Backup Documents 05/12/2020 Item #16D 2 13
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6
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 05.12.20
Services
2. Minutes and Records Clerk of Court's Office
1114) Skt11,0W lo=S.9
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 05.12.20 Agenda Item Number 16D2
Approved by the BCC
Type of Document Amendment 203.20.002 Number of Original 1
Attached 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 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 05.12.2020 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 N/A i
BCC,all changes directed by the BCC have been made,and the document is ready for the an INT
Chairman's signature. this line. _
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
16D 2
Amendment .002 OAA 203.20.002
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 move funding from OA3E to OA3ES. The total Contract Amount for Collier County
will remain the same. Funding allocations for OA3E will be decreased by$40,000.00; and allocations for OA3ES will be
increased by $40,000.00;revise ATTACHMENT II-EXHIBIT 2-Funding Summary; and ATTACHMENT IX BUDGET
AND RATE SUMMARY will not change.
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 April 1, 2020.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY C. ISS ONERS SOUTHWEST FLORIDA, INC.
VAT ./
SIGNED BY: 4 ?ell' SIGNED BY: .-7,.."4 .4.1.A.A-r "A1,'�X..
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICE ADMINISTRATOR TITLE: PRESIDENT/CEO
y/y-24.26
DATE. 041 x/2020 DATE:
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09130
DUNS: 076997790
Approved as to form and legality
Astunt County �mcy
' 9`)} oav
I
0
1611 2
Amendment .002 OAA 203.20.002
ATTACHMENT 1I-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR§200331, as revised,and Section 215 97(5),F.S.,require that the information about federal programs and State
Projects bep'ovided tothe Recipient and are stated in The Financial And Compliance Audit Attachment II, Exhibit I provided to the
recipient. Information contained herein is a prediction offmding=roes and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD (FAIN#): 2001FLOASS,2001 FLOACM,2001FLOAHD,2001FLOAPH, 2001FLOAFC
DUNS NUMBER :076997790 FEDERAL AWARD DATE: OCTOBER 01,2019
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title 11113—
Transportation $ 9,863.90
Support Services U.S. Health and Human Services 93.044 $ 375,156.79
Total IIIB $ 385,020.69
OAA Title IIICI —Congregate Meals U.S. Health and Human Services 93.045 $ 341,322.29
Total IIICI
OAA Title[II C2—Home Delivered Meals U.S. Health and Human Services 93.045 $ 301,442.67
Total I1IC2
Older Americans Act Title III E
Services(Title III E) 93.052 $ 96,240.61
Supplement Services(Title III ES) U.S. Health and Human Services $ 53,951.15
Grandparent Services(Title III EG) $ 6,000.55
Total IIIE $ 156,192.31
Nutrition Services Incentive Program(NSIP) U.S. Health and Human Services 93.053 $ 46,737.03
TOTAL FEDERAL AWARD $1,230,714.99
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200Uniform 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.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL.ASSISTANCE
Section 215.97&215.971,F.S.,Chapter 691-5,F.A.C.,State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
2
C
1611 2
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.20
Amendment Number.002
1, STEPHEN Y CARNEI.r. ,attest that no changes or revisions have been made to
the(Recipient/Contractor representati%c)
content of the above referenced agreement/contract or amendment between the Arca Agency on Aging for
Southwest Florida and
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
V .1 Li
Signature o Recipientntractor representative Date
Approved as to form and legality
C
v
o
p"•istant Count �tturnry �)"
up
l , \lD
bc
Revised August 2007
0