Backup Documents 07/26/2011 Item #16D12
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI) 6 0 1 2'"
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 #1 through #4, complete the checklist, and forward to Ian Mitchell (line #5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Ashlee Franco, Accounting HHVS ~~ 7/29/11
Supervisor
2. Jennifer White County Attorney's Office ~~ I.V <i I, 1'1
3. Ian Mitchell, Executive Manager Board of County Commissioners iLA- 1$l\cJ{(
4. Clerk of Courts Minutes and Records Dept., 4lli Fl.
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 stafffor 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 I Housing, Human and Phone Number 252-2689
Contact Veteran Services Please call or e-mail
for nick un
Agenda Date Item was July 26,2011 Agenda Item Number 16D 12 (Item#2796)
Approved by the BCC
Type of Document Contract Agreement Number of 3 sets for each
Attached an original signature from the Documents Attached contract CADI,
Chairman needed on each copy CCE, HCE) with 7
WA-S (::\\ v E. N y(?(l.M \':>S IC~ signatures required
gY'-'-~L.f f~DN~ USe: on each set for a
To total of 63
$\MQ Sfl\JC.~ C.Le<L\L signatures
A"f1'6"'TS ~ 1~IJA'TUa..E: C3 x 7 x 3 = 63)
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is Yes NIA (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 NIA
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 ofBCC approval of the AF
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 AF
signature and initials are required.
5. In most cases (some contracts are an exception), the original document and this routing slip AF
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 BCe's actions are nullified. Be aware of your deadlines!
6. The document was approved by the BCC on 7/26/2011 (enter date) and all changes AF NIA
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the chanl!es, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 126.05, Revised 2.24.05
16012
MEMORANDUM
Date:
August 11,2011
To:
Ashley Franco
Housing, Human and Veteran Services
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
Standard Contract with Area Agency on Aging for SW FL, Inc.
Community Care for the Elderly Program (CCE 203.11)
Attached for your records are three (3) originals of the document referenced above
(Item #16D12) approved by the Collier County Board of County Commissioners on
Tuesday, July 26, 2011.
Please forward on for additional signatures and return a Fullv Executed
Ori2:inal to the Minutes & Records Department to be kept in the Board's
Official Records.
If you have any questions, please feel free to contact me at 252-7240.
Thank you.
June 201 I - July 2012 1 6 n 1 2 "1~
AREA AGENCY ON AGING FOR SOUTHWEST Fto~, INC.
STANDARD CONTRACT
COMMUNITY CARE FOR THE ELDERLY PROGRAM
CCE 203.I 1
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of Commissioners, ("Recipient"), and collectively referred to as the "Parties." The term Recipient
for this purpose may designate a vendor, sub grantee 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 Recipient has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Recipient 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. Puroose 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), area plan(s), 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 July I. 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
June 30. 2012.
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 $639,667.00, 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(l)(f), 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 Recipient 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 Recipient shall comply with all applicable
standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42 V.S.C. 7401, et seq.), s.
508 of the Federal Water Pollution Control Act as amended (33 V.S.c. 1251, et seq.), Executive Order 11738, as
amended, and where applicable Environmental Protection Agency regulations 40 CFR 30. The Recipient shall
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June 2011 - July 2012
report any violations of the above to the Agency.
160 12-cCE203.11
6.1.3 The Recipient, or agent acting for the Recipient, 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 Recipient 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 Contract Manager prior to
payment under this contract.
6.1.4 In accordance with Appendix A to 2 CFR 215, the Recipient 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 If this contract contains federal funds and provides services to children up to age 18, the Recipient shall comply
with the Pro-Children Act of 1994 (20 U.S.c. 6081).
6.1.6 A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards will
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 Recipient shall comply with these provisions before doing business or entering into subcontracts
receiving federal funds pursuant to this contract. The Recipient shall complete and sign ATTACHMENT V
prior to the execution of this contract.
6.2 The Recipient shall not employ an unauthorized alien. The Agency will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.c. 1324a) and the Immigration
Reform and Control Act of 1986 (8 V.S.C. 1101). Such violation will be cause for unilateral cancellation of this
contract by the Agency.
6.3 If the Recipient 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 Pension Protection Act of 2006 or for any other reason, the Recipient
must notify the Agency in writing within thirty (30) days of receiving the IRS notice of revocation.
6.4
6.5
7.
7.1
7.2
7.2.1
7.2.2
7.2.3
The Recipient shall comply with Title 2 CFR Part 275 regarding Trafficking in Persons.
Unless exempt under 2 CFR Part 170.11 O(b), the Recipient shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 170.
Compliance with State Law
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 of laws.
The Recipient shall comply with requirements of s. 287.058, F.S. as amended.
The Recipient shall 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 Contract Manager must receive and
accept in writing prior to payment in accordance with s. 215.971, F .S. (I) and (2).
The Recipient shall submit bills for fees or other compensation for services or expenses in sufficient detail for a
proper pre-audit and post-audit.
If itemized payment for travel expenses is permitted in this contract, the Recipient shall 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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June 2011 - July 2012 16 0 1 2' CCE 203.11
7.2.4 The Recipient shall 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 Recipient in conjunction with this contract except for
those records which are made confidential or exempt by law. The Recipient's refusal to comply with this
provision will 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 Recipient 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, in
accordance with the provisions ofs. 287.134, F.S.
7.5 The Recipient shall 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. Back2round Screeninl!
The Recipient 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, will 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 apply to employees, subcontractors, consultants, direct
service providers and volunteers. Consequently, any commitment for employment, purchase of services, or
volunteer program participation will be contingent upon the passing of a Level II background check. The
background screening will 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 Recipient shall develop, 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, will provide for notice of the grievance procedure and an opportunity for review of the subcontractor's
determination( s).
10. Audits. Insoections. Investil!ations. Public Records and Retention
10.1 The Recipient shall establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of funds
provided by the Agency under this contract. Recipient shall adequately safeguard all such assets and assure they
are used solely for the purposes authorized under this contract. Whenever appropriate, financial information
should be related to performance and unit cost data.
10.2 The Recipient shall 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 Upon demand, at no additional cost to the Agency, the Recipient shall facilitate the duplication and transfer of
any records or documents during the required retention period in Paragraph 10.2.
10.4 The Recipient shall assure that the records described in Paragraph 10 will be subject at all reasonable times to
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June 2011 - July 2012 . . CCE 203.11
inspection, review, copying, or audit by federal, state, or other personnel du y au . ed Agency.
10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Agency and federal
auditors, pursuant to 45 CFR 92.36(iX I 0), will be allowed full access to and the right to examine any of the
Recipient's contracts and related records and documents pertinent to this specific contract, regardless of the form
in which kept.
10.6 The Recipient shall provide a financial and compliance audit to the Agency as specified in this contract and in
A TT ACHMENT ill and ensure that all related third-party transactions are disclosed to the auditor.
10.7 The Recipient shall 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 Rie:hts Compliance
11.1 The Recipient shall 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
Recipient 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 During the term of this contract, the Recipient shall complete and retain on file a timely, complete and accurate
Civil Rights Compliance Checklist (ATTACHMENT B).
11.3 The Recipient shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures will include notifying clients, employees, and
participants of the 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 Recipient, its successors, transferees, and assignees for the
period during which such assistance is provided. The Recipient 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 Recipient
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 Recipient shall provide services in the manner described in ATTACHMENT I.
13. Monitorine: bv the Ae:encv
The Recipient shall permit persons duly authorized by the Agency to inspect and copy any records, papers,
documents, facilities, goods and services of the Recipient which are relevant to this contract, and to interview any
clients, employees and subcontractor employees of the Recipient to assure the Agency of the satisfactory
performance of the terms and conditions of this contract. Following such review, the Agency will provide a
written report of its findings to the Recipient, and where appropriate, the Recipient shall develop a corrective
action plan. The Recipient hereby agrees to correct all deficiencies identified in the corrective action plan in a
timely manner as determined by the Contract Manager.
14. Coordinated Monitorine: with Other Ae:encies
If the Recipient 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
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June 201 I - July 2012 16 0 1 ,... CCE 203.11
service agencies shall include the Department of Children and Families, the Department of~ealth, the Agency
for Persons with Disabilities, the Department of Veterans Affairs, and the Department of Elder Affairs. Upon
notification and the subsequent scheduling of such a visit by the designated agency's lead administrative
coordinator, the Recipient shall comply and cooperate with all monitors, inspectors, and/or investigators.
15. Indemnification
The Recipient 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 perfonnance of the services provided for herein. It is understood and
agreed that the Recipient is not required to indemnify the Agency for claims, demands, actions or causes of
action arising solely out of the Agency's negligence.
15.1 Except to the extent pennitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
executed between the Department and state agencies or subdivisions defined in s. 768.28(2), F.S.
16. Insurance and Bondinl!
16.1 The Recipient shall 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 Recipient accepts full responsibility for identifying and detennining
the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the
Recipient and the clients to be served under this contract. The limits of coverage under each policy maintained by
the Recipient do not limit the Recipient's liability and obligations under this contract. The Recipient shall ensure
that the Agency has the most current written verification of insurance coverage throughout the tenn 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 tenn of this agreement, the Recipient shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Recipient 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 detennined by the insurance
company and consistent with good business practices.
17. Confidentialitv of Information
The Recipient shall not use or disclose any infonnation 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 Portabilitv and Accountabilitv Act
Where applicable, the Recipient shall comply with the Health Insurance Portability and Accountability Act (42
USC 1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
19. Incident ReDortinl!
19.1 The Recipient shall notify the Agency immediately, but no later than forty-eight (48) hours from, the Recipient's
awareness or discovery of conditions that may materially affect the Recipient or subcontractor's ability to
perfonn the services required to be perfonned under this contract. Such notice shall be made orally to the
Contract Manager (by telephone) with an email to immediately follow.
19.2 The Recipient shall 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
(l-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Recipient
and its employees.
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June 2011 - July 2012
20. New Contract(s) Reoortinl!
The Recipient 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 infonnation: (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 Recipient shall complete and provide the
infonnation in ATTACHMENT D.
160 12~
CCE 203.11
21. Bankruotcv Notification
During the tenn ofthis contract, the Recipient shall immediately notify the Agency if the Recipient, its assignees,
subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Recipient must
also provide the following infonnation to the Area Agency on Aging for Southwest Florida, Inc.: (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., United States Bankruptcy Court Middle District of Florida, Fort Myers, FL ); and, (4) the name,
address, and telephone number of the bankruptcy attorney.
22. Soonsorshio and Publicitv
22.1 As required by s. 286.25, F.S., if the Recipient 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 Collier County
Board of Commissioners, the State Department of Elder Affairs, and the Area Agency on Aging for Southwest
Florida, Inc." If the sponsorship reference is in the written material, the words "State of Florida, Department of
Elder Affairs and the Area Agency on Aging for Southwest Florida, Inc." shall appear in at least the same size
letters or type as the name of the organization.
22.2 The Recipient shall not use the words "The State of Florida Department of Elder Affairs or the Area Agency on
Aging for Southwest Florida, Inc." to indicate sponsorship of a program otherwise financed, unless specific
authorization has been obtained by the State and Agency prior to use.
23. Assil!nments
23.1 The Recipient 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 is at all times 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
Recipient. In the event the State of Florida approves transfer of the Recipient's obligations, the Recipient
remains responsible for all work perfonned and all expenses incurred in connection with the contract.
23.3 This contract shall remain binding upon the successors in interest of either the Recipient or the Agency.
24. Subcontracts
24.1 The Recipient is responsible for all work perfonned and for all commodities produced pursuant to this contract,
whether actually furnished by the Recipient or its subcontractors. Any subcontracts shall be evidenced by a
written document and subject to any conditions of approval the Agency deems necessary. The Recipient further
agrees that the Agency will not be liable to the subcontractor in any way or for any reason. The Recipient, at its
expense, shall defend the Agency against any such claims.
24.2 The Recipient 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 Recipient and subcontractor, will result in a penalty as provided by statute.
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June 2011 - July 2012
25. Independent Capacitv of Recipient
It is the intent and understanding of the Parties that the Recipient, 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 Recipient and will not be liable for any wage
and hour, employment discrimination, or other labor and employment claims against the Recipient or its
subcontractors. All deductions for social security, withholding taxes, income taxes, contributions to
unemployment compensation funds and all necessary insurance for the Recipient are the sole responsibility of the
Recipient.
160 1 2 c~ CCE203.11
26. Payment
Payments shaH be made to the Recipient pursuant to s. 215.422, F.S., as services are rendered and invoiced by
the Recipient. The Contract Manager will have final approval of the invoice for payment, and wiJ] approve the
invoice for payment only if the Recipient has met aH terms and conditions of the contract, unless the bid
specifications, purchase order, or this contract specify otherwise. The approved invoice wiJ] 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 of s. 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 Recipient shall 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
Recipient by the Agency. In the event that the Recipient or its independent auditor discovers that an
overpayment has been made, the Recipient shaH repay said overpayment immediately without prior notification
from the Agency. In the event that the Agency first discovers an overpayment has been made, the Contract
Manager will notify the Recipient in writing of such findings. Should repayment not be made forthwith, the
Recipient will be charged at the lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after
Agency notification or Recipient discovery.
28. Data Intee:ritv and Safee:uardine: Information
The Recipient shall ensure an appropriate level of data security for the information the Recipient is coHecting or
using in the performance of this contract. An appropriate level of security includes approving and tracking all
Recipient employees that request system or information access and ensuring that user access has been removed
from all terminated employees. The Recipient, among other requirements, must anticipate and prepare for the
loss of information processing capabilities. AH data and software shall be routinely backed up to ensure 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 Recipient shall ensure all subcontractors maintain written
procedures for computer system backup and recovery. The Recipient 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 aH employees, contracted employees, consultants, OPS and volunteers, including aH
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 YouTube (ATTACHMENT E).
30. Conflict of Interest
The Recipient shall 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 Recipient or subcontractor shaH
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
7
June 2011 - July 2012 1 ~ n 1 ~"CCE 203.11
agent; (b) any member of his /her immediate family; (c) his or her partner, or; (d~J.el.garltza"" which employs,
or is about to employ, any of the above, has a financial or other interest in the finn selected for award. The
Recipient 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 Recipient's
board members and management must disclose to the Agency 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 of this contract. The Recipient's employees and subcontractors must make the same disclosures
described above to the Recipient's board of directors. Compliance with this provision will be monitored.
31. Public Entity Crime
Pursuant to s. 287.133, F.S., 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 perfonn work as a Recipient, 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 of36 months following
the date of being placed on the convicted vendor list.
32. Purchasine:
32.1 The Recipient may 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 Recipient shall be deemed to be substituted for the Agency 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 The Recipient may procure any recycled products or materials, which are the subject of or are required to carry
out this contract, in accordance with the provisions ofs. 403.7065, F.S.
32.3 The Recipient may purchase articles that are the subject of, or required to carry out, this contract from a nonprofit
agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, F.S., in the same
manner and under the same procedures set forth in s. 413.036(1) and (2), F.S. For purposes of this contract, the
Recipient shall be deemed to be substituted for the Agency insofar as dealings with such qualified nonprofit
agency are concerned. Additional infonnation about the designated nonprofit agency and the products it offers is
available at http://www.respectofflorida.org.This clause is not applicable to subcontractors unless otherwise
required by law.
33. Patents. CODvri2hts. Rovalties
If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed,
produced or for which ownership was purchased in the course of or as a result of work or services perfonned
under this contract, the Recipient shall refer the discovery, invention or material to the Agency to be referred to
the Department of State and the Department of Elder Affairs. 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 of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to Paragraph 33.
33.2 If this contract is awarded solely federal funding, the tenns and conditions are governed by 2 CFR 215.36.
8
June 2011 - July 2012
34. Emer2encv Preparedness and Continuitv of Operations
160 12
1
CCE 203.11
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 Recipient shall,
within thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification of
an emergency preparedness plan. In the event of an emergency, the Recipient shall notify the Agency of
emergency provisions.
34.2 In the event a situation results in a cessation of services by a subcontractor, the Recipient shall 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.
36. Use of State Funds to Purchase or Improve Real Propertv
Any state funds provided for the purchase of or improvements to real property are contingent upon the Recipient
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 Contract Manager, who shall reduce
the decision to writing and serve a copy on the Recipient.
38. Financial Consequences of Non-Performance
If the Recipient fails to meet the minimum level of service or performance identified in this agreement, or that is
customary for the industry, then the Agency 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 Recipient will not be charged with financial consequences, when a failure to perform arises out of causes
that were the responsibility of the Agency.
39. No Waiver of Soverei2n Immunitv
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 shaH be valid or binding upon the Agency or the Recipient unless expressly contained herein or
by a written amendment to this contract signed by both Parties.
42. Force Maieure
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their 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.
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June 2011 - July 2012
160 1 2 "CCE203.11
43. Severability Clause
The Parties agree that if a court of competent jurisdiction deems any tenn 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: Aoorooriations
The Parties agree that the Agency's perfonnance 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 of Florida'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 will not constitute
or be deemed a waiver of the Agency's right thereafter to enforce those rights, nor will any single or partial
exercise of any such right preclude any other or further exercise thereof or the exercise of any other right.
47. Comoliance
The Recipient shall 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 Recipient to
abide by these laws shall be deemed an event of default of the Recipient, and subject the contract to immediate,
unilateral cancellation of the contract at the discretion of the Agency.
48. Final Invoice
The Recipient shall submit the final invoice for payment to the Agency as specified in Paragraph 3.3.5. (date for
final request for payment) of ATTACHMENT I. If the Recipient fails to submit fmal 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 tenns of this contract may be withheld until all
reports due from the Recipient and necessary adjustments thereto have been approved by the Agency.
49. Renel!otiations 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 tenninated 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 Contract Manager or the representative ofthe Recipient responsible for administration of the
contract.
50.2 In the event funds for payment pursuant to this contract become unavailable, the Agency may tenninate this
contract upon no less than twenty-four (24) hours notice in writing to the Recipient. 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 Contract Manager or the representative of the Recipient responsible for administration of the
contract. The Agency will be the final authority as to the availability and adequacy of funds. In the event of
tennination of this contract, the Recipient will be compensated for any work satisfactorily completed prior to the
date of tennination.
10
June 2011 - July 2012 16 0 1 2 '~CE 203.11
50.3 This contract may be terminated for cause upon no less than twenty-four (24) hours notice m writing to the
Recipient. Ifapplicable, the Agency may employ the default provisions in Rule 60A-1.006(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 Recipient'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 Recipient under this provision, the Recipient
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 Pavee and Representatives (Names, Addresses, and Telephone Numbers):
The Recipient name, as shown on page 1 of this contract, Collier County Board of Commissioners
a. and mailing address of the official payee to whom the Housing and Human Services Department
payment shall be made is: 3301 Tamiami Trail E. Bldg H, Rm 2 I I
Naples, FL 34112
Mary Krumbine, Director
The name of the contact person and street address where Collier County Board of Commissioners
b. financial and administrative records are maintained is: Housing and Human Services Department
3301 Tamiami Trail E. Bldg H, Rm 2 I I
Naples, FL 341 12
Mary Krumbine, Director
Collier County Board of Commissioners
c. The name, address, and telephone number of the Housing and Human Services Department
representative of the Recipient responsible for 3301 Tamiami Trail E. Bldg H, Rm 21 I
administration of the program under this contract is: Naples, FL 34112
(239252-2273
The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc.
d. 1520 IN. Cleveland Ave, Suite 1100
Requests for Payment and Receipt and Expenditure forms Fort Myers, Florida 33903
are to be mailed is:
Leigh Wade-Schield, Executive Director
e. The name, address, and telephone number of the Contract Area Agency on Aging for Southwest Florida, Inc.
Manager for this contract is: 1520 IN. Cleveland Ave, Suite I 100
Fort Myers, Florida 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.
11
June 2011 - July 2012
160 1 211 CCE203.ll
52. All Terms and Conditions Included
This contract and its Attachments, I - XI, A, B, D, E and F 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.
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused this 45 page contract, to be executed by their undersigned
officials as duly authorized.
Recipient:
COLLIER COUNTY BOARD OF
COMMISSIONERS
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC.
SIGNED BY:
NW.~
SIGNED BY:
NAME: FRED COYLE
NAME: LEIGH ANNA NOWAK
TITLE: CHAIRMAN
TITLE: BOARD PRESIDENT
DATE:
July 26, 20 I I
DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
,........,.....
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!\PPloiied as to form & jegal Sufficiency
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12
June 2011 - July 2012
'~~1
160 1 2;CCE203.11
INDEX TO CONTRACT ATTACHMENTS
ATTACHMENT ATTACHMENT DESCRIPTION PAGE
ATTACHMENT I STATEMENT OF WORK 14-24
ATTACHMENT II CERTIFICATION REGARDING LOBBYING 25
ATTACHMENT III FINANCIAL COMPLIANCE AUDIT ATTACHMENT 26-30
ATTACHMENT IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE 31
A TT ACHMENT V CERTIFICATION REGARDING DEBARMENT, SUSPENSION, 32
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS/SUBCONTRACTS
A TT ACHMENT VI ASSURANCES - NON-CONSTRUCTION PROGRAMS 33-34
A TT ACHMENT VII COMMUNITY CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY 35
ATTACHMENT VIII COMMUNITY CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE 36
ATTACHMENT IX REQUEST FOR PAYMENT, DOEA FORM 106C 37
ATTACHMENT X RECEIPTS AND EXPENDITURES, DOEA FORM 105C 38
ATTACHMENT A DEPARTMENT OF ELDER AFFAIRS PROGRAMS & SERVICES 39
HANDBOOK (A V AILABLE ON DEPARTMENT'S INTRANET SITE)
ATTACHMENT B DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE 40-43
CHECKLIST AND INSTRUCTIONS
ATTACHMENT D PROVIDER STATE CONTRACTS LIST 44
ATTACHMENT E DEPARTMENT OF ELDER AFFAIRS COMPUTER USE AND SOCIAL 45
MEDIA POLICY
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June 2011 - July 2012
160 12~
ATTACHMENT I
CCE 203.11
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INe.
STATEMENT OF WORK
COMMUNITY CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 CONTRACT ACRONYMS
Activities of Daily Living (ADL)
Adult Protective Services (APS)
Assessed Priority Consumer List (APCL)
Comprehensive Assessment and Review for Long-Term Care Services (CARES)
Community Care for the Disabled Adult (CCDA)
Community Care for the Elderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Department of Elder Affairs (DOEA)
Home Care for Disabled Adults (HCDA)
Instrumental Activities of Daily Living (IADL)
Planning and Service Area (PSA)
Web-based Database System (WebDB)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out: The condition of reaching 60 years of age and are being transitioned from the DCF Services,
CCDA or HCDA services to the Agency or Department of Elder Affairs community-based services.
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 Agency or Department of Elder Affairs instructions.
Area Plan Update: A revision to the area plan wherein the area agency on aging enters CCE specific data in
the WebDB. An update may also include other revisions to the area plan as instructed by the Agency or
Department of Elder Affairs.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to
remain independent and in the least restrictive living arrangement. DOEA Form 701B is used by case managers to
conduct the functional assessment
Primary Consideration: An assessment and services must commence within 72 hours after referral to the
Agency or Department of Elder Affairs as established in accordance with department and/or agency contracts
by local protocols developed between department/agency service contractors and ADS.
1.2 AGENCY MISSION STATEMENT
Mission: To help aging adults, 60 and older, achieve greater independence through awareness of
resources and access to qualified service providers.
Vision: To be the recognized leader in supporting older adults and their families with access to
trustworthy resources and services in their communities while empowering them to live with
independence and dignity.
Values: The Agency believes the residents of Southwest Florida are entitled to:
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June 2011 - July 2012
~ Comprehensive information about their choices of care;
~ Timely access to resources and services;
~ High standards of quality and performance;
~ Personal and professional accountability from all stakeholders.
160 1 2~ CCE203.11
Lead agencies and local service providers as partners and stakeholders in Florida's aging services
network are expected to support the agency's mission, vision, and priorities.
1.3 GENERAL DESCRIPTION
1.3.1 General Statement
The primary purpose of the CCE program is to prevent, decrease or delay premature or inappropriate and
expensive placement of older persons in nursing homes and other institutions. The CCE Program assists
functionally impaired elderly persons in living as independently as possible in their own homes or in the
homes of relatives or caregivers. The program provides a continuum of care through the development,
expansion, reorganization and coordination of multiple community-based services to assist elders to reside in
the least restrictive environment suitable to their needs.
1.3.2 Authority
The relevant authority governing CCE program are:
(1) Rule S8C-I, Florida Administrative Code
(2) Sections 430.201 through 430.207, F.S.
1.3.2.1
Incorporation of Reference Memoranda
In accordance with s. 287 F.S., as amended, and Department of Financial Services Chief Financial Officer
Memoranda the following memoranda are provided for informational purposes and are hereby incorporated by
reference:
(1) CFO Memo No. 02: Release date, August 20,2010;
(2) CFO Memo No. 03: Release date, June 29, 2010; and
(3) CFO Memo No. 06: Release date, June 30, 2010.
1.3.3 Scope of Service
The Recipient is responsible for the programmatic, fiscal, and operational management of CCE. The services
shall be provided in a manner of consistent with and described in the current Recipient's area plan update and
the current Department of Elder Affairs Programs and Services Handbook.
1.3.4 Major Program Goals
The major goals of the program are to preserve the independence of elders and prevent or delay more costly
institutional care through a community care service system that provides case management and other in-home
and community services as needed under the direction of a lead agency and provide a continuum of service
alternatives that meet the diverse needs of functionally impaired elders.
1.4. INDIVIDUALS TO BE SERVED
1.4.1 Individual Eligibility
In order to receive services under this contract, an applicant must:
(1) Be at least 60 years of age;
(2) Be functionally impaired as determined through the initial comprehensive assessment; and
(3) With the exception of APS high-risk referrals, consumers may not be dually enrolled in the CCE program
and a Medicaid capitated long-term care program.
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June 2011 - July 2012
160 1 2 ~ CCE203.11
1.4.1.1
Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk
of placement in an institution or who are abused, neglected or exploited.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the CCE program, the Recipient shall ensure the following tasks are performed:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible Clients; and
(4) Monitoring the performance of subcontractors.
2.1.1 Client Eligibility Determination
The Recipient shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a
client is based on meeting the requirements described in this Attachment I, Section 1.4.1.
2.1.1.1 APS High-Risk Referrals
APS high-risk referrals who are enrolled in a Medicaid long-term care program at the time of referral may
receive crisis-resolving CCE-funded services only under the following circumstances:
(1) The long-term care program provider is contacted regarding the referral as soon as it is received;
(2) The CCE lead agency receives notification from the long-term care program provider that the long-term
care program in which the consumer is enrolled will address the consumer's needs; and
(3) The CCE lead agency may only provide services until the crisis is resolved.
2.1.1.2 APS Intermediate and Low Risk Referrals
APS low and medium referrals who are enrolled in a Medicaid capitated long-term care program at the time of
referral will be referred to the long-term care provider.
2.1.2 Assessment and Prioritization of Service Delivery for New Clients
The following are the criteria to prioritize new clients for service delivery. It is not the intent of the Agency to
remove existing clients from services in order to serve new clients being assessed and prioritized for service
delivery.
2.1.2.1 Abuse, Neglect and Exploitation
The Recipient will ensure that pursuant to Section 430.205(5), Florida Statutes, those elderly persons who are
determined by APS to be victims of abuse, neglect, or exploitation who are in need of immediate services to
prevent further harm and are referred by APS, will be given primary consideration for receiving CCE services.
As used in this subsection, "primary consideration" means that an assessment and services must commence
within 72 hours after referral to the Agency or as established in accordance with Agency contracts by local
protocols developed between Agency service contractors and APS.
2.1.2.2 Priority Criteria for Individuals in Nursing Homes in Receivership:
The Recipient will ensure that pursuant to Section 400.126 (12), Florida Statutes, those elderly persons
determined, through a CARES assessment, to be a resident who could be cared for in a less restrictive setting
or who do not meet the criteria for skilled or intermediate care in a nursing home, will be referred for such
care, as appropriate for the resident. Residents referred pursuant to this subsection shall be given primary
consideration for receiving services under the CCE program in a manner as persons classified to receive such
services pursuant to Section 430.205, Florida Statutes.
2.1.2.3 Priority Criteria for Service Delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred to the community;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the
16
June 2011 - July 2012
community;
(3) Individuals in nursing homes that are closing and can be discharged to the community; or
(4) Individuals whose mental or physical health condition has deteriorated to the degree self care is not
possible, there is no capable caregiver, and institutional placement will occur within 72 hours;
(5) For the purpose oftransitioning individuals receiving CCDA and HCDA services through the DCF Adult
Services to community-based services provided through the Agency, when services are not currently
available, area agency on aging staff and lead agency case managers shall ensure that "Aging Out"
individuals are prioritized for services only after APS High Risk and Imminent Risk individuals.
16012
~ CCE 203.11
2.1.2.4 Priority Criteria for Service Delivery for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means of service
delivery. Service priority for individuals not included in groups one, two or three above, regardless of referral
source, will be detennined through the Agency's client assessment fonn administered to each applicant, to the
extent funding is available. First priority will be given to applicants at the higher levels of frailty and risk of
nursing home placement. For individuals assessed at the same priority and risk of nursing home placement,
priority will be given to applicants with the lesser ability to pay for services.
2.1.2.5 Referrals for Medicaid Waiver Services:
(1) The Recipient must require subcontractors, through the client assessment, to identify potential Medicaid
eligible CCE clients and to refer these individuals for application for Medicaid Waiver services.
(2) Individuals who have been identified as being potentially Medicaid Waiver eligible are required to apply
for Medicaid Waiver services in order to receive CCE services and can only receive CCE services while
the Medicaid Waiver eligibility detennination is pending. If the client is found ineligible for Medicaid
Waiver services for any reason other than failure to provide required documentation, then the individual
may continue to receive CCE services.
(3) Individuals who have been identified as being potentially Medicaid Waiver eligible must be advised of
the responsibility to apply for Medicaid Waiver services as a condition of receiving CCE services while
the eligibility detennination is being processed.
2.1.3 Delivery of Service to Eligible Clients
The Recipient shall provide a continuum of service that meet the diverse needs of functionally impaired elders.
The Recipient shall perfonn and report perfonnance of the following services in accordance with the current
DOEA Programs and Services Handbook. The services include the following categories:
(1) Core Services;
(2) Health Maintenance Services; and
(3) Other Support Services.
2.1.3.1
Core Services
Core Services include a variety of home-delivered services, day care services, and other basic services that are
most needed to prevent unnecessary institutionalization. Core services include the following:
(1) Adult Day Care; (8) Housing Improvement;
(2) Chore Services; (9) Legal Assistance;
(3) Companionship; (10) Pest Control Services;
(4) Escort; (11) Respite Services;
(5) Financial Risk Reduction; (12) Shopping Assistance; and
(6) Home Delivered Meals; (13) Transportation
(7) Homemaker;
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June 2011 - July 2012
2.1.3.2 Health Maintenance Services
Health Maintenance Services are routine health services that are necessary to help maintain the health of
functionally impaired elders. The services are limited to medical therapeutic services, non-medical prevention
services, personal care services, home health aide services, home nursing services, and emergency response
systems. Typical services provided are the following:
160 12
1
CCE 203.11
(1) Adult Day Health Care;
(2) Emergency Alert Response;
(3) Gerontological Counseling;
(7) Mental Health Counseling/Screening;
(8) Nutrition Counseling;
(9) Occupational Therapy;
(10) Personal Care;
(4) Health Support;
(5) Home Health Aide;
(6) Medication Management;
(11) Physical Therapy
(12) Skilled Nursing Services;
(13) Specialized Medical Equipment, Services
and Supplies; and
(14) Speech Therapy.
2.1.3.3 Other Support Services
Support Services expand the continuum of care options to assist functionally impaired elders and their
caregivers. Support services include the following:
(1) Caregiver Training/Support;
(2) Case Aid;
(3) Case Management;
(4) Intake;
(5) Material Aid; and
(6) Other.
2.1.4 Monitoring the Performance of Subcontractors
The Recipient will monitor at least once per year each of its subcontractors, subrecipients, vendors and/or
consultants paid from funds provided under this contract. The Recipient will perform fiscal, administrative and
programmatic monitoring to ensure contractual compliance, fiscal accountability, programmatic performance
and compliance with applicable state and federal laws and regulations. The Recipient will monitor to ensure
that time schedules are met, the budget and scope of work are accomplished within the specified time periods
and other performance goals stated in this contract are achieved.
2.1.4.1 Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the Recipient 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 Recipient shall notify the Contract Manager and the Director of Finance in writing of such delay.
The Recipient shall not permit a subcontractor to perform services related to this agreement without having a
binding subcontractor agreement executed. In accordance with Section 24.1 of the Standard Contract, the
Agency will not be responsible or liable for any obligations or claims resulting from such action.
Remedies-Nonconforming Services
2.1.5 The Recipient shall ensure that all goods and/or services provided under this contract for CCE funded
programs are delivered timely, completely and commensurate with required standards of quality (see
ATTACHMENT A). Such goods and/or services will only be delivered to eligible program participants.
In addition to meeting certain prescribed quality standards, any nonconforming goods (including home
delivered meals) and/or services not meeting such standards will not be eligible for reimbursement under this
contract. The Recipient shall solely bear the costs associated with preparing or providing nonconforming
18
June 2011 - July 2012 16 0 1 2 ~CE 203.11
goods and/or services shall be borne solely by the Recipient. The Agency requires immediate notice of any
significant and/or systemic infractions that compromise the quality, security or continuity of services to clients.
2.2
2.2.1
2.3
2.3.1
2.3.2
2.3.2.1
SERVICE TIMES AND LOCATION
Service Times
The Recipient shall ensure the provision of the services listed in this contract are available at times appropriate
to meet client service needs at a minimum, during normal business hours. Normal business hours are defined
as Monday through Friday, 8:00am to 5:00pm.
EQUIPMENT
Equipment means: (a) an article of non expendable, 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].
Recipients and subcontractors 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-I10) that include: (a) a property list with all the
elements identified in the circular; (b) a procedure for conducting a physical inventory of equipment at least
once every two years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of
the equipment; and (d) maintenance procedures to keep the equipment in good condition. The property records
must be maintained on file and shall be provided to the Agency upon request. Any loss, damage, or theft of
equipment shall be investigated and fully documented and the Recipient shall promptly notify the Contract
Manager.
The Recipient'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 of the equipment;
(2) Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
(3) Source ofthe equipment, including the award number;
(4) Whether title vests in the Recipient 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.
2.3.3 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 Agency is part of the cost of carrying out the activities and functions of the grant awards and title
(ownership) will vest in the Agency, subject to the conditions of2 CFR Part 215 Administrative Requirements
(formerly OMB Circular A-110), 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
19
June 2011 - July 2012 16 0 1 2''#1 CCE 203.11
subcontractors (not included in a cost methodology), is subject to the conditions of section 273, F. S. and 60A-
1.0017, F. A. C. or Title 45 CFR Part 74.
2.3.4
2.3.4.1
2.3.4.2
2.3.4.3
2.4
2.4.1
The Recipient shall not dispose of any equipment or materials provided by the Agency or purchased with
funds provided through this contract without ftrst obtaining the approval of the Contract Manager. When
disposing of property or equipment the Recipient must submit a written request for disposition instructions to
the Contract Manager. 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 Recipient's proposed disposition (e.g. transfer or donation to another agency that
administers federal programs, offer the items for sale, destroy the items).
The Contract Manager will issue disposition instructions. If disposition instructions are not received within
120 days ofthe written request for disposition, the Recipient is authorized to proceed as directed in 2 CFR Part
215 Administrative Requirements (fonnerly OMB Circular A-II 0).
Any penn anent storage devices (e.g. hard drives, removable storage media) must be refonnatted and tested
prior to disposal to ensure no conftdential infonnation remains.
The Recipient must adhere to the Agency's procedures and standards when purchasing Infonnation
Technology Resources (ITR) 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 me and must be provided to the Agency upon
request. The Recipient has the responsibility to require any subcontractors to comply with the Agency's ITR
procedures.
DELIVERABLES
Service Unit
The Recipient shall provide the services described in the contract in accordance with the current Department of
Elder Affairs Programs and Services Handbook. The chart below lists the services that can be perfonned and
the unit of measurement.
Service Unit of Service
Adult Day Care Health Support
Case Aid Home Health Aide
Case Management Medication Management
Chore Services Mental Health
Companionship Counseling/Screening
Escort Nutrition Counseling
Financial Risk Reduction Occupational Therapy Hour
Homemaker Personal Care
Housing Improvement Physical Therapy
Legal Assistance Skilled Nursing Services
Respite Services Speech Therapy
Adult Day Health Care Caregiver Training/Support
Gerontological Counseling Intake
Emergency Alert Response Day
Material Aid
Medication Management
Pest Control Services
Specialized Medical Equipment, Services and Supplies Episode
20
June 2011 - July 2012
16012
CCE 203.11
Escort
Shopping Assistance One-Way Trip
Transportation
Service Unit of Service
Home Delivered Meals Meal
2.5 REPORTS
The Recipient shall respond to additional routine and/or special requests for information and reports required
by the Agency in a timely manner as determined by the Contract Manager. The Recipient shall establish due
dates for any subcontractors that permits the Recipient to meet the Agency's reporting requirements.
2.5.1 Client Information and Registration Tracking System (CIRTS) Reports
The Recipient shall input CCE specific data into CIRTS to ensure CIRTS data accuracy. The Recipient shall
use CIRTS generated reports, which include the following:
(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
2.5.3
Service Costs Reports
The Recipient shall require subcontractors to submit to the Recipient semi-annual service cost reports, which
reflect actual costs of providing each service by program. This report provides information for planning and
negotiating unit rates.
Surplus/Deficit Report
The Recipient will submit a consolidated surplus/deficit report in a format provided by the Agency to the
Contract Manager by the 18th of each month. This report is for all agreements and/or contracts between the
Recipient and the Agency. The report will include the following:
(1) A list of all subcontractors and their current status regarding surplus or deficit;
(2) The Recipient's detailed plan on how the surplus or deficit spending exceeding the threshold specified by
the Agency will be resolved;
(3) Recommendations to transfer funds to resolve surplus/deficit spending;
(4) Input from the Recipient's Board of Directors on resolution of spending issues, if applicable;
(5) Number of clients currently on APCL that receive a priority ranking score of 4 or 5; and
(6) Number of clients currently on the APCL designated as Imminent Risk.
2.6 RECORDS AND DOCUMENTATION
The Recipient will ensure the collection and maintenance of client and service information on a monthly basis
from the Client Information and Registration Tracking System (CIRTS) or any.such system designated by the
Agency and the State of Florida Department of Elder Affairs. Maintenance includes valid exports and
backups of all data and systems according to Department and/or Agency standards.
2.6.1 Each contractor and subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover
from losses or outages of the computer system. Data and software essential to the continued operation of
21
June 2011 - July 2012 1 t... n 1l) .... CCE 203.11
Recipient functions must be backed up. The security controls over the tJc~ Jbbu s liwtll be as stringent
as the protection required of the primary resources. It is recommended that a copy of the backed up data be
stored in a secure, offsite location. The Recipient 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 will be made available to the Agency upon request.
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outconmes
(1) The Recipient shall timely submit to the Agency all reports described in ATTACHMENT I, SECTION
2.5 REPORTS;
(2) The Recipient shall timely submit to the Agency all information described in ATTACHMENT I,
SECTION 2.6 RECORDS AND DOCUMENTATION;
(3) The Recipient shall ensure services in this contract are in accordance with the current DOEA Programs
and Services Handbook.
2.7.2 The performance of the Recipient 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 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 group clients;
(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 likely to provide care;
(9) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor);
(10) Average time in the CCE Program for Medicaid Waiver probable customers; and
(11) Percent of customers who are at imminent risk of nursing home placement who are served with
community based services.
2.8. RECIPIENT'S FINANCIAL OBLIGATIONS
2.8.1 Matching, Level of Effort, and Earmarking Requirement
The Recipient will assure a match requirement of at least 10 percent of the cost for all CCE services. The
match will be made in the form of cash and/or in-kind resources. At the end of the contract period, all CCE
funds expended must be properly matched. State funds cannot be used to match another state-funded program..
2.8.2 Cost Sharing and Co-payments
The Recipient must ensure subcontractors establish annual co-payment goals. The Recipient has the option to
withhold a portion of the subcontractor's request for payment if goals are not met according to the Agency and
the Department of Elder Affairs' co-payment guidelines. Co-payments include only the amounts assessed
consumers or the amounts consumers opt to contribute in lieu of an assessed co-payment. The contribution
must be equal to or greater than the assessed co-payment. Co-payments collected in the CCE program can be
used as part of the local match.
22
June 2011 - July 2012 1 "0 1 2.1 CCE 203.11
2.8.3 Use of Service Dollars and Assessed Priority Consumer List Manag~e~
The Recipient is expected to spend all federal, state and other funds provided by the Agency, for the purpose
specified in each contract. The Recipient 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
Recipient. If the Agency determines that the Recipient is not spending service funds accordingly, the Agency
may transfer funds to other planning and service areas during the contract period and/ or adjust subsequent
funding allocations accordingly, as allowable under state and federal law.
2.8.4 The Recipient agrees to distribute funds as detailed in the area plan update and the Budget Summary,
A TT ACHMENT vn to this contract. Any changes in the total amounts of the funds identified on the Budget
Summary form require a contract amendment.
2.9 AGENCY RESPONSffiILITIES
2.9.1 Program Guidance and Technical Assistance
The Agency will provide to the Recipient guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Recipient.
2.9.2 Contract Monitoring
The Agency will review and evaluate the performance of the Recipient under the terms of this contract.
Monitoring shall be conducted through direct contact with the Recipient through telephone, in writing, or an
on-site visit. The Agency's determination of acceptable performance shall be conclusive. The Recipient agrees
to cooperate with the Agency in monitoring the progress of completion of the service tasks and deliverables.
The Agency may use, but is not limited to, one or more of the following methods for monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow-up on-site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third-party documents and/or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed-upon procedures review by an external auditor or consultant;
(9) Limited-scope reviews; and
(10) Other procedures as deemed necessary.
SECTION III: MEmOD 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 Recipient 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 Recipient shall consolidate all requests for
payment from subcontractors and expenditure reports that support requests for payment and shall submit to the
Agency on forms 106C (A TT ACHMENT IX) and 105C (A TT ACHMENT X).
3.2 Advance Payments
The Recipient may request up to two months of advances at the start of the contract period 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 and the State of Florida Department of Elder Affairs ("budget
release"). The Recipient shall provide the Contract Manager documentation justifying the need for an advance
and describing how the funds will be distributed.
23
June 2011 - July 2012
16012
I
CCE 203.11
3.2.1
3.2.2
3.2.3
3.3
3.3.1
3.3.2
3.3.3
3.3.4
3.3.5
3.4
3.4.1.
3.4.2.
The Recipient's requests for an advance require the approval of the Contract Manager. If sufficient budget is
available, the Agency will issue approved advance payments after July 1, 2011.
All advance payments made to the Recipient shall be returned to the Agency as follows: one - twelfth
of the advance payment received shall be reported as an advance recoupment on each request for payment,
starting with report number three, in accordance with the Invoice Schedule, ATTACHMENT VIll to this
contract.
The Recipient may temporarily place advanced funds in a FDIC insured interest bearing account. All interest
earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of each
quarter of the contract period.
Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA
forms 106C (ATTACHMENT IX) and 105C (ATTACHMENT X).
All payment requests 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 (when available) and invoices
is A TT ACHMENT VIll to this contract.
Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified
in ATTACHMENT VB, Budget Summary.
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Recipient and any adjustments
thereto, including any disallowance not resolved as outlined in section 26 of this Standard Contract.
Date for Final Request for Payment
The final request for payment will be due to the Agency no later than August 01. 2012.
Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services
provided through June 30, 2012, must be submitted to the Contract Manager by contract end date of June 30,
2012.
Documentation for Payment
The Recipient will maintain documentation to support payment requests that shall be available to the Agency
or authorized individuals, such as the Department of Financial Services, upon request.
The Recipient will be required to enter all subcontractors data per the Department's CIRTS Policy Guidelines
for clients and services in the CIRTS database. The data must be entered into the CIRTS before the Recipient
submits their request for payment and expenditure reports to the Agency by the tenth, lOth, of the month. See
ATTACHMENT VB for all invoice dates. The Recipient shall establish time frames with their
subcontractors to assure compliance with due dates for the requests for payment and expenditure reports to the
Agency.
The Agency will require the Recipient to run monthly CIRTS reports and verify that the client and service data
in the CIR TS is accurate. This report must be submitted to the Agency with the monthly request for payment
and expenditure report and must be reviewed by the Agency before the Recipient's request for payment and
expenditure reports can be approved by the Agency.
24
June20ll-July20l2
16D12~
CCE 203.11
A TT ACHMENT II
CERTIFICATION REGARDING LOBBYING
CERTIFICA TION 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 subcontractors 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. Subrnission 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 and not more than $100,000 for each such failure.
~w~
Signature
Julv 26,20 II
Date
Fred Coyle, Chairman
Name of Authorized Individual
CCE 203.11
Application or Agreement Number
Collier County Board of County Commissioners
3339 E. Tamiami Trail East
Naples, FL 34112
Name and Address of Organization
DOEA Form 103
(Revised Nov 2002)
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7"'1~/:~~7.:;::".-~~1'"\"";., ~,~~~~
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25
June 2011 - July 2012
16 0 1 2~;TAC~;/~
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Area Agency on Aging for Southwest Florida, Inc. and/or the Department
of Elder Affairs to the provider may be subject to audits and/or monitoring by the Area Agency on Aging for Southwest
Florida, Inc. and/or the Department of Elder Affairs as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-l33, 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 Agency staff,
limited scope audits as defined by OMB Circular A-l33, 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 Area Agency on Aging for Southwest Florida, Inc.. In the event the Area Agency on Aging for Southwest Florida,
Inc. determines that a limited scope audit of the provider is appropriate, the provider agrees to comply with any additional
instructions provided by the Area Agency on Aging for Southwest Florida, Inc. 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 defmed in OMB
Circular A-l33, as revised.
In the event that the provider expends $500,000 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-l33, as revised.
EXHffiIT 1 to this agreement indicates federal resources awarded through the Area Agency on Aging for Southwest
Florida, Inc. and/or 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 Area
Agency on Aging for Southwest Florida, Inc. and/or 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-l33, as revised. An
audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular A-l33, 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-l33, as revised.
If the provider expends less than $500,000 in federal awards in its fiscal year, an audit conducted in accordance with the
provisions of OMB Circular A-I33, as revised, is not required. In the event that the provider expends less than $500,000
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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida,
Inc. and/or the Department of Elder Affairs shall be fully disclosed in the audit report with reference to the Area Agency
on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs agreement involved. If not otherwise
disclosed as required by Section .31 O(b )(2) of OMB Circular A-l33, as revised, the schedule of expenditures of federal
awards shall identify expenditures by agreement number for each agreement with the Area Agency on Aging for
Southwest Florida, Inc. and/or 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.
26
June 2011 - July 2012
PART II: STATE FUNDED
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 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. EXHffiIT I to this agreement indicates state financial assistance
awarded through the Area Agency on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs by this
agreement. In determining the state fmancial assistance expended in its fiscal year, the provider shall consider all sources
of state financial assistance, including state financial assistance received from the Area Agency on Aging for Southwest
Florida, Inc. and/or 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.
160 12 ~
CCE 203.11
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 of a 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 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 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or the
Department of Elder Affairs shall be fully disclosed in the audit report with reference to the Area Agency on Aging for
Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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-l33, as revised, and required by
PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-l33, 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 Wade-Schield, Executive Director
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
27
June 2011 - July 2012 16 0 1 2 CCE 203.11
The Federal Audit Clearinghouse designated in OMB Circular A-l33, as revised (the number of copies required by
Sections .320 (d)(l) and (2), OMB Circular A-l33, 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 (t), OMB Circular A-l33, as
revised.
Pursuant to Sections .320(t), OMB Circular A-l33, as revised, the provider shall submit a copy of the reporting package
described in Section .320(c), OMB Circular A-l33, 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 Wade-Schield, Executive Director
15201 N Cleveland Ave., 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 Wade-Schield, Executive Director
15201 N Cleveland Ave., 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 infonnation required to be submitted to the Area Agency on Aging for
Southwest Florida, Inc. and/or the Department of Elder Affairs pursuant to this agreement shall be submitted timely in
accordance with OMB Circular A-l33, 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. and/or
the Department of Elder Affairs for audits done in accordance with OMB Circular A-l33 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 tenns of this agreement for a period of
six years from the date the audit report is issued, and shall allow the Area Agency on Aging for Southwest Florida, Inc.
and/or the Department of Elder Affairs or its designee, the CFO or Auditor General access to such records upon request.
The provider shall ensure that audit working papers are made available to the Area Agency on Aging for Southwest
Florida, Inc. and/or the Department of Elder Affairs, or its designee, 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 Area Agency on Aging for Southwest
Florida, Inc. and/or the Department of Elder Affairs.
28
June 2011 - July 2012
160 1 2 1 CCE203.11
ATTACHMENT ill
EXHIBIT - 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD $0
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO TillS 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
TOTAL STATE AWARD $0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Community Care for the Elderly Program General Revenue 65010 $639,667.00
TOTALAWARD $639,667.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES A WARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
29
June 2011 - July 2012
16012
ATTACHMENT ill
EXHIBIT -2
~ CCE 203.11
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-133, as
revised, and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients offederal 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 I are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-
133, 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-133 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.
~ Recipient/subrecipient subject to OMB Circular A-133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient Isubrecipient offederal and or state fmancial assistance and has been approved by
the Agency to subcontract, they must comply with Section 215.97(7), F.S., and Rule 691-.006(2), FAC [state fmancial assistance] and
Section _ .400 OMB Circular A-133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL A WARDS OR STATE MATCHING FUNDS ON FEDERAL A WARDS. 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-133 - 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-I 10 - 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 fmancial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 2 I 5.97, 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
30
June 2011 - July 2012
16 0 1 2'~ CCE 203.11
A TT ACHMENT IV
CERTIFICA TION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND
COOPERA TIVE AGREEMENTS
The undersigned, an authorized representative of the Recipient named in the contract or agreement to which this fonn is
an attachment, hereby certifies that:
(1) The Recipient and any subcontractors of services under this contract have financial management systems capable of
providing certain infonnation, 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 infonnation in accordance with these requirements could result in a return of
grant funds that have not been accounted for properly.
(2) Management Infonnation Systems used by the Recipient, subcontractor(s), or any outside entity on which the
Recipient 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, Recipient(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, finnware, 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 Recipient (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 Recipient 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 Recipient and any subcontractor(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 Recipient shall require that the language of this certification be included in all subagreements, subgrants, and other
agreements and that all subcontractors 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 of this certification is a prerequisite for making or entering into this transaction imposed by
OMB Circulars A-I02 and 2 CFR Part 215 (fonnerly OMB Circular A-IIO).
Collier County Board of County Commissioners
3339 E. Tamiami Trail East
Naples, FL 34112
Name a<l!!.tddre~s of ReciP~
f'Lt.L W. Chainnan
Signature .Title .~.
July 26,2011
Date
Fred Coyle
Name of Authorized Signer
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<.W to 'form & legai Sufficl~n~li
(Revised June 2008)
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June 2011 - July 2012
160 1 2~CCE203.11
A TT ACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGmILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective Recipient certifies, by signing this certification, neither it nor its principals is 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 Recipient is unable to certifY to any of the
prospec ive articipant shall attach an explanation to this certification.
W. ~ July 26, 2011
Date
statements in this certification, such
Signature
Fred Coyle. Chairman
Title
Collier County Board of Commissioners
Agency/Organization
(Certification signature should be same as Contract signature.)
Instructions for Certification
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction,"
"person," "primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out
in the sections of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as supplemented by 2
CFR 376.10-376.995). 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 Recipient knowingly rendered an erroneous certification,
in addition to other remedies available to the federal government, the Department or Agency may pursue
available remedies, including suspension and/or debarment.
3. The Recipient will provide immediate written notice to the Contract Manager if at any time the Recipient learns
that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances. The Recipient 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).
4. The Recipient 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 Recipient 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 Recipient 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 or Agency may pursue available remedies, including
suspension, and/or debarment.
7. The Recipient may 1'et~.ftR011 a certification of a prospective participant in a lower tier covered transaction that
it is not debarr.ed,r.siI$pe~{d;' Jneligible, or voluntarily excluded from the covered transaction, unless it knows
... ( -. /
that the certificafis:m is,~ouS",
(Revised June 2008) " ::'.' , . .~ Approved as to form & legal SuffIcIency
32
~ .
~}..J~
~5~!ltan County Attorney
-J, ~.^' \ , c:=,... r-- iJ.. ."\_,, ,___r
. .
8y:
June 2011 - July 2012
160 1 2 CCE203.11
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.
1. 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 of the 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 V.S.C.. 6101-6107), which prohibits discrimination on the
basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (Pol. 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 ofalcohol 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 (Pol. 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.
33
June 2011 - July 2012
160 12' CCE203.11
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(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 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 1173 8; (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 V.S.C.. 1451 et seq.); (f) conformity of
federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42
V.S.c.. 740 I 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 V.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 V.S.C..470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 V.S.c.. 469a-l 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 V.s.c.. 2131 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 V.S.C..4801 et seq.), which prohibits the use ofIead- based
paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of
1996 and OMB Circular No. A-133, 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
~W. cr Chairman
Fred Coyle
APPLICANT ORGANIZATION DATE SUBMITTED
Collier County Board of County Commissioners July 26, 20 II
Housing, Human and Veteran Services Department
. ~ ()i \ loi r l" .~
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DV;I~r '~::~flO$;{.~ !2;~ 7::
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A TT ACHMENT VII
, f
34
June 2011 - July 2012
160 1? ~ CCE203.11
ATtACHMENT VII
CO~TYCAREFORTHEELDERLYPROG~
BUDGET SUMMARY
for
Collier County Board of Commissioners
Collier County
1.
CCE Spending Authority
Case Management, Case Aide,
Intake Allocations
Lead Agency Operating Dollars
$425,717.00
118,000.00
2.
3.
95,950.00
Total
$639,667.00
RATE SUMMARY
for
Collier County Board of Commissioners
Collier County
Collier County Total Rate Reimbursement Rate
Case Management $50.00 $45.00
Case Aid $27.78 $25.00
Chore $20.00 $18.00
Companion $20.00 $18.00
EARS $0.83 $0.75
EARS Plus $1.11 $1.00
Enhanced Chore $30.00 $27.00
Facility Respite (24 hours) $138.90 $125.00
Homemaking $20.00 $18.00
Personal Care $22.22 $20.00
Respite-In Home $20.00 $18.00
Skilled Nursing $38.89 $35.00
Adult Day Care $10.00 $9.00
Spec. Medical Equipment 100% Cost 90% cost
35
June 201 I - July 2012
Report Number
I
2
3
4
5
6
7
8
9
10
I I
12
13
14
IS
16
Legend:
Note # I:
Note #2:
Note #3:
160 1? ' CCE203.II
n'T ACHMENT VIll
COMMUNITY CARE FOR THE ELDERLY
INVOICE REPORT SCHEDULE
Based On
Submit to Agency on this Date
July I
July I
August 10
September 10
October 10
November 10
December 10
January 10
February 10
March 10
April 10
May 10
June 10
July 10
August I
August IS
July Advance*
August Advance*
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
Final Expenditure
Closeout Report
*
Advance based on projected cash need.
Report # I for Advance Basis Agreements cannot be submitted to the Area
Agency on Aging for Southwest Florida, Inc. prior to July I or until the
agreement with the Department or Agency has been executed and a copy sent
to DFS. Actual submission of the vouchers to Area Agency on Aging for
Southwest Florida, Inc. is dependent on the accuracy of the expenditure report.
Report numbers 3 through 14 shall reflect an adjustment of one twelfth of the
total advance amount, on each of the reports, repaying advances issued the first
two months of the agreement. The adjustment shall be recorded in Part C, I of
the report (Attachment IX).
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.
36
June 2011 - July 2012
16D12~'
CCE 203.11
ATTACHMENT IX
REQUEST FOR PAYMENT
COMMUNITY CARE FOR THE ELDERLY
RECIPIENT NAME, ADDRESS, PHONE# and FEID# TYPE OF PAYMENT: This Request Period: From: To:
Regular Contrad Period
Centrad #
Advance Report #
PSA#
CERTIFICATION: I hereby certify to the best of my knowledge that this request or refund conforms with the terms and the purposes 01 the above contract.
Prepared by: Date: Approved by: Date:
PART A: BUDGET SUMMARY CCE Admin. CCE Services TOTAL
1. Approved Contract Amount $ $ $ $
2. Previous Funds Received for Contract Period $ $ $ $
3. Contract Balance $ $ $ $
4. Previous Funds Requested and Not Received for Contrad Period $ $ $ $
5. CONTRACT BALANCE $ $ $ $
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1st - 2nd months) $ $ $ $
2. Nat Expenditures For Month $ $ $ $
(DOEA Form 105C, Part B, Line 4)
3. TOTAL $ $ $ $
PART C: NET FUNDS REQUESTED
1. Less Advance Applied $ $ $ $
2. TOTAL FUNDS REQUESTED (Part B Line 3, minus Part Cline 1) $ $ $ $
DOEA FORM 106C
Revised 512512010
37
June 2011 - July 2012
16 D 1 2 i1 CCE203.11
J\TTACHMENT X
RECEIPT AND EXPENDITURE REPORT
COMMUNITY CARE FOR THE ELDERLY
PROVIDER NAME. ADDRESS. PHONE # and FEID# Program Funding: THIS REPORT PERIOD:
From To
CCE Admin. CONTRACT PERIOD:
CCE Services CONTRACT #
REPORT #
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are tor purposes set forth in the contract.
Prepared by : Date: Approved by : Dat. :
PART A : BUDGETED INCOME I RECEIPTS 1. Approved 2. Actual Receipts 3. Total Receipts 4. Percent of
Budaet For This Re....~rt Year to Date A~~roved Bud~et
1. State Funds $0.00 $0.00 $0.00 #DIV/OI
2. Program Income $0.00 $0.00 $0.00 #DIV/OI
3. Local Cash Match $0.00 $0.00 $0.00 #DIV/Ol
4. SUBTOTAL: CASH RECEIPTS
5. Local In-Kind Match
e. TOTAL RECEIPTS $0.00 $0.00 $0.00 #DIV/OI
PART B : EXPENDITURES 1 . Approved 2. Expenditures 3. Expendttures 4. Percent of
Budnet For This Renort Year to Date Annroved Budnet
1. Administrative Services $0.00 $0.00 $0.00 #DIV/OI
2. Service Subcontractor(s} $0.00 $0.00 $0.00 #DIV/OI
3. Adult Protective Services $0.00 $0.00 $0.00 #DIV/Ol
4. TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/OI
PART C : OTHER REVENUE AND EXPENDITURES II. Interest: III. Advance Recouped
I. Program Income (PI) 1. Earned on OR Advance $ $
1. CCE: PI Collected YTD $ 2. Return of GR Advance $
(Includes fees collected) 3. Other Earned $
PART D: CO-PAYMENTS CURRENT MONTH YEAR- TO-DATE
1. Total of Co-payments assessed $ $
2. Total of Co-payments collected $ $
(For Tracking Purposes only)
DOEA FORM 105C
Revlaed ~12512010
38
June 2011 - July 2012
16n121
CCE 203.11
ATTACHMENT A
Department of Elder Affairs Programs & Services Handbook
is available at the Department's Intranet site under, "Publications".
39
June2011-July2012
160 1 2 ~CCE203.11
ATTACHMENT B
CIVIL RIGHTS COMPLIANCE CHECKLIST
ProgramlFacility Name County I AANRecipient
Address Completed By
City, State, Zip Code Date I Telephone
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
PART I: READ THE A 17 ACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM.
I. Briefly describe the geographic area served by the program/facility and the type of service provided:
2. POPULATION OF AREA SERVED. Source of data:
Total # % White % Black % Hispanic
% Other
% Female
3 . STAFF CURRENTLY EMPLOYED. Effective date:
Total # % White % Black % Hispanic
% Other
% Female
% Disabled
CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
Total # % White % Black % Hispanic % Other
% Female
% Disabled
% Over 40
ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total # % White % Black % Hispanic
% Other
% Female
% Disabled
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? IfNIA or NO, explain.
N/A YES NO
ODD
7. Compare the staff composition to the population. Is staff representative of the population?
IfNI A or NO, explain.
NIA YES NO
ODD
8. Compare the client composition to the population. Are race and sex characteristics representative of the
population? IfNIA or NO, explain. NIA
o
YES NO
o 0
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
ODD
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? IfNIA or NO, explain.
N/A YES NO
ODD
I I. For in-patient services, are room assignments made without regard to race, color, national origin
or disability? IfNIA or NO, explain.
N/A YES NO
ODD
Revised August 2010, Page Iof2
40
June2011-July2012
160 1 2 dCE203.11
12. Is the program/facility accessible to non-English speaking clients? IfNI A or NO, explain.
NIA YES NO
D D D
13. Are employees, applicants and participants informed of their protection against discrimination? If YES,
how? Verbal DWrittenDPosterD IfN/AorNO,explain. NIA
D
YES NO
D D
14. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility. N/A
D
NUMBER
15. Is the program/facility physically accessible to mobility, hearing, and sight-impaired individuals? IfNIA or
NO, explain.
N/A YES NO
D D D
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.
YES NO
D D
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If
NO, explain.
YES NO
D D
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES NO
D D
19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination
on the basis of disability? If NO, explain.
YES NO
D D
20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? If
NO, explain.
YES NO
D D
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF 550,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES NO
D D
DOl \ , '-I 0\1 ,
Reviewed By In Compliance: YES 0 NO. 0
Program Office .Notice of Corrective Action Sent / I
Date I Telephone Response Due ~ ~_
On-Site 0 Desk Review 0 Response Received _I ~_
Revised August 2010, Page 2 of2
41
June 2011 - July 2012 CCE 203.11
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 1 6 0 1 2
I. 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).
II. 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).
42
June 2011 - July 2012
CCE 203.11
16D 12
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 identiry 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. Modiry 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 satisry 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 101-8, Revised August 2010
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ATTACHMENT E
Department's Computer Use Policy and its Social Media Policy, provided on CD.
45
1~D12
Attestation Statement
AgreementlContract Number CCE 203.11
Amendment Number 1
I, Fred Covle , 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.COYl~ w. c+
Signature of Recipient/Contractor representative
7/26/2011
Date
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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 12'
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract # CCE 203.11
I, Fred Coyle , certify that Collier County Board of Commissioners
(Name of authorized contractor representative) (Name of contractor)
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that
the plan will be made available to the Area Agency on Aging for Southwest Florida, Inc. (AAA)
upon request.
~w.~
Fred W. Coyle
Signature of authorized contractor representative
Chairman
7/26/201\
Date
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October 2008
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
160 12~
MEMORANDUM
Date:
August 11,2011
To:
Ashley Franco
Housing, Human and Veteran Services
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
Standard Contract with Area Agency on Aging for SW FL, Inc.
Home Care for the Elderly Program (HCE 203.11)
Attached for your records are three (3) originals of the document referenced above
(Item #16D12) approved by the Collier County Board of County Commissioners on
Tuesday, July 26, 2011.
Please forward on for additional signatures and return a Fullv Executed
Oril!inal to the Minutes & Records Department to be kept in the Board's
Official Records.
If you have any questions, please feel free to contact me at 252-7240.
Thank you.
June 2011 - July 2012
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT
160 1 2'~
HCE 203.11
HOME CARE FOR THE ELDERLY PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of Commissioners ("Recipient"), and collectively referred to as the "Parties." The term Recipient
for this purpose may designate a vendor, subgrantee or subrecipient, the status to be further identified in
ATTACHMENT Ill, 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 Recipient has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Recipient 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), area plan(s), 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 July 1. 20 II 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
June 30. 2012.
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 $83,391.00, 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)(f), 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 Recipient 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 Recipient shall comply with all applicable
standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42 U.S.c. 7401, et seq.), s.
508 of the Federal Water Pollution Control Act as amended (33 U.S.c. 1251, et seq.), Executive Order 11738, as
amended, and where applicable Environmental Protection Agency regulations 40 CFR 30. The Recipient shall
1
June 2011 - July 2012
report any violations of the above to the Agency.
160 12
t
1
HCE 203.11
6.1.3 The Recipient, or agent acting for the Recipient, 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 Recipient must, prior to contract execution,
complete the Certification Regarding Lobbying form, A TT ACHMENT II. All disclosure forms as required by
the Certification Regarding Lobbying form must be completed and returned to the Contract Manager prior to
payment under this contract.
6.1.4 In accordance with Appendix A to 2 CFR 2 I 5, the Recipient 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 If this contract contains federal funds and provides services to children up to age 18, the Recipient shall comply
with the Pro-Children Act of 1994 (20 V.S.C. 6081).
6.1.6 A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards will
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 Recipient shall comply with these provisions before doing business or entering into subcontracts
receiving federal funds pursuant to this contract. The Recipient shall complete and sign ATTACHMENT V
prior to the execution of this contract.
6.2 The Recipient shall not employ an unauthorized alien. The Agency will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 V.S.C. 1324a) and the Immigration
Reform and Control Act of 1986 (8 V.S.C. 1101). Such violation will be cause for unilateral cancellation of this
contract by the Agency.
6.3 If the Recipient is a non-profit provider and is subject to Internal Revenue Service (IRS) tax exempt organization
reporting requiremt:nts (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 Pension Protection Act of 2006 or for any other reason, the Recipient
must notify the Agency in writing within thirty (30) days of receiving the IRS notice of revocation.
6.4
6.5
7.
7.1
7.2
7.2.1
7.2.2
7.2.3
The Recipient shall comply with Title 2 CFR Part 275 regarding Trafficking in Persons.
Vnless exempt under 2 CFR Part 170.110(b), the Recipient shall comply with the reporting requirements of the
Transparency Act a'i expressed in 2 CFR 170.
Comoliance with State Law
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 of laws.
The Recipient shall comply with requirements ofs. 287.058, F.S. as amended.
The Recipient shall 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 Contract Manager must receive and
accept in writing prior to payment in accordance with s. 215.971, F.S. (I) and (2).
The Recipient shall submit bills for fees or other compensation for services or expenses in sufficient detail for a
proper pre-audit and post-audit.
If itemized payment for travel expenses is permitted in this contract, the Recipient shall 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.
2
June 2011 - July 2012 16 0 1 2 ' HCE 203.11
7.2.4 The Recipient shall 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 Recipient in conjunction with this contract except for
those records which are made confidential or exempt by law. The Recipient's refusal to comply with this
provision will 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 Recipient 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, in
accordance with the provisions ofs. 287.134, F.S.
7.5 The Recipient shall 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. Back2:round Screenin2
The Recipient 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, will 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 apply to employees, subcontractors, consultants, direct
service providers and volunteers. Consequently, any commitment for employment, purchase of services, or
volunteer program participation will be contingent upon the passing of a Level II background check. The
background screening will 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 Recipient shall develop, 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, will 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 The Recipient shall establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of funds
provided by the Agency under this contract. Recipient shall adequately safeguard all such assets and assure they
are used solely for the purposes authorized under this contract. Whenever appropriate, fmancial information
should be related to performance and unit cost data.
10.2 The Recipient shall 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 Upon demand, at no additional cost to the Agency, the Recipient shall facilitate the duplication and transfer of
any records or documents during the required retention period in Paragraph 10.2.
10.4 The Recipient shall assure that the records described in Paragraph 10 will be subject at all reasonable times to
3
-1
June 2011 - July 2012 1 "0 1? 'HCE 203.11
inspection, review, copying, or audit by federal, state, or other personn* d~ authonzeh'y the Agency.
10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Agency and federal
auditors, pursuant to 45 CFR 92.36(iX10), will be allowed full access to and the right to examine any of the
Recipient's contracts and related records and documents pertinent to this specific contract, regardless of the form
in which kept.
10.6 The Recipient shall provide a financial and compliance audit to the Agency as specified in this contract and in
A TT ACHMENT III and ensure that all related third-party transactions are disclosed to the auditor.
10.7 The Recipient shall 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 Ril!hts Compliance
11.1 The Recipient shall 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
Recipient 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 During the term of this contract, the Recipient shall complete and retain on file a timely, complete and accurate
Civil Rights Compliance Checklist (ATTACHMENT B).
11.3 The Recipient shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures will include notifying clients, employees, and
participants of the 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 Recipient, its successors, transferees, and assignees for the
period during which such assistance is provided. The Recipient 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 Recipient
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 Recipient shall provide services in the manner described in ATTACHMENT I.
13. Monitorinl! by the Al!ency
The Recipient shall permit persons duly authorized by the Agency to inspect and copy any records, papers,
documents, facilities, goods and services of the Recipient which are relevant to this contract, and to interview any
clients, employees and subcontractor employees of the Recipient to assure the Agency of the satisfactory
performance of the terms and conditions of this contract. Following such review, the Agency will provide a
written report of its findings to the Recipient, and where appropriate, the Recipient shall develop a corrective
action plan. The Recipient hereby agrees to correct all deficiencies identified in the corrective action plan in a
timely manner as determined by the Contract Manager.
14. Coordinated Monitorinl! with Other Al!encies
If the Recipient 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
4
June 2011 - July 2012 1 6 0 1 2' HCE 203.11
service agencies shall include the Department of Children and Fam~es, the Department of Health, the Agency
for Persons with Disabilities, the Department of Veterans Affairs, and the Department of Elder Affairs. Upon
notification and the subsequent scheduling of such a visit by the designated agency's lead administrative
coordinator, the Recipient shall comply and cooperate with all monitors, inspectors, and/or investigators.
15. Indemnification
The Recipient shall indemnify, save, defend, and hold hannless 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 perfonnance of the services provided for herein. It is understood and
agreed that the Recipient is not required to indemnify the Agency for claims, demands, actions or causes of
action arising solely out of the Agency's negligence.
15.1 Except to the extent pennitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
executed between the Department and state agencies or subdivisions defined in s. 768.28(2), F.S.
16. Insurance and Bondinl!
16.1 The Recipient shall 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 Recipient accepts full responsibility for identifying and detennining
the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the
Recipient and the clients to be served under this contract. The limits of coverage under each policy maintained by
the Recipient do not limit the Recipient's liability and obligations under this contract. The Recipient shall ensure
that the Agency has the most current written verification of insurance coverage throughout the tenn 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 tenn of this agreement, the Recipient shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Recipient 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 detennined by the insurance
company and consistent with good business practices.
17. Confidentiality of Information
The Recipient shall not use or disclose any infonnation 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 Recipient shall comply with the Health Insurance Portability and Accountability Act (42
USC 1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
19. Incident ReDortinl!
19.1 The Recipient shall notify the Agency immediately, but no later than forty-eight (48) hours from, the Recipient's
awareness or discovery of conditions that may materially affect the Recipient or subcontractor's ability to
perfonn the services required to be perfonned under this contract. Such notice shall be made orally to the
Contract Manager (by telephone) with an email to immediately follow.
19.2 The Recipient shall 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
(l-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Recipient
and its employees.
5
20.
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June 2011 - July 2012
New Contract(s) Reportine:
The Recipient 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 Recipient shall complete and provide the
information in ATTACHMENT D.
21.
Bankruptcv Notification
During the term of this contract, the Recipient shall immediately notify the Agency if the Recipient, its assignees,
subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Recipient must
also provide the following information to the Area Agency on Aging for Southwest Florida, Inc.: (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., United States Bankruptcy Court Middle District of Florida, Fort Myers, FL ); and, (4) the name,
address, and telephone number ofthe bankruptcy attorney.
22.
Sponsorship and Publicity
22.1
As required by s. 286.25, F.S., if the Recipient 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 Collier County
Board of Commissioners, the State Department of Elder Affairs, and the Area Agency on Aging for Southwest
Florida, Inc." If the sponsorship reference is in the written material, the words "State of Florida, Department of
Elder Affairs and the Area Agency on Aging for Southwest Florida, Inc." shall appear in at least the same size
letters or type as the name ofthe organization.
22.2
The Recipient shall not use the words "The State of Florida Department of Elder Affairs or the Area Agency on
Aging for Southwest Florida, Inc." to indicate sponsorship of a program otherwise financed, unless specific
authorization has been obtained by the State and Agency prior to use.
23.
Assie:nments
23.1
The Recipient 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 is at all times 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
Recipient. In the event the State of Florida approves transfer of the Recipient's obligations, the Recipient
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 Recipient or the Agency.
24.
24.1
Subcontracts
The Recipient is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the Recipient or its subcontractors. Any subcontracts shall be evidenced by a
written document and subject to any conditions of approval the Agency deems necessary. The Recipient further
agrees that the Agency will not be liable to the subcontractor in any way or for any reason. The Recipient, at its
expense, shall defend the Agency against any such claims.
24.2
The Recipient 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 Recipient and subcontractor, will result in a penalty as provided by statute.
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June 2011 - July 2012
25. Indeoendent Caoacitv of Recioient
It is the intent and understanding of the Parties that the Recipient, 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 Recipient and will not be liable for any wage
and hour, employment discrimination, or other labor and employment claims against the Recipient or its
subcontractors. All deductions for social security, withholding taxes, income taxes, contributions to
unemployment compensation funds and all necessary insurance for the Recipient are the sole responsibility of the
Recipient.
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26. Payment
Payments shall be made to the Recipient pursuant to s. 215.422, F.S., as services are rendered and invoiced by
the Recipient. The Contract Manager will have final approval of the invoice for payment, and will approve the
invoice for payment only if the Recipient has met all tenns 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 of s. 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 Recipient shall return to the Agency any overpayments due to unearned funds or funds disallowed and any
interest attributable to such funds pursuant to the tenns and conditions of this contract that were disbursed to the
Recipient by the Agency. In the event that the Recipient or its independent auditor discovers that an
overpayment has been made, the Recipient 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 Contract
Manager will notify the Recipient in writing of such findings. Should repayment not be made forthwith, the
Recipient will be charged at the lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after
Agency notification or Recipient discovery.
28. Data Inte2ritv and Safe2uardin2 Information
The Recipient shall ensure an appropriate level of data security for the infonnation the Recipient is collecting or
using in the perfonnance of this contract. An appropriate level of security includes approving and tracking all
Recipient employees that request system or infonnation access and ensuring that user access has been removed
from all tenninated employees. The Recipient, among other requirements, must anticipate and prepare for the
loss of infonnation processing capabilities. All data and software shall be routinely backed up to ensure 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 Recipient shall ensure all subcontractors maintain written
procedures for computer system backup and recovery. The Recipient shall complete and sign ATTACHMENT
IV prior to the execution of this contract.
29. Com outer 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 YouTube (ATTACHMENT E).
30. Conflict of Interest
The Recipient shall 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 Recipient 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
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June 2011 - July 2012 16 0 1 2 l-ICE 203.11
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
Recipient 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 Recipient's
board members and management must disclose to the Agency 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 of this contract. The Recipient's employees and subcontractors must make the same disclosures
described above to the Recipient's board of directors. Compliance with this provision will be monitored.
31. Public Entity Crime
Pursuant to s. 287.133, F.S., 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 Recipient, 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 of36 months following
the date of being placed on the convicted vendor list.
32. Purchasinl!
32.1 The Recipient may 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 Recipient shall be deemed to be substituted for the Agency 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 The Recipient may procure any recycled products or materials, which are the subject of or are required to carry
out this contract, in accordance with the provisions ofs. 403.7065, F.S.
32.3 The Recipient may purchase articles that are the subject of, or required to carry out, this contract from a nonprofit
agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, F.S., in the same
manner and under the same procedures set forth in s. 413.036(1) and (2), F.S. For purposes of this contract, the
Recipient shall be deemed to be substituted for the Agency insofar as dealings with such qualified nonprofit
agency are concerned. Additional information about the designated nonprofit agency and the products it offers is
available at http://www.respectotllorida.org.This clause is not applicable to subcontractors unless otherwise
required by law.
33. Patents. Coovril!hts. Rovalties
If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed,
produced or for which ownership was purchased in the course of or as a result of work or services performed
under this contract, the Recipient shall refer the discovery, invention or material to the Agency to be referred to
the Department of State and the Department of Elder Affairs. 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 of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to Paragraph 33.
33.2 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR 215.36.
34. Emel1Zencv Preoaredness and Continuity of Ooerations
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June 2011 - July 2012
160 1 2 IHCE203.11
34.1 If the tasks to be perfonned 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 Recipient shall,
within thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification of
an emergency preparedness plan. In the event of an emergency, the Recipient shall notify the Agency of
emergency provisions.
34.2 In the event a situation results in a cessation of services by a subcontractor, the Recipient shall retain
responsibility for perfonnance under this contract and must follow procedures to ensure continuity of operations
without interruption.
35. PUR 1000 Form
The PUR 1000 Fonn is hereby incorporated by reference. In the event of any conflict between the PUR 1000
Fonn and any tenns or conditions of this contract the tenns or conditions of this contract shall take precedence
over the PUR 1000 Fonn. However, if the conflicting tenns or conditions in the PUR 1000 Fonn are required by
any section of the Florida Statutes, the tenns or conditions contained in the PUR 1000 Fonn shall take
precedence.
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 Recipient
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 perfonnance of the contract shall be decided by the Contract Manager, who shall reduce
the decision to writing and serve a copy on the Recipient.
38. Financial Consequences of Non-Performance
If the Recipient fails to meet the minimum level of service or perfonnance identified in this agreement, or that is
customary for the industry, then the Agency 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 Recipient will not be charged with financial consequences, when a failure to perfonn arises out of causes
that were the responsibility of the Agency.
39. No Waiver of Sovereum 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 tenns and conditions agreed upon by the Parties. No oral agreements or
representations shall be valid or binding upon the Agency or the Recipient unless expressly contained herein or
by a written amendment to this contract signed by both Parties.
42. Force Maieure
The Parties will not be liable for any delays or failures in perfonnance due to circumstances beyond their 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.
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June 2011 - July 2012
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.
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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 of Florida'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 will not constitute
or be deemed a waiver of the Agency's right thereafter to enforce those rights, nor will any single or partial
exercise of any such right preclude any other or further exercise thereof or the exercise of any other right.
47. Compliance
The Recipient shall 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 Recipient to
abide by these laws shall be deemed an event of default of the Recipient, and subject the contract to immediate,
unilateral cancellation of the contract at the discretion of the Agency. .
48. Final Invoice
The Recipient shall submit the final invoice for payment to the Agency as specified in Paragraph 3.3.5. (date for
final request for payment) of ATTACHMENT I. If the Recipient 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 Recipient and necessary adjustments thereto have been approved by the Agency.
49. Reneeotiations 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 Contract Manager or the representative of the Recipient 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 Recipient. 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 Contract Manager or the representative of the Recipient responsible for administration of the
contract. The Agency will be the final authority as to the availability and adequacy of funds. In the event of
termination of this contract, the Recipient 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
Recipient. If applicable, the Agency may employ the default provisions in Rule 60A-I.006(3), F.A.C. Waiver of
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June2011-July2012 160 1 2~CE203.11
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 Recipient'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 Recipient under this provision, the Recipient
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 Recipient name, as shown on page I of this contract, Collier County Board of Commissioners
a. and mailing address of the official payee to whom the Housing and Human Services Department
payment shall be made is: 3301 Tamiami Trail E. Bldg H, Rm 21 I
NaDles, FL 34112
Mary Krumbine, Director
The name of the contact person and street address where Collier County Board of Commissioners
b. financial and administrative records are maintained is: Housing and Human Services Department
330 I Tamiami Trail E. Bldg H, Rm 211
NaDles, FL 34112
Mary Krumbine, Director
Collier County Board of Commissioners
c. The name, address, and telephone number of the Housing and Human Services Department
representative of the Recipient responsible for 3301 Tamiami Trail E. Bldg H, Rm 211
administration of the program under this contract is: Naples, FL 34112
(239252-2273
The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc.
d. 15201 N. Cleveland Ave, Suite 1100
Requests for Payment and Receipt and Expenditure forms Fort Myers, Florida 33903
are to be mailed is:
Leigh Wade-Schield, Executive Director
e. The name, address, and telephone number of the Contract Area Agency on Aging for Southwest Florida, Inc.
Manager for this contract is: 15201 N. Cleveland Ave, Suite 1100
Fort Myers, Florida 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.
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June 2011 - July 2012
HCE 203.11
16D 12"'l~
52. All Terms and Conditions Included
This contract and its Attachments, I - XI, A, B, D, E and F 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.
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused this 46 page contract, to be executed by their undersigned
officials as duly authorized.
Recipient: COLLIER COUNTY BOARD OF
COMMISSIONERS
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INe.
SIGNED BY: ~W. ~
NAME: FRED COYLE
SIGNED BY:
NAME: LEIGH ANNA NOWAK
TITLE: CHAIRMAN
TITLE: BOARD PRESIDENT
July 26, 2011
DATE:
DATE:
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
~ as to form & leg.'8~
-- ~~~
488/ . County Attorney
T'L.--0{\J\ FLQ ~. . "'
(:;) '-0~ \ \" '\..
Atta.t~" to CttaJ
. t9nlttl'~~OC} ~~~J''J?'
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June 2011 - July 2012
161rr2"
INDEX TO CONTRACT ATTACHMENTS
ATTACHMENT ATTACHMENT DESCRIPTION PAGE
ATTACHMENT I STATEMENT OF WORK 14-24
A TT ACHMENT II CERTIFICATION REGARDING LOBBYING 25
A TT ACHMENT III FINANCIAL COMPLIANCE AUDIT A IT ACHMENT 26-31
A TT ACHMENT IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE 32
A IT ACHMENT V CERTIFICA TION REGARDING DEBARMENT, SUSPENSION, 33
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS/SUBCONTRACTS
A TT ACHMENT VI ASSURANCES - NON-CONSTRUCTION PROGRAMS 34-35
A TT ACHMENT VII HOME CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY 36
A TT ACHMENT VIII HOME CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE 37
A TT ACHMENT IX REQUEST FOR PAYMENT, DOEA FORM 106H 38
ATTACHMENT X RECEIPTS AND EXPENDITURES, DOEA FORM 105H 39
A TT ACHMENT A DEPARTMENT OF ELDER AFFAIRS PROGRAMS & SERVICES 40
HANDBOOK (A V AILABLE ON DEPARTMENT'S INTRANET SITE)
A TT ACHMENT B DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE 41-44
CHECKLIST AND INSTRUCTIONS
A TT ACHMENT D PROVIDER STATE CONTRACTS LIST 45
A TT ACHMENT E DEPARTMENT OF ELDER AFFAIRS COMPUTER USE AND SOCIAL 46
MEDIA POLICY
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HCE 203.11
ATTACHMENT I
A __
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STATEMENT OF WORK
HOME CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITION OF CONTRACT TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Adult Protective Services (APS)
Activities of Daily Living (ADL)
Assessed Priority Consumer List (APCL)
Community Care for Disabled Adults (CCDA)
Community Care for the Elderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Home Care for Disabled Adults (HCDA)
Home Care for the Elderly (HCE)
Institutional Care Program (ICP)
Instrumental Activities of Daily Living (IADL)
Planning and Service Area (PSA)
Web-based Database System (WebDB)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the Department of
Children and Families Services Community Care for Disabled Adults or Home Care For Disabled Adults
services to the Agency or Department of Elder Affairs' community-based services.
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 V.S.C. 3026) of the
Older Americans Act and Agency or Department of Elder Affairs instructions.
Area Plan Update: A revision to the area plan wherein the area agency on aging enters HCE program specific
data in the web-based database system (WebDB). An update may also include other revisions to the area plan
as instructed by the Agency or Department of Elder Affairs.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability
to remain independent and in the least restrictive living arrangement. DOEA Form 701B is used by case
managers to conduct the functional assessment.
1.2 AGENCY MISSION STATEMENT
Mission: To help aging adults, 60 and older, achieve greater independence through awareness of
resources and access to qualified service providers.
Vision: To be the recognized leader in supporting older adults and their families with access to
trustworthy resources and services in their communities while empowering them to live with
independence and dignity.
Values: The Agency believes the 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;
~ Personal and professional accountability from all stakeholders.
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June2011-July2012
160 12-HCE203.,l
Lead agencies and local service providers as partners and stakeholders in Florida's aging services
network are expected to support the agency's mission, vision, and priorities.
1.3 GENERAL DESCRIPTION
1.3.1 General Statement
Area Agencies on Aging may contract with CCE lead agencies or other case management entities for the
provision of the HCE program. Approved caregivers receive a Basic Subsidy to reimburse some of their
expenses each month for caring for the consumer and may receive a Special Subsidy for other necessary
services and essential supplies. Caregivers may be approved for up to three HCE clients in their home.
1.3.2 Home Care for the Elderly Program Mission Statement
The Home Care for the Elderly Program supports family style living arrangements, on a non-profit basis, as an
alternative to nursing homes or other institutional care. Through the program, a caregiver for three or fewer
elders living in a private home provides basic services of maintenance and supervision as well as coordinating
other necessary specialized services.
1.3.3 Authority
The relevant authority governing the HCE program include:
(1) Rule Chapter 58H-l, Florida Administrative Code; and
(2) Sections 430.601 through 430.608, F.S.
1.3.3.1 Incorporation of Reference Memoranda
In accordance with s. 287 F.S., as amended, and Department of Financial Services', Chief Financial Officer
Memoranda, the following memoranda are provided for informational purposes and are hereby incorporated by
reference:
CFO Memo No. 02: Release date, August 20, 2010;
CFO Memo No. 03: Release date, June 29, 2010; and
CFO Memo No. 06: Release date, June 30, 2010.
1.3.4 Scope of Service
The Recipient is responsible for the programmatic, fiscal and operational management of HCE. The Recipient
shall provide services in a manner consistent with and described in the current Agency's area plan update and the
current Department of Elder Affairs Programs and Services Handbook.
1.3.5 Major Program Goals
The major goals of the HCE program are to ensure that:
(1) Basic Subsidy is provided to the caregiver of each client and
(2) Special Subsidy is provided when essential to the well-being of the client.
1.4 INDIVIDUALS TO BE SERVED
1.4.1 General Description
The Home Care for the Elderly program serves elders age 60 and older at risk of placement in a nursing home
or other institutional settings who can remain in a family style setting through the provision of subsidies.
1.4.2 Caregiver Requirements
(1) Be at least 18 years of age, capable of providing a family-type living environment;
(2) Be a relative or a friend who has been accepted by the client as a surrogate family or is a responsible adult
with whom the client has made an arrangement to provide home care services;
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June2011-July2012 160 1 2~HCE203.11
(3) Be willing to accept responsibility for the social, physical and emotional needs of the care recipient;
(4) Be physically present to provide supervision and to assist in arrangement of services for the client;
(5) Maintain the residential dwelling free of conditions that pose an immediate threat to the life, safety, health
and well-being of the home care client; and
(6) Be without record of conviction of abuse, neglect or exploitation of another person.
1.4.3 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk
of placement in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the HCE program, the Recipient shall ensure the following tasks are perfonned:
(1) Client Eligibility Detennination as listed in ATTACHMENT I, SECTION 1.4;
(2) Assessment and Prioritization of Eligible Clients;
(3) Delivery of Services to Eligible Clients; and
(4) The Recipient shall monitor the perfonnance of its contractors.
2.1.1 Assessment and Prioritization of Eligible Clients
The following are the criteria to prioritize new clients for service delivery. It is not the intent of the Agency to
remove existing clients from any services in order to serve new clients being assessed and prioritized for service
delivery.
2.1.2 Priority Criteria for Service Delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred to the community;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the
community;
(3) Individuals in nursing homes that are closing and can be discharged to the community; or
(4) Individuals whose mental or physical health condition has deteriorated to the degree self care is not
possible; there is no capable caregiver, and institutional placement will occur within 72 hours;
(5) For the purpose of transitioning individuals receiving Community Care for Disabled Adults (CCDA) and
Home Care for Disabled Adults (HCDA) services through the Department of Children and Families
(DCF) Adult Services to community-based services provided through the Agency or Department, when
services are not currently available, area agency on aging staff and lead agency case managers shall ensure
that "Aging Out" individuals are prioritized for services only after Adult Protective Services (APS) High
Risk and Imminent Risk individuals.
2.1.2.1 Priority Criteria for Service Delivery for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means of service
delivery. Functional impainnent shall be detennined through the Agency or Department's consumer assessment
fonn administered to each applicant. The most frail individuals not prioritized above will receive services to the
extent funding is available.
2.1.3 Delivery of Services to Eligible Clients
Client Eligibility
Clients eligible to receive services under this contract must:
(1) Be 60 years of age or older;
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June 2011 - July 2012
(2) Have income less than the Institutional Care Program (ICP) standard;
(3) Meet the ICP asset limitation;
(4) Be at risk of nursing home placement;
(5) Have an approved adult caregiver living with them who is willing and able to provide care or assist in
arranging for care; and
(6) Not be enrolled in the Aged and Disabled Adult Medicaid waiver or a Medicaid capitated long-term care
program.
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2.1.3.1 Basic Subsidy
The Basic Subsidy is a cash payment made to an approved caregiver each month to reimburse some expenses
incurred in caring for the client. The Basic Subsidy is provided for support and maintenance of the care
recipient, including housing, food, clothing, and medical costs not covered by Medicaid, Medicare or any other
insurance. A Basic Subsidy shall be paid to approved caregivers when the client is in the home for any part of
the month. If the client is hospitalized or in any other temporary institution for 30 days or less, the full Basic
Subsidy shall be provided to the caregiver as if the client were in the home.
2.1.3.1.1 Calculating the Basic Subsidy
The Basic Subsidy shall be based on the financial status of the client receiving care. In the event that both a
husband and wife are clients, their combined financial status shall be used to determine the amount of the
Basic Subsidy.
2.1.3.2 Special Subsidy Services
Though every eligible HCE client receives a Basic Subsidy, Special Subsidy payments are pre-authorized and
are based on additional specialized medical or health care services, supplies or equipment needed to maintain
the health and well-being of the individual elder. The Special Subsidy for additional medical support and
special services is a cash payment to reimburse the costs of any other service or special care not covered by
Medicaid, Medicare, or private insurance when these services are determined to be essential to maintain the
well-being of the home care recipient. A Special Subsidy shall be paid to approved caregivers when the client is
in the home for any part of the month. Special Subsidy may be authorized through a vendor agreement. All
Special Subsidy services must be performed in accordance with the Department of Elder Affairs Programs and
Services Handbook. Special Subsidy services include:
(1) Adult Day Care; (13) Material Aid;
(2) Adult Day Health Care; (14) Occupational Therapy;
(3) Caregiver Training/Support; (15) Other;
(4) Chore; (16) Outreach;
(5) Chore (Enhanced); (17) Personal Care;
(6) Counseling (Gerontological); (18) Physical Therapy;
(7) Counseling (Mental Health/Screening); (19) Respite (Facility Based or In-Home);
(8) Home Delivered Meals; (20) Skilled Nursing Services;
(9) Home Health Aide Service; (21) Specialized Medical Equipment, Services and Supplies;
(10) Homemaker; (22) Speech Therapy; and
(11) Housing Improvement; (23) Transportation.
(12) Vendor Payment;
2.1.3.3 ACCESS TO AND COORDINATION OF SERVICES
Through intake, case management and case aide services, the HCE client's needs are documented and needed
services are planned, arranged and coordinated for the client.
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June 2011 - July 2012
2.1.4 Monitoring the Performance of Subcontractors
The Recipient will monitor at least once per year each of its subcontractors, subrecipients, vendors and/or
consultants paid from funds provided under this contract. The Recipient will perform fiscal, administrative and
programmatic monitoring to ensure contractual compliance, fiscal accountability, programmatic performance,
and compliance with applicable state and federal laws and regulations. The Recipient will monitor to ensure
that time schedules are met, the budget and scope of work are accomplished within the specified time periods
and other performance goals stated in this contract are achieved.
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HCE 203.11
2.1.4.1 Use of Sub coo tractors
If this contract involves the use of a subcontractor or third party, then the Recipient 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 Recipient shall notifY the Contract Manager and the Director of Finance in writing of such delay.
The Recipient 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 or Department will not be responsible or liable for any obligations or claims resulting from such
action.
2.1.5 Remedies-Noncooformio2 Services
The Recipient shall ensure that all goods and/or services provided under this contract for HCE funded
programs are delivered timely, completely and commensurate with required standards of quality (see
ATTACHMENT A). Such goods and/or services shall only be delivered to eligible program participants.
In addition to meeting certain prescribed quality standards, any nonconforming goods (including home
delivered meals) and/or services not meeting such standards shall not be eligible for reimbursement under this
contract. The costs associated with preparing or providing nonconforming goods and/or services shall be
borne solely by the Recipient. The Agency requires immediate notice of any significant and/or systemic
infractions that compromise the quality, security or continuity of services to clients.
2.2. SERVICE LOCATION AND EQUIPMENT
2.2.1 Service Times
The Recipient shall ensure the provision of the services listed in this contract are available at times appropriate
to meet client service needs at a minimum, during normal business hours. Normal business hours are defined
as Monday through Friday, 8:00am to 5:00pm.
2.3 Equipment
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 Recipients and subcontractors 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-IIO) that include: (a) a property list with all the
elements identified in the circular; (b) a procedure for conducting a physical inventory of equipment at least
once every two years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of
the equipment; and (d) maintenance procedures to keep the equipment in good condition. The property records
must be maintained on file and shall be provided to the Agency upon request. Any loss, damage, or theft of
equipment shall be investigated and fully documented and the Recipient shall promptly notifY the Contract
Manager.
2.3.3 The Recipient's property management standards for equipment acquired with federal funds and federally-
owned equipment shall include accurately maintained equipment records with the following information:
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(1) A description of the equipment;
(2) Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
160 1 2"'" HCE 203.11
(3) Source of the equipment, including the award number;
(4) Whether title vests in the Recipient 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 Recipient 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 Agency is part of the cost of carrying out the activities and functions of the grant awards and Title
(ownership) will vest in the Agency, 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-
Recipients (not included in a cost methodology), is subject to the conditions of section 273, F. S. and 60A-
1.0017, F. A. C. or Title 45 CFR Part 74.
2.3.5 The Recipient 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 Contract Manager.
When disposing of property or equipment, the Recipient must submit a written request for disposition
instructions to the respective Contract Manager. 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 Recipient's proposed disposition (e.g., transfer or donation
to another agency that administers federal programs, offer the items for sale, destroy the items).
2.3.6 The Contract Manager will issue disposition instructions. If disposition instructions are not received within
120 days of the written request for disposition, the Recipient is authorized to proceed as directed in 2 CFR Part
215 Administrative Requirements (formerly OMB Circular A-II0).
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 fixed capital outlay grants and aids appropriations and therefore are subject to the provisions of section
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.
2.3.3.9 The Recipient must adhere to the Agency's procedures and standards when purchasing Information
Technology Resources (fIR) 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 Recipient shall ensure subcontractors comply with the Agency's ITR procedures.
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16 0 1 2 ....HCE 203.11
2.4 DELIVERABLES
2.4.1 Service Unit
The chart below lists the services that can be performed and the unit of measurement:
Service Unit of Service
Adult Day Care Housing Improvement
Adult Day Health Care Intake
Caregiver Training/Support Occupational Therapy
Case Aide Other
Case Management Outreach
Chore Personal Care Hour
Chore (Enhanced) Physical Therapy
Counseling (Gerontological) Respite (Facility Based or In-Home)
Counseling (Mental Health/Screening) Skilled Nursing Services
Home Health Aide Service
Homemaker Speech Therapy
Home Delivered Meals Meal
Material Aid
Other Episode
Specialized Medical Equipment, Services and Supplies
Transportation One-Way Trip
2.4.2 Programmatic Reports
The Recipient is responsible for responding in a timely fashion to routine and/or special requests for
information and reports required by the Agency. The Recipient must establish due dates for any subcontractors
that permit the Recipient to meet the Agency's reporting requirements. Reports and information that the
Recipient shall provide to the Agency includes, but is not limited to:
2.4.2.1 Client Information and Registration Tracking System (CIRTS) Reports
The Recipient is required to use CIRTS reports in the web-based CIRTS database system to ensure CIRTS 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.
2.4.2.2 Service Costs Reports
The Recipient shall require subcontractors to submit to it semi-annual service cost reports, which reflect actual
costs of providing each service by program. This report provides information for planning and negotiating unit
rates.
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2.4.2.3
SurpluslDeficit Report
The Recipient will submit a consolidated surplus/deficit report in a format provided by the Agency to the
Contract Manager by the 18th of each month. This report is for all agreements and/or contracts between the
Recipient and the Agency. The report will include the following:
(1) A list of all subcontractors and their current status regarding surplus or deficit;
(2) The Recipient's detailed plan on how the surplus or deficit spending exceeding the threshold specified by
the Agency will be resolved;
(3) Recommendations to transfer funds to resolve surplus/deficit spending;
(4) Input from the Recipient's board of directors on resolution of spending issues, if applicable
(5) Number of clients currently on Assessed Priority Consumer List (APCL) that receive a priority ranking
score of 4 or 5; and
(6) Number of clients currently on the APCL designated as Imminent Risk.
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2.4.3 Records and Documentation
The Recipient will ensure the collection and maintenance of client and service information on a monthly basis
from the Client Information and Registration Tracking System (CIRTS) or any such system designated by the
Agency and the State of Florida Department of Elder Affairs. Maintenance includes valid exports and backups
of all data and systems according to Department and/or Agency standards.
2.4.4 The Recipient must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System (CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th of
the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIR TS by the 15th of the month will be for units of service
provided during the previous month from the 16th and up to and including the 15th of the current month or
case management units of service may be entered according to the Recipient schedule, in aggregate on the 31 st
or daily, weekly or monthly.
2.4.4.1 The Recipient and each subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover from
losses or outages of the computer system. Data and software essential to the continued operation of contractor
functions must be backed up. The security controls over the backup resources shall be as stringent as the
protection required of the primary resources. It is recommended that a copy of the backed up data be stored in a
secure, offsite location. The Recipient 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.
2.4.5 The Recipient will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS
Monthly Service Utilization Report, by consumer and by worker identification is generated.
2.4.6 The Recipient will ensure the Monthly Utilization Report, by consumer and by worker identification is verified,
corrected, certified no later than the 20th of the month in which the report is generated.
2.4.7 The Recipient will ensure copies of receipts for all HCE special subsidies of $150 and over will accompany the
Monthly Utilization Report. These receipts should be no older than 90 days. Payment of HCE special
subsidies will not be processed until supporting documentation is received by the agency no later than the 20th
of the month in which the report is generated.
2.5 PROGRAM EVALUATION AND PERFORMANCE SPECIFICATIONS
2.5.1 Outcomes
(1) The Recipient shall timely submit to the Agency all reports described in ATTACHMENT I, SECTION
2.4., REPORTS;
(2) The Recipient shall timely submit to the Agency all information described in ATTACHMENT I,
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June 2011 - July 2012 16 D 1 2 ~CE 203.11
SECTION 2.4.3., RECORDS AND DOCUMENT A nON; and
(3) The Recipient shall ensure services in this contract are in accordance with the current Department of Elder
Affairs Programs and Services Handbook.
2.5.1.1 The performance of the Recipient 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) Average monthly savings per consumer for home and community-based care versus nursing home care for
comparable group clients;
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(4) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved;
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(7) Percent of family and family-assisted caregivers who self-report they are likely to provide care;
(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor); and
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community based services;
2.6 RECIPIENT'S FINANCIAL OBLIGATIONS
Special subsidy payments for each client and for the program overall must be maintained within the amount
of program funding available.
2.6.1 Use of Service Dollars/Assessed Priority Consumer List Management
The Recipient is expected to spend all federal, state and other funds provided by the Agency, for the purpose
specified in each contract. The Recipient 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 year, for each program managed by the Recipient. If
the Agency determines that the Recipient is not spending service dollars accordingly, the Agency may transfer
funds to other Area Agencies on Aging during the year and/or adjust subsequent funding allocations
accordingly, as allowable under state and federal law.
2.7 AGENCY RESPONSffiILITIES
2.7.1 Program Guidance and Technical Assistance
The Agency will provide to the Recipient guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Recipient.
2.7.2 Contract Monitoring
The Agency will review and evaluate the performance of the Recipient under the terms of this contract.
Monitoring shall be conducted through direct contact with the Recipient through telephone, in writing,
or an onsite visit. The Agency's determination of acceptable performance shall be conclusive. The
Recipient agrees to cooperate with the Agency in monitoring the progress of completion of the service
tasks and deliverables. The Agency may use, but is not limited to, one or more of the following methods
for monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow-up on-site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third-party documents and/or evaluation;
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3.3
3.3.1
3.3.2.
3.3.3
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June 2011 - July 2012
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed-upon procedures review by an external auditor or consultant;
(9) Limited-scope reviews; and
Other procedures as deemed necessary.
HCE 203.11
SECTION III: MEmOD 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 Recipient 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 Recipient shall consolidate all requests for
payment from subcontractors and expenditure reports that support requests for payment and shall submit to the
Agency on forms 106H (ATTACHMENT IX) and 105H (ATTACHMENT X).
3.1.1
The Recipient agrees to distribute funds as detailed in the area plan update and the Budget Summary,
ATTACHMENT VII to this contract. Any changes in the total amounts of the funds identified on the Budget
Summary form require a contract amendment.
3.2
Advance Payments
The Recipient may request up to two months of advances at the start of the contract period 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 and the State of Florida Department of Elder Affairs ("budget
release"). The Recipient shall provide the Contract Manager documentation justifying the need for an advance
and describing how the funds will be distributed.
3.2.1
3.2.2
The Recipient's requests for advance require the approval of the Contract Manager. If sufficient budget is
available, the Agency will issue approved advance payments after July 1,2011.
All advance payments made to the Recipient shall be returned to the Agency as follows: one - twelfth
of the advance payment received shall be reported as an advance recoupment on each request for payment,
starting with report number three, in accordance with the Invoice Schedule, A TT ACHMENT VIII to this
contract.
3.2.3
3.2.4
The Recipient may temporarily place advanced funds in an FDIC insured interest bearing account. All interest
earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of each
quarter of the contract period.
Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment for Case
Management/Case Aide shall be on DOEA forms 106H (ATTACHMENT IX) and 105H
(ATTACHMENT X). Duplication or replication of both forms via data processing equipment is permissible,
provided all data elements are in the same format as included on Agency forms.
All payment requests 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 and invoices is
A TT ACHMENT VIII to this contract.
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Recipient and any adjustments
thereto, including any disallowance not resolved as outlined in section 26 of this contract.
Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified
in ATTACHMENT VII, Budget Summary.
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3.3.4 Date For Final Request For Budget Revisions
final requests for budget revisions or adjustments to contract funds based on expenditures for services provided
through June 30, 2012, must be submitted to the Contract Manager no later than the contract end date of June
30,2012.
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HCE 203.11
3.3.5 Date for Final Request for Payment
The final request for payment will be due to the Agency no later than July 25,2012.
3.4 Documentation for Payment
The Recipient shall maintain documentation to support payment requests that shall be available to the Agency
or authorized individuals upon request. Such documentation shall be provided upon request to the Agency or
the Department of financial Services.
3.4.1 The Recipient must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System (CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th of
the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIR TS by the 15th of the month will be for units of service
provided during the previous month from the 16th and up to and including the 15th of the current month or
case management units of service may be entered according to the Recipient schedule, in aggregate on the 31 st
or daily, weekly or monthly. The Recipient will ensure data entry for HCE subsidies will cease on the 15th of
the month and the CIR TS Monthly Service Utilization Report, by consumer and by worker identification is
generated. The Recipient will ensure the Monthly Utilization Report, by consumer and by worker
identification is verified, corrected, certified no later than the 25th of the month in which the report is
generated.
3.4.2 The Recipient will be required to enter all subcontractors data per the Department's CIRTS Policy Guidelines
for clients and services in the CIRTS database. The data must be entered into the CIRTS before the Recipient
submits their request for payment and expenditure reports to the Agency by the twentieth, 20th, of the month.
See ATTACHMENT VII for all invoice dates. The Recipient shall establish time frames with their
subcontractors to assure compliance with due dates for the requests for payment and expenditure reports to the
Agency.
3.4.3 The Agency will require the Recipient to run monthly CIR TS reports and verify that the client and service data
in the CIRTS is accurate. This report must be submitted to the Agency with the monthly request for payment
and expenditure report and must be reviewed by the Agency before the Recipient's request for payment and
expenditure reports can be approved by the Agency.
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HCE 203.1 I
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:
(I) 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 subcontractors 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 $ I 0,000 and not more than $100,000 for each such failure.
Signam~ W ~
July 26.201 I
Date
Fred Covle. Chairman
Name of Authorized Individual
HCE 203. I I
Application or Agreement Number
Collier County Board of County Commissioners
3339 E. Tamiami Trail East
Naples. FL 341 12
Name and Address of Organization
DOEA Form 103
(Revised Nov 2002)
"
l~fOY9d Ita to form & legal SufficIency
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.sslBt .. County Mtcma'l
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25
June 2011 - July 2012
16D12~
HCE 203.11
ATTACHMENT ill
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Area Agency on Aging for Southwest Florida, Inc. and/or the Department
of Elder Affairs to the provider may be subject to audits and/or monitoring by the Area Agency on Aging for Southwest
Florida, Inc. and/or the Department of Elder Affairs, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-l33, 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 Agency staff,
limited scope audits as defined by OMB Circular A-l33, 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 Area Agency on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs. In the event the Area
Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency
on Aging for Southwest Florida, Inc. and/or 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 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-l33, as revised.
EXHIBIT 1 to this agreement indicates federal resources awarded through the Area Agency on Aging for Southwest
Florida, Inc. and/or 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 Area
Agency on Aging for Southwest Florida, Inc. and/or 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-l33, as revised. An
audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular A-l33, 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 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
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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida,
Inc. and/or the Department of Elder Affairs shall be fully disclosed in the audit report with reference to the Area Agency
on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs agreement involved. If not otherwise
disclosed as required by Section .31 O(b )(2) of OMB Circular A-l33, as revised, the schedule of expenditures of federal
awards shall identify expenditures by agreement number for each agreement with the Area Agency on Aging for
26
June 2011 - July 2012
160 12
HCE 203.11
Southwest Florida, Inc. and/or 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.
PART II: STATE FUNDED
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 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. EXHIBIT I to this agreement indicates state financial assistance
awarded through the Area Agency on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs by this
agreement. In detennining 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 Area Agency on Aging for Southwest
Florida, Inc. and/or 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 of a 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 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 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or the
Department of Elder Affairs shall be fully disclosed in the audit report with reference to the Area Agency on Aging for
Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs
retains all right and obligation to monitor and oversee the perfonnance of this agreement as outlined throughout this
document and pursuant to law.
27
June 2011 - July 2012
160 12
,
HCE 203.11
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-B3, as revised, and required by
PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-B3, 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 Wade-Schield, Executive Director
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
The Federal Audit Clearinghouse designated in OMB Circular A-B3, as revised (the number of copies required by
Sections .320 (d)(l) and (2), OMB Circular A-B3, 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-B3, as revised, the provider shall submit a copy of the reporting package
described in Section .320(c), OMB Circular A-B3, 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 Wade-Schield, Executive Director
15201 N Cleveland Ave., 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 Wade-Schield, Executive Director
15201 N Cleveland Ave., 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
28
June 2011 - July 2012 1 ~ D 1 2 .~ HCE 203.11
Any reports, management letter, or other information required to be submltt:t to the Area Agency on Aging for
Southwest Florida, Inc. and/or the Department of Elder Affairs pursuant to this agreement shall be submitted timely in
accordance with OMB Circular A-l33, 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. and/or
the Department of Elder Affairs 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 Area Agency on Aging for Southwest Florida, Inc.
and/or the Department of Elder Affairs or its designee, the CFO or Auditor General access to such records upon request.
The provider shall ensure that audit working papers are made available to the Area Agency on Aging for Southwest
Florida, Inc. and/or the Department of Elder Affairs, or its designee, 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 Area Agency on Aging for Southwest
Florida, Inc. and/or the Department of Elder Affairs.
29
June 2011 - July 2012
160 121
HCE 203.11
.. -
ATTACHMENT ill
EXHIBIT - 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO TmS AGREEMENT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD $0
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES A WARDED PURSUANT
TO TmS 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
TOTAL STATE AWARD $0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Home Care for the Elderlv Prolrram General Revenue-Glades 65001 $83,391.00
TOTALAWARD $83,391.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES A WARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
30
June 2011 - July 2012
160 12
HCE 203.11
ATTACHMENT ill
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-133, 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 are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-
133, 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-133 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.
~ Recipient/subrecipient subject to OMB Circular A-133 and/or Section 215.97, F.S.
NOTE: If a provider is detennined to be a recipient Isubrecipient of federal and or state financial assistance and has been approved by
the Agency to subcontract, they must comply with Section 215.97(7), F.S., and Rule 691-.006(2), F AC [state financial assistance] and
Section _ .400 OMB Circular A-133 [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-133 - 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-II 0 - 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-II 0 - 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 I.
STATE FINANCIAL ASSISTANCE. Providers who receive state fmancial 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
June 2011 - July 2012
160 12
1HCE 203.11
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the Recipient named in the contract or agreement to which this form is
an attachment, hereby certifies that:
(1) The Recipient and any subcontractors of services under this contract have financial management systems capable of
providing certain information, including: (I) 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 Recipient, subcontractor(s), or any outside entity on which the
Recipient 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 Recipient (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 Recipient 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 ofthe state, time being of the essence.
(4) The Recipient and any subcontractor(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 Recipient shall require that the language of this certification be included in all subagreements, subgrants, and other
agreements and that all subcontractors 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 of this certification is a prerequisite for making or entering into this transaction imposed by
OMB Circulars A-I02 and 2 CFR Part 215 (formerly OMB Circular A-I 10).
Chairman ...
Title r,ll H T" 1'('.
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Julv 26.2011
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Fred Coyle
Name of Authorized Signer
(Revised June 2008)
June 2011 - July 2012
160 1 21 HCE203.11
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGmILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective Recipient certifies, by signing this certification, neither it nor its principals is 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 Recipient is unable to certify to any of the statements in this certification, such
ProSpe~parti~iPt:;hal~~~XPlanation to this certification.
~ ~ July 26. 2011
Date
Signature
Fred Coyle. Chairman
Title
Collier County Board of Commissioners
Agency/Organization
(Certification signature should be same as Contract signature.)
Instructions for Certification
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction,"
"person," "primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out
in the sections of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as supplemented by 2
CFR 376.1 0-376.995). 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 Recipient knowingly rendered an erroneous certification,
in addition to other remedies available to the federal government, the Agency may pursue available remedies,
including suspension and/or debarment.
3. The Recipient will provide immediate written notice to the Contract Manager if at any time the Recipient learns
that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances. The Recipient 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).
4. The Recipient 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 Recipient 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 Recipient 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 Agency may pursue available remedies, including suspension, and/or
debarment.
7. The Recipient ma)':-ry,ly ~i}.qn a certification of a prospective participant in a lower tier covered transaction that
it is not debatr.eti,:~uspend{d;Jneligible, or voluntarily excluded from the covered transaction, unless it knows
that the certiflC~io}lJ$'errOneou-$.
(RevisedJune200~) -~:' ,..' _ ,:.\.pproVt1(i !.:'IS 10 f(lf,f) ~. If'Qi'31 Suffic!~rl'.';{
,,-./' ~
33
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June 2011 - July 2012
160 12~
ATTACHMENT VI
HCE 203.11
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 [mancial 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 United 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 U.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 of the 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 U.S.C..168I-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; (t) 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 financing of housing; (i) any other nondiscrimination provisions in the specific statute(s)
under which application for federal assistance is being made; and (j) 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 U.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 U.S.C..276a to 276a-7), the Copeland Act (40 V.S.C.
276c and 18 U.S.C..874) and the Contract Work Hours and Safety Standards Act (40 U.S.C.. 327-333), regarding labor standards
for federally assisted construction subagreements.
34
June 2011 - July 2012
160 1 2 ~ HCE203.11
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(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 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 (Pol. 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 V.S.C..1451 et seq.); (f) conformity of
federal actions to State (Clear Air) Implementation Plans under Section l76(c) of the Clear Air Act of 1955, as amended (42
V.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 V.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 V.S.C..470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 V.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 V.S.C..213l 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 V.S.C..480I 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 financial and compliance audits in accordance with the Single Audit Act Amendments of
1996 and OMB Circular No. A-133, 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
'1uJ- w. ~ Chairman
Fred Coyle
APPLICANT ORGANIZATION DATE SUBMITTED
Collier County Board of County Commissioners July 26,2011
Housing, Human and Veteran Services Department
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35
June 2011 - July 2012
160 1 2 1 HCE203.11
A TTACHMENT VII
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of Commissioners
HCE Case Management
HCE Basic Subsidies 22-27-HCE Clients
HCE Special Subsidies
Total
$ 5,247.00
34,344.00
43,800.00
$83,391.00
HOME CARE FOR THE ELDERLY PROGRAM
RATE SUMMARY
SERVICES
REIMBURSEMENT RATE
Case Management
Case Aide
$50.00
$27.78
36
June 2011 - July 2012
Report Number
I
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Legend:
Note # I:
Note #2:
Note #3:
16012
1
HCE203.ll-R 0>-'
A TT ACHMENT VIII
HOME CARE FOR THE ELDERLY
INVOICE REPORT SCHEDULE
Based On
Submit to Agency on this Date
July 1
July 1
August 20
September 20
October 20
November 20
December 20
January 20
February 20
March 20
April 20
May 20
June 20
July 20
August I
August 15
July Advance*
August Advance*
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
Final Expenditure
Closeout Report
*
Advance based on projected cash need.
Report # I for Advance Basis Agreements cannot be submitted to the Area
Agency on Aging for Southwest Florida, Inc. prior to July I or until the
agreement with the Department or Agency has been executed and a copy sent
to DFS. Actual submission of the vouchers to Area Agency on Aging for
Southwest Florida, Inc. is dependent on the accuracy of the expenditure report
Report numbers 3 through 14 shall reflect an adjustment of one twelfth of the
total advance amount, on each of the reports, repaying advances issued the first
two months of the agreement. The adjustment shall be recorded in Part C, I of
the report (Attachment IX).
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.
37
June 2011 - July 2012
160 12 ~
HCE 203.11
A TT ACHMENT IX
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
RECIPIENT NAME, ADDRESS, PHONE. and FEID. TYPE OF PAYMENT: This Request Period: From: To:
Regular Contract Period
Contract .
Advance Report .
PSA.
CERTIFICATION: I hereby certify to the best of my knowledge that this request or refund conforms with the terms and the purposes of the above contract.
PJepared by: Date: Approved by: Date:
PART A: BUDGET SUMMARY AM Admin. Case Management Subsidies TOTAL
1. Approved Contract Amount S S S S
2. Previous Funds Received for Contract Period S S S S
3. Contract Balance S S S S
4. Previous Funds Requested and Not Received for Contract Period S S S S
5. CONTRACT BALANCE S S S S
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1st - 2nd months) S S S S
2. N et Expend~ures For Month S S S S
(DOEA Form 10SH, Part B, Line 4)
3. TOTAL S S S S
PART C: NET FUNDS REQUESTED
1. Less Advance Applied S S S S
2. TOTAL FUNDS REClU ESTED (Part B Line 3, minus Part CLine 1) S S S S
OOEA FORM 10SH
Revtsed 512512010
38
June 2011 - July 2012
160 12
.~
HCE 203.11
ATTACHMENT X
RECEIPT AND EXPENDITURE REPORT
HOME CARE FOR THE ELDERLY PROGRAM
PROVIDER NAME. ADDRESS. PHONE # and FEID# Program Funding: THIS REPORT PERIOD:
From To
AAA Admin. CONTRACT PERIOD:
Case Management CONTRACT #
Subsidies: REPORT #
Basic
Special PSAII
CERTIFICATION : I certify to the best of my knowledge and belief that the report is complete and correct and all ouUays
herein are for purposes set forth in the contract.
Prepared by : Date : ApprO\led by : Date:
PART A: BUDGETED INCOME I RECEIPTS 1. Approved 2. Actual Receipts 3. Total Receipts 4. Percent of
Budaet For This Reoort Year to Date ADoroved Budoet
1. state Funds $0.00 $0.00 $0.00 #ONJO!
2. TOTAL RECEIPTS $0.00 $0.00 $0.00 #DIVJO!
PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of
Budoet For This Reoort Year to Date Aooroved Budaet
1. AAA Program Administration $0.00 $0.00 $0.00 #DIVJO!
2. Service Subcontractors: Case Management $0.00 $0.00 $0.00 #DIVJO!
3. Service Subcontractors: Subsidy $0.00 $0.00 $0.00 #DIVJO!
a. Basic Subsidy $0.00 $0.00 $0.00 #DIVJO!
b. Special Subsidy $0.00 $0.00 $0.00 #DIVJO!
4. TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIVJO!
PART C : OTHER REVENUE AND EXPENDITURES
I. Interest: II. Advance Recoupment
1. Earned on GR Advance $
2. Return of GR Advance $ 1. Advance Recouped $
3. Other Earned $
OOEA FORM 105H
RevIsed 512512010
39
June 2011 - July 2012
16 0 1 2"'"' HCE 203.11
ATTACHMENT A
Department of Elder Affairs Programs & Services Handbook
is available at the Department's Intranet site under, "Publications".
40
June 2011 - July 2012
160 12""
HCE 203.11
ATTACHMENT B
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name County I AAAlRecipient
Address Completed By
City, State, Zip Code Date I Telephone
PART I: READ THE A TI ACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
2. POPULATION OF AREA SERVED. Source of data:
Total # % White % Black % Hispanic
% Other
% Female
3. STAFF CURRENTLY EMPLOYED. Effective date:
Total # % White % Black % Hispanic
% Other
% Female
% Disabled
CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
Total # % White % Black % Hispanic % Other
% Female
% Disabled
% Over 40
ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total # % White % Black % Hispanic
% Other
% Female
% Disabled
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? IfN/A or NO, explain.
NIA YES NO
ODD
7. Compare the staff composition to the population. Is staff representative of the population?
IfNIA or NO, explain. NIA
o
YES NO
o 0
8. Compare the client composition to the population. Are race and sex characteristics representative of the
population? IfN/A or NO, explain. NIA
o
YES NO
o 0
9. Are eligibility requirements for services applied to clients and applicants without regard to race, color,
national origin, sex, age, religion or disability? IfNI A or NO, explain. NI A
o
YES NO
o 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? IfNI A or NO, explain.
N/A YES NO
ODD
11. For in-patient services, are room assignments made without regard to race, color, national origin
or disability? IfNI A or NO, explain.
NIA YES NO
ODD
Revised August 2010, Page lof2
41
June 2011 - July 2012
160 1 2~ HCE203.11
IfNI A or NO, explain. NI A YES NO
D D D
12. Is the program/facility accessible to non-English speaking clients?
13. Are employees, applicants and participants informed of their protection against discrimination? If YES,
how? Verbal D Written D Poster D IfNIA or NO, explain.
NIA YES NO
D D D
14. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility. NIA NUMBER
D
15. Is the program/facility physically accessible to mobility, hearing, and sight-impaired individuals? IfNIA or
NO, explain.
N/A YES NO
D D D
PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH is 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.
YES NO
D D
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If
NO, explain.
YES NO
D D
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES NO
D D
19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination
on the basis of disability? If NO, explain.
YES NO
D D
20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? If
NO, explain.
YES NO
D D
PART IV: FOR PROGRAMS OR FACiLITIES WITH SO OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF 550,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES NO
D D
DOl \ l \, 0'\ 1.\
Reviewed By In Compliance: YES 0 NO. D
Program Office *Notice of Corrective Action Sent I I
Date I Telephone Response Due I I
On-Site 0 Desk Review 0 Response Received I I
Revised August 2010, Page 2 of2
42
June 2011 - July 2012
160 1 2 HCE203.ll
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
I. 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 AsianlPacific
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).
43
June 2011 - July 2012
160 1 2 fkE203.11
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 individuaVorganization, 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 Fonn 101-8, Revised August 2010
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160 1 2'" HCE203.11
ATTACHMENTE
Department's Computer Use Policy and its Social Media Policy, provided on CD.
46
16D 12'4
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract # HCE 203.11
I, Fred Coyle , certify that Collier County Board of Commissioners
(Name of authorized contractor representative) (Name of contractor)
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that
the plan will be made available to the Area Agency on Aging for Southwest Florida, Inc. (AAA)
upon request.
FredW.cOY~ W. ~
Signature of authorized contractor representative
Chairman
7/26/2011
Date
,; .form 8, ,t'Jgai Suiflcl'dj'j(;V
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160 12'"
Attestation Statement
Agreement/Contract Number HCE 203.11
Amendment Number 1
I, Fred 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.
F.... W. coY:;:'~n W. ~
Signature of Recipient/Contractor representative
7/26/2011
Date
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AAA Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready
for AAA designee signature
initial date
Revised November 2010
16012--
MEMORANDUM
Date:
August 11,2011
To:
Ashley Franco
Housing, Human and Veteran Services
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
Standard Contract with Area Agency on Aging for SW FL, Inc.
Alzheimer's Disease Initiative Program (ADI 203.11)
Attached for your records are three (3) originals of the document referenced above
(Item #16D12) approved by the Collier County Board of County Commissioners on
Tuesday, July 26, 2011.
Please forward on for additional signatures and return a Fullv Executed
Orie:inal to the Minutes & Records Department to be kept in the Board's
Official Records.
If you have any questions, please feel free to contact me at 252-7240.
Thank you.
July 2011- June 2012
16 0 1 2"\m 203.11
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INe.
STANDARD CONTRACT
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of Commissioners, ("Recipient"), and collectively referred to as the "Parties." The term Recipient
for this purpose may designate a vendor, subgrantee or subrecipient, the status to be further identified in
ATTACHMENT In, 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 Recipient has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Recipient 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), area plan(s), 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 July I. 20 II 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
June 30. 2012.
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 $93,256.00 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(1Xt), 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 Recipient 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 Recipient shall comply with all applicable
standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42 U.S.c. 7401, et seq.), s.
I
July 2011- June 2012
160 1 2'" AD1203.11
508 of the Federal Water Pollution Control Act as amended (33 U.S.c. 1251, et seq.), Executive Order 11738, as
amended, and where applicable Environmental Protection Agency regulations 40 CFR 30. The Recipient shall
report any violations of the above to the Agency.
6.1.3 The Recipient, or agent acting for the Recipient, 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 Recipient must, prior to contract execution,
complete the Certification Regarding Lobbying form, A TT ACHMENT II. All disclosure forms as required by
the Certification Regarding Lobbying form must be completed and returned to the Contract Manager prior to
payment under this contract.
6.1.4 In accordance with Appendix A to 2 CFR 215, the Recipient 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 If this contract contains federal funds and provides services to children up to age 18, the Recipient shall comply
with the Pro-Children Act of 1994 (20 U.S.c. 6081).
6.1.6 A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards will
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 Recipient shall comply with these provisions before doing business or entering into subcontracts
receiving federal funds pursuant to this contract. The Recipient shall complete and sign A TT ACHMENT V
prior to the execution of this contract.
6.2 The Recipient shall not employ an unauthorized alien. The Agency will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.C. 1324a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. 1101). Such violation will be cause for unilateral cancellation of this
contract by the Agency.
6.3 If the Recipient 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 Pension Protection Act of 2006 or for any other reason, the Recipient
must notifY the Agency in writing within thirty (30) days of receiving the IRS notice of revocation.
6.4
The Recipient shall comply with Title 2 CFR Part 275 regarding Trafficking in Persons.
6.5
Unless exempt under 2 CFR Part 170.11 O(b), the Recipient shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 170.
7.
Compliance witb State Law
7.1
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 of laws.
The Recipient shall comply with requirements ofs. 287.058, F.S. as amended.
7.2
7.2.1
The Recipient shall 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 Contract Manager must receive and
accept in writing prior to payment in accordance with s. 215.971, F.S. (1) and (2).
The Recipient shall submit bills for fees or other. compensation for services or expenses in sufficient detail for a
proper pre-audit and post-audit. .
7.2.2
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7.2.3 If itemized payment for travel expenses is permitted in this contract, the Recipient shall 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.
7.2.4 The Recipient shall 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 Recipient in conjunction with this contract except for
those records which are made confidential or exempt by law. The Recipient's refusal to comply with this
provision will 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 Recipient 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, in
accordance with the provisions of s. 287.134, F .S.
7.5 The Recipient shall 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. BackJzround Screeninl!:
The Recipient 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, will 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 apply to employees, subcontractors, consultants, direct
service providers and volunteers. Consequently, any commitment for employment, purchase of services, or
volunteer program participation will be contingent upon the passing of a Level II background check. The
background screening will 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 Recipient shall develop, 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, will provide for notice of the grievance procedure and an opportunity for review of the subcontractor's
determ ination( s ).
10. Audits. InsDections. Investil!:ations. Public Records and Retention
10.1 The Recipient shall establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of funds
provided by the Agency under this contract. Recipient shall adequately safeguard all such assets and assure they
are used solely for the purposes authorized under this contract. Whenever appropriate, fmancial information
should be related to performance and unit cost data.
10.2 The Recipient shall 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.
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10.3 Upon demand, at no additional cost to the Agency, the Recipient shall facilitate the duplication and transfer of
any records or documents during the required retention period in Paragraph 10.2.
10.4 The Recipient shall assure that the records described in Paragraph 10 will be subject at all reasonable times to
inspection, review, copying, or audit by federal, state, or other personnel duly authorized by the Agency.
10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Agency and federal
auditors, pursuant to 45 CFR 92.36(iXIO), will be allowed full access to and the right to examine any of the
Recipient's contracts and related records and documents pertinent to this specific contract, regardless of the form
in which kept.
10.6 The Recipient shall provide a financial and compliance audit to the Agency as specified in this contract and in
A TT ACHMENT III and ensure that all related third-party transactions are disclosed to the auditor.
10.7 The Recipient shall 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 Ril!bts ComDliance
11.1 The Recipient shall 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
Recipient 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 During the term of this contract, the Recipient shall complete and retain on file a timely, complete and accurate
Civil Rights Compliance Checklist (ATTACHMENT B).
11.3 The Recipient shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures will ioclude notifying clients, employees, and
participants of the 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 Recipient, its successors, transferees, and assignees for the
period during which such assistance is provided. The Recipient 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 Recipient
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 Recipient shall provide services in the manner described in A TT ACHMENT I.
13. Monitoriol! bv the Al!encv
The Recipient shall permit persons duly authorized by the Agency to inspect and copy any records, papers,
documents, facilities, goods and services of the Recipient which are relevant to this contract, and to interview any
clients, employees and subcontractor employees of the Recipient to assure the Agency of the satisfactory
performance of the terms and conditions of this contract. Following such review, the Agency will provide a
written report of its findings to the Recipient, and where appropriate, the Recipient shall develop a corrective
action plan. The Recipient hereby agrees to correct all deficiencies identified in the corrective action plan in a
timely manner as determined by the Contract Manager.
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14. Coordinated Monitorinl! with Other Al!encies
If the Recipient 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. Upon
notification and the subsequent scheduling of such a visit by the designated agency's lead administrative
coordinator, the Recipient shall comply and cooperate with all monitors, inspectors, and/or investigators.
15. Indemnification
The Recipient 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 perfonnance of the services provided for herein. It is understood and
agreed that the Recipient is not required to indemnify the Agency for claims, demands, actions or causes of
action arising solely out of the Agency's negligence.
15.1 Except to the extent pennitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
executed between the Department and state agencies or subdivisions defined in s. 768.28(2), F.S.
16. Insurance and Bondinl!
16.1 The Recipient shall 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 Recipient accepts full responsibility for identifying and detennining
the type(s) and extent of liability insurance necessary to provide reasonable financial protections for the
Recipient and the clients to be served under this contract. The limits of coverage under each policy maintained by
the Recipient do not limit the Recipient's liability and obligations under this contract. The Recipient shall ensure
that the Agency has the most current written verification of insurance coverage throughout the tenn 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 tenn of this agreement, the Recipient shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Recipient 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 detennined by the insurance
company and consistent with good business practices.
17. Confidentiality of Information
The Recipient shall not use or disclose any infonnation 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 Recipient shall comply with the Health Insurance Portability and Accountability Act (42
USC 1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
19. Incident ReDortinl!
19.1 The Recipient shall notify the Agency immediately, but no later than forty-eight (48) hours from, the Recipient's
awareness or discovery of conditions that may materially affect the Recipient or subcontractor's ability to
perfonn the services required to be perfonned under this contract. Such notice shall be made orally to the
Contract Manager (by telephone) with an email to immediately follow.
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19.2 The Recipient shall 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 Recipient
and its employees.
20. New Contract(s) Reportin2
The Recipient 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 infonnation: (I)
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 Recipient shall complete and provide the
infonnation in ATTACHMENT D.
21. Bankruptcv Notification
During the tenn of this contract, the Recipient shall immediately notify the Agency if the Recipient, its assignees,
subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Recipient must
also provide the following infonnation to the Area Agency on Aging for Southwest Florida, Inc.: (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., United States Bankruptcy Court Middle District of Florida, Fort Myers, FL ); and, (4) the name,
address, and telephone number of the bankruptcy attorney.
22. Sponsorship and Publicitv
22.1 As required by s. 286.25, F.S., if the Recipient 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 Collier County
Board of Commissioners, the State Department of Elder Affairs, and the Area Agency on Aging for Southwest
Florida, Inc." If the sponsorship reference is in the written material, the words "State of Florida, Department of
Elder Affairs and the Area Agency on Aging for Southwest Florida, Inc." shall appear in at least the same size
letters or type as the name of the organization.
22.2 The Recipient shall not use the words "The State of Florida Department of Elder Affairs or the Area Agency on
Aging for Southwest Florida, Inc." to indicate sponsorship of a program otherwise financed, unless specific
authorization has been obtained by the State and Agency prior to use.
23. Assi2nments
23.1 The Recipient 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 is at all times 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
Recipient. In the event the State of Florida approves transfer of the Recipient's obligations, the Recipient
remains responsible for all work perfonned and all expenses incurred in connection with the contract.
23.3 This contract shall remain binding upon the successors in interest of either the Recipient or the Agency.
24. Subcontracts
24.1 The Recipient is responsible for all work perfonned and for all commodities produced pursuant to this contract,
whether actually furnished by the Recipient or its subcontractors. Any subcontracts shall be evidenced by a
written document and subject to any conditions of approval the Agency deems necessary. The Recipient further
agrees that the Agency will not be liable to the subcontractor in any way or for any reason. The Recipient, at its
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expense, shall defend the Agency against any such claims.
24.2 The Recipient 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 Recipient and subcontractor, will result in a penalty as provided by statute.
25. Independent Capacity of Recipient
It is the intent and understanding of the Parties that the Recipient, 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 Recipient and will not be liable for any wage
and hour, employment discrimination, or other labor and employment claims against the Recipient or its
subcontractors. All deductions for social security, withholding taxes, income taxes, contributions to
unemployment compensation funds and all necessary insurance for the Recipient are the sole responsibility of the
Recipient.
26. Payment
Payments shall be made to the Recipient pursuant to s. 215.422, F.S., as services are rendered and invoiced by
the Recipient. The Contract Manager will have final approval of the invoice for payment, and will approve the
invoice for payment only if the Recipient 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 of s. 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 Recipient shall 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
Recipient by the Agency. In the event that the Recipient or its independent auditor discovers that an
overpayment has been made, the Recipient 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 Contract
Manager will notify the Recipient in writing of such findings. Should repayment not be made forthwith, the
Recipient will be charged at the lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after
Agency notification or Recipient discovery.
28. Data Inteeritv and Safeeuardioe Information
The Recipient shall ensure an appropriate level of data security for the information the Recipient is collecting or
using in the performance of this contract. An appropriate level of security includes approving and tracking all
Recipient employees that request system or information access and ensuring that user access has been removed
from all terminated employees. The Recipient, among other requirements, must anticipate and prepare for the
loss of information processing capabilities. All data and software shall be routinely backed up to ensure 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 Recipient shall ensure all subcontractors maintain written
procedures for computer system backup and recovery. The Recipient shall complete and sign A TT ACHMENT
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 tlickr and Y ouTube (A TT ACHMENT E).
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30. Conflict of Interest
The Recipient shall 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 Recipient 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 ofhislher 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
Recipient 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 Recipient's
board members and management must disclose to the Agency 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 of this contract. The Recipient's employees and subcontractors must make the same disclosures
described above to the Recipient's board of directors. Compliance with this provision will be monitored.
31. Public Entity Crime
Pursuant to s. 287.133, F.S., 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 Recipient, 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 of36 months following
the date of being placed on the convicted vendor list.
32. Purchasin2
32.1 The Recipient may 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 Recipient shall be deemed to be substituted for the Agency 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 The Recipient may procure any recycled products or materials, which are the subject of or are required to carry
out this contract, in accordance with the provisions ofs. 403.7065, F.S.
32.3 The Recipient may purchase articles that are the subject of, or required to carry out, this contract from a nonprofit
agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, F.S., in the same
manner and under the same procedures set forth in s. 413.036(1) and (2), F.S. For purposes of this contract, the
Recipient shall be deemed to be substituted for the Agency insofar as dealings with such qualified nonprofit
agency are concerned. Additional information about the designated nonprofit agency and the products it offers is
available at http://www.respectofflorida.org.This clause is not applicable to subcontractors unless otherwise
required by law.
33. Patents. CODvri2hts. Rovalties
If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed,
produced or for which ownership was purchased in the course of or as a result of work or services performed
under this contract, the Recipient shall refer the discovery, invention or material to the Agency to be referred to
the Department of State and the Department of Elder Affairs. 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
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16 D 1 2 """ADI203.1I
expressed and reasonably valued in the contract.
33.1 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to Paragraph 33.
33.2 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR 215.36.
34. Emel1!:encv 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 Recipient shall,
within thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification of
an emergency preparedness plan. In the event of an emergency, the Recipient shall notify the Agency of
emergency proVISIOns.
34.2 In the event a situation results in a cessation of services by a subcontractor, the Recipient shall 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.
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 Recipient
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 Contract Manager, who shall reduce
the decision to writing and serve a copy on the Recipient.
38. Financial Consequences of Non-Performance
If the Recipient fails to meet the minimum level of service or performance identified in this agreement, or that is
customary for the industry, then the Agency 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 Recipient will not be charged with financial consequences, when a failure to perform arises out of causes
that were the responsibility of the Agency.
39. No Waiver ofSoverehm Immunitv
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
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AD! 203.11
This contract contains all the tenns and conditions agreed upon by the Parties. No oral agreements or
representations shall be valid or binding upon the Agency or the Recipient unless expressly contained herein or
by a written amendment to this contract signed by both Parties.
42. Force Maieure
The Parties will not be liable for any delays or failures in perfonnance due to circumstances beyond their 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 tenn 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 perfonnance 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 of Florida'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 will not constitute
or be deemed a waiver of the Agency's right thereafter to enforce those rights, nor will any single or partial
exercise of any such right preclude any other or further exercise thereof or the exercise of any other right.
47. Compliance
The Recipient shall 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 Recipient to
abide by these laws shall be deemed an event of default of the Recipient, and subject the contract to immediate,
unilateral cancellation of the contract at the discretion of the Agency.
48. Final Invoice
The Recipient shall submit the final invoice for payment to the Agency as specified in Paragraph 3.3.5. (date for
final request for payment) of ATTACHMENT I. If the Recipient fails to submit fmal 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 tenns of this contract may be withheld until all
reports due from the Recipient and necessary adjustments thereto have been approved by the Agency.
49. Renee:otiations 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 tenninated 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 Contract Manager or the representative of the Recipient responsible for administration of the
contract.
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16012
.
ADI203.11
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 Recipient. 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 Contract Manager or the representative of the Recipient responsible for administration of the
contract. The Agency will be the final authority as to the availability and adequacy of funds. In the event of
termination of this contract, the Recipient 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
Recipient. If applicable, the Agency may employ the default provisions in Rule 60A-I.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 Recipient'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 Recipient under this provision, the Recipient
must have (I) 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 Recipient name, as shown on page 1 of this contract, Collier County Board of Commissioners
a. and mailing address of the official payee to whom the Housing and Human Services Department
payment shall be made is: 3301 Tamiami Trail E. Bldg H, Rm 211
Naples, FL 34112
Mary Krumbine, Director
The name of the contact person and street address where Collier County Board of Commissioners
b. financial and administrative records are maintained is: Housing and Human Services Department
3301 Tamiami Trail E. Bldg H, Rm 211
Naples, FL 34112
Mary Krumbine, Director
Collier County Board of Commissioners
c. The name, address, and telephone number of the Housing and Human Services Department
representative of the Recipient responsible for 3301 Tamiami Trail E. Bldg H, Rm 211
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.
15201 N. Cleveland Ave, Suite 1100
Requests for Payment and Receipt and Expenditure forms Fort Myers, Florida 33903
are to be mailed is:
Leigh Wade-Schield, Executive Director
e. The name, address, and telephone number of the Contract Area Agency on Aging for Southwest Florida, Inc.
Manager for this contract is: 15201 N. Cleveland Ave, Suite 1100
Fort Myers, Florida 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.
II
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160 12~DI203.11
52. All Terms and Conditions Included
This contract and its Attachments, I - XI, A, B, D, E and F 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.
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused this 44 page contract, to be executed by their undersigned
officials as duly authorized.
Recipient:
COLLIER COUNTY BOARD OF
COMMISSIONERS
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INe.
SIGNED BY:
NW~
SIGNED BY:
NAME: FRED COYLE
NAME: LEIGH ANNA NOWAK
TITLE: CHAIRMAN
TITLE: BOARD PRESIDENT
DATE: July 26, 20 II
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
DATE:
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160 12
~
ADI 203.11
INDEX TO CONTRACT A TT ACHMENTS
ATTACHMENT ATTACHMENT DESCRIPTION PAGE
A TT ACHMENT I ALZHEIMER'S DISEASE INITIATIVE PROGRAM STATEMENT OF WORK 14-23
A TT ACHMENT II CERTIFICA TION REGARDING LOBBYING CERTIFICATION FOR 24
CONTRACTS, GRANTS, LOANS AND AGREEMENTS
A TT ACHMENT III FINANCIAL AND COMPLIANCE AUDIT 25-29
A IT ACHMENT IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR 30
AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
A TT ACHMENT V CERTIFICATION REGARDING DEBARMENT, SUSPENSION, 31
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS/SUBCONTRACTS
A TT ACHMENT VI ASSURANCES-NON-CONSTRUCTION PROGRAMS 32-33
ATTACHMENT VII ALZHEIMER'S DISEASE INITIATIVE INVOICE SCHEDULE 34
A TT ACHMENT VIII ALZHEIMER'S DISEASE INITIATIVE PROGRAM BUDGET SUMMARY 35
A TT ACHMENT IX None
A TT ACHMENT X REQUEST FOR PAYMENT ALZHEIMER'S DISEASE INITIATIVE
PROGRAM, DOEA FORM I06Z 36
A IT ACHMENT XI RECEIPT AND EXPENDITURE REPORT ALZHEIMER'S DISEASE 37
INITIA TIVE PROGRAM, DOEA FORM I05Z
A TT ACHMENT A DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES 38
HANDBOOK (A V AILABLE ON DEPARTMENT'S INTRANET SITE)
A TT ACHMENT B DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE 39-42
CHECKLIST AND INSTRUCTIONS
A IT ACHMENT D PROVIDER'S STATE CONTRACTS LIST 43
A TT ACHMENT E DEP AR TMENT OF ELDER AFFAIRS' COMPUTER USE AND SOCIAL 44
MEDIA POLICY
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ATTACHMENT I
STATEMENT OF WORK
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF CONTRACT TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Alzheimer's Disease (AD)
Alzheimer's Disease Initiative (ADI)
Activities of Daily Living (ADL)
Assessed Priority Consumer List (APCL)
Adult Protective Services (APS)
Client Information and Registration Tracking System (CIRTS)
Community Care for Disabled Adults (CCDA)
Department of Elder Affairs (DOEA)
Home Care For Disabled Adults (HCDA)
Instrumental Activities of Daily Living (IADL)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
Web-based Database System (WebDB)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the Department of
Children and Families Services CCDA or HCDA services to the Department's community-based services.
Area Plan: A plan developed by the Agency outlining a comprehensive and coordinated service delivery system in
the respective planning and service area, in accordance with the Section 306 of the Older Americans Act (42 U.S.c.
3026) and Department instructions.
Area Plan Update: A revision to the Area Plan wherein the Agency enters ADI specific data into the WebDB.
An update may also include other revisions to the Area Plan as instructed by the Department.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain
independent and in the least restrictive living arrangement. DOEA Form 70IB is used by case managers to conduct
the functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1) and (2), F.S., to
provide diagnostic and referral services, conduct basic and service-related multidisciplinary research, and
develop training materials and educational opportunities for lay and professional caregivers of individuals with
AD.
Model Day Care: A program of therapeutic, social and health activities specific to clients with memory
disorders. Services and activities include, but are not limited to, active and quiet games, reminiscence, validation
therapy, pet therapy, water therapy and other failure free activities appropriate to the client's level of functioning.
Model day care centers will also provide training for health care and social service personnel in the care of
persons having AD or related memory disorders.
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1.2 AGENCY MISSION STATEMENT
Mission: To help aging adults, 60 and older, achieve greater independence through awareness of
resources and access to qualified service providers.
Vision: To be the recognized leader in supporting older adults and their families with access to
trustworthy resources and services in their communities while empowering them to live with
independence and dignity.
Values: The Agency believes the 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;
~ Personal and professional accountability from all stakeholders.
Lead agencies and local service providers as partners and stakeholders in Florida's aging services
network are expected to support the agency's mission, vision, and priorities.
1.3 GENERAL DESCRIPTION
1.3.1 General Statement
The ADI program provides a continuum of services addressing the special needs of individuals with AD, their
families and caregivers.
1.3.1.1 Alzheimer's Disease Initiative Program Mission Statement
The ADI program ensures that persons afflicted with AD and other forms of dementia are given essential
services to help them age in place in an elder-friendly environment with security, dignity, and purpose. The
program also provides support to family members and caregivers of persons afflicted with AD.
1.3.2 Authority
The relevant authority governing the Alzheimer's Disease Initiative Program are as follows:
(1) Rule Chapter 58D-l, Florida Administrative Code; and
(2) Sections 430.501 through 430.504, Florida Statutes.
1.3.2.1 Incorporation of Reference Memoranda
In accordance with s. 287 F.S., as amended, and Department of Financial Services' Chief Financial Officer
Memoranda, the following memoranda are provided for informational purposes and are hereby incorporated by
reference:
(1) CFO Memo No. 02: Release date, August 20, 2010;
(2) CFO Memo No. 03: Release date, June 29, 2010; and
(3) CFO Memo No. 06: Release date, June 30, 2010.
1.3.3 Scope of Service
The Recipient is responsible for the programmatic, fiscal, and operational management of the ADl program. The
Recipient will provide services in a manner consistent with and as described in the current Agency's Area Plan
update and the current Department of Elder Affairs Programs and Services Handbook, A TT ACHMENT A.
1.3.4 Major Program Goal
The major goal of the ADI program is to provide services to meet the needs of caregivers and individuals with
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ADI203.11
AD and related memory disorders.
1.4 INDIVIDUALS TO BE SERVED
1.4.1 General Eligibility
The ADI Program addresses the special needs of individuals with AD and their caregivers.
1.4.2 Individual Eligibility
Those individuals eligible to receive services under this contract must meet the following conditions:
(1) Be 18 years of age or older and have a diagnosis of AD or a related disorder, or be suspected of having AD
or a related disorder; and
(2) Not be enrolled in a Medicaid capitated long-term care program.
1.4.3 Targeted Groups
Priority for services under this contract will be given to those eligible persons assessed to be at risk of placement
in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the ADI program, the Recipient shall ensure the following tasks are performed:
(1) Client eligibility determination as listed in this ATTACHMENT I, SECTION 1.4.2;
(2) Assessment and prioritization of service delivery for new clients;
(3) Delivery of services to eligible clients; and
(4) Monitor the performance of subcontractors.
2.1.1 Assessment and Prioritization of Service Delivery for New Clients
It is not the intent of the Agency to remove existing clients from any services in order to serve new clients being
assessed and prioritized for service delivery. The following are the criteria to prioritize new clients for service
delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred to the community;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the
community;
(3) Individuals in nursing homes that are closing and can be discharged to the community;
(4) Individuals whose mental or physical health condition has deteriorated to the degree self care is not
possible, there is no capable caregiver, and institutional placement will occur within 72 hours; and
(5) For the purpose of transitioning individuals receiving CCDA and HCDA services through the Department
of Children and Families' Adult Services to community-based services provided through DOEA when
services are not currently available, area agency on aging staff and lead agency case managers will ensure
that "Aging Out" individuals are prioritized for services only after APS High Risk and Imminent Risk
individuals.
2.1.2 Priority Criteria for Service Delivery for Other Assessed Individuals
The assessment and provision of services should always consider the most cost effective means of service
delivery. Functional impairment will be determined through the Department's functional assessment form
administered to each applicant. The most frail individuals not prioritized as described in this attachment,
Paragraph 2.1.1 will receive services to the extent funding is available.
2.1.3 Delivery of Services to Eligible Clients
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160 1 2.... ADI203.!l
The Recipient shall ensure the provision of a continuum of services addressing the diverse needs of individuals
with AD and their caregivers. The Recipient shall ensure services are performed in accordance with the current
Department of Elder Affairs Programs and Services Handbook. Services categories include:
(1) Caregiver Training/Support;
(2) Case Aid;
(3) Case Management;
(4) Counseling (Gerontological);
(5) Counseling (Mental Health/Screening);
(6) EducationlTraining;
(7) Intake;
(8) Model Day Care;
(9) Respite (Facility-Based);
(10) Respite (In-Home); and
(11) Specialized Medical Equipment, Services, and Supplies.
Caregivers benefit from receiving training, respite and related support services to assist them in caring for the
ADI client.
2.1.4 Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the Recipient 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
Recipient shall notify the Contract Manager and the Agency's Director of Finance in writing of such delay.
The Recipient 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 Contract, the
2.1.4.1 Agency will not be responsible or liable for any obligations or claims resulting from such action.
2.1.5
2.2
2.2.1
2.2.2
2.2.3
Monitoring the Performance of Subcontractors
The Recipient will monitor at least once per year each of its subcontractors, subrecipients, vendors and/or
consultants paid from funds provided under this contract. The Recipient will perform fiscal, administrative and
programmatic monitoring to ensure contractual compliance, fiscal accountability, programmatic performance,
and compliance with applicable state and federal laws and regulations. The Recipient will monitor to ensure that
time schedules are met, the budget and scope of work are accomplished within the specified time periods and
other performance goals stated in this contract are achieved.
SERVICE TIMES AND LOCATION
Service Times
The Recipient shall ensure the provision ofthe services listed in this contract are available at times appropriate to
meet client service needs, at a minimum, during normal business hours. Normal business hours are defined as
Monday through Friday, 8:00 am to 5:00 pm.
Service Delivery Location
The Recipient shall ensure that the services provided under this contract are available to all residents within the
PSA 8. The primary physical location for the services provided under this contract is where the program can best
serve the client's needs.
Changes in Service Delivery Location or Service Times
The Recipient shall provide the Contract Manager with 30 days notice of any plan temporarily or permanently
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changing any service delivery location or service times. Any changes to the service delivery location or service
times must have the approval of the Contract Manager.
2.3 EQUIPMENT
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 $5,000.00 [for federal funds]; or (b) nonexpendable,
tangible personal property of a nonconsumable nature with an acquisition cost of$I,OOO.OO 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 Recipients and subcontractors 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-I 10) 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, (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of the
equipment; and (d) maintenance procedures to keep the equipment in good condition. The property records must
be maintained on file and shall be provided to the Agency upon request. The Recipient shall promptly
investigate, fully document and notify the Contract Manager of any loss, damage, or theft of equipment. The
Recipient shall provide the results of the investigation to the Contract Manager.
2.3.2.1 The Recipient'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 of the 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 Recipient 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 Recipient compensates the Federal awarding agency for its share.
2.3.3
The Recipient must adhere to the Agency's procedures and standards when purchasing Information Technology
Resources (ITR) 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 Recipient has
the responsibility to require any subcontractors to comply with the Agency's ITR procedures.
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 Agency, subject to the conditions of 2 CFR Part 215 Administrative Requirements
(formerly OMS Circular A-I 10), Subpart C, paragraph 34. Equipment purchased under these thresholds is
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160 1 231203.11
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
subcontractors (not included in a cost methodology), is subject to the conditions of section 273, F. S. and 60A-
1.0017, F. A. C. or Title 45 CFR Part 74.
2.3.5 The Recipient 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 Contract Manager. When disposing of
property or equipment the Recipient must submit a written request for disposition instructions to the respective
Contract Manager. 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 Recipient's proposed disposition (i.e., transfer or donation to another agency that
administers federal programs, offer the items for sale, destroy the items).
2.3.5.1 The Contract Manager will issue disposition instructions. If disposition instructions are not received within 120
days of the written request for disposition, the Recipient is authorized to proceed as directed in 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A-I 10).
2.3.5.2 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.
2.3.6 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 (USC). Real property purchases from state funds can only be made
through fixed capital outlay grants and aids appropriations and therefore are subject to the provisions of section
216.348, F. S.
2.4 DELIVERABLES
2.4.1 Service Unit
The Recipient shall provide the services described in this contract in accordance with the Department of Elder
Affairs Programs and Services Handbook. The chart below lists the services that can be performed and the unit
of measurement.
Service Unit of Service
Caregiver Training/Support; Hour
Case Aid; Hour
Case Management; Hour
Counseling (Gerontological); Hour
Counseling (Mental Health/Screening); Hour
Intake; Hour
Model Day Care; Hour
Respite (Facility-Based); Hour
Respite (In-Home); Hour
Education/Training; Episode
Specialized Medical Equipment, Services, and Episode
Supplies.
2.5 REPORTS
The Recipient shall respond in a timely fashion to additional routine and/or special requests for information and
reports required by the Agency. The Recipient must establish due dates for any subcontractors that permit the
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160 1 2 ~DI203.Il
Recipient to meet the Agency's reporting requirements. Reports and information that the Recipient shall provide
to the Agency include, but are not limited to, those described in this attachment, Paragraphs 2.5.1 through 2.5.5.
2.5.1 Client Information and Registration Tracking System (CffiTS)
The Recipient is required to use CIRTS reports in the web-based CIRTS database system to ensure CIRTS data
accuracy. The report categories include the following:
(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 Recipient shall require its subcontractors to submit to it the Recipient semi-annual service cost reports,
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 Recipient shall submit a consolidated surplus/deficit report in a format provided by the Agency to the
Contract Manager by the 18th of each month. This report is for all agreements and/or contracts between the
Recipient and the Agency. This report will include the following:
(1) A list of all subcontractors and their current status regarding surplus or deficit;
(2) The Recipient's detailed plan on how the surplus or deficit spending exceeding the threshold specified by
the Agency will be resolved;
(3) Recommendations to transfer funds to resolve surplus/deficit spending;
(4) Input from the Recipient's Board of Directors on resolution of spending issues, if applicable;
(5) Number of clients currently on Assessed Priority Consumer List (APCL) that receive a priority ranking
score of 4 or 5; and
(6) Number of clients currently on the APCL designated as Imminent Risk.
2.6 RECORDS AND DOCUMENTATION
2.6.1 The Recipient shall 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 and the State of Florida Department of Elder
Affairs. Maintenance includes valid exports and backups of all data and systems according to Department and/or
Agency standards.
2.6.2 Each Recipient and subcontractor, among other requirements, must antIcIpate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover from
losses or outages of the computer system. Data and software essential to the continued operation of Recipient
functions must be backed up. The security controls over the backup resources shall be as stringent as the
protection required of the primary resources. It is recommended that a copy of the backed up data be stored in a
secure, offsite location. The Recipient 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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16 D 1 2 ~ ADI203.11
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outcomes
(1) The Recipient shall timely submit to the Agency all reports described in this attachment, Paragraphs 2.5 -
2.5.5;
(2) The Recipient shall timely submit to the Agency all information described in this attachment, Paragraphs
2.6 - 2.6.2; and
(3) The Recipient shall ensure provision of services in this contract in accordance with the current
Department of Elder Affairs Programs and Services Handbook, A TT ACHMENT A.
2.7.2 The performance of the Recipient in ensuring the provision of services described in this contract shall be
measured by the 20 II 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) Average monthly savings per consumer for home and community-based care versus nursing home care
for comparable client groups;
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(4) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved;
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(7) Percent of family and family-assisted caregivers who self-report they are very likely to provide care;
(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor); and
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community-based services.
2.7.3
Remedies-Nonconformini! Services
The Recipient 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 this attachment, Paragraphs 1.4.1 - 1.4.3,2.1 - 2.1.4.2,2.5 - 2.5.5 and 2.6 - 2.6.2.
2.7.3.1
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 Recipient. The Agency requires
immediate notice of any significant and/or systemic infractions that compromise the Recipient's ability to
provide participant services, to achieve programmatic performance or to provide sound financial management of
the program.
2.8
RECIPIENT'S FINANCIAL OBLIGATIONS
2.8.1
Cost Sharing and Co-payments
The Recipient shall ensure subcontractors establish annual co-payment goals. The Recipient has the option to
withhold a portion of the subcontractor's request for payment if goals are not met according to the Agency and
the Department of Elder Affairs' co-payment guidelines.
2.8.1.1 Co-payments include only the amounts assessed consumers or the amounts consumers opt to contribute in lieu of
an assessed co-payment. The contribution must be equal to or greater than the assessed co-payment.
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ADI203.11
2.8.2 Use of Service Dollars and Assessed Priority Consumer List Management
The Recipient is expected to spend all federal, state and other funds provided by the Agency for the purpose
specified in each contract. The Recipient must manage service funds 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 Recipient. If
the Agency determines that the Recipient is not spending service funds accordingly, the Agency may transfer
funds to other planning and service areas during the contract period and/or adjust subsequent funding allocations
accordingly, as allowable under state and federal law.
2.9 AGENCY RESPONSffiILITIES
2.9.1 Program Guidance and Technical Assistance
The Agency will provide the Recipient with guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Recipient.
2.9.2 Contract Monitoring
The Agency will review and evaluate the performance of the Recipient under the terms of this contract.
Monitoring shall be conducted through direct contact with the Recipient through telephone, in writing, or an on-
site visit. The Agency's determination of acceptable performance shall be conclusive. The Recipient agrees to
cooperate with the Agency in monitoring the progress of completion of the service tasks and deliverables. The
Agency may use, but is not limited to, one or more of the following methods for monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow-up on-site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third-party documents and/or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed-upon procedures review by an external auditor or consultant;
(9) Limited-scope reviews; and
(10) Other procedures as deemed necessary.
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 Recipient 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 Recipient shall consolidate all requests for payment
from subcontractors and expenditure reports that support requests for payment and shall submit to the Agency on
forms 106Z (ATTACHMENT X) and IOSZ (ATTACHMENT XI).
3.1.1 The Recipient agrees to distribute funds as detailed in ATTACHMENT VIll, Budget Summary. Any changes
in the total amounts of funds identified on the Budget Summary form require a contract amendment.
3.2 Advance Payments
3.2.1 The Recipient may request up to two months of advances at the start of the contract period to cover program
administrative and service costs. The schedule for submission of advance requests, if available, is shown on
A TT ACHMENT VII to this contract. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the Agency and the State of Florida Department of Elder Affairs ("budget release").
The Recipient shall provide the Contract Manager documentation justifying the need for an advance and
22
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160 12
ADI203.11
describing how the funds will be distributed.
3.2.2 The Recipient's requests for advance require the approval of the Contract Manager. If sufficient budget is
available, the Agency will issue approved advance payments after July 1, 2011.
3.2.3 All advance payments made to the Recipient shall be returned to the Agency as follows: one - twelfth of the
advance payment received shall be reported as an advance recoupment on each request for payment, starting with
report number three, in accordance with the Invoice Schedule, A IT ACHMENT VII to this contract.
3.2.4 The Recipient may temporarily place advanced funds in a FDIC insured interest bearing account. All interest
earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of each
quarter of the contract period.
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 I06Z (A IT ACHMENT X) and IOSZ (A TT ACHMENT XI).
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 schedule for submission of advance requests (when available) and invoices is
A TT ACHMENT VII 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 by the Agency of all financial and programmatic reports due from the Recipient and any adjustments
thereto, including any disallowance not resolved as outlined in Paragraph 24.1 of the Standard Contract.
3.3.3 Payment may be authorized only for allowable expenditures, which are in accord with the limits specified in
ATTACHMENT VIII.
3.3.4 Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided
through June 30, 2012, must be submitted to the Contract Manager no later than the contract end date of
June 30, 2012.
3.3.5 Date for Final Request for Payment
The final request for payment will be due to the Agency no later than August L 2012.
3.4 Documentation for Payment
The Recipient shall maintain documentation to support payment requests that shall be available to the Agency or
authorized individuals, such as the Department of Financial Services, upon request.
3.4.1 The Recipient will be required to enter all subcontractors data per the Department's ~IRTS Policy Guidelines for
clients and services in the CIRTS database. The data must be entered into the CIRTS before the Recipient
submits their request for payment and expenditure reports to the Agency by the tenth, 101\ of the month. See
A TT ACHMENT VII for all invoice dates. The Recipient shall establish time frames with their subcontractors
to assure compliance with due dates for the requests for payment and expenditure reports to the Agency.
3.4.2 The Agency will require the Recipient to run monthly CIR TS reports and verify that the client and service data in
the CIR TS is accurate. This report must be submitted to the Agency with the monthly request for payment and
expenditure report and must be reviewed by the Agency before the Recipient's request for payment and
expenditure reports can be approved by the Agency.
23
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.,.
160 1 2 ADI203.11
A TT ACHMENT II
CERTIFICATION REGARDING LOBBYING
CERTIFICA TION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(I) 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 subcontractors 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 and not more than $100,000 for each such failure.
Signat~W. ~
July 26. 2011
Date
Fred Coyle. Chairman
Name of Authorized Individual
ADl203.11
Application or Agreement Number
Collier County Board of County Commissioners
3339 E. Tamiami Trail East
Naples. FL 34112
Name and Address of Organization
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24
July 2011- June 2012
160 12
.
ADI203.11
ATTACHMENT ill
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Area Agency on Aging for Southwest Florida, Inc. and/or the Department of
Elder Affairs to the provider may be subject to audits and/or monitoring by the Area Agency on Aging for Southwest Florida,
Inc. and/or the Department of Elder Affairs as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-I33, as revised, and Section 21S.97, F.S., (see
"AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the Agency staff, limited scope
audits as defined by OMB Circular A-l33, 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 Area Agency on Aging
for Southwest Florida, Inc. In the event the Area Agency on Aging for Southwest Florida, Inc. determines that a limited scope
audit of the provider is appropriate, the provider agrees to comply with any additional instructions provided by the Area Agency
on Aging for Southwest Florida, Inc. 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 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-l33, as revised. EXHIBIT 1 to this
agreement indicates federal resources awarded through the Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest
Florida, Inc. and/or 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-l33, as revised. An audit of the provider conducted by the
Auditor General in accordance with the provisions ofOMB Circular A-I33, 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-l33, as revised.
If the provider expends less than $500,000 in federal awards in its fiscal year, an audit conducted in accordance with the
provisions of OMB Circular A-B3, as revised, is not required. In the event that the provider expends less than $500,000 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or the
Department of Elder Affairs shall be fully disclosed in the audit report with reference to the Area Agency on Aging for
Southwest Florida, Inc. and/or the Department of Elder Affairs agreement involved. If not otherwise disclosed as required by
Section .310(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 Area Agency on Aging for Southwest Florida, Inc. and/or 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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160 12 \DI203.11
PART II: STATE FUNDED
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 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. EXHIBIT I to this agreement indicates state financial assistance awarded through
the Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 I, the provider shall ensure that the audit complies
with the requirements of Section 2 I 5.97(8), Florida Statutes. This includes submission of a financial reporting package as
defined by Section 2 I 5.97(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 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 2 I 5.97, Florida Statutes, is not required. In
the event that the provider expends less than $500,000 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or the Department of Elder
Affairs shall be fully disclosed in the audit report with reference to the Area Agency on Aging for Southwest Florida, Inc.
and/or 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 Area Agency on Aging for Southwest Florida, Inc. and/or 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 Area Agency on Aging for Southwest
Florida, Inc. and/or 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-I33, 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 addresses:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Leigh Wade-Schield, Executive Director
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
26
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~
160 12 ADI203.11
The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by Sections
.320 (d)(l) 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 (t), OMB Circular A-l33, as revised.
Pursuant to Sections .320(t), OMB Circular A-l33, 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 addresses:
Area Agency on Aging for Southwest Florida, Inc.
Atio: Leigh Wade-Schield, Executive Director
15201 N Cleveland Ave., 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 addresses:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Leigh Wade-Schield, Executive Director
15201 N Cleveland Ave., 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-l33, 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 Area Agency on Aging for Southwest Florida, Inc. or its
designee, the CFO or Auditor General access to such records upon request. The provider shall ensure that audit working papers
are made available to the Area Agency on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs, or its
designee, 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 Area Agency on Aging for Southwest Florida, Inc. and/or the Department of Elder Affairs.
27
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160 12
~
ADI203.11
ATTACHMENT ill
EXHmIT - 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES A WARDED PURSUANT
TO Tms 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
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheimer's Disease Initiative General Revenue / TSTF 65004 $93,256.00
TOTALAWARD $93,256.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
28
July 2011- June 2012
160 12~ADI203.ll
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-133, as
revised, and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients offederal 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 I are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-
133, 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-133 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.
~ Recipient/subrecipient subject to OMB Circular A-133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and has been approved by
the Agency 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-133 [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-133 - 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-I 10 - 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-II 0 - 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 I.
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
29
July 2011- June 2012
'.
16 0 1 2 ADI203.11
ATTACHMENT IV
CERTIFICA TION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND
COOPERA TIVE AGREEMENTS
The undersigned, an authorized representative of the Recipient named in the contract or agreement to which this form is
an attachment, hereby certifies that:
(1) The Recipient and any subcontractors 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 Recipient, subcontractor(s), or any outside entity on which the
Recipient 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, Recipient(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 Recipient (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 Recipient 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 Recipient and any subcontractor(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 Recipient shall require that the language of this certification be included in all subagreements, subgrants, and other
agreements and that all subcontractors 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 of this certification is a prerequisite for making or entering into this transaction imposed by
OMB Circulars A-I 02 and 2 CFR Part 215 (formerly OMS Circular A-II 0).
Collier County Board of County Commissioners
3339 E. Tamiami Trail East
Naples, FL 34112
N~eWfR~
Signature -
Chairman
Title
July 26,2011
Date
Fred Coyle
Name of Authorized Signer
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160 12
.
ADI203.11
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(I) The Recipient certifies, by signing this certification, neither it nor its principals is 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 Recipient is unable to certify to any of the statements In this certification, such prospective
participant shall attach an explanation to this certification.
'1uLw. ~
Signature
July 26, 2011
Date
Fred Coyle, Chairman
Title
Collier County Board of Commissioners
Agency/Organ ization
(Certification signature should be same as Contract signature.)
Instructions for Certification
I. The tenns "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person,"
"primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out in the sections
of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as supplemented by 2 CFR 376.10-
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 detennined that the Recipient knowingly rendered an erroneous certification, in addition
to other remedies available to the federal government, the Department or Agency may pursue available remedies,
including suspension and/or debannent.
3. The Recipient will provide immediate written notice to the Contract Manager if at any time the Recipient learns that
its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The
Recipient may decide the method and frequency by which it detennines 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).
4. The Recipient will include a "Certification Regarding Debannent, 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 Recipient agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, detennined ineligible or voluntarily excluded from participation, unless otherwise authorized
by the federal government.
6. If the Recipient 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 or Agency may pursue available remedies, including suspension, and/or
debannent. r. . -."-"
.' ~ (":)IJ~r" ,..
7. The Recipient may r~~9.n'a -certlf~ion of a prospective participant in a lower tier covered transaction that it is
not debarred, SUSpeil~~Vi''J9~et-9r. ~untarily excluded from the covered transaction, unless it knows that the
. certification is errone1'ft+S. :- /~," .~ ": .;: . ,) Approved as to form & legal Sufficiency
(ReVIsed June 2008) ,=. g:.: . ',. ,,/...;./ :._ ,.
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ATTESJ't>;c/. . "'" .
o GHT E" / a,CK.
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AssIstant County Attorney
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Sv:
July 2011- June 2012
'1
160 12 ADI203.11
A TTACHMENT 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 of the 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 V.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; (t) 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 financing of housing; (i) any other nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being made; and (j) 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.
32
July 2011- June 2012
160 121.DI203.Il
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(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 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 ofwetIands 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.); (f) conformity of
Federal actions to State (Clear Air) Implementation Plans under Section I 76(c) of the Clear Air Act of 1955, as amended (42
U.S.c.. 740 I 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 V.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 V.S.c.. 2131 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 oflead- based
paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of
1996 and OMB Circular No. A-133, 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
~W. ~ Chairman
Fred Coyle
APPLICANT ORGANIZATION DATE SUBMITTED
Collier County Board of County Commissioners July 26, 2011
Housing, Human and Veteran Services Department
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33
July 2011- June 2012
16012'-'
~
ADI203.11-R
A TT ACHMENT VII
ALZHEIMER'S DISEASE INITIATIVE (ADI)
INVOICE SCHEDULE
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Based On
July Advance*
August Advance*
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
Final Request for Payment
Closeout Report
Submit to Agency
On This Date
July 1
July 1
August 10
September 10
October 10
November 10
December 10
January 10
February 10
March 10
April 10
May 10
June 10
July 10
August 1
August 15
Legend: * Advance based on projected cash need.
Note # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging
for Southwest Florida, Inc. prior to July 1 or until the contract with the Agency has been
executed and a copy sent to Area Agency on Aging for Southwest Florida, Inc. Actual
submission of the vouchers to DFS is dependent on the accuracy of the expenditure
report.
Note # 2: All advance payments made to the Recipient shall be returned to the Agency as follows:
one - twelfth of the advance payment received shall be reported as an advance
recoupment on each request for payment, starting with report number three. The
adjustment shall be recorded in Part C, 1 of the 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.
Revised August 2009-Form I
34
July 2011- June 2012
160 12
!'Ii. .
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
for
Collier County Board of Commissions
Collier County
1. Respite
2. Case Management, Case Aide, and Intake Allocation
3. Total
RATE SUMMARY
for
Senior Friendship Centers, Inc.-DeSoto, Lee, and Sarasota
SERVICES
Case Management
Case Aide
In-Home Respite
In-Facility Respite
SCSM
1
ADI203.11
A TT ACHMENT VIII
$ 92,756.00
500.00
$ 93,256.00
UNIT RATE
$50.00
$27.78
$20.00
$10.00
100% Reimbursement
35
July 2011- June 2012
160 1 2:1203.11
ATTACHMENT X
REQUEST FOR PAYMENT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
RECIPIENT NAME, ADDRESS, PHONE# and FEID# TYPE OF REPORT: This Request Period
PSA#
A. PAYMENT REQUEST: Report #
Regular _ Supplemental_ Contract #
B. METHOD OF PAYMENT: Contract Period
Advance - Reimbursement -
CERTIFICATION: I hereby certify to the best of my knowtedge that this request or refund conforms with the terms and the purposes of the above contract.
Prepared by: Date: Approved by: Date:
(1) (2)
PART A: BUDGET SUMMARY Res';;'e Model Dav Care TOTAL
1. Approved Contract Amount S S IQ..QQ
2. Previous Funds Received for Contract Period S S IQ..QQ
3. Contract Balance S S IQ..QQ
4. Previous Funds Requested and Not Received for Contract Period S S IQ..QQ
5. Contract Balance S S IQ..QQ
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Needs (1 st - 2nd month, Attach Justification) S S IQ..QQ
2. Net Expandijures For Month S S 1Q.Q!;
(DOEA Form 1052 Part B, Line 3)
3. TOTAL S S IQ.QQ
PART C: NET FUNDS REQUESTED
1. Less Advance Applied S S IQ.,Qg
2. Contract Funds are Hereby Requested for (Part B, Line 3 S S IQ.QQ
minus Part C, Line 1)
DOEA FORM 1062
ReVised 5/25/2010
36
July 2011- June 2012
160 12
.-1
ADI203.11
ATTACHMENT XI
RECEIPT AND EXPENDITURE REPORT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
PROVIDER NAME, ADDRESS, PHONE # and FEID# Program Funding: THIS REPORT PERIOD:
From To
Respite CONTRACT PERIOD
Model Day Care CONTRACT #
REPORT #
PSA#
CERTIFICATION. I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
Prepared by : Dale: Approved by : Date:
PART A : BUDGETED INCOME! RECEIPTS 1. Approved 2. Actual Receipts 3. Total Receipts 4. Percent of
Budaet For This Reoort Year to Date Aooroved Budoet
1. State Funds $0.00 $0.00 $0.00 #DIV/O!
2. Program Income $0.00 $0.00 $0.00 #DIVlO!
3. Local Cash Match $0.00 $0.00 $0.00 #DIV/O!
4. SUBTOTAL CASH RECEIPTS
5. Local In-Kind Match
6. TOTAL RECEIPTS $0.00 $000 $000 #DIVlO!
PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of
Budaet For This Reoort Year to Date Aooroved Budaet
1. Administrative Services $0.00 $0.00 $0.00 #DIV/O!
2. Service Subcontractor(s) $0.00 $0.00 $0.00 #DIVlO!
3. TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIVlO!
PART C : OTHER REVENUE AND EXPENDITURES II. Interest: III. Advance Recouped
I. Program Income (PI) 1. Earned on GR Advance $ $
1. ADI: PI Collected YTD $ 2. Return of GR Advance $
(Includes co-payments collected) 3. Other Earned $
PART D: CO-PAYMENTS CURRENT MONTH YEAR-TO-DATE
1. Total of Co-payments assessed $ $
2. Total of Co-payments collected $ $
(For Tracking Purposes only)
OOEA FORM 'OSZ
RevIsed 5125/2010
37
July 2011- June 2012
16 0 1 2.\D1203.11
ATTACHMENT A
Department of Elder Affairs Programs & Services Handbook
is available at the Department's Intranet site under, "Publications".
38
July 2011- June 2012
16 0 1 2 ~ ADI 203.1 I
ATTACHMENT B
CIVIL RIGHTS COMPLIANCE CHECKLIST
ProgramlFacility Name: County: I AANContractor
Address: Completed By:
City, State, Zip Code: Date: I Telephone:
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
PART I: READ THE A TI ACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS
FOR.\1.
I. Briefly describe the geographic area served by the program/facility and the type of service provided:
2. PO PULA nON OF AREA SERVED. Source of data:
Total # % White % Black % Hispanic
% Other
% Female
3 . STAFF CURRENTLY EMPLOYED. Effective date:
Total # % White % Black % Hispanic
% Other
% Female
% Disabled
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
Total # % White % Black % Hispanic % Other
% Female
% Disabled
% Over 40
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total # % White % Black % Hispanic
% Other
% Female
% Disabled
o
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? IfNI A or NO, explain.
N/A YES NO
D D D
7. Compare the staff composition to the population. Is staff representative of the population?
IfN/A or NO, explain.
N/A YES NO
D D D
8. Compare the client composition to the population. Are race and sex characteristics representative of the
population? IfN/A or NO, explain. N/A
D
YES NO
D D
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
D D D
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
D D D
II. For in-patient services, are room assignments made without regard to race, color, national origin
or disability? IfN/A or NO, explain.
N/A YES NO
D D D
12. Is the program/facility accessible to non-English speaking clients? IfN/A or NO, explain.
N/A YES NO
ODD
39
July 2011- June 2012
160 12
13. Are employees, applicants and participants informed of their protection against discrimination? If YES,
how? Verbal D Written D Poster D IfN/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? IfN/A or
NO, explain.
PART III: THE FOLLOWING QUESTIONS APPL Y TO PROGRAMS AND FACILITIES WITH IS 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.
ADI203.11
N/A YES NO
ODD
N/A
o
NUMBER
N/A YES NO
ODD
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 SO OR MORE EMPLOYEES A."ID FEDERAL CONTRACTS OF 5SO,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES NO
o 0
D<H \ I SI. <)'\U
Reviewed By In Compliance: YES 0 NO. 0
Program Office *Notice of Corrective Action Sent
/ /
Date I Telephone Response Due / /
On-Site 0 Desk Review 0 Response Received / /
Revised Augusl20JO, Page 2 of2
40
July 2011- June 2012
160 1 2 :1203.11
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).
41
July 2011- June 2012
160 12
.
ADI203.11
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 individuaVorganization, 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 Fonn 101-8, Revised August 20 I 0
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16 D 1 2 ADI203.11
ATTACHMENT E
Department's Computer Use Policy and its Social Media Policy, provided on CD.
44
160 12~
Attestation Statement
Agreement/Contract Number ADI 203,11
Amendment Number 1
I, Fred Covle , 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.
F"dw.c=m~ ~
Signature of Recipient/Contractor representative
7/26/2011
Date
AAA Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready
for AAA designee signature
initial date
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\0~'(OVOO as 1(. t',hi,, c~' 't-(Fi.c ' 'J;,':r <1'
Revised November 2010
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VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract # ADI 203,11
I, Fred Coyle , certify that Collier County Board of Commissioners
(Name of authorized contractor representative) (Name of contractor)
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that
the plan will be made available to the Area Agency on Aging for Southwest Florida, Inc. (AAA)
upon request.
Fred W.COYI~ w. 7
Signature of authorized contractor representative
Chairman
7/26/20 II
Date
A.pprov~d as tc ~OPi 8< iegal SUtfIC!tFlGr
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October 2008