Okaloosa County BOCC — July 15, 2014 — Judge Ben Gordon Final Pay Request Documents — reading text

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: June 26, 2014 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: ContractNo. C14-2131-JUD MANAGING DEPARTMENT: Court Administration CONTRACTOR'S NAME: Ben Gordon Jr. Family Visitation Center PROJECT TITLE: Children Exposed to Crime Prevention Project The attached has met the final payment contract requirement in subject contract. Yes No I. Final Invoice xX C) 2. Completed Contract/Lease Payment Approval Form X CT 3. Close-Out Documents Yes No N/A a. Signed Release of Lien LC] C) XX b. Proof of Completion Advertisement CT] CL] X] c. Certificate of Insurance X C] C) d. Consent of Surety to Final Payment C] C] X e. Proof of Performance/Payment Bond & C CO Continuation 12 Months Following Final Payment ~< ® a z re) ied O 4. Agenda Request 2D. Remarks 4-8-0 gServicds Coordinator DATE OKALOOSA COUNTY BOARD OF COMMISSIONERS -AGENDA REQUEST- TO: HONORABLE BOARD OF COUNTY COMMISSIONERS FROM: CATHERINE WHITE, DRUG COURT MANAGER DATE: JULY 15, 2014 SUBJECT: FINAL PAYMENT REQUEST TO BEN GORDON, JR. FAMILY VISITATION CENTER DISTRICT: ALL BACKGROUND: On January 21, 2014, Okaloosa County Board of County Commissioners entered into Contract No. C14-2131-JUD with the Ben Gordon Jr. Family Visitation Center associated to perform services associated with supervised visitation and safe exchanges of children between their parents. The grant period is coming to an end, all required services have been completed, and the Judge Ben Gordon, Jr. Family Visitation Center is ready for final payment. Exhibits: A) Final Payment Request from Judge Ben Gordon, Jr. Family Visitation Center RECOMMENDATION: Approve final payment to Judge Ben Gordon Family Visitation Center in the amount of $10,097 for services provided associated with safe parental exchanges of children for visitation purposes as well as carrying out supervised visitation of parents and their children. N RECOMMENDED BY: erine A. White Drug Court Manager CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT pate; 06/26/2014 VENDOR NAME: Judge Ben Gordon, Jr. FVC VENDOR #: CONTRACT/LEASE#; C14-2131-JUD TASK COUNTY/FEMA VENDOR BUDGET INVOICE # ORDER # PROJECT# — | nepARTMENT #| “ACCOUNT? AMOUNT $ (if Applicable) (if Applicable) . 10/1/2013 - 1/31/2014 lal? JS 701495, 534900 $ 10,097.00 ; feL< TOTAL $ 10,097.00 APPROVED FOR PROGRESS PAYMENT (lease sign, as applicable and date CONTRACTOR'S ENGINEER/ARCHITL. DATE: DATE: 06/26/2014 DATE: Glan DATE: F-ASLE pare; V#/) x COUNTY SUPERVISOR/PROJECT MANAGE DEPARTMENT DIRECTOR: —Dino J. ViTear PE CONTRACTS & GRANT MANAGER: ¢ COUNTY ADMINISTRATOR: (Payments>$25, 000.) FINAL PAYMENT FINAL PAYMENT ves\¥ ol _| Uf "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: PURCHASING DIRECTOR: (Per Initial Agreement) DATE: CONTRACTS & GRANTS MANAGER: (All Contracts) DATE: COUNTY ADMINISTRATOR APPROVAL: (Per Initial Agreement) DATE: BOARD APPROVAL: (Per Initial Agreement) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWD BY: First Judicial Circuit Court Administration Robin M. Wright, Court Administrator Catherine A. White, Drug Court Manager 100 W. Maxwell Street, Pensacola, Fl. 32501 @ Tel: (850) 595-3055 @ Fax: (850) 595-3059 MEMORANDUM VIA FEDERAL EXPRESS TO: Michelle Huber, Office Supervisor Okaloosa County Public Safety FROM: Cathy White, Drug Court Manager Court Administration DATE: June 26, 2014 RE: Final Payment Request to Ben Gordon, Jr. Family Visitation Center Byrne Grant 2014-JAGC-OKAL-6-E5-082 Okaloosa County Contract # C14-2131-JUD Pursuant to your telephone conversation with my Administrative Assistant, Stacy Roberts, attached for Dino Villani’s review, approval, signature, and further handling is the completed Contract Payment Approval Form, Contract Close-Out Checklist, and original final invoice for the Ben Gordon, Jr. Family Visitation Center in the amount of $10,097. I have also attached the Agenda Request for the July 15, 2014 Board of County Commissioners Meeting for their approval of the final payment of the invoice. Should you have any questions or need additional information, please do not hesitate to contact me. Attachments ce: Marcella Eubanks, Okaloosa County Contracts and Grants Manager (w/attachments) Sharon Rogers, Executive Director, Ben Gordon, Jr. FVC Judge Ben Gordon, Jr. Family Visitation Center P.O. Box 436, Shalimar, Florida 32579 Phone: 850-609-1850 Fax: 850-609-1851 June 12, 2014 Catherine White Drug Court Manager 100 West Maxwell Street Pensacola, FL 32501 Reimbursement Invoice for: FDLE Ed Byrne Justice Assistance Grant Program American Recovery Act Grant number: 2014-JAGC-OKAL-6-E5-082 Contractual Services: $10,097.00 Grant Period: October 1, 2013 through September 30, 2014 The unit of cost used at the Judge Ben Gordon, Jr. Family Visitation Center is one supervised visit. Services include the provision of trained staff, security, and a nurturing setting. Grant funds provided for 152.5 units of service at the current level of staff and facility. 1 Unit = $66.23 $66.23 per unit @ 152.5 units = $10,100.07 Reimbursement Period: October 1, 2013 — January 31, 2014 Reimbursement Funding Requested: $10,097.00 Remaining Ed Byrne Grant funding: $10,097.00 - $10,097.00 = $0.00 A list of Supervised Visitations for this period is attached. Please call if you have any questions. Thank you, Crystal Melton Financial Manager |, Sharon Rogers, Executive Director of the Judge Ben Gordon, Jr. Family Visitation Center, certify that the above invoice is correct and that is does not duplicate reimbursement of costs or services received from other sources. In addition, | certify that reimbursement is requested only for expenditures on items approved by the terms and conditions of the agreement with the County. Approved by Executive Director: ivory G i 2c ZO\4 Sharon G Rogers Date i; PYRADIV-01 JMARTIN ACORD CERTIFICATE OF LIABILITY INSURANCE oe yegol4 “s THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS. JcERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT i - Destin Offi FAX ao34 Galtetser Deve fale, No, Ext, (850) 650-1950 | FA, nox (850) 650-9288 Destin, FL 32541 ABDHESS: INSURER(S) AFFORDING COVERAGE NAIC # Insurer a: Michigan Commercial Insurance Mutual 10998 INSURED : HR, Inc, dba Simple HR INSURER B : Alternate Employer Judge Ben Gordon, Jr. INSURER C: 36474 Emerald Coast Pkwy. INSURER D: Bldg. B - Destin, FL 32541 INSURER & : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABSOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR ADDL SUBR POLICY EFF | POLICY EXP, LTR TYPE OF INSURANCE INSD |wvD POLICY NUMBER, {MMIDBYYYY) | {MM/DDIVYYY) UMITS COMMERGIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE L | OCCUR PREMISES (Ea occurrence) _| § |__ MED EXP (Any one person) _| $ PERSONAL &ADVINJURY | $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ poucy |_| F8% [_ ]roc PRODUCTS- COMP/OP AGG | $ OTHER: $ 3 | Avromosite LIABILITY COMBINED SINGLE TMT] ANY AUTO BODILY INJURY {Per person} | $ ee ls Sone ran et IGN-OWNED PRO HIRED AUTOS AUTOS (Per accident) 8 $ UMBRELLA LIAB occur EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ veo | [Retentions $ WORKERS COMPENSATION PER OTH AND EMPLOYERS' LIABILITY YIN Sravure | [ex A | ANY PROPRIETORIPARTNER/EXEGUTIVE WC10000154572014A 01/01/2044 | 04/01/2015 | &.1. EACH ACCIDENT $ __ 1,000,000) OFFICERMEMBER EXCLUDED? LJ NIA (Mandatory in NH) ELL, DISEASE - EA EMPLOYEE] $ 4,000,000) yes, describe under 1,000,000) DESGRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ :000, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers’ Compensation coverage is provided by contract to all employees of Pyramid Diversified Services, Inc. dba Simple HR assigned to the Altemate Employer, shown above. Coverage does not apply to any employees not approved and assigned to HR, Inc. dba Simple HR to the Alternate Employer effective 1/1/14. *10 days notice of cancellation applies in the event of nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AGCORDANCE WITH THE POLICY PROVISIONS. Okaloosa County Department of Growth Management AUTHORIZED REPRESENTATIVE Grants Specialist 600 Transit Way Fort Walton Beach, FL 32547 hte © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD en . GORD-01 OP ID: LM ACORD CERTIFICATE OF LIABILITY INSURANCE altanotd THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Seton “ta DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder ls an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of tha policy, certain policies may require an endorsement. A statament on this certificate doos not conter rights to tha certificate holder in liau of such andorsement(s). Waldorff Ins & Bonding « FWB nai Wayne Walker 45 Eglin Parkway NE, Ste 202 fale Wo, exp; 850-581 4925 [TRE oy 850-581-4930 Fort Walton Beach, FL 32548 Teese. K, Wayne Walker + INSURER(S) AFFORDING COVERAGE NAIC & twsureR a: Western World Ins, Co. INSURED Judge Ben Gordon, Jr. INSURER 8: e am iy Visitation Center INSURER G: Shalimar, FL 32579 INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS ‘TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, [ADDL /SUBI POLICY EFI POLICY EXP NgR TYPE OF INSURANCE INSR | WyD POLICY NUMBER IMMDD Te) (HON) GIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 yx | ETO RENTED A. [X | COMMERCIAL GENERAL UABILITY NPP8i4g073 92/05/2014 | 02/05/2015 | PAMICE TO RENTED coy |S 100,000) ] CLAIMS.MADE OCCUR MED EXP (Any one person) | $ 5,000} al PERSONAL & ADV INJURY $ 1,000,000 | X | Professional Liab GENERAL AGGREGATE $ 2,000,000) GEN'L AGGREGATE LIMIT APPLIES PER.