2001-CJ-9K-11-54-01-006 03/21/2001
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
BRANCH OFFICE
MARATHON SUB COURTHOUSE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
FAX (305) 289-1745
MONROE COUNTY COURTHOUSE
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
FAX (305) 295-3663
BRANCH OFFICE
PLANTATION KEY
GOVERNMENT CENTER
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
MEMORANDUM
DA TE:
April 2, 200 I
TO:
Jennifer Hill, Budget Director
Office of Management & Budget
ATTN:
Dave Owens
Grants Manager
Pamela G. Hanc~
Deputy Clerk U
FROM:
At the March 21, 2001, Board of County Commissioner's meeting the Board granted
approval and authorized execution of the following:
Residential Substance Abuse Treatment Funds Agreement between Monroe County and
the Care Center for Mental Health for the Monroe County Jail Incarceration Program, using funds
provided under the Residential Substance Abuse Treatment Grant.
Certification of Acceptance of Subgrant Award 01-CJ-9K-1l-54-006 between Monroe
~ounty and the Florida Department of Law Enforcement for the Monroe County Jail
V I~carceration Program, using funds provided under the Residential Substance Abuse Treatment
Grant.
Enclosed please find a duplicate original of each of the above for your handling. Should
you have any questions please feel free to contact this office.
Cc: County Administrator wlo document
Risk Management wlo document
County Attorney
Finance
File ./
State of Florida
Office of Criminal Justice Grants
Florida Department of Law Enforcement
CERTIFICATION OF ACCEPTANCE OF SUB GRANT AWARD
The subgrantee, through its authorized representative,
acknowledges receipt and acceptance of subgrant award number
01-CJ-9K-11-54-01-006 in the amount of $58,449,
for a project entitled: Monroe County Jail Incarceration Program
for the period of 02/15/2001 through 09/30/2001, in accordance with
the statement of work contained in the subgrant application, and
subject to the Florida Department of Law Enforcement's conditions
J;:; ;; SK[:;;ons g:erning this subgrant.
(Signature of Authorized Official)
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State of Florida
Office of Criminal Justice Grants
Florida Department of Law Enforcement
SUBGRANT AWARD CERTIFICATE
Subgrantee: Monroe County Board of Commissioners
Date of Award: February Zl, ZQQl
Grant Period: From: 02/15/2001 TO:09/30/2001
Project Title: Monroe County Jai1 Incarceration Program
Grant Number: 01-CJ-9K-11-54-01-006
Federal Funds: $58,449.00
BGMTF Funds:
State Agency Match:
Local Agency Match: $19,484.00
Total Project Cost: $77,933.00
Program Area: 001
Award is hereby made in the amount and for the period shown above
of a grant under Title IV of the Violent Crime Control and Law
Enforcement Act of 1994, P.L. 103-322, as amended, to the above
mentioned subgrantee and subject to any attached standard or
special conditions.
This award is subject to all applicable rules, regulations, and
conditions as contained in the Financial Guide for Grants,
Office of Justice Programs, Common Rule for State and Local
Governments and A-87, or OMB Circulars A-lID and A-21-,
in their entirety. It is also subiect to such further rules,
requlations and policies as may be reasonably prescribed by the
State or Federal Government consistent with the purposes and
authorization of P.L. 103-322, as amended.
SUBGRANT AWARD CERTIFICATE (CONTINUED):
This grant shall become effective on the beginning date of the
grant period provided that within 30 days from the date of award,
properly executed Certificate of Acceptance of Subgrant Award
is returned to the department.
QQ~~~. ~
Authori ed Official
Clayton H. Wilder
Community Program Administrator
J.-;21..01
Date
.
State of Florida
Office of Criminal Justice Grants
Florida Department of Law Enforcement
SPECIAL CONDITION(S)/GENERAL COMMENT(S)
Grantee (Name of SPA): Office of Criminal Justice Grants
Grant Number: 01-CJ-9K-11-54-01-006
Grant Title: Monroe County Jail Incarceration
In addition to the general conditions applicable to fiscal
administration, the grant is subject to the following Special
Condition (s):
Prior to drawdown of federal funds for contractual services,
a copy of the boilerplate agreement referencing Section H -
Acceptance and Agreement must be submitted and reviewed by
the Florida Department of Law Enforcement.
I"'C~'Yv"".-. ~""""''''''''~I''-'''' "____ - - - - ---- - --- - - -~- __
Florida Department of Law Enforcement
SUBGRANT APPLlL,ATION
REceiVED
FDLE Subgrant Number: 2001-C,J-QK-1 - -
- 4 2000
~~f W~&J~f1j~GRANTS
If this application is for continuation funding, enter prior FDLE su
I Prior Subgrant Number:
A. Names & Addresses
1. Name of Subgrant Recipient: Monroe County Board of County Commissioners
Name of Chief Elected or Appointed Official:" George Neugent
Title: Mayor
Address: 5100 College Road: Kev West. FL 33040
Zip Code: 33040
Area Code and Telephone Number: (305) 292-- 4512
SUNCOM Number:
Area Code and Fax Number: (3"05) 872 - 9195
2. Chief Financial Officer:
Name of Chief Financial Officer: Dannv L. Kolhage
Title: Clerk of the Court
Address: 500 Whitehead Street Kev West. FL
Zip Code: 33040
Area Code and Telephone Number: (305) 292-~550
SUNCOM Number:
Area Code and Fax: (305 )295-3'660
3. Name of Implementing Agency: Monroe Couftty~Board of County Commissioners
Name of Chief Executive Official: James L. Roberts
Title: County Administrator
Address: 5100 College Road Kev West. FL
Zip Code: 33040
Area Code and Telephone Number: (305) 292 - 4441
SUNCOM Number:
Area Code and Fax Number: (305) 292 - 4544
4.
Project Director:
.
David P. Owens
Name of Project Direc1'Or.
Title: Grants Administrator
Address: 5100 College Road. Room 211 Kev West. FL
Zip Code: 33040
Area Code and Telephone Number: (305~ 292 - 4482
SUNCOM Number:
Area Code and Fax Number: (305) 295-- 4320
E-mail Address: mCQ:rnts(amai 1 .l'lT::!t:P fl tiC:
5. Contact Person:
Name of Contact Person: Reed':Htirley''': j"
Title: Chief Financial Officer Telephone Number: 305-292-6Rt.1
E-mail Address:creedhurley@aol.com
SFY 2001 RSA T Subgrant Application Package
Page 1
Application (09/01100)
Florida Department of Law enforcement~
B. Administrative ta
1. Project Title (Not to exceed 36 characters, including spaces):
Monroe County Jail Incarceration Program
2. Project Period:
Period Month . Day Year
8eginning February 15 2001
Ending ~~pt;~mber 30 2001
- - ". _.
C. Fiscal Data
1. Remit Warrant to (If other than the Chief Financial Ottlcer):
David P. Owens
Grants Administrator
5100 College Road, Room 211
Key West, FL 33040
2. Vendor # (Enter Federal Employer Identification Number [FEID] of Subgrantee)
(If Subgrantee is State agency enter SAMAS number instead)
59-6000749 .
3. Will the Project eam Project Generated Income (PGI) as defined in Section H,
Paragraph 141 (Check one)
Yes
~No
4. Will the applicant be requesting an advance of federal funds? (Check one)
_ Yes (If Yes, a letter of request must be "attached) ~ No
5. Will applicant submit monthly or quarterly Reimbursement Requests (Form RSA T-003 (A-G)], as
specified in Section H. Item 1 b. of this agreement? (Check one)
~ Monthly
_ Quarterly
SFY 2001 RSA T Subgfant Application Package
Page 2
Application (09f1J1/00)
~ d 69e:60S19~V "oN/LS'OI -~S/6S:01 10 .9Z"1 (lli.:l)
~~I.:I.:IO .:I.:II~~HS O~ ~O~NOW WO:~
D. prograr ata
Florida Department of Law t:morcemem
1. Program Facility (check all that apply)
_ Prison
-L- Jail
_ Boot Camp
_ Work Camp
_ Halfway House
_ Community Corrections Program
_ Juvenile Detention Facility
_ Juvenile Correctional Facility
_ Other (specify)
2. Target Population (indicate number of clients to be served)
-5.0... Adult Males
---0-.: Adult Females _ Juvenile Males _ Juvenile Fe!flales
3. Services/Interventions Available (check all that" apply to indicate seNices that will be offered)
-1L.. Therapeutic Community
-S- 12-Step Program
-2L- Individual CounselinQ
--X- Group Counseling
_ Acupuncture
_ Pharmacotherapy
....L.- Other Orug Treatment
--X- Drug Testing
-L.. Mental Health Counseling
~ Educational Programs
_ Community Service
Victim Restitution
_ Restorative/Community Justice
Victim Awareness
~ Mediation
~ Domestic Violence Reduction
_ Family Counseling
_ Sex Offender Treatment '
-X....- Impulse/Anger Control
_ Work Activities
---X-- Job Skills Development
_ Job Placement
---X- Aftercare Services
-1.- Structured Leisure Time
_ Leadership Training
_ Mentoring
_ Parenting Training
~ Cognitive Restructuring
_ Financial Management
_ -X-- Other (specify) DruV Court T i '" cd '";"
4. Projection of Successful Completions (indicate number of clients projected for each phase):
a. A total of '\ 'i participants are projected to successfully complete the residential
substance abuse treatment service phase during the subgrant period.
b. A total of 30 participants are projected to successfully complete the aftercar~
treatment pnase during tne subgrant period.
.
*** The first year of the grant is partial funding to implement the
existing program. The numbers will increase as this projection
covers the last four months of the first year.
SFY 200t RSAT Subqrllnt Application Package
1: d 1:8E60S191:t> 'Oi'</Lt>:OI '.L8/917:01 10 ,IE 'I (a3M)
Page 3
Apolication (09/01/00)
~~I~dO jdIE3H8 00 30ENOW wo~,
Residential Substance Abuse Treatment Program
Florida Department of Law' Enfo ~ment .
E. Program Descl.t.ltion/Objectfves
Beg!n with a~ :xec~tive-~tvI~ summary which is acoroximatelv one cace in lencth. Continue, providing
a bnef .descnption With objectives for each project activity checked in Section O. Paragraph 3. descnbin
who WIll do what. when, where and how, a maximum of ten additional pages. Start below. . 9
PROBLEM IDENTIFICA nON
According to the Monroe County Detention Center over sixty percent of the inmates
currently housed here have substance abuse related charges as a direct result of their drug use
which is pervasive in Monroe County. The inmates need help with anger management. domestic
abuse, job and housing placements, educational and literacy improvements, aftercare, mental
health counseling and referrals, and phannacologica1 assessments.
SOLUTION
Presently the Sheriff's Inmate IntcrventionIResidential 0I11g Program operates an.in.
house substance abuse treatment program fun~cd by the Monroe County Substance AbU$C
Advisory Board and a Byrne Grant which runs until September 30. 200 1. This program has been
in existence for over three years, has a twenty-five percent recidivism rate among program
graduates as compared to seventy percent of the general popu18Jion.
Under the enhancement that the monies from this grant will provide, male inmates will be
housed in a separate therapeutic community. Those who volunteer for the program will have
liaison and advocacy if needed to help them get treatment either in this program or another long-
term program deemed appropriate. All male inmates will be individually screened to ascertain
any special needs and an individualized treatment plan will be written for them. (A copy of that
treatment plan form is included in this summary.) The program oudined for them will include any
special counseling in the areas of anger management, domestic abuse, and mental health as well
as appropriate screening and referral for educational and/or vocational training. transitional
housing, aftercare with the Care Center for Mental Health, work release or job services. These
enhancements will increase the likelihood of succ:css in recovery and decrease the criminal
activity associated with substance abuse.
The program win continue the prc:sc:nt substance abuse education and counseling with the
MRT workbook and the Rational Emotive Therapy treatment In additional, those inmates who
arc screened and deemed appropriate will attend anser management classes, domestic abuse
classes. (classes designed for the victim or the perpetrator). and relationship problems.
Referrals will be made and assistance provided for imnates that need English as a second
language, literacy skill improvement, and OED classes. Life skills classes will address how to
look for. fill out a job applic:atioD, write a resume, and obtain work. how to apply for educ:at:ional
assistance, provide basic reading and writing skills, and how to mentor. (A schedule and an
outline of the materials used, and a criterion for completion in each of these areas is attaChed to
this summary.)
The enhanced program will last six months, with three months of aftercare upon release
from the facility. The aftercare will be provided for the Care Center for Mental Health or referred,
as they deem appropriate.
As the first year will not be fully funded, the number of male clients who will complete
the program will be ~5.
80% of the clients served will succ:essfully complete the aftercare program.
100% of the clients served in the program will remain drug free while incarcerated.
60% of the clients served will not test positive during their aftercare program.
90% of the clients served will remain conviction free during their afterc:are program.
85% of the clients served will not violate probarion during their aftercare.
S d Z;8S6(;~19G!70~/L7:01 '1.8/8!7:01 10 .IS'1 CQ3:M)
=OI~~O ~~IH3:HS 00 3:0HNON WO~d
. i
OBJECTIVES
Under this program. ~trBCtUal staft'from ths Can: Center lor l tfental H=lth will bo able
to utilize their c:xpc:rieDQC;; and training for aD the staffing that tb~ pr )gr1 III requires. The: Can:
Ceuter for mental Health holds the substaD" abuse:: treatment JiceD! " fo r the jail. end provides the:
administrativo and case management sc::rvi~ U 1I18Ddatcd by Florit 1a.A dmiDistrati~ Code 10-
E16. The Prognun CoordiDator must hold a Mutar.s level ill COUll! c1in J and Psychology and be
a Certified Addictions Professional in Florida. The other three COD jele rs mnst be Ccrtificcl
Addiction Professionals or be certified eligible.
All the counselors will do intakes, make up treatment plaJ1S COI tduct group and individual
substance abuse counseling, address. t'clation.sbip issues, conduct M tT lad RET sessioos, submit
case Dotes. and prepare progress reports.
Under the direction ofthc Prognun Coordinator. random dug' eating will be conducted
weekly with all inmates being tc:sccd each mouth. The Oetc:uti011 Cc: !UCt has BIl ETS PIlla SystClrl
that can analyze for drug urine saecuiug. toXicological serum scree ami. and quaotitativc analysis
of ethyl alcohol in urine and serumlplasma. It worb for the foUowi 18 c lasses of chugs:
J\mph~c'McthamphetamiDe. Amphetamine, Barbiturate, Bcm oeli: JZepinc, c:annabiDoid,
Cocaine, Methadone, Mcthaqua1gne, Opiate, Phencyclidine. and Pr)JJCX :phme.
The testing is conducted by the counseling with a cleat chaitJ of cw Cod3' and a detailed test remit
fonn. (A copy oftbat form is attached to this Clmtm2f)'.)
Hdder the agrccmCllt tb.e Cue Ccuta" Cor McutaJ Heath wi: I pII )Vide tho aftetoore
program for the clicutS who complete the:: incarcc:ratcd portion ofth = p1'I'gram. The clients will be
c:valuatcd monthly wbile aUa1ding aftercare with a dieZlt Uea!ment upd Jtc.
The Program Coordinator will further evalWIlC the prognm: 's C !'cctivcne5S by tracking
the number of mcsts for the clients who completed the prognan. ill :1uc ing the aftercare. at six-
month and one year intervals. For recidivism purposes. a SllDPle of pro ~'s clients will be
complied to a TaDdom smuple within the jail's popuWion ofimDab '5 W 10 did not m:cive
tmltment in the program.
The Program Coord.iumor will review all the testing 8IJd SCi =n:ag oftbe clieDts and
make the final dc:termiDation for appropriate treatment. WIth trainiJ g m EMDR. Reality Therapy,
trauma and abuse issu~ anger mmagcmCl1t, ami mc:mal hnlth pro )I_IS, the Progrum
Coordinator will do cOunseling in these specie1 areas as weD as per :om L the administrative tasks
necessary, and be responsible for grant reporting.
FUNDING
Funding for the present program is provided from (be Mon 'Ce I :ounty Substance Abuse
Advisory Board. The Byme Gram. and TIle Sheriff ofMomoe COD 3!y. Local county government
has indicated that they are willing to fUnd the marcl1 for this grant. ':he t1eed for the program is
apparent. Once we clearly demonst:rat.c: a continued reduced recidh ism ralC. the possibility for
funding mrough fmfeiture and/or the Imnarc Welfarc ftu1d is a stm Ig P Jssibility for perDUlDent
funding for this program by 2003.
.
SFY 2.001 RSAT Svbgranl AOlllic:llion Pac:k3~e
Page 4
Applicatio" (09101100)
E d (LEGOSl9~t> -ON/CC:Ol -':'S/ZO:Ol .0 .5z:.t (NO)'(1
~~I~~O ddI~3HS O~ 3oKNOW weE
Care Center
Fo., Mental Health
1205 Fourth Street Key West. Rorida 33040 305-292-6843
FAX: 305-292-6723 SUNCOM: 464-6843
December 5, 2000
Dave Owens, Grants Manager
Monroe County Grants Department
5100 College Road, Rm 002
Key West, FL 33040
RE: RSAT Grant for Monroe County Detention Center
Dear Mr. Owens,
The Care Center for Mental Health, which is licensed by the Florida Department of
Children & Families as an Outpatient Substance Abuse Treatment provider, will give
priority-access to aftercare services to the graduates of the RSA T program provided at the
Monroe County Detention Center. The Care Center currently provides Outpatient
Services to clients in all phases of substance abuse recovery including individuals that
have been previously incarcerated. The Center will design a program of group and
individual treatment to meet the aftercare needs of these individuals.
If you have any questions or concerns please feel free to contact me at (305) 292-6843.
Sincere~
t/!:lf!y,
Chief Financial Officer
~lC'HILDREN
I2l & FAMILIES
MONROE COUNTY DETENTIO~-~ACILITY
5501 COLLEGE ROAJ.
KEY WEST, FLORIDA 33040
INDIVIDUAL SPECIMEN REPORT
Date: 10/04/2000
Time: 11:43
Operator ID: LJM
Subject ID: 26661
Last Name:
Group ID: DRUG CLASS
First Name:
Specimen ID: 001004.011
Date Collected: 10/04/2000 (mm/dd/yy)
Comment:
Time Collected:
(hh: mm)
Assay Result/Cone. Test Date/Time ETS
AO Rate Calib./Cutoff Instrument * Source
Approval Date/Time Op. In
Tray
-----------------------------------------------------------------------
Cup
=======================================================================
Barbiturates Negative 10/04/2000 11: 17 1 1
881 195 280 4154 001004-1.ETS
10/04/2000 11:30 LJM
Benzodiazepines Negative 10/04/2000 11: 17 1 1
953 337 424 4154 001004-1.ETS
10/04/2000 11:30 LJM
Cannabinoid - 50 ng Negative 10/04/2000 11: 17 1 1
1037 713 799 4154 001004-1.ETS
10/04/2000 11:30 LJM
Cocaine Negative 10/04/2000 11:17 1 1
1017 434 514 4154 001004-1.ETS
10/04/2000 11: 30 LJM
Opiates Negative 10/04/2000 11:17 1 1
929 277 382 4154 001004-1.ETS
10/04/2000 11:30 LJM
11
11
11
11
11
-----------------------------------------------------------------------
************************* Incomplete Assay(s) *************************
Ethyl A1cohol
Test Date: 10/04/2000
Specimen Outcome: *** Incomplete ***
TESTS PERFORMED BY:
.
MATERIALS USED AND CRITERION FOR COMPLETION
MRT WOOKBOOK- COMPLETE THE BOOK AS OUTLINED.
PASS STEP ELEVEN AND PRESENT THE FREEDOM LADDER.
SUBMIT WRITTEN LIFE STORY
WOMAN'S JOURNAL- COMPLETE ALL ASIGNMENTS AS OUlLINED IN THE JOURNAL
SUBMIT WRITIEN LIFE STORY
SESSIONS/ SERlES- ATIEND THE GROUP, PARTICIPATE IN GROUP DISCUSSION ON
MATERIAL PRESENTED, COMPLETE ACCOMPANYING HOMEWORK
12 STEP GROUP- ATTEND GROUP. PARTICIPATE IN DISCUSSION. COMPLETE THE
FIRST THREE STEPS IN WRITING.
LITERACY- ATIEND GROUP, PARTICIPATE IN THE EXERCISES TO THE BEST
OF THEIR ABIT.ITY, PARTICIPATE IN GED CLASSES IF ACCEPTED.
ANGER
MANAGEMENT- ATIEND THE GROUP, COMPLETE THE "CAGE THE RAGE..
WORKBOOK, PARTICIPATE IN GROUP DISCUSSIONS. COMPLETE
ANY OTHER HOMEWORK. .
DOMESTIC
VIOLENCE- ATIEND THE GROUP, COMPLETE "REPEAT AFTER ME.. WORKBOOK.,
COMPLETE ALL OTHER ASSIGNMENTS, PARTICIPATE IN
DISCUSSIONS. and PARTICIPATE IN TRUST BUll..DING EXERCISES.
COMPLETE WORK IN "COURAGE TO HEAL"' WORKBOOK.
RELA TIONSHlP
ISSUES- ATIEND GROUP, READ "CODEPEDENT NO MORE"', COMPLETE
WORKBOOK ASSIGNMENTS FROM TIlAT BOOK, PARTICIPATE IN
GROUP.
INDIVIDUALS- VARIOUS TIIERAPIES AND TECHNIQUES mAT MAY INCLUDE
TRAUMA WORK. EMDR, REALITY THERAPY, RET, MEDITATION.
AND MORE.
SERIES
tOUISE MARKS-~ADDICTION -
LOUISE MARKS- SPIRITUALITY
REBT SERIES - ANGER
GUILT/SHAME
GRIEF
ANXIETY/wORRY
DEPRESSION
UNDERSTANDING
SELF ESTEEMJPERFECTIONIST
LOUISE MARKS - RELATIONSHIPS
GORSKYIBLACK - ADDICTIVE RELATIONS I
GIE AIR II AND ill
MOYERS SERIES ON ADDICTION ONE
TWO AND THREE
FOUR
FIVE
SESSIONS
WHAT IS CHElvfICAL DEPENDENCY
COCAINE! ALCOH01.JMIND ALTERING CHEM
ALCOHOL AND DRUG QUIZ
EARLY RECOVER YIB OUND ARIES
THEUPEUTIC APPROACH TO ALCOHOLISM
5 P'S
. COCAINE-BUTTERFLY LETIERS
CROSS ADDICTION
DENIAL
COCAINE RALPH
RELAPSE PREVENTION
WOMEN'S!MEN'S ISSUES
. GRAPH- PROGRESSION OF DEPENDENCY
LIVING DRUG FREE
YOUR BRAIN ON DRUGS
LIVING CLEAN ON TIIE OUTSIDE ..__
.
:INITIAL POBHAL TREATMENT Pl.AN
.~
RU Activity Code
Client Name:
Diagnosis (DSM IV) :
ICD-9 # GAP Score
Date DeveJop~d
C ~SE:#
Goa1s and Objectives
1. Problem Statement:
Goal:
Action Steps (action to be taken by client) :
Intervention/Treatment Modality: .'
Activity to be taken by Clinician:
Pci(lrity: I II III IV
Frequency of Treatment: DuraC:.on:
Evaluation criteria:
Goal Atta~ent Target Date:
Treatment provided by:
Credential::
Name
2. Problem Statement:
Goal:
Action Steps (action to be taken by client) :_-
Intervention/Treatment Modality:
Activity to be taken by Clinician:
DU1'at ion
Frequency of Treatment:
Evaluation Criteria:
Goal Attainment Target Date:
Treatment Provided by:
Cree .en :ial s
Title
Name
.'
Title
3.Problem Statement:
Goal:
Action Steps (action to be taken by client) :
Intervention/Treatment Modality:
Activity to be taken by Clinician:
Frequency/Treatment:
Evaluation Criteria:
Goal Attainment Target Date:
Treatment provided by:
Credent..als
Title
Name
'\\
4.problem Statement:
Goal:
Action Steps (action to be taken by client) :___
Intervention/Treatment Modality:
Activity to be taken by Clinician:
Frequency of Treatment:
Evaluation Criteria:
:)wation:
D Ire.tion:
Cre'ler tials
Title
5.problem Statement:
Goal:
Action Steps ( Action to be taken by client} :___
Intervention/Treatment Modality:
Activity to be taken by clinician:
Frequency of Treatment:
Evaluation Criteria:
Goal Attainment Target date:
Treatment provided by:
credentials
Title
Name
Disc~arge Criteria/Plan:
I ur ition:
THE UNDERSIGNED TREA:'tING PHYSICIAN CERTJ:FJ:E) 't'HAT THE SERVICES
RECOMMENDED ARE HEDI:CALLY NECESSARY AND ru>J>ROPRIATE TO THE
RECIPJ:ENT' S DIAGNOSIS AND TREATMENT NEEDS.
date
Medical Dir3d:or"
client Signature
date
Therapist
date
Case ManagEr
Supervisor date
DATE OF NEXT TREATMENT PLAN:
date
.
TREATMENT PLAN UPDATe:
Date Developed
C.lse#
\
RU Activity Code
Client Name:
Diagnosis (DSM IV) :
ICD-9 # GAF Score
Pria~ity: I II III IV
Goa~s and Objectives
1. Problem Statement:
Goal:
Action Steps (action to be taken by client) :
Intervention/Treatment Modality:
Activity tQ be taken by Clinician:
Frequency of Treatmenc:
Evaluation Criteria:
Dura ti:m:
Goal Attainment Target Date:
Treatment provided by:
Credentials
Name
2. Problem Statement:
Goal:
Action Steps (action to be taken by client) :___
Intervention/Treatment Modality:
Activity to be taken by Clinician:
Dur3.t=.on
Frequency of Treatment:
Evaluation Criteria:
Goal Attainment Target Date:
Treatment Provided by:
Cred:n1.ials
Name
Discharge Criteria/plan:
Title
Title
TEE UNDERSIGNED TREATING PHYSICIAN CERTIFIES T E1AT THE SERVICES.
RECOMMENDED ARE. MEDICALLY NECESSARY .AND }, PP lOPRIATE TO THE
RECIPIENT'S DIAGNOSIS AND TREATMENT NEEDS.
Medical Dirl~ct or
date
Client Signature
date
Therapist
date
Case Manage::-
supervisor date
DATE OF NEXT TREATMENT PLAN:
date
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PLEASE BE FLEXIBLE. WE APPRECIATE YOUR UNDERSTANI INC r.
01129/01 !ION 10:10 FAX 305 ;!ll~ 1)14:;)
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MONDAY 9-11 AM MALES MIlT .
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01/26/01 FRI 15:20 FAX 305 292 6723
Care Center
~002
RE 'ential Substance Abuse Treatml__ ProQram
Florida Department of law Enforcer 1en :
F. Project Budget Narrative
The Project Budget Schedule (Section G) Includes six Budget Cs tege fries (Salaries and Benefits,
Contractual Services. Expenses. Operating Capital Outlay (OCO , DlIta Processing Services, and
Indirect Costs) and Total Project Costs. Starting below and usin{ cOlltinuation pages as necessary
up to a maximum of ten pages, group line items according to ea :h a ,plicable Budget Category for
which you are requesting subgrant funding. Provide sufficient de :ailllnd narrative justification to
establish cost relationships relative to project actiVities. In additic n. s Jecify the source of match
funds, which must be cash and must represent no less than twef ty.fi ole (25) percent of the
project's total budgeted cost, i,e,. match funding will be drawn fro n 91 meral revenue source (or
from Law Enforcement Trust Fund. etc,),
SALARY INFORMATION
Program Director ( 4 Months)
{Monitors program for compliance, supervises 3 counselors,
and provides counseling and education services)
Substance Abuse Counselor 1 . (4 Months )
(Provides counseling and education services)
Substance Abuse Counselor 2 (4 Months )
(Provides counseling and education services)
Substance Abuse Counsefor 3 (12 Months) .
(Provides counseling and education services)
TOTAL SALARIES
Benefits
FICA @ 7.65%
Health Insurance
Educational.Tools
(Workbooks, Videos, and Other Educational Supplies)
Office Supplies
{Charting materials, oopy paper, and Misc. Supplies)
Tra"el
(Travel and. fees associated with required trainings to
maintain licensure of program staff)
TOTAL PROGRAM COSTS
Match (25%)
Grant Funds Requested
" 14,000
.,
,. 8,666
01
" 8.667
oj
.. 26.000
"
t' 57,333
"
,. 4,386
.1
" 4,214
"
" 9,000.00
"
"
"
1,000
"
,I
2,000
,.
.1
77,933
<< .
"
19,484
c
. .
58,449
Matching funds will be provided by County govemmentlSheriff's Office fundi 19.
Three of the programs employees will be funded through another grant 'or tile fi 'St 8 months of
the grant year. Educational and Office Supplies consist of workbooks, videc s, end other teaching
aids as well as general office supplies and materials for client charts. The 1 ravI:1 budget will
allow the program director and counselors to attend necessary trainings whi ::h l! re
required for continuing education credits for licensure.
SFY 2001 RSAT Subgrant Application Package
Page 6
AppliC3tion (09/01/00)
. 1./ '"'0/ VJ.
.
r~J. J.'" ....J. rAA ~UU ",VI' u. _'" \..t:llTt:: \"It:U\,.t::J."
... .....~o:rlUc;UL1cU ..;JUU~HanCe Jo\DUSe . realfiHlnl r"rogram
Florida Department of Law Er''''~ E!!.t
Project Budb _. Schedule
G.
The Project Budget Schedule includes six BUdget Categories .
Services, Expenses, Operating Capital Outlay (OCO), Data PrOC'1
and Total Project Costs. The Local Match must be cash an
twenty-five (25) percent of the Total Project Budget.
Type or Print Dollar Amounts Only in Applicable Catego
Loe
Budget Category Federal Funds Ma'
,
Salaries and Benefits
Contractual Services $ 58,449 $ 1
Expen...!
Operating Capital Outlay
Data Processing
Indirect Costs
Totals $ 58,449 $ 19,1
SFY 2001 RSAT SubgrantAllllllcatlon Package
Page 7
~VVv
al
ch
lries and B.enefits, Contractual
19 Services, and Indirect Costs)
ust represent a minimum of
and Leave Others Blank.
Totals
34 $ 77,933
-
$ 77 ,933
Sa!:
5sil
drr
18S
~,4
84
Application (09101/00)
. ,......-. - - -
Florida Department of Law Enforcement
H. Acceptance and Agreement
All persons involved in or having administrative responsibility for the subgrant must read these "Acceptance
and Agreemenr' conditions. This "Acceptance and Agreement" (Section H) must be returned as part of
the completed application.
Note Condition No. 13: Only project costs incurred on or after the effective date of this agreement and on or
prior to the termination date of a recipient's project are eligible for reimbursement
Conditions of AQreement: Upon approval of this subgrant, the approved application and the following terms
of conditions will become binding. Non-compliance will result in project costs being disallowed.
Definitions:
The term "Department", unless otherwise stated, refers to the Florida Department of Law Enforcement.
The term "Recipient" refers to the governing body of a county that performs criminal justice functions as
determined by the U.S. Secretary of the Interior, and includes an "Implementing Agency" which is a
subordinate agency of a county or an agency under the direction of an elected official (for example, Sheriff).
1. Reports
a. Project Performance Reports:
The recipient shall submit Quarterly Project Performance Reports [Form RSAT-001] to the Department
by February 1, May 1, August 1, and November 1 covering subgrant activities occurring during the
previous calendar quarter.
A Project Performance Report [Form RSAT-002], covering the entire time frame of project activities, is
due within forty-five (45) days after the end of the project period.
In addition, if the subgrant award period is extended beyond the "original" project period, additional
Quarterly Project Performance Reports shall be submitted as well as a Final Project Performance
Report.
The recipient shall submit an Annual Project-Level Evaluation Report (APLER) [Form RSAT-004] by
October 30. The report shall cover subgrant activities occu.rring during the period of October 1 through
September 30 of the one-year period ending 30 days prior to the due date for this report. The report
shall meet the minimum data requirements specified in Form RSAT-004. Federal funds may be used
to track program and offender outcomes required for the APLER providing the costs are included in the
approved budget
b. Financial Reports:
The recipient shall have the choice of submitting either Monthly or Quarterly Reimbursement Request
[Form RSA T 003 (A-G)] to the Department. Monthly Reimbursement Request (months 1 through 11)
are due thirty-one (31) days after the end of the reporting period. Quarterly Reimbursement Requests
(1 st through 3rd quarter) are due thirty-one (31) days after the end of the reporting period. A final
Reimbursement Request and a Criminal Justice Contract (Financial) Closeout Package shall be
submitted to the Department within forty-five (45) days of the subgrant termination period. Such
Reimbursement Request shall be distinctly identified as "final".
Before the "final" Reimbursement Request will be processed, the recipient must submit to the
Department all outstanding project performance reports and must have satisfied all special conditions.
Failure to comply with the above provisions shall result in forfeiture of reimbursement.
The recipient shall submit Quarterly Project Generated Income Reports [Form RSAT 004] to the
SFY 2001 RSA T Subgrant Application Package
Page 8
Application (09/01/00)
r-Iorida Department of Law Enforcement
DepartmE:.. . oy February 1, May 1, August 1, and Nov~ .uer 1, covering subgrant project generated
income and expenditures occurring during the previous quarter. (See Paragraph 14. Program
Income.)
c. Other Reports:
The recipient shall submit other reports as may be reasonably required by the Department. All
required reports, instructions, and forms shall be distributed with the subgrant award.
2. Fiscal Control and Fund Accounting Procedures
The recipient shall establish fiscal control and fund accounting procedures that assure proper
disbursement and accounting of subgrant funds and required non-federal expenditures. All funds spent on
this project shall be disburserl according to provisions of the project budget as approved by the
Department
All expenditures and cost accounting of funds shall conform to the requirements of the Office of Justice
Programs' Financial Guide (as amended) and those specified in the federal Office of Management and
Budget (OMB) Circulars A-21 , A-a7, and A-110, in their entirety.
All funds not spent according to this agreement shall be subject to repayment by the recipient.
3. Compliance with "Consultant's Competitive Negotiation Act"
The recipient, when applicable, agrees to satisfy all requirements provided in Section 287.055, Florida
Statutes (F.S.), known as the "Consultant's Competitive Negotiation Act".
4. Approval of Consultant Contracts
The Department shall review and approve in writing all consultant contracts prior to employment of a
consultant. Approval shall be based upon the contract's compliance with requirements found in the Office
of Justice Programs' Financial Guide (as amended) and in applicable state statutes. The Department's
approval of the recipient agreement does not constitute approval of consultant contracts.
5. Allowable Costs
Allowance for costs incurred under the subgrant shall be determined according to "General Principles of
Allowability and Standards for Selected Cost Items" set forth in the Office of Justice Program's Financial
Guide (as amended) and federal OMS's Circular No. A-87, "Cost Principles for State and Local
Governments", or OMS's Circular No. A-21 , "Cost Principles for Educational Institutions".
All procedures employed in the use of federal funds to procure services, supplies or equipment, shall be
according to U.S. OMS's Common Rule for State and Local Governments, or Attachment "0" of OMS
Circular No. A-11 0 and Florida Law to be eligible for reimbursement.
6. Travel
All travel reimbursement for out-of-state or out-of-grant-specified work area shall be based upon written
approval of the Department prior to commencement of actual travel.
The cost of all travel shall be reimbursed according to local regulations, but not in excess of provisions in
Section 112.061, F.S.
All bills for any travel expenses shall be submitted according to provisions in Section 112.061, F.S.
SFY 2001 RSA T Subgrant Application Package
Page 9
Application (09/01/00)
Florida Department of Law Enforcement
7. Written Approval of Cnanges in this Approved Agreement
a. Changes in project activities, designs or research plans set forth in the approved agreement;
b. Budget deviations that do not meet the following criterion. That is, a recipient may transfer funds
between budget categories as long as the total .amount of transfer does not exceed ten (1 0) percent of
the total approved budget and the transfer is made to an approved budget line item; or,
c. Transfers of funds above the ten (10) percent cap shall be made only if a revised budget is approved
by the Department.
d. Under no circumstances can transfers of funds increase the total budgeted award. Transfers do not
allow. for increasing the quantitative number of items documented in any approved budget line item.
(For example, equipment items in Operating Capital Outlay or Expense categories or staff positions in
the Salaries and Benefits category.)
8. Reimbursement Subject to Available Funds
The obligation of the State of Florida to reimburse recipients for incurred costs is subject to the availability
of federal funds authorized under the Residential Substance Abuse Treatment for State Prisoners Formula
Grant Program.
9. Advance Funding
Advance funding is authorized up to twenty-five (25) percent of the federal award for each project
according to Section 216.181(15)(b), F.S.: the Office of Justice Programs' Financial Guide (as amended).
Advance funding shall be provided to a recipient upon a written request to the Department justifying the
need for such funds. This request, including the justification, shall be enclosed with the subgrant
application.
10. Commencement of Project
If a project has not begun within sixty (60) days after acceptance of the subgrant award. the recipient shall
send a letter to the Department requesting approval of a new project starting date. The letter must outline
steps to initiate the project, explain reasons for delay, and specify an anticipated project starting date.
If a project has not begun within ninety (90) days after acceptance of the subgrant award, the recipient
shall send another letter to the Department, again explaining reasons for delay and requesting approval of
a revised project starting date.
Upon receipt of the ninety (90) day letter, the Department shall determine if the reason for delay is justified
or shall, at its discretion, unilaterally terminate this agreement and reobligate subgrant funds to other
projects approved by the Department. If warranted by extenuating circumstances. the Department may
extend the starting date of "the project beyond the ninety (90) day period, but only by execution of a formal
written amendment to this agreement. .
11. Extension of a Contract for Contractual Services
Extension of a contract for contractual services between the recipient and a contractor (which includes all
project budget categories) shall be in writing for a period not to exceed six (6) months and is subject to the
same terms and conditions set forth in the initial contract. Only one extension of the contract shall be
acceptable, unless failure to complete the contract is due to events beyond the control of the contractor.
12. Excusable Delays
Except with respect to defaults of consultants, the recipient shall not be in default by reason of any failure
in performance of this agreement according to its terms (including any failure by the recipient to make
SFY 2001 RSA T Subgrant Application Pacltage
Page 10
Application (09/01100)
Florida Department of Law Enforcement
progress in the execution of work hereunder which endangt.,... such performance} if such failure arises out
of causes beyond the control and without the fault or negligence of the recipient. Such causes include but
are not limited to acts of God or of the pUblic enemy, acts of the government in either its sovereign or
contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, freight embargoes, and
unusually severe weather, but in every case the failure to perform shall be beyond the control and without
the fault or negligence of the recipient.
If failure to perform is caused by failure of a consultant to perform or make progress, and if such failure
arises out of causes beyond the control of recipient and consultant, and without fault or negligence of either
of them, the recipient shall not be deemed in default, unless:
a. Supplies or services to be furnished by the consultant were obtainable from other sources,
b. The Department ordered the recipient in writing to procure such supplies or services from other
sources, and
c. The recipient failed to reasonably comply with such order.
Upon request of the recipient, the Department shall ascertain the facts and the extent of such failure, and if
the Department determines that any failure to perform was occasioned by one or more said causes, the
delivery schedule shall be revised accordingly.
13. Obligation of Recipient Funds
Recipient funds shall not under any circumstances be obligated prior to the effective date or subsequent to
the termination date of the grant period. Only project costs incurred on or after the effective date and
on or prior to the termination date of the recipient's project are eligible for reimbursement. A cost
is incurred when the recipient's employee or consultant performs required services, or when the recipient
receives goods, notwithstanding the date of order.
14. Program Income (also known as Project Generated Income)
The term "program income" or "project generated income" means the gross income earned by the
recipient during the subgrant period, as a direct result of the subgrant award. Program income shall be
handled according to the Office of Justice Programs' Financial Guide {as amended}.
The recipient shall submit Project Generated Income Reports in accordance with Section H, Paragraph
1.b.
15. Performance of Agreement Provisions
In the event of default, non--compliance or violation of any provision of this agreement by the recipient, the
recipient's consultants arld suppliers, or both, the Departr:n.ent shall impose sanctions it deems appropriate
including withholding payments and cancellation, termination or suspension of the agreement in whole or
in part. In such event, the Department shall notify the recipient of its decision thirty (30) days in advance
of the effective da!e of such sanction. The recipient shall be paid only for those services satisfactorily
performed prior to the effective date of such sanction.
16. Access To Records
The Florida Department of Law Enforcement; the U.S. Department of Justice, Office of Justice Programs,
Bureau of Justice Assistance; Auditor General of the State of Florida; the U.S. Comptroller General or any
of their duly authorized representatives, shall have access to books, documents, papers and records of
the recipient, Implementing Agency and contractors for the purpose of audit and examination according to
the Office of Justice Program's Financial Guide (as amended).
SFY 2001 RSAT Subgrant Application Package
Page 11
Application (09/01100)
Florida Department of Law Enforcement
The Department reserves the right to unilaterally terminate this aglt:!ement if the recipient, Implementing
Agency or contractor refuses to allow public access to all documents, papers, letters, or other materials
subject to provisions of Chapter 119, F.S., and made or received by the recipient or its contractor in
conjunction with this agreement
17. Audit
a. The recipient shall provide to the Department one copy of an annual audit conducted in compliance
with The Single Audit Act of 1984, Public Law (P.L.) 98-502. The audit shall be performed in
accordance with the federal OMS's Circular A-128/A-133 and other applicable federal law. The
contract for this agreement shall be identified with the subject audit in The Schedule of Federal
Financial Assistance. The contract shall be identified as federal funds passed through the Florida
Department of Law Enforcement and include the contract number, federal Catalog For Domestic
Assistance (CFOA) number, award amount, contract period, funds received and disbursed. When
applicable, the recipient shall submit an annual financial audit which meets the requirements of
Sections 11.45 and 215.97, F.S.; and, Chapters 10.550 and 10.600, Rules of the Florida Auditor
General.
b. A complete audit report which covers any portion of the effective dates of this agreement must be
submitted within thirty (30) days after its completion, but no later than seven (7) months after the audit
period. In order to be complete, the submitted report shall include any management letters issued
separately and management's written response to all findings, both audit report and management
letter findings. Incomplete audit reports will not be accepted by the Department and will be returned to
the recipient
c. The recipient shall have all audits completed by an independent public accountant (IPA). The IPA
shall be either a Certified Public Accountant or a Licensed Public Accountant
d. The recipient shall take appropriate corrective action within six (6) months of the issue date of the
audit report in instances of noncompliance with federal laws and regulations. .
g. The completed audit reports should be sent to the following address:
Florida Department of Law Enforcement
Office of Inspector General
Post Office Sox 1489
Tallahassee, Florida 32302
18. Procedures for Reimbursement Request
All requests for reimbursement of recipient costs shall be submitted on Form RSAT-003(A-G), prescribed
and provided by the Department. A recipient shall submit reimbursement requests on a monthly or
quarterly basis, as specified in Section H, Item 1 b of this agreement, in order to report current project
costs.
All requests for reimbursement shall be submitted in sufficient detail for proper pre-audit and post-audit.
SFY 2001 RSAT Subgrant Application Package
Page 12
Application (09/01100) _
Florida Department of Law Enforcement
19. Retention of necords
The recipient shall maintain all records and documents for a minimum of three (3) years from the date of
the final financial statement and be available for audit and public disclosure upon request of duly
authorized persons.
20. Ownership of Data and Creative Material
Ownership of material, discoveries, inventions, and results developed, produced, or discovered
subordinate to this agreement is governed by the terms of the Office of Justice Program's Financial Guide
(as amended) and the federal OMB's Circular A-110, Attachment N, Paragraph Eight (8).
21. Property Accountability
The recipient agrees to use all non-expendable property for criminal justice purposes during its useful life
or request Department disposition.
The recipient shall establish and administer a system to protect. preserve, use, maintain and dispose of
any property furnished to it by the Department or purchased pursuant to this agreement according to
federal property management standar:ds set forth in the Office of Justice Programs' Financial Guide (as
amended) and the federal OMB's Circular A-110, Attachment N. This obligation continues as long as the
recipient retains the property, notwithstanding expiration of this agreement.
22. Disputes and Appeals
The Department shall make its decision in writing when responding to any disputes, disagreements or
questions of fact arising under this agreement and shall distribute its response to all concerned parties.
The recipient shall proceed diligently with the performance of this agreement according to the
Department's decision.
If the recipient appeals the Department's decision, it shall be made in writing within twenty-one (21)
calendar days to the secretary of the Department, whose decision is final.
. .
If the recipient appeals the Department's decision, it also shall be made in writing within twenty-one (21)
calendar days to the Department's agency clerk. The recipient's right to appeal the Department's decision
is contained in Chapter 120, F.S., and in procedures set fqrth in Chapters 28-5 and 9-5, Florida
Administrative Code. Failure to appeal within this time frame constitutes a waiver of proceedings under
Chapter 120, F.S.
23. Conferences and Inspection of Work
Conferences may be held at the request of any party to this agreement. At any time, a representative of
the Bureau, of the U.S. Department of Justice's Bureau of Justice Assistance or both have the privilege of
visiting the project site to monitor, inspect and assess work performed under this agreement.
24.
Publication or Printing of Reports
.
a. Before publication or printing, a final draft of any report required under or pertaining to this agreement
shall be sent to the Department for its review and comment.
b. Publications or printed reports covered under subparagraph a. above shall include the following
statements on the cover page:
SFY 2001 RSA T Subgrant Application Package
Page 13
Application (09/01/00)
Florida Department of Law Enforcement
i. "This report Wa;:; prepared for the Florida Department of L.... Enforcement, James T.
Moore, Commissioner, in cooperation with the U.S. Department of Justice, Bureau of
Justice Assistance." The next printed line shall identify the month and year the report
was published.
ii. ''This program is supported by a grant awarded to the Florida Department of Law
Enforcement, State of Florida, and by the Bureau of Justice Assistance (BJA), Office of
Justice Programs (OJP), U.S. Department of Justice. The BJA is a component of OJP
which also includes the Bureau of Justice Statistics, National institute of Justice, Office of
Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime."
Hi. "Points of view, opinions, and conclusions expressed in this report are those of the
'recipient and do not necessarily represent the official position or policies of the State of
Florida Department of Law Enforcement, the U.S. Department of Justice, Office of Justice
Programs, or any other agency of the state or federal government.
25. Equal Employment Opportunity (EEO)
No person, on the grounds of race, creed, color or national origin shall be excluded from participation in, be
refused benefits of, or otherwise subjected to discrimination under grants awarded pursuant to P.L. 89-
564, Non-Discrimination Requirements of the Anti-Drug Abuse Act of 1988; Title VI of the Civil Rights Act
of 1964; Section 504 of the Rehabilitation Act of 1973 as amended; Title IX of the Education Amendments
of 1972; The Age Discrimination Act of 1975; and, Department of Justice Non-Discrimination Regulations
28 Code of Federal Regulations (CFR) Part 42, Subparts C through H.
The recipient and a criminal justice agency that is the Implementing Agency agree to certify that they either
do or do not meet EEO program criteria as set forth in Section 501 of The Federal Omnibus Crime Control
and Safe Streets Act of 1968 as amended and that they have or have not formulated, implemented and
maintained a current EEO Program. Submission of this certification is a prerequisite to entering into
this agreement. This certification is a material representation of fact upon which reliance was placed
when this agreement was made. If the recipient or Implementing Agency meet Act criteria but have not
formulated, implemented and maintained such a current written EEO Program, they have 120 days after
the date this agreement was made to comply with the Act or face loss of federal funds subject to the
sanctions in the Justice System Improvement Act of 1979, P.L. 96-157, 42 United States Code (U.S.C.)
3701, et seq. (Reference Section 803 (a) of the Act, 42 U.S.C. 3783 (a) and CFR Section 42.707
Compliance Information).
26. Americans with Disabilities Act 1990
Subgraritees must comply with the requirements of the Americans with Disabilities Act (ADA), P.L. 101-
336, which prohibits discrimination by public and private entities on the basis of disability and requires
certain accommodations be made with regard to employment (Title I), state and local government services
and transportation (Title II}, j:)ublic accommodations (Title III), and telecommunications (Title IV).
27. Non-Procurement, Debarment and Suspension
The recipient agrees to comply with Executive Order 12549, Debarment and Suspension (34 CFR. Part 85.
Section 85.510, Participant's Responsibilities). These procedures require the recipient to certify that it shall
not enter into any lower tiered covered transaction with a person who is debarred, suspended. declared
ineligible or is voluntarily excluded from participating in this covered transaction, unless authorized by the
Department.
A person or affiliate who has been placed on the convicted vendor list following a conviction for a public
entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not
submit a bid on a contract with a public entity for the construction or repair of a public building or public
work, may not submit bids on leases of real property to a public entity, may not be awarded or perform
SFY 2001 RSAT Subgrant Application Package
Page 14
Application (09/01/00)
Florida Department of Law Enforcement
work as a con' 'tor, supplier, subcontractor, or consultan. '~h a public entity, and may not transact
business with c..."! public entity in excess of Category Two I..... a period of 36 months from the date of being
placed on the convicted vendor list.
28. Payment Contingent on Appropriation
The State of Florida's performance and obligation to pay under this agreement is contingent upon an
annual appropriation by the Florida Legislature.
29. Federal Restrictions on Lobbying
The recipient agrees to comply with Section 319 of P.L. 101.,121 set forth in "New Restrictions on
Lobbying; Interim Final Rule," published in the February 26,1990, Federal Register.
Each person shall file the most current edition of this Certification And Disclosure Form, if applicable, with
each submission that initiates agency consideration of such person for award of federal contract, grant, or
cooperative agreement of $100,000 or more; or federal loan of S150,OOO or more.
This certification is a material representation of fact upon which reliance was placed when this agreement
was made. Submission of this certification is a prerequisite to entering into this agreement subject to
conditions and penalties imposed by Section 1352, Title 31, U.S.C. Any person who fails to file the
required certification is subject to a civil penalty of not less than S10,OOO and not more than $100,000 for
each failure to file.
The undersigned certifies, to the best of his or her knowledge and belief, that
a. No federally appropriated funds have been paid or shall be paid to any person for influencing or
attempting to influence an officer or employee of any federal 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 loan, the entering into of any renewal, amendment, or modification of any federal contract,
grant, loan or cooperative agreement.
b. If any non-federal funds have been paid or shall be paid to any person for influencing or attempting to
influence 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 the standard form, Disclosure of Lobbying Activities, according to its instructions.
c. The undersigned shall require that the language of this certification be included in award documents for
all subgrant awards at all tiers and that all recipients shall certify and disclose accordingly.
30. State Restrictions on Lobbying
In addition to the provisions contained in Paragraph 29 of Section H, Acceptance and Agreement, the
expenditure of funds for the purpose of lobbying the legislature or a state agency is prohibited under this
contract.
31. Statement of Federal Funding Percentage and Dollar Amount
When issuing statements, press releases, requests for proposals, bid solicitations, and other documents
describing projects or programs funded in whole or in part with federal funds, all grantees and recipients
. receiving these federal funds, including but not limited to state and local governments, shall clearly state:
a. The percentage of the total cost of the program or project that shall be financed with federal funds, and
b. The dollar amount of federal funds to be expended on the project or'program.
SFY 2001 RSA T Subgrant Application Package
Page 15
Application (09/01/00)
Florida Department of Law Enforcement
32. Project Closeout
Project funds which have been properly obligated by the end of the subgrant funding period will have forty-
five (45) days in which to be liquidated (expended). Any funds not liquidated at the end of the 45-day
period will lapse and revert to the Department A subgrant funded project will not be closed out until the
recipient has satisfied all closeout requirements in one final subgrant closeout package.
All refunds or repayments to be made to the Department under this Agreement are to be made payable to
the order of -Florida Department of Law Enforcement", and mailed directly to the Department at the
following address:
Florida Department of Law -Enforcement
Attn: Cashier
Finance and Accounting
Post Office Box 1489
Tallahassee, FI32302
33. Background Check
It is strongly recommended that all programs targeting juveniles, implemented by other than a sworn law
enforcement officer or program licensed by the Department of Children and Family Services, conduct
background checks on all personnel providing direct services.
34. Purchase of American-Made Equipment and Products
To the greatest extent practicable, all equipment and products purchased with program funds should be
American-made.
35. Participation in National Evaluation Activities
The recipient agrees to participate in national evaluation activities of the National Institute of Justice and the
Department with respect to Residential Substance Abuse Treatment programs.
. 36. Eligibility for Employment in the United States
The State of Florida will not intentionally award publicly-funded contracts to any contractor wh~ knowingly
employs unauthorized alien workers. constituting a violation of the employment provisions contained in 8
U.S.C. Section 1324A{e) [Section 274A{e) of the Immigration and Nationality Act rINA-)]. The Department
shall consider the employment by any contractor of unauthorized aliens a violation of Section 274A{e) of
the INA. Such violation by the recipient of the employment provisions contained in Section 274A{e) of the
INA shall be grounds for unilateral cancellation of this Agreement by the Department.
SFY 2001 RSAT Subgrant Application Package
Page 16
Application (09/01/00)
-
u.s. DEPARTMENT OF J iTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they are required to
attest. Applicants should also review the instructions for certification included in the regulations before completing this
form. Signature of this form provides for compliance with certificat.ion requirements under 28 CFR Part 69, -New
Restrictions on Lobbying" and 28 CFR Part 67, -Government-wide Debarment and Suspension (Non-procurement) and
Government-wide Requirements for Drug-Free Workplace (Grants)". The certifications shall be treated as a material
representation of fact upon which reliance will be placed when the Department of Justice determines to award the
covered transaction, grant, or cooperative agreement.
1. LOBBYING
As required by Section 1352. Tille 31 of the U.S. Code. and implemented at
28 CFR Part 69, for persons entering into a grant or cooperative agreement
over S 1 00,000. as defined at 28 CFR Part 69, the applicant certifies that
(iI) No federal appropriated funds have been paid or will be paid. by or on
behalf of the undersigned, to any person for intluenclng or attempting to
lntluence an offtcer or employee of any agency, a member of Congress, an
offleer or employee of Congress. or an employee of a Member of Congress
in connection with the making of any federal grant, the entering Into of any
cooperative agreement, and the extension. continualion, renewal.
amendment, or modification of any federal grant or cooperative agreement;
(b) If any funds olller than federal appropriated funds have been paid or win
be paid to any person intluenclng or attempting to intluence an offtcer or
employee of any agency. a member of Congress. an offteer or an employee
of Congress. or an employee of a member of Congress in connection with
this federal grant or cooperative agreement, the undersigned shaU complete
and submit Standard Form. LLL. .Dlsdosure of Lobbying Activities., in
accordance with its instruclions;
(c) The undersigned shall require lhat the language of this certificalion be
included in lIle award documents for all subawards It allliers (including
subgrants, contracts under grants and cooperative Igreements. and
subcontracts) and that all subreciplents shall certify and disclose
accordingly.
2. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBIUTY MATTERS
(DIRECT RECIPIENT)
As required by Executive Order 12549, Debarmentand Suspension. and
implemented at 28 CFRPart 67. for prospective participants in primary
covered transactions. as defined at 28 CFR Part 67, Section 67.510 .
.
A. The applicant certifies that it and its principalS:
(a) Are not presenUy debarred, suspended. proposed for debarment,
declared ineligible. sentenced to a denial of federal benefits by a State or
Federal court. or voluntarily excluded from covered transactions by any
federal department or agency;
(b) Have not within a three-year period preceding this application been
convic:ed of or l1ad a civil judgement 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) transaction or
contract under a public transaction; violation of Federal or Slate antitrust
statutes or commission of embezzlement. theft forgery. bribery.
falsificalion or desltuction of records. making false statements, or receiving
stolen property;
(c) Are not presenUy indicted for or olllezwise crimlnally or c:ivilfy charged
by a govemmental enlity (Federal. State. or local) with commission of any
of the offenses enumerated in paragraph (1) (b) of this certitlcalion; and
(d) Have not within a tnree-year period preceding this application had one
or more public transaclions (Federal. State. or local) tenninaled for cause
or default; and
B. Where the applicant ls unable to certify to any of the statements In this
certillcalion. l1e or she sIlall attach an explanalion to this applicalion.
3. DRUG-FREE WORKPLACE
(GRANTEES OTHER THAN INDMDUALS)
As required by the Orug.FreeWorkplace Ad of 1988, and implemented at
28 CFR Part 67, Subpillt F. for grantees. as defined at 28.CFR PiIIt 67
Sections 67.615 and 157.620-
A. "'e applicant certifies that it will or will continue to provide a drug-free
workplace by:
(I) Publishing a statement nolifying employees that the unlawful
manufacture, distribution. dispensing. possession. or use of a controlled
substance is prollibited in the grantee's workplace and specifying the
actions lIlat will be taken against employees for violation of sucll
prohibilion;
(b) Establislling an on.going drug-free awareness program to inform
employees about.
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling. rehabilitation, and employee assistance
programs; and
(4) "'e penalties that may be imposed upon employees for drug abuse
violations oCQJrring in the workplace;
(c) Making it a requirement that each employee to be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee in the statement required by paragraph <a)
that, as a condition of employment under the grant, the employee will.
OJP Form ~06116 (3-91) Replaces OJ? Forms ~06112. ~06113, and 4061/4. wl1ich are obsolete.
OJ? FORM 4061/6 (3.91) REPLACES OJ? FORMS 4061 /2, 4061/3. AND 4061 /4. WHICH ARE OBSOLETE.
RE'eidential Substance Abuse Treatmp.nt Program
Florida Department of Law Enforc. .ent
EEO Certification Letter - Subgrant Recipient
Mr. Clayton H. Wilder
Community Program Administrator
Office of Criminal Justice Grants
Florida Department of Law Enforcement
1819 Miccosukee Commons
Tallahassee, Florida 32308
Re: Compliance with Equal Employment Opportunity (EEO) Program
Requirements - Subgrant Recipient
Dear Mr. Wilder:
I, the undersigned authorized official, certify that according to Section 501 of the Omnibus
Crime Control and Safe Streets Act of 1968 as amended, I have read the Act criteria set forth in
the Suborant Application Packaoe and Instructions. I understand that if the subgrant recipient
meets these criterion, it must formulate, implement and maintain a written EEO Program relating
to employment practices affecting minority persons and women. I also affirm that the subgrant
recipient (Initial one of the following):
xx Does meet Act Criteria and does have a current EEO Program Plan.
_ Does meet Act Criteria and does not have a current EEO Program Plan.
Does not meet Act Criteria.
I further affirm that if the recipient meets the Act criteria and does not have a current written
EEO Program, federal law requires it to formulate, implement, and maintain such a program within
120 days after a subgrant application for federal assistance is approved or face loss of federal
funds.
Requires signature of authorized official:
Type Name and Title: James L. Roberts, County Administrator
By:
~'-~ l
Date:
L~'W in)
.
Name of Subgrantee Organization: Monroe County Board of County Commissioners
SFY 2001 RSA T Subgrant Application Package
EEO Certification Letters Form (Rev 09/01l00)
Attachment B Page 27
(1) Abide by the terms 01 the statem....~ and
(2) Notil'y the employer In writing 01 his or her conviction tor a violation 01 a
criminal drug statute occurring in the workplace no later than five calendar
clays alter the conviction:
(e) Notll'ylng the agency, In writing. within 10 calendar clays atler receiving
notice under subparagraph (d) (2) from an employee or otherwise receiving
actual notice 01 such conviction. Employers 01 convicted employees must
provide notice induding position title. to: Department 01 Justice. Otnee 01
Justice Programs, ATTN: Control Desk. 633 Indiana Avenue. N.W.,
Washington, D.C. 20531. Notice shall indude the idenlitic:alion number(s)
01 eac:l\ atteeted grant:
(I) Taking one 01 the following actions. within 30 calendar days of receiving
nollce under subparagraph (d) (2). with respect to any employee who Is so
convicted-
(1) Taking appropriate personnel action against such an employee. up to
and induding termination, consistent with the requirements of the
Rehabifitatlon Act 01 1973. as amended; or
(2) Requiring such employee to participate satislactorily in a drug abuse
assistance or rehabilitation program approved lor such purposes by a
Federal, State. or local health. law enforcement. or other appropriate
agency;
(9) Making a good laith effort to continue to maintain a drug.free worltplace
through implementation of paragraphs (a), (b). (e). (d), (e), anll (t).
S. The grantee may insert in the space provided below the site(s) for the
performance of worlt done in COMection with the sptOtie grant
Place of Performance (Street addras. city, county, state. zip code)
Monro, .ountv Detention r.enter
5~?~ r.n'1_g_ ~n~o
Kev West. FL 33040
Cheek here _ If there are worltplaces on me that are not Identified here.
Section 67.630 of the regulations provides that a grantee that is a Slate
may elect to make one certilleallon In each Federa/llseal year. A copy of
which should be induded with each appratlon for Department 01 Justice
funding. Stales and State agencies may elect to use OJP Form 4061f7..
Cheek here _ If the State has elected to complete OJP Form 4061f7.
DRUG-FREE WORKPLACE
(GRANTEES WHO ARE INDIVIDUALS)
As required by the Drug-Free WorIcplace Act of 1988, and Implemented al
28 CFR Part 67. Subpart F. for grantees. as dellned at 28 CFR Part 67;
Sections 67.615 and 67.620..
A. As a condillon of the grant. I certil'y that I will not engage in the unlawful
manufacture, distribution. dispensing. possession, or use of a controlled
substance in conducting any activity with the grant: and
S. If convicted of a criminal drug ottense resulting from a violalion
oecurring during the conduct of any !:r&nt activity, I will report the
conviction. in writing. within 10 calendar days of the conviction. to:
Department of Justice. Otllce 01 Justice Programs, A TTN: Control Desk,
633 Indiana Avenue. N.W.. Washington. D.C. 20531.
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above
certifications.
1. Grantee Name and Address:
Monroe County Board of County Commissioners
5100 College Road
Key West, FL 33040
2. Application Number and/or Project Name:
Monroe County Jail Incarceration Program
3. Grantee IRSNendor Number
59-6000749
4. Typed Name and Title of Authorized Representative:
James L. Roberts, County Administrator
6. Date:
5. Signature:
--- / ~ ------. ()
~----~-...:::
12jt.(a)
J
OJ? FORM 4061 /6 (3-91) REPLo\CES OJ? FORMS 4061 /2.4061/3. AND 4061 /4. WHICH ARE OBSOLETE.
Res;riential Substance Abuse Treatme'1t Program
Florida Department of Law Enforce nt
EEO Certification Letter - Implementing Agency
Mr. Clayton H. Wilder
Community Program Administrator
Office of Criminal Justice Grants
Florida Department of Law Enforcement
1819 Miccosukee Commons
Tallahassee, Florida 32308
Re: Compliance with Equal Employment Opportunity (EEO)
Program Requirements - Implementing Agency
Dear Mr. Wilder:
I, the undersigned authorized official, certify that according to Section 501 of the Omnibus
Crime Control and Safe Streets Act of 1968 as amended, I have read the ACT criteria set forth in
the Subarant Aoolication Packaae and Instructions. I understand that if the Implementing Agency
meets these criterion, it must participate in the subgrant recipient's EEO Program or formulate,
implement and maintain its own written EEO Program relating to employment practices affecting
minority persons and women. I also affirm that the Implementing Agency (Initial one of the
following):
xx Does meet Act Criteria and does have a current EEO Program Plan.
_ Does meet Act Criteria and does not have a current EEO Program Plan.
Does not meet Act Criteria.
I further affirm that if the implementing agency meets the Act criteria and does not participate
in the subgrant recipient's EEO Program or does not have its own written EEO Program, federal
law requires it to participate in such a program or formulate, implement, and maintain its own
program within 120 days after a subgrant application is approved or face loss of federal funds.
Requires signature of authorized official:
Type Name and Title:
James L. Roberts, County Administrator
Date:
L z/ fof 6l;)
Name of Implementing Agency: Monroe County Board of County Commissioners
SFY 2001 RSAT Subgranl Application Package EEO Certification Letters Form (Rev 09/01/00)
Attachment 8 Page 28
I. Signature pr---
In witness whereof, the parties affirm they each have read and agree to conditions set forth in this
agreement, have read and understand the agreement In its entirety and have executed this agreement
by their duly authorized officers on the date. month and year set out below. .
Corrections including strike-overs, whiteout, etc.. on this page are not acceptable.
State of Aorida .
Aorida Department of.Law Enforcement
Office of Criminal Justice Grants
By:
iJ. lUAl/k-)
Type Name and
Clayton ~. Wilder. Communitv ~ro~ra~ Adrnin;R~T~~nT
Date:
.J... -1..1 - 0 J .
Subgrant Recipient
Authorizing Official of Governmental Unit
(Commission Chairman or Designated Representative)
By:
1~.L.z!. -k
Type Name and Title: James L. Roberts , County Administrator
Name of Subgrant Recipient Monroe County Board of Countv CommiSRinnl'OTR
Date: December 6, 2000
Implementing Agency
Official, Administrator or Designated Representative
By:
-::J'
-~~~
Type Name and Title: James L. Roberts , County Administrator
.
Name of Implementing Agency:
Date: December 6, 2000
Monroe County Board of County Commissinnl'OTq
SFY 2001 RSA T Subgrant Application Paeltage
Page 17
Application (09/01/00)