Backup Documents 01/12/2021 Item #16D 7 ORIGINAL DOCUMENTS CHEMUSViSciROLITING SLIP ,16 p 7
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 JY° , 01.21.21
Services
2. Minutes & Records Clerk of Court's Office MJ l Ia ,f l
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PRIMARY CONTACT INFORMATION Er'
1
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of*
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf/CHS Phone Number 252-2901 sa
Contact/ Department
Agenda Date Item was 01/12/2021 Agenda Item Number 16D7
Approved by the BCC
Type of Document AAA-OAA CARES 203.20.004 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? WK
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 WK
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 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 01.12.21 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. Q'
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
1 6 D 7
(April 2020—September 2021) CARES 203.20.004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
CARES ACT 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 CARES 203.20.
The purpose of this amendment is to add services to CA3E;and revise ATTACIIMENT VIE CARES BUDGET
AND RATE SUMMARY.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and arc hereby changed
to conform to this Amendment.
All provisions not in conflict with Ibis 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 TI IF.RP.OF,the Parties herein 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 November I,2020 upon having been duly signed by both Parties.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY COM ISSIONERS SOUTHW .ST FLORIDA.INC.
SIGNED BY: l � ' 11 (� �C % !�'' SIGNED BY:
i I'
NAME: STFPIIEN V CARNELL NAME: NORMA ADORNO
'ITI'LE:PUBLIC SERVICE DEPARTMENT HEAD TITLE: CEO s�
DATE: 12r 2( /21120 DATE: k- I.3" 9--v'r
Federal Tax ID: 59-6000558
Fiscal Yenr Ending Date: 09/30
Approved as to form and legality
Assistant Count ttorncy
1
� 6D7
(April 2020--September 2021) CARES 203.20.004
ATTACHMENT VII
CARES ACT BUDGET AND RATE SUMMARY
COLLIER
Illll
SERVICE REIMBURSEMENT METHOD OF UNIT UNIT RATE PAYMENT TYPE
CASE MANAGEMENT $54.00 Fixed Fee/Unit Rate HOURS
CHORE $22.29 Fixed Fee/Unit Rate HOURS
EMERGENCY ALERT $ 1.35 Fixed Fee/Unit Rate • DAYS
HOMEMAKER $22.55 Fixed Fee/Unit Rate HOURS
HOUSING IMPROVEMENT Cost Reimbursement 100%of Cost EPISODE
MATERIAL AID Cost Reimbursement 100%of Cost EPISODE
PERSONAL CARE $23.48 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS Cost Reimbursement 100%of Cost EPISODE
(EMERGENCIES ONLY)
RESPITE IN -HOME $23.27 Fixed Fee/Unit Rate HOURS
SKILLED NURSING SERVICES $38.06 _Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE $34.12 Fixed Fee/Unit Rate-ONE-WAY TRIPS
SPECIALIZED MEDICAL
EQUIPMENT, SERVICES, Cost Reimbursement 100%of Cost EPISODE
AND SUPPLIES
TELEPHONE REASSURANCE $13.40 Fixed Fee/Unit Rate EPISODE
TRANSPORTATION Cost Reimbursement 100%of Cost TRIPS
2
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16 ?
(April 2020—September 2021) CARES 203.20.004
ATTACHMENT VII
CARES ACT BUDGET AND RATE SUMMARY
COLLIER COUNTY
IIIE,HIES, & IIIE(;
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE
IIIE-- ADULT DAY CARE S12.76 Fixed Fee/Unit Rate FLOURS
RESPITE IN-HOME S23.27 Fixed Fee/Unit Rate HOURS
RESPITE 1N-FACILITY $11.05 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS Cost Reimbursement 100%of Cost EPISODE
(EMERGENCIES ONLY)
SCREENING & ASSESSMENT r $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE $34.12 Fixed Fee/Unit Rate ONE-WAY
TELEPHONE REASSURANCE $1 3.40 Fixed Fee/Unit Rate EPISODE
CASE MANAGEMENT S54.00 Fixed Fee/Unit Rate HOURS
EMERGENCY ALERT $ 1.35 Fixed Fee/Unit Rate DAYS
HOMEMAKER $22.55 Fixed Fee/Unit Rate HOURS
PERSONAL CARE $23.48 Fixed Fee/Unit Rate HOURS
SKILLED NURSING SERVICES $38.06 Fixed Fee/Unit Rate HOURS
TRANSPORTA IION Cost Reimbursement 100%of Cost TRIPS
IIIES--CHORE $22.29 Fixed Fec/Unit Rate HOURS
HOUSING IMPROVEMENT Cost Reimbursement 100%of Cost EPISODE
Specialized Medical Equipment, Cost Reimbursement 100%of Cost EPISODE
Service& Supplies
MATERIAL AID Cost Reimbursement 100%of Cost EPISODE
IIIEG--CHILD DAY CARE $15.00 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS Cost Reimbursement 100%of Cost EPISODE
(EMERGENCIES ONLY)
SCREENING AND ASSESSMENT $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE $34.12 Fixed Fee/Unit Rate ONE-WAY TRIPS
TELEPHONE REASSURANCE $13.40 Fixed Fee/Unit Rate EPISODE
3
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I'4 6
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1607
(April 2020— September 2021) CARES 203.20.004
ATTACHMENT V I I
CARES ACT BUDGET AND RATE SUMMARY
C-1 & C-2
COLLIER COUNTY
C-1 & C-2
SERVICE REIMBURSEMENT UNIT TYPE
UNIT RATE
Cl --CONGREGATE MEALS $11.72 MEALS
HOME DELIVERED MEALS $ 8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
CONGREGATE MEAL SCREENING $28.00 HOUR
OUTREACH $4.32 PER PERSON EPISODE
RECREATION MATERIALS Cost Reimbursement-100% EPSIODE
(EMERGENCIES ONLY)
SHOPPING ASSISTANCE $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE $13.40 EPISODE
SERVICE REIMBURSEMENT UNIT TYPE
UNIT RATE
C2 —HOME DELIVERED MEALS $ 8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
SCREENING & ASSESSMENT $48.76 HOUR
OUTREACH $4.32 PER PERSON EPISODE
RECREATION MATERIALS Cost Reimbursement-100% EPSIODE
(EMERGENCIES ONLY)
SHOPPING ASSISTANCE $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE $13.40 EPISODE
4
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1607
Revised August 2007
Attestation Statement
Agreement/Contract Number CARES 203.20
Amendment Number .004
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 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.
cy ,,,
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Signature of Recipient/C'ohtractor representative Date
Approved as to form and legality
Cl,--••(-U —
As !slant Countyontr
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Revised August 2007