Backup Documents 10/09/2012 Item #16D12ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLID Z D
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 10
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
ROUTING SLIP
Complete routing lines # 1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
rYnentinn of the Chairman's eienatnre- draw a line through routine lines # 1 through #4_ complete the checklist and forward to Ian Mitchell (line #5).
Route to Addressee(s)
(List in routing order
Office
Initials
Date
1. Louise Pelletier
HHVS
Agenda Item Number
16 D 12
2.Ian Mitchell, Executive Manager
Board of County Commissioners
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3. Minutes & Records
Clerk of Courts
M
V0(72f V
Attached
an original signatures from the
Documents Attached
Chairman needed on each copy
contracts, agreements, etc. that have been fully executed by all parties except the BCC
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Ian Mitchell needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
uoui.
Name of Primary Staff
Contact
Louise Pelletier / Housing, Duman and
Veteran Services
Phone Number
252 -2696
Please call or e-mail
for pick u
Agenda Date Item was
October 9, 2012
Agenda Item Number
16 D 12
Approved by the BCC
Original document has been signed/ initialed for legal sufficiency. (All documents to be
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Type of Document
Amendment to contract agreement
Number of
3 documents
Attached
an original signatures from the
Documents Attached
Chairman needed on each copy
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 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
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signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signa>ure 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
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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
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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
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signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
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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 10/09/12 (enter date) and all changes
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made during the meeting have been incorporated in the attached document. The
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County Attorney's Office has reviewed the changes, if applicable.
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I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16012
MEMORANDUM
Date: October 23, 2012
To: Louise Pelletier, Case Management
Housing, Human &Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Contract #OAA 203.12.002 (Amendment 2) with the Area
Agency on Aging for SWFL, Inc. to reflect additional grant funds
Attached are three (3) original copies of the document referenced above,
(Item #16D12) approved by Board of County Commissioners on October 9, 2012.
After forwarding for signature and subsequent return, please return an executed
original to the Minutes and Records Department for the Board's Official Record.
If you have any questions, please contact me at 252 -8406.
Thank you.
Attachments
16012
OFFICE OF THE CO UNTY A TTORNE Y
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grant Coordinator, HHVS
DATE: December 21, 2012
RE: October 9, 2012 Agenda Item 16. D.12
Please find attached four I fully executed amendment that was approved by the BCC on October
9, 2012 for recording in Minutes and Records. Feel free to contact me if you have any questions.
Thank you for your assistance.
Amendment 002 16 D t403.12.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT
OLDER AMERICANS ACT PROGRAM TITLE III
Collier County Board of Commissioners
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida Inc d /b /a 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 OAA 203.12.
The purpose of this Amendment is to increase contract allocations by $27,262, revise ATTACHMENT III —
Exhibit 1 and ATTACHMENT VII Budget Summary to increase Congregate Meals by $19,262. and Home Delivered
Meals by $8000. This amendment shall be effective September 30, 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
IN WITNESS WHEREOF, the parties hereto have caused
unto duly authorized.
Contractor:
Collier County Board of County
Commissioners A
SIGNED BY:
NAME: Fred W. Coyle
TITLE: Chairman
DATE: October 9. 2012
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 09/30
Approved as to form & legal Sufficiency
1)--w�o "--
Jennifer B. White
Assistant County Attorney
1
hereby made a part of this agreement.
this Amendment to be executed by their officials there
Area Agency on Aging for Southwest
Florida, Inc
SIGNED BY:
NAME: Leigh Anna Nowak
TITLE: Board President
DATE: /0 -V ► Z--
ATTEST:
Dwight E. Brock, Clerk
t� s t irm afire only
b
012
Amendment 002 OAA 203.12.002
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
Older Americans Act Title IIIB —
CA/CM/SCAS /INSC
$ 20,000.00
Transportation
U.S. Health and Human Services
93.044
$ 65,000.00
Support Services
$ 85,000.00
Total IIIB
$275,000.00**
OAA Title IIICI — Congregate Meals
U.S. Health and Human Services
93.045
$255,562.00
Spending Authority
OAA Title III C2 — Home Delivered Meals
U.S. Health and Human Services
93.045
$234,750.00
Older Americans Act Title III E —
$ 40,976.00
Supplement Services
U.S. Health and Human Services
93.052
18,079.00
Grandparent Services
.
$ 7,859.00
Total IIIE
$ 66,914.00
TOTAL FEDERAL AWARD
$642,226.00
** In Home Services $275,000.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by The Area Agency on Aging
for Southwest Florida, Inc. dba Senior Choices of Southwest Florida
2
Amendment 002
OLDER AMERICANS ACT BUDGET SUMMARY
1§00 12
3.12.002
ATTACHMENT VII
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
1. Title III B Support Services
2. Title III C 1 Congregate Meals
3. Title III C2 Home Delivered Meals
4. Title III E Services
TOTAL:
$ 85,000.00 **
$255,562.00
$234,750.00
$ 66,914.00
$642,226.00
** In Home Services $275,000.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on Aging for
Southwest Florida, Inc. dba Senior Choices of Southwest Florida
3
Attestation Statement
Agreement /Contract Number 203.12
Amendment Number 002
16012
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
(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.
Fred W. Coyle, Chairman
Collier County Board of (
Approval as to form & legal Sufficiency:
Jennifer B. White c�12y `%2
Assistant County Attorney
October 9 .2012
Date
Ys.
i
ATTEST:
Dwight E. Brock; Cl'' `
AMA& ..
p1 1 :CM n.' ,v
signature only