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Backup Documents 03/27/2012 Item #16D 9ORIGINAL DOCUMENTS CHECKLIST & RO TO ACCOMPANY ALL ORIGINAL DOCUMENTS SK THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR ROUTING SLIP Complete routing lines #I through 44 as appropriate for additional signatures, dates, and /or information needed. If the doe exception of the Chairman's sianatnre draw a line through routing lines 41 through #4. complete the checklist. and forwat G SLI1 V D TO 252 -2696 :GNATURE 1. Louise Pelletier nent is already complete with the to Ian Mitchell (line 45). Route to Addressee(s) List in routing order Office Initials 252 -2696 Date 1. Louise Pelletier HHVS Please call or e-mail 1. Original document has been signed/ initialed for legal sufficiency. (All documents to be 2.Ian Mitchell, Executive Manager Board of County Commissioners Agenda Date Item was Approved by the BCC March 27, 2012 3A0/ 1 Z 3. Minutes & Records Clerk of Courts Amendment to contract agreement Number of 9 Attached an Chairman *eeded-an Pneh copy-&- Documents Attached contracts, agreements, etc. that have been fully executed by all parties except the BCC Chairman and Clerk to the Board and possibly State Officials.) 2. All handwritten strike - through and revisions have been initialed by the County Attorney's LP 9 t.'�j PRIMARY CONTACT INFORMATION (The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the pe son who created/prepared the executive summary. Primary contact information is needed in the event one of the addressees above, including Ian Mitchell needs to ontact staff for additional or missing information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only afte the BCC has acted to approve the item ) Name of Primary Staff Louise Pelletier / Housing, Human and Phone Number 252 -2696 Contact Veteran Services (Initial ) Please call or e-mail 1. Original document has been signed/ initialed for legal sufficiency. (All documents to be LP for ick u Agenda Date Item was Approved by the BCC March 27, 2012 Agenda Item Number _ ' D Type of Doc um Amendment to contract agreement Number of 9 Attached an Chairman *eeded-an Pneh copy-&- Documents Attached INSTRUCTIONS & CHECKLIST I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revisej 2.24.05 Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is Yes N/A (Not appropriate. (Initial ) Applicable) 1. Original document has been signed/ initialed for legal sufficiency. (All documents to be LP signed by the Chairman, with the exception of most letters, must be reviewed and signed by the Office of the County Attorney. This includes signature pages from ordinances, resolutions, etc. signed by the County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully executed by all parties except the BCC Chairman and Clerk to the Board and possibly State Officials.) 2. All handwritten strike - through and revisions have been initialed by the County Attorney's LP Office and all other parties except the BCC Chairman and the Clerk to the Board 3. The Chairman's signature line date has been entered as the date of BCC approval of the LP document or the final negotiated contract date whichever is applicable. 4. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's LP signature and initials are required. 5. In most cases (some contracts are an exception), the original document and this routing slip LP should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval. 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! 6. The document was approved by the BCC on 12/13/11 (enter date) and all changes LP made during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes, if applicable. I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revisej 2.24.05 16D 9, MEMORANDUM Date: April 2, 2012 To: Louise Pelletier, Case Management Housing, Human &Veteran Services From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Area Agency on Aging of SW FL Inc., for Alzheimer's Disease Initiative Program Home Care for the Elderly Program Community Care for the Elderly Program Attached are three (3) originals of the document referenced above (Agenda Item #16D9), approved by Board of County Commissioners on Tuesday, March 27, 2012. After forwarding to the Area Agency on Aging for signature, we request that an original please be returned to the Minutes and Records Department for the Board's Official Record. If you have any questions, please contact me at 252 -7240. Thank you. 160 94 Amendment 001 ADI 203.11.001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. STANDARD CONTRACT Alzheimer's Disease Initiative Program Collier County Board of Commissioners This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida Inc hereinafter referred to as the "Agency," and Collier County Board of County Commissioners hereinafter referred to as the "Recipient," amends contract ADI 203.11. The purpose of this Amendment is to: (1) increase allocation by $1,000; (2) revise Attachment II1, Exhibit I; and (3) revise Attachment VI 11, Budget Summary. This amendment shall be effective February 9, 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, 3 pages, are 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. SIGNATURE PAGE TO FOLLOW REMAINDER OF PAGE INTENTIALL Y LEFT BLANK 1 Amendment 001 Collier County Board of County Contractor: Commissioners SIGNED BY- NAME: Fred W. Coyle TITLE: Chairman DATE: March 27, 2012 Federal Tax ID: 59- 6000588 Fiscal Year Ending Date: 09/30 ATTEST: SOCK, CLERK ASot K O"ou" OA I Approval as to form and legal Sufficiency Jennifer ETWhite Assistant County Attorney 2 I 160 94 ADI 203.11.001 Area on Aging for Southwest Florida, Inc SIGNED BY: NAME: Leigh Anna Nowak TITLE: Board President DATE: March 27, 2012 Amendment 001 160 9 4' ADI 203.11.001 ATTACHMENT III EXHIBIT - 1 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: PROGRAM TITLE FUNDING SOURCE CFDA I 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 I 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 $94,256.00 TOTAL AWARD $94,256.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 3 Amendment 001 ALZHEIMER'S DISEASE INITIATIVE PROGRAM BUDGET SUMMARY for Collier County Board of Commissions Collier County 1. Respite 2. Case Management, Case Aide, and Intake Allocation 3. Total 4 i 160 91 AD[ 203.11.001 ATTACHMENT VIII $ 93,756.00 $ 500.00 $ 94,256.00 160 go Attestation Statement Agreement/Contract Number AD1203.11.001 Amendment Number 001 1, Fred W. Coyle , 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 (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. Fred W. Coyle, Chairman Signature of Recipient /Contractor representative 03/27/2012 Date Senior Choices Contract Manager to initial and date indicating signatures /initials appropriate on all documents; ready for Seniors Choices designee signature. Initial/date ATTEST: Dwight E. Brock, Clerk Depu ' IQrli( i►tt"t n W Approval as to form legal Sufficiency: ` County Attorney (1 Ste'"' -v 1 Fl: IZ 4. w-" �- rt D Amendment 001 169 ADI 203. 1.001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. STANDARD CONTRACT Alzheimer's Disease Initiative Program Collier County Board of Commissioners This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida. Inc..hereinafter referred to as the"Agency,"and Collier County Board of County Commissioners.hereinafter referred to as the"Recipient,"amends contract ADI 203.11. The purpose of this Amendment is to: (1) increase allocation by$1,000; (2) revise Attachment III, Exhibit I; and (3) revise Attachment VIII,Bud get Summary. This amendment shall be effective February 9, 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,3 pages,are 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. SIGNATURE PAGE TO FOLLOW REMAINDER OF PAGE INTENTIALLY LEFT BLANK 1 160 9 Amendment 001 ADI 203.11.001 Collier County Board of County Contractor: Area on Aging for Southwest Florida,Inc Commissioners SIGNED BY: �` �" '` SIGNED BY: NAME: Fred W. Coyle NAME: Leigh Anna Nowak TITLE: Chairman TITLE: Board President DATE: March 27, 2012 DATE: March 27, 2012 Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 ATTEST: DWIGEIf,E CLERK G.- s, Pilv1LRK i1 #'s o . Approval as to form and legal Sufficiency Jennifer B. White Assistant County Attorney 2 1609 Amendment 001 ADI 203.11.001 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 $94,256.00 TOTAL AWARD $94,256.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 3 1609 Amendment 001 ADI 203.11.001 ATTACHMENT VIII ALZHEIMER'S DISEASE INITIATIVE PROGRAM BUDGET SUMMARY for Collier County Board of Commissions Collier County 1. Respite $ 93,756.00 2. Case Management, Case Aide, and Intake Allocation $ 500.00 3. Total $ 94,256.00 4 160 9 Attestation Statement Agreement/Contract Number ADI 203.11.001 Amendment Number 001 I, Fred W. Coyle ,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 (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. (A.). Co-18,0,k 03/27/2012 Fred W.Coyle,Chairman Date Signature of Recipient/Contractor representative Senior Choices Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready for Seniors Choices designee signature. Initial/date ATTEST: Dwight E. Brock,Clerk Approval as to form legal Sufficiency: i rr 0 County Attorney Sc N�•t`� 2 Q .c ���'ts • Deputy rk t omit. Amendment 002 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. STANDARD CONTRACT HOME CARE FOR THE ELDERLY PROGRAM Collier County Board of Commissioners 160 94 HCE 203.11 -R.002 This AMENDMENT, entered into between the Area AgencLn Aging for Southwest Florida. Inc. hereinafter referred to as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Recipient," amends contract HCE 203.11 -R. The purpose of this Amendment is to: (1) transfer $4,438.00 from Basic to Subsidy; (2) revise Attachment III, Exhibit I; and (4) revise Attachment VII, Bud get Summary. This amendment shall be effective February 9, 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, 3 pages, are hereby made a part of this agreement. 1 Amendment 002 i 160 94' HCE 203.11 -R.002 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their officials there unto duly authorized. Contractor: Collier County Board of County Commissioners SIGNED BY: IL-Xk W. ��4 NAME: Fred W. Coyle TITLE: Chairman DATE: March 27, 2012 Federal Tax ID: 59- 6000588 ATTEST?,' ' �n f�E . CLERK aw;iM wommou Sufficiency Approval as to form and legal Sufficiency Jennifer B. White Assistant County Attorney 2 Area on Aging for Southwest Florida, Inc SIGNED BY: NAME: Leigh Anna Nowak TITLE: Board President DATE: March 27, 2012 i 16D 4 i Amendment 002 HCE 203.11 -R.002 ATTACHMENT III EXHIBIT -1 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: I PROGRAM TITLE I FUNDING SOURCE I CFDA I 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 I FUNDING SOURCE CFDA I 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 $83,392.00 TOTAL AWARD $83,392.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 3 160 9 Amendment 002 HCE 203.11 -R.002 HOME CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY for Collier County Board of Commissions Collier County 1. HCE Case Management $ 5,248.00 2. HCE Basic Subsidies 22 -27 HCE Clients $24,734.00 3. HCE Special Subsidies $53,410.00 4. Total $83,392.00 HOME CARE FOR THE ELDERLY PROGRAM SERVICES Case Management Case Aide RATE SUMMARY 4 REIMBURSEMENT RATE $50.00 $27.78 ATTACHMENT VII 16D 91 Attestation Statement Agreement/Contract Number HCE 203.11 -R.002 Amendment Number 002 I, Fred W. Coyle , 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 (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. ""� W. Fred W. Coyle, Chairman Signature of Recipient/Contractor representative 03/27/2012 Date Senior Choices Contract Manager to initial and date indicating signatures /initials appropriate on all documents; ready for Seniors Choices designee signature. Initial/date ATTEST: Dwight E. Brock, Clerk er 41 , Approval as to form legal Sufficiency: County Attorney 1609 Amendment 002 HCE 203.11-R.002 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. STANDARD CONTRACT HOME CARE FOR THE ELDERLY PROGRAM Collier County Board of Commissioners This AMENDMENT,entered into between the Arm Agency on Aging for Southwest Florida. Inc.,hereinafter referred to as the"Agency,"and Collier County Board of County Commissioners, hereinafter referred to as the"Recipient,"amends contract HCE 203.11-R. The purpose of this Amendment is to: (1) transfer $4,438.00 from Basic to Subsidy; (2) revise Attachment III, Exhibit I;and (4) revise Attachment VII,Bud get Summary. This amendment shall be effective February 9, 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,3 pages,are hereby made a part of this agreement. 1 1609 Amendment 002 HCE 203.11-R.002 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their officials there unto duly authorized. Collier County Board of County Contractor: Area on Aging for Southwest Florida,Inc Commissioners SIGNED BY: SIGNED BY: 41/X6 1J'A-310( NAME: Fred W.Coyle NAME: Leigh Anna Nowak TITLE: Chairman TITLE: Board President DATE: March 27, 2012 DATE: March 27, 2012 Federal Tax ID: 59-6000588 ATTET, £34A T . 'R�iCK CLE' .' ' AA el ° �•_ ti}Dy ;TY CLERK SOOMOVIIIIIPT*Otrilieflial Sufficiency Approval as to form and legal Sufficiency Jennifer Bhite Assistant County Attorney 2 1609 Amendment 002 HCE 203.11-R.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 Home Care for the Elderly Program General Revenue 65001 $83,392.00 TOTAL AWARD $83,392.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 3 1609 Amendment 002 HCE 203.11-R.002 ATTACHMENT VII HOME CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY for Collier County Board of Commissions Collier County 1. HCE Case Management $ 5,248.00 2. HCE Basic Subsidies 22-27 HCE Clients $24,734.00 3. HCE Special Subsidies $53,410.00 4. Total $83,392.00 HOME CARE FOR THE ELDERLY PROGRAM RATE SUMMARY SERVICES REIMBURSEMENT RATE Case Management $50.00 Case Aide $27.78 4 1609 Attestation Statement Agreement/Contract Number HCE 203.11-R.002 Amendment Number 002 I, Fred W.Coyle ,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 (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. LA). Co-aksks 03/27/2012 Fred W.Coyle,Chairman Date Signature of Recipient/Contractor representative Senior Choices Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready for Seniors Choices designee signature. Initial/date ATTEST: Dwight E. Brock,Clerk Approval as to form legal Sufficiency: i1 Fy 3 p34.0 . $ t / County Attorney a < ;itteputylerk Amendment 001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. STANDARD CONTRACT COMMUNITY CARE FOR THE ELDERLY PROGRAM Collier County Board of Commissioners 160 94 CCE 203.11.001 This AMENDMENT, entered into between the Area Agen!�y on Aging for Southwest Florida Inc hereinafter referred to as the "Agency," and Collier County Board of County Commissioners hereinafter referred to as the "Recipient," amends contract CCE 203.11. The purpose of this Amendment is to: (1) increase allocation by $18,000; (2) revise Attachment III, Exhibit I; and (3) revise Attachment VIII, Budget Summary. This amendment shall be effective February 9, 2012. 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, 3 pages, are hereby made a part of this agreement. SIGNATURE PAGE TO FOLLOW REMAINDER OF PAGE INTENTIALLY LEFT BLANK 1 Amendment 001 160 9 *, CCE 203.11.001 IN WITNESS WHERE OF, the parties hereto have caused this Amendment to be executed by their officials there unto duly authorized. Collier County Board of County Commissioners Contractor: SIGNED BY: W. NAME: Fred W. Coyle TITLE: Chairman DATE: March 27, 2012 Federal Tax ID: 59- 6000588 Fiscal Year Ending Date: 09/30 ATTEST. DWIGHT,'E.9960Kti1,�LERK By: `;e ,Af PUI (6tER),K Approval as to form and legal Sufficiency: N'\ Jennifer-CWhite Assistant County Attorney 2 Area on Aging for Southwest Florida, Inc SIGNED BY: NAME: Leigh Anna Nowak TITLE: Board President DATE: March 27, 2012 16D 9 Amendment 001 CCE 203.11.001 ATTACHMENT III EXHIBIT - 1 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: PROGRAM TITLE I FUNDING SOURCE I CFDA I 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 I FUNDING SOURCE I CFDA I 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/ TSTF 65010 $657,667.00 TOTAL AWARD $657,667.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 3 Amendment 001 COMMUNITY CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY for Collier County Board of Commissions Collier County 1. CCE Spending Authority $443,717.00 Case Management, Case Aide, 2• 118,000.00 Intake Allocations 3. Lead Agency Operating Dollars 95,950.00 Total $657,667.00 RATE SUMMARY for Collier County Board of Commissioners Collier County 160 9 CCE 203.11.001 ATTACHMENT VIII Collier County Total Rate Reimbursement Rate Case Management $50.00 $45.00 Case Aid $27.78 $25.00 Chore $20.00 $18.00 Companion $20.00 $18.00 EARS $0.83 $0.75 EARS Plus $1.11 $1.00 Enhanced Chore $30.00 $27.00 Facility Respite (24 hours) $138.90 $125.00 Homemaking $20.00 $18.00 Personal Care $22.22 $20.00 Respite -in Home $20.00 $18.00 Skilled Nursing $38.89 $35.00 Adult Day Care $10.00 $9.00 Spec. Medical Equipment 100% Cost 90% cost 4 160 9 Attestation Statement Agreement/Contract Number CCE 203.11.001 Amendment Number 001 I. Fred W. Coyle , 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 (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. "'� W. Fred W. Coyle, Chairman Signature of Recipient/Contractor representative 03/27/2012 Date Senior Choices Contract Manager to initial and date indicating signatures /initials appropriate on all documents; ready for Seniors Choices designee signature. Initial/date ATTEST: Dwight E. Brock, Clerk Approval as to form legal Sufficiency: _ pc- County Attorney �'i 'L_ G� T Nry , �-- f- e 1609 Amendment 001 CCE 203.11.001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. STANDARD CONTRACT COMMUNITY CARE FOR THE ELDERLY PROGRAM Collier County Board of Commissioners This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida. Inca hereinafter referred to as the"Agency,"and Collier County Board of County Commissioners,hereinafter referred to as the"Recipient,"amends contract CCE 203.11. The purpose of this Amendment is to: (1) increase allocation by$18,000; (2) revise Attachment III, Exhibit I; and (3) revise Attachment VIII,Bud get Summary. This amendment shall be effective February 9, 2012. 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,3 pages, are hereby made a part of this agreement. SIGNATURE PAGE TO FOLLOW REMAINDER OF PAGE INTENTIALLY LEFT BLANK 1 9 Amendment 001 CE 203. 1.001 IN WITNESS WHERE OF, the parties hereto have caused this Amendment to be executed by their officials there unto duly authorized. Collier County Board of County Area on Aging for Southwest Florida,Inc Commissioners Contractor: n'A SIGNED BY: 14' SIGNED BY: 7 13 I/ NAME: Fred W.Coyle NAME: Leigh Anna Nowak TITLE: Chairman TITLE: Board President DATE: March 27, 2012 DATE: March 27, 2012 Federal Tax ID: 59-6000588 Fiscal Year Ending Date: 09/30 ATTEST: =.w, DWIGH r '4*R . RK 4 BY ,� tG atilt oviireisftio DEPUrKLE KK� $ Approval as to form and legal Sufficiency: Jennifer B.White Assistant County Attorney 2 160 9 Amendment 001 CCE 203.11.001 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/TSTF 65010 $657,667.00 TOTAL AWARD $657,667.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 3 1609 Amendment 001 CCE 203.11.001 ATTACHMENT VIII COMMUNITY CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY for Collier County Board of Commissions Collier County 1' CCE Spending Authority $443,717.00 Case Management, Case Aide, 2. 118,000.00 Intake Allocations 3. Lead Agency Operating Dollars 95,950.00 Total $657,667.00 RATE SUMMARY for Collier County Board of Commissioners Collier County Collier County Total Rate Reimbursement Rate Case Management $50.00 $45.00 Case Aid $27.78 $25.00 Chore $20.00 $18.00 Companion $20.00 $18.00 EARS $0.83 $0.75 EARS Plus $1.11 $1.00 Enhanced Chore $30.00 $27.00 Facility Respite (24 hours) $138.90 $125.00 Homemaking $20.00 $18.00 Personal Care $22.22 $20.00 Respite-In Home $20.00 $18.00 Skilled Nursing $38.89 $35.00 Adult Day Care $10.00 $9.00 Spec. Medical Equipment 100%Cost 90%cost 4 1609 Attestation Statement Agreement/Contract Number CCE 203.11.001 Amendment Number 001 I, Fred W.Coyle ,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 (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 IA). 03/27/2012 Fred W.Coyle,Chairman Date Signature of Recipient/Contractor representative Senior Choices Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready for Seniors Choices designee signature. Initial/date ATTEST: Dwight E. Brock,Clerk Approval as to form legal Sufficiency: County Attorney Atiosiptu _