FY2005 01/16/2005
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DA TE:
March 1, 20051
TO:
Monroe County Health Department
Gerri White, Administrative Assistant
Pamela G. Hanc~
Deputy Clerk C~_}'
FROM:
At the January 19, 2004, Board of County Commissioner's meeting the Board granted
approval and authorized execution of the Annual Core Contract between Monroe County and the
State of Florida Department of Health for operation of the Monroe County Health Department,
Contract Year 2004-2005, for environmental, dental and health services provided in Monroe
County.
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/
CONTRACT BETWEEN
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE MONROE COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2004-2005
This agreement ("Agreement") is made and entered into between the State of Florida,
Department of Health ("State") and the Monroe County Board of County Commissioners
("County"), through their undersigned authorities, effective October 1, 2004.
RECITALS
A. Pursuant to Chapter 154, F.S., the intent of the legislature is to "promote,
protect, maintain, and improve the health and safety of all citizens and visitors of this state
through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Monroe County Health Department eCHO") is one of the County Health
Departments created throughout Florida. It is necessary for the parties hereto to enter
into this Agreement in order to assure coordination between the State and the County in
the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference.
2. TERM. The parties mutually agree that this Agreement shall be effective from
October 1, 2004, through September 30, 2005, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three leyels of service pursuant to Section 154.01 (2), Florida
Statutes, as defined below:
a. "Environmental health services" are those services which are organized and
operated to protect the health of the general public by monitoring and regulating activities
funds and shall include those services mandated on a state or federalleyel. Examples of
enyironmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, occupational health.
b. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supported by available federal, state, and local funds and shall include those services
mandated on a state or federal leyel. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV/AIDS,
immunization, tuberculosis control and maintenance of yital statistics.
c. "Primary care services" are acute care and preventiye services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
indiYiduals, improve the collectiye health of the public, and preyent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by ayailable federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be proYided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. T he State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as proYided in
Attachment II, P art II is a n a mount not toe xceed $ 4,285.415 (State General
Revenue, Other State Funds and Federal Funds listed on the Schedule C). The State's
obligation to pay under this contract is contingent upon an annual appropriation
by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment II, Part II is an amount not
to exceed $ 417,575 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
b. Qyerall expenditures will not exceed available funding or budget authority,
whicheyer is less, (either current year or from surplus trust funds) in any service category.
Unless requested otherwise, any surplus at the end of the term of this Agreement in the
County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period.
2
c. Either party may establish service fees as allowed by law to fund actiyities of the
CHD. Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule. Fees are listed in Attachment" Part" of this contract and in the
Environmental Health Fee Schedule that is proYided by the Environmental Health Program
Office. The estimated annual enyironmental health fee revenues accruing to the County
Health Department Trust Fund are listed on Attachment VI.
d. Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding. If the State initiates the increase/decrease, the CHD will reyise the Attachment"
and send a copy of the revised pages to the County and the Department of Health,
Bureau of Budget Management. If the County initiates the increase/decrease, the County
shall notify the CHD. The CHD will then revise the Attachment" and send a copy of the
revised pages to the Department of Health, Bureau of Budget Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Monroe County
1100 Simonton Street
Post Office Box 6193
Key West, FL 33041-6193
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator
of the CHD shall be a State employee or under contract with the State and will he under
the day-to-day direction of the Deputy State Health Officer. The director/administrator
shall be selected by the State with the concurrence of the County. The
director/administrator of the CHD shall insure that non-categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan.
A report detailing the status of public health as measured by outcome measures and
similar indicators will be sent by the CHD director/administrator to the parties no later than
October 1 of each year (This is the standard quality assurance "County Health Profile" report located on
the Office of Planning, Evaluation & Data Analysis Intranet site).
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to
the extent permitted for the use of county purchasing procedures as set forth in
subparagraph b., below. All CHD employees shall be State or State-contract personnel
subject to State personnel rules and procedures. Employees will report time in the Client
Information System/Health Management Component compatible format by program
component as specified by the State.
b. The CHD shall comply with all applicable proYisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
3
Department of Health purchasing contract has been implemented for those goods or
seri/ices. In such cases, the CHD director/administrator must sign a justification therefore,
and all county-purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall
be maintained by the CHD in accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as p royided by law which are subject tot he confidentiality p royisions 0 f paragraph 6 .i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements:
i. The reyenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current yersion of the Client
Information System/Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include proYisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System/Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Monroe County.
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the state or county, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county. The equity share" of any surplus/deficit funds accruing to the state and county is
determined each month and at contract year-end. Surplus funds may be applied toward
4
the funding requirements of each participating goyernmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating goyernmental entity. The planned use of
surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy State
Health Officer has approyed the transfer. The Deputy State Health Officer shall forward
written eyidence of this approyal to the CHD within 30 days after an emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMS Circular A-133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director/administrator of the
CHD will prepare a correct;ye action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolyed at the end of fiye (5)
years, the records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures toe nsure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies, Protocols, and Procedures,
dated September 1997, as amended, the terms of which are incorporated herein by
reference. The CHD shall further adhere to any amendments to the State's security
requirements and shall comply with any applicable professional standards of practice with
respect to client confidentiality.
5
I. The CHD shall abide by all State policies and procedures, which by this reference
are incorporated herein as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof.
m. The CHD shall establish a system through which applicants for services and current
clients may present grieyances oyer denial, modification or termination of services. The
CHD will advise applicants of the right to appeal a denial or exclusion from services, of
failure to take account of a client's choice of service, and of his/her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this Agreement.
n. The CHD shall comply with the proYisions contained in the Ciyil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the county that shall include at least the
following:
i. The DE385L 1 Contract Management Variance Report and the DE580L 1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service yariances reflected in the
DE385L 1 report if the yariance exceeds or falls below 25 percent of the planned
expenditure amount. However, if the cumulative amount of the variance
between actual and planned expenditures does not exceed three percent of the
cumulatiye expenditures for the leyel of service in which the type of service is
included, a yariance explanation is not required. A copy of the written
explanation shall be sent to the Department of Health, Bureau of Budget
Management.
6
p. The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
i. March 1, 2005 for the report period October 1, 2004 through
December 31,2004;
ii. June 1, 2005 for the report period October 1, 2004 through
March 31,2005;
iii. September 1, 2005 for the report period October 1, 2004
through June 30,2005; and
iv. December 1, 2005 for the report period October 1, 2004
through September 30,2005.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilities shall be proYided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The county shall assure adequate fire and casualty insurance coverage for County-
owned C HD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
c. All yehicles will be transferred to the ownership of the County and registered as
county vehicles. The county shall assure insurance coyerage for these vehicles is
available through either a self-insurance program or insurance purchased by the County.
All vehicles will be used solely for CHD operations. Vehicles purchased through the
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund.
8. TERMINATION.
a. Termination at Will. This Agreement may be terminated by either party without
cause upon no less than one-hundred eighty (180) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties. Said
notice shall be deliyered by certified mail, return receipt requested, 0 r in person tot he
other party's contract manager with proof of deliYery.
b. Termination Because of Lack of Funds. In the eyent funds to finance this
Agreement become unayailable, either party may terminate this Agreement upon no less
than twenty-four (24) hours notice. Said notice shall be deliyered by certified mail, return
receipt requested, or in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
7
c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
obligation hereunder. Said notice shall be delivered by certified mail, return receipt
requested, or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parties further agree:
a. Availabilitv of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2005, it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature, in accordance with section 287.0582,
Florida Statutes.
b. Modification. This Agreement and its Attachments contain all of the terms
and conditions agreed upon between the parties. Modifications of this Agreement shall be
enforceable only when reduced to writing and signed by all parties.
c. Contract Manaaers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State:
For the County:
William (Bill) Conner
Name
Thomas J. Willi
Name
Actina Business Manaper
Title
County Administrator
Title
Post Office Box 6193
Gato Building, 1100 Simonton St
Key West, FL33041-6193
(305) 293-7539
Telephone
Gato Building, 1100 Simonton St
Key West, FL 33040
(305) 292-4441
Telephone
If different contract managers are designated after execution of this Agreement, the name,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
d. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
In WITNESS THEREOF, the parties hereto haye caused this 37 page agreement to be
executed by their undersigned officials as duly authorized effective the ~ay of October, 2004.
BOARD OF COUNTY COMMISSIONERS
FOR MONROE COUNTY
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED BY: "PI';' >n ~SIGNEDBY: ~C;. ~,~,.u>
, ,'. . (" ". fA:J ~Cll t.a \~ j .so~,J5Q.)i tI\ \) .FolL.
NAME: lJ J '!-1tC- '7.;> rtz~ Ii ~ NAME: John O. Aawunobi, M.D., M.B.A., M.P.H.
TITLE: 1\/\ A 'f DK TITLE: Secretary
DATE: J It '1./ 5 - DATE: ( . :z. (, .0"
I
ATTESTED TO:
SIGNED BY:
NAME:
TITLE:
DATE:
SIGNED BY:
NAME:
M.t>
TITLE:
DATE:
CHD Director/Administrator
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ATTACHMENT I
MONROE COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21) and FLAIR requirements because of
federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must
comply with the special reporting requirements for that service. The services and the reporting requirements are listed below:
Service
Reauirement
1.
Sexually Transmitted Disease
Program
Dental Health
Requirements as specified in FAC 640-3 and F.S. 384 and
the CHD Guidebook Intemal Operating Policy STD 6 and 7.
Monthly reporting on DH Form 1008*.
2.
3.
Special Supplemental Nutrition
Program for Women, Infants
and Children.
Service documentation and monthly financial reports as
specified In OHM 150-24* and all federal, state and county
requirements detailed in program manuals and published
procedures.
4.
Healthy Start!
Improved Pregnancy Outcome
Requirements as specified in the Healthy Start Standards
and Guidelines 1998 and as specified by the Health Start
Coalitions in contract with each county health department.
Periodic financial and programmatic reports as specified
by the program office and in the CHD Guidebook, Intemal Operating
Policy FAMPLAN 14*
5.
Family Planning
6.
Immunization
Periodic reports as specified by the department regarding
the survelllancelinvestigatlon of reportable vaccine
preventable diseases, vaccine usage accountability, the
assessment of various immunization levels and forms
reporting adverse events following immunization and
Immunization Module quarterly quality audits and duplicate data
reports.
Chronic Disease Program
Requirements as specified in the Community Intervention
Program (CIP) and the CHD Guidebook.
Environmental Health
Requirements as specified In DHP 50-4* and 50-21*
HIVlAIDS Program
Requirements as specified in Florida Statue 384.25 and
640-3.016 and 3.017 F.A.C. and the CHD Guidebook. Case
reporting on CDC Forms 50.428 (AdulV Adolescent) and 50.42A
(Pediatric). Socio-demographic data on persons tested for HIV in
CHD clinics should be reported on Lab Request Form 1628 or Post-
Test Counseling Form 1633. These reports are to be sent to the
Headquarters HIVlAIDS office within 5 days of the initial post-test
counseling appointment or within 90 days of the missed post-test
counseling appointment.
School Health Services
HRSM 150-25*, including the requirement for an annual plan
as a condition for funding.
*or the subsequent replacement if adopted during the contract period.
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1. GENERALREVENUE-STATE
015011 ALG/CONTRIBUTION TO CHDS-PRIMARY CARE 17,256 0 17,256 0 17,256
015011 ALGIPRIMAR Y CARE 223,310 0 223,310 0 223,310
015011 PRIMARY CARE SPECIAL PROJECT 0 0 0 0 0
015048 ALG/CONTR TO CHDS-STD PROGRAM 21,016 0 21,016 0 21,016
015050 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 128,707 0 128,707 0 128,707
015050 ALG/CONTR TO CHDS 1,517,812 0 1,517,812 0 1,517,812
015050 ALG/CONTR TO CHDS-MIGRANT LABOR CAMP SANITATION 0 0 0 0 0
015050 ALG/CONTR TO CHDS-DENTAL PROGRAM 20,000 0 20,000 0 20,000
015050 ALG/CONTR TO CHDS-IMMUNIZATION OUTREACH TEAMS 7,694 0 7,694 0 7,694
015050 ALG/CONTR. TO CHDS-INDooR AIR ASSIST PROG 0 0 0 0 0
015050 ALG/CONTR TO CHDS-SOVEREIGN IMMUNITY 0 0 0 0 0
015050 CITIZENS AGAINST TOXIC EXPOSURE (CATE) 0 0 0 0 0
015050 COMMUNITY TB PROGRAM 68,302 0 68,302 0 68,302
015050 CONTR TO CHDS - DUVAL TEEN PREGNANCY PREVENTION 0 0 0 0 0
015050 HEALTH PROMOTION & EDUCATION INITIATIVES 58,823 0 58,823 0 58,823
015050 HEALTHY BEACHES MONITORING 29,262 0 29,262 0 29,262
015050 LA LIGA CONTRA EL CANCER 0 0 0 0 0
015050 METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREY 0 0 0 0 0
015050 RED LEGISLATION - GAP GRANT (CAT 050310) 0 0 0 0 0
015050 SPECIAL NEEDS SHELTER PROGRAM 0 0 0 0 0
015065 ALG/CONTR TO CHDS-AIDS PATIENT CARE 466,663 0 466,663 0 466,663
015065 ALG/CONTR TO CHDS-AIDS PREY & SURV & FIELD STAFF 105,802 0 105,802 0 105,802
015115 VOLUNTEER SCHOOL HEALTH NURSE GRANT 0 0 0 0 0
015123 ALGIF AMIL Y PLANNING 62,578 0 62,578 0 62,578
015124 ALGIIPO - OUTREACH SOCIAL WORKERS CAT. 050707 0 0 0 0 0
015124 ALGIIPO HEALTHY START 0 0 0 0 0
015124 ALGIIPO HEALTHY STARTIIPO CAT 050707 0 0 0 0 0
015124 ALGIIPO-INFANT MORTALITY PROJECT CAT. 050707 0 0 0 0 0
015124 ALGIMCH HEALTHY STARTIIPO CAT 050870 0 0 0 0 0
015124 ALGIMCH-INFANT MORTALITY PROJECT CAT. 050870 0 0 0 0 0
015124 ALGIMCH-OUTREACH SOCIAL WORKERS CAT 050870 0 0 0 0 0
015137 ALG/CONTR TO CHDS-MCH HEALTH - FIELD STAFF COST 0 0 0 0 0
015137 HEALTHY START - DATA COLLECTION PROJECT STAFF 0 0 0 0 0
015140 ALG/SCHOOL HEAL THlSUPPLEMENT AL 41,665 0 41,665 0 41,665
GENERAL REVENUE TOTAL 2,768,890 0 2,768,890 0 2,768,890
2. NON GENERAL REVENUE - STATE
011008 RAPID AIDS TESTING - JAIL INMATES 2003 0 0 0 0 0
015010 ALG/CONTR TO CHDS-REBASING TOBACCO TF 21,864 0 21,864 0 21,864
015010 ENHANCED DENTAL SERVICES TOBACCO TF 0 0 0 0 0
015010 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 150,000 0 150,000 0 150,000
015010 ONSITE SEWAGE SPECIAL PROJECT-ATF 0 0 0 0 0
015010 PACE EH 0 0 0 0 0
015010 SUPER ACT PROGRAM ADM TF 0 0 0 0 0
015020 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF 0 0 0 0 0
015026 ALG/CONTR TO CHDS-BIOMEDICAL WASTEIDEP ADM TF 4,816 0 4,816 0 4,816
015072 ALG/CONTR TO CHDS-SAFE DRINKING WATER PRGIDEP ADM 0 0 0 0 0
015084 VARICELLA IMMUNIZATION REQUIREMENT TOBACCO TF 4,118 0 4,118 0 4,118
2. NON GENERAL REVENUE - STATE
015172 FULL SERVICE SCHOOLS - TOBACCO TF 61,720 0 61,720 0 61,720
015174 BASIC SCHOOL HEALTH - TOBACCO TF 40,839 0 40,839 0 40,839
NON GENERAL REVENUE TOTAL 283,357 0 283,357 0 283,357
3. FEDERAL FUNDS - State
007000 ARTHRITIS SELF-HELP COURSE 0 0 0 0 0
007000 CHILDHOOD LEAD POISONING PREVENTION 0 0 0 0 0
007000 COMPREHENSIVE CAROIOV ASCULAR PROGRAM 0 0 0 0 0
007000 FEDERAL COASTAL BEACH MONITORING PROGRAM 26,666 0 26,666 0 26,666
007000 GULF OF MEXICO PROGRAM- TAYLOR CHD 0 0 0 0 0
007000 STATE PROGRAMS TO PREVENT OBESITY 2003-04 0 0 0 0 0
007030 PHBGIMIGRANT LABOR CAMP SANITATION 0 0 0 0 0
007049 STD PROGRAM-CSPS 0 0 0 0 0
007049 SID PROGRAM-CSPS-2005 0 0 0 0 0
007049 STD PROGRAM-INFERTILITY PROJECT 0 0 0 0 0
007049 SID PROGRAM-MED & LAB SVCS TRNG CNTR 0 0 0 0 0
007049 STD PROGRAM-SYPHILIS ELIMINATION PROJECT 0 0 0 0 0
007049 STDIHIV PREVENTION TRAINING CENTER 0 0 0 0 0
007051 FGTF/WIC ADMINISTRATION 206,424 0 206,424 0 206,424
007056 HEALTH PROGRAM FOR REFUGEES 0 0 0 0 0
007056 REFUGEE HEALTH TB TARGETED TESTING 0 0 0 0 0
007063 PHBG/COMPREHENSlVE COMM CAROIO HLTII PRGM 0 0 0 0 0
007064 AIDS SEROPREV ALENCE 0 0 0 0 0
007064 EV AL INTEG HIV/AIDS SURV SYST PERFORMANCE 0 0 0 0 0
007064 FGTF/AJDSSURVEaLANCE 0 0 0 0 0
007065 AIDS PREVENTION 171,474 0 171,474 0 171,474
007066 FGTFIR Y AN WHITE 0 0 0 0 0
007066 FGTFIR Y AN WHITE - EMERGING COMMUNITIES 0 0 0 0 0
007066 FGTFIRY AN WHITE-AIDS DRUG ASSIST PROG-ADMIN 22,443 0 22,443 0 22,443
007066 FGTFIRYAN WHITE-CONSORTIA 532,236 0 532,236 0 532,236
007067 TUBERCULOSIS CONTROL - FEDERAL GRANT 0 0 0 0 0
007068 FGTF/AIDS INMATE INTERVENTION 0 0 0 0 0
007077 BIOTERR SURVEaLANCE & EPIDEMIOLOGY 0 0 0 0 0
007077 BIOTERRORISM - HOSPITAL PREPAREDNESS 2004-05 0 0 0 0 0
007077 BIOTERRORISM NETWORK COMMUNICATIONS 0 0 0 0 0
007077 BIOTERRORISM PLANNING & READINESS 69,248 0 69,248 0 69,248
007077 PUB HLTH PREP-EDUCATION & TRAINING 0 0 0 0 0
007084 FGTF/IMMUNIZATION ACTION PLAN 6,078 0 6,078 0 6,078
007084 FGTF/IMMUNIZATION-PROJECT FIELD STAFF 0 0 0 0 0
007084 FGTF/IMMUNIZATION-WIC LINKAGES 0 0 0 0 0
007084 IMMUNIZATION ACTION PLAN 2004-2005 5,774 0 5,774 0 5,774
007084 IMMUNIZATION FIELD STAFF 2004 0 0 0 0 0
007084 IMMUNIZATION PROJECT - VFC 0 0 0 0 0
007084 IMMUNIZATION SPECIAL PROJECT 3,720 0 3,720 0 3,720
007084 IMMUNIZATION SUPPLEMENTAL - 2004 0 0 0 0 0
007084 IMMUNIZATION SUPPORT GRANT - 2005 0 0 0 0 0
007085 FGTF/BREAST & CERVICAL CANCER-ADMIN/CASE MAN 0 0 0 0 0
007127 MCH BGTF-MCHfCHILD HEALTH 11,446 0 11,446 0 11 ,446
3. FEDERAL FUNDS - State
007132 MCH BGTF-MCH/DENTAL PROJECTS 0 0 0 0 0
007133 FGTFIFAMIL Y PLANNING TITLE X SPECIAL INITIATIVES 0 0 0 0 0
007133 FGTFIF AMIL Y PLANNING-TITLE X 78,280 0 78,280 0 78,280
007134 MCH BGTF-GADSDEN SCHOOL CLINIC 0 0 0 0 0
007134 MCH BGTF-HEALTHY START IPO 0 0 0 0 0
007134 MCH BGTF-INFANT MORTALITY PROJECT 0 0 0 0 0
007134 MCH BGTF-OUTREACH SOCIAL WORKERS 0 0 0 0 0
007135 FGTF/ABSTINENCE EDUCATION PROGRAM 0 0 0 0 0
015009 Transfer of Federal Funds Within Agency 0 0 0 .0 0
015021 MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES 0 0 0 0 0
015021 MEDIPASS WAIVER-SOBRA 0 0 0 0 0
015060 Entrant Reimburement Transfer 0 0 0 0 0
015075 FULL SERVICE SCHOOLS-TANF 6,732 0 6,732 0 6,732
015075 SCHOOL HEALTH-SUPPLEMENT-TANF 11,581 0 11,581 0 11,581
015075 TITLEXXIlSCHooL HEAL TWSUPPLEMENTAL 81,066 0 81,066 0 81,066
015075 Refugee Screening Reimbursement 0 0 0 0 0
015075 Summer Feeding Sites 0 0 0 0 0
FEDERAL FUNDS TOTAL 1,233, I 68 0 1,233,168 0 1,233,168
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001092 Environmental Health Fees 28,000 0 28,000 0 28,000
001092 OSDS Repair Permit 1,300 0 1,300 0 1,300
001092 aSDS Permit Fee 56,000 0 56,000 0 56,000
001092 I & M Zoned Operating Permit 1,500 0 1,500 0 1,500
001092 Aerobic Operating Permit 72,100 0 72,100 0 72, I 00
001092 Septic Tank Site Evaluation 79,941 0 79,941 0 79,941
001113 Mobile Home and Parks 18,000 0 18,000 0 18,000
001132 Food Hygiene Permit 14,000 0 14,000 0 14,000
001135 OSDS Variance Fee 1,150 0 1,150 0 1,150
001139 Migrant Housing Permit 0 0 0 0 0
001140 Biohazard Waste Permit 5,900 0 5,900 0 5,900
001142 Non SDWA Lab Sample 0 0 0 0 0
001144 Tanning Facilities 1,670 0 1,670 0 1,670
001145 Swimming Pools 48,000 0 48,000 0 48,000
00Il49 Body Piercing 540 0 540 0 540
001165 Private Water Constr Permit 0 0 0 0 0
001166 Public Water Annual Oper Permit 0 0 0 0 0
001166 Public Water Constr Permit 0 0 0 0 0
001166 Non-SDW A System Permit 0 0 0 0 0
001170 Lab Fee Chemical Analysis 0 0 0 0 0
001196 Water Analysis-Potable 0 0 0 0 0
001197 Nonpotable Water Analysis 0 0 0 0 0
001211 Safe Drinking Water 0 0 0 0 0
010403 Fees-Copy of Public Doc 0 0 0 0 0
015052 Transfers-Mobile Home/RV Park 0 0 0 0 0
010303 MQA Inspection Fee 0 0 0 0 0
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 328,101 0 328,101 0 328,101
5. OTHER CASH CONTRIBUTIONS - STATE
010304 Stationary Pollutant Storage Tanks 121,275 0 121,275 0 121,275
015029 Tranfers IntraAgency 0 0 0 0 0
015121 Super Act Reimbursements 2,570 0 2,570 0 2,570
015139 Well Surveillance Reimbursement - Pesticide 0 0 0 0 0
090001 Draw down from Public Health Unit -444,975 0 -444,975 0 -444,975
OTHER CASH CONTRIBUTIONS TOTAL -321,130 0 -321,130 0 -321,130
6. MEDICAID - ST A TE/COUNTY
001056 CHD Incm:Medicaid-Pharmacy 0 0 0 0 0
001076 Medicaid- TB 0 0 0 0 0
001078 Medicaid-Administration Vaccine 0 0 0 0 0
001079 Medicaid-Case Management 0 0 0 0 0
001080 CHD Incm:Medicaid-Other-Physician 001084 2,697 3,865 6,562 0 6,562
001081 CHD Incm:Medicaid-Child Health Checkup 0 0 0 0 0
001082 CHD Incm:Medicaid-Dental 0 0 0 0 0
001083 CHD Incm:Medicaid-FP 0 0 0 0 0
001085 CHD Incm:Medicaid-Nursing 0 0 0 0 0
001087 CHD Incm:Medicaid-STD 0 0 0 0 0
001089 Medicaid AIDS 45,210 64,790 110,000 0 110,000
001147 Medicaid HMO Rate 0 0 0 0 0
001191 CHD Incm:Medicaid Maternity 0 0 0 0 0
001192 CHD Incm:Medicaid Comp. Child 0 0 0 0 0
001193 CHD Incm:Medicaid Comp. Adult 0 0 0 0 0
001194 Medicaid-LAB 0 0 0 0 0
001208 Medipass $3.00 Adm. Fee 1,075 1,541 2,616 0 2,616
MEDICAID TOTAL 48,982 70,196 119,178 0 119,178
7. ALLOCABLE REVENUE - STATE
018001 Refunds, Salary 0 0 0 0 0
018003 Refunds, other Personal Services 0 0 0 0 0
018004 Refunds, Expenses 50 0 50 0 50
018006 Refunds, Operating Capital Outlay 0 0 0 0 0
018010 Refunds, Special Category 0 0 0 0 0
018011 Refunds, Other 0 0 0 0 0
018013 DMS Refunds by Journal Transfer-65900 0 0 0 0 0
018099 Refunds, Certified Forward 0 0 0 0 0
037000 Prior Year Warrant 0 0 0 0 0
038000 12 Month Old Warrant 0 0 0 0 0
ALLOCABLE REVENUE TOTAL 50 0 50 0 50
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
State Pharmacy Services 0 0 0 65,280 65,280
State Laboratory Services 0 0 0 89,978 89,978
State TB Services 0 0 0 0 0
State Immunization Services 0 0 0 148,759 148,759
State STD Services 0 0 0 0 0
State ConstructionJRenovation 0 0 0 0 0
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
WIC Food 0 0 0 655,164 655,164
ADAP Aids Drug Assistance Program 0 0 0 467,056 467,056
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 1,426,237 1,426,237
9. DIRECT COUNTY CONTRIBUTIONS - COUNTY
008030 Grants-County Tax Direct 0 342,034 342,034 0 342.034
008034 Grants Cnty Commsn Other 0 75,541 75,541 0 75,541
BOARD OF COUNTY COMMISSIONERS TOTAL 0 417,575 417,575 0 417,575
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001004 Child Car Seat Prog 0 0 0 0 0
001060 Vital Statistics Fees Other 0 40 40 0 40
001062 Rabies Vaccine 0 0 0 0 0
001074 Adult Enter. Permit Fees 0 0 0 0 0
001077 Primary Care Fees 0 10,975 10,975 0 10,975
001093 Communicable Disease Fees 0 58,376 58,376 0 58,376
001094 Environmental Health Fees 0 0 0 0 0
001114 New Birth Certificates 0 9,730 9,730 0 9,730
001115 Death Certificates 0 42,000 42,000 0 42,000
001117 Vital Stats-Adm. Fee 50 cents 0 500 500 0 500
FEES AUTHORIZED BY COUNTY TOTAL 0 121,621 121,621 0 121,621
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009 Debit Memo-Bad Checks 0 0 0 0 0
001010 Recovery-Bad Checks 0 0 0 0 0
001015 Recovery of Collection of Agency Placements 0 0 0 0 0
001026 Returned Check Fee 0 0 0 0 0
001029 Third Party Reimbursement 0 250 250 0 250
001072 Ryan White Title I 0 0 0 0 0
001073 Ryan White Title II 0 0 0 0 0
001075 Ryan White Title III 0 5,000 5,000 0 5,000
001090 Medicare 0 21,250 21,250 0 21,250
001190 Health Maintenance Organ. (HMO) 0 0 0 0 0
005040 Interest Earned 0 0 0 0 0
005041 Interest Earned-State Investment Account 0 18,000 18,000 0 18,000
007010 u.S. Grants Direct 0 692,894 692.894 0 692,894
008010 Grants Contracts Frm Cities Direct 0 0 0 0 0
008031 County AIDS Education 0 0 0 0 0
008050 Grants-Cnty Sch Board Direct 0 35,000 35,000 0 35,000
008090 Grants other Local Govn't Direct 0 0 0 0 0
008094 Grnts/Contracts other Agencies Direct 0 0 0 0 0
008095 Grants Cnty Sect 403.102 Air Pol 0 0 0 0 0
008099 ReimbIRebate Local Govn't 0 0 0 0 0
010300 Sale of Goods and Services 0 0 0 0 0
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
010301 Exp Witness Fee Consultnt Charges 0 0 0 0 0
010403 Fees-Copies of Documents 0 450 450 0 450
010405 Sale of pharmaceuticals 0 0 0 0 0
010408 Copy Fess IntralInter Agency 0 0 0 0 0
010409 Sale of Goods Outside State Government 0 0 0 0 0
010500 Sales of Services Outside State Govemmnent 0 0 0 0 0
011001 Healthy Start Coalition Contributions 0 310,458 310,458 0 310,458
011007 Cash Donations Private 0 0 0 0 0
011066 Ryan White Local Revenues 0 0 0 0 0
011067 AIDS Insurance Continuation Project 0 0 0 0 0
011099 Other GrantslDonations Direct 0 0 0 0 0
012020 Fines and Forfeitures 0 0 0 0 0
012021 Return Check Charge 0 0 0 0 0
028020 Insurance Recoveries-Other 0 0 0 0 0
090002 Draw down from Public Health Unit 0 -123,592 -123,592 0 -123,592
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 959,710 959,710 0 959,710
12. ALLOCABLE REVENUE - COUNTY
018001 Refunds, Salary 0 0 0 0 0
018003 Refunds, other Personal Services 0 0 0 0 0
018004 Refunds, Expenses 0 0 0 0 0
018006 Refunds, Operating Capital Outlay 0 0 0 0 0
018010 Refunds, Special Category 0 0 0 0 0
018011 Refunds, Other 0 0 0 0 0
018013 DMS Refunds by Journal Transfer-65900 0 0 0 0 0
018099 Refunds, Certified Forward 0 0 0 0 0
037000 Prior Year Warrant 0 0 0 0 0
038000 12 Month Old Warrant 0 0 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0
13. BUILDINGS - COUNTY
Annual Rental Equivalent Value -GATO/RICrravernier $16.68 slf 0 0 0 261,720 261,720
Maintenance- Tav,RIC,EHMar,RSC,Gato 0 0 0 45,559 45,559
Utilites- Gato $15,232/mo * 12 *30.5% 0 0 0 55,749 55,749
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
Other (specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 363,028 363,028
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
Other County Contribution of some unknow origin 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
Other County Contribution (specify) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL
GRAND TOTAL CHD PROGRAM
o
4,341,418
o
1,569,102
o
5,910,520
o
1,789,265
o
7,699,785
A. COMMUNICABLE DISEASE CONTROL:
Immunization (I 0 1) 3.75 2,500 5,200 55,253 55,253 55,253 55,253 0 221,012 221,012
SID (102) 2.00 200 1,500 33,485 33,485 33,485 33,485 0 133,940 133,940
ALD.S. (103) 17.50 475 7,000 504,710 504,710 504,710 504,710 696,720 1,322,120 2,018,840
TB Control Services (104) 2.00 575 1,500 28,723 28,723 28,723 28,723 0 114,892 114,892
Comm. Disease Surv. (106) 0.60 0 800 13,077 13,077 13,077 13,077 0 52,308 52,308
Hepatitis Prevention (109) 2.25 475 1,000 43,125 43,125 43,125 43,125 0 172,500 172,500
Public Health Preparedness and Response (116) LSO 0 0 67,312 19,312 31,812 31,812 73,000 77,248 150,248
Vital Statistics (180) 1AO 0 0 15,823 15,823 15,823 15,823 63,292 0 63,292
COMMUNICABLE DISEASE SUBTOTAL 31.00 4,225 17,000 761,508 713,508 726,008 726,008 833,012 2,094,020 2,927,032
B. PRIMARY CARE:
Chronic Disease Services (210) LSO 980 950 18,382 18,382 18,382 18,382 0 73,528 73,528
Tobacco Prevention (212) 0.00 0 0 0 0 0 0 0 0 0
Home Health (215) 0.00 0 0 0 0 0 0 0 0 0
WJ.C (221) 6.00 1,500 10,000 64,358 64,358 64,358 64,358 0 257,432 257,432
Family Planning (223) 4.75 1,100 5,600 95,882 95,882 95,882 95,882 0 383,528 383,528
Improved Pregnancy Outcome (225) 0.00 0 0 0 0 0 0 0 0 0
Healthy Start Prenatal (227) 3.50 400 10,000 63,685 63,685 63,685 63,685 254,740 0 254,740
Comprehensive Child Health (229) 0.70 280 400 20,860 20,860 20,860 20,860 0 83,440 83,440
Healthy Start Infant (231) 3.50 350 9,000 44,441 44,441 44,441 44,441 177,764 0 177,764
School Health (234) 9.00 0 100,000 97,384 97,384 97,384 97,384 35,000 354,536 389,536
Comprehensive Adult Health (237) 2.50 820 2,900 58,375 58,375 58,375 58,375 0 233,500 233,500
Dental Health (240) 0.00 0 0 2,500 2,500 12,500 2,500 0 20,000 20,000
PRIMARY CARE SUBTOTAL 31.45 5,430 138,850 465,867 465,867 475,867 465,867 467,504 1,405,964 1,873,468
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
Coastal Beach Monitoring (347) 1.75 650 890 28,508 10,000 28,508 10,000 21,088 55,928 77,016
Limited Use Public Water Systems (357) 0.00 0 0 0 0 0 0 0 0 0
Public Water System (358) 0.00 0 0 0 0 0 0 0 0 0
Private Water System (359) 0.00 0 0 0 0 0 0 0 0 0
Individual Sewage Disp. (361) 12.00 3,000 3,000 131,164 131,164 131,164 131,164 0 524,656 524,656
Group Total 13.75 3,650 3,890 159,672 141,164 159,672 141,164 21,088 580,584 601,672
Facility Programs
Food Hygiene (348) 3.00 60 250 7,157 7,157 7,157 7,157 0 28,628 28,628
Body Art (349) 0.00 0 0 1,914 1,914 1,914 1,914 0 7,656 7,656
Group Care Facility (351) 0.50 80 150 4,143 4,143 4,143 4,143 16,572 0 16,572
Migrant Labor Camp (352) 0.00 0 0 0 0 0 0 0 0 0
Housing,Public Bldg Safety,Sanitation (353) 0.00 0 0 0 0 0 0 0 0 0
Mobile Home and Parks Services (354) 0.50 65 280 9,076 9,076 9,076 9,076 0 36,304 36,304
Swimming Pools/Bathing (360) 3.00 482 1,220 24,907 24,907 24,907 24,907 50,957 48,671 99,628
Biomedical Waste Services (364) 0.30 40 60 8,585 8,585 8,585 8,585 23,624 10,716 34,340
Tanning Facility Services (369) 0.03 5 II 0 0 0 0 0 0 0
C. ENVIRONMENTAL HEALTH:
Group Total 7.33 732 1,971 55,782 55,782 55,782 55,782 91,153 131,975 223,128
Groundwater Contamination
Storage Tank Compliance (355) 2.00 290 583 47,899 47,899 . 87,899 47,899 110,321 121,275 231,596
Super Act Service (356) 0.00 0 0 1,000 1,000 1,000 1,000 0 4,000 4,000
Group Total 2.00 290 583 48,899 48,899 88,899 48,899 110,321 125,275 235,596
Community Hygiene
Occupational Health (344) 0.00 0 0 300 300 300 300 1,200 0 1,200
Consumer Product Safety (345) 0.00 0 0 0 0 0 0 0 0 0
Emergency Medical (346) 0.00 0 0 0 0 0 0 0 0 0
Lead Monitoring Services (350) 0.00 0 0 0 0 0 0 0 0 0
Public Sewage (362) 0.00 0 0 0 0 0 0 0 0 0
Solid Waste Disposal (363) 0.00 0 0 0 0 0 0 0 0 0
Sanitary Nuisance (365) 0.00 0 0 3,333 3,333 3,333 3,333 13,332 0 13,332
Rabies Surveillance/Control Services (366) 0.05 1 6 302 302 302 302 1,208 0 1,208
Arbovirus Surveillance (367) 0.15 0 20 709 709 709 709 2,836 0 2,836
Rodent/Arthropod Control (368) 0.00 0 0 0 0 0 0 0 0 0
Water Pollution (370) 0.00 0 0 1,223 1,223 1,223 1,223 4,892 0 4,892
Air Pollution (371) 0.00 0 0 900 900 900 900 0 3,600 3,600
Radiological Health (372) 0.03 0 0 450 450 450 450 1,800 0 1,800
Toxic Substances (373) 1.00 30 30 5,189 5,189 5,189 5,189 20,756 0 20,756
Group Total 1.23 31 56 12,406 12,406 12,406 12,406 46,024 3,600 49,624
ENVIRONMENTAL HEALTH SUBTOTAL 24.31 4,703 6,500 276,759 258,251 316,759 258,251 268,586 841,434 1,110,020
D. SPECIAL CONTRACTS:
Special Contracts (599) 0.00 0 0 0 0 0 0 0 0 0
SPECIAL CONTRACTS SUBTOTAL 0.00 .0 0 0 0 0 0 0 0 0
TOTAL CONTRACT 86.76 14,358 162,350 1,504,134 1,437,626 1,518,634 1,450,126 1,569,102 4,341,418 5,910,520
ATTACHMENT III
MONROE COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prOhibits
discrimination on the basis of handicap in programs and activities receiving or benefiting from federal
financial assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant
agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit
from federal financial assistance, and that it is binding upon the applicant, its successors, transferees,
and assignees for the period during which such assistance is provided. The applicant further assures
that all contracts, subcontractors, subgrantees or others with whom It arranges to provide services or
benefits to participants or employees in connection with any of its programs and activities are not
discriminating against those participants or employees in connection with any of its programs and
activities are not discriminating against those participants or employees In violation of the above
statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant
understands that the grantor may, at its discretion, seek a court order requiring compliance with the
terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance
being terminated and further assistance being denied.
ATTACHMENT IV
FACILITIES UTILIZED BY THE MONROE COUNTY HEALTH DEPARTMENT
Facility
Description
Location
GATO Building 1100 simonton street
Admin/Nursing/EnvHlth Key West, FL 33040
Health Care Center
1200 Kennedy Drive
Key West, FL 33040
Roosevelt Sands
Center
105 Olivia Street
Key West, FL 33040
Ruth Ivins Center
For Public Health
3333 Overseas Highway
Marathon, FL 33050
Environmental Health 13367 Overseas Highway
Monroe CHD Marathon, FL 33050
Monroe County Health 148 Georgia Ave
Department Tavernier, FL 33070
Venetian Plaza 85960 Overseas Highway
Islamorada Village of the Islands
Environmental Health Islamorada, FL 33036
Square
Footaae
Number of
Emplovees Owned Bv
8,691 s.f.
3,000 s.f.
2,000 s.f.
5,000 s.f.
1,250 s.f.
2,000 s.f.
1,500 s.f.
42
County
9
Lease
6
Lease
9
County
7
Lease
10
County
7
Lease
ATTACHMENT V
MONROE COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAR STATE COUNTY IQI&.
2002-2003 $ $ $
2003-2004 $ $ $
2004-2005 $ 400,000 $ $ 400,000
2005-2006 $ $ $
2006-2007 $ $ $
PROJECT TOTAL $ $ $
SPECIAL PROJECT CONSTRUCTIONlRENOVAnON PLAN
PROJECT TITLE:
Upper Keys CHD, Mariner's Hospital
50 High Point Road, Plantation Key, FlorIda
LOCATION:
CATEGORY:
NEW FACIL.ITY
RENOVATION x
NEW ADDITION
ROOFING
PLANNING STUDY
SQUARE FOOTAGE:
5,747
PROJECT SUMMARY: Construction and Renovation: site work, installation of utilities, landscaping, restoration of structural
shell, new interior walls, doors,windows, hardware, carpet. vinyl. title, plumbing and electrical. Furnishings and Equipment:
medical equipment. oIfice furnishings. flUng systems, phone equipment and wiring, technology equipment and wiring, technology
software.
ESTIMATED PROJECT INFORMATION:
8T ART DATE (initMI expenditure of funds):
COMPLETION DATE:
January-05
June-06
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITURE/EQUIPMENT
TOTAL PROJECT COST:
$
$
$
$
$
2,700
197.300
200,000
400,000
COST PER SQ FOOT:
34.80
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