Backup Documents 09/27/2016 Item #16D14 1 6 D 1 4
COMMUNITY AND HUMAN SERI VES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grants Coordinator, CHS
DATE: September 29, 2016
RE: Agreements between Area Agency on Aging for Southwest Florida, Inc and
Collier County
Please find attached a fully executed document that was approved by the BCC on the day listed
below for recording in Minutes and Records. Feel free to contact me if you have any questions.
BCC Approved on September 27,2016 Item 16D13, 16D14 and 16D15.
Thank you for your assistance.
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July 2016—June 2017 CCE 203.16
AREA AGENCY ON AGING FOR1SOUTHWEST 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 "Patties." 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 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 $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.
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6. Official Payee and Representatives(Names.Addresses.and Telephone Numbersi:
The Contractor name,as shown on page 1 of this o Collier County Board of County Commissioners
/oCollier County Community and Human Services
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 contactperson 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
c. 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. E111 Terms and Conditions Included:
This contract and its Attachments, I—III,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 COMMISSIONERS FLORIDA,INC.
SIGNED BY: V / 010 SIGNED BY: ill C><<SL.+�kt
NAME: Steve Carrell NAME: MARIANNE G LORINI
TITLE: Public Services Department Head TITLE: PRESIDENT/CEO
DATE: D L I I DATE: J I t
Federal Tax ID: 59-6000558
Approved as to form and legality
Fiscal Year Ending Date:09/30
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INDEX OF ATTACHMENTS
ATTACHMENT I 4
STATEMENT OF WORK
ATTACHMENT II 17
CERTIFICATIONS AND ASSURANCES
ATTACHMENT III ..20
EXHIBIT I: FINANCIAL AND COMPLIANCE AUDIT
EXHIBIT 2: FUNDING SUMMARY
ATTACHMENT VI 26
ANNUAL BUDGET SUMMARY and RATE SUMMARY
A'I'TACHMENT VII .27
INVOICE REPORT SCHEDULE
ATTACHMENT VIII 28
REQUEST FOR PAYMENT
ATTACHMENT IX 29
RECEIPT AND EXPENDITURE REPORT
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ATTACHMENT I
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)
Summary of Programs and Services(SOPS)
2. Program Specific Terms
Adult Protective Services Referral Tracking 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 document 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.
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Notice of Instruction (NOI): The Department's established method to communicate to the Agency and/or
Contractor the requirements to perform particular tasks or activities. NOls are located on the Department's
website at http://elderaffairs.state.fl.us/doea/'nois/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 ease 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
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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 LA. 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
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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 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
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 perforin 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.
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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 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;
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(6) Medication Management; (13) Specialized Medical Equipment,
(7) Mental Health Services and Supplies;and
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 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;
(0 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.
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3.Surplus/Deficit Report(Lead Spending Report)
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
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;
(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
(0 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 Il.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 II,A.1-4 of this contract;
c. Timely submit to the Agency all required documentation and reports described in Section IL.E.; and
d. Timely(in accordance with ATTACHMENT VII)and accurately submit to the Agency ATTACHMENTS
VIII&IX,and supporting documentation.
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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;
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.
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 11.D.,and in accordance with other
terms and conditions of the contract.
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1. Fixed Fee/Unit Rate
Payment for Fixed Fee/Unit Rates shall not exceed amounts established in ATTACHMENT VI, per unit of
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 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 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;
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.
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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). Contractors must enter this data for the previous month's billing no
later than the 9`"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 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 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. 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,
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 III. 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.
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
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 HD 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 II.D.1 of this contract—
Failure to comply with established assessment and prioritization criteria, as evidenced by CIRTS reports,
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will result in a 2%reduction of payment per business day.The reduction of payment will begin on the first
business clay 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
1II.H.
2. Services and units of services as referenced in Section II.D.2 of this contract—Failure to provide services in
accordance with the current DOEA Programs and Services Handbook,the service tasks described in Section
II.A, 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 funds 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
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a surplus of fiords 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
during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under state and
federal lay.
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 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.
IS
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ATTACHMENT II
CERTIFICATIONS AND ASSURANCES
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. ie rmeu • • 'fi ion 2 CIRP.r '5 .n145CR '._•
B. Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 931
C. Nondiscrimination&Equal Opportunity Assurance(29 CFR Part 37 and 45 SFR Part 80)
D. Certification Regarding Public Entity Crimes.section 287.133.KS,
E. Association of Community Organizations for Reform Now(ACORN)Funding Restrictions Assurajice(Pub,
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
Agreement
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
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July62016—June 2017 1 C1„t4
CC 03
Congress,or employee of a Member of Congress in connection with a Federal contract,grant, loan,or cooperative
agreement, the undersigned shall also complete and submit Standard Form--- LLL, "Disclosure Form to Report
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 I964(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 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.
This assurance applies to Contractor's operation of the WIA Title I— financially assisted program or activity, and to all
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July 2016—June 2017 CCE 203.
agreements Contractor makes to tarty out the WIA Title I—financially assisted program or activity. Contractor understands
that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of t 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 fluids 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,
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July 2016—June6cU 2017 21.
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 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.
NIL
trr DO( ttD6
(Signature and Title of Authorized Representative)
Collier County Board of County Commissioners -j/ Z <� �
Contractor Date
3339 E.Tamiami Trail,Suite 211
(Street) Approved as to form and legality
Naples,FL34112 Assistant County Attorney
s'c
be
(City,State,ZIP Code)
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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
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 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 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 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.
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PART II: STATE FUNDED
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),P.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
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July 2016--June 2017 CCE 203.16
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:
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 II 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:Tanury 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.
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ATTACHMENT III
EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of 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 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 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
Other fiscal requirements set forth in program laws,rules and regulations
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July 2016—June 2017 CCE 203.16
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 2
CFR Pait§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
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July 2016—June 2017 CCE 203.16
ATTACHMENT III
EXHIBIT 2
FINANCIAL AND COMPLIANCE AUDIT ATTACHMENT
EXHIBIT 2-FUNDING SUMMARY
f1ote: 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: 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 See.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
program laws,rules and regulations.
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July 2016--June 2017 CCE 203.16
ATTACHMENT VI
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
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July 2016—June 2017 CCE 203.16
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
{
July 2016 June 2017 1 ()C):)0316()C):)0()C):)03164
ATTACHMENT VIII
REQUEST FOR PAYMENT
COMMUNITY CARE FOR THE ELDERLY
RECIPIENT NAME.ADDRESS.PIIONE#and FEI041 TYPE OF PAYMENT: This Request Period: From: To:
Regular Contract Period
Contract#
Advance Report
PSA of
CERTIFICATION: I hereby certify to the best of my inaniedge that this request or refund conforms web the terms and the purposes of the above contract.
Prepared by. Dale: Approved by: Date:
PARTA: BUDGET SUMMARY CCE Admin. CCEServtces TOTAL
1.Approved Contract Amount 5 0.00 $ 0.00 $ 0.00
2.Previous Funds Received for Contract Period $ 0.00 $ 0.00 $ 0.00
3.Contract Balance(tine I minus line 2) $ 0.00 $ 0.00 $ 0.00
4.Previous Funds Requested and Not Received for Contract Period $ 0.00 $ 0.00 $ 0.00
5.CONTRACT BALANCE pine 3 minus he 4) $ 0.00 S 0.00 $ 0.00
PART B: CONTRACT FUNDS REQUEST
1.Anticipaled Cash Need{1st-and months) $ 0.00 $ 0.00 $ 0.00
2.Net Expend4ures For Month $ 0.00 $ 0.00 $ 0.00
(DOEA Form 105C,Part B,Une 4)
3.TOTAL S 0.00 $ 0.00 $ 0.00
PART C: NET FUNDS REQUESTED
1.Less Advance Applied $ 0.00 $ 9.00 $ 0.00
2.TOTAL FUNDS REQUESTED(Part B Une 3,minus Part C Lane 1) $ 0.00 $ 0.00 $ 0.00
List of Services/Units!Rates provided-See attached report.
DOEA FORM 1060
Revised 514!12
2 cg
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July 2016-June 2017 CCE 203.16
ATTACHMENT IX
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: Date: Approved by: Date:
PART A:BUDGETED INCOME/ RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4.Percent of
Budget For ThIs Report Year to 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 In-Kind Match
6.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.AdminisirativeServices $0.00 $0.00 $0.00 #DIV/01
2.Service Subcontractor(s) $0.00 $0.00 $0.00 #DIV/O1
3.Adult Protective Services $0.00 $0.00 $0.00 #DIV/01
4.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/01
PART C:OTHER REVENUE AND EXPENDITURES II.Interest: III.Advance Recouped
I.Program Income(PI) 1.Earned on OR Advance$ $
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 105C
Revised 5/2572010
29
16014 ,
Revised August 2007
Attestation Statement
Agreement/Contract Number:CCE 203.16
Amendment Number:N//A
I,Steve Carvell ,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.
I �
7 2( C
Signa tire o cipient/Contractor representative Date
Approved as to form and legality
Assistant County Attorney
\\�
Revised August 2007
{ I
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July 2016—June 2017 ADI 203.16
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. EuxuasgoLcantragi
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. Jncorpoxation 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$312.015.00, 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 6 014
ADI 203.16
July 2016—June 2017
6. Official Payee and Representatives(Names.Addresses.and Telephone Numbers):
Collier County Board of County Commissioners
The Contractor name,as shown on page 1 of this %Collier County Community and Human Services
contract,and mailing address of the official payee to 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.
d 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, 1-111,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 28 page contract,to be executed by their undersigned
officials as duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY COMMISSION+RS SOUTHWEST FLORIDA,INC.
01 P' ,/
SIGNED BY: i��'re. SIGNED BY; )ZIVAMA1- -M d4U .
NAME: Steve Carnerl NAME: MARIANNE G LORINI
TITLE: Public Services Department Head TITLE: PRESIDENT/CEO
DATE: ! Z ciho DATE: J
Federal Tax ID: 59-6000558
Fiscal Year Ending Date:09/30 Approved as to form and legality
2
Assistant County Attorney (37\`
16014
July 2016—June 2017 ADI 203.16
INDEX OF ATTACHMENTS
ATTACHMENT I 4
STATEMENT OF WORK
ATTACHMENT II .15
CERTIFICATIONS AND ASSURANCES
ATTACHMENT ID 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
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July 2016—June 2017 ADI 203.16
ATTACHMENT I
STATEMENT OF WORK
I. SERVICES TO BE PROVIDED
A. Definitions of Terms
1. Acronyms
Alzheimer's Disease(AD)
Alzheimer's Disease Initiative(ADD
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 Plan 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
16014
July 2016—June 2017 ADI 203.16
Notice of Instruction (NOD: The Department's established method to communicate to the Agency/and
or Contractor the requirement to perform a particular task or activity. NOIs are located on the
Department's website at http://elderaffairs.state.fl.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
Summaty 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 AD1 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.
3. 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 ADI Program addresses the special needs of individuals with AD or other related disorders, and their
caregivers.
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July 2016—June 2017 ADI 203.16
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
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July 2016—June 2017 ADI 203.16
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.
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. Deliveryof Services to Eligible Clients
g
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
July 2016—June 2017
J0&D14
(5)Counseling(Mental Health/Screening);
(6)Education/Training;
(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.
I. CIRTS Reports
The Contractor shall input ADI- 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
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July 2016— me 2017 ADI 203.16
�T
au 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;
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 sofhvare 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 primacy 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.
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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;
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.
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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.
I. 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
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 lSt 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;
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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 entry 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 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.
G. Corrective Action Plan
1. Contractor shall ensure 100%of the deliverables identified in Section 1I.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 1II.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.
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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 hi Section III.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 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 ILA.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 I11.11.
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.
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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
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 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
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ATTACHMENT II
CERTIFICATIONS AND ASSURANCES
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. 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 Crimes.section 287.133.F.S.
E. Association of Community Organizations for Reform Now(ACORN)Funding Restrictions Assurance(Pub,
L. 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
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.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
Congress,or employee of a Member of Congress in connection with a Federal contract,grant,loan,or cooperative
� I
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ADI 203.16
agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report
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 affliation,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, j
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 imposed 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 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 1-Iuman 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.
This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and to all
agreements Contractor makes to carry 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.
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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 finding 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.
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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.
(Signature and Title of Authorized Representative)
Collier County Board of County Commissioners i
Contractor Date
3339 E.Tamiami Trail, Suite 211 Approved as to form and legality
(Street)
Assistant County Attorney 0,97\ ca
Naples,FL34112
(City, State,ZIP Code)
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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-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 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 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.
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PART II: STATE FUNDED
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 691-5.003, 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 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
20
1,63.0 14
July 2016—June 2017
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:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10111 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-I 33, 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 Il 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 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
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July 2016 June 2017
ATTACHMENT III
EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of 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 69I-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 Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
22
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July 2016—June 2017 ADI 203.16
*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 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 •
23
July 2016—June 2017 1361:1 1 4
ATTACHMENT HI
EXHIBIT 2
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.
I. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): 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 FINANCIAL ASSIST„ ANCE
Section 215.97,F.S., Chapter 69I-5, FL Admin Code, Reference Guide for State Expenditures, Other fiscal requirements set forth in
program laws,rules and regulations.
24
1 6 0 1 4
July 2016—June 2017 ADI 203.16
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
DELIVERABLES REIMBURSEMENT
UNIT RATE PAYMENTS
Case Aid: Collier $33.88 Fixed Fee/Unit Rate
I Case Management: Collier $60.00 Fixed Fee/Unit Rate
Respite In-Facility: Collier $12.83 Fixed Fee/Unit Rate
Respite In-Home: Collier $25.67 Fixed Fee/Unit Rate
Specialized Medical Equipment, Services and Supplies Cost Reimbursement
Transportation Cost Reimbursement
25
1 03. 6
14
July 2016—June 2017
ATTACHMENT VII
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
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 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
July 2016-June 2017 1 6D13A1
ATTACHMENT VIII
REQUEST FOR PAYMENT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
RECiPRBiTNAl E.ADDRESS.PtiOHE#ard FEID# TWEOFREPORT: TN s Reque st Period
PSA#
A_PAYMENT REQUEST: Report#
Regu+ar Srppfemertat Codrect#
B.METHOD OF PAYTiEtIC: Corbett Period
Advance Reimbursement
CERTMATSON_Iher ebycertifyto the bed of nay lot°Wedge that this request is corrptete and correct and corforms with the terms and the puposes of the above contract.
Prepared by Date: Approved by_ Date:
(1) (2)
PARTA BUDGET SUMMARY Rewrite Model Day Care TOTAL
1.Approved Contract Amours 50.00 50.00 $0,00
2.Previous Funds Receive dfor Cortract Period 50.00 50.00 50.00
3.Contract stance(line 1 mires the 2) $0.00 50.00 50.00
4.ReviousFrmds Requested wet Not Receed for Coiliact Period 50.00 $0.00 50.00
5.ContractBalance One 3 minus be 4) $0.00 $0.00 $0.00
PARC B.CONTRACT FIJM)S REOtEST
1.Anticipated Cash Needs(1st-2nd morth,AltachJusti$cationn) $0.00 50.00 $0.00
2.stet Espenddues ForMorel 50.00 50.00 50.00
(DOEAForm 10SZ Pad B,Line 3)
3.TOTAL. $0.00 $9.00 $0.00
PART C:LET FUNDS REQUESTED
1.Less Advance Applied 50.00 50.00 50.00
2.Contract Funds are IferebyRequested for(Part B,Line 3 $0.00 $0.00 $0.00
nips Pad C.Line 1)
List of Senices f Urits iRates provided-See attached report
DOEA FORM 1062
Reo$t66'4'12
27 i.
1
Jt 34U14
July 2016 June 2017
ATTACHMENT IX
RECEIPT AND EXPENDITURE REPORT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
PROVIDER NAME,ADDRESS,PHONE#and FEI Di 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 bekef chat the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
Prepared by: Date: Approved by:_ Date:
PART A:BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4.Percent of
Budget For This Report Year to Date Approved Budget
1.State Funds $0.00 $0.00 $0.00 r #13IV/0I
2-Program Income $0.00 $0.00 $0.00 #DIV/Of
3.Local Cash Match $0.00 $0.00 $0.00 #0IV/0I
4.SUBTOTAL:CASH RECEIPTS
5.Local In-Kind Match
6.TOTAL Ft ECEIPTS $0.00 $0.00 $0.00 #DIV/01
PART 13: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 4DIV/0I
2.Service Subcontractor(s) $0.00 $0.00 $0.00 #DIVf01
3.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/OI
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 $ S
(For Traclang Purposes only)
DOEAfORu 102
Re!sect 12E12010
28 1
Revised August 2007 1 6 D 14
Attestation Statement
Agreentent/Contract Number: ADI 203.16
Amendment Number: N//A
I,Steve Camel! ,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.
01
Signature I"fRecipieiWContractorrepresentative Date
Approved as to form and legality
Assistant County Attorney t [
Revised August 2007
� I
1 6 4
July 2016—June 2017 HC 03r6
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
HOME CARE FOR THE ELDERLY PROGRAM CONTRACT
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. Purnose 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 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
July 2016—June 2017 1. &413Z164
6. Official Payee and Representatives(Names.Addresses.and Telephone Numbers):
Collier County Board of County Commissioners
The Contractor name,as shown on page 1 of this %Collier County Community and Human Services
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
o' 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
SIGNED BY: 4 el! / SIGNED BY: /�,( � X/ i0lA/tLSteve Carvell NAME: MARIANNE G LORINI
TITLE: Public Services Department Read TITLE: PRESIDENT/CEO
DATE: CEJ iI DATE qi a I
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30 Approved as to form and legality
,�
2
• Assistant CountyAttorner:�`' .�
y '~ • ar
l _
.n.N‘
July 2016—June 2017 LJ3i64
INDEX OF ATTACHMENTS
ATTACHMENT I 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 24
RECEIPT AND EXPENDITURE REPORT
ATTACHMENT G 30
BACKGROUND SCREENING
3
July 2016—June 2017 LA X95.1 4
ATTACHMENT I
STATEMENT OF WORK
HOME CARE FOR THE ELDERLY PROGRAM
I. SERVICES TO BE PROVIDED
A. Definitions of Terms
1. Acronyms
Area Agency on Aging(AAA)
Adult Protective Services(APS)
Adult Protective Services Referral Tracking Tool(ARTT)
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.)
Honie 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 Plan 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 (DOER 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
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July 2016—June 2017 HCE 203.16
Notice of Instruction (NOI): The Department's established method to communicate to the Agency
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/doea/nois.php.
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 l-ICE. 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;
d. Be at risk of nursing home placement;
5
1 6 0 1 4
July 2016--June 2017 HCE 203.16
e. Have an approved adult caregiver living in the home with them who is willing and able to provide care or
assist in arranging for care;and
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. 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.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.
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July 2016—June 2017 13C
2 .161
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 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 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 sulicontracts 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.
1 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
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1H3. i July201b—June 2017
the following services in accordance with the Agency's Area Plan,the current DOEA Programs and Services
Handbook, which is incorporated by reference, and Section ILA.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 ]I.D.I.b. and the DOEA
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 full 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:
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July 2016—June 2017 HCE 203.16
1) Adult Day Care 11)Housing Improvement
2) Adult Day Health 12)Material Aid
Care 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 ILA.
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 due
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 C1RTS-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.
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July 2016—June 2017 HCE 203.1
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.
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;
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.
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.
T. 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.1-2. of this
contract;
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July 2016--June 2017 HCE 203.16
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;
Ii. 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.
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July 2016—June 20171t:i2g,iiT
HI.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 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
registrat ion;
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
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July 2016—June 2017 1111-1§2P.,1
.i1
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 9th 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 9h 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 days 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.
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July 2016--June 2017 HCE 203. 6
I. 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.J. 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
IILJ. 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 1, 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 II.A.1-2 and Section I1.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.1.
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.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 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.
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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.
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.
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July 2016—June 2017 16 0 IHE 203.16
ATTACHMENT II
CERTIFICATIONS AND ASSURANCES
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. 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. . F rimin, iin _ Er i, I 1 • I1.I ' , • FsP.r n14 FRPir 0
D. Certification Regarding Public Entity Crimes.section 287.133.F.S.
E. Association of Con nunity Organizations for Reform Now(ACORN)Fundibg Restrictions Assurance(Pub.
IL,. 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
Agreement
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 it
modification of any Federal contract,grant,loan or cooperative agreer fent.
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
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July 2016—June 2017 HCE 203.16
agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report
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 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;
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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
or activity, and to all agreements Contractor makes to carry 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.
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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 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.
II. 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).
B igning below,Contractor certifies the representations outlined in parts A through H above are true and correct.
10t ktiZL Gillam 46,0
(Signature and Title of Authorized Representative)
Collier County Board of County Commissioners Approved as to form and legality
Contractor Date
Assistant County Attorney 'CAD
3339 B.Tamiami Trail,Suite 211 1\\
(Street)
Naples, FL34112
(City, State,ZIP Code)
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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
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 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 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.
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PART II: STATE FUNDED
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 frilly
disclosed in the audit report with reference to the Agency agreement involved. If not otherwise disclosed as required by
Rule 691-5.003, 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
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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:
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,hrc.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 II 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
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
July 2016—June 2017 �6 14
E203.
EXHIBIT I
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 niet,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 Requirements
Reference Guide for State Expenditures
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Jul 2016 Jun2
June 0 7 OT 6
Other fiscal requirements set forth in program laws,rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 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 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
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July 2016—June 2017 HCE 203.16
EXHIBIT 2
FUNDING SUMMARY
Note: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.
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July 2016—June 2017 HCE 203.16
ATTACHMENT VI
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 REIMBURSEM ENT
UNIT RATE PAYMENTS
Case Aide(CAV): Collier $33.88 Fixed 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 IFihed 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(HOIV): Collier Cost Reimbursement Cost Reimbursement
Material Aid Vendor(MATE): Collier Cost Reimbursement Cost Reimbursement
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
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July 2016—June 2017 HCE 203.16
ATTACHMENT VII
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
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.
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July 2016-June 2017 1-ICE 203.16
16014
ATTACHMENT VIII
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
RECIPIENT NAMCADDRESS,PHONE#and FEUDS TYPEOFPAYMENT: This Request Period: From: To:
Regular Contract Period
Contract#
Advance Report#
PSA#
CERTFICATtON: thereby certfy to the best dmy krovledgethat this recp.Jest Is corrgs!ete and correct and conforms wth the terms and the purposes of the abode contract.
Prepared by: Date' Approved by, Date:
PARTA BUDGET SUMMARY AAAAdmin. Case Management Subsides TOTAL
1.Approved Contract Amount $0.00 $0.00 $o.o0 3000
2.Previous Funds Recthed for Contract Period $0.00 $0.00 $0.00 SOD]
3.Contract Balance(he 1 minis line 2) $0.00 $0.00 $0.00 $0.00
4.Previous Fulls Requested and Not Received for Contract Period $0.00 $0.00 $0.00 5000
5.CONTRACT BALANCE pine 3 minus line 4) $000 $0.00 $0.00 $000
PART B: CONTRACT FUNDS REQUEST
$000 $000 $0.00 $0.00
1Anticipated Cash Need(1st-2nd months)
2.Net Fxpendtures FO‹Month $0.00 $0.00 $0.00 $090
(DOEA Form 1051{Part B,Late 4)
3.TOTAL $0.00 $0.00 $0.00 $0.00
FART C:NET FUNDS REQUESTED
$0.00 $0.00 $0.00 $090
1.Less Advance Apded
2.TOTAL FUNDS REQUESTED(Part B Line 3,mtnus Part CLIne$ $0.00 $0.00 $0.00 $0.00
Ustof Services/Units(Rates provided-See attached report.
DOEA FORM 106H
Rev sedS4/12
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July 2016--June 2017 HCE 203.16
ATTACHMENT IX
RECEIPT AND EXPENDITURE REPORT 1 6 01 .
HOME CARE FOR THE ELDERLY PROGRAM
PROVIDER NAME,ADDRESS,PHONE it 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 belief that the report Is complete and correct and all outlays
herein are for purposes set forth In the contract
Prepared by: Date: Approrsdby: 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.Slate Funds $0.00 $0.00 $0.00 #DIV/01
2.TOTAL RECEIPTS $0.00 $0.00 $0.00 #0IVI01
PART B:EXPENDITURES 1.Approved 2.Expenditures 3.Expenditures 4.Percent of
Budget For TNs Report Year to Date Approved Budget
1.AAA Program AdmlrWstration $0.00 $0.00 $0.00 JDNI01
2.Service Subcontractors:Case Management $0.00 $0.00 $0.00 #DIV101
3.Service Subcontractors:Subsidy $0.00 $0.00 $0.00 to lV/01
a.Basic Subsidy $0.00 $0.00 $0.00 #DIVA)I
b.Special Subsidy $0.00 $0.00 $0.00 fl)IVrol
4.TOTAL EXPENDITURES $0.00 $0.00 $0.00 ADIVI01
PART C:OTHER REVENUE AND EXPENDITURES
I.Interest II.Advance Recoupment
I.Earned on GR Advance$
2.Return of OR Advance $ 1.Advance Recouped $
3.Other Earned $
DOEA FOFSA 10.;31
Red 5125r20t0
29
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J 2016--Ju - 2017 HCE 203.16
DEPA1tT11ENT OF
BACKGROUND SCREENING ATTACHMENT G
BACKGROUND SCREENING
ELDER
AFFAIRS Affidavit of Compliance - Employer
STATE OF FLORIDA
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
1, 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( D �+ , 20 lr , by
1J
(Name of Representative)who is personally known
to me or produced as proof of identification.
Phq ` /14 ,I
Print,Type,or Stamp Commissioned Name of Notary Public Notary Pub`le
DOEA Form 235,Affidavit of Compliance-Employer,Effective April 2012 Section 435.05(31,F.S.
Form available at:http://elderaffairs.state.fl.us/eackgroundscreeninR.php
30 '. ANAL DIAZ
�
t ,«:: MY COMMISSION#FF 235771
EXPIRES:July 1,2019
�Pf,1t Bonded Thiu Notary Pubs Underrdars t j`1
16014
Revised August 2007
Attestation Statement
Agreement/Contract Number:HCE 203.16
Amendment Number: N//A
I,Steve Carnet) , 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.
07-Z- Z°/b'
Signature ofRecipient7Contractor representative Date
ate
Approved as to form and legality
Assistant County Attorney
nt
Revised August 2007