Backup Documents 07/28/2009 Item #16D 9
ORIGINAL DOCUMENTS CHECKLIST & ROUTING st' 09 f
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 Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has takcn 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 Chainnan's sienature, draw a line throueh routing lines # 1 through #4, complete the checklist, and forward to Sue Filson nine #5).
Route to Addressee(s) Office Initials Date
(List in routine order)
1. Debbi Maxon Housing and Human Services ?)r.. 7/28/09
2. Donna Fiala, Chairman Board of County Commissioners
3.
.
4.
5. Stl~ Fils9R, Executive Manager Board of County Commissioners ~ =t-/7,/D,
IltrJ A'\ r-rcrt eLL
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending Bce approval Normally thc primary contact is the person who created/prepared the executive
summary. Primary contact infonnation is needcd in the event one of the addressees above, including Sue Filson. necd to contact staff for additional or missing
infonnation. All original documents needing the BCC Chairman's signature arc to be delivered to the BCe ollice only aftcr the BCe has acted to approve the
item.)
Name of Primary Staff Debbi Maxon Phone Number 252-2695
Contact Case Manager II
Agenda Date Item was July 28, 2009 Agenda Item Number 1609
Approved by the BCC
Type of Document 2009-10 AD I Agreement 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 ro riate. (Initial) A Iicable)
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, 1t1.h-
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.)
2. All handwritten strike-through and revisions have been initialed by the County Attorney's ~
Office and all other arties exce t 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 J/J.-
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 BCC office within 24 hours of BCe approval. Pr.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the Bee's actions are nullified. Be aware of our deadlines!
6. The document was approved by the BCC on 7/28/09 (enter date) and all changes
made during the meeting have been incorporated in the attached document, The Vr-
Count Attorne 's Office has reviewed the chan es, if a Iicable.
I: Fonns/ County Fonns! BCC Fonns/ Original Documents Routing Slip wws Original 9.0304, Revised 1.2605. Revised 224.05
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MEMORANDUM
Date: July 30, 2009
To: Debbie Maxon, Case Manager
Housing & Human Services
From: Teresa Polaski, Deputy Clerk
Minutes and Records Department
Re: 2009-10 HCE Agreement
2009-10 CCE Agreement
2009-10 ADI Agreement
Enclosed are three (3) sets of each agreement, referenced above (Agenda
Item #16D9, #16D12 and #16D16) approved by the Board of County
Commissioners on Tuesday, July 28, 2009.
After further processin2 please forward a fully executed ori2inal 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)
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Attestation Statement
Agreement/Contract Number: ADI203.09
Amendment Number: -
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 Countv Board of Countv Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences
;n e'e"1:=s;n2~ has no affect on the agreement/enntra" eontent.
Julv 28. 2009
Signature of Recipient/Contractor representative Date
Q~~
,
Assistant County Attorney
~f ""'1..
k
. ,\
DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all
documents; ready for DOEA Secretary/designee signature
In itial date
Revised August 2007
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July 2009 ADI203.09
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA
STANDARD CONTRACT
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida,
hereinafter referred to as the "Agency" and Collier County Board of County Commissioners, hereinafter
referred to as the "Recipient", and collectively referred to as the "Parties." The term recipient for this
purpose may designate a vendor, subgrantee or subrecipient, the status to be further identified in
ATTACHMENT III, Exhibit-2 as necessary.
WITNESSETH THAT:
WHEREAS, the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Recipient has demonstrated that it has the requisite expertise and ability to faithfully
perform such services as an independent contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed and payments to be made,
together with the mutual covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions
specified in this contract including all attachments and exhibits, which constitute the contract
document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state planes), grant agreements, relevant
Department of Elder Affairs handbooks, manuals or desk books, as an integral part of the contract,
except to the extent that the contract explicitly provides to the contrary. In the event of conflict in
language among any of the documents referenced above, the specific provisions and requirements
of the contract document(s) shall prevail over inconsistent provisions in the Proposal(s) or other
general materials not specific to this contract document and identified attachments.
3. Term of Contract
This contract shall begin on July 1, 2009 or on the date on which the contract has been signed by
the last party required to sign it, whichever is later. It shall end at midnight, local time in Fort
Myers, Florida, on June 30, 2010.
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 $95,490.00 or the rate schedule, 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.
5. Renewals
By mutual agreement of the parties, in accordance with section 287.058(1)(f), F.S., the agency
may renew the contract for a period not to exceed three years, or the term of the original contract
whichever is longer. The renewal price, or method for determining a renewal price, is set forth in
the bid, proposal, or reply.
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July 2009 ADI203.09
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6. Comoliance with Federal Law
6.1. If this contract contains federal funds the provider shall comply with the provisions of 45 CFR 74
and/or 45 CFR 92, and other applicable regulations.
6.2. If this contract contains federal funds and is over $100,000, the recipient shall comply with all
applicable standards, orders, or regulations issued under section 306 of the Clean Air Act as
amended (42 USC 7401 et seq.), section 508 or the Federal Water Pollution Control Act as
amended (33 USC 1251 et seq.), Executive Order 11738, as amended, and where applicable
Environmental Protection Agency regulations 40 CFR 30. The recipient shall report any
violations of the above to the agency.
6.3. The recipient, or agent acting for the recipient, may not use any federal funds received in
connection with this contract to influence legislation or appropriations pending before the
Congress or any State legislature. If this contract contains federal funding in excess of $100,000,
the recipient must, prior to contract execution, complete the Certification Regarding Lobbying
form, ATTACHMENT II. All disclosure forms as required by the Certification Regarding
Lobbying form must be completed and returned to the Contract Manager, prior to payment under
this contract.
6.4. The recipient shall not employ an unauthorized alien. The agency shall consider the employment
of unauthorized aliens a violation of the Immigration and Nationality Act (8 USC 1324 a) and the
Immigration Reform and Control Act of 1986 (8 USC 1101). Such violation shall be cause for
unilateral cancellation of this contract by the agency.
6.5. That if this contract contains $10,000 or more of federal funds, the recipient shall comply with
Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375
and others, and as supplemented in Department of Labor regulation 41 CFR 60 and 45 CFR 92, if
applicable.
6.6. That if this contract contains federal funds and provides services to children up to age 18, the
recipient shall comply with the Pro-Children Act of 1994 (20 USC 6081).
6.7. That a contract award with an amount expected to equal or exceed 25,000.00 and certain other
contract awards shall not be made to parties listed on the government-wide Excluded Parties List
System, in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders
12549 and 12689, "Debarment and Suspension." The Excluded Parties List System contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive Order 12549. The
recipient will comply with these provisions before doing business or entering into subcontracts
receiving federal funds pursuant to this contract. The recipient shall complete and sign
A TT ACHMENT V prior to the execution of this contract.
7. Comoliance with State Law
7.1. That this contract is executed and entered into in the State of Florida, and shall be construed,
performed and enforced in all respects in accordance with the Florida law, including Florida
provisions for conflict of laws.
7.2. Requirements of Section 287.058. F.S.
7.2.1. The recipient will provide units of deliverables, including reports, findings, and drafts, as specified
in this contract, which the Contract Manager must receive and accept in writing prior to payment.
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July 2009 ADI203.09
7.2.2. The recipient will submit bills for fees or other compensation for services or expenses in sufficient
detail for a proper pre-audit and post-audit.
7.2.3. If itemized payment for travel expenses is permitted in this contract, the recipient will submit bills
for any travel expenses in accordance with section 112.061.F.S., or at such lower rates as may be
provided in this contract.
7.2.4. The recipient will allow public access to all documents, papers, letters, or other public records as
defined in subsection 119.011(11), F.S., made or received by the recipient in conjunction with this
contract except for those records which are made confidential or exempt by law. The recipient's
refusal to comply with this provision shall constitute an immediate breach of contract for which
the agency may unilaterally terminate the contract.
7.3. If clients are to be transported under any agreements and/or contracts incorporating this contract,
the recipient shall comply with the provisions of Chapter 427.F.S., and rule 41, F.A.C.
7.4. Subcontractors who are on the discriminatory vendor list may not transact business with any
public entity, in accordance with the provisions of section 287.134.F.S.
7.5. The recipient will comply with the provisions of section 1.062.F.D., and section 216.347.F.S.,
which prohibit the expenditure of contract funds for the purpose of lobbying the legislature,
judicial branch or a state agency.
8. Grievance Procedures
The recipient shall develop and implement, and ensure that its subcontractors have established,
grievance procedures to process and resolve client dissatisfaction with or denial of service(s), or
address complaints regarding the termination, suspension or reduction of services, as required for
receipt of funds. These procedures, at a minimum, should provide for notice of the grievance
procedure and an opportunity for review of the subcontractor's determination(s).
9. Audits. Inspections. Investi2ations. Public Records and Retention
9.1. To establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all income and expenditures of funds provided by the agency under this
contract.
9.2. To retain all client records, financial records, supporting documents, statistical records, and any
other documents (including electronic storage media) pertinent to this contract for a period of six
(6) years after completion of the contract or longer when required by law. In the event an audit is
required by this contract, records shall be retained for a minimum period of six (6) years after the
audit report is issued or until resolution or any audit findings or litigation based on the terms of
this contract, at no additional cost to the agency.
9.3. Upon demand, at no additional cost to the agency, the recipient will facilitate the duplication and
transfer of any records or documents during the required retention period in Paragraph 9.2.
9.4. To assure that these records shall be subject at all reasonable times to inspection, review, copying,
or audit by Federal, State, or other personnel duly authorized by the agency.
9.5. At all reasonable times for as long as records are maintained, persons duly authorized by the
agency and Federal auditors, pursuant to 45 CFR 92.36(i)(10), shall be allowed full access to and
the right to examine any of the recipient's contracts and related records and documents, regardless
of the form in which kept.
9.6. To provide a financial and compliance audit to the agency as specified in this contract and in
ATTACHMENT III and to ensure that all related party transactions are disclosed to the auditor.
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July 2009 ADI203.09
9.7. To comply and cooperate immediately with any inspections, reviews, investigations, or audits
deemed necessary by the office of the Inspector General pursuant to s. 20.055.F.S.
10. Nondiscrimination - Civil Rie:hts Compliance
10.1. The recipient will execute assurances in A TT ACHMENT VI that it will not discriminate against
any person in the provision of services or benefits under this contract or in employment because of
age, race, religion, color, disability, national origin, marital status or sex in compliance with state
and federal law and regulations. The recipient further assures that all contractors, subcontractors,
sub grantees, or others with whom it arranges to provide services or benefits in connection with
any of its programs and activities are not discriminating against clients or employees because of
age, race, religion, color, disability, national origin, marital status or sex.
10.2. The recipient will retain, on file, during the term of this agreement a timely, complete and accurate
Civil Rights Compliance Checklist (A TT ACHMENT B).
10.3. The recipient agrees to establish procedures pursuant to federal law to handle complaints of
discrimination involving services or benefits through this contract. These procedures shall include
notifying clients, employees, and participants of the right to file a complaint with the appropriate
federal or state entity.
10.4. These assurances are a condition of continued receipt of or benefit from federal financial
assistance, and are binding upon the recipient, its successors, transferees, and assignees for the
period during which such assistance is provide. The recipient further assures that all
subcontractors, vendors, or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not
discriminating against those participants or employees in violation of the above statutes,
regulations, guidelines, and standards. In the event of failure to comply, the recipient understands
that the agency may, at its discretion, seek a court order requiring compliance with the terms of
this assurance or seek other appropriate judicial or administrative relief, including but not limited
to, termination of and denial of further assistance.
11. Provisions of Services
The recipient will provide services in the manner described in A TT ACHMENT I.
12. Monitorine: bv the Ae:encv
The recipient permits persons duly authorized by the agency to inspect and copy any records,
papers, documents, facilities, goods and services of the recipient which are relevant to this
contract, and to interview any clients, employees and subcontractor employees of the recipient to
assure the agency of the satisfactory performance of the terms and conditions of this contract.
Following such review, the agency will deliver to the recipient a written report of its findings and
request for development, by the recipient, of a corrective action plan where appropriate. The
recipient hereby agrees to timely correct all deficiencies identified in the corrective action plan.
13. Indemnification
13.1. Subject to the limits of section 768.28, F.S., the recipient shall indemnify, save, defend, and hold
harmless the agency and its agents and employees from any and all claims, demands, actions,
causes of action of whatever nature or character, arising out of or by reason of the execution of
this agreement or performance of the services provided for herein. It is understood and agreed that
the provider is not require to indemnify the agency for claims, demands, actions or causes of
action arising solely out of the agency's negligence.
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July 2009 ADI203.09
14. Insurance and Bondine:
14.1. To provide continuous adequate liability insurance coverage during the existence of this contract
and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency
or subdivision as defined by subsection 768.28(2), F.S. the recipient accepts full responsibility for
identifying and determining the type(s) and extent of liability insurance necessary to provide
reasonable financial protections for the recipient and the clients to be served under this contract.
The limits of coverage under each policy maintained by the recipient do not limit the recipient's
liability and obligations under this contract. The recipient shall ensure that the agency has the
most current written verification of insurance coverage throughout the term of this contract. Such
coverage may be provided by a self-insurance program established and operating under the laws of
the State of Florida. The agency reserves the right to require additional insurance as specified in
this contract.
14.2. Throughout the term of this agreement, the recipient agrees to maintain an insurance bond from a
responsible commercial insurance company covering all officers, directors, employees and agents
of the recipient authorized to handle funds received or disbursed under all agreements and/or
contracts incorporation this contract by reference in an amount commensurate with the funds
handled, the degree of risk as determined by he insurance company and consistent with good
business practices.
15. Confidentiality of Information
The recipient shall not use or disclose any information concerning a recipient of services under
this contract for any purpose prohibited by state or federal law or regulations except with the
written consent of a person legally authorized to give that consent or when authorized by law.
16. Health Insurance Portabilitv and Accountabilitv Act
Where applicable, to comply with the Health Insurance Portability and Accountability Act (42
USC 1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
17. Incident Reportine:
17.1. The recipient shall notify the agency immediately, but no later than forty-eight (48) hours from,
the recipient's awareness or discovery of conditions that may materially affect the recipient or
subcontractor's ability to perform, such as problems, delays or adverse conditions which may
impair the ability to meet the objectives of this contract.
17.2. To immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a
child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free
telephone number (l-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is
binding upon both the recipient and its employees.
18. Sponsorship and Publicity
18.1. As required by section 286.25 F.S., if the recipient is a non-governmental organization which
sponsors a program financed wholly or in part by state funds, including any funds obtained
through this contract, it shall in publicizing, advertising, or describing the sponsorship of the
program, state: "Sponsored by (recipient's name), The Area Agency on Aging for Southwest
Florida and the State of Florida, Department of Elder Affairs." If the sponsorship reference is in
written material, the words " The Area Agency on Aging for Southwest Florida and the State of
Florida, Department of Elder Affairs" shall appear in at least the same size letters or type as the
name of the organization.
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July 2009 ADI203.09
18.2. The contractor shall not use the words "The Area Agency on Aging for Southwest Florida and the
State of Florida, Department of Elder Affairs" to indicate sponsorship of a program otherwise
financed, unless, specific authorization has been obtained by the agency prior to use.
19. Assie:nments
19.1. The recipient shall not assign the rights and responsibilities under this Contract without the prior
written approval of the agency, which shall not be unreasonably withheld. Any sublicense,
assignment, or transfer otherwise occurring without prior written approval of the agency will
constitute a material breach of the contract.
19.2. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights,
duties, or obligations under this contract to another governmental agency in the State of Florida,
upon giving prior written notice to the recipient. In the event the State of Florida approves transfer
of the recipient's obligations, the recipient remains responsible for all work performed and all
expenses incurred in connection with the contract.
19.3. This contract shall remain binding upon the successors in interest of either the recipient or the
agency.
20. Subcontracts
20.1. The recipient is responsible for all work performed and for commodities produced pursuant to this
contract, whether actually furnished by the recipient or its subcontractors. Any subcontracts shall
be evidenced by a written document and subject to any conditions of approval the agency deems
necessary. The recipient further agrees that the agency shall not be liable to the subcontractor in
any way or for any reason. The recipient, at its expense, will defend the agency against any such
claims.
20.2. The recipient shall promptly pay any subcontractors upon receipt of payment from the agency or
other state agency. Failure to make payments to any subcontractor in accordance with s.
287.0585, F.S., unless otherwise stated in the contract between the recipient and subcontractor,
will result in a penalty as provided by statute.
21. Indeoendent Caoacitv of Recioient
It is the intent and understanding of the parties that the recipient, or any of its subcontractors, are
independent contractors and are not employees of the agency and shall not hold themselves out as
employees or agents of the agency without specific authorization from the agency. It is further
intent and understanding of the parties that the agency does not control the employment practices
of the recipient and shall not be liable for any wage and hour, employment discrimination, or other
labor and employment claims against the recipient or its subcontractors. All deductions for social
security, withholding taxes, income taxes, contributions to unemployment compensation funds and
all necessary insurance for the recipient shall be the sole responsibility of the recipient.
22. Payment
Payments will be made to the recipient pursuant to s. 215,422, F.S., as services are rendered and
invoiced by the recipient. The agency's Contract Manager will have final approval of the invoice
for payment, and will approve the invoice for payment only if the recipient has met all terms and
conditions of the contract, unless the bid specifications, purchase order, or this contract specify
otherwise. The approved invoice will be submitted to the agency's finance section for budgetary
approval and processing. Disputes arising over invoicing and payments will be resolved in
accordance with the provisions of s. 215.422 F.S. A Vendor Ombudsman has been established
with the Department of Financial Services and may be contacted at (850) 413-5665.
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23. Return of Funds
The recipient will return to the agency any overpayments due to unearned funds or funds
disallowed and any interest attributable to such funds pursuant to the terms and conditions of this
contract that were disbursed to the recipient by the agency. In the event that the recipient or its
independent auditor discovers that an overpayment has been made, the recipient shall repay said
overpayment immediately without prior notification from the agency. In the event that the agency
first discovers an overpayment has been made, the Contract Manager, on behalf of the agency, will
notify the recipient by letter of such findings. Should repayment not be forthwith, the recipient
will be charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03,
F.S., after agency notification or recipient discovery.
24. Data Intee:ritv and Safee:uardine: Information
The recipient shall insure an appropriate level of data security for the information the recipient is
collecting or using in the performance of this contract. An appropriate level of security includes
approving and tracking all recipient employees that request system or information access and
ensuring that user access has been removed from all terminated employees. The recipient, among
other requirements, must anticipate and prepare for the loss of information processing capabilities.
All data and software must be routinely backed up to insure recovery from losses or outages of the
computer system. The security over the backed-up data is to be as stringent as the protection
required of the primary systems. The recipient shall insure all subcontractors maintain written
procedures for computer system back up and recovery. The recipient shall complete and sign
ATTACHMENT IV prior to the execution of this contract.
25. Conflict of Interest
The recipient will establish safeguards to prohibit employees, board members, management and
subcontractors from using their positions for a purpose that constitutes or presents the appearance
of personal or organizational conflict of interest or personal gain. No employee, officer or agent
of the recipient or subcontractor shall participate in selection, or in the award or administration of
an agreement supported by State or Federal funds if a conflict of interest, real or apparent, would
be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member
of his/her immediately family; (c) his or her partner, or; (d) an organization which employs, or is
about to employ, any of the above has a financial or other interest in the firm selected for award.
The recipient or subcontractor's officers, employees or agents will neither solicit nor accept
gratuities, favors or anything of monetary value from contractors, potential contractors, or parties
to subcontracts. The recipient's board members and management must disclose to the agency any
relationship which may be, or may be perceived to be, a conflict or interest within thirty (30) days
of an individual's original appointment or placement in that position, or if the individual is serving
as an incumbent, within thirty (30) days of the commencement of this contract. The recipient's
employees and subcontractors must make the same disclosures described above to the recipient's
board of directors. Compliance with this provision will be monitored.
26. Public Entitv Crime
Pursuant to s. 287.133, F.S., the following restrictions are placed on the ability of persons
convicted of public entity crimes to transact business with the agency. A person or affiliate who
has been placed on the convicted vendor list following a conviction for a public entity crime may
not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair
of a public building or public work; may not submit bids, proposals, or replies on leases of real
property to a public entity; may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity; and may not transact business
with any public entity in excess of the threshold amount provided in s. 287.017, F.S., for
7
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July 2009 ADI203.09
CA TEGOR Y TWO for a period of 36 months following the date of being placed on the convicted
vendor list.
27. Purchasim~
27.1. To purchase articles which are the subject of or are required to carry out this contract from Prison
Rehabilitative Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946,
F.S., in the same manner and under the procedures set forth in subsections 946.515(2) and (4), F.S.
For purposes of this contract, the recipient shall be deemed to be substituted for the agency insofar
as dealings with PRIDE. This clause is not applicable to subcontractors unless otherwise required
by law. An abbreviated list of products/services available from PRIDE may be obtained by
contacting PRIDE (800) 643-8459.
27.2. To procure any recycled products or materials, which are the subject of or are required to carry out
this contract, in accordance with the provisions of sections 403.7065 and 287.045, F.S.
28. Patents. Copvri2hts. Rovalties
If any discovery, invention or copyrightable material is developed or produced in the course of or
as a result of work or services performed under this contract, the recipient shall refer the
discovery, invention or material to the agency to be referred to the Department of State. Any and
all patent rights or copyrights accruing under this contract are hereby reserved to the State of
Florida in accordance with Chapter 286, F.S.
29. Emere:encv Preparedness and Continuity of Operations
29.1. If the tasks to be performed pursuant to this contract, include the physical care and control of
clients, or the administration and coordination of services necessary for client health, safety or
welfare, the recipient shall within 30 days of the execution of this contract, submit to the Contract
Manager verification of an emergency preparedness plan. In the event of an emergency, the
recipient shall notify the agency of emergency provisions.
29.2. In the event, a situation results in a cessation of services by a subcontractor, the recipient will
retain responsibility for performance under this contract and must follow procedures to ensure
continuity of operations without interruption.
30. PUR 1000 Form
The PUR 1000 Form is hereby incorporated by reference. In the event of any conflict between the
PUR 1000 Form and any terms or conditions of this contract the terms or conditions of this
contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or
conditions contained in the PUR 1000 Form shall take precedence.
31. Use of State Funds to Purchase or Improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon
the recipient or political subdivision granting to the state a security interest in the property at least
to the amount of state funds provided for at least 5 years from the date of purchase or the
completion of the improvements or as further required by law.
32. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager,
who shall reduce the decision to writing and serve a copy on the recipient.
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33. No Waiver of Sovereie:n Immunitv
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by
any entity to which sovereign immunity may be applicable.
34. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Lee County,
Florida.
35. Entire Contract
This contract contains all the terms and conditions agreed upon by the parties. No oral agreements
or representations shall be valid or binding upon the agency or the recipient unless expressly
contained herein or by a written amendment to this contract.
36. Force Maieure
Neither party shall be liable for any delays or failures in performance due to circumstances beyond
its control, provided the party experiencing the force majeure condition provides immediate
written notification to the other party and takes all reasonable efforts to cure the condition.
37. Severabilitv Clause
I
The parties agree that if a court of competent jurisdiction deems any term or condition herein void
or unenforceable, the other provisions are severable to that void provision and shall remain in full
force and effect.
38. Condition Precedent to Contract: Appropriations
The parties agree that the agency's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Legislature. In the event such an appropriation is
not made, the recipient shall not be entitled to file a claims bill.
39. Addition/Deletion
The parties agree that the agency reserves the right to add or to delete any of the services required
under this contract when deemed to be in the State's best interest. The parties shall negotiate
compensation for any additional services added.
40. Waiver
The delay or failure by the agency to exercise or enforce any of its rights under this contract shall
not constitute or be deemed a waiver of the agency's right thereafter to enforce those rights, nor
shall any single or partial exercise of any such right preclude any other or further exercise thereof
or the exercise of any other right.
41. Compliance
The recipient agrees to abide by all applicable current federal statutes, laws, rules and regulations
as well as applicable current State statutes, laws, rules and regulations. The parties agree that
failure of the recipient to abide by these laws shall be deemed an event of default of the recipient,
and subject the contract to immediate, unilateral cancellation of the contract at the discretion of the
agency.
42. Final Invoice
The recipient shall submit the final invoice for payment to the agency as specified in Section 3.3.5
(date for final request for payment) of ATTACHMENT I. If the recipient fails to submit final
request for payment by the deadline, then all rights to payment may be forfeited and the agency
9
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may not honor any requests submitted after the aforesaid time period. Any payment due under the
terms of this contract may be withheld until all reports due from the recipient and necessary
adjustments thereto have been approved by the agency.
43. Renee:otiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to
writing and duly signed by both parties. The rate of payment and the total dollar amount may be
adjusted retroactively to reflect price level increases and changes in the rate of payment when
these have been established through the appropriations process and subsequently identified in the
agency's operating budget.
44. Termination
44.1. This contract may be terminated by either party without cause upon no less than thirty (30)
calendar days notice in writing to the other party unless a sooner time is mutually agreed upon in
writing. Said notice shall be delivered y U.S. Postal Service or any expedited delivery service that
provides verification of delivery or by hand delivery to the Contract Manager or the representative
of the recipient responsible for administration of the contract.
44.2. In the event funds for payment pursuant to this contract become unavailable, the agency may
terminate this contract upon no less than twenty-four (24) hours notice in writing to the provider.
Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that
provides verification of delivery or by hand delivery to the Contract Manager or the representative
of the recipient responsible for administration of the contract. The agency shall be the final
authority as to the availability and adequacy of funds. In the event of termination of this contract
the provider will be compensated for any work satisfactorily completed.
44.3. This contract may be terminated for cause upon no less than twenty-four (24) hours notice in
writing to the recipient. If applicable, the agency may employ the default provisions in Rule 60A-
1.006(3), F.A.C. Waiver of breach of any provisions of this contract shall not be deemed to be a
waiver of any other breach and shall not be construed to be a modification of the terms and
conditions of this contract. The provisions herein do not limit the agency's right to remedies at
law or in equity.
44.4. Failure to have performed any contractual obligations with the agency in a manner satisfactory to
the agency will be a sufficient cause for termination. To be terminated as a recipient under this
provision, the recipient must have (1) previously failed to satisfactorily perform in a contract with
the agency, been notified by the agency of the unsatisfactory performance and failed to correct the
unsatisfactory performance to the satisfaction of the agency; or (2) had a contract terminated by
the agency for cause.
45. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
The recipient name, as shown on page I ofthis contract, Collier County Housing and Human Services
a. and mailing address of the official payee to whom the 3301 East Tamiami Trail, Building H
payment shall be made is: Naples FL 34112
Marcy Krumbine, Director
The name of the contact person and street address where Collier County Housing and Human Services
b. financial and administrative records are maintained is: 3301 East Tamiami Trail, Building H
Naples FL 34112
(239) 252-2273
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July 2009 AD1203.09
Marcy Krumbine, Director
The name, address, and telephone number of the Collier County Housing and Human Services
c. representative of the recipient responsible for 3301 East Tamiami Trail, Building H
administration of the program under this contract is: Naples FL 34112
(239) 252-2273
The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc.
d. Requests for Payment and Receipt and Expenditure forms 2285 First Street
are to be mailed is: Fort Myers, Florida 33901
Leigh Wade-Schield, Executive Director
The name, address, and telephone number of the Contract Area Agency on Aging for Southwest Florida, Inc.
e. Manager for the Agency for this contract is: 2285 First Street
Fort Myers, Florida 33901
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided
in writing to the other party and the notification attached to the originals of this contract.
46. All Terms and Conditions Included
This contract and its Attachments, I - XII, A and B, and any exhibits referenced in said attachments,
together with any documents incorporated by reference, contain all the terms and conditions agreed upon
by the parties. There are no provisions, terms, conditions, or obligations other than those contained
herein, and this contract shall supersede all previous communications, representations or agreements,
either written or verbal between the parties.
By signing this contract, the parties agree that they have read and agree to the entire contract.
IN WITNESSING THEREOF, the parties hereto have caused this 40 page contract, to be executed by
their under~i~~g'o.ff:icials as duly authorized.
,.,;~.'. .:',-. d ::" v. :~,:~:.
. ,> . "\ ...... RECEPIENT:
~;--, .~ " -: ",~~ ..:~ ".
ATTEST: '.\ ':::.::\ ~ ,~; : COLLIER COUNTY HOUSING
, . ~ .,. '""" >'f . -.;) "
DWI TE.BJ,lorKtCterk:' AND HUMAN SERVICES
,.:r'\""'.~
' .' .,~;-
. , n By:
Attest It to o.e train t BOARD OF C TY COM~~SSI7NERS
,t9ft.tyrt Oft 1.- COLLIER TY, FLORld_
Approved as to form and By: ~ f'" ~~
legal sufficiency: DONN FIALA, CHAIRMAN
-:-C(/i!Qe~~jd(kfh_9-- DA TE: July 28. 2009
ASSistant County Attorney
AREA AGENCY ON AGING FOR -< : : :~
SOUTHWEST FLORIDA, INe. . . .
SIGNED BY: . , .
NAME: Naomi Manning : : : : : :: :::::
TITLE: Board President . . . . . ,
DATE:
FEDERAL ID NUMBER 59-6000558
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July 2009 ADI203.09
INDEX TO CONTRACT ATTACHMENTS
ATTACHMENT A TT ACHMENT DESCRIPTION PAGE
A TT ACHMENT I STATEMENT OF WORK 13-22
A TT ACHMENT II CERTIFICATION REGARDING LOBBYING 23
A TT ACHMENT III FINANCIAL COMPLIANCE AUDIT ATTACHMENT 24-29
ATTACHMENT IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE 30
A TT ACHMENT V CERTIFICATION REGARDING DEBARMENT, SUSPENSION 31
INELIGIBILITY, AND VOLUNTARY EXCLUSION
A TT ACHMENT VI ASSURANCES - NON-CONSTRUCTION PROGRAMS 32-33
A TT ACHMENT VII ALZHEIMER'S DISEASE INITIATIVE (ADI) INVOICE SCHEDULE 34
ATTACHMENT VIII ALZHEIMER'S DISEASE INITIATIVE PROGRAM BUDGET 35
SCHEDULE
A TT ACHMENT IX ALZHEIMER'S DISEASE INITIATIVE PROGRAM RATE SCHEDULE 36
ATTACHMENT X ANNUAL MODEL DAY CARE CENTER TRAINING REPORT 37
A TT ACHMENT XI REQUEST FOR PAYMENT 38
A TT ACHMENT XII RECEIPTS AND EXPENDITURES 39
ATTACHMENT A DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES 40
HANDBOOK (ON CD)
ATTACHMENT B DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE 41-44
CHECKLIST AND INSTRUCTIONS
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July 2009 AD1203.09
ST A TEMENT OF WORK
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF CONTRACT TERMS AND ACRONYMS
1.1.1. DEFINITIONS OF ACRONYMS
Adult Protective Services (APS)
Alzheimer's Disease Initiative (ADI)
Alzheimer's Disease (AD)
Assessed Priority Consumer List (APCL)
Client Information and Registration Tracking System (CIRTS)
Community Care for the Disabled Adults (CCDA)
Home Care for Disabled Adults (HCDA)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
Web-based Database System (WebDB)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the
Department of Children and Families Services Community Care for Disabled Adults or Home
Care for Disabled Adults services, to the Department Of Elder Affairs' community-based services.
Area Plan: A plan developed by the recipient outlining a comprehensive and coordinated service
delivery system, in the respective planning and service area, in accordance with the Section 306 of
the Older Americans Act (42 D.S.C. 3026), and agency instructions.
Area Plan Update: A revision to the area plan wherein the recipient enters ADI specific data in
the web-based database system (WebDB). An update may also include other revisions to the area
plan as instructed by the agency.
Functional Assessment: A comprehensive systematic and multidimensional review of a person's
ability to remain independent and in the least restrictive living arrangement. DOEA Form 701B is
used by case managers to conduct the functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1)
and (2), F.S., to provide diagnostic and referral services, conduct basic and service-related
multidisciplinary research, and develop training materials and educational opportunities for lay
and professional caregivers of individuals with Alzheimer's disease.
Model Day Care: A program of therapeutic, social and health activities specific to clients with
memory disorders. Services and activities include but are not limited to, active and quiet games,
reminiscence, validation therapy, pet therapy, water therapy and other failure free activities
appropriate to the client's level of functioning. Model day care centers shall also provide training
for health care and social service personnel in the care of persons having Alzheimer's disease or
related memory disorders.
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1.2. AGENCY MISSION STATEMENT
Mission: To help aging adults, 60 and older, achieve greater independence through awareness of resources
and access to qualified service providers.
Vision: To be the recognized leader in supporting older adults and their families with access to trustworthy
resources and services in their communities while empowering them to live with independence and dignity.
Values: The Agency believes the residents of Southwest Florida are entitled to:
. Comprehensive information about their choices of care;
. Timely access to resources and services;
. High standards of quality and performance;
. Personal and professional accountability from all stakeholders.
Lead agencies and local service providers as partners and stakeholders in Florida's aging services
network are expected to support the agency's mission, vision, and priorities.
1.2.1. Alzheimer's Disease Initiative Program Mission Statement
The Alzheimer's Disease Initiative program ensures that persons afflicted with Alzheimer's
disease and other forms of dementia, are given essential services to help them age in place, in an
elder-friendly environment, with security, dignity, and purpose. The program also provides
support to family members and caregivers of persons afflicted with Alzheimer's disease.
1.3. GENERAL DESCRIPTION
1.3.1. General Statement
ADI provides a continuum of services that address the special needs of individuals with
Alzheimer's disease (AD), their families and caregivers.
1.3.2. Authority
The relevant authority governing the Alzheimer's Disease Initiative Program are:
(1) Rule Chapter 58D-l, Florida Administrative Code
(2) Sections 430.501 through 430.504, Florida Statutes
1.3.3. Scope of Service
The Area Agency on Aging is responsible for the programmatic, fiscal and operational management of the
ADI program. The recipient shall provide services in a manner consistent with and described in the
agency's current area plan update and the current Department of Elder Affairs Programs and Services
Handbook, A TT ACHMENT A.
1.3.4. Major Program Goal
The major goal of the Alzheimer's Disease Initiative program is to provide services to meet the
needs of caregivers and individuals with Alzheimer's Disease and related memory disorders.
1.4. INDIVIDUALS TO BE SERVED
1.4.1. General Eligibility
The ADI Program addresses the special needs of individuals with Alzheimer's disease (AD) and
their caregivers.
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July 2009 ADI 203.09
1.4.2. Individual Eligibility
(1) Be 18 years of age or older and have a diagnosis of Alzheimer's disease or a related disorder,
or be suspected of having Alzheimer's disease or a related disorder.
(2) Not be enrolled in a Medicaid capitated long-term program.
1.4.3. Targeted Groups
Priority for services under this contract shall be given to those eligible persons assessed to be at
risk of placement in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the ADI program, the agency shall ensure the following tasks are
performed:
(1) Client Eligibility Determination as listed in ATTACHMENT I, SECTION 1.4.2.;
(2) Assessment and Prioritization of Service Delivery for New Clients; and
(3) Delivery of Services to Eligible Clients;
2.1.1 Assessment and Prioritization of Service Delivery for New Clients
It is not the intent ofthe agency to remove existing clients from any services in order to serve new
clients being assessed and prioritized for service delivery. The following are the criteria to
prioritize new clients for service delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred into the community.
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted into
the community.
(3) Individuals in nursing homes that are closing and can be discharged into the community; or
(4) Individuals whose mental or physical health condition has deteriorated to the degree that self
care is not possible, there is no capable caregiver, and institutional placement will occur within 72
hours.
(5) For the purpose oftransitioning individuals receiving the Community Care for Disabled
Adults (CCDA) and Home Care for the Disabled (HCDA) services through the Department of
Children and Families (DCF) Adult Services to community-based services provided through the
agency, when services are not currently available, area agency on aging staff and lead agency case
managers shall ensure that "Aging Out" individuals are prioritized for services only after Adult
Protective Services (APS) High Risk and Imminent Risk individuals.
2.1.2. Priority Criteria for Service Delivery for Other Assessed Individuals
The assessment and provision of services should always consider the most cost effective means of
service delivery. Functional impairment shall be determined though the agency's client
assessment form administered to each applicant. The most frail individuals not prioritized above
will receive services to the extent funding is available.
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July 2009 ADI203.09
2.1.3. Delivery of Services to Eligible Clients
The recipient shall ensure the provision of a continuum of services that addresses the diverse
needs of individuals with Alzheimer's disease and their caregivers. The recipient shall ensure
services are performed in accordance with the current Department of Elder Affairs Programs and
Services Handbook. Services categories include:
(1) Caregiver Training/Support
(2) Case Aid
(3) Case Management
(4) Counseling (Gerontological)
(5) Counseling (Mental Health/Screening)
(6) Education/Training
(7) Intake
(8) Model Day Care
(9) Respite (Facility Based)
(10) Respite (In Home); and
(11) Specialized Medical Equipment, Services and Supplies.
Caregivers benefit from receiving training, respite, and related support services to assist them in
caring for the ADI client.
2.1.3.2. Memory Disorder Clinics
Memory Disorder Clinics are required to provide four hours of in-service training to all respite and
model day care centers in their designated service areas. In-service training topics may include
physiological, behavioral, and emotional aspects of Alzheimer's disease and related diseases as
well as caregiver techniques and coping strategies. The recipient agrees to collaborate with
Memory Disorder Clinics to assist in this effort. The recipient will respond to requests for
evaluation information and statistical data concerning its consumers, based on information
requirements of the Memory Disorder Clinics and Brain Bank.
2.1.3.3. Model Day Care Programs
The recipient will ensure Centers supported by the contract develop innovative therapies and
interventions which can be shared with other Alzheimer's Disease Initiative health and services
personnel via training. Model Day Care Centers supported by this contract must report to the
recipient all training activities provided to health care and social service personnel and caregivers,
as well as serve as a natural laboratory for service related applied research performed by Memory
Disorder Clinics. The recipient shall submit an annual Model Day Care Center Training Report,
ATTACHMENT X, to the agency by July 16,2009.
2.2. SERVICE LOCATION AND EQUIPMENT
2.2.1. Service Times
The recipient shall ensure the provisions of the services listed in this contract are available at times
appropriate to meet client service needs, at a minimum, during normal business hours. Normal
business hours are defined as Monday through Friday, 8:00am to 5:00pm.
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July 2009 ADI203.09
2.3 Equipment
2.3.1 Equipment means: (a) an article of non expendable, tangible personal property having a useful life
of more than one year and an acquisition cost which equals or exceeds the lesser of (a) the
capitalization level established by the organization for the financial statement purposes, or $5,000
[for federal funds], or nonexpendable, tangible personal property of a nonconsumable nature with
an acquisition cost of $1 ,000 or more per unit, and expected useful life of at least one year; and
hardback bound books not circulated to students or the general public, with a value or cost of $250
or more [for state funds].
2.3.2. Contractors and sub-contractors who are Institutions of Higher Education, Hospitals, and Other
Non-Profit Organizations shall have written property management standards incompliance with 2
CFR Part 215 Administrative Requirements (formerly OMB Circular A-I 10) that include: (a) a
property list with all the elements identified in the circular; and (b) a procedure for conducting a
physical inventory of equipment at least once every two years. The property records must be
maintained on file and shall be provided to the agency upon request.
2.3.3. The recipient's property management standards for equipment acquired with public funds and federally-
owned equipment shall include accurately maintained equipment records with the following information.
(1) A description of the equipment
(2) Manufacturer's serial number, model number, Federal stock number, national stock number, or other
identification number
(3) Source ofthe equipment, including the award number
(4) Whether title vests in the recipient or the Federal Government
(5) Acquisition date (or date received, if the equipment was furnished by the Federal Government) and
cost
(6) Information from which one can calculate the percentage of Federal participation in the cost of the
equipment (not applicable to equipment furnished by the Federal Government)
(7) Location and condition of the equipment and the date the information was reported
(8) Unit acquisition cost; and
(9) Ultimate disposition data, including date of disposal and sales price or the method used to determine
current fair market value where a recipient compensates the Federal awarding agency for its share.
2.3.4 Equipment purchased with federal funds with an acquisition cost over $5,000 and equipment purchased
with state funds with an acquisition cost over $1,000 that is part of the cost of carrying out the activities and
functions of the grant awards and Title (ownership) will vest with the recipient, subject to the conditions of
2 CFR Part 215 Administrative Requirements (formerly OMB Circular A-II 0), Subpart C, paragraph 34.
Equipment purchased under these thresholds is considered supplies and is not subject to property standards.
Equipment purchased with state funds identified in the budget attachments to agreements covered by this
contract, or identified in the sub-agreements with sub-contractors (not included in a cost methodology), is
subject to the conditions of section 273, F.S. and 60A-1.0017, F.A.e. or Title 45 CFR part 74.
2.3.5. The recipient shall not dispose of any equipment or materials provided by the agency, or purchased with
funds provided through this contract without first obtaining the approval of the agency's Contract Manager.
When disposing of property or equipment the recipient must submit a written request for disposition
instructions to the respective Contract Manager. The request should include a brief description of the
property, purchase price, funding source, percentage of state or federal participation, acquisition date and
condition of the property. The request should also indicate the recipient's proposed disposition (i.e.
transfer or donation to another agency that administers federal programs, offer the item for sale, destroy the
items, etc.).
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July 2009 ADI203.09
2.3.6. The agency's Contract Manager will issue disposition instructions. If disposition instructions are not
received within 120 days of the written request for disposition, the recipient is authorized to proceed as
directed in 2 CFR Part 215 Administrative Requirements (formerly OMB Circular A-II 0).
2.3.7. Real property means land (including land improvements), buildings, structures and appurtenances thereto,
but excludes movable machinery and equipment. Real property may not be purchased with state or federal
funds through agreements covered under this contract without the prior approval of the agency. Real
property purchases from Older Americans Act funds are subject to the provisions of Title 42, Chapter 35,
Subchapter III, Part A, Section 3030b United States Code (USe). Real property purchases from state funds
can only be made through a fixed capital outlay grants and aids appropriation and therefore are subject to
the provisions of section 216.348, F .S.
2.3.8. Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and
tested prior to disposal to ensure no confidential information remains.
2.3.9. The recipient must adhere to the agency's procedures and standards when purchasing Information
Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR
worksheet is required for any computer related item costing $1,000 or more, including data processing
hardware, software, services, supplies, maintenance, training, personnel and facilities. The completed ITR
worksheet shall be maintained in the LAN administrator's file and must be provided to the agency upon
request. The recipient has the responsibility to require any subcontractors to comply with the agency's ITR
procedures.
2.4 DELIVERABLES
2.4.1 Service Unit
The recipient shall provide the services described in this contract in accordance with the Department of
Elder Affairs Programs and Services Handbook. The chart below lists the services that can be performed
and the unit of measurement:
Service Unit of Service
Caregiver Training/Support
Case Aid
Case Management
Counseling (Gerontological)
2.5. Counseling (Mental Health/Screening) Hour
Intake
Model Day Care
Respite (Facility Based)
Respite (In-Home)
EducationlTraining
Specialized Medical Equipment, Services Episode
and Supplies
REPORTS
The recipient is responsible for responding in a timely fashion to additional routine and/or special requests
for information and reports required by the agency. The recipient must establish due dates for any
subcontractors that permit the recipient to meet the agency's reporting requirements. Reports and
information that the recipient shall provide to the agency include, but are not limited to:
Client Information and Registration Tracking System (CIRTS)
The recipient is required to use CIRTS reports in the web-based CIRTS database system to ensure CIRTS
data accuracy. The report categories include:
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July 2009 ADI203.09
(1) Client Reports
(2) Monitoring Reports
(3) Services Reports
(4) Miscellaneous Reports
(5) Fiscal Reports
(6) Aging Resource Center Reports
(7) Outcome Measurement Reports
Service Cost Reports
The recipient shall require its subcontractors to submit to it the recipient semi-annual service cost reports,
which reflect actual cost of providing each service by program. This report provides information for
planning and negotiating unit rates.
Surplus/deficit Report
The recipient will submit a consolidated surplus/deficit report in a format provided by the agency to the
agency's Contract Manager by the 18th of each month. This report is for all agreements and/or contracts
between the recipient and the agency. The report will include the following:
(1) A list of all subcontractors and their current status regarding surplus or deficit
(2) The recipient's detailed plan on how the surplus or deficit spending exceeding the threshold specified
by the agency will be resolved.
(3) Recommendations to transfer funds to resolve the surplus/deficit spending
(4) Input from the recipient's Board of Directors on resolution of spending issues, if applicable
(5) Number of clients currently on Assessed Priority Consumer List (APCL) that receive a priority ranking
score of 4 or 5; and
(6) Number of clients currently on the APCL designated as Imminent Risk
2.6. RECORDS AND DOCUMENTATION
2.6.1 The recipient shall ensure the collection and maintenance of client and service information on a monthly
basis from the Client Information and Registration Tracking System (CIRTS) or any such system
designated by the agency. Maintenance includes valid exports and backups of all data and systems
according to agency standards.
2.6.2. Each recipient and subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover
from losses or outages of the computer system. Data and software essential to the continued operation of
recipient functions must be backed up. The security controls over the backup resources shall be as
stringent as the protection required of the primary resources. It is recommended that a copy of the backed
up data be stored in a secure, offsite location. The recipient shall maintain written policies and procedures
for computer system backup and recovery and shall have the same requirement in its contracts and/or
agreements with subcontractors. These policies and procedures hall be made available to the agency upon
request.
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outcomes
(1) The recipient shall timely submit to the agency all reports described in A TT ACHMENT 1, SECTION
2.5 REPORTS;
(2) The recipient shall timely submit to the agency all information described in ATTACHMENT 1,
SECTION 2.6, RECORDS AND DOCUMENTATION;
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July 2009 ADI 203.09
(3) The recipient shall ensure provision of services in this contract in accordance with the current
Department of Elder Affairs Programs and Services Handbook, A TT ACHMENT A.
2.7.2. The performance of the recipient in ensuring the provision of services described in this contract shall be
measured by the 2009 area plan strategies for the following criteria:
(I) Percent of most frail elders who remain at home or in the community instead of going into a nursing
home
(2) Average monthly savings per consumer for home and community-based care versus nursing home care
for comparable client group
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score
(4) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved
(7) Percent of family and family-assisted caregivers who self-report they are very likely to provide care
(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor)
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community based services.
2.7.3. Monitoring and Evaluation Methodology
The agency will review and evaluate the performance of the recipient under the terms of this contract.
Monitoring shall be conducted through direct contract with the recipient through telephone, in writing, or
an on-site visit. The agency's determination of acceptable performance shall be conclusive. The recipient
agrees to cooperate with the agency in monitoring the progress of completion of the service tasks and
deliverables.
2.8 RECIPIENT'S FINANCIAL OBLIGATIONS
2.8.1 Cost Sharing and Co-payments
The agency will ensure the recipient establishes annual co-payments goals. The agency has the option to
withhold a portion of the recipient's Request for Payment if goals are not met according to the agency's
and department's co-payment guidelines.
Co-payments include only the amounts assessed consumers or the amounts consumers opt to contribute in
lieu of an assessed co-payment. The contribution must be equal to or great than the assessed co-payment.
2.8.2. Use of Service Dollars and Assessed Priority Consumers List Management
The recipient is expected to spend all federal, state and other funds provided by the agency for the purpose
specified in the contract. The recipient must manage service funds in such a manner so as to avoid having a
wait list and a surplus of funds at the end of the contract period for each program managed by the recipient.
If the agency determines that the recipient is not spending service funds accordingly, the agency may
transfer funds to other planning and service areas during the contract period and/or adjust subsequent
funding allocations accordingly as allowable under state and federal law.
2.9 AGENCY RESPONSIBILITIES
2.9.1. Program Guidance and Technical Assistance
The agency shall provide to the recipient guidance and technical assistance as needed.
20
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16 D9
July 2009 ADI203.09
2.9.2. Contract Monitoring
The agency shall, at its own discretion, conduct monitoring concerning any aspect of the recipient's
performance of this contract.
SECTION III: METHOD OF PAYMENT
3.1. General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for administration costs,
and fixed rate for services. The recipient shall ensure fixed rates for services include only those costs that
are in accordance with all applicable state and federal statutes and regulations and are based on audited
historical costs in instances where an independent audit is required. The recipient shall consolidate all
requests for payment from subcontractors and expenditure reports that support requests for payment and
shall submit to the agency on forms 1062 (ATTACHMENT XI) and 105 (ATTACHMENT XII)
3.1.1. The recipient agrees to implement the distribution of funds as detailed in ATTACHMENT VIII, Budget
Summary and in ATTACHMENT IX, Rate Summary. An amendment is required to change the total
amount of the contract.
3.2 Advance Payments
3.2.1 The recipient may request up to two months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the agency by the State of Florida ("budget release"). The recipient shall
provide the agency's Contract Manager with documentation justifying the need for an advance and
describing how the funds will be distributed.
3.2.2. The recipient's requests for advance require the approval of the agency's Contract Manager. If sufficient
budget is available, the agency will issue approved advance payments after July 1,2009.
3.2.3. Requests for the third through the twelfth months shall be based on the submission of actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance
requests, of available, is shown on A TT ACHMENT VII to this contract.
3.2.4 All advance payments made to the recipient shall be recouped in accordance with the Invoice Schedule,
ATTACHMENT VII, to this contract.
3.2.5. The recipient may temporarily place advanced funds in an insured interest bearing account. All interest
earned on contract fund advances must be returned to the agency within thirty (30) days of the end of each
quarter of the contract period.
3.3 Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment shall be on
DOEA forms 1062 (ATTACHMENT XI) and 105 (ATTACHMENT XII). Duplication or replication of
both forms via data processing equipment is permissible, provided that all data elements are in the same
format as included on Department of Elder Affairs' forms.
3.3.1. All payment requests shall be based on the submission of actual monthly expenditure reports beginning
with the first month of the contract. The schedule for submission of advance requests (when available) and
invoices is A TT ACHMENT VII to this contract.
3.3.2 Any payment due by the agency under the terms of this contract may be withheld pending the receipt and
approval by the agency of all financial and programmatic reports due from the recipient and any
adjustments thereto, including any disallowance not resolved as outlined in section 22 of this contract.
3.3.3. Payment may be authorized only for allowable expenditures, which are in accord with the limits specified
in ATTACHMENT VIII.
21
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16 D9 4
July 2009 ADI203.09
3.3.4. Date for Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services
provided through June 30, 2010, must be submitted to the agency's Contract Manager by July 10,2010.
3.3.5. Date for Final Request for Payment
The final request for payment will be due to the agency no later than July 25, 2010.
3.4. Documentation for Payment
The recipient shall maintain documentation to support payment requests that shall be available to the
agency or authorized individuals upon request. Such documentation shall be provided upon request to the
agency or the Department of Financial Services.
3.4.1 The agency will require recipients to enter all required data per the Department of Elder Affair' CIR TS
Policy Guidelines for clients and services in the CIRTS database. The data must be entered into the CIRTS
before the recipients submit their requests for payment and expenditure reports to the agency. The recipient
shall establish time frames to assure compliance with due dates for the requests for payment and
expenditure reports to the agency.
3.4.2. The agency will require recipients to run monthly CIR TS reports and verify client and service data in the
CIRTS is accurate. This report must be submitted to the agency with the monthly request for payment and
expenditure report and must be reviewed by the agency before the recipient's request for payment and
expenditure reports can be approved by the agency.
22
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1,.6 09 ~
July 2009 ADI203.09
A TT ACHMENT II
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any state or federal agency, a
member of congress, an officer or employee of congress, an employee of a member of congress, or an
officer or employee of the state legislature, in connection with the awarding of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section] 352, Title 31, U.S. Code. Any person who fails to file the required certification
~~~~ 7),t to a civil P] of :ot less than $10,000.00 and not more than $100,000.00 for each such
~ "'-~~ July 28, 2009
Signature Date:
Donna Fiala, Chairman ADl203.09
Name of Authorized Individual Application or Agreement Number
Collier County Board of County Commissioners
3301 Tamiami Trail East
Naples, Florida 34112
Name and Address of Organization
~~
Assistant CountY Attorney ".I; .
"
, ';
"
DOEA Form 103 ,,-';
(Revised Nov 2002) -'",TTES r '':: , ,
~~. 8RO~'
'. . ~S'> <; e";.,~
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tt.~f;~s,~ '. ~. tr..... I
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1609 ""~
July 2009 ADI 203.09
DOEA Form 103
A TT ACHMENT III
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Area Agency on Aging of Southwest Florida, Inc. to the provider
may be subject to audits and/or monitoring by the Area Agency on Aging of Southwest Florida, Inc., as described
in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97,
F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the
Agency staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By
entering into this agreement, the provider agrees to comply and cooperate with any monitoring
procedures/processes deemed appropriate by the Area Agency on Aging of Southwest Florida, Inc. In the event the
Area Agency on Aging of Southwest Florida, Inc. determines that a limited scope audit of the provider is
appropriate, the provider agrees to comply with any additional instructions provided by the Area Agency on Aging
of Southwest Florida, Inc. to the provider regarding such audit. The provider further agrees to comply and
cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Director of Finance of
the Area Agency on Aging of Southwest Florida, Inc.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB
Circular AI33, as revised.
In the event that the provider expends $500,000.00 or more in Federal awards during its fiscal year, the provider
must have a single or program-specific audit conducted in accordance with the provisions ofOMB Circular A-133,
as revised. EXHffiIT 1 to this agreement indicates Federal resources awarded through the Department of Elder
Affairs by this agreement. In determining the Federal awards expended in its fiscal year, the provider shall
consider all sources of Federal awards, including Federal resources received from the Department of Elder Affairs.
The determination of amounts of Federal awards expended should be in accordance with the guidelines established
by OMB Circular A-133, as revised. An audit of the provider conducted by the Auditor General in accordance with
the provisions ofOMB Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised.
If the provider expends less than $500,000.00 in Federal awards in its fiscal year, an audit conducted in accordance
with the provisions of OMB Circular A-133, as revised, is not required. In the event that the provider expends less
than $500,000.00 in Federal awards in its fiscal year and elects to have an audit conducted in accordance with the
provisions of OMB Circular A 133, as revised, the cost of the audit must be paid from non-Federal resources (i.e.,
the cost of such audit must be paid from provider resources obtained from other than Federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal
year. Compliance findings related to agreements with the Area Agency on Aging of Southwest Florida, Inc. shall be
based on the agreement's requirements, including any rules, regulations, or statutes referenced in the agreement.
The financial statements shall disclose whether or not the matching requirement was met for each applicable
agreement. All questioned costs and liabilities due to the Area Agency on Aging of Southwest Florida, Inc. shall be
fully disclosed in the audit report with reference to the Area Agency on Aging of Southwest Florida, Inc. agreement
involved. If not otherwise disclosed as required by Section .31 O(b )(2) of OMB Circular A-133, as revised, the
schedule of expenditures of Federal awards shall identify expenditures by agreement number for each agreement
24
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16 09 ~
July 2009 ADI203.09
with the Department of Elder Affairs in effect during the audit period. Financial reporting packages required under
this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of
the provider's fiscal year end.
PART II: STATE FUNDED
This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes.
In the event that the provider expends a total amount of state financial assistance equal to or in excess of
$500,000.00 in any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the
provider must have a State single or project-specific audit for such fiscal year in accordance with Section 215.97,
Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT I to this
agreement indicates state financial assistance awarded through the Department of Elder Affairs by this agreement.
In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of
state financial assistance, including state financial assistance received from the Department of Elder Affairs, other
state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through
awards and resources received by a nonstate entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1, the provider shall ensure that the audit
complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial
reporting package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.
If the provider expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending
September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, Florida
Statutes, is not required. In the event that the provider expends less than $500,000.00 in state financial assistance in
its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, Florida
Statutes, the cost of the audit must be paid from the nonstate entity's resources (Le., the cost of such an audit must
be paid from the provider resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal
year. Compliance findings related to agreements with the Area Agency on Aging of Southwest Florida, Inc. shall be
based on the agreement's requirements, including any applicable rules, regulations, or statutes. The financial
statements shall disclose whether or not the matching requirement was met for each applicable agreement. All
questioned costs and liabilities due to the Area Agency on Aging of Southwest Florida, Inc. shall be fully disclosed
in the audit report with reference to the Area Agency on Aging of Southwest Florida, Inc. agreement involved. If
not otherwise disclosed as required by Rule 691-5.003, Fla. Admin. Code, the schedule of expenditures of state
financial assistance shall identify expenditures by agreement number for each agreement with the Area Agency on
Aging of Southwest Florida, Inc. in effect during the audit period. Financial reporting packages required under this
part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the
provider's fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be
submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider's fiscal year
end. Notwithstanding the applicability of this portion, the Area Agency on Aging of Southwest Florida, Inc. retains
all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this
document and pursuant to law.
P ART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-l33, as revised, and
required by PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-l33,
as revised, by or on behalf of the provider directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. at each of the following addresses:
25
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1609 lIIII
July 2009 ADI203.09
Leigh Wade-Schield, Executive Director
Area Agency on Aging for Southwest Florida, Inc.
2285 First Street
Fort Myers, Florida 33901
The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by
Sections .320 (d)(l) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit
Clearinghouse), at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jefferson, IN 47132
Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMB Circular A-
133, as revised.
Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a copy of the reporting
package described in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the
auditor, to The Area Agency on Aging of Southwest Florida, Inc. at each of the following addresses:
Leigh Wade-Schield, Executive Director
Area Agency on Aging for Southwest Florida, Inc.
2285 First Street
Fort Myers, Florida 33901
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or
on behalf of the provider directly to each of the following:
The Area Agency on Aging of Southwest Florida, Inc. at each of the following addresses:
Leigh Wade-Schield, Executive Director
Area Agency on Aging for Southwest Florida, Inc.
2285 First Street
Fort Myers, Florida 33901
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Area Agency on Aging for
Southwest Florida, Inc. pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-
133, Florida Statutes, and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations), Rules of the Auditor General, as applicable.
Providers, when submitting financial reporting packages to the Area Agency on Aging for Southwest Florida, Inc.
for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting
package was delivered to the provider in correspondence accompanying the reporting package.
26
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16 D9 ,?
July 2009 ADI203.09
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a
period of six years from the date the audit report is issued, and shall allow the Area Agency on Aging for Southwest
Florida, Inc. or its designee, the Director of Finance access to such records upon request. The provider shall ensure
that audit working papers are made available to the Area Agency on Aging for Southwest Florida, Inc. or its
designee, Director of Finance upon request for a period of six years from the date the audit report is issued, unless
extended in writing by the Area Agency on Aging for Southwest Florida, Inc.
27
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1609
July 2009 ADI203.09
A TT ACHMENT III
EXHffiIT 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO TillS AGREEMENT
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 CFDA AMOUNT
Alzheimer's Disease Initiative
Respite Services General RevenuelTSTF 65004 $95,490.00
TOTAL AWARD $95,490.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS AGREEMENT ARE AS FOLLOWS:
28
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16 09
July 2009 ADI203.09
ATTACHMENT III EXHmIT -2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources mayor may not be subject to the audit requirements ofOMB Circular A-133,
as revised, and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients offederal awards
and/or state financial assistance may be subject to the audit requirements ifthe audit threshold requirements set forth in Part I
and/or Part II of Exhibit 1 are met. Providers who have been determined to be vendors are not subject to the audit requirements
ofOMB Circular A-B3, as revised, and/or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met,
providers who have been determined to be recipients or subrecipients of Federal awards and/or state financial assistance, must
comply with applicable programmatic and fiscal compliance requirements.
In accordance with Sec. 210 ofOMB Circular A-133 and/or Rule 69]-5.066, FAC, provider has been determined to be:
_Vendor or exempt entity and not subject to OMB Circular A-B3 and/or Section 2]5.97, F.S.
_X_Recipient/subrecipient subject to OMB Circular A-B3 and/or Section 25.97, F.S.
NOTE: If a provider is determined to a recipient/subrecipient of federal and or state financial assistance and has been approved
by the Agency to subcontract, they must comply with Section 2]5.97(7), F.S., and Rule 691-.006(2), F AC [state financial
assistance] and Section _0400 OMB Circular A-B3 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive
Federal awards or state matching funds on Federal awards and who are determined to be a subrecipient, must comply with the
following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A-
87)'"
OMB Circular A-I 02 - Administrative requirements
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations (Formerly OMB Circular A-22-Cost
Principles)'"
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-II 0 - Adminisrative
Requirements)
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL
GOVERNMENT) MUST FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A-21-Cost Principles)'"
2 CFR 215Administrative Requirements (Formerly OMB Circular A-II0-Administrative Requirements)
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
"'Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB
Circular A-133 Compliance Supplement, Appendix I.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215-97, Fla. Stat.
Chapter 619-5, Fla, Admin. Code
State Projects Compliance Supplement
Reference Guide for State expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
29
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16 09
July 2009 ADI203.09
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LAND AND
COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the recipient named in the contract or agreement to which this
form is an attachment, hereby certifies that:
(1) The recipient and any sub-contractors of services under this contract have financial management systems
capable of providing certain information, including: (1) accurate, current, and complete disclosure of the
financial results of each grant-funded project or program in accordance with the prescribed reporting
requirements; (2) the source and application of funds for all agreement supported activities; and 93) the
comparison of outlays with budgeted amounts for each award. The inability to process information in
accordance with these requirements could result in a return of grand funds that have not been accounted for
properly.
(2) Management Information Systems used by the recipient, sub-contractor(s) or any outside entity on which
the recipient is dependent for data that is to be reported, transmitted or calculated, have been assessed and
verified to be capable of processing data accurately, including year-date dependent data. For those systems
identified to be non-compliant, recipient(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip
technology, the undersigned warrants that these products are capable of processing year-date dependent
data accurately. All versions of these products offered by the recipient (represented by the undersigned)
and purchased by the State will be verified for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines
that impede the hardware or software programs from operating properly, the recipient agrees to
immediately make required corrections to restore hardware and software programs to the same level of
functionality as warranted herein, at no charge to the State, and without interruption to the ongoing
business of the state, time being of the essence.
(4) The recipient and any sub-contractor(s) of services under this contract warrant their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency including
emergencies arising from data integrity compliance issues.
The recipient shall require that the language of this certification be included in all subagreements,
subgrants, and other agreements and that all sub-contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was p~aced when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by OMB Circulars A-I02 and 2 CFR Part 215 (formerly OMB Circular A-llO).
July 28. 2009
Signature Date:
.~ ~--:"~S7~
Donna Fiala. Chairman ADI 203.09 .)\J\j~GH' E KROCK CJ""
Name of Authorized Individual Application or Agreement NumB'er ' . IC),:~
Collier County Board of County Commissioners -'_..._---~----~ .. -- .--.-
3301 Tamiami Trail East
Naples. Florida 34112
Name and Address of Organization
DOEA Fonn 103 (Revised Nov 2002)
30
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16 n9
July 2009 ADI203.09
ATTACHMENT V
CERTIFICATION REGARDING DEPARTMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective contractor certifies, by signing this certification, neither it nor its principals are presently
debated, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation
in this transaction by any federal department or agency.
(2) Where the pr pective contractor is unable to certify to any of the statements in this certification, such
prospectiv icipant shall attaj.h. an_explanation to this certification.
~.d July 28. 2009
Signature Date
Donna Fiala. Chairman Collier County Board of County Commissioners
~C~ Agency/Organization ~:. -..~::: I
A sistant Co Attorney "',.- "'r'~
~ ,C::~::, c. (::> _
(Certification signature should be same as Contract sJWJ ~o.B~Clft~"i; - k
Instructions for Certification MU,t:t~to ~t: .
, " ,
1. The terms (covered transaction," "debarred," "suspended," "ineligible," "lower'tlr~o\gd'.hfa~tion,"
"Person," "Primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set
out in the sections of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as
supplemented by 2 CFR 376.10-376.995). You may contact the Contract Manager for assistance in
obtaining a copy ofthose regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties
entered into this transaction. If it is later determined that the recipient knowingly rendered an erroneous
certification, in addition to other remedies available to the federal government the Agency may pursue
available remedies, including suspension and/or debarment.
3. The recipient will provide immediate written notice to the Contract Manager if at any time the recipient
learns that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances. The recipient may decide the method and frequency by which it determines the eligibility
of its principals. Each participant to a lower tier covered transaction may, but is not required to, check the
Excluded Parties List System (EPLS).
4. The recipient will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion 'Lower Tier Covered Transaction" in all its lower tier covered transactions and in all
solicitations for lower tier covered transactions.
5. The recipient agrees that it shall not knowingly enter into any lower tier covered transaction with a person
who is debarred, suspended, determined ineligible or voluntarily excluded from participation, unless
otherwise authorized by the federal government.
6. If the recipient knowingly enters into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
remedies available to the federal government, the Agency may pursue available remedies, including
suspension, and/or debarment.
7. The recipient may rely upon a certification of a prospective participant in a lower tier covered transaction,
unless it knows that the certification is erroneous.
31
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16 09 ~
July 2009 ADI 203.09
ATTACHMENT VI
ASSURANCES-NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other s=aspect of this collection
of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork
Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please
contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to
additional assurances. If such is the case, you will be notified.
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and
completion of the project described in this applications.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through
any authorized representative, access to and the right to examine all records, books, papers, or documents related to
the award; and will establish a proper accounting system in accordance with generally accepted accounting standards
or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C., 4728-4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A
ofOPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI
of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national
origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C., 1681-1683 and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.c.
794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.c., 6101-6107) which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment
Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (t) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PoL. 91-616),
as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public
Health service Act of 1912 (42 U.S.C., 290 dd-3 and 290 ee 3), as amended, relating to confidentiality ofalcoho1 and
drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U .S.C., 3601 et seq.) as amended,
relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in
the specific statute(s) under which application for Federal assistance is being made; and G) the requirements of any
other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and 11I of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These
requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.c., 1501-1508 and 7324-7328), which limit
the political activities of employees whose principal employment activities are funded in whole or in part with Federal
32
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16 09
July 2009 ADI203.09
funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 V.S.C., 276a to 276a-7), the Copeland Act
(40 U.S.C. 276c and 18 U.S.C., 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C., 327-333),
regarding labor standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of section 102(a) of the Flood Disaster
Projection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or
more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 1738 (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.c. 1451 et seq.); (t) conformity of Federal actions of State (Clear Air) Implementation Plans under
Section 176(c) or the Clear Air Act of 1955, as amended (42 U.S.c. 7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 US.c. 470), EO 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974 (16 U.S.c. 469a-l et seq).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.c.. 2131 et seq.)
pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities
supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.c.. 4801 et seq.), which prohibits the use of
lead- based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non-Profit
Organizations.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies
governing this program.
TITLE
Chairman
APPLICANT ORGANIZA nON DATE SUBMITTED
Collier County Board of County Commissioners July 28, 2009
Housing and Human Services Department ' \'
~fM-fL ""-E~':' ;'
-\! J ;" _ ,
Assistant County 1\ orney OWI'rE. SI1~{);t' . ~
33
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1609 f:tll
July 2009 ADI203.09
ATTACHMENT VII
ALZHEIMER'S DISEASE INITIATIVE (ADI)
INVOICE SCHEDULE
Report Submit to AAA
Number Based On On This Date
1 July Advance* July I
2 August Advance* July 1
3 July Expenditure August 10
4 August Expenditure September 1 0
5 September Expenditure October 10
6 October Expenditure November 10
7 November Expenditure December 10
8 December Expenditure January 10
9 January Expenditure February 10
10 February Expenditure March 10
11 March Expenditure April 10
12 April Expenditure May 10
13 May Expenditure June 10
14 June Expenditure July 1 0
15 Final Expenditure and Closeout Report July 25
Legend: * Advance based on projected cash need.
Note #1: Report # 1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging prior to
July 1 or until the contract with the department has been executed and a copy sent to DFS, Actual
submission of the vouchers to AAA is dependent on the accuracy of the expenditure report,
Note #2: Report numbers 13 and 14 shall reflect an adjustment of one half of the total advance amount, on
each of the two reports respectively, repaying advances for the first two months of the contract.
The adjustment shall be recorded in Part C, 1 of the report (Attachment XI).
Note #3: Submission of expenditure reports mayor may not generate a payment request. If final
expenditure report reflects funds due back to the department, payment is to accompany the report.
Revised July 2006 - Form I
34
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July 2009 ADI 203 .09
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
Collier County Housing and Human Services
1. Respite $ 95,290.00
2. Case Management $ 200.00
3. Total $ 95,490.00
35
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July 2009 ADI203.09
A TTACHMENT IX
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
RATE SUMMARY
Collier County Services for Seniors
SERVICES UNIT RATE
Case Management $50.51
Case Aide $27.78
In-Facility Respite $10.00
SCSM 100% Reimbursement
36
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16 1J9
July 2009 ADI203.09
ATTACHMENT X
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Print name of person completing report
Signature of person completing report
Date
The purpose of the model day care program must be to provide service delivery to persons suffering from
Alzheimer's disease or a related memory disorder and training for health care and social service personnel in the
care of persons having Alzheimer's disease or related memory disorders. This report documents the required
training for the State Fiscal Year July I st through July 30th.
Number
Number Health Social
Care Services
Professional s Personnel Total People
Actual TraininR Events Trained Trained Trained
Training Title:
Date
Training Summary:
37
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16 09
July 2009 ADI 203.09
ATTACHMENT XI
REQUEST FOR PAYMENT
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
PROVIDER NAME, ADDRESS, PHONE# and FED ID# TYPE OF REPORT: THIS REQUEST PERIOD:
FOR
A. PAYMENT REQUEST:
Regular_ Supplemental_ REPORT# -
B. METHOD OF PAYMENT: CONTRACT#
Advance -
PSA#
CERTIFICATION: I hereby certify that this request or refund conforms with the terms of the above contract.
Prepared By: Date: Approved By: Date
PART A: BUDGET (I) (2) (3) (4) (5) (6) TOTAL
SUMMARY: CM,CA Respite Model Day Memory
Care Disorder
I, Approved Contract Clinic
Amount $ $ $ $ $ $ $
2, Previous Funds Received For
Contract Peri od
3, Contract Balance
4, Previous Funds Requested For
Contract Period
5. Contract Balance
PART B: CONTRACT FUNDS
REQUEST:
I, Anticipated Cash Needs
(1st-2nd Months)
2, Net Expenditures For Month
(DOEA Form 105Z, Part B
Line 13)
3, Extraordinary Cash Needs
(Attach Doc,)
4, Total
PART C: NET FUNDS
REQUESTED:
1, Less Advance Applied
2, Contract Funds Are Hereby
Requested For (Part B Line 4
minus Par t C Line I)
I I
DOEA FORM 1062, Revised May 2006
38
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16 09
July 2009 ADI203.09
ATTACHMENT XII
RECEIPTS AND EXPENDITURES
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
RECIPIENT NAME, ADDRESS, PHONE# and FEID# PROGRAM FUNDING SOURCE: THIS REPORT PERIOD:
FROM TO
Respite_ Model Day Care_
Brain Bank_Registry_ CONTRACT
PERIOD
Memory Disorder CIininc
CONTRACT#
REPORT#
PSA#
CERTIFICA TION: I certify to the best of my knowledge and belief that the report is complete and correct and all outlays herein are for purposes
set forth in the contract.
Prepared By: Date: Approved By: Date:
PART A: BUDGETED INCOME/RECEIPTS I, Approved 2. Actual 3, Total 4. Percent of
Budget Receipts for Receipts Approved Budget
This Report Year to Date
L State Funds.".""""""""""""""."".."".., $ $ $ %
2, Program Income."""."""""""".""."""."" $ $ $ _%
3, Local Cash Match"",,,.,,,,,,,,,,,,,,,,,, ,,,,,.,,,, $ $ $ _%
4, SUBTOTAL: CASH RECEIPTS""""""."" '" $ $ $ %
5, Local In-Kind Match"""".""""""",.""",,, $ $ $ _%
6. TOTAL RECEIPTs"'"..""""""""" """" $ $ $ _0/0
PART B: EXPENDITURES I , Approved 2, Expenditures for 3, Expenditures 4, Percent of
Budget This Report Year to Date Approved
Budget
L Administrative Services"""",,,,,.,,,, " """"" $ $ $ %
2, Service Subcontractor (s)""" ,,,,,,,.,,,,. """." $ $ $ _%
3, Recoupment of Advance $ $ %
4, TOTAL""""""""",,,,,,,,,,.,,,,,,,,,,,, """,,' $ $ $ _%
PART C: OTHER REVENUE AND EXPENDITURES II. Interest:
1, Eamed on GR Advance $
I. Program Income (PI): 2, Rtn, of GR Advance $
1, ADI: PI Collected YTD $ 3, Other Eamed $
(INCLUDES CO-PAYMENTS COLLECTED)
PART D: Co-Payments II. Total-Current Month III. Total - Year To Date
I. Total Amount of Co-payments Assessed $ $
II. Total Amount of Co-payments Collected $ $
(FOR TRACKING PURPOSES ONLY)
DOEA FORM 105Z, Dated April 2006
ATTACHMENT A
39
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16 09 l>'"
July 2009 ADI203.09
Department of Elder Affairs Programs and Services Handbook, provided on CD.
Also, available at the Department's Intranet site under, "Publications,"
40
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16 D9
July 2009 ADI203.09
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA
STANDARD CONTRACT
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida,
hereinafter referred to as the "Agency" and Collier County Board of County Commissioners, hereinafter
referred to as the "Recipient", and collectively referred to as the "Parties." The term recipient for this
purpose may designate a vendor, subgrantee or subrecipient, the status to be further identified in
ATTACHMENT III, Exhibit-2 as necessary.
WITNESSETH THAT:
WHEREAS, the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Recipient has demonstrated that it has the requisite expertise and ability to faithfully
perform such services as an independent contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed and payments to be made,
together with the mutual covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions
specified in this contract including all attachments and exhibits, which constitute the contract
/ document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state planes), grant agreements, relevant
Department of Elder Affairs handbooks, manuals or desk books, as an integral part of the contract,
except to the extent that the contract explicitly provides to the contrary. In the event of conflict in
language among any of the documents referenced above, the specific provisions and requirements
of the contract document(s) shall prevail over inconsistent provisions in the Proposal(s) or other
general materials not specific to this contract document and identified attachments.
3. Term of Contract
This contract shall begin on July L 2009 or on the date on which the contract has been signed by
the last party required to sign it, whichever is later. It shall end at midnight, local time in Fort
Myers, Florida, on June 30, 2010.
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 $95,490.00 or the rate schedule, 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.
5. Renewals
By rnutual agreement of the parties, in accordance with section 287.058(1)(f), F.S., the agency
may renew the contract for a period not to exceed three years, or the term of the original contract
whichever is longer. The renewal price, or method for determining a renewal price, is set forth in
the bid, proposal, or reply.
1
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July 2009 16D9
ADI203.09
6. Compliance with Federal Law
6.1. If this contract contains federal funds the provider shall comply with the provisions of 45 CFR 74
and/or 45 CFR 92, and other applicable regulations.
6.2. If this contract contains federal funds and is over $100,000, the recipient shall comply with all
applicable standards, orders, or regulations issued under section 306 of the Clean Air Act as
amended (42 USC 7401 et seq.), section 508 or the Federal Water Pollution Control Act as
amended (33 USC 1251 et seq.), Executive Order 11738, as amended, and where applicable
Environmental Protection Agency regulations 40 CFR 30. The recipient shall report any
violations of the above to the agency.
6.3. The recipient, or agent acting for the recipient, may not use any federal funds received in
connection with this contract to influence legislation or appropriations pending before the
Congress or any State legislature. If this contract contains federal funding in excess of $100,000,
the recipient must, prior to contract execution, complete the Certification Regarding Lobbying
form, ATTACHMENT II. All disclosure forms as required by the Certification Regarding
Lobbying form must be completed and returned to the Contract Manager, prior to payment under
this contract.
6.4. The recipient shall not employ an unauthorized alien. The agency shall consider the employment
of unauthorized aliens a violation of the Immigration and Nationality Act (8 USC 1324 a) and the
Immigration Reform and Control Act of 1986 (8 USC 1101). Such violation shall be cause for
unilateral cancellation of this contract by the agency.
6.5. That if this contract contains $10,000 or more of federal funds, the recipient shall comply with
Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375
and others, and as supplemented in Department of Labor regulation 41 CFR 60 and 45 CFR 92, if
applicable.
6.6. That if this contract contains federal funds and provides services to children up to age 18, the
recipient shall comply with the Pro-Children Act of 1994 (20 USC 6081).
6.7. That a contract award with an amount expected to equal or exceed 25,000.00 and certain other
contract awards shall not be made to parties listed on the government-wide Excluded Parties List
System, in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders
12549 and 12689, "Debarment and Suspension." The Excluded Parties List System contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive Order 12549. The
recipient will comply with these provisions before doing business or entering into subcontracts
receiving federal funds pursuant to this contract. The recipient shall complete and sign
A TT ACHMENT V prior to the execution of this contract.
7. Compliance with State Law
7.1. That this contract is executed and entered into in the State of Florida, and shall be construed,
performed and enforced in all respects in accordance with the Florida law, including Florida
provisions for conflict of laws.
7.2. Requirements of Section 287.058. F.S.
7.2.1. The recipient will provide units of deliverables, including reports, findings, and drafts, as specified
in this contract, which the Contract Manager must receive and accept in writing prior to payment.
2
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1609
July 2009 ADI203.09
7.2.2. The recipient will submit bills for fees or other compensation for services or expenses in sufficient
detail for a proper pre-audit and post-audit.
7.2.3. If itemized payment for travel expenses is permitted in this contract, the recipient will submit bills
for any travel expenses in accordance with section 112.061.F.S., or at such lower rates as may be
provided in this contract.
7.2.4. The recipient will allow public access to all documents, papers, letters, or other public records as
defined in subsection 119.011(11), F.S., made or received by the recipient in conjunction with this
contract except for those records which are made confidential or exempt by law. The recipient's
refusal to comply with this provision shall constitute an immediate breach of contract for which
the agency may unilaterally terminate the contract.
7.3. If clients are to be transported under any agreements and/or contracts incorporating this contract,
the recipient shall comply with the provisions of Chapter 427.F.S., and rule 41, F.A.C.
7.4. Subcontractors who are on the discriminatory vendor list may not transact business with any
public entity, in accordance with the provisions of section 287.134,F.S.
7.5. The recipient will comply with the provisions of section 1.062,F.D., and section 216.347.F.S.,
which prohibit the expenditure of contract funds for the purpose of lobbying the legislature,
judicial branch or a state agency.
8. Grievance Procedures
The recipient shall develop and implement, and ensure that its subcontractors have established,
grievance procedures to process and resolve client dissatisfaction with or denial of service(s), or
address complaints regarding the termination, suspension or reduction of services, as required for
receipt of funds. These procedures, at a minimum, should provide for notice of the grievance
procedure and an opportunity for review of the subcontractor's determination(s).
9. Audits. Inspections. Investieations. Public Records and Retention
9.1. To establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all income and expenditures of funds provided by the agency under this
contract.
9.2. To retain all client records, financial records, supporting documents, statistical records, and any
other documents (including electronic storage media) pertinent to this contract for a period of six
(6) years after completion of the contract or longer when required by law. In the event an audit is
required by this contract, records shall be retained for a minimum period of six (6) years after the
audit report is issued or until resolution or any audit findings or litigation based on the terms of
this contract, at no additional cost to the agency.
9.3. Upon demand, at no additional cost to the agency, the recipient will facilitate the duplication and
transfer of any records or documents during the required retention period in Paragraph 9.2.
9.4. To assure that these records shall be subject at all reasonable times to inspection, review, copying,
or audit by Federal, State, or other personnel duly authorized by the agency.
9.5. At all reasonable times for as long as records are maintained, persons duly authorized by the
agency and Federal auditors, pursuant to 45 CFR 92.36(i)(1 0), shall be allowed full access to and
the right to examine any of the recipient's contracts and related records and documents, regardless
of the form in which kept.
9.6. To provide a financial and compliance audit to the agency as specified in this contract and in
A TT ACHMENT III and to ensure that all related party transactions are disclosed to the auditor.
3
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16D9 J
July 2009 ADI 203.09
9.7. To comply and cooperate immediately with any inspections, reviews, investigations, or audits
deemed necessary by the office of the Inspector General pursuant to s. 20.055.F.S.
10. Nondiscrimination - Civil Ri2hts Compliance
10.1. The recipient will execute assurances in A TT ACHMENT VI that it will not discriminate against
any person in the provision of services or benefits under this contract or in employment because of
age, race, religion, color, disability, national origin, marital status or sex in compliance with state
and federal law and regulations. The recipient further assures that all contractors, subcontractors,
sub grantees, or others with whom it arranges to provide services or benefits in connection with
any of its programs and activities are not discriminating against clients or employees because of
age, race, religion, color, disability, national origin, marital status or sex.
10.2. The recipient will retain, on file, during the term of this agreement a timely, complete and accurate
Civil Rights Compliance Checklist (A TT ACHMENT B).
10.3. The recipient agrees to establish procedures pursuant to federal law to handle complaints of
discrimination involving services or benefits through this contract. These procedures shall include
notifying clients, employees, and participants of the right to file a complaint with the appropriate
federal or state entity.
10.4. These assurances are a condition of continued receipt of or benefit from federal financial
assistance, and are binding upon the recipient, its successors, transferees, and assignees for the
period during which such assistance is provide. The recipient further assures that all
subcontractors, vendors, or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not
discriminating against those participants or employees in violation of the above statutes,
regulations, guidelines, and standards. In the event of failure to comply, the recipient understands
that the agency may, at its discretion, seek a court order requiring compliance with the terms of
this assurance or seek other appropriate judicial or administrative relief, including but not limited
to, termination of and denial of further assistance.
11. Provisions of Services
The recipient will provide services in the manner described in A TT ACHMENT I.
12. Monitorine bv the Aeencv
The recipient permits persons duly authorized by the agency to inspect and copy any records,
papers, documents, facilities, goods and services of the recipient which are relevant to this
contract, and to interview any clients, employees and subcontractor employees of the recipient to
assure the agency of the satisfactory performance of the terms and conditions of this contract.
Following such review, the agency will deliver to the recipient a written report of its findings and
request for development, by the recipient, of a corrective action plan where appropriate. The
recipient hereby agrees to timely correct all deficiencies identified in the corrective action plan.
13. Indemnification
13.1. Subject to the limits of section 768.28, F.S., the recipient shall indemnify, save, defend, and hold
harmless the agency and its agents and employees from any and all claims, demands, actions,
causes of action of whatever nature or character, arising out of or by reason of the execution of
this agreement or perforrnance of the services provided for herein. It is understood and agreed that
the provider is not require to indemnify the agency for claims, demands, actions or causes of
action arising solely out of the agency's negligence.
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July 2009 ADI203.09
14. Insurance and Bondin2
14.1. To provide continuous adequate liability insurance coverage during the existence of this contract
and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency
or subdivision as defined by subsection 768.28(2), F.S. the recipient accepts full responsibility for
identifying and determining the type(s) and extent of liability insurance necessary to provide
reasonable financial protections for the recipient and the clients to be served under this contract.
The limits of coverage under each policy maintained by the recipient do not limit the recipient's
liability and obligations under this contract. The recipient shall ensure that the agency has the
most current written verification of insurance coverage throughout the term of this contract. Such
coverage may be provided by a self-insurance program established and operating under the laws of
the State of Florida. The agency reserves the right to require additional insurance as specified in
this contract.
14.2. Throughout the term of this agreement, the recipient agrees to maintain an insurance bond from a
responsible commercial insurance company covering all officers, directors, employees and agents
of the recipient authorized to handle funds received or disbursed under all agreements and/or
contracts incorporation this contract by reference in an amount commensurate with the funds
handled, the degree of risk as determined by he insurance company and consistent with good
business practices.
15. Confidentiality of Information
The recipient shall not use or disclose any information concerning a recipient of services under
this contract for any purpose prohibited by state or federal law or regulations except with the
written consent of a person legally authorized to give that consent or when authorized by law.
16. Health Insurance Portability and Accountabilitv Act
Where applicable, to comply with the Health Insurance Portability and Accountability Act (42
USC 1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
17. Incident Reportin2
17.1. The recipient shall notify the agency immediately, but no later than forty-eight (48) hours from,
the recipient's awareness or discovery of conditions that may materially affect the recipient or
subcontractor's ability to perform, such as problems, delays or adverse conditions which may
impair the ability to meet the objectives of this contract.
17.2. To immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a
child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free
telephone number (l-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is
binding upon both the recipient and its employees.
18. Sponsorship and Publicity
18.1. As required by section 286.25 F.S., if the recipient is a non-governmental organization which
sponsors a program financed wholly or in part by state funds, including any funds obtained
through this contract, it shall in publicizing, advertising, or describing the sponsorship of the
program, state: "Sponsored by (recipient's name), The Area Agency on Aging for Southwest
Florida and the State of Florida, Department of Elder Affairs." If the sponsorship reference is in
written material, the words " The Area Agency on Aging for Southwest Florida and the State of
Florida, Department of Elder Affairs" shall appear in at least the same size letters or type as the
name of the organization.
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July 2009 ADI203.09
18.2. The contractor shall not use the words "The Area Agency on Aging for Southwest Florida and the
State of Florida, Department of Elder Affairs" to indicate sponsorship of a program otherwise
financed, unless, specific authorization has been obtained by the agency prior to use.
19. Assie;nments
19.1. The recipient shall not assign the rights and responsibilities under this Contract without the prior
written approval of the agency, which shall not be unreasonably withheld. Any sublicense,
assignment, or transfer otherwise occurring without prior written approval of the agency will
constitute a material breach of the contract.
19.2. The State of Florida shall at all times be entitled to assign or transfer, in whole or part, its rights,
duties, or obligations under this contract to another governmental agency in the State of Florida,
upon giving prior written notice to the recipient. In the event the State of Florida approves transfer
of the recipient's obligations, the recipient remains responsible for all work performed and all
expenses incurred in connection with the contract.
19.3. This contract shall remain binding upon the successors in interest of either the recipient or the
agency.
20. Subcontracts
20.1. The recipient is responsible for all work performed and for commodities produced pursuant to this
contract, whether actually furnished by the recipient or its subcontractors. Any subcontracts shall
be evidenced by a written document and subject to any conditions of approval the agency deems
necessary. The recipient further agrees that the agency shall not be liable to the subcontractor in
any way or for any reason, The recipient, at its expense, will defend the agency against any such
claims.
20.2. The recipient shall promptly pay any subcontractors upon receipt of payment from the agency or
other state agency. Failure to make payments to any subcontractor in accordance with s.
287.0585, F.S., unless otherwise stated in the contract between the recipient and subcontractor,
will result in a penalty as provided by statute.
21. Independent Capacity of Recipient
It is the intent and understanding of the parties that the recipient, or any of its subcontractors, are
independent contractors and are not employees of the agency and shall not hold themselves out as
employees or agents of the agency without specific authorization from the agency. It is further
intent and understanding of the parties that the agency does not control the employment practices
of the recipient and shall not be liable for any wage and hour, employment discrimination, or other
labor and employment claims against the recipient or its subcontractors. All deductions for social
security, withholding taxes, income taxes, contributions to unemployment compensation funds and
all necessary insurance for the recipient shall be the sole responsibility of the recipient.
22. Payment
Payments will be made to the recipient pursuant to s. 215,422, F.S., as services are rendered and
invoiced by the recipient. The agency's Contract Manager will have final approval of the invoice
for payment, and will approve the invoice for payment only if the recipient has met all terms and
conditions of the contract, unless the bid specifications, purchase order, or this contract specify
otherwise. The approved invoice will be submitted to the agency's finance section for budgetary
approval and processing. Disputes arising over invoicing and payments will be resolved in
accordance with the provisions of s, 215.422 F.S. A Vendor Ombudsman has been established
with the Department of Financial Services and may be contacted at (850) 413-5665.
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July 2009 ADI203.09
23. Return of Funds
The recipient will return to the agency any overpayments due to unearned funds or funds
disallowed and any interest attributable to such funds pursuant to the terms and conditions of this
contract that were disbursed to the recipient by the agency. In the event that the recipient or its
independent auditor discovers that an overpayment has been made, the recipient shall repay said
overpayment immediately without prior notification from the agency. In the event that the agency
first discovers an overpayment has been made, the Contract Manager, on behalf of the agency, will
notify the recipient by letter of such findings. Should repayment not be forthwith, the recipient
will be charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03,
F.S., after agency notification or recipient discovery,
24. Data Intee:rity and Safee:uardine: Information
The recipient shall insure an appropriate level of data security for the information the recipient is
collecting or using in the performance of this contract. An appropriate level of security includes
approving and tracking all recipient employees that request system or information access and
ensuring that user access has been removed from all terminated employees. The recipient, among
other requirements, must anticipate and prepare for the loss of information processing capabilities.
All data and software must be routinely backed up to insure recovery from losses or outages of the
computer system. The security over the backed-up data is to be as stringent as the protection
required of the primary systems, The recipient shall insure all subcontractors maintain written
procedures for computer system back up and recovery. The recipient shall complete and sign
ATTACHMENT IV prior to the execution of this contract.
25. Conflict of Interest
The recipient will establish safeguards to prohibit employees, board members, management and
subcontractors from using their positions for a purpose that constitutes or presents the appearance
of personal or organizational conflict of interest or personal gain. No ernployee, officer or agent
of the recipient or subcontractor shall participate in selection, or in the award or administration of
an agreement supported by State or Federal funds if a conflict of interest, real or apparent, would
be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member
of hislher immediately family; (c) his or her partner, or; (d) an organization which employs, or is
about to employ, any of the above has a financial or other interest in the firm selected for award.
The recipient or subcontractor's officers, employees or agents will neither solicit nor accept
gratuities, favors or anything of monetary value from contractors, potential contractors, or parties
to subcontracts. The recipient's board members and management must disclose to the agency any
relationship which may be, or may be perceived to be, a conflict or interest within thirty (30) days
of an individual's original appointment or placement in that position, or if the individual is serving
as an incumbent, within thirty (30) days of the commencement of this contract. The recipient's
employees and subcontractors must make the same disclosures described above to the recipient's
board of directors. Compliance with this provision will be monitored.
26. Public Entity Crime
Pursuant to s. 287,133, F.S., the following restrictions are placed on the ability of persons
convicted of public entity crimes to transact business with the agency. A person or affiliate who
has been placed on the convicted vendor list following a conviction for a public entity crime may
not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair
of a public building or public work; may not submit bids, proposals, or replies on leases of real
property to a public entity; may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity; and may not transact business
with any public entity in excess of the threshold amount provided in s. 287,017, F.S., for
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July 2009 14DQ2209
CA TEGOR Y TWO for a period of 36 months following the date of being placed on the convicted
vendor list.
27. Purchasinl!
27.1. To purchase articles which are the subject of or are required to carry out this contract from Prison
Rehabilitative Industries and Diversified Enterprises, Inc" (PRIDE) identified under Chapter 946,
F.S., in the same manner and under the procedures set forth in subsections 946.515(2) and (4), F.S.
For purposes of this contract, the recipient shall be deemed to be substituted for the agency insofar
as dealings with PRIDE. This clause is not applicable to subcontractors unless otherwise required
by law. An abbreviated list of products/services available from PRIDE may be obtained by
contacting PRIDE (800) 643-8459.
27.2. To procure any recycled products or materials, which are the subject of or are required to carry out
this contract, in accordance with the provisions of sections 403.7065 and 287.045, F.S.
28. Patents. Copvril!hts. Rovalties
If any discovery, invention or copyrightable material is developed or produced in the course of or
as a result of work or services performed under this contract, the recipient shall refer the
discovery, invention or material to the agency to be referred to the Department of State. Any and
all patent rights or copyrights accruing under this contract are hereby reserved to the State of
Florida in accordance with Chapter 286, F.S.
29. Emerl!encv Preparedness and Continuity of Operations
29.1. If the tasks to be performed pursuant to this contract, include the physical care and control of
clients, or the administration and coordination of services necessary for client health, safety or
welfare, the recipient shall within 30 days of the execution of this contract, submit to the Contract
Manager verification of an emergency preparedness plan. In the event of an emergency, the
recipient shall notify the agency of emergency provisions.
29.2. In the event, a situation results in a cessation of services by a subcontractor, the recipient will
retain responsibility for performance under this contract and must follow procedures to ensure
continuity of operations without interruption.
30. PUR 1000 Form
The PUR 1000 Form is hereby incorporated by reference. In the event of any conflict between the
PUR 1000 Form and any terms or conditions of this contract the terms or conditions of this
contract shall take precedence over the PUR 1 000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or
conditions contained in the PUR 1000 Form shall take precedence.
31. Use of State Funds to Purchase or Improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon
the recipient or political subdivision granting to the state a security interest in the property at least
to the amount of state funds provided for at least 5 years from the date of purchase or the
completion of the improvements or as further required by law.
32. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager,
who shall reduce the decision to writing and serve a copy on the recipient.
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July 2009 ADI 203.09
33. No Waiver of Sovereie:n Immunitv
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by
any entity to which sovereign immunity may be applicable.
34. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Lee County,
Florida.
35. Entire Contract
This contract contains all the terms and conditions agreed upon by the parties. No oral agreements
or representations shall be valid or binding upon the agency or the recipient unless expressly
contained herein or by a written amendment to this contract.
36. Force Maieure
Neither party shall be liable for any delays or failures in performance due to circumstances beyond
its control, provided the party experiencing the force majeure condition provides immediate
written notification to the other party and takes all reasonable efforts to cure the condition.
37. Severability Clause
The parties agree that if a court of competent jurisdiction deems any term or condition herein void
or unenforceable, the other provisions are severable to that void provision and shall remain in full
force and effect.
38. Condition Precedent to Contract: Appropriations
The parties agree that the agency's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Legislature. In the event such an appropriation is
not made, the recipient shall not be entitled to file a claims bill.
39. AdditionlDeletion
The parties agree that the agency reserves the right to add or to delete any of the services required
under this contract when deemed to be in the State's best interest. The parties shall negotiate
compensation for any additional services added.
40. Waiver
The delay or failure by the agency to exercise or enforce any of its rights under this contract shall
not constitute or be deemed a waiver of the agency's right thereafter to enforce those rights, nor
shall any single or partial exercise of any such right preclude any other or further exercise thereof
or the exercise of any other right.
41. Compliance
The recipient agrees to abide by all applicable current federal statutes, laws, rules and regulations
as well as applicable current State statutes, laws, rules and regulations. The parties agree that
failure of the recipient to abide by these laws shall be deemed an event of default of the recipient,
and subject the contract to immediate, unilateral cancellation of the contract at the discretion of the
agency.
42. Final Invoice
The recipient shall submit the final invoice for payment to the agency as specified in Section 3.3.5
(date for final request for payment) of ATTACHMENT I. If the recipient fails to submit final
request for payment by the deadline, then all rights to payment may be forfeited and the agency
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July 2009 16 QD9zo3.09
may not honor any requests submitted after the aforesaid time period. Any payment due under the
terms of this contract may be withheld until all reports due from the recipient and necessary
adjustments thereto have been approved by the agency.
43. Renee:otiations or Modifications
Modifications ofthe provisions of this contract shall be valid only when they have been reduced to
writing and duly signed by both parties. The rate of payment and the total dollar amount may be
adjusted retroactively to reflect price level increases and changes in the rate of payment when
these have been established through the appropriations process and subsequently identified in the
agency's operating budget.
44. Termination
44.1. This contract may be terminated by either party without cause upon no less than thirty (30)
calendar days notice in writing to the other party unless a sooner time is mutually agreed upon in
writing. Said notice shall be delivered y U.S. Postal Service or any expedited delivery service that
provides verification of delivery or by hand delivery to the Contract Manager or the representative
of the recipient responsible for administration of the contract.
44.2. In the event funds for payment pursuant to this contract become unavailable, the agency may
terminate this contract upon no less than twenty-four (24) hours notice in writing to the provider.
Said notice shall be delivered by U.S. Postal Service or any expedited delivery service that
provides verification of delivery or by hand delivery to the Contract Manager or the representative
of the recipient responsible for administration of the contract. The agency shall be the final
authority as to the availability and adequacy of funds. In the event of termination of this contract
the provider will be compensated for any work satisfactorily completed.
44.3. This contract may be terminated for cause upon no less than twenty-four (24) hours notice in
writing to the recipient. If applicable, the agency may employ the default provisions in Rule 60A-
1.006(3), F.A.C. Waiver of breach of any provisions of this contract shall not be deemed to be a
waiver of any other breach and shall not be construed to be a modification of the terms and
conditions of this contract. The provisions herein do not limit the agency's right to remedies at
law or in equity.
44.4. Failure to have performed any contractual obligations with the agency in a manner satisfactory to
the agency will be a sufficient cause for termination. To be terminated as a recipient under this
provision, the recipient must have (I) previously failed to satisfactorily perform in a contract with
the agency, been notified by the agency of the unsatisfactory performance and failed to correct the
unsatisfactory performance to the satisfaction of the agency; or (2) had a contract terminated by
the agency for cause.
45. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
The recipient name, as shown on page 1 of this contract, Collier County Housing and Human Services
a. and mailing address of the official payee to whom the 3301 East Tamiami Trail, Building H
payment shall be made is: Naples FL 34112
Marcy Krumbine, Director
The name of the contact person and street address where Collier County Housing and Human Services
b. financial and administrative records are maintained is: 3301 East Tamiami Trail, Building H
Naples FL 34112
(239) 252-2273
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July 2009 ADI203.09
Marcy Krumbine, Director
The name, address, and telephone number of the Collier County Housing and Human Services
c. representative of the recipient responsible for 3301 East Tamiami Trail, Building H
administration of the program under this contract is: Naples FL 34112
(239) 252-2273
The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc.
d. Requests for Payment and Receipt and Expenditure forms 2285 First Street
are to be mailed is: Fort Myers, Florida 33901
Leigh Wade-Schield, Executive Director
e. The name, address, and telephone number of the Contract Area Agency on Aging for Southwest Florida, Inc.
Manager for the Agency for this contract is: 2285 First Street
Fort Myers, Florida 33901
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided
in writing to the other party and the notification attached to the originals of this contract.
46. All Terms and Conditions Included
This contract and its Attachments, I - XII, A and B, and any exhibits referenced in said attachments,
together with any documents incorporated by reference, contain all the terms and conditions agreed upon
by the parties. There are no provisions, terms, conditions, or obligations other than those contained
herein, and this contract shall supersede all previous communications, representations or agreements,
either written or verbal between the parties.
By signing this contract, the parties agree that they have read and agree to the entire contract.
IN WITNESSING THEREOF, the parties hereto have caused this 40 page contract, to be executed by
their undersigned officials as duly authorized.
RECEPIENT:
. '~" "
". ":'.,~ COLLIER COUNTY HOUSING
Clerk AND HUMAN SERVICES
~k
By:
,
NTY COM~NERS
TY, FLORIDA_
Approved as to form and By: 'h~/ ~:-l-~
legal sufficiency: DONNA FIALA, CHAIRMAN
~~ DA TE: July 28, 2009
Assistant County Attorney
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
,.' ,..,,:;>/"" ./ ,
SIGNE~_~: .' \~~~Lt:C3c/:
NAMEi- aoml Ma nm .
TITLE: Board President
DATE:
FEDERAL ID NUMBER 59-6000558
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July 2009 ADI203.09
INDEX TO CONTRACT ATTACHMENTS
ATTACHMENT A TT ACHMENT DESCRIPTION PAGE
A TT ACHMENT I STATEMENT OF WORK 13-22
A TT ACHMENT II CERTIFICA TION REGARDING LOBBYING 23
A TT ACHMENT III FINANCIAL COMPLIANCE AUDIT A TT ACHMENT 24-29
ATTACHMENT IV CERTIFICA TION REGARDING DATA INTEGRITY COMPLIANCE 30
A TT ACHMENT V CERTIFICATION REGARDING DEBARMENT, SUSPENSION 31
INELIGIBILITY, AND VOLUNTARY EXCLUSION
A TT ACHMENT VI ASSURANCES - NON-CONSTRUCTION PROGRAMS 32-33
A TT ACHMENT VII ALZHEIMER'S DISEASE INITIATIVE (ADI) INVOICE SCHEDULE 34
A TT ACHMENT VIII ALZHEIMER'S DISEASE INITIATIVE PROGRAM BUDGET 35
SCHEDULE
A TT ACHMENT IX ALZHEIMER'S DISEASE INITIATIVE PROGRAM RATE SCHEDULE 36
A TT ACHMENT X ANNUAL MODEL DAY CARE CENTER TRAINING REPORT 37
A TT ACHMENT XI REQUEST FOR PAYMENT 38
A TT ACHMENT XII RECEIPTS AND EXPENDITURES 39
ATTACHMENT A DEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES 40
HANDBOOK (ON CD)
A TT ACHMENT B DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE 41-44
CHECKLIST AND INSTRUCTIONS
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July 2009 ADI203.09
STATEMENT OF WORK
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF CONTRACT TERMS AND ACRONYMS
1.1.1. DEFINITIONS OF ACRONYMS
Adult Protective Services (APS)
Alzheimer's Disease Initiative (ADI)
Alzheimer's Disease (AD)
Assessed Priority Consumer List (APCL)
Client Information and Registration Tracking System (CIRTS)
Community Care for the Disabled Adults (CCDA)
Home Care for Disabled Adults (HCDA)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
Web-based Database System (WebDB)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the
Department of Children and Families Services Community Care for Disabled Adults or Home
Care for Disabled Adults services, to the Department Of Elder Affairs' community-based services.
Area Plan: A plan developed by the recipient outlining a comprehensive and coordinated service
delivery system, in the respective planning and service area, in accordance with the Section 306 of
the Older Americans Act (42 D.S.C. 3026), and agency instructions.
Area Plan Update: A revision to the area plan wherein the recipient enters ADI specific data in
the web-based database system (WebDB). An update may also include other revisions to the area
plan as instructed by the agency.
Functional Assessment: A comprehensive systematic and multidimensional review of a person's
ability to remain independent and in the least restrictive living arrangement. DOEA Form 701B is
used by case managers to conduct the functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1)
and (2), F.S., to provide diagnostic and referral services, conduct basic and service-related
multidisciplinary research, and develop training materials and educational opportunities for lay
and professional caregivers of individuals with Alzheimer's disease.
Model Day Care: A program of therapeutic, social and health activities specific to clients with
memory disorders. Services and activities include but are not limited to, active and quiet games,
reminiscence, validation therapy, pet therapy, water therapy and other failure free activities
appropriate to the client's level of functioning. Model day care centers shall also provide training
for health care and social service personnel in the care of persons having Alzheimer's disease or
related memory disorders.
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July 2009 ADI203,09
1.2. AGENCY MISSION STATEMENT
Mission: To help aging adults, 60 and older, achieve greater independence through awareness of resources
and access to qualified service providers.
Vision: To be the recognized leader in supporting older adults and their families with access to trustworthy
resources and services in their communities while empowering them to live with independence and dignity.
Values: The Agency believes the residents of Southwest Florida are entitled to:
. Comprehensive information about their choices of care;
. Timely access to resources and services;
. High standards of quality and performance;
. Personal and professional accountability from all stakeholders.
Lead agencies and local service providers as partners and stakeholders in Florida's aging services
network are expected to support the agency's mission, vision, and priorities.
1.2.1. Alzheimer's Disease Initiative Program Mission Statement
The Alzheimer's Disease Initiative program ensures that persons afflicted with Alzheimer's
disease and other forms of dementia, are given essential services to help them age in place, in an
elder-friendly environment, with security, dignity, and purpose. The program also provides
support to family members and caregivers of persons afflicted with Alzheimer's disease.
1.3. GENERAL DESCRIPTION
1.3.1. General Statement
ADI provides a continuum of services that address the special needs of individuals with
Alzheimer's disease (AD), their families and caregivers.
1.3.2. Authority
The relevant authority governing the Alzheimer's Disease Initiative Program are:
(1) Rule Chapter 58D-l, Florida Administrative Code
(2) Sections 430.501 through 430.504, Florida Statutes
1.3.3. Scope of Service
The Area Agency on Aging is responsible for the programmatic, fiscal and operational management of the
ADI program. The recipient shall provide services in a manner consistent with and described in the
agency's current area plan update and the current Department of Elder Affairs Programs and Services
Handbook, ATTACHMENT A.
1.3.4. Major Program Goal
The major goal of the Alzheimer's Disease Initiative program is to provide services to meet the
needs of caregivers and individuals with Alzheimer's Disease and related memory disorders.
1.4. INDIVIDUALS TO BE SERVED
1.4.1. General Eligibility
The ADI Program addresses the special needs of individuals with Alzheimer's disease (AD) and
their caregivers.
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July 2009 ADI203.09
1.4.2. Individual Eligibility
(1) Be 18 years of age or older and have a diagnosis of Alzheimer's disease or a related disorder,
or be suspected of having Alzheimer's disease or a related disorder.
(2) Not be enrolled in a Medicaid capitated long-term program.
1.4.3. Targeted Groups
Priority for services under this contract shall be given to those eligible persons assessed to be at
risk of placement in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the ADI program, the agency shall ensure the following tasks are
performed:
(1) Client Eligibility Determination as listed in ATTACHMENT I, SECTION 1.4.2.;
(2) Assessment and Prioritization of Service Delivery for New Clients; and
(3) Delivery of Services to Eligible Clients;
2.1.1 Assessment and Prioritization of Service Delivery for New Clients
It is not the intent of the agency to remove existing clients from any services in order to serve new
clients being assessed and prioritized for service delivery. The following are the criteria to
prioritize new clients for service delivery:
(1) Individuals in nursing homes under Medicaid who could be transferred into the community.
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted into
the community.
(3) Individuals in nursing homes that are closing and can be discharged into the community; or
(4) Individuals whose mental or physical health condition has deteriorated to the degree that self
care is not possible, there is no capable caregiver, and institutional placement will occur within 72
hours.
(5) For the purpose oftransitioning individuals receiving the Community Care for Disabled
Adults (CCDA) and Home Care for the Disabled (HCDA) services through the Department of
Children and Families (DCF) Adult Services to community-based services provided through the
agency, when services are not currently available, area agency on aging staff and lead agency case
managers shall ensure that "Aging Out" individuals are prioritized for services only after Adult
Protective Services (APS) High Risk and Imminent Risk individuals.
2.1.2. Priority Criteria for Service Delivery for Other Assessed Individuals
The assessment and provision of services should always consider the most cost effective means of
service delivery. Functional impairment shall be determined though the agency's client
assessment form administered to each applicant. The most frail individuals not prioritized above
will receive services to the extent funding is available.
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July 2009 ADI 203.09
2.1.3. Delivery of Services to Eligible Clients
The recipient shall ensure the provision of a continuum of services that addresses the diverse
needs of individuals with Alzheimer's disease and their caregivers. The recipient shall ensure
services are performed in accordance with the current Department of Elder Affairs Programs and
Services Handbook. Services categories include:
(1) Caregiver Training/Support
(2) Case Aid
(3) Case Management
(4) Counseling (Gerontological)
(5) Counseling (Mental Health/Screening)
(6) Education/Training
(7) Intake
(8) Model Day Care
(9) Respite (Facility Based)
(10) Respite (In Home); and
(11) Specialized Medical Equipment, Services and Supplies.
Caregivers benefit from receiving training, respite, and related support services to assist them in
caring for the AD I client.
2.1.3.2. Memory Disorder Clinics
Memory Disorder Clinics are required to provide four hours of in-service training to all respite and
model day care centers in their designated service areas. In-service training topics may include
physiological, behavioral, and emotional aspects of Alzheimer's disease and related diseases as
well as caregiver techniques and coping strategies. The recipient agrees to collaborate with
Memory Disorder Clinics to assist in this effort. The recipient will respond to requests for
evaluation information and statistical data concerning its consumers, based on information
requirements of the Memory Disorder Clinics and Brain Bank.
2.1.3.3. Model Day Care Programs
The recipient will ensure Centers supported by the contract develop innovative therapies and
interventions which can be shared with other Alzheimer's Disease Initiative health and services
personnel via training. Model Day Care Centers supported by this contract must report to the
recipient all training activities provided to health care and social service personnel and caregivers,
as well as serve as a natural laboratory for service related applied research performed by Memory
Disorder Clinics. The recipient shall submit an annual Model Day Care Center Training Report,
ATTACHMENT X, to the agency by July 16,2009.
2.2. SERVICE LOCATION AND EQUIPMENT
2.2.1. Service Times
The recipient shall ensure the provisions of the services listed in this contract are available at times
appropriate to meet client service needs, at a minimum, during normal business hours. Normal
business hours are defined as Monday through Friday, 8:00am to 5:00pm.
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July 2009 ADI203.09
2.3 Equipment
2.3.1 Equipment means: (a) an article of non expendable, tangible personal property having a useful life
of more than one year and an acquisition cost which equals or exceeds the lesser of (a) the
capitalization level established by the organization for the financial statement purposes, or $5,000
[for federal funds], or nonexpendable, tangible personal property of a nonconsumable nature with
an acquisition cost of $1 ,000 or more per unit, and expected useful life of at least one year; and
hardback bound books not circulated to students or the general public, with a value or cost of $250
or more [for state funds].
2.3.2. Contractors and sub-contractors who are Institutions of Higher Education, Hospitals, and Other
Non-Profit Organizations shall have written property management standards incompliance with 2
CFR Part 215 Administrative Requirements (formerly OMB Circular A-II0) that include: (a) a
property list with all the elements identified in the circular; and (b) a procedure for conducting a
physical inventory of equipment at least once every two years. The property records must be
maintained on file and shall be provided to the agency upon request.
2.3.3. The recipient's property management standards for equipment acquired with public funds and federally-
owned equipment shall include accurately maintained equipment records with the following information.
(l) A description of the equipment
(2) Manufacturer's serial number, model number, Federal stock number, national stock number, or other
identification number
(3) Source of the equipment, including the award number
(4) Whether title vests in the recipient or the Federal Government
(5) Acquisition date (or date received, if the equipment was furnished by the Federal Government) and
cost
(6) Information from which one can calculate the percentage of Federal participation in the cost of the
equipment (not applicable to equipment furnished by the Federal Government)
(7) Location and condition of the equipment and the date the information was reported
(8) Unit acquisition cost; and
(9) Ultimate disposition data, including date of disposal and sales price or the method used to determine
current fair market value where a recipient compensates the Federal awarding agency for its share.
2.3.4 Equipment purchased with federal funds with an acquisition cost over $5,000 and equipment purchased
with state funds with an acquisition cost over $1,000 that is part of the cost of carrying out the activities and
functions of the grant awards and Title (ownership) will vest with the recipient, subject to the conditions of
2 CFR Part 215 Administrative Requirements (formerly OMB Circular A-II 0), Subpart C, paragraph 34.
Equipment purchased under these thresholds is considered supplies and is not subject to property standards.
Equipment purchased with state funds identified in the budget attachments to agreements covered by this
contract, or identified in the sub-agreements with sub-contractors (not included in a cost methodology), is
subject to the conditions of section 273, F.S. and 60A-l.0017, F.A.C. or Title 45 CFR part 74.
2.3.5. The recipient shall not dispose of any equipment or materials provided by the agency, or purchased with
funds provided through this contract without first obtaining the approval of the agency's Contract Manager.
When disposing of property or equipment the recipient must submit a written request for disposition
instructions to the respective Contract Manager. The request should include a brief description of the
property, purchase price, funding source, percentage of state or federal participation, acquisition date and
condition of the property. The request should also indicate the recipient's proposed disposition (Le.
transfer or donation to another agency that administers federal programs, offer the item for sale, destroy the
items, etc.).
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July 2009 ADI203.09
2.3.6. The agency's Contract Manager will issue disposition instructions. If disposition instructions are not
received within 120 days of the written request for disposition, the recipient is authorized to proceed as
directed in 2 CFR Part 215 Administrative Requirements (formerly OMB Circular A-II 0).
2.3.7. Real property means land (including land improvements), buildings, structures and appurtenances thereto,
but excludes movable machinery and equipment. Real property may not be purchased with state or federal
funds through agreements covered under this contract without the prior approval of the agency. Real
property purchases from Older Americans Act funds are subject to the provisions of Title 42, Chapter 35,
Subchapter III, Part A, Section 3030b United States Code (USe). Real property purchases from state funds
can only be made through a fixed capital outlay grants and aids appropriation and therefore are subject to
the provisions of section 216.348, F .S.
2.3.8. Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and
tested prior to disposal to ensure no confidential information remains.
2.3.9. The recipient must adhere to the agency's procedures and standards when purchasing Information
Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR
worksheet is required for any computer related item costing $1,000 or more, including data processing
hardware, software, services, supplies, maintenance, training, personnel and facilities. The completed ITR
worksheet shall be maintained in the LAN administrator's file and must be provided to the agency upon
request. The recipient has the responsibility to require any subcontractors to comply with the agency's ITR
procedures.
2.4 DELIVERABLES
2.4.1 Service Unit
The recipient shall provide the services described in this contract in accordance with the Department of
Elder Affairs Programs and Services Handbook. The chart below lists the services that can be performed
and the unit of measurement:
Service Unit of Service
Caregiver Training/Support
Case Aid
Case Management
Counseling (Gerontological)
2.5. Counseling (Mental Health/Screening) Hour
Intake
Model Day Care
Respite (Facility Based)
Respite (In-Home)
EducationfTraining
Specialized Medical Equipment. Services Episode
and Supplies
REPORTS
The recipient is responsible for responding in a timely fashion to additional routine and/or special requests
for information and reports required by the agency. The recipient must establish due dates for any
subcontractors that permit the recipient to meet the agency's reporting requirements. Reports and
information that the recipient shall provide to the agency include, but are not limited to:
Client Information and Registration Tracking System (CIRTS)
The recipient is required to use CIRTS reports in the web-based CIRTS database system to ensure CIRTS
data accuracy. The report categories include:
18
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July 2009 ADI203,09
(1) Client Reports
(2) Monitoring Reports
(3) Services Reports
(4) Miscellaneous Reports
(5) Fiscal Reports
(6) Aging Resource Center Reports
(7) Outcome Measurement Reports
Service Cost Reports
The recipient shall require its subcontractors to submit to it the recipient semi-annual service cost reports,
which reflect actual cost of providing each service by program. This report provides information for
planning and negotiating unit rates.
Surplus/deficit Report
The recipient will submit a consolidated surplus/deficit report in a format provided by the agency to the
agency's Contract Manager by the 18th of each month. This report is for all agreements and/or contracts
between the recipient and the agency. The report will include the following:
(1) A list of all subcontractors and their current status regarding surplus or deficit
(2) The recipient's detailed plan on how the surplus or deficit spending exceeding the threshold specified
by the agency will be resolved.
(3) Recommendations to transfer funds to resolve the surplus/deficit spending
(4) Input from the recipient's Board of Directors on resolution of spending issues, if applicable
(5) Number of clients currently on Assessed Priority Consumer List (APCL) that receive a priority ranking
score of 4 or 5; and
(6) Number of clients currently on the APCL designated as Imminent Risk
2.6. RECORDS AND DOCUMENTATION
2.6.1 The recipient shall ensure the collection and maintenance of client and service information on a monthly
basis from the Client Information and Registration Tracking System (CIRTS) or any such system
designated by the agency. Maintenance includes valid exports and backups of all data and systems
according to agency standards.
2.6.2. Each recipient and subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover
from losses or outages of the computer system. Data and software essential to the continued operation of
recipient functions must be backed up. The security controls over the backup resources shall be as
stringent as the protection required of the primary resources. It is recommended that a copy of the backed
up data be stored in a secure, offsite location. The recipient shall maintain written policies and procedures
for computer system backup and recovery and shall have the same requirement in its contracts and/or
agreements with subcontractors. These policies and procedures hall be made available to the agency upon
request.
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outcomes
(1) The recipient shall timely submit to the agency all reports described in ATTACHMENT 1, SECTION
2.5 REPORTS;
(2) The recipient shall timely submit to the agency all information described in ATTACHMENT 1,
SECTION 2.6, RECORDS AND DOCUMENTATION;
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July 2009 ADI203.09
(3) The recipient shall ensure provision of services in this contract in accordance with the current
Department of Elder Affairs Programs and Services Handbook, ATTACHMENT A.
2.7.2. The performance of the recipient in ensuring the provision of services described in this contract shall be
measured by the 2009 area plan strategies for the following criteria:
(1) Percent of most frail elders who remain at home or in the community instead of going into a nursing
home
(2) Average monthly savings per consumer for home and community-based care versus nursing home care
for comparable client group
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score
(4) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved
(7) Percent of family and family-assisted caregivers who self-report they are very likely to provide care
(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor)
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community based services.
2.7.3. Monitoring and Evaluation Methodology
The agency will review and evaluate the performance of the recipient under the terms of this contract.
Monitoring shall be conducted through direct contract with the recipient through telephone, in writing, or
an on-site visit. The agency's determination of acceptable performance shall be conclusive. The recipient
agrees to cooperate with the agency in monitoring the progress of completion of the service tasks and
deliverables.
2.8 RECIPIENT'S FINANCIAL OBLIGATIONS
2.8.1 Cost Sharing and Co-payments
The agency will ensure the recipient establishes annual co-payments goals. The agency has the option to
withhold a portion of the recipient's Request for Payment if goals are not met according to the agency's
and department's co-payment guidelines.
Co-payments include only the amounts assessed consumers or the amounts consumers opt to contribute in
lieu of an assessed co-payment. The contribution must be equal to or great than the assessed co-payment.
2.8.2. Use of Service Dollars and Assessed Priority Consumers List Management
The recipient is expected to spend all federal, state and other funds provided by the agency for the purpose
specified in the contract. The recipient must manage service funds in such a manner so as to avoid having a
wait list and a surplus of funds at the end of the contract period for each program managed by the recipient.
If the agency determines that the recipient is not spending service funds accordingly, the agency may
transfer funds to other planning and service areas during the contract period and/or adjust subsequent
funding allocations accordingly as allowable under state and federal law.
2.9 AGENCY RESPONSIBILITIES
2.9.1. Program Guidance and Technical Assistance
The agency shall provide to the recipient guidance and technical assistance as needed.
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July 2009 ADI203.09
2.9.2. Contract Monitoring
The agency shall, at its own discretion, conduct monitoring concerning any aspect of the recipient's
performance of this contract.
SECTION III: METHOD OF PAYMENT
3.1. General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for administration costs,
and fixed rate for services. The recipient shall ensure fixed rates for services include only those costs that
are in accordance with all applicable state and federal statutes and regulations and are based on audited
historical costs in instances where an independent audit is required. The recipient shall consolidate all
requests for payment from subcontractors and expenditure reports that support requests for payment and
shall submit to the agency on forms 1062 (A TT ACHMENT XI) and 105 (A TT ACHMENT XII)
3.1.1. The recipient agrees to implement the distribution of funds as detailed in A TT ACHMENT VIII, Budget
Summary and in ATTACHMENT IX, Rate Summary. An amendment is required to change the total
amount of the contract.
3.2 Advance Payments
3.2.1 The recipient may request up to two months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the agency by the State of Florida ("budget release"). The recipient shall
provide the agency's Contract Manager with documentation justifying the need for an advance and
describing how the funds will be distributed.
3.2.2. The recipient's requests for advance require the approval of the agency's Contract Manager. If sufficient
budget is available, the agency will issue approved advance payments after July 1,2009.
3.2.3. Requests for the third through the twelfth months shall be based on the submission of actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance
requests, of available, is shown on A TT ACHMENT VII to this contract.
3.2.4 All advance payments made to the recipient shall be recouped in accordance with the Invoice Schedule,
ATTACHMENT VII, to this contract.
3.2.5. The recipient may temporarily place advanced funds in an insured interest bearing account. All interest
earned on contract fund advances must be returned to the agency within thirty (30) days of the end of each
quarter of the contract period.
3.3 Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment shall be on
DOEA forms 1062 (ATTACHMENT XI) and 105 (ATTACHMENT XII). Duplication or replication of
both forms via data processing equipment is permissible, provided that all data elements are in the same
format as included on Department of Elder Affairs' forms.
3.3.1. All payment requests shall be based on the submission of actual monthly expenditure reports beginning
with the first month of the contract. The schedule for submission of advance requests (when available) and
invoices is ATTACHMENT VII to this contract.
3.3.2 Any payment due by the agency under the terms of this contract may be withheld pending the receipt and
approval by the agency of all financial and programmatic reports due from the recipient and any
adjustments thereto, including any disallowance not resolved as outlined in section 22 of this contract.
3.3.3. Payment may be authorized only for allowable expenditures, which are in accord with the limits specified
in A TT ACHMENT VIII.
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July 2009 ADI203.09
3.3.4. Date for Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for services
provided through June 30, 2010, must be submitted to the agency's Contract Manager by July 10,2010.
3.3.5. Date for Final Request for Payment
The final request for payment will be due to the agency no later than July 25, 2010.
3.4. Documentation for Payment
The recipient shall maintain documentation to support payment requests that shall be available to the
agency or authorized individuals upon request. Such documentation shall be provided upon request to the
agency or the Department of Financial Services.
3.4.1 The agency will require recipients to enter all required data per the Department of Elder Affair' CIRTS
Policy Guidelines for clients and services in the CIRTS database. The data must be entered into the CIRTS
before the recipients submit their requests for payment and expenditure reports to the agency. The recipient
shall establish time frames to assure compliance with due dates for the requests for payment and
expenditure reports to the agency.
3.4.2. The agency will require recipients to run monthly CIRTS reports and verify client and service data in the
CIRTS is accurate. This report must be submitted to the agency with the monthly request for payment and
expenditure report and must be reviewed by the agency before the recipient's request for payment and
expenditure reports can be approved by the agency.
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July 2009 ADI203,09
A TT ACHMENT II
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of any state or federal agency, a
member of congress, an officer or employee of congress, an employee of a member of congress, or an
officer or employee of the state legislature, in connection with the awarding of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification
shall be ~ to a civil penalty of not less than $10,000.00 and not more than $100,000.00 for each such
failure., I
~<d-~.
, July 28, 2009
Signature Date:
Donna Fiala, Chairman ADI 203.09
Name of Authorized Individual Application or Agreement Number
Collier County Board of County Commissioners
3301 Tamiami Trail East
Naples, Florida 34112
Name and Address of Organization
C~~
.
Assistant County Attorney
DOEA Fonn 103
(Revised Nov 2002)
" .[,\
ATTES'T , -,
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DW T E. ~q11,j~ .,' k
23
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16D9
July 2009 ADI203.09
DOEA Form 103
A TT ACHMENT III
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Area Agency on Aging of Southwest Florida, Inc. to the provider
may be subject to audits and/or monitoring by the Area Agency on Aging of Southwest Florida, Inc., as described
in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97,
F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the
Agency staff, limited scope audits as defined by OMB Circular A-I33, as revised, and/or other procedures. By
entering into this agreement, the provider agrees to comply and cooperate with any monitoring
procedures/processes deemed appropriate by the Area Agency on Aging of Southwest Florida, Inc. In the event the
Area Agency on Aging of Southwest Florida, Inc. determines that a limited scope audit of the provider is
appropriate, the provider agrees to comply with any additional instructions provided by the Area Agency on Aging
of Southwest Florida, Inc. to the provider regarding such audit. The provider further agrees to comply and
cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Director of Finance of
the Area Agency on Aging of Southwest Florida, Inc.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB
Circular A133, as revised.
In the event that the provider expends $500,000.00 or more in Federal awards during its fiscal year, the provider
must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133,
as revised. EXHIBIT 1 to this agreement indicates Federal resources awarded through the Department of Elder
Affairs by this agreement. In determining the Federal awards expended in its fiscal year, the provider shall
consider all sources of Federal awards, including Federal resources received from the Department of Elder Affairs.
The determination of amounts of Federal awards expended should be in accordance with the guidelines established
by OMB Circular A-133, as revised. An audit of the provider conducted by the Auditor General in accordance with
the provisions ofOMB Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph I, the provider shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised.
If the provider expends less than $500,000.00 in Federal awards in its fiscal year, an audit conducted in accordance
with the provisions of OMB Circular A-I33, as revised, is not required. In the event that the provider expends less
than $500,000.00 in Federal awards in its fiscal year and elects to have an audit conducted in accordance with the
provisions ofOMB Circular A133, as revised, the cost of the audit must be paid from non-Federal resources (Leo,
the cost of such audit must be paid from provider resources obtained from other than Federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal
year. Compliance findings related to agreements with the Area Agency on Aging of Southwest Florida, Inc. shall be
based on the agreement's requirements, including any rules, regulations, or statutes referenced in the agreement.
The financial statements shall disclose whether or not the matching requirement was met for each applicable
agreement. All questioned costs and liabilities due to the Area Agency on Aging of Southwest Florida, Inc. shall be
fully disclosed in the audit report with reference to the Area Agency on Aging of Southwest Florida, Inc. agreement
involved. If not otherwise disclosed as required by Section .31 O(b )(2) of OMB Circular A-133, as revised, the
schedule of expenditures of Federal awards shall identify expenditures by agreement number for each agreement
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1609
July 2009 ADI203.09
with the Department of Elder Affairs in effect during the audit period. Financial reporting packages required under
this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of
the provider's fiscal year end.
PART II: STATE FUNDED
This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes.
In the event that the provider expends a total amount of state financial assistance equal to or in excess of
$500,000.00 in any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the
provider must have a State single or project-specific audit for such fiscal year in accordance with Section 215.97,
Florida Statutes; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT I to this
agreement indicates state financial assistance awarded through the Department of Elder Affairs by this agreement.
In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of
state financial assistance, including state financial assistance received from the Department of Elder Affairs, other
state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through
awards and resources received by a nonstate entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph I, the provider shall ensure that the audit
complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial
reporting package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.
If the provider expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending
September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, Florida
Statutes, is not required. In the event that the provider expends less than $500,000.00 in state financial assistance in
its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, Florida
Statutes, the cost of the audit must be paid from the nonstate entity's resources (i.e., the cost of such an audit must
be paid from the provider resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal
year. Compliance findings related to agreements with the Area Agency on Aging of Southwest Florida, Inc, shall be
based on the agreement's requirements, including any applicable rules, regulations, or statutes. The financial
statements shall disclose whether or not the matching requirement was met for each applicable agreement. All
questioned costs and liabilities due to the Area Agency on Aging of Southwest Florida, Inc. shall be fully disclosed
in the audit report with reference to the Area Agency on Aging of Southwest Florida, Inc. agreement involved. If
not otherwise disclosed as required by Rule 691-5.003, Fla. Admin. Code, the schedule of expenditures of state
financial assistance shall identify expenditures by agreement number for each agreement with the Area Agency on
Aging of Southwest Florida, Inc. in effect during the audit period. Financial reporting packages required under this
part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the
provider's fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be
submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider's fiscal year
end. Notwithstanding the applicability of this portion, the Area Agency on Aging of Southwest Florida, Inc. retains
all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this
document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and
required by PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-B3,
as revised, by or on behalf of the provider directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. at each of the following addresses:
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July 2009 1609 ADI203.09
Leigh Wade-Schield, Executive Director
Area Agency on Aging for Southwest Florida, Inc.
2285 First Street
Fort Myers, Florida 33901
The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by
Sections .320 (d)(I) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit
Clearinghouse), at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jefferson, IN 47132
Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMB Circular A-
133, as revised.
Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a copy of the reporting
package described in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the
auditor, to The Area Agency on Aging of Southwest Florida, Inc. at each of the following addresses:
Leigh Wade-Schield, Executive Director
Area Agency on Aging for Southwest Florida, Inc.
2285 First Street
Fort Myers, Florida 33901
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or
on behalf of the provider directly to each of the following:
The Area Agency on Aging of Southwest Florida, Inc. at each of the following addresses:
Leigh Wade-Schield, Executive Director
Area Agency on Aging for Southwest Florida, Inc.
2285 First Street
Fort Myers, Florida 33901
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Area Agency on Aging for
Southwest Florida, Inc. pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-
133, Florida Statutes, and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations), Rules of the Auditor General, as applicable.
Providers, when submitting financial reporting packages to the Area Agency on Aging for Southwest Florida, Inc.
for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting
package was delivered to the provider in correspondence accompanying the reporting package.
26
"----
1609
July 2009 ADI203.09
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a
period of six years from the date the audit report is issued, and shall allow the Area Agency on Aging for Southwest
Florida, Inc. or its designee, the Director of Finance access to such records upon request. The provider shall ensure
that audit working papers are made available to the Area Agency on Aging for Southwest Florida, Inc. or its
designee, Director of Finance upon request for a period of six years from the date the audit report is issued, unless
extended in writing by the Area Agency on Aging for Southwest Florida, Inc.
27
.~-~..~- .,-- , -'-"""'~'"'''-''''''''-''''~''''''''''''' '<1"W
1609 j
1
July 2009 ADI203.09
A TT ACHMENT III
EXHIBIT 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTALFEDERALA~ARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE A~ARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Alzheimer's Disease Initiative
Respite Services General RevenueffSTF 65004 $95,490.00
TOTAL A~ARD $95,490.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO TillS AGREEMENT ARE AS FOLLOWS:
28
-""'-"._^ .._..~~---_.... ....-"'-.,-.....-,.,"..-.. . '"
July 2009 16 0 ~I 203.09
A TT ACHMENT III EXHIBIT -2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources mayor may not be subject to the audit requirements ofOMB Circular A-133,
as revised, and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards
and/or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I
and/or Part 11 of Exhibit] are met. Providers who have been determined to be vendors are not subject to the audit requirements
of OMB Circular A-133, as revised, and/or Section 215.97, F]a. Stat. Regardless of whether the audit requirements are met,
providers who have been determined to be recipients or subrecipients of Federa] awards and/or state financial assistance, must
comply with applicable programmatic and fiscal compliance requirements.
In accordance with Sec. 210 ofOMB Circular A-]33 and/or Rule 69]-5.066, FAC, provider has been determined to be:
_Vendor or exempt entity and not subject to OMB Circular A-] 33 and/or Section 2] 5.97, F.S.
_X_Recipient/subrecipient subject to OMB Circular A-133 and/or Section 25.97, F.S.
NOTE: If a provider is determined to a recipient/subrecipient of federal and or state financial assistance and has been approved
by the Agency to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69]-,006(2), FAC [state financial
assistance] and Section _0400 OMB Circular A- I 33 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive
Federal awards or state matching funds on Federal awards and who are determined to be a subrecipient, must comply with the
following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A-
87)*
OMB Circular A-] 02 - Administrative requirements
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations (Formerly OMB Circular A-22-Cost
Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A-II 0 - Adminisrative
Requirements)
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL
GOVERNMENT) MUST FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A-2]-Cost Principles)*
2 CFR 2]5Administrative Requirements (Former]y OMB Circular A-I ]O-Administrative Requirements)
OMB Circular A-133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB
Circular A-] 33 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 2] 5 -97, Fla. Stat.
Chapter 6] 9-5, F]a. Admin. Code
State Projects Compliance Supplement
Reference Guide for State expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
29
,"-,,,,,~.,.,,-=- ~ ",.-""~"",,.'<<. ,<-~,'-~~
July 2009 1 Q>>22.09'
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LAND AND
COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the recipient named in the contract or agreement to which this
form is an attachment, hereby certifies that:
(1) The recipient and any sub-contractors of services under this contract have financial management systems
capable of providing certain information, including: (1) accurate, current, and complete disclosure of the
financial results of each grant-funded project or program in accordance with the prescribed reporting
requirements; (2) the source and application of funds for all agreement supported activities; and 93) the
comparison of outlays with budgeted amounts for each award. The inability to process information in
accordance with these requirements could result in a return of grand funds that have not been accounted for
properly.
(2) Management Information Systems used by the recipient, sub-contractor(s) or any outside entity on which
the recipient is dependent for data that is to be reported, transmitted or calculated, have been assessed and
verified to be capable of processing data accurately, including year-date dependent data. For those systems
identified to be non-compliant, recipient(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip
technology, the undersigned warrants that these products are capable of processing year-date dependent
data accurately. All versions of these products offered by the recipient (represented by the undersigned)
and purchased by the State will be verified for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines
that impede the hardware or software programs from operating properly, the recipient agrees to
immediately make required corrections to restore hardware and software programs to the same level of
functionality as warranted herein, at no charge to the State, and without interruption to the ongoing
business of the state, time being of the essence.
(4) The recipient and any sub-contractor(s) of services under this contract warrant their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency including
emergencies arising from data integrity compliance issues.
The recipient shall require that the language of this certification be included in all subagreements,
subgrants, and other agreements and that all sub-contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made r:fntered into. Submission of this certification is a prerequisite for making or entering into this
transacti i posed by OMB <jircu~rs A-I 02 and 2 CFR Part 215 (formerly OMB Circular A-II 0).
~. ~~J July 28. 2009
Signature' Date:
Donna Fiala. Chairman AD! 203.09
Name of Authorized Individual Application or Agreement Number
Collier County Board of County Commissioners
3301 Tamiami Trail East
Naples. Florida 34112 ~~ \\ ::'/
Name and Address of Organization
Assistant County Attm:'" "''-':;7;>,. ',.
DOEA Form 103 (Revised Nov 2002) EST; ..: . I "'. ~.
~;t~:~t
30
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-twe Oft I " .
-~-~-- ",- ,,~ --""'~---''''''''-'''''-' .. . 1'1 I. ~..._"____.._.__<O___,__...,"_~__,._
July 2009 16 D ~I~03.09
A TT ACHMENT V
CERTIFICATION REGARDING DEPARTMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective contractor certifies, by signing this certification, neither it nor its principals are presently
debated, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation
in this transaction by any federal department or agency.
(2) Where *,spective co~r is.)!nable to certify to any of the statements in this certification, such
prospe i ~~~ shal ~xplanation to this certification.
. Julv 28. 2009
Signature Date
D~=," Collier County Board of County Commissioners
Agency IOrgan izati on
T'! ~
AssistantCounty ttorney "
. ,~C)(, ..' .....;. fr<
(Certification signature should be same as Contract si
_ '-, ,~1d .
Instructions for Certification 4tt,~S.{' ute ~. t'rl!k'ln s
, 1 ~~:ui'"": Qn\-~
1. The terms (covered transaction," "debarred," "suspended," "ineligible," "lower tier covere"Cr tr~nsaction,"
"Person," "Primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set
out in the sections of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as
supplemented by 2 CFR 376.10-376.995). You may contact the Contract Manager for assistance in
obtaining a copy of those regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties
entered into this transaction. If it is later determined that the recipient knowingly rendered an erroneous
certification, in addition to other remedies available to the federal government the Agency may pursue
available remedies, including suspension and/or debarment.
3. The recipient will provide immediate written notice to the Contract Manager if at any time the recipient
learns that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances. The recipient may decide the method and frequency by which it determines the eligibility
of its principals. Each participant to a lower tier covered transaction may, but is not required to, check the
Excluded Parties List System (EPLS).
4. The recipient will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion 'Lower Tier Covered Transaction" in all its lower tier covered transactions and in all
solicitations for lower tier covered transactions.
5. The recipient agrees that it shall not knowingly enter into any lower tier covered transaction with a person
who is debarred, suspended, determined ineligible or voluntarily excluded from participation, unless
otherwise authorized by the federal government.
6. If the recipient knowingly enters into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
remedies available to the federal government, the Agency may pursue available remedies, including
suspension, and/or debarment.
7. The recipient may rely upon a certification of a prospective participant in a lower tier covered transaction,
unless it knows that the certification is erroneous.
31
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1609 J
July 2009 ADI203.09
ATTACHMENT VI
ASSURANCES-NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other s=aspect of this collection
of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork
Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please
contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to
additional assurances. If such is the case, you will be notified.
1. Has the legal authority to apply for Federal assistance. and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and
completion of the project described in this applications.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through
any authorized representative, access to and the right to examine all records, books, papers, or documents related to
the award; and will establish a proper accounting system in accordance with generally accepted accounting standards
or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S,c., 4728-4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A
ofOPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI
ofthe Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national
origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C., 1681-1683 and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 ofthe Rehabilitation Act of 1973, as amended (29 U.S.c.
794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.c., 6101-6107) which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment
Act of 1972 (PoL. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616),
as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public
Health service Act of 1912 (42 U.s.c., 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and
drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.c., 3601 et seq.) as amended,
relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in
the specific statute(s) under which application for Federal assistance is being made; and G) the requirements of any
other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These
requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C., 1501-1508 and 7324-7328), which limit
the political activities of employees whose principal employment activities are funded in whole or in part with Federal
32
-~." ~,~,-.".~,---,~",...-.....
16D9
July 2009 ADI203.09
funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.c., 276a to 276a-7), the Copeland Act
(40 USc. 276c and 18 U.S.c., 874) and the Contract Work Hours and Safety Standards Act (40 U.S,c., 327-333),
regarding labor standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of section I 02(a) ofthe Flood Disaster
Projection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or
more.
II. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (PoL. 91-190) and
Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 1738 (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.c. 1451 et seq.); (t) conformity of Federal actions of State (Clear Air) Implementation Plans under
Section 176(c) or the Clear Air Act of 1955, as amended (42 USc. 7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 1973, as amended, (PoL. 93-205),
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U,S.c. 1721 et seq,) related to protecting components
or potential components of the national wild and scenic rivers system,
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.c. 470), EO 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974 (16 U.S.c. 469a-1 et seq).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and
related activities supported by this award of assistance.
IS. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.c.. 2131 et seq.)
pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities
supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S,C..4801 et seq.), which prohibits the use of
lead- based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non-Profit
Organizations.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies
governing this program.
TITLE
Chairman
APPLICANT ORGANIZATION DATE SUBMITTED
Collier County Board of County Commissioners July 28, 2009 , '''':.. ... '... .
r
Housing and Human Services Department "
-!.~.
,"".,
C~~ .c:
, ,-
Assistant County Attorney " "' "oc~"" k
~f. '" '.".. ,om.... ..-
".' '~~~
33 " Wcl-, . ""'~';c.' .".', '
, AU:.st II to C~trMtt ,
11 Qoaturf on I ·
,--- - "'>'-----,...."--..,-..-._...';-"_..;-~,."."',.,",.,,.,.~'". .
July 2009 16AgI~3.0~
ATTACHMENT VII
ALZHEIMER'S DISEASE INITIATIVE (ADI)
INVOICE SCHEDULE
Report Submit to AAA
Number Based On On This Date
1 July Advance* July 1
2 August Advance* July 1
3 July Expenditure August 10
4 August Expenditure September 10
5 September Expenditure October 10
6 October Expenditure November 10
7 November Expenditure December 10
8 December Expenditure January 10
9 January Expenditure February 10
10 February Expenditure March 1 0
11 March Expenditure April 10
12 April Expenditure May 10
13 May Expenditure June 10
14 June Expenditure July 10
15 Final Expenditure and Closeout Report July 25
Legend: * Advance based on projected cash need.
Note #1: Report # 1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging prior to
July 1 or until the contract with the department has been executed and a copy sent to DFS. Actual
submission of the vouchers to AAA is dependent on the accuracy of the expenditure report.
Note #2: Report numbers 13 and 14 shall reflect an adjustment of one half of the total advance amount, on
each of the two reports respectively, repaying advances for the first two months of the contract.
The adjustment shall be recorded in Part C, 1 of the report (Attachment XI).
Note #3: Submission of expenditure reports mayor may not generate a payment request. If final
expenditure report reflects funds due back to the department, payment is to accompany the report.
Revised July 2006 - Form 1
34
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July 2009 16 D 9 ADI 203.09
A TT ACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
Collier County Housing and Human Services
1. Respite $ 95,290.00
2. Case Management $ 200.00
3. Total $ 95,490.00
35
_,,~,,_,^,"'m'.._...~ .. ....... ,.~-_. ~_..
16D9
July 2009 ADI 203.09
ATTACHMENT IX
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
RATE SUMMARY
Collier County Services for Seniors
SERVICES UNIT RATE
Case Management $50.51
Case Aide $27.78
In-Facility Respite $10.00
SCSM 100% Reimbursement
36
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16D9
July 2009 ADI203.09
ATTACHMENT X
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Print name of person completing report
Signature of person completing report
Date
The purpose of the model day care program must be to provide service delivery to persons suffering from
Alzheimer's disease or a related memory disorder and training for health care and social service personnel in the
care of persons having Alzheimer's disease or related memory disorders. This report documents the required
training for the State Fiscal Year July 1 st through July 30th.
Number
Number Health Social
Care Services
Professionals Personnel Total People
Actual Training Events Trained Trained Trained
Training Title:
Date
Training Summary:
37
-,_.., _.'_,~,,~~- . "'''-~''''~''';'''''''-' .
1609
July 2009 ADI203.09
ATTACHMENT XI
REQUEST FOR PAYMENT
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
PROVIDER NAME, ADDRESS, PHONE# and FED 10# TYPE OF REPORT: THIS REQUEST PERIOD:
FOR
A. PAYMENT REQUEST:
Regular_ Supplemental_ REPORT# ~
B. METHOD OF PAYMENT: CONTRACT#
Advance -
PSA#
CERTIFICATION: I hereby certify that this request or refund conforms with the terms of the above contract.
Prepared By: Date: Approved By: Date
PART A: BUDGET (I) (2) (3) (4) (5) (6) TOTAL
SUMMARY: CM,CA Respite Model Day Memory
Care Disorder
I , Approved Contract Clinic
Amount $ $ $ $ --- $ $ $
2, Previous Funds Received For
Contract Period
3, Contract Balance
4, Previous Funds Requested For
Contract Period
5, Contract Balance
PART B: CONTRACT FUNDS
REQUEST:
L Anticipated Cash Needs
(1st-2nd Months) ---
2, Net Expenditures For Month
(DOEA Form I05Z, Part B
Line 13)
3, Extraordinary Cash Needs
(Attach Doc,)
4, Total -~
PART C: NET FUNDS
REQUESTED:
I, Less Advance Applied -~
2, Contract Funds Are Hereby
Requested For (Part B Line 4
minus Par t C Line I)
I I
DOEA FORM 106Z, Revised May 2006
38
--. ~"""~""-''''~_.'-'''''-~'-'''"
July 2009 16 D 9ADI203.09
A TT ACHMENT XII
RECEIPTS AND EXPENDITURES
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
RECIPIENT NAME, ADDRESS, PHONE# and FEID# PROGRAM FUNDING SOURCE: THIS REPORT PERIOD:
FROM TO
Respite_ Model Day Care_
Brain Bank _RegistTY_ CONTRACT
PERIOD
Memory Disorder Clininc__
CONTRACT#
REPORT#
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that the report is complete and correct and all outlays herein are for purposes
set forth in the contract.
Prepared By: Date: Approved By: Date:
PART A: BUDGETED INCOMEIRECEIPTS I, Approved 2, Actual 3 Total 4, Percent of
Budget Receipts for Receipts Approved Budget
This Report Year to Date
1. State Funds",.,.""",." """ "., ""'" ""'" $ $ $ %
2, Program Income""""""" , '" '''' ""'" ," '" $ $ $ _0/0
3, Local Cash Match.""" ... ..... .......... ...... $ $ --- $ %
4, SUBTOTAL: CASH RECEIPTS ,."" ."" $ $ $ - %
5, Local In-Kind Match""""" ",.""'" '"'' $ $ $ - %
6 TOTAL RECEIPTS""""""" ......... . $ $ $ _%
PART B: EXPENDITURES I , Approved 2, Expenditures for 3. Expenditures 4, Percent of
Budget This Report Year to Date Approved
Budget
1. Administrative Services"""",,,, "",'" $-- $ $ %
2, Service Subcontractor (s) """ " , ....... $ $ $ %
3, Recoupment of Advance $ $ - %
4, TOTAL" .,. .............. ............... $ $ $ - %
PART C: OTHER REVENUE AND EXPENDITURES I L Interest:
I Earned on GR Advance $
L Program Income (PI): 2. Rtn, ofGR Advance $
I, ADI: PI Collected YTD $ 3 Other Earned $
(INCLUDES CO-PAYMENTS COLLECTED)
PART D: Co-Payments II. Total-Current Month Ill. Total - Year To Date
L Total Amount of Co-payments Assessed $ $
II. Total Amount of Co-payments Collected $ $
(FOR TRACKING PURPOSES ONLY)
DOEA FORM 105Z, Dated April 2006
ATTACHMENT A
39
'-~"" W""......._~ - -
16D9
July 2009 ADI203.09
Department of Elder Affairs Programs and Services Handbook, provided on CD.
Also, available at the Department's Intranet site under, "Publications."
40
,-".~--,",-,-,."--'----' -- ,,_-..- ^",""'"",,,,,,,--.-