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Agenda 09/27/2016 Item #16D15 16.D.15 09/27/2016 EXECUTIVE SUMMARY Recommendation to approve "after-the-fact" Amendment and Attestation Statements to the Community Care for the Elderly, Alzheimer's Disease Initiative and the Home Care for the Elderly programs with Area Agency on Aging for Southwest Florida, Inc. for Services for Seniors programs (No Fiscal Impact). OBJECTIVE: To provide uninterrupted support services to Collier County Services for Seniors' (CCSS) elderly clients. CONSIDERATIONS: The Community and Human Services' Services for Seniors program has been providing support to Collier County's frail and elderly citizens for over thirty years through the Federal and State of Florida grants. The Community Care for the Elderly (CCE), Alzheimer's Disease Initiative (ADI) and Home Care for the Elderly (HCE) programs are funded by the Florida Department of Elder Affairs (DOEA) through the Area Agency on Aging for Southwest Florida, Inc. (Agency). These grant- funded services enable seniors to remain in their homes and live with independence and dignity. On August 9, 2016, the County Manger approved the current grant contract with Area Agency on Aging for Southwest Florida, Inc. (Absentia Agenda item 16D3). These contracts have a one-year term, effective July 1, 2016 through June 30, 2017 and will be presented to the Board for ratification on September 27, 2016. The proposed CCE, ADI and HCE amendments add language requiring the County to respond to additional routine or special requests for information and reports required by the Agency in a timely manner as determined by the Contract Manager. The County shall establish reporting due dates for Subcontractors that permit the County to meet the Agency's reporting requirements. These provisions are stated in section Attachment I, Manner of Service Provision, E. Reports. This item is being presented "after-the-fact"because Collier County received the grant agreement on July 29, 2016 from the Agency with a request for a 30-day turnaround. The Agency routinely sends CCSS amendments with an effective date prior to the dated the document is received which requires prompt attention. Pursuant to CMA 5330 and Resolution No. 2010-122, the County Manager authorized Steve Carnell, Public Services Department Head, to sign the agreement. These amendments are 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 CCE, ADI and HCE program services. FISCAL IMPACT: Funding from the Department of Elder Affairs via the Area Agency on Aging under the 2016 grant award is available in Human Services Grant Fund 707, Project 33462 (CCE), Project 33461 (ADI) and Project 33463 (HCE). There is no fiscal impact associated with this action at this time. GROWTH MANAGEMENT: There is no growth management impact associated with this action. 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 the after-the-fact Amendments and Attestation Statements with Area Agency on Aging for Southwest Florida, Inc. I Packet Pg. 1243 I 16.D.15 09/27/2016 Prepared by: Lisa N. Carr,Grants Coordinator, Community and Human Services ATTACHMENT(S) 1. CCE 203.16.001 (PDF) 2.ADI 203.16,001(PDF) 3. HCE 203.16.001 (PDF) 4. CCE 203,16 Contract (PDF) 5. ADI 203.16 Contract (PDF) 6. HCE 203.16 Contract (PDF) I Packet Pg. 1244 16.D.15 09/27/2016 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.15 Item Summary: Recommendation to approve "after-the-fact" Amendment and Attestation Statements to the Community Care for the Elderly, Alzheimer's Disease Initiative and the Home Care for the Elderly programs with Area Agency on Aging for Southwest Florida, Inc. for Services for Seniors programs (No Fiscal Impact). Meeting Date: 09/27/2016 Prepared by: Title: Grants Coordinator—Community&Human Services Name: Lisa Carr 09/02/2016 5:33 PM Submitted by: Title: Division Director-Cmnty& Human Svc—Public Services Department Name: Kimberley Grant 09/02/2016 5:33 PM Approved By: Review: Public Services Department Amanda O.Townsend Level 1 Sim.Reviewer 1-8 Completed 09/05/2016 11:09 AM Public Services Department Kristi Sonntag Level 1 Sim.Reviewer 1-8 Completed 09/06/2016 8:57 AM Community&Human Services Kristi Sonntag Level 1 Sim.Reviewer 1-8 Completed 09/06/2016 8:58 AM Community&Human Services Dora Carrillo Level 1 Sim.Reviewer 1-8 Completed 09/06/2016 10:32 AM Community&Human Services Maggie Lopez Level 1 Sim.Reviewer 1-8 Completed 09/07/2016 8:37 AM Public Services Department Hailey Margarita Alonso Level 1 Division Reviewer Completed 09/09/2016 3:57 PM Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 09/09/2016 4:26 PM Grants Erica Robinson Level 2 Grants Review Completed 09/14/2016 11:45 AM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 09/15/2016 8:05 AM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 09/15/2016 11:14 AM County Attorney's Office Jeffrey A.Klatzkow Level 3 County Attorney's Office Review Completed 09/15/2016 11:22 AM Grants Therese Stanley Level 3 OMB 1st Reviewer 1-4 Completed 09/16/2016 4:24 PM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 09/18/2016 9:55 PM Board of County Commissioners MaryJo Brock Meeting Pending 09/27/2016 9:00 AM I Packet Pg. 1245 (e6ueyo a6en6ue-j anuanay awls L4-94 Ad Z£64) 1,00.91:£0Z 333 :;uewyoelly N n uty 2016 to June 2017 CCE 203.16.001 a a 15 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. m C1- COMMUNITY COMMUNITY CARE FOR THE ELDERLYPROGRAM 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"), amends agreement CCE 203.16. The purpose of this amendment is to change language in ATTACHMENT I,E Reports,#2 Service Cost Reports. ATTACHMENT I E. Reports 2. Service Cost Reports a. The Agency shall require the Contractor to submit Annual Service Cost Reports, which reflect actual costs of providing each service by program. Service Cost Reports for all contracts are due by February 15, 2017 for the prior calendar year. b. Unit Cost Methodology worksheets must be submitted by August 1 of each year, if a rate increase is being requested for any contract in the next calendar year. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to 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 contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this 1 page amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this CCE contract as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR OF COUNTY C.01 I SSIONERS SOUTHWEST FLORIDA,INC. SIGNED BY: . 0 ri c./� 041 ,,..,k_ _ SIGNED B �2 �i U`Z /J� Y. (� L NAME: STEVE CARNELL NAME: MARIANNE G LORINI TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO j DATE: f 1 l f i ` DATE: ` ,/t !�/`� Federal Tax ID: 59-6000558 Fiscal Year Ending Date: 09/30 • Approved as to form and legality Assistant County Attorney C \\'`:\--C2 (a6ueyo a6en6uei anuanej a;e;S L4-94 Aj : ZE64) 400'94'£0Z 300 :;uawyoe;;fir cv T !� Revised August 2007 tr m Y C) ca a Attestation Statement Agreement/Contract Number CCE 203.16 Amendment Number 001 I, Steve 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 Collier County Board of County Commissioners (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 of Recipie /Contractor representative Date Approved as to form and legality Assistant County Attorney '17 l� w Revised August 2007 (e6uega elen6ue-I anuenaB alelS L1•-91• Ad : ZE61,) 1.00'91.tOZ Iab :;uewgoe;;y cor o July 2016 to June 2017 ADI 203.16.001 to a AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. ALZHEIMER'S DISEASE INITIATIVE PROGRAM a 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"), amends agreement ADI 203.16. The purpose of this amendment is to change language in ATTACHMENT I,MANNER OF SERVICE PROVISION,E Reports,Service Cost Reports. ATTACHMENT I MANNER OF SERVICE PROVISION E. Reports The Contractor shall respond to additional routine 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 reporting due dates for Subcontractors that permit the Contractor to meet the Agency's reporting requirements. Service Cost Reports a. The Agency shall require the Contractor to submit Annual Service Cost Reports, which reflect actual costs of providing each service by program. Service Cost Reports for all contracts are due by February 15, 2017 for the prior calendar year. b. Unit Cost Methodology worksheets must be submitted by August 1 of each year, if a rate increase is being requested for any contract in the next calendar year. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to 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 contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this 1 page amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this ADI contract as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR OF COUNTY FM 1 SSIONERSI � SOUTHWEST FLORIDA,INC. SIGNED BY: / j1' ;� /J ,� F }1 SIGNED BY: /l t-�,�--1z.ff-2 �!� 261-711U NAME: STEVE CARNELL NAME: MARIANNE G LORINI TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO DATE: O/i DATE: / /i Federal Tax ID: 59-6000558 Approved as to form and legality Fiscal Year Ending Date: 09/30 (a6uego aBen6uei anuanaN ems L4-9l. Ad : Z£66) 600`96'£OZ It7v :luauayoellb' t1� N CO Revised August 2007 n. as Attestation Statement Agreement/Contract Number ADI 203.16 Amendment Number 001 I, Steve 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 Collier County Board of County Commissioners (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. 5 » l6 Signatu e of Re . ient/Contractor representative Date Approved as to form and legality Assistant County Attorney Revised August 2007 (e6ueg3 e6en5uei anuanaa alms L4-94 Ad : Z£61.) L00-96'£OZ 33H :;uewgoe;;y o 16 !Lily GV1V LV JULIO GVt/ 111..L L VJ.1 V.1 In N 6 ,- f.16 LO T C) a AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. . n a HOME CARE FOR THE ELDERLY PROGRAM 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"), amends agreement HCE 203.16. The purpose of this amendment is to amend AMENDMENT VII by adding due dates for the Utilization Report and the billing for Basics and Subsidies and change language in ATTACHMENT I,E Reports,#2 Service Cost Reports. ATTACHMENT I E. Reports 2. Service Cost Reports a. The Agency shall require the Contractor to submit Annual Service Cost Reports, which reflect actual costs of providing each service by program. Service Cost Reports for all contracts are due by February 15, 2017 for the prior calendar year. b. Unit Cost Methodology worksheets must be submitted by August 1 of each year, if a rate increase is being requested for any contract in the next calendar year. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to 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 contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this 2 page amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this HCE contract as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR OF COUNTY C M .SIONERS \ SOUTHWEST FLORIDA,INC. SIGNED BY: 11 ) �� ', SIGNED BY: �. -4.kr advs }/5 0<G�,_,�c., NAME: STEVE CARNELL NAME: MARIANNE G LORINI TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO DATE: ' 3/1/-7///' DATE: Sli, SI/Ca Federal Tax ID: 59-6000558 Fiscal Year Ending Date: 09/30 Approved as to form and legality t ' C)3?1‘\147 1 Assistant County Attorney c (a6ue43 a6en6uei anuanam ale;S L4-94 Ad : ZE64) 400.94'£0Z 33H :4uawyae44 7 LO r �u1y GU 1010 JUNG GV 1/ is L v�.iv.i N 6 ATTACHMENT VII HOME CARE FOR THE ELDERLY a. INVOICE REPORT SCHEDULE U CIS ,_port Number Based On Submit to Agency on this Date a. 1 July Advance* July 1 2 August Advance* July 1 Monthly Utilization Report(7/1-7/15) July 20 3 July Expenditure Reports (105 & 106) August 9 Monthly Utilization Report(7/16-8/15) August 20 4 August Expenditure Report(105 & 106) September 9 Monthly Utilization Report (8/16-9/15) September 20 5 September Expenditure Report(105 & 106) October 9 Monthly Utilization Report (9/16-10/15) October 20 6 October Expenditure Report (105 & 106) November 9 Monthly Utilization Report (10/16-11/15) November 20 7 November Expenditure Report (105 & 106) December 9 Monthly Utilization Report(11/16-12/15 December 20 8 December Expenditure Report (105 & 106) January 9 Monthly Utilization Report(12/16-1/15) January 20 9 January Expenditure Report (105 & 106) February 9 Monthly Utilization Report(1/16-2/15) February 20 10 February Expenditure Report(105 & 106) March 9 Monthly Utilization Report (2/16-3/15) March 20 11 March Expenditure Report (105 & 106) April 9 Monthly Utilization Report (3/16-4/15) April 20 12 April Expenditure Report (105 & 106) May 9 Monthly Utilization Report(4/16-5/15) May 20 13 May Expenditure Report (105 & 106) June 9 Monthly Utilization Report(5/16-6/15) June 20 14 June Expenditure Report (105 & 106) July 9 Monthly Utilization Report(6/15-6/30) July 20 15 Final Expenditure Report(105 & 106) July 25 16 Closeout Report (105 & 106) August 1 Legend: * Advance based on projected cash need. Note# 1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging for Southwest Florida,Inc.prior to July 1 or until the contract with the Agency has been executed and a copy sent to the Agency on Aging for Southwest Florida, Inc. Actual submission of the vouchers to the Agency is dependent on the of the expenditure report. Note# 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. The adjustment shall be recorded in Part C, Line 1 of the report(ATTACHMENT VIII). 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(ATTACH- MENT VIII). 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. 2 (aBuego a6en6ue-i anuanaa awls L4-94 Ad : Z£64) 400'94'£OZ 3DH auewyoelly N N RevisedAugust 2007 E 4- as Attestation Statement o. 1 Agreement/Contract Number HCEI 203.16 Amendment Number 001 I, Steve 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 Collier County Board of County Commissioners (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. //11 Signature of Recipient/Contractor representative P Date Approved as to form and legality Assistant County Attorney t Revised August 2007 OVD (e6ueg3 a6en6uei anuanaN a;e1S L6-91, Al : Z£61) I3e.iluo3 96`E0Z goo :;uewyoefV ce) LCA N r r ci July 2016—June 2017 CCE 203,16 a r � ca AREA AGENCY ON AGING FOR!SOUTHWEST FLORIDA,INC. COMMUNITY CARE FOR THE ELDERLY PROGRAM CONTRACT COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS 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." 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. 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 11M014,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 July 1,2016 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 June 30,2017. 4. Contract Amount The Agency agrees to pay for contracted services according to the terms and conditions of this contract in au amount not to exceed $802,100.00, 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), Florida Statutes, 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. • 1 (a5ueg3 e6en6uei anuanaj a e;S L6-9I /d : ZE66) ;oe.;uo3 91•`£OZ 333 :;uauayoe;;y Lri r 1C) � r ca July 2016—June 2017 CCE 203.16 a — 6. ffi 1,113, ' 1101Re)r•s n i fb,, s 1 fres.e. n i Tele n • 's ' m The Contractor name,as shown on page 1 of this o Collier County Board of County Commissioners /oCollier County Community and Human Services n' a. contract, and mailing address of the official payee to 3339 E Tamiami Trail, Suite 211 whom the payment shall be made is: Naples,FL 34112 The name of the contact person and street address where Kimberley Grant, Director b' Collier County Board of County Commissioners financial and administrative records are maintained is: %Collier County Community and Human Services 3339 E Tamiami Trail, Suite 211 Naples,FL 34112 The name,address,and telephone number of the Kimberley Grant,Director e. Collier County Board of County Commissioners representative of the Contractor responsible for %Collier County Community and Human Services administration of the program under this contract is: 3339 E Tamiami Trail, Suite 211 Naples,FL 34112 (239)252-2273 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 d. forms are to be mailed is: North Fort Myers,FL 33903 Tammy Rhoades,Vice President of Finance 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 Trims and Conditions Included: This contract and its Attachments, I—111, VI—IX 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 the Parties. 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 29 page contract, to be executed by their undersigned officials as duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONEARS FLORIDA,INC. SIGNED BY: N#rA;jl/ SIGNED BY: �(�al.Ca!`uA-L .,�r3.7‘ NAME: Steve Carnell NAME: MARIANNE G LORINI TITLE: Public Services Department Head TITLE: PRESIDENT/CEO ........._. .__........ DATE: 1 I L 1DATE: / 1 I(;, f Federal Tax ID: 59-6000558 Fiscal Year Ending Date: 09/30 Approved as to form and legality 2 i(. Assistant County Attorney c cY , i (a6ueyo a6en6uei anuanaN a;e;S L6-96 AJ : Z£66) 13ei4u03 91.`£OZ BOO :4uawgoe41V � r July 2016-June 2017 CCE 203,16 a a INDEX OF ATTACHMENTS ATTACHMENT I 4 STATEMENT OF WORK ATTACHMENT II 17 CERTIFICATIONS AND ASSURANCES ATTACHMENT III ,20 EXHIBIT 1: FINANCIAL AND COMPLIANCE AUDIT EXHIBIT 2: FUNDING SUMMARY ATTACHMENT VI 26 ANNUAL BUDGET SUMMARY and RATE SUMMARY ATTACHMENT VII 27 INVOICE REPORT SCHEDULE ATTACHMENT VIII "28 REQUEST FOR PAYMENT ATTACHMENT IX 29 RECEIPT AND EXPENDITURE REPORT • 3 (e6uego e6en6uei anuanaj awls LL-94 AA Z£6I) 13e.11uo0 94`£OZ 300 :;uewgoe;;v FA N6 N co July 2016—June 2017 CCE 203.16 a ATTACHMENT I a aI AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. STATEMENT OF WORK I SERVICES TO BE PROVIDED A. Definitions of Terms 1. Contract Acronyms Area Agency on Aging(AAA) Adult Protective Services(APS) Adult Protective Services Referral Tracking Tool (ARTT) Corrective Action Plan(CAP) Community Care for the Disabled Adult(CCDA) Community Care for the Elderly(CCE) Client Information and Registration Tracking System(CIRTS) Department of Children and Families(DCF) (DOEA)/Department Florida Statutes(F.S.) Home Care for Disabled Adults(HCDA) Notice of Instruction(NOI) Planning and Service Area(PSA) Sutnmary of Programs and Services(SOPS) 2. Program Specific Terms • Adult Protective Services Referral Tracldng Tool: A system designed to track DCF APS referrals to AAAs and CCE Lead Agencies for victims of second party abuse, neglect, and exploitation who need home and community-based services as identified by APS staff. Aging Out: The condition of reaching 60 years of age and being transitioned from the DCF,CCDA,or HCDA services to DOEA's community-based services. Area Plan: A plan developed by the Area Agency on Aging for Southwest Florida, Inc. outlining a comprehensive and coordinated service delivery system in its PSA in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Act and Department instructions. The Area Plan includes performance measures and unit rates per service offered per county. Area Plan Update: A revision to the Area Plan wherein the AAA enters CCE specific data in the CIRTS. An update may also include other revisions to the Area Plan as instructed by DOEA. Department of Elder Affairs Programs and Services Handbook: An official doctunent of the State of Florida, DOEA. The Handbook includes program policies, procedures, and standards applicable to agencies which are recipients of DOEA-funded programs, and providers of program-funded services. An annual update is provided through a Notice of Instruction. Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain living independently in the least restrictive living arrangement, 4 • (a6uey3 e6en6uei anuenaa alelS 14-9l. AA : Z£64) 1,3e4uo3 94`£0Z 333 :lueunpe;lv July 2016—June 2017 CCE 203.16 ate. m Notice of Instruction (NOI): The Department's established method to communicate to the Agency and/or a Contractor the requirements to perform particular tasks or activities. NOls are located on the Department's website at http://elderaffairs.state.fl.us/doea/'noir/php. Program Highlights: Success stories, quotes, testimonials, or human-interest vignettes that are used in the Summary of Programs and Services to demonstrate how programs and services help elders, families, and caregivers. Summary of Programs and Services(SOPS):A document produced by DOEA and updated yearly to provide the public and the Legislature with information about programs and services for Florida's elders. B. General Description 1. General Statement The primary purpose of the CCE Program is to prevent, decrease, or delay premature or inappropriate and expensive placement of elders in nursing homes and other institutions. 2. Community Care for the Elderly Mission Statement The CCE Program assists functionally-impaired elderly persons in living as independently as possible, in the least restrictive environment suitable to their needs. The program provides a continuum of care through the development,expansion,reorganization,and coordination of multiple community-based services. 3. Authority The relevant authorities governing the CCE Program are: a.Rule 58C-1,Florida Administrative Code; b.Sections 430.201 through 430.207,F.S.;and c.The Catalog of State Financial Assistance(CSFA)Number 65010. 4. Scope of Service The Agency is responsible for the programmatic,fiscal,and operational management of CCE. The program services shall be provided in a manner consistent with the Agency's current Area Plan,as updated, and the current DOEA Programs and Services Handbook,which are hereby incorporated by reference. 5. Major Program Goal The major goals of the program are to preserve the independence of elders and prevent or delay more costly institutional care through a community care service system that provides case management and other in-home and community services as needed under the direction of a lead agency and to provide a continuum of service alternatives that meets the diverse needs of functionally-impaired elders. C. Clients to be Served 1. General Description The CCE Program provides a continuum of services for functionally-impaired elders. 2. Client Eligibility In order to receive services under this contract, an applicant must: a. Be at least 60 years of age; b. Be functionally impaired as determined through the comprehensive assessment;and 5 (a6uey3 aBen6ue-i anuanaB ale;S L6-9l. Ad Z£6L) 13ealuo3 gt`£OZ 300 :luauayoelld ' N July 2016—June 2017 CCE 203.16 a c. Not be dually enrolled in the CCE program and a Medicaid-capitated long-term care program. d. Be aging out as defined in Section I,A, 2.of this contract. 3. Targeted Groups Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk of placement in an institution or who are abused,neglected,or exploited. II, MANNER OF SERVICE PROVISION A.Service Tasks To achieve the goals of the CCE Program, the Contractor shall perform, or ensure that its Subcontractors perform, the following tasks: 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 section I.C.2. 2.Assessment and Prioritization of Service Delivery for New Clients The Contractor shall ensure the following criteria are used to prioritize new clients for service delivery in the sequence below. It is not the intent of the Department and/or Agency to remove existing clients from services in order to serve new clients being assessed and prioritized for service delivery. a. DCF APS High Risk individuals: The Contractor shall ensure that pursuant to Section 430.205(5)(a),Florida Statutes,those elderly persons who are determined by DCF APS to be victims of abuse,neglect,or exploitation who are in need of immediate services to prevent further harm,and are referred by APS,will be given primary consideration for receiving CCE services. As used in this subsection, "primary consideration" means that an assessment and services must commence within 72 hours after referral to the Agency or as established in accordance with local protocols developed between Agency service contractors and APS. The Contractor shall follow guidelines for DCF APS High Risk referrals established in the APS Operations Manual, which is incorporated by reference. b. For DCF APS Low, Intermediate, and High Risk Referrals for individuals enrolled in a Medicaid long-term care program at the time of referral to the Contractor or Subcontractor,the Contractor shall: (1) Ensure that the intake entity contacts and notifies the DCF APS protective investigator that the referral was not accepted because the referred individual is enrolled in a Medicaid long-term care program;and (2) Ensure that the intake entity notes that the referred individual is enrolled in a Medicaid long-term care program in the ARTT as the reason for rejection. c. Imminent Risk individuals: Individuals in the community whose mental or physical health condition has deteriorated to the degree that self-care is not possible, there,is no capable caregiver, and nursing home placement is likely within a month or very likely within 3 months. d. Aging Out individuals: Individuals receiving CCDA and HCDA services through the Department of Children and Families' Adult Services transitioning to community-based services provided through the Department when services are not currently available. e. Service priority for individuals not included in a., c., and d, above, regardless of referral source, will be determined through the Agency's functional assessment administered to each applicant, to the extent funding is available.The Contractor shall ensure that first priority is given to applicants at the higher levels of 6 3 (a5ueg3 e6en6uei anuanaj o4e;S Lv9i, AA Z£61•) ;oealuo3 91,`£OZ 203 :4uawiloe}ly 111 7 N July 2016--June 2017 CCE 203,16 a frailty and risk of nursing home placement. For individuals assessed at the same priority and risk of nursing home placement,priority will be given to applicants with the lesser ability to pay for services. 3.Referrals for Medicaid Waiver Services • a. The Contractor must require Subcontractors, through the performance of the client assessment, to identify potential Medicaid eligible CCE clients and to refer these individuals for application for Medicaid Waiver services. b. The Contractor must require individuals who have been identified as being potentially Medicaid Waiver . eligible to apply for Medicaid Waiver services in order to receive CCE services.These individuals may only receive CCE services while the Medicaid Waiver eligibility determination is pending. If the client is found ineligible for Medicaid Waiver services for any reason other than failure to provide required documentation, then the individual may continue to receive CCE services. c. The Contractor must advise individuals who have been identified as being potentially Medicaid Waiver eligible of the responsibility to apply for Medicaid Waiver services as a condition of receiving CCE services while the eligibility determination is being processed. 4. Program Services The Contractor shall ensure the provision of program services is consistent with the Agency's current area plan,as updated and approved by the Agency,and the current DOHA Programs and Services Handbook. 13, 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 circumstance occurs that may result in a delay for a period of 60 days or more the initiation of the subcontract or the performance of the Subcontractor, the Contractor shall notify the Agency's Contract Manager and the Agency's Vice President 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 23.1 of Master Contract, the Agency will not be responsible or liable for any obligations or claims resulting from such action. 1. Copies of Subcontracts The Contractor shall submit a copy of all subcontracts to the Contract Manager within thirty days of the subcontract being executed. 2. 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. C. Staffing Requirements 1. Staffing Levels The Contractor shall dedicate the staff necessaty to meet the obligations of this contract and ensure that subcontractors dedicate adequate staff,accordingly. 7 z (eBuey3 a6en6ue- anuanej a;e;s L1,-9l• Ad : Z£61) 43eJ;uo3 91,`£OZ 300 :;uewgoe;;V CO N July 2016—June 2017 CCE 203,16 a a> 2, Professional Qualifications asu The Contractor shall ensure that the staff responsible for performing any duties or functions within this contract - have the qualifications as specified in the DOEA Programs and Services Handbook, 3. Service Times The Contractor shall ensure the availability of services listed in this contract at times appropriate to meet client service needs, at a minimum during normal business hours. Normal business hours are defined as Monday through Friday, 8:00 a.m.to 5:00 p.m. D.Deliverables The following section provides the specific quantifiable units of deliverables and source documentation required to evidence the completion of the tasks specified in this contract. 1.Delivery of Service to Eligible Clients The Contractor shall ensure the provision of a continuum of services that meets the diverse, individual, and assessed needs of each functionally-impaired elder. The Contractor shall ensure performance and reporting of the following services in accordance with the Contractor's current Agency-approved Area Plan, the current DOEA Programs and Services Handbook, which is incorporated by reference, and Section II.A.1-4 of this contract. Documentation of service delivery must include a report consisting of the following: number of clients served,number of service units provided by service,and rate per service unit with calculations that equal the total invoice amount.The services include the following categories: a. Core Services for Programmatic Operation The Contractor shall ensure that core services include a variety of in-home services, day care services, and other basic services that are most needed to prevent unnecessary institutionalization. Core services, to be provided at the unit rate identified in the Contractor's Area Plan,as updated, include the following: (1) Adult Day Care; (8) Housing Improvement; (2) Chore Services; (9) Legal Assistance; (3) Companionship; (10) Pest Control Services; (4) Escort; (11) Respite Services; (5) Financial Risk Reduction; (12) Shopping Assistance;and (6) Home Delivered Meals; (13) Transportation. (7) Homemaker; b. Health Maintenance Services The Contractor shall ensure that health maintenance services are made available as necessary to maintain the health of functionally-impaired elders. These services are limited to medical therapeutic services and non- medical prevention services.Typical services to be provided at the unit rate identified in the Contractor's Area Plan, as updated, include the following: (1) Adult Day Health Care; (8) Nutrition Counseling; (2) Emergency Alert Response; (9) Occupational Therapy; (3) Gerontological Counseling; (10) Personal Care; (4) Health Support; (11) Physical Therapy; • (5) Home Health Aide; (12) Skilled Nursing Services; 8 (e6uego e6en6uei enuanaa aleiS L4-94 Ad : Z£64) loealuoO 94`£OZ 300 :luawgoellV ca th July 20I6—June 2017 CCE 203.16a- d (6) Medication Management; (13) Specialized Medical Equipment, a Services and Supplies; and (7) Mental Health Counseling/Screening; (14) Speech Therapy. c. Other Support Services The Contractor shall ensure that support services expand the continuum of care options to assist functionally- impaired elders and their caregivers. Support services to be provided at the unit rate identified in the Contractor's Area Plan as updated, include the following: (1) Caregiver Training/Support; (4) Material Aid; and (2) Case Aid; (5) Other services,as approved by the Agency. (3) Case Management; 2.Services and Units of Services The Contractor shall ensure that the provision of services described in the contract is in accordance with the current DOEA Programs and Services Handbook and the service tasks described in A T TACIT- MENT VI lists the services that can be performed,the highest reimbursement unit rate,the method of payment, and the service unit type. Units of service will be paid pursuant to the rate established in the Agency's Area Plan as updated,as shown in ATTACHMENT VI,and approved by the Agency. E.Reports The Contractor shall respond to additional routine 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 reporting deadlines and due dates for Subcontractors that permit the Contractor to review and validate the data, and meet the Agency's reporting requirements. 1. CIRTS Reports The Contractor shall ensure timely input of CCE-specific data into C1RTS.To ensure CIRTS data accuracy,the Contractor shall use CIRTS-generated reports which include the following: (a) Client Reports; (b) Monitoring Reports; (c) Services Reports; (d) Miscellaneous Reports; (e) Fiscal Reports; (f) Aging and Disability Resource Center Reports;and (g) Outcome Measurement Reports. 2. Service Cost Reports The Agency shall require the Contractor to submit Annual Service Cost Reports, which reflect actual costs of providing each service by program. This Annual Service Cost Report provides information for planning and negotiating unit rates. The General Revenue Service Cost Reports are due by August 15, 2016 for the prior year. 9 (a6ue40 a6en6ue- anuenaN a;e;S L4-9l. A3 : Z£64) 13e.;uo3 94`£OZ 300 :;uauayoe;;v co July 2016—June 2017 CCE 203.16 a 3. Surplus/Deficit Report(Lead Spending Report) a The Contractor shall submit a Consolidated Surplus/Deficit Report, in a format provided by the Agency to the Area Agency Contract Manager, by the 18th of each month. This Consolidated Surplus/Deficit Report is for a all agreements and contracts between the Contractor and the Agency and must include the following: (a) Contractor's current status regarding suplus/deficit; (b) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the Agency will be resolved; (c) Recommendations to transfer funds to resolve surplus/deficit spending; (d) Input from the Agency's Board of Directors on resolution of spending issues, if applicable; (e) Number of clients currently on APCL that receive a priority ranking score of 4 or 5;and (f) Number of clients currently on the APCL designated as Imminent Risk. F.Records and Documentation 1. Requests for Payment The Contractor shall maintain documentation to support Requests for Payment that shall be available to the Agency or authorized individuals upon request. 2. CIRTS Data and Maintenance The Contractor shall ensure,on a monthly basis,collection and maintenance of client and service information in CIRTS or any such system designated by the Agency, Maintenance includes accurate and current data, and valid exports and backups of all data and systems according to Agency standards. 3. Data Integrity and Back up Procedures Each Contractor shall 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. 4. Policies and Procedures for Records and Documentation The Contractor shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its subcontractors. These policies and procedures shall be made available to the Agency upon request. G.Performance Specifications 1. Outcomes and Outputs(Performance Measures) The Contractor must: a. Ensure the prioritization and service provision of clients in accordance with Section II.A.2, of this contract; b. Ensure the provision of the services described in this contract are in accordance with the current DOEA Programs and Services Handbook and Section ILA.1-4 of this contract; c. Timely submit to the Agency all required documentation and reports described in Section II.E.; and d. Timely(in accordance with ATTACHMENT VII)and accurately submit to the Agency ATTACHMENTS VIII&IX,and supporting documentation. 10 i • (a5um43 a6en6uei anueneN a}e}S L1.-9I. Ad : Z£6l-) }oe�}uo9 9I.' OZ 333 }uauayoe;}V U) N ci r � July 2016—June 2017 CCE 203.16 2. Monitoring and Evaluation Methodology The Agency will review and evaluate the performance of the Contractor under the terms of this contract. a Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, and/or on-site visit(s). 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: a. Desk reviews and analytical reviews; b. Scheduled,unscheduled,and follow-up on-site visits; c. Client visits; d. Review of independent auditor's reports; e. Review of third-party documents and/or evaluation; f. Review of progress reports; g. Review of customer satisfaction surveys; h. Agreed-upon procedures review by an external auditor or consultant; i. Limited-scope reviews; and j. Other procedures as deemed necessary. H. Contractor Responsibilities 1. Contractor Accountability All service tasks and deliverables pursuant to this contract are solely and exclusively the responsibility of the Contractor,and for which,by execution of the contract, the Contractor agrees to be held accountable. 2. Coordination with Other Providers and/or Entities Notwithstanding that services for which the Contractor is held accountable involve coordination with other entities in performing the requirements of the contract;the failure of other entities does not alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform pursuant to this contract. I. Agency Responsibilities 1. Agency Obligations The Agency will provide technical support to assist the Contractor in meeting the requirements of this contract. 2. Agency Determinations The Agency reserves the exclusive right to make certain determinations in the tasks and approaches. The absence of the Agency setting forth a specific reservation of rights does not mean that all other areas of the contract are subject to mutual agreement. IIL METHOD OF PAYMENT A.Payment Methods Used The Method of Payment for this contract is a combination of fixed-fee/unit rate, cost reimbursement, and advance payments,subject to the availability of funds and Contractor performance. The Agency will pay the Contractor upon satisfactory completion of the Tasks/Deliverables, as specified in Section II.D., and in accordance with other terms and conditions of the contract. 11 • ./ I (e5ueyo a5en6ue- anuane8 ems L1,-9l AA : Z£66) ;oeJ;uo3 9l'E0Z 333 :;uawyoe;;v Cotri N July 2016—June 2017 CCE 203.16 0� a I. Fixed Fee/Unit Rate Payment for Fixed Fee/Unit Rates shall not exceed amounts established in ATTACHMENT VI, per unit of o. service. 2. Cost Reimbursement Payment may be authorized only for allowable expenditures,which are in accordance with the services specified in ATTACHMENT VI. All Cost Reimbursement Requests for Payment must include the Request for Payment Report(ATTACHMENT VIII)and Receipt and Expenditure Report (ATTACHMENT IX) beginning with the first month of the contract. 3. Advance Payments The Contractor may request up to two(2)months of advances at the start of the contract period to cover program service costs.The payment of an advance will be contingent upon the sufficiency and amount of fiords released to the Agency and the Department by the State of Florida ("budget release"). The Contractor's requests for advances require the approval of the Agency and/or DOEA Contract Manager.The Contractor shall provide the Agency Contract Manager documentation justifying the need for an advance and describing how the funds will be distributed. If sufficient budget is available,the Agency will issue approved advanced payments after July 1st of the contract year. a. All advanced payments retained by the Contractor must be fully expended no later than September 30,2016. Any portion of advanced payments not expended must be recouped on the Invoice Schedule,report number 5, due to the Agency on October 9,2016,in accordance with the Invoice Schedule,ATTACHMENT VII. b. All advance payments made by the Contractor shall be reimbursed to the Agency as follows: At least 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 VII. B. Method of Invoice Payment Payment shall be made upon the Contractor's presentation of an invoice subsequent to the acceptance and approval by the Agency of the deliverables shown on the invoice. The form and substance of each invoice submitted by the Contractor shall be as follows: 1, Have a Remittance Address that corresponds exactly to the "Remit To" address provided to MFMP during registration; 2. Request payment on a monthly basis for the units of services established in the Agency's approved Area Plan and provided in conformance with the requirements as described in the DOEA Programs and Services Handbook,at the rates established in ATTACHMENT VI of the contract. Documentation of service delivery must include a report consisting of the following: number of clients served, number of service units provided by service, and rate per service unit with calculations that equal the total invoice amount. Any requested changes to the approved budget subsequent to the execution of the contract, must be submitted to the Contract Manager for approval.Any change to the total contract amount requires a formal amendment; 1 All Requests for Payment shall.be based on the submission of monthly Expenditure Reports beginning with the first month of the contract. The schedule for submission of advance requests (when available) and invoices is Invoice Schedule,ATTACHMENT VII. 12 • (a6ueg3 e6en6uei enuanay ele1S L6-9I. A.j : Z£66) 13e4uo3 9l4`£OZ BOO :I lewiloel4V N r • tth cfl July 2016—June 2017 CCE 243.16 °- Y V C.Payment WithhoIctingti Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and a , 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 26 of the Master Contract. D.Final Invoice Instructions The Contractor shall submit the final Request for Payment to the Agency no later than July 25,2017. E. CIRTS Data Entries for Subcontractors The Contractor must enter all required data for clients and services in the CIRTS database per the DOEA Programs and Services Handbook and the CIRTS User Manual — Aging Provider Network users(located in Documents on the CIRTS Enterprise Application Services). Contractors must enter this data for the previous month's billing no later than the 9th of each month into CIRTS prior to submitting their requests for payment and expenditure reports to the Agency. F. Contractor's Monthly CIRTS Reports The Contractor must run monthly CIRTS reports and verify client and service data in the C1RTS 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 Contractor before the Contractor's request for payment and expenditure reports can be approved by the Agency. G.Corrective Action Plan 1. Contractor shall ensure 100% of the deliverables identified in Section II. D. 1-3 of this contract, are performed pursuant to contract requirements. 2,If at any time the Contractor is notified by the Agency Contract Manager that it has failed to correctly,completely, or adequately perform contract deliverables identified in Section II. D. I-3 of this contract, the Contractor will have 10 days to submit a Corrective Action Plan ("CAP") to the Agency Contract Manager that addresses the deficiencies and states how the deficiencies will be remedied within a time period approved by the Agency Contract Manager.The Agency shall assess a Financial Consequence for Non-Compliance on the Contractor as referenced in Section ELI of this contract 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,If the Contractor fails to correct an identified deficiency within the approved time period specified in the CAP,the Agency shall deduct the percentage established in Section 111, I. of this contract, from the payment for the invoice of the following month. 4. If Contractor fails to timely submit a CAP,the Agency shall deduct the percentage established in Section III. I, of this contract for each clay the CAP is overdue. The deduction will be made from the payment for the invoice of the following month. If, or to the extent,there is any conflict between Section H, 1-4 above, and paragraphs 39.1 and 39.2 of the Master Contract,this section shall take precedence. H.Financial Consequences The Agency will withhold or reduce payment if the Contractor fails to perform the deliverables to the satisfaction of the Agency according to the requirements referenced in Section 11.D of this contract. The following financial consequences will be imposed if the deliverables stated do not meet in part or in whole the performance criteria as outlined in Section II.D.of this contract. 1. Delivery of services to eligible clients as referenced in Section II.A,2 and Section il.D.l of this contract— Failure to comply with established assessment and prioritization criteria, as evidenced by CIRTS reports, 13 (e6uego e6en6ue-i anuanaN a e;S 16-94 AA Z£66) ;oeiluo3 91:£0Z 300 .;uewgoe;}y co co July 2016—June 2017 CCE 203.16 a will result in a 2%reduction of payment per business day. The reduction of payment wi11 begin on the first business day following the Agency's notification to the Contractor that the identified deficiency was not a cured or satisfactorily addressed in accordance with the Agency-approved CAP, referenced in Section III.H. 2. Services and units of services as referenced in Section]LD.2 of this contract—Failure to provide services in accordance with the current DOEA Programs and Services Handbook,the service tasks described in Section ILA, ATTACHMENT VI, and submission of required documentation will result in a 2% reduction of payment per business day. The reduction of payment will begin the first business day following the Agency's notification to the Contractor that the identified deficiency is not cured or satisfactorily addressed in accordance with the Agency approved CAP,referenced in Section III.H. 3. Timely submission of a CAP—Failure to timely submit a CAP within 10 business days after notification of a deficiency by the Agency Contract Manager will result in a 2% reduction of payment per business day the CAP is not received.The reduction of payment will begin the first business day following the Agency's notification to the Contractor that the identified deficiency was not cured or satisfactorily addressed in accordance with the Agency approved CAP, referenced in Section III. H. 4. Exceptions may be granted solely, in writing, by the Agency contract manager. IV.SPECIAL PROVISIONS A. Final Budget and Funding Revision Requests Final requests for budget revisions or adjustments to contract funds based on expenditures for provided services must be submitted to the Agency Contract Manager in writing no later than June 25,2017; email requests are considered acceptable. B. Contractor's Financial Obligations 1. Matching,Level of Effort,and Earmarking Requirement The Contractor must provide a match of at least 10 percent of the cost for all CCE services. The match must be made in the form of cash and/or in-kind resources. At the end of the contract period, all CCE funds expended Must be properly matched. State finds shall not be used to match another state-funded program. 2. Cost Sharing and Co-Payments The Contractor must establish annual co-payment goals. The Agency has the option to withhold a portion of the Contractor's request for payment if goals are not met according to the Agency's co-payment guidelines, in accordance with the current DOEA Programs and Services Handbook, which is incorporated by reference. Co-payments include only the amounts assessed to consumers by the Contractor or the amounts consumers opt to contribute in lieu of an assessed co-payment. The consumer's contribution must be equal to or greater than the assessed co-payment. Co-payments collected in the CCE Program can be used as part of the local match, as detailed above in Section IV.B. 3. Use of Service Dollars and Management of the Assessed Priority, Consumer List The Contractor is expected to spend all funds provided by the Agency for the purpose specified in this contract, The Contractor must manage the service dollars in such a manner so as to avoid having a wait list and 14 • -a (a6ueg3 a6en6ue1 anuanali awls Z£64) ;oeiluoo 9VEOZ 330 :luauayoelly cri cc, cv ✓ r ci July 2016—June 2017 CCE203,16 a surplus of funds at the end of the contract period. If the Agency determines that the Contractor is not spending service funds accordingly, the Agency may transfer funds to their other Lead Agencies in the PSA a during the contract period and/or adjust subsequent funding allocations accordingly,as allowable under state and federal law. C. Remedies for Nonconforming Services I. 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. 2. 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 ruiner this contract.The Contractor's signature on the Request for Payment Form certifies maintenance of supporting documentation and.aeknowledgement 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, I5 (a6ueg3 eBen6ue-i anuanaN ems L1.-91. Id : Z£61) ;oe.i;uoo 9l•`EOZ 300 :;uewyoe;;y r tC p N co July 2016—June 2017 CCE 203.16 th ATTACHMENT II u Y CERTIFICATIONS AND ASSURANCES a The Agency and/or Department will not award this contract unless Contractor completes the CERTIFICATIONS AND ASSURANCES contained in this Attachment. In performance of this contract,Contractor provides the following certifications and assurances: A, Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 74) B, Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination$ Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crines,section 287.133.F,S, E. Association of Community Organizations for Reform Now(ACORN)Funding Restrictions Assurance(Pub. J. 111-117) F. Certification Regarding Scrutinized Companies Lists,section 287.135.F,S, G. Certification Regarding Data Integrity Compliance for Agreements, Grants. Loans And Cooperative Agreentent� H. Verification of Employment Status Certification A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS—PRIMARY COVERED TRANSACTION, The undersigned Contractor certifies to the best of its knowledge and belief,that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements,or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity(Federal,State or local) with commission of any of the offenses enumerated in paragraph A.2.of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,State,or local)terminated for cause of default. B. CERTIFICATION REGARDING LOBBYING — Certification for Contracts, Grants, Loans, and Cooperative Agreements, The undersigned Contractor certifies,to the best of its knowledge and belief,that: No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person for influencing or attempting to influence an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract,grant,loan or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employees of 16 (a6ueg3 a6en6uei anuanal ewe1S L6-S6 Al : ZE66) 1oea4uoo gCEOZ 303 :luauayoe4 V N July 2016—June 2017 CCE 203.16 th r d Congress,or employee of a Member of Congress in connection with a Federal contract, grant, loan,or cooperative R agreement, the undersigned shall also complete and submit Standard Form —LLL, "Disclosure Form to Report a Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements) and that all sub-recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352.Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. C. NON DISCRIMINATION &EQUAL OPPORTUNITY ASSURANCE(29 CFR PART 37 AND 45 CFR PART 80). As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex national origin, age, disability, political affiliation,or belief,and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I-financially assisted program or activity; 2. Title VI of the Civil Rights Act of 1964(Pub.L. 88-352),as amended,and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 80),to the end that,in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department and/or Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112) as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 84), to the end that, in accordance with Section 504 of that Act, and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under ally program or activity for which the Applicant receives Federal financial assistance from the Agency. 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 91),to the end that,in accordance with the Act and the Regulation,no person in the United States shall,on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5, Title IX of the Educational Amendments of 1972(Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86),to the end that, in accordance with Title IX and the Regulation,no person in the United States shall,on the basis of sex,be excluded from participation in, be denied the benefits of, or be.otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990(Pub.L. 101-336),prohibits discrimination in all employment practices, including, job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits,and all other employment-related activities,and; Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. his assurance applies to Contractor's operation of the WIA Title I— financially assisted program or activity, and to all 17 (a6ueg3 e6en6uei anuanam alelS Z£61) 13e.rluo3 91.`£OZ Soo :luewyoelly ti o July 2016—June 2017 CCE 203.16 co a agreements Contractor makes to cavy out the WIA Title I—financially assisted program or activity. Contractor understands Y that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of e assurance. a D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S. Contractor hereby certifies that neither it,nor any person or affiliate of Contractor,has been convicted of a Public Entity Crime as defined in section 287.133,F.S.,nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform the Agency and/or DOEA immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE(Pub.L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub, L. 111-242), provides that appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. 111-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers(including subcontracts,sub-grants and contracts under grants, loans and cooperative agreements)and that all sub recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS CERTIFICATION,SECTION 287.135,F.S. If this Contract is in the amount of$1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both Iists are created pursuant to section 215.473,F.S. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may subject Contractor to civil penalties,attorney's fees,and/or costs. If Contractor is unable to certify to any of the statements in this certification, Contractor shall attach an explanation to this Contract. G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS 1, The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing certain information, including: (1)accurate, current, and complete disclosure of the financial results of • each grant-funded project or program in accordance with the prescribed reporting requirements; (2)the source and application of funds for all agreement supported activities;and(3)the comparison of outlays with budgeted amounts for each award, The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported,transmitted or calculated,have been assessed and verified to be capable of processing data accurately, including year-date dependent data.For those systems identified to be non- compliant,Contractors will take immediate action to assure data integrity. 3.1f this contract includes the provision of hardware,software,firmware,microcode or imbedded chip technology, the undersigned warrants that these products are capable of processing year-date dependent data accurately.All versions of these products offered by the Contractor(represented by the undersigned)and purchased by the state will be verified for accuracy and integrity of data prior to transfer, 18 1 (e6ueyo a6en6uei enuane a;e;S L6"9I. A 1 : Z£60 o. 9t`£OZ BOO :;uauayoe;;d ti Lc) N T T Q July 2016—June 2017 CCE 203.16 n.. T y Y In the event of any decrease in functionality related to time and date related codes and internal subroutines that a impede the hardware or software programs from operating properly,the Contractor agrees to immediately make required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state,and without interruption to the ongoing business of the state,time being of the essence. 4.The Contractor and any Subcontractors of services under this contract warrant their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Area Agency on Aging for Southwest Florida, Inc.,Contractor certifies the use of the U.S, Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. The Contractor shall require that the language of this certification be included in all subagreements,subgrants, and other agreements and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A-102 and 2 CFR Part 200,and 215 (formerly OMB Circular A-110). By signing below, Contractor certifies the representations outlined in parts A through H above are true and correct. k ✓ (Signature and Title of Authorized Representative) Collier County Board of County Commissioners ) / 2 j l Contractor Date 3339 E.Tamiami Trail,Suite 211 (Street) Approved as to form and legality N. Assistant County Attorney \ Naples,FL34112 (City, State,ZIP Code) 19 (a6uey3 a6en5ue-i enuanaN a;elS 14-94 Ad : Z£64) ;oe.;uoo 9l'E0Z 300 :luewg3e;1y cv ni July 2016—June 2017 CCE 203.16 a ATTACHMENT III FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Agency to the provider may be subject to audits and/or monitoring by the Area Agency on Aging for Southwest Florida, Inc., as described in this section. I. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the Agency staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this agreement, the provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Agency. In the event the Agency determines that a limited scope audit of the provider is appropriate,the provider agrees to comply with any additional instructions provided by the Agency to the provider regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer(CFO)or Auditor General. AUDITS PART I:FEDERALLY FUNDED This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB Circular A-133, as revised. hi the event that the provider expends$750,000.00 or more in federal awards during its fiscal year,the provider must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. EXHIBIT 2 to this agreement indicates federal resources awarded through the Agency by this agreement. In determining the federal awards expended in its fiscal year, the provider shall consider all sources of Federal awards, including federal resources received from the Agency. The determination of amounts of Federal awards expended should be in accordance with the guidelines established by OMB Circular A-I33, as revised. An audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part. hi connection with the audit requirements addressed in Part I,paragraph 1,the provider shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133,as revised. If the provider expends less than$750,000.00 in federal awards in its fiscal year, an audit conducted in accordance with the provisions of OMB Circular A-133,as revised, is not required. In the event that the provider expends less than$750,000.00 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133, as revised, the cost of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from provider resources obtained from other than federal entities.) An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Agency shall be based on the agreement's requirements, including any rules, regulations, or statutes referenced iin the agreement. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Agency on Aging for Southwest Florida, Inc, agreement involved. If not otherwise disclosed as required by Section .310(b)(2)of OMB Circular A-133, as revised,the schedule of expenditures of federal awards shall identify expenditures by agreement number for each agreement with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider's fiscal year end. 20 -a (e6ueg3 e6en6ue-1 enuenall alelS L1.-9I. Ad : ZE61.) loeJluo3 91.`EOZ 333 :luewt.pell`d e• N 0 tD July 2016--June 2017 CCE 203.16 a PART II: STATE FUNDED a A This part is applicable if the provider is a non-state entity as defined by Section 215.97(2),F.S. In the event that the provider expends a total amount of state financial assistance equal to or in excess of$750,000.00 in any fiscal year of such provider(for fiscal years ending September 30,2004 or thereafter),the provider must have a State single or project-specific audit for such fiscal year in accordance with Section 215.97, F.S.; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT 2 to this agreement indicates state financial assistance awarded through the Agency by this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state financial assistance received from the Agency, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements. • • In connection with the audit requirements addressed in Part II,paragraph 1,the provider shall ensure that the audit complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as defined by Section 215.97(2),F.S.,and Chapter 10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations), Rules of the Auditor General. If the provider expends less than$750,000.00 in state financial assistance in its fiscal year(for fiscal years ending September 30,2004 or thereafter),an audit conducted in accordance with the provisions of Section 215.97,F.S., is not required. In the event that the provider expends less than $750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, F.S., the cost of the audit must be paid from the nonstate entity's resources(i.e.,the cost of such an audit must be paid from the provider resources obtained from other than State entities). An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Agency shall be based on the agreement's requirements, including any applicable rules, regulations, -or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Agency agreement involved. If not otherwise disclosed as required by Rule 69I-5.003, Fla. Admin. Code,the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider's fiscal year end. Notwithstanding the applicability of this portion,the Agency retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law. IL PART III: REPORT SUBMISSION Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I of this agreement shall be submitted,when required by Section .320(d),OMB Circular A-133,as revised,by or on behalf of the provider directly to each of the following: The Area Agency on Aging for Southwest Florida,Inc.at the following address: Area Agency on Aging for Southwest Florida,Inc. Attn:Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 2i • • -a (a6ueg3 e6en6ue- anuanm a;e;S LAA : Z£66) ;oe.r;uo0 9l.`EOZ 300 :;uauagoe;;ty rri c e; July 2016—June 2017 CCE 203.16 eh The Federal Audit Clearinghouse designated in OMB Circular A-133,as revised(the number of copies required by Sections .320 (d)(1) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the following address: a Federal Audit Clearinghouse Bureau of the Census 1201 East 10th Street Jeffersonville,IN 47132 Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMB Circular A-133, as revised. Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a copy of the reporting package described in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the auditor, to the Area Agency on Aging for Southwest Florida,Inc.at the following addresses: Area Agency on Aging for Southwest Florida,Inc. Attn: Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 Additionally,copies of financial reporting packages required by Part H of this agreement shall be submitted by or on behalf of the provider directly to each of the following: The Area Agency on Aging for Southwest Florida, Inc.at the following addresses: Area Agency on Aging for Southwest Florida,Inc. Attn:Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 The Auditor General's Office at the following address: State of Florida Auditor General Claude Pepper Building,Room 574 111 West Madison Street Tallahassee,Florida 32399-1450 Any reports, management letter, or other information required to be submitted to the Agency pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-133, F.S.,and Chapters 10.550(local governmental entities) or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General,as applicable. Providers, when submitting financial reporting packages to the Agency for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to the provider in correspondence accompanying the reporting package. III.PART IV:RECORD RETENTION The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six (6) years from the date the audit report is issued, and shall allow the Agency or its designee, the CFO or Auditor General Access to such records upon request. The provider shall ensure that audit working papers are made available to the Agency, or its designee, CFO, or Auditor General upon request for a period of six (6) years from the date the audit report is issued,unless extended in writing by the Agency. 22 -a (e6ueg3 a6en5uel anuenaalelS L4-94 Ad ZE64) loeiluoo 94`EOZ 333 :luaWgoelly ti �j N ✓ � July 2016--June 2017 CCE 203.16 a ATTACHMENT III m V EXHIBIT I a PART I: AUDIT RELATIONSHIP DETERMINATION Providers who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part §200.500,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 H of Exhibit I is met. Providers who have been determined to be vendors are not subject to the audit requirements of 2 CFR Part§200.38,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 2 CFR Part§200 and/or Rule 691-5.006,FAC,provider has been determined to be: Vendor not subject to 2 CFR Part§200,38 and/or Section 215.97, F.S. Recipient/subrecipient subject to 2 CFR Part§200.86 and §200.93 and/or Section 215.97,F.S. Exempt organization not subject to 2 CFR Part §200 and/or Section 215.97, F.S. For Federal awards, for-profit organizations are exempt; for state financial assistance projects, public universities, community colleges, district school boards,branches of state(Florida)government,and charter schools are exempt. Exempt organizations must comply with all compliance requirements set forth within the contract or award document. 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 691-.5006, FAC [state financial assistance] and 2 CFR Part§200.330[federal awards]. PART H: FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a subrecipient mast comply with the following fiscal laws,rules and regulations: STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW: 2 CFR Part§200.416—Cost Principles* 2 CFR Part§200.201 —Administrative Requirements** 2 CFR Part§200.500--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§200.400-.411 —Cost Principles* 2 CFR Part§200.100—Administrative Requirements 2 CFR Part§200.500--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§200.418--Cost Principles* 2 CFR Part§200.100—Administrative Requirements 2 CFR Part §200.500—Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations 23 • • i (e6ueg3 a6en6ue-j anuanaN ele;S L1.-91. Ad : Z£64) loei;uoo 94`£OZ 333 :luauayoellV ti N July 2016--June 2017 i r CCE 203.16 a *Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 2 a� CFR Part§200.400(5)(c). * For funding passed through U.S. Health and Human Services, 45 CFR 92; for funding passed through U.S. o. Department of Education,34 CFR 80. 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 24 - (e6ueg3 a6en6ue7 enuanay alelS ZE61•) lonaluoo 96`EOZ 333 :luauayoelly Lei r � G July 2016—June 2017 CCE 203.16 E. ATTACHMENT III ki EXHIBIT 2 a FINANCIAL AND COMPLIANCE AUDIT ATTACHMENT EXHIBIT 2-FUNDING SUMMARY Note: Title 2 CFR§200.331,As Revised,and Section 215.97(5),Florida Statutes,Require That Information About Federal Programs and State Projects Be Provided to the Recipient and Are Stated in the Financial and Compliance Audit Attachment and Exhibit 1. Financial and Compliance Audit Attachment, Exhibit 2-Funding Summary Provides Information Regarding the Funding Sources Applicable to This Contract,Contained Herein,Is A Prediction of Funding Sources and Related Amounts Based on the Contract Budget. 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: GRANT AWARD (FAIN#): N/A FEDERAL AWARD DATE: DUNS NUMBER: 966190837 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL FEDERAL AWARD 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 Requirements for Federal Awards. OMB Circular A-133,As amended—Audits of States,Local Governments, and Non-Profit Organizations 2. 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 Community Care for the Elderly General Revenue-Collier 65010 $ 802,100.00 TOTAL AWARD $ 802,100.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE: Section 215.97, F.S., Chapter 691-5, FL Admin Code,Reference Guide for State Expenditures, Other fiscal requirements set forth in rogram laws,rules and regulations. 25 • 1 $ (e6ueg3 e6en6ue- enuaneN awls L1.-91. Ad Z£66) loealuo3 9 .'C0Z 333 :luauayaelly 1i co co N July 2016—June 2017 CCE 203.16 a. ATTACHMENT VI a COMMUNITY CARE FOR THE ELDERLY PROGRAM ANNUAL BUDGET SUMMARY for Collier County Board of County Commissioners Collier CCE Services Allocations $ 802,100.00 RATE SUMMARY for Collier County Board of County Commissioners Collier County Total Unit Cost Reimbursement Rate-90% Case Management $60.00 $54.00 Case Aide $33.88 $30.50 Adult Day Care $12.83 $11.55 Chore $23.33 $21.00 Enhanced Chore $30.33 $27.30 Companion $23.33 $21.00 Skilled Nursing $42.00 $37.80 EARS $ 1.31 $ 1.18 Escort $21.67 $19.50 Home Delivered Meals $ 7.78 $ 7.00 Homemaking $21.50 $19.35 Personal Care $25.67 $23.10 Respite-in-Facility $12.83 $11.55 Respite-in-Home $25.67 $23.10 Home Improvement $Cost Reimbursement 90% Cost Reimbursement Material Aid $ Cost Reimbursement 90% Cost Reimbursement Specialized Medical Equipment, Service&Supplies $Cost Reimbursement 90% Cost Reimbursement Transportation $Cost Reimbursement 90% Cost Reimbursement 26 (a6ueg3 e6en6uei enuanay a e1S L4-94 A 1 : Z£64) ;oe.luo3 94`EOZ 300 :4uewgoe14V ti N cto July 2016-June 2017 CCE 203.16 a r- m C.) R ATTACHMENT VII INVOICE REPORT SCHEDULE COMMUNITY CARE FOR THE ELDERLY Report Number Based On Submit to State on this Date 1 July Advance* July 1 2 August Advance* July 1 3 July Expenditure Report August 9 4 August Expenditure Report September 9 5 September Expenditure Report October 9 6 October Expenditure Report November 9 7 November Expenditure Report December 9 8 December Expenditure Report January 9 9 January Expenditure Report February 9 10 February Expenditure Report March 9 11 March Expenditure Report April 9 12 April Expenditure Report May 9 13 May Expenditure Report June 9 14 June Expenditure Report July 9 15 Final Expenditure Report July 25 16 Closeout Report August 1 Legend: * Advance based on projected cash need. Note# 1: Report#1 for Advance Basis Agreements cannot be submitted to the Area Agency on Aging for Southwest Florida,Inc.prior to July 1 or until the agreement with the Agency has been executed and a copy sent to the Area Agency on Aging for Southwest Florida,Inc. Actual submission of the vouchers to the Area Agency on Aging for Southwest Florida,Inc. is dependent on the accuracy of the expenditure report. Note#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. The adjustment shall be recorded in Part C, Line 1 of the report(ATTACHMENT VIII). 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 VIII). 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. 27 l s/ (a6uey0 a6en6uei anuanaj a;elS LI•-91, A3 : ZE60 p9e,l}uo0 9l`EOZ 300 :luauayoe;ld 0 o N July 2016-June 2017 CCE 203.16 t31 a ai ATTACHMENT VIII c` A a � REQUEST FOR PAYMENT COMMUNITY CARE FOR THE ELDERLY RECIPIENT NAME,ADDRESS,PHONE;and FEIDIR TYPE OF PAYMENT; This Request Period:From: To: Regular Contract Period Contract; Advance Report; PSA; CERTIFICATION: I hereby certify to the best of myknoxtedge that this request or refund conforms with the terms and the purposes of the above contract. Prepared by: Date: Approved by. Dale: PART A: BUDGET SUMMARY CCE Admin. CCE Services TOTAL 1.Approved Contract Amount $ 0.00 S 0.00 $ 0.00 2.Previous Funds Received for Contract Period $ 0.00 $ 0.00 $ 0.00 3.Contract Batance Qine 1 minus line 2) $ 0.00 $ 0.00 S 0.00 4.Previous Funds Requested and Not Received for Contract Period $ 0.00 $ 0.00 $- 0.00 5.CONTRACT BALANCE(line 3 minus 6ne 4) $ 0.00 $ 080 $ 0.00 PART 8: CONTRACT FUNDS REQUEST 1.Anticipated Cash Need(1st-2nd months) $ 0.00 S 0.00 $ 0.00 2.Net ExpendeuresForMonth $ 0.00 $ 0.00 $ 0.00 (DOEA Form 105C,Part B,Une 4) 3.TOTAL 5 0.00 $ 0.00 5 0.00 PART C: NET FUNDS REQUESTED 1.Less Advance Applied $ 0.00 $ 0.00 $ 0.00 2.TOTAL FUNDS REQUESTED(Part B Line 3,minus Part C Line 1) $ 0.00 $ 0.00 $ 0.00 List of Services/Units/Rates provided-See attached report DOEA FORM 106C Revised 6/4112 28 6,,; (a6ueyo a6en6uei anuanay a;a;S L6-91. AA ZE64) 13 4UO0 91`EOZ 333 :;uauauoe;ly ir; °0 N e- d - QJuly 2016-June 2017 CCE 203.16 a m ATTACHMENT IX a RECEIPT AND EXPENDITURE REPORT COMMUNITY CARE FOR THE ELDERLY PROVIDER NAME,ADDRESS,PHONE#and FEID# Program Funding: THIS REPORT PERIOD: From To CCE Admin. CONTRACT PERIOD: CCE Services CONTRACT# REPORT# PSA# CERTIFICATION: I certify to the best of my knowledge and belief that the report Is complete and correct and all outlays herein are for purposes set forth in the contract. Prepared by: Dale: Approved by: Date: PART A:BUDGETED INCOME/ RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4.Percent of Budget For Thls Report Year to Date Approved Budget 1.State Funds $0.00 $0.00 $0.00 #DIV/01 2.Program Income $0.00 $0.00 $0.00 #DIV/01 3.Local Cash Match $0.00 $0.00 $0.00 #DIV/01 4.SUBTOTAL:CASH RECEIPTS 5.Local 1n-Kind Match 6.TOTAL RECEIPTS $0.00 $0.00 $0.00 #DIV/Ol PART B:EXPENDITURES 1.Approved 2.Expenditures 3.Expenditures 4.Percent of Budget For This Report Year to Date Approved Budget 1.Administrative Services $0.00 $0.00 $0.00 #DIV/01 2.Service Subcontractor(s) $0.00 $0.00 $0,00 #DIV/01 3.Adult Protective Services $0.00 $0.00 $0.00 #DIV/el 4.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #D1V/01 PART C:OTHER REVENUE AND EXPENDITURES II.Interest: III,Advance Recouped I.Program Income(Pi) • 1.Earned on GR Advance$ $ 1.CCE:PI Collected YTD $ 2.Return of GR Advance $ (Includes fees collected) 3.Other Earned $ PART D:CO-PAYMENTS CURRENT MONTH YEAR-TO-DATE 1.Total of Co-payments assessed $ $ 2.Total of Co-payments collected $ $ (For Tracking Purposes only) DOEA FORM 1050 Revised 5125/2010 29 ( I (a6ueyo a6en5ue-1 enuenaej a;e;S LL-94 Ad : Z£61) 43e4uo3 91.`£OZ 333 :luawyae;;v cv r t� r CO Revised August 2007 �- an R a Attestation Statement Agreement/Contract Number: CCE 203.16 Amendment Number: N//A I,Steve Carmel! ,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. 0 . ' � Signa ure f Recipient/Contractor representative Date Approved as to form and legality Assistant County Attorney Revised August 2007 y (a6ue40 a6enluei anuanay ale1S LI-9l• Al : ZE60 loeJluoa 91,TOZ Intl :luauarloelly co3.0 N T T th AD1203.16 a. July 2016—June 2017 ca a AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. ALZHEIMER'S DISEASE INITIATIVE PROGRAM CONTRACT COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS 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." 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. 2. )ncorporation 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-Hv1014,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 July 1, 2016 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 June 30,2017, 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 $ 12,015,00, 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),P.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. 1 • cu (e8uega e8en6ue- enueneN ems L6-9l. AA : ZE61) ;oe_quoa 91.TOZ IaH :4uauayoe;W co 0 r ADI 203.16 July 2016--June 2017 6. Official Payee and Reln•esentatiyes(1�Tames Addresses and Telephone Numhers� The Contractor name,as shown on page 1 of this o Collier County Board of County Commissioners a r contract,and mailing address of the official payee to �oCollier County Community and Human Services 3339 E Tamiami Trail, Suite 211 a• whom the payment shall be made is: Naples,FL 34112 • Kimberley Grant,Director The name of the contact person and street address where Collier County Board of County Commissioners b' financial and administrative records are maintained is: %Collier County Community and Human Services 3339 E Tamiami Trail,Suite 211 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 %Collier County Community and Human Services administration of the program under this contract is: 3339 E Tamiami Trail, Suite 211 Naples,FL 34112 (239)252-2273 Area Agency on Aging for Southwest Florida,Inc. cl The section and location within the Agency where 15201 North Cleveland Avenue, Suite 1100 Requests for Payment and Receipt and Expenditure North Fort Myers,FL 33903 forms are to be mailed is: Tammy Rhoades,Vice President of Finance 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,VI-IX and any exhibits referenced in said attaclunents,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 the Parties. 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 28 page contract,to be executed by their undersigned officials as duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR COUNTY COMMISSIONERS SOUTHWEST FLORIDA,INC. SIGNED BY: *441 SIGNED BY: (t_. ' 1t NAME: Steve Carnet! NAME: MARIANNE G LORINI TITLE: Public Services Department Head TITLE: PRESIDENT/CEO DATE: f 1 51/l DATE: J I J Federal Tax ID: 59-6000558 Fiscal Year Ending Date: 09/30 Approved as to form and legality 2 � Assistant County Attorney ( \ <% (a6ue40 a5en6uei anuanaa;e;S /6-86 AA : Z£61) ;oea;uoa 91:EOZ la`d :;uauayoe;;y coN ADI 203.16 a July 2016--June 2017 Y C.) t4 a INDEX OF ATTACHMENTS ATTACI-IMENT I 4 STATEMENT OF WORK ATTACHMENT II 15 CERTIFICATIONS AND ASSURANCES ATTACHMENT III 19 EXHIBIT 1:FINANCIAL AND COMPLIANCE AUDIT EXHIBIT 2:FUNDING SUMMARY ATTACHMENT VI 25 INVOICE REPORT SCHEDULE ATTACHMENT VII 26 ANNUAL BUDGET and RATE SUMMARY ATTACHMENT VIII 27 REQUEST FOR PAYMENT ATTACHMENT IX 28 RECEIPT AND EXPENDITURE REPORT 3 (e6ueya a6en6ue-j enueneN ems LL-9l• Al : Z£6 ;oei;uoa 94'£02 laV :;uewyoe;;y CO Csi July 2016—June 2017 ADI 203.16 a ATTACHMENTI . STATEMENT OF WORK a I. SERVICES TO BE PROVIDED A. Definitions of Terms I. Acronyms • Alzheimer's Disease(AD) Alzheimer's Disease Initiative(ADI) Activities of Daily Living(ADL) Assessed Priority Consumer List(APCL) Adult Protective Services(APS) Client Information and Registration Tracking System(CIRTS) Community Care for Disabled Adults(CCDA) Corrective Action Plan(CAP) Department of Elder Affairs—(DOEA)or Department Florida Statutes--(F.S.) Home Care for Disabled Adults(HCDA) Instrumental Activities of Daily Living(IADL) Memory Disorder Clinic(MDC) Planning and Service Area(PSA) Summary of Programs and Services(SOPS) United States Code—(U.S.C.) 2, Program-Specific Terms Area Plan: A plan developed by the Area Agency on Aging for Southwest Florida, Inc. outlining a comprehensive and coordinated service delivery system in the respective Planning and Service Area, in accordance with the Section 306 of the Older Americans Act (42 U.S.C. 3026) and Department instructions. The Area Plan includes performance measures and unit rates per service offered per county. Area Plan Update: A revision to the Area Plan wherein the Agency enters ADI-specific data into CIRTS. An update may also include other revisions to the Area Platt as instructed by the Department. Department of Elder Affairs Programs and Services Handbook: An official document of DOEA. The Handbook includes program policies, procedures, and standards applicable to agencies which are recipients/providers of DOEA funded programs.An annual update is provided through a Notice of Instruction. Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain independent and in the least restrictive living arrangement. Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1)and (2),F.S., to provide diagnostic and referral services, conduct basic and service-related multidisciplinary research, and develop training materials and educational opportunities for lay and professional caregivers of individuals with AD. 4 • - i (e6ueya e6en6uai enuanall a;e;S L6-9I. AA : Z£66) 13eJ41103 96'£02 lay :;uaw1-1oe44y co• N r r ADI 203.16 a July 2016—June 2017 11 Y Notice of Instruction (NOr: The Department's established method to communicate to the Agency/and a or Contractor the requirement to perform a particular task or activity. NOIs are located on the Department's website at http://elderaffairs.state.f.us/doea/nois.php. Proviso: Language used in a general appropriations bill to qualify or restrict the way in which a specific appropriation is to be expended. • Program Highlights: Success stories, quotes, testimonials, or human-interest vignettes that are used in the Summary of Programs and Services to include information that helps tell the story of'how programs and services help elders,families, and caregivers. Summary of Programs and Services (SOPS): A document produced by the Department and updated yearly to provide the public and the Legislature with information about programs and services for Florida's elders. B. GENERAL DESCRIPTION 1. General Statement The purpose of the ADI is to address the special needs of individuals with AD,their families and caregivers. 2, Alzheimer's Disease Initiative Program Mission Statement The ADI Program assists persons afflicted with AD and other forms of dementia to live as independently as possible with support to family members and caregivers. 1 Authority The relevant authority governing the ADI Program includes: a. Rule Chapter 58D-1,Florida Administrative Code; b. Sections 430.501,430.502,430.503,and 430.504,Florida Statutes;and; c. The Catalog of State Financial Assistance(CSFA)Numbers are 65004 and 65002. 4. Scope of Service The Agency is responsible for the programmatic, fiscal, and operational management of the ADI Program. The program services shall be provided in a manner consistent with the Agency's Area Plan, as updated, and the current DOEA Programs and Services Handbook,which are incorporated by reference. 5. Major Program Goal The major goal of the ADI Program is to provide services to meet the needs of caregivers and individuals with AD or other related disorders. C. Clients to be Served 1. General Eligibility The AD1 Program addresses the special needs of individuals with AD or other related disorders, and their caregivers. 5 a) (a6ueya a6en6ue-i anuenej a;e;S L6-9l. Ad : Z£60 ;oeW;uoa :;uawy3e41y enco r- ao Q r° ADI 203.16 July 2016—June 2017 a 2. Client Eligibility Clients eligible to receive services under this contract must: a. Be 18 years of age or older and have a diagnosis of AD or a related disorder, or be suspected of having AD or a related disorder; and b. Not be enrolled in any Medicaid capitated long-term care program. 3. Targeted Groups Priority for services under this contract will be given to those eligible persons assessed to be at risk of placement in an institution. II. MANNER OF SERVICE PROVISION A. Service Tasks To achieve the goals of the ADI Program, the Contractor shall perform, or ensure that its Subcontractors perform,the following tasks: 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 section I.C.2. 2. Assessment and Prioritization of Service Delivery for New Clients The Contractor shall ensure the following criteria are used to prioritize new clients in the sequence below for service delivery. It is not the intent of the Department and Agency to remove existing clients from services in order to serve new clients being assessed and prioritized for service delivery. a. Imminent Risk individuals: Individuals in the community whose mental or physical health condition has deteriorated to the degree that self-care is not possible, there is no capable caregiver, and nursing home placement is likely within a month or very likely within 3 months. b. Service priority for individuals not included above, regardless of referral source, will be determined through the Agency's functional assessment administered to each applicant, to the extent funding is available. The Contractor shall ensure that first priority is given to applicants at the higher levels of frailty and risk of nursing home placement. 3. Program Services The Contractor shall ensure the provision of program services is consistent with the Agency's current area plan,as updated and approved by the Agency,and the current DOEA Programs and Services Handbook. B. 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 circumstance occurs that may result in a delay for a period of 60 days or more the initiation of the subcontract or the performance of the Subcontractor,the Contractor shall notify the Agency's Contract Manager and the Agency's Vice President 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 23.1 of 6 m (a6uega e6en6ue- anuanay a4e)g LL-91. Ad : ZE6t) ;oe.quoa 9t.tOZ Iat/ :lUeWg3ell'y Q, ui 00 r N r cc ADI 203.16 tth, a July 2016--June 2017 a. m Master Contract, the Agency will not be responsible or liable for any obligations or claims resulting from such a action. 1. Copies of Subcontracts The Contractor shall submit a copy of all subcontracts to the Contract Manager within thirty days of the subcontract being executed. 2. 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. C. Staffing Requirements 1. Staffing Levels The Contractor shall dedicate the staff necessary to meet the obligations of this contract. 2. Professional Qualifications The Contractor shall ensure that the staff responsible for performing any duties or functions within this contract have the qualifications as specified in the DOEA Programs.and Services Handbook. 3. Service Times The Contractor shall ensure the availability of the services listed in this contract at times appropriate to meet client service needs, at a minimum during normal business hours, or as otherwise specified in Proviso or the Subcontractor's approved service provider application.Normal business hours are defined as Monday through Friday, 8:00 a.m.to 5:00 p.m. D. Deliverables The following section provides the specific quantifiable units of deliverables and source documentation required to evidence the completion of the tasks specified in this contract. 1. Delivery of Services to Eligible Clients The Contractor shall ensure the provision of a continuum of services addressing the diverse needs of individuals with AD and their caregivers. The Contractor shall ensure performance and reporting of the following services in accordance with the Contractor's current Agency-approved Area Plan, the current DOEA Programs and Services Handbook, which is incorporated by reference, and Section II.A.1-3 of this contract. Documentation of service delivery must include a report consisting of the following: number of clients served, number of service units provided by service, and rate per service unit with calculations that equal the total invoice amount.The services include the following categories: a. Respite and Other Services (1)Caregiver Training/Support; (2)Case Aide; (3)Case Management; (4)Counseling(Gerontological); 7 a) (e5uega e5en6ue-i anuana2l awls L4-91• Ad Z£66) loeJluoa 91,TOZ ia`d :luaurgoell`d LO ADI 203.16 July 2016—June 2017 (5)Counseling(Mental Health/Screening); Y v (6)Education/Training; n. (7)Intake; (8)Transportation; (9)Respite(Facility-Based); (10)Respite(In-Home);and (11)Specialized Medical Equipment, Services,and Supplies. b. Memory Disorder Clinics The Agency and Contractor shall maintain coordination with the memory disorder clinics, the Alzheimer's Disease Brain Bank, and all other components of the Alzheimer's Disease Initiative, as well as Silver Alert, in the designated planning and service area. Memory Disorder Clinics (MDCs) are required to provide annual in-service training to all respite, in-facility respite and model day care center staffs in their designated service areas, and plan and develop service-related research projects with model day care and respite providers. The Agency and Contractor shall respond to requests for statistical data concerning its consumers, based on information requirements of the MDCs and the Brain Bank,and assist the MDCs in carrying out Silver Alert protocol activities. 2. Services and Units of Service The Agency shall ensure that the provision of services described in this contract is in accordance with the current DOEA Programs and Services Handbook and the service tasks described in Section II.A. ATTACHMENT VI lists the services that can be performed, the highest reimbursement unit rate, the method of payment,and the service unit type. Units of service will be paid pursuant to the rate established in the Area Plan as updated,as shown in ATTACHMENT VI,and approved by the Agency. E. Reports The Contractor shall respond to additional routine 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 reporting due dates for Subcontractors that permit the Contractor to meet the Agency's reporting requirements. 1. CIRTS Reports The Contractor shall input AD1- specific data into CIRTS. To ensure CIRTS data accuracy, the Contractor shall use CIRTS-generated reports which include the following: a. Client Reports; b. Monitoring Reports; c. Services Reports; d, Miscellaneous Reports; e. Fiscal Reports; f. Aging and Disability Resource Center Reports;and g. Outcome Measurement Reports. 2. Service Cost Reports The Agency shall require Contractor to submit Annual Service Cost Reports, which reflect actual costs of providing each service by program. This Annual Service Cost Report provides information for planning and negotiating unit rates. The General Revenue Service Cost Reports are due by August 15, 2016 for the prior year. 3. Surplus/Deficit Report The Contractor shall submit a Consolidated Surplus/Deficit Report, in a format provided by the Agency to the Agency Contract Manager, by the 18th of each month. This Consolidated Surplus/Deficit Report is for 8 m (a6ueqo a6en6uei anuanay awls LI,-91, Ad : Z£61) ;oea;uoa 91TOZ la`d :;ueuagoe;;y N Ci th ADI203.16 n- July 2016nit agreements and contracts between the Contractor and the Agency and must include the following: 0 a a. Contractor's current status regarding surplus/deficit; b. The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the Agency will be resolved; c. Recommendations to transfer funds to resolve surplus/deficit spending; d. Input from the Agency's Board of Directors on resolution of spending issues, if applicable; e. Number of clients currently on APCL that receive a priority ranking score of 4 or 5;and f. Number of clients currently on the APCL designated as Imminent Risk, F. Records and Documentation 1. Requests for Payment The Contractor shall maintain documentation to support Requests for Payment that shall be available to the Agency or authorized individuals upon request. 2, CMTS Data and Maintenance The Contractor shall ensure,on a monthly basis, collection and maintenance of client and service information in CIRTS or any such system designated by the Agency. Maintenance includes accurate and current data, and valid exports and backups of all data and systems according to Agency standards. 3. Data Integrity and Back up Procedures Each Contractor shall 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. 4. Policies and Procedures for Records and Documentation The Contractor shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its subcontractors. These policies and procedures shall be made available to the Agency upon request. G. Performance Specifications 1. Outcomes and Outputs(Performance Measures) The Contractor must: a. Ensure the prioritization and service provision of clients in accordance with Section II,A.1-3 of this contract; b. Ensure the provision of the services described in this contract are in accordance with the current DOEA Programs and Services Handbook and Section ILD of this contract; • c. Timely submit to the Agency all required documentation and reports described in Section II.E; and d. Timely (in accordance with ATTACHMENT VII) and accurately submit ATTACHMENTS VIII, IX, and supporting documentation. 9 (a6ueya aBen6uei enuenaj ems Ll.-91. Al Z£61.) ;oei;uoa 9t'CU iav :;uawyoet;y N ADI 203.16 a July 2016—June 2017 v _ co , 2. Monitoring and Evaluation Methodology 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,and/or on-site visit(s). 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: a. Desk reviews and analytical reviews; b. Scheduled,unscheduled,and follow-up on-site visits; c. Client visits; d. Review of independent auditor's reports; e. Review of third-party documents and/or evaluation; f. Review of progress reports; g. Review of customer satisfaction surveys; h. Agreed-upon procedures review by an external auditor or consultant; 1. Limited-scope reviews;and j. Other procedures as deemed necessary. H. Contractor Responsibilities 1. Contractor Accountability All service tasks and deliverables pursuant to this contract are solely and exclusively the responsibility of the Contractor,and for which, by execution of the contract,the Contractor agrees to be held accountable. 2, Coordination with Other Providers and/or Entities Notwithstanding that services for which the Contractor is held accountable involve coordination with other entities in performing the requirements of the contract; the failure of other entities does not alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform pursuant to this contract, I. Agency Responsibilities 1. Agency Obligations The Agency will provide technical support to assist the Contractor in meeting the requirements of this contract. 2. Agency Determinations The Agency reserves the exclusive right to make certain determinations in the tasks and approaches. The absence of the Agency setting forth a specific reservation of rights does not mean that all other areas of the contract are subject to mutual agreement. • 10 a, (a6uega e6en6ue- anuene a;e3S L6-9l. Ad : ZE61,) ;oe.i;uoa 96'£02 lad :;uauayoe};br LU N ci • T T cr; AD1203.16 sa July 2016--June 2017 m a III,METHOD OF PAYMENT A. Payment Methods Used The Method of Payment for this contract is a combination of fixed-fee/unit rate, cost reimbursement, and advance payments, subject to the availability of funds and Contractor performance. The Agency will pay the Contractor upon satisfactory completion of the Tasks/Deliverables, as specified in Section II, Manner of Service Provision,and in accordance with other terms and conditions of the contract. 1. Fixed Fee/Unit Rate Payments for Fixed Fee/Unit Rate shall not exceed amounts established in ATTACHMENT VI, 2. Cost Reimbursement Payment may be authorized only for allowable expenditures, which are in accordance with the services specified in ATTACHMENT VI. All Cost Reimbursement Requests for Payment must include the Request for Payment Report (ATTACHMENT VIII) and the Receipt and Expenditure Report (ATTACHMENT IX beginning with the first month of the contract. 3. Advance Payments The Contractor may request up to two (2) months of advances at the start of the contract period 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 and the Department by the State of Florida ("budget release"). The Contractor's requests for advance require the approval of the Agency and/or DORA Contract Manager. The Contractor shall provide the Agency Contract Manager documentation justifying the need for an advance and describing how the funds will be distributed. If sufficient budget is available,the Agency will issue approved advanced payments after July ls`of the contract year. a. All advanced payments retained by the Contractor must be fully expended no later than September 30, 2016.Any portion of advanced payments not expended must be recouped on the Invoice Schedule,report number 5, due to the Agency on October 9, 2016, in accordance with the Invoice Schedule, ATTACHMENT VII. b. All advanced payments made to the Contactor shall be reimbursed to the Agency as follows: At least 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 VII. B. Method of Invoice Payment Payment shall be made upon the Contractor's presentation of an invoice subsequent to the acceptance and approval by the Agency of the deliverables shown on the invoice.The form and substance of each invoice submitted by the Contractor shall be as follows: I. Have a Remittance Address that corresponds exactly to the "Remit To" address provided to MFMP during registration; 11 (a6uega a6en6ue-i anuanaN aleIS LI.-91. Ad : Z£64) 13Biluoa 91.'£OZ lav :luauayoell' ' ADI 203.16 a. — July 2016—June 2017 fC a 2. Request payment on a monthly basis for the units of services established in the Agency's approved Area Plan, provided in conformance with the requirements as described in the DOEA Programs and Services Handbook,at the rates established in ATTACHMENT VI of the contract. Documentation of service delivery must include a report consisting of the following: number of clients served, number of service units provided by service, and rate per service unit with calculations that equal the total invoice amount. Any requested changes to the approved budget subsequent to the execution of the contract,must be submitted to the Contract Manager for approval.Any change to the total contract amount requires a formal amendment; 3. All Requests for Payment shall be based on the submission of monthly Expenditure Reports beginning with the first month of the contract.The schedule for submission of advance requests(when available)and invoices is Invoice Schedule,ATTACHMENT VII. C. Payment Withholding 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 26 of the Master Contract. D. Final Invoice Instructions The Contractor shall submit the final Request for Payment to the Agency no later than July 25,2017. E. CIRTS Data Entries for Subcontractors The Contractor must enter all required data for clients and services in the CIRTS database per the DOEA Programs and Services Handbook and the CIRTS User Manual --Aging Provider Network users (located in Documents on the CIRTS Enterprise Application Services). Contractor must enter this data into CIRTS no later than the 91 of each month prior to submitting their requests for payment and expenditure reports to the Contractor. The Contractor shall establish deadlines for completing CIRTS data entty and to assure compliance with due dates for the requests for payment and expenditure reports that Contractor must submit to the Agency. F. Contractors' Monthly CIRTS Reports The Agency must require Contractors to run monthly C1RTS reports and verify client and service data in 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 Contractor's Request for Payment and Expenditure Reports can be approved by the Agency. G. Corrective Action Plan 1. Contractor shall ensure 100%of the deliverables identified in Section II.D.1-3 of this contract, are performed pursuant to contract requirements. 2. If at any time the Contractor is notified by the Agency Contract Manager that it has failed to correctly, completely, or adequately perform contract deliverables identified in Section II. D. 1-3 of this contract, the Contractor will have 10 days to submit a Corrective Action Plan("CAP")to the Agency Contract Manager that addresses the deficiencies and states how the deficiencies will be remedied within a time period approved by the Agency Contract Manager.The Agency shall assess a Financial Consequence for Non-Compliance on the Contractor as referenced in Section III.I. of this contract 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. 12 m (a6ue49 e6enIuei anue ay a;e1S L1.-9I. AA : Z£61.) loeiluoa 96'£0Z lay :;uaw43e1;y in in co ,-- N r soADI 203.16 a July 2016—June 2017 a Y o 16 a 3. If the Contractor fails to correct an identified deficiency within the approved time period specified in the CAP, the Agency shall deduct the percentage established in Section I1I.1. of this contract,from the payment for the invoice of the following month. 4. If Contractor fails to timely submit a CAP,the Agency shall deduct the percentage established in Section 111.1, of this contract for each day the CAP is overdue.The deduction will be made from the payment for the invoice of the following month. If, or to the extent, there is any conflict between Section H, 1-4 above, and paragraphs 39.1 and 39.2 of the Master Contract,this section shall take precedence. H. Financial Consequences 1. The Agency will withhold or reduce payment if the Contractor fails to perform the deliverables to the satisfaction of the Agency according to the requirements referenced in Section 11.D of this contract. The following financial consequences will be imposed if the deliverables stated do not meet in part or in whole the performance criteria as outlined in Section II.D. of this contract. 2. Delivery of services to eligible clients as referenced in Section II.A.1-3 and Section II.D.1 of this contract —Failure to comply with established assessment and prioritization criteria, as evidenced by CIRTS reports, will result in a 2% reduction of payment per business day. The reduction of payment will begin on the first business day following the Agency's notification to the Contractor that the identified deficiency was not cured or satisfactorily addressed in accordance with the Agency-approved CAP,referenced in Section III.H. 3. Timely submission of a CAP—Failure to timely submit a CAP within 10 business days after notification of a deficiency by the Agency Contract Manager will result in a 2% reduction of payment per business day the CAP is not received. The reduction of payment will begin the first business day following the Agency's notification to the Contractor that the identified deficiency was not cured or satisfactorily addressed in accordance with the Agency approved CAP,referenced in Section III.H. 4. Exceptions may be granted solely,in writing, by the Agency contract manager IV. SPECIAL PROVISIONS A. Final Budget and Funding Revision Requests Final requests for budget revisions or adjustments to contract funds based on expenditures for provided services must be submitted to the Agency Contract Manager in writing no later than June 30, 2017; email requests are considered acceptable. B. Contractor's Financial Obligations 1. Use of Service Dollars and Management of the Assessed Priority Consumer List The Contractor is expected to spend all funds provided by the Agency for the purpose specified in this 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. If the Agency determines that the Contractor is not spending service funds accordingly,the Agency may transfer funds to other Lead'Agencies in the PSA during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under state and federal law. 13 f I a) (e6ueya a6en6uei anuenaj awls L6-91, AA : Z£61.) ;oeJiuoa 9I.TOZ lay :;uewg3elly tOADI 203.16 July 2016—June 2017 a d L. 2. Cost Sharing and Co-payments The Contractor must establish annual co-payment goals. The Agency has the option to withhold a portion of the Contractor's request for payment if goals are not met according to the Agency co- payment guidelines, in accordance with the current DOEA Programs and Services Handbook, which is incorporated by reference. Co-payments include only the amounts assessed to consumers by the Contractor or the amounts consumers opt to contribute in lieu of an assessed co-payment. The consumer's contribution must be equal to or greater than the assessed co-payment. C. Remedies for Nonconforming Services 1. 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. 2. 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. REMAINDER OF PAGE INTENTIONALLY LEFT BLANK • • 14 II • i a, (a6uego a6en6ue-i enuanaa 8;e1s L1,-91. Ad : Z£61.) ;oeJ;uo3 9 1.•£OZ la`d :;uawyoe;;y N — r ADI 203.16 a July 2016—June 2017 ATTACHMENT II c) CERTIFICATIONS AND ASSURANCES a The Agency and/or DOEA will not award this contract unless Contractor completes the CERTIFICATIONS AND ASSURANCES contained in this Attachment. In performance of this contract,Contractor provides the following certifications and assurances: A. pelrarmvnt and Suspension Certification (29 CFR Part 95 and 45 CFR Part 74) B. ,• • ' t , i l r L.•!, •1'J _s ) 'in' 2 CFR P r 3 and 45.CFR P r C. ►i i i. .•imin, Li n • , it i •,stir nee 9 ir 37 ,n 1 .5 ' P,r. '0 D. C r ifi , to Re.,r in' ' li +,i i k rim•. c ion 287 133 F S E. Association of Community Organizations for Reform Now(ACORN)Funding Restrictions Assurance(Pull, L. 111-1171 F. Certification Regarding Scrutinized Companies Lists.section 287.135.F.S, G. Certification Regarding Data Integrity Compliance for Agreements. Grants, Loans And Cooperative Agreements H. Verification of Employment Status Certification A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS—PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies to the best of its knowledge and belief,that it and its principals: 1. Are not presently debarred,suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements,or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity(Federal,State or local) with commission of any of the offenses enumerated in paragraph A.Z.of this certification; and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,State,or local)terminated for cause of default. B. CERTIFICATION REGARDING LOBBYING — Certification for Contracts, Grants, Loans, and Cooperative Agreements. The undersigned Contractor certifies,to the best of its knowledge and belief,that: No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person for influencing or attempting to influence an officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract,grant, loan or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employees of Congress, or employee of a Member of Congress in connection with a Federal contract,grant, loan,or cooperative 15 a� (e6uega a6en6ue- anuanaN a;e}S LV9I. Id : Z£60 Peiwoo 96'£OZ lay :luarugoe;ly ?n 1 July 2016—June 2017 ADI 203.16 agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. a The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements) and that all sub-recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352.Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. C. NON DISCRIMINATION&EQUAL OPPORTUNITY ASSURANCE(29 CFR PART 37 AND 45 CFR PART 80), As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex national origin, age, disability, political affiliation,or belief,and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I-financially assisted program or activity; 2. Title VI of the Civil Rights Act of 1964(Pub.L. 88-352),as amended,and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 80),to the end that,in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112) as amended, and all requirements imposed by or pursuant to the Regulation of the Agency of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act, and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposer( by or pursuant to the Regulation of the Agency of Health and Human Services(45 CFR Part 91),to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. Title DC of the Educational Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 86), to the end that, in accordance with Title DC and the Regulation,no person in the United States shall,on the basis of sex,be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or.activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990(Pub.L. 101-336),prohibits discrimination in all employment practices, including, job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits,and all other employment-related activities,and; Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA 'Title I -- financially assisted program or activity, and to all agreements Contractor makes to early out the WIA Title I—financially assisted program or activity. Contractor understands that DOEA and the United States have the right to seek judicial enforcement of the assurance. 16 d (a6ueya aBen8uei enuanay a;e;S Lt-9l. Aj : Z£61,) ;oe.quoa 91.TOZ lay :;uawyoe;;v a, CV 6 CO July 2016--June 2017 ADI 203.16 a tp D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S. Contractor hereby certifies that neither it,nor any person or affiliate of Contractor,has been convicted of a Public Entity Crime as defined in section 287.133,F.S.,nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform the Agency and/or DOEA immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE(Pub.L.111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub.L. 111-117 are available under the conditions provided by Pub.L, 111-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers(including subcontracts, sub-grants and contracts under grants,loans and cooperative agreements) and that all sub recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS CERTIFICATION,SECTION 287.135,F.S. If this Contract is in the amount of$1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to section 215.473,F.S. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may subject Contractor to civil penalties,attorney's fees,and/or costs. If Contractor is unable to certify to any of the statements in this certification,Contractor shall attach an explanation to this Contract, G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS 1, The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing certain information, including: (1)accurate,current,and complete disclosure of the financial results of each grant-funded project or program in accordance with the prescribed reporting requirements; (2)the source and application of funds for all agreement supported activities; and(3)the comparison of outlays with budgeted amounts for each award.The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported,transmitted or calculated, have been assessed and verified to be capable of processing data accurately,including year-date dependent data.For those systems identified to be non- compliant,Contractors will take immediate action to assure data integrity. 3.If this contract includes the provision of hardware,software,firmware,microcode or imbedded chip technology, the undersigned warrants that these products are capable of processing year-date dependent data accurately.All versions of these products offered by the Contractor(represented by the undersigned)and purchased by the state will be verified for accuracy and integrity of data prior to transfer. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly,the Contractor agrees to immediately make required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state,and without interruption to the ongoing business of the state,time being of the essence. 17 al (aOuego a6en6ue-i anuanaj owls LL-9I. A 1 : Z£61,) Ioa.tIuoo 91,TOZ Ia`d :;uewyoelp' r O C tC July 2016—June 2017 ADI 203.16 a required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state,time being of the essence. a 4.The Contractor and any Subcontractors of services under this contract warrant their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Area Agency on Aging for Southwest Florida,Inc., Contractor certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term, The Contractor shall require that the language of this certification be included in all subagreements, subgrants,and other agreements and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A-102 and 2 CFR Part 200,and 215 (formerly OMB Circular A-110). By signing below, Contractor certifies the representations outlined in parts A through H above are true and correct. 10 ;1 r (Signature and Title of Authorized Representative) Collier County Board of County Commissioners f-_�a ;,_ t , ' 1 /' Contractor Date 3339 E.Tamiami Trail,Suite 211 Approved as to form and legality (Street) Assistant County Attorney Naples, 97 (10 INa (City, State,ZIP Code) 18 (e6uegD a6en6uei anuanay a;elS L1.-91. AA : Z£66) ;oeiwo3 91.'£0Z It7v .;uawyoe;}y � M r r 0 ADI 203.16 July 2016—June 2017 a. ATTACHMENT III Y FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Agency to the provider may be subject to audits and/or monitoring by the Area Agency on Aging for Southwest Florida,Inc.,as described in this section. I. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the Agency staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this agreement, the provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Agency. In the event the Agency determines that a limited scope audit of the provider is appropriate,the provider agrees to comply with any additional instructions provided by the Agency to the provider regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer(CFO)or Auditor General. AUDITS PART I:FEDERALLY FUNDED This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB Circular A-133,as revised. In the event that the provider expends$750,000.00 or more in federal awards during its fiscal year,the provider must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. EXHIBIT 2 to this agreement indicates federal resources awarded through the Agency by this agreement. In determining the federal awards expended in its fiscal year, the provider shall consider all sources of Federal awards, including federal resources received from the Agency. The determination of amounts of' Federal awards expended should be in accordance with the guidelines established by OMB Circular A-133, as revised. An audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part. In connection with the audit requirements addressed in Part I,paragraph 1,the provider shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133,as revised. If the provider expends Iess than$750,000.00 in federal awards in its fiscal year,an audit conducted in accordance with the provisions of OMB Circular A-133,as revised,is not required. In the event that the provider expends less than$750,000.00 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133, as revised, the cost of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from provider resources obtained from other than federal entities.) An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Agency shall be based on the agreement's requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Area Agency on Aging for Southwest Florida, Inc. agreement involved. If not otherwise disclosed as required by Section.310(b)(2)of OMB Circular A-133, as revised,the schedule of expenditures of federal awards shall identify expenditures by agreement number for each agreement with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider's fiscal year end. 19 (e6ueg3 a6en6ue- anuanaN awls L1,-91, Ad : ZE61.) loeiluo0 91,-£02 lav :luawgoellV cv � o M � r July 2016—June 2017 ADI 203.16 a PART II: STATE FUNDEDco n. This part is applicable if the provider is a non-state entity as defined by Section 21597(2),F.S. In the event that the provider expends a total amount of state financial assistance equal to or in excess of$750,000.00 in any fiscal year of such provider(for fiscal years ending September 30, 2004 or thereafter), the provider must have a State single or project-specific audit for such fiscal year in accordance with Section 215,97, RS.; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, EXHIBIT 2 to this agreement indicates state financial assistance awarded through the Agency by this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state financial assistance received from the Agency, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements. connection with the audit requirements addressed in Part II,paragraph 1,the provider shall ensure that the audit complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as defined by Section 215.97(2),F.S.,and Chapter 10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations), Rules of the Auditor General. • If the provider expends less than$750,000.00 in state financial assistance in its fiscal year(for fiscal years ending September 30, 2004 or thereafter),an audit conducted in accordance with the provisions of Section 215.97,F,S,, is not required. In the event that the provider expends less than $750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, F.S., the cost of the audit must be paid from the nonstate entity's resources(i.e.,the cost of such an audit must be paid from the provider resources obtained from other than State entities). An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Agency shall be based on the agreement's requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Agency agreement involved. If not otherwise disclosed as required by Rule 69I-5.003, Fla. Admin, Code,the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider's fiscal year end. Notwithstanding the applicability of this portion,the Agency retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law. II, PART III: REPORT SUBMISSION Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required.by PART I of this agreement shall be submitted,when required by Section .320(d),OMB Circular A-133,as revised,by or on behalf of the provider directly to each of the following: The Area Agency on Aging for Southwest Florida,Inc. at the following address: Area Agency on Aging for Southwest Florida,Inc. Attn:Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 20 (a6ueya e6en6uei anuenaj ems Lt.-94 )d : Z£64) loeJ4uo0 94'£OZ lab' :luewil3ellV M ADI 203.16 a July 2016—June 2017 m The Federal Audit Clearinghouse designated in OMB Circular A-133,as revised(the number of copies required by Sections .320 (d)(1) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the a following address: Federal Audit Clearinghouse Bureau of the Census 1201 East 10th Street Jeffersonville,IN 47132 Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMB Circular A-133, as revised. Pursuant to Sections .320(f), OMB Circular A-133, as revised,the provider shall submit a copy of the reporting package described in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the auditor, to the Area Agency on Aging for Southwest Florida,Inc. at the following address: Area Agency on Aging for Southwest Florida,Inc. Attn:Tanuny Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 Additionally,copies of financial reporting packages required by Part 11 of this agreement shall be submitted by or on behalf of the provider directly to each of the following: The Area Agency on Aging for Southwest Florida,Inc. at the following address: Area Agency on Aging for Southwest Florida,Inc. Attn:Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 The Auditor General's Office at the following address: State of Florida Auditor General Claude Pepper Building,Room 574 111 West Madison Street Tallahassee,Florida 323994450 Any reports, management letter, or other information required to be submitted to the Agency pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-133, F.S.,and Chapters 10.550(local governmental entities) or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General,as applicable. Providers, when submitting financial reporting packages to the Agency for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),Rules of the Auditor General,should indicate the date that the reporting package was delivered to the provider in correspondence accompanying the reporting package. III.PART IV: RECORD RETENTION The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six (6) years from the date'the audit report is issued, and shall allow the Agency or its designee, the CFO or Auditor General Access to such records upon request. The provider shall ensure that audit working papers are made available to the Agency, or its designee, CFO, or Auditor General upon request for a period of six (6) years from the date the audit report is issued, unless extended in writing by the Agency. 21 • • Ig (a6uega e6en6ue- anuanaB a;e3S Lt-9l. AJ : Z£61,) I3eJIuo3 91,'£OZ lay .;ueuyoe;;y Q AD1203.16 July 2016—June 2017 ATTACHMENT III EXHIBIT 1 a PART I: AUDIT RELATIONSHIP DETERMINATION Providers who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part §200.500,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 1 is met. Providers who have been determined to be vendors are not subject to the audit requirements of 2 CFR Part§200.38,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 2 CFR Part §200 and/or Rule 691-5.006, FAC,provider has been determined to be: Vendor not subject to 2 CFR Part§200.38 and/or Section 215.97, F.S. Recipient/subrecipient subject to 2 CFR Part§200.86 and §200,93 and/or Section 215.97,F.S. Exempt organization not subject to 2 CFR Part §200 and/or Section 215.97, F,S. For Federal awards, for-profit organizations are exempt; for state financial assistance projects, public universities, community colleges, district school boards, branches of state(Florida) government, and charter schools are exempt. Exempt organizations must comply with all compliance requirements set forth within the contract or award document. 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 691-.5006, FAC [state financial assistance] and 2 CFR Part§200.330[federal awards]. PART II: FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards, state maintenance of effort funds, 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§200.416—Cost Principles* 2 CFR Part§200.201 —Administrative Requirements** 2 CFR Part§200.500—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§200.400-.411 —Cost Principles* 2 CFR Part§200.100—Administrative Requirements 2 CFR Part§200.500—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§200.418--Cost Principles* 2 CFR Part§200.100—Administrative Requirements 2 CFR Part§200.500—Audit Regnirenients Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations 22 m (a6ueg3 e6en6uel anuanaN ale;S LV94 AA : Z£66) P .1UoO 91,'EOZ 1Cly :}uauryoe]IV U) M r r d ADI 203.16 a July 2016—June 2017 a *Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 2 CFR Part§200.400(5)(c). **For funding passed through U.S. Health and Human Services, 45 CFR 92; for funding passed through U.S. Department of Education,34 CFR 80. 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 691-5,Fla.Admin. Code State Projects Compliance Supplement Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations 23 • i (a6ueyo a6en6uei anuanaB a}e;S L1•-91. Ad Z£61•) Pei woo 91'£0Z l0V :;uawgoe;;y "n coo M Q r t0 July 2016—June 2017 ADI 203.]6 a ATTACHMENT HI 'r EXHIBIT 2 a FINANCIAL AND COMPLIANCE AUDIT ATTACHMENT FUNDING SUMMARY Note: Title 2 CFR§200.331,As Revised,and Section 215.97(5),Florida Statutes,Require That Information About Federal Programs and State Projects Be Provided to the Recipient and Are Stated in the Financial and Compliance Audit Attachment and Exhibit 1. Financial and Compliance Audit Attachment, Exhibit 2-Funding Summary Provides Information Regarding the Funding Sources Applicable to This Contract,Contained Herein,Is A Prediction of Funding Sources and Related Amounts Based on the Contract Budget. 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: GRANT AWARD (FAIN/I): N/A FEDERAL AWARD DATE: DUNS NUMBER: 966140837 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL FEDERAL AWARD 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 Requirements for Federal Awards. OMB Circular A-133,As amended—Audits of States,Local Governments, and Non-Profit Organizations 2. 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 Alzheimer's Disease Initiative General Revenue/TSTF-Collier 65004 $ 312,015.00 TOTAL AWARD $ 312,015.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAT.,ASSISTANCE; Section 215.97,F.S,, Chapter 691-5, FL Admin Code, Reference Guide for State Expenditures,Other fiscal requirements set forth in program laws,rules and regulations, 24 (a6ueya e6en6uei enuana l alels LI-91. AA : ZE66) loeiluoa 9VE0Z IaV :luewg3e14V c lff M r r ADI 203.16 n°1 July 2016—June 2017 C) d ATTACHMENT VI ALZHEIMER'S DISEASE INITIATIVE PROGRAM ANNUAL BUDGET SUMMARY for Collier County Board of County Commissioners Collier ALLOCATION TOTAL $ 312,015.00 RATE REPORT HIGHEST METHOD OF E DELIVERABLES REIMBURSEMENT PAYMENTS UNIT:RATE Case Aid: Collier $33.88 Fixed Fee/Unit Rate . Case Management: Collier $60.00 Fixed Fee/Unit Rate Respite In-Facility: Collier $12.83 Fixed Feel Unit Rate Respite In-Home: Collier $25.67 Fixed Fee/Unit Rate Specialized Medical Equipment,Services and Supplies Cost Reimbursement Transportation `Cost Reimbursement 25 a) (a6ueg3 e6en6ue-i anuanoN e;e;S L1.-9l. Ad : Z£66) ;oe.;uo3 9 'EU lay :;uauayoe;;y co ci `O ADI 203,16 July 2016—June 2017 a ATTACHMENT VII t a � INVOICE REPORT SCHEDULE ALZHEIMER'S DISEASE INITIATIVE Report Number Based On Submit to State on This Date 1 July Advance* July 1 2 August Advance* July 1 3 July Expenditure Report August 9 4 August Expenditure Report September 9 5 September Expenditure Report October 9 6 October Expenditure Report November 9 7 November Expenditure Report December 9 8 December Expenditure Report January 9 9 January Expenditure Report February 9 10 February Expenditure Report March 9 it March Expenditure Report April 9 12 April Expenditure Report May 9 13 May Expenditure Report June 9 14 June Expenditure Report July 9 15 Final Request for Payment July 25 16 Closeout Report August 1 Legend: * Advance based on projected cash need. Note# 1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging for Southwest Florida, Inc. prior to July 1 or until the contract with the Agency has been executed and a copy sent to Agency on Aging for Southwest Florida, Inc. Actual submission of the vouchers to Agency is dependent on the accuracy of the expenditure report. Note#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. The adjustment shall be recorded in Part C, Line 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. 26 m (a6uego e6en6uei enuanaN ems L6-91, AA : Z£6l) 13eiluo3 9V OZ Jay :;uewg3e;ly M T T ADI 203.16 a July 2016-June 2017 m ATTACHMENT VIII IS co a REQUEST FOR PAYMENT ALZHEIMERS DISEASE INITIATIVE PROGRAM RECIPE/IT ttAA ,ADDRESS,Pi$3UE and FEW T\PE OF REPT: TiisRequestPeriod PSA# A_PA11/El fT REQUEST: Report# Regu+ar Supp'emertal Contract# B.METHOD OF PAYWEtff: Contract Period Adrarco Reltriresemerf CERTFCATKX1:therebycertlytothnbestolnryhrotvledgethnlIIisrequestiscorrptzteardcmredardcortormsvnlhthntem-sandthepeaposesoftheabovecortract. Prepared by Date: Approved by._ Date: (1) (2) PART BIAGEfSUf.'l.'IARY #smite GbdeIDayeare TOTAL 1.Appumed Contrail Amoui $0.00 $0.00 $0.00 2.Previous Funds Received for Contract Period $0.00 $0.00 $0.00 3.Contract Balance(line 1 mires ine 2) $0.00 $0.00 $0.00 4.ReviousFmdsRequested and Not Received for CortractPeriod S0.00 $0.00 50.00 5.ContractBalance(ine 3 mires be 4) 50.00 $0.00 $0.00 PART B.CONTRACT FU/DS REQUEST 1.AnticipatedCashIleeds(1si•2nd murk AttachJustification) $0.00 $0.00 $0.00 2.Net E,pendituresFor Morih $0.00 $0.00 50.00 (DOEAFonm 105Z Part B,Lire 3) 3.TOTAL $0.00 $0.00 $0.00 PART C:fET FUNDS REQUESTED 1.Less Advance Applied $0.00 $0.00 $0.00 2.Contract Funds are HetebyRequested for(Part B,line 3 $0.00 $0.00 $0.00 ni nus Pad C.Line 1) List of Seni ces I Urits/Rates provided-See attached report DOF.AFORf.1106Z Roh el V41.2 27 cu (e6uegO e6en6ue-i enuanaN a;e;S LI,-91. Ad : Z£61.) 13e.t;uo3 91•'EOZ lab' :;uauayoe;;y � M ADI 203.16 July 2016-June 2017 a ATTACHMENT IX 6 R a RECEIPT AND EXPENDITURE REPORT ALZHEIMERS DISEASE INITIATIVE PROGRAM PROVIDER NAME,ADDRESS,PHONE#and FEI D/Program Funding: THIS REPORT PERIOD: From To Respite CONTRACT PERIOD: Model Day Care CONTRACT# REPORT# PSA# CERTIFICATION: I certify to the best of my knowledge and belief that the report is complete and correct and all outlays herein are for purposes set forth in the contract. Prepared by: Date: Appreved by:_ Date: PART A:BUDGETED INCOME/RECEIPTS 1_Approved 2.Actual Receipts 3.Total Receipts 4.Percent of Budget For This Report Year to Date Approved Budget 1.State Funds $0.00 $0.00 $0.00 #DIV/01 2.Program Income $0.00 $0.00 $0.00 #DIV101 3.Local.Cash Match $0.00 $0.00 $0.00 ' #DlV/01 4.SUBTOTAL:CASH RECEIPTS 5.Local In-1Gnd Match • 6.TOTAL RECEIPTS $0.00 $0.00 $0.00 #DIV/OI PART B:EXPENDITURES 1.Approved 2.Expenditures 3.Expenditures .4.Percent of Budget For This Report Year to Date Approved Budget • 1_Administrative Services $0.00 S0.00 50.00 #DlV/01 2.Service Subcontractor(s) $0.00 $0.00 $0.00 #DIV/Ol 3.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/O1 PART C:OTHER REVENUE AND EXPENDITURES II.Interest: Ill.Advance Recouped • I.Program Income(PI) 1.Earned on OR Advance$ S 1.ADI:PI Collected YTD $ 2.Return of OR Advance $ (Includes co-payments collected) 3.Other Earned $ PART D:CO-PAYMENTS CURRENT MONTH YEAR-TO-DATE 1.Total of Co-payments assessed $ $ 2.Total of Co-payments collected $ $ (For Tracking Purposes only) DOEAt=oRu lost Relsed Wang) (a6uego a6en6ue-I anuanay alelS L6-91. A- : Z£66) loe.iluo3 96•£OZ lab' :luauatloelly Lei r r 0 th Revised August 2007 c) Attestation Statement Agreement/Contract Number:ADI 203,16 Amendment Number:NHA I,Steve Cannell ,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 uo affect on the agreement/contract content. Iit Signature of Red lent/Contractor representative Date • Approved as to form and legality Assistant County Attorney Revised August 2007 r ; (a6uegD a6en6ue-i anuana2l a1e1S Ll.-9l. A l Z£61•) Ioealuo3 9l'£OZ 3DH ;uawyoe;;y T T Ci July 2016—June 2017 HCE 203.16 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. HOME CARE FOR THE ELDERLY PROGRAM CONTRACT n. COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS CONTRACT is entered into between the State of Area Agency on Aging for Southwest Florida, Inc. (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. PurgS s f 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 HM014,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 July 1,2016 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 June 30,2017. 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 549,250.00,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. 1 �•;: 41 (e6ueg3 e6en6uei anuanaj awls Lt.-91• AA : Z£61.) ;oeJluo3 91.'£OZ 30H :}uawyoel}y M r a July 2016—June 2017 HCE 203.16 a r -- 6. Official Paxee and Retry esentatiyes(Names,Addresses and Teleone Numbersl1 .g Collier County Board of County Commissioners co 0 The Contractor name,as shown on page 1 of this %Collier County Community and Human Services a a, contract,and mailing address of the official payee to 3339 E Tamiami Trail, Suite 211 whom the payment shall be made is: Naples, FL 34112 Kimberley Grant,Director The name of the contact person and street address where Collier County Board of County Commissioners b. financial and administrative records are maintained is: %Collier County Community and Human Services 3339 E Tamiami Trail,Suite 211 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 %Collier County Community and Human Services administration of the program under this contract is: 3339 E Tamiami Trail, Suite 211 Naples,FL 34112 (239)252-2273 The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc. d. Requests for Payment and Receipt and Expenditure 15201 North Cleveland Avenue,Suite 1100 forms are to be mailed is: North Fort Myers,FL 33903 Tammy Rhoades,Vice President of Finance 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,VI-IX,G 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 the Parties. 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 30 page contract,to be executed by their undersigned officials as duly authorized. AREA AGENCY ON AGING FOR Contractor: COLLIER COUNTY BOARD OF SOUTHWEST FLORIDA,INC. COUNTY COMMISSIONER . 11 I SIGNED BY: ? elf-: V . r SIGNED BY: . A,c .A i �,�' t NAME: Steve Carnell NAME: MARIANNE G LORINI TITLE: Public Services Department Head TITLE: PRESIDENT/CEO DATE: —M51( ` 1( DATE `n )•?11U / r i Federal Tax ID: 59-6000558 fiscal Year Ending Date: 09/30 • Approved as to form and legality . 2 (• .. • . • • 'Assistant County Attorney4^_. oy,r �r\\ { (a6uey3 a6en6ue- anuanaa a;e;s L4-94 Ad : Z£64) ;OeJ;uo3 94'£OZ 30H -;uauay3e;;V ` � M co July 2016—June 2017 HCE 203.16 G INDEX OF ATTACHMENTS a ATTACHMENT 4 STATEMENT OF WORK ATTACHMENT II 16 CERTIFICATIONS AND ASSURANCES ATTACHMENT III 20 EXHIBIT I: FINANCIAL AND COMPLIANCE AUDIT EXHIBIT 2:FUNDING SUMMARY ATTACHMENT VI 26 HOME CARE FOR THE ELDERLY ANNUAL BUDGET and RATE SUMMARY ATTACHMENT VII 27 HOME CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE ATTACHMENT VIII 28 REQUEST FOR PAYMENT ATTACHMENT IX 29 RECEIPT AND EXPENDITURE REPORT ATTACI-IMENT G 30 BACKGROUND SCREENING 3 (e5ueg3 a6en6uei anuanaN awls L6-9I. AA : Z£61•) loealuoo 91,'£OZ 33H :luauayoe;;v M r � July 2016—June 2017 TICE 203.16 a ATTACHMENT I c) ca STATEMENT OF WORK a. HOME CARE FOR THE ELDERLY PROGRAM L SERVICES TO BE PROVIDED A. Definitions of Terms I. Acronyms Area Agency on Aging(AAA) Adult Protective Services(APS) Adult Protective Services Referral Tracking Tool(ARTY) Corrective Action Plan(CAP) Community Care for Disabled Adults(CCDA) Community Care for the Elderly(CCE) Client Information and Registration Tracking System(CIRTS) Department of Children and Families(DCF) Florida Department of Elder Affairs(DOEA) Florida Statutes(F.S,) Home Care for Disabled Adults(HCDA) Home Care for the Elderly(HCE) Institutional Care Program(ICP) Notice of Instruction(NOI) Planning and Service Area(PSA) Summary of Programs and Services(SOPS) United States Code(U.S.C.) 2. Program-Specific Terms Area Plan:A plan developed by the Area Agency on Aging for Southwest Florida,Inc,outlining a comprehensive and coordinated service delivery system in its PSA in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Act and Department instructions.The Area Plan includes performance measures and unit rates per service offered per county, Area PIan Update: A revision to the Area Plan wherein the Area Agency on Aging enters HCE Program specific data in CIRTS. An update may also include other revisions to the Area Plan as instructed by the Agengy and/or Department. Department of Elder Affairs Programs and Services Handbook (DOEA Handbook or Handbook): An official document of the State of Florida, DOEA. Handbook includes program policies, procedures, and standards applicable to agencies which are recipients/providers of DOEA funded programs and providers of grogram-funded services. An annual update is provided through a Notice of Instruction. Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain independent and in the least restrictive living arrangement. 4 , �1 (aBueg3 aBen6uei anueneN elels L6-9l. Ad : Z£6t.) loeJluop 91.TOZ 23H :luawyoelly July 2016—June 2017 HCE 203.16 Notice of Instruction (NOI): The Department's established method to communicate to the Agency Y and/or Contractor the requirement to perform a particular task or activities. NOls are located on the Department's website at http://elderaffairs.state.fl.us/doealnois.php, a Program Highlights: Success stories, quotes, testimonials, or human-interest vignettes that are used in the SOPS to demonstrate how programs and services help elders,families, and caregivers. Summary of Programs and Services (SOPS): A document produced by the Department and updated yearly to provide the public and the Legislature with information about programs and services for Florida's elders. B. GENERAL DESCRIPTION 1. General Statement The purpose of the HCE Program is to encourage the provision of care for elders in family-type living arrangements in private homes as an alternative to nursing homes or other institutional care settings. 2. Home Care for the Elderly Program Mission Statement The HCE Program assists caregivers of three(3)or fewer elders,living in private homes,through the provision of a basic subsidy for maintenance and supervision,as well as other necessary specialized services. 3. Authority The relevant authority governing the HCE Program includes: a. Rule Chapter 58H-1, Florida Administrative Code; b. Sections 430,601,430.602,430.603,430.604,430.605,430.606,430.608,F.S.;and c. The Catalog of State Financial Assistance(CSFA)Number 65001. 4. Scope of Service The Agency is responsible for the programmatic, fiscal and operational management of HCE. The program services shall be provided in a manner consistent with the Agency's current Area Plan, as updated, and the current Department of Elder Affairs Programs and Services Handbook,which are incorporated by reference. 5. Major Program Goals The major goals of the HCE Program are to ensure that: a. A basic Subsidy is provided to the caregiver of each client; and b. A special Subsidy is provided when essential to the well-being of the client. C. Clients to be Served 1. General Description The HCE Program serves elders age 60 and older at risk of placement in a nursing home or other institutional setting who are able to remain in a family-style setting with a caregiver through the provision of subsidies. 2. Client Eligibility Clients eligible to receive services under this contract must: a. Be 60 years of age or older; b. Have income no greater than the ICP standard; c. Meet the ICP asset limitation; c1. Be at risk of nursing home placement; 5 (a6ueqo aBen6uei anuana8 eleiS LI.-91. AA : Z£64) loeJluo3 94'£OZ 33H :luawyoel V ti +� M T July 2016---June 2017 HCE 203,16 a c. Have au approved adult caregiver living in the home with them who is willing and able to provide care or assist in arranging for care;and a f. Not be enrolled in a Medicaid capitated long-term care program, 3. Caregiver Eligibility Caregivers eligible to receive services under this contract must: a, Be at least 18 years of age; b. Be capable of providing a family-type living environment; c. Be a relative or a friend who has been accepted by the client as a surrogate family,or is a responsible adult with whom the client has made an arrangement to provide home care services; d. Be willing to accept responsibility for the social,physical,and emotional needs of the care recipient; e. Be physically present and live in the home to provide supervision and to assist in arrangement of services for the.client; f. Maintain the residential dwelling free of conditions that pose an immediate threat to the life,safety,health and well-being of the home care.client;and g. Be without record of conviction of abuse,neglect or exploitation of another person. 4. Targeted Groups Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk of placement in an institution. II. MANNER OF SERVICE PROVISION A. Service Tasks To achieve the goals of the HCE Program,the Contractor shall perform,or ensure that its Subcontractors perform, the following tasks: 1. CIient 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 Section I,C.2.and 3, 2. Assessment and Prioritization of Service Delivery for New Clients The Contractor shall ensure the following criteria are used to prioritize new clients in the sequence below for service delivery.It is not the intent of the Department and/or Agency to remove existing clients from services in order to serve new clients being assessed and prioritized for service delivery. a. Imminent Risk individuals: Individuals in the community whose mental or physical health condition has deteriorated to the degree that self-care is not possible,there is no capable caregiver, and nursing home placement is likely within a month or very likely within 3 months. b. Aging Out individuals: Individuals receiving CCDA and HCDA services through the Department of Children and Families' Adult Services, transitioning to community-based services provided through the Agency and/or Department when services are not currently available. c. Service priority for individuals not included in a. and b. above, regardless of referral source, will be determined through the Agency's functional assessment administered to each applicant, to the extent funding is available.The Contractor shall ensure that first priority is given to applicants at the higher levels of frailty and risk of nursing home placement. For individuals assessed at the same priority and risk of nursing home placement,priority will be given to applicants with the lesser ability to pay for services. 6 • s . i (a6ueg3 a6en6ue- anuanau elelS Lb-9l• Ad : Z£60 loeJluo3 91,TOZ 33H :luawyoelly co 7.0co July 2016—June 2017 HCE 203.16 3. Program Services The Agency and Contractor shall ensure the provision of program services is consistent with the Agency's current area plan, as updated and approved by the Agency, and the current DOBA Programs and Services Handbook. B. 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 circumstance occurs that may result in a delay for a period of 60 days or more the initiation of the subcontract or the performance of the Subcontractor,the Contractor shall notify the Agency's Contract Manager and the Agency's Vice President of 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 23.1 of Master Contract, the Agency will not be responsible or liable for any obligations or claims resulting from such action. 1. Copies of Subcontracts The Contractor shall submit a copy of all subcontracts to the Contract Manager within thirty days of the subcontract being executed. 2. 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. C. Staffing Requirements 1. Staffing Levels The Contractor shall dedicate the staff necessary to meet the obligations of this contract and ensure that subcontractors dedicate adequate staff accordingly. 2. Professional Qualifications The Contractor shall ensure that the staff responsible for performing any duties or functions within this contract have the qualifications as specified in the DOEA Programs and Services Handbook. 3. Service Times The Contractor shall ensure the availability of services listed in this contract at times appropriate to meet client service needs, at a minimum during normal business hours. Normal business hours are defined as Monday through Friday, 8:00 a.m.to 5:00 p.m. D. Deliverables The following section provides the specific quantifiable units of deliverables and source documentation required to evidence the completion of the tasks specified in this contract. 1. Delivery of Services to Eligible Clients The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of the functionally impaired elders and their caregivers. The Contractor shall ensure performance and reporting of 7 (a6uey3 e6en6ue7 enuanaa a;e;S LI.-9I. Ad Z£61•) Peiwoo 9t'£0Z 33H :;ueuayoeljV w � M r r- July 2016—June 2017 HCE 203.16 ad' V the following services in accordance with the Agency's Area Plan,the current DOEA Programs and Services a Handbook, which is incorporated by reference, and Section II.A.1.3 of this contract. Documentation of service delivery must include a report consisting of the following: number of clients served, number of service units provided by service, and rate per service unit with calculations that equal the total invoice amount. The services include the following categories: a. Basic Subsidy The Contractor shall ensure that the Basic Subsidy is a cash payment made to an approved caregiver each month to reimburse expenses incurred in caring for the client as detailed in II.D.1.b. and the DOHA Handbook. The Basic Subsidy is provided for support and maintenance of the care recipient, including housing, food, clothing, and medical costs not covered by Medicaid, Medicare or any other insurance. A Basic Subsidy shall be paid to approved caregivers when the client is in the home for any part of the month. If the client is hospitalized or in any other temporary institution for 30 days or less,the frill Basic Subsidy shall be provided to the caregiver as if the client were in the home. b. Calculating the Basic Subsidy The Basic Subsidy shall be based on the financial status of the client receiving care. In the event that both a husband and wife are clients,their combined financial status shall be used to determine the amount of the Basic Subsidy. The Contractor shall ensure the Basic Subsidy is calculated in accordance with the current DOEA Programs and Services Handbook. c, Special Subsidy Services The Contractor shall ensure that the Special Subsidy payments are pre-authorized and are based on additional specialized medical or health care services,supplies or equipment needed to maintain the health and well-being of the individual elder. The Special Subsidy for additional medical support and special services is a cash payment to reimburse the costs of any other service or special care not covered by Medicaid, Medicare, or private insurance when these services are determined to be essential to maintain the well-being of the home care recipient.A Special Subsidy shall be paid to the approved caregivers when the client is in the home for any part of the month. Special Subsidy Services may be authorized through a vendor agreement. All Special Subsidy services must be performed in accordance with the Department of Elder Affairs Programs and Services Handbook.Special Subsidy services include the following: 8 1 (a6ueg3 e6en6uei anuanaj awls LV9I. AA : Z£66) 1•oelluo0 91'£OZ 30H :luewyoelly Lc" © S o July 2016—.Rine 2017 HCE 203.16 a 4. • d r I} Adult Day Care a I 2) Adult Day Health 11)Housing Improvement 12)Material Aid Cara 13) Occupational Therapy 3) Caregiver 14) Other Training/Support 15)Personal Care 4) Chore 16)Physical Therapy 5) Chore(Enhanced) 17) Respite(Facility Based or In- 6) Counseling Home) (Gerontological) 18) Skilled Nursing Services 7) Counseling(Mental 19) Specialized Medical Health/Screening) Equipment,Services and 8) Home Health Aide Supplies Service 20) Speech Therapy 9) Homemaker 21)Transportation 10)Home Delivered Meals d. Access to and Coordination of Services The Contractor shall ensure,through case management and case aide services,that the HCE client's needs are documented and needed services are planned,arranged and coordinated for the client and caregiver. 2. Service Units The Contractor shall ensure that the provision of services described in this contract is in accordance with the current DOEA Programs and Services Handbook and the service tasks described in Section 1I.A. ATTACHMENT VI Iists the services that can be performed, the highest reimbursement unit rate, the method of payment, and the service unit type. Units of service will be paid pursuant to the rate established in the Agency's Area Plan as updated,as shown in ATTACHMENT VI,and approved by the Agency. E. Reports The Contractor shall respond to additional routine 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 reporting clue dates for Subcontractors that permit the Contractor to meet the Agency's reporting requirements. 1. CIRTS Reports The Contractor shall input HCE-specific data into CIRTS.To ensure CIRTS data accuracy,the Contractor shall use CIRTS-generated reports which include the following: a. Client Reports; b. Monitoring Reports; c. Services Reports; d. Miscellaneous Reports; e. Fiscal Reports; f. Aging and Disability Resource Center Reports;and g. Outcome Measurement Reports. 9 (a6ueg3 e6en6uei enueneN a;e;S LV9I. Al : Z£6l) ;oei;moo 9V'£OZ 33H :;uawyoe;;�y T N r M July 2016—June 2017 HCE 203.16 a _ m 2. Service Cost Reports a The Agency shall require the Contractor to submit Annual Service Cost Reports, which reflect actual costs of providing each service by program. This Annual Service Cost Report provides information for planning and negotiating unit rates. The General Revenue Service Cost Reports are due by August 15, 2016 for the prior year. 3. Surplus/Deficit Report The Contractor shall submit a Consolidated Surplus/Deficit Report, in a format provided by the Agency to the Agency Contract Manager, by the 18th of each month. This Consolidated Surplus/Deficit Report is for all agreements and contracts between the Contractor and the Agency and must include the following: a. Contractor's current status regarding surplus/deficit; b. The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the Agency will be resolved; e. Recommendations to transfer funds to resolve surplus/deficit spending; d. Input from the Agency's Board of Directors on resolution of spending issues, if applicable; e. Number of clients currently on APCL that receive a priority ranking score of 4 or 5; and f. Number of clients currently on the APCL designated as Imminent Risk. E. Records and Documentation 1. Requests for Payment The Contractor shall maintain documentation to support Requests for Payment that shall be available to the Agency or authorized individuals upon request. 2. CIRTS Data and Maintenance The Contractor shall ensure, on a monthly basis, collection and maintenance of client and service information in CIRTS or any such system designated by the Agency. Maintenance includes accurate and current data,and valid exports and backups of all data and systems according to Agency standards. 3. Data Integrity, and Back up Procedures Each Contractor shall 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. 4. Policies and Procedures for Records and Documentation The Contractor shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement of its subcontractors. These policies and procedures shall be made available to the Agency upon request. F. Performance Specifications 1. Outcomes and Outputs(Performance Measures) The Contractor must: a. Ensure the prioritization and service provision of clients in accordance with Section ILA.1-2. of this contract; 10 (e6uey3 e6en6ue- enuanaa 94e1S 16-91. Ad : Z£66) I9e.iluo3 9t.'£OZ 33H :;uauayoe;Iv N N 6 July 2016--June 2017 HCE 203.16 th b. Ensure the provision of the services described in this contract are in accordance with the current DOEA Programs and Services Handbook and Section ILD of this contract; c. Timely submit to the Agency all required documentation and reports described in Section ILE; and d. Timely (in accordance with ATTACHMENT VII) and accurately submit ATTACHMENTS VIII, and ATTACHMENT IX,and supporting documentation. 2. Monitoring and Evaluation Methodology 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,and/or on-site visit(s). 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: a. Desk reviews and analytical reviews; b. Scheduled,unscheduled,and follow-up on-site visits; c. Client visits; d. Review of independent auditor's reports; e. Review of third-party documents and/or evaluation; f. Review of progress reports; g. Review of customer satisfaction surveys; lr, Agreed-upon procedures review by an external auditor or consultant; i. Limited-scope reviews;and j. Other procedures as deemed necessary. G. Contractor Responsibilities 1, Contractor Accountability All service tasks and deliverables pursuant to this contract are solely and exclusively the responsibility of the Contractor, and for which,by execution of the contract,the Contractor agrees to be held accountable. 2. Coordination with Other Providers and/or Entities Notwithstanding that services for which the Contractor is held accountable involve coordination with other entities in performing the requirements of the contract; the failure of other entities does not alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform pursuant to this contract. H. Agency Responsibilities 1. Agency Obligations The Agency will provide technical support to assist the Contractor in meeting the requirements of this contract. 2. Agency Determinations The Agency reserves the exclusive right to make certain determinations in the tasks and approaches. The absence of the Agency setting forth a specific reservation of rights does not mean that all other areas of the contract are subject to mutual agreement. 11 (a6uey3 e6en6uei anuanaa eleiS L4-9l. A3 : ZE64) 1oeiluo0 94'E0Z 33H :luawyoellyeel T M ci July 2016—June 2017 HCE 203.16 a as III.METHOD OF PAYMENT a A. Payment Methods Used The Method of Payment for this contract is a combination of fixed-fee/unit rate,cost reimbursement, and advance payments, subject to the availability of funds and Contractor performance. The Agency will pay the Contractor upon satisfactoiy completion of the Tasks/Deliverables, as specified in Section II, Manner of Service Provision, and in accordance with other terms and conditions of the contract. 1. Fixed Fee/Unit Rate Payments for Fixed Fee/Unit Rate shall not exceed amounts established in ATTACHMENT VI. 2. Cost Reimbursement Payment may be authorized only for allowable expenditures,which are in accordance with the services specified in ATTACHMENT VI. All Cost Reimbursement must include Requests for Payment (ATTACHMENT VIII) and the Receipt and Expenditure Report (ATTACHMENT IX), beginning with the first month of the contract. 3. Advance Payments The Contractor may request up to two(2)months of advances at the start of the contract period 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 and the Department by the State of Florida ("budget release"). The Contractor's requests for advances require the approval of the Agency and/or DOEA Contract Manager. The Contractor shall provide the Agency Contract Manager documentation justifying the need for an advance and describing how the funds will be distributed. If sufficient budget is available, the Agency will issue approved advanced payments after July 1st of the contract year. a. All advanced payments retained by the Contractor must be fully expended no later than September 30, 2016,Any portion of advanced payments not expended must be recouped on the Invoice Schedule, report number 5, due to the Agency on October 9, 2016, in accordance with the Invoice Schedule, ATTACHMENT VII. b. All advance payments made to the Contractor shall be reimbursed to the Agency as follows: At least 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 VII. B. Method of Invoice Payment Payment shall be made upon the Contractor's presentation of an invoice subsequent to the acceptance and approval by the Agency of the deliverables shown on the invoice. The form and substance of each invoice submitted by the Contractor shall be as follows: 1. Have a Remittance Address that corresponds exactly to the "Remit To" address provided to MFMP during registration; 2. Request payment on a monthly basis for the units of services established in the Agency's approved Area Plan and provided in conformance with the requirements as described in the DOEA Programs and Services Handbook,at the rates established in ATTACHMENT VI of the contract. Documentation of service delivery must include a report consisting of the following: number of clients served, number of service units provided by service, and rate per service unit with calculations that equal the total invoice amount. Any 12 (a6uey3 a6en6ue- anuanaN a;e;S L4-9l. AA : Z£64) pei;uoo 94'£OZ 33H :;uaurtaoe;; ' er M July 2016—June 2017 HCE203.16 a as r1 requested changes to the approved budget subsequent to the execution of the contract,must be submitted to the Contract Manager for approval.Any change to the total contract amount requires a formal amendment; 3. All Requests for Payment shall be based on the submission of monthly Expenditure Reports beginning with the first month of the contract.The schedule for submission of advance requests(when available)and invoices is Invoice Schedule, ATTACHMENT VII, C. Payment Withholding 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 26 of the Master Contract. D. Final Invoice Instructions The Contractor shall submit the final Request for Payment to the Agency no later than July 25,2017. E. HCE Basics and Subsidy Data Entries Schedule The Contractor must ensure all data for HCE subsidies are entered in CIRTS by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th of the month will be for payments incurred between the 16th of the previous month and including billing up to the 15th of the current month. The Contractor shall ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS Monthly Service Utilization Report, by consumer and by worker identification is generated. The Contractor shall ensure the Monthly Utilization Report by consumer and by worker identification is verified, corrected, and certified no later than the 20th of the month in which the Report is generated. (Case management data entered into CIRTS by the entered prior to the 9th of the month shall be for units of service provided during the previous billing month from the 1st and up to and including the last day of the previous month and also entered before submitting billing reports which are due by the 9`h of each month) F, CIRTS Data Entries for Contractors The Contractor must enter all required data for clients and services in CIRTS database per the DOEA Programs and Services Handbook and the CIRTS User Manual — Aging Provider Network users (located in Documents on the CIRTS Enterprise Application Services). Contractors must enter this data, CAV and CMV for the previous month's billing, no later than the 9'h of each month into CIRTS prior to submitting their requests for payment and expenditure reports to the Agency. The Contractor must submit billing receipts over$150(total for the month), G. Time Limits The caregiver must submit the receipts to the case manager within 30 days. Caregivers will be reimbursed within 60 clays of submitting the original receipt to the Contractor. When the contractor submits the receipts to the Agency for the monthly billing,the receipts must be less than 60 days. H. Contractors'Monthly CIRTS Reports The Agency must require Contractors to run monthly CIRTS reports and verify client and service data in 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 Contractor's Request for Payment and Expenditure Reports can be approved by the Agency. 13 (a6ueg3 e6en6uei enuanej eiRls L1.-9I. AA : Z£66) ;oeJIuo3 94'£OZ 33H N tr) M � T w July 2016--June 2017 HCE 203,16 I, Corrective Action Plan 1, Contractor shall ensure 100% of the deliverables identified in Section Ii.D.1-3 of this contract, are performed a pursuant to contract requirements. 2. If at any time the Contractor is notified by the Agency Contract Manager that it has failed to correctly, completely, or adequately perform contract deliverables identified in Section II. D. 1-3 of this contract, the Contractor will have 10 days to submit a Corrective Action Plan("CAP")to the Agency Contract Manager that addresses the deficiencies and states how the deficiencies will be remedied within a time period approved by the Agency Contract Manager. The Agency shall assess a Financial Consequence for Non-Compliance on the Contractor as referenced in Section I1LJ. of this contract 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. If the Contractor fails to correct an identified deficiency within the approved time period specified in the CAP, the Agency shall deduct the percentage established in Section IILJ, of this contract, from the payment for the invoice of the following month. 4. If Contractor fails to timely submit a CAP,the Agency shall deduct the percentage established in Section 1I1.J. of this contract for each day the CAP is overdue. The deduction will be made from the payment for the invoice of the following month, If, or to the extent, there is any conflict between Section I, 1-3 above, and paragraphs 39.1 and 39.2 of the Master Contract,this section shall take precedence. J. Financial Consequences 1. The Agency will withhold or reduce payment if the Contractor fails to perform the deliverables to the satisfaction of the Agency according to the requirements referenced in Section II.D of this contract. The following financial consequences will be imposed if the deliverables stated do not meet in part or in whole the performance criteria as outlined in Section II.D.of this contract. 2. Delivery of services to eligible clients as referenced in Section 1LA.1-2 and Section II.D.1 of this contract— Failure to comply with established assessment and prioritization criteria, as evidenced by CIRTS reports,will result in a 2%reduction of payment per business day.The reduction of payment will begin on the first business day following the Agency's notification to the Contractor that the identified deficiency was not cured or satisfactorily addressed in accordance with the Agency-approved CAP,referenced in Section III.I. 3. Timely submission of a CAP—Failure to timely submit a CAP within 10 business days after notification of a deficiency by the Agency Contract Manager will result in a 2% reduction of payment per business day the CAP is not received. The reduction of payment will begin the first business day following the Agency's notification to the Contractor that the identified deficiency was not cured or satisfactorily addressed in accordance with the Agency approved CAP,referenced in Section IH.I. 4. Exceptions may be granted solely,in writing,by the contract manager IV, SPECIAL PROVISIONS A. Final Budget and Funding Revision Requests Final requests for budget revisions or adjustments to contract fiords based on expenditures for provided services must be submitted to the Agency Contract Manager in writing no later than June 25, 2017; email requests are considered acceptable. 14 (a6ueg3 a6en6ue-1 anuanall ele;S 16-96 AA : Z£66) ;oea;uoo 96'£OZ 33H :;uewrloe;;y co M ci cc July 2016--June 2017 HCE 203.16 a 1 13, Contractor's Financial Obligations a 1. Use of Service Dollars and Management of the Assessed Priority Consumer List The Contractor is expected to spend all funds provided by the Agency for the purpose specified in this 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. If the Agency determines that the Contractor is not spending service funds accordingly, the Agency may transfer funds to other Lead Agencies in the PSA during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under state and federal law. C, Remedies for Nonconforming Services 1. 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. 2. 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. 15 (a6uego e6en6uei anuanaa a els Lb-9l. Ad : Z£61.) 13e.11UO3 91•£0Z 33H :luewyoelly 16 July 2016—June 2017 HCE 203. a. ATTACHMENT II ' CERTIFICATIONS AND ASSURANCES a The Agency and/or DOEA will not award this contract unless Contractor completes the CERTIFICATIONS AND ASSURANCES contained in this Attachment. In performance of this contract,Contractor provides the following certifications and assurances: A. rrn•ntiniSrsiensienC•rifi ion2' CFR Po. 'S ,nr S _ i ' ..' • B. C r ific ion Re. rrlin' Loj 1 in' 2' CFR P '3 ,n 1 • CF ', • 3 C. ., V rimin, inn :_ Fr 1t_-• ornira • n • n • FP r 'i n1 4S ,FR Pr_SO D. Certification Regarding Public Entity Crimes.section 287.I33.F,Sti E. . r it ion of Cotrim mit Or!tniz.tions for R form A SR 1 _u Iii . R•, r: 'ins s, ❑'tn • L. ]11-YI71 F. C• ' ifi , ion Zee riin _cra iniz 1 Am .nie Li • !II : F S G. Certification Regarding Data Integrity Compliance for Agreements. Grants. Loans And Cooperative Agreements H. Verification of Employment Status Certification A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS—PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies to the best of its knowledge and belief,that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency; 2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense hi connection with obtaining,attempting to obtain,or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements,or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity(Federal, State or local) with commission of any of the offenses enumerated in paragraph A.2.of this certification;and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,State,or local)terminated for cause of default. B. CERTIFICATION REGARDING LOBBYING — Certification for Contracts, Grants, Loans, and Cooperative Agreements. The undersigned Contractor certifies,to the best of its knowledge and belief,that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,to any person for influencing or attempting to influence au officer or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal Ioan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal Coitract, grant,loan or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employees of Congress,or employee of a Member of Congress in connection with a Federal contract,grant, loan,or cooperative 16 (eBueg3 e6en5ue-i enuanab ems L6-9l. Ad : Z£66) 43e.;uo3 96'£02 33H :;uewgoelPe co N x1 July 2016—June 2017 HCE 203.16 a agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report v Lobbying,"in accordance with its instructions. a The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements) and that all sub-recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352.Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. C. NON DISCRIMINATION& EQUAL OPPORTUNITY ASSURANCE(29 CFR PART 37 AND 45 CFR PART 80). As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub, L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex national origin, age, disability, political affiliation,or belief,and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I-financially assisted program or activity; 2. Title VI of the Civil Rights Act of 1964(Pub.L.88-352),as amended,and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 80), to the end that,in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department and/or Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112) as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act, and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department. 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 91),to the end that,in accordance with the Act and the Regulation,no person in the United States shall,on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5, Title IX of the Educational Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation,no person in the United States shall,on the basis of sex,be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990(Pub.L. 101-336),prohibits discrimination in all employment practices, including, job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment-related activities,and; 17 (e6uegD e5en6uel anuanay ale1S L6-9I. AA : ZE61.) I3ealuo3 9l•'£0Z 33H :luauayoelly N Co) r � July 2016—June 2017 HCE 203.16 a a) 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program a or activity, and to all agreements Contractor makes to carty out the WIA Title I—financially assisted program or activity. Contractor understands that DOEA and the United States have the right to seek judicial enforcement of the assurance. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S. Contractor hereby certifies that neither it,nor any person or affiliate of Contractor,has been convicted of a Public Entity Crime as defined in section 287.133,F.S.,nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform the Agency and/or DOEA immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE(Pub.L,111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511 (Pub. L. 111-117), The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub.L. 111-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers(including subcontracts, sub-grants and contracts under grants,loans and cooperative agreements)and that all sub recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS CERTIFICATION,SECTION 287.135,F.S, If this Contract is in the amount of$1 million or more, in accordance with the requirements of section 287.135,F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to section 215.473,F.S. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may subject Contractor to civil penalties,attorney's fees,and/or costs. If Contractor is unable to certify to any of the statements in this certification,Contractor shall attach an explanation to this Contract, G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing certain information, including: (1)accurate, current,and complete disclosure of the financial results of each grant-funded project or program in accordance with the prescribed reporting requirements; (2)the source and application of funds for all agreement supported activities;and(3)the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported,transmitted or calculated,have been assessed and verified to be capable of processing data accurately, including year-date dependent data.For those systems identified to be non- compliant,Contractors will take immediate action to assure data integrity. 18 s (aBucg3 e6en6ue-1 anuanaN a;e3S L4-9l. Id : ZE64) lociwoo 94'EOZ 33H :;uewgaoe;;y tn M I July 2016—June 2017 HCE 203.16 3. If this contract includes the provision of hardware,software,firmware,microcode or imbedded chip technology, the undersigned warrants that these products are capable of processing year-date dependent data accurately.All versions of these products offered by the Contractor(represented by the undersigned)and purchased by the state will be verified for accuracy and integrity of data prior to transfer. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly,the Contractor agrees to immediately make required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state,and without interruption to the ongoing business of the state,time being of the essence. 4. The Contractor and any Subcontractors of services tinder this contract warrant their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Area Agency on Aging for Southwest Florida, Inc.,Contractor certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. The Contractor shall require that the language of this certification be included in all subagreements,subgrants, and other agreements and that all Subcontractors shall certify compliance accordingly, This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A-I 02 and 2 CFR Part 200,and 215 (formerly OMB Circular A-110). B ,signing below, Contractor certifies the representations outlined in parts A through H above are true and correct, (Signature and Title of Authorized Representative) Collier County Board of County Commissioners ' � � Approved as to form and legality Contractor Date Assistant County Attorney 3339 E.Tamiami Trail,Suite 211 (Street) Naples, FL34112 (City, State,ZIP Code) 19 (a6ueg3 e6en6uei anuanaa;eIS L1.-9I. A3 : Z£66) 4oe.rluo3 91-'£0Z 33H .;uawyoenv M M July 2016—June 2017 HCE 203.16 a ATTACHMENT III FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Agency to the provider may be subject to audits and/or monitoring by the Area Agency on Aging for Southwest Florida,Inc.,as described in this section, I. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the Agency staff; limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this agreement, the provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Agency. In the event the Agency determines that a limited scope audit of the provider is appropriate,the provider agrees to comply with any additional instructions provided by the Agency to the provider regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer(CFO)or Auditor General. AUDITS PART I: FEDERALLY FUNDED This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB Circular A-133, as revised. In the event that the provider expends$750,000.00 or more in federal awards during its fiscal year,the provider must have z single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. ?XHIBIT 2 to this agreement indicates federal resources awarded through the Agency by this agreement. In determining the federal awards expended in its fiscal year, the provider shall consider all sources of Federal awards, including federal resources received from the Agency. The determination of amounts of Federal awards expended should be in accordance with the guidelines established by OMB Circular A-133, as revised. An audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part. In connection with the audit requirements addressed in Part I,paragraph 1,the provider shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133,as revised. If the provider expends Iess than$750,000.00 in federal awards in its fiscal year,an audit conducted in accordance with the provisions of OMB Circular A-133,as revised,is not required. In the event that the provider expends less than$750,000.00 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133, as revised, the cost of the audit must be paid from non-federal resources (i.e.,the cost of such audit must be paid from provider resources obtained from other than federal entities.) An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Agency shall be based on the agreement's requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Department of Elder Affairs agreement involved. If not otherwise disclosed as required by Section .310(b)(2)of OMB Circular A-I33, as revised,the schedule of expenditures of federal awards shall identify expenditures by agreement number for each agreement with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider's fiscal year end. 20 47. (e5ueu oBen5uei enuane ems L1.-91 Ad : Z£66) ;oe.nuoO 9l-'£OZ 30H :�uewgoe;;y N 46 July 2016—June 2017 HCE 203,16 • a PART II: STATE FUNDED t. a This part is applicable if the provider is a non-state entity as defined by Section 215,97(2),F.S. In the event that the provider expends a total amount of state financial assistance equal to or in excess of$750,000.00 in any fiscal year of such provider(for fiscal years ending September 30, 2004 or thereafter), the provider must have a State single or project-specific audit for such fiscal year in accordance with Section 215.97, F.S.; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT 2 to this agreement indicates state financial assistance awarded through the Agency by this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state financial assistance received from the Agency, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in Part Ii,paragraph 1,the provider shall ensure that the audit complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as defined by Section 215.97(2),F.S.,and Chapter 10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations), Rules of the Auditor General. • If the provider expends less than$750,000.00 in state financial assistance in its fiscal year(for fiscal years ending September 30,2004 or thereafter),an audit conducted in accordance with the provisions of Section 215.97,F.S., is not required. In the event that the provider expends less than $750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, F.S., the cost of the audit must be paid from the nonstate entity's resources(i.e.,the cost of such an audit must be paid from the provider resources obtained from other than .State entities). An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Agency shall be based on the agreement's requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Agency agreement involved. If not otherwise disclosed as required by Rule 69I-5.003, Fla.Admin, Code,the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after delive►y of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider's fiscal year end. Notwithstanding the applicability of this portion,the Agency retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law. IL PART HI: REPORT SUBMISSION Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I of this agreement shall be submitted,when required by Section .320(d), OMB Circular A-133,as revised,by or on behalf of the provider directly to each of the following: The Area Agency on Aging for Southwest Florida,Inc.at the following address: Area Agency on Aging for Southwest Florida,Inc. Attn: Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 21 (e6ueg3 e6en6uei anuanaN ele1S L1•-91• A3 : ZE6I.) loealuo0 91,'E0Z 33H :luewgoe41V July 2016—June 2017 HCE 203.16 •a 'he Federal Audit Clearinghouse designated in OMB Circular A-133,as revised(the number of copies required by Sections .320 (d)(1) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the following address: Federal Audit Clearinghouse Bureau of the Census 1201 East 10'h Street Jeffersonville,IN 47132 Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMB Circular A-133, as revised. Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a copy of the reporting package described in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the auditor, to the Area Agency on Aging for Southwest Florida,Inc.at the following address: Area Agency on Aging for Southwest Florida,Inc. Attn: Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 Additionally, copies of financial reporting packages required by Part I1 of this agreement shall be submitted by or on behalf of the provider directly to each of the following: The Area Agency on Aging for Southwest Florida,Inc. at the following address: Area Agency on Aging for Southwest Florida,Inc. Attn: Tammy Rhoades,VP of Finance 15201 N Cleveland Ave.,Suite 1100 North Fort Myers,FL 33903 The Auditor General's Office at the following address: State of Florida Auditor General Claude Pepper Building,Room 574 111 West Madison Street Tallahassee,Florida 32399-1450 Any reports,management letter,or other information required to be submitted to the Department pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-133,F.S.,and Chapters 10.550(local governmental entities) or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General,as applicable. Providers, when submitting financial reporting packages to the Department for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General,should indicate the date that the reporting package was delivered to the provider in correspondence accompanying the reporting package. III.PART IV:RECORD RETENTION The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six (6) years from the date the audit report is issued, and shall allow the Agency or its designee, the CFO or Auditor. General Access to such records upon request. The provider shall ensure that audit working papers are made available to the .gency, or its designee, CFO, or Auditor General upon request for a period of six (6) years from the date the audit report is issued,unless extended in writing by the Agency. 22 ] (a6ueg3 a6en6uei anuanay a;e;s L1•-91 AA : Z£61•) ;oei;uoo 91,TOZ 33H :;uewyoe;;y • M July 2016—June 2017 HCH 203.16 di a m EXHIBIT 1as a ) PART I: AUDIT RELATIONSHIP DETERMINATION Providers who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part §200.500,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 1 and/or Part II of Exhibit 1 is met. Providers who have been determined to be vendors are not subject to the audit requirements of 2 CFR Part§200.38,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 2 CFR Part §200 and/or Rule 691-5.006,FAC,provider has been determined to be: Vendor not subject to 2 CFR Part§200.38 and/or Section 215.97,F.S. Recipient/subrecipient subject to 2 CFR Part§200.86 and §200.93 and/or Section 215,97,F.S, Exempt organization not subject to 2 CFR Part §200 and/or Section 215.97, F.S. For Federal awards, for-profit organizations are exempt; for state financial assistance projects, public universities, community colleges, district school boards, branches of state(Florida) government, and charter schools are exempt. Exempt organizations must comply with all compliance requirements set forth within the contract or award document. 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-.5006, FAC [state financial assistance] and 2 CFR Part §200.330[federal awards]. PART II: FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards, state maintenance of effort funds, 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§200.416—Cost Principles* 2 CFR Part§200.201 —Administrative Requirements'"` 2 CFR Part§200.500—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§200.400-.411—Cost Principles* 2 CFR Part§200.100—Administrative Requirements 2 CFR Part§200.500—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§200.418—Cost Principles* 2 CFR Part§200.100—Administrative Requirements 2 CFR Part§200.500—Audit Requirements Reference Guide for State Expenditures 23 (e6uey3 a6en6uei anus/kali a1e1s L1791. A3 Z£66) 13eJluo3 9V£0Z 30H .luauiyoefv M M � r 6 July 2016—June 2017 HCE 203.16 a ar Other fiscal requirements set forth in program laws,rules and regulations a *Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 2 CFR Part§200.400(5)(c). * For funding passed through U.S. Health and Human Services, 45 CFR 92; for funding passed through U.S. Department of Education,34 CFR 80. 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 691-5,Fla. Admin.Code State Projects Compliance Supplement Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations 24 • . (a6ueg3 a6en6ue- anuanay alelS L4-94 Al Z£64) I3ealuo3 94'EOZ 3OH :;uaunpelly M July 2016—June 2017 HCE 203,16 d) a m EXHIBIT 2 ct a FUNDING SUMMARY te:Title 2 CFR§200.331,As Revised,And Section 215.97(5),Florida Statutes,Require That the Information about Federal Programs and State Projects Included in Exhibit I Be Provided to the Recipient.Information Contained Herein is a Prediction of Funding Sources and Related Amounts Based on the Contract Budget. 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: GRANT AWARD (FAIN#):NA FEDERAL AWARD DATE: NA DUNS NUMBER: 966140837 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL FEDERAL AWARD 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 Requirements for Federal Awards. OMB Circular A-133—Audits of States,Local Governments, and Non-Profit Organizations 2. 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 Home Care for the Elderly General Revenue-Collier 65001 $ 49,250.00 TOTAL AWARD $ 49,250.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE Section 215.97,F.S.,Chapter 691-5,FL Admin Code,Reference Guide for State Expenditures,Other fiscal requirements set forth in program laws,rules and regulations. 25 (e6uey3 a6en6ue1 anuanaN ale;S LI.-9I, Al : Z£61.) ioeJ;uo3 91:£0Z 3OH 3uawg3e;lV M .. M d July 2016—June 2017 HCE 203.16 a- ATTACHMENT VI ar Y c.) CC 0- HOME HOME CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY Collier County Board of County Commissioners • Collier HCE Case Management/Case Aide $ 3805.00 HCE Basic and Special Subsidies 45,445.00 Total $ 49,250.00 RATE SUMMARY • HIGHEST . .. METHOD OF DELIVERABLES • REIMBURSEMENT • •UNIT RATE PAYMENTS ; . • Case Aide(CAV): Collier $33,88 IFixed Fee/Unit Rate Case Management(CMV): Collier $60.00 Fixed Fee/Unit Rate Respite In-Home(RESP): Collier $10.00 Fixed Fee/Unit Rate Respite Vendor Payment(RESV): Collier .$25.67 Fixed Fee/Unit Rate Homemaking Vendor Payment(HMKV): Collier$21.50 (Fixed Fee/Unit Rate Personal Care-Vendor(PECV): Collier .$25.67 Fred Fee/Unit Rate Other-Background Screen-Vendor(OTHBKV): $41.25 Fixed Fee/Unit Rate Collier Housing Improvement(HOIM): Collier Cost Reimbursement Cost Reimbursement Housing Improvement Vendor(HOW): Collier :Cost Reimbursement Cost Reimbursement Material Aid Vendor(MATE): Collier Cost Reimbursement Cost Reimbursement I i i Transportation(TRS): Collier Cost Reimbursement Cost Reimbursement Specialized Medical Equipment, Services and ;Cost Reimbursement Cost Reimbursement .Supplies(SCSM): Collier Specialized Medical Equipment,Services and Cost Reimbursement Cost Reimbursement Supplies-Vendor Payment(SCSV): Collier 26 (a6uey3 a6en6uei anuanaa a;e;S L6-9I Ad : Z£6l.) ;oeJ;uo3 91:£0Z 33H :;uawy3e;;y co T M Ci July 2016—June 2017 HCE 203.16 CD ATTACHMENT VII -Ne A a HOME CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE Report Number Based On Submit to State on this Date 1 July Advance* July 1 2 August Advance* July 1 • 3 July Expenditure Report August 9 4 August Expenditure Report September 9 5 September Expenditure Report October 9 6 October Expenditure Report November 9 7 November Expenditure Report December 9 8 December Expenditure Report January 9 9 January Expenditure Report February 9 10 February Expenditure Report March 9 I 1 March Expenditure Report April 9 12 April Expenditure Report May 9 13 May Expenditure Report June 9 14 June Expenditure Report July 9 15 Final Expenditure Report July 25 16 Closeout Report August 1 Legend: * Advance based on projected cash need. Note# 1: Report#1 for Advance Basis Agreements cannot be submitted to the Area Agency on Aging for Southwest Florida,Inc.prior to July 1 or until the agreement with the Agency has been executed and a copy sent to the Area Agency on Aging for Southwest Florida, Inc. Actual submission of the vouchers to the Area Agency on Aging for Southwest Florida,Inc. is dependent on the accuracy of the expenditure report. Note#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. The adjustment shall be recorded in Part C, Line 1 of the report(ATTACHMENT VIII). 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 VIII). 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. 27 ;; i (a5uegO a6en6uei anuanaa eles L6-91, AAZ£6�) 40e-I4 9�'£OZ 30H :luauauae;;y t1� M July 2016-June 2017 LICE 203.16 m Y V t4 ATTACHMENT VIII REQUEST FOR PAYMENT • HOMECARE FOR THE ELDERLY PROGRAM RECIPIENT NAMEADDRESS,PHON Ed and FEIDJt TYPE OFPAYMENT: 'Ws Request Period: From: To: Contract Period Regular Contracl8 Advance Report# PSAs! CERTFICATION: thereby redly to the best of my krovledge that this recp.Jest Is complete and correct and conforms vrth the terms and the purposes of the abate contract. Prepared by: Date: Approved by: Date: PARTA BUDGET SUMMARY AAAAdmin. Case fAanagement Subsides TOTAL 1.Approred Contract Amount 40.00 $0.00 $0.00 40 D0 2.Previous Funds Rece/red for Contract Period 40.00 $0.00 40.00 4000 3.Contract Balance(he taints line 2) 40.00 $0.00 $0.00 50.00 4.Previous Furls Requested and Not Received for Contract Period $0.00 $0.00 $0.00 5000 5.CONTRACT BALANCE(lOe 3 minus line4) 5000 $0.00 $0.00 $000 PART B: CONTRACT FUNDS REQUEST 4000 $000 $0.00 $0.00 tAnticipated Cash Iced(1st-2nd months) 2.Net Expendtures FO<Month $O.CO $0.00 40.00 4000 (DOEA Form 1051{Part B,Line 4) 3.TOTAL $0.00 $0.00 $0.00 $0.00 FART C: NET FUNDS REQUESTED 40.00 40.00 50.00 5000 1.Less Advance Aplted 2.TOTAL FUNDS REQUESTED(Part BLine 3,minusPart Cline 1) $0.00 $0.00 $0.00 50,00 lktof ServtcoslUnits/Rates provided-See attachedreport. D0EA FORM 106H Resised5'4/12 28 n (a6ueg3 a6en6ue-I anuanaZ{ a;e;S L4-94 Id : ZE64) ;aeiwoo 94'EOZ 301-1 :;uewyae4;V July 2016--June 2017 HCE 203.16 EL ATTACHMENT IX ;5 CL RECEIPT AND EXPENDITURE REPORT HOME CARE FOR THE ELDERLY PROGRAM PROVIDER NAME,ADDRESS,PHONE#and FEID# Program Funding: THIS REPORT PERIOD: • From To AAA Admin. CONTRACT PERIOD: Case Management CONTRACT# Subsidies: REPORT# Basic Special PSA# CERTIFICATION: I certify to the best of my knowledge and beilaf that the report Is complete and correct and all outlays herein are for purposes set forth In the contract Prepared try: Date: Appiavedby: Date: PART A:BUDGETED INCOME! RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4.Percent of Budget For This Report Year to Date Approved Budget 1.State Funds $0.00 $0.00 $0.00 #OIWOI 2.TOTAL RECEIPTS $0,00 $0.00 $0.00 #DIV/01 PART B:EXPENDITURES 1.Approved 2.Expenditures 3.Expenditures 4.Percent of Budget For This Report Year to Date Approved Budget 1.AAA Program Administration $0.00 $0.00 $0.00 #01V/01 2.Service Subcontractors:Case Management $0.00 $O.00 $0.00 #DIV/01 3.Service Subcontractors:Subsidy $0.00 $0.00 $0.00 /rDIV/Ot a.Basic Subsidy $0.00 $0.00 $0.00 llWOI b.Special Subsidy $0.00 $0.00 $0.00 trDIV/01 4.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/01 PART C:OTHER REVENUE AND EXPENDITURES 1.Interest: it.Advance Recoupment 1.Earned on OR Advance$ 2.Return of OR Advance $ 1.Advance Recouped $ 3.Other Earned $ Doe",FORM 105!1 Ro,isei 525/1010 29 (a6ueg0 e6en6uei anuenea elels L4-96 A3 : Z£66) 13eJluo3 96'£OZ 30H :luewgoel}y y7- e- C) 0. J 21 6- _ - 2017 HCE 203.16 D);PARTAi ENT OF BACKGROUND SCREENING ATTACHMENT G a BACKGROUND SCREENING E.L.DER AFFAIRS Affidavit of Compliance a Employer STATE OF F4pRlDA- AUTHORITY: This form 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. 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 Board of County Commissioners Employer Name located at 3339 Tamiami Trail E,Suite 211 Naples, FL 34112 , Street Address City State ZIP code I, Kimberley Grant,Director 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 Da e STATE OF FLORIDA,COUNTY OF Collier Sworn to (or affirmed) and subscribed before me this day of ) �,� , 20 t( , by k';in 1)0.-fie c.i Q1o,(].�l "'" (Name of Representative)who is personally known to me or produced as proof of identification. PhA Tfs b; 1 Print,Type,or Stamp Commissioned Name of Notary Public Notary Public' • DOEA Form 235,Affidavit of Compliance-Employer,Effective April 2012 Section 435.05(3),F.S. Form available at:http//eideraffalrs.state.flus/ej pjj i kackeroundscreenlnn,Php 30 ANALDIAZ h1YCOMMISSION tfF235711 EXPIRES:July t,2019 '4,Pf,W Boaded nau Nita y Puha Uadernr?.a4 } (e5ueg3 e6en6ue-i anuanaa a;e;S L6-9t Ad : ZE66) ;oe.i;uoD 96'£OZ 33H :;uauayoe;;b Q CO a Revised August 2007 0. i a Attestation Statement Agreement/Contract Number:IICE 203.16 Amendment Number: N//A I,Steve Cannell , 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 o Recipient 7Contractoi representative p Date Approved as to form and legality Assistant County Attorney • 04? Revised August 2007