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BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL (305) 289 -6027
FAX (305) 289 -1745
MEMORANDUM
"a ntip X. Rotbage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292 -3550
FAX (305) 295 -3660
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852 -7145
FAX (305) 852 -7146
DATE: November 30, 2000
TO: Jennifer Hill, Budget Director
Office of Management & Budget
ATTN: Dave Owens
Grants Administrator
FROM: Pamela G. Hanco
Deputy Clerk
At the November 21, 2000, Board of County Commissioner's meeting the Board granted
approval and authorized execution of the following:
Fiscal Year 2001 Funds Agreement between Monroe County and Historic Florida Keys
Foundation, Inc. to provide funding. - ,
Fiscal Year 2001 Human Organization Agreement between Monroe County and the
following:
Greater Miami and Keys American Red Cross
Big Brothers -Big Sisters of Monroe County, Florida
Caring Friends for Seniors, Inc.
Domestic Abuse Shelter, Inc.
Florida Keys Children's Shelter, Inc.
Florida Keys Outreach Coalition, Inc.
U.S. Fellowship of Florida, Inc. a/k/a Heron and Heron/Peacock
Hospice of the Florida Keys, Inc.
Literacy Volunteers of America - Monroe County, Inc.
Monroe Association for Retarded Citizens
Wesley House
Fiscal Year 2001 Funds Agreement between Monroe County and Monroe Council of the
Arts to provide funding.
Enclosed please find a duplicate original of each Agreement for your handling. Should
you have any questions please feel free to contact this office.
Cc: County Administrator w/o documents
County Attorney
Finance
File
AGREEMENT
Hospice
This Agreement is made and entered into this ? /� day of VIM 000,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA,
hereinafter referred to as "Board" or "County," and HOSPICE OF THE FLORIDA KEYS, INC.,
hereinafter referred to as "Provider."
WHEREAS, the Board and the Provider desire to enter into an agreement wherein the
Board contracts for services from the Provider in providing the medical, psychological,
physical and social needs of terminally ill persons and their families and to mobilize other
community resources to meet such needs for the citizens of Monroe County, and
WHEREAS, such services have been provided by the Provider in the past and have
been invaluable to the citizens of Monroe County, and
WHEREAS, such services will promote independence and
persons, and
WHEREAS, the Board recognizes the public purpose to be met by an agreement for
services to be rendered in fiscal year 2000 -2001, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is
agreed as follows:
I. AMOUNT OF AGREEMENT. The Board, in consideration of the Provider
substantially and satisfactorily performing and carrying out the duties of the Board as to
rendering services to the citizens of Monroe County, in matters of health and education in
regard to the care of terminally ill persons, shall pay to the Provider the sum of FORTY
THOUSAND DOLLARS ($40,000.00) for fiscal year 2000 -2001 o c:; °o -',
2. TERM.This Agreement shall commence on October 1, 2000, 1 " ernnaij;
September 30, 2001, unless earlier terminated pursuant to other provisions b C - ) LD
n
3. PAYMENT. Payment will be paid periodically, but no more 0 4u#ntly th�f a
monthly as hereinafter set forth. Reimbursement requests will be submittef the�oar�
via the Clerk's Finance Office. The County shall only reimburse, subject =Wv -l#e Wdig
amounts below, those reimbursable expenses which are reviewed ancVjapprovgd
complying with Florida Statutes 112.061 and Attachment A - Expense RA
Requirements. Evidence of payment by the Provider shall be in the form of a letter,
summarizing the expenses, with supporting documentation attached. The letter should
contain a certification statement as well as a notary stamp and signature. An example of a
reimbursement request cover letter is included as Attachment B.
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 of ($40,000.00) during
the term of this agreement.
4. SCOPE OF SERVICES. The Provider, for the consideration named,
covenants and agrees with the Board to substantially and satisfactorily perform and carry
out the duties of the Board in providing the medical, psychological, physical and social
needs of terminally ill persons and their families and shall mobilize other community
resources to meet such needs for the citizens of Monroe County, Florida. Said services shall
include, but are not limited to, those services described in Provider's Details of Specific
Program for Which Funding is Requested, attached hereto as Exhibit C and incorporated
herein.
S. RECORDS. The Provider shall maintain appropriate records to insure a
proper accounting of all funds and expenditures, and shall provide a clear financial audit
trail to allow for full accountability of funds received from said Board. Access to these
records shall be provided during weekdays, 8 a.m. to 5 p.m., upon request of the Board,
the State of Florida, or authorized agents and representatives of the Board or State.
The Provider shall be responsible for repayment of any and all audit exceptions which
are identified by the Auditor General of the State of Florida, the Clerk of Court for Monroe
County, an independent auditor, or their agents and representatives. In the event of an
audit exception, the current fiscal year contract amount or subsequent fiscal year contract
amounts shall be offset by the amount of the audit exception. In the event this agreement
is not renewed or continued in subsequent years through new or amended contracts, the
Provider shall be billed by the Board for the amount of the audit exception and the Provider
shall promptly repay any audit exception.
6. 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 for 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.
7. 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.
S. 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.
9. COMPLIANCE WITH COUNTY GUIDELINES. The Provider demonstrate
and sustain compliance with:
(a) 501(c)(3) Registration;
(b) Board of Directors of seven or more;
(c) Annual election of Officers and Director;
(d) Annual provision of annual report to County;
(e) Corporate Bylaws;
(f) Corporate Policies and Procedures Manual;
(g) Hiring policies for all staff;
(h) Cooperate with County monitoring visits; and
(i) Semi - annual performance reports to be presented to County.
10. 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.
1)
11. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the
services and /or reimbursement of services shall be amended by an agreement amendment,
which must be approved in writing by the Board.
12. 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.
13. NON - DISCRIMINATION. The Provider shall not discriminate against any
person on the basis race, creed, color, national origin, sex or sexual orientation, age,
physical handicap, or any other characteristic or aspect which is not job - related in its
recruiting, hiring, promoting, terminating or any other area affecting employment under this
agreement. At all times, the Provider shall comply with all applicable iaws and regulations
with regard to employing the most qualified person(s) for positions under this agreement.
The Provider shall not discriminate against any person on the basis of race, creed, color,
national origin, sex or sexual orientation, age, physical handicap, financial status or any
characteristic or aspect in its providing of services.
14. AUTHORIZED SIGNATURES. The signatory for the Provider below, certifies
and warrants that:
(a) The Provider's name in this agreement is the full name as designated in its
corporate charter, if a corporation, or the full name under which the Provider is authorized
to do business in the State of Florida.
(b) He or she is empowered to act and contract for the Provider; and
(c) This agreement has been approved by the Board of Directors of the Provider if
the Provider is a corporation.
15. 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: Louis LaTorre, Social Services Director
Monroe County Attorney and Public Service Building
PO Box 1026 5100 College Road
Key West, FL 33041 Key West, FL 33040
For Provider:
Liz Kern, President
Hospice of the Florida Keys, Inc.
1319 William Street
Key West, Florida 33040 -4736
16. CONSENT TO JURISDICTION. This agreement shall be construed by and
governed under the laws of the State of Florida and venue for any action arising under this
agreement shall be in Monroe County, Florida.
17. 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.
18. 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.
19. 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.
20. 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.
NESS WHEREOF, the parties hereto have caused these presents to be
the day and year first written above.
L. KO
E, CLERK
BOARD OF COUNTY COMMISSIONERS
05 MONROE COUNTY, FLORIDA
Clerk
er ! 6
Ori
..� Witness
Witness
jdconhospice
/Chairman
HOSPICE OF THE FLORIDA KEYS, NC.
(Federal ID No. 0 Z.3R(4Zg )
By
Exec 've Director
t,PPROVED AS T O F O C
AND L
BY NE A• H
,TG
El
ATTACHMENT A
Expense Reimbursement Requirements
This document is intended to provide "basic" guidelines to Human Service Organizations, county
travelers, and contractual parties who have reimbursable expenses associated with Monroe County
business. These guidelines, as they relate to travel, are from FS 112.061, which is attached for
reference.
A cover letter summarizing the major line items on the reimbursable expense request should also
contain a certified statement such as:
I certify 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.
Invoices should be billed to the contracting agency. Third party payments will not be considered
for reimbursement. Remember, the expenses should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all- inclusive. 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 -3528.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expenses.
If a Payroll Journal is provided, it should include:
Payroll Journal dates, employee name, salary, or hourly rate, hours worked during the payroll
journal dates, withholdings where appropriate, check number and check amount
If a Payroll Journal is not provided, the following must be listed:
Check number, date, payee, check amount, support for applicable payroll taxes
Original vendor invoices must be submitted for Worker's Compensation and Liability insurance
coverage.
Telephone Expenses
A user log of pertinent information must be remitted; the party called, the caller, the telephone
number, the date, and the purpose of the call must be identified.
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.
Supplies services, etc.
For supplies or services ordered, the County requires the original vendor invoice.
Rents leases, etc.
A copy of the rental agreement or lease is required. Deposits and advance payments will not be
allowable expenses.
Postage overnight deliveries courier, etc.
A log of all postage expenses as it relates to the County contract is required for reimbursement.
For overnight or express deliveries, the original vendor invoice must be included.
Rearoductions conies, etc.
A log of copy expenses as it relates 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 original vendor invoice
is required and a sample of the finished product.
Travel Expenses: Please refer to Florida Statute 112.061.
Travel expenses must be submitted on a State of Florida voucher for Reimbursement of Travel
Expenses. Credit card statements are not acceptable documentation for reimbursement.
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 original vendor invoice. Fuel purchases should be
documented with original paid receipts.
Original taxi receipts should be provided. However, reasonable fares will be reimbursed without
receipts. Taxis are not reimbursed if taken to arrive at a departure point: for example, taking a
taxi from one's residence to the airport for a business trip is not reimbursable.
Original toll receipts should be provided. However, reasonable tolls will be reimbursed without
receipts.
Parking is considered a reimbursable travel expense at the destination. Airport parking during a
business trip is not.
Lodging reimbursement requires a detailed listing of charges. The original lodging invoice must be
submitted. The County will only reimburse the actual room and related bed tax. Room service,
movies, and personal telephone calls (see previous guidelines) are not allowable expenses. Per
diem lodging expenses may apply. Again, refer to Florida Statute 112.061.
Meal reimbursement is breakfast at $3.00, lunch at $6.00, and dinner at $12.00. Meal guidelines
are that travel must begin prior to 6:00 a.m. for breakfast reimbursement, before noon and end
after 2:00 p.m. for lunch reimbursement, and before 6:00 p.m. and after 8:00 p.m. for dinner
reimbursement.
Mileage reimbursement is calculated at 29 cents per mile for personal auto mileage while on county
business. An odometer reading must be included on the state travel voucher for vicinity travel. A
mileage map is available for reference to allowable miles from various Florida destinations.
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.
Data - . g PC time, etc.
The original vendor invoice is required for reimbursement. Intercompany allocations are not
considered reimbursable expenditures unless appropriate payroll journals for the charging
department (see Payroll above) are attached and certified.
The fo llowing are not allowable for reimbursement:
Penalties and fines
Non - sufficient check charges
Fundraising
Contributions
Capital outlay expenditures (unless specifically included in the contract)
Depreciation expenses (unless specifically included in the contract)
ATTACHMENT B
HUMAN SERVICE ORGANIZATION LETTERHEAD
Monroe County Board
of County Commissioners
Finance Department
500 Whitehead Street
key West, Florida 33040
( Date)
The following is a summary of the expenses
time period of to
Check # Payee
for ( Human Service Oroanization name for the
Reason
Amount
101
A Company Rent
$xxxx.xx
$ xxxx.xx
102
B Company Utilities
Phone
$ xxxx.xx
103
104
D Company
Person A Payroll
$xxxx.xx
105
Person B Payroll
$xxxx.xx
(A) Total
$ xxxx.xx
(B) Total prior payments
$xxxx.xx
(C) Total requested and paid (A + B)
$ xxxx.xx
(D) Total contract amount
$ xxxx.xx
Balance of contract (D - C)
$xxxx.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 Commissioners
and will not be submitted for reimbursement to any other funding source.
Executive Director
Attachments (supporting documentation)
STATE OF FLORIDA
COUNTY OF MONROE
SWORN TO AND SUBSCRIBED before me this day of , 200_ by
(Event Contact Person) who is personally known
to me presented as identification:
Notary Public, State of Florida at Large
My Commission Expires:
Jdconhsoex
+t+ . (f_
AGENCY NAME: Hospice of the Florida Keys, Inc.
VOLUNTEERS (Including Board Members)
12. _120 contributed a total of 3,600_ hours to our agency this past year.
Board 900 hours Programs: 1000 hours Committees: 1700 fundraising hours
13. How do you utilize volunteers in the operation of your agency ?Patient care, clerical, fundraising, Board
leadership.
14. Briefly describe the training the volunteers receive. Patient care volunteers received about 20 hours of initial
Training covering: listening skills, issues of death & dying, disease process /Cancer, AIDS) as well as bereavement
issues of surviving loved ones.
AGENCY OPERATIONS
15. Does agency have a grievance procedure for clients? If yes, briefly describe. Is it a formal procedure? How
are clients made aware of the procedure? Attachment S
16. What other organizations do you network with to prevent a duplication of services? Describe any sharing
of costs, referrals of clients, etc. We are looking for more detail than your membership in Interagency
Council. An example of an appropriate answer is "one of XYZ's employees works out of our branch" or
"we joint fund X position with ABC Agency." Attachment S
17. Is your agency monitored by an outside agency? If yes, by who and how often?
If not, how does your agency document and measure its service performance and success rates?
Attachment S
FINANCIAL INFORMATION
18. Is your agency receiving any In -Kind Services i.e. free rent, utilities, maintenance, etc. from the County or
any other organization? If so, What is the fair market value? Attachment S
19. What is the percentage of total agency revenue that goes to the following: Attachment S
Fundraising Expenses? % Administration Expenses
20. Complete Attachment B - Agency Salary Detail Form. Attachment M
DETAILS OF SPECIFIC PROGRAM FOR WHICH FUNDING IS REQUESTED
21. Please give a paragraph description of the agency program for which you are requesting funding. Attachment S
22. What need or problem in this community does this program address? Include your target population.
Attachment S
23. What data supports this need. Attach copies of any relevant documents or CITE Report. Attachment S
24. Where is this program being offered? List all sites and hours of operation. Attachment S
25. What measurable changes do you plan to accomplish this next fiscal year? Attachment S
s
ATTACHMENT S
15. The agency has a grievance procedure for clients, delineated in detailed policies and
procedures. Of prime importance is the letter sent to each client upon admission, signed by the
CEO, which gives phone numbers for complaints, questions, etc. Clients are advised to call the
CEO, any staff supervisor or the Fl. hot line number which consumers can report problems
directly to the Agency for Health Care Administration.
16. This is the only licensed Hospice organization serving Monroe County, and only licensed
programs are allowed to provide Hospice services. This agency case manages all Hospice
patients and provides all of their direct Hospice care. Overhead costs are shared with Visiting
Nurse Association of the Fl. Keys, with the VNA carrying approx. 74% of the overhead.
17. As a licensed, Medicare/Medicaid certified Hospice, the agency is closely monitored by the
Agency for Health Care Administration and its fiscal intermediary, Palmetto. Site visits and/or
desk reviews occur annually.
18. The agency has been given a space to use as a drop -off office by AHEC (Marathon). This
measure has helped lower expenses as Hospice/VNA consolidated their Middle and Upper Keys
offices in Tavernier, without interrupting services to the Middle Keys. The rent paid in prior
years for the Marathon space was approximately $1100 /month.
19. Fund- raising Expenses are 2 %. Administrative Expenses are 22%
20. Attachment M
21. Hospice provides comprehensive, direct services to patients and their families experiencing
a life threatening illness (generally those with a prognosis of 6 months or less. Services include:
medical, nursing, personal care, counseling, spiritual advising, rehabilitation therapies,
nutritional, social work and bereavement. Most services are provided in a person's own place of
residence - contracts for care also are in place for all Monroe County hospitals and nursing
homes. The funds requested are used to offset unfunded and underfunded nursing and personal
care services - both are direct services.
22. This program targets all persons and their family members who have or are dealing with a
terminal illness, nearing the end of life. Most clients are elderly and have a cancer, end -stage
pulmonary or cardiac related diagnosis.
23. Statistics relating to death rates support the need for Hospice care. Various reports are used
included: those from County and City Planning Departments, The Health Council of South Fl..
the census, etc.
24. Hospice services are available and active throughout Monroe County, emanating from office
sites in Tavernier and Key West, with a drop -off site in Marathon. Services are available 7 days
a week, 24 hrs. a day, every day of the year.
25. A goal is to increase Hospice referrals by 5 % for the year. This will be done by increasing
publicity regarding the benefits offered by Hospice, by education of the public and increased.
education of physicians and other health care professionals.
26. Funds requested are to offset salary expense for direct service RNs and Home Health Aides,
to cover such expense for unfunded or underfunded care.
27. See Attachment L.