Backup Documents 05/14/2013 Item #16D 9ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLtA D 9
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
* *NEW ** ROUTING SLIP
Complete routing lines #1 through #2 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
excention of the Chairman's signature. draw a line through routing lines #I through #2_ comnlete the checklist. and forward to the Countv Attornev Office.
Route to Addressee(s) (List in routing order)
Office
Initials
Date
1. Barbetta Hutchinson
HHVS
zV
5/16/13
2. Jennifer B. White, ACA
County Attorney Office
Office located in HHVS
Department
Agenda Item Number
16D9
3. BCC Office
Board of County
Commissioners
NO
4. Minutes and Records
Clerk of Court's Office
Number of Original
1 two page document
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees ahnve. may need to contact stafffnr additinnal or missing informatinn
Name of Primary Staff
Lisa Carr
Phone Number
252 -2339
Contact / Department
a pro riate.
(Initial)
Applicable)
Agenda Date Item was
5/14/13
Agenda Item Number
16D9
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
NO
Type of Document
Amendment
Number of Original
1 two page document
Attached
Original document has been signed/initialed for legal sufficiency. (All documents to be
Documents Attached
PO number or account
signed by the Chairman, with the exception of most letters, must be reviewed and signed
YES
number if document is
by the Office of the County Attorney.
to be recorded
All handwritten strike - through and revisions have been initialed by the County Attorney's
YES
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
a pro riate.
(Initial)
Applicable)
1.
Does the document require the chairman's original signature?
NO
2.
Does the document need to be sent to another agency for additional signatures? If yes,
NO
provide the Contact Information (Name; Agency; Address; Phone) on an attached sheet.
3.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
YES
by the Office of the County Attorney.
4.
All handwritten strike - through and revisions have been initialed by the County Attorney's
YES
Office and all other parties except the BCC Chairman and the Clerk to the Board
S.
The Chairman's signature line date has been entered as the date of BCC approval of the
N/A
document or the final negotiated contract date whichever is applicable.
6.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
N/A
signature and initials are required.
7.
In most cases (some contracts are an exception), the original document and this routing slip
YES
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8.
The document was approved by the BCC on 5/14/13 (enter date) and all changes
YES
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
9.
Initials of attorney verifying that the attached document is the version approved by the
YES
BCC, all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature.
-i
AMENDMENT 002 NSIP 203.13.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. 1609
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 change the effective date of Amendment 001 changing the 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 October 1, 2012.
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
COUNTY COMMISSIONERS
SIGNED BY:
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC. DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY:
NAME: Stephen Y. Carnell NAME: Ronald Lucchino, PhD
TITLE: Interim Public Services Administrator TITLE: Board President
DATE: (�t � ( G 113 DATE:
Federal Tax ID: 59- 6000558 Approved as to form & legal Sufficiency
Fiscal Year Ending Date: 9/30 ATTEST-
DWIGHT E. BROCK, Clerk
By: �. Assis nt County Attorney 4 \(0 �3
1609
Attestation Statement
Agreement /Contract Number NSIP 203.13.
Amendment Number 002
I, Steve Carnell , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of RecipientXontractor representative
Stephen Y. Carnell, Interim Administrator
Collier County Public Services Division
A f T -S T.
DWIGHT E. BROCK, Clerk
11
Date
Appmftd as to form & legal Sufficiency