Backup Documents 11/08/2011 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6D
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMCOMMISSIONERS OFFICE FOR S IGNATU 5
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, Accting. Supervisor HHVS 11/18/11
2. Ian Mitchell, Executive Manager Board of County Commissioners, 3rd Fl. 11u/11
g Ty
3. Clerk of Courts Minutes and Records Dept.,4th Fl.
4. Ashlee Franco, Accting. Supervisor HHVS
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval.Normally the primary contact is the person who created/prepared the executive
summary.Primary contact information is needed in the event one of the addressees above,including Ian Mitchell needs to contact staff for additional or missing
information.All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff Ashlee Franco/Housing,Human and Phone Number 252-2689
Contact Veteran Services
Agenda Date Item was November 8,2011 Agenda Item Number 16D 5(Item#)OAA
Approved by the BCC Extension
Type of Document Contract Agreement Number of 3 Agreements (2
Attached Stamp of Chairman's signature Documents Attached stamps on each, 6
needed on each copy total)
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Original document has been signed/initialed for legal sufficiency.(All documents to be AF
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.This includes signature pages from ordinances,
resolutions,etc.signed by the County Attorney's Office and signature pages from
contracts,agreements,etc.that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2. All handwritten strike-through and revisions have been initialed by the County Attorney's AF N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
3. The Chairman's signature line date has been entered as the date of BCC approval of the AF
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 BCC's actions are nullified.Be aware of your deadlines!
6. The document was approved by the BCC on 11/8/2011(enter date)and all changes AF N/A
made during the meeting have been incorporated in the attached document.The
County Attorney's Office has reviewed the changes,if applicable.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05
1605
MEMORANDUM
Date: November 21, 2011
To: Ashley Franco
Housing, Human and Veteran Services
From: Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re: Contract Agreement w/Senior Choices of Southwest Florida
OAA 203.11.002/Amendment 002
Attached for your records are three (3) originals of the document referenced above
(Item #16D5) approved by the Collier County Board of County Commissioners on
Tuesday, November 8, 2011.
Please forward on for additional signatures and return a Fully Executed
Original 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 252-8411.
Thank you.
Amendment 002 OAA 203.11.002
1605
This AMENDMENT,entered into by Area Agency on Aging for Southwest Florida, Inc. (Agency)dba Senior Choices of
Southwest Florida and Collier County Board of County Commissioners, (Contractor),amends Contract OAA 203.11.
The purpose of this amendment is to(1)extend this contract for 90 days or until a new contract is executed, whichever
comes first.
This amendment shall be effective January 1, 2012.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby
changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF,the parties hereto have caused this 1 page amendment to be executed by their officials there
unto duly authorized.
CONTRACTOR: Collier County Board of AGENCY: Senior Choices of Southwest
Commissioners Florida
Signed '-',1_141 (A).
By Signed By
Name: Fred W. Coyle Name: Leigh Anna Nowak
Title: Chairman Title: Board President
Date: 11/8/2011 Date:
Federal ID Number: 59-6000558
Fiscal Year End: 9/30
ATTEST:
DWJ .T E'.'BR( ,I , CLERK
4
Attt!>•rt 611 Mil 6
i IgnitireARRIUTY CLERK
Appr.�F ... • orm and legal Sufficiency:
kid
b unty Attorney
Attestation Statement 1 6 0 5
Agreement/Contract Number OAA 203.11.002
Amendment Number 002
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.dba Senior Choices of Southwest Florida
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.
W.
11/8/2011
Fred W.Coyle,Chairman Date
Signature of Recipient/Contractor representative
AAA Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready
for AAA designee signature
initial date
Revised November 2010
ATTEST: Appri al as to fs and legal Sufficiency:
DWI(i EE.BROCK,CLERK
,DEP TY CLERK _!!F ••
Attest as to Mitred* 4
Co my Attorney
; grlature o "�:�+W�s.