Agenda 09/08/2015 Item #16D 39/8/2015 16.D.3.
EXECUTIVE SUMMARY
Recommendation to approve after - the -fact contracts, attestation statements and budget to reflect
actual award of the Community Care for the Elderly, Alzheimer's Disease Initiative, and Home
Care for the Elderly grants from Area Agency on Aging for Southwest Florida, Inc. (Total Fiscal
Impact $20,458)
OBJECTIVE: To provide uninterrupted support services to Collier Services for Seniors' frail, elderly
clients.
CONSIDERATIONS: Collier County Services for Seniors, managed within the Community and Human
Services (CHS) Division, has provided support services to Collier County's qualified seniors 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
Department of Elder Affairs through the Area Agency on Aging of Southwest Florida, Inc. (Agency).
These grants fund services to seniors and their caregivers, allowing them to remain in their homes and
live with independence and dignity.
On July 8, 2014, the Board approved the current Master Contract for Federal and State Programs (Agenda
item 16D15). The Master Contract provides the Agency's standard terms and conditions for CCE, ADI
and HCE programs and end on June 30, 2017.
Under this Master Contract, the Agency provided program funding allocation contracts for the current
year, July 1, 2015 through June 30, 2016. To prevent a disruption of service, an estimated budget that
included award amounts, Agency retained amounts, match and co- payment amounts, based upon the
previous year's allocation, was presented to the Board and approved May 26, 2015 (Agenda item 16D4).
Actual allocations are less than the estimated budget for CCE and ADI awards and match, and have
increased for HCE award and CCE and ADI co- payments. These contracts shall have an effective date of
July 1, 2015. The following table provides a detailed breakdown of the necessary adjustments to the
award and match budgets and co- payment budgets set forth in the proposed contracts:
*10% Match is Award divided by .9, multiplied by .1, per grantor requirements, rounded up to nearest
dollar to ensure compliance with matching requirements.
* *The estimated HCE Basic Subsidy of $13,356 is to be retained by the grantor agency, and therefore
is not included within Collier County's budget.
Packet Page -1458-
Approved
Actual
Estimated
Awarded
Award
Local Match
Program
Project
Budget
Budget
Difference
Difference*
Community Care for
the Elderly (CCE)
33418
$750,634.00
$747.745.00
42,889.00
41,561.00
Alzheimer's Disease
Initiative (ADI)
33420
$236,963.00
$236,025.00
- $938.00
Home Care for the
Elderly (HCE)
33419
$17.808.00
$35,894.00
$18,086.00
Total
$1,005,405.00
$1,019,664.00
$14,259.00
41,561.00
*10% Match is Award divided by .9, multiplied by .1, per grantor requirements, rounded up to nearest
dollar to ensure compliance with matching requirements.
* *The estimated HCE Basic Subsidy of $13,356 is to be retained by the grantor agency, and therefore
is not included within Collier County's budget.
Packet Page -1458-
9/8/2015 16. D . 3.
Program
Project
Estimated
Budget
Actual Co- Payment
Budget
Increase /
ecrease
CCE Co- Payment Budget
33351
$20,000.00
$21,240.00
$1,240.00
ADI Co- Payment Budget
33352
$3,200.00
$9,720.00
$6,520.00
Total
$23,200.00
$30,960.00
$7,760.00
The Agency routinely sends Collier County Services for Seniors contracts which require a few weeks
turnaround time. This time frame makes it impossible to process the documents for Boards approval in
the time requested by the Agency. The contracts for the CCE, ADI and HCE programs are being
presented as "after- the - fact" because Collier County received the grant contracts on June 26, 2015 with an
effective contract date of July 1, 2015. Consequently, pursuant to CMA 5330 and Resolution No. 2010-
122, the County Manager authorized Steve Carnell, Public Services Department Head to sign the
contracts. These contracts are being presented for Board ratification. Collier County as the Lead Agency
is responsible to respond to seniors needs and manage the spending authority for the CCE, ADI, and HCE
program services.
FISCAL IMPACT: Budget amendments are required to recognize the actual grant revenue of
$1,019,664 for the SFY CCE, ADI, and HCE grant programs funded by the Florida Department of Elder
Affairs which reflects an increase of $14,259 in grant revenue from the estimated budget previously
approved. Budget amendments are also required for the decrease of $1,561 in required CCE local match
and for the increased co- payment goals for CCE of $1,240, and ADI of $6,520. Funding will reside in
Human Services Grant Fund 707 Projects 33418 (CCE), 33420 (ADI), 33419 (HCE), 33351 (CCE Co-
Pays), and 33352 (ADI Co- Pays).
GROWTH MANAGEMENT: There is no growth management impact from this recommendation.
LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote
for Board action. — JAB
RECOMMENDATIONS: That the Board of County Commissioners approves the "after- the - fact"
contracts and attestation statements with Area Agency on Aging for Southwest Florida, Inc. and
authorize the budget amendments.
Prepared by: Lisa N. Carr, Grants Coordinator, Community and Human Services
Attachments:
Federal and State Master Contract
CCE Contract 203.15
ADI Contract 203.15
HCE Contract 2015.15
Co -Pay Goals 15 -16
Packet Page -1459-
9/8/2015 16.D.3.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.D.16.D.3.
Item Summary: Recommendation to approve after - the -fact contracts, attestation
statements and budget to reflect actual award of the Community Care for the Elderly,
Alzheimer's Disease Initiative, and Home Care for the Elderly grants from Area Agency on Aging
for Southwest Florida, Inc.
Meeting Date: 9/8/2015
Prepared By
Name: CarrLisa
Title: Grants Coordinator, Public Services Department
7/30/2015 1:41:58 PM
Submitted by
Title: Grants Coordinator, Public Services Department
Name: CarrLisa
7/30/2015 1:41:59 PM
Approved By
Name: Bendisa Marku
Title: Supervisor - Accounting, Public Services Department
Date: 7/31/2015 11:30:48 AM
Name: GrantKimberley
Title: Division Director - Cmnty & Human Svc, Public Services Department
Date: 8/14/2015 2:54:31 PM
Name: GrantKimberley
Title: Division Director - Cmnty & Human Svc, Public Services Department
Date: 8/16/2015 6:56:52 PM
Name: AlonsoHailey
Title: Operations Analyst, Public Services Department
Date: 8/19/2015 4:56:53 PM
Packet Page -1460-
9/8/2015 16.D.3.
Name: TownsendAmanda
Title: Division Director - Operations Support, Public Services Department
Date: 8/21/2015 8:20:21 AM
Name: BelpedioJennifer
Title: Assistant County Attorney, CAO General Services
Date: 8/21/2015 9:51:21 AM
Name: RobinsonErica
Title: Accountant, Senior, Grants Management Office
Date: 8/21/2015 12:59:49 PM
Name: CarnellSteve
Title: Department Head - Public Services, Public Services Department
Date: 8/21/2015 4:23:47 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 8/21/2015 4:34:20 PM
Name: StanleyTherese
Title: Manager - Grants Compliance, Grants Management Office
Date: 8/27/2015 5:13:12 PM
Name: OchsLeo
Title: County Manager, County Managers Office
Date: 8/28/2015 10:24:53 AM
Packet Page -1461-
July 2014
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
MASTER CONTRACT FOR
FEDERAL AND STATE PROGRAMS
9/8/2015 16.D.3.
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 II, Exhibit -1 as necessary.
Purpose of Contract:
The purpose of this Master Contract is to establish the Agency's standard teens 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. Incorporation of Documents within the Contract or Agreement:
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:
(I) CFO Memo No. 02: Release date, October 3, 2012;
(2) CFO Memo No, 06: Release date, .Lune 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 July 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 June 30.2017.
4. Com,Riance a pith Federal Law:
4.1 If any contract and agreement contains federal funds this section shall apply.
Packet Page -1462-
July 2014
9/8/2015 16.D.3.
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 finding in excess
of $100,000.00, the Contractor must, prior to contract execution, complete the Certification Regarding
Lobbying form, ATTACHMENT I. 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. 1 101). 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 I 1 -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
Packet Page -1463-
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
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
ATTACHWNT J prior to the execution of this Master Contract.
5. Compliance 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 law, including Florida provisions for conflict of laws.
5.2 The Contractor 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. (I) 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 funds 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.
Packet Page - 1464 -,:��
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
6. Background Screening:
6.1 The Coi }tractor shall ensure that the requirements of s. 430.0402 and Chapter 435, F.S., as amended, are met
regarding background screening for all persons Nvho 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
Health 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
http: / /eideraffair-,.,,tate.fl.ris /doea/ /l)ackgroimdscreeniu g,php.
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 Complaint Procedurest
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
Handbook, 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
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 119.01 1(2),
Florida Statutes, the Contractor, subJect to the terms of section 287.058(l)(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.
Packet Page -1465-
Ju1y 2014
9/8/2015 16.D.3.
Contract #HM203.14
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. inspections. 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 Contact 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 terns 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 -parry 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 -Civil Rights Com lire ance:
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 further
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
Packet Page -1466- '`?
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
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 b the he 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
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 determ 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
Packet Page -1467-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
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 Bondinn:
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 frill 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 funds 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. ConfidentialitvofInformation:
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 AccountabifijX 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, 162, and 164).
18. 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 Abuse 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.
Packet Page -1468-
July 2014
9/8/2015 16.D.3.
Contract 4HM203.14
19. New Contract(s) Reljorti=
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. Ilan kru11tcv Notification:
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. S Zonsorship 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 funds 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. Sube utracts:
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 Iiable to the Subcontractor in any way or for any reason. The Contractor, at its
expense, shall defend the Agency against any such claims.
n
Packet Page -1469-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
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 Contractor:
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 further 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. e t•
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
Packet Page -1470-
July 2014
9/8/2015 16.D.3.
Contract 9HM203.14
incorporating this Master Contract by reference: (a) paragraph (16) (b) of section 216.181, F.S., regarding
advances; (b) Rule 691- 40.103 F.A.C.. pertaining to Restriction of Expenditures from state funds; and, (c)
the Invoice Requirements of the Reference Guide for State Expenditures from the Department of
Financial Services at:
(http / /www rnvfloridacfo com /aad%r /reference elide /Reference Guide For State Expenditures.pd_O.
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(a) 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 terms 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. Data IntecrrijX and Safeguarding Information:
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 fi•om all terminated employees. The
Contractor, among other requirements, must anticipate and prepare for the loss of information processing
capabilities. All data and soft -ware shall be routinely backed up to ensure recovery frorn losses or outages of the
computer system. The security over the backed -up 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 ATTACkIl't ENT 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 Policyt 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 on 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 ';'elcler•affairs.state. i.us' oea'financiaLaj r)
Packet Page -1471-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
30. 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 in
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 End Crime:
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 on a contract or agreement with
a public entity for the construction or repair of a public building or public worn.; 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
Two for a period of 36 months following the date of being placed on the convicted vendor Iist.
32. Purchasinz
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 946.515(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 fi•om 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, Coll rights. Royalties:
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
Packet Page -1472-
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
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
funding, the terms and conditions are governed by 2 CPR 215.36.
34. Emergency Prgllaredness and Continuity of Operations:
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. Equinment:
35.1 Equipment means: (a) an article of nonexpendable, tangible personal property having a useful life of more
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 finds], 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 years. (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 funds 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
Packet Page -1473-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
(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 detennine
current fair market value where a Contractor compensates the federal awarding agency for its share.
35.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased
with state fiords 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 215
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
finds through 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 funds 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 funds can only be made tlu•ough 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.
Packet Page -1474-
July 2014 Cc 9/8/2015 16.D.3.
36. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
litlp• / /www.invflorida.coin /apps /vbs /adoc /F7740 PCIRIOOO.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 tenns 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 Pro ers rty:
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. Dispute 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.
-39.2 The-Contractor wil1<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:
nue:
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. Severabilitv Clause:
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or
unenforceable the other provisions are severable to that void provision and shall remain in full force and effect.
14
Packet Page -1475-
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
45. Condition Precedent to Contract Appropriations:
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/Del
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 patties. 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 Worlc:
The Agency may in its sole discretion suspend any or all activities under this Master Contract and ally
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 detenr►ines in its sole discretion that it is in the State's interest to do so. The
Packet Page -1476-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
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 and 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 shalt 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 contact 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 Contactor 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. SUecial Provisions;_
The Contractor agrees to the following provisions:
Packet Page -1477-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
54,1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the pant 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 funds 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, unarmounced
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).
Packet Page -1478
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
54.4 Use of Service Dollars/Wait List Management:
The Contractor will spend all federal, state, and other fiends 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 have 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 funds 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. The 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, H and J and any exhibits referenced in said
attachments, together with any documents incorporated by reference, contain all the terrns and conditions agreed
upon by the Parties. There are no provisions, terns, 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 Pasties,
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 Master Contract to be executed by their
undersigned officials as duly authorized.
Contractor: COLLgR CO TY BOARD OF AREA AGENCI7 N , GING FOR
COIJ ' CO NHSSIONERS SOUTIT ' S O INC. i
f 1
SIGNED�Y: SIGNED B —
NAME: Tom Henning f NAME: RONALD LUCCHINO PhD
TITLE: Chairman TITLE: BOARD PRESIDENT
DATE: Juh, 8.2014 DATE: '/ orm and legality
pprove
Federal Tax ID: 59- 6000558 r, _ �.
Fiscal Year Ending Date: 9130'
As +aunt omey
Aftest at fry Chairm an s
SigtiiUr� nn €' Packet Page -1479-
9/8/2015 16.D.3.
July 2014 Contract 4HM203.14
ATTACHMENTI
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 employee 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 funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or 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 it 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 $10,000.00 and not more than $100,000.00 for each such failure.
July 8, 2014
G'
Sigma nature Date
Tom Henning, Chairman HM203.14
Name of Authorized Individual Application or Agreement Number
Collier Coun�y Board of Count), Commissioners
Approved as to form and legality
e _ r^-
s A. Assistant Coun rttorney
.
Attest at-, t4 Chairman's
1rgnature Only. t� i s 11
1�OEA Form 103
(Revised Nov 2002)
Packet Page -1480-
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
ATTACHMENT II
FINANCIAL AND COMPi •IANCE AUDIT
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 prograrn- specific audit conducted in accordance with the provisions of OMB Circular A -133, as revised.
EXHIBIT 1 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 Iess 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 fi•om 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 snatching 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.
Packet Page -1481-
July 2014
9/8/2015 16.D.3.
Contract #HM203.I4
PART IL• STATE FUNDED
'his part is applicable if the Contractor is a non -state entity as defined by Section 21 5.97(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 proiect- 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 Elder 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 matching requirements.
In connection with the audit requirements addressed in Part 11, 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).
An 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
Packet Page -1482-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
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-] 33, 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 Il 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, hie. 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, hie 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 10.650 (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 1V: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terns 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.
Packet Page -1483-
July 2014
PART I: AUDIT RELATIONSHIP DETERMINATION
9/8/2015 16.D.3.
Contract #HM203.14
ATTACHMENT H
EMII?3IT I
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 Part 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 69I- .006(2), FAC [state financial assistance]
and Section 400 OMB Circular A -133 [federal awards].
PART It: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive federal awards or
state matching funds on federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules
and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 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 -110 — Administrative Requirements)
Requirements)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST
FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A -21 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 — 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 69I -5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
Packet Page -1484-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
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 all agreement supported activities; and (3) the comparison of outlays with budgeted amounts
for each award. The inability to process information in accordance with these requirements could result in a return of
grant fonds 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 -
compl iant, 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 wan-ants that these products are capable of processing year -date dependent data accurately. All versions
of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be
verified for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that
impede the hardware or software programs from operating properly, the Contractor agrees to immediately make
required corrections to restore hardware and software programs to the same level of functionality as warranted herein,
at no charge to the state. and without interruption to the ongoing business of the state, time being of the essence.
(4) The Contractor and any Subcontractors of, services under this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from
data integl ity compliance issues.
The Contractor shall require that the language of this certification be included in all subagreements, subgrants, and other
arareements 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).
Chairman Julv 8, 2014
Si anatare Title Date
Tom Henning
4 ,
Name of Authorized Sianer 2s to hairo an`s
khest
Approved as to form and legality
Collier Count-\, Board of Count} Commissioners (gc�tt61 Ot4�}f.
(Revised June 2008)
Assistant County k6rneY e i ,
Packet Page -1485-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
ATTACHMENT IV
CERTIFICATION IZEGA.RDING 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 explanation to this certification.
July 8, 2014
S ia t re: Torn fienning Date
Chairman Collier Count), 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 12549. (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.
1 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. Tile Contractor agrees that it shall not knowingly enter into any lower tier covered transaction %vith a person
Nvilo is debarred, suspended, determined ineligible or voluntarily excluded fi•om 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 - ovenlment, 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, in eligibic. or voluntarily excluded from the covered transaction, unless it knotivs
that the certification is erroneous. Approved as to form and legality
Revised .tune 2008
( } Assistant County A t�ti=y
0 � as to
signature 00'l!. Packet Page -1486- `°
July 2014
ASSURAN%ES— NON- CONSTRiIC T ;';.^_,N DI ROGRAMS
9/8/2015 16.D.3.
Contract #HM203.14
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.
TT
PLEASE DO NOT RETURN YOUR COMPLLTED YUKM ru rrir: vrriur, yr
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.
1. 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.S.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 limit the political
activities of employees whose principal employment activities are funded in whole or in pail 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. 8741 and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333), regarding labor standards
for federally assisted construction subagreements.
Packet Page -1487-
July 2014
9/8/2015 16.D.3.
Contract #HM203.14
0. 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 11738; (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 (lb 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.
'6. 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 performed 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 AUTHORIZE RTIF1' G OFFICIAL TITLE
Tom Henni _ Chairman
APPLICANT ORGANIZATION_ DATE SUBMITTED
j� July 8, 2014
Collier County Board of Commissio7l'ers
Attest as to Chalilnan l"
signature only. -
Packet Page -1488-
Approved as to form and legality
e%
A.ssis ant County ey ,-
P
Jul), 2014
9/8/2015 16.D.3.
Contract -#HM203.14
ATTACHMENT A
DEPARTMENT OF ELDER AFFAIRS PROGRAMS & SERVICES HANDBOOK
Department of Elder Affairs Programs & Services Handbook available at:
littp://eider,-iffairs.state.fl.tis/docalnoiL.pli
1) (scroll to *July 2013 - Notices)
Packet Page -1489-
July 2014
9/8/2015 16.D.3.
Contract 4HM203.14
ATTACHMENT B
STA c OF FLORIDA DE,P.4RTMENT OF ELDER AFFAIRS C1 i�IL County AAA /Contractor I
RIGHTS COMPLIANCE CHECKLIST Program /Facility Name Collier
Address Completed By
3339 Tamiami Trail E, Suite 211 Lisa N. Carr Grants Coordinator
City, State, Lip Code Date Telephone
Naples, FL 34112 1 06/23/2014 1 239- 252 -2339
PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMYLLI E
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/registcred
5. Advisory /Governing Board if applicable
[lowing:
Total #
White
Black
Hispani
Other
Female
Disabled
Over40
Source of data2012 Census
]9,320,749
78.3%
16.6%
23.2%
1.9%
51.1%
E
❑
Effective date: 6/24/14
8
50%
25%
25%
El
91%
1:1
9. Are all benefits, services and facilities available to applicants and participants in an equally effective manner
Effective date: 6 /24/14
361
NO
regardless of race, sex, color, age, national origin, religion or disability?
❑
10. For in- patient services, are room assignments made without regard to race, color, national origin or disability?
l 10%
5
NO
1 Oo�io
❑
❑
ao�i°
N/A
YES
PART II: 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
NO
❑
®
❑
7. Compare the staff composition to the population. Is staff representative of the population?
N/A
YES
NO
❑
E
❑
8. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national
N/A
YES
NO
origin, sea, age, religion or disability?
El
1:1
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?
❑
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
❑
0
❑
Revised Aupust2010. Page i oft
,i
Packet Page -1490-
July 2014
9/8/2015 16.D.3.
Contract 4HM203.14
13. Are employees, applicants and participants informed of their protection against discrimination? If YES, how? N/A YES NO
Verbal ❑ Written ❑ Poster ❑
❑
E ❑
14.Give the number and current status of any discrimination complaints regarding services or employment filed
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
❑
■ ❑
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?
❑
❑
1.7. Is there an established grievance procedure that incorporates due process in the resolution of complaints?
YES
NO
18. Has a person been designated to coordinate Section 504 compliance activities?
YES
NO
14.Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on
YES
NO
the basis of disability?
M
❑
20.Are auxiliary aids available to assure accessibility of services to hearing and sight - impaired individuals?
YES
NO
❑
❑
PART iv: FOR PROGRAMS OR FACILITIES WIT1150 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF 550,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain.
YES
NO
❑
❑
Revised Ausust 2010. Page 2 of 2
Packet Page -1491-
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECIi.LIST
I. Describe the geographic set-vice 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.)
Enter the total number of full -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
list 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 DOER recipients and their sub- grantees, 45 CFR 80.4 (a).
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?
8. 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
tn
Packet Page -1492-
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will
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. Indicate 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 I973 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 prograrn /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 I964, as amended.
Packet Page -1493-
go"
rn
O
L)
O
Ln
C)
r1li
0 CD N
-- CD
ui
CL UD
0
CL -0
UJ LL
w
t
ro
0 u
0
uj u
9/8/2015 16.D.3.
Packet Page -1494-
I-
Cl
LL
Ifl
M
ui
CL)
ul
r
m
r4
E
E LL,
0
F6
ct
00
Ln
0 E Ln
U m 01
C
C)
L) Ln
ru
ru _0 Uj
< U-
9/8/2015 16.D.3.
Packet Page -1494-
I-
Cl
Q)
LIA V-1
Q9
wa
Ifl
M
ul
r
m
Q)
LIA V-1
Q9
wa
9/8/2015 16.D.3.
Contract #HM203.14
DEt?- i[MMENT Of-
BACKGROUND SCREENING
E L D E RI Affidavit of Compliance - Employer
AFFAIRS
STATE OF FLORIDA
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.45(3), Florida Statutes.
Z 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. Hunan and Veteran Sersrices
Employer Name
located at 3339 Tamiami Trail E Suite 211 Naples FL 34112,
Street Address City State ZIP code
I, Kimberley Grant Director do hereby affirm under penalty of perjury
Name of Representative
that the above named employer is in compliance with the provisions of Chapter 435 and section
430.0402, Florida Statutes, regarding level 2 background screening.
Signature of Representative
STATE OF FLORIDA, COUNTY OF
1/11!10111 1Na
Sworn to (or affirmed) and subscribed before me this day of by
(Name of Representative) who is personally known.
as roof of identification.
to me or produced i" t p
Print, Type, or Stamp commissioned Name of Notary Public Notary Public
DOEA Forrn 235, Affidavit of Compliance- Employer, Effec Section 435.05(3), -'.S-
Packet available a' ht c '�� t f #ai s �e #I t lishlb PdCket Page -1495-
►11tH I f 111t/!p
��1tl
m6 ,x
Date
OFF 101384
.. O \
eT�'�• ±o�d BMriad 00
�x
``l,��CIG STATEQ�`t`4`
/
1/11!10111 1Na
Sworn to (or affirmed) and subscribed before me this day of by
(Name of Representative) who is personally known.
as roof of identification.
to me or produced i" t p
Print, Type, or Stamp commissioned Name of Notary Public Notary Public
DOEA Forrn 235, Affidavit of Compliance- Employer, Effec Section 435.05(3), -'.S-
Packet available a' ht c '�� t f #ai s �e #I t lishlb PdCket Page -1495-
9/8/2015 16.D.3.
July 2014 Contract #HM203.14
ATTACRM[ENT II
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 attachment, hereby certifies that:
(1) The Contractor understands 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.
(3) 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.
Signature: Toni Henning),-
(Same as contract sign _ re)
Chairman
Title
Collier County Board of County Commissioners
Aftest as to Chairman Is f
signature omy.
M, R
July S. 2014
Packet Page -1496-
.Approved as to form and legality
Assistant County At4K&Y
;Q
9/8/2015 16.D.3.
July 2014 Contract #I- IM203.14
ATTACHMENT 3
VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Area Agency on Aging for Southwest Florida, Inc.,
Collier County Board of County Commissioners —Human 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 worl< or providing services
pursuant to this Agree nt utilize the E- verify system to verify the employment eligibility of
all new enygoyees h Vdby the Subcontractor during the contract term.
r ate-e: Tom Henning
(Same as contract signature)
Chairman
Title
Collier County Board of County Commissioners
Attest as to Chairman's
Date
Packet Page -1497-
July 8, 2014
Approved as to form and legality
Assistant County Att'
9/8/2015 16.D.3.
Attestation Statement
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 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 /Coniractoro-epresentative
a t _
�tt�st �� fi� Cnatrr�a��y�
signature only.
Packet Page -1498-
7
Date
Approved as to farm and legality
Assistant County Atto
r
9/8/2015 16. D. 3.
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract # HM203.14
1, 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 contrictk representative
Chairman
Title
July 8, 2014
Date
Collier County Board of Commissioners
Company
October 2008
Packet Page -1499-
ApprQ,ed as tca focan and legality
Assistant County Atto
�w tris, r;
July 2015 to June 2016 9/8/2015 16.D.3.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM CONTRACT
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and
Collier County Board of County Commissioners (Contractor), and collectively referred to as the "Parties." The term
Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS, the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the mutual
covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments, forms, exhibits and references incorporated, which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks,
manuals or desk books and Master Contract number 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, 2015 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, 2016.
4. Contract.Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed S747.745A0, 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(I)(g), Florida Statutes, the Agency may renew
the contract for a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal
price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal
may be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability of funds.
Packet Page -1500-
July 2014: to June 2016
6. Official Pavee and Representatives (Names, Add resses. and Telei) one Numbers):
9/8/2015 16.D.3.
7. All Terms and Conditigns Included:
This contract and its Attachments, I, III, VI -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 agreernents, either written or verbal between the Parties.
By signing this contract, the Parties agree that the), 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
,I,
SIGNED BY: ...�
NAME: Stephen Y Carnell
TITLE: Public Services Department Head
DATE:
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Packet Page -1501-
AREA AGENCY ON AGING FOR SOUTHWEST
FLORrDA, INC.
SIGNED BY:
NAME: MARIANNE G LORINI
TITLE: PRESIDENT /CEO
DATE:
Approved as to form and legality
Assistant Count. Attorrmey
ty,i rj,
The Contractor name, as shown on page l of this
Collier County Housing, Human and Veteran
Services
a,
contract, and mailing address of the official payee to
3339 E Tamiami Trail, Building 1 °1
whom the payment shall be made is:
Naples, FL 34112
Kimberly Grant. Director
The name of the contact person and street address where
Collier County Housing, s Human and Veteran
b
financial and administrative records are maintained is:
3339 E Tamiami Trail, Building H
Naples, FL 34112
Kimberly Grant, Director
The name, address, and telephone number of the
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 14
Naples, FL 34112
(239) 252 -2273
Tammy Rhoades, VP of Finance
d'
The section and location within the Agency where
Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure
15201 North Cleveland Avenue, Suite 1 100
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 1 100
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 Conditigns Included:
This contract and its Attachments, I, III, VI -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 agreernents, either written or verbal between the Parties.
By signing this contract, the Parties agree that the), 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
,I,
SIGNED BY: ...�
NAME: Stephen Y Carnell
TITLE: Public Services Department Head
DATE:
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Packet Page -1501-
AREA AGENCY ON AGING FOR SOUTHWEST
FLORrDA, INC.
SIGNED BY:
NAME: MARIANNE G LORINI
TITLE: PRESIDENT /CEO
DATE:
Approved as to form and legality
Assistant Count. Attorrmey
ty,i rj,
July 2015 to June 2016
9/8/2015 16.D.3.
INDEX OF ATTACHMENTS
ATTACHMENTI ............................................................................. ............................... 4
ATTACHMENTIII ............................................................................ .............................14
ATTACHMENT VI
ANNUALBUDGET AND RATE SUMMARY ......................................... ....... .................... . ........................ 15
ATTACHMENT VII
INVOICEREPORT SCHEDULE ............................................................ .............................16
ATTACHMENT VIII
REQUESTFOR PAYMENT .................................................................. ............................... 17
ATTACHMENT IX
RECEIPT AND EXPENDITURE REPORT............. ................. 18
ATTACHMENT X
COST REIMBURSEMENT SUMMARY .................................................. .............................19
*Attachments 11, IV, and V are included by reference in the Master Contract HMO 14.
3
Packet Page -1502-
July 2015 to June 2016
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 Contract Acronyms
Area Agency on Aging (AAA)
Adult Protective Services (APS)
Adult Protective Services Referral Tracking Too] (ARTT)
Corrective Action Plan (CAP)
Community Care for the Disabled Adult (CCDA)
Community Care for the Elderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Florida Department of Elder Affairs (DOEA)
Florida Statutes (F.S.)
Horne Care for Disabled Adults (HCDA)
Planning and Service Area (PSA)
Summary of Programs and Services (SOPS)
1.1.2 Program Specific Terms
9/8/2015 16.D.3.
ATTACHMENT I
Adult Protective Services Referral Tracking Tool: A system designed to track DCF APS referrals to AAAs
and CCE Lead Agencies for victims of second party abuse, neglect, and exploitation who need home and
community-based services as identified by APS staff.
Aging Out: The condition of reaching 60 years of age and being transitioned from the DCF Services, CCDA
or HCDA services to the Agency'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 PSA in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Act and
Agency and /or 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 CCE specific data
in the CIRTS. An update may also include other revisions to the Area Plan as instructed by the Agency
and /or Department.
Department of Elder Affairs Programs and Services Handbook: An official document of the State of
Florida, DOEA. The Handbook includes program policies, procedures, and standards applicable to agencies
which are recipients /providers of DOEA funded programs. An annual update is provided through a Notice of
Instruction,
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to
remain independent and in the least restrictive Iiving arrangement.
0
Packet Page -1503-
July 2015 to June 2016
9/8/2015 16.D.3.
Notice of Instruction (NOI): The Department's established method to communicate to the Agency
and/or Contractor the requirement to perform a particular task or activity. NOIs are located on the
Department's website at htip: / /elcieraf.fair -s.state.fl.us /cioea /nois.php.
Program Highlights: Success stories, quotes, testimonials, or human - interest vignettes that are used in the
Summary of Programs and Services to demonstrate how programs and services help elders, families, and
caregivers.
Summary of Programs and Services (SOPS): A document produced by the Department and updated yearly
to provide the public and the Legislature with information about programs and services for Florida's elders.
1.2 GENERAL DESCRIPTION
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 elders 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 authorities governing CCE Program are:
(1) Rule 58C -1, Florida Administrative Code;
(2) Sections 430.201 through 430.207, F.S.; and
(3) The Catalog of State Financial Assistance (CSFA) Number 65.010.
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 DOEA Programs and Services Handbook, which
are hereby incorporated by reference.
1.2.5 Major Program Goals
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 functionally 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
5
Packet Page -1504-
July 2015 to June 2016 9/8/2015 16.D.3.
(3) Not be dually enrolled in the CCE Program and a Medicaid capitated long -term care program.
Y Targeted i.1 �.2 .1 aargeteo G roups
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.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the CCE Program, the Contractor shall perform, or ensure that its Subcontractors
perform the following tasks:
(1) Client Eligibility Determination;
(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 DCF APS Low, Intermediate, and High Risk Referrals Risk Referrals
For DCF APS Low, Intermediate, and High Risk Referrals for individuals who are enrolled in a Medicaid
long -term care program at the time of referral to the Contractor or Subcontractor, the Contractor shall:
(l) Ensure that the intake entity contacts the DCF APS protective investigator and notifies him /her that the
referral was not accepted because the referred individual is enrolled in a Medicaid long -term care
program; and
(2) Ensure that the intake entity notes that the referred individual is enrolled in a Medicaid long -term care
program in the ARTT as the reason for rejection.
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 in the sequence below 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.
(1) DCF APS High Risk individuals: The Contractor shall ensure that pursuant to Section 430.205(5)(a),
Florida Statutes, those elderly persons who are determined by DCF APS to be victims of abuse, neglect,
or exploitation who are in need of immediate services to prevent further harm, and are referred by APS,
will be given primary consideration for receiving CCE services. As used in this subsection, "primary
consideration" means that an assessment and services must commence within 72 hours after referral to
the Agency or as established in accordance with Agency contracts by local protocols developed between
Agency service Contractors and APS.
The Contractor shall follow guidelines for DCF APS High Risk referred individuals established in
the APS Operations Manual, which is incorporated by reference.
(2) Imminent Risk individuals: Individuals in the community whose mental or physical health condition has
deteriorated to the degree that self -care is not possible, there is no capable caregiver, and nursing home
placement is likely within a month or very likely within 3 months.
rol
Packet Page -1505-
9/8/2015 16.D.3.
July 2015 to June 2016
(3) Aging Out individuals: hdividuals receiving CCDA and HCDA services through the Department of
Children and Families' Adult Services transitioning to community -based services provided through the
Agency and /or Department when services are not currently available.
(4) Service priority for individuals not included in (1), (2), and (3) above, regardless of referral source, will
be determined through the Agency's functional assessment administered to each applicant, to the
extent funding is available. The Contractor shall ensure that first priority is given to applicants at the
higher levels of frailty and risk of nursing home placement. For individuals assessed at the same priority
and risk of nursing home placement, priority will be given to applicants with the lesser ability to pay for
services.
2.1.2.1 Referrals for Medicaid Waiver Services:
(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 to apply for Medicaid Waiver services in order to receive CCE services. These individuals may
only receive CCE services while the Medicaid Waiver eligibility determination is pending. If the client
is found ineligible for Medicaid Waiver services for any reason other than failure to provide required
documentation, then the individual may continue to receive CCE services.
(3) The Contractor must advise individuals who have been identified as being potentially Medicaid Waiver
ZD
eligible 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 services in accordance
with the current DOEA Programs and Services Handbook, which is incorporated by reference. The services
include the following categories:
(1) Core Services;
(2) Health Maintenance Services; and
(3) Other Support Services.
2.1.3.1 Core 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;
(S)
Housing Improvement;
(9)
Legal Assistance;
(10)
Pest Control Services;
(11)
Respite Services;
(12)
Shopping Assistance; and
(13)
Transportation.
VA
Packet Page -1506-
July 20'1 ` to June 2016
9/8/2015 16.D.3.
2.1.3.2 Health Maintenance Services
The Contractor shall ensure that health maintenance services are routine health services that are necessary to
maintain the health of functionally impaired eiders. These services are limited to medical therapeuti, 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, include the following:
(1) Adult Day Health Care;
(2) Emergency Alert Response;
(3) Gerontological Counseling;
(4) Health Support;
(5) Home 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- services, as approved by the Agency.
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 the Subcontractor;
the Contractor shall notify the Agency's Contract Manager and the Agency's Chief Financial Officer in
,,vriting of such dclay. The Contractor shall not permit a Subcontractor to perform services related to this
agreement without having a binding Subcontractor agreement executed. In accordance with Section 23.1 of
Master Contract, the Agency will not be responsible or liable for any obligations or claims resulting from
such action. The Contractor shall submit a copy of all subcontracts to the Contract Manager within thirty days
of the subcontract being executed.
2.1.5 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 coals stated in this contract are achieved.
Packet Page -1507-
July 2015 to June 2016 9/8/2015 16.D.3.
2.2 SERVICE TIMES
2.2.1 Service Times
The Contractor shall ensure the availability of services listed in this contract at times appropriate to meet
client service needs, at a minimum during normal business hours. Normal business hours are defined as
Monday through Friday, 8:00 a.m. to 5:00 p.m.
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 DOEA Programs and Services Handbook and the service tasks described in Section 2.1.
ATTACHMENT VI lists the services that can be performed, the highest reimbursement unit rate, the method
of payment, and the service unit type. Units of service will be paid pursuant to the rate established in the
Area Plan as updated, as shown in ATTACHMENT VI, and approved by the Agency.
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
reporting due dates for Subcontractors that permit the Contractor to meet the Agency's reporting
requirements.
2.4.1 Area Plan Update and All Revisions Thereto
The Agency is required to submit an annual Area Plan update wherein the Agency enters CCE- specific data in
the CIRTS. The Contractor may also be required to submit revisions to the Area Plan as instructed by
the Agency and /or Department.
2.4.2 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;
(3) Services Reports;
(4) Miscellaneous Reports;
(S) Fiscal Reports;
(6) Aging and Disability Resource Center Reports; and
(7) Outcome Measurement Reports.
2.4.4 Program Highlights
The Contractor shall submit Program Highlights referencing specific events that occurred in SFY/FFY 2014-
2015 by September 04, 2015. The Contractor shall provide a new success story, quote, testimonial, or human -
interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms.
For all agencies or organizations that are referenced in the highlight, the Contractor shall provide a brief
description of their mission or role. The active tense shall be consistently used in the highlight narrative, in
order to identify the specific individual or entity that performed the activity described in the highlight, The
Contractor shall review and edit Program Highlights for clarity, readability, relevance, specificity, human
interest, and grammar, prior to submitting them to the Agency.
0
Packet Page -1508-
July 2015 to June 2016
9/8/2015 16.D.3.
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 CIRTS or any such system designated by the Agency and /or Department. 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 Policies for Data and Software Backup
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
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.
2.7 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 must
be made in the form of cash and /or in -kind resources. At the end of the contract period, all CCE funds
expended must be properly matched. State funds shall not be used to match another state - funded program.
2.7.2 Cost Sharing and Co- Payments
The Agency must ensure Contractors 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 /or Department's co- payment guidelines, in accordance with the current DOEA Programs and
Services Handbook, which is incorporated by reference, Co- payments include only the amounts assessed to
consumers by Contractors or the amounts consumers opt to contribute in lieu of an assessed co-
payment. The consumer's contribution must be equal to or greater than the assessed co- payment. Co-
payments collected in the CCE Program can be used as part of the local match, as detailed above in Section
2.7.1.
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.
10
Packet Page -1509-
July 2015 to June 2016
2.8.2 Contract Monitoring
9/8/2015 16.D.3.
The Agency will review and evaluate the performance of the Contractor under the terns 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 and fixed rate for services. Payment may be
authorized for all allowable expenditures to complete the tasks identified in the deliverables, as required by
the agreement. 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 ATTACHMENT VIII,
ATTACHMENT IX, and ATTACHMENT X.
3.1.1 Funding Distribution
The Contractor agrees to distribute finds as detailed in the Area Plan update and the Annual Budget Summary,
ATTACHMENT VI 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. The Contractor's requests for advances require the approval of
the Contract Manager. If sufficient budget is available, the Agency will issue approved advance payments
after July 1, 2015.
3.2.1 Advance Recoupment
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 VII. The
Contractor may temporarily place advanced funds in a FDIC insured interest bearing account. All interest
earned on advanced funds must be returned to the Agency within 30 days or the end of each quarter of the
contract period.
Packet Page -1510-
July 2015 to June 2016
9/8/2015 16.D.3.
3.3 INVOICE SUBMITTAL AND REQUESTS FOR PAYMENT
All Requests For Payment and Receipt and Expenditure Reports submitted to the Agency shall be
submitted using ATTACHMENT VIII, ATTACHMENT IX and Cost Reimbursement Summary
(ATTACHMENT X). The Contractor shall include documentation of services provided, unit of services, and
the rates for the services provided in conformance with the requirements as described in this ATTACHMENT
I and ATTACHMENT VI.
3.3.1 Payment Requests
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 VII.
3.3.2 Payment Withholding
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in Section 26 of the Master Contract.
3.3.3 Date for Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services,
must be submitted to the Contract Manager no later than June 25, 2016.
3.3.4 Date for Final Request for Payment
The final request for payment for expenditures is due to the Agency no later than July 25, 2016.
3.4 DOCUMENTATION FOR PAYMENT
The Contractor shall maintain documentation to support payment requests that shall be available to the
Agency or authorized individuals, such as Depai tYnent of Financial Services, upon request.
3.4.1 CIRTS Data Entries for Contractors
The Agency must require Contractors to enter all required data for clients and services in the CIRTS
database per the DOEA Programs and Services Handbook and the CIRTS User Manual — Aging Provider
Network users (located in Documents on the CIRTS Enterprise Application Services). Contractors must
enter this data into the CIRTS prior to submitting their requests for payment and expenditure reports to the
Agency. The Agency shall establish deadlines for submission to assure compliance with due dates for
the requests for payment and expenditure reports that Contractor must submit to the Agency.
3.4.2 Contractors' Monthly CIRTS Reports
The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is
accurate. This report must be submitted to the Agency with the monthly request for payment and
expenditure report and must be reviewed by the Agency before the Contractor's request for payment and
expenditure reports can be approved by the .Agency.
3.5 REMEDIES FOR NONCONFORMING SERVICES
The Contractor shall ensure that all goods and /or services provided under this contract are delivered timely,
completely, and commensurate with required standards of quality. Such goods and /or services shall only be
delivered to eligible program participants. 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 wilt 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.
12
Packet Page -1511-
July 2015 to ,tune 2016
9/8/2015 16..D.3.
3.6 FINANCIAL CONSEQUENCES
Contractor shall ensure 100% of the deliverables and service tasks identified in this contract are performed
pursuant to contract requirements. If at any time after an initial written notice of deficiency, Contractor is
notified by the Agency's Contract Manager that it has failed to correctly, completely, or adequately
perform the deliverables or service tasks, Contractor will have 10 days to issue a Corrective Action Plan
( "CAP ") to the Contract Manager that addresses the deficiencies and states how the deficiencies will be
remedied within the specified time period. The Agency shall assess a Financial Consequence for Non -
Compliance on the Contractor for each deficiency identified in the CAP which is not corrected pursuant to the
CAP. The Agency will also assess a financial Consequence for failure to timely submit a CAP.
3.6.1 Payment Deduction
In the event Contractor fails to correct an identified deficiency within the timeline specified in the CAP, the
Agency shall deduct, from the payment for the invoice of the following month, 1% of the monthly value
of the contract for each day the deficiency is not corrected. If Contractor fails to timely submit a CAP plan,
the Agency shall deduct 1% of the monthly value of the administrative funds in the contract for each day the
CAP is overdue, beginning the 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 and 39.1 of the Master contract, this paragraph shall
have precedence
13
Packet Page -IS12-
July 2015 to June 2016
9/8/2015 16.D.3.
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
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 AMOUNT
TOTAL STATE AWARD $0
CTATIP 1 TNANC'TAT, A.4CTCTANCV RTTR.IFC'T TO Sec. 215.97. F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Community Care for the Elderly
General Revenue - Collier
65.010
$747,745.00
TOTAL AWARD
$747,745.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, F.S.
Chapter 691 -5, Fla. Admin. Code
14
Packet Page -1513-
July 2015 to June 2016
ANN'U ' L BUDGET SUMMARY
COMMUNITY CARE FOR THE ELDERLY PROGRAM
for
Collier County Board of County Commissioners
CCE Services $747,745.00
RATE SUMMARY
for
Collier County Board of County Commissioners
RATE SUMMARY
9/8/2015 16.D.3.
ATTACHMENT VI
Charlotte 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
Homemaking
$21.50
519.35
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
1.5
Packet Page -1514-
July 2015 to June 2016
Report Number
2
3
4
5
6
7
8
9
10
12
13
14
15
16
INVOICE REPORT SCHEDULE
COMMUNITY CARE FOR THE ELDERLY
Based 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.
9/8/2015 16.D.3.
ATTACHMENT VII
Submit to State on this Date
July I
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 #I for Advance Basis Agreements cannot be submitted to the Area Agency on Aging for
Southwest Florida, Inc. prior to July 1 or until the agreement with the Agency has been executed
and a copy sent to the Area Agency on Aging for Southwest Florida, Inc. Actual submission of
the vouchers to the Area Agency on Aging for Southwest Florida, Inc. is dependent on the
accuracy of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the Agency as follows:
one — tenth of the advance payment received shall be reported as an advance recoupment
on each request for payment, starting with report number five. The adjustment shall be
recorded in Part C, Line 1 of the report (ATTACHMENT IX). Report numbers 5 through 14
shall reflect an adjustment of one -tenth of the total advance amount on each of the
reports, repaying advances issued the first two months of the agreement. The adjustment shall
be recorded in Part C, I of the report (ATTACHMENT IX).
Note 43: 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.
16
Packet Page -1515-
July 2015 to June 2016
REQUEST FOR PAYMENT
COMMUNITY CARE FOR THE ELDERLY
9/8/2015 16.D.3.
ATTACHMENT 'VIII
RECIPIENT NAME, ADDRESS, PHONE# and FEID#
TYPE OF PAYMENT:
Regular
Advance _
This Request Period: From:__ To:_ _
Contract Period
Contract #
Report #
PSA #_
CERTIFICATION: I hereby certify to the best of my knowledge that this request or refund conforms with the terms and the purposes of the above contract-
Prepared by: _ Date:___ Approved by: _ _ -_ Date:_ _
PART A: BUDGET SUMMARY
1. Approved Contract Amount
2. Previous Funds Received for Contract Period
3. Contract Balance Oine 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
$ 0.00
CCE Services
$ 0.00
TOTAL
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0. OD
$ 0.00
$ 0,00
$ 0.00
$ 0.00
$ 0. DO
$ 0.00
$ 0.00
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1st- 2nd months)
2. Net Expenditures For Month
(DOEA Form 105C, Part B, Line 4)
3. TOTAL
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ D.00
$ 0.OD
$ 0.00
$ 0.00
$ 0.00
PART C' NET FUNDS REQUESTED
1. Less Advance Applied
2. TOTAL FUNDS REQUESTED (Pan $ Line 3, minus Part C Line 1)
$ 0,00
$ D.00
$ 0.00
$ 0,00
$ 0.00
$ 0.00
List of Services / Units / Rates provided - See attached report.
DOEA FORM 106C
Revised 5/4112
17
Packet Page -1516-
July 2015 to June 2016
RECEIPT AND EXPENDITURE REPORT
COMMUNITY CARE FOR THE ELDERLY
9/8/2015 16.D.3.
ATTACHMENT IX
PROVIDER NAME, ADDRESS, PHONE # and FEID#
Program Funding:
THIS REPORT PERIOD:
From To
CCE Admin.
CONTRACT PERIOD:
GCE Services
CONTRACT #
REPORT#
PSA#
CERTIFICATION . I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
Prepared by: Date: Approved by : Date:
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1 . State Funds
$0.00
$0.00
$0.00
#DIV /O!
2. Program Income
$0.00
$0.00
$0.00
#DIV /0!
3. Local Cash Match
$0.00
$0.00
$0.00
#DIV /0!
4. SUBTOTAL: CASH RECEIPTS
5. Local In -Kind Match
6. TOTAL RECEIPTS
$0.00
$0.00
$0.00
#DIV /01
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Administrative Services
$0.00
$0.00
$0.00
#DIV /0!
2. Service Subcontractor(s)
$0.00
$0.00
$0.00
#DIV /O!
3. Adult Protective Services
$0.00
$0.00
$0.00
#DIV /0!
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
#DIV /01
PART C: OTHER REVENUE AND EXPENDITURES
11, Interest:
111. Advance Recouped
I. Program Income (PI)
1. Earned on GR Advance $
$
1. CCE: PI Collected YTD $
2. Return of GR Advance $
(Includes fees collected)
3. Other Earned $
PART D : CO- PAYMENTS CURRENT MONTH
1. Total of Co- payments assessed $
2. Total of Co- payments collected $
(For Tracking Purposes only)
DO EA FORM 105C
R.-d 5/25/2010
ial:
$
YEAR -TO -DATE
Packet Page -1517-
July 2015 to June 2016
Cost Reimbursement Summary
Contract #
Report (invoice) Number:
9/8/2015 16.D.3.
UUF_ GVJ.IJ
ATTACHMENT X
Packet Page -1518-
1 l
9/8/2015 16.D.3.
Revised August 2007
:Attestation Statement
Agreement /Contract Number CCE 203.15
Amendment Number
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
(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.
1
Signature of Recipienf/Contractdfr representative Date
Revised August 2007
Packet Page -1519-
Approved as to form and legality
Assistant County Attorney
July 2015 to June 2016
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
ALZHEIMER'S DISEASE INITIATIVE CONTRACT
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
9/8/2015 16.D.3.
ADI 203.15
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."
WITNESSETH THAT:
WHEREAS, the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the mutual
covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract:
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments, forms, exhibits and references incorporated, which constitute the contract document.
2. Incorporation of Documents within the Contract:
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks,
manuals or desk books and Master Contract number 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.
3. Term of Contract:
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time July 1, 2015 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, 2016.
4. Contract Amount:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $236,025.00, or the rate schedule, subject to the availability of funds. Any costs or services paid for
under any other contract or from any other source are not eligible for payment under this contract.
5. Renewals:
By mutual agreement of the Parties, in accordance with s. 287.058(1)(g), F.S., the Agency may renew the contract for
a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or
method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may
be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability= of funds.
Packet Page -1S20-
July 2015 to:1une 2016
6. Official Payee and R
.1.4 ...- fh1., A.IA nn�i Trinnhnstio 74Tnmivurci•
9/8/2015 16.D.3.
AD1 203.13
7. All Terms and Conditions Included
This contract and its Attachments I, 111, VI - X. and K 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 Pal-ties.
By signing this contract, the Parties agree that they have read and agree to the entire contact.
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 SOUTHWEST FLORIDA, INC.
,
SIGNED 13Y: SIGNED BY:
NAME: Stephen Y. Carrell NAME: MARIANNE G LORINI
TITLE: Public Services Department Head
TITLE: PRESIDENT/CEO
DATE: ; s
DATE:
Federal Tax ID: 59- 6000558
Fiscal Year Endim-, Date: 09,'30 Approved as to foam and legality
Assistant County Attomey _
Packet Page - 1521 - v r i
Collier Count)! Housing, Human and Veteran
The Contractor name, as shown on page I of this
Services
a.
contract, and mailing address of the official payee to
3339 E Tamia:ni Trail, Building I-1
whom the payment shall be made is:
Naples.. FL 34112
Kimberly Grant, Director
The name of the contact person and street address where
Collier County Housing, Human and Veteran
b
financial and administrative records are maintained is:
Services
3339 ETamiami Trail, Building H
Naples, FL 34112
Kimberly Grant, Director
The name, address, and telephone number of the
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 H
Naples, FL 34112
(239) 252 -2273
Tammy Rhoades, VP of Finance
d
The section and location within the Agency where
Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure
15201 North Cleveland Avenue, Suite 1 100
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 1 100
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, VI - X. and K 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 Pal-ties.
By signing this contract, the Parties agree that they have read and agree to the entire contact.
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 SOUTHWEST FLORIDA, INC.
,
SIGNED 13Y: SIGNED BY:
NAME: Stephen Y. Carrell NAME: MARIANNE G LORINI
TITLE: Public Services Department Head
TITLE: PRESIDENT/CEO
DATE: ; s
DATE:
Federal Tax ID: 59- 6000558
Fiscal Year Endim-, Date: 09,'30 Approved as to foam and legality
Assistant County Attomey _
Packet Page - 1521 - v r i
9/8/2015 16.D.3.
July 2015 to June 2016 AD] 203.15
INDEX OF ATTACHMENTS
ATTACHMENTI ........................................................................... ..............................4
STATEMENT OF WORK
ATTACHMENTIII ......... ............................... I.......................................... .............................13
FUNDING SUMMARY
ATTACHMENTVI ................................................................................... .............................14
INVOICE REPORT SCHEDULE
ATTACHMENTVII .................. ............................... . ................................ .............................15
ANNUAL BUDGET SUMMARY
ATTACHMENTVIII .................................................................................................................. .............................16
REQUEST FOR PAYMENT
ATTACHMENT1X .................................................................................... ............................... 17
RECEIPT AND EXPENDITURE REPORT
ATTACHMENTX ..................................................................................... .............................18
COST REIMBURSEMENT SUMMARY
ATTACHMENTK .................................................................................... .............................19
SERVICE RATE REPORT
*Attachments II, IV, and V are incorporated by reference in Master Contract HMO] 4.
Packet Page -1522-
July 2015 to June 2016
STATEMENT OF WORT:
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO BE 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)
CIient Information and Registration Tracking System (CIRTS)
Community Care for Disabled Adults (CCDA)
Corrective Action Plan (CAP)
Department of Elder Affairs — (DOEA) or Department
Florida Statutes — (F.S.)
Home Care For Disabled Adults (HCDA)
Instrumental Activities of Daily Living (IADL)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
Summary of Programs and Services (SOPS)
United States Code— (U.S.C.)
1.1.2 Program Specific Terms
9/8/2015 16.D.3.
ADI 203.15
ATTACHMENT I
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 Agency enters ADI specific data into the CIRTS. An
update may also include other revisions to the Area Plan as instructed by the Department.
Department of Elder Affairs Programs and Services Handbook: An official document of the State of Florida,
DOEA, The Handbook includes program policies, procedures, and standards applicable to agencies which are
recipients /providers of DOEA funded programs. An annual update is provided through a Notice of Instruction.
Functional Assessment; A comprehensive, systematic, and multidimensional review of a person's ability to remain
independent and in the least restrictive living arrangement.
Memory Disorder Clinic; Research oriented programs created pursuant to Sections 430.502(1) and (2). F.S., to
provide diagnostic and referral services, conduct basic and service- related multidisciplinary research, and
develop training materials and educational opportunities for lay and professional caregivers of individuals with
AD.
Packet Page -1523-
July 2015 to June 2016
9/8/2015 16.D.3.
ADI 203.15
Model Day Care: A program of therapeutic, social and health activities specific to clients with memory
disorders. Services and activities include, but are not Iimited 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.
Notice of Instruction (NOI): The Department's established method to communicate to the A g e n c y
a n d / o r Contractor the requirement to perform a particular task or activity. NOIs are located on the
Department's website at httna/ ekleraffairsstate .fl.us /doea/nois,php.
Program Highlights: Success stories, quotes, testimonials, or human - interest vignettes that are used in the
Summary of Programs and Services to include information that helps tell the story of how programs and services
help elders, families, and caregivers.
Summary of Programs and Services (SOPS): A document produced by the Department and updated yearly to
provide the public and the Legislature with information about programs and services for Florida's elders.
1.2 GENERAL DESCRIPTION
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;
(2) Sections 430.501, 430.502, 430.503, and 430.504, Florida Statutes; and
(3) The Catalog of State Financial Assistance (CSFA) Number 65.004.
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 the Contractor's Request for Proposal,
RFP, and the Agency's current area plan and the current Department of Elder Affairs OEA Programs and
Services Handbook, which are incorporated by reference.
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:
Packet Page -1524-
9/8/2015 16.D.3.
July 2015 to June 2016 ADI 203.15
(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 that its Subcontractors
perform the following tasks:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible CIients; 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.
2.1.2 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.
(1) Imminent Risk individuals: Individuals in the community whose mental or physical health condition
has deteriorated to the degree that self -care is not possible, there is no capable caregiver, and nursing
home placement is likely within a month or very likely within three (3) months.
(2) Service priority for individuals not included in (1) above, regardless of referral source, will be
determined through the Agency's functional assessment administered to each applicant, to the
extent funding is available. The Contractor shall ensure that first priority is given to applicants at the
higher Ievels of frailty and risk of nursing home placement.
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 performance and reporting of the following services in
accordance with the current DOEA Programs and Services Handbook, which is incorporated by reference. The
services include the following categories:
(1) Caregiver Training /Support;
(2) Case Aide;
(3) Case Management;
me
r`
Packet Page - 1525 -'
9/8/2015 16.D.3.
July 2015 to June 2016 AD[ 203.15
(4)
Counseling (Gerontological);
(5)
Counseling (Mental Health /Screening);
(6)
Education/Training;
(7)
Intake;
(8)
Model Day Care;
(9) Respite (Facility- Based);
(10) Respite (In- Home); and
(11) Specialized Medical Equipment, Services, and Supplies.
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. In- 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 shall 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 the Subcontractor,
the Contractor shall notify the Agency's 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 the
Master Contract, the Agency will not be responsible or liable for any obligations or claims resulting from
such action. The Contractor shall submit a copy of all subcontracts to the Contract Manager within thirty days
of the subcontract being executed.
2.1.5 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
The Contractor shall ensure the availability of services listed in this contract at times appropriate to meet client
service needs, at a minimum during normal business hours. Normal business hours are defined as Monday
through Friday, 8:00 a.m. to 5:00 p.m.
7
Packet Page -1526- - --
July 2015 to .tune 2016
2.3 DELIVERABLES
9/8/2015 16.D.3.
ADI 203.15
2.3.1 Service Unit
The Contractor shall ensure the provision of the services described in the contract in accordance with the current
DOEA Programs and Services Handbook and the service tasks described in Section 2.1. ATTACHMENT K
list the services that can be performed, the highest reimbursement unit rate, the method of payment, and the
service unit type. Units of service will be paid pursuant to the rate established in the Area Plan as updated, as
shown in ATTACHMENT K, 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
reporting due dates for Subcontractors that permit the Contractor to meet the Agency's reporting
requirements.
2.4.2 CIRTS
The Contractor shall input ADI - specific data into CIRTS.
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.
To ensure C1RTS data accuracy, the Contractor shall
2.4.4 Program Highlights
The Contractor shall submit Program Highlights referencing specific events that occurred in SFY /FFY 2014-
2015 by September 4, 2015. The Contractor shall provide a new success story, quote, testimonial, or human -
interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms.
For all agencies or organizations that are referenced in the highlight, the Contractor shall provide a brief
description of their mission or role. The active tense shall be consistently used in the highlight narrative, in order
to identify the specific individual or entity that performed the activity described in the highlight. The Contractor
shall review and edit Program Highlights for clarity, readability, relevance, specificity, human interest, and
grammar, prior to submitting them to the Agency.
0
Packet Page -1527- �`�
9/8/2015 16.D.3.
July 2015 to June 2016 ADI 203.15
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.
2.5.2 Policies for Data and Software Backup
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. A copy of the backed up data shall 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 DOEA
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.
2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.7.1 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's
co- payment guidelines, in accordance with the current DOEA Programs and Services Handbook, which is
incorporated by reference. Co- payments include only the amounts assessed to consumers by the Contractor or
the amounts consumers opt to contribute in lieu of an assessed co- payment. The consumer's contribution must
be equal to or greater than the assessed co- payment.
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 the
successful fulfilbnent 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
Packet Page -1528-
9/8/2015 16.D.3.
July 2015 to June 2016 ADI 203.15
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, and fixed rate for services. Payment may be
authorized for all allowable expenditures to complete the tasks identified in the deliverables, as required by the
agreement. The Contractor shall consolidate all requests for payment from Subcontractors and expenditure
reports that support requests for payment to the Agency on ATTACHMENTS VIII, IX, and X.
3.1.1 Funding Distribution
The Contractor agrees to distribute fiords as detailed in the Area Plan update and the Budget Summary,
ATTACHMENT VII to this contract. Any changes in the total amounts of funds identified on the Budget
Summary 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 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. The Contractor's requests for advances require the approval of
the Contract Manager. If sufficient budget is available, the Agency will issue approved advance payments after
July 1, 2015.
3.2.1 Advance Recoupment
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 VI to this contract. The
Contractor may temporarily place advanced funds in a FDIC insured interest bearing account. All interest earned
on advanced funds 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 and Receipt and Expenditure Reports submitted to the Agency shall be submitted using
ATTACHMENT'S VIII, IX, and X. The Contractor shall include documentation of services provided, the units
of services, and the rates for the services provided in conformance with the requirements as described in this
Attachment I and Attachment K.
10
Packet Page -1529-
July 2015 to June 2016
9/8/2015 16.D.3.
ADI 203.15
3.3.1 Payment Requests
All Requests for Payment shall be based on the submission of actual monthly expenditure reports beginning with
the first month of the contract. The schedule for submission of advance requests (if /when available) and invoices
is ATTACHMENT VI.
3.3.2 Payment Withholding
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in Section 26 of the Master Contract.
3.3.3 Date for Final Request for Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided,
must be submitted to the Contract Manager and approved in writing no later than June 25, 2016. Email requests
and /or approvals are considered acceptable.
3.3.4 Date for Final Request for Payment
The final request for payment is due to the Agency no later than July 25, 2016.
3.4 DOCUMENTATION FOR PAYMENT
The Contractor shall maintain documentation to support payment requests that shall be available to the Agency
or authorized individuals, such as the Department of Financial Services, upon request.
3.4.1 CIRTS Data Entries for Contractors
The Contractor must enter all required data for clients and services in the CIRTS database per the DOEA
Programs and Services Handbook and the CIRTS User Manual — Aging Provider Network users (located in
Documents on the CIRTS Enterprise Application Services). Contractors must enter this data into the CIRTS
prior to submitting their requests for payment and expenditure reports to the Agency. The Agency shall
establish deadlines for submission to assure compliance with due dates for the requests for payment and
expenditure reports that Contractor must submit to the Agency.
3.4.2 Contractors' Monthly CIRTS Reports
The Contractor must run monthly CIRTS reports and verify client and service data in CIRTS is accurate. This
report must be submitted to the Agency with the monthly request for payment and expenditure report and must be
reviewed by the Agency before the Contractor's request for payment and expenditure reports can be approved
by the Agency.
3.5 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 shall only be
delivered to eligible program participants. 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.
3.6 FINANCIAL CONSEQUENCES
Contractor shall ensure 100% of the deliverables and service tasks identified in this contract are performed
pursuant to contract requirements. If at any time after an initial written notice of deficiency, Contractor is notified
by the Agency's Contract Manager that it has failed to correctly, completely, or adequately perform the
deliverables or service tasks, Contractor will have 10 days to issue a Corrective Action Plan ( "CAP ") to the
Contract Manager that addresses the deficiencies and states how the deficiencies will be remedied within the
11
Packet Page -1530-
July 2015 to June 2016
9/8/2015 16.D.3.
AD1 203.15
specified time period. The Agency shall assess a Financial Consequence for Non - Compliance on the
Contractor for each deficiency identified in the CAP which is not corrected pursuant to the CAP. The Agency will
also assess a Financial Consequence for failure to timely submit a CAP.
3.6.1 Payment Deduction
In the event Contractor fails to correct an identified deficiency within the timeline specified in the CAP, the
Agency shall deduct, from the payment for the invoice of the following month, one percent (1 %) of the
monthly value of the contract for each day the deficiency is not corrected. If Contractor fails to timely submit a
CAP plan, the Agency shall deduct one percent (1 %) of the monthly value of the administrative funds in the
contract for each day the CAP is overdue, 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 and 39.1 of the Master contract, this
paragraph shall have precedence.
12
Packet Page -1531-
July 2015 to June 2016
FUNDING SUMMARY
9/8/2015 16.D.3.
ADI 203.15
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
I PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT I
I 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:
MATCT4TNC-r RFS01JRCES FOR FEDERAL PROGRAMS
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT I
I TOTAL STATE AWARD I so
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Alzheimer's Disease Initiative
General Re%,enue;/TSTF Collier
65004
5216,025.00
TOTAL AWARD
5236,025.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FfNANICIAL ASSISTANCE
Section 215.97. Fla. Stat.
Chapter 691-5, Fla. Admin. Code
Packet Page -1532-
July 2015 to June 2016
Report Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Legend:
INVOICE REPORT SCHEDULE
ALZHEIMER'S DISEASE INITIATIVE
Based 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
* Advance based on projected cash need.
9/8/2015 16.D.3.
ADI 203.15
ATTACHMENT VI
Submit to State 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 1 or until the contract with the
Agency has been executed and a copy sent to Agency on Aging for Southwest
Florida, Inc. Actual submission of the vouchers to Agency is dependent on the
accuracy of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the Agency as
follows: one — tenth of the advance payment received shall be reported as an advance
recoupment on each request for payment, starting with report number five. The
adjustment shall be recorded in Part C, Line 1 of the report (ATTACHMENT IX).
Note # 3: Submission of expenditure reports may or may not generate a payment request. If
final expenditure report reflects funds due back to the Agency, payment is to
accompany the report.
z
Packet Page -1533-
July 2015 to June 2016
ANNUAL BUDGET SUMMARY
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
for
Collier County Board of County Commissioners
Allocation Total
Total
15
Packet Page -1534-
9/8/2015 16.D.3.
ADI 203.15
ATTACHMENT VIT
$236,025.00
$236,025.00
July 2015 to June 2016
9/8/2015 16.D.3.
ADI 203.15
ATTACHMENT VIII
REQUEST FOR PAYMENT
ALZHEIMERS DISEASE
INITIATIVE PROGRAM
RECIPIENT NAME. ADDRESS, PHONE# and FEID#
TYPE OF REPORT:
TlasRequestPeriod_
PSA #
A. PAYI4ENT REQUEST:
Report #
Regular__
Supplemental
Contract#
B METHOD OF PAWENT:
Cortract Period
Advance
Reimbursement
CERTIFICATION I hereby certilyto the best of myIcnoWedge 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:
(1)
(2)
PART A BUDGETSUMMARY
Resorre
Model DaYC are
TOTAL
1, Approved Contract Amoutt
$0.00
WOO
$0.00
2 Previous Funds Received for Contract Period
50.00
50.00
S0.00
3. Contract Balance (line 1 minus fine 2)
S001)
$000
s0 00
4. Previous Funds Requested and Not Received for Contract Period
$0,00
$0.00
$0.00
5 Contract Balance line 3 minus line 4)
$0.00
$0.00
$0.00
PART B: CONTRACTFUNDS REOUEST
1 Anticipated Cash Needs (1st- 2nd month. Attach Justification)
50.00
50.00
50.00
2. Net E>penditure s For Mw ith
50.00
$0.00
$0.00
(DOEAForm 105Z Part B Line 3)
3. TOTAL
$000
50 00
SO-00
PART C: NET FUNDS REQUESTED
t. Less Advance Applied
5000
s0.00
50 00
2. Contract Funds are HerebvRequesied for (Part 6, Line 3
50.00
$0.00
$0.00
minus Pat C, Line 1)
I
i
List of Servi ces ! Units/ Rates provided - See attached re port
DOEA FOW 1062
Rnssc fla 12
16
Packet Page -1535-
July 2015 to June 2016
RECEIPT AND EXPENDITURE REPORT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
9/8/2015 16.D.3.
ADI 203.15
ATTACHMENT IX
PROVIDER NAME, ADDRESS, PHONE #and FEID
Program Funding:
THIS REPORT PERIOD:
From i
To _
Respite
CONTRACT PERIOD:
Model Day Care _
CONTRACT #
REPORT #
PSA4
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'
_ Approvedby:_
Date'
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. State Funds
$0.00
$0.00
$0.00
#DIV /O!
2. Program Income
$0.00
$0 -00
$0.00
#0IV10!
3. Local Cash Match
$0.00
$0.00
$0.00
9DIV101
4. SUBTOTAL CASH RECEIPTS
5. Local In -Kind Match
6. TOTAL RECEIPTS
$0.00
$0.00
$0.00
#DIV 101
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4 Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Administrative Services
$0.00
$0.00
50.00
4DIV /01
2. Service Subcontractor(s)
$0.00
$0.00
$0.00
#DIV:O!
3. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
9DIV10!
PART 0: OTHER REVENUE AND EXPENDITURES
II. Interest:
ill. Advance Recouped
I. Program Income (PI)
1. Earned on GR Advance S
1. AD: PI Collected YTD $
2. Return of GR Advance $
(includes co- payments collected)
3. Other Earned
$_
_
PART D: CO- PAYME14TS CURRENT MONTH
YEAR -TO -DATE
'; Total of Co- payments assessed
$_
$
A_
2. Total of Co- payments collected
$_
S
I
(For Tracking Purposes only)
ODEAFORla 10EZ
Re•ased EJ251201C
1!
Packet Page -1536-
July 2015 to June 2016
Cost Reimbursement Summary
Contract #
Report (invoice) Number:
9/8/2015 16.D.3.
AD1203.15
ATTACHIME NT X
Budget
Number of
Category Description
units
Service Date
Amount
C
0
m
LA
C
?E
Q
TOTAL ADMINISTRATION $0.00
W
LR
a
w
TOTAL EXPENSES $0.00
18
Packet Pace -1537-
July 2015 to June 2016
SERVICE RATE REPORT
DELIVERABLES
Case Aide: Collier
Case Management: Collier
Respite In- Facility: Collier
Respite In -Home: Collier
Specialized Medical Equipment, Services and Supplies
HIGHEST
REIMBURSEMENT
UNIT RATE
$33.88
$60.00
$12.83
$25.67
Packet Page -1S38-
L l
9/8/2015 16.b.'i `5
ATTACHMENT K
METHOD OF
PAYMENTS
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Cost Reimbursement
9/8/2015 16.D.3.
Revised August 2007
Attestation Statement
Agreement /Contract Number ADI 203.15
Amendment Number
I, Stephen Y. Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Department Head
(Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of Recipient /contractor representative Date
Revised August 2007
Packet Page -1539-
4PPIOVed as to forme and legality
Assistant County Attorney
July 2015 to June 2016
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM CONTRACT
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
9/8/2015 16.D.3.
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:
I. 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.
3. Term of Contract
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time July 1, 2015 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, 2016.
4. Contract Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not
to exceed $49.250.00, or the rate schedule, subject to the availability of funds. Any costs or services paid for under
any other contract or from any other source are not eligible for payment under this contract.
5. Renewals
By mutual agreement of the Parties, in accordance with s. 287.058(1)(g), F.S., the Agency may renew the contract for
a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or
method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may
be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability of finds.
Packet Page -1540-
July 2015 to June 2016
[Type here]
6. 'Official Pa3,pe and Re rresentativg,,s (Names, Addresses, and Telephone Numbers):
9/8/2015 16.D.3.
7. All Terms and Conditions Included:
"Phis contract and its Attachments, I, 111, VI — X. and any exhibits referenced in said attachments, together with any
dOCUrnenS 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 Palsies.
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 ACING FOR
COUNTY COMMISSIO,.NERS SOUTHWEST FLORIDA, INC.
SIGNED BY-
NAME:
4
TITI_.E:
DATE:—_ I ;
Federal Tax ID: 59- 6000558
Fiscal Year Endini-,, Date: 09%30
SIGNED BY: ...;
NAME: MARIANNE G LORIN►
TITLE: PRESIDENT /CEO
DATE:
Packet Page -1541-
Approved as Eu ioml �Uld is alrty
Ass'estant CountyAt&ney
The Contractor i s • n n age 1 f his
1 ortr4c name, a show o. page o f
Collier County Housing, Human and Veteran
Services
contract, and mailing address of the official payee to
3339 E Tamiami Trail, Building H
a.
whom the payment shall be made is:
Naples, FL 34112
Kimberly Grant, Director
The name of the contact person and street address where
Collier County Housing, Human and Veteran
b'
financial and administrative records are maintained is:
3339 E TamiamiServices BuiIding H
Naples, FL 34112
Kimberly Grant, Director
The name, address, and telephone number of the
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 H
Naples, FL 34112
(239) 252 -2273
Tammy Rhoades, VP of Finance
d
The section and location within the Agency where
Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure
15201 North Cleveland Avenue, Suite 1 100
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 l 100
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:
"Phis contract and its Attachments, I, 111, VI — X. and any exhibits referenced in said attachments, together with any
dOCUrnenS 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 Palsies.
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 ACING FOR
COUNTY COMMISSIO,.NERS SOUTHWEST FLORIDA, INC.
SIGNED BY-
NAME:
4
TITI_.E:
DATE:—_ I ;
Federal Tax ID: 59- 6000558
Fiscal Year Endini-,, Date: 09%30
SIGNED BY: ...;
NAME: MARIANNE G LORIN►
TITLE: PRESIDENT /CEO
DATE:
Packet Page -1541-
Approved as Eu ioml �Uld is alrty
Ass'estant CountyAt&ney
July 2015 to June 2016 9/8/2015 16.D.3.
INDEX OF ATTACHMENTS
ATTACHMENTi ....................... ............................... . .............................. ...............................
ATTACHMENTIII ..................................................................................... .............................13
ATTACHMENT VI
HOME CARE FOR THE ELDERLY ANNUAL BUDGET AND RATE SUMMARY ............................. 14
ATTACHMENT VII
HOME CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE ................. ............................... 15
ATTACHMENT Vill
REQUESTFOR PAYMENT' ....................................................................... .............................16
ATTACHMENT IX
RECEIPT AND EXPENDITURE REPORT ..... ............................... . ....................... ............................... 17
ATTACHMENT X
COST REIMBURSEMENT SUMMARY ................ ....................... . ............ . ................... . ....... ....18
*Attachments 11, IV, and V are included by reference in the Master Contract HMO 14.
3
Packet Page -1542-
Juiv 2015 to ]Line 2016 9/8/2015 16.D.3.
!Type here]
AT'T'ACHMENT I
AREA AGENCY ON AGING FOR SOUTH v�EST FLO RIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITION OF CONTRACT TERMS AND ACRONYMS
1.1.1 Definitions of Acronyms
Corrective Action Plan (CAP)
Community Care for Disabled Adults (CCDA)
Community Care for the Elderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Florida Department of Elder Affairs (DOER)
Florida Statutes (F.S.)
Home Care for Disabled Adults (HCDA)
Home Care for the Elderly (HCE)
Institutional Care Program (ICP)
Planning and Service Area (PSA)
Summary of Programs and Services (SOPS)
1.1.2 Program Specific Terms
Aging Out: The condition of reaching 60 years of age and being transitioned from DCF Services, CCDA or
HCDA services to the Agency's and /or 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 PSA in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Act
and Department instructions. The Area Plan includes performance measures and unit rates per service offered
per county.
Area Plan Update: A revision to the Area Plan wherein the area agency on aging enters HCE program specific
data in the CIRTS. An update may also include other revisions to the Area Plan as instructed by the Agency
and /or Department.
Department of Elder Affairs Programs and Services Handbook: An official document of DOEA. Handbook
includes program policies, procedures, and standards applicable to agencies which are recipients /providers of
DOEA funded programs. An annual update is provided through a Notice of Instruction.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to
remain independent and in the least restrictive living arrangement.
Notice of Instruction (NOl): The Department's established method to communicate to the Agency and /or
Contractor the requirement to perform a particular task or activity. NOls are located on the Department's
website at http:// elderaffairs .state.fl.us /doea /nois.php.
C!
Packet Page -1543-
July 2015 to June 2016
9/8/2015 16.D.3.
Summary of'Programs and Services (SOPS): A document produced by the Department and updated
yearly to provide the public and the Legislature with information about programs and services for
Florida's elders.
1.2 GENERAL 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 Home Care for the Elderly Program Mission Statement
The I-ICE Program supports family -style living arrangements, on a non -profit basis, as an alternative to nursing
homes or other institutional care. Through the program, a caregiver for- 3 or fewer elders, 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 program includes:
(1) Rule Chapter 581-1-1, Florida Administrative Code;
(2) Sections 430.601, 430.602, 430.603, 430.604, 430.605, 430.606, 430.608, F.S.; and
(3) The Catalog of State Financial Assistance (CSFA) Number 65.00 1.
1.2.4 Scope of Service
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 as updated, and the current Department of Elder Affairs OEA
Programs and Services Handbook, which are incorporated by reference.
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
1.3.1 General Eligibility
The HCE 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.
1.3.2 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 ICP standard;
(3) Meet the ICP asset limitation;
Packet Page -1544-
July 2015 to June 2016
(4) Be at risk of nursing home placement;
9/8/2015 16.D.3.
(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;
(6) Maintain the residential dwelling free of conditions that pose an immediate threat to the Iife,
safety, health and well -being of the home care client; and
(7) 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 I ICE program, the Contractor shall perform or ensure that its Subcontractors
perform 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.
2.11. 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.
(1) Imminent Risk individuals: Individuals in the community whose mental or physical health condition
has deteriorated to the degree that self -care is not possible, there is no capable caregiver, and nursing
home placement is likely within a month or very likely within 3 months.
(2) Aging Out individuals: Individuals receiving CCD.A and HCDA services through the Department
of Children and Families' Adult Services transitioning to community -based services provided through
the Agency and /or Department when services are not currently available.
6
Packet Page -1545-
July 2015 to June 2016
9/8/2015 16.D.3.
(3) Service priority for individuals not included in (1) and (2) above, regardless of referral source, will
be determined through the Agency's functional assessment administered to each applicant, to the extent
funding is available. The Contractor shall ensure that first priority is given to applicants at the higher
levels of 11'ailty and risk of nursing home placement.
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
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. The Contractor shall ensure the Basic Subsidy is calculated in accordance with the current
DOEA Programs and Services Handbook.
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
Eider Affairs Programs and Services Handbook. Special Subsidy services include;
Service
Unit of Service
Adult Day Care
1- lousing Improvement
Hour
Adult Day Health Care
Occupational
Caregiver Training /Support
Therapy Other
i
Chore
Outreach
Chore (Enhanced)
Personal Care
Counseling (Gerontological)
Physical
Counseling (Mental
Therapy
Health /Screening)
Respite (Facility Based or h1 -Home)
Home Health Aide Service
Skilled Nursing Services Speech
Homemaker
Therapy
I
Home Delivered Meals
Meal
Material Aid
Episode
Other
Specialized Medical Equipment, Services and Supplies
Transportation
One -Way Trip
7
Packet Page -1546-
July 2015 to June 2016 9/8/2015 16.D.3.
2.1.3.3 Access to and Coordination 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. 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. The Contractor shall submit a copy of all subcontracts
to the Contract Manager within thirty days of the subcontract being executed.
2.1.5 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 Iaws 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 availability of the services listed in this contract at times appropriate to
meet client service needs, at a minimum, during normal business hours. Normal business hours are
defined as Monday through Friday, 8:00 a.m. to 5:00 p.m.
2.3 DELIVERABLES
23.1 Service Unit
The Contractor shall ensure the provision of the services described in the contract, and the service tasks
described in Section 2.1, are in accordance with the current Department of Elder Affairs Programs and
Services Handbook. ATTACHMENT VI- lists the services that can be performed, the highest
reimbursement unit rate, the method of payment, and the service unit type. Units of service will be paid
pursuant to the rate established in the Area Plan as updated and shown in ATTACHMENT VI 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
reporting due dates for Subcontractors that permit the Contractor to meet the Agency's reporting
requirements.
2.4.1 Area Plan Update and All Revisions Thereto
The Agency is required to submit an annual Area Plan update wherein the Agency enters HCE- specific
data in the CIRTS. The Contractor may also be required to submit revisions to the Area Plan as instructed by
the Agency and /or Department.
E.
Packet Page -1547-
auly 2015 to .tune 2016 9/8/2015 16.D.3.
2.4.2 CIRTS Reports
The Contractor shall input FICE- 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.
2.4.3 Program Highlights
The Contractor shall submit Program Highlights referencing specific events that occurred in SFY /FFY 2014-
2015 by September 04, 2015. The Contractor shall provide a new success story, quote, testimonial, or human -
interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms.
For all agencies or organizations that are referenced in the highlight, Contractor shall provide a brief description
of their mission or role. The active tense shall be consistently used in the highlight narrative, in order to identify
the specific individual or entity that performed the activity described in the highlight. The Contractor shall
review and edit Program Highlights for clarity, readability, relevance, specificity, human interest, and grammar,
prior to submitting them to the Agency.
2.5 RECORDS A.1\iD DOCUMENTATION
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.
2.5.1 Policies for Data and Software Backup
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
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. A copy of the backed up data shall 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 SPECK; ]CATIONS
2.6.1 Outcomes
(1) The Contractor shall ensure services provided under this contract are in accordance with the current DOEA
Programs and Services l-landbook:
(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.
2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS
Packet Page -1548-
Ju1v 2015 to June 2016 9/8/2015 16.D.3.
Subsidy payments for each client and for the prograrn must be maintained within the amount of prog7am
funding available.
2.85 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.
2.5.2 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
a`:rees 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) l.,imited -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 and fixed rates for services. Payment may be
authorized for all allowable expenditures to complete the tasks identified in the deliverables, as required by
the ag7eement. 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 ATTACHMENT VIII,
ATTACHMENT Iii, and ATTACHMENT X.
31.1 Fundinb Distribution
Tile Contractor agrees to distribute funds as detailed in the Area Plan update and ATTACHMENT VI. 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 budget and receive written approval from
the Agency's Contract Manager. Any - changes in the total amounts of the funds identified on the
ATTACHMENT VI form require a contract amendment.
3.2 AllVANCE PAYMENTS
The Contractor may request up to two months of advances at the start of the contract period to cover
service costs. The payment of an advance will be contingent upon the sufficiency and amount of funds released
to the Agency and /or Deparhmnt'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. The Contractor's requests for advances require the approval of the Contract Manager. If sufficient
budL,et is available. the Agency will issue approved advance payments after July 1. 2015.
10
Packet Page -1549-
July 2015 to June 2016
9/8/2015 16.D.3.
3.2.1 Advance Recoupment
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 recoupnent on each request for payment, starting with
report number 5, in accordance with ATTACHMENT VII to this contract. The Contractor- may temporarily
place advanced funds into an FDIC insured interest bearing account. All interest earned on advanced funds
must be returned to the Agency witI-rin 30 days of the end of each quarter of the contract period.
3.3 INVOICE SUBMITTAL AND REQUESTS FOR PAYMENT
All Requests For Payment and Receipt and Expenditure Reports submitted to the Agency shall be submitted
using ATTACHMENT VIII, ATTACHMENT IX and Cost Reimbursement Summary (ATTACHMENT X).
The Contractor shall include documentation of services provided, unit of services, and the rates for the services
provided in conformance with the requirements as described in this ATTACHMENT I.
3.3.1 Payment Requests
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 VII to this contract.
3.3.2 Payment Withholding
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in section 26 of Master Contract.
3.3.3 Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services, must be
submitted to the Contract Manager no later than June 25, 2016.
3.3.4 Date for Final Request for Payment
The final request for payment is due to the Agency no later than August 1, 2016,
3.4 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.
3.4.1 HCE Subsidy Data Entries Schedule
The Contractor must ensure all data for HCE subsidies are entered in the 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
L6th of the previous month and the 15th of the current month. Case management data entered into the CIRTS
by the 9th of the month shall be for units of service provided during the previous month from the I st and up to
and including the last day of the previous month or case management units of service may be entered according
to the Contractor schedule, in aggregate on the 31st or daily, weekly or monthly. The Contractor shall ensure
data entry for HCE subsidies will cease on the 15th of the month and the CIRTS Monthly Service Utilization
Report, by consumer and by worker identification is generated. The Contractor shall ensure the Monthly
Utilization Report by consumer and by worker identification is verified, corrected, and certified no later than
the 20th of the month in which the Report is generated.
3.4.2 CIRTS Data Entries for Contractors
The Agency must require Contractors to enter, all required data per the Agency's and/or
Department's CIRTS Policy Guidelines for clients and services in the CIRTS database. The data must be
entered into the CIRTS before the Contractors submit their request for payment and expenditure reports to the
Agency. The Agency shalt establish time frames to assure compliance with due dates for the requests for
payment and expenditure reports to the Agency and /or Department along with copies of receipts /services over
$150.
Packet Page -15S0-
July 2015 to June 20t6
9/8/2015 16.D.3.
3.4.3 Contractors' Monthly CIRTS Reports
The Agency must require Contractors to 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.
3.5 REMEDIES FOR NONCONFORMING SERVICES
The Contractor shall ensure that all goods and /or services provided under this contract are delivered
timely, completely and commensurate with required standards of quality. Such goods and /or services
shall only be delivered to eligible program participants. 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.
3.6 FINANCIAL CONSEQUENCES
Contractor shall ensure 100% of the deliverables and service tasks identified in this contract are
performed pursuant to contract requirements. If at any time after an initial written notice of deficiency,
Contractor is notified by the Agency's Contract Manager that it has failed to correctly, completely, or
adequately perform the deliverables or service tasks, Contractor will have 10 days to issue a Corrective
Action Plan ("CAP ") to the Agency's Contract Manager that addresses the deficiencies and states how the
deficiencies will be remedied within the specified time period. The Agency shall assess a financial
Consequence for Non - Compliance on the Contractor for each deficiency identified in the CAP which
is not corrected pursuant to the CAP. The Agency will also assess a Financial Consequence for failure to
timely submit a CAP.
3.6.1 Payment Deduction
In the event Contractor fails to correct an identified deficiency within the tirneline specified in the CAP,
the Agency shall deduct, from the payment for the invoice of the following month, 1 % of the monthly value
of the contract for each day the deficiency is not corrected. If Contractor fails to timely submit a CAP plan,
the Agency shall deduct 1% of the monthly value of the administrative funds in the contract for each day
the CAP is overdue, beginning the I 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 and 39.1 of the Master contract, this paragraph
shall have precedence.
12
Packet Page -1551-
July 2015 to June 2016
9/8/2015 16.D.3.
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
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:
11TATC'HING RF:SOURC ES FOR FF.IIF.RAI, PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD $0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
I -tome Care for the Elderly
General Revenue - Collier
65.001
$49,250.00
TOTAL AWARD
549,250.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAAL ASSISTANCE
Section 21597, Fla. Stat.
Chapter 691 -5, Fla. Admin. Code
13
Packet Page -1552-
July 2015 to June 2016
9/8/2015 16.D.3.
ATTACHMENT VI
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of County Commissioners
Collier
HCE Case Management/Case Aide $ 3805.00
HCE Basic and Special Subsidies 45,445.00
Total $ 49,250.00
RATE SUMMARY
Collier County Board of County Commissioners
Collier
SERVICES REIMBURSEMENT RATE
Collier
Case Management $60.00
Case Aide $33.88
14
Packet Page -1553-
July 2015 to June 2016
Report Number
2
7
8
9
10
11
12
13
14
15
16
HOME CARE FOR THE ELDERLY
INVOICE REPORT SCHEDULE
Based On
July Advance*
August Advance*
Monthly Utilization Report (7/1 -7/15)
July Expenditure Reports (105 & 106)
Monthly Utilization Report (7/16 -8/15)
August Expenditure Report (105 & 106)
Monthly Utilization Report (8/16 -9/15)
September Expenditure Report (105 & 106)
Monthly Utilization Report (9/16 - 10/15)
October Expenditure Report (105 & 106)
Monthly Utilization Report (10/16 - 11/15)
November Expenditure Report (105 & 106)
Monthly Utilization Report (11/16 -12/15
December Expenditure Report (105 & 106)
Monthly Utilization Report (12/16 -1/15)
January Expenditure Report (105 & 106)
Monthly Utilization Report (1/16 -2/15)
February Expenditure Report (105 & 106)
Monthly Utilization Report (2/16 -3/15)
March Expenditure Report (105 & 106)
Monthly Utilization Report (3/16 -4/15)
April Expenditure Report (105 & 106)
Monthly Utilization Report (4/16 -5/15)
May Expenditure Report (105 & 106)
Monthly Utilization Report (5/16 -6/15)
June Expenditure Report (105 & 106)
Monthly Utilization Report (6/15 -6/30)
Final Expenditure Report (105 & 106)
Closeout Report (105 & 106)
Legend: * Advance based on projected cash need.
9/8/2015 16.D.3.
ATTACHMENT VII
Submit to Agency on this Date
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
Apri 19
April 20
May 9
May 20
June 9
June 20
July 9
July 20
August 1
August 15
Note # 1: Repoii #I 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 4 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 f ve. The ad_}ustment shall be recorded in
Part C, Line 1 of the report (ATTACHMENT IX).
Note 43: 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
Packet Page -1554-
July 2015 to June 2016
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
9/8/2015 16.D.3.
ATTACHMENT V11I
RECIPIENT NAME, ADDRESS, PHONE# and FEID#
TYPE OF PAYMENT:
This Request Period: From: To:
Contract Period
Regular
Contract #
Advance
Report#
PSA #
CERTIFICATION: I hereby certify to the best of my knowledge that this request is complete and correct and conforms with the terms and the purposes of the above contract.
Prepared try: Dale'. Approved by Date:
PART A BUDGET SUMMARY
AAAAdmin.
Case Management
Subsides
TOTAL
1. Approved Contract Amount
$0.00
$0.00
$0.00
$0.00
2, Previous Funds Received for Contract Period,
$0.00
$0.00
$0.00
$0.00
3. Contract Balance (fine 1 minus fine 2)
$0.00
$0.00
$0.00
$0.00
4. previous Funds Requested and Not Received for Contract Period
$0.D0
$D.00
$0.00
$0.00
5. CONTRACT BALANCE (line 3 minus lino t)
$0.00
$0.00
$0.00
$0.00
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1st - 2nd months)
$0.00
$0.00
$0.00
$0.00
2. Net Expenditures For Month
$0.00
$0.00
$0.00
$0.00
(DOER Form 105H, Part B, Line 4)
3. TOTAL
$0.00
$0.00
$0.00
$0.00
PART C: NET FU14DS REQUESTED
1. Less Advance Applied
$0.00
$0.00
$0.00
$0.00
2. TOTAL FUNDS REQUESTED (Part B Line 3, minus Pad C Line 1)
$0.00
$0 AO
$0.00
$0.00
List o!Sewicas / Units 1 Rates provided - See attached report.
DOLAa OHM 113,61-1
Pav:;ed 5!411?
16
Packet Page -1555-
July 201 5 to June 2016
RECEIPT AND EXPENDITURE REPORT
HOME CARE FOR THE ELDERLY PROGRAM
9/8/2015 16.D.3.
ATTACHMENT IX
PROVIDER NAME, ADDRESS, PHONE # and FEID#
Program Funding:
THIS REPORT PERIOD:
From To
AAA Admin.
CONTRACT PERIOD:
Case Management
CONTRACT #
Subsidies:
REPORT #
Basic
Special
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
Prepared by : Bete : Apprwed 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 Bud et
1. State Funds
$0.00
SD.00
$0.00
#DIV/D!
2. TOTAL RECEIPTS
$0.00
$0.00
$0.00
#DIV /D!
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 /0!
1. AAA Program Administration
2. Service Subcontractors: Case Management
$0.00
$0.00
$0.00
#DIV /01
3. Service Subcontractors: Subsidy
$0 OD
$0.00
$0.00
#DIV /01
a. Basic Subsidy
$0,00
$0.00
$0.00
#DIV /0!
b. Special Subsidy
$0.00
$0.00
$0.00
#DIV/01
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
#DIV101
PART C : OTHER REVENUE AND EXPENDITURES
I. Interest:
II. Advance Recoupment
I. Earned on GR Advance
2. Return of GR Advance $
1. Advance Recouped $
3, Other Earned $
DOEA FORM 105H
Revised 5r2512010
17
Packet Page -1556-
July 2015 to June 2016
Cost Reimbursement Summary
Contract #
Report (invoice) Number:
9/8/2015 16.D.3.
n� r; /-w.
ATTACHMENT X
18
Packet Page -1557-
9/8/2015 16.D.3.
Revised August 2007
Attestation Statement
Agreement /Contract Number HCE 203.15
Amendment Dumber
1, Stenhen 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 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 /Contractortrepresentative
Revised August 2007
Packet Page -1558-
Date
Approved as to form and legality
Assistant County Attorney