HomeMy WebLinkAboutexhibit2BEXHIBIT B — WORK PROGRAM FOR PERSONS REQUIRING DIALYSIS TREATMENT
1. SUBRECIPIENT will recruit program participants that meet the following criteria:
a) Must be a resident of the City of Miami
b) Must be a member of a low -to moderate income household
c) Must have a medical certification of kidney ailment requiring dialysis.
2. SUBRECIPIENT will submit the following information to the City of Miami Department
of Community Development to obtain certification that proposed participant is eligible to
receive program benefits and for SUBRECIPIENT to invoice the City of Miami for
services provided.
a) Program Application, in a form providod �the
participant�or by leg 1 guardian
iami Department of
Community Development, signedby prospective
if prospective participant is incapable of doing so
b) Proof of residency
c) Proof of income
d) Proof of need to receive dialysis treatment
3. SUBRECIPIENT may replace participants who stop receiving program benefits by
providing the information required in 2 above. SUBRECIPIENT will not invoice the City
of Miami until the proposed participant is certified as eligible by the City of Miami.
4. SUBRECIPIENT will provide:
Meals delivered to participants while they are receiving dialysis
treatment at a dialysis center times per week on the following days: — Monday, —
Tuesday, Wednesday, _ Thursday, J Friday. Meals will be delivered to the following
addresses:
Address:
Meals will be provided for up to a totaFof
SUBREC1PIENT will provide proof of
participants via signed meal delivery sheets
charged to the City of Miami Program.
program days.
having delivered meals to the certified
for each day that meals were provided and
5. Program will commence on October 1, 2004 and will end on September 30, 2005.
SIGNED:
Jorge Castano, Jr. Date
Executive Director
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this by Jorge
Castaf o, Jr., Executive Director of Josefa Perez de Castano Kidney Foundation, Inc., a Florida
not -for -profit corporation, on behalf of the corporation. He is personally known to me or has
produced as identification.
Print Notary Public's Name Signature
(SEAL)