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#14-6199 (Arden Courts-Lely Palms of Naples FL,LLC) AGREEMENT14-6199 for Older American's Act (OAA) Title IIIE Facility Respite Care and Adult Day Care Services ri ., / �j THIS AGREEMENT, made and entered into on this � rl' day of tiAa 24_. 2014, by and between Arden Courts-Lely Palms of Naples, FL, LLC, authorized to do business in the State of Florida, whose business address is 6125 Rattlesnake Hammock Road, Naples, FL 34113-2912 herein called the "Vendor" and Collier County, a political subdivision of the State of Florida, (the "County"): WITNESSETH: 1. COMMENCEMENT. The Vendor shall commence the work upon the issuance of a Purchase Order. 2. CONTRACT TERM. The agreement shall commence on Date of Board award and terminate on December 31, 2016. There is the possibility of two (2) additional two (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 the Contract will not exceed six (6) years (through December 31, 2019). As outlined in the ITB #14-6199, 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 OAA Title IIIE Facility Respite Care and Adult Day Care. 3. STATEMENT OF WORK. The Vendor shall provide Facility Respite Care` and Adult Day Care in accordance with the terms and conditions of ITB #14-6199, the terms and requirements of the grant, and the Vendor's proposal referred to herein and made an integral part of this agreement. This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County Purchasing Ordinance and Purchasing Procedures in effect at the time such services are authorized. 4. THE CONTRACT SUM. The County shall pay the Vendor for the performance of this Agreement the aggregate of the units actually ordered and furnished at the unit price, together with the cost of any other charges/fee submitted in the bid as set forth in Attachment A, Contract Rates, attached hereto and made an integral part thereof. . Payment will be made upon receipt of a proper invoice as per Attachment B, Invoice and Logs, attached herein and incorporated by reference, and upon approval by the Contract Manager or his/her designee, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act". 4.1 Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of"laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. 5. SALES TAX. Vendor shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County,Florida as a political subdivision of the State of Florida,is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes,Certificate of Exemption#85-8015966531C-2. 6. NOTICES. All notices from the County to the Vendor shall be deemed duly served if mailed or faxed to the Vendor at the following Address: Arden Courts-Lely Palms of Naples FL,LLC Attention: Melody Wilson,Executive Director 6125 Rattlesnake Hammock Road,Naples,FL 34113 Telephone: 239-417-8511 Fax: 239-417-8512 Email: 449ED@hcr-manorcare.com All Notices from the Vendor to the County shall be deemed duly served if mailed or faxed to the County to: Collier County Government Center Purchasing Department-Purchasing Building 3327 Tamiami Trail,East Naples,Florida 34112 Attention:Joanne Markiewicz,Director,Procurement Services Telephone: 239-252-8407;Facsimile: 239-252-6480 The Vendor and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Vendor or to constitute the Vendor as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits necessary for the prosecution of the Work shall be obtained by the Vendor. The County will not be obligated to pay for any permits obtained by Subcontractors/Subconsultants. Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured and paid for by the Vendor. The Vendor shall also be solely responsible for payment of any and all taxes levied on the Vendor. In addition, the Vendor shall comply with all rules, regulations and laws of Collier County, the State of Florida, or the U. S. Government now in force or hereafter adopted. The Vendor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Vendor. 9. NO IMPROPER USE. The Vendor will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Vendor or if the County or its authorized representative shall deem any conduct on the part of the Vendor to be objectionable or improper, the County shall have the right to suspend the contract of the Vendor. Should the Vendor fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Vendor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 10. TERMINATION. Should the Vendor be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said agreement for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of non-performance. In the event that the County terminates this Agreement, Vendor's recovery against the County shall be limited to that portion of the Contract Amount earned through the date of termination. The Vendor shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION. The Vendor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Vendor shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $1,000,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Vendors; Products and Completed Operations and Contractual Liability. B. Business Auto Liability: Coverage shall have minimum limits of $1,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned Vehicles and Employee Non-Ownership. S C. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. The coverage must include Employers' Liability with a minimum limit of $1,000,000 for each accident. D. Professional Liability: Shall be maintained by the Vendor to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Vendor waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less than $1,000,000 each claim and in the aggregate. E. Employee Dishonesty Bond: Bond shall be for$100,000 Per Occurrence. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Vendor during the duration of this Agreement. The Vendor shall provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County ten (10) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: ten (10) days prior written notice, or in accordance with policy provisions. Vendor shall also notify County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Vendor from its insurer, and nothing contained herein shall relieve Vendor of this requirement to provide notice. Vendor shall ensure that all sub Vendors comply with the same insurance requirements that he is required to meet. 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Vendor shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this Agreement by Vendor, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Vendor or anyone employed or utilized by the Vendor in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. cq 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Vendor, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Vendor. Vendor's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Housing, Human and Veterans Services Department. 15. CONFLICT OF INTEREST: Vendor represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Vendor further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the following component parts, all of which are as fully a part of the contract as if herein set out verbatim: Vendor's Proposal, Insurance Certificate(s), Bid #14-6199 Scope of Services, Attachment A Contract Rates, Attachment B Invoice and Logs, Attachment C Core Standards for OAA IIIE, Attachment D Statement of Work with Exhibits I- X, and additional Granting Agency Requirements forms. 17. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this agreement is subject to appropriation by the Board of County Commissioners. 18. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any contract held by the individual and/or firm for cause. 19. COMPLIANCE WITH LAWS. By executing and entering into this agreement, the Vendor is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended; taxation, workers' compensation, equal employment and safety (including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes), and the Florida Public Records Law Chapter 119 (including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(d) and (3))). If Vendor observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Vendor to comply with the laws referenced herein shall constitute a breach of this agreement and the County shall have the discretion to unilaterally terminate this agreement immediately. 20. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful bidder extending the pricing, terms and conditions of this solicitation or resultant contract to other governmental entities at the discretion of the successful proposer. 21. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 22. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this contract in compliance with the Purchasing Ordinance and Purchasing Procedures. 23. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Vendor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Vendor with full decision-making authority and by County's staff person who would make the presentation of any settlement reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. 24. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. 25. KEY PERSONNEL/PROJECT STAFFING: Vendor's personnel and management to be utilized for this Contract shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the contract. The Vendor shall assign as many people as necessary to complete the required services on a timely basis, Coq and each person assigned shall be available for an amount of time adequate to meet the required service delivery dates. 26. ORDER OF PRECEDENCE: In the event of any conflict between or among the terms of any of the Contract Documents, the terms of the Invitation to Bid/ITB and/or the Vendor's Proposal, the Contract Documents shall take precedence. 27. ASSIGNMENT: Vendor shall not assign this Agreement or any part thereof, without the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement, or any part herein, without the County's consent, shall be void. If Vendor does, with approval, assign this Agreement or any part thereof, it shall require that its assignee be bound to it and to assume toward Vendor all of the obligations and responsibilities that Vendor has assumed toward the County. *****************Remainder of Page Intentionally Left Blank***************************** CD IN WITNESS WHEREOF, the parties hereto, have each, respectively, by an authorized person or agent, have executed this Agreement on the date and year first written above. BOARD OF COUNTY COMMISSIONERS ATTEST: COLLIER COUNTY, LORIDA Dwight E. Brock, C -rk of Cour 1---� By: _ Tom Henning, Chair Dated: U as�to Char atir only. ARDEN COURTS-LELY PALMS OF NAPLES, FL, LLC Vendor CAA, By: 1/77/41A-4 y. First rem 1 Signature IVICktOGNAA,IS on, rc,t,\A-1 TT Yp e/p rint witness nam TT Yp e/P rf signature and titleT / / Se/+ d Witness i ,i _ S ri ype/print witness nameT Approved as to Form and Legality: 110 ssistant C u ty Attorney rn1 Iy K. .eelo Print Name elo) Attachment A Agreement# 14-6199 Older American's Act (OAA) Title IIIE Facility Respite Care and Adult Day Care Contract Rates Total Cost Total Cost Per Reimbursement Item Service Description Service Unit Per Service Service Unit Rate Per Unit to Unit Supplier 1. Adult Day Care OAA Per Hour $11.00 $9.00 2. Respite (In-Facility) OAA Per Day $138.89 $125.00 Page 9 of 25 Attachment B Agreement#14-6199 Older American's Act(OAA) Title IIIE Facility Respite Care and Adult Day Care Invoice and Logs (Minimum Standard Invoice Information) Vendor Name Vendor Address Invoice Number County Purchasing Order Number From Date: To Date: Grant: OAA 3E Reimbursement TOTAL Rate Per Unit to Total AMOUNT Service In Kind Supplier` Cost (Multiply the Description Match (Subtract In Unit Per Reimbursement (identified Service Amount Kind Match Quantity Rate Per Unit to by line) Amount from Unit `Supplier x the Total Cost Per Unit Quantity) Service Unit) Total 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: Adjustments Reasons: County Authorization: Weekly Client Service Time Sheet(Log) Page 10 of 25 Vendor Name and Address: Grant: By client, provide the Weekly Client Service Time Sheet provided during the dates of service. This log must be submitted with all invoices. From Date: To Date: Service: Client Client Service Mon Tue Wed Thurs Fri Sat Sun Units Cost Name Signature Description Service Dates Total Page 11 of 25 Attachment C Agreement# 14-6199 Older American's Act (OAA) Title IIIE Facility Respite Care and Adult Day Care Core Standards for OAA IIIE 1. Compliance with Federal Law 1.1 If this contract contains federal funds this section 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 contract 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 Agency regulations 40 CFR 30. The Vendor shall report any violations of the above to the Department and/or County. 1.1.3 The Vendor, or agent acting for the Vendor, may not use any federal funds received in connection with this contract to influence legislation or appropriations pending before the Congress or any state legislature. If this contract contains federal funding in excess of $100,000.00, the Vendor must, prior to contract execution, complete the Certification Regarding Lobbying form, EXHIBIT I. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the Contract Manager prior to payment under this contract. 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 A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract 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 subcontracts receiving federal funds pursuant to this contract. The Vendor shall complete and sign EXHIBIT II prior to the execution of this contract. 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 contract by the County. 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 175 regarding Trafficking in Persons. Page 12 of 25 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 contract term. Vendor shall include in related subcontracts a requirement that subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment of all new employees hired by the subcontractor during the contract 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 contract 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 contract, which the Contract Manager 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 contract 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 contract for which the County may unilaterally terminate the contract. 2.3 If clients are to be transported under this contract, the Vendor shall comply with the provisions of Chapter 427, F.S., and Rule 41-2, F. A. C. 2.4 Subcontractors 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 contract funds for the purpose of lobbying the legislature, judicial branch or a state County. 2.6 In accordance with s. 287.135 F.S., any Vendor on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (Lists), created pursuant to s. 215.473 F.S., is ineligible to enter into or renew a contract with the County for goods or services of $750,000.00 or more. Pursuant to s. 287.135 F.S., the County may terminate this contract if the Vendor is found to have submitted a false certification of its status on the Lists or has been placed on the Lists. Further, the Vendor is subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of false certification. If this contract contains $750,000.00 or more, the Vendor shall complete and sign EXHIBIT III, Certification Regarding Scrutinized Companies Lists, prior to the execution of this contract. 3. Background Screening: The Vendor shall ensure that the requirements of s. 430.0402 and ch. 435, F.S., as amended, Page 13 of 25 C;1G are met regarding background screening for all persons who meet the definition of a direct service provider and who are not excepted from the Department's level 2 background screening 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. (EXHIBIT VII) 3.1 Further information concerning the procedures for background screening is found at http://elderaffairs.state.fl.us/doea/backoroundscreeninq.php. 4. Grievance Procedures: The Vendor shall develop, implement, and ensure that its subcontractors have established grievance procedures to process and resolve client dissatisfaction with or denial of service(s), and address complaints regarding the termination, suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum, will provide for notice of the grievance procedure and an opportunity for review of the subcontractor's determination(s). 5. Nondiscrimination-Civil Rights Compliance: 5.1 The Vendor shall execute assurances in EXHIBIT IV that it will not discriminate against any person in the provision of services or benefits under this contract or in employment because of age, race, religion, color, disability, national origin, marital status or sex in compliance with state and federal law and regulations. The Vendor further assures that all Vendors, subcontractors, subgrantees, or others with whom it arranges to provide services or benefits in connection with any of its programs and activities are not discriminating against clients or employees because of age, race, religion, color, disability, national origin, marital status or sex. 5.2 During the term of this contract, the Vendor shall complete and retain on file a timely, complete and accurate Civil Rights Compliance Checklist (EXHIBIT V). 5.3 The Vendor shall establish procedures pursuant to federal law to handle complaints of discrimination involving services or benefits through this contract. These procedures will include notifying clients, employees, and participants of the right to file a complaint with the appropriate federal or state entity. 5.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from federal financial assistance, and are binding upon the Vendor, its successors, transferees, and assignees for the period during which such assistance is provided. The Vendor further assures that all subcontractors, vendors, or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the Vendor understands that the County may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, including but not limited to, termination of and denial of further assistance. 6. 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 contract, and to interview any clients, employees and subcontractor employees of the Vendor to assure the County of the satisfactory performance of the terms and conditions of this contract. 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 Contract Manager. 7. Provision of Services: The Vendor shall provide services in the manner described herein. Page 14 of 25 8. Coordinated Monitorina with Other Agencies: If the County receives funding from one or more of the State of Florida other human service agencies, in addition to the Department of Elder Affairs and/or the Area Agency on Aging for Southwest Florida, Inc., dba Senior Choices of Southwest Florida, then a joint monitoring visit including such other agencies may be scheduled. For the purposes of this contract, and pursuant to s. 287.0575, F.S. as amended, Florida's human service agencies shall include the Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities, the Department of Veterans Affairs, and the Department of Elder Affairs. Upon notification and the subsequent scheduling of such a visit by the designated County's lead administrative coordinator, the Vendor shall comply and cooperate with all monitors, inspectors, and/or investigators. 9. Confidentiality of Information: The Vendor shall not use or disclose any information concerning a recipient of services under this contract 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. 10. 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). 11. Incident Reportina: 11.1 The Vendor shall notify the Agency immediately but no later than forty-eight (48) hours from the Vendor's awareness or discovery of conditions that may materially affect the Vendor or subcontractor's ability to perform the services required to be performed under this contract. Such notice shall be made orally to the Contract Manager (by telephone) with an email to immediately follow. 11.2 The Vendor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Vendor and its employees. 12. Bankruptcy Notification: During the term of this contract, the Vendor shall immediately notify the County if the Vendor, its assignees, subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Vendor must also provide the following information to the Area Agency on Aging for Southwest Florida, Inc., dba Senior Choices of Southwest Florida: (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., Middle District of Florida, Fort Myers, FL); and (4) the name, address, and telephone number of the bankruptcy attorney. 13. Sponsorship and Publicity: 13.1 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 contract, it shall, in publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by (Vendor's name) and the Area Agency on Aging for Southwest Florida, Inc., dba Senior Choices of Southwest Florida and State of Florida, Department of Elder Affairs." If the sponsorship reference is in written material, the words "Senior Choices of Southwest Florida and The State of Florida, Department of Elder Affairs" shall appear in at least the same size letters or type as the name of the organization. 13.2 The Vendor shall not use the words "Senior Choices of Southwest Florida and The State of Florida, Department of Elder Affairs" to indicate sponsorship of a program otherwise financed, unless specific authorization has been obtained by the County prior to use. Page 15 of 25 (11) 14. Indeoendent Capacity of Vendor: It is the intent and understanding of the Parties that the Vendor, or any of its subcontractors, are independent vendors and are not employees of the Agency and shall not hold themselves out as employees or agents of the Agency without specific authorization from the Agency. It is the further intent and understanding of the Parties that the Agency 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 subcontractors. 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. 15. 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 Contract Manager 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 contract, unless the bid specifications, purchase order, or this contract specify otherwise. The approved invoice will be submitted to the Agency's finance section for budgetary approval and processing. Disputes arising over invoicing and payments will be resolved in accordance with the provisions of s. 215.422 F.S. A Vendor Ombudsman has been established within the Department of Financial Services and may be contacted at (850) 413-5665. 16. Return of Funds: The Vendor shall return to the Agency any overpayments due to unearned funds or funds disallowed and any interest attributable to such funds pursuant to the terms and conditions of this contract that were disbursed to the Vendor by the Agency. 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 Agency. In the event that the Agency first discovers an overpayment has been made, the Contract Manager will notify the Vendor in writing of such findings. Should repayment not be made forthwith, the Vendor shall be charged at the lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after Agency notification or Vendor discovery. 17. Data Integrity and Safeguardina 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 contract. 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 subcontractors maintain written procedures for computer system backup and recovery. The Vendor shall complete and sign EXHIBIT VI prior to the execution of this contract. 18. 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, vendors, 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 and/or Agency'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. This policy is available on the Department's website. 19. 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 contract to Page 16 of 25 provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract 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, subcontractor, or consultant under a contract 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. 20. Patents. Copyrights. Royalties: If this contract 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 contract, the Vendor shall refer the discovery, invention or material to the County to be referred to the Department of State. Any and all patent rights or copyrights accruing under this contract 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 contract. 20.1 If the primary purpose of this contract 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 this section 33. 20.2 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR 215.36 21. Emergency Preparedness and Continuity of Operations: 21.1 If the tasks to be performed pursuant to this contract 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 contract, submit to the Contract Manager verification of an emergency preparedness plan. In the event of an emergency, the Vendor shall notify the Agency of emergency provisions. 21.2 In the event a situation results in a cessation of services by a subcontractor, the Vendor shall retain responsibility for performance under this contract and must follow procedures to ensure continuity of operations without interruption. 22. Financial Conseauences 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 Agency must apply financial consequences commensurate with the deficiency. Financial consequences may include, but are not limited to, contract suspension, refusing payment, withholding payments until deficiency is cured, tendering only partial payments, and/or cancellation of contract and reacquiring services from an alternate source. 22.1 The Vendor will not be charged with financial consequences, when a failure to perform arises out of cause that were the responsibility of the Agency. 23. 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. 24. Venue: If any dispute arises out of this contract, the venue of such legal recourse will be Collier County Florida. 25. Entire Contract: This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or Page 17 of 25 representations shall be valid or binding upon the Agency or the Vendor unless expressly contained herein or by a written amendment to this contract signed by both Parties. 26. 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. 27. 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. 28. Condition Precedent to Contract: Appropriations: The Parties agree that the Agency's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. 29. Addition/Deletion: The Parties agree that the Agency reserves the right to add or to delete any of the services required under this contract when deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties. The Parties shall negotiate compensation for any additional services added. 30. Waiver: The delay or failure by the Agency to exercise or enforce any of its rights under this contract will not constitute or be deemed a waiver of the Agency'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. 31. Compliance: The Vendor shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable current state statutes, laws, rules 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 contract to immediate, unilateral cancellation of the contract at the discretion of the Agency. 32. Final Invoice: The Vendor shall submit the final OAA IIIE invoice for payment to the County on January 15th of each contract calendar year.. If the Vendor fails to submit final request for payment by the deadline, then all rights to payment may be forfeited and the Agency may not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the Vendor and necessary adjustments thereto have been approved by the Agency. 33. Renegotiations of 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 and 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. 34. All Terms and Conditions Included This contract and its Exhibits, I — X and any exhibits 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 contract shall supersede all previous communications, representations or agreements, either written or verbal between the Parties. Page 18 of 25 Attachment D Agreement# 14-6199 Older American's Act (OAA) Title IIIE Facility Respite Care and Adult Day Care Statement of Work 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 AAA 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. Area Plan Update: A revision to the area plan wherein the AAA enters OAA specific data in CIRTS. An update may also include other revisions to the area plan as instructed by the Department or Agency. 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 GENERAL DESCRIPTION 1.2.1 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. 1.2.2 Authority The relevant authority references governing the OAA program are: (1) Older Americans Act of 2006, as amended; Page 19 of 25 (2) Rule 58A-1, Florida Administrative Code; and (3) Section 430.101, Florida Statutes. (4) EXHIBIT IX 1.2.2.1 Incorporation of Reference Memoranda In accordance with Ch. 287 F.S., as amended, and Department 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, October 3, 2012; (2) CFO Memo No. 06: Release date, July 27, 2012; (3) CFO Memo No. 01: Release date, July 26, 2012; and (4) CFO Memo No. 04: Release date, June 30, 2006 1.2.3 Scope of Service The vendor shall provided services in a manner consistent with and described in the current area plan and Department of Elder Affairs Programs and Services Handbook. 1.2.4 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. 1.3 INDIVIDUALS TO BE SERVED 1.3.1 OAA Title III, General Consumers shall not be dually enrolled in an OAA program and a Medicaid capitated long-term care program. 1.3.2 OAA Title IIIE, Caregiver Support Services Eligibility for OAA Title IIIE, Caregiver Support Services, is as follows: (1) Family caregivers of individuals age 60 or older; (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. 1.3.3 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. 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 373, Title IIIE Caregiver Support Services; and (2) Sections 321 and 373 — Information and Referral/Assistance Access Services (Elder Helplines) Page 20 of 25 CA 2.1.1 Caregiver Support Services (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, and (2) Respite Services 2.1.2 Use of Volunteers to Expand the Provision of Available Services 2.1.3 The Vendor shall ensure the use of trained volunteers in providing direct services delivered to older individuals and individuals with disabilities needing such services. If possible, the Vendor shall work in coordination with organizations that have experience in providing training, placement, and stipends for volunteers or participants (such as organizations carrying out federal service programs administered by the Corporation for National and Community Service), in community service settings. 2.1.4 Use of Subcontractors If this contract involves the use of a subcontractor or third party, then the Vendor shall not delay the implementation of its agreement with the subcontractor. If any circumstances occur that may result in a delay for a period of 60 days or more of the initiation of the subcontract or in the performance of the subcontractor, the Vendor shall notify the Contract Manager and the Agency's Chief Financial Officer in writing of such delay. The Vendor shall not permit a subcontractor to perform services related to this agreement without having a binding subcontractor agreement executed. In accordance with section 24.1 of the Standard Contract, the Agency will not be responsible or liable for any obligations or claims resulting from such action. 2.1.5 Subcontractor Outreach Reporting Requirements The Vendor shall document its oversight of subcontractor performance of outreach activities, by establishing a uniform reporting format that includes the following: number and type of provider events or activities; date and location; total number of participants at each event or activity; individual service needs identified; and referral sources or information provided. The Vendor shall require subcontractors to use this format for reporting on outreach activities at least semi-annually. 2.2 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 subcontractors 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 UNITS OF SERVICE 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 Page 21 of 25 pursuant to the rate established in this agreement as updated, and approved by the County's reporting requirements. SERVICES Adult Day Care/Adult Day Health Care Hour Respite Services Daily 2.4 REPORTS The Vendor shall respond to additional routine and/or special requests for information and reports required by the Agency in a timely manner as determined by the Contract Manager. The Vendor shall establish due dates for any subcontractors that permit the Vendor to meet the Agency's reporting requirements. 2.4.1 Service Costs Reports The Vendor shall require subcontractors to submit to the Vendor semi-annual service cost reports (August 1, 2014 and February 1, 2015), which reflect actual costs of providing each service by program. This report provides information for planning and negotiating unit rates. 2.4.2 Background Screening Affidavit of Compliance To demonstrate compliance with section 8 of the Standard Contract, the Vendor shall submit EXHIBIT VII, Background Screening Affidavit of Compliance annually, by January 15th. 2.5 RECORDS AND DOCUMENTATION The Vendor will ensure the collection and maintenance of client and service information on a monthly basis from the CIRTS or any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. 2.5.1 Each Vendor and subcontractor, 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 subcontractors. These policies and procedures shall be made available to the Agency 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 Agency all reports described in ATTACHMENT D, Paragraph 2.4 REPORTS. (3) The Vendor shall timely submit to the Agency all information described in ATTACHMENT D , 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 1 0 percent of the federal funds received. The Vendor's match will be made in the form of cash, general revenue administrative funds 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 Page 22 of 25 subcontractor'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. 2.8 AGENCY RESPONSIBILITIES 2.8.1 Program Guidance and Technical Assistance The Agency 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 Contract Monitoring The Agency 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 Agency's determination of acceptable performance shall be conclusive. The Vendor agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and deliverables. The Agency 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 for Nonconforming Services The Vendor shall ensure that all goods and/or services provided under this contract 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 reimbursed under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services not meeting such standards will not be reimbursed under this contract. The Vendor's signature on the request for payment form certifies maintenance of supporting documentation and acknowledgement that the Vendor shall solely bear the costs associated with preparing or providing nonconforming goods and/or services. The agency requires 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. Page 23 of 25 Cao 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 February 1, 2015. The final request for payment for agreement year two expenditures will be no later than February 1, 2016. 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. Page 24 of 25 CA(' EXHIBITS I -X WILL FOLLOW THIS PAGE Page 25 of 25 CA�� EXHIBIT I CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS,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 or federal agency, 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 contract,grant,loan,or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract,grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub- awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all subcontractors 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$10,000.00 and not more than$100,000.00 for each such failure. 71/(/(/(4 t ')/‘" 1A-1 I it Signature Date I r Aae h4/ i /� C qq. Name of Authorize Individual Application or Agreement Number !' t aIL`Ili ZJ Lc./ eklv e- f i-t't,`'`tz -az_ed Name and A.. ess of Organization ArAet4-' 5(iCf 3 EXHIBIT II CERTIFICATION REGARDING DEBARMENT,SUSPENSION,INELIGIBILITY AND VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS (1) The Contractor certifies, by signing this certification, neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarilyy excluded from participation in this transaction by any federal department or agency. (2) Where the Contractor is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this certification. 1C-cn/" )77- Signa to e' Date & , -e;ttft-)' 07Ye_(2-(-7}--yz-- A09„,„v Title Agency/Organization (Certification signature should be same as Contract 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 Contract 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 Contractor knowingly rendered an erroneous certification, in addition to other remedies available to the federal government, the Department may pursue available remedies, including suspension and/or debarment. 3. The Contractor will provide immediate written notice to the Contract Manager if.at any time the Contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The Contractor 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 Contractor 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 Contractor 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 Contractor 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 may pursue available remedies, including suspension, and/or debarment. 7. The Contractor 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. �) EXHIBIT III CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS The undersigned, an authorized representative of the Contractor named in the contract or agreement to which this form is an attachment,hereby certifies that: (1)The Contractor understands that pursuant to s. 287.135 F.S., any company at the time of bidding or submitting a proposal for a new contract or renewal of an existing contract, that is on the "Scrutinized Companies with Activities in Sudan List" or the "Scrutinized Companies with Activities in the Iran Petroleum Sector List (collectively, "the Lists") is ineligible for, and may not bid on, submit a proposal for or enter into or renew a contract with the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of Southwest Florida (Agency) for goods or services of$1 million or more. (2) The Contractor understands that, pursuant to s. 287.135 F.S., any company that submits a false certification to the Agency is subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of false certification. (3) The Contractor understands that the contract to which this form is an attachment may be terminated by the Agency if the Contractor submits a false certification or has been placed on the Lists. This certification, required by Florida law, 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. 3‘a L I I ({ Signature ate (Same as contract signature) Title A/iteAA_ dV- 0/25 kairre,51/v ka-t. r20(, Agency Name and Address ((2, EXHIBIT IV ASSURANCES—NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 45 minutes' per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden,to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington,DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case,you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate; the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency d tectives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest,or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. ❑04728-4763)relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration(5 C.F.R.900,Subpart F). 6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended(20 U.S.C. ❑❑1681-1683,and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended(29 U.S.C. 0794),which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the basis of age; (e)the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended,relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616),as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title.VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale,rental or financing of housing;(i)any other nondiscrimination provisions in the specific statute(s)under which application for federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply,as applicable,with the provisions of the Davis-Bacon Act(40 U.S.C.276a-7),the Copeland Act(40 U.S.C. 276c and 18 U.S.C. ❑0874)and the Contract Work Hours and Safety Standards Act(40 U.S.C. 327-333),regarding labor standards for federally assisted construction subagreements. C:1(Y 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a)of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738;(c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with E0 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. ❑❑1451 et seq.); (0 conformity of federal actions to State(Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. ❑07401 et seq.); (g)protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. ❑❑1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 0470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974(16 U.S.C. ❑0469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. ❑02131 et seq.)pertaining to the care,handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C.4801 et seq.), which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No.A-133,Audits of States,Local Governments,and Non-Profit Organizations. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING TITLE OFFICIAL F--7)(�7'1K- P!re APPLICANT ORGANIZATION DATE SUBMITTED /29//17 �l3 es il-tuvL!VL o /I/4pieS 3€11/3 Cry; INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2. Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board,leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub-grantees,45 CFR 80.4(a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons,45 CFR 80.3 (b)(6). 9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on-site record analysis of persons who applied but were denied services or employment,45 CFR 80.3 (a)and 45 CFR 80.1 (b)(2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms,reception areas,restrooms and other facilities must also be equally available to all clients,45 CFR 80.3 (b). 11. For in-patient services,residents must be assigned to rooms,wards, etc., without regard to race,color,national origin or disability. Also,residents must not be asked whether they are willing to share accommodations with persons of a different race,color,national origin,or disability,45 CFR 80.3 (a). 12. The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services,45 CFR 80.3 (a). 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a 3 cAo complaint of discrimination with either the Florida Department of Elder Affairs or the U.S.Department of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility,45 CFR 80.6(d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination,etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status,e.g., settled, no reasonable cause found,failure to conciliate, failure to cooperate,under review,etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains,information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self- evaluation to identify any accessibility barriers. Self-evaluation is a four step process: a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.),45 CFR 84.6. 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7(b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7(a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material,notices for hearings,newspaper ads, and other appropriate written communication,45 CFR 84.8(a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services,45 CFR 84.52(d). 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246,41 CFR 60 and Title VI of the Civil Rights Act of 1964,as amended. DOEA Form 101-B,Revised August 2010 4 EXHIBIT VI CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned, an authorized representative of the Contractor named in the contract or agreement to which this form is an attachment,hereby certifies that: (I) The Contractor and any subcontractors of services under this contract 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 Contractor, subcontractor(s), or any outside entity on which the Contractor 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, contractor(s)will take immediate action to assure data integrity. (3) If this contract 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 Contractor (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 Contractor 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 Contractor and any subcontractor(s) of services under this contract 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 Contractor shall require that the language of this certification be included in all subagreements,subgrants, and other agreements and that all subcontractors 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). .q/(1/1/1 C(11/1 6(eetCh dirf alere 3/; Signature Title Date Meiedcf 1:r -1.% Name of Aut orized Signer Wzc //ii41L) - M Mites r-1, 3[03 DEPARTMENT OF EXHIBIT VII BACKGROUND SCREENING ;ELDER AFFAIRS Affidavit of Compliance - Employer STATE OF FLt+'i IOA 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: �7 As the duly authorized representative of G(ell ()■15- rZ /2-5 4'( Employer Name- located at �� I/°dayG'-k JfaBKni°CZ-0-t4k#,1g -1//3 Street Address City State ZIP code I, 4- i10 �/I j /5--y-u) do hereby affirm under penalty of perjury Name of Representat' e 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. /AA" YCE - -1A-/ _ • /s- L) Signature of Representative Date STATE OF FLORIDA, COUNTY OF Sworn to (or affirmed) and subscribed before me this c day of Met fry'V1 , 20 i'f, by pip y Rejta LU c (Sco (Name of Representative)who is personally known to me or produced F/- 1L ( / Lf25- 5 -77- car= a as proof of identification. Print,Type,or Stamp Commissioned Name of Notary Public Notary Pu lic DOEA Form 235,Affidavit of Compliance-Employer,Effective April 2012 8' N tion 435.05(3),F.S. MY COMMISSION N FFOS64 Form available at:http://elderaffairs.state.fl.us/enelish/backgroundscreening.ph.• � ` EXPIRES:jimmy 27,2O18 _ . CEO EXHIBIT VIII 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 aro 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." EXHIBIT IX DEPARTMENT OF ELDER AFFAIRS PROGRAMS&SERVICES HANDBOOK Department of Elder Affairs Programs& Services Handbook is available at the Department's Internet site under "Notices". The link below is the current Programs and Services Handbook. http://elderaffairs.state.fl.us/doea/notices/1u1y13/NOI%20for%202013%20P S Y0420Handbook.pdf GAO INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2. Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3. Enter the total number of full-time staff and their percent by race, sex and disability, Include the effective date of your summary. 4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub-grantees,45 CFR 80.4(a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b)(6). 9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation(Questions 3 and 4) and also through on-site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b)(2). 10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas,restrooms and other facilities must also be equally available to all clients,45 CFR 80.3 (b). 11. For in-patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race,color,national origin, or disability,45 CFR 80.3 (a). 12. The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people C_1 live,program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services,45 CFR 80.3 (a). 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of 1-11IS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint:has been filed. Indicate the current status,e.g., settled,no reasonable cause found,failure to conciliate,failure to cooperate,under review,etc. 15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self-evaluation to identify any accessibility barriers. Self-evaluation is a four step process: a. With the assistance of a disabled individual/organization,evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7(b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7(a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads,and other appropriate written communication,45 CFR 84.8(a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services,45 CFR 84.52 (d). 21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended. CAO EXHIBIT X VERIFICATION OF EMERGENCY PREPAREDNESS PLAN Contract# /14--(01/ I, e f /c61jyi�,certify that OU (ck-17} (Name of authorized con actor representative) (Name of contractor) has a current and properly maintained Emergency Preparedness Plan. Assurance is given that the plan will be made available to Collier County Housing, Human and Veteran Services, upon request. Signature of authorized contractor representative F?( -e 0/Yeelzwz--- Title 3/-2,v i y Date Board of Commissioners,Collier County Fl Company C,1(i'. October 2008 EHIBIT V STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST Program/F cility Name: County: w a/ r2.- AAA/Contractor Addresb 12 s /w N/ecilifa_ e_ 1 fii( 140/t/2(/ Completed By ,f/f /D civ, /,w/3 Uv`-'� City,State,Zip Code m� _ Z _ c 3ti//3 Date: ,31z4 / / Telephoned 39 (`�7-d J7) PART I:READ TIE ATTACHED INSTRUCTIONS/FOR ILLUSTRATIVE INFOR TI WHICH WILL HELP YOU COMPLETE THIS FORM. 1. Briefly describe the geographic rea served by the program/facility and the type of service provided: C�eVI A ,� _�a---t-toy) z Dbeiv, a, 4.✓«Z v 1, v re&L—1 ec� .tlso i `vr`ei 2. POPULATION OF AREA SERVED. Source of data: /' ert-ti_-e .4_.it Total 4 % hie. %Black %Hispanic %Other %rF,enmale 33z)ua� �s -7. / a�,z l,7 5V11g 3. STAFF CURRENTLY EMPLOYED. Effective date: *04 Total# %White %Black %Hispam %Other % emale_ %Disabled g 2— I 4Z` / a(os ., 2--Ce %• 7 0 4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date: 31l`f)l N Total# %White,i %Black %Hispanic %Other %F rre %Disabled %Over 40 5. ADVISORY OR GOVERNING BOARD,IF APPLICABLE i-•aij Total#2 %White %Black %Hispanic %Other %Female %Disabled •7 /CD 3313 o PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. 6. Is an Assurance of Compliance on file with DOEA? If N/A or NO,explain. N/A X NO ❑ ❑ 7. Compare the staff composition to the population. Is staff representative of the population? If N/A or NO,explain. N/A YE NO ❑ ❑ 8. Compare the client composition to the population. Are race and sex characteristics representative of the population? If N/A or NO,explain. N/A E NO ❑ ❑ 9. Are eligibility requirements for services applied to clients and applicants without regard to race,color, national origin,sex,age,religion or disability? If N/A or NO,explain. N/A yE,8 NO ❑ ❑ 10. Are all benefits,services and facilities available to applicants and participants in an equally effective manner regardless of race,sex,color,age,national origin,religion or disability? If N/A or NO,explain. N/A yq. NO ❑ PK ❑ 11. For in-patient services,are room assignments made without regard to race,color,national origin or disability? If N/A or NO,explain. N/A YES NO ❑ ❑ 12. Is the program/facility accessible to non-English speaking clients? If N/A or NO,explain. N/A Air NO ❑ ❑ 13. Are employees, pplica s nd participants informed of their protection against discrimination? If YES, how? Verbal Written 1i If N/A or NO,explain. N/A ® NO 1 �, c ❑ ❑ 14. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. N/A NUMBER oN'� ❑ C 15. Is the program/facility physically accessible to mobility, hearing, and sight-impaired individuals? If N/A or NO,explain. N/A YES NO yi PART III:THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. 16. Has a self-evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? If NO,explain. NO 17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If NO,explain. X NO 18. Has a person been designated to coordinate Section 504 compliance activities? If NO,explain. NO 19. Do recruitment and notification materials advise applicants,employees and participants of nondiscrimination on the basis of disability? If NO,explain. E NO ❑ 20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? If NO,explain. 7_ NO PART IV:FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF$50,000.00 OR MORE. 21. Do you have a written affirmative action plan? If NO,explain. � NO El DOEA USE ONLY Reviewed By In Compliance: YES ❑ NO* ❑ Program Office *Notice of Corrective Action Sent / / Date Telephone Response Due / / On-Site ❑ Desk Review ❑ Response Received / / Revised August 2010,Page 2 of 2 2 �� AC°R° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYY� 3/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Strategic Risk Solutions,Inc. (A/C,NNo.Ex:419-254-5401 _FAX No):4 49-254-5133 5450 E.High Street E-MAIL Suite 300 ADDRESS: Phoenix AZ 85054 INSURER(S)AFFORDING COVERAGE NAIC i INSURER A:Manor Care Insurance. Inc, INSURED HCRMANO-04 INSURER B: HCR ManorCare, Inc. INSURER C: • and its subsidiaries INSURER D: P.O.Box 10086 Toledo OH 43699-0086 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1043138304 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR, r, POLICY NUMBER _JMM/DDIYYYYL(MM/DOIYYYYL LIMITS A GENERAL LIABILITY Y 00112 5/1/2013 5/1/2014 EACH OCCURRENCE $7,500,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ X (CLAIMS-MADE OCCUR MED EXP(Any one person) $ X Healthcare PLiab PERSONAL&ADV INJURY $ X $5,000,000 SIR GENERAL AGGREGATE $7,500,000 GEM.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ T PRO7- LOC $ X POLICY JEC _ AUTOMOBILE LIABILITY (E ac dent SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS — AUTOS (Per accident) $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y IN TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE i� N f A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes:describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) General/Professional Liability: 1)Employees&Volunteers included as Additional Insureds. 2)Medical Directors included as Insureds while acting in their capacity as Medical Directors. 3)Blanket Additional Insureds as required by contract. Collier County Board of County Commissioners are included as Additional Insureds,but only as required by written contract. RE: Arden Courts of Lely Palms#449;6125 Rattlesnake Hammock Road;Naples,FL 34133 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East Naples FL 34112-4901 AUTHORIZED REPRESENTATIVE g ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACCAREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYYY) 3/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hylant Group Inc-Toledo mcO N.Ext):419-255-1020 FAX ovc.Nor.419-255-7557 811 Madison.Avenue E-MAIL Toledo OH 43604 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Union Fire Ins Co PA INSURED HCRMANO-04 INSURER B: HCR ManorCare, Inc. INSURER C and its subsidiaries P.O.Box 10086 INSURER D Toledo OH 43699-0086 INSURER E: _INSURER F: COVERAGES CERTIFICATE NUMBER:143140864 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR MD ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE - ' LTR INSR D POLICY NUMBER I(MMIDD/YYYYL(MMIDO/YYYY)- UMITS GENERAL UABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN1 AGGREGATE LIMIT APPUES PER: PRODUCTS-COMP/OP AGG $ 7 POLICY n PECOT- LOC $ AUTOMOBILE LIABILITY E gBI tlED SINGLE INGLE LIMI1 $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) - $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE _ $ EXCESSIJAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABILITY YIN TORY I NITS I ER ANY PROPRIErOR/PARTNER/EXECUT1VE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ A CRIME INSURANCE D1-424-93-63 10/1/2013 10/1/2014 $5,000,000 Limit (EMP.DISHONESTY) • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Arden Courts of Lely Palms#449;6125 Rattlesnake Hammock Road;Naples,FL 34113 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East Naples FL 34112-4901 AUTHORIZED REPRESENTATIVE hat @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y1Yl) -------- 3/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hylant Group Inc-Toledo PHONE f FAX 811 Madison Avenue (A/C.No.Exf):419-255-1020 LLAlc Nor.419-255-7557 Toledo oh 43604 ADDRE o SS: INSURER(S)AFFORDING COVERAGE NAIC k _ INSURER A Safety National Casualty Corp 15105 _ INSURED HCRMANO-04 INSURER B: HCR ManorCare, Inc. INSURER C: Heartland Employment Services LLC INSURER D: HCR Manor Care Services,LLC P.O.Box 10086 INSURER E: Toledo OH 43699-0086 INSURER F: COVERAGES CERTIFICATE NUMBER:2050989567 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR iADOL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,INSR WVD POLICY NUMBER JMMIDD/YY YY)..,JMMIDDIYYYY)- LIMITS GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ — GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY PRO- JECT LOC S AUTOMOBILE LIABILITY Ea acid t)SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ + UMBRELLA LIAB — OCCUR EACH OCCURRENCE _ $ EXCESS LAB CLAIMS-MADE AGGREGATE _ S DED RETENTION$ $- WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A _ (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT _$ • A XS SELF-INSURED SP4050028 1/1/2014 1/1/2015 EL-Per Occurrence $2,000,000 A WORK COMP SP4050027 1/1/2014 1/1/2015 Work Comp Statutory DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) SELF-INSURED RETENTION$1,000,000 PER OCCURRENCE. RE: Arden Courts of Lely Palms#449;6125 Rattlesnake Hammock Road; Naples,FL 34113 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East Naples FL 34112-4901 AUTHORIZED REPRESENTATIVE rt ..l ill n-:` I Q ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD A`°Rll CERTIFICATE OF LIABILITY INSURANCE DATE(NM/0D/YW1) 1 3/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hylant Group Inc-Toledo /A/C PHONE FAX Ext):419-255-1020 um.No):419-255-7557 811 Madison Ave E-MAIL Toledo OH 43604 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Idrance CO of State of PA 19429 INSURED MANOR-1 INSURER B: HCR ManorCare,Inc. INSURER C: and its subsidiaries P.O.Box 10086 INSURER D Toledo OH 43699-0086 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1706864127 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER EXP LTR TYPE OF INSURANCE INSR WVD POUCY NUMBER JMM/DDY EFF Y/YYYL_RaM DD!YYYYYI UMITS GENERAL UABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 7 POUCY 12_8: LOC _ $ A AUTOMOBILE UABILITY CA6403769 5/1/2013 5/1/2014 COMBINED SINGLE LIMI A X CA6403770 6/1/2013. 3/1/2014 (Ea accident) g1,000;OD0 — ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED — AUTOS _AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NO -OWNED PROPERTY DAMAGE AUTN OS (Per accident) _ $ UMBRELLA UAB OCCUR EACH OCCURRENCE — $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ • $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY t IMITS I FR ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) EL.DISEASE-EA EMPLOYEE $ If yes.describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LIMIT $ A A HIRED CAR PHYSICAL CA6403769 3/1/2013 5/1/2014 $500 Ded.Comp. DAMAGE-$50,000 CA6403770 /1/2013 3/1/2014 $1,000 Ded.Coll. DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Hired Car Physical Damage applies to autos leased for a period not to exceed 30 days. Additional Insured/Loss Payee applies to all lessors. RE: Arden Courts of Lely Palms#449;6125 Rattlesnake Hammock Road;Naples,FL 34113 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN Collier County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East Naples FL 34112-4901 AUTHORIZED REPRESENTATIVE igazihft ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD