Backup Documents 04/09/2019 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 D 1
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 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 routin_• lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf CHS WK 04/09/19
2. Minutes and Records Clerk of Court's Office
ea. `till)lei :�-IO ar►ll
PRIMARY CONTACT INFORMATION
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,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf Phone Number 239.252.2901
Contact/ Department
Agenda Date Item was April 9,2019 Agenda Item Number 16D1
Approved by the BCC
Type of Document Amendment HCE 203.18.002 Number of Original 1
Attached Documents Attached
PO number or account
number if document is
to be recorded
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. Does the document require the chairman's original signature? NA
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. 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.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chaiiuian's signature line date has been entered as the date of BCC approval of the NA
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NA
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
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!
8. The document was approved by the BCC on 04.09.19 and all changes made
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
- 1601
July 2018—June 2019 HCE 203.18.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
HOME CARE FOR THE ELDERLY
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of County Commissioners, ("Contractor"), amends agreement HCE 203.18.
The purpose of this amendment is to change the language in ATTACHMENT I,STATEMENT OF WORK--G. Time
Limits.
G. Time Limits
The caregiver must submit the receipts to the case manager within 30 days. Caregivers will be reimbursed within 60 days of
submitting the original receipt to the Contractor.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to 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
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF, the Parties hereto have caused this amendment, to be executed by their undersigned officials as
duly authorized; and agree to abide by the terms, conditions and provisions of this HCE contract as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY CO I.SIONERS SOUTHWEST FLORIDA,INC.
SIGNED BY: �� t �� "b " / SIGNED BY: �l C�
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBL C SERVICES,� DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: a Z (C=sJ (CI DATE: d.Z.10 $/f
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
DUNS: 076997790 Approved as to form and legality
I
�f0,.
Anstant Count torny
g`
1
1601
Revised August 2007
Attestation Statement
Agreement/Contract Number HCE203.18
Amendment Number QQZ,
I,STEPHEN Y CARNFI,I,,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 and
COLLIER COUNTY BOARD OF COUNTY 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.
,0/ ‘s;" 4206( C(
Signature i f Recipie /Contractor representative Date
Approved as to form and le altty
Astant County Vey v53,
``r
Revised August 2007
e