Backup Documents 12/10-11/2013 Item #16D25ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA � 2
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.
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 Comity Attorney Office.
Route to Add s (List in routing order)
Office
Initials
Date
1. Lisa Carr
HHVS
11C
1/6/14
2. Jennifer B. White, ACA
County Attorney Office
Office located in HHVS
Department
Agenda Item Number
1 I q l i q
3. BCC Office
Board of County
Commissioners
lsfii-
4. Minutes and Records
Clerk of Court's Office
Number of Original
\
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact informadon is noeded in the event one of the
addressees above may need to contact staff for additional or mmm information.
Name of Primary Staff
Lisa Carr
Phone Number
252-2339
Contact / Department
appropriate.
(Initial)
Applicable)
Agenda Date Item was
12/10/13
Agenda Item Number
16D25 L, -
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes, .
lsfii-
Type of Document
Standard Contract Amendment for HCE
Number of Original
3 ll
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
-*es-
f t
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applicable)
1.
Does the document require the chairman's original signature?
2.
Does the document need to be sent to another agency for additional signatures? If yes, .
lsfii-
provide the Contact Information(Name; Agency; Address; Phone on an attached sheet.
iz
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
-*es-
f t
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 indicating where the Chairman's
Yes
signature and initials are
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 12/10/13 and all changes made during
Yes
the meeting have been incorporated in the attached document. The County
Attorney's Ol13ce has reviewed the changes, if applicable,
9.
Initials of attorney verifying that the attached document is the version approved by the
es
BCC, all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature.
ores Kadlec-Roussey, Chief Financial Officer
Area Agency on Aging for Southwest Florida, Inc.
d/b/a Senior Choices of Southwest Florida
15201 N. Cleveland Ave., Suite 1100
North Fort Myers, Florida 33903
(239) 652-6900
Please send documents to the above address. Thank you!
�C a
CouhtX of Collier
CLERK OF THECIRCUIT COURT
Dwight E. Brock COLLIER COUII$TY COORTHOUSE
Clerk of Courts 3315 TAMIAMI TRL E STE 102" P.O. BOX 413044
NAPLES, FLORIDA '
e.r : NAPLES, FLORIDA
34112-5324 34101-3044
January 21, 2014
Area Agency on Aging for Southwest Florida, Inc.
Attn: Delores Kadlec-Roussey, Chief Financial Officer
d/b/a Senior Choices of Southwest Florida
15201 N. Cleveland Ave.
Suite 1100
North Fort Myers, Florida 33903
Re: Home Care for the Elderly Program
HCE #203.12.007
16025
Clerk of Courts
Accountant
Auditor
Custodian of County Funds
Transmitted herewith are three (3) originals of the above referenced documents, as
adopted by the Collier County Board of County Commissioners of Collier County,
Florida on Tuesday, December 10, 2013, during Regular Session.
Very truly yours,
DWIGHT E. BROCK, CLERK
Vergara, De
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk a,collierclerk.com
16D25
HOUSING HUMAN AND VETERIAN SERI VCES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grants Coordinator, HfIVS
DATE: February 28, 2014
RE: Senior Choices OAA 203.14 Contract, Amendments OAA 20313.004 and 005
Senior Choices HCE Amendment 203.12.007
Please find attached one (1) each fully executed document that was 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.
February 11, 2014 Item 16.D.5:
Older American Act Program Title III —OAA 203.14
December 10, 2013 Item 16.D.7:
OAA Amendment 203.13.004
December 10, 2013 Item 16.D.9:
OAA Amendment 203.13.005
December 10, 2013: %+tSVN 16 -D 25
HCE 203.12.007 and OAA 203.005
Thank you for your assistance.
16025
An;trndment 007 July 2012 — June 2014 HCE 203.12.007
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
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 "Recipient," amends contract HCE 203.12 ---
July 2012 -June 201.4.
The purpose of this amendment is transfer in Collier County $6,254 from Basics and $1,246 from Specials to
Case Management for year two, 2013-2014, or the rate schedule, subject to the availability of funds; and revise
ATTACHMENT VIII.
This amendment shall be effective November 1, 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, two pages, 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.
Collier County Bo d of County
Contractor: Commissioners
SIGNED BY:
NAME: . Tom Henning
Chairman
TITLE: i - - -
DATE: December 10, 2013
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
ATTEST:
®W(t3.H T E. BROCK, Clerk
Attest as to Ctlairgian's
signature only.
Area Agency on Aging for Southwest
Florida, Inc., dba Senior Choices of
Southwest Florida
SIGNE��
BY:—tkkl��— ✓
NAME: Ronald Lucchino, PhD
TITLE: Board President
DATE:oyjrj
Approved as to form and legality
Asses ant County Att&ney
Amendment 007 July 2012 — June 2014
5
Hk602
203.12.007
ATTACHMENT VIII
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of Commissioners
HCE Case Management
HCE Basic Subsidies 14 — 18 HCE Clients
HCE Special Subsidies
Total
SERVICES
$10,268.00
16,642.00
8,965.00
$35,875.00
HOME CARE FOR THE ELDERLY PROGRAM
RATE SUMMARY
Payments to the Lead Aizency
Case Management (CMV)
Case Aide (CAV)
Homemaker (HMKV)
Personal Care (PECV)
Respite (RESV)
Specialized Medical Equipment,
Services and Supplies (SCSV)
Background Screening (OTHBKV)
Pavments to the Careeiver
Respite (RESP)
Specialized Medical Equipment,
Services and Supplies (SCSM)
Transportation (TRS)
Collier County
REIMBURSEMENT RATE
Collier
$55.56
$30.00
$21.11
$24.44
$24.44
Total Cost
Total Cost
Total Cost
Total Cost
Total Cost
2
cA
1
16D25'
Attestation Statement
Agreement/Contract Number: HCE 203.12
Amendment Number 007
Tom Henning
Chairman
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.
i
Signature of Recipient/ContractoOrepresentative
ATTEST.
DGHT E. EK, Clerk
By:
Attest as to Chairman's
signature only.
December 10, 2013
Date
Approved as to form and legality
Assistant County's prney
G