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Backup Documents 04/08/2014 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO iv 6 0 5 1 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA +��+ Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must he received in the County Attorney Office no later than Monday preceding the Board meeting. **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 ��� County Attorney Office Department 3. BCC Office Board of County ZVl Commissioners \ x 5/ 4,V0 4. Minutes and Records Clerk of Court's Office PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Lisa Carr Phone Number 252-2339 Contact/ Department — --� Agenda Date Item w 4/8/14 Agenda Item Number 16D5 }Set- Approved by the B `� Type of Document Bement Number of Original 3 copies Attached Documents Attached PO number or account number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature? YES ✓ 2. Does the document need to be sent to another agency for additional signatures? If yes, pl,g provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. UU 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman,with the exception of most letters,must be reviewed and signed YES V by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's yces_ 14-0 Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the YES ✓ document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's YES ✓ signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip R should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 4/8/14(enter date)and all changes (), N/A is not made during the meeting have been incorporated in the attached document. The an option for Count Attorne 's Office has reviewed the chan l es,if a s s licable. this line. 9. Initials of attorney verifying that the attached document is the version approved by the /A is not BCC,all changes directed by the BCC have been made,and the document is ready for th an option for Chairman's signature. rs i this line. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 160 5 Please forward Agenda Item 16D5 from 04.08.14 BCC meeting to following for signature: Kathy Gronberg, Fiscal Specialist III Senior Choices of Southwest Florida, Inc. 15201 N Cleveland Ave Ste 1100 North Fort Myers, FL 33903 2e1n. 239-652-6900 2 t. 251 160 5 NeetVirginia From: BelpedioJennifer Sent: Thursday, April 10, 2014 3:48 PM To: NeetVirginia Subject: FW: CCE Amendment Dinny, See below Should we route item with this e-mail? J A. fie L e, i,o- Assistant County Attorney Collier County, Florida Direct Dial: (239) 252-5709 From: CarrLisa Sent: Thursday, April 10, 2014 3:47 PM To: BelpedioJennifer Cc: SonntagKristi Subject: RE: CCE Amendment Jen, I contacted Kathy Gronberg at Senior Choices who said you can send the amendment as it is and she will add another signature line for the SC Board President's signature. Thanks Lisa N. Carr RSVP Project Director and Social Services Grants Coordinator Collier County Housing, Human and Veteran Services 3339 E. Tamiami Trail, Bldg. H, Room 211 Naples, FL 34112 239-252-2339 239-252-6517 (fax) Iisacarra,colliergov.net CO ICY CO' HWY ! tF Oft i NAT ION AI,Olia C.OM EoiNITV . `.� SERVICED= Rsa 1 r____ \ 1 60 5 ynty of Collier CLERK OF THE CIRCUIT COURT COLLIER COUNTY C6URTH JSE Dwight E. Brock Clerk of Courts 3315 TAMIAMI TRAIfLiGAST STt 102 Clerk of Courts Accountant P.O. BOX 41044 a Auditor NAPLES, FLORIDA 34191-3044 Custodian of County Funds -x April 14, 2014 Senior Choices of Southwest Florida, Inc. Attn: Kathy Gronberg, Fiscal Specialist III 15201 N Cleveland Ave. Suite 1100 North Fort Myers, Florida 33903 Re: Home Care for the Elderly Program — HCE 203.12.008 Transmitted herewith are (3) three originals of the above referenced document for your records per request, as adopted by the Collier County Board of County Commissioners of Collier County, Florida on Tuesday, April 8, 2014, during Regular Session. Please return (2) two fully executed documents to Board's Minutes and Records, 3299 Tamiami Trail E., Suite 401, Naples, FL 34112. Once returned to our office we will forward them to the appropriate department. Very truly yours, DWIGHT E. BROCK, CLERK -n(c\t(ju j..... .cc j Martha Vergara, Deputy er Enclosure Phone- (239) 252-2646 Fax- (239) 252-2755 Website-www.collierclerk.com Email -collierclerkPcollierclerk.com 1 Amendment 008 July 2012-June 2014 HC 20 .12.0 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. dba SENIOR CHOICES OF SOUTHWEST FLORIDA HOME CARE FOR THE ELDERLY PROGRAM COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of Southwest Florida, hereinafter referred to as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Recipient,"amends contract HCE 203.12 July 2012-June 2014. The purpose of this amendment is to transfer $1,268 from Case Management and $424 from Basics to Special Subsidies for year two, 2013-2014, or the rate schedule, subject to the availability of funds; and revise ATTACHMENT VIII. This amendment shall be effective 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,two pages, is hereby made a part of this agreement. IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their officials there unto duly authorized. Collier County Board of County Area Agency on Aging for Southwest Contractor: Comm' sinners Florida, Inc., dba Senior Choices of / Southwest Florida SIGNED SIGNED B : AIL BY: — i1/4)Le. 4F I NAME: Tom Henning NAME: Ronald Lucchino, PhD TITLE: Chairman TITLE: Board President DATE: April 8, 2014 DATE: /-)-/ Federal Tax ID: 59-6000588 / Fiscal Year Ending.Dats: 0900 Approved as to form and legality\\CA .AR_O4sne 'r Assistant County Attest as to Chairman's ci nnature'only '- _ 1 Amendment 008 July 2012—June 2014 HCE 203.12.008 160 5 ATTACHMENT VIII HOME CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY Collier County Board of Commissioners HCE Case Management $ 9,000.00 HCE Basic Subsidies 14— 18 HCE Clients 16,218.00 HCE Special Subsidies 10,657.00 Total $35,875.00 HOME CARE FOR THE ELDERLY PROGRAM RATE SUMMARY Collier County SERVICES REIMBURSEMENT RATE Payments to the Lead Agency Collier Case Management(CMV) $55.56 Case Aide(CAV) $30.00 Homemaker(HMKV) $21.11 Personal Care(PECV) $24.44 Respite (RESV) $24.44 Specialized Medical Equipment, Services and Supplies (SCSV) Total Cost Background Screening(OTHBKV) Total Cost Payments to the Caregiver Respite(RESP) Total Cost Specialized Medical Equipment, Services and Supplies(SCSM) Total Cost Transportation(TRS) Total Cost 2 6� 1605 A Attestation Statement Agreement/Contract Number: HCE 203.12 Amendment Number 008 I, 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 processing media,which has no affect on the agreement/contract content. J r 4/8/2014 Sign ture Recipient/Contractor ret •sentative Date Approved as to form and legality 3116 tic::, divic -- s Isistant Cou Attorney Attestas;to Chairman's signature only.