Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Item C02
COUNTY of MONROE The Florida Keys BOARD OF COUNTY COMMISSIONERS Mayor Michelle Lincoln, District 2 Mayor Pro Tem David Rice, District 4 Craig Cates, District 1 James K. Scholl, District 3 Holly Merrill Raschein, District 5 Regular Meeting March 11, 2026 Agenda Item Number: C2 26-0556 BULK ITEM: Yes DEPARTMENT: Fire Rescue TIME APPROXIMATE: N/A STAFF CONTACT: R.L. Colina AGENDA ITEM WORDING: Approval to renew a Class A Certificate of Public Convenience and Necessity (COPCN) to Monroe County Fire Rescue for the operation of Advanced Life Support (ALS) emergency medical transport and non -transport services, including Air Ambulance emergency medical transport services, in Monroe County, Florida, for the period of April 1, 2026 through March 31, 2028, with an application fee of $475.00 for the 2-year term, funded with Fund 141 or Fund 101. ITEM BACKGROUND: Monroe County Fire Rescue (MCFR) currently holds a Class A COPCN for the period starting on April 1, 2024 and ending on March 31, 2026. In view of the foregoing, MCFR has applied to renew the COPCN which, if approved, will become effective on April 1, 2026. This will enable MCFR to continue to provide emergency medical transport services for the benefit of the population of Monroe County, Florida. Pursuant to Section 401.25, Fla. Stat., all applicants seeking an ALS/BLS or Air Ambulance emergency medical services license from the Florida Department of Health (FDOH) must obtain a COPCN from the governing body of the County in which the applicant will operate. Currently, MCFR holds the requisite licensing and permits from FDOH to support both ground and air ambulance services, and this COPCN will enable continued compliance with such laws and administrative codes. PREVIOUS RELEVANT BOCC ACTION: 02/21/24 - BOCC approved the renewal of MCFR's Class A COPCN for the period of April 1, 2024 through March 31, 2026. 02/16/22 - BOCC approved the renewal of MCFR's Class A COPCN for the period of April 1, 2022 through March 31, 2024. And this renewal cycle continues for several years into the past. INSURANCE REQUIRED: Yes; Mandated by SOF. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval. DOCUMENTATION: MCFR Class A COPCN Renewal 2026-2028.pdf MCFR COPCN Application Class A 2026-2028 Redacted 02.26.2026 Compresssed Version.pdf FINANCIAL IMPACT: Effective Date: April 1, 2024 Expiration Date: March 31, 2028 Total Dollar Value of Contract: N/A Total Cost to County: $475 Current Year Portion: N/A Budgeted: N/A Source of Funds: Fund 141 Cost Center 11500; or Fund 101 Cost Center 11001 CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: N/A Grant: N/A County Match: N/A Insurance Required: Mandated pursuant to State of Florida licensing requirements. O _ .Z)U � o O N o ca O O cq 2 -a IZ ° .. o o D o Q Z3 N r N N O O O E U y� o 6° U � O a> o o •� Z)co c U o co Q C6 Z z p N O 0 U c3 0 o U ° a) U o f° _0 co 14) co CD o o o -0 aS N co U N U m C O O N .Q Zoo D m cm CD "Z Z, N q) co a. t� o o U c > m Jo SUM cn : UJ co 18, Z co O N N N O _ U U 4Z N U S- O N O N U Q 0 C fn o _ � _ Oj Z U ZO Qo N �— ° O N W (z z �, U)� d m O p •� -0 O Q U U 0 m _0 m W W W 'co W co a s o °� m x x x o ccu �U �� ❑� a m W U Z Q '�'^ VL co Q w d Q U �J U w 71 co 30 Q � 4 c cd gg -� v J O �v �u N 0 U C, MONROE COUNTY, FLORIDA APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY (COPCN) CLASS A EMERGENCY MEDICAL SERVICE (PRINT OR TYPE) F-1 INITIAL APPLICATION - $950.00 FEW RENEWAL APPLICATION - $475.00 IF RENEWAL,, PLEASE LIST NUMBER OF PREVIOUS CERTIFICATE: #24-02 1. NAME OF SERVICE, Monroe County Fire Rescue, a department of Monroe County, IFL BUSINESS MAILING ADDRESS7280 Overseas Hwy, Marathon, FL 33050 " 305-289-6004 BUSINESS PHONE NUMBER EMERGENCY PHONE NUMBER 9-11-1 2. TYPE OF OWNERSHIP (i.e., Sole Proprietor, Partnership, Corporation, etc.) Political Subdivision of the State DATE OF INCORPORATION OR FORMATION OF THE BUSINESS ASSOCIATION 1993 3. LIST ALL OFFICERS, DIRECTORS, AND SHAREHOLDERS (Use separate sheet if necessary): NAME AGE ADDRESS TELEPHONE # POSITION/TITLE Michelle ILincolln 64 7280 Overseas Hwy, Marathon, FL 33050 305-292-4512 Mayor David Rilce 82 9400 Overseas Hwy, Suite 210, Marathon, FL 330so 305-289-6000 Mayor Pro Tem Craig Cates 72 1 500 Whitehead Si. Suite 102, Key West, IFL 33wo 305-292-3440, Commissioner James K. Scholl 69 530 Whitehead Si, Suite 102, Key West, IFL 33ND 305-292-3430 Commissioner Holly IMerrilll Raschein 45 102050 Overseas Hwy, Suite 234, Key Largo, FL 33037 305-453-8787 Commissioner I I 4. LEVEL OF CARE TO BE PROVIDED: FIBLS or FE] ALS including Air Ambulance Services IF ALS: FEITRANSPORT or FEI NON TRANSPORT 5. DESCRIBE THE ZONES(S) THAT YOUR SERVICE DESIRES TO SERVE (Use separate sheet if necessary): All of Monroe County; Generally from the west end of Cow IKey Channel, to the west end of Seven Mile Bridge; rom the west end of the Tom's Harbor Bridge (approximately IW60) to the west end of Channel 2 Bridge and the City of Layton; and frorn the west end of Tavernier Creek Bridge to South Bay Harbor IDlrive & Lobster Lane, or as otherwise directed Iby Monroe County Central Dispatch. G. LIST THE, ADDRESS AND/OR DESCRIBE THE LOCATION OF YOUR BASE STATION AND ALL SUB- STATIONS (Use separate sheet if necessary): BASE STATION MCFR Headquarters- 7280 Overseas Hwy, IMaratholn, IFIL 33050. SUB -STATION See Attached. N Page 1 of 6 7. DESCRIBE YOUR COMMUNICATION SYSTEM (Attach copy of all FCC licenses): FRE UENCI wwwwwww_.w_...............w._...�.................. _............... ...w_...............w.._.. ES ........... ...__........... . ......... ...... ..._................. ........... CALL NUMBERS # OF MOBILES # OF PORTABLES State Approved 800MHz Radios Cellular Telephone 305-797-1136 Hard Line Telephone 305-289-6004 8. LIST THE NAMES AND ADDRESSES OF THREE (3) U.S. CITIZENS WHO WILL ACT AS REFERENCES FOR YOUR SERVICE: NAME ADDRESS Dr. Antonio Gandia, Medical Director 1080 SW 42nd Ave, Deerfield Beach, FL 33442 R.L. Colina, Fire Chief 7280 Overseas Hwy, Marathon, FL 33050 Christine Hurley, County Administrator 1100 Simonton Street, Key West, FL 33040 9. ATTACH A SCHEDULE OF RATES WHICH YOUR SERVICE WILL CHARGE DURING THE COPCN PERIOD. 10. PROVIDE VERIFICATION OF ADEQUATE INSURANCE COVERAGE DURING THE COPCN PERIOD. 11. ATTACH A COPY OF YOUR SERVICE'S CONTRACT WITH A MEDICAL DIRECTOR. 12. ATTACH A COPY OF ALL STANDING ORDERS AS ISSUED BY YOUR MEDICAL DIRECTOR. 13. ATTACH A CHECK OR MONEY ORDER IN THE APPROPRIATE AMOUNT, MADE PAYABLE TO THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS. I, THE UNDERSIGNED REPRESENTATIVE OF THE ABOVE NAMED SERVICE, DO HEREBY ATTEST MY SERVICE MEETS ALL OF THE REQUIREMENTS FOR OPERATION OF AN EMERGENCY MEDICAL SERVICE IN MONROE COUNTY AND THE STATE OF FLORIDA. I FURTHER ATTEST THAT ALL THE INFORMATION CONTAINED IN THIS APPLICATION, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. Sl ..N ' "�P11lCAN"'lI'/ AUTHORIZED REPRESENTATIVE NOTARY SEAL 2 a s ' On No ARY SIGN' 'lJ RE DATE ------------ e CApA JO NSON Notary pvwtt . Statt of l]AIWW� Commission # HH 669 ray Comm. Expim ,tun tl Itorcde-d through National t+otar Page 2 of 6 PERSONNEL — PA.RANIEDICS NAME First, Middle, Last SOCIAL SEICURITY# PARAMEDIC CERTIFICATION CERTIFICATION EXPIRATION DATE See Attached _ — _,_~~_~—_ ?age 3 of 6 PERSONNEL — EMERGENCY MEDICAL TECHNICIANS NANTE EMT CERTIFICATION First, Middle, Last SOCIAL SECITRIT17# CERTIFICATION EXPIRATION DATE See Attached Page 4 of 6 F-4 ,� �cscrc�c�s�ocrs�crc�s�?ac�carc�cs�crcrcyc�rc�ocas�ocac?caa�cyac�c�?s� Ll u a LO u F LO wrs Ors u a LO u'a LO U'a o o ua o o o 40 o o u J o o Ora o u"F LO u-a o U'S LO {D o o uO o o cv tv t°v ev cv ry t°v cv cv cv cv era ev zv ra �v s-v � ry ev cv ry c+a cv cv cv ru cv cv cv r.� cv r� s� s� CL 0� � � � ' " LOHH v c 0 CQLO LO a cid p'i � cid e s s c r LL LL� u LL � L i� LL 2 J C l L U LL et LL LL h H Tr T �r . v �r — �r m tt r- Lo u) W to 0 M C) M *:r "T o ua ta9 tta COP, s 0 cas M err Ln L!"9 o 4 o r-- - c�rcocrs��rcc�ce�crr�s�errcaocr�crere�r��r„�ca�r�mcsc°�rs�crc� — J o 4 o P'- 0 N m g no 'Cr 'Cr Cr o o C7 C' P,.' L t^+I C"+I C"+I L 'w'•' r a^ v^ C, C7 e7 a^ a t'W C"wl CJ C"J N t^+I C^+J G"+I C'+1 t^^J Cm +� t^N N N t^+1 C'^+J t"xl N N t^W N t^N t'+J S°J 4"J t""+I t"+J M^'+I t"'W t"J t^+I t"+J f^+J e"J t^+J G'"+J e"d C`+J N C'^+J N t"*J 4"*J C"J t"J t^+d t"`•J J + C 7 L 7 C rs w ca w w r� ° ca �a Fw� CY ca w e= CA cii td cad tit 'e"' ' W L,rd Ord 60 00 Lr,`d m Ul p ~ W o m LO Ord m Lp"d Ord 2 ud Ora r ud LL ua ud CY LY CJd U UJ M CAL IW W tl ] LL LU CL t r u u 1 e w U) Ln 0 E- u w I LL 0- n 0- 0- 0- CL J J J J J J J J J J J J J J J J J J J J J J J J J J J J J 'R tr,„7 4P"d L!"d C7 h hµ eR N I- o rl N m w A co ,7 0 2 +:� � CCU m 9 LidC'7 4 U1 UJ P� V [a7 C+"J C�' Lid C}i N �d r'4M r"� tG� Cd� Cd� Css CT+ C+7 C�5 Li"7 h-• �s c pp .^ C".1 N 5"J Cd N G"wl +S? r, 7 ed"d CSd tdd Nell t^,� N "tii' °ep 4rd N N N N N rN N ti^+J �+I t�J C+I C'+1 G"+J C+1 N eMJ id C*d C+1 t"+J C'^+I M^^J Cwl 5"»1 CJ C"J Q5 L'L h 11 JI 0 Ln a) ru U rp ^r ELRS!UlNNEL DRIVLR I DO HEREBY ArITST, TO THE BEST OF MY KNOWLEDGE, THAT ALLOFTILE ABOVE NAMED DRIVERS DO NIL, ET ALL OF THE REQUIREMENTS OF CHAPTER 401.281 F.S. AND ('11APTER 64F-2-012 FAC FOR AMJs1JI.A-N(E0RJVER8. N(rV SEAL & W Ak� I I J-M bb "S NO TARYIGNAYME CARAJOHNSON AMP.1, Nctary hititc . State of Florida Commission # HH� 6699,U pq� 5 �A"6 6499'86 MY Comm � Expire jun, I O�. 2029 "1 10. 2029 handed thfftih National DN0tafYASd54% so F, 10 ME I I III m 71 I _J c c I.J I�r" eao_caaI � u:�"a^ +�w r cc aarcs taea rax cma$s ca m eibr".ke� rai.3» a 0 2 3 ;auf, P.- ya 'as u� r- r- w r, w r� r- (.0 N N N N N N N N N N N O O O O O O O O O O O Q CV N N N N N N N CV N N x -A O O O O O -A O O O O LLB 0) co M M M M m M M Cl) Cl) Z I) � O O O O O O O O O O O I- N N m O) co CO 11 LO N O LO () CD .--1 LO zT c+7 m �l co I" ,:* 00 LO O CD r-i O 11 LO LO r, r-i CO r, O) 00 O) O) 11 O O rl O r� Cl) N O N LO O r, (3) 00 N Cl) Nt Cl) LO Cl) CO LO M Z Z Z Z Z Z Z Z Z Z Z Z � a N C ca N _O U C6 N U E 'a y O N O N i O U cc O f9 O N Q Z 7- i o ?� O N= •(6 U O -o N C O N C O 70 4.7 O E O L J J LL Z 00 >- Z d m 2: D_ = BOARD OF COUNTY COMMISSIONERS County of Monroed Mayor Michelle Lincoln, District 2 The Florida Keys Mayor Pro Teni David Rice, District 4 Craig Cates, District 1 James K. Scholl, District 3 Holly Merrill Raschein, District 5 Monroe County Fire Rescue 7280 Overseas Hwy. Marathon, FL 33050 Phone (305) 289-6004 6. List the address and/or describe the location of your base station and all substations (attach separate sheet if necessary) . Base Station: 7280 Overseas Hwy, Marathon, FL 33050 Sub Stations: KWIA Station 7- 3491 S. Roosevelt Blvd Key West, FL 33040 (No ALS) Stock Island Station 8- 5655 MacDonald Ave. Key West, FL 33040 Big Coppitt Station 9- 28 Emerald Dr Key West, FL 33040 Sugarloaf Station 10- Bat Tower Road Sugarloaf Key, FL 33042 Cudjoe Station 11- 22352 Overseas Highway Cudjoe Key, FL 33042 Big Pine Key Station 13- 400 Key Deer Blvd. Big Pine Key, FL 33043 Aviation Station 16 (Air Ambulance)- 10100 Overseas Highway, Marathon FL 33050 Conch Key Station 17- 10 s. Conch Ave, Conch Key, FL 33050 Layton Station 18- 68260 Overseas Highway Layton, FL 33001 Tavernier Station 22 - 151 Marine Ave Tavernier, FL 33070 Page 1 of 1 con �GJ�S COURTS °°fi' A Kevin Madok, CPA . .�b `' Clerk of the Circuit Court & Comptroller — Monroe Court Florida O�Roz COUN�y -11 DATE: March 23, 2022 TO: Cheri Taiiborski Emergency Services Mayor Bruce Halle Fire & Ambulance District 1 Board of Governors FROM: Liz Yougue, Deputy Clerk SI.JBJEC I': March 16"' BOCC Mecting At:t:achcd are electronic copies of the follmirig items for your liaiid.liii<g: C21 Resolution 079-2022, ",lricli supersedes Resolution No. 294-2008, and adopts an amended fee schedule, fcrr use by the, special taxiiig district for providirig groririd arril:nilarice serNrices. The amended fee schedule increases the existing rates for ground transport services. I1 Resolution 103-2022, which supersedes Resolution No. 294-2008, and adopts an amended fee schedule for use by the special taxing district for proNridiiig ground ambulance services. The amended fee schedule increases the existing rates for ground transport services. Should you have any questions, please feel free to contact me at (305) 292-3550. cc: County Attorney_ Finance File KEY WEST 500 Whitehead Street Key West, Florida 33040 305-294-4641 MARATHON 3117 Overseas Highway Marathon, Florida 33050 305-289-6027 PLANTATION KEY 88820 Overseas Highway Plantation Key, Florida 33070 305-852-7145 PK/ROTH BUILDING 50 High Point Road Plantation Key, Florida 33070 305-852-7145 RESOLUTION NO. 079 -2022 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, SUPERSEDING RESOLUTION NO. 294-2008, AND ADOPTING AN AMENDED FEE SCHEDULE FOR USE BY THE SPECIAL TAXING DISTRICT FOR PROVIDING GROUND AMBULANCE SERVICES WHEREAS, it is necessary for the Board of County Commissioners of Monroe County, Florida, to increase its ground ambulance fees as reflected in the subsequent ground ambulance fee schedule. WHEREAS, Ordinance No. 050-1987 was passed and adopted by the Board of County Commissioners of Monroe County, Florida on November 17, 1987, WHEREAS, in accordance with Section 3 of said Ordinance No. 050-1987, the governing bodies of several special taxing districts shall have the right to establish rates of user fees by Resolution, and WHEREAS, the Board of Governors, Fire and Ambulance District 1 of Monroe County, Florida, previously adopted Resolution No. 263-2004, adopting a fee schedule for use by the special taxing district that provides County operated ground ambulance services in Monroe County, WHEREAS, the Board of Governors, Fire and Ambulance District 1 of Monroe County, Florida, previously adopted Resolution No. 294-2008, adopting a fee schedule for use by the special taxing district that provides County operated ground ambulance services in Monroe County, WHEREAS, on February 16, 2022 the Board of County Commissioners of Monroe County, Florida adopted Ordinance 004-2022 creating Section 22-129 of Article VI Other Municipal Service Taxing Units of Chapter 22 Special Districts re -adopting Ordinance 031-1988, as amended by Ordinance 033-1996 and Ordinance 004-2002, Fire and Ambulance District 1, and WHEREAS, in accordance with Section 1 of Monroe County Code Section 22-129, the Monroe County Fire Rescue Department shall establish by resolution ambulance rates to be charged users, and subject to approval by the Monroe County Board of County Commissioners and the Board of Governors of Fire and Ambulance District 1. NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, that, 1. Resolution No. 294-2008, adopted by the Board of Governors on September 17, 2008, is hereby superseded by this Resolution; and 2. Effective March 16, 2022, the Board adopts the following Fee Schedule for use by the special taxing district for providing ground ambulance services: 1 Transport Base Fee — Basic Life Support (BLS) $600.00 Transport Base Fee — Advanced Life Support ALS 1 $750.00 Transport Base Fee — Advanced Life Support ALS2) $950.00 Transport Base Fee - Specialty Care Transport (SCT) $1050.00 Standby (Special Events) $200.00 per hour Mileage $14.50 per mile 3. Per Resolution No. 267-2021, adopted by the Board of County Commissioners of Monroe County, Florida on August 18, 2021 which provides for ground transport for VA Veterans, the following fee will apply: One Way Transport Back to County 1 $2,500.00 flat fee) PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida at the regular meeting of said Board held on the 16th day of March, 2022. Mayor David Rice Mayor Pro-Tem Craig Cates Commissioner Michelle Coldiron r^mmissioner District 3 mmissioner Holly Merrill Raschein KEVIN MADOK, CLERK By: As eputy C erk .! Digitally signed by James D j�James D. Molenaar Molenaarl—Date: 2022.03.09 _12:43:47-05'00' Approved as to Form and Legal Sufficiency James D. Molenaar Asst. County Attorney MONROE COUNTY ATTORNEY'S OFFICE Yes Yes Yes Vacant Yes 7. o BOARD OF COUNTY N COMMISSIONERS OF MONROE COUNTY, FLORIDA By: /Ox� Mayor/Chairperson con �GJ�S COURTS °°fi' A Kevin Madok, CPA . .�b `' Clerk of the Circuit Court & Comptroller — Monroe Court Florida O�Roz COUN�y -11 DATE: March 23, 2022 TO: Cheri Taiiborski Emergency Services Mayor Bruce Halle Fire & Ambulance District 1 Board of Governors FROM: Liz Yougue, Deputy Clerk SI.JBJEC I': March 16"' BOCC Mecting At:t:achcd are electronic copies of the follmirig items for your liaiid.liii<g: C21 Resolution 079-2022, ",lricli supersedes Resolution No. 294-2008, and adopts an amended fee schedule, fcrr use by the, special taxiiig district for providirig groririd arril:nilarice serNrices. The amended fee schedule increases the existing rates for ground transport services. I1 Resolution 103-2022, which supersedes Resolution No. 294-2008, and adopts an amended fee schedule for use by the special taxing district for proNridiiig ground ambulance services. The amended fee schedule increases the existing rates for ground transport services. Should you have any questions, please feel free to contact me at (305) 292-3550. cc: County Attorney_ Finance File KEY WEST 500 Whitehead Street Key West, Florida 33040 305-294-4641 MARATHON 3117 Overseas Highway Marathon, Florida 33050 305-289-6027 PLANTATION KEY 88820 Overseas Highway Plantation Key, Florida 33070 305-852-7145 PK/ROTH BUILDING 50 High Point Road Plantation Key, Florida 33070 305-852-7145 RESOLUTION NO. 103 -2022 A RESOLUTION OF THE BOARD OF GOVERNORS, FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA, SUPERSEDING RESOLUTION NO. 294-2008, AND ADOPTING AN AMENDED FEE SCHEDULE FOR USE BY THE SPECIAL TAXING DISTRICT FOR PROVIDING GROUND AMBULANCE SERVICES WHEREAS, it is necessary for the Board of County Commissioners of Monroe County, Florida, to increase its ground ambulance fees as reflected in the subsequent ground ambulance fee schedule. WHEREAS, Ordinance No. 050-1987 was passed and adopted by the Board of County Commissioners of Monroe County, Florida on November 17, 1987, WHEREAS, in accordance with Section 3 of said Ordinance No. 050-1987, the governing bodies of several special taxing districts shall have the right to establish rates of user fees by Resolution, and WHEREAS, the Board of Governors, Fire and Ambulance District 1 of Monroe County, Florida, previously adopted Resolution No. 263-2004, adopting a fee schedule for use by the special taxing district that provides County operated ground ambulance services in Monroe County, WHEREAS, the Board of Governors, Fire and Ambulance District 1 of Monroe County, Florida, previously adopted Resolution No. 294-2008, adopting a fee schedule for use by the special taxing district that provides County operated ground ambulance services in Monroe County, WHEREAS, on February 16, 2022 the Board of County Commissioners of Monroe County, Florida adopted Ordinance 004-2022 creating Section 22-129 of Article VI Other Municipal Service Taxing Units of Chapter 22 Special Districts re -adopting Ordinance 031-1988, as amended by Ordinance 033-1996 and Ordinance 004-2002, Fire and Ambulance District 1, and WHEREAS, in accordance with Section 1 of Monroe County Code Section 22-129, the Monroe County Fire Rescue Department shall establish by resolution ambulance rates to be charged users, and subject to approval by the Monroe County Board of County Commissioners and the Board of Governors of Fire and Ambulance District 1. NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF GOVERNORS, FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA, that, 1. Resolution No. 294-2008, adopted by the Board of Governors on September 17, 2008, is hereby superseded by this Resolution; and 2. Effective March 16, 2022, the Board adopts the following Fee Schedule for use by the special taxing district for providing ground ambulance services: 1 Transport Base Fee — Basic Life Support BLS $600.00 Transport Base Fee — Advanced Life Support ALS 1 $750.00 Transport Base Fee — Advanced Life Support ALS2 $950.00 Transport Base Fee - Specialty Care Transport (SCT) $1050.00 Standby (Special Events) $200.00 per hour Mileage ' $14.50 per mile Per Resolution No. 267-2021, adopted by the Board of County Commissioners of Monroe County, Florida on August 18, 2021 which provides for ground transport for VA Veterans, the following fee will apply: One Way Transport Back to County $2,500.00 flat fee) PASSED AND ADOPTED by the Board of Governors, Fire and Ambulance District 1 of Monroe County, Florida, at a regular meeting of the Board held on the 16th day of March, 2022. Chairman Bruce Halle Yes Vice -Chairman Greg Lewis, Chairperson Yes Mayor David Rice mmissioner Craig Cates mmissioner Holly Merrill Raschein IADOK, CPA, CLERK OF COURT By: &A�W s Deputy lerk r�� Digitally signed by James D. James D. Molenaar\Molenaar J 16ate: 2022.03.09 12:45:49-05'00' Approved as to Form and Legal Sufficiency James D. Molenaar Asst. County Attorney MONROE COUNTY ATTORNEY'S OFFICE Yes Yes Yes BOARD OF GOVERNORS, FIRE AND AMBULANCE DISTRICT 1 OF MONRO COUNTY, FL7 Chairperson CERTIFICATE OFICOVERAGE Ceriffificate, "older Administrator Issue Date 10/6125 Monroe County Board of County Commissioners Florida League of Cities, Inc. 7280 Overseas Highway Department of Insurance Services, P.O. lBox 5381.35 Mairathon, F'L 33050 Orlando, Florida 32853-8135 COVERAGES THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO THE DESIGNATED MEMBER FOR -nfE COVERAGE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI-TION OF ANY CONTRACT 0 R OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FNIT 0386 1 COVERAGE PERIOD: FROM 10/1/25 1 COVERAGE PERIOD: TO 1011/26 12.01 AM STANDARD TIME TYPE OF COVERAGE - LIABILITY TYPE OF COVERAGE - PROPERTY General Liability E] Buildings ❑ Miscellaneous Comprehensive General Liability, Boi Injury, Property Damage, El Basic Form E] Inland Marine Personal Injury and Advertising Injury F] Special Form F1 Electronic Data Processing Errors and Omissions Liability ❑ Personal Property Bond Employment Practices Liability ❑ Basic Form Employee Benefits Program Administration Lfabihty ❑ Special Form Medical Attendants'Nedical Directoi Malpractice Liability El Agreed Amount Broad Form Property Damage F-1 Deductible N/A ❑ Law Enforcement Liability F-1 Coinsurance N/A Underground, Explosion &Collapse Hazard F —1 Blanket Li ni its of Liability F-1 Specific * Combined Single Limit F-1 Replacement Cost Deductible N/A ❑ Actual Cash Value Automobile Liability Limits of Liability on File with Administrator M All owned Autos (Private Passenger) TYPE OF COVERAGE - WORKERS'COMPENSATION rX_1 All owned Autos (Other than Private, Passenger) ❑ Statutory Woi Compensation Hired Autos FX_� Employers Liability $1,000,000 Each Accident Non -Owned Autos $1,000,W10 By Disease $1,000,W0 Aggregate By Disease Limits of Liability r-1 Deductible N/A * Combined Single Limit rX_] $500,000 Self insured Retention Deductible N/A Autornobile/Equipment - Deductible rX_1 Physical Damage, Per Schedule - Comprehensive - Auto Per Schedule - Collision - Auto NA - Miscellaneous Equipment Other, The limit of liability is $5,000,000 (Combined single limit) bodily injury and/or property damage each occurrence, in excess of a self -insured retention of $200,001). This limit is solely for any liability resulting from entry of a claims bill Pursuant to Section, 768.28 (5) Florida Statutes or liability/settlement for which no claims bill has been filed or I iabillity imposed pursuant to Federal Law or actions outside the State of Florida. Description of Operatioiis/Locations/Veiiicles/Speci!aI Items I M F4 E. J E try �cou �GJS COURTS 00A Kevin Madok, CPA Clerk of the Circuit Court & Comptroller — Monroe County, Florida LROE COVNSy DATE: October 7, 2025 TO: Fire Chief RL Colina Monroe County Fire Rescue Mayor Bruce Halle Fire & Ambulance District 1 Board of Governors Cheri Tamborski Monroe County Fire Rescue FROM: Liz Yongue, Deputy Clerk SUBJECT: September 10, 2025 BOCC Meeting The following item has been executed and added to the record: C6/H1 Agreement with Antonio Gandia, M.D., for Medical Director services to commence on October 1, 2025, and extend through September 30, 2028, with two additional two (2) year extension terms based upon satisfactory performance and mutual agreement of the parties. Should you have any questions, please feel free to contact me at (305) 292-3550. cc: County Attorney_ Finance File KEY WEST MARATHON PLANTATION KEY 500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 AGREEMENT between MONROE COUNTY, FL and ANTONIO GANDIA, M.D. for MEDICAL DIRECTOR SERVICES THIS AGREEMENT is made and entered into this 101h day of September, 2025, by and between Monroe County, Florida, a political subdivision of the State of Florida, with principal offices located at 1100 Simonton Street, Key West, FL 33040, the Board of Governors of the Fire and Ambulance District 1 of Monroe County, Florida, a municipal services taxing unit established under Florida law and codified in Section 22-129, Monroe County Code of Ordinances, with a. principal address being the same as that of Monroe County (hereinafter collectively referred to as "County"), and Antonio Gandia, M.D., whose address is 1080 S.W. 42"d Avenue, Deerfield Beach, Florida, 33442 (hereinafter referred to as "Medical Director" or "Contractor"). WHEREAS, County provides fire and/ or emergency medical services pursuant to Chapter 401, F. S. and Chapter 641- 1, FAC; and. WHEREAS, County is required to employ or contract with a Medical Director who shall be a Florida licensed physician, Board Certified in Emergency Medicine with added qualification in Emergency Medical Services (EMS) and pre- hospital care experience, or a business entity that employs or contracts with similarly qualified physicians; and WHEREAS, County has determined it to be in the best interests of the residents of and visitors to Monroe County to contract with Medical Director for the purpose of providing direction to the Fire and Emergency Medical Services; and WHEREAS, Medical Director desires to provide professional services according to the terms and conditions stated herein. NOW THERFORE, in exchange for good and sufficient consideration, the parties hereby agree to the following terms and conditions: 1) The Contract Documents The contract documents consist of this Agreement, and the following exhibits: "Exhibit A" - the Request for Qualifications for Medical Director Services for Monroe County Fire Rescue pursuant to RFQ-588, including any addenda issued prior to execution of this Agreement; "Exhibit B" - Contractor's Qualifications Response and completed County Forms (specifically excluding the Contractor's Price Response Form); "Exhibit C" - the Negotiated Fee Schedule; "Exhibit D" - the H1:PAA Business Associate Addendum; and "Exhibit E" - the Mandatory Federal Provisions Addendum. Pagel of 8 All of the above enumerated exhibits are attached hereto and incorporated herein as if set forth in full. In the event of a conflict between the aforementioned documents, any duly executed amendment to this Agreement will control, followed by this Agreement, then "Exhibit E," "Exhibit D," "Exhibit C," "Exhibit A," and then "Exhibit B," in that order. 2) The Work/Services The Contractor must perform all work for the County required by this Agreement, and as set forth below: a) Contractor will furnish all labor, materials, and equipment necessary as indicated in "Exhibit A," "Exhibit B," and "Exhibit C." b) A written Notice to Proceed will be issued to the Consultant after approval of the contract by the Monroe County Board of County Commissioners, and subject to and consistent with the tenns and conditions of this Agreement. c) Contractor must comply with any and all Federal, State, and local laws and regulations now in effect, or hereinafter enacted during the term of this Agreement, which are applicable to the Contractor, its employees, agents or subcontractors, if any, with respect to the work and services described herein. Contractor shall. maintain throughout the teen of this Agreement, appropriate licenses. Proof of such licenses shall be submitted to the County upon execution of this Agreement, if not previously submitted to the County. d) Contractor agrees to complete such forms as County deems necessary in furtherance of its state and federal -law compliance efforts. The forms may include, but are not limited to: "Certification Regarding Debarments, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Federally Funded Transactions," etc. 3) Contract Amount Contractor will perform contract requirements with pricing as set forth in Exhibit C. County is exempt from payment of Florida State Sales and Use taxes. Contractor shall not be exempted by virtue of the County's exemption from paying sales tax to its suppliers for materials used to fulfill its obligations under this contract, nor is Contractor authorized to use the County's Tax Exemption Number in securing such materials. Contractor shall be responsible for any and all taxes, or payments of withholding, related to services rendered under this Agreement. Additionally, the Contractor must submit to the County invoices with supporting documentation that are acceptable to the Monroe County Office of Clerk and Comptroller (County Clerk). Acceptability to the County Clerk is based upon generally accepted accounting principles and such laws, rules and regulations as may govern the disbursal of funds by the County Clerk. 4) Agreement Subject to Funding The County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners. In the event that the County funds on which this Agreement is dependent are withdrawn, this Agreement is terminated, and the County has no further obligation under the terms of this Agreement to the Contractor beyond that already incurred by the termination date. Page 2 of 8 5) Effective Date/Term This Agreement will become effective October 1, 2025. The initial term of this Agreement shall be for three (3) years, commencing October 1, 2025 and terminating September 30, 2028 with two (2) additional two (2) year extension terms based upon satisfactory performance and the mutual agreement of all parties. The initial term and services provided hereunder will continue until midnight of the last day stated in the term of contract, unless otherwise extended or amended by formal amendment of the contract agreed to by the parties. 6) Conditions for Emergency/Hurricane or Disaster It is hereby made a part of this Agreement that before, during and after a public emergency, disaster, hurricane, flood, pandemic or other substantial loss that the Monroe County will require a "first priority" basis for services. It is vital and imperative that the majority of citizens are protected from any emergency situation which threatens public safety and health, as determined by the County Administrator. Contractor agrees to provide services to the County or other governmental entities, as opposed to a private citizen or corporation, on a first priority basis. The County expects to pay a fair and reasonable price for all. products/services in the event of a disaster, pandemic, emergency or hurricane. Awarded Contractor must furnish a twenty-four (24) hour telephone number in the event of such an. emergency. 7) Termination a. Termination for Uncurable Default In the event the Consultant shall default in or violate any of the terms, obligations, restrictions or conditions of this Contract in a manner that is uncurable (as determined in the sole discretion of the County), the County may, upon written notice to the Consultant, terminate this Contract effective immediately. In the event of such termination the County may hold the Consultant liable for any and all damages sustained by the County arising out of such default, including but not limited to costs of re -procurement and cover. b. Termination for Curable Default In the event the Consultant shall default in any of the terms, obligations, restrictions or conditions in the Contract Documents in a manner that is curable (as determined in the sole discretion of the County), the County shall give the Consultant written notice by registered, certified mail of the default and that such default shall be corrected or actions taken to correct such default shall be commenced within three (3) calendar days thereof. In the event the Consultant has failed to correct the conditions(s) of the default or the default is not remedied to the satisfaction and approval of the County, the County shall have all legal remedies available to it, including, but not limited to termination of the Contract in which case the Consultant shall be liable for any and all damages permitted by law arising from the default and breach of the Contract. c. Termination for Convenience of County Upon thirty (30) calendar days written notice delivered by certified mail, return. receipt requested, to the Consultant, the County may without cause and without prejudice to any other right or remedy, terminate the Contract for the County's Page 3 of 8 convenience whenever the County determines that such termination is in the best interest of the County. Where the Contract is terminated for the convenience of the County the notice of termination to the Consultant must state that the Contract is being terminated for the convenience of the County under the termination clause and the extent of termination. The Consultant shall discontinue all work on the appointed last day of service. 8) Indemnification & Release of Liability Notwithstanding any minimum insurance requirements prescribed elsewhere in this solicitation, Consultant shall defend, indemnify, and hold harmless the COUNTY, and the COUNTY's elected and appointed officers and employees, from and against (i) any claims, actions or causes of action, (ii) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury (including death), loss, damage, tine, penalty or business interruption, and (iii) any costs or expenses that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason. of, or in connection with: (A) any activity of Consultant or any of its employees, agents, contractors or other invitees during the solicitation process and any ensuing agreement, (�B) the negligence or recklessness, intentional wrongful misconduct, errors or other wrongful act or omission of Consultant or any of its employees, agents, sub -contractors or other invitees, or (C) Consultant's default in respect of any of the obligations that it undertakes during the solicitation process and under the term of any ensuing agreement, except to the extent the claims, actions, causes of action, litigation, proceedings, costs or expenses arise solely from the intentional or negligent acts or omissions of the COUNTY or any of its employees, agents, contractors or invitees (other than Consultant). Nothing contained herein is intended, nor may be construed, to waive County's rights and immunities under the common law or Section 768.28, Florida Statutes, as amended from time to time; nor will anything included herein be construed as consent to be sued by any third parties in any matter arising out of this solicitation or ensuing agreement. To the extent considered necessary by the Contract Administrator, any sums due Consultant under an ensuing agreement may be retained by the County until all of the County's claims subject to this indemnification obligation have been settled or otherwise resolved, and any amount withheld is not subject to payment of interest by the County. Insofar as the claims, actions, causes of action, litigation, proceedings, costs or expenses relate to events or circumstances that occur during or after the term of an ensuing agreement, and the rights and immunities reserved to the County, this section will survive the expiration of the term of the ensuing agreement or any earlier termination of same_ 9) Specific Insurance Requirements Contractor shall obtain and maintain at its own expense the insurance coverages listed within this paragraph prior to commencing services under this Agreement. All insurance requirements provided for in this Agreement shall be subject to annual review. Depending on the extent of contractual obligations incurred by the Contractor, the below insurances will be required. Insurances can be altered via written waiver by County's Risk Manager, if required. The Contractor must keep in full force and effect the insurance described during the term of this Agreement. If the insurance policies originally purchased that meet the requirements are canceled, terminated, or reduced in coverage, then the Contractor must Page 4 of 8 immediately substitute complying policies so that no gap in coverage occurs. Copies of current policy certificates shall be filed with the Monroe County Risk Department whenever acquired, amended, and annually during the term of this Agreement. Prior to execution of this Agreement, Contractor shall furnish the County Certificates of Insurance indicating the minimum coverage limitations in the following amounts: a) WORKERS COMPENSATION AND EMPLOYER'S LIABILTIY INSURANCE. Where applicable, coverage to apply for all employees at the minimum statutory limits as required by Florida Law, and Employee's Liability coverage in the amount of $1,000,000.00 bodily injury by accident, $1,000,000.00 bodily injury by disease, policy limits, and $1,000,000.00 bodily injury by disease, each employee. b) COMPREHENSIVE AUTOMOBILE VEHICLE LIABILITY INSURANCE. Motor vehicle liability insurance, including applicable no-fault coverage, with limits of liability of not less than $300,000.00 per occurrence, combined single limit for Bodily Injury Liability and Property Damage Liability. If single limits are provided, the minimum acceptable limits are $200,000.00 per person, $300,000.00 per occurrence, and $200,000.00 property damage. Coverage shall include all. owned vehicles, all non -awned vehicles, and all hired vehicles. c) COMMERCIAL GENERAL LIABILITY. Commercial general liability coverage with limits of liability of not less than $1,000,000.00 per occurrence combined single limit for Bodily Injury Liability and Property Damage Liability. Such coverage must include, as a minimum: Premises Operations, Products and Completed Operations, Blanket Contractual Liability, and Personal Injury Liability. An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. d) PROFESSIONAL LIABILITY / ERRORS AND OMISSIONS COVERAGE. Evidence of Professional Liability insurance with, at a minimum of $1,000,000.00 per occurrence, and $2,000,000.00 in the aggregate. "Claims -Made" forms are acceptable for Professional Liability insurance. Coverage shall include all claims arising out of the Consultant's operations or premises, any person directly or indirectly employed by the Consultant, and the Consultant's obligations under indemnification under this contract. Consultant acknowledges that the County is relying on the competence of the Consultant as a Medical Director to Monroe County Fire Rescue. CERTIFICATES OF INSURANCE. Original Certificates of Insurance shall be provided to the County at the time of execution of this Agreement and certified copies provided if requested. Each policy certificate shall be endorsed with a provision that not less than thirty (30) calendar days' written notice shall be provided to the County before any policy or coverage is canceled or restricted. The underwriter of such insurance shall be qualified to do business in the State of Florida. If requested by the County Administrator, the insurance coverage shall be primary insurance with respect to the County, its officials, employees, agents, and volunteers. Failure of Contractor to comply with the insurance requirements Page 5 of 8 of this section shall be cause for immediate termination of this Agreement. MONROE COUNTY BOARD OF COUNTY COMMISSIONERS, 1100SIMONTON STREET, KEY WEST, FLORIDA 33040, MUST BE NAMED AS ADDITIONAL INSURED AND CERTIFICATE HOLDER ONALL POLICIES EXCEPT WORKERS COMPENSATION. In the event that the Contractor subcontracts any or all of the work in this project to any third party, the Contractor specifically agrees to identify the County as an additional insured on all insurance policies required by the County. In addition, the Contractor specifically agrees that all agreements or contracts of any nature with his subcontractors shall include the County as additional insured. 10) Notice All written correspondence to the County shall be dated and signed by an authorized representative of the Contractor. Any written notices or correspondence required or contemplated under this Agreement shall be sent by U.S. Mail, certified, return receipt requested, postage pre -paid, or by courier with proof of delivery. Notice is deemed received by Contractor when hand delivered by national courier with proof of delivery or by U.S. Mail upon verified receipt or upon the date of refusal or non -acceptance of delivery. Notice shall be sent to the following persons: FOR COUNTY: FOR CONTRACTOR: County Administrator Antonio Gandia Monroe County 1080 S.W. 42 nd Avenue 1100 Simonton Street, Room 2-205 Deerfield Beach, Fl. 33442 Key West, FL 33040 Email: agandiamd((-bgmail.com And (with copy to) Monroe County Attorney's Office I I I I 12th Street, Suite 408 Key West, FL 33040 11) Attorney's Fees and Costs County and Contractor 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, at all levels of the court system, including in appellate proceedings. 12) Prompt Disclosure of Litigation, Investigations, Arbitration, or Administrative Proceedings Throughout the term of this Agreement, the Contractor has a continuing duty to promptly disclose to the County, in writing, upon occurrence, all civil or criminal litigation, investigations, arbitration, or administrative proceedings relating to or affecting Contractor's ability to perform under this Agreement. If the existence of such causes the County concern that the Contractor's ability or willingness to perform the Agreement is jeopardized, the Contractor may be required to provide the County with reasonable assurances to demonstrate its ability to perform as required hereunder, and that its Page 6 of 8 employees/agents have not or will not engage in conduct similar in nature to the conduct alleged in such proceeding. 13) Merger; Amendment This Agreement constitutes the entire Agreement between the Contractor and the County, and negotiations and oral understandings between the parties are merged herein. This Agreement can be supplemented and/or amended only by a written document executed by both the Contractor and authorized designees of the County. 14) Interpretation The titles and headings contained in this Agreement are for reference purposes only and will not in any way affect the meaning or interpretation of this Agreement. All personal pronouns used in this Agreement include the other gender, and the singular includes the plural, and vice versa, unless the context otherwise requires. Terms such as "herein" refer to this Agreement as a whole and not to any particular sentence, paragraph, or section. where they appear, unless the context otherwise requires. Whenever reference is made to a section or article of this Agreement, such reference is to the section or article as a whole, including all subsections thereof, unless the reference is made to a particular subsection or subparagraph of such section or article. Any reference to "days" means calendar days, unless otherwise expressly stated. 15) Joint Preparation It is acknowledged that each party to this Agreement had the opportunity to be represented by counsel in the preparation of this Agreement and accordingly the rule that a contract will be interpreted strictly against the party preparing same does not apply herein due to the joint contributions of both parties. 16) Severability; Waiver of Provisions Any provision in this Agreement that is prohibited or unenforceable in any jurisdiction will, as to that jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions hereof or affecting the validity or enforceability of such provisions in any other jurisdiction. The non -enforcement of any provision by either party will not constitute a waiver of that provision nor will it affect the enforceability of that provision or of the remainder of this Agreement. 17) Signatory Authority; Counterparts and Multiple Originals Upon request, the Contractor must provide the County with copies of requisite documentation evidencing that the signatory for Contractor has the authority to enter into this Agreement. This Agreement may be executed in multiple originals, and may be executed in counterparts, each of which is hereby deemed to be an original, but all of which, taken together, constitutes one and the same agreement. Page 7 of 8 M:Var119WA MONROE COUNTY, FLORIDA REQUEST FOR QUALIFICATIONS MEDICAL DIRECTOR SERVICES FOR MONROE COUNTY FIRE RESCUE RFQ#: 588 BOARD OF COUNTY COMMISSIONERS Mayor James K. Scholl, District 3 Mayor Pro Tem Michelle Lincoln, District 2 Craig Cates, District I James K. Scholl, District 3 David Rice, District 4 Holly Merrill Rashein, District 5 COUNTY ADMINISTRATOR CLERK OF THE CIRCUIT COURT Christine Hurley Kevin Madok March 2025 Prepared hy: MONROE COUNTY FIRE RESCUE R.L. Colina, Fire Chief TABLE OF CONTENTS SECTION PAGE Legal Notice — Request for Qualifications Part 1 — General Information 2-3 Part 2 — Standard Terms & Conditions 4-17 Part 3 — Statement of Work 18-22 Part 4 — Requirements & Instructions for Submission of Proposals 23-27 Part 5 — Evaluation of Submissions & Contract Negotiations & Award 28-29 Part 6 — Required Forms 30-48 Part 7 — Sample Agreement 50-71 NOTICE OF REQUEST FOR COMPETITIVE SOLICITATIONS NOTICE IS HEREBY GIVEN that on Tuesday, April 22, 2025, at 3:00 P.M., the Monroe County Purchasing Office will receive and open sealed responses for the following: MEDICAL DIRECTOR SERVICES FOR MONROE COUNTY FIRE RESCUE Pursuant to F.S. § 50.0211(3)(a), all published competitive solicitation notices can be viewed at: www.floridaoublicnotices.com, a searchable Statewide repository for all published legal notices. Requirements for submission and the selection criteria may be requested from the County's electronic bidding platform at hitps://monroecoLnty-fl,bonfirehub.com OR www.monroecounty-fl.gov/BonfireBids. The Public Record is available upon request. A local preference, as defined in Section 2-349, County Code, will not be given in this solicitation. Monroe County Purchasing Department receives bids via the Bonfire electronic bidding platform. Please do not email, mail, or attempt to deliver in -person any sealed bids or proposals. Emailed/mailed/physic ally delivered bids/proposals/responses WILL NOT be accepted. The Monroe County Purchasing Department hereby directs that bids/proposals be submitted via the Bonfire electronic bidding platform at htt s://monroecount-fl.bonfirehub.com, no later than 3:00P.M. on Tuesday, April 22, 2025. There is no cost to the bidder to use the Bonfire platform. Questions regarding this RFQ must be transmitted in writing to Zully Hemeyer, c/o Monroe County Fire Rescue, 7280 Overseas Hwy, Marathon, FL 33050, or by Email: Hemeyer-Zully(cyMonroeCounty-FL.v. Please d o n o t submit your confidential financial information as part of your proposal. There are separate uploads for each set of documents, including confidential financial information. All proposals will be made public on the platform after an intended decision or 30 days (from bid opening date), whichever is earlier, unless the bids/proposals are rejected in accordance with F.S. § 119.071. If your proposal document includes financial information, that information will not be considered confidential and will be available and viewable to the public in accordance with public records law. In the event of a discrepancy between a value listed on the "Price Response - Proposal Form" and any document within the other portions of the response uploaded into Bonfire, the values listed in the "Price Response - Proposal Form" submitted as part of the RFQ is the amount that will be considered by the County. The County reserves the right to waive any proposalibid irregularity. The bid/proposal opening for this solicitation will be held virtually, via the internet, at 3:00 P.M., on Tuesday, April 22, 2025. You may call in by phone or internet using the following: Join Zoom Meeting https://mebocc.zoom.us/i/4509326156 Meeting ID: 4509326156 One tap mobile: +16465189805„45093261564 US (New York) +16699006833„45093261564 US (San Jose) Dial by your location: +1 646 518 9805 US (New York) +1 669 900 6833 US (San Jose) Publication. Dates Keys Citizen.: Thur., March 20, 2025 Keys Weekly: Thur., March 20, 2025 Miami Herald: Thur., March 20, 2025 PART 1 — GENERAL INFORMATION 1. Definition - Request for Qualifications (RFQ) 1.1. An RFQ is a formal competitive advertised solicitation method that typically describes services or a project in enough detail to let potential vendors/consultants determine if they wish to compete. The RFQ is the basis for requesting all documents, whether attached or incorporated by reference, utilized for obtaining qualifications and performance data, including but not limited to financial capability, reputation, experience and competency from which the most highly qualified vendor(s)/consultant(s) can be identified. 1.2. For this Request for Qualifications, there will be two (2) material components submitted by any interested vendor/consultant: 1) "Qualifications Response," and 2) "Price Response." Both components must be submitted simultaneously, but uploaded in the County's Bonfire Software (electronic bidding platform hereinafter "eBid" or `Bonfire") as separate files. As further described herein, all Qualifications Responses received by the County will be unsealed and evaluated short-listed (ranked in order of highest qualified, second highest qualified, and so on), interviewed (if desired), and recommended to the Board of County Commissioners (`BOCC") for permission to negotiate a contract similar to the Sample Agreement, attached hereto, describing the scope of work and fees. After permission is granted, the County will commence pricing negotiations with the highest qualified responder using the submitted Price Proposals. If pricing negotiations fail with the highest qualified responder, the County will commence pricing negotiations with the second highest qualified responder, and so on until a recommendation for contract award is forwarded to the BOCC for consideration and approval. The Award will be based on the criteria set forth herein to the respondent who submits the highest qualifications as judged by the County, at a competitive and most advantageous price point for Monroe County. 2. Introduction 2.1. The Board of County Commissioners of Monroe County, Florida, (hereinafter "County" or `BOCC"), hereby requests sealed statements of qualifications, consistent with the requirements set forth herein, from qualified medical professionals (hereinafter "Consultant") who can provide medical director services to Monroe County Fire Rescue as detailed in the solicitation. Consultant may be required to participate in public meetings and deliver presentations, as necessary to accomplish the scope of services. 2.2. Respondents to this Request for Qualifications shall be licensed medical professionals within the State of Florida, as more specifically described herein, and carry the County's minimum mandated insurance coverage, as more specifically described herein. Statements submitted with license applications pending shall not be considered responsive. 2.3. Interested firms are invited to submit their responses in conformance with the criteria outlined herein. Notice to Proposers: The County's local preference policy is set forth in Section 2-349 of the Monroe County Code of Ordinances. The application of local preference to this solicitation/contract, for which the Monroe County Board of County Commissioners is the awarding authority, has been waived pursuant to the written recommendation of the County Administrator and approval of the Monroe County Board of County Commissioners. As such, a local preference, as defined in Section 2-349, County Code, will not be given in this solicitation. 2.4. It is the County's intention to: (a) solicit responses from interested parties; (b) evaluate qualifications listed in the responses; (c) conduct interviews and/or oral presentations (if desired); (d) verify the information presented; (e) request permission to negotiate from BOCC; (1) negotiate pricing under the contract; and (g) recommend to BOCC an award of the contract to the Consultant. 2 2.5. The selected Consultant(s) must agree to abide by and be governed by all Federal, State, and County laws, rules, and regulations, all of which may have a bearing on the services involved in any Agreements issued as a result of this RFQ. The County may seek reimbursement for expenses it incurs for Medical Director services rendered during a FEMA-declared State of Emergency. And as such, Consultant(s) agrees to comply with federal laws and procurement regulations set forth in 2 C.F.R. Part 200, and Appendix 11 to Part 200, as may be amended from time to time. 3. Point of Contact 3.1. To ensure fair consideration for all Consultants, all inquiries concerning clarifications of this solicitation or for additional information shall be submitted in writing by mail, or email and directed as follows: Monroe County Fire Rescue Attn: Zully Hemeyer Address: 7280 Overseas Hwy, Marathon, FL 33050 Email: Hemever-Zully(ci),Monrc..)eCounty-FL. v 3.2. All responses to questions/clarifications will be sent to all prospective Consultants in the form of an addendurn. Such contact is to be for clarification purposes only. Material changes, if any, to the scope of services, or 'bid procedures will only be transmitted electronically through the County's Procurement (electronic bidding) System. 4. Schedule of Events The County will use the following tentative time schedule in the selection process. The County reserves the right to change and/or delay scheduled dates. Event Date RFQ Available 3/20/25 Non -Mandatory Pre -Proposal Meeting None Last Date of Receipt of Questions 4/7/25 Addendum Release (if required) 4/14/25 Proposals Due (3:00 p.m. EST) 4/22/25 Proposal Review for Compliance 4/23/25 - 5/2/25 Selection Committee Review/Short List Completed 5/5/25 - 6/3/25 (Incl. Interviews/Presentations to Selection Committee, if determined necessary) BOCC grants permission to negotiate 6/18/25 Negotiations with 91 Ranked Consultant; and so on, as needed 6/19/25 - 7/8/25 Complete/Finalize Contract Documents 6/19/25 - 7/8/25 Commission Award of Contract 7/16/25 3 PART 2 — STANDARD TERMS AND CONDITIONS Standard Terms and Conditions These Standard Terms and Conditions apply to offers made to the Monroe County Board of County Commissioners by all prospective Proposers. Any and all special conditions (that describe a condition in more detail) within this RFQ or any ultimately negotiated agreement document that may be in variance or conflict with these Standard Terms and Conditions, shall have precedence over these Standard Terms and Conditions. Special Conditions within the Statement of Work Where there appears to be variances or conflicts between the Standard Terms and Conditions and any Special Conditions within the Statement of Work outlined in this solicitation, the Special Conditions within the Statement of Work shall prevail as to the variance or conflict. 3. Defined Terms 3.1. County: Shall mean Monroe County, Florida, a political subdivision of the State of Florida. 3.2. Contract: A deliberate written agreement between two (2) or more competent parties to perform or not to perform a certain act or acts, including all types of agreements, regardless of what they may be called, for the procurement or disposal of equipment, materials, supplies, services or construction. Contract shall be inclusive of the term "Agreement" unless stated otherwise. 3.3. Contract Administrator: An individual responsible for the management of all actions required for initiating and issuing procurements fora particular project, along with all contract - related actions performed during the course of the work from award until closeout of the contract. 3.4. Evaluation Criteria: Factors, including but not limited to, relating to management capability, technical capability, meeting performance requirements, price and other important considerations used to evaluate which proposer has made the most advantageous offer in a competitive solicitation. 3.5. Firm: means any individual, firm, partnership, corporation, association, or other legal entity permitted by law to practice medicine, or other medical specialty as recognized in the state. 3.6. First Ranked Proposer: That Proposer, responding to a County RFQ, whose proposal is deemed by the County, the most advantageous to the County after applying the evaluation criteria contained in the RFQ. 3.7. Offeror: Means a person or respondent submitting an offer in response to a Request for Qualifications or other solicitation. 3.8. Professional Services: As used in this solicitation, services within the scope of the practice of medicine, or other medical specialty as defined by the laws of the state, or those performed by medical directors in connection with his or her professional employment or practice. 3.9. Proposal: An offer or response made by executed formal document submitted by an Offeror or Respondent to the County as a basis for negotiations to enter into a contract. A proposal for purposes of this solicitation will include two (2) distinct responses: 1) "Qualifications Response," and 2) "Price Response." 3.10. Proposer: An Offeror or Respondent who submits a proposal in response to a solicitation. The terms "Consultant," "Offeror," "Respondent," "Vendor," and "Proposer" are used interchangeably and have the same meaning, except when the context dictates another meaning. 3.11. Request for qualifications (RFQ): A solicitation of responses from Consultants whereby Consultants are invited to submit a summary of their particular qualifications and to state their interest in performing a specific job or service for the County. From such submissions, the County Selection. Committee determines which of such Consultants shall be short-listed, interviewed, and recommended to the Board of County Commissioners for permission to 4 negotiate for scope of work and fees. For purposes of this solicitation, the Consultants shall be short-listed by ranking them as first -qualified, second -qualified, and so on. In arriving at such ranking, the Selection Committee may conduct interviews and/or request presentations from consultants. 3.12. Requesting department: The department or entity seeking to procure or purchase the goods or services. For purposes of this solicitation, the department is Monroe County Fire Rescue. 3.13. Selection Committee: The committee approved to review offers and responses to requests for proposals (RFP) and requests for qualifications (RFQ) in accordance with the policies and procedures of the purchasing department. 3.14. Successful Consultant: Consultant who is awarded a contract to provide professional services to the County. 3.15. Waiver of Mistake, Irregularity, or Technicality: The act of disregarding de minimis errors or technical nonconformities in proposals which do not change the substance of the proposal and will not adversely affect the competition between proposers. Monroe County BOCC, at its sole discretion, reserves the right to reject any and all proposals, waive any mistake, irregularity, or technicality in proposals received, or readvertise for the services hereunder; as such, it is the sole judge of what serves the County's best interest, and such decision is final. 4. Public Records 4.1. Consultant shall keep such records and accounts and require any and all Consultants and subconsultants to keep records and accounts as may be necessary in order to record complete and correct entries as to personnel hours charged to the project and any expenses for which Consultant expects to be reimbursed. Such books and records will be available at all reasonable times for examination and audit by County and shall be kept for a period of five (5) years after the completion of all work to be performed pursuant to this Agreement. Incomplete or incorrect entries in such books and records will be grounds for County's disallowance of any fees or expenses based upon such entries. 4.2. County is a public agency subject to Chapter 119, Florida Statutes. To the extent Consultant is a Consultant acting on behalf of the County pursuant to Section 119.0701, Florida Statutes, Consultant shall comply with all public records laws in accordance with Chapter 119, Florida Statutes. In accordance with state law, Consultant agrees to: a) Keep and maintain all records that ordinarily and necessarily would be required by the County in order to perform the services. b) Upon request from the County's custodian of public records, provide the County with a copy of the requested records or allow the records to be inspected or copies within a reasonable time at a cost that does not exceed the costs provided in Chapter 119, Florida Statutes, or as otherwise provided by law. C) Ensure that public records that are exempt or confidential and exempt from public records disclosure are not disclosed except as authorized by law for the duration of the Agreement term and following completion of the contract if the Consultant does not transfer the records to the County. d) Upon completion of the services within this Agreement, at no cost, either transfer to the County all public records in possession of the Consultant or keep and maintain public records required by the County to perform the services. If the Consultant transfers all public records to the County upon completion of the services, the Consultant shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Consultant keeps and maintains public records upon completion of the services, the Consultant shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the County, upon request 5 from the County's custodian of public records, in a format that is compatible with the information technology systems of the County. IF THE CONSULTANT HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONSULTANT'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, CONTACT THE COUNTY'S CUSTODIAN OF PUBLIC RECORDS AT: MONROE COUNTY ATTORNEYS OFFICE, 1111 12TH STREET, SUITE 408, KEY WEST, FL 33040, EMAIL: PUBLICRECORDS*MONROECOUNTY-FL.GOV, OR PHONE: 305-292-3470. 4.3. If Consultant does not comply with this Section, the County shall enforce the Agreement provisions in accordance herewith and may unilaterally cancel this Agreement in accordance with state law. 5. Audit Rights The Consultant must maintain accurate 'books, records, docuinents and other evidence that sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of any ensuing agreement, in accordance with generally accepted accounting principles. County reserves the right to audit the records of the Consultant for the commodities and/or services provided under the contract at any time during the performance and term of the contract and for a period of five (5) after completion of the contract. Such records must be retained by Consultant for a minimum of five (5) years following the close of the Agreement, or the period required for this particular type of project by the General Records Schedules maintained by the Department of State, whichever is longer. The Consultant agrees to cooperate with the County and agrees to submit to an audit as required by the County, or other authorized representative(s) of the State of Florida. The Consultant must allow the County or such other auditing agency to have access to and inspect the complete records of the Consultant in relation to this solicitation and any ensuing agreement at any and all times during normal business hours for the purposes of conducting audits or examinations or making excerpts or transcriptions. The requirements set forth in this paragraph will survive the termination of any ensuing agreement. 6. Addendum 6.1. If the Consultant should be in doubt as to the meaning of any of the RFQ document, or is of the opinion that the scope of services contains errors, contradictions or reflect omissions, Consultant shall submit a written request directed to the named County Staff Contact who will coordinate with the appropriate person or department for interpretations or clarification. No oral interpretations will be made to any Respondent as to the meaning of the contract documents. Any inquiry or request for interpretation must be received in writing ten (10) or more business days prior to the date fixed for opening of responses. Inquiries submitted after that time will not be considered. Written inquiries should be sent to Zully Hemeyer, Monroe County Fire Rescue, 7280 Overseas Hwy, Marathon, FL 33040 or emailed to Hem eyer-Zu1101),MonroeCounty-FL.gov with the subject line of the email including the RFQ name. Interpretations or clarifications deemed necessary by the County, in response to such questions, will be issued in writing as an official addendum to the RFQ no later than five (5) business days prior to the established Response opening date. 6.2. The issuance of any addendum shall be issued through the eBid System to all Consultants registered for this RFQ. The addendum is the only official method whereby interpretation, clarification, changes or additional information can be given. It is the Consultant's responsibility r to check the eBid System prior to the due date and time to ensure that the Consultant has a complete, up-to-date package. Each Respondent shall acknowledge receipt of such addenda in their Response. In case any Respondent fails to acknowledge receipt of such addenda or addendum, the response will nevertheless be construed as though it had been received and acknowledged and the submission of such response will constitute acknowledgment of the receipt of same. All addenda are a part of the contract documents, and each Respondent will be bound by such addenda, whether or not actually received. 7. Proposal Submission 7.1. Consultant shall use the electronic Bonfire (eBid) System to submit a response. The proposal shall be signed by a representative who is authorized to contractually bind the Consultant. IMPORTANT: FINANCIAL INFORMATION — SUBMIT BY SEPARATE UPLOAD. In order to determine if a proposer is responsible pursuant to Section 2-347(h), Monroe County Code of Ordinances, all proposals for contracts to be awarded under this section must contain: Financial statements for the prior three (3) years for the responding entity or for any entity that is a subsidiary to the responding entity. Note: Any financial statement that an agency requires for responding to a bid is exempt from disclosure as a public record. Please do not submit your confidential financial information as part of your proposal. Please mark as "Confidential" to exercise exemption under Subsection 119.071(1)(c), Florida Statutes, and upload by separate upload to the Bonfire (eBid) System to maintain confidentiality. There are separate uploads for each set of documents, including confidential financial information. However, any financial information the Consultant includes in the proposal packet, which is not marked as "Confidential", and is uploaded incorrectly, may be disclosed in any public records request and will not be treated as "Confidential." The County shall incur no liability for inadvertent disclosure of financial records that are not properly marked or submitted. 7.2. Consultant's response shall not contain any alteration to the document posted other than entering data in spaces provided or including attachments as necessary. By submission of a response, Consultant affirms that a complete set of bid documents was obtained from the Bonfire (eBid) System only and no alteration of any kind has been made to the solicitation. 7.3. All blanks on the proposal form(s) must be completed and notarized, if applicable. Names must be typed or printed below the signature. Facsimile or mailed proposals will not be accepted. Proposals will only be accepted electronically, submitted through the Bonfire (eBid) System. 7.4. Each Consultant for services further represents that the Consultant has examined and is familiar with the local conditions, including laws and regulations, under which the work is to be done and has correlated the observations with the requirements of the contract documents. Each Consultant by signature and by submission of a response, represents that the Consultant has read and understands the contract documents, has completed all required fields and the proposal has been made in accordance therewith. 7.5. Only one (1) proposal from any individual, firm, partnership, or corporation, under the same or different names, will be considered. Should it appear to the County that any Consultant is interested in more than one (1) proposal for work contemplated, all proposals in which such a Consultant is interested will be rejected. Consultant by submitting this proposal certifies that the proposal is made without previous understanding, agreement or connection with any person, firm or corporation making a proposal for the same material, supplies, equipment or services and is in all respects, fair and without collusion or fraud. 7.6. All proposals received from Consultants in response to this Request for Qualifications will become the property of County and will not be returned to the Consultants. In the event of Contract award, all documentation produced as part of the Contract shall become the exclusive property of the County. 7 8. RFQ Postponement/Cancellation The Board of County Commissioners may, at its sole and absolute discretion, reject any and all, or parts of any and all proposals; re -advertise this RFQ; postpone or cancel, at any time, this RFQ process; or exercise the County's waiver of mistake, irregularity, or technicality rights. 9. Costs Incurred by Consultants All expenses involved with the preparation/and or presentation and submission of proposals to the County, or any work performed in connection therewith, shall be the sole responsibility of the Consultant(s) and shall not be reimbursed by the County. 10. Protest Procedure Any Bidder/Respondent/Proposer who claims to be adversely affected by the decision or intended decision to award a contract shall submit in writing a notice of protest which must be received by the County Attorney's Office within seventy-two (72) hours or three (3) business days, whichever is greater, after the posting of the notice of decision or intended decision on the electronic bidding platform or posting of the Notice of Decision or Intended Decision on the Monroe County Board of County Commissioners' (`BOCC") agenda, whichever occurs first. Additionally, a formal written protest must be submitted in writing and must be received by the County Attorney's Office seventy-two (72) hours or three (3) business days prior to the BOCC's meeting date in which the award of contract by the BOCC will be heard. The only opportunity to address protest claims is before the BOCC at the designated public meeting in which the agenda item awarding the contract is heard. In accordance with the Rules of Debate as set forth in the Monroe County Board of County Commissioners Administrative Procedures, the Bidder/Respondent/Proposer that filed the protest is responsible for providing the Clerk with his/her name and residence prior to the agenda item to award the contract being called in order to preserve their opportunity to be heard on this matter. An individual has three (3) minutes to address the Commission and a person representing an organization has five (5) minutes to address the Commission. The BOCC decision to award the contract is final and at their sole discretion. Failure to timely protest within the times and in the manner prescribed herein shall constitute a waiver of the ability to protest the award of contract, unless the BOCC determines that it is in the best interest of the County to do so. The filing of a protest shall not stop the solicitation, negotiations, or contract award process, unless it is determined that it is in the best interest of the County to do so. 11. Indemnification & Release of Liability Notwithstanding any minimum insurance requirements prescribed elsewhere in this solicitation, Consultant shall defend, indemnify, and hold harmless the COUNTY, and the COUNTY's elected and appointed officers and employees, from and against (1) any claims, actions or causes of action, (ii) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury (including death), loss, damage, fine, penalty or business interruption, and (iii) any costs or expenses that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of, or in connection with: (A) any activity of Consultant or any of its employees, agents, contractors or other invitees during the solicitation process and any ensuing agreement, (B) the negligence or recklessness, intentional wrongful misconduct, errors or other wrongful act or omission of Consultant or any of its employees, agents, sub -contractors or other invitees, or (C) Consultant's default in respect of any of the obligations that it undertakes during the solicitation process and under the term of any ensuing agreement, except to the extent the claims, actions, causes of action, litigation, proceedings, costs or expenses arise solely from the intentional or negligent acts or omissions of the COUNTY or any of its employees, agents, contractors or invitees (other than Consultant). Nothing contained herein is intended, nor may be construed, to waive County's rights and immunities under the common law or Section 768.28, Florida Statutes, as amended from time to time, nor will anything included herein be construed as consent to be sued by any third parties in any matter arising out of this solicitation or ensuing agreement. To the extent considered necessary by the Contract Administrator, any sums due 8 Consultant under an ensuing agreement may be retained by the County until all of the County's claims subject to this indemnification obligation have been settled or otherwise resolved, and any amount withheld is not subject to payment of interest by the County. Insofar as the claims, actions, causes of action, litigation, proceedings, costs or expenses relate to events or circumstances that occur during or after the term of an ensuing agreement, and the rights and immunities reserved to the County, this section will survive the expiration of the term of the ensuing agreement or any earlier termination of same. 12.Insurance The respondent, if awarded a contract, shall maintain insurance coverage reflecting the minimum amounts and conditions as required by the County. Note: A copy of any current Certificate of Insurance may be included with your proposal. The Respondent/Contractor will be responsible for obtaining and maintaining all necessary insurance coverages listed in this RFQ and within the Sample Agreement prior to commencing operation. Certificates of Insurance must be provided to Monroe County within fifteen (15) days after notice of intended award of contract, with Monroe County BOCC listed as an additional insured on all policies, except Workers Compensation. If the proper insurance forms are not received within the fifteen (15) days, the contract may be awarded to the next selected respondent. All fornns of insurance required above shall be from insurers acceptable to the County. Policies shall be written by companies licensed to do business in the State of Florida and having an agent for service of process in the State of Florida. Companies shall have an A.M. Best rating of A: VII or better. The required insurance shall be maintained at all times while Respondent/Contractor is providing service to the County. Contractor shall provide County with updated Certificates of Insurance annually on the renewal date of each policy. All insurance policies must specify that they are not subject to cancellation, non -renewal, material change, or reduction in coverage unless a minimum of thirty (30) days' prior notification is given to the County by the insurer. 13. Legal Requirements The Consultant shall observe and comply with all federal, state, county laws and local ordinances, rules and regulations that apply to this Request for Qualifications. Failure to familiarize himself/herself with applicable laws will in no way relieve him/her from responsibility. 14. Independent Contractor This solicitation and any ensuing agreement does not create an employee/employer relationship between the Consultant and the County. It is understood and accepted by the Consultant that he/she/it is an independent contractor under this solicitation and any ensuing agreement, and not the County's employee for any purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, the State Worker's Compensation Act, and the State Unemployment Insurance law. The Consultant will retain sole and absolute discretion in the judgment of the manner and means of carrying out Consultant's activities and responsibilities hereunder provided. The Contractor agrees that it is a separate and independent enterprise from the County, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work This solicitation and any ensuing agreement must not be construed as creating any joint employment relationship between the Consultant and the County, and the County will not be liable for any obligation incurred by Consultant, including but not limited to unpaid minimum wages and/or overtime premiums. 1.5. Uncontrollable Circumstances ("Force Majeure") As used herein, "Force Majeure" means the occurrence of any event that prevents or delays the performance by either party of its obligations hereunder which are beyond the reasonable control of the non -performing party. Examples of "Force Majeure" include, but are not limited to, acts of 9 God, natural disasters, or emergency governmental action. To invoke this paragraph, immediate written notice, consistent with the "Notice" provisions of an ensuing agreement between the parties, must be sent by the non -performing party describing the circumstances constituting force majeure and proof that the non-performance or delay of performance is a direct and reasonable result of such event(s). Any claim for extension of time by Consultant pursuant to this paragraph will be made not more than Seventy-two (72) hours after the commencement of the delay. Otherwise, it shall be waived. The Consultant shall immediately report the termination of the cause for the delay within seventy-two (72) hours after such termination. The County reserves its right to challenge the invocation by the Consultant within five (5) calendar days of receipt of said notice, in such case uninterrupted performance in required. However, in the event the invocation is accepted by the County, the Consultant must take all reasonable measures to mitigate any and all resulting damages, costs, delays, or disruptions to the Consultant's performance requirements under this RFQ and any ensuing agreement. All obligations must resume when the circumstances of such event(s) have subsided, or other written arrangements as agreed to by both parties. 16. Assignment The Proposer shall not assign the proposal or any portion of the awarded agreement without prior written consent of the County, nor shall the Consultant assign any monies due or to become due to him or her, without the previous written consent of the County. Formal consent to assignment may be processed in a manner consistent with the Monroe County Purchasing Policy and Procedures Manual, as may be amended. 17. Choice of Law and Venue By submitting a proposal, the Consultant agrees that the only laws that apply to this Solicitation and any ensuing agreement are those of the State of Florida and United States of America. The parties waive the privilege of venue and agree that all litigation between them in the state courts will take place exclusively in the Sixteenth Judicial Circuit in and for Monroe County, Florida, and that all litigation between them in the federal courts will take place exclusively in the United States District Court in and for the Southern District of Florida, or United States Bankruptcy Court for the Southern District of Florida, whenever applicable. This solicitation and any ensuring agreement shall not be subject to arbitration. Mediation proceedings initiated and conducted pursuant to this solicitation and any ensuing 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, Florida. 18. References & Background Check As part of the proposal evaluation process, the County may conduct an investigation of references, including a record check, consumer affairs complaints, or criminal background check. Consultant's submission of a proposal constitutes acknowledgment of the process and consent to investigate. The County is the sole judge in determining Consultants qualifications. 19. Conflict of Interest The award of any contract hereunder is subject to the provisions of Chapter 112, Florida Statutes. Consultants must disclose with their proposal the name of any officer, director, partner, proprietor, associate or agent who is also an officer or employee of the County or any of its agencies. Further, all Consultants must disclose the name of any officer or employee of the County who owns, directly or indirectly, an interest of five percent (5%) or more in the Consultant's firm or any of its branches or affiliate companies. 20. Officials Not to Benefit Each. Consultant shall certify, upon signing a proposal, that to the best of their knowledge, no Monroe County official or employee having official responsibility for the procurement transaction, or member of his or her immediate family, has received or will receive any financial benefit relating 10 to the award of this Agreement. If such a benefit has been received or will be received, this fact shall be disclosed with the proposal or as soon thereafter as it appears that such a benefit will be received. Failure to disclose the information prescribed above may result in suspension, debarment, or rescission of the Agreement made, or could affect payment pursuant to the terms of the Agreement. 21. Prohibition on Conflict of Interest, Gratuities, Kickbacks, and Collusion The statements contained in this paragraph are true and correct, and made with the full knowledge that Monroe County relies upon the truth of the statements contained herein in awarding the contract. 21.1. Conflict of Interest. Contractor covenants that it presently has no interest and will not acquire any interest that would conflict in any manner or degree with the performance of services required. Each party hereto covenants that there is no conflict of interest or any other prohibited relationship between the County and itself. 21.2. Gratuities. Contractor hereby certifies that it has not offered, given, or agreed to give any Monroe County employee a gratuity, favor, or anything of monetary value in connection with any decision, approval, disapproval, recommendation, preparation of any part of the Project or award of this contract. 21.3. Kickbacks. Contractor certifies that it has not given payment, gratuity, or offer of employment to be made by or on behalf of a Sub -contractor under a contract to Contractor or higher tier sub -contractor or any person associated therewith, as an inducement of the award of a subcontract or order. 21.4. Non -Collusion Statement. By submitting the proposal, Contractor certifies under penalty of perjury that the price proposed by Contractor was arrived at independently without collusion, consultation, or communication for the purpose of restricting competition; and no attempt has been made to induce another person or entity to submit a proposal, or not submit, for the purpose of restricting competition in the award of this contract. 21.5. Contract Clause. The prohibitions on conflict of interest, gratuities, kickbacks, and collusion prescribed in this paragraph must be conspicuously set forth in every contract and subcontract and solicitation initiated by Contractor in its performance of work under this solicitation, and any ensuing agreement. 22. Data Management; Data Security Standards. Contractor must agree to comply with the County's written demands regarding cooperation (and any applicable financial responsibilities) for timely data breach incident reporting, response activities/fact-gathering, public and other governmental agency notification requirements, severity level assessment, and after -action reporting, consistent with Sections 282.3185(5) & (6), and 501.171, Fla. Stats., as amended from time to time. And specifically in the context of data breaches that involve Protected Health Information pursuant to Health Insurance Portability and Accountability Act (HIPAA), Contractor must comply with all requirements of the Health Information Technology for Economic and Clinical Health Act (HITECH); Section 105 of Title I of the Genetic Information Nondiscrimination Act of 2008 (GINA); and 45 C.F.R. Parts 160, 162 and 164 and Final Omnibus Rule eff. March 26, 2013). To ensure safety of personal data, Contractor must comply with the 2016 European Union's General Data Privacy Regulation (GDPR) that became effective in the European Union on May 25, 2018, and any more recently revised version thereof. For any system integration between the County's network systems and that of the Contractor, the Contractor by submitting a proposal thereby agrees to comply with ISO/IEC 27001 for its internal system, at a minimum, and any unique integration requirements of the County's network and information technology systems. 23. Anti -Discrimination Covenant Consultant agrees 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, any agreement resulting from this solicitation automatically terminates without any further action on the part of any party, effective the date of the court order. Contractor agrees 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 or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 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 s. 794), which prohibits discrimination on the basis of disability; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ce-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title V111 of the Civil Rights Act of 1968.(42 USC s. 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 s. 12101 Note), as may be amended from time to time, relating to nondiscrimination on the basis of disability; l0) Monroe County Code Chapter 14, Article ll, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; 11) The Pregnant Workers Fairness Act (PWFA) pursuant to 42 U.S.C. 2000gg et seq.; and 12) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this solicitation and any ensuing agreement. 24. Public Entity Crimes Statement Pursuant to Section 287.133(2)(a), Fla. Stat., as amended from time to time, by submitting its proposal Consultant certifies that neither it nor its affiliate(s) have been placed on the convicted vendor list following a conviction for a public entity crime. If placed on that list, Consultant must notify the County immediately and is prohibited from providing 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 Section 287.017, Fla. xStat., as amended from time to time, for Category TWO ($35,000) as may be amended, for a period of thirty-six (36) months from the date of being placed on the convicted vendor list. 25. Discriminatory Vendor List Contractor hereby acknowledges its continuous duty to disclose to the County if the Contractor or any of its affiliates, as defined by Section 287.134(1)(a), Florida Statutes, are placed on the Discriminatory Vendor List. Pursuant to Section 287.134(2)(a),Florida Statutes: "An entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies 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." 12 26. County Suspended Vendor List The eligibility of persons to bid for an award of County contract(s), or enter into a contract, may be suspended pursuant to sec. 2-347(1) of the Monroe County Code of Ordinances. In the event an eligible person is suspended by the County after the contract is awarded, or a suspended person is employed to perform work (e.g. subcontractor in a bid or contract) pursuant to a County contract, same shall constitute a material breach of the contract. The County, in its sole discretion, may terminate the contract with no further liability to the contractor beyond payment of the portion of the contract price that may be due for work satisfactorily completed up to the date of termination, and hereby reserves all other rights and remedies available at law or in equity. 27. Ethics Clause pursuant to Monroe County Ordinance No. 010-1990 By submitting it proposal, the Contractor warrants that he/she/it has not employed, retained or otherwise had act on his/her/its behalf any former County officer or employee in violation of Section 2-149, Monroe County Code of Ordinances, or any County officer or employee in violation of Section 2-150, Monroe County Code of Ordinances. 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 pursuant to Subsection 2-1.52(b), Monroe County Code of Ordinances. 28. Prompt Disclosure of Litigation, Investigations, Arbitration, or Administrative Proceedings Throughout the solicitation process, the Contractor has a continuing duty to promptly disclose to the County, in writing, upon occurrence, all civil or criminal litigation, investigations, arbitration, or administrative proceedings relating to or affecting Contractor's ability to perform under this Agreement. If the existence of such causes the County concern that the Contractor's ability or willingness to perform the Agreement is jeopardized, the Contractor may be required to provide the County with reasonable assurances to demonstrate its ability to perform as required hereunder, and that its employees/agents have not or will not engage in conduct similar in nature to the conduct alleged in such proceeding. 29. Trade Secrets Documents submitted by Contractor which constitute trade secrets as defined in Sections 812.081 and 688.002, Florida Statutes, as amended from time to time, and which are clearly marked or stamped as confidential by the Contractor at the time of submission to the County, will not be subject to public access. However, should a requestor of public records challenge Contractor's interpretation of the term "trade secrets," within five (5) calendar days of such challenge, Contractor must provide a separate written affidavit that includes an indemnification and release guarantee, as approved by the County Attorney or designee, to the County to support its claim that the alleged trade secrets actually constitutes same as defined by law. Contractor must demonstrate the need for confidentiality of the documentation by showing a business advantage or an opportunity to obtain an advantage if the documentation was released. Otherwise, Contractor is required to timely seek a protective order in the Circuit Court of the Sixteenth Judicial Circuit in and for Monroe County to prevent the County's release of the requested records. 30. Foreign Gifts and Contracts The Contractor must comply with any applicable disclosure requirements in Section 286.101, Florida Statutes. Pursuant to Section 286.101(7)(b),Florida Statutes: "In addition to any fine assessed under [§ 286.1.01(7)(a), Florida Statutes], a final order determining a third or subsequent violation by an entity other than a state agency or political subdivision must automatically disqualify the entity from eligibility for any grant or contract funded by a state agency or any political subdivision until such ineligibility is lifted by the Administration Commission [Governor and Cabinet per § 14.202, Florida Statutes] for good cause." 13 31. Scrutinized Companies and Countries of Concern per Sections 287.135, 215.473, & 287.138, Florida Statutes Contractor hereby certifies that it: a) has not been placed on the Scrutinized Companies that Boycott Israel List, nor is engaged in a boycott of Israel; b) has not been placed on the Scrutinized Companies with Activities in Sudan List nor the Scrutinized Companies with Activities in the Iran Terrorism Sectors List (formerly the Iran Petroleum Energy Sector List); and c) has not been engaged in business operations in Cuba or Syria. If County determines that Contractor has falsely certified facts under this paragraph, or if Contractor is found to have been placed on a list created pursuant to Section 215.473, Florida Statutes, as amended, or is engaged in a boycott of Israel after the execution of this Agreement, County will have all rights and remedies to terminate this Agreement consistent with Section 287.135, Florida Statutes, as amended. The County reserves all rights to waive certain requirements of this paragraph on a case -by -case exception basis pursuant to Section 287.135, Florida Statutes, as amended. Beginning January 1, 2024, the County must not enter into a contract that grants access to an individual's personal identifying information to any Foreign Country of Concern such as: People's Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People's Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolas Maduro, or the Syrian Arab Republic, unless the Contractor provides the County with an affidavit signed by an authorized representative of the Contractor, under penalty of perjury, attesting that the Contractor does not meet any of the criteria in subparagraphs (2)(a)- (c) of Section 287.138, Florida Statutes, as may be amended. 32. Noncoercive Conduct for Labor or Services As a nongovernmental entity submitting a proposal, executing, renewing, or extending a contract with a government entity, Contractor is required to provide an affidavit under penalty of perjury attesting that Contractor does not use coercion for labor or services in accordance with Section 787.06, Florida Statutes. As an authorized representative of Contractor, and by submitting this proposal, I certify under penalties of perjury that Contractor does not use coercion for labor or services as prohibited by Section 787.06, Florida Statutes. Additionally, Contractor has reviewed Section 787.06, Florida Statutes, and agrees to abide by same. 33. E-Verify Requirements Effective January 1, 2021, public and private employers, contractors and subcontractors must require registration with, and use of the E-verify system in order to verify the work authorization status of all newly hired employees. Contractor acknowledges and agrees to utilize the U.S. Department of Homeland Security's E-Verify System to verify the employment eligibility of: a) All persons employed by Contractor to perform employment duties within Florida during the term of the contract; and b) All persons (including subvendors/subconsultantslsubcontractors) assigned by Contractor to perform work pursuant to the contract with the County. The Contractor acknowledges and agrees that use of the U.S. Department of Homeland Security's E-Verify System during the term of the contract is a condition of the contract with the County. By submitting a proposal, the Contractor becomes obligated to comply with the provisions of Section 448.095, Florida Statutes, "Employment Eligibility," as amended from time to time. This includes, but is not limited to, utilization of the E-Verify System to verify the work authorization status of all newly hired employees, and requiring all subcontractors to provide an affidavit to Contractor attesting that the subcontractor does not employ, contract with, or subcontract with, an unauthorized alien. Contractor agrees to maintain a copy of such affidavit for the duration of this Agreement. Failure to comply with this paragraph will result in the termination of this Agreement as provided in. Section 448.095, Florida Statutes, as amended, and Contractor may not be awarded a public contract for at least one (1) year after the date on which the Agreement was terminated. Contractor will also be liable for any additional costs to County incurred as a result of the termination of this Agreement in accordance with this Section. Upon executing this Agreement, Contractor will provide proof of enrollment in E-verify to the County. 14 34. Prohibited Telecommunications Equipment By submitting a proposal, Contractor agrees to the following provisions, and further represents and certifies that it and its applicable subcontractors do not and will not use any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system, as such terms are used in 48 CFR §§ 52.204-24 through 52.204-26. By executing this Agreement, Contractor represents and certifies that Contractor and its applicable subcontractors must not provide or use such covered telecommunications equipment, system, or services for any scope of work performed for the County for the entire duration of this Agreement. If Contractor is notified of any use or provisions of such covered telecommunications equipment, system, or services by a subcontractor at any tier or by any other source, Contractor must promptly report the information in 40 CFR § 52.204- 25(d)(2) to County. 35. Antitrust Violations; Denial or Revocation under Section 287.137, Florida Statutes Pursuant to Section 287.1.37, Florida Statutes, as may be amended, a person or an affiliate who has been placed on the antitrust violator vendor list (electronically published and updated quarterly by the State of Florida) following a conviction or being held civilly liable for an antitrust violation may not submit a'bid, proposal, or reply for any new contract to provide any goods or services to a public entity, may not submit a bid, proposal, or reply for a new contract with a public entity for the construction or repair of a public building or public work, may not submit a bid, proposal, or reply on new leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a new contract with a public entity; and may not transact new business with a public entity. By submitting its proposal, Contractor certifies neither it nor its affiliate(s) are on the antitrust violator vendor list at the time of entering this Agreement. False certification under this paragraph or being subsequently added to that list will result in termination of any ensuing award of a contract, at the option of the County consistent with Section 287.137, Florida Statutes, as amended. 36. Environmental and Social Government and Corporate Activism Pursuant to Section 287.05701, Florida Statutes, as may be amended, the County cannot give preference to a contractor based on social, political or ideological interests as defined in the statute. Contractor is also prohibited from giving preference to any of its subcontractors based on the above referenced factors. Violations of this Section will result in termination of any ensuing or forthcoming agreement hereunder, and may result in administrative sanctions and penalties by the Office of the Attorney General of the State of Florida. 37. Drug -Free Workplace Consultant in accordance with Section 287.087, Florida Statutes, by submitting aproposal thereby certifies that he/she/it shall (upon being awarded a contract with the County): 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 contractual services hereunder a copy of the statement specified in 1.), above; 4.) In the statement specified in 1.), notify the employees that, as a condition of working on the contractual services hereunder, 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 contenders to, any violation of Chapter 893, Fla. Stat., or of any controlled substance law of the U.S. 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 15 such is available in the employee's community, or any employee who is so convicted; and 6.) Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. By submitting aproposal and signing any ensuing agreement with the County, Consultant certifies that he/she/it complies fully with the above requirements. 38. Default 38.1. Termination for Uncurable Default In the event the Consultant shall default in or violate any of the terms, obligations, restrictions or conditions of this Contract in a manner that is uncurable (as determined in the sole discretion of the County), the County may, upon written notice to the Consultant, terminate this Contract effective immediately. In the event of such termination the County may hold the Consultant liable for any and all damages sustained by the County arising out of such default, including but not limited to costs of re -procurement and cover. 38.2 Termination for Curable Default In the event the Consultant shall default in any of the terms, obligations, restrictions or conditions in the Contract Documents in a manner that is curable (as determined in the sole discretion of the County), the County shall give the Consultant written notice by registered, certified mail of the default and that such default shall be corrected or actions taken to correct such default shall be commenced within three (3) calendar days thereof. In the event the Consultant has failed to correct the conditions(s) of the default or the default is not remedied to the satisfaction and approval of the County, the County shall have all legal remedies available to it, including, but not limited to termination of the Contract in which case the Consultant shall be liable for any and all damages permitted by law arising from the default and breach of the Contract. 38.3 Termination for Convenience of County Upon thirty (30) calendar days written notice delivered by certified mail, return receipt requested, to the Consultant, the County may without cause and without prejudice to any other right or remedy, terminate the Contract for the County's convenience whenever the County determines that such termination is in the best interest of the County. Where the Contract is terminated for the convenience of the County the notice of termination to the Consultant must state that the Contract is being terminated for the convenience of the County under the termination clause and the extent of termination. The Consultant shall discontinue all work on the appointed last day of service. 39. Payment Dispute Resolution Process 39.1 Payment disputes must be handled pursuant to the procedures set forth in the Monroe County Purchasing Policies and Procedures Manual. In sum, if an improper invoice is submitted by a Consultant, Monroe County shall notify the Consultant in writing within ten (10) days after receipt of an improper invoice, that the invoice is improper. The notice should indicate what corrective action on the part of the Consultant is needed to make the payment request or invoice proper. The Consultant should take corrective action and resubmit a Proper Invoice to the County. The Consultant's steps shall be that of initially contacting MCFR to validate the invoice and receive a sign off from the department that would indicate that the invoice in question is in accordance with the terms and conditions of the agreement. Once sign off is obtained, the Consultant should then resubmit the invoice as a "Corrected Invoice" to the department which will initiate the payment timeline of a Proper Invoice. A Proper Invoice for this purpose is defined as an invoice submitted for work performed that meets prior agreed upon terms or conditions to the satisfaction of Monroe County and in accordance with Section 21.8.72, Florida Statutes. 39.2 Should a dispute result between the Consultant and the County over tender of a payment request or an invoice, then the Consultant should submit their notice of dispute in writing to the department. The department should acknowledge receipt of the Consultant's notice of dispute and provide the Consultant with the County's dispute resolution procedure by mail or email, if available. The department shall assign a representative who shall act as a "Dispute Manager" to 16 resolve the issue at departmental level. The Dispute Manager shall investigate the dispute and document the steps taken to resolve the issue. The Dispute Manager should, as part of his or her investigation, ascertain if the work, for which the payment request or invoice has been submitted, was performed to Monroe County's satisfaction and duly accepted by the Proper Authority. Proper Authority for this purpose is defined as the Monroe County representative who is designated as the approving authority for the work performed in the contractual document. Dispute resolution procedures shall be commenced no later than thirty (30) days after the date on which the payment request or invoice was received by Monroe County and shall not extend beyond sixty (60) days. The Dispute Manager must complete the investigation and furnish a written determination to the Consultant. If the Consultant is not satisfied with the Dispute Manager's resolution of the dispute, the County Administrator or his or her designee shall be the final arbiter in resolving the issue and will issue their final decision in writing within sixty (60) days after the date on which the payment request or invoice was received by Monroe County. 17 PART 3 — STATEMENT OF WORK 1. Purpose & Background 1.1. The Scope of Work includes all services as described in this RFQ to be performed for Monroe County Fire Rescue. Monroe County Fire Rescue operates nine (9) fire suppression stations and two (2) air ambulance bases across three (3) 24-hour Shift Platoons (A/B/C Shifts). Monroe County Fire Rescue provides fire and emergency medical services (EMS) to the citizens and visitors of the unincorporated areas of Monroe County (generally from Tavernier to Stock Island) plus the Key West International Airport, and also within the City of Layton. 1.2. All fire station operations personnel are Florida state certified firefighters and national and state licensed Emergency Medical Technicians or Paramedics. The air ambulance bases, which are part of the County's Trauma Star Program, are located in the cities of Marathon and Key West. Trauma Star air ambulance services include care and air transport to critically injured patients within all of Monroe County (both incorporated and unincorporated) including first response to the Dry Tortugas, an island located approximately 70 miles offshore from the City of Key West. All fire station apparatus provide Advanced Life Support (ALS) services and are staffed with a. minimum of one (1) Firefighter/Paramedic and one (1) Officer per shift. At times, the Station Officer serves as the Firefighter/Paramedic. There are (4) firefighters operating 24 hours / 7 days a week at each of the eight (8) structural fire stations (fire service zones) and three (3) ARFF personnel at Station 7 (Key West International Airport). The department's countywide minimum daily staffing level is forty (40) firefighters/EMT-Paramedics/Nurses which provide an effective response force within each fire service zone/station responding to every type of emergency incident. Monroe County Fire Rescue provides Basic Life Support (BLS) and Advanced Life Support (ALS) services to the citizens and visitors of unincorporated Monroe County, as well as the City of Layton. MCFR responds to an average of 4,000 to 5,000 incidents per year, which includes emergency medical service calls. 1.3. Each Shift is led by a Battalion Chief (supervisor), each fire station company has a Station Officer, either Captain or Lieutenant, staffing an engine, tanker or ladder truck and a Rescue (ambulance). All units are staffed with a minimum of one (1) certified Paramedic. The overall daily operational staffing consists of one (1) Battalion Chief, thirty-two (32) Firefighter/EMT-Paramedics, three (3) ARFF Firefighter/EMT-Paramedics, two (2) flight medics, and two (2) flight nurses on duty each day. In addition, there are a small number of volunteer firefighters that provide support to the department. The fire station at KWIA provides aircraft rescue and firefighting (ARFF) services during air carrier operations. Each Trauma Star air ambulance has a Flight Paramedic and Nurse on duty each day. Minimum Qualifications & Licenses 2.1. Consultant must provide documentation of the following minimum qualifications and experience as set forth herein, and consistent with the minimum criteria set forth in Rule 64J-1.004, "Medical Direction," of the Florida Administrative Code, to include, but not be limited to, the following: a) Currently licensed and practicing in the State of Florida as an M.D. or D.O., for at least ten (10) continuous years immediately preceding this solicitation. b) Board Certified in Emergency Medicine through either the American Board of Emergency Medicine, the American Board of Osteopathic Emergency Physicians, or the American Association of Physicians Specialists, for at least ten (10) continuous years immediately preceding this solicitation. c) Currently certified as an Instructor in at least one (1) of the following areas: Advanced Cardiac Life Support (ACLS), Prehospital Trauma Life Support (PHTLS), or Pediatric Advanced Life Support (PALS). d) Be able to demonstrate experience and/or training in the pre -hospital care of acutely ill or injured patients, instruction of pre -hospital personnel, and medical direction of pre -hospital emergency units. e) Be able to demonstrate experience and/or training in EMS Quality Improvement processes. f) No criminal history that includes conviction or adjudication withheld of any criminal charge. Consultant must be willing to submit to a voluntary background screening, including a Level I criminal record check. g) Be able to demonstrate experience and a broad knowledge of pre -hospital and hospital emergency medicine, as well as pre -hospital care in a fire -rescue based system, including familiarity with the operation of emergency medical services supporting this system. h) Be able to demonstrate ability to prescribe medications, including controlled substances, in the State of Florida, pursuant to the provisions of Chapters 499 and 893, Florida Statutes, and Chapter 61N-1.001, F.A.C. i) Be able to demonstrate working knowledge of federal, state of Florida and local laws and regulations in relation to emergency medical services and pre -hospital services. 3. Scope of Services 3.1. This Request for Qualifications outlines the scope of services required by Monroe County Fire Rescue tendered by a licensed physicians) pursuant to Chapter 458, Florida Statutes, to serve as the Medical Director pursuant to Chapter 401, Florida Statutes, and Rule Chapter 64J-1, Florida, Administrative Code, having authority over all clinical and patient care aspects of the Monroe County Emergency Medical Services system which includes each ALS, BLS, and/or air ambulance services within the County. 3.2. The Medical Director professional services contract shall be for an initial term of three (3) years, with two (2) additional two (2) year extension terms based upon satisfactory performance and the mutual agreement of all parties. The services provided to the County will start only after the County's issuance of a written Notice to Proceed, consistent with a valid contract executed between the parties, and will continue until midnight of the last day stated in the term of contract, unless otherwise extended or amended by formal amendment of the contract agreed to by the parties. 3.3. Monroe County Fire Rescue requires a Medical Director to perform daily professional services consistent with Section 401.265, Fla. Stat., as may be amended. The professional services, duties, and responsibilities, including, but not limited to, advising, training, counseling and overseeing Monroe County's Emergency Medical Services and Trauma Star programs. These services involve administrative and management functions for an on -going basis, with specific activities, such as meetings, testing and evaluations, etc. which will require an on -site presence and time commitment scheduled with the Fire Chief and/or designee. 3.4. The Daily or On -going services, duties, and responsibilities are further described as follows: a) Availability 24/7 to provide Medical Direction to Monroe County Fire Rescue personnel, in order to resolve problems, system conflicts, and provide services in an emergency as defined in Section 252.34(4), Fla. Stat., as may be amended. b) Provide supervision and oversight for the medical performance of the paramedics and emergency medical technicians (EMT's) working for Monroe County. This includes retaining authority to permit and/or prohibit any paramedic or EMT to use advanced life support or other emergency medical procedures, which includes career and volunteer personnel. c) Review and certify that the security and documentation of procedures for medications, fluids and controlled substances are in compliance with all applicable federal, state and local laws and requirements. d) Conduct an on -going review and maintain standards of care for Fire Rescue personnel, including review and update of Monroe County Fire Rescue Medical Protocols, and assisting to update the medical performance standards contained within these protocols. This includes an on review of all Protocols and Standing Orders, as may be necessary, to ensure reliable service delivery, appropriate patient care, and the maintenance of the current standard of care, including comprehensive review and written approval of all Protocols and Standing Orders, considering the results of the Quality Assurance performance reviews, a review of current medical literature, and input from other Fire Rescue personnel. This also includes the 19 review, revision, implementation, and maintenance of Basic and Advanced Life Support Protocols and standing orders. e) Participate in a patient care Quality Assurance Program to assess the medical performance of paramedics and EMT's. Auditing of personnel will include, but is not limited to, aprompt filing of the patient care report, direct observation on emergency scenes, as well as on transport units, and reviews of performance standards for controlled substances, medical equipment, protocols and procedures. f) Establish procedures for routine auditing of the County's medical system performance. In addition, establish procedures for special audits upon request by a) a physician involved in an incident or by a patient's personal physician; b) a provider in a case in which the provider was involved; c) an EMT or paramedic in a case which he/she was involved; d) a member of the Quality Assurance Committee that is established pursuant to Section 401.265, Fla. Stat.; e) by the County Administrator of Monroe County; or f) at the discretion of the Medical Director. g) Provide clinical reviews and evaluation of aero medical electronic patient care reports. Consultant must review a minimum of 40 reports per month using the County's electronic patient care records management portal (ESO). h) Perform clinical reviews of all patient care reports (through ESO) and review any deficiencies with medical personnel, as requested by MCFR. Provide investigations or audits, as needed, to ensure that personnel comply with the protocols and standards of care established by the department. The method and extent of the investigation or audit employed during any Quality Assurance Review will be initiated by the Medical Director, in direct coordination with the Fire Chief. i) Conduct training as requested by MCFR for revisions to Protocols and Standing Orders prior to implementation. Further, coordinate with the Fire Chief, or designee, for compliance with all Protocols and Standing Orders for Fire Rescue personnel and ensure that additional training is conducted to address any identified needs or deficiencies. j) Assist in the resolution of issues involving the delivery of pre -hospital care and other services in accordance with Rule 64J-1.004, F.A.C., as may be amended. k) Present lectures and hold trainings on medical topics to support MCFR's Continuing Education Programs. This includes live (in -person) presentations, upon request by MCFR, and the provision of training and/or study materials. 1) Conduct trainings and verify that all certified/Licensed Fire Rescue Personnel are trained in the use of the Trauma Scorecard Methodologies, as provided in Rule 64J-2.004, F.A.C., for adult trauma patients, and Rule 64J-2.005, F.A.C., for pediatric trauma patients. m) Perform in -person testing and verify the proficiency of Paramedics who complete MCFR's Paramedic Precepting Program, including reviewing the training documentation and administering an oral and/or written examination. n) Provide an orientation and initial training for newly hired EMT's and Paramedics, upon request and coordination by MCFR. o) Provide for direct observation of field level providers, while performing their duties, that meets or exceeds standards established in Section 401.265, Fla. Stat., and Rule 64J-1.004, F.A.C., as either may be amended. p) As instructor, upon completion of course, the Medical Director shall sign documents and approve the Continuing Education units to those EMTs and EMT -Ps in furtherance of their completion of the minimum 30 hours of bi-annual re -certification training, as set forth in Section 401.2715, Fla. Stat., as may be amended. q) Interact with and inform the County Administrator and local government officials on an as - needed basis. Consultant may be required to represent Monroe County in matters involving or relating to other governmental entities at the local, regional, state, or national level, pertaining to the County/State/Federal for any emergency medical services improvement program(s), permits or grants in which the County is or may be an eligible participant or has an interest. ►.i r) Must be available 24/7 for consultation and response during a disaster situation occurring in Monroe County; disasters within the meaning of this solicitation include, but are not limited to, hurricanes (before making landfall and after). s) Assist and liaise on behalf of Monroe County Fire Rescue, through the Fire Chief, between field EMS operations, the County's Emergency Department, hospitals, and public health agencies during disaster situations. t) Participate in the Florida EMS Medical Director's Association, or another similarly recognized statewide physician's group that focuses on pre -hospital care. 3.5. The Monthly services, duties, and responsibilities include, but are not limited to, the following described deliverables: a) Attend monthly meetings including, but not be limited to, Trauma Star Flight team meeting, EMS Services meeting, department staff meetings, and Monroe County Board of County Commissioner's Meetings, as requested by MCFR. b) Participate in Educational Programs at all levels, to include all Certified/Licensed Monroe County Fire Rescue response personnel. c) Provide a monthly report detailing activities performed on behalf of the department, to include meetings, training, evaluation and testing of paramedics or EMTs, etc. 3.6 The Quarterly services, duties, and responsibilities include, but are not limited to, the following described deliverables: a) Participate in Trauma Star Safety Meetings quarterly to review procedures, safety policies and issues, unusual occurrences, and audit compliance with safety policies and procedures. b) Participate in Emergency Medical Services and Quality Assurance Quality Management review meetings on a quarterly basis. c) Provide a quarterly report listing any participation in inter -agency discussions regarding identified issues, or meetings coordinated to promote collaboration and improvement of communication. This may include periodically visiting and communicating with the hospital emergency departments to exchange information and review the quality of care provided by Monroe County Fire Rescue personnel. 3.7 Annual services, duties, and responsibilities include, but are not limited to, the following described deliverables: a) Provide annual review and sign -off (certifying up-to-date) of Trauma Transport Protocols, for submission to the Florida Department of Health, Bureau of Emergency Medical Services, for approval in accordance with Chapter 64J-2, F.A.C., as may be amended. b) Certify on an annual basis the review and revision of MCFR's Protocols for Specialty Procedures or Services, including but not limited to aeromedical (Trauma Star Transport). c) Certify on an annual basis the review and revision of existing Protocols and Standing Orders to ensure that these meet nationally accepted standards of practice for use by all Monroe County Fire Rescue personnel (ALS/BLS Procedures), when contact cannot be made with the supervising physician, or when any delay in patient care would threaten the life or health of the patient. d) Provide an annual report on all training sessions provided to MCFR personnel on all Protocols and Standing Orders; report must indicate dates to ensure that such training was conducted prior to implementation; and make recommendations for upcoming training opportunities to address any identified needs and ensure compliance with Protocols and Standing Orders by Fire Rescue personnel. c) Conduct an annual review of the National Fire Protection Association standards for the Comprehensive Occupational Medical Program for Fire Departments against MCFR's current operation, and provide a written report on annual findings and recommendations. f) Develop an improved patient care Quality Assurance Program to assess the medical performance of paramedics and E.M. Ts. As part of the development, provide an annual review 21 of the existing patient care Quality Assurance Program and submit an annual report to the Fire Chief prior to the end of each County -fiscal year (Oct. 1st — Sept. 30th). g) Participate in the annual budgetary process, and in conjunction with the Fire Chief and/or designee, provide annual reviews regarding appropriate staffing, structural requirements, equipment and supplies necessary to ensure the department's compliance with all applicable laws and regulations, including air ambulances compliance with Rule 64J-1.005, F.A.C., and Section 401.251, Fla. Stat., as either may be amended. In addition, as part of any budget discussions, recommend emergency medical services continuing education programs, including educational topics, providing lectures and training events, and supporting other educational opportunities to enhance the County's EMS system. h) Provide annual reviews of an effective patient care Quality Assurance System to assess the medical performance of all Certified/Licensed Monroe County Fire Rescue response personnel. i) Review annually procedures for issuance, renewal, suspension, and revocation of practice privileges for Monroe County Fire Rescue personnel in concert with the Fire Chief, to include a process for remediation. The procedure shall contain due process provisions, and all such provisions shall be approved, in advance, by the Fire Chief. j) Review annually procedures for routine auditing of EMS System performance and adherence to protocols on individual EMS incidents and overall EMS system compliance. k) Provide and oversee a minimum of ten (1.0) hours per year of continuing medical education related to pre -hospital care, or teaching, or a combination of both, to department EMT's and Paramedics. In addition, review and approve annual training courses for continuing education units offered by outside providers, to ensure quality of training. 4. Standard of Care 4.1. Consultant shall perform all of the provisions of this contract with that degree of care and skill ordinarily exercised by members of the same profession currently practicing under the same or similar circumstances. The County shall base its determination of the Consultant's fulfillment of the scope of services in accordance with accepted professional consulting standards. 4.2. Consultant shall be responsible for the accuracy of its professional services under this Agreement and shall promptly make revisions or corrections resulting from its errors, omissions, or negligent acts without additional compensation. The County's acceptance of any of Consultant's professional services shall not relieve Consultant of its responsibility to subsequently correct any such errors or omissions. 4.3. Consultant shall respond to the County's notice of any errors, omissions, or deficiencies in the deliverables within twenty-four (24) hours of written confirmation by the Consultant of the County's notice. Such confirmation may be in the form of an email confirming receipt, or by actual hand delivery of written notice by the County to the Consultant. Consultant may be required to physically visit a site within Monroe County, if directed by the County. 22 PART 4 — REQUIREMENTS AND INSTRUCTIONS FOR SUBMISSION OF PROPOSALS 1) Rules for Submission 1.1. The submission must name all persons or entities interested in the submission as principal Consultant. The proposal must declare that it is made without collusion with any other person, or entity, submitting a proposal pursuant to the RFQ. All competitive solicitations received must remain valid for a minimum period of ninety (90) days from the competitive solicitation opening. Properly identified responses received before the deadline (i.e. the specified date and time of opening/unsealing) will be opened by the Monroe County Purchasing Department. No responses will be accepted after the specified date and time of opening/unsealing. 1.2. The proposal shall be written in sufficient detail to permit the County to conduct a meaningful evaluation of the qualifications and proposed services. Each page should be titled as described below, and inserted within its specific "Tab." The statement of qualifications shall respond to each item outlined below. Please limit response to the information requested. The proposal must include the following information: 2) Modification and Withdrawal of ProposalsPrior to the time and date designated for opening/unsealing of proposals, any proposal submitted may be modified by removing the existing proposal from. Bonfire and uploading anew, complete proposal. The new submission shall comply with. the requirements for the original proposal. Proposals may be withdrawn on Bonfire prior to the time and date designated for the opening/unsealing of proposals. Withdrawn proposals may be resubmitted on Bonfire up to the time designated for the opening/unsealing of proposals provided that they are then fully in conformance herewith. After the specified date and time of opening/unsealing the proposals, a Proposer who discovers an error in its proposal, may only withdraw its proposal under the conditions set forth in Monroe County Code Section 2-347(i)(1); however, this action removes the proposer from further consideration should the other proposers decline the award or withdraw their proposals. 3) Contents of Submission The responses to this RFQ shall be digital PDF format. Responses must be organized as indicated below. Each Respondent must submit adequate documentation, as determined by the BOCC, to certify the Respondent's compliance with the County's requirements. The following information, at a minimum, shall be included in the Response. 3.1. Cover Page Respondent shall include a cover page titled "Statement of Qualifications for Medical Director Services for Monroe County Fire Rescue." The cover page should contain the Respondent's name, address, telephone number and the name of the Respondent's primary contact. 3.2. Qualification Details in Tabbed Sections Tab A. Executive Summary (5 points) The Respondent shall provide a summary of services brief history of the firm or organization, and particularly include other contracts that are similar in nature to the services requested in the RFQ. The Respondent shall provide a narrative of the firm's qualities and capabilities that demonstrate how the firm will work with Monroe County Fire Rescue to fulfill the requirements of the scope of work. Tab B. Licensure, Qualifications, and Relevant Experience (45 points) 1) The Respondent shall provide copies of all applicable licenses and certifications for personnel, as described in the Scope of Services, herein. 2) Respondent shall provide copies of the resumes for all its personnel. 23 3) Respondent shall provide narrative describing familiarity with and experience as follows: a. Experience and training in the pre -hospital care of acutely ill or injured patients. b. Experience and training in the instruction of pre -hospital personnel. c. Experience and training in the Emergency Medical Services Quality Improvement processes. d. Demonstrate experience and a broad knowledge of pre -hospital and hospital emergency medicine. e. Demonstrate experience and training in medical direction of pre -hospital emergency units. f. Demonstrate experience in pre -hospital care in a fire -rescue based system, including familiarity with the operation of emergency medical services that support MCFR's system. g. Ability to prescribe medications, including controlled substances, in the State of Florida, pursuant to the provisions of Chapters 499 and 893 of the Florida Statute and. Chapter 6IN- 1, F.A.C. h. Practical and technical working knowledge of federal, state of Florida and local laws and regulations in relation to emergency medical services and pre -hospital services. 4) The Respondent shall provide a complete history of the firm or organization demonstrating relevant experience with services that are similar in scope to the work described herein. The demonstrated history shall include a list of at least two (2) contracts with other organizations arising within the last ten (10) years. The list should include the information below: a. Name and full address of the referenced organization (with whom the contract was made). b. Name and telephone number of primary contact person for contract. c. Date(s) of contract, including initiation, termination and contract value (compensation amount). d. Brief summary of the contracted services which are similar to the services requested in this RFQ. e. Provide a letter of reference from the contracted organization. 5) Additionally, Respondent shall name at least two (2) references outside of the organizations contracted with (listed above). Each named reference shall include, at a minimum, the information of the primary contact person, name of the organization, and contact information. Tab C. Criminal History Background Screening & Licensure Eligibility (5 points) In addition to the offenses listed in Section 435.04, Fla. Stat., the applicant must not have an arrest awaiting final disposition for, must not have been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, and must not have been adjudicated delinquent and the record not have been sealed or expunged for an offense under Section 784.03, Fla. Stat., or any similar offense of another jurisdiction relating to battery, if the victim is a vulnerable adult as defined in Section 415.102, Fla. Stat., or a patient or resident of a facility licensed under chapter 395, chapter 400, or chapter 429. The Proposer shall comply with and ensure its employees, subcontractors, and agents are in compliance with the requirements of Chapter 435, Fla. Stat., as amended, regarding background screening for all persons who are not exempt from background screenings. To demonstrate compliance with this provision, Proposer must submit the completed Criminal History Background Check Consent Form, as well as Licensure Eligibility (pursuant to Section 456.01.35, Fla. Stat.) Attestation Form, as part of its response. 24 Tab D. Approach and Management (15 points) Respondent shall provide a narrative describing the services offered by the Consultant in order to provide evaluators with insight about the qualifications, fitness, and abilities of the Respondent. In the narrative, Respondent shall provide details on its approach and management of services. It should include, but not be limited to, descriptions of. Respondent's strategy for setting up in -person site visits to the MCFR Headquarters, fire stations, or the Training Academy (a minimum of two (2) in -person visits per year is recommended); allocation of a minimum of 24 hours of work per month in addition to the time spent fulfilling any site visit requirements is recommended; how Respondent plans to complete each of the monthly, quarterly, and annual deliverables outlined in the Scope of Services, herein; and Respondent's familiarity with and utilization of the County -approved software (ESO); and the continency plan to cover MCFR's needs in the event of Consultant's inability to provide services during an active contract term. Tab E. Staffing, Qualifications of Key Personnel and Technology (30 points) 1) The Respondent shall describe the composition and structure of the firm (sole proprietorship, corporation, limited liability company, partnership, joint venture) and include the names of all persons with an interest in the firm. 2) The Respondent shall include a list of the proposed staff that will perform the work required if awarded this contract. If applicable, an organizational chart should be included in this section. The Respondent shall also include a resume for each member of the team identifying his/her role on the team and any qualifications relevant to their role. Include in this section the location of the main office where a majority of personnel physical report. Note: It is the policy of Monroe County to provide a local preference in competitive bidding when required by the Monroe County Purchasing Policy Manual and the Monroe County Code of Ordinances, to wit: Section 2-349. The intent and justification for providing a local preference is set forth in Section 2- 349 of the Monroe County Code. 3) Respondent shall describe its use of technology which may be used for such services. List any specific hardware and software currently in use or planned for use in the delivery of services under an awarded contract. Tab F. Financial Information and Litigation (Y/N) The Respondent will provide the following information by way of completing the "Consultant Qualification Form per Subsection 2-347(h), County Code," as provided in the mandatory forms section of the solicitation. Such information includes: 1) A list of the person's or entity's shareholders with five percent or more of the stock or, if a general partnership, a list of the general partners; or, if a limited liability company, a list of its members; or, if a solely owned proprietorship, names(s) of owner(s); 2) A list of the officers and directors of the entity; 3) The number of years the person or entity has been operating and, if different, the number of years it has been providing services as requested herein; 4) The number of years the person or entity has operated under its present name and any prior names; 5) Answers to the following questions regarding claims and suits: a. Has the person, principals, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or directors, ever failed to complete work or provide the goods for which it has contracted'? Yes or No. If yes, provide details; 25 b. Are there any judgments, claims, arbitration proceeding or suits pending or outstanding against the person, principal of the entity, or entity, or any entity previously owned, operated or directed by any of its officers, directors, or general partners? Yes or No. If yes, provide details; c. Has the person, principal of the entity, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or directors, within the last five years, been a party to any lawsuit, arbitration, or mediation with regard to a contract for services, goods or construction services similar to those requested in the specifications with private or public entities? Yes or No. If yes, provide details; d. Has the person, principal of the entity, or any entity previously owned, operated or directed by any of its officers, owners, partners, major shareholders or directors, ever initiated litigation against the county or been sued by the county in connection with a contract to provide services, goods or construction services? Yes or No. If yes, provide details; e. Whether, within the last five years, the owner, an officer, general partner, principal, controlling shareholder or major creditor of the person or entity was an officer, director, general partner, principal, controlling shareholder or major creditor of any other entity that failed to perform services or furnish. goods similar to those sought in the request for competitive solicitation; 6) Customer references (minimum of three (3)), including name, current address and current telephone number; 7) Credit references (minimum of three (3)), including name, current address and current telephone number; an example of a credit reference could be in the form of a letter from a financial institution, such as a Bank Confirmation Letter (BCL) or other such correspondence, verifying that the Respondent has an existing account and the financial resources to provide the services identified in the Scope of Services. 8) FINANCIAL INFORMATION — SUBMIT BY SEPARATE UPLOAD. In order to determine if a proposer is responsible pursuant to Section 2-347(h), Monroe County Code of Ordinances, all proposals for contracts to be awarded under this section must contain the following information: Financial statements for the prior three (3) years for the responding entity or for any entity that is a subsidiary to the responding entity. Note: Any financial statement that an agency requires for responding to a request for bids/proposals is exempt from disclosure as a public record. Please do not submit your confidential financial information as part of your proposal. Please mark as "Confidential" to exercise exemption under Subsection 119.071(I)(c), Florida Statutes, and upload by separate upload to Bonfire to maintain confidentiality. There are separate uploads for each set of documents, including confidential financial information. However, any financial information the Contractor includes in the proposal packet, which is not marked as "Confidential", and is uploaded incorrectly, may be disclosed in any public records request and will not be treated as "Confidential." The County shall incur no liability for inadvertent disclosure of financial records that are not properly marked or submitted. Tab G. Mandatory Forms (YIN) Respondent shall complete and execute the mandatory forms, with supporting documentation, as specified below, and shall include them in the appropriate tabbed section of the response. Failure to provide executed documents may result in Respondent being determined to be not responsive and/or not responsible: 26 • Consultant Qualification Statement (per subsection 2-347(h), Monroe County Code) • County Forms (& State -mandated provisions) Affidavit • Federal Forms ("Debarment Certification Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters" Form, Byrd -Anti Lobbying Certification & Disclosure of Lobbying Activities Forms) • Criminal History Background Check Consent Form & Attestation of Licensure Eligibility Form • Insurance Requirements Form (incl. Release of Liability & Indemnification Statement) • Insurance Agent's Statement (signed by insurance agent) SEPARATE DOCUMENT UPLOAD: • Three (3) years of Financial Statements marked "CONFIDENTIAL" SEPARATE DOCUMENT UPLOAD: • Price Response - Proposal Form 3.3. Price Response - Proposal Form Consultant must complete a price proposal form, to submit a "Prise Response," as an essential part of any responsive submittal to this R:FQ. The Price Response should be uploaded as a separate document from, but simultaneously with, the Qualifications Response. Both aspects of a response must be uploaded into the eBid system in order to be considered complete. The :Price :Response must state with sufficient detail how the Consultant desires to be paid for services described within the Scope of Work, herein. Proposer must demonstrate how the pricing request is consistent with current industry pricing for same or similar services. Proposer must describe in detail the manner of payment (e.g. annual lump sum broken down into monthly installments paid in arrears), and provide a detailed breakdown of the lump sum value. The detailed breakdown of the lump sum value breakdown of how the Lump Sum was calculated, including but not limited to: Direct Hourly Rates (for each class of staff, if applicable) tied to a specific total of hours per month; Projected/Estimated Travel Expenses per month; and other overhead/general out -of -packet costs per month. Any exclusions from the lump sum and add-ons to lump sum must be set for explicitly with the description of the specific services and associated prices per unit. Proposer must account for and include all sales, consumer, use, and other taxes required to be paid in accordance with the laws of the U.S. government, State of Florida, or Monroe County, Florida. Unless otherwise explicitly stated, the lump sum price will be deemed to include all labor, materials, equipment, insurance, licensing, and travel/lodging necessary to complete the Scope of Work set forth in the RFQ. 27 PART 5 — EVALUATION OF SUBMISSIONS & CONTRACT NEGOTIATIONS 1. Selection Committee Meeting(s) Following the receipt of Responses, a Selection Committee appointed by the County Administrator and/or Fire Chief, will meet during a publicly noticed meeting to review and evaluate the Qualifications Responses based on the criteria herein. Qualifications Responses received by the specified deadline will be reviewed by the Selection Committee for content, completeness, qualifications, experience, and conformance with the specifications stated herein. The Selection Committee will rank the Consultants in order with the first being the most qualified, in arriving at such ranking the Selection Committee may conduct interviews and/or request presentations. However, the County reserves the right to complete the selection process without proceeding to an interview phase, and may choose to rank Consultants based upon the information supplied in the Qualifications Responses. Should the County require interviews, the Consultants will be notified a minimum of seven (7) days in advance of such interviews. Respondents may be asked to sit for an interview and make a detailed presentation of their qualifications and services to the Selection Committee at a duly -noticed public meeting. 2. Ranking After interviews, if applicable, the Respondents will be assigned a final score, with the highest - qualified Respondent ranked first, and so on. The County will request permission at a duly -noticed public meeting of the BOCC to negotiate the price for services using the highest -ranked Respondent's Price Response submittal as the Respondent's starting or initial offer to the County. Upon successful negotiation of pricing and contract terms, a recommendation for award of a contract will be considered by the BOCC at its next duly -noticed public meeting, or soon thereafter. No work performed pursuant to a contract will proceed without written authorization issued in the form of a Notice to Proceed or Notice of Commencement by the Fire Chief of Monroe County Fire Rescue. 3. Negotiations If granted permission from the BOCC, the County reserves the right to enter into contract negotiations with the highest -ranked Respondent. If the County and the highest -ranked Respondent cannot successfully negotiate a contract in good faith within a reasonable amount of time, the County, in its sole discretion, may terminate such negotiations and begin negotiations with the second -highest ranked Respondent, and so on. The same negotiations procedure may continue in like manner until a contract is negotiated to the satisfaction of the parties and ready to present to the BOCC for review and ultimate approval. The County shall be the final authority in the award of the contract. No Respondent shall have any rights against Monroe County arising from such negotiations. The signed Price Response submitted as part of the Consultant's proposal is considered an initial offer on the part of the Consultant. During negotiations, such offer shall be considered by the County along with all Price Responses from all Consultants having submitted responses to the County. Rights Reserved to BOCC Responses that contain modifications, are incomplete, unbalanced, conditional, obscure, or that contain irregularities of any kind, or that do not comply in every respect with the RFQ, may be rejected at the option of the County. The BOCC reserves the right to reject any and all responses, and to waive technical errors and irregularities as may be deemed best for the interests of the County. Please note that a Response may be rejected as non -conforming, non -responsive or the Responder may be deemed not responsible in which case the number of points will become irrelevant to the final selection. ►: Tabbed Sections The Respondent must adhere to the instructions in this RFQ in preparing and submitting this response. Please note that a certain Tab(s) may not have a point value; however, failing to answer the required questions or include the required documents and forms shall be grounds for rejection of the Response. The Tabbed sections will be given the following maximum point values used by the Selection Committee to score and evaluate Respondent: EVALUATION DESCRIPTION MAXIMUM CRITERIA POINTS Tab A Executive Summary 5 Tab B Relevant Experience and References for 45 Similar Services Tab C Criminal History Background Check Consent 5 Form, as well as Licensure Eligibility (pursuant to Section 4.56.0135, Fla. Stat.) Attestation Farm Tab D Approach and. Management Narrative 1.5 Tab E Staffing, Qualifications of Key Personnel and 30 Technology Tab F Financial Information and Litigation Y/N Tab G Completion of Mandatory .Forms Y/N Total Possible Points 100 6. Best Interests of the County The County shall be the sole judge of its own best interest and the resulting negotiated agreement. In all instances, the County's decision will be final. The respondent understands that this RFQ does not constitute an agreement or a contract with the County. An official contract, or agreement, is not binding until the submission is reviewed and accepted by the County Commission and by all parties. This RFQ is intended as the means to identify these highly qualified Consultants. The County anticipates entering into a contract for Medical Director services based on the criteria set forth herein to the respondent who submits the highest qualifications asjudged by the County, at a competitive and most advantageous price point for Monroe County residents. The Commission's decision shall be final. To the extent any conflicts arise within the RFQ and other documentation related to this solicitation, the term or condition that best serves the interests of Monroe County, as determined by the BOCC, shall prevail. 7. Execution of Contract The Sample Agreement attached hereto shall be the substantive agreement formed between the awarded Consultant and Monroe County, subject to minor alternations, as needed. The Consultant to whom a contract is recommended for award shall be required to return to the County one (1) executed original of the prescribed contract, upon consent and approval of the County Attorney, together with the required certificates of insurance, and proof of any additional required licenses not previously provided, within fifteen (15) days from the date of notice of intended award of the Consultant's proposal. We PART 6 — REQUIRED FORMS CHECKLIST ACKNOWLEDGEMENT Proposer, states by its check mark in the blank beside the form and by its authorized representative's signature that it has provided the following forms: I Qualifications Response (tabbed per each criterion) 2 Consultant Qualification Statement (per subsection 2-347(h), Monroe County Code) 3 County Forms (& State -mandated provisions) Affidavit 4 Federal Forms ("Debarment Certification Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters" Form, and the Byrd -Anti Lobbying Certification & Disclosure of Lobbying Activities Forms) 5 Criminal History Background Check Consent Form, and Licensure Eligibility (pursuant to Section 456.01.35, Fla. Stat.) Attestation Form 6 Insurance Requirements Form (incl. Release of Liability & Indemnification Statement) 7 Insurance Agent's Statement (signed by insurance agent) 8 SEPARATE DOCUMENT UPLOAD: Three (3) years of Financial Statements marked "CONFIDENTIAL" 9 SEPARATE DOCUMENT UPLOAD: Price Response - Proposal Form Company FEIN: Company Name: D/B/A (if applicable) Company Ownership: Years in Business: Company Address: Company Phone Number: Fax: Company Web Address: Number of Employees: Company E-mail: Management Person Responsible for Direct Contact to County and Services required for this RFQ: Name: Title: Phone Number: Email Address: The physical business address must be registered as its principal place of business with the Florida Department of State for at least one (1) year prior to the notice of request for bid or proposal. Date: Signed: (Signature of Authorized Representative) (Name & Title) iEl CONSULTANT'S QUALIFICATION STATEMENT Section 2-347(h), Monroe County Code of Ordinances The undersigned certifies under oath the truth and correctness of all statements and of all answers to questions made hereinafter: SUBMITTED TO: MONROE COUNTY c/o BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON STREET, KEY WEST, FLORIDA 33040 Submitted By: Name: Address: City, State, Zip Telephone No. Fax No. Check One ❑ Corporation ❑ Partnership ❑ Individual ❑ Other I State the true, exact, correct and complete name of the partnership, corporation, trade or fictitious name under which you do business and the address of the principal place of business. The correct name of the Consultant is: The address of the principal place of business is: 2. Provide a list of the officers and directors of the entity: If Consultant is a corporation, answer the following — a. Date of Incorporation: b. State of Incorporation: C. President's Name: M e f. Vice President's Name: Secretary's Name: Treasurer's Name: 9- Name and Address of Resident Agent: If Consultant is an individual or a partnership, answer the following — a. Date of Organization: b. Name, Address and Ownership Units of all Partners/Off cers/Di rectors: 31 C. State whether general or limited partnership: If Consultant is operating under a fictitious name, submit evidence of compliance with the Florida Fictitious Name Statute. Provide a list of the person's or entity's shareholders with five percent (5%) or more of the stock or, if a general partnership, a list of the general partners; or, if a limited liability company, a list of its members; or, if a solely owned proprietorship, names(s) of owner(s): Provide the number of years the person or entity has been operating and, if different, the number of years it has been providing the services, goods, or construction services called for in the bid 01 specifications (include a list of similar projects): a. List the number of years and under what other names has your organization operated'? Indicate registration, license numbers or certificate numbers for the businesses or professions, which are the subject of this RFQ. Please attach certificate of competency and/or state registration. Has the person, principals, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or directors, ever failed to complete work or provide the goods for which it has contracted? YES [:] NO F1 If yes, provide details. Are there any judgments, claims, arbitration proceeding or suits pending or outstanding against the person, principal of the entity, or entity, or any entity previously owned, operated or directed by any of its officers, directors, or general partners? YES [:] NO If yes, provide details. Has the person, principal of the entity, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or directors, within the last five (5) years, been a party to any lawsuit, arbitration, or mediation with regard to a contract for services, goods or construction services similar to those requested in the specifications with private or public entities? MEMO 32 If yes, provide details. 10. Has the person, principal of the entity, or any entity previously owned, operated or directed by any of its officers, owners, partners, major shareholders or directors, ever initiated litigation against the county or been sued by the county in connection with a contract to provide services, goods or construction services? YES ❑ NO If yes, provide details. 11. Whether, within the last five (5) years, the owner, an officer, general partner, principal, controlling shareholder or major creditor of the person or entity was an officer, director, general partner, principal, controlling shareholder or major creditor of any other entity that failed to perform services or furnish goods similar to those sought in the request for competitive solicitation. YES ❑ NO ❑ If yes, provide details. 12. State the name and address of the attorney, if any, for the business of the Consultant: 13. Customer references (minimum of three (3)), including name, current address and current telephone number: 14. Credit references (minimum of three (3)), including name, current address and current telephone number: 15. CERTIFICATION OF SEPARATE CONFIDENTIAL UPLOAD: Financial statements for the prior three (3) years for the responding entity or for any entity that is a subsidiary to the responding entity: Confirm separate upload: YES NO 16. Any financial information requested by the county department involved in the competitive solicitation, related to the financial qualifications, technical competence, the ability to satisfactorily perform within the contract time constraints, or other information the department deems necessary to enable the department and board of county commissioners to determine if the person responding is responsible. 33 Confirm your understanding of the County's ability to request additional information: YES NO The Consultant acknowledges and understands that the information contained in response to this Qualification Statement shall be relied upon by County in awarding the contract and such information is warranted by Consultant to be true. The discovery of any omission or misstatement that materially affects the Consultant's qualifications to perform under the contract shall cause the County to reject the proposal, and, if after the award, to cancel and terminate the award and for contract. Consultant's Signature State of - County of - FM of Date I HEREBY CERTIFY The foregoing instrument was sworn to or affirmed before me by means of physical presence or ❑ online notarization, this _ day of 2025, by (name of person) as (type authority, e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrument was executed). WITNESS my hand and official seal. NOTARY PUBLIC SEAL OF OFFICE: NOTARY PUBLIC, STATE OF FLORIDA (Name of Notary Public: Print, Stamp, or Type as Commissioned) ❑ Personally known to me, or ❑ Produced identification: (Type of Identification Produced) 34 COUNTY FORMS (& STATE -MANDATED PROVISIONS) AFFIDAVIT By signing this Affidavit, CONTRACTOR has sworn or affirmed to the following requirements as set forth below: Public Entity Crime Statement Pursuant to Section 287.133(2)(a), Florida Statutes, as amended from time to time, Contractor hereby certifies and attests that neither it nor its affiliate(s) have been placed on the convicted vendor list following a conviction for a public entity crime. If placed on that list, Contractor must notify the County immediately and is prohibited from providing any goods or services to a public entity; may not submit a bid/proposal on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids/proposals on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and, may not transact business with any public entity in excess of the threshold amount provided in Section 287.01.7, Florida Statutes., as amended from time to time, for Category TWO ($35,000) as may be amended, for a period of thirty-six (36) months from the date of being placed on the convicted vendor list. Contractor hereby acknowledges its immediate and ongoing obligation to notify the County if it is placed on the convicted vendor list. Discriminatory Vendor List Contractor hereby acknowledges its continuous duty to disclose to the County if the Contractor or any of its affiliates, as defined by Section 287.134(1)(a), Florida Statutes, are placed on the Discriminatory Vendor List. Pursuant to Section 287.134(2)(a),Florida Statutes: "An entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies 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." Foreign Gifts and Contracts Contractor hereby acknowledges and agrees it must comply with any applicable disclosure requirements in Section 286.101, Florida Statutes. Pursuant to Section 286.101(7)(b), Florida Statutes: "In addition to any fine assessed under [§ 286.101(7)(a), Florida Statutes], a final order determining a third or subsequent violation by an entity other than a state agency or political subdivision must automatically disqualify the entity from eligibility for any grant or contract funded by a state agency or any political subdivision until such ineligibility is lifted by the Administration Commission [Governor and Cabinet per § 14.202, Florida Statutes] for good cause." Ethics Clause pursuant to Monroe County Ordinance No. 010-1990 By signing this Affidavit, the CONTRACTOR warrants that he/she/it has not employed, retained or otherwise had act on his/her/its behalf any forrner County officer or employee in violation of Section 2-149, Monroe County Code of Ordinances or any County officer or employee in violation of Section 2-150, Monroe County Code of Ordinances. 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 fall amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee pursuant to Subsection 2-152(b), Monroe County Code of Ordinances. 35 Drug -Free Workplace CONTRACTOR in accordance with Section 287.087, Florida Statutes, hereby certifies that CONTRACTOR shall: 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. The person authorized to sign this Affidavit certifies that CONTRACTOR complies fully with the above requirements. Vendor Certification Regarding Scrutinized Companies Lists CONTRACTOR agrees and certifies compliance with the following: 1. Section 287.135, Florida Statutes prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.4725, Florida Statutes, or is engaged in a Boycott of Israel. Section 287.135, Florida Statutes, also prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of $1,000,000 or more, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors Lists which were created pursuant to s. 215.473, Florida Statutes, or is engaged in business operations in Cuba or Syria. 2. As the person authorized to sign on behalf of CONTRACTOR, I hereby certify that the company identified above as "CONTRACTOR" is not listed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel and for Projects of $1,000,000 or more is not listed on either the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Terrorism Sectors List, or engaged in business operations in Cuba or Syria. 3. I understand that pursuant to Section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney's fees, and/or costs. I further understand that any contract with the County may be terminated, at the option of the County, if the company is found to have submitted a false certification or has been placed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel or placed on. the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with 36 Activities in the Iran Terrorism Sectors List or been engaged in business operations in Cuba or Syri a. Note: The List are available at the following Department of Management Services Site: httr)://www.dms.mvflorida.com/bus.iness o erations/state urchasim,,/vendor information/convicted. Suspendeddiscriminatory complaints vendor lists Non -Collusion Affidavit CONTRACTOR by signing this Affidavit, according to law on my oath, and under penalty of perjury, depose and say that the person signing on behalf of the firm of CONTRACTOR, the bidder making the Proposal for the project described in the Scope of Work, and that I executed the said proposal with full authority to do so; the prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and no attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; the statements contained in this affidavit are true and correct, and made with hill knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. Compliance with Foreign Countries of Concern pursuant to Section 287.138, F.S. Beginning January 1, 2025, the County must not extend or renew any contract that grants access to an individual's personal identifying information unless the Contractor provides the County with an affidavit signed by an authorized representative of the Contractor, under penalty of perjury, attesting that the Contractor does not meet any of the criteria in subparagraphs (2)(a)-(c) of Section 287.138, Florida Statutes, as may be amended. The below box must be completed to satisfy this requirement. Violations of this Section will result in termination of any forthcoming agreement and may result in administrative sanctions and penalties by the Office of the Attorney General of the State of Florida. is not owned by the government of a Foreign Country of Concern, is not organized under the laws of nor has its Principal Place of Business in a Foreign Country of Concern, and the government of a Foreign Country of Concern does not have a Controlling Interest in the entity. Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true. Printed Name: Title: Signature: Date: E-Verify Requirements Effective January 1, 2021, public and private employers, contractors and subcontractors must require registration with, and use of the E-verify system in order to verify the work authorization status of all newly hired employees. Contractor acknowledges and agrees to utilize the U.S. Department of Homeland. Security's E-Verify System to verify the employment eligibility of. a)All persons employed by Contractor to perform employment duties within Florida during the tenor of the contract; and b)All persons (including subvendors/suibconsuiltants/suibcontractors) assigned by Contractor to perform work. pursuant to the contract with the County. The Contractor acknowledges and agrees that use of the U.S. 37 Department of Homeland Security's E-Verify System during the term of the contract is a condition of the contract with the County. By executing this Affidavit, CONTRACTOR becomes obligated to comply with the provisions of Section 448.095, Florida Statutes, "Employment Eligibility," as amended from time to time. This includes, but is not limited to, utilization of the E-Verify System to verify the work authorization status of all newly hired employees, and requiring all subcontractors to provide an affidavit to Contractor attesting that the subcontractor does not employ, contract with, or subcontract with, an unauthorized alien. Contractor agrees to maintain a copy of such affidavit for the duration of this Agreement. Failure to comply with this paragraph will result in the termination of this Agreement as provided in Section 448.095, Florida Statutes, as amended, and Contractor may not be awarded a public contract for at least one (1) year after the date on which the Agreement was tenninated. Contractor will also be liable for any additional costs to County incurred as a result of the termination of this Agreement in accordance with this Section. Antitrust Violations; Denial or Revocation under Section 287.137, F.S. Pursuant to Section 287.1.37, Florida Statutes, as may be amended, a person or an affiliate who has been placed on the antitrust violator vendor list (electronically published and updated quarterly by the State of Florida) following a conviction or being held civilly liable for an antitrust violation may not submit a bid, proposal, or reply for any new contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply for a new contract with a public entity for the construction or repair of a public building or public work; may not submit a bid, proposal, or reply on new leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a new contract with a public entity; and may not transact new business with a public entity. By entering this Agreement, Contractor certifies neither it nor its affiliates) are on the antitrust violator vendor list at the time of entering this Agreement. False certification under this paragraph or being subsequently added to that list will result in termination of any Agreement, at the option of the County consistent with Section 287.137, Florida Statutes, as amended. Noncoercive Conduct for Labor or Services As a nongovernmental entity submitting a proposal, executing, renewing, or extending a contract with a government entity, Contractor is required to provide an affidavit under penalty of perjury attesting that Contractor does not use coercion for labor or services in accordance with Section 787.06, Florida Statutes. As an authorized representative of Contractor, I certify under penalties of perjury that Contractor does not use coercion for labor or services as prohibited by Section 787.06, Fla. Stat. Additionally, Contractor has reviewed Section 787.06, Fla. Stat., and agrees to abide by same. County Suspended Vendor List The eligibility of persons to bid for an award of County contract(s), or enter into a contract, may be suspended pursuant to Sec. 2-347(l) of the Monroe County Code of Ordinances. In the event an eligible person is suspended by the County after the contract is awarded, or a suspended person is employed to perform work (e.g. subcontractor in a bid or contract) pursuant to a County contract, same shall constitute a material breach of the contract. The County, in its sole discretion, may terminate the contract with no further liability to the contractor beyond payment of the portion of the contract price that may be due for work satisfactorily completed up to the date of termination, and hereby reserves all other rights and remedies available at law or in equity. By signing this Affidavit, Contractor certifies that he/she/it is not a County -suspended vendor pursuant to Sec. 2-347(1), Monroe County Code. UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING REQUIRED AFFIDAVIT CONTAINING THE ABOVE SWORN ATTESTATIONS AND THAT THE FACTS STATED HEREIN ARE TRUE. (Signature of Authorized Representative of Contractor) (Date) STATE OF COUNTY OF I HEREBY CERTIFY The foregoing instrument was sworn to or affirmed before me by means of ❑ physical presence or ❑ online notarization, this day of 2025, by (name of person) as (type of authority, e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrument was executed). WITNESS my hand and official seal. NOTARY PUBLIC SEAL OF OFFICE: NOTARY PUBLIC, STATE OF FLORIDA (Name of Notary Public: Print, Stamp, or Type as Commissioned) ❑ Personally known to me, or ❑ Produced identification: (Type of Identification Produced) 39 Certification Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters The undersigned certifies, to the best of its knowledge and belief, that: (i) The undersigned and/or any of its Principals - (A) Are ( ) are not ( ) presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; (B) Have ( ) have not ( ), within a 3-year period preceding this certification, been convicted of or had a civil judgment rendered against them for: Commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, state, or local) contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and (C) Are ( ) are not ( ) presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated above. (ii) The undersigned has ( ) has not ( ), within a 3-year period preceding this certification, had one or more contracts terminated for default by any Federal agency. "Principals," for the purposes of this certification, means officers; directors; owners; partners; and persons having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a subsidiary, division, or business segment, and similar positions). This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the undersigned subject to prosecution under section 1001, title 18, United States Code. The undersigned shall provide immediate written notice to the Contracting Officer if, at any time prior to the contract award or after, the undersigned learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. (Name of Company) By: (Signature) (Name and Title of Signatory) Date signed: .O BYRD-ANTI LOBBYING CERTIFICATION APPENDIX A, 44 C.F.R. PART 18 — CERTIFICATION REGARDING LOBBYING (To be submitted with each bid or offer exceeding $100,000) Certification for Contracts, Grants, Loans, and Cooperative Agreements 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 an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making 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. The undersigned shall require 'that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients 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 than S10,000 and not more than $100,000 for each such failure. The Contractor, , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Name and Title of Contractor's Authorized Official Date 41 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity 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 a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identity the appropriate classification of this report.. If this is a follow up relxn-t caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. F,nter the date of the last previously subtanitted report by this reporting entity for this covered Federal action. 4. Filter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report un item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the Rill Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RF`P) number; Invitation for Bid (IF13) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amountof the award/loan commitment for the prune entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified un item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and (late the form, print his/haer name, title, and telephone number. Accoral.rag to the Paperwork Reduction ACT, as amendeol, rao persons are required to reSpond to a Collection of information urtess it displays a valid OMB Control Number. The valid OMB control number for this inf2rra a Lion collection is OMB No. 0348-0046. Public reporting burden for this collection otmformatiorl is estimated to average 10 minutes per resPonse, including rinse hrr reviewing instructions, searching exiwting data. sources, gathering and maintaining the data needed, arid completing and reviewing the collectirrrr of iralormatiort. Sena comments regardijig 'the burden estimate or airy other aspect of"this collection (rtill krrmatioa, including suggestions for redue;irrg this burden, to the ( Wf"ice ofMaraagemcnt and Budget, Paperwork Reduction 11rcrject (0348-0046), Washingurra, DC 20503. DISCLOSURE OF LOBBYING ACTIVIUES Approved i-,Pj OMB Coinrp I ete this formi to d[sclose, iol)bying activities pursuant to 31 U.S. C. 1352 034E-0046 teie reverse lor PLIM111C IrRfrtlen (Imclosuire 1. Type of Federal Action: 2. Status of IFederall Action: 3 Lla. contract a. bid/offer/application lb. grant b. hiffial award c. cooperative agrelernent c. post -award d. Iowa n e. ljoan guaraintee I. loan insurance 4. Narneain,d Address of Reporting Entity: ❑ P'riime Sultmwardee Tiler if R'n..Q. ..................... 1 ................. ........... 6,. Feiderall Dep,arfinenVAgency: 8. F ede ra 11 Aic ti orn N ui rn bleir, jQ',q..Q1V..n ........................... 10., a., Name and Address of Lcrbbyiirr, IRe¢gistrainit (dF individua( last name, first name, M.:. 1.1 . . .......... , 1 I I rkrr 5adar r,gLAr inl I I nmyh ffifi� I'm m: l�. auflm izwd by Ni� I P. 3 1 U 5 C %ec*m 35,2 7hfir &mlu%ure af kAjibying wliv&a It an lnwvpr;� of bu i hpuri W kh iefiarce wwt p I med b,,ff'k.! fiRgr Axwe v I ier: Ili % trarm a cim i ow i iuAr. mr Mjjb,jrrj jjjf,, J�Jjfir j�w rwMw phre-A :31 US C t352 lh�� Afl: 1".. '!Jxwij W *.P'u C"obgr— aril waif rasa 'w"' nAl, km pubfic Any pvrmn whD fj%h�,jg Mr. the ieqAired 'Jof IJr. �mwbr.cr In a a 'd pmn"Ally ch na Ielig $ H'Y 01DO mis i-Pare ffian: 11000DO km each %xh fillure Federal Use Only: Report Type: La. iiniti[al filing b. inmateriiial change For IMateriiaJl Changle Only: year q LIZ rteir date of last report 5. If Reporting Ein,tity in No is Subiawairldee, Enter Nair and Address of Prime: Congressional District, ff knPiIyfl, T. Federal Program Narnie/Diescripfioin,: CFDA lNumber, if ppp 9. Award Amount, if,knDj&o_ b. Individuals Performing Services (0cluding address if different from No. I (last name, first name, Mf): Mlm Title: Telephone No-: 43 Datie:: Authjof ized for Local ReprodlUdiffl Standard Forrili LIL (Rev. 7-97) CONSENT TO CRIMINAL HISTORY BACKGROUND CHECK Please be aware, a Criminal History Background Check will be nun on you pursuant to the terms and conditions of this solicitation. Should any negative/derogatory information be reported, the County will assign such information its due weight in assessing your qualifications. If a contract for services is formed between you and the County, the County may request a Criminal History Background Check (for contracted services/employment purposes) at any time during the term/tenure of your contract for services/employment. 1 have read the above statement and understand it completely, and I voluntarily agree to it. Consultant's Signature Consultant's Printed Name Date LICENSURE ELIGIBILITY ATTESTATION FORM (PURSUANT TO SECTION 456.0135, FLA. STAT.) Please initial next to each statement below to indicate its truthfulness: I am familiar with Chapter 2024-243, Laws of Florida, and acknowledge the recent changes in the law regarding initial and renewal licensure requirements that will impact certain health care professions (see generally Section 456.0135, Fla. Stat.). Circle One: My license to deliver services solicited by this solicitation [ may impacted by the new law. If "may" was selected, please explain:_ / will not ] be negatively I acknowledge that I have an ongoing obligation to immediately notify the County if anything changes with regard to my representations here. I have read the above statement and understand it completely, and I voluntarily agree to it. Consultant's Signature Consultant's Printed Name Date INSURANCE REQUIREMENTS AND FORMS MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES General Insurance Requirements for Contractors and Subcontractors As a pre -requisite of the work and services governed, or the goods supplied under this contract (including the pre -staging of personnel and material), the Contractor shall obtain, at his/her/its own expense, insurance as specified in the attached schedules, which are made part of this contract. The Contractor will ensure that the insurance obtained will extend protection to all Sub -Contractors engaged by the Contractor. Alternatively, the Contractor may require all Subcontractors to obtain insurance consistent with the attached schedules. The Contractor will not be permitted to commence work governed by this contract (including pre -staging of personnel and material) until satisfactory evidence of the required insurance has been furnished to the County as specified below. Delays in the commencement of work, resulting from the failure of the Contractor to provide satisfactory evidence of the required insurance, shall not extend deadlines specified. in this contract and any penalties and failure to perform assessments shall be iunposed as if the work. commenced on the specified date and time, except for the Contractor's failure to provide satisfactory evidence. The Contractor shall maintain the required insurance throughout the entire term of this contract and any extensions specified in any attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced. Delays in the completion of work resulting from the failure of the Contractor to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the Contractor's failure to maintain the required insurance. The Contractor will be held responsible for all deductibles and self -insured retentions that may be contained in the Contractor's Insurance policies. The Contractor shall provide, to the County, as satisfactory evidence of the required insurance, either: Certificate of Insurance, or A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non -renewal, material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the County by the insurer. The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. The Monroe County Board of County Commissioners, its employees and officials, 1100 Simonton Street, Key West, Florida 33040, will be included as "Additional insured" on all policies, except for Workers' Compensation. 45 Any deviations from these General Insurance Requirements must be requested in writing on the County prepared form entitled "Request for Waiver of Insurance Requirements" and approved by Monroe County Risk Management. Contractor shall obtain and maintain at its own expense the insurance coverages listed within this paragraph prior to commencing service under this Agreement. All insurance requirements provided for in this Agreement shall be subject to annual review. Depending on the extent of contractual obligations incurred by the Contractor, the below insurances will be required. Insurances can be altered via written waiver by County's Risk Manager, if required. The Contractor must keep in full force and effect the insurance described during the term of this Agreement. If the insurance policies originally purchased that meet the requirements are canceled, terminated, or reduced in coverage, then the Contractor must immediately substitute complying policies so that no gap in coverage occurs. Copies of current policy certificates shall be filed with the Monroe County Risk Department or MCFR whenever acquired, amended, and annually during the term of this Agreement. Prior to execution of this Agreement, Contractor shall furnish the County Certificates of Insurance indicating the minimum coverage limitations in the following amounts: a) WORKERS COMPENSATION AND EMPLOYER'S LIABILTIY INSURANCE. Where applicable, coverage to apply for all employees at the minimum statutory limits as required by Florida Law, and Employee's Liability coverage in the amount of $1,000,000.00 bodily injury by accident, $1,000,000.00 bodily injury by disease, policy limits, and $1,000,000.00 bodily injury by disease, each employee. b) COMPREHENSIVE AUTOMOBILE VEHICLE LIABILITY INSURANCE. Motor vehicle liability insurance, including applicable no-fault coverage, with limits of liability of not less than $300,000.00 per occurrence, combined single limit for Bodily Injury Liability and Property Damage Liability. If single limits are provided, the minimum acceptable limits are $200,000.00 per person, $300,000.00 per occurrence, and $200,000.00 property damage. Coverage shall include all owned vehicles, all non -owned vehicles, and all hired vehicles. c) COMMERCIAL GENERAL LIABILITY. Commercial general liability coverage with limits of liability of not less than $1,000,000.00 per occurrence combined single limit for Bodily Injury Liability and Property Damage Liability. Such coverage must include, as a minimum: Premises Operations, Products and Completed Operations, Blanket Contractual Liability, and Personal Injury Liability. An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. d) PROFESSIONAL LIABILITY l ERRORS AND OMISSIONS COVERAGE. Evidence of Professional Liability insurance with, at a minimum of $1,000,000.00 per occurrence, and $2,000,000.00 in the aggregate. "Claims -Made" forms are acceptable for Professional Liability insurance. Coverage shall include all claims arising out of the Consultant's operations or premises, any person directly or indirectly employed by the Consultant, and the Consultant's obligations under indemnification under this contract. Consultant acknowledges that the County is relying on the competence of the Consultant as a Medical Director to Monroe County Fire Rescue. e) CERTIFICATES OF INSURANCE. Original Certificates of Insurance shall be provided to the County at the time of execution of this Agreement and certified copies provided if requested. The underwriter of such insurance shall be qualified to do business in the State of Florida. The insurance coverage shall be primary insurance with respect to the County, its officials, employees, agents, and volunteers. Failure of Contractor to comply with the insurance requirements of this section shall be cause for immediate termination of this Agreement. '1 :1�'1 i 1 II 1 1 191ICI 1 � � rr 1 0M in •01MMnpig] 46 In the event that the Contractor subcontracts any or all of the work in this project to any third party, the Contractor specifically agrees to identify the County as an additional insured on all insurance policies required by the County. In addition, the Contractor specifically agrees that all agreements or contracts of any nature with his subcontractors shall include the County as additional insured. INDEMNIFICATION & RELEASE OF LIABILITY Notwithstanding any minimum insurance requirements prescribed elsewhere in this solicitation, Consultant shall defend, indemnify, and hold harmless the COUNTY, and the COUNTY's elected and appointed officers and employees, from and against (1) any claims, actions or causes of action, (ii) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury (including death), loss, damage, fine, penalty or business interruption, and (iii) any costs or expenses that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of, or in connection with: (A) any activity of Consultant or any of its employees, agents, contractors or other invitees during the solicitation process and any ensuing agreement, (B) the negligence or recklessness, intentional wrongful misconduct, errors or other wrongful act or omission of Consultant or any of its employees, agents, sub -contractors or other invitees, or (C) Consultant's default in respect of any of the obligations that it undertakes during the solicitation process and under the term of any ensuing agreement, except to the extent the claims, actions, causes of action, litigation, proceedings, costs or expenses arise solely from the intentional or negligent acts or omissions of the COUNTY or any of its employees, agents, contractors or invitees (other than. Consultant). Nothing contained herein is intended, nor may be construed, to waive County's rights and immunities under the common law or Section 768.28, Florida Statutes, as amended from time to time; nor will anything included herein be construed as consent to be sued by any third parties in any matter arising out of this solicitation or ensuing agreement. To the extent considered necessary by the Contract Administrator, any sums due Consultant under an ensuing agreement may be retained by the County until all of the County's claims subject to this indemnification obligation have been settled or otherwise resolved, and any amount withheld is not subject to payment of interest by the County. Insofar as the claims, actions, causes of action, litigation, proceedings, costs or expenses relate to events or circumstances that occur during or after the term of an ensuing agreement, and the rights and immunities reserved to the County, this section will survive the expiration of the term of the ensuing agreement or any earlier termination of same. PROPOSER'S STATEMENT I understand the insurance that will be mandatory if awarded the contract and will comply in full with all of the requirements herein. I fully accept the indemnification and hold harmless and duty to defend as set out in this proposal. PROPOSER 47 Signature Date INSURANCE AGENT'S STATEMENT I have reviewed the above requirements with the proposer named above. The following deductibles apply to the corresponding policy. POLICY Liability policies are Occurrence Claims Made Insurance Agency DEDUCTIBLES Signature Date PRICE RESPONSE PROPOSAL FORM BID TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON STREET KEY WEST, FLORIDA 33040 The undersigned, having carefully examined the work, specifications, RFQ documents, and addenda thereto, and other Contract Documents for the services of. MEDICAL DIRECTOR SERVICES FOR MONROE COUNTY FIRE RESCUE, MONROE COUNTY, FLORIDA and having become familiar with all local conditions including labor affecting the cost thereof, and having familiarized himself/herself/itself with material availability, Federal, State, and Local laws, ordinances, rules and regulations affecting performance of the work, does hereby propose to furnish all labor, mechanics, superintendents, tools, material, equipment, transportation services, and all incidentals necessary to perform and complete said work and work incidental hereto, in a workman -like manner, in conformance with specifications, and other contract documents including Addenda issued thereto. The undersigned further certifies that he/she/it has been given the opportunity to personally inspect the actual location(s) of where the Work is to be performed, together with the local sources of supply and that he/she/it understands the conditions under which the Work is to be performed. NOTE: PROPOSER MUST DEMONSTRATE HOW THIS PRICE RESPONSE IS CONSISTENT WITH CURRENT INDUSTRY PRICING FOR THE SAME OR SIMILAR SERVICES. LUMP SUM: f Proposer must describe in detail the manner ofpayment (e.g. annual lump sum broken down into monthly installments paid in arrears). Please provide a detailed breakdown of the lump sum value.] $ US Dollars per year. Please provide a breakdown of how the Lump Sum was calculated, including but not limited to: Direct Hourly Rates (for each class of staff, if applicable) S ; includes total of hours per month Projected/Estimated Travel Expenses $ per month Other overhead/general out -of -packet costs $ per month Exclusions from Lump Sum & Add-ons to Lump Sum: Specific Services and associated prices: S Dollars, per unit. If not included in the Lump Sum, Travel Expenses Projection: $ Dollars, per month. —Pricing above must explicitly carve -out exclusions or "add -on" services, and list stand-alone pricing for any such exclusions or add-ons, otherwise the pricing proposed will be deemed all-inclusive (no exclusions). Proposer must account for and include all sales, consumer, use, and other taxes required to be paid in accordance with the laws of the U.S. government, State of Florida, or Monroe County, Florida. Unless otherwise explicitly stated, the lump sum price will be deemed to include all labor, materials, equipment, insurance, licensing, and travel/lodging necessary to complete the Scope of Work set forth in the RFQ. I acknowledge receipt of Addenda No.(s): No. Dated No. Dated (Signature of Authorized Representative of Contractor) (Date) (Print Name) PART 7 — SAMPLE AGREEMENT AGREEMENT between MONROE COUNTY, FL and for Medical Director Services pursuant to County RFQ # THIS AGREEMENT is made and entered into this day of , 202 , by and between the Monroe County, Florida, a political subdivision of the State of Florida, with principal offices located at 1100 Simonton Street, Key West, FL 33040, the Board of Governors of the Fire and. Ambulance District 1 of Monroe County, Florida, a municipal services taxing unit established under Florida law and codified in Section 22-129, Monroe County Code of Ordinances, with a principal address being the same as that of Monroe County (hereinafter collectively referred to as "County"), and , a corporation with principal offices located at (the "Contractor") to provide Now therefore, in exchange for good and sufficient consideration, the parties hereby agree to the following terms and conditions: 1) The Contract Documents The contract documents consist of this Agreement, and the following exhibits: "Exhibit A" - the Request for Qualifications for Medical Director Services for Monroe County Fire Rescue pursuant to RFQ#: , including any addenda issued prior to execution of this Agreement; "Exhibit B" - Contractor's Qualifications Response and completed County Forms (specifically excluding the Contractor's Price Response Form); "Exhibit C" - the Negotiated Fee Schedule; "Exhibit D" - the HIPAA Business Associate Addendum; and "Exhibit E" - the Mandatory Federal Provisions Addendum. All of the above enumerated exhibits are attached hereto and incorporated herein as if set forth in full. In the event of a conflict between the aforementioned documents, any duly executed amendment to this Agreement will control, followed by this Agreement, then "Exhibit E," "Exhibit D," `Exhibit C," "Exhibit A," and then "Exhibit B," in that order. 2) The Work/Services The Contractor must perform all work for the County required by this Agreement, and as set forth below: a) Contractor will furnish all labor, materials, and equipment necessary as indicated in "Exhibit A," "Exhibit B," and `Exhibit C." b) A written Notice to Proceed will be issued to the Consultant after approval of the contract by the Monroe County Board of County Commissioners, and subject to and consistent with the terms and conditions of this Agreement. c) Contractor must comply with any and all Federal, State, and local laws and regulations now in effect, or hereinafter enacted during the term of this Agreement, which are applicable to the Contractor, its employees, agents or subcontractors, if any, with respect to the work and services described herein. Contractor shall maintain throughout the term of this Agreement, appropriate licenses. Proof of Page 1 of 7 50 such licenses shall be submitted to the County upon execution of this Agreement, if not previously submitted to the County. d) Contractor agrees to complete such forms as County deems necessary in furtherance of its state and federal -law compliance efforts. The forms may include, but are not limited to: "Certification Regarding Debarments, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Federally Funded Transactions," etc. 3) Contract Amount Contractor will perform contract requirements with pricing pursuant to County is exempt from payment of Florida State Sales and Use taxes. Contractor shall not be exempted by virtue of the County's exemption from paying sales tax to its suppliers for materials used to fulfill its obligations under this contract, nor is Contractor authorized to use the County's Tax Exemption Number in securing such materials. Contractor shall be responsible for any and all taxes, or payments of withholding, related to services rendered under this Agreement. Additionally, the Contractor must submit to the County invoices with supporting documentation that are acceptable to the Monroe County Office of Clerk and Comptroller (County Clerk). Acceptability to the County Clerk is based upon generally accepted accounting principles and such laws, rules and regulations as may govern the disbursal of funds by the County Clerk. 4) Agreement Subject to Funding The County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners. In the event that the County funds on which this Agreement is dependent are withdrawn, this Agreement is terminated, and the County has no further obligation under the terns of this Agreement to the Contractor beyond that already incurred by the termination date. 5) Contract Term This Agreement will become effective as of the date written on the first page of this Agreement. The initial term of this Agreement shall be for three (3) years, with two (2) additional two (2) year extension terms based upon satisfactory performance and the mutual agreement of all parties. The initial term and services provided hereunder will start on the date appointed by the County pursuant to a written Notice to Proceed, and will continue until midnight of the last day stated in the terns of contract, unless otherwise extended or amended by formal amendment of the contract agreed to by the parties. 6) Conditions for Emergency/Hurricane or Disaster It is hereby made apart of this Agreement that before, during and after apublic emergency, disaster, hurricane, flood, pandemic or other substantial loss that the Monroe County will require a "first priority" basis for services. It is vital and imperative that the majority of citizens are protected from any emergency situation which threatens public safety and health, as determined by the County Administrator. Contractor agrees to provide services to the County or other governmental entities, as opposed to a private citizen or corporation, on a first priority basis. The County expects to pay a fair and reasonable price for all products/services in the event of a disaster, pandemic, emergency or hurricane. Awarded Contractor must furnish a twenty-four (24) hour telephone number in the event of such an. emergency. 7) Termination a. Termination for Uncurable Default Page 2 of 7 51 In the event the Consultant shall default in or violate any of the terms, obligations, restrictions or conditions of this Contract in a manner that is uncurable (as determined in the sole discretion of the County), the County may, upon written notice to the Consultant, terminate this Contract effective immediately. In the event of such termination the County may hold the Consultant liable for any and all damages sustained by the County arising out of such default, including but not limited to costs of re -procurement and cover. b. Termination for Curable Default In the event the Consultant shall default in any of the terms, obligations, restrictions or conditions in the Contract Documents in a manner that is curable (as determined in the sole discretion of the County), the County shall give the Consultant written notice by registered, certified mail of the default and that such default shall be corrected or actions taken to correct such default shall be commenced within three (3) calendar days thereof. In the event the Consultant has failed to correct the conditions(s) of the default or the default is not remedied to the satisfaction and approval of the County, the County shall have all legal remedies available to it, including, but not limited to ten7lination of the Contract in which case the Consultant shall be liable for any and all damages permitted by law arising from the default and breach of the Contract. c. Termination for Convenience of County Upon thirty (30) calendar days written notice delivered by certified mail, return receipt requested, to the Consultant, the County may without cause and without prejudice to any other right or remedy, terminate the Contract for the County's convenience whenever the County determines that such termination is in the best interest of the County. Where the Contract is terminated for the convenience of the County the notice of termination to the Consultant must state that the Contract is being terminated for the convenience of the County under the termination clause and the extent of termination. The Consultant shall discontinue all work on the appointed last day of service. 8) Indemnification & Release of Liability Notwithstanding any minimum insurance requirements prescribed elsewhere in this solicitation, Consultant shall defend, indemnify, and hold harmless the COUNTY, and the COUNTY's elected and appointed officers and employees, from and against (1) any claims, actions or causes of action, (ii) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury (including death), loss, damage, fine, penalty or business interruption, and (iii) any costs or expenses that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of, or in connection with: (A) any activity of Consultant or any of its employees, agents, contractors or other invitees during the solicitation process and any ensuing agreement, (B) the negligence or recklessness, intentional wrongful misconduct, errors or other wrongful act or omission of Consultant or any of its employees, agents, sub -contractors or other invitees, or (C) Consultant's default in respect of any of the obligations that it undertakes during the solicitation process and under the terns of any ensuing agreement, except to the extent the claims, actions, causes of action, litigation, proceedings, costs or expenses arise solely from the intentional or negligent acts or omissions of the COUNTY or any of its employees, agents, contractors or invitees (other than Consultant). Nothing contained herein is intended, nor may be construed, to waive County's rights and. immunities under the common law or Section 768.28, Florida Statutes, as amended from. time to time; nor will anything included herein be construed as consent to be sued by any third parties in any matter arising out of this solicitation or ensuing agreement. To the extent Page 3 of 7 52 considered necessary by the Contract Administrator, any sums due Consultant under an ensuing agreement may be retained by the County until all of the County's claims subject to this indemnification obligation have been settled or otherwise resolved, and any amount withheld is not subject to payment of interest by the County. Insofar as the claims, actions, causes of action, litigation, proceedings, costs or expenses relate to events or circumstances that occur during or after the term of an ensuing agreement, and the rights and immunities reserved to the County, this section will survive the expiration of the term of the ensuing agreement or any earlier termination of same. 9) Specific Insurance Requirements Contractor shall obtain and maintain at its own expense the insurance coverages listed within this paragraph prior to commencing services under this Agreement. All insurance requirements provided for in this Agreement shall be subject to annual review. Depending on the extent of contractual obligations incurred by the Contractor, the below insurances will be required. Insurances can be altered via written waiver by County's Risk Manager, if required. The Contractor must keep in full force and effect the insurance described during the term of this Agreement. If the insurance policies originally purchased that meet the requirements are canceled, terminated, or reduced in coverage, then the Contractor must immediately substitute complying policies so that no gap in coverage occurs. Copies of current policy certificates shall be filed with the Monroe County Risk Department whenever acquired, amended, and annually during the term of this Agreement. Prior to execution of this Agreement, Contractor shall furnish the County Certificates of Insurance indicating the minimum coverage limitations in the following amounts: a) WORKERS COMPENSATION AND EMPLOYER'S LIABILTIY INSURANCE. Where applicable, coverage to apply for all employees at the minimum statutory limits as required by Florida Law, and Employee's Liability coverage in the amount of $1,000,000.00 bodily injury by accident, $1,000,000.00 bodily injury by disease, policy limits, and $1,000,000.00 bodily injury by disease, each employee. b) COMPREHENSIVE AUTOMOBILE VEHICLE LIABILITY INSURANCE. Motor vehicle liability insurance, including applicable no-fault coverage, with limits of liability of not less than $300,000.00 per occurrence, combined single limit for Bodily Injury Liability and Property Damage Liability. If single limits are provided, the minimum acceptable limits are $200,000.00 per person, $300,000.00 per occurrence, and $200,000.00 property damage. Coverage shall include all owned vehicles, all non -owned vehicles, and all hired vehicles. c) COMMERCIAL GENERAL LIABILITY. Commercial general liability coverage with limits of liability of not less than $1,000,000.00 per occurrence combined single limit for Bodily Injury Liability and Property Damage Liability. Such coverage must include, as a minimum: Premises Operations, Products and Completed Operations, Blanket Contractual Liability, and Personal Injury Liability. An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. d) PROFESSIONAL LIABILITY 1 ERRORS AND OMISSIONS COVERAGE. Evidence of Professional Liability insurance with, at a unininium of $1,000,000.00 per occurrence, and $2,000,000.00 in the aggregate. "Claims -Made" forms are acceptable for Professional Liability insurance. Coverage shall include all claims arising out of the Consultant's operations or premises, any person directly or Page 4 of 7 53 indirectly employed by the Consultant, and the Consultant's obligations under indemnification under this contract. Consultant acknowledges that the County is relying on the competence of the Consultant as a Medical Director to Monroe County Fire Rescue. CERTIFICATES OF INSURANCE. Original Certificates of Insurance shall be provided to the County at the time of execution of this Agreement and certified copies provided if requested. Each policy certificate shall be endorsed with aprovision that not less than thirty (30) calendar days' written notice shall be provided to the County before any policy or coverage is canceled or restricted. The underwriter of such insurance shall be qualified to do business in the State of Florida. If requested by the County Administrator, the insurance coverage shall be primary insurance with respect to the County, its officials, employees, agents, and volunteers. Failure of Contractor to comply with the insurance requirements of this section shall be cause for immediate termination of this Agreement. MONROE COUNTY BOARD OF COUNTY COMMISSIONERS, 1100 SIMONTON STREET, KEY WEST, FLORIDA 33040, MUST BE NAMED AS ADDITIONAL INSURED AND CERTIFICATE HOLDER ONALL POLICIES EXCEPT WORKER'S COMPENSATION. In the event that the Contractor subcontracts any or all of the work in this project to any third party, the Contractor specifically agrees to identify the County as an additional insured on all insurance policies required by the County. In addition, the Contractor specifically agrees that all agreements or contracts of any nature with his subcontractors shall include the Comity as additional insured. 10) Notice All written correspondence to the County shall be dated and signed by an authorized representative of the Contractor. Any written notices or correspondence required or contemplated under this Agreement shall be sent by U.S. Mail, certified, return receipt requested, postage pre -paid, or by courier with proof of delivery. Notice is deemed received by Contractor when hand delivered by national courier with proof of delivery or by U.S. Mail upon verified receipt or upon the date of refusal or non -acceptance of delivery. Notice shall be sent to the following persons: FOR COUNTY: FOR CONTRACTOR: County Administrator Monroe County 1100 Simonton Street, Room 2-205 Key West, FL 33040 Email: And (with copy to) Monroe County Attorney's Office I I 1112th Street, Suite 408 Key West, FL 33040 11) Attorney's Fees and Costs County and Contractor 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, at all levels of the court system, including in appellate proceedings. 12) Prompt Disclosure of Litigation, Investigations, Arbitration, or Administrative Page 5 of 7 54 Proceedings Throughout the term of this Agreement, the Contractor has a continuing duty to promptly disclose to the County, in writing, upon occurrence, all civil or criminal litigation, investigations, arbitration, or administrative proceedings relating to or affecting Contractor's ability to perform under this Agreement. If the existence of such causes the County concern that the Contractor's ability or willingness to perform the Agreement is jeopardized, the Contractor may be required to provide the County with reasonable assurances to demonstrate its ability to perform as required hereunder, and that its employees/agents have not or will not engage in conduct similar in nature to the conduct alleged in such proceeding. 13) Merger; Amendment This Agreement constitutes the entire Agreement between the Contractor and the County, and negotiations and oral understandings between the parties are merged herein. This Agreement can be supplemented and/or amended only by a written document executed by both the Contractor and authorized designees of the County. 14) Interpretation The titles and headings contained in this Agreement are for reference purposes only and will not in any way affect the meaning or interpretation of this Agreement. All personal pronouns used in this Agreement include the other gender, and the singular includes the plural, and vice versa, unless the context otherwise requires. Terms such as "herein" refer to this Agreement as a whole and not to any particular sentence, paragraph, or section where they appear, unless the context otherwise requires. Whenever reference is made to a section or article of this Agreement, such reference is to the section or article as a whole, including all subsections thereof, unless the reference is made to a particular subsection or subparagraph of such section or article. Any reference to "days" means calendar days, unless otherwise expressly stated. 15) Joint Preparation It is acknowledged that each party to this Agreement had the opportunity to be represented by counsel in the preparation of this Agreement and accordingly the rule that a contract will be interpreted strictly against the party preparing same does not apply herein due to the joint contributions of both parties. 16) Severability; Waiver of Provisions Any provision in this Agreement that is prohibited or unenforceable in any jurisdiction will, as to that jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions hereof or affecting the validity or enforceability of such provisions in any other jurisdiction. The non -enforcement of any provision by either party will not constitute a waiver of that provision nor will it affect the enforceability of that provision or of the remainder of this Agreement. 17) Signatory Authority; Counterparts and Multiple Originals Upon request, the Contractor must provide the County with copies of requisite documentation evidencing that the signatory for Contractor has the authority to enter into this Agreement. This Agreement may be executed in multiple originals, and may be executed in counterparts, each of which is hereby deemed to be an original, but all of which, taken together, constitutes one and the same agreement. [Signatures to follow] Page 6 of 7 55 AGREEMENT between MONROE COUNTY, FL and for Medical Director Services pursuant to County RFQ # IN WITNESS WHEREOF, County and Contractor have executed this Agreement as of the date first written above. CONTRACTOR: Contractor Name By: Signature Print Name & Title STATE OF FLORIDA COUNTY OF The foregoing instrument was sworn to/affirmed and acknowledged before me by means of ❑ physical presence or ❑ online notarization, this _ day of _, 20_' by , President jor Authority Title] of JINSERT LEGAL NAME OF ENTITY], a Florida (Not for profit / For profit) Corporation / LLC. Be/She is personally known to me/or has produced (type of identification) as identification. Signature of Notary Public (Print & Stamp Commissioned Name of Notary Public) BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA: By: Mayor James K. Scholl BOARD OF GOVERNORS, FIRE AND AMBULANCE DISTRICT 1, MONROE COUNTY, FLORIDA: (Seal) Attest: Kevin Madok, Clerk As Deputy Clerk Approved as to legal form & sufficiency: Assistant County Attorney By: Chairperson Bruce Halle Page 7 of 7 56 "EXHIBIT D" HIPAA Business Associate Addendum 1. PREAMBLE AND DEFINITIONS. 1.1 Pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA"), Monroe County, a political subdivision of the State of Florida, through its Board of County Commissioners, (the "County"), the Board of Governors of the Fire and Ambulance District 1 of Monroe County, Florida, a municipal services taxing unit established under Florida law and codified in Section 22-129, Monroe County Code of Ordinances, with a principal address being the same as the County ('BOG'), and , ('Business Associate"), agree to this Business Associate Addendum ("BAA") as of the effective date of the underlying agreement between the parties (the "Effective Date") that addresses the HIPAA requirements with respect to "business associates," as defined under the privacy, security, breach notification, and enforcement rules at 45 C.F.R. Part 1.60 and Part 1.64 ("HIPAA Rules"). A reference in this BAA to a section in the HIPAA Rules means the section as in effect or as amended. 1.2 This BAA is intended to ensure that :Business Associate will establish and implement appropriate safeguards for the Protected Health Information ("PHI") (as defined under the HIPAA Rules) that Business Associate may receive, create, maintain, use, or disclose in connection with the functions, activities, and services that Business Associate performs for Covered Entity. The functions, activities, and services that Business Associate performs for Covered Entity are defined in AGREEMENT between MONROE COUNTY, FL and for Medical Director services pursuant to RFQ# (the "Underlying Agreement"). 1.3 Pursuant to changes required under the Health Information Technology for Economic and Clinical Health Act of 2009 (the "HITECH Act") and under the American Recovery and Reinvestment Act of 2009 ("ARRA"), this BAA also reflects federal breach notification requirements imposed on Business Associate when "Unsecured PHI" (as defined under the HIPAA Rules) is acquired by an unauthorized parry, and the expanded privacy and security provisions imposed on business associates. 1.4 Unless the context clearly indicates otherwise, the following terms in this BAA shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, disclosure, Electronic Media, Electronic Protected Health Information (ePHI), Health Care Operations, individual, Minimum Necessary, Notice of Privacy Practices, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured PHI, and use. 1.5 A reference in this BAA to the Privacy Rule means the Privacy Rule, in conformity with the regulations at 45 C.F.R. Parts 160-164 (the "Privacy Rule") as interpreted under applicable regulations and guidance of general application published by HHS, including all amendments thereto for which compliance is required, as amended by the HITECH Act, ARRA, and the HIPAA Rules. 2. GENERAL OBLIGATIONS OF BUSINESS ASSOCIATE. 2.1 Business Associate agrees not to use or disclose PHI, other than as permitted or required by this BAA or as Required By Law, or if such use or disclosure does not otherwise cause a Breach of Unsecured. PHI. 57 2.2 Business Associate agrees to use appropriate safeguards, and comply with Subpart C of 45 C.F.R. Part 164 with respect to ePHI, to prevent use or disclosure of PHI other than as provided for by the BAA. 2.3 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate as a result of a use or disclosure of PHI by Business Associate in violation of this BAA's requirements or that would otherwise cause a Breach of Unsecured PHI. 2.4 The Business Associate agrees to the following breach notification requirements: (a) Business Associate agrees to provide notification of any Breach of Unsecured PHI of which it becomes aware, as required under 45 C.F.R. § 164.410, and any Security Incident of which it becomes aware, in violation of this BAA to individuals, the media (as defined under the HITECH Act), the Secretary, and/or any other parties as required under HIPAA, the HITECH Act, ARRA, and the HIPAA Rules, subject to the prior review and written approval by Covered Entity of the content of such notification. (b) In the event of Business Associate's use or disclosure of Unsecured PHI in violation of HIPAA, the HITECH Act, or ARRA, Business Associate bears the burden of demonstrating that notice as required under this Section 2.4 was made, including evidence demonstrating the necessity of any delay, or that the use or disclosure did not constitute a Breach of Unsecured PHI. 2.5 Business Associate agrees, in accordance with 45 C.F.R. §§ 164.502(e)(1)(11) and 164.308(b)(2), if applicable, to require that any Subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information. 2.6 Business Associate agrees to make available PHI in a Designated Record Set to the Covered Entity as necessary to satisfy Covered Entity's obligations under 45 C.F.R. § 164.524. (a) Business Associate agrees to comply with an individual's request to restrict the disclosure of their personal PHI in a manner consistent with 45 C.F.R. § 164.522, except where such use, disclosure, or request is required or permitted under applicable law. (b) Business Associate agrees to charge fees related to providing individuals access to their PHI in accordance with 45 C.F.R. § 164.524(c)(4). (c) Business Associate agrees that when requesting, using, or disclosing PHI in accordance with 45 C.F.R. § 164.502(b)(1) that such request, use, or disclosure shall be to the minimum extent necessary, including the use of a "limited data set" as defined in 45 C.F.R. § 164.514(e)(2), to accomplish the intended purpose of such request, use, or disclosure, as interpreted under related guidance issued by the Secretary from time to time. 2.7 Business Associate agrees to make any amendments to PHI in a Designated Record Set as directed or agreed to by the Covered Entity pursuant to 45 C.F.R. § 164.526, or to take other measures as necessary to satisfy Covered Entity's obligations under 45 C.F.R. § 164.526. 2.8 Business Associate agrees to maintain and make available the information required to provide an accounting of disclosures to the Covered Entity as necessary to satisfy Covered Entity's obligations under 45 C.F.R. § 164.528. MOM 58 2.9 Business Associate agrees to make its internal practices, books, and records, including policies and procedures regarding PHI, relating to the use and disclosure of PHI and Breach of any Unsecured PHI received from Covered Entity, or created or received by the Business Associate on behalf of Covered Entity, available to Covered Entity (or the Secretary) for the purpose of Covered Entity or the Secretary determining compliance with the Privacy Rule (as defined in Section 8). 2.10 To the extent that Business Associate is to carry out one or more of Covered Entity's obligation(s) under Subpart E of 45 C.F.R. Part 164, Business Associate agrees to comply with the requirements of Subpart E that apply to the Covered Entity in the performance of such obligation(s). 2.11 Business Associate agrees to account for the following disclosures: (a) Business Associate agrees to maintain and document disclosures of PHI and Breaches of Unsecured PHI and any information relating to the disclosure of PHI and Breach of Unsecured. PHI in a manner as would be required for Covered Entity to respond to a request by an individual or the Secretary for an accounting of PHI disclosures and Breaches of Unsecured PHI. (b) Business Associate agrees to provide to Covered Entity, or to an individual at Covered Entity's request, information collected in accordance with this Section 2.11, to permit Covered Entity to respond to a request by an individual or the Secretary for an accounting of PHI disclosures and Breaches of Unsecured PHI. (c) Business Associate agrees to account for any disclosure of PHI used or maintained as an Electronic Health Record (as defined in Section 5) ("EHR") in a manner consistent with 45 C.F.R. § 164.528 and related guidance issued by the Secretary from time to time; provided that an individual shall have the right to receive an accounting of disclosures of EHR by the Business Associate made on behalf of the Covered Entity only during the three years prior to the date on which the accounting is requested from Covered Entity or directly from the Business Associate, whichever is later. (d) In the case of an EHR that the Business Associate acquired on behalf of the Covered Entity as of January 1, 2009, paragraph (c) above shall apply to disclosures with respect to PHI made by the Business Associate from such EHR on or after January 1, 2014. In the case of an EHR that the Business Associate acquires on behalf of the Covered Entity after January 1, 2009, paragraph (c) above shall apply to disclosures with respect to PHI made by the Business Associate from such EHR on or after the later of January 1, 2011, or the date that it acquires the EHR. 2.12 Business Associate agrees to comply with the "Prohibition on Sale of Electronic Health Records or Protected Health Information," as provided in Section 13405(d) of Subtitle D (Privacy) of ARRA, and the "Conditions on Certain Contacts as Part of Health Care Operations," as provided in Section 13406 of Subtitle D (Privacy) of ARRA and related guidance issued by the Secretary from time to time. 2.13 Business Associate acknowledges that, effective on the Effective Date of this BAA, it shall be liable under the civil and criminal enforcement provisions set forth at 42 U.S.C. § 1.320d-5 and 1320d-6, as amended, for failure to comply with any of the use and disclosure requirements of this BAA and any guidance issued by the Secretary from time to time with respect to such use and. disclosure requirements. 59 3. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE. 3.1 General Uses and Disclosures. Business Associate agrees to receive, create, use, or disclose PHI only in a manner that is consistent with this BAA, the Privacy Rule, or Security Rule (as defined in Section 5), and only in connection with providing services to Covered Entity; provided that the use or disclosure would not violate the Privacy Rule, including 45 C.F.R. § 164.504(e), if the use or disclosure would be done by Covered Entity. For example, the use and disclosure of PHI will be permitted for "treatment, payment, and health care operations," in accordance with the Privacy Rule. 3.2 Business Associate may use or disclose PHI as Required By Law. 3.3 Business Associate agrees to make uses and disclosures and requests for PHI: Consistent with Covered Entity's Minimum Necessary policies and procedures established by the Standard Operating Procedures adopted by in the Monroe County Fire Rescue Department, as may be amended from time to time. 3.4 Business Associate may not use or disclose PHI in a manner that would violate Subpart E of 45 C.F.R. Part 164 if done by the Covered Entity. 4. OBLIGATIONS OF COVERED ENTITY. 4.1 Covered Entity shall: (a) Provide Business Associate with the Notice of Privacy Practices that Covered Entity produces in accordance with the Privacy Rule, and any changes or limitations to such notice under 45 C.F.R. § 164.520, to the extent that such changes or limitations may affect Business Associate's use or disclosure of PHI_ (b) Notify Business Associate of any restriction on the use or disclosure of PHI that Covered Entity has agreed to or is required to comply with under 45 C.F.R. § 164.522, to the extent that such restriction may affect Business Associate's use or disclosure of PHI under this BAA. (c) Notify Business Associate of any changes in or revocation of permission by an individual to use or disclose PHI, if such change or revocation may affect Business Associate's permitted or required uses and disclosures of PHI under this BAA. 4.2 Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy and Security Rule if done by Covered Entity, except as provided under Section 3 of this BAA. 5. COMPLIANCE WITH SECURITY RULE. 5.1 Business Associate shall comply with the HIPAA Security Rule, which shall mean the Standards for Security of Electronic Protected Health Information at 45 C.F.R. Part 160 and Subparts A and C of Part 164, as amended by ARRA and the HITECH Act. The term "Electronic Health Record" or "EHR" as used in this BAA shall mean an electronic record of health -related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff. 5.2 Iin accordance with the Security Rule, Business Associate agrees to: A (a) Implement the administrative safeguards set forth at 45 C.F.R. § 164.308, the physical safeguards set forth at 45 C.F.R. § 164.310, the technical safeguards set forth at 45 C.F.R. § 164.312, and the policies and procedures set forth at 45 C.F.R. § 164.316, to reasonably and appropriately protect the confidentiality, integrity, and availability of the ePHI that it creates, receives, maintains, or transmits on behalf of Covered Entity as required by the Security Rule. Business Associate acknowledges that, effective on the Effective Date of this BAA, (a) the foregoing safeguards, policies, and procedures requirements shall apply to Business Associate in the same manner that such requirements apply to Covered Entity, and (b) Business Associate shall be liable under the civil and criminal enforcement provisions set forth at 42 U.S.C. § 1320d-5 and 1320d-6, as amended from time to time, for failure to comply with the safeguards, policies, and procedures requirements and any guidance issued by the Secretary from time to time with respect to such requirements; (b) Require that any agent, including a Subcontractor, to whom it provides such PHI agrees to implement reasonable and appropriate safeguards to protect the PHI; and (c) Report to the Covered Entity any Security Incident of which it becomes aware. 6. INDEMNIFICATION. The parties agree and acknowledge that except as set forth herein, the indemnification obligations contained under the Underlying Agreement shall govern each parry's performance under this BAA. 7. TERM AND TERMINATION. 7.1 This BAA shall be in effect as of the date set forth in the underlying agreement, and shall terminate on the earlier of the date that: (a) Either parry terminates for cause as authorized tinder Section 7.2. (b) All of the PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity. If it is not feasible to return or destroy PHI, protections are extended in accordance with Section 7.3. 7.2 Upon either parry's knowledge of material breach by the other parry, the non -breaching parry shall provide an opportunity for the breaching party to cure the breach or end the violation; or terminate the BAA. If the breaching party does not cure the breach or end the violation within a reasonable timeframe not to exceed seven (7) days from the notification of the breach, or if a material term of the BAA has been breached and a cure is not possible, the non -breaching parry may terminate this BAA and the Underlying Agreement, upon written notice to the other party. 7.3 Upon termination of this BAA for any reason, the parties agree that: Business associate shall return to Covered Entity all PHI received from Covered Entity, or created, maintained, or received by Business Associate on behalf of Covered Entity, that the Business Associate still maintains in any farm. The PHI shall be returned in a format that is reasonably expected to preserve its accessibility and usability. Business Associate shall retain no copies of the PH1. 7.4 The obligations of Business Associate under this Section 7 shall survive the termination of this BAA. 8. MISCELLANEOUS. 8.1 The parties agree to take such action as is necessary to amend this BAA to comply with the requirements of the Privacy Rule, the Security Rule, HIPAA, ARRA, the HITECH Act, the Consolidated Appropriations Act, 2021 (CAA-21), the HIPAA Rules, and any other applicable law. 8.2 The respective rights and obligations of Business Associate under Section 6 and Section 7 of this BAA shall survive the termination of this BAA. 8.3 This BAA shall be interpreted in the following manner: (a) Any ambiguity shall be resolved in favor of a meaning that permits Covered Entity to comply with the HIPAA Rules. (b) Any inconsistency between the BA.A's provisions and the HIPAA Rules, including all amendments, as interpreted by the :H:HS, a court, or another regulatory agency with authority over the Parties, shall be interpreted according to the interpretation of the HHS, the court, or the regulatory agency. (c) Any provision of this BAA that differs from those required by the HIPAA Rules, but is nonetheless permitted by the HIPAA Rules, shall be adhered to as stated in this BAA. 8.4 This BAA constitutes the entire agreement between the parties related to the subject matter of this BAA, except to the extent that the Underlying Agreement imposes more stringent requirements related to the use and protection of PHI upon Business Associate. This BAA supersedes all prior negotiations, discussions, representations, or proposals, whether oral or written. This BAA may not be modified unless done so in writing and signed by a duly authorized representative of both parties. If any provision of this BAA, or part thereof, is found to be invalid, the remaining provisions shall remain in effect. 8.5 This BAA will be binding on the successors and assigns of the Covered Entity and the Business Associate. However, this BAA may not be assigned, in whole or in part, without the written consent of the other party. Any attempted assignment in violation of this provision shall be null and void. 8.6 This BAA may be executed in two or more counterparts, each of which shall be deemed an original. 8.7 Except to the extent preempted by federal law, this BAA shall be governed by and construed in accordance with the same internal laws as that of the Underlying Agreement. [End of Addendum] 1 . • No "EXHIBIT E" Mandatory Federal Provisions Addendum MONROE COUNTY FEMA PUBLIC ASSISTANCE PROGRAM REQUIRED CONTRACT CLAUSES This Addendum is incorporated by this reference into the Agreement between the Contractor and the County (the "Contract") as "Exhibit E." It includes contract clauses that amend, delete or modify provisions of the Contract. All contract clauses that are not so amended, deleted or modified shall remain in full force and effect. To the extent of any conflict between the contract clauses set forth in this Exhibit and other contract clauses set forth in the Contract, the contract clauses of this Exhibit shall control. 1) APPENDIX 11 TO 2 C.F.R. PART 200 (if applicable) The Contractor and its subcontractors must follow the provisions, as applicable, as set forth in 2 C.F.R. §200.326 Contract provisions and Appendix 11 to 2 C.F.R. Part 200, as amended. 2) FEDERAL E-VERIFY The Contractor shall utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the Contractor during the term of the Contract and shall expressly require any subcontractors performing work or providing services pursuant to the Contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the Contract term. 3) MAINTENANCE OF RECORDS Contractor 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 seven (7) years from the termination of this agreement or for a period of three (3) years from the submission of the final expenditure report as per 2 CFR §200.334, whichever is greater. Each party to this Agreement or its authorized representatives shall have reasonable and timely access to such records of each other parry to this Agreement for public records purposes during the term of the Agreement and for seven years following the termination of this Agreement. 4) REMEDIES FOR BREACH. (2 C.F.R. PART 200, APPENDIX II (A)) In addition to all other remedies included in this Contract, Contractor shall, at a minimum, be liable to the County for all foreseeable damages it incurs as a result of Contractor violation or breach of the terms of this Contract. This includes without limitation, any cost incurred to remediate defects in Contactor's services and/or the additional expenses to complete Contractor's services beyond the amounts agreed to in this contract, after Contractor has had a reasonable opportunity to remediate and/or complete its services as otherwise set forth in this contract. All remedies provided for in this Contract may be exercised individually or in combination with any other remedy available hereunder or under applicable laws, rules and regulations. The exercise of any remedy shall not preclude or in any way be deemed to waive any other remedy. I 63 5) EQUAL EMPLOYMENT OPPORTUNITY. (2 C.F.R. PART 200, APPENDIX II (C)) During the performance of this Agreement, the Contractor agrees as follows: a. The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. b. The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual. orientation, gender identity, or national origin. c. The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. d. The contractor will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the labor union or workers' representative of the contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. e. The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. f. The contractor will furnish all information and reports required by Executive Order 1.1.246 of September 24, 1965, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. 114 64 g. In the event of the contractor's non-compliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, or orders, this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. h. The contractor will include the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as may be directed by the Secretary of Labor as a means of enforcing such provisions including sanctions for noncompliance: Provided, however, that in the event the contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction, the contractor may request the United States to enter into such litigation to protect the interests of the United States. Each nonexempt prime contractor or subcontractor shall include the equal opportunity clause in each of its nonexempt subcontracts. The equal opportunity clause shall be considered to be a part of every contract and subcontract required by the order and the regulations to include such a clause whether or not it is physically incorporated in such contracts and whether or not there is a written contract. 6) FURTHER COMPLIANCE WITH THE CONTRACT WORK HOURS AND SAFETY STANDARDS ACT. a) The contractor or subcontractor must maintain regular payrolls and other basic records during the course of the work and must preserve them for a period of three years after all the work on the prime contract is completed for all laborers and mechanics, including guards and watch persons, working on the contract. Such records must contain the name; last known address, telephone number, and email address; and social security number of each such worker; each worker's correct classification(s) of work performed; hourly rates of wages paid; daily and weekly number of hours actually worked; deductions made; and actual wages paid. b) Records to be maintained under this provision must be made available by the contractor or subcontractor for inspection, copying, or transcription by authorized representatives of the Department of Homeland Security, the Federal Emergency Management Agency, and the Department of Labor, and the contractor or subcontractor will permit such representatives to interview workers during working hours on the job. 7) CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT. Contractor agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean. Air Act, as amended (42 U.S.C. §§7401 c,lsic r.) and the Federal Water Pollution. Control Act, as amended (33 U.S.C. §§1.251 et seq.) and will report violations to FEMA/Federal. Agency and the appropriate Regional Office of the Environmental Protection Agency (EPA). The Clean 3 65 Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251- 1387), as amended, applies to Contracts and subgrants of amounts in excess of $150,000. The contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA/Federal agency. The contractor agrees to report each violation to the County and understands and agrees that the County will, in turn, report each violation as required to assure notification to FEMA/Federal Agency and the appropriate EPA Regional Office. 8) DEBARMENT AND SUSPENSION (Executive Orders 12549 and 12689). A contract award under a "covered transaction" (see 2 CFR 180.220) must not be made to parties listed on the governmentwide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR Part 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension" and the Department of Homeland Security's regulations at 2 C.F.R. Part 3000 (Non - procurement Debarment and suspension). SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 1.2549. SAM exclusions can be accessed at www.sam.gov. This contract is a covered transaction for purposes of 2 C.F.R. Part 1.80 and 2 C.F.R. Part 3000. Contractor is required to verify that none of the contractor's principals (defined at C.F.R. §1.80.935) or its affiliates (defined at 2 C.F.R. §180.905) are excluded (defined at 2 C.F.R. §180.940) or disqualified (defined at 2 C.F.R. §180.935). The contractor must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into. This certification is a material representation of fact relied upon by the County. If it is later determined that the contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the County, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. Bidders or Proposers agree to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The Bidder or Proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions. 9) BYRD ANTI -LOBBYING AMENDMENT (31 U.S.C. 1352). Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. § 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the recipient who in turn will forward the certification(s) to the awarding agency. Non -Federal award. If award exceeds $100,000, the required certification must be signed and submitted by the contractor to the County. 11 ME 10) PROCUREMENT OF RECOVERED MATERIALS. (2 C.F.R. § 200.323) a) Contractor must comply with section 6002 of the Solid Waste Disposal Act, as amended, by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 C.F.R part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA -designated items unless the product cannot be acquired: (1) Competitively within a timeframe providing for compliance with the contract performance schedule; (2) Meeting contract performance requirements; or (3) At a reasonable price. b) Information about this requirement, along with the list of EPA -designated items, is available at EPA's Comprehensive Procurement Guidelines web site, ,.g.@idel 111 e we ip ?, 1-��?gla �ul. The Contractor also c) agrees to comply with all other applicable requirements of Section 6002 of the Solid Waste Disposal Act. The Contactor should, to the greatest extent practicable and consistent with the law, purchase, acquire, or use products and services that can be reused, refurbished, or recycled; contain recycled content, are biobased, or are energy and water efficient; and are sustainable. 11) PROHIBITION ON CONTRACTING FOR COVERED TELECOMMUNICATIONS EQUIPMENT OR SERVICES. (2 C.F.R. § 200.216) a) Definitions. As used in this clause, the terms backhaul; covered foreign country; covered telecommunications equipment or services; interconnection arrangements; roaming; substantial or essential component; and telecommunications equipment or services have the meaning as defined in FEMA Policy 405-143-1, Prohibitions on Expending FEMA Award Funds for Covered Telecommunications Equipment or Services, as used in this clause. b) Prohibitions. i) Section 889(b) of the John S. McCain National Defense Authorization Act for Fiscal Year2019, Pub. L. No. 115-232, and 2 C.E.R. § 200.216 prohibit the head of an executive agency on or after Aug.13, 2020, from obligating or expending grant, cooperative agreement, loan, or loan guarantee funds on certain telecommunications products or from certain entities for national security reasons. ii) Unless an exception in paragraph (c) of this clause applies, the contractor and its subcontractors may not use grant, cooperative agreement, loan, or loan guarantee funds from the Federal Emergency Management Agency to: (�1) Procure or obtain any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology of any system; 5 67 (2) Enter, extend, or renew a contract to procure or obtain any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology of any system; (3) Enter, extend, or renew contracts with entities that use covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system; or (4) Provide, as part of its performance of this contract, subcontract, or other contractual instrument, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. c) Exceptions. i) This clause does not prohibit contractors from providing: (1) A service that connects to the facilities of a third -party, such as backhaul, roaming, or interconnection arrangements; or (2) Telecommunications equipment that cannot route or redirect user data. traffic or permit visibility into any user data or packets that such. equipment transmits or otherwise handles. ii) By necessary implication and regulation, the prohibitions also do not apply to: (l) Covered telecommunications equipment or services that: a. Are not used as a substantial or essential component of any system; and b. Are not used as critical technology of any system. (2) Other telecommunications equipment or services that are not considered covered telecommunications equipment or services. d) Reporting requirement. i) In the event the contractor identifies covered telecommunications equipment or services used as a substantial or essential component of any system, or as critical technology as part of any system, during contract performance, or the contractor is notified of such by a subcontractor at any tier or by any other source, the contractor shall report the information in paragraph (d)(2) of this clause to the recipient or subrecipient, unless elsewhere in this contract are established procedures for reporting the information. ii) The Contractor shall report the following information pursuant to paragraph (d)(1) of this clause: (1) Within one business day from the date of such identification or notification: The contract number; the order number(s), if applicable; supplier name; supplier unique entity identifier (if known); supplier Commercial and Government Entity (CAGE) code (if known); brand; model number (original equipment manufacturer number, manufacturer part number, or wholesaler number); item description; and any readily available information about mitigation actions undertaken or recommended. (2) Within 10 business days of submitting the information in paragraph (d)(2)(i) of this clause: Any further available information about mitigation actions undertaken or recommended. In addition, the contractor shall describe the efforts it undertook to prevent use or submission of covered telecommunications equipment or services, and any additional efforts that will be incorporated to prevent future use or submission of covered telecommunications equipment or services. 6 68 e) Subcontracts. The Contractor shall insert the substance of this clause, including this paragraph (e), in all subcontracts and other contractual instruments. 12) DOMESTIC PREFERENCE FOR PROCUREMENTS AS SET FORTH IN 2 CFR §200.322. a) Contractor should, to the greatest extent practicable, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). These requirements of this section must be included in all subawards including contracts and purchase orders for work or products under federal award. b) For purposes of this section: i) "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. ii) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer -based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber." 13) AMERICANS WITH DISABILITIES ACT OF 1990, AS AMENDED (ADA). The Contractor will comply with all the requirements as imposed by the ADA, the regulations of the Federal government issued thereunder, and the assurance by the Contractor pursuant thereto. 14) ENERGY EFFICIENCY (IFAPPLICABLE). Contractor will comply with the Energy Policy and Conservation Act (P.L. 94-163; 42 U.S.C. 6201-6422) and with all mandatory standards and policies relating to energy efficiency and the provisions of the state Energy Conservation Plan adopted pursuant thereto. 15) RIGHTS TO INVENTIONS MADE UNDER A CONTRACT OR AGREEMENT. If the Federal award meets the definition of "funding agreement" under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that "funding agreement," the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Finns Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. 16) ACCESS TO RECORDS. Contractor/Consultant and their successors, transferees, assignees, and subcontractors acknowledge and agree to comply with applicable provisions governing the Department of Homeland Security (DHS) and the Federal Emergency Management Agency's (FEMA) access to records, accounts, documents, infon-nation, facilities, and staff. Contractors/Consultants must 1. cooperate with any compliance review or complaint investigation conducted by DHS; 2. Give DHS access to and the right to examine and copy records, accounts, and other documents and sources of information related to the grant and permit access to facilities, personnel, and other individuals and information as may be necessary, as required by DHS regulations and other applicable laws or 7 Z program guidance; 3. Submit timely, complete, and accurate reports to the appropriate DHS officials and maintain appropriate backup documentation to support the reports. In compliance with the Disaster Recovery Act of 2018, the County and the Contractor acknowledge and agree that no language in this contract is intended to prohibit audits or internal reviews by the FEMA Administrator or the Comptroller General of the United States. The Contractor agrees to Monroe County, the FEMA Administrator, the Comptroller General of the United States, or any of their authorized representatives access to any books, documents, papers, and records of the Contractor which are directly pertinent to this contract for the purposes of making audits, examinations, excerpts, and transcriptions. The Contractor agrees to permit any of the foregoing parties to reproduce by any means whatsoever or to copy excerpts and transcriptions as reasonably needed. The Contractor agrees to provide the FEMA Administrator or his authorized representatives access to construction or other work sites pertaining to the work being completed under the contract. 1.7) CONTRACT CHANGES OR MODIFICATIONS. The Contractor understands and agrees that any cost resulting from a change or modification, change order, or constructive change of the agreement must be within the scope of any Federal grant or cooperative agreement that may fund this Project and be reasonable for the completion of the Project. Any contract change or modification, change order or constructive change must be approved in. writing by both the County and. Contractor. 18) DHS SEAL, LOGO, AND FLAGS. Contractor must obtain written permission from DHS prior to using the DHS seals, logos, crests, or reproductions of flags, or likenesses of DHS agency officials. This includes use of DHS component (e.g., FEMA, CISA, etc.) seals, logos, crests, or reproductions of flags, or likenesses of component officials. The Contractor shall include this provision in any subcontracts. 19) COMPLIANCE WITH FEDERAL LAW, REGULATIONS, AND EXECUTIVE ORDERS. This is an acknowledgement that FEMA financial assistance may be used to fund all or a portion of the contract. The contractor will comply will all applicable Federal Law, regulations, executive orders, FEMA policies, procedures, and directives. 20) NO OBLIGATION BY FEDERAL GOVERNMENT. The Federal Government is not a parry to this contract and is not subject to any obligations or liabilities to the County/non-Federal entity, contractor, or any other parry pertaining to any matter resulting from the contract. 21) PROGRAM FRAUD AND FALSE OR FRAUDULENT STATEMENTS OR RELATED ACTS If applicable, the contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract. 22) SOCIOECONOMIC CONTRACTING The Contractor is encouraged to take all necessary steps identified in 2 C.F.R. § 200.321(b)(1)-(5) to ensure small businesses, minority businesses, women's business enterprises, veteran -owned businesses, and labor surplus area firms are considered when possible. 23) COPYRIGHT The Contractor grants to the (insert name of the recipient or subrecipient), a paid -up, royalty -free, nonexclusive, irrevocable, worldwide license in data first produced in the performance of this contract to reproduce, publish, or otherwise use, including prepare derivative works, distribute copies to the public, and perform publicly and display publicly such data. For data required by the contract but not first produced in the performance of this contract, the Contractor will identify such data and grant to the (insertname of the recipient or subrecipient) or acquires on its behalf a license of the same scope as for data first produced in the performance of this contract. Data, as used herein, shall include any work subject to copyright under 17 U.S.C. § 102, for example, any written reports or literary works, software and/or source code, music, choreography, pictures or images, graphics, sculptures, videos, motion pictures or other audiovisual works, sound and/or video recordings, and architectural works. Upon or before the completion of this contract, the Contractor will deliver to the (insert name of the recipient or subrecipient) data first produced in the performance of this contract and data required by the contract but not first produced in the performance of this contract in formats acceptable by the (insert name of the recipient or subrecipient). 24) PROVIDING GOOD, SAFE JOBS TO WORKERS Creating Good Jobs. Pursuant to FEMA Infonnation Bulletin No. 520, the contractor will comply with all applicable federal labor and employment laws. To maximize cost efficiency and quality of work, the contractor commits to strong labor standards and protections for the project workforce by creating an effective plan for ensuring high -quality jobs and complying with federal labor and employment laws. The contractor acknowledges applicable minimum wage, overtime, prevailing wage, and health and safety requirements, and will incorporate Good Jobs Principles wherever appropriate and to the greatest extent practicable. [End of Addendum] I 71 EXHIBIT "B" Statement of Qualifications for Monroe County Fire Rescue Antanllo Gaindia,III ID, 1080 SVV 421nd Ave Deer-fidd IBac['i, 33442 954.326.1946 agaiir'idiliaiirnd@giir,y,ialli III cori"i Monroe County Fire Department RFP III,,,, Ib Summary Drs. Gandia and Manresa have extensive experience in Pre -Hospital Emergency Medicine with over 30 years of experience. Dr. Gandia has been a Fire Department Medical Director for multiple agencies, most recently City of Marathon Fire Rescue, City of Key West Fire Rescue, Monroe County Fire Rescue. He has long tenures at City of North Lauderdale Fire Rescue, Margate Fire Rescue, Miramar Fire Rescue and Lighthouse Point Fire Rescue. For the last few years Dr. Manresa has joined the team and has become an integral part of the fire rescue service.The extensive experience places them in an excellent position to be able to fulfill all the requirements needed for the scope of work. Additionally, Dr. Gandia has attending privileges at Lower Keys Medical Center and is the Community Liaison for the Monroe County Department of Health These associations foster strong community relationships and greatly support MCFD with the hospital leadership. Similarly, Dr. Manresa is an active attending physician with the Baptist hospital health system where he has fostered strong institutional relationships that further MCFD mission. Dr. Manresa is also an attending physician at Mount Sinai Medical Center, which is another hospital that MCFD frequently collaborates with. Thus, between both physicians, all three hospitals in the Florida Keys are represented which gives the agencies a greater voice within the hospital systems. Monroe County Fire Department RFP Ill ll. III,;;; Ill,,,,,,,liicensure,ia III lii�lliiC �i ., and I�� III iirm Dr. Gandia has been involved in training, education and overseeing Fire/EMS systems for over 30 years. Dr. Manresa has been a member of the team for over 7 years and has brought some innovative projects to the agencies. Dr. Gandia was instrumental in developing local and common protocols in South Florida which eventually became a published document by a national publishing company. The importance of this was that agencies saw the value in common protocols to better serve their common communities. Dr. Gandia was involved in the initial development of the 12 lead EKG course at the Gordon Center at the University of Miami. While President of the Florida Association of EMS Medical Directors, he was able to lead the organization in establishing and passing a position statement that EMS was to transport to the "closest most appropriate facility" and transporting to appropriate STEMI and Stroke facilities. In addition, changing many protocols to having "paramedic judgment" inserted into protocol. The above statements are to illustrate that our team believes that the Prehospital provider professional can provide high level of care to our community if trained and encouraged to advance their education. Drs. Gandia and Manresa have extensive experience in similar projects as Medical Directors from a county system at Monroe County, city organizations such as Key West, Marathon, Margate, and North Lauderdale. The group has developed numerous projects and initiatives such as advanced Ultrasound, advanced airways with video laryngoscope along with cadaver lab training. The team has participated in officer development initiatives including process for advance degrees for associate and bachelor's degrees through the relationship with Braxton College here locally in Ft. Myers. The relationship with the College also affords various degrees of training opportunity such as cadaver labs, Sim labs and any individualized training that may be requested by the organization. Many of these projects can be offered at the agency's facilities. Drs. Gandia and Manresa have implemented and continue to develop the community paramedic/Integrated Health programs within various systems. Dr. Gandia is the Community Outreach Medical Director for the Department of Health of Monroe County and is now developing collaborative projects with the DOH, local hospitals and Fire Rescue departments for community outreach in various forms. One important tangible component is the team's involvement in the state's organizations, such as the DOH, Florida Association of EMS Medical Directors, Florida Educators, member of the EMS Advisory Council. These relationships have added priceless benefits that have kept us abreast of upcoming regulations, grant opportunities, upcoming legislative initiatives related to Fire and EMS. In addition, these relationships have helped us gather numerous grants for our agencies. Dr. Gandia was one of the founders of the First There First Care Conference twenty-seven years ago which is now one of the premier conferences in the nation with over 1400 participants from all over the nation. In addition, he is now helping develop the EMS track and AILS competition for the Florida Fire Chiefs January conference. In our brief tenure as Medical Director at Monroe County Fire Rescue, Trauma Star and the City of Marathon Fire Rescue, we have been evaluating and revising our transport protocols, removing some of the ACS protocols that yield a burden to patients and Trauma Star alike. We believe that collaboration between local agencies is of utmost importance and we have been fortunate to bring our three local systems, Monroe County Fire Rescue, Marathon Fire Rescue and Key West Fire Rescue, to the table for open discussion on how we can better serve our communities with local and mutual responses with similar protocols yet being respectful of our local needs. This partnership has been greatly embraced by all and has already worked exceptionally well during an unfortunate incident of a house fire in Key West that required full cooperation from all three agencies. We believe that our experience, commitment to furthering the scope of practice to our EMS providers, and history with large and small EMS/Fire departments give us a unique understanding of the needs of our partners and community stakeholders. Monroe County Fire Rescue RFP III,,,, Ilb IID Appr,oadh and Management Drs. Gandia and Manresa have a long standing history of being very involved with their current and past fire departments. As a Lower Keys Medical Center emergency medicine physician, Dr. Gandia will be present in the community and interacting with Monroe County's EMS system and Trauma Star during daily work encounters. He also serves as the community outreach medical director for the department of Health in Monroe County. One of their many strengths is their approach to management. They are also very committed to personal involvement in the agencies. Since 1991, Dr. Gandia and later Dr. Manresa have been involved in the implementation of advanced and comprehensive protocols. Their belief is if we can train at a high level we can perform at a high level of care and complexity. Due to their commitment to excellence they are always available 24 hours a day/ 7 days a week. They have shown a keen interest in training and empowering ems personal to become the ultimate providers in the field and an extension of themselves. Consisting of signing off on new recruits or new training protocols will be a constant endeavor. Drs. Gandia and Manresa have been involved in numerous state and local organizations and have great experience in the 64J and state requirements for Medical Direction. In fact, Dr. Gandia during his tenure as the Florida Association of EMS Medical Directors, helped formulate and develop numerous state statutes pertaining to stroke and cardiac care for the state. Both physicians continue to serve on numerous state committees and Dr. Gandia is a member of the state of Florida EMS Advisory Council. This partnership believes in a robust QA/QI program and has vast experience in developing these programs. This ultimately ensures quality care to the community. In addition to the community, the physicians believe in a strong and collaborative relationship with the local hospitals served by the agencies. Dr. Gandia is an attending physician at Lower Keys Medical Center and Dr. Manresa is an attending physician with the Baptist Health Care system. They believe these relationships give them an exceptional advantage to partner with the stakeholder of the community and hospitals alike. It assures some quality reviews and cooperation with the local institution. -Antonio Gandia, MD, FACEP -Aldo Manresa, DO, FACEP Monroe County Fire Rescue RFP III,,,. III II[;;;;;;;; , �„�t� �I,,, lii iirm , III lii�llii� lii .�iirm S �., �I iir � iir firm III iirm� ,,,,III,,,, , � Il�m iirm�: III. Antonio Gandia, MD PA (Sole Proprietorship) Antonio Gandia, President 1080 SW 42nd Ave Deerfield Beach, FL 33442 954.326.1946 Organizational Chart Medical Director - Antonio Gandia, MD, FACEP Associate Medical Director - Aldo Manresa, DO, FACEP Technology We have developed ultrasound programs in other agencies and will explore these options as well. The physicians have great knowledge and experience with video laryngoscope use and would encourage a program. Due to the partners relationship with some of the local agencies and hospitals, we have the capability to perform SIM Lab training courses and reviews. In addition, we have the opportunity to present a cadaver lab practical course for additional instructions in various emergency medicine techniques and general review of cadaver anatomy. The physicians also attend nationwide ems conferences where they showcase new and creative ems equipment, skills and technology to bring back to their respective departments. An additional exciting program would be the Community Paramedic Program or Integrated Health System. Dr. Gandia has procured a grant award for one to the local agencies to start and develop this program locally. Dr.Gandia is the Community Liaison for the Monroe County Department of Health and will have access to their advanced practitioners for additional support to these programs including the use of Telemedicine to support the local community. Monroe County Fire Department RFQ Relevant Experience and References Medical Director for Fire Departments since 1991 North Lauderdale Fire Rescue Miramar Fire Rescue Lighthouse Point Fire Rescue Coconut Creek Fire Rescue Margate Fire Rescue City of Key West Fire Rescue City of Marathon Fire Rescue Monroe County Fire Rescue Educational Institutions Medical Director: Medical Arts Paramedic Programs Florida Medical Training Institute: Miami, Broward, Brevard, Tampa, Orlando, Jacksonville City College Ft. Lauderdale and Miami Emergency Education Institute Braxton College Southeastern Medical Academy Outside References Chief Bill McGrath North Lauderdale Fire Department 954.895.4315 Chief James Muro, Marathon Fire Department 305.304.9959 Chief Keith Hernandez, City of Key West Fire Department 305.797.8514 PART 6 — REQUIRED Fbti,-AMS Proposer, states by its check mark in the blank beside the form and by its authorized representative's signature that it has provided the following forms: ' Qualifications Response (tabbed per each criterion) 2 Consultant Qualification Statement (per subsection 2-347(h), Monroe County Code) 3 County Forms (& State -mandated provisions) Affidavit 4 Federal Forms ("Debarment Certification Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters" Form, and the Byrd -Anti Lobbying Certification & Disclosure of Lobbying Activities Fonns) 5 Criminal History Background Check Consent Form, and Licensure Eligibility (pursuanu* Section 456.0135, Fla. Stat.) Attestation Form 6 Insurance Requirements Form (incl. Release of Liability & Indemnification Statement) 7 Insurance Agent's Statement (signed by insurance agent) 8 SEPARATE DOCUMENT UPLOAD: Three (3) years of Financial Statements marked "CONFIDENTIAL" 9 SEPARATE DOCUMENT UPLOAD: Price Response - Proposal Form Company FEIN: Company Name: D/B/A �if 0 icable Years in Business: Company Address: Company Web Address: Number of Employees: Company E-mail: C, 2- C;j I Aj it kMN Ln IP1Y P . I Atm,�A JAmd Management Person Resposible for Direct Conjact to County and Services required for this RFQ: Name: c Title: Rhone Number: Email Address: The physical business address must be registered as its principal place of business with the Florida Department of State for at least one (1) year prior to the notice of rgquest'farbrd o'i proposal. Date: Signed: (Sig ture i representative) (Name &Title) 91% M-11MOR W — AM Section nty Code of Ordinances The undersigned certifies under oath the truth and correctness of all statements and ®f all answers to questions made hereinafter: XIndividual 0 Other I State the true, exact, correct and complete name of the partnership, corporation, trade or fictitious name under which you do business and the address of the principal place of business. The correct name of the Cqnsultant is: P,4 _P 4L"AN d I A yj b 0-17? "J, �— a. Date of Incoiporatiol b. C. d. e. f. 9. MMMEMMM"= Vice President's Name: Secretary's Name: Treasurer's Name: Name and Address of Resident Agent: Ga. Date ®f Organization: WIM, MMMEMM b, Name, Address and Ownership Units of all Partners/Officers/Directors: W, C. State whether general or limited partnership: sorzr— If Consultant is operating under a fictitious name, submit evidence of compliance with the Florida Fictitious Name Statute. 4. Provide a list of the person's or entity 's shareholders with five percent (5%) or more of the stock or, if a general partnership, a list of the general partners; or, if a limited liability company, a list of its members; or, if a solely owned pr pri t hip, narnes(s) of. owner(s)- 111;011111 111M 1 7 111Mill "11 -" '1!1 ........ . . ..... . . . . ---- .. . .... . ..... . ... M I I I !I I i I i I ! I I OR 6. Indicate registration, license numbers or certificate numbers for the businesses or professions, which are the subject of this RFQ. Please attach certificate of competency and/or state registration. A 6 — .44 La r> � I -r- - 7. Has the person, principals, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or directors, ever failed to complete work or provide the goods for which it has contracted? YES [] NO If yes, provide details. 8. Are there any judgments, claims, arbitration proceeding or suits pending or outstanding against the person, principal of the entity, or entity, or any entity previously owned, operated or directed by any of its officers, directors, or general partners? YES M NO If yes, provide details. P 9. Has the person, principal of the entity, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or directors, within the last five (5) years, been a party to any lawsuit, arbitration, or mediation with regard to a contract for services, goods or construction services similar to those requested in the specifications with private or public entities? YES [] NO §a 32 10. Has the person, principal of the entity, or any entity previously owned, operated or directed by any of its officers, owners, partners, major shareholders or directors, ever initiated litigation against the county or been sued by the county in connection with a contract to provide services, goods or construction services? YES [] NO If yes, provide details. 15. CERTIFICATION OF SEPARATE CONFIDENTIAL UPLOAD: Financial statements for the prior three (3) years for the responding entity or for any entity that is a subsidiary to the responding entity: colfirm se rate u oad- 2a YES E] NO 16. Any financial information requested by the county department involved in the competitive solicitation, related to the financial qualifications, technical competence, the ability to satisfactorily perform within the contract time constraints, or other information the department deems necessary to enable the department and board of county commissioners to detennine if the person responding is responsible. 33 Confirm your understandiLig of the CouM's gWlity I to re YES R NO w a terminate the award and /or contract. u Date I State of.—l- 10 r-1 DA I HEREBY CERTIFY The foregoing instrument was sworn to or affirmed before me by means of physical p sence or 0 online notarization, this e day of A-P 2025, by Ck.- (name of person) as Medical Director (type of authority, e.g. officer, trustee, attorney in fact) for Monroe County -- (name of party on behalf of'whom instrument was ame o Notary Public: Print, Stamp, or Type as Commissioned) V'i Personally known to me, or 0 Produced identification: 0tX*Y' PUBLIC, STATE OF FLORIDA ANISSAMICHELLF-BALBI Commbsion 4 HH 608358 ;7e,'7F ExplmsApM26.2028 JIM 11M, IMIT, El AFFIDAVIT By signing this Affidavit, CONTRACTOR has sworn or affirmed to the following requirements as set forth below: Public EngbLL!jML.N�� Pursuant to Section 287.133(2)(a), Florida Statutes, as amended from time to time, Contractor hereby certifies and attests that neither it nor its affiliate(s) have been placed on the convicted vendor list followin a-vublic enti IMP If or any political subdivision until such ineligibility is lifted by the Administration Commission (Governor and Cabinet per § 14.202, Florida Statutes] for good cause." V �711 �11 011WHAV, B11 ........ ....... L.Y 1jVALj%,w VL Monroe County Code of Ordinances. M "ll Activities in the Iran Terrorism Sectors List or been engaged in business operations in Cuba or Syria, Note: The List are available at the following Department of Management Services Site: hut Ti [ endor infoi-�Tiatic)zi)'c(,iti\,icied aints, vendor lists Non -Collusion Affidavit CONTRACTOR by signing this Affidavit, according to law on my oath, and under penalty of perjury, depose and say, that the person signing on behalf of the fines of CONTRACTOR, the bidder making the Proposal for the project described in the Scope of Work, and that I executed the said proposal with full authority to do so,- the prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; unless otherwise required by law, the prices which have been quoted in this bid have riot been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and no attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose ofrestricting competition; the, statements contained in this affidavit are true and correct, and made with full knowledge that. Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. QLn1p1t am cue with Foreign (-_(untries �02U 'AL , of CO2—ci —Ks aiLt to z�aALym 2W7X38,_-u- Beginning January 1, 2025, the County must not extend or renew any contract that grants access to an individual's personal identifying infori-nation unless the Contractor provides the County with an affidavit signed by an authorized representative of the Contractor, under penalty of perjury, attesting that the Contractor does not meet any of the criteria in subparagraphs (2)(a)-(c) of Section 287.138, Florida Statute-s, as may be amended. The below box must be completed to satisfy this requirement. Violations of this Section will result in termination of any forthcoming agreement and may result in administrative sanctions and penalties by the Office of the Attorney General of the State of Florida. is not owned by the government of a Foreign Country of Concern, is not organized under the laws of nor has its Principal Place of Business in a Foreign Country of Concem, and the government of a Foreign COUntry of Concern does not have a Controlling Interest in the entity, Under penalties of perjury, I declare that I have read the: foregoing statement and that the facts stated in it are tnie,# Printed Name : el Title: Signature: Date- -1-- . ..... . ------- -- — L,:VerjL2MHi[2MtnL I Effective January 1, 2021, public and private employers, contractors and subcontractors must require registration with, and use of the E-verify system in order to verify the work authorization status of all newly hired employees, Contractor acknowledges and agrees to utilize the U.S. Departmcnt of Homeland Security's E-Yerlfy System to verify the employment eligibility of. a)AH persons eniployed by Contractor to perform erriployrnent duties within Florida during the term of the contract; and b)A,ll persons (inclUding su.bvendors/subc(,)nsultants/su-beontractors) assigned by Contractor to perforin work pursuant to the contract with the County. The Contractor acknowledges and agrees that use of the U.S. M the contract with the County. By executing this Affidavit, CONTRACTOR becomes obligated to comply with the provisions of Section 448.095, Florida Statutes, "Employment Eligibilityas amended from time to time. This n-statu& T ---57-MAT-71T least one year afLer Ine Me on wnicn Tne , gree T? n i-71 for any additional costs to County incurred as a result of the termination of this Agreement in accordance with this Section. X 11WITTET1111� MT ,W's --114 --- -- 7W - IMUTHIM M Urd County Susv!2nded Vendor List The eligibility of persons to bid for an award of County contract(s), or enter into a contract, may be d --rsuant to See- 2-347 1 of the Monroe County Code of Ordinances. In the event an eligible kffl] MSEM=4 WITNESS my hand and official seal. NOT Y PUBLIC, STATE OF NOTARY PUBLIC FL A SEAL OF OFFICE: Am -91 BW�t (Name of Notary Public: Print, Stamp, or Type as Commissioned) VPersonally known to me, or 0 Produced identification: (Type of Identification Produced) ANWA MMELLE BALSI Commis" # HH 508358 Expires April 26, 2028 194 Certification Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters (i) The undersigned and/or any of its Principals - (A) Are are not (' ,�,) presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; (B) Have ( ) have not (-)4 within a 3-year period preceding this certification, been convicted of or had a civil Jud g-ment rendered against them for: Commission of fraud or a or p&rkmine, �&-p-jhlk (Federal, state, or local) contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, 'forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and (C) Are ( ) are not I go ) presently indicted for, or otherwise criminally or civilly chargei, by a vernmental en �ityvl with, commission of any of the offenses enumerated above. (ii) The undersigned has ( ) has not within a 3-year period preceding this certification, had one or more contracts terminated for 2efault by any Federal agency. "Principals," for the purposes of this certification, means officers; directors; owners; partners; and persons having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a subsidiary, division, or business segment, and similar positions). This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the undersigned subject to prosecution under section 1001, title 18, United States Code. The undersigned shall provide immediate written notice to the Contracting Officer if, at any time prior to the contract award or after, the undersigned learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. I g9i 10 CQ 4 AJ kA (Name of Company) By: (S4harffr—el---� (Name and Title of Signatory) I W/� Date signed: /4��Z-!r M t. K"raigsing -11,11 _W wg�Lw � 1, 1 IN (To be submitted with each bid or offer exceeding $100,000) Certification for Contracts, Grants, Loans, and Cooperative Agreements 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 an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making 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 ofany agency, a Member of Congress, an officer or employee of Congress, or an employee ofa 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. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients 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 sullject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The Contractor, I % V 6A VJV'A , certifies or affirms the truthfulness and accuracy of each kwm 41 statement of its certification and disclosure, if �LX. In addition, the Contractor understands and agrees that th ni 7. wiza I UZI e provision-s--6P3rZrrU-�C-'iix�7,i,- 31', At, this certification and discloWe-JiTla'k. Name and Title of Contractor's Authorized Official —20D t�l EE DISCLOSURE OF LOBBYING ACTIVITIES Approved b,i ONT Clomplete this form to disclose uiobbying activities pursLiant to 31 U S.0 1352 134S-0046 (See reVerS,e for PUNic bi-irden disclosure 'L Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a bid,'offer,�applicaticn a. enifial filing b, gfant b initial -award Is. mate6al change c cooperative agreeipent c. post-a,.vard For Material Change Only: d, loan 'Ve@F _quarter e. loan Uuarantee date of last report f. ioan ilISUrai 4. -a rn e and Address of Reporting Entity; �5. If Reporting Entity in No. 4 is a Subawardee, Enter Name Prime C] Subawardee and Address of Prime: Tier NJ Coneiressional District .opqressionaI District, . ... . ....... T. Federal Program Narne,lDescripfion: 6, F e*--deral DepartmentiAgency: �4 C F DA NN u m b e r. a b e 8, Federal Action NLAber, 9. Award Ani(P1111t , 10. a. Name and Address of Lobbying Registrant b. Individuals Perfoirning Services Idua,. raft "Om "%"o boa -1 ignatureSr41V Pin, an .f A Till e: ITelep ne No -3201 1A16 Date 4,ijthorced for Lor-al Reproduction Federal Use Only: Slandard Forni LLL *Rev. 7-97, Ex LO �JZ 7 YA lease be aware, a UniFfn-a-1fiistory ac groun neck-WiTI-6e run on you pursuam M c and conditions of this solicitation. its due weight in assessing your qualifications. if a comract L%jjL IM A=J a Criminal History Background Check (for contracted services/employment purposes) at any time during the term/tenure of your contract for services/employment. I have rethe �ent and understand it completely, and I voluntarily agree to it. ad"a ov e! s ta�em .on ultart s e ate V n 1 *0 ,onsultant's Printed Name LICENSURE ELIGIBILITY ATTESTATION FORM (PURSUANT TO SECTION 456.01359 FLA. STAT.) Please initial next to each statement below to indicate its truthfulness: kjI am familiar with Chapter 2024-243, Laws of Florida, and acknowledge the recent changes in the — law regarding initial and renewal licensure requirements that will impact certain health care professions (see generally Section 456.0135, Fla. Stat.). Circle One: My license to deliver services solicited by this solicitation [ may ,will no e negatively impacted by the new law. If "may" was selected, please explain: I acknowledge that I have an ongoing obligation to immediately notify the County if anything changes with regard to my representations here. walffl��� In the event that the Contractor subcontracts any or all of the work in this project to any third party, the Contractor specifically agrees to identify the County as an additional insured on all insurance policies required by the County. In addition, the Contractor specifically agrees that all agreements or contracts of any nature with his subcontractors shall include the County as additional insured. INDEMNIFICATION & RELEASE OF LIABILITY shall defend, indemnify, and hold harmless the COUNTY, and the COUNTY's elected and appointed officers and employees, from and against (i) any claims, actions or causes of action, (ii) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury finexenalt,, or business interru3tion, and �ii costs or exQenses that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of, or in +f ional intentional or negligent acts or omissions -5fTfi-e-CUS, I -Ur- -any of-TT-s employees, agents, contraciTTs *17, invitees (other than Consultant). Nothing contained herein is intended, nor may be construed, to waive County's rights and immunities under the common law or Section 768.28, Florida Statutes, as amended reserved to the County, this section will •iration ot the te-f ar•,1MIM,11 r any earlier termination of same. I understand the insurance that will be mandatory if awarded the contract and will comply in full with all of the requirements herein. I fully accept the indemnification and hold harmless and duty to defend as set out in this proposal. PROPOSER Date 47 1080 SW 42nd Ave Phone 954-326-1946 Deerfield Beach,FL agandiamd@gmail.com 33442 ANTONIO GANDIA, M.D. FACEP Queens College of the City University of New York. 1972-1977 Education Ross University School of Medicine, 1977-1981 Resident in General Surgery ery 1981-1984 9� New York Medical College -New Rochelle Hospital Medical Center Castle Point Veterans Hospital Columbia Presbyterian Hospital -College of Physicians and Surgeons Columbia University Babies Hospital Columbia University Neurological Institute Resident in Internal Medicine 1985-1988 Monmouth Medical Center Hahnemann University Long Branch, New Jersey Chief Resident in internal Medicine Monmouth Medical Center, Long Branch, New Jersey Professional August 2024-present Medical Director Monroe County Fire experience Rescue, Florida Keys August 2024 present Medical Director Marathon Fire Rescue, Marathon Florida November 2021 -present Lower Keys Medical Center Emergency Department Attending Physician October 2020-August 2021 Mount Sinai Medical Center/ Hialeah, Freestanding Emergency Department, Attending Physician November 2018-September 2020 Mount Sinai Medical Center/ Hialeah, Freestanding Emergency Department, Medical Director. November 2007-Novenber 2018 Mount Sinai Medical Center/ Aventura, FreeStanding Emergency Department Medical Director November 201 O-August 2021 Director Pre -Hospital Emergency Medicine, Mount Sinai Department of Emergency Medicine September 2006-September 2007,_Aventura Hospital and Medical Center, Aventura Florida, Medical Director Emergency Services September 2004-September 2006, Aventura Hospital and Medical Center, Attending Physician, Emergency Services October 1988-2005 University Hospital and Medical Center Tamarac, Florida Assistant Medical Director, Emergency Services January 2003- 2015 Palmetto General Hospital, Hialeah, Florida Attending Physician, Emergency Services (part time) October 1988-1990, Memorial Regional Hospital, Hollywood, Florida Attending Physician, Emergency Services January 1988-October 1988, Raritan Bay Memorial Hospital Center, Old Bridge, New Jersey. Bayshore Hospital, Holmdel, New Jersey January 2001-2005, Medical Director Acute Stroke Unit, University Hospital and Medical Center June 1995-1997, Medical Director Sub -Acute Care Unit Heartlands of Tamarac, Tamarac, Florida Additional January 2022-present: Medical Director Key West Fire Rescue professional activities June 2018- ' present: President and Chief Medical Officer .Braxton College June 2020- present: Medical Director Emergency Educational Institute ............... October 2018: Feb 2025 President and Medical Director Southeastern Medical Academy October 2017-present: Medical Director Margate Fire Rescue September 2000-2013 Associate Medical Director Miramar Fire Rescue November 1996-presentMedical Director North Lauderdale Fire Rescue April 1998-2000, Medical Director Lighthouse Point Fire Rescue September 1999-2009, Medical Director Florida Medical Training Institute, Paramedic/EMT and Allied Health school, Coconut Creek, Florida and Miami, Florida October 1991-1997, Medical Director Enstar Tech(formerly Medical Arts Training Center) Paramedic/EMT training programs, Margate, Florida Teaching Position Voluntary Clinical Professor of Medicine, Florida International University, School of Medicine Voluntary Associate Clinical Professor of Medicine, Department of Medicine, Miami University School of Medicine/Jackson Memorial Hospital, Miami, Florida Clinical Associate Professor, Nova University School of Medicine, Davie, Florida Clinical Preceptor, Physician Assistant Program, Nova University School of Medicine, Davie Florida Clinical Preceptor, Physician Assistant Program, Barry University, Florida Clinical Preceptor, Advance Registered Nurse Practitioner, Florida International University American Heart Association, Affiliate Faculty, Course Director, ACLS,PALS programs throughout Broward County Broward County Community College, Center for Health Sciences Education, ACLS, PEEP, program Director, Davie, Florida Emergency Educators and Consultants, President and Chair. Emergency Medicine ConEd. Programs Committees Member Department of Health EMS Advisory Council Co -Chair Medical Care Committee EMS Advisory Council Chair Stroke Sub Committee Medical Care Committee American Heart Association/Florida Mission Lifeline EMS Co - Chair Florida Mission: Lifeline Steering Committee President Florida Association of EMS Medical Directors, Inc. Florida Association EMS Medical Directors, Executive Committee Florida College of Emergency Physicians Board of Directors Chairperson, Acute Stroke Program -Steering Committee, University Hospital and Medical Center Chairperson, Continuing Medical Education Committee, University Hospital and Medical Center Vice Chair. Utilization Management, University Hospital and Medical Center Chairperson International Clinical Conference Competition Committee, International ALS/BLS Competition Florida College of Emergency Physicians, EMS/Trauma Committee Florida College of Emergency Physicians, Florida Association of EMS Medical Directors, Secretary and Treasurer University of Miami/Jackson Memorial Hospital Stroke Advisory Committee University of Miami/Jackson Memorial Hospital , Center for Research and Education -Medical Training Lab Advisory r'„h-,h-,c++n^ \OVI 111111 LLVV Medical Director and Founder Broward County Invitational Emergency Medical Services -Advance Life Support Competition, Broward Chiefs Association Florida College of Emergency Physicians, Florida Emergency Medicine Foundation, Education Committee, Program Chair. Peds. Forum, Controversies in Pediatric Emergency Medicine Broward County Chiefs Association, Emergency Medical Services Subcommittee Broward County Emergency Medical Services Council, Medical Issues Committee Pre -Hospital Medical Director, Broward County Emergency Medical Services Council and Trauma Agency Broward County Medical Association, Chairperson, Pre - Hospital Research Committee Broward County Medical Association, Emergency Medical Services -Medical Directors Committee Broward County Medical Association, Emergency Medical Services -Quality Assurance Committee Broward County Medical Reserve Corps, Steering Committee South Florida EMS Regional Protocols, Senior Editor, Publisher Jones and Barrtlet South Florida EMS Common Regional Protocols, Chairperson, Cardiac Care and Transport Committee South Florida EMS Common Regional Protocols, Chairperson, Acute Stroke Care and Transport Committee South Florida EMS Common Regional Protocols, Executive Committee American Heart Association/American Stroke Association, Broward County Medical Association, Broward Chiefs Association, Chairperson, Acute Stroke Program Evaluation Team Chairperson, American Heart Association, Operation Heart, Broward County /11_ ......._ _..........._ A .__ _...-' _......_ t-t _ 1 _ _. A _. _. - - . - L' ._ ._ -%._ _...._ L' _ ._ 1 - _. unairperson, /American z>irOKe /Associaiion, uperaiion z>irOKe, Broward Co. American Heart Association/American Stroke Association, Broward County Community Board Vice -Chairperson, American Heart Association Florida/Puerto Rico Affiliate, Health Care Initiative Committee American Heart Association/American Stroke Association, Stroke Subcommittee Capital Campaign Committee, Florida College of Emergency Physicians/Florida Emergency Medicine Foundation Broward County Stroke Council Aventura Hospital and Medical Center, Executive Committee Aventura Hospital and Medical Center, Credentials Committee. Aventura Hospital and Medical Center, Department of Medicine Committee Aventura Hospital and Medical Center, Cardiovascular Peer Review Committee. Aventura Hospital and Medical Center, Chair, Division of Emergency Medicine . Chair Comm.: Florida College of Emergency Physicians/Florida Hospital Association, Freestanding Emergency Department Profession all membersh ips ACEP-American College of Emergency Physicians FCEP-Florida College of Emergency Physicians FAEMSMD-Florida Association of EMS Medical Directors NAEMSP-National Association of EMS Physicians FEMF- Florida Emergency Medicine Foundation AMA -American Medial Association FMA-Florida Medical Association BCMA-Broward County Medical Association ASIM-America Association of Internal Medicine FGS-Florida Geriatric Society AAPS-American Association of Languages English and Spanish Specialist Licensure Florida -active: New York, New Jersey, Nebraska: inactive Certificati Fellow American College of Emergency Physicians ons Board Certification in Emergency Medicine, Diplomate BCEM/ AAPS, Certificate # 03-1784 American Board of Quality Assurance and Utilization Review Physicians, Inc. Diplomate Board Certified November 1993 Advanced Cardiac Life Support, Advanced Cardiac Life Support Instructor. Pediatric Advanced Life Support, Pediatric Advanced Life Support Instructor Advanced Trauma Life Support Awards received Presentations 16th International EMS competition Kouty, Czech Republic 1st Place International Competition/Physician Crew World Champions, May 30- June 1, 2012 The Ralph A. Marrinson Award for EMS Lifetime Achievement Award For Outstanding Contribution in the field of EMS. Presented at the 15th Annual First There First Care Conference May 2011. EMS MEDICAL DIRECTOR OF THE YEAR, Florida Department of Health, 2006 American Stoke Association National Award. Stoke Advocate of the Year- February 2004, International Stroke Conference, San Diego, California American Heart Association, Florida/Puerto Rico Affiliate Distinguished Service Award —June 2004, Tampa, Florida American Heart Association, Florida/Puerto Rico Affiliate, Freshman Award for outstanding service Broward County EMS Conference First There First Care, Broward Fire Chiefs Association, Public Educator of the Year Award- May 2002 John C. Borden Internal Medicine Award, for excellence and outstanding service in the field of Internal Medicine, Monmouth Medical Center, June 1988 Broward County EMS Conference First There First Care Speaker- 1999, 2000, 2001, 2002, 2003, 2004 The Second Mediterranean Emergency Medicine Congress, September 13-17, 2003, Sitges/Barcelona, Spain. The European Society for Emergency Medicine the Pre -hospital Track-Speaker/Moderator EMS Ambulance Competitions: A Tool for Education, Research,and International Cooperation I co IS ;11 uw. i w40�m w � , wow ��.arenwwww rr+ow,wwwww+awww.�nwww�wwww w�.www,mom �ww.ww�ry w.wn J�a-mm�s wuoa oo aw:»www wwow-.�m.mwn sw www.aw rw ow:.ww aw waver .... 0000 ..... I ILL OD � ILL U. co DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID F16921$3 09-30-2027 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 08-19-2024 3N,4,5 GANDIA, ANTONIO LOWER KEYS MEDICAL CENTER 5900 COLLEGE RD KEY WEST, FL 33040 CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 Sections 304 and 1008 (21 USC 824 and 958) of the Controlled Substances Act of 1970, as amended, provide that the Attorney General may revoke or suspend a registration to manufacture, distribute, dispense, import or export a controlled substance. THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID BG1692183 09-30-2027 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 08-19-2024 3N,4,5 GANDIA, ANTONIO Sections 304 and 1008 (21 USC 824 and 958) of the LOWER KEYS MEDICAL CENTER Controlled Substances Act of 1970, as amended, 5900 COLLEGE RD provide that the Attorney General may revoke or KEY WEST, FL 33040 suspend a registration to manufacture, distribute, dispense, import or export a controlled substance, THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID BG1692183 09-30-2027 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 08-19-2024 3N,4,5 GANDIA, ANTONIO LOWER KEYS MEDICAL CENTER 5900 COLLEGE RD KEY WEST, FL 33040 CONTROLLED SUBSTANCE/REGULATED CHEMICAL REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 Sections 304 and 1008 (21 USC 824 and 958) of the Controlled Substances Act of 1970, as amended, provide that the Attorney General may revoke or suspend a registration to manufacture, distribute, dispense, import or export a controlled substance. THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. I I REQUESTING MODIFICATIONS TO YOUR I REGISTRATION CERTIFICATE 1 To request a change to your registered name, address, the drug i schedule or the drug codes handle, oREPORT N you please CHANGES ; 1. visit our web site at dead iversion.usdoj.gov - or 2. call our customer Service Center at 1-(800) 882-9539 - or 3. submit your change(s) in writing to: ry PROMPTLY ' Drug Enforcement Administration ' P.O. Box 2839 d f Springfield, VA 22152-2839 I I See Title 21 Code of Federal Regulations, Section 1301,51 u- ( for complete instructions. 1 _______You have been registered to handle the following chemical/drug codes_______ ALDO MANRESA, DO, FACEP amanre2@gmail.com ( 786.597.0771 WORK EXPERIENCE Baptist Health of South Florida — Miami, FL August 2019 — Present • Emergency Department Physician ■ Sepsis Chair Mount Sinai Medical Center - Miami Beach, FL August 2019 — Present Emergency Department Physician Baptist Doral Hospital - Doral, FL August 2022 — Present Emergency Department Physician Monroe County Fire Department August 2024 Present, Associate Medical. Director City of Marathon Fire Department August 2024 Present Associate Medical Director Trauma Star Air Ambulance August 2024 — Present Associate Medical Director City of Key West Fire Department January 2022 — Present Associate Medical Director North Lauderdale Fire Department October 2019 — Present Associate Medical Director Margate Fire Department October 2019 — Present Associate Medical Director DOC.com April 2020 —April 2021 Telemedicine Physician Infusion Center of Florida — Weston, FL August 2018 — July 2022 Medical Director Braxton College — Bonita Springs, FL January 2020 - Present Clinical Associate Professor - EMS MD Now Urgent Care Centers - South Florida August 2018 — July 2019 ■ Urgent Care Physician - Broward and Miami -Dade EDUCATION Mount. Sinai Medical Center — Miarni Beach, FL June 2019. Emergency Medicine Residency Touro College of Osteopathic Medicine -- New York, NY June 2016 • Doctor of Osteopathic Medicine ■ Student Government Association - President 2013-2014 • Master of Science in Biomedical Sciences June 2012 Florida International University — Miami, FL May 2011 • Bachelor of Arts in Anthropology & Sociology — Cum Laude ■ Minor in Biology ■ Certificates in Latin American & Caribbean Studies; Leadership Development Mount Sinai Medical Center — Outstanding Resident Award June 2019 Excellence in Community Outreach — Touro College of Osteopathic Medicine Spring 2014 White Croat Ceremony Class Speaker - Touro College of Osteopathic Medicine Spring 2014. "Guardian of the Profession" - American Osteopathic Association. Spring 2014 Omega Beta Iota - National Osteopathic Political Action I-lonor Society February 2014 Sigma Sigma Phi - Honorary Osteopathic Service Fraternity Spring 2013 PROFESSIONAL & ACADEMIC MEMBERSHIPS Florida EMS Medical Cares Committee Member — Sepsis August 2021 - Present The Florida Association of EMS Medical Directors August 2019 - Present American College of Emergency Physicians June 2016 — Present American Academy of Emergency Medicine June 2016 — Present Florida College of Emergency Physicians June 2016 — Present American Academy of Emergency Medicine/RSA 2015 — 2016 • Medical Student Council Regional Representative - Northeast AOA Council on Minority Health Issues — Chicago, IL May 2013 — May 2014 Osteopathic Political Action Committee — Chicago, IL July 2013 - Present Student Government Association — TOuroCOM- New York February 2013 - May 2014 New York State Osteopathic Medical Society — New York February 2013 - May 2014 RESEARCH/ PUBLICATIONS Book Chapter Manresa, A, Temple, B: Chapter 913: Stem Cells, The C'ause of Autism: Concepts and Misconceptions, Edited by Steinman, Gary, et a], New York, Baffin Press, 2014. CERTIFICATIONS & LICENSURE ABEM Emergency Medicine Board Certification April 2021 Florida Board of Osteopathic Medicine License/ DEA May 2018 BLS/PALS/ACLS Certified March 2018 PALS American American Academy_ Provider Heart of Pediatrics Association. �����"'�. 0 DEDICATED TOTHE HEALTH OF ALL CHILDREN" Aldo Manresa has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Pediatric Advanced Life Support (PALS) Program. Issue Date Renew By 3/31 /2024 03/2026 Training Center Name Instructor Name Braxton College Gregory Kaplan Instructor ID Training Center ID 06060104235 FL20957 "Card Code Training Center City, State 245427265757 Ft. Myers, FL OR Code Training Center Phone Number io (888) 983-2423 Training Site Name To view or verify authenticity, students and employers should scan this QR code with their mobile device or go to www.heart.org/cpr/mycards. O 2023 American Heart Association. All rights reserved. 20-3006 R3/23 ACLS Provider Aldo Manresa American Heart Association. has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Advanced Cardiovascular Life Support (ACLS) Program. Issue Date Renew By 3/30/2024 03/2026 Training Center Name Instructor Name Braxton College Gregory Kaplan Instructor ID Training Center ID 06060104235 FL20957 eCard Code Training Center City, State 245407265707 Ft. Myers, FL OR Code Training Center Phone Number (888) 983-2423 Training Site Name To view or verify authenticity, students and employers should scan this QR code with their mobile device or go to www.heart.org/cpr/mycards. 0 2023 American Heart Association. All rights reserved. 20-3000 R3/23 1131I...S Aldo Manresa American Heart Association. has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Basic Life Support (CPR and AED) Program. Issue Date Renew By 3/30/2024 03/2026 Training Center Name Instructor Name Braxton College Gregory Kaplan Training Center ID Instructor ID FL20957 06060104235 eCard Code Training Center City, State 245417265643 Ft. Myers, FL Training Center Phone OR Code Number (888) 983-2423 Training Site Name To view or verify authenticity, students and employers should scan this QR code with their mobile device or go to www.heart.org/cpr/mycards. 0 2023 American Heart Association. All rights reserved. 20-3001 R3/23 (D ID X < — ca 0as w 0 2 T -0 fn ca CL cn C>U, -0 co ca CD 0 > E a) c® LU 0 0 ucu > 2 C: (D ccas .00 r— a) 2 LL: :3 4- 0 CD (5 q C: u > as o C > 0- a) Ca ai (n E 'r— ca ca 0 CL >1 as cn cc 11 c as (n as 0 a) in C co 0 0 3: Co C: 0 0 — — — — — — — — — — — — — — — 32:inlVNUIS 33SN3011 9ZGZ ILE H:)MVW:ale(] uo!lejidx3 VS3HNVWuvwooa-w VONOIJ JO 31VIS 3HI JO 63-inH UNV SMVI 3H.L -AO SINM381(1038 IWIM SVH M0139 (13VIVN INVIDISAHd 31H.LVdO3.LSO 3HI — --------------------- --------- V0996 6SESL so vzoz lczkNvnNvr ON 108-LNOD ON �SN901"l 3i(l 30Wa nssv AinvnolV01031N:O N101 IAIG H1199H =10 iN3VU� lVd30 VO1201JdO 31VIS — — — — — — — — — — — — — — — — — - L — — — - — — — - 4 FBI of -i of ro- CL LU 0 z U- 0 (D 0 0 lu w CL m z (D z LU 0 C0 CL LU 0 U) Ld 'o LL Z M 1-i o 1 19 2� I LL CY co In Z) LL LU I z 01 z -<j LU 0 0) LU (,) LL 0 LL 0- W, F- z LL "no Z 0 w ui z C14 0 Q < C4 Lu CO LQ F-� C4 -j :r cl: F- - * < 0 0) m Z LU w z w LLJ Q� CL f— W Z w C) 0 z CC (L 0 0 UJ W 0 0 z 0 C) w w z w z X w �g L— --- — — — — — — — — — — — — — — — — — — — — — — — DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID FM7793222 01-31-2027 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 01-02-2024 3N,4,5 MANRESA, ALDO, O, DO BAPTIST HEALTH 8900 N KENDALL DR MIAMI, FL 33176 CONTROLLED SUBSTANCE/REGULATED CHEMICAL REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 Sections 304 and 1008 (21 USC 824 and 958) of the Controlled Substances Act of 1970, as amended, provide that the Attorney General may revoke or suspend a registration to manufacture, distribute, dispense, import or export a controlled substance. THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. I I REQUESTING MODIFICATIONS TO YOUR I REGISTRATION CERTIFICATE 1 To request a change to your registered name, address, the drug i schedule or the drug codes handle, oREPORT N you please CHANGES ; 1. visit our web site at dead iversion.usdoj.gov - or 2. call our customer Service Center at 1-(800) 882-9539 - or 3. submit your change(s) in writing to: ry PROMPTLY ' Drug Enforcement Administration ' P.O. Box 2839 d f Springfield, VA 22152-2839 I I See Title 21 Code of Federal Regulations, Section 1301,51 u_ ( for complete instructions. 1 _______You have been registered to handle the following chemical/drug codes_______ DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID FM7793222 01-31-2027 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 01-02-2024 3N,4,5 MANRESA, ALDO, O, DO BAPTIST HEALTH 8900 N KENDALL DR MIAMI, FL 33176 CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 Sections 304 and 1008 (21 USC 824 and 958) of the Controlled Substances Act of 1970, as amended, provide that the Attorney General may revoke or suspend a registration to manufacture, distribute, dispense, import or export a controlled substance. THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID FM7793222 01-31-2027 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 01-02-2024 3N,4,5 MANRESA, ALDO, O, DO Sections 304 and 1008 (21 USC 824 and 958) of the BAPTIST HEALTH Controlled Substances Act of 1970, as amended, 8900 N KENDALL DR provide that the Attorney General may revoke or MIAMI, FL 33176 suspend a registration to manufacture, distribute, dispense, import or export a controlled substance, THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. U C 4 N d V X W L low d N LO r0 r o) O Q) M r Ln t0 O (p I� O N 0 co 'IT c� i o M L / M (� r O r ca >- r Cl) m N r 42 N LLLL ka K} {f} EA {f} r LO N d' (D 0 (p Cl) 0 cf) LO co 0 co W (O O N 0 rn co N o N L / CM r- r O (D (D C o } O r V- N U. {f} F!} tf} {f} fA O LO 00 00 � O co GM o r: O N 0 0 o � o M �- a7 O M (V (�0 (Q0 •y F}} K} 164 K} 'Eq Ci LO d r (D 0 (p NO 0 LO dT rn 0 m W N 0 dN d cm o co O r ca a) N ((DD (`n0 0� o O i' r N r LPL {fi iii o Co LO N r O r (V r co 0 0 0 Cl) O N O O N 0) M (D O 0 Cv (p L. i NT N O N ca N (DD 0 d ((DD ( N ) i' r r N LLLL {/} tq tq EA EA' LO r o) O 0 O N o rn Ln Uf o N N 0 © i° L.LLO f o M L d N (D N Or (0 * C(D i' N r V LLLL ka tq tq EA EA' (p O O 00 00 OO N r- o L N (D co o Lfi O p Ln ca a) Lh N r N (D (D Nt N 0 r l Cl) r N LLL EF} 4-1} tit y} ER N O O tea C � Z qi r CL a 0. 0. U Q U= M w aEi O N O 0 4 Q E = 4 c c E U 4 Q y Q a1 w C9 "EXHIBIT D" HIPAA Business Associate Addendum 1. PREAMBLE AND DEFINITIONS. 1.1 Pursuant to the Health Insurance Portability and Accountability Act of 1996, as amended ("HIPAA"), Monroe County, a political subdivision of the State of Florida, through its Board of County Commissioners, (the "County"), the Board of Governors of the Fire and Ambulance District 1 of Monroe County, Florida, a municipal services taxing unit established under Florida law and codified in Section 22-129, Monroe County Code of Ordinances, with a principal address being the same as the County ("BOG'), and Antonio Gandia, M.D. , ("Business Associate"), agree to this Business Associate Addendum ("BAA") as of the effective date of the underlying agreement between the parties (the "Effective Date") that addresses the HIPAA requirements with respect to "business associates," as defined under the privacy, security, breach notification, and enforcement rules at 45 C.F.R. Part 1.60 and Part 1.64 ("HIPAA Rules"). A reference in this BAA to a section in the HIPAA Rules means the section as in effect or as amended. 1.2 This BAA is intended to ensure that Business Associate will establish and implement appropriate safeguards for the Protected Health Information ("PHI") (as defined under the HIPAA Rules) that Business Associate may receive, create, maintain, use, or disclose in connection with the functions, activities, and services that Business Associate performs for Covered Entity. The functions, activities, and services that Business Associate performs for Covered Entity are defined in AGREEMENT between MONROE COUNTY, FL and Antonio Gandia, M.D. for Medical Director services pursuant to RFQ4 588 (the "Underlying Agreement"). 1.3 Pursuant to changes required under the Health Information Technology for Economic and Clinical Health Act of 2009 (the "HITECH Act") and under the American Recovery and Reinvestment Act of 2009 ("ARRA"), this BAA also reflects federal breach notification requirements imposed on Business Associate when "Unsecured PHI" (as defined under the HIPAA Rules) is acquired by an unauthorized party, and the expanded privacy and security provisions imposed on business associates. 1.4 Unless the context clearly indicates otherwise, the following terms in this BAA shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, disclosure, Electronic Media, Electronic Protected Health Information (ePHI), Health Care Operations, individual, Minimum Necessary, Notice of Privacy Practices, Required By Law, Secretary, Security Incident, Subcontractor, Unsecured PHI, and use. 1.5 A reference in this BAA to the Privacy Rule means the Privacy Rule, in conformity with the regulations at 45 C.F.R. Parts 160-164 (the "Privacy Rule") as interpreted under applicable regulations and guidance of general application published by HHS, including all amendments thereto for which compliance is required, as amended by the HITECH Act, ARRA, and the HIPAA Rules. 2. GENERAL OBLIGATIONS OF BUSINESS ASSOCIATE. 2.1 Business Associate agrees not to use or disclose PHI, other than as permitted or required by this BAA or as Required By Law, or if such use or disclosure does not otherwise cause a Breach of Unsecured. PHI. 2.2 Business Associate agrees to use appropriate safeguards, and comply with Subpart C of 45 C.F.R. Part 164 with respect to ePHI, to prevent use or disclosure of PHI other than as provided for by the BAA. 2.3 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate as a result of a use or disclosure of PHI by Business Associate in violation of this BAA's requirements or that would otherwise cause a Breach of Unsecured PHI. 2.4 The Business Associate agrees to the following breach notification requirements: (a) Business Associate agrees to provide notification of any Breach of Unsecured PHI of which it becomes aware, as required under 45 C.F.R. § 164.410, and any Security Incident of which it becomes aware, in violation of this BAA to individuals, the media (as defined under the HITECH Act), the Secretary, and/or any other parties as required under HIPAA, the HITECH Act, ARRA, and the HIPAA Rules, subject to the prior review and written approval by Covered Entity of the content of such notification. (b) In the event of Business Associate's use or disclosure of Unsecured PHI in violation of HIPAA, the HITECH Act, or ARRA, Business Associate bears the burden of demonstrating that notice as required under this Section 2.4 was made, including evidence demonstrating the necessity of any delay, or that the use or disclosure did not constitute a Breach of Unsecured PHI. 2.5 Business Associate agrees, in accordance with 45 C.F.R. §§ 164.502(e)(1)(11) and 164.308(b)(2), if applicable, to require that any Subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information. 2.6 Business Associate agrees to make available PHI in a Designated Record Set to the Covered Entity as necessary to satisfy Covered Entity's obligations under 45 C.F.R. § 164.524. (a) Business Associate agrees to comply with an individual's request to restrict the disclosure of their personal PHI in a manner consistent with 45 C.F.R. § 164.522, except where such use, disclosure, or request is required or permitted under applicable law. (b) Business Associate agrees to charge fees related to providing individuals access to their PHI in accordance with 45 C.F.R. § 164.524(c)(4). (c) Business Associate agrees that when requesting, using, or disclosing PHI in accordance with 45 C.F.R. § 164.502(b)(1) that such request, use, or disclosure shall be to the minimum extent necessary, including the use of a "limited data set" as defined in 45 C.F.R. § 164.514(e)(2), to accomplish the intended purpose of such request, use, or disclosure, as interpreted under related guidance issued by the Secretary from time to time. 2.7 Business Associate agrees to make any amendments to PHI in a Designated Record Set as directed or agreed to by the Covered Entity pursuant to 45 C.F.R. § 164.526, or to take other measures as necessary to satisfy Covered Entity's obligations under 45 C.F.R. § 164.526. 2.8 Business Associate agrees to maintain and make available the information required to provide an accounting of disclosures to the Covered Entity as necessary to satisfy Covered Entity's obligations under 45 C.F.R. § 164.528. 2.9 Business Associate agrees to make its internal practices, books, and records, including policies and procedures regarding PHI, relating to the use and disclosure of PHI and Breach of any Unsecured PHI received from Covered Entity, or created or received by the Business Associate on behalf of Covered Entity, available to Covered Entity (or the Secretary) for the purpose of Covered Entity or the Secretary determining compliance with the Privacy Rule (as defined in Section 8). 2.10 To the extent that Business Associate is to carry out one or more of Covered Entity's obligation(s) under Subpart E of 45 C.F.R. Part 164, Business Associate agrees to comply with the requirements of Subpart E that apply to the Covered Entity in the performance of such obligation(s). 2.11 Business Associate agrees to account for the following disclosures: (a) Business Associate agrees to maintain and document disclosures of PHI and Breaches of Unsecured PHI and any information relating to the disclosure of PHI and Breach of Unsecured. PHI in a manner as would be required for Covered Entity to respond to a request by an individual or the Secretary for an accounting of PHI disclosures and Breaches of Unsecured PHI. (b) Business Associate agrees to provide to Covered Entity, or to an individual at Covered Entity's request, information collected in accordance with this Section 2.11, to permit Covered Entity to respond to a request by an individual or the Secretary for an accounting of PHI disclosures and Breaches of Unsecured PHI. (c) Business Associate agrees to account for any disclosure of PHI used or maintained as an Electronic Health Record (as defined in Section 5) ("EHR") in a manner consistent with 45 C.F.R. § 164.528 and related guidance issued by the Secretary from time to time; provided that an individual shall have the right to receive an accounting of disclosures of EHR by the Business Associate made on behalf of the Covered Entity only during the three years prior to the date on which the accounting is requested from Covered Entity or directly from the Business Associate, whichever is later. (d) In the case of an EHR that the Business Associate acquired on behalf of the Covered Entity as of January 1, 2009, paragraph (c) above shall apply to disclosures with respect to PHI made by the Business Associate from such EHR on or after January 1, 2014. In the case of an EHR that the Business Associate acquires on behalf of the Covered Entity after January 1, 2009, paragraph (c) above shall apply to disclosures with respect to PHI made by the Business Associate from such EHR on or after the later of January 1, 2011, or the date that it acquires the EHR. 2.12 Business Associate agrees to comply with the "Prohibition on Sale of Electronic Health Records or Protected Health Information," as provided in Section 13405(d) of Subtitle D (Privacy) of ARRA, and the "Conditions on Certain Contacts as Part of Health Care Operations," as provided in Section 13406 of Subtitle D (Privacy) of ARRA and related guidance issued by the Secretary from time to time. 2.13 Business Associate acknowledges that, effective on the Effective Date of this BAA, it shall be liable under the civil and criminal enforcement provisions set forth at 42 U.S.C. § 1.320d-5 and 1320d-6, as amended, for failure to comply with any of the use and disclosure requirements of this BAA and any guidance issued by the Secretary from time to time with respect to such use and. disclosure requirements. 3. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE. 3.1 General Uses and Disclosures. Business Associate agrees to receive, create, use, or disclose PHI only in a manner that is consistent with this BAA, the Privacy Rule, or Security Rule (as defined in Section 5), and only in connection with providing services to Covered Entity; provided that the use or disclosure would not violate the Privacy Rule, including 45 C.F.R. § 164.504(e), if the use or disclosure would be done by Covered Entity. For example, the use and disclosure of PHI will be permitted for "treatment, payment, and health care operations," in accordance with the Privacy Rule. 3.2 Business Associate may use or disclose PHI as Required By Law. 3.3 Business Associate agrees to make uses and disclosures and requests for PHI: Consistent with Covered Entity's Minimum Necessary policies and procedures established by the Standard Operating Procedures adopted by in the Monroe County Fire Rescue Department, as may be amended from time to time. 3.4 Business Associate may not use or disclose PHI in a manner that would violate Subpart E of 45 C.F.R. Part 164 if done by the Covered Entity. 4. OBLIGATIONS OF COVERED ENTITY. 4.1 Covered Entity shall: (a) Provide Business Associate with the Notice of Privacy Practices that Covered Entity produces in accordance with the Privacy Rule, and any changes or limitations to such notice under 45 C.F.R. § 164.520, to the extent that such changes or limitations may affect Business Associate's use or disclosure of PHI. (b) Notify Business Associate of any restriction on the use or disclosure of PHI that Covered Entity has agreed to or is required to comply with under 45 C.F.R. § 164.522, to the extent that such restriction may affect Business Associate's use or disclosure of PHI under this BAA. (c) Notify Business Associate of any changes in or revocation of permission by an individual to use or disclose PHI, if such change or revocation may affect Business Associate's permitted or required uses and disclosures of PHI under this BAA. 4.2 Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy and Security Rule if done by Covered Entity, except as provided under Section 3 of this BAA. 5. COMPLIANCE WITH SECURITY RULE. 5.1 Business Associate shall comply with the HIPAA Security Rule, which shall mean the Standards for Security of Electronic Protected Health Information at 45 C.F.R. Part 160 and Subparts A and C of Part 164, as amended by ARRA and the HITECH Act. The term "Electronic Health Record" or "EHR" as used in this BAA shall mean an electronic record of health -related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff. 5.2 Iin accordance with the Security Rule, Business Associate agrees to: (a) Implement the administrative safeguards set forth at 45 C.F.R. § 164.308, the physical safeguards set forth at 45 C.F.R. § 164.310, the technical safeguards set forth at 45 C.F.R. § 164.312, and the policies and procedures set forth at 45 C.F.R. § 164.316, to reasonably and appropriately protect the confidentiality, integrity, and availability of the ePHI that it creates, receives, maintains, or transmits on behalf of Covered Entity as required by the Security Rule. Business Associate acknowledges that, effective on the Effective Date of this BAA, (a) the foregoing safeguards, policies, and procedures requirements shall apply to Business Associate in the same manner that such requirements apply to Covered Entity, and (b) Business Associate shall be liable under the civil and criminal enforcement provisions set forth at 42 U.S.C. § 1320d-5 and 1320d-6, as amended from time to time, for failure to comply with the safeguards, policies, and procedures requirements and any guidance issued by the Secretary from time to time with respect to such requirements; (b) Require that any agent, including a Subcontractor, to whom it provides such PHI agrees to implement reasonable and appropriate safeguards to protect the PHI; and (c) Report to the Covered Entity any Security Incident of which it becomes aware. 6. INDEMNIFICATION. The parties agree and acknowledge that except as set forth herein, the indemnification obligations contained under the Underlying Agreement shall govern each party's performance under this BAA. 7. TERM AND TERMINATION. 7.1 This BAA shall be in effect as of the date set forth in the underlying agreement, and shall terminate on the earlier of the date that: (a) Either party terminates for cause as authorized tinder Section 7.2. (b) All of the PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity. If it is not feasible to return or destroy PHI, protections are extended in accordance with Section 7.3. 7.2 Upon either party's knowledge of material breach by the other party, the non -breaching party shall provide an opportunity for the breaching party to cure the breach or end the violation; or terminate the BAA. If the breaching party does not cure the breach or end the violation within a reasonable timeframe not to exceed seven (7) days from the notification of the breach, or if a material term of the BAA has been breached and a cure is not possible, the non -breaching parry may terminate this BAA and the Underlying Agreement, upon written notice to the other party. 7.3 Upon termination of this BAA for any reason, the parties agree that: Business associate shall return to Covered Entity all PHI received from Covered Entity, or created, maintained, or received by Business Associate on behalf of Covered Entity, that the Business Associate still maintains in any farm. The PHI shall be returned in a format that is reasonably expected to preserve its accessibility and usability. Business Associate shall retain no copies of the PH1. 7.4 The obligations of Business Associate under this Section 7 shall survive the termination of this BAA. 8. MISCELLANEOUS. 8.1 The parties agree to take such action as is necessary to amend this BAA to comply with the requirements of the Privacy Rule, the Security Rule, HIPAA, ARRA, the HITECH Act, the Consolidated Appropriations Act, 2021 (CAA-21), the HIPAA Rules, and any other applicable law. 8.2 The respective rights and obligations of Business Associate under Section 6 and Section 7 of this BAA shall survive the termination of this BAA. 8.3 This BAA shall be interpreted in the following manner: (a) Any ambiguity shall be resolved in favor of a meaning that permits Covered Entity to comply with the HIPAA Rules. (b) Any inconsistency between the BAA's provisions and the HIPAA Rules, including all amendments, as interpreted by the HHS, a court, or another regulatory agency with authority over the Parties, shall be interpreted according to the interpretation of the HHS, the court, or the regulatory agency. (c) Any provision of this BAA that differs from those required by the HIPAA Rules, but is nonetheless permitted by the HIPAA Rules, shall be adhered to as stated in this BAA. 8.4 This BAA constitutes the entire agreement between the parties related to the subject matter of this BAA, except to the extent that the Underlying Agreement imposes more stringent requirements related to the use and protection of PHI upon Business Associate. This BAA supersedes all prior negotiations, discussions, representations, or proposals, whether oral or written. This BAA may not be modified unless done so in writing and signed by a duly authorized representative of both parties. If any provision of this BAA, or part thereof, is found to be invalid, the remaining provisions shall remain in effect. 8.5 This BAA will be binding on the successors and assigns of the Covered Entity and the Business Associate. However, this BAA may not be assigned, in whole or in part, without the written consent of the other parry. Any attempted assignment in violation of this provision shall be null and void. 8.6 This BAA may be executed in two or more counterparts, each of which shall be deemed an original. 8.7 Except to the extent preempted by federal law, this BAA shall be governed by and construed in accordance with the same internal laws as that of the Underlying Agreement. [End of Addendum] "EXHIBIT E" Mandatory Federal Provisions Addendum MONROE COUNTY FEMA PUBLIC ASSISTANCE PROGRAM REQUIRED CONTRACT CLAUSES This Addendum is incorporated by this reference into the Agreement between the Contractor and the County (the "Contract") as "Exhibit E." It includes contract clauses that amend, delete or modify provisions of the Contract. All contract clauses that are not so amended, deleted or modified shall remain in full force and effect. To the extent of any conflict between the contract clauses set forth in this Exhibit and other contract clauses set forth in the Contract, the contract clauses of this Exhibit shall control. 1) APPENDIX 11 TO 2 C.F.R. PART 200 (if applicable) The Contractor and its subcontractors must follow the provisions, as applicable, as set forth in 2 C.F.R. §200.326 Contract provisions and Appendix II to 2 C.F.R. Part 200, as amended. 2) FEDERAL E-VERIFY The Contractor shall utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the Contractor during the term of the Contract and shall expressly require any subcontractors performing work or providing services pursuant to the Contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the Contract term. 3) MAINTENANCE OF RECORDS Contractor 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 seven (7) years from the termination of this agreement or for a period of three (3) years from the submission of the final expenditure report as per 2 CFR §200.334, whichever is greater. Each party to this Agreement or its authorized representatives shall have reasonable and timely access to such records of each other parry to this Agreement for public records purposes during the term of the Agreement and for seven years following the termination of this Agreement. 4) REMEDIES FOR BREACH. (2 C.F.R. PART 200, APPENDIX II (A)) In addition to all other remedies included in this Contract, Contractor shall, at a minimum, be liable to the County for all foreseeable damages it incurs as a result of Contractor violation or breach of the terms of this Contract. This includes without limitation, any cost incurred to remediate defects in Contactor's services and/or the additional expenses to complete Contractor's services beyond the amounts agreed to in this contract, after Contractor has had a reasonable opportunity to remediate and/or complete its services as otherwise set forth in this contract. All remedies provided for in this Contract may be exercised individually or in combination with any other remedy available hereunder or under applicable laws, rules and regulations. The exercise of any remedy shall not preclude or in any way be deemed to waive any other remedy. I 5) EQUAL EMPLOYMENT OPPORTUNITY. (2 C.F.R. PART 200, APPENDIX II (C)) During the performance of this Agreement, the Contractor agrees as follows: a. The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. b. The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual. orientation, gender identity, or national origin. c. The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. d. The contractor will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the labor union or workers' representative of the contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. e. The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. f. The contractor will furnish all information and reports required by Executive Order 1.1.246 of September 24, 1965, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. 2 g. In the event of the contractor's non-compliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, or orders, this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. h. The contractor will include the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as may be directed by the Secretary of Labor as a means of enforcing such provisions including sanctions for noncompliance: Provided, however, that in the event the contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction, the contractor may request the United States to enter into such litigation to protect the interests of the United States. Each nonexempt prime contractor or subcontractor shall include the equal opportunity clause in each of its nonexempt subcontracts. The equal opportunity clause shall be considered to be a part of every contract and subcontract required by the order and the regulations to include such a clause whether or not it is physically incorporated in such contracts and whether or not there is a written contract. 6) FURTHER COMPLIANCE WITH THE CONTRACT WORK HOURS AND SAFETY STANDARDS ACT. a) The contractor or subcontractor must maintain regular payrolls and other basic records during the course of the work and must preserve them for a period of three years after all the work on the prime contract is completed for all laborers and mechanics, including guards and watch persons, working on the contract. Such records must contain the name; last known address, telephone number, and email address; and social security number of each such worker; each worker's correct classification(s) of work performed; hourly rates of wages paid; daily and weekly number of hours actually worked; deductions made; and actual wages paid. b) Records to be maintained under this provision must be made available by the contractor or subcontractor for inspection, copying, or transcription by authorized representatives of the Department of Homeland Security, the Federal Emergency Management Agency, and the Department of Labor, and the contractor or subcontractor will permit such representatives to interview workers during working hours on the job. 7) CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT. Contractor agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean. Air Act, as amended (42 U.S.C. §§7401 c,lsic r.) and the Federal Water Pollution. Control Act, as amended (33 U.S.C. §§1.251 et seq.) and will report violations to FEMA/Federal. Agency and the appropriate Regional Office of the Environmental Protection Agency (EPA). The Clean 3 Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251- 1387), as amended, applies to Contracts and subgrants of amounts in excess of $150,000. The contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA/Federal agency. The contractor agrees to report each violation to the County and understands and agrees that the County will, in turn, report each violation as required to assure notification to FEMA/Federal Agency and the appropriate EPA Regional Office. 8) DEBARMENT AND SUSPENSION (Executive Orders 12549 and 12689). A contract award under a "covered transaction" (see 2 CFR 180.220) must not be made to parties listed on the governmentwide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR Part 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension" and the Department of Homeland Security's regulations at 2 C.F.R. Part 3000 (Non - procurement Debarment and suspension). SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 1.2549. SAM exclusions can be accessed at www.sam.gov. This contract is a covered transaction for purposes of 2 C.F.R. Part 1.80 and 2 C.F.R. Part 3000. Contractor is required to verify that none of the contractor's principals (defined at C.F.R. §1.80.935) or its affiliates (defined at 2 C.F.R. §180.905) are excluded (defined at 2 C.F.R. §180.940) or disqualified (defined at 2 C.F.R. §180.935). The contractor must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into. This certification is a material representation of fact relied upon by the County. If it is later determined that the contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the County, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. Bidders or Proposers agree to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The Bidder or Proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions. 9) BYRD ANTI -LOBBYING AMENDMENT (31 U.S.C. 1352). Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. § 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the recipient who in turn will forward the certification(s) to the awarding agency. Non -Federal award. If award exceeds $100,000, the required certification must be signed and submitted by the contractor to the County. 91 10) PROCUREMENT OF RECOVERED MATERIALS. (2 C.F.R. § 200.323) a) Contractor must comply with section 6002 of the Solid Waste Disposal Act, as amended, by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 C.F.R part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA -designated items unless the product cannot be acquired: (1) Competitively within a timeframe providing for compliance with the contract performance schedule; (2) Meeting contract performance requirements; or (3) At a reasonable price. b) Information about this requirement, along with the list of EPA -designated items, is available at EPA's Comprehensive Procurement Guidelines web site, agrees to comply with all other applicable c The Contractor also cable requirements of Section 6002 of the Solid Waste Disposal Act. The Contactor should, to the greatest extent practicable and consistent with the law, purchase, acquire, or use products and services that can be reused, refurbished, or recycled; contain recycled content, are biobased, or are energy and water efficient; and are sustainable. 11) PROHIBITION ON CONTRACTING FOR COVERED TELECOMMUNICATIONS EQUIPMENT OR SERVICES. (2 C.F.R. § 200.216) a) Definitions. As used in this clause, the terms backhaul; covered foreign country; covered telecommunications equipment or services; interconnection arrangements; roaming; substantial or essential component; and telecommunications equipment or services have the meaning as defined in FEMA Policy 405-143-1, Prohibitions on Expending FEMA Award Funds for Covered Telecommunications Equipment or Services, as used in this clause. b) Prohibitions. i) Section 889(b) of the John S. McCain National Defense Authorization Act for Fiscal Year2019, Pub. L. No. 115-232, and 2 C.E.R. § 200.216 prohibit the head of an executive agency on or after Aug.13, 2020, from obligating or expending grant, cooperative agreement, loan, or loan guarantee funds on certain telecommunications products or from certain entities for national security reasons. ii) Unless an exception in paragraph (c) of this clause applies, the contractor and its subcontractors may not use grant, cooperative agreement, loan, or loan guarantee funds from the Federal Emergency Management Agency to: (�1) Procure or obtain any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology of any system; 5 (2) Enter, extend, or renew a contract to procure or obtain any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology of any system; (3) Enter, extend, or renew contracts with entities that use covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system; or (4) Provide, as part of its performance of this contract, subcontract, or other contractual instrument, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. c) Exceptions. i) This clause does not prohibit contractors from providing: (1) A service that connects to the facilities of a third -party, such as backhaul, roaming, or interconnection arrangements; or (2) Telecommunications equipment that cannot route or redirect user data. traffic or permit visibility into any user data or packets that such. equipment transmits or otherwise handles. ii) By necessary implication and regulation, the prohibitions also do not apply to: (l) Covered telecommunications equipment or services that: a. Are not used as a substantial or essential component of any system; and b. Are not used as critical technology of any system. (2) Other telecommunications equipment or services that are not considered covered telecommunications equipment or services. d) Reporting requirement. i) In the event the contractor identifies covered telecommunications equipment or services used as a substantial or essential component of any system, or as critical technology as part of any system, during contract performance, or the contractor is notified of such by a subcontractor at any tier or by any other source, the contractor shall report the information in paragraph (d)(2) of this clause to the recipient or subrecipient, unless elsewhere in this contract are established procedures for reporting the information. ii) The Contractor shall report the following information pursuant to paragraph (d)(1) of this clause: (1) Within one business day from the date of such identification or notification: The contract number; the order number(s), if applicable; supplier name; supplier unique entity identifier (if known); supplier Commercial and Government Entity (CAGE) code (if known); brand; model number (original equipment manufacturer number, manufacturer part number, or wholesaler number); item description; and any readily available information about mitigation actions undertaken or recommended. (2) Within 10 business days of submitting the information in paragraph (d)(2)(i) of this clause: Any further available information about mitigation actions undertaken or recommended. In addition, the contractor shall describe the efforts it undertook to prevent use or submission of covered telecommunications equipment or services, and any additional efforts that will be incorporated to prevent future use or submission of covered telecommunications equipment or services. 6 e) Subcontracts. The Contractor shall insert the substance of this clause, including this paragraph (e), in all subcontracts and other contractual instruments. 12) DOMESTIC PREFERENCE FOR PROCUREMENTS AS SET FORTH IN 2 CFR §200.322. a) Contractor should, to the greatest extent practicable, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). These requirements of this section must be included in all subawards including contracts and purchase orders for work or products under federal award. b) For purposes of this section: i) "Produced in the United States" means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. ii) "Manufactured products" means items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer -based products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber." 13) AMERICANS WITH DISABILITIES ACT OF 1990, AS AMENDED (ADA). The Contractor will comply with all the requirements as imposed by the ADA, the regulations of the Federal government issued thereunder, and the assurance by the Contractor pursuant thereto. 14) ENERGY EFFICIENCY - (IF APPLICABLE). Contractor will comply with the Energy Policy and Conservation Act (P.L. 94-163; 42 U.S.C. 6201-6422) and with all mandatory standards and policies relating to energy efficiency and the provisions of the state Energy Conservation Plan adopted pursuant thereto. 15) RIGHTS TO INVENTIONS MADE UNDER A CONTRACT OR AGREEMENT. If the Federal award meets the definition of "funding agreement" under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that "funding agreement," the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Finns Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. 16) ACCESS TO RECORDS. Contractor/Consultant and their successors, transferees, assignees, and subcontractors acknowledge and agree to comply with applicable provisions governing the Department of Homeland Security (DHS) and the Federal Emergency Management Agency's (FEMA) access to records, accounts, documents, information, facilities, and staff. Contractors/Consultants must 1. cooperate with any compliance review or complaint investigation conducted by DHS; 2. Give DHS access to and the right to examine and copy records, accounts, and other documents and sources of information related to the grant and permit access to facilities, personnel, and other individuals and information as may be necessary, as required by DHS regulations and other applicable laws or 7 program guidance; 3. Submit timely, complete, and accurate reports to the appropriate DHS officials and maintain appropriate backup documentation to support the reports. In compliance with the Disaster Recovery Act of 2018, the County and the Contractor acknowledge and agree that no language in this contract is intended to prohibit audits or internal reviews by the FEMA Administrator or the Comptroller General of the United States. The Contractor agrees to Monroe County, the FEMA Administrator, the Comptroller General of the United States, or any of their authorized representatives access to any books, documents, papers, and records of the Contractor which are directly pertinent to this contract for the purposes of making audits, examinations, excerpts, and transcriptions. The Contractor agrees to permit any of the foregoing parties to reproduce by any means whatsoever or to copy excerpts and transcriptions as reasonably needed. The Contractor agrees to provide the FEMA Administrator or his authorized representatives access to construction or other work sites pertaining to the work being completed under the contract. 1.7) CONTRACT CHANGES OR MODIFICATIONS. The Contractor understands and agrees that any cost resulting from a change or modification, change order, or constructive change of the agreement must be within the scope of any Federal grant or cooperative agreement that may fund this Project and be reasonable for the completion of the Project. Any contract change or modification, change order or constructive change must be approved in. writing by both the County and. Contractor. 18) DHS SEAL, LOGO, AND FLAGS. Contractor must obtain written permission from DHS prior to using the DHS seals, logos, crests, or reproductions of flags, or likenesses of DHS agency officials. This includes use of DHS component (e.g., FEMA, CISA, etc.) seals, logos, crests, or reproductions of flags, or likenesses of component officials. The Contractor shall include this provision in any subcontracts. 19) COMPLIANCE WITH FEDERAL LAW, REGULATIONS, AND EXECUTIVE ORDERS. This is an acknowledgement that FEMA financial assistance may be used to fund all or a portion of the contract. The contractor will comply will all applicable Federal Law, regulations, executive orders, FEMA policies, procedures, and directives. 20) NO OBLIGATION BY FEDERAL GOVERNMENT. The Federal Government is not a parry to this contract and is not subject to any obligations or liabilities to the County/non-Federal entity, contractor, or any other parry pertaining to any matter resulting from the contract. 21) PROGRAM FRAUD AND FALSE OR FRAUDULENT STATEMENTS OR RELATED ACTS If applicable, the contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor's actions pertaining to this contract. 22) SOCIOECONOMIC CONTRACTING The Contractor is encouraged to take all necessary steps identified in 2 C.F.R. § 200.321(b)(1)-(5) to ensure small businesses, minority businesses, women's business enterprises, veteran -owned businesses, and labor surplus area firms are considered when possible. N. 23) COPYRIGHT The Contractor grants to the (insert name of the recipient or subrecipient), a paid -up, royalty -free, nonexclusive, irrevocable, worldwide license in data first produced in the performance of this contract to reproduce, publish, or otherwise use, including prepare derivative works, distribute copies to the public, and perform publicly and display publicly such data. For data required by the contract but not first produced in the performance of this contract, the Contractor will identify such data and grant to the (insertname of the recipient or subrecipient) or acquires on its behalf a license of the same scope as for data first produced in the performance of this contract. Data, as used herein, shall include any work subject to copyright under 17 U.S.C. § 102, for example, any written reports or literary works, software and/or source code, music, choreography, pictures or images, graphics, sculptures, videos, motion pictures or other audiovisual works, sound and/or video recordings, and architectural works. Upon or before the completion of this contract, the Contractor will deliver to the (insert name of the recipient or subrecipient) data first produced in the performance of this contract and data required by the contract but not first produced in the performance of this contract in formats acceptable by the (insert name of the recipient or subrecipient). 24) PROVIDING GOOD, SAFE JOBS TO WORKERS Creating Good Jobs. Pursuant to FEMA Infonnation Bulletin No. 520, the contractor will comply with all applicable federal labor and employment laws. To maximize cost efficiency and quality of work, the contractor commits to strong labor standards and protections for the project workforce by creating an effective plan for ensuring high -quality jobs and complying with federal labor and employment laws. The contractor acknowledges applicable minimum wage, overtime, prevailing wage, and health and safety requirements, and will incorporate Good Jobs Principles wherever appropriate and to the greatest extent practicable. [End of Addendum] Y Nautilus Insurance Company ,An )Axizoria C"orporatiori. EMERGENCY MEDICAL SERVICES MEDICAL DIRECTORS PROFESSIONAL LIABILITY AND GENERAL LIABILITY INSURANCE POLICY This Policy consists of: * Declarations Page * Applicable Coverage Sections * Endorsements In Witness Whereof, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative. W. Robert Berkley, Jr. President Service Office: 550 W Jackson Blvd, Suite 500 Chicago, IL 60661 Toll Free (844) 466-6266 Fax (312) 207-1933 J'A 81-71KLEY COMPAMe EMD-7002-0720-NIC Philip S. Welt Secretary Administrative Office: 7233 East Butherus Drive Scottsdale, AZ 85260-2410 Telephone (480) 951-0905 Fax (480) 281 -0910 ill; ,, r * ; ;w Emergency Medical Services Medical Directors i$ f i nM Liabifity and General LialW111111ty Insurance Pol iii NOTICE: THIS POLICY PROVIDES COVERAGE ON A CLAIMS MADE AND REPORTED BASIS SUBJECT TO ITS TERMS. THIS POLICY APPLIES ONLY TO ANY CLAIM FIRST MADE AGAINST THE INSUREDS AND REPORTED TO THE INSURER DURING THE POLICY PERIOD OR ANY EXTENDED REPORTING PERIOD THAT MAY APPLY. PLEASE READ AND REVIEW THE POLICY CAREFULLY AND DISCUSS THE COVERAGE WITH YOUR INSURANCE AGENT OR BROKER. Whenever printed in this Declarations Page, the boldface type terms shall have the same meanings as indicated in the Policy. Item 1. Name and Address of Named Insured: Policy Number: EMD-1992869-P4 Antonio Gandia, MD PA 1080 SW 42nd Ave. Deerfield Beach, FL 33442 Item 2. Policy Period: From January 1, 2025 (inception date) to January 1, 2026 (expiration date) (Both dates at 12:01 a.m. Standard Time at the address of the Named Insured) Item 3. Limits of Liability for the Policy Period: A. EMD Medical Directors Error and Omissions Coverage: $1,000,000 each Claim B. EMD Medical Directors General Liability Coverage: $1,000,000 each Occurrence C. Policy Aggregate: $3,000,000 all Claims / Occurrences Item 4. RETROACTIVE DATE: A. EMD Medical Directors Error and Omissions Coverage: January 01, 2022 B. EMD Medical Directors General Liability Coverage: January 01, 2022 If a date is indicated, this insurance will not apply to any act, error, omission, medical professional injury or Occurrence that occurred before such date. Item 5. Deductible: $0 each and every Claim Item 6. Premium: $3,600 Terrorism coverage is included for $0 Item 7. Forms and Endorsements attached at inception: EMD 7000-(04-16)-N 1 028-OFAC (03-16) Trade and Economic Sanctions 2 265- 0220 Policyholder Disclosure — Notice of Terrorism Insurance Coverage 3 266- (02/20) Cap on Losses from Certified Acts of Terrorism 4 701-CR- 0419 CLAIM REPORTING PROCEDURES 5 EMD 000901 (09-15) Policyholder Notice 6 EMD 000902 (09-15) Minimum Earned Premium Endorsement 7 EMD 500902- 0920-NF Mobile Intravenous Services Excluded 8 NIC-E906- 0821 Service of Suit EMD 7001 (04-16)-N Producer: Tom James Page 1 of 2 bT. "Is I M. Imam mao m I 1 m a i m- ra --r; m, a a W m m a H Usm, I w m- "M UTRUMEM Sincerely,, 7) 00 0 �kntwwituir.ne6ndi M.D. mlt ".11 Y� 11 2111111,111 "1 knom I I IN REQUEST FOR WAIVER OF INSURANCE REQUIREMENTS It is requested that the insurance requirements, as specified in the County's Schedule of Insurance Requirements, be waived or modified on the following contract. Antonio Gandia, M.D> Contractor/Vendor: Medical Director Contract Project or Service: Contractor/Vendor 1080 SW 42nd Ave Address & Phone 4: Deerfield Beach, FL 33442 General Scope or Work: Medical Director Services Reason for Waiver or Contracted Medical Director receives medical malpractice Modification: coverage through existing insurance policies maintained by the County. Also covered under existing auto and general liability policies as County employee Policies Waiver or Modification will apply to: Auto/General Liability; Additional Insured Requirements Signature of Contractor/Vendor: Date: 08/26/25 Approved Not Approved ❑ Digitally signed by Gaelan P Jones Risk Management Signature:_ Date: P Jones Date: 2025.08.26 15:59:59 -04'00' Date: County Administrator appeal: Approved: -F] Not Approved: Date: Board of County Commissioners appeal: Approved: 11 Not Approved: Meeting Date: CERTIFICATE OF COVERAGE Certificate Holder Administrator Issue Date 1/27/25 Monroe County Board of County Commissioners Florida League of Cities, Inc. 1111 12th Street Suite 408 Department of Insurance Services P.O. Box 538135 Key West, FL 33040 Orlando, Florida 32853-8135 COVERAGES THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED TO THE DESIGNATED MEMBER FOR THE COVERAGE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED HEREIN IS SUBIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FMIT 0386 COVERAGE PERIOD: FROM 10/1/24 COVERAGE PERIOD: TO 10/1/25 12:01 AM STANDARD TIME TYPE OF COVERAGE - LIABILITY TYPE OF COVERAGE - PROPERTY General Liability ❑ Buildings ❑ Miscellaneous ❑X Comprehensive General Liability, Bodily Injury, Property Damage, ❑ Basic Form ❑ Inland Marine Personal Injury and Advertising Injury ❑ Special Form ❑ Electronic Data Processing ® Errors and Omissions Liability ❑ Personal Property ❑ Bond ® Employment Practices Liability ❑ Basic Form ® Employee Benefits Program Administration Liability Special Form ® Medical Attendants%Medical Directors' Malpractice Liability nAgreed Amount ® Broad Form Property Damage nDeductible N/A ❑ Law Enforcement Liability ❑ Coinsurance N/A ® Underground, Explosion & Collapse Hazard ❑ Blanket Limits of Liability ❑ Specific * Combined Single Limit ❑ Replacement Cost Deductible N/A ❑ Actual Cash Value Automobile Liability Limits of Liability on File with Administrator ❑X All owned Autos (Private Passenger) TYPE OF COVERAGE - WORKERS' COMPENSATION ❑X All owned Autos (Other than Private Passenger) ® Statutory Workers' Compensation ❑X Hired Autos ® Employers Liability $1,000,000 Each Accident ❑X Non -Owned Autos $1,000,000 By Disease $1,000,000 Aggregate By Disease Limits of Liability ❑ Deductible N/A * Combined Single Limit ❑ $500,000 Self Insured Retention Deductible N/A Automobile/Equipment - Deductible ® Physical Damage Per Schedule - Comprehensive - Auto Per Schedule - Collision - Auto NA - Miscellaneous Equipment Other The limit of liability is $5,000,000 (combined single limit) bodily injury and/or property damage each occurrence in excess of a self -insured retention of $200,000. This limit is solely for any liability resulting from entry of a claims bill pursuant to Section 768.28 (5) Florida Statutes or liability/settlement for which no claims bill has been fled or liability imposed pursuant to Federal Law or actions outside the State of Florida. Description of Operations/Locations/Vehicles/Special Items RE: Evidence of Insurance. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE AGREEMENT ABOVE, Designated Member Cancellations Monroe County Board of County Commissioners SHOULD ANY PART OF THE ABOVE DESCRIBED AGREEMENT BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN NOTICE TO THE 1111 12th Street Suite 408 CERTIFICATE HOLDER NAMED ABOVE, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE PROGRAM, ITS AGENTS OR REPRESENTATIVES. Key West FL 33040 AUTHORIZED REPRESENTATIVE FMIT-CERT(10/2011) 7% YAP P�II�h17 PvisuS1flRN'\YYi v - Iq ^ii it rNul,my i ill V� m1 II m 1� immFX-611 ALS Medical Emergencies ar.,. r4wrl f -ir wirl ar.r4wrl 0 MEDICAL DIRECTOR FITERTITUTRINSTO R., ITIA FIRE CHIEF R.L. Celina EDITORS Deputy Chief Mark Herneyer Deputy Chief Marcos Osorio Battalion Chief Alejandro Lucia Chief Flight Nurse Jeff Lauraitis ADDITIONAL CON-rRIBUTORS Bill McGrath: North Lauderdale Fire Rescue; Deputy Chief of Operations Vito Labriola: Margate Fire Department; Deputy Chief of Operations Javier Rodriguez: North Lauderdale Fire Rescue; Division Chief of Operations Matt Whiteshield: Margate Fire Department; Captain Charlie Gandia: Margate Fire Department; Lieutenant County�� The Florida Keiys r® �l OFFICE OF n E MEDICAL to rt DI a arrarrbrri"mr °6 rra5() 'Ihe firlirrw ira , Fw;ir~ er r ncy fef.'Ji d ' r°a°mces I'ra,'rac.rrwrrlar mv ther.; flicrl Life Surpm "rcrar,nrols fi:)rw Mr.rrrrrra, Coutinty fire J'kc ^w rricµ and are arpprr:rw ed for sr,r h use by rira, Paar nwdic:ar area I," S 'of the a eparunerra to camae for iahu wm sick arrrd irajarrr r . C.) nly, d,v.,rse, 'Mirrrrnedi s and EN11, s ark px.,Aved by the Ndcdic,ail Dccor° r°„Ir fl be rrra4k ,,;"rr �o r (ifi r diese �.ra°zrr saa�r�.wk. Uhle,ae armedalaa,al treararrrmt 1,voraarrris Iua ve L yen uwievelrrped as ar part t,-4' bra, rrrodwarl dlrrrcrlrrr'r p,ograrrrr fim rsrrrR icipatiry rrrrw ¢ ,arrraw ° Pidedraw; rl µ'par ,mrw ;: Ms) tq r,,rra,'ies. T` c Medical ark DiruNcuor (.,rf an individual 1,"N4S pr°a'wvrder"n"my c.h,.�r.rse c rla'rar"V tr *atrrri4`ry II"uadditioa'rr,'^9`rr1aCplaulOr"rr.S rrr.r ° r'equir r1°rr,jp!,f rrrrr ~alr ,� ifier� µn a rar,awc C,rr'r"rar d. 1S.'�Ir .bra r'a.rrr ara tau°r.'rar�N.rµ;.a a�rr.rrrlr� rrrrf � r^rrrr rrrrar as, �rrrw� lrrarr� , wrra, lr lli ,, bifir T bo, rralrtst, uw a`rmaAi r udf.,o,rrr r.ra rrr a, rdrsarrar'�rr+arrrrr rr .rrrrrrarrra °rwraar r l' V' arraror e'di /1"N' Ls crrurl°rµr rrr rrrrr r, corrrarir":a waaµflr ra0w r ftwrrraa of rr iffical darrrrrµrrar bra.ashta r aray cc crrrrarr,r r aor" ir.ca iv rr , ;far lrrr,ar.µ fr wr r;raarrarwrrµr,rra. a;arr with the, � lrrr� r�;, r � De arrrrne'n a 'PI n sicia r, It is dua vast, ararrrraa°r is/1'µ l Frnake rarwrrrarra,a w wilb flu." P rva,rachin for rarrnsulcatfic'wra on craimrrlaf rated pafieras whenever pr,uc,siWe. ' ben r,1 , Varra niiie('Jir;; uS arras iC era inake r arrarra,t ~nrr°lrlr rh Phl srr"a,.µrrr°r fbr rorrrdical drrr,r°;riaror rlrrwc,, P ararr°rrrrrfir r:nx,!a, a.rr"rinisr r BLS rrrarrr'rrr.r°ar acetniding to, hi,ar' r :r. judgrxicarat In this iiis . rucw the Parxiraarfimay mfin4iniswr ALS trm rrr ur �ly as alUE11rwrizio�d inthe a arear,rinc,,,,nc, arcaarrrOIS, Or a"ro r°ra°0p,,,A ir"a a ,l Medical l iMr a,tct' DaW m i?m If 0 Disciaimer e, r written in, GREEN lettering., 10ft oeneral Information 140 ADUILT & PEDIATRIC :a MEDICATION ADMINIISTRATION • Prior to administering any medication, inquire about medication, allergies or adverse reactions to medications • A true allergy to a medication causes a rash, SOB, swelling of the tongue, face and/or throat INTRAOSSEOUS SITIES (EZjO) • An 10 should be placed for patients with emergency medicall conditions that require urgent vascular access in whom an IV is not limmediately obtainable or is deemed to have insufficient access • Adult: • Proximal Humerus • Tibial Tuberosity • If conscious consider administration of liclocaine, 2% 40mg over 1 minute • Pediatric/ Newborn/Neonate: • Distal Femur * Preferred Site • Proximal Tibia • Distal Tibia • Proximal Humerus (orally if the surgical neck can be palpated) • If conscious consider administration of liclocaine 2% 20mg over 1 minute IM INJECTIONS • All IM injections shall be administered in the lateral thigh or IDeltoid • Adults: 0 21-23 gauge 1.5 inch needle a 4mL maximum per site • Pediatric: * 23 gauge I inch needle * 1mL maximum per site 0 If > 1mL needs to be administered, split the dose between both thighs MUCOSAL ATOMIZATIION DEVICE (MAD) • The following medications can be administered via the MAD: • Versed. • Narcan • Glucagon • Ativan • Ketamine • Fentanyl • Desired dose: • 0.3mL,- 0.5mL per nostril • Max 1mL per nostril 0 61 'Oft lueneral Informationcontinued... • PEDIATRIC Patients who have not reached puberty are considered pediatric patients and shall be treated under the pediatric guideline section of these protocols Patients who have reached puberty shall be treated as an adult 10 is the preferred method of vascUlar access during pediatric cardiac, arrest I a 4 RI VII 1 1.4 [IF1110:94 MW I a MARROW 0 Newborn: 0 Birth to 24 hours • Neonates: 0 1 Day to 28 month • Infants: 0 29 days to I year • ChHdren: 0 1 year to puberty. Pediatric patients for medical transport will be considered 17 years and 364 days old Pediatric patients for trauma transport will be considered 15 years and 364 days old PUBERTY • Fernale puberty is defined as breast development. ■ Male puberty is defined as underarm, chest or faciall hair. Once a child reaches puberty, use the adult guidelines for treatment, pediatrictransport guidelines still apply 0 Patient Assessment ADUIT & PEDIATRIC MENTAL STATUS (AVPUj • Alert: to person, place, time, and event (AAOX4) • Verbal: responds only to verbal stimuli • Pain: responds only to painful stimuli Unresponsive VITAL SIGNS Patient with Altered Menta I Status consider: AEIOU-TJPS, • Alcohol Epilepsy (Seizures) • Insulin (Hype r-/Hypoglycemia) • Overdose/Oxygenati'lon, • Urernia (Kidney (Failure) • Pulse (rate, rhythm and quality) Trauma • Respirations (rate and quaiity) • Infection (Sepsis) • Skin (color, condition) • Psychiatric • Temperature is Stroke/Shock • Pulse Oxi,metry • Blood Pressure (capillary refill) • EtCO2 • BGL • Pain Scale (1-10 scale or' ong Baker Scale) ALL patients shall receive at least 2 sets of vitals Unstable patients shall receive vitals every 5 minutes A manual Blood Pressure shall be taken to confirm any abnormal or significant changes of an automat Blood Pressure cuff reading Blood Pressure shall be checked before and after administration of a drug Hypotension for adults is defined as Systolic BP < 90 mm Hg ETA • Shall be utilized for the following patients: • Patients requiring ventilatory support (e.g., BVM, ET tube, SGA, CPAP) • Patients in respiratory distress • Patients with Altered Mental Status • Patients who have been sedated • Patients who have received pain medication • Seizure patients • Suspected Septic/Hemorrhagic Shock GLUCOSE, • A BGL shall be documented for patients with any of the following: • History of diabetes • Altered mental status • General weakness • Seizure • Syncope/lighthea,dedness • Dizziness • Poisoning • Stroke • Cardiac arrest ADULT & PEDIATRIC ECG MONITORING e All ALS patients sha�Il be continuously monitored in lead 11 0 12 (lead/15 lead ECG shafl be performed on the following patients: • Chest/arm/neck/jaw/upper back/shoulder/epigastric pain or discomfort 0 Palpitations a Syncope, lightheaded,ness, general weakness, or fatigue 0 CHF, SOB, hypertension or hypotension * UnexplIained diaphoresis or nausea/vomiting 0 Sickle Cell Crisis • 12 lead ECGs shall be repeated every 5 minutes and upon ROSC When transporting, heave cables connected until patient is turned over to the Emergency Department (ED) staff PATIENT HISTORY • CHIEF COMPLAINT: Why did the person call 911? • S.A.M.P.L.E. HISTORY (S.A., .P.L.E 0 SIGNS & SYMPTOMS • ALLERGIES • MEDICATIONS: Prescribed, over the counter, or not prescribed to patient • PAST MEDICAL HISTORY (patient's and immedliate family's) • LAST ORAL INTAKE • EVENTS PRECEDING • HISTORY OF THE PRESENT ILLNESS (0,.P.Q.R.S.T.A) • ONSET: Did the symptoms appear gradually or suddenly? • PALLIATIVE: What makes the symptoms better? • PROVOKE: What makes the symptoms worse? • PREVIOUS: Previous, similar episodes? • QUALITY: (What kind of pain?) pressure, squeezing, aching, dull,, etc. • RADIATION: Does the pain or discomfort radiate? Where? • SEVERITY OF PAIN: 1-10 scale (utilize "Faces" pain scale for pediatrics) • TIME: What time did the symptoms begin? • ASSOCIATED: What are the associated signs & symptoms? Patient experiencing a syncopal episode/inear syncope consider: • Cardiac Neurotogical • Toxicology • Diabetes • Etectrolyte imbalance, Dehydration Envirionmentall Orthostatic hypotensi�on Patient Assessment continued.... Determination of Death Person should be considered dead/non-salvageable that have all of the following presumptive signs of death and one conclusive sign of death. • A neic • Pulseless • Fixed Dilated Pupils Conclusive • Decomposition • Rigor mortis • Liver mortis (Lividity) • Injuries incompatible with life • Patients with suspected hypothermia, barbiturate overdose, or electrocution require full ALS resuscitation unless they have injuries incompatible with life or tissue decomposition • Children are excluded from this protocol unless cases of obvious, prolonged death should CPR not be started or discontinued on infants, children or young adults, or in cases in which an unexpected death has occurred. Basiffic Life Support 17 ADULT & PEDIATRIC AIRWAY AIRWAY IPOSITIONiNG: • Medical patient: • Position patient with external auditory meatus (a.k.a. "The Earhole") on the same external plane as the sternal notch • Trauma patient with suspected spinal cord injury: a Modified jaw thrust NASOPHARYNDEAL AIRWAY(NPA): • Semi -conscious patients with an intact gag reflex shall have a nasopharyngeal airway inserted, unless contraindicated OROPHARYNGEAL AMWAY (CPA): • Unresponsive patients without a gag reflex shall have an oropharyngeal airway inserted, unles contraindicated SUPRAGLOTTICAFRWAYDEVICE 0 Contrain6cations: Caustic Substance Ingestion, airway BUrns, Angioedema, Drowning OXYGI'EN ADMINISTRATION * DO NOT withhold Oxygen if the patient is dyspneic or hypoxic * SP02: • Maintain SP02 at least 94% for: • All patients, 6 Exception: COPD & Asthma • Maintain SP020f 90% for: a COPD & Asthma * OXYGEN ADIWNIS"PRAT11ON: • 15 LPM via NRB regardless Of SP02 • All 3rd trimester pregnancy trauma patients • Decompression sickness • Carbon Monoxide exposure • Cyanide exposure * If oxygen saturation cannot be maintained, ventilatory support should be provided CIRCULATION •'Adult: • Carotid and radial pulse present, assess capillary refill, assess skin color, condition and temperature • Refer to the "Cardiac Arrest" algorithm, for all patients found pulseless • Pediatric: • Carotid and radial pulse present (brachial in infants), assess capillary refill, assess skin color, conditionand temperature • Refer to the "Cardiac Arrest" algorithm, for all patients found pulseless • Refer to the "Bradycardia" protocol , for pediatric patients found bradycardic with signs of poc perfusion and, AIMS 0 INFORMATION • In certain patients, excessive ventilation rates may be harmful. • Overzealous positive pressure ventilation can impair: a Venous return • Cardiac output • Cerebral perfusion • U Itimately the patients SP02 and EtCO2 should determine the ventilation rate for the patient (ideaily EtCO2 should be 35-45 mm Hg). a n,i 1i T VENTILATORY RATES 0 PATIENTS WITH A PULSE: 0 1 breath every 5-6 seconds 0 PATENTSWTHOUTA PULSE,, 0 1 breath every 5-6 seconds a PATIENTSWITH 1CP and/or HERMATIOi , a Maintain EtCO'2 between 30-35 mmHg and, SP02> 90% while continuously monitoring BP PEDIATRIC VENTILATORY RATES PA'r1EN TS WTH A PULSE:: 0 1 breath every 2-3 seconds • PAT'lEf4'TS'W'TRHO,U:"TA,PtJL,S,E: a 1 breathe every 2-3 seconds • PATIENTS WITH KP and/or HERNIATION: 0 Maintain EtCO2 between 30-35, rnm Hg and SP02> 90% while continuously monitoring BP WARNING DO NOT ATTEMPT TO AGGRESIVELY NORMALIZE CAPNOMETRYATCO,2 READINGS IN THE FOLLOWING PATIENTS: • Cardiac arrest Ipre/post ROSC • Bironchospasm (i.e., asthma, COPD) • High EtCO2 levels are acceptable and even desired in these patients 0 Tracheostomylkoma Care INFORMATION Tracheostomies are indicated for long-term ventilatory support to bypass an upper airway obstruction and to aid in the removal of secretions. Tracheostomies, come in a variety of sizes and can either be single lumen or double lumen. Special attachments include a tracheostomy nose (filtration device), tracheostomy collar (for oxygen, or humidification), and Passy-Muir valve (speaker valve). An airway stoma is a surgically created opening in the neck (typically a tracheostomy or laryngectomy) that provides a direct airway to the trachea. These are commonly seen in patients with chronic respiratory conditions, upper airway obstructions, or after head and neck surgery. SiFEns of Obstruction a Excess secretions a No chest wall movement • Cyanosis • Accessory muscle use • No chest wall rise with bag -valve ventilations AD LJ L"r SUPPORT I A CAR, E • If a partial obstruction is present, and there is no immediate need to alleviate the obstruction, pro- vide Wow -by oxygen via non-rebreather mask. • If an obstruction is present, inject 1-3 mL of normal saline into the tracheostomy tube/stoma and deep suction as needed. For pediatrics, (set the suction pressure at 100 mm Hg or less). • If unable to clear the obstruction by suctioning, insert Bougie Tube (FlexGuide) into currently estab- lished tube, remove the tracheostomy tube and insert a new tube over the Bougie Tube (FlexGuide) (either of the same size or one size smaller). Do not, force the tube. In cases of obstructed stomas, an endotracheal tube may need to be inserted. • If unable to insert a new tracheostomy tube, or if one is unavailable, insert an endotracheal tube of similar size into the stoma and ventilate with a bag -valve mask as needed. • If unable to insert an endotracheal tube, ventilate with a bag -valve mask (pediatric or infant sized mask) over the stoma or over the patient's mouth while covering the stoma as needed. INFORMATION if-, 0."1" r- Priority 1: 0 Patients in Ca�rdia�c or Respiratory Arrest Priority 2: 0 Unstable patients with immediate life -threatening conditions Priority 3: 0 Stable patients with no immediate fife -threatening conditions WARNING Placing patients in the prone position is contraindicated due to the risks of asphyxiation. However, impalement or other situations may imandate the prone position. In these instances, clear docuirnentation of justification and attention to airway maintenance is mandatory. ADULT i.a, oil I trill 119219 W Transport to the closest appropriate facility PRIORITY 2 PATIENTS Shall be transported to closest appropriate facility or Landing Zone TRAUMA ALERT PATHE NTS: 0 Shall be transported via Air transport to the closest Trauma Center. If on bypass, transport patient to the next closest Trauma Center On -scene times for Trauma Alert patients should be < ' 10 minutes. On -scene times > 10 minutes shall have the reason for the delay documented in the ePCR report. Trauma patients who arrest in the presence of Fire Rescue personnel shall be transported to closest appropriate facility. Adult Transport Destin�a'tionscontin,u,ed.... 4, STVW/ ACS ALERI`S� • Shall be transported via Air transport to the dlosest STEMI/ACS facility • Patient presentations that are indicative of myocardial ischernia that DO NOT meet "STEM] Alert Criteria" should still be transported via Air transport to the closest STEMI facility STROKE ALERTS 0 All Stroke Alerts with FAST-ED score a 4 shall be transported by Air Transport to a Comprehen- sive Stroke Center • All Stroke Alerts with FAST -ECG score < 4 shall be transported by ground to closest facility 0 SEP&IS AL.ER'T": 0 All Sepsis Alerts shall be transported to Closest appropriate facility * HYPERBARK CHAMBER (Sta,We); (Contact Mag nners Hospital) * HYPERBARIIC CHAMBER (Unstable): Transport by Air- to Mercy Hospfta� * HYPERBARK CHAMBER (Alterinafive). Transport by Airto St. Mary's Mecfical Center' Examples include (Non-traUmatic) • Decompression Sickness • Carbon Monoxide Exposure • Hydrogen Sulfide Exposure • Cyanide Exposure • Transport by air if available III TUBATED flINTERFACiUll"'Y FRANSFER& • Should, be sedated and appropriately medicated for Airtransport. • All Appropriate medication ready and available for Flight crew upon arrival • All appropriate documentation, ready forflight crew upon arrival. • Pt. packaged and ready for air transport upon flight crew arrival • Bedside time for all IFTs� 20 minutes juarels I Wavan I 141n All stable patients shall be transported to closest appropriate facility. * OBSTETRICAL • Obstetrical (OB) patients are defined as gestation > 20 weeks • All OB patients should be transported to closest appropriate facility • Post-Partum up to 2 weeks BAKER ACT PATIENTS:: 0 Baker Act patients shall be transported to Closest appropriate facility for medical clearance In the case of auto rnablc/rnutuai aidl the transporting unit determines "most appropriate facility" 0 X% Pediatric Transpart Destinatians PRIORITY 1 PATIENTS TRANSPORT BY AMR� 0 Pediatric patients who have regained a ROB C 0 Pediatric respiratory arrest cases that have successful airway management (i.e., good compliance with the BVM and airway adjuncts, positive EtCO2 waveform, improving pulse oximetry) TRAM SPORTTO CLOSEST APPROPRIATE FACILITY': • Pulseless pediatric patients • Pediatric respiratory arrest patients who have an unstable airway (i.e., unable to ventilate or oxygenate) PRIORITY 2 PATIENTS 0 TRA(WA ALE-_RTPATIENTS: • Shall be transported by air transport to the closest Pediatric Trauma Center. If on bypass, transport patient to the next closest Trauma Center. • On -scene times for Trauma Alert patients should be <.10 minutes. On -scene times > 10 minutE shall have the reason for the delay documented in the ePCIR report. • Trauma patients who arrest in the presence of Fire Rescue personnel shall be transported to closest appropriate facility STROKE ALERTS/CARMAC ALERT: • All Stroke Alerts or Cardiac Alerts shall be transported via available air transport to appropriat( facility SEPSIS ALER1 S: a All Sepsis Alerts shall be transported to closest appropriate facility HYPERBARIC CHAMBER (stable): (Contact Mairiners IHospltai), HYPERB,ARIC CHAMBER (Unstable): St. Marys Mechcal Center • Examples indUrle (Non-traUrnabc) • Decompression Sickness • Carbon Monoxide Exposure • Hydrogen Sulfide Exposure • Cyanide Exposure • Transport by air if available PRIORITY 3 PATIENTS a Should be transported to closest appropriate facility. El 0 W� FA HELICOPTER OPERATIONAL CRITERIA: a Adult & Pediatric Trauma Alert • STEM I/ACS Alert • Stroke alert • Dive Emergency • Mass Casualty Incidents (MCI) involving multiple patients with traumatic injuries • Interf , acility Transfer HELICOPTER SHALL NOT BCE' USED: a Patient with CPR in progress • OB patient with imminent delivery • Children < 28 days or < 5 kg • Hazmat contaminated patient m 0 BLS Medical Emergencies ms ADULT & PEDIATRIC ALLERGIC REACTION 11 -- WOMB, Allergic reactions are characterized by any of the following: W Generalized Urticaria • Airway, Tongue, or Facial Swelling, Respiratory Distress, Bronchospasm • Nausea, Vomiting, or Diarrhea • Loss of Radial Pulse or SBP of < 90 mm IHg • Determine the source of the allergic reaction (insect, food, medications, etc.) • If patient presents with airway swelling/respiratory distress/bronchospasm/tongue and/or facial swelling/loss of a radial pulse or SBP of < 90 mm Hg: 0 Assist patient with prescribed Epi-Pen CARDIAC ARREST a Refer to the "Cardiac Arrest" algorithm (pg. 70), for all patients found pulseless OVERDOSEPOISOINING • Try to identify source of the overdose/poisoning • Assist patient with l' ARCAi lif available/applicable • Consider contacting the Florida Poison Control Center at 1-800-222-1222 SEIZURES 0 Consider the possible causes: • Meningitis a Drugs • Fever 0 Alcohol • Head trauma 0 Diabetic • Hemorrhagic stroke 0 Poisoning • Protect patient from injury if actively seizing ALTERED MENTAL STATUS • Check and record BGL • If BGL is < 60 mg/dL, and patient is able to protect their airway/swallow: • ORAL GLUCOSE� • 15g, if able to swallow and follow commands. • May repeat Ix prn • Contrain&cations�: • Patients who are not conscious enough, to swallow • Patients 2, years old ADULT & PEDIATRIC :M EXPOSE • Fully expose patient to properly assess for injuries. Cover the patient as soon as possible to keep the patient warm. Perform manual Spinal Motion Restriction by providing manual cervical stabilization and apply an appropriately sized cervical collar as appropriate if the patient meets any of the following criteria: 0 Complaint or finding of focal neurologic deficit on motor or sensory exam • Complaint or finding of pain to the neck or back • Presence of a distracting injury • Altered level of consciousness with an, MOI (Mechanism of Injury) • Intoxication with an MOI present • The key objective is to move the patient in the safest, most anatomically neutral position possible • If an appropriately sized collar is not avaflable, or if the collar compels the patient to move, remove the collar and provide Spinal Motion Restriction • Place rolled towels on the sides of the patient's head and neck • Secure with tape or other similar devices to allow for comfortable cervical stabilization/ r, IT, no@ 1191• 0 The cervical collar should not cause the patient discomfort such that they are compelled to move • Placethe patient on the stretcher cushion, supine • If the patient, is unable to tolerate this position, place in a position of comfort, that also respects normal anatomical alignment and document appropriately. HELIVIIET REMOVAL • Helmets without shoulder pads should be removed from all patients i.e motorcycle • If applicable, protective pads should also be removed • Athletic trainers should be consulted in the helmet/protective pad removal process if applicable • Spinal motion restriction should be "manually" performed during the removal process BU. RNS 0 Refer to the "Burn Injuries" protocol EYE EMERGENCIES 9 CHEWCAL EXPOSURES: Remove contact (lens if present Irrigate the affected eye(s) with NORMAL' i_ME W Be careful not to contaminate the unaffected eye with runoff a Consider pain management protocol PENETRA-ANG EYE INJURIES: 6 Stabilize any penetrating object • Cover Moth eyes with gauze and an eye shield • Keep the patient calm, as crying, screaming or coughing can force more of the tissue outward • DO NOT attempt to replace or move the protruding tissue BLS Trauma Emergenciescontinued.... CLOSED FRACTURES * Fractures should be splinted in the, position found • Exception: No pulse, present OR the patient cannot be transported due to the extremity's unusual position 2 attempts can be made to place the injured extremity in a normal anatomical position • Discontinue attempts if: • The patient complains of severe pain OR • If there is resistance to movement felt • Reassess neurovascular status before and after repositioning of patient's extremity * CLOSED MID -SHAFT FEMUR FRACTURES • Apply a Traction Splint • Contraindications; • There is all'so, a suspected pelvic fracture • There is an open femur fracture * There is, also, a Suspected hip fracture * There is an avulsion/arnputation of the ankle, or foot * Suspected fracture distal to, mid shaft fen-Wr • Reassess neurovascular status before and after repositioning of patient's extremity • May use doppler to verify presence of pulse if available OPEN FRACTURES Refer to the "Open Fracture" protocol (pg. 114) * Consider hip fractures in an, elderly patient who fell and complains of pain in the knee, hip or pelvis * A scoop stretcher should be used whenever possible to move patients with a suspected hip fracture * Splint in position, of comfort with pillows and blankets * Reassess neurovascular status before and after moving the patient * Traction splints shall INOT be used on suspected hip fractures or hip dislocations * POSTERIOR: MP DISLOCATIONS: • Most often present with the leg flexed and internally rotated, and will not tolerate having the extremity straightened * ANTERIOR HW MSLOCATiONIS: a Present with lateral rotation and shortening of the affected leg PELVIC FRACTURE 0 Assess and treat for shock • DO NOT perform a pelvic rock. Assess the pelvis by applying gentle, pressure anterior to posterior and from the sides to identify crepitus, or instability. DO NOT repeat. • Stabilize if possible • A scoop stretcher should be used whenever possible to move patients with suspected pelvic fracture • Reassess neurovascular status before and after moving the patient BLS Trauma Emergenciescontinued.... 1.] 11:11:11 Q ILI EC1991 ILI 191,141 • Direct pressure (utilizing manual pressure and pressure dressings) • Combat Application Tourniquet (C.A.T'.) • Apply high and tight on a single long bone until the bleeding stops •DO NOT apply C.A.T. directly over injury site or joint. • If bleeding persists after initial C.A.T, apply a second C.A.T. • If tourniquet applied by EMS, patient shall be transported by Air to Traurna Center • Hemostatic Agent (If 2 nd C.A.T appllication fails to controll bleeding): 0 Pack wound • Maintain pressure for a minimum of 1-3 minute or until bleeding controllecl— • Apply a pressure dressing JUNCTIONAL HEMORRHAGE (e.g.,, neck, axfflairy, p&Ms and groin): • Hemostatic Agent • Pack wound • Maintain pressure for a minimum of I minute or until bleeding controlled • Apply a pressure dressing (Occlusive if neck wound) ALL EXTREMITY TRAU! MA • Gross contamination, such as leaves or gravel, should be removed if possible • Determine mechanism of injury (MOI) and evaluate • Assess neurovascular status of extremity 0 Color, temperature, capillary refill, crep�itus AMPUTATION • Rinse off with Normal Saline • Wrap in sterile gauze and place in a sealed plastic bag • Place the sealed, bag into a second bag with ice packs • Label the bag with the patient's: 0 Name 0 Date • Time of the amputation • Time the part was wrapped and cooled =11MMIX00mms • Impaled objects shall be stabilized to prevent movement and subsequent further damage • If Weeding occurs around the impaled object, it should be controlled by holding direct pressurE a DO NOT apply excessive pressure • DO NOT palpate the abdomen, as it may cause further organ injury from the distal tip of the object EVISCERATION: • Protect the tissue from further damage • Cover the, protruding tissue with a moist sterfle dressing, then cover with a dry sterile dressing • Keep the patient calm, as crying, screaming or coughing can force more of the tissue outward • DO NOT attempt to replace or move the protruding tissue 0 BLS Bites and Stings INFORMATION • Consider contacting the Florida Poison Control Center at 1,-800-222,-1222 OR, DAN (Divers Alert Network) at (919) 684-9111 as soon as possible for treatment recommendations. ADULT & PEDIATRIC ALL BITES A N D STINGS • Clean the wound area with soap and water or sterile water • Exception: Marine animal stings • DO NOT use hydrogen peroxide on deep puncture wounds or wounds exposing fat • Refer to the "Allergic Reaction" protocol, if appllicaWe • Advise dispatch to contact animal control or the police department if necessary SNAKE BITES: Contact Venom One, 786-331-4443 • DO NOT apply ice packs, tourniquets or constrictive bands • Mark area of edema, with a, pen • Remove any constrictive jewelry or clothing • Splint any extremity that has received a bite and ensure it remains below the heart • Keep patient supine if possible • For hypotension: a Refer tothe "Fluid Resuscitation" protocol (pg. 39) • If the DEAD snake is on scene, take a picture of the head (including the eyes) with the eRCR device if possible INSECT STIINGS W Remove the stinger by scraping the patient's skin with the edge of a flat surface (e.g., a credit card) & DO NOT attempt to pull the stinger out, as this action may release more venom MARINE ANIMAL ENVENOMATIONS: STINGRAY, SCORPIONFISH, LIONFIISH, ZEBRAFIISH, STONEFISH, CATFISH. WEEVE�RFISHI, STARFISH, SEA URCHIN • Immerse the punctures in non -scalding hot water (if available) to achieve pain relief • Gently wash the wound with soap and water, and then irrigate it vigorously with sterile water (avoid scrubbing) MARINE ANIMAL STINGS: JELLYFISH, MAN-OF-WAR, SEA NETTLE, ]RUKAND.111. ANEMONE, HYDROID, FIRE CORAL 6 Rinse the skin with sea water (if available) 9 DO NOT use fresh or sterile water • DO NOT apply ice • DO NOT rub the skin Apply white vinegar (if available) topically to involve area until the pain is relieved (lifeguards may carr this) Remove large tentacle fragments using forceps with proper PPE on and stay upwind when performing this procedure A" m I . 17-s"PIR.90 =flm INFORMATION Allergic reactions are characterized by any of the following: a Generalized urticaria • Airway swe[ling, respiratory distress, bronchospasm, tongue and/or facial swelling • Nausea, vomiting, or diarrhea • Loss of radial pulse or SBP of < 90 mm Hg • Determine the source of the allergic reaction and remove potential allergen (insect, food, medications ADUILT I I I JIMC] a g Ig -.7a I �VA a pall a f rim -.1 FX93 UU, BENADRYL: A 50mg IV/10/11VI, over 2 minutes IV/10 usage (dilute in 10mi if possible) 1 11 E ;i ::; E&��glliiiiilli'!I I 1 1,1 1 in q;� 1� � qj; FACIAL SWELLING • EPINEPHRINE (1;1,00,10, lvng/mQ� a 0.3mg (0.3ml-) IM 6 May repeat 2x prn, in 5 minute intervals • BENADRYL.� 6 50mg IV/10/11VI, over 2 minutes for IV/10 usage (Dilute in 10ml if possible) 0 AILBUTEROL 0 Ad mi nister one premixed dose from plastic vial 0 May repeat prn SOLU-MEDROL� a 125mg IV/10,/IM/PO, over 2 minutes for IV/IC) usage a SEVERE — LOSS OF A RADIAL PULSE OR SBP OF < 90 mm Hg • EPINEPHRINE (1:1,000, lfflg/ML)� * 0.3mg (0.3mL) IM * Contraindications - Hypotension secondary to Wood loss k EPhNE,P-IF'' "4E [V kifusion (f rof responsii ��e to, d10 dosie'ffi a Epinephrine Infusion IV/10 5-15 mcg/min • NORMALSAUNE: • 20ml/kg IV/IC}, titrate to desired effect. Assess lung sounds and BP frequently. • May repeat 1x prn • Precautions - Particular care must betaken in the presence of significant coronary heart disease, CIF, and renal failure patients * BENADRYL: as noted above * ALBUTEROL�° as noted above 0 SOLU-MEDROL: as noted above 0 Allergic Reaciffoncontinued.. PEDIATRIC MILD — GENERALIZED URTICARIA ONLY BENADIRYL: * lmg/kg IV/10/11VI, over 2 minutes for IV/10 usage (may repeat if necessary) * Max Single dose 50mg * Contraindication - Neonates MODERATE — AIRWAY SWELLING / RESPIRATORY DISTRESS /'BRONCHOSPASM TONGUE AND/OR FACIAL SWE LLI N Gi EPINEPF�RI,INE(l.:1,00,0,1,ing,/n-nL): • O.Olmg/kg IM, max single dose 0.3mg • May repeat 2x prn, in 5 minute intervals • BENADRYL: * lmg/kg IV/10/11VI, over 2 minutes for IV/10 usage * Max dose 50mg * Contraindication - Neonates • ALBUTEROL 0 0.5 m,g Atrovent with 3mg Albuterol in 3m1 nebulized fAI May repeat prn • SOLI~.-MEDROL: • 2mg/kg IV/]O/IM/PO, over 2 minutes for IV/10 usage • Max dose 125,mg SEVERE - LOSS OF A BRACHIAL/RADIAL PU,LSE OR. AGE APPROPRIATE HIYPOTENSION • EPINERHMNE (1:1,000, Img/n'iQ: * O.Olmg/kg IM, max single dose 0.3mg * May repeat 2x prn, in 5 minute intervals * Contraindications - Hypotension secondary to Hood loss EPH\IEPHMNE PV k&.jsion (ff not respon&ivetcii 110 cfiosie� NORMAL SAUNE: • 20mL/kg IV/10, assess lung sounds and BP frequently • May repeat 2x prn, for age appropriate hypotensi,on, BENADRYL: as noted above ALBur'EROL-, as, noted above •SOLUWEDROL; as noted above INFORMATION Symptoms of Diabetic Ketoacidosis (DKA) includde: • Nausea/Vomiting • Abdominal pain • General weakness • Kus,smaul Respirations (deep rapid: respirations) Is AMS • Hypotension • Tachycardia with an acetone smell on the patient's breath Diabetic patients taking oral hypoglycemic medications should be transported (e.g., Glyburide, Glimepiride, and Glipizide). ADUILT BGL < 60 mg1dL ORAL GLUCOSE * 15g * May repeat 1x prn * Contraindications - Patients whol are not able to swallow., DIO-� • 100mLIV/10 • Retest glucose • May repeat Ix prn a 250mLIV/10. Rapid infusion GLUCAGOW a 1mg IN or IM if avaHable BGL > 300 mig/dL WITH SIGNS & SYMPTOMS OF DKA NORMAI SALHNE: * 20mllkg IV/10, titrate to desired effect. Assess lung sounds and BP frequently. * May repeat 1x prn 5 * PirecaUtions - Paiii tloiHar czlre rTWEA be taf,,,,eir� in the prest:,Ince of s�gnificaiM�� (zo,onaiiy hewt cfisease,, dill'.: n:-.Irial faOure padents 0 D la o betic Emergenciescontinued.. PEDIATRIC BGL < 60 rng/dL or < 40 mg/dI in neonate ORALGLUCOSE: 15g, if able to swaliow and follow commands Contraindications: a Patients, whol are unia:bleto swallow Is Patients, < 2 years old B D 10: • 5mL/kg IV/10 • �May repeat Ix prn Is GLUCAGOM 8 < 20kg 0 0.5mg IM/IN (if available) •2! 20kg a 1mg IM/IN (if avaflable) BGL > 300 rng/dL WITH SIGNS & SYMPTOMS OF DKA NORMALSALINE: • 20mL/kg, IWIO, assess lung, sounds and BP frequently • 10ml/kg IV/10 for neonate assess lung sounds and BP frequently • lMay repeat 2x prn, for BGL > 300 mg/dl Dystonic Reaction INFORMATION . ........ Dystonic reactions are characterized by intermittent spasmodic or sustained involuntary contractions of muscles in the: • Face • Neck • Trunk • Pelvis I El • Extremities • Even the larynx • The following classes of medications are typically responsible for dystonic reactions: • Antipsychotic (e.g., HaHol, Risperdal, etc...) • Antiernetic (e.g., Compazine, Reglan, Phenergan, etc... • Antidepressant (e.g., Prozac, Paxil, etc...) • A clystonic reaction can occur limmediately or be delayed for hours to clays. ADULT • BENADRYL: 0 50mg IV/ICE/II , over 2 minutes for IV/10 usage (Dilute in 10ml if possible) PEDIATRIC a BIENADRYL: * Img/kg IV/10/11"u'I, over 2 minutes for IV/10 usage (Dilute in 10ml if possible) * Max dose 50mg * Contraindication - INeonates 0 Ruid ResuscitationlDehydration if, INFORMATION Indications for fluid resuscitation: • Hypotension • Fatigue • Dark Color Urine • Dry Mouth • Headache • Prolonged vomiting or diarrhea with signs of dehydration • Non-traurnatic bleeding (vaginal or GI) • Suspected Rhabdomyolysis • Paramedic discretion 6% ADULT NORMALSALME • 20ml/kg IV/10, titrate to desired effect. Assess lung sounds and BP frequently. • May repeat 2x prn Prec:z�,ftoris rfisease, ( I 114F, arid f e�ina�fa.��ure palJenl�s PEDIATRIC 91 NORMALerr Aill' E: • 10ml/kg for infant -neonate over 10 minutes • 20mLjkg IV/10 for children, over 10 minutes, assess lung sounds and BP frequently • May repeat 2x prn, for age appropriate hypotension. 12MEM -INFORMATION Consider hyperkalemia in patients with a confirmed history of renal failure/dialysis who are pre -dialysis and present with any of the fog lowing: • General weakness • Cardiac arrhythmias & ECG abnormalities: TaH peaked T-waves (most prominent early sign) • Sine wave Wide complex QRS Regular Really Wide Complex Tachycardia (RRWCT) Severe bradycardia High degree AV blocks IL lj 11�jq 111191111 — �1 111''I iffli'11110 1 ADULT SINE WAVE 1lii ir�� I I I'l, 11111151111 ITUYURN Ig IV/10,, over 2 minutes prec�auti�,yin - DO NOT aditrikiister ki,, &MA:0//� [1111E,1,35 SO4 UM BICARBONATE w0miut th�XIrougf0y flushing * ALBUTEROL: 2.5mg via nebulizer • Continuous treatments (if an advanced airway is utilized, administer via in -dine nebulization) * SODUA BICARBONATE 8.4%: 0 1 mEq/Kg IV/10, over 2 minutes 0 Pre(-au.tioirr DO NOT adimuin'rsb:?ii un sr)irne /o nn(�, as CALCUM CHLORME,,rvithout thoi'm'agN°'y� ffilshUilg IF PATIENT IS HYPOTENSIVE NORMAL SAUNE 0 20ml/kg IV/10, titrate'to effect. Assess lung sounds frequently. * May repeat 1x prn Pre�,:autioi1is "art knflarcw e rrust be tat.,eii IIr4 L'h�? pii-eseirire of si�!rrhfficant coronary 'ieaft (�fisease, 0 and n:lnal fauluiie jmbeii-fts 12MEM INFORMATION Consider hyperkalemia in patients with a confirmed history of renal failure/dialysis who are pre -dialysis and present with any of the following: 0 General weakness Cardiac arrhythmias & ECG abnormalities: TaH peaked T-waves (most prominent early sign) • Sine wave • Wide complex QRS Regular Really Wide Complex Tachycardia (RRWCT) Severe bradycardia High degree AV blocks PEAKED T-WAVE al.. - PEDIATRIC SINE WAVE FOR PATIENTS PRESENTING WITH ANY OF THE ABOVE CARDIAC ARRHYTHMIIAS & ECG ABNORMALITIES CALOUV� CHLORIDE 6 20mg/kg IV/10, over 2 minutes 10 ir ecaUb011 � - DO NOT aii3rriinister un sain ime IV/O iurie a�; SODUM BUCARBONATE °�,Othout th(�)Imugl:"Ily flu.oshI iig ALBU1 EROd L: 0 < 25kg 2.5mg via nebulizer a 25-50kg 5mg, via nebulizer 0 >50kg 10mg via nebulizer • Continuous treatments (if an advanced airway is utflized, administer via in -line nebulization) SODUld B�CARBONA"FE 8.,4%� 9 1-2 mEq/Kg IV/10, over 2 minutes a Piieicauh(�m DO NOT adJrnir0steir uiiisame UV /10 li)s CALCUUM CHLORIDE wfthm,it thoMUgh[IV RM,115h11'11g IF PATIENT'IS HYPOT'ENSIVE NORMAL SAUNE • 20ml/kg IV/10, titrate to effect. Assess, lung sounds, frequently. • May repeat 1x prn 0 NausealVomioting INFORMATION Consider differential diagnosis,: • Cardiac • Stroke • Diabetic • Head Injury • Other ADULT 4n Z10FRAW • 4mg IV/10/IM/PO, over 2 minutes for IV/10 uisage • May repeat Ix prn if pregnant IE enadryl pirior to Zo,fran (Zofran adii-nin!istra-doin if Benadryl uneffecbve) 6 50mg IV/IM (Dilute in 10ml if possible) NORMAL SAIJ INE (uf needed) n • 210ml/kg IV/10, titrate to desired effect. Assess, lung sounds and BP frequently. • May repeat Ix prn Flw'dc,Aw cate! rnusbe taken 41, the presence of snfficarit �:oi�'oinwy h�::�w't 11-fiseass, (-1J-1Fw nd rena�faRure patients PEDIATRIC * NORMAL SAL NE: • 10ml/kg for infant -neonate over 10 minutes • 20mL/kg IV/10 for children , over 10 minutes, assess lung sounds and BP frequently • May repeat 2x prn, for age appropriate, hypotension 0 ZOFRAN: 0 O.Img/kg IV/IlVI/PO, over 2 minutes for IV usage 0 Max dose 4mg 0 Respiratory Distress ADULT MILD BRONCHOSPASM SECONDARY TO COPD or ASTHMA ALBUTEROL 0 Albuterol 2.5mg via nebulizer a May repeat prn SOLU-MEDROL: 0 125mg IV/10/1M/P0, over 2 minutes for IV/10 usage MODERATE OR SEVERE RESPIRATORY DISTRESS: ONCLUDING COPD, ASTHMA, AND PNEUMONIA) * IF1,CILeTreatv,ni(ent:fn,on'nPilaf Bi-oncliosp,a:sinigDILIS,,.,. * CPAP-5cmll,,O: Contraindications: SBP < 90nirn Fig Patients without sponta,neous respirations Patients with a decreased LOC (lethargic) Patients < 30 kg * Bipap * IPAP 10 cm H20, EPAP5 cm H2O Citrate to effect MODERATE TO SEVERE ASTHMA/CQPQ * Indude Treatment from MHd and Mod�erate Distress plus,.. * EFIMEPHRINE (1:1,000, lnig/mL.): • 0.3mg (0.3mL) IM • May repeat 2x prn, in 5 minute intervals • Do not adminnster Epinephrine to COPD patient * ALBUTEROL A May repeat prn * MAGNESUM SULFATE: * IV Infusion: 2g of Magnesium Sulfate 6 Administer over 10 minutes IV/10 * Contraindication - 2'-'d and 3rd Degree Heart Blocks * f.Irecavbon - wapI inft..4sion �,nay ca4 Ase 11,111ypotensn * FOLLOW AD"YANCED AIRWAY PROTOCOL WARNING Immediately rernovethe CPAP for the asthinnatic patient whose condition worsens after applying the CPAP. Consider the use of Ketarnine as the induction agent for RSI in patients with bronchospasm requiring advanced airway intervention. See Advanced Airway Protocol 0 —T-I- — TWAM'.� Ira, Resp'w tory Distresscontinued.. PEDIATRIC BRONCHOSPASM ALBUTEROL 0 2.5mg delivered via nebulizer 0 May repeat prn SOLIU-MEDROIL: • 2mg/kg [V/l0/lM/P0, over 2 minutes for IV/1 0 usage • Max dose 125mg FOR SEVERE ASTHMA NOT RESPONDING TO ABOVE TREATMENT • EPINEPHRME (1:1,000, lirng/rnQ� • 0.01mg/kg IM, max single dose 0.3mg • May repeat 2x prn, in 5 minute intervals • MAGNESIUMSULFATL * 50mg/kg over 20 minutes IV/10 * Ciontrain&cation - 2"d and 3 rd IDegree Heart Blocks * Precaution Rapid i�nfusbin may cause hypoten!:d(DIII ■ EPMEPHRINE (1:1,000, lrng/rnL)A a 3mg (3mL totally delivered via nebulizer 4V P�ecaubor,us;, DO, NOT striess ffie pahent D10 NOT atternpt to iintt;[ade oir p4ce all C)PA or NIPA • Ventilate via BVM as needed • Expedite transport to closest appropriate facility FOR EPIGLOTTITIS • Avoid any procedures that may agitate patient • Provide humidified blow -by 02 as needed • Expedite transport to closest appropriate facility Croup: • Usually < 3 years old • "Sick" for a, couple of days • Low grade fever • Not toxic appearing Epiglotfitis: • Usually 3-6 years old • Sudden onset, High grade fever �Poor generail impression Drooling • Tripod position . . ........ I ......... ..... .. . . . ....... ............ ...... . . . ......... . . ................ .... 0 Seizure INFORMATION • Consider the possible causes: • Meningitis Drugs • • Fever Alcohol • • Heed trauma • DIabet1C'. 61 Hemorrhagic strobe Poisoning • Monitoring of EtCO2 shall be performed to determine the patient's respiratory status, • Refer to the "Eclampsia" protocol (pg. 118), for pregnant patients. ADULT IF ACTIVELY SEIZING • 8ENZ IAllEFIINE� • Versed 5mg IV/10/IN/IM may repeat X1 dose Prieca�ulrcn _ Niordtor for v pd rator %:heir-essk)n IF SEIIZLIRE DOES NOT RESPOND TO ABOVE TREATMENT I EWtA '°tllNE • 1 mg/kg of I etamine IV/10 slow over -2 minutes • Contraindications: • Pregnant patients • Penetrating eye injury • Non -traumatic chest pale P r'% ca ul l dew Ire s e I IreI„%wed for r %luo-"ancedl am nk4iay rnailnager"nt:;'nt lRa. ,)r l W k4i:h011111m,w"ILradon � , s r(":x ii:it "`l:d "�TMu'd0-t rr p"k-��toiY y deIkV wrv'�'rvk.,,(n,� u~t�.�riea, and IkIq ;IP.'hdk"dd 4'.irc U! rm U l 611 Vi .Q G'*<" ses k,,k N ro%'l DIB S'ry r4.„h'll d DFUNABLE TO ESTABLISHI VASCULAR ACCESS KETAI iNE • 2 mg/'kg I/IM • Contraindications - as noted above Precautions .. as m:jted s • ove P'IDIATRIC FEBRILE AND NOT ACTIVELY SEIZING Cif patient receives Tylenol hie/she must he transported) • If patient can tolerate PO administer Acetaminophen 15mg/kg PCB (if available) May administer post seizure if child can tolerate FEBRILE SEIZURE • PASSIVE COOLING: Remove the clothing • DO NOT cover patient with a wet towel or sheet • DO NOT apply ice or cold packs to the patient's body IF ACTIVELY SEIZING • Versed 8.1 mg/kg lV/lO/Ifs/lM may repeat as needed If no response from bea zodlazepine administer: • Ketamine 1mg/kg IV/10 or 2mg/kg IN/lM may repeat once Pre ii:Dutro n ... Ir l 111 kk"1: I n"G , I.k@r"e'"r' rk rr q k I V IlurrP"k 0Se tic Shock INFORMATION • Sources, signs & symptoms of sepsis include, but are not limited to: 0 Fever • UTI (Increased urinary frequency, dysuria, and/or cloudy, bloody, or foul smelling urine) • Pneumonia (productive cough, green/yellow/brown sputum) • Wounds or insertion sites that are: PainfuVred/swollen or have a puirulent (pus) discharge • Patient is, on antibiotics and has significant diarrhea, abdominal pain or tenderness • Recent history of surgery/invasive medical procedure (eg., Foley Catheter, Central Lines, etc • AMS and/or poor oral intake over the past 24-48 hours (especially in the elderly) • Bed sores, abscesses, cellulitis, or immobility SEPSIS ALERT'Ciriteria If all of the following are rnet, call, a SEPSIS ALERT: 0 IS years, and NOT pregnant AND a Suspected or documented infection M At least TWO (2) of the criteria • Hypotension (SBP < 100 mm Fig), • Altered Mental Status or GCS � 15 (new onset) • Tachypnea (respiiratory rate > 22 and/or ETCO2 < 25) WARNING It is imperative once sepsis is identified, that the paitient is kept from becoming hypotensive, as an episode of hypoteinsi�on significantly increases morbidity and mortality. WARNING 0 Pneumonia patients with rales; still require IV fluids. * Monitor EtCO2 and SP02 during fluid administration. Septic Shockcontinued.. ADULT SEPSIS ALERT NORMAL SAUNE: 30 ml/kg IV/10, assess lung sounds and BP frequently Precauboir�s - Flartict,flar car 1rrkiust be takeri In the piesem:e tl; f sngnHicant coronary heart c4seasie, CHF, an ] ofnafa Hure pahents IF PATIENT REMAINS HYPOTENSIVE (Levophed) infusion ( if avaHabte) 5-30 mcg/rnn N hh�s�Twin * Contraindications - Hypotension secondary to blood Noss * Prii r_auLNNISI' 10 'V��)rOtor heaft rate and bkxod pireSSUH-e th-DJgIIOU't adirrn h)nstiratk)n ADULT LEFT RIAXONE (ROCEPHIN) (if available); Dilute: 2g in a 1OOmL bag of NS Administer over 10 minutes N/10 by utilizing a 10 gtt set Contraindications: Allergy to CephalospoHn antibiotics (e.g., Ancef, Cecloir, Cefdin,ir, ;eflex) PEDIATRIC SUSPECTED SEPSIS NORMAL SALINEn • 10ml/kg for infant -neonate over 10 minutes a 20mL/kg IV/10, regardless of blood pressure, assess lung sounds frequently • May repeat X2, for age appropriate hypotension • If febrile may administer PO Acetamin�ophen 15mg/kg (if available) IF PATIENT REMAINS HYPOTENSIVE (AGE APPROPRIATE HYPOTENSION) ERNEPHRH14E IV Infusion • Epinephrine Infusion IV/10 O.1mcg/kg/min-1mcg/kg/min (titrate to effect) F PEDIATRIC • Antibiotic Therapy for pediatrics must be over 15 years old. See aduIt protoCoj. of Stroke INFORMATION Cincinnati Stroke Scale should be initial stroke assessment. If Stroke or TIA suspected, pt will receive initial Cincinnati Stroke assessment followed by FAST-ED as- sessment. • Call a STROKE ALERT if: a Pt meets any criteria on Stroke form. a FAST-ED Score < 3 transport to primary stroke center a FAST-ED Score 4 transport to comprehensive stroke center via AIR transport 0 If the onset of symptoms are unable to be determined, transport patient as a STROKE ALERT • Complete Stroke form. 0 Present form to receiving facility or receiving flight crew. • Notification of a Stroke Alert with the FAST-ED score needs to be relayed to, the STROKE CENTER. DATF.;: PATIENTNAME: DOB: AGic: GnOUND CREW* AIR CREW - A V, P U GLUCOSE oxyciv'4: y T4 FLLAD°_ LQQDTHNNFR� Y LyB"I" COMMENTS: WHITE TO FLIGHT GREW YELLOW TO HOSPITAL MC-FR-075 �012�2025� PINK TO RESGUE 0 StrokeContinued"... ADULT POSITICUNG: * Supine: All patients with the exception of those (listed under 30' head elevation section 9 300 head elevation: A diagnosed or suspected intrazerebral hemorrhage Patient is short of breath OXYGEN: * 2 LP M NC if pulse oximetry less than 94%. * If the patient its in respiratory distress, manage airway as needed and consider advanced airway intervention. IV ACCESSKK • Establish an 18g catheter minimum if possible, the antecubital is preferred • Perform Glucose check HYPER"rENS0N a If patient has B/P of systolic greater than 220 or diastolic greater than, 120 AND possible signs stroke. * Labetalol 10mg IV/10 slow. May repeat X1 after 10 minutesto obtain target pressure of <185/105 0 Nk:,aiirfipIine (Carden ie) hffUSbW 2 5-151rng/hr h//�C) 0 Contraindications: Aortic Stenosis a P1 eCaUtlC)rl!': ,a �Iatiet it r;�n I Feta I.floick:',,rs I AV Heart block PEDIATRIC 0 POSff]ONMIG: Supine: 9 All patients with the exception of those listed under 300head elevation section 300 head elevation: A diagnosed intracerebral hemorrhage Patients short of breath 0 OXYGEN: 0 2 LPM NC if pulse oximetry less than 94%. ID If the patient is in respiratory distress, manage airway as needed and consider advanced airway intervention. * IV ACCESS. Estabfish a large catheter if possible, the antecubital is preferred • Perform Glucose check TRANSPORT. - ALL PEDIATRIC Stroke Aderts SHAt I be Aiirtrarq)oirted tothe do,,sest a,',q)rop6ate pediatric facphty,, *Consider,44- Transport as needed rJUMOU EMffFE 0 91"amcam 9%0f] rl up" Co 0 u urtnoon Punic 0 A& =�o � FA .MWO �F. �ar Is �A INFORMATION 0 Rapid atrial fibrillation and atri�al flutter are defined as ventricular rates > 150 beats per minute. ADULT Obtain a,12-lead and leave cables connected S1 ABI E • CARDIZEM: 10mg IV/10 over 2 minutes. If no response in 15 minutes, repeat with 15mg IV/10 over 2 minutes. (Use Arniodarone if Cardizem not available) 0 Bega rd iz e ni, 41, f LUJ(Din 'rat 5 rn g/h r 0 a a nf us, ion law. rr� p a AMIODARONE: 150mg linfusion over 10 minutes. If 10 minutes AFTER Arniodarone infu- sion has been completed, and rhythm has not changed, may repeat 150mg IV/10 over 10 minutes. (Use Cardizern if Arniodarone not available) 41..�:I. nig/irnlin vna infusion purnp J N S'l . AftLE Synchronized Cardioversion ( Lifepak Ascending Joule Setting: 200J, 300J, 360J) (Tempus Ascending Joule Settings: 100J, 150J, 200J) Consider sedation if IV access is estabiished prior to patient becoming unstable.. DO NOT DELAY CARDIOVERSION FOR SEDATION. If sedating Versed 5m,g IN/IV/IO/lM' 6 Atrial Flutter cardioversion will start at 100j and escalate as needed a If still hypotensive: Normal Saline: 20ml/kg over 10 minutes Assess lung sounds every 500mL. Cardizem is administered: ContraIndicatedfor hPotension, wide complex , history of WPW or sick sinus syndrome, Use with couti'on for patients taking beta bilockers. If'hypotension develops after Cardizerri administration, administer 50'OmL of Normal Satine and 500mg qf Calcium Chtoride over 2 minutes. Delta VVave Moy repeat 500mg of Calcium Ch,ioride, ifneeded. lwolff-Parkinson-wliite synd EM PEDIATRIC is 0 Call for orders 11� OFA-We �A INFORMATION a Rapid atrial fibrillation and atrial flutter are d'efined as ventricUlar rates > 150 beats per minute. PEDIATRIC 6 Obtain 12 lead EKG ,@ AMV IODARONE: 5m,g/kg IV push. If 10 minutes AFTER Arniodarone infusion has been com- pleted, and rhythm has not changed, may repeat 5mg/kgmg IV/10 push. AiJonat ,1mg/rnin aiha re 5.,isk)in purnp t 11 N S T AALUUyRQ1EL2!,� tul • Synchronized Cardioversion ( Ascending Joule Setting: 0.5 to I Joule/kg) Consider sedation if IV access established prior to patient becoming unstable. DO NOT DELAY CARDIOVERSION FOR SEDATION. If se. dating Versed O.Img/kg IV/10 q Atrial Flutter cardiloversion will start at 0.5 to 1 Joule/kg and escalate as needed 0 If still hypotensive: Normal Saline: 20ml/kg over 10 minutes Assess lung sounds every 500mL. Wolff-ParOson-'white Syndro Defla Cardizem, is administered: Coin train dicated for hypotension, wide complex, QRS, history, of WPW or sick sinus syndrome. Use with caution for patients taking beta blockers. If hypotension develops after Carffizem administration, administer 50IOmL of Normal Saline and 500n79 of Calcium Chloride over 2 minutes. Way repeat 500my of Calcium Chloiride if needed. 0 W==# Bradycardia is defined as a heart rate < 60 beats per minute. ADULT Obtain a 12-lead to rule out an MI and leave cables connected �STABLE a . ........ . .... — Monitor and transport U11JS EABLE� (HYPOTENSION) 9 ATROPINE: I mg rapid IVP. Repeat pm every 3-5 minutes. Max cumulative dose Brag. Contraindication - Bradycardia in the presence of an U1 H RA �'JEIIJT D171 [�N�()RATES OR I IYK) 1"ENSION PERSIS Imp il UFTER, 2 1)(I)SES �O�F A F �1 0 P I IN E 6 TRANSCUTANEOU�S PACING: Initial rate of 70 BPM and increase milliamps until capture is gained,. May gradually increase BPM to 80 if needed. UN Of! I RX'JSCUTAUIUS PACING bjej L11 [all fi 0]:1 WjYM I ',fAj Lj &11 ft1jfAjLjj:[q a VERSED: 5mgIN/IM/IV/IO. May repeat 1x prn,. If versed does not induce sedation, may administer KETAMINE 0.5-1 mg/kg IV/10 or 1-2mg/kg IN/IM If patient complains of pain while being paced, administer FENTANYL 1-3mcg/kg IV/10 may repeat once. (11. NO RE&�:,IQNSE TO, ATRQIIIWE OR1 RAN150AAMEOuS RAC1114(i 61 Noreel )inejAia-ineI-16rncgj1rnk)ute via infUSOti, 'FIrate to rnaintain a syst6kc L,uk)iod l)resSUre of90 in'urnlig. BRAD,YCARDI�A IIN THE PRESENCE OF AN MI'WITH HYPOTENSION Go directly to transcutanieous pacing as Atropine increases myocardial ischemia and may increase the size of the infarct. HIGH DEGREE AV BLOCKS WITH HYPOTENMON Immediate tiranscutaneous pacing is acceptable when IV access is not immediately available. Contime TU whifle administeringfluids and Not -epinephrine 0�% Bradcardiacontinued.. PEDIATRIC • Obtain a 12-lead and leave cables connected. I ABE E Monitor and transport UPJSTAB,III IE.'��QEEJ HE 2 AS A C, I 111j) WITI i ANIS AND POOR. PERFUSIQjil • OXYGENATION/VENTILATION/STIMULATION: Ensure adequate oxygenation and ventilation first, as hypoxia is most likely to be the cause of the bradycardia. • After oxygenation and ventilation of 1 minute for infants/children and 30 seconds for neonates (birth t 28 days), begin chest compressions if the heart rate remains below 60 BPM with signs of poor perfusio (AMS). UF INO RESF1,C)NSE TC) ()XYGULA VEr,1 ni A I ION (NOLAY E!EA�R'T' B1 OCK W1 FH Cl"R IN PROGRESS) • EPINEPHRINE: (11.10,000) 0.01mg/kg (O.ImL/kg) IV/IQ. Repeat every 3-5 minutes prn. • If no response to Epinephrine, begin TRANSgCUTANEOUS PACING. Begin pacing at 8,0 BPM and increas the rate as needed until the patient is hemodynamicaIly stable. OR Ii. NO RE&I),QNSE T() OXYGENATION XND VE��1'01LAI R 114 U00R30 /W I IEAI� F BLOCK W� ]'I I UR RJ • ATROPINE: 0.02mg/kg IV/10 (Minimum single dose 0.1mg). Max single dose 0.5mg. May repeat lxprr • If no response to Atropine, EPINEPHRINE: (1:10,000) 0.01mg/kg (O.lmL/kg) IV/10. Repeat! every 3-5 minutes pm. • If no response to Epinephrine, begin TRANSCUTANEOUIS PACING. Begin pacing at 8,0 BPM and increas the rate as needed untfl the patient is hemodynamicaIly stable. &I,E�QA'1'10114 IFOR FRANSCUTANIEQUIS PACUkIG • If unable to obtain IV/10 access, begin pacing until an acceptable blood pressure is obtained, then administer VERSED O.lmg/kg IV/I0/IN/IM. Max single dose 3mg. Max total doses 6mg. May repeat Ix prn. Contraindicated in hypotension, Mon ifor ,for' respii°atory depression. 0 Cardiogenic Shoc)4 110 INFORMATION Cardiogenic shock is a condition in which the heart suddenly cannot pump enough blood to meet the body's needs. Cardiogenic shock, often is fatal if not treated immediately. I ADULT @ Obtain a 12-lead and leave cables connected LEF] VUV'RICUIAR FILURE. PLIUMOPtARY EDEMAAND H"POI ENI&K)14' ii NCIREPii INEHR5,r, nmmnw ah,'Marmm Pcwww 9mFlg,L�f 2,Y2 !a!21LPINE:3()rm,LjjMUt11bate torAaS0 rn Do not administer Norepinephrine to patlents who are hypotensive secondary to blood loss, PEDIATRIC Epineph6rie Mfuson tn-acg/kg/rnin btrate to effect Once SIP is 100 mmHg or greater, treat CHF/Pulmonary Edema and/or Chest Pain as applicable. WITHHOLD If TG IF�OR THESE PATIENTS! 0 Hypertension INFORMATION A Hypertensive Emergency can be defined as a systolic BP > 220 and/or Diastolic BP �120. Rule out manif( tations that can cause hypertension prior to treating such as chest pain and heart failure. Symptomatic patients with elevated blood, pressure should be treated by the appropriate protocol based assessment of their signs and symptoms Chest pain consistent with myocardial ischernia or infarction ( Chest pain Protocol pg.58) Shortness of breath with signs and symptoms of acute pulmonary edema, ( CHIF Protocol pg. 60) Patients in the 2 nd or 3'd trimester of pregnancy (over 20 weeks) or up to 6 weeks postpartum with, elevatf blood pressure ( Pre-eclampsia/Ecla,mpsia protocol pg 126) Patients presenting with stroke like symptoms, obtain STROKE scale; (See Stroke protocol pg. 48) ADULT a Obtain a 12 lead and leave cables connected 0 IV access If patient is experiencing associated signs and symptoms of a hypertensive crisis : * Labetalol 10mg IV/ICE slow. May repeat X1 after 10 minutes to obtain target pressure of 190/110 * DO NOT DROP BP> 20% IN FIRST IHOUIR Do not Administer Labetalol to patients with HR less than 60bpm or AV Heart Block PEDIATRIC 6 Consult Medical control M Chest Pain I ACS INFORMATION For STEMI Alerts, or suspected STEM I Alerts, the right hand and wrist should be avoided if at al I possible foi IV ACCESS. The right AC and anywhere on the left is acceptable. ADULT • IMMEDIATE 12 lead ECG. Leave cables connected, and repeat every 5 minutes • ASPIRIN: 3 24 m g baby aspirin chewed and swallowed. Contraindications: allergy, octave G1 bleeding, <16 years old • Withhold if patient self-administered 324mg of aspirin within 24 hours. If patient self- administered Mess than 324mg of aspirin within 24 hours, administer full 324mg dose. OR a PLAVIX: 75mg PO if allergic to aspirin (if available) * FENTANYL: 1-3mcg/kg IV/IC} May repeat every 5 minutes prn. Max total dose 200mcg In rare occasions, Fentanyll may cause hypotension. If hypotension occurs, NORMAL SALINE: 1-2L. Assess Iung sounds and blood pressure every 500m L. If nausea and/or vomiting occurs, administer Zofran IWIO/IM 4mg. May repeat once prn. (Nitroglycerine may be given as a first line dnig a head of Fentany1for stable patients with historl of opiate obese or in whom drug see kingbehavior is, suspected) CIF III N DISCOMFORT PER"z6 I'c' Al 11-1) FY�fl TIM FENTANYL A[)hqjrJ1S I'RARON • NITROGLYCERINE: 0.4mg SL. May repeat every 3-5 minutes prn for pain. SBP must be 100 mmHg or greater. A 12 lead ECG must be obtained prior to the administration of NTG to rule out a right ventricular �infarction including complete right sided EKG. • An IV must be established prior to NTG administration, even in normotensive (patients. CONTRAINDICATIONS • EDD (Viagra and Levitra within 24 hours and Cialis within 48 hours) • Right Ventricular Infarction • SIDE less than 90, mn7H'g or Heart Rate leis than 50, BP'M' PEDIATRIC 0 Cal I for orders A -W14zW 0 M INFORMATION STEMI Symptoms can be variable and include discomfort of the chest, arm, neck, back, shoulder or jaw and also can be painless with syncope/near syncope (lightheadedness), general weakness/fatigue, unexplained diaphoresis, SOB, or nausea/vomiting. ADULT 0 IMMEDIATE 12 LEAD ECG WITH IMMEDIATE ACTIVATION OF TRAUMA STAR "STEMI ALERT". I. If Patient has Chest Paiin, Follow Chest Pain protocol Leave cables connected and repeat every 5 minutes 14 F-V E 14 I'R K -1 ULAR I�All LJRE�IC1 EAR UJI1443 S0LflNJDS W1 F14 14YPOTUNISIUN • NORMAL SALINE: 20ml/kg over 10 minutes. Assess lung sounds and blood pressure every 500mL. May repeat x2 prn UPA TIEI" I IIIw AINS HYPOTU,4SVE, XFITR F1 k 1III ADIVI IIINIS T 11,A 110N STEICI I AUERT CRI1'ERIA ST-Segment Elevation in two or more contiguous leads (1mrn or greater in all leads) with a ""convex" (frown face) or "straight" morphology. ST-Segment Elevation in two or more contiguous leads of Imm or greater in any lead with a ""concave"" (smiley face). ST-Segment Depression with high amplitude R waves in V1 (isolated), V2, and/or V3. "Carousel Seats" Right side EKG should be, er ormed. Posterior EK6should be performed (15 Lead,)'. *Leads V4, V5 and V6 can be, used aS V7, VB'and V9* 0 W1411M'ertcontinued... S rEIVU Al ERI DISt UAUTHNS The following are STEMI mimics,: • QRS cornplexes greater than 0.12 (LBBB, IRBBB, Pacemaker, etc.), • Left Ventrncular Hypertrophy (LVH) • Pericarditis • Early Repolarization • Less than Imm of elevation with a Concave ST Segment (Srnley Face) Morphology Patient presentations lindicative of myocardial ischernia that do not meet "STEM] or ACS criteria activate Trauma Star to transport to a PC] center. Lieft, Vientriciialair, I. ly pert noph y (L."111H) Take the largest negative deflection from, the isoelectric line of VI and V2 ("S" wave), whichever is larger, and count the small boxes. Then take the largest positive deflection of V5 or V6 ("R" wave), whichever is larger, and add it to the total from VI or V2. If the result is greater than 35, your suspicion for LVH should be high,. r'JOTES Patients with ST segment elevationin two or more Inferior Leads (11, 111, AVF) or isolated abnormalities in, lead III (isolated) and/or' 1 shall have a complete right side IS Lead EKG (V41146R) to determine if there is ST segment elevation, indicating a right ventriicular infarct (RVI,). The right sided EKG shall be labeled somewhere on the EKG,. If patient presentation is indicative of a myocardial ischemia andl it is uncertain, as to whether or not an ECG meets STEMI Criteria OR the ECG shows a STEM1, I mimic, the ECG should be transmitted to the receiving STEMI facility for determination. ed (con, vex ilown) 1 1.- E�R C'Oncave up 3 POW Notching Rk4glht-sided Leads -A� Deep 5 t",Vs In V1 or V2 j the kN av e i wi V1 is, deep gory tMN a Pie abo- .. ma.6— 'h 0 Swe we �n I'd I at I A00;h. NV 'fl. "W A --W I it, e f rA— Tali Awaves (VSorVQ 1. thia .—Pk be — VW SP V 1) RAVS) .- 41mmmP I 1,yni 1, 2111 ILI, I 1± 0 %CHIF (Pulmonary Edema) ADULT a 12 LEAD ECG Leave cables connected and repeat 12 lead every 5 minutes • CPAP (10 cm 1-120) CONTRAINDICATIONS • SBP less than 90t-nn7Hg 0 Decreased LOC (Letharg'ic) • ASPIRIN: 324mg baby aspirin chewed and swallowed, if not already administered. Con traindica tions: allergy:, active G1 beeding, <16 years old • Withhold if patient self-administered 324mg of aspirin within 24 hours. If patient self- administered Mess than 324mg of aspirin within 24 hours, administer full 324mg dose. IMIN 0 PLAVIX: 75mg PO if allergic to aspirin (if available) IF SYSTOLIC BLOOD IPRESUIRE IS GREATERT1..... 4AN 16(hnmH . ............. 0 NITROGLYCERINE: 0.8mg SL. Repeat at a dose of 0.4mg as needed every 3 minutes SYS I QUC BLOOD P1RESSURE'1,S6Iiinninl III F • NITROGLYCERINE: 0.4mg SL. Repeat as needed until BP is 120mmHg. CONTRAINDICATIONS • ADD (Viagra and Levitra withlin 24 hours and Cialis within 48borers)' • Right Ventricular lnfarcbon • SBP less than 90 rnmHg' or Heort Rate less than 50 BPM PEDIATRIC for orders 0 11771111 1111p:r;r: SVT is defined as a regular, narrow complex tachycardia of 150 BPM or greater CAUTION:, DO NOT administer Adenosine to patients with a history of a heart transplant or if talking Tegretol (Carbamazepine) or Persantine (Dipyridamole). In this case, administer Cardizern or Arniodarone as indicated below. Ruling out of secondary tachycardia must be performed prior to administration of cardiac miedicine. Check temperature, stimulant abuse, hydration: status, possible sepsis, physical exertion, anxiety, etc. If any of the previously mentioned are discovered, treat. ADULT STABLE 12 Lead EKG: leave cables connected 0 VAGAL MANEUVERS a ADENOSINE: 12mg rapid IVP, with a simultaneous 20mL Normal Saline flush. May repeat once., If rhythm fails to convert, CARDIZENI: 10irrig, WP over 21 n-0111Wtes, ff ino respionse h 5 in'�um.Aes, adrn�iiiiste° CARDLIZEIVI: 15mg PVP m. (,,)ver 2 rninutes. W��8,M�b.d.arg.ne.. ��f Qa.rdizem not ava�laUe' Contraindicatedfor hypotension, wide complex QRS, pahents with a h4story of WP''W or sick sinus syndronne. Use with caution for pots' -eats takineto blockers. AMIODARONE: 150mg infusion over 10 minutes. If 10 minutes AFTER Amiodarone infusion has been completed, and rhythm has not changed, may repeat 150mg IV/10 over 10 minutes. (Use Carclizern if Arniodarone not available. If symptomatic hypotension (below 90mmHg) develops after Cardizem administration, • NORMAL SALINE:500mL then • CALCIUM CHLORIDE: 500mg over 2 minutes. May repeat Calcium 50Omg one-time prn. W'11STXB1 E 0 Consider Sedation Versed 5mg IV/I0/1N (avoid IM medications due to shunting) SYNCHRONIZED CARDIOVERSION: (Life Pak)Ascendin,g joule settings of 100j, 200j, 300j, 360j (Terriptis) ,4scending joulesettings c�50-l", 10(11, 1,501, 200J 0 If cardioversion fails (reach max joules), contact medical control for further direction. cling out of secondary tachycardia must be performed prior to administration of cardiac medicine. ieck temperature, stimulant abuse, hydration status, possible sepsis, physical exertion, anxiety, etc. any of the previously mentioned are discovered treat accordingly. PFniATR'ir 9,5 1"A B L IC a VAGAL MANEUVERS a ADENOSINE: 0.1mg/kg rapid IV/10, with a simultaneous 10mL flush. Max dose 6mg. If no change in one minute, ADENO,SINE: 0.2mg/kg rapid IV/ICE, with a simultaneous 10mL flush., Max dose 12mg. a If no response administer fluid bolus 20ml/kg may repeat prn X1 �JIIQSTARI F fA(SE AM1101)'RIATE HYPO PEN2, IF PA TIENT 15 ALERT 0 ADENOSINE: Administer as noted above. IF PA TIENTHAS AN ALTERED MENTAL STATUS Consider sedation prior to cardioversion. Versedi: 0.1mg/kg IV/IO/IN/IM. Max single dose of 3m,g. May repeat Ix prn. Maxtotall dose 6mg. (avoid IM medication due to shunting) a SYNCHRONIZED CARDIOVERSION- Ij/kg. If not effective, increase to 2j/kg. a If cardioversion fails, contact medical control for further direction. PEDIATRIC VAGAL WOH.WERS For young children, place a bag of ice water on the child's, face completely obstructing their nose and imouth for at least 15 seconds. For older children, ask them to try and blow through a kinked piece of oxygen tubing orsyringe., SVT n infants is considered greater than 220 BPIVI. SVT in children is considered greater than 180 BPM. INFORMATION Wide complex tachycardia ('U"if T) has a QRS greater than or equal to 0.12 (0.09 for pediatrics) and a heart rate greater than or equal to 100 6PM without discernible P waves. Really wide complex tachycardia defined as: R ,greater than 0 20 and heart rate iess than 12 Consider�r rrler i4 r•otocol wvithhol'dAmiodarone ECG features that favoir a diagnosis of Ventricular Tachycardia Very wide, bizarre QRS morphology Precordial concordance — all chest leads point in the same direction (either positive OR negative) Negative Lead V6 Backward frontal plane axis 11, Ilk, and a 'F are negative. a L and aVR are positive. Presence of capture heats or fusion !beats (sinus beats that interrupt the WCT) ECG features that favor a. diagnosis of supraventricular origin P waves before the QRS complexes Normal R weave progression in the chest leads Left bundle branch block or right bundle branch bloc�k pattern, Only slight widening of the Q,RS Irregularly -irregular rhythm cardioversion terminates the OJT and the patient returns to VT, begin cardioversion at the Mast I energy setting and increase as needed. 0 EMMicardiacontinued.. I ADULT AM E REGULAR WCT * Perform 12 Lead EKG and leave cables connected * Perform serial 12 leads every 5 minutes * Consider Adenosine 12mg IV only if regular and monomorphic * AMIIODARONE INFUSION: 150mg INFUSION over 10 minutes. If 10 minutes AFTER Arniodarone infusic has been completed, and rhythm has not changed, may repeat 150mg IV/10 over 10 minutes. Administer, all 150mg, even if the VT terminates. DO NOT DELAY CARDIOVERSION TO ESTABLISH IV ACCES-S! Consider sedation prior to cardioversion. Consider Sedation Versed 5mg IV/lO/IN, Fentanyi 1-3 mcg/kg Ketamine 0.5-1mg/kg. SYNCHRONIZED CARDICIVERSION: (Life Pak)Ascending joule settings at 100j, 200j, 300j, 360j Tempus k cen&ngjoupl'e settings: 50j, 100j, 150j, 200j If unstable WCT fails to convert, AMIIODARONE INFUSION: 15Omg infusion over 10 minutes. if 10 minutes AFTER Amiodarone infusion has been completed, and rhythm has not changed, may repeat 150mg infusion lV/10 over 10 minutes. After the 150mg has been infused and the patient remains unst ble, cardiovert with (Life p,ak)360j (Tempus) 200j every 2 minutes prn. SPEQAL COP4SAIDERA PI(311,1,S AF PER CARDI0'VERSIQN For Patient's who coinvert after cardioversion OR after two or more shocks by their implantable Cardiovert (ICU) administer AMICIDARONE INFUSION: 150mg IV/10 over 10 minutes. If 10 minutes AFTER Arniodarone infusion ha been compietecl, and rhythm has not changed, may repeat 150mg IV/10 over 10 minutes. (if Arniodarone has not already been administered). PEDIATRIC 51 ABI E AM' IODARONE INFUSION: 5mg/kg iinfusion IV/10 infused over 20 minutes. Max single dose 150mg. M repeat until a max of 15mg/kg has been administered. UNS1 A131 E 0 Consider sedation prior to cardioversion. VERSED: O.Img/kg IV/10/IN/1M. Max single dose of 3mg. lvla repeat Ix prn. Max total dose 6mg. a SYNCHRONIZED CARDIOVERSION: I,i/kg. If no response, increase to 2j/kg. For patient's, who convert after cardloversion OR after two or more shocks by their Impllantable Cardiovert (IICD) administer AMIODARONE INFUSION: 5mg/kg in 100ml IV/10 infused over 20 minutes. Max single d,c 150mg. May repeat until a max of 15mg/kg has been administered. (if Arniodarone has not already been Polymorph,iffic V-Tachl Torsades de Poin,tes INFORMATION Torsades de Pointes is an uncommon form. of V-Tach characterized by a changing in amplitude or "twisting" of the QRS complexes. I ADULT SIM,BLI,PV1 0 MAG SULFATE: 2g IV/I infusion over 5 minutes. May Repeat X1 Ur�[STAKIE Mif I" DONOT DELY DEFIBRILLATION TO, ESTABLISH IVACCESS! • Consider sedation prior to defibrillation. Consider Sedation Versed 5mg IV/10/11\1 • DEFIBRILLATION: (Life Pak) Ascending joule settings at 200j, 300j, 360j (Tempos) 100j, 150j, 200j • If unstable PVT converts prior to administration of Magnesium Sulfate, administer 2,g infusion over 5 minutes. Plulseliess RVT 0 MAG SULFATE: 2g IV/IC) infusion over 2 minutes. May Repeat X1 PEDIATRIC S • MAG SULFATE: 50 mg/kg IV/10 infusion over 10 minutes, Max of 2g. i IINJ S rA II L E PVT DO, NOT DELA Y'DEFIBRILLATION TO E5TA BLISH I V A CCESS 1 0 Consider sedation prior to DEFIBRILLATION. VERSED: 0.1 mg/kg max of 3mg IV/10/IN. May repeat. 1x prn. Max total dose of 6 mg. 0 DEFI9RILLATI0N:2j1kg,,4j1kg If unstable PVT converts prior to administration of Magnesium Sulfate, administer 50mg/kg infusion over 10 minutes. If defibrillation terminates the PVT and the patienit returns to PVT,, begin, defibrillation at the last successfuil energy setting and increase as needed. 0 Left Ventricular Assist Devices - LVADs INFORMATION Left Ventricular Assist Devices (LVADs), also known as Heart Pumps, are surgically implanted circulatory support devices, designed to assist the pumping action of the heart. Caring for these patients is complicat- ed and every effort should be made to contact the patient's primary caretaker (spouse, guardian etc.) and the LVAD coordinator during your evaluation. Patients with a properly functioning LVAD may NOT have a detectable puilse, measurable blood pressure or accurate oxygen saturation. ADULT Contact the LVAD coordinator immediately; the phone number will be on the device and the equipment carrying bag. Take all equipment associated with the LVAD system to the ED, Locate patient's emergency "bag" with backup equipment. Treat Non—LVAD associated conditions in accordance with the appropriate protocol. Determine the type of device, assess allarms, auscultate for pump sounds. if needed, assist patient (caretaker) in replacing the device's batteries or cables. Locate the driveline site on the patient's abdomen:. BE CAREFUL not to cause any trauma to the site or driveline (wires). If signs of hypo -perfusion, administer NORIVIALSAILINE: 500mL and reassess. If there is bleeding at the site, apply direct pressure. UNRESP&P,45WE PXR[�NFS EVALUATE UNRESPONSIVE PATIENTS CAREFULLY FOR REVERSIBLE CAUSES! Perform a blood glucose level, if blood glucose is less than 60 mg/dI administer D10: 100mL. May re-, peat Ix prn. Performing Chest Compressions risks rupturing of the ventricular wall leading to fatal hemorrhage. ONLY perform chest compressions when the patient's LVAD is not working and no other options, exist to restart the LVAD. PACKAGING AN LVAD, PATIENT. Be aware of the cables, conitroller, and batteries. It may be best to place the stretcher straps under the LVAD cables to avoid creating torque on the device. At a minimum, be aware of this extra hardware. Transport patient to closest appropriate facility. 0 INFORMATION Pre -Flight Checklist: 0 IABP secured upright Is Battery � 60 m in utes, AC adapter present � a Go Bag Present I e Helium level > 50% �- Verify Arterial line waveform, confirm balloon placement • Transfer patient to 1:1 assist ratio,for transport. • Confirm pulses in all 4 extremities are equal e Verify adequate Urine Output � ADUILT � In-flight I@ Maintain 1:1 assist ratio. � - Monitor augmentation waveform I - Watch for: • Loss of trigger Gas Leak I- Migration alarms • Monitor Urine output and peripheral pulses in all extremities. • Monitor insertion site and tubing. Never advance or withdraw catheter. ■ \/\ Im M INFORMATION There is no scientific basis in trying to resuscitate an unwitness,ed AsystoIic patient who has succumbe to the dying process of a terminal illness. Consideration should be given to not starting resuscitation efforts in these cases. 0 In general, when the scene is safe, all Cardiac Arrests should be worked on scene. IADULT to a Perform CPR per AHA (ACLS) • LP15 may be utilized to assist with compression rate. • Emphasis is placed on minimizing interruptions in compressions to no more than 10 seconds. • Make all efforts to obtain a ROSC prior to leaving the scene. • Anterior/Posterior Pad Placement Preferred. • Once applicable, apply the Lucas with minimal interruptions to chest compressions and set to continu- ous compressions per manufacturer's recommendations. M E ll mci� r I�i 11j s • Medications should be delivered as soon as possible after the, rhythm check (during compressions) and circulated, for 2, minutes. • FoHow all IVP medication administrations with a 20ml flush of Normal Saline. • Search for possibie causes and treat accordingly (i.e. H's & T's, BG�L, etc.). rEW1v111YAT1U1Q U�1-FFIY� JS Consider terminating efforts when: 1 01 0 One defibrillation at (LifePak)360joules; (I empijs) 201,Oj if needed and 500mL of Normal Saline have to be administered. • All ALS interventions. including advanced airway, have been completed and reversible causes have been addressed. • Contact Meclica] Control to terminate efforts, if warranted, but totality of circumstances shall be consid ered. At no time shall the deceased be transported to the hospital unless resuscitation efforts are un- derway. Scene shall not be cleared until LEO is arrivai, aware of the circumstances and the termination decision and the information relevant to the case. • A DNRO may be revoked at any time by the patient, if signed by the patienit, or the patient's health care surrogate, or proxy or court appointed guardian or person acting pursuant to a durable power of attorney established pursuant to Section 709.08, F.S. Pursuant to Section • A family member CANNOT revoke the DNRO form. If a family member signed the DNRO form as the health care surrogate or health care proxy they can revoke the form in writing, by physical, destruction, failure to present the form, or orally expressing a contrary intent. Only those that signed the form (patient, healthcare surrogate or healthcare proxy) may revoke the form, 64J-2.018, FAC. Identification must be 0 :k Standing Orderscontinued..,. PEDIATRIC • Perform CPR, per AHA (PALS) • Emphasis is placed, on minimizing interruptions in compressions to no more than 10 seconds. • If applicableand'once available, apply the Lucas (if patient is over 18 y/o) with minimal interruptions to compressions and set to continuous compressions per manufacturer's recommendations. • Make all efforts, to obtain a, ROSC prior to leaving the scent. IVI 1� CA P14 S • Medications should be delivered as soon as possible after the rhythm check (during compressions) and circulated for 2 minutes. • Follow all IVP medication administrations with a 10ml flush of Normal Saline. IM, medications not indicated in cardiac arrest. • Search for possible causes and treat accordingly (i.e. H's & T's, BGL, etc.) ALL WITNESSECARDIAC ARREST PATIENTS MUSTBE TRANSPORTED. EtCO2 LEVELS During arrest, maintain EtCO2 levels greater than, 10mmH1g. If EtCO2 levels are less than 10mmHg, increase effectiveness of compressions. Levels of less than 110,mm!H,g have virtual- ly no chance of achieving ROSC. An EtCO2 level of approximately 20immHg is ideal. Hi's • Hydrogen ]on, (Acidosis): Vientilation • Hypeirkalemia (Renal Failure): Calcium Chloride, Sodium Bicarb, AlbuterM • Hypoglycemia: Glucose • Hypoxia: Oxygen & Ventilate • Hypovolemia: Flu id • Hlypothermia: Wdrii T's -Toxins or Tablets (OD): Opiates (Narcan) Beta Blockers (Gluciagon) Tricyclic, Anficlepressaints (Sotliurn Sicarb) if aliciurril Chcrnnel,fflorker (C.','.'alcium Chloride) -Tension, Prieurnothorax. Bilateral Pleural Deconipression FA.rfo, p h �*A MIENTOT Start CPA! woom hWV VON No ANYOOM w 1; 41 CPA, 2 ffl�," low, alhoollfg? I. .......... ... .... . # U'S CPR, 2 min EPIMworl rw llwgwxqf,� 3/,Ai r I v, Cuipwipw advsncmawrwam� Yes, CpR2 Ovoln ho"", 6 A-,'; M U,` ii vu qp-t s Pal r Mj j'n M. A III" u olf,fl t, o 11 C 9 V h"Irtio I uO (1,4 C,$9f,',J , 'to g4w 11 1 um s t-G ardlP a 1': 04, Fr"! pl t C", 3're, ASAP' r g I I, Y v 4' fine, 6", P If," rl v fa t vl I w-Po""A d ol ,a I I ,,4'Dof IJ)f m IPA I d cP, . c 6'r..rc d" wbl9'd L-11tllzoa y"je, ",f 14 r, r V1, n Ilk " L Au vx v f fmP,.,� r P,P I 4 "JI P 1: �XT T i 5j z� 011 llYICI-O, 4 5 r I ZY, Pl,x v "N "a �ya, "ej, PP,"j P', 0 1r"P riwa A V, ". P,� VA 11 P PP (� Pt R 1, o C IV"' "', q A lefp amuof",O 0 a f V I �"P0 J4 A), v I Ifi ,, V� " ow, ,5 a,d TM b r ui �,, ol P v "m f mr a , I e'"I w g P: "n Ij P, o,r, x, my "A PA", 0 "'a"t IVAQ answ PTPI, f2 r, nfi 'upbqj Efl, Av,vll r's ylo'j t g iv qa7 aru, M11,00,11), ir ry rPr rrr",Ofi,M ,:a:wfinn arvd T�,O,`,N f s, eu P: 4v,�Af r, l4 � r,7 �,� g�l ul vl 1, F xc, n �./s a, q "e, J ry.-f t"I" j uraeii "Icy" � rt i rm r a^r a r r, 11,, ro' e ,,v P,l rm f tP, CMCCMMM 0 C P P 1" 4 ", F I( v "a I I PP 'T uY r P It p lo 4 v, h� t[ 0,, tji ,Pry llmlavu"P,9r1, Ultrasound or Doppler may be Latilize,d to confirm Ipr�ese�nce of PEA 0 Cardiac Arrest (Pediatric) 4% Pedfatric Cardiat: A"est Algorithm ,- - �� i Start CPR �..,,, — ----- . .,, � ydat4µN,ww V,�rwpfjP,,fII, chest r i 1000 uq � :1�w ryuui w a daau UM 9r 2 m, 4*d9yffw, I Myoo"' ��� u, v�,l�'pr�Nu`ChAxn'w� vPww�`wwwuv<r°,, xn�uxuu'nq�yw UPM PO'et' s'ou l v,', and Epinephfine Asap ga�P$yMIdmB yq .......................... u CPR 2 min ( i �fh� I� 1 D @ ryp w u"; 9q)1 mi OfIq of II No �ydyd r �� y �wnu ProparwaI ovofawx 5 mrm jI m; i'9 no VI UP h141y lji wli'b rq'hms;a Iµ ry rmmj&"TJ r vein k Lu^emv a aPIDa4. Lou raj s 3lolM doses kvnowad;aVy flf°u ym 9 � � xkg k=Mg Mm qugd y o mpa x 1 q � klYmPyid�Cy✓ymmuYtlP,"JG�"w��"��`�krt5� �. IN i '� W°I:d b dmVdrxf V.W To o�Vq�'Y�ly"�"mh umm�h� r i�eq yugmmyr�° Sh elk CPR `i '� ��d�m mwmFd�wmal mre n8 ��'ftuV Ono Mww3 "7">,r fY Er,, axN gmµ'NwmtlwWo"g4 , r„t&Viµlldrm!mmiH,x'I9f oJNYsfegw,„': f � q , _ q'�irta;,�gmi,) q ("yuu�jymT,aw#ow,y III mpyo ~,w 1`30u too TI°tliAous C damwro xd ....... ..e...,,.. .,.,,; ,.,.�e�......................�. .,.,.,.�ee,.,.,. .,.,.,.... .......... 0202DAmtAumiWaal WoU;!Ahan I K. 11 111! ��ill�illillill iiiiiii !IIIIIII iiiiiiii�III A •qu 11j"1111111-Filir f''11 I INFORMATION . The below treatments are in addition to standard therapy. ADULT HYP E R IKA I E IINA [A 0 CALCIUM CHLORIDE: 1 gram, slow IV/IQ over 2 minutes. 0 SODIUM BICARBONATE: ImEq/kg, slow IV/10 over 2 minutes. 0 Once intubated, ALBUTEROL: 2.5mg via nebulizer, continuous treatments. EXGIIFE I [)ELIRR JIVI 0 SODIUM BICARBONATE: ImEq/kg IV/10, each amp administered slow over 2 minutes. 0 NORMAL SALINE: 20mL/kg IV/10. Maximum of 2L. Assess lung sounds every 500mL. 1)R0%M1,JICJ G • Immediate VENTILATION is a priority and treat as a SECONDARY ARREST. THIRD TRIIM�ESTER • Rapid Transport Recommended • Manually displace the uterus to the left • *Lucas* contraindicated in pregnancy • Transport to the Fishermen's Hosp. a Exception: Trauma alerts H,A11JG1PJ1(5 • Consider spinal motion restriction. • Transport to closest trauma facility. 0 Immediate DEFIBRILLATION as applicable. • Consider Spinal Motion Restriction. • Transport patient as a Trauma Alert 0 ADULT POD TARRES1' Patients with a ROSC should be managed in the order of: 0 12 LEAD • RATE: If patient is Bradycardic, TRANSCUTANEOUS PACING: Initial rate of 60 BPM and in- crease milliamps until capture is gained. (reference bradycardia protocol) 0 IRHYTHM: (reference specific protocol) • BLOOD PRESSURE: (Goal is to maintain a SBP of 90mm,Hg) If the patient is hypotensive, administer a NORMAL SALINE 20ml/kg bolus, may repeat Ix prn. If no response to fluid boluses, administer NORE[)INEP11,411NE 5- 310irncg/m� ri IIV/ 0, hb'ated to n'i,ain4�r� a 5BP of 90 innrnl4g, • Maintain pulse oximetryof 92-98% • Maintain ETCO2 of 35-45 mm-- Hg • Maintain 10 breathes per minute • Monitor patient temperature and treat accordingly POSTV F'IB lA"ii CQr4SIDERA T10114S • Administer AMIODARONE INFUSION: (150mg infused over 10 minutes) for patients who con- verted and have not received an Arniodarone bolus during arrest. F10ST TORSADES CONS0ERAriotis 6 Administer MAG SULFATE: (2g IV/10 infusion over 5 minutes) if paitient did not receive Mag ,Sulfate during arrest. "I"FUN114SROU IZIF PRIPAAR"Y ARREST All patients in non-traurr atic cardiac arrest will be transported to closest appropriate facility. PEDIATRIC POST' ARREST' 0 Maintain adequate oxygenation and ventilation. 0 Patients with a ROSC should be managed in the order of: RATI'" If heart rate is less than 60 BPM, provide oxygenation and ventilation for one minute (30 seconds, for a neonate). If heart rate remains less than 60 BPM with S/S of poor perfusion (Altered Mental Status) despite oxygenation and ventilation for one minute (30 seconds for a neonate), begin CPR. 0 If after one minute of CPR the heart rate remains less than 60, administer EPINEPHRINE: (1:10,,000) O.Olmg/kg (O.ImL/kg) IV/10. Repeat every 3-5 minutes prn for a heart rate less than 60 BPM. RHYD,11%1 Reference specific protocol. BZOOD PRESSURE Minimum Pediatric Systolic Blood Pressure Vailues Neonates: 60mmHg lnfants:'70mmHg Children 1-10 years old: 70 + (age lin years x 2) mmHg Children greater than 10 years old: 90mm Hg 0 NORMALSALINE: 10ml/kg IV/10 for neonate and infant over 10 min may repeat 2,x prn 20mL/kg, bolus for children over 10 min, titrated to a SBP as, listed above. May repeat 2x prn for hypotension. * Assess lung sounds and blood pressure often. rRANSF)C)RTGF PEDIAT'RIC (ZARDIAC ARREST All patients that have a ROSC should be air transported to a Pediatric emergency facility. Pulseless pediatric patients shall be transported to Fishermen's Emergency Department. wo�!! w WIR, ff ILIWN/���IIIINMIMRAL IWAA K-- ALiffus". W E ro, 111"m �q(m EWA, it] Ph, 0 Standing Orders INFORMATION The goal for effectively managing patients with an overdose/poisoning is to: 0 Support the ABCs 0 Terminate seizures Terminate any lethal cardiac arrhythmias 0 Reverse the toxic effects of the poison/medication with a specific antidote The treating, paramedic should consider contacting the Florida Poison Control Center at 1-800-222-1222 as soon as possible for additional treatment recommendations. a Treatment recommendations from Florida Poison Control should be followed. W Document the directed treatment and the name of the representative on the ePCR Report. • Use caution when supporting blood pressure with fluids. Many medications depress myocardial contractility and heart rate, which predispose the patient to heart failuire even with boluses as (little as 5OOmL. Assess lung sounds and blood pressure frequently. • It may, Ibe necessary -to limit the amount of fluids, the patient receives. ; INFORMATION Signs & Symptoms: • Bradycardia • Hypotension • Cardiac arrhythmias • Hypothermia • Hypoglycemia C a C I U I Cz� • FoHow the appropriate protocol if patient is symptomatic and treatment is not listed below. ADULT • Obtain a 12-lead and leave cables connected • If confirmed Beta 13locker Overdose and patient unstable. Administer Glucagon 3 mg IV/10 (if availab • Refer to the "Bradycardia" protocol if applicable ISOLATED HYPOTENSION • NOR MAL-SALINE • 20ml/kg IV/10, titrate to desired effect. Assess lung sounds and, BP frequently. • May repeat 1x prn Precaubons - -twCLflar care n'ILASt be takeirn iuni gnfficant cotonairy heart Diu sease, CDHF, and I�afliure paerits PEDIATRIC • Obtain a 12-lead and leave cables connected • If confirmed Beta 13llocker Overdose and patient unstable Administer Glucagon 0.1 mg/kg IV/10 (if available) ((flay repeat ix prn) • Refer to the "Brad yca rd i�a" protocol if applicable NORMAL SAUNE: 0 10ml/kg IV/10 for neonate and infant over 10 min 0 20 mL/kg IV/10 for children over 10 min. Assess lung sounds and BPfrequenVy 0 May repeat 2x prn, for age appropriate hypotension 0 INFORMATION • Signs &Symptoms: 0 Hypotension • Syncope • Seizure • AMS • Non-Cardiouenic (Pulmonary Edema Common Calcium Channel Blockers: 0 N orvasc 0 Cardizem Cardene • Procardia, 0 Bradycardia • Follow the appropriate protocol if patient is symptomatic and treatment is not listed below. ADULT * Obtain a 12-lead; and leave cables connected a CAL0UNA CHLORIDE if Patient Uristable: 9 1g IV/10, over 2 minutes, 0 If patient rernains Hypotensive NORMAL SAUNE; • 20ml/kg IV/10 over 10 minutes, titrate to desired effect. Assess lung sounds and BP frequentli • May repeat Ix, prn a, PreR attioins - Pa�-tlClUkai- 4:arie rnus,,'t be tak',en IOn th�? 1ki'eserice (,°)f signHicant coaft ronry �Iea J�sease, 0 ff, and n 1-nat faflure paheints HYPOTENSION WITH BRADYCARDIA OR NON -RESPONSIVE TO ABOVE TREATIIw ENT * Refer to the "Bradycardia" protocol, if applicable PEDIATRIC Obtain a 12-lead and leave cables connected, • CN OUM CHLORIDE if Patient Unstable: * 20mg/kg IV/10, over 2 minutes • If patient rernains lHypotensive NORMAL SAUNE: • 10ml/kg IV/10 for neonate and infant over 10 min • 20ml/kg IV/10 for children over 10 minutes, titrate to desired effect. Assess lung sounds and E frequently. • May repeat 1x, prn HYPOTENSION WITH BRADYCARDIA OR NON -RESPONSIVE TO ABOVE TREATMENT * Refer to the "Bradycardia" protocol, if applicable INFORMATION Signs &Symptoms: • Tachycardia • Supraventricular and ventricular cardiac arrhythmias • Chest pain/STEMI • HTN • Seizures • Excited delirium • Hyperthermia • Follow the appropriate protocol if patient is symptomatic and treatment is not listed below. ADULT 0 Obtain a 12-lead and leave cables connected, 31111111111111NAMM • 5mg IV/10/IN/IM • May repeat Ix prn, in 5 minutes • Contraindication - Hypotension Prey i�I-iudon- hVfonitor for respk a'��olry ci?plresaka: in • Follow appropriate protocol if: a Above treatment is unsuccessful OR If the patient has an unstable cardiac arrhythmia PEDIATRIC • Obtain a 1,2-lead and leave cables connected • VERSED: 0.1 ni IV/10, max single dose 3mg • 0.2 mg/kg IN/lM, max single dose of 6m,g • May repeat either route Ix prn • Contra ind ii cation- H ypote n s ion 11110 Pt ie�:Iaution - �'Aonit,�It:n foi: res��)�ira��oiry depress�orr, WARNING • Narcan is to be used PRN to improve intrinsic airway pautency, ventilation and oxygenation. • The goal its to restore spontane- ous respiration, NOT 'to wake the patient pup" Common Narcotic • Fentany] • Codeine • IDiiaudid Heroin Methadone • Lorcet Vicod i n Oxycointin Lortab Suspected Narcotic Overdose I NO YES NO Secure IVfI0 Access? 'Is T a so ricycitc Antidepressant (TCA) Overdose INFORMATION Signs & Symptoms: • Mad as a hatter • Red as a beet • Hot as hell • Dry as a bone • Blind as a bat a Coma • Seizures • Cardiac arrhythmia • Acidosis Common, TCA: Amitriptylinie • Desipramine • Doxepin • Follow the appropriate protocol if patient is symptomatic and. treatment is not listed below. . . ................................... . ADULT 6 Obtain a, 12-lead and leave cables connected FOR PATIENT WITH A QRS COMPLEX >.10 SEC ONDS_LZI5 SMALL BOXES • SOMUM IBNCARBONATE: * 1 mEq/kg IV/10, over 2 minutes * May repeat 2x prn, in 5 minute intervals, maxtotal dose 150 mEq If Patient remains HYPOTENSIVE • NORMAL SALNE * 20ml/kg IV/10, titrate to desired effect. Assess, lung sounds, and BP frequently. * May repeat 1x, prn * Flre�:aUtilNIS PartiCLOaii ("are rnust be takeiiii NYri the V:iresence of sgiiftcant cwona�y hear" disease, Clif', anal rena� fi:Wure patiey ts PEDIATRIC 0 Obtain a 12-lead and leave cables, connected FOR PATIENT WITH A QRS COMPLEX > 0.08 SEC INN jJZSMIALL. BOXES • SOMUM BICARBONATE 8.4%-. V lm,Eq/kg IV/10, over 2 minutes If patient remains HYPOTENSIVE • NORMAL SALANE: • 20ml/kg IV/10, titrate to desired effect. Assess lung sounds and BP frequently. • May repeat 1x, prn WARNING TCAs cause death primarily through lethal cardiac arrhythmias., Wide QRS complexes are an ominous sign and must be treated with 50MUM BNCARBONATE immediately. Digitalis Toxicity (I INFORMATION so Digitalis is a cardiac glycoside with positive inotropic effects; slows AV conduction by enhancing parasym- pathetic tone; and has a slow onset of action. Digitalis toxicity should be suspected in, patients who are taking digitalis and have signs and symptoms associated with digitalis toxicity - for example, fatigue and 11 visual disturbances (halos in field of vision). The most common arrythmias are ventricular ectopy and bradycardia, often in association with various degrees of AV block. The following rhythm disturbances should immediately suggest digitalis toxicity: atrial tachycardia with high degree AV block, nonparoxysmal accelerated junctional tachycardia,, multifocal VT, new onset bigeminy, regularized atrial fibrillation, spoor -shaped ST segment, peaked T wave. Contact with the oleander tree, squffl, lily of the valley, and toad skir can also cause a digitalis -type toxicity, which will cause the same type of dysrhythmias and requires the same treatment. DIGITALIS: GENERIC NAME (TRADE NAME) digoxin (Lanoxicaps, Lanoxin, Digoxin), digitoxin (Crystodigin) ADUILT 0 'ADULT TREATMENT: Contact PICC 1-800-222-1222 Verify Digitalis Toxicity by confirmation, from patient or by counting pills in bottle. Avoid Use of Calcium, Chloride as it is contraln&cated in the setting of Digitalis Toxicity. Perform 12 lead is clinical stability allows. Leave cables connected. * Digitalis -induced Symptomatic Bradycardias Atropine 0.5mg rapid IVP followed by 20ml flush of NSS. May repeat once if needed. Avoid pacing as patients with digitalis toxicity are more prone to pacemaker -induced ventricular rhythm disturbances. If wide complex Bradycardia is present administer Sodium Bicarbonate Imeq/kg. 0 Digital is -induced Ventricular Arrythmias -Stable Magnesium 2g IV over 2 minutes Once initial 2g is administered, administer continuous; nfusion of Magnesium 2g over I hour. 0 Digital is -Induced Vent ricu lar Arryth m i,as — Unstable Consider sedation. Synchronized Cardioversion at 25J. May repeat twice at 50J. Patients with Digitalis Toxicity may develop malignant ventricular arrythmias or asystole after cardioversion. If patient suffers cardiac arrest refer to Cardiac Arrest protocol. If no response, immediately reattempt cardioversion using defibrillation doses — 200J, 300J, 360J. Maintain at 360J if needed. I PEDIATRIC: Contact Poison Control I OrganophosphatelCarbamate Exposuri 01.11' ' INFORMATION Signs and Symptoms • Diarrhea a Emesis • Urination a Lacrimation • Mi0sis. a Salivation • Bradycardia 6 Secretion • Bronchorrhea a Sweating • Bronchospasm ADULT & PEDIAT�RIC 0 0 SUSPECTED I U-1111 FLcONFTIR&MED OR SUSPE�CTED ORGAN 0 PHOSPHATE/CARBAM ATE EXPOSURE USE CAUTION SO NOT TO EXPOSE CREW OR APPARATUS DURING TRANSPORT If the patient was exposed externally, remove his/her clothing and jewelry and decontaminate with copious amounts of water. If the patent has burns to the eye (s), immediately flush with copious amounts of water or normal saline 1000ml per eye. Contact Poison Control 1-800-222-1222 MILD to, MODERATE POISONING • Administer Atropine 1-2mg IVP. SEVERE IPOBONiNGwRh L)WONSCIOUSNESS Adult Administer Atropine 3-5mg: IVP • Repeat the dose every 3-5 minutes until improvement has begun. (Decrease SLUDGE) If patient has bronchospasm treat with Duo-Neb nebulized. • If patient seizing, see seizure protocol. If patient is hypotensive, see hypotension protocol. • If risk of exposure from fumes is high, consider HazMat or Tbx Paramedic response. Refer to ERG book. The endpoint for treatment is manifested by patient improvement with clear lung sounds. Pediatric: If the patient is bradycardic or has excessive pulmonary secretions, administer atropine 0.05mg/ kg, maximum, dose is 3mg 0 Chlorine Exposure INFORMATION Signs and Symptoms ■ AMS Hypoxia ■ Burns • Wheezing ■ Painful Cough N'on Cardiogenic PE I AQUILT & PEDIATRIC CONFIRMED OR SUSPECTED CHLORINEAMMONIA EXPOSURE • If the patient was exposed externally,, remove his/her clothing and jewelry and decontaminate with copious amounts of water. • If the patient has burns to the eye (s), immediately flush with copious amounts of water or normal saline 1000ml per eye. • Contact Poison Control 1-800-222-1222 Is Refer to ERG book. Adult: • If patient is suffering from pulmonary edema, apply CPAP 10mmHg PEEP. • If patient has bronchospasm treat with Duo Neb nebulized. • If patent has inhaled chlorine and has significant respiratory distress, administer sodium bicarbonate via nebulizer (8.4% 3mL mixed with 3mL of normal saline). 0 If patient seizing, see seizure protocol. 0 If patent has external burns, refer to burn protocol. • If patent is hypotensive, see hypotension protocol. • If risk of exposure from fumes is high, consider HazMat or Tox Paramedic response. a Hydrofluoric Acid Exposure INFORMATION Signs and Symptoms • Hyperactive Reflexes • Painful Muscle Spasms • Burns • Headache • EKG Changes - Prolonged QT • Possible Peaked T-waves ADULT & PEDIATRIC CONFIRMED OR SUSPECTED HYDROFLUORIC ACID EXPOSURE • If the patient was exposed, externally, remove his,/her clothing and jewelry and decontaminate with copious amounts of water. • If the patient has burns to the eye (s), immediately flush with copious amounts of water or normal ,saline 1000ml per eye. • Contact Poison Control 1-800-222-1222 Is Refer to ERG book. Adult: • If patient is suffering from pUlmonary edema, apply CPAP 10mmHg PEEP. • If patient has bronchospasm treat with Albuterol nebulized. • Treat inhalation injuries with sodium bicarbonate via nebulizer (8.4% 3mL mixed with 3mL of normal saline). • Perform EKG and serial 124eads. • For severe toxicity/exposure (dysrhythmia, prolonged QT interval, hypotension), administer 4 grams of Magnesium Sulfate solution over 20-30 minutes. • Administer Sodium Bicarbonate 8.4% Imeq/kg IVP. • If patient seizing, see seizure protocol. • If patient has external burns, refer to burn protocol. • If patient is hypotensive, see hypotension protocol, • If risk of exposure from fumes is high, call for a HazMat team. Ifl ,-,p ji al's, 0 INFORMATION a Restrained patients shall NOT be placed in a prone position. 0 Chemical restraint may be used in addition to physical restraint for the f6llowing: a VIOLENT/COMBATIVE PATIENTS are violent, agitated patients who place themselves and/or crew in danger 0 Have all ALS equipment ready for use ADULT and PEDIATRICS 6 If possible utilize Law Enforcement to assist with restraint FOR VIOLENT/COMIBATIIVE, a KETAMINE: 0 3-5mg/kg IM a If IV available 1-3m,g/kg IV a May repeat Ix prn, in,5 minutes 0 Contraindications - as, noted above 40 Precautions- &.11 note H above • If ineffective consider Versed 5mg IV/10/]N/IM may repeat 1X prn • Document Patient Weight (consensus of crew) FOR SPECIAL, POPULATION VIOLENT/COMBATIVE • Special p,opuilation patients: a Over 65, years old 0 Head trauma 0 < 50 kg a Already taken other sedatives (e.g., benzodia,zepines, alcohol, etc.) KETAMINE: • 2-4mg/kg IM/IN for the above patients • If IV available 1-3mg/kg IV • May repeat 3x prn, in 5 minute intervals to gain control of the patient • Contra indica don s -. * Pregnant patients * Penetrating eye injury * Non -traumatic chest pain IF Precaudons� • [!,e prepi :Ued foi ad,�,,aince(l tJ-ian 1111,Ua� Nncreases 4-1 biood :,tress14.u-es • If ineffective consider Versed 0.1 mg/kg IV/10/IN/IM may repeat as needed • Document Patient weight. LARYNGOSPASMI (STRIDOR) REACTION TO KETAMINE ADMINISTRATION • High flow 02 • Assist ventilations via BVM prn • Consider advanced airway procedures • pirec�:wtioin i ar"/11'1�7ospasirn is uncorrsinon and 0s usuaUy se�f-�Iirnitmg, �t a�n-�xft akx�,ays res�,'flves � N vgh flovv0'c)r [,�11 &%�erh,�abroiri \da B\lr,,vl,, 111�1�i!;;!�Jiili 11�11� I ; I 1 11; 1 � I! I �� I I I I ur I ��� I �� I! � I I 1� I I iilii� 1 0 ATROPRE: a 0.5mg IV/10 0 May repeat prn, in 3 minute intervals, max total dose 3mg 0 Con-traindication- Bradycardila in the presence of an MI AFTER KETAMINE ADMINISTRATION • If patient begins to wake up: VERSED: • 5mg IV/10/IN/IM May repeat 1x prn, in 5 minutes Contraindication-Hypotens,ioin, lie F1i-ei,aL0iCA1- N,10t)�Itoil- foil, N espi�-atory [Jepress'P'Oin 0 Obtain a temperature. RAPID COOLIING FOR A TEMPERATURE OF > 1013 DEGREES F • Apply ice packs to axilla and groin area 1140 R M AL SA Ll N E: 0 20ml/kg IV/10. Titrate to desired effect. Assess lung sounds and BP frequently. a May repeat 1x, prn Is Neca�,.iibors Fla rd cjl.� � ar care rm is t ae Uiken � n die pil- es le n ce of s�lg ii i �f licain roin a 6sease,, 0 iF, aini�J renaHaiilure pa'i� �en't's SODIUM BICARBONATE: a lmEq/kg, IV/10, over 2 minutes POST SEDATION • Once sedation is achieved and the patient's agitation has subsided, conduct a continuous comprehensive ALS Assessment • Secure the patient to the stretcher in a position best accessible for continued care. 0 Pain Management INFORMATION F 0 FENTANYL is the front line medication for pain, however KE FAWNE is preferred for hypotensive patients or patients who have opiate contraindications (allergy, history of abuse, etc.). a KETAWNE may be given with FENTANYL for Severe pain. 0 2 7 on the pain scale is considered "severe pain" II ADULT FOR PAIIN MANAGEMENT a FENTANYL • 1-3mcg/kg IWIO/IM/IN • May repeat prn, in 5, minute intervals, max total cumulative dose 200mcg * Contraindication, - Pregnancy near term (32 weeks or greater) or in active labor * Pre cautiori: beha,,ikDi Disc�(>ntiu we uif pzibent Ilaecoiirynes dro,,Sy Carbe reveirseci vJfli NARICAN if ne�:-essary KETAPAINE if FentanVI ineffective or FentanVI not indicated: • 0.1-0.5mg/kgof Ketaminein 100mll NORMALSALINE BAG • Administer IV/10 infusion over 10 minutes • Reassess pain scale after half of the infusion has been administered (5 minutes) or 25mg a Continue infusion if needed. Max total dose 100mg • Contraindications: a Pregnant patients * Penetrating eye injury * Non-traurnatic chest pain all, B. ::!, prepw ed fi")ii advarl ced a'away iiianaigement Rapk.i �"V adi,r0n�stradonj is as-sociatedvJth resphratory depn,�,�ssion, aj,,�nea, Brld d'ierthairii LISLII'3l k'i,creases 4) W010d P�-eSSUN�S ADULT FOR PAIN MANAGEMENT Dflauiffld (Hydrornorphone) 0 0.5-1mg IV/10 a May repeat prn XI., in 30 minutes, max total dose 2mg •ContraiindicatiolRi:—Hypef-senisitivitV, opiate adfflction, status asthmatiCUS Q POA'() �nhHLJ,Iors di, stattrs 101 Can Lie reveirsu:,d vJtl-d NARCAN 11 Pain Ma'nagementconiiffnued'.... PEDIATRIC FOR PAIN MANAGEMENT FENTANYL 0 1mcg/kg IV/10, over 2 minutes 1.5mcg/kg IN/lM Max single dose 50mcg May repeat 1x prn, in 5 minutes, max total dose 100mcg Contraindications: a < 6 months old IN Precautions�; * klon'ntor pabent for ries�,;Jirat<,�)ry deprre"Ssk)fl� * DSCC)II)b III Ue kf :itieint becomes dirow'sy * Cain, be reversed ,�vfth NARCAN mf necessary KETWINE( . 3 years old): 0.5-1mg/kg IV/]O/IN/IM May repeat 1x prn, in 5 minutes Contrainfflcabonso 0 Penetrating eye injury * F'IreCaUdMS: 11111 pre�,')a i� ecl IS r:Idvanc:„d wirway managennein DF:r)i ATRir FOR PAIN MANAGEMENT DILAUMD (HYDROMORire OI): 0.01-0.015 mg/kg IV/10, over 2-3 minutes, Q3-6 hours May repeat 1X prn, in 3-6 hours, max dose 0.015mg/kg Contiraindications:� & < 6rnonths old or10kg V PI-10CALAions� & k N' k4 o n i t o r I[�) a h �"l n t fo r r 'spIiiratoiry deprressk-x,'i * FDmsconbrue cf pattent becornes chcws"�,a' 4 10 NO HURT- HURTS HURTS HU,lad T5 HURIS HURTS LITTLF. BIT LITTLE MORIG GVEN MORE W14OLE LOT WORST 0 1 2 3 4 5 6 7 No pa in Wild mode-irato S,cvcrc wore Irgaitl,iry imaginable 11111 1111 1 111 1 111 11111 ill 11, 1 OP Il!11 � iI 111,11 ILM�� MZN�� 1"CUT11101 2mg/kg IV/10 slow IV push may repeat X1 OR VERSED: • 5 mg I'V/10 may repeat X1 I K eta mirl iinfusiaru a G.1-4rng/kg,jhr IPosition and Suction i Pre -oxygenate a Assist ventilations via BVM ■ Apneic oxygenation via NC at 15 Ilan Induction Agent Ketarnine or Etomidate (0.3mig/kg) YES H n LA 1. Successful? j NO YES YES 44-1incubation sedation (;mandatory ; I KETAMINE: • Zmg/kg slow IV/10 push over '1-2 minutes • May repeat IX Precaution: • Rapid IV administration is associated with higher increases in BP Indications: 1W Broi�iicho,coi,isirrIUiir,?.ic)n is Septic shock If Hypotensioin 'IV "IJioierit,licii�iriiballl,.ive Head Injiludes with Susplectied 1CP Contraind lcations!May use ersed5mg IVP * PregnantPatlents * Penetrating Eye injury * Ikon -traumatic ches�l Pain ffiT WMA 1 " W 10 .. 70oUT•, PTf i � - 0 MEL= KID TAM,INE- 1.5mg/kg IV/10 slow IV push may repeat X1 OR VERSED, • 0.1 mg/kg IV/10 may repeat X1 ,OR IKETAWNE Ilorrllusswan,� qP IPosition and Suctfon rPre -oxygenate 0 Assist ventilations via BVMI ■ Apneic oxygenation via NC P 15 Ipm Induction Agent: Ketamine 11 I NO Successful? YES YES I 111 T �kj L 111 • 15m,t/kg slow IV/Ifs push over -2 minutes • May irepeat 1X Precaution: • Rapid IV administration is, associated with higher increases in BP Indications: 0 Septic shock A I fkjpjoteinsioin Head injiudes wW'u suslpeirtieid HCF11 Contraindications-. May use Versed 0.1 rng/kg IVP Pregnaint Patients Penetrating Eye Injury Non-trournatic chest pain 0, rl sm 14,16, 110 40 x, ul 0 0 Y .INFORMATION • Signs & Symptoms • Stroke -like symptoms • Visual disturbances • AMS • Para,Jlysis or weakness • Numbness/tinglirig • Bowel/bladder dysfunction • Any patient with these signs & symptoms who has used SCUBA gear or compressed air within a 48-hour period shall be considered a decompression sickness patient. • Transport Stable patients to Mariners Hospital Hyperbaric Chamber (encode prior to transport to confirm availability: 305-434-3000). *Air transport only • If unavailable transport by ground. • Document the treatment and the name of the representative on the ePCR Report. • Transport Unstable Adult18 y/o patients to Mercy Hospital via Air transport. 0 Mercy Dive Emergency # 305-285-2172 • Transport unstable, Pediatric patient to St. Mary's Hospital via Air transport 0 St. Mary's, Dive Emergency # 561-804-6000 • Try to obtain an accurate history of the dive: • Depth of dives, • Air mixture type in tanks • Number of dives • Interval between dives • All dive equipment must be brought to the hospital. • Contact DAN ADULT & PEDIATRIC a, POSIT[DNING: ZA a Transport patient in a supine position * For cardiac arrhythmi,as, refer to appropriate protocol * Rule out a tension pneumothorax * OXYGEN * 15 LPM via NRB regardless Of SP02 * Advanced airway Protocol if necessary IF Non -Fatal Drowning INFORMATION ...... . .. Consider spinal motion restriction in the presence of trauma (e.g., diving, rough surf, vehicle accident with subsequent submersion, etc.). 1 ADULT & PEDIATRIC 4Q NON -FATAL DROWNING 4S, • All non -fatal drowning patients, MUST BE TRANSPORTED to the hospital • For cardiac arrhythmias, refer to appropriate protocol • Deep Suction, • CPAP - (10 cm H20) for pulmonary edema secondary to near drowning: 0 Contraindications: * SBP < 90 mm Hg * Patients WfthOLA spontaneous respirations * Patients with a decreased L; (lethargic) * Patients < 30 kg 61 ConsWeir Advanced Airway Protocol IF PATIENT IS HYPOTENSIVE WITH CLEARLUNGSOUNDS • NORMXLSALWE. a Adult: • 20ml/kg IV/10, titrate to desired effect. Assess lung sounds and BP frequently. • May repeat Ix, prn �Ilv tin ecaiutJons flarlhUflar lizaire must b::, ta[,en un the presence of s1gnhclairnt c"fir onar,,y° hear disea,se,, CHF, and renafailure pa"tierits • Pediatric: • 2QmL/kg IV/10, assess lung sounds and, BP frequently • May repeat 2x prn, for age appropriate hypotension IF PATIENT 15 HYPOTENSIVE WITH PULMONARY EDEMA • NoirepinephHne • Adult: • NOREPINEPHRINE 5-30mcg/min IV/ 10, titrated to maintain a SBP of 90 mmHg. * Contraindications - Hypotension secondary to Wood loss * Precaiuhnins; Rapnid (1 m4wtv,:,,� ons�:�t, short (5-10 M4'Wte') ffiffati()�l • LAonl�tcii hea:wt raga and Lflood pressUre thf-,CJUrfl10Ut adrnkiistrau,Jon • Pediatric: * Epinephrine Infusion O.Imcg/kg`/min—imcg/kg/min,Citrate to effect * Contraindications - Hypotension secondary to blood loss lb Precalutory qlllll� Pvlcnnlltor l,ii,eait rate ar�d No(:mJ pressure throG,Vglli�aut aiJn)Jnistratkn in Heat Emergencies INFORMATION Signs & Symptoms of heat stroke include any of the following: • AMS When treating heatstroke: • Seizures • Hypotension "COOL FIRST, TRANSPORT SECOND" • Sweating may be absent • Patients with a heat -related illness associated with an altered mental status should be considered to have heat stroke once all the other possibilities for the AIMS have been ruled out (hypoglycemia, drugs/alcoW, trauma, etc.). ADULT & PEDIATRIC ALL HEAT EMERGENCIES • Move patient into the back of the rescue as soon as possible. Decrease the air-conditioning temperature in the patient compartment. • Obtain a temperature • Remove excessive clothing • Provide oral hydration (preferably water) if patient is able to swallow and follow commands HIEAT CRAMPS & HEAT EXHAUSTION a NORMAL.SAUNE: 30 "MMI; • 20H/kg IV/10, titrate to desired effect. Assess lung sounds and BP' frequently, • May repeat 2x, prn PreCaUtioris Pardcu�ar caie ry,'ius't be tali n in fl-te prese-irwce of sigJ'hcar'at coroiiiary Nieairt &sease, CHF, and rena� f:aHu.iire ip,:Aiertts • Pediatric: • 20ni IV/10,, assess lung sounds and BP frequently • May repeat 2x prn, for age appropriate hypotension • Apply ICE RACKS toaxii1la and groin area. • Diis,continue active cooling once temperature of 101 is reached W Adult: • 20ml/kg IV/IC', titrate to desired effect. Assess lung sounds and BP frequently. • May repeat 2x, prn Prec�)utiw,Y,iris Pa tic u ia r ica ir di be ta �<e ri lin t i-we presence of s �g n ifica rit ciI:x (,)nat hieart disli CHF, and renal faHure pabents W Pediatric: • 20mL/kg IV/10, assess lung sounds and BP frequently • May repeat 2x prn, for age appropriate hypotension 0 CarbonMonoxide Exposure INFORMATION • Carbon Monoxide (CO) properties: • Chemical asphyxiant • Colorless • Ododess • Tasteless • Slightly less dense than air • Toxic to humans when encountered in concentrations above 35 parts per million (ppm) • Lower doses of CO can also be harmful due to a cumulative effect • Patients exposed to carbon monoxide (smoke inhalation, etc.) require a full head to toe patient examination including SpCO monitoring with the rainbow sensor' • All rescuing crew members shall wear their SCB,A if the patient is in a hazardous environment. • Refer to the "Cyani,cle Exposure" protocol, if applicable QADULT & PEDIATRIC vs, Apply rainbow sensor and obtain SpCO readings OXYGEN. 0 15 LPM via NRB regardless Of SP02, unless the patient requires ventilatory support Consider Advanced Airway Protocol if needed Inill i IiIiiii � i:%l I] � imanx-6121m. : lfui i ► I 161 !IKIJ 141MIDYMO)INK %7il I I L i I I I , I I 1 1 1 1 . ii 'a! 2 1 'kill min U-16TILFIR • Headache • Nausea/Vomiting • Dizziness • Altered, Mental Status • Chest pain • Dyspnea • Visual Disturbances • Seizures • Syncope • Transport Stable Patient to Mariners Hospital Hyperbaric Chamber (encode prior to transport to con- firm availability) *Air transport only • If unavailable transport to. • Transport Unstable Patient to Mercy Hospital Hyperbaric Chamber • Transport Pediatric patient to St. Mary's Hyperbaric Chamber WARNING, • Patients with CO exposures can have normal pulse oximetery readings and still be, hypoxi,c. • Strong consideration for hyperbairic treatment should be given to all pediatric and obstetrical patient with, confirmed CO exposures due to their higher susceptibiliitytothe effects ofCOexposures iregar less of SpCO level or symptoms. 0 INFORMATION Signs & Symptoms: • AMS • Pupil Nation • General Weakness • Confusion • Bizarre behavior • Excessive sleepiness • Coma • Shortness of breath • Headache • Dizziness • Seizures • Cyanide exposures may result from inhalation, ingestion or absorption from various cyanide containing compounds, linciuding exposure to fire or smoke in an enclosed space. • Direct cyanide exposure (non -smoke inhalation) is a Hazardous, Materials Incident. • Refer to the "Carbon Monoxide Exposure" protocol (pg. 99), lif applicable 1:41iill a C4 :191,91 n * 15 LPM via NRB regardless Of SP02, unless the patient requires ventilatory support * Consider Advanced Airway Protocol if needed CYANKIT. • Adult: • Preparation: • Reconstitute 5g vial by adding 200 mL of NORMAL SAUNE to the vial by using the transfer spike. • With the vial in the upright position, ffl to the "fifl line" • Mix the solution by rocking or rotating the vial for 30 seconds. DO NOT SHAKE • Use vented IV tubing and infuse as indicated below • 5g IV/10, infused over 10-15 minutes • 5,gtts/sec (broken infusion stream) • May repeat Ix prn. • The Cyanokit should be administered through a separate/dedicated" IV/10 line • Pediatric: Preparation and dosing - 70mg/kglV/10 May repeat Ix prn • The Cyanokit should be administered through a separate/dedicated IV/10 line • Transport Stable patients to Mariners Hospital Hyperbaric Chamber (encode prior to transport to confirm (availability) **Non trauma only" *Air Transport Only. • Transport unstable patients to Mercy Hospital Hyperbaric Chamber • Transport Pediatrics to St. Mary's Hospital N Or ton 7- or x Us!,///, rrr/r � t,%i v, i o /jil'lA spl,.,,,Je. S vO sill" J/1, A 6i/l/ o"s 1 71, ho d-P j jj" AL 13 'J/ "a. V, 611/ - MA, elF-, 7, E)l A W/m A" AF 'Ir 7 V Nl"�, N% /w/ A/# ri J, i /orGA ol" A, grnorrnal",�'ll""Il��,,,", . . . . . . . . . . . tw ty g, E S' A hf; 1%, . . . . ... . 4, Agrp/ l fiv 1,g 2 �N w i",-, A/ x AF 4K,/ / r//rir aa, "V /A /e 11 vi, #1 oh ly N INFORMATION ADULT & PEDIATRIC The following conditions should be managed as soon as they are discovered: • MI -Massive hemorrhage • A -Airway control • R-Respiratory Support • C-CircWation • H-Hypothermia • Unless otherwise noted, IV fluids should be given for a SBP < 90 mm Hg and should be given at a rate (boluses) necessary to maintain peripheral pulses (which is typically a SBP of 80-90 mm Hg). • If available Y tubing should, be established on all trauma allerts for the easy administration of wWe Wood ULTRASOUND FAST EXAM if available • A FAST exam can be performed during transport of the following injuries: • Blunt force trauma to abdomen or thorax • Penetrating injury to abdomen or thorax • Undifferentiated hypotension in the presence of trauma • Can be performed to identify possible: • Intra-abdominal hemorrhaging • Intra-thoracic hemorrhaging • Pericardial hemorrhaging • Cardiac motion in, PEA • This exam shall be done, in a prompt fashion and should NOT delay transport • FAST Exam findings shall be communicated to the receiving facility and documented in the ePCR Field Amputation, • Contact Trauma Centers for IPhysiician consult or intervention (Air Rescue for physician transport to scene) Crush Syndrome • Contact Trauma Center for Medical Control • Consider Mutual Ai d for Technical Rescue • Contact Trauma Centers for Physician consult or intervention (Air Rescue for physician transport to scene) ''; 111� 111111111111 b 111111 UADULT & PEDIATRIC 'a Resuscitation should NOT be attempted for trauma patients that have ALL 3 of the following presumptive signs of death present: • Apneic • Asystole • Fixed and dilated pupils, OR a Injuries incompatible with, life (e.g., decapitation, massive crush injury, incineration, etc,.) SPECIAL CONSIDERATIONS 9 PENETRATING OR IBLUN"r CHEST TRAUMA: a Finger Thoracostomy and/or Bilateral needle decompression may be performed in an attempt to achieve ROSC If Pericardial Tamporiacle is suspected perform Pericardiocentesis (if available) Resuscitation efforts DO NOT need to be started if the patient did not regain pulses immediately following the bilateral needle decompression 0 Consideration should be taken to continue care for organ donation. • To confirm, any observation of cardiac motion in PEA • Cardiac motion present: I@ Continue resuscitation efforts and treat reversible causes • Cardiac motion NOT present AND Termination of efforts to be considered: ,@ See Page 67 (Standing orders) PERICARDIAL EFFUISION • Utilize the ultrasound to assess, for pericardial effusion (Cardiac Tamponade) * If present, perform, a pericairdiocentesis (if available) * Contraindicalbon ® Loss, of cardiac output for greater than 16, minutes F START Triage Respirations > 30/min. o radial pulse Cap refill s2sec � Mental Status Unable to follow simple commands qlli�i 1111111ii YES Respiratory 7 Rate? ,1 IS-45 Pulse? ) YES AVPU ) YES Secondary Triage* NO BREATHING Position Airway MEN APNEIC NO Pul YES APNEIC 5 B r et BREATHING < 15 or> 45 NO "'P-" (inappropriate) Posturing oir "U" "A" "V" or "P" (Approprt) . . ia. .e........... DE *Evaluate infants fir: i . n secondary triage using the entire Jurnj STARTalgorithm ff ,,F Trauma ,dart Criteria, (Adult) �r ADULT'" TRAUMA CRITERIA FORM -TRAUMA UMA TAR Date _.. Crew Patient Name DOB Age ...�Gr �,/✓/�liiiiii i i %// ;;��U �, Time of lnjury P/U RIMM. Rescue Unit It Ee.. C � AN—YQN—E AIRWAY Active Airway Assistance' OR oRespiratory Rate 10 or > 29 0 Drowning or Near Drowning CIRCULATI[21+J! * NoRadlalPulse . BP < 90 OR • 5 < 110 in Paatient aver y/b +G S c 1 4R n Para ly i aw Su pi ian, of Spinal Coal injury DISABILITY 0 ~~ � a Loss of Sensaticnn w nd or 3rd Degree Burns ,� '1 % TBSA Amputl . Any Penetrating tingn at rinau injury o the love the ist or Ankle ., BOF"T T U kl eaad', Neck, Torso, car I�sctraarn�n � * Dislocation of Hip, Knee, war Ankle f * Chest Wall Instability or Deformity (Flail Chesty Crnished, Mangled, De -gloved or Pulseless Extreimity LONG BONE FRACTURE or more Long Bone Fractures ' • Bead, Trauma in patients can anticoagulants waa/ High risk of Bleeding �µI Severe Facial injury/Fractures /potential Airway Compromise MECHANISM . 'Electrocution or Lightning injury w) LOC or Visible Signs of injury OF INJURY Blunt ABD or Chest trauma Mn patient wt HX of Paralysis r (Paralalu9'iu/C'lu driple la ) * mPregnaancy � 2D" weeks vw/ ABD pain and Blunt Trauma ANY TWO = TRAUMA ,ALERT (only choose a two) 4 CIRCULATION Patients w/Renal Failure on Dialysis DISABILITY * bead injury w/ LOC *Amnesia OR Nlew Altered Mental taus SOFT TISSUE"" Craft Tissue Loss injury (Deep Flap Avuiilsion > my LONG BODE FRACTURES Single Lang Bone Fracture. Due to MVC OR Pt is onAnticoagulants A Age i+ 55 Years Old a Ejection from Automobile, Motorcycle, Golf Cart or Horse • Blunt Chest or AM ID Trauma In Patients on Anticoagulants Death in Same Passenger Compartment MECHANISM SM * Intrusion, including Roof >12 inches on Occupant, Siteor'> 18 inches of OF INJURY Any Site into Pass anger Compartment,. Fall > 10 Feet. * Auto vs Pedestrian/Bicyclist, Thrown, IRun Over or w/ impact > 2,0 MPH l lotdnra ycNe, 4 calf Cart or ATV Crash > 20 MPH if above criteria are not met & patient condition warrants a trace ns alert. select paramedic judgment, Include brief description Paramedic Judgment: I 1. Airway assistance WClurdes naarnasnt law umst, continuous sucflonlrw, or arias of other aaa#atncts to assist varratftaraaty efforts. 2 Excluding supprhrdtnf wounds in whirh the dop1h of wound can, hrr da@errr road. a � w � Pq 3. Long bone fracture sites are defined as the tap shaft at the hu marus, (2) radius and u1ne, (3] fenaaer, (4) tibia and fibula d D E] COMM KITS: ***CALL TRAUMA CENTER Hai/ PT REPORT ***ATTACH or TRANSMIT CODE SUM MARY* * WHITE ITE — FLIGHT CRC YELLOW —TRAUMA CENTER PINK -- RESCUE MCFRF --096 (tf /0 1202 ) Trauma Alert Criteria, (Pediatric) PEDIATRIC TRAUMA CRITERIA FORM - TRAUMA STAR . . . . ...... . . . ....... Date Crew Patient Naime DOBi Time of Injury PIUMM Rescue Unit# OGA , W1 AIRWAY —A ALERI leafy 0002 9.ng) ANY,.QNE = IB,A�UM . . .............. . . . . .............. . . Active Airway Assistance' OR Respiratory Rate< 20 (Infant< iVr) —. Drowning or Near Drowning Respiratory Rate <10 (Child 1-15yr) CIRCULATION Faint I NON-Palp,able Carotid or Femorail Pulse OR Systolic IMP <50, Parailysiis - Loss of Sensation DISABILITY Altered Mental Statuis2 OR Suspicion of Spinal Coird 2nd or 3rd Degree Burns 2t 10 % T13SA 0 0,» Amputation at or above the Wrist or Ankle SOFTTISSUE Any Penetrating injury or CSC to the Head, Neck,Torso, or Extrernity3 Chest Wall instability or Deformity (Flail Chest) Crushed, Maingled, De -gloved or Pulseless, Extremity Major Soft TiSSUe Disruption' or Major Avulsion of Skin Dislocation of the Hip, Knee, or Ankle LONG BONE FX 1 * Open Long Bone4 Multiple Dislocations I Fracture Sites, 1 SKELETAL . Severe Facial injury/Fractures w/polential Airway Compromise 6ectrocullon or Lightning injury w/ LOC or Visible Signs of injury -P MECHANISM Blunt ABD or Chest trauma, wl HX of Paralysis (Paraplegia/Quadriplegia) OF INJURY . Blunt Head', ABC) or Chest trauma: Anticoagulants or high risk of breeding * Auto vs Pedestrian/Bicyclist, Thrown, Run Over or wl imH pact > 20 MPH" Eiection from Auto, ATV Golf Cart or Horse w/ injury ANY TWO = TMUMA ALERT (only choqp� �two z 0 SIZE Weight < 22 kg CIRCULATION Radial or Pedal Pulse not Palpable OR . Systolic BP < 90 < DISABILITY LONG RCN_. NE FX Amnesia OR - Loss of Consciousness Single Long Bone Fracture Site x /SKELETAL Upper Extremity Dislocation (excluding Fingers) Ejection (Partial of Complete) from Auto Death in Same Passenger Compartment MECHANISM Intrusion, including IRoof >1 2 inches on Occupant Site or 1 a inches C 2 OF INJURY of Any Site into Passenger Compartment, D LAI Fall > 10 Feet OR 2-3 Times the height of the Child Motorcycle, Gol Cart or ATV Crash > 20 MPH If above criteria are not met A patient condition warrants a trauma alert. Select paramedic Judgment, Include brief descriptior, Paramedic Judgment-, 1, Airway assistanoo in dudes manuai jaw thrust continuous suctiaoing or use clother aQuncts to assist venfilatoty efforts, 2" Attersd rnentaO states irclude drowsiness, (61hargy, inabilify to Wow commands, unresponsiveness to voke, Wamy unwapowive 3. ExcWingsupeificialwourOsio,whict)ftiedepf)iolMowocindca�7bodOemiinecl. ESO CO 4 If the MArnwim f2l radios and u1na, fay famor, (4) U60 aild WAIS. . Lung bwTv fracrure sitar ura darmad as the (1) stlahL COMMENTS CALL TRAUMA CENTER W/ PT REPORT *** ATTACH or TRANSMIT CODE SUMMARY WHITE - FLIGHT CREW VELLOW -TRAVMA CENTER PINK -RESCUE MCF'RF - 097'(05/09/20231 WER= INFORMATION ■ Advanced airway procedures shall be considered for patients with respiratory involvement (i.e., hoars voice, singed nasal hairs, carbonaceous; sputum in the nose or mouth, striclor or facial burns). FIRST DEGREE BURNS 0 Involves only the epidermis and are characterized as red and, painful 0 Involves the epidermis and varying portions of the underlying dermis with blistering THIRD DEGREE BURNS • Involves deep, tissue damage and, will appear as thick, dry, white, leathery burns (regardless of race or skin color) UADULT& PEDIATRIC & • Stop the burning process by irrigating with copious amounts of room temperature water or NORMAL SALINE for 2 minutes. Never apply 'iice directly to burns. • Determine Total Body Surface Area (TBSA) percentage of the burn • DO NOT attempt to remove tar, clothing, etc., if adhered to the skin • Remove jewelry and watches from burned area • Consider Pain Management Protocol • DO NOT use Wroute for medication administration • Consider Carbon Monoxide and Cyanide Exposure 1st & 2nd DEGREE BURNS < 15% TBSA or 31rd DEGREE BURNS < 5% TBSA a Apply a dry sterile dressing 2 nd DEGREE ' BURNS > 15% TBSA or 3 rd DEG,REE BURNS > 5%, TBSA **Trauma Alert** 6 Apply a dry sterile burn sheet NORMAL SAUNE * 5 years aind YOUnger:: 125rnB� per hour * 6-13 years ol& 250 rn] peir hOUr * 14 years and order; KOH per hour ELECTRICAL BURNS • Treat associated burns as indicated. • If patient is lin cardiac arrest, follow appropriate protocol. CHEMICAL BURNS • Irrigate liquid chemical burns with copious amounts of water or sterile saline. Brush off dry chemicals prior to irrigation. • Remove patient's clothing and ensure that the patient is decontaminated prior to transport, in order to avoid contaminating personnel and equipment. Personnel shall wear protective clothing and/or respiratory protection as needed when removing chemicals. 0 Burn Injungescontinued.... 0 ADULT& PEDIATRIC & rya rat Child 0. , or, 7 NMI! 9 of patient 0 INFORMATION FLAIL CHEST 0 Occurs, when 2 or more adjacent ribs are fractured OPEN PNEUIM�OTHORAX (SUCKING CHEST WOU�ND) a Occurs, when air enters the pleural space, causing the lung to collapse 0 Occurs when air continues to enter the pleural space without an exit or release, causing an increase in intrathoracic pressure 0 Intrathoracic pressure decreases cardiac output and gas exchange. ADULT & PEDIATRIC PENETRATING OBJECTS a Stabilize with a bulky dressing FLAIIL CHEST • Stabilize with a bulky dressing. • Consider Advanced Airway if needed OPEN PNEUIM!OTHORAX (SUCKING CHEST WOUND) 0 Apply a vented chest seal or occlusive dressing to all open chest wounds and monitor for signs & symptoms of a tension pneurnothorax 0 Apply on expiration, if possiUle 01001,101011:10, IMETA101 IMSI Needle decompression should be performed when ALL of the following findings are present: 61 Respiratory distress or difficulty ventilating with a BVM a Decreased or absent breath sounds, to the affected side 0 Primary site: a 2 nd or P intercostal space, midclavicular line • Secondary site: 0 5 th intercostal space of the miclaxiHary line INFORMATION • Patients with a depressed LOC may be unable to protect their airway. • Adequate oxygenation of the injured brain is critical to preventing secondary injury. • Consider Advanced Airway Management. 0 Especially for patients with a GCS of < 9 • If patient becomes combative refer to the "Chemical Restraint" protocol (pg. 92-93) INTRACRANIAL PRESSURE/HERNIATION SIGNS INCLUDE: • A decline in GCS of 2 or more points • Dev&lopment of a sluggish or nonreactive pupil • Paralysis or weakness on I side of the body • Cushing's Triad: • A widening pulse pressure (increasing systolic, decreasing diastolic) • Change in respiratory pattern (irregUlar respirations) • Bradycardia ADULT & PEDIATRIC ALL HEAD INJURIES 0 OXYGDIJ: • As needed to maintain SP02 of 94%. Ventilate as necessary to, maintain ETCO2 of 30-35mmHg • Consider Advanced Airway Protocol •NORMAL SAU NE: • Adult: (only enough to maintain SBP of 110-120) * 20mi/kg IV/10, titrate to desired effect. Assess lung sounds and BP frequently. * May repeat Ix, prn * F'recaubons Pardcri,.ifar caire nlUlSt be ta$�en 4in dhe 1�nesence of signnhciiint conxiar�,, heart &sease, 0 IF, aind renad �I�a� k,ire I� Itients • Pediatric: (only enough to maintain an age appropriate SBP within normal range.. • 20mL/kg IV/10, assess lung sounds and 8P frequently • May repeat 2x prn for age appropriate hypotension DEPRESSED OR OPEN SKULL FRACTURE • Pressure dressings should not be app4,edto depressed or open skull fractures unless there is significant hemorrhage present, as this can cause an increase in ICP ICP/HERNIATION * POSITIONING� 0 30'heacl elevation * Maintain EtCO2 between 30-35 mm Hg and SP02 > 90% while continuously monitoring BP * AclmJinister3% NS 250mI bolus. Can repeat X1. a Contraindications: a Hypernatrernia or Hyponatrernia WARNING A SINGLE INSTANCE OF HYPOTENSIOE N OR HYPDXIA (SP02 < 90%) IN PATIENTS WITH A BRAIN INJUI MAY INCREASE THE MORTALITY RATE BY 150%. Open Fracture ADULT and PEDIATRIC 61 0 Gross contamination, such as leaves or gravel, should be removed if possible 0 Consider Pain Management Protocol Cover open fractures with a moist sterile dressing Fractures should be splinted in the position found * Exception: No pulse present OR the patient cannot be transported due to the extremity's unusua] position 2 attempts can be made to place the injured extremity in a normal anatomical position. Discontinue attempts, if the patient complains of severe pain or if there is resistance to movement felt Reassess neurovascular status before and after repositioning of patient's extremity May use cloppler to verify presence of pulse CEFAZO,LIN (ANCEF) Dilute 2g in a 50ml bag of NS Administer over 10 minutes IV/10 utilizing a 10gtt set Contraindications - Allergy to Cephalosporin antibiotics ME CEFTRIAXONE (ROCEPHIN): Dilute: 2g in a 50mL bag of NS Administer over 10 minutes IV/10 by utilizing a 10 gtt set Consider pain management as need Contraindir3tiocLs': I Allergy to Cephalosporin antibiotics (e.g.,, Ancef, Ceclor, Cefdinir, lKeflex) NOTE: If considering antibiotics fora oed�iatri Datient the child MUST be 1511yearsor older., INFORMATION COMPENSATED SHOCK • Anxiety • Agitation • Restlessness • Norm,otensive • Capillary refill normal to delayed • Tachycardia AQ�PEDIA�TRIC DECOMPENSATED SHIOCK & Decreased LC,C * Hypotension * Peripheral cyanosis 9 Delayed capillary refill 0 Inequality of central/distal pulses * Tachycardia • Maintain body temperature with blankets and consider increasing the temperature in the patient compartment • Control all major external bleeding • Establish bilateral vascular access, utilizing largest catheter size possible • NORMAL SAUNE: (only enough to maiintain peripheral pulses or Systolic BP of 80mmHg) • Adult: • 20 ml/kg IV/10, titrate to desired effect. Assess lung sounds and BP frequently. • May repeat Ix, prn PrecautJoins Parhcu�ar care rnILIII,',,'t be ta$�eri k) the presenc',ie o'�� ribgn�hcant cm heart d�sease, C-I �F, arild reir4 faflure patleirrts • Pediatric: • 10 ml/kg for infant/Neonate. Assess Tung sounds and BP frequently • 20 mL/kg IV/10. Assess lung sounds and BP frequently. • May repeat 2x prn, for age appropriate hypotension TRA N EXAM 1� C ACII I"XA) for patients, over 12-years old 0 2 grams, rnixed in 100m] bag NS administered I'V/10 over 10 minutes & Cc)r"i!sidei�',Tr,auii� taStaiirfoiiiOdFWliioieIII�I load adiw,iiiiic"tir,,tira"t,iou"t SIFICATION blood Product RKMANICYSAIMM 0 Unassived (4,110IM" 0 iLowTiterLe�.okorediuc�ed04,%Lijole.VIoj MFOAN§—M "F9!QN •Provides Mai nced herviostatic resusdtabon of red blood cells, plateiets, and plasma that can be transfused in the prehospit:Mi or (ern-haspital settings, INDICATIONS 0 An!y panient iin tiraurnatic arrest (PEA Zt 20 beats per rnihILIte) secondairy for * Penetrating traurna WITHOUT,conckisilve signs of de,aith, * Munt trauma AND ROSC has been, achieved 0 Airiy paident with evidence/suspicion of massive hemorrivage AMID one of the. foflawirig 0 Sys,tollic Wolod Pressure (SBP) < 70 mr,nHg 0 Sy5tofic Blood Pressuirle (SBP)1 < 9,0 mmHg AND Heart Rate (HR) Z 11,0 beats per minute Consideration to WhOe Blood adrnunistration shoWd be given to patients who are pirescribed Beta Wcricks and/or Calcium Chaninei llocrs with a HR < 110 beats per, rninute, Refer to the "Ha ndlevy" system for pediatrk WhOe BloodMA administration crlteHai .U?N1MN0;A S 0 P'4011f?' n111 t,,he F` R E, A U, 11 N S k. . . . . . 15, t ["') F", E F "v f, "r i J, t e l ( 1, 0 P T", `(Zi �F",, r) A "al nf r E AM 0 INFORMATION Tranexamic Acid is an anti-fibrinolytic that promotes clot formation by stabilizing fibrinogen and decrease p�la,smin formation in the setting of massive hemorrhage and should be administered within three hours (180 min) of the traumatic event, to maximize the benefits of TXA. INDICATIONS Mechanism: Blunt or Penetrating Trauma Patient Condition with suspected or impending hemorrhagic shock or, TBI. CRnic&I evidence of marked blood loss —'internal or external, sustained tachycardia and hypotension Anticoagulation medications such as Cournad in, Praclaxa, Xarelto, Eliquis, Edoxaban, Enoxa,parin, favor the use of TA. TRAUMATIC HEMORRHAGIC SHOCK: See hemorrhagic shock Protocol TRAUMATIC, BRAIN INJURY with GCS less than 13: See Head Injuries Protocol ADULT & PEDIATRIC DOSAGE: (12 years of age and above) TXA: 2 Graim IV/10 Infusion Infusion to be completed over 10 minutes. TXA can be given concurrently with Whole Blood. CONTRAINDICATIONS Injuries greater than 3 hours Patients who have a contraindication to ant-fibrinolytic therapy agents. Non -hemorrhagic shock Non -traumatic hemorrhagic shock INFORMATION Signs & Symptoms: • Warm/Dry skin (especially below the area of the injury) • Hypotension with a heart rate within normal limits • Paralysis in ADULT * Maintain body temperature with blankets and consider increasing the temperature in the patient compartment * NORMALSALINE: • 20mI/kg IV/10, Citrate to desired effect. Assess lung sounds and BP frequently. • May repeat 2x, prn 4P Plirecaudoris - P,i:irticular caire Imll..il be takein fle 1,")reseni:�e sggirOficarV coror�airy �iew cfis�?ase,, C-HF, and rer�a� faIfiire lA)adents IF PATIENT REMAINS HYPOTENSIVE AdimWster Norepnephrine Infusion 5-30mcg/min 0 Contraindicabons - Hypotension secondary to blood loss IR Precaul°ioins� Pvlonitoy heart ralbe and btlood pressure throughout adm,lni,,,Aradoin P E Q IAT R, I C • Maintain bod%, temperature with blankets and consider lincreasina the temperature, in the patient compartment NORMALSAUNE: • 20mL/kg IV/10, assess lung sounds and BP frequently • May repeat 2x prn, for age appropriate hypotension IF PATIENT REMAINS HIYPOTENSIVE •Administer Epp nephdne Infusion O.Imcg/kg/min—Imcg/kg/min titrate, to effect 0 Cointraindlcations, - Hypotension secondary to blood loss heart f ate and blc>oid pu essAin:.fl r"O U g h 0 k t a d n't i r� II s'lI', a "h on Trauma in Pregnancy INFORMATION PHYSIOLOGICAL CHIANGES DURING PREGNANCY a Due to the following physiological changes in pregnancy, it is often difficult to assess for shock: • Mother's heart rate increases. • By the third trimester, the HR can be 15-20 beats per minute above normal. • Both the systolic and diastolic blood pressures drop 5-15 mm Hg during the second trimester. • The mother's cardiac output and blood voiume increases,. • Therefore, the pregnant patient may lose 30-35% of her blood volume before the signs & symptoms of shock become apparent. a Supine hypotension usually occurs, in: the third trimester. ADULT • Assess for vaginal bleeding and a rigid abdomen 0 In the third trimester, this could indicate an abruptio placenta or a ruptured uterus a POSFIOMING: • Pregnant patients not requiring spinal motion restriction shall be transported on their left side • If a pregnant patient requires spinal motion restriction, place 4-6 inches of padding under the patient's right side while maintaining normal anatomical alignment U, I Man I ank I WIN N."TiltIj LVAT1112i'l 91:10 ki 0 OXYGEN 0 15 LP M via NRB regardless Of SP02, unless the patient requires ventilatory support 112:V4:191114 • Establish bHateral vascular access, utilizing (largest catheter size possible • NORMAL SALME (only enough to maintain peripheral pulses or systolic BP 1,00mmHg): • 20ml/kg IV/10, titrate to desired effect. Assess lung sounds and BP frequently. • May repeat 1x, prn • If Hypotensive administer TXA per protocol and consider whole Wood if available. • �,,Irecai�Au)iis - Pai-hic,,iflar cate tiiust be taken �ir� the piresence Y)f signific-ant coroinary heart rfisease, c`HF',, and iena�� fa.Hure jDadents YONIF 4 r 11/1JAWS, F 10 p I I I I I , , 0 Standing OrderI4 fooi INFORMATION 0 Obstetrical patients are defined as gestation > 20 weeks,. PHYSIOLOGICAL CHIANGES DURING PREGNANCY • mother's heart rate increases. • By the third trimester, the HR can be 15-20 beats per minute above normal. • Both the systolic and diastolic blood pressures drop 5-15 mm Hg during the second trimester. • The mother's cardiac output and blood vo[ume increases. • Therefore, the pregnant patient may lose 30-35% of her blood volume, before the signs & symptoms, of shock become apparent. • Supine hypotension usually occurs inn the third trimester. ADULT 0 Perform initial assessment a PO&ITIOMNG;; 6 Transport patients in their third,trimester and not in active labor on their left side IF WATER HAS BROKE 0 Document: • Time • Color of fluid IF BLOOD PRESENT • Document: • Time • Volume IF CROWNING • Prepare for a field delivery • DO NOT delay transport to the closest appropriate hospital FOCUSED HISTORY 0 Obtain: • Number of previous pregnancies (GRAVIDA) • Number of previous viable births (PARA) • Documented multiple births? • Gestational Diabetes? • Narcotic use? • Due date? • Frequency and length of contractions? • Feeling of having to push or have a bowel movement'? Trimester Complications INFORMATION 1 A TRIIMIESTER 0 Weeks I - 12 of the pregnancy 2 ndl TRIMESTER 9 Weeks 13 - 27 of the pregnancy ECTOPIC PREGNANCY (usually first trimester) Signs & Symptoms: • Sudden onset of severe lower abdominal pain • Vaginal bleeding • Amenorrhea (absence of menstruation) • Referred pain to the left shoulder • Cullen's Sign (perjumbifical ecch,ymosis) • Grey Turner's sign (ecchymosis of the flanks) • Abdominal distention and tenderness • Signs & Symptoms: • Abclomlnal cramping • Vaginal bleeding • Passage of tissue or fetus ADUILT • Assess and treat for shock • Rapidly transport FOR ACTIVE BLEEPING • Place loosely placed trauma pads over the vagina in an effort to stop the flown of blood • DO NOT pack the vagina IF HYPOTENSIVE • NORMAL SAI I N E: • 20ml/kg IV/10, titrate to desired effect. Assess, lung sounds and BP frequently. • May repeat Ix, prn uw F'recautioris chseasie, CHF, ardi rerii aHure patients 3rd Trimester Compfications INFORMATION THIRD TRIMESTER " Weeks 28 - delivery PLACENTA ABRUPTIO Signs & Symptoms: Sudden onset of severe abdominal pain and tenderness Painful uterine contractions • Vaginal Weeding with dark red Wood • Patient may present in shock PLACENTA PREVIA • Signs & Symptoms: 0 Painless vaginal bleeding (bright red blood) UTERINE' RUPTURE • Signs & Symptoms: • Sudden, iintense abdominal pain • Vaginal Weeding flOrr-'ki [ADULT - Assess and treat for shock 0 If in cardiac arrest refer to the "Cardiac Arrest Special Considerations" protocol POSITIONMG: During transport, place 4-6 inches of padding under the patient's right side while maintaining normal anatomical alignment FOR ACTIVE BLEEDING • Loosely place trauma pads over the vagina in an effort to stop the flow of blood' • DO NOT pack the vagina IF HYPOTENSIVE (BP less than, systolic 100mm,Hg) NORMALSAUNE: • 20mI/kg IV/10, titrate to desiredeffect. Assess lung sounds and BP frequently. • May repeat as needed Intwnal Bleexllng Bleeding Placenta Previa 0 Pre-Edampsialftlampsil 0" INFORMATION SEVERE PRE-ECLAMiPSIA • A rare pregnancy complication characterized by high blood pressure that usually begins after 20 weeks of pregnancy. • Signs & Symptoms: • HTIN (SBP > 160 mm Hg OR a DBP of > 110 mm Hg) with any of the following: • AMS • Visual disturbances • Headache • Peripheral edema ECLAMPSIA • Signs &Symptoms: • Any of the severe pre-eclampsia signs & symptoms associated with: a Seizures OR Coma • Either condition can occur for up to 30 days postpartum. ADULT 0 Check blood glucose level * 2g of Magnesium Sulfate infusion 0 Administer over 10 minutes * Contraindication — 211d and 3 rd Degree Heart Blocks D Precaubon - Rapd nnffJSOfl uTK))� CaUse i yII.mt nskn n-1 • LABETALOL (ff systokc greater thain 16OmmHg): 10 mg Slow IVP over 2 minutes WAIWAILIfiftiffil ff activeiy seizing adrninisteir Benzodiiazep0e, * MAGNESM: SULFATE: * 4g of Magnesium Sulfate in a 50rnL bag of NORMAL SAUNE * Administer IV/10 Over 10 minutes * Contraindication — 2r"�� and 3"d �Degree Heart Blocks 0 - R�:Ip@d inPas on, rnay caulse [rypi,_��teW-s' n c, � I * LABETALG].. (ff systolic greater tl'iain 160nimHg): . 10 mg Slow IVP over 2 minutes IF UNABLE TO ESTABLISH VASCULAR ACCESS • MAGNESIUM SULFATE: * 4g IM (must be divided in two separate sites) * Cclntraindicafion 2"d a n d 3,'d Degree Heart Blocks If severe Hypertension exists without signs of pre-eclampsia. (Systolic greater than 160mmHg) consider hypertensive protocol. 0 P ZLEMNEE= INFORMATION Meconium will appear as a yellow to dark green substance that may be noted in the amniotic fluid, coming from the vagina or covering the neonate's head. NEONATE I kyj I ;1418111L Ito I L7A &I ril I k, I I g • If upon delivery of the head there is meconium staining present: • No routine suctioning of meconium recommended unless airway compromise see below • For non -vigorous newborns (presenting with apnea or ineffective breathing effort) delivered through meconium stained amniotic fluid, routine laryngoscopy with or without tracheal suctioning is not recommended. • For non -vigorous newborns delivered through meconium stained amniotic fluid who have evidence of airway obstruction during PPV ' should receive intulbation and/or tracheal suction • If newborn begins to gag or arouse post intubation, sedationmay be necessary. 0 U11"111 I Mrs =I, P, Ani II T NORMAL DELIVERY • POSFFIONING: a Place patient on her back with knees flexed and feet flat on the floor • Control delivery of the head, with gentle perinea] pressure • DO NOT apply manual pressure to the uterine funclus prior to the birth of the child • DO NOT pull or push on the neonate • DO NOT allow sudden hyperextension of the neonate's head • Once the head delivers: • Support the neonate's head as it rotates to align with the shoulders, gently guide the neonate's head downward to deliver the anterior shoulder • Once the anterior shoulder delivers, gently guide the neonate's head upward to deliver the posterior shoulder and the rest of the body jigall I 101 A I kyj a .Yffel 2 1 -.1 ME10 jmW a Dry, warm, and stimulate the neonate • Keep the neonate at the same level of the placenta • Once the umbilical cord stops pulsating (usually 3-5 minutes): • Clamp the cord in the following fashion: • Place the first clamp 4" away from the neonate's body • Milk the cord away from 'the neonate and 'towards the mother (this will minimize splatter) • Place the second clamp 2" away 'from the first, towards the mother • Cut the cord between the 2 clamps • Place the neonate on the mother's chest, skin -to -skin, and cover with a dry blanket • Record and encode an APGAR score at I and 5 minutes and document the delivery time • Apply firm continuous pressure, manually massaging the uterine funclus, after the placenta delivers • Preserve the placenta in the bag provided with the OB Kit or a "Red Bio-Hazard bag" for inspection by the receiving hospital cit 1, rItI'd5 rnirlbtes qftr"r Lfirth ............ ............................................................ CRITERIA 0 1 A40viApr No movement l I I Active movement i(mili us c le to nq-) .... . ..... . f il Pulse No pulse, I ess than 100 bipm Grpnter thon 100 17pm, Grimace M respanse to Grimace or feeble Activo motion �reflex,, kirlitability) ary w1stOrputation WIsUmulabon Appearance Blue all oiler BodypMkl, IV Comy pnk pietel (Ain, color) I extreymb es blue I Respiration No fireaMing, sJow, irregujar strang Ory . . ... . ............................... bregthing ...... . . . ...... .......... .. .... ............. 0 0 X=UM ADULT BREECH BIRTH (FEET OR BUTTOCKS PRESENTATION) • If the head does not deliver within 3 minutes of the body: • Elevate the mother's hips (knee to chest position) • Insert a gloved hand into the vagina Push the vaginal wall away from the neonate's nose and mouth Expedite transport while maintaining the knee to chest position and the neonate's airway a OXYGIEN a AdministerWow-by OXYGEN to the neonate SHOULDER DYSTOCIA (DIFFICUILTY IN DELIVERING THIE SHOULDERS) MCROBERT'S PROCEDUll-RE: Hyper -flex the mother's legs tightly to her abdomen It may be necessary to apply suprapubic pressure (mother's lower abdomen) Gently pull on the neonate"s head 0 Delivery Cow ptic aLion sContinued.. NUICHALCORD • Check for the presence of a nuchal cord after delivery of the head • If the cord lis around the neck: • Gently hook your finger under the loop • Pull it over the neonates head • You may have to repeat this if there is more than I loop present • If you are unable to free the cord: • Clamp the cord in 2 places 6 Cut the cord between the clamps PROLAPSED UMBILICAL CORD POSITaONHNG: 0 Pinrin mother in the L-nom to chest position • Manually displace the uterus to the left • Insert a gloved hand into the vagina 8 Push the neonate up and away from the umbHical cord regardless if there is a pulse, present or not • Maintain'this position during transport • Frequently reassess the umbilical cord for the presence of a pulse, as contractions are likely to compress the umbilical cord • Wrap the exposed cord in a moist sterile dressing • Expedite transport 0 aa;tnVES. YES %% / �/F i � % iiri�/%/, Ili � i �j�, YES I 9 W, NIO C,ya,O,D$ Targeted preductA Sp02 After birth 1 min 60%-65% 2 min 65% - 70% 3 min 70% - 75% 4 min 75% - 80% 5 min 80% - 85% 10 min 8.5% - 95% 0 a Postpartum Hemorrhage ADULT Postpartum Hemorrhage (PPH) Postpartum hemorrhage is defined as blood loss >_500 mL after vaginal delivery or >_1,000 mL after ce- sarean delivery, or any blood loss associated with signs of hypoperfusion or shock within 24 hours of delivery (early PPH) to 6 weeks after delivery (delayed PPH). Retained placenta, uterine atony, lacera- tions, and coagulopathy are common causes FIA , l5t491lll I • ABC's • Check for signs of hypovolemic shock • Time of Delivery • Quantity of Blood Loss with or without large blood clots • Complications During Deliver • Known Uterine or Bleeding Disorders • Inspect for Active Bleeding • Palpate Uterus (at umbilicus) for Tone (soft/boggy vs firm) I TIRIE'ATMIEIN"'F • Treat per Hypovolemic Shock Protocol Normal HR for Pregnant Females is up to 117bpm Special Consideration: patients taking high dose beta blockers to control pregnancy induced hypertension (PIH) or pre-eclampsia may not have tachycardia. • Oxytocin (Pitocin) 10 units IM (if available) Avoid if delivering twins and only one baby has delivered • TXA per Protocol • Uterine Massage (fundal massage at the level of the umbilicus) Firm Circular Clockwise Motion • Encourage mother to empty bladder if possible (full bladder inhibits contraction) • Prevent hypothermia 0 Uterine Inversion ADULT GENERAL GUIDELINE'S Uterine inversion is a rare but life -threatening obstetric emergency in which the uterus turns inside out, typically following delivery. It may appear as a smooth, round mass protruding from the vagina, absence of the uterine fundus on abdominal exam, and severe hemorrhage. Shock is often out of proportion to visible bleeding. ASSESSMENT • Airway, Breathing, Circulation • Assess for signs of hypovolemic shock • Time and manner of delivery • Was traction applied to the umbilical cord? • Palpate abdomen: is fundus absent? • Visual: is there a mass at or protruding from the vaginal opening? • Pain Management • Oxytocin 10 units IM (if available) • TXA per protocol • Treat per Hypovolemic Shock Protocol Normal HR for Pregnant Females is up to 117bpm Special Consideration: patients taking high dose beta blockers to control pregnancy induced hypertension (PIH) or pre-eclampsia may not have tachycardia. • Ensure placenta is NOT removed if still attached • Prepare a gloved, lubricated dominant hand. Apply sterile water -based lubricant generously to reduce friction. • Gently insert your hand into the vagina and locate the inverted uterine fundus. It will feel like a firm, round mass, sometimes outside or just inside the vaginal introitus. • Using the lubricated fist of your hand, apply steady pressure directly upward toward the patient's umbilicus, following the natural curve of the vaginal canal and pelvis. Do not use a jabbing or jerking motion. Pressure must be continuous and firm, not intermittent. • If successful, the uterus will return to its normal anatomical position inside the pelvis. • Hold the uterus in place for several minutes to allow uterine tone to return. • Once firm, slowly withdraw your hand to avoid re -inversion. • If the cervix has contracted around the uterus (constriction ring) and prevents replacement: Do not force it. Cover the uterus with moist, sterile gauze, provide supportive care, and transport rapidly. Prevent hypothermia 0 Medication Formulary ADULT & PEDIATRIC GROUND + HEMS SHARED MEDICATIONS Adenosine • Class: Antiarrhythmic, AV node Mocker • Indications: SVT (regular, narrow complex) • Adult Dose: 12 mg rapid IV push, may repeat 12 mg once Pediatric Dose: 0.1 mg/kg (max 6 mg), may repeat 0.2 mg/kg (max 12 mg) • Notes: Large proximal IV, immediate flush; avoid in WPW w/ AF ------------------------------------------------------------------------------------------------------------------------- Albuterol • Class: Beta-2 agonist bronchodilator • Indications: Asthma, COPD, bronchospasm, allergic reaction w/ wheeze • Adult Dose: 2.5 mg neb (may repeat or continuous) • Pediatric Dose: 2.5 mg neb • Notes: May combine with Atrovent; watch for tachycardia ------------------------------------------------------------- Amiodarone • Class: Class III antiarrhythmic • Indications: VT/VF, wide complex tachycardia • Adult Dose: o Arrest: 300 mg IWIO 4 150 mg o Tachycardia (stable): 150 mg in 100 mL over 10 minutes • Pediatric Dose: 5 mg/kg • Notes: Monitor for hypotension; avoid in severe bradycardia/blocks Aspirin • Class: Antiplatelet • Indications: Suspected ACS/STEMI • Adult Dose: 324 mg PO, chewed • Pediatric Dose: Not used for ACS • Notes: Contraindicated in true aspirin allergy or major GI bleed ------------------------------------------------------------------------------------------------------------------------- Atropine • Class: Anticholinergic • Indications: Symptomatic bradycardia, organophosphate poisoning • Adult Dose: o Bradycardia: 1 mg IV q3-5 min (max 3 mg) • Pediatric Dose: o Bradycardia: 0.02 mg/kg (min 0.1 mg) 0 Notes: Inadequate for high -degree AV blocks; organophosphate doses higher 0 MEDICATION FORMULARY ADULT & PEDIATRIC Calcium Chloride 10% • Class: Electrolyte Indications: Hyperkalemia, CCB overdose, during whole blood use • Adult Dose: 1 g IV Pediatric Dose: 20 mg/kg IV • Notes: Give slowly; avoid tissue extravasation Cyanokit (Hydroxocobalamin) • Class: Cyanide antidote • Indications: Suspected cyanide poisoning (enclosed fire, AMS + hypotension) • Adult Dose: 5 g IV over 15 minutes • Pediatric Dose: 70 mg/kg IV (max 5 g) • Notes: Causes red discoloration of skin/urine; may affect lab values Dextrose (D10 / D50) • Class: Hyperglycemic agent Indications: Hypoglycemia • Adult Dose: D10 100-250 mL IV (or D50 per legacy protocol) • Pediatric Dose: D10 5 mL/kg IV • Notes: Recheck BGL after treatment; monitor for extravasation ------------------------------------------------------------------------------------------------------------------------- Diphenhydramine (Benadryl) Class: Antihistamine (H1 blocker) Indications: Allergic reaction, dystonic reaction Adult Dose: 50 mg IV/IM Pediatric Dose: 1 mg/kg IV/IM (max 50 mg) Notes: Sedating; use caution with other sedatives Dopamine • Class: Catecholamine pressor • Indications: Shock refractory to fluids (when Epi/Norepi unavailable) Adult/Peds Dose: 5-20 mcg/kg/min IV infusion Notes: Norepinephrine preferred in modern practice ------------------------------------------------------------------------------------------------------------------------- Epinephrine 1:1,000 • Class: Alpha/Beta agonist Indications: Anaphylaxis, severe asthma Adult Dose: 0.3 mg I Pediatric Dose: 0.01 mg/kg IM (max 0.3 mg) Notes: May repeat q5-10 min in anaphylaxis 0 MEDICATION FORMULARY ADULT & PEDIATRIC Epinephrine 1:10,000 • Class: Alpha/Beta agonist Indications: Cardiac arrest Adult Dose: 1 mg IV/10 q3-5 min Pediatric Dose: 0.01 mg/kg IV/10 Notes: Follow ACLS/PALS timing ------------------------------------------------------------------------------------------------------------------------- Fentanyl • Class: Opioid analgesic Indications: Moderate to severe pain; burns; trauma (with BP tolerance) Adult Dose: 1 mcg/kg IV/IN (repeat as needed) • Pediatric Dose: 1 mcg/kg IV/IN Notes: Monitor respiratory status; caution in hypotension ------------------------------------------------------------------------------------------------------------------------- Glucagon • Class: Hormone (increases blood glucose; beta-blocker antagonist) • Indications: Hypoglycemia without IV access; Beta-blocker overdose Adult Dose: 1 mg I M/IV • Pediatric Dose: 0.5-1 mg (weight -based) • Notes: Nausea/vomiting common Ketamine • Class: Dissociative anesthetic • Indications: Pain, SAI, chemical restraint (excited delirium) • Adult Dose: o Pain: 0.3 mg/kg IV o SAL 1 mg/kg IV o ED: 4 mg/kg IM • Pediatric Dose: Similar mg/kg dosing • Notes: Preserves airway reflexes; may cause emergence reactions ------------------------------------------------------------------------------------------------------------------------- Magnesium Sulfate Class: Electrolyte; smooth muscle relaxant Indications: Severe asthma, torsades de pointes, eclampsia (CCT/ED) • Adult Dose: 2 g IV over 10-20 minutes Pediatric Dose: 50 mg/kg IV (max 2 g) • Notes: Monitor for hypotension; slow infusion 0 MEDICATION FORMULARY ADULT & PEDIATRIC Methylprednisolone (Solu-Medrol) • Class: Corticosteroid • Indications: Asthma, COPD exacerbations, allergic reactions • Adult Dose: 125 mg IV • Pediatric Dose: 2 mg/kg IV (max 125 mg) 18. Midazolam (Versed) • Class: Benzodiazepine Indications: Seizures, sedation, chemical restraint • Adult Dose: 2-5 mg IWIM/IN Pediatric Dose: 0.1 mg/kg IWIM/IN (max 5 mg) Notes: Watch for respiratory depression; consider EtCO2 Naloxone (Narcan) • Class: Opioid antagonist Indications: Suspected opioid overdose with respiratory compromise • Adult Dose: 0.4-2 mg IWIM/IN (titrate to ventilation) • Pediatric Dose: 0.1 mg/kg IWIM/IN (max 2 mg) Nitroglycerin (Spray) • Class: Vasodilator • Indications: ACS, CH with hypertension Adult Dose: 0.4 mg spray SL q5 min PRN SBP > 100 Pediatric Dose: Not routinely used • Notes: Avoid in RV infarct, recent PDE5 inhibitor use Ondansetron (Zofran) Class: Antiemetic • Indications: Nausea/vomiting Adult Dose: 4 mg IWODT Pediatric Dose: 0.1 mg/kg IWODT Notes: Watch QT interval if known QT prolongation Oral Glucose • Class: Carbohydrate • Indications: Symptomatic hypoglycemia in awake, cooperative patient • Adult Dose: 15-24 g PO • Pediatric Dose: 0.3 g/kg (up to 15 g) 0 MEDICATION FORMULARY ADULT & PEDIATRIC Sodium Bicarbonate 8.4% • Class: Alkalinizing agent Indications: TCA overdose, hyperkalemia, prolonged arrest Adult Dose: 1 mEq/kg IV • Pediatric Dose: 1 mEq/kg (use 4.2% in small children/neonates) TXA (Tranexamic Acid) Class: Antifibrinolytic Indications: Suspected hemorrhagic shock within 3 hours of trauma • Adult Dose: 1 g IV over 10 min Pediatric Dose: 15 mg/kg IV (max 1 g) 0 MEDICATION FORMULARY ADULT & PEDIATRIC TRAUMA STAR —ONLY MEDS Norepinephrine (Levophed) • Class: Vasopressor • Indications: Shock (septic, cardiogenic, distributive) • Adult Dose: 0.02-0.1 mcg/kg/min IV infusion • Pediatric Dose: Same mcg/kg/min • Notes: First -line pressor for HEMS Nicardipine • Class: Calcium channel blocker (vasodilator) Indications: Hypertensive emergencies, stroke transport (BP control) • Adult Dose: Start 2.5-5 mg/hr, titrate q5 min; max 15 mg/hr • Pediatric Dose: Not typically prehospital Esmolol Class: Beta-1 blocker, ultra —short -acting • Indications: Tachyarrhythmias, AF/flutter rate control (HEMS) Adult Dose: 500 mcg/kg bolus ? 50-200 mcg/kg/min infusion Pediatric Dose: Per sending orders only ------------------------------------------------------------------------------------------------------------------------- Metoprolol Class: Beta-1 blocker Indications: Rate control in AF/flutter, tachycardia (hemodynamically stable) Adult Dose: 5 mg IV q5 min x up to 3 doses Pediatric Dose: Not typical prehospital 0 MEDICATION FORMULARY ADULT & PEDIATRIC 3% Hypertonic Saline Class: Hyperosmolartherapy Indications: Suspected herniation, severe TBI neuro bundle Adult Dose: 250 mL IV bolus Pediatric Dose: 3-5 mL/kg IV Whole Blood (O+ Low Titer, If Carried) • Class: Blood product • Indications: Hemorrhagic shock in trauma patients • Adult Dose: 1 unit, reassess, repeat per protocol Pediatric Dose: Weight -based per HEMS policy ------------------------------------------------------------ Terbutaline Class: Beta-2 agonist Indications: Severe asthma/bronchospasm (HEMS) Adult Dose: 0.25 mg SQ, may repeat Pediatric Dose: Weight -based per protocol Sedation & Paralytic Drips (HEMS) • Ketamine drip: 0.5-1 mg/kg/hr • Versed drip: 0.05-0.1 mg/kg/hr • Fentanyl drip: 1-2 mcg/kg/hr • Rocuronium drip: 5-12 mcg/kg/min Monroe County Fire Rescue Trauma Star and Emergency Medical Services Bitting Summary Trauma Star Air Transports - Number of Flights - Count by Month 2025 Total Charges Monthly Recovery Rate $ 661,071.22 $ 508,269.77 1,340,500.OiO I',, I I I $ 648,538.11 $ 535,320i.95 $ 506,806.50 1,343,000.00 $ 720,566.88 $ 791,340i.40 $ i843,466.95 $ 863,375055 $ 632,634.49 $ 579,546.33M. 548 Totals 1 686 1 $ 14,631,600.,00 1 $ 7,772,238.18 1 53.12% Note: Patient transport andfInancial data reconviled following end of the month. Report is in ar Ground Transports - Number of EMS Ground Trips - Count by Month Month Total Trips 2025 Total Charges 2025 Total Gross Deposits Monthly Recovery Rate Oct 146 $ 128,299.65 $ 89,40&46 70% Nov 178 $ 161,977.65 $ 94,916.50 59% Dec 187 $ 171,362.10 $ 91,362.47 53% Jean 194 $ 174,467.35 $ 83,94067 48% Feb 164 $ 150,66150 $ 103,993.55 69% Mar 166 $ 151,567.40 $ 97,78&83 65% Apr 176 $ 157,937.35 $ 95,912.83 61% May 172 $ 154,337.60 $ 107,35106 70% Jun 11511 $ 137,463.60 $ 9'0,195.08 66% Jul 194 $ 178,422.9�5 $ 110,727.84 62% Aug 161 $ 141,563.50 $ 106,710.59 75% Sep 138 $ 124,976.15 $ 85,182.08 68% Totals 1 2027 1 $ 1,833,036.80 1 $ 1,157,488.96 1 63% Note: Patient transport and financial data recandled following end of the month. Re) TOTAL CHARGES $ 16,464,636.80 GROSS DEPOSITS $ 8,929,727.14 Combined Gross Collection Ratio: 54.24% Trauma Star Gross Collection Ratio: 53.12% EMS Ground Gross Collection Ratio: 63.15% is in ar Periodl: Fiscal Year 2025-2026 �Oct 1, 2025 to Sep 30, 2026) Printed: 112912026 Monroe County Fire Rescue Trauma Star and Emergency MedicaL Services Bitting Summary Average Per Transport AIR $ Average, Per Transport GROUND $ 11,329w79 571.04 $1,800,000.00 $1,600,000.00 $1,400,000.00 $1,200,000.00 $1,000,000.00 $800,000.00 $600,0010.00 $400,000.00 ik A $2010,01010.100 it Oct Nlov Dec Jan, Feb Mar Apr May Jiun Jul Aug Sep Periodl: FiscaL Year 2025-2026 (Oct 1, 2025 to Sep 30, 2026) Printed: 112912026 MONROE COUNTY, FLORIDA BOARD OF COUNTY COMMISSIONERS FINANCIAL STATEMENTS As of and for the Year Ended September 30, 2024 And Report of Independent Auditor MONROE COUNTY, FLORIDA BOARD OF COUNTY COMMISSIONERS Financial Statements For The Fiscal Year Ended September 30, 2024 TABLE OF CONTENTS Table of Contents Basic Financial Statements Independent Auditor's Report Fund Financial Statements: Balance Sheet - Governmental Funds Statement of Revenues, Expenditures, and Changes in Fund Balances - Governmental Funds Statement of Revenues, Expenditures, and Changes in Fund Balances - Budget and Actual Major Governmental Funds: General Fund Fine and Forfeiture Fund Governmental Grants Fund Tourist Development, Administration and Promotional Two Cent Fund Statement of Net Position - Proprietary Funds Statement of Revenues, Expenses and Changes in Net Position - Proprietary Funds Statement of Cash Flows - Proprietary Funds Notes to Financial Statements Required Supplementary Information (Unaudited): Florida Retirement System Schedule of the Board's Proportionate Share of Net Pension Liability - Florida Retirement System Schedule of the Board's Contributions - Florida Retirement System Schedule of the Board's Proportionate Share of Net Pension Liability - Health Insurance Subsidy Program Schedule of the Board's Contributions Health Insurance Subsidy Program Pension Plan for Volunteer Firefighters and Emergency Medical Services Schedule of Changes in the Board's Net Pension Liability and Related Ratios Schedule of Employer Contributions Post Employment Benefits Other Than Pension Schedule of Changes in the Board's Total OPEB Liability and Related Ratios Combininq and Individual Fund Statements and Schedules: Schedules of Revenues, Expenditures, and Changes in Fund Balances - Budget and Actual One Cent Infrastructure Surtax Capital Project Fund All Debt Service Funds Combininq and Individual Fund Statements and Schedules: Combining Balance Sheet - Nonmajor Governmental Funds Combining Statement of Revenues, Expenditures, and Changes in Fund Balances - Nonmajor Governmental Funds PAGE C-5 C-8 C-10 C-12 C-13 C-17 C-19 D-1 E-1 E-3 E-5 E-7 E-9 E-11 E-13 F-1 F-2 G-1 G-8 (Continued) A-1 MONROE COUNTY, FLORIDA BOARD OF COUNTY COMMISSIONERS Financial Statements For The Fiscal Year Ended September 30, 2024 TABLE OF CONTENTS (continued) Combininq and Individual Fund Statements and Schedules (continued): PAGE Schedules of Revenues, Expenditures, and Changes in Fund Balances - Budget and Actual Special Revenue Funds: Affordable Housing Programs G-15 Roads and Bridges Fund G-16 Middle Keys Health Care Municipal Service Taxing Unit G-17 Tourist Development, All Districts, Two Cent G-18 Tourist Development, District One G-19 Tourist Development, District Two G-20 Tourist Development, District Three G-21 Tourist Development, District Four G-22 Tourist Development, District Five G-23 Impact Fees - Roadways G-24 Impact Fees - Parks and Recreation G-25 Impact Fees - Solid Waste G-26 Impact Fees - Fire and EMS G-27 Fire and Ambulance, District #1 - Lower and Middle Keys G-28 Unincorporated Area Service District - Parks and Recreation G-29 Unincorporated Area Service District - Planning, Building & Zoning G-30 Municipal Policing G-32 911 Enhancement Fees G-33 Duck Key Security District G-34 Local Housing Assistance G-35 Affordable Housing Initiatives G-36 Boating Improvement G-37 Miscellaneous Special Revenue G-38 Environmental Restoration G-40 Law Enforcement Trust G-41 Court Facility Fees G-42 Drug Abuse Trust G-43 Canal Special Assessments G-44 Building Fund G-45 Clerk's Revenue Note Capital Projects Fund G-46 Land Acquisition Fund Capital Projects Fund G-47 Combining Statement of Net Position - Internal Service Funds H-1 Combining Statement of Revenues, Expenses, and Changes in Net Position - Internal Service Funds H-3 Combining Statement of Cash Flows - Internal Service Funds H-5 COMPONENT UNIT Comprehensive Plan Land Authority - Statement of Net Position 1-1 Comprehensive Plan Land Authority - Statement of Activities 1-2 (Continued) A-2 MONROE COUNTY, FLORIDA BOARD OF COUNTY COMMISSIONERS Financial Statements For The Fiscal Year Ended September 30, 2024 TABLE OF CONTENTS (continued) OTHER REPORTS PAGE Report of Independent Auditor on Internal Control over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed in Accordance with Government Auditing Standards J-1 Schedule of Findings and Recommendations Corrective Action Plan Independent Auditor's Management Letter J-3 J-4 J-5 Report of Independent Accountant on Compliance with Local Government Investment J-7 Policies A-3 R&W US IIL..IIL.JP Independent Auditor's Report Honorable Mayor and Board of County Commissioners Monroe County, Florida Report on the Audit of the Financial Statements Opinions We have audited the financial statements of each major fund and the aggregate remaining fund information of the Board of County Commissioners (the Board) of Monroe County, Florida (the County), as of and for the year ended September 30, 2024, and the related notes to the financial statements, as listed in the table of contents. In our opinion, the accompanying financial statements referred to above present fairly, in all material respects, the respective financial position of each major fund and the aggregate remaining fund information of the Board of the County Commissioners as of September 30, 2024, and the respective changes in financial position, and, where applicable, cash flows thereof and the respective budgetary comparison statements for the General Fund, Fine and Forfeiture Special Revenue Fund, Governmental Grants Special Revenue Fund, and the Tourist Development Administration and Promotional Two Cent Special Revenue Fund, for the year then ended in accordance with accounting principles generally accepted in the United States of America. Basis for Opinions We conducted our audit in accordance with auditing standards generally accepted in the United States of America (GAAS) and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States (Government Auditing Standards). Our responsibilities under those standards are further described in the Auditor's Responsibilities for the Audit of the Financial Statements section of our report. We are required to be independent of the Board and to meet our other ethical responsibilities, in accordance with the relevant ethical requirements relating to our audit. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinions. Emphasis of Matter As discussed in Note 22 to the financial statements, the October 1, 2023 beginning net position and beginning balances for leases and interest receivable and deferred inflow of resources for the Key West Airport Fund and Marathon Airport Fund have been restated to correct errors. Our opinions are not modified with respect to this matter. Responsibilities of Management for the Financial Statements Management is responsible for the preparation and fair presentation of the financial statements in accordance with accounting principles generally accepted in the United States of America, and for the design, implementation and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error. i"'Ilh°RIII ow IIIt 0III'" IIItIIII.IIISIG IUII4III III:III'Z 5i"'OOIII':��i S S LJ II ,? IwtLi C. II i.. J k, C:0 IwtLi S LJ II 1 II IwtLi Uu l: i 1 I�':,M 0', 1 1 ( 11 (k¢ 0 , I11t',mkq II( I I I (at Ia',M II)(('t1I III 1 I I,1 V "1 1111t11 whivol'< of Indk1 n'I dken( If""] I IVI1tix 'I ld on' 1II(II1" (Sans, V'I51 t 1 ,I I Ii I', nIfI/,1lttlI((I,,tol11111('!I)ioi If I, 1(I on I("si,I III I,�1 "ImI'aII '11Il11 "M 11 I k1I 11,it I, I), d, Auditor's Responsibilities for the Audit of the Financial Statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes our opinions. Reasonable assurance is a high level of assurance but is not absolute assurance and therefore is not a guarantee that an audit conducted in accordance with GAAS and Government Auditing Standards will always detect a material misstatement when it exists. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations or the override of internal control. Misstatements are considered material if there is a substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a reasonable user based on the financial statements. In performing an audit in accordance with GAAS and Government Auditing Standards, we • Exercise professional judgment and maintain professional skepticism throughout the audit. • Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, and design and perform audit procedures responsive to those risks. Such procedures include examining, on a test basis, evidence regarding the amounts and disclosures in the financial statements. • Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Board's internal control. Accordingly, no such opinion is expressed. • Evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluate the overall presentation of the financial statements. We are required to communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit, significant audit findings, and certain internal control -related matters that we identified during the audit. Required Supplementary Information Accounting principles generally accepted in the United States of America require that that the pension and other post -employment benefit plans related information, as listed in the table of contents, be presented to supplement the basic financial statements. Such information is the responsibility of management and, although not a part of the basic financial statements, is required by the Governmental Accounting Standards Board who considers it to be an essential part of financial reporting for placing the basic financial statements in an appropriate operational, economic or historical context. We have applied certain limited procedures to the required supplementary information in accordance with auditing standards generally accepted in the United States of America, which consisted of inquiries of management about the methods of preparing the information and comparing the information for consistency with management's responses to our inquiries, the basic financial statements, and other knowledge we obtained during our audit of the basic financial statements. We do not express an opinion or provide any assurance on the information because the limited procedures do not provide us with sufficient evidence to express an opinion or provide any assurance. Management has omitted the management's discussion and analysis that accounting principles generally accepted in the United States of America require to be presented to supplement the basic financial statements. Such missing information, although not a part of the basic financial statements, is required by the Governmental Accounting Standards Board who considers it to be an essential part of financial reporting for placing the basic financial statements in an appropriate operational, economic, or historical context. Our opinions on the basic financial statements are not affected by this missing information. l:i 2 Supplementary Information Our audit was conducted for the purpose of forming opinions on the financial statements that collectively comprise the Board's basic financial statements. The combining and individual fund statements and schedules are presented for purposes of additional analysis and are not a required part of the basic financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the basic financial statements. The information has been subjected to the auditing procedures applied in the audit of the basic financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the basic financial statements or to the basic financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the combining and individual fund statements and schedules are fairly stated, in all material respects, in relation to the basic financial statements as a whole. Other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, we have also issued our report dated April 9, 2025, on our consideration of the Board's internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements and other matters. The purpose of that report is solely to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the effectiveness of the Board's internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards in considering the Board's internal control over financial reporting and compliance. Fort Lauderdale, Florida April 9, 2025 133 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS BALANCE SHEET GOVERNMENTAL FUNDS SEPTEMBER 30, 2024 Assets Cash and Cash Equivalents Cash with Fiscal Agent Investments Accounts Receivable, Net Assessments Receivable Due from Other Funds Due from Other Governmental Units Due from Constitutional Officers Mortgages/Notes Receivable Allowance for Mortgages/Notes Receivable Lease Receivable Prepaid Items Interest Receivable Total Assets Liabilities, Deferred Inflows of Resources and Fund Balances Liabilities: Accounts Payable Retainage Payable Accrued Wages and Benefits Payable Due to Other Funds Due to Other Governmental Units Due to Constitutional Officers Unearned Revenues Deposits in Escrow Total Liabilities Deferred Inflows of Resources: Leases Unavailable Revenues Total Deferred Inflows of Resources Fund Balances/(Deficits): Nonspendable Restricted Committed Assigned Unassigned Total Fund Balances Total Liabilities, Deferred Inflows of Resources, and Fund Balances Fine & Governmental General Forfeiture Grants $ 7,338,703 $ 1,828,273 $ 2,665,577 23,334,104 18,381,240 - 32,418 5,739,395 125,821 10,000,000 - - 660,120 30,367 27,479,514 10,755,331 2,959,008 - - - 106,351 - - (106,351) 3,424,926 - - 9,748 - - 100,000 69,899 - $ 55,655,350 $ 29,008,182 $ 30,270,912 $ 1,557,472 $ 148,734 $ 2,401,572 - - 135,972 1,189,849 210,397 180,751 - - 10,000,000 1,492,570 694 688 9,318 20,657 - - - 120,285 152,924 - - 4,402,133 380,482 12,839,268 3,328,536 - - 975 - 16,594,949 3,329,511 - 16,594,949 9,748 - - - 28,627,700 836,695 10,000,000 - - 44,626 - - 37,869,332 - 47,923,706 28,627,700 836,695 $ 55,655,350 $ 29,008,182 $ 30,270,912 The notes to the financial statements are an integral part of these statements. C-1 Tourist Development One Cent Debt Nonmajor Total Admin & Promo Infrastructure Service Governmental Governmental Two Cent Surtax Fund Funds Funds $ 3,358,572 $ 4,506,899 $ 936,979 $ 17,748,228 $ 38,383,231 - 38,243,200 - - 38,243,200 34,335,357 35,992,046 3,154,355 141,365,442 256,562,544 6,459 - - 854,766 6,758,859 - 18,655,727 - - 18,655,727 - - - - 10,000,000 - 2,826,163 - 1,248,204 32,244,368 2,070,105 5,805 - 5,394,459 21,184,708 - - - 9,982,533 10,088,884 - - - (9,982,533) (10,088,884) - - - - 3,424,926 2,263 - - 3,835 15,846 138,943 151,284 12,763 581,266 1,054,155 $ 39,911,699 $ 100,381,124 $ 4,104,097 $ 167,196,200 $ 426,527,564 $ 1,770,198 $ 2,192,610 $ - $ 2,701,852 $ 10,772,438 - 334,896 - 149,558 620,426 - 85,253 - 1,526,121 3,192,371 - - - - 10,000,000 - - - 511,974 2,005,926 - - - 71,867 101,842 - - - - 120,285 - - - 286,932 439,856 1,770,198 2,612,759 - 5,248,304 27,253,144 - - - - 3,328,536 - 18,865,332 - - 35,461,256 - 18,865,332 - - 38,789,792 2,263 - - 3,835 15,846 38,139,238 78,903,033 4,104,097 143,683,870 294,294,633 - - - 9,581,176 19,581,176 - - - 8,679,015 8,723,641 - - - - 37,869,332 38,141,501 78,903,033 4,104,097 161,947,896 360,484,628 $ 39,911,699 $ 100,381,124 $ 4,104,097 $ 167,196,200 $ 426,527,564 C-2 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES GOVERNMENTALFUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Revenues: Taxes Licenses and Permits Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues Expenditures: Current: General Government Public Safety Physical Environment Transportation Economic Environment Human Services Culture and Recreation Court -Related Capital Outlay Debt Service: Principal Interest Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Transfers from Other Funds Transfers to Other Funds Lease & SBITA Financing Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances/(Deficits) - October 1 Fund Balances/(Deficits) - September 30 Fine & Governmental General Forfeiture Grants $ 44,290,317 $ 72,214,380 $ - 15,732,447 74,946 22,497,082 672,849 9,061,777 176,296 127 105,639 - 2,385,333 4,756,036 147,069 770,840 357,557 117,201 63,851,913 86,570,335 22,937,648 47,152,177 1,737,588 2,702,621 2,659,148 78,314,444 5,735,643 863,397 - 14,140,009 541,379 - 3,298,316 1,067,317 - 32,967 8,838,933 - 1,946,553 5,707,311 - 2,574,264 6,007,342 3,114,608 - 694,099 17,013 61,374 3 - 73,592,477 83,183,656 30,430,373 (9,740,564) 3,386,679 (7,492,725) 5,099,754 - 4,548,883 (870,636) - (107,127) 229,483 47,018 - 8,946,154 2,933,562 - 13,404,755 2,980,580 4,441,756 3,664,191 6,367,259 (3,050,969) 44,259,515 22,260,441 3,887,664 $ 47,923,706 $ 28,627,700 $ 836,695 The notes to the financial statements are an integral part of these statements. C-3 Tourist Development One Cent Debt Nonmajor Total Admin & Promo Infrastructure Service Governmental Governmental Two Cent Surtax Fund Funds Funds $ 20,728,398 $ 32,599,393 $ - $ 72,252,821 $ 242,085,309 - 1,689,195 - 7,223,587 8,912,782 - - - 11,175,791 49,480,266 - - - 14,258,761 24,169,683 - - - 2,681,239 2,787,005 2,067,941 2,081,618 572,585 7,898,765 19,909,347 - 441,321 - 1,845,748 3,532,667 22,796,339 36,811,527 572,585 117,336,712 350,877,059 - - - 5,619,561 57,211,947 - - - 38,333,057 125,042,292 - - - 2,234,653 17,238,059 - - - 7,210,783 11,050,478 28,538,185 - - 28,518,616 58,157,085 - - - 2,771,142 13,556,628 - - - 5,238,879 13,520,454 - - - 634,015 9,755,965 - 24,179,147 - 1,874,579 26,053,726 95,737 49,579 19,508,524 56,544 20,421,496 18,863 20,765 3,501,944 1,633 3,604,582 28,652,785 24,249,491 23,010,468 92,493,462 355,612,712 (5,856,446) 12,562,036 (22,437,883) 24,843,250 (4,735,653) - 113,414 22,095,935 1,219,333 33,077,319 (114,278) (24,970,816) - (4,012,201) (30,075,058) - 38,320 - 84,918 399,739 214,697 5,233 914,980 1,590,063 14,604,689 100,419 (24,813,849) 23,010,915 (1,117,887) 18,006,689 (5,756,027) (12,251,813) 43,897,528 91,154,846 573,032 23,725,363 13,271,036 3,531,065 138,222,533 347,213,592 $ 38,141,501 $ 78,903,033 $ 4,104,097 $ 161,947,896 $ 360,484,628 C-4 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL GENERALFUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Taxes Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues EXPENDITURES: Cu rrent: General Government: Board of County Commissioners County Administrator County Attorney Legislative Affairs County Administration Public Works & Facilities Maintenance Tax Collector Clerk of Court & Comptroller Property Appraiser Supervisor of Elections Total General Government Public Safety: Emergency Management Medical Examiner Juvenile Detention Fire Academy Total Public Safety Physical Environment: Extension Service Sustainability Total Physical Environment Transportation: Original Final Variance with Budget Budget Actual Final Budget $ 45,280,306 $ 45,280,306 $ 44,290,317 $ (989,989) 15,028,242 15,028,242 15,732,447 704,205 670,000 670,000 672,849 2,849 5,000 5,000 127 (4,873) 335,000 352,300 2,385,333 2,033,033 477,000 592,635 770,840 178,205 61,795,548 61,928,483 63,851,913 1,923,430 $ 2,342,757 $ 2,342,756 $ 2,004,248 $ 338,508 1,063,209 1,063,209 949,199 114,010 2,176,495 2,176,495 1,672,626 503,869 682,452 682,452 681,352 1,100 9,585,228 8,268,162 6,342,364 1,925,798 13,709,131 13,713,281 11,996,310 1,716,971 7,619,420 9,048,464 8,733,478 314,986 6,168,500 6,168,500 6,168,500 - 5,877,989 5,877,990 5,568,989 309,001 3,152,039 3,152,039 3,035,111 116,928 52,377,220 52,493,348 47,152,177 5,341,171 1,360,728 1,663,904 1,186,721 477,183 912,501 912,501 755,118 157,383 1,172,723 - - - 1,057,372 1,057,372 717,309 340,063 4,503,324 3,633,777 2,659,148 974,629 286,482 286,482 269,334 17,148 984,961 984,961 594,063 390,898 1,271,443 1,271,443 863,397 408,046 County Engineer 250,775 250,775 222,042 28,733 Mass Transit 751,262 751,262 319,337 431,925 Total Transportation 1,002,037 1,002,037 541,379 460,658 (Continued) The notes to the financial statements are an integral part of these statements. C-5 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) GENERALFUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Economic Environment: Veterans Affairs Veterans Affairs Transportation Total Economic Environment Human Services: Welfare Administration Welfare Services Key West Housing Authority Agreement Social Service Transportation Animal Shelters Human Services Organizations Total Human Services Culture and Recreation: Original Final Variance with Budget Budget Actual Final Budget 838,926 850,326 849,916 410 215,323 218,323 217,401 922 1,054,249 1,068,649 1,067,317 1,332 812,096 812,096 823,327 (11,231) 1,092,264 1,029,702 970,830 58,872 741,497 741,497 656,057 85,440 1,308,785 1,389,127 1,289,222 99,905 1,882,237 1,882,238 1,833,433 48,805 2,274,722 3,397,443 3,266,064 131,379 8,111,601 9,252,103 8,838,933 413,170 Fine Arts Council 87,800 87,800 87,800 - American Association of Retired Persons 16,500 16,500 7,649 8,851 Higgs Beach Maintenance 176,729 176,729 94,241 82,488 Monroe County Public Libraries 6,161,610 6,157,617 5,517,621 639,996 Total Culture and Recreation 6,442,639 6,438,646 5,707,311 731,335 Court -Related: Law Library 28,009 32,004 115,638 (83,634) Guardian Ad Litem 321,783 321,783 235,367 86,416 Clerk of the Court 2,791,315 2,791,315 2,791,315 - State Attorney 828,867 828,867 492,157 336,710 Public Defender 693,821 693,821 312,388 381,433 Court Administration 2,486,188 2,486,188 2,060,477 425,711 Total Court Related 7,149,983 7,153,978 6,007,342 1,146,636 Debt Service: Principal - - 694,099 (694,099) Interest - - 61,374 (61,374) Total Debt Service - - 755,473 (755,473) Total Expenditures 81,912,496 82,313,981 73,592,477 8,721,504 Excess/Deficiency of Revenues Over (Under) Expenditures (20,116,948) (20,385,498) (9,740,564) 10,644,934 (Continued) The notes to the financial statements are an integral part of these statements. C-6 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) GENERALFUND FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Lease Financing Transfers from Other Funds Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 Original Final Variance with Budget Budget Actual Final Budget (481,500) (212,950) - 212,950 (3,142,950) (3,142,950) - 3,142,950 - - 229,483 229,483 4,966,034 4,966,034 5,099,754 133,720 (10,200,000) (10,200,000) (870,636) 9,329,364 5,250,000 5,250,000 8,946,154 3,696,154 (3,608,416) (3,339,866) 13,404,755 16,744,621 (23,725,364) (23,725,364) 3,664,191 27,389,555 23,725,364 23,725,364 44,259,515 20,534,151 $ - $ - $ 47,923,706 $ 47,923,706 The notes to the financial statements are an integral part of these statements. C-7 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL FINE AND FORFEITURE SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Taxes Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues EXPENDITURES: Current: General Government: Tax Increment Payment Total General Government Public Safety: Sheriff Law Enforcement Sheriff Corrections Law Enforcement Education Assistance Correction Facilities Medical Air Transport Interagency Communications Juvenile Detention Cost Share Total Public Safety Court -Related: Sheriff Extradition Sheriff Court Security Total Court Related Debt Service: Principal Interest Total Debt Service Total Expenditures Original Final Variance with Budget Budget Actual Final Budget $ 74,198,900 $ 74,198,900 $ 72,214,380 $ (1,984,520) - - 74,946 74,946 10,390,500 10,390,500 9,061,777 (1,328,723) 82,500 82,500 105,639 23,139 105,000 105,000 4,756,036 4,651,036 120,000 1,250,745 357,557 (893,188) 84,896,900 86,027,645 86,570,335 542,690 1,500,000 1,737,588 1,737,588 - 1,500,000 1,737,588 1,737,588 - 31,398,619 32,504,364 31,112,710 1,391,654 32,957,256 32,957,256 32,309,659 647,597 75,000 75,000 75,000 - 3,406,307 3,461,307 3,414,118 47,189 10,442,235 10,442,235 10,260,855 181,380 946,525 946,525 938,041 8,484 250,000 213,820 204,061 9,759 79,475,942 80,600,507 78,314,444 2,286,063 200,000 261,180 261,180 - 2,898,911 2,898,911 2,853,428 45,483 3,098,911 3,160,091 3,114,608 45,483 17,013 (17,013) 3 (3) 17,016 (17,016) 84,074,853 85,498,186 83,183,656 2,314,530 Excess/Deficiency of Revenues Over (Under) Expenditures 822,047 529,459 3,386,679 2,857,220 (Continued) The notes to the financial statements are an integral part of these statements. C-8 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) FINE AND FORFEITURE SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Lease Financing Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 Original Final Variance with Budget Budget Actual Final Budget (440,000) (147,412) - 147,412 (3,729,529) (3,729,529) - 3,729,529 - - 47,018 47,018 (33,334) (33,334) - 33,334 1,500,000 1,500,000 2,933,562 1,433,562 (2,702,863) (2,410,275) 2,980,580 5,390,855 (1,880,816) (1,880,816) 6,367,259 8,248,075 1,880,816 1,880,816 22,260,441 20,379,625 $ - $ - $ 28,627,700 $ 28,627,700 The notes to the financial statements are an integral part of these statements. C-9 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL GOVERNMENTAL GRANTS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Revenues: Intergovernmental Charges for Services Investment Income Miscellaneous Total Revenues Expenditures: Current: General Government: America Rescue Plan Act Total General Government Public Safety: Hurricane Recovery America Rescue Plan Act Emergency Management Fire Rescue Total Public Safety Physical Environment: Original Final Variance with Budget Budget Actual Final Budget $ - $ 91,321,523 $ 22,497,082 $ (68,824,441) - 435,643 176,296 (259,347) - - 147,069 147,069 - - 117,201 117,201 - 91,757,166 22,937,648 (68,819,518) - 3,669,907 2,702,621 967,286 - 3,669,907 2,702,621 967,286 - 13,684,815 485,006 13,199,809 - 3,893,768 2,330,450 1,563,318 - 1,302,748 581,731 721,017 - 2,852,739 2,338,456 514,283 - 21,734,070 5,735,643 15,998,427 Sustainability Programs 414,008 24,828,609 11,009,838 13,818,771 Conservation Resource Management - 588,234 202,593 385,641 Disaster Mitigation - 430,880 416,747 14,133 Removal of Vessels - 16,723,481 2,510,831 14,212,650 Total Physical Environment 414,008 42,571,204 14,140,009 28,431,195 Transportation: Bridge Repair - 2,415,945 1,698,630 717,315 Roadway Projects - 5,459,430 1,305,118 4,154,312 Transportation Planning - 1,300,728 124,893 1,175,835 Mass Transit - 426,000 169,675 256,325 Total Transportation - 9,602,103 3,298,316 6,303,787 Economic Environment: Community Development Block Grant - 3,602,429 32,967 3,569,462 Total Economic Environment - 3,602,429 32,967 3,569,462 (Continued) The notes to the financial statements are an integral part of these statements. C-10 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) GOVERNMENTAL GRANTS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Human Services: Title III-B Supportive Services Title III-C1 Congregate Meals Title III-C2 Home Delivered Meals Title III-E Caregiver Support Services Low Income Home Energy Program Alzheimer's Disease Initiative Weatherization Assistance Program Older Americans Act Other Social Services Grant Programs Total Human Services Culture and Recreation: State Aid to Libraries Rowell's Park Harry Harris Park Boat Ramp Other Culture & Recreation Programs Total Culture and Recreation Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Transfers from Other Funds Transfers to Other Funds Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances (Deficits) -October 1 Fund Balances (Deficits) -September 30 Original Final Variance with Budget Budget Actual Final Budget - 731,903 442,515 289,388 - 228,793 169,022 59,771 - 269,018 249,033 19,985 - 270,148 251,767 18,381 - 311,300 291,734 19,566 - 138,758 119,210 19,548 - 57,844 40,390 17,454 - 513,515 216,153 297,362 - 1,152,528 166,729 985,799 - 3,673,807 1,946,553 1,727,254 - 125,757 59,512 66,245 - 2,939,734 28,800 2,910,934 - 482,550 143,862 338,688 - 4,851,864 2,342,090 2,509,774 - 8,399,905 2,574,264 5,825,641 414,008 93,253,425 30,430,373 62,823,052 (414,008) (1,496,259) (7,492,725) (5,996,466) - 1,082,251 4,548,883 3,466,632 - - (107,127) (107,127) - 1,082,251 4,441,756 3,359,505 (414,008) (414,008) (3,050,969) (2,636,961) 414,008 414,008 3,887,664 3,473,656 836,695 $ 836,695 The notes to the financial statements are an integral part of these statements. C-11 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL TOURIST DEVELOPMENT, ADMINISTRATION AND PROMOTIONAL, TWO CENT SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 20,909,500 $ 20,909,500 $ 20,728,398 $ (181,102) Investment Income - - 2,067,941 2,067,941 Total Revenues 20,909,500 20,909,500 22,796,339 1,886,839 EXPENDITURES: Current: Economic Environment: Advertising and Promotion Administrative Services Catastrophic Emergency Special Projects Total Economic Environment Debt Service: Principal Interest Total Debt Service Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures 15,598,734 15,598,734 11,602,223 3,996,511 2,623,787 2,623,787 1,091,435 1,532,352 6,825,000 6,825,000 - 6,825,000 15,946,281 15,946,281 15,844,527 101,754 40,993,802 40,993,802 28,538,185 12,455,617 95,737 (95,737) 18,863 (18,863) 114,600 (114,600) 40,993,802 40,993,802 28,652,785 12,341,017 (20,084,302) (20,084,302) (5,856,446) 14,227,856 Other Financing Sources (Uses): Transfers to Other Funds (114,278) (114,278) (114,278) - Transfers from Constitutional Officers - - 214,697 214,697 Total Other Financing Sources (Uses) (114,278) (114,278) 100,419 214,697 Net Change in Fund Balances (20,198,580) (20,198,580) (5,756,027) 14,442,553 Fund Balances -October 1 20,198,580 20,198,580 43,897,528 23,698,948 Fund Balances -September 30 $ - $ - $ 38,141,501 $ 38,141,501 C-12 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF NET POSITION PROPRIETARY FUNDS SEPTEMBER 30, 2024 ASSETS Current Assets: Cash and Cash Equivalents Investments Accounts Receivable, Net Leases Receivable Due from Other Funds Due from Other Governmental Units Due from Constitutional Officers Interest Receivable Total Current Assets Noncurrent Assets: Restricted Cash and Cash Equivalents Leases Receivable, Noncurrent Capital Assets not being Depreciated Capital Assets, Net of Accumulated Depreciation and Amortization Total Noncurrent Assets Total Assets Business -Type Activities Enterprise Funds Major Funds Municipal Card Key Service District Sound West Waste Bridge Airport $ 2,061,974 $ 779,138 $ 5,259,236 21,371,271 7,611,975 32,422,039 745,311 500 994,969 - - 3,767,342 332,273 52,829 2,189,359 7,393 - 301,327 86,661 31,198 173,587 24,604,883 8,475,640 45,107,859 - - 27,970,253 - - 12,777,460 3,761,620 1,506,860 117,119,309 1,620,984 7,587,455 77,408,557 5,382,604 9,094,315 235,275,579 29,987,487 17,569,955 280,383,438 DEFERRED OUTFLOWS OF RESOURCES Related to Pensions 319,406 67,004 1,426,411 Related to OPEB 49,300 51,700 263,200 Total Deferred Outflows of Resources 368,706 118,704 1,689,611 LIABILITIES Current Liabilities: Accounts Payable Retainage Payable Accrued Wages and Benefits Payable Claims and Judgments Payable Due to Other Funds Due to Other Governmental Units Due to Constitutional Officers Accrued Compensated Absences Payable Unearned Revenues Leases and Subscriptions Payable Other Current Liabilities Deposits in Escrow Total Current Liabilities 1,712,527 177,764 6,122,921 - - 2,909,036 70,952 4,417 266,701 - - 328,000 1,308 - 33,621 22,554 924 122,473 - - 105,273 - - 2,502 - - 52 93,252 - - 1,900,593 183,105 9,890,579 The notes to the financial statements are an integral part of these statements. C-13 Governmental Major Funds Activities Internal Marathon Service Airport Total Funds $ 712,543 $ 8,812,891 $ 3,218,359 7,385,812 68,791,097 32,634,956 157,412 1,898,192 526,058 323,242 4,090,584 - - - 328,000 4,501,658 7,076,119 119,813 - 308,720 30,429 32,018 323,464 132,535 13,112,685 91,301,067 36,990,150 171,453 28,141,706 - 658,243 13,435,703 - 40,099,444 162,487,233 1,961,240 16,618,177 103,235,173 994,225 57,547,317 307,299,815 2,955,465 70,660,002 398,600,882 39,945,615 98,626 1,911,447 795,357 34,800 399,000 133,000 133,426 2,310,447 928,357 905,069 8,918,281 1,157,057 105,011 3,014,047 - 21,941 364,011 175,503 - - 3,554,785 - 328,000 - 7,997 42,926 602 - - 2,883 6,272 152,223 85,981 72,503 177,776 2,473 - 2,502 172,404 - 52 1,076 6,306 99,558 - 1,125,099 13,099,376 5,152,764 (Continued) C-14 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF NET POSITION (CONTINUED) PROPRIETARY FUNDS SEPTEMBER 30, 2024 Noncurrent Liabilities: Accrued Compensated Absences Payable Claims & Judgments Payable Leases and Subscriptions Payable Revenue Bonds Payable Revenue Notes Payable Total OPEB Liability Net Pension Liability Total Noncurrent Liabilities Total Liabilities Business -Type Activities Enterprise Funds Major Funds Municipal Card Key Service District Sound West Waste Bridge Airport $ 90,214 $ 3,696 $ 489,891 - - 42,459,929 - - 10,000,000 297,000 141,000 1,083,000 1,376,625 652,089 4,999,531 1,763,839 796,785 59,032,351 3,664,432 979,890 68,922,930 DEFERRED INFLOWS OF RESOURCES Related to Leases - - 16,099,137 Related to Pensions 126,446 26,258 509,167 Related to OPEB 47,100 12,500 45,500 Total Deferred Inflows of Resources 173,546 38,758 16,653,804 NET POSITION Net Investment in Capital Assets Restricted for: Passenger Facility Charges Customs Service Operations Unrestricted Total Net Position 5,382,604 8,958,225 165,931,899 - - 6,145,647 21,135,611 7,711,786 24,418,769 $ 26,518,215 $ 16,670,011 $ 196,496,315 The notes to the financial statements are an integral part of these statements. C-15 Governmental Major Funds Activities Internal Marathon Service Airport Total Funds $ 25,087 $ 608,888 $ 343,922 - - 112,051 - 42,459,929 - - 10,000,000 - 135,000 1,656,000 1,034,000 459,895 7,488,140 2,363,384 619,982 62,212,957 3,853,357 1,745,081 75,312,333 9,006,121 953,581 17,052,718 - 39,575 701,446 317,062 20,100 125,200 98,500 1,013,256 17,879,364 415,562 55,689,930 235,962,658 2,671,010 - 6,145,647 - 171,453 171,453 - 12,173,708 65,439,874 28,781,279 $ 68,035,091 $ 307,719,632 $ 31,452,289 C-16 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENSES, AND CHANGES IN NET POSITION PROPRIETARY FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Operating Revenues: Franchise Fees Charges for Services Miscellaneous Total Operating Revenues Operating Expenses: Personnel Services Operations Depreciation and Amortization Asserted and Paid Claims (Adjustments) Total Operating Expenses Operating Income (Loss) Nonoperating Revenues (Expenses): Business -Type Activities Enterprise Funds Major Funds Municipal Card Key Service District Sound West Waste Bridge Airport $ 887,626 $ - $ - 26,412,150 2,562,547 17,969,771 62,921 - 20,416 27,362,697 2,562,547 17,990,187 1,721,939 300,421 5,529,822 22,938,711 373,320 9,153,093 221,059 400,668 3,893,149 24,881,709 1,074,409 18,576,064 2,480,988 1,488,138 (585,877) Operating Grants 187,500 - 557,035 Investment Income 1,343,405 370,072 3,820,128 Insurance Recoveries - - 1,866,885 Debt Service Costs - - (2,172,290) Gain (Loss) on Disposition of Assets - - 197,951 Total Non -Operating Revenues (Expenses) 1,530,905 370,072 4,269,709 Income (Loss) Before Transfers Total Capital Contributions and Transfers: Capital Contributions Transfers from Other Funds Transfers to Other Funds Transfers from Constitutional Officers Total Capital Contributions and Transfers Change in Net Position Net Position -October 1 Restatement - Prior Period Adjustment Net Position -October 1, restated Net Position -September 30 4,011,893 1,858,210 3,683,832 21,619,882 (1,447,661) (79,776) (805,280) 4,187 - - (1,443,474) (79,776) 20,814,602 2,568,419 1,778,434 24,498,434 23,949,796 14,891,577 172,097,405 - - (99,524) 23,949,796 14,891,577 171,997,881 $ 26,518,215 $ 16,670,011 $ 196,496,315 The notes to the financial statements are an integral part of these statements. C-17 Governmental Major Funds Activities Internal Marathon Service Airport Total Funds $ - $ 887,626 $ - 1,847,232 48,791,700 38,106,836 112,100 195,437 2,648,953 1,959,332 49,874,763 40,755,789 542,455 8,094,637 4,708,805 1,498,664 33,963,788 12,700,974 962,518 5,477,394 242,656 - - 19,376,904 3,003,637 47,535,819 37,029,339 (1,044,305) 2,338,944 3,726,450 10,920,684 11,665,219 - 432,410 5,966,015 1,827,045 - 1,866,885 56,856 - (2,172,290) - (97,945) 100,006 17,633 11,255,149 17,425,835 1,901,534 10,210,844 19,764,779 5,627,984 7,764,966 29,384,848 - - - 328,000 (137,385) (2,470,102) (860,159) - 4,187 - 7,627,581 26,918,933 (532,159) 17,838,425 46,683,712 5,095,825 50,309,780 261,248,558 26,356,464 (113,114) (212,638) - 50,196,666 261,035,920 26,356,464 $ 68,035,091 $ 307,719,632 $ 31,452,289 C-18 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF CASH FLOWS PROPRIETARY FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Operating Activities: Cash Received for Services Cash Payments to Suppliers for Goods and Services Cash Payments for Employee Services Cash Payments for Claims Cash Received from (Paid to) Other Sources Other Miscellaneous Revenue Net Cash Provided by (Used in) Operating Activities Noncapital Financing Activities: Operating Grants Received Insurance Recoveries Received Transfers from Other Funds Transfers to Other Funds Transfers from Constitutional Officers Net Cash Provided by (Used in) Noncapital Financing Activities Capital and Related Financing Activities: Proceeds from Capital Grants Acquisition of Capital Assets Purchase and Construction of Capital Assets Proceeds from Issuance of Capital Debt Gain/(Loss) from Sale of Capital Assets Net Cash Provided by (Used in) Capital and Related Financing Activities Investing Activities: Investment Income (Losses) Proceeds from Sales and Maturities of Investments Purchase of Investment Securities Net Cash Provided by (Used in) Investing Activities Net Change in Cash and Cash Equivalents Cash and Cash Equivalents: October 1 September 30 Business -Type Activities Enterprise Funds Major Funds Municipal Card Key Service District Sound West Waste Bridge Airport $ 26,909,939 $ 2,562,047 $ 18,704,260 (22,147,187) (435,624) (6,101,581) (1,652,454) (318,910) (5,195,244) (21,072) (5,144) 3,933,748 37,444 (9,523) 13,258 3,126,670 1,792,846 11,354,441 187,500 - 557,035 - - 1,866,885 (1,447,661) (79,776) (805,280) 4,187 - - (1,255,974) (79,776) 1,618,640 - - 21,619,882 (114,713) 1,137 (3,893,149) (132,000) (936,689) (44,020,753) - - 7,827,710 - - 197,951 (246,713) (935,552) (18,268,359) 1,343,405 370,072 3,820,128 21,754,545 6,558,404 20,022,368 (24,029,870) (7,405,294) (26,999,934) (931,920) (476,818) (3,157,438) 692,063 300,700 (8,452,716) 1,369,911 478,438 41,682,205 $ 2,061,974 $ 779,138 $ 33,229,489 The notes to the financial statements are an integral part of these statements. C-19 Governmental Major Funds Activities Internal Marathon Service Airport Total Funds $ 1,920,849 $ 50,097,095 $ 37,942,365 (3,117,864) (31,802,256) (13,067,486) (488,093) (7,654,701) (4,217,091) - - (19,059,905) 1,048,073 4,955,605 (122,123) 104,127 145,306 2,609,011 (532,908) 15,741,049 4,084,771 10,920,684 11,665,219 - - 1,866,885 56,856 - - 328,000 (137,385) (2,470,102) (860,159) - 4,187 - 10,783,299 11,066,189 (475,303) 7,764,966 29,384,848 - (962,518) (4,969,243) (697,010) (13,134,999) (58,224,441) - - 7,827,710 - (97,945) 100,006 17,633 (6,430,496) (25,881,120) (679,377) 432,410 5,966,015 1,827,045 1,954,043 50,289,360 28,845,631 (5,792,849) (64,227,947) (32,581,844) (3,406,396) (7,972,572) (1,909,168) 413,499 (7,046,454) 1,020,923 470,497 44,001,051 2,197,436 $ 883,996 $ 36,954,597 $ 3,218,359 (Continued) C-20 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF CASH FLOWS (CONTINUED) PROPRIETARY FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Reconciliation of Operating Income (Loss) to Net Cash Provided by (Used in) Operating Activities: Operating Income (Loss) Adjustments to Reconcile Operating Income (Loss) to Net Cash Provided by (Used in) Operating Activities: Depreciation and Amortization Change in Assets, Liabilities, and Deferrals: (Increase) Decrease in Accounts Receivable (Increase) Decrease in Leases Receivable (Increase) Decrease in Due from Other Funds (Increase) Decrease in Due from Other Gov't Units (Increase) Decrease in Due from Constitutional Ofcrs (Increase) Decrease in Interest Receivable Increase (Decrease) in Accounts Payable Increase (Decrease) in Retainage Payable Increase (Decrease) in Accrued Wages/Benefits Increase (Decrease) in Claims/Judgments Payable Increase (Decrease) in Other Current Liabilities Increase (Decrease) in Due to Other Funds Increase (Decrease) in Due to Other Gov't Units Increase (Decrease) in Comp. Absences Payable Increase (Decrease) in Deposits in Escrow Increase (Decrease) in Leases Payable Increase (Decrease) in Unearned Revenue Increase (Decrease) in OPEB Liability Increase (Decrease) in Pension Liability Increase (Decrease) in Deferred Inflows Leases Increase (Decrease) in Deferred Outflows Increase (Decrease) in Deferred Inflows Pensions/OPEB Total Adjustments Net Cash Provided by (Used in) Operating Activities Noncash Investing, Capital, and Financing Activities: Gain on Disposition of Assets Noncash Investing, Capital, and Financing Activities Cash Reconciliation: Unrestricted Restricted Total Business -Type Activities Enterprise Funds Major Funds Municipal Card Key Service District Sound West Waste Bridge Airport $ 2,480,988 $ 1,488,138 $ (585,877) 221,059 400,668 3,893,149 (389,837) (500) 1,029,438 - - 6,705,148 (21,377) (5,144) 3,897,243 (1,003) - (291,421) (25,477) (9,523) (7,158) 788,324 (51,419) 1,343,247 - (10,885) 1,713,877 11,150 (3,317) 69,258 - - 33 - - 328,000 1,308 - (74) 8,772 (6,827) 19,624 3,200 - - - - (5,645) - - (32,978) 4,000 34,000 301,000 (22,883) (4,654) (71,567) - - (6,967,119) (12,055) (32,113) (199,288) 80,501 (5,578) 215,551 645,682 304,708 11,940,318 $ 3,126,670 $ 1,792,846 $ 11,354,441 $ - $ - $ (2,113) $ - $ - $ (2,113) $ 2,061,974 $ 779,138 $ 5,259,236 - - 27,970,253 $ 2,061,974 $ 779,138 $ 33,229,489 The notes to the financial statements are an integral part of these statements. C-21 Governmental Major Funds Activities Internal Marathon Service Airport Total Funds $ (1,044,305) $ 2,338,944 $ 3,726,450 962,518 5,477,394 242,656 64,738 703,839 (164,471) 4,128,475 10,833,623 - - - (328,000) 1,046,667 4,917,389 10,631 - (292,424) 198,624 (7,973) (50,131) (39,942) (1,048,153) 1,031,999 (322,807) (570,582) 1,132,410 - 3,431 80,522 34,396 - - 316,999 - 33 283 - 328,000 - 1,406 2,640 (3,378) (4,980) 16,589 91,299 - 3,200 - (465) (6,110) (46,061) 25,393 (7,585) 2,073 12,000 351,000 9,000 (7,358) (106,462) (58,195) (4,144,989) (11,112,108) - 29,262 (214,194) 248,114 22,007 312,481 167,100 511,397 13,402,105 358,321 $ (532,908) $ 15,741,049 $ 4,084,771 $ 10,726 $ 8,613 $ - $ 10,726 $ 8,613 $ - $ 712,543 $ 8,812,891 $ 3,218,359 171,453 28,141,706 - $ 883,996 $ 36,954,597 $ 3,218,359 C-22 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES The following summary of the more significant accounting policies of the Monroe County, Florida Board of County Commissioners (Board) is presented to assist the reader in interpreting these financial statements and should be viewed as an integral part of this report. Reporting Entity: Monroe County, Florida (County) is a Non -Charter County established as provided by Article VIII Section 1 of the Florida Constitution and Chapter 125, Florida Statutes. The primary government of the County is comprised of the Board of County Commissioners and five "constitutional officers": Clerk of the Circuit Court & Comptroller (Clerk), Property Appraiser, Sheriff, Supervisor of Elections, and Tax Collector. Entity status for financial reporting purposes is governed by Statement No. 14, as amended, of the Governmental Accounting Standards Board (GASB) and Rules of the Auditor General, State of Florida. The GASB is the standard -setting body for the establishment of accounting principles generally accepted in the United States of America (GAAP) for governmental entities. The financial statements of the Board, when combined with all of its blended component units and the constitutional officers, constitute the "primary government" of Monroe County according to GAAP. The primary government constitutes the complete GAAP basis financial reporting entity of the County, presented in the Monroe County, Florida Annual Comprehensive Financial Report. Since this report excludes the constitutional officers, these Board financial statements do not purport to reflect the financial position or the results of operations of Monroe County, Florida taken as a whole. Rather, they have been prepared to provide information at this level of detail greater than what is available in the County's financial statements. These statements are presented to comply with Section 218.39 Florida Statutes and Section 10.556(4) Rules of the Auditor General for Local Government Entity Audits. The Board, composed of five members, is the legislative body for Monroe County and, as such, budgets and provides the funding used by the separate Constitutional Offices with the exception of fees collected by the Clerk and the Tax Collector. Under the direction of the Clerk, the Monroe County Finance Department maintains the accounting system for the Board's operations, excluding those of the Clerk, Property Appraiser, Sheriff, Supervisor of Elections, and Tax Collector, each of which maintains its own respective accounting system. Services provided by the Board and accounted for within these financial statements include police services for unincorporated areas of the County; health and social services; emergency medical services; cultural and recreational programs; solid waste services and other governmental services. These financial statements include all funds of the Board and its blended component units, if material. "Component units" are legally separate entities for which operational or financial responsibility rests with the Board or for which the nature and significance of their relationship to the Board is such that exclusion would cause the financial statements to be misleading or incomplete. D-1 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) Blended component units are legally separate entities that are, in substance, part of the Board's operation, as they either have governing bodies that are substantively the same as the Board or they provide their services exclusively, or almost exclusively, to the Board. The financial transactions of the component unit are merged with similar transactions of the Board as part of the primary government. The blended component unit of the Board is as follows: Monroe County Industrial Development Authority (MCIDA) — The MCIDA was created by Monroe County, Florida Resolution, pursuant to Chapter 159, Florida Statutes. The MCIDA serves to assist in financing and refinancing capital projects, which will foster economic development in the County. The Board serves as the governing board and MCIDA provides services within the County. Therefore, the MCIDA, for financial reporting purposes, is considered a blended component unit of Monroe County, Florida. The MCIDA is not legally required to adopt a budget; however, the Board must authorize the issuance of bonded debt. Neither the MCIDA nor the Board has any legal obligation for repayment of the revenue bonds of the MCIDA. As an issuer of "conduit" debt obligations, the MCIDA has no assets, liabilities, or transactions during the current year. Discretely presented component units are legally separate entities which do not meet the criteria for blending. They are reported in separately issued financial statements to emphasize their legal separation from the Board. The following is a discretely presented component unit of the Board: Monroe County, Florida Comprehensive Plan Land Authority (MCLA) — The MCLA was created by Monroe County, Florida Ordinance 031-1986 pursuant to Chapter 380, Florida Statutes and is considered a legally separate entity from Monroe County. The objectives of the entity are to operate a land acquisition program in Monroe County, implement the Monroe County Comprehensive Plan and address issues created by it. The Board serves as the governing board; however, there is no financial benefit or burden relationship. Therefore, the MCLA, for financial reporting purposes, is considered a discretely presented component unit of Monroe County, Florida and is presented in a separate section of the County's financial statements. Complete financial statements for MCLA can be obtained from MCLA's administrative office at 1200 Truman Avenue, Suite 207, Key West, Florida 33040. Basis of Presentation: The Board's financial statements are prepared in accordance with Chapter 10.550, Rules of the Auditor General Local Governmental Entity Audits (Rules), which do not require separate financial statements for the Board but specify certain requirements if such financial statements are presented. Requirements include presentation of fund -level and component unit financial statements. Government -wide financial statements, related disclosures and management's discussion and analysis are not required by the Rules and are not presented. As such, these statements present information about the Board's funds, but do not present a complete presentation of the Board's financial position and changes in financial position. Separate columns are presented for each major governmental fund and for each major enterprise fund. D-2 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) The following are reported as major governmental funds: General Fund — The General Fund is the general operating fund of the Board. All general tax revenues and other receipts not required either legally or by accounting principles generally accepted in the United States of America to be accounted for in other funds, are accounted for in the General Fund. Fine and Forfeiture Special Revenue Fund — The Fine and Forfeiture Fund is used to account for revenues received from fines and forfeitures imposed from the commission of statutory offenses, ad valorem taxes transferred to the Sheriff and to account for operations of the County's court system. Governmental Grants Special Revenue Fund — The Governmental Grant Fund is used to account for operating revenues and expenditures for governmental activity of federal and state grants. Tourist Development Admin & Promo Two Cent — The Tourist Development Admin & Promo Two Cent Fund is a special revenue fund used to account for the expenditures of advertising, promotions, and special events of the County Tourist Development Council. The major funding for this fund is the Bed Tax. The fund is being presented as a major fund for consistency and public interest. One Cent Infrastructure Surtax Capital Project Fund — The One Cent Infrastructure Surtax Fund is used to account for capital improvements funded by the One Cent Infrastructure Surtax. Debt Service Fund — The Debt Service Fund is used to account for accumulation of resources for, and payment of, interest and principal on the long-term debt incurred in the issuance of various revenue bonds and notes. The following are reported as major enterprise funds Municipal Service District Waste — The Municipal Service District Waste Fund is used to account for the operations of solid waste collection, disposal, and recycling activities. This fund has been deemed a major fund for public interest purposes. Card Sound Bridge — The Card Sound Bridge Fund is used to account for the operations of Monroe County's Card Sound Toll Bridge. This fund has been deemed a major fund for public interest purposes. Key West Airport — The Key West Airport Fund is used to account for the operations of Monroe County's Key West International Airport. Marathon Airport — The Marathon Airport Fund is used to account for the operations of Monroe County's Florida Keys Marathon International Airport. This fund has been deemed a major fund for public interest purposes. D-3 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2023 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) The Board also reports the following fund types: Internal Service Funds — Internal service funds are used to account for the financing of workers' compensation insurance, health insurance, general liability insurance, and fleet maintenance services provided by one department to other departments of the Board or to other governmental units on a cost reimbursement basis. Measurement Focus and Basis of Accounting: Governmental fund financial statements are reported using the current financial resources measurement focus and the modified accrual basis of accounting. Revenues are recognized when they become susceptible to accrual; that is, when they become both "measurable" and "available" to finance expenditures of the current period. The Board considers amounts collected within 60 days after year end to be available and thus recognizes them as revenues of the current year, except for property taxes since such taxes are collected to finance expenditures of the subsequent period for which they have been levied. Further, the Board recognizes revenue for Fire Rescue billings if they are expected to be collected within a year. Expenditures are recognized in the accounting period in which the related fund liability is incurred, if measurable. Principal and interest on general long-term debt are recorded as fund liabilities when due or when amounts have been accumulated in the debt service fund for payments to be made early in the following year. In addition, expenditures related to compensated absences are recorded only when leave has been taken. Expenditures related to leases and subscription -based information technology arrangements (SBITA), pension and OPEB are recorded only when incurred. Revenues of the Board, which are susceptible to accrual under the modified accrual basis of accounting, include property taxes, gas taxes, sales taxes, interest revenue, and charges for services. In applying the susceptibility -to -accrual concept to intergovernmental revenues, the legal and contractual requirements of the numerous individual programs are used as guidance. There are, however, essentially two types of these revenues. In one type, monies must be expended for the specific purpose or project before any amounts will be paid to the Board; therefore, revenues are recognized based upon the expenditures recorded. In the other type, monies are virtually unrestricted as to purpose of expenditure and substantially irrevocable; i.e., revocable only for failure to comply with prescribed compliance requirements, such as with equal employment opportunity. These resources are reflected as revenues at the time of receipt or earlier if they meet the availability criterion. If revenues are expected to be received later than 60 days following the end of the fiscal year, then a receivable is recorded, along with deferred inflows of resources. Once the funds are received, revenue and cash are recorded and the receivable and deferred inflows of resources are eliminated. The proprietary fund statements use a flow of economic resources measurement focus and the accrual basis of accounting. Revenues are recognized when earned and expenses are recognized when incurred, regardless of when the related cash flows take place. Non -exchange transactions, in which the Board gives (or receives) value without directly receiving (or giving) equal value in exchange, include grants. On an accrual basis, revenue from grants is recognized in the fiscal year in which all eligibility requirements have been satisfied. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) The Board has chosen to fund the Volunteer Firefighter and Emergency Medical Services Length of Service Award Pension Plan (LOSAP) on a pay-as-you-go basis. Pension expenditures are made from the General Fund, which is maintained on a modified accrual basis of accounting. Benefits and refunds are recognized when due and payable in accordance with the terms of the LOSAP Plan. The LOSAP has no assets accumulated in a trust that meets the following criteria, outlined in GASB Statement Nos. 67 and 68: • Contributions to the pension plan and earnings on those contributions are irrevocable. • Pension plan assets are dedicated to providing benefits to plan members. • Pension plan assets are legally protected from the creditors or employers. Proprietary funds distinguish operating revenues and expenses from nonoperating items. Operating revenues and expenses generally result from providing services and producing and delivering goods in connection with a proprietary fund's principal ongoing operations. The principal operating revenues of the Board's enterprise funds are charges to customers for sales and services. Operating expenses for enterprise funds include the cost of sales and services, administrative expenses, and depreciation and amortization on capital assets, right -to -use leased assets, and SBITA. All revenues and expenses not meeting this definition are reported as nonoperating revenues and expenses. Budgets and Bud2etary Data: Listed below are the statutory procedures followed by the Board of County Commissioners in establishing the budget for Monroe County: 1) On or before June 1 of each year, the Sheriff, the Clerk, the Property Appraiser, the Tax Collector, and the Supervisor of Elections shall each submit to the Board a tentative budget for their respective offices for the ensuing fiscal year. 2) Within fifteen days after certification of the ad valorem tax roll by the Property Appraiser, the County Administrator submits to the Board a proposed budget for the fiscal year commencing the following October 1. The budget includes proposed expenditures and the means of financing said expenditures. 3) By Board resolution, a tentative budget is submitted to the public. Public hearings are held to obtain taxpayer comments. 4) Fifteen days after adoption of the tentative budget, a final budget is submitted for review and adoption at a final public hearing. 5) Prior to, or on September 30, the Board's budget is legally enacted through passage of a resolution. Accordingly, all fund types have an adopted budget, as required by Section 129.03, Florida Statutes. All funds have legally adopted budgets. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) 6) Throughout the fiscal year, the County Administrator acts on intradepartmental budget changes that do not alter the total revenue or expenditures budgeted to a cost center. A cost center represents a particular area of Board operations or a department. All other budget changes (whether they are transfers between cost centers or alterations of total revenues and expenditure in a fund) are approved by the Board. Supplemental appropriations were necessary and the budgetary data presented herein was amended by the Board during the year. 7) Chapter 129, Section VII, Florida Statutes as amended in 1978, provides that only expenditures in excess of total fund budgets are unlawful. However, because the Board acts on all budget changes between cost centers, this becomes the level of control. 8) Budgeted to actual expenditure reports are employed as a management control device during the year for all fund types. 9) Budgets for all funds are adopted on a basis consistent with GAAP for that fund type. 10) All appropriations lapse at year-end. Use of Estimates: The presentation of financial statements in conformity with accounting principles generally accepted in the United States of America, as applicable to governmental units, requires management to make use of estimates that affect the reported amounts in the financial statements. Actual results could differ from estimates. Actual results could differ from these estimates. Encumbrances: Encumbrance accounting is used, under which purchase orders, contracts and other commitments for the expenditure of moneys are recorded as assigned fund balance and is employed as an extension of the statutorily required budgetary process. Under Florida Statutes, appropriations, even if encumbered, lapse at fiscal year-end. The Board's intention is to substantially honor these encumbrances under authority provided in the subsequent year's budget. Cash and Cash Equivalents: Cash balances from the majority of funds are pooled for investment purposes. Earnings from such investments are allocated to the respective funds based on applicable cash participation by each fund. The investment pools are managed such that all participating funds have the ability to deposit and withdraw cash as if they were demand deposit accounts. Therefore, all balances representing participants' equity in the investment pools are classified as cash equivalents for purposes of these statements. For investments, held separately from the pools, and are highly liquid (including restricted assets) with an original or remaining maturity of 90 days or less, are considered cash equivalents. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) Investments: Section 218.415, Florida Statutes, authorizes local governments to invest its funds pursuant to a written investment plan. Monroe County's written plan allows investment of surplus funds in the following: 1) U.S. Treasury & Government Guaranteed — U.S. Treasury obligations, and obligations the principal and interest of which are backed or guaranteed by the full faith and credit of the U.S. Government. 2) Federal Agency/Government Sponsored Enterprise (GSE) — Debt obligations, participations or other instruments issued or fully guaranteed by any U.S. Federal agency, instrumentality or GSE. 3) Supranationals — U.S. dollar denominated debt obligations of a multilateral organization of governments where the U.S. is a shareholder and voting member. 4) Corporates — U.S. dollar denominated corporate notes, bonds, or other debt obligations issued or guaranteed by a domestic corporation, financial institution, non-profit, or other entity. 5) Municipals — Obligations, including both taxable and tax-exempt, issued or guaranteed by any State, territory, or possession of the U.S., political subdivision, public corporation, authority, agency board, instrumentality or other unit of local government of any state or territory. 6) Agency Mortgage Backed Securities (MBS) — MBS are backed by residential, multi -family or commercial mortgages, that are issued or fully guaranteed as to principal and interest by a U.S. Federal agency or government sponsored enterprise, including but not limited to pass-throughs, collateralized mortgage obligations (CMOs) and real estate mortgage investment conduits. 7) Asset -Backed Securities — Asset -backed securities (ABS) whose underlying collateral consists of loans, leases, or receivables, including but not limited to auto loans/leases, credit card receivables, student loans, equipment loans/leases, or home -equity loans. 8) Non -Negotiable Certificate of Deposit and Savings Accounts — Non-negotiable interest bearing time certificates of deposit, or savings accounts in banks organized under the laws of the State of Florida or in national banks organized under the laws of the United States and doing business in Florida, provided that any such deposits are secured by the Florida Security for Public Deposits Act, Chapter 280, Florida Statutes. 9) Commercial Paper — U.S. dollar denominated commercial paper issued or guaranteed by a domestic corporation, company, financial institution, trust or other entity, only unsecured debt permitted. 10) Bankers' Acceptances — Bankers' acceptances issued, drawn on, or guaranteed by a U.S. bank or U.S. branch of a foreign bank. D-7 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) 11) Repurchase Agreements — Repurchase agreements that meet specific requirements listed in Monroe County Resolution 032-2019. 12) Money Market Funds — Shares in open-end and no-load money market mutual funds, provided such funds are registered under the Investment Company Act of 1940 and operate in accordance with Rule 2a-7. 13) Intergovernmental Investment Pools — Intergovernmental Investment Pools that are authorized pursuant to the Florida Interlocal Cooperation Act, as provided in Section 163.01, Florida Statutes. All investments are stated at fair value or at amortized cost, which approximates fair value. Accounts Receivable: Amounts due from private individuals, organizations, or other governments, which pertain to charges for services rendered by Board departments, are reported as accounts receivable. Receivables are reviewed periodically to establish or update the provisions for uncollectible amounts. These provisions are estimated based on an analysis of the age of the various accounts. Leases Receivable: The Board's lease receivable is measured at the present value of lease payments expected to be received during the lease term. Under the lease agreement, the Board may receive variable lease payments that are dependent upon the lessee's revenue. The variable payments are recorded as an inflow of resources in the period the payment is received. A deferred inflow of resources is recorded for the lease. The deferred inflow of resources is recorded at the initiation of the lease in an amount equal to the initial recording of the lease receivable. The deferred inflow of resources is amortized on a straight-line basis over the term of the lease. Interfund Balances and Activity: As part of its normal operations, the Board performs transactions between funds. Examples of these transactions include providing services, constructing assets, matching grants or servicing debt. These transactions are generally recorded as interfund transfers, except for internal service fund charges, which are reflected as revenues to internal service funds and expenses/expenditures to the funds receiving the services. Additionally, short-term interfund loans are recorded as cash flow needs arise. As of fiscal year-end, any unpaid amounts related to these transactions are reported as "due from other funds" or "due to other funds" on the fund financial statements. Interfund balances and transfers are consolidated for government -wide financial reporting, and residual balances between governmental activities and business -type activities, if any, are reported on the government -wide statements of the County. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) Prepaid Items: Prepaid items are recorded using the consumption method of accounting. Under the consumption method, services paid for in advance are reported as an asset until the period in which the services are actually consumed. Capital Assets: Capital assets of the Board include property, buildings, equipment, and infrastructure assets (e.g. roads, bridges, curbs and gutters, streets and sidewalks, drainage systems and lighting systems). Constructed or purchased assets are recorded at historical or estimated historical cost at the time of purchase. Donated or contributed capital assets are recorded at estimated acquisition cost at the date of donation. Capital assets associated with business -type activities and the internal service funds are presented in the Board's basic financial statements. Capital assets associated with the Board's governmental activities are presented on the government -wide financial statements of the County, rather than on the financial statements of the Board. The Board maintains a $1,000 threshold for additions to equipment with an estimated useful life in excess of two years. Buildings are capitalized when the value is $15,000 or greater. Public domain and infrastructure assets represent major expenditures for such items as roads, water and sewer treatment plants and lines, landfill improvements, parks, and drainage systems. Additions and improvements for roads, water, sewer, landfill, and drainage infrastructure are capitalized when the cost amounts to $250,000, while park additions and improvements are capitalized at $25,000. Depreciation has been provided using the straight-line method. The estimated useful lives of the various classes of depreciable capital assets are as follows: Life -Years Buildings 10-50 Equipment 5-10 Intangible Assets 10-15 Infrastructure 10-50 Public Domain Infrastructure 20-50 Capacity Rights 99 Capacity rights represent an intangible asset that arose from a contract with a private wastewater operator that includes wastewater processing capacity for 1,500 equivalent dwelling units for a period of 99 years. • MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) Leased Assets and Subscription -Based Software: The Board is the lessee for leases of equipment and property. When the term for the leased equipment or property exceeds 12 months and has a value of $50,000 or more, the Board recognizes intangible right - to -use leased assets (leased assets) in the financial statements. Similarly, the Board recognizes SBITA for the right -to -use information technology software if the subscription term exceeds one year and has a a value greater than or equal to $50,000. The leased assets and SBITA are measured at the start of the lease or subscription as the initial amount of the lease or subscription liability, adjusted for lease or subscription payments made at or before the lease or subscription commencement date, plus certain initial direct costs. Subsequently, the lease asset or SIBTA is amortized on a straight-line basis over its useful life. Key estimates and judgments related to leases and SBITA include how the Board determines the discount rate it uses to discount the expected lease payments or subscription payments to present value, lease term and lease payments. The Board uses the interest rate charged by the lessor as the discount rate. When the interest rate is not provided, the Board uses its estimated incremental borrowing rate as the discount rate for leases and SBITA. The lease term or subscription term includes the noncancellable period of the lease or subscription. Lease payments or subscription payments included in the measurement of the lease liability or SBITA are composed of fixed payments and a purchase price option that the Board is reasonably certain to exercise. The Board monitors changes in circumstances that would require remeasurement of its leases or SBITA and will remeasure the leased asset, SBITA, and liability if certain changes occur that are expected to significantly affect the amount of the lease or SBITA liability. Leased assets and SBITA for the Board's enterprise and internal service funds are reported with capital assets on the statement of net position. Compensated Absences: Board policy permits employees to accumulate a limited amount of annual and sick leave, which will be paid to employees upon termination of employment. Accumulated annual and sick leave is accrued when earned in the proprietary fund financial statements. For the proprietary funds, an expense and a liability are recorded as the leave is earned. Compensated absences associated with the Board's governmental activities are presented on the government -wide financial statements of the County, rather than on the financial statements of the Board. Restricted Assets: The use of certain assets of enterprise funds is restricted by specific provisions of resolutions and agreements with various parties. Assets so designated are identified as restricted assets on the balance sheet. When both restricted and unrestricted resources are available for use, the hierarchy of enterprise fund spending is to use restricted resources first, followed by unrestricted resources, as they are needed. Restricted assets are classified as noncurrent if they are for acquisition or construction of capital assets, for liquidation of long-term debt, or are for other than current operations. D-10 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) Deferred Inflows of Resources: Deferred inflows of resources represent an acquisition of net position that applies to a future period and therefore will not be recognized as an inflow of resources until that time. The Board has five items that qualify for reporting in this category: (1) Unavailable revenues; (2) Advances from Other Governments; (3) Pension -related items; (4) Other Post -Employment Benefits; and (5) Leases. The advances from other governments are grants received in advance of meeting the timing requirements for revenue recognition in governmental funds. The governmental funds report unavailable revenues where receipts are not within the 60-day time frame for revenue recognition. The enterprise and internal service funds report deferred inflows for pension -related and other post -employment benefit items as actuarially determined. Deferred Outflows of Resources: Deferred outflows of resources represents a consumption of net position that applies to a future period and therefore will not be recognized as an outflow of resources (expense) until that future time. The enterprise and internal service funds report deferred outflows for pension -related and other post - employment benefit items as actuarially determined. Long -Term Obligations: Long-term obligations are reported as a liability in the proprietary fund statement of net position. Long- term debt associated with the Board's governmental activities is presented on the government -wide financial statements of the County, rather than on the financial statements of the Board. In the Board's governmental fund financial statements, the face amount of debt issued is reported as another financing source, while principal payments are reported as expenditures. Property Taxes: Property taxes, based on assessed values at January 1, are levied and become due and payable on November 1st of each year. A 4% discount is allowed if the taxes are paid in November, with the discount declining by 1% each month thereafter. Taxes become delinquent on April 1st of each year, and tax certificates for the full amount of any unpaid taxes and assessments must be sold not later than June Ist of each year. No accrual for the property tax levy becoming due in November of 2024 is included in the accompanying financial statements, since such taxes are collected to finance expenditures of the subsequent period. Investment Income: Investment income is interest income received plus any realized and unrealized gains or losses on investments during the fiscal year. D-11 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) Fund Balance Policies: The focus of fund balance reporting is to clearly communicate the constraints imposed upon resources in governmental funds. The fund balance classifications indicate the level of constraints placed upon how resources can be spent and identify the sources of those constraints. The following five classifications: non -spendable, restricted, committed, assigned, and unassigned, serve to inform readers of the financial statements of the extent to which the Board is bound to honor constraints on the specific purposes for which resources in a fund can be spent. Fund balances of governmental type funds are classified as follows: Non -spendable — Include amounts that cannot be spent because they are either not in spendable form, or for legal or contractual reasons, must be kept intact. This classification includes inventory. Restricted — Include amounts that can be spent only for specific purposes because of constitutional provisions or enabling legislation, or because of constraints externally imposed by creditors, grantors, contributors or the laws or regulations of other governments. Committed — Include amounts that can be used only for the specific purposes determined by a formal action in the form of a resolution of the Board, the County's highest level of decision - making authority. Commitments may be changed or lifted only by the Board taking the same formal action that imposed the constraint originally. Assigned — Include amounts intended by the Board to be used for specific purposes determined by a formal action in the form of a resolution but are neither restricted nor committed. The Board's policy authorizes the County Administrator to assign fund balance based on intentions for use of fund balance communicated by the Board. Unassigned — The residual classification of the General Fund. Only the General Fund reports a positive unassigned fund balance. Other governmental funds might report a negative balance in this classification, as the result of overspending for specific purposes for which amounts had been restricted, committed, or assigned. Unassigned fund balance does not necessarily represent the amount of fund balance that can be appropriated. The Board has committed $10 million in the General Fund's disaster reserve funds to ensure adequate cash flow is available for post -disaster situations. The Board has defined unrestricted General Fund balance as the amount of fund balance that the Board has placed constraints on its use (committed or assigned fund balance) plus the fund balance that does not have any specific purpose identified for the use of those net resources (unassigned fund balance). The Board's policy on unrestricted general fund balance is to achieve and maintain an unrestricted General Fund balance equal to four months of budgeted expenditures. The Board considers a balance of less than four months to be a cause for concern, barring unusual or deliberate circumstances, and a balance of more than six months as excessive. Since this is a plan for accumulating resources rather than a limitation on how existing resources can be spent, the fund balance policy does not affect the classification of fund balance and is included in the unrestricted fund balance. D-12 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) The Board spends restricted amounts first, when both restricted and unrestricted fund balance is available, unless prohibited by legal documents, grant agreements or contracts. Additionally, the Board uses committed fund balance, followed by assigned fund balance and then unassigned fund balance when expenditures are incurred for purposes for which amounts in any of the unrestricted fund balance classifications could be used. The Board adopts an annual budget for the General Fund at their September meeting preceding the fiscal year end. All annual appropriations lapse at the fiscal year end. Mid -year and year-end amendments are made to the budget as necessary. The budget is prepared and controlled at the cost center level. The Board's budget for the General Fund is prepared under a budgetary basis and adjustments necessary to convert the results of operations to the modified accrual basis of accounting are made at year-end if necessary. Net Position: Net position in the proprietary fund financial statements is classified as net investment in capital assets, restricted, and unrestricted. Restricted net position of $6,317,100 indicates constraints on resources that are either externally imposed by creditors, grantors, contributors, or laws or regulations of other governments or imposed by law through state statute. New Accounting Pronouncements: Effective October 1, 2023, the Board adopted the provisions of GASB Statement No. 101, Compensated Absences. The objective of this Statement is to better meet the information needs of financial statement users by updating the recognition and measurement guidance for compensated absences. That objective is achieved by aligning the recognition and measurement guidance under a unified model and by amending certain previously required disclosures. Note 14 to the Board's financial statements provides information regarding the Board's compensated absences as of September 30, 2024. The following are new accounting pronouncements that have been issued but are not yet effective: GASB Statement No. 102, Certain Risk Disclosures - The State and local governments face a variety of risks that could negatively affect the level of service they provide or their ability to meet obligations as they come due. Although governments are required to disclose information about their exposure to some of those risks, essential information about other risks that are prevalent among state and local governments is not routinely disclosed because it is not explicitly required. The objective of this Statement is to provide users of government financial statements with essential information about risks related to a government's vulnerabilities due to certain concentrations or constraints. This Statement defines a concentration as a lack of diversity related to an aspect of a significant inflow of resources or outflow of resources. A constraint is a limitation imposed on a government by an external party or by formal action of the government's highest level of decision -making authority. Concentrations and constraints may limit a government's ability to acquire resources or control spending. The requirements of this Statement are effective for the County beginning with its year ending September 30, 2025. D-13 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 1 — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) GASB Statement No. 103, Financial Reporting Model Improvements - The requirements of GASB 103 should improve the effectiveness of the financial statements in communicating essential information to financial statement users. The new definition of nonoperating revenues and expenses, for example, will greatly reduce diversity in practice among governments and enable users to better evaluate the results from operations for proprietary funds. The replacing of extraordinary items and special items with unusual or infrequent items should provide more value to stakeholders as the definition of "unusual in nature" and "infrequent in occurrence" is consistent with GASB 62. Changes to management's discussion and analysis will benefit users through the avoidance of unnecessary duplication and "boilerplate" discussion and placing a greater emphasis on providing a detailed analysis of a government's financial activities. The requirements of this Statement are effective for the County beginning with its year ending September 30, 2026. GASB Statement No. 104, Disclosure of Certain Capital Assets - State and local governments are required to provide detailed information about capital assets in notes to financial statements. Statement No. 34, Basic Financial Statements and Management's Discussion and Analysis for State and Local Governments, requires certain information regarding capital assets to be presented by major class. The objective of this Statement is to provide users of government financial statements with essential information about certain types of capital assets. This Statement also requires additional disclosures for capital assets held for sale. A capital asset is a capital asset held for sale if (a) the government has decided to pursue the sale of the capital asset and (b) it is probable that the sale will be finalized within one year of the financial statement date. Governments should consider relevant factors to evaluate the likelihood of the capital asset being sold within the established time frame. This Statement requires that capital assets held for sale be evaluated each reporting period. The requirements of this Statement are effective for the County beginning with its year ending September 30, 2026. Management is in the process of determining what impact, if any, implementation of the above statements may have on the financial statements of the Board. NOTE 2 — CASH, CASH EQUIVALENTS, AND INVESTMENTS The Board maintains a cash and investment pool available for use by all funds except those whose cash and investments must be segregated due to bond covenants or other legal restrictions. As of September 30, 2024, the carrying value of the Board's deposits and investments, with their respective credit ratings and years to maturity, are as follows: Iilvestment Type Credit Rating VahPtion Measisement Method Vahr Less than 6 Moiid> 6 Moiid� to I Year I to 5 Over 5 Years Years Demand Deposits N/A N/A $ 116,799,387 $ 116,799,387 $ - $ - $ FL CLASS Investments AAAra Amortized Cost 45,536,607 45,536,607 - FL Fix dIncome Tnat&Terra Pooled AAAf/S1 Amortized Cost 83,814,177 83,814,177 - - Asset -Backed Secirity (ABS) Aaa Fair Vahr - Level 12,198,377 495,640 2,868,124 8,834,613 Corporate Note Al Fair Vahr - Level 19,441,364 6,273,896 2,485,405 10,682,063 Federal Agency Mortgage -Backed Seciuity (MBS) Aaa Fair Vahr - Level 6,200,057 - 776,568 5,423,489 U.S. Treasury Aaa Fair Vahr - Level 190,798,015 92,607,425 68,726,106 29,464,484 Totals $ 474,787,984 $ 345,527,132 $ 74,856,203 $ 54,404,649 $ - D-14 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 2 — CASH, CASH EQUIVALENTS, AND INVESTMENTS (continued) The Board categorizes its fair value measurements within the fair value hierarchy established by GAAP. The hierarchy is based on the valuation inputs used to measure the fair value of the asset. Level 1 inputs are unadjusted quoted prices in active markets for identical assets. Level 2 inputs are either directly or indirectly observable for an asset (including quoted prices for similar assets), which may include inputs in markets that are not considered active. Level 3 inputs securities are significant unobservable inputs. Securities classified in Level 2 are evaluated prices from the custodian bank's primary external pricing vendors. The pricing methodology involves the use of evaluation models such as matrix pricing which is based on the securities' relationship to benchmark quoted prices. Other evaluation models use actual trade data, collateral attributes, broker bids, new issue pricings and other observable market information. There are no restrictions or limitations on withdrawals; however, FLCLASS may, on the occurrence of an event that has a material impact on liquidity or operations, impose restrictions on withdrawals for up to 48 hours. Credit Risk and Concentration of Credit Risk — The Board approved and adopted its Investment Policy (Policy) in January 2019. The Policy outlines permitted investments, and establishes limitations on portfolio composition, by both investment type and by issuer, to control concentration of credit risk. The following table identifies the investment requirements and allocation limits on security types, issuers, and maturities as established by the County. Under the Policy, the Clerk has the option to further restrict investment percentages from time to time based on market conditions, risk, and diversification strategies. The percentage allocation requirements for investment types and issuers are calculated based on the original cost at the time of purchase of each investment. Portfolio Per Issuer Investment Maximum Maximum Minimum Ratings Maximum Type (%) (%) Requirement' Maturity U.S. Treasury 100% 100% N/A 5.50 Years (5.50 Years avg. life' GNMA 40% Other U.S. Government Guaranteed (e.g. AID, GTC) 10% for GNMA Federal Agency/GSE: FNMA, FHLMC, 40%1 FHLB, FFCBS 75% N/A 5.5 Years Federal Agency/GSE 10% other than those above Supranationals Highest ST or Highest LT Rating where U.S. is a shareholder 25% 10% Categories 5.5 Years and voting member (A-1/P-1, AAA/Aaa, orequivalent) Highest ST or Highest LT Rating orporates EC 50%1 5% Categories 5.5 Years (A-1/P-1, AAA/Aaa, orequivalent) D-15 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 2 — CASH, CASH EQUIVALENTS, AND INVESTMENTS (continued) Portfolio Per Issuer Investment Maximum Maximum Minimum Ratings Maximum Type % % Requirement' Maturity Highest ST or Three Highest Municipals 25% 5% LT Rating Categories 5.50 Years SP-1/MIG 1, A-/A3, orequivalent) Agency Mortgage -Backed 25% 40%3 N/A 5.50 Years Securities MBS Avg. Life' Asset -Backed Securities Highest ST or LT Rating 5.50 Years (ABS) 25% 5% (A-1+/P-1, AAA/Aaa, or Avg. Life' Avg equivalent) Non-Negotiable None, if fully Collateralized Bank Deposits o 50% collateralized None, if fully collateralized. 2 Years or Savings Accounts Commercial Paper (CP) 50%1 5% Highest ST Rating Category 270 Days (A-1/P-1, orequivalent) Bankers' Acceptances (BAs) 10%, 5% Highest ST Rating Category 180 Days A-1/P-1, orequivalent) Highest Fund Quality and Volatility Intergovernmental Pools 50% 25% Rating Categories by all NRSROs N/A (LGIPs) who rate the LGIP, AAAm/AAAf, S1, orequivalent) Counterparty (or if the counterparty is not rated by an NRSRO, then the Repurchase Agreements counterparty's parent) must be rated (Repo or RP) o 40 /0 20 /o in the Highest ST Rating Category 1 Year (A-1/P-1, or equivalent) If the counterparty is a Federal Reserve Bank, no rating is required Money Market Funds Highest Fund Rating by all (MMFs) o 50% o 25 /o NRSROs who rate the fund N/A AAAm/Aaa-mf, orequivalent) Florida Local Government Highest Fund Rating by all Surplus Funds Trust Funds 25% N/A NRSROs who rate the fund N/A Florida Prime AAAm/Aaa-mf, orequivalent) Notes: 'Rating by at least one SEC -registered Nationally Recognized Statistical Rating Organization (NRSRO), unless otherwise noted. ST=Short-term; LT=Long-terns. Maximum allocation to all corporate and bank credit instruments is 50% combined. 3Maximum exposure to any one Federal agency, including the combined holdings of Agency debt and Agency MBS, is 40% 'The maturity limit for MBS and ABS is based on the expected average life at time of settlement, measured using Bloomberg or other industry standard methods. 5Fedral National Mortgage Association (FNMA); Federal Home Loan Mortgage Corporation (FHLMC); Federal Home Loan Bank or its District banks (FHLB; Federal Farm Credit Bank (FFCB). D-16 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 2 — CASH, CASH EQUIVALENTS, AND INVESTMENTS (continued) At September 30, 2024, 1.73 percent of the Board's investment portfolio was invested in Federal instrumentalities in the form of Federal Agency Mortgage -Backed Securities (MBS). Custodial Credit Risk — The Policy requires bank deposits to be secured as provided by Chapter 280, Florida Statutes. This law requires local governments to deposit funds only in financial institutions designated as qualified public depositories by the Chief Financial Officer of the State of Florida. Demand and time deposits are fully insured by the Federal Deposit Insurance Corporation for the first $250,000 at each institution and the remaining balances are insured 100% by the State of Florida collateral pool, a multiple institution pool with the ability to assess its members for collateral shortfalls if a member institution fails. The Policy requires execution of a third -party custodial safekeeping agreement for all purchased securities and requires that securities be held in the Board's name. As of September 30, 2024, all of the Board's investments are held in a bank's trust department in the Board's name. Interest Rate Risk — The Policy limits the investment of three months of operating expenditures to 24 months. The Policy limits the investment of noncurrent operating funds to 5.50 years. Restricted Cash and Cash Equivalents — The Board has the following unrestricted and restricted cash and cash equivalents at September 30, 2024: Cash and Cash Equivalents Governmental Activities Governmental Funds Internal Service Funds Business -Type Activities Total Unrestricted Cash and Cash Equivalents Restricted Cash and Cash Equivalents Business -Type Activities Total Cash and Cash Equivalents D-17 Demand Deposits $ 76,626,431 3,218,359 8,812,891 88,657,681 28,141,706 $116,799,387 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 3 — RESTRICTED ASSETS Restricted assets in the Enterprise Funds include those assets created by resolutions adopted by the Board for the Airport's unspent bond proceeds, passenger facility charges, and customs service operations. Total restricted assets as of September 30, 2024 are as follows: Cash and Cash Equivalents Key West Airport Passenger Facility Charges $ 6,145,647 Key West Airport Unspent Bond Proceeds 21,824,606 Marathon Airport Customs Service Operations 171,453 Total Restricted Assets $28,141,706 NOTE 4 — ACCOUNTS RECEIVABLE Accounts receivable, in the accompanying fund financial statements, are shown net of the allowance for doubtful accounts. The accounts receivable and the allowance balances are as follows: Governmental Funds: General Fund Fine & Forfeiture Fund Governmental Grants TDC Admin & Promo Two C ent Nonmajor Funds: Fire & Amb Dist 1 Fund Other Nonmajor Funds Internal Service Funds Total Governmental Funds Enterprise Funds: MSD-Waste Fund: Card Sound Bridge Key West Airport Marathon Airport Total Enterprise Funds Total Accounts Receivable Allowance for Accounts Uncollectible Service Provided Receivable Accounts Misc Air Amb Svc Misc Travel Advance $ 36,794 29,231,702 126,488 6,459 Ground Amb Svc 2,701,088 Misc 146,966 Misc 529,030 Accounts Receivable, Net $ (4,376) $ 32,418 (23,492,307) 5,739,395 (667) 125,821 - 6,459 (1,988,451) 712,637 (4,837) 142,129 (2,972) 526,058 32,778,527 (25,493,610) 7,284,917 Tipping Fees 768,665 Misc 500 Rent, Misc 1,386,140 Rent, Misc 157,412 2,312,717 $ 35,091,244 (23,354) 745,311 500 (391,171) 994,969 157,412 (414,525) 1,898,192 $ (25,908,135) $ 9,183,109 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 5 — ASSESSMENTS RECEIVABLE The County has been improving water quality by replacing cesspits and septic systems with a series of central wastewater collection and treatment systems. The Board has funded these projects with state grants and loans, local infrastructure sales surtax, and special assessments levied on the property owners. The property owners have the option of paying their special assessments up front or on an installment basis added to their real estate tax bills. Revenue is recognized on the modified accrual basis. Any remaining assessment owed is recorded as a receivable with an offset to deferred inflows of resources in the governmental funds for those amounts that are not available. NOTE 6 — MORTGAGES RECEIVABLE Mortgages receivable at September 30, 2024 consist of the following: Major Governmental Funds — Governmental Grants Fund: Second Mortgages Receivable from individuals, collateralized by personal residences. Payment of principal deferred for 10 years from date of note. Principal is amortized in equal monthly amounts starting in year 6 until 10 at which time the loan is fully forgiven. In event of sale/transfer of property or occupancy, the prorated principal balance is due in full within 30 days of sale/transfer or cessation of primary residence. Nonmajor Governmental Funds — Local Housing Assistance: Second Mortgages Receivable from individuals, collateralized by personal residences. Principal payments shall be deferred for the term of the first mortgage loan, or until the date the last payment is due on the first mortgage. Interest is not charged on the mortgages unless the mortgagor is in default, in which case the interest rate is 12% per annum from the date when payment of the second is due. The entire balance of the loan is intended to be forgiven. However, in the event the home is sold, transferred, rented, refinanced or the first mortgage loan is satisfied, the entire mortgage balance is due. Second Mortgages Receivable from individuals, collateralized by personal residences. The entire balance of the mortgages will be forgiven upon maturity, provided that the mortgagor complies with the mortgage covenants. The mortgages are interest free. Florida Homebuyer Opportunity Tax Credit, Second Mortgages Receivable from individuals, collateralized by personal residences. Interest is 6% per annum, except if paid in full within first 18 months of repayment period then interest rate shall be 0% from the date when the first payment is due. D-19 Mortgage Receivable $ 106,351 7,943,907 401,147 24,000 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 6 - MORTGAGES RECEIVABLE (continued) Second Mortgages Receivable from individuals, collateralized by personal residences. The entire balance of the mortgages will be forgiven upon maturity, provided that the mortgagor complies with the mortgage covenants. The mortgages are interest free. 137,008 Disaster Mitigation Loans that will be deferred for a period of ten years with a 0% interest rate. The entire balance of the mortgages will be forgiven at a rate of 20% per year upon maturity, provided that the mortgagor complies with the mortgage covenants. The mortgages are interest free. 1,476,471 Total Nonmajor Governmental Funds -Local Housing Assistance - Gross 9,982,533 Total Mortgages Receivable - Gross $10,088,884 The mortgages receivable associated with the governmental grants are offset by an allowance for uncollectible accounts of $106,351. As the mortgages receivable associated with the Local Housing Assistance fund are intended to ultimately be forgiven, an allowance for uncollectible accounts of $9,982,533 has been established. NOTE 7 - LEASES RECEIVABLE The Board, acting as lessor, has entered into lease agreements for its governmental funds for buildings and office space and for its enterprise funds involving airport facilities. For the governmental funds, the total lease receivable balance at September 30, 2024 is $3,424,926. For its enterprise funds, the total lease receivable at September 30, 2024 is $17,526,287. For the governmental funds, the total amount of inflows of resources, including lease revenue and interest revenue, recognized during FY 2024 was $391,374. Similarly, for its enterprise funds, the total amount of inflows of resources during FY 2024 was $4,794,066. Year Ending Governmental Fund - General Fund September 30 Principal Interest Total 2025 $ 171,214 $ 153,491 $ 324,705 2026 161,727 147,028 308,755 2027 172,505 140,430 312,935 2028 118,642 134,887 253,529 2029 70,780 130,634 201,414 2030-2034 386,052 604,032 990,084 2035-2039 494,391 505,069 999,460 2040-2044 548,783 382,973 931,756 2045-2049 659,920 240,080 900,000 Thereafter 640,912 64,089 705,001 Total $ 3,424,926 $ 2,502,713 $ 5,927,639 D-20 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 7 - LEASES RECEIVABLE (continued) Year Ending Business Type Activity - Key West Airport Business Type Activity - Marathon Airport September 30 Principal Interest Total Principal Interest Total 2025 $ 3,767,342 $ 507,886 $ 4,275,228 $ 322,972 $ 25,187 $ 348,159 2026 3,900,228 375,001 4,275,229 332,797 15,361 348,158 2027 4,037,825 237,403 4,275,228 120,691 7,188 127,879 2028 1,226,470 129,230 1,355,700 11,560 6,179 17,739 2029 269,260 113,264 382,524 11,929 5,810 17,739 2030-2034 1,213,707 413,865 1,627,572 65,299 23,394 88,693 2035-2039 948,551 251,449 1,200,000 46,955 14,880 61,835 2040-2044 1,101,916 98,084 1,200,000 54,018 7,362 61,380 2045-2049 79,503 498 80,001 15,264 578 15,842 Total $ 16,544,802 $ 2,126,680 $ 18,671,482 $ 981,485 $ 105,939 $ 1,087,424 In addition, the Board has entered into lease agreements with various aeronautical users for the use of hangar space, air cargo space, and aircraft aprons for its business -type activities. These leases are classified as regulated leases under GASB Statement No. 87, Leases, as they are subject to external regulations by the Federal Aviation Administration (FAA), which limits lease rates to a reasonable amount as determined by federal guidelines. The Board has applied the regulated lease provisions of GASB 87, which do not require recognition of a lease receivable and deferred inflow of resources for these arrangements. Instead, inflows of resources are recognized based on the payment provisions of the lease contracts (see also Note 22). As of September 30, 2024, the Board entered into 21 leases with multiple aeronautical users under exclusive and preferential user agreements. The agreements range in term from 5 to 30 years, with options to extend subject to FAA approval and mutual consent. For FY 2024, the County recognized total inflows from regulated leases of $10,085,360 consisting of $1,927,735 in base lease revenue and $8,157,625 in variable payments. The variable payments relate to payments for utilities, fuel flow, landing, and security fees, all of which are not included in the measurement of a lease receivable under standard GASB 87 provisions. These amounts are reported in the statement of revenues, expenses, and changes in net position. The following table presents the undiscounted cash flows expected to be received from regulated leases as of September 30, 2024 based on the fixed payment provisions in the lease contracts. Year Ending September 30 2025 2026 2027 2028 2029 2030-2034 2035-2039 2040-2044 2045-2049 Thereafter Total Amount $ 1,488,297 1,481,063 931,782 943,308 914,986 2,752,071 1,857,109 835,995 182,389 14,658 $ 11,401,658 Variable payments tied to regulated leases are excluded from the analysis due to their contingent nature and are recognized as revenue when earned. D-21 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 8 — CAPITAL ASSETS Amounts associated with the Board's governmental activities' capital assets, related accumulated depreciation and depreciation expense are reported on the government -wide financial statements of the County, rather than on the financial statements of the Board. Amounts associated with the Board's business -type activities' and internal service funds' capital assets, related accumulated depreciation and depreciation expense are reported on the proprietary fund financial statements of the Board. Internal service fund capital asset information is included in the governmental activities on the government -wide financial statements because the internal service funds predominately serve those activities. Capital asset activity for the year ended September 30, 2024 is shown in the following table: Governmental Activities: Capital assets not depreciated: Land Land Development Rights Construction in progress Total capital assets not depreciated Capital assets depreciated or amortized: Buildings Equipment Infrastructure Intangible Assets Total capital assets depreciated Right -to -use leased assets and SBITAs: Right -To -Use Leased Land Right -To -Use Leased Buildings Right -To -Use Leased Equip &SBITAs Total right -to -use leased assets amortized Less accumulated depreciation for: Buildings Equipment Infrastructure Intangible Assets Total accumulated depreciation Less accumulated amortization for Right - To -Use Leased Assets and SBITAs: Right -To -Use Leased Land Right -To -Use Leased Buildings Right -To -Use Leased Equip & SBITAs Total accumulated amortization Total accumulated depreciation and amortization Total capital assets depreciated/amortized, net Governmental activities, capital assets, net Beginning Additions/ Reductions/ Ending Balance Transfers Transfers Balance $ 105,789,293 1,806,167 38,206,754 145,802,214 231,371,334 42,089,356 160,674,724 7,984,393 442.119.807 36,572 5,209,077 556,484 5,802,133 (86,708,085) (31,222,067) (55,010,199) (2,957,593) (175,897,944) (16,880) (1,509,172) (220,347) (1,746,399) (177,644,343) 270,277,597 $ 416,079,811 D-22 $ 6,160,246 1,414,167 34,159,818 41,734,231 10,074,228 6,854,984 2,936,581 $ (9,278,229) (16,269,132) (25,547,361) (1,979, 897) 19,865,793 (1,979,897) (36,572) - (2,138,326) 664,849 (265,591) 664,849 (2,440,489) (5,017,582) (4,411,905) (5,847,196) ( 998,697) (16,275,3 80) (729,692) (248,3 80) (978,072) 64,702 1,873,427 1,938,129 16,880 660,211 140,380 817,471 $ 102,671,310 3,220,334 56,097,440 161,989,084 241,445,562 46,964,443 163,611,305 7,984,393 460,005,703 3,070,751 955,742 4,026,493 (91,660,965) (33,760,545) (60,857,395) (3,956,290) (190,235,195) (1,578,653) (328,347) (1,907,000) $(17,253,452) $ 2,755,600 (192,142,195) 271,890,001 $ 433,879,085 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 8 — CAPITAL ASSETS (continued) Business -Type Activities: Capital assets not depreciated: Land Construction in progress Total capital assets not depreciated Capital assets depreciated or amortized: Land improvements Buildings Equipment Infrastructure Right -to -use leased assets — equipment Total assets depreciated Less accumulated depreciation/ amortization for: Land Improvements Buildings Equipment Infrastructure Right -to -use leased assets — equipment Total accumulated depreciation or amortization Total capital assets depreciated/amortized, net Business -type activities, capital assets, net Beginning Additions/ Balance Transfers Reductions Ending Transfers Balance $ 15,404,257 $ - $ - $ 15,404,257 86,448,200 62,373,058 (1,738,282) 147,082,976 101,852,457 62,373,058 (1,738,282) 162,487,233 212,925 - - 212,925 83,713,193 1,385,887 - 85,099,080 8,352,665 1,203,660 (144,221) 9,412,104 84,796,759 - - 84,796,759 14,333 4,970 (14,333) 4,970 177,089,875 2,594,517 (158,554) 179,525,838 (212,925) - - (212,925) (26,907,716) (2,361,716) - (29,269,432) (5,734,329) (776,380) 130,875 (6,379,834) (38,075,308) (2,351,716) - (40,427,024) (5,938) (1,450) 5,938 (1,450) (70,936,216) $ (5,491,262) $ 136,813 (76,290,665) 106,153,659 103,235,173 $ 208,006,116 $ 265,722.406 Depreciation and amortization was charged to functions/programs on the government -wide statement of activities of the County as follows: Governmental Activities: General Government $ 5,433,519 Public Safety 3,557,624 Physical Environment 2,089,089 Transportation 3,323,105 Economic Environment 258,666 Human Services 248,673 Culture and Recreation 1,787,210 Court -Related 555,566 Total Governmental Activities $17,253,452 Business -Tune Activities: Municipal Service District -Waste Card Sound Bridge Key West Airport Marathon Airport Total Business -Type Activities D-23 $ 221,057 400,668 3,907,022 962,515 $5,491,262 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 9 — POST EMPLOYMENT BENEFITS OTHER THAN PENSION General Information about the Other Post -Employment Benefits: Plan Description — The Board administers a single -employer defined benefits healthcare plan (Plan). Section 112.0801, Florida Statutes, requires the County to provide retirees and their eligible dependents with the option to participate in the Plan if the County provides health insurance to its active employees and their eligible dependents. The Plan provides medical coverage, prescription drug benefits, and life insurance to both active and eligible retired employees. The Plan does not issue a publicly available financial report. No assets are accumulated in a trust that meets the criteria as set forth in GASB Statement No. 75. The Board may amend the plan design, with changes to the benefits, premiums and/or levels of participant contribution at any time. In an open session, on at least an annual basis and prior to the annual enrollment process, the Board approves the rates for the coming calendar year for the retiree and County contributions. The Plan includes participants from the Board and each Constitutional Officer. The Board is responsible for funding all obligations not funded on a pay-as-you-go basis by Constitutional Officers. However, the following disclosures are based on the Board's enterprise and internal service funds' share of the net Other Post -Employment Benefits (OPEB) obligation. Benefits Provided — Employees who retire as active participants in the Plan and were hired on or after October 1, 2001, may continue to participate in the Plan by paying the monthly premium established annually by the Board. Employees who retire as active participants in the Plan, were hired before October 1, 2001, have at least ten years of full-time service with the Board and meet the retirement criteria of the Florida Retirement System (FRS) but are not eligible for Medicare, may maintain group insurance benefits with the Board following retirement, provided that the retiring employee pays the retiree contributions based on their years of service with Monroe County. Pre -Medicare retirees with at least 25 years of service who satisfy the rule of 70 pay the FRS subsidy for coverage, which is $7.50 per year of service month with a maximum of $225 per month. For those with 10 or more years of service, the retirees will pay flat amounts based on their respective medical plan election as shown in the following table. Pre -Medicare Retiree Contribution Years of Service Traditional Health Plan High Deductible Health Plan 10-19 $517 $433 20-24 259 216 25+ FRS Subsidy 56 Retirees who have met the requirements for early retirement, have not achieved age 60 and whose age and years of service do not equal 70 (rule of 70) must pay the standard monthly premium until the age criteria or the rule of 70 is met. At that time, the retiree's cost of participation will be based on the preceding table. Surviving spouses and dependents of participating retirees may continue in the Plan if eligibility criteria specific to those classes are met. D-24 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 9 — POST EMPLOYMENT BENEFITS OTHER THAN PENSION (continued) An employee who retires as an active participant in the Plan, was hired prior to October 1, 2001, has at least ten years of full-time service with the County, and meets the retirement criteria of the FRS and is eligible for Medicare at the time of retirement or becomes eligible for Medicare following retirement, may maintain group health insurance benefits with the County following retirement, provided the retiring employee contributes the Actuarial Rate for Medicare retirees as determined by the actuarial firm engaged by the County, less a $250 per month County subsidy. Alternatively, retirees meeting these criteria may elect to leave the County health plan and receive a $250 per month payment from the County, payable for the lifetime of the retiree. Spouses and retirees who do not have at least ten years of service with the County or whose age at retirement plus years of service do not equal at least 70 must pay the full monthly premium for coverage. Employees Covered by Benefit Terms — Eligibility for post -employment participation in the Plan is limited to full-time employees of the County and the Constitutional Officers. At September 30, 2024, there were no terminated employees entitled to deferred benefits. The membership of the Board's medical plan consisted of: Active Employees 604 Retirees and Beneficiaries Currently Receiving Benefits 489 Total Membership 1,093 Contributions — The Board establishes, and may amend, the contribution requirements of Plan members. The required contribution is based on pay-as-you-go financing requirements, net of member contributions. Total OPEB Liability: The Board's enterprise and internal service funds total OPEB liabilities of $2,690,000 was measured as of September 30, 2024, and was determined by an actuarial evaluation issued on November 22, 2024. Actuarial Methods and Assumptions — The valuation as of September 30, 2024, issued on November 22, 2024, was prepared using generally accepted actuarial principles and practices, and relied on unaudited census data and medical claims data reported by the Board. The total OPEB liability for the Board's enterprise and internal service funds in the November 22, 2024 actuarial valuation was determined using the following actuarial assumptions and other inputs, applied to all periods included in the measurement, unless otherwise specified: D-25 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 9 — POST EMPLOYMENT BENEFITS OTHER THAN PENSION (continued) Actuarial Cost Method Entry Age Normal based on level of percentage of projected salary. Salary Increase Rate 3.0% per annum Discount Rate 4.09% per annum (Beginning of Year) 3.81 % per annum (End of Year) Source: Bond Buyer 20-Bond GO index Marriage Rate The assumed percentage of married participants at retirement is 25% and is based on the current retired population of the Board. Spouse Age Spouse dates of birth were provided by the County. Where this information was missing, male spouses were assumed to be three years older than female spouses. Medicare Eligibility All current and future retirees were assumed to be eligible for Medicare at age 65. Amortization Method Experience/Assumptions gains and losses were amortized over a closed period of 9.4 years starting on October 1, 2023, equal to the average remaining service of active and inactive plan members (who have no future service). Plan Participation Percentage The assumptions for participation of eligible retirees in the County's postemployment benefit plan are: Retirees with 25+ Years of Service: 100% Retirees with 20 — 24 Years of Service: 75% Retirees with 10 — 19 Years of Service: 50% The health care trend assumptions are used to project the cost of health care in future years. The actuarial assumptions include health care cost trend assumptions rates of 7.75% initially, reduced by decrements of 0.30% for ten years and 0.10% thereafter to an ultimate rate of 4.0%. The assumptions included a discount rate tied to the return expected on the funds used to pay the benefits, and assumes for an unfunded plan, that the benefits continue to be funded on a pay-as-you-go basis. Mortality rates were based on the Pub-2010 weighted base mortality table, projected generationally using Scale MP-2021, applied on a gender -specific and job class basis (teacher, safety, or general, as applicable). D-26 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 9 — POST EMPLOYMENT BENEFITS OTHER THAN PENSION (continued) Changes in the Total OPEB Liability For the Board's Enterprise and Internal Service Funds: Balance at the beginning of the year Changes for the year: Service cost Interest cost Changes of benefit terms Differences between expect and actual experiences Changes in assumptions or other inputs Benefit payments Net change in total OPEB liability Balance at the end of the year Total OPEB Liability 2,330,000 87,100 95,500 97,800 19,300 214,300 (154,000) 360,000 $ 2,690,000 Sensitivity of the Total OPEB Liability to Changes in the Discount Rate — The following presents the total OPEB liability of the Board's enterprise and internal service funds, as well as what the total OPEB liability for the Board's enterprise and internal service funds would be if it were calculated using a discount rate that is 1-percentage-point lower (2.81%) or 1-percentage-point higher (4.81%) than the current discount rate: Current Discount 1 % Decrease Rate 1 % Increase (2.81 %) (3.81 %) (4.81 %) Total OPEB Liability $2,989,100 $2,690,000 $2,436,400 Sensitivity of the Total OPEB Liability to Changes in the Healthcare Cost Trend Rates — The following presents the total OPEB liability of the Board's enterprise and internal service funds, as well as what the total OPEB liability would be for the Board's enterprise and internal service funds if it were calculated using a healthcare cost trend rates that are 1-percentage-point lower (6.75% decreasing to 3.0%) or 1- percentage-point higher (8.75% decreasing to 5.0%) than the current healthcare cost trend rates: Total OPEB Liability 1 % Decrease (6.75% decreasing to 3.0%) $2,554,800 Healthcare Cost Trend Rates Current Trend (7.75% decreasing to 4.0%) $2,690,000 D-27 1% Increase (8.75% decreasing to 5.0%) $2,855,600 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 9 — POST EMPLOYMENT BENEFITS OTHER THAN PENSION (continued) OPEB Expense and Deferred Outflows of Resources and Deferred Inflows of Resources Related to OPEB For the year ended September 30, 2024, the Board's enterprise and internal service funds recognized an OPEB expense of $546,100. At September 30, 2024, the Board's enterprise and internal service funds reported deferred outflows of resources and deferred inflows of resources related to the OPEB from the following sources: Changes of Assumptions or Other Inputs Deferred Deferred Outflows of Inflows of Resources Resources $ 532,000 $ (223,700) The amounts the Board's enterprise and internal service funds reported as deferred outflows of resources and deferred inflows of resources related to OPEB will be recognized in OPEB expense as follows: OPEB For Fiscal Year: Amount 2025 $ 32,300 2026 42,300 2027 46,900 2028 46,900 2029 46,600 Thereafter 93,300 Total $ 308,300 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS General Information: The Board's employees participate in FRS. As provided by Chapters 121 and 112, Florida Statutes, the FRS provides two cost sharing, multiple employer defined benefit plans administered by the Florida Department of Management Services, Division of Retirement, including the FRS Pension Plan (Pension Plan) and the Retiree Health Insurance Subsidy (HIS Plan). Under Section 121.4501, Florida Statutes, the FRS also provides a defined contribution plan (Investment Plan) alternative to the FRS Pension Plan, which is administered by the State Board of Administration (SBA). As a general rule membership in the FRS is compulsory for all employees working in a regularly established position for a state agency, county government, district school board, state university, community college, or a participating city or special district within the State of Florida. The FRS provides retirement and disability benefits, annual cost -of -living adjustments, and death benefits to plan members and beneficiaries. Benefits are established by Chapter 121, Florida Statutes, and Chapter 60S, Florida Administrative Code. Amendments to the law can be made only by an act of the Florida State Legislature. The State of Florida annually issues a publicly available financial report that includes financial statements and required supplementary information for the FRS. The latest available report may be obtained by writing to the State of Florida Division of Retirement, Department of Management Services, P.O. Box 9000, Tallahassee, Florida 32315-9000, or from the Web site: vww �fl1�� : iryflglida coni/wo�ki;c ce ..c er;:�t:iofl�s/ret:irenieti ublicatiotis. Pension Plan: Plan Description — The Pension Plan is a cost -sharing multiple -employer defined benefit pension plan, with a Deferred Retirement Option Program (DROP) for eligible employees. Benefits Provided — Benefits under the Pension Plan are computed on the basis of age, average final compensation, and service credit. For Pension Plan members enrolled before July 1, 2011, Regular class members who retire at or after age 62 with at least six years of credited service or 30 years of service regardless of age are entitled to a retirement benefit payable monthly for life, equal to 1.6% of their final average compensation based on the five highest years of salary, for each year of credited service. Vested members with less than 30 years of service may retire before age 62 and receive reduced retirement benefits. Special Risk Administrative Support class members who retire at or after age 55 with at least six years of credited service or 25 years of service regardless of age are entitled to a retirement benefit payable monthly for life, equal to 1.6% of their final average compensation based on the five highest years of salary, for each year of credited service. Special Risk class members (sworn law enforcement officers, firefighters, and correctional officers) who retire at or after age 55 with at least six years of credited service, or with 25 years of service regardless of age, are entitled to a retirement benefit payable monthly for life, equal to 3.0% of their final average compensation based on the five highest years of salary for each year of credited service. D-29 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) Senior Management Service class members who retire at or after age 62 with at least six years of credited service or 30 years of service regardless of age are entitled to a retirement benefit payable monthly for life, equal to 2.0% of their final average compensation based on the five highest years of salary for each year of credited service. Elected Officers' class members who retire at or after age 62 with at least six years of credited service or 30 years of service regardless of age are entitled to a retirement benefit payable monthly for life, equal to 3.0% (3.33% for judges and justices) of their final average compensation based on the five highest years of salary for each year of credited service. For Plan members enrolled on or after July 1, 2011, the vesting requirement is extended to eight years of credited service for all these members and increasing normal retirement to age 65 or 33 years of service regardless of age for Regular, Senior Management Service, and Elected Officers' class members, and to age 60 or 30 years of service regardless of age for Special Risk and Special Risk Administrative Support class members. Also, the final average compensation for all these members will be based on the eight highest years of salary. As provided in Section 121.101, Florida Statutes, if the member is initially enrolled in the Pension Plan before July 1, 2011, and all service credit was accrued before July 1, 2011, the annual cost - of -living adjustment is 3 % per year. If the member is initially enrolled before July 1, 2011, and has service credit on or after July 1, 2011, there is an individually calculated cost -of -living adjustment. The annual cost -of -living adjustment is a proportion of 3 % determined by dividing the sum of the pre -July 2011 service credit by the total service credit at retirement multiplied by 3%. Plan members initially enrolled on or after July 1, 2011, will not have a cost -of -living adjustment after retirement. In addition to the above benefits, the DROP program allows eligible members to defer receipt of monthly retirement benefit payments while continuing employment with a FRS employer for a period not to exceed 96 months after electing to participate. Deferred monthly benefits are held in the FRS Trust Fund and accrue interest. There are no required contributions by DROP participants. Contributions — Effective July 1, 2011, all enrolled members of the FRS, other than DROP participants, are required to contribute 3% of their salary to the FRS. In addition to member contributions, governmental employers are required to make contributions to the FRS based on state-wide contribution rates established by the Florida Legislature. These rates are updated as of July 1 of each year. The employer contribution rates by job class for the periods from October 1, 2023 through June 30, 2024 and from July 1, 2024 through September 30, 2024, respectively, were as follows: Regular13.57% and 13.63%; Special Risk Administrative Support 39.82% and 39.82%; Special Risk32.67% and 32.79%; Senior Management Service34.52% and 34.52%; Elected Officers'58.68% and 58.68%; and DROP participants21.13% and 21.13%. These employer contribution rates include 2.00% HIS Plan subsidy for the periods October 1, 2023, through September 30, 2024. D-30 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) The Board's contributions, including employee contributions, to the Pension Plan for its business -type activities, totaled $736,318 for the fiscal year ended September 30, 2024. Pension Liabilities, Pension Expense, and Deferred Outflows of Resources and Deferred Inflows of Resources Related to Pensions — The Board's governmental funds, which use the current resources measurement basis of accounting, generally recognize pension expense as amounts are paid. Pension liabilities are recognized at the fund level only to the extent expected to be liquidated with expendable available financial resources. Amounts associated with long-term pension liabilities and related deferred outflows of resources and deferred inflows of resources are reported on the government -wide financial statements of the County, rather than the financial statements of the Board. The Board's enterprise and internal service funds recognize pension liabilities, pension expense and deferred outflows of resources and deferred inflows of resources related to pensions on the accrual basis of accounting. At September 30, 2024, the Board's enterprise and internal service funds reported a liability of $6,994,350 for their proportionate share of the Pension Plan's net pension liability. The net pension liability was measured as of June 30, 2024, and the total pension liability used to calculate the net pension liability was determined by an actuarial valuation as of July 1, 2024. The Board's proportionate share of the net pension liability was based on the Board's FY 2024 contributions relative to the FY 2024 contributions of all participating members. At June 30, 2024, the Board's proportionate share for all funds was 0.13808%, which was an increase of 0.004341% from its proportionate share measured as of June 30, 2023. Approximately 13.09% of the Board's proportionate share of the net pension liability was allocated to the enterprise and internal service funds of the Board based on their proportionate share of the Board's Pension Plan contributions. For the fiscal year ended September 30, 2024, the Board's enterprise and internal service funds recognized pension benefit of $1,175,427. In addition, these activities reported deferred outflows of resources and deferred inflows of resources related to pensions from the following sources: Differences Between Expected and Actual Experience Changes of Assumptions Net Difference Between Projected and Actual Earnings on Pension Plan Investments Changes in Proportion and Differences Between Pension Plan Contributions and Proportionate Share of Contributions Pension Plan Contributions Subsequent to the Measurement Date Total D-31 FRS Pension Deferred Deferred Outflows of Inflows of Resources Resources $ 692,696 $ - 939,753 - - 455,723 503,434 147,995 242,807 - $ 2,378,690 $ 603,718 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) The Pension Plan's deferred outflows of resources related to the Board's enterprise and internal service funds contributions to the Pension Plan subsequent to the measurement date, totaling $242,807, will be recognized as a reduction of the net pension liability in the fiscal year ended September 30, 2025. Other amounts reported as deferred outflows of resources and deferred inflows of resources related to the Pension Plan will be recognized in pension expense of the enterprise and internal service funds as follows: For Fiscal Year 2025 2026 2027 2028 2029 Total FRS Amount $ (135,719) 1,474,383 107,481 5,084 80,936 $ 1,532,165 Actuarial Assumptions — The total pension liability in the July 1, 2024 actuarial valuation was determined using the following actuarial assumptions, applied to all periods included in the measurement: Inflation 2.40% Salary increases 3.50%, average, including inflation Investment rate of return 6.70%, net of pension plan investment expense, including inflation Mortality rates were based on the PUB2010 base table varies by member category and sex, projected generationally with Scale MP-2021 details in the valuation report. The actuarial assumptions used in the July 1, 2024, valuation were based on the results of an actuarial experience study for the period July 1, 2018 through June 30, 2023 and were the assumptions used to determine the total pension liability as of June 30, 2024. The long-term expected rate of return remained at 6.70%, and the active member mortality assumption was updated. The long-term expected rate of return on Pension Plan investments was not based on historical returns, but instead is based on a forward -looking capital market economic model. The allocation policy's description of each asset class was used to map the target allocation to the asset classes shown below. Each asset class assumption is based on a consistent set of underlying assumptions and includes an adjustment for the inflation assumption. The target allocation and best estimates of arithmetic and geometric real rates of return for each major asset class are summarized in the following table: D-32 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 - FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) Compound Annual Annual Target Arithmetic (Geometric) Standard Asset Class Allocation Return Return Deviation Cash 1.0% 3.3% 3.3% 1.1% Fixed Income 29.0% 5.7% 5.6% 3.9% Global Equity 45.0% 8.6% 7.0% 18.1% Real Estate (Property) 12.0% 8.1% 6.8% 16.6% Private Equity 11.0% 12.4% 8.8% 28.4% Strategic Investments 2.0% 6.6% 6.2% 8.7% Total 100.0% Assumed Inflation - Mean 2.4% 1.5% Discount Rate - The discount rate used to measure the total pension liability was 6.70%. The Pension Plan's fiduciary net position was projected to be available to make all projected future benefit payments of current active and inactive employees. Therefore, the discount rate for calculation of the total pension liability is equal to the long-term expected rate of return. Sensitivitv of the Board's Proportionate Share of the Net Position Liabilitv to Chanizes in the Discount Rate - The following represents the Board's enterprise and internal service funds proportionate share of the net pension liability calculated using the discount rate of 6.70%, as well as what the proportionate share of the net pension liability would be if it were calculated using a discount rate that is one percentage point lower (5.70%) or one percentage point higher (7.70%) than the current rate: FRS Net Pension Liability Current Discount 1 % Decrease Rate 1 % Increase (5.70%) (6.70%) (7.70%) Enterprise and Internal Service Funds Proportionate Share of the Net Pension Plan Liability $12,302,552 $ 6,994,350 $ 2,547,328 Pension Plan Fiduciary Net Position - Detailed information regarding the Pension Plan's fiduciary net position is available in the separately issued FRS Pension Plan and Other State -Administered Systems Annual Comprehensive Financial Report. D-33 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) HIS Plan: Plan Description — The HIS Plan is a cost -sharing multiple -employer defined benefit pension plan established under Section 112.363, Florida Statutes, and may be amended by the Florida legislature at any time. The benefit is a monthly payment to assist retirees of state -administered retirement systems in paying their health insurance costs and is administered by the Florida Department of Management Services, Division of Retirement. Benefits Provided — For the fiscal year ended September 30, 2024, eligible retirees and beneficiaries received a monthly HIS payment of $7.50 for each year of creditable service completed at the time of retirement, with a minimum HIS payment of $45 and a maximum HIS payment of $225 per month. To be eligible to receive these benefits, a retiree under a state -administered retirement system must provide proof of health insurance coverage, which may include Medicare. Contributions — The HIS Plan is funded by required contributions from FRS participating employers as set by the Florida Legislature. Employer contributions are a percentage of gross compensation for all active FRS members. For the fiscal year ended September 30, 2024, the HIS contribution for the period October 1, 2023 through June 30, 2024 and from July 1, 2024 through September 30, 2024 was 2.0% and 2.0%, respectively. The Board contributed 100% of its statutorily required contributions for the current and preceding three years. HIS Plan contributions are deposited in a separate trust fund from which payments are authorized. HIS Plan benefits are not guaranteed and are subject to annual legislative appropriation. In the event legislative appropriation or available funds fail to provide full subsidy benefits to all participants, benefits may be reduced or cancelled. The Board's contributions to the HIS Plan for its business -type activities totaled $108,470 for the fiscal year ended September 30, 2024. Pension Liabilities, Pension Expense, and Deferred Outflows of Resources and Deferred Inflows of Resources Related to Pensions — The basis of accounting and financial reporting of the Board's HIS Plan is identical to that of the Board's Pension Plan. At September 30, 2024, the Board's enterprise and internal service funds reported a liability of $2,857,174 for their proportionate share of the Board's HIS Plan's net pension liability. The net pension liability was measured as of June 30, 2024, and the total pension liability used to calculate the net pension liability was determined by an actuarial valuation as of July 1, 2024. The Board's proportionate share of the net pension liability was based on the Board's FY 2024 contributions relative to the FY 2024 contributions of all participating members. At June 30, 2024, the Board's proportionate share of all funds was 0.12667%, which was an decrease of 0.00048% from its proportionate share measured as of June 30, 2023. Approximately 15.04% of the Board's proportionate share of the net pension liability was allocated to the enterprise and internal service funds of the Board based on their proportionate share of the Board's HIS Plan contributions. D-34 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) For the fiscal year ended September 30, 2024, the Board's enterprise and internal service funds recognized HIS pension expense of $183,812. In addition, these activities reported deferred outflows of resources and deferred inflows of resources related to pensions from the following sources: Differences Between Expected and Actual Experience Changes of Assumptions Net Difference Between Projected and Actual Earnings on HIS Plan Investments Changes in Proportion and Differences Between HIS Plan Contributions and Proportionate Share of Contributions HIS Plan Contributions Subsequent to the Measurement Date Total HIS Pension Deferred Deferred Outflows of Inflows of Resources Resources $ 27,824 $ 5,531 50,999 341,149 - 1,043 210,376 67,067 38,915 - $ 328,114 $ 414,790 The deferred outflows of resources related to the HIS Plan resulting from the Board's enterprise and internal service funds contributions to the HIS Plan subsequent to the measurement date, totaling $38,915, will be recognized as a reduction of the net pension liability in the fiscal year ended September 30, 2025. Other amounts reported as deferred outflows of resources and deferred inflows of resources related to the HIS Plan will be recognized as pension expense in the enterprise and internal service funds as follows: HIS For Fiscal Year: Amount 2025 $ (20,375) 2026 (25,140) 2027 (36,622) 2028 (25,606) 2029 (13,952) Thereafter (3,896) Total $ (125,591) D-35 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) Actuarial Assumptions — The total pension liability in the July 1, 2024, actuarial valuation was determined using the following actuarial assumptions, applied to all periods included in the measurement: Inflation 2.40% Salary increases 3.50%, average, including inflation Municipal bond rate 3.93% Mortality rates were based on the Generational RP-2010 with Projection Scale MP-2021 tables. The actuarial assumptions used in the July 1, 2024, valuation were based on the results of an actuarial experience study for the period July 1, 2018 through June 30, 2023. The municipal rate used to determine total pension liability increased from 3.65% to 3.93%. Discount Rate — The discount rate used to measure the total pension liability was 3.93%. In general, the discount rate for calculating the total pension liability is equal to the single rate equivalent to discounting at the long-term expected rate of return for benefit payments prior to the projected depletion date. Because the HIS benefit is essentially funded on a pay-as-you-go basis, the depletion date is considered to be immediate, and the single equivalent discount rate is equal to the municipal bond rate selected by the HIS Plan sponsor. The Bond Buyer General Obligation 20-Bond Municipal Bond Index was adopted as the applicable municipal bond index. Sensitivitv of the Board's Proportionate Share of the Net Position Liabilitv to Chanizes in the Discount Rate — The following represents the Board's enterprise and internal service funds proportionate share of the net pension liability calculated using the discount rate of 3.93%, as well as what the proportionate share of the net pension liability would be if it were calculated using a discount rate that is 1-percentage point lower (2.93%) or 1-percentage point higher (4.93%) than the current rate: Enterprise and Internal Service Funds Proportionate Share of the Net HIS Plan Liability 1 % Decrease (2r.93 %) $ 3,252,527 D-36 HIS Net Pension Liability Current Discount Rate 1% Increase (3 93 % (4.93 %) $ 2,857,174 $ 2,528,970 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) Pension Plan Fiduciary Net Position — Detailed information regarding the HIS Plan's fiduciary net position is available in the separately issued FRS Pension Plan and Other State -Administered Systems Annual Comprehensive Financial Report. Investment Plan: The SBA administers the defined contribution plan officially titled the FRS Investment Plan. The Investment Plan is reported in the SBA's annual financial statements and in the State of Florida Annual Comprehensive Financial Report. As provided in Section 121.4501, Florida Statutes, eligible FRS members may elect to participate in the Investment Plan in lieu of the FRS defined benefit plan. County employees participating in DROP are not eligible to participate in the Investment Plan. Employer and employee contributions, including amounts contributed to individual member's accounts, are defined by law, but the ultimate benefit depends in part on the performance of investment funds. Benefit terms, including contribution requirements, for the Investment Plan are established and may be amended by the Florida Legislature. The Investment Plan is funded with the same employer and employee contribution rates that are based on salary and membership class (Regular Class, Elected County Officers, etc.), as the Pension Plan. Contributions are directed to individual member accounts, and the individual members allocate contributions and account balances among various approved investment choices. Costs of administering the Investment Plan, including the FRS Financial Guidance Program, are funded through an employer contribution of 0.04% and 0.06% of payroll and by forfeited benefits of plan members for the periods October 1, 2023 through June 30, 2024 and from July 1, 2024 through September 30, 2024, respectively. Allocations to the investment member's accounts during FY 2024, as established by Section 121.72, Florida Statutes, are based on a percentage of gross compensation, by class, as follows: Regular class 11.30%; Special Risk Administrative Support class 12.95%; Special Risk class 19.00%; Senior Management Service class 12.67%; and County Elected Officers class 16.34%. For all membership classes, employees are immediately vested in their own contributions and are vested after one year of service for employer contributions and investment earnings. If an accumulated benefit obligation for service credit originally earned under the Pension Plan is transferred to the Investment Plan, the member must have the years of service required for Pension Plan vesting (including the service credit represented by the transferred funds) to be vested for these funds and the earnings on the fiends. Non -vested employer contributions are placed in a suspense account for up to five years. If the employee returns to FRS -covered employment within the five-year period, the employee will regain control over their account. If the employee does not return within the five-year period, the employee will forfeit the accumulated account balance. For the fiscal year ended September 30, 2024, the information for the amount of forfeitures was unavailable from the SBA; however, management believes that these amounts, if any, would be immaterial to the Board. D-37 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 10 — FLORIDA RETIREMENT SYSTEM RETIREMENT PLANS (continued) After termination and applying to receive benefits, the member may rollover vested fiends to another qualified plan, structure a periodic payment under the Investment Plan, receive a lump stun distribution, leave the fiends invested for future distribution, or any combination of these options. Disability coverage is provided; the member may either transfer the account balance to the Pension Plan when approved for disability retirement to receive guaranteed lifetime monthly benefits under the Pension Plan or remain in the Investment Plan and rely upon that account balance for retirement income. The Board's Investment Plan pension expense for its business -type activities totaled $193,862 for the fiscal year ended September 30, 2024. NOTE 11 — PENSION PLAN FOR VOLUNTEER FIREFIGHTERS AND EMERGENCY MEDICAL SERVICES General Information about the Pension Plan: Plan Description — The Monroe County, Florida Volunteer Firefighter and Emergency Medical Services Length of Service Award Plan (LOSAP) is a single -employer public employee retirement system defined benefit pension plan created in 1999 and administered by the Board. LOSAP provides retirement and death benefits to plan members and beneficiaries. Monroe County Ordinance 026-1999 defines the authority under which contribution and benefit provisions may be amended. This authority is presently held by the Board. LOSAP shall be administered in accordance with the requirements of Chapter 112, Part VII, Florida Statutes. Amounts associated with the Board's LOSAP program are reported on the government -wide financial statements of the County, rather than on the financial statements of the Board. Benefits Provided — Only Volunteer Firefighters and EMS Volunteers (Volunteers) are eligible at the sole discretion of the Plan Administrator. Any Volunteer who was age 60 or older on January 1, 1999 shall not be eligible to participate. In addition, any Volunteers who are age 60 or older at the time they commence volunteer service, or who commence service at a time that will not permit them to earn ten years of service by their Normal Retirement Age, shall not be eligible to participate in this Plan. Volunteer Firefighters must attain the rank of Structural Firefighter, Non -Structural Firefighter and or Emergency Vehicle Driver -Operator prior to being credited with ten years of service. EMS Volunteers must meet all requirements as defined by the State of Florida necessary to drive an emergency medical care and transportation vehicle (ambulance) and/or attain certification as an Emergency Medical Technician or Paramedic prior to being credited with ten years of service. Eligibility for vesting is completion of ten years of service. The Plan shall be administered in accordance with the requirements of Chapter 112, Part VII, Florida Statutes. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 11 — PENSION PLAN FOR VOLUNTEER FIREFIGHTERS AND EMERGENCY MEDICAL SERVICES (continued) For each year of volunteer service, a participant will accrue a year of benefit accrual if the participant was enrolled as a member of the nonprofit corporation or municipal service taxing unit (MSTU) and was eligible for and received reimbursement of expenses for nine or more months of the year. Volunteers are vested after completion of ten years of service prior to attainment of normal retirement age. Eligible volunteers can receive an annual benefit of $1,800 for ten years of service up to $4,500 for 25 years of service. Employees Covered by Benefit Terms — LOSAP had 21 participants, of which 2 are active, 6 are terminated with deferred benefits, and 13 are retired members for the plan year ended December 31, 2023 and the County's fiscal year ending September 30, 2024. Separate, stand-alone financial statements for LOSAP are not provided. Contributions — Actuarially determined contribution rates are calculated as of January 1, which is nine months prior to the end of the fiscal year in which contributions are reported. For each Plan Year, the Board shall appropriate funds from the budgets of the various fire/rescue Municipal Service Taxing Units. These funds will be applied as a contribution to the LOSAP trust account in an amount as determined by the Plan Administrator as is necessary to fund the accrued or prospective benefits for Participants on an actuarially sound basis and in accordance with Part VII of Chapter 112, Florida Statutes. There are no participant contribution requirements. The authority under which those obligations are established is the Monroe County Ordinance No. 026-1999. Net Pension Liability: The Board's net pension liability was measured as of January 1, 2023 and the total pension liability used to calculate the net pension liability was determined by an actuarial valuation as of that date. Actuarial Assumptions — The actuarial assumptions used to compute the total pension liability, applied to all periods included in the measurement date were: Discount Rate: Funding — 3.80% GASB — 3.77% Inflation 2.5% Compensation Increases: 2.5% (required for entry age normal cost method); equal to inflation assumption, as prescribed by GASB No. 73, since benefits are not based on compensation 2023 Salary: $30,000 (the plan is not pay -related, so salary information was not provided by the County. The assumed pay is used for the entry age normal, level percent of pay cost method. D-39 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 11 — PENSION PLAN FOR VOLUNTEER FIREFIGHTERS AND EMERGENCY MEDICAL SERVICES (continued) Mortality: Male - Pub-2010 Headcount Weighted Below Median Safety Employee Mortality Tables, set forward one year, with fully generational projected mortality improvements using Scale MP-2018. Female — Pub-2010 Headcount Weighted Safety Employee Mortality Tables set forward one year, with fully generational projected mortality improvements using Scale MP-2018. Retirement: Ultimate rates from Godwin's Table 1, V Select & Ultimate Table Termination: Godwin's Table 1, V Select & Ultimate Table, w/50% termination probability for years of service <1 Benefit Commencement Age for Deferred Vested: Age 60 Administrative Expenses: $24,000 Funding Policy: The County's funding policy is to contribute at least the actuarially determined contribution, as mandated by ordinance. Summary of Significant Accounting Policies — The financial statements of LOSAP are prepared using the modified accrual basis of accounting. The contributions are recognized when they become susceptible to accrual; when they become both measurable and available. Benefits are recognized in the accounting period in which the related fund liability is incurred in accordance with the terms of LOSAP. Administrative costs are paid by the Board. Actuarial valuation costs are paid by LOSAP. All plan investments are reported at fair value. The resources in the LOSAP fund have been set aside to pay future obligations of the LOSAP but are not held in a trust that meets the criteria outlined in GASB Statement No. 67, paragraph 3 and GASB Statement No. 68, paragraph 4. Investments — Investments are pooled with all Board investments and are held in accordance to the investment policy included in Note 1. All plan investments consist of U.S. Government and U.S. Government -guaranteed obligations which represent more than 5.0% of the net position available for benefits. There are no investments in, loans to or leases with any public employee retirement system official, government employer official, party related to a public employee retirement system official or government employer official, nonemployee contributor or organization included in the reporting entity. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 11 — PENSION PLAN FOR VOLUNTEER FIREFIGHTERS AND EMERGENCY MEDICAL SERVICES (continued) Discount Rate — The discount rate was revised from 4.05% as of December 31, 2022, to 3.77% as of December 31, 2023, based on a 20-year, tax-exempt general obligation municipal bond index with a rating of AA/Aa or higher, as required by GASB Statement No. 73. The projection of cash flows used to determine the discount rate assumed that plan member contributions will be made at the applicable current contribution rates and that Board contribution will be made at rates equal to the difference between actuarially determined contributions and member contributions. Based on those assumptions, the fiduciary net position for the LOSAP pension plans was projected to be available to make all projected future benefit payments of current plan members. Therefore, the long-term expected rate of return on LOSAP's investments was applied to all periods of projected benefit payments to determine the total pension liability for each plan. Changes in Total LOSAP Pension Liability: Balance at September 30, 2023 Changes for the year: Service cost Interest cost Differences Between Expected and Actual Experience Changes of assumptions or other inputs Benefit payments Net change in total LOSAP pension liability Balance at September 30, 2024 Total LOSAP Pension Liability $ 352,370 1,527 13,647 (6,258) 4,764 (33,870) (20,190) $ 332,180 Sensitivity of the Net Pension Liability to Changes in the Discount Rate — The following presents the total pension liability of LOSAP, calculated using the discount rate of 3.77%, as well as what LOSAP's total pension liability would be if it were calculated using a discount rate of 1-percentage point lower (2.77%) or 1-percentage point higher (4.77%) than the current rate. 1 % Decrease (2r.77) Current Discount Rate (3.77) Net LOSAP Pension Liability $ 353,759 $ 332,180 D-41 1% Increase (4.77) $ 309,344 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 11 — PENSION PLAN FOR VOLUNTEER FIREFIGHTERS AND EMERGENCY MEDICAL SERVICES (continued) Pension Expense and Deferred Outflows of Resources and Deferred Inflows of Resources Related to Pensions: For the year ended September 30, 2024, the Board recognized pension expense of $33,870. At September 30, 2024, the Board reported deferred outflows of resources and deferred inflows of resources related to pensions from the following sources, which will be amortized in future periods on substantially a straight-line basis: Deferred Deferred Outflows of Inflows of Resources Resources Net Difference Between Projected and Actual Earnings on LOSAP Pension Plan Investments $ 17,064 $ - NOTE 12 — CAPITAL AND OTHER SIGNIFICANT COMMITMENTS Construction projects and significant commitments, excluding encumbrances reported below, under present contractual agreements as of September 30, 2024 are as follows: Key West Airport Concourse A Terminal $ 55,134,909 Key West Airport Apron and Mitigation 21,379,462 Twin Lakes Flood Mitigation 20,490,203 Sugarloaf Volunteer Fire Department 9,013,582 Key West Airport Taxiway Extension and Mitigation 8,025,475 Customs and Border Protection Facility 5,479,650 Harbour Drive Bridge 4,665,475 Seaview Bridge Replacement 3,401,421 Key West Airport Outbound Baggage Handling System 2,357,098 Key Largo III Roadway 1,972,207 Old Marathon Tax Collector Seawall 1,272,000 Sea Level Rise Project 1,106,075 Non -Aeronautical Building/Emergency Operations Center 1,088,908 Key West Airport Noise Improvement Project 996,027 Stillwright Point Road Elevation 921,964 Big Pine North of Watson Blvd Project 845,373 No Name key Bridge Repairs 726,317 Gato Building Spalling Repairs 725,333 Other Projects (less than $600,000) 5,617,823 Total $ 145,219,302 D-42 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 12 — CAPITAL AND OTHER SIGNIFICANT COMMITMENTS (continued) Significant encumbrance commitments at September 30, 2024 are as follows: Encumbrances Governmental Activities: General Fund $ 74,145 Fine & Forfeiture Fund 51,077 Governmental Grants Fund 4,806,164 One Cent Infrastructure Surtax 1,426,529 Nonmajor Governmental Funds 1,287,367 Total Governmental Activities 7,645,282 Business -Type Activities Municipal Service District Waste 1,436,245 Key West Airport 1,199,878 Marathon Airport 191,477 Total Business -Type Activities 2,827,600 Total Encumbrances $ 10,472,882 NOTE 13 — LEASE AND SBITA OBLIGATIONS The Board leases various office equipment that qualify as other than short-term leases under GASB Statement No. 87 and, therefore, have been recorded at the present value of the future minimum lease payments as of the date of their inception. The Board has also entered into noncancelable agreements that qualify as subscription -based information technology arrangements (SBITA) under GASB Statement No. 96 and, therefore, have been recorded at the present value of the future minimum SBITA payments as of the date of their inception. The Board has nine lease agreements and six SBITA for the year ending September 30, 2024. The future principal and interest payments as of September 30, 2024, were as follows: Year Ending September 30 2025 2026 2027 2028 2029 2030-2033 Totals Principal $ 784,610 592,169 152,218 94,979 100,620 193,129 $ 1,917,725 D-43 Interest $ 61,162 34,496 20,279 15,663 11,614 18,069 $ 161,283 Total $ 845,772 626,665 172,497 110,642 112,234 211,198 $ 2,079,008 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 14 — LONG-TERM DEBT Long-term debt activity for the year ended September 30, 2024, is as follows: Goven nnental kctivnies: Revenue Bonds Front Direct Bofrtnwings Rey°eanue Nctes From Direct Bcrrre,,vings Lease Purchase of Tmunna Star Helicopters Mayfield Agreement (K? 1VTD) Old 7 \Mile Bridge Restoration Sinking Fund . arced Comp. Absences Lease and SBITA Liabilities OB Liability Pension Liability - FRS & HIS Pensions Liability - LOS.4..t Total Governmental Activities Business -Type Activities: Revenue Bands Revenue Notes Accrued Crcnnp. Absences Lease and SBITA Liabilities OFEB Liability Pension Liability - FRS & HIS Total Business -Type activities Total Long-TP nn Debt C"utTeant Portion Beginnitig Ending of Long -terns Balances :additions payments Balances Liabilities S 15,645,000 S S 5,110,200 S 10,535„0 S 5,2.25,04C 124„569,537 7,766,511 116,303„375 7,958,666 53,0�00,000 3,010,202 49,99C„01010 2„875,0,00 4,625,000 2„125,000 2,,500,000 2„125,200 IC,314,314 355,666 9,953,645 355,666 6,251,593 5,109,652 4„285„198 7,076,077 1,415,216 4,166,297 542,125 2,793,199 1,915„22.3 782,109 30,336,000 5,384,400 300,402 35,4.10,000 - 65„891,.368 7,317,,574 8,277,693 64,931„249 352,370 19„939 40,128 332,180 S 315,151,829 S 13,373,719 S 34,063,795 S 299,461,752 S 2,0,736,657 S 42,459,929 S S S 42,,459,929 S - 10,0I0,00o I0,020,000 744,522 533,221 516,632 761,111 152,223 5,612 4,970 11,082 2,502 2,502 1,265,662 406„900 55,900 1,656.1100 7„594.,602 735.,326 944,788 7,488,140 52,112,665 11,693,417 1,428,,400 62,367,682 154.,725 S 367,264„494 S 30,057„136 S 35,492„195 S 361,829,434 S 20,391,352 The Board has outstanding revenue bonds and revenue notes from direct borrowings related to governmental activities totaling $127,338,375 at fiscal year-end. The Board has pledged non -ad valorem tax revenue to repay these borrowings. The Board cannot be compelled to use its ad valorem taxing power to repay the principal or interest of the revenue bonds or revenue notes and these obligations do not create any liens on Board property. Two of the Board's four Revenue Notes are direct borrowings from the State of Florida's Clean Water State Revolving Fund Construction Loan Program for the Board's wastewater projects. In the event of a default of either of these two notes, the Board has agreed to an accelerated repayment schedule or an increased financing rate on the unpaid principal as determined by the State. Amounts associated with the Board's governmental activities long-term liabilities are reported on the government -wide financial statements of the County rather than on the financial statements of the Board. Amounts associated with the Board's business -type activities and internal service funds long- term liabilities are reported on the proprietary fund financial statements of the Board. Internal service fund long-term debt information is included in the governmental activities on the government -wide financial statements, because the internal service funds predominately serve those activities. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 14 — LONG-TERM DEBT (continued) Governmental activities' compensated absences are liquidated by the funds to which the employee services are related. The Group Insurance Internal Service Fund assesses a monthly premium per employee in each fund. The monthly premiums paid by the various funds provide the resources necessary to liquidate the other postemployment benefit obligations paid in the current year by the Group Insurance Internal Service Fund. The following summary reflects the Board's bonds and notes as of September 30, 2024: Governmental Activities Revenue Bonds From Direct Borrowings: Infrastructure Sales Surtax Refunding Bond, Series 2016 Revenue Notes From Direct Borrowings $ 10,535,000 Clean Water State Revolving Fund Construction Loan Agreement 2010 3,462,820 Clean Water State Revolving Fund Construction Loan Agreement 2014 112,435,555 Special Obligation Refunding Revenue Note, Series 2020 Project 905,000 Total Revenue Notes From Direct Borrowings 116,803,375 Lease Purchase Trauma Star Helicopters 49,990,000 Mayfield Agreement — Key Largo Wastewater Treatment District 2,500,000 Old 7 Mile Bridge Restoration Sinking Fund 9,958,648 Total Government Debt $ 189,787,023 Business -Type Activities Revenue Bonds: Key West International Airport Revenue Bonds, Series 2022 $ 41,340,000 Unamortized Original Issue Premium, Series 2022 1,119,929 Total Revenue Bonds 42,459,929 Revenue Notes: PNC Line of Credit Taxable Master Airport Revenue Note 10,000,000 Total Business -Type Activities Debt $ 52,459,929 D-45 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 14 — LONG-TERM DEBT (continued) Debt Service Funding Requirements — The total annual debt service requirements for bonds and notes outstanding at September 30, 2024 are as follows: Governmental Activities Business -Type Activities Prhicipal interest Total Principal Interest Total 2025 18,539,332 4,825,063 23,364,39.5 2,589,689 2,589,689 2026 16,001,366 4,445,979 20,447,345 9,230,000 2,575,975 10,805,975 2027 10,978,412 4,067,403 15,045,815 2,855,000 2,168,850 5,023,850 2028 11„275,606 3,770,318 15,045„924 505,000 2,024,225 2,529,225 2029 11,458,083 3,464„689 14„922,772 530,000 1,998,350 2,528,350 2030-2034 58,942,466 1.2,593,364 71,535,830 4,840,0 ,0 9,344,250 14,184,250 2035-2039 57,968,100 4,030,024 61,998,124 6,185,000 7,972,375 14,157„375 2040-2044 1,778,330 - 1„778,330 7,895,000 6,218,456 14,113,456 2045-2049 1,778,330 1,778,330 10,150,000 3,899,294 14,049,294 2050-2054 1,066,998 1,066„998 10„ 150, 000 1,045,750 11,195,750 Total Required Debt Service S 189,787,023 S 37,196,840 $ 226,983,863 $ Unarnortized original Issue Prernium on Series 2022 Bonds 1,119,929 S 52,459,929 Total Business Debt Senice 51,340,000 S 39,837,214 S 91,177,214 Long-term debt at September 30, 2024 is composed of the following issues: $19,500,540 Clean Water State Revolving Fund Construction Loan Agreement • Type: General Government Revenue Notes • Dated: April 2010 • Final maturity: Year 2030 • Principal payment date: March 15 and September 15 • Interest payment dates: March 15 and September 15 • Interest rate: 2.71 % • Amount outstanding at September 30th: $3,462,820 • Reserve requirement: None • Revenue pledged: Non -Ad Valorem Revenues in the General Fund, the Fine and Forfeiture Fund and the Unincorporated Area Service District Funds. The total principal and interest remaining to be paid is $3,750,660. For the fiscal year, principal and interest paid was $681,938 and total pledged revenue was $46,735,806. • Purpose: Refund temporary financing for wastewater capital improvements. • Call provisions: None • MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 14 — LONG-TERM DEBT (continued) Clean Water State Revolving Fund Construction Loan Agreement • The State awarded a total of $127,200,000 (original award plus seven amendment awards) for collection, transmission and treatment facilities under the State Revolving Fund loan program. • Interest rate: various interest rates (2.35% - 3.07%) as of September 30, 2024 • Final maturity: Year 2038 • Principal payment dates: June 15 and December 15 • Interest payment dates: June 15 and December 15 • Amount outstanding as of September 30th: $112,435,555 • Reserve requirement: None • Revenue pledged: One Cent Local Government Infrastructure Sales Surtax and Cudjoe Regional Wastewater special assessments. The total principal and interest remaining to be paid is $136,002,470. For the fiscal year, principal and interest paid was $9,379,481 and total pledged revenue was $37,263,526. • Purpose: Financing for wastewater capital improvements. • Call provisions: None $16,065,000 Infrastructure Sales Surtax Refunding Revenue Bond, Series 2016 • Type: General Government Refunding Revenue Bond • Dated: September 2016 • Final maturity: Year 2026 • Principal payment date: April 1 • Interest payment dates: April 1 and October 1 • Interest rate: 1.69% • Amount outstanding at September 30th: $10,535,000 • Reserve requirement: None; MBIA insured. • Revenue pledged: All of the One Cent Local Government Infrastructure Sales Surtax accruing to Monroe County. The total principal and interest remaining to be paid is $10,802,781. For the fiscal year, principal and interest paid was $1,118,290 and total pledged revenue was $35,005,681. • Purpose: To construct and acquire equipment and capital improvements. • Call provisions: None $17,000,000 Mayfield Interlocal Agreement • Type: Interlocal Agreement • Dated: May 2015 • Final maturity: Year 2026 • Principal payment date: April 1 • Interest payment dates: April 1 • Interest rate: N/A • Amount outstanding at September 30th: $2,500,000 D-47 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 14 — LONG-TERM DEBT (continued) $17,000,000 Mayfield Interlocal Agreement • Reserve requirement: None • Revenue pledged: One Cent Local Government Infrastructure Sales Surtax. The total principal remaining to be paid is $2,500,000. For the fiscal year, principal paid was $2,125,000 total pledged revenue was $35,005,681. • Purpose: Capital improvements with respect to Cudjoe Regional Wastewater Project • Call provisions: None • See Note 15 for additional information related to this agreement. Series 2020 Special Obligation Refunding Revenue Note • Final maturity: Year 2025 • Principal payment date: April 1 • Interest payment dates: April 1 and October 1 • Interest rate: 1.11 % • Amount outstanding at September 30th: $905,000 • Reserve requirement: None • Revenue pledged: Non -Ad Valorem Revenues in the General Fund, the Fine and Forfeiture Fund, the Unincorporated Area Service District Funds. The total principal and interest remaining to be paid is $915,046. For the fiscal year, principal and interest paid was $914,980, and total pledged revenue was $46,735,806. • Purpose: Acquisition, installation, and implementation of an Enterprise Resources Planning (ERP) system. • Call provisions: None Old 7 Mile Bridge Restoration Sinking Fund • Type: Sinking Fund to cover annual maintenance costs as stated in Resolution 060-2014 • Dated: November 2022 • Final maturity: Year 2051 • Principal payment date: Annual funding required to be paid by last day of November each year. • Interest payment dates: none • Interest rate: none • Amount outstanding at September 30th: $9,958,648 • Reserve requirement: None • Revenue pledged: Non -Ad Valorem Revenues in the General Fund, the Fine and Forfeiture Fund and the Unincorporated Area Service District Funds. The total remaining to be paid is $9,958,648. For the fiscal year, the amount set aside in the sinking fund was $355,666 and total pledged revenue was $46,735,806. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 14 — LONG-TERM DEBT (continued) Old 7 Mile Bridge Restoration Sinking Fund (continued) • Purpose: In 2017, the Board provided an initial $2.7 million for refurbishment to the Florida Department of Transportation. Once refurbishment of the bridge was completed in September 2022, the Board agreed to pay $355,666 annually for 30 years as fixed capital outlay to be paid in year 30 of the agreement with the Florida Department of Transportation. • Call provisions: None $53,000,000 Lease Purchase Financing of Trauma Star Helicopters • Final maturity: Year 2038 • Principal payment date: April 1 • Interest payment dates: April 1 and October 1 • Intere st rate: 3.2 5 9 1 % • Amount outstanding at September 30th: $49,990,000 • Reserve requirement: None • Revenue pledged: None. The rental payments are to be made only from legally available revenues appropriated on an annual basis. Should the required lease payments not be made as scheduled, the lease shall be deemed terminated and the County agrees to cease use of the helicopters and return them to the lessor. The total principal and interest remaining to be paid is $63,054,265. For the fiscal year, principal and interest paid was $4,507,013. • Purpose: Lease purchase of three Trauma Star helicopters. • Call provisions: None Series 2022 Monroe County, Florida Key West International Airport (Airport) Revenue Bonds • Final maturity: October 1, 2052 • Principal payment date: October 1 with first principal payment due October 1, 2025. • Interest payment dates: April 1 and October 1, with the first payment date being April 1, 2023. • Interest rate: 5.000% for maturities from October 1, 2025, through October 1, 2042; 5.250% interest rate apples to term bonds due on October 1, 2047; 5.000% applies to term bonds due on October 1, 2052. • Capitalized Interest Fund was established in the amount of $4,275,138, with one installment of $1,138,488 paid on April 1, 2023, and three more installments of $1,045,550 to be paid over each of the next three six-month periods. • Amount outstanding at September 30, 2024: $41,340,000. • Reserve requirement: Reserve Fund was established in the initial amount of $2,573,827. • Revenue pledged: Eligible PFC Revenues in accordance with the PFC regulation. • Purpose: Provide Key West Airport funding for the costs related to the Concourse A expansion proj ect. • Call provisions: Bonds maturing on or after October 1, 2033, may be redeemed at par at the option of the Board on or after October 1, 2032. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 14 — LONG-TERM DEBT (continued) PNC Line of Credit for Monroe County, Florida Taxable Master Airport Revenue Note Series 2022 • Final maturity: July 1, 2027 • Principal payment date: Principal of all draws are due and payable on the final maturity date. Minimum draw amounts are $100,000 and must be in denomination of $10,000. Principal amount shall be in an amount equal to not exceeding $10,000,000; Provided, however, the aggregate principal amount of draws that may be made against the Tax-exempt Master Note may not exceed $8,660,000, unless and until the public approval requirements are met to the Noteholder's satisfaction with respect to the issuance by the County of tax-exempt debt in excess thereof for the Project. • Interest payment dates: Payable quarterly in arrears on the first business day of January, April, July, and October of each year. • Non -Use Fee: Beginning January 1, 2023, when the total principal drawn is less than 100% of $10 million, Key West International Airport will be charged a non-use fee of 0.12% annual of the principal amount not yet drawn. Non-use fees paid in FY 2024 totaled $7,273. • Interest rate: The tax-exempt rate equals 79% of Term Secured Overnight Financing Rate (SOFR) plus 0.73% per annum. The taxable rate equals Term SOFR pls 0.79% per annum. • Amount outstanding at September 30, 2024: $10,000,000 • Reserve requirement: None • Revenue pledged: A Senior Lien will be placed on all Airport Improvement Program (AIP) Entitlement Grants for Fiscal Years 2026, 2027, and 2028; Federal Fiscal Year 2026 Bipartisan Infrastructure Law (BIL) Entitlement Grant; and any BIL Discretionary Grant received in fiscal years 2024, 2025, 2026, 2027, and 2028. The Airport cannot use these grant proceeds for any other purpose than to repay the PNC Line of Credit unless they obtain prior written consent from PNC. If there is not sufficient grant receipts to pay quarterly interest payments or to repay principal balances due, the expectation is that the Board will pay PNC from the Airport's net revenues or eligible PFC. However, paying PNC Line of Credit with net revenues or PFC is subordinate to repaying the Airport's revenue bonds. • Purpose: Acquire, construct and equip various capital improvements at the Airport in connection with the Concourse A Expansion. D-50 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 15 — INTERLOCAL AGREEMENT EXPENSE Administered by the Florida Department of Environmental Protection (FDEP), the Mayfield Grant is the result of the State of Florida authorizing up to $200 million in grant funding to assist the Keys' wastewater entities to complete central sewer and related projects. In May 2015, Monroe County and Key Largo Wastewater Treatment District (KLWTD) entered into an interlocal agreement (ILA) whereby KLWTD "assigned" its Mayfield grant allocation funding to Monroe County in exchange for the County repaying those funds over a 10-year period. As a result of the signed ILA in 2015 between Monroe County and KLWTD, FDEP sent Monroe County an amendment to the Mayfield Grant in FY 2014-15 to add the $17 million reallocated funds to the grant agreement between FDEP and Monroe County. The amendment: (1) provided the County an additional $17 million in Mayfield grant funding; (2) reallocated the project budget and; (3) extended the date of the completion of the project. Similarly, during the 2016 legislative session, the Florida Legislature appropriated $5 million for water quality projects under the Florida Keys Stewardship Act. Of the $5 million, $1.25 million was awarded to the KLWTD and they subsequently voted to have Monroe County use its 2016 allotment. In turn, FDEP sent Monroe County an amendment to the Mayfield Grant in FY 2016-17 to add the $1.25 million reallocated fund to the grant agreement between FDEP and Monroe County. Monroe County entered into the grant agreement with FDEP in FY 2016-17 and received the $1.25 million in FY 2017-18. The ILA created transactions with two separate parts 1) a grant between FDEP and Monroe County and 2) a long-term liability payable to KLWTD from Monroe County. For part one, Monroe County recorded grant revenue, which was a reimbursement for capital expenditures already incurred in the Cudjoe Regional Wastewater fund. For part two, the County recorded a long-term liability on the government -wide financial statements, which represents funding the County is obligated to pay KLWTD. The offset to this liability was an interlocal agreement expense which represents the value of Monroe County's "right" to receive the Mayfield Grant revenue forfeited by KLWTD. D-51 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 16 — INTERFUND TRANSFERS Interfund transfers at September 30, 2024 are as follows: Transfers to General Fund from: One Cent Infrastructure Surtax Fund $ 533,877 Tourist Development Admin & Promo Two Cent Fund 114,278 Municipal Service District — Waste 235,202 Card Sound Bridge Fund 79,776 Marathon Airport 137,385 Key West Airport 477,280 Internal Service Funds 860,159 Nonmajor Governmental Funds 2,661,797 Total Transfers to General Fund 5,099,754 Transfers to Governmental Grant Fund from: General Fund 870,636 One Cent Infrastructure Surtax Fund 2,341,004 Municipal Service District — Waste 1,212,459 Nonmajor Governmental Funds 124,784 Total Transfers to Governmental Grant Fund 4,548,883 Transfers to One Cent Infrastructure Surtax Fund from: Nonmajor Funds 113,414 Total Transfers to One Cent Infrastructure Fund 113,414 Transfers to Debt Service Fund from: One Cent Infrastructure Surtax Fund 22,095,935 Total Transfers to Debt Service Fund 22,095,935 Transfers to Nonmajor Funds from: Governmental Grant Fund 107,127 Other Nonmajor Funds 1,112,206 Total Transfers to Nonmajor Funds 1,219,333 Transfers to Fleet Management Internal Service Fund from: Key West Airport 328,000 Total Transfers to Internal Service Funds 328,000 Total Interfund Transfers $ 33,405,319 The One Cent Infrastructure Surtax Fund transferred $22,095,935 to the Debt Service Fund to repay the Board's Infrastructure Sales Surtax Improvement Series 2014 Revenue Bond, the Infrastructure Sales Surtax Series 2016 Revenue Bond, the Clean Water State Revolving Fund Construction Loans for both the Big Coppitt Wastewater Project and the Cudjoe Regional Wastewater Project, the debt related to the Mayfield Interlocal Agreement, and payment on the lease purchase of three Trauma Star helicopters. During FY 2024, Monroe County closed one capital project fund that was no longer in use. The fund balance of the closed fund was transferred to the One Cent Infrastructure Sales Surtax Fund. The total transferred was $113,414. Similarly, Monroe County moved fees collected for planning and conservation land purchase totaling $1,112,206 from its Miscellaneous Special Revenue Fund to its Land Acquisition Capital Project Fund. D-52 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 16 — INTERFUND TRANSFERS (continued) Transfers were made to the Governmental Grants Fund of $4,548,883 during the fiscal year. The General Fund transferred $794,358 to meet grant match requirements: $572,926 for Hurricane Irma; $24,000 for the Harry Harris Park Resilient Redesign grant project; $75,000 for the Natural Resources Adaption Plan grant; and $122,432 for Social Services -related grants. In addition, the General Fund transferred $76,278 to cover the cost of Social Services -related expenditures that were subsequently determined not to grant -eligible. The One Cent Infrastructure Surtax Fund transferred $2,341,004 to meet match requirements for various grant projects: $249,671 for the resurfacing of Card Sound Road; $1,351,536 for the Twin Lakes Subdivision mitigation project; $458,828 for the Stillwright Point Road elevation and stormwater design project; $132,911 for the Key Largo III road project; and $148,058 for other on -going mitigation projects. Funds were also transferred to the Governmental Grants Fund to meet match requirements. The Municipal Service District -Waste Fund transferred $1,212,459 for Hurricane Irma match. The Unincorporated Area Services District Planning/Building/Zoning Fund transferred $99,854 to the Governmental Grants Fund to fund county match requirements related to the long-range transportation planning grant. The Environmental Restoration Fund transferred $24,930 in match to the Governmental Grants Fund for the exotic plant removal grant. As required by its agreement with the State of Florida Division of Emergency Management, the County also transferred $107,127 during the fiscal year from the Governmental Grants Fund to the Tourist Development District One Fund to fund the sargassum clean-up program. In FY 2024, the County received an appraisal assessing the fair market value of the Fleet Management Fund's fuel point at $328,000 that was transferred to the Key West Airport. The remaining transfers are related to supporting the County's operations. NOTE 17 — INTERFUND BALANCES The General Fund loaned the Governmental Grant $10 million due to delayed timing of the receipt of grant funds related to canal management and Hurricane Irma. In addition, based on an appraisal received in FY 24, $328,000 was due from the Key West Airport to the Fleet Management Fund for a fuel point asset. Receivable Fund Payable Funds Amount General Fund Fleet Management Fund Total Governmental Grants Fund Key West Airport D-53 $10,000,000 328,000 $10,328,000 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 18 — GOVERNMENTAL FUND BALANCE CLASSIFICATIONS Fund Balances are presented in the following categories; non -spendable, restricted, committed, assigned and unassigned (see Note 1 for a description of these categories). A detailed schedule of governmental fund balances at September 30, 2024 is presented below: Fund Balance: Non -spendable: Prepaid Items $9,748 Total Non -spendable 9,748 Restricted for: Law Enforcement - Fire & Ambulance - Public Safety - Physical Environment - Transportation - Housing Programs - Tourist Development - Human Services - Library Donations - Culture & Recreation - Court Programs - Comprehensive Planning - Federal & State Grants - Other Purposes - Debt Service - Capital Projects - Total Restricted - Committed to: Disaster Recovery 10,000,000 Physical Environment - Beach Re -nourishment - Health Care - Total Committed 10,000,000 Assigned to: Other Purposes 74,145 Fire & Ambulance - Subsequent Year Expenditures (29,519) Total Assigned 44,626 Unassigned 37,869,332 Total Fund Balances $ 47,923,706 Tourist Development Admin & Fine & Governmental Promo Two Forfeiture Grants Cent - - 2,263 - - 2,263 28,627,700 - - - - 38,139,238 - 836,695 - $ 28,627,700 $ 836,695 $ 38,141,501 D-54 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 18 — GOVERNMENTAL FUND BALANCE CLASSIFICATIONS (continued) One Cent Debt Nonmajor Total Infrastructure Service Governmental Governmental Surtax Fund Funds Funds Fund Balance: Non -spendable: Inventory $ - $ - $ 3,835 $ 15,846 Total Non -spendable - - 3,835 15,846 Restricted for: Law Enforcement - - 8,045,556 36,673,256 Fire & Ambulance - - 1,292,965 1,292,965 Public Safety - - 5,680,793 5,680,793 Physical Environment - - 4,569,952 4,569,952 Transportation - - 8,484,933 8,484,933 Housing Programs - - 3,774,084 3,774,084 Tourist Development - - 94,875,766 133,015,004 Human Services - - 87,044 87,044 Library Donations - - 445,693 445,693 Culture & Recreation - - 21719,892 2,719,892 Court Programs - - 8,480,235 8,480,235 Comprehensive Planning - - 3,733,364 3,733,364 Federal & State Grants - - - 836,695 Other Purposes - - 1,215,131 1,215,131 Debt Service - 4,104,097 - 4,104,097 Capital Projects 78,903,033 - 278,462 79,181,495 Total Restricted 78,903,033 4,104,097 143,683,870 294,294,633 Committed to: Disaster Recovery - - - 10,000,000 Physical Environment - - 8,909,714 8,909,714 Beach Re -nourishment - - 245,509 245,509 Health Care - - 425,953 425,953 Total Committed - - 9,581,176 19,581,176 Assigned to Other Purposes - - - 74,145 Fire & Ambulance - - 8,679,015 8,679,015 Subsequent Year Expenditures - - - (29,519) Total Assigned - - 8,679,015 8,723,641 Unassigned - - - 37,869,332 Total Fund Balances $78,903,033 $ 4,104,097 $ 161,947,896 $ 360,484,628 D-55 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 19 — RISK MANAGEMENT The Board is exposed to various risks of loss related to tort; theft of, damage to, and destruction of assets; errors and omissions; injuries to employees; and natural disasters. During the fiscal years ended 1976, 1984, and 1988, the County established the Workers' Compensation, Group Insurance, and Risk Management Funds, respectively, as internal service funds to account for and finance its uninsured risks of loss. Under these programs, the Workers' Compensation has self -insured coverage up to the first $500,000 per claim for regular employees. Workers' Compensation claims in excess of the self -insured coverage of $500,000 are covered by an excess insurance policy. The Group Insurance Fund provides self -insured excess claims. Risk Management has a $5,000,000 excess insurance policy for general liability claims with a $200,000 self -insured retention and building property damage is covered for the actual value of the building with a deductible of $50,000. Deductibles for windstorm and flood vary by location. The Board purchases commercial insurance for claims in excess of coverage provided by the funds and for all other risks of loss. Settled claims have not exceeded this commercial coverage in any of the past three years. All funds of the Board participate in the programs and make payments to the Workers' Compensation, Group Insurance, and Risk Management Funds based on management's estimates of the amounts needed to pay prior and current year claims. The claims liabilities reported are based on the requirements of Governmental Accounting Standards Board Statement Nos. 10 and 62, which requires that a liability for claims be reported if information prior to the issuance of the financial statements indicates that it is probable that a liability has been incurred at the date of the financial statements and the amount of the loss can be reasonably estimated. These claim liabilities have not been discounted. Changes in the claim liability amounts in fiscal years 2024 and 2023 were: Unpaid Claims at Sept. 30, 2022 Incurred Claims (Including IBNR) Claim Payments Workers' Compensation $ 1,886,397 Group Insurance Risk Management Total 786,864 $ 1,744,780 $ 4,418,041 1,694,454 17,537,474 (1,273,615) 17,958,313 (1,384,951) (17,509,247) (244,370) (19,138,568) Unpaid Claims at Sept. 30, 2023 2,195,900 815,091 226,795 3,237,786 Incurred Claims (Including IBNR) 1,547,053 18,953,096 735,232 21,235,381 Claim Payments (1,688,037) (18,918,512) (311,833) (20,918,382) Unpaid Claims at Sept. 30, 2024 $ 2,054,916 $ 849,675 $ 650,194 $ 3,554,785 D-56 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 20 — LITIGATION AND CLAIMS The County is a defendant in various lawsuits and is involved in other disputes wherein substantial amounts are claimed. The County vigorously defends itself with respect to these matters. The County's practice is to provide for these claims when a loss is probable and a loss becomes fixed or determinable in amount. The County is involved in a handful of lawsuits. Most claims have been defeated to date, but three merit mention. The first claim, John Bemke et. al. vs. Monroe County, involves property owners in a gated community suing Monroe County for inverse condemnation due to the County's interpretation of its vacation rental ordinance that was subsequently challenged and overturned on appeal. The property owners are suing over lost vacation rental income, fines paid, and diminished property values for not being able to rent their properties short-term despite being able to rent the properties on a long-term basis, occupy the properties, and sell the properties. Monroe County assesses the claim as not only having a remote possibility of success but also as frivolous and will defend the claim vigorously. The second claim, Stacey Mitchell vs. 3406 North Roosevelt Blvd., Corp., Monroe County, et. al. is a whistleblower suit filed by the former executive director of the contracted firm to administer the County's Tourist Development Council. The Plaintiff's termination resulted from her refusal to participate in a critical audit. The claim seeks lost wages, reinstatement to her contracted position, attorney fees, and costs. Monroe County assesses the claim as having a remote possibility of success. The co-defendant which employed the Plaintiff has insurance coverage to cover the losses and the corporation is being represented independent from the County. The final claim, Galleon Bay vs. Monroe County and the State of Florida, involved the property owners suing the County and the State for inverse condemnation. After extended litigation, a final judgement was entered in favor of the property owner in the amount of $480,512, as of June 1, 2016, plus statutory post judgment interest. After the judgment was affirmed on appeal, the Board deposited $531,391 in the Court Registry to satisfy the judgment and the Clerk issued a Satisfaction of Judgment. The State of Florida subsequently reimbursed the County for its 50 percent share of the final judgement. On December 23, 2023, the Court issued an Order Approving Settlement and Release Agreement on Attorneys' Fees and Costs. On January 10, 2024, the Court ordered the Clerk to disburse the funds from the Court Registry. On October 25, 2024, the Property Owner filed a Motion to Correct Clerical Mistake and set aside the Satisfaction arguing that the Clerk had miscalculated the interest due when the County deposited $531,391 into the Court Registry. At the time of the filing, the Property Owner asserts that she is entitled to an additional $34,665 plus statutory interest from 2016. The County disputes this latest motion. In the opinion of the County, it is reasonably possible that there are other open suits and claims that could result in judgements or settlements, which, in aggregate, would have a material adverse effect on the Board's financial condition. Based on the uncertainty at this point of the proceedings, an estimate of the amount or range of potential losses cannot be determined. D-57 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 21 — COMMITMENTS AND CONTINGENCIES Grant Programs — The Board participates in a number of federal and state grant programs that are governed by various rules and regulations of the grantor agencies. Amounts received or receivable from grant agencies are subject to financial and compliance audits by the grantors or their representatives. Any disallowed claims, including amounts already collected, may constitute a liability of the applicable funds. The amount, if any, which may be disallowed by the grantor, cannot be determined at this time, although the Board expects such amounts, if any, to be immaterial. Impact Fee Refunds — Unexpended or unencumbered funds arising from the collection of impact fees may be refunded within one year following the end of the sixth year from the date on which the impact fee was paid or within three months of the non -commencement of construction, subject to certain conditions. NOTE 22 — RESTATEMENT During the year ended September 30, 2024, management discovered misstated leases related to regulated leases previously reported as leases receivable, interest receivable, and deferred inflow of resources that should not have been reported as such. In addition, management discovered minimum annual guaranteed concession fees were not recorded for three Marathon Airport car rental leases which impacted leases receivable, interest receivable, and deferred inflow of resources under GASB Statement No. 87. In accordance with GASB Statement No. 100, Accounting Changes and Error Corrections, the County restated the FY 2024 financial statements to correct the errors. Beginning net position, change in net position, and beginning balances for leases and interest receivables and deferred inflow of resources have been restated as follows: Net Position at October 1, 2023 Restatement Net Position at October 1, 2023, as restated Change in Net Position at October 1, 2023 Restatement Change in Net Position at October 1, 2023, as restated Short -Term Lease Receivable at October 1, 2023 Restatement Short -Term Lease Receivable at October 1, 2023, as restated Long -Term Lease Receivable at October 1, 2023 Restatement Long -Term Lease Receivable at October 1, 2023, as restated Interest Receivable at October 1, 2023 Restatement Interest Receivable at October 1, 2023, as restated Deferred Inflow of Resources -Leases at October 1, 2023 Restatement Deferred Inflow of Resources -Leases at October 1, 2023, as restated Key West Airport Fund $ 172,097,405 (99,524) $ 171,997,881 Marathon Airnort Fund $ 50,309,780 (113,114) $ 50,196,666 $ 37,898,393 $ 25,815,645 (99,524) (113,114) $ 37,798,869 $ 25,702,531 $ 4,032,383 $ 374,865 (385,803) (37,253) $ 3,646,580 $ 337,612 $ 19,317,091 $ 4,848,209 (2,767,531) (3,841,854) $ 16,549,560 $ 166,429 (29,747) $ 136,682 $ 23,066,256 (3,083,557) $ 19,982,699 $ 1,006,355 $ 24,045 (9,382) $ 14,663 $ 5,098,570 (3,775,375) $ 1,323,195 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS Notes To Financial Statements For the Year Ended September 30, 2024 NOTE 23 — SUBSEQUENT EVENTS In January 2025 several executive orders were signed by President Trump that could impact federal financial assistance. Federal agencies have been tasked with reviewing their federal programs to ensure they align with the President's policy priorities. The County receives various federal grants and payments that could be subject to the abovementioned executive orders. The County does not believe any loss of funding would be material to its financial statements, however the implication of these executive orders is not fully known at the date these financial statements were issued. Total federal funding as of September 30, 2024 was approximately $55,198,000. As of September 30, 2024, accounts receivable related to federal grants totaled approximately $12,300,000 and are recorded in the Governmental Grants fund. These receivables, due from the Department of Homeland Security for disaster recovery, remain outstanding as of April 10, 2025. D-59 This page is intentionally left blank. REQUIRED SUPPLEMENTARY INFORMATION (Unaudited) MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF THE BOARD'S PROPORTIONATE SHARE OF NET PENSION LIABILITY FLORIDA RETIREMENT SYSTEM PENSION PLAN LAST TEN FISCAL YEARS* 2024 2023 2022 Board's proportion of the net pension liability 0.138081728% 0.133741137% 0.119102640% Board's proportionate share of the net pension liability $ 53,417,658 $ 53,292,762 $ 44,316,905 Board's covered payroll $ 53,610,355 $ 50,500,089 $ 41,413,339 Board's proportionate share of the net pension liability as a percentage of its covered payroll 99.64% 105.53% 107.01 % Plan fiduciary net position as a percentage of the total pension liability 83.70% 82.38% 82.89% The amounts presented for each fiscal year were determined as of June 30. E-1 2021 2020 0.127201763% 0.127836047% $ 9,609,799 $ 55,407,179 $ 42,082,080 $ 40,912,184 22.84% 135.43% 96.40% 78.85% 2019 2018 0.122381778% 0.129013726% $ 42,146,581 $ 38,859,603 $ 36,840,027 $ 37,018,101 114.40% 104.97% 82.61 % 84.26% 2017 2016 0.110416195% 0.107471975% $ 32,660,370 $ 27,136,758 $ 31,567,083 $ 29,517,681 103.46% 91.93% 83.89% 84.88% 2015 0.103158114% $ 13,324,254 $ 28,496,269 46.76% 92.00% E-2 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF THE BOARD'S CONTRIBUTIONS FLORIDA RETIREMENT SYSTEM PENSION PLAN LAST TEN FISCAL YEARS* 2024 2023 2022 Contractually required contribution $ 8,026,314 $ 6,544,287 $ 5,499,309 Contributions in relation to the contractually required contributions (8,026,314) (6,544,287) (5,499,309) Contribution deficiency (excess) $ - $ - $ Board's covered payroll Contributions as a percentage of covered payroll $ 54,692,220 $ 50,133,219 $ 44,175,166 14.68% 13.05% 12.45% * The amounts presented for each fiscal year were determined as of September 30. E-3 2021 2020 2019 2018 2017 2016 2015 $ 4,755,272 $ 4,418,540 $ 3,552,282 $ 3,545,505 $ 3,169,065 $ 2,620,875 $ 2,515,082 (4,755,272) (4,418,540) (3,552,282) (3,545,505) (3,169,065) (2,620,875) (2,515,082) $ 31,198,127 $ 32,741,086 $ 30,285,349 $ 31,178,120 $ 26,245,139 $ 29,517,681 $ 29,097,726 15.24% 13.50% 11.73% 11.37% 12.07% 8.88% 8.64% E-4 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF THE BOARD'S PROPORTIONATE SHARE OF NET PENSION LIABILITY HEALTH INSURANCE SUBSIDY PROGRAM LAST TEN FISCAL YEARS* 2024 2023 2022 Board's proportion of the net pension liability 0.126670029% 0.127150648% 0.113535555% Board's proportionate share of the net pension liability $ 19,001,731 $ 20,193,219 $ 12,025,218 Board's covered payroll $ 53,610,355 $ 50,500,089 $ 41,413,339 Board's proportionate share of the net pension liability as a percentage of its covered payroll 35.44% 39.99% 29.04% Plan fiduciary net position as a percentage of the total pension liability 4.80% 4.12% 4.81% ` The amounts presented for each fiscal year were determined as of June 30. E-5 2021 2020 0.118822592% 0.117668137% $ 14,575,366 $ 14,367,077 $ 42,082,080 $ 40,912,184 34.64% 35.12% 3.56% 3.00% 2019 2018 0.110141787% 0.113326095% $ 12,323,764 $ 11,994,561 $ 36,840,027 $ 37,018,101 33.45% 32.40% 2.63% 2.15% 2017 2016 0.098952229% 0.095343347% $ 10,580,429 $ 11,111,872 $ 31,567,083 $ 29,517,681 33.52% 37.64% 1.64% 0.97% 2015 0.093902398% $ 9,576,567 $ 28,496,269 33.61 % 0.50% E-6 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF THE BOARD'S CONTRIBUTIONS HEALTH INSURANCE SUBSIDY PROGRAM LAST TEN FISCAL YEARS* 2024 2023 2022 Contractually required contribution $ 1,096,167 $ 868,274 $ 732,868 Contributions in relation to the contractually required contributions (1,096,167) (868,274) (732,868) Contribution deficiency (excess) $ - $ - $ Board's covered payroll Contributions as a percentage of covered payroll $ 54,692,220 $ 50,133,219 $ 44,175,166 2.00% 1.73% 1.66% ` The amounts presented for each fiscal year were determined as of September 30. E-7 2021 2020 2019 2018 2017 2016 2015 $ 672,957 $ 689,830 $ 621,670 $ 628,246 $ 435,699 $ 488,695 $ 358,953 (672,957) (689,830) (621,670) (628,246) (435,699) (488,695) (358,953) $ 31,198,127 $ 32,741,086 $ 30,285,349 $ 31,178,120 $ 26,245,139 $ 29,517,681 $ 29,097,726 2.16% 2.11% 2.05% 2.02% 1.66% 1.66% 1.23% E-8 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS REQUIRED SUPPLEMENTARY INFORMATION SCHEDULE OF CHANGES IN THE BOARD'S NET PENSION LIABILITY AND RELATED RATIOS PENSION PLAN FOR VOLUNTEER FIREFIGHTERS AND EMERGENCY MEDICAL SERVICES LAST TEN FISCAL YEARS* (Dollar amounts in thousands) 2024 2023 2022 Total pension liability Service cost Interest Differences between expected and actual experience Changes of assumptions or other inputs Benefit payments, including refunds of employee contributions Net change in total pension liability Total pension liability -beginning Total pension liability -ending Covered -employee payroll County's total pension liability as a percentage of covered payroll Notes to Schedule: $ 1,527 $ 2,772 $ 1,819 13,647 8,721 5,939 (6,258) (66,343) (65,332) 4,764 (46,344) (33,348) (33,870) (35,295) (24,570) (20,190) (136,489) (115,492) 352,370 488,859 604,351 $ 332,180 $ 352,370 $ 488,859 N/A N/A N/A N/A N/A N/A There are no assets accumulated in a trust, as defined by Statement of Governmental Accounting Standards No. 73, to pay benefits. E-9 2021 2020 2019 2018 2017 2016 2015 $ (24,610) $ (11,774) $ (6,170) $ 12,761 $ 22,937 $ 16,394 $ 16,455 6,890 8,130 8,724 9,146 9,146 8,895 8,054 (61,382) (50,828) (35,295) 182 (39,039) 33,108 89,397 (34,680) (30,945) (31,680) (32,265) (32,265) (28,365) (30,855) (113,782) (85,417) (64,421) (10,176) (39,221) 30,032 83,051 718,133 803,550 867,971 878,147 917,368 887,336 804,285 $ 604,351 $ 718,133 $ 803,550 $ 867,971 $ 878,147 $ 917,368 $ 887,336 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A E-10 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS REQUIRED SUPPLEMENTARY INFORMATION TEN YEAR SCHEDULE OF EMPLOYER CONTRIBUTIONS PENSION PLAN FOR VOLUNTEER FIREFIGHTERS AND EMERGENCY MEDICAL SERVICES Year Ending December 31, 2023 2022 2021 2020 Actuarially determined contribution $ - $ - $ - $ 3,265 Contributions in relation to the actuarially determined contribution 95,500 - - 3,265 Contribution deficiency (excess) $ (95,500) $ - $ - $ - Covered -employee payroll $ - $ - $ - $ - Contributions as a percentage of covered payroll N/A N/A N/A N/A Notes to Schedule: Actuarially determined contribution rates are calculated as of January 1, which is nine months prior to the end of the fiscal year in which contributions are reported. Contributions in relation to the actuarially determined contribution is the amount equal to the contributions to the plan during the plan year shown. The actuarial cost method used is the Aggregate Cost Method. The remaining amortization period used for 2023 is 3.564 years. This was determined by individual district using average future service for districts with active particpants and average remaining life expectancy for districts with only inactives. The asset valuation method used is the market value of assets held by Monroe County for the LOSAP program. There was no increase in inflation as benefits are based on a flat amount per year of service. Discount rate/investment rate of return was 3.60% for 2023, net of pension plan investment expenses, including inflation. Male: Pub-2010 Headcount Weighted Safety Below Median Employee Tables, set forward one year, with fully generational projected mortality improvements using Scale MP-2018. Female: Pub-2010 Headcount Weighted Safety Employee Tables, set forward one year, with fully generational projected mortality improvements using Scale MP-2018 The above funding assumptions are for the 2023 plan year. The 2022 plan year assumptions are those stated in the prior actuary's 2022 Actuarial Valuation Report. E-11 2019 2018 2017 2016 2015 2014 $ 5,200 $ 3,265 $ 61,388 $ 39,899 $ 39,899 $ 30,304 5,200 3,265 61,388 39,899 39,899 30,304 N/A N/A N/A N/A N/A N/A E-12 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS REQUIRED SUPPLEMENTARY INFORMATION SCHEDULE OF CHANGES IN THE BOARD'S TOTAL OPEB LIABILITY AND RELATED RATIOS LAST TEN FISCAL YEARS* Total OPEB liability Service cost Interest Changes of benefit terms Differences between expected and actual experience Changes in assumptions or other inputs Benefit payments Net change in total OPEB liability Total OPEB liability - Beginning of Year Total OPEB liability - End of Year Covered -employee payroll Total OPEB liability as a percentage of covered -employee payroll Notes to Schedule: 2024 2023 2022 2021 $ 993,000 $ 962,000 $ 3,291,000 $ 971,000 1,288,000 1,274,000 743,000 719,000 2,231,000 - 2,355,000 - 266,000 (414,000) - 2,953,000 (118,000) (4,260,000) 189,000 (2,296,900) (2,420,000) (2,091,000) (2,225,000) 5,434,100 (302,000) (376,000) (346,000) 31,641,900 31,943,900 32,319,900 32,665,900 $ 37,076,000 $ 31,641,900 $ 31,943,900 $ 32,319,900 $ 47,872,000 $ 45,115,000 $ 43,801,000 $ 36,493,000 77.45% 70.14% 72.93% 88.56% No assets are accumulated in a trust that meets the criteria in paragraph 4 of GASB Statement No. 75. Effective January 1, 2018, the County implemented cost -saving benefit changes for its other postemployment benefit plan. These included premium rates that are calculated based on expected retiree costs for Medicare retirees and lower premium subsidies for eligible retirees. During the fiscal year, the discount rate changed from 3.81% at the beginning of the year to 4.09% at the end of the year. Also during the year, the Plan's benefit terms changed resulting in a $6.7 million change to the plan's liability. *This schedule should present information for the last ten years. However, until a full ten years of information can be compiled, information will be presented for as many years as are available. E-13 2020 2019 2018 650,000 $ 496,958 $ 1,067,439 678,000 932,494 1,695,315 - - (17,266,329) 7,549,000 3,431,990 (1,964,239) (2,110,000) (1,549,168) (868,434) 6,767,000 3,312,274 (17,336,248) 25,898,900 22,586,638 39,922,886 $ 32,665,900 $ 25,898,912 $ 22,586,638 $ 35,430,000 $ 32,520,000 $ 31,420,000 92.20% 79.64% 71.89% E-14 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL ONE CENT INFRASTRUCTURE SURTAX CAPITAL PROJECT FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 32,119,391 $ 32,119,391 $ 32,599,393 $ 480,002 Licenses and Permits 2,785,400 2,785,400 1,689,195 (1,096,205) Investment Income 50,000 50,000 2,081,618 2,031,618 Miscellaneous - 149,100 441,321 292,221 Total Revenues 34,954,791 35,103,891 36,811,527 1,707,636 EXPENDITURES: Current: Capital Outlay: General Government 7,187,721 9,203,914 5,488,196 3,715,718 Public Safety 24,683,255 24,090,665 14,888,953 9,201,712 Physical Environment 866,126 866,125 283,608 582,517 Transportation: Const. Mgmt. 12,393,569 18,271,603 3,476,875 14,794,728 Economic Environment - 1,679,000 - 1,679,000 Culture and Recreation 1,981,030 2,086,840 41,515 2,045,325 Total Capital Outlay Expenditures 47,111,701 56,198,147 24,179,147 32,019,000 Debt Service: Principal - - 49,579 (49,579) Interest - - 20,765 (20,765) Total Debt Service - - 70,344 (70,344) Total Expenditures 47,111,701 56,198,147 24,249,491 31,948,656 Excess/Deficiency of Revenues Over (Under) Expenditures (12,156,910) (21,094,256) 12,562,036 33,656,292 Other Financing Sources (Uses): Reserve for Contingencies (1,000,000) (136,401) - 136,401 Reserve for Cash Balance (2,548,024) (2,548,024) - 2,548,024 Lease Financing - - 38,320 38,320 Debt Proceeds 13,306,800 13,306,800 - (13,306,800) Transfers from Other Funds 4,645,645 4,759,059 113,414 (4,645,645) Transfers from Constitutional Officers - - 5,233 5,233 Transfers to Other Funds (22,629,813) (22,656,520) (24,970,816) (2,314,296) Total Other Financing Sources (Uses) (8,225,392) (7,275,086) (24,813,849) (17,538,763) Net Change in Fund Balances (20,382,302) (28,369,342) (12,251,813) 16,117,529 Fund Balances -October 1 20,382,302 28,369,342 91,154,846 62,785,504 Fund Balances -September 30 $ - $ - $ 78,903,033 $ 78,903,033 F-1 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL DEBT SERVICE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Investment Income $ 15,000 $ 15,000 $ 572,585 $ 557,585 Total Revenues 15,000 15,000 572,585 557,585 EXPENDITURES: Current: Clean Water SRF Loans Principal 6,783,458 6,783,458 6,871,511 (88,053) Interest 3,278,024 3,278,024 3,189,908 88,116 Total Clean Water SRF Loan 10,061,482 10,061,482 10,061,419 63 2014 Revenue Bonds Principal 4,088,594 4,088,594 4,185,000 (96,406) Interest 195,172 195,172 98,766 96,406 Total 2014 Revenue Bonds 4,283,766 4,283,766 4,283,766 - Mayfield Loan Principal 2,125,000 2,125,000 2,125,000 Total Mayfield Loan 2,125,000 2,125,000 2,125,000 2016 Revenue Bonds Principal 910,001 910,001 925,000 (14,999) Interest 208,673 208,673 193,290 15,383 Total2016 Revenue Bonds 1,118,674 1,118,674 1,118,290 384 (Continued) F-2 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) DEBT SERVICE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget 2020 Revenue Note Principal 885,178 885,178 895,000 (9,822) Interest 29,804 29,804 19,980 9,824 Total 2020 Revenue Note 914,982 914,982 914,980 2 Trauma Star Helicopters Principal 3,010,001 3,010,001 3,010,000 Interest 1,497,013 1,497,013 1,497,013 Total Key West Airport Line of Credit 4,507,014 4,507,014 4,507,013 Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Transfers from Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 23,010,918 23,010,918 23,010,468 450 (22,995,918) (22,995,918) (22,437,883) 558,035 (500,000) (500,000) - 500,000 (500,000) (500,000) - 500,000 22,095,936 22,095,936 22,095,935 (1) 914,982 914,982 914,980 (2) 22,010,918 22,010,918 23,010,915 999,997 (985,000) (985,000) 573,032 1,558,032 985,000 985,000 3,531,065 2,546,065 $ 4,104,097 $ 4,104,097 F-3 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING BALANCE SHEET NONMAJOR GOVERNMENTAL FUNDS SEPTEMBER 30, 2024 ASSETS Cash and Cash Equivalents Investments Accounts Receivable, Net Due from Other Governmental Units Due from Constitutional Officers Mortgages/Notes Receivable Allowance for Mortgages/Notes Receivable Prepaid Items Interest Receivable Total Assets LIABILITIES AND FUND BALANCES Liabilities: Accounts Payable Retainage Payable Accrued Wages and Benefits Payable Due to Other Governmental Units Due to Constitutional Officers Deposits in Escrow Total Liabilities Fund Balances: Nonspendable Restricted Committed Assigned Total Fund Balances Total Liabilities and Fund Balances SPECIAL Tourist Affordable Middle Keys Development Housing Roads and Health Care All Districts Programs Bridges MSTU Two Cent $ 39,682 $ 573,009 $ 33,016 $ 2,117,045 405,311 6,723,495 337,224 21,623,534 - 22,747 - - - 668,173 - - - - 54,349 1,010,988 1,640 27,595 1,364 87,493 $ 446,633 $ 8,015,019 $ 425,953 $ 24,839,060 $ - $ 159 $ - $ 822,768 - 115,008 - - - 194,143 - - - 154,269 - - - 463,579 - 822,768 446,633 7,551,440 - 24,016,292 - - 425,953 - 446,633 7,551,440 425,953 24,016,292 $ 446,633 $ 8,015,019 $ 425,953 $ 24,839,060 G-1 REVENUE FUNDS Tourist Tourist Tourist Tourist Tourist Development Development Development Development Development Impact Fees, District One District Two District Three District Four District Five Roadways $ 2,900,687 $ 444,849 $ 1,225,470 $ 712,840 $ 912,564 $ 84,222 29,664,939 4,573,265 12,516,973 7,280,969 9,395,922 860,250 1,452,667 246,521 540,202 322,873 518,830 - 120,053 18,522 50,646 29,460 38,042 3,481 $ 34,138,346 $ 5,283,157 $ 14,333,291 $ 8,346,142 $ 10,865,358 $ 947,953 $ 824,820 $ 99,777 $ 201,865 $ 69,765 $ 310,589 $ - - - - - - 14,460 8,130 6,381 - - 14,086 - 325,898 - - - - - 1,158,848 106,158 201,865 69,765 324,675 14,460 32,733,989 5,176,999 14,131,426 8,276,377 10,540,683 933,493 245,509 - - - - - 32,979,498 5,176,999 14,131,426 8,276,377 10,540,683 933,493 $ 34,138,346 $ 5,283,157 $ 14,333,291 $ 8,346,142 $ 10,865,358 $ 947,953 (Continued) G-2 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING BALANCE SHEET (CONTINUED) NONMAJOR GOVERNMENTAL FUNDS SEPTEMBER 30, 2024 ASSETS Cash and Cash Equivalents Investments Accounts Receivable, Net Due from Other Governmental Units Due from Constitutional Officers Mortgages/Notes Receivable Allowance for Mortgages/Notes Receivable Prepaid Items Interest Receivable Total Assets LIABILITIES AND FUND BALANCES Liabilities: Accounts Payable Retainage Payable Accrued Wages and Benefits Payable Due to Other Governmental Units Due to Constitutional Officers Deposits in Escrow Total Liabilities Fund Balances: Nonspendable Restricted Committed Assigned Total Fund Balances Total Liabilities and Fund Balances SPECIAL Fire & Amb Impact Fees, District #1, Parks, and Impact Fees, Impact Fees, Lower and Recreation Solid Waste Fire & EMS Middle Keys $ 43,081 $ 12,810 $ 19,135 $ 854,710 440,030 130,844 195,447 7,425,481 - - - 712,637 - - - 285,014 1,780 529 791 36,501 $ 484,891 $ 144,183 $ 215,373 $ 9,314,343 $ 98,155 20,090 - - - - - - 535,914 - - - 1,259 20,090 - - 635,328 464,801 144,183 215,373 - - - - 8,679,015 464,801 144,183 215,373 8,679,015 $ 484,891 $ 144,183 $ 215,373 $ 9,314,343 G-3 REVENUE FUNDS Unincorp. Unincorp. Area Service Area Service 911 Duck Key Local District, Dist. Planning Municipal Enhancement Security Housing Parks & Rec. Bldg & Zoning Policing Fees District Assistance $ 164,736 $ 620,641 $ 229,837 $ 48,666 $ 36,297 $ 261,998 2,096,353 6,028,824 2,347,564 - 370,746 2,736,687 244 18,495 - - - 45,000 110,540 397,986 - 45,289 - - 53,165 11,197 742,932 - 548 - - - - - - 9,982,533 - - - - - (9,982,533) 3,325 - - - - - 8,703 25,751 9,499 - 1,500 11,095 $ 2,437,066 $ 7,102,894 $ 3,329,832 $ 93,955 $ 409,091 $ 3,054,780 $ 83,944 $ 54,726 $ - $ - $ 8,867 $ - 88,483 407,160 - - - 6,637 - 719 - - - 67 - - - 45,534 - - 5,713 273,109 - - - - 178,140 735,714 - 45,534 8,867 6,704 3,325 - - - - - 2,255,601 6,367,180 3,329,832 48,421 400,224 3,048,076 2,258,926 6,367,180 3,329,832 48,421 400,224 3,048,076 $ 2,437,066 $ 7,102,894 $ 3,329,832 $ 93,955 $ 409,091 $ 3,054,780 (Continued) G-4 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING BALANCE SHEET (CONTINUED) NONMAJOR GOVERNMENTAL FUNDS SEPTEMBER 30, 2024 SPECIAL Affordable Miscellaneous Housing Boating Special Environmental Initiatives Improvement Revenue Restoration ASSETS Cash and Cash Equivalents $ 24,821 $ 365,372 $ 413,320 $ 774,233 Investments 253,528 3,759,884 4,180,922 7,932,364 Accounts Receivable, Net - - 55,151 172 Due from Other Governmental Units - - 24,916 - Due from Constitutional Officers - 47,489 54,541 - Mortgages/Notes Receivable - - - - Allowance for Mortgages/Notes Receivable - - - - Prepaid Items - - - - Interest Receivable 1,026 15,229 16,917 32,210 Total Assets $ 279,375 $ 4,187,974 $ 4,745,767 $ 8,738,979 LIABILITIES AND FUND BALANCES Liabilities: Accounts Payable $ - $ 3,322 $ 102,046 $ 2,020 Retainage Payable - - - - Accrued Wages and Benefits Payable - 5,983 - 5,313 Due to Other Governmental Units - - - 118 Due to Constitutional Officers - - 26,333 - Deposits in Escrow - - - - Total Liabilities - 9,305 128,379 7,451 Fund Balances: Nonspendable - - - - Restricted 279,375 4,178,669 4,617,388 - Committed - - - 8,731,528 Assigned - - - - Total Fund Balances 279,375 4,178,669 4,617,388 8,731,528 Total Liabilities and Fund Balances $ 279,375 $ 4,187,974 $ 4,745,767 $ 8,738,979 G-5 REVENUE FUNDS Law Court Drug Canal Total Nonmajor Enforcement Facility Abuse Special Building Special Rev Trust Fees Trust Assessments Fund Funds $ 3,892,805 $ 500,720 $ 7,338 $ 16,017 $ 393,653 $ 17,723,574 771,359 5,164,431 74,947 163,594 3,658,741 141,113,628 - - - - 320 854,766 - - - - - 1,246,904 18 47,073 4,456 1,596 - 5,394,459 - - - - - 9,982,533 - - - - - (9,982,533) - - - - 510 3,835 3,121 20,911 303 662 15,423 580,247 $ 4,667,303 $ 5,733,135 $ 87,044 $ 181,869 $ 4,068,647 $ 166,917,413 $ - $ 135 $ - $ 3,683 $ 14,886 $ 2,701,527 - - - - - 149,558 - 11,371 - - 242,520 1,526,121 - - - - 29,644 511,974 - - - - - 71,867 - - - - 8,110 286,932 - 11,506 - 3,683 295,160 5,247,979 - - - - 510 3,835 4,667,303 5,721,629 87,044 - 3,772,977 143,405,408 - - - 178,186 - 9,581,176 - - - - - 8,679,015 4,667,303 5,721,629 87,044 178,186 3,773,487 161,669,434 $ 4,667,303 $ 5,733,135 $ 87,044 $ 181,869 $ 4,068,647 $ 166,917,413 (Continued) G-6 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING BALANCE SHEET (CONTINUED) NONMAJOR GOVERNMENTAL FUNDS SEPTEMBER 30, 2024 ASSETS Cash and Cash Equivalents Investments Accounts Receivable, Net Due from Other Governmental Units Due from Constitutional Officers Mortgages/Notes Receivable Allowance for Mortgages/Notes Receivable Prepaid Items Interest Receivable Total Assets LIABILITIES AND FUND BALANCES Liabilities: Accounts Payable Retainage Payable Accrued Wages and Benefits Payable Due to Other Governmental Units Due to Constitutional Officers Deposits in Escrow Total Liabilities Fund Balances: Nonspendable Restricted Committed Assigned Total Fund Balances CAPITAL PROJECT FUNDS Total Clerk's Land Nonmajor Revenue Acquisition Governmental Note Fund Funds $ - $ 24,654 $ 17,748,228 - 251,814 141,365,442 - - 854,766 - 1,300 1,248,204 - - 5,394,459 - - 9,982,533 - - (9,982,533) - - 3,835 - 1,019 581,266 $ - $ 278,787 $ 167,196,200 $ - $ 325 $ 2,701,852 - - 149,558 - - 1,526,121 - - 511,974 - - 71,867 - - 286,932 - 325 5,248,304 - - 3,835 - 278,462 143,683,870 - - 9,581,176 - - 8,679,015 - 278,462 161,947,896 Total Liabilities and Fund Balances $ - $ 278,787 $ 167,196,200 G-7 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES NONMAJOR GOVERNMENTAL FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Revenues: Taxes Licenses and Permits Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues Expenditures: Current: General Government Public Safety Physical Environment Transportation Economic Environment Human Services Culture and Recreation Court Related Capital Outlay Debt Service: Principal Interest Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Transfers from Other Funds Transfers to Other Funds Lease & SBITA Financing Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 SPECIAL Tourist Affordable Middle Keys Development Housing Roads and Health Care All Districts Programs Bridges MSTU Two Cent $ - $ 3,310,276 $ 2,899,762 $ 10,003,105 - 4,103,202 - - - 4,681 - - 20,694 371,296 6,873 1,131,263 - 21,406 - - 20,694 7,810,861 2,906,635 11,134,368 - - 130,103 - - 7,210,783 - - - - - 9,420,013 - - 2,626,948 - - 9,260 - - - 740 - - - 7,220,783 2,757,051 9,420,013 20,694 590,078 149,584 1,714,355 - (408,919) - (72,713) - - 53,744 115,606 - (408,919) 53,744 42,893 20,694 181,159 203,328 1,757,248 425,939 7,370,281 222,625 22,259,044 $ 446,633 $ 7,551,440 $ 425,953 $ 24,016,292 G-8 REVENUE FUNDS Tourist Tourist Tourist Tourist Tourist Development Development Development Development Development Impact Fees, District One District Two District Three District Four District Five Roadways $ 14,471,184 $ 2,615,660 $ 5,626,859 $ 3,057,606 $ 4,960,195 $ - - - - - - 97,961 1,421,191 207,654 576,518 357,898 459,870 41,442 15,892,375 2,823,314 6,203,377 3,415,504 5,420,065 139,403 8,931,002 1,309,008 2,401,986 1,819,282 3,198,823 - 8,931,002 1,309,008 2,401,986 1,819,282 3,198,823 - 6,961,373 1,514,306 3,801,391 1,596,222 2,221,242 139,403 107,127 - - - - - (54,392) (14,975) (13,595) (13,002) (26,318) - 166,175 28,604 55,028 30,223 50,272 - 218,910 13,629 41,433 17,221 23,954 - 7,180,283 1,527,935 3,842,824 1,613,443 2,245,196 139,403 25,799,215 3,649,064 10,288,602 6,662,934 8,295,487 794,090 $ 32,979,498 $ 5,176,999 $ 14,131,426 $ 8,276,377 $ 10,540,683 $ 933,493 (Continued) G-9 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES (CONTINUED) NONMAJOR GOVERNMENTAL FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Revenues: Taxes Licenses and Permits Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues Expenditures: Current: General Government Public Safety Physical Environment Transportation Economic Environment Human Services Culture and Recreation Court Related Capital Outlay Debt Service: Principal Interest Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Transfers from Other Funds Transfers to Other Funds Lease & SBITA Financing Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 M:j;191 Fi11 Fire & Amb Impact Fees, District #1, Parks, and Impact Fees, Impact Fees, Lower and Recreation Solid Waste Fire and EMS Middle Keys $ 15,244,498 22,100 - 10,765 - - - - 140,574 - - - 1,234,380 34,398 6,568 9,810 789,715 - - - 339,080 56,498 6,568 20,575 17,748,247 - - - 682,941 - - - 14,815,118 469,143 - - - - - - 20,670 469,143 - - 15,518,729 (412,645) 6,568 20,575 2,229,518 - - - (1,173,110) - - - 41,627 - - - 282,165 - - - (849,318) (412,645) 6,568 20,575 1,380,200 877,446 137,615 194,798 7,298,815 $ 464,801 $ 144,183 $ 215,373 $ 8,679,015 G-10 Unincorp. Unincorp. Area Service Area Service 911 Duck Key Local District, Dist. Planning Municipal Enhancement Security Housing Parks & Rec. Bldg & Zoning Policing Fees District Assistance $ 3,441,096 $ 543,072 $ 6,079,508 $ - $ - $ - - 190 - - 120,608 - 1,624,630 5,175,735 - - - - 125,090 3,820,455 5,478,011 931,694 - - - 1,352,058 - - - - 177,378 332,414 181,773 4,346 20,472 149,708 347 1,004 - - - 629,596 5,368,541 11,224,928 11,739,292 936,040 141,080 779,304 - 4,532,242 273,275 - 1,000 - - 4,514,100 11,387,618 889,854 108,628 - - 1,113,683 - - - - - - - - - 1,240,201 4,579,202 - - - - - 12,598 12,080 - - - - - 773 - - - - 4,591,800 10,172,878 11,660,893 889,854 109,628 1,240,201 776,741 1,052,050 78,399 46,186 31,452 (460,897) (331,776) (99,854) (14,338) - - - 38,320 4,971 - - - - 52,750 11,197 742,200 - 523 - (240,706) (83,686) 727,862 - 523 - 536,035 968,364 806,261 46,186 31,975 (460,897) 1,722,891 5,398,816 2,523,571 2,235 368,249 3,508,973 $ 2,258,926 $ 6,367,180 $ 3,329,832 $ 48,421 $ 400,224 $ 3,048,076 (Continued) G-11 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES (CONTINUED) NONMAJOR GOVERNMENTAL FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Revenues: Taxes Licenses and Permits Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues Expenditures: Current: General Government Public Safety Physical Environment Transportation Economic Environment Human Services Culture and Recreation Court Related Capital Outlay Debt Service: Principal Interest Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Transfers from Other Funds Transfers to Other Funds Lease & SBITA Financing Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 SPECIAL Affordable Miscellaneous Housing Boating Special Environmental Initiatives Improvement Revenue Restoration 214,136 - 36,827 - - 98,000 - - - 798,245 1,041,078 - - - 309,958 1,019,223 6,270 182,062 227,278 409,736 - - 759,150 - 220,406 1,078,307 2,374,291 1,428,959 - - 341,880 - - 411,321 77,733 606,059 - - 198,301 - - - 144,194 - - - 185,866 4,668 - - 277,286 - - - 1,294 - - - 84 - - 411,321 1,226,638 610,727 220,406 666,986 1,147,653 818,232 - - (1,112,206) (24,930) - - (1,112,206) (24,930) 220,406 666,986 35,447 793,302 58,969 3,511,683 4,581,941 7,938,226 $ 279,375 $ 4,178,669 $ 4,617,388 $ 8,731,528 G-12 REVENUE FUNDS Law Court Drug Canal Total Nonmajor Enforcement Facility Abuse Special Building Special Rev Trust Fees Trust Assessments Fund Funds $ - $ - $ - $ 72,252,821 - - - 126,448 6,594,552 7,223,587 - - - - - 11,142,141 - 639,830 47,147 - 138,150 14,258,761 - - - - - 21681,239 250,084 258,737 3,226 8,216 216,095 7,862,985 72,241 - - - 22,924 1,845,748 322,325 898,567 50,373 134,664 6,971,721 117,267,282 5,619,561 95,825 - - - 6,180,034 38,333,057 - - - 25,857 - 21234,653 - - - - - 7,210,783 - - - - - 28,518,616 - - - - - 21771,142 - - - - - 5,238,879 - 356,729 - - - 634,015 - - - - 642 56,544 - - - - 36 1,633 95,825 356,729 - 25,857 6,180,712 90,618,883 226,500 541,838 50,373 108,807 791,009 26,648,399 - - - - - 107,127 - - - - (538,659) (3,898,787) - - - - - 84,918 6 - - 1,570 - 1,590,063 6 - - 1,570 (538,659) (2,116,679) 226,506 541,838 50,373 110,377 252,350 24,531,720 4,440,797 5,179,791 36,671 67,809 3,521,137 137,137,714 $ 4,667,303 $ 5,721,629 $ 87,044 $ 178,186 $ 3,773,487 $ 161,669,434 (Continued) G-13 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES (CONTINUED) NONMAJOR GOVERNMENTAL FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Revenues: Taxes Licenses and Permits Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues Expenditures: Current: General Government Public Safety Physical Environment Transportation Economic Environment Human Services Culture and Recreation Court Related Capital Outlay Debt Service: Principal Interest Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Ne1,III r 0:11.1•alx0rall ►IOR Total Clerk's Land Nonmajor Revenue Acquisition Governmental Note Fund Funds $ 72,252,821 - - 7,223,587 - 33,650 11,175,791 - - 14,258,761 - - 2,681,239 - 35,780 7,898,765 - - 1,845,748 - 69,430 117,336,712 - - 5,619,561 - - 38,333,057 - - 2,234,653 - - 7,210,783 - - 28,518,616 - - 2,771,142 - - 5,238,879 - - 634,015 - 1,874,579 1,874,579 - - 56,544 - - 1,633 - 1,874,579 92,493,462 - (1,805,149) 24,843,250 Transfers from Other Funds - 1,112,206 1,219,333 Transfers to Other Funds (113,414) - (4,012,201) Lease & SBITA Financing - - 84,918 Transfers from Constitutional Officers - - 1,590,063 Total Other Financing Sources (Uses) (113,414) 1,112,206 (1,117,887) Net Change in Fund Balances Fund Balances -October 1 (113,414) (692,943) 23,725,363 113,414 971,405 138,222,533 Fund Balances -September 30 $ - $ 278,462 $ 161,947,896 G-14 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL AFFORDABLE HOUSING PROGRAMS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Investment Income $ 3,000 $ 3,000 $ 20,694 $ 17,694 Total Revenues 3,000 3,000 20,694 17,694 EXPENDITURES: Current: Economic Environment: Affordable Housing Initiatives Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 290,000 290,000 - 290,000 290,000 290,000 - 290,000 (287,000) (287,000) 20,694 307,694 (12,850) (12,850) - 12,850 (15,000) (15,000) - 15,000 (27,850) (27,850) - 27,850 (314,850) (314,850) 20,694 335,544 314,850 314,850 425,939 111,089 $ 446,633 $ 446,633 G-15 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL ROAD AND BRIDGE SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Revenues: Taxes Intergovernmental Charges for Services Investment Income Miscellaneous Total Revenues Expenditures: Current: Transportation: Road Department County Engineer Road and Bridge Street Lighting Local Option Gas Tax Projects 80% Gas Tax Roadway Projects Sustainability Roads Total Transportation Debt Service: Principal Interest Total Debt Service Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Original Final Variance with Budget Budget Actual Final Budget $ 2,975,000 $ 2,975,000 $ 3,310,276 $ 335,276 3,765,000 3,765,000 4,103,202 338,202 3,700 3,700 4,681 981 150,000 150,000 371,296 221,296 - - 21,406 21,406 6,893,700 6,893,700 7,810,861 917,161 6,278,303 6,278,303 5,313,054 965,249 1,117,091 1,117,090 1,017,657 99,433 212,041 212,041 159,348 52,693 612,583 612,584 543,317 69,267 650,000 650,000 150,986 499,014 - - 11,747 (11,747) 100,000 100,000 14,674 85,326 8,970,018 8,970,018 7,210,783 1,759,235 9,260 (9,260) 740 (740) 10,000 (10,000) 8,970,018 8,970,018 7,220,783 1,749,235 (2,076,318) (2,076,318) 590,078 2,666,396 Reserve for Contingencies (448,239) (448,239) - 448,239 Reserve for Cash Balance (1,787,718) (1,787,718) - 1,787,718 Transfers to Other Funds (408,919) (408,919) (408,919) - Total Other Financing Sources (Uses) (2,644,876) (2,644,876) (408,919) 2,235,957 Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (4,721,194) (4,721,194) 4,721,194 4,721,194 181,159 7,370,281 4,902,353 2,649,087 $ 7,551,440 $ 7,551,440 G-16 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL MIDDLE KEYS HEALTHCARE MUNICIPAL SERVICE TAXING UNIT SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 2,955,186 $ 2,955,186 $ 2,899,762 $ (55,424) Investment Income 800 800 6,873 6,073 Total Revenues 2,955,986 2,955,986 2,906,635 (49,351) EXPENDITURES: Current: General Government: Property Appraiser Tax Collector Total General Government Human Services: Middle Keys Health Care Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 48,613 48,613 45,458 3,155 88,626 88,626 84,645 3,981 137,239 137,239 130,103 7,136 2,626,948 2,626,948 2,626,948 - 2,764,187 2,764,187 2,757,051 7,136 191,799 191,799 149,584 (42,215) (75,000) (75,000) - 75,000 31,000 31,000 53,744 22,744 (44,000) (44,000) 53,744 97,744 147,799 147,799 203,328 55,529 (147,799) (147,799) 222,625 370,424 $ - $ - $ 425,953 $ 425,953 G-17 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL TOURIST DEVELOPMENT, ALL DISTRICTS, TWO CENT SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 10,090,500 $ 10,090,500 $ 10,003,105 $ (87,395) Investment Income - - 1,131,263 1,131,263 Total Revenues 10,090,500 10,090,500 11,134,368 1,043,868 EXPENDITURES: Current: Economic Environment: Cultural Umbrella 1,687,797 1,687,797 1,327,255 360,542 Fishing Umbrella 1,568,999 1,644,999 1,365,134 279,865 Dive Umbrella 1,500,000 1,500,000 1,461,286 38,714 Operations - Events 9,000,474 8,799,059 2,642,654 6,156,405 Catastrophic Emergency 1,081,783 1,081,783 - 1,081,783 Special Projects 6,168,162 6,293,577 2,623,684 3,669,893 Total Expenditures 21,007,215 21,007,215 9,420,013 11,587,202 Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (10,916,715) (10,916,715) 1,714,355 12,631,070 (72,713) (72,713) (72,713) - - - 115,606 115,606 (72,713) (72,713) 42,893 115,606 (10,989,428) (10,989,428) 1,757,248 12,746,676 10,989,428 10,989,428 22,259,044 11,269,616 $ 24,016,292 $ 24,016,292 G-18 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL TOURIST DEVELOPMENT, DISTRICT ONE SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 14,845,900 $ 14,845,900 $ 14,471,184 $ (374,716) Investment Income - - 1,421,191 1,421,191 Total Revenues 14,845,900 14,845,900 15,892,375 1,046,475 EXPENDITURES: Current: Economic Environment: Advertising and Promotion 4,593,116 4,593,116 4,093,100 500,016 Administrative Services 866,358 866,358 110,854 755,504 Special Events 1,193,699 1,193,699 122,316 1,071,383 Bricks and Mortar 12,083,659 12,083,659 4,254,188 7,829,471 Information Services 350,450 350,450 350,449 1 Beaches 314,047 314,047 95 313,952 Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): 19,401,329 19,401,329 (4,555,429) (4,555,429) 8,931,002 10,470,327 6,961,373 11,516,802 Transfers from Other Funds - - 107,127 107,127 Transfers to Other Funds (11,649,225) (11,649,225) (54,392) 11,594,833 Transfers from Constitutional Officers - - 166,175 166,175 Total Other Financing Sources (Uses) (11,649,225) (11,649,225) 218,910 11,868,135 Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (16,204,654) (16,204,654) 7,180,283 23,384,937 16,204,654 16,204,654 25,799,215 9,594,561 - $ 32,979,498 $ 32,979,498 G-19 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL TOURIST DEVELOPMENT, DISTRICT TWO SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 2,464,500 $ 2,464,500 $ 2,615,660 $ 151,160 Investment Income - - 207,654 207,654 Total Revenues 2,464,500 2,464,500 2,823,314 358,814 EXPENDITURES: Current: Economic Environment: Advertising and Promotion Administrative Services Special Events Bricks and Mortar Information Services Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 760,468 760,468 109,657 109,657 2,600 2,600 1,538,314 1,538,314 100,548 100,548 660,148 100,320 20,587 89,070 2,600 - 525,125 1,013,189 100,548 - 2,511,587 2,511,587 1,309,008 1,202,579 (47,087) (47,087) 1,514,306 1,561,393 (1,642,800) (1,642,800) (14,975) 1,627,825 - - 28,604 28,604 (1,642,800) (1,642,800) 13,629 1,656,429 (1,689,887) (1,689,887) 1,527,935 3,217,822 1,689,887 1,689,887 3,649,064 1,959,177 $ 5,176,999 $ 5,176,999 G-20 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL TOURIST DEVELOPMENT, DISTRICT THREE SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 5,558,300 $ 5,558,300 $ 5,626,859 $ 68,559 Investment Income - - 576,518 576,518 Total Revenues 5,558,300 5,558,300 6,203,377 645,077 EXPENDITURES: Current: Economic Environment: Advertising and Promotion 1,642,231 1,642,231 1,275,496 366,735 Administrative Services 352,224 352,224 45,122 307,102 Bricks and Mortar 4,253,706 4,253,706 904,968 3,348,738 Information Services 176,400 176,400 176,400 - Total Expenditures 6,424,561 6,424,561 2,401,986 4,022,575 Excess/Deficiency of Revenues Over (Under) Expenditures (866,261) (866,261) 3,801,391 4,667,652 Other Financing Sources (Uses): Transfers to Other Funds (5,769,399) (5,769,399) (13,595) 5,755,804 Transfers from Constitutional Officers - - 55,028 55,028 Total Other Financing Sources (Uses) (5,769,399) (5,769,399) 41,433 5,810,832 Net Change in Fund Balances (6,635,660) (6,635,660) 3,842,824 10,478,484 Fund Balances -October 1 6,635,660 6,635,660 10,288,602 3,652,942 Fund Balances-September30 $ - $ - $ 14,131,426 $ 14,131,426 G-21 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL TOURIST DEVELOPMENT, DISTRICT FOUR SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 3,310,800 $ 3,310,800 $ 3,057,606 $ (253,194) Investment Income - - 357,898 357,898 Total Revenues 3,310,800 3,310,800 3,415,504 104,704 EXPENDITURES: Current: Economic Environment: Advertising and Promotion Administrative Services Special Events Bricks and Mortar Information Services Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures 785,615 785,615 698,185 87,430 196,723 196,723 28,377 168,346 50,000 50,000 - 50,000 2,783,727 2,783,727 927,345 1,856,382 165,375 165,375 165,375 - 3,981,440 3,981,440 1,819,282 2,162,158 (670,640) (670,640) 1,596,222 2,266,862 Other Financing Sources (Uses): Transfers to Other Funds (3,009,379) (3,009,379) (13,002) 2,996,377 Transfers from Constitutional Officers - - 30,223 30,223 Total Other Financing Sources (Uses) (3,009,379) (3,009,379) 17,221 3,026,600 Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (3,680,019) (3,680,019) 1,613,443 5,293,462 3,680,019 3,680,019 6,662,934 2,982,915 $ - $ - $ 8,276,377 $ 8,276,377 G-22 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL TOURIST DEVELOPMENT, DISTRICT FIVE SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Taxes $ 4,820,500 $ 4,820,500 $ 4,960,195 $ 139,695 Investment Income - - 459,870 459,870 Total Revenues 4,820,500 4,820,500 5,420,065 599,565 EXPENDITURES: Current: Economic Environment: Advertising and Promotion 1,496,906 1,496,906 1,188,396 308,510 Administrative Services 247,142 247,142 38,312 208,830 Bricks and Mortar 4,422,392 4,422,392 1,815,560 2,606,832 Information Services 156,555 156,555 156,555 - Total Expenditures 6,322,995 6,322,995 3,198,823 3,124,172 Excess/Deficiency of Revenues Over (Under) Expenditures (1,502,495) (1,502,495) 2,221,242 3,723,737 Other Financing Sources (Uses): Transfers to Other Funds (3,051,479) (3,051,479) (26,318) 3,025,161 Transfers from Constitutional Officers - - 50,272 50,272 Total Other Financing Sources (Uses) (3,051,479) (3,051,479) 23,954 3,075,433 Net Change in Fund Balances (4,553,974) (4,553,974) 2,245,196 6,799,170 Fund Balances -October 1 4,553,974 4,553,974 8,295,487 3,741,513 Fund Balances -September 30 $ - $ - $ 10,540,683 $ 10,540,683 G-23 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL IMPACT FEES - ROADWAYS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Licenses and Permits $ 42,500 $ 42,500 $ 97,961 $ 55,461 Investment Income 10,500 10,500 41,442 30,942 Total Revenues 53,000 53,000 139,403 86,403 EXPENDITURES: Current: Transportation: Roadway Projects 676,164 676,164 - 676,164 Key Colony Beach Road Project 44,028 44,028 - 44,028 Total Expenditures 720,192 720,192 - 720,192 Excess/Deficiency of Revenues Over (Under) Expenditures Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (667,192) (667,192) 139,403 806,595 (667,192) (667,192) 139,403 806,595 667,192 667,192 794,090 126,898 $ 933,493 $ 933,493 G-24 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL IMPACT FEES - PARKS AND RECREATION SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Licenses and Permits $ 21,000 $ 21,000 $ 22,100 $ 1,100 Investment Income - - 34,398 34,398 Total Revenues 21,000 21,000 56,498 35,498 EXPENDITURES: Current: Culture and Recreation: District 1 Projects District 2 Projects District 3 Projects Key Largo Pickleball Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 302,124 302,124 - 302,124 305,763 305,763 220,702 85,061 74,621 - - - 177,851 252,472 248,441 4,031 860,359 860,359 469,143 391,216 (839,359) (839,359) (412,645) 426,714 (839,359) (839,359) (412,645) 426,714 839,359 839,359 877,446 38,087 $ - $ - $ 464,801 $ 464,801 G-25 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL IMPACT FEES - SOLID WASTE SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Investment Income $ 300 $ 300 $ 6,568 $ 6,268 Total Revenues 300 300 6,568 6,268 EXPENDITURES: Current: Physical Environment: County -wide Solid Waste Projects 135,285 135,285 - 135,285 Total Expenditures 135,285 135,285 - 135,285 Excess/Deficiency of Revenues Over (Under) Expenditures Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (134,985) (134,985) 6,568 141,553 (134,985) (134,985) 6,568 141,553 134,985 134,985 137,615 2,630 $ 144,183 $ 144,183 G-26 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL IMPACT FEES - FIRE AND EMS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Licenses and Permits $ 13,700 $ 13,700 $ 10,765 $ (2,935) Investment Income 131 131 9,810 9,679 Total Revenues 13,831 13,831 20,575 6,744 EXPENDITURES: Current: Public Safety: District 1 Fire & EMS Project District 2 Fire & EMS Project District 3 Fire & EMS Project Key Colony Beach Fire & EMS Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 83,227 83,227 - 83,227 6,695 6,695 - 6,695 100,711 100,711 - 100,711 1,106 1,106 - 1,106 191,739 191,739 - 191,739 (177,908) (177,908) 20,575 198,483 (177,908) (177,908) 20,575 198,483 177,908 177,908 194,798 16,890 $ - $ - $ 215,373 $ 215,373 G-27 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL FIRE AND AMBULANCE, DISTRICT #1 - LOWER AND MIDDLE KEYS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Taxes Intergovernmental Charges for Services Investment Income Miscellaneous Total Revenues EXPENDITURES: Current: General Government: Tax Collector Property Appraiser Total General Government Public Safety: Fire Rescue - Central Total Public Safety Debt Service: Principal Total Debt Service Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Lease Financing Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 Original Final Variance with Budget Budget Actual Final Budget $ 15,697,012 $ 15,697,012 $ 15,244,498 $ (452,514) 35,000 35,000 140,574 105,574 850,000 850,000 1,234,380 384,380 83,000 83,000 789,715 706,715 - 216,820 339,080 122,260 16,665,012 16,881,832 17,748,247 866,415 470,685 470,685 444,481 26,204 279,599 279,599 238,460 41,139 750,284 750,284 682,941 67,343 14,931,629 15,148,449 14,815,118 333,331 14,931,629 15,148,449 14,815,118 333,331 20,670 (20,670) 20,670 (20,670) 15,681,913 15,898,733 15,518,729 380,004 983,099 983,099 2,229,518 1,246,419 (400,143) (400,143) - 400,143 (877,525) (877,525) - 877,525 - - 41,627 41,627 (1,173,110) (1,173,110) (1,173,110) - 180,000 180,000 282,165 102,165 (2,270,778) (2,270,778) (849,318) 1,421,460 (1,287,679) 1,287,679 (1,287,679) 1,287,679 1,380,200 2,667,879 7,298,815 6,011,136 $ 8,679,015 $ 8,679,015 G-28 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL UNINCORPORATED AREA SERVICE DISTRICT - PARKS AND RECREATION SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Taxes Intergovernmental Charges for Services Investment Income Miscellaneous Total Revenues EXPENDITURES: Current: General Government: Tax Collector Culture and Recreation: Parks and Beaches Unincorporated Jacob's Aquatic Center Recreation School Board Interlocal Total Culture and Recreation Debt Service: Principal Total Debt Service Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Lease Liabilities Issued Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 Original Final Variance with Budget Budget Actual Final Budget $ 3,548,891 $ 3,548,891 $ 3,441,096 $ (107,795) 1,655,533 1,658,339 1,624,630 (33,709) 75,000 75,000 125,090 50,090 17,500 17,500 177,378 159,878 25,000 25,000 347 (24,653) 5,321,924 5,324,730 5,368,541 43,811 106,437 106,437 100,791 5,646 4,263,725 4,266,531 3,809,784 456,747 500,000 500,000 349,440 150,560 509,313 509,313 287,187 222,126 32,000 32,000 32,000 - 5,305,038 5,307,844 4,478,411 829,433 12,598 (12,598) 12,598 (12,598) 5,411,475 5,414,281 4,591,800 822,481 (89,551) (89,551) 776,741 866,292 (109,931) (109,931) - 109,931 (132,770) (132,770) - 132,770 - - 38,320 38,320 (331,776) (331,776) (331,776) - - - 52,750 52,750 (574,477) (574,477) (240,706) 333,771 (664,028) (664,028) 536,035 1,200,063 664,028 664,028 1,722,891 1,058,863 $ 2,258,926 $ 2,258,926 G-29 This page is intentionally left blank. MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL UNINCORPORATED AREA SERVICE DISTRICT - PLANNING, BUILDING AND ZONING SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Taxes Licenses and Permits Intergovernmental Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues Expenditures: Current: General Government: Property Appraiser Affordable Housing Planning Department Planning Commission Planning Legal Planning Building Refunds Total General Government Public Safety: Code Enforcement Fire & Rescue Coordinator Fire Marshall Total Public Safety Physical Environment: Environmental Resources Total Physical Environment Original Final Variance with Budget Budget Actual Final Budget $ 500,000 $ 500,000 $ 543,072 $ 43,072 - - 190 190 5,335,494 5,335,494 5,175,735 (159,759) 3,622,978 3,622,978 3,820,455 197,477 1,400,000 1,400,000 1,352,058 (47,942) 50,000 50,000 332,414 282,414 - - 1,004 1,004 10,908,472 10,908,472 11,224,928 316,456 53,731 53,892 53,892 - 139, 040 141,088 141,087 1 3,345,855 3,345,855 3,097,973 247,882 30,209 88,347 87,041 1,306 1,126,368 1,159,301 1,132,438 26,863 - - 19,811 (19,811) 4,695,203 4,788,483 4,532,242 256,241 2,620,025 2,620,025 2,055,431 564,594 1,773,559 1,773,559 1,631,243 142,316 1,092,294 1,092,294 827,426 264,868 5,485,878 5,485,878 4,514,100 971,778 1,408,766 1,408,766 1,113,683 295,083 1,408,766 1,408,766 1,113,683 295,083 (Continued) G-30 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) UNINCORPORATED AREA SERVICE DISTRICT - PLANNING, BUILDING AND ZONING SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Debt Service: Principal Interest Total Debt Service Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Lease Financing Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 Original Final Budget Budget Variance with Actual Final Budget - - 12,080 (12,080) - - 773 (773) - - 12,853 (12,853) 11,589,847 11,683,127 10,172,878 1,510,249 (681,375) (774,655) 1,052,050 1,826,705 (237,604) (144,324) - 144,324 (458,514) (458,514) - 458,514 - - 4,971 4,971 - - (99,854) (99,854) - - 11,197 11,197 (696,118) (602,838) (83,686) 519,152 (1,377,493) (1,377,493) 968,364 1,377,493 1,377,493 5,398,816 2,345,857 4,021,323 $ 6,367,180 $ 6,367,180 G-31 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL MUNICIPAL POLICING SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Taxes Charges for Services Investment Income Total Revenues EXPENDITURES: Current: General Government: Tax Collector Property Appraiser Total General Government Public Safety: Insurance Unincorporated & Layton Insurance Islamorada Insurance Marathon Sheriff Unincorporated & Layton Sheriff Islamorada Sheriff Marathon Total Public Safety Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Transfers to Other Funds Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 Original Final Variance with Budget Budget Actual Final Budget $ 6,270,825 $ 6,270,825 $ 6,079,508 $ (191,317) 5,474,291 5,474,291 5,478,011 3,720 40,000 40,000 181,773 141,773 11,785,116 11,785,116 11,739,292 (45,824) 187,975 187,975 178,071 9,904 105,776 105,776 95,204 10,572 293,751 293,751 273,275 20,476 673,009 673,009 625,249 47,760 308,946 308,946 287,454 21,492 285,903 285,903 265,605 20,298 5,329,868 5,329,868 5,329,868 - 2,616,487 2,616,487 2,616,487 - 2,262,955 2,262,955 2,262,955 - 11,477,168 11,477,168 11,387,618 89,550 11,770,919 11,770,919 11,660,893 110,026 14,197 14,197 78,399 64,202 (100,000) (100,000) - 100,000 (908,564) (908,564) - 908,564 (14,338) (14,338) (14,338) - 85,000 85,000 742,200 657,200 (937,902) (937,902) 727,862 1,665,764 (923,705) (923,705) 923,705 923,705 806,261 2,523,571 1,729,966 1,599,866 $ 3,329,832 $ 3,329,832 G-32 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL 911 ENHANCEMENT FEES SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Charges for Services $ 565,000 $ 972,267 $ 931,694 $ (40,573) Investment Income 300 300 4,346 4,046 Miscellaneous - - - - Total Revenues 565,300 972,567 936,040 (36,527) EXPENDITURES: Current: Public Safety: 911 Enhancement Fund 911 Wireless Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 197,703 197,703 131,858 65,845 375,195 782,462 757,996 24,466 572,898 980,165 889,854 90,311 (7,598) (7,598) 46,186 53,784 (7,598) (7,598) 46,186 53,784 7,598 7,598 2,235 (5,363) 48,421 $ 48,421 G-33 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL DUCK KEY SECURITY DISTRICT SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Licenses and Permits $ 118,596 $ 118,596 $ 120,608 $ 2,012 Investment Income 4,500 4,500 20,472 15,972 Total Revenues 123,096 123,096 141,080 17,984 EXPENDITURES: Current: General Government: Tax Collector Public Safety: Island Security Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances 1,100 1,100 1,000 100 115,000 115,000 108,628 6,372 116,100 116,100 109,628 6,472 6,996 6,996 31,452 24,456 (15,000) (15,000) - 15,000 (30,000) (30,000) - 30,000 - - 523 523 (45,000) (45,000) 523 45,523 (38,004) (38,004) 31,975 69,979 Fund Balances -October 1 38,004 38,004 368,249 330,245 Fund Balances -September 30 $ - $ - $ 400,224 $ 400,224 G-34 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL LOCAL HOUSING ASSISTANCE FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Intergovernmental $ 475,000 $ 475,000 $ - $ (475,000) Investment Income 10,000 10,000 149,708 139,708 Miscellaneous 180,000 180,000 629,596 449,596 Total Revenues 665,000 665,000 779,304 114,304 EXPENDITURES: Current: Economic Environment: Homeowner Assistance 2,303,591 2,303,591 1,240,201 1,063,390 Total Expenditures 2,303,591 2,303,591 1,240,201 1,063,390 Excess/Deficiency of Revenues Over (Under) Expenditures (1,638,591) (1,638,591) (460,897) 1,177,694 Other Financing Sources (Uses): Reserve for Contingencies (15,000) (15,000) - 15,000 Reserve for Cash Balance (15,000) (15,000) - 15,000 Total Other Financing Sources (Uses) (30,000) (30,000) - 30,000 Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (1,668,591) (1,668,591) (460,897) 1,207,694 1,668,591 1,668,591 3,508,973 1,840,382 $ - $ - $ 3,048,076 $ 3,048,076 G-35 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL AFFORDABLE HOUSING INITIATIVES SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Licenses and Permits $ - $ - $ 214,136 $ 214,136 Investment Income - - 6,270 6,270 Total Revenues - - 220,406 220,406 EXPENDITURES: Current: Economic Environment: Affordable Housing 15,232 15,232 - 15,232 Total Expenditures 15,232 15,232 - 15,232 Excess/Deficiency of Revenues Over (Under) Expenditures (15,232) (15,232) 220,406 235,638 Net Change in Fund Balances (15,232) (15,232) 220,406 235,638 Fund Balances -October 1 15,232 15,232 58,969 43,737 Fund Balances -September 30 $ - $ - $ 279,375 $ 279,375 G-36 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL BOATING IMPROVEMENT SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Charges for Services $ 755,000 $ 755,000 $ 798,245 $ 43,245 Intergovernmental - 98,000 98,000 - Investment Income 40,000 40,000 182,062 142,062 Total Revenues 795,000 893,000 1,078,307 185,307 EXPENDITURES: Current: Physical Environment: Boating Improvement Boating Imp Fees/Retained Vessel Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 612,116 710,116 274,516 580,369 580,369 136,805 1,192,485 1,290,485 411,321 (397,485) (397,485) 435,600 443,564 879,164 666,986 1,064,471 (200,000) (200,000) - 200,000 (275,000) (275,000) - 275,000 (475,000) (475,000) - 475,000 (872,485) (872,485) 666,986 1,539,471 872,485 872,485 3,511,683 2,639,198 $ - $ - $ 4,178,669 $ 4,178,669 G-37 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL MISCELLANEOUS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Licenses and Permits Charges for Services Fines and Forfeitures Investment Income Miscellaneous Total Revenues EXPENDITURES: Public Safety: Interagency Communications Education -Building Department Environmental Resource Education Fire and Rescue Bldg Educ Crime Prevention Program Opioid Settlements Total Public Safety Physical Environment: Derelict Vessel Removal Total Economic Environment Economic Environment: Climate Leadership Summit Municipality Mobile LIDAR Services Total Economic Environment Human Services: FL Keys Council for the Handicapped Bayshore Donations Traffic Education Legal Aid Total Human Services Original Final Variance with Budget Budget Actual Final Budget $ - $ - $ 36,827 $ 36,827 - 1,041,078 1,041,078 - 309,958 309,958 - 227,278 227,278 1,722,417 759,150 (963,267) 1,722,417 2,374,291 651,874 140,000 186,224 200,058 (13,834) 70,000 70,000 31,765 38,235 53,500 53,500 32,057 21,443 5,000 5,000 - 5,000 50,000 50,000 - 50,000 - 249,152 78,000 171,152 318,500 613,876 341,880 271,996 350,000 77,733 272,267 350,000 77,733 272,267 56,715 139,105 426 138,679 - 1,218,896 197,875 1,021,021 56,715 1,358,001 198,301 1,159,700 3,000 3,000 - 3,000 1,557 1,557 - 1,557 50,000 102,781 102,781 - - 48,726 41,413 7,313 54,557 156,064 144,194 11,870 (Continued) G-38 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL (CONTINUED) MISCELLANEOUS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Culture and Recreation: Settler's Park Landscaping School Break Program Smatlak Trust Fund Library Special Programs Library Donations Total Culture and Recreation Court Related: Teen Court State Court Support State Attorney Court Technology Public Defender Court Technology Judicial Court Technology Total Court Related Debt Service: Principal Interest Total Debt Service Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Original Final Variance with Budget Budget Actual Final Budget 2,600 2,600 179 2,421 - 4,736 1,866 2,870 - 126,718 - 126,718 30,000 30,000 - 30,000 198,864 248,767 183,821 64,946 231,464 412,821 185,866 226,955 - 44,177 41,413 2,764 26,900 26,900 11,425 15,475 150,000 120,559 67,156 53,403 146,000 146,000 55,119 90,881 119,755 119,755 102,173 17,582 442,655 457,391 277,286 180,105 1,294 (1,294) 84 (84) 1,378 (1,378) 1,103,891 3,348,153 1,226,638 2,121,515 (1,103,891) (1,625,736) 1,147,653 2,773,389 Other Financing Sources (Uses): Reserve for Contingencies (1,252,117) (730,272) - 730,272 Transfers to Other Funds (1,112,206) (1,112,206) (1,112,206) - Total Other Financing Sources (Uses) (2,364,323) (1,842,478) (1,112,206) 730,272 Net Change in Fund Balances (3,468,214) (3,468,214) 35,447 3,503,661 Fund Balances -October 1 3,468,214 3,468,214 4,581,941 1,113,727 Fund Balances -September 30 $ - $ - $ 4,617,388 $ 4,617,388 G-39 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL ENVIRONMENTAL RESTORATION SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Fines and Forfeitures Investment Income Total Revenues EXPENDITURES: Current: Physical Environment: Environmental Restoration Total Physical Environment Culture and Recreation: Settler's Park Total Culture and Recreation Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Original Final Variance with Budget Budget Actual Final Budget $ 650,000 $ 650,000 $ 1,019,223 $ 369,223 15,000 15,000 409,736 394,736 665,000 665,000 1,428,959 763,959 1,606,323 1,606,323 606,059 1,000,264 1,606,323 1,606,323 606,059 1,000,264 11,483 11,483 4,668 6,815 11,483 11,483 4,668 6,815 1,617,806 1,617,806 610,727 1,007,079 (952,806) (952,806) 818,232 1,771,038 Reserve for Contingencies (130,036) (105,036) - 105,036 Reserve for Cash Balance (120,664) (120,664) - 120,664 Transfers to Other Funds - (25,000) (24,930) 70 Total Other Financing Sources (Uses) (250,700) (250,700) (24,930) 225,770 Net Change in Fund Balances (1,203,506) (1,203,506) 793,302 1,996,808 Fund Balances -October 1 1,203,506 1,203,506 7,938,226 6,734,720 Fund Balances -September 30 $ - $ - $ 8,731,528 $ 8,731,528 G-40 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL LAW ENFORCEMENT TRUST SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Investment Income $ 25,000 $ 25,000 $ 250,084 $ 225,084 Miscellaneous - - 72,241 72,241 Total Revenues 25,000 25,000 322,325 297,325 EXPENDITURES: Current: Public Safety: Law Enforcement 3,181,004 3,181,004 95,825 3,085,179 Total Expenditures 3,181,004 3,181,004 95,825 3,085,179 Excess/Deficiency of Revenues Over (Under) Expenditures (3,156,004) (3,156,004) 226,500 3,382,504 Other Financing Sources (Uses): Reserve for Contingencies (6,250) (6,250) - 6,250 Reserve for Cash Balance (17,500) (17,500) - 17,500 Transfers from Constitutional Officers - - 6 6 Total Other Financing Sources (Uses) (23,750) (23,750) 6 23,756 Net Change in Fund Balances Fund Balances -October 1 (3,179,754) (3,179,754) 226,506 3,179,754 3,179,754 4,440,797 3,406,260 1,261,043 Fund Balances -September 30 $ - $ - $ 4,667,303 $ 4,667,303 G-41 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL COURT FACILITY FEES SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Charges for Services $ 450,000 $ 450,000 $ 639,830 $ 189,830 Investment Income 40,000 40,000 258,737 218,737 Total Revenues 490,000 490,000 898,567 408,567 EXPENDITURES: Current: Court Related: Court Facility 846,608 846,608 356,729 489,879 Total Expenditures 846,608 846,608 356,729 489,879 Excess/Deficiency of Revenues Over (Under) Expenditures (356,608) (356,608) 541,838 898,446 Other Financing Sources (Uses): Reserve for Contingencies (45,000) (45,000) - 45,000 Reserve for Cash Balance (50,000) (50,000) - 50,000 Total Other Financing Sources (Uses) (95,000) (95,000) - 95,000 Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (451,608) (451,608) 541,838 993,446 451,608 451,608 5,179,791 4,728,183 $ 5,721,629 $ 5,721,629 G-42 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL DRUG ABUSE TRUST SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Charges for Services $ 30,000 $ 30,000 $ 47,147 $ 17,147 Investment Income 1,000 1,000 3,226 2,226 Total Revenues 31,000 31,000 50,373 19,373 EXPENDITURES: Current: Human Services: Drug Abuse Trust Fund 55,000 55,000 - 55,000 Total Expenditures 55,000 55,000 - 55,000 Excess/Deficiency of Revenues Over (Under) Expenditures (24,000) (24,000) 50,373 74,373 Other Financing Sources (Uses): Reserve for Contingencies (5,000) (5,000) - 5,000 Reserve for Cash Balance (5,000) (5,000) - 5,000 Total Other Financing Sources (Uses) (10,000) (10,000) - 10,000 Net Change in Fund Balances (34,000) (34,000) 50,373 84,373 Fund Balances -October 1 34,000 34,000 36,671 2,671 Fund Balances -September 30 $ - $ - $ 87,044 $ 87,044 G-43 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL CANAL SPECIAL ASSESSMENTS SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 Original Final Variance with Budget Budget Actual Final Budget REVENUES: Licenses and Permits $ 34,943 $ 35,880 $ 126,448 $ 90,568 Investment Income - - 8,216 8,216 Total Revenues 34,943 35,880 134,664 98,784 EXPENDITURES: Current: General Government: Tax Collector Physical Environment: Canal #266 Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Reserve for Contingencies Reserve for Cash Balance Transfers from Constitutional Officers Total Other Financing Sources (Uses) Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 1,048 1,048 - 1,048 62,200 67,637 25,857 41,780 63,248 68,685 25,857 42,828 (28,305) (32,805) 108,807 141,612 (5,000) (500) - 500 (10,000) (10,000) - 10,000 - - 1,570 1,570 (15,000) (10,500) 1,570 12,070 (43,305) (43,305) 110,377 153,682 43,305 43,305 67,809 24,504 $ 178,186 $ 178,186 G-44 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL BUILDING SPECIAL REVENUE FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Licenses and Permits Charges for Services Investment Income Miscellaneous Total Revenues EXPENDITURES: Current: Public Safety Building Department Building Legal Building Refunds Total Public Safety Debt Service: Principal Interest Total Debt Service Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Other Financing Sources (Uses): Original Final Variance with Budget Budget Actual Final Budget $ 5,520,000 $ 5,520,000 $ 6,594,552 $ 1,074,552 120,000 120,000 138,150 18,150 40,000 40,000 216,095 176,095 25,000 25,000 22,924 (2,076) 5,705,000 5,705,000 6,971,721 1,266,721 6,675,453 6,622,489 6,010,947 611,542 45,978 48,942 48,541 401 30,000 130,000 120,546 9,454 6,751,431 6,801,431 6,180,034 621,397 642 (642) 36 (36) 678 (678) 6,751,431 6,801,431 6,180,712 620,719 (1,046,431) (1,096,431) 791,009 1,887,440 Reserve for Contingencies (50,000) - - - Reserve for Cash Balance (50,000) (50,000) - 50,000 Transfer to Other Funds (538,659) (538,659) (538,659) - Total Other Financing Sources (Uses) (638,659) (588,659) (538,659) 50,000 Net Change in Fund Balances (1,685,090) (1,685,090) 252,350 1,937,440 Fund Balances -October 1 1,685,090 1,685,090 3,521,137 1,836,047 Fund Balances -September 30 $ - $ - $ 3,773,487 $ 3,773,487 G-45 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL CLERK'S REVENUE NOTE CAPITAL PROJECTS FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Investment Income Total Revenues EXPENDITURES: Capital Projects Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 Original Final Variance with Budget Budget Actual Final Budget 100,000 - - - 100,000 - - - (100,000) - - - (100,000) (100,000) (113,414) (13,414) 100,000 100,000 113,414 13,414 G-46 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS SCHEDULE OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCES - BUDGET AND ACTUAL LAND ACQUISITION FUND CAPITAL PROJECTS FUND FOR THE YEAR ENDED SEPTEMBER 30, 2024 REVENUES: Intergovernmental Revenue Investment Income Total Revenues EXPENDITURES: Capital Projects Total Expenditures Excess/Deficiency of Revenues Over (Under) Expenditures Original Final Variance with Budget Budget Actual Final Budget $ - $ - $ 33,650 $ 33,650 5,000 5,000 35,780 30,780 5,000 5,000 69,430 64,430 1,936,857 1,936,857 1,874,579 62,278 1,936,857 1,936,857 1,874,579 62,278 (1,931,857) (1,931,857) (1,805,149) 126,708 Other Financing Sources (Uses): Reserve for Contingencies (150,000) (150,000) - 150,000 Transfer From Other Funds 1,112,206 1,112,206 1,112,206 - Total Other Financing Sources (Uses) 962,206 962,206 1,112,206 150,000 Net Change in Fund Balances Fund Balances -October 1 Fund Balances -September 30 (969,651) (969,651) (692,943) 276,708 969,651 969,651 971,405 1,754 - $ 278,462 $ 278,462 G-47 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF NET POSITION INTERNAL SERVICE FUNDS SEPTEMBER 30, 2024 ASSETS Current Assets: Cash and Cash Equivalents Investments Accounts Receivable, Net Due from Other Funds Due from Other Governmental Units Due from Constitutional Officers Interest Receivable Total Current Assets Workers' Group Risk Compensation Insurance Management Fund Fund Fund $ 665,850 $ 1,800,851 $ 660,582 5,775,613 18,488,612 6,887,342 87,918 430,957 7,116 261 88,606 14,325 21,823 8,123 - 23,397 74,866 27,945 6,574,862 20,892,015 7,597,310 Noncurrent Assets: Capital Assets not being Depreciated - - 1,907,240 Capital Assets, Net of Accumulated Depreciation and Amortization 65 4,327 209,736 Total Noncurrent Assets 65 4,327 2,116,976 Total Assets 6,574,927 20,896,342 9,714,286 DEFERRED OUTFLOWS OF RESOURCES Related to Pensions 50,441 97,978 136,026 Related to OPEB 900 9,000 14,000 Total Deferred Outflows of Resources 51,341 106,978 150,026 LIABILITIES Current Liabilities: Accounts Payable Accrued Compensated Absences Payable Claims and Judgments Payable Due to Other Governmental Units Due to Constitutional Officers Unearned Revenues Leases and Subscriptions Payable Other Current Liabilities Accrued Comp. Absences Payable Total Current Liabilities Noncurrent Liabilities: Accrued Compensated Absences Payable Leases and Subscriptions Payable Total OPEB Liability Net Pension Liability Total Noncurrent Liabilities Total Liabilities DEFERRED INFLOWS OF RESOURCES Related to Pensions Related to OPEB Total Deferred Inflows of Resources NET POSITION 7,774 950,610 108,851 15,388 14,707 21,163 2,054,916 849,675 650,194 - - 184 - 2,883 - - 2,473 - - - 41,306 - - 597 7,940 11,485 13,908 2,086,018 1,831,833 836,203 31,760 45,940 55,630 - - 44,994 12,000 10,000 275,000 235,732 314,473 339,492 279,492 370,413 715,116 2,365,510 2,202,246 1,551,319 20,237 39,478 52,851 1,400 44,500 10,100 21,637 83,978 62,951 Net Investment in Capital Assets 65 4,327 2,030,676 Unrestricted 4,239,056 18,712,769 6,219,366 Total Net Position $ 4,239,121 $ 18,717,096 $ 8,250,042 The notes to the financial statements are an integral part of these statements. H-1 Fleet Management Fund Total $ 91,076 $ 3,218,359 1,483,389 32,634,956 67 526,058 328,000 328,000 16,621 119,813 483 30,429 6,327 132,535 1,925,963 36,990,150 54,000 1,961,240 780,097 994,225 834,097 2,955,465 2,760,060 39,945,615 510,912 795,357 109,100 133,000 620,012 928,357 89,822 1,157,057 124,245 175,503 - 3,554,785 418 602 - 2,883 - 2,473 131,098 172,404 479 1,076 52,648 85,981 398,710 5,152,764 210,592 343,922 67,057 112,051 737,000 1,034,000 1,473,687 2,363,384 2,488,336 3,853,357 2,887,046 9,006,121 204,496 317,062 42,500 98,500 246,996 415,562 635,942 2,671,010 (389,912) 28,781,279 $ 246,030 $ 31,452,289 H-2 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF REVENUES, EXPENSES, AND CHANGES IN NET POSITION INTERNAL SERVICE FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Operating Revenues: Charges for Services Miscellaneous Total Operating Revenues Operating Expenses: Personnel Services Operations Depreciation and Amortization Asserted and Paid Claims Total Operating Expenses Operating Income (Loss) Other Financing Sources (Uses): Workers' Group Risk Compensation Insurance Management Fund Fund Fund $ 2,642,514 $ 21,944,118 $ 8,923,224 929,727 1,673,267 97 3,572,241 23,617,385 8,923,321 538,365 506,088 750,215 1,853,162 2,541,179 6,572,280 260 5,659 27,357 - 18,953,096 423,808 2,391,787 22,006,022 7,773,660 1,180,454 1,611,363 1,149,661 Investment Income 280,651 1,027,060 370,467 Insurance Recoveries - - 56,856 Gain/(Loss) on Disposition of Assets - 873 (4,582) Total Other Financing Sources (Uses): 280,651 1,027,933 422,741 Income (Loss) Before Transfers Total Transfers: Transfers from Other Funds Transfers to Other Funds Total Transfers Change in Net Position Net Position -October 1 Net Position -September 30 1,461,105 2,639,296 1,572,402 (69,064) (127,936) (133,720) (69,064) (127,936) (133,720) 1,392,041 2,511,360 1,438,682 2,847,080 16,205,736 6,811,360 $ 4,239,121 $ 18,717,096 $ 8,250,042 The notes to the financial statements are an integral part of these statements. H-3 Fleet Management Fund Total $ 4,596,980 $ 38,106,836 45,862 2,648,953 4,642,842 40,755,789 2,914,137 4,708,805 1,734,353 12,700,974 209,380 242,656 - 19,376,904 4,857,870 37,029,339 (215,028) 3,726,450 148,867 1,827,045 - 56,856 21,342 17,633 170,209 1,901,534 (44,819) 5,627,984 328,000 328,000 (529,439) (860,159) (201,439) (532,159) (246,258) 5,095,825 492,288 26,356,464 $ 246,030 $ 31,452,289 H-4 MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF CASH FLOWS INTERNAL SERVICE FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Operating Activities: Cash Received for Services Cash Payments to Suppliers for Goods and Svcs Cash Payments for Employee Services Cash Payments for Claims Cash Received from (Paid to) Other Sources Other Operating Revenue Net Cash Provided by (Used in) Operating Activities Noncapital Financing Activities: Transfers from Other Funds Transfers to Other Funds Insurance Recoveries Received Net Cash Provided by (Used in) Noncapital Financing Activities Capital and Related Financing Activities: Acquisition of Capital Assets Proceeds from Sale of Capital Assets Net Cash Provided by (Used in) Capital and Related Financing Activities Investing Activities: Investment Income (Losses) Proceeds from Sales and Maturities of Investments Purchase of Investment Securities Net Cash Provided by (Used in) Investing Activities Net Change in Cash and Cash Equivalents Cash and Cash Equivalents: October 1 September 30 Workers' Group Compensation Insurance Fund Fund Risk Management Fund $ 2,602,302 $ 21,820,050 $ 8,923,100 (1,847,813) (2,695,411) (6,399,187) (503,748) (494,590) (616,863) (140,984) (18,918,512) (409) (9,850) 197,393 7,411 921,605 1,651,595 (9,700) 1,021,512 1,560,525 1,904,352 (69,064) (127,936) (133,720) - - 56,856 9,064) (127,936) (76,864) (873) (715,584) 873 (4,582) - (720,166) 280,651 1,027,060 370,467 4,601,041 16,367,728 5,285,910 (5,609,277) (18,254,419) (6,509,064) (727,585) (859,631) (852,687) 224,863 572,958 254,635 440,987 1,227,893 405,947 $ 665,850 $ 1,800,851 $ 660,582 The notes to the financial statements are an integral part of these statements. H-5 Fleet Management Fund Total $ 4,596,913 $ 37,942,365 (2,125,075) (13,067,486) (2,601,890) (4,217,091) - (19,059,905) (317,077) (122,123) 45,511 2,609,011 (401,618) 4,084,771 328,000 328,000 (529,439) (860,159) - 56,856 (201,439) (475,303) 19,447 (697,010) 21.342 17.633 40,789 (679,377) 148,867 1,827,045 2,590,952 28,845,631 (2,209,084) (32,581,844) 530,735 (1,909,168) (31,533) 1,020,923 122,609 2,197,436 $ 91,076 $ 3,218,359 (Continued) MONROE COUNTY, FLORIDA-BOARD OF COUNTY COMMISSIONERS COMBINING STATEMENT OF CASH FLOWS (CONTINUED) INTERNAL SERVICE FUNDS FOR THE YEAR ENDED SEPTEMBER 30, 2024 Reconciliation of Operating Income (Loss) to Net Cash Provided by (Used in) Operating Activities: Operating Income (Loss) Adjustments to Reconcile Operating Income (Loss) to Net Cash Provided by (Used in) Operating activities: Depreciation and Amortization Change in Assets, Liabilities, and Deferrals: (Increase) Decrease in Accounts Receivable (Increase) Decrease in Due from Other Funds (Increase) Decrease in Due from Other Gov't Units (Increase) Decrease in Due fm Constitutional Ofcrs (Increase) Decrease in Interest Receivable Increase (Decrease) in Accounts Payable Increase (Decrease) in Accrued Wages/Benefits Increase (Decrease) in Claims/Judgments Payable Increase (Decrease) in Other Current Liabilities Increase (Decrease) in Due to Other Gov't Units Increase (Decrease) in Comp. Absences Payable Increase (Decrease) in Leases Payable Increase (Decrease) in Unearned Revenue Increase (Decrease) in OPEB Liability Increase (Decrease) in Pension Liability Increase (Decrease) in Deferred Outflows Increase (Decrease) in Deferred Inflows Pensions/OPEB Total Adjustments Net Cash Provided by (Used in) Operating Activities Cash Reconciliation: Workers' Group Compensation Insurance Fund Fund Risk Management Fund $ 1,180,454 $ 1,611,363 $ 1,149,661 260 5,659 27,357 (40,212) (124,068) (124) (71) 14,039 (14,325) (2,951) 180,506 21,552 (8,122) (21,672) (9,797) 5,349 (156,305) 86,196 8,751 (77) 3,263 (140,984) 34,584 423,399 - - 597 (6,828) 2,848 184 13,547 8,188 12,921 - - 86,300 - 2,073 - 4,000 (39,000) 20,000 (3,763) (7,401) (9,193) 4,795 (8,532) 83,599 7,287 58,320 22,762 (158,942) (50,838) 754,691 1,021,512 $ 1,560,525 $ 1,904,352 Unrestricted $ 665,850 $ 1,800,851 $ 660,582 The notes to the financial statements are an integral part of these statements. H-7 Fleet Management Fund Total $ (215,028) $ 3,726,450 209,380 242,656 (67) (164,471) (328,000) (328,000) 10,988 10,631 (483) 198,624 (351) (39,942) (258,047) (322,807) 22,459 34,396 - 316,999 (314) 283 418 (3,378) 56,643 91,299 (132,361) (46,061) - 2,073 24,000 9,000 (37,838) (58,195) 168,252 248,114 78,731 167,100 (186,590) 358,321 $ (401,618) $ 4,084,771 $ 91,076 $ 3,218,359 Monroe County Comprehensive Plan Land Authority (A Component Unit of Monroe County, Florida) Statement of Net Position September 30, 2024 Assets and Deferred Outflows of Resources Assets: Cash and investments $ 31,607,356 Due from BOCC 985,507 Due from State of Florida 50,224 Mortgages receivable, net of allowance 7,419,025 Deposits 179,500 Capital assets — Equipment, net of accumulated depreciation 9,322 Capital assets — land 40,924,414 Intangible assets 17,004,934 Total assets 98,180,282 Deferred outflows of resources: Pension related items 513,153 Other postemployment benefits related items 15,323 Total deferred outflows 528,476 Liabilities, Deferred Inflows of Resource and Net Position Current liabilities: Accounts payable 12,557 Accrued wages 57,961 Compensated absences 82,032 Total current liabilities 152,550 Noncurrent liabilities: Compensated absences 127,198 Net pension liability 1,040,071 Other postemployment benefits liability 76,641 Total noncurrent liabilities 1,243,910 Total liabilities 1,396,460 Deferred inflows of resources: Pension related items 80,826 Other postemployment benefits related items 19,551 Total deferred inflows 100,377 Net position Net investment in capital assets 57,938,670 Restricted, land acquisition 14,287,421 Unrestricted 24,985,830 Total net position $ 97,211,921 The accompanying notes to the financial statements are an integral part of this statement. 1-1 Monroe County Comprehensive Plan Land Authority (A Component Unit of Monroe County, Florida) Statement of Activities Fiscal Year Ended September 30, 2024 General revenues: Intergovernmental $ 8,439,345 Investment income 1,507,234 Miscellaneous income 2,431,594 Total general revenues 12,378,173 Program expenses General government 1,198,758 Cost of land sold 2,402,864 Land contribution conveyances 390,769 Total program expenses 3,992,391 Change in net position 8,385,782 Net position, beginning of year 88,826,139 Net position, end of year $ 97,211,921 The accompanying notes to the financial statements are an integral part of this statement. WA R&W US IIL..IIL.JP Report on Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed in Accordance With Government Auditing Standards Independent Auditor's Report Honorable Mayor and Board of County Commissioners Monroe County, Florida We have audited, in accordance with the auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States (Government Auditing Standards), the financial statements of each major fund and the aggregate remaining fund information of the Board of County Commissioners (the Board) of Monroe County, Florida (the County) as of and for the year ended September 30, 2024, and the related notes to the financial statements, which collectively comprise the Board's basic financial statements, and have issued our report thereon dated April 9, 2025. The Board's financial statements include an emphasis of matter paragraph related to the restatement of the beginning net position and beginning balances for leases and interest receivable and deferred inflow of resources for the Key West Airport Fund and Marathon Airport Fund as of October 1, 2023. Our report was not modified with respect to this matter. Report on Internal Control over Financial Reporting In planning and performing our audit of the financial statements, we considered the Board's internal control over financial reporting (internal control) as a basis for designing the audit procedures that are appropriate in the circumstances for the purpose of expressing our opinions on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of the Board's internal control. Accordingly, we do not express an opinion on the effectiveness of the Board's internal control. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements on a timely basis. A material weakness is a deficiency, or a combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected, on a timely basis. A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. Our consideration of internal control was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control that might be material weaknesses or significant deficiencies and therefore, material weaknesses or significant deficiencies may exist that were not identified. We identified a certain deficiency in internal control, described in the accompanying schedule of findings and questioned costs as item IC 2024-001 that we consider to be a material weakness. i"' Ilh° R III I w° III III t 0III'" III t III I. III SI G IU III III III : III'Z 5 i"'0 0 SSLJII,?A `,LC.II i.. Jk, C:0I`,LSLJII ..IIIwtLiUu J-1 "M0',111 IvHil�0`a Inernl Iq iuI I I('Ik"M II)((�t I I'd !(,I All I s�liVI 11 i wir k of lwkapniwlenkI I u II+X'fi Id or"I Ili a r�(il I Y15, V1S1 TI`,I I II I'.-IY I/,Ih<IIIII "foI IYIofII1toY1"n,l(I on II"',II:11I I,�N"11AII"II I I, II I l 1 N W I[ I kII I I d I"In d, Report on Compliance and Other Matters As part of obtaining reasonable assurance about whether the Board's financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements, noncompliance with which could have a direct and material effect on the financial statements. However, providing an opinion on compliance with those provisions was not an objective of our audit and, accordingly, we do not express such an opinion. The results of our tests disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing Standards. Board's Response to Finding Government Auditing Standards requires the auditor to perform limited procedures on the Board's response to the finding identified in our audit and described in the accompanying schedule of findings and questioned costs. The Board's response was not subjected to the other auditing procedures applied in the audit of the financial statements and, accordingly, we express no opinion on the response. Purpose of this Report The purpose of this report is solely to describe the scope of our testing of internal control and compliance and the results of that testing, and not to provide an opinion on the effectiveness of the entity's internal control or on compliance. This report is an integral part of an audit performed in accordance with Government Auditing Standards in considering the entity's internal control and compliance. Accordingly, this communication is not suitable for any other purpose. Fort Lauderdale, Florida April 9, 2025 J-2 Monroe County, Florida Board of County Commissioners Schedules of Findings and Questioned Costs Financial Statement Finding IC 2024-001 — Restatement of Regulated Leases and Recording of Minimum Annual Guarantees Criteria: Management is responsible for the preparation and fair presentation of financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error. Internal control policies and procedures should provide reasonable assurance regarding the reliability of the financial reporting and disclosure of lease balances. Condition: We noted that material accounting adjustments were made to the financial statements for lease related balances in the Key West Airport enterprise fund and the Marathon Airport enterprise fund (the Airports). During the current year, management discovered regulated leases primarily related to fixed -base operators that were previously reported as leases receivable and deferred inflow of resources that should not have been reported in accordance with Governmental Accounting Standards Board Statement No. 87, Leases (GASB 87). In addition, we noted minimum annual guaranteed concession fees were not recorded for three Marathon Airport car rental leases that should have been recorded. This resulted in the restatement of beginning net position and beginning balances for leases receivable, interest receivable and deferred inflow of resources for the Airports. Context: The condition relates to the proper accounting and financial reporting for regulated leases by the Airports on an ongoing basis. The condition also related to the three rental car concession agreements at Marathon Airport. Cause: The Airports have multiple leases with various third parties and inadvertently recognized regulated leases that are excluded from GASB 87. Also, through an oversight error the minimum annual guaranteed concession fees were inadvertently excluded from the lease receivables recorded for the three Marathon Airport rental car concession agreements. Effect: The October 1, 2023 net position and beginning balances for leases receivable, interest receivable and deferred inflow of resources were restated. Current Year Recommendation: We recommend that management review the design of established controls and implement the changes necessary to allow for the accurate recording and disclosure of accounting transactions on an ongoing basis. Views of Responsible Officials and Planned Corrective Action: We agree with the finding. The County will conduct a review of all Airport lease agreements to verify proper classification of leases as regulated or non -regulated. As part of this review, the County will also review all the County's leases that meet the requirements for financial statement reporting under GASB Statement No. 87, Leases to verify that all minimal annual guarantees as well as other detailed provisions that could impact the calculation of lease receivables, deferred inflow of resources, and interest receivable are appropriately captured in the software program used for recording leases. J-3 OJ�t COURTS C e Kevin Madok, CPA - yo ........� F� Clerk of the Circuit Court &Comptroller Monroe County, Florida NROE cOUNSy� CORRECTIVE ACTION PLAN Material Weakness Finding IC 2024-001 — Restatement of Regulated Leases and Recording of Minimum Annual Guarantees Name of Contact Person: Pam Radloff, Finance Director Corrective Action: The County will conduct a review of all Airport lease agreements to verify proper classification of leases as regulated or non -regulated. As part of this review, the County will also review all the County's leases that meetthe requirements for financial statement reporting under GASB Statement No. 87, Leases to verify that all minimal annual guarantees as well as other detailed provisions that could impact the calculation of lease receivables, deferred inflow of resources, and interest receivable are appropriately captured in the software program used for recording leases. Proposed Completion Date: Immediately KEY WEST MARATHON 500 Whitehead Street 3117 Overseas Highway Key West, Florida 33040 Marathon, Florida 33050 PLANTATION KEY 88770 Overseas Highway Plantation Key, Florida 33070 J-4 R&W US IIL..IIL.JP Management Letter in Accordance with the Rules of the Auditor General of the State of Florida Honorable Mayor and Board of County Commissioners Monroe County, Florida Report on the Financial Statements We have audited the financial statements of each major fund and the aggregate remaining fund information of the Board of County Commissioners (the Board) of Monroe County, Florida (the County) as of and for the year ended September 30, 2024, and have issued our report thereon dated April 9, 2025. Our report included an emphasis of matter paragraph to reflect that these financial statements reflect the transactions attributable to the Board and do not represent a complete presentation of the financial statements of the County. Our report also included an emphasis of matter paragraph for the restatement of the beginning net position and beginning balances for leases and interest receivable and deferred inflow of resources for the Key West Airport Fund and Marathon Airport Fund as of October 1, 2023. Auditor's Responsibility We conducted our audit in accordance with auditing standards generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; and Chapter 10.550, Rules of the Auditor General. Other Reports We have issued our Independent Auditor's Report on Internal Control over Financial Reporting and on Compliance and Other Matters Based on an Audit of the Financial Statements Performed in Accordance with Government Auditing Standards and Independent Accountant's Report on an examination conducted in accordance with A/CPA Professional Standards, AT-C Section 315, regarding compliance requirements in accordance with Chapter 10.550, Rules of the Auditor General. Disclosures in those reports should be considered in conjunction with this management letter. Prior Audit Findings Section 10.554(1)(i)l ., Rules of the Auditor General, requires that we determine whether or not corrective actions have been taken to address findings and recommendations made in the preceding annual financial audit report. There were no findings noted in the preceding annual financial audit report. Official Title and Legal Authority Section 10.554(1)(i)4., Rules of the Auditor General, requires that the name or official title and legal authority for the primary government and each component unit of the reporting entity be disclosed in this management letter, unless disclosed in the notes to the financial statements. The legal authority is disclosed in Note 1 to the financial statements. i"'Ilh°RIII Cw°III IIIt 0III'" IIItIIII.IIISIG IUII4III III:III'Z 5i"'CCIII':��i SS U Ji II,?A `,L C.II i.. Jk, C:0I`,L S U.Ji II ..II IwtLi Uu J-5 k"M 0', 111 I" H i�� 0`a Inernl giuIII('Ik"M II)((�t I I'd l(II AEI �s�l lkll wi wit k of lwkapniwlenkfi u fl+X'fi Id or IIli a rn fil I Y15, V1S1 TI`,I I II I'.-IY I /, fhoi I W "i(,IIYlo('II)tolIY1,f(IonI�"',II:11I I,� H` aV I I" I I I I, fI I l 1H$S V I[ IkI 1 I a I"In d, Financial Condition and Management Section 10.554(1)(i)2., Rules of the Auditor General, requires that we communicate any recommendations to improve financial management. In connection with our audit, we did not have any such recommendations. Additional Matters Section 10.554(1)(i)3., Rules of the Auditor General, requires us to communicate noncompliance with provisions of contracts or grant agreements, or abuse, that have occurred, or are likely to have occurred, that have an effect on the financial statements that is less than material, but which warrants the attention of those charged with governance. In connection with our audit, we did not have any such findings. Purpose of This Letter Our management letter is intended solely for the information and use of the Legislative Auditing Committee, members of the Florida Senate and the Florida House of Representatives, the Florida Auditor General, Federal and other granting agencies and applicable management, and is not intended to be and should not be used by anyone other than these specified parties. Fort Lauderdale, Florida April 9, 2025 'QrT R&W US IIL..IIL.JP Independent Accountant's Report on Compliance With Section 218.415, Florida Statutes Honorable Mayor and Board of County Commissioners Monroe County, Florida We have examined Monroe County Florida's (the County) compliance with Section 218.415, Florida Statutes, Local Government Investment Policies (the specified requirements) during the period October 1, 2023 to September 30, 2024. Management of the County is responsible for compliance with the specified requirements. Our responsibility is to express an opinion on the County's compliance with the specified requirements based on our examination. Our examination was conducted in accordance with attestation standards established by the AICPA. Those standards require that we plan and perform the examination to obtain reasonable assurance about whether the County complied, in all material respects, with the specified requirements referenced above. An examination involves performing procedures to obtain evidence about whether the County complied with the specified requirements. The nature, timing, and extent of the procedures selected depend on our judgment, including an assessment of the risks of material noncompliance, whether due to fraud or error. We believe that the evidence we obtained is sufficient and appropriate to provide a reasonable basis for our opinion. We are required to be independent and to meet our other ethical responsibilities in accordance with relevant ethical requirements relating to the engagement. Our examination does not provide a legal determination on the County's compliance with the specified requirements. In our opinion, the County complied, in all material respects, with the specified requirements during the period October 1, 2023 to September 30, 2024. This report is intended solely for the information and use of the Florida Auditor General, the County and applicable management and is not intended to be, and should not be, used by anyone other than these parties. Fort Lauderdale, Florida April 9, 2025 i"' Ilh° R III I w° III III t 0III'" III t III I. III SI G IU III III III : III'Z 5 i"'0 0 SS U.Ji II,?A `,L C.II i.. X C:0I`,L S U.Ji II ..II IwtLi Uu J-7 "M0',111 IvHil�0`a Inernl Iq iuI I I('Ik"M II)((�t I I'd !(,I All I s�liVI ll i wir k of lwkapniwlenkI I u II+X'fi Id or"I Ili a r�(il I Y15, V1S1 TI`,I I II I'.-IY I/,Ih<IIIII "f(,I I Y I of A)toY1"n,l(Ion II"',II:11I I,�N"11AII"II I I, II I l 1 N W I[ I kII I I d I"In d,