Backup Documents 04/13/2021 Item #16D4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP ee /i
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO V `�
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human 6Jf
Services \k 6)
2. Minutes & Records Clerk of Court's Office y./bpr,
3.
4.
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/ Dept lment
Agenda Date Item was 04/13/2021 Agenda Item Number 16D4
Approved by the BCC
Type of Document Amendment CARES 203.20.005 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? 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
L.11
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.
"Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NA
1.11 signature and initials are required.
--4 7. In most cases(some contracts are an exception),the original document and this routing slip NA
^�J 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 04/13/2021 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.
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.
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
1 604
(April 2020—September 2021) CARDS 203.20.005
AREA AGENCY ON AGING FOR SOUTHWEST le1.0RI I)A,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 Hoard of County Commissioners("Contractor")amends agreement CARES 203.20.
The purpose of this amendment is to transfer S60,000 funding from Collier County C I to Collier County C2;revise
ATTACHMENT II-EXHIBIT 2-Funding; Summary; and revise ATTACHMENT VII CARES BUDGET AND RATE
SUMMARY.
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.
'Phis Amendment and all its attachments arc hereby made part of the contract.
IN WEI'NHtiti .11-1FR EDF,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 February 16,2021 upon having been duly signed by both Parties.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON ACING FOR
COUNTY COMM_y STONERS S011'I'HWE•:S'I' FI.OItll)A, INC.
SIGNED BY: tiTCiNF;I)t3Y:
NAMF IAMF r' FRPNCta NAME: JVORMA ADORNO
TITLE:PI II I It'SFR VICP rWFPA RTMPNT I-1PAfl Ti'I'LE: CFO
DATF- 03/08 /2021 DATE: 3 `1,0- Z_Z t
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Appmvcd as to form and legality
AT KST
CRYSTAL K.KINZEL,CLERK
Istant County Attar y \
RY: Nct
1 6 D 4
(April 2020—September 2021) CARES 203.20.005
ATTACHMENT II-
EXHIBIT 2 FUNDING
SUMMARY
Note: Title 2 CFR, as revised,and Section 215.97, F.S.,require that the information about Federal Programs and
State Projects included in Attachment II,Exhibit 1,be provided to the recipient. Information contained herein is a
prediction of funding sources 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#): 2001FLSSC3,2001FLHDC3,2001FLFCC3 FEDERAL AWARD DATE:
04/20/2020
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
CARES Act for Supportive Services under
Title III-B of the Older Americans Act
Transportation U.S. Health and Human Services 93.044 $ 3,581.10
Support Services $ 136,215.14
Total CARES IIIB $ 139,796.24
CARES Act for Nutrition Services under
Title III-C1 of the Older Americans Act U.S. Health and Human Services 93.045 $ 332,812.67
Total CARES IIIC1
CARES Act for Nutrition Services under
Title III-C2 of the Older Americans Act U.S. Health and Human Services 93.045 $ 191,493.21
Total CARES IHC2
CARES Act for Family Caregiver Support
Program under Title III-E of the Older
Americans Act
Services (Title III E) U.S. Health and Human Services 93.052 $ 84,701.90
Supplement Services (Title III ES) $ 8,654.09
Grandparent Services (Title III EG) $ 3,722.22
Total CARES IIIE $ 97,078.21
TOTAL FEDERAL AWARD $ 761,180.33
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200—Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards. OMB Circular A-133—Audits of States,Local Governments, and Non-Profit Organizations
2
1 604
(April 2020—September 2021) CARES 203.20.005
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
TOTAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 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
3
1 6D4
(April 2020—September 2021) CARES 203.20.00 "
ATTACHMENT VII
BUDGET AND RATE SUMMARY
CARES ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
1. CAM B Support Services $ 139,796.24
2. CAIII Cl Congregate Meals $ 332,812.67
3. CAIII C2 Home Delivered Meals $ 191,493.21
4. CAME,ES,&EG Services $ 97,078.21
TOTAL $ 761,180.33
4
1604
Revised August 2007
Attestation Statement
Agreement/Contract Number CARES 203.20
Amendment Number,005
I, ,TAMES 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.
03/8 /2021
Sign re of Recipient/Contractor representative Date
ATTEST Approved as to form and legality
CRYSTAL K.KINZEL,CLERK
BY: Assistant County Attorn�k .
v 31ci` �
Revised August 2007