Backup Documents 05/28/2013 Item #16D 7 Amendment 002 ADI 203.12.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. Li dba SENIOR CHOICES OF SOUTHWEST FLORIDA 16
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices
of Southwest Florida("Agency") and Collier County Board of County Commissioners, ("Recipient"), amends agreement
ADI 203.12.
The purpose of this amendment is to increase Collier County allocations by $11,685.00 and revise ATTACHMENT III
EXHIBIT—I and ATTACHMENT VIII,Budget Summary.
This amendment shall be effective on April 11, 2013. All provisions in the agreement and any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA, GfiVil SIGNED BY: �I�I �i� �
BY: �� �'� +`�
SIGNED BY.
NAME: Stephen Y. Carrell NAME: RONALD LUCCHINO, PhD
TITLE: Interim Public Services Administrator TITLE: BOARD PRESIDENT
DATE: April 18, 2013
DATE: (3
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
Ar$provad as to form & €egae t)V1 kw,:_:'
Azsi;tart County Atzo :rP
1 ��
Amendment 002 16 137 1203.12.002
ATTACHMENT III
EXHIBIT— 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheimer's Disease Initiative General Revenue/TSTF 65004 $106,404.00
TOTAL AWARD $106,404.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
2
Amendment 002 16 07 A141 203.12.002
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
for
Collier County Board of County Commissioners
1. Respite $105,098.00
2. Case Management and Case Aide Allocation 1,306.00
3. Total $106,404.00
RATE SUMMARY
for
Collier County Board of County Commissioners
SERVICES UNIT RATE
Case Management $55.56
Case Aide $30.00
In-Home Respite $24.44
Respite Facility $12.22
Specialized Medical Equipment,
Services and Supplies 100% Reimbursement
3 9
160. 7 1
Attestation Statement
Agreement/Contract Number ADI 203.12
Amendment Number 002
I, Stephen Y.Camel! ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida 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.
.0 `,' t 11171 4/18/13
Signature of Reci iet/Contr
/Contractor representative Date
Stephen Y.Carnell,Interim Administrator
Collier County Public Services Division
/44,i.,mvact as to form & €egal SLJ 1 cionoy.
As i .snt County a ttorney
9
Amendment 003 CCE 203.12.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
dba SENIOR CHOICES OF SOUTHWEST FLORIDA 16 D7 •
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices
of Southwest Florida ("Agency") and Collier County Board of County Commissioners, ("Recipient"), amends agreement
CCE 203.12.
The purpose of this amendment is to increase Collier County allocations by $48,000 and revise ATTACHMENT III
EXHIBIT–I and ATTACHMENT VIII,Budget Summary.
This amendment shall be effective on April 11, 2013. All provisions in the agreement and any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with 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 3 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY: AFt,,%.41 ` Y I' SIGNED BY: — o' ✓
NAME: Stephen Y. Carnell NAME: RONALD LUCCHINO, PhD
TITLE: Interim Public Services Administrator TITLE: BOARD PRESIDENT
DATE: April 18, 2013 �_ /3
DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
Appcoveci as to form & legal Sufficiency
^3'a ',1+ County Attorney
1
•
Amendment 003 16 07 'clCE 203.12.003
• ATTACHMENT III
EXHIBIT—1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Community Care for the Elderly Program General Revenue-Collier 65010 $ 709,357.00
TOTAL AWARD $ 709,357.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
2 �9
Amendment 003 CCE 203.12.003
ATTACHMENT VIII
•
1607
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
for
Collier County Board of Commissioners
Collier County
1. CCE Spending Authority $604,107.00
2. Case Management and 105,250.00
Case Aide
Total $709,357.00
RATE SUMMARY
for
Collier County Board of Commissioners
Collier County
Collier County Total Unit Cost Reimbursement Rate-90%
Case Management $55.56 $50.00
Case Aide $30.00 $27.00
Adult Day Care $12.22 $11.00
Chore $22.22 $20.00
Enhanced Chore $28.89 $26.00
Companion $22.22 $20.00
Skilled Nursing $40.00 $36.00
EARS $ 1.24 $ 1.12
Homemaking $21.11 $19.00
Personal Care $24.44 $22.00
Respite-In Home $24.44 $22.00
Respite Facility $12.22 $11.00
Respite Care—Facility Based(24 Hrs.) $150.00 $135.00
Specialized Medical Equipment,
Services&Supplies $Cost Reimbursement $90%Cost Reimbursement
Transportation $Cost Reimbursement $90%Cost Reimbursement
-
3 (',AO
1607 •
Attestation Statement
Agreement/Contract Number CCE 203.12
Amendment Number 003
I, Stephen Y.Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(Signature of Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
•
APO )
(.0 , 4/18/13
Signature of 'ecipient/Contractor representative Date
Stephen Y.Carnell,Interim Administrator
Collier County Public Services Division
4VIROVVid t%E$ Tc fcrrn eQaI SufftlitileY
r
s ."gtizita it 1:ounty Attorney
GP
Amendment 003 HCE 203.12.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. 16 D 7
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices
of Southwest Florida ("Agency") and Collier County Board of County Commissioners, ("Recipient"), amends agreement
HCE 203.12.
The purpose of this amendment is to decrease Collier County allocations by $14,270 and revise ATTACHMENT III
EXHIBIT—I and ATTACHMENT VIII,Budget Summary.
This amendment shall be effective on April 11, 2013. All provisions in the agreement and any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with 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 3 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
1
SIGNED BY: , (e �� `����I�' "1 SIGNED BY: C� -- f"
NAME: Stephen Y. Carnell NAME: RONALD LUCCHINO, PhD
TITLE: Interim Public Services Administrator TITLE: BOARD PRESIDENT
DATE: April 18, 2013
DATE: �' /3
Federal Tax ID: 59-60005 88
Fiscal Year Ending Date: 09/30
=trig is form 8E iea Suilbirity
[ �3€373'a Atri.fry pi
1 CA
Amendment 003 HCE 203.12.003
1607
ATTACHMENT III
EXHIBIT—I
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Home Care for the Elderly Program General Revenue 65001 $47,439.00
TOTAL AWARD $47,439.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
CP+
2
Amendment 003 HCE 203.12.003
ATTACHMENT VIII
1607
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of Commissioners
HCE Case Management $ 4,601.00
HCE Basic Subsidies 13-27-HCE Clients 23,410.00
HCE Special Subsidies 19,428.00
Total $47,439.00
HOME CARE FOR THE ELDERLY PROGRAM
RATE SUMMARY
Collier County
SERVICES REIMBURSEMENT RATE
Payments to the Lead Agency Collier
Case Management(CMV) $55.56
Case Aide(CAV) $30.00
Homemaker(HMKV) $21.11
Personal Care(PECV) $24.44
Respite (RESV) $24.44
Specialized Medical Equipment,
Services and Supplies(SCSV) Total Cost
Background Screening(OTHBKV) Total Cost
Payments to the Caregiver
Respite(RESP) Total Cost
Specialized Medical Equipment,
Services and Supplies(SCSM) Total Cost
Transportation(TRS) Total Cost
CA
3
•
16 !17
Attestation Statement
Agreement/Contract Number HCE 203.12
Amendment Number 003
I, Stephen Y.Camel! ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida 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.
01 0 11
Cele 4/18/13
Signature of Recipient/ ntractor representative Date
Stephen Y.Carnell,Interim Administrator
Collier County Public Services Division
kpet3v,e1 to to iorm & ie ii Sufficiency
ncy
A2A;&tent. County, Attorney
CA