HomeMy WebLinkAboutGrant Agreement between the CMB and Miami Dade County through the Miami Dade County Homeless Trust G�i�,S�- ����l �'�,
OFFICIAL FILE COPY
Docusign Envelope ID:01375622-SDCB-4267-928D-EF2B61 D96623 CLERK OF THE BOARD
OF COUNTY COMMISSIONERS
MIAMI-DADE COUNTY,FLORIDA
I'HF:CITt'Ot N(AMI @F:Af.H
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This C�rant C`ontract ( the "Contract" or"Grant Agreement") i� made and entered iato as of this
18 �y oi_MarCh , 4p 26, by and between Miami-Dade County, through the ;�tiami-Dade County
I Comcl�:ss Cnist,a political subdivision of the State of Florida(the"County"), having its principal office at
I ll :V.W`. 1'' Street, 27th Floor, Ivtiami, F'larida 33t28 and "Che Citv of !1i»mi BeachiF'EIN/tiEI t�:
59-6QQ0372 ( �1EP1NDZ2ZKLl7, a corporation organized and existing under the (aws of the State of
Florida, hav°ing its pnncipal oflice at 1'700 Convention Center Drive Niami Beach Florida 33139
("Provider"}, states conditions and covenants for the rendering oF human and social services("Services")
for tl:e County.
WIIER�:AS the Provider provides or will develop housing and social services of value to the
County and has demonstrated an ability ar desire to provide these services;and
WHF,REAS the County is authorized to subcdntract far the provision of housing services and
supportive services for individua(s and famities who are homeless in Miami-Dade County;and
WHE;RF.AS the Pravider is a sub-recipient of grant funds to provide and/or develop social services
of value to tht County and homelcss individuals and families and has dcmonstrated an ability or desire to
pravide these services;vtd
WHEREAS this Agreemrnt provides for certain rights and responsibilities of the County;and
WFiEI2EAS the Agreement provides for amendments at the discretion of the County;
Nt)W,TIIF,REFORF.,for and in consideration of the mutual covenants and agreements herein contained,
the parties hereto agree as follows:
ARTICLE i. DEFINITIONS
The following words and expressions used in this Grant Agreement shall be construed as foilows,except
when it is clear Gorri th�eantext that anothvr meaning is intended:
a) I�he wvrds"Agreement" "Con[ract"ar"Contract Uacuments"shall mean collectivcly these terms
and conditions,che Scope of Services (Attachment A)and the Budget llocuments(Attachment
B)and all other attachments hereto,as well as all amendments or budget revisions issued hereto.
b) The words°ContracC Manager"shall mean Miami-Dade County's Director of the Homeless"Crust
("County")or the Qirectar's designee,or the duly authorized representative designated to manage
the Contract.
c) The word"Days" shall mean Calendar Days,unless atherwise specifically noted.
d) I'he word"lleliverables" shall mean all documentation and any items of any nature submitted bv
the Yrovider to the C'ounty for review and approval pursuant to the terrns of tttis Contract.
e) The words"directed","reyuired","permiUed","ordered","designated","selected","prescribed"or
words of like iinport to m�an respectively, the directian, requirement, permission, order,
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designation,selection or prescription of the County's Contract Manager; and similarly the words
"appraved", acceptable", "satisfactory", "equal", "necessary", or words of like import to mean
respectively,appraveci by,or acceptable or satisfactvey to,equat or�ecessary in the sole discretion
of the County's Contract Manager.
� The words"Effective Term"shall mean the date on which this Contract is effective,including start
date and end date.
g) Che words°Extra Work"or"Change C)rder'or'`Additional bVork"shal}mean resulting in additions
or detetions oc modifications to the amount,type or�alue of the Work and Services as raquired in
this Contract,as directed andior approved by the County.
h) '`F�iPAA"means Nealth[nsurance Portabifity and Accouncabitity Act af 1946.
i} The wards"Scope of Services"shall mean the document appended hereto as Attaehment A,which
details the work to be performed k�y the Provider.
j' `t'he word "subcontractor"or"sub wnsultanC'shall mean any person,entity, fiem,or corporation,
other than the empioyees of the Provider,who furnishes(abor andfor materials,in cunnection with
the Work,whether directly or indirect(y,on behalf ancUor under the direcrion of the Pmvider and
whether o�not in privities of contract with the Provider.
k) The words "Work", "Sezvices" "Program",or"Proji:ct" shall mean all matters and things required to
be dane hy the Provider in accordance with the provisions of this Contract.
AR1'ICLE 2. A:YIOUNT' PAl'ABLE. Subject tc�available funds,the maximum amount payable
far services rendered under this contract shall not exceed:
• FfMIS STAFFI�iG PROGRAVi S 12,333.00
• [DE�V"TIFICAT[ON ASStSTANCE PROCRAYI 5 25.000.00
Total E unding Award $37,333.00
Both parties agree that should available County funding be reduced,the amount payable under this Contract
may be proportionatety reduced at the sole discretion and vption of the County. Availability of funding
shall be determined in the County's sote discretion.
Al! services undertaken by the Provider before the County's executi�n of this Contract shall be at the
Provider's risk and expense.
It is the responsibility of the Provider to maintain sufficient financial resources to meet the expenses
incucred during the period between the provisian of services and payment by the Cou�ty.
The County, at its sole discretion, mar alic�w Provider an advance of ua to two (2) months once the
Procider has submitted an appropriate reyuest and submitt�d an invoice in the form required by the County.
ART'ICLE 3. SCOPE OF SERVICES
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Docusign Envelope iD 01375622-5DC6-4267-928D-EF2B61 D96623
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A. Services."i'hc Provider shall render services and minimum standards af housing in accordance with
Scope af Serviu:uApproved Proposal incorporated herein and attached hercto as Attactunent A.
"t'he Pravider shall im�tement the Scape o#�Senices as described in Attachment A in a manner
decmcd satisfactary to the County. My modification or amendinent to the Scope of Services shall
not cffcctive until appravcd by the County an�i Providc.�r in wciting.
B. l'he Provider shall carry out services in 1�tiamt-Dadc County and adhc�re to thc minimum s,andards
of haus�ng and scrc=ices as sct forth�n t�ttachment A,incorporated here by reference,
AR"TICLE 4. BUDGE7'SGMh1ARY�
The Yrovider agrees that all expenditures or costs shall be made in accorclance with the Budget for
fl�e provision of services in accordance wiCh �lttachment A. The Budget is attached heret�and incorporateci
herein as Attachment B.
The parties agree that the Provider may, with the County's priar written approvat; revise the
schedule of payments or the line-item budget, and such revision shall not require an amendment to this
Con�-act.
Yursuant to Board of ytiami-Dade County Commissioncrs Rt�solution 630-13,the Provider will submit a
detaited project budget, and sources and uses statement as Attachment B-1, which shall be sufficiently
detailed to show(i)the total project cost,(ii)the amount of funds to be used for administrative and overhead
costs, (iii) wh�ther the County funds will be `gap' Funds meaning that they wauld be the last remaining
funds needed to ensure funding for the total praject cosk,(iv)any profit to be made by the Provider,and(v�
the amount of funds devoted toward the provision of the desired serviees or activities.
The County Mayor or Mayor's designee may make unannounced, on-site visits during normal working
hours to the Provider's heaciquarters and any locatian or site where the services contracted for under this
Agreement are performeci.
ARTICLE 5. EFFEC"I't�'E TERNI
f3oth parties agree that the F.t�ective "I�erm ot lhis Contract shall commence on October 1,1025
and[erminate at the close of business on September 30,2026. Contingen[on the existence of sufficient
tunding, performance and the approval of the C:ounty,this Contract may be extended at the County's sole
discretior.
AR"CICLE 6. I�IDENIYIFICATIUN BY Plt��'IDER
.a. Government Entity. Government entit}r shali indemnity and hold harmless the County
and its officers, employees, agents and instrumcntalitics tTotn any and all liability, lossc:s or damages,
including attarneys' fees and costs of defense, wfiich the County or its officers, employees, agents or
instrumentalities may incur as a result of claims,demands,suits,causes of actions or proceedings of any
kind or nature acising out of, relating ta or resulting from the p�rformance of this Contract 6y [he
government entity or its empioyees, agents, servanGs, paRners, pnncipals or subcontractors. Government
entity shall Pay all claims and lasses itt co�uiection therewith and shall investigate and defend all claims,
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Docusign Envelope fD:01375622-5QC8-4267-92&D-EF2881 D96623
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suits or actions of any kind or natur�in the name of the County, where applicable, including appellate
proceedings, and shall pay all costs,judgments,and attorney's fees which may issue thereon. Provided,
however,this indemni6eatic�n shall or�ly be ro the extent and within the limitations of Sectian?68.28,Fla.
Stat.
F3. All Other Providers. Frovidec shall indemnify and hold harmless the County and its
officers, employees,agents and instrumenta(ities from any and all liability,losses or damages, induding
attorneys'fees and costs af defense,which the Countp or its ofticers,employees,agents or instrumentalities
may incur as a result of claims, demands, suits, causes of actions or prex;eedings of any kind or nature
arising out of,relating to or resulting fram the performance of this Contract by the Provider or its employees,
agents, servants, partners principals or subcontractars. Pravider shall pay all claims and losses in
connection therewith and shall investibate and defend all claims,suits or actions of'any kind or nature in
the name of thc C`ounty, wh�re applicab(c, including appellate proceedin��s, and shal! pay all costs,
judgments, and attorney's f'ees which may issue thereon. Provider expressly understands and agrees that
any insurance proEcxtion requircd by this Contract or otherwisc provided by['rovider shall in no way limit
the responsibility to inderruiify,keep and save harmless and defend the County or its ofticers,emptoyees,
agents,and instrumentalities as herein provided.
C. Term of [ndemni�cation. The provisions of Article 6 shall survrive the expiration or
termination of this Contract.
ART[CI.E 7. Ii�fSliRAiVCE
If the rotal dallar value of all County contracts with the Provider exceeds $25,000 then the following
insurance coverage is required:
A. Government Entity. If the Provider is the Stat� of Florida or an agency or political
subdivision vf the State as defined by sectivn 768.28,Florida Statutes,the Provider shall
furnish the County,upon request,written verification of liability protection in accordance
with section ?68.28, Flonda Statutes. Nothing herein shall be construed to extend any
part,v's liability beyond that provided in section 768.28,Florida StatuFcs.The provider shall
also furnish the County, upon requcst, written verification of Workcrs Compensation
pmtectzon in aceordance with Florida Statutes,Chapter 440.
B. P111 Other Providers.
:. Minimum Insurance Reyuirements: Certiticates of lnsurance. "I�he Provider shall
submit ro Miami-Dade County,c/a Miami Dade County Homeless'I'rust(COU�1'I�Y), 11 1 N.W. I"Street,
27th Floor, Miami, Florida 33128-1594, onginal Certiticate(s) of Insurance indicating that insurance
coverage has been obtained which meets the requirements as outlined below:
A. All insurance certificates must list the County as "Certificate Nolder" in the fotlowing
manner:
Miami-Dade Countv
111 N.W. 1�`Street,Suite 23�0
Miatni,Florida 3312$
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Docusign Envelope fD Q1375622-5QGB-4267-928D-EF2B61D96623
(HE CITY Ob'tiII�1J11 BEACFt
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B. Worker's E:ompensation Insurance for all employees of tha Provider as required by�lorida
Statutes,Chapter 440.
C. Gommeccial Generai Liability [nsurance in an aunount not less than $300,000 combined
single limit per occurrence for bodily injury and property damage. Miami-Dade County
must be 5hown as an additional insured with respect to�his coverage.
D. Autc�mobile I.iat�ility Insurance ec�vering a(i owned, non-owneci, and hired vehicles used
in connec[ion with the VVork provided under this Cancract, in an amount not less than
$3(�0,000*combined single limi[per occurrence for bodily injury and property damage.
*NOTE: F'or Providers supplying vans or minibuses with seating capacities of fifteen(15)
passengers or more,the timit oF tiability required for Auto Liabiliry is��00,000.
E. Professional[,iabiliry Insurance in the name af the Provider,when applicable,in an a�nonnt
nok tess than g250,00�.
F. All insurance policies required above shall be issued by companies autharized to do
business under the laws of the State of Florida,with the following qualifications:
l. I�he company must be rated no less than'`B"as to management,and no less than
"Class V"as to financial strength,according ro the latest edition of Best's[nsurance
Guide published by A.'vt. Best C'ompany,Oldwiek, New lersey,ar its equivalent,
s�bject to the approval of the Caunty's Risk Management Divisian.
OR
2. Che comparty must hold a valid Florida Gertificate of Authority as shown in the
latest"I.ist of All tnsurance Companies Autharized or Approved to Do Business
in Florida,"issued by the State af Fiorida Department of lnsurance and must be a
member of the Fiorida Guaranty Fund.
G. Certificates will indicate that no modificarion or change in insurance shall be made without
thirty(30)days advance written notice to the Certificate Itolder.
H. Compliance with the foregoing requiremenes shall not relieve the Provider of its liability
and obligations under this Section or under any other section of this Contract.
I. The Counry reserves the right to inspect the Provider's originaf insurance policies at any
time during the term of this C oncract.
J. Applicability af this ARicle ro Praviders whose combined total award for all services
funded under this Contract exceeds a $25,000 threshold. In the event that the Provider
whose original tatal combined award is less than$25,000 bu[receives additional funding
during the eontract pericad which makes the total cumbined award exceed 5+25,000,then the
�eyuirements in this Artide shall apply.
K. Faiture tu Provide Certificates of Insurance. The Contractar shall be respansible for
assuring that the insurance certifirates required in conjunction with this Section remain in
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Docusign Envelope ID:01375622-5DCB-4267-928D-EF2661D96623
TNE CfTY OF 171A�1I BEACH
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force for the duration of the effective term of this Contract. If insurance certificates are
scheduled to expire during the effective term, the Pmvider shati be responsible for
submitting new or renewed insurance certificates to the County prior to expiration.
ln the event that expired certiticates are not replaced with new or renewed certificates
which cover the effective term,the County may suspend the Contract until such time as the
new or renewcd certiticates are received 6y the County in the manner prescribed hercin;
provided,however,that this suspended period does not exceed thirty(30)calendar days.
Thereafier,the County may,at its sole discretion,terminate this Contract.
AR'TICI.E 8. PROOF UF' I.ICEtiSURE/CER'I'IFICATION AND BACKGROUND
SCRI?I�:NIYG
A. Licensure. [f the Provider is required by the State of Florida or Miami-Dade Counry or any
federal, state, or loca( law or regulation to be licensed or certitied to provide the services or operate the
facilities outlined in the Scope of Services(.^ttachment A),the Provider shall furnish to the County a copy
of all requircd current licenses or ceRiticates. Examples of scrvices or operations requiring such licensure
or certification include but are not limited to childcare,day care,nursing homes,and boarding homes.
[f the Provider fails to furnish the County with the licenses or certificates required under this Section,
the County shall not disburse any funds until it is provided with such licenses or certificates. Failure to
provide the licenses or certiticates within sixty (60) days of execution of this Agreement may result in
termination of this Agreement at the County's discretion.
I3. Background Screening. The Provider agrees to comply with all applic;ab(e federal, state,
and local laws, regulations, ordinances, and resolutions regarding background screening of employees,
volunteers, and subcontractors. Provider's failure to compfy with any applicable laws, regulations,
ordinances,and resolutions regarding background saeening of employees,volunteers and subcontractors
is grounds for a matenal breach and termination of this contract at the sole discretion of the County.
Che Provider agrees to comply with all applicable laws(including but not limited to Chapters 39,
a02,409,394,408, 393, 397,984,985 and 435, Florida Statutes,as may be ame�ided form time to time},
regulations, ordinances and resolutians, regarding background screening of those who may work or
volunteer with wlnerable persons,as detined by section 435.02,Plorida Statutes,as ma}•be amended frarn
time to time.
In the event criminal background screening is required by law, the State of F'lorida and,'or the
County,the Provider will permit only employecs and subcontractors with a satisfactory national cnminal
background check through an appropriate screening agency(i.e.,the Florida Department of Juvenile Justicc,
t'londa Depamnent of I.aw E�nforcement or E�ederal I3ureau of Investigation)to work or volunteer in direct
contact with wlnerable persons.
Che Provider agrees to ensure that employees,volunteers,and subcontracted personnel who work
with vulnerablc persons sa[isfactonly complete and pass I,evel 2 background screening before working or
volunteering with wlnerable persons. Provider shall furnish the County with proof' that employees,
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Docusign Envelope ID 01375622-5DC6-4267-928D-EF2861 D96623
1 HF:CITY OF Siln�ti BF.ACPi
fi1tISS7'AFFI'�G PR(}(�RAM GRAV1 �l y1BER: PC-2526-ST��FF-Z
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volunteers, and subcontracted persannel,who work with vulnerable persons,satisfactorily passed Level 2
background screening,pursuant to Chapter 435,Florida Statutes,as may bc amended from time to time.
[f the Provider fails ro turnish co the County proof that an employee's, volunteer's, or
subcontractor's Level 2 background screening was sacisfaeEorify passed and completed prior to that
employee or subcontr~actor working ar volunteering with a wlnerable person ur winerable persons, the
Coanty shall not disburse any further funds and this C'ontract may be subject to termination at the sole
discretion of the C'c�unty.
ARTICLE 9. CC?NPt,IC'I'OF INTF,REST
A. The Provider agrees to abide by and be�overned by Miami-I3ade('ounty(lydinance Na 72-82
(Conflict of Interest C?rdinance codified at Section 2-1 1.1 et al. of the Code of Miami-Dade County),as
amended, w�hich is incorporated herein by reference as iP fully set forth herein, in connection with its
contract obligations hereunder.
B. No person under the employ of the County, who exercises any function or
responsibilities in connectian with this Contract,has at che time this Contract is entered into,or shall have
during the term of this C'ontract,any persanal financial interest,direct or indirect,in this Contract.
C. Neaotism. Notwithstanding the aforementioned provision, no relative of any officer,
board of director, manager, or supervisor cmployed by the Provider shall bc ernplayed by the Provider
unless[he emplvycnent preceded the execution of this C:�ntract by one(1)year.No family member of any
employee may be employed by the Provider if the family member is ta be employed in a direct supervisory
or administrative relationship either supervisory or subordinate to the empioyee.The assignment of family
members in the same arganizational unit shall be discouraged.�conflict of interest in employment arises
whenever an individual wauld otherwise have the responsibility ta make,or participake actively in making
decisions or recoenmendations relating to the employment status af another individual if the two individuals
(herein sometimes called"related individuals"a have one of the following relatianships:
1. By biood or adoptian:Parent,child,sibling,first cousin,uncle,aunt,nephew,or niece;
2. By marriage: Current or former spouse,brother-or sister-in-law, father-or mother-in-law, son-or
daughter-in-law,stepparent,ar stepchild;or
3. Other relatianship: .A current or former r�(ationship,occumng outside the work setting that would
make it difficul[ for the individual with the responsibility to decide or make a recommendation to be
ob}ective, or that wuu(d create the appearance that sueh individua] cotild not be objective. Examples
include,but are not timited to,personal rclationships arrd significant business�tlationships.
For purposes of this secdon. decisions or ru:ommenclations retated ro employment status include
decisions relat�d to hiring,salary,working conditions,working responsibilities,evaluation,promotion,
and termination.
An individual, however, is not deemeci to make or actively participate in making decisions or
recommendations if that individual's participation is timited to routine approva(s and the individual
ptays no role involving the exercise of any discretion in the d�cision-making procassr,s. IC any question
anses whether an individuaPs participatian is greater than is permitted by this paragraph, the matter
shall�ie immadiately referred to the'4liami-[)ede Counry Comm�ssion on Ethics and Pub(ic T�nist.
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Docusign Envelope ID 01375622-5DC8-4267-928Q-EF2661D96623
'THF.CITY�F NtA�ttl BF;A(.�t1
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I'his section applies ro hoth full-tim�and part-time employees and voting members of the Provider's
Board of Directors.
D. Na person, including but not limited to any officer, board of directors, manager, or
supervisor cmploycd by the Provider,wha is in the position of'authority,and who exercises any function
or responsibilities in connection with this Contract,has at the time this Contract is entered into,or shall
have durir,g the term af this Contract,received any of the services,or direeted or instructed any employee
under their supervision to provide such services as described in the Contract. Natwithstanding the before
mentioned provision,any officer,board of directors,manager or supervisor employed by the Provider,who
is eligible to receive any of the services describecl herein may utilize such services if he or she can
detnonstrate that he or she does not have direct supervisory responsihility over the Provider's employee(s)
or service program. Staff inembers,or their immediate family members(spouse,children,siblings,mother,
c�r father) of I[omeless Trust Eunded programs, wh�are eligible for and wish to receive services from a
Homeless Trust funded program must receive the a}�praval of the Executive Director of their empiayer(i.e.,
the Provider) prior to applying for and receiving thosz services. This apprrnal must be in writing and
accompany any refenal for such serviee..Any Provider knowingly accepUng a referral of an employee of
a Homeless Trust funded program and providing services without the written approval of the F:xecutive
Directar af the Provider,will he subject to the recoupment/disallowance by the County of any funds paid
for ser.�ices to this indi�idual and;`or their immediate family member. When the services are to be prvvided
at the same agency the employee works for,this infoanation must be disclosed in wnting to the director of
the Fiomeless Trust,which sha31 be reviewed for eligibility determination and a sign off must come Crom
the County. "Chis provision does not apply to staf�members seeking emergency shelter,medical or legal
services.Providers must complete a Client Services.Autharization Form(Attachment P)for staffinembers
seeking services.
AKTICLE 10. CIViL R[GHTS
The Provider agrees to abide by Chapter 11 A of the Gode of Miami-Dade Counry�"Counry Code"),
as amended, which prohibits discrimination in employment, housing and public accommodations on the
basis of raee,creed,religion,color,sex, familial status,marital status,sexual orientation,pregnancy,age,
ancestry,natiQnal origin or handicap;Tit(e Vtt of the Civil Rights Act of 1468,as arnended,which prohibits
discrimination in emplayment and public accommodation;the Age Discrimination Act of 1975,42 U.S.C.
§(I�1,as amended,which prohibits discrimination in employment because of age;the kehabilitation Act
of 1973, 29 U.S.G. §794, as amended, which prohibits discrimination on the basis of disability; the
Americans with Disahilities Act,42 U.S.C. §12101 et�,whicti prohibits discrimination in employment
and gublic accommodations because of disability; the Federal Transit�ct,49 U.S.C. �1612,as amended;
and the Fair Housing Act,4'2 U.S.C. g36Q1 et�, It is expressly understood that the Pr�vider must submit
an affidavit attesting that it is not in violativn af tt�e Acts. [f the Pravider ar any awner,subsidiary,or other
firm af£iliated with or related to the Provider is found by the responsible enforcement agency,the Courts,
or the County to be in violation of these acts,the County will conduct no further business with the Pravider.
Any contract entered into based upon a false affidavit sha(t be voidable by the County. [f khe Provider
violates any ot the Acts daring the term of any contract the Provider has with the Counry,such con[ract
shatl be voidable by Che County, even if the Provider was not in vio(<ition at the time it submitted its
affidavit.
The Provider ae ees that it is in compliance with the Domestic Violence Leave,codified as � I 1 A-60 et
ti�vf the Miami-Dade County Code,which reqnires an employer, who in the regular course of business
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Docusign Envelope ID 01375622-5DC6-4267-928D-EF2661D96623
I'HE CI"PY OF ti11A�1!HF.-A("k!
HYtIS STAFF7�G PROOR;1�1 GRA1"I'VIMBF:R: PC15£6-�l'AE'F-2
iUEti1'iFtf.A t ION ASSIS"T,�NCt:PROI;RAYi GRA�T YCb16F;R: PC 2526-ill-2
has ffty (SU) or more employees working in Miami-Dade County for each working day during each of
twenty(20}oe more calendar work weeks to provide domestic violence leave to its employees.
Failure to comply with this locai law may be grounds for voiding or terminating this Contract or for
commencement of debazment proceedings against Provider.
ARTICLE 11. HEALTH INSL;RA:tiCE PC?RTABILITY A:AD ACCOUNTABILITY ACT•
Any person or entity that perfanns ar assists Miami-Dade County with a function or activity
involving the use ar disclosure of'`individually identifiable heaith information ([l}ili" and/or"Protected
Fiealth (nformation (PNIj" shai( comply with the Hea(th [nsurance Portability and Accountability Act
(lIIPAA}of 1996 and the titiami-Dade County Privacy S[andards Administrative CJrder. t{IPAr1 mandates
for privacy,security,�nd electronic transfer standards,include but are not limited to:
1, Use of iniormation only for performing services required by the contract or as required by law;
2. Use of appropriate safeguards to prevent non-permitted diseloswes;
3. Report�ng to Vtiumi-Dade County af any non-pe�nitted use or diselosurc;
4. Assucances that any agents and subcontraetors agree to the same restrictions and conditians that apply
ta the Prc�vider and reasonable assurances[hat I[H('PH[will be held confiden[ial;
5. Making Protected Flealth Information(PHI)available to the customer;
6. Making PI II available ta the client for revicw;
1. Making YHI available to�'Iiami-Dade County for an accounting of disclosures;and
R. Making incemal practices, books, and records related to PHI available to �tiami-Qade County for
com�+liance audits.
PHI shall maintain its pratected status regardless of the form and method of transmission(paper
recards and.�or elech-onic transfer of data). "The Provider must give its clients written notice af its privacy
information practices, including specifically,a description of the types af uses and disclosures that would
be made with pmtected health information. Provider must post, and distribute upon request to service
recipients,a copy ot[he Cuunty's tiatice of Privacy Practices,
ARTICLE tZ. NQTICE RE�UIRE�'IE'_�iTS
Notice undcr[his Contract shall be sufficient if made in wnting,delivered personally,or sent<<ia
U.�. mail,electronic mail,facsimile,�r certiticci mai)with retum receipt requested aud pc�stage prepaid,to
the parties at the fol(owing addresses(or to such uther party and at such other address as a party may specify
by notice to others) and as further specified within this Contract. If notice is sent via elec;tronic mail or
facsimile,confirmation of the correspondence heing sent will be maintained in the sender's files.
If to the COUNTY:
Miami-Dade Counry
Hometess Crust I 1 1 N.VV. l41 Street,27th F1oor
Miami,E lorida 33 i 28
Attentia�:Victoria Mallette,Fxecuti��e Director
Etectronic mail: Vhtall�tte�cu,miamidade.gov
Page 9 of 28
Docusign Envelope ID:01375622-5DC8-4267-928D-EF2B61D96623
i'HE CITY OF�NfA�11 BtAffl
Nri1S STAFYI\G PROC;R�.�t CRAYI'\l NBt R: PC-2526-57,\F'F-t
IDF.�7IFICAIIOV A1SItil'A\CF:PROGRAM GRA\T�l�iBFR: PG252ti-ID-2
If ro thc PROV[DER:
(-:ric"l'.Carpenter
Citv�fanaaer
The Citv of:�fiami F3each.
1700 Convention Centcr Drive
Ytiamt Beac ,_h Fl�rida_33139
Elecuonic matL F�ri�C ar�unter i mian�tb�achfLi,���
Fither party may at any time designate a diffennt address and�or contact person by giving written notice as
provided above to the other party. Such notices shall be deemed given upon receipt by the addressee.
ARTICLE 13. AU1'ONOiVIY
Both panies agrec that this Contract ra;ognizes the autonomy of the contracting par►ies and impiies
no affiliation between the contracting parties. It is expressly understood and intended that the Providcr is
only a recipient of funding support and is not an agent or instrumentality of the County. Furthermore,the
Provider's agents and c�rnployees are n�t agents or employees of the County.
ARTICLF. 14. SL;RVIVAL
The parties acknowledge that some of the obligations in this Contract,including but not limited to
Provider's obligation to indemnify the County,will survive the term,termination,and cancellation hereof.
Accordingly,the respectivc obligations of the Provider under this Contract,which by nature would continue
beyond the termination, cancellation, or expiration thereof, shall survive tenninativn, canceltation, or
expiration hereof.
.�u1�icLE is. �Kr::�cfi or co��ruf�rr: co��:��r��K��i�vi�s
A. Breach. A breach by the Provider shall have occurred under this C:.untract if: (l) the
Provider fails ro provide the services outlined in the Scope of Services(Attachment A)within the effective
teRn of this Contract; (2)the Provider ineffectively or improperly uses the County ivnds allocated under
this Contricr,(3)the Pruvider does not fumish the Certificates of[nsuratice requirecl by this Cuntract or as
determined by the County's Risk vtanagement llivision; (4) if applicable, the Provider does not fumish
upon reyuest by the County proof of licensureicertification or prouf of background screening reyuireci by
this Contract; (5) the t'rovider fails to submit,or submits incorrect or incomplete,proof of expenditures to
support disbursement requests ur advance funding disbursements or fails ro submit or submits incomplete
or incorrect detailed reports of expenditures or final expenditure repons;(6j the Provider does not submit
or submits incomplete or inconect required reports;(7) the Provider refuses to allow the County access to
rccords or refuses to altow the County to monitor, evaluate and review the Provider's program; (8) the
Provider discnminates under any of the laws outlined in Article 10 of this Contracr, (9) the Provider,
attempts to meet its obligations under this Contract through fraud, misrepresentation, or material
misstatement; (10) the Prvvider fails to correct deficiencies found during a monitoring, evaluation, or
review within the specified time as describcd and detined in its Performance Impmvement Plan(PIP);(l 1)
the Provider fails to issue prompt payments to small business subcontractors or follow dispute resolution
procedures regarding a dispu[ed payment; (12) the Provider fails to submit the Certificate uf Corpvrate
Status,Board of Directors reyuirement,or proof of[ax staWs;or(l 3) the Provider fails to fulfill in a timely
and proper manner any and all of its obligations,covenants,agreements,and stipulations in this Contract;
(l4) the Provider fails tu meet any of d�e tercns and conditions of the Miami-Dade County Affidavits
(Attachment D)and the titatc Affidavits(Attachment D-l) �Applicabie ❑ \ot Appiicable or(15)
Page 10 of 28
Docusign Envelope ID.01375622-5QCB-4267-928D-EF2B61D96623
�('HF.CI"fY UP 11{A�if BE.�Cfi
HMISST.4FFI�CPRO(:RAM GRAtiTNCMBE:R: PC-252b-5fAFF-2
IDF,ITIFICATIOV ASSISTAYCF,PRpGRAM GRAM1T VC'MBF'R: PG2S26-t(}-2
the Provider fails tu fulfill in a timely and proper manner any ar all of its obligations,covenants,agreements
and stipulations in this Contract. Vdaiver of breach of'any provisions e�f this Contract shail not be deemed
to be a waiver of'any other breach and shall not be construed to 6e a modification of the terms of this
Contract.
1n the event that the Cowity detecmines certain Contract goals(as defined in the Scope of Services)are not
being met then the Coun[y, in its sale discretion may �lace the Provider on a Perfannanee Improvement
Plan(PIP). The fallowing is a delineation af some instances where a PIP may be required:
a. H;vIIS-Based on Provider's past performance on prior contracts in the area of Hameless
Management [nfonnation Systc,�n coinpliance it is subject to a PIP during this contract
tenn. Tlle Provider is required to submit a Monthly Progress Report and an HMIS-
generated Maithiy Prot;ress Report far each month of the contract. Compliance will be
detennined when it is deemed that the two(2)reports are in substantial conformity with
each other for a period of two consecutive months.(Substantial conformity as meaning
a minimum of 9S%accuracy on al]etements). At the time of comQliance,the Provider
shall only be required to submit the HMIS-generated Monthiv Progress Report.
❑ Applicable � �iot Applicable
b. Ltilization - Based on Providers past performance Un priar contracts in the area of
utiluation campliance,this contract is subject to a PIP. During this contract term,the
Provider must su6mit all invoices in a timely manner. 'I�e Provider shall invoice at a
rate of 9S% of targeted expenditures for the invoicing period. [f the Provider fails to
comply,all rights to payrrtents will be forfeired if the County so chaoses. Failure to
submit accurate invoices for appropriately documented and eligible expenditures at a
rate of 95°l0 of targeted expenditures by the end of the third quarter of this contract term
may result in the termination of this contract by che County.
❑ Applicable � tiot Applicable
c. Program Performanee -Based on Provider's past performance on prior contracts in
the area of program goals and outcome objectives, this Contract is subject to a PIP.
Uuring this Contract term, the Provider must achieve those goals specified in the
Contract.Performance against these annual goals shall be evaluated on a quarterly basis,
and if by the end af[he third quarter af the cantract period substantial complianee
(meeting the targeted goats) is not achieved, it may resuit in the tetmination of this
contract with the County.
❑ Applicable � �Iot Applicable
1'he ab�ve is subject to the review and approvat of the County
B. County Remedies. If Che Provider breaches this Contract,the County may pursue an}�or
all of the following remzdies:
1. Che Councy may terminate this Contract by giving wntten notice ro the Pr�vider
of such termination and specifying the effective date thc�reof. In the even�of termination,the County may:
(a)request the return vf finished or unfinished documents,data studies,sucveys,drawings,maps,models,
phoiographs,repons prepared and secured by the Provider with County funds under this Contract;(b)seek
reimbursement of County funds allacated to the Pmvider under this Contract;(c)terminate or cancel any
ather contracts entered into between the County and the Provider. Che Provider sha(1 be responsible for all
Page 11 of 28
Docusign Envelope ID:01375622-5DCBa267-928D-EF2B61D96623
CHE f'(IY OF kt[,A.�t[Nt;1fH
t{31tS STAFFI'�G PROGRA4t GRAti t'�t'11BER: P('-2526-5'P4FF-2
[DESTIF�CA t'IOd,1SStS"t'ANCE PR(1GN1,Yi GItAYT Yt A18F:R: PC-2526-IU-2
direc;t and indirect costs assaciated with such tenttination,including attomey's fees;
2. The County may suspend payment in whole or in part under this Contract by
providing written notice to the Provider of such suspension and sperifying the effective date thereof. If
payments are suspended,the C'ounty shall specity in writing the actions t6at roust be taken by the Prc�vider
as candition prec edent to resumption of payments dnd shail speci£y a reascinable date for complianee. The
County may also suspend any payments in whole or in part under any other contracts eniered into between
the County and the Provider. The Provider shall be responsible for all direct and indirect costs associated
with such suspension,including attomey's fecs;
3. The County may seek enforcement of this Contract including but not limited to
fiting an action in a court of'apprapriate junsdictivn. I'he I'rovider shall be resgonsibic f'or all direct and
indirect costs associated with such enforcement,including attorney's Fecs;
�. The County may debar the Provider from future County contracting;
S, tf, for any reason,the Provider should attempt to meet its obligations under this
Contract through&aud,misrepresentation or material misstatement,the County sha1L whenever practicable
terminate this Contract by giving written notice to the Provider of such termination and specifying the
effective date. The County may terminate or cancel any other contracts which such individua!or entiry has
with the County. Such individual or endry shali be resgonsible for all direct and indirect costs associated
with such termination or cancellation,including attomey's fees. Any individual or entity who attempts to
rneet its contractuai obligations with the Caunty thraugh fraud,misrepresentatian,or material misstatement
may be debarred from county cantracting for up to rive(5)years;
6. Any other remedy available at law or equity.
C. luthorization ko"Cerminate C'ontraet. The Mayor or the Mayars clesignee is authorired
to terminate this Ccmtract an behalf of the County.
D. Failures or waivers to insist on strict perfonnance of any covenant,condition,or provisian
af this Cantract by the County shall noi be deemed a waiver of any rights or remedies,nor shalt it relieve
the Provider from performing any subsequent obtigatians strictly in accordance with fhe term of this
Conh-act. No waiver shall be effective unless in writing and signed by the parties. Such waiver shall be
limited ta pravisions of this Contract specifically refetred to therein and shall not be deemed a waiver of
any other provisic�n. No wai��er shall constitute a continuing waiver unless the writing states othenvise.
E. Damages Sustained. Notwithstanding the above, the Providcr shall not be relieved of
liability to the Counry for damages sustained by the County by virtue of any breach of'the Contract,and the
County may withhold any payments to the Provider until such time as the exact amount of'damages due the
County is determined. The County may also pursue any remedies available at law or equity to compensate
for any damages sustained by the breach. The Provider shall be responsible for all direct and indirect costs
associated with such action,including attorney's fees.
ARTICI,F: 16. `I'E:RVIItiATI�N
L For Convenienee. The County may terminate this Contract,in whole or gart,when both
parties agree that the continuativn of the activities would not produce beneficial results cammensurate
Page 12 of 28
Docusign Envelope ID:01375622-SDCB-4267-928D-EF2B61 D96623
fHE CffY OF NIA.ril BEACH
H�itS S'iAFFING PROGRAM GIL�NT 5[;MBF.R: PC-2526-SI'.1FF-2
I[1E'.\TIFICATIOV ASSISCAVCE PNOGRA.�t CRA�T�(MBEH: PG2526-ID-1
with further expenditure of the funds.Both parties shall agree upun the tern►ination conditions,ineluding
the effective date and in the case of partial termination,the portiun to be terminated. However,if the
County determines in the case of partial termination that the reduced or modified portion of the grant will
not accomplish the purposes for which the gant was made it may teRninate che grant in its entirecy.
II. At Will. 'Chis Contract may be terminated by the County upon no less than ten(10)
working days' notice when the County determines, in[he sole and absolute discretion of the County,that
it would be in the bc;st interest of the County. Said notice shall be delivered by certified mail,retum
receipt requested,or in person with proof of delivery.
IIL Due to [.$ck of Funds. In the event of a funding short-fall,or a reduction in the funding
appropnations,or should funds ta finance this Contract become unavailable,the County may terminate,in
its sole diseretion and absolute authority,this Contraet upon no less than twenty-four(?4)huurs wntten
notification ro the Provider. Said notice shall be delivered by certified mail,return receipt requested,or in
person with proof of delivery. The County shall be the final authonty ro deteimine whether or not funds
are available. The County may at its discretion terminate,renegopate andior adjust che Contract award,
whichever is in the best interest of the County.
IV. Due to 5ubstantial FundinQ Reduction. [n the event of a substantial funding recluction
of the allocation to the Provider through Board of County Commissioners' (BCC)action,thc Provider
may,at its discretion,request in writing from the Director of the[�partrnent a release from its contractual
ob(igations to the County. "The Director of the Deparunent will review the eftect of the request on the
community and the County prior to making a final detennination.
VI. Banl:ruatey. tf,during the temi of any contract the Provider has w•ith the County,the
Provider becomes involved as a debtor in a bankruptcy proceeding,or becomes involved m a
reorganization,dissolution,or liqaidation proceeding or if a trustee or receiver is appointed over all or a
substantial portion of the property of the Provider under federal bankruptcy law oc any state insolvency
law.
Che Yrovider understands and acknowtedges that if the County detennines in its sole discretion that
termination of the Contract is necessary for the health,safery,or welfare of the County or its residents then
it may do so upon twenty-four(24)hours notice ro the Provider.
'Ihis Contract is subject to the ratification and approval by the �liami-Dade Caunty Board of Count}�
Commissioners and shall be void unless approved by the E�oard of County Commissioners.
ARTICLE 17. PAY�IENT PROCFDURt�:S
A. The County agrees to pay the Provider f'or services rendered under this Contract based on the
payment schedule, timely provision by the Provider of required reports and of supporting documentation
ofexpenses and activities as desecibed in this Contract,and the line-item budget(Attachment B). Payment
shall be made on a cost-reimbursement basis in accordance with procedures oudined below and if
applicable,the Sherman S. W'inn Prompt Pay-ment Ordinance�Ordinance 94-40).
l. Huw aavment will be made.Yayment invoice requests shall be made ro the County
monthly and shall be signed by the Executive Director and the Einancial Officer of the Yro�ider,
Page 13 of 28
Docusign Envelope ID:01375622-5QC6-4267-928Q-EF2661D96623
'Ffik f:ITY OF M(Ablt BB.4('fi
1{titlS 5(AFf'!VG PRUGIZI.Y/ GR1NT Yl MBER: P(:-2526-57'AFF-2
IDF:ATIFICATION ASSlSTANCE PROGRA�i GRAVT�l�A1BER: PC-2526-ID-2
unless otherwise appmved in writing.'Che payment request for[he previous month is due by the I Uth
of the month. Ntonthly payments will be based an actual costs incurred during the service month
with the required suRporting documentation.
2. Any reimbursement may be withheld pending the receipt and approval by the County
of all reports and documents required herein.
3. As applicable,during the period of N/A through N/A ,thc Providcr will submit a
record of those individuals served utilizing Social Security Administration repayments as specified
in the Scope of Services.The Provider will utilize these funds to serve those clients as specified and
authoriz.ed in Attachment A.
4. N/A Providers with cumulative utilization rates greater than ninety percent(9�°%0)
during the first nine(9j manths of this C'ontract may exceed this maximum nuznber of billable bed
days during the last quarter of the Contract term,up to the tota':Contract award amount,with the priar
approval of the F,xecuti��e Director of the Homeless Trust.
5. NlA Providers with cumulative utilization rates lower than ninety percent(9l1°�0)may
he subject ta a reduction in funding and h�ls, if deezned necessary by the i4tiami-Dade County
Homeless Trust. Bc�ts and funding may be reprogrammed as necessary and needed within the
Cuntinuum of Care. The Vtiazni-Dade County Homeless Trust will conduct a review of the utilization
of beds within the first six(6)manths of the contract penod.
6. Final payment reyuests from the pravider will be accepteci up to thirty(30)days a£ter
the expiration of the Agreement. If the Provider €ails to comply, all rights to payments will be
forfeited if the Gounty so chooses.
7. Within thirty(30)days of the te:mination ar expiration of this Contract,a final report
of expenditures shall ln submitted to the County. tf after the receipt of such final report,the County
dctermined that thc Provider has been paid funds not in compliance with the Contraet,and to which
it is not entitled, the Provider will be reyuired to return such funds to the County or submit
doGumentation demonstrating that the expendimre was in compliance with this Contract. The County
shall have the sole and absolutc discretion to determine if�the Provider is entided tv such funds and
the County's dceision in this matter shall be finai and binding.
B. Monies Owed to the Countv: l'hc County reserves the right, in its sole discretion, [o
eeduce payments to the Provider in order to recapture any monies owed to the County. [n accordance with
County Administrative Chder N«. 3-29,any Provider that is in arrears to the County is prohibited from
obtaining new County contracts or extensions of cvntracts until such time as the arrearage has been paid in
fuil or the County has agreed in writing to an approved payment plan.
1'his is a cost-based Contract in which the Provider shall be paid through reimbursement payment based
on the budget approvut under this Contract and when documeruation oC completed and satisFactory service
delivery� is provided. Thus, it is imperative that the Provider �naintain appr�priate supportine
documentation for all expenditures from the beginning of the Contract term(i.e.,receipts,bank statements,
eancelled ehecks,etnployee timesheet,etc,).
T'he Provider shall submit to the Concract:4lanager,the Monthly Keimbursement E'orrn pravided by the
County on a monthly basis. Monthly reimbursement requests(both retroactive and current)and
Page 14 of 28
Docusign Enveiope ID:01375622-5DC8-4267-928D-EF2861D96623
(HF:Cll'Y UF�t1:1�1f Ht�.ACFI
H.19[S STAFFfYG PRUGRAht GRAN'i YOMBF:R: PC-2526-STAF6-2
IDEtiTIFICAT10M1t ASSIS1�AYt`F;PROGRAM GRANT VUh1�FR: PC-2926-1[?-2
accompanying sup�rting dacumentation must be received by the County no later than the 15"'of the
month following the month far which reimbursement is requested.
C. Pio Payment of Su6contractors. [n no event shall County funds be advanced or paid Uy
the County directly to any subcontractor hereundec Payment to appraved subcantractors shatl be made by
the Provider following require►nents and limitati�ris as detai(ed in ��rticle 2l of this Contract.
D. Yrocessing the Request for Yayment. After the County stafC reviews the payment
reyuest, the C�unty will subinit a payment rec}uest to the C`c>unty's Finance Department. The County's
Finance Depart7nent will issue payment ria Automated Ctearing House(ACEI)or mail the check directly
ta the Provider at the address listed in.lrtiete l2 e�f this C'ontract,untess otherwise directed by the Provider
in w•riting. "I'he parties agree khat the processing of a payment reyuest from date of submission by the
Provider shall take a maxim�un of thirty (30) days from receipt of a comalete and accurate payment
request,pursuant to the County's Sherman S.Winn Prompt Payment Ordinance(Qrdinance 94-40),Section
?-8.1.4 of the Code of Miami-Dade County, Administrative Qrder No. 3-14, and the Florida Prompt
Payment Act,if su�porting documentationiinvoices are properly documented as de,�tcrmin�by the County
in its sole disc;retion. It is the cesponsibility of the Provider to maintain sufficient financial resources to
meet the expenses incurred dunng the peri�d between the provision of services and payment by the County.
E. Reporting Kequirements. ['ailure to submit to the County the reports listed below by the
lOth day after the end of the month in which the service was de(ivered,or failure to submit to the County
supporting documentation of Contract expenditures or activities within fourteen(14)days of any County
reyuest,shall be considered a breach of this Contract and may result in withholding payment,non-payment,
or termination of this Contract.
Applicable as indicated
1. Monthly Payment Requests!{nvoice for Services(Attachment E} �
2. Monthiy Payment Request(Attachment F) �
3. Monthiy Performance Reports(Attachment G) �
4. Outcome Performance Measurements Monthiy Report(Attachment H) �
5. Client Contnbution Report (Attachment I) �
6. Client Attendance Roster (Attachment J) �
7. Quarterly Vacancy/Permanent Housing Piacement Report(Attachment K) ❑
Perform$nce Reports. "['he Provider agrees to participate in the Homeless Managernent [nformacion
System (HMIS) selected and �stablished by the County. Participation will inelude,but is not limited to,
input of client data upon intake,daily updates of bed availability information,as well as updatcs of client
files upan client contact,and maintaining current data for statistical purposes. "t'he Provider understands
that they are responsible for any ongaing cost to access the HMIS system. "Ihe Provider shall fumish the
County with Monthly, Quarterly, and Annual Performance Reports in accoreiance with the activities and
goals detailed in the Scope of Services. The reports shall explain the Providers progress for the quartcr.
The data should be quantified when appropriate. The final progress report shatl be due no later than thirty
(30)days after the expiration ar termination of this Contract. Continuation of this Contracc and funding is
contingent upon meeting estabiished perfocmance gaals. Pragress repvrts,produced thraugh the E(omeless
Management Information System(fI:vtlS j invoices for sc:rvices and client attendance rosters signed by the
Esecutive Directoe of the agency shall by subtnitted by the Provider,as required.
F. Finat ReporURecapture of Funds. (fE�n the expiration ar termination af this Contract,
Page 15 of 28
Docusign Envelope ID 01375622-SDCB-4267-928D-EF2861 D96623
iNE CfiY OF MI:1�11 RF.:�C'H
HN[S S"fAFF1.VG PROGR��t GRAVT�C.tilBF.R: PC-2526-5"fAFF-1
[DEV77FICATIOV 1SSIS'1'AYCF.PROGRA�1 GRANT�1:�i8F.R: Pf-2526-10.2
the Provider shall submit the tinal Annual Performance Report and Annual Actual Expenditure Report
(Attachment I.) to the County no later than thirty (30) days after the expiration or termination of this
Contract. (f after receipt of such final reports,the('ounty determines that the Provider has been paid funds
not in accordance with the Contract,and to which it is not entitled,the Provider shall return such funds to
the Counry,or the C'ounty may reduce,by the amount of such funds,fram any subsequent payment to which
the Provider is en[itled, or the Provider may sulmiit appropriare documentation within seven (7) days of
notice from the County. The County shall have the sole discretion in determining if the Provider is entitled
to such funds and the County's decision on this matter shall be final and binding. Additionally, any
unexpended or unailocated funds shall be recaptured by the County.
Additionally, the Provider agrees to assign any proceeds to the County from any contract, including this
Contract,between the County,its agencies or instrumentalities and the Provider or any firm,corporation,
partnership or joint venture in which the E'rovider has a controlling financial interest in order to secure
repayment of any reimbursemenu for services provided under this or any other contract for which the
County discovers was not reimbucsable through its inspection,review and/or audit pursuant to this Contract.
ARTICLF. 18. PR01i1B1'1'ELl C;SE UFFUtillS
A. Adverse Actions or Proceeding. The Provider shall not utilize C'ounty funds to retain
legal counsel for any action or proceeding against the Counry or any of its agents, instrumentalities,
employees,or officials. The Pro��ider shall not utilize Counry funds to provide legal representation,advice,
or counsel to any client in any action or procecding against the County or any of its agents,instrumentalities,
employees,or officials.
E3. Religious Purposes. County funds shall not be used for religious purposes.
C. Commingling Funds. The Provider shall not commingle funds provided under this
Contract with funds received from any other funding sources. I'he Provider shall establish a separate
account exclusively for rcceipt of the funds received pursuant to this Contracc.
n. F.xpenditure in Viotallon of Law. The Provider shall not utilize County funds in
violation of any federal,state,or local law,rule,regulation,or order.
F.. Double Payments. Provider costs daimed un�ier this Contr�ct may not also be
claimed under another contract or grant from the Cvunty or any other agency. Any claim for double
payment by Provider shall be considered a material brcach of this Contract.
ARTICLE 19. REUU1R�ll DOCUJIEITS, RF,CORDS, REPORTS, AtiDtTS.
MO�ITORIIG A\U RF.VIEW
A. Certificate of Corporate Status. The Provider must submit to the Contract Manager,
within thirty(30)days from the date of execution of this Cantract, a cerlificate of corporate status in the
name of dte Provider. which certifies the following: that the Provider is organized under the laws of the
State of Florida;that atl f'ees and penalties have been paid;that the Providers mcnt recent annual repoR has
been 6led; that its status is acti�e;and that the Provider has not filed.Articles of Uissolution.
Page 16 of 28
Docusign Envelope ID 01375622-50C6-4267-9280-EF2661D96623
rae:crry ot��unwi�EAc►i
NNISS'1'AFFI.VGPROC;R4S1 GRA\TVC�I6F.N: PC-2516-S7A}F-2
IDEN►'IFIC,�T10N ASSItiTAM1('F'.PROGRAS1 CRANT�C�1BER: PC-2526-10.2
H. Board of 1)irector Requirements. The Provider shall ensure that the Provider's Board
of Directors is appnsed of thc programmatic, tiscal, and administrative obligations under this Contract
funded through Countv Funds by passage of a formal resolution authorizing exeru[ion of this Contract with
the County. A copy oi�this corporate resolution must be submitted to the County prior to contract execution.
A current lis►of the Yrovider's Board of Uirectors and officers must be included with the submission. The
Provider acknowledges and understands that all contract documerrts shall be signed by ei[her the Provider's
President or Vice President. The Provider's resolutio�shail at a minimum: list the name(s)of the Board's
President, Vice President and, onlv in the event that the President or Vice President is not available to
execute the contract documents, any other persons authorired ro execute this Contraet on behalf of the
Provider, affirmatively state that a quorum was prescnt at the time of adoption of the resolution; and
reference the service categories and dollar amounts in the award,as may be amended.
C. Proof of 7'ax Status. The Provider is rcquired to submit to the Counry the following
documentation: (a)W-9 Form(Attachment C); (b)The I.R.S.tax exempt status determination letter;(c)
the most recent I.R.S. form 990; (d)the annual submission of I.R.S. focm 990 within(6)months after the
Provider's fiscal year end;(e)[KS form 94] -Quarteriy F�ederal"Cax Return Reports within thirty-five(35)
days after the quarter ends and if the form 9d1 reflects a tax liability,proof of payment must be submitted
within forty-five(45)days after the quarter ends.
D. Conflicts of Interest. Section 2-1 l.l(d) of Miami-Dade County Code as amended,
requires any Counry employee or any member of the employet's immediate family who has a controlling
financial interest,direct or indirect,with Miami-Dade County or any person or agency acting for Miami-
Uade County competing or applying for any such contract as it pertains to this solicitation,to first request
a conflict of interest opinion from the County's Ethic Commission prior to their or their immediate family
member's entering into any contract or transacting any business through a firm,corporation,partnership or
business entity in�vhich the employee or any member of thr employee's immediate family has a controlling
financial interest,direct or indirect,with Miami-Dade County or any person or agency acting for tiiiazni-
Dade County. Further, any such contract, agreement or business engagement entered in violation of this
subsection,as amended,shall render this Contract voidable.
. E. Aceounting Kecords. The Provider shall keep accounting records which conform to
generally accepted accounting principles. All such rec;ords will'oe retained by the Provider for no less than
three(3)years beyond the term of this Contract and shall be made available for review upon request &om
C'ounty authorized personncl.
F. Financial Audit. if the Provider has or is required to have an annual certified public
accountant's opinion and relatc�financial statements,the Provider agrees to provide these documents to the
County no later than one hundred eighty(l 80)days following the end of the Provider's f3scal year,for each
year during which this Contract remains in force or until all funds received pursuant to this Connact have
been so audited,whichever is later.
G. Access to Records: Audit. The County reserves the right to require the Provider to submit
to an audit by an auditor of the County's choosing or approval. The Provider shall provide access to all of
its records which relate to this Contract at its place of business during regular business hours. The Provider
agrees to provide such assistance as may be necessary to facilitate their review or audit by the County to
ensure compliance with applicablz accounting and financial standards.
H. Quarterly Reviews of Fxpenditures and Records. The County Commission Auditor
may perform quarterly reviews of Provider's expenditures and records. Subsequent payments to the
Page 17 of 28
Docusign Envelope ID:01375622-SDCB-4267-928D-EF2B61D96623
�CHE CPP!'OF'ML�:tit[BF:ACH
HW[SSf4FFINGPRdGRAM GFtA\1�ll��tBt'K: PG2526�L1FF-2
IDF.\17FICA"ft0\ASStST:��CF:PROCN:1.11 GKA�7'�C�iBf.K: PC-2526-ID-2
Provider shall be �ubject to a satisfactoiy review of Provider's records and expenditUres by the County
Cummission Auditor, including but not limited ro, review of supporting docwnentation for expenditures
and the existence of sufficient documentation to support eligible expenditures. The Provider agrees to
reimburse the County For ineligible expenditures as determined by the County Commission Auditor.
I. Quality Assurance/Recordkeeping. I he Provider shall maintain and shall require that
the Provider's subcontractors and suppliers maintain,complete and accurate program and tiscal records tc�
substantiate compliance with the requirements set forth in the Attachment A, Scope of Services,of this
Contract. 1'he Frovider and its subcontractors and suppliers shall retain such records, and all other
documents relevant to the Services fumished under this Contract for a period of� thrce(3)years or�
seven(7)years(for State contracts)from the expiration date of this Cantract.
The Provider agrees to participate in evaluation studies, quality managemen[ activities,
Corrective Action Plan activities, and ana(yses camed out by or on behalf of the County to evaluate the
effectiveness of client service(s)or the appropriateness and quality of care/service delivery. Accordingly,
the Provider shall allow authorized County staff involved in such ef'f'orts to examine and review the
Pravider's premises and records.
J. Confidentiality Requirements. T'he Provider shall establish and implement policies and
procedures which ensure compliance with the following security standards and any and all applicable State
and Federal statutes and regulations for the protection of contidential client records and electrunic exchange
of confidential information. The po(icies and procedures must ensure that:
(I) There is a controlled and secure area for storing and maintaining active�onfidential
information and files,including but not limited to medical records;
(2) Confidential records are not remuved from the Provider's premises, un(ess
otherwise authorized by law or upon written consent from[he County;
(3) Access to confidential information is res�-icted to authorized personnel of the
Provider, the County, the United States Department of I{ealth, and Human
Servic;es,the l;nited States Comptroller(ieneral,and/or the t;nited States Office
of the Inspector General;
(4) Records are not left unattended in areas accessible to unauthorized individuals;
(51 Access to electronic data is controlled;
(6) Written authorization,signed hy the client,is ootained fur release of copies of client
records and�or information. Original documents must remain on file at the
uri�inatine Provider site;
(7) :4n onentation is provided to new staff persons, employees, and volunteers. All
e�nployees and volunteers must sign a con6dentiality pledge,acknowledging their
awareness and wtderstanding of confidentiality laws,regulations,and policies;
(8) Procedures are developed and implemented that address client chart and medical
rec;ord identification, filing methods, storage, retneval, organization and
maintenance,access and security,confidentiality,retention,release of information.
copying,and faxing.
Page 18 nf 28
Docusign Envelope ID:01375622-5DC6-4267-928D-EF2B61D96623
I'NP:ftTY OF rtI1�11 BF A(H
HNISST.4FFf\G PROGRAII CRAAI'NCMBER: PG2526-ST.1FF-2
IDF.N7'IF[CATlOV.4SSISTANCE PROGRAYI GR1ti7'V�iMtgF.R: PC'-2526-ID-2
K. Monitoring: Management F.valuetion and Performance Review. "I'he Provider agrees
to pennit County authunzed personnel to moniWr, review and evaluate the prograrn/work which is the
subject of this Contract. 'I'he County shall monitor fiscat, administrative, and pragrammatic comp(iance
with all the terms and conditions of the Contract. 'I'he Provider shall permit the County to conduct site
visits, client assessment survcys, and other techniques deemed reasonably necessary to fulfill the
monitoring (unction. n report of the County's tindings will be delivered to the Provider and the Provider
will rectify all deficiencies cited within the penod of time specified in the report. If such deficiencies are
not corrected within the specified time the County may suspend payments or terminate this Contract. The
C'ounty may conduct one or more formal management evaluation and performance reviews of the Provider.
C'ontinuation of this C'ontract and funding are dependent upon the County being satistied with the results
of the evaluations.
L. Client Records. The Provider shall maintain a separate individual client chart for each
ctienUfamily ser�ed,where appropriate. This client chart shall include all pertrnent information regarding
case activity. At a minimum,the c(ient chart shall contain referral and intake iniixmation,treatment plans,
and case notes documenting the dates services were provided and the type of servicc pmvided. l�hese client
charts shall be subject to the audit and inspection requirernents under Article 19, Sections F,G and H of
this Contract.
M. Disaster Plan/Continuity of Operations Plan(COOP). The Provider shall develop and
maintain an Agency Disaster Plan/COOP. At a minimum, the Plan will describe how the Provider
establishes and rnaintains an effective response to ernergencies and disastecs and must comply with any
Florida Statutes related to Emergency Management that are applicable to the Provider. The Uisaster
Plan�C(?OP must be submitted to the County no later than.4pril 1"of the contract term and is also subject
to review and approval uf the C'ounty in its sole discretion. `I'he Provider will review the Plan annually,
revise it as needed,and maintain a written copy on file at the Provider's site.
N. Continuum of Care (CoC) Coordinated Intake and Assessment Process. Che
Provider shall participate in the Continuum of Care's (CoC) Coordinated Intake and Assessment
process,m include, but not limired[o: participation in the C�C's defined proe:ess to make and receive
referrals for housing and/or services (including the use of the Fiomeless IVlanagement [nformation
System(FI�IIS)for such,if required in the Standards of Care);use of any forms required(e.g.Release
of infonnation,Homeless Verification Fonn,(`hronic Homeless Verification Form,etc.); compliance
with established Standards of Care(and any revisions therea�relating to eligibility criteria and timely
processing of referrals;and cooperation with established prioritizations for placement.
O. Public Rccords
Pursuant to Section 1 19.0701 of the Florida S�a[utes, if the Provider meets the detinitiun of"Contracror"
as defined in Section 119.0701(1)(a),the Provider shalL•
(a) Keep and maintain public records that ordinarily and necessarily would be required by the
public agency in order to perform the servicc;
I,b)Provide the public with access to public records on the sam�terms and conditions that the public
agency would pmvide th�rec;ords and at a cost that does not exceed the cost pmvided in this chapter
or as othenvise provided by law;
(c) Fnsure dlat public records that are exempt or confidential and exempt from public records
disclosure requirements are not disclosed except as authorized by law;and
Page 19 of 28
Docusign Envelope 10 01375622-SDCB-4267-928D-EF2861D96623
rHe c.iry oe��nMi sh:nctt
H41IS STAFFING PRUGRAM GItANT'.SCMBk:R: PC-2526-STAFF-2
IDENTIFICATION ASSISTANCF PROCRAM GRAVT NCMBF.R: PG2526-IDd
(d)Meet ail reyuirements for retaining pub(ic recards and transfer to the County,at no County cost,
ail public records created,received,maintai�d and or directly related to the performance of this
Agreement that are in possession of the Provider upon termination of this Agreement. Upon
termination of this Agreement, the Pravider shall destroy any duplicate public records that are
exempt or confidential and exempt from public records disclosure requirements.All records stored
electronically must be provided to the County in a format that is compatible with the information
technology systcros of thc County.
For purposes of this Article, the term "public records"'shal(mean all doe:uments,papers,letters,
maps, books, tapes, photographs, films, sound recordings, data processing software, or other
material, regardless of the physical form, characteristics, or means of transmission, made, or
received pursuant to law or ordinance or in connection with the transaction c.�f official business of
the County.
Provider's failure to comply with the public reeords disclosure requirement set forth in Section
I 19.0701 of the rlorida Statutes shali be a breach of this Agreement.
In the even�the Provider does not comply with the public records disclosure requirement set forth in Section
1 I 9.0701 of the Florida Statutes,the County may,at the County's sole di scretion,avail itself of the remedies
set forth under this Agreement and available at law.
If the Provider has questions regarding the application of Chapter
119, Florida Statutes, to the Provider's duty to provide public
records relating to this Agreement, contact :Vliami-Dade County's
Custodian of Public Records at:
iVliami-Dade County
Homeless 'frust
111 NW lst Street, 27te Floor, Suite 310
Miami, Florida 33128
Attention: Victoria 1,. Mallette, Executive Director
Email: victoria.mallette(a'miamidade.gov
AI2TICLF.20. Office of Miami-Dade Count��Insaector General
Miami-Dade County has established the Office of the Office of Inspector General which is empowered to
perform random audits on all County contracts throughout the duration of each contract.The�liami-Dade
County Inspector General is authorized and empowered to review past,present,and proposed County and
Pubiic Health Trust programs, contracts, transactions, accounts, records, and programs. In addition, the
[nspector General has the power to subpoena witnesses,administer oaths,require the production of records,
and monitor existing projects and programs. Monitoring of an existing pmject or program may include a
report concerning whether the project is on time, within budget and in compliance with plans,
specifications,and applicable law.
The lnspector general is empowered to analyze the nec:essity of and reasonableness of proposed charge
orders to the Contract. The Inspector General is empowered to retain the services of independent private
Page 20 of 28
Docusign Envelope ID:01375622-SDCB-4267-928D-EF2B61 D96623
1'HE Cl"I'1'UF 111AM1 BF:ACH
H�11S STAFF'ING PN(N:RAM GRANT NI�NBER: PC-2526STAFF-2
[UE�TIFICATIO�AtiS[ST.4NCE PROCRA�t GRANT NCv1BER: PC-2526-ID-2
sector inspectors general (IPS[G) to audit, investigate, monitor, oversee, inspect and review operations,
activities, performance and procurement process including but not (imited to project design, bid
specifications,pro�sal submittals,activiti�of the Provider,its officers,agents and employees,lobbyists,
County staff and elacted officials to ensure compliance with contract specifications and to detect fraud and
corruption.
Upon ten(10)days prior wntten notice to the Provider from the Inspector General or IPS1G retained by the
Inspecror Ueneral,the Provider shall make all requested records and dcx;uments available to the Inspector
General or [PS(U for inspection and copying. "The [nspector General and IPSIG shall have the right to
inspect and copy all documents and records in the Provider's possession,custody or controi which,in thc
[nspector General or IPS[('r's sole judgment, pertain to performance of the contract. including, but not
limited to onginal estimate files, workshcets, proposals and agreements from and with successful and
unsuccesstul subcontracrors and suppliers, all project-related correspondence, memoranda, instructions,
tinancial documents,construction documents,proposal and contract documents,back-charge documents,
all documents and records which involve cash,trade or volume discounts,insurance procceds,rebates,or
dividends received, payroll and personnel recc�rds, and supporting documentation for the aforesaid
documents and records.
The provisions in this section shall apply to the Provider,its officers, agents,emptoyees, subcontractors,
and suppliers. The Provider shall incorporate the provisions in this section in all subc:onuactors and all
other agreements executed by the Provider in connection with the performance of the contract.
Nothing in this contraet shall impair any independent right of the County to conduct audit or investigative
activities. The provisions of this section are neither intended nor shall they be construed to impose any
liability on the County hy the Provider or third parties.
AK"fICI.E Z1. SUBCONTRACTORS and ASS[GN;VIF.NTS
A. Subcontracts. fhe parties agree that no assignment or subcontract will be made or let in
connection with this Contract without the prior written approval of the County in its sole discretion,which
shall not be unr�:asonably withheld,and that all subcontractors or assignees shall be governed by all of the
terms and conditions of this Contract.
l) If the Provider will cause any part of this Contract ro be performed by a
Subcontractor,the provisions of this Contract witl apply to such Sabcontractor and
its officers,agents and employecs in all respects as if it and they were employees
of the Provider: and the Provider will not be in any manner thereby discharged
from its obtigations and liabilities hereunder, but will be liable hereunder for all
acts and negligence of the Subcantractor,its officers,agents,and employees,as if
they were employees of the Provider. I'he services performed by the Subc;ontractor
will be subject to the provisions hereof as if performed directly by the Provider.
2) 'I'he Provider,before making any subcontract for any��rtion of the services,will
state in writing to the County the name of the proposed Su�:ontractor,the portion
of the Sen•ices which the Subcontractor is to perfonn,the place of business of such
5ubcontractor,and such other information as the County may require. The County
will have the right to require the Provider nol to award any subcontract to a person,
firm,or corporation disapproved by the County in its sole discretion.
Page 21 uf 28
Docusign Envelope IO:01375622-SDGB-4267-9280-EF2661096623
�t'F[F.CI"i'Y OF,NIA�MI BEACH
Hl1lS SCAFFING PKOGftA�1 CItAN7'Y(;MQF.R: PG2326-SCAF'F-2
IDEVTIFfCAT1U5 ASSISTANCF:PRO(:RhM GRANT Yt`!ffiF.R: PG2526-tD-2
3) Before entering into any subcontract hereunder, the Provider will inform the
Subcontractor fully and completely of all provisions and requirements of this
Contract relating either directly or indirecdy to the Serviees to be pertormed. Such
Services performed by such Subeon[ractor will sMetly comply with the
requirements of this Contract.
4} In order to qualify as a Subcontractor satisfactory to the County in its sole
discretian,in additian to the other requirements herein provided,the Subcontractor
must be prepared[o prove to the satisfaction of the Gounty that it has the necessary
facilities, skill and experience, and ample Einancial resources to perform the
Services in a satisfactory manner. Ta be considered skilled and experienced, the
Sut>c;ontractor must show to the satisfaction of the Caunty in its sole discretion that
it has satisfactorily performed services of the same genc,�ral type which is required
to be performed under this eontract.
5} I'he C:ounry shall have the right to withdraw its consent ta a subcontract if it
appears to the Caunty[hai the subcontract will delay,prevent,or otherwise impair
the performance of the Contractoc's abligations under this Contract. All
Subcontractors are required to pratect the contidentiality of the County's and
County's praprietary and confidential information. Provider shall furnish to the
County copies of all subcontracts between Provider and Subcontractors and
suppliers hereunder. Within each such subcontract,there shall be a clause for the
benefit of the County permitting the County to request completion of performance
by the Subcontractor of its obligations under the subcontract, in thc event the
C�unty finds the Contractor in breach of its obligations;and the aption to pay the
Subcontractor directly fvr the performance by such subcontractar. The foregoing
shall neither canvey nor imply any obligation or(iability on the part of the County
ro any subcontractor hereunder as more fully described herein.
B. Prompt Payments to Sabcontracturs. The Provider shall issue prompt payments to
subcontractors that are smatl businesses(annual gross sales of$750,040 or(ess with iis principal place vf
business in Miami-Dade County)and shall have a dispu[e rc�;olution procedure in place to address disputed
payments. Pursuant to the Counry's Sherman S. Winn Prompt Payment Chdinance (Ordinance 94-40),
Sectian Z-8.1.4 of the Code of Miami-Uade County,.Administrative Order No.3-l 9,and the Florida Prompt
Payment Act,payments must be made within thirty(30)days of receip[of a proper invoice. Failure to issue
prompt payments to small business subcontractors or adhere to dispute resolution procedures may be
grounds for suspension or terminaUvn of this Contract or debarment.
ARTICI,F.22. LOCAL,STATE,AND FEAERAL COMPL1AlVGE REOliIREi�IE\TS
Provider agrees to camply,subject t�apglicable profcssional standazds,w�th thc pro�isions of any
and all applicahle Federal, State and the County's orde�:s. stahites,ordinanc:es, rules, and regulations that
may pertain to the Services required under this Contract,including but not limited ta:
a) Miami-Dade County Fiorida, Department of Business llevelopment Participation
Provisions,as applicable to this C:�ntract.
b) Miami-Dade C:ounty CQde,Chapter 1 IA,including but not limiCed to Articles [II and IV.
AII Pravid�rs and subcontractars performing work in conncclion with this Contract shall
pravide equal apportunity for emple>yment and services without regard to race, creed,
Page 22 of 2&
Docusign Envelope ID:01375622-5DCB-4267-928D-EF2B61D96623
IHE CI'1'Y OF�t1AMl BF:ACH
HNIS STAFFIVG PROGRAM GRAYC Vl NBk;R: PC-2526-SC�FF-2
IDENTIFICATIOV ASSItiTAVCE PROGRAM GIL1N I Nl�1BER: PC-2526-1U-2
religion, color, sex, familial status, mantal sta[us, sexual orientation, pregnancy, age,
ancestry,national origin,gender identity,gender expression,source of income or handicap.
The aforesaid provision shall include, but not be limited to, the fol]ow•ing: employment,
upL2rading,demotion or transfer,recruitment adveriising;layoff or tennination;rates of pay
or other forms of compensation;and seleciion for training, including apprenticeship. The
Provider agrees to post in a conspicuous place available for employees and applicants for
employment, such notices as may be required by the Dade County Fqual Opportunity
Board or other authoriry having jurisdiction over the work setting forth the provisions of
the nondisccimination law.
c) Conflict of Interest and Code of F,thics(hdinance, Section 2-11.1 et� of the Code of
Miami-Dade County,as amended.
d) Miami-Dade County Code Section 10-38,l�barment of contrac[ors from County work.
e) Miami-Dade County Ordinance 99-5, codified at l 1A-60 et segg Code of vliami-Dade
County pertaining to complying with the County's Domestic Leave Ordinance.
fl Miami-Dade County(hdinance 99-152 codified at Section 21-255 et se�c. prohibiting the
presentation, maintenance, or prosecution of false or fraudulent claims against Miami-
Dade County.
g) 4(iami-Dade County Resolution 478-12. The Provider will not use products or foods
containing "pink slime," as defined in Resolution 478-12 of the Board of Miami-Dade
County Commissioners,in food that is provided or served pursuant to this agreement."
h} Florida Statutes Section 125.U156 Restriction on providing funds for identiYication
documents.
Provider shall cornply with the provisions related to Florida Statutes Section 125.O1�6
Restriction on providing funds for identification documents. Specifically, Provider shal]
not use funds provided to it by the Counry,or provide funds to any person,entity,or
organization, for the purpose oF issuing an identification card or document to an
individual who does not provide proof of lawful presence in the United States.
i) Florida Statutes Section 4�18. PUE3L[C A(iENCY(;ON"CRACCING
Provider shall comply with the provisions of Florida Statutes Section 448 related to
PUBLIC.AGF:NCY CONTRAC"t'[NU:
Provider shall register with and use the E-Verify syst�n ro verify the work au[horization
status of ali new employees of the Provider and sha(1 require any subcontractor to regis[er
with and use the E-Venfy system to verify the work authorization status of all
subcontractvr's new employees.Provider or any subcontractor may not enter into a contract
unless each party to the contract registers with and uses[he E-Verify system.
If Provider enters into a contract with a subcontractor,the subcontractor must provide the
Provider with an affidavit stating that the subcontractor does not employ,contract with,or
subcontract with an unauthorized alien.Provider shall maintain a copy of such atiidavit for
the duration of this Agreement.
If the County has a good faith belicf that Provider has knowingly violated s. 4=�8.09(l 1 of
the Florida Statutes,The County shall terminate this Agrecment.
Page 23 of 28
Docusign Envelope ID:01375622-5DC8-4267-928D-EF2661D96623
fNE C[TY OF NIANI BEACH
NNISSTAFFIVGPRO(:KAN GR.AYTYGMBER: PG2S26-STAFF-2
[DE:V TIF'ICATIO�ASSISl'.1NCE PROGNAkt GRA�T�Gh1BER: PC-2526-1D-2
If Provider has a good faith belief that any subcontractor with which it is contracting has
knowingly violated s. 448.09(l) of the Florida Statutes, Provider shall terminate the
contract with the person or entity.
[f the County has a good faith belief that a subcontractor knowingly violated this
subsection, but the Provider otherwise complied with this subsection, the County shall
promptly notify the Provider and order the Provider to immediately terminate the contract
w�ith the subcontractor and the Provider shal] immediately teRninate the contract with the
subcontractor.
[f the County terminates this Agreement under this paraKraph, such termination is not a
breach of this Agreement and may not be considered as such. lf the County tenninates this
Agreement with Provider under this paragraph,the Provider may not be awarded a public
contract for at least 1 year after the date on which this Agreement was terminated.Yrovider
is liable for any additiunal costs incurred by the Counry as a result of the termination of
chis Agreement pursuant tu th�s paraeraph.
j) E3y entering into, amending, or renewing this Contract, including, without limitation, a
grant agreement or economic incentive program payment agreemcnt(all referred to as the
"Contract"), as applicable, the Provider is obligated to comply with the provisions of
Section 787 06, Ftorida Statutes ("F.S."). "Human Trafficking," as amended, which is
deemed as being incorporated by ref'erence in this Contract. All definitions and
requirements from Section 787.06,F.S.,apply to this Contract.
This compliance includes the Provider providing an affidavit that it does not use coercion
for labor or services. This attestation by the Pmvider shall be in the form at[ached as the
Fluman�I'rafficking Affidavit(the"Affidavit"),which is attached hereto as Attachment Q
and must be executed by the Contractor and provided ro the County when entering,
amending,or renewing this Contract.
This Contract shall be void if the Provider submits a false Aftidavit pursuant to Secdon
787.06,F.S.,or the Provider violates Section 7R7.06,F.S.,during the term of this Contract,
even if the Provider was not in violation at the time it submitted its Affidavit.
k) By entering into this Contract, the Provider affirms that it is not in violation of Section
287.13R,Florida Statutes,titied Contracting with Entities of Foreign Countries of Concern
Prohibited. Che Provider further aftirms that it is not giving a government of a foreign
country uf concem,as listed in Section 287.138.Florida Statutes,access to an individual's
personal identifying information if:a)the Provider is owned by a government of a foreign
country of concern; b) the government of a foreign country of concern has a controlling
interest in the Provider,or c)the Provider is organized under the laws of or has its principal
place of business in a foreign cauntry of concern as is set forth in Section 2R7.138(2)(al-
{C), Florida Statutes. 'I'his aff'irmation by the Developer shall be in the form attached to
this Agreement as Contracting with Fntities of Foreign Countries of Concern Prohibited
Affidavit, which is attached hereto as Attachment R and incorporated herein by
reference. For purpose of this agreement the ter�ri "Fore�n Country_of Cgncern" shall
mean the People's Republic of China.the Russian Federation,the lslamic Kepublic of Iran,
the Uemocratic People's Republic of Korea,the Repubhc ut Cuba,the Venezuelan regime
of Nicolas Maduro, or the Syrian Arab Republic, including any agency of or any other
entity of significant control of such foroign country of concern.
Page 24 of 28
Docusign Envelope IQ:01375622-5DCB-4267-928D-EF2661D96623
TRF�ClTY OH�ti1lA�11 tiN�ACFI
H'�tIS STAFFING PRQf:RAN GRA�T tiG�16ER: PC-2526-STAFF-2
IDENTIFiCAf10N ASSISI':1NC4:PRUGRAII GRA�T VUMBER: PC-2526-ID-2
Notwithstanding any other provision of this Contract, Provider shall not be required pursuant to this
C;ontract to take any action or abstain from taking any action if such action or abstentian wouid,in the good
faith determination of the Provider, constitute a violatian of any law or regulation to which Provider is
subject,ineiuding but not limited ta laws and regulations requiring that Provider conduct its operations in
a safe and sound manner.
ART'[CLE;23. 19ISCELLANEOU5
A. Pubiicity. It is understood and agreed between the parties hereto that this Provider is
tunded by Miami-Dadc County. Further,by thc acceptancc of thcse funds,the Provider agrees chat events
funded by this Contract shal( recognize and adequately reference the County as a funding source. The
Provider shall ensure that all publicity,public relations,advertisements,and signs recognizes and references
the Caunty(by inserting the ilriiami-Dade County F fomeless Trust l..ago an a4 materials)for the support of
all contracted ac:tivities. This is tn include,but is not limited ro,all posted signs,pamphlets,wall plaques,
cornerstones, dedications, notices, flyers, broehures, news releases, media packages, promotions, and
stationery. 1'he use of the official Ntiami-Dade C'ounry t iomeless Trust logo is permissible for the pubiicity
purposes stated herein. Provider shall submit sample or mockup of such publicity or materials to the County
for review and approval. "[he Provider shall ensure that a(1 media representatives,when inquiring about the
activities Funded by this Contract,are informed that the Counry is its funding source.
B. Governing I.aw and Venue. 1'his Contract is made in the State of Florida and shall be
governed according to tl�e laws of the State aF Florida. Venue for this Contract shall be Miami-Dade
County,Florida.
C. �Iodifieallons. My alterations, variations, modifications, extensions, or waivers of
provisians of this Contract including,but not timited to,arnount payable and effective term shall only be
valid when they have been reduced to writing,duly approved,and si�ed by both parties and attached to
the original of this Can[ract.
"Che County and Yrovider mutually agree that modification of the Scope of Services,schedule of
payments,billing,and c:ash paycnent procedures,set forth herein and other such revisions may be made as
a written amendment to this Contract exccuted by both parties.
"I'he Mayor or thc f�tayor's designee is authurized to make modifications to this Cantract as
described herein on behalf of the County.
The Office of the lnspector �eneral shall have the power to analyze the need for, and the
reasonableness of praposed modifications to this Cantract.
D. Counterparts. I'his Conkraet is exec;uted in three(3)counterparts,and each counterpart
shall constitute an originai of this Contr�ct.
L. Headings, Use of Singular and Gender. Paragraph headings are for cnnvenience only
and are not intended to expand or restrict the scope or substance of the provisions of this Contract.
Wherever used herein; the singular shall include the plwal and plura( shall include the singular, and
pronouns shall be read as masculine,feminine,or neuter as the context reyuires.
F. Review of this Contract. Each party hcreto represents and warrants tttat they have
consulted with their own attorney concerning each af the terms contained in this Contract. No
Page 25 of 28
Dacusign Envelope ID:01 37 562 2-5DCB-4267-928D-EF2661D96623
THE CII'Y QF Yt1AM1 BF:ACH
H�11S ST,\FFI�G PROGR.1M1i CRA�T�U�iBER: PC-2326STAFF-2
[UEVTIFICATIO�ASSIS'1'AtiCF:PROCRAM GRANT tiUNBEN: PG2526-ID-2
inference, assumption, or presumption shall be drawn from the fact that one party or its attomey
prepared this Contract. It shall be conclusively pre.sumed that each party participated in the
preparation and drafting of this Contract.
G. The County's Consultant T'he Provider understands that in order to facilitate the
implementation of this Contract, the County may from time to time designate in writing a development
cansultant to work with the Provider. 't'he County's consultant shall be considered thc County's designee
with res�t to all portions of this Contract except for those provisions relating to payment of thc Provider
for services rendered. The County shali provide written notification to the Provider of the name,address,
and employees of the County's consultant.
iL Contracts with Municipalities or Counties Outside �Iiami-Dade County to Provide
Homeless Housing in Miami-Dade County. The Pmvider desiring to transact business or enter into a
Contract with thc County for the provision of homcless housing andior senices swears, verifies,a�cros
and agrees that(1)it has not entered into any current contract,arrangement of any kind,or understanding
with any municipality outside of Miami-Dade County or any County (coliectively"locality") to provide
housing and services for homeless persons in Vtiami-Dade County who are transported tu Miami-Dade
County by or at the behest of such locality and(2)during the tenn of this Contract,it will not enter intu any
such contract,arrangement of any kind,or understandin�;provided,however,upon the written request of
the Provider prior to entering into such contract,unders[a»ding that the County may,in its sole and a6solute
disc;retion, tind and determine within sixty(60)days of such request that a proposed contract should not be
prohibited hereby,as the best interests of the homeless programs undertaken by and on behalf of Lfiami-
Dade County would not be negatively affected by such contract,arrangement,or undertaking.
I. Incident Reports. -Che Provider must report to the Miami-Dade County Homeless 1'rust
information related to any critical incidertts occurring dunng the administration of its programs. 1'he
Provider is to utilize thc"Incident Report" form attached as Attachment E. ln addition to reporting this
incident to the appropnate authorities, the Provider must�vithin twenty-four(24) hours of�any incident,
submit in writing a detailed account of the ineident. "I'his incident report should be addressed to the
County. This incident report should be addressed to Miami-Dade County Homeless Trust, 111 NW First
Street, 27'" Flaor, Suite 310, Miami, Fiorida 33128; telephone (305) 375-1490 and facsimile(305) 375-
2722.
J. 1'otality of Contraet/Severability of Provisions. This Contract and Attachments,with
its recitals on the tirst pagc of the Contract and �rith its attachments as referenced below contain all the
terms and conditions agrecd upon by the parties.
I. No 3�d Party t3eneficiarics. ['he Pariies agree that this contract has no intended ur
unintended third-party beneficiaries.
K. Property.This secGon applies to equipment with an acquisition cost of�5,000 or more per
unit and all real property.
t. Any real property under the Provider's control that was acquirediimproved in whole
or in part with funds from the E[omeless I'rust and any equipment purchased for
$5,000 or more shall be disposed of,at the expiration or termination of this contract,
in accordance with instruction from the Homeless Trust. Real Property is defined
as tand, including land improvements, structures, and appuRenances thereto,
inctuding mo�•able machinery and equipmen[. F.quipment means tangible,
Page 26 of 28
Docusign Envelope ID 0I375622-SDCB-4267-928D-EF2861D96623
THE CITY OF NIAMI BF:ACH
H�[IS STAE'FIVG PROGRAN GRANi Vl MBER: P(-2526-STAFF-2
IDF.VTIF7CA'1'IUN ASSISTANCE PROCILI,�1 GRAV"f VGMBF:R: PC-2526-ID-2
nonexpendable,personal property having a useful life of more than one year and an
acquisi[ion cost of$5,000 or more per unit.
2. All equipment with an acquisition cost of$5,000 or more per units and all real
property purchased in whole or in part with Punds from this and previous contracts
with the ftomeless Trust, or transferred to the Provider t after being purchased in
whole or in part with funds fram the Homeless Trust shall be listed in the property
records of the Provider and shall include a legal descnption,size,ciate of acyuisition,
value at time of purchase,owners name if different from the Provider, information
on the trar�,sfer or disposition of the property,and map indicating whether property
is in parcels,lots or blocks and showing adjacent streets and roads. Notwithstanding
documentation reyuired for reimbursement purposes,a eopy of the purchase receipt
for any asset desctibed above pwchased with Homeless Trust funds must also be
induded in the Provider's monthiy reimbursement package submitted to the
Homelcss Trust in the month in which the item was purchased along with the
"Provider Asset[nventory"(Attachment O1.
3. All equipment with an acquisition cost of SS,OOQ or morc per unit and aii real
property shall be inventoried annually by the Provider and an inventory report shall
be submitted to the flomeless Trust. This report shall include the elements listed in
the paragraph listed above.
Attachment A: Scope of Services/Proposal Application
Attachment B Budget
Attachment C: Miami Dade County A�davits
Attachment D State Affidavits(NIA�
Attachment E: Primary Care Invoice for Services
Attachment F: Monthly Payment Requests RepoRs
Attachment G: Monthly Performance Reports
Attachment H: Outcome Performance Measurements Monthiy Report
Attachment I: Client Contribution Report
Attachment J: Client Program Listing
Attachment K: Vacancy/Permanent Housing Placement Report(Quarterly)(iYIA)
Attachment L: Annual Performance Report 8 Annual Actual Expenditure Report
Attachment M: W-9 Form
Attachment N: Incident Report
Attachment O: Provider Asset Inventory Report
Attachment P: Client Services Certification Form
Attachment Q: Human Trafficking Affidavit
Attachment R: Contracting with Entities of Foreign Countries of Concern Prohibited
Affidavif
No other agreement,oral or otherwise,regarding the subject matter of this Contract shall be deemed to exist
or bind any of the parties hereto. If any provision of this Contract is held invatid or void,the remainder of
this Contract shall not be affected thereby if such remainder would then contir.ue to confonn to the terms
and requirements of applicable law and ordinance.
Page 27 of 28
Docusign Envelope ID 01375622-5DCB-4267-928D-EF2861D96623
rttt,crry oF Hinvt�t�encH
HMtIS STAFFING PROGRAM GRANT VL,MBER: PG2526-STAFF-2
IDF.NTIFICATION ASSISTAVCE PROGRAM CRANT NUMBER: PG2526-10.2
CN WITNFSS WHEREOF,the parties have executed this Contract,along with all of its Attachments,
effective as of'the contract date herein above set forth.
THE CITY OF MIAMI BEACH MIAMI-DADF.COUNTY
) �Signed By: :�L� � �:-t,� Signcd By
(Signaturc of Authorir Signatory� �
i �1 ✓
Printed Name: /�/i �CC/f�t s�JC�
vame: Cath Bur os, LCSW
(PriNed Name of Authorizcd Signatory) Y �
' Trtle: County Liaison
Titla L � �y /1I�n�qr s-
Date: 3/16/2026
Date: FEB � 7 2Q26
Attest:
AttesC Juan Femandez-Barqum
Authonzed Perso OR Notary Clerk of the Court and Comptroller
Public(lf No CoraorAte Senll
By:
(Depu "lerk SignaWre)
Print Name: RAFAEL E.GRANADO
Print Name:__�a Valver'de—e18183
Title: C�''1.�_ C�K.h oace: ___ 03/18/2026
�— _ __
Corporate Seal OR Notary SeaUStamp: �i ,GOMM,s��
=�� �,c'�''t .°��.�'�'�'�0���04
� � • :� f�`�� Z:
j ;:� �' ; � .—�_ rn -
;IN(OAP DAA1E�..� I V�oR�o���j�S�
� �
�j'r'•• n.: i •.. .•
b4' �..:•';��,. , .
�r�j CH..2�__` ����••'�.�
w.,.«..��•
APPROVED AS TO
FORM& LANGUAGE
&FOR EXECUTION
�����"� �z �� Z�
��City Attamey � Date
Approved as to form and legal sufficiency. See memorandum datcd 10.13.2025
Page 28 of 28
Docusign Envelope 10:01375622-SDCB-4267-928D-EF2B61D96623
ATTACHMENT A,SCOPE OF SERVICES
THE CITY OF MIAMI BEACH
HMIS STAFFING PR�GRAM
The PROVIDER shall provide a dedfcated HMIS Outreach staff person. The
purpose of this staff position is to maintaln data current tn the HMIS and inciudes,
but is not limited to input of client data upon i�take, updates of client files,
compilation of reports and ente�ing data for statistical purposes. Failure to
maintain this data current, as evidenced by HMiS generated Monthly Progress
Reports submitted to the County eacfi mo�th under the United States Housing
and Urban oevelopment sub-recipient Agreement between The City of Miaml
Beach and the Miami-Dade Caunty Homeless T�ust may result in the termination
of this Agreement.
Docusign Envelope ID:01375622-5DCB�267-928D-EF2861D96623
ATTACHMENT A,SCOPE Of SERVICES
THE CiTY C1F MIAMI BEACN
IDENTIFICATION ASSISTANCE PROGRAM
The Provider agrees to provide identification assistance senrices to 300 homeless persons in Miami-
Dade County. The following services must be prov�ded unAer this Agreeme�t:
➢ Ide�tification document replacement services for homeless persons in Miami-Dade County.
Documents to be replaced include but are not limited to:
1. Florida Identification Cards
2. Bfrth Certiflcates
3. Marriage Certificates
4. School Records
5. Court Documents(judgments,orde�s,related documents)
6. lawful Permanent Resident Cards
7. Naturalization Certificates
8. florida Drtvers licenses
Note: The cost of replacing the documents specified above may be funded via this grant ar where
applica6le fee waivers may be obtained via the appropriate source.
➢ Staff shall deliver identification services to homeless individuals.
➢ 5taff shall maintain a regular working schedule,as may be rnodified from time to tir»e as
mutually agreed upon in writing,with an intake specialist/case worker providing servites.
Staffing will be provided prima�ily i�the Miami Beach Office of Homeless P�ograms located
at 55517`"Street,Miaml Beach,Florlda.
i� Provide referral servlces for cnmmunfty-based resources including but not limlted to:legal
and medical services,food,employment,vocatianal training and clothing.
� Provide follow•up and trecking of each person assisted to determi�e outcome measures.
PERFORMANCE MEASURES
-- ---- _ __ _ _ __._ ------- -
i EXPERED OUTCOMES ! INOICATORS I
L_ _.�_
� 1. Homeless participants will be assessed � 300 participants will be p sessed` - i
2. Homeless partiapants will obtain vital j 200 or 66°�of homeless articipants will obtain
� �
personal ide�tification documents. � vital petsonal identification documents. '
, _. . _ _ _ _-- ___ ___----_ _ - --._____ -
j 3. Nomeless participants will obtain � 150 ar 50°.5 of hame{ess participants will obtain�
� official photo identification. �' offictal photo ideneificatton.
Docusign Envelope ID:01375622-SDCB-4267-9280-EF2B61D96623
Attachment B,Budget
Ciky of Miami Beach
HMIS Staffing Program
jCategory Position Requested Funding Justification
Annuai Salary 1 HMIS Administrator i $ 78,458.00 �$37.72 x 40 hrs per week x 52
This amouM rep�esents appraximateiy 16%of ihe
annuai salary{EXCLUOING fringe benefiu)per this
Totat Grant Award ' $ 12,333.Q4 co�tract Agteement.
Docusign Envelope ID:01375622-SDCB-4267-928D-EF2B61D96623
Attachment B,Budget
City of Miami Beach
identification Assistance Program
Category Position Requested Funding Justifitation
Salaries �1)Client 5ervi�es Specialist $ 15,244.00 9 Ho,�rs per week X 52 weeks X 32.53/hr
Supplles 5 300.00 General Office Supplies
Identification Document
Fees $ 9,456.00 Identification Document Replacement Fees
Total Grant Award $ 25,000.00
Docusign Envelope ID:01375622-5DCB-4267-928D-EF2861D96623
Miami-Dade County's Affidavits and Declarations
MIAMI•DWDE
J
Miami-Dade County requires each party desiring to enter into a con[ract with Miami-Dade County to;
(1)Sign an affidavit as to certain matters and(2}make a declaration as to certain o[her matters. This
form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration
forms for matters requiring only an affirmation or declaration for other matters.
Each section of this form must be read,and initialed in the top right hand box indicating acceptance
and/or compliance with the County's policy related to the particular affidavit. For affidavit sections that
you do not believe are applicable to your organization,please indicate this by placing"a"in the box next
to N/A.
ALL SECTIONS MUST BE COMPLETED
_ ----- - __ __ - ___ _ -- ----
THE FOLLOW[NG MATTERS REQUIRE THE ENTITY TO SIGN AN AFFIDAVIT UNDER OATH:
STATE OF( ��� /i C�il. )
I
COUNTY OF( �l a�� - �����'� 1
C.OUNTRY QF( � -S/� )
Before me the undgrsigned authority appeared
(Print Name), ����L ��� �'i'�n r� �" who is personally known to me or who has provided
as identification and who did swear to the following:
That he or she is the duly authorized representative of(Name of Entity)�/ C�/��kMi �f 4 c/►
(Address of Entity) /���'0 (i:r�✓1 rr�7�.-� C C rr/« ni��/��Qmr.�t'�E!�, /""L �3/�� _ Post Ofjrce
addresses are not acce table.
i
; a �>C:C�',p };� • j ;
� Federat Employment Identification Number
I /��'�C [ ic r�����f t r (hereinafter referred to as the contracting �
� "enti ') and that he o.� she is [he entity's (Sole Proprietor)(Partner)(President or Other Authorized Officer)
�li <hc,-,Z��� �f h<< �
'I'hat he or she has full authority to make this affidavit,and that the information given herein and the documents
attached hereto are true and correct;and
�
That he or she says for the following fifteen(16)Affidavits and Declarations: �
I
------ _-- --- -----.- -- — ------------- ___
ATTACHMENT C"Miami-Dade County Affidavits and Declarations" Page 1 of 11
Docusign Envelope ID:01375622-5DCB-4267-928D-EF2661D96623
Miami-Dade County's Affidavits and Declarations
1. MIAMI-UADE COUNTY OWNERSH[P DISCLOSURE AFFIDAViT(SECTION 2-8.1 Pertains O
OF THE COUNTY CODE) i N/A
Initial�
If the contract or business transaction is with a corporatian,the full legal name and business address shall be
', provided for each officer and director and each stockholder who holds directly or indirectly five percent(5%)or
' more of the corporation's stock.
; If the con[ract or business transaction is with a partnership,the foregoing information shall be provided for
each partner.
If the contract or business transaction is with a trust,the full legal name and address shall be provided for each
, trustee and each beneficiary. The foregoing requirements shall not pertain to contracts with publicly traded
' corporations or to contracts with the United States or any department or agency thereof,the State or any
political subdivision or agency thereof or any municipality of this State. All such names and address are outlined
below:Post 0 ce addresses are not acce table.
(Futl Legal Name,Address,%Ownenhip) (Fult Legal Name,Address,%�wnership)
(Full Legal Name,Address,%Ownership) {Full Legal Name,Address,°!o Ownership)
The full legal names and business address of any other individual(other than subcontractors,materiai person,
suppliers,laborers,or lenders)who have,or will have,any interest(legal,equitable beneficial or otherwise)in
� the contract or business transac[ion with Miami Dade County are:
Post office addresses are not acceptabte
Any person who willfuity fails to disclose the information required herein,or who knowingly discloses false
� information in this regard,shall be punished by a fine of up to five hundred doilars($500.00)or imprisonment
in jail for up to sixty(60)days or both.
—-------- ---- — _ - - —
ATTACHMENT C"Miami-Dade County Affidavits and Declarations" Page 2 of 11
Docusign Envelope ID'01375622-5DC6-4267-928D-EF286fD96623
Miami-Dade County's Affidavits and Declarations
_ _��_-------- ------ -
2. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT(COUNTY Pertains �I
ORDINANCE 40-133,AMENDING SECTION 2.8-1;SUBSECTION(d)(2)OF THE N/A
COUNTY CODE) � In[dal(�
Except where precluded by Federal or State laws or regulations,each contract or business transaction or
renewal thereof which involves the expenditure of then thousand dollars(�10,000)or more shall require the
entity contracting or transaction business to disclpse the following information. The foregoing disclosure
requirements do nut apply to contracts with the United States ur any department or agency thereof,the State or
any political subdivision or agency thereof or any municipality of this State.
��
�---- —- ----- ----- _----- "-- -------�-- -—
� Does your firm have a caltective bargaining agreement wlth its employees? Yes O No
� Does your firm provide paid healtt►care benefits for i[s employees? C�Yes ❑No
�� �.
Provide a current breakdown number of ersons of our tirm's work force and ownershi below :
White: Males ��3 �! Females f�
i
i Blackc� Males �s-�J �--�i Females ��n
- p --- �Males f���' I''r Females c�cf l
His anic: �
Asian: Male� �j Females �
-- '�---
American Native:_ Males � i Females d
! Aleut(Eskimo): Males v � Females �)
__ ___ ___ _ __ . . _ ------ ------_---_-- ---- ----
ATTACHMENT C"Miami-Dade County Affidavits and Declarations" Page 3 of 11
Docusign Envelope ID:01375622-5DC8-4267-928D-EF2B61D96623
Miami-Dade County's Affidavits and Declarations
3. MIAMI-DADE COUNTY AFFIRMATIVE ACTION/ pertains�l
NONDISCRIMINATION OF F.MPI.OYMENT,PROMOTION AND N/A Q
PROCUREMENT PRACTICES(COUNTY ORDINANCE 98-30 COD[FIED (nitial�
AT 2-8.1.5 OF THE COUNTY CODE)
Pursuant to Miami-Dade County's Qrdinance No.98-30,Section 2-8.1.5,enti[ies with annual gross revenue in
excess of 55,000,000 seeking to contract with che County shall,as a condi[inn of receiving a County contract,have:
1)a written affirmative action p►an which set�s forth the procedures the entity utilizes to assure that it does not
discriminate in its employment and promo[ion practices and 2)a written procurement policy which sets forth the
procedures the entity utilizes to assure that it does not discriminate against minority and women-owned
' businesses in its own procurement of goods,supplies and services.Such affirmative acdon plans and procurement
policies shall provide for periodic review[o determine their effectiveness in assuring the entity does not
discriminate in its employment,promotion and procurement practices.The foregoing,not withstandin�,corporate
entities whose board of directors are representative of the population make-up of the nation shall be presumed to
have non-discriminatory employment and procurement policies,and shall not be required tn have a written
affirma[ive action plan and pracurement policy in order to receive a County contract.The foregoing presumption
may be rebutted.The requirements of this section may be waived upan written recommendation of the County
Manager that it is in the best interest of the County ta do so and approval of the County Commission by majority
vote of the members present. Based on the above,please complete[he affidavit as directed and return the
completed affidavit along with a cover letter on your company's let[erhead,Iis[ing the company's address,phone
and fax numbers,and any required documents,to:Miami-Dade County,Department of Procurement
Management Affirmative Action Plan Unit 111 NW lst Street,13th Floor Miami,FL 33128
----------- ----- _- ----- — -- ---------�
Yes � No O I, My company has an affirmative action plan and procurement poticy and is
i� i available for review.
� My company has annual gross revenues in excess of$5,000,000.
Yes� No O Therefore,our compan}�s affirmative action plan and procurement policy
;� is available for review.
Yes O IYo C�l My company has annual gross revenues less than$5,000,000.
- -- -_ ---- -.--
-- -- _ _- --- — _
If at any time the Miami Dade County has reason to believe that any person or firm has willfully and knowingly
provided incorrect information�r made faise statements,the County may refer the matter to the State Attorney's
Office and/or other investigative agencies.The County may initiate debarment and/or pursue other remedies in
accordance with Miami-Dade County policy and/or applicable federal,state and local laws.
4. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAV[T � Pertains
� (SECTION 2-8.6 OF THE COUNTY CODE) I Ini alf O
�-- ------- ------ ' ---- t�-
--_-- --------- -_ __ __ - ---_ - — -_
The individual or entity en[ering into a contract or receiving funding from Miami-Dade County O has �1 has not,
as of[he date of this affidavit,been convicted of a felony during the past ten(10)years.
An officer,director,or executive officer of the entity entering into a contract or receiving funding from Miami-Dade
County D has�has not as of the date of this affidavit been canvicted of a felony during the pas[ten(10)years.
�
ATTACHMENT C"Miami-Dade County Af�davits and Deciarations" Page 4 of il
Docusign Envelope ID:01375622-5DC8-4267-928D-EF2B61 D96623
Miami-Dade County's Affidavits and Declarations
---�z�_�..��. __ _��x,�. ----_-
____— — _=_ -----
5. PUBL[C ENTITY CR[MES AFFIDAV[T(SECTION � N�A ins Q
287.133(3)(a),FLORIDA STATUTF.S) i initial�)
( _ __-_ __
The individual or entity entering into a contract or receiving funding from Miami-Dade County understands the
following: That a"public entity crime"as deFined in Paragraph 287.133(1)(g) Florida Statutes,means a violation
of any state or federal law by a person with respect to and directly related to the transaction of business with any
public entity or with an agency or political subdivision of any other state of the Uni[ed States of America,including
but not limited to,any bid or contrac[for goods or services to be provided to any public entity or an agency or
political su6division of any other state of the United States of America and involv;ng antitrus[,fraud,theft,bribery,
collusion,racketeering,conspiracy,or material misrepresentation.
T'hat"Convicted"or"conviction"as defined in Paragraph 287.133(1)(b)Florida Statutes means a finding of guilt
or a conviction of a public entity crime,with or without an adjudication of guilt,in any federal state trial court of
record relating to charges brought by indictment or information after July 1, 1989,as a result of a jury verdict,non-
jury trial,or entry of plea of guilty or nolo contendere. �
i
That an"affiliate"as defined in Paragraph 287.I33(1)(a)Florida Statutes means aJ a predecessor or successor of a
person convicted of a public entity crime;or b)an entity under the con[rol of any natural person who is active in
the management of the entity and who has been convicted of a public entity crime. The term"affitiate"includes
ihose ofFcers,directors,executives,partners,shareholders,employees,members,and agents who are active in the
management of an affiliate. The ownership by one person of shares constituting a controlling interest in another
person,or pooling of equipment or income among persons when not for fair market value under an arm's length
agreement,shall be a prima facie case that one person controls another person. A person who knowingly enters
into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding
36 months shall be considered an affiliate.
That a"person"as defined in Paragraph 287.133(1) (e)Florida Statutes means any natural person or enrity
organized under the laws of any state or of the United States of America with[he legal power to enter into a
binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public
entity,or which otherwise transacts or applies to transact business with a public entity. The term"person"
includes those officers,directors,executives,partners,shareholders,employees,members and agents who are
active in the management of an entity.
Based on information and belicf,[he statement as marked below,is true in relation to the en[ity submit[ing this
sworn statemeni. (Please indicate which statement applies by applying the individual initials near the box).
C Neither the entity submit[ing this sworn statement nor any of its officers,direc[ors,executives,par[ners,
shareholders,employees,members or agents who are active in the management of the entity,nor an affiliate of the
entity has been charged with and convicted of a public entity crime within the past 36 months.
O The entity submitting this sworn statement or onc or more of its ufficers,directors,executives,partners,
shareholders,employees,members or agenu who are active in the management of the entity,or an affiliate of the
entity has been charged with and convicted of a public entity crime within the past 36 months;and
O yes an additional statement is appiicable or O no an additional statement is not applicable.
O 1'he entity su6mitting this sworn statement,or onc or more of iu officers,directors,execu[ives,partners,
shareholders,employces,members,or agents who are active in the management of the entity has been charged
with and convicted of a public entity crime within[he past 36 months. tlowever,there have been subsequent
proceedings before a tlearing Officer of the State of Florida,Division of Administrative Hearings and the Final
Order entered by[he Hearing Officer determined that it was not in the public interest to place the en[ity submitting
this sworn statement on thc"Convicted Vendor List".
The individual or entity entering into a contract or receiving funding from�tiami-Dade County understands that he
or she is required to inform the public entity prior to entering into a contract in excess of the threshold amount
provided in Section 287.017 Florida Statues for Category 2 of any change in[he information contained in this form.
- --------------__-- — -- -- _
ATTACHMENT C"Miami-Dade County Affidavits and Declarations" Page S of il
Docusig�Envelope ID:01375622-5DC8-4267-928D-EF2861D96623
Miami-Dade County's Affidavits and Declarations
6.MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFiDAV[T Pertains� I
(County Ordinance No.142-91 codified as Section 11A-29 et. N/A
seq of the County Code) Initial(� �
_ ._ _ _ _ __ _. _ ------- _ __ _ _ _ . _ _ _- _�
That in compliance with Ordinance No.142-91 of the Code of Miami-Dade County,Florida,an employer wi[h fifty I
(50)or more employees working in Dade County for each working day during each of twenty(20)or more
calendar work weeks,shall provide the following information in compliance with ali items in the aforementioned I
ordinance: I
( An employee who has worked for the above firm at least one(1)year shall be entitled to ninety(90)days of family �
� leave during any[wenty-four(24)month period,for medical reasons,for the birth or adoption of a child,or for the
care of a child,spouse or other close relative who has a serious health condition without risk of termination of
employment or employer retaliation.
i
The foregoing requiremen[s shall not pertain to contracts with[he United States or any deparunent or agency �
thereof,or the State of Florida or any political subdivision or agency[hereof. [t shall,however,pertain to i
municipalities nf this State. �
------ —__ -----
; -- --
-- - —,r -----�:
7. MIAMI-DADE COUNTY D[SABILITY NONDISCRIMINATION i N/p �ns �
AFFIDAVIT(County Resolution R-385-95) Initial�;J
That the above named firm,corpora[ion or organization is in compliance with and agrees to continue to comply �
with,and assure that any su6contractor,or third party contractor under this project complies with all applicable
requirements of the laws listed below including,but not limited to,those provisions pertaining to employment,
provision of programs and services,transportation,communications,access to facilities,renovations,and new
construction in the following laws:The Americans with Disabitities Act of 1990 (ADA),Pub.L. I01-336, 104 Stat.
327,42 U.S.C.12101-12213 and 47 U.S.C.Sections 225 and 611 including Tit1e I,Employment;Title II,Public 'i
Services;Title III, Public Accommodation and Services Uperated by Private Entitics;Title IV,Telecommunications;
and Title V,Miscellaneous Provisions:The Rehabilitation Act of 1973,29 U.S.C.Section 794:The Federal Transit
Act,as amended 49 U.S.C.Section 1612:The Fair Housing Act as amended,42 U.S.C.Section 3601-3631.The
foregoing requirements shall not pertain[o contracts with the United States or any department or agency thereof,
or the State or any political subdivision or agency thereof or any municipality of chis State.
8.MIAMI-DADE COUNTY REGARDING DEI.INQUENT AND CURRENTI.Y DUE �—pertains �
._ ._-- -- --__— __� N/A ,
FEES OR TAXES(Sec.2-8.1(c)of the County Code) i�, lnitial[�
'--
- - ----— - �
Except for small purchase orders and sole source contracts,that above named tirm,corporation,organization or ;
individual desiring to transact business or en[er into a contract with[he County verifies that all delinquent and �
currently due fees or taxes--including but not limited to real and property taxes,utility taxes and occupational
licenses•-which are collected in the normal course by the Dade County Tax Co�lector as well as Dade County
, issued parking tickets for vehicles registered in the name of the firm,corporation,organization or individual have
been paid.
-- ---- -- --
ATTACHMENT C"Miami-Dade County Affidavits and Declarations" Page 6 of 11
Docusign Envelope ID:01375622-SDCB-4267-928D-EF2661 D96623
Miami-Dade County's Affidavits and Declarations
-- --,
;' Pertains�1
9. CURRENT ON ALL COUNTY CONTRACTS,LOANS AND OTHER OBLIGATIONS � N/A Q
Initial(�J
The individual entity seeking to transact business with the County is current in all its obligations to the County and
is not otherwise in default of any contract,promissory note or other loan document with the County or any of its
agencies or instrumentalities.
_ _-----
----- --_—--- --- --__ �
�-- -- -- Pertains �
10. DOMESTIC VIOLENCE LEAVE(Resolution 185-00;99-5 Codified At 11A-
60 Et Seq.of the Miami-Dade County Code). � N/A y
Inidal(�,�,,,.)
The firm desiring to da business with the County is in compliance with Domestic Leave Ordinance,Ordinance 99-
5,codified at 11A-60 et seq.of the Miami Dade County Code,which requires an employer which has in the regular
course of business fifty(50)or more employees working in Miami-Dade County for each working day during each
of twenty(20)or more calendar work weeks in the current or proceeding calendar years,to provide Domestic
Violence Leave to its employees.
�
--- -- ---------- - - _-- - -
---
11. MIAMI-DADE COUNTY EMPLOYMENT DRUG-FREE WORKPI.ACE Pertains
AFFIDAVIT(County Ordinance No.92-15 codified as Section 2- N/A
�
8.1.2 of the County Code) '� Initial(� )
�
That in compliance with Ordinance No.92-15 of the Code of Miami-Dade County,Florida,the above named person
or entity is providing a drug-free workplace.A written s[atement[o each employee shall inform the employee
about:
1. danger of drug abuse in the workplace;
2. the firm's policy of maintaining a drug-free environment at all workplaces;
3. availability of drug counseling,rehabilitation and employee assistance programs;
4. penalties that may be imposed upon employees for drug abuse violations. �
The person or entity shall also require an employee to sign a statement,as a condition of employment that the
employee will abide by the terms and notify the employer of any criminal drug convictian occurring no later than
i five(5)days after receiving natice of such conviction and impose appropriate personnel action against the
; employee up to and including termination.
! Compliance with Qrdinance No.92-15 may be waived�f the special char�acteristics of the product or service offered
by[he person or entity make it necessary for the operation of the County or for the health,safety,welfare economic
benefits and well-being of the public.Contracts involving funding which is provided in whole or in part by the
United States or the Sta[e of Florida shall be exempted from[he provisions of this ordinance in those instances
where thase provisions are in cuntlict with the requirements of those governmental entities.
� _--_,:_— ---
_- ----__—...__.-__._ ------- . ... _ _ ------ -----._ __.�
ATTACHMENT C"Mlami-Dade County Affidavits and Declarations" Page 7 of 11
Docusign Envelope ID Q1375622-5DC6-4267-928D-EF2B61 D96623
Miami-Dade County's Affidavits and Declarations
----�� — - � Pertains �
12. ATTESTATION REGARDING DUE AND PROPER ACKNOWLEDGEMENT OF �
COUNTY FUNDING SUPPORT �nit ai ���,'�
By initialing this subsection and accepting County funds,the a6ove named firm,corporation,organization or
individual agrees to abide by the gran[contract requirement to recognize and acknowledge Miami-Dade County's
grant support in a manner commensurate with all contributors and sponsors of its activities at comparable dollar
levels.
------- _ _ _ _. _ _ _----- --------
I 13.MIAM[-DADE COUNTY RESOLUTION NO.R-630-13 REQUIRING A DETAILED
PRO�ECT BUDGET,SOURCES AND USES STATEMENT,CERTIFICATIONS AS Pertains
� TO PAST DEFAULTS ON AGREEMENTS WITH NON-COUNTY FUNDING ! N/A �
- ----- -- ----� Initial �)
SOURCES,AND DUE DILIGENCE CHECK I
- ----------- �� - ---
� Pursuant to Miami-Dade County Resolution No.R-630-13,requirin�a detailed projec[budget,sources and uses
', statement,certifications as to past defaults on agreements wi[h non-counry futtding so�rces and due diligence
check prior to the County Mayor ar County Mayor's designee recommending a commitment of Miami-Dade County
funds to Social Services,Economic Development,Community Development,and Affordable Housing Agencies and
' Providers.
The undersigned entity certifies,to the best of his or her knowledge and belief,that:
1. Within the past five(S)years,neither the Agency n�r its directors,partners,principals,members or board
members:
(i) have been sued by a funding source for breach of contract or failure to perform obligations under a
contract;
(ii) have been cited by a funding source for non-compliance or default under a contract;
(iii) have been a defendant in a lawsuit based upon a contract with a funding source.
Please list any matters which prohibit the Agency from making the certifications required and explain how the
matters are being resolved(use separate sheet if necessary):
_ __ __-------- ---. .__ — —
14.MIAM[-DADE COUNTY RESOLUTION No.R-478-12 NOT TO USE PRODUCTS Pertains O
OR FOODS CONTAINING"PINK SLIME" N/A
i Initlal
Pursuant to Miami-Dade County Resolution No.R-478-12,the undersigned certifies,not to use meat products
containing"Pink Slime"in food provided or served as part any food program;urging all who provide food services
or operate a food program to immediately discontinue using meat products containing"pink slime"in food
provided or served in these programs.
ATTACHMENT C"Miami-Dade County Affidavits and Declarations' Page 8 of I 1
Docusign Envelope ID:01 3 7562 2-5DC6-4267-928D-EF2861D96623
Miami-Dade County's Affidavits and Declarations
15.MIAMI-DADE COUNTY RtiQUtRED L08BYIST REGfSTRAT[ON FOR � Pertains O
ORAL PRESENTATION Section 2-11.1(i)(2)CONFL[CT OF ItYTEREST ' N/A �d�
AND CODE OF E'I'HICS ORDINANCE [nitial�
-----_-- 
All lobbyists shall register with thc Clerk of the Board of County Commissioners within five(5)business days of
being retained as a lobbyist or before engaging in any lobbying ac[ivitics,whichevcr shall come firs[.Every person �
req�ired to so register shalt:
1.Register on forms prepared by the Clerk;
2.Statc under oath his or her name,business address and the name and business address of each person or entity
which has employed said registrant to lobby If the lobbyist represents a corporation,the corporation shall also be
identified.Wi[hout limiting the foregoing,the lobbyist shall also identify all persons holding,directty or indirectly,
a five(5)percent or more ownership interest in such corporation,partnership,or trust.Registration of all
lobbyists shall be required prior to January 15 of each year and each pecson who wi[hdraws as a lobbyist for a
i particular client shall file an appropriate notice of withdrawal.
i
3.Prior to conducting any lobbying,all principais must file a form with the Clerk of the Board of County �
Commissioners,signed by the principal or the principal's represen[a[ive,stating that the lobbyist is authorized to
� represent the principal.Failure of a principal to file the form required by the preceding sentence may 6e
� considered in the evaluation of a bid or proposal as evidence[hat a proposer or bidder is not a responsible I
contractor.Each principal shall 6le a fortn with the Clerk of the Board at the point in time at which a lobbyist is no i
longcr authorized to repmsent the principaL �
❑By initialing here,the principals or principal's representative have filed with the Clerk of the Board of 'I
County Commissioners stating that a lobbyist is authorized to represent the principal.
4.Any public officer,employee or appointee who only appears in his or her official capacity shall not be required to '
register as a lobbyist.
5.Any person who only appears in his or her individual capacity for the purpose of self-representation without
compensation or reimbursement,whether direct,indirect or contingent,[o express support of or opposition to any
item,shall not be required to register as a lobbyist. �
6.Any person who only appears as a representative of a not-for-profit corporation or entity(such as a charitable
� organization,or a trade association or trade union),without special compensation or reimbursemcnt for the
, appearance,whether dircct,indirect or contingent,to express support of or opposition to any item,shall register
with the Clerk as required by the Ordinance subsection,but,upon request,shalt not be required to pay any
registration fees.
The Cterk of the Board of County Commissioners shall nohfy the Commission on F.thics and Public Trust of the
failwe of a lobbyist or principal to filc a report an�l/or pay thc assessed fincs after notification. A lobbyist or ;
principal may appeal a fine and may request a hearing before the Commission on Ethics and Public Trust.A reyues[
for a hearing on the fine must be filed with the Commission on Ethics and Public Trust within fifteen(15)calendar I
� days of receipt of the notification of[he failure to file the reyuired disclosure form.The Commission on Ethics and
' Public Trust shall have the authority to waive the fine,in whole or par[,based on good cause shown.The
Commission on Ethics and Public Trust shall have the authority to adopt rules of procedure regarding appeals from
the Clerk of the Board of County Commissioncrs
Except as otherwise provided in subsection of the Ordinance,the validity of any action or determination of the
Board of County Commissioners or County personnel,board or committee shall not be affected by the failure of any
person to comply with the provisions of this subsection(s). (Ord.No.00-19,§1,2-8-00;Ord.No.01-93,§1,5-22-
O1;Ord.No.01-162,§ 1,10-23-01;Ord.No.03-1Q7,§ 1,5-6-03)
���
ATTACIiMEIYT C"Miami-Dade Caunty Affidavits and Declarations" Page 9 of 11
Docusign Envelope ID 01375622-50C6-4267-928D-EF2B61D96623
Miami-Qade County's Affidavits and Declarations
Pertains
16. Disclosure SUBCONTRACTOR/SUPPLIER LISTING(ORDINANCE 97-104) N/A �
Initial )
This form,or a comparable Form meeting the requirements of Ordinance 97-104,must be completed by all bidders and
proposers on Miami-Dade County contracts for purchase of supplies, materials or services, including professional
services which involve expenditures of $I00,000.00 or more, and all bidders and proposers on County or Public I
Heaith Trust construction contracts which involve expenditures of$100,000.00 or more. This form or a comparable
form meeting the requirements of Ordinance 97-104, must be completed and submitted even though the
bidder or proposer will not utilize subcontractors or suppliers on the contract. The bidder or proposer ,
shoutd enter the word "NONE" under the appropriate heading, in those instances where no subcontractors or '�
suppliers will be used on the contract. A bidder or proposer who is awarded the contract shall not change or I
substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or I
materials to 6e supplied from those identified except upon written approval of the County.
-- - ------_ _-- —
Business Name and Address T Principal Owner r Scope of Work to be Performed by ' (Principal Owne�
of First Tier �I Subcontractor/Subconsultant Gender Race '
Subcontractor Subconsultant i
----
P ------- � _--- -------
�� i
'� Business Name and Address Princt al Owner ' Supplies/Materials/Services to be , (Principal Owner)
of Direct Supplier i Provided by Supplier Gender Race
? �
^ ,1 .. � ---
�v,
I certify that the representations contained in this Subcontractor/Supplier Listing are to the best of my knowledge
[rue ar�d accur.ate. �
( �' ,cC, % ���L �"'� 1 f 2/13/26 �
Signature of uthorized Representative Date
-� �
� f'"/''iC (k�i�(n /r�" ) ( L � 1 /r�a nct �'ti )
Print Name Pr nt Title '
(Duplicate if addiUona)space is needed)
- ---___--- _ ---_ __ __ --- -- _ — ---__— - ---- ---_ -- ---- ---
ATTACNMENT C Miami-Dade County Affidavits and Dectarations" Page 10 of 11
Docusign Envelope ID:01375622-5DC6-4267-9280-EF2B61D96623
Miami-Dade County's Affidavits and Declarations
MIAMI•QADE
�;ari#
[ have carefully read this entire 11-page document entitled,"Miami-Dade County's Affidavits and Declara[ions"and
agree to; (1)sign an affidavit as to certain matters and(2}make a declaration as to certain other matters. This
form contains both Affidavit forms for matters requiring the entity to sign under oath and Declaration forms for
matters requiring only an affirmation or declaration for other matters.
BY S[GNING AND NOTAR[7,ING TH[S PAGF,YO[;ARE ATTF,STING TO AFFIDAVITS AND
DISCI.OSL"RF.S 1-16
MIAMI-DADE COUNTY AFFIDAVITS SIGNATURE PAGE
ay: _ _�_c_6 r<«'�. i 5__,20_ �G
Signature ofl itness or Secretary Seal Date �
� ,
` ti� ' S�-���n���z
� �' '' `'�1,L ��
Signature of Affi nt Federal Fmployer[dentification Number
�Yi G ��G(rf^�n!r i'� �^! � C f �'//Q ry1/ ,!1 C'Ctc h _
Printed hame of Affiant and Name of Agency
_l,�� U C^�n/CnI�Cn �C'/�T`"r, (�� 1�'t.f-��!!/rlf, �t'kC/� �L _i.�/.�
Address of Agency �
SUBSCRIBEU ANll SWORN `CO(or affirmed)before me this �3 day of ���_,20�
HeiShc is personally known to me or has presented p�rSorn oWn as identification.
Type of identi i�
-- �H�ltZ4�
Signatur Notary Senal i�umber
S�f,Th�+r��- �lcS _-�=._'Q-�D21 ---
Pnnt or Stamp l�ame of otary Expiration Date
Notary Public-State of FL
County o f �vl i a rr,i_l�Gd� ,,�;�':'�qlg��/µKp�,E REY 6ROOK5
`: Natary PubHc-Stat oi Fbrida
Commission)H 347040
��,.. �� an S,2027
��BonAed throu4h National Notary Assn.
-- _ _ -_. —._--_._ __ _ ----- - ._._. __- ---- _--— - -----___ _ _ _ .__ .
ATTACHMENT C"Miam�-Dade County Affidavits and Declarations" Page 11 of 11
Docusign Envelope ID 01375622-5DC6-4267-928D-EF2B61D96623
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.�.� ,�
'1 `» ATTACHMENT D,STATE AFFIDAVITS �':�'�
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Docusign Envelope ID:01375622-SDCB-4267-928D-EF2861 D96623
ATTACHMENT F
Miami-Dade County Flomeless Trust
Monthly Payment[tequest
NAME OF AGENCY: THE CITY OF MIAMI BEACH
SERVICE PERIOD: TO
NAME OF GRANT: THE CITY OF MIAMI BEACH-
ID ASSISTANCE
PROGRAM
GRANT NUMBER: PC-2526-ID-2
TOTAL AWARD AMOUNT: $25,000.00
AMOUNT OF FUNDS REQUESTED
TH1S MONTH: $
AMOUNT OF FUNDS RECEtVED TO DATE: $
BALANCE REMAINIG ON GRANT: $
(following payment of this request)
Signature of Executive Director or Date
Authorized Agency Representative
Printed Name of Executive Director or
Authorized Agency Representative
Docusign Envelope ID:01375622-5DC6-4267-928D-EF2661D96623
ATTACHMENT E
Miami-Dade County Nomeless Trust
Monthly Payment Request
NAME OF AGENCY: THE CITY OF MIAMt BEACH
SERVICE PERIOD: TO__
NAME OF GRANT: THE C1TY OF MIAMI BEACH-
HMIS STAFFING
PROGRAM
GRANT NUMBER: PG2526-STAFF-2
TOTAL AWARD AMOUNT: 512,333.00
AMOUNT OF FUNDS REQUESTED
THIS MONTH: S
AMOUNT OF FUNDS RECEIVED TO DATE: S
BALANCE REMAINIG ON GRANT: 3
(foliowing payment of this request)
Signature of ExecutIve Director or Date
Authorized Agency Representative
Printed Name of Executive Director or
Authorized Agency Representative
Docusign Envelope ID 01375622-5DC8-4267-928D-EF2B61D96623
ATTACHMENT G
CONTINUUM �F CARE (CoC) HOMELESS ASSISTANCE
PROGRAM
o HUD MONTHLY CoC MUNTHLY PERFORMANCE
REPORT (MPR� - HMIS GENERATED MONTHLY
REPORTS
o HUD ANNUAL CoC ANNUAL PERFORMANCE
REPORT (APR) - HMIS GENERATED ANNUAL
REPORTS
Reports must be generated from the ServicePoint HMIS
reporting system or HMIS system approved by the
Miami-Dade County Homeless Trust.
ATTACHMENT G,PERFORMANCE REPORTS(MONTHLY AND ANNUAL)APR AND HMIS
Docusign Envelope ID:01375622-5DC8-4267-928D-EF2661 D96623
ATTACHMENT H,OUTCOMES
THE CITY OF MIAMI BEACH
IDENTIFICATION ASSISTANCE PROGRAM
PERfORMANCE MEASURES
Ef(PECTED OUTCOMES INDICATORS
i. Homeless participants wlll be assessed 300 participants will be asseued
2. Homeless participants will obtaln 200 or 66°�of homeless participanu will obtain
vital perso�al identificatlon documents. vital personal identification documents.
3. Hometess participants will obtain 150 or SO°.6 of homeless participants wlll obtain
official photo fdentification.
official photo identification.
_ _ -----__--- -- I
--_�-� ___
i
�I
_ - ----- — --*- _ ---- ----- — --- - —
__ ,_ _ __ ____ . _ _--___._ _... .___ 1
Docusign Envelope ID:01375622-5DC8-4267-928D-EF2861D96623
REPORT[NG AGENCY AND PROGRAM NAME;
GRANT NUMBER: TOTAL MONTHLY Nk0(;RAM INCOME $ 905.00 `
Mt�t�iE
SERVICF. MON'i'H:F auuai v-Zz ':`::� T07'ALG'fU YHtJGHAM 1NCUME $ 3,615.00
' ACTUALAMOCNT
' Bld/unlc � TotaJ Aonual i "Cocat Mouthly 3f�ad�usted or DIRfiCf i o�o ContrlbuUon �ran:-to-Date
addren NMIS a Tenant Name qd usted Income Ad�usted Income 10%
( I I Br� CL(HNT � LANDLORD/ (GTDj Contrlbutlon
PROV AER '
lA in 3 months iast name,flrst 3 4,200.00 S 350.00 S 105.00 $ 245.OU 4 1O5.0U � 30°.6 3 315.00
2 18 new in ro ram last name,first S 12,000.00 S 1,000.00 3 3UOA0 S 700AU S 300.00 30% S 3U0.00
3 2A in 6 manths last name,@rst $ 21,600.Q0 3 2,800.00 f 54Q.00 Y 2,300.Q0 $ 500.00 2B96 S 3,000.00
4 28 iast name,fint f - S - S - S • S - s1DN OI ; -
5 3A last name,Flnt j • $ - s - s - S • �DIV/0! S -
6 3B las[name,flrst S - $ - 4 - S - S - dDiV 01 S -
7 4A last name,flrst $ - $ - S - S - S • �DIV/0! S -
8 4B last name,flrst 4 - S - S - S itDIV 0! S -
9 �A iast name,first 4 - $ - S tID1V Ol 4 -
10 SH last name,flrst - 4 - S - ! hDIV/0! S -
11 last name,first - - S • S - aDIV 0! S -
12 last name,flrst j - $ - S S - 5 • aDtV/OI ; -
13 last name,flrst; S - S - S - f - 5 - tIDIV/0! S -
14 tast name,first $ - g - 5 - S - 5 - aD1V OI 3 -
15 last name,first g - S - S - S - S ttUIV/0! $ -
16 last name,first S • S - S • 4 • S - NDIV/0! 5 -
1' last name,flrst � - S - S - $ - S - iiQIV/01 5 -
18 last name,flrst ; - S - S • 4 - S - 3�DlV 01 4 -
19 last name,flrst S - 4 - S - S - S - #DIV 0! S -
2U last name,first 4 - S - S - 4 - S - ND1V/0! 5 -
21 last name,fint s - S - S - S - S - aDIVJ01 ;
22 last name,Rrst f - 4 - S - S - S - t+DIV/01 S -
COMPLETE ONLY IF APPLICABLE-Occupancy charges and rent collected from program particpaats are program income and may be used as provided under 24 CFR 578.97 a LEASE
or OCCUPANCY AGREEMENT MUST BE IN PLACE
Docusign Envelope ID'01375622-5DC6-4267-928D-EF2661D96623
MIAMI-DADE COUNTY HOMELESS TRUST
Cl1ENT RQSTER
Grant ft: PC-2526-ID-1
CLIENT NAME' HMIS tl: ENTRY DATE: EXIT DATE:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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El(ECUTIVE DIRECTOR SIGNATURE
DATE
Docusign Envelope ID:01375622-SDC&4267-928D-EF2661D96623
ATTACHMENT K
THIS ATTACHMENT IS N�T APPLICABLE TO THIS
CO NTRACT AG R E E M E NT
Docusign Envelope ID 01375622-SDCB-4267-928D-EF2661096623
ATTACHMENT L
M1AM1 DADE COUNTY
ANNUAL ACTUAL EXPENDITURE REPORT
TFIE C[TY OF MIAMI BEACH-IDENTIFICATIQN ASSISTANCE PROGRAM
GRANT NUMBER#:PC-2526-STAFF-2
OCTOBER 1,2025-SEPTEMBER 30,2026
Name of Agency: THE CITY OF MIAMI BEACf1 -
HMIS STAFFING
PROGRAM
Budget S 12,333.00
Month of Services Amount Paid
Oct-25
Nov-2 S
Dec-25
Jan-26
Feb-26
Mar-26
A r-26
Ma -26
Jun-26
jul-26
Au -26
Se -26
Total Requested $ 0.00
Balance Remaining $12,333.00
Signature of Execu[ive Director or Date
Au[horized Agency Representative
Printed Name of Executive Director or
Autharized Agency Representative
Docusign Envelope ID:01 37 562 2-SDCB-4267-928D-EF2B61D96623
ATTACHMENT L
MIAMI DADE COUNTY
ANNUAL ACTUAL EXPENDiTURE REPORT
THE CITY OF MIAM1 BEACH-IDENTIFICATION PROGRAM
GRANT NUMBER#:PC-2526-ID-2
OCTOBER 1,2025-SEPTEMBER 30,2026
Name of Agency: THE CITY OF MIAMI BEACH-
ID-PROGRAM
Budget 5 26,000.00
Month of Services Amount Paid
Oct-2 S
Nov-2 5
Dec-2 S
Jan-26
Feb-26
Mar-26
Aprv26
May-26
Jun-26
Jul-26
Au -26
Sep-26
Total Requested S 0.00
Balance Remaining S26,UOU.00
Signature of Executive Direcior or Date
Authorized Agency Representative
Printed Name of Executive Director or
Authorized Agency Representative
Docusign Envelope ID:01375622-5DCB-4267-928D-EF2661D96623
.�,.�,
w_9 Request for Taxpayer Give Form to the
f1ev.Octcber2018) Identification Number and Certification requester.Do not
UeµaAr�dd of the Treasury send to the IRS.
�nternd Reven�,e SeMce ►Oo to www.lrs.gov/FormW9 for instructions and the latest Informatlon.
1 Nmne(As shnwn nn y�wr inr,ome tAfc retum).Nmie is rPqii�r�A on this lina;do not lenve ih13 Nne Alank.
-- . ________ _._.... .._.__ __.___._ __.---___.____�__
2 Buslness nameidlsiegertled entfty neme,i!difte�ent irom above
`� 3 Check appropr�ate box�or�aderal t�classlllcalio^of Ihe pereon whose reme Is entereA on�r,e 1.Chnr.k ony ene n1 me 4 ExempUons(codes apply oNy ro
� to4owing seven Ooxas. certnin ernit�es.not�ndivldu9ls;see
a �nstructlms on pags 3):
� ❑ IndividuaUsole proprietw or ❑ �TArPaatlan ❑S�orpaatbn ❑ Partnership ❑irust/esta�e
� � single-membev LLC Exemq payeo code(i!any)
ao
�'— � Limitetl I�bqity r,ompytry.Ente•tlie tex clnssificaian(G=G r.er;�o�qtion.S=S corporatlon,P=Partner.:Np)►
� � Nots:Check the appropriate box in the iine above iw the tax clasailicatiq�of the aingie-member vaner. Do not check Fxemptlnn trom FATCA rrqrvtlrx�
� rn �LC If Mu LLC is classilfed as a single-member LLC t�.at Is d+sreparded irom the owner un:ass the owne�ot the LLC�s � N
�U anather��C thet is nut diaregarAed 6om[he o�Hner ror U.S.fe.dnro�tax purposes.OthenMse,a single�memher L��_C that code d an _
� �c Aisregardexf from the owner should eheck the appropnaie box}or tM tax Gass111catlon ol rts owner.
� [f Other(see InswcUons)► _ ____._..�_. r�car.�w x�«,M.m,��r�aa.mw rr.u.s�
5 Address(number,strnat.and ept.or sulte no.)See Inst,uctlons. Requeater's name antl address(optianeq
m
a
�
8 Gry,state,and ZIP cocle
�,7 Li;t ec�nuM nurnbnr(s)here�opllnntfll �—�---
Taxpayer ldentification Number(TIN}
� --- _----- -- - - _ _
Enter your 11N in!he appropriate box.The TiN provlded must match the name gfver,oo iine 1 to avold Sooisi security number
backup withholding.For individuais,thls is generally your soaal securlty number(SSf�.However,fa a � _� _�
resident alien,sde prapric�tor,or disregarded entity,see the Instructions for Part I,later.Fcx other
enti6es,it is your employar iden;ification number(EIN).If you do not have a number,see How to get a
Tllv,later. or
Note:I}�he account is in more than one name,ses the instructlons for line 1.Also see Wbat Name and Employer identlncation number�
Num6er To�,ive the Requester for guitlelinc s on whose number to enter.
I I 1 _� �
�-- Certification
Under penalties ot perjury,I ce�tify:hat
t The number shown on this iorm is my conect taxpayer identiflcatlon number(or I am waiting fa a number to be issued to me);and
2.i am not subject to trackup withholding because;(a)I am exempt from backup.vi±hholding,or jb)I have not been nati6eci by the Intemal Revenue
Service(IRS)tfiat I am subject to backup withholding as a result of a failure to report all i�terest or dividends,or(cj the IRS has notified me that i am
no longer subject to backup withholding;and
3.I am a U.S.citizan or other U.S.person(detined belowJ;and
4.7he FATGA code(s)entereci on this form Qf any)indicating that I am exempt from FATGA reporting is correet.
CeAfflcation Inslruetions.Ya�must caoss out itflm 2 above if you have nr�en no6fied by the IRS:hat yeu are currently subjecl to backup withholding 6ecause
you have failed to�epurt aA interest and divldends on ynur tax retum,For real estate tr;insactions,ilam 2 does not apply.For mortgaga:nterest paid,
acquisition a abandonment of socurod property,cancellation of debt,contributions to an!ndlvldual retlrement anangement(IRA),and generally,payments
other than}nterest end df�idends,you are not required:o sfgn th�cerlification,but you must provide your correct fIN.See the Instructions fo�Part Ii,later.
--_ _. __..--- ---__.._. .------
--- __ _- -- -
Si9� Signature o(
Here U.S pe�son► _ _ Oate► _—T
General Instructions •Form 1099-DIV(dividends,includirg ihose from stocks a mutual
tunds)
Sectlon�eferences are to the Internal�.evanue Code unless olherNise •Form 1099-^NSC(var ous types of Income,prizUs,awards,or gross
noted. proceeds)
Future devebpments.For the latest information about developmertts .Form tt�9-B(stock or mutual fund sales and certain other
reiatc+d to Fam W-9 and its instructions,such as leglslation enacted trensactions by brokers)
after they were pablished,go to www.rrs.,qovi'FormvV9. ,F��099-5(proceeds from!eal estate transactionsj
Purpose of Farm •Form 1099-K(merchant card and third party network transactions)
M tndividual or entity(Form W-9 requester)who Is required to nle an •Form 1098(home mortgage interest),?090-E;student loa��nterest),
information retum with the IRS must obtain your correct taxpaye.r 1�98-T(tuition)
idendficaGon number(fIN)which may be your sociai security number .Fqm 1099-C(aanceled debt)
(SSN),indivldual taxpayer identi/icatton number(ITIN),adoption .F�rm 1099-A(acqulsition w abandonment of secured propertyl
taxpayea iden4ficatlon number(A7IN�,or employer identitication numbnr
(EIN;,to report on an Infamatlon retum the amount paid to you,or other Use Fortn W-9 only if yov are a U.S.parson(including a resident
amount reportable on an Infamation retum.Examples af information alien),to provide your correct TIN.
retums include,but are nnt iimited to,the}ollowing. 1f you dc not retum Form W 9 to the requester wiih a r1M,you mignt
•Fo�m 1099-INT(interest eamed�r pald) be subject to backup w8lfholding.See What�s backup wdhholdmg,
later.
cut vo w::3�x Fo�m W-9(t�ev.�o-ao�e�
Docusign Envelope ID 01375622-5DG8-4267-928D-EF2B61D96623
MIAMI L1ADE
Memorandum �a
Date: September 27, 2019
To: Miami-Qade County Homeless Trust Board Members
From: Victoria Mallette, Executive Director
Homeless Trust Homeless Trust
Subject: Revised Incident Reporting Form
On September 9, 2015, the Homeless Trust Board passed a policy to define the process for
receiving and processing incident reports. The policy outlined the types of critical incidents
which must be reported to the Continuum of Care's Incident Report Coordinator, Miguel
Pimentel. For each critical incident, a report must be submitted to the Miami-Dade County
Homeless Trust within one business day. When a critical incident occurs, subcontracted
provider staff should 1) take action to ensure the health, safety and welfare of all individuals
involved in the incide�t, and 2)contact law enforcement, emergency responders of the Abuse
Hotline.
The incident reporting form has been significantly updated to include both wrong-doing, as well
as allegations of wrongdoing. Reporting is required for both client related and staff related
incidents.
Of particular note, sexual battery has been included in the listing as State law has outlined
"Failure to report any known or suspected abuse of any kind of a child is a third-degree felony
that may result in a prison sentence of 5 years, and a fine of $5,000 (Refer to Chapter 39 &
415 of the Florida Statutes). "
The revised Incident Reporting Form is attached. This is an information only item.
Attachm ent
c� Maurice L. Kemp, Deputy Mayor
Shannon Summerset, Esq ,Assistance County Attorney
Page1 of1
Docusign Envelope ID:01375622-5DC6-4267-928D-EF2B61 D96623
MIAMKaADE
�
ATTACHMF.I�T C
[NCIDENT REPORT
CHECK IF CRITICAL ❑
IDENTIFYING [NFORMATION
RepoRing Party Phone rl{ 1 - Date of Incident . ! ! Time of Incident _am/pm
RepoRing Party Name
Contract Provider Vame
Program Namc
Provider Location
Specific Category:(check ail that apply)
❑ Allegation or wrongdoing ❑ Wrongdoing (as acknowledged by a
third party designated to investigate these claims i.e. law enforcement
detained individual, ar DCF accepted abuse report)
Specific locatian/address where incident occurred:
TYPE OF INCiDENT
CLIENT RELATED
❑ ALTF.RCATIC)N ❑ CLIENT DF.ATH
� CLIENT INJURY OR ILLIVH'SS ❑ THEFT
❑ SEXUAL BA TTERY ❑ SUICIDE A T7'E�1PT
❑ PROPERTY DAMAGE ❑ ABUSE OR NEGL�C7'*
❑ 4THFR INCIDENT
Specify _
1 of 4
Docusign Envelope ID:01375622-5DC6-4267-928D-EF2661D96623
MIAM FQADE
�
- ATTACHMENT C
* Failure to report any known or suspected abuse oF any kind of a child is a third-degree
felony that may result in a prison sen[ence of 5 years,and a fine of$5,000 (ReFer to Chapter 39
&415 of the Florida Statutes).
STAFF RELATED
❑ INAPPRpPR1�1TE EMPLOYEE ACTS OR �MISSIONS 7'HAT
RF,SU1.7'IN CI,IENT INJURY, ABUSE, NEGLECT, OR DEA7H
❑ FRA UD ❑ TH�FT
❑ BREACHES 4F CONFIDENTIALIT�
�IMPROPER EXPF.NDITURE OR COMMITMENT OF PUBLIC
FUNDS-OR-CONTRACT MISMANAGEME.NT
OCO�t�IPUTER REI.ATED MISCONDUCT
OANY I�IOLATION UNDER�435, F.S., TITLE XXXI, EMPL4YEE
SCR�ENING, THA7' WOULI�RESULT IN DISQUALIFICA7l�N
FROM e1,lENT CONIACT DUTlES
❑ FALSIF7CATION OF OFFICIAL RECORDS
❑ �'1�11SUSE OF'POSITION OR STAT'E PROPERTY, EMPLOYEES,
EQUIPMENT, OR SUPPLIES FOR PERSONAL GAIN OR PROFIT
❑ FAILURE T� RF.PORT KN4WN OR SUSPECTED NEGI,ECT OR
ABUSE OF�I CLIENT
❑ O'1'HEK INCII�EN7'THAT Yf'OUI,D BL'A VIOI,A IION OF
STA'lUTE, RULE, REGULATIQN QR POLICY
Specify __
2 of 4
Docusign Envelope ID:01375622-5DC8-4267-928D-EF2661D96623
MIAM I•0�►DE
�
ATTACHv1ENT C
PARTICIPANT(S)/W[TNESS(ES)
(Please mazk W or P for either Witness or Participant)
Staff ID ik or Client HNUS# CLIENT EMPI.�Y'EE OTNER W i P
� O ❑ OWor ❑ P
❑ ❑ ❑ ❑ Wor � P
O 0 � ❑ Wor ❑ P
DESCRIPTIO�!OF INCIDENT
Give detailcd account-who,what,where,when,why,how-add pages if necessary
CORREC'I'IVE ACT[OlY AND FOLLOW GP
lmmediate corrective action taken
ls follow up action needed? ❑Yes ❑ No
Ifyes,specify
IND[V[DUALS NOTIFIED
Abuse Registry 1-80�-962-2873 Applicable Law Enforcement Department
Indicate name of person contacted,if report was accepted,the date and time if called or copy of report
Incident Reports—The Subrecipient must report to Miami-Dade Counry Homeless Trust information related to�
critical incidents occurcing during the administration term of its programs. (n addition to reporting[his incident to
the appropriate authorities the Subrecipient must within twenty-t'our(24)hours of any incident,submit in wnting a
detailed account of the incident. (his incidenl rcport should be addressed to the Contract Officer or Administrative
Officer ass�gned. This incident report should be addressed to �tiami-Dade County Homeless Irust, 1 l I 'JW First
Street,27°�Floor,Suite 310,Miami,Florida 33128;telephonc(305)375-1490 and facsmilie(305)375-2722.
3 of 4
Docusign Envelope ID:01375622-5DC6-4267-928D-EF2B61D96623
MIAM I�D�ADE
�►'►T��
. �
` ' ' AT`I'ACHMENT C
Definitioos of Reportable Client tocidents
a. Altercation. A physical confrontation occurring between a client and employee or
two or more clients at the time services are being rendered, or when a client is in the
physical custody of the department, which results in one or more clients or employees
receiving medical treatment by a licensr;d health care professional.
b. Client Death. A person whose life terminates due co or allegedly due to an accident,
act of abuse,neglect or other incident occurring while in the presence of�an employee,
in Homeless Trust contracted program fucility.
c. Client [njury or Illness. A medical condition of a client requiring medical treatment
by a licensed health care professional sustained or allegedly sustained due to an
accident,act of abuse, neglect or other incident occurring while in the presence of an
employee, in a Homeless Trust contracted program.
d. Other Incident. An unusual occurrence or eircumstance initiated by something other
than natural causes or out of the ordinary such as a tornado, kidnapping, riot, or
hostage situation, which jeopardizes the health, safety and welfare of clients.
e. Sexual Batterv. Any allegation of a program participant or program staff
intentionally touching a minor or another person without their consent. This includes
incidents of inappropnate verbal offenses, incidents that occur outside of the
residence, and incidents were the program participant was victimized by someone
outside of the residence. Incidents involving a minor, person who is 60 or older, or
someone who is disabled must be reported to the DCF.
f. Abuse or Neglect. Any physical maltreatment of a child,disabled person,or someone
age 60 or older. Any failure to act on the part of the parent or care taker,which results
in harm to a child, disabled person,or someone age 60 or alder.
g. Suicide Attempt. An act which clearly reflects the physical attempt by a client to
cause his or her own death while in the physical custody of the department or a
departmental contracted or certified provider, which results in bodily iniury requiruig
medical treahnent by a licensed health care professional.
h. Propertv Dama�e. An incident involving damage to property pcocured with Homeless
Trust funding.
4 of4
Docusign Envelope ID.01375622-5DCB-4267-928D-EF2861D96623
A�ACfYR�T�F
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rc�a,��na�
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maveoiie�acJ�rin�xq aerd�
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Docusign Envelope ID:01375622-SDCB-4267-928D-EF2661D96623
. • , . ATTAC3tMEM' P
• r • '
' MLA.MT D�DE CQII�'TY HOMEI.PSS't'RBST :
t' � CLIEI.TSERVICFS CERT'IF7CATt0!V REF'ERRAL ROFM POR EMPLOYEES Q�-P
� � AOIVgt.ESSTRL'S7"FpNUED➢ROCW.h�S . �
`IhS7'R�t CI'fDNS: ProriJa wikia�re�'raI mast cnmgk�t f1&ttr6-ps�e form.inijndis�sl�u�uriss
• � by App6tant asd ProrfderRe�fresebatleEs. Pa:compieted fo�s to Prgvldar Reetiving Refernl for � .
Aous'hig aodDr Servkes. -
Daoe: � Ref�i�qProvider. .
' C1�utxa Pasan: ' • .
� Ndoe Tide� . . P1+oa�Nunibet • .
INFORMATIQN ON HHAD OF HOU$EHOLD: .
IastNad�e: • Piisc�Jame__
� Deu of�irth: - . S3 i�` _
BAQA'f�0 DNOTHBRF! SEHOLDMSM�El�S:. . .
. Nfine e Sac lo
� � . . . " '
. , . . . .
1S ANI�'M�MBBR OF'LSS FLOUSB�ki�LA BII�IAYEJ3BY,QR�2$,IAT'$D TO BIV"EMY�,OYI� ,'
� . � flF,A$OM$GS4STRUSf FT3t�S13 P$OGRAJ!'L? Yns; No��_ . - '
lfy� . . : ' ,
. iVemic ofF.�nptoycs:. , -
_ � � � ,
Fmpfoying Provider, • . . .
� RnlatioasNjD�':APPf'rant_ •__�____ . � '
.. C8R'JiFlEATI�N � • '
1,iho.andersibmed.do hErebp eertify 4rat dis abovaiofern+�iort pa%tiiledhy.ma.i�e+na artd muect io the
� tust ofmy knawfedgc: • �
' . . ApplicanfsName' , .
. Si�nahxc Dzcei _ .. �
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� �, Narneci Signaivrt -- �. �
Docusign Envelope I�:01375622-5DC6-4267-928Q-EF2661D96623
. . � • A7'fACHIK£13T P
, .
� � ` . � . .
� PRQ1'ibER R�F''£RRAL F7�Rivt PACE TWO
�` .4ppiiam'slvame
. . . 4 •
lf the AppSinnt ur a DumtieT b�thetr hmist�otd is an emptoy�ec et the tefvrlc�priiNtdcr,the � .
' :RPrm•r!oJ'tl�c P�orid�r EXx�ve BirzctOf is Aereb}�indiCited 6r signatnre: . .
. ?�ttat/fide . Dete . .
if tbe AppQuoY or.i�mbcr ol38eir po�ssrhold t�'iu ampieyat oLthe�xp�ater whet,e sEi�vlccs�vitt be
procldeaq U�a tRProYaJ of 7tie Yrotider Hfaartk4.birecMr,tleHoarNatt'Crnst�iseeattve Direelor, '
- , AAd�6�G01C�dSTRtSEBO�(11iA(1RbGP6�]�161�'i.l1LADyi�ffIIX6: . ' , .
. � P('OV{�J'$OCIRIYCD1Tf`4SDf � . . —_.._.� � � •
' drfla�isi-ikdeCqurkyHomeles'1}u.atClqhperson . . Date . . -
, � � � 7�fi�mi-I?�da Conotyliomdeaa Tlvei Diaaxar ' D�tr . -
'. AT>DI'IIOSQa1.HOUS$FCOlD INFORkLh'!'IQN: •
W6ene La the hoilcehDld 8�$ignow?(FaoilitJ aan0.caact�ddrqs)�; - • .
� � I?ato oC�nt homelcssoax .
B�ilion tbe�omdeaa ai�a�oa,and wh�teaised'd��t .
homelsstuaYs .. ' . -
� , .
- � r�
, NOT67Yl RI•'rF&7tRlNG,PR'QYLbFR: • . ' -
PRUVIDBi�Y't�R AHQYS IlVRQRNdATlQN AUYS NQT�L�iTfEB APFRUYAL FOR HOEf6lN6 '
. OR_QT�SB S$RVIC:;BS RRQU£s5�B3�.•A D8�'BRMZN.S'!'�J4 q(IIZ.B$MADS FOLLOWIJVC A � .
WMPL�I'$AS6&SSktE1VT 4F'FfiB AYY�LTC�iAlT'S CASL �
.� '. T'FI'!SS'EC770N FOR SEXYICE PxOVIDpF STRFF USE 0�: � ,
' AtartF Elfithtliry Crf/ar1a:',_�.�ES ,_ NO ' '
A�aa,e ajNrovideFSaeeQia�C.i�d,�}'i- ,
� I'tEASE MAR�TA[t�'PH�EXEGIITEII COPYaF TH(S DQCUMF.hT fN TK@•CLtENT�{LEAF. �
� THE S`ERYICiNG PROVID'CEt hND TSRSO4t14E4a�LE 4F RfiFER1tSt�tC:PRE)\nRER
' � . .. . .' ' . :
Docusign Envelope ID:01375622-SDCB-4267-928D-EF2B61D96623
ATTACHMENT 2
MIAMI GADE
'�!^'�-
CONTRACTING WITH ENTITIES OF FOREIGN COUNTRIES OF CONCERN PROHIBITED
AFFIDAVIT
The Contracting with EnGties of Foreign CAuntnes �f Ccncem Prohibited Affidavit Form ',"Fam')is required by Sect�on
2�?.1�FIon_c� �f�tes,_.j_"F_$ '!.which is deemed as being expressly incorporated into this Form.The Affidavit must be
canpleted by a person authonzed to make fhis attestation on behalf of the Provider for?he purpose of submitting a bid,
pr�posal, quote, or other response, or otherwise entering into a contract with the County. The associated bid,
proposal, quoie, or o�her response will not be accepted �niess and un61 this completed and executed Affdavit is
submitted to the Counry.
_ dces no�meet any of the cr!teria set forth in Paragraphs 2(a)-(c)
fiiOAe,s�prnDose�;le9��maUrr.'rr,.
of Section 287.138, F S
Pursuant to Secfion 92.525, F S, unde� penalties of perjury, I declare lhat i have read the foregoing statement and
that the facts stated in it are tNe.
Print Name o(Providers Authaized Representa6ve
Titie of Provider's Authorized Representative:
Signature of Providers Authonzed Representative
Date:
Fst12282023
Docusign Envelope ID 01375622-5DC6-4267-928D-EF2661 D96623
AI'T�►CHi�tENT J
M I�U4DE
KIDNAPPING,CUSTODY OFFENSES, HUMAN TRAFFICKING AND RELATED
OFFENSES AFFIDAVIT
The Kidnapping,Custody Offenses,Human Trafficking and Related Offenses Affidavit is required by Sec6on 787.Q6,1
Florida Statutes("F.S."),as amended by HB 7063, which is deemed as being expressly incorporated into this Form. I
?he Form must be completed by a person authorized to make this attesta6on on behalf of the Contractor
(Nongovernmental Entity) for the purpose of executing, amending, or renew�ng a Contract with the County
(Governmental Entity).The term Governmental Entity has the same rneaning as in Section 287.138(t),F.S.
does not use ccercion for labor or seroices as defined in Section 787.06,F.S.
ConUaciors legal Canpam Name
Pursuant to Section 92.525,F.S,under the penalties of perjury,I declare that I have read the foregoing statement and
that the facts stated in it are true
Print Name of Contractor's Authonzed Representative:
Title of Contractors Authonzed Representaiive:
Signature of Contractors Authorized Representative: �
Date: i
I
Est.07A1 2024