FY2024 09/20/2023 AGREEMENT
This Agreement is made and entered into this 201" day of September 2023, between the
BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as
"Board" or "County," and Burton Memorial United Methodist Church, hereinafter referred to
as "PROVIDER."
WHEREAS, the PROVIDER is a not-for-profit corporation established for the provision of a
food pantry for disadvantaged persons, and
WHEREAS, it is a legitimate public purpose to provide a food pantry and meals for
disadvantaged persons of Monroe County, now, therefore,
IN CONSIDERATION of the mutual promises and covenants contained herein, it is agreed as
follows:
FUNDING
1. AMOUNT OF AGREEMENT. The Board, in consideration of the PROVIDER substantially
and satisfactorily performing and providing a food pantry for disadvantaged persons of Monroe
County, Florida, shall pay to the PROVIDER the sum of FIFTEEN THOUSAND AND NO/100 DOLLARS
($15,000.00) for fiscal year 2024.
2. TERM. This Agreement shall commence on October 1, 2023, and terminate September
30, 2024, unless earlier terminated pursuant to other provisions herein.
3. PAYMENT. Payment will be made periodically, no less than quarterly but no more
frequently than monthly, as hereinafter set forth. Reimbursement requests shall include items paid
by the PROVIDER within 120 days of payment by the PROVIDER. Reimbursement requests will be
submitted to the Board via the Office of Management and Budget. Reimbursement request and
supporting documentation must be acceptable to the Clerk's Finance Office. Acceptability to the
Clerk is based on generally accepted accounting principles and such laws, rules and regulations as
may govern the Clerk's disbursal of funds. The County shall only reimburse, subject to the funded
amounts below, those reimbursable expenses which are reviewed and approved as complying with
Monroe County Code of Ordinances, State laws and regulations and Attachment A - Expense
Reimbursement Requirements. Evidence of payment by the PROVIDER shall be in the form of a
letter, summarizing the expenses, with supporting documentation attached. (The Office of
Management and Budget may accept Reimbursement Requests electronically, but only
when submitted and formatted in a PDF file with cover letter and attachments together
in one (1) file.) The PROVIDER agrees to submit hard copies of Reimbursement Request and
supporting documentation upon request. The letter should contain a notarized certification
statement. An example of a reimbursement request cover letter is included as Attachment B. The
organization's final invoice must be received within thirty days after the termination date of this
contract shown in Article 2 above.
After the Clerk of the Board examines and approves the request for reimbursement, the
Board shall reimburse the PROVIDER. However, the total of said reimbursement expense payments
in the aggregate sum shall not exceed the total amount shown in Article 1, above, during the term
of this agreement.
4. AVAILABILITY OF FUNDS. If funds cannot be obtained or cannot be continued at a
level sufficient to allow for continued reimbursement of expenditures for services specified herein,
this agreement may be terminated immediately at the option of the Board by written notice of
termination delivered to the PROVIDER. The Board shall not be obligated to pay for any services
or goods provided by the PROVIDER after the PROVIDER has received written notice of termination,
unless otherwise required by law.
Contract-Burton Memorial-FY24;page t
S. PURCHASE OF PROPERTY. All property, whether real or personal, purchased with
funds provided under this agreement, shall become the property of Monroe County, and shall be
accounted for pursuant to statutory requirements. Funding under this agreement shall not be used
to purchase capital assets.
RECORDKEEPING
6. RECORDS AND RIGHT TO AUDIT. PROVIDER shall maintain all books, records, and
documents directly pertinent to performance under this Agreement in accordance with generally
accepted accounting principles consistently applied. Records shall be retained for a period of ten
(10) years from the termination of this agreement. Each party to this Agreement or their authorized
representatives shall have reasonable and timely access to such records of each other party to this
Agreement for public records purposes during the term of the Agreement and for ten (10) years
following the termination of this Agreement. If an auditor employed by the County or Clerk
determines that monies paid to PROVIDER pursuant to this Agreement were spent for purposes not
authorized by this Agreement, or were wrongfully retained by the PROVIDER, the PROVIDER shall
repay the monies together with interest calculated pursuant to Sec. 55.03, Florida Statutes, running
from the date the monies were paid by the COUNTY.
Right to Audit. Availability of Records. The records of the parties to this Agreement relating to
the Project, which shall include but not be limited to accounting records (hard copy, as well as
computer readable data if it can be made available; subcontract files (including proposals of
successful and unsuccessful bidders, bid recaps, bidding instructions, bidders list, etc.); original
estimates; estimating work sheets; correspondence; change order files (including documentation
covering negotiated settlements); back charge logs and supporting documentation; general ledger
entries detailing cash and if applicable trade discounts earned, insurance rebates and dividends;
any other supporting evidence deemed necessary by County or the Monroe County Office of the
Clerk of Court and Comptroller (hereinafter referred to as "County Clerk") to substantiate charges
related to this agreement, and all other agreements, sources of information and matters that may
in County's or the County Clerk's reasonable judgment have any bearing on or pertain to any
matters, rights, duties or obligations under or covered by any contract document (all foregoing
hereinafter referred to as "Records") shall be open to inspection and subject to audit and/or
reproduction by County's representative and/or agents or the County Clerk. County or County
Clerk may also conduct verifications such as, but not limited to, counting employees at the job site,
witnessing the distribution of payroll, verifying payroll computations, overhead computations,
observing vendor and supplier payments, miscellaneous allocations, special charges, verifying
information and amounts through interviews and written confirmations with employees,
Subcontractors, suppliers, and contractors' representatives. All records shall be kept for ten (10)
years after Final Completion of the Project. The County Clerk possesses the independent authority
to conduct an audit of Records, assets, and activities relating to this Project. If any auditor
employed by the Monroe County or County Clerk determines that monies paid to Contractor
pursuant to this Agreement were spent for purposes not authorized by this Agreement, the
Contractor shall repay the monies together with interest calculated pursuant to Section 55.03, F.S.,
running form the date, the monies were paid to Contractor. The right to audit provisions survives
the termination of expiration of this Agreement.
In addition, if PROVIDER is required to provide an audit as set forth in in Section 8(e) below, the
audit shall be prepared by an independent certified public accountant (CPA) with a current license,
in good standing with the Florida State Board of Accountancy.
7. PUBLIC ACCESS. The County and PROVIDER shall allow and permit reasonable access
to, and inspection of, all documents, papers, letters or other materials in its possession or under
its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the
County and PROVIDER in conjunction with this Agreement; and the County shall have the right to
unilaterally cancel this Agreement upon violation of this provision by PROVIDER.
Contract-Burton Memorial-FY24;page 2
S. COMPLIANCE WITH COUNTY GUIDELINES. The PROVIDER must furnish to the
County the following (items (a)-(j) must be provided prior to the payment of any invoices):
(a) IRS Letter of Determination and GUIDESTAR printout indicating current 501(c)(3) status;
(b) Proof of registration with the Florida Department of Agriculture, as required by Florida
Statute 496.405, and the Florida Department of State, as require by Florida Statute
617.01201, or proof of exemption from registration as per Florida Statute 496.406.
(c) List of the Organization's Board of Directors of which there must be at least 5 and for each
board member please indicate when elected to serve and the length of term of service;
(d) Evidence of annual election of Officers and Directors/Directors At-Large or bi-annual election
of Officers and Directors/Directors At-Large as applicable;
(e) Unqualified audited financial statements from the most recent fiscal year for all organizations
that expend $150,000 a year or more; if qualified, include a statement of deficiencies with
corrective actions recommended/taken; audit shall be prepared by an independent certified
public accountant (CPA) with a current license, in good standing with the Florida State Board
of Accountancy. If the PROVIDER receives $100,000 or more in grant funding from the
County:
a. The CPA that prepares the audit must also be a member of the
American Institute of Certified Public Accountants (AICPA);
b. The CPA must maintain malpractice insurance covering the audit
services provided and
c. The County shall be considered an "intended recipient" of said
audit.
(f) Copy of a filed IRS Form 990 from most recent fiscal year with all attached schedules;
(g) Organization's Corporate Bylaws, which must include the organization's mission, board and
membership composition, and process for election of officers;
(h) Organization's Policies and Procedures Manual which must include hiring policies for all staff,
drug and alcohol-free workplace provisions, and equal employment opportunity provisions;
(i) Specific description or list of services to be provided under this contract with this grant (see
Attachment C);
(j) Annual Performance Report describing services rendered during the most recently completed
grant period (to be furnished within 30 days after the contract end date.) The performance
report shall include statistical information regarding the types and frequencies of services
provided, a profile of clients (including residency) and numbers served, and outcomes
achieved (see Attachment G);
(k) Cooperation with County monitoring visits that the County may request during the contract
year; and
(1) Other reasonable reports and information related to compliance with applicable laws,
contract provisions and the scope of services that the County may request during the
contract year.
RESPONSIBILITIES
9. SCOPE OF SERVICES. The PROVIDER, for the consideration named, covenants and
agrees with the Board to substantially and satisfactorily perform and provide the services outlined
in Attachment C to residents of Monroe County, Florida.
10. ATTORNEY'S FEES AND COSTS. The County and PROVIDER agree that in the event
any cause of action or administrative proceeding is initiated or defended by any party relative to
the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to
reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award
against the non-prevailing party, and shall include attorney's fees, courts costs, investigative, and
out-of-pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted
pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and
usual and customary procedures required by the circuit court of Monroe County.
Contract-Burton Memorial-FY24;page 3
11. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement
shall bind and inure to the benefit of the County and PROVIDER and their respective legal
representatives, successors, and assigns.
12. CODE OF ETHICS. County agrees that officers and employees of the County recognize
and will be required to comply with the standards of conduct for public officers and employees as
delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or
acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public
position, conflicting employment or contractual relationship; and disclosure or use of certain
information.
13. NO SOLICITATION/PAYMENT. The County and PROVIDER warrant that, in respect
to itself, it has neither employed nor retained any company or person, other than a bona fide
employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed
to pay any person, company, corporation, individual, or firm, other than a bona fide employee
working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon
or resulting from the award or making of this Agreement. For the breach or violation of the
provision, the PROVIDER agrees that the County shall have the right to terminate this Agreement
without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full
amount of such fee, commission, percentage, gift, or consideration.
14. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
PROVIDER is an independent contractor and not an employee of the Board. No statement contained
in this agreement shall be construed so as to find the PROVIDER or any of its employees,
contractors, servants or agents to be employees of the Board.
COMPLIANCE ISSUES
15. COMPLIANCE WITH LAW. In providing all services pursuant to this agreement, the
PROVIDER shall abide by all statutes, ordinances, rules and regulations pertaining to or regulating
the provision of such services, including those now in effect and hereinafter adopted. Any violation
of said statutes, ordinances, rules and regulations shall constitute a material breach of this
agreement and shall entitle the Board to terminate this contract immediately upon delivery of
written notice of termination to the PROVIDER.
16. PROFESSIONAL RESPONSIBILITY AND LICENSING. The PROVIDER shall assure
that all professionals have current and appropriate professional licenses and professional liability
insurance coverage. Funding by the Board is contingent upon retention of appropriate local, state
and/or federal certification and/or licensure of the PROVIDER'S program and staff.
17. NON-DISCRIMINATION. The COUNTY and PROVIDER agree that there will be no
discrimination against any person, and it is expressly understood that upon a determination by a
court of competent jurisdiction that discrimination has occurred, this Agreement automatically
terminates without any further action on the part of any party, effective the date of the court order.
The COUNTY and PROVIDER agree to comply with all Federal and Florida statutes, and all local
ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1)
Title VII of the Civil Rights Act of 1964 (PL 88-352), which prohibits discrimination in employment
on the basis of race, color, religion, sex, and national origin; 2) Title IX of the Education Amendment
of 1972, as amended (20 USC §§ 1681-1683, and 1685-1686), which prohibits discrimination on
the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC § 794),
which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as
amended (42 USC §§ 6101-6107), which prohibits discrimination on the basis of age; 5) The Drug
Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on
the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination
Contract-Burton Memorial-FY24;page 4
on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, §§ 523 and
527 (42 USC §§ 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug
abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC §§ 3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans
with Disabilities Act of 1990 (42 USC §§ 12101), as amended from time to time, relating to
nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 14,
Article II, which prohibits discrimination on the basis of race, color, sex, religion, national origin,
ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other
nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or
the subject matter of, this Agreement.
AMENDMENTS, CHANGES, AND DISPUTES
18. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the services
and/or reimbursement of services shall be accomplished by an amendment, which must be
approved in writing by the County.
19. ADJUDICATION OF DISPUTES OR DISAGREEMENTS. County and PROVIDER agree
that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions
between representatives of each of the parties. The PROVIDER and County staff shall try to resolve
the claim or dispute with meet and confer sessions to be commenced within 30 days of the dispute
or claim. If the issue or issues are still not resolved to the satisfaction of the parties, then any party
shall have the right to seek such relief or remedy as may be provided by this agreement or by
Florida law. Any claims or dispute that the parties cannot resolve shall be decided by the Circuit
Court, 161" Judicial Circuit, Monroe County, Florida.
20. COOPERATION. In the event any administrative or legal proceeding is instituted
against either party relating to the formation, execution, performance, or breach of this Agreement,
County and PROVIDER agree to participate, to the extent required by the other party, in all
proceedings, hearings, processes, meetings, and other activities related to the substance of this
Agreement or provision of the services under this Agreement. County and PROVIDER specifically
agree that no party to this Agreement shall be required to enter into any arbitration proceedings
related to this Agreement.
ASSURANCES
21. COVENANT OF NO INTEREST. County and PROVIDER covenant that neither presently
has any interest, and shall not acquire any interest, which would conflict in any manner or degree
with its performance under this Agreement, and that only interest of each is to perform and receive
benefits as recited in this Agreement.
22. NO ASSIGNMENT. The PROVIDER shall not assign this agreement except in writing
and with the prior written approval of the Board, which approval shall be subject to such conditions
and provisions as the Board may deem necessary. This agreement shall be incorporated by
reference into any assignment and any assignee shall comply with all of the provisions herein.
Unless expressly provided for therein, such approval shall in no manner or event be deemed to
impose any obligation upon the Board in addition to the total agreed upon reimbursement amount
for the services of the PROVIDER.
23. NON-WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida
Statutes, the participation of the County and the PROVIDER in this Agreement and the acquisition
of any commercial liability insurance coverage, self-insurance coverage, or local government
liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability
coverage, nor shall any contract entered into by the County be required to contain any provision
for waiver.
Contract-Burton Memorial-FY24;page 5
24. ATTESTATIONS. PROVIDER agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug-
Free Workplace Statement.
25. AUTHORITY. Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all necessary County
and corporate action, as required by law.
INDEMNITY ISSUES
26. INDEMNIFICATION AND HOLD HARMLESS. The PROVIDER covenants and agrees
to indemnify and hold harmless Monroe County Board of County Commissioners from any and all
claims and causes of action for medical malpractice, medical negligence, bodily injury (including
death), personal injury, and property damage (including property owned by Monroe County) and
any other losses, damages, and expenses (including attorney's fees) which arise out of, in
connection with, or by reason of services provided by the PROVIDER occasioned by the negligence,
errors, or other wrongful act or omission of the PROVIDER'S employees, agents, or volunteers.
27. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability,
exemptions from laws, ordinances, and rules and pensions and relief, disability, workers'
compensation, and other benefits which apply to the activity of officers, agents, or employees of
any public agents or employees of the County, when performing their respective functions under
this Agreement within the territorial limits of the County shall apply to the same degree and extent
to the performance of such functions and duties of such officers, agents, volunteers, or employees
outside the territorial limits of the County.
28. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be
deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe
County in his or her individual capacity, and no member, officer, agent or employee of Monroe
County shall be liable personally on this Agreement or be subject to any personal liability or
accountability by reason of the execution of this Agreement.
29. LEGAL OBLIGATIONS AND RESPONSIBILITIES: Non-Delegation of Constitutional
or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any
participating entity from any obligation or responsibility imposed upon the entity by law except to
the extent of actual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
30. NON-RELIANCE BY NON-PARTIES. No person or entity shall be entitled to rely upon
the terms of this Agreement to enforce or attempt to enforce any third-party claim or entitlement
to or benefit of any service or program contemplated hereunder, and the County and the PROVIDER
agree that neither the County nor the PROVIDER or any agent, officer, or employee of either shall
have the authority to inform, counsel, or otherwise indicate that any particular individual or group
of individuals, entity or entities, have entitlements or benefits under this Agreement separate and
apart, inferior to, or superior to the community in general or for the purposes contemplated in this
Agreement.
GENERAL
31. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number
of counterparts, each of which shall be regarded as an original, all of which taken together shall
constitute one and the same instrument and any of the parties hereto may execute this Agreement
by signing any such counterpart.
Contract-Burton Memorial-FY24;page 6
32. NOTICE. Any notice required or permitted under this agreement shall be in writing
and hand-delivered or mailed, postage pre-paid, by certified mail, return receipt requested, to the
other party as follows:
For Board:
Grants Administrator and Monroe County Attorney
1100 Simonton Street PO Box 1026
Key West, FL 33040 Key West, FL 33041
For PROVIDER
Kerry Foote
Burton Memorial United Methodist Church
93001 Overseas Hwy.
Tavernier, FL 33070
Phone:(305) 852-2581
Email: pastor.foote@outlook.com
33. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This
Agreement shall be governed by and construed in accordance with the laws of the State of Florida
applicable to contracts made and to be performed entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and PROVIDER agree that venue will
lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida.
The County and PROVIDER agree that, in the event of conflicting interpretations of the terms
or a term of this Agreement by or between any of them the issue shall be submitted to mediation
prior to the institution of any other administrative or legal proceeding.
34. NON-WAIVER. Any waiver of any breach of covenants herein contained to be kept
and performed by the PROVIDER shall not be deemed or considered as a continuing waiver and
shall not operate to bar or prevent the Board from declaring a forfeiture for any succeeding breach,
either of the same conditions or covenants or otherwise.
35. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or
the application thereof to any circumstance or person) shall be declared invalid or unenforceable to
any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and
provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant,
condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent
permitted by law unless the enforcement of the remaining terms, covenants, conditions and
provisions of this Agreement would prevent the accomplishment of the original intent of this
Agreement. The County and PROVIDER agree to reform the Agreement to replace any stricken
provision with a valid provision that comes as close as possible to the intent of the stricken
provision.
36. CLAIMS FOR FEDERAL OR STATE AID: PROVIDER and COUNTY agree that each
shall be, and is, empowered to apply for, seek, and obtain federal and state funds to further the
purpose of this Agreement. Any conditions imposed as a result of funding that effect the Scope of
Services will be provided to each party.
37. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the PROVIDER and the Board.
[THIS SPACE INTENTIONALLY LEFT BLANK WITH SIGNATORY PAGE TO FOLLOW]
Contract-Burton Memorial-FY24;page 7
NESS WHEREOF, the parties hereto have caused these presents to be execrated as of
h � ar first written above.
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Contract-Burton Mernoda8-FY24p page 8
ATTACHMENT A
EXPENSE REIMBURSEMENT REQUIREMENTS
This document is intended to provide basic guidelines to Human Service and Community-Based
Organizations, county travelers, and contractual parties who have reimbursable expenses
associated with Monroe County business. These guidelines, as they relate to travel, are from the
Monroe County Code of Ordinances and State laws and regulations.
Provide documentation of number of clients served and explanation of measurable outcomes
described in Q.29, of the FY2024 application submitted to the HSAB, that were achieved during the
billing period.
For reimbursement of Payroll and/or fees for services, the Provider shall provide supporting
documentation to substantiate that the work performed was for services as set forth in Attachment
C (sign-in log from clients served, a detailed work log with services rendered and client(s) served
for that time period as indicated above)
A cover letter (see Attachment B) summarizing the major line items on the reimbursable expense
request needs to also contain the following notarized certified statement:
"I certify that the above checks have been submitted to the vendors as noted and that the
attached expenses are accurate and in agreement with the records of this organization.
Furthermore, these expenses are in compliance with this organization's contract with the Monroe
County Board of County Commissioners and will not be submitted for reimbursement to any other
funding source."
The notary public is subject to the provisions of Chapter 117, Florida Statutes, must use a certificate
in substantially the following form in notarizing a tangible or an electronic record.
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online
notarization, this _day of (month), (year), by
(name of officer or agent, title of officer or agent) of
(name of entity).
Personally Known
Produced Identification: Type of ID and Number on ID_
(SEAL)
Signature of Notary
Name of Notary (Typed, Stamped or Printed)
Notary Public, State of
Invoices should be billed to the contracting agency. Third party payments will not be considered
for reimbursement. Remember, the expense should be paid prior to requesting a reimbursement.
Only current charges will be considered, no previous balances.
Contract-Burton Memorial-FY24;page 9
Reimbursement requests will be monitored in accordance with the level of detail in the contract.
This document should not be considered all-inclusive. The Clerk's Finance Department reserves
the right to review reimbursement requests on an individual basis. Any questions regarding these
guidelines should be directed to 305-292-3534.
Data Processing, PC Time, etc.
The vendor invoice is required for reimbursement. Inter-company allocations are not considered
reimbursable expenditures unless appropriate payroll journals for the charging department are
attached and certified.
Payroll
A certified statement verifying the accuracy and authenticity of the payroll expense is needed. If a
Payroll Journal is provided, it should include: dates, employee name, salary or hourly rate, total
hours worked, withholding information and paid payroll taxes, check number and check amount. If
a Payroll Journal is not provided, the following information must be provided: pay period, check
amount, check number, date, payee, and support for applicable paid payroll taxes. �3 yur(:)llll and/oir
�::ees �:oir seirvices a eClUests �. ur ureilllbUi seii eint §IIhaHH iu1dUde the Stull 11 iitin lii eintadon as detafled
above i he Oeid< may a eClUes tl:Uirblhcur dOCUIMentaUoin to veirH" and SUbstandate that the Il ayiinlent
u eClUes �:oir Il ayur llll and/oi �'ccs �:oir serrvices urcllates to the seirvices Il a ovide as set �:oiith in
Attachiment C.
Postage, Overnight Deliveries, Courier, etc.
A log of all postage expenses as they relate to the County contract is required for reimbursement.
For overnight or express deliveries, the vendor invoice must be included.
Rents, Leases, etc.
A copy of the rental or lease agreement is required. Deposits and advance payments are not
allowable expenses.
Reproductions, Copies, etc.
A log of copy expenses as they relate to the County contract is required for reimbursement. The
log must define the date, number of copies made, source document, purpose, and recipient. A
reasonable fee for copy expenses will be allowable. For vendor services, the vendor invoice and a
sample of the finished product are required.
Supplies, Services, etc.
For supplies or services ordered, a vendor invoice is required.
Telefax, Fax, etc.
A fax log is required. The log must define the sender, the intended recipient, the date, the number
called, and the reason for sending the fax.
Telephone Expenses
A user log of pertinent information must be remitted including: the party called, the caller, the
telephone number, the date, and the purpose of the call.
Travel and Meal Expenses
Travel expenses must be submitted on a State of Florida Voucher for Reimbursement of Travel
Expenses. Travel reimbursement requests must be submitted and will be paid in accordance with
Monroe County Code of Ordinances and State laws and regulations. Credit card statements are not
acceptable documentation for reimbursement. If attending a conference or meeting, a copy of the
agenda is needed. Airfare reimbursement requires the original passenger receipt portion of the
airline ticket. A travel itinerary is appreciated to facilitate the audit trail. Auto rental reimbursement
requires the vendor invoice. Fuel purchases should be documented with paid receipts. Taxis are
not reimbursed if taken to arrive at a departure point: for example, taking a taxi from one's
Contract-Burton Memorial-FY24;page 10
residence to the airport for a business trip is not reimbursable. Parking is considered a reimbursable
travel expense at the destination. Airport parking during a business trip is not.
A detailed list of charges is required on the lodging invoice. Balance due must be zero. Room must
be registered and paid for by traveler. The County will only reimburse the actual room and related
bed tax. Room service, movies, and personal telephone calls are not allowable expenses.
Mileage reimbursement shall be at the rate established by ARTICLE XXVI, TRAVEL, PER DIEM,
MEALS, AND MILEAGE POLICY of the Monroe County Code of Ordinances. An odometer reading
must be included on the state travel voucher for vicinity travel. Mileage is not allowed from a
residence or office to a point of departure. For example, driving from one's home to the airport for
a business trip is not a reimbursable expense.
Meal reimbursement shall be at the rates established by ARTICLE XXVI, TRAVEL, PER DIEM, MEALS,
AND MILEAGE POLICY of the Monroe County Code of Ordinances. Meal guidelines state that travel
must begin prior to 6 a.m. for breakfast reimbursement, before noon and end after 2 p.m. for lunch
reimbursement, and before 6 p.m. and end after 8 p.m. for dinner reimbursement.
Non-allowable Expenses
The following expenses are not allowable for reimbursement: capital outlay expenditures (unless
specifically included in the contract), contributions, depreciation expenses (unless specifically
included in the contract), entertainment expenses, fundraising, non-sufficient check charges,
penalties and fines.
Contract-Burton Memorial-FY24;page 11
ATTACHMENT B
ORGANIZATION
LETTERHEAD
Monroe County Board of County Commissioners
Finance Department
500 Whitehead Street
Key West, FL 33040
Date
The following is a summary of the expenses for (Organization name) for the time period of to _.
Check # Payee Reason Amount
101 Company A Rent $ X,XXX.XX
102 Company B Utilities XXX.XX
104 Employee A P/R ending 05/14/01 XXX.XX
105 Employee B P/R ending 05/28/01 XXX.XX
(A) Total X,XXX.XX
(B) Total prior payments $ X,XXX.XX
(C) Total requested and paid (A + B) $ X,XXX.XX
(D) Total contract amount $ X,XXX.XX
Balance of contract (D-C) $ X,XXX.XX
I certify that the above checks have been submitted to the vendors as noted and that the expenses are
accurate and in agreement with the records of this organization. Furthermore, these expenses are in
compliance with this organization's contract with the Monroe County Board of County Commissioners
and will not be submitted for reimbursement to any other funding source.
Chief Executive Officer
Attachments (supporting documentation)
TO BE COMPLETED BY NOTARY (in accordance with State notary requirements)
State of
County of
The foregoing instrument was acknowledged before me, by means of ❑ physical presence or ❑ online
notarization, this _day of (month), (year), by
(name of officer or agent, title of officer or agent) of
(name of entity).
Personally Known
Produced Identification: Type of ID and Number on ID_
(SEAL)
Signature of Notary
Name of Notary (Typed, Stamped or Printed)
Notary Public, State of
Contract-Burton Memorial-FY24;page 12
ATTACHMENT C
Specific description and list of services to be provided under this contract:
The funds will purchase food, kitchen supplies and food packaging materials as well as contribute
to direct compensation of the Food Pantry Coordinator for the Daily Bread Food Pantry and God's
Kitchen, which provides groceries and hot meals to the homeless and low-income families of the
Upper Keys community.
The services to be funded by this request are the supply of hot meals and groceries to people in
need in the Upper Keys community. This year we will solicit, collect, organize, store, and distribute
168,000 pounds of groceries and personal hygiene items and prepare about 3,300 meals from our
church in Tavernier, FL. Last fiscal year 6,505 bags of groceries were provided to Burton Memorial
United Methodist Church's clients.
Measurable Outcomes Include: (HSAB Application Q29)
A. The Food Pantry at Burton Memorial United Methodist Church plans to solicit, collect,
repackage, store, and disburse 162,000 pounds of groceries and personal hygiene items.
B. 3,2300 free meals are planned to be served.
Budget Categories Include: (HSAB ApplicationQ.36)
Salaries — Program, Purchased Food, Packaging and serving supplies.
Contract-Burton Memorial-FY24;page 13
ATTACHMENT D
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a conviction for
public entity crime may not submit a bid on a contract to provide any goods or services to a public
entity, may not submit a bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real property to public entity, may
not be awarded or perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR
under a contract with any public entity, and may not transact business with any public entity in
excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of
36 months from the date of being placed on the convicted vendor list." to
I have read the above and state that neither _ ndent's name) nor
any Affiliate has been placed on the convicted vendor list within the last 36 months.
(Signature)
Date: .......�.J, G L C
TO BE COIMIIRLET D BY NOTARY (in accordance with State notary requirements)
State of
County of
The foregoing instrument was acknowledged before me, by means of physical presence or ❑ online
notarization, this„ ,µ "' _ day ofj 2 (month), (year), by
r�
" _ ,, t1rr �officer or agent, title of officer or agent) of
L1 name of entity).
Personally Known
Produced Identification: Type of ID and Nut ber ID
(SEAL)
S e of Noi Y
r
M=CURBELO Name of otary (Typed, Stan cI or Printed)
'J MY CE Notary Public, State of Lo/
Contract-Burton Memorial-FY24;page 14
ATTACHMENT E
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
ww. fnA rr
......_ .......
(Company) �.. ._______............................._
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former
County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer
or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this
provision the County may, in its discretion, terminate this Agreement without liability and may also,
in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount
of any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
�A
,. .� . m
(Signature) ................._.._______.��.._........
0
Date: � L........... L...... . .. ..�.
TO BE COMP'LE O BY NOTARY (in accordance with State notary requirements)
State of "A
County of 10/�
The foregoing instrument was acknowledged before me, by means of physical presence or ❑ online
notarization, this � day of w_wwwwwww _ (month), (year), by
' (name of officer or agent, title of officer or agent) of
(name of entity),
Personally Known
Produced Identification: Type of ID and Numbe on I
(SEAL) ,
.Sign tary
Name of Notary (Typed, Sta, ed r Printed)
d MARGARITA CURBELO
MY COMMISSION#HH 397533 Notary Public, State of P _�mm_ITmm ITITmmm,,,,,
EXPIRES:July 14,2027
"'W'4 b'&d ri nmuaMM:pl�'"PoWd,
Contract-Burton Memorial-FY24;page 15
ATTACHMENT F
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that;
1, y -
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace and
specifying the actions that will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business' policy of
maintaining a drug-free workplace, any available drug counseling, rehabilitation, and
employee assistance programs, and the penalties that may be imposed upon employees for
drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are
under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of
working on the commodities or contractual services that are under bid, the employee will
abide by the terms of the statement and will notify the employer of any conviction of, or
plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of
any controlled substance law of the United States or any state, for a violation occurring in
the workplace no later than five (5) days after such conviction.
5. Impose a sanction on or require the satisfactory participation in a drug abuse assistance or
rehabilitation program if such is available in the employee's community, or any employee
who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that thi firm co plies Fu y with the
above requirements.
(Signature)
Date: ...........___ 1,S2-..02
TO BE COMPL.ET O B NOTARY (in accordance with State notary requirements)
State of 1
County of „�i ........
The foregoing instrument was acknowledged before me, by means of physical presence or ❑ online
day of � s (month), <�" (year), by
�
... 0
notarization this P o 5 'am F officer or agent, title of officer or agent) of
-name of entity).
Personally Known
Type of ID and Nu4/ 1)r
(SEAL) ProducedIdentification: T-
µ � FAYITT Sie of No�w w � f OMMIRSION#HH 397533 •d ry
MARGARITA CURBELO
1 ...
2cz7 #bane a��fiotat"y TYed, Star�r� or� rated)
Notary Public, State of _ _..
Contract-Burton Memorial-FY24;page 16
ATTACHMENT G
FY2024 Annual Performance Report
For year October 1, 2023—September 30, 2024
(Report Deadline: October 31, 2024)
lAgency Name -i--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Point of Contact (POCK
----------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------i
Phone/Email
------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Grant Amount
Per Section 8 of your contract, it is required that you fill out the entire form and answer every
question.
Narrative on the FY2024 Performance (i.e. successes, challenges, etc.):
Questions:
1. Please list services and client information below for the program/activities funded by the Monroe
County award.
Fill
0, Z 1v 1, �=' Ii I If ff,�WN 11� ,ON WE�11 Ili
IMEME mw I,��'I=I IF (=�' � �1'
2. What were the measurable outcomes (including numbers) accomplished in FY2024? Please base
these outcomes on the services you identified in Question#1.
3. What number and percentage of your clients/participants were at or below the federal poverty level
in FY2024; and/or 200%; and/or another standard used by your organization?
4. What area of Monroe County did you serve in FY2024?
5. During FY2024, how many months did you provide program services to (Q.1) clients?
6. How many total FTEs in your organization?
7. How many FTEs worked on the program(s) funded by the FY2024 HSAB award?
Contract-Burton Memorial-FY24;page 17
8. Volunteers: hours of program service were contributed by volunteers in FY2024.
FY2024 HSAB FINANCIAL REPORT
9. Were all the awarded funds used in FY2024?
a. If no, please explain:
10. Allocation of FY2024 Award; HSAB Award Amount = $
Program Expense Administrative Expense
Budget Cate o DollarAmount Dollar Amount
Salaries $0 $0-
Fringe $0 $0
FICA $0 $0
Independent Contractors $0 $0
Office Supplies, Telephone, Postage $0 $0
Utilities $0 $0
Insurance $0 $0-
Repair& Maintenance $0 $0 -
Travel/Transportation $0 $0
Rent/Association Dues $0 $0
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0
Client Service/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
Other Expense/Describe: $0 $0
11. Compensation Detail: Include all persons who receive compensation from the FY2024 HSAB
funding (including Independent Contractors)
Employee Name Type of Work Hrs. Worked Total Charges
FName, Last Initial Title Performed in Program on Pro ram to Pro ram
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
(Note:If you need more space,you may add additional lines or an addendum.)
Contract-Burton Memorial-FY24;page 18
12. Did the HSAB funding you received in FY2024 serve as required match for a portion or all funding
awarded by another granting agency? If yes, please provide details below:
Amount of Name of Grantor Amount Grantor Type: Grant Type: Match %
HSAB that Required Match Awarded by Federal, Competitive or Required
Funding Funding Grantor*** State, Non-Competitive by the
served as Local or Grantor
Required Foundation
Match
***Enter the Amount Awarded by the Grantor regardless of whether HSAB provided 100%of the Required Match.
For the following questions, please use the number as reported on your FY2024 IRS Form 990. If
your FY2024 IRS Form 990 is not yet prepared, please provide an estimate for the following
questions.
13. What is your organization's fiscal year?
14. What were your organization's total expenses in FY2024?
15. What was your organization's total revenue in FY2024?
16. What was the organization's total in grants and contracts for FY2024?
17. What was the organization's total donations/fundraising and in-kind in FY2024?
a. Cash Donations/Fundraising:
b. In-kind Donations/Fundraising:
18. What percentage of your expenses are program service expenses' versus management and
general expenses2 in FY2024 as reported on your IRS Form 990?
19. Additional Comments, Questions and/or Suggestions:
Email the Annual Performance Report to the Grants Coordinator for Monroe County
' ro
2Management and general expenses encompass expenses such as human resources,salaries of those not working directly with
programs, legal services, accounting services, insurance expenses,office management,auditing,and other centralized
services.
Contract-Burton Memorial-FY24;page 19