Backup Documents 01/26/2016 Item #16D 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO o 9
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATLJk
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 be 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. Michelle Rubbo CHS JP 1/11/16
2. Jennifer A. Belpedio County Attorney Office "A %`Q5 t (p
3. BCC Office Board of County DF b‘•-•\
Commissioners Nirt4,/5/ '\-r\ L
4. Minutes and Records Clerk of Court's Office
nNO \ In I tp II.24cuti,
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 Phone Number
Contact/ Department Jody Paley 252-2903
Please cal for pick up
Agenda Date Item was January 26,2016 Agenda Item Number 16D9
Approved by the BCC
Type of Document Fourth Amendment to Agreement between Number of Original 3 Amendment
Attached Community Assisted and Supportive Documents Attached documents
Living,Inc.(CASL)
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 STAMPED SIGNATURE IS ok No
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be Yes/JSP
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
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/JSP
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/JSP
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip Yes/JSP
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 1/26/2016 and all changes made Yes/JSP
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable. "°'
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for th=
Chairman's signature.
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 9
MEMORANDUM
Date: January 29, 2015
To: Jody Paley, Grant Coordinator
Community & Human Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Fourth Amendment to Sub-recipient Agreement between Collier
County and Community Assisted & Supportive Living, Inc.
Grant #M-03-UC-12-0217, Grant #M-04-UC-12-0217, Grant #M-05-
UC-12-0217, Grant #M-06-UC-12-0217, Grant #M-07-UC-12-0217,
Grant #M-08-UC-12-0217
Attached are one (1) original amendment to the agreement referenced above, (Item
#16D5) approved by the Board of County Commissioners on Tuesday, January 26,
2016.
An original has been kept by the Minutes and Records Department for the
Official Records of the Board.
If you have any questions, please feel free to contact me at 252-8411.
Thank you.
Attachment
160 9
County Of Collier
CLERK OF THE CIRCUIF COURT
COLLIER COUNTY CQ.URTHO\SE
a,.
3315 TAMIAMI TRL E STE 102 Dwight E. Brock- Clerkipf Circuit Court
P.O. BOX 413044
NAPLES,FL 34112-5324 NAPLES,FL 34101-3044
Clerk of Courts • Comptroller • Auditor • Custodian of County Funds
January 29, 2016
Renaissance Manor
Attn: Scott Eller
1693 Main Street
Suite A
Sarasota, Florida 34236
Re: Fourth Amendment to Agreement between Collier County and
Community Assisted and Supportive Living, Inc.
Transmitted herewith is one (1) original agreement 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, January 26,
2016, during Regular Session.
Very truly yours,
DWIGHT E. BROCK, CLERK
Martha Vergara, Deputy ler
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email-CollierClerk@collierclerk.com
1 6 0 9
Grant#- M-03-UC-12-0217
Grant#- M-04-UC-12-0217
Grant#- M-05-UC-12-0217
Grant#- M-06-UC-12-0217
Grant#- M-07-UC-12-0217
Grant#- M-08-UC-12-0217
CFDA/CSFA#- 14.239
Subrecipient—CASL
DUNS#-940621519
IDIS#454
FETI#-65-0869993
FY End 12/31
Monitoring Deadline 9-30-2018
FOURTH AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
COMMUNITY ASSISTED AND SUPPORTIVE LIVING, INC.
(CASL)
AAA
This Amendment is entered into this
*Le day of AL,^K 2016, by and between
"RENAISSANCE Manor, Inc. d/b/a Community Assisted and Supp ve Living " (CASL) a private not-
for-profit corporation existing under the laws of the State of Florida, herein after referred to as
SUBRECIPIENT and Collier County, Florida, herein after to be referred to as "COUNTY," collectively stated
as the "Parties."
RECITALS
WHEREAS, on October 8, 2013, the COUNTY entered into an Agreement with CASL allowing
HOME Investment Partnerships (HOME) Program funds to be used for a Multi Family Property Acquisition
Project(hereinafter referred to as the"Agreement"); which has been subsequently amended multiple times.
WHEREAS, the Parties desire to amend the Agreement to clarify beneficiary language from "Persons
with Disabilities" to "Persons with Special Needs" for reporting purposes and to remain consistent with the
Consolidated Plan and throughout the agreement.
NOW, THEREFORE, in consideration of foregoing Recitals, and other good and valuable
consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree to
amend the Agreement as follows:
Words Sok Through are deleted; Words Underlined are added
I. SCOPE OF SERVICES
* *
Project Component One: Fund building acquisition and environmental review of Multi Family Rental
Multi Family Property Acquisition
CASL(HM13-02)Amendment#4
( C ?
16D 9
Housing; the project will target eight (8) low and very low income alt-persons with special needs. The
project will consist of four (4) units with rents at the 2414 High HOME Rent Limits for Collier County.
($1,038).
The following table details the program deliverables and schedule
*** *** ***
HOME Match Documentation of rehabilitation As they occur
Requirement expenditures and supportive services paid
for from non-federal sources or any other
associated acquisition costs.
Income eligibility Client files Maintained by
SUBRECIPIENT and
eligibility documentation
submitted 60 days prior
to tenant occupancy
Eight (8)persons with Exhibit D Quarterly
special needs will benefit
from this funding and will
be low- and very low
moderate income (LMI)
presumed clientele
Progress Report Exhibit D Quarterly within 30 days
following the end of the
quarter
Insurance Certificate N/A Annually within 30 days
of expiration
Affirmative Action/ Plan Documents Within 30 days of
Marketing Plan contract execution and/or
as modified
HQS Inspections Inspection Forms Annually
Tenant Leases Signed Leases 30 days prior to
occupancy
Tenant Participation Plan Plan Document 60 days prior to leasing
and annually thereafter
Annual Audit Audit Report with Management Letter and 180 days after end of
Exhibit E fiscal year
* * *
IV. NOTICES
Multi Family Property Acquisition
CASL(HM13-02)Amendment#4
)
1609
COLLIER COUNTY
ATTENTION: Priscilla DoriaJody Paley, Grants Coordinator
3339 E Tamiami Trail, Suite 211
Naples, Florida 34112
mailto:' ' - : `: '-^-- - =tJodyPaleyncolliergov.net
Phone: 239 252 5312 239-252-2903
Signature page to follow
Multi Family Property Acquisition
CASL(HM13-02)Amendment#4
160 9
IN WITNESS WHEREOF, the Parties have each,respectively,by an authorized person or agent,
hereunder set their hands and seals on the date first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS OF COLLIER
DWIGHT E. BROOK,CLERK COUNTY, FLO', i•
i ,
ilk s Jiit .�,�.i __ BY:
I , Depqty w er � DONNA F. ALA , Chairman
f
Dated\,, �`� . • q` L(\1(
Attest as to Chain
signature only.
RENAISSANCE Manor, Inc. d/b/a Community Assisted
Supported Living, Inc. (CASL).
By: # 4
Subrecipient Signature
J. Scott Eller, CEO
Subrecipient Name and Title
Approved as to form and legality:
Jenni er A. Belpedio ‘\S
Assistant County Attorney \�`4
." )'
Multi Family Property Acquisition
CASL(HMI3-02)Amendment#4