Backup Documents 06/28/2011 Item #16D 7ORIGINAL DOCUMENTS CHECKLIST & ROUTING SJ 6 `'` 7
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
fth Cwair.,,a.,'s si nature draw a line thrn„oh rmiting lines #1 through #4. complete the checklist. and forward to Ian Mitchell (line #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Ashlee Franco, Accounting
Supervisor
HHVS
7/29/11
2. Clerk of Courts
Minutes and Records Dept., 4t Fl.
AF
for oick u
3.
June 28, 2011
Agenda Item Number
4.
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Contract Agreement
Number of
Signature Already
Attached
an original signature from the
Documents Attached
on Contracts
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
Ashlee Franco / Housing, Human and
Phone Number
252 -2689
Contact
Veteran Services
(Initial)
Please call or e-mail
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
AF
for oick u
Agenda Date Item was
June 28, 2011
Agenda Item Number
Approved by the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Contract Agreement
Number of
Signature Already
Attached
an original signature from the
Documents Attached
on Contracts
Chairman already obtained
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
appropriate.
(Initial)
Applicable)
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
AF
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
AF
N/A
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
AF
Signature
document or the final negotiated contract date whichever is applicable.
already on docs
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
AF
Signature
signature and initials are required.
already on docs
5.
In most cases (some contracts are an exception), the original document and this routing slip
AF
Signature
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
already on
Some documents are time sensitive and require forwarding to Tallahassee within a certain
docs
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 6/28/2011 (enter date) and all changes
AF
N/A
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
160 74
Amendment 002 Contract No. CCE 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 CCE 203.10.
The purpose of this amendment is to: (1) increase Collier County's CCE allocation by
$60,000.00; (2) revise Attachment III, Exhibit I; and (3) revise Attachment VIII, Budget
Summary.
This amendment shall be effective May 23, 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 Amendment to be executed by
their officials there unto duly authorized.
RECIPIENT: Collier County Board of
County Commissioners �J
Signed by : C.7`
Name: �a r 0 �� r
Title: 0 G A7 � r
Date: � 111 1
Federal ID Number: 59- 6000558
Fiscal Year End: 09/30
ATTEST:
DWIGHT E. BROCiIC, +leak
By:
Area Agency on Aging for Southwest
Florida, Inc.
Signed by: i t.�
Name: Lei na Nowak
An
Title: Board President
t�
Date:
Appmed as to tom & legal Suffl®lenv'
Ants*nt County Attorney w
N N \ 'F U2 6 . UD" N-r j
160 74
Amendment 002 Contract No. CCE 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
Community Care for the Elderly
General Revenue
65010
$713,779.00
TOTAL AWARD
$713,779.00
Amendment 002
1
2
3.
4
Contract No. CCE 203.10
160 7 4
Amendment Page 3
ATTACHMENT VIII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of Commissioners
Lead Agency $ 98,067.00
Case Management $114,000.00
CCE Services $501,712.00
Total $713,779.00
160 7 4
Attestation Statement
Agreement /Contract Number CCE 203.10
Amendment Number 002
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 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.
tc!52 G -04
Fred W. Coyle, Chairman
ATTEST:
DWIGHT E. BROCK, Cis*
By:
Date
Approved as to form & legal Sufficiency
Assls —t 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
160
Contract No. ADI 203.10 Amendment Pa e 1
Amendment 003 Cont g
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 $8,668.00;
(2) revise Attachment III, Exhibit I; and (3) revise Attachment VIII, Budget Summary.
This amendment shall be effective May 23, 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 Amendment to be executed by
their officials there unto duly authorized.
RECIPIENT: Collier County Board of
County Commissioners
Signed by:
Name: o 0 C r
Title: C 6 C. r1T ,j r\kA A I -Fr-'
Date: 0 5 � 31 11
Federal ID Number: 59- 6000558
Fiscal Year End: 09/30
<,jTESY:
: .)WIGHT E. B '� :;lerk
sy,
Area Agency on Aging for Southwest
Florida, Inc. /
Signed by:
Name: Leigh Anna "Nowak
Title: Board President
Date: �` 61 �.
APProW ' %1 3:= M form ;& legal Suf1'iCigney
inty
Attorney
.S 1 ri N 1 P£ ie- 6 • w'*-J . --Vi-
160 7
Amendment 003 Contract No. ADI 203.10 Amendment Page 2
ATTACHMENT III
EXHIBIT -t
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
$129,158.00
TOTAL AWARD
$129,158.00
Amendment 003
Contract No. ADI 203.10
e 7
Inkeont Pa g
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
Collier County Housing and Human Services
Respite
2. Case Management
$128,958.00
200.00
3. Total $129,158.00
16D 74
Attestation Statement
Agreement /Contract Number ADI 203.10
Amendment Number 003
I, Fred W. Coyle , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida, 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.
Fred W. Coyle, Chairman
ATTEST:
DWIGHT E. BROCK, Clark
By:
Date
AW d ets tai dorm & iegoai Sufficiency
Assistant County MtorTl
AAA Contract Manager to initial and date indicating signatures /initials appropriate on all documents; ready
for AAA designee signature
initial date
Revised November 2010