Backup Documents 09/14/2010 Item #16D 9ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 ® 9
TO ACCOMPANY ALI, ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 as appropriate for additional signaNres, dates, and /or information needed. If the document is already complete with the
exception of the Chairman's sigriature, draw a line throu h routing lines #1 through #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Terri Daniels
Housing, Human and Veteran
Services
(Initial)
9/17/10
2.
September' ' 2009
Agenda Item Number
16D9
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4. Ian Mitchell, Executive Manager
Board of Cot Day Commissioners
Number of Original
9 24 to
5. Minutes and Records
Clerk of Court's Office
Documents Attached
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending 13CC approval. Normally the primary contact is the person who created /prepared the executive
summary. Primary contact information is needed in the evert one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are w be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Terri Daniels
Phone Number
252 -2689
Contact
appropriate.
(Initial)
Applicable)
Agenda Date Item was
September' ' 2009
Agenda Item Number
16D9
Approved b the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
ARRA Contract Amendment #4
Number of Original
3
Attached
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
INSTRUCTIONS & CHECKLIST
1: Forms/ County Fomra/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2 24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
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
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
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
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson 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 o (enter date) and all changes
made during the meeting have been incorp ated in the attached document. The
County Attorney's Office has reviewed th changes, if applicable.
1: Forms/ County Fomra/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2 24.05
160 g
MEMORANDUM
Date: September 23, 2010
To: Terri Daniels, Grants Supervisor
Human Services Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: ARRA Contract Amendment #4
Attached, please find one (3) original as referenced above (Agenda
Item #16D9), approved by the Board of County Commissioners on
Tuesday, September 14, 2010.
Please return a fully executed copy once all signatures
have been obtained for the Board's permanent records.
If you should have any questions, please call 252 -7240.
Thank you
Amendment 4 ARRA 203.09 Page 1 160
STANDARD CONTRACT
AREA AGENCY ON AGING
Collier County Housing, Human and Veteran Services
This AMENDMENT, entered into by Area Agency on Aging for Southwest Florida, Inc.,
hereinafter referred to as the "Agency," and Collier County Housing, Human and Veteran
Services, hereinafter referred to as the "recipient," amends contract ARRA 203.09.
The purpose of this amendment is to
A) Amend the contract amount by the following:
1) In Collier County, the C1 allocation decreased by $15,000.00.
B) Revise and replace Attachment III — Exhibit 1 attached.
C) Revise and replace Attachment VII, Budget Summary attached.
This amendment shall be effective August 12, 2009.
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.
ATTEST:
DWIGHT E. BROCK, Clerk
By.
Deputy Clerk
AI�t�1+t of a CM t t
Approved as to form and
legal sufficiency
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Fred W. Coyle,,( Chairman
Date: 111q 1 rULD
Septembet 14, 2010
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA
By:
Assistant County Attorney
Leigh Anna Nowak, Board President
Date:
Federal Tax ID: 59- 6000558
Fiscal Year Ending 9/30
16D q
Amendment 4 ARRA 203.09 Page 2
ATTACHMENT III
EXHIBIT -1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONSIST OF THE FOLLOWING:
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
Program Title
Funding Source
CFDA /CSFA
Amount
Title III C1 (ARRA)Congregate
Meals
U.S. Health and Human
Services
93.707
$65,755.00
Title III C2 (ARRA) Home
Delivered Meals
U.S. Health and Human
Services
93.705
$39,756.00
TOTAL FEDERAL AWARD:
$105,511.00
ATTACHMENT VII
AMERICAN RECOVERY AND REINVESTMENT ACT
RECIPIENT: Collier County Board of County Commissioners
1. C I Congregate Meals
2. C2 Home Delivered Meals
$ 65,755.00
$ 39,756.00
TOTAL $ 105,511.00
160 g
Attestation Statement
Agreement/Contract Number ARRA 203.09
Amendment Number 4
1, Fred W. Coyle, Chairman attest that no changes or revisions have been made to
(Recipient /Contractor representative)
the content of the above referenced agreement/contract or amendment between the Area Agency on
Aging for Southwest Florida, Inc. and
Collier County Board of Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement/contract content.
Signature of Recipient/Contractor to resentative
Approved as to form and
legal sufficiency
Assistant County Attorney ��
Revised April 2010
September 14, 2010
Date
ATTEST:
DWIGHT E. BROCK, CLERK
I {Clerk
Attw as to fMtr A Y