Resolution 076-1989
RESOLUTION NO.
076
-1989
A RESOLUTION BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA,
AUTHORIZING THE MAYOR TO EXECUTE AN
AGREEMENT BETWEEN MONROE COUNTY AND THE
STATE OF FLORIDA, DEPARTMENT OF HEALTH
AND REHABILITATIVE SERVICES, CONCERNINGTHE
PURCHASE OF UNITED STATES PRODUCED
AGRICULTURAL AND OTHER FOOD COMMODITIES
FOR USE IN NUTRITION PROJECTS OPERATING
UNDER APPROVED TITLE III CONTRACTS FOR
NUTRITION SERVICES WITH THE PROVIDER.
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, that the Mayor/Chairman of the Board
is hereby authorized to execute an agreement by and between
Monroe County, Florida and the State of Florida, Department of
Health and Rehabilitative Services, a copy of same being
attached hereto, concerning the purchase of United States
produced agriculture and other food conunodities for use in
nutrition projects operating under approved Title III contracts
for nutrition services with the provider.
PASSED AND ADOPTED by the Board of County conunissioners of
Monroe County, Florida, at a regular meeting of said Board held
on this ~ day of February, 1989, A.D.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By .-?//~~
Mayor/ al' an
(Seal)
Attest: DANNY L. KOLHAGE, Clerk
AL~l~~:
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APPROVED AS TO FORM
AND LEGAL SUFFICIENCY.
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Co"tract No. ~
STATE OF FLORIDA
DePARTMENT OF HEALTH AND REHABILITATIVE SERVICES
. STANDARD RATE AGREEMENT
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THIS AGREEMENT Is entered Into between the State of "Florida, Oepartment of Health and
Rehabilitative Services, hereinafter referred to as the "department," and M:mroe ('.onn-ty ~~,.r1 nf
Coll1llissioners ,hereinafter referred to as the "provider."
. A. The ProYlder AgrHl:
1. Upon receipt of a prior authorization for services from department staff, to provide the
following services:. . .
The purchase of United States produ~ed'~qricultura1 and other
. ., ,
food commodities for use in nutrition pio1ects oDeratin9 under
approved Title III contracts for nutrition services with the
provider. .
Prior authorization tor these services will be provided by the contract manaqer . J
or their deslgnite.
2. To provide services which meet departmental standards defined in: HRSM 140 -1 ,
HRSM 55-1 and consistent with tha providers approved Title III
Plan of Action which is incorporated by reference,
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3. To allow public access to all documents, papers, letters; or other mat.,'al sublect to the pre>
vtslons of ChaPter 119, Florida Statute$. and made or received by the provider in conjunction
with this agreement. It is expressly understood that receipt of substantial evidence of the
provider's retusal to comply with this provision shall constitute a breaCh ot this agreement.
.c, To retain all flnanclal records, supporting documents, statistical records, and any other
documents pertinent to this agreement tor a period of five (5) years atter termination of this
agreement, or if an audit has been Initiated and audit findings have not been resolved at the
end of five (5) years, the records shail. be retained until resolution of the audit findings.
5. To report to the department unusual Incidents in a manner prescribed by HRS 0.10.1.
e: -obeUable, and agrees to be Uable for, and shall indemnity, deter.d aAdhold the department
harmle.s from all claims, suits, Judgements, or damages, inCluding court costs and
attorney's tee., arising out of negligence or omissions by the provider in the course of-the
operatJon of this agreement.
7. Not to use or disclose any Information co';cernlng a recipient of Hrvlc.i under this agr~..
ment for any purpose not In conformity with tht. state regulations and federal regulations (45
CFR, Part 205.50), safegUarding Information for the financial- assistance programs, except
upon written consent of the recipient, or his responsible parent or guardian when authorizect
by law.
8. It Is expressly understood and agreed that 'any articles which are the subject of. or required
~.c;auy-out tNs .greement shall be pUfcnased from the Prison Rehabilitative Industries and
Diversified Enterprises, lAC. {PRWE), identlf1ed under Chapter 946.. F.s... b:I lbe htD4 manner
and under the procedures set fonh in Section 946.15(2), (4), F.S., and for purposes of this
agreement the cerson. firm. or other business entity carrying out the orovisions of this agree.
ment $h." be deemed to be substituted for this agency insofai as dealin~s with PRIOE.
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9. To comply with the Civil Rights Certificate below: '
The provider gives this assurance In consideration of and for the purpose of obtaining
Federal grants, loans, contracts (except contracts of Insurance Of guarant}'), property, dis.
counts, or other Fldera' flnancia' assistance to programs or activities receiving or benefiting
from Federal financial assistance. .
The provider aaaurea that It will comply with:
. L Title VI of the Civil- RIghts Act of 1984, as amended, 42 U.S.C. 2000d et seq., which pro-
hibits dlacrlmlnatlon on the basis of race, color, or national origin In programs and
activities receiving or benefiting fro~ Federal flnancia' aaslstance.
b. Section 504 of the Rohabllltatlon Act of 1973, as amended, 29 U.S.C 794, which prohibits
dlacrlmlnatlon on the basis of handicap In programs and' actIvities receiving or
benefiting from Federal financial assistance. . .
c. Title IX of the Education Amendments of 1972, as amended,'2Q U.S.C.1e81'.t ;eq., which
prohibits dIscrimination on the basis of sex In education programs and activities receive
Ing or benefiting from Federal flnanciat assistance.
d. The Age DiscriminatIon Act of 1975, as amended, 42 U.S.C. 8101 et aeq., which prohibits
discrimination on the basis of age In programs or actlvlt'es rece'vlng or benefitIng from
Federat financial assistance. . . "
e. The Omnibus Budget Reconciliation Act of 1981, P.L. 97.35, wl)lch prohibits dlscrlmlna.
tlon on the basis of sex and religion In programs and activities receiving or benefiting
from Flderal financial assistance. .
f. All regulat'ons, guJdellnes..anct standards lawfUlly adopted under the above atatutes.
-The provIder agrees that compliance wIth this assurance constitutes a condItIon of Con.
~tlnued receIpt of or benefit from Federat financIal ".'stance, and that It Is bInding upon
the provider, Its successors, transferees, and assign... for the period durfng which such
..sletance Is provIded. The provIder further assure. that all contractors, subcontractors,
aubgrantees or others with whom It arranges to provide services or benefits to par.
tlclpants or employees In connection with any of Its programs and activit Ie. are not.
discriminating against those participants or employees In v'olatlon of the above
atatutes, regulations, guidelines, and standards. In the event of failure to COmply, the
provider understands that the Grantor may, at.lts discretion, seek a court order requiring
compliance wIth the terms of this assurance or Slek other appropriate ludlclal or ad.
mlnlstratlve relief, to Include assistance being terminated and further assIstance being'
denied.
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10. If Clients will be transported under this agreement, the provider will subcontract with the
designated Coordinated Community Transportation Provider, In accordance with the locel
MemorandlJm ot Agreement, or otherwise comply with the provisions of Chapter 427, F!orlda
Statute.. The provider shall submit to the department reports required pursuant to Vo'ume
10, HRS Accounting Procedures t-1anual. . ..
11. ReqUirements of Chapter 287:058, Florida Statutes
a. To submit bflls tor fees or other compensation for services or expenses in sufficient
- detalJ for. proper pr.auditand post.audlt thereof. . .. '" h.'_ ._. .....~_
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b. Where applicable, to submit bills tor any travel expenses In accordance with S. 112.061,
. Florida Statutes. The depanment mat estabtTsb rates lower than the maximum provided
IIn S. '12.061./ '. '" . . .
c. To provide units of deUverables, includlng reports. findings, and .drafts U Spec:.ifled
;n Section 0, Special Provisions ,tobereceived ancs accepted by the contract manager
prior to payment.
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d. To comply with the criteria ana final date by which such criteria must be met for com pl.
tlon:ofthlscontractuspeclfledln Section D. SDecial Provisions.
12. To provide a financial and compliance audit to the department as specified in
Attachment I I I . . .
13. The provider agrees to return to the department any overpayments dUI to unearned funds or
funds disallowed pursuant to the terma of this contract that were disbursed to the provider
by the department. The provider Shan. return any overp,ay~ent to thl depanment upon
discovery of the overpayment. In the ev~nt that the deP8nment first discovers an overpay.
ment has been made, the department will notify the provider by letter of SUCh a finding.
Should repayment not be made In 'a timely manner, the depanment will charge Interest of
. one (1)'1. per month compounded on the outstanding balance .fter forty. five (45) days. Days
will be counted. beginning .wlth the day the amount was booked as a receivable by the
department. .
8. The Department Agree.:
1. To make payments for services Identified In Section A.1 of this agreement at the rates
stipulated below, In an amount not to exceed $ N/ A . subject to the
availability of funds. The state of Florida's perfo'rmance and obligation to pay under this
agreement Is contingent upon an annual appropriation by the Legislature.
SERVICE
RATE
E1iqible conqreqate and
!tome delivered meals........
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$0.5676 per meal
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2. To make payment on a monthlY basis and In accordance with the procedures
and reqUirements for payment outlined .In
HRSM 55-1 and usinq HRSM Form 1237 Request for Reimbursement
OSDA tash-in-Lie~ of Commodities (Attachment 1) and HRS-AA
Form 3004 District/Provider Monthly Meals Report (Attachment. 2).
-- . 3. To make available to the provider. upon reque~t, copies .0Lappllcable program standards and
requJrements~nd vouch~rln.g procedura.. . . . -. ... .. .. .- .
.t.. Pursuant to section 215.422, F.S., on receipt of an Involca and receipt. Inspection, and ape
proval 9' thl goods or services, the dlpartment shall file the Invoice with the Comptroller
within 15 days. It payment of thelnvolca I. not matled by the depanment within 45 days after
receipt of the Invoice a.,d receipt, Inspection, and approval of the goods and services, the
department will pay the vendor, In addition to ..thl amount of the invoice, IntMest at a rate of
1 percent per month or 'portlon thereot on the unpaid balance from the expiration of such 45
day period untlt such time as the warrant Is mailed to the vendor. Exceptional circumstances
as defined in sectlon.215.422(2). F.S.. may permit the deadline for payment to be revised.
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- 5..... The name and address of the contract manager tOt" the department for .this rate agreement is
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JOHN M. FANATICX>, 401 N.W. 2nd. AVE. 5-312, MINa, F'WRIDA 33128
The provider's representative for this rate agreement is J .n1J; 0;: '~Tn~
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C. It I. mutually .arMCI that:
. '. 01/01/89
1. this agreement shall begin on
or the date on which this agreement has been .Igned by both parties, whichever Is lat.r.
2. this agreement shall end on 3/31/90 ,I
3. Termination
L Termination at Will
This contract may be termlnated'by either party upon no Ie.. than thirty (30) day. notlc..
without cause. Said notice shall be delivered by certified mall, return receipt requested.
or In person with proof of delivery.
b. Termination Beca~se of Lack of Funds'
In the event' funds to finance this contract become unavailable, the department may ter.
mlnate the contract upon no less than twenty. four (2~) tt~u~'notlc. In wilting to the pro-
vider. Said notice shall be delivered by certified man, return r'celpt requested, or In per.
son with proof of delivery. The department shall b. the final authority as to the avail.
ability of funds.
c. Termination for Breach
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Unless the provider's breach Is waived by the department In writing, the department may,
by written notice to the provider, terminate this cpntract upon no less than twenty. four
(24) hours notice. Said notice shall be delivered by certified mall, return receipt r.
quested, or In person with proof of delivery. If applicable, the department may employ the
default provisions In Chapter 13A.1, Florida Administrative Cod.. Waiver of breach of
any provisions of this contract shall not be deemed to be a waiver of any other breach
-and shall not be construed to be a modification of the t.rms of thl. contract. The provl.
slons herein do ~ot limit the department's right to remedies at law or to damages.
4, this agreement does not obligate the department to pay the provider unless services which
were prior authorized by the department have been rendered.
!S. Renegotiation or Modification:
L Modifications of provisions of this agreement shall only be valid when they have been
reduced to writing and..duly signed. The parties agree to renegotiate this agreement If
federal ~d/or state revisions of any applicable laws, or regulations make changes in
this agreement necessary.
.
- be The rata of payment and the ~otal dollar amount may be adjusted retroactively to reflect
price-level Increases and change. In 'the -rate 'of' payment when th.s., havw been
established ,thorough the appropriations process and subsequently Identified In the
department's ooeratlng budget.
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8. Name, Mailing and Str.et Addre.s of Payee: _
a. The nane and mailing address of the official paye. to whom the payment 'shallbe made:
Mmroe rnlm'ty lV-t::n'r1 nf',"nmmhiioR~rf.:
P.O. Box 1980.
Key West. Florida 33041~i980
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b.: . The nama of the contact person and street address where financial and administrative
records are maintained:
Sheila Malloy. Director of NUtrition p,..og~m
1315 Whitehead Street
Key West. Florida 33040
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D. Special Provisions:
1. In the event that the final reimbursement rate established
by the United States Department of Agriculture (USDA) is greater
or less than the rate in Section B.l above, then this rate
agreement shall.be appropriately,adjusted and the final rate
shall be e~fective for the en~ire rate agreement period.
2. This rate agreement is for services provided during the 1989
Federal Fiscal Year beginning October 1, through September 38,
1989. The additional six. Months (October 1, 1989 through Harch
31, 1998) are to allow the rates to be adjus~ed for ~he twelve
month service period. Rate adjustments"will'j)e.based on the
final reimbursement rate established by the USDA. This rate
agreement shall automatically terminate after the final rate for
the federal fiscal year has been established and the releas~ of
final payments are authorized by the department.
3. One half of the reimbursement earned for the last three-
months of the federal fiscal year will be withheld by the
department pending reconciliation and release of the final letter
of credit by USDA. .'.
4. The provider agrees to, provide Financial Reports in
accordance with HRSH 55-1, Financial Management of Older
Americans Act Programs.
5. Theprovider'agrees to submit a final invoice to the
department no more than 45 days after the final reimbursement
levels have been released by th.'department. Failure to do so
will result in the forfeiture of all rights by the provider and
the department will not honor any request submitted after the
aforesaid agreed-upon period. Any payment due under the terms of
this contract may be withheld pending th~ receipt and approval by
the department of ~ll fina~cial reports due from the provider as
- '" a' Pcrrt--ofthiS-COht.;t'ClC't,"-and -any' adjustments thereto. _"" __..._
6. The provide~~9rees to perform required monitoring and
submission of monitoring reports i~~c~~rdance with HRSH 55-1.
7. The following clause supersedes Section C.3.a ter~~nation It
~ill: This contract may be terminated by either party upon no
less than thirty (38) days notice pursuant to 45 CrR Part 74:
notice shall be delivered by certified mail, return receipt
~equested~-~r in person with ~oof QLdeliv~y.
8'"\ -.. . The. p~ovider assu~es that USDA funds 1will be used by the
subcontractors (who are nutrition services providers) solely tor
the purchase of United States aqriculture commodities or other
foods produced ih the United States for use in their nut~ition
.. -- project operations. .
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9. The provider assures that OSDA funds, which are
subcontracted by the nutrition subcontractors to other
subcontractors such as food service management companies,
caterers, restaurants, or institutions to provider meals, are
used to purchase United States produced commodities or foods at
least equal in v~lue to the per meal cash payment received from
USDA.
lB. The provider assures that USDA funds will not be used to
supplant or replace any other funds used by Title III nu~rition
projects. .
11. The department and provider agree to provide the services
and implement the provisions of this contract in accordance ~ith
the Federal, State and Local laws, rules, regulations and ·
policies that pertain to USDA cash'paym,n~s.and Older'Americans
Act. ~ .
12. The provider shall assure that nutrition subcontractors
maintain audit trail fot each unit of service provided. Punds
'received for any unit not supported by adequate'docuaentation
shall be returned to the department within ~ days or future
payment shall be withheld or deducted from fut~re payments.
13. Project Independence
The department bas implemented Project Independence, an
~~ initiative to assist public assistance reci~ients to enter and
remain in gainful employment. Employment of Project Independence_
participants is'a mutually beneficial goal for the contractor .and
the department in.that it provides qualified entry level .
,emFloyees needed by many contractors and provides substantial
savings to the citizens of Florida.
The contractor or its agent agree to notify the department
of entry level employment opportunities associated with this
contract that require a high school education or less. The
depart.ent will prOVide information to the contractor identifying
proj.ct Independenca,clien~..~ha~ are teferred to the contractor.
In the event that the contractor or its agent employs a person .
who was referred.b.y the department's Project Independence o(fice,
the contractor will notify the department.
14. Assignment
This contract will be assigned to the new Area Agency on
Aging for Dade and Monroe Counties once a new agency has been
Cl\esignated and at a time mutually convenient and -agreed upon by bot;
i. ~e new Area Agency a~ the Depar~ent. . _~
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E. All Terms and Conditions included
y \{C \;t
This contract and its attachments as referenced,
( 6tA~~CDt.l, 6~hmtnt 2~Ang-At~hmtnt_~. ____ ~._________
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contain all the terms and conditions agreed upon by the partiea.
IN WITNESS THEREOF, the 'parties hereto have caused this 14
page contract t~ be executed by their undersigned otticials ..
duly authorized. .
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PROVIDER STATE OF FLORIDA, DEPARTMENT OF
l!>!!rQ.Et~.Q!!llty..]Q.~ULQf_Q>.mmi~ner~EALTH AND REHABILITATIVE SERVICES
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SIGNED BY:__________________
SIGNED BY:
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NAl-t E :
TITLE:
DATE:
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NAME: . John c. Farie
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TITLE- District: Mninistrator
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DATE:
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FEDERAL ID NUMBER:
(or SS Nu~er for an indiVidual)
59-6000749
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PROVIDER FISCAL YEAR E:mING DATE:
~et>tem~f~. 1989"
APMOV6DAII TO"
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DEPARTMENT OF HEALTH , REHABILITATIVE SERVICES
REQUEST FOR REIMBURSEMENT' .
USDA CASH IN LIEU or COMMODITIES. ATTACHMENT 11
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DISTRICT
DATE
CONTRACT PERIOD:
TO
REIMBURSEMENT FOR THE
PERIOD or:
TO
1.
CONTRACT NO.
2.
3.
t .
NAME AND ADDRB#t8 or PAYEE:
4.
YEAR TO
U6D.
CURUN'l'
MONTH
REIMBURSEMENT COMPUTATION
6. NUMBER or MEALS SERVED...................
7.
LINE 6 T,IMES $
PER MEAL............$
$
$
8.
LESS VALUE or USDA COMMODITIES REPORTED..$
9. AMOUNT TO BE REIMBURSED.................................$
CONTRACT SUMMARY/STATUS - USDA CASH
11. APPRovED CONTRACT AMOUNT.. '. · . · · · · · · · · · · · · · · · · · · · · · · · · · · · $
11. REIMBURSEMENT REQUESTED THROUGH LAST REPORT.............$
12. CONTRACT BALANCE PER LAST REPORT........................$
13. REIMBURSEMENT EARNED.....................$
14. LESS: 4TH QUARTER HOLDBACK...............$
15. AMOUNT TO BE REIMBURSED THIS PERIOD......$
16. RELEASE or 4TH QUARTER HOLDBACK........:.$
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17 . TOTAL AMOON'! or REIMBURSEMENT REQUEST.............. ~ · ,. · · ..'
18 . COtrrMCT 8A.LAIICB...... .". . . · . . · · · · · · · · · · · · · · · · · · · · · · · · · · · $
I certify that to. the best of my knowledge 'the. above inform~tion is
accurate and complete and that all outlays reported herein were for
purposes set forth in the contracting documents.
Signature and Title,
Date:
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HRS USE ONLY'
Date Received:
Reviewed- And- Approved By: ; Date: -
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10.
11.
12.
13.
1.
INSTRUCTIONS
Int.r: contract numb.r.For the ar.a agencies billing
to tbe diatrict this must b. the district offic.
..s19Ded~umb.r. For provid.r ag.nci.. billings to the
ar.a ag.ncie. this should be the ar.a ag.ncy assigned
ref.rence.
2.
\
Inter the aistrict number and date that reimbursement
r.qu.st is prepared. . .
Int.r the name and address of the proYider/ar.. agency
requesting reimbursem.nt.
4.
,
Enter the total period covered by. the contract.
5.
. .
Inter the p.riod of time covered by the r.imbur....nt
being requ.sted (i... Sept. 1 to S.pt. 30, 19xx).
Inter the ausber of OSDA reimbursement .ligible ...ls
servedfxam' line __i__, form 3004 Showing both the ye.r
to dat. and current month figur...
Inter th. approved reimbursement rate a. .pecifi.d in
the contract. Multiply this rat. ti... th. nuaber. of
..al. .hown on line 6, enter reimbur....nt aaounta
e~rned in the year to date and curr.nt monthcoluan..
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6.
7.
8.
Inter the value of all USDA Commodities r.c.ived during
the contract periOd, both year to date .nd during the
current aonth.
Snter the amount of r.imbur....nt clai..d for the
curr.nt month, line 7 les. line 8.
Inter curr.nt approved maximum amount r.imbursable
und.t the contract (includ.d any contract amend..nts
that have b..n sign.d by all partie. prior to the end'
of the month being reported)..
Inter total' amount of reimbursem.nts that have b.en
reque.ted during the current contract period .xcluding
the current r.quest. This. amount includes requ.sts for
whicb caab reimbur..ment haa not been rec.iv.d.' ,
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9.
.
Inter balance arrived at by subtracting line.11 from
line 10, compare to lIne 14 on pr.vious months report
to insure figure. are the .a.e. .
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Int.r amount to be earned for the curr.nt report from
11n. 9.
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itU_QU6lt18_QlLt_Qt_~QHt86't_~~BYI~I~_2181QQ_i~UwI~_&QGUlt
6W..IIlD_l. .
14. Id.ntify 50t of 1in. 13..
15. Lin. 13 minus line 14.
16. Enter amount withheld that. was identifi.d in prior
r.ports, entry allow.d QRkI wh.n r.l.... authority has
b..n receiv.d from PDAA.,
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17. Line 15 plU8 line 16.
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18. Lin. 10 minus the sum of 1i~. 12..nd line 17.
1I.t~_2.n~~_3.[~_QU6Bt~B_Qm.I_Qt_~QtitM~t_SIBnCII_2IBlQQ
i~BI8_tBBQUGB_~UHI1.
14. No entry.
15. Ent.r amount identifi.d on Line ,.
16. No entry.
17. Enter amount identified on Line 15.
Line 10 minus the sum of lines 12 and line 17.
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Month____________________. 19_
DISTRICT______~__
SUPPLEMENTAL REPORT USDA COMMODITIES FOR CONTRACT YEAR 1~__ - 1~
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Annual COMModity. Go.L S_______________
Ca)
(b)
ec)
Cd)
V.lue Of'
COMmodities
Rec'd Fo... The
Cur....nt Month
YTD
Value 0"
ComModities
R.c::eiv.d
Value Of' COMModities
R.port.d On
HRS ForM la37
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I Cur....nt Month.:
YTO
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T....n.'.... the .Mounts f''''OM
Month l1n.,eolu.n. "c" and
lin. 8 on HRS Fo.... 1237
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the current
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)0 NOT REPORT USE OF ANY PRIOR YEARS INVENTORY FOR CURRENT'CONTRACT YE
00 NOT REPORT IN ANY COLUMN FOR ANY' YEAR, ecONUS ITE:-t'3 RECEIVS:O
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District/Provider Monthly Heals Report
lea). District NUmber
2(b). Provider Name/Number
3. Number of day~ served this month
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(a) ·
The total number~f meals, regardless of funding source, served
to all persqns 60 years of age or older and 'their spouses,
volunteers providing services during meals hour. on a regular
basis, and handicapped or.cl:i:.abled individuals .residing in
housing facilities occupied primarily by the elderly at whi~h
congregate meal. services 'are provide~ during the month was:
USDA Cash Congregate HO~-Delivered
Provider Name Meals Meals Total
4.
(b)
(c)
Sub-Totals
USDA Commodities
Provider Name
Congregate
lieals
Home-Delivered
Meals
Total
Cd) Sub-~otals
S. Total
6. Identify the number of meals (other than Title III-C) served
in line 5, and the funding source.
Congregate
Meals
Home-Delivered
Meals
Source
I certify that the above information is accurate and complete to
the best of my knowledge.
Signature
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Title
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Date
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HR$-AA Form 3004. Apr 84 (Oblol.tes pr.vious editions)
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IN~ 1'IO~S rOll cm1PLE:1':~:::; HP.S l'OP.."'1 .A 3
DISTRICT/PROVIDER MONTHLY f-!EALS REPORT
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GENERAL:
1.. Check appropriate box in upper right hand corner.
2.
This form should be prepared in quadruplicate (1 original,
3 copies). Tne District must submit one copy of this form
(with H~.Form 1237) to PDAFA.
Certifi~4tion should be by the representatiye of the area
agency as designa.ted in the approved contract.
3.
4.
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HRS district approval should be by the contract manager as
designated in the approved contract.
SPECIFIC:
Lines 1-2: These items are self-explanatory.
Line 3: Enter the average number of serving days for providers
in the district.
. Line 4 (a): For each nutrition provider reque~ting USDA cash
in the district, list the total number of congregate and home-
delivered meals regardless of funding source, served to persons
60 years of age or older and their spouses, volunteers provid1n~
servtces during meal hours on a regular basis, and handicapped
or disabled individuals' residinq in housing faciliteis occupied
~imarily by the elderly at which congregate meals served are
~rovided, during the month.
~ine 4 (b): Enter the subtotal of meals served.
tine 4 (c): For each nutrition provider utilizing'USDA
~onunodities in the district, list the .total number of congregate
and home-delivered meals regardless of funding source, served to
persons 60 years of age or older and their spouses, volunteers
providing services during meal hours on a regular basis, and
handicapped or disabled individuals residing in housing facilities
occupied primarily by the elderly at which congregate meals
services are provided, during the month.
~ine 4 (d): Enter the subtotal of meals served utilizing
commodities.
Line S: Enter the total number of all meals served to eligible
persons in all nutrition projects in the district. This must
be the same total reported on Lines II B 3 and III B 1. on HRS~AA
Form 2003 and should be the same as those reported on HRS Form
123711 line.. 6.
Line 6: Specify what "other" funds (if any) are utilized by
eiCh:nutrition provider. "O~her" funds are e.g., local funds
revenue Sharing, HUD, CSA, CCE, etc.
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This attachment is applicable if the provider is a state or local govern-
ment, university, hOSpital or other nonprofit entity. It shall not apply
if the total of all funds received or earned during the provider's fiscal
y.ar. from contract. With the department is less than S25,OOO. The provide~
ha. "received" funds when 1t has obtained cash from the department or when
it haa incurred expenses which will be reimbursed by the department.
Governmental prOViders only may determine funds "received" 1n a manner
consiatent wlth their method of ac~ountJnq.
. The provide~ agrees to have an annual financial and compliance audit per-
formed by independont auditors in accordance with the current Standards for
AUdit ot Governmental Organizations, Programs, ActiVities and Functions
~Ithe .Yellow 800k"l issued by the Comptroller General"of the United States,
'State and local governments shall comply with Office of Management and
. Budget COMB) Circular A-128, "Audits of State and Local Governments".
"Universities, hospitals and other nonprofit providers shall comply with the
audit requirements contained in Attachment F of OMS Circular A-llO, "Grants
and Agreements with Institutions of Higher Education, HOSPitalS, and Other
Nonprofit Organizations", except as modified herein. Such audits shall
cover the ant1ra organization for the organization'S fiscal year. The
Scope of audits perto~ed need include only the financial and compliance
reqUirements of the "Yellow BOOk", and may disregard those related solely
to economy and efficlency or to program results.
Compliance findings related to contracts with the department shall be based
on the contract requirements, including any rUles, regulations, or statut..
referenCed in the contract; Liabilities due to the department because of
unexpended funda O~ because funds were not expended in accordance With con-
tract terms shall be calCUlated and fUlly disclosed in the audit repor~,
This :requir_nt does not expand the scope of the audit as preSCribed by
the "Yellow Book". In addition to the basic financial statements, the
audit report shall inclUde. la' a detailed schedule of all revenues identi-
fied by source, such as individual contracts by contract number, client
fees; and private donations and Ibl a schedule of functional expenses which
presents line item expenditures such as salaries, travel and supplies by
pr09ram ..rvlce.'4nd supporting services, with the portion of total sup-
portin9 aerv1c.. allocable to proqrams presented as a 8in916 line item
lncr..sin; pro9rua .ervlc.a and decreasing supporting services. Where
IPPlicable, the aUdit raPprt shall include a computation ahowing whather or
lot ..tCh!n; ~.quirem.nt. were met.
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~e prOVider shall eneure that audit working papers are made available to
:he depare.ent or its designe. upon request for a period of five years from
:he date the aUdit report is i.sued unless ext.nded in writing by the
lepUtMnt. ',!
FINANCIAL AND COMPLIANCE AUDITS
Attachment#3
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'nless otherwise required by Florida 'Statutes, copies .of the financial and
o.Pliance.aUdit report and management letter, if any, shall be submitted
"!thin 120 day, after the end of the provider's, "fiscal year to both
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a. Office of Audit and Quali.ty Control; SerVices
IUilding 3, Room 219
1317 Winewood Boulevar~
Tallahassee, Florida 32J99-0;00
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b. Contract manaqer for the department
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