Backup Documents 05/11/2021 Item #16D2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D 2
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 J1,
Services
2. Jennifer Belpedio County Attorney's Office /,�,P IA
3. Minutes & Records Clerk of Court's Office `� '
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/ Department
Agenda Date Item was 05.11.2021 Agenda Item Number 16D2
Approved by the BCC
Type of Document EHEAP Amendment 203.19.004 Number of Original 1
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? S- AVVY 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 NA
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 05.11.2021 and all changes made WK
during 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
1602
October 2019—March 2021 El-lEAP 203.19.004
AREA AGENCY ON ACING FOR SOUTHWEST FLORIDA, INC.
EMERGENCY HOME ENERGY ASSISTANCE 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 EHEAP 203.19.
The purpose of this amendment is to decrease allocation funding by amending 4. Contract Amount; decrease
allocations by$14,920.00;revise A'I EACHMENT II—EXHIBIT 2 and ATTACHMENT IX ANNUAL BUDGET
SUMMARY AND DETAIL.
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$36,628,22 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.
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 al the level specified in the
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS TI IEREOF,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 EHEAP contract as amended.
This Amendment is effective on April 1,2021 after it has been signed by both Parties.
IN WITNESS WHEREOF,the Parties hereto have caused this contract to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD AREA AGENCY ON ACING FOR
OF'COUNTY-COMMMISSIONERS SOUTHWEST FLORIDA,INC.
SIGNEDtBY"!-` "'�`"� -- _`_ _ SIGNED
NAME: JAMF.S C FRENCH NAME: NORMA ADORNO
TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: CEO
DATE: 04/C'1/2021 I)A'I'E: Li!8- 2 021
Federal Tax ID: 59-6000558
Fiscal Year Ending Date:09/30
Duns: 076997790
AT't'ES'I Approved as to form and legality
CRYSTAL K.KINZEL,CLERK 1
•
BY: stunt County A t icy �a`
16D2
October 2019-March 2021 El LEAP 203.19.004
ATTACHMENT II—EXHIBIT 2
FUNDING SUMMARY
Vote: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 I,be provided to the recipient. Information contained herein is a
prediction of funding sources and related amounts based on the contract budget.
L FEDERAL RESOURCES AWARDED'IO TIIE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN##); 17EA-OF-13-00-I6-003 FEDERAL AWARD DATE:April I,2019
DUNS NUMBER: U76997790 I -
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Emergency Home Energy Assistance United States Department of Health
for the Elderly Program and Human Services 93.568
El lEAP Collier 93.568 $ 36,628.22
TOTAL FEDERAL AWARD $ 36,628.22
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-Protit Organizations
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.
1'ROGRAM 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 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
1602
October 2019—March 2021 EHEM'203.19.004
A1TACHMENT IX
ANNUAL BUDGET SUMMARY AND DETAIL
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
for
Collier County Board of County Commissioners
Collier
EHEAP ADMINISTRATION BUDGET $ 4,121.82
EHEAP OUTREACH BUDGET $ 6,468.60
EIIEAP CRISIS ASSISTANCE $ 26,037.80
TOTAL S 36,628.22
Projected minimum number of individuals to be served
Energy Assistance* 9
*Eligible households may be provided with multiple benefits totaling thirty:five hundred dollars. The minimum
number of consumers may reflect duplicated consumers if a consumer receives multiple benefits until the end of this
contract,March 31,2021,
3
16II2
Revised August 2007
Attestation Statement
Agreement/Contract Number EIIEAP 203.19
Amendment Number,004
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.
/ /9 ° /
plipattire of Recipient/Contractor representative ate
ATTEST pprovcd as to Conn and legality
CRYSTAL K. KINZEL,CLERK )e ;
BY: ! Assistant County Attorney
\a
Revised August 2007
1OVJ;