#12-5856 Amendment #1 (Care Club of Collier County, Inc.) Contract Amendment #1
Contract # 12-5856 "Services for Seniors"
This CONTRACT AMENDMENT #1, dated , 2013 to the referenced agreement shall be
by and between the parties to the original Agreement, are Club of Collier County, Inc. (to be referred
to as "Vendor") and Collier County, Florida, (to be referred to as "County").
Statement of Understanding
RE: Contract# 12-5856 "Services for Seniors"
In order to continue services for the original Contract document referenced above, the Vendor agrees to
the terms and conditions set forth in Exhibit A-1A, which includes Attachments C-H and Exhibits 1-10
attached hereto and incorporated by reference.
The Vendor further agrees to amend Section 1, Commencement, as follows:
1. COMMENCEMENT. This Agreement shall Commence on December 11, 2012 and shall
terminate on December 10, 2011 June 30, 2014.
The Contract award is a two (2) year contract, with the possibility of two (2) additional (2) year
terms pending funding from grantors and acceptable performance by the awarded vendor. Any
such renewals shall be mutually agreed upon in writing by the parties. The maximum duration
for this Contract for CCE, HCE, and ADI, OAA HIE AND OAA HIES funding will not exceed
six (6) years (through June 30, 2018). As outlined in RFP #12-5856, the County requires the
Vendor to contribute a cash or in-kind match of no less than ten (10) percent for all services
related to the Community Care for the Elderly Program, (CCE), Older American Title fIIF
Caregiver Support (OAA IIIE) and Older American Title HIES Caregiver Support Supplemental
Services (OAA IIIES)Programs.
Words that have been deleted are struck through, words underlined have been added.
Modification made herein shall apply as if incorporated into the Contract on the date of
Commencement. All other terms and conditions of the agreement shall remain in force.
IN WITNESS WHEREOF, the Vendor and the County have each, respectively, by an authorized person
or agent,hereunder set their hands and seals on the date(s) indicated below.
Accepted: 0.■( 21 , 2013
VENDOR:
Care gib of Collier County, Inc irst W'
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COUNTY:
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK, CLERK OF COLLIER COUNTY, FLORIDA
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A •st astaCyt.,D TY CLERK
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CIIAIRWO�MAN^
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Approval for form and legal
Sufficiency:
Jennifer B. White
Assistant County Attorney
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EXHIBIT A-lA
AGREEMENT 12-5856
SERVICES FOR SENIORS
ATTACHMENTS
ATTACHMENT ATTACHMENT DESCRIPTION PAGE
Attachment C Core Standards for CCE, HCE, ADI, OAA IIIE & IIIES 2
Attachment D Certification Regarding Lobbying 8
Attachment E Certification Regarding Data Integrity Compliance 9
Attachment F Certification Regarding Debarment, Suspension, 10
Ineligibility and Voluntary Exclusion Contracts/
Subcontracts
Attachment G Sub-Recipient Invoice Submission 11
Attachment H Background Screening Affidavit of Compliance 12
Exhibit 1 CCE Statement of work 13
Exhibit 2 HCE Statement of work 19
Exhibit 3 ADI Statement of work 25
Exhibit 4 OAA IIE and OAA IIIES Statement of work 31
Exhibit 5 Invoice 39
Exhibit 6 Detail Weekly Log 40
Exhibit 7 Monthly Log 41
Exhibit 8 Day Care/Respite Time Sheet 42
Exhibit 9 Program Time Sheet 43
Exhibit 10 Annual Audit Monitoring Report 45
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ATTACHMENT C
Core Standards for CCE,HCE,ADI,OAA HIE & IIIES
1. Compliance with Federal Law
1.1 If this agreement contains federal funds the following shall apply:
1.1.1 The vendor shall comply with the provisions of 45 CFR 74 and/or 45 CFR 92, and other
applicable regulations.
1.1.2 If this agreement contains federal funds and is over$100,000.00,the vendor shall comply with all
applicable standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended
(42 U.S.C. 7401, et seq.), s. 508 of the Federal Water Pollution Control Act as amended (33
U.S.C. 1251, et seq.), Executive Order 11738, as amended, and where applicable Environmental
Protection County regulations 40 CFR 30. The vendor shall report any violations of the above to
the County.
1.1.3 The vendor may not use any federal funds received in connection with this agreement to influence
legislation or appropriations pending before the Congress or any state legislature. If this
agreement contains federal funding in excess of$100,000.00, the vendor must, prior to agreement
execution, complete the Certification Regarding Lobbying form, ATTACHMENT D. All
disclosure forms as required by the Certification Regarding Lobbying form must be completed
and returned to the Grant Coordinator prior to payment under this agreement.
1.1.4 In accordance with Appendix A to 2 CFR 215, the vendor shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as
supplemented in Department of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
1.1.5 If this agreement contains federal funds and provides services to children up to age 18,the vendor
shall comply with the Pro-Children Act of 1994(20 U.S.C. 6081).
1.1.6 A agreement award with an amount expected to equal or exceed $25,000.00 and certain other
agreement awards will not be made to parties listed on the government-wide Excluded Parties List
System, in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders
12549 and 12689, "Debarment and Suspension." The Excluded Parties List System contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive Order 12549. The
vendor shall comply with these provisions before doing business or entering into sub-agreements
receiving federal funds pursuant to this agreement. The vendor shall complete and sign
ATTACHMENT F prior to the execution of this agreement.
1.2 The vendor shall not employ an unauthorized alien. The County will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.C. 1324a) and the
Immigration Reform and Control Act of 1986 (8 U.S.C. 1101). Such violation will be cause for
unilateral cancellation of this agreement by the County.
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1.3 If the vendor is a non-profit provider and is subject to Internal Revenue Service (IRS)tax exempt
organization reporting requirements (filing a Form 990 or Form 990-N) and has its tax exempt
status revoked for failing to comply with the filing requirements of the Pension Protection Act of
2006 or for any other reason, the vendor must notify the County in writing within thirty(30) days
of receiving the IRS notice of revocation.
1.4 The vendor shall comply with Title 2 CFR Part 275 regarding Trafficking in Persons.
1.5 Unless exempt under 2 CFR Part 170.110(b), the vendor shall comply with the reporting
requirements of the Transparency Act as expressed in 2 CFR 170.
1.6 To comply with Presidential Executive Order 12989 and State of Florida Executive Order
Number 11-116, vendor agrees to utilize the U.S. Department of Homeland Security's E-verify
system to verify the employment of all new employees hired by vendor during the agreement
term. Vendor meeting the terms and conditions of the E-Verify System are deemed to be in
compliance with this provision.
2. Compliance with State Law
2.1 This agreement is executed and entered into in the State of Florida, and shall be construed,
performed and enforced in all respects in accordance with the Florida law, including Florida
provisions for conflict of laws.
2.2 The vendor shall comply with requirements of s. 287.058, F.S. as amended.
2.2.1 The vendor shall provide units of deliverables, including various client services, and in some
instances may include reports, findings, and drafts, as specified in this agreement,which the Grant
Coordinator must receive and accept in writing prior to payment in accordance with s. 215.971,
F.S. (1)and(2).
2.2.2 The vendor shall submit bills for fees or other compensation for services or expenses in sufficient
detail for a proper pre-audit and post-audit.
2.2.3 The vendor shall allow public access to all documents, papers, letters, or other public records as
defined in subsection 119.011(12), F.S., made or received by the vendor in conjunction with this
agreement except for those records which are made confidential or exempt by law. The vendor's
refusal to comply with this provision will constitute an immediate breach of agreement for which
the County may unilaterally terminate the agreement.
2.3 If clients are to be transported under this agreement, the vendor shall comply with the provisions
of Chapter 427, F.S., and Rule 41-2, F. A. C.
2.4 Vendors who are on the discriminatory vendor list may not transact business with any public
entity, in accordance with the provisions of s. 287.134, F.S.
2.5 The vendor shall comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which
prohibit the expenditure of agreement funds for the purpose of lobbying the legislature,judicial
branch or a state agency.
3. Background Screening
The vendor shall ensure that the requirements of s. 430.0402 and ch. 435, F.S., as amended, are
met regarding background screening for all persons who meet the definition of a direct service
provider and who are not exempted from the Department's level 2 background screening
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pursuant to s. 430.0402(2)-(3), F.S. The vendor must also comply with any applicable rules
promulgated by the Department and the Agency for Health Care Administration regarding
implementation of s.430.0402 and ch. 435, F.S.
Further information concerning the procedures for background screening are found at
http://elderaffairs.state.fl.us/doeafbackgroundscreening.php.
4. Provision of Services
The vendor shall provide services in the manner described herein.
5. Monitoring by the County
The vendor shall permit persons duly authorized by the County to inspect and copy any records,
papers, documents, facilities, goods and services of the vendor which are relevant to this
agreement, and to interview any clients, employees and vendor employees of the vendor to assure
the County of the satisfactory performance of the terms and conditions of this agreement.
Following such review, the County will provide a written report of its findings to the vendor, and
where appropriate, the vendor shall develop a corrective action plan. The vendor hereby agrees to
correct all deficiencies identified in the corrective action plan in a timely manner as determined by
the Grant Coordinator.
6. Confidentiality of Information
The vendor shall not use or disclose any information concerning a vendor of services under this
agreement for any purpose prohibited by state or federal law or regulations except with the written
consent of a person legally authorized to give that consent or when authorized by law.
7. Health Insurance Portability and Accountability Act
Where applicable, the vendor shall comply with the Health Insurance Portability and
Accountability Act (42 USC 1320d.), as well as all regulations promulgated thereunder (45 CFR
160, 162,and 164).
8. Bankruptcy Notification
During the term of this agreement,the vendor shall immediately notify the County if the
Vendor, its assignees,vendors or affiliates file a claim for bankruptcy. Within ten
(10)days after notification,the vendor must also provide the following information to the
County.: (1)the date of filing of the bankruptcy
petition; (2)the case number; (3)the court name and the division in which the petition was
filed(e.g., United States Bankruptcy Court Middle District of Florida,Naples,FL); and,
(4)The name, address, and telephone number of the bankruptcy attorney.
9. Sponsorship and Publicity
9.1 As required by s. 286.25, F.S., if the vendor is a non-governmental organization which sponsors
a program financed wholly or in part by state funds, including any funds obtained through this
agreement, it shall, in publicizing, advertising, or describing the sponsorship of the program,
state: "Sponsored by Hope Hospice and Community Services, the State County of Elder Affairs,
the Area County on Aging for Southwest Florida, Inc. and Collier County." If the sponsorship
reference is in the written material, the words "State of Florida, Department of Elder Affairs, the
Area County on Aging for Southwest Florida, Inc. and Collier County" shall appear in at least
the same size letters or type as the name of the organization.
9.2 The vendor shall not use the words "The State of Florida Department of Elder Affairs or the Area
County on Aging for Southwest Florida, Inc. or Collier County" to indicate sponsorship of a
program otherwise financed, unless specific authorization has been obtained by Collier County,
or the Area Aging on Aging prior to use.
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10. Independent Capacity of Vendor
It is the intent and understanding of the Parties that the vendor, or any of its vendors, are
independent vendors and are not employees of the County and shall not hold themselves out as
employees or agents of the County without specific authorization from the County. It is the
further intent and understanding of the Parties that the County does not control the employment
practices of the vendor and will not be liable for any wage and hour, employment discrimination,
or other labor and employment claims against the vendor or its vendors. All deductions for social
security, withholding taxes, income taxes, contributions to unemployment compensation funds
and all necessary insurance for the vendor are the sole responsibility of the vendor.
11. Payment
Payments shall be made to the vendor pursuant to s. 215.422, F.S., as services are rendered and
invoiced by the vendor. The Grant Coordinator will have final approval of the invoice for
payment, and will approve the invoice for payment only if the vendor has met all terms and
conditions of the agreement, unless the bid specifications, purchase order, or this agreement
specify otherwise. The approved invoice will be submitted to the County's Grant Coordinator
approval and processing.
12. Return of Funds
The vendor shall return to the County any overpayments due to unearned funds or funds
disallowed and any interest attributable to such funds pursuant to the terms and conditions of this
agreement that were disbursed to the vendor by the County. In the event that the vendor or its
independent auditor discovers that an overpayment has been made, the vendor shall repay said
overpayment immediately without prior notification from the County. In the event that the
County first discovers an overpayment has been made, the Grant Coordinator will notify the
vendor in writing of such findings.
13. Data Integrity and Safeguarding Information
The vendor shall ensure an appropriate level of data security for the information the vendor is
collecting or using in the performance of this agreement. An appropriate level of security
includes approving and tracking all vendor employees that request system or information access
and ensuring that user access has been removed from all terminated employees. The vendor,
among other requirements, must anticipate and prepare for the loss of information processing
capabilities. All data and software shall be routinely backed up to ensure recovery from losses or
outages of the computer system. The security over the backed-up data is to be as stringent as the
protection required of the primary systems. The vendor shall ensure all vendors maintain written
procedures for computer system backup and recovery. The vendor shall complete and sign
Attachment E prior to the execution of this agreement.
14. Computer Use and Social Media Policy
The Department of Elder Affairs has implemented a new Social Media Policy, in addition to its
Computer Use Policy, which applies to all employees, contracted employees, consultants, OPS
and volunteers, including all personnel affiliated with third parties, such as, but not limited to,
Area Agencies on Aging and vendors. Any entity that uses the Department's computer resource
systems must comply with the Department's policy regarding social media. Social Media
includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video
sharing, social networks like MySpace,Facebook and Twitter, as well as content sharing networks
such as flickr and YouTube.
15. Public Entity Crime
Pursuant to s. 287.133,F.S., a person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a bid, proposal, or reply on a
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agreement to provide any goods or services to a public entity; may not submit a bid, proposal, or
reply on a agreement with a public entity for the construction or repair of a public building or
public work; may not submit bids, proposals, or replies on leases of real property to a public
entity; may not be awarded or perform work as a vendor, supplier, vendor, or consultant under a
agreement with any public entity; and may not transact business with any public entity in excess
of the threshold amount provided in s. 287.017, F.S., for CATEGORY TWO for a period of 36
months following the date of being placed on the convicted vendor list.
16. Patents,Copyrights,Royalties
If this agreement is awarded state funding and if any discovery, invention or copyrightable
material is developed, produced or for which ownership was purchased in the course of or as a
result of work or services performed under this agreement, the vendor shall refer the discovery,
invention or material to the County to be referred to the Department of State and the Department
of Elder Affairs. Any and all patent rights or copyrights accruing under this agreement are hereby
reserved to the State of Florida in accordance with Chapter 286, F.S. Pursuant to s. 287.0571 (5)
(k) 1 and 2 as amended, the only exceptions to this provision shall be those that are clearly
expressed and reasonably valued in the agreement.
16.1 If the primary purpose of this agreement is the creation of intellectual property, the State of
Florida shall retain an unencumbered right to use such property, notwithstanding any agreement
made pursuant to Paragraph 33.
16.2 If this agreement is awarded solely federal funding, the terms and conditions are governed by 2
CFR 215.36.
17. Emergency Preparedness and Continuity of Operations
17.1 If the tasks to be performed pursuant to this agreement include the physical care and control of
clients, or the administration and coordination of services necessary for client health, safety or
welfare, the vendor shall, within thirty (30) calendar days of the execution of this agreement,
submit to the Grant Coordinator verification of an emergency preparedness plan. In the event of
an emergency,the vendor shall notify the County of emergency provisions.
17.2 In the event a situation results in a cessation of services by a vendor, the vendor shall retain
responsibility for performance under this agreement and must follow procedures to ensure
continuity of operations without interruption.
18. Financial Consequences of Non-Performance
If the vendor fails to meet the minimum level of service or performance identified in this
agreement, or that is customary for the industry, then the County must apply financial
consequences commensurate with the deficiency. Financial consequences may include,but are not
limited to, agreement suspension, refusing payment, withholding payments until deficiency is
cured, tendering only partial payments, and/or cancellation of agreement and reacquiring services
from an alternate source.
18.1 The vendor will not be charged with financial consequences, when a failure to perform arises out
of causes that were the responsibility of the County.
19. No Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by
any entity to which sovereign immunity may be applicable.
20. Venue
If any dispute arises out of this agreement,the venue of such legal recourse will be Collier
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County,Florida.
21. Entire Agreement
This agreement contains all the terms and conditions agreed upon by the Parties. No oral
agreements or representations shall be valid or binding upon the County or the vendor unless
expressly contained herein or by a written amendment to this agreement signed by both Parties.
22. Force Majeure
The Parties will not be liable for any delays or failures in performance due to circumstances
beyond their control, provided the party experiencing the force majeure condition provides
immediate written notification to the other party and takes all reasonable efforts to cure the
condition.
23. Severability Clause
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void
or unenforceable the other provisions are severable to that void provision and shall remain in full
force and effect.
24. Waiver
The delay or failure by the County to exercise or enforce any of its rights under this agreement
will not constitute or be deemed a waiver of the County's right thereafter to enforce those rights,
nor will any single or partial exercise of any such right preclude any other or further exercise
thereof or the exercise of any other right.
25. Compliance
The vendor shall abide by all applicable current federal statutes, laws, rules and regulations as
well as applicable current state statutes, laws, rules, regulations and County rules, ordinances and
regulations. The Parties agree that failure of the vendor to abide by these laws shall be deemed an
event of default of the vendor, and subject the agreement to immediate, unilateral cancellation of
the agreement at the discretion of the County.
26. Final Invoice
The vendor shall submit the final CCE, HCE, ADI, IIE and IIIES invoice for payment to the
County on July 3, 2013. If the vendor fails to submit final request for payment by the deadline,
then all rights to payment may be forfeited and the County may not honor any requests submitted
after the aforesaid time period. Any payment due under the terms of this agreement may be
withheld until all reports due from the vendor and necessary adjustments thereto have been
approved by the County.
27. Renegotiations or Modifications
Modifications of the provisions of this agreement shall be valid only when they have been
reduced to writing and duly signed by both parties. The rate of payment, contract requirements
and the total dollar amount may be adjusted retroactively to reflect price level increases and
changes in the rate of payment or language.
28. All Terms and Conditions Included
This agreement and its Attachments, A-H and exhibits 1-4 referenced in said attachments,
together with any documents incorporated by reference, contain all the terms and conditions
agreed upon by the Parties. There are no provisions, terms, conditions, or obligations other than
those contained herein, and this agreement shall supersede all previous communications,
representations or agreements, either written or verbal between the Parties.
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ATTACHMENT D
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR AGREEMENTS,GRANTS,LOANS AND
AGREEMENTS
The undersigned certifies,to the best of his or her knowledge and belief,that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of any State ,Federal or
County, a member of congress, an officer or employee of congress, an employee of a member of
congress, or an officer or employee of the state legislator, in connection with the awarding of any
federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any federal agreement, grant, loan,
or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of the County, a member of congress,
an officer or employee of congress, or an employee of a member of congress in connection with this
federal agreement, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including vendors, sub-grants, and agreements under grants,
loans and cooperative agreements)and that all vendors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to
file the required certification shall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
Signature Date
Name of Authorized Individual
Name and Address of Organization
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ATTACHMENT E
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS,GRANTS,LOANS AND
COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the vendor named in the agreement or agreement to
which this form is an attachment,hereby certifies that:
(1) The vendor and any vendors of services under this agreement have financial management systems
capable of providing certain information, including: (1) accurate, current, and complete disclosure of
the financial results of each grant-funded project or program in accordance with the prescribed
reporting requirements; (2)the source and application of funds for all agreement supported activities;
and (3) the comparison of outlays with budgeted amounts for each award. The inability to process
information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly.
(2) Management Information Systems used by the vendor, vendor(s), or any outside entity on which the
vendor is dependent for data that is to be reported, transmitted or calculated, have been assessed and
verified to be capable of processing data accurately, including year-date dependent data. For those
systems identified to be non-compliant,vendor(s)will take immediate action to assure data integrity.
(3) If this agreement includes the provision of hardware, software, firmware, microcode or imbedded
chip technology, the undersigned warrants that these products are capable of processing year-date
dependent data accurately. All versions of these products offered by the vendor (represented by the
undersigned) and purchased by the State will be verified for accuracy and integrity of data prior to
transfer.
In the event of any decrease in functionality related to time and date related codes and internal
subroutines that impede the hardware or software programs from operating properly, the vendor
agrees to immediately make required corrections to restore hardware and software programs to the
same level of functionality as warranted herein, at no charge to the State, and without interruption to
the ongoing business of the state,time being of the essence.
(4) The vendor and any vendor(s) of services under this agreement warrant their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency including
emergencies arising from data integrity compliance issues.
The vendor shall require that the language of this certification be included in all vendors and other
agreements and that all vendor shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into
this transaction imposed by OMB Circulars A-102 and 2 CFR Part 215 (formerly OMB Circular A-110).
Name and Address of vendor
Signature Title Date
Name of Authorized Signer
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EXHIBIT F
CERTIFICATION REGARDING DEBARMENT,SUSPENSION,INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective vendor certifies, by signing this certification, neither it nor its principals is presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal
department or County.
(2) Where the prospective vendor is unable to certify to any of the statements in this certification,such prospective participant shall
attach an explanation to this certification.
Signature Date
Title County/Organization
(Certification signature should be same as Agreement signature.)
Instructions for Certification
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person," "primary
covered transaction,"and"voluntarily excluded,"as used herein,have the meanings set out in the sections of rules implementing
Executive Order 12549. (2 CFR 180.5-180.1020,as supplemented by 2 CFR 376.10-376.995). You may contact the Agreement
Manager for assistance in obtaining a copy of those regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties entered into this transaction.
If it is later determined that the vendor knowingly rendered an erroneous certification,in addition to other remedies available to the
federal government,the Department or County may pursue available remedies,including suspension and/or debarment.
3. The vendor will provide immediate written notice to the Agreement Manager if at any time the vendor learns that its certification
was erroneous when submitted or has become erroneous by reason of changed circumstances. The vendor may decide the method
and frequency by which it determines the eligibility of its principals. Each participant to a lower tier covered transaction may,but
is not required to,check the Excluded Parties List System(EPLS).
4. The vendor will include a"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier
Covered Transaction"in all its lower tier covered transactions and in all solicitations for lower tier covered transactions.
5. The vendor agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,
suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized by the federal
government.
6. If the vendor knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or
voluntarily excluded from participation in this transaction,in addition to other remedies available to the federal government,the
Department or County may pursue available remedies,including suspension,and/or debarment.
7. The vendor may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred,
suspended,ineligible,or voluntarily excluded from the covered transaction,unless it knows that the certification is erroneous.
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EXHIBIT G
SUBRECIPIENT INVOICE SUMMISSION
The County shall reimburse the SUBRECIPIENT for the performance of this Agreement upon
completion or partial completion of the work tasks as accepted and approved by HHVS pursuant
to the submittal of quarterly progress reports. Invoices for work performed are required every
month. If no work has been performed during that month, or if the SUBRECIPIENT is not yet
prepared to send the required backup, a$0 invoice will be required. Explanations will be
required if two consecutive months of$0 invoices are submitted. Payments shall be made to the
SUBRECIPIENT when requested as work progresses but, not more frequently than once per
month. Final invoices are due no later than 90 days after the end of the agreement. Work
performed during the term of the program but not invoiced within 90 days without written
exception from the Grant Coordinator will not be reimbursed. No payment will be made until
approved by HHVS for grant compliance and adherence to any and all applicable local, state or
Federal requirements. Payment will be made upon receipt of a properly completed invoice and in
compliance with §218.70, Florida Statutes, otherwise known as the "Local Government Prompt
Payment Act."
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DEPARTMENT OF I
EXHIBIT H
BACKGROUND SCREENING
ELDER
AFFAIRS Affidavit of Compliance -Employer
STATE OF FLORIDA
AUTHORITY: This form is required annually of all employers to comply with the
attestation requirements set forth in section 435.05(3), Florida Statutes.
➢ The term "employer" means any person or entity required by law to conduct background
screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging
and Disability Resource Centers, Lead Agencies, Long-Term Care Ombudsman Program, Serving Health
Insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or
entity which hires employees or has volunteers in service who meet the definition of a direct
service provider. See §§
435.02,430.0402, Fla.Stat.
➢ A direct service provider is "a person 18 years of age or older who, pursuant to a program to
provide services to the elderly, has direct, face-to-face contact with a client while providing services to
the client and has access to the client's living area, funds, personal property, or personal identification
information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of
residential facilities;and volunteers." §430.0402(1)(b), Fla.Stat.
ATTESTATION:
As the duly authorized representative of
Employer Name
located at
Street Address City State ZIP code
I, do hereby affirm under penalty of perjury
Name of Representative
That the above named employer is in compliance with the provisions of Chapter 435 and section
430.0402,Florida Statutes,regarding level 2 background screening.
Signature of Representative Date
STATE OF FLORIDA,COUNTY OF
Sworn to (or affirmed)and subscribed before me this day of , 20 , by
(Name of Representative)who is personally known to me or
produced as proof of identification.
Print,Type,or Stamp Commissioned Name of Notary Public Notary Public
DOEA Form 235,Affidavit of Compliance-Employer,Effective April 2012 Section 435.05(3),
F.S.Form available at:http://elderaffairs.state.fl.us/english/backgroundscreening.php
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EXHIBIT 1
STATEMENT OF WORK
COMMUNITY CARE FOR THE ELDERLY PROGRAM(CCE)
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
1.1.1
AGREEMENT ACRONYMS
Activities of Daily Living(ADL)
Adult Protective Services(APS)
Assessed Priority Consumer List(APCL)
Comprehensive Assessment and Review for Long-Term Care Services(CARES)
Community Care for the Disabled Adult(CCDA)
Community Care for the Elderly(CCE)
Client Information and Registration Tracking System(CIRTS)
Department of Children and Families(DCF)
Department of Elder Affairs(DOEA)
Home Care for Disabled Adults (HCDA)
Instrumental Activities of Daily Living(IADL)
Planning and Service Area(PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out: The condition of reaching 60 years of age and being transitioned from the
Department of Children and Families(DCF) Services,Community Care for Disabled Adults
(CCDA)or Home Care for Disabled Adults(HCDA) services to the Department's community-
based services.
Area Plan: A plan developed by the County outlining a comprehensive and coordinated
service delivery system in its planning and service area in accordance with the Section 306 (42
U.S.C. 3026) of the Older Americans Act and Department instructions. The Area Plan
includes performance measures and unit rates per service offered per county.
Area Plan Update: A revision to the Area Plan wherein the County enters CCE specific data
in the CIRTS. An update may also include other revisions to the area plan as instructed by the
County or Department of Elder Affairs.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a
person's ability to remain independent and in the least restrictive living arrangement. DOEA
Form 701B is used by case managers to conduct the functional assessment.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
The primary purpose of the CCE program is to prevent, decrease or delay premature or
inappropriate and expensive placement of older persons in nursing homes and other
institutions.
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1.2.2 Community Care for the Elderly Mission Statement
The CCE Program assists functionally impaired elderly persons in living as independently as
possible in their own homes or in the homes of relatives or caregivers. The program provides
a continuum of care through the development, expansion, reorganization and coordination of
multiple community-based services to assist elders to reside in the least restrictive environment
suitable to their needs.
1.2.3 Authority
The relevant authority governing CCE program are:
(1) Rule 58C-1, Florida Administrative Code
(2) Sections 430.201 through 430.207, F.S.
1.2.3.1 Incorporation of Reference Memoranda
In accordance with s. 287 F.S., as amended, and Department of Financial Services Chief
Financial Officer Memoranda the following memoranda are provided for informational
purposes and are hereby incorporated by reference:
(1)CFO Memo No. 02: Release date, August 20,2010;
(2)CFO Memo No. 03: Release date,June 29, 2010; and
(3)CFO Memo No. 06: Release date,June 30,2010.
1.2.4 Scope of Service
The vendor shall provide services in a manner consistent with and descried in the current area
plan and the current Department of Elder Affairs Programs and Services Handbook.
1.2.5
Major Program Goals
The major goals of the program are to preserve the independence of elders and prevent or delay
more costly institutional care through a community care service system that provides case
management and other in-home and community services as needed under the direction of the
County and provide a continuum of service alternatives that meet the diverse needs of
functionally impaired elders.
1.3.
INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The CCE program provides a continuum of services for functional impaired elders.
1.3.2 Individual Eligibility
In order to receive services under this agreement, an applicant must:
(1) Be at least 60 years of age;
(2) Be functionally impaired as determined through the initial comprehensive
assessment; and
(3) With the exception of APS high-risk referrals, consumers may not be dually enrolled in the
CCE program and a Medicaid capitated long-term care program.
1.3.2.1 Targeted Groups
Priority for services provided under this agreement shall be given to those eligible persons
assessed to be at risk of placement in an institution or who are abused, neglected or exploited.
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SECTION II: MANNER OF SERVICE PROVISION
2. Delivery of Service to Eligible Clients
The vendor shall ensure the provision of a continuum of service that meet the diverse needs of
functionally impaired elders. The vendor shall ensure performance and reporting of the following
service provision in accordance with the current DOEA Programs and Services Handbook. The
services may include the following categories:
(1) Core Services;
(2) Health Maintenance Services; and
(3) Other Support Services.
Core Services for Programmatic Operation
2.1. The vendor may deliver core services include a variety of home-delivered services, day care
services, and other basic services that are most needed to prevent unnecessary institutionalization.
Core services,to be provided at the unit rate identified in this agreement, include the following:
(1) Adult Day Care; (7) Housing Improvement;
(2) Chore Services; (8) Respite Services; and
(3) Enhanced Chore; (9) Transportation
(4) Companionship;
(5) Home Delivered Meals;
(6) Homemaker;
2.1.1 Health Maintenance Services
The vendor shall ensure that health maintenance services are routine health services that are
necessary to help maintain the health of functionally impaired elders. The services are limited
to medical therapeutic services, non-medical prevention services, personal care services, home
health aide services, home nursing services, and emergency response systems. Typical services
to be provided at the unit rate identified in this agreement, are the following:
(1) Adult Day Health Care;
(2) Emergency Alert Response;
(3) Nutrition Counseling
(4) Personal Care
(5) Skilled Nursing Services; and
(6) Specialized Medical Equipment
Services and Supplies
2.2 SERVICE TIMES
2.2.1 Service Times
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The vendor shall ensure the provisions of the services listed in this agreement are available at
times appropriate to meet client service needs at a minimum, during normal business hours.
Normal business hours are defined as Monday through Friday, 8:00 a.m. to 5:00 p.m.
2.3 DELIVERABLES
2.3.1 Service Unit
The vendor shall ensure the provision of the services described in the agreement in accordance
with the current Department of Elder Affairs Programs and Services Handbook and the service
tasks described in Section 2.1. The chart below lists the type of services allowed and the unit of
measurement. Units of service will be paid pursuant to the rate established in this agreement as
updated, and approved by the County's reporting requirements.
Service Unit of Service
Adult Day Care Homemaker
Case Aide Housing Improvement
Case Management Respite Services
Chore Services Personal Care Hour
Enhanced Chore Physical Therapy
Companionship Skilled Nursing Services
Emergency Alert Response
Day
Material Aid Episode
Specialized Medical Equipment, Services and Supplies
Escort
Shopping Assistance One-Way Trip
Transportation
Service Unit of Service
Home Delivered Meals Meal
2.4 REPORTS
The vendor shall respond to additional routine and/or special requests for information and
reports required by the County in a timely manner as determined by the Grant Coordinator. The
vendor shall establish due dates for any agreement that permits the vendor to meet the County's
reporting requirements.
Service Costs Reports
The vendor shall submit to the County semi-annual service cost reports, August 1, 2013 and
February 1, 2014, of each year which reflects actual costs of providing each service by
program. This report provides information for planning and negotiating unit rates.
2.5 RECORDS AND DOCUMENTATION
2.5.1 Each vendor, among other requirements, must anticipate and prepare for the loss of information
processing capabilities. The routine backing up of all data and software is required to recover
from losses or outages of the computer system. Data and software essential to the continued
operation of vendor functions must be backed up. The security controls over the backup
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2.6 COUNTY RESPONSIBILITIES
2.6.1 Program Guidance and Technical Assistance
The County will provide to the vendor guidance and technical assistance as needed to
ensure the successful fulfillment of the agreement by the vendor.
resources shall be as stringent as the protection required of the primary resources. It is
recommended that a copy of the backed up data be stored in a secure, offsite location. The
vendor shall maintain written policies and procedures for computer system backup and
recovery. These policies and procedures will be made available to the County upon request.
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outcomes
(1) The vendor shall ensure services provided under this agreement are in accordance with the
current Department of Elder Affairs Programs and Services Handbook.
(2) The vendor shall timely submit to the County all information described in EXHIBIT 1,
SECTION 2.4 REPORTS; and
(3) The vendor shall timely submit to the County all information described in EXHIBIT 1,
SECTION 2.5 RECORDS AND DOCUMENTATION.
2.8. VENDOR'S FINANCIAL OBLIGATIONS
2.8.1 Matching,Level of Effort,and Earmarking Requirement
The vendor will assure a match requirement of at least 10 percent of the cost for all CCE services.
The match will be made in the form of cash and/or in-kind resources. At the end of the
agreement period, all CCE funds expended must be properly matched. State funds cannot be used
to match another state-funded program.
3. SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this agreement includes a fixed rate for services.
3.2 Remedies-Nonconforming Services
The vendor shall ensure that all goods and/or services provided under this agreement for CCE
funded programs are delivered timely, completely and commensurate with required standards of
quality. Such goods and/or services will only be delivered to eligible program participants.
If the vendor fails to meet the prescribed quality standards for services, such services will not be
paid under this agreement. In addition, any nonconforming goods (including home delivered
meals) and/or services not meeting such standards will not be paid under this agreement. The
vendor's signature on the request for payment form certifies maintenance of supporting
documentation and acknowledgement that the vendor shall solely bare the costs associated with
preparing or providing nonconforming goods and/or services. The County and or Department
require immediate notice of any significant and/or systemic infractions that compromise the
quality, security or continuity of services to clients.
3.3 All payment requests shall be based on the submission of actual monthly services beginning with
the contract date the agreement. The contracted rates for services are ATTACHMENT A to this
agreement.
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3.4 Payment may be authorized only for allowable services,which are in accordance with the limits
specified in ATTACHMENT A.
3.5 Any payment due by the County under the terms of this agreement may be withheld pending the
receipt and approval by the County of all financial and programmatic reports due from the vendor
and any adjustments thereto, including any disallowance not resolved.
3.6 Date for Final Request for Payment
The final request for payment for agreement year one expenditures will be due to the County no
later than August 1, 2013. The final request for payment for agreement year two expenditures
will be no later than August 1,2014.
3.7 Documentation for Payment
The vendor shall maintain documentation to support payment requests that shall be available to
the County or authorized individuals, such as the Department of Financial Services, upon request.
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EXHIBIT 2
STATEMENT OF WORK
HOME CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1
DEFINITION OF CONTRACT TERMS AND ACRONYMS
1.1.1
DEFINITIONS OF ACRONYMS
Adult Protective Services(APS)
Activities of Daily Living(ADL)
Assessed Priority Consumer List(APCL)
Community Care for Disabled Adults(CCDA)
Community Care for the Elderly(CCE)
Client Information and Registration Tracking System(CIRTS)
Department of Children and Families(DCF)
Home Care for Disabled Adults(HCDA)
Home Care for the Elderly(HCE)
Institutional Care Program (ICP)
Instrumental Activities of Daily Living(IADL)
Planning and Service Area(PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the
Department of Children and Families Services Community Care for Disabled Adults (CCDA)
or Home Care for Disabled Adults(HCDA) services to community-based services.
Area Plan: A plan developed by the County outlining a comprehensive and coordinated service
delivery system in the respective planning and service area, in accordance with the Section 306
of the Older Americans Act (42 U.S.C. 3026) and Department instructions. The Area Plan
includes performance measures and unit rates per service offered per county.
Area Plan Update: A revision to the Area Plan wherein the County enters HCE specific data
into the CIRTS. An update may also include other revisions to the Area Plan.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a
person's ability to remain independent and in the least restrictive living arrangement. DOEA Form
701B is used by case managers to conduct the functional assessment.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
Area Agencies on Aging may contract with CCE lead agencies or other case management
entities for the provision of the HCE program. Approved caregivers receive a Basic Subsidy to
reimburse some of their expenses each month for caring for the consumer and may receive a
Special Subsidy for other necessary services and essential supplies. Caregivers may be approved
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for up to three HCE clients in their home.
1.2.2 Home Care for the Elderly Program Mission Statement
The Home Care for the Elderly Program supports family style living arrangements, on a non-
profit basis,as an alternative to nursing homes or other institutional care. Through the program,
a caregiver for three or fewer elders living in a private home provides basic services of
maintenance and supervision as well as coordinating other necessary specialized services.
1.2.3 Authority
The relevant authority governing the HCE program include:
(1) Rule Chapter 58H-1, Florida Administrative Code; and
(2) Sections 430.601 through 430.608,F.S.
1.23.1 Incorporation of Reference Memoranda
In accordance with s. 287 F.S., as amended, and Department of Financial Services', Chief
Financial Officer Memoranda, the following memoranda are provided for informational
purposes and are hereby incorporated by reference:
CFO Memo No. 02: Release date,August 20,2010;
CFO Memo No. 03: Release date,June 29,2010; and
CFO Memo No. 06: Release date,June 30,2010.
1.2.4 Scope of Service
The Vendor shall provide services in a manner consistent with and described in the current
County's area plan update and the current Department of Elder Affairs Programs and Services
Handbook.
1.2.5 Major Program Goals
The major goals of the HCE program are to ensure that:
(1) Basic Subsidy is provided to the caregiver of each client and
(2) Special Subsidy is provided when essential to the well-being of the client.
1.3 INDIVIDUAL TO BE SERVED
1.3.1 General Eligibility
The Home Care for the Elderly program serves elders age 60 and older at risk of placement in a
nursing home or other institutional settings who can remain in a family style setting through the
provision of subsidies.
1.3.2 Client Eligibility
Clients eligible to receive services under this agreement must:
(1) Be 60 years of age or older;
(2) Have income less than the Institutional Care Program(ICP) standard.
(3) Meet the ICP asset limitation;
(4) Be at risk of nursing home placement;
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(5) Have an approved adult caregiver living in the home with them who is willing to provide
care or assist in arranging for care; and
(6) Not be enrolled in the Aged and Disabled Adult Medicaid waiver or a Medicaid capitated
long-term care program.
1.3.3 Caregiver Eligibility
Caregivers eligible to receive services under this agreement must:
(1) Be at least 18 years of age,capable of providing a family-type living environment;
(2) Be a relative or a friend who has been accepted by the client as a surrogate family or is a
responsible adult with whom the client has made an arrangement to provide home care
services;
(3) Be willing to accept responsibility for the social, physical and emotional needs of the care
Vendor;
(4) Be physically present and live in the home to provide supervision and to assist in
arrangement of services for the client;
(5) Maintain the residential dwelling free of conditions that pose an immediate threat to the
life, safety, health and well-being of the home care client; and
(6) Be without record of conviction of abuse, neglect or exploitation of another person.
1.3.4 Targeted Groups
Priority for services provided under this agreement shall be given to those eligible persons
assessed to be at risk of placement in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2. Delivery of Services to Eligible Clients
The Vendor shall ensure the provision of a continuum of services that meet the diverse needs of
the functionally impaired elders and their caregivers. The Vendor shall ensure Basic Subside
and Special Subsidy services are performed in accordance with the current Department of Elder
Affairs Programs and Services Handbook.
2.1. Basic Subsidy
The Basic Subsidy is a cash payment made to an approved caregiver each month to reimburse
some expenses incurred in caring for the client. The Basic Subsidy is provided for support and
maintenance of the client, including housing, food, clothing, and medical costs not covered by
Medicaid, Medicare or any other insurance. A Basic Subsidy shall be paid to approved
caregivers when the client is in the home for any part of the month. If the client is hospitalized
or in any other temporary institution for 30 days or less,the full Basic Subsidy shall be provided
to the caregiver as if the client were in the home.
2.2. Special Subsidy Services
Though every eligible HCE client receives a Basic Subsidy, Special Subsidy payments
are pre-authorized and are based on additional specialized medical or health care
services, supplies or equipment needed to maintain the health and well-being of the
individual elder. The Special Subsidy for additional medical support and special services
is a cash payment to reimburse the costs of any other service or special care not covered
by Medicaid, Medicare, or private insurance when these services are determined to be
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essential to maintain the well-being of the home care recipient. A Special Subsidy shall
be paid to approved caregivers when the client is in the home for any part of the month.
Special Subsidy may be authorized through a vendor agreement. All Special Subsidy
services must be performed in accordance with the Department of Elder Affairs Programs
and Services Handbook. Special Subsidy services include:
2.2.1 SERVICE LOCATION AND EQUIPMENT
2.2.2 Service Times
The vendor shall ensure the provision of the services listed in this contract are available at
times appropriate to meet client service needs at a minimum,during normal business hours.
Normal business hours are defined as Monday through Friday, 8:00 a.m.to 5:00 p.m.
2.3 DELIVERABLES
2.3.1 Service Unit
The vendor shall ensure the provision of the services described in the contract in accordance
with the current Department of Elder Affairs Programs and Services Handbook and the service
tasks described in Section 2.1. The chart below lists the type of services allowed and the unit of
measurement. Units of service will be paid pursuant to the rate established in this contract as
updated, and approved by the Agency's reporting requirements.
Service Unit of Service
Adult Day Care Housing Improvement
Case Aide Other
Case Management Personal Care
Chore Respite(Facility Based or In-Home) Hour
Chore(Enhanced) Skilled Nursing Services
Homemaker
Material Aid Episode
Specialized Medical Equipment, Services and Supplies
Transportation One-Way Trip
2.2 REPORTS
The Vendor shall respond to additional routine and/or special requests for information and
reports required by the County in a timely manner as determined by the Grant Coordinator. The
Vendor shall establish due dates for any vendors that permits the Vendor to meet the County's
reporting requirements.
2.2.1 Service Costs Reports
The Vendor shall submit to the County the semi-annual service cost reports, August 1, 2013
and February 1, 2014, which reflect actual costs of providing each service by program. This
report provides information for planning and negotiating unit rates.
2.3 RECORDS AND DOCUMENTATION
2.3.1 The Vendor, among other requirements, must anticipate and prepare for the loss of information
processing capabilities. The routine backing up of all data and software is required to recover
from losses or outages of the computer system. Data and software essential to the continued
operation of vendor functions must be backed up. The security controls over the backup
resources shall be as stringent as the protection required of the primary resources. It is
recommended that a copy of the backed up data be stored in a secure, offsite location. The
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Vendor shall maintain written policies and procedures for computer system backup and
recovery.These policies and procedures shall be made available to the County upon request.
2.4 PERFORMANCE SPECIFICATIONS
2.4.1 Outcomes
(1) The Vendor shall ensure services provided under this agreement are in accordance with the
current DOEA Programs and Services Handbook.
(2) The Vendor shall timely submit to the County all reports described in SECTION 2.2
REPORTS; and
(3) The Vendor shall timely submit to the County all information described in, SECTION 2.3
RECORDS AND DOCUMENTATION.
2.5 COUNTY RESPONSIBILITIES
2.5.1 Program Guidance and Technical Assistance
The County will provide to the Vendor guidance and technical assistance as needed to ensure
the successful fulfillment of the agreement by the Vendor.
Contract Monitoring
The County will review and evaluate the performance of the Vendor under the terms of
this agreement. Monitoring shall be conducted through direct contact with the Vendor
through telephone, in writing, or an onsite visit. The County's determination of
acceptable performance shall be conclusive. The Vendor agrees to cooperate with the
County in monitoring the progress of completion of the service tasks and deliverables.
The County may use, but is not limited to, one or more of the following methods for
monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow-up on-site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third-party documents and/or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed-upon procedures review by an external auditor or consultant;
(9) Limited-scope reviews; and
(10) Other procedures as deemed necessary.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this agreement includes a fixed rate for services.
3.2 Remedies-Nonconforming Services
The vendor shall ensure that all goods and/or services provided under this agreement for CCE
funded programs are delivered timely, completely and commensurate with required standards of
quality. Such goods and/or services will only be delivered to eligible program participants.
If the vendor fails to meet the prescribed quality standards for services, such services will not be
paid under this agreement. In addition, any nonconforming goods (including home delivered
meals) and/or services not meeting such standards will not be paid under this agreement. The
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vendor's signature on the request for payment form certifies maintenance of supporting
documentation and acknowledgement that the vendor shall solely bare the costs associated with
preparing or providing nonconforming goods and/or services. The County and or Department
require immediate notice of any significant and/or systemic infractions that compromise the
quality, security or continuity of services to clients.
3.3 All payment requests shall be based on the submission of actual monthly services beginning
with the contract date the agreement. The contracted rates for services are ATTACHMENT A
to this agreement.
3.4 Payment may be authorized only for allowable services, which are in accordance with the limits
specified in ATTACHMENT A.
3.5 Any payment due by the County under the terms of this agreement may be withheld pending the
receipt and approval by the County of all financial and programmatic reports due from the
vendor and any adjustments thereto, including any disallowance not resolved.
3.6 Date for Final Request for Payment
The final request for payment for agreement year one expenditures will be due to the County no
later than August 1, 2013. The final request for payment for agreement year two expenditures
will be no later than August 1, 2014.
3.7 Documentation for Payment
The vendor shall maintain documentation to support payment requests that shall be available to
the County or authorized individuals, such as the Department of Financial Services, upon
request.
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EXHIBIT 3
STATEMENT OF WORK
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO BE PROVIDED
L1
DEFINITION OF CONTRACT TERMS AND ACRONYMS
1.1.1
DEFINITIONS OF ACRONYMS
Alzheimer's Disease(AD)
Alzheimer's Disease Initiative(ADI)
Activities of Daily Living(ADL)
Assessed Priority Consumer List(APCL)
Adult Protective Services(APS)
Client Information and Registration Tracking System(CIRTS)
Community Care for Disabled Adults(CCDA)
Department of Elder Affairs(DOEA)
Home Care For Disabled Adults(HCDA)
Instrumental Activities of Daily Living(IADL)
Memory Disorder Clinic (MDC)
Planning and Service Area(PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the
Department of Children and Families Services Community Care for Disabled Adults (CCDA)
or Home Care for Disabled Adults(HCDA)services to community-based services.
Area Plan: A plan developed by the County outlining a comprehensive and coordinated service
delivery system in the respective planning and service area, in accordance with the Section 306
of the Older Americans Act (42 U.S.C. 3026. The Area Plan includes performance measures
and unit rates per service offered per county.
Area Plan Update: A revision to the Area Plan wherein the County enters ADI specific data
into the CIRTS. An update may also include other revisions to the Area Plan.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a
person's ability to remain independent and in the least restrictive living arrangement. DOEA Form
701B is used by case managers to conduct the functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1)
and (2), F.S., to provide diagnostic and referral services, conduct basic and service-related
multidisciplinary research, and develop training materials and educational opportunities for lay
and professional caregivers of individuals with AD.
Model Day Care: A program of therapeutic, social and health activities specific to clients with
memory disorders. Services and activities include, but are not limited to, active and quiet
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games, reminiscence, validation therapy, pet therapy, water therapy and other failure free
activities appropriate to the client's level of functioning. Model day care centers will also
provide training for health care and social service personnel in the care of persons having AD or
related memory disorders.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
The ADI program provides a continuum of services addressing the special needs of individuals
with AD,their families and caregivers.
1.2.2 Alzheimer's Disease Initiative Program Mission Statement
The ADI program ensures that persons afflicted with AD and other forms of dementia are given
essential services to help them age in place in an elder-friendly environment with security,
dignity, and purpose. The program also provides support to family members and caregivers of
persons afflicted with AD.
1.2.3 Authority
The relevant authority governing the Alzheimer's Disease Initiative Program are as follows:
(1) Rule Chapter 58D-1, Florida Administrative Code; and
(2) Sections 430.501 through 430.504, Florida Statutes.
1.2.3.1 Incorporation of Reference Memoranda
In accordance with s. 287 F.S., as amended, and Department of Financial Services' Chief
Financial Officer Memoranda, the following memoranda are provided for informational
purposes and are hereby incorporated by reference:
(1) CFO Memo No. 02: Release date,August 20,2010;
(2) CFO Memo No. 03: Release date,June 29,2010; and
CFO Memo No. 06: Release date,June 30,2010.
1.2.3.2 Scope of Service
The Vendor is responsible for the programmatic, fiscal, and operational management of the
ADI program. The program services shall be provided in a manner consistent with and
described in the current Vendor's Request for Proposal, RFP, and the County's current area
plan and the current Department of Elder Affairs Programs and Services Handbook.
1.2.3.4 Major Program Goals
The major goal of the ADI program is to provide services to meet the needs of caregivers and
individuals with AD and related memory disorders.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The ADI Program addresses the special needs of individuals with AD and their caregivers.
1.3.2 Individual Eligibility
Those individuals eligible to receive services under this contract must meet the following
conditions:
(1) Be 18 years of age or older and have a diagnosis of AD or a related disorder, or be
26
suspected of having AD or a related disorder; and
(2) Not be enrolled in a Medicaid capitated long-term care program.
1.3.3 Targeted Groups
Priority for services provided under this agreement shall be given to those eligible persons
assessed to be at risk of placement in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2. SERVICE TASKS
In order to achieve the goals of the ADI program,the Vendor shall ensure the following tasks
are performed:
(1) Client eligibility determination;
(2) Assessment and prioritization of service delivery for new clients;
(3) Delivery of services to eligible clients; and
(4) Monitor the performance of vendors.
2.1 Client Eligibility Determination
The Vendor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to
become a client is based on meeting the requirements described in this SECTION 1.3.
2.2 Delivery of Services to Eligible Clients
The Vendor shall ensure the provision of a continuum of services addressing the diverse needs of
individuals with AD and their caregivers. The Vendor shall ensure services are performed in
accordance with the current Department of Elder Affairs Programs and Services Handbook.
Services categories include:
(1) Caregiver Training/Support;
(2) Case Aid;
(3) Case Management;
(4) Counseling(Gerontological);
(5) Counseling(Mental Health/Screening);
(6) Education/Training;
(7) Model Day Care;
( 8) Respite(Facility-Based);
( 9) Respite(In-Home); and
(10) Specialized Medical Equipment, Services,and Supplies.
Caregivers benefit from receiving training, respite and related support services to assist them in caring for
the ADI client.
2.3 Service Times
The Vendor shall ensure the provisions of the services listed in this contract are available at
times appropriate to meet client service needs at a minimum, during normal business hours.
Normal business hours are defined as Monday through Friday, 8:00 a.m. to 5:00 p.m.
27
3. DELIVERABLES
3.1. Service Unit
The Vendor shall ensure the provision of the services described in the contract in accordance
with the current Department of Elder Affairs Programs and Services Handbook and the service
tasks described in Section 2.1. The chart below lists the type of services allowed and the unit of
measurement. Units of service will be paid pursuant to the rate established in this contract as
updated, and approved by the County's reporting requirements.
Service Unit of Service
Caregiver Training/Support; Hour
Case Aid; Hour
Case Management; Hour
Counseling(Gerontological); Hour
Counseling(Mental Health/Screening); Hour
Respite(Facility-Based); Hour
Respite(In-Home); Hour
Education/Training; Episode
Episode
3.2 REPORTS
The Vendor shall respond to additional routine and/or special requests for information and
reports required by the County in a timely manner as determined by the Grant Coordinator.
3.2.1 Service Costs Reports
Vendor must submit to the County the semi-annual service cost reports August 1, 2013 and
February 1,2014, which reflect actual costs of providing each service by program. This report
provides information for planning and negotiating unit rates.
3.3 RECORDS AND DOCUMENTATION
3.3.1 The Vendor and each vendor, among other requirements, must anticipate and prepare for the
loss of information processing capabilities. The routine backing up of all data and software is
required to recover from losses or outages of the computer system. Data and software essential
to the continued operation of vendor functions must be backed up. The security controls over
the backup resources shall be as stringent as the protection required of the primary resources. It
is recommended that a copy of the backed up data be stored in a secure, offsite location. The
Vendor shall maintain written policies and procedures for computer system backup and
recovery. These policies and procedures shall be made available to the County upon request.
4. PERFORMANCE SPECIFICATIONS
4.1 Outcomes
(4) The Vendor shall ensure services provided under this agreement are in accordance with the
current DOEA Programs and Services Handbook.
(5) The Vendor shall timely submit to the County all reports described in SECTION 3.2
REPORTS; and
(6) The Vendor shall timely submit to the County all information described in SECTION 3.3
28
4 A
RECORDS AND DOCUMENTATION.
5. COUNTY RESPONSIBILITIES
5.1. Program Guidance and Technical Assistance
The County will provide to the Vendor guidance and technical assistance as needed to ensure
the successful fulfillment of the agreement by the Vendor.
Contract Monitoring
The County will review and evaluate the performance of the Vendor under the terms of
this agreement. Monitoring shall be conducted through direct contact with the Vendor
through telephone, in writing, or an onsite visit. The County's determination of
acceptable performance shall be conclusive. The Vendor agrees to cooperate with the
County in monitoring the progress of completion of the service tasks and deliverables.
The County may use, but is not limited to, one or more of the following methods for
monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow-up on-site visits;
(3) Client visits
(4) Review of independent auditor's reports
(5) Review third-party documents and/or evaluations
(6) Review of progress reports
(7) Review of customer satisfaction surveys
(8)Agreed-upon procedures review by an external auditor or consultant;
(9)Limited-scope reviews; and
(10)Other procedures as deemed necessary.
6. SECTION III: METHOD OF PAYMENT
6.1 General Statement of Method of Payment
The method of payment for this agreement includes a fixed rate for services.
6.1.2 Remedies-Nonconforming Services
The Vendor shall ensure that all goods and/or services provided under this agreement for HCE
funded programs are delivered timely, completely and commensurate with required standards of
quality Such goods and/or services shall only be delivered to eligible program participants.
If the Vendor fails to meet the prescribed quality standards for services, such services will not be
reimbursed under this agreement. In addition, any nonconforming goods (including home
delivered meals) and/or services not meeting such standards will not be reimbursed under this
agreement. The Vendor's signature on the request for payment form certifies maintenance of
supporting documentation and acknowledgement that the Vendor shall solely bare the costs
associated with preparing or providing nonconforming goods and/or services. The County
requires immediate notice of any significant and/or systemic infractions that compromise the
quality, security or continuity of services to clients.
6.1.3 Any payment due by the County under the terms of this agreement may be withheld pending the
receipt and approval by the County of all financial and programmatic reports due from the
Vendor and any adjustments thereto, including any disallowance not resolved.
6.1.4 Date for Final Request for Payment
29
ci\
The final request for payment for agreement year one's expenditures will be due to the County
no later than August 1,2013. The final request for payment for agreement year two
expenditures will be no later than August 1,2014.
6.2 Documentation for Payment
The Vendor shall maintain documentation to support payment requests that shall be available to
the County or authorized individuals upon request. Such documentation shall be provided upon
request to the County or the Clerk of Court.
30
c)
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EXHIBIT 4
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE HI
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 CONTRACT ACRONYMS
Area Agency on Aging(AAA)
Activities of Daily Living(ADL)
Alliance of Information&Referral Systems(AIRS)
Assessed Priority Consumer List(APCL)
Adult Protective Services(APS)
Client Information and Registration Tracking System(CIRTS)
Information and Referral(I& R)
Instrumental Activities of Daily Living(IADL)
Older Americans Act(OAA)
Planning and Service Area(PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Area Plan: A plan developed by the County outlining a comprehensive and coordinated service delivery system in
Its PSA in accordance with the Section 306(42 U.S.C. 3026)of the OAA and Department instructions.
Child: An individual who is not more than 18 years of age or an individual with disability.
Family Caregiver: An adult family member, or another individual,who is an informal provider of in-home and
community care to an older individual.
Frail: When an older individual is unable to perform at least two ADLs without substantial human assistance,
including verbal reminding,physical cueing or supervision; or due to cognitive or other mental impairment, requires
substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the
individual or
to another individual.
1.2 County Mission,Vision and Values Statement
The County's mission: To help aging adults achieve greater independence through awareness of resources and
access to qualified service providers. The County's vision: To be the recognized leader in supporting older adults
and their families with access to trustworthy resources and services in their communities while empowering
them to live with independence and dignity. The County's values: We believe residents of Southwest Florida
are entitled to: Comprehensive information about their choices of care;Timely access to resources and services;
High standards of quality and performance; and Personal and professional accountability from all stakeholders.
1.2.1 Older Americans Act Program Mission Statement
The Older Americans Act(OAA)Program is a federal program initiative that provides assistance to older
persons and caregivers and is the only federal supportive services program directed solely toward
improving the lives of older people. The program provides a framework for a partnership among the
different levels of government and the public and private sectors with a common objective, improving the
quality of life for all older individuals by helping them to remain independent and productive.
31
, )
1.3 GENERAL DESCRIPTION
1.3.1 General Statement
The OAA Program is a federal program initiative that provides assistance to older persons and caregivers
and is the only federal supportive services program directed solely toward improving the lives of older
people. The program provides a framework for a partnership among the different levels of government
and the public and private sectors with a common objective, improving the quality of life for all older
individuals by helping them to remain independent and productive. The primary purpose of the OAA
program is to foster the development and implementation of comprehensive and coordinated systems
to serve older individuals.The OAA program uses these systems to assist older individuals to attain and
maintain maximum independence and dignity in a home environment and allows for the capability of self-
care with appropriate supportive services.
1.3.2 Authority
The relevant references authority governing the OAA program are:
1. Older Americans Act of 2006, as amended;
2. Rule 58A-1, Florida Administrative Code; and
3. Section 430.101, Florida Statutes.
1.3.2.1 Incorporation of Reference Memoranda
In accordance with Ch. 287 F.S., as amended,and Agency of Financial Services' Chief Financial Officer
Memoranda,
the following memoranda are provided for informational purposes and incorporated by reference:
1. CFO Memo No. 02: Release date, August 20,2010;
2. CFO Memo No. 03: Release date,June 29, 2010; and
3. CFO Memo No. 06: Release date,June 30, 2010.
1.3.3 Scope of Service
The Vendor shall provide services in a manner consistent with and descried in the current area plan
and current Department of Elder Affairs Programs and Services Handbook.
1.3.4 Major Program Goals
The major goals of the OAA program are to improve the quality of life for older individuals,preserve their
independence and prevent or delay more costly institutional care. These goals are achieved through the
implementation of a comprehensive and coordinated service system that provides a continuum of service
alternatives that meet the diverse needs of elders and their caregivers.
1.4 INDIVIDUALS TO BE SERVED
1.4.1 Eligibility(Title III Programs)
1.4.1.1 OAA Title III,General
Consumers shall not be dually enrolled in an OAA program and a Medicaid capitates long-term care program.
1.4.1.2 OAA Title HIE,Caregiver Support Services
Eligibility for OAA Title IIIE, Caregiver Support Services,are as follows:
1. Family caregivers of individuals age 60 or older;
32
•
2. Grandparents(age 55 or older)or older individuals(age 55 or older)who are relative caregivers;
3. Priority will be given to family caregivers who provide care for individuals with Alzheimer's
disease and related disorders with neurological and organic brain dysfunction and for grandparents
or older individuals who are relative caregivers who provide care for children with severe disabilities;
and
4. For respite and supplemental services,a family caregiver must be providing care for an older
individual who meets the definition of the term"frail" in OAA, Section 102 Paragraph 22.
1.4.2 Targeted Groups
Preference shall be given to those with the greatest economic and social need,with particular attention to
low-income older individuals, including those that are low-income minorities, have limited English
proficiency, and older individuals residing in rural areas.
SECTION II—MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the OAA program,the Vendor shall ensure the following tasks are performed:
1. Client eligibility determination;
2. Targeting and screening of service delivery for new clients;
3. Delivery of services to eligible clients;
4. Use of volunteers to expand the provision of available services;
5. Monitoring the performance of its vendors.
6. Grievance and Compliance Procedures
2.1.1 Client Eligibility Determination
The Vendor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to
become a client is based on meeting the requirements described herein.
2.1.2 Targeting and Screening of Service Delivery for New Clients
The Vendor shall develop and implement policies and procedures consistent with OAA targeting and
screening Criteria
2.1.3 Delivery of Services to Eligible Clients The Vendor shall ensure the provision of a continuum of services
that meets the diverse needs of elders and their caregivers. The Vendor shall ensure the performance and
report performance of the following services in accordance with the current Department of Elder Affairs
Programs and Services Handbook. The services funded pursuant to this contract are in accordance with the
OAA,Title III, sections 321,331,336 and 373 as follows:
1. Section 321,Title IIIB Supportive Services;
2. Section 373,Title IIIE Caregiver Support Services.
2.1.3.1 Supportive Services
Supportive services include a variety of community-based and home-delivered services that support
the qualities of life for older individuals by helping them remain independent and productive. Services
include the following:
33
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(1) Adult Day Care/Adult Day Health Care; (17) Homemaker;
(2) Caregiver Training/Support; (18) Housing Improvement;
(3) Case Aide/Case Management; (19) Information;
(4) Chore Services; (20) Intake;
(5) Companionship; (21) Interpreter/Translating;
(6) Counseling(Gerontological and Mental Health); (22) Referral/Assistance;
(7) Education/Training; (23) Personal Care;
(8) Legal Assistance; (24) Physical Therapy;
(9) Material Aid; (25) Shopping Assistance;
(10) Occupational Therapy; (26) Skilled Nursing;
(11) Outreach; (27) Specialized Medical Equipment, Services,
and Supplies
(12) Recreation; (28) Respite Services;
(13) Emergency Alert Response; (29) Screening/Assessment;
(14) Escort; (30) Speech Therapy;
(15) Health Support; (31) Telephone Reassurance; and
(16) Home Health Aide; (32) Transportation
2.1.3.4 Caregiver Support Services(Title IIIE Program)
The following services are intended to provide direct help to caregivers, assist in the areas of health,
nutrition and financial literacy and assist caregivers in making decisions and problem solving
related to their caregiving roles and responsibilities:
(1) Adult Day Care/Adult Day Health Care;
(2) Caregiver Training/Support;
(3) Counseling(Gerontological and Mental Health);
(4) Education/Training;
(5) Financial Risk Reduction(Assessment and Maintenance);
(6) Information;
(7) Intake;
(8) Outreach;
(9) Respite Services;
(10) Screening/Assessment; and
(11) Transportation
2.1.3.5 Caregiver Support Supplemental Services (Title IVES Program): The following services are
provided to complement the care provided by caregivers:
(1) Chore Services;
(2) Housing Improvement;
(3) Legal Assistance;
(4) Material Aid; and
(5) Specialized Medical Equipment, Services and Supplies.
2.2 SERVICE LOCATION
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2.2.1 Service Times
The Vendor shall ensure the provision of the services listed in the contract during normal business
hours unless other times are more appropriate to meet the performance requirements of the
contract,
and it shall monitor its vendors to ensure they are available to provide services during hours
responsive to client needs and during those times which best meet the needs of the relevant
service community.
2.3 DELIVERABLES
2.3.1 Service Unit
The Vendor shall ensure the provision of the services described in the contract in accordance with
the current
Department of Elder Affairs Programs and Services Handbook and the services tasks described in
Section 2.1.
The chart below lists the services allowed and the units of measurement. Units of service will be
paid pursuant to the rate established in the 2010 RFP and approved by the County.
Services Unit of Service
Adult Day Care/Adult Day Interpreter/Translating
Health Care Legal Assistance
Caregiver Training/Support Medication Management
Case Aid/Case Management Mental Health Counseling/Screening
Chore Services Nutrition Counseling
Companionship Occupational Therapy
Counseling Services Personal Care
Escort Physical Therapy Hour
Financial Risk Reduction Recreation
Services Respite Services
Health Support Screening/Assessment
Home Health Aide Sitter
Homemaker Skilled Nursing Services
Housing Improvement Speech Therapy
Intake
Emergency Alert Response Day
Education/Training Episode
Information
Material Aid
Referral/Assistance
Specialized Medical Equipment, Services and Supplies
Telephone Reassurance
Escort One-Way Trip
Shopping Assistance
Transportation
2.4
REPORTS
The Vendor shall respond to additional routine and/or special requests for information and reports
required by the County in a timely manner as determined by the Grant Coordinator.
The Vendor shall establish due dates for any vendors that permit the Vendor to meet the County's
reporting requirements.
35
2.4.2 Service Costs Reports
The Vendor shall require vendors to submit to the Vendor semi-annual service cost reports on August 1,
2013 and February 1, 2014, which reflect actual costs of providing each service by program. This
report provides information for planning and negotiating unit rates.
2.4.5 Background Screening Affidavit of Compliance
To demonstrate compliance with section 8 of the Standard Contract,the Vendor shall submit
ATTACHMENT H, Background Screening Affidavit of Compliance annually, by January 15th.
2.5 RECORECORDS AND DOCUMENTATION
Each Vendor and vendor, among other requirements,must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover
from losses or outages of the computer system. Data and software essential to the continued operation of
vendor functions must be backed up. The security controls over the backup resources shall be as stringent
as the protection required of the primary resources. It is recommended that a copy of the backed up data
be stored in a secure, offsite location.
The Vendor shall maintain written policies and procedures for computer system backup and recovery and
shall have the same requirement in its contracts and/or agreements with vendors. These policies and
procedures shall be made available to the County upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
(1)The Vendor shall ensure services provided under this contract are in accordance with the
current DOEA Programs and Services Handbook,
(2)The Vendor shall timely submit to the County all reports described herein
(3)The Vendor shall timely submit to the County all information described in, Paragraph
2.5 RECORDS AND DOCUMENTATION.
2.7 VENDOR'S FINANCIAL OBLIGATIONS
2.7.1 Matching,Level of Effort,and Earmarking Requirements
The Vendor shall provide match of at least 10 percent of the federal funds received. The Vendor's
match will be made in the form of cash and/or in-kind resources. The Vendor will assure,through a
provision in subcontracts,a match requirement of at least 10 percent of the cost for all services
funded through this contract. The vendor's match will be made in the form of cash and/or in-kind
resources. The Vendor shall report match by title each month. At the end of the contract period,
the Vendor must properly match all OAA funds.
2.7.2 Title III Funds
The Vendor assures compliance with Section 306 of the OAA, as amended in 2006,that funds received
under Title III will not be used to pay any part of a cost incurred by the Vendor to maintain a contractual
or commercial relationship that is not carried out to implement Title III.
2.8 COUNTY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The County will provide to the Vendor guidance and technical assistance as needed to ensure the
successful fulfillment of the contract by the Vendor.
2.8.2 Program/Contract Monitoring
The County will review and evaluate the performance of the Vendor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Vendor through telephone, in writing, or an
on-site visit. The County's determination of acceptable performance shall be conclusive. The Vendor
36
4
agrees to cooperate with the County in monitoring the progress of completion of the service tasks and
deliverables. The County may use,but is not limited to,one or more of the following methods for
monitoring:
1. Desk reviews and analytical reviews;
2. Scheduled,unscheduled and follow-up on-site visits;
3. Client visits;
4. Review of independent auditor's reports- Exhibit 10;
5. Review of third-party documents and/or evaluation;
6. Review of progress reports;
7. Review of customer satisfaction surveys;
8. Agreed-upon procedures review by an external auditor or consultant;
9. Limited-scope reviews; and
10. Other procedures as deemed necessary.
2.8.3 Contract Monitoring
The County shall, at its own discretion, conduct monitoring concerning any aspect of the vendor's
performance of this contract.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this agreement includes a fixed rate for services.
3.2 Remedies-Nonconforming Services
The vendor shall ensure that all goods and/or services provided under this agreement for OAA
IIIE and OAA IIIES funded programs are delivered timely, completely and commensurate with
required standards of quality. Such goods and/or services will only be delivered to eligible
program participants.
If the vendor fails to meet the prescribed quality standards for services, such services will not be
paid under this agreement. In addition, any nonconforming goods (including home delivered
meals) and/or services not meeting such standards will not be paid under this agreement. The
vendor's signature on the request for payment form certifies maintenance of supporting
documentation and acknowledgement that the vendor shall solely bare the costs associated with
preparing or providing nonconforming goods and/or services. The County and or Department
require immediate notice of any significant and/or systemic infractions that compromise the
quality, security or continuity of services to clients.
3.3 All payment requests shall be based on the submission of actual monthly services beginning with
the contract date the agreement. The contracted rate for services is ATTACHMENT A to this
agreement.
3.4 Payment may be authorized only for allowable services, which are in accordance with the limits
specified in ATTACHMENT A.
3.5 Any payment due by the County under the terms of this agreement may be withheld pending the
receipt and approval by the County of all financial and programmatic reports due from the vendor
and any adjustments thereto, including any disallowance not resolved.
37
lc/
y Y
3.6 Date for Final Request for Payment
The final request for payment for agreement year one expenditures will be due to the County no
later than August 1, 2013. The final request for payment for agreement year two expenditures
will be no later than August 1, 2014.
3.7 Documentation for Payment
The vendor shall maintain documentation to support payment requests that shall be available to
the County or authorized individuals, such as the Department of Financial Services, upon request.
38
( It)i
EXHIBIT 5
Agreement#12-5856 "Services for Seniors
Attachment B
Invoice and Logs
(Minimum Standard Invoice Information)
County Purchasing
Order Number: Invoice Number:
Grant Name: From Date To Date
°;,a, 3e '
! en 'ate 4� ;,.
'max mt o IAN 1,
gam on ubtratto ® ! 1 � e
Se cue 1 es rlptl 1 rt, ment
ltleII if e 1 by ne� 1 � '
3 rvicev 1 nt `
'.xs ` �, ei.z y. Amount "'': 1 1 e ! nit
nit
from Total` !
'Cost Per
w grace :
Emit)
$0.00
$0.00
$0.00
Total $0.00
I certify to the best of my knowledge and belief that this invoice, and attached service detail log, is
complete and correct and all outlay herein are for the purposes set forth in the contract, and that
services are ordered by the case manager as agreed on the Contract.
Legible copies of the dated timesheet, signed by the client and the worker supporting this invoice
must be available upon request.
Collier County reserves the right to correct computation of errors to assure
proper payment amount.
Prepared by: Date:
Adjustment Reasons
Lead Agency
Authorization
Attachments: Monthly Service log,Weekly Detail log and Client Service time sheets.
39
•
EXHIBIT 6
Detail Weekly for CCE Services
Week Ending: Invoice No.
Personal
CLIENT Care Homemaker Respite Skilled Companion Chore
Total Total Total Total Total Total
NAME Units Units Units Units Units Units
Total Hours - - - - - -
$
PECA -
$
HMK -
$
RESPITE -
$
SKILLED -
$
COMPANION -
$
CHORE -
$
TOTAL -
40
■
EXHIBIT 7
Monthly Detail
Service Log
Grant
Name:
Vendor Name,
Address:
From Date To Date
By client,provide the total number of hours provided during the dates of service.
This log must be submitted with your monthly invoice for the Invoice From Date and To Date.
� e$ 2te 1dult ' Resp� mergency
(lien Pe nal ome- �.S, d h ,
9me wx ay i Orel ,�; .,or ", -•
�. re Nu � t �„; �are paRion� Response
m,a ;a Home „ ;.`S` Card _ acl t' �, a zs,', . .: ; ;-44,14 444'4- 47-1tPAT
41
EXHIBIT 8
Daycare
Grant:
Grant Service: ADC or RESF
Vendor Name and Address
By client, provide the Weekly Client Service Time Sheet provided during the dates of service.
This log must be
submitted with all invoices for the invoice From Date
and To Date.
TO
FROM DATE: DATE:
Client Thur Uni
Client Name signature Mon Tue Wed s Fri Sat Sun Match is
Service Dates
42
EXHIBIT 9
YOUR COMPANY NAME HERE
Collier County Services for Seniors
Homemaker/Personal Care/Respite/Companion Work Sheet
Client Name: Client Signature:
Week Ending:
Each Time You Perform one of the Activities Below: Put in arrival and departure times for the day worked:
****Client should Initial time of arrival and departure.
****Client should Sign form at top.
****you should sign your name at the bottom.
Date:
Day: MON TUES WED THUR FRI SAT SUN TOTAL
TIME
ARRIVAL TIME:
DEPARTURE TIME:
****CLIENT INITIALS:
Arrive:
PERSONAL
CARE Depart:
Assist W/Bath tub
Shower Bed
Assist W/Dressing
Bathroom Assist
Shave (Face Only)
Oral Hygiene
Walking/Ambulation
Feeding Assistance
Wash/Set Hair
Backrub_Soak Feet_
Nails (File only)
Change Make_Bed
Take out Trash
Clean Bedroom
Clean Bathroom
Prepare Meals
Laundry
Arrive:
HOME
MAKING Depart:
Vacuum/Sweep
Light Dusting
43
1'i
Clean Kitchen
Floor
Wash Dishes
Mop Sweep_
Grocery Shop
Errands
Arrive:
RESPITE Depart:
Arrive:
COMPANION
Depart:
EMPLOYEE'S Signature/Title
44
EXHIBIT 10
OMB Circular A-133 Audits of States, Local Governments, and Non-Profit Organizations requires
the Collier County Housing, Human and Veterans Services Department to monitor our
subrecipients of federal awards and determine whether they have met the audit requirements of
the circular and whether they are in compliance with federal laws and regulations. Accordingly, we
are requiring that you check one of the following, provide all appropriate documentation regarding
your organization's compliance with the audit requirements, sign and date this form.
Subrecipient Fiscal Year
Name Period
Total State Financial Assistance Expended during $
most recently completed Fiscal Year
Total Federal Financial Assistance Expended during most $
recently completed Fiscal Year
Check Appropriate Boxes
We have exceeded the $500,000 federal/state expenditure threshold for our fiscal year
❑ ending as indicated above and have completed our Circular A-133 audit. A copy of
the audit report and management letter are attached.
We exceeded the $500,000 federal/state expenditure threshold for our fiscal year
❑ ending as indicated above and expect to complete our Circular A-133 audit by
. Within 30 days of completion of the A-133 audit, we will provide a
copy of the audit report and management letter.
We are not subject to the requirements of OMB Circular A-133 because we:
❑ Did not exceed the $500,000 federal/state expenditure threshold for the fiscal
year indicated above
❑ Are a for-profit organization
❑ Are exempt for other reasons —explain
An audited financial statements is attached and if applicable, the independent auditor's
management letter.
(If findings were noted, please enclose a copy of the responses and corrective action plan.)
Certification Statement
I hereby certify that the above information is true and accurate.
Signature Date
Print Name and Title
45
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