Backup Documents 06/25/2013 Item #16D13 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO il 6 0 1 3
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU
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. < Il completed routing slips and original documents must be received in the Comity Attorney Office no later
than M1londay preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Barbetta Hutchinson HHVS .5Yf 6/26/13
2. Jennifer B. White, ACA Office located in HHVS -' ( to l)3
County Attorney Office Department
3. BCC Office Board of County
Commissioners ('//'- 4%.? 14:
4. Minutes and Records Clerk of Court's Office
^^ 4_ /t3 2'1.03
� ffr.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Lisa Can rC' - „"Vs" Phone Number 252-6141
Contact/ Department
Agenda Date Item was 6/25/13 Agenda Item Number 16D13
Approved by the BCC
Type of Document Amendments Number of Original 3
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial)
1. Does the document require the chairman's original signature? YES ✓
2. Does the document need to be sent to another agency for additional signatures? If yes, NO 1
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 NI 1-1A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the YES
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages ' dicating where the Chairman's YES V
ii
signature and initials are required. (&,.,1 Z p,
7. In most cases(some contracts are an exc Lion),the onginal document and this routing slip 0.
should be provided to the County Attorney Office at the time the item is input into SIRE. �,C?'
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 6/25/13 (enter date)and all changes Cd'}�
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
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
16013
MEMORANDUM
Date: July 5, 2013
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Contract Amendments with The Area Agency on Aging for
SWFL, Inc. d/b/a Senior Choices to amend contracted service
years in the FY12/13 Community Care for the Elderly, Home
Care for the Elderly and Alzheimer's Disease Initiative programs
Attached are three (3) original copies of each amendment document referenced above,
(Item #16D13) approved by the Board of County Commissioners June 25, 2013.
After the representative for Senior Choices has signed the documents, please return
an original copy of each to the Minutes & Records Department for the Board's
Official Record.
If you have any questions please call me at 252-8406.
Thank you
Attachments (9)
16D1
MEMORANDUM
Date: July 5, 2013
Lisa Carr, Grants Coordinator
Housing, Human &Veteran Services
- -\.y Fr i : Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Contract Amendments with The Area Agency on Aging for
SWFL, Inc. d /b /a Senior Choices to amend contracted service
years in the FY12 /13 Community Care for the Elderly, Home
Care for the Elderly and Alzheimer's Disease Initiative programs
Attached are three (3) original copies of each amendment document referenced above,
(Item #16DI3) approved by the Board of County Commissioners June 25, 2013.
After the representative for Senior Choices has signed the documents, please return
an original copy of each to the Minutes & Records Department for the Board's
Official Record.
If you have any questions please call me at 252 -8406.
Thank you
Attachments (9)
Amendment 004 CCE 203.12.004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,
INC. 16013
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior
Choices of Southwest Florida, hereinafter referred to as the "Agency," and Collier County Board of County
Commissioners, hereinafter referred to as the "Contractor," amends contract CCE 203.12.
The purpose of this amendment is to add an additional paragraph to Item #4. Contract Amount to read as follows:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $661,357.00 for year two, 2013 - 2014, or the rate schedule, subject to the availability of
funds. Any costs or services paid for under any other contract or from any other source are not eligible for
payment under this contract.
This amendment shall be effective June 6, 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, one page, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their officials there
unto duly authorized. /
Contractor:
SIGNED BY:
NAME: Georgia A. Hiller, Esc.
TITLE: Chairwoman
DATE: 06/25.13
Federal Tax ID: 59- 6000588
Board of County Area Agency on Aging for Southwest
Florida, Inc., dba Senior Choices of
5
Southwest Florida
SIGNED BY:
NAME: Ronald Lucchino, PhD
TITLE: Board President
DATE: 2J
App oved as to form and legality
,r
Fiscal Year Ending Date: 4,tOsJ . y 1
DWIGHT E • BROM. CLEW
�F � �auman 'S
re 0 nly.
s»
Assistant County At ey
Attestation Statement 16013
Agreement /Contract Number CCE 203.12
Amendment Number 004
1, Georgia A. Hiller. Eso. , 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.
ntractor representative
•— ®tip a, GUM
Attest as to
signature only.
Date
Approved as to form and legality
Assistant County Attey
Amendment 004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
HCE 203.12.004
16D13
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior
Choices of Southwest Florida, hereinafter referred to as the "Agency," and Collier County Board of County
Commissioners, hereinafter referred to as the "Contractor," amends contract HCE 203.12.
The purpose of this amendment is to add an additional paragraph to Item #4. Contract Amount to read as follows:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $61,709.00 for year two, 2013 - 2014, or the rate schedule, subject to the availability of
funds. Any costs or services paid for under any other contract or from any other source are not eligible for
payment under this contract.
This amendment shall be effective June 6, 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, one page, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their officials there
unto duly authorized.
&ollier unty Boa rd of County Area Agency on Aging for Southwest
nners Florida, Inc., dba. Senior Choices of
Contractor: Southwest Florida
SIGNED BY: SIGNED BY: " — � /,—J c` V--. ✓-
ci
NAME: Georgia A. Hiller, Esc.
TITLE: Chairwoman
DATE: 06/25/13
NAME: Ronald Lucchino, PhD
TITLE: Raqrd President
DATE:
Federal Tax ID: 59- 6000588
Fiscal Year Ending Dat (AT -T3~b. CLERK 1
4WIWT E. BROCK
as to Chairman's
:,nature only.
Approved as to form and
Assistant County Atto
16D13
Attestation Statement
Agreement /Contract Number HCE 203.12
Amendment Number 004
I, Georgia A. Hiller. Esg. , 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 datp-processing media, which has no affect on the agreement /contract content.
Signature o
representative
ATTEST:
?WIGHT' E. CLERK
Att est as�
signature only..
Date
Approved as to form and legal it,,
nty A ey
Assis t Cou
Amendment 003 ADI 203.12.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
16B13
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
ALZHEIMER'S DEISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida, Inc. dba Senior
Choices of Southwest Florida, hereinafter referred to as the "Agency," and Collier County Board of County
Commissioners, hereinafter referred to as the "Contractor," amends contract ADI 203.12.
The purpose of this amendment is to add an additional paragraph to Item #4. Contract Amount to read as follows:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $94,719.00 for year two, 2013 - 2014, or the rate schedule, subject to the availability of
funds. Any costs or services paid for under any other contract or from any other source are not eligible for
payment under this contract.
This amendment shall be effective June 6, 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, one page, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their officials there
unto duly authorized.
County Board of County
Contractor:
[.`Ilflhial7:�Vi
NAME: Georgia A. Hiller, Esc.
Area Agency on Aging for Southwest
Florida, Inc., dba Senior Choices of
Southwest Florida
SIGNED BY: W-%-r 6e)Ala �r
NAME: Ronald Lucchino, PhD
TITLE: Chairwoman TITLE: oard President 7
DATE: 06/25113 - _ DATE. ' 13
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 081ji. ST
DWIGHT E. BROCK, CLERK1
Chairman's-
re on',,
n y.
Approved as to form and legality
Assistant County t ey
Agreement /Contract Number
Amendment Number 003
Attestation Statement
16D13
I, Georgia A. Hiller. Eso. , 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 stat ent would be for changes in page formatting, due to the differences in
electronic data processing edia, which has no affect on the agreement/contract content.
Sign
representative
OW1 A. BROCK CLIkk
r
Attest as to Chairman's
s9nnnfiwe only.
K
Date
Approved as to form and legality
Ck
Assis ant County rney