Backup Documents 01/22/2013 Item #16D3 w _
16133
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper.Attach to original document.Original documents should be hand delivered to the Board Office.The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines#1 through#4 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#4,complete the checklist,and forward to Sue Filson(line#5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Lisa N.Can,Grants Coordinator Housing,Human,Veterans Services LNC 1/23/13
Department
2. Jennifer B.White,ACA Office located within Housing,Human,
Veterans Services Department Q *2:3 I►3
3. County Attorney's Office County Attorney's Office 4. BCC Ofce Board of County Commissioners
(j11(//-
5. Minutes and Records Clerk of Court's Office 'fled
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval.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,including Sue Filson,need to contact staff for additional or missing
information.All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff Lisa N.Carr, rants Coordinator Phone Number 239-252-23 9
Contact
Agenda Date Item was 1/22/13 Agenda Item Number 16.D.3
Approved by the BCC
Type of Document Amendment between Area Agency on Number of Original 3 total originals
Attached Aging for SW FL,Inc d/b/a Senior Choices Documents Attached
of SWFL-amends contract NSIP 203.13
INSTRUCTIONS&CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(Initial) Applicable)
1. 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 by the Office of the
County Attorney.This includes signature pages from ordinances,resolutions,etc.signed by the LNC
County Attorney's Office and signature pages from contracts,agreements,etc.that have been fully
executed by all parties except the BCC Chairman and Clerk to the Board and possibly State
Officials.)
2. All handwritten strike-through and revisions have been initialed by the County Attorney's Office and n/a
all other parties except the BCC Chairman and the Clerk to the Board
3. The Chairman's signature line date has been entered as the date of BCC approval of the document or LNC
the final negotiated contract date whichever is applicable.
4. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature and LNC
initials are required.
5. In most cases(some contracts are an exception),the original document and this routing slip should be LNC
provided to Kristi Bartlett in the BCC office within 24 hours of BCC approval. Some documents are
time sensitive and require forwarding to Tallahassee within certain time frame or the BCC's actions
are nullified.Be aware of your deadlines!
6. The document was approved by the BCC on 1-22-13 nd all changes made during the meeting LNC
have been incorporated in the attached document.The County Attorney's Office has reviewed . ,�4 ti.
the changes,if applicable.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05
«matter_number»/«document number»
160 -3
MEMORANDUM
Date: January 28, 2013
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Amendment to NSIP 203.13.001
Nutrition Services Incentive Program
Attached are three (3) original copies of the agreement referenced above (Item #16D3)
approved by the Board of County Commissioners on Tuesday, January 22, 2013.
Please forward for additional signatures and return a fully executed original
back to the Minutes and Records Department to be kept as part of the
Board's Official Records.
If you have any questions, please call me at 252-8411.
Thank you
AMENDMENT 001 NSIP 203.13.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. 160 3
DBA SENIOR CHOICES OF SOUTHWEST FLORIDA
NUTRITION SERVICES INCENTIVE PROGRAM
This AMENDMENT,entered into by the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of
Southwest Florida("Agency")and Collier County Board of County Commissioners.("Contractor"),amends contract
NSIP 203.13.
The purpose of this amendment is to increase Attachment I unit rate from $.68 per meal to$.72 per meal in the following
contract section(s)(Paragraphs and Attachments):
ATTACHMENT I.STATEMENT OF WORK:
(1) Revise section 3.1.
Line denotes completion of above summary
ATTACHMENT I:,
(1) Section 3.1 is hereby revised to read.
This is a fixed rate contract. The Department shall make payment to the Contractor for provision of services up to a
maximum number of units of service and at the prospective rate stated below:
Service to be Provided Unit of Service Unit Rate
Eligible Congregate and
I unit= 1 meal $,72
Home Delivered Meals
This amendment shall be effective on the last date that the amendment has been signed by both Parties.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby
changed to conform to this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the Parties hereto have caused this 1 page amendment to be executed by their officials there
unto duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
CO Y OMMI IONERS FLORIDA, INC. DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY:
SIGNED BY:
NAME: Georgia A. Hiller, Esq NAME: Ronald Lucchino, PhD
TITLE: Chairwoman y
TITLE:', Board President
DATE: January 22, 2013 `- : DATE:
Federal Tax ID: 59-6000558 ATTEST , Applaved Fiscal Year Ending Date: 9/30 DWI C E. }mock, Clerk u form legal '�+�"7
160 3
Attestation Statement
Agreement/Contract Number 203.13
Amendment Number 001
I, Georgia A. Hiller. Esq-Chairwoman ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
Collier County Government
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
January 22,2013
Signature of Recipient/Contractor representative Date
:�7TEST - A.NICOVIKI as to form & legal sufficiency
DWI'_ T= BHEgCK, Clerk
>` �- A33;st nt County Attorney
i 4 Aai.thr e ' •
160 3 1
OFFICE OF THE COUNTYATTORNEY
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grant Coordinator, HHVS LP�t'
DATE: January 11, 2013
RE: January 22, 2013 Agenda Item 16. D.5. and 16.D. 3.
Please find attached three (2) separated documents that are fully executed and were approved by
the BCC on Dec for recording in Minutes and Records. Feel free to contact me if you have any
questions.
Thank you for your assistance.
AMENDMENT 001 NSIP 203.13.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. 160 4
DBA SENIOR CHOICES OF SOUTHWEST FLORIDA
NUTRITION SERVICES INCENTIVE PROGRAM
This AMENDMENT,entered into by the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of
Southwest Florida("Agency")and Collier County Board of County Commissioners.("Contractor"),amends contract
NSIP 203.13.
The purpose of this amendment is to increase Attachment I unit rate from $.68 per meal to $.72 per meal in the following
contract section(s)(Paragraphs and Attachments):
ATTACHMENT I.STATEMENT OF WORK:
(1) Revise section 3.1.
Line denotes completion of above summary
ATTACHMENT I:
(1) Section 3.1 is hereby revised to read.
This is a fixed rate contract. The Department shall make payment to the Contractor for provision of services up to a
maximum number of units of service and at the prospective rate stated below:
Service to be Provided Unit of Service Unit Rate
Eligible Congregate and 1 unit— 1 meal $.72
Home Delivered Meals
This amendment shall be effective on the last date that the amendment has been signed by both Parties.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby
changed to conform to this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the Parties hereto have caused this 1 page amendment to be executed by their officials there
unto duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
CO 4 Y OMMI .IONERS FLORIDA,INC.DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY: SIGNED BY: 4Z13%-- oIG"`°,�` 41Dr-
NAME: Georgia A. Hiller,Esq NAME: Ronald Lucchino,PhD UU
TITLE: Chairwoman Board President
DATE: January 22, 2013 DAI'h. .;`
Federal Tax ID: 59-6000558 ATTEST Approved is to form &1sgai ,Sump
Fiscal Year Ending Date: 9/30 DWI C E. BROCK, Clefk
+'i` Assistant County Attnrn.v
160 3 i
Attestation Statement
Agreement/Contract Number 203.13
Amendment Number 001
I. Georgia A.Hiller.Esq-Chairwoman ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
Collier County Government
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
r
January 22,2013
Signature of Recipient/Contractor representative Date
`CT ST &Waved as to Corm & legal Sufficiency
pyy T , CK, Clerk
t
Assist nt County attorney
A test 0 ttt. Pieria 4.
14.4A4tur e