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Agenda 09/25/2012 Item #16D3 9/25/2012 Item 16.D.3. EXECUTIVE SUMMARY Recommendation to accept a Library Services and Technology Act(LSTA) Grant in the amount of $27,154; with a required match of $15,173, approve three (3) Access Florida Community Partnership Network Agreements, the E-Government Service Assistance Policy, and authorize the necessary budget amendments. OBJECTIVE: To partner with Southwest Florida Works and the Florida Department of Children and Families to teach computer skills to individuals who have little to no experience with electronic resources. CONSIDERATIONS: The Board of County Commissioners approved submission of this LSTA grant application at the February 28, 2012 Board meeting (Item 16.D.8). After an extensive review process by the State Library of Florida, the grant was approved for full funding. With this grant,the Library proposes to add services to provide training for job seekers to enhance their ability to obtain employment. The funds will be used to purchase computer equipment and supplies, and to contract with trainers to provide the computer and job skills training for the program. The grant funds will be available October 1, 2012 and must be expended by September 30,2013. Access Florida facilitates a program for the Library to offer internet services and assistance to the public for the purpose of obtaining information on and applying for government assistance. As part of grant acceptance, execution of Access Florida Partnership Agreements with the Immokalee, East Naples, and Estates Branch Libraries is necessary to provide access points to these services. The E-Government Policy Services Assistance Policy was drafted in order for the Library to effectively • provide Federal, State, and local government services, via electronic means, while limiting the Library's liability for providing these services to the public. FISCAL IMPACT: Funding is provided by the Federal LSTA, passed through the Florida Department of State, Division of Library and Information Services. The LSTA grant program requires a 33% match. The Friends of the Library has committed to provide $3,800 of the required $15,173 match amount. The balance is available with the Libraries annual operating budget. Budget amendments are required in FY13 to recognize grant revenue in the amount of $27,154 within Public Services Grant Fund 709, Project 33232 and a local match requirement of$15,173 to Public Services Match Fund (710), Project 33232 which consists of recognizing revenue from the Friends of the Library in the amount of$3,800 and a transfer from Library cost centers within the General Fund 001 in the amount of$11,373. LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney's Office,is legally sufficient,and requires a majority vote for approval. - ERP GROWTH MANAGEMENT IMPACT:None. RECOMMENDATION: To approve and authorize the Chairman to sign the LSTA Grant Agreement and three (3) Community Partnership Network Agreements between Access Florida and the East Naples Branch, the Immokalee Branch, and Estates Branch Libraries, approve the `E-Government Policy' for Collier County Public Library, and authorize the necessary budget amendments. Prepared By: Marilyn Matthes Attachments: Grant Agreement,Budget Amendment;Access Florida partnership agreement;E-Government Policy Packet Page-2479- 9/25/2012 Item 16.D.3. COLLIER COUNTY Board of County Commissioners Item Number: 16.D.3. Item Summary: Recommendation to accept Library Services and Technology Act (LSTA) Grant "Collier Connects" funds in the amount of$27,154; a partial match contribution from Friends of the Library in the amount of$3,800; approve balance of local match from the Libraries General Fund (001) in the amount of$11,373, approve E-Government Policy and Library partnership with Access Florida. Meeting Date: 9/25/2012 Prepared By Name: MatthesMarilyn Title: Director-Library,Library 7/31/2012 2:00:25 PM Submitted by Title: Director-Library,Library Name: MatthesMarilyn 7/31/2012 2:00:27 PM Approved By Name: AlonsoHailey Title: Operations Analyst,Public Service Division Date: 9/12/2012 1:03:11 PM Name: AckermanMaria Title: Senior Accountant, Grants Date: 9/12/2012 2:57:38 PM Name: CarnellSteve Title: Director-Purchasing/General Services,Purchasing Date: 9/13/2012 2:49:32 PM Name: GreeneColleen Title: Assistant County Attorney,County Attorney Packet Page-2480- 9/25/2012 Item 16.D.3. Date: 9/14/2012 8:13:31 AM Name: KlatzkowJeff Title: County Attorney Date: 9/14/2012 10:19:09 AM Name: PryorCheryl Title: Management/Budget Analyst, Senior,Office of Management&Budget Date: 9/17/2012 11:03:42 AM Name: StanleyTherese Title: Management/Budget Analyst, Senior,Office of Management& Budget Date: 9/17/2012 3:05:04 PM Name: KlatzkowJeff Title: County Attorney Date: 9/18/2012 9:15:30 AM Name: OchsLeo Title: County Manager Date: 9/18/2012 10:45:15 AM itettw Packet Page-2481- • 9/25/2012 Item 16.D.3. PROJECT NUMBER 12-LSTA-D-01 Florida Department of State,Division of Library and Information Services LIBRARY SERVICES AND TECHNOLOGY ACT GRANT AGREEMENT x AGREEMENT executed and entered into BETWEEN the State of Florida,Department of State,Division of Library and Information Services,hereinafter referred to as the DIVISION, and the SUBGRANTEE: Collier County Board of County Commissioners for and on behalf of Collier County Public Library the PROJECT: Collier Connects • the GRANT AMOUNT: Twenty-seven thousand one hundred fifty-four dollars ($27,154) released in four equal advance payments.as,determined by the Division. The funds must be expended on or before September 30,2013. Unless there is a change of address,any notice required by this agreement shall be delivered to the Division of Library and Information Services,500 South Bronough Street,Tallahassee,Florida 32399-0250,for the State, and to the Collier County Public Library,2385 Orange Blossom Drive, Naples,FL, 34109-8840,for the SUBGRANTEE. In the event of a change of address it is the obligation of the moving party'to notify the other party in writing of the change of address. The DIVISION, as administrator of federal funds authorized under Section 257.12,Florida Statutes, wishes to provide a grant of federal funds. Federal funds are provided through the Library Services and Technology Act under Florida's long range plan approved by the Institute of Museum and Library Service's. The SUBGRANTEE agrees to meet all state requirements and requirements of the Library Services and Technology Act,hereinafter referred to as LSTA. The SUBGRANTEE has made application and has met all eligibility requirements for receipt of a Library Services and Technology Act Grant. By reference,the application and any approved revisions'are hereby made a part of this agreement. The parties agree as follows: I. The SUBGRANTEE agrees to: a. Administer all funds granted to it by the DIVISION to carry out the project as described in the project proposal and revisions submitted to and approved by the DIVISION. b. Provide the DIVISION with statistical,narrative,.fmancial and other evaluative reports as requested. • • Page 1 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B 2.011(2)(d),Florida Administrative Code Packet Page -2482- 9/25/2012 Item 16.D.3. Ask c. Retain and make available to the DIVISION,upon request, all financial and programmatic records, supporting documents, statistical records, and other records for the project. d. Retain all records for a period of five years from the date of submission of the final project report. If any litigation, claim,negotiation, audit or other action involving the records has been started before the expiration of the five year period,the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five year period,whichever is later. e. Establish and maintain a proper accounting system in accordance with generally accepted accounting procedures. To use and maintain adequate fiscal authority, control, and accounting procedures that will ensure proper disbursement of, and accounting for, federal project funds. f. Perform all acts in connection with this agreement in strict conformity with all applicable State and Federal laws and regulations. g. Pay out.all project funds on or before the project ending date. h. Expend all grant funds received under this Agreement solely for the purposes of the project. To repay to the DIVISION any and all funds not expended for the purposes of the project. i. Not use any grant funds for lobbying the legislature,the judicial branch, or any state agency. Ask j. Invest temporarily surplus funds and return the interest earned on such investments to the State quarterly. k. Maintain bills for services or expenses in detail sufficient for proper preaudit and postaudit. 1. Maintain any travel expenses in accordance to the provisions of Section 112.061,Florida Statutes. m. That to the best of the SUBGRANTEE'S'lcnowledge and belief that the SUBGRANTEE, and its principals: 1. Are not presently excluded or disqualified(debarment, suspension and other responsibility matters); 2. Have not been convicted within the preceding three years of any of the offenses listed in 45 CFR 1185.800(a) or had a civil judgment rendered against the applicant or its principals for one of those offenses within that time period; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(Federal, State, or local)with commission of any of the offenses listed in 45 CFR 1185.800(a); and 4. Have not had one or more public transactions (Federal, State,°or local)terminated within the preceding three years for cause or default. • Page 2 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 18-2.011(2)(d),Florida Administrative Code Packet Page-2483- 1 "d O IQ U1G cw w >. C o hw y u 5.. C 'd w y co. b 't o n y gm 1-1-i cD c ° L �° O p C ( 0 O G q •14 ' '. • o G O a CD w 0 ?a 2 o u ° Q. r . r vD D CD � m C/2 w r. 0 pD 0cD .CD D O N c �' c ° o o A b ° , y o - p CO v a. 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As required by the Civil Rights Act of 1964,the Rehabilitation Act of 1973,the Education Amendments of 1972, and the Age Discrimination in Employment Act of 1975, as implemented at 45 CFR Part 1180.44,the SUBGRANTEE certifies that the SUBGRANTEE will comply with the following nondiscrimination statutes and their implementing regulations: 1. Title VI of the Civil Rights Act of 1964, as amended(42 USC § 2000 et seq.),which provides that no person in the United States shall, on the grounds of face, color,or national origin, be excluded from participation in, be denied the benefits of, or otherwise be subject to discrimination under'any program or activity receiving Federal financial assistance; 2. Section 504 of the Rehabilitation Act of 1973, as amended(29 USC § 701 et seq.), which prohibits discrimination on the basis of disability in Federally-assisted programs; 3. Title IX of the Education Amendments of 1972, as amended(20 USC §§ 1681-83, 1685-86),which prohibits discrimination on the basis of sex in education programs and activities receiving Federal financial assistance; 4. The Age Discrimination in Employment Act of 1975, as amended(42 USC § 6101 et seq.),which prohibits discrimination on the basis of age in Federally-assisted programs; The SUBGRANTEE shall insert similar provisions listed in Part r in all subcontracts for services required by this agreement. Aiook S. In the event that the SUBGRANTEE expends$500,000 or more in Federal awards in its NINO fiscal year,the SUBGRANTEE must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. In determining the Federal awards expended in its fiscal year, the SUBGRANTEE shall consider all sources of Federal awards, including Federal resources received from the Department of State. • The determination of amounts of Federal awards expended should be in accordance with the guidelines established by OMB Circular A-I33, as revised. An audit of the SUBGRANTEE conducted by the Auditor General in accordance with the provisions OMB Circular A-133, as revised,will meet the requirements of this part. In.connection with the audit requirements addressed in Part s.,paragraph 1,the SUBGRANTEE shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised. If the SUBGRANTEE expends less than$500,000 in Federal awards in its fiscal year, an audit conducted in accordance with the provisions of OMB Circular A-133, as revised,is not required. In the event that the SUBGRANTEE expends less than$500,000 in Federal awards in its fiscal year and elects to have an audit conducted in accordance with the • provisions of OMB Circular A-133, as revised,the cost of the audit must be paid from non-Federal resources (i.e.,the cost of such an audit must be paid from SUBGRANTEE resources obtained from other than Federal entities). Page 4 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code Packet Page-2485- 9/25/2012 Item 16.D.3. Copies of reporting packages for audits conducted in accordance with OMB Circular A- 133,as revised, and required by this agreement shall be submitted,when required by Section.320(d), OMB Circular A-133, as revised,by or on behalf of the SUBGRANTEE directly to each of the following: 1. The Department of State at the following address: Office of Inspector General Florida Department of State R.A. Gray Building,Room 114A 500 S. Bronough Street Tallahassee, Florida 32399-0250 2. The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised(the number of copies required by Sections 320 (d)(1) and(2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the following address: Federal Audit Clearinghouse Bureau of the Census 1201 East 10th Street Jeffersonville, IN 47132 3. Other Federal agencies and pass-through entities in accordance with Sections 320 (e) and(1), OMB Circular A-133, as revised. II. The DIVISION agrees to: a. Provide a grant in accordance with the terms of this agreement in the amount and frequency as stated above in consideration for the SUBGRANTEE's performance hereinunder,and contingent upon funding by the Institute of Museum and Library Services. The State of Florida's performance and obligation to pay under this agreement is contingent upon an annual appropriation by the Legislature. In the event that the state or federal funds on which this agreement is dependent are withdrawn,this agreement is terminated and the state has no further liability to the SUBGRANTEE beyond that already incurred by the termination date. In the event of a state revenue shortfall,the total grant may be reduced accordingly. b. Provide professional advice and assistance to the SUBGRANTEE as needed,in implementing and evaluating the project. c. Review the project during the grant period to ensure that adequate progress is being made toward achieving the project objectives. III. The SUBGRANTEE and the DIVISION mutually agree that: a. This instrument embodies the entire agreement of the parties. There are no provisions, • • terms;conditions, or obligations other than those contained herein;and this agreement shall supersede all previous communications,representations, or agreements, either verbal or written,between the parties. No amendment shall be effective unless reduced in writing and signed by the parties. • Page 5 of 8.. LSTA Grant Agreement,Effective 4/102012 Chapter 1B-2.0]1(2)(d),'Florida Administrative Code Packet Page-2486- 9/25/2012 Item 16.D.3. Apek b. This agreement is executed and entered into in the State of Florida, and shall be construed,performed, and enforced in all respects in accordance with the laws and rules of the State of Florida. Each party.shall perform its obligations hereunder in accordance with the terms and conditions of this agreement. If any matter arising out of this Agreement becomes the subject of litigation,venue shall be in Leon County. c. If any term or provision of the agreement is found to be illegal and unenforceable,the remainder of the agreement shall remain in full force and effect and such term or provision shall be deemed stricken. d. No delay or omission to exercise any right,power or remedy accruing to either party upon breach or default by either party under this Agreement shall impair any such right, power or remedy of either party;nor shall such delay or omission be construed as a waiver of any such breach or default, or any similar breach or default. • e. This agreement shall be terminated by the DIVISION because of failure of the SUBGRANTEE to fulfill its obligations under the agreement in a timely and satisfactory manner unless the SUBGRANTEE demonstrates good cause as to why it cannot fulfill its obligations. Satisfaction of obligations by the SUBGRANTEE shall be determined by the DIVISION based on the terms and conditions imposed on the SUBGRANTEE in this agreement and compliance with the program guidelines. The DIVISION shall provide SUBGRANTEE a written notice of default letter. SUBGRANTEE shall have 15 calendar days to cure the default. If the default is not cured by the SUBGRANTEE within the stated period,the DIVISION shall terminate this agreement,unless the SUBGRANTEE demonstrates good cause as to why it cannot cure the default within the prescribed time period. For purposes of this agreement, "good cause"is defined as circumstances beyond the SUBGR.ANTEE's control. In the event of termination of this agreement,the SUBGRANTEE will be compensated for any work satisfactorily completed prior to the notification of termination,if equitable. f. The DIVISION shall unilaterally cancel this agreement in the event that the SUBGRANTEE refuses to allow public access to all documents or other materials made or received in regard to this agreement that are subject to the provisions of Chapter 119, Florida Statutes. SUBGRANTEE agrees to immediately contact the DIVISION for assistance in the event that it receives a public records request related to this agreement or the grant that it awards. g. The DIVISION shall not be liable to pay attorney fees,interest,late charges and service fees, or cost of collection related to the grant. h. The DIVISION shall not assume any liability for the acts,omissions to act or negligence of the SUBGRANTEE,its agents, servants or employees; nor shall the SUBGRANTEE exclude liability for its own acts, omissions to act or negligence to the DIVISION. In addition,the SUBGRANTEE hereby agrees to be responsible for any injury or property damage resulting from any activities conducted by the SUBGRANTEE. Page 6 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code Packet Page -2487- 9/25/2012 Item 16.D.3. i. The SUBGRANTEE, other than a SUBGRANTEE which is the State or agency or subdivision of the State, agrees to indemnify and•hold the DIVISION harmless from and against any and all claims or demands for damages of any nature,including but not limited to personal injury, death, or damage to property, arising out of any activities performed under this agreement and shall investigate all claims at its own expense. The SUBGRANTEE shall be responsible for all work performed and all expenses incurred in connection with the Project. The SUBGRANTEE may subcontract as necessary to perform the services set forth in this agreement,including entering into subcontracts with vendors for services and commodities,PROVIDED THAT such subcontract has been approved by the DIVISION prior to its execution, and PROVIDED THAT it is understood by the SUBGRANTEE that the DIVISION shall not be liable to the subcontractor for any expenses or liabilities incurred under the subcontract and that the SUBGRANTEE shall be solely liable to the subcontractor for all expenses and liabilities incurred under the "subcontract. The SUBGRANTEE shall include the copyright provision in paragraph(o.) of this agreement in all of its subcontracts. k. Neither the State nor any agency or subdivision of the State waives any defense of sovereign immunity, or increases the limits of its liability,by entering into this contractual relationship. 1. The SUBGRANTEE, its officers, agents, and,employees, in performance of this agreement, shall act in the capacity of an independent contractor and not as an officer, employee or agent of the DIVISION. Under this agreement, SUBGRANTEE is not entitled to accrue any benefits of state employment,including retirement benefits,and any other rights or privileges connected with employment in the State Career.Service. - SUBGR.ANTEE agrees to take such steps as may be necessary to ensure that each subcontractor of the SUBGRANTEE will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant,joint venturer, or partner of the DIVISION. m. The SUBGRANTEE shall not assign, sublicense or otherwise transfer its rights, duties,or obligations under this agreement without prior written consent of the DIVISION,which consent shall not be unreasonably withheld. The agreement transferee must demonstrate compliance with the requirements of the program. If the Department approves a transfer of the SUBGRA:NTEE's obligations,the SUBGRANTEE remains responsible for all work performed and all expenses incurred in connection with the agreement. In the event the Legislature transfers the rights, duties, and obligations of the DIVISION to another government entity,pursuant to section 20.06,Florida Statutes, or otherwise,the rights, duties, and obligations under this agreement shall also be transferred to the successor government entity as if it were an original party to this agreement. n. This agreement shall bind the successors, assigns and legal representatives of the SUBGRANTEE and of any legal entity that succeeds to the obligations of the DIVISION. • Page 7 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code Packet Page-2488- 9/25/2012 Item 16.D.3. o. When publications,films, or similar materials are developed, directly or indirectly from a program,project, or activity supported with grant funds, SUBGRANTEE (and any of its subcontractors,if applicable) shall grant the Department of State an irrevocable,royalty- free,non-transferable;non-exclusive right and license to reproduce or otherwise use,to make derivative works from, and to display and distribute any copyrighted material developed under this Agreement for any state governmental purpose. The SUBGRANTEE also grants the federal awarding agency a royalty-free, nonexclusive, and irrevocable license to reproduce,publish or otherwise use, and to authorize others to use,for federal government purposes: (a) The copyright in any work developed under a grant, subgrant, or contract under a grant or subgrant; and(b) any rights of copyright to which the grantee, subgrantee, or a contractor purchases ownership with grant support. The SUBGRANTEE shall include the foregoing paragraph in all of its subcontracts. p° No costs incurred before the date of this agreement shall be eligible as project • expenditures. No costs incurred after the completion date or other termination of the Agreement shall be eligible as project expenditures unless specifically authorized by the DIVISION. q. If the SUBGRANTEE is in noncompliance with any term(s) of this grant agreement or any other grant agreement with the Division of Library and Information Services,the • Division of Historical Resources or the Division of Cultural Affairs,the Division may withhold grant payments until the SUBGRANTEE comes into compliance. Violation of a grant program requirement, including but not limited to failure to submit grant reports and other grant documents; submission of incomplete grant reports or other grant documents; or violation of other grant agreement requirements; shall constitute a basis for the Division to place the SUBGRANTEE in noncompliance status with the Department of State. IV. The term of this agreement will commence on the date of execution of the agreement. THE SUB GRANTEE THE DIVISION BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY,FLORIDA By: Judith A.Ring,Director Fred Coyle,Chairman Division of Library and Information Services Department of State, State of Florida ATTEST: DWIGHT E.BROCK,Clerk • By: _ Deputy Clerk Witness Approved as to form and legal sufficien Assistant County Attorney — Witness Witness Page 8 of 8 Witness Packet Page-2489- 9/25/2012 Item 16.D.3. E-Government Service Assistance Policy August 15, 2012 In order to fulfill its Service Response of assisting people to `understand how to find, evaluate, and use information', Collier County Public Library(CCPL) establishes this `E-Government Service Assistance Policy'. Definition and Scope of Services: E-Government represents the delivery of services traditionally provided by the Federal Government,the State of Florida and local governments,via electronic means. Library staff can help with E-Government needs in many ways: • Using library computers; • Finding information about government programs and services,jobs, education, and other government transactions; • Locating websites with applications and forms; • Providing limited assistance in completing applications and forms; (Does not include data entry by Library Staff); • Obtaining free e-mail accounts; and • Printing copies of transactions. Privacy: CCPL computers used to obtain E-Government services will not retain records of any personal information,no"cookies"are kept,temporary and Internet files are removed, and the Internet cache is cleared at the end of each user's session. CCPL and the Library Staff will not collect any personal information. Patrons are advised to keep documents containing personal information secure and private. Patrons should be aware and careful when providing personal information using library computers, completely exiting websites and closing web browsers when finished. Patrons are urged to collect all of their documents from around the computer and printer. Limits and Disclaimer: CCPL Staff members are not permitted to give legal,financial or medical advice and/or interpretation, and are not caseworkers. Library Staff cannot advise patrons as to the identification of forms or actions needed to obtain government services. CCPL Staff can assist patrons in finding E-Government materials that pertain to a specific subject in order to enable patrons to make informed decisions. Library Staff cannot submit forms for patrons. CCPL is not responsible for the content found on other government agencies' websites,for any failure in transmission of online applications or forms to other government agencies,or for accurate submission of forms or information. CCPL takes measures to secure our network,but cannot guarantee against all security intrusions. CCPL cannot guarantee that other government agencies receive forms or information submitted from library computers or act on them appropriately.No agreement or contract is created between the patron and the Library Staff or the library system. Packet Page-2490- 11 _, ' 9/25/2012 Item 16.D.3. Prtc . ® ED .,,:_,,, i 1/4, 1ff, , , , . ,.Partner Name e✓L-Licyt coop-77 0-4 -$ Access Level Assisted Self Serve fi 2 G f i'X / Service Type 44 g. Address 1266 60L-0fl., G. Bz.✓-,0 Wes r" Customers Sery d Public Current Clients /14-7044E S EL_ 2 4/2.-0 Days of Operation /1/1 bg — TV/'S o Hours of Operation /a >S/9- gy County Phone Z�°l `E�� �� p AM ' G�� RP' Fa),2,23 Agency Email i. 9 'i i'' 174 ;; '', ': ' / Website A)• Cat..ut Gou•vir /. /6W Contacts: First name Last name Telephone Extension Email Address P,iv1P G/M-L/ « Z35—Zsz4sii z 4(gm-lex ca ecx-eigx- Lie-oft - ✓ s� M Services Offered: 121 Provide Information handouts ❑ Fi-E Copy Machine to copy application related document Provide Paper Applications as requested ® Ability to explain application process ❑ Provide access to telephone to call DCF Customer Call Center ❑ Assist customer with documentation and verification tii Computer to apply for assistance on-line ® Ability to assist customers with completing the Webapp ❑ Printer for ACCESS documents Ff ESI Assist customer with setting up My Access Accounts ❑ Fax machine to fax documents to DCF Administrative Information Faith Based Ye No Signs Yard/Window/Clings Agrees to Internet Listing • Yes/ o Agrees to Phone Listing - alp 0 F I o rid a Comments: iErtA4L GM'P41LIi7 ro-A, cLi0 di 2&c5 . Packet Page -2491- 9/25/2012 Item 16.D.3. ,:e:f cc Ess Florida cc,444fvf-- Gavi7 ACCESS Florida Community Partner Network Agreement Estates Branch Library. located at, 1266 Golden Gate Blvd W Naples Fl 34120, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS Florida services are Supplemental Nutrition Assistance Program(SNAP), Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current client population Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. IS Yes ❑ No This is requested of partners with access to My ACCESS Account-Partner View. Our telephone and fax number may also be included with this advertisement. CO Yes ❑ No Phone Number: 239- 4515- 8-081r Fax Number: Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is Choose one: Self-Service Site ❑Assisted Service Site* Service Type L I AAA 'cA *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at,Our Organization''sSite(s): (4, Provide informational handouts Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center-1-866-762-2237 Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF El Provide copy machine to copy application related documents X. Provide an explanation of the application process* ❑ Provide assistance to customers to complete/submit their application and/or provide requested information* Provide assistance to customers with "My ACCESS Account"* ❑ Provide case status information and outstanding information needed to determine eligibility.* `Automated Community Connection to Economic Self-Sufficiency Packet Page -2492- 1 9/25/2012 Item 16.D.3. ismok COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend,and hold harmless the Department and its officers, agents, and employees from all claims,suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable, subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1.above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community • Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA)policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.mvflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant,the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant, the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act AlitrA Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U.S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). • Packet Page -2493- 2 9/25/2012 Item 16.D.3. E. Brochures,ACCESS Materials and Signage Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and including civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE). This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly,that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system 3 Packet Page -2494- 9/25/2012 Item 16.D.3. • Partners are expected to monitor their employees to ensure all guidelines set forth in this agreement are followed. • Prior to viewing customer case file information, a Partner using this system Alak will obtain a standalone written consent or authorization from the applicant or recipient authorizing: Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. Als 4 Packet Page -2495- i I 9/25/2012 Item 16.D.3. DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2) Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or class room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), including timely notifying applicants of the eligibility decision,the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. $ Packet Page-2496- 9/25/2012 Item 16.D.3. MUTUAL AGREEMENT Start Date and End Date I J This agreement shall begin on III ► ) ►2 or on the date on which it is signed by the last party required to sign it, whichever is latest. 0 This agreement shall end at midnight, local time in , Florida,on © This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1)previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: C6 I I l er Cou 1 y E.stddt.s .�r�rcln 1_ J r x y 12 6' Go1JtoC)0,cf"e 810,�n/ f Ins FL 3L i '� 239 - 55-BogR 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 Ian connell@dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an"as needed"basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 Packet Page-2497- 9/25/2012 Item 16.D.3. SIGNATURES Signature of Community Agency Executive or Designee — Date Printed Name of the Executive or Designee Date • Signature of DCF Regional Director, Circuit Administrator or Date Designee • Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By: Fred Coyle, Chairman ATTEST: DWIGHT E. BROCK, Clerk By: Deputy Clerk Approved as to form and legal sufficiency: Assistant County Attorney Packet Page -2498- 9/25/2012 Item 16.D.3. Additional information needed Community Partner Contact Name: Contact Phone Number(and extension, if applicable): 237- Z Contact E-Mail Address: eecUU y p,c—(7 16.arz� Alternate Contact Name: KotcY-v.. )(a cse s Alternate Contact Phone(and extension, if applicable): 23q - (455-y'd Alternate Contact E-Mail Address: �LCacSeS( Cot )fir —L so, Fax Number: Website(if applicable): Liles-Tv Days of Week Open: ' Hours of Operation: i _ Amok 8 Packet Page -2499- I 9/25/2012 Item 16.D.3. 4c4.,,71. im ,p 4.1, irrit, 1 £ 1e I , .. _. 8[1.)1 b ,v A Partner Name CO lit i'e,rC"1M l Access Level Assisted Self Se ---E� 1. Noloitr 3 rvoN cn i.ilo -c y L.t! .r y Service Type Address g7S7 laveitei.,wl i -a.►\ E• Customers Sery d Public)/Current Clients OvItts AFL 3ti I i Days of Operation A/1^(1I County Phone 231-775-5592 Hours of Operation JO - Fax !�� Agency Email Website U UJW- Coki erletl.tive--t/1;b ri.ry Contacts: First name Last name Telephone Extension Email Address bt°UII5-4 Mth0,14.01(1 239-2_52.-7M d tc'i'nalnovt @calber-file 41 f o.11 � 1 E)-e. foof 239r-'L52-75-12 10 err f@colies-(1)o.ac• J Services Offered: IProvide Information handouts ❑ Copy Machine to copy application related document id Provide Paper Applications as requested RI Ability to explain application process ❑ Provide access to telephone to call DCF Customer Call Center ❑ Assist customer with documentation and verification Computer to apply for assistance on-line 'g Ability to assist customers with completing the Webapp ❑ Printer for ACCESS documents g Assist customer with setting up My Access Accounts ❑ Fax machine to fax documents to DCF Administrative Information Faith Based Yes/9 Signs Yard/Window Cling Agrees to Internet Listing Ye /No ; e nl CC ESS Agrees to Phone Listing (WNO Florida Comments: Packet Page-2500- 9/25/2012 Item 16.D.3.CCESS o: Florida COwog. couvey ACCESS Florida Community Partner Network Agreement East Naples Library.located at, 8787 Tamiami Trail E Naples Fl 34113, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS' Florida services are Supplemental Nutrition Assistance Program(SNAP),Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current client population Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. ) Yes ❑ No This is requested of partners with access to My ACCESS Account-Partner View. Our telephone and fax number may also be included with this advertisement. i,,Yes ❑ No Phone Number:2-33-715-55'32 Fax Number ll J', Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is: Choose one: b Self-Service Site ❑Assisted Service Site* Service Type 1-1 1 *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our Organization's Site(s): Si Provide informational handouts SI Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center-1-866-762-2237 12( Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents Provide an explanation of the application process* ❑ Provide assistance to customers to complete/submit their application and /or provide requested information* Provide assistance to customers with "My ACCESS Account"* ❑ Provide case status information and outstanding information needed to determine eligibility.* ' Automated Community Connection to Economic Self-Sufficiency Packet Page -2501- 1 9/25/2012 Item 16.D.3. COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all claims,suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable,subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1.above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA)policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at htto://www.myflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant,the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant,the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). E. Brochures,ACCESS Materials and Signage 2 Packet Page -2502- 9/25/2012 Item 16.D.3. Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and including civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE).This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark,the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly,that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. orsok • Follow Department policies regarding obtaining information not available on the Partner View system • Partners are expected to monitor their employees to ensure all guidelines set forth in this 3 Packet Page -2503- 9/25/2012 Item 16.D.3. agreement are followed. • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. 4 Packet Page -2504- 9/25/2012 Item 16.D.3. DEPARTMENT ASSURANCES Aokkt A. Training Department will offer training to Community Partner in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or class room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), including timely notifying applicants of the eligibility decision,the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. • 5 Packet Page -2505- i I 9/25/2012 Item 16.D.3. MUTUAL AGREEMENT Start Date and End Date ❑ This agreement shall begin on 11// ) '2- or on the date on which it is signed by the last party required to sign it, whichever is latest. ❑ This agreement shall end at midnight, local time in , Florida, on © This agreement will remain in effect unless terminated by either party with proper notice. Termination 1.This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1)previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local • Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: / /�/ CO t Y' 1 . 1 rS rr� LLb rosy 4 '7 ia.0 . ! e a_ s �( 34i I,LS 213 "715-'55/2 5,1 r,4Gltv.w'Jr�t:��`.ra�J1�� 10 AA 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan_connell@dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an"as needed"basis during Department's normal business hours and days of operation.All contact with Department by the Community Partner must be through Department's local contact person. 6 Packet Page -2506- 9/25/2012 Item 16.D.3. SIGNATURES Signature of Community Agency Executive or Designee Date Printed Name of the Executive or Designee Date • Signature of DCF Regional Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee • BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By. Fred Coyle,Chairman ATTEST: DWIGHT E. BROCK, Clerk By: Deputy Clerk Approved as to form and legal sufficiency: Assistant County Attorney • Packet Page-2507- 7 9/25/2012 Item 16.D.3. Additional information needed Community Partner Contact Name: Contact Phone Number(and extension, if applicable): 2,39- 252-7 5112- Contact E-Mail Address: c wt c.Inon( c-ott r-1il0 yr j Alternate Contact Name: 'C a Ji 'o.(%-bool- Alternate Contact Phone(and extension, if applicable): '139_1Sa 7 51{ . Alternate Contact E-Mail Address: p d e QisTOOrt®colhev-1)13.afFs Fax Number: 2,6fik7aRRY15§14i Website(if applicable): WWW.Gat 1I`p,V 90v.vitt Allow-7 Days of Week Open: M� Hours of Operation: I o- Co 8 Packet Page-2508- 9/25/2012 Item 16.D.3. 9 H e i @ I 1 , i • %� ,_ : a etc , o Partner Name Cal)itc Covniy Access Level Assisted/ elf Serve 1 Wiwi 0'I4-atPx Bf c_in1. 7b CNCY J1 L.���„rN, Service Type Address -I 17 1 57 c5-1., Customers Server Publi /Current Clients 1 \NW erig4 re , PZ- e31-1 I`I 2 _ Days of Operation M, i' 1 I-( �T tn/,r el-Lj County Phone 2 47-457 2-& Z Hours of Operation gee. GiocrTe- Fax 233-657- 1- 0 I Agency Email t Website uvwi v.Col I 1-rlw b. /j;lor.Yy Contacts: First name LLast {naame Telephone Extension Email Address 1 /A,A yo, Wtl'tia,V'i s 2,17-5173 q — 551 +Will:a1:WISBCdl'itneV Il�.o ( Si I v i o.. puenlit 131_457_23g2 z r Ueatht,aeoll r—ith,(11 J Services Offered: 91 Provide Information handouts ❑ Copy Machine to copy application related document XProvide Paper Applications as requested Ability to explain application process El Provide access to telephone to call DCF Customer Call Center ❑ Assist customer with documentation and verification Computer to apply for assistance on-line X Ability to assist customers with completing the Webapp ❑ Printer for ACCESS documents 154, Assist customer with setting up My Access Accounts ❑ Fax machine to fax documents to DCF Administrative Information Faith Based Yes e Signs Yard/Window/ ling Agrees to Internet Listing Ye /No Agrees to Phone Listing ()NO Florida Comments: Packet Page-2509- 9/25/2012 Item 16.D.3.CC Ess �o Florida eoctine. coup1/ ACCESS Florida Community Partner Network Agreement Immokalee Branch Library.located at,417 1St Street Immokalee Fl 34142, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS Florida services are Supplemental Nutrition Assistance Program(SNAP),Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current client population V Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. `Yes ❑ No This is requested of partners with access to My ACCESS Account—Partner View. Our telephone and fax number may also be included with this advertisement. g Yes ❑ No Phone Number:237-657-2. 8•2.. Fax Number::39-(057-L190 i Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of:ourorganization IS Choose one: Self-Service Site ❑Assisted Service Site* Service Type l"I brvs-ry *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our.Organization's'Site(s): X Provide informational handouts X Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center-1-866-762-2237 K Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents Provide an explanation of the application process* ❑ Provide assistance to customers to complete/submit their application and /or provide requested information* Provide assistance to customers with "My ACCESS Account"* 1\10 l'\o ❑ Provide case status information and outstanding information needed to determine eligibility.* Automated Community Connection to Economic Self-Sufficiency 1 Packet Page-2510- 9/25/2012 Item 16.D.3. COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all claims,suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect,or omission by Community Partner, its agents, employees, and if applicable,subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1.above,within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA)policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.mvflorida.com/accessflorida/. If this web page is not accessible to customers,the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant,the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant,the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). r`° E. Brochures, ACCESS Materials and Signage 2 Packet Page -2511- 9/25/2012 Item 16.D.3. Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and(3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally,the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and including civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE).This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark,the . name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State,or represent, directly or indirectly, that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system • Partners are expected to monitor their employees to ensure all guidelines set forth in this 3 Packet Page-2512- 9/25/2012 Item 16.D.3. agreement are followed. • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. tott •• 4 Packet Page -2513- 9/25/2012 Item 16.D.3. DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2) Civil Rights requirements; and(3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or class room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), including timely notifying applicants of the eligibility decision, the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. S Packet Page-2514- 9/25/2012 Item 16.D.3. MUTUAL AGREEMENT Start Date and End Date 0 This agreement shall begin on II / ) II. or on the date on which it is signed by the last party required to sign it, whichever is latest. ❑ This agreement shall end at midnight, local time in , Florida, on © This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1)previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. Aimek The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: Cot(-%8.c CuvVriy !M maktA I t2.2_ 111riA L,o(e,,(y 4.17 15-T I Yin I FL -VI(LIZ mac- co 57- .2 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan connell@dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an as needed" basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 Packet Page -2515- 9/25/2012 Item 16.D.3. SIGNATURES Signature of Community Agency Executive or Designee Date Printed Name of the Executive or Designee Date • Signature of DCF Regional Director, Circuit Administrator or Date Designee • Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By: Fred Coyle, Chairman ATTEST: DWIGHT E. BROCK, Clerk By: Deputy Clerk Approved as to form and legal sufficiency: Assistant County Attorney Packet Page -2516- 7 9/25/2012 Item 16.D.3. Additional information needed Community Partner Contact Name: —r-L �'�{ os,ms Contact Phone Number(and extension, if applicable): 2:39_ 593_35 1 Contact E-Mail Address: -}-W I Mica s c•.o)letc Alternate Contact Name: Alternate Contact Phone(and extension, if applicable): 9 _ ��7 ,2182 Alternate Contact E-Mail Address: 5 I 0 e© --Now0 Fax Number: 2-39- 457-9'fl I Website(if applicable): 9 /' lo'CAC Days of Week Open: M T.k j[-/o )T W)F 9_L1 Hours of Operation: ,KIM, Packet Page-2517-