HomeMy WebLinkAbout2013-171 e�a�io �� 3
CONTRACT BETWEEN K
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE INDIAN RIVER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2013 =2014
This agreement ("Agreement") is made and entered into between the State of Florida ,
Department of Health (" State ") and the Indian River County Board of County
Commissioners ( " County") , through their undersigned authorities , effective October 1 ,
2013 .
RECITALS
A . Pursuant to Chapter 154 , Florida Statutes , the intent of the legislature is to
" promote , protect , maintain , and improve the health and safety of all citizens and visitors of
this state through a system of coordinated county health department services . "
B . County Health Departments were created throughout Florida to satisfy this
legislative intent through " promotion of the public' s health , the control and eradication of
preventable diseases , and the provision of primary health care for special populations . "
C . Indian River County Health Department ( " CHD ") is one of the County Health
Departments created throughout Florida .
D . It is necessary for the parties hereto to enter into this Agreement in order
to
ensure coordination between the State and the County in the operation of the CHD .
NOW THEREFORE , in consideration of the mutual promises set forth herein , the
sufficiency of which are hereby acknowledged , the parties hereto agree as follows :
1 . RECITALS . The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference .
2 . TERM . The parties mutually agree that this Agreement shall be effective from
October 1 , 2013 , through September 30 , 2014 , or until a written agreement replacing this
Agreement is entered into between the parties , whichever is later , unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8 ,
below .
3 . SERVICES MAINTAINED BY THE CHD . The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to Section 154 . 01 (2 ) , Florida
Statutes , as defined below :
a . " Environmental health services " are those services which are organized and
operated to protect the health of the general public by monitoring and regulating activities
I
MENEM
in the environment which may contribute to the occurrence or transmission of disease .
Environmental health services shall be supported by available federal , state and local
funds and shall include those services mandated on a state or federal level . Examples of
environmental health services include , but are not limited to , food hygiene , safe drinking
water supply , sewage and solid waste disposal , swimming pools , group care facilities ,
migrant labor camps , toxic material control , radiological health , and occupational health .
b . " Communicable disease control services " are those services which protect the
health of the general public through the detection , control , and eradication of diseases
which are transmitted primarily by human beings . Communicable disease services shall
be supported by available federal , state , and local funds and shall include those services
mandated on a state or federal level . Such services include , but are not limited to ,
epidemiology , sexually transmissible disease detection and control , HIV/AIDS ,
immunization , tuberculosis control and maintenance of vital statistics .
C . " Primary care services " are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control . These services are provided to benefit
individuals , improve the collective health of the public , and prevent and control the spread
of disease . Primary health care services are provided at home , in group settings , or in
clinics . These services shall be supported by available federal , state , and local funds and
shall include services mandated on a state or federal level . Examples of primary health
care services include , but are not limited to : first contact acute care services ; chronic
disease detection and treatment ; maternal and child health services ; family planning ;
nutrition ; school health ; supplemental food assistance for women , infants , and children ;
home health ; and dental services .
4 . FUNDING . The parties further agree that funding for the CHD will be handled as
follows :
a . The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II .
i. The State 's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II , Part II is an amount not to exceed $ 2 , 941 , 871 (State General
Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C) , The
State's obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature .
u. The County' s appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment II , Part II is an amount not
to exceed $ 534 , 521 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment) .
b . Overall expenditures will not exceed available funding or budget authority ,
whichever is less , (either current year or from surplus trust funds) in any service category .
Unless requested otherwise , any surplus at the end of the term of this Agreement in the
2
County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period .
c . Either party may establish service fees as allowed by law to fund activities of the
CHD . Where applicable , such fees shall be automatically adjusted to at least the
Medicaid fee schedule .
d . Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding . If the State initiates the increase/decrease , the CHD will revise the Attachment II
and send a copy of the revised pages to the County and the Department of Health ,
Bureau of Budget Management . If the County initiates the increase/decrease , the County
shall notify the CHD . The CHD will then revise the Attachment II and send a copy of the
revised pages to the Department of Health , Bureau of Budget Management .
e . The name and address of the official payee to who payments shall be made is :
County Health Department Trust Fund
Indian River County Health Department
Accounts Receivable
Vero Beach , FL 32960- 3383
5 . CHD DIRECTOR/ADMINISTRATOR . Both parties agree the director/administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day4o-day direction of the Deputy Secretary for Statewide Services . The
director/administrator shall be selected by the State with the concurrence of the County .
The director/administrator of the CHD shall ensure that non -categorical sources of funding
are used to fulfill public health priorities in the community and the Long Range Program
Plan . A report detailing the status of public health as measured by outcome measures
and similar indicators will be sent by the CHD director/administrator to the parties no later
than October 1 of each year (This is the standard quality assurance "County Health Profile " report
located on the Office of Planning, Evaluation & Data Analysis Intranet site) .
6 . ADMINISTRATIVE POLICIES AND PROCEDURES . The parties hereto agree that
the following standards should apply in the operation of the CHD :
a . The CHD and its personnel shall follow all State policies and procedures , except to
the extent permitted for the use of county purchasing procedures as set forth in
subparagraph b . , below . All CHD employees shall be State or State-contract personnel
subject to State personnel rules and procedures . Employees will report time in the Health
Management System compatible format by program component as specified by the State .
b . The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services . In such cases , the CHD director/administrator must sign a justification therefore ,
and all county- purchasing procedures must be followed in their entirety , and such
3
compliance shall be documented . Such justification and compliance documentation shall
be maintained by the CHD in accordance with the terms of this Agreement . State
procedures must be followed for all leases on facilities not enumerated in Attachment IV .
c . The CHD shall maintain books , records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP ) and Governmental
Accounting Standards Board ( GASB ) , and the requirements of federal or state law . These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public , except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6 . i . ,
below . Books , records and documents must be adequate to allow the CHD to comply with
the following reporting requirements :
i. The revenue and expenditure requirements in the Florida Accounting
System Information Resource ( FLAIR) .
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System/Health Management Component Pamphlet ;
iii. Financial procedures specified in the Department of Health ' s Accounting
Procedures Manuals , Accounting memoranda , and Comptroller' s
memoranda ;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System/Health Management Component
Pamphlet .
d . All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer . These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Indian River County .
e . That any surplus/deficit funds , including fees or accrued interest , remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the state or county , as appropriate , based on the funds contributed by
each and the expenditures incurred by each . Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county . The equity share of any surplus/deficit funds accruing to the state and county is
determined each month and at contract year-end . Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year .
However, in each such case , all surplus funds , including fees and accrued interest , shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
4
which has been credited to each participating governmental entity . The planned use of
surplus funds shall be reflected in Attachment II , Part I of this contract , with special capital
projects explained in Attachment V .
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public' s health and the Deputy Secretary
for Statewide Services has approved the transfer . The Deputy Secretary for Statewide
Services shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g . The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement . Any such subcontract shall include all
aforementioned audit and record keeping requirements .
h . At the request of either party , an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year . This audit will follow requirements
contained in OMB Circular A- 133 and may be in conjunction with audits performed by
county government . If audit exceptions are found , then the director/administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties .
i . The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy .
j . The CHD shall retain all client records , financial records , supporting documents ,
statistical records , and any other documents ( including electronic storage media ) pertinent
to this Agreement for a period of five ( 5) years after termination of this Agreement . If an
audit has been initiated and audit findings have not been resolved at the end of five
(5)
years , the records shall be retained until resolution of the audit findings .
k . The CHD shall maintain confidentiality of all data , files , and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law . The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384 . 29 , 381 . 004 , 392 . 65
and 456 . 057 , Florida Statutes , and all other state and federal laws regarding
confidentiality . All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies , Protocols , and Procedures .
The CHD shall further adhere to any amendments to the State ' s security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality .
I . The CHD shall abide by all State policies and procedures , which by this reference
are incorporated herein as standards to be followed by the CHD , except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6 . b . hereof.
5
m . The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial , modification or termination of services . The
CHD will advise applicants of the right to appeal a denial or exclusion from services , of
failure to take account of a client ' s choice of service , and of his/her right to a fair hearing to
the final governing authority of the agency . Specific references to existing laws , rules or
program manuals are included in Attachment I of this Agreement .
n . The CHD shall comply with the provisions contained in the Civil Rights Certificate ,
hereby incorporated into this contract as Attachment III .
o . The CHD shall submit quarterly reports to the county that shall include at least the
following :
i. The DE385L1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report ;
ii. A written explanation to the county of service variances reflected in the
DE385L1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount . However, if the amount of the service specific variance
between actual and planned expenditures does not exceed three percent of the
total planned expenditures for the level of service in which the type of service is
included , a variance explanation is not required . A copy of the written
explanation shall be sent to the Department of Health , Bureau of Budget
Management .
6
p . The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD ' s control :
i. March 1 , 2014 for the report period October 1 , 2013 through
December 31 , 2013 ;
ii. June 1 , 2014 for the report period October 1 , 2013 through
March 31 , 2014 ;
iii. September 1 , 2014 for the report period October 1 , 2013
through June 30 , 2014 ; and
iv. December 1 , 2014 for the report period October 1 , 2013
through September 30 , 2014 .
7 . FACILITIES AND EQUIPMENT . The parties mutually agree that :
a . CHD facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b . The county shall ensure adequate fire and casualty insurance coverage for County.
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self- insurance program or insurance purchased by the County .
c . All vehicles will be transferred to the ownership of the County and registered as
county vehicles . The county shall ensure insurance coverage for these vehicles is
available through either a self- insurance program or insurance purchased by the County .
All vehicles will be used solely for CHD operations . Vehicles purchased through the
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund .
8 . TERMINATION .
a . Termination at Will . This Agreement may be terminated by either party without
cause upon no less than one- hundred eighty ( 180 ) calendar days notice in writing to the
other party 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 to the
other party' s contract manager with proof of delivery .
b . Termination Because of Lack of Funds . In the event funds to finance this
Agreement become unavailable , either party may terminate this Agreement upon no less
than twenty-four (24 ) hours notice . Said notice shall be delivered by certified mail , return
receipt requested , or in person to the other party ' s contract manager with proof of delivery .
c . Termination for Breach . This Agreement may be terminated by one party , upon no
less than thirty ( 30 ) days notice , because of the other party ' s failure to perform an
obligation hereunder . Said notice shall be delivered by certified mail , return receipt
requested , or in person to the other party' s contract manager with proof of delivery .
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 .
9 . MISCELLANEOUS . The parties further agree :
a . Availability of Funds . If this Agreement , any renewal hereof, or any term ,
performance or payment hereunder, extends beyond the fiscal year beginning July 1 ,
2014 , it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature , in accordance with section 287 . 0582 ,
Florida Statutes .
b . Contract Managers . The name and address of the contract managers for
the parties under this Agreement are as follows :
For the State : For the County :
Mayur Rao Jason Brown
Name Name
Business Manager Budget Director
Title Title
190027 th Street 1801 27th Street
Vero Beach , FI . , 32960 -3383 Vero Beach , FI . , 32960 -3383
Address Address
772 -794-7464 772 - 567-8000 Ext . 1214
Telephone Telephone
If different contract managers are designated after execution of this Agreement , the name ,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement .
c . Captions . The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify , amplify , or give
additional notice of the provisions hereof.
8
In WITNESS THEREOF , the parties hereto have caused this 24 page agreement to be
executed by their undersigned officials as duly authorized effective the 1t�7day of October, 2013 .
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR INDIAN RIVER COUNTY DEPARTMENT OF HEALTH
SIGNED BY : SIGNED BY : �L��K�
y �' pNlrv11SSj0< ee
NAME : Jo h E . Flescher '`'F `NAME : John H . Armstrong , MD
to
TITLE : Chairman : FTLE : Sur eon
g General/Secretary of Health
DATE : ►TEN
ATTESTED TO : '`2RNFR co�N� , °"va
b HU Ny Y . II IIM YN
SIGNED BY . SIGNED BY : C,/Zc.O
NAME . NAME : Cheryl Dunn
TITLE . TITLE : Acting CHD Administrator
Now
DATE . DATE :
Attest: Jefh+eY R. Smith, Ckwk of
APPROVED AS TO FORM CirOA Court and Comptroller
AND LEGAL SUFFICI
BY
DYLAN REINGOLDBottommost are w" clerk
COUNTY ATTORNEY
9
ATTACHMENT I
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet ( DHP 50-20) , Environmental Health Coding Pamphlet ( DHP 50-21 ) and FLAIR requirements because
of federal or state law, regulation or rule . If a county health department is funded to provide one of these services , it
must comply with the special reporting requirements for that service . The services and the reporting requirements are
listed below:
Service Reguirement
1 . Sexually Transmitted Disease Requirements as specified in F .A. C . 6413-3 , F . S . 381 and
Program F . S . 384 .
2 . Dental Health Monthly reporting on DH Form 1008*. Additional reporting
requirements , under development, will be required . The
additional reporting requirements will be communicated upon
finalization .
3 . Special Supplemental Nutrition Service documentation and monthly financial reports as
Program for Women , Infants specified in DHM 150-24* and all federal , state and county
and Children ( including the WIC requirements detailed in program manuals and published
Breastfeeding Peer Counseling procedures .
Program )
4 . Healthy Start/ Requirements as specified in the 2007 Healthy Start
Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
5 . Family Planning Periodic financial and programmatic reports as specified
by the program office .
6 . Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade
pursuant to instructions contained in the Immunization
Guidelines-Florida Schools , Childcare Facilities and Family
Daycare Homes ( DH Form 150-615) and Rule 64D-3 .046,
F .A. C . In addition , periodic reports as specified by the
department pertaining to the surveillance/investigation of
reportable vaccine-preventable diseases , adverse events ,
vaccine accountability, and assessment of immunization
levels as documented in Florida . SHOTS and supported by
CHD Guidebook policies and technical assistance guidance .
7 . Environmental Health Requirements as specified in Environmental Health Programs
Manual 1504* and DHP 50-21 *
8 . HIV/AIDS Program Requirements as specified in F . S . 384 . 25 and
F .A. C . 64D-3 . 030 and 64D-3 . 031 . Case reporting should be
on Adult HIV/AIDS Confidential Case Report CDC Form
DH2139 and Pediatric HIV/AIDS Confidential Case Report
CDC Form DH2140 .
ATTACHMENT I (Continued )
Requirements as specified in F .A. C . 64D-2 and 64D-3, F . S .
381 and F . S . 384 . Socio-demographic and risk data on
persons tested for HIV in CHD clinics should be reported
on Lab Request DH Form 1628 in accordance with the Forms
Instruction Guide . Requirements for the HIV/AIDS Patient
Care programs are found in the Patient Care Contract
Administrative Guidelines .
9 . School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines ( May 2012 ).
10 . Tuberculosis Tuberculosis Program Requirements as specified in F .A. C .
64D-3 and F . S . 392 .
11 . General Communicable Disease Control Carry out surveillance for reportable communicable and other
acute diseases , detect outbreaks , respond to individual cases
of reportable diseases , investigate outbreaks , and carry out
communication and quality assurance functions , as specified
in F .A . C . 64D-3 , F . S . 381 , F . S . 384 and the CHD
Epidemiology Guide to Surveillance and Investigations .
or the subsequent replacement if adopted during the contract period .
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PART I . PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES
Estimated State Estimated County
Share of CHD Trust Share of CHD Trust
Fund Balance Fund Balance Total
1 . CHD Trust Fund Ending Balance 09/30/13 5691394 581 , 130 11150 , 524
2 . Drawdown for Contract Year (3367253) (2547441 ) (590 , 694)
October 1 , 2013 to September 30 , 2014
3 , Special Capital Project use for Contract Year 0 0 0
October 1 , 2013 to September 30 , 2014
4 , Balance Reserved for Contingency Fund 233 , 141 326 , 689 559 , 830
October 1 , 2013 to September 30 , 2014
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects , and
mobile health vans .
iI , Ile
I eve ��br
� `
Nee
C5 ee
Ile I 1 1, T ' � DEP2RTl1�TT
Fain II, abrtes oantrbi�ns tctianty Tealttt �eparfinent `
e I
jell
e el ell October t 2013w4w SepteWber, 30 201
;,$tate C46 I County Total CM
Trust Fund . M Trust Fund' Other
{cash) Trust Fund I {cash} Coutt button Total
1 . GENERAL REVENUE - STATE
015040 AIDS PREVENTION 0 0 0 0 0
015040 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0
015040 ALG/CONTR TO CHDS-AIDS PATIENT CARE NETWORK 0 0 0 0 0
015040 ALG/IPO HEALTHY START/IPO 0 0 0 0 0
015040 COMMUNITY SMILES - MIAMI-DADE 0 0 0 0 0
015040 COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA 0 0 0 0 0
015040 DUVAL TEEN PREGANCY PREVENTION - DUVAL 0 0 0 0 0
015040 FL CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0
015040 HEALTHY START GENERAL REVENUE CHD 0 0 0 0 0
015040 HEALTHY START MED-WAIVER - CLIENT SERVICES 0 0 0 0 0
015040 LA LIGA-LEAGUE AGAINST CANCER - MIAMI-DADE 0 0 0 0 0
015040 METRO ORLANDO URBAN LEAGUE - ORANGE 0 0 0 0 0
015040 MINORITY OUTREACH-PENALVERCLINIC - MIAMI-DADE 0 0 0 0 0
015040 PREPAREDNESS GRANT MATCH 29,492 0 299492 0 29,492
015040 SCHOOL HEALTH GENERAL REVENUE 66, 590 0 66, 590 0 66, 590
015040 STATEWIDE DENTISTRY NETWORK - ESCAMBIA 0 0 0 0 0
015040 STD GENERAL REVENUE 0 0 0 0 0
015040 TREASURE COAST MIDWIFERY - MARTIN 0 0 0 0 0
015040 AIDS SURVEILLANCE 0 0 0 0 0
015040 ALG/CONTR TO CHDS-AIDS PATIENT CARE 100,000 0 1005000 0 10000
015040 ALG/CONTR TO CHDS-SOVEREIGN IMMUNITY 0 0 0 0 0
015040 ALG/PRIMARY CARE 183 ,226 0 1835226 0 1839226
015040 COMMUNITY TB PROGRAM 30,445 0 30,445 0 303445
015040 DENTAL SPECIAL INITIATIVES 6, 540 0 6, 540 0 65540
015040 FAMILY PLANNING GENERALREVENUE 27,270 0 275270 0 27,270
015040 FL HEPATITIS & LIVER FAILURE PREVENTIONICONTROL 0 0 0 0 0
015040 HEALTHY START MED WAIVER - SOBRA 0 0 0 0 0
015040 JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI-DADE 0 0 0 0 0
015040 MANATEE COUNTY RURAL HEALTH SERVICES 0 0 0 0 0
015040 MIGRANT LABOR CAMP SANITATION 0 0 0 0 0
015050 NON -CATEGORICAL GENERAL REVENUE 112305077 0 1 ,2301077 0 11230, 077
GENERAL REVENUE TOTAL 19673 ,640 0 196735640 0 11673 ,640
I NON GENERAL REVENUE - STATE
015010 ALG/CONTR. TO CHDS-BIOMEDICAL WASTE 121021 0 123021 0 12,021
015010 INDIAN RIVER SUPERACT 65000 0 61000 0 6,000
015010 DOH INDIRECT 63 , 151 0 63 , 151 0 63 , 151
015010 SCHOOL HEALTH TOBACCO TF 702277 0 70,277 0 70,277
015010 TOBACCO COMMUNITY INTERVENTION 0 0 0 0 0
015010 ALG/CONTR. TO CHDS-SAFE DRINKING WATER PRG 0 0 0 0 0
015010 MEDICAID INCENTIVE FOR ELECTRONIC HEAUH RECORDS 63737 0 6, 737 0 65737
015010 PUBLIC SWIMMING POOLPROGRAM 0 0 0 0 0
015010 TOBACCO ADMINISTRATION & MANAGEMENT 0 0 0 0 0
015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0
015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0
015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0
015060 NON-CATEGORICAL TOBACCO REBASING 4,266 0 49266 0 4,266
Version : 2 Page 1 of 7
ti
w
r4 o w 00 o M o 0 0 0 0 0 0 0 0 0 o 00 0 0 0 0 0 o 0 0 0 0 0 0 00 0 � o 0 0 0 00 0 0 00 0 0 0 0 O
00 CO O h O M No6 ON N O O
N
V 00 N Q�
I : N (0
CL
�. '. O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O
ow
w"CieNN
IN
IN I%N
IN
INK
..
IN
kil =r e N O 00 00 O M O O O O O O O O O O O 000 0 O O O O O N O O O O O O O 0o O 7 O O O O O O O O O
O O O
Ile, I� V h O M .-. O O y) N N O O
4i N oo
U N N N M M
�y
R
a
IN I
IN er
O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O
O O O O O O
�,-
IN 'lee
rIN
+ `
Ile
NJ
IN Nei I
j
,m nell
'�„ N O o0 O O h O O O O O O O O O O O O O O O O O 00 O O O O O O O 00 O V O O O O 00 O
O 00 O O O O
el 0 eel IN ton ^ 00 O C4
O O n N N O O
NI
9,11
el `..+ N N M M N h
le
I IN
I IN Nie
I ix
ej
I Nee
w w z z p=
a
� I reel,
.+ �-iI
1 jj ile, z Q 0 z F z
L �Neree ,% w O U a p
;� ' t IN I
z p
ill I
IN
u: �' F U `i' a
` ' IN lee, IN
�Ne: - C7 z ¢ Q ti W Q V) 7^ W C7 z
IN Ile I* , O ° c7 a O ° F� vz O W W O x z a U m a z z ¢
Ile
v, 7w ¢ 3 Q z w w w o cY
F- ¢ n� U w U
Ile I
z a > w z O X p v, n F- t7 w
c7 cC w z a w w 0 > O w
Ill 91, 1
p U a u. U O z vi' U
0 a w E- q a a n: tx z
.a a a z w Z ° ¢ x v
z > C7 a U W Lc1 v> >
' re IN' Q p p z U n w Q a z a w z m
F. a z m j Ea q CL;
w Q F w w z 0 w C7 x Q U z
IN
Op a c7 W z w x
9 WINF . a z x w �, U U Q �, a Z a OIN eel
v, o p u c m 3 g w ¢ i' Q o�
W ; U z z Q O x O C7 Ex- W x a ¢ U a n z ° v
IN ,. w F- c7 w ¢ w C] > u. a c7 p ¢ a L1 z U ¢ con
W z ¢ > F- > 0 0 a w a q a �_ a c7 a W w w
;eyew" INZ w rx O F rn x Z w w v ¢� a Q w F ¢ ua ¢ U p v, ¢ F. [- w 0
,'Ile �eerjW U F¢ u: yQ j. U w F u. w " U w Oa v' con
w w Ca w
VI z a O W W z x x x w W cn O z R: U qN F 04
u F F x x x
w A p � � Q � 33p ° iUw �a > � zwz Q ° � ¢ c� ow. 333a ¢ u
r, NY „ Z z a H ¢ z m cC cC z w O F [- n Q O m U U w a
x O a w z z z w
IN IF v, E- F- Q u Q x 0 0 c7 a z z F z Q z x v' cc x ° z
IN
a
99 P4
w a X CF7 W U z ? F Q O U ° > U w
.a QN:91 IN ll
I el
W d
�� JI
„ y W A O o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
o 0 0 0 0 0
V W 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0
eri 155 NJ Z o 0 0 0 0 0 0 0 0 o O o o O o 0 0 o O O o 0 0 0 0 0 0 0 0 0 o O o O o O o
O o 0 0 0 0 0 0 0
Gz h r r h r r h h r r r r r r h r h r r r h h h r h r r r h r r r h r r h h r r h h r r h r r
IN
New , I
O o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0
IN N
IN
OWN
�p �� IN
Ix IN e IN
yIN 4, NN
rF INe
s /
ij h iell - A A A
aI IN a AI O)( 1 � b11tr .1�ttl � ut tat 38rttBt i r re
5'. 14
s c
Biber 1, 2813'to Septemb r .3l1I IN I IN , X14
State County Total CIS
Timst Feud C6` ' Treat Fanid Other
( } Tn% i t Fund (cash) Contr butwk Total
3. FEDERAL FUNDS - State
007000 WIC ADMINISTRATION 4855339 0 485 ,339 0 485 ,339
015009 MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES 0 0 0 0 0
015009 MEDIPASS WAIVER-SOBRA 0 0 0 0 0
007055 ARRA FEDERAL GRANT - SCHEDULE C 0 0 0 0 0
015075 SCHOOL HEALTH TITLE XXI 1505068 0 1509068 0 1501068
015075 SCHOOL HEALTH 0 0 0 0 0
015075 SCHOOL HEALTH 0 0 0 0 0
015075 SCHOOL HEALTH 0 0 0 0 0
FEDERAL FUNDS TOTAL 1 , 103 ,833 0 191035833 0 1 , 103 , 833
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020 PUBLIC WATER ANNUAL OPER PERMIT 3 , 564 0 31564 0 31564
001020 NON-SDWA SYSTEM PERMIT 0 0 0 0 0
001020 SWIMMING POOLS 545085 0 545085 0 54,085
001020 BODY PIERCING 270 0 270 0 270
001020 MOBILE HOME AND PARKS 135414 0 13 ,414 0 139414
001020 BIOHAZARD WASTE PERMIT 15 , 645 0 155645 0 159645
001020 TANNING FACILITIES 2,242 0 29242 0 21242
001020 MIGRANT HOUSING PERMIT 0 0 0 0 0
001020 FOOD HYGIENE PERMIT 17 ,350 0 17,350 0 175350
001020 TATTOO FACILITY SERVICES 1 ,643 0 19643 0 17643
001020 PUBLIC WATER CONSTR PERMIT 0 0 0 0 0
001020 SAFE DRINKING WATER 0 0 0 0 0
001092 OSDS PERMIT FEE 222 ,777 0 2225777 0 2221777
001092 AEROBIC OPERATING PERMIT 0 0 0 0 0
001092 NON SDWA LAB SAMPLE 0 0 0 0 0
001092 ENVIRONMENTAL HEALTH FEES 129988 0 12,988 0 12 ,988
001092 I & M ZONED OPERATING PERMIT 0 0 0 0 0
001092 SEPTIC TANK SITE EVALUATION 0 0 0 0 0
001092 OSDS VARIANCE FEE 0 0 0 0 0
001092 OSDS REPAIR PERMIT 0 0 0 0 0
001170 LAB FEE CHEMICALANALYSIS 0 0 0 0 0
001170 NONPOTABLE WATER ANALYSIS 0 0 0 0 0
001170 WATER ANALYSIS=POTABLE 0 0 0 0 0
010304 MQA INSPECTION FEE 0 0 0 0 0
001206 CENTRAL OFFICE SURCHARGE 33 ,344 0 335344 0 335344
001093 CHD ON-LINE BILLING FEE 0 0 0 0 0
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 377,322 0 377,322 0 3773322
5. OTHER CASH CONTRIBUTIONS - STATE
010304 STATIONARY POLLUTANT STORAGE TANKS 0 0 0 0 0
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 336,253 0 336,253 0 3365253
031005 CHDTF CASH TRANSFER 0 0 0 0 0
OTHER CASH CONTRIBUTIONS TOTAL 336,253 0 3365253 0 336,253
6. MEDICAID - STATE/COUNTY
001056 MEDICAID PHARMACY 0 0 0 0 0
Version : 2 Page 3 of 7
'_- O O N M O O o O 00 O O fV O o O O O O O O O O O � O o O o O O O O
O 00 O O O
N v� [� 7 0o v-� �D ^ 00 0o n QN+ N 7
('n N � [� r M 7 Q� M 9tp rO ^ N O
v�j N ^ N 7 O
N N 7 N (d
�. N M
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o O O O o r o n o 0 ON o o � 00 O
ncq 00 Q N
N
O
' V rA
N O
T. .. N
(y M
r 3P ', O %%o O N _M O C V O O w O O N O O O o O O O O O O O n O O O O 0 0 0 0 0 0 0 0 0 0
0 O
AAIN
N N r 7 00 ^ 00
AN IN
4 • "' _ I O � O N M O C R O O M qO o N O O o O O O O O O O O O O O O 0 0 0 0
0 0 0 0 0 0 0 O
AN
, 00
eee
11, _ N O� M
cq R O� M 00
N R N
All
Ar
r ell
, A
r
yyOr All "~ O o o O O O O O O O O O O O O o O O o O O O O O O O O O O O O O
O O O O O O O O O o
Ir
..
AlIAN
I All! ell
ell r
IDr
� F
.: EAra-
ell, .: ,
A
z
a
%
'A r
r a
I AreaF
w Q
z A x
a w z
I AN
laNe
r ever,'' % ley
IZVI� p z w U Q -a d U x F- w z z F
Ir r
U z > > O x
�¢' v z U pa
A ell' y y c ¢ a ¢ [4. >' w w O r'' ¢ y Q p x w U z Ea. Z cC •� ., v� U
O z
E- z w a F w w OU U o a F- .� w H z0 x Q F U > w
ANN rsN v %eANA A,
a z W A H a U W a a ¢ z Aw x H w x ua. C01z 3 ¢ w -AT
0 d z n O w o 3 w x w w O o w U a
AN riAl
U m A ¢ 2 w ¢ Q A 0 0 ¢ O w O A a x z C] z
ANN r,
'Ir NAM A
cn
U U U U U U U U U U U U a U U U U U U U U U Q 04 z
> U cG w O Q x c� O
F �= O [- w 0 v�
F- Q W F ¢ x ¢ A U Z x W Z
o a Q
'W� F
Q
U Q O
sr
p A o 0o rn ^ N M rn — N M oo rn -- oo N v a n oo c o U .a o 0 o
r W r o0 00 00 00 00 qrn a0rn o n n n n o n v n oo r. a 0 0 0
e1,ll A'rr �� 0 0 0 0 0 0 0 0 -- -- N o 0 0 0 0 0 0 0 -- o — Q a O
0o r oo y
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 W Q
r r , o 0 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 r o 0 o Q O
00 D\ O 7 O O O — [� O+ 00 O O O ao O 00 O O O ON O O M O O O O O O O �O O O O O — O
o
T h 00 M M N 7 LO
\O h O N
7 oho O N �
00 CO) [� M O M N QI
N CL
X '
z O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O
O O O
O O
I IV
e I?
IV
I
en
\ ' O r O Nen O O O O r N O O O M O O O O O O O O O
O -- O
g nq oo �o vi O N �o �o O' 00 M M
00
7
Ile 1
mt
VII
le 11 Zee 1�1 ellIV IV I rb
N
IV
VVV
O O Rn� N M O O O O r 00 N
00 O O O O O O O ON O O O O O O O O O O O O OTr
O
, . m en
00 �o �n O N �O �O 00 O r N
M 00 M V1 ,r,
O v V M
,` ... N
IV
xiIle' y
Ile elI IVs� 0 0 0 0 0 o Z 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Ile
le UVeIle
119
Z
� 11,
F
F U
XIVm
X"Ver .
Vy
p E zF-
e9 lee
X115 ,
z X X U
lee
.1,911
h d F¢ E¢- a Zd tWa O O O z E¢ Cw7 w
OUC > O U Z F C4 FK E w a z ¢ v x z
O x x w Q O w z a U > Ed. R' w c7
Pw
E Z F rx w x o F OLLJ
KIV
Fw- W
r z ILO
w w O F a z F- z O 0 O w
a Q O u. O U Q ❑ n R z CC '" O O A- F- x >
VV 9 IV x O O a O z Q �; W u z Q ¢ W ¢ U O U z
U U
pp a� U x acon cn
u- O � z Q m z Q Q w U F- ¢ w ¢ O U Ln W U O O
a U ¢ W U U W a
xx Fa„ z z p z U z ¢ �'¢ ° ¢ w F Q z z U 0 x F" F- z D Qa' ti A z Q
Q p U w U
Ile,IV
xC F F W U w �' ¢ [= cn
VI
IV
O
If wWX�Pe 11
15 4
U d
rV a o a �, �, z � � � �- � w x FU3u �- wW Joao oo � �, x z
z d F C7 U F O w o A U Fa Q ^a arAL -� O z w x 3
' rfeO O U O U z [�. F� W x C] n O W F F O IV a W C4 d �F�yy x W w �¢
Gc1 W F F^ vi U aw. X ¢ ¢ W ¢ K W cnN
U U O U cs F- x o x z = U oG
W v� x u. Ll C7
NN
We
O N M �"� w �D r t� [� l� D\ 1n [\ r N 7 d F" O N N vii 1� D\ a O O
O O N N N O O O
n r ^ W ^ -- .�. _ _ _ ^ ^ — ^
,y O O O O O �+ O O O O O O_ O O O O V1 O 0 0 0 0 0 0 O O O O O M
M V O O O O O O O
_ _ _ _ _ _ _ �n �n t� 00 00 O O O O — N N N —
? VV A 00 O O O O 00
O O O O O O O O O O O O O O w 00 00 O O O O O O O O O O O O
`
o 0 0 0 o A o 0 0 0 0 0 0 0 0 0 0 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 o N
I IV
a '�
ti
00 00 O O O O O O O O O O O O � O O O O O O O O O O O O O O O O M � O O O O
++ Cn CD o ^ M o r o CD
N pp M
n eela
Iley O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O M O O
O
4 O r D
+ n
• 'w ' z N
4b
z
Q'
' eO O O O 00 C O O n M O O O O O O O O O O O O O O O O O O O 7 O O O O
el O O O O O O O O
O
Ile00N
Ile
Ile I % Ile I
INI
1 14 11 11 1
�� ?
O O O O 00 00 O O M O O O O O O O O O O O O O O O O O O O O O O O O O
O O O O O O O
55 vl �D O M
Ile
N 00
K
I we
O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 0 0 O
O O O
e eel
ke
elee
' w
ze
l ' U
' "
w
Ilk
III
Ilk
Ile
" w
yl
ZI
w EE-
III' I Ilk
Z r Z UIle
Ile
Q Fw- O z z ° c��
wjr
%I Ile
` Ca w e O COO ° oC ¢ Z O O w w
OU 3 `" z z
le
U 3 Ex O F- W O z a z z x O x ww z O z z `n Z U z a z Q
Q
a ¢ F O > a ¢ ¢ ¢ E A z C] ; F F- U Q .� w Q ❑. W d w
w
a1, Ile
� x w I ell k , F. O O x z ri z rL Q O p W O x Q Q [— c7 " W 3
w [ - F-
OFw x a ] ¢ w a Z z o w Q U Q p W
•a O D U U U U U U U U U U ¢ ¢ u. m U a: w Qp ¢ r1 o F a w w U Z 3 w 0.
Z z U ¢ ¢ U
A x w w w w w w w A w w w x p Q w c7 p w W W z w v' O W x O > W
A w w w w
xxxxxxxxzxxQF � � � Qoz¢ a W � W � w O Qz �
Ile I INz ¢ Q Q Q Q D Q Ll Ca Q Q C] z w w z U z w w O Q w U a Z
' Q w p ¢ q� p w w u z F A zQ �- z F- Q U Q
U z¢ ¢z ¢z¢ z¢¢ ¢z z¢ ¢z z¢ z¢ ¢z az ¢z r O Ueel
w w C] cC 3 .W7 w p W p
11 11 w ° `' z p w u p O a O N
Ile
a C7 C7 C7 C7 C7 C7 C7 C7 C7 C7 C7 C7 n w ¢ cG u, r� U ¢ w 3 U Q A
F cn
o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o o o cMi o o � v o o 0 o W ra o 0
0 Z c
Q o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o o� 00 00 _ 0 0 0 0 0 0 0_ o_ o_ ,�, Q 00
o 00
o_ CO O
^ ^ ^ ^ ^ ^ ^ O O O ^ N O C O O ^ O E.,, ^ M cel O O `
le I '.r O O O O O O O O O O O O O O O O O O O O O O 0 0 0 O O O O O O N O O O O U wMr
rr ~
c O O O O O O
0
49
E� r CD
N
O
NElm
d C O O O O O O O
000 r
ryR"
.+ ..:
Y M
IN I
O O O O O O O
I ell
CF
V
e N
IN
� o 0 0 0 0
� �
ell
el eel
IN
wIANIN
kle lei
ell IN
o o O o O o O o
n, Nn%1I ellF
Nile kn
NI z
IN
U O
�+' N ell
U
" � .. A
IleZ
La
„ -I led
b a
�, w w
IN IN
z
.� v v
IN
Ne
I IN ill I I
IN
y Ile'
Ile 11
O c0.n” ra
IN
ell I ' IN
Y 'ej 1 %
a O
1 15
C r
IN I IN
x co o�
ell
ell
ill
C~ w w ¢ 0 0 F
IN, s 04 U z Z .7 a
IN
F. w U UIN
I Nil
IN
C4
V E-
se IN ell
o Z a z
z O
a H wwwoo, cl ill 11
a
ev
IN 51511 I'll,
F a U U w w U
IN
S x z x x F N
N, IN 11NY I Ile I el
U d > > O O Q
IN III 'fee
a O E,
I ell
IN Ili
' A O W Z g
a ._ Ile
lei INH N
0 >
N
O O M ^ O M n O O r M N m O� N N N v1 D` '/� 0
y�i �O o0 N vl 00 �n 00 vl �o N O O 1� r` v1 N 7 7 O 7 �O 7 N O
n �O M 7 ^ N � m O N 7 V 00 ^ N 7 D, 7 N Nfb
N 1�eel , " I
O w O N
[�n N N �O 1� 7 �O M 7 00 �O N M 00 O� 1� ON �D vi O 7 ON vi N 7 W 1�
7 M \D 00 �O 00 M N h 00 W Vl h D1 N M N N � 00 N N 1� M N
AAA
la In in 11 A I
A co
IN
O �/"� �D O O O 1� O O O O O� O O O O M O ON M M O 1� O �O M N 00
_ N O O l� 00 N N N DD O� M 00 N M N O
N N O 1� 7 O 7 M ^% O` r M N% 1` 00 � N N oo N �n
oo vi N 7 R �0 00 O+ff, M 00 7 00 M t` t` N
N
11 11 AAA An e5
" 7 �O M o0 7 M �O O 7 O O N**
O M 7 7 IN I
O O 7 O N O O oo n �O O O
AN
In
�O N M v� M 7 N t` 00 N a0
11 % lee " .� , .w H 7 7 v� 7 00 D` N N t` M V
7� - V 1� ON �O N 7 ^ �O V N M 00 Q` 0Re 00 M N N N M DD r
N
p ' „ - 0 7 M 00 N O 00 00 Vl ^N.. M N 00 N M N
in
W
nine
ne�A
ANN
1q vo vi ac M O qtt 1` ro O O O O t� O O -- 00 �O O ^ O ^ O 0 '� M M O ^ o0 00 O+ ON 4tr
N o0
.. . 00 Q\ O M O'� M 7 ^ 1� O\ l� 00 7 D\
,l IAn ii. % OWNin IN AN ' AN
Is
M W v� �n 1� M D` ^ 7 M N O O� D\ O+ O N O� N �n l� ^ N Q` O 0 M
^ O O 7 00 ON N
ao N '� '� in N 7 O\ � CD
N N 00
, ^ 000 7 � N M �O N Me� AN Ann An ^
^
AN
All J,
eel Aa
Z ao O �n 7 O_ 7 O O M 7 O O \O o0 �O 7 0` N O M O
111 .1 1 O ^ r4qzr ^ O qzr O N N Qui 0 00
6Ale '�'� �f .+. opo vii v'�i l� 00 C>M OM+ 'n M vii n ^ N O�On
l� Off, O� Mft
�O
11,
IN I - ca '" •� 00 �O N 7 t` O vi vi vi O 00 0o O� N
�ee �°" � O 00 7 N v'� N 7 Q\ h N �D N 00
IIA A M
Ali A
a , N t` r O� 7 O N O w �O l� O N O M O 00 �n �O O �n �n v� �O O 7 00 An in ,
Ili, NJ lee ao O �
�' '� [� N [� \O O ^� 00 O 00 M 00 ^' �D M Q� �O 7 M D\ N 7 Vl V1 V1 00 --� V1
�fi '� 7 DD 00 M �O M -• Vi V'f D\ [� M 1` ON 00 r� �O O+ 7 O 7 h DD 0 01 M DD [� t` t` O
A O r M I I lee IS N vii N M 00 N N N 7 N M oo O 7 �_
On rt an n �n 7 r O r N
Nip Ar
� AAA lee t i �. 00 O 7 O 7 O �o O �o v� 1� O O M "Cr O O �D oo N O M
O
ee ��ll , Do t` D, v'� 00 O M O N 7 y N N �O 7 O+ 1� ^ 00 [� Q� N
00 y� h v'� O n M 7 M M O T O
66�,, On
w '" AAA Ann 6 Ile O+ 0�0 ^ 00 7 � N M N N N N vi O N 7 O\ O+ O to 0 N 070 0o O+
N
11
A, 11 zn�
00 O D\ t` a, O 7 O O
v� 7 ^\ ^ 7 M N N
_ O O 1� 7 O O ell O O !` O O M O O O N N 0 O� O 0 N N 0 O MTr
; O M ^ N M 7 N N 00 ON 7 1�9tr 00 eq
6 If AN
^ ^ 7
pAll
' �p ..- .... .-- 00 M M M M M O� N 0 Vl 00
An
�u Do
N
in An , 1 11
=t h,;, �-, "F1, In � M O ^ O� M N O O O O O+ 00 N O N O O O ^ 7 N O O N ^ 00 �O 00 M N M M
D0 O O00
. I Ill � C p ry 7 0�o 00 W O 7 �O N ^
%: 1111'er ' 00 M M N M Vl N N
InIn IIANAn
c
AAA
1 in AN ' Q � ag n _. D` N t` n [� O O O 7 M 7 O 00 7 O -- 7 00 ^ M 7 W �O �O ^ ` ) O 7 l� O� M
N M
- N Os 1` N 7 00 O 1� O � O � ^ h O ^ 7 Ax 7 Q\
N DD ^ M O M O+ 7 O -- O
16
n�' �n �n N O N O N O .-. O O+ O M o0 N O ^ 7 O O O .-. �n O O O O
11 1 .5. W N All
N M
e line
(, F Q N" i11 n
a y Oz
A AN AN
N
A 61, N M z IU) w
U F w v W � w U
Iz, E 7
� ��. c ^ S FS- a .F7
1�z 11 'AAAs� ax. .., d ^ Cn N_ O O N �-1-1 ^a O d O VI . . �O W
e AN
s W .. �¢ W W U F— .N., ¢ Q .a d W o` zz oo a; •M., v' N
AVAaAAA AAA , A M o fn I
o �_ p Q U " w O ¢ S S W O W rn LLI >0F ¢ �' E- a
&:� W z U W z ¢ � �. >a' z °- N U z p z S p W F 3 z 3 ❑a W p ^a F
el 66� rl z fx W > O o W W O S o U F W Q
pa O ¢ ¢ U W w " °O A ai F- Z ¢ w S w M p F- 7 U z m O VI oo U a U
166 %, jYAAn 1a U S x U Z v Q a v W to "� >' Q ui M w
d o F- > z 04 W d w z p V z a W w ¢ m m J U 04
U " z [ wm i' w a S .a U `n W w Z C7 F > E S > w S W = x p v' y. 3 E w ¢ O
An I�N C0� r.. W W Z W W > S a U W Q > W W 0. R' F. �» F a N U p 0.. W 10 z W C1
% AAAAn � � - z > > w v, w [ - Q F- d y w w 2 x Q �„ Q z y ¢ d O c �¢ w w �w w w j w ¢
ANNa ¢ v O Q W W d D a F- z a F- 2 E- tMPA a, O v� ¢ ¢ ¢ ` rx
IN, AN 11 IFS � 'A % I a v� a ¢ �, w S ¢ O Q a p `n wx n x x x U .. v p 3 o m w
¢ F
4 : N cn n rn M F- C] S w F- z V v 3 °' > x W S -� W ^a OCG > R ¢ p U W Q F a x 0.
a z c
j An
y O o A p p o z F U Cw7 a O PG z v a O a a a a F d z F ¢ > o p >- a O
Q ¢ a O Q S 0. O ¢ a: W :: ¢ tp > o 'v p c7 N
% U C] > > > pQ m o w w x v v ¢ LU o w v o o w " p 04 Q C7 �m u. °m c�7 j
An 6li z 2 S p F- U S o. x > O U F- 3 3 s S U S U U Ca V U a a
d
In 11N v NNN 1 �
.; � gN III, u - In, �- .� * ;� qua ', ' ' s c erreenr + "` .a In N
% % ere Nerl
s : y 4 ? ° 3 .}; .Z
,3 �. `. ,. g `tel'
NI leInee 1'
IINI'
% JMllaone Sta Ping,: Clients� errrice x• i� Expe>ri hares 'ragt m ryiceareaWerye
ithinWNIeN
Each Level > miceeIIr,
Octokrer-1 � 2U13, : hep#eiber 3t}s 2O14
I ere I In 11
eII
II
rNI
nN
IIn
el
lI
eNr
t �ArIC , i7CI1CA3� fk' IAfl
��a 4 � cilC1 vl lit ` it a l{I 4 tlr eI
lI
(T1 II
eIn
afl
` < � (Q,4�} ¢ „ i3tlltS Sit4 {1 ?bd doilArss iy} tatC o» ty Total
C. ENVIRONMENTAL HEALTH :
Facility Programs
HOUSING,PUBLIC BLDG SAFETY,SANITATION (353) 0 . 07 8 50 104 1 ,374 1 ,604 11602 0 6, 184 61184
MOBILE HOME AND PARKS SERVICES (354) 0. 18 53 129 31265 25798 3 ,265 31263 12,329 262 12, 591
SWIMMING POOLSBATHING (360) 0 . 98 361 827 18,279 15 ,664 18 ,279 18,271 64,028 61465 70,493
BIOMEDICAL WASTE SERVICES (364) 0. 52 277 355 95005 75717 9,005 9,002 32,788 1 ,941 34, 729
TANNING FACILITY SERVICES (369) 0 . 02 10 24 410 352 410 410 1 , 556 26 15582
Group Total 2 . 44 840 19899 45 ,618 395091 45 ,618 45 , 595 141 ,922 345000 1759922
Groundwater Contamination
STORAGE TANK COMPLIANCE (355 ) 0. 00 0 0 0 0 0 0 0 0 0
SUPER ACT SERVICE (356) 0. 14 51 61 25754 25360 29754 2 ,754 8, 760 19862 10,622
Group Total 0 . 14 51 61 29754 21360 2 ,754 25754 8 ,760 1 ,862 109622
Community Hygiene
TATTOO FACILITIES SERVICES 0 . 07 0 40 15369 1 , 173 1 ,369 11369 55160 120 55280
COMMUNITY ENVIR. HEALTH (345) 0. 77 0 285 8,200 7,027 8,200 8, 196 0 315623 311623
INJURY PREVENTION (346) 0 . 00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0. 00 0 1 10 9 10 10 38 1 39
PUBLIC SEWAGE (362) 0 . 11 3 39 25074 15778 2,074 2,074 0 8,000 8 ,000
SOLID WASTE DISPOSAL (363 ) 0. 00 0 0 92 78 92 91 0 353 353
SANITARY NUISANCE (365) 0 . 05 4 45 996 854 996 996 0 39842 3 ,842
RABIES SURVEILLANCEICONTROL SERVICES (366) 0. 22 19 150 49494 35851 45494 4,494 0 17 ,333 17,333
ARBOVIRUS SURVEILLANCE (367) 0. 01 0 0 173 148 173 174 0 668 668
RODENT/ARTHROPOD CONTROL (368) 0 . 01 0 9 162 139 162 163 0 626 626
WATER POLLUTION (370) 0. 19 0 400 41269 3 ,658 4,269 4 ,266 0 169462 16,462
INDOORAIR (371 ) 0 . 10 0 80 15993 1 ,708 1 ,993 15993 75564 123 71687
RADIOLOGICAL HEALTH (372) 0. 00 0 0 149 128 149 148 0 574 574
TOXIC SUBSTANCES (373 ) 0.48 2 35 9,308 7,976 95308 9,303 0 35 , 895 359895
Group Total 2 . 01 28 1 ,084 339289 28 , 527 335289 33 ,277 125762 115 ,620 1289382
ENVIRONMENTAL HEALTH SUBTOTAL 10. 56 2,027 99513 200,407 171 , 734 200,407 2003324 476, 761 2965111 772, 872
D. NON-OPERATIONAL COSTS :
NON-OPERATIONAL COSTS (599) 2 . 00 0 0 37 , 582 32,205 37, 582 37 , 567 71 ,000 739936 1443936
ENVIRONMENTAL HEALTH SURCHARGE (399) 0 . 00 0 0 8,336 8 ,336 8 ,336 85336 339344 0 33 ,344
MEDICAIDBUYBACK (611 ) 0. 00 0 0 44,224 44,224 44,224 44,225 176,897 0 176, 897
NON-OPERATIONAL COSTS SUBTOTAL 2 . 00 0 0 909142 84 ,765 90, 142 90, 128 281 ,241 73 ,936 355 , 177
TOTAL CONTRACT 132 . 05 40,522 3265319 29376,766 21051 ,081 29384,766 29391 ,864 35653 ,500 59550,977 9,2041477
Version : 4 Page 2 of 2
ATTACHMENT III
INDIAN RIVER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants , loans ,
contracts (except contracts of insurance or guaranty) , property, discounts , or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance . The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period ) , if so requested by the department.
The applicant assures that it will comply with :
1 . Title VI of the Civil Rights Act of 1964 , as amended , 42 U . S . C . , 2000 Et seq . , which prohibits
discrimination on the basis of race , color or national origin in programs and activities
receiving or
benefiting from federal financial assistance .
2 . Section 504 of the Rehabilitation Act of 1973 , as amended , 29 U . S . C . 794 , which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance .
3 . Title IX of the Education Amendments of 1972 , as amended , 20 U . S . C . 1681 et seq . ,
which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting
from
federal financial assistance .
4 . The Age Discrimination Act of 1975 , as amended , 42 U . S . C . 6101 et seq . , which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance .
5 . The Omnibus Budget Reconciliation Act of 1981 , P . L . 97-35 , which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance .
6 . All regulations , guidelines and standards lawfully adopted under the above statutes . The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors , transferees , and assignees
for the period during which such assistance is provided . The applicant further assures that all contracts ,
subcontractors , subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes , regulations , guidelines , and
standards . In the event of failure to comply, the applicant understands that the grantor may,
at its
discretion , seek a court order requiring compliance with the terms of this assurance or seek
other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied .
ATTACHMENT IV
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description Location Owned By
Clinic , Dental , Vital Statistics , 1900 27th Street County of
Environmental Health , WIC , Vero Beach , FL 32960-3383 Indian River
Administrative Headquarters
36 , 475 sq . ft .
Gifford Health Center 467528 th Court Indian River County
10 , 642 sq ft Vero Beach , FL 32967- 1330 Hospital District
Co- Located Site .
WIC 21 South Cypress Street City Of Fellsmere
Fellsmere , FL 32948-6714
ATTACHMENT V
INDIAN RIVER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT,
CONTRACT YEAR STATE COUNTY TOTAL
2011 -2012 $ $ $ -
2012-2013 $ $ $ -
2013-2014 $ $ $ -
2014-2015
2015-2016
PROJECT TOTAL $ - $
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME : N / A
LOCATION/ ADDRESS :
PROJECT TYPE : NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE :
PROJECT SUMMARY: Describe scope of work in reasonable detail.
ESTIMATED PROJECT INFORMATION :
START DATE (initial expenditure of funds) :
COMPLETION DATE :
DESIGN FEES : $
CONSTRUCTION COSTS : $
FURNITURE/EQUIPMENT $
TOTAL PROJECT COST: $ -
COST PER SQ FOOT: $ #DIV/0 !
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans .