Item C02BOARD OF COUNTY COMMISSIONER
S
AGENDA ITEM SUMMARY
Meeting Date: Dec 12 2012
Division: Employee Services
Bulk Item: Yes X No
-- — .� Department: Human Resources
Staff Contact /Phone #: Teresa A 'ar X445
AGENDA ITEM WORDING:8
Approval of Agreement with State •
provide funding t wide Guardian Ad Litem Office to
p g o pay for salary and benefits for a Senior Administrative Assistant position.
ITEM BACKGROUND: For man ear y years, the County has hired and laced a Case C
one other position within the local p Coordinator and
Guardian Ad Litem office. Both were Co
supervised by the local Guardian Ad County employees but
• Litem program. In 2012, the Florida legislature
Bill 1960, now codified in Section 39 g tore passed Senate
.8297 F.S., stating that if counties provide • •
in the GAL program, the p ��g for positions
p y may enter into an interlocal agreement with the •
' ' um, provides that • indemnify GAL program which, at a
p the GAL program will indemni the Co .
employment fy sty for any violation of state and
p oyment laws. The County and the Statewide G
IL , . AL Office have reached agreement on terms A covering this position. of an
PREVIOUS RELEVANT BOCC ACTIO
N: None.
CONTRACT/AGREEMENT CHANGES:
The key terms of the ILA are as follows: The
employed will be hired, supervisemanaged, persons
d mana
g , and terminated by the executive director of the
Statewide GAL office. The Coup is the e •
• ty employer for the purpose of Section 440.1
compensation), Chapter 443 F.S., F. S •(workers'
p S. (unemployment benefits), and em to ent •
insurance, aid leave et p ym benefits (i.e., health
p c.). The Statewide GAL Office will indemnif
y the County for any liability under state and federal employment laws.
STAFF RECOMMENDATIONS: Approval.
Pius benefits
TOTAL COST $43.762.15 INDIREC • T COST. BUDGETED: Yes X
No
DIFFERENTIAL OF LOCAL PREFERENCE:
Plus benefits
COST TO COUNTY: $43.762.15 SOUR
CE OF FUNDS: Ad Valorem
REVENUE PRODUCING: Yes No
-- X AMO T PER MONTH Year
APPROVED BY: `� .
County Atty O IPurc asin
g Risk Management
DOCUMENTATION: Included X •
Not Required
DISPOSITION:
AGENDA ITEM #
Revised 7/09
MONROE COUNTY BOARD OF COUNTY COMMIS
SIONERS
CONTRACT SUMMARY
Contract with: Statewide GAL Office Contra
ct #
Effective Date: Dec 12, 2012
Contract Purpose/Description: Expiration Date: NIA
Approval of Agreement with Statewide Guardian Ad
Lztem Office to provide funding to
pay for salary and benefits for a Senior Administrative A ' ' Assistant position.
Contract Manager: _Teresa Aguiar X4458 Human Resources/#1
(Name) (Ext.) (Department/Stop #)
for BOCC meeting on Dec 12, 2012 Agenda ' wmmn�g da Deadline: Nov 27, 2012
CONTRACT COSTS
Plus benef
Total Dollar Value of Contract: $ 43,762.15 r„�Pn+ vA�,. n,,,.�;,....
Budgeted? Yes No ElAccount Codes:
Grant: $
County Match: $
Estimated Ongoing Costs: $—jyr
(Not included in dollar value above)
Date n
Division Director
Risk Management
V��
O.M.B./Purchasing 111W6-1200000"
County Attorney /01l�3 ��
Comments:
OMB Form Revised 2/27/01 Mrp -A-)
ear onion. $ 2,524.74
00 11-041 00-5 0-1 20-
ADDITIONAL COSTS
For:
eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes Date Out
Needed Reviewer
Yes] No[n
Yes[] Nola
YesO No0
YesO No I 1 /� f in..,
INTERLOCAL AGREEMENT FOR PERSONNEL SERVICES
AND ASSIGNMENTS BY AND BETWEEN MONROE COUNTY9 FLORIDA
AND THE STATEWIDE GUARDIAN AD LITEM OFFICE
THIS AGREEMENT, made and entered into on the date(s) specified � by herein b and
p
between the STATEWIDE GUARDIAN AD LITEM OFFICE(hereinafter called the
"GAL"), and the Board of County Commissioners of Monroe County,Florida(hereinafter
called the "COUNTY), which when referenced together shall hereinafter be called "the
Parties."
WITNE S SETH
WHEREAS, y y Florida children involved in the State's dependent system have long
been aided by Guardian ad Litem (GAL) programs located within the State's Judicial
Circuits; and
WHEREAS, the circuit programs historically were under and reported to the local
court administration offices; and
WHEREAS, in 2003 the Florida Legislature found, in Florida Statute
§ 39.8296(1)(b), that this reporting mechanism created perceived conflicts, and thus created,
in Florida Statutes § 39.8296(2), a Statewide Guardian ad Litem Office, which it
administratively located within the Florida Justice Administrative Commission (FJAC); and
WHEREAS, pursuant to Florida Statutes § 39.8296(2)(b), the Statewide GAL Office
is required to provide oversight responsibility and technical assistance to each of the local,
circuit -based GAL programs; and
WHEREAS, pursuant to Florida Statutes § 43.16(5)(a), the FJAC must provide all
administrative services and assistance to the Statewide GAL Office; and
WHEREAS, Florida Statutes § 29.008(1) requires the Monroe County Board of
County Commissioners (the Board) to provide facilities, communications equipment and
maintenance to the GAL program operating in Monroe County; and
WHEREAS, in the 2012 regular legislative session, the Florida legislature passed SB
1960, now codified in � 3 9.8297, F.S., which in pertinent art states that the Statewide
. p
Guardian Ad Litem Office may enter into an agreement by which the coup agrees to
county �'
provide funding to the local guardian ad litem office in order to y
em to persons who will
p
assist in the operation of the GAL program within the county, and that any such agreement,
at a minimum, must provide that the statewide office shall fully indemnify the County for
any liability for violation for state and federal laws by the Statewide Guardian Ad Litem
Office, its agents or employees as authorized by § 768.28(19), F. S, to the extent such liability
is the result of the acts or omissions of the Statewide Guardian ad Litem Office or its agents
or employees; and
WHEREAS, the Board recognizes the benefit the Monroe Count
y GAL program
provides to the County's children involved in the State's dependency ' . , , p y system and desires to
provide, in its discretion, additional personnel support to the local GAL o
herein; and
pp program as set forth
WHEREAS, the Board further desires the personnel services provided ' p herein shall
not result in it or the County bearing employment liability risk as a result of . tY the fact that the
County will not be able to manage, control, or oversee the perso
nnel nnel funded under this
Agreement, nor the work environment in which such personnel will work
p ,and
WHEREAS, the Board desires to achieve these aims
b enteringinto this
Interlo calAgreement; and
WHEREAS, this Interlocal Agreement is entered into pursuant to § 163.01, Florida
Statutes, and the Parties have the authority pursuant to § 163.01 to enter into said Agreement
concerning the provision of the GAL services under a joint exercise of power hereinafter
described, and, in particular, to spell out the manner of employing necessary personnel
pursuant to § 163.01(5)(g).
Now, THEREFORE, it is declared to be the purpose of this Interlocal Ag
reement
greement
to define the GAL services to be provided to the Monroe County -based GAL
ty program by the
COUNTY, and to set forth the rights and responsibilities of the Parties as p to same, and the
Parties therefore agree as follows:
1. LOCAL OPTION GUARDIAN AD LITEM COURT SUPPORT STA
FF
Based upon the Statewide GAL Office's certification of need the COUNTY ag
rees to
provide funding to pay for salary and benefits sufficient to a for one(1)Guard' 'p Y Guardian ad Litem
Senior Administrative Assistant position to assist with the operation of the Circuit's' . p Guardian
ad Litem program in Monroe County (annual sal $43,762.15 lus benefit. �`Yp s, 40 hours per
week}. The Parties agree that for budgetary, organizational or an other, or no reason, the
COUNTY may choose to discontinue funding the position. Funding is subject . p g � t to an annual
appropriation by the Board of County Commissioners.
2. PROVISIONS GOVERNING COUNTY -FUNDED POSITION
a. Employment Status - The persons employed will be hired, supervised,
managed, and terminated by the executive director of the Statewide GAL office. The
County
is the employer for the purpose of Section 440.10, F.S. com ens
(workers' compensation) and Chapter
443, F.S. (unemployment benefits), only.
b. Position Title, Salary and Pay Grade -- The position title sal and/or
grade p � � or pay
gr level of the individual lured pursuant to this Agreement may be modified b a
y y agreement
of the COUNTY and the Circuit GAL Executive Director due to job '
classif cation
reorganization or for other good cause shown. Any such revision shall be in writing and
signed by the Executive Director of the Statewide GAL Office and the Coup Administrator
rustrator
N
or designee, subject to approval of the Board of County Commissioners. Any increase in
salary or pay grade of the personnel whose positions are funded as described in paragraph
(1), above, beyond current levels, requires the prior written consent of the Board of County
Commissioners.
C. Evaluation and Discipline - Because this position involves solely y GAL -
related duties, the Circuit Director of the 16th Circuit GAL ro
p gram or his or her managerial
designee, shall evaluate and discipline the employee as may be appropriate. Tis position on
shall serve at the sole will and pleasure of the Guardian ad Lite m Program and may be
terminated by the Program for any lawful reason. A person holding position p g the position may not
seek review of any disciplinary or other employment decision of the ' Program or his or her
designee via any policy or rule of the COUNTY.
d. Reimbursement - The loaded sal(salarywith benefit '. �`Y s� for the Senior
Administrative Assistant will continue to be aid in the current manner anner as long as Lacey
Caraballo is in the position, meaning that the sal will be aid base
�'Y p d on a biweekly pay
issued ssued two weeks in arrears via a Monroe Countypaycheck. When p Y n Ms. Caraballo
departs the position, the position will revert to a GAL OP S position an ' . p d be paid for by the
County on a reimbursement basis. Payments shall then be made periodi
cally, cally, but no more
frequently than monthly, as hereinafter set forth.
i. On or before the first month of the Agreement when occupied by a new
employee, the County shall place on deposit an amount equal to one -twelfth (1/12) of
the annual budgeted amount, sufficient to pay for one (1) month's worth of salary and
benefits for the positions described in paragraph (1), above, minus any offsets
necessary for payment of unemployment or workers' compensation benefits to any
current or former employees of the GAL program.
ii. Thereafter, reimbursement requests shall be submitted to the Board via the
Clerk's Finance Office, no later than the tenth (loth) day of the following month,
beginning on the tenth (l Oth) day of the second (2nd) month of the term of this
Agreement, for the previous month, in arrears.
those reimbursable expenses m
The COUNTY shall onlyreibth
iii. that are
reviewed and approved as complying with Monroe Coup Code of Ordinances, . County ances, state
laws and regulations, which are submitted in accordance with Attachment-- A
Expense Reimbursement Requirements. Evidence of payment b the ' . p ym y Statewide
Guardian ad Litem Office or the local guardian ad litem office within
the 16th
Judicial Circuit shall be in the form of a letter, summarizing g expenses, wi
th
supporting documentation attached. The letter should contain a notarized
certification statement. An example of a reimbursement request cover q letter is
included as Attachment B.
iv. After the Clerk of the Board examines and approves the request for
reimbursement, the Board shall reimburse the entity that submitted the request. The
total of said reimbursement expense payments shall not exceed the total amount
3
authorized by Monroe County Board of County Commissioners through the
budgetary process.
3. DURATION AND TERMINATION
This Agreement will automatically renew annually on the first day of each County
fiscal year unless the GAL program informs the COUNTY in writing that it no longer
requires the funded position, or the County Administrator or his or her designee states in
writing that the COUNTY is exercising its right to cease funding the position.
The position funded by this Agreement shall terminate upon ' p n the expiration of, or
substantial breach of, the Agreement, or upon the expiration • .. p p of COUNTY funding, from
whatever source, for the position. Nothingin this Agreement Florida, gr t obligates the State of Flori
or any of its agencies, offices or subdivisions to fund an personnel positions. y p positions.
4. SEVERABILITY AND EFFECT ON PRIOR AGREEM
ENTS
S
This Agreement represents the sole agreement between the �' Parties. Should any
section, sentence or clause of this Agreement be deemed unlaw
ful by a Court of competent
jurisdiction, no other provision hereof shall be affected
and all other provisions of this
Agreement shall continue in full force and effect to the extent • permitted by law. The Parts e s
agree that upon the effective date of this Agreement, this Agreement
gi' gr ent shall supersede all
previously approved/adopted formal or informal agreements or unde
rstandings erstandings between the
Pa
rties on the same subj ect(s).
5. INDEMNIFICATION
The Statewide GAL Office is responsible for compliance p with state and federal
employment laws. The Statewide GAL Office as a State agency orsubdivisi
on as defined by
Section 768.28, Florida Statutes, and b virtue of the authority ' . ' ' ' • y rity granted to it in Section
768.28(19), F.S., agrees to fully indemnifythe COUNTY from liability • any liability as authorized
thereby as a result of any acts or omissions of the Statewide
GAL Office or its agents or
employees, including but not limited to claims arisingunder T' • Title VII of the Civil Rights
Acts of 1964; Title I of the Americans with Disabilities Act 43 U.S.C. § 1983; the Family
Medical Leave Act; the Fair Labor Standards Act' chapters 4 p 40, 443, 447 and 760, Florida
Statutes; Section 112.3187, F.S.; and the Age Discriminatio
g n in Employment Act, as
amended from time to time.
6. MISCELLANEOUS
Both parties agree that their officers and employees are re required q to comply with the
standa
rds of conduct for public officers and employees as delineated in '
1 Sections 112.313 and
12.3143, Florida Statutes, regarding, but not limited to the following •
. wing subjects. Gifts, doing
business with ones own agency, unauthorized compensation,• • . misuse of public position,
conflicting employment or contractual relationships, and disc • . p , disclosure or use of certain
information.
W
The County and the Statewide GAL Office each warrant that with respect
p ct to itself, it
has neither employed nor retained any company person, other than p Y or p 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 or business entity other than a bona fide employee working solely for it, any
fee, commission, percentage, gift, or other consideration on contingent upon p or resulting from
the award or making of this Agreement. For breach or violation of this r ' ' p ovision, the parties
agree that the County shall have the right to terminate this Agreement and offset from ' �' om monies
owed the full amount of such fee, commissions, percentage, or consideration.
7. EFFECTIVE DATE
This Agreement shall be effective upon the filing of a fully executed copy of this
Agreement with the Clerk of the Circuit Court of Monroe County, Florida, pursuant to
§ 163.01(11), Florida Statutes.
IN WITNESS WHEREOF, the parties hereto have caused these resents to be p executed on
the day of , 2012.
APPROVED:
(seal)
Attest:
By.
ATTEST:
CLERK OF CIRCUIT COURT
STATEWIDE GUARDIAN AD LITEM
OFFICE
By:
Printed Name: f Aar r•
Title. � M%CJE
Date:
- )NO& ML-JS
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY
By: By:
Deputy Clerk Mayor
Printed Name: Printed Name:
Title: Title:
Date: Date:
ON E COUNTY ATTORNEY
AP oVD A T F CIA:
NTH IA L. HFALL
ASSISTANT CC7 NTY ATTORNEY
DateLf_:.......�,.:W2 0 L
MONROE COUNTY
JOB DESCRIPTION
Position Title: SR ADMINISTRATIVE ASSISTANT .
Date. 08/17/12
Position Level: 9 FLSA Status: NonexemptI Class ode. •
8 16
GENERAL DES ON
Primary function is to perform specialized office and administrative work within the GAL department.
KEY RESPONSIBn NoO
1. Acts as personal secretary/Mmi 'InI
'strative aide to the Supervisor
2 • Maintains the supervisor's �
Pe sor's calendar, schedules appointments, and makes travel arrangements. Kee
supervisor informed of scheduled appointments.
g Ps
3. Assists in budget preparation and monitoring budget control.
4. General HR duties. Responsible for preparing and Processingall Personnel Action
Hire's, Reviews all documents ct�on Forms, as well as New
• is pertaining to Employee's to ensure compliance with County and State policies
and regulations; ensure time keeping and
p g . payroll is accurately reflected and meets the payroll deadlines.
5. Receives and routes all mncomung mail and faxes for necessary action.
6. Processes purchase orders, invoices and travel vouchers for the department.
7. Types and composes correspondence.
8. Answers telephone and greets public.
9. Maintains office stock supplies.
10. Prepare and/or research agenda items as necessary.
11. Other clerical and administrative duties as assigned.
* Indicates an "essential" job function.
The information on this description has been designed to indicate the general
employees within this c1 g nature and level of work performed
b
yclassification. It is not designed to contain or be interpreted as a comprehensive nsive
invento of all duties, responsibilities andualqualifications uiredof employees assigned to this nob.
A nL4iwei/� A
Position Title: SR ADMINISTRATIVE ASST Mass Cade: 8-1 Position 6 Pasl4on Level: 8
KEY JOB REQUEREAffMS
Education:
H.S. Diploma or GED required,
Experience*
3 to 5 ears.
Impact of Actions:
Makes recommendations or decisions which usual/ affect • •
y the assigned department,
. .
but may at times affect operations, services, individuals, or activities of others' outside
of the assi ed department.
Complexity.
Varied: work is complex and varied and requires the sele
ction ection and- application of
technical and detailed guidelines. Problems are not to identify, but are ' '
fy, similar to
those�Y
seen before. Moderate analytic ability is needed to gather and interpret data
�
where results/answers can be found after analysis of several facts. Solutions can often
be found by using methods chosen before in other situations.
Decision Making:
Analytic: Supervision is present to establish and review broad• objectives relative to
basic position duties or departmental responsibilities. Independent •ud
Pe 1 gment is
required to study previously established., often partially relevant guidelines; 1 gm , pan for
various interrelated activities; and coordinate such activities within a work unit or
while completing a project.
Communication
with Others:
Requires regular contact with internal and external e '
p rsons of importance and
influence
involving considerable tact, discretion and • •
persuasion in obtaining desired
•
actions and/or m relationships at a hig level.
Managerial Skills:
Responsible for orienting and trainin others and assi
g , going and reviewing their work.
May also be responsible for acting in a "lead" or "senior" capacity over other
P rty
positions o
po performing ing essentially the same work, or related technical tasks and
reporting to a higher level on a formal basis.
Working Conditionsl
Work requires only minor physical exertion and/or h '
y physical strain. Work
Physical Effort.-
On Call
environment involves only infrequent exposure to disagreeable elements.
Requirements:
May be required to provide disaster assistance during times of emergency in any
ca aci deemed a ro ate.
Other:
Valid Florida Drivers License
Department Head: APPROVALS
Name:
Division Director:
Name:
County Administrator:
Name:
Signature: Date:
Signature: Date:
Signature: �Date:
Position Tide: SR ADMMSTRATIVE AS S T.1 Class Code:
Position Level, 8
On this date I have received a copy of my job description relating m to
Monroe County.Y employment with
p
Name: Signature:
Date:
ATTACHMENT B
Expense Reimbursement Requirements
This document is intended to provide basic guidelines to Human man 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 Co • County code of ordinances
and State laws and regulations.
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 ' g nt with the records of
this organization. Furthermore, these expenses are in compliance with this
organization's contract with the Monroe county Board of count Commissioners
Y mm�ssioners
and will not be submitte
d for reimbursement to any other fundingsource."
Invoices should be billed to the contractingagency. Third a ' party payments will not
be considered for reimbursement. Remember, the expense • p e should be paid prior to
requesting a reimbursement.
Only current charges will be considered, no previous balances
Reimbursement requests will be monitored in accordance with
the level of detail in
the contract. This document should not be considered all-inclusive.
clusive. The Clerk -Is
Finance Department reserves the right to review reimbursement
requests on an
individual basis, Any questions regarding these guidelines should hould be directed to
305-292-35348
Data Processing, Pc Time, etc.
The vendor invoice is required for reimbursement. Inter -co •
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 ► g information and
payroll taxes, check number and check amount. If a Payroll
y l Journal is not
provided, the following information must be provided: a
P pay period, check amount,
check number, date, payee, support for applicable payroll
PP p y taxes.
1
Postage, overnight Deliveries, courier etc.
A log of all postage expenses as the relate to the •
Y County my contract �s 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, De
posits epasits and advance
payments are not allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the count •
y contract is required for
reimbu
rsement. The log must define the date, number of copies p made, source
document purpose, and recipient. A reasonable fee for co ex '
copy expenses p will be
allowable. For vend
or services, the vendor invoice and a sample of
product are r p the finished
p required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Te l efax, Fax, etc.
A fax log is required. The log must define the sender
,, the intended recipie
nt, the
date, the number called, and the reason for sendin
g 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 reimburs
ement requests must be
submitted and will be paid in accordance with Ma • Monroe county code of Ordinances
and State laws and regulations. credit card statem
ents are not acceptable
documentation far reimbursement. If attending a •
t g conference or meeting a copy of
he agenda is neeed. Airfare reimbursement re •
dquires the original passenger
receipt portion of the airline ticket. A travel 'itineraryis a • -
audit trail. Au appreciated to facilitate the
Auto rental reimbursement requires the vendor invoice
, Fuel purchases
should be documente
d with paid receipts. Taxis are not reimbursed
arrive at a departure �f taken to
• p re point: far example, taking a taxi from one's residence
airport for a business tripis sacs to the
not reimbursable. Parking is considered a reimbursa
ble
travel expense at the destina
tion. Airport parking during a business tripis
not,
A detailed list of charges is required on the lodging '
9 n9 invoice. Balance due must be
Zero. Room must be registered and paid for b traveler. The •
reimburse they county will only
actual room and related bed tax. Roam service
hone call .modes, and
personal telephone s are not allowable expenses,
0�
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 paint of
departure. For example, driving from one's home tat he 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 Cade of
Ordinances. Meal guidelines state that travel must begin '
9 n prior to 6 a.m. for
breakfast
reimbursement, before noon and end after . m. for lunch
nch
reimbursement, and before 6 p.m. and end after 8 .m. for ' p r dinner reimbursement.
Non -allowable Expenses
The following expenses are not allowable for reimburse • reimbursement: capital outlay
expenditures (unless specifically included in the contract co • }■ contributions,,
depreciation expenses (unless specifically included in the •
.. Y e contract}, entertainment
expenses, fundraising non -sufficient check charges, penalties an 9 . P d fines.
ATTACHMENT C
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
(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.
Executive Director
Attachments (supporting documentation)
Sworn to and subscribed before me this . dayof
by boo
wh
o is personally known to me,
Notary Public NotaryStamp
amp
4