Backup Documents 10/08/2019 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human 10/08/19
Services
2. Minutes &Records Clerk of Court's Office 10141
19 1,14#1
wins
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf/CHS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 10/08/19 Agenda Item Number 16D5
Approved by the BCC
Type of Document ATF/CCE 203.18.004;ADI 203.18.005 Number of Original 3
Attached HCE 203.18.005 Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? NA
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the NA
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NA
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 10.08.19 and all changes made during WK
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the WK
BCC, all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1605
July 2018—June 2019 CCE 203.18.004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of County Commissioners,("Contractor"),amends agreement CCE 203.18.
The purpose of this amendment is to increase 4. Contract Amount with the final allocation for the 2018-2019 contract
year by: $1,730.15 and revise ATTACHMENT II-Exhibit 2 and ATTACHMENT VIII-Annual Budget Summary.
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$883,378.15 subject to the availability of funds. Any costs or services paid for under any other contract
or from any other source are not eligible for payment under this contract.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF, the Parties hereto have caused this amendment,to be executed by their undersigned officials as
duly authorized; and agree to abide by the terms,conditions and provisions of this CCE contract as amended.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY COM)IISSIONERS SOUTHWEST FLORIDA,INC.
SIGNED BY: �J t SIGNED BY: (AC:VAL
NAME: STEPHEN Y. CARNELL NAME: MARIANNE G LORINI
TITLE:PUBLIC SERVICE DEPARTMENT HEAD TITLE: PRESIDENT/CEO
C �
DATE: /2c/3// � DATE: 9 /�`p'/
!q
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
DUNS: 076997790
Approved as to form and legality
1 Assistant County urney
0
July 2018—June 2019 CCE 203.18.004 16 05
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR&2 CFR Part 200, as revised, and Section 215.97(5),F.S.require that the information about
Federal Programs and State Projects included in Exhibit 1 be provided to the recipient. Information contained herein
is a prediction of funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): FEDERAL AWARD DATE:
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS.,
2 CFR Part 200—Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal
Awards. OMB Circular A-133—Audits of States,Local Governments, and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST
OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Community Care for the Elderly General Revenue-Collier 65.010 $ 883,378.15
TOTAL AWARD $ 883,378.15
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
,STATE FINANCIAL ASSISTANCFF
Section 215.97,F.S.,Chapter 69I-5,F.A.C, State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
2
n
July 2018—June 2019 CCE 203.18.004 16 !? 5
ATTACHMENT VIII
ANNUAL BUDGET SUMMARY
COMMUNITY CARE FOR THE ELDERLY PROGRAM
for
Collier County Board of County Commissioners
Collier
CCE Services Allocations $ 883,378.15
3
0
Revised August 2007 16 0 5
Attestation Statement
Agreement/Contract Number CCE 203.18
Amendment Number 004
I,Stephen Y Carnet! ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of 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.
CI, 7/2929
Signature of Recipi t/Contractor representative Date
Approved as to form and legality
(14
Assistant County At %ley
Revised August 2007
July 2018—June 2019
ADI 203.18.005 1 b D 5
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency")and Collier
County Board of County Commissioners, ("Contractor"), amends agreement ADI 203.18.
The purpose of this amendment is to increase 4. Contract Amount with the final allocation for the 2018-2019 contract year
by: $9,395.66 and revise ATTACHMENT II-Exhibit 2 and ATTACHMENT X-Annual Budget Summary.
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 $476,365.68 subject to the availability of funds. Any costs or services paid for under any other contract or from
any other source are not eligible for payment under this contract.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF,the Parties hereto have caused this amendment,to be executed by their undersigned officials as duly
authorized; and agree to abide by the terms, conditions and provisions of this ADI contract as amended.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY COMMISSIONERS SOUTHWEST FLORIDA,INC. D
SIGNED BY: *'G\' ( /�Q -\ SIGNED BY: l�Y - ( —14-
kRNELL
NAME: STEPHEN Y NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: / / 61 DATE: 9/3/19
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
DUNS: 076997790 Approved as to form and legality
Assn t County Attornc
1
July 2018–June 2019 ADI 203.18.005 16 D 5
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR, as revised, and Section 215.97,F.S.require that the information about Federal Programs and State
Projects included in Attachment II,Exhibit 1 be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD (FAIN#): FEDERAL AWARD DATE:
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200–Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133–Audits of States,Local Governments, and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheimer's Disease Initiative General Revenue—TSTF-Collier 65004 $ 476,365.68
TOTAL AWARD $ 476,365.68
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97&215.971,F.S.,Chapter 69I-5,F.A.C,State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
2
July 2018 —June 2019
ADI 203.18.005 16 D 5
ATTACHMENT X
ANNUAL BUDGET SUMMARY
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
For
Collier County Board of County Commissioners
Collier
ALLOCATION TOTAL $ 476,365.68
Ude
3
Revised August 2007 16 D 5
Attestation Statement
Agreement/Contract Number ADI 203.18
Amendment Number 005
I, Stephen Y Carnell , attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of 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.
- '14-LjLtA-04-5 VA/iCi
Signature of Recipient/C tractor representative Date
Approved as to form and legality
assistant County ttorney
Revised August 2007
July 2018 —June 2019 HCE 203.18.005 16 p 5
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
HOME CARE FOR THE ELDERLY
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and Collier
County Board of County Commissioners, ("Contractor"), amends agreement HCE 203.18.
The purpose of this amendment is to increase 4. Contract Amount with the final allocation for the 2018-2019 contract year
by: $5,459.80 and revise ATTACHMENT II-Exhibit 2 and ATTACHMENT IX-Annual Budget Summary.
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 $64,539.80, 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.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF, the Parties hereto have caused this amendment, to be executed by their undersigned officials as duly
authorized; and agree to abide by the terms,conditions and provisions of this HCE contract as amended.
CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING FOR
BOARD OF COUNTY COMMISSOERS SOUTHWEST FLORIDA,INC.
SIGNED BY: `7-'').6.4/ � -6L_ SIGNED BY: >741114.414:40...
0� �
NAME: STEPHEN Y. CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: $l Z8 / I q DATE: q/3//g
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30 Approved as to form and legality
DUNS: 076997790
yssistant Cou itti Attorney `-X)''
July 2018—June 2019 HCE 203.18.003 16 D 5
ATTACHMENT II-EXHIBIT
2 FUNDING SUMMARY
Note:Title 2 CFR,as revised, and Section 215.97,F.S. require that the information about Federal Programs and State
Projects included in Attachment II,Exhibit 1 be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): FEDERAL AWARD DATE:
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200—Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
OMB Circular A-133—Audits of States,Local Governments, and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST
OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Home Care for the Elderly General Revenue-Collier 65.001 $ 64,539.80
TOTAL AWARD $ 64,539.80
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
Sections 215.97&215.971,F.S.,Chapter 69I-5,F.A.C, State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
2
July 2018—June 2019 HCE 203.18.003 16 D 5
ATTACHMENT IX
ANNUAL BUDGET SUMMARY
1. HCE Services (Subsidies &
Case Management) Collier $ 64,539.80
Total $64,539.80
3
Revised August 2007 16 D 5
Attestation Statement
Agreement/Contract Number HCE 203.18
Amendment Number 005
I, Stepehn Y. Carvell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of 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.
5v2i iq
Signature of Recipi t/Contractor representative Date
Li
Approved as to form and legality
,
Assistant County 1:14rncy
S VAC°\��
Revised August 2007
[19-GRC-00833/1493987/1]
CA