Backup Documents 05/26/2009 Item #16D 4
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6D 4
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 delivcred to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only lifter the Board has taken action on the Item.)
ROUTING SLIP
Complete routing lines # I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exception of the Chairman's sienature, draw a line through routing lines #1 through #4, complete the checklist, and forward to Sue Filson (line #5),
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Debbi Maxon Housing and Human Services i3"n- 5/26/09
2. Donna Fiala, Chairman Board of County Commissioners
3.
4.
5. Sue Filson, Executive Manager Board of County Commissioners
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder ofthe original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. AJI original documents needing the BCC Chairman's signature arc to be del ivered to the BCe office only after the BCC has acted to approve the
item.)
Name of Primary Staff Debbi Maxon Phone Number 252-2695
Contact Case Manager II
Agenda Date Item was May 26, 2009 Agenda Item Number . 1 ~Jll>'P' J (p 0 t.f
Approved by the BCC
Type of Document HCE Contract Amendment N umber of Original 3
Attached Documents Attached
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a ro riate.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chainnan, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and ossibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce t the BCe Chairman and the Clerk to the Board
The Chairman's signature Ii ne date has been entered as the date of BCC approval of the
document or the final ne otiated contract date whichever is a licable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BeC oftice within 24 hours of Bec approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of our deadlines!
The document was approved by the BCC on 5/26/09 (enter date) and all changes
made during the meeting have been incorporated in the attached document. The
Count Attorne 's Office has reviewed the chan es, if a licable.
Yes
(Initial)
N/A (Not
A licable)
2.
3.
4.
5.
6.
~
~
~
i)A
liA
~
1: Forms! County Forms! BCC Forms! Original Documcnts Routing Slip WWS Original 9.0304, Rcvised 1.26.05, Rcvised 2.24.05
1604
MEMORANDUM
Date:
May 29,2009
To:
Debbie Maxon, Case Manager
Housing & Human Services
From:
Ann J ennej ohn, Deputy Clerk
Minutes and Records Department
Re:
Contract #HCE 203.08 Amendment between Collier
County and the Area Agency on Aging of Southwest
Florida, Inc., to reflect decrease in 2009 grant funding
for the Home Care for the Elderly Program (HCE)
Enclosed are three (3) original amendment documents, referenced above
(Agenda Item #16D4) approved by the Board of County Commissioners on
Tuesday, May 26, 2009.
After further processinf! please forward a fullv executed orif!inal to the
Minutes and Records Department for the Board's Records.
If you should have any questions, you may contact me at 252-8406.
Thank you.
16D4
Amendment #001
Contract HCE 203.08
STANDARD CONTRACT
AREA AGENCY ON AGING
Collier County Services for Seniors
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc.,
hereinafter referred to as the "agency", and Collier Countv Services for Seniors. hereinafter
referred to as the "recipient", amends agreement #HCE 203.08.
The purpose of this amendment is to;
1. decrease the subsidy funds by $5,048.00 and increase the case management funds by
$248.00, effective February 12,2009, and
2, revise the Budget Summary, Attachment III.
All provisions in the agreement and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2. page amendment to be executed
by their officials there unto duly authorized.
ATTEST:
DWIGrIT E. BROCK, Cl~rk
By':
COLLIER COUNTY HOUSING
AND HUMAN SERVICES
By:
BOARD O~. TY..C..OMMISSIONERS
~~LLIER 171>:':~Od-
DONNA FIALA, CHAIRMAN~
Date: Mav 26. 2009
Approved as to form and
legal sufficiency:
C~m~
Assistant County Attorney
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
SIGNED BY:
NAME: John Koehler
TITLE: Immediate Past Board President
DATE: April 10. 2009
1
Amendment #001
1604
Contract HCE 203.08
ATTACHMENT III
Collier County Services for Seniors
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
1. HCE Subsidies
$ 66,380.00
$ 6,191.00
2. HCE Case Management
3.
Total
$ 72,571.00
2
1684
Attestation Statement
Agreement/Contract Number: HCE 203.08
Amendment Number: 001
I, Donna Fiala, Chairman, attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on
Aging and
Collier Countv Board of Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for cbanges in page formatting, due to tbe differences
in electronic data processing media, whicb bas no affect on tbe agreement/contract content.
Signature of
C~m~
Assista~~c,P.W;lty Attorney
>. ;\', :'/:-
" I
ATTESt:
DWI<iHTBRoC~, C~rk
B.x:1 CJ.ut'~~O,(
.I~ ..'--.. ' .
"......,,,
DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all
documents; ready for DOEA Secretary/designee signature
Initial date
Revised August 2007
16D4
Amendment #001
Contract HCE 203,08
STANDARD CONTRACT
AREA AGENCY ON AGING
Collier County Services for Seniors
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc.,
hereinafter referred to as the "agency", and Collier County Services for Seniors. hereinafter
referred to as the "recipient", amends agreement #HCE 203.08.
The purpose of this amendment is to;
1. decrease the subsidy funds by $5,048.00 and increase the case management funds by
$248.00, effective February 12,2009, and
2. revise the Budget Summary, Attachment III.
All provisions in the agreement and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2. page amendment to be executed
by their officials there unto duly authorized.
ATTEST~
DWIGHT E. BRQCKLClerk
COLLIER COUNTY HOUSING
AND HUMAN SERVICES
.'
By:
Iltc" ..' ~
It..... ..-
Approved as to form and
legal sufficiency:
~~
Assistant County Attorney
.( .
By:
TY COMMISSIONERS
TY, FLORIDA I
By:
Date: May 26. 2009
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
SIGNED BY:hU~Uy1-- r:-
NAME: J~ Koehler
TITLE: Immediate Past Board President
DATE: April 10. 2009
1
Amendment #001
16D4
Contract HCE 203,08
A TT ACHMENT III
HOME CARE FOR THE ELDERLY PROGRAM
Collier County Services for Seniors
BUDGET SUMMARY
1. HCE Subsidies
$ 66,380.00
$ 6,191.00
2. HCE Case Management
3.
Total
$ 72,571.00
2
16D4:\~
Attestation Statement
Agreement/Contract Number: HCE 203.08
Amendment Number: 001
I, Donna Fiala, Chairman, attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of tbe above referenced agreement/contract or amendment between the Area Agency on
Aging and
Collier Countv Board of Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences
in electronic data processing media, which has no affect on the agreement/contract content.
(l
d !
ljJ,n-YrM-'
Signature of Recipient/Contracto r representative
I
d~
Mav 26. 2009
Date
~/11 ~
Assistant County Att6rney
-1:',I'';l
ATTEST: ' "
DWJGHT BROCk, Clerk
B;~~~v.J:,D{ ·
-~...-
DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all
documents; ready for DOEA Secretary/designee signature
Initial date
Revised August 2007