Backup Documents 12/01/2009 Item #16D2
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 0 2
TO ACCOMPANY ALL 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 Officc. 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 signatures, dates, and/or information needed. lrthe document is already complete with the
exc~tion of the Chairman's sianature. draw a line throup;h routing lines #1 through #4. complete the checklist, and forward to Sue Filson ine#51.
Route to Addressee(s) Office Initials Date
(List in routing: order)
1. Terri Daniels Housing and Human Services 12/4/09
2.
3.
4. Ian Mitchell, Manager Board of County Commissioners ,Ii 11./~/o'j
..f L
\. /
J
5. Minutes and Records Clerk ofCourl's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder oCthe original document pending Bee approval. Normally the primary contact is the person who created/prepared the executive
sunnnary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the Bee Chairman's signature are to be delivered to the Bee office only after the Bee has acted to approve the
item.)
Name of Primary Staff Terri Daniels Phone Number 252-2689
Contact
Agenda Date Item was December I, 2009 Agenda Item Number 16D2
Aooroved bv the BCC
Type of Document Amendment #003-- OAA 203.09 Number of Original 3
Attached Documents Attached
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/ A" in the Not Applicable column, whichever is
a ro riate.
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 ossibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce t the BCC Chainnan and the Clerk to the Board
The Chairman's signature line date has been entered as the date ofBCC approval of the
document or the tinal ne otiated contract date whichever is a licable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
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 nullitied. B our deadlines!
Tbe document was approved by tbe BCC on I (enter date) and all cbanges
made during tbe meeting bave been incorporate in tbe attacbed document. Tbe
Coun Attorne 's Office bas reviewed tbe cban es if a licable.
Yes
(Initial)
I
2.
3.
4.
5.
6.
I: Formsl County Forms! BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
160 2
MEMORANDUM
Date:
December 8, 2009
To:
Terri Daniels, Grants Supervisor
Human Services Department
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
Amendment #3 (Contract OAA 203.09) &
Attestation Agreement
Contractor: Collier County Housing & Human Services
Attached, please find three (3) originals as referenced above
(Agenda Item #16D2), along with the Original Attestation
Agreement approved by the Board of County Commissioners on
Tuesday, December 1,2009.
Please return any fully executed original documents back to the
Minutes & Records Department for the Board's Official Record.
If you should have any questions, please call 252-7240.
Thank you.
160 2
Amendment 003
Contract OAA 203.09
CONTRACT
Collier County Housin!! and Human Services
THIS CONTRACT is entered into between Area Agency on Aging for Southwest Florida,
Inc., hereinafter referred to as the "Agency", and Collier County Housin!! and Human
Services, hereinafter referred to as the "Vendor". This contract is subject to all provisions
contained in the CONTRACT executed between the Agency and the vendor, Contract No.
OAA 203.09, and its successor, incorporated herein by reference.
I. The purpose ofthis amendment is to revise the Attachment III, Exhibit-I and Budget
Summary, Attachment VII. The Collier County budget is revised by the following amount:
a. Title C I funds increase by $25,000.00
This amendment shall be effective on November I, 2009. All provisions in the contract and
any Attachments thereto in conflict with this amendment shall be 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 contract.
This amendment and all its attachments are herby made a part of the agreement.
IN WITNESS THEREOF, the parties hereto have caused this 2 page contract to be executed
by their undersigned officials as duly authorized.
ATTEST:
:~~
Attest Q>et'j '. ' ,,' ,
'......01..
"" .,'
BOARD OF UNTY COMMiSIONERS
COLLIER,t TY, FLORID .
J.) - //
. '~'>,'r'..A../ cc;J.t.t. <c"
By: ......
DONNA FIALA, CHAIRMAN
Approved as to form and
legal sufficiency
Date: December I. 2009
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA
By:
NAOMI MANNING, BOARD PRESIDENT
Date:
December I. 2009
ltem# J 10 D2-
Federal Tax 10: 59-6000558
Fiscal Year Ending Date: 09/30
Agenda 1?I,/a'l
Date ~
n"le r'/t/n1
flec'd ~
16D 2
Amendment 003
Contract OAA 203.09
A TT ACHMENT III
EXHIBIT - 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONSIST
OF THE FOLLOWING:
Pr02ram Title Year Fundin2 Source CFDAlCSFA Amount
Older Americans Act Title 2009 U.S. Health and 93.044
II1B Human Services $ 50,000.00
CN CM/ SCAS/ INSC
Transportation $ 75,000.00
Support Services $240,161.00
Title 111 C I Congregate Meals 2009 U.S. Health and Human 93.045 $210,878.00
Spending Authority Services
Title 111 C2 Home Delivered 2009 U.S. Health and Human 93.045 $332,252.00
Meals -Spending Authority Services
Older Americans Act Title 2009 U.S. Health and 93.052 $43,268.00
II1E Human Services
Supplement Services $19,330.00
Grandparent Services $ 2,336.00
I TOTAL FEDERAL AWARD: $973,225.00
ATTACHMENT VII
OAA BUDGET SUMMARY
RECIPIENT: Collier County Housing and Human Services
I. Title III B Support Services $ 365,161.00
2. Title III CI Congregate Meals $ 210,878.00
3. Title III C2 Home Delivered Meals $ 332,252.00
4. Title III E Services $ 64,934.00
TOTAL $973,225.00
2
160 2
Attestation Statement
Agreement/Contract Number OAA 203.09
Amendment Number 03
I, Donna Fiala. Chairman
made to the (Recipient/Contractor/ representative)
, attest that no changes or revisions have been
content of the above referenced agreement/contract or amendment between the Area Agency of Aging for
Southwest Florida, Inc. and the Collier Countv 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 pr cessing media, which has no affect on the agreement/contract content.
/
,J /7
c.,,/f <t./I(.
December 1 2009
Date
Signature of ecipient/Contractor representative
Approved as to fonn and
legal sufficiency
ATTEST:
DWIGHT E, BROCK, Clerk
By:
Mtwt .. to eil.t
.t~ OIl'.
r~~
Assistant County Attorney
DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all documents;
ready for DOEA Secretary /designee signature.
Item # [!g~L
initial date
Revised August 2007
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