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HomeMy WebLinkAbout2005-310 0 _ 10 Jeb Bush M. Rony Frangois, M.D. , M . S .P.H. , Ph. D. Governor Emig Secretary, Department of Health INDIAN RIVER COUNTY HEALTH DEPARTMENT September 30 , 2005 Mr. Jason E . Brown , Budget Director Office of Management & Budget Board of County Commissioners 184025 th Street Vero Beach , FL 32960 Dear Mr. Brown : Enclosed you will find a fully executed 2005/2006 contract between Indian River County Board of County Commissioners and the State of Florida Department of Health for your files . Please call me if you have any questions . DL . ely , AO-C -� Kline , R . N . , M . P . H . County Health Department Administrator JLK/sah Enclosure ZO � OCT 3 20 ativrR:�p Jean L. Kline, R. N., M.P.H. pT� Telephone 772-794-7400 County Health Department Administrator Suncom 259-7400 1900 27th Street -t Fax 772-794-7453 Vero Beach, FL 32960-3383 Op` i v CONTRACT BETWEEN 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 2005 =2006 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 , 2005 . RECITALS A . Pursuant to Chapter 154 , F . S . , 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 . It is necessary for the parties hereto to enter into this Agreement in order to assure 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 , 2005 , through September 30 , 2006 , 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 in the environment which may contribute to the occurrence or transmission of disease . I 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 , 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 11 , Part II is an amount not to exceed $ 3 , 466 , 295 . 00 (State General Revenue, 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 . ii. The County' s appropriated responsibility (direct contribution excluding any fees, other cash or local contributions) as provided in Attachment I I , Part I I is an amount not to exceed $ 834 , 418 . 00 (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 Attn : Accounts Receivable 190027 th Street 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 day-to-day direction of the Deputy State Health Officer. The director/administrator shall be selected by the State with the concurrence of the County . The director/administrator of the CHD shall insure 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 Client Information System/Health Management Component 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 3 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 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. 4 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 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 State Health Officer has approved the transfer . The Deputy State Health Officer 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 , dated September 1997 , as amended , the terms of which are incorporated herein by reference . 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 , 2006 for the report period October 1 , 2005 through December 31 , 2005 ; ii. June 1 , 2006 for the report period October 1 , 2005 through March 31 , 2006 ; iii. September 1 , 2006 for the report period October 1 , 2005 through June 30 , 2006 ; and iv. December 1 , 2006 for the report period October 1 , 2005 through September 30 , 2006 . 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 assure 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 assure 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 , 2006 , 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 : Ernesto G . Rubio Jason Brown Name Name Business Manager Budget Manager Title Title 190027 th Street 184025 th Street Vero Beach , FL 32960-3383 Vero Beach , FL 32960 -3365 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 37 page agreement to be executed by their undersigned officials as duly authorized effective the 1sday of October , 2005 . BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR INDIAN RIVER COUNTY DEPARTMENT OF HEALTH SIGNED BY . C. SIGNED BY : NAME : Thomas S _ I owther NAMEIohn O . Agwunobi , M. D . M . B . A. , M . P . H . TITLE . f. hairman TITLE : Secretary DATE : September 13 , 2005 DATE : ATTESTED , / All 10*7�f�f �f A.&A SIGNEDSIGNED BY : NAME : PATRICIAo'! ' F� s. «� C' ELY NAME : Jean L . Kline , R . N . , M . P . H . TITLE : DEPUTY CLERK TITLE : CHD Director/Administrator DATE : oc� � DATE : AP ROVED : my AdrrAnistrator APS' Q O FORM AN LS IENCY i EL SSIS NT , OUNTY ATTO NEY 9 ATTACHMENT 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 Requirement 1 . Sexually Transmitted Disease Requirements as specified in FAC 64D-3 , F . S . 381 and Program F . S . 384 and the CHD Guidebook . 2 . Dental Health Monthly reporting on DH Form 1008 * . 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 . requirements detailed in program manuals and published procedures . 4 . Healthy Start/ Requirements as specified in the Healthy Start Standards Improved Pregnancy Outcome and Guidelines 1998 and as specified by the Health Start Coalitions in contract with each county health department . 5 . Family Planning Periodic financial and programmatic reports as specified by the program office and in the CHD Guidebook, Internal Operating Policy FAMPLAN 14 * 6 . Immunization Periodic reports as specified by the department regarding the surveillance/investigation of reportable vaccine preventable diseases , vaccine usage accountability , the assessment of various immunization levels and forms reporting adverse events following immunization and Immunization Module quarterly quality audits and duplicate data reports . 7 . Chronic Disease Program Requirements as specified in the Community Intervention Program ( CIP ) and the CHD Guidebook . 8 . Environmental Health Requirements as specified in DHP 50-4* and 50-21 * 9 . HIV/AIDS Program Requirements as specified in Florida Statue 384 . 25 and 64D-3 . 016 and 3 . 017 F . A. C . and the CHD Guidebook . Case reporting on CDC Forms 50 . 426 (Adult/ Adolescent) and 50 . 42A ( Pediatric) . Socio-demographic data on persons tested for HIV in CHD clinics should be reported on Lab Request Form 1628 or Post-Test Counseling Form 1633 . These reports are to be sent to the Headquarters HIV/AIDS office within 5 days of the initial post-test counseling appointment or within 90 days of the missed post-test counseling appointment. ATTACHMENT I ( Continued ) 10 . School Health Services HRSM 150-25* , including the requirement for an annual plan as a condition for funding . *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 Share Estimated County Share of CHD Trust Fund of CHD Trust Fund Balance as of 09/30/05 Balance as of 09/30/05 Total 1 . CHD Trust Fund Ending Balance 09/30/05 $518 , 309 . 00 $ 441 , 522 . 00 $ 9597831 . 00 2 . Drawdown for Contract Year October 1 , 2005 to September 30 , 2006 $ ( 180 , 213 . 00) $ (39 , 505 . 00 ) $ (219 , 718 . 00) 3 . Special Capital Project use for Contract Year October 1 , 2005 to September 30 , 2006 $ _ $ _ $ _ 4 . Balance Reserved for Contingency Fund $3381096 . 00 $ 402 , 017 . 00 $ 740 , 113 . 00 October 1 , 2005 to September 30 , 2006 Note : The total of items 2 , 3 and 4 must equal the ending balance in item 1 . Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects , and mobile health vans . Pursuant to 154 . 02 , F . S . , At a minimum , the trust fund shall consist of: an operating reserve , consisting of 8 . 5 percent of the annual operating budget, maintained to ensure adequate cash flow from nonstate revenue sources . Working Copying ATTACHMENT IL INDIAN RIVER COUNTY HEALTH DEPARTMENT Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service October 1 , 2005 to September 30, 2006 Quarterly Expenditure Plan FTE's Clients 1st 2nd 3rd 4th Grand (0..00) Units Services (Whole dollars only) County State Total COMMUNICABLE DISEASE CONTROL: IMMUNIZATION ( 101 ) 5 . 62 45155 195875 158,941 85 , 155 91 ,744 61 , 731 218,664 178,907 3975571 STD ( 102) 5 . 56 648 2,604 58,767 64,817 50,096 55,597 77,954 1515323 229,277 A. I. D. S . ( 103 ) 3 .94 480 7,200 487779 51 ,849 46,392 47,614 505605 1445029 194,634 TB CONTROL SERVICES ( 104) 2 . 92 350 2, 100 27,484 35 ,701 29, 111 26, 173 23 ,694 94,775 1185469 COMM. DISEASE SURV. ( 106) 2 . 09 0 500 37, 582 245581 303720 455023 0 137,906 137,906 HEPATITIS PREVENTION ( 109) 0. 00 0 0 0 0 0 0 0 0 0 PUBLIC HEALTH PREP AND RESP ( 116) 2. 52 0 0 425532 459811 329690 109, 569 0 230,602 2305602 VITAL STATISTICS ( 180) 1 . 18 0 0 135596 149207 119672 12,625 527100 0 525100 OMMUNICABLE DISEASE SUBTOTAL 23 . 83 53633 32,279 3875681 3229121 2925425 358,332 423 , 017 9379542 15360,559 B. PRIMARY CARE : CHRONIC DISEASE SERVICES (210) 2. 85 2, 700 65000 69,372 81 ,061 51 ,821 57,862 52,023 2085093 2605116 TOBACCO PREVENTION (212) 0. 00 0 0 0 0 0 0 0 0 0 HOME HEALTH (215) 0. 00 0 0 0 0 0 0 0 0 0 W. I.C. (221 ) 8 . 84 4, 710 30,000 945561 116,812 98,426 120,023 0 429,822 4295822 FAMILY PLANNING (223) 10. 05 39000 139000 137,292 149,591 108,035 135 , 141 286,232 243 ,827 5305059 IMPROVED PREGNANCY OUTCOME (225 ) 0 . 00 0 0 0 0 0 0 0 0 0 HEALTHY START PRENATAL (227) 3 . 98 650 14,000 593241 70,942 42, 768 515241 2241192 0 224, 192 COMPREHENSIVE CHILD HEALTH (229) 24 . 68 4,246 20,000 366,286 378, 574 303 , 859 3963196 895, 847 549,068 1 ,444,915 HEALTHY START INFANT (23 1 ) 3 .23 150 10,440 33 , 871 48,219 315461 47,210 1603761 0 160,761 SCHOOL HEALTH (234) 7 . 00 0 180,000 1025708 1159995 95 , 164 1113602 49000 421469 4255469 COMPREHENSIVE ADULT HEALTH (237) 40. 66 65690 42,450 6105554 731 ,965 621 ,718 774,903 1424,353 1 ,314, 787 2,7395140 DENTAL HEALTH (240) 12. 04 4,700 175015 201 ,628 229,352 2045096 232,353 607,200 260,229 867,429 RIMARY CARE SUBTOTAL 113 .33 26,846 332,905 1 ,6759513 1 ,922,511 155575348 1 ,9265531 3 ,654,608 3 ,4279295 750815903 Co ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COASTAL BEACH MONITORING (347) 0. 25 578 720 6,998 79431 61043 75793 0 28 ,265 28,265 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.31 47 355 3 ,270 4,435 85335 31533 8,808 10, 765 193573 PUBLIC WATER SYSTEM (358) 0. 04 2 55 507 1 ,732 986 1 , 141 0 4,366 4,366 PRIVATE WATER SYSTEM (359) 1 .24 630 11150 14,469 165611 9,582 25 , 106 52,614 135154 65, 768 INDIVIDUAL SEWAGE DISP. (361 ) 10.44 4,290 11 ,500 138,956 166,417 1115301 185,052 96,276 505 ,450 6015726 Group Total 12.28 5,547 13,780 1649200 196,626 136,247 222,625 157, 698 562,000 719,698 Facility Programs FOOD HYGIENE (348) 0. 71 100 430 7, 595 135310 9,995 6, 139 37,039 0 375039 BODY ART (349) 0. 01 3 3 0 62 199 388 0 649 649 GROUP CARE FACILITY (351 ) 0.38 128 210 75296 6, 151 5,644 3 ,424 0 22, 515 225515 MIGRANT LABOR CAMP (352) 0. 01 1 7 160 190 289 140 0 779 779 HOUSING,PUBLIC BLDG SAFETY,SANITATION (350)27 301 310 2, 707 35436 5 ,455 65622 18,220 0 18 ,220 MOBILE HOME AND PARKS SERVICES (354) 0.22 50 145 79116 492 35680 1 ,705 0 125993 12,993 SWIMMING POOLS/BATHING (360) 0. 70 340 880 12,071 10,395 45813 11 ,640 5 , 838 33 ,081 38,919 BIOMEDICAL WASTE SERVICES (364) 0. 61 290 330 75419 73055 14, 151 5,515 12,973 213167 34, 140 TANNING FACILITY SERVICES (369) 0. 07 10 35 101 21767 574 397 0 3 , 839 3 ,839 Working Copying ATTACHMENT H, INDIAN RIVER COUNTY HEALTH DEPARTMENT Part M. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Levet Of Service October 1, 2005 to September 30, 2006 Quarterly Expenditure Plan F+TE's Clients 1st 2nd 3rd 4th Grand (0000) Units Services (Whole dollars only) County State Total C. ENVIRONMENTAL HEALTH: Group Total 2 . 98 15223 25350 44,465 43 , 858 445800 359970 745070 95 ,023 169,093 Groundwater Contamination STORAGE TANK COMPLIANCE (355) 1 . 06 142 400 12492 125546 8,743 34,818 0 685599 685599 SUPER ACT SERVICE (356) 0. 39 12 140 4,208 6, 514 4,060 7,798 0 22, 580 22, 580 Group Total 1 .45 154 540 16, 700 19,060 12,803 42,616 0 913179 915179 Community Hygiene OCCUPATIONAL HEALTH (344) 0 . 10 0 0 1 ,232 19437 1 ,026 1 ,437 3 ,028 2, 104 5 , 132 CONSUMER PRODUCT SAFETY (345) 0 . 00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION (346) 0. 00 0 0 0 0 0 0 0 0 0 LEAD MONITORING SERVICES (350) 0 . 00 2 3 98 111 101 118 428 0 428 PUBLIC SEWAGE (362) 0 . 13 0 350 3,903 29081 2,768 2,376 2,671 8,457 115128 SOLID WASTE DISPOSAL (363) 0 .21 0 50 15882 1 ,996 4,964 25169 0 11 ,01 I 11 , 011 SANITARY NUISANCE (365) 0. 05 20 50 15303 407 1 ,097 649 3,456 0 3 ,456 RABIES SURVEILLANCE/CONTROL SERVICES (3667) 10 30 100 1 , 783 1 ,783 15784 1 , 784 71134 0 7, 134 ARBOVIRUS SURVEILLANCE (367) 0 . 00 0 1 9 9 9 9 36 0 36 RODENT/ARTHROPOD CONTROL (368) 0 . 01 0 20 285 287 239 197 0 108 1 , 008 WATER POLLUTION (370) 0 . 38 0 1 , 100 6, 500 6,500 65500 65501 18,981 7,020 265001 AIR POLLUTION (371 ) 0 . 19 0 80 29460 55484 2,229 25692 0 12,865 125865 RADIOLOGICAL HEALTH (372) 0 . 00 0 2 23 99 29 44 0 195 195 TOXIC SUBSTANCES (373) 0 . 15 75 130 25367 45148 25058 2,287 10,860 0 105860 Group Total 1 . 32 127 1 ,886 21 , 845 24,342 22,804 20,263 465594 425660 89,254 NVIRONMENTAL HEALTH SUBTOTAL 18. 03 75051 18,556 2475210 2839886 216,654 321 ,474 278,362 790,862 1 ,0699224 SPECIAL CONTRACTS : SPECIAL CONTRACTS (599) 0. 00 0 0 0 0 0 0 0 0 0 PECIAL CONTRACTS SUBTOTAL 0. 00 0 0 0 0 0 0 0 0 0 OTAL CONTRACT 155 . 19 39,530 383,740 253105404 29528,518 2,066,427 2,606,337 493555987 59155,699 9, 511 ,686 y � Working Copy ATTACHMENT H. INDIAN RIVER COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1 , 2005 to September 30, 2006 State CHD County CHD Total CHD Trust Fund Trust Fund Trust Fund Other (cash) (cash) (cash) Contributions Total 1 . GENERAL REVENUE - STATE 015050 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0 015050 ALG/CONTR TO CHDS 1 ,7305309 0 117305309 0 1 , 730,309 015050 ALG/CONTR TO CHDS-AIDS PATIENT CARE 10000 0 10000 0 1009000 015050 ALG/CONTR TO CHDS-AIDS PREV & SURV & FIELD STAFF 0 0 0 0 0 015050 ALG/CONTR TO CHDS-MIGRANT LABOR CAMP SANITATION 21919 0 2,919 0 2,919 015050 ALG/CONTR. TO CHDS-DENTAL PROGRAM 0 0 0 0 0 015050 ALG/CONTR. TO CHDS-IMMUNIZATION OUTREACH TEAMS 105227 0 10,227 0 109227 015050 ALG/CONTR. TO CHDS-INDOOR AIR ASSIST PROG 95939 0 9,939 0 91939 015050 ALG/CONTR. TO CHDS-MCH HEALTH - FIELD STAFF COST 0 0 0 0 0 015050 ALG/CONTR. TO CHDS-SOVEREIGN IMMUNITY 0 0 0 0 0 015050 ALG/CONTRIBUTION TO CHDS-PRIMARY CARE 15 ,789 0 155789 0 159789 015050 ALG/FAMILY PLANNING 36,022 0 36,022 0 36,022 015050 ALG/IPO - OUTREACH SOCIAL WORKERS CAT. 050707 0 0 0 0 0 015050 ALG/IPO HEALTHY START 0 0 0 0 0 015050 ALG/IPO HEALTHY START/IPO CAT 050707 0 0 0 0 0 015050 ALG/IPO-INFANT MORTALITY PROJECT CAT. 050707 0 0 0 0 0 015050 ALG/MCH HEALTHY START/IPO CAT 050870 0 0 0 0 0 015050 ALG/MCH-INFANT MORTALITY PROJECT CAT. 050870 0 0 0 0 0 015050 ALG/MCH-OUTREACH SOCIAL WORKERS CAT 050870 245000 0 2400 0 24,000 015050 ALG/PRIMARY CARE 204,314 0 204,314 0 204,314 015050 ALG/SCHOOL HEALTH/SUPPLEMENTAL 50, 548 0 501548 0 50,548 015050 CHD SUPPORT SERVICES 0 0 0 0 0 015050 COMMUNITY INTERVENTION PROGRAM 75,000 0 7500 0 753000 015050 COMMUNITY TB PROGRAM 943624 0 945624 0 94,624 015050 CONTR TO CHDS - DUVAL TEEN PREGNANCY PREVENTION 0 0 0 0 0 015050 ENHANCED DENTAL SERVICES 375900 0 375900 0 37,900 015050 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 0 0 0 0 0 015050 HEALTH PROMOTION & EDUCATION INITIATIVES 0 0 0 0 0 015050 HEALTHY BEACHES MONITORING 105328 0 105328 0 10,328 015050 HEALTHY START - DATA COLLECTION PROJECT STAFF 0 0 0 0 0 015050 LA LIGA CONTRA EL CANCER 0 0 0 0 0 015050 MEDIVAN PROJECT 0 0 0 0 0 015050 METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREV 0 0 0 0 0 015050 RED LEGISLATION - GAP GRANT (CAT 0503 10) 148,421 0 148,421 0 148,421 015050 SPECIAL NEEDS SHELTER PROGRAM 0 0 0 0 0 015050 STD GENERAL REVENUE 0 0 0 0 0 015050 VOLUNTEER SCHOOL HEALTH NURSE GRANT 0 0 0 0 0 GENERAL REVENUE TOTAL 2,5505340 0 2, 5509340 0 2,5505340 2, NON GENERAL REVENUE - STATE 015010 ALG/CONTR TO CHDS-REBASING TOBACCO TF 27,287 0 27,287 0 27,287 015010 BASIC SCHOOL HEALTH - TOBACCO TF 705001 0 70,001 0 70,001 015010 CHD SUPPORT SERVICES 0 0 0 0 0 015010 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 0 0 0 0 0 015010 FULL SERVICE SCHOOLS - TOBACCO TF 74,304 0 74,304 0 745304 015010 ONSITE SEWAGE RESEARCH FUND 0 0 0 0 0 015010 PACE EH 500 0 55000 0 5,000 015010 SUPER ACT PROGRAM ADM TF 8,070 0 85070 0 8,070 Working Copy ATTACHMENT H. INDIAN ' RIVER COUNTY HEALTH DEPARTMENT Part K Sources of Contributions to County Health Department October 1, 2005 to September 30, 2006 State CHD County CHD Total CHD Trust Fund Trust Fund Trust Fund Other (cash) (cash) (cash) ContributionsTotal 2. NON GENERAL REVENUE - STATE 015010 SUPPLEMENTAUCOMPREHENSIVE SCHOOL HEALTH - TOB TF 0 0 0 0 0 015010 VARICELLA IMMUNIZATION REQUIREMENT TOBACCO TF 5,474 0 55474 0 5 ,474 015020 ALG/CONTR. TO CHDS-BIOMEDICAL WASTE/DEP ADM TF 99580 0 9,580 0 91580 015020 ALG/CONTR. TO CHDS-SAFE DRINKING WATER PRG/DEP ADM 0 0 0 0 0 015020 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0 NON GENERAL REVENUE TOTAL 199,716 0 1995716 0 199, 716 3. FEDERAL FUNDS - State 007000 AIDS PREVENTION 51 ,778 0 51 , 778 0 515778 007000 AIDS SEROPREVALENCE 0 0 0 0 0 007000 AIDS SURVEILLANCE 0 0 0 0 0 007000 BIOTERR SURVEILLANCE & EPIDEMIOLOGY 83 ,306 0 835306 0 832306 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 0 0 0 0 0 007000 BIOTERRORISM NETWORK COMMUNICATIONS 0 0 0 0 0 007000 BIOTERRORISM PLANNING & READINESS 168,661 0 168,661 0 168,661 007000 CHD SUPPORT SERVICES 0 0 0 0 0 007000 CHILDHOOD LEAD POISONING PREVENTION 0 0 0 0 0 007000 COASTAL BEACH MONITORING PROGRAM 9,354 0 95354 0 95354 007000 COMP COMMUNITY CARDIO - PHBG 2004-2005 255000 0 259000 0 25 ,000 007000 COMPREHENSIVE CARDIOVASCULAR PROGRAM 0 0 0 0 0 007000 FGTF/AIDS MORBIDITY 0 0 0 0 0 007000 FGTFBREAST & CERVICAL CANCER-ADMIN/CASE MAN 0 0 0 0 0 007000 FGTF/FAMILY PLANNING TITLE X SPECIAL INITIATIVES 0 0 0 0 0 007000 FGTF/FAMILY PLANNING-TITLE X 575471 0 575471 0 575471 007000 FGTF/IMMUNIZATION ACTION PLAN 16, 156 0 163156 0 163156 007000 FGTF/WIC ADMINISTRATION 344,028 0 3443028 0 344,028 007000 HEALTH PROGRAM FOR REFUGEES 0 0 0 0 0 007000 HOUSING OPPORTUNITIES FOR PEOPLE WITH AIDS (HOPWA) 0 0 0 0 0 007000 IMMUNIZATION SPECIAL PROJECT 293 0 293 0 293 007000 IMMUNIZATION-WIC LINKAGES 0 0 0 0 0 007000 MCH BGTF-GADSDEN SCHOOL CLINIC 0 0 0 0 0 007000 MCH BGTF-HEALTHY START IPO 0 0 0 0 0 007000 MCH BGTF-INFANT MORTALITY PROJECT 0 0 0 0 0 007000 MCH BGTF-MCH/CHILD HEALTH 10, 535 0 10,535 0 10,535 007000 MCH BGTF-MCH/DENTAL PROJECTS 473500 0 47, 500 0 475500 007000 MCH BGTF-OUTREACH SOCIAL WORKERS 0 0 0 0 0 007000 PHP-CITIES RESPONSE INITIATIVE 2004-2005 0 0 0 0 0 007000 REDUCING BURDEN OF ARTHRITIS & RHEUMATIC CONDTNS 0 0 0 0 0 007000 REFUGEE HEALTH TB TARGETED TESTING 0 0 0 0 0 007000 RISK COMMUNICATIONS 0 0 0 0 0 007000 RYAN WHITE 0 0 0 0 0 007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0 007000 RYAN WHITE-AIDS DRUG ASSIST PROG-ADMIN 355000 0 355000 0 35,000 007000 RYAN WHITE-CONSORTIA 0 0 0 0 0 007000 STATE PROGRAMS TO PREVENT OBESITY 2003 -04 0 0 0 0 0 007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0 007000 STD PROGRAM - PHYSICIAN TRAINING CENTER 0 0 0 0 0 007000 STD PROGRAM - SYPHILIS ELIMINATION (SE) 0 0 0 0 0 Working Copy ATTACHMENT H. INDIAN RSR COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1 , 2005 to September 30, 2006 State CHD County CHD Total CHD Trust Fund Trust Fund ` Trust Fund Other (cash) (cash) (cash) Contributions Total 3. FEDERAL FUNDS - State 007000 STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 0 0 0 0 0 007000 STD PROGRAM-INFERTILITY PREVENTION PROJECT (IPP) 0 0 0 0 0 007000 STRATEGIC NATIONAL STOCKPILE 20,000 0 20,000 0 20, 000 007000 TRAINING AND EDUCATION 0 0 0 0 0 007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 0 0 0 0 0 007000 WIC BREASTFEEDING PEER COUNSELING PROG FFY 2004 0 0 0 0 0 007000 WIC INFRASTRUCTURE GRANT 2005 -2006 0 0 0 0 0 015009 MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES 0 0 0 0 0 015009 MEDIPASS WAIVER-SOBRA 0 0 0 0 0 015009 SCHOOL HEALTH-SUPPLEMENT-TANF 14,050 0 14,050 0 14,050 015075 CHD SUPPORT SERVICES 0 p 0 0 0 015075 TITLEXXI/SCHOOL HEALTH/SUPPLEMENTAL 98,347 0 98,347 0 981347 015075 REFUGEE SCREENING REIMBURSEMENT 0 0 0 0 0 FEDERAL FUNDS TOTAL 9815479 0 981 ,479 0 981 ,479 4, FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 MIGRANT HOUSING PERMIT 0 0 0 0 0 001020 MOBILE HOME AND PARKS 12,379 0 125379 0 125379 001020 FOOD HYGIENE PERMIT 12, 137 0 125137 0 125137 001020 BIOHAZARD WASTE PERMIT 105500 0 109500 0 103500 001020 SWIMMING POOLS 37,050 0 37,050 0 37,050 001020 PRIVATE WATER CONSTR PERMIT 29457 0 2,457 0 2,457 001020 PUBLIC WATER ANNUAL OPER PERMIT 0 0 0 0 0 001020 PUBLIC WATER CONSTR PERMIT 0 0 0 0 0 001020 NON-SDWA SYSTEM PERMIT 0 0 0 0 0 001020 SAFE DRINKING WATER 0 0 0 0 0 001021 TANNING FACILITIES 29290 p 2,290 0 2,290 001021 BODY PIERCING 405 0 405 0 405 001092 NON SDWA LAB SAMPLE 0 0 0 0 0 001092 OSDS VARIANCE FEE 0 p 0 0 0 001092 ENVIRONMENTAL HEALTH FEES 0 p 0 0 0 001092 OSDS REPAIR PERMIT 25, 171 0 25, 171 0 25 , 171 001092 OSDS PERMIT FEE 3085074 0 308,074 0 3085074 001092 1 &amp ; M ZONED OPERATING PERMIT 10,350 0 10,350 0 109350 001092 AEROBIC OPERATING PERMIT 0 p 0 0 0 001092 SEPTIC TANK SITE EVALUATION 1695220 0 1695220 0 169,220 001170 LAB FEE CHEMICAL ANALYSIS 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 500 0 55000 0 500 010403 FEES-COPY OF PUBLIC DOC 120 0 120 0 120 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 595 , 153 0 595 , 153 0 595 , 153 5. OTHER CASH CONTRIBUTIONS - STATE 010304 STATIONARY POLLUTANT STORAGE TANKS 92,773 0 92,773 0 925773 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 1805213 0 180,213 0 1809213 OTHER CASH CONTRIBUTIONS TOTAL 2725986 0 272,986 0 272,986 Working Copy ATTACHMENT H. INDIAN RIVER COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1 , 2005 to September 30, 2006 State CHD County CHD Total CHD Trust Fuad Trust Fund Trust FundOther (cash) (cash) (cash) Contributions Total 6. MEDICAID - STATE/COUNTY 001080 CHD INCM:MEDICAID-NURSING 0 0 0 0 0 001080 CHD INCM :MEDICAID-STD 741 1 ,063 19804 0 15804 001080 MEDICAID AIDS 0 0 0 0 0 001080 MEDICAID HMO RATE 0 0 0 0 0 001080 CHD INCM :MEDICAID MATERNITY 0 0 0 0 0 001080 CHD INCM :MEDICAID COMP. CHILD 173 , 532 2485688 422,220 0 422,220 001080 CHD INCM : MEDICAID COMP. ADULT 82, 839 1185716 201 , 555 0 201 , 555 001080 MEDICAID-LAB 0 0 0 0 0 001080 CHD INCM :MEDICAID-PHARMACY 0 0 0 0 0 001080 MEDICAID-TB 0 p 0 0 0 001080 MEDICAID-ADMINISTRATION VACCINE 125124 17,374 29,498 0 293498 001080 MEDICAID-CASE MANAGEMENT 0 0 0 0 0 001080 CHD INCM :MEDICAID-OTHER 0 0 0 0 0 001080 CHD INCM:MEDICAID-CHILD HEALTH CHECKUP 135 ,756 194,551 330,307 0 330,307 001080 CHD INCM :MEDICAID-DENTAL 795140 1135415 1929555 0 1925555 001083 CHD INCM : MEDICAID-FP 149185 127,661 141 , 845 0 1415845 001208 MEDIPASS $3 . 00 ADM. FEE 56,406 805836 137,242 0 137,242 MEDICAID TOTAL 554,724 902,302 15457,026 0 1 ,4579026 7. ALLOCABLE REVENUE - STATE 018000 REFUNDS, SALARY 0 0 0 0 0 018000 REFUNDS, OTHER PERSONAL SERVICES 0 0 0 0 0 018000 REFUNDS, EXPENSES 1 ,301 0 1 ,301 0 1 ,301 018000 REFUNDS, OPERATING CAPITAL OUTLAY 0 0 0 0 0 018000 REFUNDS, SPECIAL CATEGORY 0 0 0 0 0 018000 REFUNDS, OTHER 0 0 0 0 0 018000 DMS REFUNDS BY JOURNAL TRANSFER-65900 0 0 0 0 0 018000 REFUNDS, CERTIFIED FORWARD 0 0 0 0 0 037000 PRIOR YEAR WARRANT 0 p 0 0 0 038000 12 MONTH OLD WARRANT 0 0 0 0 0 ALLOCABLE REVENUE TOTAL 1 ,301 0 15301 0 11301 8, OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE STATE PHARMACY SERVICES 0 0 0 0 0 STATE LABORATORY SERVICES 0 0 0 134,912 134,912 STATE TB SERVICES 0 0 0 0 0 STATE IMMUNIZATION SERVICES 0 0 0 260, 527 260, 527 STATE STD SERVICES 0 0 0 0 0 STATE CONSTRUCTION/RENOVATION 0 0 0 0 0 WIC FOOD 0 0 0 1 ,428,284 1 ,4285284 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 19823 , 723 1 ,8239723 9. DIRECT COUNTY CONTRIBUTIONS - COUNTY Working Copy ATTACHMENT IL INDIAN RIVER COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2005 to September 30, 2006 State CUD County CHD Total CHD ` Trust Fund Trust Fund Trust Fund Other (cash) (cash) (cash) Contributions Total 9. DIRECT COUNTY CONTRIBUTIONS - COUNTY 008030 GRANTS-COUNTY TAX DIRECT 0 1 , 187465 1 , 187465 0 1 , 187,465 008034 GRANTS CNTY COMMSN OTHER 0 834,418 834,418 0 834,418 BOARD OF COUNTY COMMISSIONERS TOTAL 0 2,0215883 250215883 0 2, 021 , 883 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001060 VITAL STATISTICS FEES OTHER 0 800 800 0 800 001077 RABIES VACCINE 0 0 0 0 0 001077 CHILD CAR SEAT PROG 0 p 0 0 0 001077 PRIMARY CARE FEES 0 2455506 2455506 0 245 , 506 001077 COMMUNICABLE DISEASE FEES 0 1185336 118,336 0 118,336 001094 ENVIRONMENTAL HEALTH FEES 0 1475636 1479636 0 1479636 001094 ADULT ENTER. PERMIT FEES 0 0 0 0 0 001114 NEW BIRTH CERTIFICATES 0 28,032 285032 0 28,032 001115 DEATH CERTIFICATES 0 127,535 1279535 0 127, 535 001117 VITAL STATS-ADM. FEE 50 CENTS 0 15496 1 ,496 0 11496 FEES AUTHORIZED BY COUNTY TOTAL 0 6695341 669,341 0 669,341 11 , OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 DEBIT MEMO-BAD CHECKS 0 0 0 0 0 001009 RECOVERY-BAD CHECKS 0 0 0 0 0 001009 RECOVERY OF COLLECTION OF AGENCY PLACEMENTS 0 0 0 0 0 001009 RETURNED CHECK FEE 0 100 100 0 100 001029 THIRD PARTY REIMBURSEMENT 0 19,223 19,223 0 19,223 001029 HEALTH MAINTENANCE ORGAN. (HMO) 0 0 0 0 0 001077 RYAN WHITE LOCAL REVENUES 0 0 0 0 0 001077 RYAN WHITE TITLE lI 0 0 0 0 0 001090 MEDICARE 0 1445564 144,564 0 144, 564 005040 INTEREST EARNED 0 0 0 0 0 005041 INTEREST EARNED-STATE INVESTMENT ACCOUNT 0 125000 125000 0 129000 007010 U . S . GRANTS DIRECT 0 0 0 0 0 010300 SALE OF GOODS AND SERVICES 0 4,955 4,955 0 4,955 010301 EXP WITNESS FEE CONSULTNT CHARGES 0 0 0 0 0 010403 FEES-COPIES OF DOCUMENTS 0 750 750 0 750 010405 SALE OF PHARMACEUTICALS 0 0 0 0 0 010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0 010500 SALES OF SERVICES OUTSIDE STATE GOVERNMNENT 0 0 0 0 0 011000 RAPID AIDS TESTING - JAIL INMATES 2003 0 0 0 0 0 011001 HEALTHY START COALITION CONTRIBUTIONS 0 3185929 318,929 0 318,929 011007 CASH DONATIONS PRIVATE 0 p 0 0 0 012020 FINES AND FORFEITURES 0 p 0 0 0 012021 RETURN CHECK CHARGE 0 0 0 0 0 028020 INSURANCE RECOVERIES-OTHER 0 0 0 0 0 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 39, 505 39,505 0 39,505 011000 OTHER GRANTS &AMP; DONATIONS 0 201 ,018 201 ,018 0 201 ,018 011000 OTHER GRANT-ECB 0 209116 20, 116 0 20, 116 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 Working Copy ATTACHMENT H. INDIAN RIVER COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1 , 2005 to September 30, 2006 State CUD County CHD Total CHD Trust Fund Trust Fund Trust Fund Other (cash) (cash) (cash) Contributions Total 11 , OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 010408 COPY FEES INTRA/INTER AGENCY 0 0 0 0 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 761 , 160 761 , 160 0 761 , 160 12, ALLOCABLE REVENUE - COUNTY 018000 REFUNDS, SALARY 0 0 0 0 0 018000 REFUNDS, OTHER PERSONAL SERVICES 0 0 0 0 0 018000 REFUNDS, EXPENSES 0 1 ,301 1 ,301 0 13301 018000 REFUNDS, OPERATING CAPITAL OUTLAY 0 0 0 0 0 018000 REFUNDS, SPECIAL CATEGORY 0 0 0 0 0 018000 REFUNDS, OTHER 0 0 0 0 0 018000 DMS REFUNDS BY JOURNAL TRANSFER-65900 0 0 0 0 0 018000 REFUNDS, CERTIFIED FORWARD 0 p 0 0 0 037000 PRIOR YEAR WARRANT 0 0 0 0 0 038000 12 MONTH OLD WARRANT 0 0 0 0 0 COUNTY ALLOCABLE REVENUE TOTAL 0 11301 1 ,301 0 15301 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 401 , 126 401 , 126 MAINTENANCE 0 0 0 139,237 139,237 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 5405363 5405363 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY OTHER COUNTY CONTRIBUTION OF SOME UNKNOW ORIGIN 0 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 0 GRAND TOTAL CHD PROGRAM 5, 155 ,699 4,3555987 9, 511 ,686 25364,086 1118759772 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 , sub grantees 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 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 39 , 200 sq . ft . Gifford Health Center 4675 28th Court Indian River County 10 , 642 sq ft Vero Beach , FL 32967- 1330 Hospital District Co- Located Site : WIC 12196 County Road 512 Fellsmere Medical Fellsmere , FL 32948-5463 Center 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 2003-2004 $ $ $ _ 2004-2005 $ $ $ _ 2005-2006 $ $ $ _ 2006-2007 $ $ $ _ 2007-2008 $ $ $ _ PROJECT TOTAL $ - $ _ $ _ SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN PROJECT NAME : NONE 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 contruction or renovation projects and new furniture or equipment associated with these projects and mobile health vans . ATTACHMENT VI Primary Care " Primary Care" as conceptualized for the county health departments and for the use of categorical Primary Care funds ( revenue object code 015011 ) is defined as : " Health care services for the prevention or treatment of acute or chronic medical conditions or minor injuries of individuals which is provided in a clinic setting and may include family planning and maternity care . " Indicate below the county health department programs that will be supported at least in part with categorical Primary Care funds this contract year: X Comprehensive Child Health (229/29) X Comprehensive Adult Health (237/37) X Family Planning (223/23) Maternal Health/IPO (225/25) X Laboratory (242/42) Pharmacy (241 /93) Other Medical Treatment Program ( please identify) Describe the target population to be served with categorical Primary Care funds . The target population served with categorical Primary Care funds are the residents of Indian River County , who fall at or below 200 % of Federal Poverty Does the health department intend to contract with other providers for the delivery of primary health care services using categorical (015011 ) Primary Care funds ? If so , please identify the provider(s) , describe the services to be delivered , and list the anticipated contractual amount by provider. In addition , contract providers are required to provide data on patients served and the services provided so that the patients may be registered and the service data entered into HCMS . No . . ENVIRONMENTAL HEALTH FEE SCHEDULE FISCAL YEAR 2005-2006 EFFECTIVE 07/01 /2005 FEE DEPOSIT ORG OBJECT REVEFUND BUDGET PROGRAM DESCRIPTION EO Sl OCA IBI AMOUNT JAMOUNT L4/LS CODE ICATEG] NTITYECOMPPUBLIC SWIMMING POOLS AND BATHING PLACES GFSF-FIDONENT 1 . Annual Permit - Up to and including) 25, 000 gallons 100. 00 90. 00 XX-360 DK 001020 000100 CD 8000 20-2-141001 64200700 ** 1306000000 9,630. 00 1a. Transfer to headquarters 10. 00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000 2. More than 25 , 000 gallons 200.00 180. 00 XX-360 DK 001020 000100 CD 81<000 20-2- 141001 64200700 ** 1306000000 2a. Transfer to headquarters 25, 350. 0020 . 00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000 3. Exempted Condo Pools (over 32 units) 50. 00 45 . 00 XX-360 DK 001020 000100 CD 81<000 20-2-141001 64200700 * 1306000000 23070. 00 3a. Transfer to headquarters 5 . 00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000 OTHER FEES Collected by the 13 delegated counties Broward , Dade, Duval , Hillsborough , Lee , Manatee, Collier, Palm Beach , Pinellas, Polk, Sarasota, Volusia, Escambia . Permits and variances for Okaloosa , Santa Rosa, Walton , Bay, Homes, and Washington Counties are processed by Escambia County and variances and permits for Pasco County are processed by Pinellas County as follows: 1 . Plan review new construction 350. 00 350. 00 XX-360 DK 001092 000100 CD 81<000 1 20-2-141001 64200700 `* 1306000000 2. Modification to a contsrtuction permit (permit issued and pool not finished 100. 00 100. 00 XX-360 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 with contruction 3. Modification to a completed pool, one that has been in operation 150 . 00 150. 00 XX-360 DK 001092 000100 CD 81<000 20-2- 141001 64200700 "* 1306000000 4. Plan/application review for bathing lace development 275. 00 275. 00 XX-360 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 5 . Initial operating ermit 150. 00 150. 00 XX-360 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 6 . Variance applications 240. 00 216. 00 XX-360 DK 001092 000100 CD 81<000 20-2- 141001 64200700 ** 1306000000 6a. Transfer to Headquarters 24 . 00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000 All other counties are to send the fee to Bureau of Water Programs in Tallahassee or the Environmental Engineering section in Orlando as follows: 1 . Plan review (new construction) 350 . 00 350 . 00 XX-360 DK001092 000100 CD 81<000 20-2- 141001 64200700 *` 1306000000 2. Modification to a contsrtuction permit (permit issued and pool not finished 100. 00 100. 00 XX-360 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 with contruction) 3. Modification to a completed pool, one that has been in operation 150. 00 150. 00 XX-360 DK 001092 g000100 CD 8K000 20-2- 141001 64200700 ** 1306000000 4 . Plan/application review for bathing place development 275 . 00 275 . 00 XX-360 DK 001092 CD 8K000 20-2-141001 64200700 1306000000 5 . Initial operating permit 150. 00 150. 00 XX-360 DK 001092 CD 8K000 20-2-141001 64200700 ** 1306000000 6. Variance applications 240 . 00 216. 00 XX-360 DK 001092 CD 8K000 20-2- 141001 64200700 ** 1306000000 **Must use County Health Department IBI (01 -67) Page 1 9/6/2005 =FEEDEPOSIT ORG OBJECT REVENUE FUND BUDGET PROGRAM DESCRIPTION EO SI OCA IBIAMOUNT L4/L6 CODE CATEGORY GF-SF-FID ENTITY COMPONENT MOBILE HOME & RECREATIONAL VEHICLE PARKS (FEES ARE PRORATED ON A QUARTERLY BASIS) 1 . Annual permit for 5 to 14 spaces 50. 00 45.00 XX-354 DK 001020 000100 CD 8K000 20-2-141001 64200700 '* 1306000000 675.00 1a . Transfer to headquarters 5. 00 XX-910 MP 001206 000100 RV 00000 10-2-021042 64200600 00 1302000000 3 . 50 per 2. Annual permit for 15 to 171 spaces space XX-354 DK 001020 000100 CD 8K000 20-2- 141001 64200700 ** 1306000000 51764. 0 2a . Transfer to headquarters 10% XX-910 MP 001206 000100 RV UQ000 10-2-021042 64200600 00 1302000000 3. Annual permit for 172 and above spaces 600.00 540 . 00 XX-354 DK 001020 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 55940. 00 3a . Transfer to headquarters 60 . 00 XX-910 MP 001206 000100 RV I UQ000 10-2-021042 64200600 00 1302000000 MIGRANT LABOR CAMPS 1 . Annual permit for facilities with 5-50 occupants 125.00 125 . 00 XX-352 DK 001020 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 2. Annual permit for facilities with 51 -100 occupants 225. 00 225. 00 XX-352 DK 001020 000100 FCD 8K000 20-2-141001 64200700 ** 1306000000 3. Annual permit for facilities with over 100 occupants 500.00 500. 00 XX-352 DK 001020 000100 8K000 20-2-141001 64200700 ** 1306000000 BIOMEDICAL WASTE GENERATORS 1 . Initial permit (prorated after 3/31 for generator, storage and treatment) 55. 00 55.00 XX-364 DK 001020 000100 CD 8K000 20-2- 141001 64200700 ** 1306000000 82550. 00 2. Renewal of annual permit except physician office generating less than 25lbs/30 days) postmarked by October 1 55. 00 55. 00 XX-364 DK 001020 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 1 ,800.00 3. Renewal of annual permit except physician office generating less than 25lbs/30 days) postmarked after October 1 75. 00 75 . 00 XX-364 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 150. 00 4. Initial Transporter Registration (prorated after 3/31 , includes 1 truck) 55. 00 55.00 XX-364 DK 001020 000100 CD 81<000 20-2-141001 1 64200700 ** 1306000000 5. Initail Registration of Each Additional Truck 10.00 10. 00 XX-364 DK 001020 000100 CD 8K000 20-2- 141001 64200700 ** 1306000000 6. Annual Registration Renewal (postmarked by 10/01 , includes 1 truck) 55. 00 55.00 XX-364 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 7. Annual Registration Renewal (postmarked after 10/01 , includes 1 truck) 75. 00 75.00 XX-364 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 8 . Annual Registration of Each Additional Truck 10. 00 10. 00 XX-364 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 TANNING FACILITIES 1 . Annual license fee 150.00 135. 00 XX-369 DK 001021 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 11894. 00 1a. Transfer to headquarters 15 . 00 XX-910 TN 001206 000100 RV R9000 10-2-021042 64200600 00 1302000000 2 . Fee for each additional device 55 . 00 49. 50 XX-369 DK 001021 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 396.00 2 . a . Transfer to headquarters 5. 50 XX-910 TN 001206 000100 RV R9000 10-2-021042 64200600 00 7302000000 3 . Late fee 25. 00 25 . 00 XX-369 DK 001021 000100 CD 8K000 20-2- 141001 64200700 *' 1306000000 75. 00 BODY PIERCING 1 . Initial License (proratedquarterly) 150. 00 135. 00 XX-349 DK 001021 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 1a. Transfer to headquarters 15 . 00 XX-910 iE 001206 000100 RV PIERS 10-2-021042 64200600 00 1302000000 2. Temporary Establishment 75.00 67. 50 XX-349 DK 001021 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 2a . Transfer to headquarters 7 . 50 XX-910 iE 001206 000100 RV PIERS 10-2-021042 64200600 00 1302000000 3. Annual Renewal License Fee 150. 00 135. 00 XX-349 DK 001021 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 405. 00 3a . Transfer to headquarters 15.00 XX-910 iE 001206 000100 RV PIERS 10-2-021042 64200600 00 1302000000 4. Late fee 100. 00 100. 00 XX-349 DK 001021 000100 CD I 8K000 20-2- 141001 64200700 ** 1306000000 * Must use County Health Department 1131 (01 -67) Page 2 9/6/2005 DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA IBI FUND BUDGET PROGRAM FOOD ESTABLISHMENTS AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT 1 . Annual Permit for Fraternal/Civic 160 . 00 144 . 00 XX-348 DK 001020 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 2, 016. 00 1a . Transfer to headquarters 16. 00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 2. Annual Permit School Cafeteria Operating for 9 months or less 130.00 117. 00 XX-348 DK 001020 000100 CD 8K000 20-2-141001 64200700 1306000000 2,470. 00 2a. Transfer to headquarters 13 . 00 XX-910 FP 001206 000100 RV 10000 1 10-2-021042 64200600 00 1302000000 3. Annual Permit School Cafeteria Operating for more than 9 months 160. 00 144 . 00 XX-348 DK 001020 000100 CD 81<000 20-2- 141001 64200700 '* 1306000000 3a . Transfer to headquarters 864. 0016 . 00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 4. Annual Permit for Hospital/Nursing Hospital/NursingFood Service 210.00 189. 00 XX-348 DK 001020 000100 CD 81<000 20-2-141001 64200700 1306000000 1 ,323. 00 4a. Transfer to headquarters 21 . 00 XX-910 FP 1 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 5. Annual Permit for Movie Theaters 160 . 00 144. 00 XX-348 DK 001020 000100 CD 81<000 20-2- 141001 64200700 *' 1306000000 288. 00 5a . Transfer to headquarters 16. 00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 6. Annual Permit for Jails/Prisons 210. 00 189. 00 XX-348 DK 001020 000100 CD 81<000 20-2-141001 64200700 1306000000 378.00 6a . Transfer to headquarters 21 . 00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 7. Annual Permit for Bars/Lounges Drink Service Only) 160. 00 144.00 XX-348 DK 001020 000100 CD 8K000 20-2- 141001 64200700 1306000000 1 ,872. 00 7a . Transfer to headquarters 16. 00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 8. Annual Permit for Residential Facilities 110. 00 99. 00 XX-348 DK 001020 000100 CD 81<000 20-2-141001 64200700 1306000000 1 , 782 .00 8a . Transfer to headquarters 11 . 00 1 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 9. Annual Permit for Child Care Centers without C&F license 85.00 76. 50 XX-348 DK 001020 000100 CD 8K000 20-2- 141001 64200700 1306000000 9a . Transfer to headquarters 8 . 50 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 10. Annual Permit for Limited Food Service 85 . 00 76 . 50 XX-348 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 612 . 00 10a . Transfer to headquarters 8. 50 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 11 . Annual Permit Other Food Service 160. 00 144. 00 XX-348 DK 001020 000100 CD 81<000 20-2-141001 64200700 *' 1306000000 11a. Transfer to headquarters 432.0016 . 00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000 12. Plan Review $35/hour $35/hour XX-348 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 70. 00 13. Food Worker Training (perperson) 10. 00 10. 00 XX-348 DK 001092 000100 CD I 81<000 20-2-141001 64200700 1306000000 14. Request for Inspection 40. 00 40. 00 XX-348 DK 001092 000100 CD 8K000 20-2- 141001 64200700 `* 1306000000 40. 00 15. Re-inspection after the first reins ection 30. 00 30. 00 XX-348 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000 30. 00 16. Late Renewal 25. 00 25. 00 XX-348 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000 108. 00 17. Alcoholic Beverage Inspection Approval 30. 00 30. 00 XX-348 DK 001092 000100 CD 81<000 20-2-141001 64200700 1306000000 "Must use County Health Department 1131 (01 -67) Page 3 9/6/2005 FEE DEPOSIT IORG OBJECT REVENUE FUND BUDGET PROGRAM DESCRIPTION EO SI OCA IBI AMOUNT AMOUNT L41L5 CODE CATEGORY GFSF-FID ENTITY COMPONENT ONSITE SEWAGE DISPOSAL PROGRAM (OSTDS) 1 . Application for Permitting of an onsite sewage 50.00 46. 00 XX-361 DK 001092 000100 CD 81<000 20-2- 141001 64200700 1306000000 81 ,466.00 treatment and disposal system which includes application and plan review for new and repair permits 1a . Transfer to headquarters 4 . 00 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000 2 . Application and a proval for existing system , does not includes stem inspection 35. 00 32.20 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 4, 959.00 in 2a. Transfer to headquarters 2 . 80 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 3. Application for permittinq of a new Performance-based treatments stem 125. 00 115. 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 115. 00 3a . Transfer to headquarters 10 . 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 4. Site evaluation for a new system 115. 00 105 . 80 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 1231680. 00 4a . Transfer to headquarters 9. 20 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 5. Site evaluation for a system repair or modification of system 75. 00 69. 00 XX-361 DK 001092 000100 CD 81<000 20-2- 141001 64200700 ** 1306000000 45,540. 00 5a . Transfer to headquarters 6. 00 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000 6 . Site re-evaluation , new or repair or modification 75 . 00 69. 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 6a . Transfer to headquarters 6. 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 7. Permit for news stems, or modification to system 55. 00 50.60 xx_361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 60,467. 00 7a. Transfer to headquarters 4 .40 XX-910 ST 001206 000100RV 1 E000 10-2-021042 64200600 00 1302000000 8 . News stem ors stem modification installation inspection 80.00 73.60 XX-361 DK 001092 000100 CD 81<000 20-2-141001 642007001306000000 86, 008. 00 8a . Transfer to headquarters 6.40 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 8b. Research fee to be collected in addition , and concurrent with 5 . 00 5 . 00 XX-910 RF 001206 000100 RV 89000 10-2-021042 64200600 00 1302000000 the permit for a new system installation fee. 9 . Repair permit issuance which includes inspection 50. 00 41 .40 XX-361 DK 001092 000100 CD 81<000 20-2- 141001 64200700 ** 1306000000 25, 171 .00 9a . Transfer to headquarters 3.60 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000 9b. Transfer to headquarters for training center 5 . 00 XX-910 TC 001206 000100 RV SEWTN 10-2-021042 64200600 00 1302000000 10. Inspection of system previously in use 50 . 00 46 . 00 XX-361 DK 001092 000100 CD 81<000 20-2- 141001 64200700 1306000000 21392. 00 10a . Transfer to headquarters 4. 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 11 . Reinspection fee per visit for site inspections afters stem 50. 00 46.00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 '* 1306000000 332782. 00 construction a2proval 11a. Transfer to headquarters 4. 00 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000 12. Installation reinspection of non-compliant system per 50. 00 46. 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 32, 129. 00 each site visit 12a. Transfer to headquarters 4. 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 13. System abandonment permit, includes permit 40. 00 36. 80 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 41780.00 issuance and inspection 13a . Transfer to headquarters 3. 20 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 14. Annual operating ermit fee fors stems in IM and 150. 00 138. 00 XX-361 DK 1 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 10, 350.00 equivalent areas, and fors stems receiving commercial waste 4a. Transfer to headquarters 12. 00 XX-910 ST 001206 1 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 15. Amendments or changes to the operating ermit during 50. 00 46. 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 "Must use County Health Department 1131 (01 -67) Page 4 9/6/2005 DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM AMOUNT AMOUNT L41L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT the permit period per change or amendment 15a . Transfer to headquarters 4. 00 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000 16. Aerobic treatment unit operating permit (biennial) 100. 00 92.00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 16a. Transfer to headquarters 8. 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 17. Biennial operating permit fee for performance-based treatment systems. 100. 00 92.00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000 A prorated fee is to be charged beginning with second year of operation. 17a . Transfer to headquarters 8 . 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 18. Review of application due to proposed amendments or changes after 75. 00 69. 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 initial operating ermit issuance foraperformance-based treatment system 18a . Transfer to headquarters 6 . 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 19. Tank manufacturer's inspection per annum 100.00 50.00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 19a . Transfer to headquarters 50 . 00 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000 20. Se to a disposal service permit per annum 75.00 69.00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 690.00 20a. Transfer to headquarters 6 . 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 21 . Additional charge per pump out vehicle 35.00 32. 20 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000515.00 21a. Transfer to headquarters 2 . 80 XX-910 ST 001206 000100 RV IE000 10-2-021042 64200600 00 1302000000 22. Portable or temporary toilet service permit per annum 75.00 69. 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 69.00 22a. Transfer to headquarters 6 . 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 23. Additional charge per pump out vehicle 35. 00 32. 20 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 129. 00 23a. Transfer to headquarters 2 . 80 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 24 . Se to a stabilization facility inspection fee per annum 150. 00 138. 00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 24a . Transfer to headquarters 12. 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 24. Se to a disposal site evaluation fee per annum 200. 00 184. 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 24a . Transfer to headquarters 16. 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1 1302000000 24. Aerobic treatment unit maintenance entity permit per annum 25. 00 23. 00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 24a . Transfer to headquarters 2 . 00 XX-910 ST 001206 000100 RV 1 E000 10-2-021042 64200600 00 1302000000 25. Variance application for a single family residence per 150. 00 75 . 00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 150. 00 each lot or building site 25a . Transfer to headquarters 75 . 00 XX-910 CR 001206 000100 RV BY000 10-2-021042 64200600 00 1302000000 26. Variance application for a multi-family or commercial 200. 00 100.00 XX-361 DK 001092 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 building per each building site 26a. Transfer to headquarters 100. 00 XX-910 CR 001206 000100 RV BY000 10-2-021042 64200600 00 1302000000 27. Inspection for construction of an injection well (FL Keys) 125 . 00 125 . 00 XX-361 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 FEE COLLECTED AT HEADQUARTERS - Onsite Sewage Program 1 . Application for Innovative product approval 500 . 00 For headquarters use only 2. Application for registration including initial examination 75. 00 For headquarters use only 3 . Initial registration 100 . 00 For headquarters use only 4 . Renewal registration 100 . 00 For headquarters use only 5 . Certificate of authorization each two year period 250 . 00 1 For headquarters use only "Must use County Health Department 1131 (01 -67) Page 5 9/6/2005 FEE DEPOSIT ORG OBJECT REVENUE FUND BUDGET =PROGRAMDESCRIPTION EO SI OCA IBAMOUNT AMOUNT L41L5 CODE CATEGORY GFSF-FID ENTITY DRINKING WATER 1 . First Year Public Water Annual Operation Permit and 75.00 67. 50 XX-357 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 Construction Permit - Limited Use 1 a . Transfer to headquarters 7. 50 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000 2 . Second Year Public Water Annual Operation Permit - Limited Use 70. 00 63.00 XX-357 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 21457. 00 2a. Transfer to headquarters 7. 00 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000 3. Multi-Family Water Construction Permit - serving 3 or 4 40. 00 36. 00 XX-357 DK 001020 000100 CD 81<000 20-2- 141001 64200700 ** 1306000000 non-rental residences 3a. Transfer to headquarters 4. 00 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000 4. Initial Operating Permit Fee After March 31 of Any Year 35. 00 31 . 50 XX-357 DK 001020 000100 CD 81<000 20-2- 141001 64200700 ** 1306000000 4a . Transfer to headquarters 3 . 50 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000 5. Non-SDWA Lab Sample (Sample Collection/Review of Analytical Results/Health Risk Interpretation): Bacterial Sample Collection 40. 00 40.00 1 XX-357 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 Chemical Sample Collection 50. 00 50 . 00 XX-357 DK 001020 000100 CD 8K000 20-2-141001 64200700 ** 1306000000 Combined Chemical microbiological 55. 00 55.00 XX-357 DK 001020 000100 CD 8K000 20-2-141001 64200700 1306000000 6 . Reinspection of Multi-family Water System 25. 00 25 .00 XX-357 DK 001092 000100 CD 81<000 20-2- 141001 64200700 ** 1306000000 7. Reinspection of Public Water System 40.00 40. 00 XX-357 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 8. Delineated Area Clearance Fee 50. 00 50.00 XX-357 DK 001092000100 CD 8K000 20-2- 141001 64200700 ** 1306000000 100 . 00 9 . Limited Use Commercial Registered System 15. 00 15. 00 XX-357 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 10. Limited Use Commercial Public Water System 25.00 25.00 XX-357 DK 001092 000100 CD 81<000 20-2-141001 64200700 ** 1306000000 Operating Permit Family Day Care Establishment 11 . Limited Use Commercial Public Water System Operating Permit 15.00 15. 00 XX-357 DK 001092 000100 CD 81<000 20-2-141001 64200700 1306000000 Family Day Care Establishment After March 31 of Any Year. Safe Drinking Water Act (Delegated Counties) 1 . Construction permit for each Category I through III treatment plant, as defined in Rule 62-699.310, F.A. C. . , with treatment other than disinfection only. a. Treatment plant - 5 MGD and above 71500. 00 71500. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 b. Treatment plant - 1 MGD up to 5 MGD 6, 000. 00 63000. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1 1306000000 c. Treatment plant - 0.25 MGD up to 1 MGD 4,000 . 00 41000 . 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 d. Treatment plant - 0. 1 MGD up to .25 MGD 21000. 00 23000. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 e. Treatmentplant - u to0. 1 MGD 1 , 000. 00 17000 .00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 2. Construction permit for each Category IV treatment plant, as defined in Rule 62-699. 310, F.A. C. . , with treatment other than disinfection only. *"Must use County Health Department IBI (01 -67) Page 6 9/6/2005 FEE DEPOSIT ORG OBJECT REVENUE FUND BUDGET PROGRAM DESCRIPTION EO SI OCA IBI AMOUNT AMOUNT LEEENN� 4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT a. Treatment plant - 5 MGD and above 7, 500.00 7, 500. 00 XX-358 WC 001020 000100CD SDWCH 2O-2-141001 64200700 1306000000 b. Treatment plant - 1 MGD up to 5 MGD 6,000. 00 6,000.00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1306000000 c. Treatment plant - 0.25 MGD up to 1 MGD 4,000.00 41000. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 d . Treatment plant - 0. 1 MGD u to .025 MGD 20000.00 22000. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 *' 1306000000 e. Treatment plant - 0. 01 u to 0. 1 MGD 11000. 00 1 ,000 .00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 1306000000 f. Treatment plant - u to 0. 01 MGD 400. 00 400. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 3. Construction permit for each Category V treatment plant, as defined in Rule 62-699.310, F.A. C. . , - Disinfection Only a. treatment plant - 5 MGD and above 51000. 00 5,000 . 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 b. Treatment plant - 1 MGD up to 5 MGD 3,000.00 3 , 000. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 c. Treatment plant - 0.25 MGD up to 1 MGD 1 , 000. 00 19000.00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 d . Treatment plant - 0. 1 MGD up to . 025 MGD 500. 00 500 . 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 e. Treatment plant - up to 0. 1 MGD 300.00 300. 00 1 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1306000000 4. Distribution and transmissions stems, including raw water lines into the plant, except those under general permit. a. Serving a community public water system 500.00 500. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 b. Serving a non-transient non-community public water systems 350.00 350.00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 c. Serving a non-communitV Dublic waters stem 250. 00 250.00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 5. Construction permit for each public water supply well. a. Well located in a delineated area pursuant to Chapter 62-524, F.A. C. . 500. 00 500.00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 b. Any other public water supply well. 250. 00 250. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1306000000 6. Major modifications to systems that alter the existing treatment without expanding the capacity of the system and are not considered substantial changes pursuant to Rule 62-4.050(7) below. a. 1MGD and above 2,000.00 29000. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 b. A MGD up to 1 MGD 10000. 00 1 ,000. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1306000000 C. 0. 01 up to . 1 MGD 500. 00 500. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 d . Up to 0.01 MGD 100. 00 100. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 '* 1306000000 e. Lead and Copper Corrosion Fee 100. 00 100.00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1306000000 7. Minor modifications to s stems that result in no change in the treatment or capacity. a. . 1 MGD and above 300. 00 300.00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 b. U to 0. 1 MGD 100. 00 100. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 *' 1306000000 8. Fines and Forfeitures Variable Variable XX-358 WC 001020 001200 CD SDWCH 2O-2-141001 64200700 ** 1306000000 9 . General Permit Fee for any General Permit not specifically listed: 100. 00 100 . 00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1306000000 a . General Permits requiring Professional Engineer or Professional 250.00 250. 00 XX-358 WC 001020 000100 CD SDWCH 2O-2-141001 64200700 ** 1306000000 6eolo ist certification Ia. General Permits not requiring Professional Engineer or 100. 00 100 . 00 XX-358 WC 001020 000100 CD SDWCH 2O-2- 141001 64200700 ** 1306000000 "Must use County Health Department 1131 (01 -67) Page 7 9/6/2005 ;AMOUNTIAMOUNT EEEPOSIT ORG OBJECT REVENUE FUND BUDGET PROGRAM DESCRIPTION EO SI OCA IBI L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT Professional Geologist certification Radioactive Materials Licenses - General 1 . Annual fee: static elimination devices $25. 00 For headquarters use only 2. Annual fee: measuring , gauging and control devices $25. 00 For headquarters use only 3. Annual fee: in vivo testing license $ 125 . 00 For headquarters use only 4. Annual fee: in vitro testing license $ 125. 00 For headquarters use only 5 . Annual fee: depleted uranium license $ 125.00 For headquarters use only Radioactive Materials Licenses - Specific Application Fees 1 . Source Material. a. Concentration of uranium from phosphate ores for the production of uranium as "yellow cake" or powdered solid; $6,907 For headquarters use only b. Concentration of uranium from phosphate ores for the production of "green cake" or equivalent, moist or solid ; $31768 For headquarters use only c. All other specific source material licenses excluding depleted uranium used as shielding and counterweights. $544 For headquarters use only 2. Special Nuclear Material (SNM). a. SNM in sealed sources contained in devices in measuring systems; $653 For headquarters use only b. SNM not sufficient to form a critical mass, except as in 2. a. , 2.c. and 5 .e. $12340 For headquarters use only c. SNM to be used as calibration and reference sources. $205 For headquarters use only 3 . Byproduct, naturally occurring or accelerator produced material . a. Processing or manufacturing for commercial distribution or industrial uses; $2 , 923 For headquarters use only b. Processing or manufacturing and distribution of radiopharmaceuticals. This category includes radiopharmacies. $2, 560 For headquarters use only c. Industrial radiography performed only in an approved shielded radiography installation , $ 17558 For headquarters use only d . Industrial radiography performed only at the address indicated in the license, or at temporary job sites of the licensee; $ 1 ,643 For headquarters use only e. Radioactive materials in sealed sources for irradiation of materials where the source is not removed from the shield and is less than 10,000 curies; $605 For headquarters use only f. (I) Radioactive materials in sealed sources for irradiation of materials when the source is not removed from the shield and is greater than 10 , 000 curies and less than 100 ,000 curies, or where the source is less than 100,000 curies and is removed from the shield ; $ 12414 For headquarters use only II) Radioactive materials in sealed sources for irradiation of materials when the source is equal to or greater than 100,000 " Must use County Health Department 1131 (01 -67) Page 8 9/6/2005 FEE DEPOSIT ORG OBJECT REVENUE FUND BUDGET DESCRIPTION EO SI OCA :LL4XRAM AMOUNT AMOUNTL4IL5 CODE CATEGORY GF-SF-FID ENTITY T curies and less than 1 ,000, 000 curies; $3,659 For headquarters use only (III) Radioactive materials in sealed sources for irradiation of materials when the source is greater than 1 ,000,000 curies; $9,780 For headquarters use only g. Distribution of items containing radioactive materials to persons under a general license; $ 1 , 643 For headquarters use only h . Distribution of exempt quantities or items containing naturally occurring or accelerator produced material to persons exempt from licensing ; $ 1 ,643 For headquarters use only i . Well logging (1) Sealed sources or sub-surface tracer studies $ 1 , 135 For headquarters use only (11) Sub-surface tracer studies and sealed sources $ 1 ,436 For headquarters use only j . Nuclear Laundry; $32200 For headquarters use only k. Industrial or medical research and development; $ 1 , 184 For headquarters use only L (I) Fixed and portable gauging devices $605 For headquarters use only (II) In Vitro and clinical laboratory $725 For headquarters use only (III) Academic $978 For headquarters use only IV) Possession of uranium or thorium, or their decay products, as a result of mining or processing $978 For headquarters use only M All other specific licenses except as otherwise noted $725 For headquarters use only m. Licenses of broad scope (1) Academic $3,200 For headquarters use only (11) Medical $3, 200 For headquarters use only (III) Industrial or Research and Development $39200 For headquarters use only n . Gas chromatography devices; $434 For headquarters use only o. Reference or calibration sources equal to or less than one millicurie total ; $314 For headquarters use only p. Nuclear service licenses, such as leak testing , instrument calibration, etc. ; $518 For headquarters use only 4. Waste disposal or processing a. Commercial waste disposal or treatment facilities, including burial or incineration ; $275 , 842 For headquarters use only b. All other commercial facilities involving compaction , repackaging, storage or transfer, $27,084 For headquarters use only c. Commercial treatment of radioactive materials for release to unrestricted areas. $5,760 For headquarters use only 5. Medical use. a. Teletherapy or high dose rate remote after loading devices; $ 1 ,414 For headquarters use only b. Medical institutions including hospitals, except 5 .a . and 5.e. ; $ 1 ,643 For headquarters use only C. Private practice physicians except 5.a. and 5. d. ; $ 13184 For headquarters use only d. Private practice physicians using only strontium 90 eye " Must use County Health Department IBI (01 -67) Page 9 9/6/2005 DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA IBI FUND BUDGET PROGRAM AMOUNT AMOUNT L4/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT applicators, materials authorized by Rule 64E-5. 631 , F.A. C. , and materials authorized by Rule 64E-5.630; F.A.C. $605 For headquarters use only e. Nuclear powered pacemakers; $434 For headquarters use only f. Mobile nuclear medicine services. $ 1 ,414 For headquarters use only 6. Civil defense. $544 For headquarters use only 7. Device, product, or sealed source safety evaluation . a. Device evaluation, per device; $ 1 , 208 For headquarters use only b. Sealed source design , per source. $528 For headquarters use only Radioactive Materials Licenses - Specific Annual Fees 1 . Source Material. a. Concentration of uranium from phosphate ores for the production of uranium as "yellow cake" or powdered solid; $ 11 , 942 For headquarters use only b. Concentration of uranium from phosphate ores for the production of "green cake" or equivalent, moist or solid; $7,439 For headquarters use only c. All other specific source material licenses excluding depleted uranium used as shielding and counterweights. $229 For headquarters use only 2. Special Nuclear Material (SNM). a. SNM in sealed sources contained in devices used in measuring systems; $518 For headquarters use only b. SNM not sufficient to form a critical mass, except as in 2.a. , above, and 2.c. and 5. e. , below; $ 1 ,944 For headquarters use only c. SNM to be used as calibration and reference sources. $ 109 For headquarters use only 3. Byproduct, naturally occurring or accelerator produced material . a. Processing or manufacturing for commercial distribution or industrial uses; $2, 802 For headquarters use only b. Processing or manufacturing and distribution of radiopharmaceuticals. This category includes radiopharmacies. $3 , 840 For headquarters use only c. Industrial radiography performed only in an approved shielded radiography installation , $23161 For headquarters use only d. Industrial radiography performed only at the address indicated in the license, or at temporary job sites of the licensee; $2,657 For headquarters use only e. Radioactive materials in sealed sources for irradiation of materials where the source is not removed from the shield and is less than 10, 000 curies; $605 For headquarters use only f. (1) Radioactive materials in sealed sources for irradiation of materials when the source is not removed from the shield and is greater than 10, 000 curies and less than 100,000 curies, or where jpe source is less than 100, 000 curies and is removed from the shield ; $ 1 ,630 For headquarters use only * Must use County Health Department 1131 (01 -67) Page 10 9/6/2005 FEE DEPOSIT OR]H: REVENUE FUND BUDGET PROGRAM DESCRIPTION SI OCA IBI AMOUNT AMOUNT L41LCATEGORY GFSF-FID ENTITY COMPONENT (II) Radioactive materials in sealed sources for irradiation of materials when the source is equal to or greater than 100,000 curies and less than 1 , 000 , 000 curies; $33961 For headquarters use only (III) Radioactive materials in sealed sources for irradiation of materials when the source is greater than 1 , 000, 000 curies, $4 , 398 For headquarters use only g . Distribution of items containing radioactive materials to persons under a general license; $2, 150 For headquarters use only h. Distribution of exempt quantities or items containing naturally occurring or accelerator produced material to persons exempt from licensing ; $2, 150 For headquarters use only i. Well logging (1) Sealed sources or sub-surface tracer studies $ 13498 For headquarters use only (11) Sub-surface tracer studies and sealed sources $ 1 , 594 For headquarters use only j . Nuclear Laundry; $55651 For headquarters use only k. Industrial or medical research and development; $ 1 ,474 For headquarters use only l. (I) Fixed and portable gauging devices $966 For headquarters use only (11) In Vitro and clinical laboratory $918 For headquarters use only (111) Academic $ 1 , 171 For headquarters use only IV) Possession of uranium or thorium, or their decay products, as a result of mining or processing $870 For headquarters use only M All other specific licenses except as otherwise noted $ 1 , 002 For headquarters use only m. Licenses of broad scope (I) Academic $79346 For headquarters use only (II) Medical $5,474 For headquarters use only (III) Industrial or Research and Development $4, 568 For headquarters use only n. Gas chromatography devices; $314 For headquarters use only o. Reference or calibration sources equal to or less than one millicurie total; $ 132 For headquarters use only p. Nuclear service licenses, such as, leak testing, instrument calibration, etc. ; $410 For headquarters use only 4. Waste disposal or processing a. Commercial waste disposal or treatment facilities, including burial or incineration ; $250, 555 For headquarters use only b. All other commercial facilities involving compaction , repackaging , storage or transfer; $24, 971 For headquarters use only c. Commercial treatment of radioactive materials for release to , unrestricted areas. $5, 735 For headquarters use only 5. Medical use. 4. Teletherapy or high dose rate remote after loading devices; $ 1 , 378 For headquarters use only b. Medical institutions including hospitals, except category 5.a . **Must use County Health Department 1131 (01 -67) Page 11 9/6/2005 FEE DEPOSIT ORG OBJECT REVENUE FUND BUDGET PROGRAM DESCRIPTION EO SI OCA IBI AMOUNT AMOUNT L4IL5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT and 5.e. ; $ 1 ,908 For headquarters use only c. Private practice physicians except category 5.a. and 5.d. ; $ 1 , 340 For headquarters use only d. Private practice physicians using only strontium 90 eye applicators, materials authorized by Rule 64E-5.631 , F.A. C. , and materials authorized by Rule 64E-5. 630; F.A.C. $748 For headquarters use only e. Nuclear powered pacemakers; $266 For headquarters use only f. Mobile nuclear medicine services. $ 1 ,625 For headquarters use only 6 . Civil defense. $821 For headquarters use only 7. Device, product, or sealed source safety evaluation . a. Device evaluation , per device; NONE b. Sealed source design, per source. NONE Reclamation Fee 5% of annual For headquarters use only licensing fee X-Ray Machine Annual Registration Fees 1 . Medical, chiropractic, osteopathic, or naturopathic machines - First tube $ 145 For headquarters use only Each additional tube $85 For headquarters use only 2. Veterinary machines - First tube $50 For headquarters use only Each additional tube $34 For headquarters use only 3 . Educational or industrial machines - First tube $47 For headquarters use only Each additional tube $23 For headquarters use only 4 . Dental or podiatry machines - First tube $31 For headquarters use only Each additional tube $ 11 For headquarters use only 5 . Medical accelerators $258 For headquarters use only Each additional tube $148 For headquarters use only 6. Non-medical accelerators $81 For headquarters use only Each additional tube $48 For headquarters use only Radiologic Technologist Certifications "Must use County Health Department 1131 (01 -67) Page 12 9/6/2005 FEE DEPOSIT ORG OBJECT REVENUE :GF-SF-FID UND BUDGET PROGRAM DESCRIPTION EO SI OCA IBI AMOUNT AMOUNT L4/L5 CODE CATEGORY ENTITY COMPONENT 1 . Application and study guide (applicant also pays whatever fee the testing service charges) $75 For headquarters use only 2. Application without study guide (applicant also pays whatever fee the testing service charges) $50 For headquarters use only 3. Application through endorsement (no test needed) $45 4. Repeat examinations (applicant also pays whatever fee the For headquarters use only testing service charges) $35 For headquarters use only 5. Renewal - first category $55 For headquarters use only Each additional category $40 For headquarters use only 6. Change in status from active to inactive $40 For headquarters use only 7. Late renewal fee $ 100 For headquarters use only 8. Duplicate certificate $ 10 For headquarters use only 9. Listings and mailing labels, per name $0.05 For headquarters use only Setup charge $55 For headquarters use only 10. Study guide $25 For headquarters use only Pre and Post Mining Fees 1 . Gamma radiation exposure measurement (1 per acre) $7.50 For headquarters use only 2. Soil characterization measurement (1 per 20 acres) $320 For headquarters use only 3. Air monitoring measurements $ 165 For headquarters use only 4. Surface and ground water measurements $300 For headquarters use only Low-Level Radioactive Waste Inspection Fee Cubic foot of waste shipped (minimum fee = $50 per shipment) $ 1 . 95 For headquarters use only Low-Level Radioactive Waste Transport Fee Annual transport permit $100 For headquarters use only Water Analysis Fees 1 . Gross alpha $28 For headquarters use only 2. Gross beta $28 For headquarters use only 3. Radium 226 $ 110 For headquarters use only 4. Radium 228 $ 110 For headquarters use only 5. Uranium $ 110 For headquarters use only 6. Tritium $40 For headquarters use only 7. Strontium 89, strontium 90 $95 For headquarters use only 8. Iodine 131 $ 110 For headquarters use only 9. Photon emitters $ 128 For headquarters use only Laboratory Certification Fees 1 . Safe drinking water certification $500 2. Clean water certification $500 For headquarters use only 3 . Resource conservation recovery $500 For headquarters use only 4 . Field of testing application For headquarters use only$200 For headquarters use only Must use County Health Department IBI (01 -67) Page 13 9/6/2005