Backup Documents 10/14/2014 Item #16D10 1 60 10
HOUSING HUMAN AND VETERIAN SERI VCES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grants Coordinator, HHVS
DATE: October 14, 2014
RE: Contract amendments between Area Agency on Aging for Southwest Florida, Inc
and Collier County: ADI 203.14.001, HCE 203.14.001 and NSIP 203.15
Contract
Please find attached one (1) each fully executed documents that were approved by the BCC on
the days listed below for recording in Minutes and Records. Feel free to contact me if you have
any questions.
BCC Approved on October 14, 2014:
Item: 16.D.9- ADI 203.114.001 and HCE 203.14.001
Item: 16.D.10- Contract NSIP 203.15
Thank you for your assistance.
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AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
STANDARD CONTRACT
NUTRITION SERVICES INCENTIVE PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and
Collier County Board of County Commissioners (Contractor), and collectively referred to as the"Parties."
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.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments,proposal(s),state plan(s),grant agreements,relevant Department handbooks,
manuals or desk books and Master Contract number I-11V1014,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 October 1,2014 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 September 30, 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 $38,255 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. Renewals
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 determining 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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• funds.
6. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
Collier County Housing,Human and Veteran
The Contractor name, as shown on page 1 of this Services
a. contract, and mailing address of the official payee to 3339 E Tamiami Trail, Building H
whom the payment shall be made is: Naples, FL 34112
Kimberly Grant, Director
Collier County Housing, Human and Veteran
b The name of the contact person and street address where Services
financial and administrative records are maintained is: 3339 E Tamiami Trail, Building H
Naples, FL 34112
Kimberly Grant, Director
The name, address, and telephone number of the Collier County Housing, Human and Veteran
C. representative of the Contractor responsible for Services
administration of the program under this contract is: 3339 E Tamiami Trail, Building H
Naples, FL 34112
(239)252-2273
Nancy Dean, Financial Officer
d The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure 15201 North Cleveland Avenue, Suite 1100
forms are to be mailed is: North Fort Myers,FL 33903
239-652-6900
Marianne Lorini,President/CEO
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 Cleveland Avenue, Suite 1100
North Fort Myers,FL 33903
239-652-6900
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, and VII and any exhibits referenced in said attachments, together
with any documents incorporated by reference, contain all the terms and conditions agreed upon by the
Parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and
this contract shall supersede all previous communications, representations or agreements, either written or
verbal between by signing this contract, the Parties agree that they have read and agree to the entire
contract.
IN WITNESS THEREOF, the Parties hereto have caused this contract, to be executed by their undersigned
officials as duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
C• f T COMMI�NERS SOUTHWEST FLORIDA,INC.
SIGNED BY: j'.'rgi l 60' SIGNED BY: .�. >HidLLltA:_
NAME: Stephen Y. Carnell NAME: MARIANNE G LORINI
TITLE: Public Services Administrator TITLE: PRESIDENT/CEO
DATE: September 5, 2014 DATE: (11.25-1)01q
Federal Tax ][ 5,000558 Approved as to form and legality
DWIGHT E. BROCK, Clerk 2 \,y9�
By. ' �� Assistant County rney cog
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INDEX OF ATTACHMENTS
ATTACHMENT I STATEMENT OF WORK....................................... 4
ATTACHMENT III FUNDING SUMMARY....................................... .12
ATTACHMENT HI EXHIBIT 1.............................................................................................................................13
ATTACHMENT VII REQUEST FOR REIMBURSEMENT............................................................ 14
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ATTACHMENT I
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.INC.
STATEMENT OF WORK
NUTRITION SERVICES INCENTIVE PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Area Agency on Aging(AAA)
Client Information and Registration Tracking System(CIRTS)
Dietary Reference Intake(DRI)
Nutrition Services Incentive Program(NSIP)
Older Americans Act(OAA)
Planning and Service Area(PSA)
United States Department of Agriculture(USDA)
State of Florida(State)
Department(Florida Depaitment of Elder Affairs)
DOEA(Department of Elder Affairs)
1.1.2 PROGRAM SPECIFIC TERMS
Area Plan: A plan developed by the Area Agency on Aging outlining a comprehensive and coordinated
service delivery system in its planning and service area in accordance with Section 306 (42 U.S.C. 3026)
of the OAA and Agency instructions.
Area Plan Update: A revision to the area plan wherein the Area Agency on Aging enters OAA program
specific data in the CIRTS. An update may also include other revisions to the area plan as instructed by the
Agency.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
The NSIP is intended to provide incentives for the effective delivery of nutritious meals to older individuals.
NSIP allows programs to increase the number and/or the quality of meals served. NSIP is a cash allotment
or commodity program that supplements funding or food used in meals served under the OAA. Florida has
opted for cash payments in lieu of donated foods.
1.2.2 Authority
The relevant authority governing NSIP are:
(1) Older Americans Act of 2006, as amended, Section 311 (42 U.S.C. § 3030a)
(2) 42 U.S.C. 303a, 42 U.S.C. 604
(3) Section 430.101,Florida Statutes.
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1.2.3 Scope of Service
The Contractor is responsible for the programmatic, fiscal and operational management of the NSIP,
involving oversight of the nutrition service operations of its subcontracted providers. The program services
provided under this contract shall be provided in a manner consistent with and described in the Contractor's
current area plan update, which is incorporated by reference, and the current DOEA Program and Services
Handbook,which is also incorporated by reference.
1.2.3.1 In fulfilling the terms of this agreement, the Contractor's scope of services shall consist of completion of
the following service tasks: (1) Client Eligibility Determination; (2) Program Eligibility Compliance; (3)
Program Coordination and Oversight; (4) Ensuring Compliance with Prescribed Nutrition Requirements;
(5) Ensuring Compliance with Prescribed Food Origin Requirements; (6) Compliance with Program
Reporting and Records Management Requirements;and(7)Monitoring the Performance of Subcontractors.
1.2.3.2 The Contractor shall use the NSIP funding under this contract to supplement funding for food used in meals
served under the OAA.
1.2.4 Term of Provision of Services
The term of this contract for the delivery of services shall be as referenced in Paragraph 3 of this contract.
However, for the purpose of settling upon the appropriate meal reimbursement rate, as provided by USDA,
the contract shall remain open until December 31, 2015. Notwithstanding this three (3) month
reconciliation period, this contract makes no provisions for the payment of any services provided beyond
September 30,2015.
1.2.5 Major Program Goals
The major goals of the NSIP program are as follows:
(1) To supplement funding for food used in meals served by OAA Nutrition Program Providers;and
(2) Provide incentives for the effective delivery of nutritious meals to older individuals.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 Congregate Meals
Client eligibility for congregate meals is as follows:
(1) Individuals age 60 or older;
(2) Spouses(regardless of age)attending the dining center with their eligible spouse;
(3) Persons with a disability, regardless of age, residing in a housing facility occupied primarily by older
individuals where congregate nutrition services are provided;
(4) Persons with disabilities residing at home with and accompanying an eligible person to the dining
center; and
(5) Volunteers, regardless of age, providing essential services on a regular basis during meal hours.
1.3.2 Home Delivered Meals
Client eligibility for congregate meals is as follows:
(1) Individuals age 60 or older who are homebound by reason of illness, disability or isolation;
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(2) The spouse of a homebound eligible individual,regardless of age if the provision of the collateral meal
supports maintaining the homebound eligible individual at home;
(3) Individuals with a disability, regardless of age, residing at home with eligible individuals and are
dependent on them for care;
(4) Persons at nutritional risk having physical,emotional or behavioral conditions,which would make their
presence at the congregate site inappropriate; and
(5) Persons at nutritional risk who are socially or otherwise isolated and unable to attend a congregate
nutrition site.
1.3.3 Restrictions
Meals served to an elderly individual funded in whole or in part under the Medicaid Waiver, Home Care
for the Elderly or Community Care for the Elderly Programs or other means tested programs may not be
included in the NSIP count.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
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 I,Section 1.3.
2.1.2 Program Eligibility Requirements
Entities must meet the following criteria in order to be eligible for program participation:
(1) An agency that has received a grant under the OAA Title III(OAA section 311(42 U.S.C.3030a)); and
(2) A nutrition service provider that serves meals and is under the jurisdiction, control, management and
audit authority of the Area Agency on Aging and the Department of Elder Affairs.
2.1.3 Oversight of Provider's Nutrition Service Operations
The Contractor shall oversee the nutrition service operations of the provider to ensure that the requirements
of ATTACHMENT I are met, as well as any other applicable regulations and policies prescribed by the
Department of Health and Human Services,USDA, state and local health departments or any other agency
designated to inspect meal quality for the State.
2.1.4 Prescribed Nutritional Requirements
The Contractor shall ensure that each meal provided under this NSIP contract meets the following criteria:
(1) Comply with the current Dietary Guidelines for Americans, published by the Secretaries of the
Department of Health and Human Services and the Department of Agriculture; and
(2) Provide a minimum of 33 1/3 percent of the dietary reference intakes/adequate intakes for an age 70+
female as established by the Food and Nutrition Board of the National Academy of Sciences.
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NSIP 203.15
2.1.5 Food Origin and Commodities Requirements
Consistent with existing requirements of the Nutrition Services Incentive Program, the Contractor and its
service providers may use NSIP cash to purchase foods of U.S.origin for their nutrition projects under Title
III of the OAA. NSIP funds must be used to expand meal services to older adults.
2.1.6 Compliance with Program Reporting and Records Management Requirements
(1) The Contractor shall ensure that all program reporting requirements evidencing service delivery are
timely met. The Contractor must establish interim report submittal due dates for its providers or
Subcontractors to permit the Contractor to meet the Agency's reporting deadlines.
(2) In addition to any special reports that may be requested by the Agency, the Contractor shall comply
with the reporting and records management requirements as referenced in this ATTACHMENT I,
sections 2.4 through 2.5.1.
2.1.7 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.
The Contractor shall not permit a Subcontractor to perform services related to this agreement without
having a binding Subcontractor agreement executed. In accordance with Section 25 of the Master Contract,
HM014 the Agency will not be responsible or liable for any obligations or claims resulting from such
action.
2.1.8 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 contract. 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 time 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.
2.2 SERVICE TIMES
2.2.1 Service Times
The Contractor shall ensure the services listed in this contract are available at times appropriate to meet
client service needs, at a minimum, during normal business hours. Normal business hours are defined as
Monday through Friday, 8:00am to 5:00pm.
2.3 DELIVERABLES
2.3.1 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 service tasks described in
ATTACHMENT I, Section 2.1. The chart below lists the type of services allowed and the unit of
measurement:
Service Unit of Service
Congregate Meals Meal
Home Delivered Meals Meal
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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 Area Plan Update and All Revisions Thereto
The Contractor is required to submit an area plan update wherein the Contractor enters OAA specific data
in the Client Information and Registration Tracking System(CIRTS).
2.4.2 Client Information and Registration Tracking System (CIRTS)Reports
The Contractor shall input NSIP 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 and Disability Resource Center Reports; and
(7) Outcome Measurement Reports.
2.4.3 Service Costs Reports
The Contractor shall require subcontractors to submit to the Contractor annual service cost reports which
reflect actual costs of providing each service by program. This report provides information for planning
and negotiating unit rates.
2.4.4 Surplus/Deficit Report
The contractor shall submit a consolidated surplus/deficit report in a format provided by the Agency to the
Contract Manager by the 18th of each month. This report is for all agreements and/or contracts between
the Contractor and the Department. The report will include the following:
(1) A list of all subcontractors and their current status regarding surplus/deficit;
(2) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by
the Agency will be resolved;
(3) Recommendations to transfer funds to resolve surplus/deficit spending;
(4)Input from the Contractor's Board of Directors on resolution of spending issues, if applicable;
(5) The number of clients currently on the Assessed Priority Consumer List(APCL)that receive a priority
ranking score of 4 or 5; and
(6) The number of clients currently on the APCL designated as Imminent Risk.
2.5 RECORDS AND DOCUMENTATION
The Contractor shall 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
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shall be as stringent as the protection required of the primary resources. It is recommended that a copy
of the backed up data be stored in a secure, offsite location. The 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 will be made
available to the Agency upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
The Contractor shall ensure services provided under this contract are in accordance with the current
DOEA Programs and Services Handbook.
The Contractor shall timely submit to the Agency all reports and information described in
ATTACHMENT I, SECTION 2.4 and 2.5.
2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.7.1. The Contractor agrees to distribute funds as detailed in this contract and the area plan update. Any changes
in the total amounts of the funds identified in this contract, number of meals served or meal rate require a
contract amendment. If the Agency determines that the Contractor is not spending service funds
accordingly, the Agency may transfer funds to other planning and service areas during the contract period
and/or adjust subsequent funding allocations accordingly, as allowable under state and federal law.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide the Contractor with guidance and technical assistance as needed to ensure the
successful fulfillment of the contract by the Contractor.
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.
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SECTION III: METHOD OF PAYMENT
3.1 GENERAL STATEMENT OF METHOD OF PAYMENT
This is a fixed rate contract. The Agency shall make payment to the Contractor for provision of services up to a
maximum number of units of service and at the prospective rate stated below:
Service to be Provided Unit of Service Unit Rate
Eligible Congregate and 1 unit— 1 meal $.72
Home Delivered Meals
The prospective rate is based on the estimated OAA grant award.
COLLIER
Service to be Provided Unit of Service Unit Rate Maximum Units Allocation
Eligible Congregate and 1 unit= 1 meal $.72 53,131 $38,255
Home Delivered Meals
3.2 REQUESTS FOR PAYMENT
3.2.1 Date for Final Request for Payment
(1) The final request for payment is due to the Agency no later than November 5. 2015. This contract is for
services provided during the 2014 Federal Fiscal Year beginning October 1. 2014 through ,September 30,
2015;however,the contract is in effect through December 31.2015. The additional three months(October 1,
2015 through pecember 31. 2015) are to allow rates to be adjusted for the service period. This contract shall
automatically terminate after the final rate for the federal fiscal year has been established and the release of
final payments are authorized by the Agency.
(2) In the event that the final reimbursement rate is greater or less than the rate in ATTACHMENT I, Section 3.1,
then this contract shall be appropriately adjusted upon notice from the Contract Manager.
(3) In the event of a conflict between this paragraph and any other provision in the contract, this section shall
supersede.
3.2.2 Documentation for Payment
The Contractor shall submit all requests for reimbursement in accordance with the Master Contract 1-11M014
(ATTACHMENT A)All requests for reimbursement must include the following:
(1) The Contractor shall submit the request for reimbursement on DOEA Form 117NSIP, NSIP Request
for Reimbursement, (ATTACHMENT VII);
(2) The Contractor shall submit a CIRTS report with DOEA Form 117NSIP as supporting documentation
for the total number of meals reported. The CIRTS report must match the number of meals reported
on DOEA Form 117NSIP;
(3) The due date for the request for reimbursement and report(s) is no later than the 21 day of the month
following the month being reported, except for the final request for reimbursement, which is due no
later than November S.2015.
3.2.2.1 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.
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3.2.2.2 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of complete and accurate financial and programmatic reports due from the
Contractor and any adjustments thereto, including any disallowance not resolved as outlined in Section 27
of the Master Contract HM014.
3.2.2.3 The Contractor must require Subcontractors to enter all required data per the Master Contract HM014
(ATTACHMENT A). The data must be entered into the CIRTS before the Subcontractors submit their
request for payment and expenditure reports to the Contractor. The Contractor shall establish time frames
to assure compliance with due dates for the submission of requests for payment and expenditure reports to
the Agency.
3.2.2.4 The Contractor must require Subcontractors to run monthly CIRTS reports and verify client and service
data in the CIRTS is accurate. This report must be submitted to the Contractor with the monthly request
for payment and expenditure report and must be reviewed by the Contractor before the Subcontractor's
request for payment and expenditure reports can be approved by the Contractor.
3.2.3 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 shall only be
delivered to eligible program participants.
3.2.3.1 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.
3.2.4 Consequence for Noncompliance/Financial Consequences
The Contractor shall ensure 100% of the deliverables identified in ATTACHMENT I are
performed pursuant to contract requirements. The Service Tasks identified in Section 2.1 are
Major Deliverables in this contract.
3.2.4.1 If at any time the Contractor is notified by the Agency's Contract Manager that it has
failed to correctly, completely, or adequately perform the Major Deliverables,the Contractor
will have 10 days to issue a Corrective Action Plan ("CAP") to the Contract Manager or
delegee that addresses the deficiencies and states how the deficiencies will be remedied
within the specified time period. The Agency shall assess a Financial Consequence of 1%
of the monthly value of the contract 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.
3.2.4.2 In the event the Contractor fails to correct an identified deficiency within the timeline
specified in the CAP, the Agency shall deduct, from the payment for the invoice of the
following month, 1% of the monthly value of the contract for each day the deficiency is not
corrected.
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ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Nutrition Services Incentive Program Collier County FGTF 93.053 $ 38,255.00
TOTAL FEDERAL AWARD $ 38,255.00
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200 Uniform Administrative Requirements,Cost Principles,and Audit Requirement for Federal Awards.
STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
TOTAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
N/A
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ATTACHMENT III
EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A-133,as
revised,and/or Section 215.97,Fla. Stat. Providers who are determined to be Recipients or Subrecipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II
of Exhibit I are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-
133,as revised,and/or Section 215.97,Fla.Stat. Regardless of whether the audit requirements are met,providers who have been
determined to be Recipients or Subrecipients of Federal awards and/or state financial assistance,must comply with applicable
programmatic and fiscal compliance requirements.
In accordance with Sec.210 of OMB Circular A-133 and/or Rule 69I-5.006,FAC,provider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A-133 and/or Section 215.97,F.S.
Recipient/Subrecipient subject to OMB Circular A-133 and/or Section 215.97,F.S.
NOTE: If a provider is determined to be a Recipient/Subrecipient of federal and or state financial assistance and has been approved
by the Agency to subcontract,they must comply with Section 215.97(7),F.S.,and Rule 69I-5.006(2),FAC [state financial
assistance]and Section 400 OMB Circular A-133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive federal awards or
state matching funds on federal awards and who are determined to be a Subrecipient,must comply with the following fiscal laws,rules
and regulations:
STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 200 Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-102—Administrative Requirements
OMB Circular A-133—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 200 Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
EDUCATIONAL INSTITUTIONS(EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT)MUST
FOLLOW:
2 CFR Part 200 Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
*Some federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular
A-133 Compliance Supplement,Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
Recipient/Subrecipient,must comply with the following fiscal laws,rules and regulations:
Section 215.97,Fla.Stat.
Chapter 69I-5,Fla.Admin.Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations.
13
Cop
Qctober 2014 - September 2015 NSIP 203.15
16010
ATTACHMENT VII
REQUEST FOR REIMBURSEMENT
Nutrition Services Incentive Program
PROVIDER NAME,ADDRESS,PHONE#and FEID# TYPE OF REPORT: THIS REQUEST PERIOD:
Payment Request: From To
Regular Final Report#
Contract Period To
Contract#
PSA#
CERTIFICATION: I hereby certify that to the best of my knowledge the information in this report is accurate and complete and that all outlays reported hereinwere for purposes
set forth in the contract documents.
Prepared by: Date: Approved by: Date
PART A: REIMBURSEMENT COMPUTATION YEAR TO DATE CURRENT MONTH
CONGREGATE HOME DELIVERED CONGREGATE HOME DELIVERED
1.Number of Meals Served 0 0 0 0
2.Line 1 Times$.72 cents per Meal $0.00 $0.00 $0.00 $0.00
Year To Dale Total Meals 0 Current Month Total Meals 0
Year To Date Total Reimbursed $0.00 Total Reimbursement Requested $0.00
PART B: CONTRACT SUMMARY
1.Approved Contract Amount $0.00
2. Previous Reimbursements Requested $0.00
3. Contract Balance $0.00.
4.Amount to be Reimbursed-This Report $0.00
5. Contract Balance $0.00
DOEA For 117nsip revised 7/14
14
CA()
16010
Attestation Statement
Agreement/Contract Number NSIP 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 and
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.
�� (it 6(//z/
9/5/2014
Signature of Recip nt/Contractor representative Date
Approved as to form and leg,
Assistant County^torncNJ (o i¢.
S