Backup Documents 02/13/2018 Item #16D20 Co ler ctorty
Public Services Department 1 6 2 2 0
Community & Human Services Division
March 6, 2018
TO: Minutes and Records
Subject: Meeting Date—February 13, 2018
Agenda Item 16.D.11
OAA 203.17.003 Amendment
Please find enclosed one original executed copy of the Older American Act Amendment#3 which was
approved at the February 13, 2018 Board Meeting.
If you have any questions, please feel free to contact me at 239-252-2903.
Thank you,YAIED9066
Jody Paley
Grants Coordinator
Collier County Government
(239) 252-2903
ePtIN
Community&Human Services Division•3339 Tamiami Trail East,Suite 211 •Naples,Florida 34112-5361
239-252-CARE(2273)•239-252-CAFE(2233)•239-252-4230(RSVP)•wuvw.colliergov.net/humanservices
Amendment 02 0Al2$;11.7. )22 0
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. JJJJJJ......
OLDER AMERICANS ACT PROGRAM TITLE III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc., (Agency)
and Collier County Board of County Commissioners (Contractor) and amends contract OAA 202.17.
The purpose of this amendment is to (1) extend this contract for 60 days or until a new 2018 OAA 202.18 contract is
executed,whichever comes first.
This amendment shall be effective on January 1, 2018
RECITALS:
WHEREAS, on January 19, 2017, the parties entered into the Standard Contract for social services to be
provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract"); and
WHEREAS, on October 30, 2017, the parties entered into a First Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on December 31, 2017; and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agency from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so that
both parties wish to extend the Contract to February 28, 2018 while they await notification of funding of a successor
contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration,the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
1. The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to February 28, 2018.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level specified
in the agreement.
SIGNATURE PAGE TO FOLLOW
1 0.
Amendment 02 01 2 .1 . 02 0
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there unto
duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.
11110 I t
SIGNED BY: �► .1 1 t;:y' / SIGNED BY: ,6//0)-(;(-(L
NAME: STEVE Y. CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: ( l 23 izo C DATE: 1/02 //P
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
2
1 i •
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Revised August 2007 1 6 0 20
Attestation Statement
Agreement/Contract Number 203.17
Amendment Number 002
I,Steve Camel! ,attest that no changes or revisions have been
made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of County Commissioners
(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.
AlPO
6/..7-//7".
g
Signature of4Recipient/Contractor representative Date
Revised August 2007
January 2018 to December 2018 OAA 203.18
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. 1 6 0 �'1
0
STANDARD CONTRACT t�..
OLDER AMERICANS ACT
THIS CONTRACT is entered into between Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier
County Board of County Commissioners, (Contractor), collectively referred to as the "Parties." The term Contractor for
this purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS,the Agency has determined that it is in need of certain services as described herein; and WHEREAS,
the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such services as an
independent Contractor of the Agency.
NOW THEREFORE,in consideration of the services to be performed and payments to be made,together with the
mutual covenants and conditions hereinafter set forth,the Parties agree as follows:
Purpose of Contract:
The purpose of this Contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments,forms and exhibits,which constitute the contract document.
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, as an integral part of the contract, except to the extent that the contract explicitly provides to the
contrary. In the event of conflict in language among any of the documents referenced above, the specific provisions and
requirements of the contract document(s) shall prevail over inconsistent provisions in the proposal(s) or other general
materials not specific to this contract document and identified attachments.
Term of Contract:
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time January 1, 2018 or on the date the contract has
been signed by the last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) P.M., Eastern
Standard Time December 31,2018.
Contract Amount:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to
exceed $1,056,506.28 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.
Renewals:
By mutual agreement of the Parties, in accordance with Section 287.058(1)(g), Florida Statutes (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.
Compliance with Federal Law;
If this contract contains federal funds this section shall apply.
The Contractor shall comply with the provisions of 45 Code of Federal Regulations (CFR) 75 and/or 45 CFR Part 92, 2
CFR Part 200 and other applicable regulations.
If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all applicable
standards, orders, or regulations issued under Section 306 of the Clean Air Act as amended (42 United States Code
(U.S.C.) 7401, et seq.), Section 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 2 CFR Part
1500. The Contractor shall report any violations of the above to the Agency.
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January 2018 to December 2018 OAA V3.6
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The Contractor, or agent acting for the Contractor, may not use any federal funds received in connection wi is
contract to influence legislation or appropriations pending before the Congress or any state legislature. The Contractor
must complete all disclosure forms as required, specifically the Certification and Assurances Attachment, which must be
completed and returned to the Contract Manager prior to the execution of this contract.
In accordance with Appendix II to 2 CFR Part 200, 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 regulations 41 CFR Part 60 and in Department of Health and Human Services regulations 45 CFR Part 92, if
applicable.
A contract award with an amount expected to equal or exceed$25,000.00 and certain other contract 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 this contract.
The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract.
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. 1101). Such violation will be cause for unilateral cancellation of this contract by the Agency.
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.
The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
Unless exempt under 2 CFR §170.110(b), the Contractor shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR Part 170.
To comply with Presidential Executive Order 12989, as amended, and State of Florida Executive Order Number 11-116,
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 term. Contractor shall include in related subcontracts a
requirement that Subcontractors performing work or providing services pursuant to the state contract utilize the E-verify
system to verify employment of all new employees hired by the Subcontractor during the contract term. Contractors
meeting the terms and conditions of the E-Verify System are deemed to be in compliance with this provision.
Compliance with State Law:
This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all
respects in accordance with Florida law, including Florida provisions for conflict of laws.
If this contract contains state financial assistance funds, the Contractor shall comply with Section 215.97, F.S., and
Section 215.971, F.S., and expenditures must be in compliance with laws, rules, and regulations, including, but not limited
to,the Reference Guide for State Expenditures.
The Contractor shall comply with the requirements of Section 287.058,F.S. as amended.
The Contractor shall perform all tasks contained in Attachment I.
The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in Attachment I,to
be received and accepted by the contract manager prior to payment.
The Contractor shall comply with the criteria and final date by which such criteria must be met for completion of
this contract as specified in Attachment I, Section III. Method of Payment.
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January 2018 to December 2018 OAA 21.16
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.
If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit bills for any travel
expenses in accordance with Section 112.061,F.S.,or at such lower rates as may be provided in this contract.
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 this 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 for which the Agency may unilaterally terminate this contract.
If clients are to be transported under this contract, the Contractor shall comply with the provisions of Chapter 427, F.S.,
and Rule Chapter 41-2,Florida Administrative Code(F.A.C).
Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in accordance
with the provisions of Section 287.134,F.S.
The Contractor shall comply with the provisions of Section 11.062, F.S., and Section 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the legislature,judicial branch or a state agency.
In accordance with Section 287.135 F.S., any Contractor on the Scrutinized Companies with Activities in Sudan List, ef-the
Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that
Boycott Israel List (Lists), created pursuant to Section 215.473 F.S. and 215.4725, F.S., or is engaged in a boycott of
Israel, or is engaged in business operations in Cuba or Syria, is ineligible to enter into or renew a contract with the Agency
for goods or services of$1,000,000 or more. Pursuant to Section 287.135 F.S., the Agency may terminate this contract if
the Contractor is found to have submitted a false certification of its status on the Lists or has been placed on the Lists or is
engaged in a boycott of Israel or has been engaged in business operations in Cuba or Syria. 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. The Contractor shall complete and sign the Certifications and Assurances Attachment, prior to the execution
of this contract.
Background Screening:
The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435,F.S., as amended,are met
regarding background screening for all persons who meet the definition of a direct service provider and who are not
exempt from the Agency's level 2 background screening pursuant to Section 430.0402(2)-(3),F.S. The Contractor
must also comply with any applicable rules promulgated by the Agency and/or Department and the Agency for Health
Care Administration regarding implementation of Section 430.0402 and Chapter 435, F.S. To demonstrate compliance
with this provision,Contractor shall submit to the Agency,the Background Screening Affidavit of Compliance
(Screening Form)upon thirty(30)days of execution of this contract. Should the Agency have a completed Screening
Form on file for the Contractor, a new Screening Form will be required every twelve(12) months.
Further information concerning the procedures for background screening may be found at
http://elderaffairs.state.fl.us/doea/backgroundscreening.php.
Grievance Procedures:
The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to
process and resolve client dissatisfaction with or denial of service(s), and address complaints regarding the termination,
suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum, will provide for
notice of the grievance procedure and an opportunity for review of the Subcontractor's determination(s).
Public Records and Retention:
By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any other applicable law, and
shall:
Keep and maintain public records required by the Agency to perform the contracted services.
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January 2018 to December 2018 OAl 2.113 20
Upon request from the Agency's custodian of public records, provide the Agency a copy of the requested records or
allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in
Chapter 119,F.S., or as otherwise provided by law.
Ensure that public records that are exempt, or confidential and exempt, from public records disclosure requirements are
not disclosed except as authorized by law for the duration of the contract term and following completion of the
contract if the Contractor does not transfer the records to the Agency.
Upon completion of the contract,the Contractor will either transfer,at no cost to the Agency,all public records in possession
of the Contractor, or will keep and maintain public records required by the Agency. If the Contractor transfers all public
records to the Agency upon completion of the contract, Contractor shall destroy any duplicate public records that are
exempt, or confidential and exempt, from public records disclosure requirements. If the Contractor keeps and maintains
public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining
public records. All records stored electronically must be provided to the Agency in a format that is compatible with the
information technology systems of the Agency.
The Agency may unilaterally cancel this contract, notwithstanding any other provisions of this contract, for refusal by the
Contractor to comply with Section 10 of this contract by not allowing public access to all documents, papers, letters, or other
material made or received by the Contractor in conjunction with this contract, unless the records are exempt, or
confidential and exempt, from Section 24(a) of Article I of the State Constitution and Section 119.07(1),F.S.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF
CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE
CUSTODIAN OF PUBLIC RECORDS AT:
Public Records Coordinator
Area Agency on Aging for Southwest Florida,Inc.
15201 N Cleveland Ave., Suite 1100
North Fort Myers,FL 33903
239-652-6900
Audits.Inspections.Investigations:
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 this contract. Contractor shall adequately safeguard all such assets and assure they are used solely for the
purposes authorized under this contract. Whenever appropriate, financial information should be related to performance and
unit cost data.
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 this contract for a period of six (6) years after
completion of the contract or longer when required by law. In the event an audit is required by this contract,records shall
be retained for a minimum period of six(6)years after the audit report is issued or until resolution of any audit findings or
litigation based on the terms of this contract,at no additional cost to the Agency.
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.
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.
At all reasonable times for as long as records are maintained, persons duly authorized by the Agency and federal auditors,
pursuant to 45 CFR Part 75, will be allowed full access to and the right to examine any of the
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January 2018 to December 2018 O26.10
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Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the form in
which kept.
The Contractor shall provide a Financial and Compliance Audit Attachment to the Agency as specified in this contract
and ensure that all related third-party transactions are disclosed to the auditor.
Contractor agrees to comply with the Inspector General in any investigation, audit, inspection,review, or hearing performed
pursuant to Section 20.055, Florida Statutes. Contractor further agrees that it shall include in related subcontracts a
requirement that subcontractors performing work or providing services pursuant to this contract agree to cooperate with the
Inspector General in any investigation, audit, inspection, review, or hearing pursuant to Section 20.055(5), F.S. By
execution of this contract the Contractor understands and will comply with this subsection.
Nondiscrimination-Civil Rights Compliance:
The Contractor shall execute Assurances as stated in the Assurances-Non-Construction Programs Attachment that it will not
discriminate against any person in the provision of services or benefits under this contract 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, Sub-grantees, or others with whom it
arranges to provide services or benefits in connection with any of its programs and activities are not discriminating
against clients or employees because of age, race, religion, color, disability,national origin,marital status or sex.
During the term of this contract, the Contractor shall complete and retain on file a timely, complete and accurate Civil
Rights Compliance Checklist, attached to this contract.
The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving services or
benefits through this contract. These procedures will include notifying clients, employees, and participants of the right
to file a complaint with the appropriate federal or state entity.
If this contract 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.
Monitoring by the Agency:
The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records, papers,
documents, facilities, goods, and services of the Contractor which are relevant to this contract, 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 this contract. Following such review,the Agency will provide a written report of
its fmdings 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 determined by the Agency's
Contract Manager.
Provision of Services:
The Contractor shall provide services in the manner described in Attachment I.
Indemnification:
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 contract 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 negligence of
the Agency.
Except to the extent permitted by Section 768.28, F.S., or other Florida law, this section 16 is not applicable to contracts
executed between the Agency and state agencies or subdivisions defined in Section 768.28(2),F.S.
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Insurance and Bonding:
The Contractor shall provide continuous adequate liability insurance coverage during the existence of this contract
and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or subdivision as
defined by Section 768.28(2), F.S., the Contractor accepts full 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 contract. The limits of coverage under each policy maintained by the Contractor do not limit the
Contractor's liability and obligations under this contract. The Contractor shall ensure that the Agency has the most
current written verification of insurance coverage throughout the term of this contract. 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 this contract.
Throughout the term of this contract, 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 agreements and/or contracts incorporating this 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.
Confidentiality of Information:
The Contractor shall not use or disclose any information concerning a recipient of services under this contract 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.
Health Insurance Portability and Accountability Act:
Where applicable, the Contractor shall comply with the Health Insurance Portability and Accountability Act (42 USC
1320d.),as well as all regulations promulgated thereunder(45 CFR Parts 160, 162,and 164).
Incident Reporting:
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 Contractors or Subcontractors ability to perform the
services required to be performed under this contract. Such notice shall be made orally to the Agency's Contract Manager
(by telephone)with an email to immediately follow.
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.
Bankruptcy Notification:
During the term of this contract, the Contractor shall immediately notify the Area Agency on Aging for Southwest Florida,
Inc. if the Contractor, its assignees, Subcontractors 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., Northern District of Florida, Tallahassee Division); and (4) the name, address, and
telephone number of the bankruptcy attorney.
Sponsorship and Publicity:
As required by Section 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 this contract, 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/or State of Florida, Department of Elder Affairs." If the sponsorship
reference is in written material, the words "Area Agency on Aging for Southwest Florida, Inc. and/or State of Florida,
Department of Elder Affairs" shall appear in at least the same size letters or type as the name of the organization.
The Contractor shall not use the words "Area Agency on Aging for Southwest Florida, Inc. and/or State of Florida,
Department of Elder Affairs" to indicate sponsorship of a program otherwise financed, unless specific authorization has
been obtained by the Department prior to use.
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Assignments:
The Contractor shall not assign the rights and responsibilities under this contract 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.
The State of Florida is, at all times, entitled to assign or transfer, in whole or part, its rights,duties, or obligations under this
contract 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 this contract.
This contract shall remain binding upon the successors in interest of either the Contractor or the Agency.
Subcontracts:
The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract, whether
actually furnished by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a written document
and subject to any conditions of approval the Agency deems necessary. The Contractor further agrees that the Agency
will not be liable to the Subcontractor in any way or for any reason. The Contractor, at its expense, shall defend the
Agency against any such claims.
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 Section 287.0585, F.S., unless otherwise stated in the
contract between the Contractor and Subcontractor, will result in a penalty as provided by statute.
Independent Capacity of Contractor:
It is the intent and understanding of the Parties that the Contractor, and any of its Subcontractors, are independent
Contractors 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.
Payment:
Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in
Attachment I. The Contract Manager will have final approval of the Contractor's invoice submitted for payment, and will
approve the invoice for payment only if the Contractor has met all terms and conditions of the contract, unless the bid
specifications, purchase order, or this contract 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 Section 215.422, F.S. A Vendor Ombudsman has been established within the Florida
Department of Financial Services and may be contacted at 800-342-2762.
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 this contract 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 Section 55.03, F.S., after Agency notification or Contractor discovery.
Data Integrity 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 this contract. An appropriate level of security includes approving and tracking all Contractor
employees that request system or information access and ensuring that user access has been removed from all terminated
employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information
0
processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of
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January 2018 to December 2018 OAA 20 .1 8
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 the Certification Regarding Data Integrity Compliance for Agreements,
Grants,Loans,and Cooperative Agreements prior to the execution of this contract.
Computer Use and Social Media Policy:
The Florida Department of Elder Affairs has implemented a Social Media Policy, in addition to its Computer Use Policy,
which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel
affiliated with third parties, such as, but not limited to, contractors and subcontractors. 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://elderaffairs.state.fl.us/doea/financial.php.
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 the
selection,or in the award of a contract 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 Subcontractor's 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 Contractor's 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 the commencement of this contract. The Contractor's employees and Subcontractors must make the
same disclosures described above to the Contractor's board of directors. Compliance with this provision will be monitored.
Public Entity Crime:
Pursuant to Section 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 to provide any goods or
services to a public entity; may not submit a bid, proposal,or reply on a contract with a public entity for the construction or
repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public
entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a contract
with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in
Section 287.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of being placed on
the Convicted Vendor List.
Purchasing:
The Contractor may purchase articles which are the subject of or are required to carry out this contract 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 this contract, the
Contractor shall be deemed to be substituted for the Agency insofar as dealings with PRIDE. This clause is not applicable
to Subcontractors unless otherwise required by law. An abbreviated list of products/services available from PRIDE
may be obtained by contacting PRIDE, 800-643-8459.
The Contractor may procure any recycled products or materials, which are the subject of or are required to carry out this
contract, in accordance with the provisions of Section 403.7065,F.S.
The Contractor may purchase articles that are the subject of, or required to carry out, this contract 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 Section 413.036(1) and (2), F.S. For purposes of this contract, 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
http://www.respectofflorida.org. This clause is not applicable to Subcontractors unless otherwise required by law.
8 C5itt.)
January 2018 to December 2018 OAA 203.1
6 D 20
Patents.Copyrights.Royalties:
If this contract 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 this contract, 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 this contract are hereby reserved to the State of Florida in accordance with
Chapter 286, F.S. Pursuant to Section 287.0571(5)(k), as amended,the only exceptions to this provision shall be those that
are clearly expressed and reasonably valued in this contract.
If the primary purpose of this contract 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 34.
If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR §200.315 or 45 CFR
§75.322,as applicable.
Notwithstanding the foregoing provisions, if the Contractor or one of its Subcontractors is a university and a member of
the State University System of Florida, then Section 1004.23, F.S., shall apply, but the Agency shall retain a perpetual,
fully-paid, nonexclusive license for its use and the use of its Contractors, Subcontractors or Assignees of any resulting
patented, copyrighted or trademarked work products.
n•r. • t ' • 1 .r•• • •1 it II • • .
If the tasks to be performed pursuant to this contract 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 this contract, submit to the Agency's Contract Manager, verification of an
Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the Agency of emergency
provisions.
In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall retain
responsibility for performance under this contract and must follow procedures to ensure continuity of operations without
interruption.
Equipment:
Equipment means: (a) tangible personal property (including information technology systems) having a useful life of more
than one year and a per-unit 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 funds - 2 CFR
§200.33 and 45 CFR §75.2, as applicable], 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
(1) 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].
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 200 Administrative
Requirements (formerly OMB Circular A-110) that include: (a) a property list with all the elements identified in the
circular; (b) a procedure for conducting a physical inventory of equipment at least once every two (2) 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 Agency's Contract
Manager of any loss, damage, or theft of equipment. The Contractor shall provide the results of the investigation to the
Agency's Contract Manager.
The Contractor's property management standards for equipment (including replacement equipment), whether acquired in
whole or in part with federal funds and federally-owned equipment shall, as a minimum, meet the following requirements
and include accurately maintained equipment records with the following information:
Property records must be maintained that include a description of the equipment;
Manufacturer's serial number, model number, federal stock number, national stock number, or other identification
number;
Source of funding for the equipment, including the federal award identification number;
Whether title vests in the Contractor or the federal government; �• ,
9
January 2018 to December 2018OAA 203.—> b20
Acquisition date(or date received, if the equipment was furnished by the federal government)and cost;
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);
Location,use and condition of the equipment and the date the information was reported;
Unit acquisition cost; and
Ultimate disposition data, including date of disposal and sales price or the method used to determine current fair market
value where a Contractor compensates the federal awarding agency for its share.
A physical inventory must be taken and the results reconciled with the property records at least once every two years.
A control system must be developed to ensure adequate safeguards to prevent loss, damage, or theft of the property. Any
loss,damage, or theft must be investigated.
Adequate maintenance procedures must be developed to keep the property in good condition.
If the Contractor is authorized or required to sell the equipment,proper sales procedures must be established to
ensure the highest possible return.
Equipment purchased with federal funds with an acquisition cost over$5,000.00 and equipment purchased with state funds
with an acquisition cost over $1,000.00 is part of the cost of carrying out the activities and functions of the grant awards
and Title (ownership) will vest in the Contractor [for federal funds see 2 CFR §200.313(a) and 45 CFR §75.320(a), as
applicable], subject to the conditions of 2 CFR Part 200 and/or 45 CFR Part 75. 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 this contract, or identified in the sub-agreements with Subcontractors
(not included in a cost methodology), is subject to the conditions of Chapter 273, F. S. and 60A-1.017, F. A. C. and 2
CFR Part 200 and/or 45 CFR Part 75.
The Contractor shall not dispose of any equipment or materials provided by the Agency, or purchased with funds provided
through this contract without first obtaining the approval of the Agency's Contract Manager. When disposing of property or
equipment the Contractor must submit a written request for disposition instructions to the Agency's Contract Manager.
The request should include a brief description of the property, purchase price, funding source, and percentage of state
or federal participation, acquisition date and condition of the property. The request should also indicate the Contractor's
proposed disposition (i.e., transfer or donation to another agency that administers federal programs, offer the items for sale,
destroy the items,etc.).
The Agency's Contract Manager will issue disposition instructions. If disposition instructions are not received within
one hundred twenty(120)days of the written request for disposition,the Contractor is authorized to proceed as directed in 2
CFR§200.313 or 45 CFR§75.320,as applicable.
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 funds through agreements
covered under this 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., Section 3030b U.S.C. Real property
purchases from state funds can only be made through fixed capital outlay grants and aids appropriations and therefore are
subject to the provisions of Section 216.348, F.S.
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.
The Contractor must adhere to the Agency's procedures and standards when purchasing Information Technology
Resources (ITR) as part of any agreement(s) incorporating this 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.
(52)
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January 2018 to December 2018
OAA 20318
PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
http://www.myflorida.com/apps/vbs/adoc/F7740 PUR1 000.pdf
In the event of any conflict between the PUR 1000 Form and any terms or conditions of this contract the terms or
conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained in
the PUR 1000 Form shall take precedence.
Use of State Funds to Purchase or Improve Real Property:
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds provided for at
least five(5)years from the date of purchase or the completion of the improvements or as further required by law.
Dispute Resolution:
Any dispute concerning performance of the contract shall be decided by the Agency's Contract Manager,who shall reduce
the decision to writing and serve a copy on the Contractor.
Financial Consequences;,
If the Contractor fails to meet the minimum level of service or performance identified in this contract, the Agency will
impose financial consequences as stated in Attachment I.
No Waiver of Sovereign Immunity:
Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
Venue:
If any dispute arises out of this contract,the venue of such legal recourse shall be Lee County,Florida.
Entire Contract:
This contract 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 amendment to
this contract signed by both Parties.
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.
Severability 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.
Condition Precedent to Contract Appropriations:
The Parties agree that the Agency's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
Addition/Deletion:
The Parties agree that the Agency reserves the right to add or to delete any of the services required under this contract
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.
Waiver:
The delay or failure by the Agency to exercise or enforce any of its rights under this contract 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.
11 2
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January 2018 to December 2018 OAA 203.
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 the contract to immediate, unilateral cancellation of the
contract at the discretion of the Agency.
Final Invoice:
The Contractor shall submit the fmal invoice for payment to the Agency no later than thirty (30) days upon the contract
ending date unless otherwise specified in Attachment I. If the Contractor fails to do so, all right to payment is forfeited and
the Agency may not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this
contract may be withheld until all required documentation and reports due from the Contractor and necessary adjustments
thereto have been approved by the Agency.
Renegotiations of Modifications:
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively 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.
Suspension of Work;
The Agency may in its sole discretion suspend any or all activities under the contract or purchase order,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 (90) 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.
Termination:
Termination for Convenience. The Agency,by written notice to the Contractor,may terminate this contract in whole or in
part when the Agency determines in its sole discretion that it is in the State's interest to do so. The Contractor shall not
furnish any product after it receives the notice of termination, except as necessary to complete the continued portion of
this contract, if any. The Contractor shall not be entitled to recover any cancellation charges or lost profits.
Termination for Cause. The Agency may terminate this 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 contract, 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.
Upon termination of this contract, the Contractor and Subcontractors shall, at no cost to the Agency, transfer all public
records in their possession to the Agency and destroy any duplicate public records that are exempt, or confidential and
exempt, from public records disclosure requirements. All records stored electronically shall be provided to the Agency in
a format that is compatible with the information technology systems of the Agency.
12
, January 2018 to December 2018 OAA 2031,8 6 0 2 0
Electronic Records and Signature:
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 contract. A Contractor that creates and
retains electronic records and uses electronic signatures to conduct transactions shall comply with the requirements
contained in the Uniform Electronic Transaction Act, Section 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 29, 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 this contract.
The Agency's authorization pursuant to this section does not authorize electronic transactions between the Contractor and
the Agency. The Contractor is authorized to conduct electronic transactions with the Agency only upon further written
consent by the Agency.
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 identify the person and the person's capacity who electronically signed the document on any non-electronic
copy of the document.
Contract Manager:
The Agency may substitute any Agency employee to serve as the Contract Manager.
REMAINDER OF THE PAGE INTENTIONALLY LEFT BLANK
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January 2018 to December 2018 OAA 20318 6 0 20
Official Payee and Representatives (Names.Addresses.and Telephone Numbers):
Collier County Board of County Commissioners
The Contractor name,as shown on page 1 of this 3339 E Tamiami Trail, Building H
a. contract, and mailing address of the official payee to Naples,FL 34112
whom the payment shall be made is:
The name of the contactperson and street address Kimberley Grant,CDounty
Cr
Collier County Board of County Commissioners
b. where financial and administrative records are %Community and Human Services
maintained is: 3339 E Tamiami Trail,Building.H
Naples,FL 34112
Kimberley Grant,Director
The name,address, and telephone number of the Collier County Board of County Commissioners
c' representative of the Contractor responsible for %Community and Human Services
administration of the program under this contract is: 3339 E Tamiami Trail, Building H
Naples,FL 34112
(239)252-2273
Area Agency on Aging for Southwest Florida, Inc.
d. The section and location within the Agency where 15201 North Cleveland Avenue, Suite 1100
Requests for Payment and Receipt and Expenditure North Fort Myers, FL 33903
forms are to be mailed is:
Tammy Rhoades,Vice President of Finance
e. The name,address, and telephone number of the Area Agency on Aging for Southwest Florida,Inc.
Contract Manager for this contract is: 15201 North Cleveland Avenue, Suite 1100
North Fort Myers,FL 33903
(239)652-6900
Upon change of representatives(names,addresses,telephone numbers)by either party,notice shall be provided in
writing to the other party.
All Terms and Conditions Included:
This contract and its Attachments, I — XVIII including any exhibits referenced in said attachments, together with any
documents incorporated by reference, contain all the terms and conditions agreed upon by the Parties. There are no
provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all
previous communications,representations or agreements, either written or verbal between the Parties.
By signing this contract,the Parties agree that they have read and agree to the entire contract.
IN WITNESS WHEREOF, the Parties hereto have caused this contract to be executed by their undersigned officials as
duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY CO I Al SSI I RS SOUTHWEST FLORIDA,INC.
Oa
SIGNED BY: >%'" SIGNED BY: 210‘1.A.-
NAME: Steve Y. Carnell NAME: MARIANNE G LORINI
TITLE: Public Service Department Head TITLE: PRESIDENT/CEO
DATE:January 20,2018 DATE: i/a 6/i
Federal Tax ID: 59-60000588
Fiscal Year Ending Date: 09/30
Duns: 076997790
14 ����\
January 2018 to December 2018 OAA 203.181 6 0 20
INDEX OF ATTACHMENTS
ATTACHMENT I 16
STATEMENT OF WORK
ATTACHMENT II 34
FINANCIAL AND COMPLIANCE AUDIT
ATTACHMENT III 40
CERTIFICATIONS AND ASSURANCES
ATTACHMENT IV 45
ASSURANCES—NON-CONSTRUCTION PROGRAMS
ATTACHMENT V 47
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
ATTACHMENT VII 51
BACKGROUND SCREENING
ATTACHMENT IX 52
BUDGET AND RATE SUMMARY
ATTACHMENT X 55
INVOICE SCHEDULE
ATTACHMENT XI 56
REQUEST FOR PAYMENT
ATTACHMENT XII 57
RECEIPTS AND EXPENDITURE REPORT(IIIB)
ATTACHMENT XIII 58
RECEIPTS AND EXPENDITURE REPORT(IIICI)
ATTACHMENT XIV 59
RECEIPTS AND EXPENDITURE REPORT(IIIC2)
ATTACHMENT XV 60
RECEIPTS AND EXPENDITURE REPORT(IIIE)
ATTACHMENT XVI 61
RECEIPTS AND EXPENDITURE REPORT(NSIP)
ATTACHMENT XVII 62
OAA QUARTERLY VOLUNTEER ACTIVITY REPORT SPECIFICATIONS
ATTACHMENT XVIII 64
OAA QUARTERLY VOLUNTEER ACTIVITY REPORT
15
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January 2018 to December 2018 OAA 20186 020
ATTACHMENT I
STATEMENT OF WORK
I. SERVICES TO BE PROVIDED
A. Definitions of Terms
1. Contract Acronyms
Area Agency on Aging(AAA)
Activities of Daily Living(ADL)
Administration on Aging(AoA)
Administration on Community Living(ACL)
Alliance of Information&Referral Systems(AIRS)
Assessed Priority Consumer List(APCL)
Adult Protective Services(APS)
Client Information and Registration Tracking System(CIRTS)
Chronic Disease Self-Management Education(CDSME)
Chronic Disease Self-Management Program(CDSMP)
Dietary Reference Intake(DRI)
Evidence-Based Disease Prevention and Health Promotion(EBDPHP)
Florida Department of Business and Professional Regulations (DBPR)
Florida Department of Elder Affairs(DOEA or Depth tment)
Florida Department of Health(DOH)
Information and Referral(I&R)
Instrumental Activities of Daily Living(IADL)
National Council on Aging(NCOA)
Nutrition Services Incentive Program(NSIP)
Older Americans Act(OAA)
Planning and Service Area(PSA)
State of Florida(State)
Statewide Medicaid Managed Care Long-Term Care(SMMC LTC)
United States Department of Agriculture(USDA)
United States Department of Health and Human Services(USDHHS)
2. Program Specific Terms
Area Plan: A plan developed by the AAA outlining a comprehensive and coordinated service delivery system in
its PSA in accordance with Section 306(42 U.S.C. §3026)of the OAA and Agency instructions.
Area Plan Update: A revision to the Area Plan wherein the AAA enters OAA specific data in CIRTS. An
update may also include other revisions to the Area Plan as instructed by the Agency.
Child: An individual who is not more than eighteen(18)years of age or an individual with disability.
Criteria: A standard which the Administration on Aging/Administration for Community Living set for the Title
III D Program. AoA/ACL's standard criterion consists of three tiers: Minimal Criteria, Intermediate Criteria,
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January 2018 to December 2018 OA 20.1
10
20
and Highest-Level Criteria.
Family Caregiver: An adult family member, or another individual, who is an informal provider of in-home and
community care to an older individual.
Frail: When an older individual is unable to perform at least two ADLs without substantial human assistance,
including verbal reminding, physical cueing or supervision; or due to cognitive or other mental impairment,
requires substantial supervision because the individual behaves in a manner that poses a serious health or safety
hazard to the individual or to another individual.
Grandparent: A grandparent or step-grandparent of a child, or a relative of a child by blood, marriage or
adoption and who lives with the child; is the primary caregiver of the child because the biological or adoptive
parents are unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the
child, such as legal custody or guardianship, or is raising the child informally.
Living Healthy: Also known as CDSMP for the State of Florida.
B. General Description
1. General Statement
The primary purpose of the OAA Program is to foster the development and implementation of comprehensive and
coordinated systems to serve older individuals. These systems assist older individuals to attain and maintain
maximum independence with supportive services.
The NSIP provides incentives for the effective delivery of nutritious meals to older individuals. NSIP allows
programs to increase the number and/or the quality of meals served. NSIP is a cash allotment or commodity
program that supplements funding or food used in meals served under the OAA. Florida has opted for cash
payments in lieu of donated foods.
2. Authority
All applicable federal laws, regulations, action transmittals, program instructions, review guides and similar
documentation related to the following:
a. Catalog of Federal Domestic Assistance No. 93.043,93.044, 93.045,93.052,and 93.053;
b. Older Americans Act of 1965, as amended 2016;
c. Older Americans Act of 1965, as amended 2016, Section 311 (42 U.S.C. §3030a);
d. 42 U.S.C. §303, 42 U.S.C. §604;
e. Rule 58A-1,Florida Administrative Code(FAC);
f. Section 430.101,Florida Statutes(F.S.); and
g. DOEA Programs and Services Handbook, which is hereby incorporated by reference, to include any
subsequent revisions,thereof.
3. Scope of Service
The Agency is responsible for the programmatic, fiscal, and operational management of the OAA Title IIIB, Title
IIIC1, Title IIIC2, Title IIID, Title IIIE Programs and NSIP, within its designated PSA. The program services
shall be provided in a manner consistent with the Agency's current Area Plan, as updated, and the current DOEA
Programs and Services Handbook, which are incorporated by reference. The Contractor shall use the NSIP
funding to supplement funding for food used in meals served by OAA Nutrition Program Providers.
4. Major Program Goals
The major goals of the OAA Program are to improve the quality of life for older individuals, preserve their
independence and prevent or delay costlier institutional care. These goals are achieved through the
implementation of a comprehensive and coordinated service system that provides a continuum of service
alternatives and effective delivery of nutritious meals that meet the diverse needs of elders and their caregivers.
17
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January 2018 to December 2018 OAA 20318 6 13 20
C. Clients to be Served
1. General Description
The OAA Program gives preference to individuals with the greatest economic and social need, with particular attention
to low-income older individuals, including those that are low-income minorities, have limited English proficiency, and
older individuals residing in rural areas.
2. Client Eligibility
a. OAA Title III
Consumers shall not be dually enrolled in an OAA Program and a Medicaid capitated Long-Term Care
Program, except consumers in need of OAA Legal Assistance services and OAA Congregate Nutrition Services,
including transportation to and from congregate meal sites.
b. NSIP
Meals served to an elderly individual, funded in whole or in part under Statewide Medicaid Managed Care Long-
Term Care, Home Care for the Elderly, Community Care for the Elderly Programs, or other means tested
programs may not be included in the NSIP count. OAA-funded congregate meals provided to SMMC LTC clients
may be included in the NSIP count.
c. OAA Title IIIB,Supportive Services
i. Individuals must be age sixty(60)or older; and
ii. Information and Referral/Assistance services are provided to individuals regardless of age.
d. OAA Titles IIIC1 and I HC2,Nutrition Services,General
General factors that shall be considered in establishing priority for nutrition services include those older persons
who meet the following:
i. Cannot afford to eat adequately;
ii. Lack the skills or knowledge to select and prepare nourishing and well-balanced meals;
iii. Have limited mobility which may impair their capacity to shop and cook for themselves; or
iv. Have a disabling illness or physical condition requiring nutritional support or have been screened at a
high nutritional risk.
e. OAA Title IIIC1,Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in Section I.C.2.d, above,
individuals must be mobile, not homebound, and physically, mentally, and medically able to attend a
congregate nutrition program. Individuals eligible to receive congregate meals include the following:
i. Individuals age sixty(60)or older;
ii. Any spouse(regardless of age)who attends the dining center with his/her eligible spouse;
iii. Persons with a disability,regardless of age,who reside in a housing facility occupied primarily by older
individuals where congregate nutrition services are provided;
iv. Disabled persons who reside at home with and accompany an eligible person to the dining center; and
v. Volunteers,regardless of age,who provide essential services on a regular basis during meal hours.
f. OAA Title IIIC2,Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements as listed in Section I.C.2.d,
individuals must be homebound and physically, mentally, or medically unable to attend a congregate nutrition
program. Individuals eligible to receive home delivered meals include the following:
i. Individuals age sixty(60)or older who are homebound because of illness, disability or isolation;
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ii. The spouse of a homebound eligible individual,regardless of age,if the provision of the collateral meal
supports maintaining the person at home;
iii. Individuals with disabilities, regardless of age, who reside at home with eligible individuals and are
dependent on them for care; and
iv. Persons at nutritional risk who have physical, emotional or behavioral conditions, which would make their
presence at the congregate site inappropriate, and persons at nutritional risk who are socially or otherwise
isolated and unable to attend a congregate nutrition site.
g. OAA Title IIIE,Caregiver Support Services
Eligibility for OAA Title IIIE,Caregiver Support Services,are as follows:
i. Family caregivers of individuals age sixty(60)or older;
ii. Grandparents [age fifty-five (55) or older] or older individuals [age fifty-five (55) or older] who are
relative caregivers;
iii. Priority will be given to family caregivers who provide care for individuals with Alzheimer's disease and
related disorders with neurological and organic brain dysfunction and for grandparents or older
individuals who are relative caregivers who provide care for children with severe disabilities; and
iv. For respite and supplemental services,a family caregiver must be providing care for an older individual who
meets the definition of the term"frail"as defined above.
I I. MANNER OF SERVICE PROVISION
A. Service Tasks
To achieve the goals of the OAA Program,the Contractor shall ensure performance of the following tasks:
1. Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a
client is based on meeting the requirements described in Section I.C.2.
2. Targeting and Screening New Clients for Service Delivery
The Contractor shall develop and implement policies and procedures consistent with OAA targeting and
screening criteria.
3. Program Services
The Contractor shall ensure the provision of program services is consistent with the Agency's current Area
Plan,as updated and approved by the Agency, and the current DOEA Programs and Services Handbook.
4. Program Eligibility Requirements
a. Eligibility Criteria
Entities must meet the following criteria to be eligible for program participation:
i. An agency that has received a grant under OAA Title III [OAA section 311(42 U.S.C. § 3030a)]; and
ii. A nutrition service provider that serves meals and is under the jurisdiction, control, management and
audit authority of the Area Agency on Aging and the Florida Department of Elder Affairs.
b. Provider's Nutrition Service Operations
The Contractor shall ensure the nutrition service operations of the provider meet the requirements of this
contract,as well as any other applicable regulations and policies prescribed by the current DOEA Programs
and Services Handbook, the Department of Health and Human Services, USDA, DOH and local health
departments,DBPR, or any other agency designated to inspect meal quality for the State.
c. Prescribed Nutritional Requirements
The Contractor shall ensure that each meal provided under this contract meets the following criteria:
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i. Complies with the current Dietary Guidelines for Americans, published by the Secretaries of the
Department of Health and Human Services and the Department of Agriculture; and
ii. Provides a minimum of 33 1/3 percent of the dietary reference intakes/adequate intakes for an age 70+
female as established by the Food and Nutrition Board of the National Academy of Sciences.
d. Food Origin and Commodities Requirements
Consistent with existing requirements of the NSIP, the Contractor and its service providers may use NSIP
cash to purchase foods of U.S. origin for their nutrition projects under Title III of the OAA. NSIP funds
must be used to expand meal services to older adults.
B. Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the Contractor shall not delay the
implementation of its agreement with the subcontractor. If any circumstance occurs that may result in a delay for a
period of sixty (60) days or more the initiation of the subcontract or the performance of the Subcontractor, the
Contractor shall notify the Agency 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 contract without
having a binding Subcontractor agreement executed. The Agency will not be responsible or liable for any
obligations or claims resulting from such action.
1. Copies of Subcontracts
The Contractor shall submit a copy of all subcontracts to the Agency Contract Manager within thirty(30)
days of execution of each subcontract agreement.
2. Monitoring the Performance of Subcontractors
The Contractor shall monitor, at least once per year, each of its subcontractors, sub-recipients, 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.
a. The Contractor shall require subcontractors to enter all required data per the Agency's and Department's
CIRTS Policy Guidelines for clients and services in the CIRTS database.The data must be entered into the
CIRTS before the subcontractors submit their Request for Payment and Expenditure Reports to the
Contractor. The Contractor shall establish time frames to ensure compliance with due dates for the
Requests for Payment and Expenditure Reports to the Agency.
b. The Contractor shall require subcontractors to run monthly CIRTS reports and verify that client and service
data in the CIRTS is accurate. This report must be submitted to the Contractor with the monthly Request
for Payment and Expenditure Report and must be reviewed by the Contractor before the subcontractor's
Request for Payment and Expenditure Reports can be approved by the Agency.
c. The Contractor shall require subcontractors to report on outreach activities at least semi-annually using a
uniform reporting format established by the Contractor.The format must include the following information:
number and type of provider events or activities; date and location; total number of participants at each
event or activity; individual service needs identified;and referral sources or information provided.
C. Staffing Requirements
1. Staffing Levels
The Contractor shall assign its own administrative and support staff as needed to perform the tasks,
responsibilities and duties under this contract and ensure that subcontractors dedicate adequate staff
accordingly.
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2. Professional Qualifications
The Contractor shall ensure that the staff responsible for performing any duties or functions within this contract
have the qualifications as specified in the DOEA Programs and Services Handbook.
3. Service Times
The Contractor shall ensure the availability of services listed in this contract at times appropriate to meet client
service needs, at a minimum during normal business hours. Normal business hours are defined as Monday
through Friday, 8:00 a.m.to 5:00 p.m. local time.
D. Deliverables
The following section provides the specific quantifiable units of deliverables and source documentation required to
evidence the completion of the tasks specified in this contract. The Contractor must submit all required
documentation in the time and manner specified for the minimum performance levels to be met. Each deliverable
must be accepted in writing by the Agency Contract Manager based on the requirements for each deliverable before
the Contractor submits an invoice requesting payment.
1. Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of elders and
their caregivers. The Contractor shall ensure the performance and reporting of the following services in
accordance with the Agency's current DOEA-approved Area Plan, the current DOEA Programs and
Services Handbook, and Section II.A.1-4 of this contract. Documentation of service delivery must include a
report consisting of the following: number of clients served, number of service units provided by service, and
rate per service unit with calculations that equal the total invoice amount. The services include the following
categories:
a. Supportive Services (MB Program) - Supportive services include a variety of community-based and
home-delivered services that support the quality of life for older individuals by helping them remain
independent and productive. Services include the following:
i. Adult Day Care/Adult Day Health xiii. Physical Therapy;
Care;
xiv. Shopping Assistance;
ii. Caregiver Training/Support; xv. Skilled Nursing;
iii. Case Aid/Case Management; xvi. Specialized Medical Equipment, Services,and
iv. Chore Services; Supplies
v. Companionship; xvii. Recreation;
vi. Counseling(Gerontological and xviii. Emergency Alert Response;
Mental Health); xix. Escort;
vii. Education/Training; xx. Health Support;
viii. Legal Assistance; xxi. Home Health Aid;
ix. Material Aid;
xxii. Homemaker;
x. Occupational Therapy;
xxiii. Housing Improvement;
xi. Outreach;
xxiv. Information;
xii. Personal Care;
xxv. Intake;
xxvi. Interpreter/Translating;
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xxvii. Referral/Assistance; xxx. Speech Therapy;
xxviii.Respite Services; xxxi. Telephone Reassurance; and
xxix. Screening/Assessment; xxxii. Transportation.
a. Congregate Nutrition Services(HICl Program)
Nutrition Services are provided in congregate settings and are designed to reduce hunger and food
insecurity, promote socialization and the health and well-being of older individuals by assisting them to
gain access to nutrition and other disease prevention and health promotion services. Services include the
following:
i. Congregate meals;
ii. Congregate meals screening;
iii. Nutrition education and nutrition counseling; and
iv. Outreach.
b. Home Delivered Nutrition Services(HIC2 Program)
In-home nutrition services are provided to reduce hunger and food insecurity; promote socialization and
the health and well-being of older individuals by assisting such individuals to gain access to nutrition and
other disease prevention and health promotion services. Services include the following:
i. Home delivered meals;
ii. Nutrition education and counseling;
iii. Outreach; and
iv. Screening/Assessment.
c. Disease Prevention and Health Promotion Services(Title IIID Program)
Evidence-Based Disease Prevention and Health Promotion (EBDPHP) services have been demonstrated
through evaluation to be effective for improving the health and wellbeing or reducing disease, disability
and/or injury among older adults, and proven effective with older adult populations. The ACL defines
EBDPHP services as meeting highest-level criteria. Only services that meet the highest-level criteria are
allowable under the IIID Program.EBDPHP services must be delivered per the requirements of the program
and ensure program fidelity. Evidence based programs include the following:
i. A Matter of Balance;
ii. Active Living Every Day;
iii. Arthritis Foundation Exercise Program;
iv. Arthritis Foundation Tai Chi Program (Tai Chi for Arthritis);
v. Arthritis Self-Management Program;
vi. Brief Intervention&Treatment for Elders(BRITE);
vii. Chronic Disease Self-Management Program;
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viii. Chronic Pain Self-Management Program;
ix. Diabetes Empowerment Education Program(DEEP);
x. Diabetes Self-Management Program;
xi. Disease Information;
xii. Enhance Fitness;
xiii. Enhance Wellness;
xiv. Fit and Strong!;
xv. Healthy Eating Every Day;
xvi. Healthy Ideas;
xvii. Healthy Moves for Aging Well;
xviii. HomeMeds;
xix. Physical Fitness;
xx. Powerful Tools for Caregivers;
xxi. Program to Encourage Active Rewarding Lives for Seniors(PEARLS);
xxii. Programa de Manejo Personal de la Artritis;
xxiii. Programa de Manejo Personal de la Diabetes;
xxiv. Stepping On;
xxv. Stay Active and Independent for Life (SAIL);
xxvi. Tai Chi/Tai Ji Quan Moving for Better Balance(Highest-Level);
xxvii.Tomando Control de su Salud;
xxviii.Un Asunto de Equilibrio; and
xxix. Walk with Ease.
e. Caregiver Support Services(hUE Program)
The following services are intended to provide direct help to caregivers, assist in the areas of health,
nutrition and financial literacy, and assist caregivers in making decisions and problem solving related to
their caregiving roles and responsibilities:
i. Adult Day Care/Adult Day Health vii. Intake;
Care;
viii. Outreach;
ii. Caregiver Training/Support; ix. Powerful Tools for Caregivers;
iii. Counseling(Gerontological and
Mental Health); x. Referral/Assistance;
iv. Education/Training; xi. Respite Services;
v. Financial Risk Reduction(Assessment xii. Screening/Assessment;
and Maintenance); xiii. Stress-Busting Program for Family Caregivers;and
vi. Information; xiv. Transportation.
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(1) Caregiver Support Supplemental Services(IIIES Program)
At least ten(10)percent,but no more than twenty(20)percent,of the total Title IIIE funds shall
be used to provide supplemental support services. The following services are provided to
complement the care provided by caregivers:
(a) Chore Services;
(b) Housing Improvement;
(c) Legal Assistance;
(d) Material Aid; and
(e) Specialized Medical Equipment, Services and Supplies.
(2) Caregiver Support Grandparent Services(1111 G Program)
At least five (5) percent, but no more than ten (10) percent, of the total Title IIIE funds shall be
used to provide support services to grandparents and older individuals who are relative caregivers.
Services for grandparents or older individuals who are relative caregivers designed to help meet
their caregiving obligations include the following:
(a) Caregiver Training/Support;
(b) Child Day Care;
(c) Counseling(Gerontological and Mental Health);
(d) Education/training;
(e) Legal Assistance;
(f) Outreach;
(g) Referral/Assistance;
(h) Screening/Assessment;
(i) Sitter; and
(j) Transportation.
2. Provision of Services
The Agency and/or contractor shall ensure the provision of the services described in this contract are in
accordance with the current DOEA Programs and Services Handbook and the tasks described in Section II.A.
i. Complaint Procedures
The Agency and/or 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 of the DOEA Programs and Services Handbook. The complaint procedures shall include
notification to all clients of the complaint procedure and include tracking the date, nature of complaint,
and the determination of each complaint.
ii. Legal Provider Grievance Procedures
The Agency and/or Contractor shall ensure that legal providers have an internal grievance procedure
that addresses both denial of service and complaints by clients about manner or quality of legal assistance.
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January 2018 to December 2018 OAA 203.18
Grievance policies that comport with requirements of the Legal Services Corporation are sufficient to
meet this standard. At a minimum,the procedure must provide applicants with:
(1) Adequate notice of the grievance procedures;
(2) Information on how to file a grievance or complaint,and;
(3) An opportunity for review of the complaint by the Legal Provider's Executive Director or the
Executive Director's designee.
(4) The Contractor may not serve in an appellate capacity or otherwise interfere in the grievance review
process for legal providers. However, the Contractor may request that legal providers maintain a
file of complaints and statements of disposition of complaints, with redacted client identifying
information,for examination by the Contractor during monitoring.
b. Ensure compliance with CIRTS regulations.
c. Monitor performance objective achievements per targets set by the Agency.
d. Conduct client satisfaction surveys to evaluate and improve service delivery.
E. Reports
The Contractor shall respond to additional, routine, or special requests for information and reports required by the
Agency in a timely manner as determined by the Agency Contract Manager. The Contractor shall establish
reporting deadlines and due dates for subcontractors that permit the Contractor to review and validate the data,and
meet the Agency's reporting requirements.
1. OAA Quarterly Volunteer Activity Report
The Contractor shall submit an OAA Quarterly Volunteer Activity Report electronically,to Becky MacKenzie
at the following email address: Becky.MacKenzie@aaaswfl.org per the report specifications
provided in Attachment XVII. The Quarterly Volunteer Activity Report must be completed and submitted by
the 15th of the month following the end of the quarter. The form is Attachment XVIII.
2. CIRTS Reports
a. Contractor shall input OAA-specific and NSIP-specific data into CIRTS. To ensure CIRTS data accuracy,
the Contractor shall use CIRTS-generated reports which include the following:
i. Client Reports;
ii. Monitoring Reports;
iii. Services Reports;
iv. Miscellaneous Reports;
v. Fiscal Reports; and
vi. Outcome Measurement Reports.
b. CIRTS Data Entries for Subcontractors
The Contractor must require Subcontractors 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).
Subcontractors must enter this data into the CIRTS prior to submitting their requests for payment and
expenditure reports to the Contractor. The Contractor shall establish deadlines for completing CIRTS data
entry and to assure compliance with due dates for the requests for payment and expenditure reports
that Contractor must submit to the Agency.
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c. Subcontractors' Monthly CIRTS Reports
The Contractor must require Subcontractors to run monthly CIRTS reports and verify client and service data
in the CIRTS is accurate. This report must be submitted to the Contractor with the monthly request for
payment and expenditure report and must be reviewed by the Contractor before the Subcontractor's request
for payment and expenditure reports can be approved by the Contractor.
3. Annual 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. This Annual Service Cost Report will be due by February 15, of
each year. The report will include actual costs for performing all services during the preceding calendar year.
Supporting documentation must accompany the report which will include General Ledger, Trial Balance
and/or Statement of Revenue and Expenditures along with a narrative explanation and justification of
increases.
Any multi-year contracts entered into with service providers on or after the effective date of this contract shall
contain a provision requiring the contract's parties to re-evaluate the contract's reimbursement rates on an
annual basis. The Contractor may annually renegotiate rates based on factors including but not limited to a
review of sustainability, the respective consumer price index, or current market conditions. However, it is the
intent of the Department and/or Agency that the quality of services provided to current program recipients not
be reduced. Unit Cost Methodology worksheets must be submitted by August 1 of each year,if a rate increase
is being requested.
4. Surplus/Deficit Report
a. The Contractor shall submit a Consolidated Surplus/Deficit Report, Lead Spending Report, in a format
provided by the Agency, to the Area Agency on Aging for Southwest Florida, Inc. Contract Manager by
the 18th of each month. This Consolidated Surplus/Deficit Report is for all agreements and/or contracts
between the Contractor and the Agency and must include the following
b. A list of all subcontractors and their current status regarding surplus/deficit;
c. The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the
Agency will be resolved;
d. Recommendations to transfer funds to resolve surplus/deficit spending;
e. Input from the Contractor's Board of Directors on resolution of spending issues,if applicable;
f. Number of clients currently on APCL that receive a priority ranking score of four(4)or five(5); and
g. Number of clients currently on the APCL designated as Imminent Risk.
5. OAA National Aging Program Information System(NAPIS)Report
Data required for the OAA NAPIS Report that is not recorded in CIRTS will be provided to the Agency's
Contract Manager in the format and on the date established by the Agency.
6. Program Highlight Narratives
The Contractor shall submit brief written narratives for the program highlight sections of the Agency's
Summary of Programs and Services, which is hereby incorporated by reference, to include any subsequent
revisions thereof. The narratives shall reference specific events that occurred in FFY 2017, including new
success stories, quotes, testimonials, or human-interest vignettes. The narratives shall be written for a general
audience, with no acronyms or technical terms. For all agencies or organizations that are referenced in the
narratives, the Contractor shall provide a brief description of their mission or role. The active tense shall be
consistently used in the narratives, to identify the specific individuals or entities that performed the activities
described in the narratives. The Contractor shall review and edit narratives for clarity, readability, relevance,
specificity,human interest,and grammar,prior to submitting them to the Agency.
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F. Records and Documentation
1. The Contractor agrees to make available to Agency staff and/or any party designated by the Agency all
contract related records and documentation. The Contractor shall ensure the collection and maintenance of all
program related information and documentation on any such system designated by the Agency.
Maintenance includes valid exports and backups of all data and systems according to Agency standards.
Data must be usable and in a readable format by the Agency.
2. CIRTS Data and Maintenance
The Contractor shall ensure monthly collection and maintenance of client and service information in CIRTS or
any such system designated by the Agency. Maintenance includes accurate and current data, and valid
exports and backups of all data and systems according to Agency standards.
3. Policies and Procedures for Records and Documentation
The Contractor shall maintain written policies and procedures for computer system backup and recovery and
shall have the same requirement of its subcontractors. These policies and procedures shall be made available to
the Agency upon request.
G. Performance Specifications
1. Outcomes and Outputs(Performance Measures)
At a minimum,the Contractor shall:
a. Ensure the provision of the services described in this contract are in accordance with the DOEA Programs
and Services Handbook and Section II.A.1-4 of this contract.
b. Timely and accurately submit to the Agency all documentation and reports described in Attachment I,
Section II.E.
c. Timely and accurately, per Attachment X, submit to the Agency Attachments XI — XVIII (whichever
reports pertain to your specific contract).
d. Develop and document strategies in the Area Plan to support the Agency's standard of performance
achievement, including increases for the following:
i. Percent of most frail elders who remain at home or in the community instead of going into a nursing
home;
ii. Percent of APS referrals who need immediate services to prevent further harm who are served within
seventy-two(72)hours;
iii. Percentage of active clients eating two or more meals per day;
iv. Percent of new service recipients whose ADL assessment score has been maintained or improved;
v. Percent of new service recipients whose IADL assessment score has been maintained or improved;
vi. After service intervention,the percentage of caregivers who self-report being very confident about their
ability to continue to provide care;and
vii. Percent of customers who are at imminent risk of nursing home placement who are served with
community based services.
2. The Contractor's performance of the measures in G.1., above, will be reviewed and documented in the
Agency's Annual Programmatic Monitoring Reports.
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3. Monitoring and Evaluation Methodology
The Agency will review and evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or an
on-site visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor
agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and
deliverables. The Agency may use, but is not limited to, one or more of the following methods for
monitoring:
a. Desk reviews and analytical reviews;
b. Scheduled,unscheduled,and follow-up on-site visits;
c. Client visits;
d. Review of independent auditor's reports;
e. Review of third-party documents and/or evaluation;
f. Review of progress reports;
g. Review of customer satisfaction surveys;
h. Agreed-upon procedures review by an external auditor or consultant;
i. Limited-scope reviews; and
j. Other procedures as deemed necessary.
4. Performance Definitions
"Work day" shall mean a provider's staff member's eight (8) hour work period, unless specifically noted
otherwise. "Day"shall mean a calendar day,unless specifically noted otherwise.
H. Contractor Responsibilities
1. Contractor Unique Activities
All tasks listed above in Section II.are solely and exclusively the responsibility of the Contractor and for which,
by execution of this contract,the Contractor agrees to be held accountable; and
2. Coordination with Other Providers and/or Entities
Notwithstanding that services for which the Contractor is held accountable involve coordination with other
entities in performing the requirements of this contract, the failure of other providers or entities does not
alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform
pursuant to this contract.
I. Agency Responsibilities
1. Agency Obligations
The Agency may provide technical support and/or assistance to the Contractor within the resources of the
Agency to assist the Contractor in meeting the requirements of this contract. The support, or lack thereof,
shall not relieve the Contractor from full performance of contract requirements.
2. Agency Determinations
The Agency reserves the exclusive right to make certain determinations in the tasks and approaches. The
absence of the Agency setting forth a specific reservation of rights does not mean that all other areas of the
contract are subject to mutual agreement.
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II. METHOD OF PAYMENT
A. Payment Method Used
Method of Payment for this contract is a combination of Fixed-Fee/Unit Rate, Cost Reimbursement, and Advance
Payments, subject to the availability of funds and Contractor performance. The Agency will pay the Contractor upon
satisfactory completion of the Tasks/Deliverables, as specified in Section II.D., and in accordance with all other terms
and conditions of this contract.
B. Unit of Service
1. Fixed Fee/Unit Rate
Contractor must meet the minimum level of performance stated in the contract in order to receive payment. Payments
for Fixed Fee/Unit Rates shall not exceed amounts established in Attachment IX.
2. Fixed Rates for NSIP Program
Payments for NSIP Fixed rate shall not exceed the unit rate of service identified below:
Service to be Provided Unit of Service Unit Rate
Eligible Congregate and Home Delivered Meals 1 unit= 1 meal $.72
3. Cost Reimbursement
Payment may be authorized only for allowable expenditures, per the limits specified in Attachment IX. All Cost
Reimbursement Requests for Payment must include the actual Expenditure Reports beginning with the first month of the
contract. The Contractor must meet the minimum level of performance stated in the contract to receive payment.
The Contractor agrees to distribute funds as detailed in the Area Plan Update and the Budget Summary, Attachment
IX, to this contract. Any changes in the total amounts of the funds identified on the Budget Summary form require a
contract amendment.
C. Advance Payments
The Contractor may request up to two (2) months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and amount of funds
released to the Agency. The Contractor's requests for advance payments require the approval of the Agency Contract
Manager. The Contractor shall provide the Agency Contract Manager documentation justifying the need for an advance
and describing how the funds will be distributed. If sufficient budget is available, the Agency will issue approved
advance payments after January 1st of the contract year. Advance payments will not be issued for NSIP.
1. Any advance payments the Contractor requested for subcontractors must be distributed within seven (7) days
of receipt of payment from the Agency. The Contractor shall submit to the Agency documentation to support
full distribution of advanced funds with report number 5, due to the Agency on April 09, 2018, in accordance
with the Invoice Schedule,Attachment X to this contract.
2. All advance payments retained by the Contractor must be fully expended no later than March 31, 2018. Any
portion of advanced payments not expended must be recouped on the Request for Payment, report number 5,
due to the Agency on April 09, 2018, in accordance with the Invoice Schedule, Attachment X to this
contract.
3. All advance payments made to the Contractor shall be reimbursed to the Agency as follows: one—tenth of the
advance payment received shall be reported as an advance recoupment on each Request for Payment,
starting with report number 5, in accordance with the Invoice Schedule,Attachment X to this contract.
4. Interest earned on advances must be identified separately by source of funds, state or federal. Contractors shall
maintain advances of federal funds in FDIC interest bearing accounts unless an exception is made in accordance
with 45 CFR §75.305. Earned interest must be returned to the Agency at the end of each quarter of the
contract period.
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D. Invoice Instructions
Payment shall be made upon the Contractor's presentation of an invoice, following acceptance and approval by the Agency
of the deliverables shown on the invoice. The form and substance of each invoice submitted by the Contractor shall be as
follows:
1. The invoice shall include a"Remit to" address that corresponds exactly to the remittance address identified in
the MFMP registration.
2. The monthly invoice shall include the units of services established in the Agency's approved Area Plan, per
the requirements in the DOEA Programs and Services Handbook, at the rates established in Attachment IX to
this contract. Documentation of service delivery shall include a report consisting of the following: number of
clients served,number of service units provided by service,and rate per service unit with calculations that equal
the total invoice amount. Reimbursement amounts for administrative costs shall be reflected on the Cost
Reimbursement Summary Form and include only items contained on the Contractor's budget approved by the
Agency. Any requested changes to the approved budget subsequent to the execution of this contract, must be
submitted to the Agency Contract Manager for approval. Any change to the total contract amount requires a
contract amendment.
3. The Contractor shall consolidate requests for payment from subcontractors and expenditure reports that support
requests for payment and submit to the Agency Requests for Payment (Attachment XI), Receipt and
Expenditure Reports(Attachment XII-XVI according to your contract).
4. The Contractor shall include with the Fixed Fee/Unit Rate portion of its invoice,the units of services provided
based on rates established in Attachment IX, number of clients, and the rates for the services provided per the
requirements described in the deliverables and service tasks, and clearly state the provider name, the report
month, and the invoice number.
5. All Requests for Payment shall be based on the submission of actual monthly Expenditure Reports beginning
with the first month of the contract. The schedule for submission of advance requests (when available) and
invoices is found in the Invoice Schedule,Attachment X.
6. Final contract invoices must be submitted to the Agency no later than February 15,2019.
E. 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.
F. Corrective Action Plan
1. Contractor shall ensure 100% of the deliverables identified in Section II.D.1-3 of this contract are performed
pursuant to contract requirements.
2. If at any time the Contractor is notified by the Agency Contract Manager that it has failed to correctly,
completely, or adequately perform contract deliverables identified in Section II.D.1-3 of this contract, the
Contractor will have ten(10)days to submit a Corrective Action Plan("CAP")to the Agency Contract Manager
that addresses the deficiencies and states how the deficiencies will be remedied within a time period approved
by the Agency Contract Manager. The Agency shall assess a Financial Consequence for Non-Compliance on
the Contractor as referenced in Section III.H of this contract for each deficiency identified in the CAP which is
not corrected pursuant to the CAP. The Agency will also assess a Financial Consequence for failure to
timely submit a CAP.
3. If the Contractor fails to correct an identified deficiency within the approved period specified in the CAP, the
Agency shall deduct the percentage established in Section III.H. of this contract, from the payment for the
invoice of the following month.
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January 2018 to December 2018 OAA 203.11 6 0 20
4. If the Contractor fails to timely submit a CAP,the Agency shall deduct the percentage established in Section
III.I. of this contract for each day the CAP is overdue. The deduction will be made from the payment for the invoice of
the following month.
G. Financial Consequences
The Agency will withhold or reduce payment if the Contractor fails to perform the deliverables to the satisfaction
of the Agency according to the requirements referenced in Section II.D of this contract. The following financial
consequences will be imposed if the deliverables stated do not meet in part or in whole the performance criteria as
outlined in Section II.D. of this contract.
1. Delivery of services to eligible clients as referenced in Section II.A.2 and Section II.D.1 of this contract —
Failure to comply with established assessment and prioritization criteria, as evidenced by CIRTS reports, will
result in a 2%reduction of payment per business day. The reduction of payment will begin on the first business
day following the Agency's notification to the Contractor that the identified deficiency was not cured or
satisfactorily addressed in accordance with the Agency-approved CAP,referenced in Section III.G.
2. Services and units of services as referenced in Section II.D.2 of this contract —Failure to provide services in
accordance with the current DOEA Programs and Services Handbook, the service tasks described in Section
II.A, Attachment IX, and submission of required documentation will result in a 2% reduction of payment per
business day.The reduction of payment will begin the first business day following the Agency's notification to
the Contractor that the identified deficiency is not cured or satisfactorily addressed in accordance with the
Agency approved CAP,referenced in Section III.G.
3. Administrative duties as referenced in Section II.D.3 of this contract—Failure to perform management and
oversight of Program operations will result in a 2%reduction of payment per business day.The reduction of
payment will begin the first business day following the Agency's notification to the Contractor that the
identified deficiency was not cured or satisfactorily addressed in accordance with the Agency approved
CAP,referenced in Section III.G.
4. Timely submission of a CAP—Failure to timely submit a CAP within ten(10)business days after notification
of a deficiency by the Agency Contract Manager will result in a 2%reduction of payment per business day the
CAP is not received. The reduction of payment will begin the first business day following the Agency's
notification to the Contractor that the identified deficiency was not cured or satisfactorily addressed in
accordance with the Agency approved CAP,referenced in Section M.G.
5. Exceptions may be granted solely, in writing,by the Agency Contract Manager.
III.SPECIAL PROVISIONS
A. Final Budget and Funding Revision Requests
Final requests for budget revisions or adjustments to contract funds based on expenditures for provided services must be
submitted to the Agency Contract Manager in writing no later than December 31, 2018; email requests are considered
acceptable.
B. Contractor's Financial Obligations
1. Matching,Level of Effort,and Earmarking Requirements
The Contractor shall match at least twenty-five (25) percent of the federal administrative funds received. The Contractor's
match will be made in the form of cash, general revenue administrative funds, and/or in-kind resources. The Contractor
will assure,through a provision in subcontracts, a match requirement of at least ten
(10) percent of the cost for services funded through this contract, except for Title IIID. The subcontractor's match will
be made in the form of cash and/or in-kind resources. The Contractor shall report match by title each month. At the end of
the contract period,the Contractor must properly match OAA funds that require a match.
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January 2018 to December 2018 OAA 203.1 6 D 20
2. Consumer Contributions
Consumer contributions are to be used under the following terms:
a. The Contractor assures compliance with Section 315 of the OAA as amended in 2006,in regard to consumer
contributions;
b. Voluntary contributions are not to be used for cost sharing or matching;
c. Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and
d. Voluntary contributions are to be used only to expand services.
3. Use of Service Dollars and Management of the Assessed Priority Consumer List
The Contractor is expected to spend all federal, state, and other funds provided by the Agency for the purpose
specified in this contract. The Contractor must manage the service dollars in such a manner so as to avoid having a wait
list and a surplus of funds at the end of the contract period, for each program managed by the Contractor. If the Agency
determines that the Contractor is not spending service funds accordingly, the Agency may transfer funds to other AAAs
during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under state and federal
law.
4. Title III Funds
The Contractor assures compliance with Section 306 of the OAA, as amended in 2006, that funds received under Title
III will not be used to pay any part of a cost (including an administrative cost) incurred by the Contractor to maintain a
contractual or commercial relationship that is not carried out to implement Title III.
C. Remedies for Nonconforming Services
1. The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely,
completely and commensurate with required standards of quality. Such goods and/or services will only be
delivered to eligible program participants.
2. If the Contractor fails to meet the prescribed quality standards for services,such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services
not meeting such standards will not be reimbursed under this contract. The Contractor's signature on the
Request for Payment Form certifies maintenance of supporting documentation and acknowledgement that the
Contractor shall solely bear the costs associated with preparing or providing nonconforming goods and/or
services. The Agency requires immediate notice of any significant and/or systemic infractions that
compromise the quality, security or continuity of services to clients.
D. Incident Reporting
The Contractor shall notify the Agency immediately but no later than forty-eight (48) hours from the Contractors
awareness or discovery of changes that may materially affect the Contractor or any subcontractor's ability to perform the
services required to be performed under this contract. Such notice shall be made orally to the Agency Contract Manager
(by telephone) with an email to immediately follow, including the Contractor's plan for provision of services required by
contract.
E. 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).
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January 2018 to December 2018 OAA 203.18
.
F. Enforcement
1. In accordance with Section 430.04, F.S., the Agency shall rescind designation of an area agency on aging or
take intermediate measures against the Contractor, including corrective action, unannounced special monitoring,
temporary assumption of operation of one or more programs by the Agency, placement on probationary
status, imposing a moratorium on Contractor action, imposing financial penalties for nonperformance, or other
administrative action pursuant to Chapter 120, F.S., if the Agency finds that any of the following have
occurred:
a. An intentional or negligent act of the Contractor has materially affected the health, welfare, or safety of
clients, or substantially and negatively affected the operation of an aging services program.
b. The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual funds
have been misappropriated.
c. The Contractor has committed multiple or repeated violations of legal and regulatory requirements or
Agency standards.
d. The Contractor has failed to continue the provision or expansion of services after the declaration of a state
of emergency.
e. The Contractor has exceeded its authority or otherwise failed to adhere to the terms of this contract with the
Agency or has exceeded its authority or otherwise failed to adhere to the provisions specifically
provided by statute or rule adopted by the Agency.
f. The Contractor has failed to properly determine client eligibility as defined by the Agency or efficiently
manage program budgets.
g. The Contractor has failed to implement and maintain a Agency-approved client grievance resolution
procedure.
2. In making any determination under this provision the Agency may rely upon findings of another state or
federal agency, or other regulatory body. Any claims for damages for breach of contract are exempt from
administrative proceedings and shall be brought before the appropriate entity in the venue of Lee County,
Florida. In the event the Agency initiates action to rescind an area agency on aging designation, the
Agency shall follow the procedures set forth in 42 U.S.C. §3025(b).
G. Investigation of Criminal Allegations
Any report that implies criminal intent on the part of the Contractor or any subcontractors and referred to a
governmental or investigatory agency must be sent to the Agency. 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
governmental agency, the Contractor shall notify 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 Depaitment's Inspector General with a summary of the investigation
and allegations.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
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January 2018 to December 2018 OAA 203.1 6 20
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Agency 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 2 CFR Part 200 (formerly 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 contract,the Contractor agrees to comply and cooperate with any monitoring procedures/processes deemed
appropriate by the Agency. In the event the Agency determines that a limited scope audit of the Contractor is
appropriate, the Contractor agrees to comply with any additional instructions provided by the Agency 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 2 CFR Part
200, Subpart A.
In the event that the Contractor expends $750,000.00 or more in federal awards during its fiscal year, the Contractor must
have a single or program-specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial
Compliance Audit Attachment, Exhibit 2 indicates federal resources awarded through the Agency by this contract. 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 Agency. The determination of amounts of Federal awards expended
should be in accordance with 2 CFR Part 200. An audit of the Contractor conducted by the Auditor General in accordance
with the provisions of 2 CFR Part 200 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 2 CFR§200.508.
If the Contractor expends less than $750,000.00 in federal awards in its fiscal year, an audit conducted in accordance with
the provisions of 2 CFR Part 200 is not required. In the event that the Contractor expends less than $750,000.00 in federal
awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200 the cost
of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from Contractor resources
obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to contracts with the Agency shall be based on the contract's requirements, including any
rules, regulations, or statutes referenced in the contract. The financial statements shall disclose whether or not the matching
requirement was met for each applicable contract. All questioned costs and liabilities due to the Agency shall be fully
disclosed in the audit report with reference to the Area Agency on Aging for Southwest Florida, Inc. contract involved. If
not otherwise disclosed as required by 2 CFR §200.510 the schedule of expenditures of federal awards shall identify
expenditures by contract number for each contract with the Agency in effect during the audit period. Financial
reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or
9 months after the end of the Contractor's fiscal year end.
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. January 2018 to December 2018 OAA 203.18 1 6 0 20
PART II: STATE FUNDED
This part is applicable if the Contractor is a non-state entity as defined by Section 215.97(2),F.S.
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of$750,000.00 in
any fiscal year of such Contractor, the Contractor must have a State single or project-specific audit for such fiscal year in
accordance with Section 215.97, F.S.; applicable rules of the Department of Financial Services; and Chapters 10.550 (local
governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. Financial
Compliance Audit Attachment, Exhibit 2 indicates state financial assistance awarded through the Agency by this
contract. 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 Agency, 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 II, paragraph 1, the Contractor shall ensure that the audit
complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as
defined by Section 215.97(2), F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations), Rules of the Auditor General.
If the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year, an audit conducted in
accordance with the provisions of Section 215.97, F.S., is not required. In the event that the Contractor expends less than
$750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the
provisions of Section 215.97, F.S., the cost of the audit must be paid from the 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.
Compliance findings related to contracts with the Agency shall be based on the contract'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 contract. All questioned costs and liabilities due to the Agency shall be fully disclosed in the
audit report with reference to the Agency contract involved. If not otherwise disclosed as required by Rule 691- 5.003,
F.A.C., the schedule of expenditures of state financial assistance shall identify expenditures by contract number for each
contract with the Agency in effect during the audit period. Financial reporting packages required under this part must be
submitted within 45 days after delivery of the audit report, but no later than 12 months after the Contractor's fiscal year end
for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after
delivery of the audit report, but no later than 9 months after the Contractor's fiscal year end. Notwithstanding the
applicability of this portion, the Agency retains all right and obligation to monitor and oversee the performance of this
contract as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of this Financial
Compliance Audit Attachment, shall be submitted, when required by 2 CFR §200.512 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: Tammy Rhoades,Vice President of Finance
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
35
• January 2018 to December 2018 OAA 203.181 6 0 2 0
For fiscal year 2013 and earlier to the Federal Audit Clearinghouse designated in 2 CFR§200.36 at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville,IN 47132
For fiscal year 2014 and later, pursuant to 2 CFR §200.512, the reporting package and the data collection form must be
submitted electronically to the Federal Audit Clearinghouse.
Pursuant to 2 CFR §200.512, all other Federal agencies, pass-through entities and others interested in a reporting package
and data collection form must obtain it by accessing the Federal Audit Clearinghouse.
The Contractor shall submit a copy of any management letter issued by the auditor, to the Area Agency on Aging for
Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida,Inc.
Attn: Tammy Rhoades,Vice President of Finance
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
Additionally, copies of financial reporting packages required by this contract's Financial Compliance Audit Attachment,
Part II shall be submitted by or on behalf of the Contractor directly to each of the following:
The Area Agency on Aging for Southwest Florida,Inc. at the following address:
Area Agency on Aging for Southwest Florida,Inc.
Attn: Tammy Rhoades,Vice President of Finance
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building,Room 574
111 West Madison Street
Tallahassee,Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Agency pursuant to this contract shall
be submitted timely in accordance with 2 CFR Part 200, 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 Agency for audits done in accordance with 2 CFR Part 200
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 IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of
six (6) years from the date the audit report is issued, and shall allow the Agency or its designee, the CFO or Auditor
General access to such records upon request. The Contractor shall ensure that audit working papers are made available to
the Agency or its designee, CFO, or Auditor General upon request for a period of six (6) years from the date the audit
report is issued,unless extended in writing by the Agency.
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January 2018 to December 2018 OAA 2031 6 Q 20
ATTACHMENT II-EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200
and/or Section 215.97,F.S. Contractors who are determined to be recipients or sub-recipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I
and/or Part II of Exhibit 1 are met. Contractors who have been determined to be vendors are not subject to the audit
requirements of 2 CFR§200.38,and/or Section 215.97, F.S. Regardless of whether the audit requirements are met,
Contractors who have been determined to be recipients or sub-recipients of Federal awards and/or state financial
assistance must comply with applicable programmatic and fiscal compliance requirements.
In accordance with 2 CFR Part 200 and/or Rule 691-5.006,F.A.C.,Contractor has been determined to be:
Vendor not subject to 2 CFR§200.38 and/or Section 215.97,F.S.
X Recipient/sub-recipient subject to 2 CFR§200.86 and §200.93 and/or Section 215.97, F.S.
Exempt organization not subject to 2 CFR Part 200 and/or Section 215.97, F.S. For Federal awards, for-profit
organizations are exempt; for state financial assistance projects, public universities, community colleges, district school
boards, branches of state (Florida) government, and charter schools are exempt. Exempt organizations must comply with
all compliance requirements set forth within the contract or award document.
NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and or state financial assistance and has been
approved by the Agency to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-5.006, F.A.C.
[state financial assistance] and 2 CFR§200.330[federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal
awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a sub-
recipient must comply with the following fiscal laws,rules and regulations:
STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR§200.416 - §200.417—Special Considerations for States, Local Governments and Indian Tribes* 2 CFR§200.201
—Administrative Requirements**
2 CFR§200 Subpart F—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§200.400- §200.411 —Cost Principles* 2 CFR§200.100—
Administrative Requirements 2 CFR§200 Subpart F—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§200.418—§200.419—Special Considerations for Institutions of Higher Education* 2 CFR§200.100
—Administrative Requirements
2 CFR§200 Subpart F—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 2 CFR
§200.400(5)(c).
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. January 2018 to December 2018 OAA 203.1 6 0 2 0
**For funding passed through U.S. Health and Human Services, 45 CFR Part 75; for funding passed through U.S.
Department of Education,34 CFR Part 80.
STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a
recipient/sub-recipient must comply with the following fiscal laws,rules and regulations:
Sections 215.97&215.971,F.S.
Chapter 69I-5,F.A.C.
State Projects Compliance Supplement Reference
Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
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January 2018 to December 2018 OAA 203.181 6 0 20
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR, as revised,and Section 215.97,F.S. require that the information about Federal Programs and State
Projects included in Attachment II,Exhibit 1 be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD (FAIN#): 18AAFLT3SS, 18AAFLT3CM, 18AAFLT3HD, 18AAFLT3PH, 18AAFLT3FC
DUNS NUMBER : 076997790 FEDERAL AWARD DATE: OCTOBER 20,2017
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title IIIB—
Transportation U.S. Health and Human Services 93.044 $ 10,010.00
Support Services $ 325,543.00
Total MB $ 335,553.00
OAA Title IIIC1 —Congregate Meals U.S. Health and Human Services 93.045 $ 288,549.00
Total IIIC 1
OAA Title III C2—Home Delivered Meals
Total IIIC2 U.S. Health and Human Services 93.045 $ 258,599.00
Older Americans Act Title HI E
Services(Title III E) $ 105,594.00
Supplement Services(Title III ES) U.S.Health and Human Services 93.052 $ 12,287.00
Grandparent Services(Title III EG) $ 6,145.00
Total HIE $ 124,026.00
NSIP U.S.Health and Human Services 93.053 $ 49,779.28
TOTAL FEDERAL AWARD $1,056,506.28
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards/
OMB Circular A-133—Audits of States, Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97,F.S.,Chapter 69I-5,FL Admin Code,Reference Guide for State Expenditures,Other fiscal requirements set forth in
program laws,rules and regulations.
39
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. January 2018 to December 2018 OAA 203.18
ATTACHMENT III
Area Agency on Aging for Southwest Florida,Inc.will not award this Contract unless Contractor completes this
CERTIFICATIONS AND ASSURANCES. In performance of this contract,Contractor provides the following
certifications and assurances:
A. Debarment and Suspension Certification(29 CFR Part 95 and 45 CFR Part 751
B. Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 931
C. Nondiscrimination &Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes.section 287.133.F.S.
E. Association of Community Organizations for Reform Now(ACORN)Funding Restrictions Assurance(Pub.
L. 111-117)
F. Certification Regarding Scrutinized Companies Lists.section 287.135.F.S.
G. Certification Regarding Data Integrity Compliance For Contracts. Agreements. Grants. Loans And
Cooperative Agreements
H. Verification of Employment Status Certification
I. Records and Documentation
J. Certification Regarding Inspection of Public Records
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
—PRIMARY COVERED TRANSACTION.
The undersigned Contractor certifies to the best of its knowledge and belief,that it and its principals:
Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered
transactions by a Federal department or agency;
Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (Federal,
State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or
receiving stolen property;
Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State or local) with
commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or
Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,
State,or local)terminated for cause of default.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers
(including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements)and that all sub recipients
and contractors shall provide this certification accordingly.
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January 2018 to December 2018 OAA 203.1
D 20
B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS.
The undersigned Contractor certifies,to the best of its knowledge and belief,that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any
Federal contract, grant, loan or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative
agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report
Lobbying,"in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers
(including subcontracts, sub-grants and contracts under grants,loans and cooperative agreements)and that all sub- recipients
and contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this Contract was made or
entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31
U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than$100,000 for each such failure.
C. NON DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART
80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal
opportunity provisions of the following laws:
1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination
against all individuals in the United States on the basis of race, color, religion, sex national origin, age, disability,
political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted
immigrant authorized to work in the United States or participation in any WIA Title I-financially assisted program or
activity.
2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to
the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance with
Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national
origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under
any program or activity for which the Applicant receives Federal financial assistance from the Agency.
3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112) as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in
accordance with Section 504 of that Act, and the Regulation, no otherwise qualified handicapped individual in the
United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be
subjected to discrimination under any program or activity for which the Applicant receives Federal financial
assistance from the Agency.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the
Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with
the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be
excluded from participation in, or be subjected to discrimination under any program or activity for which the
Applicant receives Federal financial assistance from the Agency
5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in
accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded
from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education
program or activity for which the Applicant receives Federal financial assistance from the Agency.
41 G40
D 20
• January 2018 to December 2018 OAA 20 .18
6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment
practices, including,job application procedures, hiring, firing, advancement, compensation, training, and other terms,
conditions,and privileges of employment. It applies to recruitment,advertising,tenure,layoff,leave,fringe benefits, and
all other employment-related activities.
Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed
above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity, and
to all contracts, Contractor makes to carry out the WIA Title I — financially assisted program or activity. Contractor
understands that Area Agency on Aging for Southwest Florida, Inc. and/or DOEA and the United States have the right to
seek judicial enforcement of the assurance.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers
(including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements)and that all sub recipients
and contractors shall provide this assurance accordingly.
). CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S.
Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity
Crime as defined in section 287.133,F.S.,nor placed on the convicted vendor list.
Contractor understands and agrees that it is required to inform Area Agency on Aging for Southwest Florida, Inc.
immediately upon any change of circumstances regarding this status.
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RESTRICTIONS ASSURANCE (Pub.L. 111-117).
As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions
pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511 (Pub.
L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that
appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub.L. 111-117.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers
(including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements)and that all sub recipients
and contractors shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS CERTIFICATION,SECTION 287.135,F.S.
If this Contract is in the amount of $1 million or more, in accordance with the requirements of Section 287.135, F.S.,
Contractor hereby certifies that it is not participating in a boycott of Israel, is not listed on either the Scrutinized
Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy
Sector List, and that it does not have business operations in Cuba or Syria. Both lists are created pursuant to Section
215.473,F.S.
Contractor understands that pursuant to Section 287.135, F.S., the submission of a false certification may subject
Contractor to civil penalties,attorney's fees,and/or costs.
If Contractor is unable to certify any of the statements in this certification,Contractor shall attach an explanation to this
Contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS,
AGREEMENTS, GRANTS,LOANS AND COOPERATIVE AGREEMENTS
1. The Contractor and any Subcontractors of services under this contract have financial management systems capable
of providing certain information, including: (1)accurate,current, and complete disclosure of the financial results
of each grant-funded project or program in accordance with the prescribed reporting requirements; (2)the source
and application of funds for all contract supported activities;and(3)the comparison of outlays with budgeted
amounts for each award.The inability to process information in accordance with these requirements could result in
a return of grant funds that have not been accounted for properly.
2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the
Contractor is dependent for data that is to be reported,transmitted or calculated,have been assessed and verified to
be capable of processing data accurately, including year-date dependent data. For those systems identified to be
42
as)
ba20
January 2018 to December 2018 OAA 203.t8
non-compliant,Contractors will take immediate action to assure data integrity.
3. If this contract includes the provision of hardware, software,firmware, microcode or imbedded chip technology,
the undersigned warrants that these products are capable of processing year-date dependent data accurately.All
versions of these products offered by the Contractor(represented by the undersigned)and purchased by the state
will be verified for accuracy and integrity of data prior to transfer.
4. 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.
5. The Contractor and any Subcontractors of services under this contract warrant their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies
arising from data integrity compliance issues.
3. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Area Agency on Aging for Southwest Florida,Inc., Contractor certifies the use of
the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees
hired by Contractor during the contract term to perform employment duties pursuant to this contract and that any
subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this
Contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor
during the entire contract term.
The Contractor shall require that the language of this certification be included in all sub-agreements, sub-grants,and
other agreements/contracts 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
Circulars A-102 and 2 CFR Part 200, and 215 (formerly OMB Circular A-110).
I. RECORDS AND DOCUMENTATION
The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract
related records and documentation.The Contractor shall ensure the collection and maintenance of all program related
information and documentation on any such system designated by the Agency.Maintenance includes valid exports and
backups of all data and systems according to Agency standards.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
In addition to the requirements of sections, 10.1, 10.2 of the Standard Contract, and 119.0701(3)and(4)F.S.,and any other
applicable law, if a civil action is commenced as contemplated by Section 119.0701(4),F.S.,and the Agency is named in the
civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency, and any
attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S.,
concerning this contract or services performed thereunder.
Notwithstanding Section 119.0701, F.S., or other Florida law,this section is not applicable to contracts executed between
the Agency and state agencies or subdivisions defined in Section 768.28(2), F.S.
Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership
contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial,
business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging for
Southwest Florida, Inc.) are public records. Section 119.07,F.S, states that every person who has custody of such a public
record shall permit the record to be inspected and copied by any person desiring to do so,under reasonable circumstances.
43 C;(5
, January 2018 to December 2018 OAA 203.11 6 0 20
Additionally, I certify this organization does X_does not
provide for institutional memberships.
Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are
available for inspection as stated above.
By execution of this contract,Contractor must include these provisions in all related subcontract agreements(if applicable).
By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if
applicable).
By signing below, Contractor certifies the representations outlined in parts A through J above, are true and correct.
V� r C 5 Me f q _ ((ca 3339 Tamiami Trail E., Suite 217
Signature and Title of Authorized Representative Street Address
g p
Collier County Board of County January 20, 2018
Naples, FL 34112
Contractor Date City,State,Zip code
*v\o
44
January 2018 to December 2018 OAA 201U6 D 20
ATTACHMENT IV
ASSURANCES—NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average forty-five (45)minutes per response, including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project(0348-0043),
Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET,SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program.If you have questions,please
contact the awarding agency.Further,certain federal awarding agencies may require applicants to certify to
additional assurances.If such is the case,you will be notified.
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.
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.
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.
Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
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).
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. §1681-1683, 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 (j) the requirements of any other nondiscrimination statute(s) which
may apply to the application.
Will comply, or has already complied, with the requirements of Titles II 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.
45 o
, January 2018 to December 2018 OAA 203.18 6 D 2 0
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 part with federal funds.
Will comply, as applicable,with the provisions of the Davis-Bacon Act(40 U.S.C. §276a to 276a-7),the Copeland Act (40
U.S.C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act(40 U.S.C. §327-333), regarding
labor standards for federally assisted construction sub-contracts.
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.
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 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section
176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground sources of
drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered
species under the Endangered Species Act of 1973,as amended,(P.L. 93-205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
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.).
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.
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.
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.
Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and 2 CFR Part 200.
Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies
governing this program.
SI .
NATURE OF AUTHO D CERTIFYING OFFICIAL TITLE
4 Cr J i Public Services Department Head
APPLI ANT ORGANIZATION DATE SUBMITTED
Collier County Government January 20, 2018
46
1 6 0 20
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name: Collier County Services for Seniors County:Collier AAA/Contractor
AAA of Southwest Florida
Address:3339 Tamiami Trail E.,Suite 211 Completed By:Jody Paley
City,State,Zip Code: Naples,FL 34112 Date: 1/16/18 Telephone:239-252-2903
PART I:READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE
THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
Services are situated over a 2,300 square mile area. Collier County Community and Human services provides in-home care,facility
adults day care, case management and nutrition services to frail, elderly residents of Collier
County.
% % % % % % %
For questions 2-5,please indicate the following: Total# Whit Black Hispanic Other Female Disabled Over 4(
e
2.Population of area served Source of data 129,475 95.3 3.5% 5.6% 1.1% 53.5% na 100%
DOEA %
3.Staff currently employed Effective 10 30% 10% 40% 2% 90% 0% 100%
Date 1/16/18
4.Clients currently enrolled/registered Effective 619 71% 7% 38% 19% 66% NA 100%
Date 1/16/18
5.Advisory/Governing Board if applicable NA
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
1. Is an Assurance of Compliance on file with DOEA? N/A YES NO
n ® ❑
2. Compare the staff composition to the population. Is staff representative of the population? N/A YES NO
❑ ® n
3. Are eligibility requirements for services applied to clients and applicants without regard to race,color,
national origin,sex,age,religion or disability? N/A YES NO
n ® n
4. Are all benefits,services and facilities available to applicants and participants in an equally effective
manner regardless of race,sex,color,age,national origin,religion or disability? N/A YES NO
❑ ® II
5. For in-patient services,are room assignments made without regard to race,color,national origin
or disability? N/A YES NO
® ❑ ❑
6. Is the program/facility accessible to non-English speaking clients? N/A YES NO
n ® ❑
7. Are employees, applicants and participants informed of their protection against discrimination? If YES,
how? Verbal El Written /1 Poster® N/A YES NO_
111 �� —
CO 61
16020
' 8. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility. N/A NUMBER
9. Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? N/A YES NO
❑ ® n
PART III:THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO
EXPLAIN
10. Has a self-evaluation been conducted to identify any barriers to serving disabled individuals,and to make any
necessary modifications? YES NO
❑ n
11. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO
n
12. Has a person been designated to coordinate Section 504 compliance activities? YES NO
❑ n
13. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination
on the basis of disability? YES NO
n
14. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? YES NO
❑ n
PART IV:FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF$50,000.00 OR
MORE.
15. Do you have a written affirmative action plan? If NO,explain. YES NO
C ❑
DOEA USE ONLY
Reviewed By In Compliance: YES NO* ❑
Program Office *Notice of Corrective Action Sent / /_
Date Telephone Response Due / /_
On-Site D Desk Review ❑ Response Received / /
Revised August 2010,Page 2 of 2
January 2018 to December 2018 OAA 203.11 6 0 2 0
ATTACHMENT V
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a
specific target population such as adolescents, describe the target population. Also, define the type of service provided.
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.
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.
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 Area Agency on Aging for Southwest Florida, Inc. Recipients and their Sub-grantees,45 CFR 80.4(a).
Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the
population, the program/facility has the responsibility to determine the reasons for such variation and take whatever
action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are
sanctioned to serve target populations such as elderly or disabled persons,45 CFR 80.3 (b)(6).
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).
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).
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).
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 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).
49
n
• January 2018 to December 2018 OAA 203.1$1 6 0 20
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 Area Agency on Aging for Southwest Florida, Inc. and/or Florida Department of
Elder Affairs or the U.S. Department of HRS. 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).
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.
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.
Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self-
evaluation to identify any accessibility barriers. Self-evaluation is a four step process:
With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with
Section 504.
Modify policies and practices that do not meet Section 504 requirements.
Take remedial steps to eliminate any discrimination that has been identified.
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.
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).
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).
Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination
on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate
written communication, 45 CFR 84.8(a).
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).
Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain
a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of
the Civil Rights Act of 1964, as amended.
50 t-J►
DEPARTMENT OF 1 6 0 20
BACKGROUND SCREENING
ELDER
AFFAIRS Affidavit of Compliance - Employer
STATE OF FLORIDA
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.05(3), Florida Statutes.
D 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 Community and Human Services
Employer Name
located at 3339 Tamiami Trail East,Suite 211, Naples FL 34112 ,
Street Address City State ZIP code
I, Steve Y. Camel!, Public Services Department Head 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.
• jb/ Q /1 ((g
[ (':
Signature of 'epreserf�ative / Date
STATE OF FLORIDA, COUNTY OF Collier
ie
Sworn to (or affirmed) and subscribed before me this`- day of ,,r'u.0 , 20 � , , by
r\ 'rl \/ CCi f (Name of Representative)who i personally known
t. u- • Fres -d _ _ as proof of identification.
Notary Public State a'Florida
d My ndyCom Mop,Commission
J
c: • My Commisakm FF 96ti391 �
pr p. Expires 04/12/2020
PSI. . - u' !-1 fr•i .i• ". • .1 - . .tary Public Notary Publi
DOEA Form 235,Affidavit of Compliance-Employer,Effective April 2012 Section 435.05(3),F.S. s,\
Form available at:http://elderaffairs.state.fl.us/english/backgroundscreening.php
03' filC
January 2018 to December 2018 OAA 203.18 1 6 0 20
ATTACHMENT IX
BUDGET and RATE SUMMARY
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
1. Title III B Support Services $ 335,553.00
2. Title III Cl Congregate Meals $ 288,549.00
3. Title III C2 Home Delivered Meals $ 258,599.00
4. Title III E Services $ 124,026.00
5. NSIP $ 49,779.28
TOTAL $1,056,506.28
52
al
January 2018 to December 2018 OAA 203.18 1 6 0 20
OLDER AMERICANS ACT RATE SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
IIIB
Services Total Cost Reimbursement Rate
Adult Day Care 12.83 11.55
Case Aide 33.89 30.50
Case Management 60.00 54.00
Chore 23.33 21.00
Chore (Enhanced) 30.33 27.30
Companionship 23.33 21.00
Emergency Alert Response 1.31 1.18
Escort 21.67 19.50
Homemaker 21.50 19.35
Housing Improvement 100% Cost 90% of Cost
Material Aid 100% Cost 90% of Cost
Personal Care 25.67 23.10
Respite In-Facility 12.83 11.55
Respite In-Home 25.67 23.10
Screening and Assessment 60.00 54.00
Shopping Assistance 21.00 18.90
Skilled Nursing Services 42.00 37.80
Specialized Medical Equipment, Services, and 100% Cost 90% of Cost
Supplies
Transportation 100% Cost 100% of Cost
53 ��O
January 2018 to December 2018 OAA 203.181 6 0 20
COLLIER COUNTY
IIIE,HIES,& MEG
Services Total Cost Reimbursement Rate
IIIE- Adult Day Care $ 12.83 $ 11.55
Direct Pay Respite $ 16.67 $ 15.00
Respite In-Facility $ 12.83 $ 11.55
Respite In-Home $25.67 $23.10
Screening&Assessment $ 60.00 $ 54.00
IIIES-- Chore $ 23.33 $ 21.00
Enhanced Chore $ 30.33 $ 27.30
Specialized Medical Equipment, Service& 100% Cost 90% of Cost
Supplies
Material Aid 100% Cost 90% of Cost
MEG- Child Day Care $ 16.67 $ 15.00
Screening/Assessment $ 60.00 $ 54.00
COLLIER COUNTY
C-1 & C-2
Services Total Cost Reimbursement Rate
Cl
Congregate Meals $ 9.88 $ 8.90
Nutrition Education $ 1.80 $ 1.62
Congregate Meal Screening $31.12 $28.00
Outreach $4.80 per person $4.32 per person
C2
Home Delivered Meals $ 9.77 $ 8.80
Nutrition Education $ 1.80 $ 1.62
Screening &Assessment $60.00 $54.00
Outreach $4.80 per person $4.32 per person
54 0
January 2018 to December 2018 OAA 203.18 1 6 0 20
ATTACHMENT X
INVOICE SCHEDULE
Report Number Based On Submit to Agency
On This Date
1 January Advance* January 1
2 February Advance* January 1
3 January Expenditure Report February 9 *See Note#4*
4 February Expenditure Report March 9
5 March Expenditure Report April 9
6 April Expenditure Report May 9
7 May Expenditure Report June 9
8 June Expenditure Report July 9
9 July Expenditure Report August 9
10 August Expenditure Report September 9
11 September Expenditure Report October 9
12 October Expenditure Report November 9
13 November Expenditure Report December 9
14 December Expenditure Report January 9
15 Final Expenditure and Request for Payment February 15
16 Closeout Report March 1
Legend: * Advance based on projected cash need.
Note# 1: Report#1 for Advance Basis Agreements cannot be submitted to the Agency prior to
January 1 or until the agreement with the Agency has been executed.
Note#2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the agree-
ment. The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT XI).
Note# 3: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the Agency, payment is to accompany the
report.
Note#4: ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 9th falls
on a Saturday, then the report will be due by the 8th by 12:00 p.m. AND IF the 9th falls on
a Sunday,the report will be due by the 10th by 12:00 p.m. Actual submission of the
vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report
which is verified and paid by CIRTS data only.
55 0
Janualy GV 10 lV LGl.G1111/G1 GV 10 \Jtiti GVJ.10
ATTACHMENT XI 1 6 0 20
REQUEST FOR PAYMENT
OLDER AMERICANS ACT
PROVIDER NAME,ADDRESS,PHONE&FED ID NUME TYPE OF REPORT:
Contract#
Advance
Contract Period:
Reimbursement Report Period
Report#
PSA
Invoice#
CERTIFICATION: I hereby certify to the best of my knowledge that this request conforms with the terms and the purposes set forth in the above contract.
Prepared By: Date: Approved By: Date:
PART A: (1) (2) (3) (4) (5) (6) (7)
BUDGET SUMMARY IIIB IIIC1 11102 IIID IIIE NSIP TOTAL
I.Approved
Contract Amount 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2.Previous Funds
RECEIVED for
Contract period 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3.Contract Balance 0.00 0.00 0.00 0.00 0.00 0.00 0.00
(Line 1 minus line 2)
4.Previous Funds
REQUESTED and
Not Received. 0.00 0.00 0.00 0.00 0.00 0.00 0.00
5.Contract Balance 0.00 0.00 0.00 0.00 0.00 0.00 0.00
(Line 3 minus line 4)
PART B:
FUNDS REQUESTED
1.1st-2nd Months
Request Only 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2.Net Expenditures
For Month 0.00 0.00 0.00 0.00 0.00 0.00 0.00
3.Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PART C:
NET FUNDS REQUESTED:
1.Less:Over-Advance 0.00 0.00 0.00 0.00 0.00 0.00 0.00
2.Contract Funds are
Hereby Requested 0.00 0.00 0.00 0.00 0.00 0.00 0.00
List of Services/Units I Rates provided-See attached report.
DOEA Use Only
DOER FORM 106A rensed 11/17/16
r
56 �
Jalival y LAI 10 (Al Lccclllucl LAI 1 0 kJ1-11-1LVJ.1 0
ATTACHMENT XII 1 6 0 20
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE#AND FEID# PROGRAM FUNDING SOURCE: ,THIS REPORT PERIOD
FROM: TO:
IIIB CONTRACT
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: Approved by : Date:
PART A : BUDGETED INCOME/RECEIPTS 1.Approved 2. Actual Receipts 3.Total Receipts 4. Percent of
Budget For This Report Year to Date Approved Budget
1. Federal Funds $0.00 $0.00 $0.00
2. State Funds $0.00 $0.00 $0.00
3. Program Income-Non Match $0.00 $0.00 $0.00 %
4. Local Cash Match $0.00 $0.00 $0.00
5. SUBTOTAL: CASH RECEIPTS $0.00 $0.00 $0.00 %
6. Local In-Kind Match $0.00 $0.00 $0.00
7. TOTAL RECEIPTS $0.00 $0.00 $0.00 %
PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of
Budget For This Report Year to Date Approved Budget
1.AAA Direct Services $0.00 $0.00 $0.00
2. Subcontractor $0.00 $0.00 $0.00
3. IIIB Set Aside $0.00 $0.00 $0.00
4. TOTAL EXPENDITURES $0.00 $0.00 $0.00
PART C: OTHER EXPENDITURES 1.Approved 2. Expenditures 3. Expenditures 4. Percent of
(For Tracking Purposes only) Budget For This Report Year to Date Approved Budget
1. Match
a. Other and In-Kind $0.00 $0.00 $0.00 %
b. Local Match $0.00 $0.00 $0.00 %
2. Program Income $0.00 $0.00 $0.00
3. TOTAL OTHER $0.00 $0.00 $0.00
PART D: INTEREST
1. Earned on Advances $0.00
2. Return on Advances $0.00
3. Other Earned $0.00
DOEA FORM 105as-IIIB revised 4/2/2015 C4.
L.0
57
Ja11Ual V GU 1 0 LU 1/1-A.,1.:1111/G1 GU 1 0 kJt1C1 U.J.G1 0
ATTACHMENT XIII
1 6 0 20
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME,ADDRESS, PHONE#AND FEID# PROGRAM FUNDING SOURCE: THIS REPORT PERIOD
FROM: TO:
Cl CONTRACT
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: Approved by : Date:
PART A : BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3. Total Receipts 4. Percent of
Budget For This Report Year to Date Approved Budget
1. Federal Funds $0.00 $0.00 $0.00 ok
2. State Funds $0.00 $0.00 $0.00 ok
3. Program Income-Non Match $0.00 $0.00 $0.00 ok
4. Local Cash Match $0.00 $0.00 $0.00 ok
5. SUBTOTAL: CASH RECEIPTS $0.00 $0.00 $0.00 ok
6. Local In-Kind Match $0.00 $0.00 $0.00 %
7. TOTAL RECEIPTS $0.00 $0.00 $0.00 %
PART B : EXPENDITURES 1.Approved 2. Expenditures 3. Expenditures 4. Percent of
Budget For This Report Year to Date Approved Budget
1. Subcontractor $0.00 $0.00 $0.00 ok
2. TOTAL EXPENDITURES $0.00 $0.00 $0.00 ok
PART C : OTHER EXPENDITURES 1.Approved 2. Expenditures 3. Expenditures 4. Percent of
(For Tracking Purposes only) Budget For This Report Year to Date Approved Budget
1. Match
a. Other and In-Kind $0.00 $0.00 $0.00 ok
b. Local Match $0.00 $0.00 $0.00 ok
2. Program Income $0.00 $0.00 $0.00 ok
3. TOTAL OTHER $0.00 $0.00 $0.00 ok
PART D: INTEREST
1. Earned on Advances $0.00
2. Return on Advances $0.00
3. Other Earned $0.00
DOEA FORM 105as-C1 revised 4/2/2015
G.6)
58
JQ11U0.1) LJl0 LV 1_1G1.,G111UG1 1-1./10 kJ[ALAGV3.1O
ATTACHMENT XIV 1 6 0 20
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME,ADDRESS, PHONE#AND FEID# PROGRAM FUNDING SOURCE: THIS REPORT PERIOD
FROM: TO:
C2 CONTRACT
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by: _ Date: Approked by : Date:
PART A: BUDGETED INCOME/RECEIPTS 1.Approked 2.Actual Receipts 3. Total Receipts 4. Percent of
Budget For This Report Year to Date Approked Budget
1. Federal Funds $0.00 $0.00 $0.00 ok
2. State Funds $0.00 $0.00 $0.00 %
3. Program Income-Non Match $0.00 $0.00 $0.00 ok
4. Local Cash Match $0.00 $0.00 $0.00 %
5. SUBTOTAL: CASH RECEIPTS $0.00 $0.00 $0.00 ok
6. Local In-Kind Match $0.00 $0.00 $0.00 %
7. TOTAL RECEIPTS $0.00 $0.00 $0.00 ok
PART B : EXPENDITURES 1.Approked 2. Expenditures 3. Expenditures 4. Percent of
Budget For This Report Year to Date Approked Budget
1. Subcontractor $0.00 $0.00 $0.00
2. TOTAL EXPENDITURES $0.00 $0.00 $0.00 ok
PART C: OTHER EXPENDITURES 1.Approked 2. Expenditures 3. Expenditures 4. Percent of
(For Tracking Purposes only) Budget For This Report Year to Date Approked Budget
1. Match
a. Other and In-Kind $0.00 $0.00 $0.00 ok
b. Local Match $0.00 $0.00 $0.00 ok
2. Program Income $0.00 $0.00 $0.00 ok
3.TOTAL OTHER $0.00 $0.00 $0.00 ok
PART D: INTEREST
1. Earned on Advances $0.00
2. Return on Advances $0.00
3. Other Earned $0.00
DOER FORM 105as-C2 revised 4/2/2015
V
59
J ral1UQ1 v LU 1 0 to LJGGG1111/G1 LU 1 0 Vii-1/-1..1 UJ.1 0
ATTACHMENT XV
16020
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME,ADDRESS, PHONE#AND FEID# PROGRAM FUNDING SOURCE : 11-115 REPORT PERIOD
FROM: TO:
CONTRACT
Title III E PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: Approved by : Date:
PARTA : BUDGETED INCOME/RECEIPTS 1.Approved 2. Actual Receipts 3. Total Receipts 4. Percent of
Budget For This Report Year to Date Approved Budget
1. Federal Funds $0.00 $0.00 $0.00 %
2. State Funds $0.00 $0.00 $0.00 %
3. Local Cash Match $0.00 $0.00 $0.00 %
4. SUBTOTAL: CASH RECEIPTS $0.00 $0.00 $0.00 %
5. Local In-Kind Match $0.00 $0.00 $0.00
6. Program Income-Non Match $0.00 $0.00 $0.00 %
7. TOTAL RECEIPTS $0.00 $0.00 $0.00 %
PART B : EXPENDITURES 1.Approved 2. Expenditures 3. Expenditures 4. Percent of
Budget For This Report Year to Date Approved Budget
1.AAA Direct Services $0.00 $0.00 $0.00 %
2. Sub-Contracted Services $0.00 $0.00 $0.00
3. TOTAL EXPENDITURES $0.00 $0.00 $0.00
PART C: OTHER EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of
(For tracking purposes only) Budget For This Report Year to Date Approved Budget
1. Match
a. Other and In-Kind $0.00 $0.00 $0.00 %
b. Local Match $0.00 $0.00 $0.00 %
2. Program Income $0.00 $0.00 $0.00 %
3. TOTAL OTHER $0.00 $0.00 $0.00
PART D: EXPENDITURES ANALYSIS
1. Expenditures by Services Year to Date: 2. Units of Services Year to Date 3. Number of People Served Year to Date
1. Information $0.00 . 0 0
2.Assistance $0.00 . 0 0
3. Counseling $0.00 . 0 0
4. Respite $0.00 0 0
5. Supplemental Services $0.00 0 0
6. TOTAL $0.00
Part B Line 3, column 3 should be equal to this total.
PART E : GRANDPARENT SERVICES (reported by Federal Fiscal Year)
FFY $ FFY $ FFY $
Match $ Match$ Match$
PART F: INTEREST
1. Earned on Advances $0.00
2. Returned on Advances $0.00
3. Other Earned $0.00
DOEA FORM 105as-IIIE revised 4/2/15
(b"t"),)
60
JCLIIUCLI y GV 1 V O V1-11-1/.6 0 /� U/�
ATTACHMENT XVI _(4//w
RECEIPTS AND EXPENDITURES
Nutrition Services Incentive Program
PROVIDER NAME,ADDRESS,PHONE#and FEID# PROGRAM FUNDING SOURCE
Contract#
TITLE III Contract Period
NSIP Report Period
Report#
Invoice#
CERTIFICATION: I hereby certify that to the best of my knowledge the information in this report is accurate and complete and that all outlays reported herein were for purposes
set forth in the contract documents.
Prepared by: Date: Approved by: Date
PART A: EXPENDITURE COMPUTATION YEAR TO DATE CURRENT MONTH
CONGREGATE HOME DELIVERED CONGREGATE HOME DELIVERED
1.Number of Meals Served 0 0 0 0
2.Line 1 Times$.72 cents per Meal $0.00 $0.00 $0.00 $0.00
Year To Date Total Meals 0 Current Month Total Meals 0
Year To Date Total Reimbursed $0.00 Total Current Expenditures $0.00
PART B. CONTRACT SUMMARY
1. Approved Contract Amount $0.00
2. Actual Receipts for this Report $0.00
3. Total Receipts Year to Date $0.00
DOEA Form 105as NSIP revised 11/17/16 ........ --- -
(47)
61
January 2018 to December 2018 OAA 21.6 0 20
ATTACHMENT XVII
OAA ANNUAL VOLUNTEER ACTIVITY REPORT SPECIFICATIONS
Categories&Definitions
Direct Volunteers: volunteers who have person-to-person contact with clients,e.g., information and referral specialists,
SHINE counselors,and individuals providing respite and companionship.
Indirect Volunteers: volunteers who coordinate, manage, or participate in specific services,programs,or activities that
assist paid staff planning, implementing,and evaluating goals and objectives of an organization,e.g., speaker's bureau
volunteer, data entry,board members,etc.
Episodic Volunteers: volunteers who participate in a specific,one-time event for a limited time,regardless of direct or
indirect.
NOTE: A volunteer can only be counted once. Select the category(direct, indirect,or episodic)that best describes the
individual volunteer and his/her volunteer work.
Unduplicated direct or indirect volunteers: number of volunteers who perform service activities.
Survey Questions
User input: Email address
User input: Survey questions
Number of unduplicated direct service volunteers.
Number of unduplicated indirect service volunteers.
Number of episodic volunteers engaged during the contract year.
Total number of direct volunteer hours served.
Total number of indirect volunteer hours served.
Total number of episodic volunteer hours served.
Number of clients served by volunteers.
Number of volunteers 60 or older.
Number of volunteers under 60.
Service Categories
Groupings for reporting the number of volunteers providing services during the data collection period(January 1 —
December 31). If there are no activities during the year, enter zero.
Adult Day Care: non-residential facility specializing in providing activities for elderly or individuals with disabilities.
Operates 10— 12 hours per day and provides meals, social or recreational outings,and general supervision.
Advisory Council/Board Membership: group of experts and leaders in a particular industry who share knowledge,
contacts,and leadership skills to benefit an organization; comprised of people who have no material interests in the
organization other than their directorship and are responsible for a fiduciary role within the organization.
AmeriCorps: network of national service programs that engage members and community volunteers in intensive service
to meet needs in education, public health, and the environment. This service produces volunteers who will provide direct
services to clients.
AmeriCorps Vista: VISTA members commit to serve full-time for a year at a nonprofit organization or local
government agency,working to fight illiteracy, improve health services,create businesses, strengthen community
groups,and much more.This service produces volunteers who will provide direct services to clients.
Clerical/Administration: complex work tasks performed under direction in support of one or more persons serving in
an administrative or professional capacity; completion of routine administrative tasks directly related to the work of
supervisor(s).
Companionship Programs: programs that help elders to help other elders with their daily lives.Tasks may include
grocery shopping,household chores, going out to lunch, or simply visiting the elders to keep them company.
Congregate Meals: service in a group setting to individuals who cannot prepare or obtain nutritionally adequate meals
themselves. Meals assist individuals to maintain a nutritious diet.
62
January 2018 to December 2018 OAA 3. 8
D20
Consumer Education/Counseling: enhances the capacity of mature consumers to navigate the increasingly complex
marketplace. Consumer education programs provide significant benefits, including identification of market information,
compliant and consumer redress procedures,and understanding of a technology-based consumer environment.
Disaster Preparation/Recovery: services in coordination with American Red Cross, FEMA, and local task forces in
response or in preparation of a disaster.
Education: community outreach program of an academic institution that offers educational and cultural programs
specifically designed to foster and support lifelong learning.
Foster Grandparents: provides a way for volunteers age 55 and over to stay active by serving children and youth in their
communities,through tutoring and mentoring.
Fundraising: any service directly related to the solicitation of contributions for a committee,program,or organization.
Health Promotion: programs specifically for older adults in the areas of health education,physical activity, coordinated
screening, and mental health.
Home Delivered Meals: service delivered to the homes to individuals who cannot prepare or obtain nutritionally adequate
meals for themselves.Meals assist individuals to maintain a nutritious diet.
Homemaker Programs: programs provide in-home services to elders at-risk of premature placement in a nursing home.
Clients must be 60 years of age or older.
Home Repair: home improvement,remodeling,or handyman work, including small odd jobs, and routine tasks.
Information and Referral: one on one services directing elders to appropriate programs and resources based on elders'
needs and specialized knowledge of aging services within the community.
Intergenerational: activities or programs that increase cooperation, interaction,or exchange between any two or more
generations.
Legal Assistance: services to elders age 60 and older,that deal with issues such as property taxes,mobile home, and other
landlord tenant issues,advance directives,Medicaid eligibility, Social Security denial,and state and local welfare benefit
denials.
RSVP: Retired Senior Volunteer Program includes a network for individuals age 55 and older who use their skills and
talents in volunteer activities such as home repairs,tutoring and mentoring, and assisting victims of natural disasters.
Recreation: programs for older adults, including health education,physical activity, coordinated screening for physical and
mental health.
RELIEF: Respite for Elders Living in Everyday Families offers respite services to caregivers of frail elders and those with
Alzheimer's disease and related dementia.
Respite: service that provides a temporary break for a family member from daily caregiving responsibilities.
Senior Companions: volunteers provide services to elders at risk of institutionalization due to chronic illness, disability, or
isolation. Services may include transportation to medical appointments, shopping assistance, meal preparation,
companionship,and advocacy, as well as respite for caregivers.
Senior Fraud Abuse Prevention Programs: safety education and prevention strategies for elder abuse,Medicare fraud
and abuse, identity theft,and programs on home safety.
SHINE: Serving Health Insurance Needs of Elders provides educational materials and free,unbiased insurance counseling
to Florida elders,caregivers, and family members.
Special Events: time limited.
Speakers' Bureau: service that provides the right professional speaker for every type of event.
Telephone Reassurance: scheduled telephone calls to check on homebound elders,which may include a friendly visit via
law enforcement or volunteers.
Transportation: service provided for older adults and individuals with disabilities including lift-equipped vehicles for
wheelchair transport and medical transportation for appointments,dialysis, and chemotherapy.
0
1 6 0 20
41,...,
£ Area Agency on Aging
FOR SOUTHWEST FLORIDA
2018 Quarterly Volunteer Report
1st 2nd 3rd 4th
Category
Quarter Quarter Quarter Quarter
Number of unduplicated direct service volunteers
Number of unduplicated indirect service volunteers
Number of episodic volunteers engaged this quarter
Total number of direct volunteer hours served
Total number of indirect volunteer hours served
Total number of episodic volunteer hours served
Number of clients served by volunteers
Number of volunteers 60 or older
Adult Daycare
A non-residential facility specializing in providing activities for
elderly and/or handicapped individuals. Operate 10-12 hours
per day and provide meals,social/recreational outings, and
general supervision.
Advisory Council/Board Membership
A group of assorted experts and leaders in a particular industry
that share knowledge, contacts, and leadership skills for the
betterment of a growing organization. Is comprised of people
who have no material interests in the organization other than
their directorship and are responsible for fiduciary role within
the organization.
AmeriCorps
A network of national service programs that engage members
and community volunteers in intensive service to meet critical
needs in education,public health, and the environment.
AmeriCorps Vista
VISTA members commit to serve full-time for a year at a
nonprofit organization or local government agency, working to
fight illiteracy, improve health services, create businesses,
strengthen community groups, and much more.
L'
1 6 0 20
Clerical/Administration
Under direction, performs complex clerical and administrative
work tasks in support of one or more persons serving in an
administrative or professional capacity;completes routine
administrative tasks directly related to the work of their
supervisor(s); and performs other related work as required.
Companionship Programs
A program, that helps senior citizens find persons to help them
with their daily lives. Tasks may include grocery shopping,
household chores, going out to lunch, or simply visiting the
senior's house or ALF to keep them company.
Congregate Meals
An individually designed service which provides meals to waiver
participants who cannot prepare or obtain nutritionally
adequate meals for themselves, or when the provision of such
meals will decrease the need for more costly supports to
provide in-home meal preparation. These meals will assist the
waiver participant to maintain a nutritious diet.
Consumer Education/Counseling
Highlights the role of consumer education in enhancing the
capacity of mature consumers to navigate the increasingly
complex marketplace. Consumer education programs can
provide significant benefits, including identification of market
information, complaint and consumer redress procedures, and
understanding a more technology-based consumer
environment.
Disaster Preparation/Recovery
Services in coordination with American Red Cross, FEMA, &
local task forces, in response or in preparation of a disaster.
Education
A community outreach program of an academic institution that
offers educational and cultural programs specifically designed
to foster and support lifelong learning.
1 6 20
Fundraising
Performs any service directly related to the solicitation of
contributions for a committee,program or organization.
Health Promotion
Programs specifically for older adults in the areas of health
education,physical activity, coordinated screening and mental
health.
Home Delivered Meals
(e.g. Meals on Wheels); an individually designed service which
provides meals to waiver participants who cannot prepare or
obtain nutritionally adequate meals for themselves, or when
the provision of such meals will decrease the need for more
costly supports to provide in-home meal preparation.
Homemaker Programs
The program provides in-home services to senior citizens.
Services are available to eligible clients who are at-risk of
premature placement in a nursing home due to a medical,
emotional or psychological impairment. Clients of the
homemaker program must be 60 years of age or older and
homebound.
Home Repair
Home improvement, remolding or handyman work. Small or
odd jobs;and routine tasks.
Information& Referral
Provides in-depth information and referral services directing
seniors to appropriate programs and resources based on
specialized knowledge of aging services and seniors'needs
within their community.
Intergenerational
Activities or programs that increase cooperation, interaction or
exchange between any two or more generations.
J
1 6 0 20
Legal Assistance
Offers free civil legal services to senior citizens age 60 and older
with no income eligibility requirements. The issues that are
dealt with may include:property tax problems, mobile home
and other landlord tenant issues, advance directives and
Medicaid eligibility, help with social security denial, and help
with state and local welfare benefit denials.
Recreation
Programs specifically for older adults in the areas of health
education, physical activity, coordinated screening and mental
health.
RELIEF
Respite for Elders Living in Everyday Families-Offers respite
services to caregivers of frail elders and those with Alzheimer's
disease and related dementia.
Respite
Provides a temporary break for a family member from daily
care-giving responsibilities.
Senior Companion
Volunteers provide services to elders at risk of
institutionalization due to chronic illness, disability or isolation.
Services include such things as transportation to medical
appointments,shopping assistance, meal preparation,
companionship and advocacy, as well as respite for caregivers
Senior Prevention/Fraud/Abuse Programs
Elder abuse prevention, Medicare fraud and abuse, identity
theft,safety education and prevention strategies including
programs on home safety etc.
SHINE
Provides educational materials and free, unbiased insurance
counseling to Florida elders, caregivers and family members.
(.119
1 6020
Special Events/Time Limited
Speaker's Bureau (list topics below)
A service that provides the right professional speaker for every
type of event.
Telephone Reassurance
Scheduled telephone calls to check on homebound seniors who
may include a friendly visit via law enforcement or volunteers.
Transportation
Programs specifically for older adults in the areas of public
transportation and specialized transportation for disabled
individuals may include lift-equipped vehicles for wheelchair
transport and medical transportation for appointments,
dialysis, and chemotherapy.
0
1 6 0 20
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract# CAA L3 , 1
I, 'leurnel t , certify that 6)111,0 r Cax\-t y T rd 4I Low)11/1 t s 100
(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 Department of Elder Affairs(DOEA) upon request.
414040,/i4 •
Signature of authorized contractor representative
��1tc Iry S +(-4- re/N.+ 1 2c(CI
Title
2-3(1
Date
DOEA Contract Manager's Review
October 2008
Revised August 2007 1 6 0 20
Attestation Statement
Agreement/Contract Number OAA 203.18
Amendment Number
1, Steve Y. Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of County Commissioners
(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.
/771-/C;0 January 20, 2018
Signature`of Recipi4it/Contractor representative Date
Revised August 2007
-\\`
Page 1 of 2
Cotter County
1 6 13 20
Grant Budget Request Budget
For Budget/Finance Use
BA#:
Agenda Item : Date: Type:
Agenda Item : Date: Type:
Prepared By : Dory Carrillo Date: 01/17/2018
Fund : 707 HUMAN SERVICES GRANT
Grant: 33541-01 OAA Cl 2018
Start: 01/01/2018
End: 12/31/2018
Sponsor: 613 Area Agency on Aging
Sponsored Program : 613 OAA Cl-UPDATED
Funded Program : 33541 OAA Cl 2018
Grant Percent: 90.00
Match Percent: 10.00
Revenue Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
331666 1110 CONG MEALS 2000 AAA OAA REV 155970 (3,352.00)
489200 CARRY FORWARD GEN CARRYFORWARD 155970 (372.44)
TOTAL REVENUE (3,724.44)
Expense Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
512100 REGULAR SALARIES AAA OAA EXP 155970 (600.00)
512600 ER 457 AAA OAA EXP 155970 (3,124.44)
TOTAL EXPENSE (3,724.44)
Total Sponsor Budget: (3,724.44)
Total Cost Sharing : 0.00
Total Project: (3,724.44)
Why are funds needed?
Funds are needed to provide services to qualified Collier County Citizens in compliance with grant responsibilities and regulations. Funds are also
needed to ensure compliance with the 10% matching requirements.
What is the source of funding?
Funds will be available from the Area Agency on Aging of Southwest Florida,Older Americans Act Grant contract OAA203.18. Match funds are
available in Human Services Grant Fund 707 reserves via carry forward.
Reviewed By :
Cost Center Director: Date:
Division Administrator: Date:
Budget Department: Date:
33541-01 Form Last Saved:01/17/2018 @ 16:34:48
Grant Budget Request Budget Page 2 of 2
Agency Manager: Date:
16020
33541-01 Form Last Saved:01/17/2018 @ 16:34:48
• Page 1 of 2
Cot tier County
16020
Grant Budget Request Budget
For Budget/Finance Use
BA#:
Agenda Item : Date: Type:
Agenda Item : Date: Type:
Prepared By : Dory Carrillo Date: 01/17/2018
Fund : 707 HUMAN SERVICES GRANT
Grant: 33543-01 OAA 3E 2018
Start: 01/01/2018
End : 12/31/2018
Sponsor: 612 Area Agency on Aging
Sponsored Program : 612 OAA 3E-UPDATED
Funded Program : 33543 OAA 3E 2018
Grant Percent: 90.00
Match Percent: 10.00
Revenue Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
331666 IIIC CONG MEALS 2000 AAA OAA REV 155970 (582.00)
489200 CARRY FORWARD GEN CARRYFORWARD 155970 (64.66)
TOTAL REVENUE (646.66)
Expense Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
512100 REGULAR SALARIES AAA OAA EXP 155970 (200.00)
(X 634104 PERS/RESPITE/HOMEMAK AAA OAA EXP 155970 (446.66)
TOTAL EXPENSE (646.66)
Total Sponsor Budget: (646.66)
Total Cost Sharing : 0.00
Total Project: (646.66)
Why are funds needed?
Funds are needed to provide services to qualified Collier County Citizens in compliance with grant responsibilities and regulations. Funds are also
needed to ensure compliance with the 10% matching requirements.
What is the source of funding?
Funds will be available from the Area Agency on Aging of Southwest Florida,Older Americans Act Grant contract OAA203.18. Match funds are
available in Human Services Grant Fund 707 reserves via carry forward.
Reviewed By :
Cost Center Director: Date:
Division Administrator: Date:
Budget Department: Date :
33543-01 Form Last Saved:01/17/2018 @ 16:44 23
Grant Budget Request Budget Page 2 of 2
Agency Manager: Date:
1 6 0 20
33543-01 Form Last Saved:01/17/2018 @ 16:44:23
Page 1 of 1
Coiner County
Grant Budget Request Budget
1 61320
For Budget/Finance Use
BA# :
Agenda Item : Date: Type:
Agenda Item : Date : Type:
Prepared By : Dory Carrillo Date: 01/17/2018
Fund : 707 HUMAN SERVICES GRANT
Grant: 33544-01 NSIP 2018
Start: 01/01/2018
End : 12/31/2018
Sponsor: 23 AREA AGENCY ON AGING-ELDER AFFAIRS
Sponsored Program : NSIP PROGRAM
Funded Program : 33544 NSIP 2018
Grant Percent: 100.00
Match Percent: 0.00
Revenue Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
C 331666 IIIC CONG MEALS 2000 OAA GRANT REVENUE 155970 0.28
TOTAL REVENUE 0.28
Expense Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
652210 FOOD OPERATING SUP SPENDING AUTHORITY 155970 0.28
TOTAL EXPENSE 0.28
Total Sponsor Budget: 0.28
Total Cost Sharing : 0.00
Total Project: 0.28
Why are funds needed?
Funds are to support and enhance the Collier County Nutrition program serving Collier County meals clients.
What is the source of funding?
Funds will be available from the Area Agency on Aging of Southwest Florida,Older Americans Act Grant contract OAA203.18.
Reviewed By :
Cost Center Director: Date:
Division Administrator: Date:
Budget Department: Date:
Agency Manager: Date:
33544-01 Form Last Saved:01/17/2018 @ 16.48:46
Page 1 of 2
Cotler County
1 6 0 20
Grant Budget Request Budget
For Budget/Finance Use
BA#:
Agenda Item : Date: Type:
Agenda Item : Date: Type:
Prepared By : Dory Carrillo Date: 01/17/2018
Fund : 707 HUMAN SERVICES GRANT
Grant: 33545-01 OAA 3B 2018
Start: 01/01/2018
End : 12/31/2018
Sponsor: 615 Area Agency on Aging
Sponsored Program : 615 OAA 3B-UPDATED
Funded Program : 33545 OAA 3B 2018
Grant Percent: 90.00
Match Percent: 10.00
Revenue Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
331666 IIIC CONG MEALS 2000 AAA OAA REV 155970 (4,908.00)
489200 CARRY FORWARD GEN CARRYFORWARD 155970 (545.33)
TOTAL REVENUE (5,453.33)
Expense Budget
Commit Commit.Description Sponsored Class Grant F.Ctr Grant Amt
512100 REGULAR SALARIES AAA OAA EXP 155970 (1,000.00)
X 634104 PERS/RESPITE/HOMEMAK AAA OAA EXP 155970 (4,453.33)
TOTAL EXPENSE (5,453.33)
Total Sponsor Budget: (5,453.33)
Total Cost Sharing : 0.00
Total Project: (5,453.33)
Why are funds needed?
Funds are needed to provide services to qualified Collier County Citizens in compliance with grant responsibilities and regulations. Funds are also
needed to ensure compliance with the 10%matching requirements.
What is the source of funding?
Funds will be available from the Area Agency on Aging of Southwest Florida,Older Americans Act Grant contract OAA203.18. Match funds are
available in Human Services Grant Fund 707 reserves via carry forward.
Reviewed By :
Cost Center Director: Date:
Division Administrator: Date:
33545-01 Form Last Saved:01/17/2018 @ 16:25:23 0
Grant Budget Request Budget Page 2 of 2
Budget Department: Date:
Agency Manager: Date: 6 d 12
ii
33545-01 Form Last Saved:01/17/2018 @ 16:25:23