Resolution 183-1989
RESOLUTION NO.
183
-1989
A RESOLUTION BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA,
AUTHORIZING THE MAYOR TO APPROVE THE
TITLE III-D GRANT APPLICATION BY MONROE
COUNTY AND THE MONROE COUNTY IN HOME
SERVICES.
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, that the Mayor/Chairman of the Board
is hereby authorized to approve the Title III-D Grant
application by and between Monroe County and the Monroe County
In Home Services Program for the period of January 1, 1989
through June 30, 1989, a copy of same being attached hereto.
PASSED AND ADOPTED by the Board of County Commissioners of
Monroe County, Florida, at a regular meeting of said Board held
on this -'/1-11 day of 4r// , 1989, A.D.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
~~~
Mayor/Chairman
(Seal)
Attest: DANNY L. KOLHAGE, Clerk
~~~/ /1/
APPROVED AS TO FORM
AND LEGAL SUFFICIENCY.
(( ~ 'fIJi/
By .4.tt " /W' tIIAt ,~' "
v At~r~ y's Office
MEMORANDUM
TO
Peter J. Horton,
Division Director
Community Services ~
UB EeT Titl
Louis LaTorre, Executive Direct{jo ~G t 1 be
. vr ran approva Y
Monroe County Soc1al Services BOCC
Gwen Rodriguez, Project Direc r
Monroe Count In Home Services
DATE
March 20, 1989
FROM
III-D
the
It is requested that the Title III-D (Homemaker for Frail Older
Individuals) grant be approved at th~ earliest meeting of the
Board of County Commissioners, within the alloted deadline
allowed. Also that the Mayor be empowered to sign appropriate
signature papers required.
Be advised that the contract has already received Board approval.
This grant is for a six month period (1/1/89-6/30/89) only and
will be expended as follows:
Personnel
Travel
Printing & Supplies
$7753.00
480.00
100.00
TOTAL BUDGET
$8,333.00
Less Local Match
833.00
(County match)
General Revenue Request $7,500.00
(Title III-D OAA Funds)
It is proposed to serve 25 unduplicatea clients with 585 units
of homemaking services during this period at the budget as
presented above.
Thank you for your continued cooperation and support for assistance
to the frail elderly citizens of Monroe County.
..
(FI)
SERVI~ ~r~VrDER SU~~~ INFORMl~TICN
Contract ~~endnent 3
PSA/District
11
I)a.te of this application:
( ) Revision Dated' 2/89
- \v , .
r 1- PRDVIDER AGENCY NAME, STREET ADDRESS 2. NAME AUD ADDR1::SS OF TIr~ FRES:::j)E~IT-1
AND PHONE: (CHAIRMAN ) OF THE BOARD OF DIRECTORS :
Monroe County In Home Services Michael H. Puto, Mayor
1315 Whitehead Street 10600 Aviation Boulevard
Key West, Fl. 33040 Marathon, Fl. 33050
305/294-8468 " .
NAME OF GRANTEE AGENCY:
Monroe Countv Board of Countv Commissioners
3. PROVIDER NUMBER (IF ASSIGNED) : 4. PROPOSED PERIOD OF FUNDING:
2/1/89-6/10/89
3. ~~VIDER STAFF RESOURCES: I 6. EXECUTI~lE DIRECTOR OF P~OVIDER:
I Name: Louis LaTorre
Q) ~ Business (Maili ng) Address:
.UNPAID STAFF PAID STAFF e
"" ~ "" ~ 1315 Whitehead Street
E-<~ E-4~
SCSEP (OAA TITLE V) III III Key West, Fl. 33040
ro4~ ~~
Positions Assigned: ro4(/) \.I(/)
:s III
Ii.. 0.
2 TOTAL bS 6
Total Budgeted Age 60+ " " Business Phone: 305-294-8468,
Volunteer Hours: Female 1 a " Emergency Contact Phone:
Minori ty " 7 0 305- 296-7171 (home)
1614 Handicapped 2 0
7. TYPE OF ORGANIZATION: 8. APPLICATION DATA: 9. FUNDS REQUESTED: TOTAL
(Check one) (Check one) BUDGET:
xxi Public Agency ( ) New Applicant OAA Title IIIB $ $
( ) Private, Non-Profit, ( ) Continuation Title IIIC-l $ $
Charitable (xk Revision to Title IIIC-2 $ $
( ) Private for Profit Application Title IIIl;) $ 7,500. $ 8,333.
Dated: 2/89 Other $ S
10. SERVICES TO BE PROVIDED: 11. SERVICE AREA: (K) Single County
ro4 N ( ) Multi-County Specify:
I I
CQ CJ CJ Q List: MONROE
... ... ... ...
... ... ... ...
... ... ... ... ( ) Selected Communities
Homemaker (FOr) X of a County. Specify:
,
12. ---~.
IDENTIFICATION OF AGENCY OFFICIAL I
---. _.. ,.,-, -
AUTHORIZED TO SIGN 1~PLICATION:
~~~-
(Signature)
Name: Michael H. Puto
Title: MAYOR
Address: 10600 Aviation BlvC:l.
Marathon, FL. 33050 APPROVED AS TO 'ORM
A D LEC;'iL ~'(.
Phone: 305-294-4641 ::~ /h
Date Signed: .v
13. ADDRESS FOR PA~~ or. .dffian,a )
(x) Item #1. ( ) Item #6.
( ) Item #2. ( ) Item #12.
-63- '
PSA/DISTRIC'l' 11
~ ( ) TITLE III B (X) TITLE III D
T ( ) TITLE III C-l
, · ( ) TITLE III C-2 ( ) OTHER (SPECITY):
'- STAT~.E!-.~ OF OBJECT:tVE (WHAT service will be done,who will do it, who will receive the
service.\ Homemaker services under Title III-D (FOI) will be provided by one Homemaker
to eligible frail elderly residents of the Lower Keys area of Monroe County.
25 Undup1icated clients will be served with 585 units of service
through 6/30/89.
(FS)
STATEMENT OF OBJEC'1'IVE
Provider Name: Monroe County In Home Services( )
(
(x)
Origina.l,
D. te d -
ReYi.siQn,
Dated 2/89
DESCRIPTION OF SERVICE ESSENTIALS:
~:. Services will be provided Monday through Friday, from 8:30 A.M. until 5:00 P.M.
excluding legal hOlidays.
WHERE: Services will be provided from our-area office by the Uomemaker
in the individual homes of the eligible clients.
HOW: Under the supervision of the Case Management staff, Homemaker will be trained
and assigned to specifically targeted frail older individuals for the specific
performance of all related homemaking services specifically addressed in their total
care plan.~ Staff will perform these services in the respective homes of the individuals.
ir,-ny :
- To assist the frail older individuals with the greatest economic or social needs
with appropriate homemaking services to ensure their basic survival and support which
will allow them to live a lifestyle of dignity, promote independence, and to prevent
or delay premature institutionalizarinn.
MAJOR WORK TASKS TO ACHIEVE OBJECTIVE: ESTDiATED DATE
(J:' COMPI..ETION:
(
...
'--I
I
I
TASK Initial pre-service and ongoing in-service training of the
Homemaker staff with: Purpose of the OAA program, physical and mental
characteristics of older persons, responsibility of care plan imple-
mentation, use of equipment, organization of tasks, principles of
safety and cleanliness.
TASK
CPR and First Aid training for Homemakers to provid~
responsive care for older individuals in emergencies.
TASK On-going assessment of the clients' needs by the Case Manage-
ment staff to ensure proper care plan and total community support.
TASK Skill training for communication, observation, documentation
and implementation actions for the Case Management and Homemaker
staff to ensure adequate community support and care for the frail
older individuals receiving said services. _
\
~- ATTACH CONTINUATION SHEETS AS NEEDED.
-14-
At time of hire
and quarterly
thereafter.
3/89-6/89-9/89-12189
3/89
At in-take of each
client and every
90. days minimum
thereafter.
Quarterly
3/89-6/89-9/89
12/89
r
(
(F9 )
Contract Amend#
\.
PSA/District 11
-
ESTIMATED PROGRAM OUTPUT
( ) Original
Dated
(X) Revision
Dated 2/89
Title III D: In-Horne Services for Frail Older Individuals
Provider Name: Monroe County In Home Services
Title III D
Services
I COUNTY: I County: : COUNTY:
IUndupli-: Units IUndupli-: Units IUndupli-: Units
I cated : of l cated : of I cated : of I
lpersons :ServicelPersons :ServicelPersons :Servicel
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Reassurance
In-Horne
Respite Care I
Adult Day Care
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Housing Improvement
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11 'd N ( ) OriginAl,
PSA/DISTRICT Provl. er ame: Monroe County In Home Services D~ted
{ ) TITLE III B ex) TITLE II~ D (~ ReyiziQll,
( ) TITLE III C-l Dated 2/89
( ) TIT~ III C-2 ( ) OTHER (SPEC~Y): .
S'rAT~lF.hWX' OF OB.JECTIYE {WHAT service will be done,who will do it, ",ho ....ill race1.ve th
service.\ To provide Homemaking Services to 25 unduplicated frail older
individuals who are clients, with 585 units of service.
This service will b~ provided by one Homemaker in the
lower keys area.
(FS)
STA'l'ulEN'l' or C~EC'!'!VE
DESCRIPTION OF SERVICE ESSENTIALS:
WHEN: Service will be provided Monday through Fridays, excluding legal
holidays, from 8:30 A.M. - 5:00 P.M.~hrough 6/30/89.
WSERE :
HeM:
\toW :
I-
I
Homemaking services will be provided in the homes of the elderly eligible
clients.
The case manager of said clients will assess for need and implement the
care plan for homemaking services through the Homemaker staff person.
To promote independence and maintain the frail older individual in their
homes and to prevent or delay premature institutionalization.
MAJOR WORK TASKS TO ACHIEVE OBJECTIVE:
ESTIMATED DATE
OF COMPLETION:
TASK
TASK
TASK
TASK
Inservice training to assist the Homemaker staff with abi1it'
to provide quality service to OAA Title III-D FOI clients
CPR and, First Aid training 3/89
Inservice training for Adult Abuse Prevention
3/89
Intake assessment for eligibility and review assessment
to maintain clients needs and ensure continued eligibility
and that goals are being met
~
Intake - at time
of referral
Review minimum
of every 90 days.
Skilled training for communication, observation,documentation
and implementation of actions for homemaker staff to ensure
adequate community support and care for the frail older
individuals receiving said services
Quarterly
3/89-6/89-9/89
12/89
ATTACH' COt-rrINUATION SHEETS AS NEEDED.
-67-
(F9)
Contract Amend#
?SA/DiSi:rict~
ESTIMATED PROGRAM OUTPU'r
() Ori~inal
Dated
(J i:\evision
Dated~/Rq
Title III D: In-Home Services for Frail Older Individuals
Provider Name:
MONROE COUNTY IN HOME SERVICES
Title III D
Services
-----------------------..-------------------------------.----------
l COUNTY :Monroe : County: l COUNTY:
IUndupli-: Units lUndupli-: Units IUndupli-: Units
I cated : of I cated : of I cated : of I
lpersons :Service!persons :ServiceIPe~sons :Servicel
. .
. .
Homemaker 25 . 585 .
. .
Home He al th . .
. .
Aide : :
.
.
Chore
.
.
Companionship .
.
Telephone .
.
Reassurance
In-Home
Respite Care :
Adult Day Care
as Respite Care . .
. 0-
for Families I
I
Housing Improvement .
.
I :
limit of S150'
:
.
.
-71-
F.4.1 Site Budget Information
Services
Title III-B
Administration
Chore
Companionship
Counseling
Day Care
Education
Escorting
Health Support
Home Health Aide
Homemaker
Housing Improvement
Information
Legal Services
Outreach
Recreation
Referral
Shopping Assistance
Telephone Reassurance
Transportation
Total
Title III-C-1
Administration
Congregate Meals
Nutrition Education
Outreach
Total
Title III-C-2
Administration
Home-Delivered ~eals
Nutrition Education
Outreach
Total
Title III D FOI
Administration
Homemaker
Home Health Aide
Chore
Companionship
Telephone Reassurance
In-Home Respite Care
Adult Day Care - Respite
Care for Families
Housing Improvement
limit of $ 150
Name of Site Lower keys area of
Monroe County
Total Budget
By Site
$8.333.00
Unduplicated
Clients
25
units of
Service
585
(Fl))
(Annually Updated)
ASSl'RA."lCE 0F COMPL!ANCE wrrn THE DEPARTME."-i"T OF
HEALTIl AND HUMAN SERVICES REGULATION UNDER
TITLE VI or THE CIVIL RIGHTS ACT Of 1964
Monroe County Board of County Commissioners/ Monroe (l-}eremafter cailed the "Appli,=a~t")
County In Home Services,l'ilMc 01 Applican!}
HEREBY AGREES THAT it will eomply with .itle VI of the Civil Rights Act of 1964 (P.L. 88-352)
and all requir:ments imposed by or pursuant to the Regulation of the Dep;mmer.t of Health wd
Human Services (45 CFR Part 80) im~ed pursuant \:0 that title, to the end that, in accordwce ....-ith
title VI of that Act and the Reguution, no person in d~e U~ited States shall. on the ground of race,
colcr. or natio~al origin, be excluded from participatio!l in, be denied the benef~ts of, or be other.\:ise
subjected to discriminatir.m under any program or activit)' for which the Applicant receiv~s federal
fir.ancioll assistwce from the Departmen:; and HEREBY GIVES ASSURANCE THAT it will imme-
dioltely take any measures necessary to effectuate this a6Teement.
If ..~y re.J property or structure thereon is pro\'ided or improved with the aid of Fede..al fir.ancial
assistance extended to the Applicant by the Department. this assurance shail obligate the Applicant. or
in the case of any transfer of such pro pert)', any transferee. for the period during which the real
proper.ty or structure is used for a. purpose for which the Federal financial assistance is extended or for
another purpose involving the pro\'ision of similar ser....ices or benefits. If wy personal propert)' is so
provided. this assurance shall obligate the Applicant for the period during which it retains ownership
or possession of the propert)'. In all other cases, this assurance shall obligate the Applicant for the
period during which the Federal fina~cia1 assistance is extended to it by the Department.
THIS ASSURA.\;CE is s-!ven in consideration of and for the purpose of obtaining any and all Federal
~:;.nts. loans, contracts. properc~'. discounts or other Federal fina~cial assistance extended after the
date hereof to the Applicant by the Department. including insta.llment payments after such dat~ on
.cC01.:nt of :;.ppl:cations for Federal financial assistance which were appr~\"ed before such date. The
Appiicanc recognizes and agrees that such Federal financial assistance wi!! be extended in reliance on
the representations and agreements made in this assurance, and that the United States shall have the
right to seek judicial enforcement of this assurance. This assurance is binding on the App!icant, its
suc:essor:;. t~a;lsfcrees. and ass:gnees. and the per:;on or Fersons w~ose signatures appear below are
authc~ized to sign this assurance on behalf of the Applicant.
D:.ted
Monroe County Board of County Commissioners
(Applicant)
By ~k~
(Presidcnt, Chai:nun of Board. or compa~ablc
a\:thorized official)
Michael H. Puto, Mayor
500 Whitehead Street
Key West, Fl. 33040
(Ap~l;c.nr's m..ilin~ acdrcss:
AIWfOWDAI TQ fIORM
AND LEGAL SVFF<
hTISGRANTSMANAGEMENT
HHS-~41
flY
-75-
,Fi..)
'DEP ART~1E~1 OF HEALTH AND HUMAN SER VICeS
ASSURANCE OF COMPLIANCE WITH SECTION SG4 OF THE
REHABILITATION Act Of 1973, AS AMENDED
(Annually UpdateJ)
The ~ndersig:'led (hertinafter ~ed !he "recipient'} HEREfY AGREES nu. T it will ccrnp:y with section S04 of the Re.
habilitation Act of 1973, as amended (29 US.C. 794), all requirements imposed by the ai'?licable HHS regulation (45 C.F.R.
Put 84), and all guidelines and i;nterpletations issued pursuant thereto.
Punuant to ~ 84.S(t) of the reruation i4S C.F.R. 84.5(a)) , the recipient gives this As.!urance in consideration (If and for the
purpose of obtaining a..'lY and aU federal &Tints, Joans, contracts (ex~pt procurement contracts and contracts of insurance
or guaranty), property, discounts, or other federal financial assistan~ extended by t~e Department of Health and Human
Senices after the date of this Assurance, including payments or other assistance made: after such cLlte on applica~ons for
federal fmancial assistance that "'ere appro"/ed before such date. The recipient recognizes and agrees that such iederal flllancial
assiSWlce will be exter.ded in reliance on the representations and agreements made in this Asst;rance and that the United
States will have the ri&ht to er.force this Assurance throuih awful means. This Assurano:e is binding on the recipient, its
successors, transferees, and assignees, and the person or persons whose signatures appear below are'iuthorized to sign this
Assurance on behalf of the recipient.
nus Assurance obligates the recipient for the period during which federal fmancial assistAnce is extended to it by the De.
partment of Health and Human Sen'ices or, where the assistance is in the form of real or personal property, for the peri01
provided for in ~ 84.5(b) of the regulation (4S C.F.R. 84.5(b)].
The recipien.:
a. ( )
A73
b. ( xx)
A74
[Check (a) or (b)]
employs fewer than futeen persons;
employs futeen or more persons and, pursuant to ~ 84.7(a) of the regulation [45 C.F.R. 84.7(a)] ,has
designated the following person(s) to coordinate its efforts to comply with the HHS regulation:
Thomas W. Brown
Name of Designee(s) - Type or Print
C12
C42
Monroe County In Home Servi~e~
Name of Recipient - Type or Print
A12
03-00021-0354
(IRS) Employer l:ier.ti!ication NUlllber
Al
B1
CJ
A41
1115 Whitehe~d Street
Street Address or P.O. Box
A42
Key West
City
B12
Florida
State
B42
A71
All
B11
Cll
B4l
33040
Zip
B71
I certify that the 3bove information is complete and correct to the best of my knowledge.
Date
B72
B77
Signature and Title of Authorized Ofticial
B78 Michael H. Puto, Mayor
If there has been a chanl!e in name or O'wner!hip within the last year. please PRINT the former name below:
~ AJIIMOWD AI TO /IOIIM
AND LEGAL MJFFICtDIf/f.
NOTE: The 'A', '5', and 'C' foUowed by r.umbers uc: for .:omputer use. Please disreg;o.ar. } ~)
PLEASE RETt.."RN ORJGINAL TO: Office for Chil Ri~'1t!, HHS P. O. Box 8222, W~sf::..iston,
HHS-641110/801
-76-
lIDS GR.A~7S MA.~AGEMENT
(F1S)
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TITLE III D
~SA/D13trict XI
BUDGeT EXPLANATION ~OR~~HEET
PAR! I - BUDGETED C~SH CC57S \.
1'18)
?~cp la ,>
I I CCE I CCDA I ~t'and 1
TITLE I I Amount I Amount I Total 1
III, D 1 SERVICE 'I I 1 Cash 1
---------1 ------..--1 ________1 ________1 _________1
Provider I , 1 1 1
Adm. I Homemaker I 1 I
1$ 1.3 IS. 1$__1
I 5, 35'S. 54 j I I
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' Sub Total - Salarie:J/Wages I S 1$ l S I $ IS, I
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' PERSONNEL: Fringe B~nefits I I I I 1'1
I 1$ 1$ \IS 1$ 1$ I
I FI CA (7. 51 % ) I I 402 , 421 I I I
I Rptirement 14.48% I 1 770.551 I I I
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1 Workmen's Compensation J I 268.991 I 1 I
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: Sub Tot.l - FrinQ. &.nefl ts :. __h_____:. _2_'}J_~._4_6_: ' _n_____:' __nu__:. ___ __ _ _ h I
I SUB TOTAL - PERSONNEt. :'$ , 1$ :.$ is'S I
1======--------- . ---.' 7,753.00::1' I _________1
---------=====~==:=======~========--., =========1 ======== . ========' ======== ________.
I
PROV:OER MONROE COUNTY, IN HOME
TITLE III-D
Cos1: C"itegC'lry
,xpl~na1:1on/J~at~f1cation
SERVICES
I
I.
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l~. PtRSOSNEi.: Salar1es/Wol~es 'I
Position Title Rate '!,
'IS
1 - Homemaker 28A $12,665.67 Yrly, :1
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(:23)
PSAlOistrict
XI
aUDGET EXPLANATION WORKSHEET
(
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I S~B TOTAL - TRAVEL .3
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TRAVEL: In State, Out of Area
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TRAVEL: Out of State
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PART I - BUCGETED CAS~ COSTS
. 1989
~ ---..Paq~ 2d~
CCDA , ~rand 1
Amount ~otal I
C.l$h I
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P~OVlCER MONROE COUNTY IN HOME SERVICES
TITLE III-D I Provider' I CCE I
Ccst Category I Admin. I SERVICE: 1 Amount ,
1 Explanation/Justification I 'Homemaker I I
I-----------------~-------------------------I --------1 --------1 ________,
12. TRAVEl.: I n Area @20c; per mile ::r I I .~ I
I 1$ 1$ 1$ 1$
1 480 mi. /mo. x 5 mos. I 1 480.001 I
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PSA/District Xl
BUDGET EXPLANATION WOR~SHEET
PART 1 - BUDGETED
{
\
P~OVID:.P. MONROE COUNTY IN HOME SERVICES
I TITLE III D I CCD
i Cost Category 1 PROVIDER: I SERVICE: CCE A
\ Explan3t~on:Justification I ADM. rOMEMAKER : Amount : Amount
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1989
Page 3~_>>.~
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XI
BUDGET EXPLANATION WORKSHEET
PART I - BUD~E!ED C~S~ COSTS
1969
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rROVIDER MONROE COUNTY IN HOME SERVICES
I TITLE III D 1
1 Cost Category JPROV}DER: SERVICE:
1 Explanation/Justification I ADM. I HOMEMAKER I
1 -------------- -- - ----- ------_______ ___: __ _ __ __ __ ,~.;._________I,
16. EQUIPME~T - ~urc~ases i
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17. MEALS/FOOD I
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(f6i)
COM."'iITMENT OF CASH
CONTRILUTION
TO:
Monroe County In Home Services
(n".me of provider 3.seI1cy)
FROM:
Monroe County Board of County Commissioners
(donor name)
500 Whitehead Street
(street address)
Key West
(city)
Monroe
(county)
Cash in the amount of $ 833.00 is com.'t\itted for use
by your pr.oject for the current year. This donation will
be made in
one
payment(s) of $ R11 00
each,
beginning on or before
2/89
and being
completed on or before
6/89
This cash is not included as contribution for any other
Federally assisted program or any Federal contract and
is not borne by the federal government directly or in-
directly under any federal grant or contract except as
provided for under (cite the authorizing federal regulation
or law).
Monroe County Board of County Commissioners, Michael H. Puto
(donor)
~~~
(pos1tion)
MAYOR
(donor I s signature)
(date)
/lY
-129-