Backup Documents 03/25/2014 Item #16D8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO i � r r
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s)(List in routing order) Office Initials Date
1. Lisa Carr HHVS It 3/21/14
2. Jennifer B. Belpedio, ACA Office located in HHVS p� 3'2� I
County Attorney Office Department c-W'� 1
3. BCC Office Board of County
Commissioners ;
MEMORANDUM 16D 8
Date: March 28, 2014
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Community Care for the Elderly Program
Amendment 007— CCE 203.12.007
Attached are two (3) originals of the document referenced above, (Agenda Item
#16D8) approved by the Board of County Commissioners on Tuesday, March 25,
2014.
Please forward for additional signatures and return a fully executed original
back to the Minutes and Records Department to be kept in the Board's
Official Records.
If you have any questions please call me at 252-8411.
Thank you
Attachment
Amendment 007 CCE 203.12.007
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
dba SENIOR CHOICES OF SOUTHWEST FLORIDA 1 6 D
COMMUNITY CARE FOR THE ELDERLY PROGRAM �}J�
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices
of Southwest Florida ("Agency") and Collier County Board of County Commissioners, ('`Recipient'), amends agreement
CCE 203.12.
The purpose of this amendment is to move $6,000.00 Collier County allocations from Case Management and Case Aide
to Spending Authority affecting Year Two, 2013-2014, and revise ATTACHMENT VIII,Budget Summary.
This amendment shall be effective on February 13, 2014. All provisions in the agreement and any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY C MMISSI NERS FLORIDA, INC. DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY: SIGNED BY:
NAME: "tom Henning NAME: RONALD LUCCHINO, PhD
TITLE: Chairman TITLE: BOARD PRESIDENT
DATE: March 25, 2014
DATE:_
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
TT7ST: - Approved as to form and legality
T E. 901 ft, clerk
__ —_--�-. •e�. �. . Assistant Co Attorney
Attfsf fO nh 1 x111'`,.
7Nt 114
1
Amendment 007 1 6 D 8 CCE 203.12.007
ATTACHMENT VIII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
for
Collier County Board of Commissioners
Collier County
2013-2014
1. CCE Spending Authority $629,681.00
2. Case Management and 99,000.00
Case Aide
Total $728,681.00
2
1608
Attestation Statement
Agreement/Contract Number: CCE 203.12
Amendment Number 007
1, Tom Henning ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
•
• I iI I i Iun• '•II •
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data proc sing media which has no affect on the agreement/contract content.
ter,,
3/25/2014
Signature of Recipient/Contractor representative Date
'` Approved as to form and legality
Divvw T E: fO' , Clerk
`mm Assistant County orney
Attest as to Chairman's
�c,jn�ti�re only 3 y
•
0
Amendment 007 CCE 203.12.007
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
COMMUNITY CARE FOR THE ELDERLY PROGRAM 1 (�L D 8
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices
of Southwest Florida ("Agency") and Collier County Board of County Commissioners, ("Recipient"), amends agreement
CCE 203.12.
The purpose of this amendment is to move $6,000.00 Collier County allocations from Case Management and Case Aide
to Spending Authority affecting Year Two, 2013-2014, and revise ATTACHMENT VIII,Budget Summary.
This amendment shall be effective on February 13, 2014. All provisions in the agreement and any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
• COUNTY C MMISSI NERS FLORIDA,INC. DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY: SIGNED BY:
NAME: Tom Henning NAME: RONALD LUCCHINO, PhD
TITLE: Chairman TITLE: BOARD PRESIDENT
DATE: March 25, 2014 W)I1
'DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
ATTEST Approved as to form and legality
DiNt. T E BR'' " K, Clerk
0
.. .Lid Assistant Co Attorney
Attest as to C ha rrm 11's 31 11`$
1
Amendment 007 CCE 203.12.007
ATTACHMENT VIII
1608
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
for
Collier County Board of Commissioners
Collier County
2013-2014
1. CCE Spending Authority $629,681.00
2. Case Management and 99 000.00
Case Aide '
Total $728,681.00
2
GP
16138
Attestation Statement
Agreement/Contract Number: CCE 203.12
Amendment Number 007
1, Tom Henning ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data proc sing media which has no affect on the agreement/contract content.
.4
r3/25/2014
Signature of Recipient/Contractor representative Date
p r.
et TTEST.c Approved as to form and legality
y DWI o- i VA3R0 , Clerk
Assistant County orney
Attest as to Chairman's
3 ( yl14-t.
-*naive only.
0