HomeMy WebLinkAboutComposite Exhibit BCOMPOSITE EXHBIT B
(February 2018 — June 2019) XQ801 FLORIDA DEPARTMENT OF ELDER
AFFAIRS STANDARD CONTRACT (for Reimbursement Grant for Badia Center
Capital Project in an amount not to exceed $500,000.00)
2. Chapter 2017-70 Laws of Florida: Section 3 Human Services, 400B Grants and
Aids to Local Governments and Non -State Entities — Fixed Capital Outlay Grants
and Aids — Senior Citizens Centers from General Revenue Fund — Badia Center
3. Appropriations Project Request — Fiscal Year 2017-18 for projects meeting the
Definition of House Rule 5.14 Title of Project: Southwest Social Services
Programs, Inc. — Dr. Armando Badia Senior Center
(February 2018 — June 2019) XQ$O1
FLORIDA DEPARTMENT OF ELDER AFFAIRS
STANDARD CONTRACT
THIS CONTRACT is entered into between Florida Department of Elder Affairs (Department or DOEA) and Southwest
Social Services Programs, Inc. (Contractor or SWSS), collectively referred to as the "Parties." The term Contractor for this
purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS, the Department has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Department.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the
mutual covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract:
The purpose of this Contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments, forms and exhibits, which constitute the contract document.
2. Incorporation of Documents within the Contract:
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks,
xnanwils or desk books, as an integral part of the contract, except to the extent that the contract explicitly provides to
the contrary. In the event of conflict in language among any of the documents referenced above, the specific provisions
and requirements of the contract document(s) shall prevail over inconsistent provisions in the proposal(s) or other
general materials not specific to this contract document and identified attachments.
3. Term of Contract:
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time 02/01/2018 or on the date the contract has been
signed by the last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) P.M., Eastern
Standard Time 06/30/2019.
4. Contract Amount:
The Department agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $500,000.00, subject to the availability of funds. Any costs or services paid for under any other contract
or from any other source are not eligible for payment under this contract.
5. Renewals:
By mutual agreement of the Parties, in accordance with Section 287.058(1)(g), Florida Statutes (F.S.), the Department
may renew the contract for a period not to exceed three years, or the term of the original contract, whichever is longer.
The renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs
for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original contract and
contingent upon satisfactory performance evaluations by the Department and the availability of funds.
6. Compliance with Federal Law:
6.1 If this contract contains federal funds this section shall apply.
6.1.1 The Contractor shall comply with the provisions of 45 Code of Federal Regulations (CFR) 75 and/or 45
CFR Part 92, 2 CFR Part 200 and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all
applicable standards, orders, or regulations issued under Section 306 of the Clean Air Act as amended (42
United States Code (U.S.C.) 7401, et seq.), Section 508 of the Federal Water Pollution Control Act as
amended (33 U.S.C. 1251, et seq.), Executive Order 11738, as amended, and where applicable
Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations
of the above to the Department.
6.1.3 The Contractor, or agent acting for the Contractor, may not use any federal funds received in connection
with this contract to influence legislation or appropriations pending before the Congress or any state
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legislature. The Contractor must :.otnplete all disclosure forms as required, specifically the Certification
and Assurances Attachment, which must be completed and returned to the Contract Manager prior to the
execution of this contract.
6.1.4 In accordance with Appendix II to 2 CFR Part 200, the Contractor shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as
supplemented in Department of Labor regulations 41 CFR Part 60 and in Department of Health and Human
Services regulations 45 CFR Part 92, if applicable.
6.1.5 A contract award with an amount expected to equal or exceed S25,000.00 and certain other contract awards
will not be made to parties listed on the government -wide Excluded Parties List System, in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 and 12689, "Debarment and
Suspension." The Excluded Parties List System contains the names of parties debarred, suspended, or
otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority
other than Executive Order 12549. The Contractor shall comply with these provisions before doing
business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor
shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract.
6.2 The Contractor shall not employ an unauthorized alien. The Department will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 LT.S.C. 1324a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. 1101). Such violation will be cause for unilateral cancellation of this
contract by the Department.
6.3 If the Contractor is a non-profit provider and is subject to Internal Revenue Service (IRS) tax exempt organisation
reporting requirements (filing a Form 990 or Form 990-N) and has its tax exempt status revoked for failing to
comply with the filing requirements of the Pension Protection Act of 2006 or for any other reason, the Contractor
must notify the Department in writing within thirty (30) days of receiving the IRS notice of revocation.
6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR §170.110(b), the Contractor shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR Part 170.
6.6 To comply with Presidential Executive Order 12989, as amended, and State of Florida Executive Order Number
11-116. Contractor agrees to utilize the L.S. Department of Homeland Security's E-verify system to verify the
employment of all new employees hired by Contractor during the contract term. Contractor shall include in
related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the
state contract utilize the E-verify system to verify enaployinent of all new employees hired by the Subcontractor
during the contract term.: Contractors meeting the terms and conditions of the E.-Verify System are deemed to be
in compliance with this provision.
7. Compliance with State Law:
7.1 This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced
in all respects in accordance with Florida law, including Florida provisions for conflict of laws.
7.2 If this contract contains state financial assistance funds, the Contractor shall comply with Section 215.97, F.S.,
and Section 215.971, F.S., and expenditures must be in compliance with laws, rules, and regulations, including,
but not limited to, the Reference Guide for State Expenditures.
7.3 The Contractor shall comply with the requirements of Section 287,058; F.S. as amended.
7.3.1 The Contractor shall perform all tasks contained in Attachment I_
7.3.2 The Contractor shall provide units of deliverables, including reports, findings; and drafts, as specified in
Attachment I, to be received and accepted by the Department's Contract Manager prior to payment,
7.3.3 The Contractor shall comply with the criteria and final date by which such criteria must be met for
completion of this contract as specified in Attachment I, Section HI. Method of Payment.
7.3.4 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre -audit and post -audit.
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7.3.5 If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit bills for
any travel expenses in accordance with Section 112,061, F.S., or at such lower rates as may be provided in
this contract.
7.3.6 The Contractor shall allow public access to all documents, papers, letters, or other public records as defined
in subsection 119.011(12), F.S., made or received by the Contractor in conjunction with this contract except
for those records which are made confidential or exempt by law. The Contractor's refusal to comply with
this provision will constitute an immediate breach of contract for which the Department may unilaterally
terminate this contract.
7.4 If clients are to be transported under this contract, the Contractor shall comply with the provisions of Chapter
427, F.S., and Rule Chapter 41-2, Florida Administrative Code (F.A.C).
7.5 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in
accordance with the provisions of Section 287.134, F.S.
7.6 The Contractor shall comply with the provisions of Section 11.062, F.S., and Section 216.347, F.S., which prohibit
the expenditure of contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
7.7 In accordance with Section 287.135 F.S., any Contractor on the Scrutinized Companies with Activities in Sudan
List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized
Companies that Boycott Israel List (Lists), created pursuant to Section 215.473 F.S. and 215.4725, F.S., or is
engaged in a boycott of Israel, or is engaged in business operations in Cuba or Syria, is ineligible to enter into or
renew a contract with the Department for goods or services of $1,000,000 or more. Pursuant to Section 287.135
F.S., the Department may terminate this contract if the Contractor is found to have submitted a false certification
of its status on the Lists or has been placed on the Lists or is engaged in a boycott of Israel or has been engaged
in business operations in Cuba or Syria. Further, the Contractor is subject to civil penalties, attorney's fees and
costs and any costs for investigations that led to the finding of false certification. The Contractor shall complete
and sign the Certifications and Assurances Attachment, prior to the execution of this contract.
8. Background Screening:
The Contractor shall ensure that the requirements of Section 430,0402 and Chapter 435, F.S., as amended, are met
regarding background screening for all persons who meet the definition of a direct service provider and who are not
exempt from the Departments level 2 background screening pursuant to Section 430.0402(2)-(3), F.S. The Contractor
must also comply with any applicable rules promulgated by the Department and the Agency for Health Care
Administration regarding implementation of Section 430.0402 and Chapter 435, F.S. To demonstrate compliance with
this provision, Contractor shall submit to the Department, the Background Screening Affidavit of Compliance
(Screening Form) upon thirty (30) days of execution of this contract. Should the Department have a completed
Screening Form on file for the Contractor, a new Screening Form will be required every twelve (12) months.
8.1 Further information concerning the procedures for background screening may be found at
http://elderaffairs.state.fl.us/doeatbackgroundscreening.php
9. Grievance Procedures:
The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to
process and resolve client dissatisfaction with or denial of service(s), and address complaints regarding the termination,
suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum, will provide for
notice of the grievance procedure and an opportunity for review of the Subcontractor's determination(s).
10. Public Records and Retention:
10.1 By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any other applicable
law, and shall:
10.1.1 Keep and maintain public records required by the Department to perform the contracted services.
10.1.2 Upon request from the Department's custodian of public records, provide the Department a copy of the
requested records or allow the records to be inspected or copied within a reasonable time at a cost that does
not exceed the cost provided in Chapter 119, F.S., or as otherwise provided by law.
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10.1.3 Ensure that public records that are exempt, or confidential and exempt, from public records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and
following completion of the contract if the Contractor does not transfer the records to the Department.
10.1.4 Upon completion of the contract, the Contractor will either transfer, at no cost to the Department, all public
records in possession of the Contractor, or will keep and maintain public records required by the
Department. If the Contractor transfers all public records to the Department upon completion of the
contract, Contractor shall destroy any duplicate public records that are exempt, or confidential and exempt,
from public records disclosure requirements. If the Contractor keeps and maintains public records upon
completion of the contract, the Contractor shall meet all applicable requirements for retaining public
records. All records stored electronically must be provided to the Department in a format that is compatible
with the information technology systems of the Department.
10.2 The Department may unilaterally cancel this contract, notwithstanding any other provisions of this contract, for
refusal by the Contractor to comply with Section 10 of this contract by not allowing public access to all documents,
papers, letters, or other material made or received by the Contractor in conjunction with this contract, unless the
records are exempt, or confidential and exempt, from Section 24(a) of :article I of the State Constitution and
Section 119.07(1), F.S.
IF THE CONTRACTOR LEAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT
THE CUSTODIAN OF PUBLIC RECORDS AT:
Public Records Coordinator
Florida Department of Elder Affairs
4040 Esplanade Way
Tallahassee, Florida 32399
850-414-2352
doeapublicrecords@elderaffairs.org
11. Audits, Inspections, Investigations:
11.1 The Contractor shall establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobiigated balances, income, interest and expenditures of funds
provided by the Department under this contract. Contractor shall adequately safeguard all such assets and assure
they are used solely for the purposes authorized under this contract. Whenever appropriate, financial information
should be related to performance and unit cost data.
11.2 The Contractor shall retain and maintain all client records, financial records, supporting documents, statistical
records, and any other documents (including electronic storage media) pertinent to this contract for a period of
six (6) years after completion of the contract or longer when required by law. In the event an audit is required
by this contract, records shall be retained for a minimum period of six (6) years after the audit report is issued or
until resolution of any audit findings or litigation based on the terms of this contract, at no additional cost to the
Department.
11.3 Upon demand, at no additional cost to the Department. the Contractor shall facilitate the duplication and transfer
of any records or documents during the required retention period.
11.4 The Contractor shall assure that the records described in this section will be subject at all reasonable times to
inspection; review, copying, or audit by federal, state, or other personnel duly authorized by the Department.
11.5 At all reasonable times for as Long as records are maintained, persons duly authorized by the Department and
federal auditors, pursuant to 45 CFR Part 75, will be allowed full access to and the right to examine any of the
Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the
form in which kept.
11.6 The Contractor shall provide a Financial and Compliance Audit Attachment to the Department as specified in
this contract and ensure that all related third -party transactions are disclosed to the auditor,
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11.7 Contractor agrees to comply with the Inspector General in any investigation, audit, inspection, review, or hearing
performed pursuant to Section 20.055, Florida Statutes. Contractor further agrees that it shall include in related
subcontracts a requirement that subcontractors performing work or providing services pursuant to this contract
agree to cooperate with the Inspector General in any investigation, audit, inspection, review, or hearing pursuant
to Section 20.055(5), F.S. By execution of this contract the Contractor understands and will comply with this
subsection.
12. Nondiscrimination -Civil Rights Compliance:
12.1 The Contractor shall execute Assurances as stated in the Assurances -Non -Construction Programs Attachment that
it will not discriminate against any person in the provision of services or benefits under this contract or in
employment because of age, race, religion, color, disability, national origin, marital status or sex in compliance
with state and federal law and regulations. The Contractor further assures that all Contractors, Subcontractors,
Sub -grantees, or others with whom it arranges to provide services or benefits in connection with any of its
programs and activities are not discriminating against clients or employees because of age, race, religion, color,
disability, national origin, marital status or sex.
12.2 During the term of this contract, the Contractor shall complete and retain on file a timely, complete and accurate
Civil Rights Compliance Checklist, attached to this contract.
12.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures will include notifying clients, employees, and
participants of the right to file a complaint with the appropriate federal or state entity.
12.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance, and are binding upon the Contractor, its successors, transferees, and assignees for the
period during which such assistance is provided. The Contractor further assures that all Subcontractors, Vendors,
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 violation of
the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the Contractor
understands that the Department may, at its discretion, seek a court order requiring compliance with the terms of
this assurance or seek other appropriate judicial or administrative relief, including but not limited to, termination
of and denial of further assistance.
13. Monitoring by the Department:
The Contractor shall permit persons duly authorized by the Department to inspect and copy any records, papers,
documents, facilities, goods, and services of the Contractor which are relevant to this contract, and to interview any
clients, employees, and Subcontractor employees of the Contractor to assure the Department of the satisfactory
performance of the terms and conditions of this contract. Following such review, the Department will provide a written
report of its findings to the Contractor, and where appropriate, the Contractor shall develop a Corrective Action Plan
(CAP). The Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determined
by the Department's Contract Manager.
14. Provision of Services:
The Contractor shall provide services in the manner described in Attachment I.
15. Coordinated Monitoring with Other Agencies:
If the Contractor receives funding from one or more State of Florida human service agencies, in addition to the
Department of Elder Affairs, then a joint monitoring visit including such other agencies may be scheduled. For the
purposes of this contract, and pursuant to Section 287.0575, F.S. as amended, Florida's human service agencies shall
include the Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities,
the Department of Veterans' Affairs, and the Department of Elder Affairs. Upon notification and the subsequent
scheduling of such a visit by the designated agency's lead administrative coordinator, the Contractor shall comply and
cooperate with all monitors, inspectors, and/or investigators.
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16. Indemnification:
The Contractor shall indemnify, save, defend, and hold harmless the Uepartazent and its agents and employees from
any and all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the
execution of this contract or performance of the services provided for herein. It is understood and agreed that the
Contractor is not required to indemnify the Department for claims, demands, actions or causes of action arising solely
out of the negligence of the Department.
16.1 Except to the extent permitted by Section 768.28, F.S., or other Florida law, this section 16 is not applicable to
contracts executed between the Department and state agencies or subdivisions defined in Section 768.28(2), F.S.
17. Insurance and Bonding:
17.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or
subdivision as defined by Section 768.28(2.), F.S.; the Contractor accepts full responsibility for identifying and
determining the type(s) and extent of liability- insurance necessary to provide reasonable financial protections
for the Contractor and the clients to be served under this contract. The limits of coverage under each policy
maintained by the Contractor do not limit the Contractor's liability and obligations under this contract. The
Contractor shall ensure that the Department has the most current written verification of insurance coverage
throughout the term of this contract. 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 this contract.
17.2 Throughout the term of this contract. the Contractor shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Contractor
authorized to handle funds received or disbursed under all agreements and or contracts incorporating this
contract by reference in an amount commensurate with the funds handled, the degree of risk as determined by
the insurance company and consistent with good business practices.
18. Confidentiality of Information:
The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal lain or regulations except with the written consent of a person legally authorized
to give that consent or when authorized by law.
19. Health Insurance Portability- and Accountability Act:
`'here applicable. the Contractor shall comply with the Health Insurance Portability and Accountability Act (42 USC
1320d.), as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164).
20. Incident Reporting:
20.1 The Contractor shall notify the Department immediately but no later than forty-eight (48) hours from the
Contractor's awareness or discovery of conditions that may materially affect the Contractors or Subcontractors
ability to perform the services required to be performed under this contract. Such notice shall be made orally to
the Department's Contract Manager (by telephone) with an email to immediately follow.
20.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of
a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number
(1-800-96ABE SE). As required by Chapters 39 and 415, F.S,, this provision is binding upon the Contractor,
Subcontractors, and their employees.
21. New Contract(s) Reporting:
The Contractor shall notify the Department within ten (10) days of entering into a new contract with any of the remaining
four (4) state human service agencies. The notification shall include the following information: (1) contracting state
agency and the applicable office or program issuing the contract; (2) contract name and number; (3) contract start and
end dates; (4) contract amount; (5) contract description and commodity or service; (6) Contract Manager name and
contact information. In complying with this provision, and pursuant to Section 287.0575, F.S., as amended, the
Contractor shalt complete the Contractor's State Contracts List attached to this contract.
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22. Bankruptcy Notification:
During the term of this contract, the Contractor shall immediately notify the Florida Department of Elder Affairs if the
Contractor, its assignees, Subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after notification,
the Contractor must also provide the following information to the Florida Department of Elder Affairs: (1) the date of
filing of the bankruptcy petition; (2) the case number; (3) the court name and the division in which the petition was filed
(e.g., Northern District of Florida, Tallahassee Division); and (4) the name, address, and telephone number of the
bankruptcy attorney.
23. Sponsorship and Publicity:
23.1 As required by Section 286.25, F.S., if the Contractor is a non -governmental 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 (Contractor's
name) and the State of Florida, Department of Elder Affairs." If the sponsorship reference is in written material,
the words "State of Florida, Department of Elder Affairs" shall appear in at least the same size letters or type as
the name of the organization.
23.2 The Contractor shall not use the words "State of Florida, Department of Elder Affairs" to indicate sponsorship
of a program otherwise financed, unless specific authorization has been obtained by the Department prior to use.
24. Assignments:
24.1 The Contractor shall not assign the rights and responsibilities under this contract without the prior written
approval of the Department, which shall not be unreasonably withheld. Any sublicense, assignment, or transfer
otherwise occurring without prior written approval of the Department will constitute a material breach of the
contract.
24.2 The State of Florida is, at all times, entitled to assign or transfer, in whole or part, its rights, duties, or obligations
under this contract to another governmental agency in the State of Florida, upon giving prior written notice to
the Contractor. In the event the State of Florida approves transfer of the Contractor's obligations, the Contractor
remains responsible for all work performed and all expenses incurred in connection with this contract.
24.3 This contract shall remain binding upon the successors in interest of either the Contractor or the Department.
25. Subcontracts:
25.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a
written document and subject to any conditions of approval the Department deems necessary. The Contractor
further agrees that the Department will not be liable to the Subcontractor in any way or for any reason. The
Contractor, at its expense, sh .11 defend the Department against any such claims.
25.2 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the Department or other
state agency. Failure to make payments to any Subcontractor in accordance with Section 287.0585, F.S., unless
otherwise stated in the contract between the Contractor and Subcontractor, will result in a penalty as provided
by statute.
26. Independent Capacity of Contractor:
It is the intent and understanding of the Parties that the Contractor, and any of its Subcontractors, are independent
Contractors and are not employees of the Department and shall not hold themselves out as employees or agents of the
Department without specific authorization from the Department. It is the further intent and understanding of the Parties
that the Department does not control the employment practices of the Contractor and will not be liable for any wage
and hour, employment discrimination, or other labor and employment claims against the Contractor or its
Subcontractors. All deductions for social security, withholding taxes, income taxes, contributions to unemployment
compensation funds and all necessary insurance for the Contractor are the sole responsibility of the Contractor.
27. Payment:
Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in
Attachment I. The Contract Manager will have final approval of the Contractor's invoice submitted for payment, and
will approve the invoice for payment only if the Contractor has meet all terms and conditions of the contract, unless the
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bid specifications, purchase order, or this contract specify otherwise. The approved invoice will be submitted to the
Department's finance section for budgetary approval and processing. Disputes arising over invoicing and payments
will be resolved in accordance with the provisions of Section 215.422, F.S. A Vendor Ombudsman has been established
within the Florida Department of Financial Services and may be contacted at 800-342-2762.
28. Return of Funds:
The Contractor shall return to the Department any overpayments due to unearned funds or funds disallowed and any
interest attributable to such funds pursuant to the terms and conditions of this contract that were disbursed to the
Contractor by the Department. In the event that the Contractor or its independent auditor discovers that an overpayment
has been made, the Contractor shall repay said overpayment immediately without prior notification from the
Department. In the event that the Department first discovers an overpayment has been made, the Contract Manager
will notify the Contractor in writing of such findings. Should repayment not be made forthwith, the Contractor shall be
charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03, F.S., after Department
notification or Contractor discovery.
29. Data Integrity and Safeguarding Information:
The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using
in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor
employees that request system or information access and ensuring that user access has been removed from all terminated
employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information
processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages
of the computer system. The security over the backed -up data is to be as stringent as the protection required of the
primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system
backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance
for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract.
30. Computer Use and Social Media Policy:
The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy,
which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel
affiliated with third parties; such as, but not limited to, contractors and subcontractors. Any entity that uses the
Department's computer resource systems must comply with the Department's policy regarding social media. Social
Media includes, but is not limited to blogs, podcasts, discussion forums. RSS feeds, video sharing, social
networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube. This
policy is available on the Department's website at: http:/lelderaffairs.state.fl.usldoealfinancial.php.
31. Conflict of Interest:
The Contractor shall establish safeguards to prohibit employees, board members, management and Subcontractors from
using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of
interest or personal gain. No employee, officer or agent of the Contractor or Subcontractor shall participate in the
selection, or in the award of a contract supported by, state or federal funds if a conflict of interest, real or apparent, would
be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member of his -her immediate
family; (c) his or her partner; or (d) an organization which employs, or is about to employ, any of the above, has a
financial or other interest in the firm selected for award. The Contractor or Subcontractor's officers, employees or
agents will neither solicit nor accept gratuities, favors or anything of monetary value from Contractors, potential
Contractors, or parties to Subcontracts. The Contractor's board members and management must disclose to the
Department any relationship which may be, or may be perceived to be, a conflict of interest within thirty (30) calendar
days of an individual's original appointment or placement in that position, or if the individual is serving as an incumbent,
within thirty (30) calendar days of the commencement of this contract. The Contractor's employees and Subcontractors
must make the same disclosures described above to the Contractor's board of directors. Compliance with this provision
will be monitored,
32. Public Entity Crime:
Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a
conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or
services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction
Revised October 2017 Page 8 of 51
(February 2018 —June 2019) XQ801
or repair of a public building or public work; may not submit bids, proposals, or replies 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 Section 287.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of
being placed on the Convicted Vendor List.
33. Purchasing:
33.1 The Contractor may purchase articles which are the subject of or are required to carry out this contract from
Prison Rehabilitative Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, F.S.,
in the same manner and under the procedures set forth in subsections 946.515(2) and (4), F.S. For purposes of
this contract, the Contractor 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 list of
products/services available from PRIDE may be obtained by contacting PRIDE, 800-643-8459.
33.2 The Contractor may procure any recycled products or materials, which are the subject of or are required to carry
out this contract, in accordance with the provisions of Section 403.7065, F.S.
33.3 The Contractor may purchase articles that are the subject of, or required to carry out, this contract from a
nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, F.S.,
in the same manner and under the same procedures set forth in Section 413.036(1) and (2), F.S. For purposes of
this contract, the Contractor shall be deemed to be substituted for the Department insofar as dealings with such
qualified nonprofit agency are concerned. Additional information about the designated nonprofit agency and
the products it offers is available at http://www.respectofflorida.org_ This clause is not applicable to
Subcontractors unless otherwise required by law.
33.4 The Contractor shall provide a Certified Minority Business Subcontractor Expenditure (CMBE) Report
summarizing the participation of certified suppliers for the current reporting period and project to date. The
CMBE Report shall include the names, addresses, and dollar amount of each certified participant, and a copy
must be forwarded to the Florida Department of Elder Affairs, Division of Financial Administration and must
accompany each invoice submitted to the Department. The Office of Supplier Diversity (850-487-0915) will
assist in furnishing names of qualified minorities. The Florida Department of Elder Affairs, Minority
Coordinator (850-414-2134) will assist with questions and answers. The CMBE Report is attached to this
contract.
34. Patents, Copyrikpts, Royalties:
If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed, produced
or for which ownership was purchased in the course of or as a result of work or services performed under this contract,
the Contractor shall refer the discovery, invention or material to the Department to be referred to the Department of
State. Any and all patent rights or copyrights accruing under this contract are hereby reserved to the State of Florida in
accordance with Chapter 286, F.S. Pursuant to Section 287.0571(5)(k), as amended, the only exceptions to this provision
shall be those that are clearly expressed and reasonably valued in this contract.
34.1 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to this Section 34.
34.2 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR §200.315 or
45 CFR §75.322, as applicable.
34.3 Notwithstanding the foregoing provisions, if the Contractor or one of its Subcontractors is a university and a
member of the State University System of Florida, then Section 1004.23, F.S., shall apply, but the Department
shall retain a perpetual, fully -paid, nonexclusive license for its use and the use of its Contractors, Subcontractors
or Assignees of any resulting patented, copyrighted or trademarked work products.
35. Emergency Preparedness and Continuity of Operations:
35.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety or welfare, the Contractor shall,
within thirty (30) calendar days of the execution of this contract, submit to the Department's Contract Manager,
Revised October 2017 Page 9 of 51
(February 2018 — June 2019) XQS 01
verification of an Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the
Department of emergency provisions.
35.2 In the event a situation results in a cessation of services by a Subcontractor. the Contractor shall retain
responsibility for perform. ance under this contract and must follow procedures to ensure continuity of operations
without interruption.
36. Equipment:
36.1 Equipment means: (a) an article of nonexpendable, tangible personal property (including information technology
systems) having a useful life of more than one year and a per -unit acquisition cost which equals or exceeds the
lesser of the capitalization level established by the organization for the financial statement purposes, or S5,000.00
[for federal funds - 2 CFR 200.33 and 45 CFR §75.2, as applicable], or (b); nonexpendable, tangible personal
property of a non -consumable nature with an acquisition cost of S1,000.00 or more per unit, and expected useful
life of at least one (1) year; and hardback bound books not circuiated to students or the general public, with a
value or cost of S250.00 or more [for state funds].
36.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non -Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 200
Administrative Requirements (formerly- OMB Circular A-110) that include: (a) a property list with all the
elements identified in the circular; (b) a procedure for conducting a physical inventory of equipment at least once
every two (2) years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of the
equipment; and (d) maintenance procedures to keep the equipment in good condition. The property records must
be maintained on file and shall be provided to the Department upon request. The Contractor shall promptly
investigate, fully document and notify the Department's Contract Manager of any loss, damage, or theft of
equipment. The Contractor shall provide the results of the investigation to the Department's Contract Manager
36.3 The Contractor's property management standards for equipment (including replacement equipment), whether
acquired in whole or in part with federal funds and federally -owned equipment shall, as a minimum, meet the
following requirements and to include accurately maintained equipment records ‘with the following information:
36.3.1 Property records mint be maintained that include a description of the equipment;
36.3.2 Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
36.3.3 Source of fur.ding for the equipment, including the federal award identification number;
36.3.4 \Whether title vests in the Contractor or the fedcial government;
36.3.5 Acquisition date (or date received, if the equipment was furnished by the federal government) and cost;
36.3.6 Information from which one can calculate the percentage of federal participation in the cost of the
equipment (not applicable to equipment furnished by the federal government);
36.3.7 Location, use and condition of the equipment and the date the information was reported;
36.3.8 Unit acquisition cost; and
36.3.9 Ultimate disposition data, including date of disposal and sales price or the method used to determine
current fair market value where a Contractor compensates the federal awarding agency for its share.
363.10 A physical inventory must be taken and the results reconciled with the property records at least once
every two years,
36.3.11 A control system must be developed to ensure adequate safeguards to prevent loss, damage, or theft of
the property. Any toss, damage, or theft must be irxestigated.
36.3.12 Adequate maintenance procedures must be developed to keep the property in good condition.
36.3.13 If the Contractor is authorized or required to sell the equipment, proper sales procedures must be
established to ensure the highest possible return.
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(February 2018 — June 2019) XQ801
36.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with
state funds with an acquisition cost over $1,000.00 is part of the cost of carrying out the activities and functions
of the grant awards and Title (ownership) will vest in the Contractor [for federal funds see 2 CFR §200.313(a)
and 45 CFR §75.320(a), as applicable], subject to the conditions of 2 UR Part 200 and/or 45 CFR Part 75.
Equipment purchased under these thresholds is considered supplies and is not subject to property standards.
Equipment purchased with funds identified in the budget attachments to agreements covered by this contract, or
identified in the sub -agreements with Subcontractors (not included in a cost methodology), is subject to the
conditions of Chapter 273, F. S, and 60A-1.017, F. A. C. and 2 CFR Part 200 and/or 45 CFR Part 75.
36.5 The Contractor shall not dispose of any equipment or materials provided by the Department, or purchased with
funds provided through this contract without first obtaining the approval of the Department's Contract Manager.
When disposing of property or equipment the Contractor must submit a written request for disposition
instructions to the Department's Contract Manager. The request should include a brief description of the
property, purchase price, funding source, and percentage of state or federal participation, acquisition date and
condition of the property. The request should also indicate the Contractor's proposed disposition (i.e., transfer
or donation to another agency that administers federal programs, offer the items for sale, destroy the items, etc.).
36.6 The Department's Contract Manager will issue disposition instructions. If disposition instructions are not
received within one hundred twenty (120) days of the written request for disposition, the Contractor is authorized
to proceed as directed in 2 CFR §200.313 or 45 CFR §75.320, as applicable.
36.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract without the prior approval of the Department. Real property
purchases from Older Americans Act funds are subject to the provisions of Title 42, Chapter 35, Subchapter III,
Part A., Section 3030b U.S.C. Real property purchases from state funds can only be made through fixed capital
outlay grants and aids appropriations and therefore are subject to the provisions of Section 216.348, F.S.
36.8 Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and tested prior
to disposal to ensure no confidential information remains.
36.9 The Contractor must adhere to the Department's procedures and standards when purchasing Information
Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR
worksheet is required for any computer related item costing $1,000.00 or more, including data processing
hardware, software, services, supplies, maintenance, training, personnel and facilities. The completed 11R
worksheet shall be maintained in the LAN administrator's file and must be provided to the Department upon
request. The Contractor has the responsibility to require any Subcontractors to comply with the Department's ITR
procedures.
37. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
http://www.myflorida.com/apps/vbs/adoc/F7740 PUR1000.pdf
In the event of any conflict between the PUR 1000 Form and any terms or conditions of this contract the terms or
conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained
in the PUR 1000 Form shall take precedence.
38. Use of State Funds to Purchase or Improve Real Property.
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor
granting to the state a security interest in the property (Fixed Capital Outlay Certification - Attachment XIII) at least to
the amount of state funds provided for at least five (5) years from the date of purchase or completion of the
improvements or as further required by law.
39. Dispute Resolution:
Any dispute concerning performance of the contract shall be decided by the Department's Contract Manager, who shall
reduce the decision to writing and serve a copy on the Contractor.
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(February 2018 — June 2019) XQ801
40. Financial Consequences:
If the Contractor fails to meet the minimum level of service or performance identified in this contract, the Department
will impose financial consequences as stated in Attachment I.
41. No Waiver of Sovereign Immunity:
Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign irmnurtity- may be applicable.
42. Venue:
If any dispute arises out of this contract, the venue of such legal recourse shall be Leon County, Florida.
43. Entire Contract:
This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or representations
shall be `-acid or binding upon the Department or the Contractor unless expressly contained herein or by a written
amendment to this contract signed by both Parties.
44. Force "1Iajeure:
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party_ experiencing the force majeure condition provides immediate written notification to the other party
and takes all reasonable efforts to cure the condition.
45. Severabiiiw Clause:
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable the
other provisions are severable to that void provision and shall remain in full force and effect.
46. Condition Precedent to Contract Appropriations:
The Parties agree that the Department's performance and obligation to pay under this contract is contingent upon an
annual appropriation by the Legislature.
47. Addition/Deletion:
The Parties agree that the Department reserves the right to add or to delete any of the services required under this
contract when deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both
Parties. The Parties shall negotiate compensation for any additional services added.
48. Waiver:
The delay or failure by the Department to exercise or enforce any of its rights under this contract will not constitute or
be deemed a waiver of the Department's right thereafter to enforce those rights, nor will any single or partial exercise
of any such right preclude any other or further exercise thereof or the exercise of any other right.
49. Compliance:
The Contractor shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable
current state statutes, laws, rules and regulations. The Parties agree that failure of the Contractor to abide by these laws
shall be deemed an event of default of the Contractor, and subject the contract to immediate, unilateral cancellation of
the contract at the discretion of the Department.
50. Final Invoice:
The Contractor shall submit the final invoice for payment to the Department no later than thirty (30) days upon the
contract ending date : mless otherwise specified in Attachment [. If the Contractor fails to do so, all right to payment is
forfeited and the Department may not honor any requests submitted after the aforesaid time period. Any payment due
under the terms of this contract may be withheld until all required documentation and reports due from the Contractor
and necessary adjustments thereto have been approved by the Department.
51. Renegotiations of Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price
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(February 2018 — June 2019) XQ801
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.
52. Suspension of Work:
The Department may in its sole discretion suspend any or all activities under the contract or purchase order, at any time,
when in the best interests of the State to do so. The Department shall provide the Contractor written notice outlining
the particulars of suspension. Examples of the reason for suspension include, but are not limited to, budgetary
constraints, declaration of emergency, or other such circumstances. After receiving a suspension notice, the Contractor
shall comply with the notice and shall not accept any purchase orders. Within ninety (90) days, or any longer period
agreed to by the Contractor, the Department shall either (1) issue a notice authorizing resumption of work, at which
time activity shall resume, or (2) terminate the contract or purchase order. Suspension of work shall not entitle the
Contractor to any additional compensation.
53. Termination:
53.1 Termination for Convenience. The Department, by written notice to the Contractor, may terminate this contract
in whole or in part when the Department determines in its sole discretion that it is in the State's interest to do so.
The Contractor shall not furnish any product after it receives the notice of termination, except as necessary to
complete the continued portion of this contract, if any. The Contractor shall not be entitled to recover any
cancellation charges or lost profits.
53.2 Termination for Cause. The Department may terminate this contract if the Contractor fails to (1) deliver the
product within the time specified in the contract or any extension, (2) maintain adequate progress, thus
endangering performance of the contract, (3) honor any term of the contract, or (4) abide by any statutory,
regulatory, or licensing requirement. Rule 60A-1.006(3), F.A.C., governs the procedure and consequences of
default. The Contractor shall continue work on any work not terminated. Except for defaults of Subcontractors
at any tier, the Contractor shall not be liable for any excess costs if the failure to perform the contract arises from
events completely beyond the control, and without the fault or negligence, of the Contractor. If the failure to
perform is caused by the default of a Subcontractor at any tier, and if the cause of the default is completely beyond
the control of both the Contractor and the Subcontractor, and without the fault or negligence of either, the
Contractor shall not be liable for any excess costs for failure to perform, unless the subcontracted products were
obtainable from other sources in sufficient time for the Contractor to meet the required delivery schedule. If, after
termination, it is determined that the Contractor was not in default, or that the default was excusable, the rights
and obligations of the Parties shall be the same as if the termination had been issued for the convenience of the
Department. The rights and remedies of the Department in this clause are in addition to any other rights and
remedies provided by law or under the contract.
53.3 Upon termination of this contract, the Contractor and Subcontractors shall, at no cost to the Department, transfer
all public records in their possession to the Department and destroy any duplicate public records that are exempt,
or confidential and exempt, from public records disclosure requirements. All records stored electronically shall
be provided to the Department in a format that is compatible with the information technology systems of the
Department.
54. Electronic Records and Signature:
The Department authorizes, but does not require, the Contractor to create and retain electronic records and to use
electronic signatures to conduct transactions necessary to carry out the terms of this contract. A Contractor that creates
and retains electronic records and uses electronic signatures to conduct tr nsactions shall comply with the requirements
contained in the Uniform Electronic Transaction Act, Section 668.50, F.S. All electronic records must be fully
auditable; are subject to Florida's Public Records Law, Chapter 119, F.S.; must comply with Section 29, Data Integrity
and Safeguarding Information; must maintain all confidentiality, as applicable; and must be retained and maintained by
the Contractor to the same extent as non -electronic records are retained and maintained as required by this contract.
54.1 The Department's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the Department. The Contractor is authorized to conduct electronic transactions with the
Department only upon further written consent by the Department.
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(February 2018 — June 2019) XQSO1
54.2 Upon request by the Department, the Contractor shall provide the Department with non -electronic (paper) copies
of records. Non -electronic (paper) copies provided to the Department of any document that was originally in
electronic form with an electronic signature must identify the person and the persons capacity who electronicalh
signed the document on any non -electronic copy of the document.
55. Contract Manager:
The Department may substitute any Department employee to serve as the Contract Manager.
REMAINDER OF THE PAGE INTENTIONALLY LEFT BLANK
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(February 2018 — June 2019)
XQ801
56. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
a.
The Contractor name, as shown on page 1 of this
contract, and mailing address of the official payee to
whom the payment shall be made is:
Southwest Social Services Programs, Inc.
25 Tamiami Blvd.
Miami, Fl. 33144
b.
The name of the contact person and street address
where financial and administrative records are
maintained is:
Angela Vazquez
25 Tamiami Blvd
Miami, Fl. 33144
C'
The name, address, and telephone number of the
representative of the Contractor responsible for
administration of the program under this contract is:
Angela Vazquez
25 Tamiarni Blvd
Miami, Fl. 33144
(305) 261-6202
d.
The section and location within the Department where
Requests for Payment and Receipt and Expenditure
forms are to be mailed is:
Florida Department of Elder Affairs
Division of Financial Administration
4040 Esplanade Way, Suite 215
Tallahassee, Florida 32399-7000
e.
The name, address, and telephone number of the
Contract Manager for this contract is:
Josh Register, FCCM
4040 Esplanade Way, Suite 250G
Tallahassee, Florida 32399-7000
850-414-2148
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided
in writing to the other party.
57. All Terms and Conditions Included:
This contract and its Attachments, I — XIII including any exhibits referenced in said attachments, together with any
documents incorporated by reference, contain all the terms and conditions agreed upon by the Parties. There are no
provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all
previous communications, representations or agreements, either written or verbal between the Parties.
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS, THEREOF, the Parties hereto have caused this fifty-one (51) page contract to be executed by their
undersigned officials as duly authorized.
CONTRACTOR: SOUTHWEST SOCIAL
SERVICES PROG , INC.
STATE OF FLORIDA,
DEPART OF EL AFFAIRS
SIGNED BY: SIGNED B � 11,
�/
iv
NAME: s ' 1'( �6i,� NAME: RICHARD PRUDOM
TITLE: _ tcn ___ .A.) TITLE: DEPUTY SECRETARY/CHIEF OF STAFF
DATE: '' . i /3— 020 I
Duns: Federal y 29
Duns: ((mod
DATE: -7 I I r f?
+ 1
Revised October 2017
Page 15 of 51
(February 2018 —June 2019) XQ801
INDEX OF ATTACHMENTS
ATTACHMENT I 17
STATEMENT OF WORK 17
ATTACHMENT II 24
FLN4_\ CL4L AND COMPLIANCE AUDIT 24
ATTACHMENT III 30
CERTIFICATIO.\SAVD ASSURANCES 30
ATTACHMENT IV 35
ASSURANCES —NON -CONSTRUCTION PROGRAMS 35
ATTACHMENT V 37
FLORIDA DEP 4RME_\"T OF ELDER AFFAIRS CII7L RIGHTS COMPLIANCE CHECKLIST 37
ATTACHMENT VI 41
CONTRACTOR'S STATE CO ATR4 CT LIST 41
ATTACHMENT VII 42
BACKGROUND SCREENING 42
ATTACHMENT VIII 43
CERTIFIED _LIL\ORITY BUSLVESS SUBCONTRACTOR EXPENDITURES (CMBE FORM) 43
ATTACHMENT IX 45
STATEMENT OF LSE OF FUNDS (BUDGET) 45
ATTACHMENT IX 46
STATEMENT OF USE OF FUNDS (BUDGET) 46
ATTACHMENT X 47
RECEIPTS AND EXPENDITURE REPORT FIXED CAPITAL OUTLAY 47
ATT ACHIIENT XI 48
REQUEST FOR PAYMENT FIXED CAPITAL OUTLAY 48
ATTACILNIENT XII 49
COST RELMIBL RSEME\'T SL:IIiIARY FORM 49
ATTACHMENT XIII 50
FIXED CAPITAL OUTLAY CERTIFICATION 50
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(February 2018 — June 2019) XQ801
ATTACHMENT I
STATEMENT OF WORK
I. SERVICES TO BE PROVIDED
A. Definitions of Terms
1. SWSS - Southwest Social Services Programs, Inc.
2. DOEA -- Florida Department of Elder Affairs
3. Badia Center — Dr. Armando Badia Senior Center
4. HVAC - Heating Ventilation and Air Conditioning
B. General Description
1. General Statement - The 2017-2018 General Appropriations Act, line item 400B appropriated $500,000 to
Southwest Social Services Programs, Inc. to assist in the construction of an addition that will include a
computer lab, exercise room/gym, AV/Special Presentation room, three classrooms, and an additional men's
and women's restroom to the Dr. Armando Badia Center. The Badia Center serves low income seniors and
some of the services provided are congregate meals, high risk nutrition program, nutrition education, nutrition
counseling, screening & assessments, referrals, transportation, recreation and adult education. On a daily
basis there is an attendance between 220 and 280 participants. The additional space shall be used to provide
more of the services the center currently provides, and also some additional services SWSS cannot currently
provide due to space restrictions. The addition will accommodate more seniors and in return provide more
services for the seniors who rely on the Badia Center for resources.
2. Authority All applicable state and federal laws, regulations, action transmittals, program instructions, review
guides and similar documentation related to the following:
Chapter 430, Florida Statutes (F.S.)
GAA Appropriation line item 400 B
3. Scope of Work — The funds appropriated shall be used to build an addition onto the current Badia Center. The
addition shall include a computer lab, exercise room/gym, AV/Special Presentation room, three classrooms,
and additional restrooms. Contractor shall hire an Architect or Engineer to design the engineering drawings.
Contractor shall perform all site work needed to prepare for construction, complete all interior, exterior and
general construction, and purchase all materials needed for the addition. Purchase and install all finishing's and
coverings to the newly built addition. Apply for any permitting needed including certification of occupancy at
the end of the project. The addition shall be fully constructed at completion and ready for use by the seniors
who rely on the services provided by the Badia Center.
IL MANNER OF SERVICE PROVISION
A. Tasks, Deliverables and Performance Measures - All work required by this contract must be performed at the
Badia Senior Center located at 25 Tamiami Blvd., Miami, FL. 33144. The Contractor must adhere to the Statement
of Use of Funds (Budget), Attachment IX. Attachment IX may only be adjusted with prior written approval from
the DOEA Contract Manager and each amendment requires an amendment to the contract. In performing all work
utilizing the funds allocated to the project, the Contractor shall ensure that all contractors fully comply with all
applicable local, state, and federal laws, rules, and regulations.
Revised October 2017 Page 17 of 51
(February 2018 — June 2019) XQ801
1. Service Tasks Pre -Construction Phase Submit Engineering drawings of the proposed addition to
DOEA Contract Manager and any site and prep work needed before construction of the addition. Pre -
construction shall include:
a. Provide copies of the final Engineering drawings of the proposed addition that include a computer lab,
exercise room gym, AV. Special Presentation room, three classrooms, and additional restrooms to the
DOEA Contract Manager. Electronic copies of documents are acceptable.
b. The Engineering drawings must have the Architect or Engineers name, or company's name, on the
submitted Mans.
c. Obtain permits required to start construction by the county and city. Provide copies of permits to the
DOEA Contract Manager.
d. Completion of site work and prep needed to the current Badia Center to begin the construction phase
of the addition.
2. Service Tasks Construction Phase- Build and construct the new addition and connect to the current
Badia Center. Construction of the new addition shall. include;
a. Purchase and installation of general building materials needed to construct the addition:
b. Purchase and installation all plumbing for addition to include all piping, fixtures, and equipment
needed for the addition;
c. Purchase and installation of all HVAC materials needed including all HVAC equipment, ductwork,
and fixtures that the addition will require;
d. Purchase and installation of all electrical materials; panels, wiring, lighting fixtures and any other
electrical work needed;
e. Purchase and installation of all floor and wall coverings for the interior;
f. Purchase and installation of roofing and or siding materials as well as any other coverings needed for
the exterior;
g. Purchase and installation of weatherization and insulation;
h. Purchase and installation of railings and guards needed to make the addition ADA compliant;
i. Purchase and installation of all doors and windows needed to complete the project;
j. All connections to the current Badia center as well as any hook up needed to the city or county for
water and sewer;
k. Purchase and installation of materials needed to complete parking lots, walkways, driveways, and
landscaping;
1. Contractor must submit a report shoving a summary- of progress with updated timeline and
photographs to the DOER Contract Manager for each reimbursement as specified in section II.D.3;
m. Must provide certification by licensed Engineer or Architect using AIA forms G702 and G703 or
their equivalent if approved in xvriting by DOEA Contract Manager, certifying that the project or a
quantifiable portion of the project is complete. with submission of each reimbursement;
n. Perform construction close-out activities that include the assembly of final construction
documentation and all necessary waste removal and disposal from site.
o. During the term of this Agreement and to the extent required by law, the Contractor shall perform in
accordance with the provisions of Chapter 255, F.S.
3. Deliverables, Source Documentation & Performance Measures
The Contractor must complete the tasks found in section II, tilanner of Service Provision, and as stated in the
Schedule of Deliverables and Payments Table found in this section. The Contractor must submit all required
documentation in the time and manner specified in order for the minimum performance levels to be met. Each
deliverable must be accepted in writing by the DOEA Contract Manager based on the requirements for each
deliverable before the Contractor submits an invoice requesting payment.
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XQ801
Deliverable No. 1 — Pre- Construction
Service Task
Pre -Construction Phase -
Submit Engineering drawings
of the proposed addition to
DOEA Contract Manager and
any site and prep work needed
before construction of the
addition as stated in section
II.A.1.
Minimum Level of Service
Provide copies of the final
Engineering drawings with
timeline of the proposed addition
that include a computer lab,
exercise room/gym, AV/Special
Presentation room, three
classrooms, and additional
restrooms to the DOEA Contract
Manager.
Completion of site work needed
for the construction phase to
begin. As evidence of completion,
the Contractor shall submit to
DOEA's Contract Manager the
following:
• All documents in the
Invoice package as stated
in section III.B.1.
• Copies of permits required
to start construction by the
county and city.
Financial Consequences
Failure to provide the minimum
level of service in this contract will
result in non-payment.
DOEA will not release the first
reimbursement payment until the
plans have been received by the
DOEA Contract Manager and this
deliverable has been completed.
Deliverable 1-10% or less of total contract amount.
Deliverable No. 2 — Construction Phase
Service Tasks
Construction Phase —
Build and construct the new
addition and connect to the
current Badia Center as stated
in section II.A.2.
Minimum Level of Service
Deliverable 1 must be completed
before reimbursements are
submitted for deliverable 2.
A minimum of 10% completion
with certification by licensed
Engineer or Architect using AIA
forms G702 and G703, or their
equivalents, certifying that the
project, or a quantifiable portion of
the project, is complete.
As evidence of completion, the
Contractor shall submit to
DOEA's Contract Manager the
following as stated in section
III.B:
• Copies of documents
required in the invoice
package as stated in
Section III.B.
Financial Consequences
Failure to provide the minimum
level of service in this contract will
result in non-payment.
No reimbursements will be paid
until deliverable 1 (Pre -
Construction Phase) has been
completed.
Final Payment will not be paid until
Contractor provides proof of
completion to DOEA, and DOEA
accepts that the project is 100%
complete as stated in section III.B.3
of this contract.
DOEA will withhold payment if
monthly report with timeline and
photographs are not submitted per
section II.D.3 of this contract.
Revised October 2017
Page 19 of 51
(February 2018 — June 2019) XQ801
• Submit a report showing a
summary of progress with
updated timeline and
photographs to the DOEA
Contract Manager for each
reimbursement as specified
in section II.D.3
Any Advance funding received that
is not recouped will be recouped
from the final payment.
Deliverable 2 — 90% of contract amount plus any remaining amount from Deliverable No. 1
4. Task Limits — The Contractor shall not perform any tasks related to the project other than those described in
this contract without the prior express written consent of the Department.
5. Reporting - The Contractor shall respond within ten (10) business days to the Department's request for routine
and or special requests for information and ad hoc reports. The Contractor must establish due dates for any
subcontractors that permit the Contractor to meet the Department's reporting requirements.
6. Records and Documentation - The Contractor shall make available to Department staff, and or any party
designated by the Department, all contract related records and documentation. The Contractor shall ensure the
collection and maintenance of all program related information and documentation on any such system
designated by the Department. Maintenance includes valid exports and backups of all data and systems
according to Department standards.
B. Staffing Requirements
1. Staffing Levels - The Contractor shall assign its own administrative and support staff as needed to perform the
tasks, responsibilities and duties under the contract. It is the Contractors responsibility to ensure subcontractors
have the appropriate staff needed to perform the tasks;, responsibilities, and duties under this contract.
2. Professional Qualifications - Contractor shall ensure that all subcontractors and or vendors performing work
related to this contract are certified and or have licenses in the trade area in which work is being performed, as
required by state and federal law.
3. Staffing Changes - Any employee whose continued presence would be detrimental to the success of this
contract as determined by the Department shall be replaced by the Contractor with an employee of equal or
superior qualifications. The Department's Contract Manager shall exercise judgment in this matter as approved
by the Department
4. Subcontractors - The Contractor is permitted to use subcontractors to perform work as required by this
contract.
C. Service Location and Equipment
1. Service Delivery Location — All work and improvements must be performed for the location specified herein.
The Badia Senior Center located at 25 Tamiami Blvd., Miami, FL. 33144, is the location verified by SWSS.
2. Service Times - Work can begin upon execution of this contract. All work associated with this contract must
be performed on or before June 30, 2019.
3. Changes in Location - The Contractor shall receive written approval from DOEA's Contract Manager prior to
making any changes in location. Each request to make a change in location shall be made in writing to the
DOEA Contract Manager.
Revised October 2017 Page 20 of 51
(February 2018 — June 2019) XQ801
D. Contractor Responsibilities
1. Contractor Unique Activities - All tasks listed above in. Section II. are solely and exclusively the responsibility
of the Contractor and for which, by execution of this contract, the Contractor agrees to be held accountable.
2. Coordination with Entities Notwithstanding that services for which the Contractor is held accountable
involve coordination with other entities in performing the requirements of this contract, the failure of other
entities does not alleviate the Contractor from any accountability for tasks or services that the Contractor is
obligated to perform pursuant to this Contract.
3. Contractors Report — Contractor must submit a report showing a summary of progress with updated
timeline with photographs to the DOEA Contract Manager for each reimbursement as specified in this
section. A report shall be submitted with each reimbursement submitted to the DOEA Contract Manager.
The report shall include at minimum- Completion of service tasks with dates and photographs, time line with
updates, budgetary issues, weather related setbacks, and any other issues or events that may affect the ability
of the Contractor to meet the teens of this Agreement. This report is for documentation purposes and does
not serve as an amendment to the contract or official notification of a change to the DOEA Contract Manager.
4. Engineering Drawings - Provide copies of the final Engineering drawings of the proposed addition that
include a computer lab, exercise room/gym, AV/Special Presentation room, three classrooms, and additional
restrooms to the DOEA Contract Manager. These must be received by the DOEA Contract Manager before
the first payment will be made per section ILA of this contract. Electronic copies of these documents are
acceptable.
E. Department Responsibilities
1. Department Obligations - The Department may provide technical support and/or assistance to the Contractor
within the resources of the Department to assist the Contractor in meeting the requirements of this contract.
The support and/or assistance, or lack thereof, shall not relieve the Contractor from full performance of contract
requirements.
2. Department Determinations - The Department reserves the exclusive right to make certain determinations in
the tasks and approaches. The absence of the Department setting forth a specific reservation of rights does not
mean that all other areas of the contract are subject to mutual agreement.
F. Monitoring and Evaluation Methodology - The Department shall review and evaluate the performance of the
Contractor under the terms of this contract. Monitoring shall be conducted through direct contact with the Contractor
through telephone, in writing, or on -site visit. The Department's determination of acceptable performance shall be
final. The Contractor agrees to cooperate with the Department in monitoring the progress of completion of the
service tasks and deliverables. The Department may use, but is not limited to, one or more of the following methods
for monitoring:
1. Desk reviews and analytical reviews;
2. Scheduled, unscheduled and follow-up on -site visits;
3. Review of third -party documents and/or evaluation;
4. Review of progress reports;
S. Agreed -upon procedures review by an external auditor or consultant;
6. Other procedures as deemed necessary.
III. METHOD OF PAYMENT
A. Payment Method Used - The Method of Payment for this contract is Cost Reimbursement and an Advance
Payment may be available, subject to the availability of funds and Contractor performance. The Department will
pay the Contractor upon satisfactory completion of the Tasks/Deliverables, as specified in Section II.A and in
accordance with other terms and conditions of the contract. Total contract amount shall not exceed the amount
specified on page one (1) of this contract.
Revised October 2017 Page 21 of 51
(February 2018 — June 2019) XQ801
1, Cost Reimbursement - Payment will be authorized only for allowable expenditures, which are in accordance
with the Statement of Use of Funds Attachment IX(Budget). and Section II. Manner of Service Provision. The
Contractor must meet the minimum level of performance stated in the contract in order to be eligible to receive
payment.
2. Advance Payment - The Contractor can request up to two (2) months of advances at the start of the contract
period to cover program administrative and service costs. The payment of an advance will be contingent
upon the sufficiency and amount of funds released to the Department by the State of Florida ("budget
release"). The Contractor's requests for advance require the written approval of the DOEA Contract Manager.
The Contractor shall provide the DOEA Contract Manager documentation justifying the need for an advance
and describing how the funds will be distributed. If sufficient budget is available, the Department may issue
approved advanced payments after contract is executed. Any advance payment under this Agreement is subject
to section 216.181(16), F.S.
a. Any advance payments the Contractor requested for subcontractors must be distributed within seven (7)
days of receipt of payment from the Department. The Contractor shall submit to the Department
documentation to support full distribution of advanced funds; submitted documentation is due to the
Department no later than thirty (30) days after receipt of payment from the Department.
b. All advance payments retained by the Contractor must be fully expended no later than ninety (90) days
from date of execution of this contract. Any portion of advanced payments not expended must be
recouped on the next invoice submitted to the Department.
c. All advance payments made to the Contractor shall be reimbursed to the Department as follows: A
minimum of 20% o of each reimbursement submitted shall be reported as an advance recoupment until the
total amount of advance funds are recouped.
d. Contractor must maintain a separate interest -bearing account in a United States (US) banking institution
for funds provided under this Contract, and remit interest earned on the account to DOEA within thirty (30)
days of expiration or termination of the Agreement, or apply interest earned against DOEA's obligation to
pay ander this the Agreement.
B. Invoice Instructions - Payment shall be made upon Contractor's presentation of an invoice subsequent to the
acceptance by the Department of the deliverables shown on the invoice. Final contract invoices must be submitted
by Contractor within thirty (30) business days after the expiration of the contract. Funds paid and or reimbursed to
Contractor must be in line with the approved budget on Attachment IX.
Grantee shall provide invoices no more than one (1) time per month for all services rendered during that period of
time.
1. Invoice Package — Each invoice must identify the deliverable(s) or line item(s) for which payment is being
requested, the contract number, an invoice number, the amount being requested for reimbursement, and the
`Remit to' address exactly as it appears in this contract.
When submitting an invoice for reimbursement, Contractor must submit the following:
a. The Receipts and Expenditure Report Fixed Capital Outlay Form (Attachment X).
b. The Cost Reimbursement Summary Form (Attachment XII).
c. The Request for Payment Fixed Capital Outlay Form (Attachment XL).
d. Certification by licensed Engineer or Architect using ALA. forms G702 and G703, or their equivalent if
approved in writing by DOEA Contract Manager, certifying that the project, or a quantifiable portion of
the project is complete.
e. Vendor invoice(s) — A copy of the detailed vendor invoice(s) that totals the amount listed in Contractors
invoice.
f. Proof of payment — May be a copy of a payment instrument, check number. accounting Department detail
sheet — as long as the detail information corresponds to the copies of the vendor invoices.
g. MBE Expenditure Report Deliverable (Attachment VIII) — this is considered a Deliverable and must be
completed in its entirety and submitted with each invoice.
Revised October 2017 Pave 22 of 51
(February 2018 — June 2019) XQ801
h. Submit a report showing a summary of progress with updated timeline and photographs to the DOEA
Contract Manager for each reimbursement as specified in section II.D.3
2. Advance Payment Recoupment — Advances granted to the Contractor will be recouped by adjusting approved
reimbursements per the terms of this contract. Contractor will update the recouped amounts on the Receipts
and Expenditure Report Fixed Capital Outlay (Attachment X), and the Request for Payment Fixed Capital
Outlay (Attachment XI) when invoices are submitted per section III.A.2 above.
3. Final Payment Instructions — Any advance funds that have not been recouped will be recouped from the final
payment. Contractor shall submit a final request for payment when the project is 100% complete and it shall
contain the following documentation:
a. Invoice package as stated in section III.B.1.
b. Statement from Professional Engineer and/or Architect certifying the work was performed as required and
is 100% complete.
c. A certificate of occupancy (C.O.) or its equivalent issued by local government agency or building
department certifying the building's compliance with applicable building codes and other laws, and
indicating it is in a condition suitable for occupancy.
C. Financial Consequences — Failure to perform the services as stated in Section H.A. and submit the required
documentation will result in non-payment.
IV. Special Provisions
A. Budget (Attachment IX) Modifications — Contractor may request changes to the approved budget line items set
forth in the Statement of Use of Funds, Attachment IX (Budget), provided that the total contract amount does not
change. Any request to modify the budget line items must be made, in writing, to the DOEA Contract Manager,
and requires an amendment to the contract. Contractor must include a revised budget with details for each
change. The Contractor shall not make any change to budget line items without the prior written consent of the
DOEA Contract Manager. All approvals are final and subject to the discretion of the DOEA Contract Manager.
An e-mail (request and response) is considered acceptable.
B. Contract Modifications — The Contract Manager has the authority to modify and/or extend deliverable deadlines.
All deliverable extension requests must be made in writing thirty days prior to the required deadline, to the
Contract Manager. All approvals for deliverable extensions must be communicated, in writing, by the Contract
Manager to Contractor and are subject to the discretion of the DOEA Contract Manager. The requests and the
approval must occur prior to the established deadline. An e-mail writing (request and response) is considered
acceptable.
C. General Procurement Standards - Contractor shall not order Equipment or Supplies, provide services or
perform any other action related to this contract until notified that this contract has been executed by the
Department. These same actions shall not take place after the contract has expired.
D. Monitoring - The primary, secondary or signatory of the contract must be present for any on -site programmatic
monitoring visit. The Department reserves the right to conduct an unannounced on -site visit by persons duly
authorized by the Department.
E. Security Interest - Pursuant to section 287.05805, F.S. (2017), Section 38 of the Standard Contract, and Fixed
Capital Outlay Certification (Attachment XIII) of this contract, the Contractor shall execute and deliver a security
interest or other appropriate document to the Department's Contract Manager prior to receiving any funds under
this contract. Requirements stated in this section are considered service tasks and deliverables. The Contractor's
failure to meet this provision will result in non-payment and/or immediate termination of this contract.
END OF ATTACHMENT I
Revised October 2017 Page 23 of 51
(February 2018 — June 2019) XQ801
ATTACHMENT II
FL%:UNCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Department to the Contractor may be subject to audits and/or monitoring
by the Florida Department of Elder Affairs, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with 2 CFR Part 200 (formerly OMB Circular A-133 as revised);
and Section 215.9 , F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits
by the Department staff, limited scope audits as defined by OMB Circular A-133, as revised, and 'or other procedures. By
entering into this contract, the Contractor agrees to comply and cooperate with any monitoring procedures. processes deemed
appropriate by the Department. In the event the Department determines that a limited scope audit of the Contractor is
appropriate, the Contractor agrees to comply with any additional instructions provided by the Department to the Contractor
regarding such audit. The Contractor 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 Contractor is a State or local government or a non-profit organization as defined in 2 CFR Part
200, Subpart A.
In the event that the Contractor expends $750,000.00 or more in federal awards during its fiscal year, the Contractor must
have a single or program -specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial
Compliance Audit attachment, Exhibit 2 indicates federal resources awarded through the Department by this contract. In
determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards,
including federal resources received from the Department. The determination of amounts of Federal awards expended
should be in accordance with 2 CFR Part 200. An audit of the Contractor conducted by the Auditor General in accordance
with the provisions of 2 CFR Part 200 will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the Contractor shall fulfill the requirements
relative to auditee responsibilities as provided in 2 CFR §200.50S.
If the Contractor expends less than S750,000.00 in federal awards in its fiscal year, an audit conducted in accordance with
the provisions of 2 CFR Part 200 is not required. In the event that the Contractor expends less than S750,000.00 in federal
awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200 the cost
of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from Contractor resources
obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year_
Compliance findings related to contracts with the Department shall be based on the contract's requirements, including any
rules, regulations, or statutes referenced in the contract. The financial statements shall disclose whether or not the thatching
requirement was met for each applicable contract. All questioned costs and liabilities due to the Department shall be fully
disclosed in the audit report with reference to the Florida Department of Elder Affairs contract involved. If not otherwise
disclosed as required by 2 CFR §200.510 the schedule of expenditures of federal awards shall identify expenditures by
contract number for each contract with the Department 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 Contractor's fiscal year end.
Revised October 2017 Page 24 of 51
(February 2018 — June 2019)
PART I1: STATE FUNDED
This part is applicable if the Contractor is a non -state entity as defined by Section 215.97(2), F.S.
XQ801
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of $750,000.00 in
any fiscal year of such Contractor, the Contractor must have a State single or project -specific audit for such fiscal year in
accordance with Section 215.97, F.S.; 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. Financial
Compliance Audit Attachment, Exhibit 2 indicates state financial assistance awarded through the Department by this
contract. In determining the state financial assistance expended in its fiscal year, the Contractor shall consider all sources
of state financial assistance, including state financial assistance received from the Department, other state agencies, and
other non -state entities. State financial assistance does not include Federal direct or pass -through awards and resources
received by a non -state entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1, the Contractor shall ensure that the audit
complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as
defined by Section 215.97(2), F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit
organizations), Rules of the Auditor General.
If the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year, an audit conducted in
accordance with the provisions of Section 215.97, F.S., is not required. In the event that the Contractor expends less than
$750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the
provisions of Section 215.97, F.S., the cost of the audit must be paid from the non -state entity's resources (i.e., the cost of
such an audit must be paid from the Contractor resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to contracts with the Department shall be based on the contract's requirements, including any
applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the snatching requirement
was met for each applicable contract. All questioned costs and liabilities due to the Department shall be fully disclosed in
the audit report with reference to the Department contract involved. If not otherwise disclosed as required by Rule 691-
5.003, F.A.C., the schedule of expenditures of state financial assistance shall identify expenditures by contract number for
each contract with the Department 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 Contractor'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 Contractor's fiscal year end. Notwithstanding the
applicability of this portion, the Department retains all right and obligation to monitor and oversee the performance of this
contract as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of this Financial
Compliance Audit Attachment, shall be submitted, when required by 2 CFR §200.512 by or on behalf of the Contractor
directly to each of the following:
The Florida Department of Elder Affairs at the following address:
Florida Department of Elder Affairs
Attn: Josh Register, FCCM
4040 Esplanade Way, Suite 250G
Tallahassee, Florida 32399-7000
For fiscal year 2013 and earlier to the Federal Audit Clearinghouse designated in 2 CFR §200.36 at the following address:
Revised October 2017 Page 25 of 51
(February 2018 — June 2019) XQ801
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
For fiscal year 2014 and later, pursuant to 2 CFR §200.512, the reporting package and the data collection form must be
submitted electronically to the Federal Audit Clearinghouse.
Pursuant to 2 CFR §200.512. all other Federal agencies, pass -through entities and others interested in a reporting package
and data collection form must obtain it by accessing the Federal Audit Clearinghouse.
The Contractor shall submit a copy of any management letter issued by the auditor, to the Florida Department of Elder
Affairs at the following address:
Florida Department of Elder Affairs
Attn: Josh Register, FCCM
4040 Esplanade Way, Suite 250G
Tallahassee, Florida 32399-7000
Additionally, copies of financial reporting packages required by this contract's Financial Compliance Audit Attachment,
Part II shall be submitted by or on behalf of the Contractor directly to each of the following:
The Florida Department of Elder Affairs at the following address:
Florida Department of Elder Affairs
Attn: Josh Register, FCCM
4040 Esplanade Way-, Suite 250G
Tallahassee, Florida 32399-7000
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Department pursuant to this contract
shall be submitted timely in accordance with 2 CFR Part 200, Florida Statutes, and Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General, as applicable.
Contractors, when submitting financial reporting packages to the Department for audits done in accordance with 2 CFR Part
200 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 Contractor in correspondence
accompanying the reporting package.
PART IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of
six (6) years from the date the audit report is issued, and shall allow the Department or its designee, the CFO or Auditor
General access to such records upon request. The Contractor shall ensure that audit working papers are made available to
the Department or its designee, CFO. or Auditor General upon request for a period of six (6) years from the date the audit
report is issued, unless extended in writing by the Department.
Revised October 2017 Page 26 of 51
(February 2018 — rune 2019) XQ801
ATTACHMENT II -EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200
and/or Section 215.97, F.S. Contractors who are determined to be recipients or sub -recipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the anrlit threshold requirements set forth in Part I
and/or Part II of Exhibit 1 are met. Contractors who have been determined to be vendors are not subject to the audit
requirements of 2 CFR §200.38, and/or Section 215.97, F.S. Regardless of whether the audit requirements are met,
Contractors who have been determined to be recipients or sub -recipients of Federal awards and/or state financial
assistance must comply with applicable programmatic and fiscal compliance requirements.
In accordance with 2 CFR Part 200 and/or Rule 69I-5.006, F.A.C., Contractor has been determined to be:
Vendor not subject to 2 CFR §200.38 and/or Section 215.97, F.S.
X Recipient/sub-recipient subject to 2 CFR §200.86 and §200,93 and/or Section 215.97, F.S.
Exempt organization not subject to 2 CFR Part 200 and/or Section 215.97, F.S. For Federal awards, for -profit
organizations are exempt; for state financial assistance projects, public universities, community colleges, district
school boards, branches of state (Florida) government, and charter schools are exempt. Exempt organizations must
comply with all compliance requirements set forth within the contract or award document.
NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and or state financial assistance and has been
approved by the department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-5.006, F.A.G.
[state financial assistance] and 2 CFR §200.330[federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal
awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a sub -
recipient must comply with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR §200.416 - §200.417 — Special Considerations for States, Local Governments and Indian Tribes*
2 CFR §200.201 —Administrative Requirements**
2 CFR §200 Subpart F — 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 §200.400 - §200.411 — Cost Principles*
2 CFR §200.100 — Administrative Requirements
2 CFR §200 Subpart F — 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 §200.418 — §200.419 — Special Considerations for Institutions of Higher Education*
2 CFR §200.100 —Administrative Requirements
2 CFR §200 Subpart F — 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 2 CFR
§200.400(5) (c).
Revised October 2017 Page 27 of 51
(February 2018 —June 2019) XQ801
**For funding passed through S. Health and Human Services, 45 CFR Part 75; for funding passed through U.S.
Department of Education, 34 CFR Part 80.
STATE FINANCLAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a
recipient sub -recipient must comply with the following fiscal laws, rules and regulations:
Sections 215.97 & 215.971, F.S.
Chapter 69I-5, F.A.C.
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
Revised October 2017 Page 28 of 51
(February 2018 —June 2019)
XQ801
ATTACHMENT II -EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR, as revised, and Section 215.97, F.S. require that the information about Federal Programs and State
Projects included in Attachment II, Exhibit 1 be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD (FAIN#): FEDERAL AWARD DATE:
DUNS NUMBER:
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200 — Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
OMB Circular A-133 — Audits of States, Local Governments, and Non -Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Badia Senior Center
FY 17-18 GAA Appropriation. Line Item:
400 B
500,000.00
General Revenue
TOTAL AWARD
500,000.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97 & 215.971, F.S., Chapter 691-5, F.A.C, State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
Revised October 2017 Page 29 of 51
(February 2018 — June 2019) XQ801
ATTACHMENT III
CERTIFICATIONS AND ASSURANCES
DOER will not award this Contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In
performance of this contract, Contractor provides the following certifications and assurances:
A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75)
B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93)
C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes, section 287.133, F.S.
E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance (Pub. L.
111-117)
F. Certification Regarding Scrutinized Companies Lists, section 287.135. F.S.
G. Certification Regarding Data Integrity Compliance For Contracts, Agreements, Grants, Loans And Cooperative
Agreements
H. N'eriflcation of Employment Status Certification
I. Records and Documentation
J. Certification Regarding Inspection of Public Records
A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS — PRIMARY COVERED TRANSACTION.
The undersigned Contractor certifies to the best of its knowledge and belief, that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment. declared ineligible, or voluntarily excluded from
covered transactions by a Federal department or agency;
2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing
a public (Federal. State. or Iocal) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State or local)
with commission of any of the offenses enumerated in paragraph A.2. of this certification; and or
4. Have not within a three-year period preceding this application proposal had one or more public transactions
(Federal, State, or local) terminated for cause of default.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all
tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that ail sub
recipients and contractors shall provide this certification accordingly.
B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS.
The undersigned Contractor certifies, to the best of its knowledge and belief, that:
Revised October 2017 Page 30 of 51
(February 2018 — June 2019) XQ801
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 employee of Congress, or an employee of a Member of Congress in
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..
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 employee of any agency, a Member of Congress, an officer or employee of
Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative
agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all
tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub -
recipients and contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this Contract was made or
entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31
U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than
S 10,000 and not more than $100,000 for each such failure.
C. NON DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART
80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal
opportunity provisions of the following laws:
1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination
against all individuals in the United States on the basis of race, color, religion, sex national origin, age, disability,
political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted
immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program
or activity.
2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance
with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or
national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity for which the Applicant receives Federal financial assistance from the
Depai tment.
3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112) as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in
accordance with Section 504 of that Act, and the Regulation, no otherwise qualified handicapped individual in the
United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of,
or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial
assistance from the Department.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance
with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of,
be excluded from participation in, or be subjected to discrimination under any program or activity for which the
Applicant receives Federal financial assistance from the Department.
5. Title IX of the Education Amendments of 1972 (Pub, L. 92-318), as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in
accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded
from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education
program or activity for which the Applicant receives Federal fmancial assistance from the Department.
6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment
practices, including, job application procedures, hiring, firing, advancement, compensation, training, and other
terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe
benefits, and all other employment -related activities.
Revised October 2017 Page 31 of 51
(February 2018 — June 2019) XQ801
Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed
above. This assurance applies to Contractor's operation of the `VIA Title I — financially assisted program or activity,
and to all contracts, Contractor makes to carry out the \VIA Title I — financially assisted program or activity. Contractor
understands that DOEA and the United States have the right to seek judicial enforcement of the assurance.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub
recipients and contractors shall provide this assurance accordingly.
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S.
Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity
Crone as defined in section 287.133, F.S., nor placed on the convicted vendor list.
Contractor understands and agrees that it is required to inform DOEA immediately upon any change of circumstances
regarding this status.
E. ASSOCIATION OF COMl1IUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RESTRICTIONS ASSURANCE (Pub. L. 111-117).
As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions
pertaining to ACORN" and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub.
L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that
appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. 111-117.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub
recipients and contractors shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS CERTIFICATION, SECTION 287.135, F.S.
If this Contract is in the amount of S1 million or more, in accordance with the requirements of Section 287.135, F.S.,
Contractor hereby certifies that it is not participating in a boycott of Israel, is not listed on either the Scrutinized
Companies with Activities in Sudan List or the Scrutinized Companies with activities in the Iran Petroleum Energy
Sector List, and that it does not have business operations in Cuba or Syria. Both lists are created pursuant to Section
215.473, F.S.
Contractor understands that pursuant to Section 287.135, F.S., the submission of a false certification may subject
Contractor to civil penalties, attorney's fees, and. or costs.
If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to
this Contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS,
GRANTS, LOANS AND COOPERATIVE AGREEMENTS
1. The Contractor and any Subcontractors of services under this contract have financial management systems
capable of providing certain information, including: (1) accurate, current, and complete disclosure of the financial
results of each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the
source and application of funds for all contract supported activities; and (3) the comparison of outlays with
budgeted amounts for each award. The inability to process information in accordance with these requirements
could result in a return of grant funds that have not been accounted for properly.
2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the
Contractor is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified
to be capable of processing data accurately, including year -date dependent data. For those systems identified to be
non -compliant, Contractors will take immediate action to assure data integrity.
Revised October 2017 Page 32 of 51
(February 2018 —June 2019) XQ801
3. If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology,
the undersigned warrants that these products are capable of processing year -date dependent data accurately. All
versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state
will be verified for accuracy and integrity of data prior to transfer.
4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that
impede the hardware or software programs from operating properly, the Contractor agrees to immediately make
required corrections to restore hardware and software programs to the same level of functionality as warranted
herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the
essence.
5. The Contractor and any Subcontractors of services under this contract warrant their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies
arising from data integrity compliance issues.
II. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Florida Department of Elder Affairs, Contractor certifies the use of the U.S.
Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired
by Contractor during the contract term to perform employment duties pursuant to this contract and that any
subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to
this Contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the
Subcontractor during the entire contract term.
The Contractor shall require that the language of this certification be included in all sub -agreements, sub -grants, and
other agreements/contracts and that all Subcontractors shall certify compliance 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 Circulars A-102 and 2 CFR Part 200, and 215 (formerly OMB Circular A-110).
I. RECORDS AND DOCUMENTATION
The Contractor agrees to make available to Department staff and/or any party designated by the Department any and
all contract related records and documentation. The Contractor shall ensure the collection and maintenance of all
program related information and documentation on any such system designated by the Department. Maintenance
includes valid exports and backups of all data and systems according to Department standards.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of sections, 10.1, 10.2 of the Standard Contract, and 119.0701(3) and (4) F.S., and any
other applicable law, if a civil action is commenced as contemplated by Section 119.0701(4), F.S., and the Department
is named in the civil action, Contractor agrees to indemnify and hold harmless the Department for any costs incurred
by the Department, and any attorneys' fees assessed or awarded against the Department from a Public Records Request
made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder.
a. Notwithstanding Section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed
between the Department and state agencies or subdivisions defined in Section 768.28(2), F.S.
2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership
contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial,
business, and membership records of such an entity which pertain to the public agency (Florida Department of
Elder Affairs) are public records. Section 119.07, F.S, states that every person who has custody of such a public record
shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances.
Additionally, I certify this organization does does not 1K
Revised October 2017 Page 33 of 51
(February 2018 — June 2019)
provide for institutional memberships.
XQ8801
Contractor's signature below attests that records pertaining to the dues or membership application by the Department are
available for inspection as stated above.
By execution of this contract, Contractor must include these provisions isions in all related subcontract agreements (if applicable).
By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if
applicable).
By signing below, Contractor certifies the representations outlined in parts A through J above, are true and correct.
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Revised October 2017 Page 34 of 51
(February 2018 — June 2019)
XQ801
ATTACHMENT IV
ASSURANCES —NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348 -0043),
Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please
contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to
additional assurances. If such is the case, you will be notified.
1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and
completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the
award; and will establish a proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §4728-4763) relating to prescribed standards
for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's
Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of
the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin;
(b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.
§794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.C. §6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment
Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §523 and 527 of the Public Health Service
Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse
patient records; (h) Title VDT of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific
statute(s) under which application for federal assistance is being made; and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements
apply to all interests in real property acquired for project purposes regardless of federal participation in purchases.
Revised October 2017 Page 35 of 5I
(February 2018 — June 2019) XQ801
8. Will comply, as applicable, with the provisions of the Hatch Act (5 L.S.C. §1501-1508 and 7324-7328), which limit
the political activities of employees whose principal employment activities are funded in. whole or in part with federal
funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §276a to 276a-7), the Copeland Act
(40 C.S.C. 276c and 18 U.S.C. §874) and the Contract Rork Hours and Safety Standards Act (40 U.S.C. §327-333),
regarding labor standards for federally assisted construction sub -contracts.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 19"3 (P.L. 93-234) which requires recipients in a special flood ba7ard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is S10,000.00 or
more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L, 91-190) and
Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under
Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection
of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. § 1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.C. §470). EO 11593 (identification and protection of historic properties); and the
Archaeological and Historic Preservation Act of 1974 (i6 U.S.C. §469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.)
pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other acti %zties
supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. §4801 et seq.), which prohibits the use of
lead- based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and 2 CFR Part 200.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies
governing this program.
SIGNATURE OF AUTHORIZED CERTIFYIN OFFICIAL
TITLE
APPLICANT ORGANIZATION
DATE SUBMITTED
Revised October 2017 Page 36 of 51
(February 2018 —June 2019)
XQ801
ATTACHMENT V
FLORIDA DEPARMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHF KLIST
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PART I: READ TIIE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE
THIS FORM.
1. Bn y escri • e the geographic area served by the progr: facility and the • e of service provided:
�� - 1 r 1 !-0 ,1' .' M.E. /
For questions 2-5 please indicate the fol
2. Population of area served
3. Staff currently employed
4. Clients currently enrolled/registered
5. Advisory/Governing Board if applicable
owing:
Total #
Rio
White
°se
Black
Rio
Hispanic
%
Other
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Female
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Disabled
Rio
Over 40
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PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO EXPLAIN.
6. Is an Assurance of Compliance on file with DOEA? N/A YE NO
❑ ❑
7. Compare the staff composition to the population. Is staff representative of the population? N/A NO
❑ ❑
8. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national N/A YENO❑
origin, sex, age, religion or disability?
9. Are all benefits, services and facilities available to applicants and participants in an equally effective manner N/A NO
regardless of race, sex, color, age, national origin, religion or disability? ❑ ❑
10. or in -patient servic- , are r m assig a made out regard to r e, color, nati origip or ,ability?
11. Is the program/facility accessible to non-English speaking clients?
12.Are employees, applicants and participants informed of their protection against discrimination? If YES, how?
Verbal ❑ Written ❑ Poster ❑
NIA /YES NO
❑ ❑
N/A YES NO
N/A YES O
❑ ❑
Revised October 2017 Page 37 of 51
(February 2018 — June 2019) XQ8O1
13. Give the number and current status of any discrimination complaints regarding services or employment filed. N/A
against the program.facility.
UV 0
14. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals?
N/A YES NO
PART ill: THE FOLLOWT G QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO
EXPLAIN.
15. Has as a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any YESNO
necessary modifications?
16, Is there an established grievance procedure that incorporates due process in the resolution of complaints?
17. Has a person been designated to coordinate Section 504 compliance activities?
YES NO
D
YES/ NO
18. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on YES NO
the basis of disabilit?
19. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? YES / NO
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF S50,000.00 OR MORE.
YES / NO
�1d,/ C
20. Do you have a written affirmative action plan? 1f NO, explain.
DOH 1 USE. ONI..l
Reviewed by
In Compliance: YES i NO*
fl
Program Office
*Notice of Corrective Acden Sent
—
Date
i Telephone
Response Due
On -Site u
Desk Review 0
Response Received 1
Revised October 2017
Page 38 of 51
(February 2018 — June 2019) XQ801
ATTACHMENT V
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves
a specific target population such as adolescents, describe the target population. Also, define the type of service
provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city, county or other regional area. Population statistics
can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing
Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific
Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of
your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list
their percent by race, sex and disability. Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for DOEA Recipients and their Sub -grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability
in the population, the program/facility has the responsibility to determine the reasons for such variation and take
whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when
programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a)
and 45 CFR 80.1 (b) (2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin,
religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied
uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting
rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b).
11. For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants, including those persons who
may not speak English. In geographic areas where a significant population of non-English speaking people live,
program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy
or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist
in the provision of services, 45 CFR 80.3 (a).
Revised October 2017 Page 39 of 51
(February 2018 — June 2019) XQ801
13. Programs facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries or any other interested parties. This should include information on their right to file a
complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS.
The information may be supplied verbally or in writing to every individual, or may be supplied through the use of
an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the program facility. Indicate the basis, e.g., race, color,
creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement,
termination. etc. Indicate the civil rights law or policy alleged to have been violated along with the name and
address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status,
e.g., settled; no reasonable cause found, failure to conciliate, failure to cooperate, under review, ete.
15. The program facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public
telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door
widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines
should be observed for accessibility. Elevators should be observed for door width, and Braille orraised numbers.
Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an
appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self -
evaluation to identify any accessibility barriers. Self -evaluation is a four step process:
a. With the assistance of a disabled individual organization, evaluate current practices and policies which do not
comply with Section 504.
b, Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have
been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 13 or more persons must adopt grievance procedures that incorporate appropriate
due process standards and provide for the prompt and equitable resolution of complaints alleging any action
prohibited by Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the programfacility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads, and other appropriate written communication, 45 CFR 84.8 (a).
20. Programs facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired
sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters
for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide
equally effective services, 45 CFR 84.52 (d).
21. Programs facilities with 50 or more employees and S50,000.00 in federal contracts must develop, implement and
maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60
and Title VI of the Civil Rights Act of 1964, as amended.
Revised October 2017 Page 40 of 51
(February 2018 — June 2019)
ATTACHMENT VI
CONTRACTOR'S STATE CONTRACT LIST
Contractor's State Contract List
CON I IZA T ll; INFO 1.\TIO\:
Name c * IAL V185
Address: Oft (AN/ (5LuI: #Afro AFL?
FEID:
SICK..; l'L C.:
rrrl_; :
Revised October 2017
icy It>
Page 41 of 51
Email: skoSSc°!�L
Contact: ACZO2d„ rX
• '1
■
4/48
(February 2018 —June 2019) XQ801
Df Wi'M t NT (A
ELDER
AFFAIRS
STATE OE FLORIDA
ATTACIBIENT VII
BACKGROUND SCREENLNG
BACKGROUND SCREENING
Affidavit of. Compliam.7.e - Employer
AL) T;-V:...!t:,':-. i. ' ..71:"-.!. 4?i,-.'' VZ, 4.1 ne:a..j:i,L2,...' V21:i E. !.1i;.' V frf •ar1 .,.:11:pi...wii'i.:,:.., .f.,,,..:,FAT..",.../ .;,-;i".',1•5 -....`:1,7, ..i'cti.,..,itailori
• " ;:';
; LC,
representative of
Employer Nome
located at 2'46 7- tit Agit 8411bi F ge I j7111
Str State ZIP code'
ige
Nome of Representative
that the above named employer is n compliance with the provisions of Chapter section
Statutes, regarding level 2 r. k:iuidscri-;iF.F.
Signature ntal e
STATE OF FLORIDA, COUNTY CP
"2- do hereby affirm
°C.11.
Date
Sworn to (or affirmed) and subscribed before me this 21 day of _ , 20 1 by
1;11§1C14,_
to me or produced rt.
Thivc,
Print, Typd
s
(Name of Representative) who is personally known
e, or S p Comthiss red Name of Notary Public Note
of of identification.
Farm avallabie at: ,httb://eicieraiiair &statellAolaraitsheoa,lkoroundscresnincczhv
ec.c.f.1:`..4.14c., DEMPSEY B GUERRA
Commission #00136704
Expires August 21, 2021
c r1.0° &Mad Thu Budget Notary Seroicaa
Revised October 2017 Page 42 of 51
(February 2018 — June 2019) XQ801
ATTACHMENT VIII
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES (CMBE FORM)
CMBE FORM MUST ACCOMPANY INVOICES SLiBMI1 T EED TO DOEA
CONTRACTOR NAME:
DOEA CONTRACT NUMBER:
*REPORTING PERIOD -FROM: TO:
*(DATE RANGE OF RENDERED SERVICES, MUST MATCH INVOICE SUBMITTED TO DOEA)
DOEA CONTRACT MANAGER:
REPORT ALL EXPENDITURES MADE TO CERTIFIED MINORITY BUSINESS (SUBCONTRACTORS).
CONTACT DOEA CMBE COORDINATOR FOR ANY QUESTIONS, AT 850-414-2134.
SUBCONTRACTOR NAME
SUBCONTRACTOR'S
FEID
CMVIBE
EXPENDITURES
DOEA USE ONLY — REPORTING ENTITY (DIVISION, OFFICE, ETC)
SEND COMPLETED FORMS VIA INTEROFFICE MAIL TO: EVE EEINTON
CMBE COORDINATOR, CONTRACT T ADMINISTRATION & PURCHASING. TALLAHASSEE, FLORIDA 32399-7000.
Revised October 2017
Page 43 of 51
(February 2018 — June 2019) XQ801
If unsure if subcontractor is a certified minority supplier. click on the hvperlink below. Enter the name of the supplier. click
"search". Only Certified Minoritv Business Entities will be displayed.
https:fiosd.dms.myflor€da.comldirectories
I(. INSTRUCTIONS
(A) ENTER THE COMPANY NAME AS IT APPEARS ON YOUR DOEA CONTRACT.
(B) ENTER THE DOEA CONTRACT NUMBER,
(C) ENTER THE SERVICE PERIOD MATCHING THE CURRENT INVOICE'S SERVICE PERIOD.
(D) ENTER ALL CERTIFIED MINORITY BUSEV.ESS EXPENDITURES FOR THE TIME PERIOD COVERED BY
THE INVOICE:
1. ENTER CERTIFIED MINORITY BUSINESS NAME.
2. ENTER THE CERTIFIED MINORITY BUSINESS FEID NUMBER.
3. ENTER THE CERTIFIED MINORITY BUSINESS CMBE NUMBER.
4. ENTER THE AMOUNT EXPENDED WITH THE CERTIFIED MINORITY BUSINESS FOR THE TIME
PERIOD COVERED BY THE INVOICE.
(E) MBE FORM MUST ACCOMPANY INVOICE PACKAGE SUBMITTED TO DOEA FINANCIAL
ADMINISTRATION FOR PROCESSING.
(F) FINANCIAL ADMINISTRATION WILL FORWARD ALL COMPLETED MBE FORMS TO CONTRACT
AD?1ILNISTRATION & PURCHASING OFFICE
Revised October 2017 Page 44 of 51
(February 2018 —June 2019)
XQ801
ATTACHMENT IX
STATEMENT OF USE OF FUNDS (BUDGET)
Project Name: Dr. Armando Badia Senior Center
Total Project Budget: $568.500
Sr. Center
State
FCO
Funds
Matching
Funds
Other
lioFunds
Total
Projectn-FC0
Funds
TYPE AND SOURCE OF FUNDS:
V2, DO
Federal Grant(s)
Sr2 03
Other State Funds (i.e., DCA)
5500,000.0D
•:i-F..K,iH.10 riD
CitylCoun Grant()
Senior Centers FCO Grant
Private Contributions/Donations
In -kind Expenditure Credits
.._ _....
Total Funds Available From All Sources
..:-,D)DCC'912E.
7.,:i.i-A'
. - . -,-, -,,,
' ,I- • -, '- - - ',
...-,-, ,...,, ,-,-
-;
4,- ' , --- ' , -. •-- -
$$tE WORK
$0.00
Perking Lot
$15,000.00
$15,000.00
Walks/Driveways
$3,000.00
$3,000 00
Awnings/Covered Walkways
SO.00
$0.00
Drainage/Retention Pond
$0.0D
50.00
Treeslandscaping
$1,000.00
$1,1300.00
Fencing
SO OD
$0 OD
Signage
.1:-0 C21:1
WOO
Other (Please Specify)
$0.00
$0.00
Total
519,000.00
°",,.r..'7,,
$0.00
$19,000 00
Mallon
Insulation/Weatherization
$5,000.00
$5,000 .00
Plumbing
$27,000.00
$27,000.00
Healing/Air Conditioning
$25,000 00
$25,000 00
Electrical
$28,000.00
$28,000.00
Flooring
$15,000.00
$15,000 OD
Masonry
$13,300.00
$13,300.00
Ceiling/Acoustics
;:7-0.00
$0.00
Railing/Guards
$1.800.00
$1,800.D0
50.00
Other (Please Specify)
$0.00
$0.00
Total
$115,100.00
',.K.,.''.?-il
50.00
$115,101100
Revised October 2017
Page 45 of 51
(February 20 1 S — June 2019)
ATTACILMENT EX
XQSO
STATEMENT OF USE OF FUNDS (BUDGET)
Project Name: Dr. Atra...r;o t3adia Senior
Total Project Budget: $560,° tit
Lenaer
€, t.: niter
State
FCC
Funds
127iC:hirig
Funds
Other
Hon-FCO Funds
Total
Protect
ec
ro ds
Roofing9 iding
$€20,000.00
l
$20,O00_00
DoorsriNindows
! $17,000.00
S17,000_00
Porches, Hacks. Pzhos
$0_00
j j
$0 00
Septic Tank
j .O0
$ .0O
Sewer Hook-Up(CityICounty)
'; $I,S 3.OQ 1
$1,50f3.00
Generate (Ga.. Powered)
i $0.00
'
$0.00
Other (Please Specify)
$0.00
$0.03
T._dal
S38,500_00
:0 4'! SO OD1
$38,-cA0_00
Security/Alarm System
These it k '. x-e.
included in the
et- : ,i:. A 'w ,tit€ ti` <<mv7
:.a, � .. 4 ;=
$O-OO
? !
0_00
Telephone System
$0.00
! 1$0.00
Smoke Detectors
`l 0.00
I
$0.09
E merrJency/Fist Aid stations
$0.00
I
WOO
Klichen Appliances
$0.00"
$1 etc,
Cahinets/Counter Tops
$0.0001
1
i.03
Bathroom Fixtures
SO 00
i
$il 00
Lighting Fixtures
$0.00.
$0.00
Cie,--; Pl*,:: ."�f,_€.ifwl
$0.00
$0_00
Total
$0.00
`,i`I to
i;_€30"
v %.00
P FESS1Pt+Ex.L SERVICES
Architect/ Engineer/ Speed Consultant t
:. iG :;i 0i 1.16
$35,53CLOO
Schematic Design Phase
?J) !o:i
$0.00
Dtsi jn Development Phase
SO 00
$O.00
Construction Document Pt. se
,s,ii,i10
$0 00
Bidding
SO it
4.00
ConslrL#wtiori ,Administration
Si:i i0)
$0_0O
Other (Please $plc€fy): AN equip, PC's, seating, etc.
$:(Ore iY)
03,O00.00
Taiai
1i.00
�) Cr;
r.r! .Tie.: i) 1
$68.500.00
3pcify)
i
. _ atruction
= / f fy.) (i- l I
$''3227,4 '7.00
t e
Tolnli,
:3- .f.! 1U } �, 01
S327,400.OD
II I
TOTAL PROJECT COST
,- s ry i{, IIl i i fill -S,6V,1,1:,t, i,,_,I
$568,500.00
Revised October 2017
Page 46 of 51
(February 2018 -June 2019)
XQ801
ATTACHMENT X
RECEIPTS AND EXPENDITURE REPORT FIXED CAPITAL OUTLAY
RECIPIENT NAME, ADDRESS, PHONE# and FEID#
Program Funding Source:
General Revenue
This Report Period:
From To
Contract Period :
Contract #
Invoice #
CERTIFICATION : I certify
above contract.
Prepared byDate
to the best of my knowledge and belief that this report is complete
: Approved by :
and correct and all the outlays herein are for the purposes set forth in the
PART A: BUDGETED INCOME/ RECEIPTS
1. State Funds
2. TOTAL RECEIPTS
t• Approved
Contract Budget
0.00
0.00
2. Actual Receipts
for this Report
0.00
0.00
3. Total Receipts
Year to Date
0.00
0.00
4. Percent of Approved Budget
#DIV/0!
#DIV/0!
PART B : EXPENDITURES
(Identify Line Item Categories from Approved Budget)
1. Site Work
2. Interior
3. Exterior ....................................................
4. Fixtures
5. Professional Service
6. Other
7. TOTAL EXPENDITURES
1. Approved Budget
0.00
0.00
0.00
0.00
0.00
0.00
1
0.00
2. Expenditures
For This Report
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3. Expenditures
Year to Date
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4. Percent of
Approved Budget
#DIV/0!
#DIV10!
#DWIO!
#DIV/01
#DIV/OI
#DIV/O!
#DIVIO!
PART C : OTHER REVENUE
II. Advance Recoupment
1. Advance Recouped
AND EXPENDITURES
$
Revised October 2017 Page 47 of 51
(February 2018 —June 2019)
ATTACIBIENT XI
XQ801
REQUEST FOR PAYMENT FIXED CAPITAL OUTLAY
RECIPIENT NAME, ADDRESS, PHONE# and FEiD#
PAYMENT REQUEST:
Regular
This Request 9 er'od :
From To
invoice #
Suodlernentai
Contract #
Advance Payment
Contract Period
CERTIFICATION: i hereby certify that this request conforms with the terms of the above contract.
Prepared by Date-_ Aooroved by.
Date:
PART A: BUDGET SUMMARY
FCO
1. Approved Contract Amount
$0.00
2. Previous Funds Received for Contract Period
$0.00
3. Contract Balance
$0.00
4. Previous Funds Requested and Not Received for Contract Period
$0.00
5. Contract Ba ance
$0.00
PART B: CONTRACT FUNDS REQUEST
1 Antic;pated Cash Need (advance)
$0.00
2. Net Expenditures For Month
$0.00
3. TOTAL
$0.00
PART C: NET FUNDS REQUESTED
1, Less Advance Applied
$0.00
2. TOTAL FUNDS REQUESTED (Part B Line 3, minus Part C Line 1)
$0.00
DOEA form 106f, revised 2/2018
Revised October 2017 Page 48 of 51
(February 2018 —June 2019)
XQ801
ATTACHMENT XII
COST REIMBURSEMENT SUMMARY FORM
Cost Reimbursement Summary
Contract #
Report Number:
Budget
Category Description
Number of units
Amount
Administration
TOTAL ADMINISTRATION $0.00
Expenses
TOTAL EXPENSES $0.00
Revised October 2017
Page 49 of 51
(February 2018 —June 2019) XQ801
ATTACHYIE1\T XIII
FIXED CAPITAL OUTLAY CERTIFICATION
The Parties acknowledge that the Contractor is using state funds to improve real property that is not owned by the
Contractor, The following items must be completed by the Contractor.
1. Specify the leasehold or other real property interest the Contractor has in the real property.
geo. e_d-r tti AN)
2. List the name of the owner of the real property and the contact address for the owner of the real property.
e 141 oar /-uti/[l
wzir*o(fobAvi,
LVI90
3. Describe the relationship between the owner of the real property and the Contractor.
_A vat gs:Aht5 &fob gemu trkt 0/110V-0
kit
4. In accordance with section 287.05805, F.S. (2017), Section 38 of the Standard Contract and Section IV.E. of
Attachment I, the Contractor shall execute and deliver a security interest or other appropriate document securing the
interest of the Department, in the total amount of funds received under this contract, in the improvements, renovations,
and personality being purchased with funds received under this contract. The Department's security interest shall last for
at least five (5) years from the date of completion of the improvements and during this time the Contractor is prohibited
from selling, transferring, mortgaging, or assigning the Department's interest in the leasehold, improvements, renovations,
or personality, unless the Department approves, in writing, the sale, transfer, mortgage, or assignment.
5. The Contractor shall continue the operation, maintenance, repair, and administration of the property in accordance
with the purposes for which the funds were originally appropriated and for at least five (5) years from the date of
completion of the improvements. If the Contractor fails to operate, maintain, repair, and administer the property in
accordance with the purposes for which the funds were originally granted. the Contractor shall return to the Department,
no later than upon demand by the Department, the total amount of funds received under this contract, less 20% of that
total amount for each full year for which the property was used for such purposes after the date of completion of the
improvements
THIS SPACE INTENTIONALLY LEFT BLANK
Revised October 2017 Page 50 of 51
(February 2018 —June 2019)
XQ801
6. The Department shall be immune from civil or criminal liability resulting from acts or omissions of the Contractor
and the Contractor's agents, employees, or assigns.
7. The Department shall execute a satisfaction of security interest upon full compliance by the Contractor with the
terms of this contract.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
APPLIC TION
o�� dim ae,v/Ie.S
TITLE
Asi6MA)1. bherd-ex)
a/�i
DATE SUBMITTED
Revised October 2017 Page 51 of 51
Ch. 2017-70
LAWS OF FLORIDA Ch. 2017-70
SECTION 3 - HUMAN SERVICES
Manolo Piniero Homebound Diabetes Services (recurring
base appropriation project funded as nonrecurring) 139,414
Aging and Disability Resource Center of Broward (recurring
base appropriation project funded as nonrecurring) 119,537
395 SPECIAL CATEGORIES
CONTRACTED SERVICES
FROM GENERAL REVENUE FUND
FROM ADMINISTRATIVE TRUST FUND .
FROM FEDERAL GRANTS TRUST FUND
FROM GRANTS AND DONATIONS TRUST
FUND
114,710
33,131
458,925
22,700
FROM OPERATIONS AND MAINTENANCE
TRUST FUND 53,564
396 SPECIAL CATEGORIES
GRANTS AND AIDS - CONTRACTED SERVICES
FROM GENERAL REVENUE FUND
FROM ADMINISTRATIVE TRUST FUND .
FROM FEDERAL GRANTS TRUST FUND .
FROM OPERATIONS AND MAINTENANCE
TRUST FUND
397 SPECIAL CATEGORIES
RISK MANAGEMENT INSURANCE
FROM GENERAL REVENUE FUND
2,003,545
38,263
31,397
9,135,359
796,511
398 SPECIAL CATEGORIES
LEASE OR LEASE -PURCHASE OF EQUIPMENT
FROM GENERAL REVENUE FUND 9,639
FROM FEDERAL GRANTS TRUST FUND . 6,635
FROM OPERATIONS AND MAINTENANCE
TRUST FUND 6,182
399 SPECIAL CATEGORIES
TRANSFER TO DEPARTMENT OF MANAGEMENT
SERVICES - HUMAN RESOURCES SERVICES
PURCHASED PER STATEWIDE CONTRACT
FROM GENERAL REVENUE FUND
FROM FEDERAL GRANTS TRUST FUND .
FROM OPERATIONS AND MAINTENANCE
TRUST FUND
8,227
11,852
4,775
400 SPECIAL CATEGORIES
PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY (PACE)
FROM GENERAL REVENUE FUND 18,314,216
FROM OPERATIONS AND MAINTENANCE
TRUST FUND 29,403,907
100A CRANTS AND AIDS TO LOCAL GOVERNMENTS AND
NONSTATE ENTITIES FIXED CAPITAL OUTLAY
GRANTS AND AIDS ALZIIEIMER'S COMMUNITY
CARE AND SERVICES
FROM CENERAL REVENUE FUND
31C,000
Fr m thc fundc in Specific Appr priati n 100A, thc f 11 wing pr jccta
arc fundcd fr m n nrccurring general revenue funds:
Easter S als f S uth F1 rida Kendall (IIB 32C3) 19C,000
Easter S als f S uth F1 rida Ilial ah (IIB 3013) 150,000
400B GRANTS AND AIDS TO LOCAL GOVERNMENTS AND
NONSTATE ENTITIES - FIXED CAPITAL OUTLAY
GRANTS AND AIDS - SENIOR CITIZEN CENTERS
FROM GENERAL REVENUE FUND
1,500,000
From the funds in Specific Appropriation 400B, the following projects
are funded from nonrecurring general revenue funds:
Southwest Social Services Program - Badia Senior
Center (HB 4361) 500,000
N rth Miami F undati n f r Scni r Citizens Services, Inc
(Senate F rm 1209) 1,000,000
94
CODING: Language ctrickcn has been vetoed by the Governor
Appropriations Project Request - Fiscal Year 2017-18
For projects meeting the Definition of House Rule 5.14
1. Title of Project: Southwest Social Services Programs, Inc. - Dr. Armando Badia Senior Center
2. Date of Submission: 02/07/2017
3. House Member Sponsor: Jose Diaz
Members Copied:
4. DETAILS OF AMOUNT REQUESTED:
a. Has funding been provided in a previous state budget for this activity? Yes
1f answer to 4a is ?NO? skip 4b and 4c and proceed to 4d
b. What is the most recent fiscal year the project was funded? 2016-17
c. Were the funds provided in the most recent fiscal year subsequently vetoed? No
d. Complete the following Project Request Worksheet to develop your request (Note that column E will be the total of Recurring funds requested and
Column F will be the total Nonrecurring funds requested, the sum of which is the Total of the Funds you are requesting in column G):
FY:
Input Prior Year Appropriation for this project
for FY 2016-17
(If appropriated in 2016-17 enter the
appropriated amount, even if vetoed.)
Develop New Funds Request
for FY 2017-18
(Requests for additional RECURRING funds are prohibited. Any additional
Nonrecurring funding requested to supplement recurring funds in the base will
result in the base recurring amount being converted to Nonrecurring .)
Column:
A
B
C
D
E
F
Funds
Description:
Prior Year
Recurring
Funds
Prior Year
Nonrecurring
Funds
Total Funds
Appropriated
(Recurring plus
Nonrecurring:
column A + column
B)
Recurring Base
Budget
(Will equal non-
vetoed amounts
provided in Column
A)
Additional
Nonrecurring
Request
TOTAL Nonrecurring Request
(Will equal the amount from the Recurring base in
Column D to be CONVERTED to Nonrecurring plus
the Additional Nonrecurring Request in Column E.
These funds will be appropriated non -recurring if
funded in the House Budget or the Final Conference
Report on the budget.)
Input
Amounts:
653,501
653,501
653,501
500,000
1,153,501
5. Are funds for this issue requested in a state agency?s Legislative Budget Request submitted for FY 2017-18? No
5a. If yes, which state agency?
Page 1 of 8
5b. If no, which is the most appropriate state agency to place an appropriation for the issue being requested? For example, if the requested issue pertains
to services provided to inmates at correctional facilities, the Department of Corrections would be the most appropriate state agency. Agency for Health
Care Administration
6. Requester:
a. Name: Angela Vazquez
b. Organization: Southwest Social Services Programs, Inc.
c. Email: swss@southwestsocial.org
d. Phone #: (305)261-5442
7. Contact for questions about specific technical or financial details about the project (Please retype if same as Requester):
a. Name: Angela Vazquez
b. Organization: Southwest Social Services Programs, Inc.
c. Email: swss@southwestsocial.org
d. Phone #: (305)261-5442
8. If there is a registered lobbyist, fill out the lobbyist information below.
a. Name: None
b. Firm: None
c. Email:
d. Phone #:
9. Organization or Name of Entity Receiving Funds(Please retype if same as Requestor or Contact):
a. Name: Southwest Social Services Programs, Inc.
b. County (County where funds are to be expended): Miami -Dade
c. Service Area (Counties being served by the service(s) provided with funding): Miami -Dade
10. What type of organization is the entity that will receive the funds? (Select one)
O For Profit
O Non Profit 501(c) (3)
O Non Profit 501(c) (4)
O Local Government
Page 2 of 8
O University or College
O Other (Please describe)
11. What is the specific purpose or goal that will be achieved by the funds being requested?
Build two additional classrooms and handicap accessible bathrooms for the Dr. Armando Badia Senior Center which is located at 25 Tamiami Blvd., Miami,
FL 33144. We serve a growing population of older adults. The average age is eighty years of age. They are low income Hispanic seniors. The Dr. Armando
Badia Senior Center was built in 1985 with local and state funding. We are out of space to offer additional services to these seniors.
12. Provide specific details on how funds will be spent. (Select all that apply)
Spending Category
Description
Nonrecurring
(Should equal 4d, Col. F)
Enter ?0? if request is zero for the
category
Administrative Costs:
■ a. Executive Director/Project Head Salary and Benefits
• b. Other Salary and Benefits
■c. Expense/Equipment/Travel/Supplies/Other
■ d. Consultants/Contracted Services/Study
Operational Costs:
■ e. Salaries and Benefits
Elf. Expenses/Equipment/Travel/Supplies/Other
Provides congregate meals, home
delivered meals, transportation
services, and recreation and
educational services
653,501
■ g. Consultants/Contracted Services/Study
Fixed Capital Construction/Major Renovation:
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Oh. Construction/Renovation/Land/Planning Engineering
The building of two classrooms,
men's and women's handicap
bathrooms attaching them to the Dr.
500,000
Armando Badia Senior Center.
TOTAL
1,153,501
13. For the Fixed Capital Costs requested with this issue, what type of ownership will the facility be under when complete? (In Question 12, if ?h.
Fixed Capital Outlay? was not selected, question 13 is not applicable)
OFor Profit
ONon Profit 501(c) (3)
ONon Profit 501(c) (4)
OLocal Government (e.g., police, fire or local government buildings, local roads, etc.)
OState agency owned facility (For example: college or university facility, buildings for public schools, roads in the state transportation system,
etc.)
()Other (Please describe): Will be built on City of Miami land (park).
14. Is the project request an information technology project?
No
15. Is there any documented show of support for the requested project in the community including public hearings, letters of support, major
organizational backing, or other expressions of support?
Yes
15a. Please Describe:
There are requests for additional programming/classes but the building does not have the capacity. The Alliance for Aging, Chamberlain
College of Nursing as well as public service organizations have offered services/programs that can only be accommodated if an ongoing
class is canceled due to a lack of space. The seniors would like exercise and dance classes for cardio benefits but we do not have the
capacity. The senior center serves 225-290 seniors on a daily basis.
16. Has the need for the funds been documented by a study, completed by an independent 3rd party, for the area to be served?
Yes
16a. Please Describe:
Page 4 of 8
APR #. 1015
The need is evident through requests and daily programming. There have been numerous requests for programming that we cannot
accommodate. The two rooms will enable us to meet these needs. The additional bathrooms are mandated by code.
17. Will the requested funds be used directly for services to citizens?
Yes
17a. Describe the target population to be served. Select all that apply to the target population:
Q EIderly persons
❑ Persons with poor mental health
Q Persons with poor physical health
❑ Jobless persons
Q Economically disadvantaged persons
❑ At -risk youth
❑ Homeless
❑ Developmentally disabled
Q Physically disabled
❑ Drug users (in health services)
❑ Preschool students
❑ Grade school students
❑ High school students
❑ University/college students
❑ Currently or formerly incarcerated persons
❑ Drug offenders (in criminal Justice)
❑ Victims of crime
❑ Other (Please describe)
17b. How many in the target population are expected to be served?
0< 25
025-50
051-100
0101-200
0201-400
0401-800
0>800
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18. What benefits or outcomes will be realized by the expenditure of funds requested? (Select all that applies)
Benefit or Outcome
Provide a specific measure of the benefit
or outcome
Describe the method for measuring level
of benefit
la mprove physical health
Dance and exercise classes will
improve cardiovascular health and
aid in weight loss. It also provides
mental and social benefits.
Client satisfaction surveys, before
and after measurements of weight
and cardio.
la mprove mental health
Lecture series on self improvement,
depression, isolation, exercise and
socialization.
Client satisfaction surveys as well as
before and after questionnaires.
IZEnrich cultural experience
Classes and lecture series which
include language, history and cultural
interaction.
Client satisfaction surveys as well as
before and after questionnaires.
• Improve agricultural production/promotion/education
• Improve quality of education
• Enhance/preserve/improve environmental or fish and
wildlife quality
IZJProtect the general public from harm (environmental,
criminal, etc.)
Lecture series including identity theft,
elder abuse, hurricane preparedness,
telephone scams, medicaid fraud,
etc.
Client satisfaction surveys as well as
before and after questionnaires
• Improve transportation conditions
• Increase or improve economic activity
• Increase tourism
•Create specific immediate job opportunities
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■ Enhance specific individual?s economic self sufficiency
■ Reduce recidivism
■ Reduce substance abuse
■ Divert from Criminal/Juvenile justice system
■ Improve wastewater management
■ Improve stormwater management
■ Improve groundwater quality
■ Improve drinking water quality
■ Improve surface water quality
■Other (Please describe):
19. Provide the total cost of the project for FY 2017-18 from all sources of funding (Enter ?0? if amount is zero):
Type of Funding
Amount
Percent of Total
(Automatically Calculates)
Are the other sources of
funds guaranteed in
writing?
1. Amount Requested from the State in this Appropriations
Project Request:
1,153,501
98.3%
N/A
2. Federal:
0
0.0%
No
3. State: (Excluding the requested Total Amount in #4d,
Column F)
0
0.0%
No
4. Local:
13,000
1.1 %
No
5. Other:
6,420
0.5%
Yes
TOTAL
1,172,921
100%
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20. Is this a multi -year project requiring funding from the state for more than one year?
No
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