MEMORANDUM OF AGREEMENTAttachment 1
MEMORANDUM OF AGREEMENT BETWEEN
THE PINELLAS COUNTY HEALTH DEPARTMENT
205 Dr. M.L. King St N., St Petersburg, FL 33701
AND
CITY of CLEARWATER
112 S. Osceola Ave., Clearwater, FL 33756
Preface
The State of Florida Purchase Order, being a legal and binding agreement is sufficient to procure
goods and/or services. This Agreement has been created as an attachment to Purchase Order
# A 3 8 Z 13 . The terms and conditions of this Agreement shall become part of the purchase
order upon execution February 1, 2011 or when the agreement is signed by both parties,
whichever is later, until termination June 30, 2011.
A. Services to be provided.
1. Definition of Terms.
a. Agreement Terms.
1. Department. The Pinellas County Health Department (PinCHD) is a state and
county funded health department of the Florida Department of Health (DOH)
with jurisdiction over Pinellas County.
2. Provider. The City of Clearwater, Florida, (the "city"), created by Chapter
9710, Special Laws of Florida, 1923, as amended, exists as a municipal
corporation with all governmental, corporate and proprietary powers to
enable it to conduct municipal government, perform municipal functions and
render municipal services.
3. Communities Putting Prevention to Work (CPPW) - A Federal award funded
by the Prevention and Public Health Fund included in the Affordable Care
Act, the program will provide a comprehensive prevention and wellness
initiative administered by the Centers for Disease Control and Prevention
(CDC).
b. Program Specific Terms.
Community Action Plan (CAP) - Program work plan
Benchmarks - Time sensitive evaluation requirements set by CDC
2. General Description.
a. General Statement. Through implementing evidence and practice based
approaches in policy, systems, and environmental change, CDC's Communities
Putting Prevention to Work program aims to achieve broad reaching, highly
impactful, and sustainable change to reduce chronic disease morbidity and
mortality associated with obesity and tobacco use.
b. Authority. Grant Title: Communities Putting Prevention to Work, CFDA #:
93.520. Cooperative Agreement: 1 U58DP002526-01.
Attachment 1
c. Scope of Service. Services provided seek to reduce the burden of obesity
focusing on healthier food access and choices and increasing physical activity.
This agreement will provide services through Pinellas County targeting
underserved populations.
d. Major Program Goals. Major goals of the program are to achieve broad
reaching, highly impactful, and sustainable change to reduce chronic disease
morbidity and mortality associated with obesity implementing evidence and
practice-based approaches in policy, systems, and environmental change.
Purpose for this contract is to perform data collection, policy analysis and
implementation for Cooperative Agreement requirements.
B. Manner of Service Provision
Service Tasks.
a.Task List
1. Hire/house and provide supervision for one full time City employee dedicated
to CPPW project. City employee will serve on the CPPW Membership Team.
2. Conduct assessments/surveys of:
i. wellness policies/programs for employees
ii. public event policies/programs
iii. city legislation on complete street policies
iv. bicycle and pedestrian infrastructure minor renovation needs
v. lighting and signage requirements for bike and pedestrian usage in key
locations
vi.County/City zoning policies on community gardens
vii.Other surveys as requested by CPPW evaluation team
3. Promote city wide healthy lifestyle awareness campaigns at public events
within the City of Clearwater
4. Develop/implement policies that focus on healthy lifestyles in the workplace
5. Develop/implement policies to promote healthy choices at community events
6. Prepare evaluation surveys, reports/summaries per program and CDC
requirements
7. Attend monthly membership team meetings
8. Attend/present program information at City Council meetings
9. Collaborate with all CPPW partners including evaluation and media services
b. Performance Measures.
1. Staff hired within 30 days of signed agreement
2. 100% all required assessments completed
3. 2 completed City wide awareness campaigns/year
4. Wellness Policies developed for worksite and community settings
by June 30, 2011
5. 100% surveys, reports/summaries completed as required
6. At least 80% attendance at required meetings
2. Deliverables.
a. Provider will supply 1 FTE for policy analysis services.
b. Reports. Provider will submit quarterly reports and a final project report to the
Program Manager on the implementation and evaluation of interventions
contained within the CAP and anticipated policy outcomes.
c. Benchmarks. Provider will meet all benchmark quarterly measures required by
Program Manager and CDC. (Attachment 1 D)
2
Attachment 1
3. Provider Responsibilities.
a. Provider Unique Activities.
1) The Provider agrees to comply with agreement specifications listed in B.2.a.
B.2.b. and B.2.c.
2) The provider agrees to comply with General Agreement Terms and
Conditions, (Attachment 1A).
b. Coordination with Other Providers/Entities. The provider agrees to coordinate
with the collaborating partners. Failure of other providers or entities does not
alleviate the provider from any accountability for tasks or services that the
provider is obligated to perform pursuant to the agreement.
4. Department Responsibilities.
a. Department Obligations:
1) CPPW Program Manager will provide project management and
coordination of program components.
2) CPPW Program Manager will liaise with partnering staff.
3) CPPW Program Manager will track performance outcomes, quality
improvement, and evaluation activities.
C. Method of Payment
1. Payment.
a. This is a fixed price agreement. The Pinellas County Health Department shall pay the
provider for the delivery of service units in accordance with terms of this agreement for a
total dollar amount not to exceed $ 35,185 subject to the availability of funds. Payments
will be made at a fixed price of $7,037.00 per month for 5 months.
2. Invoice Requirements,
a. The provider shall request payment on a monthly basis through submission of a
properly completed Agency Request for Payment (Attachment 1 C) within fifteen (15)
days following the end of the month for which payment is being requested. The
payment must be submitted with the supporting documentation.
b. The following supporting documentation is required for each invoice:
1) Documentation for expenses and a summary of the information demonstrating the
completion of each specific deliverable,
c. Any portion of the deliverable payments received that are not supported by
documentation will be returned to the department.
E. Attachments
Attachment 1A - General Agreement Terms and Conditions
Attachment 1 B - Financial and Compliance Audit
Attachment 1 C -- Contract Invoice
Attachment 1 D- CDC Benchmarks
3
Attachment 1
Countersigned:
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Frank rd
Mayor
Appr ed as to #orm:
Laura Mahony
Assistant City Attorney
PINELLAS COUNTY HEALTH
DEPARTMENT
By: IILQ?
Claude Dharamraj, M.D., M.P. ., F.A.A.P.
Director
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Date:
CITY OF CLEARWATER, FLORIDA
By: 11A.-
William B. Horne II
City Manager
Attest:
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Rosemarie Call
City Clerk
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STATE OF FLORIDA )
COUNTY OF PINELLAS ) ??F
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foregoing instrument was acknjrM/edged before me this 9 day of
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Notary Public
STATE OF FLORIDA
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The for o'ng instrument was acknowledged before me this 1`t ' h day of
20 1 I , by WILLIAM B. HORNE II, City Manager of the City of
Clearwater, Who is personally known to me.
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Notary Public
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GENERAL AGREEMENT TERMS AND CONDITIONS
A. Monitoring
Attachment 1A
1. Records and Documentation.
The provider agrees to maintain fiscal records documenting all expenditures
that are applicable to this contract, participant records, and curriculum
materials used in the provision of services. Records will be available for
review by the department.
2. Monitoring and Evaluation Methodology.
By execution of this agreement the provider hereby acknowledges and
agrees that its performance under the agreement must meet the standards
set forth above and will be bound by the conditions set forth below. If the
provider fails to meet these standards, the department, at its exclusive option,
may allow up to three (3) months (or other specified time frame depending on
the agreement duration) for the provider to achieve compliance with the
standards. If the department affords the provider an opportunity to achieve
compliance and the provider fails to achieve compliance within the specified
time frame, the department will terminate the agreement in the absence of
any extenuating or mitigating circumstances. The determination of the
extenuating or mitigating circumstances is the exclusive determination of the
department.
B. Termination
1. Termination at Will.
This agreement may be terminated by either party upon no less than thirty
(30) calendar days notice in writing to the other party, without cause, unless a
lesser time is mutually agreed upon in writing by both parties. Said notice
shall be delivered by certified mail, return receipt requested, or in person with
proof of delivery.
2. Termination Because of Lack of Funds.
In the event funds to finance this agreement become unavailable, the
department may terminate the agreement upon no less than twenty-four (24)
hours notice in writing #o the provider. Said notice shall be delivered by
certified mail, return receipt requested, or in person with proof of delivery.
The department shall be the final authority as to the availability and adequacy
of funds. In the event of termination of this agreement, the provider will be
compensated for any work satisfactorily completed prior to notification of
termination.
3. Termination for Breach.
This agreement may be terminated for the provider's non-performance upon
no less than twenty-four (24) hours notice in writing to the provider. If
applicable, the department may employ the default provisions in Chapter
60A-1.006 (3), FAC. Waiver of breach of any provisions of this agreement
shall not be deemed to be a waiver of any other breach and shall not be
construed to be a modification of the terms of this agreement. The provisions
herein do not limit the department's right to remedies at law or in equity.
4. Termination for Failure to Satisfactorily Perform Prior Agreement.
Failure to have performed any contractual obligations with the department in
a manner satisfactory to the department will be sufficient cause for
termination. To be terminated as a provider under this provision, the provider
must have: (1) previously failed to satisfactorily perform in an agreement with
5
Attachment 1A
the department, been notified by the department of the unsatisfactory
performance, and failed to correct the unsatisfactory performance to the
satisfaction of the department; or (2) had an agreement terminated by the
department for cause.
C. No Lobbying
State funds cannot be used to lobby the Executive or Legislative branches of the
Federal Government in connection with the department.
D. Discriminatory Vendor List
Provider acknowledges it is informed of the provisions of 287.134 (2)(a), F.S., and
represents to the department that those provisions do not prohibit the department from
contracting with the provider or any subcontractors hereunder.
E. Background Check
The provider must comply with the policy of the Department of Health, which requires
employees and certain other persons in positions of special trust, responsibility, or
sensitive location to be background screened in accordance with Sections 110.1127
and 435.04, Florida Statutes. Initial screening includes fingerprint checks through the
Florida Department of Law (FDLE) and the Federal Bureau of Investigation (FBI). Re-
screening requires only correspondence checks through FDLE every five (5) years. In
addition, all cooperative agreements and contracts must be in compliance with the
department's Information Security Policies, Protocols and Procedures.
F. Information Security
The provider shall maintain confidentiality of all data, files, and records including client
records related to the services provided pursuant to this agreement and shall comply
with state and federal laws, including, but not limited to, sections 384.29, 381.004,
392.65, and 456.057, Florida Statues. Procedures must be implemented by the
provider to ensure the protection and confidentiality of all confidential matters. These
procedures shall be consistent with the Department of Health Information Security
Policies copyright 2007, as amended, which is incorporated herein by reference and
the receipt of which is acknowledged by the Provider, upon execution of this
agreement. The provider will adhere to any amendments to the department's security
requirements provided to it during the period of this agreement. The provider must also
comply with any applicable professional standards of practice with respect to the client
confidentiality. There must be an individual designated with specified responsibility for
managing the security and confidentiality of this data. It is the responsibility of the
contract provider designee to develop policies, which ensure the confidential flow of
client information between authorized staff and the provider. Discipline will be applied
for breach of security of confidential information consistent with Florida Statues,
Florida Administrative Code, and Department of Health protocols, policies and
procedures. The contract manager performs information security assessments of
contract providers during scheduled compliance visits.
G. HIPAA
Where applicable, the provider will comply with the Health Insurance Portability and
Accountability Act as well as all regulations promulgated there under (45CFR Parts
160, 162, and 164).
6
Attachment 1A
H. Public Access
Allow public access to all documents, papers, letters, or other materials subject to the
provisions of Chapter 119, FS, made or received by the provider in conjunction with
this contract. It is expressly understood that the provider's refusal to comply with this
provision shall constitute an immediate breach of contract.
1. Construction or Renovation of Facilities Using State Funds
Any state funds provided for the purchase of or improvements to real property are
contingent upon the provider granting to the state a security interest in the property at
least to the amount of the state funds provided for at least five (5) years from the date
of purchase or the completion of the improvements or as further required by law. As a
condition of a receipt of state funding for this purpose, the provider agrees that, if it
disposes of the property before the department's interest is vacated, the provider will
refund the proportionate share of the state's initial investment, as adjusted by
depreciation.
J. Insurance
To provide adequate liability insurance coverage on a comprehensive basis and to
hold such liability insurance at all times during the existence of this contract and any
renewal(s) and extension(s) of it. Upon execution of this contract, unless it is a state
agency or subdivision as defined by §768.28, FS, the provider accepts full
responsibility for identifying and determining the type(s) and extent of liability insurance
necessary to provide reasonable financial protections for the provider and the clients to
be served under this contract. Upon the execution of this contract, the provider shall
furnish the department written verification supporting both the determination and
existence of such insurance coverage. Such coverage may be provided by a self-
insurance program established and operating under the laws of the State of Florida.
The department reserves the right to require additional insurance.
K. Indemnification
The provider shall be liable for and shall indemnify, defend, and hold harmless the
department and all of its officers, agents, and employees from all claims, suits,
judgments, or damages, consequential or otherwise and including attorneys' fees
and costs, arising out of any act, actions, neglect, or omissions by the provider, its
agents, or employees during the performance or operation of this contract or any
subsequent modifications thereof, whether direct or indirect, and whether to any
person or tangible or intangible property.
2. The provider's inability to evaluate liability or its evaluation of liability shall not
excuse the provider's duty to defend and indemnify within seven (7) days after
such notice by the department is given by certified mail. Only adjudication or
judgment after highest appeal is exhausted specifically finding the provider not
liable shall excuse performance of this provision. The provider shall pay all costs
and fees related to this obligation and its enforcement by the department. The
department's failure to notify the provider of a claim shall not release the provider
of the above duty to defend.
END OF TEXT
FINANCIAL AND COMPLIANCE AUDIT
Attachment 1B
The administration of resources awarded by the Department of Health to the provider may be
subject to audits and/or monitoring by the Department of Health, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised,
and Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be
limited to, on-site visits by Department of Health staff, limited scope audits as defined by OMB
Circular A-133, as revised, and/or other procedures. By entering into this agreement, the provider
agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate
by the Department of Health. In the event the Department of Health determines that a limited
scope audit of the provider is appropriate, the provider agrees to comply with any additional
instructions provided by the Department of Health to the provider regarding such audit. The
provider further agrees to comply and cooperate with any inspections, reviews, investigations, or
audits deemed necessary by the Chief Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non-profit organization as
defined in OMB Circular A-133, as revised.
In the event that the provider expends $500,000 or more in Federal awards during its
fiscal year, the provider must have a single or program-specific audit conducted in
accordance with the provisions of OMB Circular A-133, as revised. Exhibit 1 to this
agreement indicates Federal resources awarded through the Department of Health by this
agreement. In determining the Federal awards expended in its fiscal year, the provider
shall consider all sources of Federal awards, including Federal resources received from
the Department of Health. The determination of amounts of Federal awards expended
should be in accordance with the guidelines established by OMB Circular A-133, as
revised. An audit of the provider conducted by the Auditor General in accordance with the
provisions of OMB Circular A-133, as revised, will meet the requirements of this part.
2. In connection with the audit requirements addressed in Part I, paragraph 1, the provider
shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of
OMB Circular A-133, as revised.
3. If the provider expends less than $500,000 in Federal awards in its fiscal year, an audit
conducted in accordance with the provisions of OMB Circular A-133, as revised, is not
required. In the event that the provider expends less than $500,000 in Federal awards in
its fiscal year and elects to have an audit conducted in accordance with the provisions of
OMB Circular A-133, as revised, the cost of the audit must be paid from non-Federal
resources (i.e., the cost of such audit must be paid from provider resources obtained from
other than Federal entities.)
4. An audit conducted in accordance with this part shall cover the entire organization for the
organization's fiscal year. Compliance findings related to agreements with the Department
of Health shall be based on the agreement's requirements, including any rules,
regulations, or statutes referenced in the agreement. The financial statements shall
disclose whether or not the matching requirement was met for each applicable agreement.
All questioned costs and liabilities due to the Department of Health shall be fully disclosed
in the audit report with reference to the Department of Health agreement involved. If not
8
Attachment IB
otherwise disclosed as required by Section .310(b)(2) of OMB Circular A-133, as revised,
the schedule of expenditures of Federal awards shall identify expenditures by agreement
number for each agreement with the Department of Health in effect during the audit
period. Financial reporting packages required under this part must be submitted within the
earlier of 30 days after receipt of the audit report or 9 months after the end of the
provider's fiscal year end.
PART II: STATE FUNDED
This part is applicable if the provider is a non-state entity as defined by Section 215.97(2), Florida
Statutes.
In the event that the provider expends a total amount of state financial assistance equal to
or in excess of $500,000 in any fiscal year of such provider (for fiscal years ending
September 30, 2004 or thereafter), the provider must have a State single or project-
specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes;
applicable rules of the Department of Financial Services; and Chapters 10.550 (local
governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the
Auditor General. Exhibit 1 to this agreement indicates state financial assistance awarded
through the Department of Health by this agreement. In determining the state financial
assistance expended in its fiscal year, the provider shall consider all sources of state
financial assistance, including state financial assistance received from the Department of
Health, other state agencies, and other non-state entities. State financial assistance does
not include Federal direct or pass-through awards and resources received by a non-state
entity for Federal program matching requirements.
2. In connection with the audit requirements addressed in Part II, paragraph 1, the provider
shall ensure that the audit complies with the requirements of Section 215.97(8), Florida
Statutes. This includes submission of a financial reporting package as defined by Section
215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General.
3. If the provider expends less than $500,000 in state financial assistance in its fiscal year
(for fiscal years ending September 30, 2004 or thereafter), an audit conducted in
accordance with the provisions of Section 215.97, Florida Statutes, is not required. In the
event that the provider expends less than $500,000 in state financial assistance in its
fiscal year and elects to have an audit conducted in accordance with the provisions of
Section 215.97, Florida Statutes, the cost of the audit must be paid from the non-state
entity's resources (i.e., the cost of such an audit must be paid from the provider resources
obtained from other than State entities).
4. An audit conducted in accordance with this part shall cover the entire organization for the
organization's fiscal year. Compliance findings related to agreements with the Department
of Health shall be based on the agreement's requirements, including any applicable rules,
regulations, or statutes. The financial statements shall disclose whether or not the
matching requirement was met for each applicable agreement. All questioned costs and
liabilities due to the Department of Health shall be fully disclosed in the audit report with
reference to the Department of Health agreement involved. If not otherwise disclosed as
required by Rule 691-5.003, Fla. Admin. Code, the schedule of expenditures of state
financial assistance shall identify expenditures by agreement number for each agreement
with the Department of Health in effect during the audit period. Financial reporting
packages required under this part must be submitted within 45 days after delivery of the
audit report, but no later than 12 months after the provider's fiscal year end for local
9
Attachment 1B
governmental entities. Non-profit or for-profit organizations are required to be submitted
within 45 days after delivery of the audit report, but no later than 9 months after the
provider's fiscal year end. Notwithstanding the applicability of this portion, the Department
of Health retains all right and obligation to monitor and oversee the performance of this
agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-
133, as revised, and required by PART I of this agreement shall be submitted, when
required by Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the
provider directs to each of the following:
A. The Department of Health at each of the following addresses:
Contract Administrative Monitoring Unit
4052 Bald Cypress Way, Bin B01 (HAFACM)
Tallahassee, FL 32399-1729
The contract manager for this agreement listed in the standard agreement.
B. The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the
number of copies required by Sections .320 (d)(1) and (2), OMB Circular A-133, as
revised, should be submitted to the Federal Audit Clearinghouse), at the following
address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
C. Other Federal agencies and pass-through entities in accordance with Sections .320 (e)
and (f), OMB Circular A-133, as revised.
2. Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a
copy of the reporting package described in Section .320(c), OMB Circular A-133, as
revised, and any management letter issued by the auditor, to the Department of Health at
each of the following addresses:
Contract Administrative Monitoring Unit
4052 Bald Cypress Way, BIN B01 (HAFACM)
Tallahassee, Florida 32399-1729
The contract manager for this agreement listed in the standard agreement.
3. Additionally, copies of financial reporting packages required by Part II of this agreement
shall be submitted by or on behalf of the provider directly to each of the following:
A. The Department of Health at each of the following addresses:
Contract Administrative Monitoring Unit
10
4052 Bald Cypress Way, BIN B01 (HAFACM)
Tallahassee, FL 32399-1729
Attachment 1B
The contract manager for this agreement listed in the standard agreement.
B. The Auditor General's Office at the following address:
Auditor General's Office
Claude Pepper Building, Room 401
111 West Madison Street
Tallahassee, Florida 32399-1450
4. Any reports, management letter, or other information required to be submitted to the
Department of Health pursuant to this agreement shall be submitted timely in accordance
with OMB Circular A-133, Florida Statutes, and Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, as
applicable.
5. Providers, when submitting financial reporting packages to the Department of Health for
audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local
governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the
Auditor General, should indicate the date that the reporting package was delivered to the
provider in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this
agreement for a period of six years from the date the audit report is issued, and shall allow the
Department of Health or its designee, the CFO or Auditor General access to such records upon
request. The provider shall ensure that audit working papers are made available to the
Department of Health, or its designee, CFO, or Auditor General upon request for a period of six
years from the date the audit report is issued, unless extended in writing by the Department of
Health.
11
Attachment 1B
Exhibit 1
FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
Federal Program 1 Cooperative Agreement CFDA#1 U58DP002526 Title CPPW $ 35,185
Federal Program 2 CFDA# Title $ 0
TOTAL FEDERAL AWARDS
$ 35J 85
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS:
OMB Circular A133: http://www.whitehouse..qov/omb/circulars/al33/al33.htmi
OMB Circular A122: http://www,whitehouse.aov/omb/circulars/al22/al22.htmi
OMB Circular A110: http://www.whitehouse.gov/omb/circulars/a110/a110.html
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations:
2, STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
Matching resources for federal program(s)
N/A CFDA#
State financial assistance subject to Sec. 215.97, F.S.:
CSFA# N/A Title
$0
$0
TOTAL STATE FINANCIAL ASSISTANCE AWARDED PURSUANT TO SECTION 215.97, F.S.
$0
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED
PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS:
Title
12
Exhibit 2
PART I: AUDIT RELATIONSHIP DETERMINATION
Attachment 1B
Providers who receive state or federal resources may or may not be subject to the audit
requirements of OMB Circular A-133, as revised, and/or Section 215.97, Fla. Stat. Providers who
are determined to be recipients or sub-recipients of federal awards and/or state financial
assistance may be subject to the audit requirements if the audit threshold requirements set forth
in Part 1 and/or Part 2 Exhibit 1 are met. Providers who have been determined to be vendors are
not subject to the audit requirements of OMB Circular A-133, as revised, and/or Section 215.97,
Fla. Stat. Regardless of whether the audit requirements are met, providers who have been
determined to be recipients or sub-recipients of Federal awards and/or state financial assistance,
must comply with applicable programmatic and fiscal compliance requirements.
In accordance with Sec. 210 of OMB Circular A-133 and/or Rule 691-5.006, FAC, provider
has been determined to be:
X Vendor or exempt entity and not subject to OMB Circular A-133 and/or Section 215.97,
F. S.
Recipient/sub-recipient subject to OMB Circular A-133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /sub-recipient of federal and or state financial
assistance and has been approved by the department to subcontract, they must comply with
Section 215.97(7), F.S., and Rule 691-.006(2), FAC [state financial assistance] and Section _ .400
OMB Circular A-133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who
receive Federal awards or state matching funds on Federal awards and who are determined to be
a sub-recipient, must comply with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
OMB Circular A-87 -- Cost Principles*
OMB Circular A-102 -Administrative Requirements
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
OMB Circular A-122 - Cost Principles*
OMB Circular A-110 - Administrative Requirements
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL
GOVERNMENT) MUST FOLLOW:
OMB Circular A-21 - Cost Principles*
OMB Circular A-110 - Administrative Requirements
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
13
Other fiscal requirements set forth in program laws, rules and regulations
Attachment 1B
*Some Federal programs may be exempted from compliance with the Cost Principles
Circulars as noted in the OMB Circular A-133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who
are determined to be a recipient/sub-recipient, must comply with the following fiscal laws, rules
and regulations:
Section 215.97, Fla. Stat.
Chapter 691-5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
Additional audit guidance or copies of the referenced fiscal laws, rules and regulations may be
obtained at tLtp://www.doh.state.fl.us/ by selecting "Contract Administrative Monitoring" in the
drop-down box at the top of the Department's webpage. *Enumeration of laws, rules and
regulations herein is not exhaustive nor exclusive. Fund recipients will be held to applicable legal
requirements whether or not outlined herein.
END OF TEXT
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PINELLAS COUNTY HEALTH DEPARTMENT
CONTRACT INVOICE
FEE FOR CONTRACTUAL SERVICES DATE
FROM: City of Clearwater
112 S. Osceola Ave.,
Clearwater, FL 33756
TO: Pinellas County Health Department
Richard Curtin
CPPW Contract Manager
205 Dr. M.L.K. Street North
St. Petersburg, Florida 33701
DO #:
SERVICE PERIOD:FROM: TO:
EXPENDITURE TYPE APPROVED CURRENT
BUDGET REQUEST
Project Title $35,185 $
$35,185 $
TOTAL
Total Amount:
Prepared by:
Approved by:
(Signature)
Title:
Date:
Attachment 1C
INVOICE MUST BE RECEIVED BY PinCHD AS A HARD COPY WITH ORIGINAL
SIGNATURE.
For PinCHD Use Only:
Invoice Received Date
Service Received Date
Inspected & Approved Date
Object Code
ORG 64-36-52-
OCA
DO/Contract #
I certify that the goods and services have been received and
are approved for payment.
(Signature)
(Title)
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CDC Benchmarks
Attachment 1D
2" -3 rd 1-30 days 30-60 days 60-90 days
Quarters - -Ensure that the majority of
staff/contractors are hired.
-Submission of quarterly
measures that will be included in
community performance plans.
4` 90 -120 days_ 120 -150 da_Ys_ 150 -180 days
Quarters -Submission of quarterly
Continue to implement measures that will be included in
intervention/policy strategies. community performance plans.
4` - 51 180 - 210 days 210 - 240 days 240 -- 270 days
Quarters
- Submission of quarterly
measures that will be included in
community performance plans.
5` -6 t 270 - 300 days 300 - 330 days 330 - 360 days
Quarters -Attend peer-peer meeting.
6` - 11` Awardees will submit quarterly reports on the implementation and evaluation of interventions contained
Quarters within the CAP and anticipated policy outcomes.
Federal Quarter 1: Oct - Dec 2009 Quarter 5: Oct - Dec 2010 Quarter 9: Oct - Dec 2011
Quarters Quarter 2: Jan - Mar 2010 Quarter 6: Jan - Mar 2011 Quarter 10: Jan - Mar 2012
Quarter 3: Apr - Jun 2010 Quarter 7: Apr - Jun 2011 Quarter 11: Apr - Jun 2012
Quarter 4: Jul - Sep 2010 Quarter 8: Jul - Sep 2011
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