10/16/2002
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STATE OF FLORIDA
DEPARTMENT OF ELDER AFFAIRS
STANDARD CONTRACT
Contract No. XM 194
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THIS CONTRACT is entered into between the State of Florida, Department of Elder Affairs, hereinafter referred
to as the "department", and Monroe County Board of County Commissioners, hereinafter referred to as the
"recipient" .
THE PARTIES AGREE:
I. THE Recipient AGREES:
A. To provide services according to the conditions specified in Attachment(s)~.
B. Federal Laws and Regulations
1. If this contract contains federal funds, the recipient shall comply with the provisions of 45 CFR, Part 74,
and/or 45 CFR, Part 92, and other applicable regulations as specified in AttachmentJ....
2. If this contract contains federal funding in excess of $100,000, the recipient shall comply with all applicable
standards, orders, or regulations issued under Section 306 of the Clean Air Act, as amended (42 U.S.C.
1857(h) et seq,), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368 et seq.), Executive
Order 11738, and Environmental Protection Agency regulations (40 CFR Part 15). The recipient shall report
any violations of the above to the department within ten (10) days of the discovery of any such violation.
3. If this contract contains federal funding the recipient must, prior to contract execution, complete the
Certification Regarding Lobbying form, Attachment VII. If a Disclosure of Lobbying Activities form,
Standard Form III, 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 no more than 10 days after contract execution.
4. The recipient shall comply with the provisions of the U.S. Department of Labor, Occupational Safety and
Health Administration (OSHA) code, 29 CFR, Part 1910.1030.
5. If this contract contains federal funding in excess of $100,000, the recipient or vendor must, prior to
contract execution, complete the Debarment, Suspension, Ineligibility and Voluntary Exclusion Certification
form, Attachment-Y!!L.
C. Civil Rights Certification
1. The recipient gives this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial
assistance to programs or activities receiving or benefitting from federal financial assistance. The recipient
agrees to complete the Civil Rights Compliance Questionnaire, DOEA Form 101 A and B, if services are
provided to consumers and if fifteen (15) or more persons are employed. For recipients employing less than
15 persons, the department requests completion of the Civil Rights Compliance Questionnaire, in
accordance with the Governor's One Florida Initiative, Executive Order 99-281.
2. The recipient assures that it will comply with:
a. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq., which prohibits
discrimination on the basis of race, color, or national origin in programs and activities receiving or
benefitting from federal financial assistance.
b. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits
discrimination on the basis of handicap in programs and activities receiving or benefitting from federal
financial assistance.
c. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefitting from
federal financial assistance.
d. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits
discrimination on the basis of age in programs or activities receiving or benefitting from federal financial
assistance.
e. Section 654 of the Omnibus Budget Reconciliation Act of 1981, as amended, 42 U.S.C. 9849, which
. prohibits discrimination en the basis of race, creed, color, national origin, sex, handicap, political
J affiliation or beliefs in programs and activities receiving or benefitting from federal financial assistance,
f. The Americans with Disabilities Act of 1990, 42 USC 12101, et. seq., which prohibits discrimination
against, and provides equal opportunities for individuals with
disabilities, in employment, public services, and.lO public
accommodations.
g. All regulations, guidelines, and standards as are now or maf"be lawfully adopted under the above
statutes.
3. The recipient shall establish procedures to handle complaints of discrimination involving services or benefits
through this contract. The recipient shall advise consumers, employees, and participants of the right to file
a complaint, the right to appeal a denial or exclusion from the services or benefits from this contract, and
their right to a fair hearing. Complaints of discrimination involving services or benefits through this contract
may also be filed with the Secretary of the department or the appropriate federal or state agency.
4. The recipient agrees that compliance with this assurance is a condition of continued receipt of or benefit
from federal financial assistance, and that it is binding upon the recipient, its successors, transferees, and
assignees for the period during which such assistance is provided. The recipient 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 in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the recipient understands that the Department may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, including but not limited to, termination of and denial of further
assistance.
D. Requirements of Chapter 287, Florida Statutes
1. To submit bills for fees or other compensation for services or expenses in sufficient detail for a proper
preAaudit and post.A.audit thereof. Expenditures prohibited from state funds unless expressly provided by
law include, but are not limited to:
(1) Congratulatory telegrams;
(2) Flowers and/or telephone condolences;
(3) Presentation of plaques for outstanding service;
(4) Entertainment for visiting dignitaries;
(5) refreshments such as coffee and doughnuts;
(6) Decorative items (globes, statues, potted plants, picture frames, wall hangings, etc.);
(7) Greeting cards (section 286.24, F.S.);
(8) Alcoholic beverages;
(9) Portable heaters and fans, refrigerators, stoves, microwave ovens, coffee pots, coffee mugs, etc.;
(10) Clocks for private offices;
(11) Meals, except for those served to inmates and clients of State Institutions.
(12) Lobbying expenses(see section I., paragraph L of this agreement).
2. To follow the policies of the department regarding any and all business travel pursuant to this agreement
and to submit bills for any travel expenses in accordance with section 112.061, Florida Statutes. The State
of Florida Voucher for Reimbursement of Travel Expenses form, or an equivalent form developed by the
recipient, must be completed for all travel funded by this contract. Receipts for car rental, air fare, lodging,
and incidental expenses allowed by statute, are required documentation to be retained on file to support
expenditures. Conference and convention travel require an agenda. Conference, convention, and out-of-
state travel funded by this contract require written authorization from the appropriate authority at the
department. Per diem and meal reimbursement will be paid in accordance with the time periods and rates
specified in statues.
3. To provide units of deliverables, including reports, findings, and drafts as specified in Attachment I to be
received and accepted by the contract manager prior to payment, -
4. To comply with the criteria and final date by which such criteria must be met for completion of this contract
as specified in Section I, Paragraph V., of this contract.
5. To allow public access to all documents, papers, letters, or other materials subject to the provisions of
Chapter 119, Florida Statutes, and made or received by the recipient in conjunction with this contract, It
is expressly understood that substantial evidence of the recipient's refusal to comply with this provision
shall constitute a breach of contract.
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6. To develop procurement procedures for ail services purchased pursuant to this contract and subcontracts
sL:bject to this agreement in accordance with state and federal regulations that encourage competition and
promote a diversity of contractors for services for the elder consumers.
E. Withholdings and Other Benefits
1. The recipient is responsible for Social Security and Income Tax withholdings.
2. The recipient is not entitled to state retirement or leave benefits except where the recipient is a state
agency,
3. Unless justified by the recipient and agreed to by the department in Attachment I, Special Provisions,
Section n/a the department will not furnish services of support (e.g., office space, office supplies,
telephone service, secretarial, or clerical support) normally available to career service employees.
F. Indemnification
If the recipient is a state or local governmental entity, pursuant to subsection 768.28(18) Florida Statutes, the
provisions of this section do not apply,
1. Recipient and all subrecipients agree to indemnify, defend, and hold harmless the department and all of the
department's officers, agents, and employees from any claim, loss, damage, cost, charge, or expense
arising out of any acts, actions, neglect or omission, action in bad faith, or violation of federal or state law
by the recipient, its agents, employees, or subcontractors during the performance of this agreement and
all contracts incorporating this agreement by reference, whether direct or indirect, and whether to any
person or property to which the department or said parties may be subject, except neither recipient nor any
of its subcontractors will be liable under this section for damages arising out of injury or damage to persons
or property directly caused or resulting from the sole negligence of the department or any of its officers,
agents, or employees.
2. Recipient's and subrecipient's obligation to indemnify, defend, and pay for the defense or, at the
department's option, to participate and associate with the department in the defense and trial of any claim
and any related settlement negotiations, shall be triggered by the department's notice of claim for
indemnification to recipient. Recipient's and subrecipient's inability to evaluate liability or its evaluation of
liability shall not excuse recipient's or subrecipient's duty to defend and indemnify the department, upon
notice by the department. Notice shall be given by registered or certified mail, return receipt requested.
Only an adjudication or judgment after the highest appeal is exhausted specifically finding the department
solely negligent shall excuse performance of this provision by recipients and subrecipients. The recipient
shall pay all costs and fees related to this obligation and its enforcement by the department. The
department's failure to notify recipient of a claim shall not release recipient of the above duty to defend.
3. It is the intent and understanding of the parties that the recipient is NOT an agent of the department for
purposes of application of section 768.28, F.S., and is NOT entitled or subject to any of the benefits and
limitations therein. Recipient expressly agrees to and does hereby waive any and all claims or entitlement
to any and all application of section 768.28, F.S., recipient may have or may hereafter acquire by reason
of this agreement or by any interpretation of this agreement and applicable law by any court of law equity,
or by or through any other dispute resolution method or forum, regarding any and all claims that may
directly or indirectly arise from or otherwise involve recipient's direct or indirect involvement, obligations,
or benefits under this agreement. Not withstanding the foregoing provisions, nothing in this agreement shall
serve as a waiver of sovereign immunity, or any other defense, by the department. Neither the recipient
nor any of its subcontractors, are employees of the department and shall not hold themselves out as
employees or agents of the department without specific authorization from the department. It is the further
intent and understanding of the parties that the department does not control the employment practices of
the recipient and shall not be liable for any wage and hour, employment discrimination, or other labor and
employment claims, which arise against the recipient.
G. Insurance and Bonding
1. 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. The recipient accepts full responsibility for
identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable
financial protections for the recipient and the consumers to be served under this contract. Upon the
execution of this contract, the recipient 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 where appropriate.
2. To furnish an insurance bond from a responsible commercial insurance company covering all officers,
directors, employees and agents of the recipient authorized to handle funds received or disbursed under
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this contract in an amount commensurate with the funds handled, the degree of risk as determined by the
ih~1Urance company and consistent with good business practices.
3. If the recipient is a state agency or subdivision as defined by section 768.28, Florida Statutes, the recipient
shall furnish the department, upon request, written verification of liability protection in accordance with
section 768.28, Florida Statutes. Nothing herein shall be construed to extend any party's liability beyond
that provided in section 768.28, Florida Statutes. (See also Paragraph F above.)
H. Abuse, Neglect and Exploitation Reporting
In compliance with Chapter 415, Florida Statutes, an employee of the recipient who knows, or has reasonable
cause to suspect, that a child, aged person or disabled adult is or has been abused, neglected, or exploited,
shall immediately report such knowledge or suspicion to the State of Florida central abuse registry and tracking
system on the statewide toll-free telephone number (1 A800A96ABUSE).
I. Transportation Disadvantaged
If consumers are to be transported under this contract, the recipient will comply with the provisions of Chapter
427, Florida Statutes, and Rule Chapter 41-2, Florida Administrative Code.
J. Purchasing
1. PRIDE
It is expressly understood and agreed that any articles which are the subject of, or are required to carry out
this contract shall be purchased from Prison Rehabilitative Industries and Diversified Enterprises, Inc.
(PRIDE) identified under Chapter 946, Florida Statutes, in the same manner and under the procedures set
forth in subsections 946.515(2) and (4), Florida Statutes. For purposes of this contract, the person, firm,
or other business entity carrying out the provisions of this contract shall be deemed to be substituted for
the department insofar as dealings with PRIDE. This clause is not applicable to any subcontractors, unless
otherwise required by law. An abbreviated list of products/services available from PRIDE may be obtained
by contacting PRIDE'S Tallahassee branch office at (850) 487 A3774 or SunCom 277-3774.
2. Procurement of Products or Materials with Recycled Content
Additionally, it is expressly understood and agreed that any products or materials which are the subject of,
or are required to carry out this contract shall be procured in accordance with the provisions of section
403.7065 and 287.045, Florida Statutes.
3. Equity in Contracting
Pursuant to Section 287.09451, F.S., the department is committed to embracing diversity in the provision
of services to Florida's elders and in providing fair and equal opportunities for all qualified minority
businesses in Florida. The recipient shall report information to the department on utilization of certified, and
non-certified minority recipients and vendors for all subcontractors and vendors receiving funds pursuant
to all contracts covered by this contract. This report shall be submitted quarterly to the department.
K. Publication or Statement of State Sponsorship
1. As required by Section 286.25, Florida Statutes, if the recipient or subrecipient is a nongovernmental
organization which sponsors a program financed wholly or in part by state funds, including any funds
obtained through contracts executed in accordance with this agreement, it shall in publicizing, advertising
or describing the sponsorship of the program, state: "Sponsored by
Monroe County Board of County Commissioners
Recipient
and the State of Florida, Department of Elder Affairs". If the sponsorship reference is in written material
the words "State of Florida, Department of Elder Affairs" shall appear in the same size letters and type as
the name of the organization. The recipient shall also display a graphic of the department's logo on all
printed material. This shall include, but is not limited to, any correspondence or other writing, publication
or broadcast that refers to such program.
2. If the recipient is a governmental entity or political subdivision of the state, the department requests
compliance with the conditions specified above.
3. The recipient shall not use the words "The State of Florida, Department of Elder Affairs" to indicate
sponsorship of a program otherwise financed unless specific authorization has been obtained by the
department prior to use.
L. Use of Funds for Lobbying Prohibited
To comply with the provisions of section 216.347, Florida Statutes, which prohibit the expenditure of contract
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funds for the purpose of lobbying the legislature, a Judicial orancn or a state agency,
M. Public Entity Crime; Denial or revocation of the right to transact business with public entities.
It is the intent of the legislature to place the following restrictions on the ability of persons convicted of public
entity crimes to transact business with the department per section 287.133, Florida Statute~:
A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity
crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit
a bid on a contract with a public entity for the construction or repair of a public building or public work, may
not submit bids on leases of real property to 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 s. 287.017 for CATEGORY TWO
for a period of 36 months from the date of being placed on the convicted vendor list,
The recipient agrees that compliance with this statute is a condition of receipt or benefit from state or federal
funds and it is binding upon the recipient, and it's successors during the period of this agreement. The
recipient further assures that the recipient, it's officers, directors, senior management, partners, employees,
or agents, have not been convicted of any public entity crimes within the last 36 months. If the recipient or
any of its officers or directors are convicted, pursuant to the definition set forth in s. 287.133 (1l(b), of a public
entity crime during the period of this agreement, the recipient shall notify the department immediately, Non-
compliance with this statute shall constitute a breach of contract.
N. Employment
If the recipient is a non-governmental organization, it is expressly understood and agreed that the recipient
will not knowingly employ unauthorized alien workers. Such employment constitutes a violation of the
employment provisions as determined pursuant to section 274A(e) of the Immigration Nationality Act
(lNA), 8 U.S.C. s.1324 a (e) (section 274A(e). Violation of the employment provisions as determined
pursuant to section 274A(e) shall be grounds for unilateral cancellation of this contract.
O. Audits and Records
1. To 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. Recipients
and subrecipients agree to maintain records including paid invoices, payroll registers, travel
vouchers, copy logs, postage logs, time sheets, etc., as supporting documentation for service cost
reports and for administrative expenses itemized for reimbursement. This documentation will be
made available upon request for monitoring and auditing purposes.
2. To assure that these records shall be subject at all reasonable times to inspection, review, or audit
by state personnel and other personnel duly authorized by the department, as well as by federal
personnel.
3. To maintain and file with the department such progress, fiscal and inventory reports as specified
in Attachment I , and other reports as the department may require within the period of this
contract. Such reporting requirements must be reasonable given the scope and purpose of this
contract.
4. To provide a financial and compliance audit to the department as specified in
Attachment VI and to ensure that all related party transactions are disclosed to the auditor.
Additional audit requirements are specified in Attachment I, Special Provisions, Section n/a,
5. To include these aforementioned audit and record keeping requirements in all approved
subcontracts and assignments.
6. The recipient agrees to respond to requests for consumer information and statistical data for
research and evaluative purposes when requested by the department.
7. To provide to the department all fiscal information regarding services contracted to subrecipients
pursuant to this agreement using the application or format required by the department.
P. Retention of Records
1. Unless otherwise expressly set forth in the Special Provisions Section of Attachment I , of this
contract, the recipient agrees to retain all consumer 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 this contract, or if an
audit has been initiated and audit findings have not been resolved, the records shall be retained
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until resolution of the audit findings. Any special provisions regarding retention of records must
be in accord with applicable state or federal law or regulation.
2. Persons duly authorized by the department and federal auditors, pursuant to 45 CFR, Part 74.53(e),
and 92.42(e) (1) and (2) shall have full access to and the right to examine or duplicate any of said
records and documents during said retention period.
Q. Monitoring and Incident Reporting
1. The recipient will provide reports as specified in Attachment~. These reports will be used for
monitoring progress or performance of the contractual services as specified in Attachment 1.
2. The recipient will permit persons duly authorized by the department to inspect any records, papers,
documents, facilities, goods and services of the recipient and subrecipient which are relevant to
this agreement or the mission and statutory authority of the department, and/or interview any
consumers and employees of the recipient and subrecipient to be assured of satisfactory
performance of the terms and conditions of this contract. Following such inspection the
department will deliver to the recipient a list of its concerns with regard to the manner in which
said goods or services are being provided. The recipient will rectify all noted deficiencies provided
by the department within the time set forth by the department, or provide the department with
a reasonable and acceptable justification for the recipient's failure to correct the noted deficiencies.
The department shall determine whether such failure is reasonable and acceptable. The
recipient's failure to correct or justify within a reasonable time as specified by the department may
result in the department taking any of the actions identified in the Suspension section, or the
department deeming the recipient's failure to be a breach of contract.
1 . Recipients will perform administrative and programmatic monitoring of subrecipients to ensure
contractual compliance, fiscal accountability, programmatic performance, and compliance with
applicable state and federal laws and regulations.
2. The recipient will notify the department within 48 hours of conditions related to subrecipient
performance that could impair continued service delivery. Reportable conditions may include:
· proposed consumer terminations
· recipient or subrecipient financial concerns/difficulties
· service documentation problems
· contract non-compliance
· service quality and consumer complaint trends.
Recipients will provide the department with a brief summary of the problem(s) and proposed
corrective action plans and time frames for implementation.
R. Safeguarding Information
Not to use or disclose any information concerning a recipient of services under this contract for any
purpose not in conformity with applicable state and federal regulations (45 CFR, Part 205.50), except
upon written consent of the recipient, or the custodial parent or legal guardian of the recipient, as
authorized by law. .
S. Consumer Information
To submit management, program, and consumer identifiable data, as specified by the department in
Attachment I .
T. Assignments and Subcontracts
1. To neither assign the responsibility of this contract to another party nor subcontract for any of the
work contemplated under this contract without prior written approval of the department. No such
approval by the department of any assignment or subcontract shall be deemed in any event or in
any manner to obligate the department beyond the total dollar amount agreed upon in this
contract. All such assignments or subcontracts shall be subject to the conditions of this contract
(except Section I, Paragraph J.1., Section II, Paragraph B and Section I, Paragraph M., [unless the
subcontractor is a political subdivision of the state]) and to any conditions of approval that the
department shall deem necessary.
2. Unless otherwise stated in the contract between the recipient and subcontractor, payments made
by the recipient to the subcontractor must be within seven (7) working days after receipt by the
recipient of full or partial payments from the department in accordance with section 287,0585,
Florida Statutes. Failure to pay within seven (7) working days will result in a penalty charged
against the recipient and paid to the subcontractor in the amount of one-half of 1 percent of the
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amount due, per day from the expiration of 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.
U. Financial Reports
To provide financial reports to the department as specified in Attachment I, VI and Attachment XA and
XB.
V. Final Invoice
The recipient must submit the final invoice for payment to the department no more than~ days after
the contract ends or is terminated; if the recipient fails to do so, all right to payment is 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 recipient, and necessary
adjustments thereto, have been approved by the department.
W. Return of Funds
1. 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 recipient by the department. The recipient
shall return any overpayment to the department within forty (40) calendar days after either
discovery by the recipient, or notification by the department, of the overpayment. In the event
that the recipient or its independent auditor discovers an overpayment has been made, the
recipient shall repay said overpayment within forty (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 recipient 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 forty (40) calendar days after the date of notification
or discovery.
2. For universities located in the state of Florida, should repayment not be made within forty (40)
calendar days after the date of notification, the department will notify the State Comptroller's
Office who will then enact a transfer of the amounts owed from the state university's account to
the account of the Department of Elder Affairs.
X. Data Integrity
Pursuant to the accounting and reporting requirements for federal grants management in OMB Circulars
A-102 and A-11 0, and the Department of Management Services (DMS) Memorandum No.6 (98-99) which
requires certification of Data Integrity for any procurement document, the recipient must, prior to
execution of this agreement, complete the Data Integrity Certification form, ATTACHMENT IX.
In the event a data integrity issue results in a delay of service, the recipient agrees to execute their agency
disaster plan to ensure the delivery of service{s) continues.
Y. Conflict of Interest
The recipient hereby agrees that it will ensure that its employees, board members, management and
subcontractors, will avoid any conflict of interest or the appearance of a conflict of interest when
disbursing or using the funds described in this agreement or when contracting with another entity which
will be paid by the funds described in this agreement. A conflict of interest includes but is not limited to
receiving, or agreeing to receive, a direct or indirect benefit, or anything of value from a recipient,
consumer, subcontractor, or any person wishing to benefit from the use or disbursement of these funds.
To avoid a conflict of interest a recipient must ensure that all individuals make a disclosure to the
department of any relationship which may be, or may be perceived to be, as a conflict of interest within
thirty (30) days of an individual's original appointment or placement on a board, or if the individual is
serving as an incumbent, within thirty (30) days of the commencement of the contract.
Z. Successors and Transferees
This contract and its attachments are binding on the recipient and its successors and transferees,
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
$54,558.00, subject to the availability of funds. The funds awarded to the recipient pursuant to this
contract consists of the following:
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Program Title Year Funding Source CFDA# Fund Amounts
Senior Community 2002-2003 Title V, Older Americans Act 17.235 $54,558,00
Service Employment
Program
Total Funds Contained In This TOT AL $ $54,558.00
Contract:
The State of Florida's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature. The costs of services paid under any other contract or from any other
source are not eligible for reimbursement under this contract.
B. Contract Payment
Pursuant to Section 215.422, Florida Statutes, the department shall take no longer than 5 working days
to inspect and approve goods and services, unless bid specifications or the contract specifies otherwise.
With the exception of payments to health care recipients for hospital, medical, or other health care
services, if payment is not available within 40 days, measured from the latter of the date the invoice is
received or the goods or services are received, inspected and approved, a separate interest penalty set
by the Comptroller pursuant to Section 55.03, Florida Statutes, will be due and payable in addition to the
invoice amount. Payments to health care recipients for hospitals, medical or other health care services,
shall be made not more than 35 days from the date of eligibility for payment is determined, and the
interest penalty is set by Subsection 215.422(13), Florida Statutes. Invoices returned to a vendor due
to preparation errors will result in a payment delay. Invoice payment requirements do not start until a
properly completed invoice is provided to the department.
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) 488A2924
or by calling the State Comptroller's Hotline, 1 A800A848-3792.
III. The Recipient Agrees to the following special provisions:
A. Grievance and Appeal Procedures
If this contract contains funds for services to elder consumers, the recipient will:
1 . Have procedures for handling complaints from persons who complain service has been
denied, terminated or reduced.
2. Recipients and subrecipients will establish complaint procedures for older consumers who
are dissatisfied with or denied services. These procedures must include notice of the right
to complain and to have their complaint reviewed.
B. Investigation of Allegations
Any report that implies criminal intent on the part of this recipient or any subrecipient and is
referred to a governmental or investigatory agency must be sent to the department. The recipient
must investigate allegations regarding falsification of client information, service records, payment
requests, and other related information. If the recipient has reason to believe that the allegations
will be referred to the State Attorney, a law enforcement agency, the United States Attorney's
Office, or other governmental agency, the recipient shall notify the Inspector General at the
department immediately. A copy of all documents, reports, notes or other written material
concerning the investigation, whether in the possession of the recipient or subrecipient, must be
sent to the department's Inspector General with a summary of the investigation and allegations.
C. Disaster
In preparation for the threat of an emergency event as defined in the State of Florida
Comprehensive Emergency Management Plan, the Department of Elder Affairs may exercise
authority over a service provider to implement preparedness activities to improve the safety of the
elderly in the threatened area and to secure service provider facilities to minimize the potential
impact of the event. These actions will be within the existing roles and responsibilities of the
service providers.
In the event the President of the United States or Governor of the State of Florida declares
a disaster or state of emergency, the Department of Elder Affairs may exercise authority
over the service provider to implement emergency relief measures and/or activities.
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In either of these cases, only the Secretary, Deputy Secretary or his/her designee of the
Department of Elder Affairs shall have such authority to order the implementation of such
measures. All actions directed by the department under this section shall be for the purpose of
ensuring the health, safety and welfare of the elderly in the potential or actual disaster area.
4. Volunteers
The recipient will promote the use of volunteers as prescribed in Section 306(a)( 1 2), Older
Americans Act, as amended, and Section 430.07, Florida Statutes. In addition, the recipient will
increase the use of volunteers by providing training, technical assistance and funding, where
possible, to service subrecipients.
E. Computer System Backup and Recovery
Each recipient, among other requirements, must anticipate and prepare for the loss of information
processing capabilities. The routine backing up of data and software is required to recover from
losses or outages of the computer system. Data and software essential to the continued operation
of recipient functions must be backed up. The security controls over the backup resources shall
be as stringent as the protection required of the primary resources. It is recommended that a copy
of the backed up data be stored in a secure, offsite location. The recipient will submit to the
department, annually or upon revision, their written policy for backing up data and software,
IV. THE Recipient AND DEPARTMENT MUTUAllY AGREE:
A. Effective Date
1. This contract shall begin on October 1, 2002 or on the date on which the contract has been
signed by both parties, whichever is later.
2. This contract shall end on June 30, 2003.
B. Termination
1 . Termination at Will
This contract may be terminated by either party upon no less than thirty (30) calendar days notice,
without cause, unless a lesser time is mutually agreed upon by both parties. Said notice shall be
delivered by certified mail, return receipt requested, or in person with proof of delivery. In the
event the recipient terminates a contract at will the recipient agrees to submit, at the time it serves
notice of intent to terminate, a plan which identifies procedures to ensure services to consumers
will not be interrupted or suspended by the termination.
2. Termination Because of lack of Funds
In the event funds to finance this contract become unavailable, the department may terminate the
contract upon no less than twentyAfour (24) hours notice in writing to the recipient. 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 of funds.
3. Termination for Breach
Unless the recipient's breach is waived by the department in writing, or the recipient fails to cure
the breach within the time specified by the department, the department may, by written notice to
the recipient, terminate this contract upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with 'proof of delivery.
If applicable, the department may employ the default provisions in Chapter 60AA 1.006(3), Florida
Administrative Code. 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 to
damages or legal or equitable nature.
4. Termination after Suspension
If the department engages any of the suspension provIsions contained in part C below, the
department may, in its sole discretion, determine if termination is warranted.
c. Enforcement:
1. The department may take measures against the recipient, including: corrective action,
unannounced special monitoring, temporary assumption of the operation of one or more
contractual services, placement of the recipient on probationary status, imposing a moratorium on
9
recipient action, imposing financial penalties for nonperformance, or other administrative action
pursuant to Chapter 1 20 Florida Statutes, if the department finds that:
· an intentional or negligent act of the recipient has materially affected the health,
welfare, or safety of consumers served pursuant to this agreement, or substantially
and negatively affected the operation of services covered under this agreement
· the recipient lacks financial stability sufficient to meet contractual obligations or
that contractual funds have been misappropriated.
· the recipient has committed multiple or repeated violations of legal and regulatory
standards, regardless of whether such laws or regulations are enforced by the
department, or the recipient has committed or repeated violations of department
standards.
· the recipient has failed to continue the provision or expansion of services after the
declaration of a state of emergency.
· the recipient has failed to adhere to the terms of this agreement or the terms of any
contract(s) covered by this agreement and incorporating it by reference.
2. In making any determination under this provision the department may rely upon the findings
of another state or federal agency, or other regulatory body. Any claim for breach of
contract is exempt from administrative proceedings and shall be brought before the
appropriate entity in the venue of Leon County. Before the department formally initiates
any intermediate measure, or either party commences equitable or legal action of any sort,
both parties agree to engage in informal mediation through a meeting of each party's
representative at a place and location designated by the department.
D. Notice and Contact
1. The name, address and telephone number of the contract manager for the department for this
contract is:
Department of Elder Affairs
ATTN: JoAnn Williams
4040 Esplanade Way
Tallahassee, FL 32399-7000
(850) 414-2000
2. The name, address and telephone number of the representative of the recipient responsible for
administration of the program under this contract is:
Dianne Russell, Senior Administrator SCSEP
1100 Simonton Street, Suite 1-206
Key West, Florida 33040
(305) 292-4593
3. In the event that different representatives are designated by either party after execution of this
contract, notice of the name and address of the new representative will be rendered in writing to
the other party and said notification attached to originals of this contract.
E. Renegotiation or Modification
1. Modifications of provisions of this contract shall only be valid when they have been reduced to
writing and duly signed. The parties agree to renegotiate this contract if federal and/or state
revisions of any applicable laws, or regulations make changes in this contract necessary.
2. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level
increases and changes in the rate of payment when these have been established through the
appropriations process and subsequently identified in the department's operating budget.
F. Name, Mailing and Street Address of Payee
1. The name (recipient name as shown on page 1 of this contract) and mailing address of the official
payee to whom the payment shall be made:
10
Monroe County Board of County Commissioners
Clerk of the Court
Attention: Tina Boan
Post Office Box 1 980
Key West. Florida 33041-1 980
2. The name of the recipient's contact person and street address where financial and administrative
records are maintained:
Dianne Russell, Senior Administrator, SCSEP
1100 Simonton Street, Suite 1-206
Key West, Florida 33040
IN WITNESS THEREOF, the parties hereto have caused this 41 page contract to be executed by their undersigned
officials as duly authorized.
Recipient: Monroe Count
Commissioners
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SIGNED BY:
NAME: Charles "Sonny" McCoy
TITLE: Mayor
DA TE: /~~t:; 9-
FEDERAL ID NUMBER (or SS Number for an
individual)
59-6000749
Recipient FISCAL YEAR ENDING DATE: 9/30
S
STATE AGENCY 29 DIGIT SAMAS CODE:
STATE OF FLORIDA
DEPARTMENT OF ELDER AFFAIRS
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NAME:
CONTRACT.IS NOT VALI[)UN~L.SIGNtIJ'4.&fl,D
Date: 1()!Zj 10'z.,
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11
Contract No. XM194
ATTACHMENT I
Senior Community Service Employment Program
I. STATEMENT OF PURPOSE
The Senior Community Service Employment Program (SCSEP) is funded under Title V of the
Older Americans Act (OAA) of 1965, Public Law 89-73. The purpose of the SCSEP is to foster
and promote useful part-time work experience opportunities in community service activities for
persons with low incomes who are 55 years of age or older, who have poor employment
prospects, and have the greatest economic need. Through these community service and related
activities, the SCSEP enhance the skills and abilities of enrollees, increases their employability,
develops appropriate job opportunities, and places them in unsubsidized employment after the
completion of community-service work experience. DOEA is purchasing these services for
enrollees in state-share SCSEP positions, funded by Florida's Title V allotment.
II. SERVICES TO BE PROVIDED
A. Services:
The recipient will conduct services including, but not limited to recruitment, eligibility
determination, orientation, assessment, placement of enrollees in community service activities
with host agencies, payment of enrollee wages and fringe benefits, community service, job
development, placement in unsubsidized employment, follow-up and other enrollee services as
appropriate, in accordance with federal regulations implementing Title V of the OAA. The
recipient may subcontract services to be provided under this contract, but the recipient is
responsible for ensuring the terms and conditions of this contract are met.
Project sites will be located as follows:
PSA Project Director/Address Phone Number
11 Dianne Russell 305/292-4593
1100 Simonton Street, Suite 1-206
Key West, Florida 33040
12
B. Manner of Service Provision:
(1) Recruitment and Selection of Participants
The recipient will use methods of recruitment and selection which will assure that the maximum
number of eligible individuals will have an opportunity to participate in the program.
(2) Intake and Eligibility Determination
To be eligible for initial enrollment, each individual shall meet the following criteria for age,
income, and place of residence:
· A2e. Each individual shall be no less than 55 years of age. No person whose age is 55
years or more shall be determined ineligible because of age, and no upper age limit shall
be imposed for initial or continued enrollment.
· Income. The income of the family of which the individual is a member shall not exceed
the low-income standards as issued annually by the Department of Health and Human
Services. In addition, a disabled person may be treated as a "family of one" for income
eligibility purposes.
· Residence. Each individual, upon initial enrollment, shall reside in the State in which the
project is authorized.
· No additional eli2ibility requirement. Recipient cannot impose any additional
conditions or requirements for enrollment eligibility unless required by Federal law.
(3) Continued Eligibility for Enrollment in the SCSEP.
The recipient must recertify the income of each enrollee once each project year, and shall
maintain documentation to support the recertification. Enrollees found to be ineligible for
continued enrollment because of income must be given a written notice of termination and must
be terminated 30 days after the notice. No enrollee can participate in a community service
position for more than 12 months without having his or her income recertified.
If, at any time, the recipient determines that an enrollee was incorrectly declared eligible as a
direct result of false information given by that individual, the individual shall be given a written
notice explaining the reason or reasons for the determination and shall be terminated
immediately.
If, at any time, the recipient determines that an enrollee was incorrectly declared eligible through
no fault of the enrollee, the recipient must give the enrollee immediate written notice explaining
the reason or reasons for termination, and the enrollee shall be terminated 30 days after the
notice,
If the recipient makes an unfavorable determination on continued eligibility, it must be explained
in writing to the enrollee the reason(s) for the determination and the enrollee must be provided a
notice of the right of appeal. When the recipient terminates an enrollee for cause, shall inform the
13
enrollee, in writing, of the reason( s) for termination and of the right of appeal in accordance with
the required procedures set forth in S 641.324.
When the recipient makes an unfavorable determination of enrollment eligibility, it should assure
that the individual is given a reason for non-enrollment and, when feasible, should refer the
individual to other potential sources of assistance.
(4) Orientation
(a) Enrollee - The recipient must provide orientation to eligible individuals who are enrolled as
soon as practicable after a determination of eligibility. The orientation shall provide, as
appropriate, information related to: project objectives; community service assignments; training;
supportive services; responsibilities, rights, and duties of the enrollee; permitted and prohibited
political activities; plans for transition to unsubsidized employment and a discussion of safe
working conditions at the host agencies.
(b) Host A2ency - The recipient shall provide to those individuals who will supervise enrollees
at the host agencies, an orientation similar to the one provided to enrollees. This is to assure that
enrollees will receive adequate supervision and opportunities for transitioning to the host agency
staff or other unsubsidized employment.
(c) Supervision - The recipient must ensure that host agencies provide adequate supervision,
adequate orientation and instruction regarding, among other things, job duties and safe working
procedures.
(5) Assessment
Each enrollee must be assessed to determine the most suitable community service assignment
and to identify appropriate employment, training, and community service objectives for each
individual. The assessment shall be made in partnership with the new enrollee and should
consider the individual's preference of occupational category, work history, skills, interests,
talents, physical capabilities, need for supportive services, aptitudes, potential for performing
proposed community service assignment duties, and potential for transition to unsubsidized
employment. The assessment of each enrollee shall take into consideration his or her physical
capabilities.
The recipient should seek a community service assignment which will permit the most effective
use of each enrollee's skills, interests, and aptitudes. Alternative assignments may be developed
for an enrollee, when feasible, should there be one of the following determinations: (1) That a
different community service assignment will provide greater opportunity for the use of an
enrollee's skills and aptitudes; (2) That an alternative assignment will provide work experience
which will enhance the potential for unsubsidized employment; or (3) That an alternative
assignment will otherwise serve the best interests of the enrollee.
14
(6) Individual Development Plan (IDP)
The recipient must use the assessment or reassessment as a basis for developing or amending the
individual development plan (IDP). The IDP shall be developed in partnership with the enrollee
to reflect the needs of the enrollee as indicated by the assessment, as well as the expressed
interests and desires ofthe enrollee. The recipient must review the IDP at least once in a 12
month period for the following purposes: to evaluate the progress of each enrollee in meeting the
objectives of the IDP; to determine each enrollee's potential for transition to unsubsidized
employment; to determine the appropriateness of each enrollee's current community service
assignment; and to review progress made toward meeting their training and employment
objectives.
(7) Subsidized Employment/Community Service Assignments
After the completion of an enrollee's orientation and initial training, if any, the recipient must
refer the enrollee, as soon as possible, to a useful part-time community service assignment, if
appropriate, according to the IDP. Each enrollee must be placed in a community service
assignment which contributes to the general welfare of the community and provides services
related to publicly-owned and operated facilities and projects, or projects sponsored by
organizations other than political parties, exempt from taxation under the provisions of section
50l(c)(3) of the Internal Revenue Code of 1986. Project sponsors may provide enrollees with
opportunities to assist in the administration of the SCSEP.
.
Each enrollee's community service assignment shall not exceed 1,300 hours during a 12-
month period specified in the grantee's agreement. The 1,300 hours includes paid hours of
orientation, training, sick leave, and vacation and hours of enrollment. No enrollee shall
be paid for more than 1,300 hours in any l2-month period.
The recipient must not require an enrollee to participate more than 20 hours during one
week; however, hours may be extended with the consent of the enrollee.
The recipient cannot offer an enrollee an average of fewer than 20 hours of paid
participation per week.
The recipient must, to the extent possible, ensure that the enrollee works during normal
business hours, if the enrollee so desires and the enrollee should be employed at work
sites in or near the community where the enrollee resides.
Enrollees shall not be permitted to work in a building or surroundings or under conditions
which are unsanitary, hazardous, or dangerous to the enrollees' health or safety. The
recipient should make periodic visits to the enrollees' work site(s) to assure that the
working conditions and treatment of the enrollee are consistent with the OAA.
.
.
.
.
Host Agency Agreements: Each host agency agreement between the host agency and the
recipient must be developed and signed prior to the assignment of an enrollee. The agreement
15
must be for one project year or the appropriate portion thereof. Host agencies must sign a new
host agency agreement for each project year.
(8) Wages/Fringe Benefits
Upon engaging in part-time community service assignments, including orientation and training
in preparation for community service assignments, each enrollee shall receive wages at a rate no
less than the highest applicable rate:
(1) The minimum wage which would be applicable to the enrollee under the Fair Labor
Standards Act of 1938; (2) The State or local minimum wage for the most nearly comparable
covered employment; or (3) The prevailing rates of pay for persons employed in similar public
occupations by the same employer.
Regarding staying within the 1300 hour limit, no one may work more than 20 hours per week
The recipient must ensure that enrollees receive all fringe benefits required by law. Within a
project, fringe benefits must be provided uniformly to all enrollees, unless the Department agrees
to waive this provision due to a determination that such a waiver is in the best interests of
applicants, enrollees, and the project administration.
Physical Examination: Each enrollee shall be offered the opportunity to take a physical
examination annually. A physical is a fringe benefit, and is not an eligibility criterion. The
examining physician shall provide, to the enrollee only, a written report of the results of the
examination. The enrollee may, at his or her option, provide the recipient a copy of the report.
The results of the physical examination shall not be taken into consideration in determining
placement into a community service assignment. An enrollee may refuse the physical
examination offered. In such' a case, the recipient should document this refusal, through a signed
waiver or other means, within 60 work days after commencement of the community service
assignment.
(9) Enrollee Supportive Services
(a) The recipient must provide supportive services designed to assist the enrollee in participating
successfully in community service assignments and, where appropriate, to prepare and assist the
enrollee in obtaining unsubsidized employment. To the extent feasible, the recipient should
utilize supportive services available from other titles of the OAA, particularly those administered
by area agencies on aging and other funding sources. Supportive services may include, but need
not be limited to, all or some of the following: Counseling, work shoes, badges, uniforms, safety
glasses, eyeglasses, and hand tools, may be provided if necessary for successful participation in
community service assignments and if not available from other sources.
16
(10) Enrollee Meetings
Recipient should have periodic meetings on topics of general interest, including matters related
to health, job seeking skills, safety, and consumer affairs.
(11) Training
The recipient must provide or arrange for training specific to an enrollee's community service
assignment. Training may be provided through lectures, seminars, classroom instruction,
individual instruction or other arrangements including, but not limited to, arrangements with
employment and training programs. The recipient is encouraged to obtain such services through
locally available resources, including employment and training programs, and through host
agencies, at no cost or reduced cost to the project.
Training shall consist of up to 500 hours per grant year and shall be consistent with the enrollee's
IDP. Such training may cover all aspects of training; ~, skill, job search, etc. Enrollees shall
not be enrolled solely for the purpose of receiving job search and job referral services. Waivers
for additional hours of training will be considered on an exception basis.
In addition to training in preparation for community service assignments, the recipient is
encouraged to arrange for, or directly provide, skills-training opportunities beyond the SCSEP
community service training activities which will permit the enrollee to acquire or improve skills,
including literacy training, applicable in community service assignment or for unsubsidized
employment.
The recipient, to the extent feasible, shall arrange skill-training for the enrollee which is realistic
and consistent with his or her IDP. The recipient should place major emphasis on the training
available through on-the-job experience at SCSEP work sites, thereby retaining the community
service focus of the SCSEP.
(12) Over-enrollment
Should attrition or funding adjustments prevent a portion of project funds from being fully
utilized, the recipient may use those funds during the period of the agreement to over-enroll
additional eligible individuals. The number over-enrolled cannot exceed 20 percent of the total
number of authorized positions established under the grant agreement without the written
approval from the Department. Payments to or on behalf of enrollees in such positions shall not
exceed the amount of the unused funds available. Each individual enrolled in such a position
shall be informed in writing that the assignment is temporary in nature and may be terminated.
The recipient shall first seek to maintain full enrollment in authorized positions and must seek to
schedule all enrollments and terminations to avoid excessive terminations at the end of the grant
period.
17
(13) Job Development/Referral
The recipient may contact private and public employers directly or through the State employment
security agencies to develop or identify suitable unsubsidized employment opportunities; and
should encourage host agencies to employ enrollees in their regular work forces. The following
activities will be conducted to assist enrollees in finding unsubsidized employment:
(14) Unsubsidized Placement/Performance Goals
Number of Authorized Positions: 10
Number of Enrollees (140%): 14
Number of Required Unsubsidized Placements (20 percent): 2
Number of Targeted Unsubsidized Placements (30 percent): 3
(15) Maximum duration of enrollment.
Time limits on enrollment are not allowed under this contract.
(16) Customer Satisfaction
The recipient will develop measures to determine if enrollees are satisfied with services.
(18) Follow-Up
The recipient must follow-up on each enrollee who is placed into unsubsidized employment and
must document each follow-up at least once within 3 months of unsubsidized placement.
(19) Complaint Resolution/Grievance Procedures
The recipient must have complaint and grievance procedures.
III. METHOD OF PAYMENT
A. The method of payment in this contract includes advances, cost reimbursement for
administration costs and for other services. The recipient must ensure all costs
include only those costs which are in accordance with all applicable state and
federal statutes and regulations and are based on historical costs and audited
historical costs when applicable. The recipient shall consolidate all requests for
payment and all expenditure reports that support requests for payment from
18
subrecipients and vendors and shall submit to the department on forms I05V and
I06V (Attachment XA and XB).
B. The recipient shall maintain documentation to support payment requests which
shall be available to the Comptroller or the department upon request.
C. The recipient may request a monthly advance for administration and service costs
for each of the first two months of the contract period, based on immediate
anticipated cash needs. Detailed documentation justifying cash needs for
advances must be submitted with the signed contract, approved by the department,
and maintained in the contract manager's file. For profit organizations cannot
receive advance funds. All payment requests for the third through the last month
shall be based on the submission of monthly actual expenditure reports beginning
with the first month of the contract. The schedule for submission of invoices is
A TT ACHMENT III to this contract. Reconciliation and recouping of advances
made under this contract are to be completed by the time the final payment is
made. All payments are subject to the availability of funds.
D. A final receipt and expenditure report will be forwarded to the department within
forty-five (45) days after the contract ends or is terminated. All monies which
have been paid to the recipient and not used to retire outstanding obligations of
the contract being closed out must be refunded to the department along with the
final receipt and expenditure report.
E. If applicable, all interest income earned on the advance of general revenue and
federal funds must be separately identified and returned to the department in
accordance with departmental procedures.
F. Any payment due by the department under the terms of this contract may be
withheld pending the receipt and approval by the department of all financial and
programmatic reports due from the recipient and any adjustments thereto,
including any disallowance not resolved.
G. The recipient agrees to implement the distribution of funds as detailed in the
Budget Summary, ATTACHMENT IIA to this contract. Any changes in the
amounts of federal funds-identified on the Budget Summary form require a
contract amendment.
H. Financial Reports: The recipient agrees to provide an accurate, complete and
current disclosure of the financial results of this contract as follows:
1. To submit all requests for payment and expenditure reports according to
the format, schedule and requirements specified in ATTACHMENT III .
19
2. A 10 percent cash or in-kind match is required under this program and
must be reported on monthly invoices.
IV. Contract Amendments:
1. The recipient agrees to implement the contract as detailed in A TT ACHMENT I
and the Budget Summary, ATTACHMENT IIA to this contract. Any changes
in the total amounts of the funds identified on the Budget Summary form require
a contract amendment. Any changes between line items in the Budget Summary
that do not affect the total must be requested to the Department's contract
manager in writing and approved in writing prior to moving funds
V. SPECIAL PROVISIONS
A. State Laws and Regulations:
As specified in the contract.
B. Program Income:
Program income earned may be spent in the same contract year as earned and
must be used to expand services. Any program income funds not spent may be
carried forward and must be spent in the next state fiscal year.
C. Outcome Achievement:
1. At least 20 percent of the total number of authorized positions will be placed into
unsubsidized employment.
2. The placement must be confirmed as still employed after 30 calendar days.
3. At the time of placement, the employer must intend for the job to last at least 90
days.
4. The enrollee must be better off economically than he/she was under the SCSEP.
5. Employment must occur within 90 days after termination, and the placement must
be attributable to the SCSEP.
20
D. Monthly Performance ReportS/QUarterly Progress Report (QPR)/Narrative
Report
1. A Monthly Performance Report must be submitted the department with
monthly requests for payment using Attachment IV. The report shall
accurately reflect activities for each month.
2. Recipients must submit a QPR to the Contract Manager no later than 15
days after the ending date of each quarter.
3. A narrative report should be submitted with each QPR., identifying any
noteworthy achievements of the project, as well as any problems areas
encountered during the reporting period.
E. Match Requirements
The non-federal share of costs may be in cash or in-kind, or a combination of the
two, and shall be calculated in accordance with 29CFR 97.24 or 29CFR 95.23, as
appropriate.
21
Senior Community Services Employment Program
BUDGET SUMMARY
AGENCY: Monroe County Board of County Commissioners
1. Administration $ 1,441.00
2. Enrollee Wages/Fringe Benefits $ 43,479.00
3. Other Program Costs $ 9,638.00
4. Total $ 54, 558.00
5. Required Match $ 7,360.00
22
A TT ACHMENT II A
Original ~
Amendment
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23D
Exhibit A
o:l
H
H
Monroe County
Senior Community Service Employment Program
8
Z
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U
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8
8
t::ll
Workers Compensation
PY 2002 through 2003
Code
Position
Salary
8742 Job Developer $ 7,280
8810 Clerical $ 5,356
8810 Library Clerk $ 5,356
8742 Program Aide $ 5,356
8742 Nutrition Aide $ 5,356
8742 Teacher's Aide $ 5,356
Total Participant Workers Compensation Charge
Rate Number of
Positions Cost
1.10 1 $ 19.51
0.59 2 $ 53.09
0.59 2 $ 53.09
1.10 2 $ 98.98
1.10 2 $ 98.98.
1.10 1 $ 49.49
$ 373.13
9410
SCSEP Director
1
$ 1,913.96
$ 47,161 16.66
Figures Provided by Employee Benefits Section.
Worker's Compensation: The rate times each hundred dollars of salary minus 84% of the total
times the number of positions.
23E
Report
Number
1
2
3
4
5
6
7
8
9
10
11
13
Legend:
Note # 1:
Note # 2:
A TT ACHMENT III
Senior Community Services Employment Program
CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Based On
October Advance*
November Advance*
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report /October Ad. Recoup**
May Expenditure ReportlNovember Adv. Recoup.**
June Expenditure Report
Final Expenditure and Request for Payment Report
Submit on
this Date
October 1
October 1
November 15
December 15
January 15
February 15
March 15
April 15
May 15
June 15
July 15
August 14
*
**
Advance based on projected cash need.
Submission of expenditure reports mayor may not generate a payment
request. If final expenditure report reflects funds due back to the
department, payment is to accompany the report.
Report #1 for Advance Basis Contracts cannot be submitted to the State
Comptroller prior to October 1 or until the contract with the department
has been executed and a copy sent to the Comptroller. Actual submission
of the vouchers to the State Comptroller is dependent on the accuracy of
the expenditure report.
The last three months of the recipient's fiscal reports covering actual
expenditures should reflect an adjustment repaying advances for the first
two months of the contract.
24
ATTACHMENT IV
Senior Community Service Employment Program
Monthly Performance Report
(A report must be submitted for each PSA being served.)
Organization:
PSA#
Month Enrollees Community Service # Place in Unsubsidized
Assignments Employment
Octo ber
November
December
January
February
March
April
May
June
July
25
_t..'t.,'_
..;.:J ~ t).::
ci:;u-....l.....- _~.:.J'-.......
U~~~ ~U~';K~~: M~~:.
,-I-4'~c..
Quarterly Progress Report
i'_'Z''!'ACRMENr v
U.S. Department of Labar M
Employment and Tf3lning Administration ,(-p">
SI!II'lIOr Community Service Employment Pr09ram ~
RIPpel': "erood Ending (Month & year) OMS ~ppro'lal No, 12Q5-<)040
E:.;(J::l1rallon Dale: 06/3112003
Type or Report (Check OM)
o Il"Ilenm 0 i=inal
project Sponsor
CI;Y at1d State
~bproJ9C:: No,
,Oroject ""nOd
Agra9ment Numb!:'r
Fro'"
To
No. Enrollment F'oslrion:; E!sl'l.blilShed:
Unsubs,diz:eO Placsment Goal:
A ENROLLMENT LEVELS (Number of .Enrall....)
1. Carried over from
prevIous projElct
J. /Jlaced In unsuOsldrl:ed
employment t~js ~roJect
4. Other termlnalions thiS
prOleel
5. Current enrolimern
(Errd ot P"r;oo)
2.. Started undar rhlS
prOject
B. JOB INVENTORY
Services to G."er~l CornmlOnity
6. EI1rollment vaeanCles
(End of F'~riod)
1. Educallon 110 Project Adm'ntWiltlOr'l
2- Htlalrh a(Id HospllalS . It. Healtn at'ld I-lome Care I
3. Housirlg/Home !:lehabllftalien I t3. 'HoasingIHome Rehabilitation
"". EmpleymSl'lr ASSistance ) 14. Employment ASSlslance
5, Fler;:raatlcn, ~arks, and Forests 15. ReCl'eal.oI'l/StlnIOr Cel'1!11rs
G. EnvlrOllmemal Quality 16. Nul(!t10n ~rograms
~ Public Works and TranspOl'Talion 17, TranSl"artarioCl
I.
a, Soda! Services 18. Outreach/Referral
9, Other 19. Orl'le(
10. TQTA(. (1 . 9) I zOo TOTAL (11 . 19)
NO. .lobs
Servicu to eJd.(ly Community
No. Jobs
C. eNROLLEE CHARACTERISTICS
Ch~r~ct.ri$'liC':l StMts (Cum,) Cur. Enroll. Ch:aracteristh:s Starts (Cum.) Cur, Enroll,
Mal" AmerIcan Indian
.. or Alaska NlltiVII
... I c;.
<n Femal@ "
, 2 A:lan
I 0
etr. ~ ~~~l!Ir 6~ci~~ :j( ,.:..tric.or l...""71E.-;~~
~
C gtn . 1 Hh = Hi,panlc or l.atlClO
~ w
... "i'fSChOO' Gra.d Native Hawaiian or
u or "yivalet'll ""~A'
.2
u:; 1 . J years Of Colllt\;'e
While
4 yr'i.. COflegl! or marl!! SS.59
Family Income at/below
Poverty Levit! I II 50.54
eo
\1eler~ 0( 5S.5'.?
;:I,,.,,:>:e;; I -- -4 I i
I tu - / I
D. AVERAGE HOURI..Y WAGE/CURRE;N'l' I , I
~NROLLMENT is and Over
YES 0
NO 0
e. NARRA nVl! REpORT' A TT A.CHED:
Si onarur~
Dare
';he.. ~pat'llng r"'ltJ,remenrs are approvea by the Office of "Ilona...",,,,,' and l!ud<;1"' una.... U'l.. i>~.".."rl( "-"auction A<;f Of 1in. O!.,lB Appl"OV~ No. 1205-00-40,
c:xpi~tlon d.~t. 6./11/%Q03. ?e'"'iQl"\$ .,re no'!: "~utret2 to rc:tFond to th.is C::QIle<:rton at lnfor"""atiO,", unleu rt d..sp1ayS a cutTettlJy va.lid OMB ~nD"oJ t1umbef.
Raspondents obll911dQn to r~ly ta tn..s.. repQtllnll '<quor.mlnts are recurred to cln..in Oell.f1I~ (:lO CFR 5-41.Z01(c), 5ol1.204, 54L~Z5("), and 5~ 1.409. O~cl""
...m....cans....., ,s02(b)(1)(I') and S06(d). and 29 CFR 5-41.321(0)(2) and ~'.zo1(<;)). Publ;!: repo/'tin<;1 bul'd.." ror tn.. collectJon of ,nformat,,,,, 'S ..sllmated to
.ve:r4lge 6 rrours per r~.sporuc. lncJudinq th. time for rlviewlng irurNc:ticn.!. Sc&fCZ,in9 .xist."q data ,our't:'~s.. !i'ath.nng al"td m~it"t.in."g tf'te dat3. "~4Mi. V'Q
Comp.letlng oU\d revlewlt1q the COl\ectlot'l or Inrorm~,iC('\. Sel1l1i ~om""ef1ts r~;.n:fing t'hi! blJr::1~t'l estlmat& or ~y athl:r J.&pecf of tt'li; cQllectJan elr in.fo1"mation,
11"':C"!udlng IU5l9:.st1Qn..;: ro.f reducing til.3: b~l"dcn, to th. 'J.S. Oe~&f"["'e.nt af Laoor, Orvisilon of Older WQr~e(s ~rograms. Aoom N,..46A.T, 200 Cc"stltUIlorr "'venue.
~w.. 'WU",nqf"", DC ~O,10. ;:26
ETAS;4Q
August 23 2003
Audit Attachment
Attachment~
The administration of funds awarded by the department to the recipient and the sub-recipient through
contracts with the recipient may be subject to audits and/or monitoring as described in this section
by the department, and other authorized state personnel or federal personnel,
MONrTORING
In addition to reviews of audits conducted in accordance with OMS Circular A-133 and Section
215.97, F ,S" as revised (see "AUDITS" below), monitoring procedures may include, but not be limited
to, on-site visits by department staff, limited scope audits as defined by OMS Circular A-133, as
revised, andfor other procedures. Sy entering into this agreement, the recipient agrees to comply and
cooperate with any monitoring procedures/processes deemed appropriate by the department, In the
event the department determines that a. limited scope audit of the recipient is appropriate, the
recipient agrees to comply with any additional instructions provided by the department to the recipient
regarding such audit, The recipient further agrees to comply and cooperate with any inspections,
reviews, investigations, or audits deemed necessary by the Comptroller, Auditor General or federal
personnel.
OTHER REQUIREMENTS
If the recipient is a non profit organization, the Oath of Not for Profit Status form (EXHISIT2 of this
attachment) must be completed and returned to the department with the signed contract.
AUDfTS
PART I: FEDERALLY FUNDED
This part is applicable if the "recipient is a State or local government or a non-profit organization as
defined in OMS Circular A-133, as revised.
1. In the event that the recipient ~xpends $300,000 or more in Federal awards in its fiscal year, the
recipient must have a sing.le or program-specific audit conducted. in accordance with the
provisions of OMS Circular A-133, as revised. Federal funds awarded through the department
by this agreement, if any, are indicated in Section II. A. of the .contract(s) of which this document
is an attachment. ./n determining the Federal awards expended in its fiscal year, the' recipi.ent
shail consider all sources of Federal awards, including Federal funds received from the
department. The determination 'of amounts of Federal awards expended should be ir') accordance
with the guidelines established by OMS Circular A-133, as revised. An audit of the recipient
conducted by the Auditor General in accordance with the provisions OMS Circular A-133, as
revised, will meet the requirements of this part,
2. In connection with the audit requirements addressed in Part 1, paragraph 1.: the recipient shall
fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMS
Circular A-1 33, as revised,
3. ff the recipient expends less than $ 300,000 in Federal awards in its fiscal year, an audit
conducted in accordance with the provisions of OM a Circular A-133, as revised, is not required,
In the event that the recipient expends less than $300,000 in Federal awards in its fiscal year
and elects to have an audit conducted in accordance with the provisions of OMS Circular A-133,
as revised, the cost of the audit must be paid from non-Federal funds (i.e" the cost of such an
audit must be paid from recipient resources obtained from other than Federal entities).
27
4. Information regarding audit, ~quirements contained in OMB Circulc.. A-133 and 215.97, Florida
Statutes (F. S.), can be obtained from the following web-sites:
htto://www,whitehouse,qov/omb/circulars/
and:
htto ://www.lea"state.fl.us/
PART 11: STATE FUNDED
This part is applicable if the recipient is a non-state entity as defined by Section 215.97, Florida
Statutes.
1. In the event that the recipient expends a total amount of State awards (i.e" State financial
assistance provided to the recipient to carry out a State project) equal to or in excess of
$300,000 in any fiscal year of such recipient, the recipient must have a State 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. State grants and aids amounts awarded through the department by this
agreement are indicated in Section II., A. of the contract(s) of which this agreement is an
attachment. 111 determining the State awards expended in its fiscal year, the recipient shall
consider all sources of State awards, including State funds received from the department, other
state agencies, and other nonstate entities except that State awards received by a non-state
entity for Federal program matching requirements shall be excluded from consideration.
2. In connection with the. audit requirements addressed in Part fI, paragraph 2, the recipient sh.all
ensure that the audit complies with the requirements of Section 215.97, Florida Statutes. This
includes submission of a reporting package as defined by Section 215.97, Florida Statutes, and
Chapter, 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),
Rules of the Auditor General, to in,clude an auditor's examination attestation report, management
assertion report (alternatively, management's assertion may be included in the management
representi.3tiori letter), and a schedule of State financial assistance.
The auditor's examination attestation report must indic"ate whether management's assertion as
to compliance with the following requirements is fairly stated, in all material respects: activities
allowed or unallowed; allowable costs/cost principles; matching (if applicable), and; reporting.
3. If the recipient expends less than $300,000 in State awards in its fiscal year, an audit
conducted in accordance with the provisions of Section 215.97, Florida Statutes, is not
required, In the event that the recipient expends less than $ 300,000 in State awards in its fiscal
year and elects to h.a.ve an audit conducted in accordance with t~e" provi~ions of S~~ti~m
215.97, Florida Statutes, the cost of the audit must be paid from non-State funds (i.e., the cost
of such an audit must be paid from the recipient's resources obtained from other than State
entities)..
4. If an audit is not required or performed, the head of the recipient entity or organization must
provide a written attestation, under penalty of perjury, that the recipient has complied with the
allowable cost provisions and submit it to the department within 90 days of the recipient
agency's fiscal year end (congruent with the department's Client Services f\jJanual, the
Comptro!ler's Voucher Processing Handbook, and OMB Circular A-122 or A-87, whichever is
applicable). EXHIBIT 1 to this attachment provides an example attestation document that should
be used by the agency head or authorized signatory for contracts to attest to compliance with
these provisions.
28
PART III: REPORT SUBMISSION
.
.1. Copies of reporting packages for audits conducted in accordance with OMS Circular A-133, as
revised, and required by PART I of this attachment shall be submitted, when required by Section
.320 (d), OMS Circular A-133, as revised, by or on behalf of the recipient directly to each of
the following within 45 days of receipt of the report but no later than nine (9) months of
recipient's fiscal year end:
A. The Department of Elder Affairs at the following address:
Department of Elder Affairs
Attn.: CONTRACT MANAGER
4040 Esplanade Way, Bldg. B
Tallahassee, Fl 32399-7000
S. The Federal Audit Clearinghouse designated in OMS Circular A-133, as revised (the
number of copies required by Sections .320 (d)(1) and (2), OMS Circular A-133, as
revised, should be submitted to the Federal Audit Clearinghouse), at the following
address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
C. Other Federal agencies and pass-through entities in accordance with Sections .320 (e)
and (fl, OMS Circular A-133, as revised. .
2. The recipient shall submit a copy of the reporting package described in Section .320 (c), OMS
Circular A-133, as revised, and any management letters issued by the auditor, to the
department at the following address within 45 days of receipt of the report but no later than
nine (9) months of recipient's fiscal year end:
Department of Elder .n.ffairs
Attn.: CONTRACT MANAGER
4040 Esplanade Way, Bldg. B
Tallahassee, Fl 32399-7000:
3. Copies of audits and reporting packages req~ired by PART II of this attachment shall be
submitted by or on behalf of the recipient directly to each of the following within 45 days of
receipt of the report but no later than nine (9) months of recipient's fiscal year end::
A. The Department ot" Elder Affairs at the following address:
Department of Elder Affairs
.4ttention: Contract Manager
4040 Esplanade Way, Bldg. B
Tallahassee, F!orida 32399-7000
B. The Auditor General's Office at the following address:
State of Florida Auditor General
. Room 574, Claude Pepper Building
111 West Madison Street
T=>II~h~~~~n C:1~_;rl'" ':! ,)":I(\,)_1l1 ~(\
29
.
.
4. Any reports, management letters, or other information required to be submitted to the
department pursuant to this attachment shall be submitted timely in accordance with OMS
Circular A-133, 215.97 Florida Statutes, and Chapters 10.550 (local governmental entities) or
10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, as applicable and
should indicate the date that the reporting package was delivered to the recipient in
correspondence accompanying the package.
5. Recipients, when submitting the financial reporting packag...es to the department,.should indicate
the date that the audit report was delivered to the recipient in correspondence accompanying
the audit report.
PART IV: RECORD RETENTION
The recipient shall retain sufficient records demonstrating its compliance with the terms of this
attachment for a minimum period of five (5) years, for contractual agreements, and for a period of
fifteen (15) years for fixed capitol outlay appropriation agreements, from the date the audit report
is issued or longer if requested by the department in writing, and shall allow the department or its
authorized designee, and the Comptroller or ft,uditor General access to such records upon request.
The recipient shall ensure that audit working papers are made available to the department or its
designee, and the Comptroller or Auditor General upon request, for a minimum period of five (5)
years from the date the audit report is issued, or longer if requested in writing by the department.
PART V: SPECIFIC REQUIREMENTS OF DEPARTMENT ADMINISTERED PROGRAMS
The department req"uires a supplemental schedule of 'functional expenses be prepared in a format
provided by the department, which presents costs by service (as defined by the department),
including units of service delivered, for recipients or subrecipients expending state or federal awards
for services performed by their employees, contractors, and other payees who receive payment from
department-administered funds for units of service recorded in the department's Client Registration
and Tracking System (CIRTS). This supplemental schedule shall be prepared using the same
methodology as used in determining the contractual rates.
Interest earned on general revenue funds must be returned to the department. Interest earned on
federal funds may be used to expand, improve, or sustain the program from which it is generated.
A chart is included in all contracts identifying the funding source(s), program titles, applicable CFDA
or CSFA numbers and the amount of funds granted.
Specific requirements for match, co-payments, and program income applicable to piOgrams
administered by the department are outlined in the following applicability chart. Brief definitions of
terms used in the chart are included.
30
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Attachment VI
EXHIBIT - 1
MANAGEMENT ATTESTATION LETTER
Contract or Agreement Number:
I, Charles "Sonny" McCoy , hereby attest under penalty of perjury
(recipient's authorized representative)
that Monrop- r.01mty Board of r.01mty
(recipient agency name)Commissioners
, based on the criteria
set forth in the department's Audit Attachment, P ARTS I and II, that:
4.
The above named recipient agency is not required to provide an audit report or reporting
package because [check applicable statement(s)]:
[J
the above-named entity has not expended $300,000 or more in total federal awards in its
fiscal year and therefore is not required to have a single or program-specific audit
performed in accordance in OMB Circular A- 133, as revised, and/or;
~
the above-named entity has not expended a total amount equal to or in excess of $300,000
in state awards in its fiscal year and therefore is not required to have a State single or
program-specific audit in accordance with section 215.97, Florida Statutes.
5.
The recipient has complied with the allowable cost provisions [congruent with State and Federal
law, the department's Client Services Manual, the Comptroller's Voucher Processing Handbook,
and Office of Management and Budget (OMB) Circular A-122, A-I 10, or A-87, whichever is
applicable] .
By making this statement the recipient has considered not only funding or awards from the department,
but all sources of Federal and State funding or awards.
Fiscal year ended
(Mo ,day, year)
(Signature)
(Title)
fill ayoY
,
34
. (Date)
Attachment VI
Exhibit - 2
Oath of Not for Profit Status
Contract or Agreement Number:
As an authorized representative for the Recipient identified herein, and in the above referenced
document(s), I do hereby swear under oath that this entity is currently a "not for profit"(non-profit)
organization as defined in section 501(c)(3)of the Internal Revenue Code. If this non-profit status
changes for any reason during the life of the above referenced contract or agreement, the Department of
Elder Affairs will be notified in writing immediately.
Name of Recipient entity
Signature of Authorized Representative
Printed name and Title of Authorized Representative
Date of Oath
P:lcontract administrationlcontract fO~ W ordlAudit Attchment August 23 2002. wpd
35
Attachment VII
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENT
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any state or federal agency, a member of congress, an officer or
employee of congress, an employee of a member of congress, or an officer or
employee of the state legislator, in connection with the awarding of any federal grant,
the making of any federal loan, the entering into of any cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of any federal
contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a member of congress, an officer or employee of congress, or an employee
of a member of congress in connection with this federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions,
(3) The undersigned shall require that the language of this certification be included in the
award documents for all sub-awards at all tiers (including subcontracts, sub-grants,
and contracts under grants, loans and cooperative agreements) and that all sub-
recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code,
Any person who fails to file the required certification shall be subject to a civil penalty of not
less th $10,000 and not more than $100,000 for each such failure,
IO/;~/O~
, ..
Date
Mayor Charles "Sonny" McCoy
Name of Authorized Individual
Application or Contract Number
Monroe County Board of County Commissioners, Monroe County SCSEP, 1100 Simonton
Street, Suite #1-206, Key West, Florida 33040
Name of Address of Organization
DOEA Form 103, (Revised Jan 2001)
P:\COMMON\pdrive\Contract Administration\CONTRACT FORMS\Form103-Lobbying Jan2001, frm
36
INSTRUCTIONS
CERTIFICA nON REGARDING
DEBARMENT, SUSPENSION, INELIGffiILITY
AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS
ATTACHMENT
VIII
1. Each recipient or vendor whose contract equals or exceeds $100,000 in federal monies must sign
this debarment certification prior to contract execution. Independent auditors who audit federal
programs regardless of the dollar amount are required to sign a debarment certification form.
Neither the Department of Elder Affairs nor its contract recipients or vendors can contract with
subrecipients if they are debarred or suspended by the federal government.
2. This certification is a material representation of fact upon which reliance is placed when this
contract is entered into. If it is later determined that the signed knowingly rendered an erroneous
certification, the Federal Government may pursue available remedies, including suspension and/or
debarment.
3. The recipient or vendor shall provide immediate written notice to the contract manager at any time
the recipient or vendor learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "debarred," "suspended," "ineligible," "person," "principal," and "voluntarily
excluded," as used in this certification, have the meanings set out in the Definitions and Coverage
sections ofmles implementing Executive Order 12549 and 45 CFR (Code of Federal Regulations),
Part 76. You may contact the contract manager for assistance in obtaining a copy of those
regulations.
5. The recipient or vendor further agrees by submitting this certification that, it shall not knowingly
enter into any subcontract with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this contract unless authorized by the Federal
Government.
6, The recipient or vendor further agrees by submitting this certification that it will require each
subrecipient of this contract whose payment will equal or exceed $100,000 in federal monies, to
submit a signed copy of this certification with each contract.
7, The Department of Elder Affairs and its contract recipients or vendor may rely upon a
certification of a recipient/subrecipients that is not debarred, suspended, ineligible, or voluntarily
exclude from contracting/subcontracting unless it knows that the certification is erroneous.
8. If the recipient or vendor is an Area Agency on Aging (AAA), the AAA may rely upon a
certification of a recipient/subrecipient or vendor entity that is not debarred, suspended, ineligible,
or voluntarily excluded from contracting/subcontracting unless the AAA knows that the
certification is erroneous.
9. The signed certifications of all subrecipients or vendors shall be kept on file with recipient.
DOEA FORM 112A
(Revised May 2(02)
P:\contract administration\contract forms\WordPerfect\form112a&b debarment instructions-form, wpd
37
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGmILITY
AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS
This certification is required by the regulation implementing Executive Order 12549, Debarment and
Suspension, signed February; 18, 1986. The guidelines were published in the May 29, 1987 Federal
Register (52 Fed. Reg., pages 20360-20369).
(1) The prospective recipient or vendor certifies, by signing this certification, that neither he nor
his principals is presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from participation in contracting with the Department of Elder Affairs
by any federal department or agency.
(2) Where the prospective recipient or vendor is unable to certify to any of the statements in this
certification, such prospective recipient or vendor shall attach an explanation to this
certification.
Mayor, Charles "Sonny" McCoy
Name and Title of Authorized Individual
(Print or type)
Monroe County Board of County Commissioners
Name of Organization
DOEA FORM 112B
(Revised May 2002)
P:\contract administration\contract forms\WordPerfect\form112a&b debarment instructions-form.wpd
38
'CEj~T'lFlaA TION REGARDING DATA INTEGRITY COMPLIANCE
FOR CONTRACTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
Contract No.
Attachment .. 11.
Federal Grants Management regulations and the Florida Single Audit Act require financial management systems for
recipients of state and federal funds to be capable of providing certain information, assuring accuracy and
accountability, in accordance with prescribed reporting requirements. These reporting requirements may require certain
calculations or the provision of specified data to fully disclose the financial results of each federally funded or state-
sponsored program.
To ensure the integrity of the State's accounting systems are not compromised, the following language was composed
to protect the interests of the State and the elderly population of Florida who rely on the programs in place to assist
them in preserving the quality and duration of their lives.
The undersigned, an authorized representative of the recipient named in the contract or agreement to which this form
is an attachment, hereby certifies that:
(1) The recipient and any sub-recipients of services under this contract have financial management systems capable
of providing certain information, including: (1) accurate, current, and complete disclosure of the financial results
of each grant-funded project or program in accordance with the prescribed reporting requirements; (2) the
source and application of funds for all contract supported activities; and (3) the comparison of outlays with
budgeted amounts for each award. The inability to process information in accordance with these requirements
could result in a return of grant funds that have not been accounted for properly.
(2) Management Information Systems used by the recipient, sub-recipient(s), or any outside entity on which the
recipient is dependent for data that is to be reported, transmitted or calculated, have been assessed and
verified to be capable of processing data accurately, including year-date dependent data. For those systems
identified to be non-compliant, recipient(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip
technology, the undersigned warrants that these products are capable of processing year-date dependent data
accurately. All versions of these products offered by the recipient (represented by the undersigned) and
purchased by the State will be verified for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines
that impede the hardware or software programs from operating properly, the recipient agrees 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 State, and without interruption to the ongoing business of the state, time
being of the essence.
(4) The recipient and any sub-recipient(s) of services under this contract warrant their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency including
emergencies arising from data integrity compliance issues.
The recipient shall require that the language of this certification be included in all subcontracts, subgrants, and other
agreements and that all sub-contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by Department of Management Services (OMS) Memorandum No.6 (98-99) and OMS Circulars A-1 02 and A-11 O.
/J1 on rDf!- Co uh -ry./ tc L
of Recipient ./
Signature
A~/(/r
Title
/O//G,/O:L
Date .
e{r
(Revised July2001)
P:\COMMON\pdrive\Contract Administration\CONTRACT FORMS\Data Integrity July2001.wpd
nl'TE~j1~~~~,_
39
RECIPIENT NAME, ADDRESS, PHONE# and ACCOUNT PROGRAM FUNDING SOURCE: THIS REPORT PERIOD:
NUMBER FOR PAYMENT FROM TO
TITLE V OAA
SENIOR COMMUNITY SERVICES
EMPLOYMENT PROGRAM (SCSEP) CONTRACT
PERIOD
CONTRACT#
REPORT#
CERTIFICATION: I certify to the best of my Imowledge and belief that the report is complete and correct and all outlays herein are for purposes
set forth in the contract.
Prepared By: Date: Approved By: Date:
PART A: BUDGETED INCOME/RECEIPTS 1, Approved 2. Actual 3, Total 4. Percent of
Budget Receipts for Receipts Approved Budget
Tllis Report Year to Date
1, Federal Funds.,... .....,.. ..........,....................... $ $ $ - %
2, Program Income....,................ ..................., $ $ $ - %
3, Local Cash Match....................................... $ $ $ - %
4, Local Cash Match $ $ $ - %
5. TOTAL RECEIPTS....................................,; $ $ $ - %
PART B: EXPENDITURES 1. Approved 2, Expenditures for 3. Expenditures 4, Percent of
Budget This Report Year to Date Approved
Budget
1. Administrative Services............................. $ $ $ - %
2, Enrollee Wages & F,B............................, $ $ $ - %
3, Other Program Cost............................. $ $ $ - %
4, TOTAL..""""."" ,...,." "'" ",., ,."""", $ $ $ - %
PART C: OTHER EXPENDITURES( For tracking purpose
only)
a , Third Party Contributions...........,
b , All other recip, Outlays ............
Total Local Match............................
PART D: OTHER REVENUE and EXPENDITURES
a. Program Income collected YTD $.................
b, Interest Earned $..................
.l-iliCEIPTS AND EXPENDITURES ATTACHMENT XA
TITLE V OAA SENIOR COMMUNITY SERVICE E EMPLOYMENT PROGRAM (SCSEP)
DOEA FORM 105V 1/4/02
40
REQUEST FOR PAYMENT
TITLE V OAA SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM
ATTACHMENT XB
RECIPIENT NAME, ADDRESS, PHONE# and FEID# TYPE OF REPORT: THIS REQUEST PERIOD:
FOR
B, METHOD OF
PAYMENT: REPORT#_
Advance CONTRACT#
-
Reimbursement_
CERTIFICATION: I hereby certify that this request or refund conforms with the terms of the above contract.
Prepared By: Date: Approved By: . Date
PART A: BUDGET (1) (2) (3) (4)
SUMMARY: ADMIN ENROLLEE Other TOTAL
Wages & F,B Program Cost
1, Approved Contract
Amount $ $ $ $
2. Previous Funds Received
For Contract Period $
3, Contract Balance $
4, Previous Funds Requested
For Contract Period $
5. Contract Balance $
PART B: CONTRACT FUNDS
REQUEST:
1, Anticipated Cash Needs
(1st-2nd Months)
2, Net Expenditures For Month
(DOEA Form 105V, Part B
Colunm 2 )
3. Total
PART C: NET FUNDS
REQUESTED:
1. Less Overadvance
2. Contract Funds Are Hereby
Requested For (Part B Line 4
minus Part CLine 1)
,
DOEA FORM lOGY) 1/4/02
41