HomeMy WebLinkAboutPrime Time Seniors, Inc.
AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH AND PRIME TIME SENIORS, INC.
This Agreement made and entered into this 1st day of May, 2007, by and between the CITY OF MIAMI BEACH,
a Florida municipal corporation, hereinafter referred to as "the City", and PRIME TIME SENIORS INC., hereinafter
referred to as "Provider".
WHEREAS, the City has funded the Provider for the period of May 1, 2007, to April 30, 2008, (one year)
(hereinafter "the contract period"); and
WHEREAS, the primary objective of the program is to provide socialization opportunities for senior citizens; and
WHEREAS, the City has determined, through City Commission action, to provide the following funding to
Provider to render the following services in Miami Beach: Prime Time Seniors, Inc. (the Program).
NOW, THEREFORE, in consideration of the mutual benefits contained herein, the City and Provider agree as
follows:
Section 1. Agreement Documents: Agreement documents shall consist of this Agreement and four (4) attachments,
all of which are incorporated by reference into this Agreement:
• Attachment I contains a description of the Program services and goals offered by the Provider.
• Attachment II is a line item Budget.
• Attachment III outlines financial management procedures and reporting forms for use with City
funds.
Section 2. Statement of Work: The Provider agrees to implement the Program in accordance with Attachments 1
and II, and as summarized as follows:
Prime Time Seniors, Inc.
To provide socialization opportunities and activities for Miami Beach senior citizens.
Section 3. Agreement Amount: The City agrees to make available FIFTEEN THOUSAND DOLLARS AND 00/100
($15,000) for use by the Provider to implement the Program during the term of the Agreement.
Section 4. Alterations: Any proposed alterations in the Program offered by the Provider and/or the Budget shall first
be submitted to and approved in writing by the City, said approval at the City's sole judgment and
discretion.
Section 5. Method of Payment and Reporting Requirements: Upon execution of this Agreement, the Provider
agrees to submit a current list of its members/clients to the City. Additionally, the Provider agrees to
submit quarterly Program progress reports to the City on the 10` day of the month following the end of
each quarter, throughout the term of this Agreement. The Provider also agrees to submit, on May 30,
2008, a comprehensive final report covering the agreed-upon Program objectives, activities, and
expenditures during the term of this Agreement, including, but not limited to, performance data on client
feedback, with respect to the goals and objectives outlined in Attachment I. Attachment III contains
reporting forms to be used in fulfillment of this requirement. Other reporting requirements may be required
by the City in the event of Program changes; the need for additional information or documentation arises;
and/or legislative amendments are enacted. The Provider shall be informed, in writing, if any changes
become necessary. Reports and/or requested documentation not received by the due date shall be
considered delinquent and may be considered by the City, at its sole discretion, as sufficient cause to
suspend pending payments to the Provider, and/or terminate the Agreement for cause, pursuant to Section
11 herein.
Section 6. Monitoring: The City, at its discretion, shall schedule no less than six (6) annual on-site monitoring visits
with the Provider to evaluate the progress and performance of the Program and to provide technical
assistance. A desk top review of the activities may be conducted in lieu of an on-site visit, if and only if,
the Provider has had a satisfactory on-site review in the previous Program year, and is not a high risk
Provider.
Page 1 of 16
Section 7. Additional Conditions and Compensation - It is expressly understood and agreed that in the event of
curtailment or non-production of said City funds, the financial sources necessary to continue to pay the
Provider all or any portions of the funds contemplated herein will not be available, and that this Agreement
will thereby terminate effective as of the time that it is determined by the City, in its sole discretion and
judgment, that said funds are no longer available. In the event of such determination, the Provider agrees
that it will not look to, nor seek to hold liable, the City nor any individual member of the City Commission
and/or City Administration thereof personally for the performance of this Agreement, and all of the parties
hereto shall be released from further liability each to the other under the terms of this Agreement.
Section 8. Compliance with Local, State and Federal Regulations -The Provider agrees to comply with all
applicable Federal regulations as they may apply to Program administration and to carry out each activity
in compliance with the laws and regulations. Additionally, the Provider will comply with all State and
local (City and County) laws and ordinances hereto applicable. It shall be the Provider's sole and absolute
responsibility to continually familiarize itself with any and all such applicable Federal, State, County, and
City regulations, laws, and/or ordinances.
Section 9. Subcontract: No part of this Agreement may be assigned or subcontracted without the prior written
consent of the City, such consent to be at the City's sole discretion and judgment.
Section 10. Term: This Agreement commences on May 1, 2007, and terminates on April 30, 2008, with the
understanding that at the end of the Agreement, the City has the authority to reappropriate any remaining
unused funds.
Section I1. Termination of Agreement:
11.1 Termination for Convenience: The City and Provider agree that this Agreement may be terminated
for convenience and without cause, by either party hereto by written notice to the other party of such
intent to terminate, at least thirty (30) days prior to the effective date of such termination. In the event of
such termination for convenience by either party, the City shall cease any payments to Provider for costs
resulting from obligations, which were not properly incurred before the effective date of termination.
Additionally, Provider shall be solely responsible for submitting a final report, as provided in Section 5 of
the Agreement, detailing all Program objectives, activities and expenditures up to the effective date of the
termination. Said "final report" shall be due within five (5) working days following the effective date of
the termination. Upon timely receipt of Provider's "final report", the City, at its sole discretion, shall
determine the amount (if any) of the City funds to be returned to the City as a result of any incomplete
Program items and/or items not satisfactorily performed, and shall provide Provider with written notice of
any monies due. Said monies shall be due immediately and payable upon receipt of such notice by
Provider. Notwithstanding the preceding, the City reserves any and all legal rights and remedies it may
have with regard to recapture of the City funds herein, or any assets acquired or improved in whole or in
part with said funds.
11.2 Termination for Cause: Notwithstanding Subsection 11.1 above, the City may also place the
Provider in default of this Agreement, and may suspend or terminate this Agreement, for cause. "Cause"
shall include, but not be limited to, the following:
a. Failure to comply and/or perform in a material way, as same shall be determined by the
City, in its sole discretion and judgment, in accordance with the terms of this Agreement, or
any Federal, State, County or City statute or regulation.
b. Submitting reports to the City, which are late, incorrect or incomplete in any material
respect.
c. Implementation of this Agreement, for any reason, is rendered impossible or infeasible.
d. Failure to respond in writing to any concerns raised by the City, including substantiating
documents when required/requested by the City.
e. Any evidence of fraud, mismanagement, and/or waste, as determined by the City's
monitoring of the Provider, and applicable City, County, State or Federal rules and
regulations.
The City shall notify the Provider in writing when the Provider has been placed in default. Such
notification shall include: (i) actions taken by or to be taken by the City, such as withholding of
payments; (ii) actions to be taken by the Provider as a condition precedent to clearing the deficiency;
Page 2 of 16
and (iii) a reasonable date for compliance, which shall be no more than fifteen (15) days from
notification date or, in the event the default is of such nature that it cannot reasonably be cured
within fifteen (15) days, and provided the Provider shall have commenced to cure the default within
such fifteen (15) days and shall, in any event, cure same no later than sixty (60) days from
notification thereof. In the event that Provider fails to correct such deficiency within the aforestated
period, this Agreement shall be considered terminated for cause by the City, without further notice to
Provider, and Provider shall be solely responsible for repayment to the City of any or all monies
disbursed to Provider under this Agreement. Said monies shall be due immediately and payable
upon receipt of notice by Provider. Notwithstanding the preceding, the City reserves any and all legal
rights and remedies it may have with regard to recapture of the City's funds herein, or any assets
acquired or improved in whole or in part with said funds.
11.3 Termination for Lack of Funds: In the event of curtailment of, or regulatory constraints placed on
the funds by the City, this Agreement will terminate, effective as of the time that it is determined such
funds are no longer available. Costs of the Provider resulting from obligations incurred during a
suspension or after termination, are not allowable unless the City expressly authorizes them in the notice
of suspension or termination, or subsequent thereto. Other costs during suspension or after termination
which are necessary and not reasonably avoidable may be allowable if, in the sole discretion of the City:
a. The costs resulting from obligations which were properly incurred before the effective date
of suspension or termination, are not in anticipation of it, and, in the case of termination,
are noncancelable; and
b. The costs would be allowable if the award were not suspended or expired normally at the
end of the funding period in which the termination takes effect.
In the event of termination of the Agreement, at its sole discretion, the City may require Provider to
transfer any assets to the City pursuant to Section 14 herein.
Section 12. Equal Employment Opportunities: The Provider shall comply with equal employment opportunities as
stated in Executive Order 11246, entitled "Equal Employment Opportunity" as amended Executive Order
11.375, and as supplemented in Department of Labor regulations.
Section 13. Religious Organization or Owned Property: City funds may be used by religious organizations or on
property owned by religious organizations only with prior written approval from the City.
a. It will not discriminate against any employee or applicant for employment on the basis of religion and
will not limit employment or give preference in employment to persons on the basis of religion.
b. It will not discriminate against any person applying for public services on the basis of religion and
will not limit such services or give preference to persons on the basis of religion.
c. It will retain its independence from Federal, State, and local governments, and may continue to carry
out its mission, including the definition, practice, and expression of its religious beliefs, provided that
it does not use direct City funds to support any inherently religious activities, such as worship,
religious instruction, or proselytizing.
d. The funds received under this Agreement shall not be used for the acquisition, construction, or
rehabilitation of structures to the extent that those structures are used for inherently religious activities.
Section 14. Reversion of Assets: In the event of a termination of this Agreement pursuant to Section 11 herein, or
upon expiration of the Agreement, the Provider shall immediately transfer to the City any City funds on
hand at the time of termination or expiration and any account receivable attributable to the use of City
funds.
Section 15. Sponsorships: The Provider agrees that all notices, informational pamphlets, press releases,
advertisements, descriptions of the sponsorship of the Program, research reports, and similar public notices
prepared and released by the Provider for, on behalf of, and/or about the Program, shall include the
statement:
"FUNDED BY THE CITY OF MIAMI BEACH"
In written materials, the words
"CITY OF MIAMI BEACH" shall appear in the same size letters or type as the name of the Provider.
Page 3 of 16
Section 16. Examination of Records: The Provider shall maintain sufficient records in accordance with this
Agreement to determine compliance with the requirements of this Agreement, and all applicable laws and
regulations. This documentation shall include, but not be limited to, the following:
a. Books, records and documents in accordance with generally accepted accounting principles,
procedures and practices, which sufficiently and properly reflect all revenues and expenditures of
funds provided directly or indirectly by this Agreement, including matching funds. These records
shall be maintained to the extent of such detail as will properly reflect all net costs, direct and
indirect labor, materials, equipment, supplies and services, and other costs and expenses of
whatever nature for which reimbursement is claimed under the provisions of this Agreement.
b. Time sheets for split-funded employees, which work on more than one activity, in order to record
the City activity delivery cost by Program and the non-City related charges.
The Provider is responsible for maintaining and storing all records pertinent to this Agreement in an
orderly fashion in a readily accessible, permanent and secured location for a period of four (4) years after
expiration of this Agreement, with the following exception: if any litigation, claim or audit is started before
the expiration date of the four year period, the records will be maintained until all litigation, claims or audit
findings involving these records are resolved. The City shall be informed in writing after closeout of this
Agreement, of the address where the records are to be kept.
Section 17. Audits and Inspections: At any time during normal business hours, and as often as City representatives
may deem necessary, the Provider shall make available all records, documentation, and any other data
relating to all matters covered by the Agreement for review, inspection or audit.
Audits shall be conducted annually and shall be submitted to the City 180 days after the end of the
Provider's fiscal year. The Provider shall comply with the requirements and standards of OMB A-133,
"Audits of Institutions of High Education and Other Non-Profit Institutions" (as set forth in 24 CFR Part
45), or OMB Circular A-128, "Audits of State and Local Governments" (as set forth in 24 CFR Part 44), as
applicable. If this Agreement is closed-out prior to the receipt of an audit report, the City reserves the right
to recover any disallowed costs identified in an audit after such closeout.
Section 18. Indemnification/Insurance Requirements: The Provider shall indemnify and hold harmless the City, its
officers, employees and agents, from any and all claims, liability, losses and causes of action which may
arise out of an act, omission, negligence or misconduct on the part of the Provider or any of its agents,
officers, servants, employees, contractors, patrons, guests, clients, licensees or invitees pursuant to this
Agreement and/or the Program. The Provider shall pay all claims and losses of any nature whatsoever in
connection therewith and shall defend all suits in the name of the City, when applicable, and shall pay all
costs (including attorney's fees) and judgments which may issue thereon. This Indemnification shall
survive the termination and/or expiration of the term of this Agreement.
The Provider shall not commence any work and/or services pursuant to this Agreement until all insurance
required under this Section has been obtained and the City's Risk Manager has approved such insurance.
In the event evidence of such insurance is not forwarded to the City's Risk Manager within thirty (30) days
after the execution of this Agreement, this Agreement shall become null and void and the City shall have
no obligation under the terms thereof unless a written extension of this thirty (30) day requirement is
secured from the City Administration.
The Provider shall maintain and carry in full force during the term of this Agreement and/or throughout the
duration of the Program contemplated herein, whichever is longer, the following insurance:
a. General Liability Policy with coverage for Bodily Injury and Property Damage, in the amount of
$300,000 single limit. The policy must include coverage for contractual liability to cover the
above indemnification.
b. Worker's Compensation and Employers Liability, as required pursuant to Florida Statute.
c. Automobile and vehicle coverage shall be required when the use of automobiles and other
vehicles are involved in any way in the performance of the Agreement. Limits for such coverage
shall be in the amount of $500,000.
d. The City of Miami Beach shall be named as an additional insured under all such insurance
certificates.
Page 4 of 16
e. Thirty (30) day written notice of cancellation or substantial modification of the insurance
coverage must be given to the City's Risk Manager by the Provider and his/her insurance
company.
f. The insurance must be furnished by insurance companies authorized to do business in the State of
Florida, and approved by the City's Risk Manager. The companies must be rated no less than
"B+" as to management, and not less than "Class VI" as to strength by the latest edition of Best's
Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent,
subject to the approval of the City's Risk Manager.
g. Original Certificates of Insurance for the above coverage must be submitted to the City's Risk
Manager for approval prior to any work commencing. These certificates will be kept on file in
the Office of the Risk Manager, Third Floor City Hall.
All insurance required by this Agreement shall be and remain in full force and effect for the entire term of
the Agreement and/or throughout the duration of the Program, whichever is greater, and each certificate or
policy shall carry the provision that the insurance shall not terminate, lapse or otherwise expire, prior to
thirty (30) days written notice to that effect, given by the insurance carrier to the City, and that the
insurance carrier will not invoke the defense of performance of a governmental function by the Provider in
performing this contract.
Compliance with the foregoing requirements shall not relieve the Provider of the liabilities and obligations
under this Section or under any other portion of this Agreement. The City shall have the right to obtain
from the Provider specimen copies of the insurance policies, in the event that submitted Certificates of
Insurance are inadequate to ascertain compliance with required coverage. All of Provider's certificates,
above, shall contain endorsements providing that written notice shall be given to the City at least thirty
(30) days prior to termination, cancellation or reduction in coverage of the policy.
Section l9. Conflict of Interest: The Provider covenants that no person under its employ who presently exercises any
functions or responsibilities in connection with the City funded activities has any personal financial
interests, direct or indirect, in this Agreement. The Provider covenants that in the performance of this
Agreement, no person having such conflicting interest shall be employed. The Provider covenants that it
will comply with all provisions of the Federal, State, County and City statutes, laws, regulations,
ordinances or resolutions governing conflicts of interest. The Provider shall disclose, in writing, to the
City any possible conflicting interest or apparent impropriety that is covered by the above provisions. This
disclosure shall occur immediately upon knowledge of such possible conflict. The City will then render an
opinion, which shall be binding on both parties.
Section 20. Venue: This Agreement shall be enforceable in Miami-Dade County, Florida, and if legal action is
necessary by either party with respect to the enforcement of any or all of the terms or conditions herein,
exclusive venue for the enforcement of the same shall lie in Miami-Dade County, Florida.
This Agreement shall be governed by, and construed in accordance with, the laws of the State of Florida,
both substantive and remedial, without regard to principles of conflict of laws. The exclusive venue for
any litigation arising out of this Agreement shall be Miami-Dade County, Florida, if in state court, and the
U.S. District Court, Southern District of Florida, if in federal court. BY ENTERING INTO THIS
AGREEMENT, CITY AND PROVIDER EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY MAY
HAVE TO A TRIAL BY JURY OF ANY CIVIL LITIGATION RELATED TO, OR ARISING OUT OF,
THIS AGREEMENT.
Section 21. Notices: All notices required under this Agreement shall be sent to the parties at the following address:
City: Vivian P. Guzman, Director
Neighborhood Services Department
City of Miami Beach
] 700 Convention Center Drive
Miami Beach, FL 33139
Provider: Jacqueline S. Hertz, President
Prime Time Seniors, Inc.
565 North Shore Drive
Miami Beach, FL 33141
Page 5 of 16
Section 22. Limitation of Liability: The City desires to enter into this Agreement only if in so doing the City can
place a limit on City's liability for any cause of action for money damages due to an alleged breach by the
City of this Agreement, so that its liability for any such breach never exceeds the sum of $15,000.
Provider hereby expresses its willingness to enter into this Agreement with Provider's recovery from the
City for any damage action for breach of contract to be limited to a maximum amount of $15,000, less the
amount of all funds actually paid by the City to Provider pursuant to this Agreement.
Accordingly, Provider hereby agrees that the City shall not be liable to Provider for damages in an amount
in excess of $15,000, which amount shall be reduced by the amount of the funding actually paid by the
City to Provider pursuant to this Agreement, for any action or claim for breach of contract arising out of
the performance or nonperformance of any obligations imposed upon the City by this Agreement. Nothing
contained in this subparagraph or elsewhere in this Agreement is in any way intended to be a waiver of the
limitation placed upon City's liability as set forth in Florida Statutes, Section 768.28.
This Agreement shall be binding upon all parties hereto and their respective heirs, executors, administrators,
successors and assigns.
In witness thereof, the parties hereto have executed or caused to be executed by their duly authorized officials, this
Agreement in three (3) copies, each of which shall be deemed an original on the date first above written.
AT ST:
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CITY CLERK
Robert Parcher
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S.E~I2ETARY/SIGNATURE
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P'1ZINT NA AND TITL>J
CITY OF MIAMI BEACH, FL/OR~A
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Matti Herrera Bower
Vice-Mayor
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~PR D T/SIGNATURE
BY: Jacqueline S. Hertz, President
NAME AND TITLE OF AUTHORIZED
SIGNATORY
APPROVED AS TO
FORM & LANGUAGE
& FOR F,UTION
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Page 6 of 16
AGREEMENT
May 1, 2007 to Apri130, 2008
ATTACHMENT I
STATEMENT OF WORK AND GOALS
DESCRIPTION OF PROGRAM
To continue senior education program such as current events, music appreciation, health related issues, coping with problems
associated with aging and many wonderful social programs.
PROGRAM GOALS AND MEASURABLE OUTCOMES
1. Prime Time Seniors, Inc. will meet two times per week from May 1, 2007, to April 30, 2008, for current events,
yoga and music appreciation. The sessions must include a minimum of 12 informational seminars with guest
speakers to discuss issues including but not limited to Medicaid, Medicare, Social Security benefits, affordable
housing and other topics of interest to senior citizens. A total of 104 sessions will be provided.
2. Prime Time Seniors, Inc. will increase membership by 50%.
3. Prime Time Seniors will serve a minimum of 40 seniors at each of the events.
4. Prime Time Seniors will reduce Administrative costs from 57% to 30%.
SCHEDULE FOR IMPLEMENTATION
Goal 7/2007 10/2007 1 /2008 4/2008
1 X X X X
2 X X X X
3 X X X X
4 X X X X
Page 7 of 16
AGREEMENT
May 1 2007 to April 30, 2008
ATTACHMENT II
BUDGET SUMMARY SHEET
Project Name: Elders and Seniors Emereine Needs Funding Year: 2007/2008
Provider Name: Prime Time Seniors, Inc.
Categ
Other
Num Category Breakdown City of Miami Other Funding Total
Beach Funds Funds Sources Funds
ber
Total City Funds
Total Other Funds
Grand Total
Page 8 of 16
AGREEMENT
BUDGET ITEMIZATION SHEET
Project Name: _ Elders and Seniors Emeraine Needs Funding Year: 2007/2008
Provider Name: Prime Time Seniors. Inc.
Category Amount
Categ Category Breakdown City of O Total Funds
ory Miami t
Numb Beach h
er Funds e
r
F
u
n
d
s
Total Amount
Page 9 of 16
AGREEMENT
May 1, 2007 to April 30, 2008
ATTACHMENT III
GUIDELINES FOR FINANCIAL MANAGEMENT OF City of Miami Beach-FUNDED ACTIVITIES
FINANCIAL MANAGEMENT SYSTEM
To comply with this Agreement, each Program must have a financial management system that provides accurate, current and
complete disclosure of the financial status of the activity. This means the financial system must be capable of generating
regular financial status reports which indicate the dollar amount allocated for each activity (including any budget revisions),
amount obligated (i.e., for which contract exists), and the amount expended for each activity. The system must permit the
comparison of actual expenditures and revenues against budgeted amounts. The City must be able to isolate and to trace
every City of Miami Beach dollar received and prove where it went and for what it was used.
The City is responsible for reviewing and certifying the financial management of any operating agency, which is not a City
department or bureau, in order to determine whether or not it meets all of the above requirements. If the Provider's system
does not meet these requirements and modifications are not possible, the City must administer the City of Miami Beach
funds for the Program.
SUPPORT FOR EXPENDITURES
Sufficient support for expenses depends on the type of expenditure. They normally include the following items:
• Salaries (should be supported by proper documentation in personnel files of hire date, position, duties, compensation,
raises with effective date, termination date, and similar type information. Non-exempt employees are required by law to
complete a timesheet showing number of hours they worked during the day. All employees paid in whole or in part
from City of Miami Beach funds should prepare a time sheet indicating the hours worked on City of Miami Beach
funded projects for each pay period. Based on these time sheets and the hourly payroll costs for each employee, a
voucher statement indicating the distribution of payroll charges should be prepared and placed in the appropriate files.)
• Employee Benefits (should be supported by personnel policies and procedures manual, describing the types of benefits,
eligibility and other relevant information.)
• Professional Services (should be supported by a complete and signed copy of the contract between the organization and
the independent contractor, describing at the minimum, period of service, type of service and method for payments, in
addition to the invoice from the private contractor.)
• Purchases (at a minimum, purchases should be supported by a purchase order, packing list and vendor invoice. Credit
card statements, travel itineraries, vendor statements, and similar items do not represent support for an expense.)
RECORDS
Accounting records must be supported by source documentation. Invoices, bills of lading, purchase vouchers, payrolls and
the like must be secured and retained for four years in order to show for what purpose funds were spent. Payments should
not be made without invoices and vouchers physically in hand. All vouchers/invoices should be on Provider's letterhead.
Financial records are to be retained for a period of four years, with access guaranteed to the City, or U.S. Treasury officials
or their representative.
AUDITS
One copy of the Provider's audited financial statement shall be submitted to the City immediately following the end of the
fiscal year(s) during which City of Miami Beach funds are received.
Page 10 of 16
REQUESTS FOR PAYMENTS
Payments to Provider will be on a reimbursement basis. Requests are to be submitted utilizing the enclosed financial status,
client profile, and narrative report forms, in a format consistent with the approved budget as shown in Attachment I1,
including an analysis of expenses to budget. A cash advance may be available upon special request. All requests must be
submitted to:
Vivian P. Guzman, Director
Neighborhood Services Department
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
Page 11 of 16
CMB Bud et Account
CITY OF MIAMI BEACH
Provider: Prime Time Seniors, Inc.
Reporting Period:
Month/Year
Project Name: Elders and
Seniors Emerging Needs
Date Submitted:
FY 2006/2007 Bud et Amount ~IrJ~U~O
Month This Month Year to Date Balance
Ma -07 $ - $ $ 15,000.00
June-07 $ - $ $ 15,000.00
Jul -07 $ - $ $ 15,000.00
Au -07 $ - $ $ 15,000.00
Se -07 $ - $ $ 15,000.00
Oct-07 $ - $ $ 15,000.00
Nov-07 $ - $ $ 15,000.00
Dec-07 $ - $ $ 15,000.00
Jan-08 $ - $ $ 15,000.00
Feb-08 $ - $ $ 15,000.00
Mar-08 $ - $ $ 15,000.00
A r-08 $ - $ $ 15,000.00
This Request
Attached you will find original invoices or canceled checks plus copies of paid invoices to substantiate the above
expenditures. I certify that all goods and services have been received, that they all fall within the contractual scope of
services and budget, and that these costs have not been paid previously by any other funding source. I certify that
substantially all Program income received has been disbursed or will be disbursed within three (3) days of this
request, in accordance with the provisions at 24 CFR 570.504 and that the amount of this request is additionally
needed to pay invoices as listed.
Authorized Signature
FINANCIAL STATUS REPORT
Name and Title of Person Submitting Report
Page 12 of 16
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CERTIFICATION REGARDING LOBBYING
Name of Recipient: CITY OF MIAMI BEACH
Name of Provider: PRIME TIME SENIORS, INC.
Date:
The undersigned certifies, to the best of his or her knowledge and belief, that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or any employee of a Member of Congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan,
the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or any employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions.
The undersigned shall require that the language of this certification be included in the award documents for
all sub-awards at all tiers (including sub-contracts, sub-grants, and contracts under grants, loans, and
cooperative agreements) and that all individuals receiving sub-awards shall certify and disclose accordingly.
PRIME TIME SENIORS. INC.
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Sign ur = Date
Print Name of Authorized Signatory
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Print Title of Authorized Signatory
Page 14 of 16
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
Name of Recipient: CITY OF MIAMI BEACH
Name of Provider: PRIME TIME SENIORS. INC.
Date: '7 ~t ~ I d ~
The Provider shall insert in the space provided below the site(s) expected to be used for the performance of the
Program contemplated under the Agreement:
Place of Performance (include street address, city, county, state, zip code for each site):
/Yl c hoc ~ ` ~'~l c e.4-~ F='C
PRIlVIE TIME SENIORS. INC.
~.^\~y/
\ ~Sign`dtur~~
fF-r--mac: '~-v~ s !•~s Z
Print Name of Authorized Signatory
~;~t7J~
Print Title of Authorized Signatory
~,/i ~r~
Date
Page 15 of 16
ACKNOWLEDGEMENT OF DISABILITY NONDISCRIMINATION AFFIDAVIT
NAME OF FIRM, CORPORATION, OR ORGANIZATION PRIME TIME SENIORS, INC.
AUTHORIZED AGENT COMPLETING AFFIDAVIT ~A-~. ~~,,.a.~ ~{-Z~c.F~
POSITION ~ t~-4-~ ~~ PHONE NUMBER (~~) ~6~ `l ~ ~ ~
I, ~'~=+' ~~~~ ~ ~ - l~~".~~`~"~- ,being duly first sworn state:
That the above named form, corporation or organization is in compliance with and agrees to continue to
comply with, and assure that any subcontractor, or third party contractor under this project complies with all
applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to
employment, provision of programs and services, transportation, communications, access to facilities,
renovations, and new construction.
The Americans with Disabilities Act of 1990 (ADA): Pub. L. 101-336, 104 Stat 327, 42 U.S.C. 12101-
12213 and 547 U.S.C. Sections 225 and 611 including Title I, Employment; Title II, Public Services;
Title III, Public Accommodations and Services Operated by Private Entities; Title IV,
Telecommunications; and Title V, Miscellaneous Provisions.
The Rehabilitation Act of 1973: 29 U.S.C. Section 794.
The Federal Transit Act, as amended: 49 U.S.C. Section 1612.
The Fair Housing Act as amended: 42 U.S.C. Section 3601-3631.
~~ S i at re
Date
SUBSCRIBED AND SWORN TO (or affirmed) before me on 1 ~~ ~ ~~ l~rt , ,.:, , by
(Affiant)
presented
(Type of identification)
(Signature,~f N
(Print
otary)
~~
. V
Notary Public State of Flo
Nydia Burgos
My Commfasion DD542199
Expires 05IO6/2010
.v' 'r
Notary Public ~%? /'~ C~l' .~ (State) Notary Seal
~/:,2 U/d
The City of Miami Beach will not award a contract to any firm, corporation or organization that fails to complete
and submit this Affidavit with the firm, corporation or organization's bid or proposal or fails to have this Affidavit
on file with the City of Miami Beach.
(Date)
He/She ' personally known to m~ or has
as identification.
'al Number)
Page 16 of 16
Hernandez, Kerry
From: Parcher, Robert
Sent: Wednesday, August 22, 2007 7:22 AM
To: Fernandez, Hilda; Guzman, Vivian
Cc: Hernandez, Kerry
Subject: RE: Prime Time Seniors, Inc -Agreement
Vivian, I will process the above agreement for May 1, 2007 -April 30, 2008 based on
Resolution 2005-25974 approved 7/27/05.
Kerry, pls see me.
Bob
MIAMIBEACH
Robert Parcher, City Clerk
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 / Fax: 305-673-7254 / www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work
and play in our vibrant, tropical, historic community.
-----Original Message-----
From: Fernandez, Hilda
Sent: Tuesday, August 21, 2007 10:25 AM
To: Parcher, Robert
Subject: Re: Prime Time Seniors, Inc - Agreement
Vivian:
Pls follow up with Bob. As I recall, the appropriation was carried over for this FY. Call
him asap. Thx
MIAMIBEACH
Hilda M. Fernandez, Assistant City Manager
OFFICE OF THE CITY MANAGER
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7010 / Fax: 305-673-7782 / www.miamibeachfl.gov
Sent from my BlackBerry wireless Handheld
----- Original Message
From: Parcher, Robert
To: Fernandez, Hilda
Sent: Tue Aug 21 10:01:45 2007
Subject: Fw: Prime Time Seniors, Inc - Agreement
Hilda, pls see my email below. How do yo want me to handle?
Thanks
1
Bob
MIAMIBEACH
Robert Parcher, City Clerk
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 / Fax: 305-673-7254 / www.miamibeachfl.gov
<blocked::http://www.miamibeachfl.gov/>
We are committed to providing excellent public service and safety to all who live, work
and play in our vibrant, tropical, historic community.
From: Parcher, Robert
Sent: Thursday, August 16, 2007 5:28 PM
To: Fernandez, Hilda
Subject: Prime Time Seniors, Inc - Agreement
Hilda,
At the July 27, 2005 Commission meeting, the City Commission authorized a one-year
allocation and to allocate $15,000 to Prime Time Seniors as a one-time allocations from
the General Fund and next year to submit their request via the CDBG process.
I am in possession of an agreement between the COMB and Prime Time Seniors, Inc., where
the City has funded the Provider in the amount of $15,000 for the period of May 1, 2007 to
April 30, 2008.
Please confirm that this agreement (May 2007 - April 2008) is related to the City
Commission action of July 27, 2005 or is this being approved pursuant to the City
Manager's purchasing authority?
Thanks
Bob
MIAMIBEACH
Robert Parcher, City Clerk
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 / Fax: 305-673-7254 / www.miamibeachfl.gov
<blocked::http://www.miamibeachfl.gov/>
We are committed to providing excellent public service and safety to all who live, work
and play in our vibrant, tropical, historic community.
2