HomeMy WebLinkAboutExhibitTHE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
GRANT CONTRACT
This Grant Contract ( the "Contract" or "Grant Agreement") is made and entered into as of this
day of , 20 , by and between Miami -Dade County, through the Miami -Dade County
Homeless Trust, a political subdivision of the State of Florida (the "County"), having its principal office at
111 N.W. 1st Street, 27th Floor, Miami, Florida 33128 and The City of Miami/FEIN #: 59-6000372, a
corporation organized and existing under the laws of the State of Florida, having its principal office at 444
SW 2nd Avenue, Miami, Florida 33130 ("Provider"), states conditions and covenants for the rendering of
human and social services ("Services") for the County.
WHEREAS the Provider provides or will develop social services of value to the County and has
demonstrated an ability or desire to provide these services; and
WHEREAS the County is authorized to subcontract for the provision of housing services and
supportive services for individuals and families who are homeless in Miami -Dade County; and
WHEREAS, the County has appropriated grant funding for the proposed housing and supportive
services; and
WHEREAS this Agreement provides for certain rights and responsibilities of the County; and
WHEREAS the Agreement provides for amendments at the discretion of the County;
NOW, THEREFORE, for and in consideration of the mutual covenants and agreements herein contained,
the parties hereto agree as follows:
ARTICLE 1. DEFINITIONS
The following words and expressions used in this Grant Agreement shall be construed as follows, except
when it is clear from the context that another meaning is intended:
a) The words "Agreement" "Contract" or "Contract Documents" shall mean collectively these terms
and conditions, the Scope of Services (Attachment A) and the Budget Documents (Attachment
B) and all other attachments hereto, as well as all amendments or budget revisions issued hereto.
b) The words "Contract Manager" shall mean Miami -Dade County's Director of the Homeless Trust
("County") or the Director's designee, or the duly authorized representative designated to manage
the Contract.
c) The word "Days" shall mean Calendar Days, unless otherwise specifically noted.
d) The word "Deliverables" shall mean all documentation and any items of any nature submitted by
the Provider to the County for review and approval pursuant to the terms of this Contract.
e) The words "directed", "required", "permitted", "ordered", "designated", "selected", "prescribed" or
words of like import to mean respectively, the direction, requirement, permission, order,
designation, selection or prescription of the County's Contract Manager; and similarly the words
"approved", acceptable", "satisfactory", "equal", "necessary", or words of like import to mean
respectively, approved by, or acceptable or satisfactory to, equal or necessary in the sole discretion
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
of the County's Contract Manager.
f) The words "Effective Term" shall mean the date on which this Contract is effective, including start
date and end date.
g) The words "Extra Work" or "Change Order" or "Additional Work" shall mean resulting in additions
or deletions or modifications to the amount, type or value of the Work and Services as required in
this Contract, as directed and/or approved by the County.
h) "HIPAA" means Health Insurance Portability and Accountability Act of 1996.
i) The words "Scope of Services" shall mean the document appended hereto as Attachment A-1,
which details the work to be performed by the Provider.
j)
The word "subcontractor" or "sub consultant" shall mean any person, entity, firm or corporation,
other than the employees of the Provider, who furnishes labor and/or materials, in connection with
the Work, whether directly or indirectly, on behalf and/or under the direction of the Provider and
whether or not in privities of contract with the Provider.
k) The words "Work", "Services" "Program", or "Project" shall mean all matters and things required to be
done by the Provider in accordance with the provisions of this Contract.
ARTICLE 2. AMOUNT PAYABLE. Subject to available funds, the maximum amount payable for
services rendered under this contract shall not exceed:
Memorandum of Agreement (MOA) Program $ 340,000.00
Total Funding Award $ 340,000.00
Both parties agree that should available County funding be reduced, the amount payable under this
Contract may be proportionately reduced at the sole discretion and option of the County. Availability of
funding shall be determined in the County's sole discretion.
All services undertaken by the Provider before the County's execution of this Contract shall be at the
Provider's risk and expense.
It is the responsibility of the Provider to maintain sufficient financial resources to meet the expenses
incurred during the period between the provision of services and payment by the County.
The County, at its sole discretion, may allow Provider an advance of up to two (2) months once the
Provider has submitted an appropriate request and submitted an invoice in the form required by the County.
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
ARTICLE 3. SCOPE OF SERVICES
A. Services. The Provider shall render services in accordance with Scope of Services incorporated
herein and attached hereto as Attachment A-1. The Provider shall implement the Scope of Services
as described in Attachment A-1 in a manner deemed satisfactory to the County. Any modification
or amendment to the Scope of Services shall not effective until approved by the County and
Provider in writing.
B. Reimbursement of COVID-19 Expenditures. The County is instructing Provider to undertake
protective measures to prevent or mitigate the spread of COVID-19 during the period in which
public officials advise that COVID-19 special measures should be taken. The County will reimburse
Provider for expenses incurred in taking such protective measures during such time period.
Allowable COVID-19 expenditures are set forth in Scope for COVID-19 Expenditures incorporated
herein and attached hereto as Attachment A-2. The County has sole discretion to determine if
expenditures were made for the purpose of preventing or mitigating the spread of COVID-19 and
incurred during the period in which public officials advise that COVID-19 special measures should
be taken. Total reimbursement for incurred COVID-19 costs under this Agreement shall not exceed
$ N/A without the County's prior written approval. Payment processes and documentation
requirements are set forth in Attachment A-2.
ARTICLE 4. BUDGET SUMMARY
The Provider agrees that all expenditures or costs shall be made in accordance with the Budget for
the provision of services in accordance with Attachment A, the "Scope of Services". The Budget is attached
hereto and incorporated herein as Attachment B.
The parties agree that the Provider may, with the County's prior written approval; revise the
schedule of payments or the line -item budget, and such revision shall not require an amendment to this
Contract.
Pursuant to Board of Miami -Dade County Commissioners Resolution 630-13, the Provider will submit a
detailed project budget, and sources and uses statement as Attachment B-1, which shall be sufficiently
detailed to show (i) the total project cost, (ii) the amount of funds to be used for administrative and overhead
costs, (iii) whether the County funds will be 'gap' funds meaning that they would be the last remaining
funds needed to ensure funding for the total project cost, (iv) any profit to be made by the Provider, and
(v) the amount of funds devoted toward the provision of the desired services or activities.
The County Mayor or Mayor's designee may make unannounced, on -site visits during normal working
hours to the Provider's headquarters and any location or site where the services contracted for under this
Agreement are performed.
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
ARTICLE 5. EFFECTIVE TERM
Both parties agree that the Effective Term of this Contract shall commence on October 1, 2022
and terminate at the close of business on September 30, 2023. Contingent on the existence of sufficient
funding, performance and the approval of the County, this Contract may be extended at the County's sole
discretion.
ARTICLE 6. INDEMNIFICATION BY PROVIDER
A. Government Entity. Government entity shall indemnify and hold harmless the County and
its officers, employees, agents and instrumentalities from any and all liability, losses or damages, including
attorneys' fees and costs of defense, which the County or its officers, employees, agents or
instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any
kind or nature arising out of, relating to or resulting from the performance of this Contract by the government
entity or its employees, agents, servants, partners, principals or subcontractors. Government entity shall
pay all claims and losses in connection therewith and shall investigate and defend all claims, suits or
actions of any kind or nature in the name of the County, where applicable, including appellate proceedings,
and shall pay all costs, judgments, and attorney's fees which may issue thereon. Provided, however, this
indemnification shall only be to the extent and within the limitations of Section 768.28, Fla. Stat.
B. All Other Providers. Provider shall indemnify and hold harmless the County and its
officers, employees, agents and instrumentalities from any and all liability, losses or damages, including
attorneys' fees and costs of defense, which the County or its officers, employees, agents or
instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any
kind or nature arising out of, relating to or resulting from the performance of this Contract by the Provider
or its employees, agents, servants, partners principals or subcontractors. Provider shall pay all claims and
losses in connection therewith and shall investigate and defend all claims, suits or actions of any kind or
nature in the name of the County, where applicable, including appellate proceedings, and shall pay all
costs, judgments, and attorney's fees which may issue thereon. Provider expressly understands and
agrees that any insurance protection required by this Contract or otherwise provided by Provider shall in
no way limit the responsibility to indemnify, keep and save harmless and defend the County or its officers,
employees, agents, and instrumentalities as herein provided.
C. Term of Indemnification. The provisions of Article 6 shall survive the expiration or
termination of this Contract.
ARTICLE 7. INSURANCE
If the total dollar value of all County contracts with the Provider exceeds $25,000 then the following
insurance coverage is required:
A. Government Entity. If the Provider is the State of Florida or an agency or political
subdivision of the State as defined by section 768.28, Florida Statutes, the Provider shall
furnish the County, upon request, written verification of liability protection in accordance
with section 768.28, Florida Statutes. Nothing herein shall be construed to extend any
party's liability beyond that provided in section 768.28, Florida Statutes. The provider shall
also furnish the County, upon request, written verification of Workers Compensation
protection in accordance with Florida Statutes, Chapter 440.
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
B. All Other Providers.
1. Minimum Insurance Requirements: Certificates of Insurance. The Provider shall
submit to Miami -Dade County, c/o Miami Dade County Homeless Trust (COUNTY), 111 N.W. 1st Street,
27th Floor, Miami, Florida 33128-1994, original Certificate(s) of Insurance indicating that insurance
coverage has been obtained which meets the requirements as outlined below:
A. All insurance certificates must list the County as "Certificate Holder" in the following manner:
Miami -Dade County
111 N.W. 1st Street, Suite 2340
Miami, Florida 33128
Worker's Compensation Insurance for all employees of the Provider as required by Florida
Statutes, Chapter 440.
C. Commercial General Liability Insurance in an amount not less than $300,000 combined
single limit per occurrence for bodily injury and property damage. Miami -Dade County must
be shown as an additional insured with respect to this coverage.
D. Automobile Liability Insurance covering all owned, non -owned, and hired vehicles used in
connection with the Work provided under this Contract, in an amount not less than
$300,000* combined single limit per occurrence for bodily injury and property damage.
*NOTE: For Providers supplying vans or minibuses with seating capacities of fifteen (15)
passengers or more, the limit of liability required for Auto Liability is $500,000.
E. Professional Liability Insurance in the name of the Provider, when applicable, in an amount
not less than $250,000.
F. All insurance policies required above shall be issued by companies authorized to do
business under the laws of the State of Florida, with the following qualifications:
1. The company must be rated no less than "B" as to management, and no less than
"Class V" as to financial strength, according to the latest edition of Best's Insurance
Guide published by A.M. Best Company, Oldwick, New Jersey, or its equivalent,
subject to the approval of the County's Risk Management Division.
OR
2. The company must hold a valid Florida Certificate of Authority as shown in the latest
"List of All Insurance Companies Authorized or Approved to Do Business in Florida,"
issued by the State of Florida Department of Insurance and must be a member of
the Florida Guaranty Fund.
G. Certificates will indicate that no modification or change in insurance shall be made without
thirty (30) days advance written notice to the Certificate Holder.
H. Compliance with the foregoing requirements shall not relieve the Provider of its liability and
obligations under this Section or under any other section of this Contract.
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
. The County reserves the right to inspect the Provider's original insurance policies at any
time during the term of this Contract.
J. Applicability of this Article to Providers whose combined total award for all services funded
under this Contract exceeds a $25,000 threshold. In the event that the Provider whose
original total combined award in less than $25,000 but receives additional funding during
the contract period which makes the total combined award exceed $25,000, then the
requirements in this Article shall apply.
Failure to Provide Certificates of Insurance. The Contractor shall be responsible for
assuring that the insurance certificates required in conjunction with this Section remain in
force for the duration of the effective term of this Contract. If insurance certificates are
scheduled to expire during the effective term, the Provider shall be responsible for
submitting new or renewed insurance certificates to the County prior to expiration.
In the event that expired certificates are not replaced with new or renewed certificates which
cover the effective term, the County may suspend the Contract until such time as the new
or renewed certificates are received by the County in the manner prescribed herein;
provided, however, that this suspended period does not exceed thirty (30) calendar days.
Thereafter, the County may, at its sole discretion, terminate this Contract.
ARTICLE 8. PROOF OF LICENSURE/CERTIFICATION AND BACKGROUND SCREENING
A. Licensure. If the Provider is required by the State of Florida or Miami -Dade County or any federal,
state, or local law or regulation to be licensed or certified to provide the services or operate the facilities
outlined in the Scope of Services (Attachment A), the Provider shall furnish to the County a copy of all
required current licenses or certificates. Examples of services or operations requiring such licensure or
certification include but are not limited to childcare, day care, nursing homes, and boarding homes.
If the Provider fails to furnish the County with the licenses or certificates required under this Section,
the County shall not disburse any funds until it is provided with such licenses or certificates. Failure to
provide the licenses or certificates within sixty (60) days of execution of this Agreement may result in
termination of this Agreement at the County's discretion.
B. Background Screening. The Provider agrees to comply with all applicable federal, state,
and local laws, regulations, ordinances, and resolutions regarding background screening of employees,
volunteers, and subcontractors. Provider's failure to comply with any applicable laws, regulations,
ordinances, and resolutions regarding background screening of employees, volunteers and subcontractors
is grounds for a material breach and termination of this contract at the sole discretion of the County.
The Provider agrees to comply with all applicable laws (including but not limited to Chapters 39,
402, 409, 394, 408, 393, 397, 984, 985 and 435, Florida Statutes, as may be amended form time to time),
regulations, ordinances and resolutions, regarding background screening of those who may work or
volunteer with vulnerable persons, as defined by section 435.02, Florida Statutes, as may be amended
from time to time.
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
In the event criminal background screening is required by law, the State of Florida and/or the
County, the Provider will permit only employees and subcontractors with a satisfactory national criminal
background check through an appropriate screening agency (i.e., the Florida Department of Juvenile
Justice, Florida Department of Law Enforcement or Federal Bureau of Investigation) to work or volunteer
in direct contact with vulnerable persons.
The Provider agrees to ensure that employees, volunteers, and subcontracted personnel who work
with vulnerable persons satisfactorily complete and pass Level 2 background screening before working or
volunteering with vulnerable persons. Provider shall furnish the County with proof that employees,
volunteers, and subcontracted personnel, who work with vulnerable persons, satisfactorily passed Level 2
background screening, pursuant to Chapter 435, Florida Statutes, as may be amended from time to time.
If the Provider fails to furnish to the County proof that an employee, volunteer, or subcontractor's
Level 2 background screening was satisfactorily passed and completed prior to that employee or
subcontractor working or volunteering with a vulnerable person or vulnerable persons, the County shall
not disburse any further funds and this Contract may be subject to termination at the sole discretion of the
County.
ARTICLE 9. CONFLICT OF INTEREST
A. The Provider agrees to abide by and be governed by Miami -Dade County Ordinance No. 72-
82 (Conflict of Interest Ordinance codified at Section 2-11.1 et al. of the Code of Miami -Dade County), as
amended, which is incorporated herein by reference as if fully set forth herein, in connection with its
contract obligations hereunder.
B. No person under the employ of the County, who exercises any function or
responsibilities in connection with this Contract, has at the time this Contract is entered into, or shall have
during the term of this Contract, any personal financial interest, direct or indirect, in this Contract.
C. Nepotism. Notwithstanding the aforementioned provision, no relative of any officer,
board of director, manager, or supervisor employed by the Provider shall be employed by the Provider
unless the employment preceded the execution of this Contract by one (1) year. No family member of any
employee may be employed by the Provider if the family member is to be employed in a direct supervisory
or administrative relationship either supervisory or subordinate to the employee. The assignment of family
members in the same organizational unit shall be discouraged. A conflict of interest in employment arises
whenever an individual would otherwise have the responsibility to make, or participate actively in making
decisions or recommendations relating to the employment status of another individual if the two individuals
(herein sometimes called "related individuals") have one of the following relationships:
1. By blood or adoption: Parent, child, sibling, first cousin, uncle, aunt, nephew, or niece.
2. By marriage: Current or former spouse, brother- or sister-in-law, father- or mother-in-law,
son- or daughter-in-law, stepparent, or stepchild; or
3. Other relationship: A current or former relationship, occurring outside the work setting that
would make it difficult for the individual with the responsibility to make a decision or
recommendation to be objective, or that would create the appearance that such individual could
not be objective. Examples include, but are not limited to, personal relationships and significant
business relationships.
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
For purposes of this section, decisions or recommendations related to employment status
include decisions related to hiring, salary, working conditions, working responsibilities,
evaluation, promotion, and termination.
An individual, however, is not deemed to make or actively participate in making decisions or
recommendations if that individual's participation is limited to routine approvals and the
individual plays no role involving the exercise of any discretion in the decision -making
processes. If any question arises whether an individual's participation is greater than is
permitted by this paragraph, the matter shall be immediately referred to the Miami -Dade County
Commission on Ethics and Public Trust.
This section applies to both full-time and part-time employees and voting members of the
Provider's Board of Directors.
D. No person, including but not limited to any officer, board of directors, manager, or supervisor
employed by the Provider, who is in the position of authority, and who exercises any function or
responsibilities in connection with this Contract, has at the time this Contract is entered into, or shall have
during the term of this Contract, received any of the services, or direct or instruct any employee under their
supervision to provide such services as described in the Contract. Notwithstanding the before mentioned
provision, any officer, board of directors, manager or supervisor employed by the Provider, who is eligible
to receive any of the services described herein may utilize such services if he or she can demonstrate that
he or she does not have direct supervisory responsibility over the Provider's employee(s) or service
program. Staff members, or their immediate family members (spouse, children, siblings, mother, or father)
of Homeless Trust funded programs, who are eligible for and wish to receive services from a Homeless
Trust funded program must receive the approval of the Executive Director of their employer (i.e., the
Provider) prior to applying for and receiving those services. This approval must be in writing and
accompany any referral for such services. Any Provider knowingly accepting a referral of an employee of
a Homeless Trust funded program and providing services without the written approval of the Executive
Director of the Provider, will be subject to the recoupment/disallowance by the County of any funds paid
for services to this individual and/or their immediate family member. When the services are to be provided
at the same agency the employee works for, this information must be disclosed in writing to the director of
the Homeless Trust, which shall be reviewed for eligibility determination and a sign off must come from the
County. This provision does not apply to staff members seeking emergency shelter, medical or legal
services. Providers must complete a Client Services Authorization Form (Attachment P) for staff members
seeking services.
ARTICLE 10. CIVIL RIGHTS
The Provider agrees to abide by Chapter 11A of the Code of Miami -Dade County ("County Code"),
as amended, which prohibits discrimination in employment, housing and public accommodations on the
basis of race, creed, religion, color, sex, familial status, marital status, sexual orientation, pregnancy, age,
ancestry, national origin or handicap; Title VII of the Civil Rights Act of 1968, as amended, which prohibits
discrimination in employment and public accommodation; the Age Discrimination Act of 1975, 42 U.S.C.
§6101, as amended, which prohibits discrimination in employment because of age; the Rehabilitation Act
of 1973, 29 U.S.C. §794, as amended, which prohibits discrimination on the basis of disability; the
Americans with Disabilities Act, 42 U.S.C. §12101 et seq., which prohibits discrimination in employment
and public accommodations because of disability; the Federal Transit Act, 49 U.S.C. §1612, as amended;
and the Fair Housing Act, 42 U.S.C. §3601 et seq. It is expressly understood that the Provider must submit
an affidavit attesting that it is not in violation of the Acts. If the Provider or any owner, subsidiary, or other
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
firm affiliated with or related to the Provider is found by the responsible enforcement agency, the Courts,
or the County to be in violation of these acts, the County will conduct no further business with the Provider.
Any contract entered into based upon a false affidavit shall be voidable by the County. If the Provider
violates any of the Acts during the term of any contract the Provider has with the County, such contract
shall be voidable by the County, even if the Provider was not in violation at the time it submitted its affidavit.
The Provider agrees that it is in compliance with the Domestic Violence Leave, codified as § 11A-60 et
seq. of the Miami -Dade County Code, which requires an employer, who in the regular course of business
has fifty (50) or more employees working in Miami -Dade County for each working day during each of twenty
(20) or more calendar work weeks to provide domestic violence leave to its employees.
Failure to comply with this local law may be grounds for voiding or terminating this Contract or for
commencement of debarment proceedings against Provider.
ARTICLE 11. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT.
Any person or entity that performs or assists Miami -Dade County with a function or activity involving the
use or disclosure of "individually identifiable health information (IIHI)" and/or "Protected Health Information
(PHI)" shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Miami -
Dade County Privacy Standards Administrative Order. HIPAA mandates for privacy, security, and electronic
transfer standards, include but are not limited to:
1. Use of information only for performing services required by the contract or as required by law.
2. Use of appropriate safeguards to prevent non -permitted disclosures.
3. Reporting to Miami -Dade County of any non -permitted use or disclosure.
4. Assurances that any agents and subcontractors agree to the same restrictions and conditions that apply to
the Provider and reasonable assurances that IIHI/PHI will be held confidential.
5. Making Protected Health Information (PHI) available to the customer.
6. Making PHI available to the client for review.
7. Making PHI available to Miami -Dade County for an accounting of disclosures; and
8. Making internal practices, books, and records related to PHI available to Miami -Dade County for compliance
audits.
PHI shall maintain its protected status regardless of the form and method of transmission (paper records
and/or electronic transfer of data). The Provider must give its clients written notice of its privacy information practices,
including specifically, a description of the types of uses and disclosures that would be made with protected health
information. Provider must post, and distribute upon request to service recipients, a copy of the County's Notice of
Privacy Practices.
ARTICLE 12. NOTICE REQUIREMENTS
Notice under this Contract shall be sufficient if made in writing, delivered personally, or sent via U.S. mail,
electronic mail, facsimile, or certified mail with return receipt requested and postage prepaid, to the parties at the
following addresses (or to such other party and at such other address as a party may specify by notice to others) and
as further specified within this Contract. If notice is sent via electronic mail or facsimile, confirmation of the
correspondence being sent will be maintained in the sender's files.
If to the COUNTY:
Miami -Dade County
Homeless Trust 111 N.W. 1st Street, 27th Floor
Miami, Florida 33128
Attention: Victoria Mallette, Executive Director
Electronic mail: VMallette@miamidade.gov
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If to the PROVIDER:
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
Mr. Arthur Noriega
City Manager
The City of Miami
444 SW 2nd Avenue
Miami, Florida 33130
Electronic mail: anoriega@miamigov.com
Either party may at any time designate a different address and/or contact person by giving written notice
as provided above to the other party. Such notices shall be deemed given upon receipt by the addressee.
ARTICLE 13. AUTONOMY
Both parties agree that this Contract recognizes the autonomy of the contracting parties and implies
no affiliation between the contracting parties. It is expressly understood and intended that the Provider is
only a recipient of funding support and is not an agent or instrumentality of the County. Furthermore, the
Provider's agents and employees are not agents or employees of the County.
ARTICLE 14. SURVIVAL
The parties acknowledge that any of the obligations in this Contract, including but not limited to
Provider's obligation to indemnify the County, will survive the term, termination, and cancellation hereof.
Accordingly, the respective obligations of the Provider under this Contract, which by nature would continue
beyond the termination, cancellation, or expiration thereof, shall survive termination, cancellation, or
expiration hereof.
ARTICLE 15. BREACH OF CONTRACT: COUNTY REMEDIES
A. Breach. A breach by the Provider shall have occurred under this Contract if: (1) the
Provider fails to provide the services outlined in the Scope of Services (Attachment A) within the effective
term of this Contract; (2) the Provider ineffectively or improperly uses the County funds allocated under
this Contract; (3) the Provider does not furnish the Certificates of Insurance required by this Contract or as
determined by the County's Risk Management Division; (4) if applicable, the Provider does not furnish
upon request by the County proof of licensure/certification or proof of background screening required by
this Contract; (5) the Provider fails to submit, or submits incorrect or incomplete, proof of expenditures to
support disbursement requests or advance funding disbursements or fails to submit or submits incomplete
or incorrect detailed reports of expenditures or final expenditure reports; (6) the Provider does not submit
or submits incomplete or incorrect required reports; (7) the Provider refuses to allow the County access
to records or refuses to allow the County to monitor, evaluate and review the Provider's program; (8) the
Provider discriminates under any of the laws outlined in Article 10 of this Contract; (9) the Provider,
attempts to meet its obligations under this Contract through fraud, misrepresentation, or material
misstatement; (10) the Provider fails to correct deficiencies found during a monitoring, evaluation, or
review within the specified time as described and defined in its Performance Improvement Plan (PIP); (11)
the Provider fails to issue prompt payments to small business subcontractors or follow dispute resolution
procedures regarding a disputed payment; (12) the Provider fails to submit the Certificate of Corporate
Status, Board of Directors requirement, or proof of tax status; or (13) the Provider fails to fulfill in a timely
and proper manner any and all of its obligations, covenants, agreements, and stipulations in this Contract;
(14) the Provider fails to meet any of the terms and conditions of the Miami -Dade County Affidavits
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THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
(Attachment C) and the State Affidavits (Attachment D) ❑ Applicable ❑X Not Applicable or (15)
the Provider fails to fulfill in a timely and proper manner any or all of its obligations, covenants, agreements
and stipulations in this Contract. Waiver of breach of any provisions of this Contract shall not be deemed
to be a waiver of any other breach and shall not be construed to be a modification of the terms of this
Contract.
In the event that the County determines certain Contract goals (as defined in the Scope of Services) are
not being met then the County, in its sole discretion may place the Provider on a Performance Improvement
Plan (PIP). The following is a delineation of some instances where a PIP may be required:
a. HMIS- Based on Provider's past performance on prior contracts in the area of Homeless
Management Information System compliance it is subject to a PIP during this contract
term. The Provider is required to submit a Monthly Progress Report and an HMIS-
generated Monthly Progress Report for each month of the contract. Compliance will be
determined when it is deemed that the two (2) reports are in substantial conformity with
each other for a period of two consecutive months. (Substantial conformity as meaning
a minimum of 95% accuracy on all elements). At the time of compliance, the Provider
shall only be required to submit the HMIS-generated Monthly Progress Report.
❑ Applicable ❑X Not Applicable
b. Utilization — Based on Provider's past performance on prior contracts in the area of
utilization compliance, this contract is subject to a PIP. During this contract term, the
Provider must submit all invoices in a timely manner. The Provider shall invoice at a rate
of 95% of targeted expenditures for the invoicing period. If the Provider fails to comply,
all rights to payments will be forfeited if the County so chooses. Failure to submit
accurate invoices for appropriately documented and eligible expenditures at a rate of
95% of targeted expenditures by the end of the third quarter of this contract term may
result in the termination of this contract by the County.
❑ Applicable 0 Not Applicable
c. Program Performance — Based on Provider's past performance on prior contracts in
the area of program goals and outcome objectives, this Contract is subject to a PIP.
During this Contract term, the Provider must achieve those goals specified in the
Contract. Performance against these annual goals shall be evaluated on a quarterly
basis, and if by the end of the third quarter of the contract period substantial compliance
(meeting the targeted goals) is not achieved, it may result in the termination of this
contract with the County.
❑ Applicable 0 Not Applicable
The above is subject to the review and approval of the County
B. County Remedies. If the Provider breaches this Contract, the County may pursue any or
all of the following remedies:
1. The County may terminate this Contract by giving written notice to the Provider of
such termination and specifying the effective date thereof. In the event of termination, the County may:
(a) request the return of finished or unfinished documents, data studies, surveys, drawings, maps, models,
photographs, reports prepared and secured by the Provider with County funds under this Contract; (b)
seek reimbursement of County funds allocated to the Provider under this Contract; (c) terminate or cancel
any other contracts entered into between the County and the Provider. The Provider shall be responsible
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for all direct and indirect costs associated with such termination, including attorney's fees.
2. The County may suspend payment in whole or in part under this Contract by
providing written notice to the Provider of such suspension and specifying the effective date thereof. If
payments are suspended, the County shall specify in writing the actions that must be taken by the Provider
as condition precedent to resumption of payments and shall specify a reasonable date for compliance.
The County may also suspend any payments in whole or in part under any other contracts entered into
between the County and the Provider. The Provider shall be responsible for all direct and indirect costs
associated with such suspension, including attorney's fees.
3. The County may seek enforcement of this Contract including but not limited to filing
an action in a court of appropriate jurisdiction. The Provider shall be responsible for all direct and indirect
costs associated with such enforcement, including attorney's fees.
4. The County may debar the Provider from future County contracting.
5. If, for any reason, the Provider should attempt to meet its obligations under this
Contract through fraud, misrepresentation or material misstatement, the County shall, whenever
practicable terminate this Contract by giving written notice to the Provider of such termination and
specifying the effective date. The County may terminate or cancel any other contracts which such
individual or entity has with the County. Such individual or entity shall be responsible for all direct and
indirect costs associated with such termination or cancellation, including attorney's fees. Any individual or
entity who attempts to meet its contractual obligations with the County through fraud, misrepresentation,
or material misstatement may be debarred from county contracting for up to five (5) years.
6. Any other remedy available at law or equity.
C. Authorization to Terminate Contract. The Mayor or the Mayor's designee is authorized
to terminate this Contract on behalf of the County.
D. Failures or waivers to insist on strict performance of any covenant, condition, or provision
of this Contract by the County shall not be deemed a waiver of any rights or remedies, nor shall it relieve
the Provider from performing any subsequent obligations strictly in accordance with the term of this
Contract. No waiver shall be effective unless in writing and signed by the parties. Such waiver shall be
limited to provisions of this Contract specifically referred to therein and shall not be deemed a waiver of
any other provision. No waiver shall constitute a continuing waiver unless the writing states otherwise.
E. Damages Sustained. Notwithstanding the above, the Provider shall not be relieved of
liability to the County for damages sustained by the County by virtue of any breach of the Contract, and
the County may withhold any payments to the Provider until such time as the exact amount of damages
due the County is determined. The County may also pursue any remedies available at law or equity to
compensate for any damages sustained by the breach. The Provider shall be responsible for all direct and
indirect costs associated with such action, including attorney's fees.
ARTICLE 16. TERMINATION
I. For Convenience. The County may terminate this Contract, in whole or part, when both
parties agree that the continuation of the activities would not produce beneficial results commensurate
with further expenditure of the funds. Both parties shall agree upon the termination conditions, including
the effective date and in the case of partial termination, the portion to be terminated. However, if the
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County determines in the case of partial termination that the reduced or modified portion of the grant will
not accomplish the purposes for which the grant was made it may terminate the grant in its entirety.
II. At Will. This Contract may be terminated by the County upon no less than ten (10)
working days' notice when the County determines, in the sole and absolute discretion of the County, that
it would be in the best interest of the County. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery.
III. Due to Lack of Funds. In the event of a funding short -fall, or a reduction in the funding
appropriations, or should funds to finance this Contract become unavailable, the County may terminate,
in its sole discretion and absolute authority, this Contract upon no less than twenty-four (24) hours written
notification to the Provider. Said notice shall be delivered by certified mail, return receipt requested, or in
person with proof of delivery. The County shall be the final authority to determine whether or not funds
are available. The County may at its discretion terminate, renegotiate and/or adjust the Contract award,
whichever is in the best interest of the County.
IV. Due to Substantial Funding Reduction. In the event of a substantial funding reduction
of the allocation to the Provider through Board of County Commissioners' (BCC) action, the Provider
may, at its discretion, request in writing from the Director of the Department a release from its contractual
obligations to the County. The Director of the Department will review the effect of the request on the
community and the County prior to making a final determination.
VI. Bankruptcy. If, during the term of any contract the Provider has with the County, the
Provider becomes involved as a debtor in a bankruptcy proceeding, or becomes involved in a
reorganization, dissolution, or liquidation proceeding or if a trustee or receiver is appointed over all or a
substantial portion of the property of the Provider under federal bankruptcy law or any state insolvency
law.
The Provider understands and acknowledges that if the County determines in its sole discretion
that termination of the Contract is necessary for the health, safety, or welfare of the County or its residents
then it may do so upon twenty-four (24) hours' notice to the Provider.
This Contract is subject to the ratification and approval by the Miami -Dade County Board of County
Commissioners and shall be void unless approved by the Board of County Commissioners.
ARTICLE 17. PAYMENT PROCEDURES
The County agrees to pay the Provider, on a reimbursement basis, for services rendered under
this Contract based on the payment schedule, timely provision by the Provider of required reports and of
supporting documentation of expenses and activities as described in this Contract, and the line -item budget
(Attachment B). Payment shall be made in accordance with procedures outlined below and if applicable,
the Sherman S. Winn Prompt Payment Ordinance (Ordinance 94-40).
1. How payment will be made. Payment requests shall be made to the County on a monthly
basis and shall be signed by the Executive Director and the Financial Officer of the Provider,
unless otherwise approved in writing, on the form incorporated herein as Attachment E
"Primary Care Invoice for Services". The payment request for the previous month is due
by the 10th of the month following the month for which payment is invoiced.
2. Any reimbursement may be withheld pending the receipt and approval by the County of all
reports and documents required herein.
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3. The parties agree that this is a cost reimbursement Agreement, and the Provider will
receive reimbursement for service provision based on actual costs incurred for the operating
month. The Provider must submit the applicable invoice forms and supporting documentation
as required.
4. Maximum monthly reimbursements are limited to actual amounts as stipulated above for each
month, unless the Provider has obtained prior, written consent from the County to modify the
Budget.
5. As applicable, during the period of N/A through N/A , the Provider will submit a record of
those individuals served utilizing Social Security Administration repayments as specified in
the Scope of Services. The Provider will utilize these funds to serve those clients as specified
and authorized in the Scope of Services
6. N/A Providers with cumulative utilization rates greater than ninety percent (90%) during the
first nine (9) months of this Contract may exceed this maximum number of billable bed days
during the last quarter of the Contract term, up to the total Contract award amount, with the
prior approval of the Executive Director of the Homeless Trust.
7. N/A Providers with cumulative utilization rates lower than ninety percent (90%) may be
subject to a reduction in funding and beds, if deemed necessary by the Miami -Dade County
Homeless Trust. Beds and funding may be reprogrammed as necessary and needed within
the Continuum of Care. The Miami -Dade County Homeless Trust will conduct a review of the
utilization of beds within the first six (6) months of the contract period.
8. Within thirty (30) days of the termination or expiration of this Contract, a final report of
expenditures shall be submitted to the County. If after the receipt of such final report, the
County determined that the Provider has been paid funds not in compliance with the Contract,
and to which it is not entitled, the Provider will be required to return such funds to the County
or submit documentation demonstrating that the expenditure was in compliance with this
Contract. The County shall have the sole and absolute discretion to determine if the Provider
is entitled to such funds and the County's decision in this matter shall be final and binding.
B. Monies Owed to the County: The County reserves the right, in its sole discretion,
to reduce payments to the Provider in order to recapture any monies owed to the County. In accordance
with County Administrative Order No. 3-29, the Provider that is in arrears to the County is prohibited from
obtaining new County contracts or extensions of contracts until such time as the arrearage has been paid
in full or the County has agreed in writing to an approved payment plan.
This is a cost -based Contract in which the Provider shall be paid through reimbursement payment based
on the budget approved under this Contract and when documentation of completed and satisfactory
service delivery is provided. Thus, it is imperative that the Provider maintain appropriate supporting
documentation for all expenditures from the beginning of the Contract term (i.e., receipts, bank statements,
cancelled checks, employee timesheet, etc.).
The Provider shall submit to the Contract Manager, the Monthly Reimbursement form provided by the
County on a monthly basis. Monthly reimbursement requests (both retroactive and current) and
accompanying supporting documentation must be received by the County no later than the 15th of the
month following the month for which reimbursement is requested.
C. No Payment of Subcontractors. In no event shall County funds be advanced or paid by
the County directly to any subcontractor hereunder. Payment to approved subcontractors shall be made
by the Provider following requirements and limitations as detailed in Article 21 of this Contract.
D. Processing the Request for Payment. After the County staff reviews the payment
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request, the County will submit a payment request to the County's Finance Department. The County's
Finance Department will issue payment via Automated Clearing House (ACH) or mail the check directly to
the Provider at the address listed in Article 12 of this Contract, unless otherwise directed by the Provider
in writing. The parties agree that the processing of a payment request from date of submission by the
Provider shall take a maximum of thirty (30) days from receipt of a complete and accurate payment request,
pursuant to the County's Sherman S. Winn Prompt Payment Ordinance (Ordinance 94-40), Section 2-
8.1.4 of the Code of Miami -Dade County, Administrative Order No. 3-19, and the Florida Prompt Payment
Act, if supporting documentation/invoices are properly documented as determined by the County in its sole
discretion. It is the responsibility of the Provider to maintain sufficient financial resources to meet the
expenses incurred during the period between the provision of services and payment by the County.
E. Reporting Requirements. Failure to submit to the County the reports listed below in a
manner deemed correct and acceptable by the County by the 15th day after the end of the month in which
the service was delivered, or failure to submit to the County supporting documentation of Contract
expenditures or activities within fourteen (14) days of any County request, shall be considered a breach of
this Contract and may result in withholding payment, non-payment, or termination of this Contract.
Applicable as indicated
1. Monthly Payment Requests/Invoice for Services (Attachment E)
2. Monthly Payment Request (Attachment F) ❑
3. Monthly Performance Reports (Attachment G)
4. Outcome Performance Measurements Monthly Report (Attachment H) ❑
5. Client Contribution Report (Attachment I) ❑
6. Client Attendance Roster (Attachment J) ❑
7. Quarterly Vacancy / Permanent Housing Placement Report (Attachment K) ❑
Performance Reports. The Provider agrees to participate in the Homeless Management
Information System (HMIS) selected and established by the County. Participation will include,
but is not limited to, input of client data upon intake, daily updates of bed availability information,
as well as updates of client files upon client contact, and maintaining current data for statistical
purposes. The Provider understands that they are responsible for any ongoing cost to access
the HMIS system. The Provider shall furnish the County with Monthly, Quarterly, and Annual
Performance Reports in accordance with the activities and goals detailed in the Scope of
Services. The reports shall explain the Provider's progress for the quarter. The data should be
quantified when appropriate. The final progress report shall be due no later than thirty (30)
days after the expiration or termination of this Contract. Continuation of this Contract and
funding is contingent upon meeting established performance goals. Progress reports,
produced through the Homeless Management Information System (HMIS) invoices for services
and client attendance rosters signed by the Executive Director of the agency shall by submitted
by the Provider, as required.
F. Final Report/Recapture of Funds. Upon the expiration or termination of this Contract, the
Provider shall submit the final Annual Performance Report and Annual Actual Expenditure Report
(Attachment L) to the County no later than thirty (30) days after the expiration or termination of this
Contract. If after receipt of such final reports, the County determines that the Provider has been paid funds
not in accordance with the Contract, and to which it is not entitled, the Provider shall return such funds to
the County, or the County may reduce, by the amount of such funds, from any subsequent payment to
which the Provider is entitled, or the Provider may submit appropriate documentation within seven (7) days
of notice from the County. The County shall have the sole discretion in determining if the Provider is
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entitled to such funds and the County's decision on this matter shall be final and binding. Additionally, any
unexpended or unallocated funds shall be recaptured by the County.
Additionally, the Provider agrees to assign any proceeds to the County from any contract, including this
Contract, between the County, its agencies or instrumentalities and the Provider or any firm, corporation,
partnership or joint venture in which the Provider has a controlling financial interest in order to secure
repayment of any reimbursements for services provided under this or any other contract for which the
County discovers was not reimbursable through its inspection, review and/or audit pursuant to this
Contract.
ARTICLE 18. PROHIBITED USE OF FUNDS
A. Adverse Actions or Proceeding. The Provider shall not utilize County funds to retain legal
counsel for any action or proceeding against the County or any of its agents, instrumentalities, employees,
or officials. The Provider shall not utilize County funds to provide legal representation, advice, or counsel
to any client in any action or proceeding against the County or any of its agents, instrumentalities,
employees, or officials.
B. Religious Purposes. County funds shall not be used for religious purposes.
C. Commingling Funds. The Provider shall not commingle funds provided under this
Contract with funds received from any other funding sources. The Provider shall establish a separate
account exclusively for receipt of the funds received pursuant to this Contract.
D. Double Payments. Provider costs claimed under this Contract may not also be
claimed under another contract or grant from the County or any other agency. Any claim for double
payment by Provider shall be considered a material breach of this Contract.
ARTICLE 19. REQUIRED DOCUMENTS, RECORDS, REPORTS, AUDITS, MONITORING AND
REVIEW
A. Certificate of Corporate Status. The Provider must submit to the Contract Manager,
within thirty (30) days from the date of execution of this Contract, a certificate of corporate status in the
name of the Provider, which certifies the following: that the Provider is organized under the laws of the
State of Florida; that all fees and penalties have been paid; that the Providers most recent annual report
has been filed; that its status is active; and that the Provider has not filed Articles of Dissolution.
B. Board of Director Requirements. The Provider shall ensure that the Provider's Board of
Directors is apprised of the programmatic, fiscal, and administrative obligations under this Contract funded
through County Funds by passage of a formal resolution authorizing execution of this Contract with the
County. A copy of this corporate resolution must be submitted to the County prior to contract execution.
A current list of the Provider's Board of Directors and officers must be included with the submission. The
Provider acknowledges and understands that all contract documents shall be signed by either the
Provider's President or Vice President. The Provider's resolution shall at a minimum: list the name(s) of
the Board's President, Vice President and, only in the event that the President or Vice President is not
available to execute the contract documents, any other persons authorized to execute this Contract on
behalf of the Provider; affirmatively state that a quorum was present at the time of adoption of the
resolution; and reference the service categories and dollar amounts in the award, as may be amended.
C. Proof of Tax Status. The Provider is required to submit to the County the following
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documentation: (a) W-9 Form (Attachment M); (b) The I.R.S. tax exempt status determination letter; (c)
the most recent I.R.S. form 990; (d) the annual submission of I.R.S. form 990 within (6) months after the
Provider's fiscal year end; (e) IRS form 941 - Quarterly Federal Tax Return Reports within thirty-five (35)
days after the quarter ends and if the form 941 reflects a tax liability, proof of payment must be submitted
within forty-five (45) days after the quarter ends.
D. Conflicts of Interest. Section 2-11.1(d) of Miami -Dade County Code as amended,
requires any County employee or any member of the employee's immediate family who has a controlling
financial interest, direct or indirect, with Miami -Dade County or any person or agency acting for Miami -
Dade County competing or applying for any such contract as it pertains to this solicitation, to first request
a conflict of interest opinion from the County's Ethic Commission prior to their or their immediate family
member's entering into any contract or transacting any business through a firm, corporation, partnership
or business entity in which the employee or any member of the employee's immediate family has a
controlling financial interest, direct or indirect, with Miami -Dade County or any person or agency acting for
Miami -Dade County. Further, any such contract, agreement or business engagement entered in violation
of this subsection, as amended, shall render this Contract voidable.
E. Accounting Records. The Provider shall keep accounting records which conform to
generally accepted accounting principles. All such records will be retained by the Provider for no less than
three (3) years beyond the term of this Contract and shall be made available for review upon request from
County authorized personnel.
F. Financial Audit. If the Provider has or is required to have an annual certified public
accountant's opinion and related financial statements, the Provider agrees to provide these documents to
the County no later than one hundred eighty (180) days following the end of the Provider's fiscal year, for
each year during which this Contract remains in force or until all funds received pursuant to this Contract
have been so audited, whichever is later.
G. Access to Records: Audit. The County reserves the right to require the Provider to submit
to an audit by an auditor of the County's choosing or approval. The Provider shall provide access to all its
records which relate to this Contract at its place of business during regular business hours. The Provider
agrees to provide such assistance as may be necessary to facilitate their review or audit by the County to
ensure compliance with applicable accounting and financial standards.
H. Quarterly Reviews of Expenditures and Records. The County Commission Auditor may
perform quarterly reviews of Provider's expenditures and records. Subsequent payments to the Provider
shall be subject to a satisfactory review of Provider's records and expenditures by the County Commission
Auditor, including but not limited to, review of supporting documentation for expenditures and the existence
of sufficient documentation to support eligible expenditures. The Provider agrees to reimburse the County
for ineligible expenditures as determined by the County Commission Auditor.
Quality Assurance / Recordkeeping. The Provider shall maintain and shall require that
the Provider's subcontractors and suppliers maintain, complete and accurate program and fiscal records
to substantiate compliance with the requirements set forth in the Attachment A, Scope of Services, of this
Contract. The Provider and its subcontractors and suppliers shall retain such records, and all other
documents relevant to the Services furnished under this Contract for a period of 0 three (3) years or 0
years (for State contracts) from the expiration date of this Contract.
The Provider agrees to participate in evaluation studies, quality management activities,
Corrective Action Plan activities, and analyses carried out by or on behalf of the County to evaluate the
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effectiveness of client service(s) or the appropriateness and quality of care/service delivery. Accordingly,
the Provider shall allow authorized County staff involved in such efforts to examine and review the
Provider's premises and records.
J. Confidentiality Requirements. The Provider shall establish and implement policies and
procedures which ensure compliance with the following security standards and any and all applicable State
and Federal statutes and regulations for the protection of confidential client records and electronic
exchange of confidential information. The policies and procedures must ensure that:
(1) There is a controlled and secure area for storing and maintaining active confidential
information and files, including but not limited to medical records.
(2) Confidential records are not removed from the Provider's premises, unless
otherwise authorized by law or upon written consent from the County.
(3)
Access to confidential information is restricted to authorized personnel of the
Provider, the County, the United States Department of Health, and Human Services,
the United States Comptroller General, and/or the United States Office of the
Inspector General.
(4) Records are not left unattended in areas accessible to unauthorized individuals.
(5) Access to electronic data is controlled.
(6) Written authorization, signed by the client, is obtained for release of copies of client
records and/or information. Original documents must remain on file at the
originating Provider site.
(7)
An orientation is provided to new staff persons, employees, and volunteers. All
employees and volunteers must sign a confidentiality pledge, acknowledging their
awareness and understanding of confidentiality laws, regulations, and policies.
(8) Procedures are developed and implemented that address client chart and medical
record identification, filing methods, storage, retrieval, organization and
maintenance, access and security, confidentiality, retention, release of information,
copying, and faxing.
K. Monitoring: Management Evaluation and Performance Review. The Provider agrees
to permit County authorized personnel to monitor, review and evaluate the program/work which is the
subject of this Contract. The County shall monitor fiscal, administrative, and programmatic compliance
with all the terms and conditions of the Contract. The Provider shall permit the County to conduct site
visits, client assessment surveys, and other techniques deemed reasonably necessary to fulfill the
monitoring function. A report of the County's findings will be delivered to the Provider and the Provider will
rectify all deficiencies cited within the period of time specified in the report. If such deficiencies are not
corrected within the specified time the County may suspend payments or terminate this Contract. The
County may conduct one or more formal management evaluation and performance reviews of the Provider.
Continuation of this Contract and funding are dependent upon the County being satisfied with the results
of the evaluations.
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L. Client Records. The Provider shall maintain a separate individual client chart for each
client/family served, where appropriate. This client chart shall include all pertinent information regarding
case activity. At a minimum, the client chart shall contain referral and intake information, treatment plans,
and case notes documenting the dates services were provided and the type of service provided. These
client charts shall be subject to the audit and inspection requirements under Article 19, Sections F, G and
H of this Contract.
M. Disaster Plan/Continuity of Operations Plan (COOP). The Provider shall develop and
maintain an Agency Disaster Plan/COOP. At a minimum, the Plan will describe how the Provider
establishes and maintains an effective response to emergencies and disasters and must comply with any
Florida Statutes related to Emergency Management that are applicable to the Provider. The Disaster
Plan/COOP must be submitted to the County no later than April 1st of the contract term and is also subject
to review and approval of the County in its sole discretion. The Provider will review the Plan annually,
revise it as needed, and maintain a written copy on file at the Provider's site.
N. Continuum of Care (CoC) Coordinated Intake and Assessment Process
The Provider shall participate in the Continuum of Care's (CoC) Coordinated Intake and Assessment
process, to include, but not limited to: participation in the CoC's defined process to make and receive
referrals for housing and/or services (including the use of the Homeless Management Information
System (HMIS) for such, if required in the Standards of Care); use of any forms required (e.g. Release
of Information, Homeless Verification Form, Chronic Homeless Verification Form, etc.); compliance
with established Standards of Care (and any revisions thereof) relating to eligibility criteria and timely
processing of referrals; and cooperation with established prioritizations for placement.
O. Public Records
Pursuant to Section 119.0701 of the Florida Statutes, if the Provider meets the definition of "Contractor"
as defined in Section 119.0701(1)(a), the Provider shall:
(a) Keep and maintain public records that ordinarily and necessarily would be required by the public
agency in order to perform the service.
(b) Provide the public with access to public records on the same terms and conditions that the
public agency would provide the records and at a cost that does not exceed the cost provided in
this chapter or as otherwise provided by law.
(c) Ensure that public records that are exempt or confidential and exempt from public records
disclosure requirements are not disclosed except as authorized by law; and
(d) Meet all requirements for retaining public records and transfer to the County, at no County cost,
all public records created, received, maintained and or directly related to the performance of this
Agreement that are in possession of the Provider upon termination of this Agreement. Upon
termination of this Agreement, the Provider shall destroy any duplicate public records that are
exempt or confidential and exempt from public records disclosure requirements. All records stored
electronically must be provided to the County in a format that is compatible with the information
technology systems of the County.
For purposes of this Article, the term "public records- shall mean all documents, papers, letters,
maps, books, tapes, photographs, films, sound recordings, data processing software, or other
material, regardless of the physical form, characteristics, or means of transmission, made, or
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received pursuant to law or ordinance or in connection with the transaction of official business of
the County.
Provider's failure to comply with the public records disclosure requirement set forth in Section
119.0701 of the Florida Statutes shall be a breach of this Agreement.
In the event the Provider does not comply with the public records disclosure requirement set forth in
Section 119.0701 of the Florida Statutes, the County may, at the County's sole discretion, avail itself of the
remedies set forth under this Agreement and available at law.
If the Provider has questions regarding the application of Chapter
119, Florida Statutes, to the Provider's duty to provide public
records relating to this Agreement, contact Miami -Dade County's
Custodian of Public Records at:
Miami -Dade County
Homeless Trust
111 NW 1st Street, 27th Floor, Suite 310
Miami, Florida 33128
Attention: Victoria L. Mallette, Executive Director
Email: vmallette@miamidade.gov
ARTICLE 20. Office of Miami -Dade County Inspector General
Miami -Dade County has established the Office of the Office of Inspector General which is empowered to
perform random audits on all County contracts throughout the duration of each contract. The Miami -Dade
County Inspector General is authorized and empowered to review past, present, and proposed County
and Public Health Trust programs, contracts, transactions, accounts, records, and programs. In addition,
the Inspector General has the power to subpoena witnesses, administer oaths, require the production of
records, and monitor existing projects and programs. Monitoring of an existing project or program may
include a report concerning whether the project is on time, within budget and in compliance with plans,
specifications, and applicable law.
The Inspector general is empowered to analyze the necessity of and reasonableness of proposed charge
orders to the Contract. The Inspector General is empowered to retain the services of independent private
sector inspectors general (IPSIG) to audit, investigate, monitor, oversee, inspect and review operations,
activities, performance and procurement process including but not limited to project design, bid
specifications, proposal submittals, activities of the Provider, its officers, agents and employees, lobbyists,
County staff and elected officials to ensure compliance with contract specifications and to detect fraud and
corruption.
Upon ten (10) days prior written notice to the Provider from the Inspector General or IPSIG retained by the
Inspector General, the Provider shall make all requested records and documents available to the Inspector
General or IPSIG for inspection and copying. The Inspector General and IPSIG shall have the right to
inspect and copy all documents and records in the Provider's possession, custody or control which, in the
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Inspector General or IPSIG's sole judgment, pertain to performance of the contract, including, but not
limited to original estimate files, worksheets, proposals and agreements from and with successful and
unsuccessful subcontractors and suppliers, all project -related correspondence, memoranda, instructions,
financial documents, construction documents, proposal and contract documents, back -charge documents,
all documents and records which involve cash, trade or volume discounts, insurance proceeds, rebates,
or dividends received, payroll and personnel records, and supporting documentation for the aforesaid
documents and records.
The provisions in this section shall apply to the Provider, its officers, agents, employees, subcontractors,
and suppliers. The Provider shall incorporate the provisions in this section in all subcontractors and all
other agreements executed by the Provider in connection with the performance of the contract.
Nothing in this contract shall impair any independent right of the County to conduct audit or investigative
activities. The provisions of this section are neither intended nor shall they be construed to impose any
liability on the County by the Provider or third parties.
ARTICLE 21. SUBCONTRACTORS and ASSIGNMENTS
A. Subcontracts. The parties agree that no assignment or subcontract will be made or let in
connection with this Contract without the prior written approval of the County in its sole discretion, which
shall not be unreasonably withheld, and that all subcontractors or assignees shall be governed by all of
the terms and conditions of this Contract.
1) If the Provider will cause any part of this Contract to be performed by a
Subcontractor, the provisions of this Contract will apply to such Subcontractor and
its officers, agents and employees in all respects as if it and they were employees
of the Provider; and the Provider will not be in any manner thereby discharged from
its obligations and liabilities hereunder, but will be liable hereunder for all acts and
negligence of the Subcontractor, its officers, agents, and employees, as if they were
employees of the Provider. The services performed by the Subcontractor will be
subject to the provisions hereof as if performed directly by the Provider.
2) The Provider, before making any subcontract for any portion of the services, will
state in writing to the County the name of the proposed Subcontractor, the portion
of the Services which the Subcontractor is to perform, the place of business of such
Subcontractor, and such other information as the County may require. The County
will have the right to require the Provider not to award any subcontract to a person,
firm, or corporation disapproved by the County in its sole discretion.
3) Before entering into any subcontract hereunder, the Provider will inform the
Subcontractor fully and completely of all provisions and requirements of this
Contract relating either directly or indirectly to the Services to be performed. Such
Services performed by such Subcontractor will strictly comply with the requirements
of this Contract.
4) In order to qualify as a Subcontractor satisfactory to the County in its sole discretion,
in addition to the other requirements herein provided, the Subcontractor must be
prepared to prove to the satisfaction of the County that it has the necessary facilities,
skill and experience, and ample financial resources to perform the Services in a
satisfactory manner. To be considered skilled and experienced, the Subcontractor
Page 21 of 27
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
must show to the satisfaction of the County in its sole discretion that it has
satisfactorily performed services of the same general type which is required to be
performed under this Contract.
5) The County shall have the right to withdraw its consent to a subcontract if it appears
to the County that the subcontract will delay, prevent, or otherwise impair the
performance of the Contractor's obligations under this Contract. All Subcontractors
are required to protect the confidentiality of the County's and County's proprietary
and confidential information. Provider shall furnish to the County copies of all
subcontracts between Provider and Subcontractors and suppliers hereunder.
Within each such subcontract, there shall be a clause for the benefit of the County
permitting the County to request completion of performance by the Subcontractor of
its obligations under the subcontract, in the event the County finds the Contractor in
breach of its obligations; and the option to pay the Subcontractor directly for the
performance by such subcontractor. The foregoing shall neither convey nor imply
any obligation or liability on the part of the County to any subcontractor hereunder
as more fully described herein.
B. Prompt Payments to Subcontractors. The Provider shall issue prompt payments to
subcontractors that are small businesses (annual gross sales of $750,000 or less with its principal place
of business in Miami -Dade County) and shall have a dispute resolution procedure in place to address
disputed payments. Pursuant to the County's Sherman S. Winn Prompt Payment Ordinance (Ordinance
94-40), Section 2-8.1.4 of the Code of Miami -Dade County, Administrative Order No. 3-19, and the Florida
Prompt Payment Act, payments must be made within thirty (30) days of receipt of a proper invoice. Failure
to issue prompt payments to small business subcontractors or adhere to dispute resolution procedures
may be grounds for suspension or termination of this Contract or debarment.
ARTICLE 22. LOCAL, STATE, AND FEDERAL COMPLIANCE REQUIREMENTS
Provider agrees to comply, subject to applicable professional standards, with the provisions of any
and all applicable Federal, State and the County's orders, statutes, ordinances, rules, and regulations that
may pertain to the Services required under this Contract, including but not limited to:
a) Miami -Dade County Florida, Department of Business Development Participation
Provisions, as applicable to this Contract.
b) Miami -Dade County Code, Chapter 11A, including but not limited to Articles III and IV. All
Providers and subcontractors performing work in connection with this Contract shall provide
equal opportunity for employment and services without regard to race, creed, religion, color,
sex, familial status, marital status, sexual orientation, pregnancy, age, ancestry, national
origin, gender identity, gender expression, source of income or handicap. The aforesaid
provision shall include, but not be limited to, the following: employment, upgrading,
demotion or transfer, recruitment advertising; layoff or termination; rates of pay or other
forms of compensation; and selection for training, including apprenticeship. The Provider
agrees to post in a conspicuous place available for employees and applicants for
employment, such notices as may be required by the Dade County Equal Opportunity Board
or other authority having jurisdiction over the work setting forth the provisions of the
nondiscrimination law.
c) Conflict of Interest and Code of Ethics Ordinance, Section 2-11.1 et seq. of the Code of
Page 22 of 27
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
Miami -Dade County, as amended.
d) Miami -Dade County Code Section 10-38, Debarment of contractors from County work.
e) Miami -Dade County Ordinance 99-5, codified at 11A-60 et seq. Code of Miami -Dade
County pertaining to complying with the County's Domestic Leave Ordinance.
f) Miami -Dade County Ordinance 99-152 codified at Section 21-255 et seq. prohibiting the
presentation, maintenance, or prosecution of false or fraudulent claims against Miami -Dade
County.
g)
Miami -Dade County Resolution 478-12. The Provider will not use products or foods
containing "pink slime," as defined in Resolution 478-12 of the Board of Miami -Dade County
Commissioners, in food that is provided or served pursuant to this agreement."
Notwithstanding any other provision of this Contract, Provider shall not be required pursuant to this
Contract to take any action or abstain from taking any action if such action or abstention would, in the good
faith determination of the Provider, constitute a violation of any law or regulation to which Provider is
subject, including but not limited to laws and regulations requiring that Provider conduct its operations in a
safe and sound manner.
ARTICLE 23. MISCELLANEOUS
A. Publicity. It is understood and agreed between the parties hereto that this Provider is
funded by Miami -Dade County. Further, by the acceptance of these funds, the Provider agrees that events
funded by this Contract shall recognize and adequately reference the County as a funding source. The
Provider shall ensure that all publicity, public relations, advertisements, and signs recognizes and
references the County (by inserting the Miami -Dade County Homeless Trust Logo on all materials) for the
support of all contracted activities. This is to include, but is not limited to, all posted signs, pamphlets, wall
plaques, cornerstones, dedications, notices, flyers, brochures, news releases, media packages,
promotions, and stationery. The use of the official Miami -Dade County Homeless Trust logo is permissible
for the publicity purposes stated herein. Provider shall submit sample or mockup of such publicity or
materials to the County for review and approval. The Provider shall ensure that all media representatives,
when inquiring about the activities funded by this Contract, are informed that the County is its funding
source.
B. Governing Law and Venue. This Contract is made in the State of Florida and shall be
governed according to the laws of the State of Florida. Venue for this Contract shall be Miami -Dade
County, Florida.
C. Modifications. Any alterations, variations, modifications, extensions, or waivers of
provisions of this Contract including, but not limited to, amount payable and effective term shall only be
valid when they have been reduced to writing, duly approved, and signed by both parties and attached to
the original of this Contract.
The County and Provider mutually agree that modification of the Scope of Services, schedule of
payments, billing, and cash payment procedures, set forth herein and other such revisions may be made
Page 23 of 27
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
as a written amendment to this Contract executed by both parties.
The Mayor or the Mayor's designee is authorized to make modifications to this Contract as
described herein on behalf of the County.
The Office of the Inspector General shall have the power to analyze the need for, and the
reasonableness of proposed modifications to this Contract.
D. Counterparts. This Contract is executed in three (3) counterparts, and each counterpart
shall constitute an original of this Contract.
E. Headings, Use of Singular and Gender. Paragraph headings are for convenience only
and are not intended to expand or restrict the scope or substance of the provisions of this Contract.
Wherever used herein, the singular shall include the plural and plural shall include the singular, and
pronouns shall be read as masculine, feminine, or neuter as the context requires.
F. Review of this Contract. Each party hereto represents and warrants that they have
consulted with their own attorney concerning each of the terms contained in this Contract. No
inference, assumption, or presumption shall be drawn from the fact that one party or its attorney
prepared this Contract. It shall be conclusively presumed that each party participated in the
preparation and drafting of this Contract.
G. The County's Consultant. The Provider understands that in order to facilitate the
implementation of this Contract, the County may from time to time designate in writing a development
consultant to work with the Provider. The County's consultant shall be considered the County's designee
with respect to all portions of this Contract with the exception of those provisions relating to payment of the
Provider for services rendered. The County shall provide written notification to the Provider of the name,
address, and employees of the County's consultant.
H. Contracts with Municipalities or Counties Outside Miami -Dade County to Provide
Homeless Housing in Miami -Dade County. The Provider desiring to transact business or enter into a
Contract with the County for the provision of homeless housing and/or services swears, verifies, affirms
and agrees that (1) it has not entered into any current contract, arrangement of any kind, or understanding
with any municipality outside of Miami -Dade County or any County (collectively "locality") to provide
housing and services for homeless persons in Miami -Dade County who are transported to Miami -Dade
County by or at the behest of such locality and (2) during the term of this Contract, it will not enter into any
such contract, arrangement of any kind, or understanding; provided, however, upon the written request of
the Provider prior to entering into such contract, understanding that the County may, in its sole and
absolute discretion, find and determine within sixty (60) days of such request that a proposed contract
should not be prohibited hereby, as the best interests of the homeless programs undertaken by and on
behalf of Miami -Dade County would not be negatively affected by such contract, arrangement, or
undertaking.
Incident Reports. The Provider must report to the Miami -Dade County Homeless Trust
information related to a y critical incidents occurring during the administration of its programs. The
Provider is to utilize the "Incident Report" form attached as Attachment N. In addition to reporting this
incident to the appropriate authorities, the Provider must within twenty-four (24) hours of any incident,
submit in writing a detailed account of the incident. This incident report should be addressed to the
County. This incident report should be addressed to Miami -Dade County Homeless Trust, 111 NW First
Street, 27th Floor, Suite 310, Miami, Florida 33128; telephone (305) 375-1490 and facsimile (305) 375-
Page 24 of 27
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
2722.
J. Totality of Contract / Severability of Provisions. This Contract and Attachments, with
its recitals on the first page of the Contract and with its attachments as referenced below contain all the
terms and conditions agreed upon by the parties.
1. No 3rd Party Beneficiaries. The Parties agree that this contract has no intended or
unintended third -party beneficiaries.
K. Property. This section applies to equipment with an acquisition cost of $5,000 or more per
unit and all real property.
1. Any real property under the Provider's control that was acquired/improved in whole
or in part with funds from the Homeless Trust and any equipment purchased for
$5,000 or more shall be disposed of, at the expiration or termination of this contract,
in accordance with instruction from the Homeless Trust. Real Property is defined as
land, including land improvements, structures, and appurtenances thereto, including
movable machinery and equipment. Equipment means tangible, nonexpendable,
personal property having a useful life of more than one year and an acquisition cost
of $5,000 or more per unit.
2. All equipment with an acquisition cost of $5,000 or more per units and all real property
purchased in whole or in part with funds from this and previous contracts with the
Homeless Trust, or transferred to the Provider t after being purchased in whole or in
part with funds from the Homeless Trust shall be listed in the property records of the
Provider and shall include a legal description, size, date of acquisition, value at time
of purchase, owner's name if different from the Provider, information on the transfer
or disposition of the property, and map indicating whether property is in parcels, lots
or blocks and showing adjacent streets and roads. Notwithstanding documentation
required for reimbursement purposes, a copy of the purchase receipt for any asset
described above purchased with Homeless Trust funds must also be included in the
Provider's monthly reimbursement package submitted to the Homeless Trust in the
month in which the item was purchased along with the "Provider Asset Inventory"
(Attachment 0).
3. All equipment with an acquisition cost of $5,000 or more per unit and all real property
shall be inventoried annually by the Provider and an inventory report shall be
submitted to the Homeless Trust. This report shall include the elements listed in the
paragraph listed above.
Attachment A-B:
Attachment C:
Attachment D:
Attachment E:
Attachment F:
Attachment G:
Attachment H:
Scope of Services/Budget
Miami Dade County Affidavits
State Affidavits (N/A)
Primary Care Invoice for Services
Monthly Payment Requests Reports (N/A)
Monthly Performance Reports
Outcome Performance Measurements Monthly Report (N/A)
Page 25 of 27
Attachment I:
Attachment J:
Attachment K:
Attachment L:
Attachment M:
Attachment N:
Attachment 0:
Attachment P:
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
Client Contribution Report (N/A)
Client Attendance Roster (N/A)
Vacancy/Permanent Housing Placement Report (Quarterly) (N/A)
Annual Performance Report & Annual Actual Expenditure Report
W-9 Form
Incident Report
Provider Asset Inventory Report
Client Services Certification Form
No other agreement, oral or otherwise, regarding the subject matter of this Contract shall be
deemed to exist or bind any of the parties hereto. If any provision of this Contract is held invalid or void,
the remainder of this Contract shall not be affected thereby if such remainder would then continue to
conform to the terms and requirements of applicable law and ordinance.
SIGNATURES APPEAR ON THE FOLLOWING PAGE
Page 26 of 27
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT (MOA) PROGRAM
PC-2223-MOA
IN WITNESS WHEREOF, the parties have executed this Contract, along with all its Attachments, effective
as of the contract date herein above set forth.
WITNESSES:
ENTITY: CITY OF MIAMI, FLORIDA
A municipal corporation of
The State of Florida
BY: BY:
TODD B. HANNON ARTHUR NORIEGA
CITY CLERK CITY MANAGER
Approved as to Form and Correctness: Approved as to Insurance Requirements:
BY: BY:
VICTORIA MENDEZ ANN-MARIE SHARPE
CITY ATTORNEY RISK MANAGEMENT
Counterparts and Electronic Signatures - This Agreement may be executed in
any number of counterparts, each of which so executed shall be deemed to be an
original, and such counterparts shall together constitute but one and the same Agreement.
The parties shall be entitled to sign and transmit an electronic signature of this Agreement
(whether by facsimile, PDF or other email transmission), which signature shall be binding
on the party whose name is contained therein. Any party providing an electronic
signature agrees to promptly execute and deliver to the other parties an original signed
Agreement upon request.
Affix Incorporation SEAL Here
ATTEST: Miami -Dade County, a political subdivision of
The State of Florida
HARVEY RUVIN, CLERK
BY:
DEPUTY CLERK DANIELLA LEVINE-CAVA
DATE
COUNTY MAYOR
Affix Miami -Dade County Seal Here
Approved as to form and legal sufficiency. See memorandum dated October 12, 2022.
Page 27 of 27
MOA FY-2022-2023 - Budget Narrative
SUPPORTIVE SERVICES:
SALARIES+ FICA:
Info & Referral Specialist ($156.949.96= $145,796.53/Salaries+$11,153.43/Fica (7.65%)), Funds for 14.00
FTE: An employee in this position is responsible for a wide variety of technical assistance activities. Work
involves gathering and disseminating information to citizens on services and activities provided by federal, state,
and local agencies and in assessing the needs of individuals and groups. The employee will be responsible for
establishing and maintaining contacts with the appropriate agencies. Independence of judgment is required of an
employee of this classification in the performance of these duties.
The essential functions for this position are: interviews citizens to assess their needs and determines which agency
best suits the participant's needs, develops a network of supportive service resources for referral of clients,
continues on -going research for additional sources, and maintains on -going evaluation of the services provided,
identifies supportive service resources, and makes referrals where appropriate, counsels citizens, discusses short
and long range plans available to them and assists them in formulating plans to reach their objectives, contacts
and refers citizens to the appropriate federal, state, and/or local agency and explains the process and procedures
involved in receiving information or service from the agency contacted. Reports to a higher -level administrator.
# I&RS
Funds would
cover by MOA
Funds would cover by CE
Consolidation CoC.
Funds would cover by
City of Miami (ESG)
1
15%
32%
53%
1
16%
40%
44%
1
20%
40%
40%
1
20%
80%
1
20%
80%
1
20 %
50%
30%
1
20%
43 Vo
37%
1
20%
30%
50%
3
25%
75%
3
30%
70 %
14
2
Info & Referral Aide: ($40,027.48= $37,182.98/Salaries+$2,844.50/Fica(7.65%)), Funds for 5.00 FTE:
The essential functions for this position are: Maintains files of information gathered on the various governmental
and social service agencies, Assists the Information and Referral Specialists or other staff members in distributing
information to clients, translating documents and gathering routine background data on clients, either in the office
or field, identifies supportive service resources, and makes referrals where appropriate, assists in developing
systems for documenting and reporting all activities and services provided for clients.
# IRA
Funds would cover
by MOA
Funds would cover by CE
Consolidation CoC.
Funds would cover by
City of Miami (ESG)
1
15%
85%
2
20%
80%
1
20%
40%
40%
1
20%
30%
50%
5
Housing Specialist ($30,420.02= $28,258.26/Salaries+$2,161.76/Fica (7.65%)), 2.00 FTE: The duties include,
but are not limited to, the following: providing outreach and housing services to homeless clients; assessing the
housing needs and eligibility of clients; assisting clients in identifying permanent or transitional housing;
placing clients in permanent or transitional housing and following up periodically on clients referred through
the criminal justice and public health systems. Reports to the Homeless Housing Supervisor or designee.
# HS
Funds would cover
by MOA
Funds would cover by CE
Consolidation CoC.
Funds would cover by
City of Miami (ESG)
1
20%
30%
50%
1
38%
62%
2
Housing Supervisor ($31,768.64= $29,511.04/Salaries+$2,257.60/Fica(7.65%)), 1.00 FTE: Funds would cover
salary 50% of one position time, 25% will be covered by funds of CE Consolidation CoC) and 25% will be
covered by. the City of Miami (ESG).
This is supervisory work of a specialized nature responsible for coordinating housing assessment and placement
services offered through the Miami Homeless Assistance Program. An employee in this classification establishes
and maintains relationships with housing providers and community agencies, coordinates efforts with service
providers, and monitors the provision of services to clients, and ensures clients are appropriately matched with
housing and supportive services.
Case Manager Assistant ($29,439.95= $27,347.84/Salaries+$2,092.11/Fica(7.65%)): Funds would cover salary
for 40% of position time. The other 60% fund will be covered by CE Consolidation Grant.
This is a paraprofessional position responsible for assisting Case Managers and Supervisory staff with varied case
management activities including following up with clients pursuant to counseling sessions, assisting with the
progress of clients in the fulfillment of their individual employment and training program service strategies.
Work involves responsibility for recruiting clients and providing information to potential and actual clients via
outreach efforts. Assists in providing counseling services to targeted parties in an effort to decrease undesirable
influences and outcomes. Meets with employers, parents, teachers, and others to assist in determining causes of
problems experienced by clients. Assists in altering attitudes and behaviors of clients and makes recommendations
3
for effective remedies. Works with assessment, placement, and case management staff along with clients and
external resources to assist in developing Individual Service Strategies as appropriate.
Special Project Assistant ($29,092.89= $27,025.44/Salaries+$2,067.45/Fica(7.65%)) 1.00 FTE: Funds would
cover salary for 30% of one position time, the other 68% would cover by CE Consolidation Grant. This is a
supervisory position overseeing the information and referral operation. Assist/coordinate special projects; assist
with overall program operation. Serve as a liaison between program and outside businesses. Provide assistance to
Director with other duties as needed.
Communication ($4,500.00): The requested is needed to cover the cost of office cell phones/push to talk. These
are used to communicate with outreach teams out in the field.
Rent of Equipment ($990.00): This amount will be used for to pay the rent of print (SHARP BUSINESS
SYSTEM). The total amount is $3490.08 per year, this fund would cover 28.37% ($990.00) of the total amount.
Transportation ($9,000.00): This amount will be used for to pay the services GSA for to rent the cars for to use
in the transportation the homeless. The total amount is $45,000.00 per year, this fund would cover $9,000.00=(1
car=$750.00* 12) of the total amount ($650,00 for rent per month and $100.00 of gas).
Operating Supplies ($3,511.06): The requested is needed in order to purchase supplies to cover the demand of
services for to homeless. These services include:
Operating Supplies:
Hand sanitizer
Gloves
Garbage Bags
Disinfectant Spray
- Office Supplies: Paper
Folders
Toners for printers and fax machine
First aid kit
Pens and pencil
Binder
Staples and binder and paper clips
File prongs
Indirect Administrative Costs ($4,300.00): Administrative Cost Grants Distribution. The total amount is
$27,049.00 per year, this fund would cover $4,300.00 to this amount, CE Consolidation would be covering the
rest of the total amount.
4
���► FYL'OP2�2O£23`aku,
.x %a. sit ,..h.k.Tsb
, ,, ;E§
Supportive Services Expense
Current Budget
14.0 FTE =>1 (15%), 1(16%), 6 (20%), 3 (25%), 3 (30%),
Information & Referral Specialist
Total
156,949.96
56,949.96
Salary
...
FICA (7,65%)
11,153.43
5.0 FTE=>4(20%), 1(15%). Information and. Referral
Aide
Total
40, 027.48
Salary
37,182 .98
. .
FICA (7.65%)
2,844.50
2.00 FTE =>1 (20%), 1 (38%). Housing Specialist
Total
30, 420.02
. _.. .. Salary ........
- .26
28, 258
FICA (7.65%)
2,161.76
1.00 FIE => (50%) Housing Supervisor
Total
31, 768.64
Salary
29, 511.04
FICA (7.65%)
2,257.60
1.00 FTE => (40%) Case Manager Assistant
Total
29,439.95
Salary
27, 347.84
FICA (7.65%)
2,092.11
1.00 FTE => (30%), Special Project Assistant.
Total
29, 092.89
Salary
27, 025.44
FICA (7.65%)
2,067.45
ISubtotaY ,
31 ,698 94
Communication
4,500.00
Rent of Equipment
990.00
Transportation
9,000.00
Operating Supplies
3,511.06
Indirect Administrative Costs
4,300.00
Total
340,000.00
Miami -Dade County's Affidavits and Declarations
M IAM I -DADS
COUNTY
Miami -Dade County requires each party desiring to enter into a contract with Miami -Dade County to;
(1) Sign an affidavit as to certain matters and (2) make a declaration as to certain other matters. This
form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration
forms for matters requiring only an affirmation or declaration for other matters.
Each section of this form must be read, and initialed in the top right hand box indicating acceptance
and/or compliance with the County's policy related to the particular affidavit. For affidavit sections that
you do not believe are applicable to your organization, please indicate this by placing "Q" in the box next
to N/A.
ALL SECTIONS MUST BE COMPLETED
THE FOLLOWING MATTERS REQUIRE THE ENTITY TO SIGN AN AFFIDAVIT UNDER OATH:
STATE OF (
COUNTY OF (
COUNTRY OF (
Before me the undersigned authority appeared
(Print Name), who is personally known to
as identification and who did swear to the following:
me or who has provided
That he or she is the duly authorized representative of (Name of Entity)
(Address of Entity)
addresses are not acce table.
r
Federal Employment Identification Number
(hereinafter referred
"entity"), and that he or she is the entity's (Sole Proprietor)(Partner)(President or
That he or she has full authority to make this affidavit, and that the information given
attached hereto are true and correct; and
That he or she says for the following fifteen (16) Affidavits and Declarations:
Post Office
to as the contracting
Other Authorized Officer)
herein and the documents
ATTACHMENT C "Miami -Dade County Affidavits and Declarations"
Page 1 of 11
Miami -Dade County's Affidavits and Declarations
1. MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (SECTION 2-8.1
OF THE COUNTY CODE)
Pertains O
N/A O
Initial (_)
If the contract or business transaction is with a corporation, the full legal name and business address shall be
provided for each officer and director and each stockholder who holds directly or indirectly five percent (5%) or
more of the corporation's stock.
If the contract or business transaction is with a partnership, the foregoing information shall be provided for
each partner.
If the contract or business transaction is with a trust, the full legal name and address shall be provided for each
trustee and each beneficiary. The foregoing requirements shall not pertain to contracts with publicly traded
corporations or to contracts with the United States or any department or agency thereof, the State or any
political subdivision or agency thereof or any municipality of this State. All such names and address are outlined
below: Post Office addresses are not acceptable.
(Full Legal Name, Address, % Ownership)
(Full Legal Name, Address, % Ownership)
(Full Legal Name, Address, % Ownership)
(Full Legal Name, Address, % Ownership)
The full legal names and business address of any other individual
suppliers, laborers, or lenders) who have, or will have, any
the contract or business transaction with Miami Dade County
(other than subcontractors, material person,
interest (legal, equitable beneficial or otherwise) in
are:
required herein, or who knowingly discloses false
up to five hundred dollars ($500.00) or imprisonment
Post office addresses are not acceptable
Any person who willfully fails to disclose the information
information in this regard, shall be punished by a fine of
in jail for up to sixty (60) days or both.
ATTACHMENT C "Miami -Dade County Affidavits and Declarations" Page 2 of 11
Miami -Dade County's Affidavits and Declarations
2. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (COUNTY
ORDINANCE 90-133, AMENDING SECTION 2.8-1; SUBSECTION (d)(2) OF THE
COUNTY CODE)
Pertains O
N/A O
Initial (_)
Except where precluded by Federal or State laws or regulations, each contract or business transaction or
renewal thereof which involves the expenditure of then thousand dollars ($10,000) or more shall require the
entity contracting or transaction business to disclose the following information. The foregoing disclosure
requirements do not apply to contracts with the United States or any department or agency thereof, the State or
any political subdivision or agency thereof or any municipality of this State.
Does your firm have a collective bargaining agreement with its employees? O Yes O No
Does your firm provide paid health care benefits for its employees? O Yes O No
Provide a current breakdown (number of persons) of your firm's work force and ownership (below):
White:
Males
Females
Black:
Males
Females
Hispanic:
Males Females
Asian:
Males
Females
American Native:
Males
Females
Aleut (Eskimo):
Males Females
ATTACHMENT C "Miami -Dade County Affidavits and Declarations" Page 3 of 11
Miami -Dade County's Affidavits and Declarations
3. MIAMI-DADE COUNTY AFFIRMATIVE ACTION /
NONDISCRIMINATION OF EMPLOYMENT, PROMOTION AND
PROCUREMENT PRACTICES (COUNTY ORDINANCE 98-30 CODIFIED
AT 2-8.1.5 OF THE COUNTY CODE)
Pertains O
N/A O
Initial (_)
Pursuant to Miami -Dade County's Ordinance No. 98-30, Section 2-8.1.5, entities with annual gross revenue in
excess of $5,000,000 seeking to contract with the County shall, as a condition of receiving a County contract, have:
1) a written affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not
discriminate in its employment and promotion practices and 2) a written procurement policy which sets forth the
procedures the entity utilizes to assure that it does not discriminate against minority and women -owned
businesses in its own procurement of goods, supplies and services. Such affirmative action plans and procurement
policies shall provide for periodic review to determine their effectiveness in assuring the entity does not
discriminate in its employment, promotion and procurement practices. The foregoing, not withstanding, corporate
entities whose board of directors are representative of the population make-up of the nation shall be presumed to
have non-discriminatory employment and procurement policies, and shall not be required to have a written
affirmative action plan and procurement policy in order to receive a County contract. The foregoing presumption
may be rebutted. The requirements of this section may be waived upon written recommendation of the County
Manager that it is in the best interest of the County to do so and approval of the County Commission by majority
vote of the members present. Based on the above, please complete the affidavit as directed and return the
completed affidavit along with a cover letter on your company's letterhead, listing the company's address, phone
and fax numbers, and any required documents, to: Miami -Dade County, Department of Procurement
Management Affirmative Action Plan Unit 111 NW 1st Street, l3th Floor Miami, FL 33128
Yes O No O
My company has an affirmative action plan and procurement policy and is
available for review.
Yes O No O
My company has annual gross revenues in excess of $5,000,000.
Therefore, our company's affirmative action plan and procurement policy
is available for review.
Yes O No O My company has annual gross revenues less than $5,000,000.
If at any time the Miami Dade County has reason to believe that any person or firm has willfully and knowingly
provided incorrect information or made false statements, the County may refer the matter to the State Attorney's
Office and/or other investigative agencies. The County may initiate debarment and/or pursue other remedies in
accordance with Miami -Dade County policy and/or applicable federal, state and local laws.
4. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT
(SECTION 2-8.6 OF THE COUNTY CODE)
Pertains O
N/A O
Initial (_)
The individual or entity entering into a contract or receiving funding from Miami -Dade County 0 has 0 has not,
as of the date of this affidavit, been convicted of a felony during the past ten (10) years.
An officer, director, or executive officer of the entity entering into a contract or receiving funding from Miami -Dade
County 0 has 0 has not as of the date of this affidavit been convicted of a felony during the past ten (10) years.
ATTACHMENT C "Miami -Dade County Affidavits and Declarations"
Page 4 of 11
Miami -Dade County's Affidavits and Declarations
5. PUBLIC ENTITY CRIMES AFFIDAVIT (SECTION
287.133(3) (a), FLORIDA STATUTES)
Pertains O
N/A O
Initial (_)
The individual or entity entering into a contract or receiving funding from Miami -Dade County understands the
following: That a "public entity crime" as defined in Paragraph 287.133 (1) (g) Florida Statutes, means a violation
of any state or federal law by a person with respect to and directly related to the transaction of business with any
public entity or with an agency or political subdivision of any other state of the United States of America, including
but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or
political subdivision of any other state of the United States of America and involving antitrust, fraud, theft, bribery,
collusion, racketeering, conspiracy, or material misrepresentation.
That "Convicted" or "conviction" as defined in Paragraph 287.133 (1) (b) Florida Statutes means a finding of guilt
or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal state trial court of
record relating to charges brought by indictment or information after July 1,1989, as a result of a jury verdict, non -
jury trial, or entry of plea of guilty or nolo contendere.
That an "affiliate" as defined in Paragraph 287.133 (1) (a) Florida Statutes means a) a predecessor or successor of a
person convicted of a public entity crime; or b) an entity under the control of any natural person who is active in
the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes
those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the
management of an affiliate. The ownership by one person of shares constituting a controlling interest in another
person, or pooling of equipment or income among persons when not for fair market value under an arm's length
agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters
into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding
36 months shall be considered an affiliate.
That a "person" as defined in Paragraph 287.133 (1) (e) Florida Statutes means any natural person or entity
organized under the laws of any state or of the United States of America with the legal power to enter into a
binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public
entity, or which otherwise transacts or applies to transact business with a public entity. The term "person"
includes those officers, directors, executives, partners, shareholders, employees, members and agents who are
active in the management of an entity.
Based on information and belief, the statement as marked below, is true in relation to the entity submitting this
sworn statement. (Please indicate which statement applies by applying the individual initials near the box).
O Neither the entity submitting this sworn statement nor any of its officers, directors, executives, partners,
shareholders, employees, members or agents who are active in the management of the entity, nor an affiliate of the
entity has been charged with and convicted of a public entity crime within the past 36 months.
O The entity submitting this sworn statement or one or more of its officers, directors, executives, partners,
shareholders, employees, members or agents who are active in the management of the entity, or an affiliate of the
entity has been charged with and convicted of a public entity crime within the past 36 months; and
O yes an additional statement is applicable or O no an additional statement is not applicable.
O The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity has been charged
with and convicted of a public entity crime within the past 36 months. However, there have been subsequent
proceedings before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final
Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting
this sworn statement on the "Convicted Vendor List".
The individual or entity entering into a contract or receiving funding from Miami -Dade County understands that he
or she is required to inform the public entity prior to entering into a contract in excess of the threshold amount
provided in Section 287.017 Florida Statues for Category 2 of any change in the information contained in this form.
ATTACHMENT C "Miami -Dade County Affidavits and Declarations"
Page 5 of 11
Miami -Dade County's Affidavits and Declarations
6. MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT
(County Ordinance No.142-91 codified as Section 11A-29 et.
seq of the County Code)
Pertains O
N/A O
Initial (_)
That in compliance with Ordinance No. 142-91 of the Code of Miami -Dade County, Florida, an employer with fifty
(50) or more employees working in Dade County for each working day during each of twenty (20) or more
calendar work weeks, shall provide the following information in compliance with all items in the aforementioned
ordinance:
An employee who has worked for the above firm at least one (1) year shall be entitled to ninety (90) days of family
leave during any twenty-four (24) month period, for medical reasons, for the birth or adoption of a child, or for the
care of a child, spouse or other close relative who has a serious health condition without risk of termination of
employment or employer retaliation.
The foregoing requirements shall not pertain to contracts with the United States or any department or agency
thereof, or the State of Florida or any political subdivision or agency thereof. It shall, however, pertain to
municipalities of this State.
7. MIAMI-DADE COUNTY DISABILITY NONDISCRIMINATION
AFFIDAVIT (County Resolution R-385-95)
Pertains O
N/A O
Initial (_)
That the above named firm, corporation or organization is in compliance with and agrees to continue to comply
with, and assure that any subcontractor, or third party contractor under this project complies with all applicable
requirements of the laws listed below including, but not limited to, those provisions pertaining to employment,
provision of programs and services, transportation, communications, access to facilities, renovations, and new
construction in the following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336,104 Stat.
327, 42 U. S. C. 12101-12213 and 47 U. S. C. Sections 225 and 611 including Title I, Employment; Title II, Public
Services; Title III, Public Accommodation and Services Operated by Private Entities; Title IV, Telecommunications;
and Title V, Miscellaneous Provisions: The Rehabilitation Act of 1973, 29 U.S.C. Section 794: The Federal Transit
Act, as amended 49 U .S. C. Section 1612: The Fair Housing Act as amended, 42 U.S.C. Section 3601-3631. The
foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof,
or the State or any political subdivision or agency thereof or any municipality of this State.
8. MIAMI-DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE
FEES OR TAXES (Sec. 2-8.1(c) of the County Code)
Pertains O
N/A O
Initial (_)
Except for small purchase orders and sole source contracts, that above named firm, corporation, organization or
individual desiring to transact business or enter into a contract with the County verifies that all delinquent and
currently due fees or taxes -- including but not limited to real and property taxes, utility taxes and occupational
licenses -- which are collected in the normal course by the Dade County Tax Collector as well as Dade County
issued parking tickets for vehicles registered in the name of the firm, corporation, organization or individual have
been paid.
ATTACHMENT C "Miami -Dade County Affidavits and Declarations"
Page 6 of 11
Miami -Dade County's Affidavits and Declarations
9. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS
Pertains O
N/A O
Initial (_)
The individual entity seeking to transact business with the County is current in all its obligations to the County and
is not otherwise in default of any contract, promissory note or other loan document with the County or any of its
agencies or instrumentalities.
10. DOMESTIC VIOLENCE LEAVE (Resolution 185-00; 99-5 Codified At 11A-
60 Et. Seq. of the Miami -Dade County Code).
Pertains O
N/A O
Initial (_)
The firm desiring to do business with the County is in compliance with Domestic Leave Ordinance, Ordinance 99-
5, codified at 11A-60 et. seq. of the Miami Dade County Code, which requires an employer which has in the regular
course of business fifty (50) or more employees working in Miami -Dade County for each working day during each
of twenty (20) or more calendar work weeks in the current or proceeding calendar years, to provide Domestic
Violence Leave to its employees.
11. MIAMI-DADE COUNTY EMPLOYMENT DRUG -FREE WORKPLACE
AFFIDAVIT (County Ordinance No. 92-15 codified as Section 2-
8.1.2 of the County Code)
Pertains O
N/A O
Initial (_)
That in compliance with Ordinance No. 92-15 of the Code of Miami -Dade County, Florida, the above
or entity is providing a drug -free workplace. A written statement to each employee shall inform the
about:
1. danger of drug abuse in the workplace;
2. the firm's policy of maintaining a drug -free environment at all workplaces;
3. availability of drug counseling, rehabilitation and employee assistance programs;
4. penalties that may be imposed upon employees for drug abuse violations.
named person
employee
The person or entity shall also require an employee to sign a statement, as a condition of employment that the
employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than
five (5) days after receiving notice of such conviction and impose appropriate personnel action against the
employee up to and including termination.
Compliance with Ordinance No. 92-15 may be waived if the special characteristics of the product or service offered
by the person or entity make it necessary for the operation of the County or for the health, safety, welfare economic
benefits and well-being of the public. Contracts involving funding which is provided in whole or in part by the
United States or the State of Florida shall be exempted from the provisions of this ordinance in those instances
where those provisions are in conflict with the requirements of those governmental entities.
ATTACHMENT C "Miami -Dade County Affidavits and Declarations"
Page 7 of 11
Miami -Dade County's Affidavits and Declarations
12. ATTESTATION REGARDING DUE AND PROPER ACKNOWLEDGEMENT OF
COUNTY FUNDING SUPPORT
Pertains O
N/A O
Initial (_)
By initialing this subsection and accepting County funds, the above named firm, corporation, organization or
individual agrees to abide by the grant contract requirement to recognize and acknowledge Miami -Dade County's
grant support in a manner commensurate with all contributors and sponsors of its activities at comparable dollar
levels.
13. MIAMI-DADE COUNTY RESOLUTION NO. R-630-13 REQUIRING A DETAILED
PROJECT BUDGET, SOURCES AND USES STATEMENT, CERTIFICATIONS AS
TO PAST DEFAULTS ON AGREEMENTS WITH NON -COUNTY FUNDING
SOURCES, AND DUE DILIGENCE CHECK
Pertains O
N/A O
Initial (_)
Pursuant to Miami -Dade County Resolution No. R-630-13, requiring a detailed project budget, sources and uses
statement, certifications as to past defaults on agreements with non -county funding sources and due diligence
check prior to the County Mayor or County Mayor's designee recommending a commitment of Miami -Dade County
funds to Social Services, Economic Development, Community Development, and Affordable Housing Agencies and
Providers.
The undersigned entity certifies, to the best of his or her knowledge and belief, that:
1. Within the past five (5) years, neither the Agency nor its directors, partners, principals, members or board
members:
(i) have been sued by a funding source for breach of contract or failure to perform obligations under a
contract;
(ii) have been cited by a funding source for non-compliance or default under a contract;
(iii) have been a defendant in a lawsuit based upon a contract with a funding source.
Please list any matters which prohibit the Agency from making the certifications required and explain how the
matters are being resolved (use separate sheet if necessary):
14. MIAMI-DADE COUNTY RESOLUTION No. R-478-12 NOT TO USE PRODUCTS
OR FOODS CONTAINING "PINK SLIME"
Pertains O
N/A O
Initial (_)
Pursuant to Miami -Dade County Resolution No. R-478-12, the undersigned certifies, not to use meat products
containing "Pink Slime" in food provided or served as part any food program; urging all who provide food services
or operate a food program to immediately discontinue using meat products containing "pink slime" in food
provided or served in these programs.
ATTACHMENT C "Miami -Dade County Affidavits and Declarations"
Page 8 of 11
Miami -Dade County's Affidavits and Declarations
15. MIAMI-DADE COUNTY REQUIRED LOBBYIST REGISTRATION FOR
ORAL PRESENTATION Section 2-11.1(i)(2) CONFLICT OF INTEREST
AND CODE OF ETHICS ORDINANCE
Pertains O
N/A O
Initial (_)
All lobbyists shall register with the Clerk of the Board of County Commissioners within five (5) business days of
being retained as a lobbyist or before engaging in any lobbying activities, whichever shall come first. Every person
required to so register shall:
1. Register on forms prepared by the Clerk;
2. State under oath his or her name, business address and the name and business address of each person or entity
which has employed said registrant to lobby. If the lobbyist represents a corporation, the corporation shall also be
identified. Without limiting the foregoing, the lobbyist shall also identify all persons holding, directly or indirectly,
a five (5) percent or more ownership interest in such corporation, partnership, or trust. Registration of all
lobbyists shall be required prior to January 15 of each year and each person who withdraws as a lobbyist for a
particular client shall file an appropriate notice of withdrawal.
3. Prior to conducting any lobbying, all principals must file a form with the Clerk of the Board of County
Commissioners, signed by the principal or the principal's representative, stating that the lobbyist is authorized to
represent the principal. Failure of a principal to file the form required by the preceding sentence may be
considered in the evaluation of a bid or proposal as evidence that a proposer or bidder is not a responsible
contractor. Each principal shall file a form with the Clerk of the Board at the point in time at which a lobbyist is no
longer authorized to represent the principal.
OBy initialing here, the principals or principal's representative have filed with the Clerk of the Board of
County Commissioners stating that a lobbyist is authorized to represent the principal.
4. Any public officer, employee or appointee who only appears in his or her official capacity shall not be required to
register as a lobbyist.
5. Any person who only appears in his or her individual capacity for the purpose of self -representation without
compensation or reimbursement, whether direct, indirect or contingent, to express support of or opposition to any
item, shall not be required to register as a lobbyist.
6. Any person who only appears as a representative of a not -for -profit corporation or entity (such as a charitable
organization, or a trade association or trade union), without special compensation or reimbursement for the
appearance, whether direct, indirect or contingent, to express support of or opposition to any item, shall register
with the Clerk as required by the Ordinance subsection, but, upon request, shall not be required to pay any
registration fees.
The Clerk of the Board of County Commissioners shall notify the Commission on Ethics and Public Trust of the
failure of a lobbyist or principal to file a report and/or pay the assessed fines after notification. A lobbyist or
principal may appeal a fine and may request a hearing before the Commission on Ethics and Public Trust. A request
for a hearing on the fine must be filed with the Commission on Ethics and Public Trust within fifteen (15) calendar
days of receipt of the notification of the failure to file the required disclosure form. The Commission on Ethics and
Public Trust shall have the authority to waive the fine, in whole or part, based on good cause shown. The
Commission on Ethics and Public Trust shall have the authority to adopt rules of procedure regarding appeals from
the Clerk of the Board of County Commissioners.
Except as otherwise provided in subsection of the Ordinance, the validity of any action or determination of the
Board of County Commissioners or County personnel, board or committee shall not be affected by the failure of any
person to comply with the provisions of this subsection(s). (Ord. No. 00-19, § 1, 2-8-00; Ord. No. 01-93, § 1, 5-22-
01; Ord. No. 01-162, § 1, 10-23-01; Ord. No. 03-107, § 1, 5-6-03)
ATTACHMENT C "Miami -Dade County Affidavits and Declarations"
Page 9 of 11
Miami -Dade County's Affidavits and Declarations
16. Disclosure SUBCONTRACTOR / SUPPLIER LISTING (ORDINANCE 97-104)
Pertains O
N/A O
Initial (_)
This form, or a comparable form meeting the requirements of Ordinance 97-104, must be completed by all bidders and
proposers on Miami -Dade County contracts for purchase of supplies, materials or services, including professional
services which involve expenditures of $100,000.00 or more, and all bidders and proposers on County or Public
Health Trust construction contracts which involve expenditures of $100,000.00 or more. This form or a comparable
form meeting the requirements of Ordinance 97-104, must be completed and submitted even though the
bidder or proposer will not utilize subcontractors or suppliers on the contract. The bidder or proposer
should enter the word "NONE" under the appropriate heading, in those instances where no subcontractors or
suppliers will be used on the contract. A bidder or proposer who is awarded the contract shall not change or
substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or
materials to be supplied from those identified except upon written approval of the County.
Business Name and Address
of First Tier
Sub co ntra cto r/ S ub c o n sulta nt
Principal Owner
Scope of Work to be Performed by
Subcontractor/Subconsultant
(Principal Owner)
Gender Race
Business Name and Address
of Direct Supplier
Principal Owner
Supplies/Materials/Services to be
Provided by Supplier
(Principal Owner)
Gender Race
I certify that the representations contained in this Subcontractor/Supplier Listing are to the best of my knowledge
true and accurate.
( ) ( )
Signature of Authorized Representative
Print Name
(Duplicate if additional space is needed)
Date
Print Title
ATTACHMENT C "Miami -Dade County Affidavits and Declarations" Page 10 of 11
Miami -Dade County's Affidavits and Declarations
M IAM I-DADE
COUNTY
I have carefully read this entire 11-page document entitled, "Miami -Dade County's Affidavits and Declarations" and
agree to; (1) sign an affidavit as to certain matters and (2) make a declaration as to certain other matters. This
form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration forms for
matters requiring only an affirmation or declaration for other matters.
BY SIGNING AND NOTARIZING THIS PAGE YOU ARE ATTESTING TO AFFIDAVITS AND
DISCLOSURES 1-16
MIAMI-DADE COUNTY AFFIDAVITS SIGNATURE PAGE
By: , 20
Signature of Witness or Secretary Seal Date
Signature of Affiant Federal Employer Identification Number
Printed Name of Affiant and Name of Agency
Address of Agency
SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20
He/She is personally known to me or has presented as identification.
Type of identification
Signature of Notary Serial Number
Print or Stamp Name of Notary Expiration Date
Notary Public — State of
County of
Notary Seal
ATTACHMENT C "Miami -Dade County Affidavits and Declarations" Page 11 of 11
ATTACHMENT D
THIS ATTACHMENT IS NOT APPLICABLE TO THIS
CONTRACT AGREEMENT
ATTACHMENT F
Miami -Dade County Homeless Trust
Monthly Payment Request
NAME OF AGENCY: THE CITY OF MIAMI
SERVICE PERIOD: TO
NAME OF GRANT: MEMORANDUM OF
AGREEMENT (MOA)
GRANT NUMBER: PC-2223-MOA
TOTAL AWARD AMOUNT: $340,000.00
AMOUNT OF FUNDS REQUESTED
THIS MONTH: $
AMOUNT OF FUNDS RECEIVED TO DATE: $
BALANCE REMAINIG ON GRANT: $
(following payment of this request)
Signature of Executive Director or Date
Authorized Agency Representative
Printed Name of Executive Director or
Authorized Agency Representative
ATTACHMENT I
THIS ATTACHMENT IS NOT APPLICABLE TO THIS
CONTRACT AGREEMENT
ATTACHMENT G
CONTINUUM OF CARE (CoC) HOMELESS ASSISTANCE
PROGRAM
o HUD MONTHLY CoC MONTHLY PERFORMANCE
REPORT (MPR) — HMIS GENERATED MONTHLY
REPORTS
o HUD ANNUAL CoC ANNUAL PERFORMANCE
REPORT (APR) — HMIS GENERATED ANNUAL
REPORTS
Reports must be generated from the ServicePoint HMIS
reporting system or HMIS system approved by the
Miami -Dade County Homeless Trust.
ATTACHMENT G, PERFORMANCE REPORTS (MONTHLY AND ANNUAL) APR AND HMIS
ATTACHMENT H
THIS ATTACHMENT IS NOT APPLICABLE TO THIS
CONTRACT AGREEMENT
ATTACHMENT I
THIS ATTACHMENT IS NOT APPLICABLE TO THIS
CONTRACT AGREEMENT
ATTACHMENT J
THIS ATTACHMENT IS NOT APPLICABLE TO THIS
CONTRACT AGREEMENT
ATTACHMENT K
THIS ATTACHMENT IS NOT APPLICABLE TO THIS
CONTRACT AGREEMENT
ATTACHMENT L
MIAMI DADE COUNTY
ANNUAL ACTUAL EXPENDITURE REPORT
THE CITY OF MIAMI-OUTREACH SALARY MATCH / SUPPLEMENTAL
STAFFING COSTS PROGRAM
GRANT NUMBER #: PC-2223-MOA
OCTOBER 1, 2022 - SEPTEMBER 30, 2023
Name of Agency:
Budget
THE CITY OF MIAMI
MEMORANDUM OF AGREEMENT
(MOA) PROGRAM
$ 340,000.00
Month of Services
Amount Paid
OCTOBER -2022
NOVEMBER-2022
DECEMBER-2022
JANUARY-2023
FEBRUARY-2023
MARCH-2023
APRIL-2023
MAY-2023
JUNE-2023
JULY-2023
AUGUST-2023
SEPTEMBER-2023
Total Requested
Balance Remaining
$
0.00
$ 340,000.00
Signature of Executive Director or Date
Authorized Agency Representative
Printed Name of Executive Director or
Authorized Agency Representative
FormRequest
(Rev. October2018)
Department of the Treasury
Internal Revenue Service
for Taxpayer
a Certification $
Identification Number and Ce1 tiiication
- Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
Print or type.
See Specific Instructions on page 3.
f Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
4 Exemptions
certain entities,
instructions
Exempt payee
Exemption
code (if any)
(Applies to accounts
(codes apply only to
not individuals; see
on page 3):
code (if any)
• Individual/sole proprietor or • C Corporation ❑ S Corporation ❑ Partnership 111 Trust/estate
single -member LLC
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Note: Check the appropriate box in the line above for the fax classification of the single -member owner.
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
NI Other (see instructions) ►
to
from FATCA reporting
Do not check
of the LLC is
-member LLC that
maintained outside the dJ.S.)
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part l Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
or
Employer identification number
Part 1!
Certification
Under penalties of perjury, I certify that;
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 1l, later.
Sign
Here
Signature of
I.I.S. person
Date ►
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MIISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X
Form W-9 (Rev. 10-2018)
MbAMla
COUNTY COUNTY
Zc(1>yri &rc
INCIDENT REPORT
ATTACHMENT N
CHECK IF CRITICAL ❑
IDENTIFYING INFORMATION
Reporting Party Phone # ( ) Date of Incident / / Time of Incident : am/pm
Reporting Party Name
Contract Provider Name
Program Name
Provider Location
Specific Category: (check all that apply)
❑ Allegation or wrongdoing ❑ Wrongdoing (as acknowledged by a
third party designated to investigate these claims i.e. law enforcement
detained individual, or DCF accepted abuse report)
Specific location/ address where incident occurred:
TYPE OF INCIDENT
CLIENT RELATED
❑ ALTERCATION
❑ CLIENT DEATH
❑ CLIENT INJURY OR ILLNESS ❑ THEFT
❑ SEXUAL BATTERY ❑ SUICIDE ATTEMPT
❑ PROPERTY DAMAGE ❑ ABUSE OR NEGLECT*
❑ OTHER INCIDENT
Specify
1 of 4
MIAMI=
COUN
TY
ATTACHMENT N
* Failure to report any known or suspected abuse of any kind of a child is a third-degree
felony that may result in a prison sentence of 5 years, and a fine of $5,000 (Refer to Chapter 39
& 415 of the Florida Statutes).
STAFF RELATED
❑ INAPPROPRIATE EMPLOYEE ACTS OR OMISSIONS THAT
RESULT IN CLIENT INJURY, ABUSE, NEGLECT, OR DEATH
❑ FRAUD ❑ THEFT
❑ BREACHES OF CONFIDENTIALITY
0IMPROPER EXPENDITURE OR COMMITMENT OF PUBLIC
FUNDS -OR-CONTRACT MISMANAGEMENT
0 COMPUTER RELATED MISCONDUCT
OANY VIOLATION UNDER §435, F.S., TITLE X XI, EMPLOYEE
SCREENING, THAT WOULD RESULT IN DISQUALIFICATION
FROM CLIENT CONTACT DUTIES
❑ FALSIFICATION OF OFFICIAL RECORDS
❑ MISUSE OF POSITION OR STATE PROPERTY, EMPLOYEES,
EQUIPMENT, OR SUPPLIES FOR PERSONAL GAIN OR PROFIT
❑ FAILURE TO REPORT KNOWN OR SUSPECTED NEGLECT OR
ABUSE OF A CLIENT
❑ OTHER INCIDENT THAT WOULD BE A VIOLATION OF
STATUTE, RULE, REGULATION OR POLICY
Specify
2 of 4
MIAMKO
COUNTY OUNTY
bc6erI 5 c c//cxtc E*, c7y
ATTACHMENT N
PARTICIPANT (S) / WITNESS (ES)
(Please mark W or P for either Witness or Participant)
Staff ID # or Client HMIS # CLIENT EMPLOYEE OTHER
❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ❑
W/P
❑ Wor❑P
❑ Wor❑P
❑ Wor❑P
DESCRIPTION OF INCIDENT
Give detailed account — who, what, where, when, why, how — add pages if necessary
CORRECTIVE ACTION AND FOLLOW UP
Immediate corrective action taken
Is follow up action needed?
❑ Yes ❑ No
If yes, specify
INDIVIDUALS NOTIFIED
Abuse Registry 1-800-962-2873
Applicable Law Enforcement Department
Indicate name of person contacted, if report was accepted, the date and time if called or copy of report
Incident Reports — The Subrecipient must report to Miami -Dade County Homeless Trust information related to my
critical incidents occurring during the administration term of its programs. In addition to reporting this incident to
the appropriate authorities the Subrecipient must within twenty-four (24) hours of any incident, submit in writing a
detailed account of the incident. This incident report should be addressed to the Contract Officer or Administrative
Officer assigned. This incident report should be addressed to Miami -Dade County Homeless Trust, 111 NW First
Street, 27th Floor, Suite 310, Miami, Florida 33128; telephone (305) 375-1490 and facsmilie (305) 375-2722.
3 of 4
MIAMI•�
COUN
TY
Dejorrn6 Exelleitce El.cry
Definitions of Reportable Client Incidents
ATTACHMENT N
a. Altercation. A physical confrontation occurring between a client and employee or
two or more clients at the time services are being rendered, or when a client is in the
physical custody of the department, which results in one or more clients or employees
receiving medical treatment by a licensed health care professional.
b. Client Death. A person whose life terminates due to or allegedly due to an accident,
act of abuse, neglect or other incident occurring while in the presence of an employee,
in Homeless Trust contracted program facility.
c. Client Injury or Illness. A medical condition of a client requiring medical treatment
by a licensed health care professional sustained or allegedly sustained due to an
accident, act of abuse, neglect or other incident occurring while in the presence of an
employee, in a Homeless Trust contracted program.
d. Other Incident. An unusual occurrence or circumstance initiated by something other
than natural causes or out of the ordinary such as a tornado, kidnapping, riot, or
hostage situation, which jeopardizes the health, safety and welfare of clients.
e. Sexual Battery. Any allegation of a program participant or program staff
intentionally touching a minor or another person without their consent. This includes
incidents of inappropriate verbal offenses, incidents that occur outside of the
residence, and incidents were the program participant was victimized by someone
outside of the residence. Incidents involving a minor, person who is 60 or older, or
someone who is disabled must be reported to the DCF.
f. Abuse or Neglect. Any physical maltreatment of a child, disabled person, or someone
age 60 or older. Any failure to act on the part of the parent or care taker, which results
in harm to a child, disabled person, or someone age 60 or older.
g.
Suicide Attempt. An act which clearly reflects the physical attempt by a client to
cause his or her own death while in the physical custody of the depail.inent or a
departmental contracted or certified provider, which results in bodily injury requiring
medical treatment by a licensed health care professional.
h. Property Damage. An incident involving damage to property procured with Homeless
Trust funding.
4 of 4
ZrirErer o
■
Real Property and Equipment Asset Inventory
Equipment � an acquisition crest afgreater t .t 0.06 per trillit and an real prey rustA
inventoried. Real property includes land, laud mp ns. structures and appurtenance%
Plowable machinery and equipment,
Property and Property improsement Recent
Legal Description;
Size
Date aff
Vahe at TIME of Pan:base
Owne'4 .s Name (if id. than the 1, Hi ill III-1 611 13:
wax (attach tom) indicate where property is in para,is 1lots our blocks and Strallir adjacenit streets and
roads
Equipment 1:
Sena' 1 f ID Number
Dam..
F. ;IFilr' �.
Cost
Vendor Name
�; Sa of Purchase from Grant
Eoctlt. l SiPYg'5��t.1.
Use Condition of PIl ty:
Who Holds r?
Equipment 2:
rip/ir-r`lta
of Property:
SerialID limber;
Cost
Vr Name
Parobase Cost from Grant
Location of Pmparty:
Used Condition of Properly:
Tide?Who Holds
Equipment3:
Description of Property:
Sandal / ID litinitt
Acq 'McMinn
Cost
Vendor Name
etviPurchase Cost from Grant
LaSegian of Property:
Use and of
Who Holds "fie?
Vitiease create additional pages as required)
ArrAciotorri
Courtly l Property and Equipment Asset Inventory'
AT . CtIMEN'r P
MIAMI DADE ODUNT Y' HOMELESS *`RUST
• CLIEN #`SERRV/MS CERTIF'MCA710 REFERRAL'FORM FOR EMPLOYEES OF
1:I0ME1 SS TRUST FlUNDEUPROaRAlvlS
IRS3RUCJ 1WNS: Provider paling referral must Complete this two -page form, *jading- signatorss
by Applicant and 1'roriderRep resentatives. Fax completed forms to PviderReceivingReferral for
o�se;.ar}dar5esclees. -
Date: Refuting Provides. -
Contact Parson:
Naive
INF0RMATIQN ON HEAD OF HOUSEHOLD: _
FiistName:
SS
Last Nance:
Date of $itch:
Title - ' • - .. Phone Nurrkb ' .
• I1,I17O1 MATION ON arlimIKVSEHOLD MOW&
Relationship ttployer
Name
Age
•
IS. ANY MS3VIBER OP THE 11011SILHOLH RivIPLOYKD'B ?, QREZLATlgi TOANEMPLOYEE
0?, A HtiM1FL US'T RU IDPI».R0GRAMY Yeses ' Na
1 -
IVarne of Ernployee:-
Employing Provider.
Relationzhipto•Applicarit
GHRTIFIGATION .
I, the undersigned, do Hereby certify that Se above:informatian p i•Otlul-lxj! me,ir3r ee:EreetV the
rest of irry kt►oaledge: '
Applicant's Name -
'�ifurec-
Referring Provider Author/v.4_Representative
Nance: .Sirrnar€.
a
ATTACHMENT P
- PROVIDER REFERRAL FORM. PACE TWO .
- Appl canf s Nam -
If the Applicant or a Member oatheir h beld is an employeeef the refrrriag provider, the
• apprcrral of the Prorir r E*e�ye Director is hereby indit:ited by rgnature:
Narnelritle Date
•
If the Applicant ar.a member of their housthald is'in employett of the provider where services -will be
provided,. the approval nine Prdvider)?zeeutive nectar, tl a Homeless Trust xe c tive Dir:#or;
and the Homeless Treat Board Chair -are hereby it lusted by signature:
•
ProdiderExecutive Director '
l+Ilanii-Dade Comity Homeless Trast Chairperson
i i-pade Comity Homeless trastExecative Disector
ADD1T' O:NAL. HouSEHoLD INFORMATION. _
Where is the household livg nc ? (Fasility Hanle, and *Tr*
Date
Date of prtsetrt homelessness:
Explain the homeless simal3on, and what caused the c rrett
homelessness:
Date
PROVIDII 3 Tl of:WE-INFORMATION DOES NOT ENSURE APPROVAL FOR HOUSING
• OROT R SERViC$S RNQUEESTRD.'A DETERMINATION WILL OE MADE FOLLOWING A
-COMPLM �SMENT OF MX APPLICANT'S CASL -
THIS SECTION FOR SERVICE PROVIDER STAFF USE ONLY.
Medc YES �- NO •
l yrinse-of Ftrovfder-Seresting. `:
PLEASE MAINTAIN THE EXECUTED -COPY -OF THIS DOCUMENT IN THECLIEN'r FILE 4F
1'IiE $Ea%'ICING PROVIDER AND PEItSONNEi<Fi l.E OF REFER` ING PRO1VlMR. •