Backup Documents 06/22/2021 Item #16D10 • - S
16D10
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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 Coun Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human `WK,
Services
2. Minutes & Records Clerk of Court's Office .22`
G/'4C m
3.
haw/ d �V
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 06/22/2021 Agenda Item Number 16D10
Approved by the BCC
Type of Document Agreement EHEAP 203.21 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? 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 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 fmal 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 06/22/21 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.
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
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AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida,Inc.(Agency)and Collier
County Board of County Commissioners (Contractor), collectively referred to as the "Parties." The term Contractor for ,
this purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS,the Agency has determined that it is in need of certain services as described herein; and
WHEREAS,the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed;and payments to be made,together with the
mutual covenants and conditions set forth herein,the Parties agree as follows:
I. Purpose of Contract:
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments,forms and exhibits,which constitute the contract document.
2 Incorporation of Documents within the Contract:
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department
handbooks, manuals and/or desk books, as an integral part of the contract, except to the extent that the contract
explicitly provides to the contrary.In the event of conflict in language among any of the documents referenced above,
the specific provisions and requirements of the contract document(s) shall prevail over inconsistent provisions in the
proposal(s)or other general materials not specific to this contract document and identified attachments.
a Term of Contract:
This contract shall begin at twelve(12:00)AM.,Eastern Standard Time April 1,2021 or on the date the contract has
been signed by the last party required to sign it,whichever is later.It shall end at eleven fifty-nine(11:59)P.M.,Eastern
Standard Time September 30,2023.
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 $96,708.79 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.
5. Renewals:
By mutual agreement of the Parties,in accordance with Section 287.058(1)(g),Florida Statutes(F.S.),the Agency may
renew the contract for a period not to exceed three years,or the term of the original contract,whichever is longer.The
renewal price, or method for determining a renewal price, is set price, is set forth in the bid, proposal, or reply. No
other costs for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original
contract and contingent upon satisfactory performance evaluations by the Agency and the availability of funds.
6. Compliance with Federal Law:
6.1 If this contract contains federal funds this section shall apply.
6.1.1 The Contractor shall comply with the provisions of 45 Code of Federal Regulations(CFR)75 and/or 45 CFR
Part 92,2 CFR Part 200 and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all
applicable standards,orders,or regulations issued under Section 306 of the Clean Air Act as amended(42
United States Code(U.S.C.)7401,et seq.), Section 508 of the Federal Water Pollution Control Act as
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amended (33 U.S.C. 1251, et seq.), Executive Order .11738, as amended, and where applicable
Environmental Protection Agency regulations 2 CFR Part 1500.The Contractor shall report any violations
of the above to the Agency.
6.1.3 Neither the Contractor nor any agent acting on behalf of the Contractor, may not use any federal funds
received in connection with this contract to influence legislation or appropriations pending before
Congress or any state legislature. The Contractor must complete all disclosure forms as required,
specifically the Certification and Assurances Attachment, which must be completed and returned to the
Contract Manager prior to the execution of this contract.
6.1.4 In accordance with Appendix II to 2 CFR Part 200, the Contractor shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as
supplemented in Department of Labor regulations 41 CFR Part 60 and in Department of Health and Human
Services regulations 45 CFR Part 92, if applicable.
6.1.5 A contract award with an amount expected to equal or exceed$25,000.00 and certain other contract awards
will not be made to parties listed on the government-wide Excluded Parties List System, in accordance
with the Office of Management and Budget(OMB)guidelines at 2 CFR Part 180 that implement Executive
Orders 12549 and 12689, "Debarment and Suspension." The Excluded Parties List System contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared
ineligible under statutory or regulatory authority other than Executive Order 12549.The Contractor shall
comply with these provisions before doing business or entering into subcontracts receiving federal funds
pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances
Attachment prior to the execution of this contract.
62 The Contractor shall not employ an unauthorized alien. The Agency will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act(8 U.S.C. § 324a)and the Immigration
Reform and Control Act of 1986 (8 U.S.C. § 1101). Such violation will be cause for unilateral cancellation of
this contract by the Agency.
63 If the Contractor is a non-profit provider and is subject to Internal Revenue Service (IRS) tax exempt
organization reporting requirements (filing a Form 990 or Form 990-N) and has its tax-exempt status revoked
for failing to comply with the filing requirements of the Pension Protection Act of 2006 or for any other reason,
the Contractor must notify the Agency in writing within thirty (30) days of receiving the IRS notice of
revocation.
64 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
65 Unless exempt under 2 CFR § Part 170.110(b),the Contractor shall comply with the reporting requirements of
the Transparency Act as expressed in 2 CFR Part 170.
66 To comply with Presidential Executive Order 12989,as amended,and State of Florida Executive Order Number
11-116, Contractor agrees to utilize the U.S. Department of Homeland Security's E-verify system to verify the
employment of all new employees hired. by Contractor during the contract term. Contractor shall include in
related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the
state contract utilize the E-verify system to verify employment of all new employees hired by the Subcontractor
during the contract term. Contractors meeting the terms and conditions of the E-Verify System are deemed to
be in compliance with this provision.
7. Compliance with State Law:
7.1 This contract is executed and entered into in the State of Florida,and shall be construed,performed,and enforced
in all respects in accordance with.Florida law, including Florida provisions for conflict of laws.
7.2 If this contract contains state financial assistance funds,the Contractor shall comply with Section 215.97,F.S.,
and Section 215.971,F.S.,and expenditures must be in compliance with laws,rules,and regulations including,
but not limited to,the Reference Guide for State Expenditures.
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7.3 The Contractor shall comply with the requirements of Section 287.058,F.S.,as amended.
73.1 The Contractor shall perform all tasks contained in.ATTACHMENT 1.
73.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in
ATTACHMENT Ito be received and accepted by the Area Agency contract manager prior to payment.
733 The Contractor shall comply with the criteria and final date by which such criteria must be met for
completion of this contract as specified in ATTACHMENT I, Section I1I. Method of Payment.
7.3.4 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre-audit and post-audit.
735 If itemized payment for travel expenses is permitted in this contract,the Contractor shall submit invoices
for any travel expenses in accordance with Section 112.061,F.S.,or at such lower rates as may be provided
in this contract.
73.6 The Contractor shall allow public access to all documents,papers,letters,or other public records as defined
in Section 119.011(12),F.S., made or received by the Contractor in conjunction with this contract except
for those records,which are made confidential or exempt by law.The Contractor's refusal to comply with
this provision will constitute an immediate breach of contract for which the Agency may unilaterally
terminate this contract.
7.4 if clients are to be transported under this contract,the Contractor shall comply with the provisions of Chapter
427,F.S.,and Rule Chapter 41-2,Florida Administrative Code(F.A.C).
7.5 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in
accordance with the provisions of Section.287.134,F.S.
7.6 The Contractor shall comply with the provisions of Section 11.062, F.S., and Section 216.347, F.S., which
prohibit the expenditure of contract funds for the purpose of lobbying the legislature,judicial branch or a state
agency.
7.7 The Agency may, at its option, terminate the Contract if the Contractor is found to have submitted a false
certification as provided under Section 287.135(5), F.S., has been placed on the Scrutinized Companies with
Activities in the Iran Petroleum Energy Section List,the Scrutinized Companies with Activities in Sudan List,
or the Scrutinized Companies that Boycott Israel list,or if the contractor had been engaged in business operations
in Cuba or Syria or is engaged in a boycott of Israel.
8. Background Screening:
The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435, F.S.,as amended,are met
regarding background screening for all persons who meet the definition of a direct service provider and who are
not exempt from the Agency's level 2 background screening pursuant to Sections 430.0402(2)-(3), F.S. The
Contractor must also comply with any applicable rules promulgated by the Agency and the Agency for Health
Care Administration regarding implementation of Section 430.0402 and Chapter 435, F.S. To demonstrate
compliance with this provision, Contractor shall submit the Background Screening Affidavit of Compliance
(Screening Form)to the Agency within thirty(30)days of execution of this contract. Should the Agency have a
completed Screening Form on file for the Contractor, a new Screening Form will be required every twelve (12)
months.
8.1 Further information concerning the procedures for background screening may be found at
http://el deratfairs.state.fl.us/doeaibackgroundscreeni ng.php.
9. Grievance Procedures:
The Contractor shall develop,implement,and ensure that its Subcontractors have established grievance procedures
to process and resolve client dissatisfaction with, or denial of, service(s) and address complaints regarding the
termination,suspension or reduction of services,as required for receipt of funds.These procedures,at a minimum,
will provide for notice of the grievance procedure and an opportunity for review of the Subcontractor's
determination(s).
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10. Public Records and Retention:
10.1 By execution of this contract,Contractor agrees to all provisions of Chapter 119,F.S.,and any other applicable
law,and shall:
10.1.1 Keep and maintain public records required by the Agency to perform the contracted services.
10.1.2 Upon request from the Agency's custodian of public records, provide the Agency a copy of the requested
records or allow the records to be inspected or copied within a reasonable time at a cost that does not
exceed the cost provided in Chapter 119,F.S.,or as otherwise provided by law.
10.13 Ensure that public records that are exempt or confidential and exempt from public records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and
following completion of the contract if the Contractor does not transfer the records to the Agency.
10.1.4 Upon completion of the contract,the Contractor will either transfer, at no cost to the Agency, all public
records in possession of the Contractor to the Agency, or will keep and maintain public records required
by the Agency.If the Contractor transfers all public records to the Agency upon completion of the contract,
Contractor shall destroy any duplicate public records that are exempt or confdential and exempt from
public records disclosure requirements. If the Contractor keeps and maintains public records upon
completion of the contract, the Contractor shall meet all applicable requirements for retaining public
records. All records stored electronically must be provided to the Agency in a format that is compatible
with the information technology systems of the Agency.
10.2 The Agency may unilaterally cancel this contract,notwithstanding any other provisions of this contract,for refusal
by the Contractor to comply with Section 10 of this contract by not allowing public access to all documents,
papers,letters,or other material made or received by the Contractor in conjunction with this contract,unless the
records arc exempt or confidential and exempt from Section 24(a)of Article I of the State Constitution and Section
119.07(1),F.S.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119,
FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT,CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT:
Public Records Coordinator
Area Agency on Aging for Southwest Florida,Inc.
2830 Winkler Ave,Suite 112
Fort Myers,FL 33916
239-652-6900 or 866-413-5337
10.3 Upon termination of this contract,whether for convenience or for cause as detailed in section 52 of this contract,
the Contractor and Subcontractors shall,at no cost to the Agency,transfer all public records in their possession to
the Agency and destroy any duplicate public records that are exempt, or confidential and exempt, from public
records disclosure requirements. All records stored electronically shall be provided to the Agency in a format
that is compatible with the information technology systems of the Agency.
11. Audits,Inspections,Investigations:
11.1 The Contractor shall establish and maintain books, records and documents(including electronic storage media)
sufficient to reflect all assets,obligations,unobligated balances,income,interest and expenditures of funds
provided by the Agency under this contract. Contractor shall adequately safeguard all such assets and assure
that they are used solely for the purposes authorized under this contract. Whenever appropriate, financial
information should be related to performance and unit cost data.
11.2 The Contractor shall retain and maintain all client records, financial records, supporting documents, statistical
records, and any other documents(including electronic storage media)pertinent to this contract for a period of
six(6)years after completion of the contract,or longer when required by law. In the event an audit is required
by this contract,records shall be retained for a minimum period of six(6)years after the audit report is issued
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or until resolution of any audit findings or litigation based on the terms of this contract,at no additional cost to
the Agency.
11.3 Upon demand,at no additional cost to the Agency,the Contractor shall facilitate the duplication and transfer of
any records or documents during the required retention period.
11.4 The Contractor shall ensure that the records described in this section will be subject at all reasonable times to
inspection,review,copying,or audit by federal,state,or other personnel duly authorized by the Agency.
11.5 At all reasonable times for as long as records are maintained,persons duly authorized by the Agency and federal
auditors, pursuant to 45 CFR Part 75, shall be allowed full access to and the right to examine any of the
Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the
form in which kept.
11.6 The Contractor shall provide a Financial and Compliance Audit to the Agency as specified in this contract and
ensure that all related third-party transactions are disclosed to the auditor.
11.7 Contractor agrees to comply with the Inspector General in any investigation,audit,inspection,review,or hearing
performed pursuant to Section 20.055,Florida Statutes. Contractor further agrees that it shall include in related
subcontracts a requirement that subcontractors performing work or providing services pursuant to this contract
agree to cooperate with the inspector General in any investigation,audit, inspection,review,or hearing pursuant
to Section 20.055(5), F.S. By execution of this contract, the Contractor understands and will comply with this
subsection.
12. Nondiscrimination-Civil Rights Compliance:
12.1 The Contractor shall execute Assurances as stated in the Assurances-Non-Construction Programs Attachment
that it will not discriminate against any person in the provision of services or benefits under this contract or in
employment because of age,race,religion,color,disability,national origin,marital status,or sex in compliance
with state and federal law and regulations. The Contractor further assures that all Contractors, Subcontractors,
Sub-grantees, or others with whom it arranges to provide services or benefits in connection with any of its
programs and activities are not discriminating against clients or employees because of age,race,religion,color,
disability,national origin,marital status,or sex.
12.2 During the term of this contract,the Contractor shall complete and retain on file a timely,complete,and accurate
Civil Rights Compliance Checklist,attached to this contract.
12.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination
involving services or benefits through this contract.These procedures shall include notifying clients,employees,
and participants of the right to file a complaint with the appropriate federal or state entity.
12.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance, and are binding upon the Contractor, its successors,transferees, and assignees for
the period during which such assistance is provided. The Contractor further assures that all Subcontractors,
Vendors, or others with whom it arranges to provide services or benefits to participants or employees in
connection with any of its programs and activities are not discriminating against those participants or employees
in violation of any statutes, regulations, guidelines, and standards. In the event of failure to comply, the
Contractor understands that the Agency may,at its discretion,seek a court order requiring compliance with the
terms of this assurance or seek other appropriate judicial or administrative relief including, but not limited to,
termination of the contract and denial of further assistance.
13. Monitoring by the Agency:
The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records, papers,
documents, facilities, goods, and services of the Contractor, which are relevant to this contract, and to interview any
clients, employees, and Subcontractor employees of the Contractor to assure the Agency of the satisfactory
performance of the terms and conditions of this contract. Following such review, the Agency will provide a written
report of its findings to the Contractor and, where appropriate,the Contractor shall develop a Corrective Action Plan
(CAP).The Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determined
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by the Contract Manager.
1.4 Provision of Services:
The Contractor shall provide services in the manner described in ATTACHMENT I.
15 New Contract(s)Reporting:
The Contractor shall notify the Agency within ten(10)days of entering into a new contract with any of the remaining
four(4)state human service agencies. The notification shall include the following information: (1)contracting state
agency and the applicable office or program issuing the contract;(2)contract name and number;(3)contract start and
end dates; (4) contract amount; (5) contract description and commodity or service; and (6) Contract Manager name
and contact information. In complying with this provision, and pursuant to Section 287.0575,F.S., as amended,the
Contractor shall complete the Contractor's State Contracts List attached to this contract.
16 Indemnification:
The Contractor shall indemnify,save, defend, and hold harmless the Agency and its agents and employees from any
and all claims, demands, actions, and causes of action of whatever nature or character arising out of, or by reason of
the execution of this agreement or performance of the services provided for herein. It is understood and agreed that
the Contractor is not required to indemnify the Agency for claims,demands,actions,or causes of action arising solely
out of the negligence of the Agency.
161 Except to the extent permitted by Section 768.28, F.S., or other Florida law,this Section .17 is not applicable
to contracts executed between the Agency and state agencies or subdivisions defined in Section 768.28(2),F.S.
17. Insurance and Bonding:
17.1. The Contractor shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewal(s)and extension(s)of it.By execution of this contract,unless it is a state agency or
subdivision as defined by Section 768.28(2),F.S.,the Contractor accepts full responsibility for identifying and
determining the type(s) and extent of liability insurance coverage necessary to provide reasonable financial
protections for the Contractor and the clients to be served under this contract. The limits of coverage under
each policy maintained by the Contractor do not limit the Contractor's liability and obligations under this
contract. The Contractor shall ensure that the Agency has the most current written verification of insurance
coverage throughout the term of this contract. Such coverage may be provided by a self-insurance program
established and operating under the laws of the State of Florida. The Agency reserves the right to require
additional insurance as specified in this contract.
172 Throughout the term of this contract, the Contractor shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees, and agents of the Contractor
authorized to handle funds received or disbursed under all agreements and/or contracts incorporating this
contract by reference in an amount commensurate with the funds handled,the degree of risk as determined by
the insurance company,and consistent with good business practices.
18 Confidentiality of Information:
The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized
to give that consent or when authorized by law.
19t Health Insurance Portability and Accountability Act:
Where applicable,the Contractor shall comply with the Health Insurance Portability and Accountability Act(42 USC
§ 1320d.), as well as all regulations promulgated thereunder(45 CFR Parts 160, 162,and 164).
2t1 Incident Reporting:
20.1 The Contractor shall notify the Agency immediately but no later than forty-eight (48) hours from the
Contractor's awareness or discovery of conditions that may materially affect the Contractor's or
Subcontractor's ability to perform the services required to be performed under this contract. Such notice shall
be made orally to the Agency's Contract Manager(by telephone)with an email to immediately follow.
202 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation
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of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone
number (1-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon the
Contractor,its Subcontractors,and their employees.
21. Bankruptcy Notification:
During the term of this contract,the Contractor shall immediately notify the Area Agency on Aging for Southwest
Florida, Inc. if the Contractor,its assignees, Subcontractors, or affiliates file a claim for bankruptcy. Within ten(10)
days after notification,the Contractor must also provide the following information to the Area Agency on Aging for
Southwest Florida, Inc.: (1)the date of filing of the bankruptcy petition;(2)the case number;(3)the court name and.
the division in which the petition was filed (e.g., Middle District of Florida, Fort Myers, Florida); and (4) the name,
address,and telephone number of the bankruptcy attorney.
22. Sponsorship and Publicity:
22.1. As required by Section 286.25, F.S., if the Contractor is a non-governmental organization which sponsors a
program financed wholly or in part by state funds,including any funds obtained through this contract, it shall,
in publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by (Contractors
name) and the State of Florida,Department of Elder Affairs and/or the Area Agency on Aging for Southwest
Florida, Inc.." If the sponsorship reference is in written material, the words "State of Florida, Department of
Elder Affairs and/or the Area Agency on Aging for Southwest Florida, Inc." shall appear in at least the same
size letters or type as the name of the organization.
222 The Contractor shall not use the words"State of Florida,Department of Elder Affairs and the Area Agency on
Aging for Southwest Florida, Inc." to indicate sponsorship of a program otherwise financed, unless specific
authorization has been obtained by the Agency prior to such use.
23 Assignments:
Zit The Contractor shall not assign the rights and responsibilities under this contract without the prior written
approval of the Agency. A.ny sublicense, assignment, or transfer otherwise occurring without prior written.
approval of the Agency shall constitute a material breach of the contract. In the event the State of Florida
approves transfer of the Contractor's obligations, the Contractor remains responsible for all work performed
and all expenses incurred in connection with this contract.
Zit The State of Florida,is at all times,entitled to assign or transfer,in whole or part,its rights,duties,or obligations
under this contract to another governmental agency in the State of Florida upon giving prior written notice to
the Contractor.
233 This contract shall remain binding upon the successors in interest of the Contractor and the Agency.
24 Subcontracts:
241 The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a
written document and subject to any conditions of approval the Agency deems necessary. The Contractor
further agrees that the Agency will not be liable to the Subcontractor in any way or for any reason. The
Contractor,at its expense,shall defend the Agency against any such claims.
2A2 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the Agency or other state
agency. Failure to make payments to any Subcontractor in accordance with Section 287.0585, F.S., unless
otherwise stated in the contract between the Contractor and Subcontractor, will result in a penalty as provided
by statute.
2S Independent Capacity of Contractor:
It is the intent and understanding of the Parties that the Contractor and any of its Subcontractors are independent
Contractors and are not employees of the Agency,and that they shall not hold themselves out as employees or agents
of the Agency without prior specific authorization from the Agency. It is the further intent and understanding of the
Parties that the Agency does not control the employment practices of the Contractor and will not be liable for any
wage and hour,employment discrimination,or other labor and employment claims against the Contractor or its
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Subcontractors.All deductions for social security,withholding taxes, income taxes, contributions to unemployment
compensation funds,and all necessary insurance for the Contractor are the sole responsibility of the Contractor.
26L Payment:
Payments shall be made to the Contractor for all completed and approved deliverables(units of service)as defined in
ATTACHMENT I. The Area Agency Contract Manager will have final approval of the Contractor's invoice
submitted for payment and will approve the invoice for payment only if the Contractor has met all terms and
conditions of the contract, unless the bid specifications, purchase order, or this contract specify otherwise. The
approved invoice will be submitted to the Agency's finance section for budgetary approval and processing.Disputes
arising over invoicing and payments will be resolved in accordance with the provisions of Section 215.422,F.S. A
Vendor Ombudsman has been established within the Florida Department of Financial Services and may be contacted
at 800-342-2762.
27. Return of Funds:
The Contractor shall return to the Agency any overpayments due to unearned funds or funds disallowed, and any
interest attributable to such funds pursuant to the terms and conditions of this contract, that were disbursed to the
Contractor by the Agency.In the event that the Contractor or its independent auditor discovers that an overpayment
has been made,the Contractor shall repay said overpayment immediately without prior notification from the Agency.
In the event that the Agency first discovers an overpayment has been made,the Area Agency Contract Manager will
notify the Contractor in writing of such findings. Should repayment not be made forthwith, the Contractor shall be
charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03, F.S., after Agency
notification or Contractor discovery.
2K Data Integrity and Safeguarding Information:
The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or
using in the performance of this contract. An appropriate level of security includes approving and tracking all
Contractor employees that request system or information access and ensuring that user access has been removed from
all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities.All data and software shall be routinely backed up to ensure recovery from losses
or outages of the computer system.The security over the backed-up data is to be as stringent as the protection required
of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer
system backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity
Compliance for Agreements, Grants,Loans,and Cooperative Agreements prior to the execution of this contract.
21 Computer Use and Social Media Policy:
The Department has implemented a Social Media Policy,in addition to its Computer Use Policy,which applies to all
employees, contracted employees, consultants, Other Personal Services(OPS) employees and volunteers, including
all personnel affiliated with third parties, such as, but not limited to,contractors and subcontractors.Any entity that
uses the Department's computer resource systems must comply with the Department's policy regarding social media.
Social Media includes, but is not limited to, blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing,
social networks like MySpace,Facebook and Twitter,as well as content sharing networks such as flickr and YouTube.
This policy is available on the Department's website at: httpJ/el.deraffairs.state.f..l.us/cloea'fi.nancial.php.
30L Conflict of Interest:
The Contractor shall establish safeguards to prohibit employees, board members,management, and Subcontractors
from using their positions for a purpose that constitutes or presents the appearance of personal or organizational
conflict of interest or personal gain.No employee,officer,or agent of the Contractor or Subcontractor shall participate
in the selection, or in the award of a contract supported by state or federal funds if a conflict of interest, real or
apparent,would be involved. Such a conflict would arise when: (a)the employee,officer or agent; (b) any member
of his/her immediate family; (c)his or her partner;or(d)an organization which employs,or is about to employ,any
of the above individuals, has a financial or other interest in the firm being selected for award. The Contractor's or
Subcontractor's officers, employees, or agents will neither solicit nor accept gratuities, favors, or anything of
monetary value from Contractors,potential Contractors, or parties to Subcontracts. The Contractors board members
and management must disclose to the Agency any relationship which may be', or may be perceived to be,a conflict
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April 1,2021 —September 2023 EHEAP 203.21
of interest within thirty(30)calendar days of an individual's original appointment, or, placement in that position, or
if the individual is serving as an incumbent, within thirty(30) calendar days of the commencement of this contract.
The Contractor's employees and Subcontractors must make the same disclosures described above to the Contractor's
board of directors. Compliance with this provision will be monitored.
3L Public Entity Crime:
Pursuant to Section 287.133,F.S.,a person or affiliate who has been placed on the Convicted Vendor List following
a conviction for a public entity crime may not submit a bid,proposal,or reply on a contract to provide any goods or
services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the
construction or repair of a public building or public work;may not submit bids,proposals,or replies on leases of real.
property to a public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or
Consultant under a contract with any public entity; and may not transact business with any public entity in excess of
the threshold amount provided in Section 287.017,F.S.,for CATEGORY TWO for a period of thirty six(36)months
following the date of being placed on the Convicted Vendor List.
3. Purchasing:
321 The Contractor shall procure products and/or services required to perform this contract in accordance
with section413.036,F.S.
32.1.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES THAT ARE
THE SUBJECT OF, OR REQUIRED TO CARRY OUT, THIS CON TRACT SHALL BE
PURCHASED FROM A NONPROFIT AGENCY FOR THE BLIND OR FOR THE
SEVERELY HANDICAPPED THAT IS QUALIFIED PURSUANT TO CHAPTER 413,
FLORIDA STATUTES,IN THE SAME MANNER ANDUNDER THE SAME PROCEDURES
SET FORTH IN SECTION 413.036(1) AND (2), FLORIDA STATUTES; AND FOR
PURPOSES OF THIS CONTRACT THE PERSON, FIRM,OR OTHER BUSINESS ENTITY
CARRYING OUT THE PROVISIONS OF THIS CONTRACT SHALL BE DEEMED TO BE
SUBSTITUTED FOR THE STATE AGENCY INSOFAR AS DEALINGS WITH SUCH
QUALIFIED NONPROFIT AGENCY ARE CONCERNED.
32.1.2 Pursuant to sections 413.036(1) and (4), F.S., the Contractor shall not be required to procure a
product or service from RESPECT if: (a) the product or service is not available within a
reasonable delivery time, (b)the Contractor is required by law to procure the product or service
from any agency of the state, or (c) the Contractor determines that the performance
specifications, price, or quality of the product or service is notcomparable to the Contractor's
requirements.
32.1.3 This act shall have precedence over any law requiring state agency procurement of products or
services from any other nonprofit corporation unless such precedence is waived by the Agency
in accordance with its rules.
32.1.4 Additional information about the designated nonprofit agency and the products it offers is
available at http://www.respectofflorida.org.
32.2 The Contractor shall procure any recycled products or materials,which are the subject of,or are required
to carryout,this contract when the Department of Management Services determines that those products
are available,inaccordance with the provisions of section 403.7065,F.S.
32.3 The Contractor shall procure products and/or services required to perform this contract in accordance
with section 946.515,F.S.
32.3.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES WHICH
ARE THESUBJECT OF,OR REQUIRED TO CARRY OUT,THIS CONTRACT SHALL BE
PURCHASED FROMTHE CORPORATION IDENTIFIED UNDER CHAPTER 946,F.S.,IN
THE SAME MANNER AND UNDER THE SAME PROCEDURES SET FORTH IN
SECTION 946.515(2) AND (4), F.S.; AND FOR PURPOSES OF THIS CONTRACT THE -
' s
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PERSON, FIRM, OR OTHER BUSINESS ENTITY CARRYING OUT THE PROVISIONS OF
THIS CONTRACT SHALL BE DEEMED TO BE SUBSTITUTED FOR THIS AGENCY
INSOFAR AS DEALINGS WITH SUCH CORPORATION ARE CONCERNED.
32.3.2 The corporation identified is Prison Rehabilitative Industries and Diversified Enterprises, Inc.
(PRIDE). Additional information about PRIDE and the commodities or contractual services it
offers is available at https://pride-enterprises.org/.
33. Patents,Copyrights,Royalties:
If this contract is awarded state funding and if any discovery, invention, or copyrightable material is developed or
produced in the course of or as a result of work or services performed under this contract or in any way connected
with this contract,or if ownership of any discovery,invention,or copyrightable material to the Agency to be referred
to the Department of State. Any and all patent rights or copyrights accruing under this contract are hereby reserved
to the State of Florida in accordance with Chapter 286, F.S. Pursuant to Section 287.0571(5)(k), F.S., the only
exceptions to this provision shall be those that are clearly expressed and reasonably valued in this contract.
331 If the primary purpose of this contract is the creation of intellectual property,the State of Florida shall retain
an unencumbered right to use such property,notwithstanding any agreement made pursuant to this Section 34.
332 If this contract is awarded solely federal funding,the terms and conditions are governed by 2 CF.R§200.315
or 45 CFR§ 75.322,as applicable.
333 Notwithstanding the foregoing provisions, if the Contractor or one of its Subcontractors is a university and a
member of the State University System of Florida,then Section 1004.23,F.S.,shall apply,but the Agency shall
retain a perpetual,fully-paid,nonexclusive license for its use and the use of its Contractors, Subcontractors,or
Assignees of any resulting patented,copyrighted,or trademarked work products.
34 Emergency Preparedness and Continuity of Operations:
31.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health,safety,or welfare,the Contractor shall,
within thirty (30) calendar days of the execution of this contract, submit to the Agency's Contract Manager
verification of an Emergency Preparedness Plan. In the event of an emergency,the Contractor shall notify the
Agency of emergency provisions.
342 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall remain
responsible for performance under this contract and must follow procedures to ensure continuity of operations
without interruption.
M Equipment:
3i1. Equipment means: (a)tangible personal.property(including information technology systems)having a useful
life of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization
level established by the organization for the financial statement purposes, or$5,000.00 [for federal funds—2
CFR 200.33 and 45 CFR § 75.2, as applicable], or (b); nonexpendable, tangible personal property of a non-
consumable nature with an acquisition cost of$5,000.00 or more per unit, and expected useful life of at least
one(1)year; and hardback bound books not circulated to students or the general public,with a value or cost of
$250.00 or more[for state funds].
352 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations shall have written property management standards in compliance with 2 CF.R Part 200
Administrative Requirements (formerly OMB Circular A-110) that include: (a) a property list with all the
elements identified in the circular; (b) a procedure for conducting a physical inventory of equipment at least
once every two(2)years;(c)a control system to insure adequate safeguards to prevent loss,damage,or theft of
the equipment;and(d)maintenance procedures to keep the equipment in good condition.The property records
must be maintained on file and shall be provided to the Agency upon request. The Contractor shall promptly
investigate, fully document, and notify the Agency's Contract Manager of any loss, damage, or theft of
equipment.The Contractor shall provide the results of the investigation to the Agency's Contract Manager.
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i3 The Contractor's property management standards for equipment(including replacement equipment), whether
acquired in whole or part with federal funds and federally-owned equipment shall, at a minimum, meet the
following requirements and shall include accurately maintained equipment records with the following
information:
35.3.1. Property records must be maintained that include a description of the equipment;
35.3.2 Manufacturer's serial number,model number,federal stock number,national stock.
number,or other identification number;
35.3.3 Source of funding for the equipment,including the federal award number identification
number;
35.3.4 Whether title vests in the Contractor or the federal government;
35.3.5 Acquisition date(or date received,if the equipment was furnished by the federal government);
35.3.6 Information from which one can calculate the percentage of federal participation in the cost of the
equipment(not applicable to equipment furnished by the federal government);
35.3.7 Location,use and condition of the equipment and the date the information was reported;
35.3.8 Unit acquisition cost;and
35.3.9 Ultimate disposition data,including date of disposal and sales price or the method used to determine
current fair market value where a Contractor compensates the federal awarding agency for its share.
35.3.10 A physical inventory must be taken,and the results reconciled with the property records at least once
every two(2)years.
35.3.11 A control system must be developed to ensure adequate safeguards to prevent loss,damage, or theft
of the property. Any loss,damage,or theft must be investigated.45 CFR§75.320(d)(3).
35.3.12 Adequate maintenance procedures must be developed to keep the property in good condition.
35.3.13 l:f the Contractor is authorized or required to sell the equipment, proper sales procedures must be
established to ensure the highest possible return.
35.4 Equipment purchased with federal funds with an acquisition cost over$5,000.00 and equipment purchased with
state funds with an acquisition cost over$5,000.00 is part of the cost of carrying out the activities and functions
of the grant awards and title(ownership) will vest in the Contractor[for federal funds see 2 CFR § 200.313(a)
and 45 CFR § 75.320(a), as applicable], subject to the conditions of 2 CFR Part 200 and/or 45 CFR part 75.
Equipment purchased under these thresholds is considered supplies and is not subject to property standards.
Equipment purchased with funds identified in the budget attachments to agreements covered by this contract or
identified in the sub-agreements with Subcontractors (not included in a cost methodology), is subject to the
conditions of Chapter 273,F.S.,rule 60A-1.001 7,F.A. C.,and 2 CFR Part 200 and/or 45 CFR Part 75.
35.5 The Contractor shall not dispose of any equipment or materials provided by the Agency, or purchased with
funds provided through this contract without first obtaining the approval of the Agency's Contract Manager.
When disposing of property or equipment the Contractor must submit a written request for disposition
instructions to the Agency's Contract Manager. The request should include a brief description of the property,
purchase price, funding source, and percentage of state or federal participation, acquisition date and condition
of the property. The request should also indicate the Contractor's proposed disposition of the property (i.e.,
transfer or donation to another agency that administers federal programs,offer of the items for sale,destroy the
items,etc.).
35.6 The Agency's Contract Manager will issue disposition instructions. If disposition instructions are not received
within one hundred twenty (120) days of the written request for disposition, the Contractor is authorized to
proceed as directed in 2 CFR§200.313 or 45 CFR§75.320,as applicable.
35.7 Real property means land(including land improvements),buildings, structures and appurtenances thereto,but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract without the prior approval of the Agency. Real property
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April. 1,2021 —September 2023 EHEAP 203.21
purchases from Older Americans Act funds are subject to the provisions of Title 42,Chapter 35,Subchapter.III,
Part A., Section 3030b United States Code(USC).Real property purchases from state funds can only be made
through fixed capital outlay grants and aids appropriations and therefore are subject to the provisions of Section
216.348,F.S.
35.8 Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and tested
prior to disposal to ensure no confidential information remains.
35.9 The Contractor must adhere to the Agency's procedures and standards when purchasing Information Technology
Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR worksheet is
required for any computer related item costing$1,000.00 or more,including data processing hardware,software,
services, supplies, maintenance, training, personnel, and facilities. The completed ITR worksheet shall be
maintained in the LAN administrator's file and must be provided to the Agency upon request. The Contractor
has the responsibility to require any Subcontractors to comply with the Agency's ITR procedures.
36.PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
http://www.mvflorida.com/apps/vbsiadoc/F7740__PUR. 1.000.pdf
In the event of any conflict between the PUR 1000 Form and any terms or conditions of this contract,the terms or
conditions of this contract shall take precedence over the PUR1000 Form. However, if the conflicting terms or
conditions in the PUR.1000 Form are required by any section of the Florida Statutes,the terms or conditions contained
in the PUR1.000 Form shall take precedence.
37. Use of State Funds to Purchase or Improve Real Property:
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds provided
for at least five (5)years from the date of purchase or the completion of the improvements or as further required by
law.
38. Dispute Resolution:
Any dispute concerning performance of the contract shall be decided by the Agency's Contract Manager, who shall
reduce the decision to writing and serve a copy on the Contractor.
39. Financial Consequences:
If the Contractor fails to meet the minimum level of service or performance identified in this contract,the Agency will
impose financial consequences as stated in ATTACHMENT 1.
40. No Waiver of Sovereign Immunity:
Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
41. Venue:
If any dispute arises out of this contract,the venue of such legal recourse shall be Lee County,Florida.
42. Entire Contract:
This contract contains all the terms and conditions agreed upon by the Parties.No oral agreements or representations
shall be valid or binding upon the Agency or the Contractor unless expressly contained herein or by a written
amendment to this contract signed by both Parties.
43. Force.Maieure:
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party experiencing the force majeure condition provides immediate written notification to the other party
and takes all reasonable efforts to cure the condition.
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April 1,2021 —September 2023 EHEAP 203.21
44. Severability Clause:
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
45. Condition Precedent to Contract Appropriations:
The Parties agree that the Agency's performance and obligation to pay under this contract are contingent upon an.
annual appropriation by the Legislature.
46. Addition/Deletion:
The Parties agree that the Agency reserves the right to add or to delete any of the services required under this contract
when deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties.
The Parties shall negotiate compensation for any additional services added.
47. Waiver:
The delay or failure by the Agency to exercise or enforce any of its rights under this contract will not constitute or be
deemed a waiver of the Agency's right thereafter to enforce those rights,nor will any single or partial exercise of any
such right preclude any other or further exercise thereof or the exercise of any other right.
48. Compliance:
The Contractor shall abide by all applicable current federal statutes,laws,rules,and regulations as well as applicable
current state statutes, laws, rules and regulations. The Parties agree that failure of the Contractor to abide by these
laws shall be deemed an event of default of the Contractor and subject the contract to immediate unilateral cancellation
of the contract at the discretion of the Agency.
49. Final Invoice:
The Contractor shall submit the final invoice for payment to the Agency no later than thirty(30)days after the contract
ending date unless otherwise specified in ATTACHMENT 1. If the Contractor fails to do so, all right to payment is
forfeited and the Agency shall not honor any requests submitted after the aforesaid time period. Any payment due
under the terms of this contract shall be withheld until all required documentation and reports due from the Contractor
and necessary adjustments thereto have been approved by the Agency.
50.Renegotiations of Modifications:
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price
level increases and changes in the rate of payment when these have been established through the appropriations process
and subsequently identified in the Agency's operating budget.
51. Suspension of Work:
The Agency may in its sole discretion,suspend any or all activities under the contract or purchase order, at any time,
when in the interest of the State to do so. The Agency shall provide the Contractor written notice outlining the
particulars of suspension.Examples of the reason for suspension include,but are not limited to,budgetary constraints,
declaration of emergency, or other such circumstances. After receiving a suspension notice, the Contractor shall
comply with the notice and shall not accept any purchase orders.Within ninety(90)days,or any longer period agreed
to by the Contractor,the Agency shall either(I)issue a notice authorizing resumption of work, at which time activity
shall resume, or(2)terminate the contract or purchase order. Suspension of work shall not entitle the Contractor to
any additional compensation.
52. Termination:
52.1 Termination for Convenience. The Agency, by written notice to the Contractor, may terminate this contract
in whole or in part when the Agency determines in its sole discretion that it is in the State's interest to do so.
The Contractor shall not furnish any product after it receives the notice of termination,except as necessary to
complete the continued portion of this contract, if any. The Contractor shall not be entitled to recover any
cancellation charges or lost profits.
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April 1,2021. —September 2023 EHEAP 203.21
52.2 Termination for Cause. The Agency may terminate this contract if the Contractor fails to: (.1) deliver the
product within the time specified in the contract or any extension, (2) maintain adequate progress, thus
endangering performance of the contract, (3) honor any term of the contract, or (4) abide by any statutory,
regulatory, or licensing requirement. Rule 60A.-1.006(3), F.A.C., governs the procedure and consequences of
default.The Contractor shall continue work on any work not terminated. Except for defaults of Subcontractors
at any tier,the Contractor shall not be liable for any excess costs if the failure to perform the contract arises
from events completely beyond the control,and without the fault or negligence,of the Contractor.If the failure
to perform is caused by the default of a Subcontractor at any tier,and if the cause of the default is completely
beyond the control of both the Contractor and the Subcontractor,and without the fault or negligence of either,
the Contractor shall not be liable for any excess costs for failure to perform,unless the subcontracted products
were obtainable from other sources in sufficient time for the Contractor to meet the required delivery schedule.
If, after termination, it is determined that the Contractor was not in default, or that the default was excusable,
the rights and obligations of the Parties shall be the same as if the termination had been issued for the
convenience of the Agency. The rights and remedies of the Agency in this clause are in addition to any other
rights and remedies provided by law or under the contract.
53. Electronic Records and Signature:
The Agency authorizes,but does not require,the Contractor to create and retain electronic records and to use electronic
signatures to conduct transactions necessary to carry out the terms of this contract.A Contractor that creates and retains
electronic records and uses electronic signatures to conduct transactions shall comply with the requirements contained
in the Uniform Electronic Transaction Act, Section 668.50, F.S. All electronic records must be fully auditable; are
subject to Florida's Public Records Law,Chapter 119,F.S.;must comply with contract Section 29,Data Integrity and
Safeguarding Information; must maintain all confidentiality, as applicable; and must be retained and maintained by
the Contractor to the same extent as non-electronic records are retained and maintained as required by this contract.
53.1 The Agency's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the Agency.The Contractor is authorized to conduct electronic transactions with the Agency
only upon further written consent by the Agency.
53.2 Upon request by the Agency, the Contractor shall provide the Agency with non-electronic (paper) copies of
records. Non-electronic(paper)copies provided to the Agency of any document that was originally in electronic
form with an electronic signature must identify the person and the person's capacity who electronically signed
the document on any non-electronic copy of the document.
54. Contract Manager:
The Agency may substitute any Agency employee to serve as the Area Agency's Contract Manager.
REMAINDER OF THE PAGE INTENTIONALLY LEFT BLANK
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55. Official Payee and Representatives(Names, Addresses,and Telephone Numbers):
The Contractor name,as shown on page 1 of this Collier County Board of County Commissioners
a, contract,and mailing address of the official payee to 3339 E Tamiami Trail,Building H
whom the payment shall be made is: Naples,FL 34112
The name of the contact person and street address Kristi Sonntag,Director
b. where financial and administrative records are Collier County Board of County Commissioners
maintained is: %Community and Human Services
3339 E Tamiami Trail,Building H
Naples,FL 34112
The name,address,and telephone number of the Kristi Sonntag,Director
c, representative of the Contractor responsible for Collier County Board of County Commissioners
administration ofthe program under this contract is: %Community and Human Services
3339 E Tamianu Trail,Building H
Naples,FL 34112
(239)252-2273
The section and location within the Agency where Area Agency on Aging for Southwest Florida,Inc.
d. Requests for Payment and Receipt and Expenditure Richard Cocchleri,Fiscal Director
forms are to be mailed is: 2830 Winkler Ave.,Suite 112
Fort Myers,FL 33916
The name,address,and telephone number of the Mnriceln Morado,Direclorof Program&Planning
e. Contract Manager for this contract is: Area Agency on Aging for Southwest Florida,Inc.
2830 Winkler Ave.,Suite 112
Fort Myers,FL 33916
239.652-6900
Upon change of representatives(names,addresses,and telephone numbers)by either party,notice shall be provided in
wilting to the other party.
56. All'Perms and Conditions Included:
This contract and its ATTACHMENTS I -XXIV including any exhibits referenced in said attachments,together with any
documents incorporated by reference,contain all the terms and conditions agreed upon by the Parties.There are no provisions,
Icons, conditions, or obligations other than those contained herein, and this contract shall supersede all previous
communications,representations or agreements,either written or verbal between the Parties.
By signing this contract,the Parties agree that they have read and agree to the entire contract.
IN WITNPSS,THEREOF,the Parties hereto have caused this contract to be executed by their undersigned officials as duly
authorized.
CONTRACTOR: OLLIER COU Y: dARD AREA AGENCY ON AGING FOR SOUTHWEST
OF COUNT O ISM FLORIDA,INC,
SIGNED BY: SIGNED BY; .
NAME: Daniel R Rodr e NAME: NORMA ADORNO
TITLE: Public Service Department Head TITLE: CEO
DATE: 05/r.� /2021 DATE: '5 13 — a d a 1
Federal Tax ID:59.6000558
Fiscal Year Ending Date:09/30 Approved as to form and legality
DUNS: 076997790
�tlnt County Aunt
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INDEX OF ATTACHMENTS
ATTACHMENT I
STATEMENT OF WORK ••. 17
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT,Exhibit 1 and Exhibit 2 41
ATTACHMENT III
CERTIFICATIONS AND ASSURANCES ••47
ATTACHMENT IV
ASSURANCES-NON-CONSTRUCTION PROGRAMS 51
ATTACHMENT V
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST 53
ATTACHMENT VII
BACKGROUND SCREENING 57
ATTACHMENT IX
BUDGET SUMMARY 58
ATTACHMENT X
EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL 59
ATTACHMENT XI
RECEIPTS AND EXPENDITURE REPORT 60
ATTACHMENT XII
REQUEST FOR PAYMENT 61
ATTACHMENT XIII
INVOICE REPORT SCHEDULE 62
ATTACHMENT XIV
POVERTY INCOME GUIDELINES 63
ATTACHMENT XV
LIFIEAP PAYMENT MATRIX 64
ATTACHMENT XVI
SOURCES OF INCOME 65
ATTACHMENT XVIII
EHEAP APPLICATION AND ELIGIBILITY WORKSHEET 66
ATTACHMENT XIX
EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS 68
ATTACHMENT XX
EHEAP CLIENT FILE CONTENT CHECKLIST 71
ATTACHMENT XXI
EHEAP COST REIMBURSEMENT SUMMARY 72
ATTACI-IMENT XXII
COST ALLOCATION PLAN 73
ATTACHMENT XXIII
SERVICE RATE REPORT 76
ATTACHMENT XXIV
OUTREACH PLAN SURVEY 77
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ATTACHMENT I
STATEMENT OF WORK
I. SERVICES TO BE PROVIDED
A. DEFINITION OF TERMS
1. Eighteen(18)hour rule—The timeframe within which all applications for life-threatening crisis assistance
shall be acted upon, with an eligible action to mediate the crisis being taken and documented in the client
file within eighteen(18)hours of the application date stamp
2. Forty-eight(48)hour rule—The timeframe within which all applications for standard crisis assistance shall
be acted upon, with an eligible action to mediate the crisis being taken and documented in the client file
within forty-eight(48)hours of the application date stamp.
3. Caseworker—Person who is responsible for determining program eligibility by completing the Emergency
Home Energy Assistance for the Elderly Program (EHEAP) Eligibility Worksheet (ATTACHMENT
XVIII)and awarding crisis benefits.
4. Caseworker Signature Date — The date that the client's completed application is processed, eligibility
determined, and the crisis resolved. This date shall not be changed. Signatures must be in ink. Rubber-
stamped signatures will not be accepted.
5. Categorically Eligible—Applicants will be considered eligible to receive EHEAP services, regardless if
their household is exceeding 150% of the Federal Poverty Guideline, if any member of their household is
receiving Temporary Assistance for Needy Families (TANF), Supplemental Social Security (SSI), or
Supplemental Nutrition Assistance Program(SNAP)benefits.
6. Client Application Date—The date the application is completed (whether by self or with assistance) and
signed by the elder. This date shall not be changed. If an elder cannot write their signature on the application,
or any other required document,the elder shall sign with an"X"in the presence of two witnesses,who shall
also sign the application. Signatures must be in ink. Rubber-stamped signatures will not be accepted.
7. Crisis—A home cooling or heating crisis exists when an elder has no access to, or is in immediate danger
of losing access to,needed home energy.
8. Crisis Assistance—Assistance provided to an elder who has no access to, or is in danger of losing access
to,needed home energy.
9. Date of Resolution —The date that a documented commitment to pay was made to the utility vendor to
resolve the energy crisis.This date is used as the EHEAP Client Enrollment date in.the Depai talent's Client
Information and Registration Tracking System(CIRTS).This date shall not be changed.
a. The amount of time elapsed between the Date Stamp and the Date of Resolution shall determine if the
18 or 48-hour rule was met.
b. Vendors must be paid within forty-five(45)days of the date of resolution.
10.Date Stamp—The date the application and all required documentation is presented in acceptable form to
intake staff.An inked stamp must be used,and the date shall not be changed.The 18-hour hour rule for crisis
resolution begins when the application is date stamped.
11.Disability — A disabling condition that causes an elder to be determined eligible to receive Supplement
Security:Income(SSI)or Social Security Disability Income(SSDI:)from the Social Security Administration.
12.Elder—An individual aged sixty(60)years or older.
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April 1,2021 —September 2023 EHEAP 203.21
13.Eligible Action — An action taken by the caseworker to mediate an elder's energy crisis. Eligible actions
include:
a. Approval of an elder's application;
b. Denial of an elder's application pending further information;
c. Denial of an elder's application because the elder is deemed ineligible;
d. Contact with a utility vendor to halt utility disconnection or interruption in services;or
e. Written referral to and providing the elder with assistance contacting another agency if EHEAP funding
is not available or the elder is ineligible.
14. Energy Subsidy — Utility costs paid directly or indirectly to the elder who lives in government-
subsidized housing. For the purposes of this contract,the terms "Subsidy" and "Allowance"maybe
used interchangeably.
15.Household—Any individual or group of individuals who are living together as one economic unit for whom
residential energy is customarily purchased in common or who make undesignated payments for energy in
the form of rent.
16.Household Member—Persons in a household who share a common kitchen or bath and purchase residential
energy in common.
17.intake Worker—Person who accepts the EHEAP application and required documentation and may have
the responsibility to determine eligibility or award crisis benefits.
18.Minimum Level of Service—Service to a minimum of one household per month.
19.Crisis Assistance Benefit — Payment of a heating/cooling energy bill; the purchase of heating/cooling
device; and/or the repair of a heating/cooling device.
20.Priority for Assistance—Households with the highest home energy needs and lowest household income,
which will be determined by taking into account both the energy burden and the unique situation of such
households with members of vulnerable populations, including very young children, individuals with.
disabilities,and frail elder individuals.
21.Provider — The entity that has entered into a contract, subcontract, or Memorandum of Understanding
(MOU) to provide services under EHEAP. For the purposes of this contract, the terms "Provider" and
"Contractor"may be used interchangeably.
22.Reasonable Promptness—Within fifteen(15)working days of receiving the client's completed
application.
23. Request for Payment—Submission of actual monthly expenditures for reimbursement.
24.Service Unit—One individual(elder)served.
25.Social Security Number—The number on an elder's Social Security card or the number provided by an.
award or determination letter from an entity, such as a government agency, that has already verified the
social security number.
26. Supervisory/Peer Review Date — The date that a supervisor or peer reviewed the application and
documentation and signed the application indicating vendor payment can be made. The intent of the
supervisor/peer review is to avoid errors in eligibility determination and payment amounts and to alleviate
the possibility of fraud.This date shall not be changed.Signatures must be in ink.Rubber-stamped signatures
will not be accepted.
27.Verification Date - The date the caseworker verified previous Low-Income Home Energy Assistance
Program(LIHEAP)crisis benefits with the LIHEAP provider or the minimum amount necessary to resolve
the crisis with the utility company. This date shall not be changed.
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April 1, 2021. —September 2023 EHEAP 203.21
B. GENERAL DESCRIPTION
1. General Statement
The Emergency Home Energy Assistance for the Elderly Program (EHEAP) serves the mission of the
Agency by providing home energy assistance aid to elders in the event of a home energy heating or cooling
emergency.EHEAP is designed to assist low-income households with at least one member aged sixty(60)
or older experiencing a heating or cooling emergency
2. Authority
The relevant federal and state authorities governing EHEAP are:
a. Low Income Home Energy Assistance Act of 1981;(Title XXVI of the Omnibus Budget Reconciliation
Act of 1981,P.L.97-35),as amended.;
b. 42 United States Code(U. S. C.) § 8621 et seq.;
c. 45 Code of Federal Regulations(CFR)Part 96, Subpart H(§§96.80-96.89);
d. Section 409.508, Florida Statutes (F.S.) and Rule 73C-26.021 (3), Florida Administrative Code
(F. A. C.);
e. Rule Chapter 73C-26, F.A.C.;
f. State of Florida LIHEAP Policies and Procedures Manual; and
g. LIHEAP State Plan.
3. Scope of Service
The Contractor is responsible for the programmatic,fiscal,and operational management of EHEAP.Eligible
elders may receive one crisis assistance benefit per heating or cooling season,not to exceed$1,000.00 each.
if eligible, elders may receive one summer crisis assistance benefit during the period from April 1 to
September 30,and one winter crisis assistance benefit during the period of October 1 to March 31,each year.
An elder's eligibility for crisis benefits is not related to EHEAP contract periods.
Weather-Related/Supply Shortage funds can he provided in addition to crisis benefits when authorized by
the Florida Department of Economic Opportunity(DEO). In the event of a weather-related event or supply
shortage,the President of the United States,Governor of the State of Florida,or Executive Director of DEO
may declare a weather- related crisis and release additional funds to assist affected households. When
benefits are distributed for a weather-related/supply shortage emergency,the Contractor shall comply with
directives provided by the Florida Department of Elder Affairs (DOEA or Department) as to the allowable
expenditures of these funds.
a. The services provided under this contract shall be in a manner consistent with and described in
ATTACHMENT I, Section II: Manner of Service Provision. The Contractor, in collaboration with
its EHEAP program partners,shall ensure the following service tasks are completed:
(1) Consumer Outreach;
(2) Program Partners and Stakeholders Coordination;
(3) Elder's Benefit Eligibility Determination;and
(4)Benefit Disbursement.
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April 1,2021. —September 2023 EHEAP 203.21
4. Major Program Goals
EHEAP is designed to provide crisis assistance to eligible low-income households with at least one
individual aged sixty (60) or older experiencing a heating or cooling emergency. The program allows for
payments to utility companies and/or fuel suppliers; for the purchase of blankets, portable heaters, fans,
and/or air conditioners; for the repair or replacement of existing heating or cooling equipment; for the
payment of deposits, late fees,disconnect and reconnection fees; for the provision of temporary emergency
shelter; or to resolve other heating and cooling emergencies. Any Insufficient Funds Charges are not to be
paid through this program. The program also provides eligible elders with weather-related/supply shortage
emergency benefits when authorized by DEO.
a. Standard Crisis
A standard home cooling or heating crisis exists when an elder has no access to,or is in danger of losing
access to,needed home energy because one or more of the following conditions is present:
(1)The elder has been notified that the elder's home cooling or heating is going to be disconnected;
(2)The elder has received a notice indicating the energy source is delinquent or past due;and/or
(3)The elder has an energy bill for which the due date has lapsed;
b. Life-Threatening Crisis
A life-threatening home cooling or heating crisis exists if one of the following conditions is present:
(1)The elder's home cooling or heating energy source has been disconnected;
(2)The elder is unable to get delivery of fuel for heating,is out of fuel for heating,or is in danger of
being out of fuel for heating;or
(3)The elder has other problems with lack of cooling or heating in the home,such as needing to pay a
deposit,needing a repair of heating or cooling equipment,or needing an interim emergency
measure to avoid further crisis.
c. Crisis Assistance
Allowable categories for crisis assistance are:
(1) Utility payments for heating/cooling bill assistance for electric,gas,propane,wood,coal,or
refillable fuels;
(2)Temporary emergency shelter(if needed due to energy-related crisis);
(3)Payment to landlords(when utility cots are included in rent);
(4)Repairs or replacements to heating/cooling units(as long as the amount is within the benefit limits
and the work is done by a licensed contractor);
(5)Deposits to connect or restore energy;
(6)Late fees,disconnect fees,and reconnect fees;
(7)Charges from a previous account held by the applicant that is now closed;
(8)Blankets and fans;
(9)Taxes and fees associated with the client's utility bill towards the energy portion. In some cases,
where the utility vendor combines all the other fees and taxes,which also includes non-home
energy services such as taxes can be paid with EHEAP funding.
(10)Other allowable payments are those related to the start-up of services, including reasonable
connection or reconnection fees,delivery fees,deposits,and other fees related to the start-up of
service.
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April. 1,2021. —September 2023 EHEAP 203.21
C. CLIENTS TO BE SERVED
1.. General Description
EHEAP provides for direct client services to elders in low-income households experiencing a home energy
heating or cooling emergency.A household receiving EHEAP services may not have an income above one
hundred fifty percent(150%)of the poverty level, as published by the United States Department of Health
and Human Services,unless the household is determined categorically eligible.
2. Client Eligibility
To be eligible for services under this contract,and to receive assistance,an elder must:
a. Be aged sixty(60)or older;
b. Reside in the EHEAP service area(Planning and Service Area)at the time the home energy costs were
incurred;
c. Complete and return an EHEAP application with all required information and verification to the
Contractor,while funds remain available;
d. Provide a fuel bill or other documentation evidencing an energy emergency and an obligation to pay
for home energy costs for the home in which they live;
e. Possess a total gross household income of not more than one hundred fifty percent(150%)of the Office
of Management and Budget (OMB) federal poverty level for the size of the household. In accordance
with Section I.C.3.d. below,or be determined categorically eligible to receive Ea-LEAP benefits.
f. Be experiencing one or more verifiable home cooling or heating crises.
g. Not be a resident of a group living facility or a home where the cost of residency is at least partially
paid(or subsidized)through a foster care or residential program administered by the state;
h. Not be a student living in a dormitory;and
i. Legally reside in the State of Florida.
3. Client Determination
Contractor shall begin taking applications for EH.EAP services upon execution of this contract and continue
taking applications until the contract expires or funds are exhausted.Contractor shall not accept applications
when funds are exhausted for a particular time period.Contractor shall:
a. Provide assistance to elders in completing Agency-provided applications for assistance and
determining eligibility;
b. Ensure that no one is excluded from program participation on the grounds of race,color,national origin,
sex, or age, and ensure that such persons shall not be subjected to discrimination under any activity
funded in whole or in part with these funds;
c. Treat homeowners and those who rent equitably under this contract;
d. Calculate the income eligibility of the elder by using the past thirty(30)days earnings for all occupants
of the household annualized or the elder's current economic situation and reference the current Sources
of Income (ATTACHMENT XVI) to determine what is considered allowable income. Contractor
shall proceed as follows;
(1)Total household income cannot exceed one hundred fifty percent (150%) of the current federal
Poverty Income Guidelines (ATTACHMENT XIV), unless the household is determined
categorically eligible;and
(2) Obtain a written self-declaration from household members aged eighteen (18) years or older
claiming zero income. The self-declarations must be completed and signed by the household
member who is claiming zero income.
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April 1,2021 —September 2023 EHEAP 203.21
e. Determine if all or part of the elder's utility costs are paid directly(utility reimbursement)or indirectly
(utility allowance)by the government if the elder lives in government-subsidized housing. Contractor
shall proceed as follows:
(1) If total home heating or cooling costs are included in the rent and the elder has no obligation to pay
any portion of the costs,then the elder is not eligible for assistance;and
(2)If there is a Florida Section 8 (Housing Choice Voucher Program) or a Public Housing Authority
(PHA) Program energy subsidy available to the elder during the period covered by the utility bill,
then the elder is only eligible for partial assistance. The energy subsidy for the period covered by
the utility bill must be subtracted from the allowable EHEAP benefit calculated for the household.
f. Use program qualification approvals or notifications to document household size and income of elders
receiving Supplemental Nutrition Assistance Program (SNAP) or SSI. Elders shall meet program
income eligibility guidelines and possess a total gross household income of not more than 150%of the
OMB federal poverty level for the size of the household. The benefit level to be provided to elders
receiving SSI, and SNAP shall be the same as that provided to other qualified elders;
g. Obtain a signed statement of maintenance from the elder explaining how basic living expenses, (i.e.,
food, shelter, and transportation) are being provided if the total household income is less than fifty
percent(50%)of the current federal poverty guidelines and no one in the household is receiving SNAP;
h. Ensure elders receive no more than one approved crisis assistance benefit during the cooling season,
April 1 — September 30, and one approved crisis assistance benefit during the heating season,
October 1 —March 31. The Contractor shall proceed as follows:
(1) Crisis assistance benefit may consist of payment of more than one energy obligation, per heating
and cooling season,for a household to resolve a single crisis,thus allowing for:
(i) The purchase or repair of fans,blankets,air conditioners, and/or portable heaters in addition to
heating/cooling bill assistance,that combined does not exceed the maximum crisis: and
(ii)Crisis situations which may involve a heater or air conditioner that is powered by both gas and
electricity, in which case both energy obligations are eligible for a crisis benefit payment that
combined does not exceed the maximum crisis benefit.
(2) Water,sewer,and garbage,and fire,etc.charges may not be paid.
(3)Repair or replacement of a heating/cooling unit is allowable, provided any required installation or
repair work is completed by a licensed contractor;
(4) Deposits to connect or restore energy are allowable;
(5)Late fees,disconnect fees,and reconnect fees are allowable;
(6) Charges from a previous account held by the elder that is now closed are allowable;
(7)Payment to landlord when utility costs are included in the elder's rent is allowable;and
(8)Payment for temporary emergency shelter is allowable,if due to energy-related crisis.
i. In no case shall the Contractor be required to incur costs in excess of the full contract amount to
provide services to the clients.
II. MANNER OF SERVICE PROVISION
A. SERVICE TASKS
In order to achieve the goals of EHEAP,the Contractor shall ensure the following tasks are performed:
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April 1,2021 —September 2023 EHEAP 203.21
1. Ensure that all eligible elders meet the requirements of Section.[.C.2. of this contract;
2 Ensure that all energy assistance payments made to home energy vendors comply with the requirements of
Section II.A.14.d.of this contract;
3. Implement appropriate program management and operational controls to ensure actions are taken to resolve
a home energy emergency within 18 hours of application approval for crisis benefits when the consumer is
in a life-threatening situation. For nonlife-threatening situations, actions must be undertaken to resolve the
home energy emergency within 48 hours of application approval with standard crisis assistance.
4 Provide all elders approved for EHEAP funding with a written Notice of Approval and Appeal within fifteen
(15)working days of crisis resolution. The written Notice of Approval and Appeal shall include:
a. Type and amount of assistance;
b. Name of the home energy vendor to be paid on elder's behalf;
c. The next date when the elder will be eligible to apply for further assistance; and
d. Contractor's appeal process.
5. Provide all elders whose EHEAP applications were denied with a written Notice of Denial and Appeal within
fifteen(15)working days of receiving the elder's application.The written Notice of Denial and Appeal shall
contain:
a. Name of the elder;
b. Date of application;
c. Type of benefit sought;
d. Reason(s)for denial;
e. Statement on Contractor's benefit limits,if applicable;
f. Contractor's appeal process;
g. Explanation of circumstances under which the elder may reapply;
h. Information or documentation needed for the elder to reapply;
i. The name,address,and phone number applicable to the appeal process;and
j. Number of days the elder has to file the appeal.
6. Maintain consumer appeal procedures that provide an opportunity for a fair administrative hearing to elders
whose applications for assistance are denied or whose applications are not acted upon with reasonable
promptness;
7. Provide an opportunity for elders to file a written appeal or complaint with the Contractor's Program
Supervisor within ten(1.0)working days of receipt of the written Notice of Denial and Appeal.
a. Upon receipt of a validly filed appeal or complaint,Contractor must respond in writing within ten(10)
working days;
b. Elders may appeal the Contractor's first response by filing its objections to the response with the
Contractor's Director,Executive Director,or Board.Chair,as applicable,within five(5)working days of
receipt of the first response;and
c. Upon receipt of a validly filed objection to the first response,the Contractor must respond in writing
within ten(10)working days, and the response must clearly state the final outcome of the appeal,that
the decision is final,and if applicable,the circumstances under which the elder may reapply for
services.
8. Post appeal provisions in a prominent place and in plain view at all locations where EHEAP applications
are received;
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April 1,2021 —September 2023 EHEAP 203.21
9. Ensure all ineligible applicants and applicants denied crisis assistance,when EHEAP funds are not
available or are insufficient to meet their emergency home energy needs,are referred to and assisted in.
securing help through other community resources;
10. Ensure no consumer fees are charged to,nor donations accepted from,an elder as a prerequisite for
receiving EHEAP benefits.Post in a conspicuous place at all locations where EHEAP applications are
received the following notice: "No money, cash,or checks will be requested or received from customers in
the EHEAP office.If an employee asks for money,report this to the agency executive director or agency
head."
11. Compare LIHEAP records and EHEAP records for households with elderly members to avoid duplicate
crisis assistance payment during the same eligibility period and maintain documentation sufficient to
ensure compliance with this requirement;
12. Maintain a written policy and implement procedures to protect and secure elder applicants' information
and social security numbers in order to protect their identities from theft or fraud.This policy shall address
the handling of both paper and electronic records and files.The Contractor shall, in collecting elders'social
security numbers,use the Notice Regarding Collection of Social Security Numbers,which is incorporated
into this contract by reference,(Notice of Instruction#071113-1-I-SWCBS,
http://elderaffairs.state.fl.us/doea/notices/July 13/LIHFA.P%20Notice%20re%20Social%20Security%20
Numbers%20F.inal.pdt). The Notice Regarding Collection of Social Security Numbers shall be signed by
the elder and retained in the client file;
13.Perform consumer outreach to ensure that households in all counties within the service area wishing to
benefit from the program have the opportunity to do so. Contractor shall undertake consumer outreach
initiatives in all counties within the service area designed to inform potentially eligible households about
EHEAP. Outreach efforts must focus on elderly households with disabled individuals,young children, and
where the highest percentage of the household income is required to pay for their home energy. Specific
outreach initiatives shall include,but are not limited to:
a. Informing all service area local agencies,non-profits,and similar organizations that are in regular
contact with the low-income population about the EHEA.P program,especially those serving seniors;
b. Encouraging EHEAP program participation through local television and radio programs, and placing
announcements of the EHEAP program in media community calendars;
c. Developing and implementing a written procedure for making home visits to households with
homebound elderly persons in order to assist with the completion of the program application when other
assistance is not available;
d. Making visits to provide information,and/or making presentations about EHEAP in response to requests
by local congregational centers serving elderly or disabled persons;
e. Providing information concerning the local weatherization program to all persons who request it
(including organizations that provide outreach activities);and
f. Maintaining an EHEAP Outreach Activity Report to demonstrate to the Agency that outreach efforts to
inform potentially eligible households about EHEAP shall be made to target households in all counties.
14. Coordinate services with other program partners and stakeholders to prevent the duplication of services
facilitate referrals, and improve the efficiency of services for consumers. Coordination activities shall
include,but not be limited to:
a. Communicating with the DEO LIHEAP contractors in their respective service areas to prevent the
duplication of benefits to elders.Additionally,the Contractor shall review LIHEAP and EHEAP records
for households with elderly members to ensure duplicate crisis assistance payments are not received
during the same heating or cooling season;
b. Developing a new,or continuing an existing,MOU with the Weatherization Assistance Program(WAP)
in the service area. The MOU shall detail cooperative efforts and describe the actions that will be taken
by both parties to ensure coordination and referrals.The Contractor,in coordination with the local WAP
agency,shall develop a system by which elders who have received more than three EHEAP and LIHEAP
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April 1,2021 —September 2023 EHEAP 203.21
benefits in the last eighteen(18)months and who are homeowners are referred to a WA.P provider. The
MOU shall be reviewed and renewed at least every five years. The Contractor shall maintain copies of
all MOUs. MOUs with local WAP agencies shall be updated if the contracting parties change. The
MOUs must be applicable to the Contractor's current EHEAP program requirements and guidelines;
c. Establishing a new,or continuing an existing,MOU with service area LIHEAP contractors.Each MOU
shall ensure coordination of services, to avoid duplication of assistance and increase the quality of
services provided to elders.The MOU shall direct LIHEAP providers to refer elders aged sixty (60)or
older to EHEAP providers for energy assistance.The MOU shall be reviewed and renewed at least every
five(5)years. Contractor shall maintain copies of all MOUs.MOUs with local LIHEAP agencies shall
be updated if the contracting parties change. The MOUs must be applicable to Contractor's current
EHEAP program requirements and guidelines;
d. Developing agreements with home energy vendors that benefit elders. Contractor shall maintain copies
of all vendor agreements. All agreements between Contractor and home energy vendors shall contain
the following conditions:
(1)The beginning and ending date of the Vendor Agreement;
(2)The Contractor's representative(s) authorized to resolve a crisis situation and make a payment
commitment on behalf of an elder;
(3)The home energy vendor's representative(s)authorized to resolve a crisis;
(4)A description of how energy payments will be made directly to the home energy vendor on behalf
of the EHEAP eligible customer;
(5)Assurance from the home energy vendor that no household receiving EHEAP assistance will be
treated adversely because of such assistance under applicable provisions of state law or public
regulatory requirements;
(6)Assurance that the home energy vendor will not discriminate,either in the cost of goods supplied or
the services provided,against the eligible household on whose behalf payments are made;
(7)A.statement that only energy-related elements of a utility bill are to be paid. Water,sewer,garbage,
and fire, etc. charges are not covered as part of the utility bill of the household. However,EHEAP
does allow an exception with water that is used for air conditioning,i.e.an evaporated cooler;
(8)A statement that the Contractor may not pay for charges that result from illegal activities such as a
worthless check or meter tampering, and that the home energy vendor is aware that those charges
are the responsibility of the elder;
(9)Assurance from the home energy vendor that when the benefit amount to the elder does not pay for
the complete charges owed by an elder,the elder is responsible for the remaining amount owed;
(10)Details on how the home energy vendor will assist Contractor in verifying the elder's account
information and, in the case of crisis assistance, make timely commitments to resolve the crisis. A
process should be in place to verify the current amount owed and the minimum amount necessary to
resolve the crisis situation;
(1.1.)The Contractor's commitment to make payment to the home energy vendor within forty-five (45)
days of the date of crisis resolution;
(12)Assurance from the home energy vendor that when EHEAP payments made to the vendor cannot be
applied to the elder's account,the funds will be returned to Contractor or,with Contractor's approval,
applied to another eligible customer's account;
(13)Assurance that the Contractor shall collect a signed Authorization for Release of General and/or
Confidential Information
(http://eldl.eraffairs.state.fl.us/doea/noticies/sentl5/Authorization. .for Release client%20waiver
8%2020%201.5.pdf)for EHEAP Data from each eligible elder and ensure the signed releases are
available for inspection by the home energy vendor;
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April 1,2021. —September 2023 EHEAP 203.21
(14)Assurance that home energy vendors is aware that as long as signed Authorization for Release of
General and/or Confidential Information for EHEAP Data are collected and available,the home
energy vendor will provide the requested customer date to DEO;
(15)The agreement will be reviewed by both parties at least every five(5)years;
(16)The agreement must be signed by a representative of both the Contractor and the vendor who has
authority to bind the entity and enter into such commitments; and
(17)The home energy vendor,with the exception of municipal providers,must be in"active"status with
the State of Florida: (http://sunbiz.org/search.html) and the vendor's name must be checked on
Excluded Parties List System (EPLS) (https://www.epls.gov). The business name on the vendor
agreement must match the legal business name on the State of Florida website.
15 Comply with the Federal Financial Accountability and Transparency Act(FFATA) by securing a Dun and
Bradstreet Numbering System (DUNS) number (www.dnb.com) and maintaining an active and current
profile in the System for Award Management(SAM)(www.sam.gov);and
16 Based on local need for EHEAP services and other non-EHEAP energy assistance resources in the service
area, the Contractor may limit crisis benefits to less than those stated in Section I.C.3.h. Policy changes
concerning the amount of crisis benefits available to elders require Agency approval and require notification
of the change be sent to current and potential elders.
B. STAFFING REQUIREMENTS
1. Use of Subcontractors
If an entity other than the Contractor provides any service required under this contract,the Contractor shall
ensure the following requirements are met:
a. Eligible entities that provide outreach,perform intake,make eligibility determinations, or process
benefit payments must be one of the following:
(1)A Local City Government;
(2)A Local County Government;
(3)A Community-Based Organization;
(4)A Faith-Based Organization;or
(5)A State-Community Services Agency.
b. For the term of this contract,each month the Subcontractor shall provide to the Contractor the following
information:
(1)The total number of individuals served with crisis assistance for the reporting month;
(2)The total number of individuals ineligible or denied assistance during the reporting month;
(3)The total number of individuals served by referral to other community resources for energy assistance
during the reporting month;
(4)The total amount of funding expended for crisis assistance per county for the reporting month;and
(5)An EHEAP Outreach Activity Report to demonstrate that outreach efforts to inform potentially
eligible households about EHEAP are conducted to target households in all counties.
c. Entities providing any service required under this contract must comply with the FFATA. This includes
securing a DUNS number(www.dnb.com)and maintaining an active and current profile in the System
for Award Management(SAM)(https://sam.gov/SAM/).
d. Entities must maintain current written agreements in the following formats with service providers:
(1.)A MOU shall be executed by both parties if a service provider performs any service required under
this contract and is paid for providing specific services without a direct pass-through of federal funds.
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April 1,2021 —September 2023 EHEAP 203.21
The MOU shall clearly state program expectations and the role and responsibilities of each.entity.
The Contractor shall submit a copy of all MOUs to the Agency's Contract Manager within thirty
(30)days of the contract execution date; and.
(2)An EHEAP subcontract shall be executed by both parties if a service provider performs any service
required under this contract and is awarded a direct pass-through of federal funds to operate the
program and provide program services.The Contractor shall submit a copy of all subcontracts to the
Agency's Contract Manager within thirty(30)days of the contract execution date.
(3)All service provider written agreements shall include the requirements set forth in paragraph ten,
Public Records and Retention, and paragraph eleven, Audits, Inspections, Investigations, of the
Standard Contract section of this Agreement.
(4)All service providers must complete the Assurances and Certifications attachment to this agreement.
e. Eligible entities must provide the service provider commensurate compensation for the delivery
of administrative and outreach activities and for the delivery of crisis benefits. Commensurate
compensation of administration and outreach activities shall include cost-reimbursement of actual
expense or a negotiated rate for specific activities.
f. The Contractor is bound by the terms of this Agreement and by all applicable State and Federal
laws and regulations; therefore, if any of the work required under this contract is subcontracted,
the Contractor shall include in the written agreement that the subcontractor is bound by the terms
of this contract, is bound by all applicable state and federal laws and regulations, and shall hold
the Agency and the Contractor harmless against all claims of any nature arising out of the
subcontractor's performance of work under thiscontract to the extent allowed and required by law.
g. A subcontractor shall not be permitted to perform services related to this contract without an
executed subcontract and an approved Provider Cost Analysis or MOU verifying that the
subcontractor's staff is paid from non-federal resources or is compensated for such activities by
EHEAP. In accordance with Sections 25-26 of the Department's Standard Contract, the Agency
shall not be responsible or liable for any obligations or claims resulting from any subcontract.
h. The Contractor shall document the subcontractor's progress in performing its work under this
contract in the monthly client service report.
i. For each subcontractor,Contractor shall provide a written statement to the Agency regarding whether
that subcontractor is a minority vendor, as defined in Section 288.703,F.S.
j. If this contract involves the use of a subcontractor or third party, then Contractor shall not delay the
implementation of its agreement with the subcontractor.If any circumstances occur that may result in a
delay of the initiation of the subcontract or in the performance of the subcontractor for a period of sixty
(60) days or more, The Contractor shall notify the Agency's Contract Manager and the Agency's
Director of Finace in writing of such delay.
C. SERVICE DELIVERY
1.. Service Delivery Location
The Contractor shall ensure that the services provided under this contract are available to residents within
each county in the Planning and Service Area(PSA)by in-person service,telephone,and/or other electronic
means.
2. Service Times
The Contractor shall provide the services listed in this contract during normal business hours. Normal
business hours are defined as Monday through Friday,8:00 a.m.to 5:00 p.m.local time,excluding holidays,
and force majeure.
3. The Contractor shall publish its service delivery location,toll-free telephone number,and normal business
hours in available forms of media(i.e.newspapers,radio,television,website,publications,etc.)
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April 1,2021 —September 2023 EHEAP 203.21
D. DELIVERABLES
1. Deliverables
a. Certification that the Contractor must operate during its regular business hours, as identified in Section
I:I.C.2 of this contract.
b. The Contractor shall provide the minimum level of service per month in each county served, as defined
in Section I.A.18.
2. Source Documentation
The deliverables shall be reported monthly on Contractor's monthly financial status reports. Successful
completion of the deliverables shall be determined by the Agency's receipt of Contractor's Receipts and
Expenditure Report (ATTACHMENT XI) and Request for Payment (ATTACHMENT XII) containing
the number of individuals served with crisis assistance;number of individuals ineligible or denied assistance;
number of applicants served by referral to other community resources for energy assistance; a summary of
funds expended per county for the reporting month using the EHEAP Cost Reimbursement Summary form
(ATTACHHMENT XXI);and the certification required in Section II,D.I.
3. Records and Documentation
The Contractor will maintain a separate record(paper and CIRTS)for each EHEAP applicant that includes
the following as applicable:
a. The EHEAP Application and Eligibility Worksheet, (ATTACHMENT XVIII), completed and signed
by the Contractor and the elder. The application must be approved by a supervisor or peer prior to
payment remittance. The Contractor is responsible for using the most recent application, eligibility
worksheet, and EHEAP Application and Eligibility Worksheet Instructions (ATTACHMENT XIX),
issued by the Agency.
(1)If the Contractor approves an application, one elderly member of the household must be registered.
in CIRTS using the EHEAP Application and Eligibility Worksheet(ATTACHMENT XVIII);or
(2)If the Contractor denies an application,the elder must be registered in CIRTS using the EHEAP
Application and Eligibility Worksheet(ATTACHMENT XVIII).
b. The elder's name,address,sex, and age;
c. Names,ages and current identification documentation(no more than one year expired)of all household
members;
d. Social Security numbers and documentation of those numbers for all household members or the
citation to the applicable exemption;
e. Signed notice regarding the collection of Social Security numbers(Notice of Instruction#071113-1-I-
SWCBS,
http://elderaffairs.state.f.us/doea/notiices/Julyl3/LIHEAP%20Notice%20re%20Social%20
Security%20Num bers%20Fi nal.pd f);
f. Income amount and method of verification for all household members;
g. Income documentation to support eligibility that is representative of the elder's current economic
situation;
h. Statement of self-declaration of income,if applicable;
i. A signed statement of how basic living expenses(i.e., food,shelter,and transportation)are being
provided if the total household income is less than fifty percent(50%)of the current Federal Poverty
Guidelines and no one in the household is receiving SNAP assistance;
j. Documentation of the elder's obligation(s)to pay an energy bill for the residence in which they live;
(1)The elder's utility bill must include detail to identify unallowable categories of assistance resulting
from charges for water, sewer, garbage, and fire, etc.; charges resulting from meter-tampering and
returned checks;and other charges that are not energy-related and are not required for cooling/heating
the household.
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(2) Use of the most current utility bill(s), which provides the vendor's name and address,
account holder's name,and physical address,account number,and amount(s)due is required.
If an elder's utility bill, cutoff notice, or door-hanger notice or similar documentation does not
include all of this information, The Contractor must document the verified missing information by
writing the information on the utility bill and on the EHEAP Application and Eligibility
Worksheet(ATTACHMENT VIII).
k. Signed Authorization for Release of General and/or Confidential Information for LIHEAP/EHEAP
Federal Reporting or a statement on the application which states that the elder refused to sign the
waiver;
1. Copies of approval or denial letters,including those related to the initial application and all appeals,
which are provided to the elder;
m. :If preference is given due to a disability,documentation of such disability that includes disability
income or a physician's statement;
n. Documentation of referrals to LIHEAP and WAP;
o. Notation if EHEAP prevented a disconnection or restored an energy disruption;
p. Documentation of coordination with LIHEAP providers to avoid duplication of crisis services for
households with elderly residents;
q. Proof of payment made to vendors;
r. Documented calculation of crisis benefits for elders living in subsidized housing;
s. Documented calculation of crisis benefits for elders whose energy bill includes unallowable charges;
and
t. Completed EHEAP Client File Content Checklist,(ATTACHMENT XX).
E. PERFORMANCE SPECIFICATIONS
1.Reports
The Contractor is responsible for responding in a timely fashion to additional routine and/or special requests
for information and reports required by the Agency. The Contractor must establish due dates for any
subcontractor's report that permits the Contractor to meet the Agency's reporting requirements.
a. Contractor shall report monthly on Contractor's Request for Payment,(ATTACHMENT XII)as
delineated in this section of the contract.
b. Administrative and Outreach Expense Budget Detail
Contractor shall submit by the 96 of the month to the Agency's EHEAP Contract Manager the EHEAP
Administrative and Outreach Expense Budget Detail (ATTACHMENT X). The Administrative and
Outreach Expense Budget Detail shall clearly delineate planned expenditures for funds retained by the
Contractor and funds subcontracted. The Administrative and Outreach Expense Budget Detail shall
include all Contractor positions, by title, to be paid with these funds and shall detail the estimated
number of hours, the hourly wage, and the estimated salary to be paid by EIIEAP. Funding sources,
estimated hours, and hourly wage shall be identified for the balance of salary where EHEAP funds are
used to pay less than one hundred percent(100%)of the salary.Percentages must be supported by the
submitted cost allocation plan.
c. E.HEAP Administrative Costs Report
Within the first quarter of this contract,the Contractor shall provide the EHEAP Contract Manager a list
of all individuals performing any administrative functions for EHEAP. The list must include the
Contractor's employees,agents,and representatives;as well as,all employees,agents,or representatives
of subcontractors,serving EHEAP administratively. For each individual on the list,the Contractor must
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April 1,2021 —September 2023 EHEAP 203.21
also provide the individual's EHEAP administrative duties and functions. Additionally,the Contractor
must provide total salary and benefit amounts for each individual on the list, specifying all funding
sources from which that person is paid, and the corresponding amounts of that pay charged to each
funding source.
d. Cost Allocation Plan
The Contractor shall submit to the Agency's EHEAP Contract Manager the EHEAP Cost Allocation
Plan (ATTACHMENT XXII). The Cost Allocation Plan shall provide budgeting methodology,
allocation distribution,and the data source(s)used.
e. Provider Cost Analysis
State of Florida Chief Financial Officer Memorandum No. 02 (released October 3, 2012), requires
Contractor to provide assistance to the Agency's Contract Manager in completing the DOEA Cost
Analysis for Non-Competitively Procured Contracts in Excess of Category II-Addendum to the EHEAP
Cost Allocation Plan(ATTACHMENT XXII).
(1)The Contractor shall submit a completed Cost Analysis,which shall reflect Administrative,
Outreach, and Crisis Service allocations as delineated on the Budget Summary(ATTACHMENT
IX) and must be sufficient to explain the expenditures' allowability, allocability, and
reasonableness. The Cost Analysis shall be submitted and approved by the Agency prior to
execution of this contract. All subsequent amendments that affect the budget shall also be submitted
to and approved by the Agency prior to any change.
f. Monthly Client Service Report
For the term of this agreement,each month the Contractor shall provide the EHEAAP Contract Manager,
on the 9" of the month for the preceding calendar month,the following: (enter this information on the
106 report).
(1)The total number of households served per county;
(2)The total amount of funding expended for crisis assistance per county;
(3)The total number of households served by referral to other community resources for energy
assistance; and
(4)The total number of households ineligible or denied crisis assistance.
g. EHEAP Outreach Activity Report
The Contractor shall ensure the use of outreach efforts that will inform potentially eligible households
about EHEAP to the Agency Contract Manager or its designee by the 9t'of each month along with the
county's monthly billing. The EHEAP Outreach Activity Report shall consist of the following:
(1)Date;
(2)County:
(3)Location Address
(4)Description of Activity;and
(5)Name and Position of Staff
h. Surplus/Deficit Report—Lead Agency Spending Report
The Contractor shall submit a Consolidated Surplus/Deficit Report,Lead Agency Spending Report,in a
format provided by the Agency, to the Agency Contract Manager by the 18th of each month. This
Consolidated Surplus/Deficit Report is for all agreements and contracts between th.e Contractor and the
Agency and must include the following:
(1) A list of all contracts and their current status regarding surplus/deficit;
(2) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the
Agency will be resolved;
(3) Recommendations to transfer funds within the PSA to resolve surplus/deficit spending;and
(4) Input from the Agency's Board of Directors on resolution of spending issues,if applicable.
i. Quarterly Reports
EHEAP Summary Report
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April 1,2021 —September 2023 EHEAP 203.21
Contractor shall ensure timely and accurate CIRTS data entry of EHEAP activity and submit to the
Agency's EHEAP Contract Manager or designee the service report entitled,"EHEAP SUMMARY,"
from CIRTS. The report shall reflect the use of EHEAP in your county(s) in the PSA and shall be
inclusive of all elders applying for crisis energy assistance during the reporting quarter.
The CIRTS EHEAP Summary Report shall be submitted based on the following schedule:
REPORT REPORTING PERIOD SEASON DATE DUE TO AGENCY
1 04/01/21 —06/30/21 Cooling Season July 09,2021
2 07/01/21—09/30/21 Cooling Season October 09,2021
3 10/01/21 —12/31/21 Heating Season January 09,2022
4 01/01/22—03/31/22 Heating Season April 09,2022
5 04/01/22—06/30/22 Cooling Season July 09,2022
6 07/01/22—09/30/22 Cooling Season October 09,2022
7 10/01/22—12/31/22 Heating Season January 09,2023
8 01/01/23—03/31/23 Heating Season April 09,2023
9 04/01/23—06/30/23 Cooling Season July 09,2023
10 07/01/23—09/30/23 Cooling Season October 09,2023
The EHEAP Summary Report parameters for the program year shall be:
(i) PSA;
(ii) All Providers;
(iii) Your Location;
(iv) EHEAP;
(v) All Cities;
(vi) Poverty Line$19,140;
(vii) Each Additional Household Members $6,720;and
(viii) Current Reporting Period.
j. Program Effectiveness Reports
The Contractor agrees to provide the Agency any additional service reports requested by the Agency
concerning the effectiveness of the program and shall include any statistics and information that the
Agency may require. The reporting period shall begin with the effective date of this contract in a format
and according to a schedule provided by the Agency for each report.
2. Monitoring and Evaluation Methodology
The Contractor shall monitor its performance under this contract as swell as that of its subcontractors,
subrecipients and consultants who are paid from funds provided under this contract to ensure that the scope
of work is accomplished within specified time periods and budgets set and that other performance goals
stated in this contract are achieved. Such review shall be made for each function or activity set forth in this
contract and reported in the quarterly report.
a. Contractor shall review completed EHEAP applications in accordance with the EHEAP Client File
Content Checklist(ATTACHMENT XX).
b. The Agency shall, at its own discretion, conduct investigations concerning any aspect of Contractor's
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April 1,2021. —September 2023 EHEAP 203.21
performance of this contract.
c. The Agency shall conduct a full onsite review of Contractor at least once during each three-year period.
The Contractor shall allow the Agency to carry out monitoring,evaluation,and technical assistance,and
shall ensure the cooperation of its employees,and of any subcontractors with whom Contractor contracts
to carry out program activities.
d. The Agency shall conduct desk review activities throughout the year to monitor contractual program
requirements.
e. The Agency shall conduct EHEAP intake site visits.
f. In conjunction with onsite monitoring visits and desk review activities,the Agency shall review a sample
of completed EHEAP client files in accordance with the EHEAP Client File Content Checklist,
(ATTACHMENT XX).
g. The Agency shall conduct follow-up reviews including prompt return visits to Contractors that fail to
meet the goals,standards,and requirements established by the state and federal funding agency.
3. Program Highlights
The Contractor shall submit Program Highlights referencing specific events that occurred in SFY/FFY 2021-
2023 by August 30,2021,August 30,2022,and August 30,2023. The Contractor shall provide a new success
story,quote,testimonial,or human-interest vignette. The highlights shall be written for a general audience,
with no acronyms or technical terms. For all agencies or organizations that are referenced in the highlight,
the Contractor shall provide a brief description of their mission or role. The active tense shall be consistently
used in the highlight narrative, to identify the specific individual or entity that performed the activity
described in the highlight.
4. Outreach Plan Survey
Contractor shall submit to the EHEAP Contract Manager the EHEAP Outreach Plan Survey
(ATTACHMENT XVII).The purpose of the Outreach Plan Survey is to delineate all activities and efforts
for the program year. The EHEAP Outreach Plan Survey is due within thirty (30) days of the contract
execution date.
5. For the term of this contract,each month Contractor shall provide to the Agency,by the 9th of each month
for the preceding month,the following information will be entered on ATTACHMENT XII,Request for
Payment,under Part D: Service Information
(i) The total number of individuals served with crisis assistance for the reporting month;
(ii) The total number of individuals ineligible or denied assistance during the reporting
month;
(iii) The total number of individuals served by referral to other community resources for
energy assistance during the reporting month;and
(iv) The total amount of funding expended for crisis assistance per county for the
reporting month.
F. CONTRACTOR RESPONSIBILITES
1. Make vendor payments directly to fuel and/or home energy providers on behalf of eligible elders.
2. Determine the correct amount of each crisis benefit based on the minimum necessary amount needed to
resolve the crisis,but not more than the item limits or total limit set by the Agency.
3. Encourage households to seek assistance prior to incurring non-energy penalties such as
disconnect/reconnect fees,additional deposits,interest or late payments.
4. Provide EHEAP crisis services to households with elders in every city within the service area.
a. Contractor shall ensure that each city within their service area receives a minimum level of crisis
services monthly,as delineated in Section 1.A.18.;
b. EHEAP funded staff shall make themselves available in all underserved counties as needed,to ensure
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April 1,2021 —September 2023 EHEAP 203.21
that the minimum level of service is met;and
c. Contractor shall provide oversight to ensure that the minimum level of service is provided monthly in
each city in Contractor's service area.
5. Make crisis benefit payments to vendors on behalf of approved elders within forty-five(45)days of the date
of crisis resolution.
6. Make payments on behalf of those elders with the highest home energy needs and the lowest household
income,which will be determined by taking into account both the energy burden and the unique situation of
households that result from having members of a vulnerable population, including very young children,the
disabled,and frail elders.
7. Refund to the Agency, with non-federal funds, all funds incorrectly paid on behalf of elders that cannot be
collected from the elder.
8. Develop adequate procedures to ensure EHEAP funds are appropriately budgeted and expended to permit
payment of energy assistance benefits in both the heating and cooling seasons, ensure that this is a twelve-
month program, and ensure that funding is available to and expended in, all counties within Contractor's
service area. Procedures should include referral to other community agencies when funds budgeted for a
particular time period are exhausted and elders are subsequently denied.
9. Develop monitoring and oversight procedures to ensure that administrative costs that exceed the contracted
EHEAP administrative award to Contractor or Subcontractor are paid from non-federal sources.
10. Develop adequate procedures to address the use of EHEAP funds for elders who are on oxygen support or a
"Lifeline Program"and must have power.
11.Develop a written policy regarding the use of funds for repairing or replacing heating or cooling equipment.
The procedures must address the conditions under which an elder is eligible for such funds and what
constitutes an emergency related to lack of heating or cooling.
12.Ensure providers and appropriate staff participate in training opportunities scheduled by the Agency to cover
EHEAP policies and procedures.
13 Ensure the provision of training for all providers and staff members assigned responsibilities within the
program.
14 Maintain an EHEAP Policies and Procedures Manual to serve as a local resource for program administration,
training,and reference.The EHEAP Policies and Procedures Manual shall be distributed to all subcontractors
that provide any service under EHEAP. The .EHEAP Policies and Procedures Manual shall be reviewed
during, and in accordance with, the Agency's EHEAP contract monitoring schedule, and shall include the
following:
a. The State of Florida LIHEAP Policies and Procedures Manual;
b. An MOU or Subcontract with EHEAP providers;
c. An MOU with all service area LIHEAP providers;
d. An MOU with all service area WAP providers;
e. Contractor's cost allocation methodology;
f. Written policies and procedures to ensure that all energy assistance payments made to home energy
vendors comply with the requirements of the Vendor Agreement;
g. Adequate procedures to ensure that EHEAP funds are appropriately budgeted and expended to
sufficiently allow for energy assistance benefits in both the heating and cooling seasons,ensure that this
is a twelve- month program, and to ensure that funding is available to, and expended in, all counties
within Contractor's service area;
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April 1,2021 —September 2023 EHEAP 203.21
h. Policies regarding the detection and prevention of fraud and abuse of program funds. At a minimum,
the policy will address initiatives reflective of the detection and prevention of internal and external
collusion,conspiracy,and complacency.
i. These policies will incorporate internal controls that provides for safeguarding assets,proper
recording of transactions,efficient and effective accomplishment of goals and objectives,and
compliance of rules and other governance through the segregation of duties.
ii. The concept of segregation of duties is to separate the following responsibilities in each business
process.
1. Custody of assets
2 Record keeping
3 Authorization
4 Reconciliation
iii. When duties cannot be segregated,compensating controls should be considered. Compensating
controls can be preventative,detective,or monitoring controls that are executed by an independent,
supervisory-level employee who does not have custody,record-keeping,authorization,or
reconciliation responsibilities for the process.
i. Policies that address serving family members and employees,that includes senior management
oversight and approval of:
1. Application and eligibility determination;and
2. Benefit determination and award.
j. Policies and procedures to secure applicant Social Security Numbers,in order to protect applicants'
identities,that at a minimum, include:
i. Storage of active and archived paper client files.
ii. Access to,use of,storage,and disposal of client database printouts and reports containing client
information.
iii. Transporting applicant information and client files from one location to another.
iv. Authorization to access both paper and electronic files.
v. Retention conditions and means of disposal of archived client information and files.
k. Procedures for data integrity;
i. The AAAs will ensure all providers maintain written procedures for computer system backup and.
recovery.
ii. All data and software shall be routinely backed up to ensure recovery from losses or outages of the
computer system.
iii. The security over the backed-up data is to be as stringent as the protection required of the primary
system.
iv. An appropriate level of security includes approving and tracking all AAA and provider employees
that request system or information access and ensuring that user access has been removed from all
terminated employees.
1. Procedures for referral or access assistance to the"Lifeline Program";
m. A policy outlining the criteria to determine if a household has a"home energy crisis" and the
information and/or documentation required to verify the crisis;as outlined in Section I.B.4a.
Standard Crisis,and b. Life-Threatening Crisis,of this Attachment;
n. Policies and procedures for determining the eligibility of elders applying for EHEAP; as outlined in
Section 1. C.2. Client Eligibility,and 3. Eligibility Determination;
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April 1,2021 —September 2023 EHEAP 203.21
o. Policies which encourage households to seek assistance prior to incurring non-energy penalties such as
disconnect/reconnect fees, additional deposits,interest,or late payments;
p. Procedures referring elderly homeowners who have received more than three energy benefits(EHEAP
or LIHEAP)in the last eighteen(18)months to the WAP provider;
q. A policy concerning the use of funds for the purchase or repair of heating or cooling equipment;
r. Policies and procedures which detail allowable timeframes for elders to submit required
documentation,if missing at the time of application;
s. A resource guide,or the utilization of the Information and Referral database(ReferNET),to access other
energy assistance resources available at the local level to provide referrals to elders when EHEAP
Funding is not available or they do not qualify; or contacting the Area Agency's Elder Help Line for
resources.
t. Consumer appeal procedures that provide an opportunity for a fair administrative hearing at the provider
level to elders whose applications for assistance are denied, or whose applications are not acted upon
with reasonable promptness; and
u. Policies and procedures for conducting home visits to home-bound elders for completion of the
program application or eligibility determination when other assistance is not available,that at a
minimum,includes:
i. Designation of appropriate staff to conduct home visits;
ii. Applicant and staff safety and security precautions;
iii. Confidentiality;
iv. Means to collect required documentation;
v. Safeguarding Applicant information and documentation during transport;and
vi. Training and technical assistance.
15 Notwithstanding that tasks for which the Contractor is held accountable involve coordination with other
entities in performing this contract, the failure of other entities does not alleviate the Contractor from any
accountability for tasks or services that the Contractor is obligated to perform pursuant to this contract.
16 Ensure timely and accurate CIRTS data entry of EHEAP activity is completed prior to submitting Request
for Payment(ATTACHMENT XII).
G. AGENCY RESPONSIBILITIES
1. The Agency may provide technical support and assistance to Contractor within the resources of the Agency
to assist the Contractor in meeting the requirements of this contract. The Agency's support and assistance,
or lack thereof, shall not relieve Contractor from full performance of contract requirements.
Z The Agency will provide to Contractor the State of Florida LIHEAP Policies and Procedures Manual.The
State of Florida LIHEAP Policies and Procedures Manual will provide information and procedures needed
to administer EHEAP in Florida.
a. This contract excludes all provisions of the State of Florida LIHEAP Policies and Procedures Manual
in reference to LIHEAP Regular Home Energy Annual Benefits.
b. To the extent any conflict arises between this contract and any incorporated reference contained herein,
this contract shall have precedence.
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April. 1,2021. —September 2023 EHEAP 203.21
Ill.METHOD OF PAYMENT
A. PAYMENT METHOD USED
The Method of Payment for this contract is a combination of cost reimbursement and advance payments,subject
to the availability of funds and Contractor performance. The Agency will pay the Contractor upon satisfactory
completion of the Tasks/Deliverables,as specified in Section II, Manner of Service Provision,and in accordance
with other terms and conditions of this contract.
1. Cost Reimbursement
The Contractor agrees to distribute funds as detailed in the Budget Summary (ATTACHMENT IX),
attached to this contract.Any change in allocation of categorical or total amounts of funds identified on the
Budget Summary form require a contract amendment. Payment may be authorized only for allowable
expenditures, which are in accordance with the limits specified in ATTACHMENT IX. All Cost
Reimbursement Requests for Payment must include the actual Receipts and Expenditure Reports beginning
with the first month of this contract.
a. Budget Summary
The Contractor agrees to implement the distribution of funds as detailed in the Budget Summary
(ATTACHMENT IX).An amendment is required to change category allocations or the total amount of
this contract.
(1) Administrative Expense
Administrative expenses include costs for general administration and coordination of the program,
including direct and indirect costs. This includes the salaries, fringe benefits (i.e. insurance,
retirement,etc.),rent, utilities,travel, etc.associated with financial and administrative management
of the program. The use of other federal funds to supplement the administrative operations of
EHEAP,above and beyond the budgeted amount,is prohibited.Administrative costs that exceed the
contracted EHEAP administrative award to Contractor or subcontractor must be paid from non-
federal sources. Contractors must have adequate procedures for monitoring and oversight to ensure
compliance.
(2) Outreach Expense
Outreach expenses are those costs incurred in delivering EHEAP services that are not purely
administrative in nature. This may include staff and subcontractor expenses such as salaries, fringe
benefits (i.e. insurance, retirement, etc.), rent, utilities, travel, etc. for those employees performing
outreach and intake.Outreach expense shall not include senior management expense,unless outreach
and intake involving direct contact with elders occurs.Documentation to support this exception shall
be maintained by Contractor and available upon request.
b. Weather/Related Supply Shortage
Weather Related/Supply Shortage funds are a set-aside for emergency assistance. These funds must be
held in this budget line item category until December 15'of the program year,for use in response to a
possible disaster. These funds shall only be used during state or federal emergencies declared officially
by the President of the United States,the Governor of the State of Florida, or the Executive Director of
DEO. In the event of an emergency being officially declared, if Contractor or the Agency finds that the
budgeted amount of Weather Related/Supply Shortage emergency assistance funds is not sufficient to
meet the emergency, Contractor may, with the Agency's written authorization, draw on other contract
categories up to fifty percent(50%)of the total contract budget.When funds are distributed for a weather-
related/supply shortage emergency, the Agency will provide binding directives as to the allowable
expenditures of the funds.After December I5,if no emergency has been declared,the Agency will release
the funds and Contractor shall allocate these funds to the crisis category of the program.
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April 1,2021 —September 2023 •
EHEAP 203.21
c. Indirect Cost Rate
Per 2 C.F.R.§200.331(a)(4),Subrecipients of federal awards are required to have an approved,federally
recognized indirect cost rate, negotiated between the Subrecipient and the Federal Government. If no
such rate exists, then the Subrecipient shall have either a rate negotiated with DOEA (in compliance
with 2 C.F.R..Part 200), or a de minimis indirect cost rate as defined in 2 C.F.R. § 200.414(f).
Subrecipient shall maintain its current Indirect Cost Rate Proposal and make the proposal available upon
request.If Subrecipient chooses to use the de minimal rate,Subrecipient shall make sure it is entitled to
use that rate and include a statement to that effect. Subrecipient is not obligated to establish an indirect
cost rate if Subrecipient does not charge an indirect cost rate.
2 Advance Payments
Contractor may request up to two(2)months of advances at the start of the contract period to cover program
administration, outreach, and service costs. The payment of an advance will be contingent upon the
sufficiency and amount of funds released to the Agency by the State of Florida ("budget release"). The
Contractor's requests for advance payments require the written approval of the Agency's Contract Manager.
For the first month's advance request, the Contractor shall provide the Agency's Contract Manager with
documentation justifying the need for an advance and describing how the funds will be distributed. If the
Contractor is requesting two (2) months of advances, documentation must be provided reflecting the cash
needs of the Contractor within the initial two (2) months and should be supported through a cash-flow
analysis or other information appropriate to demonstrate the Contractor's financial need for the second
month of advances. The Contractor must also describe how the funds will be distributed for the first and
second month. If sufficient budget is available, and the Agency's Contract Manager, in his or her sole
discretion, has determined that there is a justified need for an advance, the Agency will issue approved
advance payments after April. 1,2021.
a. Any advance payment the Contractor requests for subcontractors must be distributed within seven days
of receipt of payment from the Agency. The Contractor shall submit to the Agency documentation to
support full distribution of advance funds with report number 5,due to the Agency on the 9th of the 5th
month upon execution of contract, in accordance with the Invoice Report Schedule, (ATTACHMENT
XIII),to this contract.
b. All advance funds requested for the Contractor must be fully expended no later than June 15,2021.Any
amount of advance payments not fully recouped on the Request for Payment starting with Receipts and
Expenditure Report number 5,due to the Agency on July 9,2021,in accordance with the Invoice Report
Schedule,(ATTACHMENT XIII),attached to this contract.
c. All advance payments made to the Contractor shall be reimbursed to the Agency as follows: one-tenth
of the advance payment received shall be reported as an advance recoupment on each Request for
Payment, starting with Receipts and Expenditure Report number 5, in accordance with the Invoice
Report Schedule,(ATTACHMENT XIII), attached to this contract.
d. Interest earned on advances must be identified separately by source of funds,state or federal.Contractor
shall maintain advances of federal funds in FDIC interest bearing accounts,unless an exception is made
in accordance with 45 C.F.R. § 75.305(b)(8). interest earned in excess of$250 per year on Federal cash
balances shall be returned to the Agency at the end of each quarter of the contract period.
B. All payment requests shall be based on actual monthly expenditures beginning with the first month of this
contract.The schedule for submission of advance requests and requests for payment is in ATTACHMENT XIII
to this contract.
C. The final close-out request for payment is due to the Agency no later than October 15,2023.
D. METHOD OF INVOICE PAYMENT
Payment shall be made upon Contractor's presentation of an invoice subsequent to the acceptance and approval
by the Agency of the deliverables on the invoice. The form and substance of each invoice submitted by
Contractor shall be as follows:
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April. 1,2021 —September 2023 EHEAP 203.21
I. Have Remittance Address that corresponds exactly to the"Remit To" address provided to My Florida
MarketPlace(MFMP)during registration;
2 Request payment for services as established in the Service Rate Report(ATTACHMENT XXIII);
3 Contractor shall consolidate all Requests for Payment from subcontractors and Receipts and Expenditure
Reports that support requests for payment and shall submit them to the Agency using Receipts and
Expenditure Report (ATTACHMENT XI), Request for Payment (ATTACHMENT XII), and Cost
Reimbursement Summary(ATTACHMENT XXI);
4. Contractor shall include requiring supporting documentation as delineated in Section III. F. with the cost
reimbursement portion of the invoice.
E. PAYMENT WITHHOLDING
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any adjustments
thereto,including any disallowance not resolved.
F. SUPPORTING DOCUMENTATION REQUIREMENTS
For the reporting month, Agency shall include the following with Request for Payment:
1. The number of individuals served,that include:
a. The number of individuals served with crisis assistance during the reporting month;
b. The number of individuals ineligible or denied assistance during the reporting month;
c. The number of individuals referred to other community resources for energy assistance during the
reporting month;
2. Certification that Contractor operated during its normal business hours during the reporting month; and
3. The total amount of funding expended for crisis assistance per county for the reporting period;
G. FINANCIAL CONSEQUENCES
Failure to meet the deliverables described in this contract may result in a financial consequence and may result
in the redistribution of funding. Contractor shall ensure the provision of services and the successful completion
of deliverables as set forth in this contract.
1. The Agency shall not reimburse any expenditures associated with Deliverables not accepted by the Agency
as successfully completed; however, this does not preclude Contractor from receiving payment for such
expenditures upon successful completion of the deliverable.
22 If Contractor fails to be open and available for services according to its regular business hours as identified
in Section II.C.2 of this contract, excluding weekends or state and federal holidays, Contractor shall pay to
the Agency financial consequences for such failure,unless the Agency waives such failure in writing based
upon its determination that the failure was due to factors beyond the control of Contractor.
3. Contractor's failure to operate according to its regular business hours shall result in an assessment of a
financial consequence in the amount of$10.00 per day.
4 Any amounts due from financial consequences shall be paid by Contractor out of non-federal funds.
H. REMEDIES-NONCONFORMING SERVICES
Contractor shall ensure that all participants served under this contract are eligible for the program and that all
monthly and/or quarterly performance reports and financial records are maintained for each reporting period and
submitted as stipulated in this contract.
1. Any nonconforming program service, performance report, or financial record not meeting the
aforementioned requirements is not eligible for reimbursement under this program. Contractor shall solely
bear the costs associated with enrolling, training, reporting and/or managing the program. Contractor shall
give immediate notice to the Agency of any significant and/or systemic infraction that compromises
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April 1,2021 —September 2023 EHEAP 203.21
Contractor's ability to provide participant services, to achieve programmatic performance, or to provide
sound financial management of the program.
I. CONSEQUENCES FOR NON-COMPLIANCE
Contractor shall ensure one hundred percent (100%) of the deliverables identified in this contract are
performed pursuant to contract requirements, and as described in Section 1I.D, are identified as major
deliverables in this contract.
1. If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to correctly,
completely,or adequately perform these major deliverables,the Contractor will have ten(10)days to submit
a Corrective Action Plan (CAP) to the Contract Manager that addresses the deficiencies and states how
the deficiencies will be remedied within a time period approved by the Contract Manager.The Agency shall
assess a Financial Consequence for Non-Compliance on the Contractor for each deficiency identified in
the CAP which is not corrected pursuant to the CAP.The Agency will also assess a Financial Consequence
for failure to timely submit a CAP. If Contractor fails to timely submit a CAP,the Agency shall deduct 1%
of the monthly value of the administrative funds in the contract for each day the CAP is overdue,beginning
the 11`t' day after notification by the Contract Manager of the deficiency. The deduction will be made from
the payment for the invoice of the following month.
2 In the event that Contractor fails to correct an identified deficiency within the approved time period specified
in the CAP, the Agency shall deduct,from the payment for the invoice of the following month, 1%of the
monthly value of the administrative funds in the contract for each day the deficiency is not corrected. The
Agency may also deduct, from the payment for the invoice of the following month, 1%of the monthly
value of the administrative funds in the contract for each day the Contractor fails to timely submit a CAP.
IV.SPECIAL PROVISIONS
A. The following is incorporated by reference:
1. State of Florida LIHEAP Policies and Procedures Manual,
B. Modifications
The Agency shall not be obligated to reimburse Contractor for expenditures in excess of the funded amount of
this contract unless and until the Agency officially approves such expenditures by executing a written
modification to the original contract,signed by both parties.
1. Contractor must use an Agency approved budget modification process.
2 For the purpose of transferring funds, the following are considered budget categories
(.1)Administrative,(2)Outreach,and(3)Crisis Assistance.
C. Enforcement
1. In accordance with Section 430.04, F.S., the Agency shall rescind designation of an lead
agency or take intermediate measures against the Contractor, including corrective action,
unannounced special monitoring,temporary assumption of operation of one or more programs
by the Agency, placement on probationary status, imposing a moratorium on Contractor
action, imposing financial penalties for nonperformance, or other administrative action
pursuant to Chapter 120, F.S., if the Agency finds that anyof the following have occurred:
a. An intentional or negligent act of the Contractor has materially affected the health,
welfare, or safety of clients, or substantially and negatively affected the operation of an
aging services program;
b. The Contractor lacks financial stability sufficient to meet contractual obligations or that
contractual funds have been misappropriated;
c. The Contractor has committed multiple or repeated violations of legal and regulatory
requirements or Agency and/or Department standards;
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April l, 2021 —September 2023 EHEAP 203.21
d. The Contractor has failed to continue the provision or expansion of services after the
declaration of a stateof emergency;
e. The Contractor has exceeded its authority or otherwise failed to adhere to the terms of
this contract with the Agency, or has exceeded its authority or otherwise failed to
adhere to the provisions specifically provided by statute or rule adopted by the
Agency;
f. The Contractor has failed to properly determine client eligibility as defined by the
Agency or efficiently manage program budgets; or
g. The Contractor has failed to implement and maintain an Agency-approved client
grievance resolution procedure.
2 In making any determination under this provision, the Agency may rely upon findings of
another state or federal agency or other regulatory body. Any claims for damages for breach
of contract are exempt from administrative proceedings and shall be brought before the
appropriate entity in the venue of Lee County,Florida.In the event the Agency initiates action
to rescind a lead agency designation, the Agency shall follow the procedures set forth in 42
U.S.C. § 3025(b).
END OF ATTACHMENT
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April 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Agency to the Contractor may be subject to audits and/or monitoring by the Area Agency
on Aging for Southwest Florida as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with 2 CFR Part 200(formerly OMB Circular A-133 as revised), and Section
215.97, F.S., (see "AUDITS"below), monitoring procedures may include, but not be limited to, on-site visits by the Agency and/or
Department staff,limited scope audits and/or other procedures.By entering into this contract,the Contractor agrees to comply and cooperate
with any monitoring procedures/processes deemed appropriate by the Agency and/or Department. In the event the Agency and/or
Department determines that a limited scope audit of the Contractor is appropriate, the Contractor agrees to comply with any
additional instructions provided by the Agency and/or Department to the Contractor regarding such audit. The Contractor further agrees
to comply and cooperate with any inspections,reviews,investigations,or audits deemed necessary by the Agency's Director of Program
and Planning.
AUDITS
PART I:FEDERALLY FUNDED
This part is applicable if the Contractor is a State or local government or a non-profit organization as defined in 2 CFR Part 200,Subpart
A.
In the event that the Contractor expends$750,000.00 or more in federal awards during its fiscal year,the Contractor must have a single
or program-specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial and Compliance
Audit ATTACHMENT I I, EXHIBIT 2 to this agreement indicates federal resources awarded through the Agency by this
contract. In determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards,
including federal resources received from the Agency. The determination of amounts of Federal awards expended should be in accordance
with 2 CFR Part. An audit of the Contractor conducted by the Auditor General in accordance with the provisions of 2 CFR Part 200 will
meet the requirements of this part.
In connection with the audit requirements addressed in Part I,paragraph 1,the Contractor shall fulfill the requirements relative to auditee
responsibilities as provided in 2 CFR§200.508.
If the Contractor expends less than$750,000.00 in federal awards in its fiscal year,an audit conducted in accordance with the provisions
of 2 CFR Part 200 is not required. In the event that the Contractor expends less than$750,000.00 in federal awards in its fiscal year and
elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200, the cost of the audit must be paid from non-
federal resources(i.e.,the cost of such audit must be paid from Contractor resources obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to contracts with the Agency shall be based on the contract's requirements,including any rules, regulations, or statutes
referenced in the contract.The financial statements shall disclose whether or not the matching requirement was met for each applicable
contract. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Area
Agency on Aging for Southwest Florida,Inc.contract involved. If not otherwise disclosed as required by 2 CFR §200.510,the schedule
of expenditures of federal awards shall identify expenditures by contract number for each agreement with the Agency in effect during
the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the
audit report or 9 months after the end of the Contractor's fiscal year end.
PART II: STATE FUNDED
This part is applicable if the Contractor is a non-state entity as defined by Section 215.97(2),F.S.
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of$750,000.00 in any fiscal
year of such Contractor, the Contractor must have a State single or project-specific audit for such fiscal year in accordance with
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April 1,2021. —September 2023 EHEAP 203.21
Section 215.97,F.S.;applicable rules of the Department of Financial Services;and Chapter 10.550(local governmental entities)or 10.650
(nonprofit and for-profit organizations),Rules of the Auditor General. ATTACHMENT I I, EXHIBIT 2 to this agreement
indicates state financial assistance awarded through the Agency by this contract.In determining the state financial assistance expended in
its fiscal year,the Contractor shall consider all sources of state financial assistance,including state financial assistance received from the
Agency, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through
awards and resources received by a non-state entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II,paragraph 1,the Contractor shall ensure that the audit complies with the
requirements of Section 215.97(8),F.S.This includes submission of a financial reporting package as defined by Section 215.97(2),F.S.,
and Chapter 10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations), Rules of the Auditor General.
If the Contractor expends less than$750,000.00 in state financial assistance in its fiscal year,an audit conducted in accordance with the
provisions of Section 215.97, F.S., is not required. In the event that the Contractor expends less than $750,000.00 in state financial
assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97,F.S.,the cost of the
audit must be paid from the non-state entity's resources(i.e.,the cost of such an audit must be paid from the Contractor resources obtained
from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to contracts with the Agency shall be based on the contract's requirements,including any applicable rules, regulations,
or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable contract.
All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Agency contract
involved. If not otherwise disclosed as required by Rule 69I-5.003, F.A.C., the schedule of expenditures of state financial assistance
shall identify expenditures by contract number for each contract with the Agency in effect during the audit period. For local governmental
entities, financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report,but no
later than 12 months after the Contractor's fiscal year end. For non-profit or for-profit organizations, financial reporting packages
required under this part must be submitted within 45 days after delivery of the audit report, but no later than 9 months after the
Contractor's fiscal year end. Notwithstanding the applicability of this portion,the Agency retains all right and obligation to monitor and
oversee the performance of this contract as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of financial reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of this
Financial Compliance Audit Attachment, shall be submitted, when required by 2 CFR § 200.512 by or on behalf of the Contractor
directly to each of the following:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville,IN 47132
Pursuant to 2 CFR§200.512,all other Federal agencies,pass-through entities and others interested in a reporting package and data
collection form must obtain it by accessing the Federal Audit Clearinghouse.
The Contractor shall submit a copy of any management letter issued by the auditor,to the Area Agency on Aging for Southwest Florida,
Inc.at the following address:
Area Agency on Aging for Southwest Florida,Inc.
Attn:Richard Cocchieri,Fiscal Director
2830 Winkler Ave,Suite 112
Fort Myers,FL 33916
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April 1,2021. —September 2023 EHEAP 203.21
Additionally, copies of financial reporting packages required by PART II of this contract's Financial and Compliance Audit
Attachment shall be submitted by or on behalf of the Contractor directly to each of the following:
The Area Agency on Aging for Southwest Florida,Inc.at the following address:
Area Agency on Aging for Southwest Florida,Inc.
Attn: Richard Cocchieri,Fiscal Director
2830 Winkler Ave,Suite 112
Fort Myers,FL 33916
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building,Room 574
111 West Madison Street
Tallahassee,Florida 32399-1450
Any reports,management letters,or other information required to be submitted to the Agency pursuant to this agreement shall be submitted
timely in accordance with 2 CFR Part 200, F.S., and Chapter 10.550 (local governmental entities)or 10.650(nonprofit and for-profit
organizations),Rules of the Auditor General,as applicable.
Contractors,when submitting financial reporting packages to the Agency for audits done in accordance with 2 CFR Part 200 or Chapter
10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General,should indicate the
date that the reporting package was delivered to the Contractor in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six(6)years
from the date the audit report is issued, and shall allow the Agency or its designee,the CFO or Auditor General Access to such records
upon request. The Contractor shall ensure that audit working papers are made available to the Agency or its designee,CFO,or Auditor
General upon request for a period of six(6)years from the date the audit report is issued,unless extended in writing by the Agency.
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April 1., 2021. —September 2023 EHEAP 203.21
ATTACHMENT II-EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200 and/or Section
215.97,F.S. Contractors who are determined to be recipients or sub-recipients of federal awards and/or state financial assistance may
be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 are met. Contractors
who have been determined to be vendors are not subject to the audit requirements of 2 CFR§200.38,and/or Section 215.97,F.S.
Regardless of whether the audit requirements are met,Contractors who have been determined to be recipients or sub-recipients of
Federal awards and/or state financial assistance must comply with applicable programmatic and fiscal compliance requirements.
In accordance with 2 CFR Part 200 and/or Rule 69I-5.006,F.A.C.,Contractor has been determined to be:
Vendor not subject to 2 CFR§200.38 and/or Section 215.97,F.S.
X Recipient/sub-recipient subject to 2 CFR§§200.86 and 200.93 and/or Section 215.97,F.S.
Exempt organization not subject to 2 CFR Part 200 and/or Section 215.97, F.S.For Federal awards, for-profit organizations
are exempt; for state financial assistance projects, public universities, community colleges, district school boards,branches of
state(Florida)government,and charter schools are exempt. Exempt organizations must comply with all compliance requirements
set forth within the contract or award document.
NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and/or state financial assistance,and has been approved
by the Agency to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-5006, F.A.C. [state financial assistance]
and/or 2 CFR§200.330[federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal awards,state
maintenance of effort funds,or state matching funds on Federal awards and who are determined to be a sub- recipient must comply with
the following fiscal laws,rules,and regulations:
STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR§200.416-§200.417—Special Considerations for States,Local Governments,and Indian Tribes*
2 CFR§200.201—Administrative Requirements**
2 CFR§200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR§200.400-§200.411—Cost Principles*
2 CFR§200.100—Administrative Requirements
2 CFR§200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
EDUCATIONAL INSTITUTIONS(EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST
FOLLOW:
2 CFR§200.418—§200.419—Special Considerations for Institutions of Higher Education*
2 CFR§200.100—Administrative Requirements
2 CFR§200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
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April 1, 2021 —September 2023 EHEAP 203.21
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in 2 CFR
§200,400(5)(c).
**For funding passed through U.S. Health and Human Services, 45 CFR Part 75; for funding passed through U.S.
Department of Education,34 CFR Part 80.
STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a
recipient/sub-recipient must comply with the following fiscal laws,rules,and regulations:
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
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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 I,be provided to the recipient.Information contained herein is a
prediction of funding sources and related amounts based on the contract budget.
5 FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): 2002FLLIEA FEDERAL AWARD DATE: 10/01/2019
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Emergency Home Energy Assistance United States Department of Health and
for the Elderly Program Human Services 93.568
EHEAP Collier 93.568 $ 96,708.79
TOTAL FEDERAL AWARD $ 96,708.79
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
6 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 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
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April 1, 2021 —September 2023 EHEAP 203.21
ATTACHMENT III
CERTIFICATIONS AND ASSURANCES
DOEA will not award this contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In performance of this
contract,Contractor provides the following certifications and assurances:
A. Debarment and Suspension Certification(29 CFR Part 95 and 45 CFR Part 751
B. Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 931
C. Nondiscrimination&Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80)
D. certification Regarding Public Entity Crimes.Section 287.133.F.S.
E. Association of Community Organizations for Reform Now(ACORN)Funding Restrictions Assurance(Pub. J,. 111-1171
F. Scrutinized Companies Lists and No Boycott of Israel Certification.Section 287.135.F.S,
G. Certification Regarding Data Integrity Compliance for Contracts. Grants. Loans. and Cooperative Agreements
H. Verification of Employment Status Certification
I. Records and Documentation
J. Certification Regarding Inspection of Public Records
A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS—PRIMARY COVERED TRANSACTION.
The undersigned Contractor certifies,to the best of its knowledge and belief,that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered
transactions by a Federal department or agency;
2. Have not within a three-year period preceding this contract been convicted or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public(Federal, State,
or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with
commission of any of the offenses enumerated in paragraph A.2.of this certification;and/or
4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,State,
or local)terminated for cause of default.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers(including
subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub- recipients and contractors
shall provide this certification accordingly.
B. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS,GRANTS,LOANS,AND
COOPERATIVE AGREEMENTS
The undersigned Contractor certifies,to the best of its knowledge and belief,that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding
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of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any cooperative agreement,
and the extension,continuation,renewal,amendment,or modification of any Federal contract,grant,loan,or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a
Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also
complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying,"in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers(including
subcontracts,sub-grants, and contracts under grants,loans,and cooperative agreements) and that all sub- recipients and contractors
shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this contract was made or entered into.
Submission of this certification is a prerequisite for making or entering into this contract imposed by 31
U.S.C. § 1352.Any person who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than$100,000 for each such failure.
C. NON-DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART 80). -As a
condition of the Contract,Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of
the following laws:
1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all
individuals in the United States on the basis of race, color,religion, sex, national origin, age, disability, political affiliation,or
belief,and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the
United States or participation in any WIA Title I-financially assisted program or activity.
2. Title VI of the Civil Rights Act of 1964(Pub.L.88-352),as amended,and all requirements imposed by or pursuant to the Regulation
of the Department of Health and Human Services(45 CFR Part 80),to the end that,in accordance with Title VI of that Act and the
Regulation,no person in the United States shall,on the ground of race,color,or national origin,be excluded from participation
in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant
receives Federal financial assistance from the Department and/or Agency.
3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to
the Regulation of the Department of Health and Human Services(45 CFR Part 84),to the end that, in accordance with Section
504 of that Act,and the Regulation,no otherwise qualified handicapped individual in the United States shall,solely by reason of
his handicap,be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program
or activity for which the Applicant receives Federal financial assistance from the Agency.
4. The Age Discrimination Act of 1975(Pub.L.94-135),as amended,and all requirements imposed by or pursuant to the Regulation
of the Agency of Health and Human Services(45 CFR Part 91),to the end that,in accordance with the Act and the Regulation,no
person in the United States shall,on the basis of age,be denied the benefits of, be excluded from participation in,or be subjected
to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency.
5. Title IX of the Education Amendments of 1972(Pub.L.92-318),as amended,and all requirements imposed by or pursuant to the
Regulation of the Department of Health and Human Services(45 CFR Part 86),to the end that,in accordance with Title IX and
the Regulation,no person in the United States shall,on the basis of sex,be excluded from participation in, be denied the benefits
of,or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal
financial assistance from the Agency.
6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices
including job application procedures, hiring, firing, advancement, compensation, training, and other terms,conditions,and
privileges of employment. It applies to recruitment,advertising,tenure,layoff,leave,fringe benefits and all other employment-
related activities.
7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above.
This assurance applies to Contractor's operation of the WIA Title I—financially assisted program or activity;and to all contracts,
Contractor makes to carry out the WIA Title I — financially assisted program or activity. Contractor understands that the
Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers(including
subcontracts, sub-grants,and contracts under grants,loans,and cooperative agreements) and that all sub- recipients and contractors
shall provide this assurance accordingly.
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April 1,2021 —September 2023 EHEAP 203.21
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S.
Contractor hereby certifies that neither it,nor any person or affiliate of Contractor,has been convicted of a Public Entity Crime as defined
in Section 287.133,F.S.,nor placed on the Convicted Vendor List.
Contractor understands and agrees that it is required to inform Area Agency and DOEA immediately upon any change of circumstances
regarding this status.
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW(ACORN)FUNDING
RESTRICTIONS ASSURANCE(Pub.L. 111-117).
As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to
ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511(Pub.
L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations
made under Pub.L. 111-117 are available under the conditions provided by Pub.L. 111-117.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers(including
subcontracts,sub-grants,and contracts under grants,loans,and cooperative agreements)and that all sub recipients and contractors shall
provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION,SECTION 287.135,F.S.
In accordance with section 287.135,F.S., Contractor hereby certifies that it has not been placed on the Scrutinized Companies that
Boycott Israel List and that it is not engaged in a boycott of Israel.
If this contract is in the amount of$1 million or more,in accordance with the requirements of section 287.135,F.S.,Contractor hereby
certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with
Activities in the Iran Petroleum Energy Sector List and that it is not engaged in business operations in Cuba or Syria.
Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency
terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs,
including any costs for investigations that led to the finding of false certification.
If Contractor is unable to certify any of the statements in this certification,Contractor shall attach an explanation to this contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS,AGREEMENTS, GRANTS,
LOANS,AND COOPERATIVE AGREEMENTS
1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing
certain information,including:(1)accurate,current,and complete disclosure of the financial results of each grant-funded project
or program in accordance with the prescribed reporting requirements;(2)the source and application of funds for all contract
supported activities;and(3)the comparison of outlays with budgeted amounts for each award.The inability to process
information in accordance with these requirements could result in a return of grant funds that have not been accounted for
properly.
2. Management Information Systems used by the Contractor,Subcontractors,or any outside entity on which the Contractor is
dependent for data that is to be reported,transmitted,or calculated have been assessed and verified to be capable of processing
data accurately,including year-date dependent data.For those systems identified to be non-compliant,Contractors will take
immediate action to assure data integrity.
3. If this contract includes the provision of hardware,software,firmware,microcode,or imbedded chip technology, the
undersigned warrants that these products are capable of processing year-date dependent data accurately.All versions of these
products offered by the Contractor(represented by the undersigned)and purchased by the state will be verified for accuracy and
integrity of data prior to transfer.
4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the
hardware or software programs from operating properly,the Contractor agrees to immediately make required corrections to
restore hardware and software programs to the same level of functionality as warranted herein,at no charge to the state,and
without interruption to the ongoing business of the state,time being of the essence.
5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency,including emergencies arising from data
integrity compliance issues.
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April 1,2021 —September 2023 EHEAP 203,21
H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Agency,Contractor certifies the use of the U.S. Department of Homeland Security's E-verify
system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform
employment duties pursuant to this contract,and that any subcontracts include an express requirement that Subcontractors
performing work or providing services pursuant to this contract utilize the E-verify system to verify the employment eligibility of all
new employees hired by the Subcontractor during the entire contract term.
The Contractor shall require that the language of this certification be included in all sub-agreements,sub-grants,and other
agreements/contracts and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this contract was made or entered into.
Submission of this certification is a prerequisite for making or entering into this transaction imposed by Circulars A-102 and 2 CFR
Part 200 and 215(formerly OMB Circular A-110).
I. RECORDS AND DOCUMENTATION
The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all contract related
records and documentation.The Contractor shall ensure the collection and maintenance of all program related information and
documentation on any such system designated by the Agency.Maintenance includes valid exports and backups of all data and systems
according to Agency standards.
J.CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of Sections 10 of the Standard Contract sections 119.0701(3)and(4)F.S.,and any other applicable
law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the Agency is named in the civil action,
Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency, and any attorneys' fees
assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S.,concerning this
contract or services performed thereunder.
a. Notwithstanding Section 119.0701,F.S.,or other Florida law,this section is not applicable to contracts executed between the
Department and state agencies or sub divisions defined in section 768.28(2),F.S.
2. Section 119.01(3),F.S.,states if public funds are expended by an agency in payment of dues or membership contributions for any
person, corporation, foundation, trust, association, group, or other organization, all the financial, business, and membership
records of such an entity which pertain to the public agency (Area Agency on Aging for Southwest Florida,Inc.) are public
records.Section 119.07,F.S,states that every person who has custody of such a public record shall permit the record to be inspected
and copied by any person desiring to do so,under reasonable circumstances.
Additionally,i certify this organization does ._does not provide for institutional memberships.
Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for
inspection if applicable,as stated above.
By execution of this contract,Contractor must include these provisions(A-J)in all related subcontract agreements(if applicable).
By signi a ow,Contractor certifies th representations out' d in parts A through J above are true and correct.
•
3339 Tamiami Trail E,Suite 211
I /
Daniel R Rodrigi. , u ervice Department Head Street Address
Collier County Board of County Commissioners Naples, FL 34112
Contractor Date City,State, Zip code
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April. 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT IV
ASSURANCES—NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average forty-five(45) minutes per response, including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden,to the Office of Management and Budget.Paperwork Reduction Project(0348-0043),
Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note:Certain of these assurances may not be applicable to your project or program.If you have questions,please contact the
awarding agency.Further,certain federal awarding agencies may require applicants to certify to additional assurances.If
such is the case,you will be notified.
1. Has the legal authority to apply for federal assistance,and the institutional,managerial and financial capability (including funds
sufficient to pay the non-federal share of project cost)to ensure proper planning,management,and completion of the project
described in this application.
2 Will give the awarding agency,the Comptroller General of the United States,and if appropriate,the state,through any authorized
representative, access to and the right to examine all records, books, papers,or documents related to the award; and will establish
a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of,
personal or organizational conflict of interest or personal gain.
4 Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970(42 U.S.C.§§4728-4763)relating to prescribed standards for merit
systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration(5 C.F.R.900,Subpart F).
fi Will comply with all federal statues relating to nondiscrimination. These include but are not limited to:(a)Title VI of the Civil Rights
Act of 1964(P.L.88-352)which prohibits discrimination on the basis of race,color or national origin;
(b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and §§1685-1686), which prohibits
discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended(29 U.S.C.§794),which prohibits
discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which
prohibits discrimination on the basis of age;(e)the Drug Abuse Office and Treatment Act of 1972(P.L.92-255),as amended,relating
to nondiscrimination on the basis of drug abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism;(g)
Sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to
confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et
seq.), as amended, relating to nondiscrimination in the sale,rental or financing of housing;(i)any other nondiscrimination provisions
in the specific statute(s) under which application for federal assistance is being made; and (j) the requirements of any other
nondiscrimination statute(s)which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property
acquired for project purposes regardless of federal participation in purchases.
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April 1,2021 —September 2023 EHEAP 203.21
R Will comply,as applicable,with the provisions of the 1-latch Act(5 U.S.C.§§ 1501-1508 and§§7324-7328),which limit the political
activities of employees whose principal employment activities are funded in whole or in part with federal funds.
9. Will comply,as applicable,with the provisions of the Davis-Bacon Act(40 U.S.C.§§276a to 276a-7),the Copeland Act (40 U.S.C. §
276c and 18 U.S.C. §874)and the Contract Work 1-lours and Safety Standards Act(40 U.S.C. §§327-333), regarding labor standards
for federally assisted construction sub-contracts.
IQ Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act
of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood
insurance if the total cost of insurable construction and acquisition is $10,000.00 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental
quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order(EO) 11514;
(b) notification of violating facilities pursuant to EO 11738; (c)protection of wetlands pursuant to EO 11990; (d) evaluation of flood
hazards in floodplains in accordance with EO 11988;(e)assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972(16 U.S.C.§ 1451 et seq.);(f)conformity of federal actions to State(Clear
Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection
of underground sources of drinking water under the Safe Drinking Water Act of 1974,as amended(P.L.93-523);and (h)protection of
endangered species under the Endangered Species Act of 1973,as amended(P.L.93-205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. § 1721 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966,as amended
(16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation
Act of 1974(16 U.S.C. §469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities
supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.) pertaining to
the care,handling,and treatment of warm-blooded animals held for research,teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C.§4801 et seq.),which prohibits the use of lead-based paint
in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of
1996 and 2 CFR Part 200.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations, and policies governing this
program.
SIGNATURE OF AUTH ED CER F F IALE
Daniel R Rodriguez, Public Service Department Head
APPLICANT ORGANIZATION �!% DATE SUBMITTED
Collier County Board of County Commissioners ��
Approved as to form nd legality
52
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April 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT V
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name County AAA/Contractor
Address Completed By
City,State,Zip Code Date Telephone
PART I:READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
..... % % %
Total#
For questions 2-5 please indicate the following: White Black Hispanic Other Female Disabled Over 40
2.Population of area served Source of data:
3.Staff currently employed Effective date:
4.Clients currently enrolled/registered Effective date:
5.Advisory/Governing Board if applicable
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO,EXPLAIN.
6. Is an Assurance of Compliance on file with DOEA? N/A YES NO
7. Compare the staff composition to the population. Is staff representative of the population? N/A❑ ❑YES NO
❑
8. Are eligibility requirements for services applied to clients and applicants without regard to race,color,national origin,sex,age, N/A YES NO
religion or disability? 0 ❑ ❑
9. Are all benefits,services and facilities available to applicants and participants in an equally effective manner regardless of N/A YES NO
race,sex,color,age,national origin,religion or disability? ❑ ❑ ❑
10.For in-patient services,are room assignments made without regard to race,color,national origin or disability? N/A YES NO
N/A YES NO
11.Is the program/facility accessible to non-English speaking clients?
N/A YES NO
12 Are employees,applicants and partici ants informed of their protection against discrimination? If YES,how?
`Verbal ❑ Written❑ Poster
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April 1,2021 —September 2023 EHEAP 203.21
13.Give the number and current status of any discrimination complaints regarding services or employment filed against the N/A NUMBER
program/facility. ❑
14.Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? N/A YES NO
PART III:THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO, EXPLAIN.
15.Has as a self-evaluation been conducted to identify any barriers to serving disabled individuals and to make any necessary YES NO
modifications? ❑ 0
16.Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO
❑ ❑
17.Has a person been designated to coordinate Section 504 compliance activities? YES NO
❑ ❑
18.Do recruitment and notification materials advise applicants,employees,and participants of nondiscrimination on the basis of YES NO
disability? ❑ ❑
19.Are auxiliary aids available to ensure accessibility of services to hearing and sight-impaired individuals? YES NO
❑ ❑
PART IV:FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF$50,000.00 OR MORE.
20.Do you have a written affirmative action plan? If NO,explain. YES NO
❑ ❑
AGENCY USE ONIA
Reviewed by In Compliance: YES LJ NO*LJ
Program Office *Notice of Corrective A Action Sent
Date Telephone Response Due
On-Site❑ Desk Review ❑ Response Received
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April 1,2021 —September 2023 EHEAP 203.21
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district,county,city,or other locality. If the program/facility serves a specific
target population such as adolescents, describe the target population. Also, define the type of service provided.
2. Enter the percent of the population served by race, sex,disability,and over the age of 40. The population served includes
persons in the geographical area for which services are provided such as a city,county or other regional area. Population statistics
can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida
population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and
American Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race,sex,disability,and over the age of 40. Include the effective
date of your summary.
4. Enter the total number of clients who are enrolled,registered or currently served by the program or facility,and list their percent
by race,sex,disability,and over the age of 40. Include the date that enrollment was counted.
a. Where there is a significant variation between the race,sex,or ethnic composition of the clients and their availability in
the population,the program/facility has the responsibility to determine the reasons for such variation and take whatever
action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are
sanctioned to serve target populations such as elderly or disabled persons.
5. Enter the total number of advisory board members and their percent by race, sex, disability,and over the age of 40. If there
is no advisory or governing board,leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance
with all nondiscriminatory provisions as required in 45 CFR Part 80.This is usually a standard part of the contract language for
DOEA Recipients and their Sub-grantees.45 CFR§80.4(a).
7. Is the race, sex,and national origin of the staff reflective of the general population? For example, if 10%of the population is
Hispanic,is there a comparable percentage of Hispanic staff?
8. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment?
Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on-site record
analysis of persons who applied but were denied services or employment.45 CFR§80.3 (a) and 45 CFR§80.1.
9. Participants or clients must be provided services such as medical, nursing, and dental care, laboratory services, physical and
recreational therapies,counseling,and social services without regard to race,sex,color,national origin, religion,age,or disability.
Courtesy titles,appointment scheduling,and accuracy of record keeping must be applied uniformly and without regard to race,
sex, color,national origin,religion, age,or disability. Entrances, waiting rooms,reception areas,restrooms,and other facilities
must also be equally available to all clients.45 CFR§80.3(b).
10. For in-patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin, or
disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different
race,color,national origin,or disability.45 CFR§80.3(a).
11. The program/facility and all services must be accessible to participants and applicants,including those persons who may not speak
English. In geographic areas where a significant population of non-English speaking people live, program accessibility may
include the employment of bilingual staff. In other areas,it is sufficient to have a policy or plan for service,such as a current list
of names and telephone numbers of bilingual individuals who will assist in the provision of services.45 CFR§80.3(a).
12. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants,
beneficiaries,or any other interested parties.45 CFR §80.6(d)This should include information on their right to file a complaint
of discrimination with either the Area Agency on Aging for Southwest Florida, Inc. and/or the Florida Department
of Elder Affairs or the U.S. Department of Health and Human Services. The information may be supplied verbally or in writing
to every individual or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the
facility.
13. Report number of discrimination complaints filed against the program/facility.Indicate the basis, (e.g.,race,color, creed,sex,
age,national origin,disability,and/or retaliation)and the issues involved,(e.g.,services or employment,placement, termination,
etc.). Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local,state,
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April 1,2021 —September 2023 EHEAP 203.21
or federal agency with whom the complaint has been filed. Indicate the current status of the complaint ( e.g., settled, no
reasonable cause found,failure to conciliate,failure to cooperate,under review,etc.).
14. The program/facility must be physically accessible to mobility, hearing, and sight-impaired individuals. Physical accessibility
includes designated parking areas,curb cuts or level approaches,ramps,and adequate widths to entrances. The lobby,public
telephone, restroom facilities, water fountains, and information and admissions offices should be accessible.Door widths
and traffic areas of administrative offices,cafeterias,restrooms,recreation areas,counters,and serving lines should be observed
for accessibility.Elevators should be observed for door width and Braille or raised numbers. Switches and controls for light,
heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired
individuals.
15. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self- evaluation to
identify any accessibility barriers. Self-evaluation is a four-step process:
a. Evaluate,with the assistance of disabled individuals(s)/organization(s),current policies and practices that do not or may not
comply with Section 504;
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate the effects of any discrimination that resulted from adherence to these policies and
practices;and
d. Maintain self-evaluation on file,including a list of the interested persons consulted,a description of areas examined,and
any problems identified,and a description of any modifications made and of any remedial steps taken 45 CFR§84.6. (This
checklist may be used to satisfy this requirement if these four steps have been followed.).
16. Programs or facilities that employ 15 or more persons shall adopt grievance procedures that incorporate appropriate due process
standards that provide for the prompt and equitable resolution of complaints alleging any action prohibited by Part 84 of
Title 45,CFR§84.7(b).
17. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with
Part 84 of Title 45 CFR§84.7(a).
18. Programs or facilities that employ 15 or more persons shall take appropriate initial and continuing steps to notify participants,
beneficiaries,applicants,and employees that the program/facility does not discriminate on the basis of handicap in violation of
Section 504 and Part 84 of Title 45, CFR. Methods of initial and continuing notification may include the posting of notices,
publication in newspapers and magazines,placement of notices in publications of the programs or facilities,and distribution of
memoranda or other written communications. 45 CFR§84.8(a).
19. Programs/facilities that employ 15 or more persons shall provide appropriate auxiliary aids to persons with impaired sensory,
manual or speaking skills where necessary to afford such persons an equal opportunity to benefit from the service question.
Auxiliary aids may include,but are not limited to,brailed and taped materials,interpreters and other aids for persons with impaired
hearing or vision. 45 CFR§84.52(d).
20. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement, and maintain a
written affirmative action compliance program in accordance with Executive Order 11246,41 CFR Part 60 and Title VI of the
Civil Rights Act of 1964,as amended.
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April 1,2021. —September 2023 EHEAP 203.21
ATTACHMENT VII
BACKGROUNDSCREENING
Ron DeSanti.s
(..?over nor
Dcpartmcnt of
ELDER AFFAIRSIlik Richard Prudom
STATE F F.I,C7RIITA Se:retar
BACKGROUNDSCREENING
Attestation of Compliance-Employer
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.05(3),Florida Statutes.
> The term"employer"means any person or entity required by law to conduct background screenings,
including but not limited to,Area Agencies on Aging/Aging and Disability Resource Centers,Lead
Agencies, and Service Providers that contract directly or indirectly with the Department of Elder
Affairs(DOEA),and any other person or entity which hires employees or has volunteers in service
who meet the definition of a direct service provider.See§§435.02,430.0402,Fla.Stat.
> A direct service provider is"a person 18 years of age or older who,pursuant to a program to provide
services to the elderly,has direct,face-to-face contact with a client while providing services to the
client and has access to the client's living area,funds,personal property,or personal identification
information as defined in s. 817.568.The term includes coordinators,managers,and supervisors of
residential facilities and volunteers."§430.0402(1)(b),Fla.Stat.
ATTESTATION:
As the duly authorized representative of
Employer Name
located at
Street Address City State ZIP code
1 do hereby affirm under penalty of
Name of Representative
perjury that the above-named employer is in compliance with the provisions of Chapter 435 and
section430.0402, Florida Statutes, regarding level 2 background screening.
Signature of Representative Date
DOEA Form 235,Attestation of Compliance-Employer,E,/Jective January 19,2021
Section 435.05(3),
F.S.Form available at:http://elderaffairs.statell.us/english/backgroundscreeninz.vhp
1.us/english/backgroundscreeninz..vhp
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April 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT IX
ANNUAL BUDGET SUMMARY AND DETAIL
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
for
Collier County Board of County Commissioners
Collier
EHEAP ADMINISTRATION BUDGET $ 8,247.89
EHEAP OUTREACH BUDGET $ 13,569.80
EHEAP CRISIS ASSISTANCE $ 74,891.10
TOTAL $ 96,708.79
Projected minimum number of individuals to be served
Energy Assistance* 269
*Program expenditures may not exceed the spending authority as provided in the Budget Summary. As program funds are
released,written notification of additional spending authority will be provided to Contractors.
**Eligible households may be provided with one benefit per season. The minimum number of consumers may reflect duplicated
consumers if a consumer receives a benefit in both seasons.
***Weather Related/Supply Shortage funds are a set-aside for emergency assistance.These funds must be held in this
budget line item category until December 15th of the program year,for use in response to a possible disaster.
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April 1, 2021 —September 2023 EHEAP 203.21
ATTACHMENT X
EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL
PSA CONTRACT #
Emergency Home Energy Assistance Program
Administrative a Outreach Expense Budget Detail
ADD ADDITIONAL 1,IN1:::S AS NEEDED
Budget Quantity/
Line Item Expenditure Detail lira Unit Cost Total Cost
S0.00
S0.00
80.00
80.00
S0.00
S0.00
S0.00
S0.00
SO.00
S0.00
S0.00
S0.00
S0.00
80,00
S0.00
S0.06
S0.00
•
S0.00
S0.00
- SO.ob
so.00
s0.00
$0.00
$0.00
80.00
Total $0.00
Administration Subtotal $
Outreach Subtotal $
Total $
59
6010
1
April 1,2021 -September 2023 EHEAP 203.21
ATTACHMENT XI
RECEIPTS AND EXPENDITURE REPORT
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
PROVIDER NAME,ADDRESS, PHONE#AND FEID# Program Funding Source: THIS REPORT PERIOD
FROM:
EHEAP CONTRACT
(Emergency Home Energy PERIOD:
Assistance for the Elderly Program) CONTRACT#
REPORT#
PSA# 8
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
To the best of my knowledge,all CIRTS is accurate and correct.
Prepared by: Date: Approved by: Date
PART A:BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4.Percent of
Budget For This Report Year to Date Approved Budget
'
1.Agreement Amount $0.00 $0.00 $0.00 #DIV/0!
2.Interest on Agreement Funds $0.00 $0.00 $0.00 0.00%
3.TOTAL AGREEMENT AMOUNT $0.00 $0.00 $0.00 #DIV/0!
PART B:EXPENDITURES 1.Approved 2.Expenditures 3.Expenditures 4.Percent of
Budget For This Report Year to Date Approved BudgE t
1.Administration $ - $0.00 $0.00 #DIV/0!
2.Outreach $ - $0.00 $0.00 #DIV/0!
3.Crisis Services $ - $0.00 $0.00 #DIV/0!
4.Weather Related Services $ - $0.00 $0.00 #DIV/0!
5.Weather Related Administration $ - $0.00 $0.00 0.00%
6.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/0!
DOEA FORM 105p revised 12/08
60
16D10
April 1,2021 -September 2023 EHEAP 203.21
ATTACHMENT XII
REQUEST FOR PAYMENT
REQUEST FOR PAYMENT
...... ....
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
Contract# _n HP019
CONTRACTOR NAME,ADDRESS,PHONE#and FEID# TYPE OF REPORT: Request Period
PSA# 8
Advance Request Report#
Contract# HP019
Reimbursement Request X Contract Period_10/01/19-09/30/20
CERTIFICATION I hereby certify that this request to the best of my knowledge to be complete and correct and conforms with the terms of the above contract
To the best of my knowledge,all CIRTS Is accurate and correct.
Prepared by: Date: Approved by: Date:
ADMINISTRATION
PART A: BUDGET SUMMARY ADMINISTRATION OUTREACH CRISIS WEATHER WEATHER TOTAL
SERVICES SERVICES SERVICES RELATED RELATED
1.Approved Contract Amount $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2.Previous Funds Received for $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Contract Period
3.Contract Balance(line 1 minus line 2) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
4.Previous Funds Requested and Not $0.00 $0.00 $0.00 $0.00 .,...$0.00 $0.00
Received for Contract Period ..
6.Contract Balance(line 3 minus line 4) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
PART B: CONTRACT FUNDS REQUEST
1.Anticipated Cash Needs.... $0.00.. $000.... $0.00 $0.00. .__......._. $0.00 $0.00
(1st.2nd month,Attach Justification)
. . .. .. _... _ ..
2.Net Expenditures For Month 50.00 .$0.00 ... $0.00 .._, $0.00 $0.00 $0.00
(DOEA Form 106P,Part B,Line 6) _ ..
3.TOTAL _.......... _......._. .._..._ ...... ......... $000.. ........._. $0 00..... _.. ............ $0 00......_... .......$0.00 $0.00., _......... ...$0 00. ..........
PART C: NET FUNDS REQUESTED
1.Less Advance Applied $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2.TOTAL FUNDS REQUESTED $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
(Part B,Line 3 minus Part C,Line 1)
PART D: SERVICE INFORMATION
Number of individuals(units)served with crisis energy assistance during the report month 0
Number of Individuals Ineligible or denied assistance during the report month
Number of Individuals served by referral to other community resources for energy during the report month .. ........................
Certification statement: Contractor hereby certifies that It has been open and operating during Its normal business hours for the reporting month,as
described in the Statement of Work section,of the EHEAP contract.
DOEA FORM 106P
reNsed 4/6/17_
61
1 6010
April 1,2021 -September 2023 EHEAP 203.21
ATTACHMENT XIII
INVOICE REPORT SCHEDULE
Report Number Based Upon Date Due to the Agency
1 April Advance Request* Upon receipt of executed contract
2 May Advance Request* Upon receipt of executed contract
3 April Expenditure Report May 9,2021
4 May Expenditure Report June 9,2021
5 June Expenditure Report July 9,2021
6 July Expenditure Report August 9,2021
7 August Expenditure Report September 9,2021
8 September Expenditure Report October 9,2021
9 October Expenditure Report November 9,2021
10 November Expenditure Report December 9,2021
11 December Expenditure Report January 9,2022
12 January Expenditure Report February 9,2022
13 February Expenditure Report March 9,2022
14 March Expenditure Report April 9,2022
15 April Expenditure Report May 9,2022
16 May Expenditure Report June 9,2022
17 June Expenditure Report July 9,2022
18 July Expenditure Report August 9,2022
19 August Expenditure Report September 9,2022
20 September Expenditure Report October 9,2022
21 October Expenditure Report November 9,2022
22 November Expenditure Report December 9,2022
23 December Expenditure Report January 9, 2023
24 January Expenditure Report February 9,2023
25 February Expenditure Report March 9,2023
26 March Expenditure Report April 9,2023
27 April Expenditure Report May 9,2023
28 May Expenditure Report June 9,2023
29 June Expenditure Report July 9,2023
30 July Expenditure Report August 9,2023
31 August Expenditure Report September 9,2023
32 September Expenditure Report October 9,2023
33 Final/Closeout Report October 15,2023
*Advance based on projected cash need
Note# 1: Report#1 and#2 for advance basis invoices, cannot be submitted to the Agency prior to October 1 or
until the agreement with the Agency has been executed and a copy sent to the Agency. Actual
submission of the vouchers to the Agency is dependent on the accuracy of the Receipts and Expenditure
Report.
Note#2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance amount,on
each of the reports,repaying advances issued the first one or two months of the agreement. The
adjustment shall be recorded in Part C. 1 of the report(ATTACHMENT XII).
Note#3: Submission of expenditure reports may or may not generate a payment request. If final expenditure
report reflects funds due back to the Agency,payment is to accompany the report.
Note#4: ALL Expenditure Reports are due by 12:00 p.m.on the 9th of each month. IF the 9th falls on a Saturday,
then the report will be due by the 8th by 12:00 p.m. AND IF the 9th falls on a Sunday,the report will be
due by the 10th by 12:00 p.m. Actual submission of the vouchers to Dept. of Elder Affairs is dependent
on the accuracy of the expenditure report,which is verified and paid by CIRTS data only.
62
16f1
April 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT XIV
DE4)
FLORIDA DEPARTMENT¢f
ECONOMIC OPPORTUNITY
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP)
POVERTY INCOME GUIDELINES*
EFFECTIVE JULY 1,2020
PEOPLE IN THE HOUSEHOLD 150%
1 $19,140
2 $25,860
3 $32,580
4 $39,300
5 $46,020
6 $52,740
7 $59,460
8 $66,180
For each additional person in the household with $ 6,720
more than 8 people, add:
*These figures are based on the 2020 U.S.Department of Health and Human Services (HHS) poverty guidelines published
in the Federal Register on January 17,2020.
63
1 6010
April 1,2021 -September 2023 EHEAP 203.21
ATTACHMENT XV
LIHEAP PAYMENT MATRIX
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM PAYMENT MATRIX-FY 2020
HOME ENERGY BENEFITS'AND POVERTY LEVELS
BY HOUSEHOLD SIZE AND INCOME
HOUSEHOLD INCOME IN DOLLARS PER YEAR
At least 75%but no
NUMBER OF 50%of Poverty Over 5096 of Poverty Over 10096 but no more Over 125%but no more
more 100%
PEOPLE IN or Less but Less than 75% than than 125%Poverty than 150%Poverty
Poverty
HOUSEHOLD At or Below Annual Income at Least but No Greater Than
1 56,380 56,381 59,569 S9,570 S12,760 512,761 S1S,950 $15,951 S19,140
2 $8,620 $8,621 512,929 512,930 $17,240 517,241 521,550 521,551 525,860
3 510,860 510,861 $16,289 516,290 S21,720 521,721 $27,150 527,151 $32,580
4 $13,100 513,101 519,649 $19,650 526,200 526,201 532,750 532,751 $39,300
5 515,340 515,341 523,009 523,010 530,680 530,681 $38,350 5.33,351 S46,020
6 517,580 $17,581 526,369 526,370 $35,160 535,161 543,950 543,951 552,740
7 $19,820 519,821 529,729 $29,730 $39,640 $39,641 S49,550 $49,551 559,460
8 522,060 522,061 533,089 533,090 544,120 544,121 555,150 555,151 $66,180
9 524,300 524,301 $36,449 $36,450 $48,603 548,601 $60,750 $60,751 $72,900
10 526,540 526,541 539,809 539,810 553,080 553,081 566,350 566,351 $79,620
11 $28,780 528,781 $43,169 $43,170 $57,560 $57,561 $71,950 571,951 $86,340
12 531,020 $31,021 546,529 546,530 $62,040 $62,041 577,550 577,551 593,060
13 $33,260 $33,261 549,889 549,890 566,520 566,521 $83,150 583,151 $99,760
14 535,500 $35,501 $53,249 553,250 $71,000 571,001 $88,750 $88,751 5106,500
15 $37,740 537,741 $56,609 556,610 575,480 575,481 S94,350 594,351 S113,220
16 $39,980 539,981 559,969 559,970 579,960 579,961 599,950 599,951 5119,940
17 542,220 542,221 $63,329 S63,330 584,440 $84,441 5105,550 5105,551 5126,660
18 $44,460 544,461 566,689 $66,690 588,920 588,921 $111,150 $111,151 5133,380
19 546,700 546,701 $70,049 5770,050 593,400 593,401 5116,750 $116,751 S140,100
20 548,940 $48,941 573,409 573,410 $97,880 597,881 5122,350 $122,351 5146,820
U HEAP HOME
ENERGY BENEFrr= $350 to$600** $300 to$550** $250 to$500** $200 to$450**
4•Atiefitiaral Assistance it applicant rwgaebeeGatutlea: 'These benefit kvtl's ore effect iveJarly:t,2020
(II tuu,r, 5r5 mett,*;g orrr are bvastd Iwo tfk ,0 LEI Department a jlroaRA old
Human Serma(Hru Firorr,yccsaefnespdbisne9enMeFe#engitopter
.n a(' a S7s
orricresa y Yl 2A s?
01 X=+V'tKrmi oat at+J ito S v+e" 4"_ S100
64
1 6010
April 1,2021 -September 2023 EHEAP 203.21
ATTACHMENT XVI
SOURCES OF INCOME
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP)SOURCES OF INCOME
EFFECTIVE July 1,2020
INCLUDED SOURCES OF INCOME EXCLUDED SOURCES OF INCOME
(Includes total annual cash receipts before taxes from all sources)
1. Money wages and salaries before any deductions 1.CAPITAL GAINS
Any Assets drawn down as withdrawals from a bank,orthe
2. Net receipts from non-farm employment(receipts from a sale of property,a house,or a car.
person's own unincorporated business,professional 2. Tax Refunds
enterprise,or partnership,after deductions for business 3. Gifts
expenses) 4. Loans
5. Lump-sum inheritances
3. Net receipts from farm self-employment(receipts from a 6. One-time insurance payments
farm which one operates as an owner,renter,or 7. Foster Care Payments*
sharecropper,after deductions for farm operating 8. Compensation for injury
expenses) 9. Combat zone pay to the military
10.Adoption Subsidies
4. REGULAR PAYMENTS FROM: 11.Reverse Mortgage Payments
Social Security 12. NON-CASH BENEFITS
Railroad retirement Unemployment (a) Employer-paid or union paid portion of health
compensation Strike benefits from insurance or other employee benefits
union fundsWorker's compensation
Veteran's payments (b) Food or housing received in lieu of wages
Public Assistance or Temporary Assistance for Needy Families
(TANF),Supplemental Security Income,and non-federally funded (c) The value of food and fuel produced and
General Assistance or General Relief money payments. consumed on farms.
5. Payments to foster children age 18 or older received through the (d) The imputed value of rent from owner-occupied
Independent Living Program non-farm or farm housing.
6. Training stipends (e) Federal non-cash benefit programs such as Medicare,
7. Alimony Medicaid,Food Stamps,school lunches,and housing
8. Child Support assistance.
9. Social Security Benefit Garnishes for Non-Payment of 13. Supplemental Security Income(SSI)benefits cannot be
School Loans.(The total amount of the Social Security Retirement garnished for any reason unless a recipient received an
benefit including the garnished deduction must be used when overpayment of benefits.
calculating the applicant's income.) The total amount of the SSI benefit minus the garnished
deduction for recoupment must be used when calculatingthe
10. Military family allotment or other regular support from applicant's income.
a family member or someone not living in the
household
*Persons whose cost of residence is paid through a fostercare
11. Private pensions or residential program administered by the state cannot be
counted as household members.
12. Government employee pensions(including military
retirement pay)
13. Regular insurance or annuity payments
14. Educational Assistance:
Grants,Fellowships,Assistantships,College or
University Scholarships-Only count as income those funds
specifically allotted for living expenses
15. Dividends
16. Interest
17. Net rental income
18. Net royalties
19. Periodic receipts from estates or trusts
20. Net gambling or lottery winnings
65
16D1Q
April 1,2021. —September 2023 EHEAP 203.21
ATTACHMENT XVIII
EHEAP APPLICATION AND ELIGIBILITY WORKSHEET
Emergency Home Energy Assistance for the Elderty Program-Application
Section One: Applicant(Aged SO and older)Information
Name irirn:,rd,L,a.t: Hra!r9 Sa rcn i'Coding Sraurn
Date of birth: (Age: SSN:
Service address: Date Stamp
City I Florida County: I ZIP Cate: Intake worker's name:
Sex 'LI Male Cl Female I Number of people it the household: I Phone:
Marital Status: C'i Married C:Partnered LS Single O Separated CI Divorced Ut Wdowed Phone:
Race:r Wnite t t Black/African American r. Asian C Native Hawaiiian?Pacific Islander [American Indian/Alaska Native it Other
Ethnicity. C Nisparuckatino 15 Other I Primary Language: 0 Enggish 11 Spanish Cl Other
Does sent have kneed ability reading,writing,speaking.or understanding the English language? Ct Yes_,No
Is the client a veteran? two Yes No I Was cent referred to the local Veterans Affairs of1loe?C Yes Ut No 't NlA
Applicant's income type(s): +pp'rant s monthly income amount
Section Two: Additional Household IIlembers Information
Name: Income type(s):
#//�4V, SIN: I Monthly mime amount
nt.
Name: Income type(s):
///////r///.f //✓/// //////�1 Age: SSW I Monthly some amount
Name:m Inome types).
fie Age SSIti: I ttonthty income amount
Name: /�� Income type(s):
�//1// �///A Aga: 5514: I Monthly income amount
Name: Income Pipets):
Age: SSN: Monthly income amount
Section Three: Household Characteristics
Is there a child:years of age or younger in the houselroki? Ct Yes El No
If Yes.select a:teat app'xs: 0-2 years old C 3-5 years old
Is there an individual with a disability in the household?c.Yes 'w fdo
Is the applicant a V S.citizen or an alien lawfuty admitted for permanent residence? °Yes 0 No
Is the applicant a homeowner?Cl Yes is No
Does applicant avert government subsidized housing,such as Seaton 5? 0 Yes Ct No
If yes,provide the complex flans*:
If yes.does the household receive an energy subsidy?c Yes Ci No
Does applicant eve et a student dormitory,adult family care home,or any kind of group Irving facility?U Yes No
If yes,provide the facility name'.
Section Four: Heating and Cooling Information
Have you or any member of your household received energy assistance in the current season? :::Yes :;No
If yes.provide tine name of Agency
Type of Assistance rt Crisis C Home Energy U h'leather-Re'ated Owe:
What is the primary source of home heath.;(seleO one)Ci Etectrcity C Natural Gas E.Propane f'1 Wood/Coal : Refillable Fuels
Does household use supptementat heating source? Electricity c:.i ItifoodiCaal CI WA
Air oorsd toning unit type? Central AG Ci WndoewWall A'C ;3 Fans C3 Other-specify including evaporative cosier}
Section Five: Energy Crisis Explanation Client Attestation and Signature
Home cooling or heart;energy source has beers The information provided on this appttratan,is to the best or my
disconnected ected Vfe Threatening} cnonedge,true and complete. I understand that priority at providing
assistance will rue given to those households well the lowest income
::I Unable to get delivery of fuel,is out of fuel or is in danger of and greatest need.i,e.those households or which the elderly,
being cut of fuel for heating,(Lee-Three:enfnar d'sabled,medcaly needy,or children reside. I auftsore the agency
to make bene•i payments directly to my energy supplier. i am aware
I Other problems with lack of sooting o heating in the one, that after I have provided all the information requested to determine
such as needing to pay a deposit,repair of essipntent,or my eligibility,if I am applying for crisis assistance,the agency has 13
creel r em*ge cy measure to avoid further crisis. aware
to act upon my application with an eligible action. tam also
aware that'rf!am not approved or denied within the time allowed,or
(rite-Threreen ngl not approved for the correct amount,I have a right to appeal the
Notified that the energy source for*coring or creating is going decision.(If you sign with an`,k-two witnesses are required.)
to be disconnected.(S>andard)
a Received a notice indicating the energy source bill is Coin
deLrq_era or past due.(Standerst) Sanaxr r
;.3 Has an energy source till for Mich the due date has lapsed.
(Standard) Oaur'
AIL GIJENi TS SHOOLD SIGN THE WAIVER AUTHORr27HG THE RELEASE OF GENERAL ARUA(fR CONFIDENNTIAL lrFORTAAMR FOR
LIHEAFrEHEAP FEDERAL REPORTING.
66
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April 1,2021 —September 2023 EHEAP 203.21
Enter.enc Home Ener, Assistance for the Elder' Prot ram-Eli ibili Worksheet
Section Six: Income Eligibility Determination
Ar atrat ze es household income. 5tapc cirulato!tape here shaving Poverty Guideline*tRrettve 07f010020.
Income Canutatcrs or wete eaIc 31ioni
1. Add all gross monthly earned and in tills spa x Seert the snrsue interne&tzar by t>eastetrdd sze
unearned income from the past 30 I SCA,er s•c.env 30%of Prr:eV
days of all household members, -01 ..,x„1Ill 140 S d.3ao
2 Add Ideda are Premium(S140.50). t7 2.....,._S25,Ca0 S 9,e21)
if not included in SSA amount. Q 3........,,c:}32.SOO $10.0e0
3. Add Medicare Part D,ii apphcabte. D a Flo aa0 SIX too
5....,._34O.02 5 :313340
4. To 3rtraua3»a,multiply the monthly Da.....,,AS2.74o 317,560
total by 12 months. r77 ,,,,,S59,at;t# 319,a2fi
Annual Household Income Dann eS,lao $22,080
;Agri t a,72c'or ear%WI lcr,_rt eras er,5ir of Gomty
$ ertitermn a ri cre nnten)
ii lie force annual houselrali ireorm is less than 50%of pc came i'triers P,serV Gutetree nor I an.nhrif s re
❑Categoriea'y E'';.bs tier)Char.aln ei.•ir.l me one in'he timer 4d ur tore:I o sNtP asps:anea''tr_al Tre r.'+tu rf prrrue a soneri
swelt,•re or Ferri bast erirar enmities i e.ar'XI.mat and arena r*r lorml are:rc rdei kr U.e Mover id
Section Seven: Vendor,Benefit,and Verification Information
Envoy Vendor it Other Vendor iel C.nnt.ci made vide lntEAP presider w',tr'ey
wane: triers: presxse tress ass stmm:•e.
.Arxiurt t aa+Paer: Nusrtrer Dines cd
Nat die n lca^t reieru LfhEAP cisis
waist ee during the tuTa4 semttane
Minn=reroute Eh*_s........,,...,._,.�...e..,.._................. +Lrratm quiz:..,..,,,,,.,e.w.. ............._..._�............ Ye4?"�No
.et/ann d Caneritntnt C Glarn.et E Ascot Cas'ay Tatar
Parade Fan ar C6c6trJ Taiip'rent If the ma^antum amount due is more than
c:nimi Pelson syxe CI Errs eery Sinter the past due amount.did the energy
0eV•. .._ C ruse AC ❑&le` vendor verify that this amount is required?
Energyvarwor@ Other Vendor to LIYen 13Ito Cl N/A
warm:
AmotrtVrzr.*ker
A.x::.are haenber tiumtltr: Date. If the mehmum amount due to resolve the
crisis is more than the maxstlum allowed,
tdaw-nan Amoanr Amefre per; explain hare the bazar,ce of the amount
due tat be paid if approved for EHEAP
Vivdcdtixi and Crrrrinarrn G 013/0.4.1 C:Rtfp8r Erdv:rtq tstrw,r4 SrisiS assistance
C Port tee ran or COtirrg£�ru'ixrcm.
Contutt Perrin _ .. G SNte Ikate• C Emars}ence acrtei .
Dine'..._....._.........d.w.,................_•A�......_..,w......�_ C:Vies'w MZ i t CV4'
)'l)Total Energy vendorr t i4)Total Other VanClOrn $ Is the name on the fuel bill
12)EMrgy suaaIdy S that of the applicants?
Total EttEaP Bement :J'Yes C No
)3)water,sever,Garbage, $ Add If no,provide narra on ba4'
sue.etc, Total Energy Vendor 14)
(4)Deduct pea)horn(I) S a Tafal otter vendor(4)
Section Eight: Weatheriration Assistance Program(WAP)Referral
If the applicant is a homeowner,has he:she received mote than three LINEA?or EHEAPbenefits in the last 13 months?
Yes sit No r3 N/A
tf tit answer to the previous question is"yes',was the applicant referred to tt;AP? Dr Yes Ill No N/A
if the answer to the last question is'no".explain:
Section Nine: Resolution of Crisis
Resolition Odle Hear htsCootrg Energy Crisis occurred within 18t48 hours,by the fofowatg eligible action(s)•(Select all that apply)
7 Approval of appfuation C EHEAP benefit prevented disconnection
cl Commitment made to vendor a ENEAP benefit restored energy already disconnected
Cl Denial of AppfdaTion.pending additional information t.Yes,client signed waver
Cl Denial,dAppdcaton.remit e C No,client refused to sign waiver
Cl Written referral and assistance to access other community resources
Case Worker Signature Approval Signature
I save eatemenag eta iefYSHty stem.(Decent I arc rive ttie TM application rod Mobile detemkarion mat tar reviewed for turves
spirant,not sm 1 a Maxi tWave,or employee of die ppaaent and*pastime tie documentation prior to milli.;payment.Mire
tonaliveil aria soorinsa true eplricitlon for aisle asides:o nce.
Cast Aiseic%c t•t rrn: reitrerhwr.�Peer s
Case Miters So,arse ikaiereesriPeers>ivaahne:
Dane Cale.
Ammer Name Agerny Harm'
67
16B10
April 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT XIX
EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS
EHEAP Application InstructionsSection One: Applicant(Age 60 and olderl
Jnformatiou
Complete Section One in its entirety.
Special notes:
✓ The Date Stamp is the official application date;
✓ The Intake Worker(with name and phone number recorded)is the person who accepts the application and
required documentation;
V The applicant's income type(s)and monthly income amount is recorded in this section,and
✓ If any field is determined to he not applicable, complete the field by entering N!4.
Section Two: Additional Household Members Information
Complete Section Two by listing additional household members and providing the information requested.
Special notes:
V At a minimum,the name(s), age(s), and Social Security number(s)of each additional household member
is required;
✓ You will be attaching a calculator tape of the household's income calculations in the section provided on
the EHEAP Eligibility Worksheet; and
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Three: Household Characteristics
Complete Section Three by answering each"Yes"or"No" question and providing additional information if applicable.
Special note:
✓ If any,field is determined to he not applicable, complete the field by entering N/A.
Section Four: Heating and Cooling Information
Complete Section Four by answering each question.
Special note:
✓ If any field is determined to he not applicable, complete the field by entering NA.
Section Five: Energy Crisis Explanation
Section Five is completed by choosing the best possible explanation for the applicant's crisis and obtaining their signatureand
date of signature.
Special note:
✓ If energy crisis is life-threatening,provide crisis resolution within 18 hours.
✓ If energy crisis is non-life-threatening,provide crisis resolution within 48 hours.
✓ If any field is determined to he not applicable, complete the field by entering NiA.
client Attestation and Signature
The applicant should read the attestation statement.If the applicant is unable to read the attestation statement,the intake
worker should read it to them before they sign and date the application.
At this point,the intake worker should have the applicant sign the waiver authorizing the release of general and/or
confidential information for LIHEAP/EHEAP federal reporting. CIRTS will require you to verify that either the waiver
has been signed or that the client has refused to sign.
68
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April 1,2021 —September 2023 EHEAP 203.21
EHEAP Eligibility Worksheet InstructionsSection Six: Income Eligibility
Determination
Complete Section Six by stapling the calculator tape in the space provided,entering the annual income, and checking the
appropriate number of individuals in the household to determine the household annual income limit.
Special notes:
✓ If the applicant is over-income and received TANF, SSI,or SNAP,check the categorical eligibility box
and include the appropriate documentation in client file.
✓ Adjacent to the annual income limit by household size is the fifty percent(50%)of poverty amount by
household size. If the annual household income is below the amount for the household size, AND the
household does not receive SNAP,the applicant must provide a written statement of how basic living
expenses are provided for the household.
✓ If any field is determined to he not applicable, complete the field by entering.WA.
Section Seven: Vendor.Benefit.and Verification Information
Complete Section Seven by completing in its entirety.
Special notes:
✓ The minimum amount due is the amount provided to you during the verification process with the home
energy vendor.
✓ For those applicants receiving an energy subsidy,the minimum amount due will be reduced by the energy
subsidy amount listed on the applicant's public housing lease to determine the total EHEAP benefit.The
energy subsidy is deducted from home energy vendor payments only.
✓ Water,sewer,garbage, and fire,etc. MAY NOT be paid with EHEAP funds.Utility bills that include
charges that are not directly related to cooling and heating will be reduced by the amounts for these
charges.
✓ Charges incurred due to illegal activities,such as a worthless check or meter tampering,MAY NOT be
paid with EHEAP funds.
V It is allowable to make several crisis benefit payments for a household to resolve a single crisis. This may
include the purchase of blankets,portable fans,space heaters, and/or repair of existing heating/cooling
equipment, in addition to energy bill assistance.
✓ Crisis situations that involve a heater or air conditioner that is powered by both gas and electricity are
eligible for a crisis benefit payment to both home energy vendors.
✓ Allowable utility categories for heating/cooling bill assistance include the following:
• Utility payments for heating/cooling bill assistance for electric,gas,propane,wood, coal, or
refillable fuels;
• Temporary emergency shelter(if needed due to energy-related crisis);
• Payment to landlords(when utility costs are included in rent);
• Repairs or replacements to heating/cooling units(as long as the amount is within the benefit
limits and work is done by a licensed contractor);
• Deposits to connect or restore energy;
• Late fees, disconnect fees, and reconnect fees;
• Charges from a previous account held by the applicant that is now closed;
• Blankets and fans;
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April 1,2021. —September 2023 EHEAP 203.21
• Taxes and fees associated with the client's utility bill towards the energy portion.In some cases,
where the utility vendor combines all the other fees and taxes,which also includes non-home
energy services,such taxes and fees can be paid with EHEAP funding.Example:In a case where
heating and cooling taxes are commingled with other service taxes,proceed with paying the
taxesportion of the bill.
• Other allowable payments are those related to the start-up of services,including reasonable
connection or reconnection fees,delivery fees,deposits,and other fees related to the start-up of
service.
✓ If any field is determined to he not applicable, complete the field by entering N/A.
Section Eight: Weatherization Assistance Program(WAP)Referral
Complete Section Eight in its entirety.
Special notes:
✓ When determining the number of LIHEAP or EHEAP crisis benefits the applicant has had,you will
include the current application in the count,provided the application is approved.Refer back to Section
Seven,to the information obtained from the LIHEAP provider.
✓ If any field is determined to he not applicable, complete the field by entering N/A.
Section Nine: Resolution of Crisis
Complete Section Nine by selecting all that applies to this applicant and application for services.
Special notes:
✓ The left-hand selections indicate that the application has been acted upon within the 18-hour or 48-hour
requirement.
✓ If the selection is made to deny the application pending additional information from the client,the 18-
hour or 48-hour requirement has been met and does not repeat itself when the client returns with the
pending information. You have already met the requirement.
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Case Worker Signature
To complete this section,the individual who completes the EHEAP Eligibility Worksheet,determines income eligibility,
and provides the commitment to the utility vendor must sign and complete the requested information.
Special note:
✓ If you are the applicant,or a friend,relative, or employee of the applicant,you cannot determine the
eligibility or award EHEAP benefits. This application must be processed by someone who is not the
applicant or a friend,relative,or employee of the applicant.
Approval Signature
To complete this section,the signer is attesting that he/she has reviewed the application for completeness,determined that
all required documentation is included,and verified that the annual household income calculation and EHEAP benefit
awarded are correct.
Instructions for DOEA Form 114—10/01/2019
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April 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT XX
EHEAP CLIENT FILE CONTENT CHECKLIST
PROGRAM REQUIREMENTS MONITORED Yes No N/A COMMENTS
1. Individual client file for the elder includes consumer's name,address,sex,and age.
2. Household contains a member 60 or older.
3. The household is in the Florida county covered by the contract.
4. All household members are listed and their name,age,DOB,and income(s)are included.
55 Client file contains documentation of Social Security numbers for all household members,or citation
td the applicable exemption.
6. Client file contains signed notice regarding collection of social security number(s).
The client file contains official income documents for all household members and TANF,SSI,or
NAP documentation,if categorically eligible.
8 If income is self-declared,is there a self-declaration form signed by each individual household
member(18 years of age or older)lacking income verification or claiming zero income?
The household's total gross income is calculated correctly and is at or below 150%of the OMB
Federal Poverty Level for the household size,or the household is determined categorically eligible.
Statement of how basic living expenses(i.e.,food,shelter and transportation)are being provided if
10. total household income is less than 50%of the current Federal Poverty Guidelines and no one in the
household is receiving SNAP assistance.
Checked that elder does not live in student dormitory,adult family care home,or any kind of group
riving facility.
2 Verified and documented household has not received LIHEAP Crisis Assistance during the same
?ieating or cooling season.
13. Documentation of Weatherization Assistance Program(WAP)referral,if applicable.
4 Copies of fuel bills,or other supporting documentation as proof of energy crisis,for the residence in
Which they reside.
15. Signed copy of Authorization for Release of General and/or Confidential Information.
16. Only eligible components of the utility bill are paid to resolve the crisis.
7 Only the minimum necessary to resolve the crisis is paid.If a different amount is required by the
utility company,provide additional information on the Eligibility Worksheet.
1Crisis energy benefit was reduced by unallowable charges,such as:water,sewer,garbage,and fire,
etc.,if applicable.
19. Crisis energy benefit was reduced by energy subsidy,if applicable.
20. Energy crisis resolved within 18 or 48 hours by an eligible action.
Written notice of approval or denial for services that includes appeal procedures is issued within 15
working days of eligibility determination.
22. Appropriate benefit provided.
23 All required sections of the application are signed and dated by the elder,staff,and supervisory/peer
PRIOR to payment.
24. Proof of payment to vendor.
25. Place completed DOEA Form 211 in client file.
INSTRUCTIONS: A check mark in the Yes column indicates the requirement has been met.A check mark in the No column indicates the requirement has
not been met or is questionable. Each"No"mark must be explained under"COMMENTS".
Supervisor/Peer Signature Consumer File Monitoring Date
DOEA FORM 211 4/1/2021
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April 1, 2021 —September 2023 EHEAP 203.21
ATTACHMENT XXI
EHEAP COST REIMBURSEMENT SUMMARY
Contract#
Report Period:
Budget
Category Description Numer of units Amount
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16 D 1 'J
April 1,2021 —September 2023 EHEAP 203.21
ATTACHMENT XXIII
SERVICE RATE REPORT
PROGRAM:EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PRORAM(EHEAP)
Federally Funded From 04/01/2021 to 09/30/2023
Category METHOD OF PAYMENT HIGH
SERVICE REIMBURSEMENT UNIT TYPE
RATE
Administration ADMINISTRATIVE COSTS* Cost Reimbursement Cost Reimbursement EPISODE
Outreach OUTREACH COSTS* Cost Reimbursement Cost Reimbursement EPISODE
Crisis CRISIS ENERGY ASSISTANCE Cost Reimbursement Cost Reimbursement EPISODE
Assistance BENEFITS*
*As stipulated in contract,these services are provided on a cost reimbursement basis.
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April 1,2021 —September 2023 EHEAP 203.21
\ATTACHMENT XXIV
OUTREACH PLAN SURVEY
PSA Click here to enter text.
COUNTY(IES)Click here to enter text.
AGENCY'S EHEAP COORDINATOR Click here to enter text,
PHONE W/EXT. Click here to enter text.
EMAIL Click here to enter text.
1. ELDERLY OUTREACH
Describe the efforts to increase the number and percentage of elderly households served.
Ciic+ here to enter text.
2. INTEGRATION OF OTHER LOCAL AGENCIES IN OUTREACH
Describe what local coordination efforts support outreach activities. Identify agencies, utilities,charities,and
others incorporated in these efforts and the activities included.
Click here to enter text.
3. ADVERTISING,PROMOTIONAL, MEDIA,AND OTHER PRINT OUTREACH EFFORTS
a. Brochures—please select all of the options you currently use in your program from the list below:
a Use a locally developed brochure (send an electronic copy with your survey)
❑ Other, please describe Click here to enter text.
How will the brochures be distributed/used (check all that apply):
❑ Display at County courthouse/office building
• Provide to Senior Citizen Centers in county
❑ Provide to meal sites in county
❑ Provide to"Meals on Wheels"for distribution
• Provide to local utility companies and heating fuel providers
• To cooperating local agencies(such as Salvation Army)
• Grocery stores or similar businesses
❑ Provide to churches
❑ Provide to hospitals
• Provide to day care facilities
• Provide to local libraries
❑ Laundromats
• Provide to banks
❑ Provide to clinics
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April 1, 2021 —September 2023 EHEAP 203.21
❑ Provide to Head Start Programs
❑ Other: Click here to enter text.
b. POSTERS
Please select all of the options you currently use in your program from the list below:
❑ Use locally developed poster(send a copy with your survey)
❑ Don't use posters
How does your agency distribute or use program posters (check all that apply):
❑ Display at County courthouse/office building
❑ Provide to Senior Citizen Centers in county
❑ Provide to meal sites in county
❑ Provide to grocery stores
❑ Provide to Laundromats
❑ Provide to churches
❑ Provide to hospitals
❑ Provide to day care facilities
❑ Provide to local libraries
❑ Provide to other businesses
❑ Provide to clinics
❑ Provide to Head Start Programs
❑ Provide to banks
❑ Other: Click here to enter text.
c. PAID ADVERTISING
Does your agency use paid advertising to promote the program?
❑ Yes
❑ No(if you answered No—go to Section D)
Total Budget for advertising(per fiscal year)$ Click here to enter text.
Does you agency advertise in NEWSPAPERS? ❑ Yes ❑ No
Name of Paper Click here to enter text. City/Location Click here to enter text.
Name of Paper Click here to enter text. City/Location Click here to enter text.
Name of Paper Click here to enter text. City/Location Click here to enter text.
Frequency or#of times ads are placed per cooling season: Click here to enter text.
Frequency or#of times ads are placed per heating season: Click here to enter text.
When do you advertise (check all that apply)?
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• April ❑ October
❑ May ❑ November
• June ❑ December
• July ❑ January
❑ August ❑ February
❑ September ❑ March
Do you use the same ad for all newspaper advertising? ❑ Yes ❑ No
If not, how many different ads do you place? Click here to enter text.
In which language(s)are your ads place? (check all that apply)
• English
Spanish
• Other(please list) Click here to enter text.
Does your agency advertise in SHOPPERS? ❑ Yes ❑ No
Name of Shopper Click here to enter text. City/Location Click here to enter text,
Name of Shopper Click here to enter text. City/Location Click here to enter text.
Frequency or#of times ads are placed per cooling season: Click here to enter text.
Frequency or#of times ads are placed per heating season: Click here to enter text.
When do you advertise(check all that apply)
❑ April ❑ October
• May ❑ November
❑ June ❑ December
❑ July ❑ January
• August ❑ February
❑ September ❑ March
Do you use the same ad for all shopper advertising? ❑ Yes ❑ No
If not, how many different ads do you place? Click here to enter text.
In which language(s)are your ads place? (check all that apply)
❑ English
• Spanish
• Other(please list) Click here to enter text,
Does your agency advertise on RADIO? ❑ Yes ❑ No
Station Call Letters Click here to enter text. City/Location Click here to enter text.
Station Call Letters Click here to enter text. City/Location Click here to enter text.
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Frequency or#of times ads are placed per cooling season: Click here to enter text.
Frequency or#of times ads are placed per heating season: Click here to enter text.
When do you advertise (check all that apply)
❑ April ❑ October
❑ May ❑ November
❑ June ❑ December
❑ July ❑ January
❑ August ❑ February
❑ September ❑ March
Do you use the same ad for all radio advertising? 0 Yes ❑ No
If not, how many different ads do you place? Click here to enter text.
In which language(s)are your ads place? (check all that apply)
❑ English
❑ Spanish
❑ Other(please list)Click here to enter text.
Does your agency advertise on TELEVISION? ❑ Yes ❑ No
Station Call Letters Click here to enter text. City/Location Click here to enter text.
Cable Operator Click here to enter text. City/Location Click here to enter text.
Frequency or#of times ads are placed per cooling season: Click here to enter text.
Frequency or#of times ads are placed per heating season: Click here to enter text.
When do you advertise (check all that apply)
❑ April ❑ October
❑ May ❑ November
❑ June ❑ December
❑ July ❑ January
❑ August ❑ February
❑ September ❑ March
Do you use the same ad for all television advertising? ❑ yes ❑ No
If not, how many different ads do you place? Click here to enter text.
In which language(s)are your ads place? (check all that apply)
❑ English
❑ Spanish
❑ Other(please list) Click here to enter text.
OTHER PAID AVERTISING(Please Describe): Click here to enter text,
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d. FREE MEDIA PROMOTION/COVERAGE
Please check all the appropriate selections related to how your agency utilizes free media
promotion/coverage:
❑ Issue Press Releases to local/area media
Are press releases sent out more than one time per year? ❑ Yes ❑ No
If yes, how often? Click here to enter text.
Do you use the same press release each time? ❑ Yes ❑ No ❑ N/A
❑ Prepare announcements for public access to►evision (cable)
❑ Prepare public service announcements(PSAs)
❑ Arrange for on air radio or television interviews
❑ Post information on a County or Agency website
❑ Post information or link to other local websites
❑ Our agency does not take part in any Free Media Promotion
Are any of these materials translated? ❑ Yes ❑ No
❑ Spanish ❑ Other non-English languages
Web activities:
❑ Post information on a County or Agency website
❑ Post information or link to other local websites
e, DIRECT PROMOTIONAL ACTIVITIES
Please select all of the appropriate selections related to how your agency completes Direct Promotional
Activities:
❑ Direct mail—Anticipated size of mailing(s) Click here to enter text, (number of pieces sent)
• Telephone promotion(not application taking)
• Displays/at stores,malls,etc.
❑ Displays/booths at events (check all that apply):
❑ Home Show
❑ Job Fair
❑ Meal Sites
❑ Health Fairs
❑ Other(please list): Click here to enter text.
Who will you target with your direct promotional activities(check all that apply)?
❑ Aging/Seniors/Elderly
❑ Disabled
❑ High Energy Users
❑ Families with children
❑ Last year's applicants
❑ Homebound
❑ Last year's home visit applicants
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❑ Churches
❑ Head Start
❑ Specific Vendors
❑ Subsidized-housing residents
❑ Other(List)
f. HOME VISITS
Does your agency perform home visits? ❑ Yes ❑ No (if no,skip to Section 6,Special Outreach
Efforts)
Number of home visits conducted last year Click here to enter text.
Number of home visits expected this year Click here to enter text.
Do early applications reduce the number of home visits? ❑ Yes ❑ No
Check the criteria used to determine when home visits will be done(check all that apply);
❑ Age
❑ Disability
❑ Transportation difficulties(no car,can't drive,etc.)
❑ Applicant's work schedule
❑ Small children in household
❑ Language barrier/availability of translator
❑ Other(please list): Click here to enter text.
4. SPECIAL OUTREACH EFFORTS
Please check each of the Target/Special Needs populations you are carrying out special efforts to reach from the
list below:
❑ The working poor(check all activities that apply):
❑ Evening office hours
❑ Saturday morning office hours
❑ Saturday afternoon office hours
❑ Promote at churches
❑ Special phone/mail application efforts
❑ After hours home visits
❑ Promote at specific employers
❑ Other(please list):
❑ Households with young children:
❑ Provide materials to day care facilities
❑ Take applications at day care facilities
❑ Promote at churches
❑ Handouts to school children
❑ Materials for Pediatricians and clinics
❑ Other(please list):
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❑ Non-English speaking population,etc.:
• Promote through Hispanic groups
❑ Provide brochures/posters in other languages to hospitals and clinics
❑ Promote through religious organizations
❑ Identify local interpreters to use
❑ Have signage at office in multiple languages
❑ Use pre-recorded messages in different languages
❑ Set application site at gatherings and events where minority groups congregate and interpreters
are available
5. INTAKE SITES AND TIMES
Please select the statement that best fits your application process:
❑ Take applications primarily through appointments
CI Take applications by appointment and work in walk-ins
❑ Take applications by appointment and have day(s)for doing walk-ins
❑ Take applications primarily through walk-ins and reserve appointments for special needs or problem
cases.
❑ Take applications from walk-ins only
a. Identify the intake sites to be used daily(Monday through Friday)
Name of Site Area/County(s)Served Hours Also LIHEAP provider?
Click here to enter text. Click here to enter text, Click here to enter text, ❑Yes ❑No
Click here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text, Click here to enter text, Click here to enter text. ❑Yes ❑No
Click here to enter text.. Click here to enter text. Click here to enter text, ❑Yes ❑No
Click here to enter text., Click here to enter text, Click here to enter text. ❑Yes ❑No
Click here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text, Click here to enter text. Click here to enter text, ❑Yes ❑No
Ciicl;here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text, Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text, Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
Click here to enter text. Click here to enter text. Click here to enter text. ❑Yes ❑No
b. Identify the intake sites to be used regularly,as In once a week,twice a month,etc.
Name of Site Area/County(s)Served Day(s) of Frequency Hours Also LIHEAP
Week (time/??) provider?
Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes ❑No
to enter to enter enter text.
text, text,
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Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes ❑No
to enter to enter enter text,
text, text.
Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes DNo
to enter to enter enter text,
text, text.
Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes CJNo
to enter to enter enter text,
text. text,
Click here to enter text, Click here to enter text. Click here Click here Click here to ❑Yes DNo
to enter to enter enter text,
text, text.
Click here to enter text. Click here to enter text, Click here Click here Click here to El Yes DNo
to enter to enter enter text,
text. text.
Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes ❑No
to enter to enter enter text,
text. text.
Click here to enter text, Click here to enter text, Click here Click here Click here to ID Yes ❑No
to enter to enter enter text.
text. text.
c. Identify other sites to be used.
Name of Site Area/County(s)Served Day(s)of Frequency Hours Also LIHEAP
Week (time/??) provider?
Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes No
to enter to enter enter text,
text. text.
Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes DNo
to enter to enter enter text.
text. text.
Click here to enter text, Click here to enter text, Click here Click here Click here to ❑Yes DNo
to enter to enter enter text.
text, text.
Click here to enter text. Click here to enter text. Click here Click here Click here to Dyes DNo
to enter to enter enter text.
text. text.
Click here to enter text. Click here to enter text. Click here Click here Click here to ❑Yes DNo
to enter to enter enter text.
text. text.
d. Planned extended or flexible application times.
Area/County(s)Served Day(s)of Frequency Hours Also LIHEAP
Week (time/??) provider?
Evening Hours Click here to enter text. Click here Click here Click hereto ID Yes DNo
to enter to enter enter text.
text. text.
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Evening Hours Click here to enter text. Click here Click here Click here to ❑Yes ❑No
to enter to enter enter text,
text, text.
Saturday Hours Click here to enter text. Click here Click here Click here to ❑Yes ❑No
to enter to enter enter text.
text, text.
Other Click here to enter text. Click here Click here Click hereto ❑Yes ❑No
to enter to enter enter text.
text. text.
e. Days Offices are Closed
Check all holidays the agency is closed:
❑ Columbus Day
❑ Veterans Day
❑ Thanksgiving
❑ Friday after Thanksgiving
❑ Christmas Eve
❑ Christmas Day
❑ New Year's Eve
❑ New Years Day
❑ Martin Luther King,Jr.'s Birthday
❑ President's Day
❑ Good Friday
❑ Memorial Day
❑ Independence Day
❑ Labor Day
❑ Other(Please List)
❑ Click here to enter text.
❑ Click here to enter text.
❑ Click here to enter text,
b. SENIOR STAFF WORK SCHEDULES
Please provide the regular weekly office hours for the following:
Title Name Mon Tue Wed Thurs Fri
Executive Director Click here to enter text. Click Click Click Click Click
here to here to here to here to here to
enter enter enter enter enter
text. text. text. text. text,
Chief Financial Officer Click here to enter text. Click Click Click Click Click
here to here to here to here to here to
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text. text. text, text. text.
EHEAP Program Click here to enter text. Click Click Click Click Click
Coordinator here to here to here to here to here to
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16D10
April 1, 2021 —September 2023 EHEAP 203.21
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text, text,: text. text. text,
7. OUTREACH ASSESSMENT/EVALUATION
Do you survey your applicants to assess the effectiveness of outreach efforts? 0 Yes 0 No
Surveys are targeted at
O Elderly
O Handicapped/disabled
❑ Households with young children
❑ Non-English speaking households
Surveys are not targeted 0 Yes ❑ No
Do you track numbers of applicants at each outreach site? ❑ Yes ❑ No
Each time the site is used? ❑ For all visits combined? 0
Do you compare types of outreach sites? ❑ Yes ❑ No
What is the most effective type of outreach site? (For example: senior center, library,town hall,fire
station,housing facility,etc.) Click here to enter text,
Do you track the number of home visits? 0 Yes 0 No
Do you track the reason for doing each home visit? ❑ Yes 0 No
What other way do you assess the effectiveness and success of your outreach efforts? Click here to enter text.
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16010
Revised August 2007
Attestation Statement
Agreement/Contract Number EHEAP 203.21
Amendment Number NA
I DANIEL R RODRIGUEZ ,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)
I,
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.
Signature of Recipient/Conti• 'y� five Date
Approved as to form and legality
Assistant At racy -
Revised August 2007
16D10
CERTIFICATIONS
In accordance with the applicable statutes and the regulations governing the consolidated plan regulations,
the jurisdiction certifies that:
Affirmatively Further Fair Housing--The jurisdiction will affirmatively further fair housing.
Uniform Relocation Act and Anti-displacement and Relocation Plan -- It will comply with the
acquisition and relocation requirements of the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970,as amended,(42 U.S.C. 4601-4655)and implementing regulations at
49 CFR Part 24. It has in effect and is following a residential anti-displacement and relocation assistance
plan required under 24 CFR Part 42 in connection with any activity assisted with funding under the
Community Development Block Grant or HOME programs.
Anti-Lobbying--To the best of the jurisdiction's knowledge and belief:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of it,to any person for
influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an
officer or employee of Congress, or an employee of a Member of Congress in connection with the
awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the
entering into of any cooperative agreement,and the extension,continuation, renewal,amendment,or
modification of any Federal contract, grant, loan,or cooperative agreement;
2. If any funds other than Federal appropriated funds have been paid or will he paid to any person for
influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an
officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal contract,grant, loan, or cooperative agreement, it will complete and submit Standard Form-LLL,
"Disclosure Form to Report Lobbying," in accordance with its instructions;and
3. It will require that the language of paragraph 1 and 2 of this anti-lobbying certification be included in
the award documents for all subawards at all tiers(including subcontracts,subgrants, and contracts under
grants,loans,and cooperative agreements)and that all subrecipients shall certify and disclose
accordingly.
Authority of Jurisdiction --The consolidated plan is authorized under State and local law(as applicable)
and the jurisdiction possesses the legal authority to carry out the programs for which it is seeking
funding, in accordance with applicable HUD regulations.
Consistency with plan--The housing activities to be undertaken with Community Development Block
Grant, HOME, Emergency Solutions Grant,and Housing Opportunities for Persons With AIDS funds are
consistent with the strategic plan in the jurisdiction's consolidated plan.
Section 3 --It will comply with section 3 of the Housing and Urban Development Act of 1968(12
U.S. 701u)and implementing regulations at 24 CFR Part 75.
8/Z/2/f
Signature uthorize fficial Date
Gnat ree rS6Y`
Title
A 1 1'ES"I Approved as to form and legality
CRYSTAL K. KINZEL CLERK
Assistant County tom)/ CAO
Attest as to Chairman's
cinn-Aftrn r.r;Itr
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Specific Community Development Block Grant Certifications
The Entitlement Community certifies that:
Citizen Participation -- It is in full compliance and following a detailed citizen participation plan that
satisfies the requirements of 24 CFR 91.105.
Community Development Plan -- Its consolidated plan identifies community development and housing
needs and specifies both short-term and long-term community development objectives that that have been
developed in accordance with the primary objective of the CDBG program (i.e.,the development of viable
urban communities, by providing decent housing and expanding economic opportunities, primarily for
persons of low and moderate income)and requirements of 24 CFR Parts 91 and 570.
Following a Plan-- It is following a current consolidated plan that has been approved by HUD.
Use of Funds--It has complied with the following criteria:
1.Maximum Feasible Priority. With respect to activities expected to be assisted with CDBG
funds,it has developed its Action Plan so as to give maximum feasible priority to activities
which benefit low-and moderate-income families or aid in the prevention or elimination of
slums or blight.The Action Plan may also include CDBG-assisted activities which the grantee
certifies are designed to meet other community development needs having particular urgency
because existing conditions pose a serious and immediate threat to the health or welfare of the
community, and other financial resources are not available(see Optional CDBG Certification).
2.Overall Benefit.The aggregate use of CDBG funds, including Section 108 guaranteed loans,
during program year(s) 2.0 21 [a period specified by the grantee of one,
two,or three specific consecutive program years], shall principally benefit persons of low and
moderate income in a manner that ensures that at least 70 percent of the amount is expended for
activities that benefit such persons during the designated period.
3. Special Assessments. It will not attempt to recover any capital costs of public improvements
assisted with CDBG funds, including Section 108 loan guaranteed funds,by assessing any
amount against properties owned and occupied by persons of low and moderate income,
including any fee charged or assessment made as a condition of obtaining access to such
public improvements.
However,if CDBG funds are used to pay the proportion of a fee or assessment that relates to the
capital costs of public improvements(assisted in part with CDBG funds)financed from other
revenue sources,an assessment or charge may be made against the property with respect to the
public improvements financed by a source other than CDBG funds.
In addition, in the case of properties owned and occupied by moderate-income(not low-income)
families,an assessment or charge may be made against the property for public improvements
financed by a source other than CDBG funds if the jurisdiction certifies that it lacks CDBG funds
to cover the assessment.
Excessive Force--It has adopted and is enforcing:
1.A policy prohibiting the use of excessive force by law enforcement agencies within its
jurisdiction against any individuals engaged in non-violent civil rights demonstrations;and
2.A policy of enforcing applicable State and local laws against physically barring entrance to or
exit from a facility or location which is the subject of such non-violent civil rights
demonstrations within its jurisdiction. P�
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Compliance with Anti-discrimination laws--The grant will be conducted and administered in
conformity with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d)and the Fair Housing Act(42
U.S.C.3601-3619)and implementing regulations.
Lead-Based Paint-- Its activities concerning lead-based paint will comply with the requirements of 24
CIF'R Part 35, Subparts A, B. J, K and R.
Comp ' ce with Laws-- It will comply with applicable laws.
cS)//"e/7/
Signature of thorize fficial Date
C1Aa'i r` fe cso-1
Title
ATTEST - Approved as to form and legality
CRY AL K.KINZE ,CLERK
"Assistraij1/4-Ait County Al me
Most asfo Chairman's
..!mature on
-O
1 6 D 1 0
Specific HOME Certifications
The HOME participating jurisdiction certifies that:
Tenant Based Rental Assistance-- If it plans to provide tenant-based rental assistance,the tenant-based
rental assistance is an essential element of its consolidated plan.
Eligible Activities and Costs-- It is using and will use HOME funds for eligible activities and costs,as
described in 24 CFR §§92.205 through 92.209 and that it is not using and will not use HOME funds for
prohibited activities,as described in §92.214.
Subsidy layering-- Before committing any funds to a project, it will evaluate the project in accordance
with the guidelines that it adopts for this purpose and will not invest any more HOME funds in
combination with other Federal assistance than is necessary to provide affordable housing;
VA'
Signature of , dthorize fficial Date
C\c r
Title
ATTEST CRY L K.KINZ CLERK Approved as to form and legality
Astant County Alto
r, Gst as to Chairman's
salute only.
0
CJT
1 6010
Emergency Solutions Grants Certifications
The Emergency Solutions Grants Program recipient certifies that:
Major rehabilitation/conversion/renovation—If an emergency shelter's rehabilitation costs exceed
75 percent of the value of the building before rehabilitation,the recipient will maintain the building as a
shelter for homeless individuals and families for a minimum of 10 years after the date the building is first
occupied by a homeless individual or family after the completed rehabilitation.
If the cost to convert a building into an emergency shelter exceeds 75 percent of the value of the building
after conversion,the recipient will maintain the building as a shelter for homeless individuals and
families for a minimum of 10 years after the date the building is first occupied by a homeless individual
or family after the completed conversion.
In all other cases where ESG funds are used for renovation,the recipient will maintain the building as a
shelter for homeless individuals and families for a minimum of 3 years after the date the building is first
occupied by a homeless individual or family after the completed renovation.
Essential Services and Operating Costs—In the case of assistance involving shelter operations or
essential services related to street outreach or emergency shelter,the recipient will provide services or
shelter to homeless individuals and families for the period during which the ESG assistance is provided,
without regard to a particular site or structure, so long the recipient serves the same type of persons(e.g.,
families with children, unaccompanied youth,disabled individuals,or victims of domestic violence)or
persons in the same geographic area.
Renovation—Any renovation carried out with ESG assistance shall be sufficient to ensure that the
building involved is safe and sanitary.
Supportive Services—The recipient will assist homeless individuals in obtaining permanent housing,
appropriate supportive services(including medical and mental health treatment,victim services,
counseling,supervision,and other services essential for achieving independent living), and other Federal
State, local,and private assistance available for these individuals.
Matching Funds—The recipient will obtain matching amounts required under 24 CFR 576.201.
Confidentiality—The recipient has established and is implementing procedures to ensure the
confidentiality of records pertaining to any individual provided family violence prevention or treatment
services under any project assisted under the ESG program,including protection against the release of the
address or location of any family violence shelter project,except with the written authorization of the
person responsible for the operation of that shelter.
Homeless Persons Involvement—To the maximum extent practicable,the recipient will involve,
through employment, volunteer services,or otherwise,homeless individuals and families in constructing,
renovating, maintaining, and operating facilities assisted under the ESG program, in providing services
assisted under the ESG program,and in providing services for occupants of facilities assisted under the
program.
Consolidated Plan—All activities the recipient undertakes with assistance under ESG are consistent
with its consolidated plan.
0
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16010
Discharge Policy—The recipient will establish and implement,to the maximum extent practicable and
where appropriate,policies and protocols for the discharge of persons from publicly funded institutions
or systems of care(such as health care facilities,mental health facilities,foster care or other youth
facilities,or correction programs and institutions) in order to prevent this discharge from immediately
resulting in homelessness for these persons.
g/tz/.z,
Signature of Au rized icial Date
°emir person
Title
ATTF.S7 Approved as to form and legality
CRYS AL K.K1NZ CLERK
Assistant County At rney
Attest as to Chairman's
;innntur?only.
C40
16010
APPENDIX TO CERTIFICATIONS
INSTRUCTIONS CONCERNING LOBBYING CERTIFICATION:
Lobbying Certification
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352,title 31,U.S. Code.Any person who fails to file the required
certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for
each such failure.
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