Backup Documents 09/15/2009 Item #16D12
ORIGINAL DOCUMENTS CHECKLIST & ROUTING sq16 D 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 2
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 OtTice. The completed routing slip and original
documents are to be forwarded to th,: Board OtTice 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. If the document is already complete with the
exception of the Chairman's signature, draw a line through routinl! lines # I throulili #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Debbi Maxon Housing and Human Services yn- 9/15/09
2. Donna Fiala, Chaimlan Board of County Commissioners
3.
4.
5. Ian Mitchell, Executive Manage Board of County Commissioners {Z- ~ II to I DJ
6. Minutes and Records Clerk of Court's Office
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 informatlOn 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 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 Debbi Maxon Phone Number 252-2695
Contact Case Manager II
Agenda Date Item was September 15, 2009 Agenda Item Number l6D12
Approved by the BCC
Type of Document NSIP Contract Amendment 203.9 Number of Original 3
Attached Documents Attached
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is Yes N/A (Not
a pro riate. (Initial) A licable)
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, fJh-
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 ossibly State Officials.)
2. All handwritten strike-through and revisions have been initialed by the County Attorney's ~
Office and all other m1ies except the BCC Chairman and the Clerk to the Board
3. The Chairman's signature line date has been entered as the date ofBCC approval of the ~
document or the final ne otiated contract date whichever is a licable.
4. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's ~
si nature and initials are re uired.
5. In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the Bee office within 24 hours of Bee approval. 'i)r.
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 9/15/09 (enter date) and all changes
made during the meeting have been incorporated in the attached document. The J;h-
Count Attorne 's Office has reviewed the chan es, if a Iica ble.
I: Forms! County Forms! BCC Fomls! Original Documents Routing Slip WWS Original 90304, Revised 12605, Revised 2.24.05
l6D12
MEMORANDUM
Date: September 17, 2009
To: Debbie Maxon, Case Manager
Housing & Human Services
From: Teresa Polaski, Deputy Clerk
Minutes and Records Department
Re: NSIP Contract Amendment 203.9
Enclosed are three (3) sets of each agreement, referenced above (Agenda
Item #16DI2) approved by the Board of County Commissioners on
Tuesday, September 15, 2009.
After further processiDl!: please forward a fullv executed ori2:inal to the
Minutes and Records Department for the Board's Records.
If you should have any questions, you may contact me at 252-8411.
Thank you.
Enclosures (3)
16D12
Amendment 001 Contract NSIP 203.09
CONTRACT
Collier County Housine: and Human Services
TillS CONTRACT is entered into between Area Agency on Aging for Southwest Florida,
Inc., hereinafter referred to as the "Agency", and Collier Countv Housine: 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.
NSIP 203.09, and its successor, incorporated herein by reference.
The purpose of this amendment is to: (1) amend Paragraph 4 of the contract to increase the
contract amount by $699.34 and increase the level of service accordingly; (2) amend
Paragraph 3.1 of Attachment I and (3) revise and replace Attachment III, Exhibit-I.
This amendment shall be effective on June 1,2009. 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 the.i~ undersigned officials as duly authorized.
, ," '",
.... . "'rll VENDOR:
,~ ATTEST:. . COLLIER COUNTY HOUSING
:: DWI 'T ~,~OCl(, Clerk AND HUMAN SERVICES
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Approved as to form and By:
legal sufficiency:
~~ Date: September 15.2009
Assistant County Attorney
AGENCY: AREA AGENCY ON AGING FOR Ji:~:k/
SOUTHWEST FLORIDA, INC.
. . .
. .
SIGNED BY: :~/::~~>~~~>
NAME: Naomi Manning
TITLE: Board President
DATE:
FEDERAL ID NUMBER: 59-6000558
FISCAL YEAR-END DATE: 9/30
1
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Amendment 001 Contract NSIP 203.09
3.1. STATEMENT OF METHOD OF PAYMENT
This is a fixed rate contract. The agency shall make payment to the contractor for
provision of services up to a maximum number of units of service and at the
prospective rate stated below.
Services to be Provided Units of Service Unit Rate Maximum Units
Eligible Congregate
and Home Delivered
Meals 1 unit = 1 meal $ 0.6051040 42,849
Eligible Congregate
and Home Delivered
Meals 1 unit = 1 meal $ 0.6295267 28,635
The prospective rate is based on the estimated OM grant award.
A TT ACHMENT III
EXHIBIT -1
1. FEDERAL RESOURCES AWARDED TO THE FOLLOWING SUBRECIPIENT
PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING:
FUNDING
PROGRAM TITLE SOURCE CFDA AMOUNT
Nutrition Services Incentive Older Americans
Program Act 93.053 $ 43,954.66
TOTAlFEDERAlA~ARD $ 43,954.66
2
16D12
Attestation Statement
Agreement/Contract Number NSIP 203.09
Amendment Number 001
I, Donna Fiala. Chairman, 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 and
Collier County Board of County Commissioners
(Recipient/Contractor name)
. -. . -. ......
. . . ' " ::.:.', 'fhe 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.
. . '. . . ' . September 15.2009
. '. . : . . . . . . . 'Signature of Recipient/Contractor representative Date
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Assistant County ttorney
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DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all
documents; ready for DOEA Secretary/designee signature
initial date
Revised August 2007
16D12
Amendment 001 Contract NSIP 203.09
CONTRACT
Collier County Housin2 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 Housine: 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.
NSIP 203.09, and its successor, incorporated herein by reference.
The purpose ofthis amendment is to: (1) amend Paragraph 4 of the contract to increase the
contract amount by $699.34 and increase the level of service accordingly; (2) amend
Paragraph 3.1 of Attachment I and (3) revise and replace Attachment III, Exhibit-I.
This amendment shall be effective on June 1,2009. 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.
VENDOR:
'1.\ COLLIER COUNTY HOUSING
AND HUMAN SERVICES
, 4.~
:: By.: By:
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Approved as to form and
legal sufficiency:
AS~ Date: September 15,2009
AGENCY: AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INe. ............. .
. . .
. . .
. . .
SIGNED BY:
NAME: Naomi Manning
TITLE: Board President
DATE: . . .
FEDERAL ill NUMBER: 59-6000558 . . .
. . . .......
FISCAL YEAR-END DATE: 9/30
1
16D12
Amendment 001 Contract NSIP 203.09
3.1. STATEMENT OF METHOD OF PAYMENT
This is a fixed rate contract. The agency shall make payment to the contractor for
provision of services up to a maximum number of units of service and at the
prospective rate stated below.
Services to be Provided Units of Service Unit Rate Maximum Units
Eligible Congregate
and Home Delivered
Meals 1 unit = 1 meal $ 0.6051040 42,849
EI igible Congregate
and Home Delivered
Meals 1 unit = 1 meal $ 0.6295267 28,635
The prospective rate is based on the estimated OAA grant award.
A TT ACHMENT III
EXHIBIT -1
1. FEDERAL RESOURCES AWARDED TO THE FOLLOWING SUBRECIPIENT
PURSUANT TO TIDS AGREEMENT CONSIST OF THE FOLLOWING:
FUNDING
PROGRAM TITLE SOURCE CFDA AMOUNT
Nutrition Services Incentive Older Americans
Program Act 93.053 $ 43,954.66
TOTAlFEDERAlA~ARD $ 43,954.66
2
16D12
Attestation Statement
Agreement/Contract Number NSIP 203.09
Amendment Number 001
I, Donna Fiala. Chairman, 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 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
: . : . :. .::::: ~n electronic data processing media, which has no affect on the agreement/contract content.
September 15.2009
: .':': . Signature of Recipient/Contractor representative Date
. . . .
. . . . . . .
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ATTTEST:
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DOEA tonttactManiger to initial and date indicating signatures/initials appropriate on all
documents; ready for DOEA Secretary/designee signature
initial date
Revised August 2007
16Dl~
Amendment 001 Contract NSIP 203.0
CONTRACT
Collier County Housin2 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 Housine: 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.
NSIP 203.09, and its successor, incorporated herein by reference.
The purpose ofthis amendment is to: (1) amend Paragraph 4 of the contract to increase the
contract amount by $699.34 and increase the level of service accordingly; (2) amend
Paragraph 3.1 of Attachment I and (3) revise and replace Attachment III, Exhibit-I.
This amendment shall be effective on June 1, 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,.uncletsign~d officials as duly authorized.
" 'j~{\
VENDOR:
COLLIER COUNTY HOUSING
AND HUMAN SERVICES
.~ By:
j~~~i~r:'l~:}tQ; . ~A1\.~ tJ BOARD OF CO TY COMMI2RS
J ,,~... ""If COLLIER CO Y, FLORIDA
Approved as to form and By: ~~
legal sufficiency: DONNA IALA, CHAIRMAN
A~~~ Date: September 15. 2009
AGENCY: AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
............. ,
. . .
SIGNED BY: ..... I
NAME: Naomi Manning
TITLE: Board President
DATE:
FEDERAL ID NUMBER: 59-6000558 . . .
FISCAL YEAR-END DATE: 9/30 .........:.:. :
I
16D12
Amendment 001 Contract NSIP 203.09
3.1. STATEMENT OF METHOD OF PAYMENT
This is a fixed rate contract. The agency shall make payment to the contractor for
provision of services up to a maximum number of units of service and at the
prospective rate stated below.
Services to be Provided Units of Service Unit Rate Maximum Units
Eligible Congregate
and Home Delivered
Meals 1 unit = 1 meal $ 0.6051040 42.849
Eligible Congregate
and Home Delivered
Meals 1 unit = 1 meal $ 0.6295267 28.635
The prospective rate is based on the estimated OAA grant award.
ATTACHMENT III
EXHIBIT-l
1. FEDERAL RESOURCES AWARDED TO THE FOLLOWING SUBRECIPIENT
PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING:
FUNDING
PROGRAM TITLE SOURCE CFDA AMOUNT
Nutrition Services Incentive Older Americans
ProRram Act 93.053 $ 43.954.66
TOTALFEDERALA~ARD $ 43.954.66
2
16D 1Z
Attestation Statement
Agreement/Contract Number NSIP 203.09
Amendment Number 001
I, Donna Fiala. Chairman, 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 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.
. . . .. .. .. .. .. .. ..
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.. .. .. .. .... ......
. . .
. .
. .. .. .. .... .... September 15. 2009
.. .. .. .... ........
" .. .. .. .. .. .. .. .. ..
. : . : . : . : . : . : . : . : ' : . : Signature of Recipient/Contractor representative Date
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.. .. .. .. .. .. .. .. .. I
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Assistant County Attorney
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DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all
documents; ready for DOE A Secretary/designee signature
initial date
Revised August 2007