Agenda 10/13/2015 Item #16D 6� EXECUTIVE SUMMARY
^,
10/13/2015 16.D.6.
Recommendation to approve after - the -fact Amendments and Attestation Statements with Area
Agency on Aging for Southwest Florida, Inc. for the Community Care for the Elderly, Alzheimer's
Disease Initiative and Home Care for the Elderly programs and authorize Budget Amendments to
ensure continuous funding for FY 2014 /2015. (Net Fiscal Impact $26,967.41)
OBJECTIVE: To provide uninterrupted support services to Collier County Services for Seniors'
(CCSS) elderly clients.
CONSIDERATIONS: The Community and Human Services Division's Services for Seniors program
has been providing support to Collier County's frail and elderly citizens for over thirty-four years through
the Community Care for the Elderly (CCE), Alzheimer's disease Initiative (ADI) and Home Care for the
Elderly (HCE) grant programs. These grants are funded by the Florida Division of Elder Affairs (DOEA)
through the Area Agency on Aging of Southwest Florida, Inc. ( "Agency "). These grant fund services
enable clients to remain in their homes and live with independence and dignity.
On September 23, 2014, the Board approved the current grant contracts with the Agency (Agenda item
16D16). The contracts have a one -year term, effective July 1, 2014 through June 30, 2015, with a three -
year renewal option.
The purposed of these amendments are to amend CCE, ADI and HCE final allocation for the 2014 -2015
contract year. The Agency agrees to pay for contracted services in the amount of $792,887.81 for the
CCE program, $244,428.43 for the ADI program and $31,167.17 for the HCE program. The stated
amounts represent an overall increase in funding for each grant program. The budget adjustments reflect
fluctuations in the case workers' client load and client services that routinely result from the loss /addition
of clients and increase /decrease in client service needs. Reallocation and increases of funding will allow
Services for Seniors to provide case management and services based on current and projected program
needs. The effective dates of these amendments are June 30, 2015.
ThP fhUnwin¢ tahle nrnvidec n detailed breakdown of the increased award adiustment:
* 10% Match is Award divided by .9, multiplied by .l, per grantor requirements, rounded to nearest dollar
"The HCE Basic Subsidy is to be retained by the grantor agency, and therefore is not included within
Collier County's budget.
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Current
Revised
Increase /
Local Match
Program
Project
Budget
Budget
Decrease
Increase/ Decrease
Community Care
for the Elderly
CCE
33336
$775,634.00
$792,887.81
$17,253.81
$1,917.00
Alzheimer's
Disease Initiative
Program (ADI)
33337
$236,963.00
$244,428.43
$7,465.43
$0
Home Care for the
Elderly (HCE)
Basic Subsid **
33338
$18,752.00
$19,083.17
$331.17
$0
Total
$1,031,349.00
$1,056,399.41
$25,050.41
$1,917.00
* 10% Match is Award divided by .9, multiplied by .l, per grantor requirements, rounded to nearest dollar
"The HCE Basic Subsidy is to be retained by the grantor agency, and therefore is not included within
Collier County's budget.
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10/13/2015 16.D.6.
This item is being presented after -the -fact because CCSS received the grant agreement on August 13,
2015 from the Agency with a request for an approximate 30 day turnaround. The Agency routinely sends
CCSS amendments with an effective date prior to the date the documents are received. Pursuant to CMA
5330 and Resolution No. 2010 -122, the County Manager authorized Stephen Y. Carnell, Public Services
Department Head to sign the amendment. These amendments are being presented for Board ratification.
Collier County, as the Lead Agency, is responsible to respond to seniors' needs and to manage the
spending authority for the Federal and State funded Services for Seniors programs.
FISCAL IMPACT: Total grant award amount is $1,056,399.41. The funding source is the Florida
Division of Elder Affairs. Budget amendments are required to recognize additional grant revenue of
$17,253.81 for SFY 15 CCE Program to Human Services Grant Fund (707), Project 33336, and $7,465.43
for SFY 15 ADI Program, Project 33337, and $331.17 for Special Subsidies and Case.Management for
SFY 15 HCE Program, Project 33338. Local match in the amount of $1,917.00 is available through prior
year excess revenue in Human Services Grant Fund (707) Reserves.
LEGAL CONSIDERATIONS: This is a standard form amendment provided by the Area Agency on
Aging for Southwest Florida, Inc. This item is approved for form and legality and requires a majority
vote. — JAB
GROWTH MANAGEMENT: There is no growth management impact associated with this action.
RECOMMENDATIONS: That the Board of County Commissioners approves the after - the -fact
Amendments and an Attestation Statements with Area Agency on Aging for Southwest Florida, Inc. for
the Community Care for the Elderly (CCE), Alzheimer's Disease Initiative (ADI) and Home Care for the
Elderly (HCE) grant programs and authorizes budget amendments to ensure continuous funding for FY
2014/2015.
Prepared by: Lisa N. Carr, Grants Coordinator, Community and Human Services Division
Attachments:
Master Federal & State Contract
Community Care for the Elderly Contact 203.14 and Amendments 001, 002, 003,004 and 005
Alzheimer's Disease Initiative Program Contract 203.14 and Amendments 001, 002, 003 and 004
Home Care for the Elderly Contract 203.14 and Amendments 001, 002, 003 and 004
Packet Page -1011-
WOO
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n.
10/13/2015 16.D.6.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16. D. 16. D. 6.
Item Summary: Recommendation to approve after - the -fact Amendments and Attestation
Statements with Area Agency on Aging for Southwest Florida, Inc. for the Community Care for
the Elderly, Alzheimer's Disease Initiative and Home Care for the Elderly programs and
authorize Budget Amendments to ensure continuous funding for FY 2014/2015. (Net Fiscal
Impact $26,967.41)
Meeting Date: 10/13/2015
Prepared By
Name: CarrLisa
Title: Grants Coordinator, Public Services Department
9/11/2015 3:11:58 PM
/'\ Submitted by
Title: Grants Coordinator, Public Services Department
Name: Cart-Lisa
9/11/2015 3:11:59 PM
Approved By
Name: LopezMaggie
Title: Accountant, Senior, Public Services Department
Date: 9/14/2015 9:01:43 AM
Name: TownsendAmanda
Title: Division Director - Operations Support, Public Services Department
Date: 9/14/2015 11:24:29 AM
Name: GrantKimberley
Title: Division Director - Cmnty & Human Svc, Public Services Department
Date: 9/14/2015 11:26:33 AM
n Name: AlonsoHailey
Title: Operations Analyst, Public Services Department
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10/13/2015 16.D.6.
Date: 9/14/2015 4:52:13 PM 11—S,
Name: SonntagKristi
Title: Manager - Federal /State Grants Operation, Public Services Department
Date: 9/15/2015 4:26:13 PM
Name: CarnellSteve
Title: Department Head - Public Services, Public Services Department
Date: 9/22/2015 2:25:31 PM
Name: RobinsonErica
Title: Accountant, Senior, Grants Management Office
Date: 9/22/2015 3:07:50 PM
Name: BelpedioJennifer
Title: Assistant County Attorney, CAO General Services
Date: 9/22/2015 3:10:21 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 9/23/2015 11:23:27 AM
Name: StanleyTherese
Title: Manager - Grants Compliance, Grants Management Office
Date: 10/2/2015 9:10:56 PM
Name: CasalanguidaNick
Title: Deputy County Manager, County Managers Office
Date: 10/3/2015 8:44:25 AM
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10/13/2015 16.D.6.
Amendment 005 July 2014 to June 2015
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida, hereinafter referred
to as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Contractor,"
amends contract CCE 203.14.
The purpose of this amendment is to amend 4. Contract Amount with the final allocation for the 2014 -2015 contract
year, revise ATTACHMENT III and ATTACHMENT VII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
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 $792,887.81, 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
This amendment shall be effective June 30, 2015.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby
n 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, one page, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY: /,14
NAME: Stephen Y. Carnell
TITLE: Public Services Department Head
DATE: 11a( ( f
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC.
SIGNED BY:
NAME: MARIANNE G LORINI
TITLE: PRESIDENT /CEO
DATE:
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Approved as to form and legality
0"`�`�
Assistant County Attorney
b�
10/13/2015 16.D.6
Amendment 005 July 2014 to June 2015
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD I I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
N,r e 70 LTTXT (3 R F enT TR rF C F(1R FFT)FR AT. PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA I AMOUNT
$0
CT 1 TT r. i�T ,► 1�T!'�i A 7 A QQTQT A ATI-U QTT12 YV d" r 'rn Qnn '11 G 07 F C
y y yPROGRAM TITLE _
FUNDING SOURCE
CSFA
AMOUNT
Community Care for the Elderly
Revenue - Collier
65010
$ 792,887.81
—General
TOTAL AWARD
$ 792,887.81
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin.
Code
2
Packet Page -1015-
'�J
10/13/2015 16. D.6.
Amendment 005 July 2014 to June 2015 _
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
ANNUAL BUDGET SUMMARY
for
Collier County Board of County Commissioners
Collier
CCE Services Allocations S 792,887.81
3
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10/13/2015 16.D.6.
Revised August 2007
Attestation Statement
Agreement /Contract Number: CCE 203.14
Amendment Number 005
I,�SteRhen 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.
. ` — N — ( S
Signature of ikeeipient/C&fractor representative Date
Revised August 2007
Approved as to form and legality
Assistant County Attorney
Sk \`
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�`%
10/13/2015 16. D.6.
Amendment 004 July 2014 to June 2015 • ---- -- � • - . • - -
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS,
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida, hereinafter referred
to as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Contractor,"
amends contract ADI 203.14.
The purpose of this amendment is to amend 4. Contract Amount with the final allocation for the 2014 -2015 contract
year, revise ATTACHMENT III and ATTACHMENT VIII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
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 $244,428.43, 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
This amendment shall be effective June 30, 2015.
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.
n 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, one page, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment to be executed by their officials there
unto duly authorized.
COLLIER COUNTY BOARD OF
Recipient: COUNTY COMMISSIONERS
SIGNED BY: 2-01�4 &,-7,
•
NAME: Stephen Y. Carnell
TITLE: Public Services Department Head
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC.
SIGNED BY:
NAME: MARIANNE G LORINI
TITLE: PRESIDENT /CEO
DATE: 1 t i S DATE:
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Approved as to form and legality
Assistant Cora,.,. A +f, m,Pv \�
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10/13/2015 16.D.6.
Amendment 004 July 2014 to June 2015 X — • A .
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA F AMOUNT
TOTAL FEDERAL AWARD I I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
ra A TrT4W R RROT TR CRC FOR FRT)RR AT. PROGRAMS
PROGRAM TITLE I FUNDING SOURCE CFDA I AMOUNT
$0
c+T A TL' VT1AT A XTt' l A T A QQTQT A 1V9"V CTTR TV f"T 'rn Cnn ')I C 07 F C
y + PROGRAM TITLE
FUNDING SOURCE
CSF
AMOUN
Alzheimer's Disease Initiative
General Revenue / TSTF- Collier
65004
$ 244,428.43
TOTAL AWARD
S 244,428.43
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
2
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10/13/2015 16.D.6.
Amendment 004 July 2014 to June 2015 1 - - . • -- -
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL BUDGET SUMMARY
For
Collier County Board of County Commissioners
Collier
ALLOCATION TOTAL $ 244,428.43
3
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ATTACHMENT VIII
10/13/2015 16.D.6.
Attestation Statement
Agreement/Contract Number ADI 203.14
Amendment Number 004
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
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement/contract content.
6 C4 - ((- I Z-1,5
Signature of Recipient /Contractor representative
Packet Page -1021-
I
Date
Approved as to form and legality
Assistant County Attorney
10/13/2015 16.D.6.
Amendment 004 July 2014 to June 2015 ).1-r•VV-r
n AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida, hereinafter referred to
as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Contractor,"
amends contract HCE 203.14.
The purpose of this amendment is to amend 4. Contract Amount with the final allocation for the 2014 -2015 contract
year, revise ATTACHMENT III and ATTACHMENT VII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
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 $31,167.17, 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
This amendment shall be effective June 30, 2015.
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, one page, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY CIZ, am
i
NAME: Stephen Y. Camel]
TITLE: Public Services Department Head
DATE:TI"
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC.
SIGNED BY:
NAME:
TITLE:
DATE:
Packet Page -1022-
MARIANNE G LORINI
PRESIDENT /CEO
Approved as to form and legality
Assistant County Attorney \�7
1�
10/13/2015 16.D.6.
Amendment 004 July 2014 to June 2015 i1�L iT•��
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE 1 CFDA ] AMOUNT
TOTAL FEDERAL AWARD I I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT
$0
CTATF 1PINANd -TA1. AQCTCTANCF. CTTRJV4 T TO Cer_ 21S_97_ F_C_
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Home Care for the Elderly
General Revenue — Collier
65001
$ 31,167.17
TOTAL AWARD
$ 31,167.17
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin.
Code
2
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Amendment 004 July 2014 to June 2015
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of County Commissioners
Collier
HCE Case Management/Case Aide
HCE Basic and Special Subsidies
Total
10/13/2015 16.D.6.
L1�L LV✓.1 T.VVT
ATTACHMENT VII
$ 2,536.07
28,631.10
$ 31,167.17
RATE SUMMARY
Collier County Board of County Commissioners
Collier
SERVICES REIMBURSEMENT RATE
Collier
Case Management $60.00
Case Aide $33.88
3
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10/13/2015 16.D.6.
Attestation Statement
Agreement/Contract Number HCE 203.14
Amendment Number 004
1, 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
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
,�b� ((i - �� [
Signature o Recipient/ ontractor represdintative Date
Approved as to form and legality
Assistant County Attorney
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10/13/2015 16.D.6.
Amendment 004 CCE 203.14.004
� AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA
COMMUNITY CARE FOR THE ELDERLY ]PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDN4ENT, entered into between the Area Agency on aging for Southwest Florida hereinafter referred. to
as the "A kycncy," and Collier Countv Board of County Commissioners, hereinafter referred to as the "Contractor,"
collectively stated as the "Parties" which amends contract CCE 203.1.4.
This amendment shall be effective July 1, 2015.
RECI.TAI...S:
WHEREAS, oil August 14, 2014, the parties entered into the Standard Contract for social services to be
provided to Collier County's frail and elderly seniors (hereinafter referred to is "Contract "); and
WHEREAS, on November 12, 201.4, the parties entered into a First Amendment to the Contract, and
W IIEREAS, on December 16, 2014, the parties entered into a Second Amendment to the Contract; and
W.14F..REAS, on May 4., 201.5, the parties entered into a Third Amendment to the Contract; and
W 1IEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2015; 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;
WI- IEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to August 30, 2015 while they await notification of funding of a
successor contract.
NOSY, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually ackno \��ledged, the Parties agree as follows:
The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2015.
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
Packet Page -1026-
10/13/2015 16.D.6.
CCE 203,14.004
Amendment 004
IN WITNES)S WHE-REOF, the parties he're'to have caused This Amcnclnm(°nt Im, he --xecuttd by their
Ofl►CKIIS 111CrC UrJO (JUIV authorilzcd.
Collier County Board of County
Contractor: Commissioners
SIGNED BY:
NAME: Stephen Y. Carnell
TITLE: Public Services Department Head
DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
Area Agency on Aging for Southwest Florida
SIGNED
BY:
NAME: Marianne G Lorini
TITLE: President/CEO
DATE:
Approved as to fiorm and legality
Assistant
2
Packet Page -1027-
Revised August 2007
Attestation Statement
Agreement /Contract Number 203.14
Amendment Number 004
10/13/2015 16.D.6.
1, Stenhen V. Carneli , attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Department Head
(Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature bf Recipi4dnt/Contractor representative
Revised August 2007
Date
Approved as to form and legality
Packet Page -1028-
(C' .
Amendment 003 July 2014 to June 2015 10/13/2015 16.D.6.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement CCE 203.14.
The purpose of this amendment is to increase the allocation by $25,000 and revise ATTACHMENT III and
ATTACHMENT VII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
This amendment shall be effective April 1, 2015. 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 WITLESS WI IEREOF, the parties hereto have caused this 3 page amendment to be executed by their officials there n
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
/,— "t
SIGNED BY: "t` SIGNED BY:
NAME: Stephen Y. Carnell NAME: MARIANNE G LORINI
TITLE: Public Services Administrator TITLE: PRESIDENT /CEO
DATE: April 9, 2015
DATE:
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Approved as to form and legality
—' A§�Tistant County`A'ttorney
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Amendment 003 July 2014 to June 2015 10/13/2015 16.D.6.
ATTACHMENT III
1, FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
T141S CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD I '
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE i FUNDING SOURCE CFDA I AMOUNT
$0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE
Community Care for the Elderly General Revenue - Collier
TOTAL AWARD
CSFA AMOUNT
65010 $ 775,634.00
$ 775,634.00
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
2
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Amendment 003 July 2014 to June 2015 10/13/2015 16.D.6.
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
ANNUAL BUDGET SUMMARY
for
Collier County Board of County Commissioners
Collier
CCE Services Allocations S 775,634.00
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10/13/2015 16.D.6.
Revised August 2007
Agreement /Contract Number: CCG 203.14
Amendment Number 003
I, SteRhen Y C'arnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(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.
4 4 -9 -15
Signature of Recipient ontractor representative
Revised August 2007
Packet Page -1032-
Date
Approved as to form and legality
Assistant CountyAttorney —
Amendment 002 July 2014 to ,Tune 2015 10/13/2015 16.D.6.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement CCE 203.14.
The purpose of this amendment is to amend ATTACHMENT I, SECTION III: METHOD OF PAYMENT Paragraph.
3.1 General Statement of Method of Payment and 3.4 Consequences for Non - Compliance; increase the allocation by
$30,000.00 and revise ATTACHMENT III and ATTACHMENT VII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
ATTACHMENT I:
Paragraph 3.1 and 3.4 of the Attachment 1, is hereby amended to read:
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, and fixed rate for services. The Contractor shall
ensure fixed rates for services include only those costs that are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an independent audit is
required. The Contractor shall consolidate all requests for payment from Subcontractors and expenditure
reports that support requests for payment and shall submit to the Agency on forms I06C (ATTACHMENT
IX) and 105C (ATTACHMENT X).
3.4 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.4., Scope of Services are
performed pursuant to contract requirements, and as described in Section 2.3,
Deliverables in this contract. If at any time the Contractor is notified by the Agency's 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 Contract Manager that addresses the identified deficiency and
states how the deficiency will be remedied within a time period approved by the 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 may also assess a financial consequence for failure to
timely submit a CAP. In the event the 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 amount billed for each day the deficiency is not corrected. The Agency may also deduct, frorn the
payment for the invoice of the following month, 1% of the monthly amount billed for each day the Contractor fails
to timely submit a CAP, beginning the l lth day after notification by the Contract Manager of the deficiency.
If, or to the extent, there is any conflict between this paragraph and paragraphs 39 and 39.1 of Master Contract
HMO 14, this paragraph shall have precedence.
This amendment shall be effective October 1, 2014. 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 stilt 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.
Packet Page - 1033 - n-
Artiendment 002 July 2014 to June 201 5) 10/13/2015 16.D.6.
IN WITNESS WHEREOF, the parties Hereto have caused this 4 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF
COIJNTY COMMISSIONERS
SIGNED BY ter rg { t J
r ...
NAME Stephen Y. Carnell
TITLE: Public Services Administrator
r i
DATE:_
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC.
}
SIGNED BY
NAME: MARIANNE G LORINI
TITLE: PRESIDENT /CEO
DATE: /I')- / % ,'` ; `%
Packet Page -1034-
Amendment 002 July 2014 to June 2015 10/13/2015 16.D.6.
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT
TOTAL FEDERAL AWARD I I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
MATCHTNG RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT
$0
CTATF FIN ANCTAI. ACCTCTANC'F. S4FR.IFCT TO See_ 215.97- F -S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Community Care for the Elderly
General Revenue - Collier
65010
$ 750,634.00
TOTAL AWARD
$ 750,634.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin.
Code
3
Packet Page -1035- 0
Amendment 002 July 2014 to June 2015 10/13/2015 16.D.6.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
ANNUAL BUDGET SUMMARY
for
Collier County Board of County Commissioners
Collier
CCE Services Allocations $ 750,634.00
0
Packet Page -1036-
ATTACHMENT VII
G
10/13/2015 16.D.6.
Attestation Statement
Agreement /Contract Number: CCE 203.14
Amendment Number 002
i, sephen Y Cal•nell , attest that no changes or revisions have been made to tine
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of Recipient /Contractor representative Date
Packet Page -1037-
Anien-Iment 001 July 2014 to June 2015 10/13/2015 16.D.6.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of County Commissioners, ("Contractor"), amends agreement CCE 203.14.,
The purpose of this amendment is to change effective date for rates and revise ATTACHMENT VII, RATE
SUMMARY.
Line denotes completion of above summary
This amendment shall be effective September 30, 2014. 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 duty authorized,
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGEI�G FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: SIGNED BY:
NAME: Stephen Y. Cornell
TITLE: Public Services Administrator
DATE:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09130
NAME: N4ARIANNE G LOWNI
TITLE: PRESIDENTiCEO
DATE:
Packet Page -1038-
Cou J��PeY
Assistant ounty ey
Amendment 001 July 2014 to June 2015 10/13/2015 16.D.6.
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
RATE SUMMARY effective July 1 through August 31, 2014
for
Collier County Board of County Commissioners
Collier County
Total Unit Cost
Reimbursement Rate -90%
Case Management
$58.33
$52.50
Case Aide
$31.50
$28.35
Adult Day Care
$12.22
$11.00
Chore
$23.33
$21.00
Enhanced Chore
$30.33
$27.30
Companion
$23.33
$21.00
Skilled Nursing
$40.00
$36.00
EARS
$ 1.31
$ 1.18
Homemaking
$21.50
$19.35
Personal Care
$25.67
$23.10
Respite-in-Home
$25.67
$23.10
Home Improvement
$ Cost Reimbursement
90% Cost Reimbursement
Material Aid
$ Cost Reimbursement
90% Cost Reimbursement
Specialized Medical Equipment,
Service & Supplies
$ Cost Reimbursement
90% Cost Reimbursement
Transportation
$ Cost Reimbursement
90% Cost Reimbursement
RATE SUMMARY effective September 1, 2014
Collier County
Total Unit Cost
Reimbursement Rate -90%
Case Management
$60.00
$54.00
Case Aide
$33.88
$30.50
Adult Day Care
$12.83
$11.55
Chore
$23.33
$21.00
Enhanced Chore
$30.33
$27.30
Companion
$23.33
$21.00
Skilled Nursing
$42.00
$37.80
EARS
$ 1.31
$ 1.18
Homemaldng
$21.50
$19.35
Personal Care
$25.67
$23.10
Respite-in-Home
$25.67
$23.10
Home Improvement
$ Cost Reimbursement
90% Cost Reimbursement
Material Aid
$ Cost Reimbursement
90% Cost Reimbursement
Specialized Medical Equipment,
Service & Supplies
$ Cost Reimbursement
90% Cost Reimbursement
Transportation
$ Cost Reimbursement
90% Cost Reimbursement
2
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/'\
10/13/2015 16.D.6.
Agreement /Contract Number CCE 203.14
Amendment Number 001
I, Stenhen V. Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
A IkA-11 - V I • — -
Signatur'e ofReeipiAt /Contractor representative
'0
Date
Approved as to form and legality
Packet Page -1040-
July 2014 to June 2015
10/13/2015 16.D.6.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
CONTRACT
COMMUNITY CARE FOR THE ELDERLY PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida (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. Pur,4ro,e f Contract
The purpose of 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. Tneorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant
Department handbooks, manuals or desk books and Master Contract number HM014, as an integral
part of the contract, except to the extent that the contract explicitly provides to the contrary. In the
event of conflict in language among any of the documents referenced above, the specific provisions
and requirements of the contract document(s) shall prevail over inconsistent provisions in the
proposal(s) or other general materials not specific to this contract document and identified attachments.
3. Term of Contract
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time July 1, 2014 or on the date
the contract has been signed by the last party required to sign it, whichever is later. It shall end at
eleven fifty -nine (11:59) P.M., Eastern Standard Time June 30, 2015.
4. Contract Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this
contract in an amount not to exceed 5720.634.00, or the rate schedule, subject to the availability of
finds. Any costs or services paid for under any other- contract or from any other source are not eligible
for payment under this contract.
5. Renevtals
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 terns 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 finds.
Packet Page -1041-
July 2014 to June 2015
N BT4Yr;Cd 131"'11p • artd Pot
CCE 203.14
onif afE ,vre tl'aTimp.g_ Andre.-,seq. P.m] Teler le Numbers) 10/13/2015 16.D.6.
7. All Terms and Conditions Included._
This contract and its Attachments, I, III, 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 Patties. 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
COUNT' COMMISSIONERS SOUTHWFWi FI�RIDA, INC. �r
X111
f
SIGNED BY: r }' ,' `' �� .. ` SIGNS
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: July 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Packet Page -1042-
NAME: RONALD LUCCRINO PhD
TTTI.F• WARn PRF.CTT)F,'NT
DATE: 1.
The Contractor name, as suown on page 1 of this
Collier CoEUrty Housing, Human and Veteran
a.
contract, and mailing address of the official payee to
Services
whom the payment shall be made is:
3339 E Tamiami Trail, Building H
Naples, FL 34112
Kimberly Grant, Director
b
The naive of the contact person and street address where
Collier County Housing, Ilurnan and Veteran
financial and administrative records are maintained is:
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
The name, address, and telephone number of the
Kimberly Grant, Director
Collier County Housing, Human and Veteran
c.
representative of the Contractor responsible for
Services
administration of the program under this contract is:
3339 E Tamiami Trail, Building IT
Naples, FL 34112
(239) 252 -2273
d'
The section and location Nvithin the Agency where
Nancy Dean, Director of Finance
Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure
15201 North Cleveland Avenue, Suite 1100
15201
forms are to be mailed is:
North Fort Myers, FL 33903
Marianne Lorini, Executive Director
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 CIeveland Avenue, Suite 1100
North Fort Myers, FL 33903
239- 652 -6900
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
7. All Terms and Conditions Included._
This contract and its Attachments, I, III, 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 Patties. 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
COUNT' COMMISSIONERS SOUTHWFWi FI�RIDA, INC. �r
X111
f
SIGNED BY: r }' ,' `' �� .. ` SIGNS
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: July 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Packet Page -1042-
NAME: RONALD LUCCRINO PhD
TTTI.F• WARn PRF.CTT)F,'NT
DATE: 1.
July 2014 to June 2015
INDEX OF ATTACEMENTS
10/13/2015 16.D.6.
ATTACHMENTI 10-1�1
STATEMENTOF WORK ..................................................................................................... 4
ATTACHMENT III
FUNDINGSOURCE ................................................................................................ 15
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY ANNUAL BUDGET AND RATE SUMMARY ........ 16
ATTACHMENT VIII
COMMUNITY CARE FOR THE ELDERLY INVOICE RE-PORT 17
ATTACHMENT IX
REQUEST FOR PAYMENT . ...................................................................................... 18
ATTACHMENT X
RECEIPT AND EXPENDITURE REPORT .................................................................... 19
9
Packet Page -1043-
July 2014 to June 2015
STATEMENT OF WORK
COMMUNITY CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
10/13/2015 16.D.6.
ATTACHMENT I
1.1.1 CONTRACT ACRONYMS
Activities of Daily Living (ADL)
Adult Protective Services (APS)
Adult Protective Services Referral Tracking Tool (ARTT)
Assessed Priority Consumer List (APCL)
Comprehensive Assessment and Review for Long -Term Care Services (CARES)
Community Care for the Disabled Adult (CODA)
Community Care for the EIderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Department of Elder Affairs (DOEA)
Home Care for Disabled Adults (HCDA)
Instrumental Activities of Daily Living (IADL)
Planning and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
n Adult Protective Services Referral Tracking Tool: A system designed to track DCF APS
referrals to AAAs and CCE Lead Agencies for victims of second party abuse, neglect, and
exploitation who need home and community -based services as identified by APS staff.
Aging Out: The condition of reaching 60 years of age and being transitioned from the
Department of Children and Families (DCF) Services, Community Care for Disabled Adults
(CCDA) or Home Care for Disabled Adults (HCDA) services to the Department's community-
based services.
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and
coordinated service delivery system in its planning and service area in accordance with the Section
306 (42 U.S.C. 3026) of the Older Americans Act and Department instructions. The Area Plan
includes perforiIlance measures and unlit rates per service offered per county.
Area Plan Update: A revision to the area plan wherein the area agency on aging enters CCE
specific data in the CIRTS. An update may also include other revisions to the area plan as
instructed by the Department.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a
person's ability to remain independent and in the least restrictive living arrangement. DOEA Form
701B is used by case managers to conduct tine functional assessment.
0
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July 2014 to June 2015
1.2 GENERAL DESCRIPTION
10/13/2015 16.D.6.
1.2.1 General Statement
The primary purpose of the CCE program is to prevent, decrease or delay premature or
inappropriate and expensive placement of olderpersons in nursing homes and other institutions.
1.2.2. Community Care for the Elderly Mission Statement
The CCE Program assists functionally impaired elderly persons in living as independently as
possible in their own homes or in the homes of relatives or caregivers. The program provides
a continuum of care through the development, expansion, reorganization and coordination of
multiple community -based services to assist elders to reside in the least restrictive environment
suitable to their needs.
1.2.3 Authority
The relevant authority governing CCE program are:
(1) Rule 58C -1, Florida Administrative Code
(2) Sections 430.201 through 430.207, F.S.
1.2.4 Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of
CCE. The program services shall be provided in a manner consistent with and described in the
Contractor's Request for Proposal, RFP, and the Agency's current area plan and the current
Department of Elder Affairs Programs and Services Handbook, located on the DOEA website,
http://elderaffairs.state.fl.us/doca/iiois.php.
1.2.5 Major Program Goals n
The major goals of the program are to preserve the independence of elders and prevent or delay
more costly institutional care through a community care service system that provides case
management and other in -home and community services as needed under the direction of a lead
agency and provide a continuum of service alternatives that meet the diverse needs of
functionally impaired elders.
1.3. INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The CCE program provides a continuum of services for functional impaired elders.
1.3.2 Individual Eligibility
In order to receive services under this contract, an applicant must:
(1) Be at least 60 years of age;
(2) Be functionally impaired as determined through the initial comprehensive
assessment; and
(3) Not be dually enrolled in the CCE program and a Medicaid capitated long -term
care program.
1.3.2.1 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons
assessed to be at risk of placement in an institution or who are abused, neglected or exploited.
Packet Page -1045-
July 2014 to June 2015 CCE 2 10/13/2015 16.D.6.
SECTION 11: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the CCE program, the Contractor shall perform, or ensure the
performance of its Subcontractors, for the following tasks:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible Clients; and
(4) Monitoring the performance of Subcontractors.
2.1.1 Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility
to become a client is based on meeting the requirements described in this ATTACHMENT I,
Section 1.3.
2.1.1.1 APS High -Risk Referrals
The Contactor shall ensure that for APS high -risk referrals who are enrolled in a Medicaid
long -term care program at the time of referral the CCE lead agency rejects the referral in ARTT
and enter notes indicating the individual is a Medicaid managed care client.
2.1.1.2 APS Intermediate and Low Risk Referrals
The Contractor shall ensure that APS low and medium referrals who are enrolled in a Medicaid
capitated long -term care program at the time of referral be referred to the long -tern care
provider.
^1.2 Assessment and Prioritization of Service Delivery for New Clients
The Contractor shall ensure the following criteria are used to prioritize new clients for service
delivery. It is not the intent of the Agency to remove existing clients from services in order to
serve new clients being assessed and prioritized for service delivery.
2.1.2.1 Abuse, Neglect and Exploitation
The Contractor shall ensure that pursuant to Section 430.205(5)(a), Florida Statutes, those
elderly persons who are determined by APS to be victims of abuse, neglect, or exploitation who
are in need of immediate services to prevent further harm and are referred by APS, will be
given primary consideration for receiving CCE services. As used in this subsection, "primary
consideration" means that an assessment and services must commence within 72 hours after
referral to the Agency or as established in accordance with Agency contracts by local
protocols developed between Agency service Contractors and APS.
2.1.2.2 Priority Criteria for Individuals in Nursing Homes in Receivership:
The Contractor shall ensure that pursuant to Section 400.126 (1.2), Florida Statutes, those
elderly persons determined, through a CARES assessment, to be a resident who could be cared
for in a less restrictive setting or who do not meet the criteria for skilled or intermediate care in
a nursing home, will be referred for such care, as appropriate for the resident. Residents
referred pursuant to this subsection shall be given primary consideration for receiving services
under the CCE program in a manner as persons classified to receive such services pursuant to
Section 430.205, Florida Statutes.
0
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July 2014 to June 2015 cc, 10/13/2015 16.D.6.
2.1.2.3 Priority Criteria for Service Delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred to the community;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted
to the community;
(3) Individuals in nursing homes that are closing and can be discharged to the community; or
(4) Individuals whose mental or physical health condition has deteriorated to the degree self -
care is not possible, there is no capable caregiver, and institutional placement will occur
within 72 hours;
(5) For the purpose of transitioning individuals receiving CCDA and HCDA services through
the DCF Adult Services to community-based services provided through the Agency,
when services are not currently available, the Contractor shall ensure that "Aging Out"
individuals are prioritized for services only after APS High Risk and Imminent Risk
individuals.
2.1.2.4 Priority Criteria for Service Delivery for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means
of service delivery. Service priority for individuals not included in groups one, two or three of
section 2.1.2.3 above, regardless of referral source, will be determined through the
Agency's client assessment form administered to each applicant, to the extent funding is
available. The Contractor shall ensure that first priority is given to applicants at the higher
levels of frailty and risk of nursing home placement. For individuals assessed at the same
priority and risk of nursing home placement, priority will be given to applicants with the lesser
ability to pay for services.
2.1.2.5 Referrals for Medicaid Waiver Services: n
(1) The Contractor must require Subcontractors, through the performance of the client
assessment, to identify potential Medicaid eligible CCE clients and to refer these
individuals for application for Medicaid Waiver services.
(2) The Contractor must require individuals who have been identified as being potentially
Medicaid Waiver eligible are required to apply for Medicaid Waiver services in order to
receive CCE services and can only receive CCE services while the Medicaid Waiver
eligibility determination is pending. If the client is found ineligible for Medicaid Waiver
services for any reason other than failure to provide required documentation, then the
individual may continue to receive CCE services.
(3) The Contractor must advise individuals who have been identified as being potentially
Medicaid Waiver eligible must be advised of the responsibility to apply for Medicaid
Waiver services as a condition of receiving CCE services while the eligibility
determination is being processed.
2.1.3 Delivery of Service to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meet the diverse
needs of functionally impaired elders. The Contractor shall ensure performance and
reporting of the following service provision in accordance with the current DOEA
Programs and Services Handbook. The services include the following categories:
(1) Core Services;
(2) Health Maintenance Services; and
(3) Other Support Services.
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July 2014 to June 2015
10/13/2015 16.D.6.
2.1.3.1Core Services for Programmatic Operation
The Contractor shall ensure that core services include a variety of home- delivered
services, day care services, and other basic services that are most needed to prevent
unnecessary institutionalization. Core services, to be provided at the unit rate identified
in the Area Plan, as updated, include the following:
(1)
Adult Day Care;
(2)
Chore Services;
(3)
Companionship;
(4)
Escort;
(5)
Financial Risk Reduction;
(6)
Home Delivered Meals;
(7)
Homemaker;
(8) Housing Improvement;
(9) Legal Assistance;
(10) Pest Control Services;
(11) Respite Services;
(12) Shopping Assistance; and
(13) Transportation
2.1.3.2 Health Maintenance Services
The Contractor shall ensure that health maintenance services are routine health services that
are necessary to help maintain the health of functionally impaired elders. The services are
limited to medical therapeutic services, non - medical prevention services, personal care
services, home health aide services, home nursing services, and emergency response systems.
Typical services to be provided at the unit rate identified in the Area Plan as updated, are the
following:
(1) Adult Day Health Care;
(2) Emergency Alert Response;
(3) Gerontological Counseling;
(4) Health Support:
(5) Horne Health Aide;
(6) Medication Management;
(7) Mental Health Counseling/Screening;
(8) Nutrition Counseling;
(9) Occupational Therapy;
(10) Personal Care;
(11) Physical Therapy;
(12) Skilled Nursing Services;
(13) Specialized Medical Equipment,
Services and Supplies; and
(14) Speech Therapy.
2.1.3.3 Other Support Services
The Contractor shall ensure that support services expand the continuum of care options to assist
functionally impaired elders and their caregivers. Support services to be provided at the unit
rate identified in the Area Plan as updated, include the following:
(1)
Caregiver Training/Support;
(2)
Case Aid;
(3)
Case Management;
(4)
Intake;
(5)
Material Aid; and
(6)
Other.
E.
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July 2014 to June 2015
2.1.4 Use of Subcontractors
10/13/2015 16.D.6.
If this contract involves the use of a Subcontractor or third party, then the Contractor shall not n
delay the implementation of its agreement with the Subcontractor. If any circumstances occur
that may result in a delay for a period of 60 days or more of the initiation of the subcontract or
in the performance of the Subcontractor, the Contractor shall notify the Contract Manager and
the Agency's Chief Financial Officer in writing of such delay.
The Contractor shall not permit a Subcontractor to perform services related to this agreement
without having a binding Subcontractor agreement executed. In accordance with Section 23.1
of Master Contract HMO 14, the Agency will not be responsible or liable for any obligations or
claims resulting from such action.
2.1.4.1 Monitoring the Performance of Subcontractors
The Contractor shall monitor at least once per year each of its Subcontractors, Subrecipients,
Vendors, and /or Consultants paid from funds provided under this contracts. The Contractor
shall perform fiscal, administrative and programmatic monitoring to ensure contractual
compliance, fiscal accountability, programmatic performance and compliance with applicable
state and federal laws and regulations. The Contractor shall monitor to ensure that time
schedules are met, the budget and scope of work are accomplished within the specified time
periods and other performance goals stated in this contract are achieved.
2.2 SERVICE TIMES
2.2.1 Service Times
The Contractor shall ensure the services listed in this contract are available at times appropriate
to meet client service needs at a minimum, during normal business hours. Normal business
hours are defined as Monday through Friday, 8:00am to 5:00pm.
2.3 DELIVERABLES
The Contractor shall ensure the provision of the services described in the contract in accordance
with the current Department of Elder Affairs Programs and Services Handbook and the services
tasks described in Section 2.1. ATTACHMENT VII lists the services that can be
performed, the highest reimbursement unit rate and the method of payment. Units of service
will be paid pursuant to the rate established in the Request for Proposal, RFP, and approved by
the Agency.
2.4 REPORTS
The Contractor shall respond to additional routine and /or special requests for information and
reports required by the Agency in a timely manner as determined by the Contract Manager. The
Contractor shall establish due dates for any Subcontractors that permits the Contractor to
meet the Agency's reporting requirements.
2.4.1 Client Information and Registration Tracldng System (CIRTS) Reports
The Contractor shall input CCE specific data into CIRTS to ensure CIRTS data accuracy. The
Contractor shall use CIRTS generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
G�
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July 2014 to .tune 2015 10/13/2015 16.D.6.
(3) Services Reports;
^y (4) Miscellaneous Reports;
(S) Fiscal Reports;
(6) Aging and Disability Resource Center Reports; and
(7) Outcome Measurement Reports.
2.5 RECORDS AND DOCUMENTATION
The Contractor shall ensure, on a monthly basis, that client and service information is properly
collected and maintained within the Client Information and Registration Tracking System
(CIRTS) or any such system designated by the Agency. Maintenance includes valid
exports and backups of all data and systems according to Agency and /or Department standards
and the DOEA Programs and Services Handbook.
2.5.1 Each Contractor and Subcontractor, among other requirements, must anticipate and prepare for
the Ioss 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. The Contractor shall maintain written policies and procedures for computer system
backup and recovery and shall have the same requirement in its contracts and/or agreements
with Subcontractors. These policies and procedures will be made available to the Agency
upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
(1) The Contractor shall ensure services provided under this contract are in accordance with
the current DOEA Programs and Services Handbook.
(2) The Contractor shall timely submit to the Agency all reports described in
ATTACHMENT I, SECTION 2.4 REPORTS;
(3) The Contractor shall timely submit to the Agency all information described in
ATTACHMENT I, SECTION 2.5 RECORDS AND DOCUMENTATION.
2.6.2 The Contractor shall develop and document strategies in the area plan to support performance
achievement of 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) Average monthly savings per consumer for home and community -based care versus
nursing home care for comparable group clients;
10
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10/13/2015 16.D.6.
(4) Percent of elders assessed with high or moderate risk environments who improved their
environment score;
(5) Percent of new service recipients with high -risk nutrition scores whose nutritional status
improved;
(6) Percent of new service recipients whose ADL assessment score has been maintained or
improved;
(7) Percent of new service recipients whose IADL assessment score has been maintained or
improved;
(8) Percent of family and family- assisted caregivers who self - report they are likely to provide
care;
(9) Percent of caregivers whose ability to provide care is maintained or improved after one
year of service intervention (as determined by the caregiver and the assessor);
(10) Average time in the CCE Program for Medicaid Waiver probable customers; and
(I1) Percent of customers who are at imminent risk of nursing home placement who are served
with community based services.
The Contractor's performance of these measures will be documented in the Agency's
annual monitoring reports.
2.7. CONTRACTOR'S FINANCIAL OBLIGATIONS
2.7.1 Matching, Level of Effort, and Earmarking Requirement
The Contractor must provide a match of at least 10 percent of the cost for all CCE services.
The match will be made in the form of cash and /or in -kind resources. At the end of the contract
period, all CCE Kinds expended must be properly matched. State funds cannot be used to match
another state - funded program.
2.7.2 Cost Sharing and Co- payments
The Contractor must establish annual co- payment goals. The Agency has the option to
withhold a portion of the Contractor's request for payment if goals are not met according to
the Agency and the Department of Elder Affairs' co- payment guidelines. Co- payments include
only the amounts assessed consumers or the amounts consumers opt to contribute in lieu of an
assessed co- payment. The contribution must be equal to or greater than the assessed co-
payment. Co- payments collected in the CCE program can be used as part of the local match.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide to the Contractor guidance and technical assistance as needed to
ensure the successful fulfillment of the contract by the Contractor.
2.8.2 Contract Monitoring
The Agency will review and evaluate the performance of the Contractor under the terms of
this contract. Monitoring shall be conducted through direct contact with the Contractor through
telephone, in writing, or an on -site visit. The Agency's determination of acceptable
performance shall be conclusive. The Contractor agrees to cooperate with the Agency in
monitoring the progress of completion of the service tasks and deliverables. The Agency
may use, but is not limited to, one or more of the following methods for monitoring:
(1) Desk reviews and analytical reviews;
11
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July 2014 to June 2015
(2) Scheduled, unscheduled and follow -up on -site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third -party documents and /or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed -upon procedures review by an external auditor or consultant;
(9) Limited -scope reviews; and
(10) Other procedures as deemed necessary.
SECTION III: METHOD OF PAYMENT
10/13/2015 16.D.6.
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for
administration costs, and fixed rate for services. The Contractor shall ensure fixed rates for
services include only those costs that are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an
independent audit is required. The Contractor shall consolidate all requests for payment from
Subcontractors and expenditure reports that support requests for payment and shall submit to
the Agency on forms 106C (ATTACHMENT IX) and 105C (ATTACHMENT X).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update, and the Budget
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.
3.2 Advance Payments
The Contractor may request up to two months of advances at the start of the contract period to
cover program administrative and service costs. The payment of an advance will be contingent
upon the sufficiency and amount of funds released to the Agency and the Department by
the State of Florida ( "budget release "). The Contractor shall provide the Contract Manager
documentation justifying the need for an advance and describing how the funds will be
distributed.
3.2.1 The Contractor's requests for an advance require the approval of the Contract Manager. If
sufficient budget is available, the Agency will issue approved advance payments after
July 1, 2014.
3.2.2 All advance payments made to the Contractor shall be returned to the Agency as follows: one
— tenth of the advance payment received shall be reported as an advance recoupment on
each request for payment, starting with report number five, in accordance with the Invoice
Schedule, ATTACHMENT VIII to this contract.
3.2.3 The Contractor may temporarily place advanced funds in a FDIC insured interest bearing
account. All interest earned on contract fund advances must be returned to the Agency
within thirty (30) days of the end of each quarter of the contract period.
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July 2014 to June 2015
10/13/2015 16.D.6.
3.3 Invoice Submittat And Requests for Payment
All requests for payment documentation and expenditure reports submitted to support requests
for payment shall be on DOEA forms 106C (ATTACHMENT IX) and 105C
(ATTACHMENT X). The Contractor shall include with its request for payment
documentation of services provided, the units of services provided, and the rates for the services
provided in conformance with the requirements as described in the deliverables and service
tasks.
3.3.1 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.
3.1.1 If the Contractor fails to meet the prescribed quality standards for services, such services will
not be reimbursed under this contract. In addition, any nonconforming goods (including home
delivered meals) and /or services not meeting such standards will not be reimbursed under this
contract. The Contractor's signature on the request for payment form certifies maintenance of
supporting documentation and acknowledgement that the Contractor shall solely bear the costs
associated with preparing or providing nonconforming goods and /or services. The Agency
requires immediate notice of any significant and /or systemic infractions that compromise the
quality, security or continuity of services to clients.
3.3.2 Financial Consequences
Contractor shall ensure the provision of services to the projected number of clients in
accordance with the Area Plan as updated and within the contract amount. The Contractor shall
ensure expenditure of 100% of the contract amount budgeted for services to clients at the unit
rates established in the Area Plan. In the event the Contractor has a surplus of 1% or more at
the end of the contract term, the Agency will reallocate 1% of the budget for the next year of
the contract term to other area agencies found to be serving clients to the fullest extent of
their allocated budgets. If, or to the extent, there is any conflict between this paragraph and
paragraphs 39.1 and 39.2 of the Master Contract HMO 14, this paragraph shall have precedence.
3.3.3 All payment requests 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 ATTACHMENT VIII to this contract.
3.3.4 Payment may be authorized only for allowable expenditures, which are in accordance with the
limits specified in ATTACHMENT VII, Budget Summary.
3.3.5 Any payment due by the Agency under the terms of this contract may be withheld pending the
receipt and approval by the Agency of all financial and programmatic reports due from the
Contractor and any adjustments thereto, including any disallowance not resolved as outlined in
Section 26 of this contract.
3.3.6 Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for
services provided through .Tune 25, 2015, must be submitted to the Contract Manager no later
than June 25, 2015.
3.3.7 Date for Final Request for Payment
The final request for payment for expenditures is due to the Agency no later than
July 25, 2015.
13
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July 2014 to June 2015
10/13/2015 16.D.6.
3.4 Consequences for Non- Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.4., Scope of
Services are performed pursuant to contract requirements, and as described in Section 2.3,
Deliverables in this contract. If at any time the Contractor is notified by the Agency's
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 Contract Manager that addresses the identified deficiency and states how the deficiency
will be remedied within a time period approved by the 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 may also
assess a financial consequence for failure to timely submit a CAP. In the event the 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, I% of
the monthly value of the administrative funds in the contract for each day the deficiency is not
corrected. The Agency may also 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
Contractor fails to timely submit a CAP, beginning the I Ith day after notification by the
Contract Manager of the deficiency. If, or to the extent, there is any conflict between this
paragraph and paragraphs 39 and 39.1 of Master Contract HM014, this paragraph shall have
precedence.
3.5 Documentation for Payment
The Contractor shall maintain documentation to support payment requests that shall be
available to the Agency and /or Department or authorized individuals, such as
Department of Financial Services, upon request.
3.5.1 The Contractor must enter all required data per the Department's CIRTS Policy Guidelines
for clients and services in the CIRTS database. The data must be entered into the CIRTS
before they submit their request for payment and expenditure reports to the Agency. The
Agency shall establish time frames to assure compliance with due dates for the requests for
payment and expenditure reports to the Agency.
3.5.2 The Contractor must run monthly CIRTS reports and verify client and service data in the
CIRTS is accurate. This report must be submitted to the Agency with the monthly request for
payment and expenditure report and must be reviewed by the Agency before the
Contractor's request for payment and expenditure reports can be approved by the Agency.
Remainder of page in(entionally left blank
14
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July 2014 to June 2015 10/13/2015 16.D.6.
ATTACHMENT III n
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE RE, QUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD $0
STATV FINANCIAL. AQglgTANC Ti. fiTTA TV9-T �rn co,. '714 a'7 -V c
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Community Care for the Elderly
General Revenue -- Collier
65010
$ 720,634.00
TOTAL AWARD
S 720,634.00
COMPLIANCE RE, QUIREMENTS 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
15
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July 2014 to June 2015
10/13/2015 16.D.6.
ATTACHMENT VII
COMMUNITY
ANNUAL BUDGET SUMMARY
for
Collier County Board of County Commissioners
Collier
CCE Services Allocations $ 720,634.00
RATE SUMMARY
Hope Hospice and Community Services, Inc.
for
Collier County
Collier County
Total Unit Cost
Reimbursement Rate -90%
Case Management
$60.00
$54.00
Case Aide
$33.88
$30.50
Adult Day Care
$12.83
$11.55
Chore
$23.33
$21.00
Enhanced Chore
$30.33
$27.30
Companion
$23.35
$21.00
Skilled Nursing
$42.00
$37.80
EARS
$ 1.31
$ 1.18
Homemaking
$22.17
$19.35
Personal Care
$25.67
$23.10
Respite-in-Home
$25.67
$2310
Home Improvement
$ Cost Reimbursement
90% Cost Reimbursement
Material Aid
$ Cost Reimbursement
90% Cost Reimbursement
Specialized Medical Equipment,
Service & Supplies
$ Cost Reimbursement
90% Cost Reimbursement
Transportation
$ Cost Reimbursement
90% Cost Reimbursement
16
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July 2014 to June 2015
Report Number
1
2
3
6
7
8
10
11
12
13
14
15
16
COMMUNITY CARE FOR THE ELDERLY
INVOICE SCHEDULE
Eased On
July Advance*
August Advance*
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
Final Expenditure Report
Closeout Report
Legend: * Advance based on projected cash need.
10/13/2015 16.D.6.
ATTACHMENT 'VIII
Submit to Agency on this Date
July 1
July 1
August 9
September 9
October 9
November 9
December 9
January 9
February 9
March 9
April 9
May 9
June 9
July 9
July 25
August 1
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Area on
Aging for Southwest Florida, Inc. prior to July 1 or until the agreement with the
Agency has been executed and a copy sent to the Area on Aging for Southwest
Florida, Inc. Actual submission of the vouchers to the Area on Aging for
Southwest Florida, Inc. is dependent on the accuracy of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the Agency as follows:
one — tenth of the advance payment received shall be reported as an advance recoupment
on each request for payment, starting with report number five. The adjustment shall
be recorded in Part C, Line 1 of the report (ATTACHMENT A ).
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.
17
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July 2014 to June 2015
REQUEST FOR PAYMENT
COMMUNITY CARE FOR THE ELDERLY
10/13/2015 16.D.6.
ATTACHMENT IX
RECIPIENT NAME, ADDRESS, PHON E# and FEW
TYPE OF PAYMENT:
Regular
Advance
This Request Period: From: To:
Contract Period
Contract #
Report #
PSA #
CERTIFICATION: I hereby certify to the best of my tmovAedge that this request is complete and correct and conforms with the terms and the purposes of the above contract.
Prepared by: Date, Approved by: Date:
PART A: BUDGET SU MMARY
1. Approved Contract Amount
2. Previous Funds Received for Contract Period
3. Contract Balance (line 1 minus line 2)
4. Previous Funds Requested and Not Received for Contract Period
5. CONTRACT BALANCE (line 3 minus line 4)
CCE Admin.
$ 0.00
CCE Services
$ 0.00
TOTAL
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ OAO
$ 0.00
$ D.00
$ 0.00
$ 0.00
$ 0.00
$ 0.0D
, RT B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1st- 2nd months)
2. Net Expenditures For Month
(DOEA Form 1050, Part B, Line 4)
3. TOTAL
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
PARTC: NETFUNDS REQUESTED
1. Less Advance Applied
2. TOTAL FUNDS REQUESTED (Part B Urte 3, minus Part C Line 1)
$ 0.00
$ 0.00
$ D.00
$ 0.00
$ 0.00
$ O.OD
List of Services I Units / Rates provided - See attached report.
DOF.A FORM 106C
Revised 5/4112
18
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?uly2U14 to June 2015
RECEIPT AND EXPENDITURE
REPORT COMMUNITY CARE FOR
THE ELDERLY
CCE 203.14
10/13/2015 16. D.6.
ATTACHMENT X
PROVIDER NAME, ADDRESS, PHONE # and FEID#
Program Funding ;
THIS REPORT PERIOD:
From To
CCE Admin.
CONTRACT PERIOD:
CC E S ervi ces
CONTRACT*
REPORT#
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
Prepared by : Date:
Approved by:
Date
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
$0.00
$0.00
$0.00
#DIV /0!
1. State Funds
2. Program Income
3. Local Cash Match
4. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
$0.00
$0.00
$0,00
#DIV /01
#DIV /01
5. Local !n -Kind Match
6. TOTAL RECEIPTS
$0.00
$0.00
$0.00
#DIV /0!
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
$0.00
$0.00
$0.00
#DIV 10!
1. Administrative Services
2. Service Subcontractor(s)
$0.00
$0.00
$0.00
#DIV 10!
3. Adult Protective Services
$0.00
$0.00
$0.00
#DIV101
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
#DIV /0!
PART C: OTHER REVENUE AND EXPENDITURES
II. Interest:
111. Advance Recouped
1. Program Income (PI)
1. Earned on GR Advance $
$
1. CCE: PI Collected YTD $
2. Return of GR Advance $
(Includes fees collected)
3. Other Earned
$
PART D: CO- PAYMENTS
CURRENT MONTH
YEAR -TO -DATE
1. Total of Co- payments assessed $
$
2. Total of Co- payments collected $
$
(For Tracking Purposes only)
IJOEA FORM 105C
Revised 512512010
I ()
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10/13/2015 16.D.6.
Agreement /Contract Number CCC 203.14
Amendment Number n/a
1, Stephen Y. Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreern en t/con tract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
( Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of Recipient /Contractor representative
Packet Page -1060-
July 31, 2014
Date
Amendment 003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUN'T'Y COMMISSIONERS
10/13/2015 16.D.6.
ADI 203.14,003
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida hereinafter referred to
as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Contractor,"
collectively stated as the "Parties" which amends contract AD] 203. 1.
This amendment shall be effective July 1, 2015.
RECITALS:
WHEREAS, on August 14, 2014, 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 September 25, 2014, the parties entered into a First Amendment to the Contract; and
WHEREAS, on November 12, 2014, the parties entered into a Second Amendment to the Contract; and
WE-IF,REAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2015; and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the n
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 August 30, 2015 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:
The foregoing, Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2015.
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
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Packet Page -1061- �, .
Amend•nent 003
Collier County Board of County
Contractor: Commissioners
SIGNED BY:
NAME: Stephen Y Carnell
TITLE: Public Services Department Head
DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
10/13/2015 16.D.6.
A DI 20 ). 14.003
Area Agency on Aging for Southwest Florida
SIGNED
BY.
NAME: Marianne G Lorini
TITLE: President/CEO
DATE:
Approved a� tr and legality
Assistant Count,,,' A'? ,- r
2
Packet Page -1062-
Revised August 2007
Attestation Statement
Agreement/Contract Number 203.14
Amendment Number 003
10/13/2015 16.D.6.
I,_ Stenhen 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 Denartment Head
(Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of
Revised August 2007
r..
representative
Packet Page -1063-
l
!.
Date
Approvcd as to `' -.rm and legality
Assistant Covuty
Y
F�n�endmenfi 002 Jul 2014 to .Tune 2015 10/1312015 16.D.6.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY HOARD 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 Coin inissioners, ("Contractor "), amends agreement ADI 203.14.
Tlie purpose of this amendment is to change effective date for rates and revise ATTACHMENT K, SERVICE RATE
REPORT.
Line denotes completion of above summary
This amendment shall be effective September 30, 2014. 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.
SIN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there
.unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY:.;� � �� "�l.!�°t --�= S
NAME: Stephen Y. Carnell NAME: MARIANNE G LORINI
TITLE: Public Services Administrator TITLE: PRESIDENT /CEO
DATE: j 1 � 4, ( i
DATE:
Federal Tax 1D: 59- 6000558
Fiscal Year Ending Date: 09/30
Approved as to form and legality
_—Assistant County ttocneY�
1
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Amendment 002 July 2014 to June 2615
SERVICE RATE REPORT
Rate Summary effective July 1 through July 31, 2014
10/13/2015 16.D.6.
ATTACHMENT K
Rate Summary effective August 1, 2014
HIGHEST
DELIVERABLES
REIMBURSEMENT
METHOD OF
DELIVERABLES
REIMBURSEMENT
PAYMENTS
UNIT RATE
Case Aide: Collier
$30.00
Fixed Fee / Unit Rate
Case Management: Collier
$58.33
Fixed Fee / Unit Rate
Respite In- Facility: Collier
$12.22
Fixed Fee / Unit Rate
Respite In -Home: Collier
$25.67
Fixed Fee / Unit Rate
Specialized Medical Equipment, Services and Supplies
Cost Reimbursement
Rate Summary effective August 1, 2014
N
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HIGHEST
METHOD OF
DELIVERABLES
REIMBURSEMENT
PAYMENTS
UNIT RATE
Case Aide: Collier
$33.88
Fixed Fee / Unit Rate
Case Management: Collier
$60.00
Fixed Fee / Unit Rate
Respite In- Facility: Collier
$12.83
Fixed Fee / Unit Rate
Respite In -Home: Collier
$25.67
Fixed Fee / Unit Rate
Specialized Medical Equipment, Services and Supplies
Cost Reimbursement
N
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10/13/2015 16.D.6.
Agreement /Contract Numbcr: ADI 203.14
Amendment Number 002
1, Stephen V, Carnell , attest that no changes or revisions have been made to the
( Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signatur'c of Recip
tractor representative
Packet Page -1066-
-((r(-
Date
An►endment 001 July 2014 to June 2015
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
10/13/2015 16.D.6.
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement ADI 203.14.
The purpose of this amendment is to amend ATTACHMENT I, SECTION III: METHOD OF PAYMENT Paragraph
3.1 General Statement of Method of Payment and 3.5 Consequences for Non - Compliance; amend ATTACHMENT
K, SERVICE RATE REPORT; and increase the allocation by $1 32,683.00 and revise ATTACHMENT III and
ATTACHMENT VIII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
ATTACHMENT I:
Paragraph 3.1 and 3.5 of the Attachment I, is hereby amended to read:
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, and fixed rate for services. The Contractor shall
ensure fixed rates for services include only those costs that are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an independent audit is
required. The Contractor shall consolidate all requests for payment from Subcontractors and expenditure
reports that support requests for payment and shall submit to the Agency on forms 106Z (ATTACHMENT
IX) and 105Z (ATTACHMENT X).
3.5 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.3., Scope of Services are
performed pursuant to contract requirements, and as described in Section 2.3,
Deliverables in this contract. If at any time the Contractor is notified by the Agency's 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 Contract Manager that addresses the identified deficiency and
states how the deficiency will be remedied within a time period approved by the 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 may also assess a financial consequence for failure to
timely submit a CAP. In the event the 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 amount billed for each day the deficiency is not corrected. The Agency may also deduct, from the
payment for the invoice of the following month, I % of the monthly amount billed for each day the Contractor fails
to timely submit a CAP, beginning the 1 lth day after notification by the Contract Manager of the deficiency.
If, or to the extent, there is any conflict between this paragraph and paragraphs 39 and 39.1 of Master Contract
HM014, this paragraph shall have precedence.
This amendment shall be effective July I, 2014. 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.
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Amendment 001 July 2014 to June 2015 10/13/2015 16.D.6.
IN WITNESS WHET EOF, the parties hereto have caused this 5 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY:
U
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE September 5, 2014
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
AREA AGENCY ON AGING FOR SOUT14WEST
FLORIDA, INC.
la
SIGNED BY: 7Tj2,1,tfAj-' ff-?� LUV-
NAME: RON ALA -I-U-GGI=[N", 4ig
Pr;'4'1'&0v3C"h4 " NCO
TITLE: BQAPcD+f �'fiDE-N-T-
DATE: Ci I '/
2
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Assistant County Attor'ITY
,Amendment 001 July 2014 to June 2015 10/13/2015 16.D.6.
ATTACHMENT III -*-N
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE CFDA I AMOUNT
I TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT
$0
STATE FINANCIAL ASSISTANCE SUBJECT TO See. 215.97. F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Alzheimer's Disease Initiative
General Revenue / TSTF- Collier
6004
$ 236,963.00
TOTAL AWARD
$ 236,963.00
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
3
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Ametldment 001 July 2014 to .Tune 2015 I�.VV=
n
ALZHEIMER'S DISEASE INITIATIVE. PROGRAM
ANNUAL BUDGET SUMMARY
For
Collier County Board of County Commissioners
Collier
ALLOCATION TOTAL $ 236,963
m
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ATTACHMENT VIII
Amendment 001 Julv 2014 to June 2015 10/1-3/201-5-l..6.-D.6.
SERVICE RATE REPORT
DELIVERABLES
Case Aide: Collier
Case Management: Collier
Respite In- Facility: Collier
Respite In -Home: Collier
Specialized Medical Equipment, Services and Supplies
H IGHEST
REIMBURSEMENT
UNIT RATE
$33.88
$60.00
$12.83
$25.67
5
ATTACHMENT K
METHOD OF
PAYMENTS
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Cost Reimbursement
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/14
10/13/2015 16.D.6.
Agreement /Contract Dumber: ADI 203.14
Amendment Dumber 001
1, Stcnhen V. Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor narne)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of Recipient /Contractor representative
Packet Page -1072-
9/5/2014
Date
4
Assistant County Attorney
July 201+ to June 2015
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC. CONTRACT
ALZHEIMER'S DISEASE INITIATIVE
10/13/2015 16.D.6.
All! "03.14
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier
County Board of County Commissioners (Contractor),
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 THERE FORE, in consideration of the services to be performed and payments to be made, together witty the mutual
covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract:
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments, forms, exhibits and references incorporated, which constitute the contract document.
2. Incorporation of Documents within the Contract:
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks,
manuals or desk books and Master- Contract number HMO 14, as an integral part of the contract, except to the extent that
the contract explicitly provides to the contrary. hr the event of conflict in language among any of the documents
referenced above, the specific provisions "and requirements of the contract documents) shall prevail over inconsistent
provisions in the proposal(s) or other general materials not specific to this contract document and identified attachments.
3. Term of Contract:
This contract shall begin at twelve (12 :00) A.M., Eastern Standard Time July 1, 2014 or on the date the contract has
been signed by tyre last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) P.M., Eastern
Standard Time June 30, 2015.
4. Contract Amount: (wording re: contract modification after G months)
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not
to exceed $104,280.00, 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(l)(g), F.S., the Agency may renew the contract
for a period not to exceed three years, or the terra of the original contract, whichever is longer. The renewal price, or
method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may
be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability of funds.
1
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July 2014 to June 2015
6. ®tfieial Payee and
Addresses, and T
The Contractor name, as shown on page I of this
a. contract, and mailing address of the official payee to
whom the payment shall be made is:
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1-tJ1 2U -3.14
Hier County Housing, Hunnarn and Veteran
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
b The name of the contact person and street address where Kimberly Grant, Director
financial and administrative records are maintained is: Collier County Housing, Human and Veteran
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
c The name, address, and telephone number of the
representative of the Contractor responsible for
administration of the program under this contract is:
d The section and location within the Agency where
Requests for Payment and Receipt and Expenditure
forms are to be mailed is:
e. IThe name, address, and telephone number of the
Contract Manager for this contract is:
DILUM rry urant, Director
Collier County Housing, Human and Veteran
Services
3339 E Tamiami Trait, Building H
Naples, FL 34112
(239) 252 -2273
Nancy Dean, Director of Finance
°a Agency on Aging for Southwest Florida, Inc
15201 North Cleveland Avenue, Suite 1 I00
North Fort Myers, FL 33903
Marianne Lorini, Executive Director
a Agency on Aging for Southwest Florida, Innc
15201 North Cleveland Avenue, Suite 1 100
North Fort Myers, FL 33903
239 - 652 -6900
1iUpon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided
n writing to the other party and the notification attached to the originals of this contract.
2
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,JulN, 201.E to Vane 2015
ADI 203.14
All Terms and Conditions Inc.lutl 10/13/2015 16.D.6.
This contract and its Attaclunents I, 1114 VII — X, and h any exhibits referenced in said attachments, together with any
doctunents 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
COUNTY COMMISSIONERS
SIGNED BY:vi: 1 !
NAME: Stephen Y, Carnell
TITLE: Public Services Administrator
DATE: July 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year I'nding Date: 09(30
Packet Page -1075-
AREA AGENCY OIL AGING FOR
SOUTH[V6'EST L IDA, INC. SIGNED3'* .
NAME: RONALD LUCCHINO. PhD
TITLE: BOARD PRESIDENT
DATE:.
n
July 2014 to June 2015
LNDEX OF ATTACHMENTS
10/13/2015 16.D.6.
ADI 203.14
ATTACHMENT L ...... , .. .
. ...............................
STATEMENT OF WORK 5
ATTACHIYIENT III ................
FUNDING SOURCE
ATTACHMENT VII ...........
.............. ...............................
.............. ...............................
" " " ""
INVOICE REPORT SCHEDULE
ATTACHMENT V111 .............. .
.........................
........................ ...............................
ANNUAL BUDGET SUMMARY
ATTACHMENT IX.........
.................. ...............................
REQUEST FOR PAYMENT
17
ATTACHMENT X ...............
RECEIPT AND EXPENDITURE REPORT
ATTACHMENT K ..............
.... ...............................
SERVICE RATE REPORT
11
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July 2014 to June 2015
STATEMENT OF WORK
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO RE PROVIDED
1.1 DEFINITIONS OF CONTRACT TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Alzheimer's Disease (AD)
Alzheimer's Disease Initiative (ADI)
Activities of Daily Living (ADL)
Assessed Priority Consumer List (APCL)
Adult Protective Services (APS)
Client Information and Registration Tracking System (CIRTS)
Community Care for Disabled Adults (CODA)
Department of Elder Affairs — (DOEA) or Department
Home Care For Disabled Adults (HCDA)
Instrumental Activities of Daily Living (IA.DL)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
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ADI 203.14
ATTACHMENT I
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the Department of
Children and Families Services Community Care for Disabled Adults (CCDA) or Home Care for Disabled
Adults (HCDA) services to the Department's community -based services. n
Area Plan: A plan developed by the Agency outlining a comprehensive and coordinated service delivery system in
the respective planning and service area, in accordance with the Section 306 of the Older Americans Act (42
U.S.C. 3026) and Department instructions. The Area Plan includes performance measures and unit rates per service
offered per county.
Area Plan Update: A revision to the Area Plan wherein the Contractor enters ADI specific data into the CIRTS.
An update may also include other revisions to the Area Plan as instructed by the Department.
.Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain
independent and in the least restrictive living arrangement. DOEA Form 701B is used by case managers to conduct
the functional assessrment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1) and q, F.S., to
Provide diagnostic and referral services, conduct basic and service- related multidisciplinary research, and
develop training materials and educational opportunities for lay and professional caregivers of individuals with
AD.
Model Day Care: A program of therapeutic, social and health activities specific to clients with memory
disorders. Services and activities include, but are not limited to, active and quiet games, reminiscence, validation
therapy, pet therapy, water therapy and other failure free activities appropriate to the client's level of functioning.
Model day care centers will also provide training for health care and social service personnel in the care of
persons having AD or related memory disorders.
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July 2014 to June 2015
1.2 GENERAL DESCRIPTION
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A"I 20J.14
1.2.1 General Statement
The ADI program provides a continuum of services addressing the special needs of individuals with AD, their
families and caregivers.
1.2.1.1 Alzheimer's Disease Initiative Program Mission Statement
The ADI program ensures that persons afflicted with AD and other forms of dementia are given essential
services to help them age in place in an elder - friendly environment with security, dignity, and purpose. The
program also provides support to family members and caregivers of persons afflicted with AD.
1.2.2 Authority
The relevant authority governing the Alzheimer's Disease Initiative Program are as follows;
(1) Rule Chapter 58D -1, Florida Administrative Code; and
(2) Sections 430.501 through 430.504, Florida Statutes,
1.2.3 Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of the ADI program.
The program services shall be provided in a manner consistent with and described in the Contractor's
Request for Proposal, RFP, and the Agency's current area plan and the current Department of Elder Affairs
Programs and Services Handbook.
1.2.4 Major Program Goal
The major goal of the ADI program is to provide services to meet the needs of caregivers and individuals with
AD and related memory disorders.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The ADI Program addresses the special needs of individuals with AD and their caregivers.
1.3.2 Individual Eligibility
Those individuals eligible to receive services under this contract must meet the following conditions:
(1) Be 18 years of age or older and have a diagnosis of AD or a related disorder, or be suspected of having AD
or a related disorder; and
(2) Not be enrolled in a Medicaid capitated long -term care program.
1.3.3 Targeted Groups
Priority for services under this contract will be given to those eligible persons assessed to be at risk of placement
in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the ADI program, the Contractor shall perform or ensure the performance of its
Subcontractors, the following tasks:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible Clients; and
(4) Monitoring the Performance of Subcontractors.
b
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July 2014 to June 2015
2.1.1. Client Eligibility Determination
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rivd t.VJ.P+
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a
client is based oil meeting the requirements described in this ATTACHMENT I, Section 1.3.
2.1.2 Assessment and Prioritization of Service Delivery for New Clients
Tile Contractor shall ensure the following criteria are used to prioritize new clients for service delivery. It is
not the intent of the Agency to remove existing clients from any services in order to serve new clients being
assessed and prioritized for service delivery.
2.1.2.1 Priority Criteria for Service Delivery
(1) Individuals in nursing homes under Medicaid who could be transferred to the conununity;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the
community;
(3) Individuals in nursing homes that are closing and can be discharged to the community;
(4) Individuals whose mental or physical health condition has deteriorated to the degree self care is not
possible, there is no capable caregiver, and institutional placement will occur within 72 hours; and
(5) For the purpose of transitioning individuals receiving CCDA and HCDA services through the
Department of Children and Families' Adult Services to community -based services provided through
DOEA when services are not currently available, area agency on aging staff and lead agency case
managers will ensure that "Aging Out" individuals are prioritized for services only after APS High Risk
and Imminent Risk individuals.
2.1.2.2 Priority Criteria for Service Delivery for Other Assessed Individuals
The assessment and provision of services should always consider the most cost effective means of service
delivery. Functional impairment will be determined through the Agency's functional assessment form
administered to each applicant. The most frail individuals not prioritized as described in this attachment,
Paragraph 2.1.2.1 will receive services to the extent funding is available.
2.1.3 Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services addressing the diverse needs of individuals
with AD and their caregivers. The Contractor shall ensure services are performed in accordance with the current
Department of Elder Affairs Programs and Services Handbook. Services categories include:
(1) Caregiver Training/Support;
(2) Case Aid;
(3) Case Management;
(4) Counseling (Gerontological);
(5) Counseling (Mental Health/Screening);
(6) Education /Training;
(7) Intake;
(S) Model Day Care;
(9) Respite (Facility- Based);
(10) Respite (In- Home); and
(11) Specialized Medical Equipment, Services, and Supplies.
Caregivers benefit from receiving training, respite and related support services to assist them in caring for the
ADI client.
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liLi LUJ. 14
2.1.3.1 Memory Disorder Clinics
MDCs are required to provide four (4) hours of in- service training to all respite, in- facility respite and model
day care centers in their designated service areas. hr- service training topics may include physiological,
behavioral and emotional aspects of AD and related diseases as well as caregiver techniques, coping strategies
and information regarding Silver Alert. The Contractor shalt collaborate with MDCs to assist in this effort and
in the effort to carry out Silver Alert protocol activities. The Contractor shall respond to requests for evaluation
information and statistical data concerning its consumers, based on information requirements of the MDCs and
Brain Bank.
2.1.4 Use of Subcontractors
If this contract involves the use of a Subcontractor or third party, then the Contractor shall not delay the
implementation of its agreement with the Subcontractor. If any circumstances occur that may result in a delay
for a period of 60 days or more of the initiation of the subcontract or in the performance of tine Subcontractor,
the Contractor shall notify the Contract Manager and the Agency's Chief Financial Officer in writing of
such delay.
2.1.4.1 The Contractor shall not permit a Subcontractor to perform services related to this agreement without having a
binding Subcontractor agreement executed. In accordance with Section 23.1 of the Master Contract, the
Agency will not be responsible or liable for any obligations or claims resulting from such action.
2.1.4.2 Monitoring the Performance of Subcontractors
The Contractor shall monitor at least once per year each of its Subcontractors, Subrecipients, Vendors and /or
Consultants paid from funds provided under this contract. The Contractor shall perform fiscal, administrative
and programmatic monitoring to ensure contractual compliance, fiscal accountability, programmatic
performance, and compliance with applicable state and federal laws and regulations. The Contractor shall
monitor to ensure that time schedules are met, the budget and scope of work are accomplished within the
specified time periods and other performance goals stated in this contract are achieved.
2.2 SERVICE TIMES
Service Times
The Contractor shall ensure the services listed in this contract are available at times appropriate to meet client
service needs, at a minimum, during normal business hours. Normal business hours are defined as Monday
through Friday, 8:00am to 5:00pm.
2.2.1 Service Unit
The Contractor shall ensure the provision of the services described in the contract in accordance with the current
Department of Elder Affairs Programs and Services Handbook and the service tasks described in Section 2.1.
The chart below lists the type of services that can be performed. The highest reimbursement unit rate and the
method of payment are shown in ATTACHMENT K Units of service will be paid pursuant to the ra #e
established in the contract as updated, and approved by the Agency's reporting requirements.
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July 2014 to June 2015
2.3 DELIVERABLES
Service
Unit of Service
Case Aide
Counseling;
Counseling (Gerontological);
Individual;
Model Day Care;
Hour
Respite Iii - Facility
Respite In -Home
Caregiver Train /Support (Indv)
Case Management
Education/Training;
Episode
Specialized Medical Equipment, Services
and Supplies
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2.4 REPORTS
The Contractor shall respond to additional routine and /or special requests for information and reports required
by the Agency in a timely manner as determined by the Contract Manager. The Contractor shall establish due
dates for any Subcontractors that permits the Contractor to meet the Agency's reporting requirements.
2.4.2 Client Information and Registration Tracking System ( CIRTS)
The Contractor shall input ADI specific data into CIRTS to ensure CIRTS data accuracy. The Contractor shall
use CIRTS generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports;
(4) Miscellaneous Reports;
(5) Fiscal Reports;
(6) Aging and Disability Resource Center Reports; and
(7) Outcome .Measurement Reports.
2.5 RECORDS AND DOCUMENTATION
2.5.1 The Contractor shall ensure the collection and maintenance of client and service information on a monthly basis
from the CIRTS or any such system designated by the Agency. Maintenance includes valid exports and
backups of all data and systems according to Agency standards.
E
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J-u1y 2014 to June 2015
10/13/2015 16.D.6.
2.5.2 Each Contractor and Subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover from
losses or outages of the computer system. Data and software essential to the continued operation of Contractor
functions must be backed up. The security controls over the backup resources shall be as stringent as the
protection required of the primary resources. It is recommended that a copy of the backed up data be stored in
a secure, offsite location. The Contractor shall maintain written policies and procedures for computer system
backup and recovery and shall have the same requirement in its contracts and /or agreements with Subcontractors.
These policies and procedures shall be made available to the Agency upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
(1) The Contractor shall ensure services provided under this contract are in accordance with the current
Department of Eider Affairs Programs and Services Handbook;
(2) The Contractor shall timely submit to the Agency all reports described in ATTACHMENT I,
SECTION 2.4, REPORTS.; and
(3) The Contractor shall timely submit to the Agency all information described in ATTACHMENT I,
SECTION 2.5, RECORDS AND DOCUMENTATION.
2.6.2 The Contractor shall develop and document strategies in the area plan, to support performance achievement of
the following:
(1) Percent of most frail elders who remain at home or in the community instead of going into a nursing
home;
(2) Average monthly savings per consumer for home and community-based care versus nursing home care
n, for comparable client groups;
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(4) Percent of new service recipients with high -risk nutrition scores whose nutritional status improved;
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(6) Percent of new service recipients whose LkDL assessment score has been maintained or unproved;
(7) Percent of family and family- assisted caregivers who self - report they are very likely to provide care;
(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor); and
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community-based services.
The Contractor's performance of these measures will be documented in the Agency's annual
monitoring reports.
2.7 CONTRACTOR'S FINANCIAL, OBLIGATIONS
2.7.1 Cost Sharing and Co- payments
The Contactor must establish annual co- payment goals. The Agency has the option to withhold a portion of
the Contractor's request for payment if goals are not met according to the Agency and the Department of
Elder Affairs' co- payment guidelines.
10
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10/13/2015 16.D.6.
2.7.1.1 Co- payments include only the arnounts assessed consumers or the amounts consumers opt to contribute in lieu
of an assessed co- payment. The contribution must be equal to or greater than the assessed co- payment.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide the Contractor with guidance and technical assistance as needed to ensure [lie
successful fulfillment of the contract by the Contractor.
2.8.2 Conti-act Monitoring
The Agency will review and evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or an
on -site visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor
agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and
deliverables. The Agency may use, but is not limited to, one or more of the following methods for
monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow -up on -site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third -party documents and /or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed -upon procedures review by an external auditor or consultant;
(9) Limited -scope reviews; and
(10) Other procedures as deemed necessary.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for administration costs, and
fixed rate for services. The Contractor shall ensure fixed rates for services include only those costs that are in
accordance with all applicable state and federal statutes and regulations and are based on audited historical costs
in instances where an independent audit is required. The Contractor shall consolidate all requests for payment
from Subcontractors and expenditure reports that support requests for payment and shall submit to the
Agency on forms 106Z (ATTACHMENT IX) and 105Z (ATTACHMENT X).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary,
ATTACHMENT VIII to this contract. Any changes in the total amounts of hinds identified on the Budget
Summary require a contract amendment. .
3.2 Advance Payments
3.2.1 The Contractor- may request up to two months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and amount
of funds released to the Agency by the State of Florida Department of Elder Affairs ( "budget release "). The
Contractor shall provide the Contract Manager documentation justifying the need for an advance and
describing how the funds will be distributed.
I1
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July 2014 to June 2015 10/13/2015 16.D.6.
3.2.2 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient budget is
available, the Agency will issue approved advance payments after July 1, 2014.
3.2.3 All advance payments made to the Contractor shall be returned to the Agency as follows: one — tenth of the
advance payment received shall be reported as an advance recoupment on each request for payment, starting
with report number five, in accordance with the Invoice Report Schedule, ATTACHMENT V111 to this contract.
3.2.4 The Contractor may temporarily place advanced funds in a FDIC insured interest bearing account. All interest
earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of each
quarter of the contract period.
3.3 Invoice Submittal and Requests for Payment
All requests for payment documentation and expenditure reports submitted to support requests for payment shall
be on DOEA forms 106Z (ATTACHMENT IX) and 105Z (ATTACHMENT X).. The Contractor shall
include with its request for payment documentation of services provided, the units of services provided, and the
rates for the services provided in conformance with the requirements as described in the deliverables and service
tasks.
3.3.1 Remedies-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.
3.3.1.1 If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and /or services
not meeting such standards will not be reimbursed under this contract. The Contractor's signature on the request
for payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor
n 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 infiactions that compromise the
quality, security or continuity of services to clients.
3.3.2 Financial Consequences
Contractor shall ensure the provision of services to the projected number of clients in accordance with the Area
Plan as updated and within the contract amount. The Contractor shall ensure expenditure of 100% of the contract
amount budgeted for services to clients at the unit rages established in the Area Plan. In the event the Contractor
has a surplus of 1% or more at the end of the contract term, the Agency will reallocate 1% of the budget for the
next year contract term to other area agencies found to be serving clients to the fullest extent of their allocated
budgets. If, or to the extent, there is any conflict between this paragraph and paragraphs 39.1 and 39.2 of the
Master Contract, this paragraph shall have precedence.
3.3.2.1 All payment requests 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
ATTACHMENT VH to this contract.
3.3.2.2 Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified
in ATTACHMENT VIII, Budget ,Summary.
3.3.2.3 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in Section 26 of the Master Contract.
3.3. Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided
through June 25, 2015, must be submitted to the Contract Manager no later than June 25, 2015.
12
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July 2014 to June 2015 10/13/2015 16.D.6.
3.4 Date for Final Request for Payment
The final request for payment is due to the Agency no later than July 25, 2015.
3.5 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.3 Scope of Services are performed
pursuant to contract requirements, and as described in Section 2.3 are identified as major deliverables in this
contract. If at any time the Contractor is notified by the Agency's 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 Plait ( "CAP ") to the Contract Manager that addresses the deficiency and states how
the deficiency will be remedied within a time period approved by the 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. 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 of the invoice for the
following month, 1% of the monthly value of the contract funds for each day the deficiency is not corrected.
The Agency may also deduct, from the payment of the invoice for the following month, 1% of the monthly
value of the contract fiends for each day the Contractor fails to timely submit a CAP, beginning the 1 lth day
after notification by the Contract Manager of the deficiency. The deduction will be made from the payment for
the invoice of the following month. If, or to the extent, there is any conflict between this paragraph and
paragraphs 39.1 and 39.2 of the Master Contract, this paragraph shall have precedence.
3.6 Documentation for Payment
The Contractor shall maintain documentation to support payrnent requests that shall be available to the
Agency or authorized individuals, such as the Department of Financial Services, upon request.
3.6.1 The Contractor must enter all required data per the Department's CIRTS Policy Guidelines for clients n
and services in the CIRTS database. The data must be entered into the CIRTS before they submit their
request for payment and expenditure reports to the Agency. The Agency shall establish time frames to assure
compliance with due dates for the requests for payment and expenditure reports to the Agency.
3.6.2 The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is accurate.
This report must be submitted to the Agency with the monthly request for payment and expenditure report
and must be reviewed by the Agency before the Contractor's request for payment and expenditure reports
can be approved by the Agency.
13
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10/13/2015 16.D.6.
ATTACHMENT III
n
�. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD I I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA I AMOUNT
TOTAL STATE AWARD I $0
STATE FINANCIAL ASSISTANCE SUBJECT TO See. 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Alzheimer's Disease Initiative
General Revenue / TSTF- Collier
65004
$ 104,280.00
TOTAL AWARD
S 104,280.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin. Code
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July 2014 to June 2015
Report Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
INVOICE REPORT SCHEDULE
ALZHEIMER'S DISEASE INITIATIVE (ADI)
INVOICE SCHEDULE
Rased On
July Advance*
August Advance"
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
Final Request for Payment
Closeout Report
Legend: * Advance based on projected cash need.
10/13/2015 16. D.6.
ATTACHMENT VIII
Submit to Agency on This Date
July 1
July 1
August 9
September 9
October 9
November 9
December 9
January 9
February 9
March 9
April 9
May 9
June 9
July 9
July 25
August 1
Note # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency
on Aging for Southwest Florida, Inc. prior to July I or until the contract with the
Agency has been executed and a copy sent to the Agency on Aging for Southwest
Florida, Inc. Actual submission of the vouchers to the Agency is dependent on the
of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the Agency as
follows: one — tenth of the advance payment received shall be reported as an advance
recoupment on each request for payment, starting with report number five. The
adjustment shall be recorded in Part C, Line 1 of the report (ATTACHMENT X).
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.
15
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July 2014 to June 2015
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL BUDGET SUMMARY
For
Collier County Board of County Commissioners
Collier
ALLOCATION TOTAL $ 104,280
Ire
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10/13/2015 16.D.6.
AUI 203.14
ATTACH ME VIII
July 2014 to June 2015
10/13/2015 16.D.6.
ADI 203.14
ATTACHMENT IX n
REQUEST FOR PAYMENT
ALZHEINIERS DISEASE INITIATIVE PROGR64fiIJ1
RECDI EJJTIJAPAE,ADDFESS.PHCX- .1&4and FEO=
TI *PE OF REPORT:
Ths Request Pebod
PSA T
A PAtiT.ETITREQUEST:
Report«
Regitar _ St3:plerr:erAal
Contract=
8, METHOD OF PAY,. Etff:
Conlrad Period
Advance Rein- burseIT✓rt
CERT`IC- ATIOFI: I harebycen yto tha best of myana;dedgetFt Ois request is con•Plete and cofred and cordnrmsrAllitlte term; and tine purposes of the above contrail
Prepared by_ Date Approved by. Date:
PARTA BUDGET SUfJlMW
Rer1 spite
Model Da Da Care
TOTAL,
1 ApprmedCoriractAmount
$0.00
50.00
SO.00
2. Previous Funds Received for Contract Period
SO.00
S0.00
5000
3. Contract Balance (ine t rrinus lire 2)
S0,00
50.00
50.00
d Prelious Funds Requested and t lot Recened (of Conlracl Period
50.00
5000
5000
5, Contract Balance (ine 3 minus line 4)
50,00
50.00
$000
PART B: COMRACTFUNDSREOLEST
1.ArticipatedCashl,Jeeds( 1st- 2rdrrorxb.AttachJustificafion)
50.00
50.00
SO.00
2. filet E6penditraes For MorXh
Saco
Saco
SO.00
(DOEAFornt 1052 Part 6, Line 3)
3. TOTAL
50,00
50.00
5000
PARTC: hETFUIDSREQUESTED
1 Less AdvarxeApplied
$000
$000
5000
2. C ortract Funds are Hereby Requested for I Pad B. Line 3
50.00
50.00
Saco
misers Part C, Line 1}
List of Serices 1 UntsIRates pm ided -See anacFed report.
DOER FORM 1062
P•c.i;H K 4 12
17
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July 2014 to June 2015
RECEIPTAND EXPENDITURE REPORT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
10/13/2015 16.D.6.
All1 2U3.14
ATTACHMENT X
PROVIDER NAh4E, ADDRESS, PHONE R and FEID<
Program Funding :
THIS REPORT PERIOD:
From
To
Respite
CONTRACT PERIOD:
f3odel Day Care
CONTRACT a
REPORT
PSAT
CERTIFICATION: I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in
the contract.
Prepared by;__ _ Gate :
Approved by:_
___
Date :
_-
PART A: BUDGETED INCOME/ RECEIPTS
1, Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. State Funds
SO.00
50.00
50.00
DIV /D!
2. Program Income
50.00
S0,00
50.00
9DIV /0!
3. Local Cash Match
50.00
50.00
s0.00
RDIV /DI
4. SUBTOTAL: CASH RECEIPTS
5. Local In -Kind Match
6. TOTAL RECEIPTS
50.00
$0.00
$0.00
90IVIO!
PART B: EXPENDITURES
1. Approved
2, Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Administrative Services
SO.00
S0.00
S0.00
RD!V/o!
2. Service Subconiractor(s)
SO.00
50.00
SO.00
4DIV /0!
3. TOTAL EXPENDITURES
50.00
$0.00
SO.00
RDIVIO!
PART C: OTHER REVENUE A14D EXPENDITURES
1!_ Interest:
III. Advance Recouped
1. Prograin I ncome (PI)
1. Earned on G R Advance S_
$
_
1. ADI: PI Collected YTD S
2. Return or GR Advance S
(Includes co- payments collected )
3. Other Earned
S__
PART D: C0.PAYMENTS CURRENT MONTH
YEAR -TO -DATE
1. Total of Co- payments assessed S -_
S__
2. Total of Co- payments collected S
S
(For Tracking Purposes only)
17OZZ111 105_%
A 5QSryo10
18
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July 2014 to June 2015
DELIVERABLES
Case Aide: Collier
Case Management: Collier
Respite In- Facility: Collier
Respite In -Home: Collier
Specialized Medical Equipment, Services and Supplies
III
HIGHEST
REIMBURSEMENT
UNIT RATE
$33.88
$60.00
$12.22
$24.44
Packet Page -1091-
10/13/2015 16. D.6.
ATTACHMENT K
METHOD OF
PAYMENTS
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Cost Reimbursement
10/13/2015 16.D.6.
Attestation Statement
Agreement /Contract Number AD] 203.14
Amendment Number n(a
1, Stephen Y. Carnell , attest that no changes or revisions have been made to the
( Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
r
Signature of Recipient /Contractor representative
Packet Page -1092-
July 31, 2014
Date
Am:°.ndmei.t 003
10/13/2015 16.D.6.
I -ICE 203.14.003
AREA AGENCY ON ACING FOR SOUTHWEST FLORIDA, INC. �
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT, entered into between the Area ALenc y on n .Aging for Southwest Florida hereinafter referred to
as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Contractor,"
collectively stated as the "Parties" which amends contract HCE 203.14.
This amendment shall be effective July 1., 2015.
RECITALS:
WHEREAS, on August 14, 2014, 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
WI- IF..REAS, an September 25, 2014, the parties entered into a First Amendment to the Contract; and
WHEREAS, on November 12, 2014, the parties entered into a Second Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2015;
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 August 30, 2015 while they await notification of funding of
successor contract..
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby iriutually acknowledged, the Parties agree as follows:
The foregoing Recitals are true and correct and are ineorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2015.
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
IN WI'T'NESS W14EREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Packet Page -1093- �'!_J
Amundmen, 003
/0—*N
Collier County Board of County
Conti-actor: Commissioners
Il
SIGNED BY: A i 4/
NAME: Stephen Y. Carnell
TITLE: Public Services Department 1 -lead
DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
0
10/13/2015 16.D.6.
I-ICE 203.14.003 )
Area Agency on Aging for Southwest Florida
SIGNED
BY:
NAME: Marianne G Lorini
TITLE: President /CEO
DATE:
APproved ps to fonn and legality
Assistant County Attorney
2
Packet Page -1094-
R,�•v ised August 2007
Attestation Statement
Agreement /Contract Number 203.14
Amendment Number 003
10/13/2015 16.D.6.
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 Set-vices Department Head
(Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of Recipient/ tractor rep
Revised August 2007
Packet Page -1095-
Date
Approved as to form and legality
Assistant County Attorney
10/13/2015 16.D.6.
A inertdinent 002 July 2014 to June 2015
n AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMT',NIIMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, (" Contractor "), amends agreement HCE 203.14.
The purpose of this amendment is to change effective date for rates and revise ATTACHMENT VII, RATE
SUMMARY
Line denotes completion of above seminary
This amendment shall be effective September 30, 2014. All provisions in the agreement and any attachments thereto in
conflict with this amendment sliall 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.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: SIGNED BY: GCLi�I
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: h16- (!4
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
NAME: MARIANNE G. LORINI
TITLE: PRESIDENT /CEO
DATE:T I t / 2-�`''
Packet Page -1096-
Assistant Cou csrne,Y�
Amendment 002 July 2014 to Jude 2015 10/13/2015 16.D.6.
ATTACHMENT V11
RATE SUMMARY effective July I through August 31, 2014
for
Collier County Board of County Coirunissioners
Charlotte
SERVICES REIMBURSEMENT RATE
Collier
Case Management $55.56
Case Aide $30.00
RATE SUMMARY effective September 1, 2014
SERVICES REIMBURSEMENT RATE
Collier
Case Management $60.00
Case Aide $33.88
2
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10/13/2015 16.D.6.
Attestation Statement
Agreement /Contract Number: HCE 203.14
?amendment Number 002
I,enhen Y. Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement/contract content.
G(
Signature o Recipient /Contractor representative
Packet Page -1098-
4`,
me.idnient 001 July 2014 to June 2015 10/13/2015 16.D.6.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. "
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement HCE 203.14.
The purpose of this amendment is to amend ATTACHMENT I, SECTION III: METHOD OF PAYMENT Paragraph
3.1 General Statement of Method of Payment and 3.4 Consequences for Non - Compliance, and correct the CSFA #
on ATTACHMENT III to 65001.
Line denotes completion of above summary
ATTACHMENT I:
Paragraph 3.1 and 3.4 of the Attachment I, is hereby amended to read:
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, and fixed rate for services. The Contractor shall
ensure fixed rates for services include only those costs that are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an independent audit is
required. The Contractor shall consolidate all requests for payment from Subcontractors and expenditure
reports that support requests for payment and shall submit to the Agency on forms 106H (ATTACHMENT
IX) and 105H (ATTACHMENT X).
3.4 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.4., Scope of Services are n
performed pursuant to contract requirements, and as described in Section 2.3, Deliverables in this contract. if
at any time the Contractor is notified by the Agency's 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 Contract Manager that addresses the identified deficiency and states
how the deficiency will be remedied within a time period approved by the 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 may also assess a financial consequence for
failure to timely submit a CAP. In the event the 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 amount billed for each day the deficiency is not corrected. The Agency may
also deduct, from the payment for the invoice of the following month, 1% of the monthly amount billed for each
day the Contractor fails to timely submit a CAP, beginning the 11th day after notification by the Contract
Manager of the deficiency. If, or to the extent, there is any conflict between this paragraph and paragraphs 39
and 39.1 of Master Contract HM014, this paragraph shall have precedence.
ATTACHMENT III:
Correct the CSFA# to 65001.
This amendment shall be effective July 1, 2014. 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.
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Eli
Amendment 001 July 2014 to June 2015 10/13/2015 16.D.6.
IN WITNESS WHEREOF, the parties hcreto have caused this 2 page amendment to be executed by their officials there
unto duly authorized,
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: SIGNED BY: aj LAA-
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: September 5, 2014
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
11�
NAME: MARIANNE G. LORIN]
TITLE: PRESIDENT/CEO
DATE:
2
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Approved as to form and legality
Assistant County Attor¢i g
10/13/2015 16. D.6.
Agreement /Contract Number: HCE 203.14
Amendment Number 001
I, Stephen V. Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
r
�f 9/5/2014
Signature of Recipient /Contractor representative Date
Approved as to form and legality
Assistant County attorney
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1.
July 2014 — June 2015 HCE 203.14 .
10/13/2015 16.D.6.
AREA AG—ACY ON AGING FOR SOUTHWEST Fi-JRIDA, INC.
CONTRACT
n HOME CARE FOR THE ELDERLY PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and
Collier County Board of County Commissioners, (Contractor), and collectively referred to as the "Parties." 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:
Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this
contract including all attachments, forms, exhibits and references incorporated, which constitute the contract
document.
2. Incorporation of Documents. within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department
handbooks, manuals or desk books and Master Contract number HMO 14, 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.
Term of Contract
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time July 1, 2014 or on the date the contract has
been signed by the last party required to sign it, whichever is later. It shall end at eleven fifty -nine (11:59) P.M.,
Eastern Standard Time June 30, 2015,
4. Contract Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed J30,836.00. 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 terns and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability of funds.
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in
f�ffoeia[
Payee and Renr esentative 1I°rTarares. Addresses. anti
Telenhonc N nmj2es s : 10/13/2015 16.
The Contractor name, as s4. -n on page I of this
Collier Cr y Housing,
Services
a.
contract, and mailing address of the official payee to
3339 E Ta.mianii Trail Building H
whom the payment shall be made is:
Naples, FL 341.12
Kimberly Grant, Director
b'
The name of the contact person and street address where
Collier County Housing, Human and Veteran
financial and administrative records are maintained is:
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
Kimberly Grant, Director
C.
The name, address, and telephone number of the
Collier County Housing, I -tuman and Veteran
representative of the Contractor responsible for
Services
administration of the program under this contract is:
3339 E Tamiami Trail, Buildin H Cl
Naples, FL 34112
(239) 252 -2273
d.
The section and location within the Agency where
Nancy Dean, Director of Finance
Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure
15201 North Cleveland Avenue, Suite 1100
forms are to be mailed is:
North Fort Myers, FL 33903
Marianne Lorini, Executive Director
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 I L00
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, 111, 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 COMMISSIONERS SOUTHW F RIDA, INC.
SIGNED BY tt %, r `` r'
` SIGNED`
°y tt
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: July 31 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
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NAME: RONALD LUCCHINO, PhD
TITLE: BOARD PRESIDENT
r i
n
DATE: / .' ; - +. c
M
July 2014 — June 2015
INDEX OF ATTACHMENTS
HCE 203.14
10/13/2015 16.D.6.
ATTAC14MENT I
STATEMENTOF WORK ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. 4
ATTACHMENT III
FUNDINGSUMMARY ........................................................................................................ 17
ATTACHMENT VII
HOME CARE FOR THE ELDERLY ANNUAL BUDGET and RATE SUMMARY .............................. 18
ATTACHMENT VIII
HOME CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE ................................................ 19
ATTACHMENT IX
REQUESTFOR PAYMENT .................................................................................................... 20
ATTACHMENT X
RECEIPT AND EXPENDITURE 21
10-11�1
3
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r $
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITION OF CONTRACT TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Adult Protective Services (APS)
Activities of Daily Living (ADL)
Assessed Priority Consumer List (APCL)
Community Care for Disabled Adults (CCDA)
Community Care for the Elderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Home Care for Disabled Adults (HCDA)
Home Care for the Elderly (HCE)
Institutional Care Program (ICP)
Instrumental Activities of Daily Living (LA-DL)
Planning and Service Area (PSA)
HCE 203.14
10/13/2015 16.D.6.
ATTACHMENT I
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out: The condition of reaching 60 years of age and being transitioned from the Department of
Children and Families (DCF) Services, Community Care for Disabled Adults (CCDA) or Home Care for
Disabled Adults (HCDA) services to the Department's community -based services.
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and coordinated service
delivery system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the
Older Americans Act and Department instructions. The Area Plan includes performance measures and unit
rates per service offered per county.
Area Plan Update: A revision to the area plan wherein the area agency on aging enters IICE program
specific data in the CIRTS. An update may also include other revisions to the area plan as instructed by the
Department.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to
remain independent and in the least restrictive living arrangement. DOEA Form 701B is used by case
managers to conduct the functional assessment.
1.2 GENE, RAL DESCRIPTION
1.2.1 General Statement
Area Agencies on Aging may contract with CCE lead agencies or other case management entities for the
provision of the HCE program. Approved caregivers receive a Basic Subsidy to reimburse some of their
expenses each month for caring for the consumer and may receive a Special Subsidy for other necessary
services and essential supplies. Caregivers may be approved for up to three HCE clients in their home.
1.2.2 Horne Care for the Elderly Program Mission Statement
The Horne Care for the Elderly Program supports family style living arrangements, on a non -profit basis, as an
alternative to musing homes or other institutional care. Through the program, a caregiver for three or fewer elders ^
4
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living in a private home provides basic services of maintenance and supervision as well as coordinating other
necessary specialized services.
1.2.3 Authority
The relevant authority governing the HCE prograrn include:
(1) Rule Chapter 58HA, Florida Administrative Code; and
(2) Sections 430.601 through 430.608, F.S.
1.2.4 Scope of Set-vice
The Contractor is responsible for the programmatic, fiscal, and operational management of HCE. The
program services shall be provided in a manner consistent with and described in the Contractor's Request for
Proposal, RFP, and the Agency's current area plan and the current Department of Elder Affairs Programs
and Services Handbook, located on the DOEA website, http:// elderaffairs .state.fl.us /doea/nois.plip.
1.2.5 Major Program Goals
The major goals of the HCE program are to ensure that:
(1) Basic Subsidy is provided to the caregiver of each client and
(2) Special Subsidy is provided when essential to the well-being of the client.
1.3 INDIVIDUALS TO BE SERVED
1.31 General Eligibility
The Home Care for the Elderly program serves elders age 60 and older at risk of placement in a nursing
home or other institutional settings who can remain in a family style setting through the provision of
subsidies.
.3.2 Client Eligibility
Clients eligible to receive services under this contract must:
(1) Be 60 years of age or older;
(2) Have income no greater than the Institutional Care Program (ICP) standard;
(3) Meet the ICP asset limitation;
(4) Be at risk of nursing home placement;
(5) Have an approved adult caregiver living in the home with them who is willing and able to provide
care or assist in arranging for care; and
(6) Not be enrolled in a Medicaid capitated long -term care program.
1.3.3 Caregiver Eligibility
Caregivers eligible to receive services under this contract must:
(1) Be at least 18 years of age;
(2) Be capable of providing a family -type living environment;
(3) Be a relative or a friend who has been accepted by the client as a surrogate family or is a responsible
adult with whom the client has made an arrangement to provide home care services;
(4) Be willing to accept responsibility for the social, physical and emotional needs of the care recipient;
(5) Be physically present and live in the home to provide supervision and to assist in arrangement of services
for the client;
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(6) Maintain the residential dwelling free of conditions that pose an immediate threat to the life, safety,
health and well -being of the home care client; and
(6) Be without record of conviction of abuse, neglect or exploitation of another person.
1.3.4 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at
risk of placement in an institution.
SECTION 11: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the HCE program, the Contractor shall perform or ensure the performance of its
Subcontractors, for the following tasks:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible Clients; and
(4) Monitoring the performance of its Subcontractors.
2.1.1. Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a
client is based on meeting the requirements in ATTACHMENT I, Section 1.3.
2.1.2 Assessment and Prioritization of Service Delivery for New Clients
The Contractor shall ensure the following criteria are used to prioritize new clients for service delivery. It is
not the intent of the Agency to remove existing clients from any services in order to serve new clients
being assessed and prioritized for service delivery.
2.1.2.1
2.1.2.2
Priority Criteria for Service Delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred to the conununity;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the
community;
(3) hndividuals in nursing homes that are closing and can be discharged to the community; or
(4) Individuals whose mental or physical health condition has deteriorated to the degree self -care is not
possible; there is no capable caregiver, and institutional placement will occur within 72 hours;
(5) For the purpose of transitioning individuals receiving Community Care for Disabled Adults (CCDA)
and Home Care for Disabled Adults (HCDA) services through the Department of Children and Families
(DCF) Adult Services to community-based services provided through the Department, when services
are not currently available, area agency on aging staff and lead agency case managers shall ensure that
"Aging Out" individuals are prioritized for services only after Adult Protective Services (APS) High
Risk and hmminent Risk individuals.
Priority Criteria for Service Delivery for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means of service
delivery, Functional impairment shall be determined through the Agency's consumer assessment form
administered to each applicant. The most frail individuals not prioritized above will receive services to the
extent funding is available.
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2.1.3 Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meet the diverse needs of the
110� functionally impaired elders and their caregivers. The Contractor shall ensure Basic Subsidy and Special
Subsidy services are performed in accordance with the current Department of Elder Affairs Programs and
Services Handbook.
2.1.3.1 Basic Subsidy
The Basic Subsidy is a cash payment made to an approved caregiver each month to reimburse some expenses
incurred in caring for the client. The Basic Subsidy is provided for support and maintenance of the care
recipient, including housing, food, clothing, and medical costs not covered by Medicaid, Medicare or any
other insurance. A Basic Subsidy shall be paid to approved caregivers when the client is in the home for any
part of the month. If the client is hospitalized or in any other temporary institution for 30 days or less, the
full Basic Subsidy shall be provided to the caregiver as if the client were in the home.
2.1.3.1.1 Calculating the Basic Subsidy
The Basic Subsidy shall be based on the financial status of the client receiving care. In the event that both
a husband and wife are clients, their combined financial status shall be used to determine the amount of the
Basic Subsidy.
2.1.3.2 Special Subsidy Services
Though every eligible HCE client receives a Basic Subsidy, Special Subsidy payments are pre - authorized and
are based on additional specialized medical or health care services, supplies or equipment needed to maintain
the health and well -being of the individual elder. The Special Subsidy for additional medical support and
special services is a cash payment to reimburse the costs of any other service or special care not covered by
Medicaid, Medicare, or private insurance when these services are determined to be essential to maintain the
well -being of the home care recipient, A Special Subsidy shall be paid to the approved caregivers when the
client is in the home for any part of the month. Special Subsidy Services may be authorized through a vendor
agreement. All Special Subsidy services must be performed in accordance with the Department of Elder Affairs
Programs and Services Handbook. Special Subsidy services include:
(1) Adult Day Care;
(2) Adult Day Health Care;
(3) Caregiver Training/Support;
(4) Chore;
(5) Chore (Enhanced);
(6) Counseling (Gerontological);
(7) Counseling (Mental Health /Screening);
(8) Home Delivered Meals;
(9) Home Health Aide Service;
(10) Homemaker;
(11) Housing Improvement;
(12) Vendor Payment;
(13) Material Aid;
(14) Occupational Therapy;
(15) Other•,
(16) Outreach;
(17) Personal Care;
(18) Physical Therapy;
(19) Respite (Facility Based or In- Home);
(20) Skilled Nursing Services;
(21) Specialized Medical Equipment, Services and Supplies;
(22) Speech Therapy; and
(23) Transportation.
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2.1.3.3 ACCESS TO AND COOI.<D NATION OF SERVICES
The contractor shall ensure through case management and case aide services, that the HCE clients' needs
are documented and needed services are planned, arranged and coordinated for the client and caregiver.
2.1.4 Use of Subcontractors
If this contract involves the use of a Subcontractor or a third party, then the Contractor shall not delay the
implementation of its agreement with the Subcontractor. If any circumstances occur that may result in a
delay for a period of 60 days or more of the initiation of the subcontract or in the performance of the
Subcontractor, the Contractor shall notify the Contract Manager and the Agency's Chief Financial
Officer in writing of such delay.
2.1.4.1 The Contractor shall not permit a Subcontractor to perform services related to this agreement without
having a binding Subcontractor agreement executed. In accordance with Section 23.1 of the Master
Contract, the Agency will not be responsible or liable for any obligations or claims resulting from such
action.
2.1.4.2 Monitoring the Performance of Subcontractors
The Contractor shall monitor at least once per year each of its Subcontractors, Subrecipients, Vendors
and /or Consultants paid from funds provided under this contract. The Contractor shall perform fiscal,
administrative and programmatic monitoring to ensure contractual compliance, fiscal accountability,
programmatic performance, and compliance with applicable state and federal laws and regulations. The
Contractor shall monitor to ensure that time schedules are met, the budget and scope of work are
accomplished within the specified time periods and other performance goals stated in this contract are
achieved.
2.2. SERVICE TIMES
2.2.1 Service Times
The Contractor shall ensure the services listed in this contract are available at times appropriate to meet
client service needs at a minimum, during nonnal business hours. Normal business hours are defined as
Monday through Friday, 8:00am to 5:00pm.
2.3 DELIVERABLES
2.3.1 Service Unit
The Contractor shall ensure the provision of the services described in the contract in accordance with the
current Department of Elder Affairs Programs and Services Handbook and the service tasks described in
Section 2.1. The chart below lists the types of services allowed and the unit of measurement. Units of
service will be paid pursuant to the rate established in the Area Plan as updated and shown in
ATTACHMENT VII and approved by the Agency's reporting requirements.
Remainder of page intentionally left
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2.4 REPORTS
The Contractor shall respond to additional routine and /or special requests for information and reports
required by the Agency in a timely manner as determined by the Contract Manager. The Contractor shall
establish due dates for any Subcontractors that permits the Contractor to meet the Agency's reporting
requirements.
2.4.1 Client Information and Registration Tracking System ( CIRTS) Reports
The Contractor shall input HCE specific data into CIRTS to ensure CIRTS data accuracy. The Contractor
shall use CIRTS generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports;
(4) Miscellaneous Reports;
(5) Fiscal Reports;
^, (6) Aging and Disability Resource Center Reports; and
(7) Outcome Measurement Reports.
2.5 RECORDS AND DOCUMENTATION
The Contractor shall ensure the collection and maintenance of client and service information on a
monthly basis from the Client Information and Registration Tracking System ( CIRTS) or any such
system designated by the Agency. Maintenance includes valid exports and backups of all data and
systems according to Agency standards.
2.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System ( CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by the 9th of the month will be for units of service
provided during the previous month from the 1st and up to and including the last day of the month. The
Contractor will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS
Monthly Service Utilization Report, by consumer and by worker identification is generated, verified,
corrected, certified and submitted to the Agency no later than the 20th of the month along with copies of
receipts /services over $150.
0
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Service
Unit of Service
Case Aide
Housing Improvement
Case Management
Physical Therapy
Hour
Chore
Respite (Facility Based or In -Home)
Homemaker
Other
Personal Care
Material Aid
Episode
Specialized Medical Equipment, Services and Supplies
Transportation
One -Way Trip
2.4 REPORTS
The Contractor shall respond to additional routine and /or special requests for information and reports
required by the Agency in a timely manner as determined by the Contract Manager. The Contractor shall
establish due dates for any Subcontractors that permits the Contractor to meet the Agency's reporting
requirements.
2.4.1 Client Information and Registration Tracking System ( CIRTS) Reports
The Contractor shall input HCE specific data into CIRTS to ensure CIRTS data accuracy. The Contractor
shall use CIRTS generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports;
(4) Miscellaneous Reports;
(5) Fiscal Reports;
^, (6) Aging and Disability Resource Center Reports; and
(7) Outcome Measurement Reports.
2.5 RECORDS AND DOCUMENTATION
The Contractor shall ensure the collection and maintenance of client and service information on a
monthly basis from the Client Information and Registration Tracking System ( CIRTS) or any such
system designated by the Agency. Maintenance includes valid exports and backups of all data and
systems according to Agency standards.
2.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System ( CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by the 9th of the month will be for units of service
provided during the previous month from the 1st and up to and including the last day of the month. The
Contractor will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS
Monthly Service Utilization Report, by consumer and by worker identification is generated, verified,
corrected, certified and submitted to the Agency no later than the 20th of the month along with copies of
receipts /services over $150.
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2.5.2 The Contractor and each Subcontractor, among other requirements, must anticipate and prepare for the loss
of information processing capabilities. The routine backing up of all data and software is required to recover n
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. The Contactor shall maintain written policies and procedures for
computer system backup and recovery and shall have the same requirement in its contracts and /or agreements
witli Subcontractors. These policies and procedures shall be made available to the Agency upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
(1) The Contractor- shall ensure services provided under this contract are in accordance with the current
DOEA Programs and Services Handbook;
(2) The Contractor shall timely submit to the Agency all reports described in SECTION 2.4,
REPORTS; and
(3) The Contractor shall timely submit to the Agency all information described in SECTION 2.5,
RECORDS AND DOCUMENTATION.
2.6.2 The Contractor shall develop and document strategies in the Area Plan to support performance achievement
of the following:
(1) Percent of most frail elders who remain at home or in the commmunity instead of going into a nursing
home;
(2) Average monthly savings per consumer for home and community -based care versus nursing home care
for comparable group clients;
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(4) Percent of new service recipients with high -risk nutrition scores whose nutritional status improved;
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(7) Percent of family and family- assisted caregivers who self - report they are likely to provide care;
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(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor); and
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community based services;
The Contractor's performance of these measures will be documented in the Agency's annual monitoring
reports.
2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS
Subsidy payments for each client and for the program overall must be maintained within the amount of
program funding available.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide to the Contractor guidance and technical assistance as needed to ensure the
successful fulfillment of the contract by the Contractor.
2.8.2 Contract Monitoring
The Agency will review and evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or
an onsite visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor
agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and
deliverables. The Agency may use, but is not limited to, one or more of the following methods for
monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow -up on -site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third -party documents and /or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed -upon procedures review by an external auditor or consultant;
(9) Limited -scope reviews; and
(10) Other procedures as deemed necessary.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for administration costs, and
fixed rate for services. The Contractor shall ensure fixed rates for services include only those costs that are
in accordance with all applicable state and federal statutes and regulations and are based on audited historical
costs in instances where an independent audit is required. The Contractor shall consolidate all requests for
payment from Subcontractors and expenditure reports that support requests for payment and shall submit to
the Agency on forms 106H (ATTACHMENT I)X) and 105H (ATTACHMENT X).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary,
ATTACHMENT VII to this contract. To request a budget line item change between the budget categories
of Case Management and Subsidies, the Contractor must submit the request in writing with a revised contract
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budget and receive writt, pproval from the Agency's Contract Mai ,r. Any chat. 10/13/2015 16.D.6.
amounts of the funds identified on the Budget Summary form require a contract amendment.
3.2 Advance Payments
3.2.1 The Contractor may request up to two months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the Agency and the Department by the State of Florida ( "budget release"), The
Contractor shall provide the Contract Manager documentation justifying the need for an advance and
describing how the funds will be distributed.
3.2.2 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient budget is
available, the Agency will issue approved advance payments after July 1, 2014.
3.2.3 All advance payments made to the Contractor shall be returned to the Agency as follows: one-
tenth of the advance payment received shall be reported as advance recoupment on each request for
payment, starting with report number five (5), in accordance with the invoice schedule as shown on
ATTACHMENT VIII to this contract.
3.2.4 The Contractor may temporarily place advanced funds in a FDIC insured interest bearing account. All interest
earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of
each quarter of the contract period.
3.3 Invoice Submittal and Requests for Payment
All requests for payment documentation and expenditure reports submitted to support requests for payment
shall be on DOEA forms 106H (ATTACHMENT IX) and 105H (ATTACHML+ NT X). The Contractor
shall include with its request for payment documentation of services provided, the units of services provided,
and the rates for the services provided in conformance with the requirements as described in the deliverables
and service tasks.
3.3.1 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.
3.3.2 If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and /or services not
meeting such standards will not be reimbursed under this contract. The Contractor's signature on the request for
payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor shall
solely bear the costs associated with preparing or providing nonconforming goods and /or services. The
Agency requires immediate notice of any significant and /or systemic infractions that compromise the quality,
security or continuity of services to clients.
3.3.3 Financial Consequences
Contractor shall ensure the provision of services to the projected number of clients in accordance with the Area
Plan as updated and within the contract amount. The Contractor shall ensure expenditure of 100% of the
contract amount budgeted for services to clients at the unit rates established in the Area Plan. In the event the
Contractor has a surplus of 1% or more at the end of the contract term, the Agency will reallocate 1% of the
budget for the next year contract term to other area agencies found to be serving clients to the fullest extent of
their allocated budgets. If, or to the extent, there is any conflict between this paragraph and paragraphs 39
and 39.1 of the Master Contract, this paragraph shall have precedence.
3.3.4 All payment requests 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 and invoices is
ATTACHMENT VIII to this contract.
12
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10/13/2015 16.D.6.
3.3.5 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in section 26 of this contract.
3.3.6 Payment may be authorized only for allowable expenditures, which are in accordance with the limits
specified in ATTACHMENT VII, Budget Summary.
3.3.7 Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services
provided through June 25, 2015, must be submitted to the Contract Manager no later than June 25, 2015,
3.3.5 Date for Final Request for Payment
The final request for payment is due to the Contract Manager no later than Augrist 1, 2015.
3.4 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.4. Scope of Services are
performed pursuant to contract requirements, and as described in Section 2.3., Deliverable in this
contract. If at any time the Contractor is notified by the Agency's 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 Contract Manager that addresses the
identified deficiency and states how the deficiency will be remedied within a time period approved by
the 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 may also assess a financial consequence for failure to timely submit a CAP. In the event
Contractor fails to correct an identified deficiency withui the approved time period specified in the CAP,
the Agency shall deduct, from the payment of the invoice for 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 may also deduct, from the payment of the invoice for the following month, 1% of the
monthly value of the administrative funds in the contract for each day the Contractor fails to timely
submit a CAP, beginning the I Ith day after notification by the Contract Manager of the deficiency. If,
or to the extent, there is any conflict between this paragraph and paragraphs 39 and 39.1 of the Master
Contract, this paragraph shall have precedence.
3.5 Documentation for Payment
The Contractor shall maintain documentation to support payment requests that shall be available to the
Agency or authorized individuals, such as Department of Financial Services, upon request.
3.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System (CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by the 9th of the month will be for units of service
provided during the previous month from the 1st and up to and including the last day of the month. The
Contractor will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS
Monthly Service Utilization Report, by consumer and by worker identification is generated, verified,
corrected, certified and submitted to the Agency no later than the 20th of the month along with copies of
receipts /services over $150.
13
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3.5.2 The Agency requires the Contractor to enter all required data per the Department's CIRTS Policy
Guidelines for clients and services in the CIRTS database. The data must be entered into the CIRTS before
the Contractor submits their request for payment and expenditure reports to the Agency. The
Agency shall establish tune frames to assure compliance with due dates for the requests for payment and
expenditure reports to the Agency.
3.5.3 The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is
accurate. This report must be submitted to the Agency with the monthly request for payment and
expenditure report and must be reviewed by the Agency before the Contractor's request for payment and
expenditure reports can be approved by the Agency.
Remainder of page intentionally left
16
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10/13/2015 16.D.6.
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
n CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA I AMOUNT
I TOTAL STATE AWARD I $0
STATE FINANCIAL ASSISTANCE SUBJECT TO See. 215.97. F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Home Care for the Elderly
General Revenue - Collier
65010
$30,836.00
TOTAL AWARD
1 $30,836.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin. Code
j7
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HC: 10/13/2015 16.D.6.
ATTACHMENT V11
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of County Commissioners
Collier
HCE Case Management /Case Aide $ 2,400.00
HCE Basic and Special Subsidies 28,436.00
Total $ 30,836.00
RATE SUMMARY
Collier County Board of County Commissioners
Collier
SERVICES REIMBURSEMENT RATE
Collier
Case Management $60.00
Case Aide $33.88
is
Packet Page -1117-
July 2014 —June 2015
INVOICE SCHEDULE
Report Number
Based On
1
July Advance*
2
August Advance*
Monthly Utilization Report (7/1 -7/15)
3
July Expenditure Reports (105 & 106)
Monthly Utilization Report (7/16 -8/15)
4
August Expenditure Report (105 & 106)
Monthly Utilization Report (8/16 -9/15)
5
September Expenditure Report (105 & 106)
Monthly Utilization Report (9/16- 10/15)
6
October Expenditure Report (105 & 106)
MontWy Utilization Report (10/16 - 11/15)
7
November Expenditure Report (105 & 106)
Monthly Utilization Report (11/16 -12/15
8
December Expenditure Report (105 & 106)
Monthly Utilization Report (12/16 -1/15)
9
January Expenditure Report (105 & 106)
Monthly Utilization Report (1 /16 -2/15)
10
February Expenditure Report (105 & 106)
Monthly Utilization Report (2/16 -3/15)
11
March Expenditure Report (105 & 106)
n
Monthly Utilization Report (3/16 -4/15)
12
April Expenditure Report (105 & 106)
Monthly Utilization Report (4/16 -5/15)
13
May Expenditure Report (105 & 106)
Monthly Utilization Report (5/16 -6/15)
14
June Expenditure Report (105 & 106)
Monthly Utilization Report (6/15 -6/30)
15
Final Expenditure Report (105 & 106)
16
Closeout Report (105 & 106)
Legend: * Advance based on projected cash need.
Hch LUJ' 14
A 10/13/2015 16.D.6.
Submit to Agency on this hate
July 1
July 1
July 20
August 9
August 20
September 9
September 20
October 9
October 20
November 9
November 20
December 9
December 20
January 9
January 20
February 9
February 20
March 9
March 20
April 9
April 20
May 9
May 20
June 9
June 20
July 9
July 20
August 1
August 15
Note # 1: Report 41 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging
for Southwest Florida, Inc. prior to July 1 or until the contract with the Agency has been
executed and a copy sent to the Agency on Aging for Southwest Florida, Inc. Actual submission
of the vouchers to the Agency is dependent on the of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the Agency as follows: one -- tenth
of the advance payment received shall be reported as an advance recoupment on each request for
payment, starting with report number five. The adjustment shall be recorded in Part C, Line 1 of
the report (ATTACHMENT X).
Note 93: 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.
19
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July 2014 - June 2015
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
HCE 203.14
A 10/13/2015 16.D.6.
RECIPIENT NAME, ADDRESS, PHONE #and FEID#
TYPE OF PAYMENT
This Request Period: From To:
Regular
Contract Period
Contracl#
Advance - _ _ _
Report#
PSA#
CERTIFICATION: thereby certify to the best of my knowledge that this request is complete and correct and conforms with the terms and (he purposes of the above contract.
Prepared by: Date: Approved by: Date:
PARTA'. BUDGET SUMMARY
AAAAdmin.
Case Management
Subsidies
TOTAL
1Approved Contract Amount
$0.00
$ODD
$0.00
$0.00
2. Previous Funds Received for Contract Period
$0.00
$O.OD
$0.00
$0.00
3. Contract Balance (line 1 minus line 25
$0.00
$0.00
$0.00
$0.00
4. Previous Funds Requested and Not Received for Contract Period
$ODD
$0.00
$0.00
$0.00
S.CONTRACT BALANCE Qine 3 minus line 4)
$0.00
$0.00
$0.00
$0.00
PART B. CONTRACT FUNDS REQUEST
i.Anticipated Cash Need (1sl2nd months)
$0.00
$0.00
$0.00
$0.00
2. Net Expenditures For Month
$0.00
$0,00
$0.00
$O.DD
(DOEA Form 1051 -( Part 8, Line 4)
3.TOTAL
$ODO
$0.00
$0.00
$0.00
PART C: NET FUNDS REQUESTED
1. Less Advance Applied
$000
$0 DO
$ODO
$0.00
2 TOTAL FUNDS REQUESTED (Part 8 Line 3, minus Part C Line 1)
$O.OD
$0.00
$0.00
$0.00
ListofServices /Units /Rates provided See atlachedreport_
DOEA FORM 106H
Revised 5!4/12
E
Packet Page -1119-
July LU14 -June 2U15
RECEIPTAND EXPENDITURE REPORT HOME CARE
FOR THE ELDERLY PROGRAM
HCE 203.14
10/13/2015 16.D.6.
PROVIDER NAME,ADDRESS, PHONE# and FEID#
Program Funding:
THIS REPORT PERIOD:
From To
AAAAdmin.
CONTRACT PERIOD:
Case Management
CONTRACT#
Subsidies:
REPORT#
Basic
Spedal
PSA#
CERTIFICATION. Icertify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
Prepared by : Date: Approved by : Date:
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2.Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budqet
1. State Funds
$0.00
$0.00
$0.00
#DIV /01
2. TOTAL RECEIPTS
$0.00
$000
$0.00
#DIV /0 t
PART B: EXPENDITURES
1.Approved
2. Expenditures
3.Expendtures
4. Percent of
Budget
For This Report
Year to Date
Approved Budqet
$0.00
$0.00
$ODO
#DIV /01
1. AAA Program Admiristration
2. Service Subcontractors: Case Management
$0.00
$0A0
$0.00
#DIV 10 1
Service Subcontractors: Subsidy
$0.00
$0.00
$0.00
#DIVIO 1
a. Basic Subsidy
$0.00
$0,00
$0.00
#DIV /01
b. Special Subsidy
$0.00
$ODO
$0.00
#DIV /01
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
4DIV /01
PART C:OTHER REVENUE AND EXPENDITURES
I. Interest:
II.Advance Recoupment
1 Earned onGRAdvance$
2. Return of G Advance $
1. Advance Recouped $
3. Other Earned $
DOEA FORM 105H
Revi -d 512 51 201 0
>I
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r ,
Agreement /Contract Plumber HCE 203.14
Amendment Number n/a
1, Stenhcn Y. Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreerent /contract content.
Signature of Recipient /Contractor representative
Packet Page -1121-
luiv 31.. 2014
Date
July 2014
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
MASTER CONTRACT FOR
FEDERAL AND STATE PROGRAMS
10/13/2015 16.D.6.
Contract #HM203.14
THIS MASTER 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, the status to be further identified in
ATTACHMENT 11, Exhibit -1 as necessary.
Purpose of Contract:
The purpose of this Master Contract is to establish the Agency's standard terms and conditions for services
provided in any contract or agreement incorporating this Master Contract by reference including all attachments,
forms and exhibits, which constitute the contract document.
The Contractor agrees to provide the services specified in each contract or agreement incorporating this Master
Contract during the period this contract is in effect.
The Contractor agrees that this Master Contract covers all services provided by the Contractor under contracts or
agreements with the Agency which incorporate this Master Contract by reference.
Agency Mission Statement:
To lead and cultivate relationships with our community partners to better serve the dynamic aging and disability
networks through education, advocacy, program development and resources.
2. Incorpwation of Documents within the Contract or Agreemenh
^ All contracts or agreements including attachments, proposal(s), solicitation(s), state plan(s), grant agreements,
relevant Department handbooks, manuals or desk books executed between the Contractor and the Agency
shall incorporate this Master Contract by reference and be subject to the conditions set forth in this Master
Contract for the duration of the contract period(s). Any and all contracts or agreements executed between the
Contractor and the Agency during the effective period of this Master Contract will incorporate this Master
Contract by reference and shall be governed in accordance with the applicable laws, statutes, and other conditions
set for in this Master Contract.
Incorporation of Reference Memoranda:
In accordance with Chapter 287 F.S., amended, and Department of Financial Services' Chief Financial Officer
Memoranda, the following memoranda are hereby incorporated by reference:
(1) CFO Memo No. 02: Release date, October 3, 2012;
(2) CFO Memo No. 06: Release date, June 27, 2012;
(3) CFO Memo No. 01: Release date, July 26, 2012; and
(4) CFO Memo No. 04: Release date, June 30, 2006
3. Term of Master Contract:
This .Master Contract will become binding at twelve (12:00) A.M., Eastern Standard Time on duly 1. 2014 or on
the date the Master 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 dune 30.2017.
4. Cj?m12liance with Federal Lai;:
4.1 If any contract and agreement contains federal funds this section shall apply.
I
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Contract 4HM203.14
4.1.1 The Contractor shall comply with the provisions of 45 CFR 74 and /or 45 CFR 92, and other applicable
regulations.
4.1.2 If the contract and agreement contains federal funds and is over $100,000.00, the Contractor shall
comply with all applicable standards, orders, or regulations issued under s. 306 of the Clean Air Act as
amended (42 U.S.C. 7401., et seq.), s. 508 of the Federal Water Pollution Control Act as amended (33
U.S.C. 1251, et seq.), Executive Order 11738, as amended, and where applicable Environmental
Protection Agency regulations 40 CFR 30. The Contractor shall report any violations of the above to
the Agency.
4.1.3 The Contractor, or agent acting for the Contractor, may not use any federal finds received in
connection with any contract and agreement to influence legislation or appropriations pending before
the Congress or any State Legislature. If any contract or agreement contains federal funding in excess
of $100,000.00, the Contractor must, prior to contract execution, complete the Certification Regarding
Lobbying form, ATTACHMENT 1. All disclosure forms as required by the Certification Regarding
Lobbying form must be completed and returned to the Contract Manager prior to payment under any
contract or agreement.
4.1.4 In accordance with Appendix A to 2 CFR 215, the Contractor shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as
supplemented in Department of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
4.1.5 A contract or agreement award with an amount expected to equal or exceed $25,000.00 and certain
other contract or agreement awards will not be made to parties listed on the government -wide
Excluded Parties List System, in accordance with the OMB guidelines at 2 CFR 180 that implement
Executive Orders 12549 and 12689, "Debarment and Suspension." The Excluded Parties List System
contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as
parties declared ineligible under statutory or regulatory authority other than Executive Order 12549.
The Contractor shall comply with these provisions before doing business or entering into subcontracts
receiving federal funds pursuant to any contract or agreement. The Contractor shall complete and sign
ATTACHMENT IV prior to the execution of this Master Contract.
4.2 The Contractor shall not employ an unauthorized alien. The Agency will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.C. 1324a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. l 101). Such violations will be cause for unilateral cancellation of
this Master Contract and any /all contracts or agreements by the Agency.
4.3 If the Contractor is a non -profit provider and is subject to Internal Revenue Service (IRS) tax exempt
organization reporting requirements (filing a Form 990 or Form 990 -N) and has its tax exempt status revoked
for failing to comply with the filing requirements of the Pension Protection Act of 2006 or for any other
reason, the Contractor must notify the Agency in writing within thirty (30) days of receiving the IRS
notice of revocation.
4.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
4.5 Unless exempt under 2 CFR Part 170.110(b), the Contractor shall comply with the reporting requirements of
the Transparency Act as expressed in 2 CFR 170.
4.6 To comply with Presidential Executive Order 12989 and State of Florida Executive Order Number 11 -116,
the Contractor agrees to utilize the U.S. Department of Homeland Security's E- verify system to verify the
employment of all new employees hired by Contractor during the contract or agreement term. The Contractor
shall include in related subcontracts a requirement that Subcontractors performing work or providing services
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Contract 4HM203.14
pursuant to the state contract utilize the E- verify system to verify employment of all new employees hired by
the Subcontractor during any contract or agreement term. Contractors meeting the terms and conditions of the
E- Verify System are deemed to be in compliance with this provision. The Contractor shall complete and sign
ATTACHMENT 3 prior to the execution of this Master Contract.
5. !Zgmpliance with State Law:
5.1 This Master Contract and all contracts or agreements incorporating this Master Contract by reference is
executed and entered into in the State of Florida, and shall be construed, performed and enforced in all
respects in accordance with the Florida taw, including Florida provisions for conflict of laws.
5.2 The Conti-actor shall comply with requirements of s. 287.058, F.S. as amended.
5.2.1 The Contractor shall provide units of deliverables, including various client services, and in some
instances may include reports, findings, and drafts, as specified in this Master Contract and all
contracts or agreement incorporating this Master Contract, which the Contract Manager must receive
and accept in writing prior to payment in accordance with S. 215.971, F.S. (1) and (2).
5.2.2 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient
detail for a proper pre -audit and post - audit.
5.2.3 If itemized payment for travel expenses is permitted in any contract or agreement incorporating this
Master Agreement by reference, the Contractor shall submit bills for any travel expenses in
accordance with s. 112.061, F.S., or at such lower rates as may be provided in this Master Contract
and any contract or agreement incorporating this Master Contract by reference.
5.2.4 The Contractor shall allow public access to all documents, papers, letters, or other public records as
defined in subsection 119.011(12), F.S., made or received by the Contractor in conjunction with any
contract or agreement incorporating this Master Contract, except for those records which are made
confidential or exempt by law. The Contractor's refusal to comply with this provision will constitute
an immediate breach of contract or agreement for which the Agency may unilaterally terminate the
Master Contract and any contract or agreement incorporating the Master Contract.
5.3 if clients are to be transported under any contract or agreement incorporating this Master Contract by
reference, the Contractor shall comply with the provisions of Chapter 427, F.S., and Rule Chapter 41 -2, F.
A. C.
5.4 Subcontractors who are on the discriminatory vendor list may not transact business with any public entity,
in accordance with the provisions of s. 287.134, F.S.
5.5 The Contractor shall comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the
expenditure of contract finds for the purpose of lobbying the legislature, judicial branch or a state agency.
5.6 In accordance with s. 287.135 F.S., any Contractor on the Scrutinized Companies with Activities in Sudan
List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (Lists), created
pursuant to s. 215.473 F.S., is ineligible to enter into or renew a contract or agreement with the Agency for
goods or services of $1 million or more. Pursuant to s. 287.135 F.S., the Agency may terminate this Master
Contract and any contract or agreement incorporating this Master Contract by reference if the
Contractor is found to have submitted a false certification of its status on the Lists or has been placed on the
Lists. Further, the Contractor is subject to civil penalties, attorney's fees and costs and any costs for
investigations that led to the finding of false certification. If any contract or agreement incorporating this
^, Master Contract contains $1 million or more, the Contractor shall complete and sign ATTACHMENT H,
Certification Regarding Scrutinized Companies Lists, prior to the execution of this Master Contract.
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July 2014 Contract 4HM203.14
6. Background Screening:
6.1 The Contractor shall ensure that the requirements of s. 430.0402 and Chapter 435, F.S., as amended, are met
regarding background screening for all persons who meet the definition of a direct service provider and who
are not exempt from the Department's level 2 background screening pursuant to s. 430.0402(2) -(3), F.S. The
Contractor must also comply with any applicable rules promulgated by the Department and the Agency for
l lealth Care Administration regarding implementation of s. 430.0402 and Chapter 435, F.S.
6.2 Further information concerning the procedures for background screening is found at
ittp_Uelderalfair =s.st. kite.fl.us /doea/back(-,round screen inu,.tnht).
6.3 Background Screening Affidavit of Compliance - To demonstrate compliance with section 6 of this
Master Contract, the Contractor shall submit ATTACHMENT G, Background Screening Affidavit of
Compliance annually, by January 15th.
7. Grievance and Comul ,intProcedures:
7.1 Grievance Procedures:
The Contractor shall comply with and ensure subcontractor compliance with the Minimum Guideline for
Recipient Grievance Procedures, Appendix D, Department of Elder Affairs Programs and Services
I landbook, to address complaints regarding the termination, suspension or reduction of services, as required
for receipt of funds.
7.2 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 n
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 the complaint and the determination of the
complaint.
8. Public Records and Retention:
8.1 If, under any contract or agreement incorporating this Master Contract by reference, the Contractor is
providing services and is acting on behalf of the Agency as provided under section 119.011(2),
Florida Statutes, the Contractor, subject to the terms of section 287.058(1)(c), Florida Statutes, and any
other applicable legal and equitable remedies, shall:
a) Keep and maintain public records that ordinarily and necessarily would be required by the public
agency in order to perform the services.
b) Provide the public with access to public records on the same terms and conditions that the Agency
would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida
Statutes, or as otherwise provided by law.
c) Ensure that public records that are exempt or confidential and exempt from public records disclosure
requirements are not disclosed except as authorized by law.
d) Meet all requirements for retaining public records and transfer, at no cost, to the Agency all
public records in possession of the Contractor upon termination or expiration of any contract or
agreement incorporating this Master Contract by reference and destroy any duplicate public records
that are exempt or confidential and exempt from public records disclosure requirements. All records
stored electronically must be provided to the Agency in a format that is compatible with the
information technology systems of the Agency.
J
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n
8.2 The Agency may unilaterally cancel this Master Contract, and any contract or agreement
incorporating this Master Contract by reference, notwithstanding any other provisions of this Master
Contract, for refusal by the Contractor to comply with Section 8 of this Master Contract by not allowing
public access to all documents, papers, letters, or other material made or received by the Contractor in
conjunction with the contract or agreement incorporating this Master Contract by reference, unless the
records are exempt from Section 24(a) of Article I of the State Constitution and Section 119.07(l),
Florida Statutes.
9. Audits Incneetion5 Investigations:
9.1 The Contractor shall establish and maintain books, records and documents (including electronic storage
media) sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures
of funds provided by the Agency under any contract or agreement incorporating this Master Contract by
reference. Contractor(s) shall adequately safeguard all such assets and assure they are used solely for
the purposes authorized under any contract or agreement which incorporates this Master Contract by
reference. Whenever appropriate, financial information should be related to performance and unit cost
data.
9.2 The Contractor shall retain and maintain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent to any contract
or agreement which incorporates this Master Contract by reference for a period of six (6) years after
completion of the contract or agreement incorporating this Master Contract by reference or longer when
required by law. In the event an audit is required for any contract or agreement incorporating this Master
Contract by reference, records shall be retained for a minimum period of six (6) years after the audit report
is issued or until resolution of any audit findings or litigation based on the terms of any contract or
agreement incorporating this Master Contract by reference, at no additional cost to the Agency.
9.3 Upon demand, at no additional cost to the Agency, the Contractor shall facilitate the duplication and
transfer of any records or documents during the required retention period.
9.4 The Contractor shall assure that the records described in this section will be subject at all reasonable times
to inspection, review, copying, or audit by federal, state, or other personnel duly authorized by the
Agency.
9.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Department
and /or Agency and Federal Auditors, pursuant to 45 CFR 92.36(i)(10), will be allowed full access to
and the right to examine any of the Contractor's contracts or agreements, related records and documents
pertinent to any contract or agreement, regardless of the form in which it is kept.
9.6 The Contractor shall provide a financial and compliance audit to the Agency as specified in this Master
Contract and in ATTACHMENT II and ensure that all related third -party transactions are disclosed to the
auditor.
9.7 The Contractor shall comply and cooperate immediately with any inspections, reviews, investigations, or
audits deemed necessary by the office of the Inspector General pursuant to s. 20.055, F.S.
10. Nondiscrimination - iyilRightsCoin lID ances
10.1 The Contractor shall execute assurances in ATTACHMENT V that it will not discriminate against any
person in the provision of services or benefits under any contract or agreement incorporating this Master
Contract by reference or in employment because of age, race, religion, color, disability, national origin,
marital status or sex in compliance with state and federal law and regulations. The Contractor farther
assures that all Contractors, Subcontractors, Subgrantees, or others with whom it arranges to provide
services or benefits in connection with any of its programs and activities are not discriminating against
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clients or employees because of age, race, religion, color, disability, national origin, marital status or sex.
The Contractor shall complete and sign ATTACHMENT V prior to the execution of the Master Contract.
10.2 During the term of any contract or agreement incorporating this Master Contract by reference, the
Contractor shall complete and retain on file a timely, complete and accurate Civil Rights Compliance
Checklist (ATTACHMENT B).
10.3 The. Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination
involving services or benefits through any contract or agreement incorporating this Master Contract by
reference. These procedures will include notifying clients, employees, and participants of the right to file a
complaint with the appropriate federal or state entity.
10.4 If any contract or agreement incorporating this Master Contract by reference, contains federal funds, these
assurances are a condition of continued receipt of or benefit from federal financial assistance, and are
binding upon the Contractor, its successors, transferees, and assignees for the period during which such
assistance is provided. The Contractor further assures that all Subcontractors, Vendors, or others with whom
it arranges to provide services or benefits to participants or employees in connection with any of its
programs and activities are not discriminating against those participants or employees in violation of the
above statutes, regulations, guidelines, and standards. in the event of failure to comply, the Contractor
understands that the Agency may, at its discretion, seek a court order requiring compliance with the
terms of this assurance or seek other appropriate judicial or administrative relief, including but not limited
to, termination of and denial of further assistance.
11. Monitoring by the Agency:
The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records, papers,
documents, facilities, goods and services of the Contractor which are relevant to any contract or agreement which n
incorporate this Master Contract by reference, and to interview any clients, employees and Subcontractor
employees of the Contractor to assure the Agency of the satisfactory performance of the terms and conditions of
any contract or agreement which incorporate this Master Contract by reference. Following such review, the
Agency will provide a written report of its findings to the Contractor, and where appropriate, the Contractor
shall develop a Corrective Action Plan (CAP). The Contractor hereby agrees to correct all deficiencies identified
in the CAP in a timely manner as deter►n ined by the Contract Manager.
12. Provision of Services:
The Contractor shall provide services in the manner to be described in subsequent contracts or agreements
incorporating this Master Contract by reference.
13. Coordinated Monitoring with Other Agencies:
If the Contractor receives funding from one or more of the State of Florida other human service agencies, in
addition to the Department of Elder Affairs and/or the Area Agency on Aging for Southwest Florida, Inc., then a
joint monitoring visit including such other agencies may be scheduled. For the purposes of any contract or
agreement incorporating this Master Contract by reference, and pursuant to s. 287.0575, F.S. as amended,
Florida's human service agencies shall include the Department of Children and Families, the Department of
Health, the Agency for Persons with Disabilities, the Department of Veterans Affairs, and the Department of
Elder Affairs. Upon notification and the subsequent scheduling of such a visit by the designated agency's lead
administrative coordinator, the Contractor shall comply and cooperate with all monitors, inspectors, or
investigators.
14. Indemnification:
14.1 The Contractor- shall indemnify, save, defend, and hold harmless the Agency and its agents and
employees from any and all claims, demands, actions, causes of action of whatever nature or character, �
arising out of or by reason of the execution of this Master Contract and any contract or agreement
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^` incorporating this Master Contract by reference, or performance of the services provided for herein. It is
understood and agreed that the Contractor is not required to indemnify the Agency for claims,
demands, actions or causes of action arising solely out of the Agency's negligence.
14.2 Except to the extent permitted by s. 768.28, F.S., or other Florida law, this section 14 is not applicable to
contracts or agreements executed between the Agency and state agencies or subdivisions defined in s.
768.28(2), F.S.
15. Insurance and Hording:
15.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of any
contract or agreement incorporating this Master Contract by reference and any renewal(s) and
extension(s) of it. By execution of this Master Contract and any contract or agreement incorporating the
Master Contract by reference, unless it is a state agency or subdivision as defined by subsection
768.28(2), F.S., the Contractor accepts fill responsibility for identifying and determining the type(s) and
extent of liability insurance necessary to provide reasonable financial protections for the Contractor and
the clients to be served under this any contract or agreement incorporating this Master Contract by
reference. The limits of coverage under each policy maintained by the Contractor do not limit the
Contractor's liability and obligations under this any contract or agreement incorporating this Master
Contract by reference. The Contractor shall ensure that the Agency has the most current written
verification of insurance coverage throughout the term of any contract or agreement incorporating this
Master Contract by reference. Such coverage may be provided by a self - insurance program established
and operating under the laws of the State of Florida. The Agency reserves the right to require
additional insurance as specified in any contract or agreement incorporating this Master Contract by
reference.
15.2 Throughout the term of any contract or agreement incorporating this Master Contract by reference, the
Contractor shall maintain an insurance bond from a responsible commercial insurance company covering
all officers, directors, employees and agents of the Contractor authorized to handle finds received or
disbursed under all contracts or agreements incorporating this Master Contract by reference in an amount
commensurate with the funds handled, the degree of risk as determined by the insurance company and
consistent with good business practices.
16. Confidentiality of Information:
The Contractor shall not use or disclose any information concerning a recipient of services under any contract or
agreement for any purpose prohibited by state or federal law or regulations except with the written consent of a
person legally authorized to give that consent or when authorized by law.
17. Health Insurance Portability and Accountability Act:
Where applicable, the Contractor shall comply with the Health Insurance Portability and Accountability Act (42
USC 1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 1.62, and 164).
I8. Incident Reporting:
18.1 The Contractor shall notify the Agency immediately but no later than forty -eight (48) hours from the
Contractor's awareness or discovery of conditions that may materially affect the Contractor or
Subcontractor's ability to perform the services required to be performed under any contract or agreement
which incorporate this Master Contract by reference. Such notice shall be made orally to the Contract
Manager (by telephone) with an email to immediately follow.
18.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or
exploitation of a child, aged person, or disabled adult to the Florida Abase Hotline on the statewide toll-
free telephone number (1- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is
binding upon the Contractor, Subcontractors, and their employees.
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19. New Contract(s) RelortiM
The Contractor shall notify the Agency within ten (10) days of entering into a new contract or agreement with any
of the remaining four (4) state human service agencies. The notification shall include the following
Information: (1) contracting state agency; (2) contract name and number; (3) contract or agreement start and end
dates; (4) contract or agreement amount; (5) contract or agreement description and commodity or service; and (6)
Contract Manager name and number. in complying with this provision, and pursuant to s. 287.0575, F.S. as
amended, the Contractor shall complete and provide the information in ATTACHMENT D.
20. BanlcruntcyNotification:
During the term of any contract or agreement incorporating this Master Contract by reference, the Contractor shall
immediately notify the Area Agency on Aging for Southwest Florida, Inc. if the Contractor, its Assignees,
Subcontractor's or Affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Contractor
must also provide the following information to the Area Agency on Aging for Southwest Florida, Inc.: (1) the
date of filing of the bankruptcy petition; (2) the case number; (3) the court name and the division in which
the petition was filed (e.g., Middle District of Florida, Fort Myers, FL); and (4) the name, address, and telephone
number of the bankruptcy attorney.
21. Spon�sorshin and Publicity:
21.1 As required by s. 286.25, F.S., if the Contractor is a non- governmental organization which sponsors a
program financed wholly or in part by state funds, including any fiords obtained through any contract or
agreement incorporating this Master Contract by reference, it shall, in publicizing, advertising, or
describing the sponsorship of the program, state: "Sponsored by (Contractor's name) and the Area
Agency on Aging for Southwest Florida, Inc., and the State of Florida, Department of Elder Affairs." If
the sponsorship reference is in written material, the words the "Area Agency on Aging for Southwest
Florida, Inc. and the State of Florida, Department of Elder Affairs" shall appear in at least the same size
letters or type as the name of the organization.
21.2 The Contractor shall not use the words the "Area Agency on Aging for Southwest Florida, Inc., and the
State of Florida, Department of Elder Affairs" to indicate sponsorship of a program otherwise
financed, unless specific authorization has been obtained by the Agency prior to use.
22. Assignments;
22.1 The Contractor shall not assign the rights and responsibilities under any contract or agreement
incorporating this Master Contract by reference without the prior written approval of the Agency,
which shall not be unreasonably withheld. Any sublicense, assignment, or transfer otherwise occurring
without prior written approval of the Agency will constitute a material breach of the contract or
agreement.
22.2 The State of Florida is at all times entitled to assign or transfer, in whole or part, its rights, duties, or
obligations under any contract or agreement to another governmental agency in the State of Florida, upon
giving prior written notice to the Contractor. In the event the State of Florida approves transfer of the
Contractor's obligations, the Contractor remains responsible for all work performed and all expenses
incurred in connection with the contract or agreement.
22.3 All contracts or agreements incorporating this Master Contract by reference shall remain binding upon the
successors in interest of either the Contractor or the Agency.
23. Subcontracts:
23.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to any
contract or agreement incorporating this Master Contract by reference, whether actually furnished by the
Contractor or its Subcontractors. Any subcontracts shall be evidenced by a written document and subject
to any conditions of approval the Agency deems necessary. The Contractor further agrees that the
Agency will not be liable to the Subcontractor in any way or for any reason. The Contractor, at its
expense, shall defend the Agency against any such claims.
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23.2 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the Agency or
other state agency. Failure to make payments to any Subcontractor in accordance with s. 287.0585, F.S.,
unless otherwise stated in the contract or agreement incorporating this Master Contract by reference
between the Contractor and Subcontractor, will result in a penalty as provided by statute.
23.3 Service Cost Reports — The Contractor shall require Subcontractors to annually submit to the Contractor
service cost reports, which reflect actual costs of providing each service by program. This report provides
information for planning and negotiating unit rates.
24. Funding Obligations:
24.1 The Agency acknowledges its obligation to pay the Contractor for the performance of the
Contractor's duties and responsibilities set forth in any contract or agreement incorporating this Master
Contract by reference.
24.2 The Agency shall not be liable to the Contractor for costs incurred or performance rendered unless
such costs and performances are in accordance with the terms and conditions of any contract or agreement
executed between the parties, which incorporates this Master Contract by reference, including but not
limited to terms, governing the Contractor's promised performance and unit rates and /or reimbursement
capitations specified.
24.3 The Agency shall not be liable to the Contractor for any expenditures which are not allowable costs as
defined in the C.F.R., Title 45, Parts 74 and 92, as amended, or which expenditures have not been made in
accordance with all applicable state and federal rules.
24.4 The Agency shall not be liable to the Contractor for expenditures made in violation of regulations
promulgated under the Older Americans Act, as amended, or in violation of applicable state and federal
laws, rules, or provisions of any contract or agreement incorporating this Master Contract by reference.
25. Independent Capacity of Contracipri
It is the intent and understanding of the Parties that the Contractor, or any of its Subcontractors, are independent
Contractor's and are not employees of the Agency and shall not hold themselves out as employees or agents of
the Agency without specific authorization from the Agency. It is the fi►rther intent and understanding of the Parties
that the Agency does not control the employment practices of the Contractor and will not be liable for any wage
and hour, employment discrimination, or other labor and employment claims against the Contractor or its
Subcontractors. All deductions for social security, withholding taxes, income taxes, contributions to
unemployment compensation funds and all necessary insurance for the Contractor are the sole responsibility of
the Contractor.
26, me
26.1 Payments shall be made to the Contractor pursuant to s. 215.422, F.S., as services are rendered and
invoiced by the Contractor. The Contract Manager will have final approval of the invoice for payment,
and will approve the invoice for payment only if the Contractor has met all terms and conditions of the
contract or agreement incorporating this Master Contract by reference, unless the bid specifications,
purchase order, or the contract or agreement specify otherwise. The approved invoice will be submitted to
the Agency's finance section for budgetary approval and processing. Disputes arising over invoicing and
payments will be resolved in accordance with the provisions of s. 215.422 F.S. A Vendor
Ombudsman has been established within the Department of Financial Services and may be contacted at
850 -413 -5665.
26.2 The Contractor agrees to submit bills for fees or other compensation for services or expenses in sufficient
detail for a proper pre audit and post audit thereof. The contractor shall comply with the particular
requirements under the following laws and guidelines that are applicable to the contracts or agreements
c�
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incorporating this Master Contract by reference: (a) paragraph (16) (b) of section 216.1 8 1, F.S., regarding n
advances; (b) Rule 691- 40.103 F.A.C. pertaining to Restriction of Expendittn•es fi-om state funds; and, (c)
the Invoice Requirements of the Reference Guide for State Expenditures from the Department of
Financial Services at:
(htt // ��ti vtiv. myiloridacfo .comlaadirlreference uuidc /Reference Guide For State Expenditures.pdf).
The Contractor will certify that detailed documentation is available to support each item on the itemized
invoice or payment request for cost reimbursed expenses, fixed rate or deliverables contracts or
agreements incorporating this Master Contract by reference, including paid Subcontractor invoices, and
will be produced upon request by the Agency. The Contractor will further certify that reimbursement
requests are only for allowable expenses as defined in the laws and guiding circulars cited in Sections 4
and 5 of this Master Contract, in the Reference Guide for State Expenditures, and any other laws or
regulations, as applicable, and that administrative expenses do not exceed amounts budgeted in the
Contractor's approved area plan as developed in accordance with and pursuant to section 306(x) of the
Older Americans Act of 1965, as amended.
26.3 The Contractor and Subcontractors shall provide units of deliverables, including reports, findings, and
drafts as specified in the contracts or agreements and attachments which incorporate this Master Contract
by reference, and the area plans developed by the Contractor (pursuant to section 306(a) of the Older
Americans Act), to be received and accepted by the Contract Manager prior to payment.
27. Return of Funds:
The Contractor shall return to the Agency any overpayments due to unearned funds or funds disallowed and any
interest attributable to such funds pursuant to the terns and conditions of any contract or agreement
incorporating this Master Contract by reference that were disbursed to the Contractor by the Agency. In the
event that the Contractor or its independent auditor discovers that an overpayment has been made, the Contractor
shall repay said overpayment immediately without prior notification from the Agency. In the event that the
Agency first discovers an overpayment has been made, the Contract Manager will notify the Contractor in
writing of such findings. Should repayment not be made forthwith, the Contractor shall be charged at the lawful
rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after Agency notification or Contractor
discovery.
28. I?ata Integrity and Safeguarding Info►•mation:
The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or
using in the performance of any contract or agreement incorporating this Master Contract by reference. An
appropriate level of security includes approving and tracking all Contractor employees that request system or
information access and ensuring that user access has been removed from all terminated employees. The
Contractor, among other requirements, must anticipate and prepare for the loss of information processing
capabilities. All data and software shall be routinely backed up to ensure reccvery fror:: losses or outages of the
computer system. The security over the backed -tip data is to be as stringent as the protection required of the
primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system
backup and recovery. The Contractor shall complete and sign ATTACMI 4ENT III prior to the execution of the
Master Contract.
29. Computer Use and Social Media Policy:
The Department of Elder Affairs has implemented a new Social Media Policy, in addition to its Computer Use
Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all
personnel affiliated with third parties, such as, but not limited to, Area Agencies oil Aging and vendors. Any
entity that uses the Department's computer resource systems must comply with the Department's policy regarding
social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds,
video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as
flickr and YouTube. This policy is available on the Department's website at:
http:.'. %� lcieralWf�ur s.st< rte .il.rtslderea!(it�ancial.tnl�p
10
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0. Conflict of Interest;
The Contractor shall establish safeguards to prohibit employees, board members, management. and Subcontractors
from using their positions for a purpose that constitutes or presents the appearance of personal or organizational
conflict of interest or personal gain. No employee, officer or agent of the Contractor or Subcontractor shall
participate in selection, or in the award of an agreement supported by state or federal funds if a conflict of interest,
real or apparent, would be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any
member of his /her immediate family; (c) his or her partner; or (d) an organization which employs, or is about to
employ, any of the above, has a financial or other interest in the firm selected for award. The Contractor or
Subcontractors officers, employees or agents will neither solicit nor accept gratuities, favors or anything of
monetary value from. Contractors, potential Contractors, or parties to subcontracts. The Contractors board
members and management must disclose to the Agency any relationship which may be, or may be perceived to
be, a conflict of interest within thirty (30) calendar days of an individual's original appointment or placement ill
that position, or if the individual is serving as an incumbent, within thirty (30) calendar days of tine
commencement of any contract or agreement incorporating this Master Contract by reference. The Contractors
employees and Subcontractors must make the same disclosures described above to the Contractors Board of
Directors. Compliance with this provision will be monitored.
31. Public Tntity .rune:
Pursuant to s. 287.133, F.S., a person or affiliate who has been placed on the convicted vendor list following a
conviction for a public entity crime may not submit a bid, proposal, or reply on a contract or agreement to provide
any goods or services to a public entity; may not submit a bid, proposal, or reply oil a contract or• agreement with
a public entity for the construction or repair of a public building or public work; may not submit bids, proposals,
or replies on leases of real property to a public entity; may not be awarded or perform work as a Contractor,
Supplier, Subcontractor, or Consultant under a contract or agreement with any public entity; and may not transact
business with any public entity in excess of the threshold amount provided in s. 287.017(2), F.S., for Category
i-� Two for a period of 36 months following the date of being placed on the convicted vendor list.
32, purchasing:
32.1 The Contractor may purchase articles 'which are the subject of or are required to carry out any contract or
agreement from Prison Rehabilitative Industries and Diversified Enterprises, Inc., (PRIDE) identified
under Chapter 946, F.S., in the same manner and under the procedures set forth in subsections 946.51.5(2)
and (4), F.S. For purposes of any contract or agreement incorporating this Master Contract by reference,
the Contractor shall be deemed to be substituted for the Agency insofar as dealings with PRIDE. This
clause is not applicable to Subcontractors unless otherwise required by law. An abbreviated list of
products /services available from PRIDE may be obtained by contacting PRIDE, 800- 643 -8459.
32.2 The Contractor may procure any recycled products or materials, which are the subject of or are required
to carry any contract or agreement incorporating this Master Contract by reference, in accordance with the
provisions of s. 403.7065, F.S.
32.3 The Contractor may purchase articles that are the subject of, or required to carry out, any contract or
agreement from a nonprofit agency for the Blind or for the Severely Handicapped that is qualified
pursuant to Chapter 413, F.S., in the same manner and under the same procedures set forth in s.
413.036(1) and (2), F.S. For purposes of any contract or agreement incorporating this Master Contract by
reference, the Contractor shall be deemed to be substituted for the Agency insofar as dealings with
such qualified nonprofit agency are concerned. Additional information about the designated nonprofit
agency and the products it offers is available at This clause is not
applicable to Subcontractors unless otherwise required by law.
33. Patents<Co vright� sORovalties:
33.1 If any contract or agreement incorporating this Master Contract by reference is awarded state funding and
if any discovery, invention or copyrightable material is developed, produced or for which ownership was
purchased in the course of or as a result of work or services performed under any contract or agreement
ll
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incorporating this Master Contract by reference, the Contractor shall refer the discovery, invention or
material to the Agency to be referred to the Department of State. Any and all patent rights or
copyrights accruing under any contract or agreement incorporating this Master Contract by reference are
hereby reserved to the State of Florida in accordance with Chapter 286, F.S. Pursuant to s. 287.0571 (5)
(k) 1 and 2 as amended, the only exceptions to this provision shall be those that are clearly expressed and
reasonably valued in any contract or agreement incorporating this Master Contract by reference.
33.2 If the primary purpose of any contract or agreement incorporating this Master Contract by reference is the
creation of intellectual property, the State of Florida shall retain an unencumbered right to use such
property, notwithstanding any agreement made pursuant to this section 33.
33.3 If any contract or agreement incorporating this Master Contract by reference is awarded solely federal
finding, the terms and conditions are governed by 2 CPR 215.36.
34. Emet•geneyPrellarednessand ContinuilyofOoerations:
34.1 If the tasks to be performed pursuant to any contract or agreement incorporating this Master Contract by
reference include the physical care and control of clients, or the administration and coordination of
services necessary for client health, safety or welfare, the Contractor shall, within thirty (30) calendar
days of the execution of any contract or agreement, submit to the Contract Manager verification of an
emergency preparedness plan. In the event of an emergency, the Contractor shall notify the Agency of
emergency provisions.
34.2 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall retain
responsibility for performance under any contract or agreement incorporating this Master Contract by
reference and must follow procedures to ensure continuity of operations without interruption.
35. Equi ment:
35.1 Equipment means: (a) an article of nonexpendable, tangible personal property having a useful life of more n
than one year and an acquisition cost which equals or exceeds the lesser of the capitalization level
established by the organization for the financial statement purposes, or $5,000.00 [for federal fields], or (b);
nonexpendable, tangible personal property of a non - consumable nature with an acquisition cost of
$1,000.00 or more per unit, and expected useful life of at least one year; and hardback bound books not
circulated to students or the general public, with a value or cost of $250.00 or more [for state funds].
35.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non -Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A -110) that include: (a) a property list with all the
elements identified in the circular; and, (b) a procedure for conducting a physical inventory of equipment at
least once every two yearns. (c) a control system to insure adequate safeguards to prevent loss, damage, or
theft of the equipment; and (d) maintenance procedures to keep the equipment in good condition. The
property records must be maintained on file and shall be provided to the Agency upon request. The
Contractor shall promptly investigate, fully document and notify the Contract Manager of any loss,
damage, or theft of equipment. The Contractor shall provide the results of the investigation to the Contract
Manager.
35.3 The Contractor's property management standards for equipment acquired with Federal fiends and federally -
owned equipment shall include accurately maintained equipment records with the following information:
(1) A description of the equipment;
(2) Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
(3) Source of the equipment, including the award number; ,^
(4) Whether title vests in the Contractor or the federal government,
(5) Acquisition date (or date received, if the equipment was furnished by the federal government) and
cost;
I -'
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n
(6) information from which one can calculate the percentage of federal participation in the cost of the
equipment (not applicable to equipment furnished by the federal government);
(7) Location and condition of the equipment and the date the information was reported;
(8) Unit acquisition cost; and
(9) Ultimate disposition data, including date of disposal and sales price or the method used to determine
current fair market value where a Contractor compensates the federal awarding agency for its share.
35.4 Equipment purchased with federal finds with an acquisition cost over $5,000.00 and equipment purchased
with state funds with an acquisition cost over $1,000.00 that is specifically identified in the area plan
approved by the Agency is part of the cost of carrying out the activities and functions of the grant
awards and Title (ownership) will vest in the Contractor, subject to the conditions of 2 CFR Part 235
Administrative Requirements (formerly OMB Circular A -110), Subpart C, paragraph 34. Equipment
purchased under these thresholds is considered supplies and is not subject to property standards. Equipment
purchased with funds identified in the budget attachments to agreements covered by any contract or
agreement incorporating this Master Contract by reference, or identified in the sub - agreements with
Subcontractors (not included in a cost methodology), is subject to the conditions of section 273, F. S. and
60A- 1.0017, F. A. C. or Title 45 CFR Part 74.
35.5 The Contractor shall not dispose of any equipment or materials provided by the Agency, or purchased with
funds provided through any contract or agreement incorporating this Master Contract without fast
obtaining the approval of the Contract Manager. When disposing of property or equipment the Contractor
must submit a written request for disposition instructions to the respective Contract Manager. The request
should include a brief description of the property, purchase price, funding source, percentage of state or
federal participation, acquisition date and condition of the property. The request should also indicate the
Contractors proposed disposition (i.e., transfer or donation to another agency that administers federal
programs, offer the items for sale, destroy the items, etc.).
35.6 The Contract Manager will issue disposition instructions. If disposition instructions are not received within
120 days of the written request for disposition, the Contractor is authorized to proceed as directed in 2 CFR
Part 215 Administrative Requirements (formerly OMB Circular A -110).
35.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto,
but excludes movable machinery and equipment. Real property may not be purchased with state or federal
fiords duough agreements covered under any contract or agreement incorporating this Master Contract
without the prior approval of the Agency. Real property purchases from Older Americans Act finds are
subject to the provisions of Title 42, Chapter 35, Subchapter III, Part A., Sec. 3030b United States Code
(USC). Real property purchases from state finds can only be made through fixed capital outlay grants and
aids appropriations and therefore are subject to the provisions of section 216.348, F.S.
35.8 Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and tested
prior to disposal to ensure no confidential information remains.
35.9 The Contractor must adhere to the Agency's procedures and standards when purchasing Information
Technology Resources (ITR) as part of any contract or agreement incorporating this Master Contract by
reference. An ITR worksheet is required for any computer related item costing $1,000.00 or more, including
data processing hardware, software, services, supplies, maintenance, training, personnel and facilities. The
completed ITR worksheet shall be maintained in the LAN administrator's file and must be provided to the
Agency upon request. The Contractor has the responsibility to require any Subcontractors to comply with
the Agency's ITR procedures.
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36. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at: n
littp: //v w�v.myflorida.coin /apps /vbs /adoc /F7740 Pt1RI000.pdf
In the event of any conflict between the PUR 1000 Form and any terms or conditions of any contract or
agreement terms or conditions the contract shall take precedence over the PUR 1000 Form. However, if the
conflicting terms or conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the
terms or conditions contained in the PUR 1000 Form shall take precedence,
37. Use of State Funds to Purchase or Improve Real Property.
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor
or political subdivision granting to the state a security interest in the property at least to the amount of state funds
provided for at least 5 years from the date of purchase or the completion of the improvements or as further
required by law.
38. Distnute Resolution:
Any dispute concerning performance of any contract or agreement incorporating this Master Contract by
reference shall be decided by the Contract Manager, who shall reduce the decision to writing and serve a copy on
the Contractor.
39. Financial Consequences of Non- Performance:
39.1 If the Contractor fails to meet the minimum level of service or performance identified in any contract or
agreement incorporating this Master Contract by reference, or that is customary for the industry, then the
Agency must apply financial consequences commensurate with the deficiency. Financial consequences
may include, but are not limited to, contract or agreement suspension, refusing payment,
withholding payments until the deficiency is cured, tendering only partial payments, and /or cancellation
of any contract or agreement and reacquiring services from an alternate source. n
34.2 The Contractor -will not=be charged with financial: consequences; when °a -- failure to perform arises °out of
causes that were the responsibility of the Agency.
40. No Waiver of Sovereign Immunity:
Nothing contained in any contract or agreement incorporating this Master Contract by reference is intended to
serve as a waiver of sovereign immunity by any entity to which sovereign immunity may be applicable.
41. Venue:
If any dispute arises out of any contract or agreement incorporating this Master Contract by reference, the venue
of such legal recourse will be Lee County, Florida.
42. Entire Contract:
This Master Contract and /or any contract or agreement incorporating this Master Contract by reference, contains
all the terms and conditions agreed upon by the Parties. No oral agreements or representations shall be valid or
binding upon the Agency or the Contractor unless expressly contained herein or by a written subsequent
contract, agreement and /or amendment to this Master Contract signed by both Parties.
43. Force Majeure:
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party experiencing the force majeure condition provides immediate written notification to the other
party and takes all reasonable efforts to cure the condition.
44. Severabil&Clause:
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or n
unenforceable the other provisions are severable to that void provision and shall remain in full force and effect.
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/ `l5. Condition Precedent to Contract A2nronrr iations:
The Parties agree that the Agency's performance and obligation to pay under any contract or agreement
incorporating this Master Contract by reference is contingent upon an annual appropriation by the Legislature.
46. Addition/Deletion:
The Parties agree that the Agency reserves the right to add or to delete any of the services required under any
contract or agreement incorporating this Master Contract by reference when deemed to be in the State of Florida's
best interest and reduced to a written amendment signed by both Parties. The Parties shall negotiate compensation
for any additional services added.
47. Waiver:
The delay or failure by the Agency to exercise or enforce any of its rights under this Master Contract and any
contract or agreement incorporating this Master Contract by reference will not constitute or be deemed a waiver
of the Agency's right thereafter to enforce those rights, nor will any single or partial exercise of any such right
preclude any other or further exercise thereof or the exercise of any other right.
48. Compliance:
The Contractor shall abide by all applicable current federal statutes, laws, rules and regulations as well as
applicable current state statutes, laws, rules and regulations. The Parties agree that failure of the Contractor to
abide by these laws shall be deemed an event of default of the Contractor, and subject any contract or agreement
incorporating this Master Contract by reference, to immediate, unilateral cancellation at the discretion of the
Agency.
49. Final invoice:
The Contractor shall submit the final invoice for payment to the Agency as specified in any contract or
agreement incorporating this Master Contract by reference. If the Contractor fails to submit final request for
payment as specified in any contract or agreement, then all rights to payment may be forfeited and the Agency may
not honor any requests submitted. Any payment due under the terms of any contract or agreement incorporating
this Master Contract by reference may be withheld until all reports due from the Contractor and necessary
adjustments thereto have been approved by the Agency.
50. Renegotiation or Modification
Modifications of the provisions of any contract, agreement, and this Master Contract shall be valid only when
they have been reduced to writing and duly signed by both parties. The rate of payment and the total dollar
amount may be adjusted retroactively for any contract or agreement incorporating this Master Contract by
reference to reflect price level increases and changes in the rate of payment when these have been established
through the appropriations process and subsequently identified in the Agency's operating budget.
51. Suspension of Work:
The Agency may in its sole discretion suspend any or all activities under this Master Contract and any
Contract or agreement incorporating this Master Contract by reference, at any time, when in the best interests of
the State to do so. The Agency shall provide the Contractor written notice outlining the particulars of
suspension. Examples of the reason for suspension include, but are not limited to, budgetary constraints,
declaration of emergency, or other such circumstances. After receiving a suspension notice, the Contractor shall
comply with the notice and shall not accept any purchase orders. Within ninety days, or any longer period agreed
to by the Contractor, the Agency shall either (1) issue a notice authorizing resumption of work, at which time
activity shall resume, or (2) terminate the Contract or purchase order. Suspension of work shall not entitle the
Contractor to any additional compensation.
52. Termination:
52.1 Termination for Convenience. The Agency, by written notice to the Contractor, may terminate the
Master Contract and any contract or agreement incorporating this Master Contract by reference in whole or
in part when the Agency determines in its sole discretion that it is in the State's interest to do so. The
1 =�
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Contractor shall not furnish any product after it receives the notice of termination, except as necessary to
complete the continued portion of the contract, if any. The Contractor shall not be entitled to recover any
cancellation charges or lost profits.
52.2 Termination for Cause. The Agency may terminate the Master Contract and any contract or agreement
incorporating this Master Contract if the Contractor fails to (1) deliver the product within the time specified
in the contract or any extension, (2) maintain adequate progress, thus endangering performance of the
contract, (3) honor any term of the Master Contract and any contract or agreement incorporating this Master
Contract by reference, or (4) abide by any statutory, regulatory, or licensing requirement. Rule 60A-
1.006(3), F.A.C., governs the procedure and consequences of default. The contractor shall continue work on
any work not terminated. Except for defaults of Subcontractors at any tier, the Contractor shall not be liable
for any excess costs if the failure to perform the Contract arises from events completely beyond the control,
and without the fault or negligence, of the Contractor. if the failure to perform is caused by the default of a
Subcontractor at any tier, and if the cause of the default is completely beyond the control of both the
Contractor and the Subcontractor, and without the fault or negligence of either, the Contractor shall not be
liable for any excess costs for failure to perform, unless the subcontracted products were obtainable from
other sources in sufficient time for the Contractor to meet the required delivery schedule. If, after
termination, it is determined that the Contractor was not in default, or that the default was excusable, the
rights and obligations of the Parties shall be the same as if the termination had been issued for the
convenience of the Agency. The rights and remedies of the Agency in this clause are in addition to any
other rights and remedies provided by law or under the Contract.
52.3 Upon expiration or termination of this Master Contract and any contract or agreement incorporating this
Master Contract by reference the Contractor and Subcontractors shall transfer all public records in its
possession to the Agency and destroy any duplicate public records that are exempt or confidential and
exempt from public records, disclosure requirements at no cost to the Agency. All electronically stored
records shall be provided to the Agency in a format that is compatible with the Agency's information
technology system(s).
53. Electronic Records na d Signature:
53.1 The Agency authorizes, but does not require, the Contractor to create and retain electronic records and to
use electronic signatures to conduct transactions necessary to carry out the terms of this Master Contract
and any contract(s) or agreement(s) which incorporate this Master Contract by reference. A Contractor that
creates and retains electronic records and uses electronic signatures to conduct transactions shall comply
with the requirements contained in the Uniform Electronic Transaction Act, s. 668.50, F.S. All electronic
records must be fully auditable; are subject to Florida's Public Records Law, chapter 119, F.S.; must
comply with section 28, Data Integrity and Safeguarding Information; must maintain all confidentiality, as
applicable; and must be retained and maintained by the Contractor to the same extent as non - electronic
records are retained and maintained as required by any contract or agreement incorporating this Master
Contract by reference.
53.2 The Agency's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the Agency. The Contractor is authorized to conduct electronic transactions with the
Agency only upon further written consent by the Agency.
53.3 Upon request by the Agency, the Contractor shall provide the Agency with non- electronic (paper) copies
of records. Non - electronic (paper) copies provided to the Agency of any document that was originally
in electronic form with an electronic signature must indicate the person and the person's capacity
who electronically signed the document on any non - electronic copy of the document.
54. Special Provisions:
The Contractor agrees to the following provisions:
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54.1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part of the Contractor or any Subcontractors and referred to
a governmental or investigatory agency must be sent to the Agency and /or Department. If the Contractor
has reason to believe that the allegations will be referred to the State Attorney, a law enforcement
agency, the United States Attorney's office, or other governmental agency, the Contractor shall notify
the Agency and the Inspector General at the Department immediately. A copy of all documents, reports,
notes or other written material concerning the investigation, whether in the possession of the Contractor
or Subcontractors, must be sent to the Agency and the Department's inspector General with a summary of
the investigation and allegations.
54.2 Volunteers:
The Contractor shall ensure the use of trained volunteers in providing direct services delivered to older
individuals and individuals with disabilities needing such services. If possible, the Contractor shall work
in coordination with organizations that have experience in providing training, placement, and stipends for
volunteers or participants (such as organizations carrying out federal service programs administered by
the Corporation for National and Community Service), in community service settings.
54.3 Enforcement:
54.3.1 In accordance with Section 430.04, F.S., the Agency may, without taking any intermediate
measures available to it against the Contractor, rescind the Contractors designation as a lead
agency, if the Agency finds that:
54.3.2 An intentional or negligent act of the Contractor has materially affected the health, welfare, or
safety of clients served pursuant to any contract or agreement incorporating this Master Contract
by reference, or substantially and negatively affected the operation of services covered under any
contract or agreement;
54.3.3 The Contractor lacks financial stability sufficient to meet contractual obligations or that
contractual fiends have been misappropriated;
54.3.4 The Contractor has committed multiple or repeated violations of legal and regulatory standards,
regardless of whether such laws or regulations are enforced by the Agency, or the Contractor has
committed or repeated violations of Agency standards;
54.3.5 The Contractor has failed to continue the provision or expansion of services after the declaration
of a state of emergency; and /or
54.3.6 The Contractor has failed to adhere to the terms of any contract or agreement incorporating this
Master Contract by reference.
54.3.7 In the alternative, the Agency may, at its sole discretion, in accordance with section 430.04,
F.S., take immediate measures against the Contractor, including: corrective action, unannounced
special monitoring, temporary assumption of the operation of one or more contractual services,
placement of the Contractor on probationary status, imposing a moratorium on Contractor action,
imposing financial penalties for nonperformance, or other administrative action pursuant to
Chapter 120, F.S.
54.3.8 In making any determination under this provision the Agency may rely upon the findings of
another state or federal agency, or other regulatory body. Any claims for damages for breach of
any contract or agreement incorporating this Master Contract by reference are exempt from
administrative proceedings and shall be brought before the appropriate entity in the venue of
Lee County. In the event the Agency initiates action to rescind an area agency on aging's
designation, the Agency shall follow the procedures set forth in 42 U.S.C. § 3025(b).
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54.4 Use of Service Dollars /Wait List Management:
The Contractor will spend all federal, state, and other funds provided by the Agency, for the purpose
specified in each contract or agreement incorporating this Master Contract by reference. The Contractor must
manage the service dollars to ensure that the Assessed Prioritized Consumer List (APCL) contains no
individuals who ]lave been assigned a ranking of four (4) or five (5) when service dollars are available.
If the Agency determines that the Contractor is not spending fiords accordingly, the Agency may transfer
funds to other PSAs during the contract period and /or adjust subsequent funding allocations accordingly, as
allowable under state and federal law.
54.5 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary,
included in each contract or agreement incorporating this Master Contract by reference. Any changes in the
amounts of federal or general revenue funds identified on the Budget Summary form require a contract
amendment.
54.6 Surplus/Deficit Report:
The Contractor will submit a consolidated surplus /deficit report in a format provided by the Agency to
the Agency's Contract Manager by the 15th of each month, "Lead Agency Spending Report." This report is
for all contracts or agreements incorporating this Master Contract by reference between the Contractor and
the Agency. Tine report will include the following
54.6.1 The Contractor's detailed plan on how the surplus or deficit spending exceeding the threshold
of +/- 2 %: and
54.6.2 Recommendations to transfer funds to resolve surplus /deficit spending.
55. All Terms and Conditions Included:
This Master Contract and its Attachments, I – V, A, B, D, G, 14 and J 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 Master 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 leave caused this Master Contract to be executed by their
undersigned officials as duly authorized.
Contractor: COLL +R CO TY BOARD OF AREA AGENN DING FOR
COU� SSIONERS SOUTIIV4'.LC.
SI GNED w.- _..,- `` , SIGNED B
NAME: Tom Henning_ l 1 NAME: RONALD LUCCHI_NO, PhD
TITLE: Chairman TITLE: BOARD / PRESIDENT
DATE: July & 2014 DATE: LIZ .P t I I
—� Pprsave ` U51, orm and legality
Federal Tax ID: 59- 600055 c '
Fiscal Year E ndino Date: 9130 _l t t Assistant Cann nary
Aftest asb Chairman ' � s �
sipattsre only, `'
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Contract 4H.M203.14
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(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 employee of any state or federal agency, a member of congress, an
officer or or
of congress, an employee of a member of congress, or an officer or employee of the state
legislator, in connection with the awarding 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 fiords have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of
congress, or an employee of a member of congress in 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 Subcontractors 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 section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of nql�ess than 010,000.00 and not more than $100,000.00 for each such failure.
Signature
Tom Henning, Chairman
Name of Authorized Individual
Collier County Board of County Commissioners
.t
Attest as to Chairman's .'
g�lature only.
I)(7EA Form 103
(Revised Nov 2002)
July 8, 2014
Date
FU\4203.14
Application or Agreement Number
Approved as to form and legality
A astat�t Coun o�rney 4
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FINANCIAL AND COMPLIANCE AUDIT
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ATTACHMENTII
The administration of resources awarded by the Area Agency on Aging for Southwest Florida, Inc. to the Contractor
may be subject to audits and /or monitoring by the Area Agency on Aging for Southwest Florida, Inc., as described in this
section.
Monitoring
In addition to reviews of audits conducted in accordance with OMB Circular A -133, as revised, and Section 215.97, F.S.,
(see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the Agency staff,
limited scope audits as defined by OMB Circular A -133, as revised, and /or other procedures. By entering into this
agreement, the Contractor agrees to comply and cooperate with any monitoring procedures /processes deemed appropriate
by the Area Agency on Aging for Southwest Florida, Inc. In the event the Area Agency on Aging for Southwest Florida,
Inc. determines that a limited scope audit of the Contractor is appropriate, the Contractor agrees to comply with any
additional instructions provided by the Area Agency on Aging for Southwest Florida, Inc. to the Contractor regarding
such audit. The Contractor further agrees to comply and cooperate with any inspections, reviews, investigations, or
audits deemed necessary by the Chief Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the Contractor is a state or local government or a non - profit organization as defined in OMB
Circular A -133, as revised.
In the event that the Contractor expends $500,000.00 or more in federal awards during its fiscal year, the Contractor must
have a single or program - specific audit conducted in accordance with the provisions of OMB Circular A -133, as revised.
EXHIBIT I to this agreement indicates federal resources awarded through the Department of Elder Affairs by this
agreement. In determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of
federal awards, including federal resources received from the Department of Elder Affairs. The determination of amounts
of federal awards expended should be in accordance with the guidelines established by OMB Circular A -133, as revised.
An audit of the Contractor conducted by the Auditor General in accordance with the provisions of OMB Circular A -133,
as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the Contractor shall fulfill the requirements
relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised.
If the Contractor expends less than $500,000.00 in federal awards in its fiscal year, an audit conducted in accordance with
the provisions of OMB Circular A -133, as revised, is not required. In the event that the Contractor expends less than
$500,000.00 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of
OMB Circular A -133, as revised, the cost of the audit must be paid from non - federal resources (i.e., the cost of such audit
must be paid from Contractor resources obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs shall be based on the agreement's
requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall
disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and
liabilities due to the Department of Elder Affairs shall be fully disclosed in the audit report with reference to the
Department of Elder Affairs agreement involved. If not otherwise disclosed as required by Section .310(b)(2) of OMB
Circular A -133, as revised, the schedule of expenditures of federal awards shall identify expenditures by agreement
number for each agreement with the Department of Elder Affairs in effect during the audit period. Financial reporting
packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9
months after the end of the Contractors fiscal year end.
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ART II: STATE FUNDED
'his part is applicable if the Contractor is a non -state entity as defined by Section 215.97(2), Florida Statutes.
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of $500,000.00 in
any fiscal year of such Contractor (for fiscal years ending September 30, 2004 or thereafter), the Contractor must have a
State single or project- specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable
rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and
for - profit organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial assistance
awarded through the Department of Elder Affairs by this agreement. In determining the state financial assistance
expended in its fiscal year, the Contractor shall consider all sources of state financial assistance, including state financial
assistance received from the Department of Eider Affairs, other state agencies, and other non -state entities. State financial
assistance does not include federal direct or pass - through awards and resources received by a non -state entity for federal
program matchingrequirements.
In connection with the audit requirements addressed in Part II, paragraph 1, the Contractor shall ensure that the audit
complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting
package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650
(nonprofit and for - profit organizations), Rules of the Auditor General.
If the Contractor expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending
September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, Florida
Statutes, is not required. In the event that the Contractor expends less than $500,000.00 in state financial assistance in its
fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the
cost of the audit must be paid from the non -state entity's resources (i.e., the cost of such an audit must be paid from the
Contractor resources obtained from other than state entities).
,__,�,n audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
'ompliance findings related to agreements with the Department of Elder Affairs shall be based on the agreement's
requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or
not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the
Department of Elder Affairs shall be fully disclosed in the audit report with reference to the Department of Elder Affairs
agreement involved. If not otherwise disclosed as required by Rule 691 - 5.003, Fla, Admin. Code, the schedule of
expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the
Department of Elder Affairs in effect during the audit period. Financial reporting packages required under this part must
be submitted within 45 days after delivery of the audit report, but no later than 12 months after the Contractors fiscal year
end for local governmental entities. Non - profit or for -profit organizations are required to be submitted within 45 days
after delivery of the audit report, but no later than 9 months after the Contractors fiscal year end. Notwithstanding the
applicability of this portion, the Department of Elder Affairs retains all right and obligation to monitor and oversee the
performance of this agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and required by
PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A -133, as revised, by or
on behalf of the Contractor directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Marianne G. Lorini, President /CEO
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
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The Federal Audit Clearinghouse designated in OMB Circular A -133, as revised (the number of copies required by
Sections .320 (d)(1) and (2), OMB Circular A -133, as revised, should be submitted to the Federal Audit Clearinghouse), at
the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10 "' Street
Jeffersonville, IN 47132
Other federal agencies and pass - through entities in accordance with Sections .320 (e) and (f), OMB Circular A -133, as
revised.
Pursuant to Sections .320(f), OMB Circular A -133, as revised, the Contractor shall submit a copy of the reporting package
described in Section .320(c), OMB Circular A -133, as revised, and any management letter issued by the auditor, to the
Area Agency on Aging for Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Marianne G. Lorini, President /CEO
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on
behalf of the Contractor directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn-. Marianne G. Lorini, President /CEO
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399 -1450
Any reports, management letter, or other information required to be submitted to the Area Agency on Aging for Southwest
Florida, Inc pursuant to this agreement shall be submitted timely in accordance with OMB Circular A -133, Florida
Statutes, and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of
the Auditor General, as applicable.
Contractors, when submitting financial reporting packages to the Area Agency on Aging for Southwest Florida, Inc. for
audits done in accordance with OMB Circular A -133 or Chapters 10.550 (local governmental entities) or I0.650 (nonprofit
and for -profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was
delivered to the Contractor in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the tenns of this agreement for a period
of six years from the date the audit report is issued, and shall allow the Department of Elder Affairs and /or the
Area Agency on Aging for Southwest Florida, Inc. or its designee, the CFO or Auditor General access to such records
upon request. The Contractor shall ensure that audit working papers are made available to the Area Agency on Aging for
Southwest Florida, Inc., or its designee, CFO, or Auditor General upon request for a period of six years from the date the
audit report is issued, unless extended in writing by the Area Agency on Aging for Southwest Florida, Inc.
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PART I: AUDIT RELATIONSHIP DETERMINATION
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ATTACHMENTH
EXHIBIT 1
Providers who receive state or federal resources mayor may not be subject to the audit requirements of OMB Circular A -133, as
revised, and /or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards or state
financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and /or Pail Il of
Exhibit 1 are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-
133, as revised, and /or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been
determined to be recipients or subrecipients of Federal awards and/or state financial assistance, must comply with applicable
programmatic and fiscal compliance requirements.
In accordance with Sec. 210 of OMB Circular A -133 and /or Rule 691 - 5.006, FAC, provider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A -133 and /or Section 215.97, F.S.
X Recipient /subrecipient subject to OMB Circular A -133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and has been approved by
the Department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 691 - .006(2), PAC [state financial assistance]
and Section 400 OMB Circular A -133 [federal awards].
PART IL FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive federal awards or
state matching fiords on federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules
and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A -87)*
OMB Circular A -102 — Administrative Requirements
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON- PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non - Profit Organizations (Formerly OMB Circular A -122 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -I 10 — Administrative Requirements)
Requirements)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program Iaws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST
FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A -21 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -1 10 — Administrative Requirements)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular
A -133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient /subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 691 -5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
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ATTACHMENT III
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS,
LOANS AND COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the Contractor named in the contract or agreement to which this form is
an attachment, hereby certifies that:
(1) The Contractor and any Subcontractors of services under this contract have financial management systems capable of
providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each
grant - funded project or program in accordance with the prescribed reporting requirements; (2) the source and
application of funds for al.1 agreement supported activities; and (3) the comparison of outlays with budgeted amounts
for each award. The inability to process information in accordance with these requirements could result in a return of
grant funds that have not been accounted for properly.
(2) Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the
Contractor is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be
capable of processing data accurately, including year -date dependent data. For those systems identified to be non-
compliant, Contractors will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the
undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions
of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be
verified for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that n
impede the hardware or software programs from operating properly, the Contractor agrees to immediately make
required corrections to restore hardware and software- programs to the same level of functionality as warranted herein,
at no charge to the state, and without interruption to the ongoing business of the state, time being of the essence.
(4) The Contractor and any Subcontractors of services under this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from
data integrity compliance issues.
The Contractor shall require that tile language ofthis certification be included in all subagreemetits, subgrants, and other
agreenrents and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by
OMB Circulars A -102 and 2,•�'FR Part 215 (formerly OMB Circular A -110).
Signature
Title
Chairman July 8, 2014
Date
Tam Henning�
Name of Authorized Signer
t as to Chairman S 4N Approved as to form and legality
Collier County Board of County Commissioners Slgtiature only. (
(Revised June 2008) � N-
Assistant County ey
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ATTACHMENT IV
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY
EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The Contractor certifies, by signing this certification, neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any federal department or agency.
(2) Where the Contractor is unable to certify to any of the statements in this certification, such prospective
participant shall attach ag explanation to this certification.
r
July S, 2014
Date om -enning
Chairman Collier County Board of County Commissioners
Title Agency /Organization
(Certification signature should be same as Contract signature.)
Instructions for Certification
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction,"
"person," "primary covered transaction," and "Voluntarily excluded," as used herein, have the meanings Set Out
in the sections of rules implementing Executive Order 1.2549. (2 CFR 180.5 - 180.1020, as supplemented by 2
CFR 376.10 - 376.995). You may contact the Contract Manager for assistance in obtaining a copy of those
regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties entered
into this transaction. if it is later determined that the Contractor knowingly rendered an erroneous certification,
in addition to other remedies available to the federal government, the Department may pursue available
remedies, including suspension and/or debarment.
3. The Contractor will provide immediate written notice to the Contract Manager if at any time the Contractor
learns that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances. The Contractor may decide the method and frequency by which it determines the eligibility of
its principals. Each participant to a lower tier covered transaction may, but is not required to, check the
Excluded Parties List System (EPLS).
4. The Contractor will include a Certification Regarding Debarment, Suspension, ineligibility and Voluntary
Exclusion - Lower Tier- Covered Transaction" in all its lower tier covered transactions and in all solicitations
for lower tier covered transactions.
5. The Contractor agrees that it shall not knowingly enter into any Lower- tier covered transaction with a person
who is debarred, suspended, determined ineligible or voluntarily excluded from participation. unless otherwise
authorized by the federal government.
6. If the Contractor knowingly enters into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies
available to the federal government, the Department may pursue available remedies, including suspension,
and /or debarment.
7. The Contractor may rely upon a certification" of a prospective participant in a lower tier covered transaction that
it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows
that the certification is erroneous. Approved as to form and legality
e w AtaaC y t(Rey ;sed tune 2008)
�i
Attest as t GY►artlal�
signature Oilij. Packet Page -1146-
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ASSURANCES— NON - CONSTRUCTION PROGRAMS
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Contract #I-1M203.14
ATTACHMENT V �
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the
collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348 - 0043),
Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the
awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
I. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds
sufficient to pay the non - federal share of project cost) to ensure proper planning, management, and completion of the project
described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any authorized
representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish
a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728 -4763) relating to prescribed standards for merit
systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil
Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or national origin; (b) Title iX of the
Education Amendments of 1972, as amended (20 U.S.C. I681 -1683, and 1685- 1686), which prohibits discrimination on the basis
of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S,C. 794), which prohibits discrimination on the basis
of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101- 6107), which prohibits discrimination on the
basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on
the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism, (g) 523 and 527 of the
Public Health Service Act of 1912 (42 U.&C. 290 dd -3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug
abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s)
under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s)
which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles 11 and III of the uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L. 91 -646) which provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501 -1508 and 7324 - 7328), which finit the political
activities of employees whose principal employment activities are funded in whole or in part with federal funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. 276a to 276a -7), the Copeland Act (40 U.S.C.
276c and 18 U.S.C. 874) and the Contract Work Homy and Safety Standards Act (40 U.S.C. 327 -333), regarding labor standards n
for federally assisted construction subagreements.
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July 2014
�. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of
1973 (P.L. 93 -234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood
insurance if the total cost of insurable construction and acquisition is $ 10,000.00 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental
quality control measures under the National Environmental Policy Act of 1969 (P.L. 91 -190) and Executive Order (EO) 11514;
(b) notification of violating facilities pursuant to EO 1 1738; (c) protection of wetlands pursuant to EO '11990; (d) evaluation of
flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of
federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42
U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
amended, (P.L. 93 -523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L.
93 -205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1721 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. 469a -1 et seq.).
14. Will comply with P.L. 93 -348 regarding the protection of human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 -544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the
care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of
assistance.
7. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), which prohibits the use of lead- based
paint in construction or rehabilitation of residence structures.
17. Will cause to be perforried the required financial and compliance audits in accordance with the Single Audit Act Amendments of
1996 and OMB Circular No. A -133, Audits of States, Local Governments, and Non -Profit Organizations.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED/CERTIFY G OFFICIAL TITLE
f
Tom Henning;, — ' __-� Chairman
APPLICANT ORGANIZATION DATE SUBMITTED
July 8, 2014
Collier County Board of Corrimissio ers
Attest as to Ctlaiii6b s I °
signature only. .
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ATTACHMENT A
DEPARTMENT OF ELDER AFFAIRS PROGRAMS & SERVICES HANDBOOK
Department of Elder Affairs Programs & Services Handbook available at:
Li (scroll to *July 2013 -Notices)
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ATTACHMENT B
� STATE OFFLORIDA DEPARTMENT OF ELDER AFFAIRS CI FIL County AAA /Contractor
RIGIITS COMPLIANCE CHECKLIST Program /Facility Name Collier
Address Completed By
3339 Tamialni Trail E, Suite 211 Lisa N. Cats Grants Coordinator
City, State, Zip Code Date I Telephone
Naples, FL 34112 06/23/2014 239 -252 -2339
PART 1: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE 1N110KMA ttutu wriu rn WIUJ. rrcL.,- I "U .., ... �.._.
THIS FORM.
1. Briefly describe the geographic area served by the program /facility and the type of service provided:
Collier County is situated over a 2,300 square mile area. Collier County Services for Seniors provides in -home care, care management and nutritional services
For questions 2 -5 please indicate the fo
2. Population of area served
3. Staff currently employed
4. Clients currently enrolled /registered
5. Advisory/Governing Board if applicable
[lowing:
Total
White
Black jHipani0thcr
YES
0
NO
❑
Female
Disabled
Over40
Source of data: 201.2 Census
19,320,74978.3%
N/A
16.6%
23.2%
1.9%
51.1%
Effective date: 6/24/14
8
50%
25%
25%
❑
91
❑
10. For in- patient services, are room assignments made without regard to race, color, national origin or disability?
Effective date: 6/24/14
361
NO
❑
❑
11. For in- patient services, are room assignments made without regard to race, color, national origin or disability?
100%
5
NO
I00%
❑
❑
40%
PART H: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO EXPLAIN.
6. Is an Assurance of Compliance on file with DOER?
N/A
❑
YES
0
NO
❑
7. Compare the staff composition to the population. Is staff representative of the population?
/
®S
NO
8. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national
N/A
YES
®
NO
El
origin, sex, age, religion or disability?
❑
9. Are all benefits, services and facilities available to applicants and participants in an equally effective manner
N/A
YES
NO
regardless of race, sex, color, age, national origin, religion or disability?
❑
E
❑
10. For in- patient services, are room assignments made without regard to race, color, national origin or disability?
N/A
YES
NO
❑
❑
11. For in- patient services, are room assignments made without regard to race, color, national origin or disability?
N/A
YES
NO
❑
❑
12. Is the program /facility accessible to non - English speaking clients?
N/A
YES
NO
❑
❑
Revised August 2010, Page 1 of 2
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13. Are employees, applicants and participants informed of their protection against discrimination? If YES, how?
Verbal ❑ Written ❑ Poster ❑
N/A
❑
YES
0
NO
❑
14.Give the number and current status of any discrimination complaints regarding services or employment fled
N/A
NUMBER
against the program/facility.
15. Is the program /facility physically accessible to mobility, hearing, and sight- impaired individuals?
N/A
YES
NO
❑
N
❑
PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. iF NO
EXPLAIN.
16. Has as a self - evaluation been conducted to identify any barriers to serving disabled individuals, and to make any
YES
NO
necessary modifications?
❑
❑
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints?
YES
NO
❑
❑
r\
18. Has a person been designated to coordinate Section 504 compliance activities?
YES
NO
❑
❑
19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on
YES
NO
the basis of disability?
❑
❑
20.Are auxiliary aids available to assure accessibility of services to hearing and sight - impaired individuals?
YES
NO
❑
❑
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR AIORE EDIPLOVLCS AND FEDERAL CONTRACTS OF 550,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain.
YES
NO
❑
❑
Revised Au,ust 2010, Page 2 of 2
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n INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECIaIST
1. Describe the geographic service area such as a district, county, city or other locality. If the program /facility
serves a specific target population such as adolescents, describe the target population. Also, define the type of
service provided.
2, Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city, county or other regional area. Population
statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. ( "Other" races include
Asian /Pacific Islanders and American Indian /Alaskan Natives.)
3, Enter the total number of hill -time staff and their percent by race, sex and disability. Include the effective date of
your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and
1 ist their percent by race, sex and disability. Include the date that enrollment was counted.
Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for DOEA recipients and their sub- grantees, 45 CFR 80.4 (a).
i-o 7. is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
Where there is a significant variation between the race, sex or ethnic composition of the clients and their
availability in the population, the program /facility has the responsibility to determine the reasons for such
variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities
may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR
80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a)
and 45 CFR 80.1 (b) (2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies, counseling and social services without regard to race, sex, color, national
origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be
applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances,
waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR
80.3 (b).
11. For in- patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a).
12. The program /facility and all services must be accessible to participants and applicants, including those persons
who may not speak English. In geographic areas where a significant population of non - English speaking people
live, program accessibility may include the employment of bilingual staff. in other areas, it is sufficient to have a
'.I
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policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will n
assist in the provision of services, 45 CFR 80.3 (a).
13. Programs /facilities must make information regarding the nondiscriminatory provisions of Title VI available to
their participants, beneficiaries or any other interested parties. This should include information on their right to
file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of
HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the
use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the program /facility. Indicate the basis, e.g., race, color,
creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment,
placement, termination, etc. hndicate the civil rights law or policy alleged to have been violated along with the
name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the
current status, e.g.; settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc.
15. The program /facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby,
public telephone, restroom facilities, water fountains, information and admissions offices should be accessible.
Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and
serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or
raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a
self - evaluation to identify any accessibility barriers. Self- evaluation is a four step process:
a. With the assistance of a disabled individual /organization, evaluate current practices and policies which do
not comply with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
C. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps
have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any
action prohibited by Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program /facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads, and other appropriate written communication, 45 CFR 84.8 (a).
20. Programs /facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with
impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to,
interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be
used to provide equally effective services, 45 CFR 84.52 (d).
21. Programs /facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and
maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60
and Title VI of the Civil Rights Act of 1964, as amended. n
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ELDER
AFFAIRS
STAa`e E OF FLORIDA
10/13/2015 16.D.6.
Contract #HM203.14
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.05(3), Florida Statutes.
y The term "employer" means any person or entity required by law to conduct background screening,
including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability
Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving Health Insurance Needs
of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires
employees or has volunteers in service who meet the definition of a direct service provider. See §§
435.02, 430.0402, Fla. Stat.
A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide
services to the elderly, has direct, face -to -face contact with a client while providing services to the client
and has access to the client's living area, funds, personal property, or personal identification information
as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential
facilities; and volunteers." § 430.0402(1)(b), Fla. Stat.
ATTESTATION:
As the duly authorized representative of _Collier County Housing, Human and Veteran Services �
Employer Name
located at 3339 Tarniami "frail E. Suite 211 Naples FL 34112
Street Address City State Z/P code
I, Kimberlev Grant Director do hereby affirm under penalty of perjury
Name of Representative
that the above named employer is in compliance with the provisions of Chapter 435 and section
430.0402, Florida Statutes, regarding level 2 background screening.
�MISSIpN •. g
Signature of Representative Date _� �a o,�� °•_ �s
p #FF 101384 pQ
STATE OF FLORIDA, COUNTY OF s ;.'�t t %��o•��8tikbi, une�e�a�•'� °���
;1 i„ � ltr�rfiuu tit��t�
Sworn to (or affirmed) and subscribed before me this ',)'T"` of �3� .4 .c tL0 i , by
, (Name of Representative) who is personally known
to me or produced -t~ -, 'y, c,1 L I i� ;-C rN A') %! l,J� as proof of identification.
1 _?
Print, Type, or Stamp i Commissioned Name of Notary Public No+y Public
DOEA Form 235, Affidavit of Compliance- Employer, Effec ' " "- - Section 435.05(3), F.S.
Packet Page -1155 -
Form available at: htt:t /elderaffairs.state.FLtss lish b g
Y," r'
July 2014
n
10/13/2015 16.D.6.
Contract #HM203.14
ATTACRMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
The undersigned, an authorized representative of the Contractor named in the contract or agreement to
which this form is an attaclmnent, hereby certifies that:
(1) The Contractor tmderstand.s that pursuant to s_ 287.135 F.S., any company at the time of bidding or
submitting a proposal for a new contract or renewal of an existing contract, that is on the "Scrutinized.
Companies with Activities in Sudan List" or the "Scrutinized Companies with Activities in the Iran.
Petroleum Sector List (collectively, "the Lists ") is ineligible for, and may not bid on, submit a proposal
for, or enter into or renew a contract with the Area Agency on Aging for Southwest Florida, Inc.
(Agency) for goods or services of $1 million or more.
(2) The Contractor understands that, pursuant to s. 287.135 F.S., any company that submits a false
certification to the Agency is subject to civil penalties, attorney's fees and costs and any costs for
investigations that led to the finding of false certification.
(a) The Contractor understands that the contract to which this form. is an attachment may be terminated
by the Agency if the Contractor submits a false certification or has been placed on the Lists.
This certification, required by Florida law, 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.
July 8, 2014
Signature: Tom Henning Date
(Same as contract sign re
Chairman
Title
Collier CoLmty Board of County Commissioners
Attest as to Chairman Is
signature offly.
Packet Page -1156-
Approved as to form and legality
Assistant County At y
10/13/2015 16.D.6.
.lulu 2014 Contract 4HM203.1.4
VERIFICATION DF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Area Agency on Aging for Southwest Florida, Inc.,
Collier County Board of County Commissioners Ilurnan Services, hereby referred to as
Contractor, certifies the use of the U.S. Department of Homeland Security's E- verify system to
verify the employment eligibility of all new employees hired by Contractor during the contract
term to perform employment duties pursuant to this Agreement and that any subcontracts
include an express requirement that Subcontractors performing work or providing services
pursuant to this AgreVjdby nt utilize the E- verify system to verify the employment eligibility of
all new enoyees 1i the Subcontractor during the contract term.
,Sr atLfie: Tom Henning '7j Date
(Same as contract signature)
Chainnan
Title
Collier County Board of County Coniinissioners
�f
Signature Only,
f
July 8, 2014
Packet Page -1157-
10/13/2015 16.D.6.
Agreement /Contract Number HM203.14
Amendment Number N/A
1, Tom Henning. Chairman , attest that no changes or revisions have been made to the
( Recipient /Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of Commissioners
(Signature of Recipieut/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of Recipient /Contractor) presentative
7/8/2ola
Date
Approved as to form and legality
hr-,
Packet Page -1158-
10/13/2015 16.D.6.
VERIFICATION OF EMERGENCY PREPAREDNESS PLAID
Contract # HM203.14
I, Tom Henning Chairman certify that Collier County Board of Commissioners
(Name of authorized contractor representative) (Name of contractor)
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that
the plan will be made available to the Area Agency on Aging for Southwest Florida, Inc. upon
request.
Signature of authorized contrhk representative
Chairman
Title
July 8, 2014
Date
Collier County Board of Commissioners
Company
- APProved as to form and legality
c s tc Crtai'Mali 5 Assistant
C®ucaty Atto
A
lap
October 2008 '° �
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