Okaloosa County BOCC — October 7, 2014 — AH105 OKALOOSA BCC amendment #7 renewal Fully Executed — reading text

additional special audit schedules. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 or 10.650, Rules of the Auditor General. The schedule of expenditures should disclose the expenditures by contract number for each contract with BBCBC in effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due BBCBC shall be fully disclosed in the audit report package with reference to the specific contract number. PART III: REPORT SUBMISSION 2 Any reports, management letters, or other information required to be submitted to BBCBC pursuant to this agreement shall be submitted within 180 days after the end of the provider’s fiscal year or within 30 days of the recipient’s receipt of the audit report, whichever occurs first, directly to each of the following unless otherwise required by Florida Statutes: A. To Big Bend Community Based Care at E-Mail: mecontracts@bigbendcbc.or; (1 electronic copy and management letter, if issued) B. 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 recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse’s Internet Data Entry System at: http://harvester.census.gov/fac/collect/ddeindex.html and other Federal agencies and pass-through entities in accordance with Sections .320(e) and (f), OMB Circular A-133, as revised. C. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to the following address: Auditor General Local Government Audits/342 Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399-1450 Email address: flaudgen_localgovt@aud.state.fl.us Providers, when submitting audit report packages to the department for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for-profit organizations), Rules of the Auditor General, should include, when available, correspondence from the auditor indicating the date the audit report package was delivered to them. When such correspondence is not available, the date that the audit report package was delivered by the auditor to the provider must be indicated in correspondence submitted to the department in accordance with Chapter 10.558(3) or Chapter 10.657(2), Rules of the Auditor General. PARTIV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of seven years from the date the audit report is issued and shall allow BBCBC, the department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to BBCBC, the department or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by BBCBC or the department. Attachment TIT CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: (1) 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 an employee of any agency, a member of congress, an officer or employee of congress, or an 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. (2) 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 an 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. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. thal A. PP ie RY/L) Signature Date Charles K. Windes, Jr., Chairman Name of Authorized Individual Okaloosa County Board of County Commissioners Name of Organization 1804 Lewis Turner Blvd Suite 206, Fort Walton Beach, Florida 32547 Address of Organization Attachment IV AFFIDAVIT REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS This affidavit is required by the regulations implementing Executive Order 12549, Debarment and Suspension, signed February 18, 1986. The guidelines were published in the May 29, 1987 Federal Register (52 Fed. Reg., pages 20360 - 20369). I Charles K. Windes, Jr. Chairman hereby affirm on behalf of Okaloosa County Board of County Commissioners attest that one or more of the five (5) disqualifying conditions listed below does not exist. Okaloosa County Board of County Commissioners 1. Is barred, suspended, or otherwise prohibited from doing business with any government entity, or has been barred, suspended, or otherwise prohibited from doing business with any government entity within the last 5 years; 2. Is under investigation or indictment for criminal conduct, or has been convicted of any crime which would adversely reflect on their ability to provide services to vulnerable populations, including, but not limited to, abused, neglected children, or which adversely reflects their ability to properly handle public funds; 3. Is currently involved, or has been involved within the last 5 years, with any litigation, regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to the department, the state or its subdivisions, or a federal entity providing funds to the department; 4. Has had a contract terminated by the department for a failure to satisfactorily perform or for cause; or 5. Has failed to implement a corrective action plan approved by the department or any other governmental entity, after receiving due notice. By signing this AFFIDAVIT, Okaloosa County Board of County Commissioners is providing assurances that the above disqualifying conditions do not exist. ALK hdek, LVt Chairman SIGNATURE TITLE State of TI [x4 ida, County of Okol psa On this, the a & day of Sskonlas 201, before me a notary public, the undersigned, personally appeared, Charles K. Windes, Jr., Chairman, known to me (or satisfactorily proven) to be the person whose signature is subscribed to this document, and acknowledged that he/she is the person that has executed this Affidavit for the purpose therein. ereunto set my hand and official seal. a hereof, eas rd r0y— Notary Publi) sini, CATHY CARDREON Commission # EE 218431 Expires July 22, 2016 Bonded Thru Troy Fain Insurance 800-385-7019 EXHIBIT A 08/25/14 Client Non- ifi CLIENTS / PARTICIPANTS paiacienes Contract TO BE SERVED SAMH Services Program A. General Description The provider shall furnish services funded by this contract to the target population(s) checked below: The Provider agrees to deliver Drug Court Case Management Services, Forensic Mental Health Services, Mental Health Court Case Management Services and Mental Health Pretrial Services to eligible clients in accordance with the Program Description on file in the Contract Manager’s file and incorporated by reference into this contract. Non-Prevention Prevention xX Adult Mental Health-Forensic Involvement |_| Adult Substance Abuse Adult Mental Health-Severe & Persistent Mental Illness |_| Children’s Substance Abuse Adult Mental Health-Serious & Acute Episodes of Mental Illness [| Community Prevention-Adult and/or Children SA Adult Mental Health-Mental Health Problems Children’s Mental Health-Emotional Disturbances Children’s Mental Health-At Risk of Emotional Disturbances Children’s Mental Health-Serious Emotional Disturbances Adult Substance Abuse = | Children’s Substance Abuse B. Client/Participant Eligibility (1) The provider agrees that all persons meeting the target population descriptions in the table above are eligible for services based on the availability of resources. A detailed description of each target population is contained in s. 394.674, Florida Statutes. (2) Drug Court Case Management Services will be provided to clients who are participants in the Okaloosa County Drug Court program. Forensic Mental Health Services, Mental Health Court Case Management Services and Mental Health Pretrial Services will be provided to clients with a mental illness pursuant to Chapter 916, Florida Statutes. These clients have either been court ordered for an evaluation, or an evaluation has been deemed necessary by a member of the judicial partnership in Okaloosa County, or the clients may have been committed to the Department under the provisions of Chapter 916, F.S. by a Circuit One Circuit Court Judge. Okaloosa County BOCC Contract No.AH105 08/25/14 EXHIBIT A Client Non-specific CLIENTS / PARTICIPANTS Performance Contract TO BE SERVED SAMH Services Program C. Client/Participant Determination Determination of client eligibility is exclusively the responsibility of the provider. D. Contract Limits (1) The provider agrees that funds provided in this contract will not be used to serve persons outside the target population(s) specified above. (2) Services provided under this contract are limited by the availability of funds. The provider may not authorize or incur indebtedness on behalf of BBCBC or the Department. Okaloosa County BOCC Contract No.AH105 9/12/14 EXHIBIT B Client Non-Specific Performance Contract SAMH Service Program Method of Payment 1. Payment Clauses a. This is a fixed price (unit cost) contract. BBCBC shall pay the provider for the delivery of service units provided in accordance with the terms and conditions of this contract for a total dollar amount not to exceed $120,339.00 for the period of 10/1/2014 to 6/30/2015, subject to the availability of funds. The unit prices are listed on Exhibit G, Funding by Program and Activity. b. The provider agrees to submit proof of MATCH pursuant to s. 394.76(3), Florida Statutes (F.S.), and Financial Rule 65E-14.005 quarterly according to Exhibit C- Required Reports. c. In accordance with the provisions of s. 402.73(1), F.S., and Rule 65-29.001, Florida Administrative Code (F.A. C.), corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract. Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans. 2. Additional Release of Funds At its sole discretion BBCBC may