Agenda 05/10/2016 Item #16D 6It
5/10/201616.D.6.
EXECUTIVE SUMMARY
Recommendation to approve an "after -the -fact" amendment, attestation statement and budget
amendment for the Older Americans Act Program Title III from Area Agency on Aging for
Southwest Florida, Inc. to reflect the final FY15 grant funding amount. (Net Fiscal Impact is a
reduction in award and match totaling $24,517.67).
OBJECTIVE: To continue provision of meals and other support services to qualified Collier County
Seniors.
CONSIDERATIONS: Collier County Services for Seniors (CCSS) managed by the Community and
Human Services Division has provided support services to Collier County's qualified senior citizens for
over 30 years through Older Americans Act programs (OAA). Funding is provided through the Florida
Department of Elder Affairs, and administered by Area Agency on Aging for Southwest Florida, Inc
(AAA). The contract period for OAA programs is January 1, 2015 through December 31, 2015. The
contract period was extended by a Board approved amendment until a new 2016 OAA 202.16 contract is
executed. The original award and budget amendments were approved by the Board on February 24, 2015
(Agenda item 16D4).
The OAA amendment is the final allocation for FY 2015. The amendment decreases the grant awards for
C1 Congregate Meals, C2 Home Delivered Meals and increases III -E Services, administered directly by
CCSS. Finally, the amendment increases OAA 3B in home support services, retained by AAA. The
effective date of the amendment is December 31, 2015.
* This budget is retained and directly administered by AAA and does not directly impact the County
budget.
* * 10% Match amount is Award divided by .9, multiplied by .1, per Federal and State calculation
requirements, rounded up to the nearest dollar.
This item is being presented after -the -fact because Collier County received the grant agreement on March
23, 2016 from the Agency with a request for a 30 -day turnaround timeframe. The Agency routinely sends
CCSS amendments with an effective date prior to the date the document is received which requires
prompt attention. This time frame makes it in impossible to meet agenda submittal deadlines to process
the documents for Board consideration. Pursuant to CMA 5330 and Resolution No. 2010-122, the County
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Match Fund
Project
Current Award
Revised
Increase/
Increase/
Program
Number
Budget
Budget
Decrease
(Decrease)**
Title III -B Support
Services
33401
$54,574.00
$54,868.56
$294.56
$33.00
Title C 1
Congregate Meals
33403
$290,097.00
$284,745.16
$5,351.84
$596.00
Title C2 Home
Delivered Meals
33404
$250,835.03
$231,884.26
$18,950.77
$2,107.00
Title III -E
Services
33405
$130,364.92
$132,309.30
$1,944.38
$216.00
Total
$725,870.95
$703,807.28
$22,063.67
$2,454.00
Title II113 retained
by grantor
agency*
NA
$326,722.00
1 $296,089.30
*
NA
* This budget is retained and directly administered by AAA and does not directly impact the County
budget.
* * 10% Match amount is Award divided by .9, multiplied by .1, per Federal and State calculation
requirements, rounded up to the nearest dollar.
This item is being presented after -the -fact because Collier County received the grant agreement on March
23, 2016 from the Agency with a request for a 30 -day turnaround timeframe. The Agency routinely sends
CCSS amendments with an effective date prior to the date the document is received which requires
prompt attention. This time frame makes it in impossible to meet agenda submittal deadlines to process
the documents for Board consideration. Pursuant to CMA 5330 and Resolution No. 2010-122, the County
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5/10/2016 16.D.6.
Manager authorized Steve Carnell, Public Services Department Head, to sign the agreement. This
amendment is being presented for Board ratification. Collier County, as the Lead Agency, is responsible
to respond to seniors' needs and to manage the spending authority for the OAA program services.
FISCAL IWACT: A budget amendment is required for Program Year 2015 projects 33401, 33403,
33404, and 33405 to recognize overall final grant reduction of the OAA Grant in the amount of
($22,063.67) and a 10% local match requirement reduction of ($2,454.00). These funds resided in
Human Services Grant Fund 707.
GROWTH MANAGEMENT: There are no growth management impacts from this recommendation.
LEGAL CONSIDERATIONS: This is a standard form amendment provided by the Area Agency on
Aging for southwest Florida, Inc. This item has been approved for form and legality and requires a
majority vote for Board approval. - JAB
RECOMMENDATIONS: That the Board of County Commissioners approves an "after -the -fact"
amendment and attestation statement with Area Agency on Aging for Southwest Florida, Inc. and
authorizes the corresponding budget amendment.
Prepared by: Lisa N. Carr, Grants Coordinator, Community and Human Services
Attachments:
1) OAA 203.15.005 Amendment
2) OAA 203.15.004 Executed
3) OAA 203.15.003 Executed
4) OAA 203.15.002 Executed
5) OAA 203.15.001 Executed
6) OAA 203.15 Contract - Ex
/0'1
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5/10/2016 16.D.6.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.D.16.D.6.
Item Summary: Recommendation to approve an "after -the -fact" amendment, attestation
statement and budget amendment for the Older Americans Act Program Title III from Area
Agency on Aging for Southwest Florida, Inc. to reflect the final FY15 grant funding amount. (Net
Fiscal Impact is a reduction in award and match totaling $24,517.67).
Meeting Date: 5/10/2016
Prepared By
Name: CarrLisa
Title: Grants Coordinator, Community & Human Services
4/19/2016 2:25:39 PM
Submitted by
Title: Grants Coordinator, Community & Human Services
Name: CarrLisa
4/19/2016 2:25:40 PM
Approved By
Name: CarrilloDora
Title: Accountant, Community & Human Services
Date: 4/19/2016 3:42:02 PM
Name: CarrilloDora
Title: Accountant, Community & Human Services
Date: 4/19/2016 3:42:53 PM
Name: GrantKimberley
Title: Division Director - Cmnty & Human Svc, Community & Human Services
Date: 4/20/2016 9:18:15 PM
Name: TownsendAmanda
Title: Division Director - Operations Support, Public Services Department
Date: 4/21/2016 3:55:15 PM
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5/10/2016 16.D.6.
Name: AlonsoHailey
Title: Operations Analyst, Public Services Department
Date: 4/25/2016 9:23:03 AM
Name: LopezMaggie
Title: Supervisor - Accounting, Community & Human Services
Date: 4/25/2016 12:20:13 PM
Name: RobinsonErica
Title: Accountant, Senior, Grants Management Office
Date: 4/25/2016 12:42:54 PM
Name: BelpedioJennifer
Title: Assistant County Attorney, CAO General Services
Date: 4/26/2016 2:51:42 PM
Name: CarnellSteve
Title: Department Head - Public Services, Public Services Department
Date: 4/26/2016 3:10:21 PM
Name: BelpedioJennifer
Title: Assistant County Attorney, CAO General Services
Date: 4/26/2016 3:53:53 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 4/28/2016 10:42:04 AM
Name: StanleyTherese
Title: Manager - Grants Compliance, Grants Management Office
Date: 4/29/2016 10:30:45 AM
Name: CasalanguidaNick
Title: Deputy County Manager, County Managers Office
Date: 5/2/2016 11:04:15 AM
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5/10/2016 16.D.6.
Amendment 005 OAA 203.15.005
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
OLDER AMERICANS ACT PROGRAM TITLE III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS,
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency)
and Collier County Board of County Commissioners (Contractor) and amends contract OAA 203.15.
The purpose of this amendment is to amend 4. Contract Amount with the final allocation for the 2014-2015 contract year,
and revise ATTACHMENT III and ATTACHMENT VII.
4. Contract Amount:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $703,807.28 ($296,089.30 In -Home Services), subject to the availability of funds. Any costs or
services paid for under any other contract or from any other source are not eligible for payment under this contract.
This amendment shall be effective on December 31, 2015. 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 3 page amendment to be executed by their officials there unto
duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS, FLORIDA, INC.
SIGNED BY: SIGNED BY:
NAME: STEPHEN Y. CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE:. PRESIDENT/CEO
DATE: April 12, 2016 DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30 Approved as to form and legality
PP 8 tY
Assistant County Attorney \�
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Amendment 005
5/10/2016 16.D.6.
OAA 203.15.005
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Older Americans Act Title IIIB —
$ 24,750.00
CA/CM/SCAS
Transportation
U.S. Health and Human Services
93.044
$ 30,118.56
Support Services
$ 54,868.56
Total IIIB
$ 296,089.30*
OAA Title IIIC1 —Congregate Meals
$ 284,745.16
Meals
Screening
Nutrition Counseling
U.S. Health and Human Services
93.045
Nutrition Education
Outreach
Total IIICI
$ 284,745.16
OAA Title III C2 — Home Delivered
$ 231,884.26
Meals
Meals
Nutrition Education
U.S. Health and Human Services
93.045
Screening
TotalIIIC2
$ 231,884.26
Older Americans Act Title III E
CA/CM & Services (Title III E)
93.052
$ 94,116.98
Supplement Services (Title III ES)
U.S. Health and Human Services
$ 18,594.07
Grandparent Services (Title III EG)
$ 19,598.25
Total IIIE
$ 132,309.30
TOTAL FEDERAL AWARD
$ 703,807.28
*In Home Services $296,089.30
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
Aging for Southwest Florida, Inc.
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A-122 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-110 — Administrative Requirements)
OMB Circular A-133 — Audit Requirements
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 691-5, Fla. Admin. Code
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Amendment 005
5/10/2016 16.D.6.
OAA 203.15.005
ATTACHMENT VII
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
OLDER AMERICANS ACT BUDGET SUMMARY
COLLIER COUNTY
1. Title III B Support Services $ 54,868.56*
2. Title III C 1 Congregate Meals $ 284,745.16
3. Title III C2 Home Delivered Meals $ 231,884.26
4. Title III E Services $ 132,309.30
TOTAL $ 703,807.28
*In Home Services $296,089.30
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
Aging for Southwest Florida, Inc.
3
C90
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5/10/2016 16.D.6.
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.15
Amendment Number .005
1. Stenhen V. Carnell , 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 and
_Public Services Department Head
(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.
Signature U RecipieVIContractor representative
Revised August 2007
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)ril 12, 201
Date
Approved as to form and legality
Assistant County Attorney
Amendment 04
0
OAA 203.15_ _5/10/2016 16.D.6.
I�_V�to
AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
OLDER AMERICANS ACT PROGRAM TITLE III
COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency)
and Collier County Board cf County Commissioners (Contractor) and amends contract OAA 202.15.
The purpose of this amendment is to (1) extend this contract for 60 days or until a new 2016 OAA 202.16 contract is
executed, whichever comes first and (2) to add 4.1 Rates, add OA313 rates, and revise ATTACHMENT VII Budget and
Rate Summary.
4.1 Rates:
The Agency agrees to pay the new rates listed under OA3B effective the January 1, 2016 when the Contractor
assumes responsibility for the OA313 allocation of paying the OA313 Vendors.
This amendment shall be effe4tive on January 1, 2016
RECITALS:
WHEREAS, on Janu 21, 2015, the parties entered into the Standard Contract for social services to be
provided to Collier County' frail and elderly seniors (hereinafter referred to as "Contract"); and
WHEREAS, on June 111, 2015, the parties entered into a First Amendment to the Contract; and
WHEREAS, on Octoper 5, 2015, the parties entered into a Second Amendment to the Contract; and
WHEREAS, on November 24, 2015, the Agency has processed a Third Amendment to the Contract, which
has not been executed; and
WHEREAS, Section � of the Contract provides that the agreement is to expire on December 31, 2015; and
WHEREAS, the fl
Agency from the Florida
WHEREAS, the Par
both parties wish to extend
contract.
NOW, THEREFORE, in
receipt and sufficiency of
1. The foregoing
2. Both parties
3. All other provisi<
in the agreement.
source for a successor agreement for senior services is not yet available to the
:ment of Elder Affairs;
are satisfied with the arrangement that they currently enjoy under the Contract so that
Contract to February 29, 2016 while they await notification of funding of a successor
ideration of the foregoing Recitals, and other good and valuable consideration, the
i is hereby mutually acknowledged, the Parties agree as follows:
are true and correct and are incorporated by reference herein.
to extend the contract to February 29, 2016.
of the Contract are to remain in effect and are to be performed at the level specified
SIGNATURE PAGE TO FOLLOW
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5/10/2016 16. D.6.
Amendment 04 • OAA 202.15.004
4 .
IN WITNESS WHEREOF, tht parties hereto have caused this 3 page amendment to be executed by their officials there unto
duly authorized.
Contractor: COLLIER C LINTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY CONIMSSIONERS FLORIDA, INC.
SIGNED BY: SIGNED BY: 0&0-0 / ,U pC,url, t
NAME: STEVEN Y. CARNE L NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD. TITLE: PRESIDENT/CEO
DATE: December 4, 2015 DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/3
Approved as to form and legality
Assistant CountyA ,3`��
2
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Amendment 04
0
OLDER AMERICANS ACT RATE SUMMARY
COLLIER COUNTY
I1I13
5/10/2016 16.D.6.
OAA ZUZ.15.004
ATTACHMENT VII
Budget and Rate Summary
Tntal rnet Raimhnreomnn* ID.+.
Adult Day Care
12.83
r11.55v
Case Aide
33.89
30.50
Case Management
55.00
49.50
Chore
20.00
18.00
Chore (Enhanced)
26.00
23.40
Companionship
23.33
21.00
Emergency Alert Response
1.31
1.18
Escort
21.66
19.50
Homemaker
21.50
19.35
Housing Im rovem
nt
100% Cost
90% of Cost
Material Aid
100% Cost
90% of Cost
Personal Care
25.67
23.10
Respite In -Facility
12.83
11.55
Respite In -Home
25.67
23.10
Screening and Assessment
55.00
49.50
Shopping Assistance
21.00
18.90
Skilled Nursing Se
ices
42.00
37.80
Specialized Medical
E ui ment, Services, and Supplies
100% Cost
90% of Cost
Transportation
100% Cost
90% of Cost
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5/10/2016 16.D.6.
Revised August 2007
Attestation Statement
Agreement/ContracNumber OAA 203.15
Amendment Numbe 004
1 , attest that no changes or revisions have been made to the
(Recipient/Coin tractor representative)
content of the above eferenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida a id
Public Services Department Head
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data proce sing media, which has no affect on the agreement/contract content.
'�ly'i (/t ILS f 12/4/15
Signature of Recipie4t/Contractor representative Date
Revised August 2007
Approved as to form and legality
Assistant Co Attorney
909 �s
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11:11, -ki t 6 r L. t1 c
Amendment 03 5/10/2016 16.D.6.
VHA LU3.t_5.UUi
AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
OLDER AMERICANS ACT PROGRAM TITLE III
COUNTY BOARD OF COUNTY COMMISSIONERS,
THIS AMENDMENT isi entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency)
and Collier County Board Iof County Commissioners (Contractor) and amends contract OAA 203.15.
The purpose of this amei
Amount and revise ATT
4. Contract Amount:
The Agency agrees to
amount not to exceed S
services paid for under
This amendment shall be e;
conflict with this amendm
All provisions not in
the agreement.
,-This amendment and all of:
IN WITNESS WHEREOF,
duly authorized.
Contractor: COLLIER
COUNTY
SIGNED BY:
NAME: STEVEN P.
TITLE: PUBLIC SERVICES
DATE: December 4, 2015
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/3,
is to increase Collier County OA3EG allocations by $6,300, revise Paragraph 4. Contract
ENT III and ATTACHMENT VII Budget and Rate Summary.
r for contracted services according to the terms and conditions of this contract in an
5,870.95 ($326,722.00 In -Home Services), subject to the availability of funds. Any costs or
y other contract or from any other source are not eligible for payment under this contract.
Jve on November 1, 2015. All provisions in the agreement and any attachments thereto in
shall be and are hereby changed to conform with this amendment.
with this amendment are still in effect and are to be performed at the level specified in
attachments are hereby made a part of this agreement.
parties hereto have caused this 3 page amendment to be executed by their officials there unto
BOARD OF
ARTMENT HEAD
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC.
NAME: MARIANNE G LORINI
TITLE: PRESIDENT/CEO
DATE: 3 al/ ///S
Approved as to form and legality
Assistant County Attorney
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Amendment 03
1. FEDERAL RESOUI
CONSIST OF THE ]
i 5/10/2016 16.D.6.
GAA ZW.15=3
ATTACHMENT III
AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
OWING:
COLLIER COUNTY
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Older Americans Act Title
HIB —
CA/CM/SCAS
$ 23,574.00
Transportation
U.S. Health and Human Services
93.044
$ 31,000.00
Support Services
$ 54,574.00
Total HIB
$ 326,722.00*
OAA Title IHC 1— Congregate
Meals
$ 290,097.00
Meals
Screening
Nutrition Counseling
U.S. Health and Human Services
93.045
Nutrition Education
Outreach
Total HIC1
$ 290,097.00
OAA Title III C2 — Home
Delivered
Meals
$ 250,835.03
Meals
Nutrition Education
U.S. Health and Human Services
93.045
Screening
TotalIHC2
$ 250,835.03
Older Americans Act Tit
a IH E
CA/CM & Services (Title
1I E)
$ 92,608.00
Supplement Services (Titl
III ES)
U.S. Health and Human Services
93052
.
$ 17,761.00
Grandparent Services (Titl
III EG)
$ 19,995.92
Total HIE
$ 130,364.92
TOTAL FEDERAL AWA
$ 725,870.95
*In Home Services $326,
In Home Services are
Aging for Southwest ]
COMPLIANCE REQUIR]
TO THIS CONTRACT Al
FEDERAL FUNDS:
2 CFR Part 230 Cost Principles
2 CFR Part 215 Administrative
OMB Circular A-133 — Audit P
COMPLIANCE REQUI]
THIS CONTRACT ARE
STATE FINANCIAL ASSIST
Section 215.97, Fla. Stat.
Chapter 69I-5, Fla. Admin. Co
to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
i, Inc.
LENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
AS FOLLOWS:
Non -Profit Organizations (Formerly OMB Circular A-122 — Cost Principles)*
iuirements (Formerly OMB Circular A-110 — Administrative Requirements)
LENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
FOLLOWS:
2
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5/10/2016 16.D.6.
Amendment 03 OAA 203.15.003
ATTACHMENT VII
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
OLDER AMERICANS ACT BUDGET SUMMARY
COLLIER COUNTY
1. Title III B Support Services $ 54,574.00*
2. Title III CI Congregate Meals $ 290,097.00
3. Title III C2 Home Delivered Meals $ 250,835.03
4. Title III E Services $ 130,364.92
TOTAL $ 725,870.95
*In Home Services $326,72 .00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
Aging for Southwest Florida, Inc.
OLDER AMERICANS ACT RATE SUMMARY
COLLIER COUNTY
IIIB
Pl'V7(`PC '1'..x..1 /1....♦ n-_�L__�__�_�a T__
Adult Day Care
12.83
�11.55vL
Case Aide
33.89
30.50
Case Management
55.00
49.50
Chore
20.00
18.00
Chore (Enhanced)
26.00
23.40 .
Companionship
23.33
21.00
Emergency Alert Response
1.31
1.18
Escort
21.66
19.50
Homemaker
21.50
19.35
Housing Improvement
100% Cost
90% of Cost
Information
9.00
8.10
Intake
27.50
24.75
Material Aid
100% Cost
90% of Cost
Personal Care
25.67
23.10
Referral/Assistance
25.00
22.50
Respite In -Facility
12.83
11.55
Respite In -Home
25.67
23.10
Screening and Asses
ment
55.00
49.50
Shopping Assistance
21.00
18.90
Skilled Nursing Sery
ces
42.00
37.80
Specialized Medical
ui ment, Services, and Supplies
100% Cost
90% of Cost
Transport ion
1100%
Cost
90% of Cost
3
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Revised August 200 5/10/2016 16.D.6.
Attestation Statement
AgreemenvContract Number OAA 203.15
Amendment Numb r 003
1 , 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 and
(Kecipient/C ntractor 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.
L" It l d v 12/4/15
Signature* Recipie t/Contractor representative Date
Revised August 2007
APProved as to form and legality
-__ .
ssistant Coun ttomey
�v
1�
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5/10/2016 16.D.6.
Amendment 02 OAA 203.15.002 \b,
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
OLDER AMERICANS ACT PROGRAM TITLE III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS,
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency)
and Collier County Board of County Commissioners (Contractor) and amends contract OAA 203.15.
The purpose of this amendment is to increase Collier County allocations by $13,101.95, move $20,000 allocation from
OA3B to Cl, revise Paragraph 4. Contract Amount and add Paragraph 4.1 Rates, 6. Official Payee and Representatives
Contractor Name correction, add OA3B rates, and revise ATTACHMENT III and ATTACHMENT VII Budget and
Rate Summary.
4. Contract Amount:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $719,570.95 ($326,722.00 In -Home Services), subject to the availability of funds. Any costs or
services paid for under any other contract or from any other source are not eligible for payment under this contract.
4.1 Rates:
The Agency agrees to pay the new rates listed under OA3B effective November 1, 2015 or the 1St day of the billing
month when the Contractor assumes responsibility for the OA3B allocation.
, '. • .8a' • 1 • • 1FT Q1F1[M_W.LiCiJ TiLaIMM..'TiT��mm' mm.I
a.
The Contractor name, as shown on page 1 of this
contract, and mailing address of the official payee
to whom the payment shall be made is:
Collier County Board of County Commissioners
3339 E Tamiami Trail, Building H
Naples, FL 34112
Kimberley Grant, Director
b.
The name of the contact person and street address
Collier County Board of County Commissioners
c/o Community and Human Services
where financial and administrative records are
3339 E Tamiami Trail, Building H
maintained is:
Naples, FL 34112
Kimberley Grant, Director
The name, address, and telephone number of the
Collier County Board of County Commissioners
C.
representative of the Contractor responsible for
clo Community and Human Services
administration of the program under this contract
3339 E Tamiami Trail, Building H
is:
Naples, FL 34112
(239) 252-2273
This amendment shall be effective on September 1, 2015. 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.
1 d0
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Amer dment 02
5/10/2016 16.D.6.
OAA 203.15.0v/ -
IN WITNESS WHEREOF, the parties hereto have caused this 4 page amendment to be executed by their officials there unto
duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS, FLORIDA, INC.
SIGNED BY: v G SIGNED BY: 7�1
NAME: Stephen Y. Carrell NAME: MARIANNE G LORINI
TITLE: Public ServicesD
epartmentHead TITLE: PRESIDENT/CEO
DATE: � I ,� DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
Approved as to form and legality
Assistant County Attorney�\��
2
Packet Page -792-
Ea
Amendment 02 OAA 203.15.1 5/10/2016 16.D.6.
ATTACHMENT III
�•.1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Older Americans Act Title II113—
$ 23,574.00
C A/CM/SCAS
$ 31,000.00
Transportation
U.S. Health and Human Services
93.044
$ 54,574.00
Support Services
$ 326,722.00X
Total IM
OAA Title IIICI — Congregate Meals
$ 290,097.00
Meals
Screening
Nutrition Counseling
U.S. Health and Human Services
93.045
Nutrition Education
Outreach
TotalIIIC1
$ 290,097.00
OAA Title III C2 — Home Delivered
$ 250,835.03
Meals
Meals
U.S. Health and Human Services
93.045
Nutrition Education
Screening
$ 250,835.03
TotalIIIC2
Older Americans Act Title III E
CA/CM & Services (Title III E)
93.052
$ 92,608.00
Supplement Services (Title III ES)
U.S. Health and Human Services
$ 17,761.00
Grandparent Services (Title III EG)
$ 13,695.92
Total IHE
$ 124,064.92
TOTAL FEDERAL AWARD
$ 719,570.95
*In Home Services $326,722.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
Aging for Southwest Florida, Inc.
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A-122 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-110 — Administrative Requirements)
OMB Circular A-133 — Audit Requirements
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
,---..Section 215.97, Fla. Stat.
-hapter 69I-5, Fla. Admin. Code
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00vo
Amendment 02 OAA 203.15.( 5/10/2016 16.D.6.
ATTACHMENT VII
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
OLDER AMERICANS ACT BUDGET SUMMARY
COLLIER COUNTY
12.83
1. Title III B Support Services
$
54,574.00*
2. Title III Cl Congregate Meals
$
290,097.00
3. Title III C2 Home Delivered Meals
$
250,835.03
4. Title III E Services
$
124,064.92
TOTAL
$
719,570.95
*In Home Services $326,722.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
Aging for Southwest Florida, Inc.
OLDER AMERICANS ACT RATE SUMMARY
COLLIER COUNTY
IIIB
Services Total Cost Reimhursement Rate
Adult Day Care
12.83
11.55
Case Aide
33.89
30.50
Case Management
55.00
49.50
Chore
20.00
18.00
Chore (Enhanced)
26.00
23.40
Companionship
23.33
21.00
Emergency Alert Response
1.31
1.18
Escort
21.66
19.50
Homemaker
21.50
19.35
Housing Improvement
100% Cost
90% of Cost
Information
9.00
8.10
Intake
27.50
24.75
Material Aid
100% Cost
90% of Cost
Personal Care
25.67
23.10
Referral/Assistance
25.00
22.50
Respite In -Facility
12.83
11.55
Respite In -Home
25.67
23.10
Screening and Assessment
55.00
49.50
Shopping Assistance
21.00
18.90
Skilled Nursing Services
42.00
37.80
Specialized Medical E quipment, Services, and Supplies
100% Cost
90% of Cost
Transportation
100% Cost
90% of Cost
4 UdC
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5/10/2016 16.D.6.
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.15
Amendment Number 002
I, Stephen Y. Carnell , 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 and
Public Services Department Head
(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.
114;
ci-3)Signature of Recipien&tontractor representative Date
Revised August 2007
Packet Page -795-
Approved as to form and legality
Assistant County ty Attorne Y
Ct � a3 X15
Amendment 01 OAA 03.15.( 5/10/2016 16.D.6.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, I qC.
OLDER AMERICANS ACT PROGRAM TITLE III -�
COLLIER COUNTY BOARD OF COUNTY COMMISSIONEI LS
i
THIS AMENDMENT is entered into between the Area Agency on Aging for Southw st Florida, Inc., (Agency)
and Collier County Board of County Commissioners (Contractor) and amends contract PAA 203.15.
The purpose of this amendment is to increase Collier County allocations by $14,677, relse ATTACHMENT III and
ATTACHMENT VII Budget Summary and revise Paragraph 4. Contract Amount.
4. Contract Amount: i
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $686,469.00 ($346,722.00 In -Home Services), subject to the availlyment
lity of funds. Any costs
or services paid for under any other contract or from any other source are not eligible for under this contract.
This amendment shall be effective on May 26, 2015. All provisions in the agreement and ally
conflict with this amendment shall be and are hereby changed to conform with this amendrr.
All provisions not in conflict with this amendment are still in effect and are to be
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 3 page amendment to be
duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: SIGNED BY:
NAME: Stephen Y. Carrell NAME:
TITLE: Department Head — Public Services TITLE:
DATE:6 � -'o � ( DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
1
Packet Page -796-
thereto in
at the level specified in.
by their officials there unto
FOR SOUTHWEST
of OL�liC:
MARIANNE G LORINI
PRESIDENT/CEO
Approved as o form and legality
Assistant ountyAttorney \
Amendment 01 O' 5/10/2016 16.D.6.
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE
FUNDING SOURCE
C
FDA
AMOUNT
Older Americans Act Title IIIB —
CA/CM/SCAS
$ 23,574.00
Transportation
U.S. Health and Human Services
9
.044
$ 31,000.00
$ 54,574.00
Support Services
$ 346,722.00*
Total IIIB
OAA Title IIIC1 — Congregate Meals
$ 258,853.00
Meals
Screening
Nutrition Counseling
U.S. Health and Human Services
9
.045
Nutrition Education
Outreach
Total IIICI
$ 258,853.00
OAA Title III C2 — Home Delivered Meals
$ 250,832.00
Meals
1
Nutrition Education
U.S. Health and Human Services
9
.045
Screening
Total MC2
$ 250,832.00
Older Americans Act Title III E
CM & Services (Title III E)
9
$ 92,608.00
,pplement Services (Title III ES)
U.S. Health and Human Services
i
.052
$ 17,761.00
Grandparent Services (Title III EG)
$ 11,841.00
Total IRE
$ 122,210.00
TOTAL FEDERAL AWARD
$ 686,469.00
*In Home Services $346,722.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid dire4tly by the Area Agency on
Aging for Southwest Florida, Inc. I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCESAWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A-122 — Cost Pr Inciples)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-110 — Administrative Requi ments)
OMB Circular A-133 — Audit Requirements
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS: I
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 691-5, Fla. Admin. Code
Packet Page -797-
n
Amendment 01
A'
Budget and Rate
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY
1. Title III B Support Services $ 54,574.00*
2. Title III C1 Congregate Meals $ 258,853.00
3. Title III C2 Home Delivered Meals $ 250,832.00
4. Title III E Services $ 122,210.00
TOTAL $ 686,469.00
*In Home Services $346,722.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid
by the Area Agency on
Aging for Southwest Florida, Inc. dba Senior Choices of Southwest Florida
3
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\A
5/10/2016 16.D.6.
VF1I-1 GVJ.IJ.VV1
In
Revised August 2007
Attestation Statement
Agreement/Contract Number OSA 203.15
Amendment Number 001
5/10/2016 16.D.6.
I, ___Stephen Y. Carnell , attest that no changes or revisions h#e been made to the
(Recipient/Contractor representative) 3
content of the above referenced agreement/contract or amendment between the Area Ajncy on Aging for
Southwest Florida and
Department Head- Public Services
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to thedifferences in
electronic data processing media, which has no affect on the agreement/contract content.]
Signature of Rceipient/Contractor representative
Revised August 2007
G -10 -
Signature
10 -
Approved as to form and legality
Assistant County Attorney
OP, Is
COX
Packet Page -799-
5/10/2016 16.D.6.
January 2015 Contract #OAA GUs. l
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT
OLDER AMERICANS ACT TITLE III
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, hic. (Agency) and
Collier County Board of County Commissioners (Contractor), and collectively referred to as the "Parties." The term
Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS, the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the mutual
covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments, forms, exhibits and references incorporated, which constitute the contract document.
1.1 Agency Mission. Vision and Values Statement:
The agency's mission: To help aging adults achieve greater independence through awareness of resources and access
qualified service providers. The agency's vision: To be the recognized leader in supporting older adults and their
families with access to trustworthy resources and services in their communities while empowering them to live with
independence and dignity. The agency's values: We believe residents of Southwest Florida are entitled to:
Comprehensive information about their choices of care; Timely access to resources and services; High standards of
quality and performance; and Personal and professional accountability from all stakeholders.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Agency and/or
Department handbooks, manuals or desk books and Master Contract number HMO 14, as an integral part of the contract,
except to the extent that the contract explicitly provides to the contrary. In the event of conflict in language among
any of the documents referenced above, the specific provisions and requirements of the contract document(s) shall
prevail over inconsistent provisions in the proposal(s) or other general materials not specific to this contract document
and identified attachments.
3. Term of Contract
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time January 1, 2015 or on the date the contract
has been signed by the last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) P.M.,
Eastern Standard Time December 31, 2015.
4. Contract Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $671,792.00 ($346,722.00 In -Home Services), or the rate schedule, subject to the availability of funds.
Any costs or services paid for under any other contract or from any other source are not eligible for payment under
this contract.
5. Rgnewals
By mutual agreement of the Parties, in accordance with s. 287.058(1)(g), F.S., the Agency may renew the contract
for a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or
method for detennining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may
be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability of funds.
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January 2015
i
5/10/2016 16.D.6.
Contr�t #OAr% ave. x.,
3
6. Official Payee and Representatives (Names, Addresses, and Tele hone Numbers): !
7. All Terms and Conditions Included:
This contract and its Attachments, I, III, VII, VIII, IX, X, XI 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 containederein, and this contract shall
supersede all previous communications, representations or agreements, either written or�erbal between the Parties.
By signing this contract, the Parties agree that they have read and agree to the entire
IN WITNESS THEREOF, the Parties hereto have caused this contract to be executed
duly authorized.
Contractor: COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY: �*
J,
NAME: Stephen Y, Carnell
TITLE: Public Services Administrator
DATE:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 9/30
AREA AGENCY
SOUTHWEST F]
SIGNED BY:
NAME: MAI
TITLE: PRE;
DATE:
N
Packet Page -801-
their undersigned officials as
AGING FOR
IDA, INC.
Approved as to fonn and legality
Collier County Hou ing, Human and Veteran
The Contractor name, as shown on page 1 of this
S rvices
a.
contract, and mailing address of the official payee to
3339 E Tamiami Trail, Building H
whom the payment shall be made is:
Naples, )"L 34112
Kimberly Giant, Director
The name of the contact person and street address where
Collier County Homing, Human and Veteran
b
financial and administrative records are maintained is:
Services
3339 E Tamiami Trail, Building H
Naples— L 34112
The name, address, and telephone number of the
Kimberly G .ant, Director
and Veteran
Collier County HomSg
C.
representative of the Contractor responsible for
grvcesuman
administration of the program under this contract is:
3339 E Tamiat�ffrail, Building H
Naples, L 34112
(239) 2-2273
d.
The section and location within the Agency where
Area Agency on Aging or Southwest Florida, Inc.
15201 North Clevel ind Avenue, Suite 1100
Requests for Payment and Receipt and Expenditure
North Fort b 1yers, FL 33903
forms are to be mailed is:
Fiscal
Director.
e.
The name, address, and telephone number of the
Area Agency on Aging
for Southwest Florida, Inc.
Contract Manager for this contract is:
15201 North Cleveli
ind Avenue, Suite 1100
North Fort Myers,
FL 33903
Upon change of representatives (names, addresses, telephone numbers) by either party,
notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
7. All Terms and Conditions Included:
This contract and its Attachments, I, III, VII, VIII, IX, X, XI 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 containederein, and this contract shall
supersede all previous communications, representations or agreements, either written or�erbal between the Parties.
By signing this contract, the Parties agree that they have read and agree to the entire
IN WITNESS THEREOF, the Parties hereto have caused this contract to be executed
duly authorized.
Contractor: COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY: �*
J,
NAME: Stephen Y, Carnell
TITLE: Public Services Administrator
DATE:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 9/30
AREA AGENCY
SOUTHWEST F]
SIGNED BY:
NAME: MAI
TITLE: PRE;
DATE:
N
Packet Page -801-
their undersigned officials as
AGING FOR
IDA, INC.
Approved as to fonn and legality
January 2015
INDEX OF ATTACHMENTS
ATTACHMENT I
5/10/2016 16_D.6.
Contract #Oaa/-oJ./D
STA TE MEW OF WORK ____________________~~.________,._________--.-4
ATT
MENT III
�
FEDERAL RESOURCES A WARD
..........................................'..................'^'...,,,.........,...,,....................._/6
ATTACHMENT V11
BUDGET AND RA TE SUMAMR Y
._______,,,.'_'_____,_,,.,.____',,,..`~____,,,--..17
ATTACHMENT V111
INVOICE SCHED ULE
_.,_____~.~_.,~.______^_._._____._,,.,,___.,,.,.~_--......}V
ATTACHMENT IX
REQUE ST FOR PAYMENT—] 06A.................................................................................................................. J0
ATTACHMENT X
RECEIPTS A ArD EXPENDITURE RE, POR T-1 UJox....................................................................................... 2/
ATTACHMENT XI
RECEIPTS AND EXPENDITURE REPORT—] 0jAf...................................................................................... 22
]
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January 2015
5/10/2016 16.D.6.
Contract #OAA 203.15
ATTACHMENT I
�— AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE III
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 CONTRACT ACRONYMS
Area Agency on Aging (AAA)
Activities of Daily Living (ADL)
Alliance of Information & Referral Systems (AIRS)
Assessed Priority Consumer List (APCL)
Adult Protective Services (APS)
Client Information and Registration Tracking System (CIRTS)
Chronic Disease Self -Management Education (CDSME)
Chronic Disease Self -Management Program (CDSMP)
Evidence -Based Disease Prevention and Health and Promotion (EBDPHP)
hiformation 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 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.
Grandparent: A grandparent or step -grandparent of a child, or a relative of a child by blood, marriage or adoption
and who lives with the child; is the primary caregiver of the child because the biological or adoptive parents are
unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the child, such as
legal custody or guardianship, or is raising the child informally.
.19
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January 2015
1.2 GENERAL DESCRIPTION
5/10/2016 16.D.6.
Contract #OAA 203.15
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, irnproving 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 set -vices.
1.2.2 Authority
The relevant authority references governing the OAA program are:
(1) Older Americans Act of 1965, as amended;
(2) Rule 58A-1, Florida Administrative Code; and
(3) Section 430.101, Florida Statutes.
1.2.3 Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of the Title 11113, Title
IIIC1, Title IIIC2, and Title IHE programs of the OAA within its designated PSA. The scope of service includes
planning, coordinating and assessing the needs of older persons, and assuring the availability and quality of
services. The services shall be provided in a manner consistent with and described in both the current
Contractor's Request for Proposal and the Agency's Area Plan Update, and the current 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, with
the exception of consumers in need of OAA Legal Assistance services.
1.3.2 OAA Title HIB, Supportive Services
Eligibility for OAA Title IIIB, Supportive Services, are as follows:
(1) Individuals must be age 60 or older; and
(2) Information and Referral/Assistance services are provided to individuals regardless of age.
1.3.3 OAA Titles IIIC1 and IIIC2, Nutrition Services, General
General factors that should be considered in establishing priority for Nutrition Services, both C1 and C2, include
those older persons who meet the following:
(1) Cannot afford to eat adequately;
(2) Lack the skills or knowledge to select and prepare nourishing and well-balanced meals;
(3) Have limited mobility which may impair their capacity to shop and cook for themselves; or
(4) Have a disabling illness or physical condition requiring nutritional support or have been screened at a high
nutritional risk.
5
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Contract 90AA 1-U.J. ►
1.3.3.1 OAA Title HIC1, Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I, Paragraph
1.3.3, individuals must be mobile, not homebound and physically, mentally and medically able to attend a
congregate nutrition program. Individuals eligible to receive congregate meals include the following:
(1) Individuals age 60 or older; and
(2) Any spouse (regardless of age) who attends the dining center with his/her eligible spouse;
(3) Persons with a disability, regardless of age, who reside in a housing facility occupied primarily by older
individuals where congregate nutrition services are provided;
(4) Disabled persons who reside at home with and accompany an eligible person to the dining center; and
(5) Volunteers, regardless of age, who provide essential services on a regular basis during meal hours.
1.3.3.2 OAA Title IIIC2, Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT 1,
Paragraph 1.3.3, individuals must be homebound and physically, mentally or medically unable to attend a
congregate nutrition program. Individuals eligible to receive home delivered meals include the following:
(1) Individuals age 60 or older who are homebound by reason of illness, disability or isolation;
(2) The spouse of a homebound eligible individual, regardless of age, if the provision of the collateral meal supports
maintaining the person at home;
(3) Individuals with disabilities, regardless of age, who reside at home with eligible individuals and are dependent
on them for care; and
(4) Persons at nutritional risk who have physical, emotional or behavioral conditions, which would make their
presence at the congregate site inappropriate; and persons at nutritional risk who are socially or otherwise
isolated and unable to attend a congregate nutrition site.
1.3.4 OAA Title BEE, Caregiver Support Services
Eligibility for OAA Title IIIE, Caregiver Support Services, are 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.
1.3.5 Targeted Groups
Preference shall be given to those with the greatest economic and social need, with particular attention to low-
incorne older individuals, including those that are low-income minorities, have limited English proficiency, and
older individuals residing in rural areas.
SECTION II — MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the OAA program, the Contractor shall ensure the following tasks are performed:
(1) Client eligibility determination;
(2) Targeting and screening of service delivery for new clients;
(3) Delivery of services to eligible clients;
(4) Use of volunteers to expand the provision of available services;
(5) Development of Partnerships and Collaborations;
(6) Monitoring the performance of its subcontractors;
(7) Information and Referral/Assistance Access Services (Elder Helplines); and
(S) Grievance and Complaint Procedures.
r
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January 2015
5/10/2016 16.D.6.
Contract #CHH 2w. i D
2.1.1 Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a client
is based on meeting the requirements described in this ATTACHMENT 1, Section 1.3.
2.1.2 Targeting and Screening of Service Delivery for New Clients
The Contractor shall develop and implement policies and procedures consistent with OAA targeting and screening
criteria.
2.1.3 Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of elders and their
caregivers. The Contractor 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, 361, and 373 as follows:
(1) Section 321, Title II113 Supportive Services;
(2) Section 331, Title IIIC1 Congregate Nutrition Services;
(3) Section 336, Title IIIC2 Home Delivered Nutrition Services; and
(4) Section 373, Title IIIE Caregiver Support Services
2.1.3.1 Supportive Services (111B Program)
Supportive services include a variety of community-based and home -delivered services that support the quality of
life for older individuals by helping them remain independent and
productive. Services include the following:
(1)
ADRC Access;
(17)
Recreation;
(2)
Adult Day Care/Adult Day Health Care;
(18)
Emergency Alert Response;
(3)
Caregiver Training/Support;
(19)
Escort;
(4)
Case Aid/Case Management;
(20)
Health Support;
(5)
Chore Services;
(21)
Horne Health Aid;
(6)
Companionship;
(22)
Homemaker;
(7)
Counseling (Gerontological and Mental Health);
(23)
Housing Improvement;
(8)
Education/Training;
(24)
Information;
(8)
Legal Assistance;
(25)
Intake;
(9)
Material Aid;
(26)
Interpreter/Translating;
(10)
Occupational Therapy;
(27)
Referral/Assistance;
(11)
Outreach;
(28)
Respite Services;
(12)
Personal Care;
(29)
Screening/Assessment;
(13)
Physical Therapy;
(30)
Speech Therapy;
(14)
Shopping Assistance;
(31)
Telephone Reassurance; and
(15)
Skilled Nursing;
(32)
Transportation
(16)
Specialized Medical Equipment, Services, and Supplies
2.1.3.2 Congregate Nutrition Services (1HC1 Program)
Nutrition services are provided in congregate settings and are designed to reduce hunger and food insecurity,
promote socialization and the health and well-being of older individuals by assisting them to gain access to nutrition
and other disease prevention and health promotion services. Services include the following:
(1) Congregate rneals;
(2) Congregate meals screening;
(3) Nutrition education and nutrition counseling; and
(4) Outreach.
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2.1.3.3 Home Delivered Nutrition Services (II1C2 Program)
In-home nutrition services are provided to reduce hanger and food insecurity; promote socialization and the health
and well-being of older individuals by assisting such individuals to gain access to nutrition and other disease
prevention and health promotion services. Services include the following:
(1) Home delivered meals;
2 Nutrition education and counseling; and
3� Outreach.
2.1.3.4 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;
(7)
Intake;
(2)
Caregiver Training/Support;
(8)
Outreach;
(3)
Counseling (Gerontological and Mental Health);
(9)
Referral/Assistance;
(4)
Education/Training;
(10)
Respite Services;
(5)
Financial Risk Reduction (Assessment and
(11)
Screening/Assessment; and
Maintenance);
(12)
Transportation.
(6)
Information;
2.1.3.5 Caregiver Support Supplemental Services (HIES Program)
At least 10 percent, but no more than 20 percent, of the total Title IIIE funds shall be used to provide supplemental
support services. The following services are provided to complement the care provided by caregivers:
(1)
Chore Services;
(2)
Housing Improvement;
(3)
Legal Assistance;
(4)
Material Aid; and
(5)
Specialized Medical Equipment, Services and Supplies.
2.1.3.6 Caregiver Support Grandparent Services (HIEG Program)
At I east 5 percent, but no more than 10 percent, of the total Title IIIE finds shall be used to provide support services
to grandparents and older individuals who are relative caregivers. Services for grandparents or older individuals
who are relative caregivers designed to help meet their caregiving obligations include the following:
(1) Caregiver Training/Support; (7) Outreach;
(2) Child Day Care; (8) Referral/Assistance;
(3) Counseling (Gerontological and Mental Health); (9) Screen ing/Assessment;
(4) Education/Training; (1.0) Sitter; and
(5) Information; (11) Transportation
(6) Legal Assistance;
2.1.4 Use of Volunteers to Expand the Provision of Available Services
2.1.4.1 The Contractor 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 Contractor 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.
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2.1.4.2 The Contractor shall submit a quarterly report of volunteer activities and services electronically on the internet in
a format provided by the Agency and/or the Department's Office of Volunteer and Community Services. The ^
quarterly report schedule is as follows:
Report Period
Report Due Dates
January I - March 31
April 15, 2015
April I - June 30
July 15, 2015
July I- September 30
October 15, 2015
October 1 - December 31
January 15, 2016
2.1.5 Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the Contractor 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 Contractor shall notify the Contract Manager and the Agency's Chief Financial Officer in
writing of such delay.
2.1.5.1 The Contractor shall not permit a subcontractor to perforin services related to this agreement without having
a binding subcontractor agreement executed. In accordance with section 23.1 of the Master Contract, the Agency
will not be responsible or liable for any obligations or clairns resulting from such action.
2.1.5.2 The Contractor shall submit a copy of all subcontracts to the Contract Manager within thirty days of the
subcontract being executed.
2.1.5.3 Monitoring the Performance of Subcontractors
The Contractor shall monitor at least once per year each of its subcontractors, subrecipients, vendors,
and/or consultants paid from funds provided under this contracts. The Contractor shall perform fiscal,
administrative and programmatic monitoring to ensure contractual compliance, fiscal accountability,
programmatic performance and compliance with applicable state and federal laws and regulations. The
Contractor shall monitor to ensure that tirne schedules are met, the budget and scope of work are
accomplished within the specified time periods and other performance goals stated in this contract are
achieved.
2.1.5.4 The contractor shall docurnent, and provide upon request, evidence of partnerships created formally
through Memorandums of Agreement or Understanding or informally through emails and phone calls.
Contractor will be required to keep track of partnerships in the Monthly Programmatic Report. Each month
the Contractor should review and provide updates as necessary.
2.1.6 Subcontractor Outreach Reporting Requirements
The Contractor 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 Contractor shall require subcontractors to use this format for
reporting on outreach activities at least semi-annually.
2.1.7 Grievance and Complaint Procedures
2.1.7.1 Grievance Procedures
The Contractor shall comply with and ensure subcontractor compliance with the Minimum Guidelines for
Recipient Grievance Procedures, Appendix D, Department of Elder Affairs Programs and Services
Handbook, to address complaints regarding the termination, suspension or reduction of services, as required for
receipt of funds.
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2.1.7.2 Complaint Procedures
^ The Contractor shall develop and implement complaint procedures and ensure that subcontractors develop and
implement complaint procedures to process and resolve client dissatisfaction with set -vices. Complaint procedw-es
shall address the quality and timeliness of services, provider and direct service worker complaints, or any other
advice related to complaints other than termination, suspension or reduction in services that require the grievance
process as described in Appendix D, Department of Elder Affairs Programs and Services Handbook. The complaint
procedures shall include notification to all clients of the complaint procedure and include tracking the date, nature
of complaint and the determination of each complaint.
2.2 SERVICE TIMES
The Contractor shall ensure the provision of the services Iisted 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 Programmatic Operations/Administration
The Contractor shall ensure the provision of services outlined in Section 2.3.2 in accordance with Department of
Elder Affairs Programs and Services Handbook through its review of reports outlined in Section 2.4 of this
agreement at Ieast as follows; A.) monthly review of subcontractors' surplus/deficit reports, and CIRTS data
accuracy reports; B.) annual review of service cost reports; and C.) at least annually and as needed to correlate with
applicable contract amendments area plan update for OAA service units, recording of manual units of service
portions of the OAA Annual Report.
Service Unit
The Contractor shall ensure the provision of the services described in the contract in accordance with the current
Department of Elder Affairs Programs and Services Handbook and the services tasks described in Section 2.1. The
chart below lists the services allowed and the units of measurement. Units of service will be paid pursuant to the
rate established in the 2015 Area Plan as updated in ATTACHMENT VII and approved by the Agency.
Services
Unit of Service
Adult Day Care/Adult Day Health Care
Interpreter/Translating Legal
Caregiver Training/Support
Assistance Medication
Case Aid/Case Management
Management
Child Day Care
Mental Health Counseling/Screening
Chore Services
Nutrition Counseling
Companionship
Occupational Therapy
Congregate Meals Screening
Personal Care
Counseling Services
Physical Therapy
Escort
Financial Risk Reduction Services
Recreation
Respite Services
Hour
Health Support
Screening/Assessment
Home Health Aide
Sitter
Homemaker
Skilled Nursing Services
Housing Improvement
Speech Therapy
Intake
Emergency Alert Response
Da
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Education/Training
Information
Material Aid Nutrition Education
Episode
Outreach
Referral/Assistance
Specialized Medical Equipment, Set -vices and Supplies
Telephone Reassurance
Escort
Shopping Assistance
One -Way Trip
Transportation
Congregate and Home Delivered Meals
Meal
2.4 REPORTS
The Contractor 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 Contractor shall establish due dates for
any subcontractors that permit the Contractor to meet the Agency's reporting requirements.
2.4.1 Client Information and Registration Tracking System (CIRTS) Reports
The Contractor shall input OAA specific data into CIRTS to ensure CIRTS data accuracy. The contractor shall use
CIRTS generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports;
(4) Miscellaneous Reports;
(5) Fiscal Reports;
(6) Aging Resource Center Reports; and
(7) Outcome Measurement Reports.
2.4.2 Service Costs Reports
The Contractor shall require subcontractors to submit to the Agency annual service cost reports, which reflect
actual costs of providing each service by program. This report provides information for planning and negotiating
unit rates and is due February 15, 2016.
2.4.3 Surplus/Deficit Report
The Contractor will submit a consolidated surplus/deficit report in a format provided by the Agency to the
Contract Manager by the 1 8th of each month. This report is for all agreements and/or contracts between the
Contractor and the Agency. The report shall include the following:
(1) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the
Agency will be resolved;
(2) Recommendations to transfer funds to resolve surplus/deficit spending;
2.5 RECORDS AND DOCUMENTATION
The Contractor 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 Contractor 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 contractor
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.
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2.5.11 The Contractor 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 Contractor shall ensure services provided under this contract are in accordance with the current
DOEA Programs and Services Handbook.
(2) The Conti -actor shall timely submit to the Agency all reports described in ATTACHMENT I, Paragraph
2.4 REPORTS.
(3) The Contractor shall timely submit to the Agency all information described in ATTACHMENT 1,
Paragraph 2.5 RECORDS AND DOCUMENTATION.
2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.7.1 Matching, Level of Effort, and Earmarking Requirements
The Contractor shall provide match of at least 10 percent of the federal funds received. The Contractor's
match will be made in the form of cash, general revenue administrative funds and/or in-kind resources.
The Contractor will assure, through a provision in subcontracts, a match requirement of at least 10 percent of the
cost for services funded through this contract. The subcontractor's match will be made in the form of cash and/or
in-kind resources. The Contractor shall report match by title each month. At the end of the contract period, the
Contractor must properly match OAA fiords that require a match.
2.7.2 Consumer Contributions
Consumer contributions are to be used under the following terms:
(1) The Contractor assures compliance with Section 315 of the OAA as amended in 2006, in regard to consumer
contributions;
(2) Voluntary contributions are not to be used for cost sharing or matching;
(3) Accumulated voluntary contributions are to be used prior to requesting federal reunbursement; and
(4) Voluntary contributions are to be used only to expand services.
2.7.3 Use of Service Dollars and Management of the Assessed Priority Consumer List
The Contractor is expected to spend all federal, state and other funds provided by the Agency for the purpose
specified in the contract. The Contractor must manage the service dollars in such a manner so as to avoid having a
wait list and a surplus of funds at the end of the contract period, for each program managed by the Contractor. If
the Agency determines that the Contractor is not spending service funds accordingly, the Agency may
transfer funds to other Contractors during the contract period and/or adjust subsequent funding allocations
accordingly, as allowable under state and federal law.
2.7.4 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget and Rate Summary,
ATTACHMENT VII to this contract. Any changes in the amounts of federal or general revenue funds identified
on the Budget Summary form require a contract amendment.
2.7.5 Title III Funds
The Contractor assures compliance with Section 306 of the OAA, as amended in 2006, that funds received under
Title III will not be used to pay any part of a cost (including an administrative cost) incurred by the Contractor to
maintain a contractual or commercial relationship that is not carried out to implement Title III.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide to the Contractor guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Contractor.
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2.8.2 Contract Monitoring
The Agency will review and evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or an on-
site visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor 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 contract includes advances, cost reimbursement for administration costs, and fixed-
rate
ixedrate for services. The Contractor shall ensure that the fixed rates for services include only those costs that are in
accordance with all applicable state and federal statutes and regulations and are based on audited historical costs in
instances where an independent audit is required. The Contractor shall consolidate all requests for payment from
subcontractors and expenditure reports that support requests for payment and shall submit to the Agency on
forms 106A (ATTACHMENT IX), 105as (ATTACHMENT X), and 105AE (ATTACHMENT XI).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget and Rate Summary,
ATTACHMENT VII to this contract. Any changes in the total amounts of the funds identified on the Budget
Summary form require a contract amendment.
3.2 Advance Payments
The Contractor may request up to two months of advances at the start of the contract period, if available, to cover
program administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the Agency by the State of Florida ("budget release"). The Contractor shall provide the
Contract Manager documentation justifying the need for an advance and describing how the funds will be
distributed.
3.2.1 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient budget is
available, the Agency will issue approved advance payments after January 1, 2015.
3.2.2 All advance payments made to the Contractor shall be returned to the Agency as follows: one—tenth of the
advance payment received shall be reported as an advance recoupment on each request for payment, starting with
report number five, in accordance with the Invoice Schedule, ATTACHMENT VIII to this contract.
3.2.3 Interest earned on advances must be identified separately by source of funds, state or federal. Contractors shall
maintain advances of federal funds in FDIC interest bearing accounts unless otherwise exception is made in
accordance with 45 CFR 74.22(k). Earned interest must be returned to the Agency at the end of each quarter of
the contract period.
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3.3 Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment shall be on DO.EA
forms 106A (ATTACHMENT IX), 105as (ATTACHMENT X), and 105AE (ATTACHMENT XI). The
Contractor shall include with its request for payment documentation of services provided, the units of
services provided, and the rates for the services provided in conformance with the requirements as
described in the deliverables and service tasks.
3.3.1 Remedies for Nonconforming Services
The Contractor 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.
3.3.1.1 If the Contractor 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 Contractor's signature on the request for
payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor 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.
3.3.2 Financial Consequences
Contractor shall ensure the provision of services to the projected number of clients in accordance with the
2014 RFP as updated and within the contract amount. The Contractor shall ensure expenditure of 100%
of the contract amount budgeted for services to clients at the unit rates established in the RFP. In the
event the Contractor has a surplus of 1% or more at the end of the of the grant term, the Agency will
reallocate an amount equal to 1% reverted carry forward amount in the next contract terrn to other area
agencies found to be serving clients to the fullest extent of their allocated budgets. If, or to the extent,
there is any conflict between this paragraph and paragraphs 39.1 and 39.2 of the Master Contract, this
paragraph shall have precedence.
3.3.3 All payment requests shall be based on the submission of actual monthly expenditure reports beginning with the
first month of the contract. The schedule for submission of advance requests (when available) and invoices is
ATTACHMENT VIII to this contract.
3.3.4 Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in
ATTACHMENT VII, Budget and Rate Summary.
3.3.5 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in Section 25 of the Master Contract.
3.3.6 Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided
between January 1, 2015 and December 31, 2015, must be submitted to the Agency's Contract Manager no
later than December 31, 2015.
3.4 Consequences for Noncompliance
Contractor shall ensure 100% of the deliverables identified in SECTION II — MANNER OF SERVICE
PROVISION are performed pursuant to contract requirements, and as described in Section 2.3.1 are identified as
major deliverables in this contract.
3.4.1 If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to correctly,
^ completely, or adequately perform these major deliverables, the Contractor will have 10 days to submit a
Corrective Action Plan ("CAP") to the Contract Manager that addresses the deficiencies and states how the
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deficiencies will be remedied within a time period approved by the Contract Manager. The Agency shall assess
a Financial Consequence for Non -Compliance on the Contractor for each deficiency identified in the CAP which
is not corrected pursuant to the CAP. The Agency will also assess a Financial Consequence for failure to timely
submit a CAP.
3.4.2 In the event Contractor fails to correct an identified deficiency within the approved time period specified in the
CAP, the Agency shall deduct, from the payment for the invoice of the following month, I% of the monthly
amount billed for each day the deficiency is not corrected. The Agency may also deduct, from the payment for
the invoice of the following month, 1% of the monthly value of the administrative funds in the contract for each
day the Contractor fails to timely submit a CAP.
3.4.3 if Contractor fails to timely submit a CAP plan, the Agency shall deduct 1% of the monthly amount billed
for each day the CAP is overdue, beginning the IIg' day after notification by the contract manager of the
deficiency. The deduction will be made from the payment for the invoice of the following month.
3.4.4 if, or to the extent, there is any conflict between subsections 3.4 — 3.4.4 and paragraphs 39.1 and 39.2 of the
Master Contract, subsections 3.4 — 3.4.4 shall have precedence.
3.5 Dates for Final Request for Payment
The Contractor shall submit the final request for payment to the Agency no later than February 15, 2416.
3.6 Documentation for Payment
The Contractor shall maintain documentation to support payment requests that shall be available to the Agency
or authorized individuals, such as Department of Financial Services, upon request.
3.6.1 The Contractor must enter all required data per the Department's CIRTS Policy Guidelines for clients and services
in the CIRTS database. The data must be entered into the CIRTS before they submit their request for payment
and expenditure reports to the Agency. The Agency shall establish time frames to assure compliance with due
dates for the requests for payment and expenditure reports.
3.6.2 The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is accurate. This
report must be submitted to the Agency with the monthly request for payment and expenditure report and must be
reviewed by the Agency before the request for payment and expenditure reports can be approved by the Agency.
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ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Older Americans Act Title 111.13—
CA/CM/SCAS
$ 23,574.00
Transportation
U.S. Health and Human Services
93.044
$ 31,000.00
$ 54,574.00
Support Set -vices
$ 346,722.00*
Total IIII3
OAA Title I[IC I — Congregate Meals
$ 255,419.00
Meals
Screening
Nutrition Counseling
U.S. Health and Human Services
93.045
Nutrition Education
Outreach
Total IIICI
$ 255,419.00
OAA Title I[I C2 — Home Delivered Meals
$ 243,081.00
Meals
Nutrition Education
U.S. Health and Human Services
93.045
Screening
TotalIIIC2
$ 243,081.00
Older Americans Act Title III E
CA/CM & Services (Title III E)
93.052
$ 89,116.00
Supplement Services (Title III ES)
U.S. Health and Human Services
$ 17,761.00
Grandparent Services (Title III EG)
$ 11,841.00
Total IIIE
$ 118,718.00
TOTAL FEDERAL AWARD
$ 671,792.00
*In Home Services $346,722.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
Aging for Southwest Florida, Inc.
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A-122 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-1 10 — Administrative
Requirements) OMB Circular A-133 — Audit Requirements
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL
ASSISTANCE Section 215.97,
Fla, Stat.
Chapter 691-5, Fla. Admin. Code
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ATTACHMENT VII
Budget and Rate Summary
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
1. Title III B Support Services $ 54,574.00*
2. Title III CI Congregate Meals $ 255,419.00
3. Title III C2 Home Delivered Meals $ 243,081.00
4. Title III E Services $ 118,718.00
TOTAL $ 671,792.00
*In Home Services $346,722.00
In Home Services are funds to serve Collier County clients. The Vendors are paid directly by the
Area Agency on Aging for Southwest Florida, Inc.
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ATTACHMENT VII
Budget and Rate Summary
OLDER AMERICANS ACT
RATE SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
IIIB, IIIE, IIIES & IIIEG
Services Total Cost Reimbursement Rate
ITIR
Case Management
$ 55.00
$ 49.50
Screen ing/Assessment
$ 55.00
$ 49.50
Transportation
100% Cost
90% of Cost
Services Total Cost Reimbursement Rate
IRE. HIES and IIIEG
IIIE - Respite In -Home
$ 21.66
$ 19.50
Respite In -Facility
$ 12.00
$ 10.80
Direct Pay Respite
$ 16.66
$ 15.00
Adult Day Care
$ 12.00
$ 10.80
Screen ing/Assessment
$ 55.00
$ 49.50
IIIES- Specialized Medical Equipment, Service &
Supplies
100% Cost
90% of Cost
IIIEG-Child Day Care
$ 16.67
$ 15.00
Screening/Assessment
$ 55.00
$ 49.50
C-1 & C-2
COLLIER COUNTY
Services Total Cost
C1
Reimbursement Rate
Congregate Meals
$ 9.88
$ 8.90
Nutrition Counseling
$58.88
$53.00
Nutrition Education
$ 1.80
$ 1.62
Outreach
$4.80 per person
$4.32 per person
C2
Home Delivered Meals
$ 9.77
$ 8.80
Nutrition Counseling
$58.88
$53.00
Nutrition Education
$ 1.80
$ 1.62
Nutrition Screening
$55.00
$49.50
Outreach
I $4.80.per person
$4.32 per person
18
Packet Page -817-
C-19
January 2015
5/10/2016 16.D.6.
Contract #OAA 2U3, l5
Legend: * Advance based on projected cash need.
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Agency prior to
January 1 or until the agreement with the Agency has been executed.
Note #2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the
agreement.The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT IX).
Note # 3: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the Agency, payment is to accompany the
report.
Note #4: ALL Expenditure Reports are due by 12:00 p.m. on the 9`l' of each month. IF the 91l' falls
on a Saturday, then the report will be due by the 8t" by 12:00 p.m. AND IF the 9rr' falls
on a Sunday, the report will be due by the 10`l' by 12:00 p.m. Actual submission of the
vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report
which is verified and paid by CIRTS data only.
19
Packet Page -818-
ATTACHMENT VIH .-.
INVOICE SCHEDULE
ADVANCE BASIS CONTRACT
Report Number
Based On
Submit to AgencyOn
This Date
1
January Advance*
January 1
2
February Advance*
January 1
3
January Expenditure Report
February 9 *See Note 44*
4
February Expenditure Report
March 9
5
March Expenditure Report
April 9
6
April Expenditure Report
May 9
7
May Expenditure Report
June 9
8
June Expenditure Report
July 9
9
July Expenditure Report
August 9
10
August Expenditure Report
September 9
11
September Expenditure Report
October 9
12
October Expenditure Report
November 9
13
November Expenditure Report
December 9
14
December Expenditure Report
January 9
15
Final Expenditure and Request for Payment
February 15
16
Closeout Report
March 1
Legend: * Advance based on projected cash need.
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Agency prior to
January 1 or until the agreement with the Agency has been executed.
Note #2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the
agreement.The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT IX).
Note # 3: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the Agency, payment is to accompany the
report.
Note #4: ALL Expenditure Reports are due by 12:00 p.m. on the 9`l' of each month. IF the 91l' falls
on a Saturday, then the report will be due by the 8t" by 12:00 p.m. AND IF the 9rr' falls
on a Sunday, the report will be due by the 10`l' by 12:00 p.m. Actual submission of the
vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report
which is verified and paid by CIRTS data only.
19
Packet Page -818-
January 2015
REQUEST FOR PAYMENT
5/10/2016 16.D.6.
Contract #OAA 203.15
ATTACHMENT IX
REQUEST FOR PAYMENT
OLDER AMERICANS ACT
PROVIDER NAME, ADDRESS, PHONE AND FED ID NUMBER
TYPE OF REPORT:
THIS REQUESTPERIOD:
AdvanceReport#
_.._... ....._.
. .
............. ...... .
Reimbursement
Contract #:
Contract Period:
PSA
CERTIFICATION: I hereby cattily to the best of my knaMedge.that ttgs request conforms vkh the terms, and tha purposes set forth in the. abae contract, ... .... . ... ... .
Prepared By: Date: Approved By: Dale:
PART A:
(1)
(2)
(3)
(4)
(5)
(6)
(7) -
BUDGET SUMMARY
AIB
HICII
HIC2
HIE
TOTAL
1. Approved
Contract Amount
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2. Previous Funds
RECEIVED for
Contract period
0.00
0.00
0.00
O.OD
0.00
O.DO
0.00
3. Contract Balance
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1 minus line 2)
revious Funds
REQUESTED and
Not Re calved.
0.00
0.00
0.00
0.00
O.OD
0.00
0.00
5. Contract Balance
0.00
0.00
0.0D
0.00
0.00
0.00
0.00
(Una 3 minus line 4)
_
..
PART B:
FUNDS REQUESTED
1. tst-2nd Months
Request Orgy
0.00
0.00
D.00
0.00
0.00
0.00
_ .DAO
2. Net Expenditures
..
For Month
O.DO
0.00
0.00
0.00
0.00
0.00
0.00
3. Total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PART C:
NET FUNDS REQUESTED:
1. Less: Over-Advence
0.00
0.00
0.00
0.00
0.00
0.00
0,00
2. Contract Funds are
Hereby Requested For
0.00
0.00
0.00
0.00
0.00
0.00
0.00
List of Services 1 Units / Rates provided - See attached report.
DOFA FOFN 106A revaee elle
20
Packet Page -819-
January 2015
5/10/2016 16.D.6.
Contract #GAA 2U.S. ID
21
Packet Page -820 7.
-
ATTACHMENT
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
PROGRAM FUNDING SOURCE:
THIS REPORT PERIOD
FROM:
TO:
1118
111C1
CONTRACT
PERIOD:
IIIC2
CONTRACT #
REPORT #
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that this report is
complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date :
Approved by :
Date:
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2, Actual Receipts
3. Total Receipts
4, Percent of
Budget
For This Report
Year to Dale
Approved Budget
1. Federal Funds
$0.00
$0.00
$0.00
%
2. State Funds
$0.00
$0.00
$0.00
%
3. Program Income - Non Match
$0.00
$0.00
$0,00
%
4. Local Cash Match
$0.00
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
%
6. Local In -Kind Match
$0.00
$0.00
$0.00
%
7. TOTAL RECEIPTS
$0.00
$0.00
$0.00
%
PART B : EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Meals f Meal Agreements
$0.00
$0,00
$0,00
%
2. Service/ Subcontractor
$0.00
$0,00
$0.00
%°
3. Other
$0.00
$0.00
$0.00
4. Indirect Cost
$0.00
$0.00
$0.00
%
5. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
%
PART C : OTHER EXPENDITURES
(For Tracking Purposes only)
1. Match
a. Other and In -Kind
$0.00
$0.00
$0.00
b. Local Match
$0.00
$0.00
$0.00
2. NSIP Cash Received
$0.00
$0.00
$0.00
3. Program Income
$0.00
$0.00
$0,00
4. TOTAL OTHER
$0.00
$0.00
$0.00
%
PART D: INTEREST
1. Earned on Advances $0.00
2. Return on Advances $0.00
3. Other Eamed $0.00
DOFA FORM 105as revised 9123!2014
21
Packet Page -820 7.
-
January 2015
5/10/2016 16.D.6.
Contract #OAA 203.15
ATTACHMENT XI
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source:
THIS REPORT PERIOD
FROM:
TO:
CONTRACT
Title III E
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION; I certify to the best of my knowledge and
belief [hat this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date :_Approved
by:
Date ;
PARTA : BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Federal Funds
50.00
$0.00
$0.00
%
2. Slate Funds
$0.00
$0.00
$0.00
%
3. Program Income
$0.00
$0.00
$0.00
4. Local Cash Match
$0.00
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
MCI[)
%
6. Local In -Kind Match
$0.00
$0.00
$0.00
%
7. TOTALRECEIPTS
$0.00
$0.00
$0.00
%
PART B: EXPENDITURES
1, Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
A: Direct Services
1. Personnel
$0,00
$0.00
$0.00
%
2. Travel
$0.00
$0.00
$0.00
%
3. Building Space
$0.00
$0.00
$0.00
°6
4. Communication / Utilities
$0.00
$0.00
$0.00
5. Printing /Supplies
$0.00
$0.00
$0.00
6. Equipment
$0.00
$0.00
$0.00
7. Other
$0.00
$0.00
$0.00
%
B : Agreement Services
8. Senices S ubconfracted
$0.00
$0.00
$0.00
%
9. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
10. DEDUCTIONS
a. Total Local Match
$0.00
$0.00
$0.00
%
b. Program Income Used
$0.00
$0.00
$0.00
%
c. TOTAL DEDUCTIONS
$0.00
$0.00
$0.00
%
11. NETEXPENDITURES
$0.OG
$0.00
$0.00
%
PART C: EXPENDITURES ANALYSIS
2. Units of Services Year to Date
3. Number of People Served Year to Date
A. Expenditures by Services Year to Date:
1. Information ..................... 00
.........
$0.00
.................
0100
2. Assistance ..................... $0.00
..-
$000
..........................
0_00
3. Counseling ..................... $0.00
........................
$0.00
......... I................
0.00
4. Respite ......................... 0.00
........................$0.00
...... ..... I..............
0.00
5. Supplemental Ser4ces $0,00
........................
$0.00
...........................0.00
6. TOTAL .......................... $0.00
Part B Line 11, column 3 should be equal to this total.
PART D; GRANDPARENT SERVICES (reported by Federal Fiscal Year)
FFY $ FFY
$
FFY
$
Match $
Match $
Match $
22
Packet Page -821-
5/10/2016 16.D.6.
Attestation Statement
Agreement/Contract Number OAA 203.15
Amendment Number . n/a
I,_ Stephen Y. Carnell , 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
Public Services Administrator
(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.
of Recfflient/Contractor representative Date
Approved as to form and legality
Assistant Coun
Packet Page -822- 91c)
5/10/2016 16.D.6.
VERIFICATION OF EMERGENCY PREPAREDNESSPLAN
Contract # OAA 203.15
1, Stephen Y C'amell certify that Collier County Government
(Name of authorized contractor representative) (Name of contractor)
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that
the plan will be made available to the Area Agency on Aging for Southwest Florida, Inc. upon
request.
Signature of aui`horized contractor representative
Public Services Administrator
Title
i 120 IS
Date
Collier County Government
Company
October 2008
Approved as to form and legality
Assistant Cou Attorney
Packet Page -823- 9
5/10/2016 16.D.6.
�.
UEPARTRiL-"NT OF
51MRAe
AUTHORITY: This farm 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.
Y A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide
services to the elderly, has direct, face-to-face contact with a client while providing services to the client
and has access to the client's living area, funds, personal property, or personal identification information
as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential
facilities; and volunteers." § 430.0402(1)(b), Fla. Stat.
ATTESTATION:
As the duly authorized representative of Collier County Community and Human Services
Employer Name
located at 3339 Tamiami Trail E Room 211 Naples FL 34112
Street Address city State ZIP code
I, Kimberley Grant Director of Community and Human Services do hereby affirm under penalty of perjury
Name of Representative
that the above named employer is in compliance with the provisions of Chapter 435 and section
430.0402, Florida Statutes, regarding level 2 background screening.
Signature of Representative Date
STATE OF FLORIDA, COUNTY OF Collier
Sworn to (or affirmed) and subscribed before me thisday of=»� 20, by
b u 1i t'l 'CoA " (Name, of Representative) who is personally known
to me or produced as roof of identification.
p* e"' •., PRISCILLA DORIA
MY COMMISSION it EE 876607 1
DOEA Form 235, Affidavit of Compliance - Employer, Effective April 2012 Section 435.05(3), F.S.
Form available at: htt : elderaffairsstate.fl.us/engiishJb
Packet Page -824-
5/10/2016 16.D.6.
,-. —.� T' T i1T17'Y1 A 7lTn A n rTt iri 7%T'r nV T'i T JIF_R A RVA A 1l112 C
—--
CIVIL RIGHTS COMPLIANCE CHECKLIST
Progran,/facility Name: Collier County Community and Human
County:
AAA/Contractor
AAA Southwest Florida
Collier
of
Services
care, facility adult day care, case management and nutrition services to frail, elderly residents of Collier County.
Address:
Completed By:
3339 Tamiami Trail E, Room 211
Lisa N. Carr
City, State, Zip Code:
Date:Telephone:
239-252-2339
Naples, FL 34122
January 8, 2015
%Hispanic
Other
r...r a mr T ti/fTTd"U \DTT
T TT17T P vnrt 4-0K4PTRTF. THIS
rAK 11: 1<L' A31 ME A l I Hl-ni.L Tiru a fIUi.. av,.o a v.= .......... ... . . . . .. .• •_ ____.� _ _ _ _ . .
FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided: Collier County Community
and Human Services is situated over a 2,300 square mile area. Collier County Community and Human Services provides in-home
care, facility adult day care, case management and nutrition services to frail, elderly residents of Collier County.
2. POPULATION OF AREA SERVED. Source of data:
Total#
%White
%Black
%Hispanic
Other
%female
341,015
96.4%
2.7%
7.0%
.9%
53.8%
3. STAFF CURRENTLY EMPLOYED. Effective date:
Total # % White % Black % Hispanic % Other %female %Disabled
0%
7 50010 20% 20% 10% 90%
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
Total # % White %Black % Hispanic %Other %Female % Disabled
% Over 40
300%
381 64% 9% 33% 22% 64% n/a
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total #
% White
% Black
% Hispanic
%Other
% Female
% Disabled
5
100%
40%
0
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❑
YES®
NO❑
7. Compare the staff composition to the population. Is staff representative of the population?
If N/A or NO, explain. N/A YES
I❑ ®
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 YES
❑ ®
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 YES
NO
10. Are all benefits, services and facilities available to applicants and participants in an equally effective
regardless of race, sex, color, age, national origin, religion or disability? If N/A or NO, explain. N/A
YES
NO
manner
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
YES
NO
13. Are employees, applicants and participants informed of their protection against discrimination? If YES, N/A YES NO
1
Packet Page -825-
5/10/2016 16.D.6.
how? Verbal ❑ Written ® Poster ® If N/A or NO, explain.
❑ ® ❑
14. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility.
N/A
NUMBER
15. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? If N/A or
NO, explain.
N/A
YES NO
❑
® ❑
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.
YES
NO
❑
❑
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If
NO, explain.
YES
NO
❑
❑
18, Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES
NO
❑
❑
19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination
on the basis of disability? If NO, explain.
YES
NO
❑
❑
20. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals? If
NO, explain.
YES
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.
YES
NO
❑
❑
1 i
Reviewed By In Compliance: YES ❑ NO* ❑
Program Office *Notice of Corrective Action Sent
Date
Telephone Response Due
On -Site ❑ Desk Review ❑ Response Received I /
Revised August 2010, Page 2 of 2
2
Packet Page -826-
5/10/2016 16. D.6.
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 pet -sons 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, Iibraries, 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- DOER 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
Packet Page -827-
5/10/2016 16.D.6.
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 101-11, Revised August 2010
4
Packet Page -828-
L.VI'1'1 l\ltl'LL'1\1 VCj
5/10/2016 16.D.6.
r
ELDER.!
2014 Florida County IRSI
STAT£ OF FLORIDA
Collier
amp" by Age Category
All Ages
341,015
100.0%
Under 60
224,649
65.9%
60+
116,366
34.1%
65+
92,803
27.2%
70+
67,616
19.8%
75+
43,669
12.8%
80+
25,513
7.5%
85+
11,541
3.4%
-tel Fnanctaf Status (80�; % 60+} „_,,_
White
112,198
96.4%"
Non -White
4,168
3.6%
Black
3,092
2.7%
Other Minorities
1,076
0.9%
Poverty Guideline
10
Sheltered Beds
P;o utatton b'`
Ethnictt 60+M
0
Total Hispanic
8,153
7.0%
White
7,807
6.7%
Non -White
346
0.3%
Total Non -Hispanic
108,213
93.0%
Total Minorities'
11,975
10.3%
"���aPopufat�on by Gender.{fi0+), ��� _
Population 60+
116,366
34.1%
Male
53,811
46.2%
Female
62,555
518%
-tel Fnanctaf Status (80�; % 60+} „_,,_
Below Poverty Guideline
8,119 7.0%
Below 125% of Poverty
11,174 9.6%
Guideline
153
Minorities Below Poverty
2,292 2,0%
Guideline
0
Minorities Below 125% of
3,157 2.7%
Poverty Guideline
10
aMedy Undersery
fcalletl},(65�j rx
Total Medicallyy Underserved 23,317
Medically Underserved
Populations - Living in Areas 23,317
Defined as Having Medically
Underserved Populations
Medically Underserved Areas -
Living in Medically Underserved 0
Areas
Ltung Slfuatton (60+)
Living Alone 21,803
Male 6,540
Female 15,263
Total 60+ Living With Own 3,659
Grandchildren Under Age 18)
Grandparent Responsible for
Own Grandchildren 751
(Under Age 18)
Grandparent Not Responsible
for Own Grandchildren 2,913
60+ Not Living With Own 111,676
Grandchildren (Under Age 18)
Skilled Nursing (=acuity Util,tzttongg
SNF Beds
908
Community Beds
755
Sheltered Beds
153
Veterans Administration Beds
0
Other Beds
0
SNFs With Beds
13
Community Beds
10
Sheltered Beds
3
Veterans Administration Beds
0
Other Beds
0
SNFs With Community Beds
10
Community Bed Days
275,575
Community Patient Days
245,142
Medicaid Patient Days
116,713
Occupancy Rate
89.0%
Percent Medicaid
47.6%
R Home Health ggenckes
Y
Agencies
34
Medicaid Certified Agencies
2
Medicare Certified Agencies
10
Homemaker& Gomtpanaon Serr��ce
Companies 24
gmbu[atorySurgical Centers ;; x .'
Facilities 14
Operating Rooms 32
Recovery Beds 74
Packet Page -829-
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5/10/2016 16.D.6.
ELDER
201 1 ri o my Profiles AFFAIRSi
STATE OF FLORIDA
Collier (Continued)
-::mss lilt. i_ e
wg_ a
n�
Rural (Yes/No) NO
RE,As: j4f6 l V1' F`acil[ties
Total Beds
1,334
OSS Beds'
6
Non -OSS Beds
1,328
Total Facilities
19
Facilities With ECC License'
8
Facilities With LMH License
1
Facilities With LNS License'
8
-.
Medical Doctors
Registered to Vote in
Licensed
Hospitals
5
Hospitals With Skilled Nursing Units
0
Hospital Beds
980
Skilled Nursing Unit Beds
0
-.
Medical Doctors
Registered to Vote in
Licensed
831
Limited License
21
Critical Need Area License
8
Restricted
0
Medical Faculty Certificate
0
Public Heath Certificate
0
Specialties
39.7%
Licensed Podiatric Physicians
31
Licensed Osteopathic Physicians
82
Licensed Chiropractic Physicians
103
Registered Nurses
Licensed Registered Nurses
3,350
Participants (60+) 3,667
Potentially Eligible 11,174
Food Stamp Participation Rate 60+ 32.8%
yc is d Of@ s'�r
�
,es
Registered to Vote in
Drivers With Florida Driver's
Florida - All Ages
Medicaid Eligible - 60+
262,597
License - All Ages
Florida - Age 60+
Drivers With Florida Driver's
Percent of Population Registered
License - Age 60+
104,344
Percent of Drivers With Florida
4,295
Independent Living
39.7%
Driver's License - Age 60+
13,203
Participants (60+) 3,667
Potentially Eligible 11,174
Food Stamp Participation Rate 60+ 32.8%
yc is d Of@ s'�r
�
,es
Registered to Vote in
178,913
Florida - All Ages
Medicaid Eligible - 60+
Registered to Vote in
90'101
Florida - Age 60+
Dual Eligible - 60+
Percent of Population Registered
50.4%
to Vote in Florida - Age 60+
Self -Care
H�use'fi: sTVV>it1�-fi�t�t8u. cle kiov�i==.;
>
30 fl a d 1>r�cotir�e�e�o�nr�SQ. o �,e�
Elder Households 49,733
Percent of All Households 10.6%
�,�'clian House_holtl Iticome��All?Ages��:j
2008-2012 $56,104
'�.`5"�=c�sN.� •:"A:
FP f
z z� IVi.ai 8:NleclicalreEi�gbli �;>:
�
,es
`
Medicaid Eli ible Ai! A
9 9
4
Medicaid Eligible - 60+
5,391
Dual Eligible - All Ages
6,138
Dual Eligible - 60+
4,611
.j ::.,.-. f_ J5$. 3.. r„u+ ';ii•;;;c: . yt�ti:`"z: ,.ygNg:- n.�.:. n.�:9. u � � "�'"3.-^• `}-< H" '.S' �'�<�T�n''3 <Y,d co-
�:i::
`
Total
25,135
Age 45-64
6,722
Age 65-84
15,182
Age 85+
3,231
_ '-ip; .+r'ro5,'n3s'- �,w.?,n;�.::{.,�pr: }y `T•'S`o<y5'� •,y". ;_.. e.a�r'�,yie:^:.cg?s�.
With One Type of Disabilitye
13,246
Hearing
11,930
Vision
4,405
Cognitive
6,308
Ambulatory
15,896
Self -Care
4,295
Independent Living
10,153
With Two or More Disabilities
13,203
With No Disabilities
91,584
Probable Alzheimer's Cases'
12,467
` n<wuEriglish ProflciencY {60)
With Limited English Proficiency 6,138
Packet Page -830-
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Ei.DER
014 Florida ®I.BC1tyProfiles�FF.r.ORD
SSI�YE QF PCQRiDp �
011ier (Continued)
Costof Lllyng �:
Annual
Expenses
Single Elders
Owner without Mortgage $25,104
Renter, one bedroom $29,364
Owner with Mortgage $37,920
Elder Couple
Owner without Mortgage $37,572
Renter, one bedroom $41,832
Owner with Mortgage $50,388
Note: Wider Opportunities for Women Elder Economic
Security Standard TM Index (Elder Index) measures how
much income retired older adults require to meet their
basic needs—without public or private assistance. The
Elder Index measures basic expenses for elders age
65+ living in the community, not in institutions.
Packet Page -831-
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5/10/2016 16.D.6.
ELDER
kF�
2014 1 ri �
County P�o�'
STdTE OF Ft,OftipA i
'Total Minorities = (60+ Population) — (White Non -Hispanic 60+)
2OSS beds: Optional State Supplementation beds
3 ECC License: Extended Congregate Care License
4 LMH License: Limited Mental Health License
5 LNS License: Limited Nursing Services License
6 With One Type of Disability: 65+ people who have only one type of disability
7 Probable Alzheimer's Cases = (65-74 Population x 0.0334) + (75-84 Population x 0.1760) + (85+ Population x
0.4480)
a Annual expenses include: housing, including utilities, taxes, insurance; food; transportation; health care, based
on good health; and miscellaneous.
Sources
• Population: Florida Population by County, Age, Race, Ethnicity and Gender provided by Florida Legislature, Office of Economic
and Demographic Research
• Financial Status & Living Situation: Department of Elder Affairs calculations based on Florida Population data and 2007-2011
American Community Survey
• Medically Underserved Population (Data as of 7/18/2014): Florida Department of Health and U.S. Department of Health and
Human Services
• Grandparents: Department of Elder Affairs calculations based on Florida Population data and 2007-2011 American Community
Survey, Special Tabulation on Aging
• Skilled Nursing Facility Utilization, Adult Day Care, Adult Family Care Home, Ambulatory Surgical Centers, Assisted Living
Facilities, Home Health Agencies, Homemakers & Companion Service Companies, Hospitals: Florida Agency for Health Care
Administration
• Rural Designation: Based on the definition of Rural Designation by Rural Economic Development Initiative
• Medical Professionals: Florida Department of Health
• Driver's License: Florida Department of Highway Safety & Motor Vehicles
• Food Stamps: Florida Department of Children and Families
• Registered Voters (Data as of 1/31/2014) : Florida Department of State
• Households with Cost Burden Above 30% and income below 50% Area Median Income: The Shimberg Center for Housing Studies
• Median Household Incomes: U.S. Census Bureau: State and County QuickPacts
• Medicaid & Medicare Eligibility and Medicaid Eligibility: Florida Agency for Health Care Administration
• Veterans Demographics: Florida Department of Veterans' Affairs
• Disability Status: Department of Elder Affairs calculations based on Florida Population data and 2009-2011 American Community
Survey Data
• Probable Alzheimer's Cases: Department of Elder Affairs calculations based on Florida Population data and Alzheimer's by Age in
2014 Alzheimer's Disease Facts and Figures report at
httU'//www alz oreJdocuments custom/facts 2014/alz ff tlorida pdi'?type=interior man&facts=undefined&facts=facts
• Engl ish Proficiency: Department of Elder Affairs calculations based on Florida Population data and 2007-2011 American
Community Survey, Special Tabulation on Aging
• Cost of Living (Data as of 7/18/2014): Wider Opportunities for Women Elder Economic Security StandardTM Index (Elder Index)
at http://%vww.basicecononiiesectirity,or EU
Packet Page -832-