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RESOLUTION 92-20544
CITY OF MIAMI BEACH TO: Shirley Prakelt DATE: 7/20/92 Economic/Community Development FROM: Richard E. Brown A' 1M City Clerk SUBJECT: State of Fla. Health & Rehabilitative Services (HRS) Contracts Enclosed are 8 copies of the contract between the City of Miami Beach and the State of Florida Health & Rehabilitative Services (HRS) Contracts (four (4) for independent living skills and four (4) for supported employment training programs for developmentally disabled, mentally retarded adults) , together with the authorizing Resolution No. 92-20544. Please forward all to the appropriate official for signature, with the request that the blue-backed copy be returned to the attention of Mercy Williams in this office. You should also, request an original signed set for your files. Thank you. Plm*tZ;11 Gilliq3. 11114jefiA-Ak4A)/ &tree; J'fi;/41 l 4 RESOLUTION NO. 92-20544 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE TWO CONTRACTS WITH THE STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES (HRS) FOR INDEPENDENT LIVING SKILLS AND SUPPORTED EMPLOYMENT TRAINING PROGRAMS FOR DEVELOPMENTALLY DISABLED (MENTALLY RETARDED ADULTS) AT THE MIAMI BEACH ACTIVITY CENTER. (AFTER THE FACT) BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF MIAMI BEACH FLORIDA: WHEREAS, on April 8 , 1992 , the City Commission, pursuant to Resolutions Nos. 92-20480 and 92-20481 authorized the Mayor and City Clerk to execute two contracts with HRS for funding of the Developmental and Supported Employment Training Programs at the Miami Beach Activity Center; and WHEREAS, Resolution Nos. 92-20480 and 92-20481 had attached to them a standard contract which had stricken therefrom clause I . F. 1, a portion of the Indemnification provision; and WHEREAS, HRS advised the City that inclusion of the stricken indemnification provision is required for execution and funding of these contracts by the State; and WHEREAS, HRS executed the contract on July 1, 1992 , so as not to impair and interrupt the funding of the program or service delivery, with assurance from the City that the contracts would be approved by the Commission after the fact. NOW, THEREFORE, BE IT DULY RESOLVED BY THE CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Clerk are hereby authorized to execute the contracts which are attached hereto. PASSED and ADOPTED this 8th day of July , 1992 . ATTEST: 111' AlOP i City Clerk 116154, Mayo PNB: lm FORM APPROVED C:\resoluti\rehabili.2ct July 1, 1992 L DEPT. Date 7' / Fz_ CITY MIAMI BEACH "1:11 CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH FLORIDA 33139 TELEPHONE: (305) 673-7010 OFFICE OF THE CITY MANAGER FAX: (305) 673-7782 COMMISSION MEMORANDUM NO. DATE: July 8 , 1992 TO: Mayor Seymour Gelber and Members of the City Commission FROM: Roger M. Ci , ,� i I City Mana v'L' SUBJECT: ADOPTION OF A RESOLUTION AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE TWO CONTRACTS WITH THE STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES (HRS) FOR INDEPENDENT LIVING SKILLS AND SUPPORTED EMPLOYMENT TRAINING PROGRAMS FOR DEVELOPMENTALLY DISABLED (MENTALLY RETARDED ADULTS) AT THE MIAMI BEACH ACTIVITY CENTER (AFTER-THE-FACT) . ADMINISTRATION RECOMMENDATION: The Administration recommends adoption of the attached Resolution which ratifies, after-the-fact, the execution of two (2) contracts with the State of Florida Department of Health and Rehabilitative Services (HRS) for Independent Living Skills and Supported Employment Training Programs for developmentally disabled (mentally retarded adults) . BACKGROUND: Since 1983 , the City's Miami Beach Activity Center (MBAC) , located at 8128 Collins Avenue, contiguous to the Log Cabin Nursery, has operated an HRS program entitled Developmental Training (Independent Living Skills Training) designed to benefit developmentally disabled (mentally retarded) adults. This mental retardation program is administered by the City's Department of Economic and Community Development. Participants in this program are limited to forty (40) . The program strives to teach its clients basic living skills, which will allow them to become self- reliant. In 1989, the City's MBAC also became involved in another HRS program for developmentally disabled (mentally retarded) adults entitled Supported Employment. Participants in this program are limited to seven (7) . This program focuses exclusively on preparing and training clients to assume jobs utilizing the skills already learned under the Developmental Training Program. Both of these programs, while funded separately, are intricately linked together. 1 AGENDA (") ITEM ' _H DATE v 0 1 COMMISSION MEMO JULY 8, 1992 PAGE 2 Therefore, annually, the City must apply to HRS for continued funding of these two programs, as these grant awards are not guaranteed from year to year, nor are funds automatically allocated to the City. As such, two (2) grant applications were prepared combining these programs, and resulted in a total grant request of $225, 315 for Fiscal Year 1992-93 to fund the MBAC. The program period begins on July 1, 1992 and ends on June 30, 1993 , to coincide with the State of Florida's fiscal year. HRS requires that the City adopt Resolutions which demonstrate the Commission's approval to apply to the State of Florida - Department of HRS, for the provision of continued funding for these two (2) essential programs. On April 8, 1992 , the City Commission approved Resolution #92- 20480, authorizing the Supported Employment Training Program contract and Resolution #92-20481, authorizing the Independent Living Skills Training Program contract. The two (2) contracts had removed from them an indemnification provision, which the City had successfully removed the year before. ANALYSIS: Although the City had executed the two contracts and advised HRS in writing on April 10, 1992 , of a deletion of a portion of the indemnification clause (as used in last year's contracts which were approved by HRS) , they did not advise the City that due to a new policy their core contract could not be changed until June 29, 1992, and confirmed on June 30, 1992 by our Legal Department. Economic and Community Development staff and the City's Legal Department immediately contacted HRS to resolve this issue since the new contracts are effective July 1, 1992 . I authorized the execution of the two (2) contracts with HRS's indemnification language, so as not to impair and interrupt the funding of the programs or service delivery, with assurance from the City that the contracts would be approved by the Commission after the fact. CONCLUSION: The two (2) HRS contracts: 1) Independent Living Skills Training Program in the amount of $178, 751, and 2) the Supported Employment Training Program in the amount of $35, 122 , were executed on July 1, 1992 by the Department of HRS. The only section which changed was "Indemnification" . At this time, we are requesting that the City Commission adopt the attached Resolution which authorizes this action, after-the-fact. RMC/STP/cmc 4/ Contract No. 1 a gi- - ��,, '' STATE OF FLORIDA , DEPARTMENT OF HEALTH AND RE HA B I L I TAS SERVICES STANDARD CONTRACT THIS CONTRACT is entered Into between the State of Florida,Department of Health and Rehabilitative Services,hereinafter referred to as the'department', and _HE CITY OF MIAMI BEACH hereinafter referred to as the"provider'. 'rfE PARTIES AGREE: THE PROVIDER AGREES: 2. To permit persons duly authorized by the department to inspect any records, papers, documents, facilities, goods and services of the L To provide services according to the conditions specified in provider which are relevant to this contract, and/or interview A?taChrnent(s) _ I � / any clients and employees of the provider to be assured of satisfactory I. Federal Laws and Regulations performance of the terms and conditions of this contract Following 1. If this contract contains federal funds, the provider shall comply with such inspe ion the department will deliver to the provider a list of its the provisions of 45 CFR, Part 74, and/or 45 CFR, Part 92, and other comments with regard to the manner in which said goods or services applicable regulations as specified in Attachment I_, are being provided. The provider will rectify all noted deficiencies provided by the department within the specified period of time set 2. if this contract contains federal funds and is over $100,000, the forth in the commentsprovide rovorp de the department with a reasonable provider shall comply with all applicable standards, orders, or and acceptable Justification for net correcting the noted regulations issued under Section 306 of the Clean Air Act,U amended The provider's failure to correct or justifywithin a reasonable shortcomings.time (42 U.S.C, 1857(h) et seq.), Section 508 of the Clean Water Act, as specified by the department mayresult in ith as amended (3.3 U.S.C. 1368 et seq.), Executive Order 11738, and payments, the withholding of Environmental Protection Agency regulations (40 CFR Part 15). The nabeing deemed In breach or default, or termination of this provider shall report any violations of the above to the department. 3, ft this contract contains federal funding in excess of S100,000, the F. ndetrntf�caUott providerpriorLeto the Certification 1. damagThe es. agrees to be liable for all claims, :salts, J�dgments, or must, to contract execution, cgryp Including court costs and attorney's fees, arisen Regarding Lobbying form, Attachment IN!�i, � a Disclosure of negligent Ypout of the Lobbying Activities form, Standard Form �,LL, is required, it may be agents, or irttentlonaJ acts or omissions of the provider, and Its obtained from the contract manager. All disclosure forms as required O 'subcontractors,and employees,in the course of the operation by the Certification Regarding Lobbying torn must be Completed and of this aantract. Further. the provider agrees to indemnify the returned to the contract manager. department against all claims,'suits, judgments, or damages, Including court costs and attorney's fees, arising out of the negligent Audits and Records or intentional acts or omissions of the provider, and Its agents, 1. To maintain books, records, and documents (including electronic subcontractors,and employles,in the course of the operation of this contract. Aso, the provider agrees to defend the department, upon storage media) in a000rdanos with generally accepted accounting procedures and practices which suffice ntly and properly reflect all receiving timely written notification from the department, against all revenues and expenditures of funds rovided bythe department claims, suits,Judgments,or damages, Includingco foes,arising out of the negligent or intentional acts ot�ornls os and missions s under this contract. a ons of the 2. To assure that these records shall be subject at ail reasonable times to of provider eoperation d its agents,subcontractors,and employees,In the course inspection, review, or audit bystate Pe anon of this contract. Where the provider and the personnel and outer personnel department commit joint negligent acts, the provider shall not be duly authorized by the department,as well as by federal personnel, liable for nor have any obligation to defend the department with 3. To maintain and file with the department such progress, fiscal and respect to that put of the joint negligent act committed by the department. In no event shall the provider be liable for or have any inventory reports as specified in Attachment , and other obligation to defend the department reports as the department may require within a period of this department against such claims, suits, contract. Such reporting requirements must be reasonable given the judgements, or damages,Including costs and attorney's fees, arising scope and purpose of this contractout of the s016 negligent acts of the department. 4. To provide a financial and compliance audit to the department as 2. Any provider who Is a state agency or subdivision, as defined in section 768.28, Florida Statutes, agrees to be fully responsible for its specified in Attachment IV and to ensure that all related party transactions are disclose tv the auditor. Additional audit negligent acts or omissions or intentional tortious acts which result in claims or suits against the department,and agrees to be liable for any requirements we specified in Attachment I, Special Provisions, Section___NLA damages proximately caused by said acts or omissions. Nothing herein is Intended to serve as ■waiver of sovereign immunity by any 5. To include these aforementioned audit and record keeping provider to which sovereign Immun applies. Nothing requirements in all approved subcontracts and assignments, be construed as consent bya state a en y Or su ioherein shallg agency subdivision of the State Retention of Records Of Florida to be sued by third parties in any matter arising out of any 1. To retain all client records, financial records, supporting documents, contract. The provider agrees that It Is an independent contractor of statistical records, and any other documents (including electronic the department and not an agent or employee. storage media) pertinent to this contract for a period of five (5) years 0.Insurance atter termination of this contract, or if an audit has been initiated and 1. To provide adequate liabili coverage on a Co audit findings have not been resolved at the end of five (5) ty`�nsurance Q mpreherlsive years,the basis and to hold such liability insurance at all times during the records shall be retained until resolution of the audit findings, existence of this contract. Theder accepts full 1. p� p responsibility for Persons duly authorized by the department and fedoral auditors, identifying and determining the type(*) and extent of liability pursuant to 45 CFR. Part 92,42(e)(t) and (2), shall have full access to Insurance necessary to provide reasonable financial protections for the provider and t and the right to examine any of said records and documents duringthe clients to be served under this contract. Upon said retention period or as long as records are retained, whichever is the execution of this contract, the provider shall furnish the later, department written verification Supporting both the determination and t1aniloNng existence of such insurance coverage. Such coverage may be To provide reports as specified In Attachment T provided by a self-insurance program established and operating These under the laws of the State of Florida. The department reserves the reports will be used for monitoring progress or par of pe of the right to re uire additional Insurance as contractual services as specified in Attachment specified in Attachment N A where appropriate, 1 711/12 / i t , f , 2 if the provider is a site agency or subdivision as defined by 0. Purchasing , section 76828, Florida Statutes, the provider shall furnish the 1. PRIDE ` department.upon request,written verification of liability protection In It is expressly understood and agreed that any articles which are the a000rdenoe with section 768,28, Florida Statutes. Nothing herein subject of, or are required to carry out this contract shall be shall be construed to extend any party's liability beyond that purchased from Prison Rehabilitative industries and Diversified provided in section 758.26,Florida Statutes. Enterprises, Inc. (PRIDE) Identified under Chapter 946, Florida �' Safeguarding Information subsections in the same manner and under the procedures set forth in subse tions 946.515(2)and (4),Florida Statutes. For purposes of this Not to use or disclose any Information concerning a recipient of services contract. the person, firm, or other business entity carrying out the under this contract for any purpose not In conformity with the state provisions of this contract shall be deemed to be substituted for the regulations and federal regulations (45 CFR, Part 205.50),except upon department Insofar as dealings with PRIDE. This clause is not written consent of the recipient. or his responsible parent or guardian applicable to any subcontractors, unless otherwise required by law. when authorized by law. An abbreviated list of products/services available from PRIDE may I. Client Information be obtained by contacting PRIDE'S Tallahassee brand office at(904) To submit management, program, and client identifiable data, as 4874774 or SunCom 2774774. specified by the department in Attachment_.I,II r &I II 2- Procurement of Products or Materials with Recycled Content .1. Assignments and Subcontracts Additionally,It Is expressly understood and agreed that any products To neither assign the responsibility of this contract to another party nor or materials which ate the subject of,or are required to carry out this subcontract for any of the work contemplated under this contract contract shall be procured in a000rdanoe with the provisions of without prior written approval of the department No such approval by section 403.7055,Florida.Statutes. the department of any assignment or subcontract *hail be deemed in P. Civil Rests Certtficatton any event or In any manner to provide for the incurrence of any t, The provide( gives this assurance In consideration of and for the obligation of the department In addition to the total dollar amount purpose of obtaining federal grants, loans, contracts (except agreed upon in this contract ANI such assignments or subcontracts shall be subject to the conditions of this contract (except Section 1, contracts of Insurance or guaranty), Property, discounts, or other Paragraph 0.1.) and to any conditions of approval that the department federal financial assistance to programs or activities receiving or shall deem race benefiting from federal financial assistance. The provider agrees to ssary complete the Civil Frights Compliance Questionnaire,HRS Forms 946 K.Financial Reports A and B,if so requested by the deportment To provide financial dal reports to the department as specified in 2. The provider assures that it will comply with: Attachment a. Title Vi of the CM Rights Act of 1984, as amended, 42 U.S.C. L heturn of Funds -.-.• 2000d et seq.,which prohibits discrimination on the basis of race, 1. To return to the department any overpayments due to unearned color, or national origin in programs and activities receiving or funds or funds disallowed pursuant to the terms of this contract that benefiting from federal financial assistance. were disbursed to the provider by the department. The provider shall b. mon 504 of Rehabilitation Act of 1973, as amended, return any overpayment to the department within forty (40) calendar 20 U.S.C.794, whish prohibits discrimination on the basis of days after either discovery by the provider, or notification by the handicap In programs end activities receiving or benefiting from department,of the overpayment, In the event that the provider or Its federal financial assistance. Independent auditor discovers an overpayment has been made,the provider shall repay said overpayment within forty(40)calendar days o. Title IX of the 6ucation Amendments of 1972, as amended, without prior notification from the department. In the event that the 20 U.S.C. 1681 et seq.,which prohibits discrimination on the basis department first discovers an overpayment has been made, the of sex in education programs and activities reoeiving or benefiting department will notify the provider by letter of such a finding, Should from federal financial assistance. repayment not be made in a timely manner, the department will ds The Age Discrimination Act of 1975, as amended, 42 U.S.C.6101 charge Interest of one (1) percent per month compounded on the et meq,, which prohibits discrimination on the basis of age in outstanding balance atter forty (40) calendar days after the date of programs or activities receiving or benefiting from federal financial notification or discovery. assistance. 2. For state universities,should repayment not be made within forty(40) e. Section 884 of the Omnibus Budget Reconciliation ACL of 1081,as calendar days after the date of notification,the department will notify amended, 42 U.S.C.9849, which prohibits discrimination on the the State Comptroller's Office who will then enact a transfer of the basis of race,creed,color,national origin, amounts owed from the state university's account to the account of sex,handicap,political HRS. affiliation or beliefs in programs and acfNitiet receiving or benefiting from federal financial aaalstanae. M.incidentie Client Risk Reporting Prevention 1. Clientf. Ail regulations, guidelines, and standards as are now or may be If services to clients will be provided under this contract,the provider lawfully adopted under the above statutes, and any subcontractors shall, in accordance with the client risk 3. The provider agrees that compliance with this assurance constitutes prevention system, report those reportable situations listed in a condition of continued receipt of or benefit from federal financial HRSR 215-8, Paragraph 5, in the manner prescribed in HRSR 2156 assistance, and that it is binding upon the provider, its successors, or district operating procedures. transferees, and assignees for the period during which such 2. Abuse,Neglect and Explottation Reporting assistance Is provided, The provider further assures that all In compliance with Chapter 415,Florida Statutes,an employee of the contra , subcontractors, aubprantses, or others with whom it who knows,or has reasonable cause toarranges to provide services or benefitsto participants or employees providersuspect,that a child, . aged person or disabled adult is or has been abused, neglected, or in connection wrth any of its programs and activities ars not exploited, shall immediately report such knowledge or suspicion to discriminating against those participants or employees in violation of the central abuse registry and tracking system of the department on the above statutes, regulations, guidelines, and standards. In the the single statewide toll-free telephone number(1-803-96ABUSE), event of failure to comply.the provider understands that the Grantor may, at its discretion, seek a court order requiring compliance with N.Transportation Disadvantaged the terms of this assurance or seek other appropriate judicial or If clients ars to be transported under this contract, the provider will administrative relief, to Include assistance being terminated and subcontract with a designated Community Transportation Coordinator, further assistance being denied. In accordsnos with the provisions of Chapter 427, Florida Statutes, and Rule Chapter 41.2, Florida Administrative Code. The provider shall Q. Requirements of Section 287.058,Florida Statutes submit to the department the reports required pursuant to Volume 10, 1. To submit bills for fees or other compensation for services or Chapter 27,HRS Accounting Procedures Manual. expenses in sufficient detail for a proper pre-audit and post-audit thereof. 2 I 7/1r?2 `. Where applic.ab►e, to suDmrt bilis for any travel expenses in E. ontrsct Payment aoGoroance with section 112.x1, Florida S:a:'.:tes. The Oepar`.rhen: ursuart: to sec•ion 215.42. Florida S tIrtes. the voucher a.r^c': may, when specified in A`..o.:tment \ / L , establish rates lower payment o`. an invoice suDmrnec to the oeDa-silent &nal: be filet w' than the maximum provided in section 112..D51,F►onoa Statutes. the State Cor tot olier not later tnart twenty (2v) cays trom the la::e, a. To provide units of deliverables, Including reports, findings, and the date a proper invoice is received or receipt., inspection and appro of the goon: or services, except that in the case of a bona foe disoL drafts as speiliie�d inAttachment i Inc voucher shall contain a statement of the dispute and author to be received and aeceptec oy tris contract manager prior to payment only in the amount not disouted. The date on wfticn an intro► payment. is deemed received Is the date on which a proper invoice is first receiv• 4. 7o comply with the criteria and final date by which such critena must at the place designated by the department. Invoices which have to : be met for completion of this contract as specified In Section 111, returned to a vendor because of vendor preparation errors will result in delay in the payment The Invoice payment requirements do no: s-.: Patagrapn A.Z.of this contract. . access to all documents, papers, letters, or other until a property completed invo►ce, as defined in Rule Chapter 2.4-2 5. To allow publicFlonoa Administrative Code, Is provided to the department. APC• materials subject to the provisions of Chapter 119, Flonoa Statutes, and inspection of goods or services shall take no longer titan five and made or received by the provider in conjunction wi•,?,, this working days unless the bid specl`fications, purchase order or cor.;:z. contract. ft is expressly understood that substantial evidence of the specifies otherwise. &Joh approval Is for the purpose of author::: provider's refusal to comply with this provision shall constitute a payments and does not constitute a final approve.)of services purchas, breach of contract. under this contract. A payment is deemed to be issued on the f. R. Y holdIng.a and Other Benefits working day that payment Is available for delivery or mailing to t 1. The provider is responsible for Social Security and Income 'ax provider. II a warrant in payment of an invoice is not issued within I: w::holdings. (40) days, or thirty-five (3.5) days for health care providers as define: Rule Chapter 2.A-24, Monde Administrative Code, after the receipt cl 2. The provider is not entitled to state retirement or leave benefits invoice and receipt, Inspection, and approval of the goods and servict except where the provider is a state agency. the department shall pay to the provider, in addition to the amount 3. Unless justified by the provider and agreed to by the department in the invoice,interest at a rate of one (1) percent per month calculated Attachment 1, Special Provisions, Section A , the department a daily basis on the unpaid balance from the expiration of such 1c• will not furnish services of support (e.g., o ice space, office supplies, (40)day period,or thirty-five (35) day period for health care providers telephone service, secretarial, or clerical support) normally available defined in Rule Chapter 34-24, Ronda Administrative Code, until su: to career service employees. time that the warrant is. issued to the provider. The tempora unavailability of funds to make a timely payment due for goocs S. Sponsorship services does not relieve the department from this obligation to p As required by section 286.2,Florida Statutes, tf the provider Is a Interest penalties. nongovernmental organisation which sponsors a program financed wholly or in part by state funds, Including any funds obtained througn C.Vendor Ombudsman this contract, It shall, in publicizing, advertising or describing the A Vendor Ombudsman has been established within the Depa.me": sponsorship of the program, state: 'Sponsored by Banking and Finance. The duties of this Individual include acting acva..ate for vendors who may be experiencing problems in c:,o:n1 • timely payment(s) from a state agency. The Vendor Ombudsman ;" of Miamibe contacted at (904) 4.o&-v24 or by calling the State Comptrolie. The City Beach Hotline, 1 752_ PROV1Dcn and the State of Ao•ida, Department of Health and Rehabilitative Ill. THE PROS►, c. Services'. If the sponsorship reference is in written material, the words IDER AND D.-.PARTMEK MUTUALLY AGREE: 'State of Florida, Department of Health and Rehabilitative Services' shall A. Effective Date appear in the came size letters or type as the name of the organization. 1. This contract shall begin on Ju 1 yI , 1 o Q 2 On the date on whicrt the contra= nas been signed oy Ootn pa T. Discounted Ir iolces To allow a N/Z, percent dismount on selected invoices which are whichever is later. paid In less titan NT/z, days. The provider must clearly mark any 2 This contract shall end on June 30 , 1 9 9 3 . invoice with the discount hit is to be allowed. The provider may submit invoices with or without the negotiated discount terms. The department �. Te*rmTet�In3tion tio4i n Will shall comply with subsection 215.422(4), Florida Statutes, N a This contractmay be terminated by either party upon no less tl-. discounted invoice is offered. thirty(30)calendar days notice,without cause,unless a lesser UmE U. :Ina] Invoice mutually agreed upon by both parties. Said notice shall be delive- The provider must submit the final invoice for payment to the by certified mail, return receipt requested, or in person with proc' department no more than 4 5 days after the contract ends or Is delivery. terminated;If the provider taxis to co so, all right to payrr er. , forfeited, 2_ Tnrml;udon Bec3us-c of Lack at Funs and the depart-�e-.; will no: honor any requests suomined atter the In L.t^ event funds to finance this contract berme unavailable. aforesaid time pet._d. Any payment due under the terms of this department may terminate the contract upon no less "' contract may be withheld until all reports due from the provider, and twenty-four (24) hours notice in writing to the provider. Said not. necessary adjustments thereto,have been approved by the department. shall be delivered by certified mall, return receipt recues:^d, c' V. Use O'f Funds For Lying Prohlbtted person with proof of delivery. The department shall be the f To comply with the provisions of section 216.347, Florida Statutes, authority as to the availability of tends. which prohibits the expenditure of contract fends for ;.he purpose of lobbying the Legislature or a state agency. 3. Terminatjn or Broach Unless the provider's breach Is waived by the department In writ. il. TY.E DEl'ARTMENT AGRE.�-:: the department may, by written notice to the provider, terminate contract upon no less than twenty-four (24) hours notice. Said nc• A. Contract Amount • s.`•" be delivered by certified malt, return receipt revuested, c To pay *or contracted services nxording to the conditions of pc:...on with proof of delivery. Y applicable, the department ; Attachment I In an amount not to exceed s 35-,12248___________ employ the default provisions In Chapter 13A-1, Flor. subject to the availability c; funds. The State ot =iorioa's penormance Administrative Code. Waiver of breach of arty provisions of and obligation to pay under this contract Is contingent upon an annual contract small not be deemed to be a waiver of any other breach appropriation by the Legislature. The costs of services paid under any shall not be construed to be a modification of the terms cf other contract or from any other source are not eligible for conract.. The provisions herein do not limit the department's rig'' reimbursement under this contra.. remedies at law or to damages. • I t ' , , K,L 994 Mt= Con $Ct No. the appropriations paymoM n these have been established throughdepartment's operatingtis piss and subsequently identified in the :.Notice and e,addr and phone number of me contract manaaar for budget 1. The�•,address vt PsyM • E Nam and Strsat the Department for this contract Is. • 1 of this oontractbe Kn 1 h t—HSPS 1. The name (provider name as rt►own on� page the payment shall nd G u s s�e H. Mc g mailing address of Me official payee 4 Venue S-522 made: Miami Florida 33 THE CITY • u Au B : w P - 69 • Collins Avenue presentative of the rami Beach, Florida The name.adorers and ti1ephon•number of xerogram under this 2. ��• foraominlstration of P �vresponsible contract Is: mon and street address where Finan al enc • Z The name of the contact p+ AGI LONG-Mental R e t a r d a administrative records are maintained: Collins Ave. M mi eac Florida 338128 Co ' P : 3-2009 rami Beach, Florida s are designated by either Darty 3. �the event that different representatives of the name and address of the after execution of this contractnotiIn wring to the other party included naw representative will be rendered �ndtd°ns A t t a c hme re t attached m originals this oontraci. F. T+ and Its a crimenta as reerenoed, s.9 notification a This contract D. Renogo ion or Modification shall only be valid when 1_,....±.2.E., IV and Exhibit A and B 1. Modifications of provisions of this contract a regi they navy been reduced t�wtttinp and duly signed. The partes 0 • this coa..t if federal and/or state revisions ofnany applicable laws, or � to r•Mtyregulationmake changes in this w ract Ma w' adjusted agreed upon Dy me parties. and the total dollar amount may be ad) contain ail me terms and conditions Z, �• rate of paymentchanges in the este of retroactively to reflect price level increases and hereto have caused this 22 page contract to be• xeari•d by their undersigned officials as duty a�°rued. IN THEREOF, the parties STATE OF FLORIDA,DEPARTMENT OF PROVIDERHEALTH AND REHAB1UTATIVE SERVICES THE CITY OF MIAMI BEACH . SIGHED 8Y: SIGNED BY: pima: Anita M. Bock fame: Seymour Gelber Z'TTLE• .___________.__— Deputy District Administrator �,ra: Mayor DATE: aATE: FEDERAL ID NUMBER(or SS Number for an tel: FORM A 596000372 LEGAL DEPT. S CODE: By DIGIT SAMA STATE AGENCY 29 dir Ali .'"'" / --1- NA Date PROVIDER FISCAL YEAR ENDING DATE: 06/30/93 ___________________ VALID UNTIL SIGNED AND A D BY BOTH PARTIES CO IS NOT • C • .�- u- ., -� C • sag TMPTW c • • - . 2TW . • ou dAk' s-T-T loD 8ZI8 :suo-;zeooT buTmoTTo? at4- aq 7 72us saoT.ti;aS . Z • ( •Mao -.{=ort aTTgc= pus ane Toua ' uarz o-rdt:;a an ;aduloo pa zoddns TenpTJTPu T ao 7;-O s;bona sig Te;uauidoTanaQ a1.4 Aq panoadde uaaq ansq t=7g.•% s iapouz TuamCoTdma pa;.oddns ate IZuo asn o;. e.ze s.;apTnc=d •Z Uo T s T Ao. d. :Z atlU 2rt • a r=an d =Inca-mos 3'r?,', o S3.LflUI'1 (sT) Aia3Z3I3 itiiii t • 5ZI.:..IAI.I.O1 C3'''Inc_.-iJs Om ONI.1. 0dSgYUM an C=Id Sc .TM S.L.N?IrIO zNa inO'1d'r4�. CZMUOddflS .3.O a.K3Ou3a 06 ' Z •aaz�aa ZOY MMoc ? i ttlx�,IM ttOI SI:VdZdflSO 'Ian= mxati ?mL oS, C3S.yf1C' do 3AH TIIM ,y'-i3r� .dri3 C3S.2iOaaflS RI Cz'TIOUN3 SJ t•t3I'IO dO msaOu'aa 01. •I : duoo;np •o ' S-097 nS'd LIT pauTe;uoo ,♦Tduoo zsn= s..opuan 'Tv • SuTaoq T uoj.{ puu2;nssy n,T1en0 S-09 t uT PauTszuoo .aas uo Tgoe anTgoa.maoo ;o; s;uaciaa}nbaa .opuan pus saTgTA T 4oe bu Taort Tuoaz a;Ts-up •-t • aoUul..:o; ad, uts::oo- d •q T 80'ZZ IS.E doge:.Auoo sT 4Z aoy aTq.2T`ne spun; ;o ;unovse Isgoat;S, • E • sq.auouz f :og sao :aos a -no-d o, o os;,uoo s nou©5e at;- • e�uaTTo c4 s3=TA S ;uar.LLCoTd=a, pa,aoddnp Tno.:d =o2.:ou00 s-t;;, aous=ao.,:ad 7.oe:74uoSutr‘o LTo a4.4 ;.- nTd=oo a4Z * Z 'uo T;d TrosaP '5 -d -apT nc.=,d v147, ru2 DoT'=:uoo s T t UT paoua...a;a.: suoT 4eTr.b323 pu2 Sp�2puv7.S ' sI2nuw,4 sooT.l:as Ze:uo dotanaC Suri ett: ;Trt aou-p:000e u- s:uaT;o saoTn_.-as .1-e�undoTan3Q aZgTSTTa 0.4 papTno. d aq o; a;: a-=e?77d de T uoT22�:odscte u2 sao t.:,as ;uau:Ao'du? e .;oddnS .T ( � � y � P ) T � p -. • • • i 3. SUPPORTED EMPLOYMENT and Transportation services will be provided for a minimum of 12 months during the period of this contract. Vacations, holidays and in-service time is not reimbursable as a service day for computing units of service under this contract. Hours and months of service shall meet minimum standard requirements, shall be described and met as per agency proposal , and per any other special provisions or other section of this contract. C . Method of Payment 1 . Payment: This is a fixed price (unit cost) contract. The Department shall pay the provider for the delivery of service units provided in accordance with the terms of this contract for a total dollar amount not to exceed $35 , 122.08 , subject to the availability of funds. The Department agrees to pay for the service units at the unit price(s) and limits listed below: Service Units ( -ervices) Unit Price Maximum # of Units Supported Employment (CRT) $ 424.37 24 Units (Months) Supported Employment (IFL) $ 415.62 60 Units (Months) frIA7 Ab71-1-4 i Fo 0*11-1 2. Invoice Requirements : The provider shall request payment on a monthly basis through submission of a properly completed invoice (Exhibit A ) within 10 days following the end of the month for which payment is being requested. Payments may be authorized only for service units on the invoice which are in accord with the above list and other terms and conditions of this contract. The service units for which payment is requested may not either by themselves, or cumulatively by totaling service units on previous invoices, exceed the total number of units authorized by this contract. 3. For the purpose of reimbursement, enrollment is related to continuing attendance. No lay of unexcused absence wi l l be reimbursed. 4. Each client upon enrollment in a program is authorized up to 15 days of annual leave during the nine month contract period. A provider may not be reimbursed for more than 15 annual leave day per year without prior authorization from the District Program Manager or designee. Clients who do not use all of their Annual Leave days during one contract period may carry forward up to five unused LInnual leave days to the next contract period. 5. If an individual becomes ill , an absence will be reimbursed up to five days per calendar month. Documentation of family (or caretaker) contract is required for an absence due to illness . 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Tddns ;St1t4 .17FLAQad a 5a��Z .,�,as _ poTgvs;o-trot, uo Ip 9c1 PT' SCJ:{�Q1h.-.p3 a. ,�� '�'QJ MOT o; s�? os pa , ''es" T 4, 3.zow obi . g _ auaq abttT;; �u-� ��•2d ua tno�.�a(Cordova :,ato aq; Yan a .1o� q; s;ua .� ' T3 ' fir s-lrN aM, yo umulTuTw 74t.;-o7 cnod's -s uaurozvT , + ( , ��aTut�T ' fit sa �roC ac?�� �, T T JI`''1•J�� ;�:U.''1 �T:gQt1t O� • �.,� , n , fit;: mo o C t n ^p a s oddo _sseqdw2 * g ; :sow ���� uT pJ..�T �j� an , ,O;) J 0 y soo �Lh .uap:;adzp act 7Tmoq 5a�� _. tu- 1 � • u. ?er)or is 2%. Monthly a . HPS-DS Y0P c 2020 - (Exhibit B) (Dai..y Attendance and Enrollment Roster ) One copy must be submitted monthlya Invoice -- as back up documentation attached `o • ..he Exhibit A . n and for and � -- purpose,s a copy should remain within the _ provider ' s central file . This form, together with the client entries case record , reflecting g conce nln client absences , provide the basic pa } verlcords for the provider and au a vital document must be completed A five month- and maintained for a period of not less than �ive ( S) years or until .- question; are satisfactorily ~1 any un_esolved and • concluded. b. A tracking f o^n (provided by the Department) must accompany invoice. . • 2 . Yearly a. Expenditure Reports - The ?r oyider shall submit to the Department by April 10 , a report of actual costs for directly operated center ubcont-acted items incurred for the p services coveredby provision of this contract. The report shall reflect lect for the _ of establishing-'i> , ( 6) rnon the actual expenditures purpose .- blish_ng rates • this contractfor renego` .at�on of (From: July 1 , 1992 to Dec . 1 , 1992 J 1 ATTACHMENT : I SPECIAL PROVISIONS 1 . CLIENT CASE �• 1 . The prove der agrees that all clients enrolled in a Behavioral Educational Training and Therapy program should be evaluated annually by the end of the second quarter after the effective date of this contract . A copy of the report should be mailed to the Contract Manager. 2. Reimbursement shall be made only for those expenditures incurred in the provision of eligible service to eligible clients. Eligible services are specified in Section i Services To Be Provided) , first paragraph of Attachment I . Client eligibility and the determination of such is defined within the Department' s Developmental Services Client Services Manual ( 160-2) . 3. Eligibility for Purchase of Services: Determination of Eligibility. a. The HRS/.DS shall have the right to determine what services any eligible person shall receive. b. The provider shall be responsible for identifying recipients eligible for said services according to standards of eligibility furnished by the (HRS/DS. c. The HRS/DS shall not reimburse the provider for any ineligible person served. d. If the provider has knowledge of any circumstances affecting eligibility of any person authorized , the provider shall notify the HRS/DS Contract Manager in writing within ten ( 10) business days. 4. All new admi s:. ons shall have written approval of the Contract Manacer for the Department prior to enrollment for services under this contract. (For specific guidelines, see Attachment II► . ) 5 . Grievances and Fair Hearings The provider will utilize a system through which clients may present a request for a fair hearing . The preliminary procedural requirement ►or the fair hearing system must 10 compatible with the Department' s fair hearing system, will 1 notify applicants outlined in HRSM 195-1 . The provider services , in accordance with reci i ents to a fair hearing for reduction ofnt or P rule 10E-8, and as outlined in Attachment 6 . The provider will maintain a current record on each client served the program. which includes authorization for the �►� provision of service. 7 . Abuse Reporting The provider will report all suspected cases of abuse or , neglect of children , disabled or elderly individuals ndividuals to the a client' s social worker, immediately. Compliance with this A rt all clause does not exclude the responsibility to repo suspected cases of abuse or neglect to the Central Registry. II . PROVIDER RESPONSIBILITIES 1 . Behavioral programming shall refer to any attempt to teach new skill , to reduce inappropriate ina ro riate behavior, to make behavior occur under appropriate conditions and/or to maintain appropriate behavior . forthose clients who require above and 2. Specialty contracts to the need for sped al i zea beyond the �as�c LTRC ratedue benavioral programming will be required to adhere to the following stipulations : a. Behavioral programs designed to reduced maladaptive behavior shall be developed to address only those barriers i rs identified on the client' s Individual Habilitation Plan . If the provider rovider assessment reveals a identified problem with behavior that is not 'dDnti f i ed on the Habilitative Plan, the provider must initiate an amendment of the Habilitative Plan prior to, or m muss.program be concurrent with, intervention. Behavior developed and the emergency of new maladaptive behaviors requiring formal intervention. b. All behaviors ors selected for acquisition and reduction functional (beneficial ) for the individual ,c pn must t and not selected for staff or facility convenience .. All behaviors selected for reduction must have a runcti replace -rel at2d behavior designed to the aonal ly maladaptive behavior. c . All behaviors selected cted for intervention must be defined such thattheyare observable and directly measurable. date Prior to intervention, empirical basaline (one weekis of minimum)imum) must be taken to establish current leve 11 , I f I functioning . Baseline data may be suspended if the behavior could cause damage to self or others, cause major property damage, or is seriously disruptive. e. Interventions designed to decrease mal asap ti ve shall be based upon a functional analysis of the behavior. f . Empirical data must be collected on all behaviors (acquisition or reduction) selected for change during theentire course of training. Empirical data for behaviors selected for acquisition must be collected�c ,. g. A minimum of three times per week and tod a graphed no less frequently than monthly. Data for behaviors that occur in the normal environment less that three times per week (e .g. , laundry) may be collected weekly. Request for exemptions from this requirement must be made in writing to the HRS/DS District 11 Behavioral Programs Review Committee and will be considered on a case by case basis . h. Empirical data behaviors selected for reduction must collect daily and graphed no less frequently than Bi -weekly (every two weeks. ) i . Data for behaviors selected for acquisition must be reviewed no less frequently than monthly. Data for behaviors selected for reduction must receive desk review in accordance with the requirements set forth in HRSM 160-4. Documentation in the form of a dated signature must exist indicating that the review took place. j . If the empirical data ►or behavior selected for acquisition or reduction indicate a lack of progress (two months maximum) a program change must be made and documented. Program changes may include major procedural changes or minor alterations of the existing program ram including , but not limited to, changes in staff implementation, prompting strategies, types of reinforcers, reinforcement schedules, and task analyses . All program changes or other significant environmental events (e.c . illness, change in residence, chance in day program)ram) mast be documented on the client' s graphs( s ) . k. Any attempt to change behavior shall utilize the least restrictive and intrusive method likely to be effective. 1 . All staff who may intervene with the client must be adequately trained to implement behavioral programs within their setting. This should include but not be limited to: HRSM 160-4, principle and procedures of behavior analysis , individual client programs, data collection, and ,-he Bill of Right of Retarded Persons . 12 a ce with written programs �'�. Moni tori ng of staff comp} ian a s required by KRS �� 160-4 must occur n. All behavior cr programs snall receive the appropriate tz level of approval in accordance with the relevant HRSM 160-4. requirements in the provider monitored by behavior programs shall be _ i n ';��,SM o . All bcor 1 e with the requirements contained i n accordance 160-4. must attend the eoresen tati ve of the program meetings no less p • A clinical r i ng Review Committee Behavioral Programming monthly . with the requirements shallramming, and q. The provider 0_4, Behavioral comply fully p1 contained in HRSM 16 vioral Prog i n HRS/DS Form 2 6 0- g, Client Programm g Standards , and the HabiRSM 1 ramming Minimum St Hb�l�tative Programming Program Protocol ►or Residential Programs for Cl1ents with Behavior Disorders . r. The provider shall maintain aintain a minimum ratio oT one full time Florida Certified Behavior Analyst for every 24 clients undergoing behavior reduction programming . For fewer clients , these services ervicAs may be provided rovided by a part-time or consulting Florida Certified Behavior Al • This person shall have primary responsibility forthe development, implementation and supervision of all acquisitiQn and reduction programs . Requestsfor alterations of the above requirements may be made in•� � to the District 11 Behavioral Programs Review writing Committee. s. The provider ovider shall all submit uomit progress rOgcess recor*s for all l behaviors selected for intervention tothe District t 11 Behavioral Programming ReV1ew Committee Chairerson . These reports shall be in theform of graphic displays s ofdata and be submitted no lessfrequently than quarterly. ,e behavioral programming Review Committee chairperson may request more frequentprogress reports . 3. An annual comp i; ance auditreport ro ort prA aced b y a Certified er}ified Public Accountant is reuired as well as , and in addition to o quarterly expenditure reportsin the format specified in an attachment to this contract or otherwise available to the provider through the District Program OrriCe . A copy of the Compliance Audit will be delivered y0 the Contract Manager, no later than one hundred twenty (120) daysafter the last ,. tract.. effective date of this con 4. Anyearnings ni ngs real " ze by the �r o v i der as a result esult of _cntract-related and spportpa activities, incluain royalties reCeived from ccrjrighvs on publication or other r works developed under this contract, interest incomefrom fees. or sale of assets purchased with contract funds shall not oe expended without the prior written approval of the Department. The Department reserves the right to require those funds be used to reduce the cost borne by the Federal Government or the Department or both. 5 . Bonding The provider wi l l obtain and maintain at all times during the terms ;,f .chis agreement , a ►ri d-;� ► i ty bond covering the activities of all officers, employees, servants , and agents of the provider authorized to handle funds received, or disbursed , under this contract in an amount commensurate with the funds handl;i, the degree of risk as determined by the surety company and consistent with good business practice. 6 . The provider agrees to comply with the Education for Al 1 Handicapped Children Act (P.L . 94-142) and the Rules of the Department of Education: HRS Programs for Handicapped (Chapter 6A-15 F.A.C . ) 7 . The provider agrees to comply with all the departmental policies and procedures implementing 393.067 (3) , F.S . Screening Requirements for non-departmental employee(s)/applicant( s ) . 8. The services will be provided in a manner that complies with applicable procedures in the Community Services Resource Utilization Manual (HRSM 160-1 ) , Behavioral Management Guidelines (HRSM 160-4) , Client Programming Manual (HRSM 1 . .)-(8) and Client Services Manual HRSM 160-2. ) 9 . The provider shall participate in Habilitation Planning Committee meetings (HPC) for HRS Development Services Clients . 10. Human Rights Advocacy Committee (HRAC) The provider agrees to allow properly identified memoers of HR1 access to the facility and/or agency and the right to communicate with any client being served, as well as staff or volunteers who serve them, in accordance with Section 20. 19 (6 ) f .2. , F.S . Members of the Committee shall be free to examine all records pertaining to any case unless legal pronioition exists to prevent disclosure of those records . 1 1 . Funds made available pursuant to this con tract shall not be used by the provider and/or subcontractor for the purpose of initiating or pursuing litigation against the Department . 1 ' . Analysis of Expenditure Rate The provider agrees to submit an expenditure report for the six <b , month period of July 1 , 1992 through December 31 , 1992 justifying the negotiated rate of service . 1 ' i e 3 . THE DEPARTMENT RETAINS SOLE AUTHORITY FOR DETERMINING THE TYPES OF CLIENTS WHO -RECD:':E SERVICE UNDER THIS CONTRACT. 1 �. " e e ATTACHMENT •III A . Criteria for Admissions and Services Prospective clients except private clients must be referred by the department of Developmental Services , District 11 . The prospective client maydemonstrate to be an appropriate � f dCl l 1 t��' , in accordancewith the approved written candidate for pl acomen �,,. at _.i=_admission criteria established by the provider . The Department shall not be held liable for payment if a client � en � mi tted to a resi uenti al setting without written authorization from i s admitted the Developmental Services Program Office . Additionally , the provider ^ � shall notify the placement coordinator in Developmental Services prior to accepting anyother proposed placement from other HRS program offices , private pay or any other referral source . Each client Developmental nt of Develo mental Services who participates in a residential or non -residential program shall be subject to ah probationary probationary onary period of ninety calendar days . During the p period , the provider shall evaluate the appropriateness of the client ' s placement in relation to the service provider ' s approved written criteria for admission . ServiceP roviders shall verbally notify the department as soon not the written criteria foras a client i s suspected of meeting admission . Service providers shall notify the department in writing by certified mail as soon as a client is determined not to meet the written criteria for admission . If the client is found not to meet the service provider ' s . � fordmissions and services , the district Developmental written, criteria a Services program office is responsible for removing the client within a of twent -five calendar days maximum of receipt of certified notice to Y the department , and providing alternative service arrangements necessary to ensure client safety and prevent regression , unless the service provider agrees to extend the probationary period . The provider der shall continue to provide services in the facility until the client is removed by the department . The removal shall be completed�..d t� wihi n a maximum of twenty -five calendar days from the date of p re cel t of certified notice to the department unless otherwise agreed upon by the department and the provider . B . Suspension of Services Suspension of services can not be implemented by a service provider in a resi dent i al ► aci l i ty . Suspension of services can be implemented by a service provider in a non - residential facility under the conditions and following the procedures sti ul ated in rule 10E -8 . 030 , Rules for Suspension of Services by the Provider . of Services by the Provider � , Termination ',:ri t ten notice of intent to terminate erminate services by the provider shall be received by certified mail fifteen departmental worKingoars prior to the proposed roposed effective date . Termination of services by the he provider will follow ythe procedures stipulated in rule 10E -8 . 031 . The client shall continue t0 ring receive services by the proveder , until all appeals are exhausted the administrative n istratiVe hearing process . of ; ces by the Department � • Termination Sery ; 0 ) days provider at least ten the will notify � the residential setting . Tne Department r of a c client en from to removal or transfer rans f e payment" prior � " ten day holding of bedP bout provider der w� 1 1 be paid d a t without The the resi dents al setting ng any P who are removed from .. clients _ does not result from a Y Tor those daysnotice i f the transfer ten ( 1 0 ) prior Anadequacy of the provider vider or residential setting . Theholding of bed payment will also be p a' d d if a client ent i s from the residential set _ing due tohospita , zation , home visit ,absent i t vacation , treatment program or for any otherpre- authorizedaosenca from orn r _ residence . The holdingof bed payment period for absences of any t client must n.Dt exceed thirty ( 2( ) ConseCutivdays . Request for tne Holding of ped payment exceeding ten ( 10 ) days must be prior a.pproved by the District DeVelopmental Services Program Administrator . specified i n Tor Tai 1 ur .. to adhere to the conditionsn of Penalties . ��- . , s � concerning additions ,� su Pensi ons and termination o tnis contract b the provider : services for clients Y if a residential services p rovider terminates , suspends or reduces Services without adheringto the guidelines sPeCifled in e 10- - 8 , the department may impose afine aoainst the residential services provider in the amount of X100 a day not to exceed S5 , 000 per incident . imposing a fine against a residential services provider must oin accordance with procedures specified in said rule 10E - 8 . 32 . E . Utters Providers will attend all training currently offered by Developmental Serviceso tne provider community and any future training raininc deemedappropriate by the program office so as to ensure t1e Provision of hign level servi ces . Providers ( ordes I aneo ) will attend ttend and participate in their heir ta ' annual nabilitation plan meeting . The provider wi11 also c maintain a current haoi1itation plan on each client in their residence . 17 The Program Office reserves the right to make periodic reviews of the utilization of funded slots in each residential or non -residential setti nc and adjust the allocation of slots accordingly _ to meet the changing needs of the client population . Payment for services ty the HRS Developmental Services Program Office shall l 1 be considered payment i n full . 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PRIDE • department, upon request,written verification of liability protection in it is expressly understood and agreed that any articles which are the a000rdanoe with section 768.28, F•loridP Statutes. Nothing herein subject of, or are required to carry out this contract shalt be shall be conevued to extend any rnarty's iiaaility beyond that purchased from Prison Rehabilitative Industries and Divvrsifie0 provided in section 7G8.28,Florida Statutes. EnterPrises, rc, (PRIDE) klentlfied under Chapter 946, Florica K. 5 squardi nQ i of orrnadon Statutes, in the same manner and under the procedures set forth In Not to use or disolose any information concerning a recipient of sarvioesa subsections 946.515(2)and (4),Florida Statutes. For purposes of this under this contract for any purpose not in conformity with the state contra the person, firm, or other business entity carrying out the regulations and federal regulations (45 CFR, Part 205.50), except upon provisions of this contract shelf be deemed to be s:ubstttuted for the written consent of the recipient, or his responsible parent or guardian department Insoles as dealings with PRIDE,. Thi, clause is no; when authorized by law, applicable to any subcontractors, unless otherwise required by law. M abbreviated list of products/services available from PR OE may I. Client Information be obtained by contacting PRIDE'S Tallahassee branch office at( ) To submit management, program, and client Identifiable data, as 487.3774 or SunComn 277.3774. specified by the department I n Attachment _I& Z I Z Procurement of Pr,i cta or Materials with ft vecyc1 ed Content J. Assignments and Suboontrscts Additionally,it is expressly understood and agreed that any products To neither a.aaipn the responsibility of this contract to another party nor or materials which are the subject of,or we required to carry out this subcontract for any of the work contemplated under this contract contract shall be procured in accordance with the provisions of without prior written approval of the department No such approval by section 403.706.5, Florida.Statutes. the department of any assignment or subcontract shall be deemed In any event or in any manner to provide for the Incurrernoe of any P. Civil RSghts C bort obligation o1 the department In addition to the total dollar amount I. The provider gives this assurance in consideration sof and for the agreed upon In this oontract. r4JI such assignments or subcontracts shall rp°sa of obtaining federal grants, loans, contracts (except be subject to the conditions of this contract (except Section !, contracts of Insurance or guaranty), property, discounts, or other federal Paragraph 0.1.) and to any conditions of approval that the department financial assistance to programs or activities receiving or shall deem neoes$sary, benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire,I-IRS Forms 948 K Financial Reports A and B,ft so requested by the department. To provide financial reports to the departmesnt as specified in Attachment Y 2. The provider assures that it will comply with; a. Title VI of the Clvil Rights Act of 19154, as amended, 42 U.S.C. 1. Return of Funds 20001 et seq.,which prohibits discrimination on the basis of race, 1. To return to the department any overpayments due to unearned color, or national origin in programs and activities receiving or funds or funds disallowed pursuant to the terms of this contract that • benefiting from federal firtiancial assistance. were disbursed to the provider by the department. The provider shall b. Section 504 of the Rehabilitation Act of 1973, as amended, return any overpayment to the department within forty (40) calendar 219 U.S.C.�� which prohibits discrimination on the bast: of days atter either discovery by the provider, or notification by the handicap in programs and activities receiving or benefiting •rorr. department,of the overpayment. In the event that the provider or Its federal financial asslsiYtssit,noe, independent auditor discovers an overpayment has been made, the provider shall repay said overpayment within forty(40)calendar days c. Title• bC of the Education Amendments of 1972, as amended, without prior notification from the department. in the event that the 20 U.S.C. 1681 et seq,,which prohibits discrimination on the basis department first discovers an overpayment has been made, the of sex in education programs and activities receiving or benefiting department will notify the provider by letter of such a finding, Should from federal financial assistance, repayment not be made in a timely mariner, the department will ei The Age Discrimination Act of 1975, as amended. 42 U.S.C. 6101 charge interest of one (1) percent per month compounded on the outstandingbalance after fortyet seq., which prohibits discrimination on the basis of age in (40) cslender days atter the date of g notification or disoovary, programs Of activities receiving or benefiting from federal financial assistance. 2. For state universAles,should repayment not be made within forty(40) ` Section 654 of the Omnibus Bud et Reconciliation Act of 198' calendar days atter the date of notification,the department will notify9 amended, 421I.S.C.9849, which prohibits discrimind+'— the State Comptroller's Office who will then enact a transfer of the basis of dorigin, sex,her, &mounts owed from the state university's amount to the s000unt of race,creed,color,national HRS, affiliation or beliefs in programs and activitie4 M.Incident Reporting benefiting from federal financial assistance, 1. Client Risk Prevention 1. All regulations, guidelines, and standards as are now or may If services to clients will be provided under this contract the provider lawfully adopted under the above statutes, and any subcontractors shall, in accordance with the client risk 3. The provider agrees that compliance with this assurance oonstit.e• prevention system, report those reportable situations listed In a condition of continued receipt of or benefit from federal finer, • HRSR 215-8, Paragraph 5, In the manner prescribed in HRSR 215-6 assistance, ani that it is binding upon the provider,its suooessc!. or district operating procedures. transferees, and assignees lot the period during which suc. 2. Abuse,Neglect and Expiottatlon Reporting assistance is provided. The provider further assures that ail In compliance with Chapter 415,Florida Statutes,an employes of the contractors, subcontractors, subgrarttessss, or others with whom it who known,or has reasonable cause to arranges to provide services or benefits to participants or employees providersuspect,that a child, in connection with anyof its programs and activities ate not aged person or disabled adult Is or has been abused, neglected, orp o9 discriminatlnQ against those exploited, shall immediately report such knowledge or suspicion participants or employees in violation of the centra/ abuse registry and tracking system of the department on thea Ye statutes, regulations, guidelines, and standards, in the the single statewide toll-free telephone number (1-84Z-96A13USE). event of failure to comply,the provider understands that the Grantor N. Transportation Ddvant#g� may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or if clients are to be transported under this contact, the provider will administrative relief, to include assistance being terminated and subcontract with a designated Community Transportation Coordinator, further r.tistance being denied. in accordance with the provisions of Chapter 427, Florida Statutes,and - Rule Chapter 414, Florida Administrative Code. The provider shall O. Requirements of Section 287.058,Florida Statutes t, To submit bills for foes or other oompenstation for services or submit to the department the reports required pursuant to Volume 10, expenses In sufficientd 'I Chapter 27,HRS Amounting Procedures Manual, etas for a properpre-audit and posit-audit thereof. 2 I • • 'rtiInere Loplicaoie, to submit oiilS for any t.rave, expenses in a. Contract Psyeeent _ a orcarioe with section112.7.4—.. Flo.►„a Sia:„:es. The oeoa,, ,.^)er, Pursuant to sectio 2 -: ' may, v.nen specified in A a:..'irner: J A _ es'.a.ltsn rates lower payment of an invoice suomz ted to tie deoa.:mer.: s.a. cb f,,e.: ;,`►art the maximum provided in section 1 12-:JC Florida S:.a:u:es. the State Comotroiier no; later than twenty ;�, cays from the late' -, including reports, findings, and the date a prober invoke is received or reoeiOt, inspection and a:7-Ors, To provide unrs of oeliveraoies, g drafts as specified in ATTACHMENT I g of the coos or services, excect that in the case of a bona rode Cis;:. the voucher shall contain a statement of the dispute and author:. to be received and accepted cy the contras manager prior to payment only in the amount not disputed. Tne Cate on wnicn an Invc. payment. is deemed received is the date on which a proper invoice is firs•.reaeivt 4. To comply with the criteria and final date by which such criteria must at the place aesignated by the department. invoices which have to : be met for completion of this contra as specified in Sect cn Ill, returned to a vendor because of vendor preparation errors will res::.:.7 Paragraph k2.of:,his contract. delay in the payment Trio invoice payment requirements cc no until a property =mpi•-•ed invoice, as defined in Rule Chapter - 5. Tc allow public access to all documents, papers, letters, or other •c.- Fonda ,comini=ative Coee, is provided to the deparument. materials subject to the orovisi:ns of G`~,acter .19, Florida Statutes, and inaceC..on of goods or services tna!! : ke no longer than `,tie and made or reeved by the pro•.der in conjunct:on with this working days unless trio bid specifications, baro.~ase order cr coni_ contract. t: is exoress:y understood that suos:antiai evidence of the spe:.ifie>; otherwise. Such approve: is to. the purpose of a:::~:.r:_ provider's refusal to compiy with this ^rovis:on shall cons-:.:::te a payments and does not constitute a f,nai a:provai of services pu::n.t breach of contra. under this contract. A payment is seemed ,c oe issued on •„tie R. W'thholdtngs and Other Benefits working cay that payment is available for delivery or mailing to ...- 1. The provider is responsicie for Social Security and lnxme Tax provider. e, a warrant in payment of an invoice is nc' issued w;tnir. '_ w;tnho;dings. (40) Cays, or thirty-five (25) says for health care providers as cef:nez Ririe G aster 3:•-24, Florida Azministrative Coca, aster the sec-old: or The provider is not entitled to state retirement or leave benefits invuioe and receipt, Ins -.ion, and approval of the goods and sere except where the provider is a sate agency, the ocoartment shall pay to the provicer, in addition to the amour.: 3. Unless justified by the provider and agreed to by the csaartment in the invoice, interest at a rate of one (1) percent per month calculated = A,i acrment 1, Special Provisions, Section N`41 , the oepart.-nent a daily basis on the unpaid balance from the expiration of such fc- will not furnish services of support (e.g., office space, office supplies, (40) day period,or thirty-five (3.5) day period for health care provicers telephone service, secretarial, or clerical support) normally available defined in Rule C'iapter 3.A-24, Florida Administrative Code, until sits to career service employees. time that the warrant is. issued to the provider. The terno: ur"vaiiability of funds to maze a timely payment due for goo^:. S. Sponsorship sit..vices does not relieve the department from this obligation to p= As required by section 22,5.25, Florida Statutes, K the provider is a interest penalties. nongovernmental organization which sponsors a program financed wholly or in part by state funds, including any funds obtained throu;n C. Vendor Ombudsman this contra.~, It shall, in publicizing, advertising or describing the A Vendor Ortoud.man has been established within the Depar..mer: spor.:.orship of the program, state: 'Sponsored 5y Bank:r►g and Finance. The d:.ties u'this individual include actin; as advocate for vendors who may be vxperiencir; problems i,n cc•. • timely payment(s) from a state agency. The Vendor Osnbuds:han THE CITY OF MiAMI BEACH be contacted at (904) 42&-2324 or by calling the Sate Cornp:.'c'.ie, Pr,. vIDEr -iodine, ; ,. 2. and the State of Florida, Decar trent of Heart and Rehabiiitative Services'. tf tine sponsor-hip reference is in written material, tie words III. THE PROVIDER AND DEPARTMENT MUTUALLY AGREE: 'Slate of Florida, Department of Health and Rehabilitative Services'shall A Effective Date appear in the same size loners or^,fie as the name of the organ. -::on. 1. This contras shall begin on July 1 , 1992 On the ca:e on which the con::a.7.:: nae Coen :.;neo cy Dc:-. .. .e. a'. T. Dls:canted invoices .. To allow a N/_ pc cent discount on seiec:e-d invoices which are wnichever is later. paid in less than . A says. The provider must ciear y mark any 2_ This contra shall end on June 30 , 1993 invoice with the discount il In is to be allowed. The prov.ntr may sum:t invoices with or without the negotiated discount terms. The department E. Tarmin211o1 shall comply v►.;; subsection 215.422(4), Ronda Statutes, fl a 1. Tarm in.aton at W111 discounted invoice is offered. This contract, may be terminated by either parry upon no less thirty (30) calendar days notice,without cause,unless a lesser t:rr. U. Final invoice mutually agreed upon by both parties. Said notice shall be ceiive The provider must &ubmit the final invoice for payment to the by certifies mail, return receipt rec.i.•ssted, or in perton with pro:: department no n.:.ire than 4 S days after the contract ends or is delivery. terminated;If the provicer fay:s to do sr, al! right to p;yrnent Is forfeited, and the department will not honor any requerz submitted atter the 2- Terminaton Because of i ic i of Funds aforesaid time pends. Any payment due arses the •cans of thisIn the event funds to fina.-ce this contract Seco•ne unavaila;le. c department ria} temirn A the contract :_do no less : cos - ot :nay be wifield until all reports due from n crcvider, and twen- -four (24; :ours nc ce in wrttin.,, to tine .cider. Said nctic necessary ad)usrnents thereto,have peen approved by the debarment. shall 3-e delivered cy certified mail, return receipt repuected, or V. Use Of Funds For Lobbying Prohlbred person with proof of delivery. The department shall be :ne ::- To comply with the provisions of se:-.tion 215.37, =�orida Sta:::tes, authority as to the availab City of funds. which pro;ibits the expenditure of contras funds to: me purpose of 2. Terminaton for Breach lobbying the Legislature or a state agency. Unless the provider's breach Is waived by the deoartmer: in writ:- iI. THE C=°ARTh ENT 1ZREES: the department may, by written notice to the provider, terminate :: cont:act uc:.n no cc than twenty-four ;24) hours notice. ...sec no., A. Corrt'act A.mourzt shall be deiiverec .)v certified mall, ~um receipt recues-ed, or To pay for cos;.: _-4d services according to tie conditions of person with proof of delivery. tf app!.cable, the department m. A"tacn vent I in art nrr aunt not to exceed 5 178 , 751 . 36 employ the de;autt provisions in Chapter 13A.-1, fon: subject to the availabi..-i of f:-nca. The State or Florida s peso ance Administrative Code. Waiver of br3ac.h of any provisions and obligation to pay under .this xr;:ac is contingent upon an annual contras shall not be deemed to be a waiver of any other breaon a.- acprepnat'on by the Leg,slatLre. The co of services paid under any snail not be construed to be a modification of the terms of other contract or from any other source are not eligible for contract. The provisions herein do not limit the department's rich: reirn,ursement under this contrac_ remedies at taw or to damages. • 3 . • 1/DiLLI.:j �' Cs... ntrict NCI payment when arose have Den establishr 'nroug,h tne ar;,rcpr.at. Notce and Contact process and k;Js.equentiv• idem`+ec in e department's opera 1. The name, address and telephone number of the contras manager for budget_ the aepyrtment for tnis ;.ontrac is: B_ Karre, {taping and St-v.-et Addras.s of Payfre Gus s ie H . McKNI GHT-Hsps 1. The name (provider name as shown on page 1 of ,:pis ntrac 1 NW 2nd Avenue S-522 maiiin address of the o` i:ia payee to wnom the payment s~.2,' • Nam , 1 O r i a 3 2 8 mace: T 7 _ _ _ _ THE CITY OF MIAMI BEACH. 81: 8 Coll Avenue The name, address. and to ennone r,-renber of the representative c: the pvvid c onsibie for administration of tne progprogramunder ,s Miami Beach , Florida 3314 ^ e, re.,a„ ten::aC is: AGI LONG-Mental Retardationclip . 2 The name of the conac ;Terson and o eet acoreas where finar,c,a. b O111nS Ave . acministrative records are maintained: +cz..,l ieacn , r for Lac .:.: i ; AGI LONG PH : 993-2009 oI _ .,J8 Lolllr.s Avenue 2. In the event that d;~er'nt rebresentatives are oesignated by either party Miami Beach , Florida 3 2 1 4 1 cher execution of this contract, notice of the name anc accress of the new repres-entative wili be rendered in writing to the other party and said notification attached to originals of this contract. F. MI Towns and Condttiona lncludeid ATTACHMENT Reno dation or Modtfc.ation This contract and Its attachments as referenced, , 1. modifications cf provisions of this contract shalt only be valid whenT T y I 1 II 1 1. I 1 IV, & V and Exhibits A they have been reduced t^ writing and duly signet. The paries agree & C) to renegotiate this con•Ja..t if federal and/or state revisions of any apli:able laws, or regulations rnai;e changes in this contract necessary. •men: and the total dollar amour may be adjusted ,. , !�4 rate of Fr.;. cont::.rn all the terms and cor,,c,Uons agreed upon by tne parties. retroactively to refile.. price ieve: increases anc changes in the rate of ./i7r 4.f L w,...., -e...44-!..,21,./......,,, ....,�•1:-.4.,,,�y.•f..7fJM.•��✓•. • 4.., %...s:.:.e.,/..�`t. ..,-;i...7:•4.I.T1.•-..:41":d•V:.i...i;,.....:T� ", .,go ig:.F. !!.. ✓t,,,re.-• YIN...,-.1. parties hereto have caused t,'-ii57 page contra=',to ba executed by;,heir undersign' : officials as d::ly aL t cried. OVI✓`.:. STA-T.7_ OF FLORIDA, DEPARTMENT OF /• N E&L HAND R EHA5 I LITATI E S CES THE CI Y OF MIAMI .7:40V _ - S;uts1:D BY: Agikillard MM. BY: 7/( , -- N..M`: Anita M , Bock -'--7 �-. MAYOR TILE: Deout� District Administrator ll1L... / ` 7.,)=.-1-E: P-- DAA . 7 / / ii r)-- :1R:.L ID NUMBER (or SS Number for an tndlvldual): FOI"" APPROVED 596000372 LEGAL DEPT. STATE AGENCY 2-9 Di,aT S. h .S CO E. _;;,F-i-;-;?;3( 71---- N/A r , N/A B 0//f.-2 Date PROVIDER FISC.•.L YE:-,R ENDING DATE: 06/ 30/93 • CONTRACT IS NOT VALID UNTIL SIGNED AND DA `D BY BOTH PARTIES .1 • • 5 . -J. • • • • • • • • ,-Pr= =mid c.:. f1C2r_OS -..L .ro s2.LaN Na2Laii HiM ZIM SIT.:.,IA1.LO`' csrinca- S OW CNIidOd SIS" i of do =mid 2E =+m . 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';o ;unoti T2;o: a % . s . slap do . o s;;;a T To o4 saotn..7as apTno.�d oq paT,o1e.14uo0 sT noc.iafir at;; • y • s:uaTTo S o� saOTfti;as ;ua'hu oTdax pa;:oddns sapTnc•z: -a02.:;uo='' sT ,I, • c squaT 0 OE o SaoTt.;:a s Uo T;2;:odsu2:,I, sapT nc: ;02 ;uoo s T u,i, . z • aqua T 7c OE o7.1 saoT,•�;as •::2�5c�.�_ 5u-u'2:iz, I2 7.uatudc 7aAaQ sapT Ac- sT qz san- . saw►:� C v,1 a�u2��•-c_:ad :02,::00 ;u-::c T Ic; ; a ; , Tc:cc .,a;, , A0-zd 3.1 • pine 10 :,uc0 s71-1-7 pacua;a;Dw �o . ,.� ,_0s:�p a w��.5o.�c wap ln,.sw� � suo T;2 7n-ate puv sp.:epu s I ;UaL.�.:�;dC TanaC SZH D ••''/, a\./u 2 c r o 2 U_ 5 c.:a t,o s ✓T t,...;a S 7 2 1,la`::d o T a n a Q a T�..�T.../7 i s o.� p 7 J p-A c.:d 1. u0 :ods;:.2..4 pu'?) a� o07. a�2 (a �c2o .ZddP ?;- , -,2T 55..//� a...do-anaQ a .., �. . ., ,2 �.. aq 0a��.cd�..►s ;.t.e sa., t.L,as �.�.�, � � S . . \ 1 t t ► 4 9 E CENT Ur UTP CLIENTS w I L 1 eO PER CENT OF THE — ND1viDUALiZED HABILITATILN Th� S : �cH.�;Y.�hS SPSC,:� �J ON ;��:� I ��� . PLAN ANC i NL:.VQUAL PROGRAMS PLANS LANS WITHIN THE CONTRACT PCR' V . - !,a ner o= Cervi ce Provision Service. shall be provided ►n the county( i es ) of : Dade Ser'Y; ces sna I i oe proviG`c 7710 �' tt o .4.4C17.4 p 7 7 . Ser:-ices sna i i be at the fol :owi r►e locations : 9133 Collins Avenue Mia:;:_ 3eac^, Florida 33i '1 4 . DTP and Transportation ser:ices will be provided for a minimum of 230 days durino the period of this contract . Supported 1 oyment Services will be provided for a period of 12 months . Vacations , holidays and in-service time is not reimbursable as a service day for computing units of service under this contract. Hours and days of service shall meet minimum standard requirements, shall be described and met as per agency proposal , and per any other special provisions or other section of this contract. Method of P yment I . Payment: This is a fixed xed price (unit cost) contract . The Department shal 1 pay the provider for the delivery of service units provided in accordance with the terms of this contract ►or a total dollar amount not to exceed S 7 S ,7 c 1 ,36 , subject to the availability of funds . The Department agrees to pay for the service units at the unit price( s) and limits listed below:.. 2 . Service Units ( services ) Unit Price Maximum r of Units DTP - (CRT) $ 18 .27 9L0 DTP - (IFL) $ 17 .90 5980 • Transportation - (CRT) S 6 .33 920 ' ' Transportation - (IFL) S 4 ..24 5980 - Supp. Employment - (CRT) $ 433 . 18 12 Supp . Employment (IFL) S . 25 48 - 3 . I nv` i ce ecui rement s : The provider shall request payment on a mon to ir �oasis tnroun submission of a properly completed invoicea (Exhibit A ) within 10 Gays following ^ she end of the month for anica oavme,nt is being requested . r Payments may be authorized only for service' units cn the invoice wnicn are in accord with the above list and other terms and cor::;:tions of this contract. 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Il, 1 -.1 N n a) ,(: 1 l'1 -'I ) a) 1 t Q --i a) CJ Q) ;) U U) 11 Of .(: ••1 , l •rI Di U JJ r'J f 1 r-1 0 fl, J• • -,1 ;), > l: ' 4) U E_ > 0 tl) U) 'U O > 4.) g rl ,-1 CJ N U ) -r-1 U N n, N n, n, to a) U h O Q) C)' -a) Q) Ci r 1 > > IT a) 0 ,, pN N U ' e) N N ,) c) 1..:U 0, -0 to a) n, n. t). 0 1: a) (1) 1 1 (1 • 1) .f: U >, n.,c f 1 ,-I--1 N, C) ? ,c f 1 U) N G) :) > a) a) ,c N .0 O O c X O :1 a) .) )t .0 (V E• U to 0,-f) E i f 1 XI to I J 0. (t1 41 'U 11 r I E-♦ P.•-I n, )1 'iU ti, r. n E-1 l,-:. o ,-1 O U n) ) to Q u, u, E t .-1 • c) v r l ('1 r-- ,--I r I ,-1 ,-1 r-1 r-t , w r w Y� -rt t ' share is upon the local match share 18 . The Department ' s� s contingent a r basis . Theprovider' s' s failure tc _uc ion ofmeet the being met on yearly ba local matching requirement P will result in a prorate reduction the Department ' smatching ratio . funding to maintain the stated 19 , The Provider will establish an accounting mechanism for tracking receipts and expenditures on matching funds . � been matched at If an audit reveals Department funds have no 20 ' budget, the Provider agrees to 12 . 5� of the approved funds operating 9 Y} within `ort}'-five return any unmatched funds to the Department (45) days of the audit. D. Days of Services : FY 92 to 93 FY 92 to 93 Month Days Month Days January 1_9 January February 19 February !;arch 22 March __ April April May May _21___ June 21 June July 21 July August 16 August _____ September 18 September October 22 October November 19 November - December 14 December TOTAL = 230 Days 9 i: I• I L.1 1 1 UI IV (J' U 'l) Al U N 41 • C. r :)•' 1-) 14 U N . •1 �, 1 n} ,. •) 01 l.1 (-) l'1 01 t) 1)..n d1 'U .I U I U 13 1 r1 U I) % r1 ��) o I� .. 11 `1 VI •1 U) N ,-I ''1 c1 ' :1 0 ,r: ,I 01 0 1; M �, 1�� 1� ��' :� �' l4 ;) is n.-. v : . �) .n U `1) )1 1 Ql O 1``� cJ 1 ' �) til 11 4 1 '•� U` • lJ 1`1 , ri . ▪ 1 )) 'C1 111 (: i• 0 '• C�..,.I ,-1 ql 0 (3 • U• i) U U )) h e! 1-I N U ( :1 (. 1 4-1 .{ � •V U IJ ) 1 : :1 1I • I) 1 w v - .(, e) 11 o )1 'U 0 .l N >> i. , 1 (1, I) l) Q j -Uv Cl I) U N 11 -� 1 0) • ) !1 0 4 4 /4 Ui 0 •• I ,-1 Si U ,L •1 til 4.1 0 -� • � Iv rJ c1 0 ,--1 I l,i 1� 'V F. !1 1-1 I� I� •" .t`' 4.) •.;---- i c} ) '0 •(l .N 11 N 1�l .1 r: a U► , VI �) }i t: 1 U 0 I) 1 t: d1 ' t) Zi 1 � 'U It) 11. 0 1 1 O i.: Q) .3 c'. 1 J 0 N N3 1 1•J U U (-) I) .1 Ci ,, C) I) '(1 t7 1 `I 1 N ,i i%) ) 01S)-•-•, •, r- 1: ,0 1 U 0 C; 01 IV 4-) t3'Q1• c1` ,3 1: I; 0 1J U cJ N I: 11 U 0 11 ii 'rl ci _ , l in 10 • { c-� r 1 r C. , C! .C1 'U (:) U �, (l 1) O O O •�I Ul ,-..1 �, :1 P. .• +' 11 C1 =) •c I/ •c• 11 V1 I r-1 Ul I J •i 1 r._.i C� '�1 c �' U U )) .r; L 11 U ►11 0 1) U u cj 1:1 Ili ill 0 • -n � i) Q ••-1 1) c'J lJ N ~• l) �1 11 I� .� �; •rl • � I) � �. � tl ii,:;) ,1 .V :s •.1 l •U U 0 0 �V I .;l I) U 41 .-I U) J..t>> �� }''C) t: .j r-1 •r1 rJ ►1, ' '1 ul U S� 11; q1 •• �'. �. ►►) t: 11 Cl. F. U 7 'll ,- `•1 C? U t.1 N ••I a. Ul E3 1 �� v • N ,) ••1 11 9 U1 '.1 in W. }1 0 UI 1 r-1 "1 !1 y.1 0 • •-.r c.)1 u� lu (.) LP 11 i) v 1 •-) I f 1 r-1 v 1 'El 0 11 S • -. -0 .1 . 00 �! U U 1) •.1 .-1 (: N Li) .1) D. .0 I) (U ,-.1 Q) `-� i l_ � -i---,, �. rJ t: .f: al 11 U t� Cl `C1. N Vl 0 q} Ul I) U 11 IU VI . �i, 1 1 ,C I. r. :1 V, J ,C; U 1) + cJ, c 1 N i 0 tJ I) 0 11 U U' �1 1-:: O 1i 0) ul O � .< CA 'tJ ) U ,-1 11 C to t;) 1 )J U U �1 1�1 1�. I () 1 1 N ._ �U ti i) 1) - N :1 c.0 0I VI N .0 11 '0 tU i:' U I) :J 1 1 i c) H AR O 0 i. t) P. .. 1. n I , V. 1 .;1 i C: - 1 I) :- n 1 ft 0 l,1 l,'1 11 0 0 �; U 'll 1.1 � U � ,C: U U v F. �. Z- b sli \ LI >, 0 +� V 1 U '(3 00 I) •-� U I•• 'U - .J •U I. .c: -s� +1 ti 1 )r ), 0 0 c: 0. Si i= 01 cy • 3 I i 1 `) • U• N O U v 0 01 v +� N 11 U ii i s Iv C 0, tJ (41 'U )1 01 11 •r 1,*. ,C. 01 1.-. (1) .c: 0 .1: i.i ti, i3) (J., ,� > U1 N C. 1-: C_ U U `<1 •1� U �_1 U (,) E•1 rl 1v V7 FI 11-1 .i� �• ;� -� cJ V :1: - "� �1 1 ,L -�- O �) ,V E 1 u �1 1� U v r-1 is G) • ,(i 1 Rl 1 _ � l _1 N 1.1 w • F. Supported Emc lovment All contracts containing funds for supported employment must adhere tc following provisions : 1 . Providers are to use oly the supported employment models which have been approved by the Developmental Services Program Office (eg . individual supported competitive employment, enclave and mobile work crew. ) 2 . It is the provider ' s responsibility to provide a " Safety Net" for clients who may require several supported placements prior to the perfect match. This will be the responsibility of the the provider and at no additional expense to the Department. 3 . The rate for supported employment will be a monthly amount. Separate invoices for payment must be prepared by the provider and submitted on a monthly basis no later than the tenth day of the month following the month in which services were provided . A tracking from (provided by the Department) must also accompany the invoice . 11 SPECIAL PROVISIONS G. CL:.MT CASE 1 . The prc.vl ger agrees :hat all client: enrolled r a E,ena► l a :duc a..l ona Ira; n nc ant T ne. a:'. :. v.. G __ aluated u. r an lual ly by the end o l the seconc quarterafter :he e7 I e . ve date of tni s contract . A copy of ane report snow d be ma i eo to the Contract Mar .aver . 2 . Reimbursement shall be made only for those expend tures incurred in the provision of eligible service to eligible clients. Eligible services are specified in Section T (Services To Be Provided) , first paragraph of Attachment 1 . Client el i a_i bi l i ty and the determination of such is defined within the Department ' s Developmental Services Client Services Manual ( 160-2) . 3. Eligibility for Purchase of Services : Determination of a. The HRS/.DS shall have the i what to determine services any eligible person shall receive . b. The provider shall be responsible ►or identifying recipients eligible for said services according to standards of eligibility furnished by the (HRS/DS. c. The HRS/DS shall not reimburse the provider for any ineligible person served . d. If the provider has knowledge of any circumstances affecting eligibility of any person authorized, the provider shall notify the HRS/DS Contract Manager in writing within ten (10) business days. 4. All new admissions shall have written approval of the the tract Manager for Department prior to enrollment for services under this contract,. (For specific guidelines, see Attachment i 1► . ) 5. Grievances and Fair Hearings The provider will utilize a system through which clients may present a request for a `air hearing. The preliminary procedural requirement for the fair hear;ng system must 12 outin.c ,,, c;_ Tfla wi7. 1 or • to - f r rl C a`.'i n c i e r c tio cf se-vices . in accorr- fC y;i T rue. „- -`, ant as Cu y eacn C . ('r "'r' on �"-; � ! 1 Grp., The '�!-O - `�' r •~ ri a c G v ♦ E c r o r r ,1 �.�' 1 ,.C ��%^ - a.V ,o ` ` y. .. cervec t proviSior, of service . 7 . A L-1 1:e r e r'1 V r L 1 n ec:et cases of EDuSe Or Th.= nrLw ICr �'. 1 1 � ems+., alli srte _� 1 `/ .��� . �C.ir � to neoll ec;, c, chi ;�dr::r. . c sat i Ec or client' s socia to-Ker,immediately .` Comancc with -:his �: h; l - -�- to ."• ;,ori a clause 0:- .as ,.��s r.cexclude `he re Spon_ bi � ,..., suspected cases of abuse or neglect to tree C`n tra i Regi s trY. H. PROVIDER RESPONSIBILITIES 1 . Behavioral programminc_ shall refer efer t c any attempt to teach h no, to reduceinappropriate behavior to make behavior occur under aro,- o i ^ conditions maintain and y c ,, r L r � ^ � �G..� 1.'� �-eQu1 re GC-C�•'C GnN Aci a;t contrac is , of ,hose c I ; �s ..ho rspecialized an 2. Specialty _ ,, the need for be beyond the basic � �.�, rate due to1 ,. +,-. the .. • - - to adhere ,.., �, behavioral procra7. inc ,, b required l red - iCl 10�';lng Stip UIG:.-,Ors: a. Behavioral programs designed to reduced ma; ac:a .t i ve behay or shall be cevel opec to address only those barriers idents_i ec on the client' s ; iEnt' s Individual Habilitation Plan. If the provider assessment reveals a problem with behavior that is not identified on the Nabilitative Plan, the provider must initiate amendment of t a 'iabi 1 i tat ve Plan prior to, or concurrent with, intervention. Behavior program m must be developed ant the emore Cti `= new ralGdactive behaviors requiring formal terve; n . b. 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() fD Cl (D n -S ct -h Co 77 tD O Cu -'•CD a tO (D )fD -t� It Cu � J O m fD O (D •-•• C t^ • � tT n' c' --S Cu to o a -h :' (D 3 > > x Ci I rt' o- O � c °� • c _, -'• (D (D O -S T O CJ n V1 -S (D c c (i to rt rt 3 Cr (D to m CO rt -S (D V) (D r t/, %7 -'. 0 n, 0 to (D cl (D -� �. :3 to to to 0 c O m r+ N to 7 rt c< rt rt co to ;c- S rt to U (D J. to - 0, to n, __'. : r1 0_ c t N � D U (D to -t)tO D rt t '_� OCr a11iS corer, ince with written yen p'"'• r I , �,�. �,�,n^ _ �Or iC c'y HF.S��1 160-4. must occur _�.0, required n. , 1 behavior procrams shall receive the app hG roprYatc level of a:proval in accordance with , . e relevant �C-c re u �.ements = n l '�1' io P � h .ten �r`rG' � .. ,.. � ' o�'la1'►Cr �rOC'-C!;'c shall r_a, 1eC in t'1i�S1 � � V C C r, accordance i to e requirements 7, clinical . . . n . r • vA of the c r^^ "ar must C� -` n BOn. I7GF Review , o,1 r. , ,e meetings no iss monthly . ll,�r� shall l fu1�� with the req=►ire and,,,. The provider comply E viorzl Programming, q . s ' 160-4 , Bela contained �n ��r'`�'' mmi n HRS/DS Form 2012. HP.Si•'1 1 6 0- E, Client Progra 9Standards , and the n i ve Programming Minimum Clients Habl 1� ,,at �� Residential Programs for Prooram Protocol or with Behavior Disorders . full r . _ - �- n a minimum ratio�-io o• one The provider s;,G i 1 ma � n�.oi time , - for every �` time Florida Certlfied Behavior _ ,� programming. For ping behavior clients undergoing reduction � i ded by a theseservices ma y be pro fewer clients , se part-time or consulting Florida lo-ida Certi'ieC Behavior Analyst. This person s _a ll have primary responsibility J y -ion and supervision of f c;• the development, implementation all acquisition and reduction programs . Requests for : l..�may be made i n alterations of the above requirements_- Programs Review y- 11 Behavioral writing to the District Committee. •�' progress reports for all shall submit p s, The provider �or intervention to the District 11 behaviors selected T Behavioral ;oral Pr ogramming Review evsew Committee ommiflee Chairperson. These reportsshall be in the form cf graphic displays y s of data and must be submitted no less frequently than quarterly. The behavioral r , _^ . . Review Committee E chairperson may request more ^request progress reports . 3. An annual compliance audit report prepared by a Certified ed Public Accountant is required as well as, and in additio n to o quarterly expenditure reports in the format ;peCified inan ne or otherwise available o the to this contract A c p� o. attachment Program Office . ° provider ;:h�-000n the District ., Manager , _♦ to ♦►�� Contract Compliance Audit� � �11 be delivered the one hundred twenty (120) days after the last no later than effective ective date of this contract. _ •• theprovider as a result of Any earns ngs real�zed by P •�i e� including 4 • supported activities,contract-related and aon publication or other royalties received from copyrights � income from works developed under this contract, n tere s t I tL1u l v.. 1 1.- . - f\be . ' ' . ' ';t 1 ,,‹. 7nE ;--,. :: ra7. ..-7 '. : (., - i- ',,,-- \ .: $. : - .i. - - :: !. : : : 7' !: ' S. -.. ercs - : .. ,: vev. s � r ; .',E ;: . 1AcG . � '. • = ac.: � - ' r�F ti1bCci � bfs of c1G . S ccCs _ re , ; �Er.� � � 1 5e � . � nc enc �c„u� � . non � „� ;; 3 �� � ori . meet tree changing nefCS of the c1 i enr ��r .. ac F•roorct". r services by he HP.S De\gel opmen l Services en s I. Payment o roti icer sr� rl > t�o� Office si..�1 1 IDE. considered payment in , u1 l . Inc from/or lr on • or eymen for the client ' s care ortraining receive E aCCe�� p - 1 c o` the cmOunt, of tern�i neG c.nd ou thorn tet by bC�hc � ` o � c client � f� � ),t � 5 � The Department . •r The Provider has agreed to be open for their operation of services for a minimum of 230 daysduring FY 1992-1993 in order to allow the clients to receive the services fi Specify t in the contract. 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(D t , N P. t-' (i) a rt m 3 m m0 m it)' r t ,--i P, r t I h m ,t :7• ._I t It it c1. n. :1 O. :i ►- I h 11 11 rt '< ft- 'U m -1 n to 0. m m !-• 0 1'- '< 1'• 1-• P' n• - N 1•- 1.• tt (D 1• 'ii rt c t In CI P, ,cn pi r t C to C 1-' 0 '-) :) to m 1 • II (,• N .ai t t t 1- n f� m ,t t t • iv t.) ►'` 1 4t (D C C: m N m C O m O P. rD ►t to N J .t 0 c t I to :t 'c-1 11 tit G ►* m ►h m C-: p' n' It N to O. - ' :) (D rt J f' ►t :1 ft rt I t' 1'• • rt P' m • to to 1-' (1. m tr N N r1 n :r 1 t tt (0 it it 1'• 3 1'• - : m rt 1 • ►h N rt 1-- In () 0 m r) ►t :3 0 O.•t 0 rtm t'' coN 1 n N J C :l :3 1t r; rn t h (0 0 m ►h O (n m O N O n• O' • • - rt It J ;) m t'. It - V• r it m to U ►-" O rl in '(1 t-• �► 't O .f O• � m m rt r t m O. 'Li .) .l rD m a m fl• ► ►� (t p, O `< U 't c) :t D CJ (c 0 1 a it O J n :i m O r) t7 I t m m O a' P, 71.. 1'. P' r, ►.. to () O (t o [1. o c C '(1 1' 1• 0► ft. ►1 m• 0 0.m 0 1-' 0 < Ih 0. 1-• rt m :� (1 1-' C Pt 1•• 0. 1t :r0 0. 7 t-' 1.- n. -.1: 1'- if 1 '1 f ' < it �' m O m J• 1'• ft m 1•• Pt rt m ft (D 1•- '-- ft t) ► ' 0. t)- ft J m 0 J m n. it 9 n' 1- 7 N X rt 0 :r U. 'i to '< :J .) to O '] m J 0 to .I I- in (D :J cl- to ' .7 n. 1t rt �n m - :1 m ►1 P. •• 7 v" 0 :) (1, m ro 0 0 7 in 0 m :l It m '1 :1. (0 I h 11 in O. (D • o .r Services C r • e Criteria a - C r m- s C , o r s a n c A ' Prespect ; ve c , i err s except private must De r e• E ► " e` • ` District 11 . the department cf Developmental Sarvices , The prospective client may demonstrate to be e a n appropriate candidate for placement at , re facility , in accordance vl , rtrE Gr - r o` Er written adm ss on cr er a established by the provider . The ep rtm;n S - l no: he riC1C , ia : ' e cr paymen i - a c` ier i I.e Department� ., � �, admitted to a residential set r in , witr ` written G V_ hor, z a- - V r i QCT : re Developmental Services Procram Additionally , the provider shall notify og i fJ the placement coordi nafor in Developmental scr e ' es prior to acre^: ing any otner proposed placement from o• .-,Er HRS pro - - : m ` or any ober re' crra l source .i res , private pay Each cl i e n` of Developmental Services who participates in a residential or non- residential program shall be subject to a ninety calendar days .. Duri ng the probationary probationary period of ni n � - _ period , the provider shall evaluate the appropriateness of the client ' s placement i n relation to the service provi der ' s approved written criteria for admission . Service providers shall verbally notify the department as soon as a client is suspected of no: mee_ i nc the wri • ten criteriaforadmis - si of Servicel providers shall not ,y he department., in ting ty certified mail as soon as a client is determined not to meet the writ`en criteria for admission . meet the client is found not to meet tho service provider ' s written criteria for admissions and services , the district Developmental Services program office is responsible for removing the client within _ maximum of calendar days of receipt of certified notice to the department , and providing alternative service arrangements necessary rY toensureclient safetyand prevent regression , unless the service provider agrees to extend the probationary period . The provider shall continue to provide services in the facility until theclient is removed by the d epar tmen t . The removal shall be completed within a maximum of twenty-five calendar days from the of receipt of certified notice to the department unless otherwise agreed upon by the department ant the provider . E . Suspension of Services Suspension of services can not be implemented by a service provider in a residential facility . Suspension of services can be implemented by a service provider in a . non-resi dent i al facility under the conditions and following the P rocedures stipulated in rule 10E- 8 . 030 , Rules for Suspension of Services by the Provider . 19 Termination c Services by the Provider L . I - �'r i t ten notice of intent t t services by the provider rSCE vaC by certified mail fifteen departmental : par- mpr - Gl V.Or ; -; nc days rc • to trpivpvs - . _ ctve date . Termination of services e vi = es t y ` n E o: . c er- r` - ' r ►c o 1 ' OF - E . 031 . T r,` client - i C e t � r' ^roce�'�r< < S L ; �v i a�c � � n rule . until all� r,r�r_ G , S are E�:hc� s � rPcei \'e ce vi ces pv the crov1 de'- un;, ; l a ; I ap the '11 - r - i "e hear ce _ . Termination o , Services by the Department L The Department w_ l 1 notify y rr provider Ger a� least ten ( 10 ) da } s prior to removal or transfer of a client from the regideitial settl ►� . • , a " ten Cay, holding of bed payment " p to The provider will 1 be paid - are from the residential setting without Tor those cl i er� � s who removednot result from any ten ( 10 ) days prior notice if the transfer does 1 setting . inadequacy of the provider or residential l a te Tait if a { �• r• / J C � 1'1 v .� i ... .. t c _ y .. hospitalization , home V � .. - Ge-- int due to i absent from the reS i CEn �, i �.: 1 setting� -'• rF - aJ �hOrl ZeC ZDSencE from other of �r for any P program c � vacation , treatment o ., of period for absences any The bed payment the residence . holdingclient must notexceed ed � 3 0 : consecutive ys Request for x1 . 10irinC of ced payment E ; CeEC1nC ten ( 10 ) days must be prior approved °y the District Developmental -- rntal ServiceProgram AdminlstraL�' s- ri AQ Penalties for failure to adhere to the conditions spec i f tnis contract concerning nc Gaditions , suspensions and termination of by �,,. . services for clients the p� Ifprovider terminates , suspends or a residential services des i n rule rthe Guidelines specified reduces services without adhering ng a toacainst. ` the residential service : Or - � thedepartment r•�a}' impose fine tical ns 1 " d SE 000 per i nci oE., �- c exceed provider i n the amount of _ � Ov a day Imposing a fine acainst a residential cervices provider must DE in accordance with procedures specified in said 10E - o . 0 : L • L . UtnerS offered by Providers will attend all training currently _ . • any future LL;rC r�� � 1. Services to the provider community and Developmental officeprovision r,,_�- c �, � G, 1 . ,, e so as to ensure the deemed approp, 1 G � _ b� the program o► hi ch level ;ervi des . Providers attend i n their ( or designee ) will attend and participate -; clients ' annum had ; itation plan meet 'ing . The provider will also maintain a current Nabi1 c �,. .1 ��_ _ ; or, plan cn each client i r. their residence . • . r rt De e .`n v`✓ Department . e Departmentreserves � r ;nese Tunes be used _o reduce ,he mos . borrC ,- tne Federal Government cr the Department or both. 5 . Bor_ting The provider Hi i I obtain and maintain at all times cu r;n c , 1` terms agreement, a + i eli-y bond covering tne � activities of l officersemployees . servan�s , and Coen`s of the provider autnorizeCto hang. I funds Cce- vet , or dispuG 1.0 r under this contract in an amount oml.,_ the funds handled, tne cecre of risk as determined � �h good business S�ne<< pr cc c e . surety company and consistent �r All provider agrees to comply with the Education for «h E . The tne Rules of the Handicapped Children Act (P.L. 94-142) and o PP Department� of Education: HRS Programs for Handicapped .. (Chapter 6A-15 r .A•C • ) to comply�� vri th all the departmental 7 , The provider agrees p � � � nc 393 .067 (3) , F .S . policies and procedures implement ScreeningRequirements ni ng for non-departmental employee(s)/applicant(s). Z. T services will be pr•ovi ded in a manner that complies with applicable prr e ur-es iii tne Community Services Ls orce . Manual (HRSM � Behavioral Management Utilization 160- , ) , Guidelines (HRSM 160-4) , Client Programming Manual al (HRSM 160-8; and Client Services Manual (HRSM 160-2 . ) 9. , The provideroviaer shall P ar ti ci pate in Habilitation Planning ng Comm►atee meetings (HPC) for HRS Development Services Clients. 10. Human Rights Advocacy Committee (HRAC) The provider der aorees to allow properly identified membersoT 4-,QAC access eto the facility and/or agency and the right _to communicate withclient being served, as well as staff or any volunteerswho serve them, in accordance Y ;:r Section 2G• 19 (6) I .L. , F .S . Members of the Committee shall be free to examine all records pe-aininc to any case unless legal pronib �orl exists s;.s to prevent t disclosure of those records . .t 1 1 . Funds made available pursuant ursuant to this contract shall not be provider by the rovi der and/or subcontractor for the purpose of initiating or pursuing litigation agai nst the Department. i 2. Analysis' of Expenditure Rate The provideragrees agrees to submit an expenditure reportfor the e six (6) monthperiod eri od oT July 1 , 1992 through December 31 , .. 1992 justifying the negotiated rate of sere;ce. 21 i 1) t) I) t1- f- i) v) () > - (1) t/) () l) 1 1 1 1 () 1.1 • UI C (D v) t.)- - () (1) .1: 1 - a) : t:: (1) i. 0 .0 S 1-- (v J 1 9__ to •.- O t:: (.. -1 U. -U (j) •r- )) t 1 ((I) I) V) (') (t1 ,t.) •_) I I I. r- :) c F t: - 1 - f- () .0 !.) C) (1) >, () L-- . : s. 1- iU 1) I) i .0 () (1) -- ) a) 0 1 tt) .► t1) LZ r-- . . I_) -U •-- I i (d 1. (I-)r-- -- ••- I, l-. .t) (1) 1 - 0 0O Ct: V 1 > 0 I I- - S- I.1 . • 0 U F .1) ;-, 4, 1- 71-'1- - I- () t►) • L-: I() ()- I.) ) - t1 1 (I- (1) 11) .' •,• E. Fy I:) t') U U.) !.--) () .0 I.I O (l: (Q) • i. 1: l.) C. C) (•,' l.1 .0 'U) (1) ') (/I IU () (1) •I) c'-, (-) 1-- ,-- t I) 4t) C :- l: 1: U) L _ :V _) 40 1_: •r-- 0 •- V) I J i- C .- vl C •,-- 7 I J 1 - ).I t) C) (_) -•- .t) () C rt) t) C/) . . • ) 0) .- c (It I-2 C ,U I. E= r 1 • . /) +, (I) 1;' (') iU 0 ;7 (U - O U _1 0 to 0 C c - I. '.12 (J (I) X 7) (11 -Li IJ C 1 1.1 •r- V) (1) 1) 1,) t: t: C) ) v) -C. E_ •.-- VI 0 Cl) -1: C) (I- W 0 L) C ._-__: C 1,1 1- (.) _C C •••- 4.• .1) •r- 1.1 Cl_ )- U. it) I) L > r— '.-) I,) (.)) C t/) r- -U It) .- tU iU U) t ) C C) ♦) >, 'I- F) C. U t.1 - •r- •.- 0 W C) U) 0 1 - t,) tr: >, v) () 1.1 > U 1- >- • [) r- •r- 0 I-) 2) Cl_ t . i.) 1) > C .-- -t C-: r- • CO -•C :1 C) 0 0 C) 0 C1) :•, n _J 1_ i. t1- I F C t: O O (•) .1 Cl. 11. O I) •r- •.- C I 1-- 0 (1) C (U all •U .-- C 0.(2) (4- -- -- _-:. t1- - (.. V) L= C) IU a) ,0 01 :0 1.1 IJ •r- 0 to (1) -) r- CV I .1 • . t 1) ..0 Cl_ -t.) C) l) ••- (1) 1 t`) • 1 C) t_ j S_-- 23 ••-- G 1 I J 'JJ (_-) 1 - ( ) t: 0 _. 0 W > Cl rU CO :U •t: _.) •r- •• Ll i F .C: •r-- i‹ 1) V I -1. I L I 4_ . v) C.) )-, C-) tl) (/I ,-- C.. •_) Q) U) • C cr I,I V- >, I- c ---, 1. t~_ •.- U) it.: (-:. I ) (/) () r-- _) 1, t) U ,-- C) (Jl t.1 (1 0 l_ (} C. V I t_ --- w t t 1 0_ (1) E 'U U- U r- I! •.- --, C -I: i- to 0 I) 0 ()I (1) •r- L. 03 ..) •r--- 1-- I -- :.7:.7.). L) (J) (I- -0 1 ` 1, L. ',- .0 _ ) • I•) .1 t!1 r iG A. Bu l ding,-'Space Donor retains title : a . renta' v , ue-subs tan tia..ed in contractor ' s _ o_ s • G J... � of fair r v- " � value .►"���� confirmation (s) a _ _enta_ qualified individuals , e . g . , real ors , property managers , etc . • r / • • b . ( 1) Established monthly rental value of space (2) Number of months donated • during contract m hs Value to Project (b. 1 x b. 2 ) • 2 . Title passes to contractor: a . Der ec is zion 1 . Cost of—fair market value (MV) at accuisi tion (excl%:ding land) $ 2 . Estimated useful life at date of acquisition S yrs 3 . Annual depreciation (a. 1-a. 2) $ 4 . Total square f o:J rage sc. f`. 5 . Number of square feet to be used on iiRS Con`rac1.. ." sc. `. 6 . Percentage .of time during contract period the project will occurs'y the building/wade • 7 . Value to project (a. 5/a. 4 x a. 6 x a. 3) (*) May exceed 2% of (a. 5/a. 4 x a . l x a . 6) 23 a , • • ► • `1 b . Use Allowance 1 . To be used 4n the absence of depreciation schedule " ( ' . e . when the item is not normally Dept ecia`ec the contractor ' s accounting records) . 2 uav include an a+i ouance for space as well as the no--a' cost of up);eep, such as repairs anc maintenance , insurance , etc. E. Equipment 1 . Donor retains `itle : . J . . a . Fair rental va_ue S Title passes to contractor: • a . F?:V at time of donation $ , or b . Annual value to project (not to exceed 6 . 2/3% >: (2 . a) ) = • C. Personnel Services • Annual salary x Number of hours to be provided = $ 2 . Volunteer (indicate if volunteer is also an employee of the provider) : Comparable annual salary $ Annual salary x *Number of hrs . to be • 2080 provided = S D. Goods/Supplies a. Fair market value at time o' donation $ Ac the discretion of the Department, .financial _eco_cs (e. g statements, independent audits , ependi sur e reports) , shall be available and periodically assessed: 'or assurance of financial stability . • • 24 • • • . • • • • SZ • • • (a=17 2u5T S ;ouou) . . • •o2a r:oo =u2a5 T2=.a^as a7, ... r +rr-. � a;2,s Aug ;o a:;t pu dxa u2 4.otr s uo 2uop us2o s ..-r -.�(�"►, :� t^'_:a7, • pa o- sa: / S3- - t s- uoT 7,2ucp s'...1, ;o as • a�,o ac :o/uo pa-a T d co aq 777.-. 7,112 ,. _ - a7, T T;;; "0-- 2U00 S ;s s ua:;`T2,sit : U , ap2�� -- S = :lOI:,V:ZCC ::S•�� , O ,�.:�i.C •i SS:NCC` 'dC:1CC TI-1s cash donation n is not being used to meet the catching requirements of any other .-` or federal grant or contract stat (Contractor S icna e) Th s cash donation 'is accepted for meeting use in �, ..c.. _ec-�_r e:�e::_ •,�1 4 o: contract nu oer (Department Contract Manager) (Date) • • • • r • . 26 LZ • • • • • • • • • S • � $ Z 1, • S anT2A • (uoz7,2ni2n ..o-;2n'2 ;o s's2s- pu2 uo 4a:a-LsaQ ;O S Z S2� pa ... ao2d co-4 _.a;a�.) [Z • (.:ouop nq a i T.7 7,) 'nZ .:.;2:ocya,Z �o pot�ad au: _7.0; (moo-7,27.-•svi5.:o 0: . s.ass2d a77.77.) pa7.2uop o sT ' sa0T,ti.;as saT-cdns/pcc.5 .:ua=d71.ba ' ao2�s :,�uT. c I'cy a4L V V • ►{o ' t pa--a7,:,,.c aq os i2 'sr,=-11 0; .. •pat,'02:�2 ^u2 a`''•2� ;....2 S2 .. , ;0 ss2S ati: 'pas:: 57 =0; L:OT:2'ucC ;0 7.'-:9=7.7-:=00 S74= >- .t V:.L t.t'.,C J W 1 t 2 W r W1•t J.; 1 0 Tne above donation ( s) is not currently included as a cos (either drect or - •r. i n.-.) of any state or federal contract nor has been previously purchased from or used as match for any state cr `ecera:. contract or grant. Donor S, g f ..--e ( p_ Ln../ ►..ype Bono s name) Date Con ac;cr S:.cnatur e r..n` e cont. s name) D =_ —=================arc==== The Department has reviewed the valuation of donated tem (s) and has , in the space ace p_ovi indicated the valuation amount acceptable to the ed n` use in meeting a match requirement t for this Department for _ contract. Donated 'iters are subject. to disallowance should they be found to be a current or previous cost or matching item of a state/federal grant or contract. - ::R5 Con`r 'Mg, . signature (Print/type HRS C. Mg . ' name Date • • • • • • .• • 28 • . ALLachine(11- V .l 1►cptrtment of Health anc! Rehalbi l itat ive Services hcveloctnental Servicet Progra.a Office . Client Pro2ramming Unit pt�►E(.OPIt£tl'C1�(. 1'I�t_A111tl)G PRC (t>`11 Revised October, lyes _ --- j MIUIMUU `;TAIz()AiloS ('ART 1 - IU01VIDt)A(.IttD CI It'..lT t'i1c(;(1AH)IIUG f'I:0.:t•'D1)RNS - ADULT Survay Dates Total I Cllcnte Name of Center ' Center Addreaa _ ^Director Total i Staff In 1 Y li... IK IIT, C n ru 1.n t e_ -- -_P. 1 .0 Staff Ratio P.1.1 The Director of the 11rajram is not a full-time 1notructnr P.1.2 The staffing ratio and r)roup site Is aa tollovur c. -. P. 1.2.1 One direct service staff peraun for each ten (101,i'11e lta, with _ IV -• . ' ko P.1 .2.1 .1 cllcnte in groupa of twenty ' `- (20) or less. . . • • P.1.) DIMS Devclollaentsl Training funds are not uued to _ _ ----- --- - provide services to public school eligible cl lents. P. 2.0 Staff Q2111ticdtions --5- ---- P.2.) The Program Director has at least a Dachelor'a Degree from an accredited college or university with a ms jor relevant in Ids or her stated jnp . a duties and reupnisaillilltles (e.g.- behavior analysis, vocational education, mental retardation, exceptional . child education, business a(tminist!ation, rnllaL[litotive• ------- co'1n:;`( in1), physical thetapy, psychology), Ina (•. 2. 1 .1 nes at leas( two 121 years of full-time -'" - -----------_____ experience working with retarded/devel- opmentally etarded/devel- opmentally 1(i a:shied adul t s, or in a :Managerial -sul►,:rvisory capacity. or 1.-I •. .:."4. -A. 1-A-1.,: ir, (1)I1::1•Ict,:, p11''!:..0:: d1 a 11::1;: which 111.11 11.1t h1_ 11:;cd) .. I. tltc� ti11 Yt P.1.2 Lacking nn an appropriate [1schclor'a Degree, 1;r 11C 11 .-- --_- -7, _- ------.__CnnuMe:ntn ----- ` Director has two (2) years of college week, and ' P. 2.2.1 four (l) years of. full-time experience --- work ing with retarded/developmentally disabled adults, or in a manayerial- sul►ctviaory capacity. Bonus' Projra. director has qualifications In exceua of -- _ a,l nLe..a rc•lul re=enta which arc relevant to the services being provided. P.2.3 Instructora e:ep1oyc:►) by the agency have a Bachelorio - ------ --- -- Degreo ftc.ot an acccciltcd college or urtivurnity with major courie:work in such subject/1 se behavior analyele, vocational education, axcept tonal child education, mental retardation, recreation, speech therapy, occupational or physical therapy, paychology and social or reliabllltstlnn acicncaa,_ and P. 7. 1.1 unlcse certified in their respective --_ _____ — .__. ----_------- --------_-� dI acipl Inca,, have had one year of full- timc rx1 riocce working vltlt ' rctardcd/dcvel oletcntal ly di cabled ntlttl t 9, or P.?. ) Lack i r.g an appropriate Bachelor', Degree, the ' r- instructor- Ilan two (2) years of college wort:, and P. 2. 1. 1 three (1) years of full lime experience working — ------- ---- ----- vorking with ietarded/deve:lot.•neitt-ally/ diMabled adults. Bonus: Instructora have quallfIcatlone 1n excenn • _-- _______ of minimum requirements which ate relevant. to si:rvic:cu beifiq provided. P. ?.S Aides have a ntinin.iun of eight (81 ycara of education, ae..: - - - -- -- P. 2.S. 1 are under the direct supervision of an instrector/,upervisor. 1 . . . si and ��Y1�,r l cilcC N1 '!P.'': t1(1 ilJj, - ----- c'ni�un�.nt u - --------• ' P.2.6.2.6 Al 1 otter ata(( have the qualifications �c:t ---- ---- ---- - -- ___------------- - --- - out II ne:tl in the: approved proposal and contract_ ___ -- --- ------=--------------------------- Bonus: At leaat one staff cecber Is Level III certified In behavioral analysis. ---- ----- ---- - -- P.2.3 All therapy vendors (park-Limo .or (1111 tCmr) o Center providing therapy services at the mcldt be licensed, certi f led, or meet state requirements In their respective dtc:lP nes or ..-their ro• eau is supervised by such a person. I . P.2.1.1 Other stat( who are supervined by licensed program or certified tircre(�luts must have tl�c I r 1�ro) rcvievr1 insularly by that theraplirt. 'tirlrn cunt occur •: icaat c,'icc fee week. P.2.8 Any scr-vico I::-ovldc,1 by such lherapleta rrlrall be 1 . documented. ------ - — - ------ — i P. Z.0 Soeirl Services - - --- - - --- — mental Se:rvie.�::c ' P. 3.! If more than thirty (301 Deve:lof • Social rvicer l� cl ienta ere enrolled, a full t,me . employed Eq the Center. --- - - ---- - - — -- li 3.2 If a Social Worker is employed by the Centers then, P. 3.2.1 he or she hss a Bachelor's Degree, ______— P. 3.2.2 specialized t'rdinirry in social cork principles and techniques, and . P. 1.?. ] is responsible (or duties conrtlstcnt with •.:.ose found In '.he aplsroved pr op.)as 1 and contract which delineates the rales of the (kvelo(aental Services — Case NariA(Jcr (cGea those of the agency Social worker. The social worker had pial i(ication'r in exeeSu Cf minimum requirements. i 1 •-- WI -YI:;�-11( 1J 1�- Couunc n l 3 - P.). 3 Thu Social Worker (or person dcdlgnatecl by Ow Center) sub.-sits cumulative ivc client reports indlcalln:J prc.,3ress tovaret target behaviors and the redulta of the formal assessments conducted by tho Center (refer to standard P.5.2) to the assigned District feveloimenta1 Services Case 11anacicr, priot to or at the tltiiu of the. Irrole:.ted reasacasinent data 3trc.v:l on the Habilitation Plan (aa per district Instructions), and t .'P ).).1 participates on the 1)idtrlc:t Develc►ime ntal Services Ilabl l ttation Planning) Conunl t.t t•r:. P. ). 1 The Social Worker- Ant- a peraon.designatcc) 1.1. rho Center) docurcnts on-going Cadtvork act lvi t i e::+ :a specified in the contract for servicers and in tlkSH 160-2, Client Services t hnt>al. —__ p-)-5 1'.r: serviced providedprovidedtry the Center arc efnnlgneel to address the t,arrlcra to optimum independent functioning identified In Section H of the client'a Habilitation Plan. P. 1.0 Hours and pays of •-p-------- . 1 . 1.1 Six (61 or more hours of care and training ate C...) 4- available (or each client per day. P. 4.2 The Center provides (or at 1e0EZ 2)0 clays of . cl!cert training per year. P.5.0 PreAram Coide:L '- '- _ P.5. 1 Apr In tivlulttal Prc►.)rarn Plan (active treatment_ plan, — _--- -- prescriptive poo-)ram, etc. ), 13 designed to .,.I,lteso . barriers to optimum functioning on the client's ,� current Ilabi 1 i tat lore Plan. P.S.? Appropriate formal and informal assessment procedures arc -- u:sed to determine the: client's current level (if functioning in the arva:r described as b.irrIcr'a to optimum (ttnr:tIoninq on each client's current: Habilitation Plan. This assess'.i:nt in(Ormar.LOn in uaCrl lir --t'.5.2.1 select tarujet behaviors (vhOn not id ntiIled �- -- ---'-- -on the IIa►rititation Plant, retalcel to hart lz[:1 to 0011(1 11(08% t une.l i on i nl, av::cl . —_ . --- - -- — - ------- -- ----- • . 1 e - . P.5.2.2 identity t-oecl ino data neceeaary to develop . • the initial short tet-u objectives ntnd the Implementation plan* for that target behavior. P.S.) The 1PP le de:vclnt►cd by nn interdisciplinary loartl�n�, eondiating of all staff responsible (� )r tlio *octal votker, thorapl at (when applicable) and the client and guardian (when appropriate). i P.S. 1 The IPP, ATP, etc., is prepared no more than thirty O0) warkiny days after a client enters the prc>jratn or after the I1PC t:.cetlng, In a (orxat that includeut P.S. 1.1 Nca*crrablo target behavior* needed to lti� ovurcc«c 1,_tit r(era to optimum idcnti f ied on tho Habilitation Plan. _ _ _ `. .___- -- describing tho client's (. --__ - __ ------ -.-----' P.5. 4. 2 Basollne c1eta 1 current functioning In the target W t.chavior to.ho addrCaaed in pro'Jrarrrnln9. P.5. 4. ) Short-term objectives, which 4 I'.5. 1. 3.l relate to target behavior:r, _— -- __-- __-----__-_--_----- P.S, 1.).2 arc determined from Lauel ine data, and . . - P.S. 1.).) are written in measurable lcrtnu, P.S. 1. 1 tlethod and f rt.quency (..: data collection. P.S. 4.5 Staff nsae(a) responsible for implementing --- -- each short term objective. P.S. 4.6 Slclnaturca of all persona present At the intcrdlacipi Inary..11l_P, .1P1', ATP) rttatf 1_t)cJ,. -_- P.S. 1.7 Hclateel aervice3 to be provided to the client (transportation, speech thora()y, etc. ) aa.authorited by the Habilitation Han. P.S. 1.8 11ea date and prj ru t o data for each ishur t'- -ti1:1 YN!,-ItC tJlr� -- (:i�:n::ee nt r term utbjective is recorded on the IPI► (uuat Lc at least raonthlyl. P.5.5 Appropriate pro7r3E,.,t Ic adjustments arc r_ do Kaeicd on ►:.apirical data rotiertinO client progre:nu toward Meeting short--ter* objectives. P.5.6 each client's Instructional/work program con:Oulu of activities throughriut the day for the ach l ever^_ent of short-term objectives and' target behaviors in the client's lPP . • • P.5.6.1 Ac:tivlticr are arc appropriate and culturally — -- notmativc. - P.5.7 Ccniistent p:ogram.ing le facilitated through they - uda 0( forueal I reel I•plemantatlon plans. P.S.8 Effective prcjra.aing (a facilitated through tile. use of current, state-of-tha-art technology, resources, matcrialn- incl/or erluipnent au • 4 applicable. P.S.9 The client and/or guardian/LTRC operator (as appropriate)' --- - _ . . 4. receives a copy of the Individual Pro)raea Plan. P.5.10 The client and/or guar►Ii an/LTRC op•'rator (au apps opr i ate) --- receives semi-annual rei.Jrtu (copien must be so i nta i nod in client records. P.5.11 Docum=:^ted referrals are made: to the District Office of vocational !rehabilitation for thoac clients utiO have demonstrated satisfactory compe:tenc7 in lievelo(',,acntal Training i'rc,)ram cork contracts anti training activities and are potent tally appropriate for Vit aervlee:•e. _ _ ____ -6- —-- 1 corm r t y P.5.12 A . :stet Ilii of referral : to the OffIca of Vocational Rehabilitation is ke(:' on tllo by the Center and Includes' P. 5. 12.1 Ilacnco of cllcl 'e found feasible for dcrvlcc.c by like: Office of VoCntional ltchabl !Itatlon and p.5. 1 2.1 .1 type of VR service(a) recommended . (vocational evaluation, work adjustment, on the job training, trial placennent, placement, etc. ) p.5.12.1 .2 naoed of cllenta found not feasible for cervices by the: Off eco of Vc:atlonnl Rehabilitation and p5.12.2.1 epeci f is behavioral def iclto/weas•nessec which make tlu client not feasible. two P.5. 1) A follow-up plan (or c1 I ente (cued fess(blc for -the Office of Vocational Rehabilitation serviced is maintained by the Center to determine appropriateness of rccc.mmended serviced and lclntJ range effectiveness (Impact) of dcvclo[tuental training. P. 5. 1 1 A plan for cl l ent s found nonf eae l bla. for services is implemented by the Center, and andrCa`1C:l there►: specific behavioral def icits/weakness ident1 f lace by the O(f ire of Vocat lona1 ftcbabi l i tt+t ion. • P. 5. 15 When en inteldincipl inary team determines that a client has succeos(ii1ly completed the training pro-)ram, documented referral a are-made to • appropriate proi)rams and reported to the DIntrltt_ Developmental Scrvicc••i P(0x11.+lu. 1•. S. lb '11►e use oh (e'itr.tintn and .all programs clt:i1.1ned to � Iia►tilc' I► lievior5 l�.I,IC.! 3110/Or CI Ilnln�l[t' Il 11 elf'.. adhere 10 the cci)ul.11 i iins ,►nd procedure!) c►ut 1 i ned in liel!avic►r.►1 It(u(j(ammin;l ,►Ilei tt.►ntc umunt . • IISt1 1 Ell .1 ) 1- • --- tir'li YF`, 11C'_Uhl -- -- --Commentu------ P.6.0 p_rcx�ram OutcrMC HC3eurCs . , - ---' . P.6.1 The client hao nchlcvcJ clew skills ad a rcu%)lt of pro.2rsmaing. P.6.2 The client l a regularly using the new nk111. P.6.3 The client ciccaonstratn■ the skills Indicated as 'Achlcvecl' on the IPP upon tcyucut. p.6. 1 Programming has enabled a client to advance to a 'netting which allays for him/her tot P.6. 1.1 function tore Independently, P.6. 1.2 Improve al,111s/competencies, Nonunr t;c integrated with non-handicapped p,-era, and to Bonus: fulfill social roles cYpceted of life/flet ago, cultural oily and conuaunity. 01 • • -0- • • • • Department of Health ti and Rehabilitative Services . Developmantal Service Program Office Client Programming Unit pE'�IEI.U['I(l'l11'A(• TilAI11t11C; 1'It(�_;Itf+:{ Revised October, 1985 --- HIH1N(111-STANDARDS PART 11 -VliE i,Tli All() SAFETY PROCEDURES p,t e Tl l�a ------------------ Agcncy - H.1.0 phy;leaf Plant Requi reuenta 1 . 1.1 T he facility aci1lty is inspected nspected at least annually nnually by the - - 1 . 1.1.1 local certified Fire Authority, and - _----_-_--- - _ --- . - ---__-----------__--� w H. 1,1 ,2 local (!celth Department sanitarian. _-- - ll.l .7 Deficiencies iciencie s note3 'during inspections are corrected - within thirty (301'daya, or efforts to do no are documented. --- - - - -- - - - _. e v Il. 1 .) For Child programa, a minimum of f i ty 1501 tquar feet of indoor claaaroom and/oract Y space it available her client, and __ ----- -- --- - ------ ----- -- 11. 1 .3.1 a mini-...rs of sixty (601 sg1s rc feet of outdoor rccr :ion apace is available pe•r child. 11.1 . 1 For Adult programa, a minimum of sixty i .01 dquare feet of indoor classroom and/or vor'K ) 1i .5 availat)lt. per client. _ ------_- -- ----- -- __- .s - I1.1.S The area 13 fenced, where apprcpr i e to. - -- - • ,s .tt1:1Lfs, October 05 (Obsoletes previcus c:l i i ions �.isich may not be used) Il1lti (,S I•c.�•. COmmontfl • H. 1 .6 ror Centers serving children, tnerc in ono (luatc111c: toilet for the (I rat (I(teen' (iSI ct.i Iclren and cnc toilet (or every thirty (301 children thereafter. - 11. 1 .7 I';,. centers serving adults, an adequate, number of t e a t ruocas .arc provided. 11.1 .8 ftestroc'na are private. Partitions hetwnen (luahable tc'I lcta arc not applicable for children in toileting r► programs. Xn adequate nuabcr of rc atrocxta aro accessible to the Icilya Ical 1 y handicapped. 11.1.10 In Centers sr:rvicic) children, one wash bast:: in provided (or the (1 rat fifteen (ISI cltl ldi r.cc and one ::sh h.aain (or every thirty (30) children • thereafter. 11. 1 .11 In Centers serving adults, an adequate number of • - 00 v.a ctcica:Ins are provlcikd. 11. 1 . 1 provisions _tor clients ' c.l cant ineua '.arc mad.: to -- -. 1 assure that client has to leave the Ilrcvaul (or Improper 1lyglcrc.: or soiling. 11. 1 .1) ' The facility la accessible to the physically handicapped. H. 1 .14 Pier Center assures that the bullclltcis, grounds and +� --_-- stot.0 e areas are free of hazards to the clients. 11. 1 . 15 The following are stored apart from food: 11. 1 .15.11 Cleaning supplies H.1 .15.2 Pesticides II.1 .15.) Poisonous products. II. 1 .I5. Unless cocci as part of the t 1.11 11 0) pro')c"acn. all of the above :It:: s:oc CUL Of reach of cl ient:J. -1" • 11.1 .16 HediCllle3 and drugs adnlnlatcred by the Center are kept under lock, incl ----- ----- -- ---- ------ 11.1 .16.1 narcotics administered) by the Center are kept under double lock. 11.1 .11 .Janitorial and housekeeping dlutiea ars: performed au needed. - -- ----- -- - ------- - H.1 .111 ," Private space Is avalleblu fcr co ference3 v1 tit parents, staff and visitors LO Inuure c_onf idlential ity. 11.2.0 Fire and _Safety -- --- -- ------ -- -- ---- H.2.1 Vire exita are clearly marked, and -- - -- - -- ---------- --- ---H.2.1.1 kept clear and acceaa:blc. -- -=-- --- _ --- --- -- • 11.2.? Functional firc'extingulahers are provided, and UD H. 2.2.1 -are inspected and tagriedl annually. H. 2•) FI re drum n are conducted once per month and documented to include; 11. 2.3.1 Date, H.2.3.72 Time, 11. 2. 1. l Time required to evacuate, 11.2.). 1 Whether announced or unannounced), and 11.2. 1. 4 Initial:1 of person who conducted drill. 11.?. 4 Schematic evacuation plans arc-conapict oualy-potitcdl. 1 ?.5 Xdldi:ional evacuation procedures arc provided for clients with upectal needs. All volatile materials arc Mord:.-1 In covered metal containers or f 1 re-ccs1stant contoiner9• -- - -- - -- -- ---- --- . i, ► w '()U!.) tt )SI !%'(►t' o ijv(1 )o :)In�EUb!S put. ::I!,tl ;� )o atllt'll 'Jl)1!isol) 'amp 'ault•u !.. 111,1( lp ''t I( of s p)o:)a.1 atl.l. 'OaJ ls!uiwpQ uut fit:•-ip:'u' . . -uou ptiv uo l lt.)t l o6 aJd )o ldal c I l�Jooaa Alit ) Y : [ 'II lupladmoD an) y/11) 'aJnlvti puv autotp.►u) Jo z :tuu 'al)ut;op Gulpn join Joiviot)o 711.1'1 » ut'II)'rntt • •atll )o •1t:anbaa pa7t'p uodn Aluo ))vIc JaluOJ r(q. (t;)a;l1r:lUlwpv a.)V cuolavolpaw uoll�fl��t:a�tJ-uull 1 '[ 'll ittlDallc) ;)tll ''1 po3z1t:lula'pv GI uolltDIp31.4 lratll 'ajclQLIt,•A lot, GI OttJllu pDt;ttaol l t' )1 t'['[ 'll •au l of POW ]o ?wcu put, w 1 1 'al):t:op ':11cp lotlpnlool JOLT JO) uulp-1Vnl Jtll '9 poul)lt; lbaoGaa I)71cp uo'Jo 1'['[ .11 ►��Ulolj);r' )U DMvU pUV pulp 'of)t•oop 'Plop apnloul Pit)oVp 31110(1 uo pcivi xU) uvlolt:. ild v WO)) ttaap.to ua»lah .uodn A1uo )a1ua;) 0(11 Ag paaaacluimpv cl uollcoll)w) CD vaa3D> JOO)InO I)uv _loopu l •�alllnlloc vanvlaj/volt l clic•Woaddv a6v JO) Al ut►lav'Jdo 09) 'v:,l)I nuad »>uaJ 3111 ---- ,----------- --- -------------------------- -- •1u�.1 ir>> >dax Z.112+ ntruIlviIunu:a1 act l ca.�nrul avitt°J 0(31 'c)cc�f•JJd pl I'IJ Of 1'[ 'll I • - - - -- ---- --- - riu:►usai lttt):Ill lual iJ • •pairoal l,jonan3It)$ltoo aav Dump? Gullao(Jaa ]U). gaanl)aooad 1'6'/'11 Ait;Hort:)ldnuoa t:l a,panu auotpi AlipIGuH asttci•r 6'Z'I1 - _ - - -- 1p4100J A jnttono)t)uuc)o aav raanl) »'J Gullau-1.).t luaplJJv 041 B'Z '11 ------------------------- ----------------- ---- •ua)lr) uulloc pity 'luaploov aye httl)JodOJ uot:a:)ci Jo vanlcu6is 'sual))33v Jo a�tt1vu awn ;lt•p opuloul O3 sic I1ua()loov ijY L'Z'll -------- - t�-1 u a u:,lu�j�----__--_._._-�_ --_�X1'1 OIt `.�:1.� _ • i r I r ----vii' YE`a 11r-ji7h ------- cm:,, r nt n \ . y -- --- 11.).6 The Centdr has a proc edure for Isolating cl lcniT . who arrive ill or lwccme ill during thn day, and — -.— -- -- - -----`- - - H. 3.6.1 attt:¢hts are documented to notify 9uardian/I.TI1C oheratcr. If a nurse Is not on staff, at least two staff mcpbers htva a current Red Cross first aid card. ___ --.------._---__-___- _.__ -------------- -- it.).11 First aid auppl ies arc naintalne•i that include+ aattt+: t cJ ' lca;+t t>.�riclalclo, one and two inch �oectcrn,•ucluuor:+, paths (2' x 2' or )' x )'), tape, en antlatiPtic and a lhcr©ot1etcr (aterillied at all C1mcul. — __-- ------ - -- ------ _ 11. ) 8.1 Thd ei ppl I ca are readily accessible to ' staff, and --- - - --- - ---- - - If.�. - • • 8.2 kcpt in a ;'.)rtable container (thermometer may be kept In a .el»-ale location acctsall,la to staff). U. ).9 When cklllu.requlrinq thane items are indicated in , 4. Individual I'r( jra Plans, each client Iu provided • with or provides an individual ' - -------- --- - ----- -- -- H. 3.9.1 towel, (disposable If possible), - — - - - - - -----_ U. ).9.2 washcloth (disposable If possible), _ _ -- - -- - - - 11. 3.9.) toothbrush (clearly marked), and .-' - __ -- ------ -- -- ----- 11. ).9. 4 comb or brush (clearly ma rk cd). - -_._ — --- - - -- - --- II. 1.9. k+Ich of the Above is kept in nen i t s ry I condition at all times, and - - -- - - - - - 11. ).9.6 separate ntur�tgc hl a�:^'9 or cont.:l ncrs arc provided for toothbrushes anti combu/b+t: tf,,.•+. __ - -- - ----- - ---- -- ------- II. 3.1i. Pre-school prof;rams provide supervised rent I'eriod:i after lunch. ___ --- - - ----- ----- - .�_li(-11- __ —___ --_(-- � -u---- --_ (1. 1.0 rood Service mote:( Develor,mental Training Programs nerving children must provide food acrvlce as outlined below. _ -- --_-`-!-'------ --_-`- hevclO((ar_ntal Training erograns•scrving adults e o not required to provl.;e: food service. If food iervice 13 provided In an adult program, all ntandnrdn apply, except nunt)crd 1.1 through 1.6. If food in not t, provide=d, ntanelarda preceded by (X) will :apply If cl i cn[a cat at ccntdr• — ---------------------------_____� 11. 1.1 Children acje.l.,ix (6) weeks to ono (I) year aro fed in accordance with schedule provided Ly the parents or family phya Klan. U. 1.2 C:elldren aged nix (6) cocks to one (1) year arc held by a staff member during feeding or in accor- dance with prescribed poaltloning for c:l lenta with special needs. 11. 1.) ilutrittonal snacks arc derved.on! and a half to two hours 1,e fore lunch . H.4. 4 Children who arc in the program receive at leant lunch and a snack. U. J.5 Children are: seated in small groups with at leant one adult supervisor per croup. (A)11. 1.6 The eating area Is bright and well-ventilated, with t iA111. 1.6.1 appropriately ailed chairs and tables. (A)11. 1.7 rood t� maintained at an appropciatc temperature until served to clients., -- 11. 1.8 The person supervising the food service (li/'f, for Cr!ntcrs receiving public school lunches f(o:1 private vendors, etc. ) I1. J.B.( 1:; c,wl(:et,;(:a1(lc' of nutritional needs of c1 ie:nl.s, quantity fool preparatiu(l, safe,An it :.:init.(ry methods of food :;lu(:(�le, Ier(:p.er0( io(e and ..iorvicet:, And c()thine 11. 4.8.? has at least semi-annual documented: ' con.ultation from a nutritionist or tc9Iatercd dietitian. 11. 4.9 Sandwiches are served as tho stain item only two times (uiaxlauisl per week. H. 1.10 11enu,s Aro prepared at least ono week in advance, dated, and H. 1. 10.1 posted In areal aCCCsdll)lo to parcnto and clienta. 11. 1.1 1 stents ars: kept on (lin (or a minimum of tlir::e months, and H. 4.11.1 substitutions aro noted. ( )(1. (.11 --Ynod' 1 s prepared nnd ae:vcd In a tons easy for clients to manage.. (N)H.(.13 Provisions are ta.ade--for special diet needs as prescribed L-1 a physician in writing and kept • on file. e (A)11. (.11' Dishes and eating utensils are durable and of a —suitable hilt.:gilt: and shape, and 1.'.III. (.11.1 adaptive utensils are provided an neceis.tr1 . (Consultation uitb a Physical Therapist or Occupational '1hecapi ai I. rcconunenticd. ) (— -7- • • . r 7 M Department of ifr.alth and Ilcllabilltt+ttve Services _ Developmental S rvic:ca Program Office • Client Prr.)ramminy Unit . Revlued October, 198S I)EVUf•OPIIt:)ITA(_ TIMAI11IHI( PROGRAM MI11IMIlif ST.\I)DAI111S LAnT 1 i I = ?i� , .tiit_S'lIlATIVE vuocroll0FS Agency- --- ------ - — _ ___ •______Typo WI _Yet; Il,I 'h j.i----- --- Cons e n t u - -- - -- _ A.1.0 Agency IttquI rement n • A.1.1 The operating agency assurer and practices compliance with: A.1.1.1 TI t I c VI of the Civ11 Rights Act of 1961 IPA.. e11-3521, . A.1.1.2 TI t 1 c IY'of the tJucatlon Amenclrte nta of . it 1932, -, - • 7__ _____. ___ ____ __,....* _ • A.1 .1 .1 Section SOI, Rehabilitation Act of 197) IPA.i.. 92-1 1 21, . XL? The operating Agency posts In a confpIcuoue place a Statement outlining protections contained in Title ' of of the Civil Rights ).ct of 1961, Title IX of the Education Amendments of 1972 and Section SO4 of the I)e)'ebi 1 i t.it I0,: Act of 1913, and hrocedur c:;, for filing cc•..plaintri. A. 1 .1 The operating) agency has: h.l. ).11 Stat: :oproved Articles of Incorporation indicating a non-profit agency, If applicable, and A.1 .3.2 A current CertI(Ic'r.e of nec)i3tr.,l.lon for solicitation of funds. A. 1 . 4 The Hoard of Directors serves as the governing boar.l (or the a.1:ncy In that it 0.etermi n1:5 policy. I1i1•-1•. i .,r•. _1.1(.1.. ....1..1,:r U 1 (rit.:.:rl.`t c..; l,rc:vlc)..;; t'I:t iol::: t,Iitch :ii.",, ant I:.: u';cci) • ' j ' • • _N1'�_ye'.:' llc; 11 !r - A.1.5 The agency's Policies and Procedures include a description ; of activities and services offered, a statement of philosophy and idcnt I f y the purpose of the Developmental Training Prc jram which A. 1.5.1 clearly c:c(ines the agency's role and function ' in the service delivery syetcn, - -- ------ -- - -- -------- • A.1.5. 2 relates the Agenc_y's objcctivee to the other members of the service del ivory system, and -------__—_-- - -------- - — --- . A.1.5.) de(iaes the population the agency inlendu. 10 A.1.6 The agency's Policies and Procedures include entrance nand exit criteria (or clients to bo served. ___ — - - --- - -- - ------- A.1.7 The agency 1»a written policies and procedures for coordination with other cceponenta of the uervice delivery system which at lrcSt cover _-- - -- ----- "- ------- - 1 ' A.1.7.1 coordinated planning of services with other Cn agencies, • A.1.7.2 referrals of individuals to other agencies, And _-- _ _-----.--_______--- -.--_ _- A. 1.7.1 follow-up of referrals. - The Pol ici ea And Procedures Include unuoual incident reporting procedures. _ _— _ - - _ - 11117.: tK—1.7i � - ----- 11--- end Personnel Records' '-- rolcioe -- A.2.0 Personnel l .----- ----- ----- --- A,2,1 Personnel policies arc clearly stated and available --- - --- - ----- In yr i ttcn. foLa to Mp1,.yeea. Personnel policies provide (or the (ol lou/I -----_ ------ ___-------- 119)1 A.2.1.1.1 Uaalth requirements, ee outlined 1n Part III (A.2.3.1.2.) ___ �- .1.1.2 (�tlieetivc nev i ry of ��r I c:van- �___-- - ------ _ cos and c.uy(�ln lnt+�, A.2.1.1.3 uorl.nan'o compensation plan, _ _ _ ---------- ----- --- ------ A.1.1.1. 1 Job descriptions (qualifications - - ---- - -- and tequireaantal, - - - -- 1 .5 A ,tetCnCr��. of Ctn(�1UyCo bene- 2.1.1 .6 l� statement of employee than A. other Cm responeih tlt•1en, those Included 1 n Ike ):,�: ---- - - dcecrlptlon. _ ----- -- -- and selecting personnel )..2.2 Methods of recruiting - --- --- - -- -- - _ equal n,t,ortunity for all Interested persons Incur`Sr` t application and have !I considered. `- - - - - to A.2.1 f'erson..Cl piles - h i.:n I oyes 1 I nc l ud i nq pull !c school em .(. has a personnel f 1 le that _..- __---- - tont.+Ino: - - A.2.3.1 .1 Periodic Cat leant written and signcd work .eva- luat lona Indicat i nn) employer/employee conference, _3- . . w 1 _ of a tul,��e�r;ulo■I d �2.- YY.!i 1;: IIL�, -- ---------.._Coy;►rne:e►t o --- ------I A. 2.1.l .2 The regatta __ --- ---- - ------- -- -------- -- screen (chose x-ray, sputum - culture, or tine test) per- (,Cved within tut:lvu monthu prior to cnployment or within . 30 days after er.ploynen! , A.?.1.1.2.1 Every fifth y=ar thereafter for child pLc>.Jrosne. A. 2.).2 Each (i.ployco hired by the Center ham A personnel filo that slao conta nn: • A.2.3.2.1 Tho rosults of the rmplra�.=cnt screening in accordance with Chapter 393.0655 P.S. (Each day aervico facility shall enuuro thit beglnninq_calendar ye:nr__1986 • . exlsttnq caretakeru meet the sll nimu% requirements for good moral -oharactor. ) A.2.).?.2 Information uhtalhccl f rco at least two re(erencea, A.2. ).2.) signed ntstement ackno 1 e:d9 I eg that they have read the peroonnel policies. A.?. 1 An individual file is kept for each regularly uche_d- uied volunteer containing; A.2. 1.1 Information obtained from at leant two 111 rctert:nc es, j -. A.?.S Upon employment, staff receive a copy of job de- acriptlona and an opportunity to discuaa their rot e't and rc:srona I t,i 1 I t I c9. _ _ -- ----------- ------ -------- ---- -4- fa I Commentu X.3.0 Stott TraIninq Wi__ ___ ----YE!'-.. -1_-.'—_ _----_- _ ---------- -- A.3.1 All employees 1o,. CCs and volunteers recelvo an orl,'tnt at ion . .I th i n 30 days of c.ployotnt to I nc:l ude a _ -- ------ A. 1.1 .1 Orientation to manta' retardation and ' ottlot' dcvclopsontal dl a{JI 1 1 tl ca, _ ---- -- - - cBehavior Hanagemontt lits f Rt 000 rded 1'L r aonn r, A. �.l.� 71�c U�11 of NIS - - - L --__f_ --- - - ---- Abuse. of Chlldron and Develnf�oentally A.l.1. I t)iaabled Adults (Chapter 827, ?.6. ) ___ .—_— ---- -- ---- A.3.1.5 An explanation of tho foliating f edo1,6 tlavas lx Tltlo v1 of the Civil Rights Act of , of tilt, t1ncat ion ) icnd.enta�of 137', YJucatlon for All ltatdlcal; ed Children Act I . 1-1l7I , and icer:un Sot, Rchabililn.loJ�t of 1973, . — ---- -------------- - - X. 3.1 .6 Principles .;( normalization, -_-- -- ---- -- --- ----- -- A.).1.7 t'mergsncy.1;rocedures, accident prevention 42. and control of specific hazards, -_--CO . A.).1.8 Z'h e u y c of fire extinguishers, --- A.3.1.9 t:p( ---- ----------------------------- v �haa I s on the importance of good hygiene ene as - pertinent to job responsibilities, ani • , - ------ — ----- -- ---- - A.1. 1 .10 1. ytateDent signed by 1:tc etr.I)loyen indi- ', catingJ I1ltllclpatlon in training In the above ,\t ra b. _� _ --------- - --- - - - Staf t are trained In the Implementation of individual A.3.2 � client pro.-lra�oa and in state-of-the-art technology tor training IIt oJ r awa. ___ __ ---- ---- - ------ A.3.2.1 Staff are regularly supervised toensure . contI:IL:nt pro-)ram implementation. - - -- --- __-_-I .- -- -5- r 1 117 ,iii`- 1'l -11]; - - _— c,,,,,t e m u_ _ --- — A.7,3 Al1 staff ;o•.olvecl Ir, physical rostraI ct .1:,d control Gf : 1lcnta a,id . aciccasa(ully hava ccAiptctnci a training 1►cc.•jta. in xathoda of control of acjgresaivo - -----__ cilent x. --- (Niart-limo) rl��tl A. 1.1 All clrlvorR c•..l,loy.,1 by lho Canter (to ldoi'lv� .i nun-public cert i f led by -':c State of rlorlel cctlou 316.615, rlot ida Statutes.aChuJ1 bus as [c1ui rccl by 9 _ ..__- _.., _— - ------ ---- - -- X. 1.2 Xgrncy vehicics uac.1 to transport cllonto Arc' — ---_ - -- ----- - ---- - _- - -- ).. 1.2.1 ito jclarly c•a 1,►lalnc.J to ensure safely, — -- —__ ._-_.-------- - ------- A. 1.2.2 Inenr•,1 against acciclanta to clients and Against 1 1ht l c. 11 abl l i ly, - ----- -- ----------- - -------- X. 1.2. 3 M u I iTc.1 with f i r s t aid kit: --- — ---------------- -------- -- - A. 1.2. 1 ::1 u 1 ppad ..i t h At lout a two and on c-ica 1( pound extinguisher,ngul dlaer, that I i c1 i y c h�u I c o l fire __. - - -- _------------- ----- X. 1.2. 1.1 i n s f,ec:::1 and tagged annually, sicd X. 1.2.5 t':It11I,ped with scalpel t s, Infant acat.a or vhcc:lr�c.dlr floor locks which are unc: l at all tline„ to secure clients wt;lla l,c:iiii) t c ane;:OI tcc1. A. 1. 3 The Center and Vencic,ra provide written policies id procedures concerning the trannport,dtion of cl icl►t.0 to the appropriate 1-%taunnc1 (to Include piivatc: vendors) . ' - — -- - - -- - - 1.l 1 drivers employed by the agency a_t t incl . 1,. 1. 3.1 �l it� es an crick,:atic,n rcc)crc�lfO written 1 and procc,lclica concerning the lran.11)ot- tation of clients, - - --- A. 1. 1. 2 Orientation 1.1 documented within thirty - ----- -_- t 301 clayy of employment. •- — ------ ---- 1 • . 1,.S.0 Medical l'o1Ic_ivi Related to l:lIcnt• - '+W j'- - ___ __ (IIS _ _.__�__Cnu`_____ a __ __- X.S. 1 The operating agency t.covldcs liability insur.in:.:e for t h e Center. ____________ ------ - A.S.2 Guardians ant I.TRC operators aro inforwed In wilting ct the need to notify the Center: of di agnoo l a o f cc,.paunlc.ahlc dlacaaa In [ha home,. __: ,---- ---------- - --- - - .. A.S.) Written policies state that when tho Center in le. that one of its cl ienta has a cowrocrrrIc.-.b j informed ,f disease tor which hc.�.c or hospital care is nOrraall tr:lulred (o.g. , nrra(rs, s.ca.lcs), every gua rel Ir.n and l.'1KG operator la notillcd within 21 hour:. ---- ---- - ------- -------- -- A.S. 1 Written poi icics state that clients who arelient • du r. to cc.u�xurrlcabl e ,11 jC"�-�unlcable hQuit o t` cs ph)..1 I.- fully recovered anti non co clan, guardian or cT(a: operator upon readmission to ------+---- --- --the CcnCcr. A.6.0 Client Records - i4 ni; 11CNhi -- ----Coninti.nt'1- --- ._ NOTE: Items precededhy the notation (el shall be kept In toCD a central location (Mel within Lite agency. items prr-ccded by the,. notation (c/g1 shall he kept ler y" either a central location or In a group file (e.g. , rolodex, c!rac t1. _��`- ,_—_------ -- --- ------- A.6.1 Intake - Prior to or at the time of enrollment, doc-r. _::1 it ion of the following Information i:r , included in each !:llcit'3 file: . (CIA.6.I .1 Full name, and - --- - ---- - (ctb.6. 1.1.1 birthdate of client ---,- -- -- t r.1 h.o.1 .1 ..il,l r c 9 a of c 1 i�n t, -- -- - ---------------------------------,- -- -• ------ - (c1A.6.l.) Full AaMC of both gua:rllans/l.TltC opi:ia- (CIA.C.I . t Addre:;:;c:; of both guardians/(.THC opera- tori at home, (sled , i�1A.6. 1 .4. 1 it ,C)rrc, -)- --• --- - -- --- - - - - _..- --- --------- . • � t � • • ; Fa.' Yt'�� tIC 11IE. -�— Comment 3 --- _-' (c)A.6. 1 .S Telephone numbers of both guarcll.tna/ (.ThC at .;1►cratora l.c'ue, and (c)X.6.1.5.1 at work (c)A.6.1.6 Report. of appropc I:te previous oval- uat!ona or utaaervat ions (e.g., educa- tion, ••.3r1 evaluations, work hiatus ), as related to the prcg]ram, '-- -- -- -___-- _ _--- (c)A.6.1 .7 Information pcutalning to current medi- cation(s) ec11-Catl0n(s) which lncludeas the nate of the r.e llclne, cl ago, Limos of alml- nlatrAtic,n and nano nt prescribing doctor, (c)A.6.1.8 Any special halilta or nceda of the client: Ic/o1A.6. 1.9 throe and te)ephono no:Ab.r of at leaul one reahors!1;1c: ('.crsen other than guardians c:r,l:i-RC operator to contact cn of eraergcncy, Ic01A.6.i.10 hospital he of e cncc • (c/j ..6.) .1 0.1 hospital phone number (c/g)A.6.1.11 tl.ame of ta::.i ly physician, and (c-h l.A.6.1. 1 l.l telephone numbe r, - <_ Doc:timenlat ion rpt client's immuni tat Icon record in child 1.1 prcgiaroa, a Icig IA.6. 1 . 1 ) Names of persons other than level titans who lace permission to take client frca facility :not- applicable for Ccmpetent clients), (C,()1A.6. 1 . 1 1 Transportation Glans co Include point of pickup, point of drop off and method of Li i iipc.rt.►l tin, • •.:1-x.6. 1 . lS n :thine,) st.ite.cnt by clicnt or (.Arent acant ins) e,iu:rgency wedical tention, -0- ___� ---- ---- - —•—---- --- - - -- ,..• , w y 1 r 1 • • i J�oto�r��lr fc)r �u1�1 lc 1 ty . 1c1A.6.1 .1 6 Pcrrol t a ion Ior�i to f rtcnt cl lo;�t�tl r ____-- r� purpoari, IN/A for c t� -- u atcd every three ;'c. ra, --------— lc1),.6.1 .16.1 which areI _ _----- A 6 1 1 7 Date o f enrollment, __ — —�----- .. _--------------------- lc � ►A 6 1 1 8 A corrcnt Habilitation —"f 1 A dl� ne�1 �[a teme.nt to the effect that the client/ (c11�.L.1.19 1 operator lean been informed�l��ar�)l�n ant! LTn(: o� ', right. ender Title Vi of the Civil lh�. rl 1 cnt 9 _. __---- ---- ---- Il1ghti ).c:t of 1961, and _ _ --------- ---- 6.1.19.1 the Abuta of Children and A • Develoc ontal ly ()l,Aid 1:0 /.Ault. 1.ct (Chapter 01I,r•.5.1, --- - �tiona number of tho Ic/�1�..6.1.20 The address �►n•S t• .. Districtl)ovcloVc,g iental Services I'rrkm Office fIce Social •Worker ansljne CJI l to loo client. N - A.6.2 Recorded entr es during the elicnt 'a lloccmcninclude: 4 . Ic/�lA.6.2.1 �c ort, oant� conducted by the program, _ - - — - (c/d)n.6.1.2 Individual LAucatton Program or individual ---- Program Plan, _ - _ --------- ti cf reviev9 and evalualionn of thel�n. c 1 c,'.�);..E.2.� Il�-leo r P r og r a to o r V:r,g r a u► l __ ------- ._—._ t. Individual Education _ - in enrollment.6.2. 1 h�l�l i t l ona and/or changesr I information to beep it current (e•g. addresses, phone numbers, medic:.t Ion, _ _— --- ---- ._- -- - - Ic1P..6.2.5 Copies of progress reports stni _. ------------ ------- __ --- cl lcnti/guardians, _ _ -- of ci lent/cl�larrli.tr: cotif ei�:�rcc5 ,c/..0A.6.2.6 (1�:1=1u�,���r�ltan involvement,, -9- .I ------ ---------- ------ - -- ..- -- au I .• Y i / w ill yL'`.+ 1X -0")-- _ (oujr47nt a _�-------- . lc/y1 A.6.1. 7 Kccordt/report, as roqui red by Vag., and (lour [)Ivi.ion, ().A. Dcl»rtxont of Labor (if *( 1 i c:a b l c), (c1 A.6.2.8 Signe..1 Nrxlsalon for)... (or oath field trip (not •ppllcabla for Ccapctai%t cllenta) , --- ------ (c)A.6.2.9 Doetemdntatlon of abaoncts And teal.lne thore(oie. ____________L______._____________ --- . A.6.) PollOwing termination of 'the client's placccacnt, the following) arc entered In each client'' iccot d: • (e)A.6.).1 All i- formation previously kept in .;roup f I les - - (c)A.&.).1 Data of withdrawal , _ -- -- -------- -- --- -- - (clA.6.).) Rcaann (or termination andccu,ne It As to it, ippropriatenca,, CM lc),.6.). 1 ;;heti(Ic'recc,m.cndatlufa (or foturo pt'G:)rosrclng. , Ca --- A.6. 1 All entries Vy tl�. Center aro lc•)1�1c, A.6. l.1 sign,', and ' 1..6. 1. 2 dated. A.6.5 Rccorda are kept in a lockable container In a protected location to aaaote conf ident ial lty of information. ' . _ A.6.6 Ali persona having acceae to client records are familiar with ant btrictly adhere to confidentiality A3 outlined In 'Ihe: Bi l 1 of itighla of Retarded person - -- -.- -- A.6.E.1 The agency keeps a record of l►�i:ions other than employees obtaining access to the ellt'nt recotdo. . -1 0- ,- _ -- —---- ----— -- -- -- - .. f r y r 'VI —Yti`i 1K ll/l� - -- --C0:,..y c_lit n~ _ - -- A.7.0 General Cl i crit policies A.1.1 1c.1.inIstrativa policies have, 1>ccn uritt'1nl clients:d aro in effect, which ' ,+,ranteo chose rlhjht a LJ Tito cll.nt is not raatrictod in tho pvAc— tice of hi./hor religion) notthcr is 11a1. client 'Nut to pirticipato in aclivr- cl � a _ lits tii&t conflict with hii/hcr auligiou -- ---- -_- -_--- - --- I,cllc(�, • The cl 1 ant shall 1 ' •,, an tanrcat t icled -_ --- _-_ .-- ?..7.1.2 - right to cc..,.unicat.lun, A.1.1.1 The cit,nt his tha right tololtl►!n� Daae) 1.,-,Ac•*ion of 1►i•/her own j rson31 c((ccta, ----- -- '--- -- A.1.1.1.1 wr l t t•n pro.ednrea inanro • docu•antatlon of any receipt for i c.•po;a ry cuLLoth/ of the cl i cnt'a I,traonal effects, - `�-- y )tea the right to dignity, and -- - — Jt.7.l. l T1�c client — _ _ 1�.7. l.5 The client liao the right to aoc I 1 Intersction. _ ---- -- -- -11- SS T�-IGT -,E L.•,vNoIs E2CIAC'd S 71-1,10J, 7X-7:N ,1, 2.7:10 :C O I c Z H ES • 'c - 77 -O,••j_STS e I �. • 4 •• r 1 S R '• ctP RT ffNT cf- 1 rr LT11 t RI7 L n 7I.I T AT IVF Siw.r1 T X I 1 1 hit:L "C3..h1STRICT: / [Z�Iii I,rrn itw z t t 1Ni17 ,tt:r r - // SEIiVICE: ir FACI I.I TY L_ • - • • • PfI�'1Utf D EiY• -- -- AC�OiLSS: _.. _ _ - F,cr- E1 iqi- Enter t1)tr-s of CV.ration for tbnth of vice EArjg._t hi1ily D3 P.ai 1 ILSint+.ir- v.vr.. cr. u D,r 1 2 S 6 1 8 9 12 13 14 15 16 2 0 21 ?2 23 •2 6 27 23 2 1 3 0 l_category 1 tigara►.� Ti r 1 r mac______ mUth P•1:r _____";(:71111t.... _-. 1 I .T I fli 1 __ . 11 ... _ _ — L__ - — _-NL&�___-__ ---_ I____Ifi..... ___._-- -_____ __i_____r___L i_ 1 II _,- --- --- - _ -- - ---- ---------......•_ - __. 1 _ _ _ _ __ __._ •J__ 1 -- -' �._��- -_-. -L-�► rte-- ��_ �-. , .....___ 1.............,. ____._____.. (n __•-. ` ---4.-••-- - 1-•••••••. _••••-ate-•••• --4••••••-•--- I•••-•••••••••••••. -•••••••••••••••••i ---•-•._ -t -- 1 11-7-AL 1 1 i DAY __ArranurF _ 1 I rTLILI -` ; - O i: E:.?::":�D:I'r'll[Y�Y _______ _. X i XJ1_I/TNT-PIL... ENT E: C:713 11-D-EDt"i1STD ARSE U: 17;;;01 ./D-L; E rk:S1J) 5: ElTOL ID-S 1CX N: for C�.O l l E , nu, Tal S C0112:t Ill OLY IF CLI INT IS F1 TO.E-D LS MAN il:t' REL11IPM ;ft-4lE1 RAYS. I: 1rSE Niki TPA 1,,•'t)r: MY . ___ ._ • y 1 ^, w^ ' . . ~ 1, ` ^ � STATE OF FLORIDA . Exhibit "C" ~ ° I D 8 B S � O D � � �� I O H DEPARTMENT OF B � C O D D HEALTH t, REHABILITATIVE SERVICES ' e I�\�iliL Address ' Destination bate �c Remarks _ anc�_i�\��gso . - ' __ -__-_ 4 } . -- ----' _ _ __ _____ __- _--__- _- '__-' �_ ---_______-_ ._ _- --� -_-_-' _' _ _'_ - .. - -- - -..-__________'. \--------- ----'---' ---- ' 4 ---�--' - ) � . --emenii- UGINAL L� R rySC�LUrl'1vN 1vU• 92-20544 Authorizing the Mayor and City Clerk to execute two contracts with the State of Florida Department of Health and # Rehabilitative Services (HRS) for independent linving skills for develop- mentally disabled (mentally retarded adults) at the Miami Beach Activity Center. (after the fact) i