Backup Documents 04/28/2020 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 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. ll�cotnpll4trouting slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting. L E-i L1
**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 Coun Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human voK, 04.28.20
Services
2. Minutes and Records Clerk of Court's Office 7$14 4.40
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 04.28.2020 Agenda Item Number 16D5
Approved by the BCC
Type of Document 5 Amendments: CCE,ADI,HCE, OAA& Number of Original 5
Attached EHEAP 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. rr (Initial) Ap licable)
1. Does the document require the chairman's original signature? f,l i n tar Rewid RJrr NA
2. Does the document need to be sent to another agency for additional signa[fures? 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 fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's WK
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 04.28.2020 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 :p ler
I 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
16Q5
Amendment .001 OAA 203.20.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT TITLE III
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 OAA 203.20.
The purpose of this amendment is to correct Collier County's Federal Tax ID and DUNS Number on the Signature Page 15 of
the Contract.
The Federal Tax ID as well as the DUNS # on the signature page, page 15, of the contract should read as follows:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
DUNS: 076997790
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 OAA contract as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY 0 MI STONERS
1110 SOUTHWEST FLORIDA,INC.
SIGNED BY: Le. SIGNED BY: !( �
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICE ADMINISTRATOR TITLE: PRESIDENT/CEO
DATE: 02(pt`992020 DATE: 9/-20
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30 Approved as to form and legality
DUNS: 076997790 r i •P 0a9
Assi's�,mt County ' orney
1 '�-�
16D5
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.20
Amendment Number,001
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.
N ////#' /,.;z
' 1
Signature of Recipient/Contractor representative Date
Approved as to form and legality O
Assistant County Attt ►ry c)0��
19
ZN
Revised August 2007
(ID
1605
July 2019 to June 2020 CCE 203.19.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
COMMUNITY 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 CCE 203.19.
The purpose of this amendment is to correct Collier County's Federal Tax ID below the signature area of the Contract.
The Federal Tax ID below the signature area of the Contract should read as follows:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
DUNS: 076997790
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 WHEREOF, the Parties hereto have caused this amendment to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING FOR
BOARD OF _$ N�Y COMMISSIONERS SOUTHWEST FLORIDA,INC.
wAkSIGNED BY: lio- i,, 4,�)I SIGNED BY: ' (0...<.Le. o
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: 02/ 6/2020 DATE: ,--)VIY'C
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
Approved as to form and legality
lAss Cant County At 'lky
1605
Revised August 2007
Attestation Statement
Agreement/Contract Number CCE 203.19
Amendment Number .001
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 far changes hi page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
02n8r2020
Signatur l of Reci nt/Contractor representative Date
1i
Approved as to form and legality
Assis ant County Au"
Revised August 2007
o47
0
1605
July 2019 to June 2020 ADI 203.19.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM STANDARD CONTRACT
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 AD1 203.19.
The purpose of this amendment is to correct Collier County's Federal Tax ID below the signature areas of the Contract and
Amendment.001.
The Federal Tax ID below the signature areas of the Contract and Amendment#.001 should read as follows:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
DUNS: 076997790
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 WHEREOF,the Parties hereto have caused this amendment to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING FOR
BOARD OF C T COMM(I�.SIOL ERS SOUTHWEST FLORIDA,INC.
SIGNED BY: I.r° r/i SIGNED BY: '2722.4°_./ ,O-•^-.&Q
NAME: STEPHEN Y CARNELL NAME: MARIANNE 0 LORINI
TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: 02/,_,;/2020 DATE: Si 9/2 U
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
Approved as to tbrm and legality
1
A Stant County ey
C.0
1605
Revised August 2007
Attestation Statement
Agreement/Contract Number ADI 203.19
Amendment Number .002
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.
�� , • 02/28/2020
Signat.re of Recipient/Co ractor representative Date
Approved as to form and legality
Assis ant County Attu%
Revised August 2007
i
16D5
July 2019 to June 2020 HCE 203.19.001
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 203.19.
The purpose of this amendment is to correct Collier County's Federal Tax ID below the signature area of the Contract.
The Federal Tax ID below the signature area of the Contract should read as follows:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
DUNS: 076997790
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 WHEREOF, the Parties hereto have caused this amendment to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING FOR
BOARD OF C!!`-;TY1 OMMI IONERS SOUTHWEST FLORIDA,INC.
SIGNED BY: .4 �I 45) SIGNED BY: J-Le
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: PRESIDENT/CEO/
DATE: 02/� '/2020 DATE: 3/ 9e0
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
Approved as to form and legality
1 Ass nt County Alto
1605
Revised August 2007
Attestation Statement
Agreement/Contract Number HCE 203.19
Amendment Number,001
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.
•
pro / 02/28/2020
Signatur of Recip' t/Contractor representative Date
Approved as to form at d legality
A—At A
Ass' ant County Att•y
Revised August2007
1bp5
July 2019 to June 2020 EHEAP 203.19.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
EMERGENCY HOME ENERGY ASSISTANCE 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 EHEAP 203.19.
The purpose of this amendment is to correct Collier County's Federal Tax ID below the signature area of the Contract.
The Federal Tax ID below the signature area of the Contract should read as follows:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
DUNS: 076997790
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 WHEREOF,the Parties hereto have caused this amendment to be executed by their undersigned officials
as duly authorized.
. CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING FOR
BOARD OF C S TY COMMISSIr NERS SOUTHWEST FLORIDA,INC.
SIGNED BY: I .! 7 SIGNED BY: _ , ,�2.4 r1✓cs
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: 02/:;,p2020 DATE: e?/20
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
Approved as to form and legality
1 Assistant County ley
1bD5
Revised August 2007
Attestation Statement
Agreement/Contract Number EHEAP 203.19
Amendment Number,,C01
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.
G" 02/28/2020
Si nature of RecipientlContractot•representative Date
gP
Approved as to form and legality
A.
!Pi stnmt County Att�•y
Revised August 2007