Contract Hotel/Motel Placement Program (-2�l z---- 2779 3�
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
CONTRACT
This Contract made and entered into as of this AT'�_da Y of 00). 2012
by and between Miami-Dade County, 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 Beach//F.E.I.N #59-6000372, a corporation organized and existing
under the laws of the State of Florida, having its principal office 1700 Convention Center
Drive, Miami Beach, FL 33139 ("Provider"), states conditions and covenants for the rendering
of human and social services ("Services")for the County.
WHEREAS, the Home Rule Charter authorizes the County to provide for the uniform
health and welfare of the residents throughout the County and further provides that all functions
not otherwise specifically assigned to others under the Charter shall be performed under the
supervision of the Mayor or the Mayor's designee; and
WHEREAS, the Provider provides or will develop services of value to the County and
has demonstrated an ability or desire to provide these services; and
WHEREAS, the County is desirous of assisting the Provider in providing those services
and the Provider is desirous of providing such services; and
WHEREAS, the County has appropriated funds for the proposed services;
NOW, THEREFORE, 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 Contract 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 /
Page 1 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 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) "HIPAX means Health Insurance Portability and Accountability Act of 1996.
i) The words "Scope of Services" shall mean the document appended hereto as
Attachment A, 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:
Emergency Hotel/Motel Placement Program $50,040.00
HMIS Staffing Program $12,333.00
Total Award $62,373.00
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.
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 N/A once the
Provider has submitted an appropriate request and submitted an invoice in the form required by
the County.
Page 2 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
ARTICLE 3. SCOPE OF SERVICES
The Provider shall render services in accordance with the Scope of Services
incorporated herein and attached hereto as Attachment A.
The Provider shall implement the Scope of Services as described in Attachment A in a
manner deemed satisfactory to the County. Any modification or amendment to the Scope of
Services shall not be effective until approved by the County and Provider in writing.
ARTICLE 4. BUDGET SUMMARY
The Provider agrees that all expenditures or costs shall be made in accordance with the
Budget, which 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.
ARTICLE 5. EFFECTIVE TERM
Both parties agree that the Effective Term of this Contract shall commence on
October 1, 2012 and terminate at the close of business on September 30, 2013. Contingent of
the existence of sufficient funding and the approval of the County, this Contract may be
extended for two (2) additional one (1) year terms, 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.,
subject to the provisions of that Statute whereby the government entity shall not be held liable to
pay a personal injury or property damage claim or judgment by any one person which exceeds
the sum of $100,000, or any claim or judgment or portions thereof, which, when totaled with all
other claims or judgment paid by the government entity arising out of the same incident or
occurrence, exceed the sum of $200,000 from any and all personal injury or property damage
claims, liabilities, losses or causes of action which may arise as a result of the negligence of the
government entity.
Page 3 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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.
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. 1 St Street, Suite 2340
Miami, Florida 33128
B. 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.
Page 4 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 mini-buses 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.
I. 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 Providers whose combined total award for all services
funded under this Contract exceed 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.
Page 5 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
K. 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 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
laws, regulations, ordinances and resolutions regarding background screening of employees
and subcontractors. Provider's failure to comply with any applicable laws, regulations,
ordinances and resolutions regarding background screening of employees 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 with vulnerable persons, as defined by section 435.02, Florida
Statutes, as may be amended from time to time.
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 in direct contact with vulnerable persons.
Page 6of27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
The Provider agrees to ensure that employees and subcontracted personnel who work
with vulnerable persons satisfactorily complete and pass Level 2 background screening before
working with vulnerable persons. Provider shall furnish the County with proof that employees
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 or subcontractor's
Level 2 background screening was satisfactorily passed and completed prior to that employee
or subcontractor working 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, step-parent, or step-child; 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.
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.
Page 7 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 se q., which prohibits discrimination in
Page 8 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 se g. 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 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 se g. 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.
Page 9 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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. 1 St Street, 27th Floor
Miami, Florida 33128
Attention: Hilda M. Fernandez, Executive Director
Electronic mail: .HildaFernandez @miamidade.gov
If to the PROVIDER:
Kathie G. Brooks
Interim City Manager
The City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
Electronic mail: KathieBrooks @miamibeachfl.gov
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
Page 10 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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
I icensu re/certifi cation 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 (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 0 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 ® Not Applicable
Page 11 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 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;
Page 12 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 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
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.
The County may also, in its sole discretion, terminate the contract.
The Provider understands and acknowledges that if the County determines in its sole
discretion that termination of the Contract is necessary for the healthy, safety, or welfare of the
County then it may due so upon twenty-four(24) hours notice to the Provider.
Page 13 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
ARTICLE 17. PAYMENT PROCEDURES
The County agrees to pay the Provider 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 F "Monthly Payment Request". The payment
request for the previous month is due by the 15th of the month following the month
for which payment is invoiced.
2. Payment will be processed as follows: a) The Hotel/Motel Placement funds will
be paid on a reimbursement basis for the provision of placement services. B) The
HMIS Staffing Program funds will be paid in twelve (12) equal monthly installments
of$1,027.75.
3. Any reimbursement may be withheld pending the receipt and approval by the
County of all reports and documents required herein.
4. The parties agree that payment will be based upon the provision of services
outlined in Attachment A, the "Scope of Services", for each program.
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.
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.
Page 14 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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.
The County reserves the right, at its sole discretion to convert this Contract to 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.).
Once the County, in its sole discretion has made the determination to convert to a cost-based
method, 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 25th 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 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.
Page 15 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 Performance Reports (Attachment G) 0
3. Outcome Performance Measurements Monthly Report (Attachment H) ❑
4. Client Contribution Report (Attachment 1) ❑
5. Client Attendance Roster (Attachment J) ❑
6. 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
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.
Page 16 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 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.
Page 17 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 of 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.
I. 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 ❑x three (3) years or ❑ years (for State contracts)
from the expiration date of this Contract.
The Provider agrees to participate in evaluation studies, quality:-management
activi
ites, Corrective Action Plan activities, and analyses carried out by or on behalf of the
County to evaluate the effectiveness of client service(s) or the appropriateness and quality of
Page 18 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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
Page 19 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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.
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.
ARTICLE 20. Office of Miami-Dade County Inspector General and the Commission
Auditor
The Provider understands that it may be subject to an audit, random or otherwise, by the
Office of Miami-Dade County Inspector General or an Independent Private Sector Inspector
General retained by the Office of the Inspector General, or the County Commission Auditor.
Independent Private Sector Inspector General Reviews. The attention of the
Provider is hereby directed to the requirements of Miami-Dade County Code Section 2-1076; in
that the Office of the Miami-Dade County Inspector General (IG) shall have the authority and
power to review past, present and proposed County programs, accounts, records, contracts and
transactions. The IG shall have the power to subpoena witnesses, administer oaths and require
the production of records. Upon ten (10) days written notice to the Provider from IG, the Provider
shall make all requested records and documents available to the IG for inspection and copying.
The IG shall have the power to report and/or recommend to the Board of County
Commissioners whether a particular project, program, contract or transaction is or was
necessary and, if deemed necessary, whether the method used for implementing the project or
program is or was efficient both financially and operationally. Monitoring of an existing project or
program may include reporting whether the project is on time, within budget and in conformity
with plans, specifications, and applicable law. The IG shall have the power to analyze the need
for, and reasonableness of, proposed change orders.
The IG may, on a random basis, perform audits on all County contracts throughout the
duration of said contract (hereinafter "random audits"). This random audit is separate and
distinct from any other audit by the County. To pay for the functions of the Office of the
Inspector General, any and all payments to be made to the Provider under this contract will be
assessed one quarter (1/4) of one percent of the-total amount of the payment, to be deducted
from each progress payment as the same becomes due unless this Contract is federally or state
Page 20 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
funded where federal or state law or regulations preclude such a charge. The Provider shall in
stating its agreed prices be mindful of this assessment, which will not be separately identified,
calculated or adjusted in the proposed budget form.
The IG shall have the power to retain and coordinate the services of an independent
private sector inspector general (IPSIG) who may be engaged to perform said random audits,
as well as audit, investigate, monitor, oversee, inspect, and review the operations, activities and
performance and procurement process including, but not limited to, project design,
establishment of bid specifications, bid submittals, activities of the contractor, its officers, agents
and employees, lobbyists, County staff and elected officials in order to ensure compliance with
contract specifications and detect corruption and fraud.
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
Page 21 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
be considered skilled and experienced, the Subcontractor 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 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
Page 22 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 sec. of the Code
of 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 mock up 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.
Page 23 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
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 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.
Page 24 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
I. Incident Reports. The Provider must report to the Miami-Dade County
Homeless Trust information related to any 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) 375-2722.
J. Totality of Contract / Severability of Provisions. This Contract and
Attachments, with it 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:
K. Property. This section applies to equipment with an acquisition cost of $5,000 or
more per unit and all real property.
a. 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.
b. 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 O).
Page 25 of 27
The City of Miami Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
C. 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: Scope of Services
Attachment B: Budget
Attachment C: Miami Dade County Affidavits
Attachment D: State Affidavits(NOT APPLICABLE)
Attachment E: Primary Care Invoice for Services(NOT APPLICABLE)
Attachment F: Monthly Payment Requests Reports
Attachment G: Monthly Performance Reports (NOT APPLICABLE)
Attachment H: Outcome Performance Measurements Monthly Report
Attachment I: Client Contribution Report (NOT APPLICABLE)
Attachment J: Client Attendance Roster(NOT APPLICABLE)
Attachment K: Vacancy/Permanent Housing Placement Report(Quarterly)
(NOT APPLICABLE)
Attachment L: Annual Performance Report&Annual Actual Expenditure Report
Attachment M: W-9 Form
Attachment N: Incident Report
Attachment O: Provider Asset Inventory Report
Attachment P: 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 Beach
Hotel/Motel Placement Program PC-1213-HTMT-2
HMIS Staffing PC-1213-HMIS-2
IN WITNESS WHEREOF, the parties have executed this Contract, along with all of its
Attachments, effective as of the contract date herein above set forth.
THE CITY OF MIAMI BEACH MIAMI-DADE CO
'Y/
By: W7""�
B Y Name: 'I -Y
Name: K —R-HL 12-(D ptj Title: AA U V
Title: C P—Ae 0 M(a-C\-( YVVH�W Date:
Date: >
Attest: HARVEY RUVIN, Clerk
Attest: � Board of County Commissioners
uthorized Verson OR
Notary Public
By:
Print Name: ' Print Name: 1 -=w
Title: �b •
°0
tim.3 .e• �.+-`—g. s
Corporate Seal OR Notary Seal/Stamp: k 01,
_� 8� p�fn•. �
Uj r
i �y R.�1 •
.�e
lb
09 983701
! �m 49 1 F R
APPROVED AS TO
FORM & LANGUAGE G
& FOR EXECUTION
ify orn �,, Date
Page 27 of 27
Attachment A
The City of Miarni Beach
Emergency Hotel/Motel Placement Program
Scope of Services
The Provider agrees to provide emergency hotel/motel placemmb of homeless families
with children for a period of up to seven (7) days in axea hotPldmotels. In addition, the
PROVIDER may also place chronic homeless individuals as well as hard-to-serve,
transgender clients, on an as-needed basis.
Chronic homeless individuals as' well as hard--to-serve transgender clients may be
provided food vouchers on an as-needed basis of up to $20.00 per diem. Families with
two (2) to three (3) members may be provided food vouchers on an as needed basis of
$20.00 per diem while residing in hotels/motels. Families with four (4) to five (5)
members may be provided $25.00 per diem,-families with six (6) to eight (8) members
maybe provided $40.00 per diem, and families with nine (9) members may be provided
$45.00 per diem while residing in hotels/motels.
Reimbursements will only be made for properly documented disbursement of food
vouchers.
All reimbursements must be submitted to the County by the I5th day of each month
following the month of service.
All reimbursement requests must be approved by the County prior to the disbursement of
funds.
The City of Miami Beach
HMIS Staffing
Scope of Services
The PROVIDER shall provide a dedicated HMIS Outreach staff person. The purpose of
this staff position is to maintain data current in the HMIS and includes, but is not limited
to input of client data upon intake, updates of client files, compilation of reports
entering data for statistical purposes. Failure to maintain this data current, as evidenced
by HMIS generated Monthly Progress Reports submitted to the County each month under
the U.S. HUD sub-recipient Agreement between the City of Miami Beach and the
Miami-Dade County Homeless Trust may result in the termination of this Agreement.
Attachment B
City of Miami Beach/Hotel and Motel Placement
6. Categorical Budget
B. Operating Costs
City of
Object Class Cost MDHT% Miami Justification
Beach %
323 nights @ Emergency hotel stays for
Emergency average rate ° homeless families and trans-
Hotel of$130.00 per $41,990.00 100% gendered individuals due to
Placement night unavailable emergency shelter
Emergency hotel stays for
50 nights @ homeless families and trans-
$59.00 per $ 2,950.00 100% gendered individuals due to
night unavailable emergency shelter
beds
200 vouchers Food Gift Cards for families of less
Food Vouchers @$20.00 per $ 4,000.00 100% than 3 persons per household or
voucher trans-gendered individuals
10 vouchers
@$25.00 per $ 250.00 100% Food vouchers for families with 4 or
5 household members
voucher
10 vouchers
@$40.00 per $ 400.00 100% Food vouchers for families with 6 to
8 household members
voucher
10 vouchers
@$45.00 per $ 450.00 100% Food vouchers for families with 9 or
more household members
voucher
TOTAL j $50,040.00
C. Other Outside Contractual Services: N/A
D. Indirect Administrative Charges: N/A
1�
ATTACHMENT B
City of Miami Beach/HMIS Staffing
HMIS Staffing Grant Budget
1 HMIS Administrator
Annual Salary $42,719.30
HMIS Staffing Grant Amount" $12,333.00
"This amount represent a portion of the annual salary per this contract agreement.
Attachment C
City of Miami Beach/HMIS Staffing
Hotel/Motel Placement
M[YAAH-DADS COUNTY HOMELESS TRUST
R+L"H-DARE COUNTY REQUDZED AFFIDAVITS
The contracting individual or entity(governmental.or otherwise)shalt indicate by an"X"ap affidavits that pertain
to.this conblet acid shall indicate by an"NIA"all affidavits that do not pertain to this contract. All blank spaces must be
fitted.
The. A±IIAMWADE COUNTY QWNERSHIP DISCLOS[RE AFFIDAVIT; MIAMI-DARE COUNTY
EM
PWYMENT DISCLOSURE AFFIDAVIT; MlA"-DAD,E CRIMINAL.RECORD AFFIDAVIT; DISABILITY
NONDISCRIMINATION AFFIDAVIT;and the PROJECT FRESH START AFF115AVIT shall not pertain.to contracts
with the United States or any of its departMents.or agencies thereof; the State or any political subdivision or agency
thereof or any engnicipality-of this State. The MIAMI-DADS FAMILY LEAVE AFFIDAVIT shall not pertain to
contrasts with the United States or any of its departments or agencies or the State of Florida or any political subdivision or
agency thereof, it shall, however,.pertain,t4:inunicipalities of the.State.of Florida.. All.other contracting entities or
individuals shall read carefully each affidavit to deterrtiide whether or not it pertains to this contract
L. Pao k-S
I► � � � .being first duly sworn state:
The full legal nine and business address of the per or entity contracting or transacting business with Miami-Dade
County are(Post Office addresses are not acceptable):
000-3--72
Federal Employer Identification Number(If none;Social Security)
Name of Entity,Individual ft Partners,or Corporation
Doing Business As(if safti as above,leave blank)
t'10 C� Cc� 1��Ctc� N C 1012-1 VVv e4rvu ►3��-L-��C—�33r�5
Street Address -City State zip Code
XIr MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT(See.2-8.1 of the County Code)
1. If the contract or business transaction is with s corporation,the full legal pan and business address shall be
provided for each otlicer and director and.peach stockholder who bolds directly or indirectly five percent.(3%)or
More.of-tht corporation's. stock_. If the contract or business trAosacbon is with a partnership, the foy.W grog
inforipation shall.be provided for each partner. If the contract or business transaction os vrith a mist,the full
legaR carne and address shall be,provided for each trustee.and each benefrciary. Tire.foregoing requirements
shall p0`pertain to.contracts with publicly traded corporations or to contracts with the United States or any
department or agency thereof,the State or any"poiitical subdivision or agency thereof or any municipality of this
State. All such names and addresses are(Post Office addresses are not acceptable):
I of 3
Full Legal Name Address Ownership
%
%
2. The full legal,names and business address of any other individual(other than subcontractors,material men,
suppliers,laborers,or lenders)who have,or will have,any interest (legal,equitable beneficial or otherwise)
in the contract or business transaction with Dade County are(Post Office ad sses are not acceptabie):
3. Any person who willfully fails to disclose the information required herein, or who knowingly discloses
false information in this regard, shall be punished by a fine of up to five hundred dollars ($500.00)or
imprisonment in the County jail.for up to sixty(60)days or both..
R. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT(County Ordinance No.9.0-
133,Ameadift sec.2.&l;Subsection(r x2}ofthd County Code).
Except where pre eluded.by federal or State.laws or.Tgvlations,each+coirtract or business transaction or renewal
thereof which involves the exliendituru of tdn thobsati dollars ($100000) or mote.shall require the entity
contracting or transacting business to disclose the fotlowing 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 theaedor any municipality df this State.
,yesjyour firm have a collective bargaining agreement with its employees?
s
2. your firm provide paid health care benefits for its..employees?
des _No
3. Provide a current bi eakkdov*'n(humber of persons)of your-firm's
Work force;and ownership as to race,national origmt'and gendei: --7
White: Wes es(� Females Asian; (�Males / Females
B1ack:2 Males Females American Indian: Males Females
Hispanics.2 Mal females Me kimo): Males Females
�,( Males Females: ocx�►�► _Males-7 Females
Y-]I. AI~FUtHATIVE ACTIONINONDISCRIMINATION OF EWLOYM.ENT, PROINQTION AND
PROCUREMENT PRACTICES(County Ordinance 98-30 codified at 2-8.1.5 of the County Code.)
In 4c cordance with County Ordinance No, 98-30, entities with annual gross revenues in excess of$5,000.000
seeking to. contract with She County sha]J, as a.condition of reeiving a County contract, havu.; i) a.written
affirmative action plan whicli sets forth the procedures the entity utilizes to assure that it does not discriminate-in
its empla}rent and promotion practices;and ii)a written procurement policy which sets forth the procedures the
entity. utilizes to assulm 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 notwithstanding, corporate entities whose
boards of directors are representative of the populatiorr make-up of the nation shall be presumed to have non-
discriminatory employment and procurement policies,and shall not be required to have written affirmative action
plans and procurement policies in order to receive a.County contract. The foregoing presumption may be
rebutted.
2 of
j
The requirements of County Ordinance No. 98-30 may be waived upon the written recommendatiop.of the
County Manager that it is in the best interest of the County to do so and upon approval of the Board of County
Commissioners by majority vote of the members present.
The firm does not have annual gross revenues in excess of$5,000,000.
The firm does have annual revenues in excess of $5,000,000; however, its Board of Directors is
representative of'the populatioo make.-up,of the nation and has submitted a written,detailed
listing of its Board of Directors, including the race or ethnicity of each board member,to the County's
Department of business Development,175 N.W,1 st Avenue,28th Floor,Haim,Florida 33128.
The firm has annual gross reyedues in excess of$5,000,000 and.the firm does have a written afrwriative
9ction plan and procurement policy as-described above,which includes periodic reviews to determine
effectiveness, and has submitted the plan and policy to the County's Dgmxta ant of Business
Development 175 N.W.la Avenue,28th Floor,Miami,Florida 33128;
The firm-does not have an affirmative action plan and/or a procurement policy as described above,but has
been granted aawaiver.
P v_ MIAW_DADE COUNTY CRIMINA ,RECORD AFFIDAVIT(Section 2-8:6 ofthe.County Code)
The individual or nti .entering nto a contract or receiving funding rom the County as has not of
the date ofthis af�dait been cativicwd of a felony during the past en(10).years. tY
An officer ,' r,or executive of the entity entering into a contract or receiving funding from the County
has as not of the date of this affidavit been convicted of a felony during the past ten(10)years.
V. MLkMI-DADS EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT(County Ordinance No.
92-15 codified as Section 2-8.1.2 of the County.Codej
That.in corripliance with Ordinance No.92-15 of the Code.of Miami-Dade Corrnt3!,Florida,the above named
parson or entity is provii1i ig a drug;-fret workplace. A written statement to each employee shall inform the
erployee about:
1. danger of dfug abuse in the workplace
2. the firm's.poliey of maintaining a drag-free environment at all workplaces
3., availability of drug cbgnseling,rehabilitation and.employee assistance programs
4. penalties that may be imposed upon employees for drug abuse violations
The person or entity shall also require an employee to sign a statement,as a condition.of employmc at that the
employee swill abide by the ternGis and notify the-employer of any criminal drug conviction occurring no later
than five.(5)days after receiving nptice 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 W the person or entity. make it necessary for the operation of the County,or for the health, saky,
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.arose provisions are in conflict with the requirements of those governmental
entities.
3 of S
i
VI. MIAMI-DARE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinance No.
142-91 codified as Section i I A-29 et seq of the County Code)
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 we*s, 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
faintly leave during anxtwenty-four(24)month period,for medical reasons,for the birth or adoption of a chi Id,
or for tile.care of a chid, spouse or other close relafive who has a serious health condition without risk of
termination of employment oremployer retaliation.
The foregoing requimments shall not pertain to contracts with the United States or any.department or agency
thereo.t or the State.of Florida or any political subdivision or agency thereof. It shall, however, pertain to
municipalities ofthis State.
:
,_VII. DISABILITY NON DISCRIMINATION AFFIDAVIT(County Resolution R-385-95)
That the above named Fwn,corporation or or:gariization is in compliance with and a&rees to continuo to,comply
with,and assist that any subcontractor,or third party"eoiltraotor under this project.complies with all applicable.
requirenients of the Haws Bated below includin&but'not limited to,those provisions pertaining to employment,
provision.of programs.aced seivices,transportation,communications,access to.facilities,renovations,and new
construction in the.following laves: The Americans with Disabilities Act of 1990(ADA),Pub.L.101-3362 104
Stat 327,42 U.S.C. 12101-12213 and 47 U.S.C.Sections 225 and 611 including Title 1,Etnployrnept;Title
II, Public Services; Title I1I, Public Accommodations and Services Operated.by Private Entities; Title IV,
Telecommunication's; and Title_V, Miseella dous Provisions; The Rehabilitation Act of 1973,.29 U.S.C.
Section 794;The Federal Transit Act,as amended 49'U.S.C.Section 1612;'lase Fair(lousing Act as amended,
42;U:S.C.Section 3601-3631. The foregoing.requirements shall not pettaip to-contracts with the United.States
or any department:or agency thereof;the State or any political subdivision or'r ge
ancy thereof or any"municipal.ity
of this State.
VIII. MIAhI[Y-I�DE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE FEES OR
TAXES(Sec.2-8.1(c)of the C ianty Code)
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
curtendy due fees or tames.»inclu4.bhg but not limited to real and.properly 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.
_IX. CURRENT ON ALL COUNTY CONTRACTS,LOANS AND OTHER OBLIGATIONS
The individual entity seeking to transact business with the County is curtent in.all its obligations to the County
arid.is opt-otherwise in default of any contract;promissory note or-other loan document with the County or any
of its agencies or instrumentalities.
4ofS
X. PROJECT FRESH START(Resolutions R-702-98 and 358-99)
Any firm that has a contract with the County that results in actual payment of$500,040 or more.shall contribute
to Project Fresh. Start, the County's Welfare to Work Initiative. However,if five percent(5%)of the firm's
work force consists of individuals who reside in Miami--Dade County and who have lost or will lose cash
assistance benefits (formerly Aid to Families with Dependent Children) as a result of the Personal
Responsbility aid Work Opportunity Reconciliation Act of 1996; the firm may request waiver from the
requmements of R-702-98 and R-38-99 b}+submitting a waiver request affidayit� T[ae fgi-egoSctg requirement
does not pertain to government entities,not'for profit organizations or recipients of grant a�i+ards.
�—XI- DOMPSTIC VIOLENCE LEAVE(Resolution 185-00;99-5 Codified At 11 A-60 Et Seq.of the Miami-Dade
County Code).
The firm desiring to do business with.the County is in compliance with Domestic Leave Ordinance,Ordinance
0-5,codified at 11A-60 et.seq.of the Miami Dade County Code,which requires an employer which has in the
regular eourse of business fifty(50)or more employees working in Miami-Dade County for each working day
during each of twenty(20)or more calendar woik weeks in the current or proceeding calendar years,to.provide
136m0stic V iolence heave to its employees.
[ have carefully read this satire five (5) page document entitled, "Miami-Dade County Affidavits". and have
indicated.by.dln "X".all affidavits that pertain to this contract and have indicated by an-"NIA"all-affidavits that do not
pertain to this conract
�'� d /2 e /12-
(Signatm of Affiant) (Date)
/
SUBSCRIBED AND SWOkN'�'O(or afFutred)before me this�,da y of k.
20_Zby 4�1 /e C �0 .41dShe is.personally
known to me or has presented as identification.
(Type of identification)
4 ie of Notary) (Serial'Number)
�
f"? , A 0-- e- �,f,
N����A�1$t81!!lOd�lgri
(Pant or Stamp.of Notary) 28 FAA ion Date)
• . Z
9p #DD 983701 Notary Public–Stamp State of F/1) ? �;• -
Zot Sea]Q�'0ndd V4 State • Q �
IC STATr--3 ON"
of
8WORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)FLORIDA STATUTES ON
PUBLIC EAITITX CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE
PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO
ADMINISTER OATHF�
1. This sworn statement is submitted to Miami Dade County by U-r.F.2_CA T`t rvrflnJrint individual's
name annd title in blank). For CI T4 of roc y%rn 1 f?2!E votc print name of entity subm itting sworn
s in blaroQ,whose business address is t-xnp ro r,j,E t, t N Cc=t��(%F-2 0 r2
and(if applicable)who;e Federal•Employer Identification Number(FEIN)is —W no 3'12.or if the
entity has no FEIN,include the Social Security Number(SSN)of the individual signing the sworn statement.
2. 1 understand that a"pubt(c entity crime"as defined in Paragraph 287.133(I)(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.arty public
eirtity or-an agehoy or political subdivision of any other state of thie United States of Ainerica and involving
ahtitiUd,fraud,theft,bribe rry,collusidn,racketeering,conspiracy,or thaterial inlsrepresentation.
3_ 1 udderatand that'"eom►foed"or"corwicrion"as-defined in Paragraph 28y:133(1)(b)Flor(ds:Statutes.rtieans
a 6rld. g of guilt or.a wbviction of a public entity crime,with or withoµtari adjudicatidn of guilt,in any federal
state trial cburt:of recor4 rdiatjng to charges brought by indictmept or informatign after July 1,1989,as a result
of'a jury verdict,non-jury trial,or entry of plea ofguilty orriolo contendere.
4. I understand that an 'ardiare" as defined in Paragraph 28.7.133 (t) (a). Florida Statutes means a) a
predecessor or sacoessor of a person convicted of a public entity crime;or b)an entity under the control of any
ttatui'al person who is.active in the management of the entity and who has been convicted of a public entity
crime. The term"afillarc"includes those officers,directors,-executives,partners,,shareholders,employees,
meinbers,and agents who are active in the managei'nent of an affiliate. The.ownership by one persbin of shares
constitutir#g a coi"lliiig interest-in anothet person;or porting of equipt�nt or incoinie afiwng.persons wben not
fnr£air market value under an 4hn's�length.agreement,shall be.a pains facie case that one person controls
another person. A perms who knowingly enters info a:jpint venture with a person wdia has been convicted of a
piibic�ritity crime in I=lorjda during ohe preceding 36 months shatlbe considered an affiliate.
5. 1.understand.that a "person"as defined in Paragraph 287.133(1)(e)Florida Statutes means any natural
person or entity mpnized tinder the laws.of any state or bf the United States of Ainerica with the legal power to
eater 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 otberw,ire transacts or applies to transact business with a public entity. The berm
'person"includes those officers,directors,executives,partners,shareholders,employees,meinbers and agents
who are.active m the management of an entity.
6. Base¢on Informs!(oia.and belief,the statement as.marked below and-on the next page,is true in relation to the
entity.subtttfitii%hurls sworn statement;.
(Please brdlcate iphich statemenf applies by applying the in&Wdual Initials fn'the blank).
X\. Nelthor the entity submitting this sworn statement nor any of its officers,dbmciors,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.
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
(please Indicate IP1he additional statement is applicable)
CONTINUES ON NEXT PAGE
I
The entity submitting this sworn statement,or one or more of its officers,directors,executives,
partners,shareholdets,.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 Offi w'of the State of Florida,
Division ofAdminlstra#ye t-Iearings 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"(attached is a copy ofthe Final Order).
IC UNDERS'T'AND THAT.THE SUBMISSION OF $HIS FORM TO THE CONTRACTING OMCE
FOR THE PU13LIC ENTITy ID IN PARAGOAPII ONE(1)OF TJA E PREVIOUS PAGE IS
&`OR'I•HA3'PUBBLIC ENTd'g'Y ONLY.AND THAT THIS FORM IS VALID TMIOlUGH THE LEE OF
TIRE CONTRACT:
I AIL SO WMERSTAND.TUAT I AM RE.Q><!�[tE0 TO.INFOR'. 719 PUBLIC ENTITY!?RI®R TO
ENTERING,D"-A C0.1�J I ACi' IN EXCESS.OF THE-77iRE5'#IOLD AMOIJN'I' PROVIDED IN
SECT. . 287.017 F QRIDA STATUTES FOR CATEGORY 2 OF ANY CHANGE IN THE
IxF ORMATiION CONTAINED IN THLS FOB.
htgnatur,e and Date).
State of Flo
County of_,�/
(ERSONAI;LY APPEARED before me,the undersigned authority
1 a 6`• iStOralcS(name of individual signing).who,after-being swom by me,
affixed hisTher signature i the space provided above on
this tlfre / i tray of ,�- �/2 a
, ��111111111111///
\\t1AN BF �
'ex /Z NOTARY PUBLIC
\X� N0129 X04, �9�y My commission expires
:-ate
e�e ADD®• .a m:
co
G .Y0% r •
3, dthru :
Of 10\\\\
AFFIDAVIT OF MIAMI-DADS COUNTY
LOBBYIST REGISTRATION FOR ORAL PRESENTATION
(1) Project Title: HYn l S 9-TOV6r rJG 1+0TtF-,L Project No:
(2) Depwtnent: et-,-14-CO
(3) FirntlProposer's Name: C iT`j O F rV\t AeV%t 8 C pn'G H
Address: aLzip:
Business Telephone: 6CO (p-13--75"i 0 -
(4) List All Members ofthe Presentation Team Who Will Be Participating in the Oral Presentation
NAME TITLE EMPLOYED BY TEL.NO.
sv0--f t-ro rySl-�-t=u &V4qAfiS nAG-r� Gt'tY or 30,�--C73=)E(a
QS -7 3--724 o
N�A7.`fe.Q6 4-H' DkEPT 1 t2 f61nq La:1 72505-X7 3--)Z6c7
(ATTACH ADDITIONAL SHEET IF NECESSARY)
The ind,ividtWs named above aro registered and Registration Fee is not required for the Oral Presentation
ONLY. Proposers are advised that any individual substituted for or added to the presOntation team after
submittal of the proposal and filling by staff. MUST register with the Clerk of the Board and pay all-applicable
fees.
Otte than for the oral presentation. Proposers who wish to address the country commission,,a coaaty board or
county committee concep tg any action, decision or recommendatiost of country personnel regarding.this
solicitation MUST register with the Cleric of the Boaird.(Form BCCTORm=C}and pay all appl eablefees.
I do solemnly swear that all the foregoing facts are true and correct and!have read or am familiar with the
provisions of Section 2-11.1(s)of the Code of Metropolitan Dade County as amen
Signature of Authorized Representative: Gy/�
Title:�-f2 Y X).—C
STATE OF
COUNTY OF ,, 1 leg&
The fore oin'* instiunnent was knowledged before me •
by rs�OCe , t l'4ho is personally known
(Sole Proprietor, lion
(Individual,Officer,Partner or Agent) Partnership)
T�r w as identifi o did/did not take an oath.
Sr atxtre of, ing adrnowledgem � °•°�pMMISSj�•.el.,y°.
• Amor-J) Ppril 29�'LF�•9��
=�v o o roe
erne of Acknowledger typed,printed or slam ) °• # °® �;
/1� 4 •v:y X09
e-oG'•'O�b oPdrhru o w
(Title o ) (Serial Number,if airy) °i B ' c Under OP".ae• QP��
°•oeeo°°
�rArE of
Od01111000
Attachment D
City of Miami Beach/HMIS Staffing
NOT APP.LICABLE
r
Attachment E
City,of Miami Beach/HMIS Staffing
NOT APPLICABLE
r
ATTACHMENT F
Miami-Dade County Homeless Trust
Invoice For Services
NAME OF AGENCY: The City of Miami Beach
SERVICE PERIOD: TO
NAME OF GRANT: . Emergency Hotel/Motel Placement
.Program
GRANT NUMBER: PC-1213-HTMT-2
TOTAL AWARD AMOUNT: $50,040.00
AMOUNT OF FUNDS REQUESTED;_
THIS MONTH: $
AMOUNT OF FUNDS RECEIVED TO DATE:. $
BALANCE REMAINING ON GRANT:".$
(following payment of this request)
Signature of Agency Representative Date
Printed Name of Agency Representative
ATTACHMENT F
Miami-Dade County_ Homeless Trust
Invoice For Services
NAME OF AGENCY: The City of Miami Beach
SERVICE PERIOD: TO
NAME OF GRANT: BMS_Staffing Program
GRANT NUMBER: PC-1213-HMIS-2
TOTAL.AWARD AMOUNT: $12,333.00
AMOUNT OF FUNDS REQUESTED
THIS MONTH: $
AMOUNT OF FUNDS RECEIVED TO DATE: $
BALANCE REMAINING ON GRANT: $
(following payment of this request)
Agency Representative Date
Signature of A
g g Y P
Printed Name of Agency Representative
Attachment G
City_of Miami Beach/HMIS Staffing
NOT APP,LICABLE
Attachment H
City of Miami Beach/HMIS Staffing
Hotel/Motel Placement
5. Performance Measures
Expected Outcomes Indicators
Homeless transgendered individuals and • 100% of transgendered individuals and
families will be assessed by outreach teams families will be assessed as
and placed in hotels when appropriate. demonstrated in HMIS.
• 100%of families will be referred to
Chapman Partnership's Hotel Case
-
Homeless transgendered individuals and Management Program as demonstrated by HMIS referrals.,..-
families will be referred to various housing-
providers . 100%of families and.individuals will be
referred to various housing providers
within the continuum of care
• 95%of transgendered individuals and
families will enter into emergency
shelter.
Homeless transgendered individuals &families 5%of transgendered individuals and
will be placed in housing.
families will enter into transitional or
permanent housing.
i
39
7. Implementation Work Plan
PROJECT GOAL STATEMENT:.To provide short term hotel placement for homeless families with minor
children and transgendered individuals who cannot be placed into emergency shelter due to capacity
issues until shelter space or an alternate type of housing option becomes available.
OUTCOME#1: Homeless transgendered individuals and families will be assessed by outreach teams
and placed in hotels when appropriate.
Outcome#1 Work Plan
...._. _ Act ....... ..... ......... : _
........._._. .. .. .. ,.....__.._.. ..............:. ._... mat
Transgendered individuals/families will be HMIS Homeless
assessed by the City of Miami Beach Assessment, As required Outreach
Homeless Outreach Team(HOT) Team
Contact homeless shelters for available When contact is made with Homeless
Outreach
beds family
Team
HOT will transport and make placement into When contact is made with Homeless
appropriate hotel based on client needs HMIS Service individual/family needing Outreach
assessment hotel placement Team
Copy of gift card Homeless
Client will be provided food voucher when and receipt As needed Outreach
needed signed by the Team
client
Homeless
Families will be contacted daily HMIS Service Daily Outreach
Team
OUTCOME#2: Homeless transgendered individuals and families placed
in hotels will be referred to
various housing providers.
Outcome#2 Work Plan _
SsIgn
.ties. _._..... _.:.,...:...
HMIS Referral
Families will be referred to Chapman Hotel Within 24 hours of initial Homeless
Case Management Program Client File assessment Outreach
Documentation Team
Families and individuals will be referred to Within 24 hours of initial Homeless
various housing providers within the HMIS Referral assessment Outreach
Team
continuum of care
OUTCOME#3:All homeless transgendered individuals&families will be placed in housing.
Outcome#3 Work Plan _
:IJata t=
...:.....:::.:. ..
,
;::.:. :::.:::::..:::::.,: .:::: ::: :. eframe:: ;.:::; .: .'•:.::,A.ssl
tivities rn
valua M...
-n Once accepted into Outreach
Clients will be transported to next housing HMIS each
placement placement Team
41
Attachment
City of Miami Beach/HMIS Staffing
NOT AP.,PLICABLE
f Attachment J
City-of Miami Beach/HMIS Staffing
, . NOT API:,P, LICABLE
'
Attachment K
-. City of Miami Beach/HMIS Staffing
NOT APPLICABLE
- � � � � 1.• � A ., ,1 - '-'.
-
I
ATTACHMENT L
MIAMI-DADE COUNTY HOMELESS TRUST
ANNUAL ACTUAL EXPENDITURE REPORT
i
HMIS STAFFING PROGRAM
CITY OF MIAMI BEACH-GRANT NUMBER#: PC-1213-HMIS-2
OCTOBER 1,2012—SEPTEMBER 30,2013
Name of Agency: The City of Miami Beach
$ 129333.00
Month of Services Amount Paid
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Total Requested $ 0.00
Balance Remaining $ 129333.00
ATTACHMENT L
MIAMI-DADE COUNTY HOMELESS TRUST
ANNUAL,ACTUAL EXPENDITURE REPORT
HOTEL/NVIOTEL PLACEMENT PROGRAM
CITY OF MIAMI BEACH-GRANT NUMBER#: PC-1213-HTMT-2
OCTOBER 1,2012—SEPTEMBER 30,2013
Name of Agency: The City of Miami Beach
$ 509040.00
Month of Services Amount Paid
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Total Requested $ 0.00
Balance Remaining $ 509040.00
Attachment M
Font -9 Request for Taxpayer Mve form to the
ole".Jwuwy 200 Identification Number and Certification requester.UO not
neperimem a d ft Tieeaay
send to the IRS.
Irsemd Reveme Swede
!V (V
�
( GY� Y1n t t"-lA G t
CD Business name,if diffamM from abmm
c
o.
a �y £x--*t from backup
VCheck appropriate bwL❑ Sole popriewr ❑cowat m ❑Paanerop ❑other► ------------------ ❑w'lhholdmg
Address(raumber sweeL end apt,tx suke n o ReWeste's name and address(optima
r IM rz (1oa COn�J N T l�li CT t2 +0V,--
J CL(t City,state,and ZIP Code
YA4 Ate-( 3 ter-} 33 3
ust D=oors numberw addle(optwu*
FURM Tau• ier lden!tification Number IN
Enter Ww TI.N In the pippropriate box.For indMduals,this is.your Wgial security number(SSN)• Social s6MR4 n'xnb i-
Howeuer;•for a veesident Mien,sole propPiotgr,tar disregarded:entity,,see t1�e.Part 1 instructions oft
pale 3:For gther eiivms,it•lis your.employer identification rn,unber.(Em).it yoti do not have a number,
see Kow tg get a_TIN on page 3.
No" if d;--account is•rn more than one name,see me chaff on page 4 for gi ideffnes on Wmse'number r plover idendfrcaiion nurnbiW
to enter
Cerfficatibn
Under penalties of perjury,I certify that
1. The number shown on Oft form is my correct taxpayer Identification number(or 1 am waiting for a number to be issued to me),and
Z. I am nbt sybject in backup w(thtwi pq because:(a)1 am exempt from backup withholdiing..or(b)1 have not been notified by the Internal
Revenue Service ORS)Mat I am subject to backup withholding as a result of a fanure to report ae.lritemst or d'i4i ends,or(c)the IRS figs
notified n*that I am no longer subject to backup woihowirtg,and
3. 1 am a US.person'(kKIu.cflng a U.S.resident amen).
CeWrteatiorl iiv trric'NS L You mdu cross out k m 2 above if you have been notified by the,IRS that you are currerrjy sirtgect to Wi.dkup.
w Iiglctirig because ynp have faliiiO t,q rel o4-a�Interest Cad.dM1!94s dmybur tax.rcturn.For r estate transactions,Rein 2 dogs.rat apply.
FQr mort�acye tp est:oao,eequ)sitiori Qr abendonryi.. of secured property,eaacellation of debt.ror!iritxkions to art individual retirement
wrap k, rnent_pRQ.call gei>eralty;p.MOts other Dian.interest arid'dividends,ybn are'not requaed to s{gn the Geridicat{oli bayou racist
provide your eogect T1 N.(See the Instructions onpage
Sigel s ,ts ar
Heft US. ► Date
�(Bt'�90Se Of Form. Aonresident alien who becomes a residprst alien.
Generalty,only a nonresident alien individual may use the
A person who Is requlred to an information return with terms of a tax.treaty to reduce or eliminate U.S!tax on
the PS,roust obtain your correct taxpayer Iderttificado certain types of income.HoWever„most tax treaties contain a
number(TIN)to reports for exaitipfe,kicome•paid to you,real_ - provision knowh as�a."saving clause."Exceptions specified
estate transalcUogs,mortgage iotenesf you paid,acquisition in the saving clause may permit.an exeinpuon from tax.to
or atiandonrnertt of secured property,cancellation of debt,a ' continue for certain types of Income even after the recipient
coribril6l[A .. you made to an 1R�1. has,otti&-Mse become a LIS.r6s de'rii alien'for tax purposes.
t1..s-oersoeti Use Form W-9 txflf if you.are a U.S.person If you are a U.S.resident alien,who is relying on an
(including a resident awn),.to povide your correct 11?4 to the exception contained in dme saying clause.of a tax treaty to
person requesting it(tale.requeste>l and,when applicable,to: claitr an exert�tion from l]:S,tar on certain types of incatne,
1.Certify that the TIN you are giving is correct(or you are you must attach a statement that specifies the following fore
waiting for a number to be issued, Items:
2.Cert ify that you are not subject to backup withholding, 1..The treaty,country.Generally,this must be the same
or treaty under which you claimed exemption from tax as a
3.Claim exemption from backup withholding)f you are a nonresident alien.
U.S.exempt payee; 2 The treaty article addressing the income.
Note:ff.a.requester gives you a form other than Form W-9. 3.The article number(or location)in time tax treaty that
td request YOW TIN,you must use the requesters farm if it is contains the saving clause and its exceptlons.
substandaily similar to Amts Form W-9. a,The type and amount of iricome that giiaiifies for the
Foreign person-If you are a.foleign person,use the exemption from tax.
appropriate Form.W-8(see Pub.515,Withholding of Tax on S.Sufficient.facts to justify the exemption from tax under
Nonresident Aliens and Foreign Entities). the terms of the treaty article.
Cat.No.10231X Form 1N-9(Rev.1-2003)
M1.AM ` : ATTACHMENT
INCIDENT REPORT
JIDENTIFXING INFORMATION
Reporting Party Phone# Date of Incident 1 1 Time of Incident_am/pm
Reporting Party Name
Contract Provider Name
Program Name
Provider.Locafion
Specific Program:(check all that apply)
❑ HT ❑ Primary Care ❑ SHP ❑-Emergency ❑ Challenge
Sl pecffl-c incnfionl adores where irwidmt occurred:
TV-?E-OF INCIDENT
❑ALTERCATION ❑ CLIENT DEATH
® CLIENT INJURY OR ILLNESS ❑ THEFT
❑ SEWAL RAYTERY ❑ SUICIDE A 7TEMPT
❑PR-OPER-TYDAAMCE ❑ OTHER.INCIDENT
Specify
PARTICIPANT(S)!WrMSS(ES)
(Please mark W or P for either Witness or Participant)
LAST NAME,FIRST IDENTIFIER# CLIENT EMPLOYEE OTHER W/P
10f3
DESCRIPTION OF INCIDENT
Give deladed account—who,what,where,when,why,how—add pages if necessary
CORRECTM AC'T'ION AND FOLLOW UP
Immediate conwtive action taken
Is follow up action needed? ❑Yes ❑ No
If yes,specify,
MrVIDUALS NOTEMD
Abuse Registry 1-800-962-2873 Applicable Law Enforcement Department
Indicate pason contacted,if report was accepted,the date and the time,and if by telephone or if copy of report
available.
Zacident Reports—The Subrecipient must report to Miami-Dade County Homeless Trust information related to an
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,27111 Floor,Suite 310,Miami,Florida 33128;telephone(305)375-1490 and facsmilie(305)375-2722.
2of3
i
IAR '
Definitions.of Reportable Incidents
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 In or Illness. A medical condition of a client requiring medical treatment
by a licensed health care professiunal sustained or allegedly sustained due to an
accident,act of abuse,neglect or other umident 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. An allegation of sexual battery by a client on a client,employee on a
client,or client on an employee as evidenced by medical evidence or law eiafoarcement .
involvement
f. 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 department or a
departmental contracted or certified provider,which results.in bodily injury requiring
medical treatment by a licensed health care professionaL
Property Damage
An incident involving damage to property procured with homeless Trust funding.
Print Name of Person Submitting Report Signature
3 of 3
a
k
b e
H �
16� 4'
o.
ea.
0
O
H
v V
a�
rA a
W �
d
aI
Qo �V
' a.a
ca
ca
o
a
.w; Ot ...
= q
cr
me
Q �
u
s..
a-y
1 � �
'c
z o
.iz ice.
0
u
4`
1
ATTb.CHPVIENT P
N iA,NII D-kDE COU-NTI'HOI IEE-LESS TRUST
i CLIENT SER1'ICES CERTIFICATION REFERRAL FORM FOR EJAPLOYEES OF i
HOMELESS TRUST FUNDED'PROCR-04S '
INSTRUCTIONS: Provider malting referral must complete this rivo-pabe form,inciudinff signatures
Representatives. Fax completed farms to Provider Rcceis ing Referral fur
by Applicant and Provider R
Housing,and ur Services.
Date: - Refemng Provider:
Contact Person: Phone Number
Name Title
.IN`TFORMATION ON HEAD OF BOUSEHOLD:
Last Name: First Name:
Date of Birth: SS#:
INFORMATION ON OTHER HOUSEHOLD MEMBERS:Relationshi Employer
Name Age Sex
IS ANY MEMBER OF THE ROUSEHOLD EMPLOYED BY,DR.RELATED TO AN EMPLOYEE
QF,A HOMELESS TRUST FUNDED PROGRAW Yes No
I f Yes:
Narne of Employee:
Employing Provider:
Relationship to Applicant:
CERTIFICATION
1.the undersfg-ned.do hereby certi% that the above-information provided.b.A!.m.e,is.;rue,and correct.t.o the
hest ctf my kriowled,e.
Applicant's Tame
�i�:nature:
Date:
Rtferrin t'r0 ider Authori Cd Representative
SiL*nawre Date
C7Name: `
ATTAC:If4ENT P
PROVIDER R EF ERkAL FORD! PACE TWO
DPI icani's?lame
if the Applicant or a memtier of their 1,ouselrold is an empI()NU of the refei-ring provider,the
approval of tfre Provider E•iecutive Director is hereby indicated b`°si nature:
-NarnelTitle Date
Jf the Applicant or a member of their-household is'an employee of the provider vvhere services will be .
provided,the approval of The Provider Executive Director,the Homeless Trust.Executive Director,
and the)imeless Trust Board Chair are hereby indicated bysigmature:
Provider Executive Director Date
Miarrii-Dade County Homeless Trust Chairperson Date
Miami-Dade County Homeless Trust Executive Director Date
ADDITIOTIAL HOUSEHOLD DNFORMATION:
s 'Where is the household ffidn.3 now? (Facility name,exact address)
Date of present homelessness:
i
Explain the homeless situation,and what caused the current
homelessness:
.NOTE TO REFERRIAIG PRO VI DER:
PROVIDING THE ABOVE XNI+O.RMATION DOES NOT ENSURE APPROVAL FOR ROUSING
OR OTHER SER\OCES REQUESTED. A DETERMINATION Mr[LL LE MADE FOLLOWING A
COMPLT&TE ASSESSMENT OF THE APPLICANT'S CASE.
TIIIS SECTIUIW FOR SER T'ICE pj7o f'IDER S'T.4 Fr USE OA'L
l��eelc Elie;ihi1Y)!Criteria:' YES 1\10
f'here•rrf Provi(ler Scr•eerriirg Si�Tff'
I.'LEASE MAINTAIN ME E-XECLITED COPY OF THIS DOCUMENT IN THE-CLIENT FILE OF
THE SE1\YICING PROVIDER AND PEItSONNEL FILE OF REFERRING PROVIDER.
J