HomeMy WebLinkAboutExhibit 2Florida Department of Health
Contract #DEV05
City of Miami
School Crossing Guards
$323,476 .
To provide adequate liability insurance coverage on a comprehensive basis and to hold such liability insurance at all times during the existence of this contract and any
renewal(s) and extension(s) of it. Upon execution of this contract, unless it is a state agency or subdivision as defined by §768.28, FS, the provider accepts full responsibility
for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the provider and the clients to be served
under this contract. Upon the execution of this contract, the provider shall furnish the department written verification supporting both the determination and existence of such
insurance coverage. Such coverage may be provided by a self-insurance program established and operating under the laws of the State of Florida. The department reserves
the right to require additional insurance as specified in Attachment I where appropriate.
H. Safeguarding Information
Not to use or disclose any information concerning a recipient of services under this contract for any purpose not in conformity with state and federal law or
regulations except upon written consent of the recipient, or his responsible parent or guardian when authorized by law.
I. Assignments and Subcontracts
1. To neither assign the responsibility of this contract to another party nor subcontract for any of the work contemplated under this contract without prior written
approval of the department, which shall not be unreasonably withheld. Any sub -license, assignment, or transfer otherwise occurring shall be null and void.
2. The provider shall be responsible for all work performed and all expenses incurred with the project. If the department permits the provider to subcontract all or
part of the work contemplated under this contract, including entering into subcontracts with vendors for services and commodities, it is understood by the
provider that the department shall not be liable to the subcontractor for any expenses or liabilities incurred under the subcontract and.the provider shall be
solely liable to the subcontractor for all expenses and liabilities incurred under the subcontract. The provider, at its expense, will defend the department
against such claims.
3. The State of Florida shall at all times be entitled to assign or transfer its rights, duties, or obligations under this contract to another governmental agency in the State of
- Florida, upon giving prior written notice to the provider. In the event the State of Florida approves transfer of the provider's obligations, the provider remains responsible
for all work performed and all expenses incurred in connection with the contract. In addition, this contract shall bind the successors, assigns, and legal representatives
of the provider and of any legal entity that succeeds to the obligations of the State of Florida.
The contractor shall provide a monthly Minority Business Enterprise report summarizing the participation of certified and non -certified minority subcontractors/material
suppliers for the current month, and project to date. The report shall include the names, addresses, and dollar amount of each certified and non -certified MBE
participant, and a copy must be forwarded to the Contract Manager of the Department of Health. The Office of Supplier Diversity (850-487-0915) will assist in
furnishing names of qualified minorities. The Department of Health, Minority Coordinator (850-245-4199) will assist with questions and answers.
5. Unless otherwise stated in the contract between the provider and subcontractor, payments made by the provider to the subcontractor must be within seven (7) working
days after receipt of full or partial payments from the department in accordance with §§287.0585, FS. Failure to pay within seven (7) working days will result in a penalty
charged against the provider and paid to the subcontractor in the amount of one-half of one (1) percent of the amount due per day from the expiration of the period allowed
herein for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15) percent of the outstanding balance due.
J. Return of Funds
To return to the department any overpayments due to unearned funds or funds disallowed pursuant to the terms of this contract that were disbursed to the provider by the
department. in the event that the provider or its independent auditor discovers that overpayment has been made, the provider shall repay said overpayment within 40
calendar days without prior notification from the department. In the event that the department first discovers an overpayment 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 department will charge interest of one (1) percent per month compounded on the
outstanding balance after 40 calendar days after the date of notification or discovery.
K Incident Reporting
Abuse, Neglect, and Exploitation Reporting
In compliance with Chapter 415, FS, an employee of the provider who knows or has reasonable cause to suspect that a child, aged person, or disabled adult is or
has been abused, neglected, or exploited shall immediately report such knowledge or suspicion to the Florida Abuse Hotline on the single statewide toll-free
telephone number (1-800-96ABUSE).
L Transportation Disadvantaged
If clients are to be transported under this contract, the provider will comply with the provisions of Chapter 427, FS, and Rule Chapter 41-2, FAC. The provider shall submit to
the department the reports required pursuant to Volume 10, Chapter 27, DOH Accounting Procedures Manual.
M. Purchasing
:�. PRIDE
it is agreed that any articles which are the subject of, or are required to carry out this contract shall be purchased from Prison Rehabilitative Industries and Diversified
Enterprises, Inc. (PRIDE) identified under Chapter 946, FS, in the same manner and under the procedures set forth in §§946.515(2) and (4), FS. For purposes of this
contract, the provider shall be deemed to be substituted for the department insofar as dealings with PRIDE. This clause is not applicable to subcontractors unless otherwise
required by law. An abbreviated fist of products/services available from PRIDE may be obtained by contacting PRIDE, (850) 487-3774.
2. Procurement of Materials with Recycled Content
3.
4.
It is expressly understood and agreed that any products or materials which are the subject of, or are required to carry out this contract shall be procured in accordance with
the provisions of §403.7065, and §287.045, FS.
MyFloridaMarketPlace Vendor Registration
Each vendor doing business with the State of Florida for the sale of commodities or contractual services as defined in section 287.012, Florida Statutes, shall register in the
MyFloridaMarketPlace system, unless exempted under Florida Administrative Code Rule 60A-1.030(3) (F.A.C.).
MyFloridaMarketPlace Transaction Fee
The State of Florida, through'the Department of Management Services, has instituted MyFloridaMarketPlace, a statewide eProcurement system. Pursuant to section
287.057(23), Florida Statutes (2002), all payments shall be assessed a Transaction Fee of one percent (1.0%), which the Provider shall pay to the State.
For payments within the State accounting system (FLAIR or its successor), the Transaction Fee shall, when possible, be automatically deducted from payments to the
vendor. If automatic deduction is not possible, the vendor shall pay the Transaction Fee pursuant to Rule 60A-1.031(2), FA.C. By submission of these reports and
corresponding payments, vendor certifies their correctness. All such reports and payments shall be subject to audit by the State or its designee.
The Provider shall receive a credit for any Transaction Fee paid by the Provider for the purchase of any Rem(s) if such item(s) are returned to the Provider through no fault,
act, or omission of the Provider. Notwithstanding the foregoing, a Transaction Fee is non-refundable when an item is rejected or returned, or dedined, due to the vendor's
failure to perform or comply with specifications or requirements of the agreement.
Failure to comply with these requirements shall constitute grounds for declaring the vendor in default and recovering reprocurement costs from the vendor in addition to all
outstanding fees. Providers delinquent in paying transaction fees may be excluded from conducting future business with the State.
Civil Rights Requirements
Civil Rights Certification: The provider will comply with applicable provisions of DOH publication, "Methods of Administration, Equal Opportunity in Service
Delivery."
Independent Capacity of the Contractor
In the performance of this contract, it is agreed between the parties that the provider is an independent contractor and that the provider is solely liable for the
performance of all tasks contemplated by this contract, which are not the exclusive responsibility of the department.
Except where the provider is a state agency, the provider, its officers, agents, employees, subcontractors, or assignees, in performance of this contract, shall act in the
capacity of an independent contractor and not as an officer, employee, or agent of the State of Florida. Nor shall the provider represent to others that it has the authority
to bind the department unless specifically authorized to do so.
Except where the provider is a state agency, neither the provider, its officers, agents, employees, subcontractors, nor assignees are entitled to state retirement or state leave
benefits, or to any other compensation of state employment as a result of performing the duties and obligations of this contract.
The provider agrees to take such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be an independent contractor and
will not be considered or permitted to be an agent, servant, joint venturer, or partner of the State of Florida.
Contract# DEV05
5. Unless justified by the provider and agreed to by the department in Attachment I, the department will not furnish services of support (e.g., office space, office supplies,
telephone service, secretarial, or clerical support) to the provider, or its subcontractor or assignee.
6. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds, and all necessary insurance for the provider,
the provider's officers, employees, agents, subcontractors, or assignees shall be the responsibility of the provider.
;Q. Sponsorship
iAs required by §286.25, FS, if the provider is a non-govemmental organization which sponsors a program financed wholly or in part by state funds, including any funds
:Obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program, state: Sponsored by (providers name) and the State of
'Florida, Department of Health. If the sponsorship reference is in written material, the words State of Florida, Department of Health shall appear in the same size letters or
`:type as the name of the organization.
-Q. Final Invoice
To submit the final invoice for payment to the department no more than 30 days after the contract ends or is terminated. If the provider fails to do so, all right to payment is
forfeited and the department will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all
reports due from the provider and necessary adjustments thereto have been approved by the department.
R. Use of Funds for Lobbying Prohibited
To comply with the provisions of §216.347, FS, which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature, judicial branch, or a state agency.
S. Public Entity Crime and Discriminatory Vendor
1. Pursuant to §287.133, FS, the following restrictions are placed on the ability of persons convicted of public entity crimes to transact business with the department:
When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, he/she 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 a 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 §287.017, FS, for CATEGORY TWO
for a period of 36 months from the date of being placed on the convicted vendor list.
2. Pursuant to §287.134, FS, the following restrictions are placed on the ability of persons convicted of discrimination to transact business with the department: When a
person or affiliate has been placed on the discriminatory vendor list following a conviction for discrimination, he/she 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 a 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 §287.017, FS, for CATEGORY TWO for a
period of 36 months from the date of being placed on the discriminatory vendor list.
r?. Patents, Copyrights, and Royatties
If any discovery or invention arises or is developed in the course or as a result of work or services performed under this contract, or in anyway connected herewith, the
provider shall refer the discovery or invention to the department to be referred to the Department of State to determine whether patent protection will be sought in the
name of the State of Florida. Any and all patent rights accruing under or in connection with the performance of this contract are hereby reserved to the State of Florida.
In the event that any books, manuals, films, or other copyrightable materials are produced, the provider shall notify the Department of State. Any and all copyrights
`r accruing under or in connection with the performance under this contract are hereby reserved to the State of Florida.
3. The provider, without exception, shall indemnify and save harmless the State of Florida and its employees from liability of any nature or kind, including cost and
expenses for or on account of any copyrighted, patented, or unpatented invention, process, or article manufactured by the provider. The provider has no liability when
such claim is solely and exclusively due to the Department of State's alteration of the article. The State of Florida will provide prompt written notification of claim of
copyright or patent infringement. Further, if such claim is made or is pending, the provider may, at its option and expense, procure for the Department of State, the right
to continue use of, replace, or modify the article to render it non -infringing. If the provider uses any design, device, or materials covered by letters, patent, or copyright, it
is mutually agreed and understood without exception that the bid prices shall include all royalties or cost arising from the use of such design, device, or materials in any
way involved in the work.
U. Construction or Renovation of Facilities Using State Funds
Any state funds provided for the purchase of or improvements to real property are contingent upon the provider granting to the state a security interest in the
property at least to the amount of the state funds provided for at least (5) years from the date of purchase or the completion of the improvements or as further
required by law. As a condition of a receipt of state funding for this purpose, the provider agrees that, if it disposes of the property before the department's
interest is vacated, the provider will refund the proportionate share of the state's initial investment, as adjusted by depreciation.
V. Electronic Fund Transfer
The provider agrees to enroll in Electronic Fund Transfer, offered by the State Comptroller's Office. Copies of Authorization forth and sample bank letter are
available from the Department. Questions should be directed to the EFT Section at (850) 410-9466. The previous sentence is for notice purposes only.
W. Information Security
The provider shall maintain confidentiality of all data, files, and records including client records related to the services provided pursuant to this agreement
and shall comply with state and federal laws, including, but not limited to, sections 384.29, 381.004, 392.65, and 456.057, Florida Statutes. Procedures must
be implemented by the provider to ensure the protection and confidentiality of all confidential matters. These procedures shall be consistent with the
j Department of Health Information Security Policies, as amended, which is incorporated herein by reference and the receipt of which is acknowledged by the
provider, upon execution of this agreement. The provider will adhere to any amendments to the department's security requirements provided to it during the
period of this agreement. The provider must also comply with any applicable professional standards of practice with respect to client confidentiality.
a.
= i THE DEPARTMENT AGREES:
A. Contract Amount
To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $323,476.00 subject to the availability of funds.
The State of Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. The costs of services paid under
any other contract or from any other source are not eligible for reimbursement under this contract.
B. Contract Payment
Pursuant to §215.422, FS, the department has five (5) working days to inspect and approve goods and services, unless the bid specifications, Purchase Order, or this
contract specifies otherwise. With the exception of payments to health care providers for hospital, medical, or other health care services, if payment is not available within 40
days, measured from the latter of the date the invoice is received or the goods or services are received, inspected and approved, a separate interest penalty set by the
Comptroller pursuant to §55.03, FS, will be due and payable in addition to the invoice amount. To obtain the applicable interest rate, contact the fiscal office/contract
administrator. Payments to health care providers for hospitals, medical, or other health care services, shall be made not more than 35 days from the date eligibility for
payment is determined, at the daily interest rate of O.D3333%. Invoices returned to a vendor due to preparation errors will result in a payment delay. Interest penalties less
than one dollar will not be enforced unless the vendor requests payment. Invoice payment requirements do not start until a properly completed invoice is provided to the
department.
C. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of Financial Services. The duties of this individual include acting as an advocate for vendors who may be
experiencing problems in obtaining timely payment(s) from a state agency. The Vendor Ombudsman may be contacted at (850) 410-9724 or (800) 848-3792, the State of
Florida Chief Financial Officer's Hotline.
Coniract'#1 DEV05
III. THE PROVIDER AND THE DEPARTMENT MUTUALLY AGREE
A. Effective and Ending Dates
This contract shall begin on June 1, 2010 or on the date on which the contract has been signed by both parties, whichever is later.
It shall end on March 18, 2012
B. Termination
1. Termination at Will
This contract may be terminated by either party upon no less than thirty (30) calendar days notice in writing to the other party, without cause, unless a lesser time is mutually
agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
2. Termination Because of Lack of Funds
In the event funds to finance this contract become unavailable, the department may terminate the contract upon no less than twenty-four (24) hours notice in writing to the
provider. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The department shall be the final authority as to the
availability and adequacy of funds. In the event of termination of this contract, the provider will be compensated for any work satisfactorily completed prior to notification of
termination.
3. Termination for Breach
This contract may be terminated for the provider's non-performance upon no less than twenty-four (24) hours notice in writing to the provider. If applicable, the department
;jpay employ the default provisions in Chapter 60A-1.006 (3), FAC. 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 terms of this contract. The provisions herein do not limit the department's right to remedies at law or in equity.
4. Termination for Failure to Satisfactorily Perform Prior Agreement
Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient cause for termination. To be
terminated as a provider under this provision, the provider must have: (1) previously failed to satisfactorily perform in a contract with the department, been notified by the,
department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the department; or (2) had a contract terminated by
the department for cause.
C. Renegotiation or Modification
Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly signed by both parties. The rate of payment and dollar amount
may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and
subsequently identified in the department's operating budget.
D. Official Payee and Representatives (Names, Addresses and Telephone
1. The name (provider name as shown on page 1 of this contract) and mailing
address of the official payee to whom the payment shall be made is:
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ATTACHMENT I
A. Services to be Provided
1. Definition of Terms
a. Contract Terms
1. Contract Manager — The Department's employee responsible for enforcing the
performance of contract terms and conditions, scheduling and monitoring of work
being performed, inspection and acceptance of Services provided and approval for
payment of Services completed. The Contract Manager is the Department's primary
point of contact through which all contracting information flows between the
i}{
Department and the Provider.
2. Corrective Action Procedures — Procedures which will be used by the Provider to
respond to and correct deficiencies in service which have been identified by either
the Provider or Contract Manager.
3. Department: — The Florida Department of Health or its representative county health
Department.
4. Department Contact — A Department employee responsible for the supervision of
this contract. This employee will ensure the goals of the contract are being met and
the guidelines are being followed.
5. Fixed Price -Fixed Fee — A method of payment used when a Provider is paid a pre-
determined price for each unit of service delivered. A unit of service may be based
on time, tasks, activities, contacts, or any combination thereof.
6. Hours of Operation — The Department's Hours of Operation are Monday through
Friday, from 8:00 am - 5:00 pm, excluding holidays.
7. Proiect Manager(s) — The Provider's employee responsible for the management of
the contract, scheduling and monitoring of work being performed, inspection of
Services provided and the submission of payment documents for all Services
completed. The project manager is the Provider's primary point of contact through
which all contracting information flows between the Department and the Provider.
8. Provider — The entity awarded the contract.
b. Program or Service Specific Terms
1. Communities Putting Prevention to Work (CPPW) — Community based obesity
prevention campaign that will include culturally sensitive educational materials and
;a resources aimed at supporting healthy policy, system and environmental changes,
for impacting obesity, physical activity and nutrition in the Miami -Dade County area.
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2. Consortium — The Consortium for a Healthier Miami -Dade.
2. General Description
a. General Statement
1. Services to be performed under this contract include but are not limited to training
and providing school crossing guards to Miami -Dade County schools to promote
child physical activity by providing safe routes to and from school in support of the
objectives of the Communities Putting Prevention to Work campaign.
b. Authority
1. Chapter 287.057, Florida Statutes.
2. Section 112.061, Florida Statutes, which prescribes per diem and travel expenses of
public officers, employees, and other authorized persons.
3. DOH Travel and Transportation Manual, 40APM1 dated 8/14/00.
c. Scope of Service
1. Services specified in this contract will be provided to schools in Miami -Dade County.
d. Major Program Goals
1. The goal of this program is to increase physical activity by encouraging children to
walk or use bicycles to get to school and ensuring their safety while doing so in order
to manage the prevalence of obesity and other health disparities among
underserved and underinsured populations.
3. Clients to be Served
a. Individuals seeking to utilize crosswalks in Miami -Dade County Schools and throughout
Miami -Dade County.
B. Manner of Service Provision
1. Service Tasks
a. Task List
The general types of services performed by the Provider include, but are not limited to. -
1.
o:
1. Training school crossing guards.
2. Providing school crossing guards to Miami -Dade County schools.
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3. Supervising school crossing guards while they are on duty.
4. Placing crossing guards at dangerous intersections in inner cities to encourage
walking to school.
6. Adhering to the Guidelines for calculating mileage reimbursement in certain
situations as attached in APPENDIX B.
7. Maintaining documentation identifying any approved travel expenses, as listed in the
DOH Travel and Transportation Manual (40APM1) (APPENDIX A & C).
b. Task Limits
1. The Provider and its personnel are required to adhere to all Federal, State and local
laws that apply to the provision of services under the contract.
2. Staffing Requirements
a. Staffing Levels
1. The Provider shall have available at all times, a sufficient number of capable and
qualified employees to enable the contract to properly, adequately, and safely
perform all work required under the terms of this contract.
b. Professional Qualifications
1. Employees shall maintain all professional licenses, certifications, and/or experience
as required by Federal, State and Local Laws.
c. Staffing Changes
t
1. Staffing changes may be made as long as the staff members continue to meet the
professional qualifications listed above.
d. Subcontractors
1. The Provider shall not subcontract for any services provided under this contract.
3. Service Location and Equipment
a. Service Location
1. The financial and overall administrative responsibilities for this project will be
administered at the Provider's headquarters office located at 400 N.W. 2 I Avenue,
2nd Floor, Miami, Florida 33128.
2. Service locations shall be determined by the Director of the Office of Community
Health and Planning and the CPPW Program Manager in conjunction with the
Provider.
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b. Service Times
1. The Provider's office will be open from Monday through Friday, except on State of
Florida and Miami -Dade County recognized holidays or during local emergencies.
2. The service times for the service locations shall be determined by the Director of the
Office of Community Health and Planning and the CPPW Program Manager in
conjunction with the Provider.
c. Change in Location
1. The Provider shall notify the contract manager in writing of any change in the
Provider's location at least one month prior to moving.
d. Equipment
1. The Provider shall provide equitable support services necessary to carry out the
provisions of this contract.
2. All equipment under this contract is under the sole responsibility of the Provider.
4. Deliverables
a. Service Unit
Each Deliverable shall be considered to be one (1) service unit, with a total of twenty-two
(22) Deliverables, one for each month of the contract. Monthly Reports containing
deliverables are due on the last day of every month of this contract. All Deliverables
submitted by the Provider must contain the following:
1. Number of crossing guards working at Miami -Dade County schools under this
project.
2. Crossing guard schedules.
3. Number of training classes performed.
4. Number of new and existing crossing guards trained.
5. Number of crossing guards placed at dangerous intersections in inner cities.
6. Completed travel expense forms (APPENDIX A & C).
b. Reports
1. Monthly reports must be presented to the Contract Manager and the Department
Program Manager within 15 days of issuance. These reports may be presented to
the Contract Manager after the end of the contracting period.
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c. Records and Documentation
1. The Provider will maintain the following records and documentation:
(a) A fully executed original of this contract, and any amendments hereto.
(b) Information sufficient to document compliance with this contract.
5. Performance Specifications
a. Outcomes and Outputs
1. The Provider will create monthly reports where the Department can follow up the
progress of the installation of bicycle racks and signage. Performance indicators
shall include:
(a) Placement of crossing guards in Miami -Dade County schools.
(b) Placement of crossing guards at dangerous intersections in inner cities.
(c) Completion of training classes for new and existing crossing guards.
b. Monitoring and Evaluation Methodology
1. By execution of this contract, the Provider hereby acknowledges and agrees that its
performance under the contract must meet the standards set forth above, and will be
bound by the conditions set forth below. If the Provider fails to meet these standards,
the Department at its exclusive option, may allow up to six months for the Provider to
achieve compliance with the standards. If the Department affords the Provider and
opportunity to achieve compliance, and the Provider fails to achieve compliance
within the specified time frame, the Department will terminate the contract in the
absence of any extenuating or mitigating circumstances. The determination of the
extenuating or mitigating circumstances is the exclusive determination of the
Department.
2. At least once per year, the contract manager will conduct an on-site monitoring of
the Provider. This monitoring will include an entrance interview, file and document
review and an exit interview.
3. The Provider will receive a written report within 30 days of the on-site monitoring
visit.
4. If performance deficiencies are identified, the Provider will draft a corrective action
plan and submit it to the contract manager within 30 days of receipt of the
notification of deficiencies. The contract manager will approve the corrective action
plan prior to implementation by the Provider. No corrective action can be considered
valid without the Departments authorization. The Provider is solely responsible for
correcting performance deficiencies. The Department will provide technical
9
assistance as requested by the Provider in writing or identified in the corrective
action plan.
6. Provider Responsibilities
a. The Provider will deliver the services set forth in this contract in accordance with the terms
of this contract.
b. Consortium Meetings - It is a mandatory obligation that the Provider shall attend any and all
Consortium meetings specifically related to the Provider's respective interventions.
Furthermore, the Provider must be proactive in the aforementioned Consortium meetings
and actively contribute to the goals and objectives determined by said Consortium.
7. Department Responsibilities
a. Department Obligations
1. The Department shall submit to the Provider only those invoices for payment that
have been deemed in compliance with Chapter 287, Florida Statutes.
b. Department Determinations.
1. The Department has full authority over approving the quality and acceptability of
services delivered. The Department reserves the right to renegotiate or terminate
this contract if the performance standards are not met.
2. The determination of extenuating or mitigating circumstances is the exclusive
determination of the Department.
3. Resolution of final questions regarding the approval for payment of travel requests
will be the Department's responsibility.
C. Method of Payment
1. Fixed Price/Fixed Fee
a. This is a fixed price (fixed fee) contract. The Department agrees to pay the Provider, upon
satisfactory completion of both the service(s) rendered and all terms and conditions specified
in this contract, the amount of $323,476.00, paid in twenty-one (21) equal monthly payments of
$14,703.46 and one (1) monthly payment of $14,703.34, subject to the availability of the funds.
The costs of services paid under any other contract or from any other source are not eligible
for reimbursement under this contract.
b. The Department reserves the right to withhold any or all contract fees if the Provider fails to
comply with any terms and/or conditions in this contract. The Department's decision to
withhold or reduce monthly payments shall be submitted to the Provider in writing. The written
notice shall specify the manner and extent to which the Provider has failed to comply with the
terms of the contract and the timeframes for compliance.
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c. Invoice Requirements: In order to receive the monthly payment, the Provider shall request
payment on a monthly basis through submission of a properly completed invoice (Attachment
IV) within ten 10 days following the end of the quarter for which reimbursement is being
requested. A monthly report as outlined in Section B.4.b shall accompany each invoice.
d. The Provider shall submit one (1) original and four (4) copies of the Monthly Request for
Payment Invoice (Attachment IV) to: Frederick Villari, Contract Manager, 8323 NW 12th Street,
Suite 214, Miami, Florida 33126.
e. The Department reserves the right to withhold any or all contract fees if the Provider fails to
comply with any terms and/or conditions in this contract. The Department's decision to
withhold or reduce monthly payments shall be submitted to the Provider in writing. The written
notice shall specify the manner and extent to which the Provider has failed to comply with the
terms of the contract and the timeframes for compliance. The Department will pay the withheld
funds to the Provider upon receipt of a supplemental invoice for the amount previously reduced
accompanied by supporting documentation of the appropriately amended invoice.
f. The Provider is required to maintain and have available certain documentation. The
Department of Health or the State of Florida Comptroller's Office may request additional
information at any time. In addition to all documentation listed above being submitted with the
invoice, the same information must be kept on file with the Provider and made available within
twenty-four hours notice. Examples of the types of support documentation that must be
available upon request are listed below:
1. Documentation of service delivery is required. The Provider must maintain records
documenting any and all work performed and the date(s) on which the work was
performed, so that an audit trail documenting service provision is available.
2. Program Income: Program income refers to income received or earnings realized from
he performance of a specific activity during the period of the contract. The Provider
must maintain records documenting the kind and amount of any income received as a
direct result of income/expenditures which shall detail the amount and disposition of all
program income.
D. Special Provisions Section
1. Required Notification
The Provider agrees to notify the Department's Contract Manager within five (5) business days
of any change of event in the agency's corporate status, i.e. administrative dissolution, etc.
2. Facility Standards
The Provider agrees that any facility used, pursuant to the provision of Services under this
contract shall comply with state and local fire and health codes, the Americans with Disabilities
Act, and all other codes that would apply if space so utilized were owned or leased by the
State.
3. Inspection and Effect of Payment
11
The Services performed by the Provider shall be subject to the Department's reasonable
inspection and approval. The Department shall at all times have access to the areas where the
services are being performed. Neither inspection, nor lack thereof, or payment of an invoice
by the Department shall be deemed approval or be construed to be a waiver of the
Department's rights under this contract.
4. Further Acts
Each party to this contract agrees to perform any further act and to execute, acknowledge, and
deliver any documents, which may be reasonably necessary to carry out the provisions of this
contract.
5. Severability
If any term, covenant, condition, or provision of this contract, or their application to any person
or circumstance, shall to any extent be held by a court of competent jurisdiction to be invalid,
void, or unenforceable, the parties shall renegotiate the unenforceable or invalid terms so as to
effect the intent of this contract, and the remainder of the provisions of this contract, or their
application to any person or circumstance, and shall remain in full force and effect.
6. Litigation
This contract is governed by the laws of the state of Florida.
9. Provider's Authority
Provider warrants and represents that Provider has authority to enter into this contact and any
person signing it on Provider's behalf has been duly authorized to execute this contract for
Provider.
8. Renewal
This contract may not be renewed.
9. Information Security
The Provider shall comply with Department of Health Information Security Policies as it relates
to electronic transmission of confidential or sensitive information via the Internet. The Provider
agrees to the following:
a. Electronic transmission of confidential information via Internet must be encrypted.
Unless encrypted, the Provider may not send any patient, confidential or sensitive
information via electronic mail
b. Wireless Devices: Sending Confidential information via wireless devices is prohibited
unless the information can be encrypted in transmission and the device is secured by
password. In addition, the wireless device must be an approved DOH standard.
12
c. All external, electronic data files with confidential information must be encrypted. This
applies to all files to be electronically transmitted or transported in any way.
d. Other electronic transmissions of confidentiaUsensitive information must be safeguarded
consistent with current departmental policies and protocols.
e. Confidential/sensitive information must be kept secured within the facility and while in
transit to an authorized recipient by using appropriate administrative, technical and physical
safeguards.
f. Confidential/sensitive information about clients and employees must be kept
private/secured when using facsimile machines, telephones and mail or courier services.
End of Text
13
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Department of Health to the provider may be subject
to audits and/or monitoring by the Department of Health, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and
Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited
to, on-site visits by Department of Health staff, limited scope audits as defined by OMB Circular A-
133, as revised, and/or other procedures. By entering into this agreement, the provider agrees to
comply and cooperate with any monitoring procedures/processes deemed appropriate by the
Department of Health. In the event the Department of Health determines that a limited scope audit of
the provider is appropriate, the provider agrees to comply with any additional instructions provided by
the Department of Health to the provider regarding such audit. The provider further agrees to comply
and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief
Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non-profit organization as
defined in OMB Circular A-133, as revised.
1. In.the event that the provider expends $500,000 or more in Federal awards during its fiscal
year, the provider must have a single or program -specific audit conducted in accordance with
the provisions of OMB Circular A-133, as revised. EXHIBIT 1 to this agreement indicates
Federal resources awarded through the Department of Health by this agreement. In
determining the Federal awards expended in its fiscal year, the provider shall consider all
sources of Federal awards, including Federal resources received from the Department of
Health. The determination of amounts of Federal awards expended should be in accordance
with the guidelines established by OMB Circular A-133, as revised. An audit of the provider
conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as
revised, will meet the requirements of this part.
2. In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall
fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB
Circular A-133, as revised.
3. If the provider expends less than $500,000 in Federal awards in its fiscal year, an audit
conducted in accordance with the provisions of .OMB Circular A-133, as revised, is not
required. In the event that the provider expends less than $500,000 in Federal awards in its
fiscal year and elects to have an audit conducted in accordance with the provisions of OMB
Circular A-133, as revised, the cost of the audit must be paid from non -Federal resources (i.e.,
14
the cost of such audit must be paid from provider resources obtained from other than Federal
entities.)
4. An audit conducted in accordance with this part shall cover the entire organization for the
organization's fiscal year. Compliance findings related to agreements with the Department of
Health shall be based on the agreement's requirements, including any rules, regulations, or
statutes referenced in the agreement. The financial statements shall disclose whether or not
the matching requirement was met for each applicable agreement. All questioned costs and
liabilities due to the Department of Health shall be fully disclosed in the audit report with
reference to the Department of Health agreement involved. If not otherwise disclosed as
required by Section .310(b)(2) of OMB Circular A-133, as revised, the schedule of
expenditures of Federal awards shall identify expenditures by agreement number for each
agreement with the Department of Health in effect during the audit period. Financial reporting
packages required under this part must be submitted within the earlier of 30 days after receipt
of the audit report or 9 months after the end of the provider's fiscal year end.
PART il: STATE FUNDED
This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida
Statutes.
1. In the event that the provider expends a total amount of state financial assistance equal to or in
excess of $500,000 in any fiscal year of such provider (for fiscal years ending September 30,
2004 or thereafter), the provider must have a State single or project -specific audit for such
fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of the
Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT I to this
agreement indicates state financial assistance awarded through the Department of Health by
this agreement. In determining the state financial assistance expended in its fiscal year, the
provider shall consider all sources of state financial assistance, including state financial
assistance received from the Department of Health, other state agencies, and other nonstate
entities. State financial assistance does not include Federal direct or pass-through awards and
resources received by a nonstate entity for Federal program matching requirements.
2. In connection with the audit requirements addressed in Part II, paragraph 1, the provider shall
ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes.
This includes submission of a financial reporting package as defined by Section 215.97(2),
Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-
profit organizations), Rules of the Auditor General.
3. If the provider expends less than $500,000 in state financial assistance in its fiscal year (for
fiscal years ending September 30, 2004 or thereafter), an audit conducted in accordance with
the provisions of Section 215.97, Florida Statutes, is not required. In the event that the
provider expends less than $500,000 in state financial assistance in its fiscal year and elects to
have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes,
the cost of the audit must be paid from the nonstate entity's resources (i.e., the cost of such an
audit must be paid from the provider resources obtained from other than State entities).
15
4. An audit conducted in accordance with this part shall cover the entire organization for the
organization's fiscal year. Compliance findings related to agreements with the Department of
Health shall be based on the agreement's requirements, including any applicable rules,
regulations, or statutes. The financial statements shall disclose whether or not the matching
requirement was met for each applicable agreement. All questioned costs and liabilities due to
the Department of Health shall be fully disclosed in the audit report with reference to the
Department of Health agreement involved. If not otherwise disclosed as required by Rule 691-
5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance shall
identify expenditures by agreement number for each agreement with the Department of Health
in effect during the audit period. Financial reporting packages required under this part must be
submitted within 45 days after delivery of the audit report, but no later than 12 months after the
provider's fiscal year end for local governmental entities. Non-profit or for-profit organizations
are required to be submitted within 45 days after delivery of the audit report, but no later than 9
months after the provider's fiscal year end. Notwithstanding the applicability of this portion, the
Department of Health retains all right and obligation to monitor and oversee the performance of
this agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as
revised, and required by PART I of this agreement shall be submitted, when required by
Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the provider directly to
each of the following:
A. The Department of Health at each of the following addresses:
Contract Administrative Monitoring Unit
4052 Bald Cypress Way, Bin B01 (HAFACM)
Tallahassee, FL 32399-1729
The contract manager for this agreement listed in the standard agreement.
B. The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the
number of copies required by Sections .320 (d)(1) and (2), OMB Circular A-133, as revised,
should be submitted to the Federal Audit Clearinghouse), at the following address.-
Federal
ddress:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
C. Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and
(f), OMB Circular A-133, as revised.
2. Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a copy
of the reporting package described in Section .320(c), OMB Circular A-133, as revised, and
any management letter issued by the auditor, to the Department of Health at each of the
following addresses:
16
Contract Administrative Monitoring Unit
4052 Bald Cypress Way, BIN B01 (HAFACM)
Tallahassee, Florida 32399-1729
The contract manager for this agreement listed in the standard agreement.
3. Additionally, copies of financial reporting packages required by Part II of this agreement shall
be submitted by or on behalf of the provider directl to each of the following:
A. The Department of Health at each of the following addresses:
Contract Administrative Monitoring Unit
4052 Bald Cypress Way, BIN B01 (HAFACM)
Tallahassee, FL 32399-1729
The contract manager for this agreement listed in the standard agreement.
B. The Auditor General's Office at the following address:
Auditor General's Office
Claude Pepper Building, Room 401
111 West Madison Street
Tallahassee, Florida 32399-1450
4. Any reports, management letter, or other information required to be submitted to the
Department of Health pursuant to this agreement shall be submitted timely in accordance with
OMB Circular A-133, Florida Statutes, and Chapters 10.550 (local governmental entities) or
10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, as applicable.
5. Providers, when submitting financial reporting packages to the Department of Health for audits
done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities)
or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, should indicate
the date that the reporting package was delivered to the provider in correspondence
accompanying the reporting package.
PART IV: RECORD RETENTION
he provider shall retain sufficient records demonstrating its compliance with the terms of this
agreement for a period of six years from the date the audit report is issued, and shall allow the
Department of Health or its designee, the CFO or Auditor General access to such records upon
request. The provider shall ensure that audit working papers are made available to the Department
of Health, or its designee, CFO, or Auditor General upon request for a period of six years from the
date the audit report is issued, unless extended in writing by the Department of Health.
End of Text
17
EXHIBIT 1
`1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE
FOLLOWING:
Federal Program 1 CDC-RFA-DP09-912ARRA09 CFDA# 93.724 Title ARRA — CPPW $323,476.00
Federal Program 2 CFDA# Title $0.00
TOTAL FEDERAL AWARDS $323,476.00
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE
AS FOLLOWS:
`2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE
FOLLOWING:
Matching resources for federal program(s) CFDA# Title $0.00
State financial assistance subject to Sec. 215.97, F.S.: CSFA# Title $0.00
TOTAL STATE FINANCIAL ASSISTANCE AWARDED PURSUANT TO SECTION 215.97, F.S. $0.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS
FOLLOWS:
r
W
EXHIBIT 2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A-133, as revised,
,and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state financial
assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 are met.
Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-133, as revised, and/or
Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to be recipients or
subrecipients of Federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance
requirements.
In accordance with Sec. 210 of OMB Circular A-133 and/or Rule 691-5.006, FAC, provider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A-133 and/or Section 215.97, F.S.
Recipient/subrecipient subject to OMB Circular A-133 and/or Section 215.97, F.S.
❑ Recipient who is exempt from Section 215.97, F.S. (public university, community college, district school board, branch of
state government, charter schools)
❑ Subrecipient who is exempt from OMB Circular A-133 (for-profit organization)
NOTE: If a provider is determined to be a recipient/subrecipient of federal and or state fmancial assistance and has been approved by
the department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-.006(2), FAC [state financial assistance]
knd Section — .400 OMB Circular A-133 [federal awards].
'COTE: Recipients/Subrecipients who are exempt from the audit requirements set forth in OMB Circular A-133 and Section 215.97,
'=1a. Stat., are not required to have a Single Audit. However, the exempt organization must comply with all compliance -requirements
et forth within the contract or award document.
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state
matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and
regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR 225 a/k/a OMB Circular A-87 — Cost Principles*
OMB Circular A-102 — Administrative Requirements**
OMB Circular A-133 —Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR 230 a/k/a OMB Circular A-122 — Cost Principles*
2 CFR 215 a/k/a OMB Circular A-110 — Administrative Requirements
OMB Circular A-133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW:
2 CFR 220 a/k/a OMB Circular A-21 — Cost Principles*
2 CFR 215 a/k/a OMB Circular A-1 10 —Administrative Requirements
OMB Circular A-133 —Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular
A-133 Compliance Supplement, Appendix 1.
**For funding passed through U.S. Health and Human Services, 45 CFR 92; for funding passed through U.S. Department of
Education, 34 CFR 80.
We
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations
Section 215.97, Fla. Stat.
Chapter 691-5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
Additional audit guidance or copies of the referenced fiscal laws, rules and regulations may be obtained at http://www,doh.state.fl.us/ by
selecting "Contract Administrative Monitoring" in the drop-down box at the top of the Department's webpage. * Enumeration of laws,
rules and regulations herein is not exhaustive nor exclusive. Fund recipients will be held to applicable legal requirements whether or not
outlined herein.
all
INSTRUCTIONS FOR COMPLETING EXHIBITS 1& 2
FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF:
NOTE: if the resources awarded to the subrecipient represent more than one Federal program, provide the same information
shown above for each Federal program and show total Federal resources awarded.
Federal Program (List Federal agency, Catalog of Federal Domestic Assistance title and number, and the amount of the
Federal award).
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT ARE AS FOLLOWS:
NOTE: If the resources awarded to the subrecipient represent more than one Federal program, list applicable compliance
requirements for each Federal program in the same manner as shown below.
federal Proaram 1
NOTE: Instead of listing the specific compliance requirements as shown below, the State agency may elect to use
language that requires the subrecipient to comply with the requirements of applicable provisions of specific laws, rules,
regulations, etc. For example, for Federal Program 1, the language may state that the subrecipient must comply with a
specific law(s), rule(s), or regulation(s) that pertains to how the awarded resources must be used or how eligibility
determinations are to be made. The State agency, if practical, may want to attach a copy of the specific law, rule, or
regulation referred to.
1. First applicable compliance requirement (e.g., what services/purposes resources must be used for).
2. Second applicable compliance requirement (e.g., eligibility requirements for recipients of resources).
Federal Program 2:
NOTE: List applicable compliance requirements in the same manner as illustrated above for Program 1.
--$TATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE
FOLLOWING:
Matching Resources for Federal Programs:
NOTE: If the resources to the subrecipient for matching represent more than one Federal program, provide the same
information shown below for each Federal program and show total State resources awarded for matching.
Federal Program (List Federal agency, Catalog of Federal Domestic Assistance title, number and matching amount)
State Financial Assistance Subiect to Section 215.97, Florida Statutes:
NOTE: If the resources awarded to the recipient represent more than one State project, provide the same information
shown below for each State project and show total State financial assistance awarded that is subject to Section 215.97,
Florida Statutes..
State Project (List State awarding agency, Catalog of State Financial Assistance title, number and amount of state
;�;Ilancial assistance).
.f'
21
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOUCRES AWARDED PURSUANT TO THIS
AGREEMENT ARE AS FOLLOWS:
NOTE: List applicable compliance requirements in the same manner as illustrated above for Federai resources. For
matching resources provided by the Department of Health for Federal programs, the requirements might be similar to the
requirements for the applicable Federal programs. Also, to the extent that different requirements pertain to different
amounts of the non -Federal funds, there may be more than one grouping (i.e., 1, 2, 3, etc.) listed under this category.
,NOTE: Section 400(d) of OMB Circular A-133, as revised, and Section 215.97(5), Florida Statutes, require that the
,:information about Federal Programs and State Projects included in Exhibit 1 be provided to the receipient/subrecipient.
AUDIT RELATIONSHIP DETERMINATION:
For Federal awards or state matching funds on Federal awards, complete the Federal Subrecipient and Vendor
Determination Checklist to determine whether the provider is a subrecipient or vendor/exempt entity.
For State resources (other than state matching funds on Federal awards), complete the Florida Single Audit Act Checklist
For Non -State Organizations — Recipient/Subrecipient Vs. Vender Determination to determine whether the provider is a
recipient or vendorlexempt entity.
NOTE: If provider has been determined to be a vendor/exempt entity, do not complete any of the information in Section
1 or 2 of Exhibit 1. However, you must complete Exhibit 2.
22
APPENDIX A
VICINITY MILEAGE TRIP LOG
Name: Program:
SSN: Unit:
Headquarters: Period:
Date
Time
Odometer
Mileage
Meals
Other
Address and Purpose
In
Out
Begin
End
Map
Vicinity
23
APPENDIX B
GUIDELINES FOR CALCULATING MILEAGE
REIMBURSEMENT IN CERTAIN SITUATIONS
This appendix provides guidelines to use in calculating the mileage reimbursement in certain, situations.
Situation 1: A DUH employee has already been to his/her official headquarters for a normal workday and
returned home, but is 'on-call" for additional duties beyond normal working hours. During the course of
the evening, the employee is called upon to perform additional duties. The employee is allo,,ved to claim
mileage from official headquarters or home, whichever is tine lesser distance. Trave€ should be by the
most direct route and mileage, point-to-point andfor vfciRity, claimed in accordance with Appendix E of this
operating procedure For exam pie. a couris for who has already been to his official headquarters and
returned hoarse for the day is later called on to counsel a client at Point A..
14
Horne _fiicial Headquarters
The employee can cla inn 8 miles each way, the distance. from official headquarters to Point A. If Inc -
Counselor was required -only to go to official headquarters and return home no mileage could be ciairned.
Sftatior.'_ A OOH visLttnc nurses ro.3ls=ne)3" � uvels from Z:ppoirTtr: e is appo inlet, dLrn, ig t�� our G'
Gi=
the day. The employee schedules the first appo%mt
n_ent at Poin' A. As it is more tune -efficient and
economical t the State for the employee 'ka travel directiy from home to Pont A and alien proceed to.
('if€3C!a4 hiradquzriers as opposed to reper:rng first to the C'fice and, then tna.veling the round trip from
headquarters to PolnF A. The employee mav, claim 11 miles (3 miles fain home to Point A plus o miles
from Poin Ato official headcu2cter_)..
fv
v
Horne .Ti{ ial I'lcatlCii.:a:rtefS
Stwaton 33: Similarly, if the ernpiurvee haw appointrnents rater in tine day, tha eanployee may travel directly
dome from that last'aPpointment 2nd ,C 2iM mile20e from the last appoiatmen€ to home if tt m r orE
e conornlcal and lime-efifcient to & so. For example, an employee 112E her last appointrr ent at Point 6.
Instead of returning to heacquarters, she ones directly home. The employee may claim me 2 miles from
Point P to home, as 'this is more economical to the State than the employee returni[nO to tFle office before
goang home and claiming 10 miles from Poiret B bade to headquarters.
Official Headquarters Home
L
5
M47
Situation 4: A DOH employee Neriorms assigned duties for the Department, e.g., delivering blood
samples to a laboratory on the way to or from work Either a courier service is not available, or a courier
service is available but because of the type of service needed, and costs involved, it is more economica±
for the State to reimburse mileage. if one of these conditions exists. the employee can claim the mileage
traveled to perform this service for DOM. In the example below, the employee delivers the blood sample
to the lab at Point A on the vray home. The employee can be reimbursed for the 10 miles from official
headquarters to Point A and the 2 miles from Point A to home. a total of 12 miles. This is more time -
efficient and economical to the State because the employee could claim a 20 mile round trip from
headquarters to Point A and return if the delivery vrere performed during the middle of the workday. it is
more economical and tune-efficienl for DOH to reimburse the employee for 12 miles.
Home
0=ficiat
Headquarters 2
0 „�
25
Traveler's Name:
Supervisor's Approval:
Date of Purchase:
Vehicle Used: (Check one)
Vendor Name & Address:
APPENDIX C
Gas/Fuel Replacement Receipt Form
Date Received:
Rental State Tag #:
FUEL TYPE
QUANTITY
(# of Gallons)
UNIT PRICE
(Price per Gallon)
TOTAL PRICE
Total Charge $
Used P -Card for Purchase: Yes No Cardholder Group ID:
receipt was (check one) Lost Not Obtainable
If not obtainable, Please explain:
business.
Signature
Print Name
, the undersigned, do certify that the above purchase was made for official state
ALL FIELDS ON THE FORM MUST BE COMPLETED.
99
ATTACHMENT III
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or an employee of any agency,
a member of Congress, an officer or employee of Congress, or an employee of a member of
Congress in the connection with the awarding of any Federal contract, the making of any Federal
grant, the making of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan
or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid, to any person
for influencing or attempting to influence an officer or an employee of any agency, a member of
Congress, an officer or employee of Congress, or an employee of a member of Congress in the
connection with this Federal contract, grant, loan or cooperative agreement, the undersigned
shall complete and submit Standard Form -LLL, Disclosure Form to Report Lobbying, in
accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all sub -awards at all tiers (including subcontracts, sub -grants and contracts under
grants, loans and cooperative agreements) and that all sub -recipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by §1352, Title 31, U.S. Code. Any person who fails to file the
required certification shall be,subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
Signature
Name of Authorized Individual
City of Miami Police Department
Name of Organization
400 NW 2nd Avenue 2nd Floor Miami Florida 33128
Address of Organization
_ 27
i'
Date
Application or Contract Number
CONTRACT INVOICE # DEV05
PROVIDER NAME AND ADDRESS
City of Miami Police Department
Attn:Mae C. Shepherd
400 N.W. 2"d Avenue, 2"a Floor
Miami, FL 33128
PERIOD COVERED BY
THIS INVOICE:
FROM TO
CONTRACT: DEV05
TITLE: City of Miami Police Department
A.
B. C.
D. E. F.
G.
Unit of Service
Budget Rate No. of Units Amount Year To Date
Balance
1.
$
$
$
$
$
2.
$
$
$
$
$
3.
$
$
$
$
$
4.
$
$
$
$
$
5.
$
$
$
$
$
6.
$
$
$
$
$
7.
$
$
$
$
$
8.
$
$
$
$
$
9.
$
$
$
$
$
TOTAL
$
H. AMOUNT OF FUNDS
REQUESTED
I. LISTING OF ATTACHMENTS:
I certify that the above report is a true and
correct reflection of thisperiod's activities, as stipulated by
this contract.
APPROVED FOR PAYMENT: I certify
that the contract
deliverables have been received and
meet the terms and
SIGNATURE OF PROVIDER AGENCY OFFICIAL
conditions of the contract.
J. TYPE OF REQUEST:
CONTRACT MANAGER
TITLE DATE
REGULAR
CONTRACT MANAGER'S SUPERVISOR
_ FINAL
PHONE NUMBER SC
DATE
W.
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