Backup Documents 02/09/2021 Item #16D3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 3
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 Irk 02/09/2021
Services
2. Minutes & Records Clerk of Court's Office 01-1 ( df
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 02/09/2021 Agenda Item Number I 6D3
Approved by the BCC
Type of Document Amendment 203.20.006 Number of Original
Attached Documents Attached
PO number or account NA
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 02/09/2021 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. if
9. Initials of attorney verifying that the attached document is the version approved by the WK is"
BCC,all changes directed by the BCC have been made, and the document is ready for the ;c p
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
1 6 D 3
January—December 2020 OAA 203.20.006
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 change allocations for OA3B,0A3C1,0A3C2,OA3E, OA3ES,OA3EG,and NSIP by
amending 4. Contract Amount;revise section I. Method of Payment,B. Unit of Service,2. Fixed Rates for NSIP
Program;add services to 3E;revise ATTACHMENT II-EXHIBIT 2-Funding Summary; and revise ATTACHMENT IX
BUDGET AND RATE 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$1,555,600.66 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
I. METHOD OF PAYMENT
B. Unit of Service
2. Fixed Rates for NSIP Program
Payments for NSIP Fixed rate shall not exceed the unit rate of service identified below:
Service to be Provided Unit of Service Unit Rate
Eligible Congregate and Home Delivered Meals 1 unit= 1 meal $.72
COLLIER
Service to be Provided Unit of Service Unit Rate Maximum Units Allocation
Eligible Congregate and 1 unit= 1 meal $.72 72,427 $52,147.74
Home Delivered Meals
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.
(07;1)
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January_December 2020 OAA 203.20.006
iN \VITNESS THEREOF, the Pasties 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 executed upon having been signed by both Parties, but the effective date of this amendment will be
November 1,2020.
Contractor:COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY COMMISSIONERS SOUTI-W`F+ST FLORIDA,IN'
SIGNED ---- SIGNED
BY �
NAME: JAMES C FRENCH NAME: NORMA ADCKNO
TIT!.L: pUBLIC SERVICE DEPARTMENT I[BAD TITLE: CEO
DATE:
01/ /2021 DATE: 13-2,62.1
Federal Tax ID:59-6000558
Fiscal Year Ending Date:09./30
Duns: 076997790
Approved as to form and legality
Assi ant County AM ey
2
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January—December 2020 OAA 203.20.006
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR§200331, as revised,and Section 21597(5),F.S.,require that the information about federal programs and StateProjects be
provided to the Recipient and are stated in The Financial And Compliance Audit Attachment II,Exhibit 1 provided to the recipient. Information
contained herein is a prediction offundingsourcesand 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 IIIB—
Transportation U.S.Health and Human Services 93.044 $ 2,522.88
Support Services $ 182,446.77
Total IIIB $ 184,969.65
OAA Title IIIC1 —Congregate Meals U.S.Health and Human Services 93.045 $ 638,262.88
Total IIICI
OAA Title III C2—Home Delivered Meals U.S.Health and Human Services 93.045 $ 285,493.28
Total IIIC2
Older Americans Act Title III E
Services(Title III E) 93.052 $ 160,592.68
Supplement Services(Title III ES) U.S. Health and Human Services $ 16,407.94
Grandparent Services(Title III EG) $ 7,057.23
Total HIE $ 184,057.85
Nutrition Services Incentive Program(NSIP) U.S.Health and Human Services 93.053 $ 52,147.74
Family First Act U.S.Health and Human Services 93.045 $ 85,890.16
COVID-19 Congregate Meals**
Family First Act U.S.Health and Human Services 93.045 $ 124,779.10
COVID-19 Home Delivered Meals**
TOTAL FEDERAL AWARD $1,555,600.66
**Effective April 1,2020
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 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
3644,
16D3
January—December 2020 OAA 203.20.006
ATTACHMENT IX
BUDGET AND RATE SUMMARY
OLDER AMERICANS ACT BUDGET SUMMARY
COLLIER COUNTY
1. Title III B Support Services $ 184,969.65
2. Title III Cl Congregate Meals** $ 638,262.88
3. Title III C2 Home Delivered Meals** $ 285,493.28
4. Title III E Services $ 184,057.85
5. NSIP $ 52,147.74
6. COVID-19 C1** $ 85,890.16
7. COVID-19 C2** $ 124,779.10
TOTAL $ 1,555,600.66
** Effective April 1,2020: All current Cl clients will be converted to the COVID-19 Cl funds for their meals.
** Effective April 1,2020: All current C2 clients will be converted to the COVID-19 C2 funds for their meals.
** Effective April 1,2020: All new clients will be added to the COVID-19 C2 funds for their meals. All new 60+
and Adults with disabilities receiving meals(Must have a 701C completed).
4
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January—December 2020 OAA 203.20.006
ATTACHMENT IX
BUDGET AND RATE SUMMARY
COLLIER COUNTY
IIIE,IIIES,&MEG
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE
IIIE-- ADULT DAY CARE $12.76 Fixed Fee/Unit Rate HOURS
RESPITE IN-HOME $23.27 Fixed Fee/Unit Rate HOURS
RESPITE IN-FACILITY $11.05 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS Cost Reimbursement 100%of Cost EPISODE
(EMERGENCIES ONLY)
SCREENING&ASSESSMENT $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE $34.12 Fixed Fee/Unit Rate ONE-WAY
TELEPHONE REASSURANCE $13.40 Fixed Fee/Unit Rate EPISODE
CASE MANAGEMENT $54.00 Fixed Fee/Unit Rate HOURS
EMERGENCY ALERT RESPONSE $ 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
TRANSPORTATION Cost Reimbursement 100%of Cost TRIPS
TRANSPORTATION TO MEAL SITE Cost Reimbursement 100%of Cost TRIPS
FOR MANAGED LONG-TERM
CARE CLIENTS
IIIES--CHORE $22.29 Fixed Fee/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
5
Revised August 2007 1 6 0 3
Attestation Statement
Agreement/Contract Number OAA 203.20
Amendment Number,006
I,JAMES C FRENCH ,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.
/— 5 — /
Signature of Recipient/Contractor representative Date
Approved as to form and legality
Ass'sTant County Attorn
Revised August 2007
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