Backup Documents 12/11-12/2012 Item #16D28 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SIII6 D 2 8
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper.Attach to original document.Original documents should be hand delivered to the Board Office.The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
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
exception of the Chairman's signature,draw a line through routing lines#1 through#4,complete the checklist,and forward to Sue Filson(line#5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Lisa N.Can,Grants Coordinator Housing,Human,Veterans Services LNC 12/11/12
Department
2. Jennifer B.White,ACA Office located within Housing,Human, 12 „f'1
Veterans Services Department l
3. County Attorney's Office County Attorney's Office
4. BCC Office Board of County Commissioners
1-2".I2 0 112
5. Minutes and Records Clerk of Court's Office
12.(20((2.
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 Sue Filson,need 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
item.)
Name of Primary Staff Lisa N.Can,Grants Coordinator Phone Number 239-252-2339
Contact
Agenda Date Item was 12/11/12 Agenda Item Number 1• P.28.
Approved by the BCC
Type of Document Subrecipient Contract Amendment—Area Number of Original 3 to .1(1 of each
Attached Agency on Aging for Southwest Florida Documents Attached Sub -cipient Contract
Inc./OAA grant program and Attestation - endment)
Statement
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Ctic;t4eAl-totAA(rn o �r,c,cicJ
INSTRUCTIONS&CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(Initial) Applicable)
1. 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 by the Office of the
County Attorney.This includes signature pages from ordinances,resolutions,etc.signed by the LNC
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 Office and n/a
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 document or INC
the final negotiated contract date whichever is applicable.
4. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature and —NC
initials are required.
5. In most cases(some contracts are an exception),the original document and this routing slip should be LNC
provided to Kristi Bartlett 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 12-11-2012 and all changes made during the LNC
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,Revised 224.1
«matter_numben>/ document number»
16D28
MEMORANDUM
Date: December 31, 2012
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Area Agency on Aging of SWFL
Agreement #OAA 203.12.003 Amendment 003
Attached for further processing are three (3) original copies of the document
referenced above (Item #16D28) approved by the Board of County Commissioners
on Tuesday, December 11, 2012.
After you've acquired all necessary signature(s) on the amendment documents
please return one of the fully executed original copies to the Board's Minutes
and Record's Department where it will be held for the Official Record.
If you have any questions, please call me at 252-8406.
Thank you
Amendment 003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT AMENDMENT
OLDER AMERICANS ACT PROGRAM TITLE III
Collier County Board of Commissioners
16®28
OAA 203.12.003
This AMENDMENT is entered into on this 11th day of December by and 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 " Contractor," aolleecctivvelystatedasthe "parties"
RECITALS:
WHEREAS, on February 28, 2012, the Parties enter into the Standard Contract for the Older American's Act
Program Title III for social services to be provided to Collier County's frail and elderly seniors (hereinafter referred
to as "Contract "); and
WHEREAS, on October 9, 2012 the Parties entered into a a Second Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on December 31, 2012; and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agenda from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to February 1, 2013 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
1. The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both Parties agree to extend the contract to February 1, 2013.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level specified
in the agreement.
1
16028
Amendment 003 OAA 203.12.003
SIGNATURE PAGE TO FOLLOW
REMAINDER OF PAGE LEFT INTENTIONALLY BLANK
2
16028
Amendment 003 OAA 203.12.003
IN WITNESS WHEREOF,the parties hereto have caused this Amendment to be executed b y their
officials there unto duly authorized.
Collier County Board of County Area Agency on Aging for Southwest
Commissioners Florida,Inc
SIGNED BY: ' ( SIGNED BY:
NAME: FAD . C-oy LE NAME: Leigh Anna Nowak
TITLE: C'-> k't K/-'14\ 'i TITLE: Board President
DATE: l, \ . \\ DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
••. � Approved as to torm & legal Sufficiency
ATTEST - • .
D ' G8T 4: ROCK, Clerk
By: E+► AssIstirnt County Attorney
rI
Attest ss i Otat 1213 \\N
f�ynaywre �3 :>t��'
3
16 D28
Attestation Statement
Agreement/Contract Number:_203.12
Amendment Number:003 •
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.
,
—I-1-4 a Date
Signature of Recipient/Contractor re ese
Approved as to form & legal Sul ioncy
AT EST:, ... -
•D , HT E. B •9K, Clerk
Y� ,�, -` ���l� Assts ant County Attorne
6 ,
y
Attest as to Chi i 2 3'
)1011,are �4-•�s..
16EI28 �
OFFICE OF THE COUNTYATTORNEY
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grant Coordinator, HHVS 1,(1
DATE: January 11, 2013
RE: December 11, 2012 Agenda Item 16. D.28
Please find attached the fully executed document approved by the BCC on December 11, 2012
for recording in Minutes and Records. Feel free to contact me if you have any questions.
Thank you for your assistance.
16021'
Amendment 003 OAA 203.12.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT AMENDMENT
OLDER AMERICANS ACT PROGRAM TITLE III
Collier County Board of Commissioners
This AMENDMENT is entered into on this 11th day of December by and 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"Contractor,"collectivelystatedasthe"Parties."
RECITALS:
WHEREAS, on February 28, 2012, the Parties enter into the Standard Contract for the Older American's Act
Program Title III for social services to be provided to Collier County's frail and elderly seniors (hereinafter referred
to as"Contract"); and
WHEREAS,on October 9, 2012 the Parties entered into a a Second Amendment to the Contract; and
WHEREAS,Section 3 of the Contract provides that the agreement is to expire on December 31, 2012; and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agenda from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to February 1, 2013 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged,the Parties agree as follows:
1. The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both Parties agree to extend the contract to February 1, 2013.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level specified
in the agreement.
1
6O28
Amendment 003 203.12.003
SIGNATURE PAGE TO FOLLOW
REMAINDER OF PAGE LEFT INTENTIONALLY BLANK
2
16U 8
Amendment 003 OAA 203.12.003
IN WITNESS WHEREOF,the parties hereto have caused this Amendment to be executed b y their
officials there unto duly authorized.
Collier County Board of County Area Agency on Aging for Southwest
Commissioners Florida,Inc
SIGNED BY: _.. , SIGNED BY:
NAME: r 6 0 W 2 Lf% NAME: Leigh Anna Nowak 1441- cc-4"(101
TITLE: CFA lie- AA) TITLE: Board President
DATE: ` ( DATE: b C. (3
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
Approved as to form & legal SufMCIecy
ATTEST
HT E. BR K, _lerk ti:,`
if
Assi fast County Attorney� �
Attest u to Cb trifle
i I9r►eLt+r'$ . .
3
16028
Attestation Statement
Agreement/Contract Number: 203.12
Amendment Number:003
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.
31--(b./N j (16-- )\
1.Z\\\\1Z Signature of Recipient/Contractor repr tire Date
Approved as to form & legal Sufficiency
ATTEST:
DWIGHT E. BROOK Clerk _e_
By: • ,; .MIL. Assist nt County Attorney
s
Attest as to ( 1 WY 1--- ._ PJ ry t rEe t%. L-A 1 i z_