a
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.
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.
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2
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 y
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.
cv
14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the >_
PROVIDER is an independent contractor and not an employee of the Board. No statement contained
in this agreement shall be construed so as to find the PROVIDER or any of its employees,
contractors, servants or agents to be employees of the Board. �-
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
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 v,
agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
16. 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.
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
DATF Contract:Florida Keys Children's Shelter FY22 Page 14 Packet Pg.712
D23.a
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
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 2
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.
19. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree y
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 15 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. v,
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
DATF Contract:Florida Keys Children's Shelter FY22 Page 15 Packet Pg.713
D23.a
coverage, nor shall any contract entered into by the County be required to contain any provision
for waiver.
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. y
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.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
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 E
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.
DATF Contract:Florida Keys Children's Shelter FY22 Page 16 Packet Pg.714
D23.a
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.
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 2
Key West, FL 33040 Key West, FL 33041
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For PROVIDER
Ben Kemmer, Co-CEO
Florida Keys Children's Shelter, Inc.
73 High Point Road y
Tavernier, FL 33070
(305) 852-4246
Email: bkemmer@fkcs.orq
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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
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
or a term of this Agreement by or between any of them the issue shall be submitted to mediation
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.
DATF Contract:Florida Keys Children's Shelter FY22 Page 1 7 Packet Pg.715
D23.a
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]
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DATF Contract:Florida Keys Children's Shelter FY22 Page 8 Packet Pg.716
D23.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_ ..... ........_
As Deputy Clerk Mayor/Chairman .�
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Florida Keys Children's Shelter, Inc.
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(Federal ID No.� _m
Witness 3.�
_. �i
By .
fitness lief Executive Officer c„
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DATF Contract:Florida Keys Children's Shelter FY22 Page 9
Packet Pg.717
D23.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 (Application, Q.2) and goals achieved
(, pplication, Q.9), described in the Fv2 22 application submitted to the SAPAB, 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
hment �
C (sign-in log from clients server, a detailed work log with services rendered and client(s) servers
for that tlrne period as indicated above) °®
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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
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source." `V
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w.i.,.he notary public is subject to the provisions of Chapter 1 17, Florida Statutes, must use a certificate --
in substantially the foll,,3win form in notarizing a tangibly or an electronic record.
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
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.
DATF Contract:Florida Keys Children's Shelter FY22 Page 110 Packet Pg.718
D23.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, support for applicable paid payroll taxes. I EPayroll
and/or fees for services requests for reirnb rsernent shall include the supporting r ocurne tati n as
detailed above. The Clerk may request further documentation 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.
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. v,
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the number
called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the
telephone number, the date, and the purpose of the call.
Travel 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
DATF Contract:Florida Keys Children's Shelter FY22 Page 111 Packet Pg.719
D23.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, 2
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 y
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
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DATF Contract:Florida Keys Children's Shelter FY22 Page 12 Packet Pg.720
D23.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
2
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 05/28/01 XXX.XX
(A) Total $ X,XXX.XX y
(B) Total prior payments $ X,XXX.XX 2
(C) Total requested and paid (A + B) $ X,XXX.XX N
(D) Total contract amount $ X,XXX.XX
Balance of contract (D-C) $ X,XXX.XX W
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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 organization's contract with the Monroe County Board of County Commissioners
and will not be submitted for reimbursement to any other funding source.
Chief Executive Officer
Attachments (supporting documentation)
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
0
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
DATF Contract:Florida Keys Children's Shelter FY22 Page 113 Packet Pg.721
D23.a
ATTACHMENT C
Specific description and list of services to be provided under this contract: (SAPAB Application
Q.2)
Implementation of an All-Stars Research Based Program, serving the at-risk families from Monroe
County and help reduce the risk of substance abuse. The primary goal of the Florida Keys Children's
Shelter is to prevent risky behaviors among adolescents. When operating All-Stars from the end of
elementary school through high school, it delays the onset of substance use. As an added benefit,
All-Stars also prevents other behaviors, including early sexual activity, bullying, and fighting.
Whatever risky behavior exists, it is the program's goal to reduce it, postpone it and prevent it.
The secondary goal of All Stars is to give kids hope and envision a bright and positive future for
themselves. Research shows children who have a clear vision for their future, know what they need
to do to make it happen. They believe risky behaviors will get in the way of achieving the future
they desire. All Stars inspires kids to dream about, develop, and carry out a plan for a positive and
bright future.
Areas of Focus: Alcohol, Tobacco &Other Drugs, Nutrition, and Personal Health - Includes activities
which:
JA
• Develop positive norms
• Build idealism and pro-social values
• Develop resistance skills
• Develop decision-making skills `V
• Reinforce appropriate beliefs about consequences of alcohol, tobacco, & other drug (ATOD) use
• Practice goal setting --
• Teach stress management
• Reinforce appropriate beliefs about consequences of nutritional practices
• All Stars Senior Logic Model
Children and adolescents who present at risk for substance use, aggressive/violent behavior and
premature sexual activity will receive these services:
Ages 6-12 (Childhood) ,
Ages 13-17 (Adolescent)
Genders - Male and Female v,
Races/Ethnicities - Asian, Black, or African American, Hispanic, or Latino White and White. Program
participants could be referred by DJJ. Many of our current community-based counseling cases are
referred by DJJ for being at-risk with substance abuse or ungovernable behaviors. FKCS plans to
serve 50 youth with the "ALL STARS" program.
Identify Goals Achieved: (SAPAB Application Q.9)
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The program focuses on five topics important to preventing high-risk behaviors:
(1) Developing positive ideals that do not fit with high-risk behavior;
(2) Creating a belief in conventional norms;
(3) Building strong personal commitments to avoid high-risk behaviors;
(4) Bonding with school, pro social institutions, and family; and
(5) Increasing positive parental attentiveness such as positive communication and parental
monitoring.
Budget Categories Include: (SAPAB Application, Section 4)
Salaries & Benefits - The services will be provided by six employees at FKCS; the staff members
who are providing the services include one Licensed Mental Health Counselor. FKCS is requesting
funding equal to 10% of the professional's current salary to provide the"ALL STARS" program. Four
staff members will be funded by this program.
DATF Contract:Florida Keys Children's Shelter FY22 Page 114 Packet Pg.722
D23.a
ATTACHMENT D
PUBLIC ENTITYT
"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."
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I have read the above and state that neither &66-1 k iw"0-re (Respondent's name) nor
any Affiliate has been placed on the convicted vendor'list within the last 36 months.
(Sig �
Date 12—o2, ca
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) )
State of
County of .. a......... U
_.
The foregoing instrument was acknowledged before me, by means of El physical presence or ❑ online �
notarization, thisZ90 day of r (month), (year), by
. (name of officer or agent, title of officer or agent) of
(name of entity). m
Personally Known
_..__.... .. . ... Produced Identification: Type of ID and Number on ID„ ---
r fd
(SEAL) r
Sign 'ture of Notary
,• KATYA MDIWI
OM� ' � ' Name ito�ta-r�yj- Se"ZLr��rfnied)
- = F • Notary Public, State of ...... ,
DATF Contract.•Florida Keys Children's Shelter FY22 Pagel 15
Packet Pg.723
D23.a
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
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(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,
in its discretion,deduct from the Agreement or purchase price, or otherwise recover, the full amount
of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
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(Si re)
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Date: ® cv
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) w
State of .... _.t'm..
County of + ........ -a
The me, by means of physical presence or online
as
notarization,9 n
this
instrument wday ofnowled ed El
nbefore M-- (month), x,__--- (year), by
_ (name of officer or agent, title of officer or agent) of
_ _ ....... t ... e of entity). U
Personally Known
Produced Identification: Type of ID and Number on ID _....
(SEAL) `?
Signatu a of Notary
='Puff ssX41YA AWFADE ' Name of Pdotary ( yped, Stamped or Printed)
EXPNS;Jam Notary Public, State of
DATF Contract:Florida Keys Children's Shelter FY22 Pagel 16
Packet Pg.724
D23.a
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
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(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 2
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
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.
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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 certif at s firm complies fully with the
above requirements. ` c�
(Si nature
Date: __ a
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of47A..,. ... �._ .�
The foregoing instrument was acknowledged befo a me, by means of ❑ physical presence or ❑ online Uo
notarization, this ` Y da of
(month), (Year), by
111 ..W_ . name of officer or agent, title of officer or agent) of
'05 r
o entity).
Personally Known
Produced Identification: Type of ID and Number on ID
(SEAL)
Sig a of Not ry
KgyA plgp Name of otary (Typed, Stamped or Printed)
mycommommmal
evmjum2s,20 Notary Public, State of
9
DATF Contract:Florida Keys Children's Shelter FY22 Page 17
Packet Pg.725
D23.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
-�
----------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------;
Phone/Email
-------- --------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Grant Amount
-------------------------------------------------------------------------------------------'---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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:
N
1. Please list services and client information below for the program/activities funded by the Monroe >`--
County award.
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�ri1 t1 `r� S t`cif t 2 Stl ' I, s t l ti t'.,, t� t (i
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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 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2022.
DATF Contract:Florida Keys Children's Shelter FY22 Page 118 Packet Pg.726
D23.a
FINANCIAL REPORT
FY2022 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note:Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2022?
a. If no, please explain:
10. Allocation of FY2022 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense _
Budget Category (Dollar Amount) (Dollar Amount)
Salaries $0 $0
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Frin e $0 $0 2
FICA $0 $0
Independent Contractor(s) $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0 v,
Insurance $0 $0-
Repair& Maintenance $0 $0
Travel/Transportation $0 $0
Rent/Association Dues $0 $0
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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
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: 1 $0 1 $0 ca
11. Compensation Detail: Include all persons who receive compensation from the FY2022 Clerk's Drug 2
Abuse Trust Fund (including Independent Contractors)
U
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.)
DATF Contract:Florida Keys Children's Shelter FY22 Page 119 Packet Pg.727
D23.a
12. Did the FY2022 funding from the Clerk's Drug Abuse Trust Fund 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%
Funding that Required Match Awarded by Federal, Competitive or Required
served as Funding Grantor*** State, Non-Competitive by the
Required Local or Grantor
Match Foundation
***Enter the Amount Awarded by the Grantor regardless of whether DATF 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.
13. What is your organization's fiscal year?
14. What were your organization's total expenses in FY2022? y
15. What was your organization's total revenue in FY2022?
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16. What was the organization's total in grants and contracts for FY2022?
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17. What was the organization's total donations/fundraising and in-kind in FY2022?
a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising: ca
18. What percentage of your expenses are program service expenses' versus management and
general expenses2 in FY2022 as reported on your IRS Form 990?
19. Additional Comments, Questions and/or Suggestions:
c
Email the Annual Performance Report to the Grants Coordinator for Monroe 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.
DATF Contract:Florida Keys Children's Shelter FY22 Page 120 Packet Pg.728
D.23.b
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 Keys to Be the Change, Inc., hereinafter referred to as "PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of
providing various programs for vulnerable children in Monroe County, and
WHEREAS, it is a legitimate public purpose to provide programs for vulnerable children and
adolescents who present at risk for substance use and aggressive/violent behavior, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows:
FUNDING
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and providing programs for vulnerable children in Monroe County,
Florida, shall pay to the PROVIDER the sum of SIX THOUSAND EIGHTY AND 24/100 DOLLARS
($6,080.24) for fiscal year 2022, as recommended by the Substance Abuse Policy Advisory Board
and funded by the Clerk's Drug Abuse Trust Fund.
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2. TERM. This Agreement shall commence on October 1, 2021, and terminate September >-
30, 2022, unless earlier terminated pursuant to other provisions herein.
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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 U-
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
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 ca
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.
DATF Contract:Keys to Be the Change FY22;Page I 1 Packet,Pg.729
D.23.b
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 y
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.
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
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
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
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information and amounts through interviews and written confirmations with employees,
Subcontractors, suppliers, and contractors' representatives. All records shall be kept for ten (10) v,
years after Final Completion of the Project. The County Clerk possesses the independent authority a
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.
DATF Contract:Keys to Be the Change FY22;Page 12 1 Packet,Pg.730
D.23.b
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 y
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); y
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);
(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
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
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(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 v,
contract year. a
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.
DATF Contract:Keys to Be the Change FY22;Page 13 Packet,Pg.731
D.23.b
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 y
employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed 2
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. y
14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the T
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, CD
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
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.
16. 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.
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
527 (42 USC §§ 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug
DATF Contract:Keys to Be the Change FY22;Page 14 1 Packet,Pg.732
D.23.b
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 y
and/or reimbursement of services shall be accomplished by an amendment, which must be
approved in writing by the COUNTY. °®
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 y
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.
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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.
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. v,
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.
DATF Contract:Keys to Be the Change FY22;Page 15 Packet,Pg.733
D.23.b
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 y
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, y
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.
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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.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
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 v,
constitutional or statutory duties of the County, except to the extent permitted by the Florida a
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.
DATF Contract:Keys to Be the Change FY22;Page 16 Packet,Pg.734
D.23.b
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
Heidi Golightly, Executive Director
Keys to Be the Change, Inc. y
1208 Watson Street 2
Key West, FL 33040
Phone: (541) 974-4398
Email: heidiraoliahtly@amail.com
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 y
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
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
or a term of this Agreement by or between any of them the issue shall be submitted to mediation �-
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, v,
condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent a
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 E
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]
DATF Contract:Keys to Be the Change FY22;Page 1 7 1 Packet,Pg.735
D.23.b
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
y By
As Deputy Clerk Mayor/Chairman
2
Keys to Be the Change, Inc.
(Federal ID No.
Witness
Witness Chief ecu ive Officer N
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DA TF Contract.°Keys to Be the Change FY22t Page 8 Packet,Pg. 736
D.23.b
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 (Application, Q.2) and goals achieved
(, pplication, Q.9), described in the Fv2 22 application submitted to the SAPAB, during the billing
period.
For reir b rser ent of Payroll and/or fees for services, the Provider shall provide supporting y
docurnentation to substantiate that the work performed was for services as set forth in Attachment hment 2
Cy (sign-in log from clients server, a detailed work log with services rendered and client(s) servers °®
for that tlrne period as indicated above)
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
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source."
w.i.,.he notary public is subject to the provisions of Chapter 1 17, Florida Statutes, must use a certificate
in substantially the foll,,3win form in notarizing a tangibly or an electronic record.
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 m
notarization, this _day of (month), (year), by
0
(name of officer or agent, title of officer or agent) of y
(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
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.
DATF Contract:Keys to Be the Change FY22;Page 19 Packet,Pg.737
D.23.b
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, support for applicable paid payroll taxes. I EPayroll
and/or fees for services requests for reirnb rsernent shall include the supporting r ocurne tati n as
detailed above. The Clerk may request further documentation 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 Cyr �
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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.
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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. c
For supplies or services ordered, a vendor invoice is required. v,
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.
c
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
DATF Contract:Keys to Be the Change FY22;Page 110 1 Packet,Pg.738
D.23.b
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. y
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 y
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions, depreciation expenses (unless specifically 2
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
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DATF Contract:Keys to Be the Change FY22;Page 11 Packet Pg.739
D.23.b
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 _.
2
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 05/28/01 XXX.XX y
i
(A) Total X.XXX.XX 2
(B) Total prior payments $ X,XXX.XX N
CD
(C) Total requested and paid (A + B) $ X,XXX.XX U_
(D) Total contract amount $ X,XXX.XX N
Balance of contract (D-C) X.XXX.XX N
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 organization's contract with the Monroe County Board of County Commissioners
and will not be submitted for reimbursement to any other funding source.
Chief Executive Officer U
Attachments (supporting documentation) m
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) o
0
State of
County of '
The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online
0
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
DATF Contract:Keys to Be the Change FY22;Page 112 Packet,Pg.740
D.23.b
ATTACHMENT C
Specific description and list of services to be provided under this contract: (SAPAB Application
Q.2)
Keys to Be the Change will utilize funds from this grant for our Kids Win Mentoring Program. Kids
Win is a youth mentoring program that pairs at-risk youth with community leaders such as Key
West Police Department personnel, City of Key West personnel, US Coast Guard personnel and
other community members. This program helps to reduce high risk behaviors that are associated
with alcohol and drug use. The program has expanded to both Horace O'Bryant School and
Poinciana Elementary School. Our goal is to reach (serve) 35 students 2021-2022 school year.
Parents as well as students are reaching out for our guidance. Currently our students have the
option to attend school full time or continue with three days a week every other week. Most of the
youth in the Kids Win Program have continued the three-day schedule. This inconsistency is very
difficult for our high-risk youth to manage. Our mentors are continuing to connect with their
mentees via texting, calling or in person. The Success Coach is in the schools every day working
with administrators, teachers, guidance counselors and the youth to guide them toward success.
This individualized attention has proven effective as our success rate in this program of reducing y
truancy while increasing grades is over 70%. The main goal of all KTBTC programs is to build self-
confidence and self-esteem which ultimately leads to drug, alcohol and violence free lives.
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Schools Receiving Services: Key West High School, Horace O'Bryant School, and Poinciana
Elementary School.
Identify Goals Achieved: (SAPAB Application Q.9/Q.11)
The goal of all Keys to Be the Change programs is to increase self-esteem and self-confidence which
in turn will create youth who refrain from high-risk behaviors. Keys to Be the Change is the only
youth serving organization that works with high-risk youth on campus every day. The goal is to
increase school bonding and educational success of high-risk youth by increasing grades and/or
decreasing truancy while promoting healthy lifestyles that refrain from drugs, alcohol, and violence.
Youth in the Kids Win program are monitored on a daily basis by the Success Coach who tracks
behavior, grades and attendance. The mentors receive grade reports on a weekly basis when they
meet with their mentee. Mentors are also in touch with the Success Coach when necessary.
Relationships are built and the youth look forward to sharing their successes with their mentor each
week. Certificates of merit are given to those students who achieve the goal of reducing truancy v,
and/or increasing grades every quarter. If straight A's happen, a large pizza is delivered to their a
home! Twice a year we celebrate successes with our mentors and mentees with a breakfast or lunch ,
at the end of the first semester and again at the end of the school year.
Budget Categories Include: (SAPAB Application, Section 4)
Program Expenses: Student rewards and celebration luncheons are held after the first semester
and at end of the school year for successful participants in the program. Monies are also used if a
mentor leaves before the school year ends. We honor the relationship that has formed and celebrate
with a breakfast or lunch for them.
Success Coach: The Success Coach is paid on a monthly basis at the rate of $50.00/hour. Much of
her time is volunteered. Currently the Success Coach works an average of 5 hours per day for
approximately 140 days during the school year. Additionally, the Success Coach monitors youth
during the summer months as many have been and will be attending summer school.
Other Expense: One graduating senior that has been in the Kids Win Program and showed
exceptional perseverance during his/her tenure receives a $500.00 scholarship.
DATF Contract:Keys to Be the Change FY22;Page 113 1 Packet,Pg.741
D.23.b
ATTACHMENT
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 y
excess of the threshold amount provided in Section 27.017, for CATEGORY TWO for a period of
36 months from the date of being placed on the convicted vendor list."
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I have read the above and state that neither (Respondent's name) nor
any Affiliate has been placed on the convicted endor list With the lasf 36 nths.
i nature)
Date: . N
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(in accordance with State notary requirements)
State of
County of
�A -*,N,N"
The foregoing instrument was acknowledged before me, by means of physical presence or ❑ online
notarization, this ` day of V1, Pal . . (month), - (year), by
(name of officer or agent, title of officer or agent) of
__. (name of entity). a
Personally Known
_. Produced Identification: Type of ID and b r on ID, r
(SEAL.)
olyl
LpA OPF A ignat re of Notary
MY COMMISSION#EXP h 05,2024
- - - -
wvv, Name of Notary (Typed, ra aped or Printed)
Notary Public, State of ,r"d"r—"I
DATF Contract.Keys to Be the Change FY22;Page 14 Packet,Pg. 742
D.23.b
COUNTY, ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE
FLORIDA
ETHICS CLAUSE
DJAi
(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. 010-190 or any County officer
or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this y
provision the County may, in its discretion, terminate this Agreement without liability and may also,
in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount
of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
r,
i gYalture) N
Date:
N
N
COMPLETED (in accordance with State notary requirements)
State of
County of,. �,p o
The foregoing instru ent was acknowledged before me, by means 01 physical presence or ❑ online
notarization, this day of L (month), (year), by
( )r (name of officer or agent, title of officer or agent) of
o
(name of entity). ca
Personally Known
Produced Identification: Type of ID and Number on ID.E1 4 01
(SEAL)
A HOPF ........
nat of Notary
MY COMMISSION 0 00 6624
EXPIRES.Maw►
Name of Notary yed, Stamp d or Printed)
Notary Public, State ofv�'IQ"'Kio( 67
_s..:
ATFContract:Keys to Be the Change FY22;Page 15 Packet,Pg. 743
D.23.b
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Busines
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
any controlled substance law of the United States or any state, for a violation occurring in N
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 U_
implementation of this section. U_
As the person authorized to sign the statement, I c ify that this m co he fully with the
above requirements. °'
Lure)
Date:
TO BE COMPLETED (in accordance with stare notary requirements)
State of __ i
County of f04 r
The foregoing instrument was acknowledged befor me, by means of physical presence or ❑ online
notarization, this day of _i (month), {year}, by
_ _ .
_e t O 11( E
�. (name of officer or agent, title of officer or agent) of
name of entity).
/eP
Personally Known
Produced Identification: Type of ID and u on ID,_,[_
(SEAL)
a Nota /
A A HOPF t"
MY COWSSION N GG4605 M "
EXPIRES:Mareb05,2024 Name of Notary (Typed, Stamped or Printed)
Notary Public, State of
DA TF Contract. Keys to Be the Change FY22;Page i 16 Packet,Pg. 744
D.23.b
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.): y
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Questions: CD
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1. Please list services and client information below for the program/activities funded by the Monroe --
County award.
1
1 1
Ile
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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 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2022.
DATF Contract:Keys to Be the Change FY22;Page 117 1 Packet,Pg.745
D.23.b
FINANCIAL REPORT
FY2022 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2022?
a. If no, please explain:
10. Allocation of FY2022 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category (Dollar Amount) (Dollar Amount)
Salaries $0 $0
Fringe $0 $0
FICA $0 $0
Independent Contractor(s) $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0
Insurance $0 $0
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Repair& Maintenance $0 $0
Travel/Transportation $0 $0 U-
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
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 1 $0
Other Expense/Describe: 1 $0 $0
11. Compensation Detail: Include all persons who receive compensation from the FY2022 Clerk's Drug
Abuse Trust Fund (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.)
DATF Contract:Keys to Be the Change FY22;Page 118 Packet,Pg.746
D.23.b
12. Did the FY2022 funding from the Clerk's Drug Abuse Trust Fund 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%
Funding that Required Match Awarded by Federal, Competitive or Required
served as Funding Grantor*** State, Non-Competitive by the
Required Local or Grantor
Match Foundation
***Enter the Amount Awarded by the Grantor regardless of whether DATF provided 100%of the Required Match.
Ch
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 v
questions.
13. What is your organization's fiscal year?
14. What were your organization's total expenses in FY2022?
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15. What was your organization's total revenue in FY2022?
16. What was the organization's total in grants and contracts for FY2022? cV
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17. What was the organization's total donations/fundraising and in-kind in FY2022?
a. Cash Donations/Fundraising: ca
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?
CO
19. Additional Comments, Questions and/or Suggestions:
c
Email the Annual Performance Report to the Grants Coordinator for Monroe 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.
DATF Contract:Keys to Be the Change FY22;Page 119 Packet,Pg.747
D.23.c
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 Florida Keys Outreach Coalition, Inc., hereinafter referred to as "PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of
services such as substance abuse treatment, relapse prevention and education for individuals and
families in Monroe County, and
WHEREAS, it is a legitimate public purpose to provide substance abuse treatment, relapse
prevention and education services, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows:
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2
FUNDING
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1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially 25
and satisfactorily performing and providing substance abuse treatment, relapse prevention and
education services for individuals and families in Monroe County, Florida, shall pay to the PROVIDER
the sum of FOUR THOUSAND EIGHT HUNDRED SIXTY-FIVE AND 11/100 DOLLARS ($4,865.11) for
fiscal year 2022, as recommended by the Substance Abuse Policy Advisory Board and funded by
the Clerk's Drug Abuse Trust Fund.
2. TERM. This Agreement shall commence on October 1, 2021, and terminate September `CD
V
30, 2020, 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
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
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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
DA TF Contract:FKOCFY22;Page I 1 I Packet,Pg.748
D.23.c
or goods provided by the PROVIDER after the PROVIDER has received written notice of termination,
unless otherwise required by law.
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.
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
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 W
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 e®
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
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
DA TF Contract:FKOCFY22;Page 12 1 Packet,Pg.749
D.23.c
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.
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; W
(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); e®
(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
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
DA TF Contract:FKOCFY22;Page 13 1 Packet,Pg.750
D.23.c
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.
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.
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14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee of the Board. No statement contained
in this agreement shall be construed so as to find the PROVIDER or any of its employees,
contractors, servants or agents to be employees of the Board. W
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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
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.
16. 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.
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
DA TF Contract:FKOCFY22;Page 14 1 Packet,Pg.751
D.23.c
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
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.
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.
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
DA TF Contract:FKOCFY22;Page 15 1 Packet,Pg.752
D.23.c
coverage, nor shall any contract entered into by the County be required to contain any provision
for waiver.
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. W
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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.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
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.
DA TF Contract:FKOCFY22;Page 16 Packet,Pg.7S3
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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.
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
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For PROVIDER
Jeanette McLernon, Executive Director
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Florida Keys Outreach Coalition, Inc.
PO Box 4767
Key West, FL 33041
Phone: (305) 293-8189
Email: Jmclernon@fkoc.org_
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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
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
or a term of this Agreement by or between any of them the issue shall be submitted to mediation
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.
DA TF Contract:FKOCFY22;Page 17 Packet,Pg.754
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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]
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DA TF Contract:FKOCFY22;Page 8 Packet,Pg.755
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IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of
the day and year first written above.
(SEAL) BOARD OF COUNTY COMMISSIONERS
ATTEST: KEVIN MACHO , CLERK OF MONR.OE COUNTY, FLORIDA
By By
As Deputy Clerk Mayor/Chairman
2
Florida Keys Outreach Coalition, Inc.
(Federal ID No. )
Witness
By ca
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Vit�ness Chief Executive Officer
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L�,-�TF C"or�trcac'C.I�A'CJC'�Y'?;Page
D.23.c
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 (Application, Q.2) and goals achieved
(, pplication, Q.9), described in the Fv2022 application submitted to the SAPAB, 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
hment
Cy (sign-in log from clients server, a detailed work log with services rendered and client(s) servers
for that tlrne period as indicated above)
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A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense r
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
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source." _m
w.i.,.he notary public is subject to the provisions of Chapter 1.1.7, Florida Statutes, must use a certificate
in substantially the foll,,3wing form in notarizing a tangible or an electronic record.
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
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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).
0
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
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.
DA TF Contract:FKOCFY22;Page 110 Packet,Pg.757
D.23.c
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, support for applicable paid payroll taxes. I EPayroll
and/or fees for services requests for reirnb rsernent shall include the supporting r ocurne tati n as �
detailed above. The Clerk may request further documentation 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 Cyr
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.
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Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not W
allowable expenses.
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Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The e®
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc. c
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
DA TF Contract:FKOCFY22;Page 111 I Packet,Pg.758
D.23.c
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.
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DA TF Contract:FKOCFY22;Page 12 Packet,Pg.759
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ATTACHMENT B
ORGANIZATION
LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, FL 33040
Date
The following is a summary of the expenses for (Organization name) for the time period of to _.
Check # Payee Reason Amount
101 Company A Rent $ X,XXX.XX
102 Company B Utilities XXX.XX
104 Employee A P/R ending 05/14/01 XXX.XX
105 Employee B P/R ending 05/28/01 XXX.XX
(A) Total X.XXX.XX
(B) Total prior payments $ X,XXX.XX ?�
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(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 N
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 organization's contract with the Monroe County Board of County Commissioners
and will not be submitted for reimbursement to any other funding source.
Chief Executive Officer
Attachments (supporting documentation)
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) ,
State of
0
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
DA TF Contract:FKOCFY22;Page 113 Packet,Pg.760
D.23.c
ATTACHMENT C
Specific description and list of services to be provided under this contract (SAPAB Application
Q.2):
The project will provide drug and alcohol abuse prevention and education services to clients to
reduce recidivism and increase personal and housing stability. All clients served under the Clerk's
Drug Abuse Trust Fund (CDATF) grant program will have a documented history with the criminal
justice system. Clients are tested on-site frequently and randomly for drug and alcohol use.
FKOC's experience has been that requiring ex-offenders with a history of substance abuse to seek
treatment and participate in relapse prevention activities is not so much that coercion may improve
the individual's chance of continued sobriety and reduce the likelihood of re-offending, but that
relapse prevention programs do indeed improve coercion's dismal record, particularly the risk of
incarceration, in reducing criminal behavior.
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Drug tests detect the use of alcohol, cocaine, THC, Amphetamines, benzodiazepine, opiates and r
oxycodone. FKOC will purchase testing supplies and administer a minimum of 7,100 alcohol/drug
tests between 10/01/2021 and 09/30/2022. FKOC's CDATF grant funded supportive services will
be limited strictly to:
• Alcohol and drug abuse relapse prevention and education at an estimated cost of$1.25 per test.
• None of these grant funds will be used to pay staffing costs.
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FKOC will provide copies of invoices to show purchasing and monthly spreadsheets to show drug
and alcohol testing statistics. Additionally, upon request, FKOC will be able to provide individual
drug and alcohol testing sheets and service records from our HMIS system with names of
participants redacted. Please note, due to the large number of individuals served, to provide this
as a regular documentation would create a substantial amount of paperwork to be reviewed by
Monroe County grant management staff.
FKOC staff and trained volunteers will administer on-site drug testing. Five (5) paid staff members
and ten (10) volunteers will assist with testing. The tests do not require a level of certification.
FKOC provides regular, ongoing staff and volunteer training to ensure FKOC's policies and
procedures are being executed fully and completely.
Identify Goals Achieved: (SAPAB Application Q.9/Q.11)
To provide a drug and alcohol abuse prevention and education program to FKOC adult residential
program clients with a criminal background to reduce recidivism and increase personal and housing
stability.
Major Activities include:
• Drug and Alcohol testing on-site (in each facility) to a minimum of 175 residents on a regular
basis and more often as needed.
• All FKOC programs provide life skills and case management services; however, FKOC's ex-
offenders receive comprehensive services that are directed to help them overcome the
multitude of challenges that could lead the person to re-offend. These services include: meeting
with probation officers, accompaniment to court, intensive one-on-one sessions, smaller
interactive group discussions, increased drug testing and linkages to other resources deemed
necessary on a case by case basis.
Budget Categories Include: (SAPAB Application, Section 4)
Salaries & Benefits and Program Expenses.
DA TF Contract:FKOCFY22;Page 114 Packet,Pg.761
D.23.c
-ATTACHMENT
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 rids 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 �, O (Respondent's name) nor
any Affiliate has been placed on the convict �cd*en�dor list within the last 36 months. F-
(Si nature) -
Date: 1 - l, y
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TO BE COMPLETEDY NOTARY (in accordance with State notary requirements)
State of
County of3 _.�
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The foregoing instrument was acknowledged before me, by means of Cl physical presence or 0 online
notarization, this 0 day of (month), ®6`- t • (year), by
( 0 (name of officer or agent, title of officer or agent) of
OMWAV - (name of entity).
Personally Known
Produced Identification; Type of ID and Number D
(SEAL) r
Signature of Notary
CHR15TOPNcRwE-75
rr Notary POlic-State of Florida Name of Notary ('Types`, Stamped or Printed)
>< Commission"N� �9g 1
OFF--� my Comm.Expires Feb 11,2025 Notary Public, State of �-� "�
3nrred'through Nationa!Notary Assr,
LLt7F ConP-rrct:Fh OCF}'2';Puge I 15 Packet,Pg.762
D23.c
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
lY
(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,
in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount
of any fee, commission, percentage, gift, or consideration paid to the former County officer or °®
employee."
( i ature)
Date: j _ . _ T
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CD
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TO BE COMPLETEDV NOTARY (in accordance with State notary requirements)
State of
County of t
The foregoing instrument was acknowledged before me, by means of 0 physical presence or 0 online
notarization, this i day of (month), (year), by
(dame of officer or agent title of officer or agent) of
(name of entity).
Personally Known
Produced Identification: Type of ICE and Nuber,✓on
(SEAL) I
Signature of Notary
2 cHR sraPHE 7: Name of Notary (Typed, Stamped or(printed)
Notary Public State of Honda
Commission 0 HH 89981
� 1 my Comm.Expire,Feb ?Y,2025 9 V
Notary Public, �Slate of ( .-g ,
Bonded through Nationale Notary Assn:.
D t T F Conn-cwt:F fJC'FY22;Fite 116 Packet Pg.763
D.23.c
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance. with Florida Statute 287,087 hereby certifies that:
a
(Dame 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.
. 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
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. W
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As the person authorized to sign the statement, I certify that this firm complies fully with the >_
above requirements,
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( jture)
Cate.
O BE COMPLETEDNOTARY (ire accordance with State notary requirements)
State of
County of
VAD t
The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online m
notarization, this IaI day of (month), (year), by
t/0C b A too (name of officer or agent, title of officer or agent) of
4 t E _ (name of entity).
Personally Known
Produced Identification, Type of Its and Nu "b r orb IC
S' are of Notary
S pJ�'. CHRISTOPHER WITS
` `m t+otarv��rl stace�rror�o Name of Notary (Typed, Stamped orPrinted)
4 Commission#HIS 8998 s
p v o-ti µU Corrarr..Expires r eG t t.20 5
3 aar�e ?4 through Nit onai hetaryAssr, Notary Public, State of
DATF Contt'oci. FKOC 1=Y7_':;Ptic e 1 17 Packet Pg.764
D.23.c
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
---- --- - ---- - - - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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.
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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 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2022.
DA TF Contract:FKOCFY22;Page 118 1 Packet,Pg.765
D.23.c
FINANCIAL REPORT
FY2022 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2022?
a. If no, please explain:
10. Allocation of FY2022 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category (Dollar Amount) (Dollar Amount)
Salaries $0 $0
Fringe $0 $0
FICA $0 $0
Independent Contractor(s) $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0
Insurance $0 $0-
Repair& Maintenance $0 $0
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Travel/Transportation $0 $0
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Rent/Association Dues $0 $0
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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
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
0
11. Compensation Detail: Include all persons who receive compensation from the FY2022 Clerk's Drug
Abuse Trust Fund (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.)
DATF Contract:FKOCFY22;Page 119 Packet,Pg.766
D.23.c
12. Did the FY2022 funding from the Clerk's Drug Abuse Trust Fund 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%
Funding that Required Match Awarded by Federal, Competitive or Required
served as Funding Grantor*** State, Non-Competitive by the
Required Local or Grantor
Match Foundation
***Enter the Amount Awarded by the Grantor regardless of whether DATF 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.
2
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?
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17. What was the organization's total donations/fundraising and in-kind in FY2022?
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a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising:
18. What percentage of your expenses are program service expenses' versus management and ca
general expenses2 in FY2022 as reported on your IRS Form 990?
19. Additional Comments, Questions and/or Suggestions:
c
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.
DA TF Contract:FKOCFY22;Page 120 Packet,Pg.767
D.23.d
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 Guidance/Care Center, Inc., a Florida 501(c)(3) not-for-profit corporation,
hereinafter referred to as "PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of
mental health support for disadvantaged, mentally ill persons, and
WHEREAS, it is a legitimate public purpose to provide mental health support for
disadvantaged, mentally ill persons, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows: 2
FUNDING
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and providing mental health support for disadvantaged, mentally ill
persons living in Monroe County, Florida, as provided for in this Agreement, shall pay to the y
PROVIDER the sum of NINETEEN THOUSAND NINE HUNDRED ELEVEN AND 45/100 DOLLARS
($19,911.45) for fiscal year 2022, as recommended by the Substance Abuse Policy Advisory Board
and funded by the Clerk's Drug Abuse Trust Fund.
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2. TERM. This Agreement shall commence on October 1, 2021, and terminate September N
30, 2022, unless earlier terminated pursuant to other provisions herein.
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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
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 E
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
DATF Contract:G/CC The Heron FY22 Page I 1 Packet Pg.768
D.23.d
or goods provided by the PROVIDER after the PROVIDER has received written notice of termination,
unless otherwise required by law.
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. y
Right to Audit. Availability of Records. The records of the parties to this Agreement relating to 2
the Project, which shall include but not be limited to accounting records (hard copy, as well as
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computer readable data if it can be made available; subcontract files (including proposals of
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
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
DATF Contract:G/CC The Heron FY22 Page 12 Packet Pg.769
D.23.d
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.
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 y
American Institute of Certified Public Accountants (AICPA);
b. The CPA must maintain malpractice insurance covering the audit
services provided and
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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);
(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
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 E
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
DATF Contract:G/CC The Heron FY22 Page 13 Packet Pg.770
D.23.d
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.
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 2
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 y
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.
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14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee of the Board. No statement contained >_
in this agreement shall be construed so as to find the PROVIDER or any of its employees, .�
contractors, servants or agents to be employees of the Board.
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
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. ca
16. 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.
17. NON-DISCRIMINATION. The COUNTY and PROVIDER agree that there will be no E
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
DATF Contract:G/CC The Heron FY22 Page 14 Packet Pg.771
D.23.d
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
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
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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.
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 y
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 T
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.
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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.
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 E
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
DATF Contract:G/CC The Heron FY22 Page 15 Packet Pg.772
D.23.d
coverage, nor shall any contract entered into by the County be required to contain any provision
for waiver.
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' 2
compensation, and other benefits which apply to the activity of officers, agents, or employees of
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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.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any ca
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.
DATF Contract:G/CC The Heron FY22 Page 16 Packet Pg.773
D.23.d
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.
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 2
For PROVIDER
Craig Knierim, Deputy COO
Guidance/Care Center
1205 Fourth Street
Key West, FL 33040
Copies of all default notices, notices of breach, termination, legal claim, or indemnity copied to:
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WestCare Foundation, Inc.
Attn: Executive Vice President
1711 Whitney Mesa Drive .�
Henderson, Nevada 89014
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
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 ,
or a term of this Agreement by or between any of them the issue shall be submitted to mediation
prior to the institution of any other administrative or legal proceeding.
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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.
DATF Contract:G/CC The Heron FY22 Page 1 7 Packet Pg.774
D.23.d
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]
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DATF Contract:G/CC, The Heron FY22 Page 8 Packet Pg.775
D.23.d
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
Guidance/Care Center, Inc. a Florida W
501(c)(3) not-for-profit corporation 2
....... (Federal ID No. 5 -14583 4 )
Witness
i
_.. By 2
Witness Chief Executive Officer
Pursuant to resolution WC-GCC 2021-01 N
CD
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Contract-G/CC, The Heron-FY22;page 9
Packet Pg.776
D.23.d
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 (Application, Q.2) and goals achieved
(, pplication, Q.9), described in the Fv2 22 application submitted to the SAPAB, 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
hment
C (sign-in log from clients server, a detailed work log with services rendered and client(s) servers
W
for that tlrne period as indicated above) 2
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. y
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."
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w.i.,.he notary public is subject to the provisions of Chapter 1.1.7, Florida Statutes, must use a certificate >_
in substantially the foll,,3wing form in notarizing a tangible or an electronic record. --
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) �-
State of
County of
2
The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online
notarization, this _day of (month), (year), by c,
(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
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.
DATF Contract:G/CC The Heron FY22 Page I 10 Packet Pg.777
D.23.d
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
and/or fees for services requests for reirnb rsernent shall include the supporting r ocurne tati n as
detailed above. The Clerk may request further documentation 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.
A log of all postage expenses as they relate to the County contract is required for reimbursement.
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For overnight or express deliveries, the vendor invoice must be included.
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Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not
allowable expenses. >-
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required. ,
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the number
called, and the reason for sending the fax.
Telephone Expenses E
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
DATF Contract:G/CC The Heron FY22 Page 111 Packet Pg.778
D.23.d
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 y
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
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0
DATF Contract:G/CC The Heron FY22 Page 12 Packet Pg.779
D.23.d
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
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101 Company A Rent $ X,XXX.XX 2
102 Company B Utilities XXX.XX
104 Employee A P/R ending 05/14/01 XXX.XX
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
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.
Chief Executive Officer
Attachments (supporting documentation)
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
CJ
CJ
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
DATF Contract:G/CC, The Heron FY22 Page 113 Packet Pg.780
D.23.d
ATTACHMENT C
Specific description and list of services to be provided under this contract (SAPAB Application
Q.2):
The Heron will provide housing and supportive services to 3 men or women who are mentally ill
and have a history of both incarceration and substance abuse or dependence. Residents will
maintain sobriety and will not be re-institutionalized or re-incarcerated while living at The Heron.
This will be accomplished by the supported activities provided by the direct care staff on-site and
through community integration.
These services will be documented in the form of a daily summary noted in the resident record and
will include:
• Specific interventions by staff to support each resident
• Activities that the resident has participated in that support the program goals 2
• Identification of risk factors that may inhibit success in obtaining the goals
• Intensified efforts to address relapse, criminal activity, and psychiatric decompensation
Identify Goals Achieved: (SAPAB Application Q.9/Q11.)
The goals of this program are:
A. Significantly reduce or eliminate re-arrest or re-incarceration of program participants
B. Significantly reduce or eliminate re-institutionalization of program participants
C. Significantly reduce or eliminate substance use by program participants
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For each goal listed, residents will be evaluated to assure that a comprehensive support plan is >_
developed to address their complex needs. Each resident will be oriented to the Heron environment and educated on all the services and options available to them. Each resident will be assigned a
semi-private room with space to keep personal items safe. They will be housed in a safe, nurturing, �-
substance-free environment. Additionally, Direct Care staff provide the following daily assistance
to support residents of The Heron:
• Medication Supervision
• Meal preparation
• Coordination of physical and behavioral health services
• Coordination of access to education and employment
• Linkage to legal services
• Coordination of transportation to all ancillary services
• Coordination of access to social and religious opportunities
• Coordination of access to entitlements
• Assistance with money management
0
Budget Categories Include: (SAPAB Application, Section 4)
Contractual Services
DATF Contract:G/CC The Heron FY22 Page 114 Packet Pg.781
D.23.d
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."
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I have read the above and state that neither (Respondent's name) nor
any Affiliate has been placed on the convicted vendor Fist within the last 36 months.
(signature)
Date: to
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of 0 Or r -
The foregoing instrument was acknowledged before me, by means o,� physical presence or ❑ online
c
notarization, this� 3n day of e. (month) "' (year), by
i' J . , ice` _ (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)
Sinitu e of NotaryV
OY Alt ry F�rtFkic St IB Est Florid,, 1 i° Maryanne L Johnson �` � �
my Commismon GG 175345 Name of Notary (Typed, Stamped or Printed)
' Fit Expires aviSW22
7
Notary Public, State of
DATF Contract:G/CC The Heron FY22 Page 1 1 S Packet Pg.782
D.23.d
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
y,
(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 2
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,
in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount
of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
(Signature)
Date: -
—Loj�
N
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) ,
State of
County of
The foregoing instrument was acknowledged before me, by means qf)� physical presence or ❑ online
notarization, this day of (month), (year), by
(name of officer or agent, title of officer or agent) of ye v
44 ,` i tU (name of entity),
Personally Known
Produced Identification: Type of ID and Number on ID
(SEAL) 1 , w x
Signa re/of Notary '
c r -a Notary Public State of Florida w
Maryanne L Johnson Name of Notary t TYed. t raped or Print d)
My Commission GG 175345
crn�s Expves01I15I2022
Notary Public, State of
DATF Conlracl:G/CC, The Heron FY22 Page 1 /6 Packet Pg.783
D.23.d
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
a f
(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 2
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 y
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
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 at this firm complies fully with the
above requirements.
0
(Signature)
Date: ,
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of,
County of 00le
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The foregoing instrument was acknowledged before me, by means o `physical presence or ❑ online
notarization, this `' day of (month), ` (year), by
YA/1hAA4`%,( r (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
F
(SEAL) � f
Si n t re f Notary
LVNotary€�ubfic State at Florida � )
M ryanne L Johnsn Name of otary (Typed, Stamped or Printed)
_f k4y CcaMmissron r 107 5 8
s res tat It 5t2t122
Notary Public, State of , ) ZA,,
DATF Contract:G/CC, The Heron FY22 Page 117 Packet Pg.784
D.23.d
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
---- --- - ---- - - - -------------------------------------------'---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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:
N
1. Please list services and client information below for the program/activities funded by the Monroe
County award.
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2. What were the measurable outcomes (including numbers) accomplished in FY2022? Please base
these outcomes on the services you identified in Question#1.
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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 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2022.
DATF Contract:G/CC The Heron FY22 Page 118 Packet Pg.785
D.23.d
FINANCIAL REPORT
FY2022 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2022?
a. If no, please explain:
10. Allocation of FY2022 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category (Dollar Amount) (Dollar Amount)
Salaries $0 $0
Fringe $0 $0
FICA $0 $0
Independent Contractor(s) $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0
Insurance $0 $0
Repair& Maintenance $0 $0
Travel/Transportation $0 $0
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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
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
11. Compensation Detail: Include all persons who receive compensation from the FY2022 Clerk's Drug
Abuse Trust Fund (including Independent Contractors) ca
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.)
DATF Contract:G/CC The Heron FY22 Page 119 Packet Pg.786
D.23.d
12. Did the FY2022 funding from the Clerk's Drug Abuse Trust Fund 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%
Funding that Required Match Awarded by Federal, Competitive or Required
served as Funding Grantor*** State, Non-Competitive by the
Required Local or Grantor
Match Foundation
***Enter the Amount Awarded by the Grantor regardless of whether DATF 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.
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?
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16. What was the organization's total in grants and contracts for FY2022?
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17. What was the organization's total donations/fundraising and in-kind in FY2022?
a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising:
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18. What percentage of your expenses are program service expenses' versus management and
general expenses2 in FY2022 as reported on your IRS Form 990? ,
19. Additional Comments, Questions and/or Suggestions:
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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.
DATF Contract:G/CC The Heron FY22 Page 120 Packet Pg.787
D.23.e
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 Literacy Volunteers of America — Monroe County, Inc., hereinafter referred to as
"PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of
literacy training, and
WHEREAS, it is a legitimate public purpose to provide facilities and services related to
literacy training to persons of Monroe County, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows:
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FUNDING 2
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and providing services for literacy training for persons living in Monroe
County, Florida, shall pay to the PROVIDER the sum of FOURTEEN THOUSAND, NINE HUNDRED
FIFTY-FIVE AND 56/100 DOLLARS ($14,955.56) for fiscal year 2022, as recommended by the
Substance Abuse Policy Advisory Board and funded by the Clerk's Drug Abuse Trust Fund. y
2. TERM. This Agreement shall commence on October 1, 2021, and terminate September
30, 2022, unless earlier terminated pursuant to other provisions herein.
CD
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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
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.
DATF Contract:LVA FY22 Page I 1
Packet Pg.788
D.23.e
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.
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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
successful and unsuccessful bidders, bid recaps, bidding instructions, bidders list, etc.); original v,
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
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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
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.
DATF Contract:LVA FY22 Page 12 Packet Pg.789
D.23.e
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; v,
(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);
(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 U_
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.
DATF Contract:LVA FY22 Page 13 Packet Pg.790
D.23.e
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
PROVIDER is an independent contractor and not an employee of the Board. No statement contained v,
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.
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COMPLIANCE ISSUES CD
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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
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 U_
agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
16. 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.
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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
DATF Contract:LVA FY22 Page 14 Packet Pg.791
D.23.e
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.
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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 15 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 v,
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 C
agree that no party to this Agreement shall be required to enter into any arbitration proceedings
related to this Agreement. U_
ASSURANCES U
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.
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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.
DATF Contract:LVA FY22 Page 15 Packet Pg.792
D.23.e
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. 2
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 v,
to the performance of such functions and duties of such officers, agents, volunteers, or employees
outside the territorial limits of the County.
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28. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be
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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.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
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. ca
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.
DATF Contract:LVA FY22 Page 16 Packet Pg.793
D.23.e
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
Mary Casanova, Executive Director
Literacy Volunteers of America - Monroe County, Inc.
2405 North Roosevelt Blvd
Key West, FL 33040
(305) 304-0578
Email: marycasanova77@gmail.com
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
enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will v,
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
or a term of this Agreement by or between any of them the issue shall be submitted to mediation
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 ca
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]
DATF Contract:LVA FY22 Page 1 7 Packet Pg.794
D.23.e
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
Literacy Volunteers of America -
Monroe County, Inc.
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(Federal ID No. )
Witness
By v,
Witness Chief Executive Officer
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DATF Contract:LVA FY22 Page 8 Packet Pg.795
D.23.e
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 docu nentation of number of clients servers (Application,Lion, Q.2) and goals achieved
(, pplication, Q.9), described in the Fv2 22 application submitted to the SAPAB, during the billing
period.
For reirnb rsernent of Payroll and/or fees for services, the Provider shall provide supporting
docur entati n to substantiate that the work performed was for services as set forth in Attachment
hment
C (sign-in log from clients served, a detailed work log with services rendered a rr client(s) served
for that Clans period as indicated above)
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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
County Board of County Commissioners and will not be submitted for reimbursement to any other y
funding source."
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w.i.,.he notary public is sullied to the provisions of Chapter 1.1.7, Florida Statutes, must use a certificate
in substantially the following form in notarizing a tangible or an electronic record.
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
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State of U_
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).
0
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
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.
DATF Contract:LVA FY22 Page 19 Packet Pg.796
D.23.e
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, support for applicable paid payroll taxes. I EPayroll
and/or fees for services requests for reirnb rsernent shall include the supporting r ocurne tati n as
detailed above. The Clerk may request further documentation to verify and substantiate that the
payment request for payroll roll and/or fees for services relates to the services provided as set forth in
Attachment Cyr
Postage, Overnight Deliveries, Courier, etc. v,
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.
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Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not >-
allowable expenses.
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Reproductions, Copies, etc. U_
A log of copy expenses as they relate to the County contract is required for reimbursement. The U_
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the number
called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the
telephone number, the date, and the purpose of the call.
Travel 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
DATF Contract:LVA FY22 Page 110 Packet Pg.797
D.23.e
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. 2
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. v,
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DATF Contract:LVA FY22 Page 11 Packet Pg.798
D.23.e
ATTACHMENT B
ORGANIZATION
LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, FL 33040
Date
The following is a summary of the expenses for (Organization name) for the time period of to _.
Check # Payee Reason Amount
101 Company A Rent $ X,XXX.XX
102 Company B Utilities XXX.XX
104 Employee A P/R ending 05/14/01 XXX.XX 2
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 T
Balance of contract (D-C) $ X,XXX.XX N
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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 organization's contract with the Monroe County Board of County Commissioners cv
and will not be submitted for reimbursement to any other funding source.
Chief Executive Officer
Attachments (supporting documentation)
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
DATF Contract:LVA FY22 Page 112 Packet Pg.799
D.23.e
ATTACHMENT C
Specific description and list of services to be provided under this contract (SAPAB Application Q.2):
ACTIVITIES: (1) Provide individuals and families who need help with reading, writing, and
communicating in English with one-to-one and small group instruction at no charge. (2) Encourage
students to identify a minimum of one and maximum of three short and/or long-term goals that
they wish to achieve. (3) Assist with instruction, encouraging student progress as each student
works toward personal goal achievement through increased literacy skills.
OBJECTIVES: (1) To increase literacy skills for participating adults and families and (2) To offer
services to as many Monroe County residents who need our help as possible.
OUTCOMES: (1) Clients will see skill improvements for themselves via one or more of the following:
(a)standardized test scores, (b) tutor and teacher reporting (c) comparative writing samples (d)
student self-reporting and (2) Clients will achieve goals.
2
TASKS: Students at the lowest literacy levels will be identified, with special attention paid students
in
who experience language difficulties who are identified and sentenced through the court system in
Monroe County. Each student will create a personal goal plan. Students become better engaged
through formalized setting of goals and more aware of their progress as goal achievement is
chronicled. Lessons are held at LVA centers county wide, with the addition of a service delivery site
in Big Pine Key (Monroe County Library). Financial literacy materials will be provided through a y
partnership with Keys Federal Credit Union, our program will continue in the use of authentic
student created materials and language experience approach, where students make the focus of
their lesson a story of personal relevance to their own lives, LVA will continue to assist in the drug
court in Marathon with Spanish to English interpretation. Motivational training utilizing "The Magic
of Thinking Big" (Schwartz, 1958) will be delivered throughout FY 2021-22 through tutor training >'
workshops and individually in tutor and student lessons.
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Locations used to provide services for this project: LVA serves clients in Lower, Middle and Upper U_
Keys. We tutor at 5 branches of the Monroe County library in Key Largo, Islamorada, Marathon,
Big Pine and Key West. We work in Marathon on-site at the drug court helping interpret for students
while teaching English. We also mentor these students upon release. Tutoring takes place at flexible
non-traditional service delivery sites such as parks, libraries, churches, the workplace, LVA study
center in Key West and as scheduled by tutors with their students.
Identify Goals Achieved: (SAPAB Application Q.9)
Goal is to offer our new program to a minimum of 100 and a maximum of 300 students who we
plan to serve in 2021-2022; as well as train a minimum 10 and maximum 20 new and/or existing
tutors to use updated materials and teaching tools.
Budget Categories Include: (SAPAB Application, Section 4) Program Expense, Contractual Services
and Other Expense.
A. Personnel/Independent Contractor Services: (1) Program Instructor/Trainer/Manager (.09 FTE)
will provide county wide leadership for this project, training tutors and instructors, visiting
partner sites, managing all aspects of program and (2) Instructors/Coordinators (.3 FTE)
Identify Lower Keys students for targeted training, provide instruction for Citizenship, Financial
Literacy, Workplace Literacy.
B. Travel: Travel will be accomplished by car primarily along the 124 mile stretch of the Florida
Keys, and/or, as directed by LVA Board of Directors, ($.54 per mile)
C. Eau0ment: Touchscreen laptops, office 360 software, refurbished ipads series with wifi and
cellular, Applecare, power adapters, chargers, cables, thumb drives, laptop, ipad cases.
D. Supplies and Printing: Pens, pencils, printing cartridges, copier paper, copies.
E. Books: "The Magic of Thinking Big" and "I Speak English"
DATF Contract:LVA FY22 Page 113 Packet Pg.800
D.23.e
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. 2
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(Signature)
Date: y
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
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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
DATF Contract:LVA FY22 Page 114 Packet Pg.801
D.23.e
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,
in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount 2
of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
(Signature) y
Date:
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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
U
notarization, this _day of (month), (year), by
(name of officer or agent, title of officer or agent) of E
(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
DATF Contract:LVA FY22 Page 1 1 S Packet Pg.802
D.23.e
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
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 _m
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.
N
As the person authorized to sign the statement, I certify that this firm complies fully with the >_
above requirements.
(Signature)
Date:
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
0
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
DATF Contract:LVA FY22 Page 116 Packet Pg.803
D.23.e
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
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Per Section 8 of your contract, it is required that you fill out the entire form and answer every 2
question.
Narrative on the FY2022 Performance (i.e. successes, challenges, etc.):
Questions: y
1. Please list services and client information below for the program/activities funded by the Monroe
County award.
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1
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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 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2022.
DATF Contract:LVA FY22 Page 117 Packet Pg.804
D.23.e
FINANCIAL REPORT
FY2022 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note:Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2022?
a. If no, please explain:
10. Allocation of FY2022 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category (Dollar Amount) (Dollar Amount)
Salaries $0 $0 _
Fringe $0 $0
FICA $0 $0
Independent Contractor(s) $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0
Insurance $0 $0
Repair& Maintenance $0 $0
Travel/Transportation $0 $0
Rent/Association Dues $0 $0
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0
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Client Service/Describe: $0 $0
Client Service/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: 1 $0 1 $0
0
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11. Compensation Detail: Include all persons who receive compensation from the FY2022 Clerk's Drug
Abuse Trust Fund (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.)
DATF Contract:LVA FY22 Page 118 Packet Pg.805
D.23.e
12. Did the FY2022 funding from the Clerk's Drug Abuse Trust Fund 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%
Funding that Required Match Awarded by Federal, Competitive or Required
served as Funding Grantor*** State, Non-Competitive by the
Required Local or Grantor
Match Foundation
***Enter the Amount Awarded by the Grantor regardless of whether DATF 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.
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?
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17. What was the organization's total donations/fundraising and in-kind in FY2022?
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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?
19. Additional Comments, Questions and/or Suggestions:
c
Email the Annual Performance Report to the Grants Coordinator for Monroe 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.
DATF Contract:LVA FY22 Page 119 Packet Pg.806