Backup Documents 03/11/2011 Item #16D5ORIGINAL DOCUMENTS CHECKLIST &ROUTING SLIP 16 D 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
ROUTING SLIP
Complete routing lines # 1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exception of the Chairman's signature, draw a line through routing lines #I through #4, complete the checklist, and forward to Ian Mitchell (line #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Louise Pelletier
HHVS
(Initial)
Please call or e-mail
2. Jennifer White
County Attorney's Office
�J
3 15 1
3. Ian Mitchell, Executive Manager
Board of County Commissioners
Agenda Item Number
3 Ib I
Approved b the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Amendment to contract agreement
Number of
3
Attached
an original signature from the
Documents Attached
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Ian Mitchell needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Louise Pelletier / Housing, Human and
Phone Number
252 -2696
Contact
Veteran Services
(Initial)
Please call or e-mail
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
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for vick u
Agenda Date Item was
March 8, 2011
Agenda Item Number
16 D 5
Approved b the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Amendment to contract agreement
Number of
3
Attached
an original signature from the
Documents Attached
Chairman needed on each copy
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
a ro riate.
(Initial)
Applicable)
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
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signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
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Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
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document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
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signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
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should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 3/8/2011 (enter date) and all changes
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made during the meeting have been incorporated in the attached document. The
County Attorne 's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
1605
MEMORANDUM
Date: March 11, 2011
To: Louise Pelletier, Case Management
Housing, Human &Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Contract amendments with the Area Agency on Aging
of Southwest Florida, Inc. to reflect additional grant
funding for the Alzheimer's Disease Initiative Program
Attached are three (3) original copies of the document referenced above,
(Item #16D5) approved by Board of County Commissioners March 8, 2011.
After forwarding to the Area Agency on Aging for signature, we request that
an original please be returned to the Minutes and Records Department
for the Board's Official Record.
If you have any questions, please contact me at 252 -8406.
Thank you.
Attachment
16D5
Amendment 002 Contract No. ADI 203.10 Amendment Page 1
STANDARD CONTRACT
AREA AGENCY ON AGING -
Collier County Board of Commissioners
This AMENDMENT, entered into by Area Agency on Aging for Southwest Florida Inc.,
hereinafter referred to as the "Agency," and Collier County Board of County Commissioners,
hereinafter referred to as the "recipient," amends contract ADI 203.10.
The purpose of this amendment is to: (1) increase Collier County's ADI allocation by $25,000;
(2) revise Attachment III, Exhibit I; and (3) revise Attachment VIII, Budget Summary.
This amendment shall be effective February 10, 2011.
All provisions in the agreement and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment to be executed
by their officials there unto duly authorized.
RECIPIENT: Collier County Board of
County Commissioners
Signed by:
Name: Fred W. Cole
Title: _ Cvt A % O-A A 4
Date: 3/8/11
Federal ID Number: 59- 6000558
Fiscal Year End: 09/30
Approved as to form and
Legal Sufficiency
JennifFY'B. White
Assistant County Attorney
Area Agency on Aging for Southwest
Florida, Inc.
Signed by: XAX2:e1_
Name: Leigh Anna Nowak
Title: Board President
Date: 3 A— I
ATTEST'
DWIGHT E. BROCK, Clerk
By;
Attest 1�lM.:�
1 60T
Amendment 002 Contract No. ADI 203.10 Amendment Page 2
ATTACHMENT III
EXHIBIT -1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
STATE FINANCIAL ASSISTANCE SUBJECT,TO Sec. 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Alzheimer's Disease Initiative
Respite Services
General Revenue /TSTF
65004
$120,490.00
TOTAL AWARD
$120,490.00
Amendment 002
Contract No. ADI 203.10
1605
Amendment Page 3
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
Collier County Housing and Human Services
Respite
2. Case Management
$120,290.00
►11 11
Total $120,490.00
1605 1
Attestation Statement
Agreement /Contract Number ADI 203.10
Amendment Number 2
I, Fred Coyle attest that no changes or revisions have been made to
(Recipient/Contractor representative)
the content of the above referenced agreement /contract or amendment between the Area Agency on
Aging for Southwest Florida, Inc. and
Collier County Board of Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
ir-iti
Jtaan
Signature of Recipient/Co r to7resentative
Fred W. Coyle
Approved as to form and
Legal sufficiency
1'�ie, 1
Assi t County Attorney
Jennifer B. White
Revised November 2010
3/8/11
Date
ATTEST ,
DWIGHT
By:
Attast s in l"W ''s
1 at.-We ,