Backup Documents 06/23/2020 Item #16D 9ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1609
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 # I through #2 complete the checklist and forward to the Coun Attome Office
Route to Addressees (List in routing order)
Office
Initials
Date
1. Wendy Klopf
Community and Human
Services
Vole
06/23/20
2. Minutes and Records
Clerk of Court's Office
y:2�p�
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
06/23/20
Agenda Item Number
16139
Approved by the BCC
Type of Document
Amendment CCE 203.19.002
Number of Original
1 each
Attached
Amendment HCE 203.19.002
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
aDDrODriate.
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
rovide 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
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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
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sip -nature 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 06.23.20 and all changes made during
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the meeting have been incorporated in the attached document. The County
Attorne 's Office has reviewed the changes, if applicable.
9.
Initials of attorney verifying that the attached document is the version approved by the
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it
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
1609
July 2019 to June 2020 CCE 203.19.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
TEAS 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 add Shopping Assistance and Telephone Reassurance services; revise
ATTACHMENT I and ATTACHMENT XII SERVICE RATE REPORT.
1. ATTACHMENT I, Section I1.D. I .a. 12 & 14, is hereby added:
12) Shopping Assistance — CO V I D-19
14) Telephone Reassurance—COVID-19
2. Client Call Tracker Spreadsheet provided by the Area Agency will be used for maintaining records for
Telephone Reassurance.
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. The Telephone Assurance and Shopping Assistance is effective as of April I, 2020.
IN WITNESS WHEREOF, the Parties hereto have caused this contract to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD
OF COUNTY C MI STONERS
SIGNED BY:
NAME: STEPHEN Y CARNELL
TITLE: PUBLIC SERVICE DEPARTMENT HEAD
DATE: 05/ ZZ. /2020
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
SIGNED BY: �Lut.i
NAME: MARIANNE G LORINI
TITLE: PRESIDENT/CEO
DATE: 0 -5 2 z/.g-o �v
Approved as to forni and legality
C'
Ass S unt Co-untyAtt icy
1609
July 2019 to June 2020
ATTACHMENT' XII
SERVICE RA'I'E REI'ORT
Rate Stnn►nary
Collier County Board of County Commissioners
CCE 203.19.002
SERVICE
SFY 19/20
REIMBURSEMENT
UNIT RATE
METHOD OF
PAYMENT
UNIT
TYPE
ADULT DAYCARE
$14.09
Fixed Fee/Unit Rate
HOURS
CASE AIDE
$30.50
Fixed Fee/Unit Rate
HOURS
CASE MANAGEMENT
$54.00
Fixed Fee/Unit Rate
HOURS
CHORE
$21.77
Fixed Fee/Unit Rate
HOURS
CHORE (ENHANCED)
36.00
Fixed Fee/Unit Rate
HOURS
COMPANIONSHIP
$21.00
Fixed Fee/Unit Rate
HOURS
EMERGENCY ALERT RESPONSE
$ 1.35
Fixed Fee/Unit Rate
DAYS
ESCORT
$19.50
Fixed Fee/Unit Rate
TRIPS
HOME DELIVERED MEALS
$ 7.00
Fixed Fee/Unit Rate
MEALS
HOMEMAKER
$24.28
Fixed Fee/Unit Rate
HOURS
HOUSING IMPROVEMENT
Cost Reimbursement
Cost Reimbursement
EPISODE
MATERIAL AID
Cost Reimbursement
Cost Reimbursement
EPISODE
OTHER SERVICES
Cost Reimbursement
Cost Reimbursement
EPISODE
PERSONAL CARE
$25.16
Fixed Fee/Unit Rate
HOURS
PEST CONTROL (Maintenance)
$50.00
Fixed Fee/Unit Rate
EPISODE
PEST CONTROL (Initiation)
$150.00
Fixed Fee/Unit Rate
EPISODE
RESPITE IN - FACILITY
$10.29
Fixed Fee/Unit Rate
HOURS
RESPITE IN - HOME
$22.51
Fixed Fee/Unit Rate
HOURS
SHOPPING ASSISTANCE—COVID-19**
$34.12
Fixed Fee/Unit Rate
ONE WAY TRIPS
SKILLED NURSING SERVICES
$40.26
Fixed Fee/Unit Rate
HOURS
SPECIALIZED MEDICAL EQUIPMENT,
SERVICES AND SUPPLIES
Cost Reimbursement
Cost Reimbursement
EPISODE
TELEPHONE REASSURANCE—COVID-19**
$13.40
Fixed Fee/Unit Rate
EPISODE
TRANSPORTATION
Cost Reimbursement
Cost Reimbursement
TRIPS
*Effective April 1, 2020. I'lease note, these two services arc temporary and will be ►•eevaluated once the Governor's
Executive Order has been lifted.
G<<
1609
Revised August 2007
Attestation Statement
Agreement/Contract Number CCL 203.19
Amendment Number _002
1, Stephen Y Carrell , attest that no Changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or an►enchnent behveen the Area Agency on Aging for
Southwest Florida and
Collier County Board of Commissioners
(Recipient/Cm►traclor name)
The only exception to this statement would be for changes in page formatting, (file to the differences in
electronic data processing media, which has uo affect on the agreement/contract content.
A4 r - S- 1 ZZ Zola
Signature of Recipient/ 011tractor representative Date
Approved as to form and legality
As 'tart County Allo ICY
Revised August 2007
1609
July 2019 to June 2020
HCE 203.19.002
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 i-ICE 203.19.
The purpose of this amendment is to add Shopping Assistance and Telephone Reassurance services; revise
ATTACHMENT I and ATTACHMENT XIV SERVICE RATE REPORT,
1. ATTACHMENT I, Section II.C.I.b. 22-23, is hereby added:
22) Shopping Assistance—COVID-19
23) Telephone Reassurance—COVI D- 19
2. Client Call Tracker Spreadsheet provided by the Area Agency will be used for maintaining records for Telephone
Reassurance.
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. The Telephone Assurance and Shopping Assistance is effective as of April 1, 2020.
IN WITNESS WHEREOF, the Parties hereto have caused this contract to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD
OF COUNTY 7z'
ONERS
1
SIGNED BY:
NAME: STEPHEN Y CARNELL
TITLE: PUBLIC SERVICE DEPARTMENT HEAD
DATE: 05/ 2Z/ 2020
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
SIGNED BY: //a&/ A� (575 &UA-t.
NAME: MARIANNE G LORINI
TITLE: PRESIDENT/CEO
DATE: V 5�0?- o -0az>
ApprCovcd as to form and legality
A istant County ACounn y A t��y
i
1609
July 2019 to June 2020
ATTACHMENT XIV
SERVICE, RATE REPORT
Collier
HCE 203.19.002
SERVICE
SFY 19/20
REIMBURSEMENT
UNIT RATE
METHOD OF
PAYMENT
UNIT
TYPE
BASIC SUBSIDY
Cost Reimbursement
Cost Reimbursement
EPISODE
CASE AIDE VENDOR
$33.88
Fixed Fee/Unit Rate
HOURS
CASE MANAGEMENT- VENDOR PAYMENT
$60.00
Fixed Fee/Unit Rate
HOURS
HOMEMAKING —VENDOR PAYMENT
$21.50
HOUSING IMPROVEMENT - HCE
Cost Reimbursement
Cost Reimbursement
EPISODE
HOUSING IMPROVEMENT -VENDOR PAYMENT
Cost Reimbursement
Cost Reimbursement
EPISODE
MATERIAL AID
Cost Reimbursement
Cost Reimbursement
EPISODE
OTHER -BACKGROUND SCREEN —VENDOR
$41.25
Fixed Fee/Unit Rate
HOURS
PERSONAL CARE —VENDOR
$25.67
Fixed Fee/Unit Rate
HOURS
RESPITE -VENDOR PAYMENT
$25.02
Fixed Fee/Unit Rate
HOURS
SHOPPING ASSISTANCE —COVID-19**
$34.12
Fixed Fee/Unit Rate
ONE WAY
TRIPS
SPECIALIZED MEDICAL EQUIPMENT, SERVICES, AND
SUPPLIES
Cost Reimbursement
Cost Reimbursement
EPISODE
SPECIALIZED MEDICAL EQUIPMENT, SERVICES, AND
SUPPLIES - VENDOR PAYMENT
Cost Reimbursement
Cost Reimbursement
EPISODE
TELEPHONE REASSURANCE —COVID-19**
$13.40
Fixed Fee/Unit Rate
EPISODE
TRANSPORTATION
Cost Reimbursement
Cost Reimbursement
TRIPS
*Effective April 1, 2020. Please note, these two services ac•e temporary and will be reevaluated once the Governor's
Executive Order has been lifted.
1609
Revised August 2007
Attestation Statement
Agreement/Contract Number HCE 203.19
Amendment Number _002
1, Steuhen Y Carrell , attest that no changes or revisions have been matte 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)
'File only exception to this statement would be for changes in page formatting, clue to the differences in
electronic data processing media, which has no affect oil the agreement/contract content.
,(W . S(2�
Signature of Recipient/Contractor representative Date
Approved as to form and legality
start County irnry
Revised August 2007