HomeMy WebLinkAboutsocial program agreement2BEXHIBIT B — MEALS 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 provided by the City of Miami Department of
Community Development, signed by prospective participant or by legal guardian
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 10 participants while they are receiving dialysis treatment at the
dialysis centers 2 times per week on the following days: _X_ Monday, X_ Tuesday,
_X_Wednesday, _X_ Thursday, _X_ Friday. Meals will be delivered to the following
dialysis centers:
Address: John Cunio Dialysis Center, 2561 Coral Way, Miami, FL 33145
Metro Miami Dialysis Center, 5550 W Flagler St., Miami, FL :33134
Dade BMA of Miami Dialysis, 1601 NW 8th Ave., Miami, FL 33138
Meals will be provided for up to a total of 104 program days.
SUBRECIPIENT will provide proof of having provided the delivered meals to the
certified participants via signed meal delivery sheets for each day that meals were
provided and charged to the City of Miami Program.
5. Program will commence on October 1, 2004 and will end on September 30, 2005.
SIGNED:
fo 6.Castafio; JT.
Executive Director
STATE OF FLORIDA
COUNTY OF H I t (AVE
cl
Date
The foregoing instrument was acknowledged before me this 64 / I- alioyya by Jorge
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Castario, Jr., Executive Director of Josefa Perez de Castano Kidney Foundation, Inc. a Florida
not -for -profit corporation, on behalf of the corporation. He/she is personally known to me or has
produced '1-3/51- ss 4)6 as identification.
Print Notary Public's Name
(SEAL)
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