2nd Amendment to 06/16/2004
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DA TE:
June 30, 2004
TO:
Fire Chief Clark Martin
Fire-Rescue Department
ATTN:
Susan Hover
Administrative Assistant
FROM:
Pamela G. Hancoc~..
Deputy Clerk CJ
At the June 16, 2004, Board of County Commissioner's meeting the Board granted
approval and authorized execution of a Contract Amendment between Monroe County, Board of
Governors, Fire and Ambulance District I and Advanced Data Processing, Inc. for rescue
ambulance billing and related professional services to extend the existing agreement for ten (10)
months, September I, 2004 through June 30, 2005, which would allow parties sufficient time to
work out future contractual issues.
Enclosed is a duplicate original of the above-mentioned for your handling. Should you
have any questions please do not hesitate to contact this office.
cc: County Administrator w/o document
County Attorney
Finance
File I
CONTRACT AMENDMENT
THIS CONTRACT AMENDMENT entered this 16th day of June, 2004,
between the Board of Governors, Fire and Ambulance District 1 of Monroe
County, Fl. and Advanced Data Processing, Inc. (ADPI).
WHEREAS, the parties entered into an agreement on August 16, 2000,
and thereafter amended said agreement on September 1, 2002, and on
September 1, 2003; and
WHEREAS, said agreement as amended previously terminates August
31,2004;and
WHEREAS, it is desired to extend the agreement for ten months to allow
the parties sufficient time to determine the details of the future contractual
ambulance billing relationship.
The parties agree as follows:
1. The contract dated August 16,2000, as previously amended,
shall be extended through June 1, 2005, at the rate of 7% of monthly
collections and $11.40 per Medicaid account. ($25,330.14 FY 2003).
2. All other provisions of the contract dated August 16, 2000, as
amended September 1, 2002 and September 1,2003, not inconsistent
herewith, shall remain in full force and effect.
r-.,)
:r c=
BOARD OF GOVERNORS OF FIRE Alib ~ ~
AMBULANCE DISTRICT 1 ~p :;; ~
OF MO~?p COU':;:' F~~DA ~~~ l:l
BY: ~ ':.. /~/~ ;gS; ~
Mayor / Chairman ;!J ~ '9
> (T1
::VAN~ROC~SSING INC. (ADPI)
Doug mon, CEO
suzp, ,~!: /" HuTTON
Date ASSISTAN~ ~~-rNEY
(7\
"T1
r-
rrl
o
."
o
::0
::0
rrl
c;
C
:::u
G
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
/tDVANCf..J) bArn f1e,uct.6SJNC, JNc- (At:>pr)warrants that he/it has not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No.1 0-1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or employee.
~
(,/Jf!or
Date:
.
STATE OF Ftol-/blf
COUNTY OF d/2(Jwlf~
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
1)0 tJ G SlJriY1 P /I
who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this f}. t..j ill day of
-:Jv " .e
, 20 0 t.f .
~111,7I~
N ARY PUBLIC
,\\~llll*' D,c:-""Hl'r..'t
M .. . ,"~YPI.J.'.~ ...~J.J..j.' _,..l~
Y commISSIOn expIres: .3'<);.'....'.~~~r')"''T;,,;"1:'..
), ~ ~"!'! ~ \c;'c.-..,.'..;, -.. " ,. ','
f_ ~tz'Ot.I ~::'\~l~:; F;;:~iD:;2S ,pecl' r!, t.,;'vO
<.p I "::.:};>l-'~~"~~;;- hu~C:.:~ T~a
~,,~~,~h.." !"tlmt;.:: Bcz~c.:.:~8 Co., l~c4
OMB - MCP FORM #4
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list
following a conviction for public entity crime may not submit a bid on a
contract to provide any goods or services to a public entity, may not submit
a bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real
property to public entity, may not be awarded or perform work as a
contractor, supplier, subcontractor, or consultant under a contract with any
public entity, and may not transact business with any public entity in excess
of the threshold amount provided in Section 287.017, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor list."