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Agenda 03/28/2017 Item #16D 603/28/2017 EXECUTIVE SUMMARY Recommendation to approve an “after-the-fact” amendment, attestation statement, and budget amendment for the Older Americans Act Program Title III from Area Agency on Aging for Southwest Florida, Inc. to reflect the final FY16 grant funding amount. (Net Fiscal Impact of $85,000.93 in program funds and local match funding of $9,444.76). OBJECTIVE: To continue provision of meals and other support services to qualified Collier County Seniors. CONSIDERATIONS: Collier County Services for Seniors (CCSS) managed by the Community and Human Services Division has provided support services to Collier County’s qualified senior citizens for over 30 years through Older Americans Act programs (OAA). Funding is provided by the Florida Department of Elder Affairs, and is administered by Area Agency on Aging for Southwest Florida, Inc. (Agency). The contract period for the OAA program is January 1, 2016 through December 31, 2016. The original award and budget amendments were approved by the Board on February 23, 2016 (Agenda item 16D5). The OAA amendment is the final allocation for FY 2016. The amendment increases the grant awards for III-B support services, C1 Congregate Meals, C2 Home Delivered Meals, and III-E Services. The effective date of the amendment is December 31, 2016. Program Project Numbe r Current Award Budget Revised Budget Increase/ (Decrease) Match Fund Increase/ (Decrease)** Title III-B Support Services 33443 $340,296.00 $355,098.43 $14,802.43 $1,644.71 Title C1 Congregate Meals 33444 $293,000.00 $313,624.70 $20,624.70 $2,291.63 Title C2 Home Delivered Meals 33445 $250,832.00 $280,435.16 $29,603.16 $3,289.46 Title III-E Services 33446 $129,222.00 $149,192.64 $19,970.64 $2,218.96 Total $1,013,350.00 $1,098,350.93 $85,000.93 $9,444.76 *10% Match amount is Award divided by .9, multiplied by .1, per Federal and State calculation requirements, rounded up to the nearest dollar. **The match amount under C2 is slightly higher due to rounding in order to true up the match budget. This item is being presented after-the-fact because Collier County received the grant agreement on February 23, 2017 from the Agency with a request for a 30-day turnaround timeframe. The Agency routinely sends CCSS amendments with an effective date before the date the document is received which requires prompt attention. This time frame makes it impossible to meet agenda submittal deadlines to process the documents for Board consideration. Pursuant to CMA 5330 and Resolution No. 2010-122, the County Manager authorized the Public Services Department Head to sign the agreement. This amendment is being presented for Board ratification. Collier County, as the Lead Agency, is responsible for responding to seniors’ needs, as well as managing the spending authority for the OAA program services. FISCAL IMPACT: A budget amendment is required for Program Year 2016 projects 33443, 33444, 33445, and 33446 to recognize overall final grant increase of the 2016 OAA Grants in the amount of 03/28/2017 $85,000.93 and a 10% local match requirement increase of $9,444.76. These funds resided in Human Services Grant Fund 707. GROWTH MANAGEMENT: There are no growth management impacts from this recommendation. LEGAL CONSIDERATIONS: This is a standard form amendment provided by the Area Agency on Aging for Southwest Florida, Inc. This item has been approved for form and legality and requires a majority vote for Board approval. - JAB RECOMMENDATIONS: To approve the “after-the-fact” amendment and attestation statement with Area Agency on Aging for Southwest Florida, Inc. and authorize the corresponding budget amendments. Prepared by: Lisa N. Carr, Grants Coordinator, Community and Human Services ATTACHMENT(S) 1. OAA 203.16.008 Final Allocation (PDF) 2. OAA 203.16.007 Increase Allocation for OA3EG program (PDF) 3. OAA 203.16.006 Contract Extension (PDF) 4. OAA 203.16.005 Decrease Allocation for OA3B program (PDF) 5. OAA 203.16.004 Increase Allocation for C1 program (PDF) 6. OAA 203.16.003 Reallocation of award and Language Changes (PDF) 7. OAA 203.16.002 Increase Allocation for C1 program (PDF) 8. OAA 203.16.001 Language Changes (PDF) 9. OAA 203.16 Contract Executed (PDF) 03/28/2017 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.6 Doc ID: 2851 Item Summary: Recommendation to approve an “after-the-fact” amendment, attestation statement and budget amendment for the Older Americans Act Program Title III from Area Agency on Aging for Southwest Florida, Inc. to reflect the final FY16 grant funding amount. (Net Fiscal Impact of $85,000.93 in program funds and local match funding of $9,444.76). Meeting Date: 03/28/2017 Prepared by: Title: Grants Coordinator – Community & Human Services Name: Lisa Carr 03/07/2017 10:33 AM Submitted by: Title: Division Director - Cmnty & Human Svc – Public Services Department Name: Kimberley Grant 03/07/2017 10:33 AM Approved By: Review: Community & Human Services Kristi Sonntag Additional Reviewer Completed 03/07/2017 12:06 PM Community & Human Services Dora Carrillo Additional Reviewer Completed 03/07/2017 1:41 PM Public Services Department Kimberley Grant Additional Reviewer Completed 03/07/2017 6:14 PM Public Services Department Joshua Hammond Additional Reviewer Completed 03/10/2017 2:02 PM Community & Human Services Maggie Lopez Additional Reviewer Completed 03/13/2017 1:34 PM Public Services Department Hailey Margarita Alonso Level 1 Division Reviewer Completed 03/13/2017 4:13 PM County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 03/13/2017 4:15 PM Grants Erica Robinson Level 2 Grants Review Completed 03/14/2017 8:53 AM Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 03/14/2017 11:06 AM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 03/15/2017 10:21 AM Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 03/15/2017 10:29 AM Grants Therese Stanley Additional Reviewer Completed 03/17/2017 4:17 PM Budget and Management Office Ed Finn Additional Reviewer Completed 03/20/2017 2:55 PM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 03/20/2017 9:40 PM Board of County Commissioners MaryJo Brock Meeting Pending 03/28/2017 9:00 AM Amendment .008 OAA 203.16.008 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners, (Contractor) and amends contract OAA 203.16. The purpose of this amendment is to amend 4. Contract Amount with the final allocation for the 2016 contract year, and revise ATTACHMENT III and ATTACHMENT VII. 4. Contract Amount The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $1,098,350.93 or the rate schedule, subject to the availability of funds. Any costs or services paid for payment under any other contract or from any other source are not eligible for payment under this contract. This amendment shall be effective on December 31, 2016. All provisions in the agreement and any attachments. thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the Ievel specified in the agreement. This amendment and all of its attachments are hereby made a part of this agreement. IN WITNESS WHEREOF, the parties hereto have caused this 4 page amendment to be executed by their officials there unto duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. t r SIGNED BY: ;_ SIGNED BY: NAME:1 e 4e— `I , C w` /wL I NAME: MARIANNE G LORINI TITLE: l"" c S-_fgcce�, 1b„xur-F nn&v4 WeaA TITLE: PRESIDENT/CEO DATE: h o'c" TiZv t -4 DATE: Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 Approved as to form and legality Assistant County Attorney Amendment .008 FUNDING SUMMARY OAA 203.16.008 ATTACHMENT III 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 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. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: COLLIER COUNTY GRANT AWARD (FAIN#): 16AAFLT3SS, 16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC DUNS NUMBER :076997790 FEDERAL AWARD DATE: OCTOBER 20, 2015 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title IIIB — CA/CM/SCAS Transportation U.S. Health and Human Services 93.044 Support Services Total 11113 $ 355,098.43 OAA Title IIICI — Congregate Meals Meals Screening U.S. Health and Human Services 93.045 Nutrition Education Outreach Total HIC1 $ 313,624.70 OAA Title III C2 — Home Delivered Meals Meals Nutrition Education U.S. Health and Human Services 93.045 Screening Outreach Total 111C2 $ 280,435.16 Older Americans Act Title III E CA/CM & Services (Title III E) 93.052 $ 117,424.42 Supplement Services (Title III ES) U.S. Health and Human Services $ 18,528.77 Grandparent Services (Title III EG) $ 13,239.45 Total IIIE $ 149,192.64 TOTAL FEDERAL AWARD $1,098,350.93 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: Amendment .008 OAA 203.16.008 FEDERAL FUNDS: 2 CFR Part 2000niform 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. COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE 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. 3 Amendment .008 OAA 203.16.008 ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY 1. Title III B Support Services $ 355,098.43 2. Title III C1 Congregate Meals $ 313,624.70 3. Title HI C2 Home Delivered Meals $ 280,435.16 4. Title III E Services $ 149,192.64 TOTAL S 1,098,350.93 4 Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 008 1, Steve Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services Department Head (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data processing media, which has no affect on the agreement/contract content. March 3, 2017 Signature of Recipient/Contractor representative Date Approved as to form and legality Assistant County Attorney Revised August 2007 Amendment .007 OAA 203.16.007 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners, (Contractor) and amends contract OAA 203.16. The purpose of this amendment is increase OA3EG allocations for Collier County by $6,512.00, revise #4 Contract Amount and revise ATTACHMENT III and ATTACHMENT VII. 4. Contract Amount The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $1,013,350.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for payment under any other contract or from any other source are not eligible for payment under this contract. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to this Amendment. All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this 4 page amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this OAA contract as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. SIGNED BY: SIGNED BY NAME: Steve Y. Carrell NAME: TITLE: Public Services Department Head TITLE: DATE: November 12016 DATE: Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 1 MARIANNE G LORINI PRESIDENT/CEO Approved as to form and legality 3 • t County Attor'fw`) As'z Amendment .007 ATTACHMENT III FUNDING SUMMARY OAA 203.16.007 Note: Title 2 CFR § 2003 3 ],as revised, and Section 215.97(5), Florida Statutes, require that the information about federal programs and State Projects belrovidedtotheRecipientandarestatedinTheFinancialAndComplianceAuditAttachment And Exhibit I. Financial And Compliance Audit Attachment, Exhibit 2 -Funding Summary Provides Information Regardingthe Funding Sources Applicable to this contract, contained herein, is aprediction offunding sources and related amounts based onthe contract budget. 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: COLLIER COUNTY GRANT AWARD (FAIN#): 16AAFLT3SS, 16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC DUNS NUMBER :076997790 FEDERAL AWARD DATE: OCTOBER 20, 2015 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title IIIB — CA/CM/SCAS $ 23,574.00 Transportation U.S. Health and Human Services 93.044 $ 0.00 Support Services $ 316,722.00 $ 340,296.00 Total IIIB OAA Title IIIC1 — Congregate Meals $ 293,000.00 Meals Screening U.S. Health and Human Services 93.045 Nutrition Education Outreach Total IIIC1 $ 293,000.00 OAA Title III C2 — Home Delivered _ Meals $ 250,832.00 Meals Nutrition Education U.S. Health and Human Services 93.045 Screening Outreach $ 250,832.00 Total IIIC2 Older Americans Act Title III E CA/CM & Services (Title III E) $ 97,755.00 Supplement Services (Title III ES) U.S. Health and Human Services 93.052 $ 18,335.00 Grandparent Services (Title III EG) $ 13,132.00 Total HIE $ 129,222.00 TOTAL FEDERAL AWARD $1,013,350.00 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: Amendment .007 OAA 203.16.007 FEDERAL FUNDS: 2 CFR Part 200Uniform 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. 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. Amendment .007 OAA 203.16.007 ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY 1. Title III B Support Services $ 340,296.00 2. Title III CI Congregate Meals $ 293,000.00 3. Title III C2 Home Delivered Meals $ 250,832.00 4. Title III E Services $ 129,222.00 TOTAL $ 1,013,350.00 4 Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 007 I, Steve Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services Department Head (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data processing media, which has no affect on the agreement/contract content. November 2016 Signature o ReciptenMM ontractor representative Date Approved as to form and legality Assistant County Attorney Revised August 2007 Amendment 06 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS OAA 203.16.006 THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners (Contractor) and amends contract OAA 202.16. The purpose of this amendment is to (1) extend this contract for 60 days or until a new 2017 OAA 202.17 contract is executed, whichever comes first. This amendment shall be effective on January 1, 2017 RECITALS: WHEREAS, on February 2, 2016, the parties entered into the Standard Contract for social services to be provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract"); and WHEREAS, on February 12, 2016, the parties entered into a First Amendment to the Contract; and WHEREAS, on June 16, 2016 the parties entered into a Second Amendment to the Contract; and WHEREAS, on October 27, 2016, the Agency has processed a Third Amendment to the Contract, and WHEREAS, on October 27, 2016, the Agency has processed a Fourth Amendment to the Contract, and WHEREAS, on November 2, 2016, the Agency has processed a Fifth Amendment to the Contract, which has not been executed; and WHEREAS, Section 3 of the Contract provides that the agreement is to expire on December 31, 2016; and WHEREAS, the funding source for a successor agreement for senior services is not yet available to the Agency from the Florida Department of Elder Affairs; WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so that both parties wish to extend the Contract to February 28, 2017 while they await notification of funding of a successor contract. NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows: 1. The foregoing Recitals are true and correct and are incorporated by reference herein. 2. Both parties agree to extend the contract to February 28, 2017. 3. All other provisions of the Contract are to remain in effect and are to be performed at the level specified in the agreement. SIGNATURE PAGE TO FOLLOW y Amendment 06 OAA 203.16.006 IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there unto duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. . � t SIGNED BY: - SIGNED BY NAME: STEVE Y, CARNELL NAME: MARIANNE G LORINI TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO DATE: November , 2016 DATE: Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 Approved as to form and legality Assistant County Attorney 4 , r 2 Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 006 I, Steve Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services Department Head (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data processing media, which has no affect on the agreement/contract content. November r , 2016 Signature ol KeCipient/Contractor representative Oate Approved as to form and legality Assistant County Attorney 4'y> Revised August 2007 ,Amendment .005 OAA 203.16.005 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners, (Contractor) and amends contract OAA 203.16. The purpose of this amendment is decrease allocations for Collier County by $19,500 from OA3B Transportation, revise #4 Contract Amount and revise ATTACHMENT III and ATTACHMENT VII. 4. Contract Amount The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $1,006,838.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for payment under any other contract or from any other source are not eligible for payment under this contract. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to this Amendment. All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this 4 page amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this OAA contract as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. SIGNED BY: _ f r SIGNED BY:. NAME: STEVE Y. CARNELL NAME: MARIANNE G LORINI TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE DATE: November i' , 2016 DATE: Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 PRESIDENT/CEO Approved as to form and legality Assistant County Attorney r Amendment .005 ATTACHMENT HI FUNDING SUMMARY OAA 203.16.005 Note: Title2CFR§200331,asrevised,andSection21597(5),FloridaStatutes,requirethattheinformationaboutfederalprograms and State Projects bep•ovidedtothe Recipient and are stated in TheFinancial And Compliance Audit Attachment And Exhibit t. Financial And Compliance Audit Attachment, Exhibit 2 -Funding Summary Provides Information Regardingthe Funding Sources Applicable tothiscontract, contained herein, isapredictionoffundingsources and related amounts based on the contract budget. 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: COLLIER COUNTY GRANT AWARD (FAIN#): 16AAFLT3SS, 16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC DUNS NUMBER :076997790 FEDERAL AWARD DATE: OCTOBER 20, 2015 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title IIIB — CA/CM/SCAS $ 23,574.00 Transportation U.S. Health and Human Services 93.044 $ 0.00 Support Services $ 316,722.00 $ 340,296.00 Total 11113 OAA Title IIIC I — Congregate Meals $ 293,000.00 Meals Screening Nutrition Education U.S. Health and Human Services 93.045 Outreach Total 111C $ 293,000.00 OAA Title III C2 — Home Delivered Meals $ 250,832.00 Meals Nutrition Education U.S. Health and Human Services 93.045 Screening Outreach $ 250,832.00 Total IIIC2 Older Americans Act Title III E CA/CM & Services (Title III E) $ 97,755.00 Supplement Services (Title III ES) U.S. Health and Human Services 93.052 $ 18,335.00 Grandparent Services (Title III EG) $ 6,620.00 Total HIE $ 122,710.00 TOTAL FEDERAL AWARD $1,006,838.00 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: Amendment .005 OAA 203.16.005 FEDERAL FUNDS: 2 CFR Part 200Uniform 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. COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE 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. 3 f, Amendment .005 OAA 203.16.005 ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY 1. Title III B Support Services $ 340,296.00 2. Title III Cl Congregate Meals $ 293,000.00 3. Title III C2 Home Delivered Meals $ 250,832.00 4. Title III E Services $ 122,710.00 TOTAL S 1,006,838.00 4 Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 005 I, Steve Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services Department Head (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data processing media, which has no affect on the agreement/contract content. t � t` November 5 2016 ignature ot ltecipient/CoFtfract3r representative Mate Approved as to form and legality Assistant County Attorney y Y V Revised August 2007 Amendment .004 OAA 203.16.004 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners, (Contractor) and amends contract OAA 203.16. The purpose of this amendment is increase allocations for Collier County by $2,000 for CI, revise #4 Contract Amount and revise ATTACHMENT III and ATTACHMENT VII. 4. Contract Amount The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $1,026,338.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for payment under any other contract or from any other source are not eligible for payment under this contract. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to this Amendment. All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this 4 page amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this OAA contract as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. : DTZ -. { SIGNED BY: I+ �� "; SIGNED BY: r' NAME: STEVE Y. CARNELL NAME: MARIANNE G LORINI TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO DATE: October 2016 DATE: Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 Approved as to form and legality Assistant County Attorney Amendment .004 ATTACHMENT III FUNDING SUMMARY OAA 203.16.004 Note: Title 2 CFR § 200 33 1, as revised, and Section 215.97(5),, Florida Statutes, require that the information about federal programs and State Projectsbep-ovided tothe Recipient and are stated in The Financial And Compliance Audit Attachment And Exhibit I . Financial And Compliance Audit Attachment, Exhibit2-Funding Summary Provides Information Regarding the F und i n g S o urc es App I i cable to th i s c ontract, contained herei n, isapre dictionoffund ingsourcesand related amounts based on the contract budget. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: COLLIER COUNTY GRANT AWARD (FAIN#): 16AAFLT3SS,16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC DUNS NUMBER: 076997790 FEDERAL AWARD DATE: OCTOBER 20, 2015 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title 1I113 — CA/CM/SCAS $ 23,574.00 Transportation U.S. Health and Human Services 93.044 $ 19,500.00 Support Services $ 316,722.00 $ 359,796.00 Total IIIB OAA Title IIICI — Congregate Meals $ 293,000.00 Meals Screening U.S. Health and Human Services 93.045 Nutrition Education Outreach Total IIIC1 $ 293,000.00 OAA Title III C2 — Home Delivered Meals $ 250,832.00 Meals Nutrition Education U.S. Health and Human Services 93.045 Screening Outreach $ 250,832.00 Total IIIC2 Older Americans Act Title III E CA/CM & Services (Title III E) $ 97,755.00 Supplement Services (Title III ES) U.S. Health and Human Services 93.052 $ 18,335.00 Grandparent Services (Title III EG) $ 6,620.00 Total HIE $ 122,710.00 TOTAL FEDERAL AWARD $1,026,338.00 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: Amendment .004 OAA 203.16.004 FEDERAL FUNDS: 2 CFR Part 2000niform 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. COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE 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. Amendment .003 ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY 1. Title III B Support Services 2. Title III C1 Congregate Meals 3. Title III C2 Home Delivered Meals 4. Title III E Services TOTAL 4 $ 359,796.00 $ 293,000.00 $ 250,832.00 $ 122,710.00 S 1,026,338.00 OAA 203.16.003 r Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 004 I, Steve Y Farnell , 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. Revised August 2007 %j October , 2016 W., Approved as to form and legality Assistant County Attorn-ey !�.mendment .003 OAA 203.16.003 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners, (Contractor) and amends contract OAA 203.16. The purpose of this amendment is increase allocations for Collier County by $6,000 carry -forward money, decrease allocations by $11,000 (-$11,500 transportation and +$500 OA3EG), revise #4 Contract Amount and revise ATTACHMENT III by showing the FAIN #'s for the Grant Award and the DUNS Number for the county as well as the new allocation, and ATTACHMENT VII and change language in ATTACHMENT I, MANNER OF SERVICE PROVISION, D Deliverables, 2. Reports, a. Programmatic Operations/Administrative-(2) Annual review of service cost reports; Service Cost Reports. 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 $1,024,338.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for payment under any other contract or from any other source are not eligible for payment under this contract. ATTACHMENT MANNER OF SERVICE PROVISION D. Deliverables 2. Reports a. Programmatic Operations/Administration- The Contractor shall ensure the provision of services, as outlined in this contract, are in accordance with the Agency and/or the Department of Elder Affairs Programs and Services Handbook through its review of reports as outlined below: (1) Monthly review of subcontractors' surplus/deficit reports, and CIRTS data accuracy reports; (2) Annual review of service cost reports: The Contractor shall respond to additional routine or special requests for information and reports required by the Agency in a timely manner as determined by the Contract Manager. The Contractor shall establish reporting due dates for Subcontractors that permit the Contractor to meet the Agency's reporting requirements. Service Cost Reports a. The Agency shall require the Contractor to submit Annual Service Cost Reports, which reflect actual costs of providing each service by program. Service Cost Reports for all contracts are due by February 15, 2017 for the prior calendar year. b. Unit Cost Methodology worksheets must be submitted by August 1 of each year, if a rate increase is being requested for any contract in the next calendar year. !`amendment .003 OAA 203.16.003 All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to this Amendment. All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this 5 page amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this OAA contract as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. Contractor: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS SIGNED BY: ` NAME: STEVE Y. CARN ELL TITLE: PUBLIC SERVICES DEPARTMENT HEAD DATE: October 2016 Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 I) AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. SIGNED BY: l/ a'..' /a, NAME: MARIANNE G LORINI TITLE: PRESIDENT/CEO DATE: Approved as to form and legality } Assistant County Attorney Amendment .003 ATTACHMENT III FUNDING SUMMARY OAA 203.16.003 Note: Title CFR § 2003 3 1, as revised. and Section 215.97(5), Florida Statutes, require that the information about federal programs and State Projects be provided tothe 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 Regardingthe Funding Sources Applicable to this contract, contained herein, is aprediction 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: COLLIER COUNTY GRANT AWARD (FAIN#): 16AAFLT3SS, 16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC DUNS NUMBER: 076997790 FEDERAL AWARD DATE: OCTOBER 20, 2015 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title IIIB — CA/CM/SCAS $ 23,574.00 Transportation U.S. Health and Human Services 93.044 $ 19,500.00 Support Services $ 316,722.00 $ 359,796.00 Total IIIB $ 291,000.00 OAA Title IIIC1 — Congregate Meals Meals Screening U.S. Health and Human Services 93.045 Nutrition Education Outreach Total IIIC1 $ 291,000.00 OAA Title III C2 — Home Delivered Meals $ 250,832.00 Meals Nutrition Education U.S. Health and Human Services 93.045 Screening Outreach $ 250,832.00 Total IIIC2 Older Americans Act Title III E CA/CM & Services (Title III E) $ 97,755.00 Supplement Services (Title III ES) U.S. Health and Human Services 93.052 $ 18,335.00 Grandparent Services (Title III EG) $ 6,620.00 Total IIIE $ 122,710.00 TOTAL FEDERAL AWARD $1,024,338.00 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: ,amendment .003 OAA 203.16.003 FEDERAL FUNDS: 2 CFR Part 200Uniform 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. COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE 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. Ll Amendment .003 ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY 1. Title III B Support Services $ 359,796.00 2. Title III C1 Congregate Meals $ 291,000.00 3. Title III C2 Home Delivered Meals $ 250,832.00 4. Title III E Services $ 122,710.00 TOTAL S 1,024,338.00 5 OAA 203.16.003 Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 003 1, Steve Y Carne❑ , 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. 4i ature QC Revised August 2007 ve October i , , 2016 Approved as to fornt and IcPality Assistant County Attorney -Y Amendment .002 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS OAA 203.16.002 THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners, (Contractor) and amends contract OAA 203.16. The purpose of this amendment is increase allocations by $6,147 for Collier County; change reimbursement percentage of OA313 Transportation; revise #4 Contract Amount and revise ATTACHMENT III and ATTACHMENT VII. 4. Contract Amount The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $1,029,338.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for payment under any other contract or from any other source are not eligible for payment under this contract. This amendment shall be effective on May 18, 2016. All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the agreement. This amendment and all of its attachments are hereby made a part of this agreement. IN WITNESS WHEREOF, the parties hereto have caused this 4 page amendment to be executed by their officials there unto duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. SIGNED BY:AD�(2K- SIGNED BY: /i.r L4 - 2 � NAME: STEPHEN Y CARNELL TITLE: PUBLIC SERVICES DEPARTMENT HEAD DATE: June 10, 2016 Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 NAME: MARIANNE G LORINI TITLE: PRESIDENT/CEO DATE: 1 Approved as to form and legality Assistant County Attorney ,> O� Amendment .002 OAA 203.16.002 ATTACHMENT IH 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: COLLIER COUNTY PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title 11 B$ $ 23,574.00 CA/CM/SCAS Transportation U.S. Health and Human Services 93.044 $ 31,000.00 Support Services $ 316,722.00 TotaIIIIB $ 371,296.00 $ 285,000.00 OAA Title IIIC1 — Congregate Meals Meals Screening U.S. Health and Human Services 93.045 Nutrition Education Outreach TotalIIIC1 $ 285,000.00 OAA Title III C2 — Home Delivered $ 250,832.00 Meals Meals Nutrition Education U.S. Health and Human Services 93.045 Screening $ 250,832.00 Outreach Total IIIC2 Older Americans Act Title III E CA/CM & Services (Title III E) 93.052 $ 97,755.00 Supplement Services (Title III ES) U.S. Health and Human Services $ 18,335.00 Grandparent Services (Title III EG) $ 6,120.00 Total HIE $ 122,210.00 TOTAL FEDERAL AWARD $1,029,338.00 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: FEDERAL FUNDS: 2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A-122 — Cost Principles)* 2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-110 — Administrative Requirements) OMB Circular A-133 — Audit Requirements COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE Section 215.97, Fla. Stat. 2 f Amendment .002 ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS CK�a 11-i K�1iJ�W4 1. Title III B Support Services $ 371,296.00 2. Title III Cl Congregate Meals $ 285,000.00 3. Title III C2 Home Delivered Meals $ 250,832.00 4. Title III E Services $ 122,210.00 TOTAL $1,029,338.00 3 OAA 203.16.002 Amendment .002 OAA 203.16.002 ATTACHMENT VII OLDER AMERICANS ACT RATE SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS Services COLLIER COUNTY Total Cost Reimbursement Rate Adult Day Care 12.83 11.55 Case Aide 33.89 30.50 Case Management 60.00 54.00 Chore 23.33 21.00 Chore (Enhanced) 30.33 27.30 Companionship 23.33 21.00 Emergency Alert Response 1.31 1.18 Escort 21.67 19.50 Homemaker 21.50 19.35 Housing Improvement 100% Cost 90% of Cost Material Aid 100% Cost 90% of Cost Personal Care 25.67 23.10 Respite In -Facility 12.83 11.55 Respite In -Home 25.67 23.10 Screening and Assessment 60.00 54.00 Shopping Assistance 21.00 18.90 Skilled Nursing Services 42.00 37.80 Specialized Medical Equipment, Services, and Supplies 100% Cost 90% of Cost Transportation 100% Cost 100% of Cost Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 002 I,__ Stephen Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services Department Head (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data processing media, which has no affect on the agreement/contract content. 7I June 10, 2016 Approved as to form and legality Assistant County Attorney'` O� Revised August 2007 Amendment .001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. OLDER AMERICANS ACT PROGRAM TITLE III COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS OAA 203.16.001 THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency) and Collier County Board of County Commissioners, (Contractor) and amends contract OAA 203.16. The purpose of this amendment is remove some sections that do not pertain to this contract regarding subcontracts/vendors and revise ATTACHMENT VII Rate Summary by adding additional services to OA3ES. 1. Under II MANNER OF SERVICE PROVISION: A. Service Tasks: 4. Monitoring the Performance of its Subcontracts: Item b. Subcontractor Outreach Reporting Requirements should be deleted as it does not apply to vendors; 2. Under II MANNER OF SERVICE PROVISION: A. Service Tasks: 5. Grievance and Compliant Procedures: Item b. Legal Provider Grievance Procedures should be deleted as it does not apply to vendors; 3. Under II MANNER OF SERVICE PROVISION: B. Staffing Requirements: 3. Subcontractors—Use of Subcontractors: d. "The Contractor shall require subcontractors to enter....." should be deleted as it does not apply to vendors; 4. Under II MANNER OF SERVICE PROVISION: B. Staffing Requirements: 3. Subcontractors—Use of Subcontractors: e. "The Contractor shall require subcontractors to run monthly CIRTS....." should be deleted as it does not apply to vendors; 5. Under II MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: a. Programmatic Operations/Administration should be deleted as it does not apply to vendors. 6. Under II MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: c. Surplus/Deficit Report: (1) A list of all subcontractors and their current status regarding surplus/deficit; should be deleted as it does not apply to vendors; 7. Under II MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: c. Surplus/Deficit Report: (5) Number of clients currently on APCL that receive a priority ranking score of 4 or 5; should be deleted as it does not apply to vendors; Under II MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: c. Surplus/Deficit Report: (6) Number of clients currently on the APCL designated as Imminent Risk; should be deleted as it does not apply to vendors; 9. Revise ATTACHMENT VII Rate Summary by adding Material Aid, Chore, and Enhanced Chore to the services listed under OA3ES. Amendment .001 Services COLLIER COUNTY IIIE, IIIES, & IIIEG Total Cost OAA 203.16.001 Reimbursement Rate IIIE — Adult Day Care $ 12.83 $ 11.55 Direct Pay Respite $ 16.67 $ 15.00 Respite In -Facility $ 12.83 $ 11.55 Respite In -Home $ 25.67 $ 23.10 Screening & Assessment $ 60.00 $ 54.00 IIIES-- Chore $ 23.33 $ 21.00 Enhanced Chore $ 30.33 $ 27.30 Specialized Medical Equipment, Service & Supplies 100% Cost 90% of Cost Material Aid 100% Cost 90% of Cost IIIEG- Child Day Care $ 16.67 $ 15.00 Screening/Assessment $ 60.00 $ 54.00 This amendment shall be effective on January 31, 2016. All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the agreement. This amendment and all of its attachments are hereby made a part of this agreement. IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there unto duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. j SIGNED BY: SIGNED BY: ��i'�n�.- 6.�dt.t✓~�t�. NAME: Stephen Y. Carnell TITLE: Public Services Department Head DATE: February 5, 2016 Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 NAME: MARIANNE G LORINI TITLE: PRESIDENT/CEO DATE: 2�j2 Ao Approved as to form and legalif 2 istant Cotr3 atom Re-vised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number 001 I, Stephen Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services Department Head (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data processing media, which has no affect on the agreement/contract content. Approved as to form and legality '3 .. Assistant County Atto r� Revised August 2007 O '/lanuary 2016 — December 2016 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. CONTRACT OLDER AMERICANS ACT TITLE III OAA 203.16 THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier County Board of County Commissioners (Contractor), and collectively referred to as the "Parties." The term Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient. WITNESSETH THAT: WHEREAS, the Agency has determined that it is in need of certain services as described herein; and WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such services as an independent Contractor of the Agency. NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the mutual covenants and conditions hereinafter set forth, the Parties agree as follows: 1. Purpose of Contract The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract including all attachments, forms, exhibits and references incorporated, which constitute the contract document. 2. Incorporation of Documents within the Contract The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Agency and or 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 January 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 December 31, 2016. 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 $1.023.191.00, 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. n s ,r January 2016 — December 2016 6 nff Bial PavPv anti Renrecentativec !Names_ Addresses_ and Telenhone Numbers): OAA 203.16 7. All Terms and Conditions Included: This contract and its Attachments, I, II, III, IV, VII, VIII, IX, & X 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 contract to be executed by their undersigned officials as duly authorized. CONTRACTOR: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR COUNTY CO:! SIONERS SOUTHWEST FLORIDA, INC. SIGNED BY: � � �" �✓ �.. °��' `"�' SIGNED BY: NAME: Stephen Y, Carnell TITLE: Public Services Department Head DATE: January 8, 2016 Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 9/30 NAME: MARIANNE G LORINI TITLE: PRESIDENT/CEO DATE: a l Z f/ o Approved as to form and legality CAO 2 Assistant County Attorney The Contractor name, as shown on page 1 of this Collier County Board of County Commissioners3339 E Tamiami Trail, Building H a.. contract, and mailing address of the official payee to Naples, FL 34112 whom the payment shall be made is: Kimberley Grant, Director b. The name of the contact person and street address where Collier County Board of County Commissioners financial and administrative records are maintained is: %Community and Human Services 3339 E Tamiami Trail, Building H Naples, FL 34112 C. The name, address, and telephone number of the Kimberley Grant, Director Collier County Board of County Commissioners representative of the Contractor responsible for o /oCommunity and Human Services administration of the program under this contract is: 3339 E Tamiami Trail, Building H Naples, FL 34112 (239) 752-2273 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, II, III, IV, VII, VIII, IX, & X 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 contract to be executed by their undersigned officials as duly authorized. CONTRACTOR: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR COUNTY CO:! SIONERS SOUTHWEST FLORIDA, INC. SIGNED BY: � � �" �✓ �.. °��' `"�' SIGNED BY: NAME: Stephen Y, Carnell TITLE: Public Services Department Head DATE: January 8, 2016 Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 9/30 NAME: MARIANNE G LORINI TITLE: PRESIDENT/CEO DATE: a l Z f/ o Approved as to form and legality CAO 2 Assistant County Attorney January 2016 — December 2016 OAA 203.16 ATTACHMENT I STATEMENTOF WORK.................................................................................................................................... 4 ATTACHMENT II CERTIFICATION REGARDING LOBBYING --Certification for Contracts, Grants, Loans and Cooperative Agreements........................................................................................................................................................ 19 ATTACHMENT III FEDERALRESOURCES AWARD................................................................................................................... 20 ATTACHMENT IV Certification Re ag rding Debarment Suspension Ineligibility and Voluntary Exclusion Contracts / Subcontracts............................................................................................................................... 21 ATTACHMENT VII BUDGETAND RATE SUMMARY.................................................................................................................... 22 ATTACHMENT VIII INVOICESCHEDULE..................................................................................................................................... 25 ATTACHMENT IX REQUESTFOR PAYMENT-106A.................................................................................................................. 26 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 1-105as-IIIB............................................................. 27 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 2-105as-IIICI........................................................... 28 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 3-105as-IIIC2........................................................... 29 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 4-105as-IIIE............................................................. 30 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 5 IIIB Unit Cost Report ............................................ 31 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 6—IIICI Unit Cost Report....................................32 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 7—IIIC2 Unit Cost Report ......................................... 33 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT—Exhibit 8—IIIE Unit Cost Report ............................................ 34 3 CAO /January 2016 — December 2016 ATTACHMENT I STATEMENT OF WORK L SERVICES TO BE PROVIDED A. Definitions of Terms 1. Contract Acronyms Area Agency on Aging (AAA) Activities of Daily Living (ADL) Alliance of Information & Referral Systems (AIRS) Assessed Priority Consumer List (APCL) Adult Protective Services (APS) Client Information and Registration Tracking System (CIRTS) Information and Referral (I & R) Instrumental Activities of Daily Living (IADL) National Council on Aging (NCOA) Older Americans Act (OAA) Planning and Service Area (PSA) 2. Program Specific Terms OAA 203.16 Area Plan: A plan developed by the AAA outlining a comprehensive and coordinated service delivery system in its PSA in accordance with Section 306 (42 U.S.C. 3026) of the OAA and Agency instructions. Area Plan Update: A revision to the Area Plan wherein the AAA enters OAA specific data in CIRTS. An update may also include other revisions to the Area Plan as instructed by the Agency. Child: An individual who is not more than eighteen (18) years of age or an individual with disability. Criteria: A standard which the Administration on Aging/Administration for Community Living set for the Title III D Program. AoA/ACL's standard criterion consists of three tiers: Minimal Criteria, Intermediate Criteria, and Highest Level Criteria. Family Caregiver: An adult family member, or another individual, who is an informal provider of in- home and community care to an older individual. Frail: When an older individual is unable to perform at least two ADLs without substantial human assistance, including verbal reminding, physical cueing or supervision; or due to cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to another individual. Grandparent: A grandparent or step -grandparent of a child, or a relative of a child by blood, marriage or adoption and who lives with the child; is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the child, such as legal custody or guardianship, or is raising the child informally. M January 2016 — December 2016 B. General Description OAA 203.16 1. General Statement The OAA Program is a federal program initiative that provides assistance to older persons and caregivers and is the only federal supportive services program directed solely toward improving the lives of older people. The OAA Program provides a framework for a partnership among the different levels of government and the public and private sectors with a common objective, improving the quality of life for all older individuals by helping them to remain independent and productive. The primary purpose of the OAA Program is to foster the development and implementation of comprehensive and coordinated systems to serve older individuals. The OAA Program uses these systems to assist older individuals to attain and maintain maximum independence and dignity in a home environment and allows for the capability of self-care with appropriate supportive services. 2. Authority All applicable federal laws, regulations, action transmittals, program instructions, review guides and similar documentation related to the following: Catalog of Federal Domestic Assistance No. 93.043, 93.044, 93.045, and 93.052 Older Americans Act of 1965, as amended; Rule 58A-1, Florida Administrative Code (FAC); and Section 430.101, Florida Statutes (F.S.). 3. Scope of Service The Contractor is responsible for the programmatic, fiscal, and operational management of the OAA Title IIIB, Title lIICI, Title IIIC2, and Title IIIE Programs within its designated PSA. This Scope of Service includes planning, coordinating and assessing the needs of older persons, and assuring the availability and quality of services. The services shall be provided in a manner consistent with, and described in, both the current Agency's Area Plan Update and the current Florida Department of Elder Affairs Programs and Services Handbook. 4. Major Program Goals The major goals of the OAA Program are to improve the quality of life for older individuals, preserve their independence and prevent or delay more costly institutional care. These goals are achieved through the implementation of a comprehensive and coordinated service system that provides a continuum of service alternatives that meet the diverse needs of elders and their caregivers. C. Clients to be Served 1. General Statement Preference shall be given to those with the greatest economic and social need, with particular attention to low-income older individuals, including those that are low-income minorities, have limited English proficiency, and older individuals residing in rural areas. a. OAA Title III, General Consumers shall not be dually enrolled in an OAA Program and a Medicaid capitated Long -Term Care Program, with the exception of consumers in need of OAA Legal Assistance services and OAA Congregate Nutrition Services, including transportation to and from congregate meal sites. b. OAA Title HIB, Supportive Services (1) Individuals must be age sixty (60) or older; and (2) Information and Referral/Assistance services are provided to individuals regardless of age. 5 CAO January 2016 — December 2016 OAA 203.16 c. OAA Titles IHC1 and IHC2, Nutrition Services, General General factors that shall be considered in establishing priority for nutrition services, include those older persons who meet the following: (1) Cannot afford to eat adequately; (2) Lack the skills or knowledge to select and prepare nourishing and well-balanced meals; (3) Have limited mobility which may impair their capacity to shop and cook for themselves; or (4) Have a disabling illness or physical condition requiring nutritional support or have been screened at a high nutritional risk. d. OAA Title HIC1, Congregate Nutrition Services In addition to meeting the general nutrition services eligibility requirements listed in Section I.C.l.c, above, individuals must be mobile, not homebound, and physically, mentally, and medically able to attend a congregate nutrition program. Individuals eligible to receive congregate meals include the following: (1) Individuals age sixty (60) or older; (2) Any spouse (regardless of age) who attends the dining center with his/her eligible spouse; (3) Persons with a disability, regardless of age, who reside in a housing facility occupied primarily by older individuals where congregate nutrition services are provided; (4) Disabled persons who reside at home with and accompany an eligible person to the dining center; and (5) Volunteers, regardless of age, who provide essential services on a regular basis during meal hours. e. OAA Title IIIC2, Home Delivered Nutrition Services In addition to meeting the general nutrition services eligibility requirements as listed in Section I.C.l.c, individuals must be homebound and physically, mentally, or medically unable to attend a congregate nutrition program. Individuals eligible to receive home delivered meals include the following: (1) Individuals age sixty (60) or older who are homebound by reason of illness, disability or isolation; (2) The spouse of a homebound eligible individual, regardless of age, if the provision of the collateral meal supports maintaining the person at home; (3) Individuals with disabilities, regardless of age, who reside at home with eligible individuals and are dependent on them for care; and (4) Persons at nutritional risk who have physical, emotional or behavioral conditions, which would make their presence at the congregate site inappropriate; and persons at nutritional risk who are socially or otherwise isolated and unable to attend a congregate nutrition site. f. OAA Title IIIE, Caregiver Support Services Eligibility for OAA Title IIIE, Caregiver Support Services, are as follows: (1) Family caregivers of individuals age sixty (60) or older; (2) Grandparents [age fifty five (55) or older] or older individuals [age fifty five (55) or older] who are relative caregivers; (3) Priority will be given to family caregivers who provide care for individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction and for 0 January 2016 — December 2016 OAA 203.16 grandparents or older individuals who are relative caregivers who provide care for children with severe disabilities; and (4) For respite and supplemental services, a family caregiver must be providing care for an older individual who meets the definition of the term "frail" as defined in this contract, I.A.2. II. MANNER OF SERVICE PROVISION A. Service Tasks In order to achieve the goals and objectives of the OAA Program, the Contractor shall ensure the following Service Tasks are performed at the level specified in this contract. 1. Client Eligibility Determination The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a client is based on meeting the requirements described in this Contract. 2. Targeting and Screening of Service Delivery for New Clients The Contractor shall develop and implement policies and procedures consistent with OAA targeting and screening criteria. 3. Delivery of Services to Eligible Clients The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of elders and their caregivers. The Contractor shall ensure the performance and report performance of the following services are in accordance with the current Florida Department of Elder Affairs Programs and Services Handbook. The services funded pursuant to this contract are in accordance with the OAA, Title III, Sections 321, 331, 336, and 373 as follows: Section 321, Title IIIB Supportive Services; Section 331, Title IIIC1 Congregate Nutrition Services; Section 336, Title IIIC2 Home Delivered Nutrition Services; Section 373, Title IIIE Caregiver Support Services; and a. Supportive Services (HEB Program) - Supportive services include a variety of community-based and home -delivered services that support the quality of life for older individuals by helping them remain independent and productive. Services include the following: (1) Adult Day Care/Adult Day Health Care; (17) Recreation; (2) Caregiver Training/Support; (18) Emergency Alert Response; (3) Case Aid/Case Management; (19) Escort; (4) Chore Services; (20) Health Support; (5) Companionship; (21) Home Health Aid; (6) Counseling (Gerontological and Mental Health); (22) Homemaker; (7) Education/Training; (23) Housing Improvement; (8) Legal Assistance; (24) Information; (9) Material Aid; (25) Intake; (10 Occupational Therapy; (26) Interpreter/Translating; (11 Outreach; (27) Referral/Assistance; (12 Personal Care; (28) Respite Services; (13 Physical Therapy; (29) Screening/Assessment; (14 Shopping Assistance; (30) Speech Therapy; (15 Skilled Nursing; (31) Telephone Reassurance; and (16 Specialized Medical Equipment, Services, & Supplies (32) Transportation 7 ED January 2016 — December 2016 OAA 203.16 b. Congregate Nutrition Services (HIC1 Program) Nutrition Services are provided in congregate settings and are designed to reduce hunger and food insecurity, promote socialization and the health and well-being of older individuals by assisting them to gain access to nutrition and other disease prevention and health promotion services. Services include the following: (1) Congregate meals (2) Congregate meals screening; (3) Nutrition education and nutrition counseling; and (4) Outreach. c. Home Delivered Nutrition Services (IHC2 Program) In-home nutrition services are provided to reduce hunger and food insecurity; promote socialization and the health and well-being of older individuals by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services. Services include the following: (1) Home delivered meals; (2) Nutrition education and counseling; (3) Outreach; and (4) Screening/Assessment. d. Caregiver Support Services (HIE Program) The following services are intended to provide direct help to caregivers, assist in the areas of health, nutrition and financial literacy, and assist caregivers in making decisions and problem solving related to their caregiving roles and responsibilities: (1) Adult Day Care/Adult Day Health Care; (2) Caregiver Training/Support; (3) Counseling (Gerontological and Mental Health); (4) Education/Training; (5) Financial Risk Reduction (Assessment and Maintenance); (6) Information; (7) Intake; (8) Outreach; (9) Powerful Tools for Caregivers; (10) Referral/Assistance; (11) Respite Services; (12) Screening/Assessment; (13) Stress -Busting Program for Family Caregivers; and Transportation January 2016 — December 2016 OAA 203.16 (i) Caregiver Support Supplemental Services (IIIES Program) At least ten (10) percent, but no more than twenty (20) percent, of the total Title IIIE funds shall be used to provide supplemental support services. The following services are provided to complement the care provided by caregivers: (1) Chore Services; (2) Housing Improvement; (3) Legal Assistance; (4) Material Aid; and (5) Specialized Medical Equipment, Services and Supplies. (ii) Caregiver Support Grandparent Services (IIIEG Program) At least five (5) percent, but no more than ten (10) percent, of the total Title IIIE funds shall be used to provide support services to grandparents and older individuals who are relative caregivers. Services for grandparents or older individuals who are relative caregivers designed to help meet their caregiving obligations include the following: (1) Caregiver Training/Support; (2) Child Day Care; (3) Counseling (Gerontological and Mental Health); (4) Education/training; (5) Legal Assistance; (6) Outreach; (7) Referral/Assistance; (8) Screening/Assessment; (9) Sitter; and (10) Transportation. 4. Monitoring the Performance of its Subcontractors a. 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. b. Subcontractor Outreach Reporting Requirements—The Contractor shall document its oversight of subcontractor performance of outreach activities, by establishing a uniform reporting format that includes the following: number and type of provider events or activities; date and location; total number of participants at each event or activity; individual service needs identified; and referral sources or information provided. The Contractor shall require subcontractors to use this format for reporting on outreach activities at least semi-annually. C January 2016 — December 2016 5. Grievance and Complaint Procedures OAA 203.16 Grievance Procedures The Contractor shall comply with and ensure subcontractor compliance with the Minimum Guidelines for Recipient Grievance Procedures, Appendix D, Department of Elder Affairs Programs and Services Handbook, to address complaints regarding the termination, suspension or reduction of services, as required for receipt of funds. a. Complaint Procedures The Contractor shall develop and implement complaint procedures and ensure that subcontractors develop and implement complaint procedures to process and resolve client dissatisfaction with services. Complaint procedures shall address the quality and timeliness of services, provider and direct service worker complaints, or any other advice related to complaints other than termination, suspension or reduction in services that require the grievance process as described in Appendix D, Department of Elder Affairs Programs and Services Handbook. The complaint procedures shall include notification to all clients of the complaint procedure and include tracking the date, nature of complaint, and the determination of each complaint. b. Legal Provider Grievance Procedures The Contracts shall ensure that legal providers have an internal grievance procedure that addresses both denial of service and complaints by clients about manner or quality of legal assistance. Grievance policies that comport with requirements of the Legal Services Corporation are sufficient to meet this standard. At a minimum, the procedure must provide applicants with: (1) Adequate notice of the grievance procedures; (2) Information on how to file a grievance or complaint, and; (3) An opportunity for review of the complaint by the Legal Provider's Executive Director or the Executive Director's designee. (4) The Contractor may not serve in an appellate capacity or otherwise interfere in the grievance review process for legal providers. However, the Contractor may request that legal providers maintain a file of complaints and statements of disposition of complaints, with redacted client identifying information, for examination by the Contractor during monitoring. B. Staffing Requirements 1. Staffing Levels — The Contractor shall dedicate the staff necessary as required to meet the obligations of the contract. 2. Professional Qualifications — The Contractor shall ensure that the staff responsible for performing this contract have the qualifications as specified in the DOEA Programs and Services Handbook. 10 CAO January 2016 — December 2016 OAA 203.16 U11 It of Services Adult Day Care/Adult Day Health Care Home Health Aide Service Caregiver Training/Support Homemaker Case Aid/Case Management Housing Improvement Hour Child Day Care Legal Assistance Chore Services Nutrition Counseling Companionship Skilled Nursing Services Congregate Meals Screening Emergency Alert Response Day Specialized Medical Equipment, Services and Material Aid Supplies Episode Escort One -Way ShoppingAssistance Trip Transportation Congregate and Home Delivered Meals Meal 2. Reports The Contractor shall respond to additional routine and/or special requests for information and reports required by the Agency in a timely manner as specified by the Agency. The Contractor shall establish due dates for any subcontractors that permit the Contractor to meet the Agency's reporting requirements. a. Programmatic Operations/Administration- The Contractor shall ensure the provision of services, as outlined in this contract, are in accordance with the Agency and/or the Department of Elder Affairs Programs and Services Handbook through its review of reports as outlined below: (1) Monthly review of subcontractors' surplus/deficit reports, and CIRTS data accuracy reports; (2) Annual review of service cost reports; b. Client Information and Registration Tracking System (CIRTS) Reports- Contractor shall input OAA -specific data into CIRTS to ensure CIRTS data accuracy. Contractor shall use CIRTS- generated reports which include the following: (1) Client Reports; (2) Monitoring Reports; (3) Services Reports; (4) Miscellaneous Reports; (5) Fiscal Reports; (6) Aging Resource Center Reports; and (7) Outcome Measurement Reports. c. Surplus/Deficit Report - The Contractor shall submit a Consolidated Surplus/Deficit Report, in a format provided by the Agency to the Contract Manager, by the 18th of each month. This Consolidated Surplus/Deficit Report is for all agreements and/or contracts between the Contractor and the Agency and must include the following: 12 January 2016 — December 2016 OAA 203.16 (1) A list of all subcontractors and their current status regarding surplus/deficit; (2) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the Agency will be resolved; (3) Recommendations to transfer funds to resolve surplus/deficit spending; (4) Input from the Contractor's Board of Directors on resolution of spending issues, if applicable; (5) Number of clients currently on APCL that receive a priority ranking score of 4 or 5; and (6) Number of clients currently on the APCL designated as Imminent Risk. (7) Information provided in the Monthly Programmatic Report must match CIRTS data and the Request for Payment. (8) The Contractor shall review program documentation to ensure documentation is complete and adequately supports the information reported on the Monthly Programmatic Report prior to submitting a Request for Payment. The Contractor will attest to the review in the "comments" section of the Monthly Programmatic Report, and provide relevant information regarding the documentation as needed. d. Program Highlights - The Contractor shall submit Program Highlights referencing specific events that occurred in FFY 2015 by August 30, 2016. The Contractor shall provide a new success story, quote, testimonial, or human -interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms. For all agencies or organizations that are referenced in the highlight, the Contractor shall provide a brief description of their mission or role. The active tense shall be consistently used in the highlight narrative, in order to identify the specific individual or entity that performed the activity described in the highlight. The Contractor shall review and edit Program Highlights for clarity, readability, relevance, specificity, human interest, and grammar, prior to submitting them to the Agency. e. Invoices - The Contractor shall submit complete and accurate monthly invoices as referenced in Section III, Method of Payment. 3. Records and Documentation a. The Contractor shall maintain documentation to support Requests for Payment that shall be available to the Agency or authorized individuals, such as Department of Financial Services, upon request. b. CIRTS Data and Maintenance The Contractor shall ensure collection and maintenance of client and service information on a monthly basis from CIRTS or any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. c. 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. d. 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. 13 January 2016 — December 2016 E. Performance Specifications 1. Outcomes and Outputs (Performance Measures) — At a minimum, the Contractor must: OAA 203.16 a. The Contractor shall ensure the provision of the services described in this contract are in accordance with the current Florida Department of Elder Affairs Programs and Services Handbook and the Service Tasks described in Section II.A. b. The Contractor shall timely submit to the Agency all documentation and reports described in ATTACHMENT I, Section II.D. c. The Contractor shall develop and document strategies in the Agency's Area Plan to support the Department's standard of performance achievement (as referenced on the Department website http://floridafiscalportal.state.fl.us/PDFDoe.aspx?ID=9126) including increases for the following: (1) Percent of most frail elders who remain at home or in the community instead of going into a nursing home; (2) Percent of APS referrals who are in need of immediate services to prevent further harm who are served within 72 hours; (3) Percentage of active clients eating two or more meals per day; (4) Percent of new service recipients whose ADL assessment score has been maintained or improved; (5) Percent of new service recipients whose IADL assessment score has been maintained or improved; (6) After service intervention, the percentage of caregivers who self-report being very confident about their ability to continue to provide care; and (7) Percent of customers who are at imminent risk of nursing home placement who are served with community based services. d. The Contractor's performance of these measures will be reviewed and documented in the Agency's Annual Programmatic Monitoring Reports. 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, or an on-site visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and deliverables. The Agency may use, but is not limited to, one or more of the following methods for monitoring: 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; 14 January 2016 — December 2016 OAA 203.16 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. 3. Performance Definitions "Work day" shall mean a provider's staff member's eight (8) hour work period, unless specifically noted otherwise "Day" shall mean a calendar day, unless specifically noted otherwise. F. Contractor Responsibilities 1. Contractor Unique Activities 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; and 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. G. 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 Method 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 VII Budget and Rate Summary. 2. Cost Reimbursement —The Contractor agrees to distribute funds as detailed in contract and the Budget and Rate Summary, ATTACHMENT VII, to this contract. Any changes in the total amounts of the funds identified on the Budget Summary form require a contract amendment. Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in ATTACHMENT VII. All Cost Reimbursement Requests for Payment must include the actual Expenditure Reports beginning with the first month of the contract. 15 January 2016 — December 2016 OAA 203.16 B. 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 the amount of funds released to the Department of the State of Florida ("budget release"). The Contractor's requests for advance require the approval of the Agency's 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 January 1 st of the contract year. 1. Any advanced payments the Contractor requested for subcontractors must be distributed within seven days of receipt of payment from the Agency. The Contractor shall submit to the Agency documentation to support full distribution of advanced funds with report number 5, due to the Agency on March 15, 2016, in accordance with the Invoice Schedule, ATTACHMENT VIII to this contract. 2. All advance payments made to the Contractor shall be reimbursed to the Agency as follows: one— tenth of the advance payment received shall be reported as an advance recoupment on each Request for Payment, starting with report number five, in accordance with the Invoice Schedule, ATTACHMENT VIII to this contract. 3. Interest earned on advances must be identified separately by source of funds, state or federal. Contractors shall maintain advances of federal funds in FDIC interest bearing accounts unless otherwise exception is made in accordance with 45 CFR 74.22(k). Earned interest must be returned to the Agency at the end of each quarter of the contract period. C. Final Invoice Instructions -The Contractor shall submit the final Request for Payment to the Agency no later than February 15, 2017. D. 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 — this must correspond exactly to the "Remit To" address provided to MFMP during registration; 2. Request payment for services as established in ATTACHMENT VII Budget and Rate Summary of the contract; 3. The Contractor shall consolidate all Request for Payment from subcontractors and Expenditure Reports that support requests for payment and shall submit to the Agency using forms Request for Payments (ATTACHMENT IX), Receipt and Expenditure Reports (ATTACHMENT X Exhibits 1-8) 4. The Contractor shall include with its fixed fee/unit rate portion of the invoice, the units of services provided based on rates as established in ATTACHMENT VII Budget and Rate Summary of the contract, number of clients, and the rates for the services provided in conformance with the requirements as described in the deliverables and service tasks; and 5. All Requests for Payment shall be based on the submission of actual monthly Expenditure Reports beginning with the first month of the contract. The schedule for submission of advance requests (when available) and invoices is Invoice Schedule, ATTACHMENT VIII. 16 January 2016 — December 2016 E. Financial Consequences OAA 203.16 1. Contractor shall ensure 100% of the deliverables identified in SECTION II — MANNER OF SERVICE PROVISION are performed pursuant to contract requirements, and as described in Section II.D. are identified as major deliverables in this contract. 2. If at any time the Contractor is notified by the Agency Contract Manager that it has failed to correctly, completely, or adequately perform these major deliverables, the Contractor will have 10 days to submit a Corrective Action Plan ("CAP") to the 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 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. In the event Contractor fails to correct an identified deficiency within the approved time period specified in the CAP, the Agency shall deduct, from the payment for the invoice of the following month, 1 % of the monthly value of the administrative funds in the contract for each day the deficiency is not corrected. The Agency shall also deduct, from the payment for the invoice of the following month, I% of the monthly value of the administrative funds in the contract for each day the Contractor fails to timely submit a CAP. 4. If Contractor fails to timely submit a CAP, the Agency shall deduct 1% of the monthly value of the administrative funds in the contract for each day the CAP is overdue, beginning the l lth day after notification by the Agency Contract Manager of the deficiency. The deduction will be made from the payment for the invoice of the following month. 5. Remedies for Nonconforming Services The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely, completely and commensurate with required standards of quality. Such goods and/or services will only be delivered to eligible program participants. 6. 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. If, or to the extent, there is any conflict between Section D, 1-6 above, and paragraphs 39.1 and 39.2 of the Master Contract, this section shall take precedence. 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 December 31, 2016; email requests are considered acceptable. 17 January 2016 — December 2016 OAA 203.16 B. Contractor's Financial Obligations 1. Matching, Level of Effort, and Earmarking Requirements The Contractor's match will be made in the form of cash, general revenue administrative funds, and/or in-kind resources. The Contractor will assure, through a provision in subcontracts, a match requirement of at least 10 percent of the cost for services funded through this contract. The subcontractor's match will be made in the form of cash and/or in-kind resources. The Contractor shall report match by title each month. At the end of the contract period, the Contractor must properly match OAA funds that require a match. 2. Consumer Contributions Consumer contributions are to be used under the following terms: a. The Contractor assures compliance with Section 315 of the OAA as amended in 2006, in regard to consumer contributions; b. Voluntary contributions are not to be used for cost sharing or matching; c. Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and d. Voluntary contributions are to be used only to expand services. 3. Use of Service Dollars and Management of the Assessed Priority Consumer List The Contractor is expected to spend all federal, state, and other funds provided by the Agency for the purpose specified in the contract. The Contractor must manage the service dollars in such a manner so as to avoid having a wait list and a surplus of funds at the end of the contract period, for each program managed by the Contractor. If the Agency determines that the Contractor is not spending service funds accordingly, the Agency may transfer funds to other AAAs during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under state and federal law. 4. The Contractor agrees to distribute funds as detailed in this contract and ATTACHMENT VII. Any change in the funds identified in ATTACHMENT VII require a contract amendment. 5. Title III Funds The Contractor assures compliance with Section 306 of the OAA, as amended in 2006, that funds received under Title III will not be used to pay any part of a cost (including an administrative cost) incurred by the Contractor to maintain a contractual or commercial relationship that is not carried out to implement Title III. 18 C'90 January 2016 — December 2016 ATTACHMENT II CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: OAA 203.16 (1) 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 an employee of any Agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in the 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. (2) 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 an employee of any Agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in the connection with this Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, Disclosure Form to Report Lobbying, in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all sub - awards at all tiers (including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub -recipients shall certify and disclose 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 § 1352, Title 31, U.S. Code. 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. YJ 1 Signature Stephen Y. Carnell Name of Authorized Individual Collier County Government Name of the Organization 3339 Tamiami Trail E., Suite 211, Naples, FL 34112 Address of Organization January 8, 2016 Date OAA 203.16 Contract/Agreement Number Approved as to form and legality Assistant County Attorney 19 C,�O January 2016 — December 2016 OAA 203.16 ATTACHMENT III 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: COLLIER COUNTY PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title IIIB — CA/CM/SCAS $ 23,574.00 Transportation U.S. Health and Human Services 93.044 $ 31,000.00 Support Services $ 316,722.00 $ 371,296.00 Total 11113 OAA Title IIIC1 — Congregate Meals $ 278,853.00 Meals Screening U.S. Health and Human Services 93.045 Nutrition Education Outreach Total IIIC1 $ 278,853.00 OAA Title III C2 — Home Delivered Meals $ 250,832.00 Meals Nutrition Education U.S. Health and Human Services 93.045 Screening Outreach $ 250,832.00 Total IIIC2 Older Americans Act Title III E CA/CM & Services (Title III E) 93.052 $ 97,755.00 Supplement Services (Title III ES) U.S. Health and Human Services $ 18,335.00 Grandparent Services (Title III EG) $ 6,120.00 Total IIIE $ 122,210.00 TOTAL FEDERAL AWARD $1,023,191.00 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: FEDERAL FUNDS: 2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A-122 —Cost Principles)* 2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-110 — Administrative Requirements) OMB Circular A-133 —Audit Requirements COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE Section 215.97, Fla. Stat. Chapter 691-5, Fla. Admin. Code 20 C9 0 January 2016 — December 2016 OAA 203.16 ATTACHMENT IV Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Contracts / Subcontracts This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, signed February 18, 1986. The guidelines were published in the May 29, 1987 Federal Register (52 Fed. Reg., pages 20360- 20369).(2 CFR 180.5-180.1020, as supplemented by 2 CFR 376.10-376.995). Instructions 1. Each provider whose contract/subcontract contains federal monies or state matching funds must sign this certification prior to execution of each contract/subcontract. Additionally, providers who audit federal programs must also sign, regardless of the contract amount. Florida Department of Elder Affairs (DOEA) and/or Agency cannot contract with these types of providers if they are debarred or suspended by the federal government. 2. This certification is a material representation of fact upon which reliance is placed when this contract/subcontract is entered into. If it is later determined that the signer knowingly rendered an erroneous certification, the Federal Government may pursue available remedies, including suspension and/or debarment. 3. The provider shall provide immediate written notice to the Agency Contract Manager at any time the provider learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "debarred", "suspended", "ineligible", "person", "principal", and "voluntarily excluded", as used in this certification, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the Agency Contract Manager for assistance in obtaining a copy of those regulations. 5. The provider agrees by submitting this certification that, it shall not knowingly enter into any subcontract with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this contract/subcontract unless authorized by the Federal Government. 6. The provider further agrees by submitting this certification that it will require each subcontractor of this contract/subcontract, whose payment will consist of federal monies, to submit a signed copy of this certification. 7. The Agency may rely upon a certification of a provider that it is not debarred, suspended, ineligible, or voluntarily excluded from contracting/subcontracting unless it knows that the certification is erroneous. 8. This signed certification must be kept in the Agency Contract Manager's file and provided to Agency Contract Administration. Subcontractor's certifications must be kept at the contractor's business location. CERTIFICATION (1) The prospective provider certifies, by signing this certification, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract/subcontract by any federal department or Agency. (2) Where the prospective provider is unable to certify to any of the statements in this certification, such prospective provider shall attach an explanation to this certification. (3) By initialing. Agency Contract Manager confirms that prospective provider has not been listed in the EPLS database ',/ Verification Date 12-31-15 be same as contract signature) January 8, 2016 Date Approved as to form and legality Title and Organization County of Collier & 21 Assistant County Attorney %UJ� ,� r) kl January 2016 — December 2016 OAA 203.16 ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY 1. Title III B Support Services $ 371,296.00 2. Title III Cl Congregate Meals $ 278,853.00 3. Title III C2 Home Delivered Meals $ 250,832.00 4. Title III E Services $ 122,210.00 TOTAL $ 1,023,191.00 22 INE January 2016 - December 2016 OAA 203.16 ATTACHMENT VII OLDER AMERICANS ACT RATE SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY IIIB L -T -Vi `PC Total Cost Reimbursement Rate Adult Day Care av 12.83 11.55 Case Aide 33.89 30.50 Case Management 60.00 54.00 Chore 23.33 21.00 Chore (Enhanced) 30.33 27.30 Companionship 23.33 21.00 Emergency Alert Response 1.31 1.18 Escort 21.67 19.50 Homemaker 21.50 19.35 Housing Improvement 100% Cost 90% of Cost Material Aid 100% Cost 90% of Cost Personal Care 25.67 23.10 Respite In -Facility 12.83 11.55 Respite In -Home 25.67 23.10 Screening and Assessment 60.00 54.00 Shopping Assistance 21.00 18.90 Skilled Nursing Services 42.00 37.80 Specialized Medical Equipment, Services, and Supplies 100% Cost 90% of Cost Transportation 100% Cost 90% of Cost Services COLLIER COUNTY IIIE, IIIES, & IIIEG Total Cost Reimbursement Rate IIIE- Adult Day Care $ 12.83 $ 11.55 Direct Pay Respite $ 16.67 $ 15.00 Respite In -Facility $ 12.83 $ 11.55 Respite In -Home $ 25.67 $ 23.10 Screening & Assessment $ 60.00 $ 54.00 IIIES- Specialized Medical Equipment, Service & Supplies 100% Cost 90% of Cost IIIEG- Child Day Care $ 16.67 $ 15.00 Screening/Assessment $ 60.00 $ 54.00 23 c'90 January 2016 — December 2016 COLLIER COUNTY C-1 & C-2 Services Total Cost Reimbursement Rate Cl OAA 203.16 Congregate Meals $ 9.88 $ 8.90 Nutrition Education $ 1.80 $ 1.62 Congregate Meal Screening $31.12 $28.00 Outreach $4.80 per person $4.32 per person C2 Home Delivered Meals $ 9.77 $ 8.80 Nutrition Education $ 1.80 $ 1.62 Screening & Assessment $60.00 $54.00 Outreach $4.80 per person $4.32 per person 24 January 2016 — December 2016 OAA 203.16 ATTACHMENT VIII INVOICE SCHEDULE Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Agency prior to January 1 or until the agreement with the Agency has been executed. Note #2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance amount, on each of the reports, repaying advances issued the first two months of the agree- ment. The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT IX). Note # 3: Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the Agency, payment is to accompany the report. Note #4: ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 91h falls on a Saturday, then the report will be due by the 8th by 12:00 p.m. AND IF the 9th falls on a Sunday, the report will be due by the 10th by 12:00 p.m. Actual submission of the vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report which is verified and paid by CIRTS data only. 25 O Submit to Agency Report Number Based On On This Date 1 January Advance* January 1 2 February Advance* January 1 3 January Expenditure Report February 9 *See Note #4* 4 February Expenditure Report March 9 5 March Expenditure Report April 9 6 April Expenditure Report May 9 7 May Expenditure Report June 9 8 June Expenditure Report July 9 9 July Expenditure Report August 9 10 August Expenditure Report September 9 11 September Expenditure Report October 9 12 October Expenditure Report November 9 13 November Expenditure Report December 9 14 December Expenditure Report January 9 15 Final Expenditure and Request for Payment February 15 16 Closeout Report March 1 Legend: * Advance based on projected cash need. Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Agency prior to January 1 or until the agreement with the Agency has been executed. Note #2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance amount, on each of the reports, repaying advances issued the first two months of the agree- ment. The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT IX). Note # 3: Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the Agency, payment is to accompany the report. Note #4: ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 91h falls on a Saturday, then the report will be due by the 8th by 12:00 p.m. AND IF the 9th falls on a Sunday, the report will be due by the 10th by 12:00 p.m. Actual submission of the vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report which is verified and paid by CIRTS data only. 25 O January 2016 - December 2016 OAA 203.16 ATTACHMENT IX REQUEST FOR PAYMENT OLDER AMERICANS ACT Provider Name, Address and Phone #: Type of Report: This Report Period: From: To: Report # Advance Contract # Contract Period: Reimbursement 01/01/16 - 12/31/16 CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth in the contract. Prepared By: Date: Approved By: Date: PART A: (1) (2) (3) (4) (5) BUDGET SUMMARY III B IIIC1 IIIC2 IIIE TOTAL 1. Approved Contract Amount. $0.00 $0.00 $0.00 $0.00 $0.00 2. Previous Funds RECEIVED for Contract period $0.00 $0.00 $0.00 $0.00 $0.00 3. Contract Balance $0.00 $0.00 $0.00 $0.00 $0.00 4. Previous Funds REQUESTED and Not Received. $0.00 $0.00 $0.00 $0.00 $0.00 5. Contract Balance $0.00 $0.00 $0.00 $0.00 $0.00 PART B: FUNDS REQUESTED 1. Net Expenditures For Month $0.00 $0.00 $0.00 $0.00 $0.00 PART C: NET FUNDS REQUESTED: 1. Less Advance Payment Hereby Requested For $0.00 $0.00 $0.00 $0.00 $0.00 2. Contract Funds are Hereby Requested For $0.00 $0.00 $0.00 $0.00 $0.00 26 �9 O nn 1 11 7N _..,....,. L.,... n n L L OAA 203.16 0.11Ua1 GvlV -LVVVi11Vvi �. ATTACHMENT X - Exhibit 1 RECEIPTS AND EXPENDITURE REPORT OLDER AMERICAN ACT Provider Name, Address and Phone #: Program Funding Source : This Report Period: From: To: Title III Report # B Contract # Contract Period: 01/01/16 - 12/31/16 CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth in the contract. Prepared by : Date : Approved by : Date PART A : BUDGETED INCOME/ RECEIPTS 1. Approved 2. Actual Receipts 3. Total Receipts (5) Budget For This Report Year to Date Approved Budget 1. Federal Funds $0.00 $0.00 $0.00 0.00% 2. State Funds $0.00 $0.00 $0.00 0.00% 3. Other, In -Kind & Local Match $0.00 $0.00 $0.00 0.00% 4. Program Income $0.00 $0.00 $0.00 0.00% 5. TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of Budget For This Report Year to Date Approved Budget 1. All 1116 Services $0.00 $0.00 $0.00 0.00% 2. TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00% PART C: OTHER EXPENDITURES (For Tracking Purposes only) 1. Match a. Other and In -Kind $0.00 $0.00 $0.00 0.00% b. Local Match $0.00 $0.00 $0.00 0.00% 2. Program Income $0.00 $0.00 $0.00 0.00% 3. TOTAL OTHER $0.00 $0.00 $0.00 0.00% 2% January 2016 - December 2016 OAA 203.16 ATTACHMENT X - Exhibit 2 RECEIPTS AND EXPENDITURE REPORT OLDER AMERICAN ACT Provider Name, Address and Phone #: Program Funding Source : This Report Period: From: To: Title III Report # C1 Contract # Contract Period: 01/01/16 - 12/31/16 CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth in the contract. Prepared by : Date : Approved by : Date PART A : BUDGETED INCOME/ RECEIPTS 1. Approved 2. Actual Receipts 3. Total Receipts (5) Budget For This Report Year to Date Approved Budget 1. Federal Funds $0.00 $0.00 $0.00 0.00% 2. State Funds $0.00 $0.00 $0.00 0.00% 3. Other, In -Kind & Local Match $0.00 $0.00 $0.00 0.00% 4. Program Income $0.00 $0.00 $0.00 0.00% 5. TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% PART B: EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of Budget For This Report Year to Date Approved Budget 1. All IIIC1 Services $0.00 $0.00 $0.00 0.00% 2. TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00% PART C: OTHER EXPENDITURES (For Tracking Purposes only) 1. Match a. Other and In -Kind $0.00 $0.00 $0.00 0.00% b. Local Match $0.00 $0.00 $0.00 0.00% 2. Program Income $0.00 $0.00 $0.00 0.00% 3. TOTAL OTHER $0.00 $0.00 $0.00 0.00% 28 CJ ,: January 2016 - December 2016 OAA 203.16 ATTACHMENT X - Exhibit 3 RECEIPTS AND EXPENDITURE REPORT OLDER AMERICAN ACT Provider Name, Address and Phone #: Program Funding Source : This Report Period: From: To: Title III Report # C2 Contract # Contract Period: 01/01/16 - 12/31/16 CERTIFICATION : i certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth in the contract. Prepared by : Date : Approved by : Date PART A : BUDGETED INCOME/ RECEIPTS 1. Approved 2. Actual Receipts 3. Total Receipts (5) Budget For This Report Year to Date Approved Budget 1. Federal Funds $0.00 $0.00 $0.00 0.00% 2. State Funds $0.00 $0.00 $0.00 0.00% 3. Other, In -Kind & Local Match $0.00 $0.00 $0.00 0.00% 4. Program Income $0.00 $0.00 $0.00 0.00% 5. TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of Budget For This Report Year to Date Approved Budget 1. All IIIC1 Services $0.00 $0.00 $0.00 0.00% 2. TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00% PART C: OTHER EXPENDITURES (For Tracking Purposes only) 1. Match a. Other and In -Kind $0.00 $0.00 $0.00 0.00% b. Local Match $0.00 $0.00 $0.00 0.00% 2. Program Income $0.00 $0.00 $0.00 0.00% 3. TOTAL OTHER $0.00 $0.00 $0.00 0.00% 29 �9 O January 2016 - December 2016 OAA 203.16 ATTACHMENT X - Exhibit 4 RECEIPTS AND EXPENDITURE REPORT OLDER AMERICAN ACT Provider Name, Address and Phone #: Program Funding Source : This Report Period: From: To: Title III Report # E Contract # Contract Period: 01/01/16 - 12/31/16 CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth in the contract. Prepared by : Date : Approved by : Date PART A : BUDGETED INCOME/ RECEIPTS 1. Approved 2. Actual Receipts 3. Total Receipts (5) Budget For This Report Year to Date Approved Budget 1. Federal Funds $0.00 $0.00 $0.00 0.00% 2. State Funds $0.00 $0.00 $0.00 0.00% 3. Other, In -Kind & Local Match $0.00 $0.00 $0.00 0.00% 4. Program Income $0.00 $0.00 $0.00 0.00% 5. TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of Budget For This Report Year to Date Approved Budget 1. All IIIE Services $0.00 $0.00 $0.00 0.00% 2. TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00% PART C: OTHER EXPENDITURES (For Tracking Purposes only) 1. Match a. Other and In -Kind $0.00 $0.00 $0.00 0.00% b. Local Match $0.00 $0.00 $0.00 0.00% 2. Program Income $0.00 $0.00 $0.00 0.00% 3. TOTAL OTHER $0.00 $0.00 $0.00 0.00% 30 n� O January 2016 - December 2016 OAA 203.16 Provider Name: ATTACHMENT X - Exhibit 5 Unit Cost Report Older Americans Act 1116 This Report Period: From: To: Report # Contract # Contract Period: 01/01/16 - 12/31/16 Unit Rate Services Retro's Units this Month Total Units this YTD Units Request Rate Earned this Period Earned YTD ADC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 CA 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 CHO 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 ECHO 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 CM 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 COMP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 EAR 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 ESC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 HMK 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 HN 0.00 0.00 0.00 0.00 (5) $0.00 $0.00 PECA 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 RESP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 SA 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 SCAS Cost Reimb Services 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 $0.00 Varies $0.00 $0.00 $0.00 $0.00 HOW MATE 0.00 0.00 0.00 0.00 Varies $0.00 $0.00 SCSM 0.00 0.00 0.00 0.00 Varies $0.00 $0.00 TRS 0.00 0.00 0.00 0.00 Varies $0.00 $0.00 Tota 1 0.00 0.00 $0.00 $0.00 i Please include the following CIRTS reports: For all unit rate services: Monthly and YTD Service Units with Unduplicated Client Counts Please be sure that the YTDunits tie out to this report. For cost reimbursement services: Services Reported by Program and Service Report Run from 01/01/16 through the current month end. Please be sure that allYTDdollars are equal to or less than the YTD amounts on this report. 31 A J uary 2016 - December 2016 (SAA 203.16 Provider Name: ATTACHMENT X - Exhibit 6 This Report Period: Unit Cost Report From: To: Older Americans Act Report # IIIC1 Contract # Contract Period: 01/01/16 -12/31/16 Unit Rate Services Retro's Total Units this Units this YTD Units Rate Earned this Earned YTD Month Period Request CNTL 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 NTED 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 NTSC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 NUCOI 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 OTR 1 0.00 0.00 0.00 0.00 $0.00 $0.00 Tota 1 0.00 0.00 $0.00 $0.00 , Please include the following CIRTS report: Monthly and YTD Service Units with Unduplicated Client Counts Please be sure that the YTD units tie out to this report. 32 J uary 2016 - December 2016 OAA 203.16 Provider Name: ATTACHMENT X - Exhibit 7 This Report Period: Unit Cost Report From: To: Older Americans Act Report # IIIC2 Contract # Contract Period: 01/01/16 - 12/31/16 Units this Total Earned this Unit Rate Services Retro's Units this YTD Units Rate Earned YTD Month period Request HDM 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 NTED 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 NUCOI 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 OTR 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 SCAS 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 Total 0.00 0.00 $0.00 $0.00 Please include the following CIRTS report: Monthly and YTD Service Units with Unduplicated Client Counts Please be sure that the YTD units tie out to this report. 33 OAQ tr January 2016 - December 2016 OAA 203.16 Provider Name: ATTACHMENT X - Exhibit 8 This Report Period: Unit Cost Report From: To: Older Americans Act Report # IIIE Contract # Contract Period: 01/01/16 - 12/31/16 Units this Total Earned this Unit Rate Services - IIIE Retro's Month Units this YTD Units Rate Period Earned YTD Request ADC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 DPRESP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 RESF 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 RESP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 SCAS 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 Unit Rate Services - IIIEG CTSG 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 DCC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 DPSIT 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 SCAS 0.00 0.00 0.00 0.00 (5) $0.00 $0.00 Cost Reimb Servs -IIIES HOW 0.00 0.00 0.00 0.00 Varies $0.00 0.00 MATE 0.00 0.00 0.00 0.00 Varies $0.00 0.00 SCSM 0.00 0.00 0.00 0.00 Varies $0.00 0.00 Tota 1 0.001 $0.00 $0.00 : Please include the following CIRTS reports: For all unit rate services: Monthly and YTD Service Units with Unduplicated Client Counts Please be sure that the YTD units tie out to this report. For cost reimbursement services: Services Reported by Program and Service Report Run from 01/01/16 through the current month end. Please be sure that all YTD dollars are equal to or less than the YTD amounts on this report. i 34 ,C40 Revised August 2007 Attestation Statement Agreement/Contract Number: OAA 203.16 Amendment Number n/a I, Stephen Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services 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. Revised August 2007 CAO