Backup Documents 10/22/2013 Item #16D 9ORIGINAL DOCUMENTS CHECKLIST & ROUTIN S
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT
TQ
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 N'londay preceding the Board meeting.
* *NEW ** ROUTING SLIP
Complete routing lines #I through #2 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
--ti— ..f the (`ha:rman's a fi— draw a line thrnooh rnutina lines t11 thrnnah #1 emmnle.te. the checklist and forward to the Cnmty Attnmev Office.
Route to Addressees (List in routing order)
Office
Initials
Date
1. Ashley Royer
A . 6f-
HHVS
;M
10/23/13
2. Jenniferte, ACA
County Attorney Office
Office located in HHVS
Department
Agenda Item Number
16139
3. BCC Office
Board of County
Commissioners
No
a z,
4. Minutes and Records
Clerk of Court's Office
Number of Original
,O (25 ((-3
7
(0 =2gQM
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 cnntact staff fnr additinnal nr miseino information
Name of Primary Staff
Ashley Royer
Phone Number
252 -4230
Contact / Department
a ro riate.
(Initial)
A licable)
Agenda Date Item was
10/22/13
Agenda Item Number
16139
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
No
Type of Document
OAA Amendment 43 kpr tCQS
Number of Original
3 orig Is
Attached
S.0V^Wes-1:
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 ro riate.
(Initial)
A licable)
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
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
5.
The Chairman's signature line date has been entered as the date of BCC approval of the
Yes
document or the fmal negotiated contract date whichever is applicable.
6.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
Yes
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 10/22/13 all changes made during the
Yes
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 th$
Chairman's signature.
16D 91
MEMORANDUM
Date: October 29, 2013
To: Ashley Royer, RSVP Coordinator
Housing, Human & Veteran Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: OAA Amendment #3
OAA Program Title III - #203.13.003
Attached for your records three (3) originals of the document referenced above,
(Item #16D9) approved by the Board of County Commissioners on October 22, 2013.
Please forward a fully executed original to the Minutes & Records Department
for the Board's Official Record.
If you have any questions, please feel free to contact me at 252 -7240.
Thank you.
Amendment 003 OAA 203.13.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
dba SENIOR CHOICES OF SOUTHWEST FLORIDA 94
OLDER AMERICANS ACT PROGRAM TITLE III
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
OAA 203.13.
The purpose of this amendment is to add Respite Service to OA3E and revise ATTACHMENT VII Rate Summary.
This amendment shall be effective on July 22, 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 2 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLD COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY:
NAME: Georgia A. Hiller, Esq.
TITLE: Chairwoman
DATE: October 22, 2013
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 09/30
ATTEST`
DW HT E. iCKr Ci�li
Ely.
Attest as to Chairman'
signature only.
1
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC. DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY:
NAME: RONALD LUCCHINO, PhD
TITLE: BOARD PRESIDENT
DATE:
t
01
Amendment 003
OLDER AMERICANS ACT
RATE SUMMARY
160 203
1
ATTACHME T VII
Rate Summary
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
IIIB &IIIE
Services Total Cost
IIIB
Reimbursement Rate
Case Aide
$27.78
$25.00
Case Management
$50.00
$45.00
*Intake -EHEAP Only
$27.78
$25.00
Screening/Assessment
$50.00
$45.00
Transportation
100% Cost
90% of Cost
"Intake Units only used for EHEAP
$16.67
$15.00
Services Total Cost Reimbursement Rate
IIIE
Respite
$20.00
$18.00
Respite-Day Care
$11.12
$10.00
Direct Pay Respite
Must include match
Up to $21.00
Direct Pay Facility Respite
Must include match
24 hours -- $125.00
Day Care Sitter
$13.34
$12.00
I1IEG - Child Day Care
$16.67
$15.00
Screening/Assessment
$50.00
$45.00
Specialized Medical Equipment,
Service & Supplies
100% Cost
90% of Cost
Services
C1
C -1 & C -2
COLLIER COUNTY
Total Cost Reimbursement Rate
Congregate Meals
$ 9.84
$ 8.86
Nutrition Counseling
$58.89
$53.00
Nutrition Education
$ 1.80
$ 1.62
Nutrition Screening
$31.11
$28.00
Outreach
$4.80 per person
$4.32 per person
C2
Home Delivered Meals
$ 9.77
$ 8.79
Nutrition Counseling
$58.89
$53.00
Nutrition Education
$ 1.80
$ 1.62
Nutrition Screening
$50.00
$45.00
Outreach
$4.80 per person
$4.32 per person
2
0
16D 94
Attestation Statement
Agreement/Contract Number: OAA 203.13
Amendment Number: 003
I, Georgia A. Hiller. EsU. , 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 processirMmedia, w)ich has no afferct on the agreement /contract content.
Signature of Recipient /Contractor representative
ATTEST: 'K. 018fk
DWI HT E. B
Attest as to Chalrma s
October 22, 2013
Date
ApproVed as to form and legality
Asatstsnt Count torney 3 \ t 3
0
1609
HOUSING HUMAN AND VE TERIAN SERIVCES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Can, Grants Coordinator, HHVS
DATE: January 6, 2014
RE: Senior Choices Amendments
Please find attached two (2) fully executed amendments that were approved by the BCC on the
days listed below for recording in Minutes and Records. Feel free to contact me if you have any
questions.
October 22, 2013 Item 16.D.9:
Older American Act Program Title III—OAA 203.13.003
October 22, 2013 Item 16.D.14:
Nutrition Services Incentive Program-NSIP 203.14
Thank you for your assistance.
Amendment 003 OAA 203.13.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. D
dba SENIOR CHOICES OF SOUTHWEST FLORIDA 9
OLDER AMERICANS ACT PROGRAM TITLE HI 7
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
OAA 203.13.
The purpose of this amendment is to add Respite Service to OA3E and revise ATTACHMENT VII Rate Summary.
This amendment shall be effective on July 22, 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 2 page amendment to be executed by their officials there
unto duly authorized.
COUNTY BOARD OF
Recipient: AREA AGENCY ON AGING FOR SOUTHWEST
ecipient:
COUP4Y C MMI SIGNERS FLORIDA,INC.DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
■
SIGNED BY: `\ SIGNED BY: kit
NAME: Georgia A. Hiller, Esq. NAME: RONALD LUCCHINO,PhD
TITLE: Chairwoman TITLE: BOARD PRESIDENT
DATE: October 22, 2013
DATE: (JLL ° I, D- 0(
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
ATTEST:
e
Clerk. Approved .�, , . ... „ �i ,y
� HT 1B 1 - . kr
Sy: �,.
Assi t ('osi,
ry \it ��� ,cv
Attest as to Chairman's ® 3
signature only, \2.3 \\
1 0
Amendment 003 OAA 203.13.003
ATTACHMENT VII
Rate Summary
OLDER AMERICANS ACT
RATE SUMMARY 1 6 El 9
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
IIIB & IIIE
Services Total Cost Reimbursement Rate
IIIB
Case Aide $27.78 $25.00
Case Management $50.00 $45.00
*Intake-EHEAP Only $27.78 $25.00
Screening/Assessment $50.00 $45.00
Transportation 100%Cost 90% of Cost
*Intake Units only used for EHEAP
Services Total Cost Reimbursement Rate
IIIE
Respite $20.00 $18.00
Respite-Day Care $11.12 $10.00
Direct Pay Respite Must include match Up to$21.00
Direct Pay Facility Respite Must include match 24 hours--$125.00
Day Care Sitter $13.34 $12.00
IIIEG-Child Day Care $16.67 $15.00
Screening/Assessment $50.00 $45.00
Specialized Medical Equipment, 100% Cost 90% of Cost
Service& Supplies
C-1 & C-2
COLLIER COUNTY
Services Total Cost Reimbursement Rate
Cl
Congregate Meals $ 9.84 $ 8.86
Nutrition Counseling $58.89 $53.00
Nutrition Education $ 1.80 $ 1.62
Nutrition Screening $31.11 $28.00
Outreach $4.80 per person $4.32 per person
C2
Home Delivered Meals $ 9.77 $ 8.79
Nutrition Counseling $58.89 $53.00
Nutrition Education $ 1.80 $ 1.62
Nutrition Screening $50.00 $45.00
Outreach $4.80 per person $4.32 per person
2
0
16D9
Attestation Statement
Agreement/Contract Number: OAA 203.13
Amendment Number: 003
I, Georgia A.Hiller.Esq. ,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.
October 22,2013
Signature of Re ipi: t/I In, .ctor representative Date
ATTEST:
D, c HT E. BRO K, Clerk
B A j7"- Approved as to form and legality
Attest as to Chairman's (
sianature only. Assistant County Anon*