Item C10 C.10
Coty f � ,�� ,' BOARD OF COUNTY COMMISSIONERS
�� Mayor David Rice,District 4
The Florida Keys � Mayor Pro Tem Craig Cates,District 1
y Michelle Coldiron,District 2
James K.Scholl,District 3
Ij Holly Merrill Raschein,District 5
County Commission Meeting
October 19, 2022
Agenda Item Number: C.10
Agenda Item Summary #11180
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Oksana Christow 3052924474
No
AGENDA ITEM WORDING: Approval of FY23 Clerk's Drug Abuse Trust Fund agreements,
totaling $55,000. Agreements are with Keys to Be the Change ($4,998), Florida Keys Children's
Shelter ($9,323), Guidance/Care Center, Heron ($22,745), Samuel's House ($12,998), and Florida
Keys Outreach Coalition ($4,936), and 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
September 9, 2022, 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(10/20/2021, Agenda Item D.23) BOCC
approved the recommendation of the SAPAB and allocation of$55,000.00 from the Clerk's
Drug Abuse Trust Fund.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Contract- Keys to Be the Change CDATF FY23
Contract- Children's Shelter CDATF FY23
Contract- GCC - Heron CDATF FY23
Contract - Samuel's House CDATF FY23
Contract- FKOC CDATF FY23
FINANCIAL IMPACT:
Packet Pg. 357
C.10
Effective Date: October 1, 2022
Expiration Date: September 30, 2023
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: No
10/19/22 164-04569 DRUG ABUSE TRUST $22,745.00
G/CC - The Heron
10/19/22 164-04569 DRUG ABUSE TRUST $12,998.00
Samuel's House
10/19/22 164-04569 DRUG ABUSE TRUST $9,323.00
Florida Keys Children's Shelter
10/19/22 164-04569 - DRUG ABUSE TRUST $4,998.00
Keys to Be The Change
10/19/22 164-04569 - DRUG ABUSE TRUST $4,936.00
FKOC
Total: $55,000.00
REVIEWED BY:
Christine Limbert Completed 10/04/2022 2:02 PM
Tina Boan Completed 10/04/2022 2:07 PM
Brian Bradley Completed 10/04/2022 2:34 PM
Lindsey Ballard Completed 10/04/2022 2:41 PM
Board of County Commissioners Pending 10/19/2022 9:00 AM
Packet Pg. 358
C.10.a
AGREEMENT
This Agreement is made and entered into this 191" day of October 2022, 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,
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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, U)
Florida, shall pay to the PROVIDER the sum of FOUR THOUSAND NINE HUNDRED NINETY-EIGHT id
AND NO/100 DOLLARS ($4,998.00) for fiscal year 2023, 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, 2022, and terminate September >_
30, 2023, 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 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 Office of Management and Budget. Reimbursement request and U
supporting documentation must be acceptable to the Clerk's Finance Office. 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 Office of 0
Management and Budget 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 t0
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.
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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 M
computer readable data if it can be made available; subcontract files (including proposals of N
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 U
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 0
information and amounts through interviews and written confirmations with employees, U)
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 0
the monies together with interest calculated pursuant to Section 55.03, F.S., running form the date, U
the monies were paid to Contractor. The right to audit provisions survives the termination of
expiration of this Agreement. E
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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.
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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
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American Institute of Certified Public Accountants (AICPA);
b. The CPA must maintain malpractice insurance covering the audit a�
services provided and
c. The County shall be considered an "intended recipient" of said audit. N
(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 U
achieved (see Attachment G);
(k) Cooperation with County monitoring visits that the County may request during the contract
year; and 0
(1) Other reasonable reports and information related to compliance with applicable laws, U)
contract provisions and the scope of services that the County may request during the
contract year.
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RESPONSIBILITIES
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9. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and U
agrees with the Board to substantially and satisfactorily perform and provide the services outlined
in Attachment C to residents of Monroe County, Florida. E
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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.
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C.10.a
11. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement
shall bind and inure to the benefit of the County and PROVIDER and their respective legal
representatives, successors, and assigns.
12. CODE OF ETHICS. County agrees that officers and employees of the County recognize
and will be required to comply with the standards of conduct for public officers and employees as
delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or
acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public
position, conflicting employment or contractual relationship; and disclosure or use of certain
information.
13. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect
to itself, it has neither employed nor retained any company or person, other than a bona fide
employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed
to pay any person, company, corporation, individual, or firm, other than a bona fide employee
working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon
or resulting from the award or making of this Agreement. For the breach or violation of the
provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement
without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full
amount of such fee, commission, percentage, gift, or consideration.
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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, N
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contractors, servants or agents to be employees of the Board.
COMPLIANCE ISSUES M
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.
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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 0
and/or federal certification and/or licensure of the PROVIDER'S program and staff. U)
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. 0
The COUNTY and PROVIDER agree to comply with all Federal and Florida statutes, and all local c)
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 E
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 FY23;Page 14 1 Packet Pg. 362
C.10.a
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 30 days of the dispute
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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. N
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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
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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 0
benefits as recited in this Agreement. U)
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. 0
Unless expressly provided for therein, such approval shall in no manner or event be deemed to c)
impose any obligation upon the Board in addition to the total agreed upon reimbursement amount
for the services of the PROVIDER. E
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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.
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C.10.a
24. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug-
Free Workplace Statement.
2S. AUTHORITY. Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all necessary County
and corporate action, as required by law.
INDEMNITY ISSUES
26. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees
to indemnify and hold harmless Monroe County Board of County Commissioners from any and all
claims and causes of action for medical malpractice, medical negligence, bodily injury (including
death), personal injury, and property damage (including property owned by Monroe County) and
any other losses, damages, and expenses (including attorney's fees) which arise out of, in
connection with, or by reason of services provided by the PROVIDER occasioned by the negligence,
errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers.
27. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, U)
exemptions from laws, ordinances, and rules and pensions and relief, disability, workers'
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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 0
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the U)
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
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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 0
to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER U
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 E
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.
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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.
1208 Watson Street
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
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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.
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35. 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 0
provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, U)
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 0
provision. U
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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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
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Keys to Be the Change, Inc.
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C.10.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.
: irovi c dMlimentadon off'" a%imheir off:: cIlients seirve (All 11 llicado , ) and goaIIs achy cvc
(All 11 llicado , ), descirflbed in the II::)12023 KK Il 11 llicatioin Stull imftte to the SAII3AII:�, dL11111g the Il iillll n
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it a ec imbLli seii ent off' I:3ayiVI and/oi �.ccs �:oir seirvices, the II3irovideir shay III pirovide Stull 1p01—du'1 U)
(Sign...i11 II �:Ir.: nl CIlieints seirve , a detafled woid< IIog Mth seirvices arendeired and cIlient(s) seirve
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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:
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"I certify that the above checks have been submitted to the vendors as noted and that the id
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 Q
funding source."
i he un taury Il)LlblliC iS SUbject to the Il i~o vv si ons off:: Chapter 1 17 Il::]oiIdC statUtes, 1111LIS Use a ceirtd1cate
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
U
The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online
notarization, this _day of (month), (year), by
0
(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) U
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 FY23;Page 19 Packet Pg. 367
C.10.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. �3 yur llll and/oir tl"ccs
�:oir seirvices a eClUests �:oir ureilllbUi seii eint §IIhaHH iu1dUde the SLIppoiting dMlimentadon as detafled
above i he Oeid< may a eClUes tl:Uirblhcur dOCUIMentaUoin to veirH" and SUbstandate that the Il ayiinlent A
u eClUes �:oir Il ayur llll and/oi �'ccs �:oir serrvices urcllates to the seirvices Il a ovide as set �:oiith in
Attachiment C.
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Postage, Overnight Deliveries, Courier, etc. C'
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.
N
Rents, Leases, etc. >_
A copy of the rental or lease agreement is required. Deposits and advance payments are not LL
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 U
sample of the finished product are required.
Supplies, Services, etc. 0
For supplies or services ordered, a vendor invoice is required. U)
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.
0
Telephone Expenses U
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. E
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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 FY23;Page 110 1 Packet Pg. 368
C.10.a
residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable
travel expense at the destination. Airport parking during a business trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must
be registered and paid for by traveler. The County will only reimburse the actual room and related
bed tax. Room service, movies, and personal telephone calls are not allowable expenses.
Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading
must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a
residence or office to a point of departure. For example, driving from one's home to the airport for
a business trip is not a reimbursable expense.
Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS,
AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel
must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch
reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement.
Non-allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless id
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines. N
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DATF Contract:Keys to Be the Change FY23;Page 11 Packet Pg. 369
C.10.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
U)
101 Company A Rent $ X,XXX.XX
102 Company B Utilities XXX.XX �s
104 Employee A P/R ending 05/14/01 XXX.XX
105 Employee B P/R ending 05/28/01 XXX.XX U)
id
(A) Total $ X,XXX.XX
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(B) Total prior payments $ X,XXX.XX N
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(C) Total requested and paid (A + B) $ X,XXX.XX U_
(D) Total contract amount $ X,XXX.XX M
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 t3
and will not be submitted for reimbursement to any other funding source.
Chief Executive Officer U
Attachments (supporting documentation)
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
0
State of
County of
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The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online
0
notarization, this _day of (month), (year), by U
(name of officer or agent, title of officer or agent) of
(name of entity).
c�
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 FY23;Page 112 Packet Pg. 370
C.10.a
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, members of JIATFS, 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. Currently there are 35 students being served. Keys' to be the Change hope is
to double that number 2022-2023 school year.
Parents as well as students are reaching out for our guidance. High-risk youth need structure. 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 truancy while increasing grades is over
75%. 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.
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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
and/or increasing grades every quarter. If straight A's happen, a large pizza is delivered to their 0
home! Keys to Be the Change also awards one senior student $500.00 who showed the most U)
improvement while engaged in the Kids Win Program.
Budget Categories Include: (SAPAB Application, Section 4)
Program Expenses: Student rewards and celebration luncheons are held after the first semester 0
and at end of the school year for successful participants in the program. Monies are also used if a U
mentor leaves before the school year ends. We honor the relationship that has formed and celebrate
with a breakfast or lunch for them. E
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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 158 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 FY23;Page 113 Packet Pg. 371
............................................................ ..........
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 U-
not be awarded or perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR U)
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
U)
36 months from the date of being placed on the convicted vendor li,t."
C�0I have read the above and state that neither A (Respondent's name) nor
any Affiliate has been placed on the convicted vendor list withirliJte last 36 n s.
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Date: CN
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of R�')nc
The foregoing instrument was acknowledged before me, by means of Erphysical presence or 0 online
notarisation, is day of C: OLK (month), (year), by
�l
p l U al fo(l dil�, 411 (name of officer or agent, title of officer or agent) of
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(name of entity). U
Personally Known 0
G q2- 1:3 5 01 tf C, E
Produced Identification: Type of ID and Number on ID F1, 0 ikl-lf-5,
(SEAL)
I k-11A
tNotar Signature r Notary
=ANGELA J HALL 0
NOTARYPUBLIC
McD el n ry (Typed, Stamped or Printed)
ow I = ty
rt C
McDowell County Name 0 Kota
North Carolina Notary Public State of
MY Commission Expires June 22,2027
DATF Contract:Keys to Be the Change FY23;Page 114
Packet Pg. 372
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO° 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
+) &C- Q— U-
(Company) U)
" warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former
County officer oremployee in violation of Section 2of Ordinance No. O1O-1Q9Oor 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 ur purchase price, or otherwise a the full amount �
of any fee, commission, percentage, gift, or id04 or
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employee."
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TO BE COMPLETED BY NOTARY (in accordance with State notary U
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--- - w
County of 0
The foregoing instrument was acknowledged before me, by means of Vphyslcal presenceorO online
notarization, this day of month), (year), by '
agent, title of officer oragent) of
(name of enti_--''. U
,Wrsonally Known
Produced Type <-�
' '`~'''~�' ~'' ^� / U
OE
(SEAL) North Carolina
My C�m �
NOTARY PUBLIC
McDowell County N6Vq of Notary (Typeid, Stamped or Printed)
Notary Public, State of Lj
L---------J
ATTACHMENT IF
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 207.O87 hereby certifies that:
(Name ofBusiness)
1. Publish a statement notifying employees that the unlawful manufacture, distribution, �
dispensing, possession, or use of 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 +-
nnaintaining a drug-free workplace, any available drug counseling, rehabilitation, and
employee assistance programs, and the penalties that may be imposed upon employees for J�
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 JA
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 U
plea of guilty or nu|o contendena 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.
6. Impose a sanction on #r require the satisfactory participation /n a drug abuse assistance or
rehabilitation program if such is available in the employee's community, or any employee
who is so convicted. >_
u_
G. Make a good faith effort to continue to maintain a drug-free workplace through
implementation of this section.
As the person authorized tn sign the `=
above requirements.
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Date:
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TO BE COMPLETED BY NOTARY (in accordance with Sbate notary requirements) 0
State of
�
County of '
/'
The foregoing instrument was acknowledged before me, by means nfVphys|ca| presence or O online
notarization, this____�, day of— 0(fPi bT )r (month), (year), by U
(name of officer or agent, title of officer or agent) of
Personally Known
Produced Identification: Type of ID and Number on ID
(SEAL)
Si ur Notary
NOTARY PUBLIC Naine 0 tary (Typed, Stamped or Pri ed)
McDowell County AM
,1
| North Carolina Notary Public, State of
lW?F(onmact:Keys mBu the Change FY2j Page|}6
C.10.a
ATTACHMENT G
FY2023 Annual Performance Report
For year October 1, 2022—September 30, 2023
(Report Deadline: October 31, 2023)
AgencyName -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 FY2023 Performance (i.e. successes, challenges, etc.): JA
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Questions: Q
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1. Please list services and client information below for the program/activities funded by the Monroe
County award. M
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2. What were the measurable outcomes (including numbers) accomplished in FY2023? 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 FY2023; and/or 200%; and/or another standard used by your organization?
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4. What area of Monroe County did you serve in FY2023?
5. During FY2023, 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 FY2023 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2023.
DATF Contract:Keys to Be the Change FY23;Page 117 1 Packet Pg. 375
C.10.a
FINANCIAL REPORT
FY2023 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2023?
a. If no, please explain:
10. Allocation of FY2023 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category DollarAmount Dollar Amount
LL
Salaries $0 $0
Fringe $0 $0
FICA $0 $0
Independent Contractors $0 $0
Office Supplies, Telephone, Postage $0 $0
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Utilities $0 $0 -119
Insurance $0 $0 U
Repair& Maintenance $0 $0 Q
Travel/Transportation $0 $0 U,
Rent/Association Dues $0 $0 N
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 U
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: 1 $0 $0
11. Compensation Detail: Include all persons who receive compensation from the FY2023 Clerk's Drug
Abuse Trust Fund (including Independent Contractors)
Employee Name Type of Work Hrs. Worked Total Charges U
(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 FY23;Page 118 Packet Pg. 376
C.10.a
12. Did the FY2023 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 FY2023 IRS Form 990. If
your FY2023 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 FY2023?
15. What was your organization's total revenue in FY2023?
16. What was the organization's total in grants and contracts for FY2023?
17. What was the organization's total donations/fundraising and in-kind in FY2023?
a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising: as
18. What percentage of your expenses are program service expenses' versus management and as
general expenses2 in FY2023 as reported on your IRS Form 990?
as
19. Additional Comments, Questions and/or Suggestions:
as
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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 FY23;Page 119 Packet Pg. 377
C.10.b
AGREEMENT
This Agreement is made and entered into this 191" day of October 2022, 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,
U)
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 a program for the prevention of risky behaviors and U)
help build a positive future for children and adolescents in Monroe County, Florida, shall pay to the
PROVIDER the sum of NINE THOUSAND, THREE HUNDRED TWENTY-THREE AND NO/100
DOLLARS ($9,323.00) for fiscal year 2023, as recommended by the Substance Abuse Policy
Advisory Board and funded by the Clerk's Drug Abuse Trust Fund. N
N
2. TERM. This Agreement shall commence on October 1, 2022, and terminate September
30, 2023, unless earlier terminated pursuant to other provisions herein. CN
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 U
submitted to the Board via the Office of Management and Budget. Reimbursement request and
supporting documentation must be acceptable to the Clerk's Finance Office. 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 JA
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 Office of
Management and Budget 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 t0
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. c�
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 FY23 Page I 1 Packet Pg. 378
C.10.b
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 N
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, c3
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 0
to conduct an audit of Records, assets, and activities relating to this Project. If any auditor U
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 E
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 FY23 Page 12 Packet Pg. 379
C.10.b
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); a�
b. The CPA must maintain malpractice insurance covering the audit M
services provided and N
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. 0
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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 FY23 Page 13 Packet Pg. 380
C.10.b
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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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 se
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.
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. 0
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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 E
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 FY23 Page 14 Packet Pg. 381
C.10.b
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 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 N
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. M
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. U)
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. 0
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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 E
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 FY23 Page 15 Packet Pg. 382
C.10.b
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 N
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.
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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 c,
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 0
constitution, state statute, and case law. U
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:Florida Keys Children's Shelter FY23 Page 16 Packet Pg. 383
C.10.b
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
Ben Kemmer, Co-CEO
Florida Keys Children's Shelter, Inc.
73 High Point Road
Tavernier, FL 33070
(305) 852-4246
Email: bkemmerOfkcs.orq
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33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This CN
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. U)
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. c,
3S. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or 0
the application thereof to any circumstance or person) shall be declared invalid or unenforceable to U
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, E
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 FY23 Page 17 Packet Pg. 384
C.10.b
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 FY23 Page 8 Packet Pg. 385
C.10.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
BY- .._._................. BY. ........
As Deputy Clerk Mayor/Chairman
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Florida Keys Children's Shelter, Inc.
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(Federal ID No.5'... Wit
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Witness ve Officer cam,
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DATF Contract:Florida Keys Children's ShelterFY23 Page 9
Packet Pg. 386
C.10.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.
:3irovide dMlimentation off'" uIL11111 beir off:: cIlients sewed (All 11 llicado , ) and goaIIs achy cvc
(All 11 llicado , Q ), des iribed in the II::)12023 KK Il 11 llication Stull imftte to the SAIIWI:�, dL11111g the Il iilllliin
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ir ureilllbLli seem ent off' I:3ayiVI and/ i �.ccs �: ir sei vv ces, the II3i ovidcir shay III pirovide Stull 11 a-dill
(Sign i111 II �:Ir.:nl CIlients sei ved, a detafled woid< IIog Mth sei vv ces urendei ed and cIlient(s) sei ved
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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 M
funding source." Q
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i he not airy Il)LlblliC iS SUbject to the Il i oviss ons off:: Chapteir 1 17, II::] iIdC statUtes, 1111LIS Use a ceit01cate
�111 SLIbstantial ly the �'VI oMn �: inm iin unotai oz ng a tang 11 llc oir an electiroinic ecoird
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
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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 0
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(SEAL)
Signature of Notary E
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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 FY23 Page 110 Packet Pg. 387
C.10.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, cc ecc number,bp i
ate, payee, support or applicable e paid payroll taxes. II a ro n c e
fled
above i he Oeid< may u eClUes tl:Ui bheir dOCUIMentadon to vci-Hy" and SUbstandate that the Il ayiinlent
u eClUest �° ur Il ayi oHH and/ i Fees �° ur seirvices urelates to the seirvices Il i ovide as set � i bh iin
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Attadhiment C.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for reimbursement. N
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 >_
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allowable expenses. LL
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. U)
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
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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. 0
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Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the E
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 FY23 Page 111 Packet Pg. 388
C.10.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.
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, U
penalties and fines.
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DATF Contract:Florida Keys Children's Shelter FY23 Page 12 Packet Pg. 389
C.10.b
ATTACHMENT B
ORGANIZATION
LETTERH EAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, FL 33040
Date
The following is a summary of the expenses for (Organization name) for the time period of to
Check # Payee Reason Amount U)
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
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(B) Total prior payments $ X,XXX.XX
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(C) Total requested and paid (A + B) $ X,XXX.XX N
(D) Total contract amount $ X,XXX.XX N
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 N
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.
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Chief Executive Officer
Attachments (supporting documentation)
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
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County of
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The foregoing instrument was acknowledged before me, by means of❑ physical presence or ❑ online
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notarization, this day of (month), (year), by U
(name of officer or agent, title of officer or agent) of
(name of entity).
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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 FY23 Page 113 Packet Pg. 390
C.10.b
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
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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:
• Develop positive norms
• Build idealism and pro-social values
• Develop resistance skills M
• Develop decision-making skills Q
• 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 U)
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.
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Identify Goals Achieved: (SAPAB Application Q.9)
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The program focuses on five topics important to preventing high-risk behaviors: U
(1) Developing positive ideals that do not fit with high-risk behavior;
(2) Creating a belief in conventional norms; E
(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 FY23 Page 114 Packet Pg. 391
C.10.b
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 neithe mm "r t .Iyl ..r �I .. - (Respondent's name) nor
any Affiliate has been placed on the convicted Veinclor list within the last 36 months.
"(Signature—,"'
Date:
.,.
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TO BE COMPLETED BY NOTARY(in accordance with State notary requirements) n
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State of e"—, ....
County of A,Aj21" & ° ....................
The foregoing instrument was acknowledged before me, by means of 0'"physical presence or❑ online
notarization,this C day oft , - (month), . ° r mm-..(year) by
0
w m
name of officer or agent, title of officer or agent) of U
��,�V-_eilcl� ..
..._.�� � � �� .� �� e of entity).
_ITmmmITITmmm_ITIT °,;m,m„m_Personally Known
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Produced Identification: Type of ID and Number on ID
(SEAL) �..�
Signat-re`of y ,"
KATYA
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a. .oar
' dsi�°.•r
EXPIRES:,Iu�re26,2026 Name of No
ta (Typ d, Stamped or Printed)
Notary Public, State of � ...."
DATF Contract:Florida Keys Children's Shelter FY23 Page 15
Packet Pg. 392
C.10.b
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
of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
Date:
N
LL
LL
TED BY NOTARY(in accordance with State notary requirements)
�O BEoCOMPLE NT� � � A
_.
County of
The foregoing instrument was acknowledged before me, by means of physical presence or ❑ online L?
notarization this da of
-. �
�'�� y ��.�. "���"�1"i ..�a �" (month) � )' �..�! .(yea cs
m r) by
(name of officer or agent,'title IT 0
7 rof officer or agent) of
m ' 'ZjQ g g O " name of entity).
Personally Known
Produced Identification: Type of ID and Number on ID
(SEAL)
............ . .............
Er
KA'tVA" Signature of Notary
EXPIRES.June 26,2= Namew mte ...T ed Stamm m
ry (gip Stamped or Printed)
p,Notary Public, State of &,� �� ��,_m
DATF Contract:Florida Keys Children's Shelter FY23 Page 116
Packet Pg. 393
C.10.b
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
�Q T , '
(N of Busin..r��ess)ame
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 M
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 N
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 c i this firm complies fully with the
above requirements. i
w �
Si natu )
Date: W JA
TO BE COMPLETED BY NOTARY(in accordance with State notary requirements)
State of UD oz:1 U
County of "ry "
The foregoing instrument was acknowledged before me b means of
0
1
y physical presence or❑ online
notarization,this, day of "°°,r + (month) mw^ - (year), by
war in .,.,. (name of officer or agent, title of officer or agent) of
�m m
- 'Ofname of entity).
Personally Known
Produced Identification: Type of ID and Number on ID,
,, ..
(SEAL) � ...........
Signatyre o Notary
KAtYA ANDRADE �� 1 �
MY Name of N to (typed,,. comm m ry( Yp_ ,. Stamped or Printed)
HM234�
E*MAM20.20N
Notary Public, State ofM
DATF Contract:Florida Keys Children's Shelter FY23 Pagel 17
Packet Pg. 394
C.10.b
ATTACHMENT G
FY2023 Annual Performance Report
For year October 1, 2022—September 30, 2023
(Report Deadline: October 31, 2023)
AgencyName -I--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Point of Contact (POC)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Phone/Email
-------------------------------------------------------------------------------------------i----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------i
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 FY2023 Performance (i.e. successes, challenges, etc.):
U
Questions:
N
1. Please list services and client information below for the program/activities funded by the Monroe >-
County award.
11,13
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2. What were the measurable outcomes (including numbers) accomplished in FY2023? 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 0
in FY2023; and/or 200%; and/or another standard used by your organization? U
4. What area of Monroe County did you serve in FY2023?
5. During FY2023, 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 FY2023 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2023.
DATF Contract:Florida Keys Children's Shelter FY23 Page 118 Packet Pg. 395
C.10.b
FINANCIAL REPORT
FY2023 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2023?
a. If no, please explain:
10. Allocation of FY2023 Award; Clerk's Drug Abuse Trust Fund Award Amount= $
Program Expense Administrative Expense
Budget Category Dollar Amount Dollar Amount
Salaries $0 $0
M
Fringe $0 $0
FICA $0 $0-
Independent Contractors $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0
Insurance $0 $0
U
Repair& Maintenance $0 $0 M
Travel/Transportation $0 $0 N
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 JA
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0 U
11. Compensation Detail: Include all persons who receive compensation from the FY2023 Clerk's Drug
Abuse Trust Fund (including Independent Contractors)
U
Employee Name Type of Work Hrs.Worked Total Charges
FName,Last Initial Title Performed in Program on Pro ram 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 FY23 Page 119 Packet Pg. 396
C.10.b
12. Did the FY2023 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 FY2023 IRS Form 990. If
your FY2023 IRS Form 990 is not yet prepared, please provide an estimate for the following
questions.
13. What is your organization's fiscal year?
CID
14. What were your organization's total expenses in FY2023?
as
15. What was your organization's total revenue in FY2023?
CD
16. What was the organization's total in grants and contracts for FY2023?
17. What was the organization's total donations/fundraising and in-kind in FY2023?
a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising:
L_
as
as
18. What percentage of your expenses are program service expenses' versus management and
general expenses2 in FY2023 as reported on your IRS Form 990?
as
19. Additional Comments, Questions and/or Suggestions:
e
�b
0
dS
E
�b
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 FY23 Page 120 Packet Pg. 397
C.10.c
AGREEMENT
This Agreement is made and entered into this 191" day of October 2022, 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:
FUNDING U)
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
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PROVIDER the sum of TWENTY-TWO THOUSAND SEVEN HUNDRED FORTY-FIVE AND NO/100
DOLLARS ($22,745.00) for fiscal year 2023, as recommended by the Substance Abuse Policy
Advisory Board and funded by the Clerk's Drug Abuse Trust Fund.
N
2. TERM. This Agreement shall commence on October 1, 2022, and terminate September N
30, 2023, unless earlier terminated pursuant to other provisions herein.
M
CN
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 Office of Management and Budget. Reimbursement request and
supporting documentation must be acceptable to the Clerk's Finance Office. Acceptability to the a
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 cs
Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense U
Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a
letter, summarizing the expenses, with supporting documentation attached. (The Office of
Management and Budget may accept Reimbursement Requests electronically, but only
when submitted and formatted in a PDF file with cover letter and attachments together 0
in one (1) file.) The PROVIDER agrees to submit hard copies of Reimbursement Request and U
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 E
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: G/CC The Heron FY23 Page I 1 Packet Pg. 398
C.10.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.
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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 M
computer readable data if it can be made available; subcontract files (including proposals of N
successful and unsuccessful bidders, bid recaps, bidding instructions, bidders list, etc.); original N
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 a
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, U
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) 0
years after Final Completion of the Project. The County Clerk possesses the independent authority U
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 E
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 FY23 Page 12 Packet Pg. 399
C.10.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
JA
American Institute of Certified Public Accountants (AICPA);
b. The CPA must maintain malpractice insurance covering the audit a�
services provided and
c. The County shall be considered an "intended recipient" of said audit. N
(f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; N
(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 a
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); U
(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 0
contract year. U
RESPONSIBILITIES
c�
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 FY23 Page 13 Packet Pg.400
C.10.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
JA
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.
c,
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14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the N
PROVIDER is an independent contractor and not an employee of the Board. No statement contained N
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. M
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 cs
written notice of termination to the PROVIDER. U
16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure c,
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 0
and/or federal certification and/or licensure of the PROVIDER'S program and staff. U
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: G/CC The Heron FY23 Page 14 Packet Pg.401
C.10.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
U)
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 se
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 N
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 a
agree that no party to this Agreement shall be required to enter into any arbitration proceedings
related to this Agreement.
ASSURANCES L)
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 0
benefits as recited in this Agreement. U
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: G/CC The Heron FY23 Page 15 Packet Pg.402
C.10.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.
JA
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 a
accountability by reason of the execution of this Agreement.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional cs
or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any U
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 0
constitutional or statutory duties of the County, except to the extent permitted by the Florida U
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 FY23 Page 16 Packet Pg.403
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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
For PROVIDER U)
Craig Knierim, Deputy COO
Guidance/Care Center
1205 Fourth Street
Key West, FL 33040
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-119
Copies of all default notices, notices of breach, termination, legal claim, or indemnity copied to:
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WestCare Foundation, Inc. N
Attn: Executive Vice President N
1711 Whitney Mesa Drive
Henderson, Nevada 89014 M
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.
a
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. �
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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 U
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, E
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 FY23 Page 1 7 Packet Pg.404
C.10.c
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 FY23 Page 8 Packet Pg.405
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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 MADOK, CLERK OF MONROE COUNTY, FLORIDA
By. -..................m.... By. __.,_____..._._........ _.—
As Deputy Clerk Mayor/Chairman
Guidance/Care Center, Inc. a Florida
501(c)(3) not-for-profit corporation
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(Federal ID No. 59-1458324
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WitnessJA
Byi _. _......_
W tip. r Frank Rabbito, Chief Operations Officer Q
e. Guidance/Care Center, Inc. a Florida >_
501(c)(3) not-for-profit corporation
Resolutio,n,,,,,,WCGCC 2022-02 M
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Packet Pg.406
DATF Contract:G/CC, The Heron FY23 Page 9
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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.
:3iovidc dMlimentadon off'" a%imheir off:: cIlients seirve (All 11 llicado , ) and goaIIs achy cvc
(All 11 llicado , ), descirflbed in the II::)12023 KK Il 11 llicatioin Stull imftte to the SAII3AII:�, dL11111g the Il iillll n
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it a ec imbLli seii ent off' I:3ayiVI and/oi �.ccs �:oir seirvices, the II3irovideir shay III pirovide Stull 1p011—dui
poi iilhat Ituimc peiIod as hide c to 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.
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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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i he un taury Il)LlblliC iS SUbject to the Il i~o vv si ons off:: Chapter 1 1 I' Il::]oiIdC statUtes, 1111LIS Use a ceirtd1cate
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements) >_
State of
County of U
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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 U
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(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_ _ U
(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 FY23 Page 110 Packet Pg.407
C.10.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
c hck number, date pp pp p payroll taxes 3ayu��(:)lHH and/ it U)
p . check reCl gists tl u c payee, support§IIh or applicable SLIl� ll� oita n lii� mint loin as eta lac �
a , p y orltiiu� Il�u�Nc �II�.��II
amount,i h... .,id<, im� u ... a...� . tl ii ur.11h...i u u i11M ..un � u un � it�. and S ii ll � .�n u�... that the � iini...n.
��II �� � � may �211���� � � � � � �� � � � y � �� ��� � � �� � � � � � III y � �
u eClUes �:oir Il ayirdH and/oi �'ccs �:oir seirvices urcllates to the seirvices Il a ovide as set �:oiith in
Attachiment C.
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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. N
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Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not M
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
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. U
For supplies or services ordered, a vendor invoice is required.
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Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the number 0
called, and the reason for sending the fax. U
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: G/CC The Heron FY23 Page 111 Packet Pg.408
C.10.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
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included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
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DATF Contract: G/CC The Heron FY23 Page 12 Packet Pg.409
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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
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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 JA
(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 N
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
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Attachments (supporting documentation) 0
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 U
notarization, this _day of (month), (year), by
(name of officer or agent, title of officer or agent) of E
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(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 FY23 Page 113 Packet Pg.410
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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
• 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
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 a
• Coordination of physical and behavioral health services
• Coordination of access to education and employment
• Linkage to legal services U
• Coordination of transportation to all ancillary services U
• Coordination of access to social and religious opportunities
• Coordination of access to entitlements
• Assistance with money management
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Budaet Categories Include: (SAPAB Application, Section 4) U
Contractual Services
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DATF Contract: G/CC The Heron FY23 Page 114 Packet Pg.411
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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_ ktM/(Respondent's name) nor
any Affiliate has been placed on the convicted vendor list withii 5 months. JA
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(Signature)
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Date:
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
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Stateof .. .. ................ ..... ..... ........................... .m...m.
County of
....... . ._
The foregoing instrurneit was acknowledged before me, by means of physical presence or ❑ online t0
notarization, th
is � � _day of (month), -� � '��.... (year), by
� ( (name of officer or agent, title of officer or agent) of
h.........
�ww ._. . ,. . _._m.. .... (name of entity).
i ersonally Known
Produced Identification: Type of ID and Number on ID . ......�......................��,,,......
(SEAL) g " ..�.
11 i r I��d�rti State
of Florida SI i dr 41 of NOtar
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IvM�r Coro I slojgy on Name t Notary (Typed, .
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AM 13715
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Notary Public, State of Zvi
Packet Pg.412
DATF Contract: G/CC, The Heron FY23 Page 15
C.10.c
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
ry $
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- a_ ... ....................... ....._ ... _..� .......... .Comp.. .... ... ..�_.. ...,.. _—_____ � �� ��..�.
any)
"...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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Date: .. ., �... ...._ cN
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of O --
County of
The foregoing instrument was acknowledged before me, by means oil,N' physical presence or ❑ online t0
notarization this ( ,
day of�_ mm �d
name.... _,,..,..._ .....�_ (month), " � . (Year), by
F � ( 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) "to
Signatu�of Notary
6oyrir� 6 �raa�� r�� � � °w
WPIyaruwAS �irr m. _
jjj% � Name a: Notary (Typed, Stamped or Printed)
Notary Public, State of
Packet Pg.413
DATF Contract: G/CC, The Heron FY23 Page 116
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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 JA
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 U
the workplace no later than five (5) days after such conviction. N
5. Impose a sanction on or require the satisfactory participation in a drug abuse assistance or N
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 N
implementation of this section.
As the person authorized to sign the statement, I certify than this firm complies fully with the
above requirements. U
(Signature)
Date:
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
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State of , ;
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County of vP- 0
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The foregoing instrumen was ackn wledged before me, by means of A, physical presence or ❑ online
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notarization, this � day Of � � � �� �° . .......... (month), (year), by �
Y W I (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)SEAL Notary Public State of Florida t
r 'ommissionnson Slan
IMtt9 kttt 1/15t20 6a ItBi _....
E xp, 2 Name f Notary (Typed, Stamped or Printed)
Notary Public, State of
Packet Pg.414
DATF Contract:G/CC, The Heron FY23 Page 117
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ATTACHMENT G
FY2023 Annual Performance Report
For year October 1, 2022—September 30, 2023
(Report Deadline: October 31, 2023)
AgencyName -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 FY2023 Performance (i.e. successes, challenges, etc.):
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Questions:
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1. Please list services and client information below for the program/activities funded by the Monroe Q
County award.
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2. What were the measurable outcomes (including numbers) accomplished in FY2023? 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 U
in FY2023; and/or 200%; and/or another standard used by your organization?
4. What area of Monroe County did you serve in FY2023?
5. During FY2023, 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 FY2023 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2023.
DATF Contract: G/CC The Heron FY23 Page 118 Packet Pg.415
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FINANCIAL REPORT
FY2023 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2023?
a. If no, please explain:
10. Allocation of FY2023 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category DollarAmount Dollar Amount
Salaries $0 $0
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Fringe $0 $0
FICA $0 $0-
Independent Contractors $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0
Insurance $0 $0 JA
Repair& Maintenance $0 $0
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Travel/Transportation $0 $0 N
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Rent/Association Dues $0 $0
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0 U_
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0 U
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Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
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Other Expense/Describe: $0 $0 U
Other Expense/Describe: $0 1 $0
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11. Compensation Detail: Include all persons who receive compensation from the FY2023 Clerk's Drug
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: G/CC The Heron FY23 Page 119 Packet Pg.416
C.10.c
12. Did the FY2023 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 FY2023 IRS Form 990. If
your FY2023 IRS Form 990 is not yet prepared, please provide an estimate for the following
questions.
as
13. What is your organization's fiscal year?
14. What were your organization's total expenses in FY2023?
as
15. What was your organization's total revenue in FY2023?
16. What was the organization's total in grants and contracts for FY2023?
17. What was the organization's total donations/fundraising and in-kind in FY2023?
a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising:
r_
0
18. What percentage of your expenses are program service expenses' versus management and as
general expenses2 in FY2023 as reported on your IRS Form 990?
19. Additional Comments, Questions and/or Suggestions:
e
0
(D
E
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 FY23 Page 120 Packet Pg.417
C.10.d
AGREEMENT
This Agreement is made and entered into this 191" day of October 2022, between the BOARD
OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "Board"
or "County," and Samuel's House, Inc., 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:
FUNDING U)
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
PROVIDER the sum of TWELVE THOUSAND NINE HUNDRED NINETY-EIGHT AND NO/100 DOLLARS JA
($12,998.00) for fiscal year 2023, as recommended by the Substance Abuse Policy Advisory Board
and funded by the Clerk's Drug Abuse Trust Fund. U
M
N
2. TERM. This Agreement shall commence on October 1, 2022, and terminate September N
30, 2023, unless earlier terminated pursuant to other provisions herein.
M
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 Office of Management and Budget. Reimbursement request and
supporting documentation must be acceptable to the Clerk's Finance Office. Acceptability to the U
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 0
amounts below, those reimbursable expenses which are reviewed and approved as complying with U)
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 E
letter, summarizing the expenses, with supporting documentation attached. (The Office of
Management and Budget 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 t0
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.
c�
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:Samuels House,FY23 Page I 1 Packet Pg.418
C.10.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 U)
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. JA
Right to Audit. Availability of Records. The records of the parties to this Agreement relating to U
the Project, which shall include but not be limited to accounting records (hard copy, as well as c
computer readable data if it can be made available; subcontract files (including proposals of N
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 U
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 0
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, E
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 0
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 E
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:Samuels House,FY23 Page 12 Packet Pg.419
C.10.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 U)
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 JA
American Institute of Certified Public Accountants (AICPA); as
b. The CPA must maintain malpractice insurance covering the audit U
services provided and N
c. The County shall be considered an "intended recipient" of said audit. N
(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); c,
(j) Annual Performance Report describing services rendered during the most recently completed U)
grant period (to be furnished within 30 days after the contract end date.) The performance 0
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); E
(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. t0
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:Samuels House,FY23 Page 13 Packet Pg.420
C.10.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.
U)
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 U)
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 JA
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.
N
14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the N
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, CN
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 0
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. E
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. t0
4i
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:Samuels House,FY23 Page 14 Packet Pg.421
C.10.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
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 JA
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 c)
or claim. If the issue or issues are still not resolved to the satisfaction of the parties, then any party c
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. ,
N
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 c)
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 0
related to this Agreement. U)
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. t0
4i
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:Samuels House,FY23 Page 15 Packet Pg.422
C.10.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' U
compensation, and other benefits which apply to the activity of officers, agents, or employees of N
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 U
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. 0
JA
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 E
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 t0
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:Samuels House,FY23 Page 16 Packet Pg.423
C.10.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
U)
For PROVIDER
Tara Salinas, Executive Director
Samuel's House, Inc.
5450 McDonald Avenue, Suite 4
Key West, FL 33040 JA
33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This U
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. N
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 U
0
prior to the institution of any other administrative or legal proceeding.
0
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, E
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 t0
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:Samuels House,FY23 Page 17 Packet Pg.424
C.10.d
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:Samuels House,FY23 Page 8 Packet Pg.425
C.10.d
IN WITNESS WHEREOF, the parties hereto have caused 'these presents to be executed as of
the day and year first wHtten above.
(SEAL) BOARD OF COUNTY COMMISSIONERS
ATTEST: KEVIN MAD OK, CLERK OF M NR E COUNTY, FLORIDA
By U3y......... �-
As Deputy (,,'le ll4c Mayer/Chairman
LL
uidance/C'are Center, Inc. a Florid
501(c)(3) not-fear-profit corporation
... ..... Federall '10 No,... -0 51,120
( ..... ................................. U)
Witness id
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W" e Clhie ....lE: enti�te Cieuw cN
Gui ante/C'ar» Center, Inc. a Florida
01(r°)( ) not.,,.for-profit corporation M
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.DATF Contract:Samuel',s House,F Y23 Page 9
Packet Pg.426
C.10.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.
:3iovidc dMlimentadon off'" a%imheir off:: cIlients seirve (Alppl l cado , ) and goaIIs achy cvc
(Alppl l cado , Q ), descirflbed in the II::)12023 appl licatioin SLIbimftte to the SAII3AII:�, dL11111g the Il iillll n
eiI
it a ec imbLli seii ent off' I:3ayiVI and/oi �.ccs �:oir seirvices, the II3irovideir shay III pirovide SL1pp01—d1'1
limentat a k Il ciitoin e as �:oir seirvo c as
( iiu iiu II �u : iilluilIIKKIIiillc ull< II c ucuctl tlull iiu Atllliincu
III
ur that tiiii��c cu�ii ��� iiu� ii ���c ��II rir � �cu��u ..� � cu c � u� Iliicu������ �cu��c
�: s ' 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 U
funding source." N
N
i he un taury Il)Llbl iC iS SUbject to the Il irovisions off:: Chapteir 1 1 I' Il::]oiIdC statUtes, 1111LIS Use a ceit01cate
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TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
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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).
c�
Personally Known
Produced Identification: Type of ID and Number on ID_ _ t0
(SEAL)
Signature of Notary
c�
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:Samuels House,FY23 Page 110 Packet Pg.427
C.10.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 U)
amount, check number, date, payee, and support for applicable paid payroll taxes. �3 yur(:)llll and/oir
�::ees �:oir seirvices a eClUests �. ur ureilllbUi seii eint §IIhaHHI iu1dUde the Stull 11 iitin lii eintadon as detafled �
above i he Oeid< may a eClUes tl:Uirblhcur dOCUIMentaUoin to veirH" and SUbstandate that the Il ayiinlent
u eClUes �:oir Il ayur llll and/oi �'ccs �:oir serrvices urcllates to the seirvices Il a ovide as set �:oiiylli iin
Attadhiment C. JA
Postage, Overnight Deliveries, Courier, etc. U
A log of all postage expenses as they relate to the County contract is required for reimbursement. N
For overnight or express deliveries, the vendor invoice must be included. N
Rents, Leases, etc. CN
A copy of the rental or lease agreement is required. Deposits and advance payments are not >_
allowable expenses. LL
LL
Reproductions, Copies, etc.
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 0
sample of the finished product are required. U)
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. t0
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:Samuels House,FY23 Page 111 Packet Pg.428
C.10.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.
U_
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 U)
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 JA
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines. U
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DATF Contract:Samuels House,FY23 Page 12 Packet Pg.429
C.10.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
101 Company A Rent $ X,XXX.XX
102 Company B Utilities XXX.XX U)
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
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(B) Total prior payments $ X,XXX.XX
L)
(C) Total requested and paid (A + B) $ X,XXX.XX N
(D) Total contract amount $ X,XXX.XX N
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 N
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.
t3
Chief Executive Officer U)
Attachments (supporting documentation) 0
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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 U
(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:Samuels House,FY23 Page 113 Packet Pg.430
C.10.d
ATTACHMENT C
Specific description and list of services to be provided under this contract (SAPAB Application
Q.2):
The Samuel's House Prevention Through Provision program will provide Intensive Case
Management, Individual and Group Therapy, Basis Human Needs services to 48 clients assisting
them in achievement and maintenance of sobriety.
I) Intensive Case Management: The team of Case Managers in collaboration with a contracted
Clinical Social Worker and Shelter Monitors manage the needs providing a structure for
rehabilitation and transition to all shelter residents.
U)
The Samuel's House Case Management Services will incorporate the following Evidence Based
Practices (EBP's) in the Prevention Through Provision Program (this is the expense that SH is
requesting funding assistance for): U)
• Substance Abuse and Criminal Conduct: Strategies for Self-Change - a Cognitive Behavioral
Therapy based curriculum (CBT).
• Moral Resonation Therapy (MRT): a systematic treatment strategy that seeks to decrease
JA
recidivism among criminal offenders by increasing moral reasoning.
• Seeking Safety: a trauma-informed, trauma specific, and gender-responsive treatment
model that integrates treatment of PTSD and sub-clinical trauma into treatment of
substance use disorders. These relational models support the development of healthy N
relationships with self, significant others, and the community at large to reduce the risk of >_
relapse and recidivism.
• The Living in Balance treatment model: a wrap-around approach to improve life function in
the context of recovery. This model incorporates Motivational Interviewing to facilitate >`
movement through the stages of change and helps participants develop real life tools to
cope with relapse triggers.
• Anger Management: is a CBT based SAMHSA 12 session treatment model.
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II) Individual Therapy, Group Therapy and Contracted Medical and Mental Health Services:
Samuel's House will provide medical and mental health services as required, based on the
clients' individualized treatment plan which results from the screen and intake process, in- JA
house, by our experienced CM team. These services will be contracted via the Guidance Care
Center for Mental Health, Key Bridge Mental Health, and many other professional providers in
Monroe County.
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III) Provision of Basic Human Needs: SH believes that no woman or child should have to endure
a state of homelessness or exist in fear for their personal safety without even the most basic of 0
human needs - food and shelter. Since 1999, SH has been providing for those needs. U
Identify Goals Achieved: (SAPAB Application Q.9/Q11.)
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Overall goals for the Prevention Through Provision program apply to those women who complete
the full treatment services offered at the MSWC (90-180 days with post activities recommended)
via the SH Prevention Through Provision Program, as follows:
1) Increased coping and decision-making skills.
2) Reduced, or no use, of substances (prescribed and street drugs / alcohol.
3) Reduced mental health symptoms with the recommended follow through on treatment plan,
and post release.
4) Reduced criminal activity and recidivism (repeat) behaviors - post release.
DATF Contract:Samuel's House,FY23 Page 114 Packet Pg.431
C.10.d
Goal A) - To prevent crime by and against women in crisis, and women with children, in Monroe
County, through case management and the provision of basic human needs.
Objectives / Activities:
• Samuel's House will advocate for all clients.
• Samuel's House will complete an assessment for all clients to determine the best individual
approach.
• Samuel's House will provide resource management and service facilitation for all clients
according to their needs.
• Samuel's House will have appropriate on-going communication will all clients.
• Samuel's House will remove from the streets, those homeless women, and women with
children in Monroe County who are willing to improve their own lives.
U)
Goal B) - To contribute to improved health and safety of women, and women with children, in
Monroe County, through case management and the provision of basic human needs. U)
Objectives / Activities:
• Residents will develop individualized plans of action, clearly delineating their goals
regarding health and safety. JA
• Victims of violence will participate in safety planning and counseling.
• Women released from jail will receive support for a new, improved lifestyle. U
• All residents are alcohol and drug tested at intake and up to every 72 hours thereafter, N
they are part of the random and/or reasonable suspicion testing protocol. N
• Residents will receive care coordination to access all available resources leading to self-
sufficiency.
• Samuel's House will provide relapse prevention education and program resources. >_
• Samuel's House will monitor the behavior, well-being, and progress of each resident.
Budget Categories Include: (SAPAB Application, Section 4) U
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Salary Expenses: Samuel's House is requesting a grant that represents 15% of its budgeted case 0
management base salary expense (no benefits or related payroll expenses). JA
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DATF Contract:Samuel's House,FY23 Page 15 Packet Pg.432
C.10.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. "
I have read the above and state that neither e ,
(Respondent®s name) nor
any Affiliate has been placed on the convicted vendor list within the last 36 months.
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(Signature)
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Dated _ c14
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TO E COMPLETED BY NOTARY (in accordance with State notary requirements) �
State of_ _ L J
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County of
The foregoing instrument was acknowledged before me, by means of physical presence or 0 online
notarization, this day of (month), (year), by
(name of officer or agent, title of officer or agent) of
._. _ (name of entity).
_... Personally Known
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Produced Identification: Type of Its and Number on Ell':
(SEAL)
Fr p4
Sid" i ,,.,-...,
���p�e .D'I'::a0"y
ti.10'.1:. o'I" NG
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�a iA PR070PSf115 of Nob 7 Stamped v
�/ "� Notary Public-State of Flora Namely � �...... .., r p'd
� �or Printed)
Commission#GG 351662
._ My Comm.Expires Oct 30,20I3
Bonded through National Notary Assn. µ
� Notary Public, State of, "''A e.1............
DATA Contract:S'amuel's douse,FY23 Page j 16 Packet Pg.433
C.10.d
COUNTY, ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE
FLORIDA
ETHICS CII,,,,AUSE
flfl Samuel's House e
(Company)
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°...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. 010-19 0 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."
A
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(Signature)
Date: S �.S/2022
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TO BE COMPLETEDT (fry accordance with Mate notary requirements) JA
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State of d9
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to
County of
The foregoing instrument was acknowledged before me, by means of physical presence or 11 online
notarization, this dayof o
(month}, (year), by U
(name of officer or agent, title of officer or agent) of
r (name of entity).
Personally itnown
Produced Identification: Type of ID and Number on
( )
SEAL
Sig"a ture..of Notar�� ..
VA,��,, v MARIAPROMPSALTiS Name of Notary ed �t
` . N®tary blk-Stated%rida y ( k d or Printed)
Commission GG 351662
: 6 ,. y Comm.Expires Oct 30,2023 Notary Public, State of "
ded through National Notary Assn.
I.3ATF Contract:,Samuel's House,FY23 Page 117
Packet Pg.434
C.10.d
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 207.07 hereby certifies that:
Samuel's House
(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 U)
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).
4a 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 JA
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 U
any controlled substance law of the United States or any state, for a violation occurring In
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the workplace no later than five (5) days after such conviction, Q
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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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S. Make a goad faith effort to continue to maintain a drug-free workplace through u_
implementation of this sections
s the person authorized to sign the statement, I certify that this firm complies fully with the U
above requirements, m;I,
W us
0
(Signature)
Date: 2/19/2022 JA
TO BE COMPLETEDY 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
.S _____ (name of officer or agent, title of officer or agent) of
t �
(name of entity).
Personally Known
Produced Identifications Type of ID and Number on IID_
� r
(SEAL)
Si ture of Notary
R;m
Paorr�PSALrisName of Notary (T d, S'ta ped or�Printed)
lic-�kat�ofiorida' #GG 351662xpires 30,20D Notary Public, State ofational Notary Assay,
DA TF Contract: Samuel s House,FY23 Page 118
Packet Pg.435
C.10.d
ATTACHMENT G
FY2023 Annual Performance Report
For year October 1, 2022—September 30, 2023
(Report Deadline: October 31, 2023)
AgencyName -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 FY2023 Performance (i.e. successes, challenges, etc.):
JA
Questions: M
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1. Please list services and client information below for the program/activities funded by the Monroe N
County award. U,
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Epsom=Epsom=w Um Z
2. What were the measurable outcomes (including numbers) accomplished in FY2023? 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 0
in FY2023; and/or 200%; and/or another standard used by your organization? U
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4. What area of Monroe County did you serve in FY2023?
5. During FY2023, 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 FY2023 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2023.
DATF Contract:Samuels House,FY23 Page 119 Packet Pg.436
C.10.d
FINANCIAL REPORT
FY2023 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2023?
a. If no, please explain:
10. Allocation of FY2023 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category Dollar Amount DollarAmount
Salaries $0 $0
Fringe $0 $0
FICA $0 $0
Independent Contractors $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0 A
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Insurance $0 $0
Repair& Maintenance $0 $0
N
Travel/Transportation $0 $0 N
Rent/Association Dues $0 $0
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Client Service/Describe: $0 $0 >-
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0
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Client Service/Describe: $0 $0
Other Expense/Describe: $0 $0 0
Other Expense/Describe: $0 $0 JA
Other Expense/Describe: 1 $0 1 $0
Other Expense/Describe: $0 $0 ,
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11. Compensation Detail: Include all persons who receive compensation from the FY2023 Clerk's Drug
Abuse Trust Fund (including Independent Contractors) 0
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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:Samuels House,FY23 Page 120 Packet Pg.437
C.10.d
12. Did the FY2023 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 FY2023 IRS Form 990. If
your FY2023 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 FY2023?
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15. What was your organization's total revenue in FY2023?
16. What was the organization's total in grants and contracts for FY2023?
17. What was the organization's total donations/fundraising and in-kind in FY2023?
a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising:
as
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18. What percentage of your expenses are program service expenses' versus management and
general expenses2 in FY2023 as reported on your IRS Form 990?
as
19. Additional Comments, Questions and/or Suggestions: F
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(D
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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:Samuel's House,FY23 Page 121 Packet Pg.438
C.10.e
AGREEMENT
This Agreement is made and entered into this 191" day of October 2022, 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:
FUNDING
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1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially 22
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 NINE HUNDRED THIRTY-SIX AND NO/100 DOLLARS ($4,936.00) for
fiscal year 2023, as recommended by the Substance Abuse Policy Advisory Board and funded by
the Clerk's Drug Abuse Trust Fund. U
M
2. TERM. This Agreement shall commence on October 1, 2022, and terminate September N
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30, 2023, 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 Office of Management and Budget. Reimbursement request and
supporting documentation must be acceptable to the Clerk's Finance Office. Acceptability to the U
Clerk is based on generally accepted accounting principles and such laws, rules and regulations as U
may govern the Clerk's disbursal of funds. The County shall only reimburse, subject to the funded 0
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 Office of
0
Management and Budget may accept Reimbursement Requests electronically, but only U
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:FKOC FY22;Page I 1 I Packet Pg.439
C.10.e
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 JA
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 U
successful and unsuccessful bidders, bid recaps, bidding instructions, bidders list, etc.); original N
estimates; estimating work sheets; correspondence; change order files (including documentation N
covering negotiated settlements); back charge logs and supporting documentation; general ledger U
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 U
hereinafter referred to as "Records") shall be open to inspection and subject to audit and/or U
reproduction by County's representative and/or agents or the County Clerk. County or County �e
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, 0
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 E
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:FKOC FY22;Page 12 1 Packet Pg.440
C.10.e
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 JA
services provided and
c. The County shall be considered an "intended recipient" of said audit. U
(f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules; N
(g) Organization's Corporate Bylaws, which must include the organization's mission, board and N
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 U
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 �e
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, 0
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:FKOC FY22;Page 13 1 Packet Pg.441
C.10.e
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. JA
14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the C3
PROVIDER is an independent contractor and not an employee of the Board. No statement contained N
in this agreement shall be construed so as to find the PROVIDER or any of its employees, N
contractors, servants or agents to be employees of the Board. U
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COMPLIANCE ISSUES CN
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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 c)
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 �e
written notice of termination to the PROVIDER.
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16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure
that all professionals have current and appropriate professional licenses and professional liability t0
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:FKOC FY22;Page 14 1 Packet Pg.442
C.10.e
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. 0
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 JA
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 c)
Florida law. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit N
Court, 161" Judicial Circuit, Monroe County, Florida. N
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 c)
related to this Agreement. U
ASSURANCES
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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 t0
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:FKOC FY22;Page 15 1 Packet Pg.443
C.10.e
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' JA
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 U
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. U
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29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional �e
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 t0
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.
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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:FKOC FY22;Page 16 Packet Pg.444
C.10.e
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
Florida Keys Outreach Coalition, Inc.
PO Box 4767
Key West, FL 33041
Phone: (305) 293-8189
Email: Jmclernon@fkoc.oro
33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This U
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. N
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 U
prior to the institution of any other administrative or legal proceeding. U
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. 0
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35. 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:FKOC FY22;Page 17 Packet Pg.445
C.10.e
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:FKOC FY22;Page 8 Packet Pg.446
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of
the day and year first written above.
(S,EAL) BOARD OF COUNTY COMMISSIONERS
ATTEST: KEVIN ADO , CLERK OF MONROE COUNTY, FLORIDA
By By
As Deputy Clerk Ma,yor/Cha,irman
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Florida Keys Outreach Coalition, Inc.
(Federa I ID No.
Witness JA
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By w AP �.-e V'X,j9'VU m
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Aitness Chief Executivd Officer Q
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DA Tr Contract-FKOC FY22;Page 9
Packet Pg.447
C.10.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.
: irovide dMlimentadon off'" a%imIbeir off:: cIlients 2c1rvc (AII II IIicado , Q ) and goa11s achy cvc
(AII II IIicado , Q ), descirilll ed in the II::)12023 KK II II IIicati1 11n SLIbii ifttc to the SAIIaAII:�a dL11111g the Il illlll n
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it a ec iie bLli seii ent off' I:3ayi IIII and/oi �.cc2 �:oir 2c1rvices, the II irovideir shay III pirovide 2LIIII II a-dIli
limentation to 2U11bsta da to that the woidk II clitoin e as �:oir 2c1rv1ces as set �:oir lh h1 AttachIment
(Sil ly i111 II �:Ir: nl CIlients 2c1rvc a a detafled woid< IIog Mth 2c1rvices rendeired and cIlient(s) 2c1rvc
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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 JA
funding source." a�
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iu h� unota�ur Lu a i1� tlllll II11 Chapter1 17, ll'"Ilan �ata�tV�
o LIIIbs a�11�i1a�Iy the � Mngo ':oin hi uno a�1i1i � a to �gflb1 1e oir an electi one II ecoird11
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
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State of
County of
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The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online U
notarization, this _day of (month), (year), by U_
(name of officer or agent, title of officer or agent) of
(name of entity).
0
Personally Known U
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:FKOC FY22;Page I 10 Packet Pg.448
C.10.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. �3 yur llll and/oir tl"ccs
�:oir seirvices ureC1Uests �:oir ureilllbUi seii eint 211haHH iu1dUde the SLIppoiting dMlimentadon as detafled �
above i he Oeid< may ureC1Uest tl:Uirblhcur dOCUIMentaUoin to veirH"y and SLIbstanUate that the Il ayiinlent
ureC1Uest �:oir Il ayur llll and/oi �'cc2 �:oir seirvices urcllates to the seirvices Il a ovide as set �:oiiylli iin
Attadhiment C.
Postage, Overnight Deliveries, Courier, etc. JA
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. U
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Rents, Leases, etc. N
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.
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 U
sample of the finished product are required. U
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc. 0
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:FKOC FY22;Page I 11 I Packet Pg.449
C.10.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.
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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. JA
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DATF Contract:FKOC FY22;Page 12 Packet Pg.450
C.10.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
105 Employee B P/R ending 05/28/01 XXX.XX
(A) Total $ X,XXX.XX
(B) Total prior payments $ X,XXX.XX JA
(C) Total requested and paid (A + B) $ X,XXX.XX L)
(D) Total contract amount $ X,XXX.XX
N
Balance of contract (D-C) X.XXX.XX Q
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 N
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 t3
Attachments (supporting documentation) U
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
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State of
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County of U
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:FKOC FY22;Page 113 Packet Pg.451
C.10.e
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
oxycodone. FKOC will purchase testing supplies and administer a minimum of 7,100 alcohol/drug
tests between 10/01/2023 and 09/30/2023. 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. U)
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FKOC will provide copies of invoices to show purchasing and monthly spreadsheets to show drug U
and alcohol testing statistics. Additionally, upon request, FKOC will be able to provide individual M
drug and alcohol testing sheets and service records from our HMIS system with names of Q
participants redacted. 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 U
grant management staff. N
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 U
procedures are being executed fully and completely. U
Identify Goals Achieved: (SAPAB Application Q.9/Q.11)
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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 0
stability. U
Major Activities include:
• Drug and Alcohol testing on-site (in each facility) to a minimum of 170 residents on a regular
basis and more often as needed.
• All FKOC programs provide life skills and case management services and Individual Service
Plans
• FKOC's ex-offenders receive comprehensive services that are directed to help them overcome
the challenges including: 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.
• Coordination of services with the Guidance Care Center's Offender Re-Entry Program
specifically at FKOC's Emergency Shelter, the Neece Center, which is applicable to all programs.
Budget Categories Include: (SAPAB Application, Section 4)
Program Expenses.
DATF Contract:FKOC FY22;Page 114 Packet Pg.452
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 mot transact business with any public entity in
excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of
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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 nelther;' g_0d`fMC[-eVM0tj (Respondent's name) nor
ven,or ,is
any Affiliate has been placed on the convicte vendor list within the last 36 months.
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Date:
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TO lBE COMPLETED BY NOTARY (in accordance with State notary requirements) 0
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State of
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County of
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The foregoing instrument was acknowledged before me, by means ofs,ETphysical presence or 0 online U
,e A,` (month) 24Z� (year), by notarization, this —Lt4-1day of J749 b , E
(name of officer, or agent, title of officer or agent) of
(name of entity).
Personally Known
Produced Identificatlon: Type of ID and Number, on ID
(SEAL)
Signature of Aotary
EMCAROLYN WOODHEAD ?�,IA-jl
State of Florida Notary Pubde
9 V Commission#HH 01472 10 Na rne of Notar�(Type d,' Stamped or Printed)
of P
My Comm.Expires Sep 28,2024
Bonded through NatlOna�Notary ASSn,
Notary Public, State of P-- ,os LZV. ......ZA
DA TF Contract:FKOC FY22;Page 115
1 Packet Pg.453
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
'T'
(Company)
...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former C
County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer U-
or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this U)
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
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of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
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(S�gature) "dc
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Date: 2 M
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TO, BE COMPLETED BY NOTARY (in accordance with State notary requirements) U
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State of 55 �
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County of
The foregoing instrument was acknowledged before me, by means of Pr-physical presence or 0 online
0
notarization this N /L-day of (month), (year), by U
j akiati'A (name of officer or agent, title of officer or agent) of E
(name of entity).
Personally Known
Produced Identification: 'Type of ID ain,d Number on ID
(SEAL) '41",
Signature of Notary
Avl-,
CAROLYN WOODHEAD
Name of Not" (Typed, Stamped or Printed)
Notary Public•state of F106da
Commission#pH 047210
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my Comm,Expires Sep 28,2024 Notary PuUlic, State of T bonded through Nationat Notary Assn.
DA TF Conti-act:FKOC FY22;Page 116
Packet Pg.454
C.10.e
ATTACHMENIT
WORKPLACE
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
invi . f
(Nairne 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 lousiness` 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.
u wive each employee engaged in providing the commodities or contractual services that are
under bid a copy of the statement specified in subsection (1).
n In the statement specified in subsection (1), not'lfy 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 polo contendere to, any violation of Chapter 893 (Florida Statutes) or of
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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 U
rehabilitation program if such is available in the employee's community, or any ernpioyee CN
who is so convicted. CN
5, Make a good faith effort to continue to maintain a drug-free workplace through u
implementation of this section
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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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t4nature) U
Crate: 2- c u_
TO BE COMPLETEDNOTARY (in accordance with State notary requirements) c�
State of ;, .
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UCounty of
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The foregoing instrument was acknowledged before me, by means of physical presence or ❑' online
notarization, thiis diay of (month), ✓, (year), by
� .. (name of officer or agent, title of officer or anent) of
(rnarne of entity).
Personally Known
Produced Identification; Type of ID and Number
_.®
igna re dtNotary
F, Commlssion
r puhut Stateof rnri Name of iNot (Typed, Stamped narrated)
#HH 047210,
n .Epix�s Sip 28"202ruh raaci �, u wn't,n An, Notary Public„ Mate of
e ATF Contract,-I"Fi C;FY2 ;Page 117
Packet Pg.455
C.10.e
ATTACHMENT G
FY2023 Annual Performance Report
For year October 1, 2022—September 30, 2023
(Report Deadline: October 31, 2023)
AgencyName -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.
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Narrative on the FY2023 Performance (i.e. successes, challenges, etc.):
Questions: A
1. Please list services and client information below for the program/activities funded by the Monroe U
County award. N
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2. What were the measurable outcomes (including numbers) accomplished in FY2023? Please base
these outcomes on the services you identified in Question#1. U
3. What number and percentage of your clients/participants were at or below the federal poverty level
in FY2023; and/or 200%; and/or another standard used by your organization?
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4. What area of Monroe County did you serve in FY2023?
5. During FY2023, 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 FY2023 DATF award?
8. Volunteers: hours of program service were contributed by volunteers in FY2023.
DATF Contract:FKOC FY22;Page 118 1 Packet Pg.456
C.10.e
FINANCIAL REPORT
FY2023 CLERK'S DRUG ABUSE TRUST FUND (DATF)
(Note: Report Only DATF Grant Expenditures)
9. Were all the awarded funds used in FY2023?
a. If no, please explain:
10. Allocation of FY2023 Award; Clerk's Drug Abuse Trust Fund Award Amount = $
Program Expense Administrative Expense
Budget Category DollarAmount Dollar Amount
Salaries $0 $0
Fringe $0 $0
LL
FICA $0 $0
Independent Contractors $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
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Rent/Association Dues $0 $0 N
N
Client Service/Describe: $0 $0 U`
Client Service/Describe: $0 $0 M
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0
Other Expense/Describe: $0 $0 U
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Other Expense/Describe: $0 $0 0
Other Expense/Describe: 1 $0 $0 ,
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Other Expense/Describe: $0 $0
0
11. Compensation Detail: Include all persons who receive compensation from the FY2023 Clerk's Drug U
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:FKOC FY22;Page 119 Packet Pg.457
C.10.e
12. Did the FY2023 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 FY2023 IRS Form 990. If
your FY2023 IRS Form 990 is not yet prepared, please provide an estimate for the following
questions.
13. What is your organization's fiscal year? as
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14. What were your organization's total expenses in FY2023?
15. What was your organization's total revenue in FY2023?
16. What was the organization's total in grants and contracts for FY2023?
17. What was the organization's total donations/fundraising and in-kind in FY2023?
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 FY2023 as reported on your IRS Form 990?
19. Additional Comments, Questions and/or Suggestions:
0
as
F
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:FKOC FY22;Page 120 Packet Pg.458