Backup Documents 04/25/2017 Item #16D5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURElA
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the CounttoTfiey ffice
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Dawn Whelan Community and Human � 4/17/17
Services
2. County Attorney Office County Attorney Office
3. BCC Office Board of County
Commissioners / ‘41,`t-A
4. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Dawn Whelan,Grant oordinator, Phone Number 239-252-4230
Contact/ Department Community and Hu an Services
Agenda Date Item was April 25,2017 Agenda Item Number 16D - 5--
Approved by the BCC
Type of Document Amendment(3 original copies) Number of Original 3
Attached Documents Attached
PO number or account
number if document is N/A
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? 1.1'
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be DMW c3X <=-NN-'e-
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the DMW
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's DMW
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip DMW
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on and all changes made during the
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the p
BCC,all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
Instructions
1 613 5
1) Please send 1 Chairman signed agreement to:
Dawn Whelan
Grant Coordinator
Collier County Government
3339 Tamiami Trail East
Building H, Suite 211
Naples, FL 34112
DLC:
1) Please send 1 Chairman signed agreement to:
Nancy Dauphinais, COO
David Lawrence Center
6075 Bathey Ln
Naples, FL 34116
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1 605
MEMORANDUM
Date: May 2, 2017
To: Dawn Whelan, Grant Coordinator
Community & Human Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Amendment #4 to the Criminal Justice Mental Health Substance
Abuse Agreement with the David Lawrence Mental Health Center
Please find an original copy of the amendment document referenced above,
(Item #16D5) approved by the Board of County Commissioners on April 25, 2017.
An original copy was sent to Nancy Dauphinais with the David Lawrence Center
and the third original amendment will be held in the Minutes and Records
Department for the Board's Official Record.
If you have any questions, please feel free to call me at 252-8406.
Thank you
Attachment (1)
L/---==•-ii._ae, \ 1 6 0 5
rtrit of oilier
CLERK OF THE)CIR UIT COURT
Dwight E. Brock COLLIER COUIY CO THOUSE Clerk of Courts
Clerk of Courts Accountant
3315 TAMIAMI TRL E STE 102 P.O.BOX 413044
NAPLES,FLORIDA NAPLES,FLORIDA Auditor
34112-5324 34101-3044 Custodian of County Funds
141-‘7,,
May 2, 2017
Nancy Dauphinais, COO
David Lawrence Center
6075 Bathey Lane
Naples, FL 34116
Re: Amendment #4 to the Criminal Justice Mental Health Substance
Abuse Agreement with the David Lawrence Mental Health Center
Ms. Dauphinais,
An original copy of Amendment#4 to the Criminal Justice Mental Health Substance Abuse
Agreement, that was approved by the Collier County Board of County Commissioners
April 25, 2017, is attached for you records.
If your office requires further information, please contact me at 239-252-8406.
Thank you,
DWIGHT E. BROCK, CLERK
Ann Jennejohn,
Deputy Clerk
Attachment (1)
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk@collierclerk.com
1 6 0 5
FOURTH AMENDMENT TO AGREEMENT CJMHSA-001 BETWEEN
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
DAVID LAWRENCE MENTAL HEALTH CENTER, INC.
This Amendment, is entered into this S day of CU� , 2017,
by and between David Lawrence Mental Health Center, Inc. hereinafter referred to as
Subrecipient and Collier County, a political subdivision of the State of Florida, hereinafter
referred to as "COUNTY," collectively stated as the "Parties."
WHEREAS, on June 10, 2014, the County and Subrecipient entered into an agreement
for Subrecipient to provide "FIRST grant services" to Collier County residents (hereinafter
referred to as the "Agreement"); and
WHEREAS, on September 23, 2014, the Board of County Commissioners approved the
First Amendment to Agreement which added provisions for proper accountability over state
resources and a property clause for the purchase of tangible personal property; and
WHEREAS, on June 23, 2015, the Board of County Commsisioners approved the
Second Amendment to Agreement which revised the division name, added Board directed
Corrective Action language, removed and replaced Exhibits and added grantor required State
and Federal Laws, Rules and Regulations as Exhibit I; and
WHEREAS, on October 25, 2016, the Board of County Commissioners approved the
Third Amendment to Agreement to extend the contract term, reduce the grant budget, adjust the
match budget, and revise the staffing pattern; and
WHEREAS, the parties desire to modify Exhibit "F" to the Agreement to reduce the
activity identified as "Personnel" by $35,000 and increase the activity identified as "Incidental
Expenses" by $35,000 for Program Year 3; and
WHEREAS, the effective date of this amendment shall be retroactive to April 1, 2017
NOW, THEREFORE, in consideration of foregoing Recitals, and other good and
valuable consideration, the receipt and sufficiency of which is hereby mutually acknowledged,
the Parties agree to modify the Agreement as follows:
3. Exhibit F, Method of Payment, is amended as follows:
F-3 Modifications to the "Budget and Scope" may only be made if approved in advance.
Budgeted fund shifts between budget categories and line items shall not be more than 10% and
does not signify a change in scope. Fund shifts that exceed 10% of budget category or line item
shall only be made with board approval.
1
1 6 0 5
Program
Period Activity Amount
Personnel $66,497.07
Travel $6,408.00
Program Equipment $2,000.00
Year 1
Incidental $8,808.53
Expenses
Program $12,000.00
Evaluator
Personnel $66,497.07
Travel $6,408.00
Program
Year 2 Incidental
Expenses $18,808.53
Program $12,000.00
Evaluator
Personnel $1-2074-97,06
$85,497.06
Travel $6,408.00
Program
Year 3 Incidental $28,808.54
Expenses $63,808.54
Program $12,000.00
Evaluator
CONTRACT TOTAL $367,140.80
1 6 0 5
IN WITNESS WHEREOF, the parties hereto, have each, respectively, by an authorized person
or agent, have executed this Contract on the date and year first written above.
ATTEST: David Lawrence Mental Health Center, Inc.
DWIGHT E. BROCK,,CLERK
6111
\r)A•, r ��, By:
A`T P,. � ,CLERK Scott Bur.;ss
Attest as to Minn s Title: President/CEO
signature only.,
Date: April 10, 2017
Approval for form and legality: CO Lial COUNTY
ar
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Jennifer A. Belpedio Penns.ylor, CH Aar AN
Assistant County Attorney
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Date: 4
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