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Item M1 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: November 21, 2012 Division: Monroe County Health Department Bulk Item: Yes x No Staff Contact: Robert Eadie 809-5610 AGENDA ITEM WORDING: Approval of the contract between Monroe County Board of County Commissioners and the State of Florida, Department of Health for operation of the Monroe County Health Department—contract year 2012-2013. ITEM BACKGROUND: Review of annual contract and fee schedule for county funding of local health department. PREVIOUS RELEVANT BOCC ACTION: This is the annual renewal of an agreement between Monroe County and Florida Department of Health that has continued for 20+years. CONTRACT/AGREEMENT CHANGES: As allowed by Iaw, Monroe County Health Department has established communicable disease control and primary care services rates at 160% of the Medicare fee schedule, rounded up to the next whole dollar. Monroe County Health Department has established environmental health services fees in line with local recommendations and economic factors. STAFF RECOMMENDATIONS: Approval. TOTAL COST: $939,070.00 INDIRECT COST: BUDGETED: Yes X No COST TO COUNTY: $939,070.00 SOURCE OF FUNDS: REVENUE PRODUCING: Yes No AMOUNT PER MONTH Year APPROVED BY: County Atty OMB/Purchasing Risk Management`s DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM # Revised 1/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: MC Health Department Contract# Effective Date: October 1, 2012 Expiration Date: September 30, 2013 Contract Purpose/Description: Ap royal of the contract between Monroe County Baard of Commissioners and The State of Florida Department of Health- for operation of the Monroe County Health De artment Contract year 2012-2013 Contract Manager: Robert Eadie 809-5610 MC Health Department (Name) (Ext.) (Department/Stop #) for BOCC meeting on 11/21/2012 Agenda Deadline: 11/6/2012 CONTRACT COSTS Total Dollar Value of Contract: $ 939,070 Current Year Portion: $ Budgeted? Yes❑ No ❑ Account Codes: - - - Grant: $ 0 - - - - County Match: ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (eg. maintenance,utilities,janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out Date In Needed Reviewer Division Director Yes[] No❑ Risk Manager ent (,� 7 ,;J--Yes❑ No[l❑� O.M.B./Purlasing�`a+( i� Yes❑ No❑ County Attorney s Yes❑ No[X /Ai r Comments: OMB Form Revised 2/27/01 MCP #2 CONTRACT BETWEEN MONROE COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE MONROE COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2012-2013 This agreement ("Agreement") is made and entered into between the State of Florida, Department of Health ('State") and the Monroe County Board of County Commissioners ("County"), through their undersigned authorities, effective October 1, 2012. RECITALS A. Pursuant to Chapter 154, F.S., the intent of the legislature is to "promote, protect, maintain, and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services." B. County Health Departments were created throughout Florida to satisfy this legislative intent through "promotion of the public's health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." C. Monroe County Health Department ("CHD") is one of the County Health Departments created throughout Florida. It is necessary for the parties hereto to enter into this Agreement in order to assure coordination between the State and the County in the operation of the CHID, NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parities hereto agree as follows; 1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this Agreement shall be effective from October 1, 2012, through September 30, 2013, or until a written agreement replacing this Agreement is entered into between the parties, whichever is later, unless this Agreement is otherwise terminated pursuant to the termination provisions set forth in paragraph 8, below. 3. SERVICES MAINTAINED BY THE CHID. The parties mutually agree that the CHIDshall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to Section 154.01(2), Florida Statutes, as defined below; a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. Environmental health services shall be supported by available federal, state and local r funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" .are those services which protect the health of the general public through the detection, control, and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIWAIDS, immunization, tuberculosis control and maintenance of vital statistics, C. "Primary care services" are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control. These services are provided to benefit Individuals, improve the collective health of the public, and prevent and control the spread of disease. Primary health care services are provided at home, in group settings, or in clinics. These services shall be supported by available federal, state, and local funds and shall include services mandated on a state or federal level. Examples of primary health care services include, but are not limited to: first contact acute care services; chronic disease detection and treatment; maternai and child health services; family planning; nutrition; school health; supplemental food assistance for women, infants, and children; home health; and dental services. 4. �=UNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources are set forth in Part If of Attachment 11 hereof. This funding will be used as shown in Part I of Attachment Il. i. The State's appropriated responsibility (direct contribution excluding any state tees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment 11, Part II is an amount not to exceed $ 4,168,860 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). Tile State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, othercash or local contributions) as provided in Attachment ll, Part I1 is an amount not to exceed $939,070 (amount listed under the "Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category, Unless requested otherwise, any surplus at the end of the term of this Agreement in the County Health Department Trust Fund that is attributed to the CHID shall be carried forward to the next contract period. 2 c, Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. As allowed by law, Monroe County Health Department has established Communicable disease .control and Primary care services rates at 160% of the Medicare Fee Schedule, rounded up to the next whole dollar. Monroe County Health Department has established Environmental Health Services--Fees-in--line--with.-local-recomtrmendations----,___,_......_. and economic factors d. Either party may increase or decrease funding of this Agreement during the term hereof by notifying the other party in writing of the amount and purpose for the change in funding. If the State initiates the increase/decrease, the CHD will revise the Attachment II and send a copy of the revised pages to the County and the Department of Health, Bureau of Budget Management. If the County initiates the increase/decrease, the County shall notify the CHD. The CHD will then revise the Attachment Il and send a copy of the revised pages to the Department of Health, Bureau of Budget Management. e. The name and address of the official payee to who payments shall be made is: County Health Department Trust Fund Monroe County PO Box 6193 1100 Simonton Street Key West, FL 33040 5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of the CHD shall be a State employee or under contract with the State and will be under the day-to-day direction of the Deputy Secretary for Statewide Services. The director/administrator shall be selected by the State with the concurrence of the County. The director/administrator of the CHD shall insure that non-categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan, A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director/administrator to the parties no later than October 1 of each year (This is the standard quality assurance "County Health Profile" report iocated on the Office of Planning, Evaluation &Data Analysis Intranet site). 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of county purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State-contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of county purchasing procedures shall be allowed when it will result in a better price or service and no statewide 3 Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director/administrator must sign a justification therefore, and all county-purchasing procedures must be followed in their entirety, and such compliance shall be documented. Such justification and compliance documentation shall be maintained by the CHD in accordance with the terms of this Agreement, State procedures must be followed for all leases on facilities not enumerated in Attachment 1V. C. The CHD shall' maintain books, records and documents in accordance with those promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph 6J., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: i. The revenue and expenditure requirements in the Florida Accounting System Information Resource (FLAIR). ik The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System/Health Management Component Pamphlet; N. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System/Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Monroe County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the state or county, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by state and county based on the ratio of pEanned expenditures in the core contract and funding from all sources is credited to the program accounts by state and county. The equity share of any surplus/deficit funds accruing to the state and county is determined each month and at contract year-end. Surplus funds may be applied toward 4 the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital projects explained in Attachment V. f. There shall be no transfer of funds between the three levels of services without a contract amendment unless the CHD director/administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy Secretary for Statewide Services has approved the transfer. The Deputy Secretary for Statewide Services shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this Agreement, Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either party, an audit may be conducted by an independent CPA on the financial records of the CHD and the results made available to the parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements contained in OMB Circular A-133 and may be in conjunction with audits performed by county government. If audit exceptions are found, then the directorladministrator of the CHID will prepare a corrective action plan and a copy of that plan and monthly status reports will be furnished to the contract managers for the parties, i, The CHID shall not use or disclose any information concerning a recipient of services except as a#lowed by federal or state law or policy. j. The CHD shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this Agreement for a period of five (5) years after termination of this Agreement. If an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. k, The CHD shall maintain confidentiality of all data, files, and records that are confidential under the law or are otherwise exempted from disclosure as a public record under Florida law. The CHD shall implement procedures to ensure the protection and confidentiality of all such records and shall comply with sections 384,29, 381.004, 392.65 and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality. All confidentiality procedures implemented by the CHD shall be consistent with the Department of Health Information Security Policies, Protocols, and Procedures. The CHD shall further adhere to any amendments to the State's security requirements and shall comply with any applicable professional standards of practice with respect to client confidentiality. 5 I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using county procedures pursuant to paragraph 6.b, hereof. m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The CHIC will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his/her right to a fair hearing to the fina€ governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment l of this Agreement. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment Ill. o. The CHD shall submit quarterly reports to the county that shall include at least the following: i. The DE385L1 Contract Management Variance Report and the DE58OL1 Analysis of Fund Equities Report; ii. A written explanation to the county of service variances reflected in the DE3851,1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Bureau of Budget Management, 6 p. The dates for the submission of quarterly reports to the county shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control; i. March 1, 2013 for the report period October 1, 2012 through December 31, 2012; ii, June 1, 2013 for the report period October 1, 2012 through March 31, 2013; iii, September 1, 2013 for the report: period October 1, 2012 through June 30, 2013; and iv. December 1, 2013 for the report period October 1, 2012 through September 30, 2013. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in Attachment IV to this contract and the county shall own the facilities used by the CHD unless otherwise provided in Attachment IV. b, The county shall assure adequate fire and casualty insurance coverage for County- owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self-insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as county vehicles. The county shall assure insurance coverage for these vehicles is available through either a self-insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust !Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. 8. TERMINATION. a. Termination at Will. This Agreement may be terminated by either party without cause upon no less than one-hundred eighty (180) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. b. Termination Because of Lack of Funds. In the event funds to finance this Agreement become unavailable, either party may terminate this Agreement upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. c. Termination for Breach. This Agreement may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an 7 obligation hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery, Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Agreement. 9, MISCELLANEOUS. The parties further agree: a. Availability of.Funds, If this Agreement, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2013, it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature, in accordance with section 287,0582, Florida Statutes. b. Contract Managers, The name and address of the contract managers for the parties under this Agreement are as follows: For the State: For the County: Mary Vanden Brook _ _ Roman Gastesi Name Name Administrative Services Director County Administrator Title Title PO Box 6193 Gato Building, 1100 Simonton St. Gato Building, 1100 Simonton St. KeWest, FL 33041 . Key!West, FL 33041 Address Address 305-809-5612 305-292-4441 Telephone Telephone If different contract managers are designated after execution of this Agreement, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this Agreement. c, Captions. The captions and headings contained in this Agreement are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. 8 In WITNESS THEREOF, the parties hereto have caused this page agreement to be executed by their undersigned officials as duly authorized effective the 1S day of October, 2012. BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR COUNTY DEPARTMENT OF HEALTH SIGNED BY: SIGNED BY: NAME: NAME: John H. Armstrong, MD TITLE: TITLE: Surgeon General/Secrets of Health DATE: DATE: ATTESTED TO: SIGNED BY: SIGNED BY: NAME: NAME: Robert Eadie, J.D. TITLE: TITLE: CHD Director/Administrator DATE: DATE: M RDAS I COUNTY. OR A PR UV AS Q r1 T CO 1' A, I"O INEY , 9 ATTACHMENT MONROE COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21) and FLAIR requirements because of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must comply with the special reporting requirements for that service. The services and the reporting requirements are fisted below: Service Requirement 1. Sexually Transmitted Disease Requirements as specified in F.A.C, 64D-3, F.S. 381 and Program F.S. 384, 2. Dental Health Monthly reporting on DH Form 1008k. Additional reporting requirements, under development, will be required. The additional reporting requirements will be communicated upon finalization. 3. Special Supplemental Nutrition Service documentation and monthly financial reports as Program for Women, Infants specified in DHM 150-24"and all federal, state and county and Children (including the WIC requirements detailed in program manuals and published Rreastfeeding Peer Counseling procedures. Program) 4, Healthy Start/ Requirements as specified in the 2007 Healthy Start Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. 5. Family Planning Periodic financial and programmatic reports as specified by the program office. 6. Immunization Periodic reports as specified by the department regarding the surveillance/investigation of reportable vaccine preventable diseases, vaccine usage accountability as documented in Florida SHOTS, the assessment of various immunization levels as documented in Florida SHOTS and forms reporting adverse events following immunization. 7. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4�and DHP 50-21* 8, HIV/AIDS Program Requirements as specified in F.S. 384.25 and F.A.C. 64D-3.030 and 64D-3.031. Case reporting should be on Adult HIV/AIDS Confidential Case Report CDC Form DH2139 and Pediatric HfV/AIDS Confidential Case Report CDC Form DH2140. 10 ATTACHMENT I (Continued) Socio-demographic data on persons tested for HIV in CHD clinics should be reported on Lab Request DI-1 Form 1628 or Post-Test Counseling DH Form 1628C. These reports are to be sent to the Headquarters HIVIA€DS office within 5 days of the initial post-test counseling appointment or within 90 days of the missed post-test counseling appointment. 9, School Health Services Requirements as specified in the Florida School Health Administrative Guidelines (May 2012). 10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C. 64D-3 and F.S, 392. 11. General Communicable Disease Contro€ Carry out surveillance for reportable communicable and other acute diseases, detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions, as specified in the CHD Guide to Surveillance and Investigations. *or the subsequent replacement if adopted during the contract period. 4 � � \ � � > / ~ \ (Ti s LD L 2 \� \ « � / y & \ 7\ \ 2 \ / \ \ o o / \ _ \ om m @ e ( E _ / % ƒ ¥ \ \ 0 \ m / / n / z \ L a j \ ( \ 8 z @uloR 2 k / = k n 3 -J \ / q \ o o \ \ / \ $ + t # K / \ k \ ~ ~ g z % ui 0 \ \ k \ ƒ m 0 _ # S / 2 @ 2 f }/2 CD § \ } � C) � / 0 co \ / i \ [ / t % \ / \ ( \ / m 9m / e e L t3 / o so » LL / \ L J / e / E ® / // o \ co \ YiJgrldllg copy A TTACIimNT II MONI2QE COUNTY HEAI,TkI l]il'ARTM1a3�1T Dart II Soarces of Cnnti bt)tLo>I)s to County Health)D6p tn�ent pctofser I,�2�E2 to�epte)nl)e 30,2+13 Sts3cLlil) County iMAI, iIB l rirs#i.i ntl £EED Trost ?tin' Qtt cr (ensfi) ii'tlstFnncl� (cash] (.ontrrbutgn ""• totilt 1. GENERAL RLVENUE -STAT1's 015040 AIDS PR1=Vl"NTJON 73,552 0 7 3,55 2 0 73,552 015040 AIDS SURVI:d,I,AN`Cli 0 0 (I U 0 0),5040 AI..GICI:_SfiPOOL IDFINI1'IPICATION AND I'<I,IMINATION 64,707 0 64,707 0 64,707 015040 ALWCON'IR TO C:IiDS A)Ds PA"1'1L:N'I'C.:ARI: 370.000 {) 370,000 0 370.000 015040 ALG/CONTR TO Cl-IDS-AIDS€'A'I'11."N'I'CARI:NI l'\�IORK 194;100 U 194,400 0 194;400 015640 ALGICONITR TO C:'1IDS-SOVI:{Rl:;lfi,'IN9Ml1Nl'I'1' 0 0 0 0 0 015040 ,MINORITY 0IJ'1')21''-ACI-111':NA1.VER CLINIC-M(AMI-DADL 0 0 0 0 0 015040 PRI:PARI-:DN# SS(;RANT MATCI f 4,69I 0 4,o1 0 4,69) 0)504U SC:a#OOI,1113A1.:NIOFNFRA1.RI':VI':NUI 55,223 0 55,223 0 55,223 0I.i040 S"I'A"I'I:?1;rIDl3 Dt:N'I'IS'I'RY NIT WORK-P:SC'AVIBIA 0 0 0 0 0 015040 S'I'D(IFNl?RAL fU-.V}aNUl-, 16.7>5 U 105j U 16,755 015040 TRL:ASURI':COAS MIDWIFI:,RY-MARTIN 0 0 0 0 0 f)I S040 IFIALTHY START MI-D-WAIVL.R-('fJI:Nl•SI.iRVV:S 0 0 0 U 0 015040 I}SS#I '1'RIC'f CANCER CTR/I IIiAUI I CI IOIC -MIAMW)ADF 0 0 0 0 015040 LA Lu;n-1.L:A(3ur: u;nlNs t'cANCI:R•a-IIAN4)-DADF 0 0 0 0 0 015040 -M1ANATI:1:COUNTY RURAL 1WA131I SI RVI(C1 s 0 0 0 0 0 01.5040 NMF RO 0RI.,AND0 URBAN).l AGIJI:-ORAN(sl 0 0 0 0 0 015040 V)ICiIZAN'I'),A13(.)It CAMP SANITATION 0 U () 0 0 015040 i)I:N'1'ALSPI'.(:IAt.INI'I'lA'1'1VI{S 0 0 0 0 O W 5040 I)JVAI,'I')ii:N PRI:GANCY PREVENTION'-DUVAI" O 0 {3 0 0 015040 I AN411,1'PI_ANNINC GI>NIiRAI.,RI.:Vl-"NIJI: 47373 0 47,373 0 47,373 01,5a•lo rL,CLPPPSCRITNINO&,(.'As1:MANA0FMFNT {) 0 0 0 0 015040 1:1.1WTATITIS&LIVt:I:PA1).u1:1:1');r:vr:N'r1()Nic:()N'r1:oL 72,000 0 72,000 0 72:000 015040 111:AIJf I S1'ART iMI.il)WAIVfiR-S013RA {) O (1 0 0 0150,10 A1,611POIIFAl;LlIYSPAR171PO O 0 0 0 f) 0150.10 M,G/PRIMARY CARE: (99,71{) 0 190,740 0 199.740 015040 3RFAST R(AI'RVICAL-AI)MiIN15l'RA'I'IONJC'ASI N9ANACi1.`.MI;N`'f (} 0 (} 0 0 01504) COMMUNITY SNfII..I:.S-MIIAMI-DADF 0 0 0 0 0 015040 COMMUNITY TR PROGRAM 32,536 [S 32,536 U 32,536 01,io-Q COUNTY SPIiCIYIC DFNTAI,PROJECTS'-HSCAMBIA 0 0 U 0 0 015050 NON-(:AT3.(JORICAI.GI NI:RAI,RL:VI:NUI: 1,078,429 0 1,078429 (} 1,078,429 GEsNERAL RLVEs'NUE?TOTAL 2,209,40b 0 2,209,406 0 2,209,406 2, NUN GEN`RRALRF,VENUE-STATE 015010 AI.G/CONTR.TO Cl IDS-BIC)WDICAI,WASTP 3.3£O 0 3,3,0 0 3,380 O150)0 ALGICONI'It.'I'0 C:}IDS-5AIT DRINKING WA'I'I R PRO 0 0 0 0 0 015010 CI ID PROGRAM StJPPORT {) 0 0 0 0 015010 FOOD AND 4kIA'l'f:Rl3(7ltNI'-'I)ISi ASI PR0(jiZAMI ADMf T /DACS {) 0 0 0 0 015010 PRI:PARL.f)NI.SS GRANT N-IATCH () 0 0 i1 0 01>Ol0 PUBLIC SWIMMING POOL"PR00RAMI 0 0 0 0 0 0)5010 SCHOOL11FA1. 1'fl"#ORACCOTI: 41,000 0 41,000 0 41,000 015010 1OBACCO ADMINISTRATION&MANAGEMENT 0 0 0 0 0 015010 TOBACCO COMMUNITY INTI-:RVI3NTION' 109,255 0 109.255 0 109,255 015020 TRANS,I:R FROM ANU'I'1 iE"lt S'1'A'I'L:ACs33A3C'Y-WIUS 20.064 0 20t664 0 26,664 015020 TRANSFE-R,''ROM ANOTI IC:R STATE AGENCY-INDIR 30.000 i} 30,000 0 30,000 015020 TRANSFER FROM ANIOTI IL:R S')'A"I I AGI':NCI' D 0 0 0 0 0 5060 \ql l-CA'f13GOItiC 11..'I't)13RCC;{)R1:i13A.SING 16,745 0 16,745 0 10,745 15 F MELTXY Woi kut Copy ATTACK ,MONRO COUNTYH AT�TTi.p 'A;RTNI N� i'a t II :Sotlrcc inEyl�ealtheflrttzzeitt Oc#Aber 1 :2(fi2#©';5epten4i3er 3©,20:13 StafeCI�t3 Ca;uaty lotstl(,I1TJ TrusE Rtir�d � Cl�l3=. �'ru4tF�ru<f r Otlier , � st�nnt ontrlbutiop I'tltAl NON GF,NFRA1,REVLNIir,TO TA1, 227.044 0 227,044 0 227,044 3, F LDL<'RAL FUNDS-State 007000 ABST4NI:NC:1:EDUC.:A"110N GRAN I'PROGRAM 0 0 (1 0 c) 007000 AIDS PRIM N,noN, 143,291 0 143,281 0 I=43,28I 00700{) AIDS SURVI:II.I.ANCI: {) 0 0 0 0 007000 131011-ARNRISN4 HOSPITAL PRI-TARI'i3')NFS'S 0 0 0 C) C3 007000 Cl IRONIC I)1SI:A.SI::I'$ ,- :N, 'H0N M-WAl,:il I PR0\M0' ION 32.000 0 32,000 0 32,000 007000 COAS'IAl-I31::A('l 3 MONITORING PROGRAM 29,764 0 29.704 0 29,764 007000 -I(113I:RCUL,0SIS(:ON"['R01_-I-I:I)I:RAL GRAN]' 0 () 0 0 (3 007000 IJNIN'J'l Nf:)I':1.)/IJNIVAN'1'I:I)1'RI'6-11-A-N PREGNANCY PRI;V 37,228 {) 37,228 0 37,229 007000 ll'IC ADMJN1.4'I'RKHON' 291,672 0 2<)1.672 0 29[,672 007000 WIC 13RI AS'1'Ilil}:DIN(j PFF."R COUNS)-'L.INIG 77,f06 0 7TJ06 0 77,106 007000 STD FI'DI-'RA1,0RANT-CSP.S 0 0 O 0 0 0070()0 SID PROGkAM INFLATILYI'Y PKINFINTIONPIlOJI?C:'I'(IPP} {> 0 0 () 0 OWN() SYPHILIS E.,I AMINATION 0 0 0 U 0 007000 'J'f:I:NAU PREGNANCY PRl-All:N'llON RITUC'A'I'ION 0 0 0 0 0 007000 1 I']"L4;?X 1'11V/A10S PROJI:C T 0 0 {} 0 0 0070U0 I"ORACCO FAI"II I BASED PROJI':C"I' 0 0 U 0 0 007000 RAP}-.'PRL:VI•:N'HON&Y I DUCA'I'lON 0 0 U 0 () 007000 RYAN Vd1 VP( 96.450 0 90,450 0 96,450 007000 RYAN MWIT- 0 {} 0 0 007000 RYAN 1','LII'1'I:-AIDS DRUG ASSIST"FROG-ADMIN 3 5,4 43 0 35,443 [} 3 5,4 43 007000 RYAN WlIH -CONSORTIA 355.914 0 355,()[4 0 355i)A 007000 S FI::S[.I'IiY I-I'DUC:A'I'ON 0 0 (} {} 0 007000 NflNORI"I'Y INVOI,VL:1f1:N1'IN I]MAIDS PROGRAM () 0 0 0 (1 007000 PI IP-CI'I'lPS RI:ADJk''l:SS INVIIA LIVE: {) (} 0 0 0 007000 11R):CONCI;P'I'JON I ll_Al:IlI CART: 0 0 (S 0 () 007000 PRI"'GNAN(:Y ASSOC: A'1'1:1)MoRl'Al.11'Y PRINI'XI]ON 0 0 0 0 0 007000 I'1J1.31..IC IIliAI l')I INERAS'1'RUC'RJRII 8,{ti39 (1 9.09 0 8,639 007000 P(I[3LIC Ili:Al.'NI YRI:I'Al7I:DNIiSS BASE", !Sh,fi9<t 0 154,691) 0 154,699 007000 HMMUN')7.ATION WIC LINKAGES 0 0 (} 0 0 607000 MCII)3Ci'IF•(3ADSlX:N SC'I 1001.CLINIC U 0 (S 0 0 007000 MCI t3GI d 1)::Al_'31[Y.S'1"AR'I'C0ALHl0NS () 0 0 0 £) 007000 MCI I QUAITYY IMPROV€:MI1 NI'!'AC'TIVI'I•II:S\4CI113(3 0 0 0 0 0 O07O00 MINORITY AII)S€NIT!A'1'#VI:: 0 0 0 0 0 007000 MINORI'I-Y AIDS INI']'IA'I(VI{'I'C'1{COLLABORMAVI}: 0 0 0 O (1 007000 PGITIFAMILY PL"ANf'INl'i !'I}'L,Ti X 78,097 U 78.097 0 78,097 007000 111-A III II II(M1:S ANI)1..f'.AI)POISOV HNG(RANT' 0 0 0 0 0 007000 1IIV 310US)NG FOR 111"OPL,I:L,IVINIG IVI'I'I I MOS.' 390,590 0 390,590 0 390,5<)0 007000 [41V INt'II)I'":1\`C 1::SLIIV[:II•I.ANL'I {) 0 0 0 () 007000 11`=MUNl%ATION FI-DI:RAL GRAM'AC HVl'I'Y SkiPPORl' 14.646 () 14,646 0 )4.646 007000 liiMMUNIZA'I-Il3N FII:I.I)S'1'nPl' I'i\Pl'iNSli 0 0 0 0 0 097000 COI.URI:iC'IA!.,CALICI=RSCRF'..VNING2009-€0 0 0 0 0 0 007000 1)1{N"fA1,SI.:RV ICES (1 0 (1 0 0 007000 I:N'11ANC1:COMPRl':1[I::NS€VI:PRI::VI:N'IION PLANKING AND IM151_ 0 0 0 0 0 007000 1;XI'ANI)1;17'I');S'1°SNCi!NI'IIA'IAW-I'(I::')'1) U 0 (1 0 0 007000 1=CiT]/All)S 1,9C)R131[717'Y 0 0 0 0 0 007000 CANC'I:R-ADMINWASt:MAN{ 0 (f 0 0 0 1�l ' W�icl��n Co r ATTACHlYII`NtTTi ' M©NI217� GAIJIVT�HEALTH Dt1�A�'i'M�l�x l'ar t 1T Sources of Con#rllztf#t©ris to CaEit�ty Ieftlt)> Dep'ar#nref Oetnl�er 1;2012 tp;Scpternbcr 3©,201;3 ' C.Ii<I) f`'OJ[rl(} 'Iutfrf Crtl) cr�r> nunc nE rer SEatc Ts ust Filutl [rirsE i {cnsN) I'r.asE Iirrnd� (ca�Il) Corrtribufiiin ,: T�)thf 3. FEDERAL FUNDS-State 015009 MIiDIPASSWAIM.R-11),T)IYS'1'12"I'{'1.11'.N'I'tiliR\f1C:'I:iS fY 0 0 0 {) 015009 MI:DIPASS WAiV1,P-S013RA 0 0 () 0 0 007055 AR RA rl:DERAI,UZANIT-SClfll1D.1I_F-C 0 0 0 0 015075 SC11001,11I AL:1'II TIT1.1"XXI 123.839 (1 12.3,ti19 0 121,839 015073 SUMMI.-.R FOOD PROUZAN1 INSITCI'IONS 200 0 200 0 200 015075 RUru uc I lealtli 76,000 0 76.000 0 76,000 FEDMAL FUNDS TOTAL 1,945.568 0 1,945,16S 0 1,945,569 4. FEES ASSESSE D BY STATE OR FEDERAL RULES-STATE 001020 'I ANMNO PAC IL)TN'S 1,395 0 1,395 0 1.395 001020 BODY PWRC'1NO 1,265 0 1,265 0 1,265 001020 MICIRANT 110USINO PE RMIT 0 0 0 0 (I 001020 MOM IA: 21,000 (I 21,000 0 21,000 0(j1U20 FOOD I11'CiII:N1:PERMIT 17,521 0 )7,521 0 I7,52( 0O)020 M011A%ARI)WASTI:PI:IZMIT 6,740 U 6,740 0 6,740 001021) PRIVA'rr WATER CONSTR PI MIT 0 u 0 0 f) 001020 PUBLIC WATER ANNUAI-OPER P1 RM('r 0 0 0 0 0 001020 PUBLIC WATER C'ONSTR P4RMIT 0 £) U 0 0 001020 N()N-SI)WA SYSTEM Pl_RMIT 0 0 u u 0 001020 SArl:DRINKNIC WATFA 0 0 0 0 0 001020 SWIMMING PO()1.S 1),50() it '1 1,500 0 41,500 00i092 OSDS 111,1WIT 1:1.:1. 180.292 O 190,292 0 180,292 001092 1&;M 7.ONF'D 01TRATING('I':IZMI-I' U 0 0 0 tl 001092 A1iROBJC:C)i>):RA'I':'AIO PERMIT t} 0 (1 (I 0 001092 Sl PTIC TANt#i S1 rE l."VALUATION U 0 U 0 0 O01092 NUN SI)WA I,A13 SAMPLi: 0 (Y 0 0 0 (MWQ OSDS VARIANCI:I'-l"I3 0 U 0 0 (1 (10t092 I:N'VIRUNMINITAL IIFALTiI FFI S 0 0 0 0 0 001092 OSDS REPAIR l'i:IZNII'I' 0 0 (1 0 0 001 IM LAB FEI Cril_:MICAL ANALYSIS I? 0 0 0 0 001170 \VATFfZ ANALYSIS-P()TA3!_I 0 0 0 0 f) 001170 NONPOTAM-1-WATER ANAI.1'SIS 0 0 0 0 O 010304 MQA IN1SP1''.CI'ION FIIf: 1,525 0 1,525 0 1,525 00)206 CHNITRAL£)1I ICI SURC14A 01_ 0 0 0 0 [) ITES ASSESSED BY STATI,',OR FEI.)E RAL RULES TOTAL, 271,218 0 27#,238 [) 271,239 5, OTHER CASES CONTRIBOTIONS-STATE 010304 SI'ATJONARI'P(1LL.1J'I'AN'I'S'I'O12A(iL:'i'ANKS 69,000 U 68,000 0 68,000 f)90001 I)RAW DOWN FROM PUBLIC Ill-ALTI I UNIT (} 0 O 0 O OTHER CASH CON'I RIBU`I'IONS TOTAL 68,000 0 68.000 0 68,000 6, \9[;DIC'Aii)-STATE/COUNTY 00I0?6 Mli:DIC:AID 1>1[ARMACY (I 0 (] 0 0 001076 WDIC'AID'1-13 0 0 0 0 0 001078 MI DIC;AID Al.)MNIIS RATIONt OF VACC•IN]_ 0 22944 22,944 0 22.944 00079 MI:DiCAID CASI,MANA(;I:11 ENT 0 0 0 U 0 MIMI \41.'.DICA11.)CI111.D PI€iALTII CI11iCK UP 0 11,809 11,909 U 11,909 I�, g C()py 11II'NT Woi Iettt , CACI TI iVTONRO COUNTY','IT;A 1,,TH WWR"IA 0 Par#II.Sold ces:nl Cantr� tttta) #a Co#my ITeaI#II i e artEa1c31t pc#olaer I;2#I12#o. up cm Dr Stutc(13t) Cotanty: 'IcatuI:GII� st Ii�irsl C't"lI); t�ast`I<trnd Oth:cr {ertstr) #�:iEs3 X uncE (ens3f) f onTrJbiEtion T«tal G. MEDICAID-STATE/COUNTY 001092 Ml::D1C'AJD 1.)i:N't'AI, {) U () U 0 001083 tMIDICAII:)PAM10' PI"ANNIK' (1 26,757 26,757 0 26,757 001087 M)'DICA1 D S'I'D tY 4,405 4.405 U 4105 001089 MEDIC'AIDAIDS 0 91,206 91,208 0 91,206 00J 147 N1I{DICA11)1 IMO('A PH'ATION 0 U 0 0 0 00111)1 M.17DICAID P4A'I'fiRNl'I'Y 0 0 0 0 0 001192 MWICAIDC;O.MPRI:I-II- S1VF(':1III.D 0 0 {y 0 0 001193 NIEDICAI€)COW'RI:111:19SiVl'r11)I.17;1' 0 135,169 135-169 0 135,161) 001194 N DI(:AN)LABORA'I'ORY 0 0 0 0 0 00!208 \9lif)IPnSSS3.OUADM.t'I;I'i 0 5,780 S,790 0 5,780 001059 Ml.")ICAII)LOW INC0441.POO., 0 0 (S 0 0 00 105 1 0 0 0 0 001058 \4) DICA?D-131:11AMItALII FA1.r11 [) 0 0 0 0 Of)1071 N11"'MCAID-OWN OIIFD1C. (3 0 0 0 0 (101072 MI.-DICAID-OFRIvM'01,00)' 0 0 0 0 0 001075 MI'DICAID-S01001.I f1 ALTI I C:i';12T[HN)MA'RA1 0 17,981 17,981 0 17,981 001U(9 hIT:DIC'A11)-R1-11JCi1':I'IIf`AL'H1 0 0 0 0 0 001055 Nfl.'DICAID-IIMPl'I'Ai. 0 0 0 0 0 001 148 N,*'DK.'AED I INTO N0N-C'0J'I'A'1'I0N 0 0 0 0 0 001074 NII'DICAID- SCM.'I'NINO 0 0 0 0 0 MI DICA11)TOTAL, (> 316,051 316,051 0 316,051 7, AI,I.00AI3I,T;R1?VrNE)E?-S"I'A'I'r 018000 RITUNi)5 0 0 0 0 0 037000 PRIOR YI,AR WARRANT {) 0 0 0 0 03810O0 12 MON'I'l I OLD WARIRANT o 0 0 O n ALLOCABIX RLVIsNUL TOTA1. 0 U 0 0 0 8, ()'j'jjLeRSTATE1 CONTRIBUTIONS NOT IN CTID TRUST FUND-STATE PHARMACY S1{IIVIC1iS 0 U p 70,325 70,32.5 LA13ORKFORY S111tVECE:iS 0 0 0 22,934 22,834 1'13 SI'.RVICF:S 0 0 0 0 0 Ih4E1 UNI'/-A'HON SI':RVICI:S 0 0 0 "5,795 585,795 S'1"D s('.RVICI S 0 0 O 0 0 CON'S'1'ROC'1'1ON/RI-,NOVNVION 0 0 0 0 0 WIC FOOD U 0 0 915,670 915,670 ADAP 0 0 0 498,388 498,388 DI"N'I'AI SF)(VICI;S 0 0 U 0 0 0'11ti1i12(Si'IiCIFY) 0 0 1) 0 0 0")'II)-'k(ST'1 CIPY) 0 0 0 0 0 O"I'1lLR STATE CONTRIBUTIONS TOTAL 0 0 0 2,09:3,012 2,091012 9, f)IIZLCT I,O(.At.(:ON'I'ItEBU`I'IONS-BCC/TAX DISTRICT 00900 CON'I'RIBLYI'ION KRONA(TI'Y(30VI:;RN'NWN'I" [) 0 0 0 U 008020 CUN''1"R11311'I'lON PIZC)A IiliAt:l'11 C:ARI 'I'AXI*'O'1"1't1R[1 i3C'C a 0 0 0 0 008040 33CC(MANTICON'I'RAC]' 0 0 0 0 0 008030 CON'LRIBU130N FROM I-H'A1,111 CAJ2I,—I AX [) 0 O 0 0 6) V4'o>!litn Co ATTAC IMI�NT TI � PY IVx)NRO >J ('OU1 TY 1 �LTH Dta'�.R MN7 1'ar t 11 SptlMes o�Corrtlrrbut301IN to Ct)y my Health bel artment O tU: 13. ctober.l,;2Q,12#o Sep �mer3Q,�4„ - Y ` C11T) �snd . 1'Ir Ht4 C,I1II} -� CO tlSf 1 r131(1 ' T1'.rrstl?un� .(mall) Gontrllrirt:on 'I1;tal 9. DIRLC['LOCAL CONTRI1 UTJONS-BCC/TAX DISTRICT 008034 13(C C()N'iR113UH0N'PR(W G1:NI:RA1, -UND 0 09,000 939,000 0 939,000 DIRECT COUNTY CON'I'RIBU'I'ION•I'O'I'AL (J 939,000 939,000 0 939,000 10, f-El.r,ALJ'1`1-1O1ZIZrD 13Y COC)N'I'V OIZI)INAN('E OR IZLSOLtJ"I'ION-C011i\T)I 001060 (:)ID SUPPORT 110S1110N 0 2.600 2,600 0 2,600 001077 RA13I1 ,VACCINI7 0 1 300 1,300 (S 1,300 001077 C'1111.13 CAR SLAT P€ZOG O 0 0 0 0 401077 11FRSONAL HFALTI1 I I:I:S 0 227,301 227,301 0 227;301 00107 AIDS CO-PAPS 0 0 0 0 f1 001094 ADULT Y NTER.ITRNIIT 1 I� S 0 0 1) 0 (1 001094 I.00'A).ORI)1NANC:1:;1 1':1'iS 0 145 999 145,999 0 145,k)99 001€14 NI:IV 131RT)I U-IR)I ICATFS (} 19,000 19MO 0 19,000 ()01 I Is Vl')'n3,STATIS K'S-NEAT)I C:I.'t WJCA'1T: 0 51.000 5I,000 U 51,000 U01 1 17 VITAL STATI -ADM.I-(_'I:5()C'f.:N'1'S (1 700 700 0 700 001073 CO-PAY€OR'1'III:AIDS C'ARI:PROGRAM (1 9,854 9,856 O 9,,856 (101025 C'I.II::N'1'IZI VI::N'IJI:FiZOMGRC f1 U (1 () 0 001040 CIiLL PHONIi ADMINISTRATIVE:Plil {) O 0 O if RF.I:S AUTHORIZED BY C:OUN"I'Y'I'O'T'AL (1 457,756 457,750 0 457356 11. 0'1'lfrR CASH ANI) LOCAL('ON'l'[Z]13EJ'I'IONS-COt,'N'['1' 001009 R1:TI1RNI:ll C'I(I:("K ITI:N1 () 0 {) 0 0 001029 TJ11RI)PARTY RI M1311WMNI:NT (1 2,15.138 245,138 0 245,13,9 001029 I11iAl:l'II N/A INT[iNANCI:ORGAN.(HMO) 0 U 001054 IN]HAC'ARI:PART 1) 0 0 {) 0 0 001077 RYAN\VIII'IT?'IT H-. 11 U 0 0 0 {) 001090 MIMIC'A4iC:PART 13 () 260.250 260,250 0 200,250 ()()I)90 111;ALTH MAlNTI'NANEC '.OR(jANIZATION () () (1 (} 0 005040 JNTI:RF:ST 1'*AIZN1 D 0 0 0 0 0 005041 IN'1'I:fZ1:S'1'I:ARNI:I)-S'1'A'1'I:1NVli4'1't9l:N'I'AC.'COIRNT 0 )2,000 12,000 0 12,000 007010 U.S.GRANTS DIR13C T 0 695.328 695,328 0 695,328 0080�0 SC:I1001.13OARI)C.ONTRIBUI 'IC)N (J t1 0 0 0 008060 SM"C1Al.('}2(3.11?C:'I'C;i)NT'121R1J'llON (1 U 0 0 0 010300 SAL[.(31 GOODSANI)Si:>IzviCl":5'I'Q$'t'A'fl AGI: AB' 0 0 0 U U 0103W 1XPWIT'N[:SSPIa?C;C)N5lJl;iNIC;IInRCII_CS 0 0 0 0 0 010405 SAI.I:OP PI IARMACia1"I1C'ALS O 0 (1 0 0 010409 SAH-'OP G{)O]>S Ol1'I'SI1)I S'1'Al'h('s'C)V1:iRN°tvlliN'I' 0 0 0 U 0 (11 1001 11I AL;1IfY S1-ARTCOALITION CONITRIf3UTIONS 0 3:10,000 330,000 0 330,000 011007 (:ASH DONATIONS PRIVATI: 0 (S 0 {) 0 012020 FINES AND f Ol:i'fil'I'111tI:S 0 0 0 0 0 012021 RI ITJRN C'1113CK CHARU." 0 0 0 O (1 028020 INSURANCE,Rf::CC)VI?RII S-{)'l'I'il it 0 U U 0 0 090002 DRAW DOWN PROM P[MLIC 111:?ALTIi UNIT 0 0 0 0 0 011000 (JRANT DlRIiC:'T-N'0VA 11NI€V13RSITY CIiD TRAINING; 0 (y fl O (} 011000 GRANT-DIIZ1VT 0 10,000 10.000 (J 10,000 011000 Cil:AN1"i'DitiliC."I'-CO111#'I'1'1 IFAUF1I 1?lil'ARTNII1:NT DIRI-'CT SI:RVICI::S 0 0 (1 0 0 0110(}0 DIRPCT-ARROW ll 0 (1 U 0 01IND GRANT-DIRI.C'1' 0 0 0 0 0 1 -) Woil 1cing CoJ y A T I ACT<II lV ONRO COUiVTY HT.AI.TH: �'AxtT 1�[T I'aI t II ;Sotrt ces dot COil 1*1 ut obis to cai.inty ea x Deal ttnent °, Octabrt 1,2012 to SePte►tthet 30,2413 st•fiin�J sYt'a��c� C3tIEcr 5tn ' Co�ititt `lot I ru C IID t'ri� � (ci`s_I�) I'a•tisf 1"(i�d; ;.(s�sh .Caittklhutoh 'C'otal 11. OTHER CASH AND LOC:ALCONTRIBUTIONS-COUNTY {)IIMR) GRANIT-DIRf:CT 0 0 0 U (1 031000 UZANT-JYRI C T 0 0 0 0 f} 011000 C#RANT DIRT C'I'-ARROW (} 0 0 0 0 M)000 GRr1N'] DIRI C'"L-Q(lAN'I'11h1 D#NTM. U 0 q 0 O 01 1000 (;RANT DW]-'C('-l1 AL J'I1 CAM:I)NTR10E'PAHOKI-'I-' 0 0 0 0 0 01 1000 GRANT-DIRf Ul' 0 0 0 0 0 011000 0) ANT-DERIiC'T 0 0 0 0 0 (111000 (iRAN'I'-U#RJ::C"!' 0 0 0 0 U 01)000 GRAN"l-UfUiCT 0 0 0 0 0 00,102 R#?CYC'I.I:I)MATUTAL.SAI-kS 0 0 0 (I 0 010303 FDU:1:PN(j) RPRINTJNG U 0 0 0 0 007030 ARIZAFI?DI:RALCJRANT 0 0 0 0 0 001010 REC'OVFlR)'{)F 13ADC')11'CKS 0 0 {) 0 0 008065 I-CO CONTRIBUTION, 0 Cl 0 0 0 01 1006 Rt:S1'R)CTM)CAS I DONATION 0 0 C) 0 (} 028000 INSl1RANCS Rl'iC<)VI:{RIIiS 0 0 ) 0 0 0010333 C'MS A4ANACit;:{vli 1\7'i=1:1::-PA41'h4PC` 0 0 0 0 0 ())O4UO SALT OP GOODS OU)'SIDL. A'A'IT?GOVI NINIENT 0 122,657 122,657 0 122,057 0105)00 R1=Pf1Uil:iEi 111:{ALTI1 0 0 U 0 U 005045 I\'J'I:{JtES'I'C?Alt\I I)=1'}IIRI)PARTY PROVIDER 0 0 (1 0 0 0050113 !N'i')::i2Ii5'1'C:AItNI;;J)-C:ON"I'RAC"I'/G€2AN'1 0 0 0 0 0 0I0306 DOH)DOC INIT'RAGENC'Y AGRl.:HN41.-NT 0 0 0 0 0 011002 ARRA Ft IA'IRAL(3RANT-SUl3-Rf:01111:J\T 0 0 {) 0 0 01 1004 I.OMY INCOME'POOL-SIJBIUt CIPI1:NT (1 0 f) 0 c) O"TIIERCASH AND LOCAt,CONTRIBUTIONS'TOTAL 0 1,675,373 1,675,373 0 L675.373 12. AL,I,OC,'A13LI: Ct1'sV1iR(JIs-C:OIJJ\'I'Y 0 WOO REFUNDS 0 LJ {I 0 0 037000 PRIOR YEAR WARRANT 0 0 0 0 0 035000 12 MONTI I OLD WARRANIT D 0 {) £) 0 COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0 13. BUILDTNGS-COUNTY ANNUAL RE'NITAL?:QUIVAU`NT VALUE 0 0 0 527,454 527,454 OROONDS MAINITI`NANC', (I 0 0 102.000 102.000 O'1'I IIR(SP1C'II:Y) 0 0 f,1 U () EN5(1RANC I 0 0 (y 0 0 UTILITIES 0 0 {) 65,930 65.930 C)'I'141iI2(SI'LiC:IPYJ O 0 0 0 0 BUILDING MMN'I-# NANC F.' () 0 0 65,123 65,128 13C1I1-.DINGS TOTAL 0 0 0 7fiO.512 760,512 14. OTHER COUNTY CONTRIBUTIONS NOT IN CI-1D"TRUST FUND-COUNTY J:(HAPh4liNTYVI I IICI_li PURC:)IASI:S 0 0 () 0 0 WHIC1.1'INSURANCI 0 0 0 0 0 VIiI IIC'U'MAENTENIANCI_: 0 0 () 0 0 OTHGR COUNIT),CONTRIBUTION��{SYI::C'IFY; 0 0 0 0 0 f � WDIl{IIEI COj3 ATTA TMENT:` X MONStOT COUN I ' T ALTi�bEI'ART31 t Fart I] Sources of Cont`rlbitttom� to U'Wit) CAtf1- CPA: lllvf%f Octoljer 1,2012 to,$eptensbet 30,�0 3 tt: , ('rust r�nd C CIJ1Il, C�tst':Fanld 4} Gcr .; Patel • ,, nsli) Trust Tirrnd•:. (rasJt) E:orjtr3btit�o�i 14, OTHEAl COUNTY CONTRIBUTIONS NOT IN('111)TRUST FUND-COUNTY OTI WR COUNTY(:ON')RIRU f)ON(SPGCBFY) {} p t) {} (I OTHER COUNTY COI\NJ RIBUTIONSTOTAL tl (1 0 0 U GRAND TOTAL CHU PROGRAM 4.72),256 3.389.180 8,109,436 2,8s3,524 10,962 960 1 - r WorIcw�R Co Yit� AT ACHM *� P 9 Mn1NRObC, Um"' 'Y HEADI DCPAItTM N!': I.m►t IIi PIt«En6d,Stslffing:Clients,5ervrics,rla3d LxpendEiErt s>�y l'togrr?m Se vt�e Af cA W�#Il�6 60i LCO Of Service '< OctobcE 1,2©I2 to Septegtl)er'3Q,2Dl3 (}uHrtcrlt I zpen�lilure k'lhn I`!I's .Clients,::FsctN'Ces , 1st 2rl<I.; 3t,tJ Atli (;r rh t 0 lirErts Q U :`Visits ;- (+(VllolctloE)arsunl}) 5tute -; Cnt►ntj, I`�tal A, C:OMMYINICABLV MSII ASE CONTROL: ROL: MMMUNVAT1C)N001) 6.00 5,000 14.500 135,479 107.S9U 135,479 107.890 119,348 367,39f) 486,718 S'I'D(102) 2.00 260 1,66G 32.620 27,255 31,170 27,255 70,508 47,992 118,500 IIIViAII)S PRI`V1:NTION(03AI} 4-S0 25(1 S,000 67.500 57,500 67,500 57.500 250,000 0 250,000 141VIAIDS SURVIi11,I.AN'('li(03A2) 0.17 21 31 3.700 3.300 3,700 3.300 8,330 S,670 14,000 JIMAMS PATIL:NT C1RI:(03A3) 17.00 500 5,600 426,000 863,325 903,325 883,325 1,672,260 1,40,715 3,075;)75 ADAP(03A4) 1.26 8 15 19.980 17,020 19,980 17,020 74,000 0 74,000 TBCONTROI SE€tVICGS(104) 1.40 2125 1,260 37,102 20,60, 27,827 29,605 118,639 5,500 12.1,119 COMM.I)NI?ASI;SIIRV.()06) 1-20 0 1.,560 28.385 24,180 28,385 2.4,180 62:552 42,578 105,110 I II:PATIT)S 1110:VI NTION(109) 1-00 416 2,0.50 25,099 44,470 32,199 44,470 146,838 (1 146,839 PUBUC;III:ALTII PREP AND RISI'(116) 3,43 0 1,000 37.500 36,815 48,936 36.815 f60.066 0 160,066 VITA1.SLATISTIC:S(IS()) 1-25 2,006 5,500 19,515 IS,749 19,515 15,749 (1 70,528 70,528 COMMUNICABLE DISEASESU13T0TAL 39.15 8.696 38,122 833,480 1,227,109 1,318,216 1.247,109 2,682,541 1,943,373 4.625,914 13. PIMMARY CARE: CI IRON[C UKAS1:S1 )tvICI..S(210) ().17 0 U 8,640 7,360 8,641) 7,360 32,000 0 32,000 TOPACCO PR I'-VIIN'TION(212} 1AO O 25 29A99 2S,129 29,499 25.129 109,2j0 0 109,256 11'It;(2I M) 5.53 1.287 16,350 92.075 73,350 80,000 73,350 31 M81 0 319,791 h,IIC RREAS'1l'I"1::DING PC:L R C'OUNSF.L.ING(2)W2) 1,78 (1 600 20,05 )7,866 21,310 17,866 77.677 0 77,677 PAMfl,YPI,Ai9N1NO(223) 5.1.3 1,250 14,500 97,400 96254 128,S89 96,254 334,798 83.699 419,497 IM11I20VI D PRI'GNANCY OUTC'ON (225) 0.00 0 0 U 0 0 0 0 0 0 I IL:Al,'PlY 53TAR'I'P1t1 NATAI.(227) 1.25 S()0 8,600 46,931 51.612 59,345 51,612 83,760 125,640 209,400 C0M$11ZI'I II:NSIV1:CI IILJ)I11.1Ai,:I'l1(229) 0.72 375 2,134 8,900 7,920 8.460 6,820 27.200 4,900 32,000 ))I-'AI,TI IY SLA1 T)N'I�AN"1'(231) 2.18 340 6,000 3 4.14 0 '2 4,288 37.894 24,288 72,360 48,240 120.600 SC'I1001_1-1FAI,T'1 (234) 4,66 0 100,000 52,600 697274 81,321 69,274 220,104 52,365 272,469 COMPItl;I P.:NSIVL:ADULT I MAI-TI1(237) 0.23 €,500 8,700 240,858 342,859 342,859 218.858 M6:359 859,075 1,145,434 coN 14()1,')'i"Y II)3AI:1'1I DI.M-,'I,0P1vII NT(238) 0.23 0 0 0 () 0 0 () 0 0 LN:N'1'A1,f)1 A4.:LI I(240) 0,01) 0 0 (1 0 0 0 0 0 0 PRIMARY CARE SUBTOTAL 3534 5,942 156,909 611,578 715,812 797:9i3 590,811 1,562,295 1,173,819 2,736,114 C. EN\1fRONAJFNTA1.11 RALTI1: Water and Onsite Sewage Programs COMSAT.BEAU MONITORING(347) 0.35 350 350 7,875 6,708 7,875 6,708 29.166 0 29,166 I..IP4ITH)OSf:PUIi1..1C WATH. SYSI'IMS(357) 0.00 0 0 0 0 0 0 (1 U 0 PI)13L IC IVATLR SYS'1'tiM(358) 0.00 0 0 0 0 0 0 0 0 0 PRiVATI-'WAIL?R SYS'1'I:M 059) 0.00 0 (1 0 U 0 0 0 0 0 IND)VIDIIAI.S1 4ilAC1I:I)IS1'.(361) 6.44 J 927 10,579 109,485 93,265 109,495 93,265 2,11,273 164,227 405,500 Gr'ollp ToUll 6.79 4.277 10.929 117.360 T),973 117,360 99.971 Z70,439 164,227 4.14,660 Facility Programs 1:001)111'GlFNI (3,18) 0.52 45 206 4.285 3,125 5,685 3,625 9,948 6,772 16,720 ?30DY P!I?RCIN(3 PACIl.i"1')liS S1:{1tV1C:'ITS 0.05 7 7 0 0 0 (1 0 0 0 CR0t11)CAIt1 FAC11_ITY(Ii1) 0.06 35 55 159 1,047 1,326 1,047 2,308 1,571 3,879 MIC1RANT I,ABOR CAMP(352) 0.00 0 0 a 0 0 0 n 0 0 I10USINUIIUBLIC.'BLDGSAFE;TY.SANI'1ATION(353){).09 0 4 0 100 0 100 I19 81 200 d� Wfllrhing Copyi�>g AT,IrACI M�N'T M N120 °C() NTX I� ALTN 'ARTMRN7' 1?att1ll'Pltnr)eclStatlisg,' bents,Setvrces,;-AndExlieltditttres y 'rograntSc)vrceArertWrtfuriEach +rvelOffervice Octo� ct 3,21112 to Sel7tcxnbcr;3fl, OX3. ` A re 'lan Mir tcrh I i;penrirtu , ,' 7.`I'3 s C'Iitnts 5�)rtces! ,: Ict Zrtd "� 3rd: �41h (;ra'iitl (0,(J 11I1[fc (Wlro)ciotlarsonlvj Stntc (nYtnYy Total VlSrts :'. C. LN'VIRONMENTALflRALTII: Facility Programs N401311.1:110Ml ANI.)PARKS S4:RVi(:l:S(354) 0.59 115 250 6,650 .1,968 2,602 3,968 10,263 (ORi 17,249 S41°)MMINIO POOI.S/13A'1111NG(.360) 1.27 502 1,325 13,800 19,05.1 )8.661 19.053 41,987 28,580 70,567 J340M LDIC.'AI_WAST•I'SI?RVIC HS(364) 0.49 15.1 155 6,960 1.775 1,990 1,775 7,438 5.062 12.500 TANNINCi FACILITY SI:RVI('.)iS(369) 0.01 5 10 0 0 0 0 0 0 0 Group Twit 3.08 922 2,012 32,154 29,068 30.324 29,568 72,063 49,051 121,I14 Groundwater Contamination STORA01 TANK<:ONIPI.IANCE:'(335) ).06 210 400 24,631 20,309 24.631 20,369 9000 0 90.000 SUH`R ACTS IRV ICE(356) 0.01 0 2 174 148 174 148 6,14 0 644 GroupTot:rl 1.07 2t0 402 2,1,805 20,517 24,805 20,5)7 90,644 0 90,644 Cor mUnity Hygiene 'l:AT CO FAC'II,f111 S SI`RVI(TS ().().1 U 20 () () 0 0 0 0 0 COMMUNITY) NVIR.IIIiAI:I'11(345) 0.00 0 3 (y {) {) 0 0 0 0 INJURY PREV1 NTION(.3461 0.00 0 0 0 0 0 0 0 0 0 I.I.:AD NION)TORIN(i SI:,RV1CHS(350) 0.01 1 1 0 0 (] 0 0 0 0 I'(1131-•IC'SENVAGIr'(362) 0,00 ) 1 0 0 O 0 0 0 0 S01,I1)WASTE UIS110SAI,(163) 0.00 0 {) (I 0 0 (s 0 0 0 SANITARY NUISAN(:'I:(365) 0.2.1 90 200 3.093 2,035 3,093 2.635 6,816 4,640 11,456 RAMS :SSURVFIILANC`I'?1C:ON'I'It01.SI'atVIC'I:S(366)0,02 3 15 450 383 450 383 991 675 1.066 ARBOVIRUS SURVI`111ANCF(307) 0.00 0 0 0 0 0 0 0 (1 0 RO71:N')'/ARTIIROPOI)CONTROL 068) 0.02 0 {} 0 0 0 0 0 0 0 NVA"JTR POLLUTION(370) 0.00 O 0 0 (S 0 0 0 0 0 WDOOR AIR(371) 0.00 0 () 458 392 458 392 980 720 1,700 IfA1)10L(.)01CA1.I II:ALTI I(372) 0.02 () 1 208 179 208 178 445 .127 772 TOXICSO STAN FS(371) (1.98 1.400 1,400 1.1.864 HAM 13,$64 11,810 0 $I,348 51,348 Crau4)Tntal 1.31 1,485 I.o4) 19,073 15,398 1&073 15,398 9,232 57,710 66,942 ENIVIRONMI:.N`tAL HEALTH SUBTOTAL 12..25 6,894 14,984 192392 164,956 190.502 165,456 442,378 270,984 70366 U. NON-OPL:RA'TIONAL COSTS: NON-OPNZATTONAI,COSTS(599) 0.20 0 1) 6,542 (I 0 0 6.542 p 6.542 IiNVIRONYII:NTM..IP:ALTIiSURCI1AIZGI (399) 0.00 0 0 6,875 C),875 6,875 6,975 277500 O 27,500 NON-OPERATTONAL COSTS SUBTOTAL, 0.20 0 0 11,417 6,875 6.875 6,R75 34,042 U 34,042 TOTAL,CONTRACT M.94 21,522 210,015 1,670.867 2,1147752 2.313,566 2,010,251 4,721.256 3,398,180 3,i09,416 01 ATTACHMENT Ill MONROE COUNTY HEALTH DEPARTMENT CIVIL. FIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance, The provider agrees to complete the Civil Rights Compliance Questionnaire, DI-i Forms 946 A and B (or the subsequent replacement if adopted during the contract period), if so requested by the department. The applicant assures that it will comply with: 1. Title VI of the Civif Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C, 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. a- ATTACHMENT IV MONROE COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Location Owned B_y Gato Building 1100 Simonton Street Monroe County Administration Key West, 1=L 33040 Nursing Environmental Health Heath Care Center 3134 Northside Drive MW &JC, LLC and Building B Leased to Key West, FL 33040 Monroe County For MCHD use Murray E. Nelson Government Center 102050 Overseas Highway Monroe County Environmental Health Key Largo, FL 33037 Roosevelt Sands Center 105 Olivia Street City of Key West Key West, FL 33040 subject to Inter-local Agreement with Monroe County for MCHD use Ruth Ivins Center 3333 Overseas Highway Monroe County Marathon, FL 33050 Roth Building 50 High Point Road Monroe County Tavernier, FL 33070 ATTACHMENT V MONROE COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN IDENTIFY THE AMOUNT OF CASH THAT IS AN'NC9ATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT. CONTRAG1_YEAR STATE COUNTY TOTAL 2007-2008 $ $ $ 2008-2009 $ $ $ 2009-2010 $ $ $ '.._ 2010.2011 $ $ $ 2011-2012 $ $ $ PROJECT TOTAL $ N/A $ NIA $ NIA SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN PROJECT NAME: LOCATIONI ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING _ RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work in reasonable detail. ESTIMATED PROJECT INFORMATION: START DATE(initial expenditure of funds): COMPLETION DATE: DESIGN FEES: $ CONSTRUCTION COSTS: $ FURNITURE EQUIPMENT $ TOTAL PROJECT COST: $ COST PER SQ FOOT: $ Special Capital Projects are new construction or renovation projects and new furniture orequipment associated with these projects and mobile health vans. FEE RESOLUTIONS A. PURPOSE. To establish public health service,fees in order to expand existing public health services to the community at large. B. PRIMARY CARE SERVICES. (1) Primary care and Ancillary services include well and sick adult and child health services and family planning services. These services will be charged at not more than 160% of the prevailing Medicare rate, Where there is no Medicare fee, the fee will be the Medicaid rate, Service levels will be determined utilizing current Medicare guidelines for coding and billing services provided. Discounting adjustments will be made to client fees based upon the current contract for services with Medicare and other- 3"' party payers. In addition, sliding scale adjustments to fees foi- primary cane services will be based upon Federal OMB guidelines and in accordance with State of Florida Department of Health Policy 56-66-08, Medicaid is billed at the current Medicaid Cost-based rate and reimbursement for these services is considered payment in full. (2) Pharmacy — Medications issued will be provided at the most recent cost. Medicaid is accepted as payment in full. (3) Injection fee for parenteral rnedicatiens per injection $35.00 (4) Lab fees - All laboratory and pathology fees are subject to sliding scale flee adjustment based upon OMB Federal Guidelines. a. Specimens tested in clinic- $10,00 (hemoglobin, urine, blood sugar, rnona, wet mount, sVep) b. Pregnancy test No charge C. COMMUNITY PUBLIC HEALTH SERVICES (1) Tuberculosis X-ray for suspected, confirmed or Symptomatic contact or case No Charge (2) Tuberculosis Skin Test for suspected, confirmed or Symptomatic contact or case No Charge (3) Tuberculosis (TB) Sputum Culture for suspected, confirmed, or symptomatic contact of case No Charge (4) Tuberculin (TB) Skin Test, with reading, any other than $35,00 listed above in C, (1), (5) Tuberculin assessment of clients with a past history of positive skin test $35.00 (6) Sexually Transmitted Diseases — The fee below will be adjusted considering the client sliding fee group which is calculated at eligibility determination, based on Federal OMB Guidelines. Medicaid identification will be accepted as full payment in lieu of charges. A,f017r0e County health Dopariment Core Contract Attachment 1011112012 1 �� Professional Component fees: Office/Outpatient Visit, New $178.00 Office/Outpatient Visit, Established $117.00 (7) Required Vaccines for children up to age 18 and eligible for the Vaccine for Children program No Charge Administration fee charged to third party payer $35.00 (8) Special vaccination campaigns Accept insurance contracted amount, no co-pay or deductible to client. Where manufacturer offers rebate, assistance or replacement plans, un- insured clients are eligible for no cost. (9) Seasonal Flu shots given at public, $20 cash, check advertised clinics, (Does not apply to flu credit card; no shots administered at any of our clinical sites insurance accepted, during a scheduled appointment) Fee scale applies (10) All other lnimunizations Cost of vaccine x 2 + $35 injection fee (11) Class/Seminar attendance registration Per person charge for health care, social work and counseling employees. AIDS 101 No Charge AIDS 500 No Charge AIDS 501 No Charge (12) Expendable medical/wound care supplies such as: Sponge Gauze, Bandages/Dressings, Gloves Cost x 3.5 (13) International Certificates of Vaccination Cost x 3.5 D. VITAL STATISTICS: (1) Birth Certificates: $ 16.00 Additional Copies $ 16.00 (2) Protective Covers $ 4.00 (3) Death Certificates — Certified Copy $ 20.00 Additional Copies $ 20.00 (4) Express Fee $ 10.00 Monroe County 1-kaRh Departinent Come Contract Attachment 1011112012 2 �� E. MEDICAL RECORDS: Copying of Medical Record (per page) 1.00 F. PUBLIC RECORDS: Copying of Public Record (per page) 25 cents G. RETURNEDIDfSHONORED CHECKS: (S. 215.34(2), P.S.) A service fee of$15.00 or 5% of the face amount of the check, draft, or irsoncy order whichever is greater, not to exceed $150.00 H, PUBLIC HEALTH AND MEDICAL PREPAREDNESS New or annual review of Comprehensive Emergency Management Plan for Horne Health Agencies, Hospices, Nurse Registries; Home Medical Equipment Providers $ 75.00 Monroe County Health Department Core Contract Aaachnment 1()/11/2012 3 O� Monroe County Health Deptttnez>t—Fee Schedule, 1�nvironnlental Hcalth Coulity Feo List(In addition to State fees on alternate Fee Schedule DESCRIPTION 0NSY1'D SEWAGE DIPOSAL PROGRAM (OS'FDS) County Fee Application and plan review for construction permit for new systems Application and approval for existing system,if system inspection not required. 10 Application and Exisiting System Evaluation with inspection 50 Application for permitting of an new Performance-based treatment system 75 Site Evaluation 0 Site re-evaluation 40 Permit or permit amendment for new systems 25 Initiat system inspection 50 System reinspection(stabilization,non-compliance,or other inspection after initial 25 inspection, Research fee(State Fee) 0 Repair Permit with Inspection 50 Application for system abandonment permit 45 Tank manufacturer's inspection per annum 20 Amendment 10 an Operating Permit 0 Septage Disposal Service Permit per annum 2X per yr inspection 45 Poflable or temporary toilet service permit per annum 45 Additional charge per pump out vechicle 5 Annual operating permit industria Ili nun ufacturing zoning or commercial sewage Q waste Biennial Operating permit for aerobic treatment unit or performance based 0 treatment system Aerobic treatment unit maintenance entity permit per annum 0 Variance application for a single family residence per each lot or building site 100 Variance application for a multifamily or commercial building site _ 140 Inspection for construction of an Injection well(FL Keys) _ 95 OSTDS Operating Permit Late Fee(45 days past due) 50 Per request-Expediting-Fast Track Permitting New&Exisitng(48 hour turn- 500 around)Charged in addition 10 state fee Letter of Coordination for development review committees 250 Expedited OSTDS Variance Processing.Received within 6 days of monthly 500 deadline.Charged in addition 10 state fee OSTDS PETS screening test fee 25 PUBLIC SWIMMING POOLS Annual permit-up to and including 25,000 gallons 116 Annual permit-more than 26,000 gallons 100 Non routine inspeollon(no charge for first inspection 100 Exempted condom iniumslCooperatives with over 32 units 25 MOBILE 110HE&REM,'WI'IONAL VEHICLE PARES Annual permit for 5 to 25 spaces 125 Annua!permit for 26 to 149spaces$4.00 per space $3.50 per space Annual permlt for 150 and above spaces 400 l FOOD I S"rABLISI-IMENTS Annual Permit for Fraternal/Civic 35 Annual Permit School Cafeteria Operating for 9 months or less 105 Annual Permit School Cafeteria Operating for more than 9 months 125 Annual Permit for Movie Theaters 0 Annual Permit for Jails/Prisons 0 Annual Permit for Bars/Lounges 35 Annual Permit for Residential FaciNites 85 Annual Permit for Limbed Food Service 115 Child care center 40 Caterer 45 Mobfle Food Units 45 Other Food Service 35 Vending machine dispensing potentially hazardous food 0 Plan review per hour public schools,colleges,and vocational teaching facilities 20 are exempt from this fee Food establishment worker training course per person 0 AEcoholic beverage inspection approval 15 Request for inspection 10 Re-inspection(for each reinspection after the first) 0 Temporary event food service establishment (a)spcnser w/o existing 100 sanitation certificate b)vendor or booth at an establishment or location w/o an existing sanitation 50 certificate Late renewals 15 BIOMEDICAL Exempt Facilities 50 Generators 40 Storage Facilities 40 Late Fee 20 TANNING FACILITIES Annual Permit 100 Fee per 17evice 0 Consultation J0 Late Renewal Fee 0 BODY PIERCING ESTABLISHMENTS License Fee 100 Temporary Establishment 15 Late fee 0 Consultation 50 HEALTHY HOMES PROGRAM Healthy home Assessment Voluntary Inspection living unit(radon,CO2, 300 Mold,Safety) Pubfic Education-Per Attendee 25 l o n o 0 o a o 0 n o o c0, p o :O..�a 0 0 0 0 w o 0 '� M s+s M sn r ri rn M M rn U - t` �_ co co in w ra ra ra � m en cf V T P Y 7 V' c 9 (V [J (V (V C4 N N N N N IL N N h N N N ON N CV N uJ O W O W O W W W a ' .a �4 O F7A p U. 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