Backup Documents 12/11-12/2012 Item #16D24 Amendment 002 HCE 203.12.002
AREA dba SE IOR CHOIIC S OF SOUTHWEST FLORIDA INC.16 na
STANDARD CONTRACT
HOME CARE FOR THE ELDERLY PROGRAM
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
HCE 203.12.
The purpose of this amendment is to add Item 3.1.3 under ATTACHMENT I, STATEMENT OF WORK, SECTION
III: METHOD OF PAYMENT and add additional rates on ATTACHMENT VIII, BUDGET AND RATE
SUMMARY.
SECTION III: METHOD OF PAYMENT
3.1.3 Effective October 16,2012,the Recipient will be responsible for paying vendors for in-home services. The
Agency will reimburse the Recipient for these services based on the contracted rate,ATTACHMENT VIII,
BUDGET AND RATE SUMMARY.
This amendment shall be effective on October 16, 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 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: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
SIGNED BY ■ 444' / SIGNED BY: 1/e-'1-
NAME: Shp e v1 CrçeL/ NAME: LEIGH A A NOWAK
TITLE: �°(�f�,Y� ti �1 �, Cni)uei d !S J II un TITLE: BOARD PRESIDENT
DATE: ' I I DATE: / 11311
;3-
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
1
Amendment 002 16 n 2 J HCE 203.12.002
ATTACHMENT VIII
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of Commissioners
HCE Case Management $ 4,601.00
HCE Basic Subsidies 13-27-HCE Clients 40,680.00
HCE Special Subsidies 16,428.00
Total $61,709.00
HOME CARE FOR THE ELDERLY PROGRAM
RATE SUMMARY
Collier County
SERVICES REIMBURSEMENT RATE
Payments to the Lead Agency Collier
Case Management(CMV) $55.56
Case Aide(CAV) $30.00
Homemaker(HMKV) $21.11
Personal Care(PECV) $24.44
Respite(RESV) $24.44
Specialized Medical Equipment,
Services and Supplies(SCSV) Total Cost
Background Screening(OTHBKV) Total Cost
Payments to the Caregiver
Respite(RESP) Total Cost
Specialized Medical Equipment,
Services and Supplies(SCSM) Total Cost
Transportation(TRS) Total Cost
2
• 16D24
Attestation Statement
Agreement/Contract Number LICE 203.12
Amendment Number 002
I, Stephen Y.Carnell ,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.
or I. �� r /(641(0 r
Stephen .Carnell,Interim Administrator Date
Collier County Public Services Division
Appfoved as to form & legal Suificitrnoy
Ae3 taint County Attorney --