Backup Documents 12/13-14/2011 Item #16D11ORIGINAL DOCUMENTS CHECKLIST & ROUTI "
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT'9
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)
List in routing order
Office
Initials
Date
1. Louise Pelletier
HHVS
Initial
Im
2.Ian Mitchell, Executive Manager
Board of County Commissioners
Agenda Item Number
t r It
3. Minutes & Records
Clerk of Courts
Type of Document
Amendment to contract agreement
Number of
3
Attached
an original signature from the
Documents Attached
Chairman needed on each copy
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Ian Mitchell needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.
Name of Primary Staff
Louise Pelletier / Housing, Human and
Phone Number
252 -2696
Contact
Veteran Services
Initial
Im
Agenda Date Item was
December 13, 2011
Agenda Item Number
16 D 11
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Amendment to contract agreement
Number of
3
Attached
an original signature from the
Documents Attached
Chairman needed on each copy
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms / Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
a ro riate.
Initial
Applicable)
L
Original document has been signed/ initialed for legal sufficiency. (All documents to be
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signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
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Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
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document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
LP
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
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should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 12/13/11 (enter date) and all changes
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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
16011,
MEMORANDUM
Date: January 11, 2012
To: Louise Pelletier, Case Management
Housing, Human &Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Contract HCE 203.11 Amendment #1 to between
Collier County and the Area Agency on Aging of
SWFL Inc., d/b /a Senior Choices of Southwest Florida
Attached are three (3) original copies of the document referenced above,
(Item #16D11) approved by Board of County Commissioners December 13, 2011.
After forwarding to the Area Agency on Aging for signature, we request that
an original please be returned to the Minutes and Records Department for the
Board's Official Record.
If you have any questions, please contact me at 252 -8406.
Thank you.
Attachment (3)
AMENDMENT 001
Contract No. HCE 203.11 Amendment Page 1
16D11
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc., dba
Senior Choices of Southwest Florida hereinafter referred to as the "Agency ", and Collier
County Board of County Commissioners, hereinafter referred to as the "Recipient ", amends
agreement #HCE 203.11.
The purpose of this amendment is to revise Attachment VII, Budget Summary. The revised
2011 -2012 allocation is shown below with a decrease of $5,172.00 of HCE Basic Subsidies to an
increase of $5,172.00 in HCE Special Subsidies.
Program Title
Funding Source
CFDA/CSFA#
2011 -2012
Fund Amounts
Home Care for the
General Revenue
65001
$83,391.00
Elderly
This amendment shall be effective on December 13, 2011. All provisions in the agreement and
any attachments thereto in conflict with this amendment shall be and are hereby changed to
conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed
by their officials there unto duly authorized.
RECIPIENT• Collier County Board of
County Commissioners
SIGNED BY: / � "A
NAME: Fred W
TITLE: Chairman
DATE: December 13, 2011
FEDERAL ID NUMBER: 59- 60000558
FISCAL YEAR -END DATE: 9/30
ATTEST:
DWIGHT� LERK
- VT
AGENCY: Area Agency on Aging for
Southwest Florida, Inc. dba Senior
Choices of Southwest Florida
SIGNED BY:
NAME: Leigh Anna Nowak _
TITLE: Board President
DATE:
Approval as to form and legal Sufficiency:
Jennifer B. White
Assistant County Attorney
item * UVW
Age
Date U�I_t U
Date
AMENDMENT 001 Contract No. HCE 203.11 Amendment Page 2
1
2
a
4,
ATTACHMENT VII
Home Care for the Elderly
BUDGET SUMMARY
Collier County Board of Commissioners
HCE Case Management
HCE Basic Subsidies
HCE Special Subsidies
Total
2
16D11
$ 5,247.00
$ 34,344.00
$ 43,800.00
$ 83,391.00
16011
Attestation Statement
Agreement /Contract Number HCE 203.1 1.001
Amendment Number 001
1, 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.
! 12/13/2011
Fred W. Coyle, Chair n Date
Signature of Recipient /Contractor re esenta e
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�: ,,,,�'l
DWIO4BROC -K, CLP-U
_ •.fit' �f'�'i ^;.
St `, U R
Approval as to form and legal Sufficiency:
JenniferM.. White
Assistant County Attorney