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Resolution 044-1987 David P. Rice, Ph.D., Executive Director - Guidance Clinic of the Middle Keys, Inc. RESOLUTION NO. 044-1987 A RESOLUTION OF THE BOARD OF COUNTY COMMMIS- SIONERS OF MONROE COUNTY, FLORIDA, AUTHORIZING THE MAYOR AND CHAIRMAN OF THE BOARD TO EXECUTE AN AGREEMENT FOR BAKER ACT MATCHING FUNDS BY AND BETWEEN THE BOARD AND THE GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. CONCERNING FUNDING FOR FISCAL YEAR 1986-87. BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, as follows: That the Mayor and Chairman of the Board of County Commis- sioners of Monroe County, Florida, is hereby authorized to execute an Agreement for Baker Act Matching funds by and between the Board and the Guidance Clinic of the Middle Keys, Inc., a copy of same being attached hereto, concerning funding for fiscal year 1986-87. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the ~ t'~ day of -J~ M aG. It-- ~ , A.D. 1987. BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA (SEAL) Y (f ?i/ n/. d et- ~oR-h~.5//~ Attes t: DANNY L. I:::'OLIIAGZ, Clerk -,Q~,IJ~ '&.~ LERK r !lPP~lf[) AS TO FORM A 9:U=,9/1.L SupnCfEhCY ;:;"~~}I ~~~.._.,~--',-".'~'~-'_...-.....~...._-..:-- AGREEMENT FOR BAKER ACT MATCHING FUNDS THIS AGREEMENT, made this day of , 198 , by and between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as "BOARD", and the GUIDANCE CLINIC '.. OF THE MIDDLE KEYS, INC., hereinafter referred to as "CLINIC", For and in consideration of the mutual covenants made herein, the parties hereby agree as follows: (1) The Board agrees to reimburse the Clinic twenty-five percent (25%) of total $129,524.00 expenditures for Baker Act hospital, physician, and crisis stabilization services, as billed to the Clinic on state approved Baker Act Billing Forms (HRS 346) for clients qualifying for such services under applicable state and federal regulations and eligibility determination procedures. This cost is not to exceed a total reimbursement of Thirty Two Thousand Three Hundred Eighty One Dollars ($32,381.00) during the period beginning October 1, 1986, and ending September 30, 1987. (2) The Clinic agrees to provide to the Board on a regular basis a copy of the Baker Act Summary Billing Form from which reimbursement due the Clinic can be calculated; however, copies of individual client bills will not be available for inspections by the Board for reim- bursement purposes in order to comply with regulations safeguarding the patient's right to confidentiality. Copies of individual client bills are kept on file in the Clinic business office and will be made available under controlled condition to qualified auditors for audit purposes. The Clinic further agrees to provide the Board any Baker Act statistical data normally available to the Clinic and to make an annual report to the Board of the expenditure of County funds for the above specified purposes. This agreement shall terminate at 11:59 P.M., September 30, 1987 and the Board shall not be liable under the terms of this agreement for any liability incurred after the time of termination; however, the Board shall be liable for outstanding costs incurred prior to the termination of this agreement provided the Clinic submits to the Board the required Baker Act Summary Billing Form within three (3) weeks of the date of termination of this agreement, provided, however, that the maximum of reimbursement specified above is not exceeded. This agreement may also be terminated by either party upon thirty (30) days written notice delivered by certified mail to the party receiving notice of termination. County warrants or checks written for reimbursement to the Clinic shall be made payable to the Guidance Clinic of the Middle Keys, Inc. IN WITNESS WHEREOF, the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, has caused these presents to be signed in its name by .. its Chairman, Board of County Commissioners, and the Clerk of the Board of County Commissioners, and the Guidance Clinic of the Middle Keys, Inc., has caused these presents to be signed in its name by its President/Board of Directors and Executive Director all as of the day and year first above written. BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By Mayor/Chairman (Seal) Attest: Clerk GUIDANCE CLINIC OF THE MIDDLE KEYS, INC. By ~~;t::: P esident/Board of Directors BY~~~ {lDfL (jjp~~~ /Z~/L ~J~HZ ~ Witnesses H)" 2