10/18/2000 Contract
1/1199
CFDA No.
Grants and Aids XX
CLERK'S ORIGINAL.
Clientl8l Non-Client 0
Multi-DistrictD
STATE OF FLORIDA
DEPARTMENT OF CHILDREN AND FAMILIES
STANDARD CONTRACT
THIS CONTRACT is entered into between the State of Florida, Department of Children and Families, hereinafter referred
to as the "department," and Monroe County In Home Services
I.
A.
THE PROVIDER AGREES:
Attachment I
hereinafter referred to as the "provider."
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To provide services in accordance with the conditions specified in Attachment I. g ~:' ~- .s;- ~
B. Requirements of Section 287.058, FS ~~D':::: -0 >0
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To provide units of deliverables, including reports, findings, and drafts, as specified in Attachmenrt,:fcepe l&)eiv~ and
accepted by the contract manager prior to payment. To comply with the criteria and the final date;b'y WJ1ich "S,\lch oteria
must be met for completion of this contract as specified in Section III, Paragraph A. of this contrC!Qt. 1"6 s~it tifRs for
fees or other compensation for services or expenses in sufficient detail for a proper pre-audit and post-auClit t~reof.
Where applicable, to submit bills for any travel expenses in accordance with section 112.061, FS. The department may, if
specified in Attachment I, establish rates lower than the maximum provided in section 112.061, FS. To allow public
access to all documents, papers, letters, or other materials subject to the provisions of Chapter 119, FS, made or received
by the provider in conjunction with this contract. It is expressly understood that the provider's refusal to comply with this
provision shall constitute an immediate breach of contract.
C. Governing Law
1. State of Florida Law
a. That this contract is executed and entered into in the State of Florida, and shall be construed, performed, and
enforced in all respects in accordance with the laws, rules, and regulations of the State of Florida. Each party shall
perform its obligations herein in accordance with the terms and conditions of the contract.
b. That it understands that the department, the Department of Labor and Employment Security, and the WAGES
Program State Board of Directors have jointly implemented WAGES, an initiative to empower recipients in the Temporary
Assistance To Needy Families Program to enter and remain in gainful employment. Employment of WAGES participants
is a mutually beneficial goal for the provider and the department in that it provides qualified entry level employees needed
by many providers and provides substantial savings to the citizens of Florida.
2. Federal Law
a. That if this contract contains federal funds, the provider shall comply with the provisions of 45 CFR, Part 74, and/or
45 CFR, Part 92, and other applicable regulations as specified in Attachment I.
b. That if this contract contains federal funds and is over $100,000, the provider shall comply with all applicable
standards, orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 U.S.C. 7401 et seq.),
section 508 of the Federal Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.), Executive Order 11738, and
Environmental Protection Agency regulations (40 CFR Part 30). The provider shall report any violations of the above to
the department.'"
c. That no federal funds received in connection with this contract may be used by the provider, or agent acting for the
provider, to influence legislation or appropriations pending before the Congress or any State legislature. If this contract
contains federal funding in excess of $100,000, the provider must, prior to contract execution, complete the Certification
Regarding Lobbying form, Attachment.w.A.......- If a Disclosure of Lobbying Activities form, Standard Form LLL is required,
it may be obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying
form must be completed and returned to the contract manager.
d. That unauthorized aliens shall not be employed. The department shall consider the employment of unauthorized
aliens a violation of section 274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324 a). Such violation shall be
cause for unilateral cancellation of this contract by the department.
e. That if this contract contains $10,000 or more of federal funds, the provider shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375, and as supplemented in Department of
Labor regulation 41 CFR, Part 60. [45CFR, Part 92]
f. That if this contract contains federal funds and provides services to children up to age 18, the provider shall comply.
with the Pro-Children Act of 1994, Public Law 103-227. Failure to comply with the provisions of the law may result in the
imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative
compliance order on the responsible entity. This clause is applicable to all approved subcontracts.
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CONTRACT # KG032
CF STDCT JF 12/98
1/1/99
D. Audits, Records, and Records Retention
1. To establish and maintain books, records, and documents (including electronic storage media) in accordance with
generally accepted accounting procedures and practices which sufficiently and properly reflect all revenues and
expenditures of funds provided by the department under this contract.
2. To retain all client records, financial records, supporting documents, statistical records, and any other documents
(including electronic storage media) pertinent to this contract for a period of five (5) years after termination of the contract,
or if an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be
retained until resolution of the audit findings or any litigation which may be based on the terms of this contract.
3. Upon completion or termination of the contract and at the request of the department, the provider will cooperate with
the department to facilitate the duplication and transfer of any said records or documents during the required retention
period as specified in Section I, Paragraph D.2. above.
4. To assure that these records shall be subject at all reasonable times to inspection, review, copying, or audit by
Federal, State, or other personnel duly authorized by the department.
5. At all reasonable times for as long as records are retained, persons duly authorized by the department and Federal
auditors, pursuant to 45 CFR, Part 92.36(i)(10), shall be allowed full access to and the right to examine any of the
provider's contract and related records and documents, regardless of the form in which kept.
6. To provide a financial and compliance audit to the department as specified in Attachment 11-- and to ensure that
all related party transactions are disclosed to the auditor.
7. To include the aforementioned audit and record keeping requirements in all approved subcontracts and assignments.
E. Monitoring by the Department
To permit persons duly authorized by the department to inspect any records, papers, documents, facilities, goods, and
services of the provider which are relevant to this contract, and to interview any clients and employees of the provider to
assure the department of the satisfactory performance of the terms and conditions of this contract. Following such
evaluation the department will deliver to the provider a written report of its findings and will include written
recommendations with regard to the provider's performance of the terms and conditions of this contract. The provider will
correct all noted deficiencies identified by the department within the specified period of time set forth in the
recommendations. The provider's failure to correct noted deficiencies may, at the sole and exclusive discretion of the
department, result in anyone or any combination of the following: (1) the provider being deemed in breach or default of
this contract; (2) the withholding of payments to the provider by the department; and (3) the termination of this contract
for cause.
F. Indemnification
NOTE: Paragraph I.F.1. and 2. are not applicable to contracts executed between state agencies or subdivisions, as
defined in subsection 768.28(2), FS.
1. To be liable for and indemnify, defend, and hold the department and all of its officers, agents, and employees
harmless from all claims, suits, judgments, or damages, including attorneys' fees and costs, arising out of any act, actions,
neglect, or omissions by the provider, its agents, or employees during the performance or operation of this contract or any
subsequent modifications thereof, whether direct or indirect, and whether to any person or tangible or intangible property.
2. That its inability to evaluate its liability or its evaluation of liability shall not excuse the provider's duty to defend and
to indemnify within seven (7) days after notice by the department by certified mail. After the highest appeal taken is
exhausted, only an adjudication or judgment specifically finding the provider not liable shall excuse performance of this
provision. The provider shall pay all costs and fees, including attorneys' fees related to these obligations and their
enforcement by the department. The department's failure to notify the provider of a claim shall not release the provider of
these duties. The provicjer shall not be liable for the sole negligent acts of the department.
G. Insurance
To provide adequate liability insurance coverage on a comprehensive basis and to hold such liability insurance at all times
during the existence of this contract and any renewal(s) and extension(s) of it. Upon execution of this contract, unless it is
a state agency or subdivision as defined by subsection 768.28(2), FS, the provider accepts full responsibility for identifying
and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the
provider and the clients to be served under this contract. Upon the execution of this contract, the provider shall furnish the
department written verification supporting both the determination and existence of such insurance coverage. Such
coverage may be provided by a self-insurance program established and operating under the laws of the State of Florida.
The department reserves the right to require additional insurance as specified in Attachment I.
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CONTRACT # KG032
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H. Safeguarding Information
Not to use or disclose any information concerning a recipient of services under this contract for any purpose not in
conformity with state regulations and Federal law or regulations (45 CFR, Part 205.50), except upon written consent of the
recipient, or the responsible parent or guardian when authorized by law.
I. Assignments and Subcontracts
1. To neither assign the responsibility for this contract to another party nor subcontract for any of the work contemplated
under this contract without prior written approval of the department which shall not be unreasonably withheld. Any
sublicense, assignment, or transfer otherwise occurring shall be null and void.
2. To be responsible for all work performed and an expenses incurred with the project. If the department permits the
provider to subcontract all or part of the work contemplated under this contract, including entering into subcontracts with
vendors for services and commodities, it is understood by the provider that all such subcontract arrangements shall be
evidenced by a written document subject to prior review and comment by the department. Such review of the written
subcontract document by the department will be limited to a determination of whether or not subcontracting is permissible,
whether the offered subcontractor is acceptable to the department, and the inclusion of applicable terms and conditions of
this contract. The provider further agrees that the department shall not be liable to the subcontractor for any expenses or
liabilities incurred under the subcontract and the provider shall be solely liable to the subcontractor for all expenses and
liabilities incurred under the subcontract. The provider, at its expense, will defend the department against such claims.
3. That the State of Florida shall at all times be entitled to assign or transfer its rights, duties, or obligations under this
contract to another governmental agency in the State of Florida, upon giving prior written notice to the provider. In the
event the State of Florida approves transfer of the provider's obligations, the provider remains responsible for all work
performed and all expenses incurred in connection with the contract. In addition, this contract shall bind the successors,
assigns, and legal representatives of the provider and of any legal entity that succeeds to the obligations of the State of
Florida.
4. To make payments to the subcontractor within seven (7) working days after receipt of full or partial payments from
the department in accordance with section 287.0585, FS, unless otherwise stated in the contract between the provider and
subcontractor. Failure to pay within seven (7) working days will result in a penalty charged against the provider and raid
to the subcontractor in the amount of one-half of one (1) percent of the amount due per day from the expiration 0 the
period allowed herein for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen
(15) percent of the outstanding balance due.
J. Return of Funds
To return to the department any overpayments due to unearned funds or funds disallowed pursuant to the terms of this
contract that were disbursed to the provider by the department. In the event that the provider or its independent auditor
discovers that an overpayment has been made, the provider shall repay said overpayment within 40 calendar days
without prior notification from the department. In the event that the department first discovers an overpayment has been
made, the department will notify the provider by letter of such a finding. Should repayment not be made in a timely
manner, the department will charge interest of one (1) percent per month compounded on the outstanding balance after
40 calendar days after the date of notification or discovery.
K. Client Risk Prevention and Incident Reporting
1. That if services to clients will be provided under this contract, the provider and any subcontractors shall, in
accordance with the client risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner
prescribed in CFOP 215-6 or district operating procedures.
2. To immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person,
or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96ABUSE). As required
by Chapters 39 and 415, FS, this is binding upon both the provider and its employees.
L. Transportation Disadvantaged
To comply with the provisions of Chapter 427, FS, and Chapter 41-2, FAC, if clients are to be transported under this
contract. The provider shall submit to the department the reports required pursuant to Volume 10, Chapter 27, DCF
Accounting Procedures Manual.
M. Purchasing
1. To purchase articles which are the subject of or are required to carry out this contract from Prison Rehabilitative
Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, FS, in the same manner and under the
procedures set forth in subsections 946.515(2) and (4), FS. For purposes of this contract, the provider shall be deemed to
be substituted for the department insofar as dealings with PRIDE. This clause is not applicable to subcontractors
unless otherwise required by law. An abbreviated list of products/services available from PRIDE may be obtained by
contacting PRIDE, (850) 487-3774.
2. To procure any products or materials which are the subject of, or are required to carry out this contract, in
accordance with the provisions of sections 403.7065, and 287.045, FS.
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CONTRACT # KG032
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N. Civil Rights Requirements
1. Not to discriminate against any employee in the performance of this contract, or against any applicant for
employment, because of age, race, creed, color, disability, national origin, or sex. The provider further assures that all
contractors, subcontractors, subgrantees, or others with whom it arranges to provide services or benefits to participants or
employees in connection with any of its programs and activities are not discriminating against those participants or
employees because of age, race, creed, color, disability, national origin, or sex. This is binding upon the provider
employing fifteen (15) or more individuals.
2. To complete the Civil Rights Compliance Questionnaire, CF Forms 946 A and S, in accordance with HRSM 220-2.
This is applicable if services are directly provided to clients and if 15 or more individuals are employed.
O. Independent Capacity of the Contractor
1. To be solely liable for the performance of all tasks contemplated by this contract which are not the exclusive
responsibility of the department.
2. To act in the capacity of an independent contractor and not as an officer, employee, or agent of the State of Florida,
except where the provider is a state agency. The provider shall not represent to others that it has the authority to bind the
department unless specifically authorized in writing to do so. In addition to the provider, this is also applicable to the
provider's officers, agents, employees, subcontractors, or assignees, in performance of this contract.
3. Except where the provider is a state agency, neither the provider, its officers, agents, employees, subcontractors,
nor assignees are entitled to state retirement or state leave benefits, or to any other compensation of state employment as
a result of performing the duties and obligations of this contract.
4. To take such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be
an independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the
State of Florida.
5. The department will not furnish services of support (e.g., office space, office supplies, telephone service, secretarial
or clerical support) to the provider, or its subcontractor or assignee, unless justified by the provider and agreed to in
advance by the department in Attachment I.
6. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation
funds, and all necessary insurance for the provider, the provider's officers, employees, agents, subcontractors, or
assignees shall be the responsibility of the provider.
P. Sponsorship
As required by section 286.25, FS, if the provider is a nongovernmental organization which sponsors a program financed
wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or
describing the sf:)onsorship of the program state: "Sponsored by (provider's name) and the State of FlOrida, Department
of Children and Families.' If the sponsorship reference is in written material, the words "State of Florida, Department of
Children and Families" shall appear in the same size letters or type as the name of the organization.
Q. Final Invoice
To submit the final invoice for payment to the department no more than__~t5_ days after the contract ends or is
terminated. If the. provider fails to do so, all rights to payment are forfeited and the department will not honor any
requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld
until all reports due from the provider and necessary adjustments thereto have been approved by the department.
R. Use Of Funds For Lobbying Prohibited
To comply with the provisions of sections 11.062 and 216.347, FS, which prohibit the expenditure of contract funds for the
purpose of lobbying the Legislature, judicial branch, or a state agency.
S. Public Entity Crime
Pursuant to section 287.133, FS, the following restrictions are placed on the ability of persons convicted of public entity
crimes to transact business with the department: When a person or affiliate has been placed on the convicted vendor list
following a conviction for a public entity crime, he/she 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 the repair of a public
building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform
work as a contractor, supplier, subcontractor, or consultant 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, FS, for CATEGORY TWO
for a period of 36 months from the date of being placed on the convicted vendor list.
T. Patents, Copyrights, and Royalties
1. If any discovery or invention arises or is developed in the course or as a result of work or services performed under
this contract, or in anyway connected herewith, the provider shall refer the discovery or invention to the department to be
referred to the Department of State to determine whether patent protection will be sought in the name of the State of
Florida. Any and all patent rights accruing under or in connection with the performance of this contract are hereby
reserved to the State of Florida.
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2. In the event that any books, manuals, films, or other copyrightable materials are produced, the provider shall notify
the Department of State. Any and all copyrights accruing under or in connection with the performance under this contract
are hereby reserved to the State of Florida. .
3. The provider, without exception, shall indemnify and save harmless the State of Florida and its employees from
liability of any nature or kind, including cost and expenses for or on account of any copyrighted, patented, or unpatented
invention, process, or article manufactured by the provider. The provider has no liability when such claim is solely and
exclusively due to the Department of State's alteration of the article. The State of Florida will provide prompt written
notification of claim of copyright or patent infringement. Further, if such claim is made or is pending, the provider may, at
its option and expense, procure for the Department of State, the right to continue use of, replace, or modify the article to
render it non-infringing. If the provider uses any design, device, or materials covered by letters, patent, or copyright, it is
mutually agreed and understood without exception that the bid prices shall include all royalties or costs arising from the
use of such design, device, or materials in any way involved in the work.
U. Requirements of Section 20.19, F.S.
That the department shall file a lien against the property where facilities are located which have been constructed or
substantially renovated, in whole or in part, through the use of state funds. However, the department is not required to
file a lien if the amount of state funds does not exceed $25,000 or 10 percent of the contract amount, whichever amount
is less. As a condition of receipt of state funding for this purpose, the provider agrees that, if it disposes of the property
before the department's interest is vacated, the provider will refund the proportionate share of the state's initial
investment, as adjusted by depreciation.
II. THE DEPARTMENT AGREES:
A. Contract Amount
To pay for contracted services according to the conditions of Attachment I in an amount not to exceed
$63,788.00 , subject to the availability of funds. The State of Florida's performance and obligation to pay under
this contract is contingent upon an annual appropriation by the Legislature. Any costs or services paid for under any other
contract or from any other source are not eligible for payment under this contract.
B. Contract Payment
Pursuant to section 215.422, FS, the department has five (5) working days to inspect and approve goods and services,
unless the bid specifications, purchase order, or this contract specifies otherwise. With the exception of payments to
health care providers for hospital, medical, or other health care services, if payment is not available within 40 days,
measured from the latter of the date a properly completed invoice is received by the department or the goods or services
are received, inspected, and approved, a separate interest penalty set by the Comptroller pursuant to section 55.03, FS,
will be due and payable in addition to the invoice amount. To obtain the applicable interest rate, contact the district fiscal
office/contract administrator. Payments to health care providers for hospital, medical, or other health care services, shall
be made not more than 35 days from the date eligibility for payment is determined. Financial penalties will be calculated
at the daily interest rate of .03333%. Invoices returned to a vendor due to preparation errors will result in a payment
delay. Interest penalties less than one dollar will not be enforced unless the vendor requests payment.
C. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of Banking and Finance. The duties of this individual
include acting as an advocate for vendors who may be experiencing problems in obtaining timely payment(s) from a state
agency. The Vendor Ombudsman may be contacted at (850) 488-2924 or 1-800-848-3792, the State of Florida
Comptroller's Hotline.
III. THE PROVIDER A~D DEPARTMENT MUTUAllY AGREE:
A. Effective and Ending Dates
This contract shall begin on October 1, 2000 or on the date on which the contract has been signed by
both parties, whichever is later. It shall end on June 30, 2001
B. Termination: At Will, Because of lack of Funds, or For Breach or Failure to Satisfactorily Perform Prior
Agreement
1. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days notice in
writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be
delivered by certified mail, return receipt requested, or in person with proof of delivery.
2. In the event funds to finance this contract become unavailable, the department may terminate the contract upon no
less than twenty-four (24) hours notice in writing to the provider. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery. The department shall be the final authority as to the availability and
adequacy of funds. In the event of termination of this contract, the provider will be compensated for any work
satisfactorily completed prior to notification of termination.
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CONTRACT # KG032
1/1/99
3. This contract may be terminatea ror the provider's non-performance upon no less than twenty-four (24) hours notice
in writing to the provider. If applicable, the department may employ the default provisions in Chapter 60A-1.006 (3), FAC.
Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other breach and shall not be
construed to be a modification of the terms of this contract. The provisions herein do not limit the department's right to
remedies at law or in equity.. .
4. Failure to have performed any contractual obligations with the department in a manner satisfactory to the department
will be a sufficient cause for termination. To be terminated as a provider under this provision, the provider must have: (1)
previously failed to satisfactorily perform in a contract with the department, been notified by the department of the
unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the department; or
(2) had a contract terminated by the department for cause.
C. Renegotiation or Modification
Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly signed by
both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level increases
and chanQes in the rate of payment when these have been established through the appropriations process and
subsequently identified in the department's operating budget.
D. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
1. The provider name, as shown on_page 1 of this 3. The name, address, and telephone number of the
contract, and mailing address of the official payee to whom contract manager for the department for this contract is:
the payment shall be made is:
Monroe County In Home Services
5100 ColleQe Road
Key West, FL 33040
Theresa Phelan
Department of Children and Families
1111 12th Street #301
Key West, FL 33040
305/292-6810
2. The name of the contact person and street address 4. The name address, and telephone number of the
where financial and administrative records are maintained representative of the provider resronsible for administration
is: of the program under this contrac is:
Deloris Simpson Deloris Simpson
Monroe County In Home Services Monroe County In Home Services
5100 ColleQe Road 5100 ColleQe Road, Key West, FL 33040
Key West. FL 33040 305/292-4589
5. Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
E. All Terms and Conditions Included
This contract and its attachments as referenced I, II and Exhibits A, B, C & D
contain all the terms and conditions agreed upon by the parties. There are no provisions, terms, conditions, or obligation~
other than those contained herein, and this contract shall supersede all previous communications, representations, or
agreements, either verbal or written between the parties. If any term or provision of the contract is found to be illegal or
unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be
stricken.
The parties have read the entire contract inclusive of all its attachments, as referenced in Paragraph III.E. above,
and understand each section and paragraph.
INffiV\lITNESS THEREQF,-the parties hereto have caused this _32_ page contract to be executed by their undersigned
o IClals as duly authOrized.
PROVIDER: STATE OF FLORIDA
DEPARTMENT OF CHILDREN AND FAMILIES
SIGNED BY~ ~ ~
NAME: Charles M. Auslander \
\
District Administrator
TITLE:
./ cr /;{i'J /'erp
/' ./
Provider Fiscal Year E ing Date:~/-2L
APfJROV' ~ ',) f\S -IO Foa~'l..l
- :~ L~;F~~9~ () CONTRACT # KG032
A~,;:,\:~':~. DL;;. ::~ L~:,~..J ('\<_~.15~1
.7.
6
/ ZANNE A. H~ON
r"ll\TE Iq/{i~ fI7)
07/0112000
Community Care f< lisabled AdultslFixed Price
Adult Services Program
ATTACHMENT I
A. Senrices to be Provided
1. Definition of Terms
a. Contract Terms
(1) Amendment - A document by which substantial changes are made
to the terms of an executed contract. (Changes requiring an amendment
include, but are not limited to, adjustments in costs, services, time
period, and methods of payment. The amendment is incorporated as
part of the original contract.)
(2) Contract - An agreement between the department and an individual
or organization for the procurement of services. (A formal contract
consists of the Standard Contract, Program Specific Model Attachment
lor Attachment I, plus all attachments or exhibits.)
(3) Contract Manager - Either a department or provider employee
designated by the contract signer to be responsible for the success of the
contract. (The contract manager enforces performance of the contract
terms and conditions and often serves as a liaison between the
department and the provider.)
(4) Department - The Florida Department of Children and Families.
(5) District - The Florida Department of Children and Families'
territorial division pertains to a geographical service area.
(6) Exhibit - A document or material object added to the Program
Specific Model Attachment I, or any other district specific attachment I.
(7) Fiscal Year - An accounting period of twelve months; July Pl_..
through June 30th.
(8) Fixed Price - A payment method used when services can be broken
down into unit costs (e.g., hours, client days), or a fixed fee (e.g.,
payment based on delivery of a complete service).
(9) Invoice - A standardized form used by the provider to request
payment from the department.
Revised 5/5/2000
7
PSMAI No. GA08
Contract No. KG032
07/0112000
Community Care Disabled AdultsIFixed Price
Adult Services Program
(10) Local Match - A contribution, in cash or in kind, specified by the
funding source to be used in conjunction with the donation of the
funding source, and upon which receipt of that donation is contingent.
(11) Method of Payment - A payment specification includes the
maximum dollar amount of the contract, the manner in which contract
costs will be displayed on invoices, the frequency with which invoices
will be submitted to the department, and any special conditions
pertaining to payment of contract invoices.
(12) Provider - An individual or organization contracted to provide
services or materials to the department, in accordance with the terms
specified in the contract.
b. Program or Senrice Specific Terms
A glossary of approved terms is contained in The Community Care for
Disabled Adults Instructional Guide, (CCDA Instructional Guide), Section D,
which is maintained as part of the contract file and incorporated herein by
reference..
(1) Activities of Daily Living (ADL) - Basic activities performed in the
course of daily living, such as dressing, bathing, grooming, eating,
toileting, and ambulating around one's own home.
(2) Client - Any person at least eighteen years old, but under sixty
years of age, who has one or more permanent physical or mental
limitations that restrict his ability to perform normal activities of daily
living, and impede his capacity to live independently or with relatives
or friends without the provision of community-based services.
(3) Medicaid Institutional Care Program (MICP) - A program that
serves Medicaid recipients who are determined eligible for a nursing
home level of care, which provides primary, acute, and long-term care
services at capitated federally-matched rates. (The average cost per
client cannot exceed the average general revenue portions of Medicaid
nursing home beds within a district.)
2. General Description
a. General Statement
The Community Care for Disabled Adults (CCDA) program is designed to
assist disabled adults, age eighteen through fifty-nine, in utilizing available
Revised 5/5/2000
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community and personal resources to help them remain in their homes, and to
prevent them from premature or unnecessary institutionalization.
Service providers will ensure that appropriate community-based services
(including the duration, frequency, and scope of the care plan) are provided to
clients in a manner developed to meet the client's changing needs.
b. Authority
Sections 410.601-606, Florida Statutes (F.S.), Chapter 65C-2, Florida
Administrative Code (F.A.C.), and the annual appropriations act, with any
proviso language or instructions to the department, constitute the legal basis for
services to be delivered through the CCDA program.
c. Scope of Senrice
Services will be targeted toward eligible adults, age eighteen through fifty-
nine, in Monroe County, Florida.
d. Major Program Goal
The community-based services provided under this contract are designed to
prevent unnecessary institutionalization of disabled adults.
3. Clients to be Served
a. General Description
Adults with disabilities, age eighteen through fifty-nine, who are no longer
eligible to receive children's services, and are too young to qualify for
community and home-based services for the elderly, may be served by the
provisions of this contract.
b. Client Eligibility
(I) Clients must have one or more permanent physical or mental
limitations, which restricts the ability to perform normal activities of
daily living, as determined through the initial functional assessment and
medical documentation of disability. Determination of a disability must
be established and evidenced in one of the following manners:
(a) The client may present a check, awards letter, or other proof
showing receipt of Social Security Disability, or some other
disability payment (e.g., Worker's Compensation).
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(b) The client may present a written statement from a licensed
physician, licensed nurse practitioner, or ment~l health
professional, which meets the district's criteria for evidence of a
disability. This written statement must, at a minimum, include
the client's diagnosis, prognosis, a broad explanation of level of
functioning, and the interpretation of need for services based on
identified functional barriers caused by the client's disabling
condition.
(2) Clients whose individual incomes exceed the prevailing Medicaid
Institutional Care program eligibility standard will be assessed a fee for
CCDA services, as found in Rule 65C-2.007, F.A.C. Applicants
assessed for a share of the costs may provide volunteer services in lieu
of payment.
c. Client Determination
(1) Clients will be assessed for eligibility determination and prioritized
for services by district or provider case management staff in accordance
with s. 410.604 (2), F.S.
(2) The department will determine client eligibility for this program.
The department's contract manager will make the final determination in
the event of a dispute regarding client eligibility.
(3) Clients must not be receiving comparable services from any other
entity. In order to prevent duplication of services, client files must
contain documentation verifying that all comparable community
services and funding sources have been explored and exhausted.
d. Contract Limits
(I) The total annual cost, estimated or actual, for an individual
receiving CCDA services shall not exceed the annual general revenue
portion of a Medicaid nursing home bed within the district area.
(2) The provider shall deliver services only to those persons who meet
program eligibility criteria, and only to the extent the funds are
available.
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Adult Services Program
B. Manner of Senrice Provision
1. Senrice Tasks
a. Task List
(1) This contract will provide for the following CCDA services. The
CCDA Instructional Guide provides descriptions and minimum
requirements for each service listed below: (Services are marked
accordingly [8J)
DAdult Day Care [8JCase Management DEmergency Alert
Response
[8JPersonal Care DHome Health Aide DGroup Activity
Therapy
~Homemaker DHome Nursing [8JHome Delivered
Meals
DInterpreter DTransportation DMedical Therapeutic
Services
~Chore DRespite DPhysical and Mental
Exams
DEscort
(2) Details of services to be provided under this contract and the
negotiated parameters of those services are as indicated in the CCDA
Instructional Guide, incorporated herein by reference.
b. Task Limits
(I) Each district CCDA program shall include case management
services and at least one other community service.
(2) Respite care may be provided for up to 240 hours per client per
calendar year, depending upon individual need. The service may be
extended to 360 hours, as recommended by the case manager with.
documentation of approval by their immediate supervisor evident in the
case manager's file.
(3) Personal Care Services will not substitute for the care usually
provided by a registered nurse, licensed practical nurse, therapist, or
home health aide. The personal care aide will not change sterile
dressings, irrigate body cavities, administer medications, or perform
other activities prohibited by Chapter 59A-8, F.A.C.
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(4) Homemaker service time does not include time spent in transit to
and from the client's place of residence except when providing
shopping assistance, performing errands or other tasks on behalf of a
client.
(5) Several restrictions apply to persons providing Homemaker Service
activities. Persons providing services must not
(a) engage in work that is not specified in the Homemaker
assignment
(b) accept gifts from clients
(c) lend or borrow money or articles from clients
(d) handle client money, unless authorized in writing by a
supervisor or case manager (as evident in the personnel file) and
unless bonded or insured by the employer
(e) transport clients, unless authorized in writing by a
supervisor or case manager.
(6) The parameters of service delivery, by type of service, are detailed
in the CCDA Instructional Guide.
(7) District task limits, which exceed those in the CCDA Instructional
Guide, and are distinctive to this contract, are listed here: There are no
District specific limits..
2. Staffing Requirements
3. Staffing Levels
(1) The provider will notify the department within thirty days
whenever the provider is unable, or appears unable, to provide the.,
required quality or quantity of service because of staff inadequacies.
(2) The provider will meet the minimum staffing requirements for each
service, as specified in the CCDA Instructional Guide.
b. Professional Qualifications
The provider will ensure that staff meets the professional qualifications for
each service as specified in the CCDA Instructional Guide.
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c. Staffing Changes
The provider agrees to notify the department's contract manager within two
working days if an administrative position (e.g., executive director) becomes
vacant. Planned staffing changes that may affect program objectives, as
stipulated in this contract, must be presented in writing to the contract manager
for approval at least two weeks prior to the implementation of the change.
d. Subcontractors
The provider is responsible for the performance of its subcontractors. Copies
of all performance monitoring reports shall be made available to the
department.
3. Service Location & Equipment
a. Senrice Delivery Location & Times
(1) CCDA services may be delivered in the client's home or on-site at
a facility, as negotiated by the department and the provider.
(2) Facilities delivering on-site services to clients shall pass an annual
inspection by the local environmental health and fire authorities.
(3) Service providers will meet the minimum service location and time
requirements as specified in the CCDA Instructional Guide.
(4) Services for this contract will be delivered at the following
location(s) and times:
SERVICE LOCATION TIME
Case Management Client's Home As Needed
Homemaking Client's Home As Needed
Home Delivered Meals Client's Home As Needed
Personal Care Client's Home As Needed '--
Chore Client's Home As Needed
b. Changes in Location
The department and the provider must negotiate location of service delivery, as
indicated above. Once the service delivery location is agreed upon, any
proposed change must be presented in writing to the contract manager for
approval, prior to implementation of that proposed change. In the event of an
emergency, temporary changes in location may necessitate waiver of this
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designated standard by the district's program office. Such a waiver will take
into consideration the continuity, safety, and welfare of the department's
clients, and is at the department's sole discretion.
c. Equipment
(1) The equipment required to perform the contracted services must be
negotiated by the department and the provider. To ensure uniformity,
safety, and quality of service to clients, any requests for equipment
change must be presented in writing to the contract manager for
approval at least ten days prior to any proposed change.
(2) The provider must inventory all equipment acquired under this
contract annually. The inventory list must be made available within
seven days upon receipt of written request by the contract manager.
4. Deliverables
a. Senrice Units
A service unit is an appropriate, distinct amount of given service, which may
include, but is not limited to, an hour or quarter hour of direct service delivery;
a meal; an episode oftrave1; or a twenty-four-hour period of Emergency Alert
Response maintenance, as defined in the CCDA Instructional Guide.
b. Reports
(1) Reporting requirements for this contract include Exhibit A,
Monthlv Summary Reoorts and Exhibit B, Quarterlv Cumulative
SummarY Reoorts. Districts will negotiate with the provider on specific
submission requirement criteria for these reports.
(2) Providers of case management services agree to submit quarterly
reports, which include management program data (e.g., client
identifiable. data) to the department, according to negotiated instructions
provided by the districts. The quarterly reports are due according to the
following schedule:
Quarterly Cumulative Summary Report Due Date
three month October 30
six month February 15
nine month April 30
twelve month August 15
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(3) Providers will submit the twelve month Quarterly Cumulative
Summary Report, Exhibit B, to the department within forty days after
the contract ends or is terminated. This report identifies the total units
of service and the total payment received. Any monies paid by the
department as a result of an overpayment must be returned to the
department with this report.
(4) The Provider agrees to submit to the Department Contract Manager
an original signed Security Agreement Form(s) CF-l14, Exhibit C, for
all required personnel no later than thirty (30) days following the
execution of this contract or thirty (30) days from date of
employment. All personnel who require access to departmental
information must sign the Security Agreement Form prior to receiving
access to the information.
c. Records and Documentation
(1) Case Management provider files shall contain the following:
(a) a completed client assessment (not more than one year old)
(b) a care plan (not more than one year old)
(c) a release of information form
(d) a copy ofa completed Client Information System (CIS)
form
(e) documentation of the client's age, disability, and income
(f) a copy of the referral/intake form
(g) a case narrative.
(2) Providers shall maintain information on each client served by this
contract, which includes the following:
(a) documentation of the client by name or unique identifier
(b) current documentation of eligibility for services
(c) number of service units provided
(d) dates of service provision and delivery
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(e) information documenting the client's need to receive
services
(t) the number of service units provided
(g) all other forms or records necessary for program operation
and reporting, as set forth by the department.
(3) Providers must ensure that all client records match the invoices
submitted for payment. Records must track to each invoice for
payment.
(4) Providers must maintain documentation necessary to facilitate
monitoring and evaluation by the department.
(5) The case management provider must maintain documentation in the
client's file that all existing funding sources have been explored and
exhausted before using CCDA funding.
5. Performance Specifications
a. Performance Measures (Outcomes and Outputs)
(1) 99% of clients will not be placed in a nursing home.
(2) 40 clients will be served through this contract.
(3) 95 % of clients will be satisfied with services, based on responses to the
Department's Client Satisfaction Survey.
The provider will survey 100% of its clients. Satisfaction is deternlined by
calculating a percentage of client responses that "agree" and "strongly agree"
to question # 1 0, which states, "Overall, I am satisfied with the services that I
received."
The provider is required to use the Department's Client Satisfaction Survey
and must follow the prescribed process for distribution and collection. The
appointed program or district coordinator will provide instructions for the
district staff. The district staff will distribute the survey and instructions to
the provider.
b. Standards Definitions
(I) Clients - Eligible individuals who have met the eligibility criteria
outline in A.3.b of this Attachment, and who have received case
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management or any of the other services funded through the CCDA
program during the fiscal year evaluated.
(2) Placed - Assessment of an individual who is no longer able to
remain in his present place of residence (To place a client involves
preparation for and follow up of moving a client into a more restrictive
alternative living environment.)
(3) Nursing home - Any facility, which provides nursing services as
defined in Chapter 464, and which is licensed in accordance with
Chapter 400, F.S.
(4) Will be served - The eligible individuals who will receive case
management or negotiated service under this contract.
c. Monitoring and Evaluation Methodology
All monitoring activity performed by the District will be in accordance with
CFOP 75-8, Contract Monitoring.
(a) By execution of this contract, the provider hereby
acknowledges and agrees that its performance under the contract
must meet the standards set forth above and will be bound by
the conditions set forth below. If the provider fails to meet these
standards, the department, at its exclusive option, may allow up
to six months for the provider to achieve compliance with the
standards. If the department affords the provider an opportunity
to achieve compliance, and the provider fails to achieve
compliance within the specified time frame, the department will
terminate the contract in the absence of any extenuating or
mitigating circumstances. The determination of the extenuating
or mitigating circumstances is the exclusive determination of the
department.
(b) The Contract Performance Unit ("CPU") may elect to
perform an on-site administrative and programmatic monitoring
during the contract period. At a minimum, an annual desk
monitoring will be performed which will be accomplished by a
combination of the review(s) of reports or other documentation
submitted by the provider, input from service recipients and
others, and visits to the site of service delivery for programmatic
reVIew.
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(c) For on-site monitorings, a random discovery sample of
open and closed files will be taken for review. This sample may
be increased to a random statistical sample depending on the
results of our review. The number of files reviewed will be
contingent upon the population size of services rendered. To
facilitate the sampling process, upon CPU request, the provider
shall submit an universal events listing of all services provided
under the contract prior to the monitoring visit.
(d) A report outlining the department's findings during the
on-site monitoring will be submitted to the provider within 30
days of concluding field work with an exit conference. The
provider agrees to respond and submit a corrective action plan,
ifrequired, within 30 days of receiving the department's
monitoring report.
d. Performance Definitions
The contract period is defined as October 1,2000 through June 30, 2001.
6. Provider Responsibilities
a. Provider Unique Activities
In addition to the approved application or program proposal, the provider will
be required to use volunteers to the fullest extent feasible in the provision of
services and program operations. The provider is required to train, supervise,
and appropriately support all volunteers with insurance coverage.
b. Coordination With Other ProviderslEntities
(1) The case management provider must coordinate, as necessary, with
the Vocational Rehabilitation Division of the Department of Labor and
Employment Securities, The Developmental Services Office of the
Department of Children and Families, the Department of Education,
The Department of Health, and the Human Rights Advocacy
Committee, to serve those clients who are eligible for services through
two or more service delivery continuums.
(2) All providers must comply with the local environmental health and
fire authorities' annual inspections.
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7. Departmental Responsibilities
a. Department Obligations
(1) The department will supply all new providers with a copy of the
CCDA Program Manual (HRSM 140-8) and the CCDA Instructional
Guide.
(2) The department will provide CCDA technical assistance to the
provider, relative to the negotiated terms of this contract and
instructions for submission of required data.
b. Department Determinations
Should a dispute arise, the department will make the final determination as to
whether or not the contract terms are being fulfilled according to the contract
specifications.
C. Method of Payment
1. Payment Clause
a. This is a Fixed Price contract. The department shall pay the provider for
the delivery of service units provided in accordance with the terms of this
contract for a total dollar amount not to exceed $63,788.00, subject to the
availability of funds.
b. The department shall make payment to the provider for provision of
services up to the maximum number of units of service at the rates shown
below:
Senrice Unit Rate Maximum Units
-~ . ~ . TotallDepartment to be Delivered
Case Management $39.97/ Hour 410 Hours
Homemaker Services $22.78/ Hour 674 Hours
Home Delivered Meals $ 4.50 / Meal 5030 Meals
Personal Care $27.13/ Hour 314 Hours
Chore $28.82 / Hour . 31 Hours
c. The provider's dollar match for this contract is $7,086.00. Case
management and transportation services may be exempt from match
requirement at the discretion of each district.
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2. Invoice Requirements
The provider shall request payment through submission of a properly completed
Invoice, Exhibit D, within 15 days following the completion of all terms and
conditions for the delivery of service under this contract. If the provider fails to do so,
all right to payment is forfeited, and the department will not honor any requests
submitted after the aforesaid time period. Payment due under this contract will be
withheld until the department has approved the final product. Replication of the form
via data processing equipment is permissible; replications must include all data
elements included on the departmental form.
3. Supporting Documentation
a. The provider shall submit an original invoice for payment to the contract
manager on a monthly basis. The due date for these invoices is the 15th day of
the month following the month being reported.
b. It is expressly understood by the provider that any payment due the provider
under the terms of this contract may be withheld pending the receipt and
approval by the department of all financial and program reports due from the
provider as a .part of this contract and any adjustments thereto. Requests for
payment that cannot be documented with supporting evidence will be returned
to the provider upon inspection by the department.
c. The provider must maintain records documenting the total number of
recipients and names (or unique identifiers) of recipients to whom services
were provided and the dates the services were provided so that an audit trail
documenting service provision can be maintained.
4. Medicaid Billing
The department and the provider specifically agree and acknowledge that the
Medicaid program is the payor of last resort and:
a. in no event shall the provider bill the Medicaid program for services or
expenses for Medicaid recipients for which the provider has already been paid
by any other liable third party, and
b. provider services covered under the Florida Medicaid program for Medicaid
recipients may be billed to the Medicaid program by the provider, unless the
provider is already being paid by any other liable third party, and
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c. authorized provider services to non-Medicaid recipients, or for non-
Medicaid covered services, may only be billed to the department or any other
non-Medicaid first or third party payor, and
d. the provider shall identify and report Medicaid earning separate from all
other fees, and
e. Medicaid earnings cannot be used as local match, and
f. the provider will ensure that Medicaid payments are accounted for in
compliance with federal regulations, and
g. in no event shall both Medicaid and the department be billed for the same
servIce.
D. Special Provisions
1. Fees
a. The provider will collect fees for services provided according to Rule 65C-
2.007, F.A.C.
b. No fees shall be assessed other than those set by the department. Fees
collected in compliance with the department directives will be disposed of in a
manner prescribed by the department.
2. Florida Statewide Advocacy Council
The provider agrees to allow properly identified members of the Florida Statewide
Advocacy Council, formerly the Human Rights Advocacy Committee, access to the
facility or agency and the right to communicate with any client being served, as well as
staff or volunteers who serve them in accordance with s. 402.165(8)(a) & (b), F.S.
Members of the Florida Statewide Advocacy Council shall be free to examine all--
records pertaining to any case unless legal prohibition exists to prevent disclosure of
those records.
3. Information Technology Resources.
All contract providers must adhere to the Department's procedures and standards when
purchasing Information Technology Resources (ITRs) as part of this contract. These
resources will revert to the Department at the conclusion of the contract. ITRs are data
processing hardware, software, service, supplies, maintenance, training, personnel, and
facilities. The provider agrees to secure prior written approval through the contract
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manager from the District Management Systems Director for the purchase of any ITR.
The provider will not be reimbursed for any purchase made prior to this written
approval.
4. Provider Proposal
Provider proposal is hereby incorporated by reference for programmatic assurance of
service provision. This proposal will be part of the contract manager's file.
5. Morals Clause
The provider understands that performance under this contract involves the
expenditure of public funds from both the state and federal governments, and that the
acceptance of such funds obligates the provider to perform its services in accordance
with the very highest standards of ethical and moral conduct. Public funds may not be
used for purposes of lobbying, or for political contributions, or for any expense related
to such activities, pursuant to Section I R of the Standard Contract ofthis contract.
. The provider understands that the Department is a public agency which is mandated to
conduct business in the sunshine, pursuant to Florida Law, and that all issues relating
to the business ofthe Department and the provider are public record and subject to full
disclosure. The provider understands that attempting to exercise undue influence on
the Department and its employees to allow deviation or variance from the terms of this
contract other than negotiated, publicly disclosed amendment, is prohibited by the
State of Florida, pursuant to Section III C of the Standard Contract. The provider's
conduct is subject to all state and federal laws governing the conduct of entities
engaged in the business of providing services to government.
6. Year 2000 Compliance Warranty (Existing Hardware and Software)
The provider shall warrant that their existing hardware and software shall not
experience abnormal ending and/or produce invalid or incorrect results in the operation
of the business of the State after the turn of the century. In the event of any
recognition, calculation, or indication of century problems related to the Year 2000,
the provider shall warrant that they will make all code adjustments necessary at no cost
to the State in order to ensure that the code and databases are "Year 2000 Compliant".
The warranty shall be in effect until December 31, 2000 or one year after system
reconfiguration, which ever is later.
Year 2000 compliant: "Year 2000 compliance" means that information resources meet
the following criteria and/or perform as described.
a. Data structures (databases, data filed, etc.) provide 4-digit data century
recognition. Example: "1996" provides "data century recognition", "96 does
not.
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b. Stored data contains date century recognition, including (but not limited to)
data stored in databases and hardware/device internal system dates.
c. Calculations and program logic accommodate both same century and multi-
century formulas and data values. Calculations and logic include (but are not
limited) sort algorithms, calendar generations, event recognition, and all
processing actions that use or produce data values.
d. Interfaces (to and from other systems or organization) prevent non-compliant
dates and data from entering or exiting any state system.
e. User interfaces-(i.e. screens, reports, etc.) accurately show 4-digit years (if
critical to business functions).
f. Year 2000 is correctly treated as a leap year within all calculation and calendar
logic.
7. Year 2000 Compliance Warranty-(New Hardware and Software
Purchases)
For purposes of this Year 2000 warranty, the term "Product" shall include software,
firmware, microcode, hardware and embedded chip technology.
Provider warrants that the Product is Year 2000 Compliant. All versions of the
Product offered by the provider and purchased by the State, for which provider is
obligated to provide maintenance service are, and in the future, will be, Year 2000
Compliant. Year 2000 Compliant means the Product will include the ability to:
consistently handle date information before, during, and after January 1, 2000,
including accepting date input, providing date output, and processing dates; function
before, during and after January 1,2000, without the need for program changes caused
by the advent of the new century; properly handle all date related information before
and following Jan. 1, 2001, including but not limited to accurate and reliable
performance in processing date and date related data, including calculating, comparing
and sequencing; properly process any and all date calculations before, on and after- the
leap year date of February 29, 2000 and store and provide output of date information in
ways that are unambiguous as to century.
The duration of this warranty and the remedies available to the State for breach of this
warranty shall be defined in, and subject to, the terms and limitations of any general
warranty provisions of this contract, provided that notwithstanding any provision to
the contrary in such warranty provision(s), or in the absence of any such warranty
provision(s), defects in the Product with regard to Year 2000 Compliance, if any, will
be corrected by provider at provider's cost within a timeframe mutually agreed upon
with the State. Provider cannot be held responsible for errors resulting from devices or
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systems external to this contract which are permitted to directly access any database
provided under this Agreement and overwrite Product date fields or from the users
improper integration of non- Year 2000 Compliant systems. Nothing in this warranty
shall be construed to limit any rights or remedies the State may otherwise have under
this contract with respect to defects other than Year 2000 performance.
8. Year 2000 Remedy Clause
In the event of any decrease in product functionality related to time and date related
codes and internal subroutines that impede the hardware or software programs from
operating beyond the Millennium Date Change, Licensors and providers or Licensors
products, agree to immediately make required corrections to restore hardware and
software programs to the same level of functionality as warranted herein at no charge
to the licensee, and without interruption to the ongoing business of the licensee, time
being of the essence.
9. ReseUers
All products bid under this bid/contract will be Year 2000 compliant. Year 2000
Compliant means the Product will include the ability to: consistently handle date
information before, during, and after January 1,2000, including accepting date input,
providing date output, and processing dates; function before, during and after January
1, 2000, without the need for program changes caused by the advent of the new
century; properly handle all date related information before and following Jan. 1, 2001,
including but not limited to accurate and reliable performance in processing date and
date related data, including calculating, comparing and sequencing; properly process
any and all date calculations before, on and after the leap year date of February 29,
2000 and store and provide output of date information in ways that are unambiguous
as to century. Resellers may provide a "pass through warranty" from the
manufacturer/software developer, which meets all the warranty requirements by the
State, and which shall include all other warranties provided by the manufacturer or
software developer. Reseller shall be responsible for warranty assurance, assistance,
enforcement and any other actions or remediation, required to satisfy warranty
requirements.
10. Incident Reporting
All providers will be required to document reportable incidents, as set forth in CFOP
215-6, paragraph 3, in the following manner:
a. The provider must fill out an incident report, as set forth in CFOP 215-6, for
each incident occurring during the administration of its program.
b. A copy of the incident report must be placed in a central file marked "Incident
Report", in each client's file involved in the incident and immediately forward a
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copy of the incident report to the contract manager for the Department. The
contract manager shall then be responsible for dissemination of the incident
report to the program office.
c. If the incident report is an emergency in that the provider is aware that the
health, safety or welfare of any person has been threatened or may be in
imminent danger, the provider shall make telephonic contact with the
department program office immediately.
11. Emergency Plan
The provider shall be responsible for the care, maintenance and, if necessary, the
relocation of clients during any natural disaster or period of civil unrest. The provider
shall submit its emergency plan to the Department for approval at the time of
submission of the agency's proposal and must be updated on a yearly basis. In case of
evacuation, the emergency plan must identify the method of evacuation, the address of
the emergency or shelter facility to be utilized, and the method of notification ofthe
. Department of the evacuation.
12.
CCDA Medicaid Waiver Transfers
By January 1,2001, the provider will assess all clients being served through t~is
CCDA contract for possible transfer to services provided through the CCDA Medicaid
Waiver program. Contract funding will be evaluated at that time to determine if any
funding can be moved to the CCDA Medicaid Waiver program.
Revised 5/5/2000
25
PSMAI No. GA08
Contract No. KG032
~L('HILADREN .
lS21 & FAMILIES
Exhibit A
Fiscal Year 2000-2001
Community Care for Disabled Adults Monthly Summary Report
Name of Contract Manager:
Contract Number:
District: 11 B
Month Being Reported:
I. Expenditures
(1) Total contracted CCDA dollars:
(2) Total amount spent this month:
(3) Expenditure Percentage Y-T-D:
Unduplicated Client Count This Month:
II. Services
Number of Clients Units Provided This
Name of Service Receiving This Service Month Cost Per Unit
--- . '.' . -~.
ZG,
~LORIDA DEPARTMENT OF
CHILDREN
~ & FAMILIES
Exhibit B
Fiscal Year 2000-2001
Community Care for Disabled Adults Quarterly Summary Report
District:
Name of Contract Manager:
Phone Number: SC
Local
Reporting Period:
3 Month
6 Month
9 Month
12 Month
I. Expenditures
(1) Total CCDA dollars:
(2) Total expenditures this quarter:
(3) Total expenditures spent to date:
(4) Encumbrances *:
(5) Balance:
II. Report Prepared By:
III. Phone Number:
27
~"(IH .rDREN
v & FAMILIES
EXHIBIT C
SECURITY AGREEMENT FORM
The Department of Children and Families has authorized you:
Employee's Name/Organization
to have access to sensitive data through the use of computer-related media (e.g. printed reports,
microfiche, system inquiry, on-line update, or any magnetic media).
Computer crimes are a violation of the department's disciplinary standards and, in addition to
departmental discipline, the commission of computer crimes may result in felony criminal charges.
The Florida Computer Crimes Act, Chapter 815, Florida Statutes, addresses the unauthorized
modification, destruction, disclosure, or taking of information resources.
. I have read the above statements and have been provided a copy of the Computer Related
Crimes Act, Chapter 815, F.S.
. By my signature, I acknowledge that I have received, read and understan.d Chapter 815,
F.S., and have received any necessary clarification from my supervisor.
. By my signature, I acknowledge that it is the policy of the Department of Children and
Families that under no circumstances shall any contract employee have access or be
allowed access to IRS tax information. Such access, if allowed, would be in violation of the
Internal Revenue Code 7213 and may be punishable by fine and/or imprisonment.
I understand that a security violation may result in criminal prosecution according to the provisions
of Chapter 815, F.S., and may also result in disciplinary action against me according to the
provisions in the Employee Handbook. The minimum security requirements are:
. Personal passwords are not to be disclosed.
. Information is not to be obtained for my own or another person's personal use.
Print Employee's Name
Signature of Employee
Date
Print Supervisor's Name
Signature of Supervisor
Date
CF 114, JF 11/99
2<6
Distribution of Copies;... Original. Personnel File/Contract File
Copy. SeCurity File
Copy. Employee
DEPARTMENT OF CHILDREN AND FAMILIES Exhibit D
OFFICE OF FAMILY SAFTEY
MONTHLY REQUEST FOR PAYMENT AND EXPENDITURE REPORT
PROVIDER FED. 10 #
NAME AND MAILING ADDRESS OF PAYEE:
CONTRACT AMNT.:_
REIMBURSEMENT YTD.:_
CONTRACT BALANCE:
DATE:
CONTRACT#:
PERIOD OF SERVICE PROVISION:
NAME OF SERVICE UNITSI AMOUNT PER UNITI TOTAL AMOUNT
OR DESCRIPTION OF MATERIALS QUANTITY EPISODE DUE
TOTAL
TOTAL MATCH REQUIRED PAYMENT
FOR CONTRACT: REQUESTED
THIS MNTH. YTD.
LOCAL CASH MATCH r\ FLORIDA DEPARTMENT OF
LOCAL IN-KIND CHILDREN
TOTAL DEDUCTIONS
.2 & FAMILIES
REMAINING MATCH BALANCE
SIGNITURE OF PREPARER
APPROVED BY
DATE COMPLETED
TITLE
.IF THIS INVOICE IS FOR A FIXED PRICE CONTRACT. THE REQUEST FOR PAYMENT WilL BE DETERMINED
BY DIVIDING THE LENGTH OF THE CONTRACT INTO THE CONTRACTED AMOUNT (EX..SI2.000{ALLOCATIONj DIVIDED BY
12 MONTHS [THE LENGTH OF THE CONTRACTj=Sl.000 PAYMENT REQUEST) ON A COST REIMBURSEMENT CONTRACT
THE PAYMENT REQUEST WILL BE THE MONTHLY REQUEST EXPENSE.
CHILDREN AND FAMILIES USE ONLY
DATE INV. RCD.
APPROVED BY:
DATE
IORG
EO
OBJ
DESC.
AMNT.
IOCA
21
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
This attachment is applicable if the provider is any state or local government entity, non-profit
organization, or for-profit organization. For State or local government entities, a Single Audit perfonned
by the Auditor General shall satisfy the requirements of this attachment. If the provider does not meet any
of the requirements below, no audit is required by this attachment.
PART I: FEDERAL AUDIT REQUIREMENTS
This part is applicable if the recipient is a State or local government or a non-profit organization as defined
in OMB Circular A-I33, as revised.
In the event that the recipient expends $300,000 or more in Federal awards in its fiscal year, the recipient
must have a single or program-specific audit conducted in accordance with the provisions ofOMB Circular
A-133, as revised. In detennining the Federal awards expended in its fiscal year, the recipient shall
consider all sources of Federal awards. The detennination of amounts of Federal awards expended should
be in accordance with guidel1nes established by OMB Circular A-133, as revised. An audit of the recipient
conducted by the Auditor General in accordance with the provisions ofOMB Circular A-133, as revised,
will meet the requirements of this part. In connection with the audit requirements, the recipient shall fulfill
the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-l33, as
revised.
The reporting package shall include a schedule that discloses the amount of expenditures by contract
number for each contract with the department in effect during the audit period. Compliance findings related
to contracts with the department shall be based on contract requirements including any rules, regulations, or
statutes referenced in the contract. The reporting package shall disclose whether or not the matching
requirement was met for each applicable contract. All questioned costs and amounts due to the department
shall be fully disclosed in the report with reference to the department contract involved.
For recipients who are subject to both Part I and Part 11 below, the audit must also address applicable State
audit requirements.
PART II: STATE REQUIREMENTS
In the event the recipient expends a total amount of State financial assistance to carry out state projects
equal to or in excess of $300,000 in any fiscal year of such recipient, the recipient must have a Single or
project-specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable
rules of the Executive Office of the Governor and the Comptroller, and Chapter 10.600, Rules of the
Auditor General. In detennining the State financial assistance expended in its fiscal year, the recipient
shall consider all sources of State financial assistance, including State funds received from the Department
of Children & Families, except that amounts received by a nonstate entity for Federal program matching
requirements shall be excluded from consideration.
07/01/2000
3-D
In connection with the audit requirements addressed in the preceding paragraph, the recipient shall ensure
that the audit complies with the requirements of Section 215.97(7), Florida Statutes. This includes
submission ofa reporting package as defined by Section 215.97(2)(d), Florida Statutes, and Chapter
10.600, Rules of the Auditor General.
The reporting package shall include a schedule that discloses the amount of expenditures by contract
number for each contract with the department in effect during the audit period. Compliance findings
related to contracts with the department shall be based on contract requirements including any rules,
regulations, or statutes referenced in the contract. The reporting package shall disclose whether or not the
matching requirement was met for each applicable contract. All questioned costs and amounts due the
department shall be fully disclosed in the audit report with reference to the specific contract involved.
P ART III: SUBMISSION OF REPORTS
For any of the above requirements, copies of the audit report and any management letter by the independent
auditors shall be submitted within 180 days after the end of the provider's fiscal year or within 30 days of
the recipient's receipt of the audit report, whichever occ.urs first, directly to each of the following, unless
otherwise required by Florida Statutes:
A. Contract manager for this contract
Theresa Phelan, Contract Manager
Department of Children and Families
1111 12th Street, Suite 30 I
Key West, FL 33040
B. District office:
Contract Compliance Unit
Attention: Audit Review Analyst
40 I NW 2nd A venue
Suite # N-92I
Miami, FL 33128
C. Copies of reports for audits conducted in accordance with OMB Circular A-133, as revised, and
required by Part I of this agreement shall be submitted, when required by Section .320(d), OMB
Circular A-133, as revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse
designated in OMB Circular A-I33, as revised (the number of copies required by Sections .320(dXl)
and (2), OMB Circular A-l33, as revised, should be submitted to the Federal Auditing Clearinghouse),
at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East lOth Street
Jefferson, IN 47132
and Other Federal agencies and pass-through entities in accordance with Sections .320(e) and (t),
OMB Circular A-133, as revised.
07/0112000
~/
D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf
of the recipient directly to the Auditor General's Office at the following address:
State of Florida Auditor General
Attn: Ted J. Sauerback
Room 574, Claude Pepper Building
III West Madison Street
Tallahassee, Florida 32302-1450
PART IV: RECORD RETENTION
The provider shall ensure that audit working papers are made available to the department, or its designee,
upon request for a period of five years from the date the audit report is issued, unless extended in writing by
the department.
07/0 1I2000
/};7/