Backup Documents 03/27/2018 Item #16D 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 D 7
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Michelle Rubbo CHS
2. Jennifer A. Belpedio County Attorney Office ck.(1j 3 J )I I
3. BCC Office Board of County A5
Commissioners }/� 3-a-4--c
4. Minutes and Records Clerk of Court's Office 3/01i.,1 at 10:3-lairt
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Lisa Oien Phone Number
Contact/ Department 252-6141 252-6141
Please call for pick up
Agenda Date Item was 03/27/2018 minute traq#5012 v/ Agenda Item mber
Approved by the BCC 16D'T- i/ lu
Type of Document Youth Haven Amendment (in triplicate)/ Number of Original 3 Amendment/
Attached Documents Attached documents
PO number or account
number if document is to be
recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column -- Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? 1.ED SIGNATURE IS o LO
2. Does the document need to be sent to another agency for additional signatures? If yes,
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. N/A
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed LO
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the �y
document or the final negotiated contract date whichever is applicable. J1L -Of-
/
.r1�k
%1 Center -�J�1
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's LO
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. N )
Some documents are time sensitive and require forwarding to Tallahassee within a certain ((
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 03/27/2018 and all changes N/A is nal
made during the meeting have been incorporated in the attached document. The 1: 1-a--16an option •
County Attorney's Office has reviewed the changes,if applicable. . this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made, and the document is ready for the cv an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1607
MEMORANDUM
Date: March 27, 2018
To: Lisa Oien, Grants Coordinator
Community & Human Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Amendment #2 to Agreement #B-15-UC-12-0016
w/Youth Haven, Inc.
Attached are two (2) originals of each document referenced above,
(Item #16D7) approved by the Board of County Commissioners on
Tuesday, March 27, 2018.
An original has been kept by the Minutes and Record's Department for the
Board's Official Record.
If you have any questions, please feel free to contact me at 252-8411.
Thank you
Attachment
16D7
FAIN# B-15-UC-12-0016
B-12-UC-12-0016
B-11-UC-12-0016
Federal Award 10/2011
Date(s) 10/2012
Est. 10/15
Federal Award HUD
Agency
CFDA Name CDBG
CFDA/CSFA# 14.218
Total Amount of FY 2011 $34,067
Federal Funds FY 2012 $61,087
Awarded FY 2015 $489,821
Subrecipient Youth Haven, Inc.
Name
R&D No
DUNS# 077283349
Indirect Cost No
Rate
FEIN# 23-7065187
Period of From execution of
Performance agreement to March 31,
2018 June 30, 2018
Fiscal Year End 06/30
Monitor End: 06/30/2023
SECOND AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
YOUTH HAVEN, INC.
SHELTER AND TRANSITIONAL LIVING HOME FOR COLLIER COUNTY YOUTH PROJECT
This Amendment is entered into this day of /Plitt h 2018, by and between Youth
Haven, Inc., a private not-for-profit corporation existing under the laws of the State of Florida, herein
after referred to as SUBRECIPIENT and Collier County, Florida, hereinafter to be referred to as
"COUNTY," collectively stated as the "Parties."
RECITALS
WHEREAS, on October 27, 2015, the COUNTY entered into an Agreement for awarding
Community Development Block Grant Program funds to be used for the Shelter and Transitional Living
Home for Collier County Youth Project (hereinafter referred to as the "Agreement"); and
Youth Haven, Inc.
CDBG CD15-04 IDIS#517—Second Amendment
Shelter and Transitional Living Home for
Collier County Youth Project Page 1 of 6
1607
WHEREAS, on June 28, 2016 the Parties amended the agreement to increase the amount of
project funds, include environmental mitigation activities, remove design activity, clarify project
management as an activity and adjust performance deliverables; and
WHEREAS,the parties desire to extend the period of performance.
Words Struckaugh are deleted;Words Underlined are added
NOW, THEREFORE, in consideration of the mutual benefits contained herein, it is agreed by the parties
as follows:
PART I
SCOPE OF WORK
* * *
1.3 PERIOD OF PERFORMANCE
Services of the Subrecipient shall start effective the date of the execution of this agreement and
shall end on March 31, 2018 June 30, 2018.
* * *
Exhibit"C" is amendment as follows:
EXHIBIT C
QUARTERLY PERFORMANCE REPORT DATA
GENERAL
Youth Haven, Inc.
CDBG CDl 5-04 IDIS#517—Second Amendment
Shelter and Transitional Living Home for
Collier County Youth Project Page 2 of 6
1bD7
Grantee is required to submit to HUD, through the Integrated Disbursement and Information System
("IDIS") Performance Reports. The County reports information on a quarterly basis. Tofacilitate in the
preparation of such reports, Subrecipient shall submit the information contained herein within ten (10)
days of the end of each calendar quarter.
QUARTERLY PROGRESS REPORT
Sub-recipients: Please fill in the following shaded areas of the report
Agency Name: Youth Haven, Inc. Date:
Project Title: Shelter and Transitional Living Home for Collier County Youth Project
Program Alternate
Contact: Joyce Zirkle Contact:
Telephone
Number: 239-687-5180
Activity Reporting Period Report Due Date
October 1st-December 31st January 10th
January 3151—March 3151 April 10th
April 1st—June 30th July loth
July 1st—September 30th October 10th
Please take note: Each quarterly report needs to include cumulative data beginning from the start of the agreement date.
Please list the outcome goal(s)from your approved application&sub-recipient agreement and indicate your progress in meeting those
goals since the beginning of the agreement.
A.Outcome Goals: list the outcome goal(s)from your approved application&sub-recipient agreement.
Outcome 1: Obtain Certificate of Occupancy for new homeless youth shelter
Outcome 2: Serve 100 homeless youth by March 31, 2018 June 30, 2018
B.Goal Progress: Indicate the progress to date in meeting each outcome goal.
Youth Haven, Inc.
CDBG CD 15-04 IDIS#517—Second Amendment
Shelter and Transitional Living Home for
Collier County Youth Project Page 3 of 6
1607
Outcome 1:
Outcome 2:
Is this project still in compliance with the original project schedule?if more than 2 moot
Is schedule,must submit a new timelin
2. for approval.
a 0
Yes No
If no,explain:
3. Since October 1,2015,of the persons assisted,howmany....
44.1
0
a. ...now have new access(continuing)to this service or benefit?
0
b. ...now has improved access to this service or benefit?
0
c. ...now receive a service or benefit that is no longer substandard?
TOTAL: 0
4. What funding sources are,applied for this period
I program year?
Other Consolidated Plan Funds CDBG
Other Federal Funds ESG
State/Local Funds HOME
Total
Entitlement
Total Other Funds $ 0.00 Funds $ 0.00
5. What is the'total number of UNDUPLICATED clients'served this quarter,if applicable?
Youth Haven, Inc.
CDBG CD15-04 IDIS//517—Second Amendment
Shelter and Transitional Living Home for
Collier County Youth Project Page 4 of 6
0
1607
a. Total No.of adult females served: 0 Total No.of females served under 18: 0
b. Total No.of adult males served: 0 Total No. of males served under 18: 0
TOTAL: 0 TOTAL: 0
c. Total No. of families served: Total No.of female head of household: 0
6. What is the total number of UNDUPLICATED clients served since**Bar;If'applicable?
a. Total No.of adult females served: 0 Total No. of females served under 18: 0
b. Total No. of adult males served: 0 Total No.of males served under 18: 0
TOTAL: 0 TOTAL: 0
c. Total No.of families served: 0 Total No. of female head of household: 0
Complete EITHER question#7 OR#8. Complete question#7 if your program only serves clients in one or more of the listed HUD Presumed Benefit
categories. Complete question#8 if any client in your program does not fall into a Presumed Benefit category.
DO NOT COMPLETE BOTH QUESTION 7 AND 8
7. PRESUMED BENEFICIARY'DATA: $. .:. OTHER BENEFICIARY DATA:INCOME RANGE
Indicate the total number of UNDUPLICATED persons served Indicate the total number of UNDUPLICATED persons served
since October 1 who fall into each presumed benefit category since October 1 who fall into each income category(the total
(the total should equal the total in question#6) should equal the total in question#6)
REPORT AS: REPORT AS:
0 Abused Children Homeless 0 Extremely low Income(0-30%)
0 Person Battered 0 Low Income(31-50%)
0 Battered Spouses 0 Moderate Income(51-80%)
0 Persons w/HIV/AIDS 0 Above Moderate Income(>80%)
0 Elderly Persons
0 Veterans
0 Chronically/Mentally III
0 Physically Disabled Adults
0 Other-Youth
TOTAL: D TOTAL: o
9. Racial&Ethnic Data: (if applicable)
Please indicate how many UNDUPLICATED clients served since October fall into each race category.In addition to each race category,please
indicate how many persons in each race category consider themselves Hispanic(Total Race column should equal the total cell).
RACE ETHNICITY
White 0 ;of whom,how many are Hispanic? 0
Black/African American 0 ;of whom,how many are Hispanic? 0
Asian 0 ;of whom,how many are Hispanic? 0
American Indian/Alaska Native 0 ;of whom,how many are Hispanic? 0
Native Hawaiian/Other Pacific Islander 0 ,of whom,how many are Hispanic? 0
American Indian/Alaskan Native&white 0 ;of whom,how many are Hispanic? 0
Black/African American&White 0 ;of whom,how many are Hispanic? 0
Am.Indian/Alaska Native&Black/African Am. 0 ;of whom,how many are Hispanic? 0
Other Multi-racial 0 ;of whom,how many are Hispanic? 0
TOTAL: 0 TOTAL:HISPANIC 0
Name: Signature:
Your Typed name here represents your electronic signature
Youth Haven, Inc.
CDBG CD15-04 IDIS#517—Second Amendment
Shelter and Transitional Living Home for
Collier County Youth Project Page 5 of 6
16D7
IN WITNESS WHEREOF, the SUBRECIPIENT and the County, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date first written above.
ATTEST: b,.; BOARD 0- COU COMM! - 1E;-: OF COLLIER
DWIGHT E. BROCK CLERK COUNT , FLO' 'aA
By:
elk .. �'
Andy Solis, CHAIRMAN
eSa,e`. .11 ' s
signature only. Date: /4 v Z 27, 20 if.
YOUTH HAVEN, INC.
By:
S ephan Spell, PRESI E T
YOUTH HAVEN INC.
Date: 3- 2/ -
Approved
/ -Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attorney
Youth Haven, Inc.
CDBG CDI5-04 IDIS#517—Second Amendment
Shelter and Transitional Living Home for
Collier County Youth Project Page 6 of 6
w