Backup Documents 01/25/2011 Item #16D3
ORIGINAL DOCUMENTS CHECKLIST & ROU1Jl'jG N--Jil
TO ACCOMPANY ALL ORIGINAL DOCUMENTS stINOrU J
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document Original documents should be hand dclivcrcd to the Board Offlcc, Thc complctcd routing slip and original
documcnts are to bc forwarded to the Board Office only aftct. the Board has taken action on the item,)
ROUTING SLIP
Complete routing lines # I through #4 as appropriate for additional signatures. dates, and/or information needed, If the document is already complete with the
exce tion of the Chairman's si nature, draw a line throu h routin lines # I throu h #4, com lete the checklist, and forward to Sue Filson (line #5 ,
Route to Addressee(s) Office Initials Date
(List in routin order
I.Frank Ramsey HHVS 1/26/2011
2. Jennifer B. White
CAO
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3. Chairman Fred W. Coyle
Board of County Commissioners
PRIMARY CONTACT INFORMATION
I, The primary contact is the holder of the original document pending Bce 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 BCe Chairman's "ignature are to be delivercd to the BCC office only after the BCC has acted to approve the
item,)
4. Oe I ~lN & S\G-NA~~
fl,~SE
Name of Primary Staff Frank Ramsey, Housing Manager Phone Number 252-2336
Contact
Agenda Date Item was 01/25/2011 Agenda Item Number 160-3
Approved by the BCC
Type of Document Agreement Number of Original 3
I Attached Documents Attached
5. Ian Mitchell, Executive Manager Board of County Commissioners
6. Minutes and Records
Clerk of Court's Office
Yes
(Initial)
N/A (Not
A licable)
I.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a ro riate,
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 County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCe
Chairman and Clerk to the Board and ossibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce t the BCC Chairman and the Clerk to the Board
The Chairman's signature line date has been entered as the date of BCC approval ofthe
document or the final ne otiated contract date whichever is a licable
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
In mo~.1 cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours ofBCC 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 ofvour deadlines!
The document was approved by the BCe on 01/25/2011 and all changes made during
the meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the chan es, if a Iicable.
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I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9,03,04, Revised 1,26,05. Revised 2,24.05
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6.
16D3
MEMORANDUM
Date:
February 10,2011
To:
Frank Ramsey, Housing Manager
Housing, Human & Veteran Services
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
Standard Contract with the Area Agency on
Aging for SWFL, Inc. for the Older Americans
Act Program - Title III
Attached are three (3) original copies of the contract document referenced
above, (Item #16D3) approved by the Board of County Commissioners on
January 25, 2011.
After further processing, please return an executed original to the Minutes
and Records Department so the Official Records of the Board are complete.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachments (3)
January 2011
16 [lt~tOA03.11
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT
OLDER AMERICANS ACT PROGRAM TITLE III
THIS CONTRACT is 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 "Contractor", and collectively
referred to as the "Parties." The term contractor for this purpose may designate a vendor, subgrantee or subrecipient, the status
to be further identified in ATTACHMENT III, Exhibit-2 as necessary.
WITNESSETH THAT:
WHEREAS, the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such services as
an independent contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the mutual
covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments and exhibits, which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state planes), grant agreements, relevant department handbooks,
manuals or desk books, as an integral part of the contract, except to the extent that the contract explicitly provides to
the contrary. In the event of conflict in language among any of the documents referenced above, the specific
provisions and requirements of the contract document(s) shall prevail over inconsistent provisions in the Proposal(s) or
other general materials not specific to this contract document and identified attachments.
3. Term of Contract
This contract shall begin on January L 2011 or on the date on which the contract has been signed by the last party
required to sign it, whichever is later. It shall end at midnight, local time in North Fort Myers, Florida, on
December 31,2011.
4. Contract Amount
The agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $934,162.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for
under any other contract or from any other source are not eligible for payment under this contract.
5. Renewals
By mutual agreement of the parties, in accordance with s. 287.058(1)(t), F.S., the agency may renew the contract for a
period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or
method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may
be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon
satisfactory performance evaluations by the agency and the availability of funds.
6. Compliance with Federal Law
6.1. If this contract contains federal funds the following shall apply:
6.1.1 The provider shall comply with the provisions of 45 CFR 74 and/or 45 CFR 92, and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the contractor shall comply with all applicable
standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42 D.S.C. 7401, et seq.), s. 508
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of the Federal Water Pollution Control Act as amended (33 D.S.C. 1251, et seq.), Executive Order 11738, as amended,
and where applicable Environmental Protection Agency regulations 40 CFR 30. The contractor shall report any
violations of the above to the agency.
6.1.3 The contractor, or agent acting for the contractor, may not use any federal funds received in connection with this
contract to influence legislation or appropriations pending before the Congress or any State legislature. If this contract
contains federal funding in excess of $100,000.00, the contractor must, prior to contract execution, complete the
Certification Regarding Lobbying form, ATTACHMENT II. All disclosure forms as required by the Certification
Regarding Lobbying form must be completed and returned to the Executive Director, prior to payment under this
contract.
6.1.4 That if this contract contains $10,000.00 or more of federal funds, the contractor shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in
Department of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
6.1.5 That if this contract contains federal funds and provides services to children up to age 18, the contractor shall comply
with the Pro-Children Act of 1994 (20 D.S.C. 6081).
6.1.6 That a contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards shall
not be made to parties listed on the government-wide Excluded Parties List System, in accordance with the OMB
guidelines at 2 CFR 180 that implement Executive Orders 12549 and 12689, "Debarment and Suspension." The
Excluded Parties List System contains the names of parties debarred, suspended, or otherwise excluded by agencies, as
well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The
contractor will comply with these provisions before doing business or entering into subcontracts receiving federal
funds pursuant to this contract. The contractor shall complete and sign ATTACHMENT V prior to the execution of
this contract.
6.2 The contractor shall not employ an unauthorized alien. The agency shall consider the employment of unauthorized
aliens a violation of the Immigration and Nationality Act (8 D.S.C. 1324 a) and the Immigration Reform and Control
Act of 1986 (8 D.S.C. 1101). Such violation shall be cause for unilateral cancellation of this contract by the agency.
6.3 If the contractor is a non-profit provider and is subject to Internal Revenue Service (IRS) tax exempt organization
reporting requirements (filing a Form 990 or Form 990-N) and has its tax exempt status revoked for failing to comply
with the filing requirements of the 2006 Pension Protection Act or for any other reason, the contractor must notify the
agency in writing within thirty (30) days of receiving the IRS notice of revocation.
7. Compliance with State Law
7.1 That this contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in
all respects in accordance with the Florida law, including Florida provisions for conflict oflaws.
7.2 Requirements ofs. 287.058, F.S. as amended.
7.2.1 The contractor will provide units of deliverables, including various client services, and in some instances may include
reports, findings, and drafts, as specified in this contract, which the Executive Director must receive and accept in
writing prior to payment in accordance with s. 215.971, F.S. (1) and (2).
7.2.2 The contractor will submit bills for fees or other compensation for services or expenses in sufficient detail for a proper
pre-audit and post-audit.
7.2.3 If itemized payment for travel expenses is permitted in this contract, the contractor will submit bills for any travel
expenses in accordance with s. 112.061, F.S., or at such lower rates as may be provided in this contract.
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January 2011 Contract OAA 203.11
7.2.4 The contractor will allow public access to all documents, papers, letters, or other public records as defined in
subsection 119.011(12), F.S., made or received by the contractor in conjunction with this contract except for those
records which are made confidential or exempt by law. The contractor's refusal to comply with this provision shall
constitute an immediate breach of contract for which the agency may unilaterally terminate the contract.
7.3 If clients are to be transported under this contract, the contractor shall comply with the provisions of Chapter 427, F.S.,
and Rule 41-2, F. A. C.
7.4 Subcontractors who are on the discriminatory vendor list may not transact business with any public entity, III
accordance with the provisions ofs. 287.134, F.S.
7.5 The contractor will comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the expenditure
of contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
8. Back!!round Screenin2
The contractor shall ensure that, prior to providing services, all persons having access to vulnerable elders and children,
their living area, funds or personal property, or protected health information pertaining to such individuals, shall pass a
Level II criminal background screening in accordance with the requirements of s. 430.0402 and ch.435, F.S., as
amended. These provisions shall apply to employees, subcontractors, consultants, direct service providers and
volunteers. Consequently, any commitment for employment, purchase of services, or volunteer program participation
shall be contingent upon the passing of a Level II background check. The background screening shall include
employment history checks as provided in s. 435.03(1), F.S., and both local and national criminal record checks
coordinated through law enforcement agencies.
8.1 For purposes of this section, the term "direct service provider" means a person 18 years of age or older who, pursuant
to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to
the client or has access to the client's living areas or to the client's funds or personal property. This term includes
coordinators, managers, and supervisors of residential facilities and volunteers.
9. Grievance Procedures
The contractor shall develop and implement, and ensure that its subcontractors have established grievance procedures
to process and resolve client dissatisfaction with or denial of service(s), and address complaints regarding the
termination, suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum,
should provide for notice of the grievance procedure and an opportunity for review of the subcontractor's
determination( s).
10. Audits. Inspections. Investi2ations. Public Records and Retention
10.1 To establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all
income and expenditures of funds provided by the agency under this contract.
10.2 To retain all client records, financial records, supporting documents, statistical records, and any other documents
(including electronic storage media) pertinent to this contract for a period of six (6) years after completion of the
contract or longer when required by law. In the event an audit is required by this contract, records shall be retained for
a minimum period of six (6) years after the audit report is issued or until resolution of any audit findings or litigation
based on the terms of this contract, at no additional cost to the agency.
10.3 Dpon demand, at no additional cost to the agency, the contractor will facilitate the duplication and transfer of any
records or documents during the required retention period in Paragraph 10.2.
10.4 To assure that the records described in Paragraph 10 shall be subject at all reasonable times to inspection, review,
copying, or audit by Federal, State, or other personnel duly authorized by the agency.
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10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the agency, the department
and Federal auditors, pursuant to 45 CFR 92.36(i)(10), shall be allowed full access to and the right to examine any of
the contractor's contracts and related records and documents pertinent to this specific contract, regardless of the form in
which kept.
10.6 To provide a financial and compliance audit to the agency as specified in this contract and in ATTACHMENT III and
to ensure that all related party transactions are disclosed to the auditor.
10.7 To comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by the
office of the Inspector General pursuant to s. 20.055, F.S.
11. Nondiscrimination-Civil Ri2hts Compliance
11.1 The contractor will execute assurances in ATTACHMENT VI that it will not discriminate against any person in the
provision of services or benefits under this contract or in employment because of age, race, religion, color, disability,
national origin, marital status or sex in compliance with state and federal law and regulations. The contractor further
assures that all contractors, subcontractors, subgrantees, or others with whom it arranges to provide services or benefits
in connection with any of its programs and activities are not discriminating against clients or employees because of
age, race, religion, color, disability, national origin, marital status or sex.
11.2 The contractor will retain, on file, during the term of this agreement a timely, complete and accurate Civil Rights
Compliance Checklist (ATTACHMENT B).
11.3 The contractor agrees to establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures shall include notifying clients, employees, and participants
ofthe right to file a complaint with the appropriate federal or state entity.
11.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from federal
financial assistance, and are binding upon the contractor, its successors, transferees, and assignees for the period during
which such assistance is provided. The contractor further assures that all subcontractors, vendors, or others with whom
it arranges to provide services or benefits to participants or employees in connection with any of its programs and
activities are not discriminating against those participants or employees in violation of the above statutes, regulations,
guidelines, and standards. In the event of failure to comply, the contractor understands that the agency may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or
administrative relief, including but not limited to, termination of and denial of further assistance.
12. Provision of Services
The contractor will provide services in the manner described in ATTACHMENT I.
13. Monitorin2 bv the A2encv
The contractor will permit persons duly authorized by the agency to inspect and copy any records, papers, documents,
facilities, goods and services of the contractor which are relevant to this contract, and to interview any clients,
employees and subcontractor employees of the contractor to assure the agency of the satisfactory performance of the
terms and conditions of this contract. Following such review, the agency will deliver to the contractor a written report
of its findings and request for development, by the contractor, a corrective action plan where appropriate. The
contractor hereby agrees to timely correct all deficiencies identified in the corrective action plan.
14. Coordinated Monitorin2 with Other A2encies
If the contractor receives funding from one or more of the State of Florida other human service agencies, in addition to
the Department of Elder Affairs, then a joint monitoring visit including such other agencies may be scheduled. For the
purposes of this contract, and pursuant to s. 287.0575, F.S. as amended, Florida's human service agencies shall include
the Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities, the
Department of Veterans Affairs, and the Department of Elder Affairs. Dpon notification and the subsequent scheduling
of such a visit by the designated agency's lead administrative coordinator, the contractor shall comply and cooperate
with all monitors, inspectors, and/or investigators.
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15. Indemnification
The contractor shall indemnify, save, defend, and hold harmless the agency and its agents and employees from any and
all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the
execution of this agreement or performance of the services provided for herein. It is understood and agreed that the
provider is not required to indemnify the agency for claims, demands, actions or causes of action arising solely out of
the agency's negligence.
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15.1 Except to the extent permitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
executed between the agency and state agencies or subdivisions defined in s. 768.28(2), F.S.
16. Insurance and Bondin2
16.1 To provide continuous adequate liability insurance coverage during the existence of this contract and any renewal(s)
and extension(s) of it. By execution of this contract, unless it is a state agency or subdivision as defined by subsection
768.28(2), F.S., the contractor accepts full responsibility for identifying and determining the type(s) and extent of
liability insurance necessary to provide reasonable financial protections for the contractor and the clients to be served
under this contract. The limits of coverage under each policy maintained by the contractor do not limit the contractor's
liability and obligations under this contract. The contractor shall ensure that the agency has the most current written
verification of insurance coverage throughout the term of this contract. Such coverage may be provided by a self-
insurance program established and operating under the laws of the State of Florida. The agency reserves the right to
require additional insurance as specified in this contract.
16.2 Throughout the term of this agreement, the contractor agrees to maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the contractor authorized to
handle funds received or disbursed under all agreements and/or contracts incorporating this contract by reference in an
amount commensurate with the funds handled, the degree of risk as determined by the insurance company and
consistent with good business practices.
17. Confidentiality of Information
The contractor shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized
to give that consent or when authorized by law.
18. Health Insurance Portability and Accountability Act
Where applicable, the contractor will comply with the Health Insurance Portability and Accountability Act (42 USC
1320d.), as well as all regulations promulgated there under (45 CFR 160, 162, and 164).
19. Incident Reportin2
19.1 The contractor shall notify the agency immediately, but no later than forty-eight (48) hours from, the contractor's
awareness or discovery of conditions that may materially affect the contractor or subcontractor's ability to perform the
services required to be performed under this contract. Such notice shall be made orally to the contract manager (by
telephone) with an email to immediately follow.
19.2 To immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or
disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96ABUSE). As required
by Chapters 39 and 415, F.S., this provision is binding upon both the contractor and its employees.
20. New Contract(s) Reportin2
The contractor shall notify the agency within ten (10) days of entering into a new contract with any of the remaining
four (4) state human service agencies. The notification shall include the following information: (1) contracting state
agency; (2) contract name and number; (3) contract start and end dates; (4) contract amount; (5) contract description
and commodity or service; and (6) contract manager name and number. In complying with this provision, and pursuant
to s. 287.0575, F.S. as amended, the contractor shall complete and provide the information in ATTACHMENT D.
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21. Bankruptcv Notification
If, at any time during the term of this contract, the contractor, its assignees, subcontractors or affiliates files a claim for
bankruptcy, the contractor must immediately notify the Area Agency on Aging for Southwest Florida, Inc. Within ten
(10) days after notification, the contractor must also provide the following information to the Department of Elder
Affairs: (1) the date of filing of the bankruptcy petition; (2) the case number; (3) the court name and the division in
which the petition was filed (e. g., Northern District of Florida, Tallahassee Division); and, (4) the name, address, and
telephone number of the bankruptcy attorney.
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22. Sponsorship and Publicity
22.1 As required by s. 286.25, F.S., if the contractor is a non-governmental organization which sponsors a program financed
wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising,
or describing the sponsorship of the program, state: "Sponsored by the Area Agency on Aging for Southwest Florida,
Inc. and the State of Florida, Department of Elder Affairs." If the sponsorship reference is in written material, the
words "State of Florida, Department of Elder Affairs" shall appear in at least the same size letters or type as the name
of the organization.
22.2 The contractor shall not use the words "The State of Florida, Department of Elder Affairs" to indicate sponsorship of a
program otherwise financed, unless, specific authorization has been obtained by the agency prior to use.
23. Assi2nments
23.1 The contractor shall not assign the rights and responsibilities under this Contract without the prior written approval of
the agency, which shall not be unreasonably withheld. Any sublicense, assignment, or transfer otherwise occurring
without prior written approval of the agency will constitute a material breach of the contract.
23.2 The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations
under this contract to another governmental agency in the State of Florida, upon giving prior written notice to the
contractor. In the event the State of Florida approves transfer of the contractor's obligations, the contractor remains
responsible for all work performed and all expenses incurred in connection with the contract.
23.3 This contract shall remain binding upon the successors in interest of either the contractor or the agency.
24. Subcontracts
24.1 The contractor is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the contractor or its subcontractors. Any subcontracts shall be evidenced by a written
document and subject to any conditions of approval the agency deems necessary. The contractor further agrees that the
agency shall not be liable to the subcontractor in any way or for any reason. The contractor, at its expense, will defend
the agency against any such claims.
24.2 The contractor shall promptly pay any subcontractors upon receipt of payment from the agency or other state agency.
Failure to make payments to any subcontractor in accordance with s. 287.0585, F.S., unless otherwise stated in the
contract between the contractor and subcontractor, will result in a penalty as provided by statute.
25. Independent Capacity of Contractor
It is the intent and understanding of the parties that the contractor, or any of its subcontractors, are independent
contractors and are not employees of the agency and shall not hold themselves out as employees or agents of the
agency without specific authorization from the agency. It is the further intent and understanding of the parties that the
agency does not control the employment practices of the contractor and shall not be liable for any wage and hour,
employment discrimination, or other labor and employment claims against the contractor or its subcontractors. All
deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds
and all necessary insurance for the contractor shall be the sole responsibility of the contractor.
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26. Payment
Payments will be made to the contractor pursuant to s. 215.422, F.S., as services are rendered and invoiced by the
contractor. The agency's Executive Director will have final approval of the invoice for payment, and will approve the
invoice for payment only if the contractor has met all terms and conditions of the contract, unless the bid specifications,
purchase order, or this contract specify otherwise. The approved invoice will be submitted to the agency's finance
section for budgetary approval and processing. Disputes arising over invoicing and payments will be resolved in
accordance with the provisions ofs. 215.422 F.S. A Vendor Ombudsman has been established within the Department
of Financial Services and may be contacted at (850) 413-5665.
27. Return of Funds
The contractor will return to the agency any overpayments due to unearned funds or funds disallowed and any interest
attributable to such funds pursuant to the terms and conditions of this contract that were disbursed to the contractor by
the agency. In the event that the contractor or its independent auditor discovers that an overpayment has been made,
the contractor shall repay said overpayment immediately without prior notification from the agency. In the event that
the agency first discovers an overpayment has been made, the Executive Director, on behalf of the agency, will notify
the contractor by letter of such findings. Should repayment not be made forthwith, the contractor will be charged at the
lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after agency notification or contractor
discovery.
28. Data Inte2rity and Safe2uardin2 Information
The contractor shall insure an appropriate level of data security for the information the contractor is collecting or using
in the performance of this contract. An appropriate level of security includes approving and tracking all contractor
employees that request system or information access and ensuring that user access has been removed from all
terminated employees. The contractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. All data and software must be routinely backed up to insure recovery from losses
or outages of the computer system. The security over the backed-up data is to be as stringent as the protection required
of the primary systems. The contractor shall insure all subcontractors maintain written procedures for computer system
back up and recovery. The contractor shall complete and sign ATTACHMENT IV prior to the execution of this
contract.
29. Computer Use and Social Media Policv
The Department of Elder Affairs has implemented a new Social Media Policy, in addition to its Computer Use Policy,
which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel
affiliated with third parties, such as, but not limited to, Area Agencies on Aging and vendors. Any entity that uses the
Department's computer resource systems must comply with the Department's policy regarding social media. Social
Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social
networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and Y ouTube.
(ATTACHMENT E)
30. Conflict of Interest
The contractor will establish safeguards to prohibit employees, board members, management and subcontractors from
using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of
interest or personal gain. No employee, officer or agent of the contractor or subcontractor shall participate in selection,
or in the award of an agreement supported by State or Federal funds if a conflict of interest, real or apparent, would be
involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member of his/her immediate
family; (c) his or her partner, or; (d) an organization which employs, or is about to employ, any of the above, has a
financial or other interest in the firm selected for award. The contractor or subcontractor's officers, employees or
agents will neither solicit nor accept gratuities, favors or anything of monetary value from contractors, potential
contractors, or parties to subcontracts. The contractor's board members and management must disclose to the
department any relationship which may be, or may be perceived to be, a conflict of interest within thirty (30) calendar
days of an individual's original appointment or placement in that position, or if the individual is serving as an
incumbent, within thirty (30) calendar days of the commencement ofthis contract. The contractor's employees and
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January 2011 Contract OAA 203.11
subcontractors must make the same disclosures described above to the contractor's board of directors. Compliance with
this provision will be monitored.
31. Public Entity Crime
Pursuant to s. 287.133, F.S., the following restrictions are placed on the ability of persons convicted of public entity
crimes to transact business with the agency. A person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any
goods or services to a public entity, may not submit a bid, proposal, or reply on a contract with a public entity for the
construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real
property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant
under a contract with any public entity; and may not transact business with any public entity in excess of the threshold
amount provided in s. 287.017, F.S., for CATEGORY TWO for a period of 36 months following the date of being
placed on the convicted vendor list.
32. Purchasin2
32.1 To purchase articles which are the subject of or are required to carry out this contract from Prison Rehabilitative
Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, F.S., in the same manner and under
the procedures set forth in subsections 946.515(2) and (4), F.S. For purposes of this contract, the contractor shall be
deemed to be substituted for the department insofar as dealings with PRIDE. This clause is not applicable to
subcontractors unless otherwise required by law. An abbreviated list of products/services available from PRIDE may
be obtained by contacting PRIDE, (800) 643-8459.
32.2 To procure any recycled products or materials, which are the subject of or are required to carry out this contract, in
accordance with the provisions of s. 403.7065, F.S.
33. Patents. Copvri2hts. Rovalties
If any discovery, invention or copyrightable material is developed or produced in the course of or as a result of work or
services performed under this contract, the contractor shall refer the discovery, invention or material to the agency to be
referred to the Department of State. Any and all patent rights or copyrights accruing under this contract are hereby
reserved to the State of Florida in accordance with Chapter 286, F.S. Pursuant to s. 287.0571 (5) (k) I and 2 as
amended, the only exceptions to this provision shall be those that are clearly expressed and reasonably valued in the
contract.
33.1 If the primary purpose of this contract is the creation of intellectual property, the state shall retain an unencumbered
right to use such property, notwithstanding any agreement made pursuant to Paragraph 33.
34. Emer2encv Preparedness and Continuity of Operations
34.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety or welfare, the contractor shall, within
thirty (30) calendar days of the execution of this contract, submit to the Executive Director verification of an
emergency preparedness plan. In the event of an emergency, the contractor shall notify the agency of emergency
prOVISIOns.
34.2 In the event, a situation results in a cessation of services by a subcontractor, the contractor will retain responsibility for
performance under this contract and must follow procedures to ensure continuity of operations without interruption.
35. PUR 1000 Form
The PUR 1000 Form is hereby incorporated by reference. In the event of any conflict between the PUR 1000 Form and
any terms or conditions of this contract the terms or conditions of this contract shall take precedence over the PUR
1000 Form. However, if the conflicting terms or conditions in the PUR 1000 Form are required by any section of the
Florida Statutes, the terms or conditions contained in the PUR 1000 Form shall take precedence.
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January 2011 Contract OAA 203.11
36. Use of State Funds to Purchase or Improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon the contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds
provided for at least 5 years from the date of purchase or the completion of the improvements or as further required by
law.
37. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Executive Director, who shall reduce the
decision to writing and serve a copy on the contractor.
38. Financial Consequences of Non-Performance
If the contractor fails to meet the minimum level of service or performance identified in this agreement, or that is
customary for the industry, then the department must apply financial consequences commensurate with the deficiency.
Financial consequences may include but are not limited to contract suspension, refusing payment, withholding
payments until deficiency is cured, tendering only partial payments, and/or cancellation of contract and reacquiring
services from an alternate source.
38.1 The contractor shall not be charged with financial consequences, when a failure to perform arises out of causes that
were the responsibility of the department.
39. No Waiver of Soverei2n Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
40. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Lee County, Florida.
41. Entire Contract
This contract contains all the terms and conditions agreed upon by the parties. No oral agreements or representations
shall be valid or binding upon the department or the contractor unless expressly contained herein or by a written
amendment to this contract signed by both parties.
42. Force Maieure
Neither party shall be liable for any delays or failures in performance due to circumstances beyond its control, provided
the party experiencing the force majeure condition provides immediate written notification to the other party and takes
all reasonable efforts to cure the condition.
43. Severability Clause
The parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
44. Condition Precedent to Contract: Appropriations
The parties agree that the agency's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
45. AdditionlDeletion
The parties agree that the agency reserves the right to add or to delete any of the services required under this contract
when deemed to be in the State's best interest and reduced to a written amendment signed by both parties. The parties
shall negotiate compensation for any additional services added.
46. Waiver
The delay or failure by the agency to exercise or enforce any of its rights under this contract shall not constitute or be
deemed a waiver of the agency's right thereafter to enforce those rights, nor shall any single or partial exercise of any
such right preclude any other or further exercise thereof or the exercise of any other right.
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47. Compliance
The contractor agrees to abide by all applicable current federal statutes, laws, rules and regulations as well as
applicable current State statutes, laws, rules and regulations. The parties agree that failure of the contractor to abide by
these laws shall be deemed an event of default of the contractor, and subject the contract to immediate, unilateral
cancellation of the contract at the discretion of the department.
48. Final Invoice
The contractor shall submit the final invoice for payment to the agency as specified in Paragraph 3.3.4. (date for final
request for payment) of ATTACHMENT I. Ifthe contractor fails to submit final request for payment by the deadline,
then all rights to payment may be forfeited and the agency may not honor any requests submitted after the aforesaid
time period. Any payment due under the terms of this contract may be withheld until all reports due from the
contractor and necessary adjustments thereto have been approved by the agency.
49. Rene2otiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price
level increases and changes in the rate of payment when these have been established through the appropriations process
and subsequently identified in the agency's operating budget.
50. Termination
50.1 This contract may be terminated by either party without cause upon no less than thirty (30) calendar days notice in
writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by
U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the
Executive Director or the representative of the contractor responsible for administration of the contract.
50.2 In the event funds for payment pursuant to this contract become unavailable, the agency may terminate this contract
upon no less than twenty-four (24) hours notice in writing to the contractor. Said notice shall be delivered by U.S.
Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the
Executive Director or the representative of the contractor responsible for administration of the contract. The agency
shall be the final authority as to the availability and adequacy of funds. In the event of termination of this contract, the
contractor will be compensated for any work satisfactorily completed prior to the date of termination.
50.3 This contract may be terminated for cause upon no less than twenty-four (24) hours notice in writing to the contractor.
If applicable, the agency may employ the default provisions in Rule 60A-l.006(3), F .A.C. Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a
modification of the terms and conditions of this contract. The provisions herein do not limit the agency's or the
contractor's rights to remedies at law or in equity.
50.4 Failure to have performed any contractual obligations with the agency in a manner satisfactory to the agency will be a
sufficient cause for termination. To be terminated as a contractor under this provision, the contractor must have (1)
previously failed to satisfactorily perform in a contract with the agency, been notified by the agency of the
unsatisfactory performance and failed to correct the unsatisfactory performance to the satisfaction of the agency; or (2)
had a contract terminated by the agency for cause.
51. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
The contractor name, as shown on page 1 of this contract, Collier County Housing, Human and Veteran Services
a. and mailing address ofthe official payee to whom the 3301 E Tamiami Trail, Building H
payment shall be made is: Naples, FL 34112
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C t t OAA 203.11
uary on rac
Marcy Krumbine, Director
The name of the contact person and street address where Collier County Housing, Human and Veteran Services
b. 3301 E Tamiami Trail, Building H
financial and administrative records are maintained is: Naples, FL 34112
(239) 252-2273
Marcy Krumbine, Director
c. The name, address, and telephone number of the Collier County Housing, Human and Veteran Services
representative of the contractor responsible for 3301 E Tamiami Trail, Building H
administration of the program under this contract is: Naples, FL 34112
(239) 252-2273
d. The section and location within the agency where Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure forms 1520 I N Cleveland A venue, Suite 1100
are to be mailed is: North Fort Myers, FL 33903
Leigh Schield, Executive Director
The name, address, and telephone number of the Area Agency on Aging for Southwest Florida, Inc.
e. 15201 N. Cleveland Avenue, Suite. 1100
Executive Director for the agency for this contract is: North Fort Myers, FL 33903
(239) 652-6900
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
52. All Terms and Conditions Included
This contract and its Attachments, I - XI, A, B, D, and E, and any exhibits referenced in said attachments, together
with any documents incorporated by reference, contain all the terms and conditions agreed upon by the parties. There
are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede
all previous communications, representations or agreements, either written or verbal between the parties.
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Contract OAA 203.11
By signing this contract, the parties agree that they have read and agree to the entire contract. This contract will be effective on
January 1,2011.
IN WITNESS THEREOF, the parties hereto have caused this 45 page contract, to be executed by their undersigned officials as
duly authorized.
Contractor:
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Area on Aging for Southwest Florida, Inc
SIGNED BY:
SIGNEDBy:~;f;fL~.
NAME: Leigh't::Nowak
FRED W. COYLE
NAME:
TITLE:
CHAIR MAN
TITLE: Board President
DATE: January 25,2011
DATE:
Federal Tax ID: 59-60000558
Fiscal Year Ending Date: 9/30
ATTEST:
By:
tl
Approved as to form and
legal sufficiency:
~\--B "^-.) .~
'-'"
Jennifer B. White
Assistance County Attorney
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Contract OAA 203.11
INDEX TO CONTRACT ATTACHMENTS
ATTACHMENT ATTACHMENT DESCRIPTION PAGE
ATTACHMENT I STATEMENT OF WORK 14-25
ATTACHMENT II CERTIFICATION REGARDING LOBBYING, CERTIFICATION FOR 26
CONTRACTS, GRANTS, LOANS AND AGREEMENTS
ATTACHMENT III FINANCIAL COMPLIANCE AUDIT 27-31
ATTACHMENT IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR 32
AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
ATTACHMENT V CERTIFICATION REGARDING DEBARMENT, SUSPENSION, 33
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS/SUBCONTRACTS
A TT ACHMENT VI ASSURANCES - NON-CONSTRUCTION PROGRAMS 34-35
ATTACHMENT VII OLDER AMERICANS ACT BUDGET SUMMARY 36
ATTACHMENT VIII OLDER AMERICANS ACT RATE SUMMARY-IIIB, IIIE, Cl and C2 37
ATTACHMENT IX OLDER AMERICANS ACT CONTRACT REPORT CALENDAR ADVANCE 38
BASIS CONTRACT
ATTACHMENT X REQUEST FOR PAYMENT 39
ATTACHMENT XI, RECEIPTS AND EXPENDITURES, TITLE IIIB, IIIC1, AND IIIC2 40
EXHIBIT 1
ATTACHMENT XI, RECEIPTS AND EXPENDITURES, TITLE IIIE 41
EXHIBIT 2
ATTACHMENT A DEPARTMENT OF ELDER AFFAIRS' PROGRAMS & SERVICES 42
HANDBOOK (ON CD)
ATTACHMENT B DEPARTMENT OF ELDER AFFAIRS' CIVIL RIGHTS COMPLIANCE 43
CHECKLIST AND INSTRUCTIONS
ATTACHMENTD PROVIDER'S STATE CONTRACTS LIST 44
ATTACHMENT E DEPARTMENT OF ELDER AFFAIRS' COMPUTER USE AND SOCIAL 45
MEDIA POLICY
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January 2011 Contract OAA 203.11
ATTACHMENT I
AREA ON AGING FOR SOUTHWEST FLORIDA, INC.
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE III
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 CONTRACT ACRONYMS
ADL - Activities of Daily Living
APS - Adult Protective Services
AIRS - Alliance of Information & Referral Systems
ADA - Americans with Disabilities Act
AAA - Area Agency on Aging
APCL - Assessed Priority Consumer List
CIRTS - Client Information and Registration Tracking System
FLAIRS - Florida Alliance of Information and Referral Services
I&R - Information and Referral
IADL - Instrumental Activities of Daily Living
MOA - Memorandum of Agreement
MOU - Memorandum of Understanding
OAA - Older Americans Act
PSAs - Planning and Service Areas
WebDB - Web-based Database System
1.1.2 PROGRAM SPECIFIC TERMS
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and coordinated service delivery
system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Act
and department instructions.
Area Plan Update: A revision to the area plan wherein the area agency on aging enters OAA specific data in the
web-based database system (WebDB). An update may also include other revisions to the area plan as instructed by
the department.
Child: An individual who is not more than 18 years of age or an individual with disability.
Family Caregiver: An adult family member, or another individual, who is an informal provider of in-home and
community care to an older individual.
Frail: When an older individual is unable to perform at least two activities of daily living (ADL) without substantial
human assistance, including verbal reminding, physical cueing or supervision; or due to cognitive or other mental
impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or
safety hazard to the individual or to another individual.
Grandparent: A grandparent or step-grandparent of a child, or a relative of a child by blood, marriage or adoption
and who lives with the child; is the primary caregiver of the child because the biological or adoptive parents are
unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the child, such as
legal custody or guardianship, or is raising the child informally.
1.2 AGENCY MISSION, VISION AND VALUES STATEMENT
The agency's mission: To help aging adults achieve greater independence through awareness of resources and access
to qualified service providers. The agency's vision: To be the recognized leader in supporting older adults and their
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January 2011 Contract OAA 203.11
families with access to trustworthy resources and services in their communities while empowering them to live with
independence and dignity. The agency's values: We believe residents of Southwest Florida are entitled to:
Comprehensive information about their choices of care; Timely access to resources and services; High standards of
quality and performance; and Personal and professional accountability from all stakeholders.
1.2.1 Older Americans Act Program Mission Statement
The Older Americans Act (OAA) Program is a federal program initiative that provides assistance to older persons and
caregivers and is the only federal supportive services program directed solely toward improving the lives of older
people. The program provides a framework for a partnership among the different levels of government and the public
and private sectors with a common objective, improving the quality of life for all older individuals by helping them to
remain independent and productive.
1.3 GENERAL DESCRIPTION
1.3.1 General Statement
The primary purpose of the OAA program is to foster the development and implementation of comprehensive and
coordinated systems to serve older individuals. The OAA program uses these systems to assist older individuals to
attain and maintain maximum independence and dignity in a home environment and allows for the capability of self-
care with appropriate supportive services.
1.3.2 Authority
The relevant references authority governing the OAA program are:
(1) Older Americans Act of 2006, as amended;
(2) Rule 58A-1, Florida Administrative Code; and
(3) Section 430.101, Florida Statutes.
1.3.3
1.3.4
1.4
1.4.1
1.4.1.1
1.4.1.2
Scope of Service
The agency is responsible for the programmatic, fiscal, and operational management of the Title IIIB, Title IIIC1,
Title IIIC2 and Title IIIE programs of the Older Americans Act within its designated Planning and Service Area
(PSA). The scope of service includes planning, coordinating and assessing the needs of older persons, and assuring
the availability and quality of services. The services shall be provided in a manner consistent with and described in
the current contractor's RFP Proposal, the Area on Aging for Southwest Florida, Inc.'s area plan update and the
current Department of Elder Affairs Programs and Services Handbook (ATTACHMENT A).
Major Program Goals
The major goals of the OAA program are to improve the quality of life for older individuals, preserve their
independence and prevent or delay more costly institutional care. These goals are achieved through the implementation
of a comprehensive and coordinated service system that provides a continuum of service alternatives that meet the
diverse needs of elders and their caregivers.
INDIVIDUALS TO BE SERVED
Eligibility (Title III Programs)
OAA Title III, General
Consumers shall not be dually enrolled in an OAA program and a Medicaid capitated long-term care program.
OAA Title IIIB, Supportive Services
(1) Individuals age 60 or older; and
(2) Information and Referral/Assistance services are provided to individuals regardless of age.
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1.4.1.3 OAA Titles IIICl and C2, Nutrition Services, General
General factors that should be considered in establishing priority for Nutrition Services, both CI and C2, include
those older persons who:
(1) Cannot afford to eat adequately;
(2) Lack the skills or knowledge to select and prepare nourishing and well-balanced meals;
(3) Have limited mobility which may impair their capacity to shop and cook for themselves; or
(4) Have a disabling illness or physical condition requiring nutritional support or have been screened at a high
nutritional risk.
1.4.1.3.1 OAA Title IIIC1, Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I, Paragraph
1.4.1.3 individuals must be mobile, not homebound and physically, mentally and medically able to attend a
congregate nutrition program. Individuals eligible to receive congregate meals include:
(1) Individuals age 60 or older; and
(2) Any spouse (regardless of age) who attends the dining center with his/her eligible spouse;
(3) Persons with a disability, regardless of age, who reside in a housing facility occupied primarily by older
individuals where congregate nutrition services are provided;
(4) Disabled persons who reside at home with and accompany an eligible person to the dining center; and
(5) Volunteers, regardless of age, who provide essential services on a regular basis during meal hours.
1.4.1.3.2 OAA Title IIIC2, Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I, Paragraph
1.4.1.3, individuals must be homebound and physically, mentally or medically unable to attend a congregate nutrition
program. Individuals eligible to receive home delivered meals include:
(1) Individuals age 60 or older who are homebound by reason of illness, disability or isolation;
(2) The spouse of a homebound eligible individual, regardless of age, if the provision of the collateral meal supports
maintaining the person at home;
(3) Individuals with disabilities, regardless of age, who reside at home with eligible individuals and are dependent on
them for care; and
(4) Persons at nutritional risk who have physical, emotional or behavioral conditions, which would make their
presence at the congregate site inappropriate; and persons at nutritional risk who are socially or otherwise
isolated and unable to attend a congregate nutrition site.
1.4.1.4
OAA Title IIIE, Caregiver Support Services
(1) Family caregivers of individuals age 60 or older;
(2) Grandparents (age 55 or older) or older individuals (age 55 or older) who are relative caregivers;
(3) Priority will be given to family caregivers who provide care for individuals with Alzheimer's disease and related
disorders with neurological and organic brain dysfunction and for grandparents or older individuals who are
relative caregivers who provide care for children with severe disabilities; and
(4) For respite and supplemental services, a family caregiver must be providing care for an older individual who
meets the definition of the term "frail" in OAA, Section 102 Paragraph 22.
1.4.2 Targeted Groups
Preference shall be given to those with the greatest economic and social needs, with particular attention to low-
income older individuals, including those that are low-income minorities, have limited English proficiency, and older
individuals residing in rural areas.
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SECTION II - MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the OAA program, the contractor shall ensure the following tasks are performed:
(1) Client eligibility determination;
(2) Targeting and screening of service delivery for new clients;
(3) Delivery of services to eligible clients;
(4) Use of volunteers to expand the provision of available services;
(5) Monitoring the performance of its subcontractors; and
(6) Information and Referral/Assistance Access Services (Elder Helplines).
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Contract OAA 203.11
2.1.1 Client Eligibility Determination as listed in ATTACHMENT I, Paragraph 1.4.
2.1.2 Targeting and Screening of Service Delivery for New Clients
The contractor shall develop and implement policies and procedures consistent with OAA targeting and screening
criteria.
2.1.3 Delivery of Services to Eligible Clients
The contractor shall provide a continuum of services that meets the diverse needs of elders and their caregivers. The
contractor shall perform and report performance of the following services in accordance with ATTACHMENT A. The
services funded pursuant to this contract are in accordance with the OAA, Title III, sections 321, 331, 336, and 373 as
follows:
(1) Section 321, Title HID Supportive Services;
(2) Section 331, Title IIIC 1 Congregate Nutrition Services;
(3) Section 336, Title IIIC2 Home Delivered Nutrition Services; and
(4) Section 373, Title HIE Caregiver Support Services.
2.1.3.1
Supportive Services
Supportive services include a variety of community-based and home-delivered services that support the quality of life
for older individuals by helping them remain independent and productive. Services include the following:
(1) Adult Day Care/Adult Day Health Care; (12) Personal Care;
(2) Caregiver Training/Support; (13) Physical Therapy;
(3) Case Aid/Case Management; (14) Recreation;
(4) Chore Services; (15) Emergency Alert Response;
(5) Companionship; (16) Escort;
(6) Counseling (Gerontological and Mental (17) Health Support;
Health);
(7) Education/Training;
(8) Legal Assistance;
(9) Material Aid;
(10) Occupational Therapy;
(11) Outreach;
(18) Home Health Aid;
(19) Homemaker;
(20) Housing Improvement;
(21) Information;
(22) Intake;
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January 2011
(23)
(24)
(25)
(26)
(27)
2.1.3.2
2.1.3.3
2.1.3.4
Interpreter/Translating;
Referral! Assistance;
Respite Services;
Screening/Assessment;
Shopping Assistance;
(28) Skilled Nursing;
(29) Specialized Medical Equipment, Services, and
Supplies
(30) Speech Therapy;
(31) Telephone Reassurance; and
(32) Transportation
Congregate Nutrition Services
Nutrition services are provided in congregate settings and are designed to reduce hunger and food insecurity, promote
socialization and the health and well being of older individuals by assisting them to gain access to nutrition and other
disease prevention and health promotion services. Services include:
(1) Congregate meals;
(2) Congregate meals screening;
(3) Nutrition education and nutrition counseling; and
(4) Outreach.
Home Delivered Nutrition Services
In-home nutrition services are provided to reduce hunger and food insecurity; promote socialization and the health
and well being of older individuals by assisting such individuals to gain access to nutrition and other disease
prevention and health promotion services. Services include:
(1) Home delivered meals;
(2) Nutrition education and counseling; and
(3) Outreach.
Caregiver Support Services (IIIE Program)
The following services are intended to provide direct help to caregivers, assist in the areas of health, nutrition and
financial literacy and assist caregivers in making decisions and problem solving related to their caregiving roles and
responsibilities:
(1) Adult Day Care/Adult Day Health Care;
(2) Caregiver Training/Support;
(3) Counseling (Gerontological and Mental Health);
(4) Education/Training;
(5) Financial Risk Reduction (Assessment and Maintenance);
(6) Information;
(7) Intake;
(8) Outreach;
(9) Referral/Assistance;
(10) Respite Services;
(11) Screening/Assessment; and
(12) Transportation.
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January 2011 Contract OAA 203.11
2.1.3.5 Caregiver Support Supplemental Services (IllES Program): At least 10 percent, but no more than 20 percent, of
the total Title IIIE funds shall be used to provide supplemental support services. The following services are provided
to complement the care provided by caregivers.
(1) Chore Services;
(2) Housing Improvement;
(3) Legal Assistance;
(4) Material Aid; and
(5) Specialized Medical Equipment, Services and Supplies.
2.1.3.6
2.1.4
2.1.5
2.1.5.1
Caregiver Support Grandparent Services (IIIEG Program): At least 5 percent, but no more than 10 percent, of
the total Title IIIE funds shall be used to provide support services to grandparents and older individuals who are
relative caregivers. Services for grandparents or older individuals who are relative caregivers designed to help meet
their caregiving obligations include:
(1) Caregiver Training/Support; (7) Outreach;
(2) Child Day Care; (8) Referral/Assistance;
(3) Counseling (Gerontological and Mental Health); (9) Screening/Assessment;
(4) Education/Training; (10) Sitter; and
(5) Information; (11) Transportation
(6) Legal Assistance;
Use of Volunteers to Expand the Provision of Available Services
The contractor shall make use of trained volunteers in providing direct services delivered to older individuals and
individuals with disabilities needing such services. If possible, the contractor shall work in coordination with
organizations that have experience in providing training, placement, and stipends for volunteers or participants (such
as organizations carrying out Federal service programs administered by the Corporation for National and Community
Service), in community service settings.
Monitoring the Performance of Subcontractors
The agency shall conduct at least one monitoring per year of each subcontractor. The contractor shall perform fiscal,
administrative and programmatic monitoring of each subcontractor to ensure contractual compliance, fiscal
accountability, programmatic performance, and compliance with applicable state and federal laws and regulations.
Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the contractor shall not delay the
implementation of its agreement with the subcontractor. If any circumstances occur that may result in a delay for a
period of 60 days or more of the initiation of the subcontract or in the performance of the subcontractor, the
contractor shall notifY the agency's Executive Director in writing of such delay.
The agency shall not permit a subcontractor to perform services related to this agreement without having a binding
subcontractor agreement executed. In accordance with Paragraph 24.1 of the Standard Agreement, the agency will
not be responsible or liable for any obligations or claims resulting from such action.
2.2 SERVICE LOCATION AND EQUIPMENT
2.2.1 Service Times
The contractor shall ensure the provision of the services listed in the contract during normal business hours unless
other times are more appropriate to meet the performance requirements of the contract, and it shall monitor its
subcontractors to ensure they are available to provide services during hours responsive to client needs and during
those times which best meet the needs of the relevant service community.
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January 2011
2.3 Equipment
16 Qn3ctOAA1203.11
2.3.1 Equipment means: (a) an article of nonexpendable, tangible personal property having a useful life of more than one
year and an acquisition cost which equals or exceeds the lesser of the capitalization level established by the
organization for the financial statement purposes, or $5,000.00 [for federal funds], or (b); nonexpendable, tangible
personal property of a nonconsumable nature with an acquisition cost of $1,000.00 or more per unit, and expected
useful life of at least one year; and hardback bound books not circulated to students or the general public, with a value
or cost of $250.00 or more [for state funds].
2.3.2 Contractors and sub-contractors who are Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 215 Administrative
Requirements (formerly OMB Circular A-II0) that include: (a) a property list with all the elements identified in the
circular; and, (b) a procedure for conducting a physical inventory of equipment at least once every two years. The
property records must be maintained on file and shall be provided to the agency upon request.
2.3.3 The contractor's property management standards for equipment acquired with Federal funds and federally-owned
equipment shall include accurately maintained equipment records with the following information:
(1) A description ofthe equipment;
(2) Manufacturer's serial number, model number, Federal stock number, national stock number, or other
identification number;
(3) Source of the equipment, including the award number;
(4) Whether title vests in the contractor or the Federal Government;
(5) Acquisition date (or date received, if the equipment was furnished by the Federal Government) and cost;
(6) Information from which one can calculate the percentage of Federal participation in the cost of the equipment
(not applicable to equipment furnished by the Federal Government);
(7) Location and condition of the equipment and the date the information was reported;
(8) Unit acquisition cost; and
(9) Ultimate disposition data, including date of disposal and sales price or the method used to determine current fair
market value where a contractor compensates the Federal awarding agency for its share.
2.3.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with state
funds with an acquisition cost over $1,000.00 that is specifically identified in the area plan approved by the
department is part of the cost of carrying out the activities and functions of the grant awards and Title (ownership)
will vest in the contractor, subject to the conditions of2 CFR Part 215 Administrative Requirements (formerly OMB
Circular A-II 0), Subpart C, Paragraph 34. Equipment purchased under these thresholds is considered supplies and is
not subject to property standards. Equipment purchased with funds identified in the budget attachments to agreements
covered by this contract, or identified in the sub-agreements with sub-contractors (not included in a cost
methodology), is subject to the conditions of Chapter 273, F. S. and 60A-1.0017, F. A. C. or Title 45 CFR Part 74.
2.3.5 The contractor shall not dispose of any equipment or materials provided by the agency, or purchased with funds
provided through this contract without first obtaining the approval of the agency's Executive Director. When
disposing of property or equipment the contractor must submit a written request for disposition instructions to the
respective Executive Director. The request should include a brief description of the property, purchase price, funding
source, percentage of state or federal participation, acquisition date and condition of the property. The request should
also indicate the contractor's proposed disposition (i.e., transfer or donation to another agency that administers federal
programs, offer the items for sale, destroy the items, etc.).
2.3.6 The agency's Executive Director will issue disposition instructions. If disposition instructions are not received within
120 days of the written request for disposition, the contractor is authorized to proceed as directed in 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A-II0).
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January 2011 Contract OAA 203.11
2.3.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds through
agreements covered under this contract without the prior approval of the agency. Real property purchases from Older
Americans Act funds are subject to the provisions of Title 42, Chapter 35, Subchapter III, Part A., Sec. 3030b United
States Code (USe). Real property purchases from state funds can only be made through a fixed capital outlay grants
and aids appropriation and therefore are subject to the provisions of s. 216.348, F. S.
2.3.8 Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and tested prior to
disposal to ensure no confidential information remains.
2.3.9 The contractor must adhere to the agency's procedures and standards when purchasing Information Technology
Resources (lTR) as part of any agreement(s) incorporating this contract by reference. An ITR worksheet is required
for any computer related item costing $1,000.00 or more, including data processing hardware, software, services,
supplies, maintenance, training, personnel and facilities. The completed ITR worksheet shall be maintained in the
LAN administrator's file and must be provided to the agency upon request. The contractor has the responsibility to
require any subcontractors to comply with the agency's ITR procedures.
2.4 DELIVERABLES
2.4.1 Service Unit
The contractor shall provide the services described in the contract in accordance with ATTACHMENT A. The chart
below lists the services that can be performed and the unit of measurement.
Services U nit of Service
Adult Day Care/Adult Day Health Care
Caregiver Training/Support
Case Aid/Case Management
Child Day Care
Chore Services
Companionship
Congregate Meals Screening
Counseling Services
Escort
Financial Risk Reduction Services
Health Support
Home Health Aide
Homemaker
Housing Improvement
Intake
Interpreter/Translating
Legal Assistance
Medication Management
Mental Health Counseling/Screening
Nutrition Counseling
Occupational Therapy
Personal Care
Physical Therapy
Recreation
Respite Services
Screening/Assessment
Sitter
Skilled Nursing Services
Speech Therapy
Hour
Services (Continuation) Unit of Ser\'ice
Emergency Alert Response
Day
Education/Training
Information
Material Aid
Nutrition Education
Outreach
Referral! Assistance
Specialized Medical Equipment, Services and Supplies
Telephone Reassurance
Episode
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16 D3
Contract OAA 203.11
Escort
Shopping Assistance One-Way Trip
Transportation
Congregate and Home Delivered Meals Meal
2.5 REPORTS
The contractor is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the agency. The contractor must establish due dates for any subcontractors that
permit the contractor to meet the agency's reporting requirements.
2.5.1 Client Information and Registration Tracking System (CIRTS) Reports
The contractor is required to use CIRTS reports in the web-based CIRTS database system to ensure data accuracy.
The report categories include:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports;
(4) Miscellaneous Reports;
(5) Fiscal Reports;
(6) Aging Resource Center Reports; and
(7) Outcome Measurement Reports.
2.5.2 Service Costs Reports
The agency requires the contractor to submit semi-annual service cost reports by August 15 (covering the months of
January through June) and February 15 (covering the months of July through December), which reflect actual costs of
providing each service by program. This report provides information for planning and negotiating unit rates.
2.5.3 Surplus/Deficit Report
The contractor will submit a consolidated surplus/deficit report in a format provided by the agency to the agency's
Fiscal Department by the 18th of each month. This report is for all agreements and/or contracts between the
contractor and the agency. The report shall include the following:
(1) The contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the
agency will be resolved;
(2) Recommendations to transfer funds to resolve surplus/deficit spending; and
(3) Input from the contractor's Board of Directors on resolution of spending issues, if applicable.
2.6 RECORDS AND DOCUMENTATION
The contractor will ensure the collection and maintenance of client and service information on a monthly basis from
the CIRTS or any such system designated by the agency. Maintenance includes valid exports and backups of all data
and systems according to department and agency standards.
2.6.1 Each contractor and subcontractor, among other requirements, must anticipate and prepare for the loss of information
processing capabilities. The contractor shall maintain written policies and procedures for computer system backup
and recovery and shall have the same requirement in its contracts and/or agreements with subcontractors. These
policies and procedures shall be made available to the agency upon request.
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2.7 PERFORMANCE SPECIFICATIONS
16 D3
Contract OAA 203.11
2.7.1 The performance of the contractor in providing the services described in this contract shall be measured by the
current Area Plan strategies for the following criteria:
(1) Percent of most frail elders who remain at home or in the community instead of going into a nursing home;
(2) Percent of Adult Protective Services (APS) referrals who are in need of immediate services to prevent further
harm who are served within 72 hours;
(3) Average monthly savings per consumer for home and community-based care versus nursing home care for
comparable client groups;
(4) Percent of elders assessed with high or moderate risk environments who improved their environment score;
(5) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved;
(6) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(7) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(8) Percent of family and family-assisted caregivers who self-report they are very likely to provide care;
(9) Percent of caregivers whose ability to continue to provide care is maintained or improved after one year of
service intervention (as determined by the caregiver and the assessor); and
(10) Percent of customers who are at imminent risk of nursing home placement who are served with community
based services.
2.7.2 Monitoring and Evaluation Methodology
The agency will review and evaluate the performance of the contractor under the terms of this contract. Monitoring
shall be conducted through direct contact with the contractor through telephone, in writing, and/or an on-site visit.
The agency's determination of acceptable performance shall be conclusive. The contractor agrees to cooperate with
the agency in monitoring the progress of completion of the service tasks and deliverables.
2.7.3 Remedies-Nonconformine: Services
The contractor shall ensure that all participants served under this agreement are eligible for the program, and that all
monthly and/or quarterly performance reports and financial records are maintained for each reporting period and
submitted as stipulated in Paragraphs 1.4 - 1.4.2 and 2.1 - 2.1.6.
Any nonconforming program services, performance reports or financial records not meeting the aforementioned
requirements shall not be eligible for reimbursement under this program. The costs associated with enrolling,
training, reporting and/or managing the program shall be borne solely by the contractor. The department requires
immediate notice of any significant and/or systemic infractions that compromise the contractor's ability to provide
participant services, to achieve programmatic performance or to provide sound financial management of the program.
2.8 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.8.1 Matching, Level of Effort, and Earmarking Requirements
The contractor will assure, through a provision in subcontracts, a match requirement of at least 10 percent of the cost
for all services funded through this contract. The subcontractor's match will be made in the form of cash and/or in-
kind resources. Match must be reported by title each month. At the end of the contract period, all OAA funds must
be properly matched.
2.8.2 Consumer Contributions
(1) The contractor assures compliance with Section 315 of the Older Americans Act as amended in 2006, in regard
to consumer contributions;
(2) Voluntary contributions are not to be used for cost sharing or matching;
23
January 2011
(3)
(4)
16 0 3ntractOAA203.11
Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and
Voluntary contributions are to be used only to expand services.
2.8.3 Use of Service Dollars
The contractor is expected to spend all federal, state and other funds provided by the department for the purpose
specified in the contract. The contractor must manage the service dollars in such a manner so as to avoid having a
wait list and a surplus of funds at the end of the contract period, for each program managed by the contractor. If the
department determines that the contractor is not spending service funds accordingly, the department may transfer
funds to other PSAs during the contract period and/or adjust subsequent funding allocations accordingly, as allowable
under state and federal law.
2.8.4 The contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary,
ATTACHMENT VII to this contract. Any changes in the amounts of federal or general revenue funds identified on
the Budget Summary form require a contract amendment.
2.8.5 Title III Funds
The contractor assures compliance with Section 306 of the Older Americans Act, as amended in 2006, that funds
received under Title III will not be used to pay any part of a cost (including an administrative cost) incurred by the
contractor to maintain a contractual or commercial relationship that is not carried out to implement Title HI.
2.9 AGENCY RESPONSffiILITIES
2.9.1 Program Guidance and Technical Assistance
The agency will provide to the contractor guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the contractor.
2.9.2 Contract Monitoring
The agency shall, at its own discretion, conduct monitoring concerning any aspect of the contractor's performance of
this contract.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for administration costs, and fixed
rate for services. The contractor shall ensure fixed rates for services include only those costs that are in accordance
with all applicable state and federal statutes and regulations and are based on audited historical costs in instances
where an independent audit is required. The contractor shall consolidate all requests for payment from subcontractors
and expenditure reports that support requests for payment and shall submit to the agency on forms 106A
(ATTACHMENT X),105AS (ATTACHMENT XI-EXHIBIT 1), and 105AE (ATTACHMENT XI-EXHIBIT 2).
3.1.1 The contractor agrees to implement the distribution of funds as detailed in ATTACHMENT VII, Budget Summary.
An amendment is required to change the total amount of the contract.
3.2 Advance Payments
3.2.1 The contractor may request up to two months of advances at the start of the contract period, if available, to cover
program administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the agency by the State of Florida ("budget release"). The contractor shall provide the
agency's Executive Director documentation justifYing the need for an advance and describing how the funds will be
distributed.
3.2.2 The contractor's requests for advance require the approval of the agency's Executive Director. If sufficient budget is
available, the agency will issue approved advance payments after January 1,2011.
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January 2011 Contract OAA 203.11
3.2.3 Requests for the first through the twelfth months shall be based on the submission of actual monthly expenditure
reports beginning with the first month of the contract. The schedule for submission of advance requests, if available is
shown on ATTACHMENT IX of this contract.
3.2.4 All advanced payments made to the contractor shall be recouped in accordance with the Reporting Schedule,
ATTACHMENT IX of this contract.
3.2.5 Interest earned on advances must be identified separately by source of funds, state or federal. Contractors shall
maintain advances of federal funds in interest bearing accounts unless otherwise excepted in accordance with 45 CFR
74.22(k). Earned interest must be returned to the department at the end of each quarter.
3.3 Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA forms
106A (ATTACHMENT X), 105AS (ATTACHMENT XI-EXHffiIT 1) and 105AE (ATTACHMENT XI-
EXHffiIT 2).
3.3.1 All payment requests shall be based on the submission of actual monthly expenditure reports beginning with the first
month of the contract. The billing cut-off date is the last Friday of each month. The payment requests are due to the
agency by close of business on the date specified on the Invoice Schedule, ATTACHMENT IX to this contract.
3.3.2 Any payment due by the agency under the terms of this contract may be withheld pending the receipt and approval of
all financial and programmatic reports due from the contractor and any adjustments thereto, including any
disallowance not resolved as outlined in Paragraph 26 of this contract.
3.3.3 Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in
ATTACHMENT VII, Budget Summary. Any changes in the amounts of federal or general revenue funds
identified on the Budget Summary form require a contract amendment.
3.3.4 Date for Final Request for Payment
The final request for payment will be due to the agency no later than February 15,2012.
3.4 Documentation for Payment
The contractor shall maintain documentation to support payment requests that shall be available to the agency or
authorized individuals, such as Department of Financial Services, upon request.
3.4.1 The contractor shall ensure subcontractors enter all required data per the department's CIRTS Policy Guidelines for
clients and services in the CIRTS database. Data must be entered into CIRTS before the subcontractors submit their
request for payment and expenditure reports to the contractor. The contractor shall establish time frames to assure
compliance with due dates for the requests for payment and expenditure reports to the agency.
3.4.2 The contractor will require subcontractors to run monthly CIRTS reports and verifY that client and service data in
CIRTS is accurate. This report must be submitted to the contractor with the monthly request for payment and
expenditure report and must be reviewed by the contractor before the subcontractor's request can be approved by the
contractor.
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. January 2011
16
07
elntract OAA 203.11
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress, an
officer or employee of congress, an employee of a member of congress, or an officer or employee of the state legislator, in
connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting
to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an
employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at
all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-
contractors shall certifY and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section
1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less
than $10,000.00 and not more than 100,000.00 for each such failure.
FRED W. COYLE
o A A 203.11
,
Signature
January 25, 2011
Date
Name of Authorized Individual
Application or Agreement Number
Board of County Commissioners; 3299 Tamiami Trail, E., Suite 303, Naples, FL 3a112
Name and Address of Organization
Approved as to form & legal Sufficiency
DOEA Form 103
(Revised Nov 2002)
~~~~._--
Assistant County Attorney
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16 D3 .
Contract OAA 203.11
ATTACHMENT III
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Department of Elder Affairs to the provider may be subject to audits and/or
monitoring by the Department of Elder Affairs, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S., (see
"AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the department staff, limited
scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this agreement, the
provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Department of
Elder Affairs. In the event the Department of Elder Affairs determines that a limited scope audit of the provider is appropriate,
the provider agrees to comply with any additional instructions provided by the Department of Elder Affairs to the provider
regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or
audits deemed necessary by the Chief Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB Circular A-
133, as revised.
In the event that the provider expends $500,000.00 or more in Federal awards during its fiscal year, the provider must have a
single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. EXHIDIT 1
to this agreement indicates Federal resources awarded through the Department of Elder Affairs by this agreement. In
determining the Federal awards expended in its fiscal year, the provider shall consider all sources of Federal awards, including
Federal resources received from the Department of Elder Affairs. The determination of amounts of Federal awards expended
should be in accordance with the guidelines established by OMB Circular A-133, as revised. An audit of the provider conducted
by the Auditor General in accordance with the provisions ofOMB Circular A-133, as revised, will meet the requirements of this
part.
In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the requirements relative to
auditee responsibilities as provided in Subpart C ofOMB Circular A-133, as revised.
If the provider expends less than $500,000.00 in Federal awards in its fiscal year, an audit conducted in accordance with the
provisions ofOMB Circular A-133, as revised, is not required. In the event that the provider expends less than $500,000.00 in
Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-
133, as revised, the cost of the audit must be paid from non-Federal resources (i.e., the cost of such audit must be paid from
provider resources obtained from other than Federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs shall be based on the agreement's requirements,
including any rules, regulations, or statutes referenced in the agreement. The financial statements shall disclose whether or not
the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Department of
Elder Affairs shall be fully disclosed in the audit report with reference to the Department of Elder Affairs agreement involved. If
not otherwise disclosed as required by Section .31 O(b )(2) of OMB Circular A-133, as revised, the schedule of expenditures of
Federal awards shall identifY expenditures by agreement number for each agreement with the Department of Elder Affairs in
effect during the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30
days after receipt of the audit report or 9 months after the end of the provider's fiscal year end.
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January 2011
PART II: STATE FUNDED
16 0 ~ntract O~A 203.11
This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes.
In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000.00 in any
fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider must have a State single or
project-specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of the Department
of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),
Rules of the Auditor General. EXHIDIT I to this agreement indicates state financial assistance awarded through the Department
of Elder Affairs by this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall
consider all sources of state financial assistance, including state financial assistance received from the Department of Elder
Affairs, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-
through awards and resources received by a nonstate entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1, the provider shall ensure that the audit complies with
the requirements of Section 215.97(8), Florida Statutes. This includes submission ofa financial reporting package as defined by
Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations), Rules of the Auditor General.
If the provider expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending September 30,
2004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, is not required. In
the event that the provider expends less than $500,000.00 in state financial assistance in its fiscal year and elects to have an audit
conducted in accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit must be paid from the
nonstate entity's resources (i.e., the cost of such an audit must be paid from the provider resources obtained from other than State
entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs shall be based on the agreement's requirements,
including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching
requirement was met for each applicable agreement. All questioned costs and liabilities due to the Department of Elder Affairs
shall be fully disclosed in the audit report with reference to the Department of Elder Affairs agreement involved. If not
otherwise disclosed as required by Rule 691-5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance
shall identifY expenditures by agreement number for each agreement with the Department of Elder Affairs in effect during the
audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit
report, but no later than 12 months after the provider's fiscal year end for local governmental entities. Non-profit or for-profit
organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after the
provider's fiscal year end. Notwithstanding the applicability of this portion, the Department of Elder Affairs retains all right and
obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I
of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the
provider directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Leigh Schield, Executive Director
15201 N. Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
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January 2011 Contract OAA 203.11
The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by Sections
.320 (d)(1) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the following
address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMB Circular A-133, as revised.
Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a copy of the reporting package
described in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the auditor, to the Area
Agency on Aging for Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Leigh Schield, Executive Director
15201 N. Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on behalf of
the provider directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Leigh Schield, Executive Director
15201 N. Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Area Agency on Aging for Southwest
Florida, Inc. pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-133, Florida Statutes, and
Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General,
as applicable.
Providers, when submitting financial reporting packages to the Area Agency on Aging for Southwest Florida, Inc. for audits
done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-
profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to the
provider in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six
years from the date the audit report is issued, and shall allow the Department of Elder Affairs or its designee, Area Agency on
Aging for Southwest Florida, Inc., the CFO or Auditor General access to such records upon request. The provider shall ensure
that audit working papers are made available to the Department of Elder Affairs, or its designee, Area Agency on Aging for
Southwest Florida, Inc., CFO, or Auditor General upon request for a period of six years from the date the audit report is issued,
unless extended in writing by the Department of Elder Affairs.
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16 D3 :J
Contract OAA 203.11
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 -
CAlCMlSCAS/INSC $35,000.00
Transportation U.S. Health and Human Services 93.044 $70,000.00
Support Services $255,436.00
TotalllIB $360,436.00
OAA Title IIICl - Congregate Meals U.S. Health and Human Services 93.045 $182,000.00
Spending Authority
OAA Title III C2 - Home Delivered Meals U.S. Health and Human Services 93.045 $328,539.00
Older Americans Act Title III E - $36,083.00
Supplement Services U.S. Health and Human Services 93.052 $17,931.00
Grandparent Services $9,173.00
TotalllIE $63,187.00
TOTAL FEDERAL AWARD $934,162.00
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
TOTALSTATEAWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
TOTALAWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT ARE AS FOLLOWS:
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Contract OAA 203.11
ATTACHMENT III
EXHIBIT 2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources mayor may not be subject to the audit requirements of OMB Circular A-B3, as revised,
and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state financial
assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 is met.
Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-B3, as revised, and/or
Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to be recipients or
subrecipients of Federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance
requirements.
In accordance with Sec. 210 ofOMB Circular A-B3 and/or Rule 691-5.006, FAC, provider has been determined to be:
_ Vendor or exempt entity and not subject to OMB Circular A-133 and/or Section 215.97, F.S.
---.X_ Recipient/subrecipient subject to OMB Circular A-B3 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /subrecipient of federal and lor state financial assistance and has been approved by the
department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 691-.006(2), FAC [state financial assistance] and
Section _ .400 OMB Circular A-B3 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state
matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and
regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A-87)*
OMB Circular A-I 02 - Administrative Requirements
OMB Circular A-B3 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations (Formerly OMB Circular A-122 - Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-IIO - Administrative Requirements)
Requirements)
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A-21 - Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-IIO - Administrative Requirements)
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular A-133
Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 691-5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
31
16 0 3f
January 2011
Contract OAA 203.11
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the contractor named in the contract or agreement to which this form is an
attachment, hereby certifies that:
(1) The contractor and any sub-contractors of services under this contract have financial management systems capable of
providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant-
funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds
for all agreement supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The
inability to process information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly.
(2) Management Information Systems used by the contractor, sub-contractor(s), or any outside entity on which the contractor is
dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of
processing data accurately, including year-date dependent data. For those systems identified to be non-compliant,
contractor(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the
undersigned warrants that these products are capable of processing year-date dependent data accurately. All versions of these
products offered by the contractor (represented by the undersigned) and purchased by the State will be verified for accuracy
and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the
hardware or software programs from operating properly, the contractor agrees to immediately make required corrections to
restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the State, and
without interruption to the ongoing business of the state, time being of the essence.
(4) The contractor and any sub-contractor(s) of services under this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data
integrity compliance issues.
The contractor shall require that the language of this certification be included in all subagreements, subgrants, and other
agreements and that all sub-contractors shall certifY compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered
into. Submission ofthis certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A-
102 and 2 CFR Part 215 (formerly OMB Circular A-II 0).
FRED W. COYLE, 3299 Tamiami Trail, E., Suite 303, Naples, FL 34112
Name and Address of Contractor
Signature Title
FRED W. COYLE
.... '~,\tJtJlS"~l
Name of Authorized Signeb~~..:""';"":'(':~"
(Revised June 2008) (.~;,...., ~iffi...;:r!~, /,zj).
-.lO-l' ~'A, '".
AIIaC:ST',,',;;">"..1 ~
DWfGH-re;,$ROQ(K.Cl~
~ 5~' .:: ,:,:'..:;~~,,' ':-' ~
',0.
" .. .~,' . ,"t
.......... .AI.
Chairman
01/25/2011
Date
Approved as to form & legal SufficIency
32
.
ASSIJt~~~ -
-::s-~.,..) N \ r't. ~ 13. w'" \ \' \.
January 2011
1603
Contract OAA 203.11
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGffiILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective contractor certifies, by signing this certification, neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction
by any federal department or agency.
(2) Where the prospective contractor is unable to certifY to any of the statements in this certification, such prospective
participant shall attach an explanatio to this certification.
01/25/2011
Signature
Chairman
Date
Board of County Com missioners
Title
(Certification signature should be same as Contract signature.)
Instructions for Certification
eton"
,
"primary covered transaction," and "voluntarily excluded," as used herein, have the m anmgs .. tn:thesections of
rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as supplemented by2 CFR376.10-376.995).
You may contact the Contract Manager for assistance in obtaining a copy of those regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties entered into
this transaction. If it is later determined that the contractor knowingly rendered an erroneous certification, in addition
to other remedies available to the federal government, the department may pursue available remedies, including
suspension and/or debarment.
3. The contractor will provide immediate written notice to the Contract Manager if at any time the contractor learns that
its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The
contractor may decide the method and frequency by which it determines the eligibility of its principals. Each
participant to a lower tier covered transaction may, but is not required to, check the Excluded Parties List System
(EPLS).
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower
4. The contractor will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
- Lower Tier Covered Transaction" in all its lower tier covered transactions and in all solicitations for lower tier
covered transactions.
5. The contractor agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized by
the federal government.
6. If the contractor knowingly enters into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the
federal government, the department may pursue available remedies, including suspension, and/or debarment.
7. The contractor may rely upon a certification of a prospective participant in a lower tier covered transaction that it is
not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the
certification is erroneous.
33
Approved as to form & iegai Sufficiency
. A.~~~::::Y
~,v~,~Q... ~. ~\''-
(Revised June 2008)
January 2011
16 D3
Contract OAA 203.11
ATTACHMENT VI
ASSURANCES-NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If
such is the case, you will be notified.
I. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds
sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and completion of the project described
in this application.
2. Will give the awarding agency, the Comptroller General of the Vnited States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of
personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 V.S.C.. 4728-4763) relating to prescribed standards for merit systems
for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI ofthe Civil Rights
Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 V.S.C..1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c)
Section 504 of the Rehabilitation Act of 1973, as amended (29 V.S.C.. 794), which prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42 U.S.C.. 6101-6107), which prohibits discrimination on the basis of age; (e) the
Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f)
the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g), 523 and 527 of the Public Health Service Act of 1912 (42
V.S.c.. 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 V.S.C.. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or fmancing of housing;
(i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and G)
the requirements of any other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is
acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for
project purposes regardless of Federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 V.S.C..1501-1508 and 7324-7328), which limit the political activities
of employees whose principal employment activities are funded in whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 V.S.C..276a to 276a-7), the Copeland Act (40 V.S.C. 276c
and 18 V.S.c.. 874) and the Contract Work Hours and Safety Standards Act (40 V.S.C.. 327-333), regarding labor standards for federally
assisted construction subagreements.
34
1603
January 2011 Contract OAA 203.11
lO. Will comply, if applicable, with flood insurance purchase requirements of Section lO2(a) of the Flood Disaster Protection Act of 1973
(P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the
total cost of insurable construction and acquisition is $10,000.00 or more.
II. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality
control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed
under the Coastal Zone Management Act of 1972 (16 U.S.C..1451 et seq.); (t) conformity of Federal actions to State (Clear Air)
Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C..7401 et seq.); (g) protection of
underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C..1721 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended
(16 U.S.C.. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of
1974 (16 U.S.C.. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities
supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C..2l31 et seq.) pertaining to the care,
handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C..4801 et seq.), which prohibits the use of lead- based paint
in construction or rehabilitation of residence structures.
17. Will cause to be performed the required [mancial and compliance audits in accordance with the Single Audit Act Amendments of 1996
and OMB Circular No. A-l33, Audits of States, Local Governments, and Non-Profit Organizations.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
~
CHAIR MAN
APPLICANT ORGANIZATION
DATE SUBMITTED
Board of County Com missioners
01/25/2011
Approved as to form & legal Suff!ciency
.\It CUi')UIf}
c,,~>~:. ......" :~(':'~,
,,; ..tKITrr~, '~.>
ATIE$I:;' . ,.1>-',("'" /-:\a>
DWIGgr:E~Bl:idc~t.
^>".' :.' . .. ~., ....~!
"." ,{ .'-- ~
.
~~&:)~
As tsnt County At.torn8~i:-'~--"
~ ~ N v' F"i... t<. ~ .-~, ,,'1.....
35
January 2011
16 03
Contract OAA 203.11
ATTACHMENT VII
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
1. Title III B Support Services $360,346.00
2. Title III C 1 Congregate Meals $182,000.00
3. Title III C2 Home Delivered Meals $328,539.00
4. Title III E Services $ 63,187.00
TOTAL: $934,162.00
36
January 2011
1603
Contract OAA 203.11
ATTACHMENT VIII
OLDER AMERICANS ACT
RATE SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
IIIB & IIIE
Services
Total Cost
Reimbursement Rate
11m
Case Aide $27.78 $25.00
Case Management $50.00 $45.00
Intake $27.78 $25.00
Screening/i\ssessment $50.00 $45.00
Transportation 100% Cost 90% of Cost
IIIE
Outreach $58.89 $53.00
Respite-Day Care $11.12 $10.00
Screening/i\ssessment $50.00 $45.00
RATE SUMMARY
C-l & C-2
Services
Total Cost
Reimbursement Rate
Cl
Congregate Meals $ 9.84 $ 8.86
Nutrition Counseling $58.89 $53.00
Nutrition Education $ 1.80 $ 1.62
Nutrition Screening $31.11 $28.00
Outreach $4.80 per person $4.32 per person
C2
Home Delivered Meals $ 9.77 $ 8.79
Nutrition Counseling $58.89 $53.00
Nutrition Education $ 1.80 $ 1.62
Nutrition Screening $50.00 $45.00
Outreach $4.80 per person $4.32 per person
37
January 2011
Report Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
1603
Contract OAA 203.11
ATTACHMENT IX
OLDER AMERICANS ACT
CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Based On
January Advance*
February Advance*
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report**
November Expenditure Report
December Expenditure Report
Final Expenditure and Request for Payment
Closeout Report
Submit to State
On This Date
January 1
January 1
February 9
March 9
April 9
May 9
June 9
July 9
August 9
September 9
October 9
November 9
December 9
January 9
February 15
March 1
Legend: * Advance based on projected cash need.
* * Recoupment of advance due with this report.
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Area Agency on
Aging for Southwest Florida, Inc. prior to January 1 or until the agreement with the agency
has been executed.
Note # 2: All advance payments made to the contractor shall be returned to the agency by the
submission date of report #12. The adjustment shall be recorded in Part C, 1 ofthe report
(ATTACHMENT X).
Note #3: Submission of expenditure reports mayor may not generate a payment request. If final
expenditure report reflects funds due back to the agency, payment is to accompany the
report.
38
16 D 3 J
January 2011 Contract OAA 203.11
ATTACHMENT X
REQUEST FOR PAYMENT
OLDER AM ERICANS ACT
PROVIDER NAME, ADDRESS, PHONE AND FED ID NUMBER
TYPE OF REPORT:
lHlS REQUEST PERIOD:
Advance
Report #
Reimbursement
Agreement #:
Agreement Period:
PSA:
CERTIFICATION: I hereby certify to the best of my knowledgethat this request conforms with the terms and the purposes set forth in the abole agreement.
Prepared By:
Date:
Approled By:
Date:
PART A:
BUDGET SUMMARY
(1)
ADMIN,
(2)
III B
(3)
II1C1
(4)
IIIC2
(7)
Title IIIE
(6)
TOTAL
I. Approled
Agreement Amount.
0.00
0.00
0,00
0.00
0.00
0.00
2, Pre\1ous Funds
RECEIVED for
Agreement period,
0,00
0,00
0.00
0,00
0,00
0,00
3, Agreement Balance
0,00
0,00
0.00
0,00
0,00
0,00
4, Pre\1ous Funds
REQUESTED and
Not Received.
0.00
0.00
0,00
0.00
0.00
0,00
5, Agreement Balance
0,00
0,00
0,00
0,00
0,00
0,00
PART B:
FUNDS REQUESTED
1, 1 st-2nd Months
Request Only
0.00
0.00
0,00
0.00
0,00
0,00
2. Net Expenditures
For Month
0,00
0,00
0.00
0,00
0,00
0.00
3. Additional
Cash Needs (Attach Doc,)
0,00
0,00
0,00
0.00
0.00
0,00
4, Total
PART C:
NET FUNDS REQUESTED:
0,00
0,00
0,00
0,00
0,00
0,00
1, Less: Oler-Advance
0,00
0,00
0,00
0,00
0,00
0.00
2, Agreement Funds are
Hereby Requested For
0,00
0,00
0,00
0,00
0,00
0,00
DOEA FORM 106A revised 5/10
39
16 0 3 j
January 2011
Contract OAA 203.11
ATTACHMENT XI
EXHmIT 1
i
PROVIDER NAME, ADDRESS, PHONE# AND FEID# Program Funding Source: THIS REPORT PERIOD
FROM: TO:
IIIB IIIC1
CONTRACT
II1C2 PERIOD:
CONTRACT #
REPORT #
PSA#
CERTlFICATlON: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: Appro\ed by : Date:
PART A : BUDGETED INCOMEI RECEIPTS 1. Appro\ed 2, Actual Receipts 3, Total Receipts 4. Percent of
Budget For This Report Year to Date Appro\ed Budget
1, Federal Funds $0,00 $0.00 $0.00 %
2, State Funds $0,00 $0,00 $0,00 %
3, Program Income $0.00 $0,00 $0,00 %
4, Local Cash Match (CCE, HCE and Other) $0,00 $0,00 $0,00 %
5, SUBTOTAL: CASH RECEIPTS $0,00 $0.00 $0,00 %
6, Local In-Kind Match $0,00 $0,00 $0,00 %
7. TOTAL RECEIPTS $0,00 $0,00 $0.00 %
PART B : EXPENDITURES 1, Appro\ed 2, Expenditures 3, Expenditures 4, Percent of
Budget For This Report Year to Date Appro\ed Budget
1. Meals 1 Meal Agreements $0.00 $0.00 $0,00 %
2, Ser\1ce Subcontractor $0.00 $0,00 $0,00 %
3. Other $0,00 $0.00 $0,00 %
4, Indirect Cost $0,00 $0,00 $0,00 %
5, TOTAL EXPENDITURES $0,00 $0,00 $0,00 %
PART C : OTHER EXPENDITURES
(For Tracking Purposes only)
1. Match
a, Other and In-Kind $0,00 $0,00 $0,00 %
b, Local Match $0,00 $0,00 $0,00 %
2. USDA Cash Recei\ed $0,00 $0,00 $0,00 %
3, TOTAL OTHER $0,00 $0,00 $0.00 %
PART D : OTHER REVENUE AND EXPENDITURES 2, Addition Cost Altemati\e Program Income 3, Interest
1. Program Income (PI) a. Appro\ed Budget $ a. Earned on GR Advances $
a, OAA Unbudgeted PI Receipts YTD
b, Recei\ed YTD $ b. Retum of GR Advance $
$
c. Expenditures $ c, Other Earned $
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
DOEA FORM 105as re\ised 11/09
40
16 IJ 3
January 2011
Contract OAA 203.11
ATTACHMENT XI
EXHIBIT 2
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
i
PROVIDER NAME, ADDRESS, PHONE# AND FEID# Program Funding Source: THIS REPORT PERIOD
FROM: TO:
CONTRACT
Title IIIE - PERIOD:
CONTRACT #
REPORT #
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: ApprolA9d by : Date:
PART A: BUDGE1ED INCOME! RECEIPTS 1. Approved 2, Actual Receipts 3, Total Receipts 4, Percent of
Budget F or This Report Year to Date Approved Budget
1, Federal Funds $0,00 $0,00 $0,00 %
2, State Funds $0,00 $0,00 $0,00 %
3, Program Income $0,00 $0,00 $0,00 %
4, Local Cash Match $0,00 $0,00 $0,00 %
5, SUBTOTAL: CASH RECEIPTS $0,00 $0,00 $0,00 %
6, Local In-Kind Match $0,00 $0,00 $0,00 %
7, TOTAL RECEIPTS $0,00 $0,00 $0,00 %
PART B : EXPENDITURES 1, Approved 2, Expenditures 3, Expenditures 4, Percent of
Budget For This Report Year to Date ApprolA9d Budget
A : Direct Sen.;ces
1, Personnel $0,00 $0,00 $0,00 %
2, Travel $0,00 $0,00 $0,00 %
3, Building Space $0,00 $0,00 $0,00 %
4, Communication! Utilities $0,00 $0,00 $0,00 %
5, Printing! Supplies $0,00 $0,00 $0,00 %
6, Equipment $0,00 $0,00 $0,00 %
7, Other $0,00 $0,00 $0,00 %
B : Agreement Sen.;ces
8, Sen.;ces Subcontracted $0,00 $0,00 $0,00 %
9, TOTAL EXPENDITURES $0,00 $0,00 $0,00 %
10, DEDUCTIONS
a, Total Local Match $0,00 $0,00 $0,00 %
b, Program Income Used $0,00 $0,00 $0,00 %
c, TOTAL DEDUCTIONS $0,00 $0,00 $0,00 %
11. NET EXPENDITURES $0,00 $0,00 $0,00 %
PART C : EXPENDITURES ANALYSIS
2, Units of Sen.;ces Year to Date 3, Number of People Served Year to Date
A, Expenditures by Sen.;ces Year to Date:
1, Information..........,.. ....... $0,00 . . . . . . . . . . . . . . ,.. , $0,00 ............ ..,..0,00
2, Assistance.. .... ..... $0,00 .... ... ..$0,00 .., .., ......... .... ..,0,00
3, Counseling ............ ....... $0,00 .............. .. $0,00 .................... ,....0,00
4, Respite, ............. $0,00 . . . . . . . . . . . . ' ...... $0,00 .., ....... ........ ..,..0,00
5, Supplemental Sen.;ces.. $0,00 .... $0,00 ,..........,..,....,.....,0,00
6, TOTAL., .. ......... $0,00
Part B Line 11, column 3 should be equal to this total.
PART D : GRANDPARENT SERVICES (reported by Federal Fiscal Year)
FFY $ FFY $ FFY $
Match $ Match $ Match $
DOEA FORM 105AE relised 12/08
41
January 2011
16 D ~ntract ~AA 203.11
ATTACHMENT A
Department of Elder Affairs Programs & Services Handbook, provided on CD.
Also, available at the Department's Intranet site under, "Publications".
42
January 2011
1603
Contract OAA 203.11
ATTACHMENT B
DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST AND INSTRUCTIONS
To be inserted during the routing process (4 pages)
43
1603
ATTACHMENT B
ProgramlFacility Name
Collier Coun
Address
3339 Tamiami Trail E. Suite 211
City, State, Zip Code Telephone
Na les Fl rida 4112 n 1 2011 239-252-46 3
PART I: READ THE A TT ACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WlDCH WILL HELP YOU COMPLETE THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
Collier County is situated over a 2.300 square mile area. CCSS provides in-home care. facility adult day care.
case management and nutritional services to frail, elderly residents of Collier County
2. POPULATION OF AREA SERVED. Source of data: census.
Total # % White % Black % Hispanic
o 0 0
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST
CountJ:
AAAlContractor
N/A YES NO
o IX! 0
7. Compare the staff composition to the population. Is staff representative of the population?
IfN/A or NO, explain.
N/A YES NO
o IXI 0
8. Compare the client composition to the population. Are race and sex characteristics representative of the
population? IfN/A or NO, explain.
N/A YES
o ~
NO
o
9. Are eligibility requirements for services applied to clients and applicants without regard to race, color,
national origin, sex, age, religion or disability? IfN/A or NO, explain.
N/A YES NO
o IX! 0
10. Are all benefits, services and facilities available to applicants and participants in an equally effective
manner regardless of race, sex, color, age, national origin, religion or disability? IfN/A or NO, explain.
N/A YES NO
o IX! 0
11. For in-patient services, are room assignments made without regard to race, color, national origin
or disability? IfNI A or NO, explain.
N/A YES NO
lXI 0 0
Revised August 2010, Page I of 2
33
12. Is the program/facility accessible to non-English speaking clients? IfN/A or NO, explain.
13. Are employees, applicants and participants informed of their protection against discrimination? If YES,
how? Verbal 0 Written IX! Poster IX! IfNI A or NO, explain.
14. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility.
15. Is the program/facility physically accessible to mobility, hearing, and sight-impaired individuals? If NI A or
NO, explain,
PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES.
16. Has a self-evaluation been conducted to identify any barriers to serving disabled individuals, and to make
any necessary modifications? If NO, explain.
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If
NO, explain.
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination
on the basis of disability? If NO, explain.
20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? If
NO, explain.
16 D3
N/A YES NO
o IX! 0
N/A YES NO
o 1XI 0
N/A NUMBER
IX!
N/A YES NO
o IXI 0
YES NO
o 0
YES NO
o 0
YES NO
o 0
YES NO
o 0
YES NO
o 0
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES NO
o 0
DOEA USE ONL Y
Reviewed By In Compliance: YES 0 NO* 0
Program Office *Notice of Corrective Action Sent I I
--
Date I Telephone Response Due _I_I
On-Site 0 Desk Review 0 Response Received ~ _1_
Revised August 2010, Page 2 of2
34
16 D3
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility
serves a specific target population such as adolescents, describe the target population. Also, define the type of
service provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city, county or other regional area. Population
statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. ("Other" races include
Asian/Pacific Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date
of your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and
list their percent by race, sex and disability. Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted
in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part
of the contract language for DOEA recipients and their sub-grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their
availability in the population, the program/facility has the responsibility to determine the reasons for such
variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities
may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR
80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on-site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3
(a) and 45 CFR 80.1 (b)(2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies, counseling and social services without regard to race, sex, color, national
origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must
be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability.
Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all
clients, 45 CFR 80.3 (b).
11. For in-patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants, including those persons
who may not speak English. In geographic areas where a significant population of non-English speaking people
live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have
a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who
will assist in the provision of services, 45 CFR 80.3 (a).
35
16 D 3 ·
13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to
their participants, beneficiaries or any other interested parties. This should include information on their right to
file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of
HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through
the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race,
color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment,
placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the
name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the
current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review,
etc.
15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby,
public telephone, restroom facilities, water fountains, information and admissions offices should be accessible.
Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and
serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or
raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a
self-evaluation to identify any accessibility barriers. Self-evaluation is a four step process:
a. With the assistance of a disabled individual!organization, evaluate current practices and policies which do
not comply with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps
have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging
any action prohibited by Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads, and other appropriate written communication, 45 CFR 84.8 (a).
20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with
impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited
to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can
be used to provide equally effective services, 45 CFR 84.52 (d).
21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement
and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41
CFR 60 and Title VI of the Civil Rights Act of 1964, as amended.
DOEA Form 101-B, Revised August 2010
36
ACORD
1603
'N CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYVYI
12/17/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the polley, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsementtsl.
PRODUCER ~CT I r~ No\:407-788-7933
Insurance Office of America, Inc. r~N:OEdI: 407-788-3000
1855 West State Road 434 E.MAlL
ADDRESS:
Longwood, FL 32750 PRODUCER In II,
INSURER(S) AFFORDING COVERAGE HAlC ,
INSURED INSURER A : United National Ins Co 13064
Eleven Ash, Inc. INSURER B : Bridgefield Employers Insurance 10701
DBA:Health Force INSURER C :
5276 Summerlin Commons Way INSURER D :
Suite #702 INSURER E :
- Fort~yer~, FL 33907 --,- . . , ... INSURI!!R F : ~
COVERAGES
CERTIFICATE NUMBER: 10/11-FL
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR ,:S~J%~ I :.S~~%~ , UMrrs
LTR IMSR WVD POLICY NUMBER
GENERAL UABlLITY AHB0722340 12/27/2010 12/27/2011 EACH OCCURRENCE $ 3.000,OO(J
- DAMAGE TO RENTED 100,000
X COMMERCIAL GENERAL LIABILITY "ence} $
U CLAIMS-MADE [!] OCCUR // MED EXP (Anyone person) $ 10,000
- 3,000,000
A X Professional Liab PERSONAL & ADV INJURY $
X Hired/Non-Owned GENERAL AGGREGATE $ 5,000,00(J
GEN'L AGG~En LIMIT APPUES PER: PRODUCTS-COM~OPAGG $ 3,00O,00(]
!Xl PRO- n J $
POLICY JECT LOC
AUTOMOBILE LIABlUTY COMBINED .SINGLE LIMIT $
f--- (Ea accident)
- ANY AUTO BODILY INJURY (Per person) $
- ALL OWNED AUTOS / BODILY INJURY (Per accident) $
,
- SCHEDULED AUTOS 1,1 PROPERTY DAMAGE
$
HI RED AUTOS (Per accident)
- $
NON-OWNED AUTOS
- /1 $
UMBRELLA UAB H OCCUR I~ I EACH OCCURRENCE $
-
EXCESS UAB CLAIMS-MADE AGGREGATE $
__l=- DEDUCTIBLE I $
, -- -.-.---, --.~-- _.~ - ------,---' ____ _,_ n_ ..-.- -' ---,. .. ---..- ,-
1'lETEI'ITlON'-$" $
WORKERS COMPENSATION "(~08'O-4'72i'~'0 12/24/2011 X I T"Xg~T~J#~ I IDJ~-
AND EMPLOYERS' LIABILITY Y/N 1 ,000 , OO(J
B ANY PROPRIETORIPARTNER/EXECUTIVED E.L, EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A 1,OOO,00(J
(Mandatory In NH) E.L DISEASE. EA EMPLOYEE $
~rssc~~~~ g'~~PERATIONS below E.L DISEASE. POLICY LIMIT $ 1. 000 OO(J
/If
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AtIach ACO~D 101, Addl1lonal Remarka SChedule, "mora spac:a la required)
..
~) { Of\Jl'l
J
CANCELLATION
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Collier County Services for
3301 Tam;ami Trail East
Na 1 es, FL 34112
AUTHORIZED REPRESENTATIVE
q.;;
~
ACORD 25 (2009/09)
Jeff La os GONZAR
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
16 D3
ACORDru
AGENCY CUSTOMER 10:
LOC#:
AGENCY NAMED INSURED
Insurance Office of America, Inc. Eleven Ash, Inc.
POLICY NUMBER 5276 Summerlin Commons Way
Suite #702
CARRIER I NAIC CODE Fort Myers, FL 33907
EFFECTIVE DATE:
ADDITIONAL REMARKS SCHEDULE
Page
of
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: ACORD Certi ficate of liabil itv Insurance
Garage Liability
INSR ADD'L
L TR INSRD
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDDIYY) DATE (MMIDDIYY)
LIMITS
AUTO ONLY. EAACCIDENT $
EA ACC $
AGG $
OTHER THAN
AUTO ONLY:
ANY AUTO
Automobile Liability
INSR ADD'L
LTR INSRD
POUCY NUMBER
POLICY EFFECTIVE POUCY EXPIRATION
DATE (MM/DDIYY) DATE (MMJDDIYY)
Excess/Umbrella Liability
INSR AOD'L
L TR INSRD
POLICY NUMBER
POLICY EFFECTIVE POLICY exPIRATION
DATE (MMIDDIYY) DATE (MM/DDIYY)
LIMITS
$
Other Liability
INSR
LTR
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDD/YY) DATE (MM/DD/YY)
LIMITS
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES
ACORD 101 (2008/01)
@ 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
16 D3
Attestation Statement
Agreement/Contract Number: OAA 203.11
Amendment Number: N/A
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, Inc. and
Collier County
(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, whi has no affect on the agreement/contract content.
Januar 25 2011
Date
,
. :. :';;~1~;~~~~~:" .
"~ AmsT;!,,; 'I'" ',',: "{?
/''':. 'DM~ft : ~~,_CK~lERK
':'b~~':,;'~'.':' l' <:,:',-:: .', ":' ~.'0
Approved 38 to form & legal Sufficiency
tJ,( "
~ -e '"\\:)~
---------~
Assistant County Attorney
.
AAA Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready
for AAA designee signature
initial date
Revised November 2010
161DJ)t
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract # OAA 203.11
I, Fred W. Coyle , certify that
(Name of authorized contractor representative)
Collier County
(Name of contractor)
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that
the plan will be made available t the Area Agency on Aging for SW FL, Inc., upon request.
January 25. 2011
Date
,- " '
- '.'
;'~~""';""'I;~
Approved as to form & legal Sufflclenoy {;Ii$(~_&!:C,:!\/:
.liItf[j.
..
Chairman
Title
.
~ '~~~r, ,.'..."
Assista County AU"rney
~,
DOEA Contract Manager's Review
Initial Date
October 2008