Backup Documents 04/09/2019 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO T14 0 �t/�
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA
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 routing 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
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/ Dept lucent
Agenda Date Item was April 9,2019 Agenda Item Number 16D4
Approved by the BCC
Type of Document Amendment EHEAP 203.18.001 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 Chairman'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 VjGz
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
October 2018—September 2019 EHEAP 203.18.O0l1 6 Y 4
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
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 EHEAP 203.18.
The purpose of this amendment is to increase allocations for Collier County by$36,044, amend 4. Contract Amount
amend ATTACHMENT II,Exhibit 2 Funding Summary and amend ATTACHMENT IX Annual Budget Summary
and Detail.
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 $91,801.00 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.
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 EHEAP contract as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING FOR
BOARD OF COUNTY C!MMISSIONE SOUTHWEST FLORIDA,INC.
i
SIGNED BY: �'� P t SIGNED BY: (Yen-4;1-Z,
NAME: STEPEHN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: .3/4/ 5 DATE: S/ b 9
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30 \pproved as to form and legality
DUNS: 076997790 %"n
y.
Assistant County At y
1 ° 3 1 1\\°1
October 2018—September 2019 EHEAP 203.18.001 1 6 0 4
EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR,as revised, and Section 215.97(5),F.S.require that the information about Federal Programs and
State Projects included in Exhibit 1 be provided to the recipient. Information contained herein is a prediction of funding
sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
GRANT AWARD (FAIN#): 17EA-OF-13-00-16-003 FEDERAL AWARD DATE: April 1,2018
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Emergency Home Energy Assistance United States Department of
for the Elderly Program Health and Human Services 93.568 $ 91,801.00
EHEAP Collier 93.568 $ 91,801.00
TOTAL FEDERAL AWARD $ 91,801.00
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200—Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133—Audits of States,Local Governments, and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT 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
TOTAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
aJ,'&TE FINANCIAL ASSISTANCE
Section 215.97,F.S.,Chapter 69I-5,F.A.C, State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
q0b2
October 2018—September 2019 EHEAP 203.18.001 1 6 D 4
ATTACHMENT IX
ANNUAL BUDGET SUMMARY AND DETAIL
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
for
Collier County Board of County Commissioners
Collier
EHEAP ADMINISTRATION BUDGET $ 7,674.00
EHEAP OUTREACH BUDGET $ 12,655.00
EHEAP CRISIS ASSISTANCE $ 71,472.00
TOTAL $ 91,801.00
Projected minimum number of individuals to be served
Energy Assistance* 257
*Eligible households may be provided with one benefit per season up to six hundred dollars per benefit. The
minimum number of consumers may reflect duplicated consumers if a consumer receives a benefit in both
seasons.
3
Revised August 2007
16114
Attestation Statement
Agreement/Contract Number EHEAP 203.18
Amendment Number al
I,Stephen Y Carnell ,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.
cc:pr,
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Signature of Recipiet`/Contractor representative Date
Approved as to form and legality
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Assistant County A ley 9) J
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Revised August 2007