Case 1:11-cv-20120-PAS Document 83-2 Entered on FLSD Docket 12/16/2011 Page 1 of 62

Case 1:11-cv-20120-PAS Document 83-2 Entered on FLSD Docket 12/16/2011 Page 1 of 62

IN THE UNITED STATES DISTRICT COURT FOR
THE SOUTHERN DISTRICT OF FLORIDA

CASE NO.: 11-20120-CIV-SEITZ/SIMONTON

TRAIAN BUJDUVEANU,

Plaintiff,

vs.

DISMAS CHARITIES, INC., ANA GISPERT,
DEREK THOMAS and ADAMS LESHOTA

Defendants.
/

AFFIDAVIT IN SUPPORT OF
MOTION FOR SUMMARYJUDGMENT

STATE OF FLORIDA )

COUNTY OF BROWARD )

BEFORE ME, this date personally appeared the undersigned, who after

being first duly sworn hereby state, as follows:

1. My name is Ana Gispert. I am over the age of 18 years and not laboring

under any disabilities. I have personal knowledge of the facts and matters below.

2. I serve as the Director for Dismas Charities, Hollywood, Florida location.

3. Plaintiff pled guilty to charges of conspiring to illegally export military

and dual use aircraft parts to Iran. Plaintiff was sentenced to 35 months for his crimes.

4. Towards the end of his sentence, Plaintiff was transferred to Dismas, a

"halfway house," on July 28, 2010 until his release date of January 31, 2011.

5. Dismas is a private non-profit corporation known as a CCC Contractor.

6. As a result of the Plaintiffs health issues, Plaintiff was released to home

confinement and was required to report back to Dismas every Wednesday.


7. Plaintiff attended a resident orientation, had the program policies and
procedures explained to him and was give the opportunity to ask questions and receive
clarification of any policies and procedures. (True and correct copies of the relevant
portions of the Resident Handbook, Rules, Regulations, Expectations, Sanctions and

Contraband List provided to the Plaintiff and are attached to my affidavit as Exhibit 1)
8. The Residential Handbook is quite clear that all participants in the Dismas
program, like the Plaintiff, consent to searches of their persons and vehicles (p. 16,

Exhibit 1); are not permitted to possess or use cell phones without authorization (p. 16,
Exhibit 1) and cannot drive without the prior approval of Dismas. (p.21, Exhibit 1).

9. The Residential Handbook is quite clear that all participants in the Dismas

program are not permitted to possess or use cell phones without authorization that

unauthorized cell phones are contraband and any unauthorized cell phone is contraband,

which will be confiscated and not returned, (p. 16, and Contraband List Exhibit 1)

10. Plaintiff also received Dismas' Rules and Regulations. (True and correct

copies of the relevant portions of the Rules and Regulations are attached to my affidavit
as Exhibit 2)

11. The Rules and Regulations of Dismas-Dania Beach are quite clear that all

participants in the Dismas program, like the Plaintiff, consent to searches of their vehicles

(p.3, Section 2(d), Driving Privileges, Exhibit 2); are not permitted to possess or use cell

phones without authorization (p.3, Section 6(c), Contraband, Exhibit 2) and cannot drive

without the prior approval of Dismas. (p.3, Section 2(a), Driving Privileges, Exhibit 2).

12. The Rules and Regulations of Dismas-Dania Beach are quite clear quite

clear that violations of the rules and regulations could lead to sanctions, including
termination from the Program, (p.6, Section 2(a), Sanctions, Exhibit 2).


13. Plaintiff acknowledged on May 27, 2010 and on July 28, 2010, that he

received a copy of Dismas Rules, Regulations and Restrictions and would abide by the
rules and regulations. True and correct copies of the Plaintiffs Acknowledgement Forms
are attached to Exhibit 3.

14. On May 27, 2010 and on July 28, 2010, Plaintiff acknowledged that: he

received a copy of the Contraband List; that if he is found with contraband it would be

confiscated and disposed of by Dismas; and that if he was found with contraband, he

would be subject to disciplinary action. True and correct copies of the Plaintiffs

Acknowledgement Forms are attached to Exhibit 3 to this affidavit.

15. On February 24, 2010, the Plaintiff signed a Federal Bureau of Prisons

Form in which he understood that as part of his residential reentry center release that he

would abide by the rules and regulations of the program. A true and correct copy of the

Plaintiffs BOP Acknowledgement Form is attached to Exhibit 4 to this affidavit.

16. On September 10, 2010, one month before the Plaintiff drove without

authorization from Dismas and was found to be in possession of an unauthorized cell

phone, the Plaintiff signed a Department of Justice, Federal Bureau of Prison Conditions

of Confinement Form in which the Plaintiff agreed that he would not drive a motor

vehicle without CCM approval. A true and correct copy of the Plaintiffs BOP Conditions

of Home Confinement Form, containing condition 12, is attached to Exhibit 5 to this

affidavit.

17. On September 10, 2010, one month before the Plaintiff drove without

authorization from Dismas and was found to be in possession of an unauthorized cell

phone, the Plaintiff signed a Home Confinement Special Conditions Form in which he

acknowledged he would adhere to the Rules of the Bureau of Prisons Conditions of


Home Confinement as well as the policies and procedures ofhis CCC facility, Dismas.
A true and correct copy ofthe Plaintiffs Home Special Conditions Form, containing is
attached to this affidavit as Exhibit 6.

18. The use of cell phones between felons is a security risk. Certainly, the
Plaintiff could not have a cell phone in prison and as he was still serving a prison
sentence (in home confinement), possession of a cell phone was prohibited. Cell phones
are hazardous to institutional security, as is demonstrated by the fact that they are not
allowed in prison. Cell phones, for example, would permit people to talk and
communicate after lights out to potentially organize disruptions of the institution.

19. The authorized use of a motor vehicle by a CCC participant also provides
a security risk. Certainly, the Plaintiff could not use a motor vehicle in prison and as he

was still serving a prison sentence (in home confinement), use of a motor vehicle without

authorization was prohibited.

20. The Plaintiffwas also not permitted to attend religious services outside of

a 5 mile radius of his confinement as per Federal Bureau of Prison guidelines. A copy of

the guidelines for religious services is attached to this affidavit as Exhibit 7.

21. On October 13, 2010, the Plaintiff appeared on his reporting date by

driving himself to Dismas in Plaintiffs family vehicle.

22. While Plaintiff may have held a valid driver's license, he was not

authorized by Dismas to drive or operate a motor vehicle.

23. The Plaintiff was not authorized to operate a motor vehicle without

approval of the Director of Dismas, Ana Gispert.

24. At no time did I authorize the Plaintiff to drive a motor vehicle.


25. Following the violation, the vehicle was searched for safety reasons and a
cell phone allegedly belonging to the Plaintiffs family was discovered.
26. The Plaintiff was not authorized to possess acell phone, regardless of who
owned it.

27. A phone can be hazardous to safety as it can be used to call or
communicate with other persons not confined or other half way house residents, which
could cause security issues.

28. A Disciplinary Report was then prepared and signed by the Plaintiff after
the incident on October 13, 2010. True and correct copies of the Dismas Reports are
attached as Exhibit 8 to this affidavit.

29. The Plaintiffs personal items were then held by Dismas. As the phone
was contraband, Dismas donated the phone.

30. The remainder of the Plaintiffs personal items were held by Dismas.

31. Dismas requested that the family members pick up the items. However,

the Plaintiff or his designated family member refused to pick the personal items up from
Dismas and Dismas, at its own cost, delivered the items to the Plaintiff. A copy of the
property release memorandum is attached as Exhibit 9 to this affidavit.

32. Since the Plaintiff violated Federal Bureau of Prison guidelines

concerning his CCC confinement, the Federal Bureau of Prisons was notified on or about

October 19, 2010.

33. On October 19, 2010, the Federal Bureau of Prisons, not Dismas, then sent

the United States Marshall's Service to Dismas to take the Plaintiff back to FDC Miami

to complete the rest of his sentence. A copy of the Federal Bureau of Prisons pick up
notice to the United States Marshall Service is attached to my affidavit as Exhibit 10.


34. It is my understanding that Plaintiff was transferred by the Bureau of
Prisons into the custody of FDC Miami, where a subsequent hearing was held by the
Bureau of Prisons concerning his possession of a cell phone and driving a vehicle without
authorization. He was found guilty of these offenses at the hearing and required to serve
the remaining 68 day balance of his initial sentence at FDC Miami. A copy of the
Plaintiffs United States Bureau of Prison Center Discipline Committee Report is
attached to this affidavit as Exhibit 11.

35. The Plaintiff, at all times, was under the control of the Federal Bureau of

Prisons until his sentence was completed.

36. CCC is a privilege not a right. The Plaintiff, as well as other felons, is still

under the control, rules and regulations of the Federal Bureau of Prisons. While not

locked behind a cell door while and out of a federal correctional institution, the Plaintiff

is still serving the terms of his sentence even when at a CCC. The Plaintiff, despite his
beliefs, was not a "free man" able to do whatever he wanted.


FURTHER AFFIANT SAYETH NAUGHT.

SWORN TO AND SUBSCRIBED before me this JU.s* day of

~"3>jgg«HWi ,2011.

NOTA

My Commission Expires: 3V'H I 3o2>
(PrintVFype or Stamp Commissioned
Name of I 'otary Public

Personally Known • OR Produced Identification Q3 LAURIE L JACKSON
Notary PuoHc - tU» of florid*
Type of Identification Produced: pU->*zi£*3XVw</^ LiC^tn&C My Comm. Expkn Mar 14.2011]
Jfc* Cornmittioa#OON46a7
* BorMTlmgklWIoaiMIMryAiHj


CERTIFICATE OF SERVICE

I HEREBY CERTIFY that on the 16th day of December, 2011, I electronically
filed the foregoing document with the Clerk of the Court using CM/ECF. I also certify
that the foregoing document is being served this day on all counsel of record or pro se
parties identified on the attached Service List in the manner specified, either via
transmission of Notices of Electronic Filing generated by CM/ECF or in some other
authorized manner for those counsel or parties who are authorized to receive
electronically Notices of Electronic Filing.

/s/ David S. Chaiet
DAVID S. CHAIET, ESQUIRE
Florida Bar No. 963798


SERVICE LIST

Traian Bujduveanu v. Dismas Charities, Inc., et al.
Case No..: 11-20120-CIV-SEITZ/SIMONTON
United States District Court, Southern District of Florida

Traian Bujduveanu
Pro Se Plaintiff
5601 W. Broward Blvd.
Plantation, FL 33317

Tel: (954) 316-3828
Email: orionavfa),msn.com


DISMAS CHARITIES, INC.
Dania Beach, Florida

"Healing the Human Spirit"

Residential Reentry Center

Resident Handbook

Rules, Regulations, Expectations, Sanctions, and Contraband List

/
/

/

Dismas Charities, Inc. Proprietary Information {_ > ' ' "J Yj
Dismas Charities Dania Beach Operations Manual - Reviewed/Revised 5/2010


Your Counselor will assist you in referrals to outside agencies and/or services. Remember: Non-compliance
with required program and/or group participation will delay your progression through the Level System and
may affect your release from the program.

Additionally, within two weeks you will be required to participate in the journaling program which is mandated
by the Federal Bureau of Prisons. Should you choose not to participate you will be restricted to the Community
Corrections Component of our program until your release.

You will be released based on your successful completion of the program, along with the set release date
mandated hy the Supervising Authorities,

AUTHORITY
Residents are to treat all staff and other residents with courtesy and respect at all times. No resident may use
profanity or demeaning language to staff or other residents. No resident may have authority over another
resident.

All residents will address staff by MR. or MS. (followed by their last name). Note: All staff will refer to all
residents in the same manner.

RESIDENT BEHAVIOR
Any resident behavior which leads staff to believe that the resident may be harmful to themselves, staff, or the
public will be removed from the program. Remember: During yourprogramming at Dismas you will encounter
and interact with many persons (staff and residents) from many differentbackgrounds, beliefs, and economic
levels; therefore, it is imperative that you treat everyone with respect in regards to their mannerisms, religious
practices, language, etc. Remember your successful re-entry into the community will be contingent in part on
your acceptance and ability to get along with various persons from different cultural backgrounds. The use of
profanity, racial and/or sexual gestures or speech is prohibited.

Additionally, Dismas wishes all residents to be watchful of fellow resident's behaviors which couldindicate
that the resident may attempt to do harm to themselves. Signs can be, but are not limited to: Withdrawal from
group participation or conversations, discouraging comments, isolation, poor hygiene, etc. Should youwitness
these signs you are to notify Dismas staff immediately. Should you yourself have these symptoms and feelings
of hopelessness you are encouraged to contact any Dismas staffmember immediately for referral for treatment.

RESIDENT BULLETIN BOARD
All residents are required to read the Resident Bulletin Boardon a daily basis, which is located in the Dining
Area. Residents are not permitted to remove any information from the Resident BulletinBoard. Staffwill
communicate procedure changes, notice of meetings, etc. via a Memorandum on the ResidentBulletin Board.
The Resident Bulletin Board also contains information that is permanent, including: Resident Rules and
Regulations; BOP Prohibited Acts; Emergency Medical and Evacuation Procedures; Resident Rights & Contact
Information; etc.

COMMUNITY MOVEMENT
You are requiredto be accountable to Dismas staff at all times. Dismas will not approve you to have any
movements within the community where you cannot be immediately reached by phone. Destinations where
phones have call forwarding, three-way calling, and/or answering services, or cell phone only services will not
be authorized. When signing out of the facility, you are responsible for putting your finger print on the scanner
and waiting until you are cleared by the RAM system. Remember: If you have to go to another destination
""anWoTaddiTiorial move IrTthe community, otheTthanybur approved"sfgn-out deltmatibn,youare~requiredTo
call in and request achange ofdestination, prior to making the move. Itis important to remember that asking to
v- Dismas Charities, Inc. Proprietary Information 4

f change a destination is a request, and staff will make the decision if the changewill be granted. All information
regarding the newdestination must be provided to staff when the request is made.
Staff will not granta move without the necessary information (name, full address, phone number, and purpose
of the movement). Furthermore, when you reach your approved destination, you are to call the facility and
reportin. Note: When you call in, the location and telephone number will be monitored by Caller-ID, and staff
are permitted to contact you at your approved sign-out destination, at any time. When you get ready to leave
your approved sign-out destination you are to call the facility and report to staff that you will be returning. Note:
Your call in location will be monitored by Caller-ID, and staff are permitted to contact you at your approved
sign-out destination at any time. Returning lateto the facility can result in a disciplinary report. *Movement
Requests must be provided for all non-emergency movements at least24 hours in advance. Does not apply to
weekend requests, which have to be submitted by Thursday at 12 noon.

Residents may not frequent the racetrack, bingo, or other destinations where the primary purpose is gambling.
Residents arenot to enter places wherepornography or liquor is a main commodity. Residents may not eat at
food establishments where alcohol is served, even on approved pass movements._Remember:
Unaccountability is a serious violation, and may warrant loss of privileges or yourtermination from the
program. These accountability procedures protect you and verify to Dismas, the community, andthe United
States Probation Office and the Federal Bureau of Prisons your accountability.

COUNTS
Head counts are conducted randomly during all shifts. Residents in the facility are required to be accountable to
staff within the facility at all times, unless you are on an approved movement outside of the facility.

ROOM CLEANLINESS/RESIDENT ROOM ACCESS
You are responsible for the cleanliness of your living area at all times. Your assigned bedis to be neatly made
at all times when not occupied. You are required to keep all of your propertyneatly organized in your assigned
locker. You are not to leave clothes or other items on the floor, on the side or tops of lockers, in chairs, or on the
bed. Note: Only (3) pairs of shoes will be permitted to be placed neatly under your bed. Nothingis to be
hanging on the bedposts or end rails except drying towels and your laundry bag.

A staffmember will conduct room inspections on a daily basis. Whenpossible, you will be given the
opportunity to correct any problems with your area before property is confiscated or disciplinary action is taken.
Repeat violations however, will result in disciplinary action. Forlife safety reasons and for the respect of others,
no TV's, DVD's or DVD tapes, recorders, or other electronic equipment, withthe exception of a Radio, IPOD,
MP3, or CD player w/headphones use only will be permitted, No I-Touches are permitted. Headsets are not an
excuse for non-compliance to drills, counts, or responding to pages, etc. No extension cords, stuffed animals,
cardboard boxes, rugs, non-issued linen, and non-issued pillows are not permitted, and will be considered
contraband. *Medical equipment when required by a doctorwill be permitted.

No resident ispermitted to change rooms or beds without permission from their Counselor, Dismas has the right
to change your bed and room assignment at anytime. No resident is permitted in another resident's locker, bed,
or dorm area. Your locker must be secured at all time. Residents are not permitted Lu use empty lockeis or
beds. Property found stored in a lockerthat has not been assigned will be thrown out.

No resident is permitted in any restricted area or staff office without the permission and presence of staff.

WORK DETAILS
Youwill be assigned a Work Detail Assignment during your stay. The Work Detail Assignment Sheet is posted
'"onthe Bulletin Board, alongwith a detaUeddescription of your assigned Work Detail Task. You are required"
to complete your detail as assigned and described, and residents are not permitted to switch details or complete
Dismas Charities, Inc. Proprietary Information 5


In a Fire Situation:

> DO NOT PANIC! DO NOT USE THE ELEVATOR! USE THE STAIRWAY
> Ifthe room is smoky or you smell smoke, get on your hands and knees (or stomach) and crawl to the
door.
> Feel the doorknob; if hot, DO NOT open the door; if cold, open the door slowly, and move toward the
closest exit.
> DO NOT PROP EXIT DOORS OPEN!
> Ifthe doorknob is hot, place atowel or other barrier at the bottom ofthe door and wait for help.
> Pull tViP fire al^rm ag ymi evatmatp if this has not already hem done.
> After exiting the building, all persons shall meet in the far left side ofthe parking lot and or across the
street. Staff will conduct a count and report any persons missing to the Police and Fire Department
officials.
> NEVER REENTER A BURNING BUILDING!

DISCIPLINARY ACTION (The Federal Bureau of Prisons, CCM, office has acopy of the Dismas Charities Dania Beach
Resident Handbook/Rules and Regulations and hasapproved itscontents)

Prior to transfer from an institution, each resident is forwarded acopy ofthe Dismas Charities Dania Beach
Rules and Regulations/ Resident Handbook. At the time of your orientation, this information is reviewed. The
Receipt ofRules and Regulations/Resident Handbook form is signed at this time by both the resident and staff
and placed in the resident's file. All non-sentenced residents (Public Law) are provided acopy ofthe Dismas
Charities Dania Beach Handbook/Rules and Regulations at the time ofinitial intake.
7A copy ofthe Dismas Charities Dania Beach Rules and Regulations are incorporated in this Handbook.
Additionally, Federal Pre-Release Residents receive acopy ofthe Federal Prohibited Acts. You are responsible
for knowmg'ajKUjadeJstanding the information contained within these documentsandj^^lbeheld
^gounteblefortter^ ofthe rules, then staff
wii^gxrowr-feem^ndep^la^fflly-^ith you. If you violate aDismas (In-House) rule, then an appropriate staff
member will write aDisciplinary Report (DR.). The PR is presented to you for signature and it is then
forwarded to your Counselor or designee for investigation ofthe report. The signing ofaDisciplinary Report
by you is not an admission of guilt, but an acknowledgement that you are aware ofthe Disciplinary Report. The
investigating staff member will investigate the report and will recommend an appropriate sanction, which could
range from expunging the report to aloss ofprivileges or program termination. Once the Director has signed off
on the Disciplinary Report, then the action is deemed appropriate. The Director can increase or decrease the
action recommended. If you feel that action was not appropriate, then you can file an informal grievance to the
Director, for review of the action.

Remember it is Dismas Charities Dania Beach's intent to handle minor disciplinary infractions with in-house
sanctions such as loss of privileges; reprimands; verbal warnings; special assignments; dorm or facility
restriction- reduction in level; impound or confiscation of unaudited personal property; or extra details.
However, apattern or increasing number of disciplinary infractions or gross violation of program rules could
result in greater sanctions, up to and including your termination from the program.
When aFederal Prohibited Act is committed, by aPre-Release (BOP) Resident, staff will initiate a(Formal)
Incident Report. The report will be investigated by astaffmember who was not awitness to the incident, and
then aformal hearing will be conducted by the Center Disciplinary Committee, which can be made upofone to
-threerstaffnrcmbervriH^ A
.recommended sanction(s) will be determined at the conclusion of the formal hearing and the report, hearing,


and substantiated evidence and sanction recommendation(s) will be forwarded to the Community Correction
Manger (CCM) for review and processing by the Disciplinary Hearing Office (DHO) with the Federal Bureau
of Prisons. Note: Category three or four offenses can be resolved at the facility level.

BOP PROHIBITED ACTS & SANCTIONS
FEDERAL BUREAU OF PRISONS
Prohibited Acts (CCCs)

Note to CDC Chairman- Choice of recommended sanctions must coincide with the severity range of the infraction. Normally, the more sever infractions should carry
^t.rp.n.itiP.^n.hncPinfh.i^rs.vmrvl.vHs Sanctions ARBim and Frrgnirf CCM approval prior to imposition
The Community Corrections Manager may increase the severity ofsanction(s) recommended, but may not exceed the ranges specified.
More than onesanction may beimposed fora particular infraction.
Severity Range: 100 =Greatest 200 =High 300 =Moderate 400 =Low
CODE PROHIBITED ACTS SANCTIONS
197 Useofthe telephone to furthercriminal activity.
100 Killing

101 Assaulting any person (includes sexual assault) oran. Acharge for 198 Interfering with a staffmember intheperformance ofduties.
assaulting any person atthis level istobeused only when serious (Conduct must beoftheGreatest Severity nature.) This charge is
physical injury has been attempted orcarried out by an inmate. to be used onlywhen another charge of greatest severity isnot
applicable.
102 Escape from escort; escape from asecure institution (low, medium,
and high security level and administrative institutions); orescape from 199 Conduct which disrupts or interferes withthesecurity or orderly
a minimum institution with violence
running of the institution or theBureau ofPrisons. (Conduct must
be of the GreatestSeveritynature.) This chargeis to be usedonly
103 Setting a fire (charged only when found topose athreat tolife or whenanotherchargeof greatestseverityis not applicable.
a threat ofserious bodily harm or furtherance ofa prohibited actof
Greatest Severity, e.g. infurtherance ofa riot or escape; otherwise A. Recommended parole date rescissionor retardation
thecharge is properly classified Code 218or 329)
B. Forfeitearnedstatutorygood time or non-vested goodconduct
104 Possession, manufacture, or introduction of a gun, firearm, weapon, time (upto 100 %) and/or terminate ordisallow extra good time
sharpened instrument, knife, dangerous chemical, explosive orany (an extragoodtimeor goodconduct timesanction maynotbe
suspended).
ammunition.

B.I Disallow ordinarily between 50and75%(27-41days)ofgood
105 Rioting
conducttime credit available for year (a good conducttime sanction
may not be suspended)
106 Encouragingothers to riot
C. Disciplinary Transfer(recommend)
107 Taking hostage(s)

108 Possession manufacture, orintroduction ofa hazardous tool (Tools D. Disciplinary segregation (up to 60 days)
most likelyto be used in an escapeor escapeattemptor to serve as
weapons capable ofdoing serious bodily harm toothers; orthose E. Make monetary restitution
hazardous to institutional securityor personal safety; e.g., hack
F. Withhold statutory good time (NOTE: can be in addition to A throi
saw blade)
E - cannot be the only sanction executed)
109 (Not to be used)
G. Loss of Privileges (NOTE: cannotbe the only sanction executed)
110 Refusing toprovide a urine sample ortotake part inother drug
abuse testing

11 ] Introduction ofany narcotics, marijuana, drugs, orrelated paraphernalia
not prescribed for the individual bythe medical staff
II? Use ofany narcotics, marijuana drugs, or related paraphernalia
not prescribed for the individual bythe medical start

113 Possession ofany narcotics, marijuana, drugs, or related
paraphernalia not prescribed for the individual by the medical staff

SANCTIONS
CODE PROHIBITED ACT

200 Escape from unescorted Community Programs and activities and 202 (Not to be used)
Open Insh'tutions (minimum) and from outside secure institutions-
203 Threatening anotherwithbodilyharmor anyotheroffense
- without violence.

204 Extortion, blackmail, protection: Demanding or receiving money or
201 Fightingwith another person
anything ofvalue inreturn forprotection against others, toavoid bodily



GRIEVANCES
If you have a grievance of any nature, then your first action is to request a meeting with the
Counselor for an attempt at an "informal resolution". You can begin this process by submitting
an "Action Request" describing the problem, to the Counselor's attention. If the Counselor
concludes the complaint has merit, a meeting will be scheduled with all parties concerned. After
a careful analysis of all the facts, a decision regarding the complaint will then be made by the
Counselor (and/or) Director/ Assistant Director and any appropriate r.orrer.tive action will he
taken at that time. Always utilize the chain of command.

If an informal resolution cannot be reached, then you can file a grievance through the Bureau of
Prisons Adrhinistrative Remedy process on a (BP-9) form (Administrative Remedy) or Public
Law^pksemeits through their respective US Probation Officer.

j:arci
it any tiprfe, staff may conduct a search ofthe facility, your personal belongings, vehicles, or
irpefson. You do not have to bepresent for staff to search your personnel property, vehicle,
.Jor living area. Items that are deemed contraband will beconfiscated and destroyed and/or
.donated to a local charity of Dismas' choice. They are not returned. Note: This includes
^authorized cell phones, electronic game systems, computers, etc.

SMOKING
For everyone's health and safety, smoking is prohibited. This is a smoke free facility. All
smoking products and accessories are considered contraband. This applies to all visitors to the
facility.

PHONE CALLS
There are pay phones available for your use between the hours of 6:00 am and 10:00 pm. There
is a ten (10) minute limit on all telephone calls. You may not use Dismas business phones unless
approved by the Counselor (and/or) Director/Assistant Director. Staff will not take messages for
you unless it is an extreme emergency or employment/program related. Any abuse ofthe
telephone (including inappropriate conversations and language) will result in suspension ofyour
phone privileges.

BEEPERS/PAGERS/UNAUTHORIZED CELL PHONES AND I -TOUCH/1-
PADS/PASS RESIDENCE PHONES/COMPUTERS: The use of beepers, pagers, or
unauthorized cell phones whether inside oroutside ofthe center is prohibited without the specific
written approval ofthe Facility Director and the Bureau ofPrisons (BOP). Authorized beepers^
pagers, and cell phones must be left at their place of employment or for those residents on
home confinement at their approved residence. Any resident found in the possession of one of
these devices, whether active or inactive, will receive a disciplinary report, andthe itemwillbe
confiscated and not returned.

Resident who are requesting release residence passes must submit documentation each month in
the form ofa phone bill that your release residence phone does not have the following disallowed

16


features: Call forwarding, three way calling, call message or answering service. Additionally, if
your release residence is outside the local calling area to our facility, you must have the
capability on your phone to call long distance. Acopy ofyour monthly phone bill will be placed
in your file. Failure to provide your Counselor with this documentation will result inyour loss of
pass privileges. Resident eligible for home confinement must use an approved phone company
such as Bell South, Comcast or AT&T to be compatible with HC equipment. No exceptions.

While on pass, you are not allowed to utilize anv cordless phone. Contact with Dismas staff must
always be done bya stationary phone. Remember: Dismas staff will berandomly contacting you
during your pass. Should you be unreachable (unaccountable); you will be placed onescape
status, and disciplined accordingly.

The use ofany computer internet service at anytime, without the approval ofyour Counselor
(and/or) the Facility Director/ Assistant Director and in some cases the CCM orUSPO is
prohibited.

EMPLOYMENT
You are required to obtain employment within 15 calendar days after your arrival. Employment
is obtained through daily participation in our Job Search Program. If you are not employed
within 15 calendar days, you may be terminated from the program. If you pass your 15 day
without securing employment, the Director will notify the CCM for a decision regarding your
continued placement within the program.

Job search is conducted Monday through Friday, 8:00 am - 4:00 pm. A Job Readiness Class will
be mandatory, each week, for those residents who remain unemployed. All unemployed residents
are required to seek employment during these above reference times. Failure to effectively look
for employment will result in program termination. Attendance Verification Forms must be
submitted to Staff upon your return from job search. These forms must be signed by any
prospective employers you have contacted throughout the day.
Before beginning employment, you must provide the Employment Specialist and your Counselor
with the following information.

1. Company Name (must be alegal company which carries workers compensation and takes appropriate taxes
from your wages)
2. Physical Address (nota PO BOX or Route Address)
3. Phone Number
4. Immediate Supervisor
—S-. Work Schedule
6. Full or Part-Time Status
7. Salary and Pay Schedule (Can not work a commission only job)

Employment must be verified prior to your first day on the job. Your employer must be notified
ofyour legal status and your secured employment must be full-time and meaningful to your
program needs and programming objectives. Note: Dismas staff will conduct an on-site visit with
you and your employer within the first seven days ofemployment. All changes ofemployment
~must-be4mmediately-reported-to-the-Employment-Speeialistand-your-Gounselor^-Any changes—
in jobs must be pre-approved by your Counselor and the Facility Director and/or Assistant
17


Any and all contact with Law Enforcement officials must be reported to your Counselor or
Facility Director/ Assistant Director immediately. Ifaticket or summons has been issued, acopy
must be provided to staff upon your return to the facility. This includes traffic accidents.
Residents must remain arrest free to guarantee their continued participation in this program.

pSierimlst attend all required program meetings unless otherwise permitted to be absent
from the Facility Director and/or Assistant Director, Counselor, or BOP.
STAFF DIRECTION AND INSTRUCTION
Residents must obey all direct orders from staff. Residents will obey all orders and special
conditions imposed by the supervising authorities. Residents will follow all conditions set forth
by the Individual Program Plan, supervising authorities and court orders.
RECREATION .
Recreational opportunities will be provided in-house. Recreation Hours:
Male: Monday-Wednesday-Friday -Sunday 6a.m. until 11 a.m.
Tuesday-Thursday- Saturday 6:30 p.m. until 8:00 p.m.
Female: Monday-Wednesday-Friday -Sunday 6:30 p.m. until 8:00 p.m.
Tuesday - Thursday- Saturday 6:00 a.m. until 11:00 a.m.
Reminder: The dress code still applies to the recreation areas of the facility. No recreation will
be allowed during meal or visitation hours.

Drs^^harities Dania Beach provides meal service for all residents In-House. Dining out
privileges, to non-alcohol service restaurants, will be approved on acase-by-case basis for those
residents who are eligible for pass movement privileges. Areceipt from the restaurant
documenting your purchases must be provided upon your return from pass. Note: Public Law,
Pre-trial or CCC status Placements are not eligible for this privilege.
TRANSPORTATION ,f
While indigent you will be provided bus passes, if needed. These passes are to be used for
program related activities only, and will only be given to you until you receive your firs
paycheck. Ifyou choose employment which is not serviced by the bus line, or normal bus hours,
—you are responsible fui vour cost and means oftransportation. _
Ifyou wish to operate amotor vehicle while in the program prior approval must be obtained
The following paperwork must be submitted to your Counselor: Valid Driver sLicense, Current
Driving Record; Valid Insurance with your name on the Policy; Current Registration.
Additionally, if you are not the owner ofthe vehicle anotarized letter authorizing you to drive
the owner's vehicle must be provided to your Counselor. Note: The car will be searched and
inspected bv staffto ensure that the regtotiorijcard^
"car^heTcenTe and inspectic^tickeTare current. The Director approves the request and acopy
21


of our approved driving information is maintained in your file. Note: Vehicles may be used for
approved work and program related activities only. Residents may not transport other residents.
Ifresident are riding to work or program activities with family members or co-workers the driver
must show a current drivers license, registration, and insurance policy to Dismas staff before the
resident will be allowed to ride with this person and must complete and have approved by their
Counselor, Director and/or Assistant Director the POV Form.
SUPERVISING AUTHORITIES (This list is subject to change, so please consult the Resident Bulletin Board
for the most update list of contract information)

Carlos Rodriquez, Community Corrections Manager (CCM)
401 N. Miami Avenue, Florida 33128
Phone (305) 536-4024

Leslie Castro, Management Center Administrator (MCA)
401 N. Miami Avenue, Miami, Florida 33128-1830
Phone (305) 536-6522

Cheryl Dennings, Community Corrections Regional Administrator (CCRA)
3800 Camp Creek Parkway, SW, Building 2000, Atlanta, GA 30331-6226
Phone (678) 686-1399

Jeff Anderson, TDAT
715 McDonough Blvd, SE
Atlanta, GA 30315
Phone: (404) 635-5669

Raymond E. Holt, South East Regional Director (RD)
3800 Camp Creek Parkway, SW, Building 2000, Atlanta, GA 30331-6226
Reginald D. Michael, Chief United States Probation Officer (SUSPO)
Tower 101 Building 101 NE 3rd Avenue, Suite 200, Fort Lauderdale, Florida 33301
Phone (954) 769-5508

FEDERAL RESIDENT LEVELS . . .
Each level is based on aseries of goals (tasks) that you must complete and maintain dunng your
stay at Dismas. With each level oftasks and achievements, certain privileges are rewarded,
which bring you closer to your goal of 100% re-entry back into the community. This level
system is arewards system, based on your positive development and longevity in the program. It
should be noted that not all residents will progress at the same rate or levels due to the seventy of
their charges orthe level ofprivileges granted.
All pass movement requests for the week (church, social, release residence passes, non-
emergency medical treatments, etc.) must be submitted to your Counselor by 12 noon on
Thursday. NO EXCEPTIONS! Home Passes will only be given to your pre-approved
release address, which was signed off by the Supervising Authority. NO EXCEPTIONS!
COMMUNITY CORRECTIONS COMPONENT:
LEVEL 1- This is the most restrictive level. Designation to this level is made by the BOP, the
~ColH^SFO~^"Facllit^ level are denied'access to the communiry—
except for employment, program needs, community service or emergency situations. Residents


DISMAS CHARITIES DANIA BEACH
CONTRABAND LIST
Mouthwash orover the counter medications containing alcohol or Quinine unless prescribed by a
physician, i.e., Tonic Water, Mineral Water, Vinegar
Prescription Medications and over the counter medications that contain a narcotic, sleeping aid,
stimulant, orother over the counter medications not approved by policy.
Weapons (includes knives ofany kind, or pointed scissors or fingernail clippers with asharp file
orknife attachment, firearms, box cutters, loose razor blades, pepper spray, or any other device
which could be used as a weapon).
Food or Beverages outside the Dining Room. Food orbeverages containing poppy seeds.
Computers, Blackberry type hand-held devices, typewriters with memory, TV/VCR, I-Touch,
I-Pads, DVD's/Video Game Equipment, and Tape Recorders. (Includes video games &Tapes)
Personal fans or heaters
Credit cards
Cameras or any video recording devices
Extension cords, multi-plug devices
Tools
Gambling devices, to include lottery tickets, tip boards, dice, track tickets, etc.
Alcohol, narcotics, vinegar, golden seal, over the counter inhalers, or controlled substances
Paint
Non-issued: locks, linens, blankets, pillows, mattresses or mattress covers
Glue and any other solvent type products, to include White Out
Aerosol spray, candles, incense
Tobacco products smoke and smokeless
Condoms
Pornographic material
y item containing the following words on the label: Warning, Toxic, Danger or Flammable
Ik Jnauthorized: Beepers, pagers, cellphones (either active or inactive)
Possession of another residents' property, whether bonowed, loaned, or otherwise
Tattoo making equipment and supplies
Cardboard boxes orplastic bags, stuffed animals, plastic waste baskets orbags, shoe boxes.

NOTE- ANY CONTRABAND ITEM THAT IS CONFISCATED WILL NOT BE
RETURNED. IT WILL BE DISPOSED OF. NO EXCEPTIONS!

29


Dismas Charities Dania Beach
Rules and Regulations

As a resident of Dismas Charities Dania Beach you are expected to read (or have
someone read to you) the following rules. You are also required to abide by the
rules while residing in Dismas Charities Dania Beach. Please advise staff of any
questions you may have regarding the rules.

1. Accountability
(a) Residents are required to digitally sign out and in when leaving and
returning to the Center. Residents must have a staff member digitally
acknowledge each time they leave and return to the Center.
(b) Residents are responsible for knowing their return time; they are to get a
return time from staff prior to leaving the Center.
(c) Residents are not permitted to be late returning to the Center.
(d) Requests for time extensions must be made prior to the assigned return time.
Employer/supervisormust call if extension is for work purposes.
(e) Residents must call the Center and receive permission prior to making
destination changes. Center Staff must approve all destinations.
(f) Residents must return directly to the Center after work, church,
appointments, etc., regardless of the time; even if there is extra time.
(g) Residents must be able to be reached via telephone while out of the facility,
(h) Call forwarding, three way calling, and answering services are prohibited.
Residents are not allowed to sign out to destinations that receive these
services; and, residents are not to use these services, in communication with
Center Staff.

ing Privileges
esidents must obtain written authorization from Dismas Charities Director
and/or the appropriate Supervising Authority prior to operating any vehicle.
Vehicles may be used only to go to and from work, training, approved
programming and school. Dismas Charities Staff and/or Supervising
Authority must approve use nf a vehicle, for any other purpose.
Residents must maintain liability insurance, registration, and a valid driver's
license. Proof of all must be submitted and maintained throughout one's
residency.
Residents are required to submit to a search of their vehicle by staff at
anytime.

Dismas Charities, Inc. Proprietary Information
Dismas Charities Dania Beach Operations Manual - Reviewed/Revised 12-09
HhUA X


(e) All lights and electrical equipment must be turned off when a dorm is
unoccupied.
(f) Residents may go outside in the recreation areas at the assigned times only.
(g) Gambling in any form is prohibited.
(h) Residents may not visit any destination whose primary business is gambling,
alcohol, or pornography.

6. Contraband
(a) Alcohol, narcotics, controlled substances, fire arms, gambling paraphernalia
(including lottery tickets), pornography, incense, and anything listed on the
Dismas Charities Contraband List are not allowed on Dismas Charities'
property. Possession of any of the items by a Resident is prohibited. A
complete contraband list is included in your Resident Handbook and posted
on the Resident Bulletin Board.
(b) Residents are not to consume or use any product that may contain poppy
seeds, illegal substances, alcohol, Quinine, etc. unless prescribed by a
physician.
Use or possession of any unauthorized pagers and cellular telephone
quipment (to include charges) is not permitted. The Supervising Authority
ust approve use of these devices. If approved, they are not permitted on
the premises of Dismas Charities.
Residents are not to associate with anyone who may be carrying a firearm
and/or any illegal material.

7. Program Requirements
(a) All residents must arise by 6am. Residents who work 3rd shift will be
permitted to sleep for 8 hours.
(b) Residents may not leave the Center prior to 6am unless for work or other
approved programming purposes.
(c) Residents must submit to an ALCO (breathalyzer) test and/or drug screen
when requested by Staff.
(d) Subsistence must be paid on residents' payday, unless other arrangements
have been made with the Director.
(e) Fraudulent use of the Dismas Charities' food program is prohibited (this
includes giving meals to others).
(f) Residents must eat the meals they sign for at the designated times.
(g) Residents will obey all orders imposed by their Supervising Authority.
(h) Residents will abide by conditions set forth in their Individual Program Plan.
JT)__ Residents will abide by all conditions set forth in the Resident Handbook.



(j) Residents must attend all required meetings, groups, and/or classes as
scheduled,
(k) Residents are to read the bulletin board daily as they are responsible for the
information posted.
(1) No resident may enter into any contract without prior approval from the
Director.
(m) Residents will act in an orderly manner during emergency drills. Failure to
evacuate in 3 minutes or less is prohibited.

8. In House Visitation
(a) Visitors may visit only during designated times.
(b) Items may be left for residents only during visiting times.
(c) Residents are responsible for the conduct of their visitors (To include dress)
Note: Staff may ask visitors to leave if behavior is inappropriate.
(d) Residents are to clean up after their visitors.
(e) Visitors are not allowed in resident rooms.
(f) Physical contact must be limited to that described in the Resident Handbook.
(g) Ex-residents and convicted felons are not allowed to visit residents without
special permission from the Director and the Supervising Authority.

9. General Conduct
(a) Residents are to treat all Staff and other residents with respect.
(b) Residents will not lie to Dismas Charities Staff.
(c) Residents are to obey all direct orders from Staff.
(d) Double asking is prohibited - meaning once a resident asks one staff
member permission for a desired activity and receives an answer, they are
not to ask a different staff member the same question for a more desirable
answer

(e) Use of profanity is prohibited.
(f) No resident may have authority over another resident; harassment in any
form is prohibited.
(g) Personal relationships and physical contact between residents is prohibited.
(h) Residents are not to go anywhere together without permission from the
Director,
(i) Residents are not to associate with former residents,
(j) Residents are to be fully clothed in the Center
(k) Residents must remain arrest free. Any contact with legal authorities must
be reported to Staff immediately.
_QX_JRfisideBt§_ar£jg^^

Dismas Charities DaniaBeachOperations Manual - Reviewed/Revised 12-09


(m) Residents are to remain in their dorm when the house is closed. Any
business outside the room must be taken care of prior to the house closing,
(n) Residents must respond and be in their rooms during standing headcounts,
next to their beds,
(o) Residents are not allowed in unauthorized areas.
(p) Residents will not falsify, destroy, or alter records or documents, including
time cards,
(q) Residents will not vandalize or destroy Center property. Center property is
not to be taken out of the Center for any reason,
(r) Food and drinks are not allowed in resident rooms,
(s) No outside food is to be brought in the facility by residents. Visitors may
bring food in during visiting times,
(t) Tobacco products are not to be used in the Center the Center vehicle or on
property,
(u) Residents will not jeopardize public safety in any way, while in the Center
or in the community,
(v) Any activity or behavior not specifically listed in these rules which Staff
consider to violate the intentions and goals of the Dismas Charities Program;
endanger the security of the facility or its residents; or creates hostility or
disorder among residents or staff is prohibited.

10. Medication
(a) Residents must inform Dismas Charities Staff of any prescribed or over the
counter medication they are taking.
(b) All prescription medication must be turned in to Staff. The Director will
determine if the resident may keep the medication in their possession.
(c) Medication approved for the SAM program must be kept LOCKED up in
the resident's locker, The SAM form must be taped to the inside of the
locker door.
(d) Residents must take medication as prescribed.
(e) Over the counter medication containing sleep aids, alcohol, or stimulants is
prohibited.

Sanctions:
The imposition of sanctions is based on the severity of the violation. Resident
attitude and previous violations are also considered. At the discretion of Staff, a
verbal or written warning may be given for^ninoj:, first time violators. Sanctions
imposed may include, but are not limited to:
(1) House Restriction .

DismasCharities Dania Beach Operations Manual - Reviewed/Revised 12-09


Room Restriction
Extra Duty Details
Loss of Privileges
Termination from the Program
Any Other Sanction Deemed Appropriate by Counselor and/or Director



Dismas Charities. Inc.
Receipt of Rules - Federal Facilities

Ihave received a copy of the Federal Prohibited Acts dated &'/ / ^O/O. Ihave read
them, or had them read to me. I understand them and I agree to abide by them. I am aware
that a copy of the Federal Prohibited Acts is posted on the Resident Bulletin Board. I am also
aware that these rules are reviewed and subject to change.

/)
Resident Signature Q , * Date / /

j / i

StaffStgpature//, Date
/^J^- 7/28 fa

have received a copy pf tne Dismas Charities Rules, Regulations and Minimum
jpy pt the ui
Restrictions dated 'O . I have read them, or had them read to me. 1 understand
them and I agree to abide by them. I am aware that a copy of the Dismas Charities Rules,
Regulations and Minimum Restrictions is posted on the Resident Bulletin Board. I am also
aware that these rules are reviewed and subject to change.

Re'sident Signature -n t * Date

0Z/<z4J2o/o
Date

!Ss^4^ 7/2£ //a

m ffl^
PrintNamef^^if^—
title Qitie/ewt Title /z.

dci215fed Page 1 of 1
RsviS9d 11/30/04


Dismas Charities, inc.
Conditions of Residential Community Programs Residence

I, TiHftfiH Jhl&hu/efflLf (RegisterNumber) f&ST-OOf'
hereby authorize employees of the Department of Justice and employees of any facility contracting
with the Department ofJustice to release any orall ofthe contents ofinformation in my inmate
central file to educational facilities, social agencies, prospective employers, etc., for the purpose of
assisting in all phases ofcommunity programming and release planning. Ialso authorize the above
person to advise prospective employers that Iamcurrently in the custody of the U. S. Attorney
General serving sentence or under the supervision of the U.S. Parole Commission or U.S.
Probation Office. This consent will remain in effect until my release from supervision or until
revoked in writing by me. Revocation of this authorization may result in my removal from a
community-based correctional program.

I understand that while a resident of a community corrections center (CCC) or work release
program Iwill be expected to contribute to the cost of my residence through payments to the
contractor and Iagree to make such payments. I understand thatfailure to make payments may
result in my removal from a community-based program. (Not applicable for MINT referrals).
I understand that urinalysis or other Bureau of Prisons authorized testing to detect unauthorized
drug or alcohol use may be required as a condition of residence in a community corrections center
or work release program, and ifrequired, I agree to submit to such testing. I understand that
ingestion of poppyseed products may result in positive test results for unauthorized drug use and is
therefore prohibited.

I understand that I am expected to assume financial responsibility for my health care while I am a
resident of a community-based correctional program. Should I be unable or unwilling to bear the
cost of necessary medical care I understand that I may be transferred to a suitable institution or
facility, at the Government's option, to receivesuch care. I understand that no medical care may be
provided to me at the government expense without prior authorization of the Bureau of Prisons.

I understand that I may be required to cooperate with substance abuse assessment and participate
in any treatment recommended as a result of assessment.

I understand that I may be required to abide by the conditions of supervision as imposed by the
sentencing court or the U.S. Parole Commission, including the payments of fines and restitution and
to follow the instructions of the probation officer as ifon supervision.

I understand that upon arrival at the community corrections center I may be initially placed in the
restrictive Community Corrections Component for a period of orientation. In this component, I will
be expected to remain at the CCC unless authorized to leave for employment or other authorized
program purposes. Additionally, I understand that social visits and recreational/leisure activities will
be confined to the CCC.

/ Iunderstand that while a resident of a community mrrfirtinns ranter nr wnrk releasR program, Iwill
/ be required to abide by the rules and regulations promulgated by such program.
For MINT referrals, I understandthat I or the guardian shall assume total financial responsibility for
my child's care while am a resident of a CCC. Should I or the guardian be unable to or unwilling to
bear my child's financial cost, I will be transferred back to my parent institution immediately. I
understand that no financial support will be provided to my child by the Bureau of Prisons.

dci228 Page 1 of 2
Revised 07/01/03


Dismas Charities, Inc.
Conditions of Residential Community Programs Residence

Part II

In the event that Iam approved for home confinement, I agree to abide by the following conditions
related to my legal participation in home confinement.

understand my participation in home confinement will be an alternative to placement in a CCC for
o more than the last six months or 10% of my sentence, whichever is less. I am aware that I will
remain legally in the custody of the Bureau of Prisons and/or the U.S. Attorney General and that
failure to remain at the required locations may result in disciplinary action and/or prosecution for
escape.

I agree to report to my assigned probation officer or the contractor's facility immediately upon
reaching my release destination.

I understand that ifIdecline to participate in the recommended home confinement program I may
face administrative reassignment out of the community corrections program.

I agree that during the home confinement period, I will remain at my place of residence, except for
employment, unless Iam given permission to do otherwise. I also understand that I will be required
to pay the costs of the program based upon my ability to pay.

I also agree to maintain a telephone at my place of residence without "call forwarding", a modem
"Caller ID" or portable cordless telephones for this period. I also agree that if my confinement is to
be electronically monitored, Iwill wear any electronic monitoring device required, follow procedures
specified and not have "call forwarding" on my telephone.

Resident Printed Name ent Signature Date

T&fi/frt BUfr3"*tef/-/£f wvr&f 4j^a&
<ay< ^/<fo^_ 97/2J/20/G
Staff Printed Name Staff Signature* ,/ Date

~?/z0//O

Print Name 7##fly S^u^MAfr 3rint Name &u,.<i,<*. £*,o*
Signture u/^'QU^Wu^^_ 0 z^

iitle /2 (ATi

(The contents of this form are derived from Federal Bureau of Prisons form BP-S434.073 COMMUNITY BASED PROGRAM
AGREEMENT dated Dec 98)

dd228 Page 2 of 2
Revised 07/01/03


Dismas Charities, inc.
Consent to Disclosure of Information

, hereby consent to the release of information
deemed necessary fo respond to all request(s) for information from persons seeking information
fo to all
from my resident file relating to employment placement, resident placement, community
supervision, or other necessary aspects of release planning.

Resident Signature
2£>A?
jftature/^iC
Staff Witness Signature K_^Dili ~?/ZjL
^^J^- 7/^ /a

CLOTHING RELEASE - ACKNOWLEDGEMENT BY RESIDENT
I authorize Dismas Charities Staff to release all my personal belongings to the following
person(s) in situations where Ican not personally retrieve them. If not retrieved in seven days, I
authorize Dismas Charities Staff to dispose of them. I understand that my personal belongings
will not be released until I have returned all property of Dismas Charities, Inc.
Name Phone Number

MAtit^ nu$W£t/Sk
Address, City, State, ZIP

ResidentSignatur^^^^/^^^ ™* &?/22/&J3
Staff Witness Signature Date
-7/?<0//*

MEDICAL CARE AND HEALTH SERVICES - ACKNOWLEDGEMENT BY RESIDENT
A. I will not seek non-emergency dental or medical care without the advance approval of
the CCM (federal only) or the Facility Director.
B. Ifurther understand that if I require emergency medical care, I will make every effort to
utilize the facility listed below with which arrangements have been made by the staff.
C. I understand that no medical services may be rendered at government expense without
I
prior authorization.
D. Hearth facilities to be used in emergencies:

ResidentSignature^/^^^.^^^ •pat, fiyfa/^
Staff Witness Signature Date

Print IfamSuwe a«^
dcl206
Revised 07/01/03
Signture ///U7fxa/rs^lf/aa^^ mure
HygjM?oi 'i
'^

Titled si&fckt Title /? ?y


Release of Information Consent Form- Employment / Release Planning

Facility-—/ -^
' fry

Date of Inquiry for Information: Any time while a resident at Dismas Charities

Person Requesting Information: Any Prospective or Current Employer

Organization: Dismas Charities, Inc.

Specific Information to be Released:
Case file material relevant to employment including work history, offence, legal status, periods
of incarceration, recommendation of staff, etc.

Purpose or Need for Information:
So that Dismas Charities staff may give information to prospective employers who are
considering hiring a resident and so that Dismas Charities staff may verify current
employment.

Register Number Expiration of Consent

Resident Signature « . Date

97/al^/o
Staff Signature £^4 Date

~?/2.& //O

Note: All Information disclosed Is limited by confidentiality requirements in regard to the Privacy Act of
iau- Print Name%afe?//Mktutewv Print Name^w^^^r
Signture {on/a* /£*'ai>«** Signture/^
Title feK/eui Title ^rn
dci225 Page 1 of 1
Revised 07/01/03


Hazard Communication Training

Facility
&^
Resident Name
lent Registration Number

I acknowledge that I have received training in the requirements of the OSHA Hazard
Communication Program on 7 / 2<S / /a . Ihave been made aware of the location(s)
of all Material Safety Data Sheets (MSDS's), for those products requiring them, in this facility.
Further, the following items have been explained to me:

• The proper handling, use, and emergency procedures for each chemical product
purchased for use in this facility;

• The requirements of how chemical product(s) will be issued, inventoried, and controlled;

• The need for all remaining chemical products issued to me to be returned to staff;

• All empty containers in which chemical products were issued need to be returned to
staff at the end of each usage for proper storage (i.e., inventory and control) and/or
disposal, if needed.

Resident Signature
</^#xybf>tf*
A' aviSD/L^,
Date
07/2^J^O/O
Staff Signature Date

£-< 7/lt//*

S€lUt_

Title fietfcfe*^ Slgntur
fitle a^

dci243 Page 1 of 1
Revised 07/01/03

Dismas Charities, Inc. ~
Receipt of Personal Property / Contraband List

Receipt of Personal Property List
7XfiTM &w>ui*#//<< nave received
Persona. Property List.. understand that this list contains the maximum!number an!J type of
each item of personal property Iam permitted to possess while at a Dismas Charities Center I
IM ZS!^thereWi,lHK n° 6XCepti0nS a"0Wed to this >aterAnV excess p'opeCr p?oP^
S UndP^nH?hTVed ^ me °r my rePresentative n° ,ist- than 24 hours afteTrecent offhis
iniL Z 2? will be any 6XC!lS Pr°Perty °r Pr°perty not ,isted which is in lhe facility after the
initial 24 hours •^ removed by Dismas staff and disposed of.

Center guidelines."? *" PerSOn,al Pr°perty wi" be stored in a<*ordancenot stored in acco dance
^nt°0rJnMewrS!and Any personal property regardless of quantity or type with Dismas Charities
w.th these guidelines will be considered excess property and removed by Dismas staff
Resident Signature 0 ~ Date

a ?!&)*2o/D
StaffSignature Date
>SC 7/2g> [

Receipt of Contraband List

Contraband Listffierstandthat all items.on ihis^Ta^for^dVn mZSSZoESL
"•"'"•>
have received a copy ofthe Dismas Charities
»^"« ">'u»o »j>i die lorrjiaaen in tneuismasC
,—g-eflgf.. '"any Dismas Charities Center vehicleoronPismas Charities Center prope
""derstand hat if IafrTTourTd to be In^ossessiolToTanyTtuiii un lliib IIU, the Hem wrtTBe
confiscated from me and disposed of by Dismas Charities staff. Ialso understand™ atff
found to be in possession of any item on this list Iwill be subject to disciplinary action. am

cejjueiu oignaiure.-i / Date

07/<&)2oio
-7/2A//0
Print WimiWtiM bobusteffl* Print Name^^r &.^
Signture
Title fatftfewt' Title £=?>
dci263
Revised 07/01/03 Page 1 of 1

Resident Employment Orientation Form

Resident Name «• Date Time
W/zilto/o <zo:3D

Each resident will be thoroughly oriented to the following:

• Intake / Individual Employment Data
• Work Entry Programs / Job Skills Group
• Inter Agency / Referrals / Vocational-Rehabilitation / Dept. of Employment Services
• Employment Contacts / Forms / Verification
• On-Site / telephone job verification contacts
• Verification of wages / Pay stubs
• Notification to supervising authority of 15 day unemployment status
• Incident / Disciplinary Report
• Job Search / Summary Review Conference

I have had the above orientation. I was allowed the opportunity to question and receive
clarification on all Employment Program Policies and Procedures and now understand them.

Resident Signature Q j Date

OIJZZUO/O
Idiscussed and explained to the residentthe above orientation and allowed him the opportunity
to question and receive clarification on all Employment Program Policies and Procedures.

Staff Sii Date
7/20 //o

Print Name T&ffm &xjdui/ap7*
Print Name %u^it fiesta
%tim^m7au^/#/u<se>L. 3igntur|^C^L__
Title jZotfe/en^—
Titte /?-/*

dci214 Page 1 of 1
Revised 07/01/03


Financial Responsibility Agreement

Federal

I understand that once I obtain employment and/or am in a earning capacity, I must pay
subsistence to the Federal Bureau of Prisons in the amount of 25% of my gross income. I
agree to pay this subsistence to Dismas Charities on a weekly basis, each and every Friday by
8:00 PM. I also understand that at the time of paying subsistence I must submit a pay stub and
report all financial earnings to my Counselor. Documentation of those earnings will be
submitted to my Counselor as well. I understand that failure to meet financial obligations during
my residency will result in disciplinary action.

In addition, I understand that my last week of subsistence is due the Friday before my release.
Failure to do so will result in loss of all privileges, and an Incident Report will be initiated, which
will result in a possible delay of release date. I also understand that I must open a savings
account and maintain a minimum of 10% of my net earnings in that account. I agree to make
these deposits on a paycheck by paycheck basis. If I cannot open a savings account, I will seek
out an alternative savings method with my Counselor. I am also aware that I may not withdraw
any money from my account unless authorized by my Counselor.

* sident Signature^ Date

Q7/&)2>/e?
Staff Sig Date

~>/i gA

Print Name iTfoVM £hJM4&/J£< Print Name 6^/7/g G^h
Signture
Title i&U^e^/- - A fin

dd210fed Page 1 of 1
Revised 07/01/03


Acknowledgment of Custody

Public Law 89-176, 89th Congress, H.R. 6964, September 10, 1965, amends Section (d) of
Section 4082 of Title 18, United States Code as follows:

"The willful failure of a prisoner to remain within the extended limits of-riis confinement, or to
return within the time prescribed to an institution or facility designated by the Attorney General,
shall be deemed an escapee from custody ofthe Attorney General, punishable as provided in
Chapter 35 of this title."

ACKNOWLEDGMENT OF CUSTODY

I understand that I am in the custody of the Attorney General of the United States. I further
understand that leaving the Residential Center without permission from the Center Director or
his/her authorized representative, shall be deemed an escape from the custody of the Attorney
General. Ialso understand that leaving my place ofemployment or training, without permission
from the Center Director or his/her authorized representative, or failure to return to the
Residential Center within the time prescribed, shall be deemed an escape from the custody of
the Attorney General of the United States.

I do hereby acknowledge that I fully understand this law.

This is the <£8 day of A1*- y ,20 ID.

urey
Resident Signature ~Q T~Z

Staff Sign

Print Name^'rtn'C (^cjfy-n
Siqnture ^/Ta/ak A^'cCwr**^ ^-J^~
Title £erfe/etr-i- fitle /2- r*n

dcl242 Page 1 of 1
Revised 07/01/03


Check-In Form

Resident Name . . Facility
EcM

The following items were issued to the above named resident upon his or her
arrival. It is agreed that all items will be returned when he or she departs from
this Dismas facility.

Quantity Item Value ($) Issued Turned-in
Lock 5.00 dl D
Pillow 7.50 d- •
Pillowcase 2.00 d •
Sheets each 4.00 tf •
Blanket or Bedspread 12.00 jzr •
Washcloth 1.00 £f •
Towel 3.00 vr •
Mattress Pad 10.00 jr a
Laundry Containers 8.00 ur •

I understand that ifany of the above items are not turned in, Iwill be personally
responsible for reimbursing Dismas Charities, Inc. for the dollar value of any item
not returned to Dismas.

ResidentSignaturcy^^ ^J/j^^r Datt* f)?J^/2o7^
Staff Witness Signal Date
Hm?oib

Print Name^^y &4dus&fM yv7/<f Cr,csl-osi
Siqnture^Vv^ £&«/cfic*/eek *> ?
Title Q^i^en-i /£_/r)

dci204 Page 1 of 1
Revised 07/01/03

Resident Orientation and Acknowledgement Form
Facilit j'
t . „
X2*"7/* rzA

rmw &ta^ ^wcTT^T^/.zs>/<? Time
Zo3o
Each resident will be thoroughly oriented to the following:
Program Goals / Staff Expectations • Personal Property List
Program Services Available
Community Services Available
• Linen Exchange And Laundry Facilities
Special Aftercare Conditions
• Work Detail Assignments
• Timecard Procedures
Individual Program Plan / Changes • Escape Policy
Program LevelAdvancement • Financial Responsibility
Legal Status
• Subsistence
Eligibility For Discharge • Savings Accounts
ConfidentialityOf Information • Budgets
Resident Rights)
• Restitution / Fines / Child Support
Resident Grievances / Admin. Remedy • Resident Bulletin Boards
^3 Program Rules / Restrictions • Wake Up
- Disciplinary Actions
• Food Service Program
Emergency Plans / Drills
• Recreation
• Fire
• Severe Weather
• Medical Care/ Health Services
• Medication
• Disaster Emergencies
• Medical Back-Up • Over-The-Counter / Prescription
• Hazard Communications
• Medication Call (SAM)
Contraband Policy/ List
• Urine Surveillance Policy
Searches
• Emergency Clothing
• Transportation Assistance
Room Inspections
• Authorization To Drive Policy
• Visitation

And Procedures and now understand them clarification of all Program Policies
In addition, Ihave received and read the following program statements:
1. Sexual Abuse /Sexual Assault Policy
2. Resident Suicide Prevention / Intervention Information Sheet
•i. Blood Bourne Pathogens and Universal Precautions (HIV /AIDS)
Residepr'Signaturav . Date
-/ <€/£/q<f&^ P7/2lJjolo_
s^jss^zsssssr-
Staff Signature
HS5£r Date
7/£l/
,

dci223
Revised 09/30/04 Page 1 of 1

BP-S0434.073 COF NITY BASED PROGRAM AGREEMEF cdfrm
JUL 08
U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

Traian Bujduveanu Register Number, 80655-004 / hereby
authorize employees of the Department of Justice and employees of any facility contracting with the Department of Justice
to release any or all of the contents of information in my inmate central file to educational facilities, social agencies,
prospective employees, etc., for the purpose of assisting in all phases of community programming and release planning.
I also authorize the above persons to advise prospective employers that I am currently in the custody of the U.S. Attorney
General serving sentence or under the supervision of the U.S. Parole Commission or U.S. Probation Office. This consent
will remain in effect until my release from supervision or until revoked in writing by me. Revocation of this
authorization may result in my removal from a community-based correctional program.

I understand that while a resident of a residential reentry center or work release program I will be expected to contribute
to the cost of my residence through payments to the contractor and I agree to make such payments. I understand that
failure to make payments may result in my removal from a community-based program (Not applicable for MINT referrals) .

I understand that urinalysis or other Bureau of Prisons authorized testing to detect unauthorized drug or alcohol use may
be required as a condition of residence in a residential reentry center or work release program, and if required, I agree
to submit to such testing. I understand, that ingestion of poppy seed products may result in positive test results for
unauthorized drug use and is therefore prohibited.

I understand that no non-emergency medical care may be provided to me at the Bureau's expense without prior authorization
of the BOP. I understand that, as part of my transition to release, I am expected to assume increased responsibility for
my health care while I am a resident of a community-based correctional program.

I also understand that I may be transferred by the BOP to a suitable institution or facility at the Bureau's option for
medical care should the Government deem it necessary.

I understand that I may be required to undergo clinical assessment and may be required to participate in treatment', e.g.
mental health/psychiatric treatment, substance abuse treatment, sex offender treatment, recommended as a result of the
assessment. I understand that failure to abide by treatment program recommendations may result in my return to a secure
facility.

I understand that I may be required to abide by the conditions of supervision as imposed by the sentencing court or the
U.S. Parole Commission, including the payments of fines and restitution and to follow the instructions of the probation
officer as if on supervision.

I understand that upon arrival at the residential reentry center I may be initially placed in the restrictive Community
Corrections Component for a period of orientation. In this component, I will be expected to remain at the RRC unless
authorized to leave for employment or other authorized program purposes. Additionally, I understand that social visits
d recreational/leisure activities will be confined to the RRC.

understand that while a resident of a residential reentry center or work release program I will be required to abide
by the rules and regulations promulgated by such program.

For MINT referrals, I understand that I or the guardian shall assume total financial responsibility for my child's care
while I am a resident of a RRC. Should I or the guardian be unable or unwilling to bear my child's financial cost, I will
be transferred back to my parent institution immediately. I understand that no financial support will be provided to my
child by the Bureau of Prisons.

PART II

In the event that I.am approved for Home Detention, I agree to abide by the following conditions related to my legal
participation in H6rag_Detention.

I understand that my participation in Home Detention will be an alternative to placement in a RRC for no more than the
last six months or 10% of my sentence, whichever is less. I am aware that. I will legally remain in the custody of the
Bureau of Prisons and/or the U.S. Attorney General and that failure to remain at the required locations may result in
disciplinary action and/or prosecution for escape.

I agree to report to my assigned probation officer or the contractor's facility immediately upon reaching my release
destination.

I understand that if I decline to participate in the recommended Home Detention program I may face administrative
reassignment out of the residential reentry program.

I agree that during the Home Detention period, I will remain at my place of residence, except for employment, unless I
am given permission to do otherwise. I also understand that I will be required to pay the costs of the program based on
my ability tb pay. — —

I also agree to maintain a telephone at my place of residence without "call forwarding," or "three-way calling" for this
period. I also agree that if instructed to do so, as a condition of Home Detention, I will not have access to a computer
with a modem or other .device for accessing the internet. I also agree that if my confinement is to be electronically
monitored, I will weapjany electronic monitoring device required, follow procedures specified, and comply with any
telephone and computer access restrictions as they apply to the monitoring device requirements.

Traian Bujduveanu
"nate's Printed N;
1//Q{0^A^/dui/^ci^k
D. Beasley-Knigh
Witness' Printed Name-and Signature
A^-io Date

Record Copy - CCM; Copy - CCM; Copy Central File

(This form may be replicated via UP)
^vhvVv T Replaces BP-S434.073 dtd DEC 98

Case 1:11-cv-20120-PAS Document 83-2 Entered on FLSD Docket 12/16/2011 Page 1 of 62

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