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Agenda 07/13/2021 Item #16D 2 (After-the-Fact Contract Amendment to AAA of SWFL)16.D.2 07/13/2021 EXECUTIVE SUMMARY Recommendation to approve an "After -the -Fact" amendment and an attestation statement with Area Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy Assistance Program to amend contract language and replace attachments. OBJECTIVE: To provide home energy assistance aid to elders in the event of a home energy heating or cooling emergency. CONSIDERATIONS: The Community and Human Services (CHS) Division's Services for Seniors program has been providing support to Collier County's frail and elderly citizens for over thirty (30) years through various grant programs. Some of these grants are funded by the Florida Department of Elder Affairs (DOEA) through the Area Agency on Aging of Southwest Florida, Inc. (Agency). These grant fund services enable clients to remain in their homes and live with independence and dignity. The Collier County Services for Seniors Program is responsible for responding to seniors' needs and managing the spending authority for the Federal and State Funded Services for Seniors Programs. Collier County, as the Lead Agency, manages the spending authority for the Emergency Home Energy Assistance Program (EHEAP). EHEAP provides crisis assistance to eligible low-income households with at least 1 individual aged sixty (60) or older experiencing a heating or cooling emergency. The program allows for payments to utility companies, fuel suppliers for the repair or replacement of existing heating or cooling equipment, for the payment of deposits, late fees, disconnect and reconnection fees with Florida Power and Light (FPL) & Lee County Electric Cooperative (LCEC). This item is being presented "After -the -Fact" because Collier County received the amendment on May 25, 2021, from the grantor agency and is required to return it within thirty (30) days. This time frame makes it impossible to process the document for the Board of County Commissioners' (Board) consideration. Pursuant to CMA #5330 and Resolution No. 2018-202, the County Manager authorized the Public Services Department Head to sign the agreement. This Agreement is being presented for Board ratification. The current service agreement for EHEAP 203.21 was approved "After -the -Fact" at the Board Meeting on June 22, 2021 (Agenda Item #16D10). The contract has a term that is, effective April 1, 2021 to September 30, 2023. The proposed EHEAP Amendment 203.21.001 is to replace attachments of the 2021 EHEAP contract wherever stated throughout the contract as well as: 1. ATTACHMENT I, Section II.E.l.g., EHEAP Outreach Activity Report, is replaced. 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 9th of eaeh moffth along with the atm4y's monthly billing, 9th day following the end of each quarter. The EHEAP Outreach Activity Report shall consist of the following: (1) Date; (2) County; (3) Location Address; (4) Description of Activity; and Packet Pg. 1523 07/13/2021 16.D.2 (5) Name and Position of Staff. 2. ATTACHMENT XVIII, EHEAP Application and Eligibility Worksheet, is replaced. FISCAL IMPACT: There is no Fiscal impact associated with this action, the funds reside in the Human Services Grant Fund (707), Project 33756 (EHEAP). GROWTH MANAGEMENT: There is no Growth Management impact from this recommendation. LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote for Board action. - JAB RECOMMENDATIONS: To approve an "After -the -Fact" amendment and an attestation statement with Area Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy Assistance Program to amend contract language and replace attachments. Prepared By: Wendy Klopf, Grant Coordinator, Community and Human Services Division ATTACHMENT(S) 1. (Linked) EHEAP 203.21 -Exec (PDF) 2. EHEAP 203.21.001 exec (PDF) 3. APPLICATION 05_21_2021 (Fillable)-EHEAP CARES -REPLACED 5.2021 (PDF) 4. Resolution 2018-202 (PDF) Packet Pg. 1524 16.D.2 07/13/2021 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.2 Doe ID: 16044 Item Summary: Recommendation to approve an "After -the -Fact" amendment and an attestation statement with Area Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy Assistance Program to amend contract language and replace attachments. Meeting Date: 07/13/2021 Prepared by: Title: Operations Coordinator — Community & Human Services Name: Wendy Klopf 06/02/2021 2:54 PM Submitted by: Title: Manager - Federal/State Grants Operation — Community & Human Services Name: Kristi Sonntag 06/02/2021 2:54 PM Approved By: Review: Community & Human Services Blanca Aquino Luque Additional Reviewer Community & Human Services Kristi Sonntag CHS Review Community & Human Services Maggie Lopez Additional Reviewer Operations & Veteran Services Kimberley Grant Additional Reviewer Public Services Department Todd Henry Public Services Department Grants Erica Robinson Level 2 Grants Review Public Services Department Dan Rodriguez PSD Department Head County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Grants Therese Stanley Additional Reviewer Budget and Management Office Ed Finn Additional Reviewer County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review County Manager's Office Sean Callahan Level 4 County Manager Review Board of County Commissioners Geoffrey Willig Meeting Pending Completed 06/02/2021 4:53 PM Completed 06/03/2021 5:00 PM Completed 06/07/2021 11:38 AM Completed 06/09/2021 3:02 PM Completed 06/10/2021 9:29 AM Completed 06/17/2021 9:47 AM Completed 06/17/2021 1:25 PM Completed 06/17/2021 4:03 PM Completed 06/18/2021 3:49 PM Completed 06/22/2021 10:17 AM Completed 06/22/2021 5:32 PM Completed 06/23/2021 2:23 PM Completed 06/30/2021 8:21 AM 07/13/2021 9:00 AM Packet Pg. 1525 16.D.2.b April 2021 — September 2023 EI-IEAP 203.21.001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. EMERGENCY HOME ENERGY ASSISTANCE PROGRAM WHEREAS, the purpose of this Amendment is to amend contract language and replace attachments of Contract EHEAP 203.21. NOW THEREFORE, in consideration of the mutual covenants and obligations set forth herein, the receipt and sufficiency of which are hereby acknowledged, the Parties agree to the following: i. ATTACHMENT I, Section II.E.I.g., EHEAP Outreach Activity Report, is hereby replaced. g. EHEAP Outreach Activity Report The Contractor shall ensure the use of outreach efforts that will inform potentially eligible households about EHEA P to the Agency Contract Manager or its designee by the 9"' day following the end of each quarter. 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. 2. ATTACHMENT XVIII, EHEAP Application and Eligibility WoNksheet, is hereby replaced. All provisions in the contact and any attachments thereto in conflict with this Amendment shall be and are hereby changedto conform to this Amendment. All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract. N x m This Amendment and all its attachments are hereby made part of the contact. c 0 IN WITNESS THEREOF, the Parties hereto have caused this amendment, to be executed by their officials as duly authorized; N and agree to abide by the terms, conditions and provisions of this EHEAP amendment as amended. This Amendment is effective CO) on the last date the Amendment has been signed by both Parties. a a LU IN WITNESS WHEREOF, the Parties hereto have caused this contract to be executed by their undersigned off.:hds as duly = authorized. w (D CONTRACTOR: COLLIER COUN AREA AGENCY ON AGING FOR BOARD OF 6li CO 5g . ERS SOUTHWEST VLORIDA, INC. SiGNED B �- SIGNED BY: ,,,rr NAME: DANIEL R RODRIGUEZ NAME: NORMA ADORNO TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: I44W-VRES€DENT/CEO DATE: 0k C' 4 /2021 DATE: LC Z C1 '- 2_1) 2— Federal Tax iD: 59-6000558 Fiscal Year Ending Date: 09/30 DUNS: 076997790 ro Packet Pg. 1526 16.D.2.b April 2021 — September 2023 EHEAP 203.21.001 ATTACHMENT XVIII Emergency Home Energy Assistance for the Elderly Program -Application Name: (Rr.1. 1.1, LarAi — ! beano 3ercn ` roornp sea.x Data Stamp -__-_ _..---.---- Date at 13ITIM l ge: ;3N: 3ery/ae address: ory: FlanOa .- ZIP Code: Inw�l:e vrcrl ersnarie: Dex. j M,'Ve s Female Ndrnber ct people In use arcuseno1d: Phone: Pnone: Whanta? -^.ta -us: i I ►tariled I 1 Partnered 011g'e ! 0epparated Divonred %0.1 Race: ' 11AVIe '.' atam'A71'1a1aq Arnersmn 01 - N.31lve Ha5Y3113n1PaII islander American IndatiAla-ka Watt.* ; i Other Elh•ltaty: ;_., H spanlrwl_Vr na 1 other Prtmxy Language: Englsll .. OpaMeh : -. Oihar Does dlent have Irnh,ed aafty reading, +vrinrg, SDE3k I1g, Of understand ng the EN(sh language? : " Yes ; Na Is U* client a usW_ran? :., Yes I. i No Was Glsist -erred to the laaai velera.rys Arralrs amoE? .- Yes . : No NSA Apgrcatt's Mont- type(s): Applicants mormy I:quorna arni IC Name: rYRe s)Age: MCrlsliMccow. xMu'tl: t1noome Wame: me IyFWS): htgn my I1aa7reaWU'1t: Mime: 7e tyw's): " Age: ._.....-.,._.__._... --.._.._...__..._...._.._.._ - .._. _..................__..._..... •N: FdctYgtly Incivz'I- arncu Il name: _...__,_...._..._........_.-....,.....__........__ _._...__..._ .__.._ ._ Irtaolrr_ tyFe{sl; Age: hla'alty Inccrne amaa+nl: Nang: Irr}�me type•5): III insane allcllnl: Age: Is Mere a MCA G years Of age or younger Iq the hauSehotd? . Yes :: No If Yes, see-n all thI a ales: : 4r? 'ears Otd . 3-5 LSars oi.d Is there al a dsablfly in ale nCUsehold? : i Yes No Is tale appfloant a U.S. dozen or an al -en la.wruly ad•nttted for parrnanent restdepc--? Yes tva is t1w app Wnt a horn eolhner? ' ; Yes ' , No Caee. Vp!lcwl Fie to gormm•nent subrd zed housing, *rich as deao.'r B? : yes. . No If yes, FrlrAtle the oamplek name•: If }%es, does the twusehold receive art eyle;gr suDsl7y? : Yea c r43 Web 1p!tcant raretn a sGlderR dOf171h6r)', a.0uh farnty Aare 170'rhe, or arn• l,nd cr group IiVlrg facts tr ': Yes No If )'es, FraA IIe the Ta cti ty n3 rne: Have you orany member of your nousehOd asV*Ianee In the ourrent season? , : Yes NO If yes. I;Av iae the name to Agency: 7'Ipe at A.selstanx: CI Is : Home &12ryy 1Vea her-4e algid Cabe: What Is We primary source ct inane heallfvg? (selectonI : , E1e r?j1diy r Natural Gas ; I propa•le Y"Ioal+Coaa :.rte"Ilave, Fuels Roee h0us mold use suaFUrtlental he313119 source? : E)e-- ttrry .: tt:o3CVCoai i N,A Alt aondto lig• unit. type?, 1 Cerdrat. A,'C , t VoIndovAl0 al A.'C Fans : Ctner- specs'y (lnolLyW lg veapora:',+e water) I Hone coI or heatng energy swroe 7las been Tr1e lnran»aCa'1 p:r+•,lum on this aaFlF:,afJci7, Is 10 the to st of fr'ry" dIII nW.ad. (LNe-7?Vearenblgr knowledge, to 1e ark? complete. I untlefs"and I1,,V pMIII ty In ptovIdl.•1g assls:3rce W111 she green to Ih7se housencias wtlfs. the lowest lrlaome and grea'.est need. Le. :nb5e nCUsel'4ds 1711W11I the elderly'• i 11,'latkp IO get delhyery' Gf M�I, 16 Ci1t Gt A1ef, 6r 151n dahgef U Cca'.ng out of fuel to healing. (Ure-77treafen!,W) dlsat{ed, medipalry needy, or GYld,ten reside. I WWrize the agency tc make aenem payme�••Its d redly to my e•Isrgy slroFrler. i am taare hah Sg aster I a're pywiltied XI the Information requevedto detant:ne other OroWerns'Wth tack cr coUl•lg or heTrr,) ir. ^ie'tcrne, such as needing 10 pay a tlepaelt, repair Or rgLlFrn=tlt, or nny etlglb+ltEy. If 1 am aFpfytng $Dr W" assistance• the agency has la tnberlm en'rergency measure to avolrf rut ..Ier ensis, (LMr JAreas�n gl ncurs to act Upon 17w app>lcaaon W.31 an eligMe, aolkin. I a.rn also aware that If I am net approved ar den''ed'. MIn the tlme allc eff. or nc{ app-co-ed mr the correct amoum• I have a rght to apaea the deuslon. (M yw arg1 W'tll an "X' TWO Wi nesses are required.) NoUned V1at She energy source f'3rL=IIqqOrnea24ng Is gong to be dlsconneCled. (Sr"af.j) Kecetved a nopoe indicating the energy scurce of Is de0n,1 ql or past due. I' aroardj 31a eturc:...,-_..___._._.._.._....___......_..... _ .- _ : Has an energy source U11 for wI the due dab- has lapsed. (Sranderv) -- --- ----------- .......- - -.... - - - - -- - -- -- - — CL CLIL IV f Is 2;jPjvLw .City Inc .N A1filIWaLI ffC.f tMf: f+.1:L EA CW'df4AL RAL AM visl'i GlYr fVJ1L%9fi1Lf WA t.VIY FtWi "P1L.Q"LW&Af- t C M ie L&F 6oNti IiI a.d. y{�L roYr .w�...Gr:Y•..L M. IW ,• wr .. r-lY.�.'./. ww..n •y,r 4 +.•IMJ, r>rt .+. .wl.`�.-!•+w !s'a.'i. r ti•„ ....1. .. ,utir�ry'w lwl uwa IM J4aA ��+Y ,�er.}.}� v u r.. !�1wa2yY ,� v,r ,e >rol., :ue, a•_w.i •sir VaT.•.I,.fw.Y ..: .. ,J.. L+.�• ... w. . .�:i.�i NYyw „•.'4��. L�.� rJ le ..Y. }I4 +I•�h•.,:�,.,.1h +.yM .� Ir..n �... 2 _V Packet Pg. 1527 16.D.2.b April 2021 — I-- 2023 crrrrr Cif V" noTlle 1=1Y•Pr AnntrAlzeat hmmehtia Imaome. r. Ada at: gross M;glh'y earnecl and unearned Moome horn Me gust •3D slays of all tlaruSehold members. 2. Add Medtoare Ptem?um (S145,53). If nct limilucled to SSA aroolinl. 3. Ada !Medloare Part D. It ap¢11cat4e. a. 7o annualze. rtwlnl7Ay the m. fTthty 'x),LW a 12rnongts, Antra` ., we Income ' C3lEg0V=Iy EjlglNe Enanre tiandor A Name: Account Number. Vc Mcntan and CC,-MA-;-enl Catract Peron: Dale:_--- Enwmy Lander 02 Name: Account Nuwbsr. EHEAP 203.21.001 0G-7r= 'C l3[:•_ I'.•2 r2 Sl-G': .RQ Potrtty 6ubdennac erleollNa Cpro V2020. h'•:•.�+•tt•�a+r.rtlar: ar'.Y'4s" ctrccrra�•7n,£ ea I ':'1 t•`l3 S03CA, 'Select the annual Incomal-•41 t� fw ehaH .Ize: `:Sd?4 of Aae'LY;,• 57 isair'+G4 ' 1..........519, t4a S 6.300 3..._......532.Ee5 afaesa 4.......... S3q 300 ;13, mo !- 9.......... i4=,1120 *15,340 -- 6..... ... ..i=w?.7Ab �17,58a - e.......... *ss,tect nee 0%m>; 6,+ M far eac. atlasAnse me, -•ter at inm to �Jl •n^m more ttwn 6 mer-bem,k. 11'",e total dnnlwv homehE�d 'rKp--,e 12 Jess than S3'% of the ears:: Federal poverty Crr4alrres Jar hw< er1D'C tlae I t W ng ctvrt abyr a ,, any rro ane to the r ouserrera Is rec eW:VV VILAP W -I nonce, tNe appS lc and pravldr a upni+s ststemerl. of Jim rsmate 10n? expense9 Il.e., rood, ahe:?.er and transportatcn) ar+_ Wou'.Eed for the hou--eho'd 1dnV-e_m A wurfl Due:_-- Vennca Gon and Cor. xn :rent Gorrx-t Person: . Daic-� I Total Enmw Vendom # 21 Energy 8u4cldy i al Waldr. Bawer. Garbage, _ FYv, e•ta. 11 Deduol 12db1 frurn (I) f Crth er Ve:erinr 11 Name: Amourr."%'cucher M.imtxr, tare: .hrrlofaxDue :_.._.._.__.._.._._......_....__...__._......_..._._.... Repsir EvIzUrq Heatig PartaOf Fan cr CoaEr.7 equ'grner•,t "I Spare Hexer .: Erergencr Shelter -i'AirmWhD Cttrr Other Werbdur 32' , • • •• Nzme: Aoccurmlvcucher hh.rnfr., r �u:e= Armum Blark e. "? Repalr ErICU^.q FHenllra -� PorrabF- Fan 7r GoDWQ equ"ert _.;. Space Herrr _ =nxrgence Sherer d;l ra al other Vandtwo 4 ToWrl EHE4P Benent aigp V.�d t Thalm Erendor (•t) A Total Other vondar () Canlart made ", h LWEAP prc deer tG -,+M1y prev'cu,- creak mmlztance. Conrad Person: __.._—_._,......... _ Date orccrnlacl: __.____._,...,,.,• ....__._....—.__.___.. HOD r_.«,e opo scant recef led LIHEAP crtsfr aSUstante dUW,.p the currer'.eacan? ! :Yes , lf-.o Ii the rr-mr num amaum cue Is more than the past due 3MOUnt, did the energy vamSDi,.*MTy that :ills arnounl is Tequirea? Yes h{3 ; RIA IT the RYMrYrJm am ml due bo riesorie the cnsrs. Is mare than vne maximum arlahrd, eNV31n how the Wfanre of the amunl d:le Aft be pats If aFPrerrea Its EHEA R ca Ws assts.tinoe. Is ,71e nanw_ On the Tuel txt That of the A1)PI103nt57 Yes No If no, prov{3e narme. 0 1 bill: If yle 3F1YIcan1 IS a hoR'1ep'mier, has hrets:ne W-DL-:Wd mare Ih3n three LIHEAP or EHEAP Wnerrts In Ilse ias1 1131mo'itps? Yes . No :: t,{A tf fie answer to'3te prermous quesllon Is'}rc5', teas the 10�Mavt rre•'erre•J loWAP? Yes t b it If me answer to!he East q suon Is `.IW. expiate: ftescluCon "Ifte He.311ngrCooFniz EaleMV Lasts o6GtrrreQ WUnin lai43 hours. tv the .11lh� — t,k : Appawal of app{cart{3R t EHEAP berletlt preMkjTbM d'scoM. ect:on Cre mihmnt male to vaMor I t EMEAP bemetlt ree4ofed energy area:ly disconnected : DetYW, of Appil-DalWR. punling aaaClonal Infogtl3ticn 1 Y.e6, aegt slgrtaa h�Yer oerY9?.atApp(k7311011. Inellglole : :No, Client Tenreed bovg'1 walver vvauuen rElert A arts .4"IS Mrtx W a4zess a31er cormxrltty resources CartyErorters Marne: Gabe Wags ers Sxnah Date.: Nam-: rAW;,ee%1-3 Name: sor:=eer�3 6•analrre: O O N M O N C a) E C d E Q a a W 2 tit O t:p r u CD K 0 0 O N M O N lL Q W 2 W C d E L V rt3 �-r t Ao-ncr NWIe: 3 GO� Packet Pg. 1528 16.D.2.b Revised August 2007 Attestation Statement Agreentent/Contract Number: EIIEAP CARES 203.21 Amendment Number .001 1, DANIEL. R RODR[ . EZ , attest that no changes or revisions have been inade to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, clue to the differences in electronic data processing media, which has uo affect on the agreement/contract content. 0& e, Signature of Rccipieatdr( 11 Approved as to form and legality , ^� Assistant County Attorney , Revised August 2007 /2021 Date d K m 9 Packet Pg. 1529 Emergency Home Energy Assistance for the Elderly Program CARES Act - Applica 16.D.2-c Section One: .. .0 and.. Name: (First, M, Last) ❑ EHEAP CARES Act Date Stamp Date of birth: Age: SSN: Service address: City: Florida County: ZIP Code: Intake worker's name: Phone: Sex: ❑ Male ❑ Female Number of people in the household: Phone: Marital Status: ❑ Married ❑ Partnered ❑ Single ❑ Separated ❑ Divorced ❑ Widowed Race: ❑ White ❑ Black/African American ❑ Asian ❑ Native Hawaiian/Pacific Islander ❑ American Indian/Alaska Native ❑ Other Ethnicity: ❑ Hispanic/Latino ❑ Other Primary Language: ❑ English ❑ Spanish ❑ Other Does client have limited ability reading, writing, speaking, or understanding the English language? ❑ Yes ❑ No Is the client a veteran? ❑ Yes ❑ No Was client referred to the local Veteran's Affairs office? ❑ Yes ❑ No ❑ N/A Applicant's income type(s): Applicant's monthly income amount: Section Two: Additional Household Members Information Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Section Three: Household Characteristics Is there a child 5 years of age or younger in the household? ❑ Yes ❑ No If Yes, select all that applies: ❑ 0-2 years old ❑ 3-5 years old Is there an individual with a disability in the household? ❑ Yes ❑ No Is the applicant a U.S. citizen or an alien lawfully admitted for permanent residence? ❑ Yes ❑ No Is the applicant a homeowner? ❑ Yes ❑ No Does applicant live in government subsidized housing, such as Section 8? ❑ Yes ❑ No If yes, provide the complex name: If yes, does the household receive an energy subsidy? ❑ Yes ❑ No Does applicant live in a student dormitory, adult family care home, or any kind of group living facility? ❑ Yes ❑ No If yes, provide the facility name: CoolingSection Four: Heating and Have you or any member of your household received energy assistance in the current season? ❑ Yes ❑ No If yes, provide the name of Agency: What is the primary source of home heating? (select one) ❑ Electricity ❑ Natural Gas ❑ Propane ❑ Wood/Coal ❑ Refillable Does household use supplemental heating source? ❑ Electricity ❑ Wood/Coal ❑ N/A Air conditioning unit type? ❑ Central A/C ❑ Window/Wall A/C ❑ Fans ❑ Other — specify (including evaporative cooler) EnergySection Five: • •Attestation ❑ Home cooling or heating energy source has been disconnected. (Life-Threatening/18-hour) The information provided on this application, is to the best of my knowledge, true and complete. I understand that priority in providing assistance will be given to those households with the lowest income and greatest need, i.e. those households in which the elderly, disabled, medically needy, or children reside. I authorize the agency to make benefit payments directly to my energy supplier. I am aware that after I have provided all the information requested to determine my eligibility, if I am applying for crisis assistance, the agency has 18 hours to act upon my application with an eligible action. I am also aware that if I am not approved or denied within the time allowed, or not approved for the correct amount, I have a right to appeal the decision. (If you sign with an "X" two witnesses are required.) Client Signature: ❑ Unable to get delivery of fuel, is out of fuel, or is in danger of being out of fuel for heating. (Life-Threatening/18-hour) ❑ Other problems with lack of cooling or heating in the home, such as needing to pay a deposit, repair of equipment, or interim emergency measure to avoid further crisis. (Life-Threatening/18-hour) ❑ Notified that the energy source for cooling or heating is going to be disconnected. (Standard/48 hour) ❑ Received a notice indicating the energy source bill is delinquent or past due. (Stan dard/48-hour) I Date: ❑ Has an energy source bill for which the due date has lapsed. (Standard/48-hour) N CD N Sri w U a J d w 1* rn w Q U IL Q w 2 w a� R ii N 0 N I r N uO I 0 z O H Q U J d d Q c m E t a ALL CLIENTS SHOULD SIGN THE WAIVER, AUTHORIZING THE RELEASE OF GENERAL AND/OR CONFIDENTIAL INFORMATION FOR LIHEAP/EHEAP FEDERAL REPORTINC *Your Social Security Number (SSN) is confidential under law. We may not collect your SSN unless we explain the reason for collecting your SSN in writing and provide the applicable statutory authority for doing so. Certain provisions of Chapter 430, Florida Statutes, read with Section 119.071(5), Florida Statutes, specifically authorize the Department of Elder Affairs (DOEA) and its designated staff/employees to collect SSNs when authorized by law or when collection of SSNs is imperative to the performance of DOEA's statutorily assigned duties. The Department is collecting your social responsibility to provide Emergency Home Energy Assistance. Packet Pg. 1 530 DOEA Form 114 Emergency Home Energy Assistance for the Elderly Program CARES Act - Eligibility Works 16.D.2.c Section Six: Income Eligibility Determination Annualize all household income. Staple calculator tape here showing income calculations or write calculations in this space. Poverty Guidelines effective 07/01/2020. 1. Add all gross monthly earned and Select the annual income limit by household size: unearned income from the past 30 150% of Poverty 50% of Poverty days of all household members. ❑ 1..........$19,140 $ 6,380 2. Add Medicare Premium ($148.50), ❑ 2.......... $25,860 $ 8,620 if not included in SSA amount. ❑ 3.......... $32,580 $10,860 ❑ 4..........$39,300 $13,100 ❑ 5.......... $46,020 $15,340 3. Add Medicare Part D, if applicable. 4. To annualize, multiply the monthly total by 12 months. ❑ 6.......... $52,740 $17,580 ❑ 7..........$59,460 $19,820 Annual Household Income ❑ 8.......... $66,180 $22,060 (Add $6,720 for each additional member of family $ unit with more than 8 members.) If the total annual household income is less than 50% of the current Federal Poverty Guidelines for household size c ❑ Categorically Eligible (using chart above), and no one in the household is receiving SNAP assistance, the applicant must provide a signed o statement of how basic living expenses (i.e., food, shelter and transportation) are provided for the household. N SectionVendor,. Verification Informationo N Energv Vendor #1 Other Vendor #1 Contact made with LIHEAP provider to verify41 Name: Name: previous crisis assistance. Contact Person: Account/Voucher Account Number: Number: Date: Date of contact: Has the applicant received LIHEAP crisis Q assistance under the CARES Act Contract? d Minimum Amount Due: Amount Due: ❑Yes ❑ No W Verification and Commitment ❑ Blanket ❑ Repair Existing Heating p 9 9 = W ❑ Portable Fan or Cooling Equipment If the minimum amount due is more than Contact Person: ❑ Space Heater ❑ Emergency Shelter P the past due amount, did the energy V o Date: ❑ Window A/C ❑ Other vendor verify that this amount is required? ❑ Yes ❑ No ❑ N/A Energy Vendor #2 Other Vendor #2 Name: Name: N c N Account/Voucher LO o Account Number: Number: Date: If the minimum amount due to resolve the W crisis is more than the maximum allowed Q Minimum Amount Due: Amount Due: ($3,500), explain how the balance of the J amount due will be paid if approved for EHEAP crisis assistance. w Verification and Commitment ❑ Blanket ❑ Repair Existing Heating ❑ Portable Fan or Cooling Equipment W Contact Person: ❑ Space Heater ❑ Emergency Shelter Q U Date: ❑ Window A/C ❑ Other (1) Total Energy Vendors $ (4) Total Other Vendors $ Is the name on the fuel bill that of the applicants? a W W (2) Energy Subsidy $ Total EHEAP Benefit Add $ 1-1YesEl No If no, provide name on bill: N (3) Water, Sewer, Garbage, $ Fire etc. Total Energy Vendor (4) & Total Other Vendor (4) j,L .... (4) Deduct (2&3) from (1) $ r N Section• • •• p N If the applicant is a homeowner, has he/she received more than three LIHEAP or EHEAP benefits in the last 18 months? I r ❑ Yes ❑ No ❑ N/A NI uO 0 If the answer to the previous question is "yes", was the applicant referred to WAP? ❑ Yes ❑ No ❑ N/A Z O If the answer to the last question is "no", explain: Q Section Nine: Resolution of Crisis V J Resolution of the Energy Crisis occurred within 18/48 hours, by the following eligible action(s): (Select all that apply) d Q ❑ Approval of application ❑ EHEAP CARES Act benefit prevented disconnection El Commitment made to vendor ❑ EHEAP CARES Act benefit restored energy already c E disconnected t ❑ Denial of Application, pending additional information ❑ Yes, client signed waiver a ❑ Denial of Application, ineligible ❑ No, client refused to sign waiver ❑ Written referral and assistance to access other community resources Worker Signature I have determined the eli-gibility of the applicant. I friend, I am not the the ApprovalCase The application and eligibility and appropriate file documentation prior to making payment. I have applicant, nor am a relative, or employee of applicant. Case Worker's Name: reviewed and approved this application for crisis assistance. Supervisor/Peer's Name: Case Worker's Signature: Supervisor/Peer's Signature: Date: Date: Agency Name: Agency Name: Packet Pg. 1531 DOEA Form 114- 5/21/2021 Im 16. D.2.d RESOLUTION NO. 2018- 2 0 2 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, REPEALING AND SUPERSEDING RESOLUTION NO. 96-268 and 10-122 AND AUTHORIZING THE COUNTY MANAGER OR HIS/HER DESIGNEE TO EXECUTE CERTAIN STANDARD SOCIALISENIOR SERVICES GRANT APPLICATIONS AND CONTRACT DOCUMENTS INCLUDING AMENDMENTS IN COMPLIANCE WITH CMA #5330, GRANT COORDINATION. WHEREAS, the Board of County Commissioners (Board) has the authority to apply for and receive social/senior services grants including the Older American's Act Program (OAA), Community Care for the Elderly Program (CCE), Alzheimer's Disease Initiative Program (ADI), Medicaid Waiver Agreement, the Home Care for the Elderly program (HCE), and USDA Nutritional Supplement Incentive Program, and Emergency Home Energy Assistance Program (EHEAP); and WHEREAS, in order for Collier County's social/senior services grant documents to be submitted in a timely fashion, the Board adopted Resolution No. 96-268 and 10-122 authorizing the County Manager or his/her designee to execute the required standard grant documents; and WHEREAS, Collier County CMA 95330, Grant Coordination, provides authorization for the County Manager or his/her designee to execute certain grant documents and return to the Board of County Commissioners for after -the -fact approval; and WHEREAS, the Board wishes to delegate signature authorization to the County Manager or his/her designee for the above -referenced social/senior services grant programs and as it relates to grant applications, standard contract documents, and major and minor amendments provided that said submissions and contracts require no additional Collier County matching funds. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that the County Manager or his/her designee is hereby authorized to execute grant applications, standard contract documents, and "IN Packet Pg. 1532 16. D.2.d amendments in compliance with CMA H5330, Grant Coordination, for the Older American's Act Program (OAA), Community Care for the Elderly Program (CCE), Alzheimer's Disease .Initiative Program (ADI), Medicaid Waiver Agreement, the Horne Care for the Elderly program (HCE), and USDA Nutritional Supplement Incentive Program, Emergency Home Energy Assistance Program (EHEAP) provided said -submissions and contracts require no additional Collier County matching funds. BE IT FURTHER RESOLVED that this Resolution repeals and supersedes Resolution No. 96-268 and No.10-122. THIS RESOLUTION ADOPTED after motion, second, and majority vote favoring same this j-1 day of J . , -Y , 2018. ATTEST: CRYSTAL K. KiNZEL CLERK :s s By: By: 'A eSt as tp (;€t�PK%gTY CLERK signature only, Approval for form and legality: 3ennl r A. Belpedio Assistant County Attorney tiO 2 Packet Pg. 1533 April I, 2021 — September 2023 EHEAP 203,21 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: 1. 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 documents) shall prevail over inconsistent provisions in the proposal(s) or other general materials not specific to this contract document and identified attachments. 3► 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 (1 1:59) 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(I)(g), Florida Statutes (f .S.), the Agency may renew the contact for a period not to exceed three years, or the term of the original contact, 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 ►yith Federal La► - 6.1 If this contract contains federal fiends 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 CPR 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 April 1, 2021 — September 2023 EHFAP 203.21 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 not, any agent acting on behalf of the Contractor, may not use any federal finds 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 tine 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 525,000.00 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 repotting 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 170.1 10(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 terns. Contractors meeting the terns 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. 2 April 1, 2021 — September 2023 EHEAP 203.21 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. 7.3.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in ATTACHMENT 1 to 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 1, Section 1I1. 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. 7.3.5 If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit invoices for any travel expenses in accordance with Section 1 12.061, F.S., or at such lower rates as may be provided in this Contract. 7.3.6 The Contractor shall allow public access to all documents, papers, letters, or other public records as defined in Section 119.01 1(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), VS., 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, S. Bnckground Screenin : 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 deraffairs.state.fl.us/doca/backgrounclscreeni 11g.P11P. 9. Grievance Procedures: The Contractor steal I 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). 3 April I, 2021 — September 2023 10. Public Records and Retention: E1 iEAP 203.21 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 fi-om 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. 10.1A 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 confidential 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 I t9.07(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, Inca 2830 Winkler Ave, Suite 112 Fort Myers, FL 33916 239-652-6900 or 866-413-5337 103 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, InvestijZations: 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 4 April 1, 2021 — September 2023 EHEAP 203.21 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 daring 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 contacts 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 contact 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 contact 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. 12,4If this contact 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, 136 Monitoring by the Apen The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records, papers, documents, facilities, goods, and serviees 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 Contactor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determined April 1, 2021 — September 2023 EHEAP 203.21 by the Contract Manager. 14. Provision of Services: The Contractor shall provide services in the manner described in ATTACHMENT 1. 1S New Contract(s) Reportinr?: 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. 1(i 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 contacts 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 lull responsibility for identifying and determining the type(s) and extent of liabifity 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 contact, the Contactor shall maintain an insurance bond from a responsible commercial insurance company covering ail 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. 1a Confidentiality of Information: The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any purpose prohi bited 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). 2a incident Reporting: 2tll The Contactor shall notify the Agency inmiediately 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 contact. Such notice shall be made orally to the Agency's Contract Manager (by telephone) with an email to immediately follow. 2Q2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation April 1, 2021 — September 2023 EHEAP 203.21 of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number (1-800-96ASUSE). As requited 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,; (I) 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 Public 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. 21 Assignments: 2AI The Contractor shall not assign the rights and responsibilities under this contract without the prior written approval of the Agency. Any 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. 232. The State of Florida, is at all tinies, 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 sliall remain binding upon the successors in interest of the Contractor and the Agency. m Subcontracts: 241 The Contractor is responsible for all work performer{ 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. 242 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. 23 Independent Capacity of Contt'aCtor: 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 shal I 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 Parries 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 April 1, 2021 — September 2023 EHEAP 203.21 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. 2fi Payment: Payments shall be made to the Contractor for all completed and approved deliverables (uni(s of service) as defined in ATTACHMENT 1, 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 500-342-2762. 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. 29 Data Intearity and SafejZuarding 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. Tire 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. 2% 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; hitpalelcleraffairs.state.fl,us/doea/linancial.ultlz• 30t 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 panties 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 Apri 1 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 clays 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. 31. 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 Nvith 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. 3Z Purchasing 37.1 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 CONTRACT 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 deiiveiy 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 April 1, 2021 — September 2023 EHEAP 203.21 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:Hpride-enterprises.org/. 33 Patents, Conyriehts, 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. 33I 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. 3M If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR § 200.315 or 45 CFR § 75,322, as applicable. 33.3 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, frilly -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: 3411 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 Nvelfare, 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. -49 Equipment: M1 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, 4vith a value or cost of $250.00 or more [for state fiends]. 352 Contractors and Subcontractors Nvho are Institutions of Higher Education, Hospitals, and Other Non -Profit Organizations shall have written property management standards in compliance with 2 CFR Part 200 Administrative Requirements (formerly OMB Circular A-110) that include: (a) a property list %vith 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 shatt provide the results of the investigation to the Agency's Contract Manager. full April t, 2021 — September 2023 EHEAP 203.21 353 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 burnished 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 if 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 rvitli 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 Avith 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 (lie Agency's Contract Manager. The request should include a brief description of the property, purchase price, binding 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 [lie 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 I April 1, 2021 — September 2023 EHEAP 203.21 purchases front Older Americans Act funds are subject to the provisions of Title 42, Chapter 35, Subchapter III, Pant 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 agreennent(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, soil ware, services, supplies, maintenance, training, persorunel, 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: htt );//%v ww.nnvflorida .com!a _ ts,'vbsr'aduc/F7710 PUR 1000. tdf 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 I000 Form are required by any section of the Florida Statutes, the terms or conditions contained in the PUR 1000 Form shall take precedence. 37. Use of State Funds to Purchase or Improve Real Pro ert 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 fi-om 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 inununity 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 Majeure: 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. 12 April I, 2021 — September 2023 44. Severability Clause: EHEAP 203.21 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 Bill 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 payinent 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 (1) issue a notice authorizing resumption of work, at which time activity sliall 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 far• Convenience. Tile 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. 13 April I, 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, alter 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 anti Signnture: 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 14 April 1, 2021 — September 2023 55. Oftielal Pnyee and Representatives (Nantes, Addresses, and Telephone Numbers): EHEAP203.21 The Contractor name, as shown on page I of this Collier County Board of County Commissioners a. contract, and mailing address of the official payee to 3339 E 'Cainiami Trail, Building H whom the payment shall be (Wade is; Naples, FL 34112 The name of the contact person and street address Kiisti Sonntag, Director b. where financial and administrative records are Collier County Board of County Commissioners maintained is: %Community and Human Services 3339 E Tautiami 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 of the program under this contract is: %Community and Human Services 3339 E Tamianri Trail, Building I{ 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 Cocchieri, 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 Merlcela Morado,Direclorof Program & Planning e. Contract Manager for this contract is: Area Agency on Aging for Soullrwest Florida, luc. 2830 Winkler Ave., Suite 112 Fort Myers, FL 33916 239-652-6900 Upon change of representatives (names, addresses, and tc ephotte numbers) Ey either party, notice shall be provided it writing to the other party. 56. All 'I'crnrs and Conditions Included: 11ris contract and its ATTACHMENTS I -XXIV including any exhibits referenced in said attachments, together with any documents incorporated by reference, contain nil (lie terms mid conditions agreed upon by the Pniiics. There nre no provisions, terms, conditions, or obligations other thmi those contained herein, and this contract shalt supersede all previous communications, representations or agreements, either written or verbal between the Parties. By signing this contract, the Parties agree that they have rend and agree to the entire contract. iN 1V1TNFSS, THEREOF, the Parties Itercto have caused this contract to be executed by their imdea•signed ofAeials as duly authorized. CONT[LtCTUIi: SIOLLIE, R COU Y dARD AREA AGENCY ON AGING FOR SOUTHWEST OIr COUNT OMMISSI FLORIDA, INC. SIGNED BY: SIGNED 13Y: NAME; Daniel R Rodr' ez NAME: NORMA ADORNO TITLE: Public Service Department Head DATE: 05/ l3 /2021 Federal Tax iD: 59.6000558 Fiscal Year Ending Date: 09/30 DUNS: 076997790 TITLE: CEO DATE; 15 C.dd J Approved as to form and legality tlai of County Attur April 1, 2021 — September 2023 EHEAP 203,21 INDEX OF ATTACHMENTS ATTACHMENT I STATEMENTOF WORK....................................................................................................... 17 ATTACHMENT 11 FINANCIAL AND COMPLIANCE AUDIT, Exhibit i and Exhibit 2....................................................41 ATTAC14MENT 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 BUDGETSUMMARY............................................................................................................................................ 58 ATTACHMENT X EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL .............................................. 59 ATTACHMENT XI RECEIPTS AND EXPENDITURE REPORT......................................................................................................... 60 ATTACHMENT XII REQUESTFOR PAYMENT................................................................................................................................... 61 ATTACHMENT XIII INVOICE REPORT SCHEDULE...........................................................................................................................62 ATTACHMENT XIV POVERTYINCOME GUIDELINES...................................................................................................................... 63 ATTACHMENT XV LIHEAPPAYMENT MATRIX..............................................................................................................................64 ATTACHMENT XVI SOURCESOF INCOME ............. .......................................................................... ............................... I.................. 65 ATTACHMENT XVI11 EHEAP APPLICATION AND ELIGIBILITY WORKSHEET..............................................................................66 AT'I'ACHMENT XIX EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS.......................................................................... 68 ATTACHMENT XX EHEAP CLIENT FILE CONTENT CHECKLIST..................................................................................................71 ATTACHMENT XXI EHEAP COST REIMBURSEMENT SUMMARY .......... ....................................................................................... 72 ATTACHMENT XXII COST ALLOCATION PLAN.................................................................................................................................73 ATTACHMENT XXIII SERVICERATE REPORT..................................................................................................................................... 76 ATTACHMENT XXIV OUTREACHPLAN SURVEY................................................................................................................................77 [no April 1, 2021 — September 2023 ATTACHMENT I STATEMENT OF WORK I. SERVICES TO BE PROVIDED A. DEFINITION OF TERMS EHEAP 203,21 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 he changed, If an elder cannot write their signature on the appl ication, 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 Department's Client information and Registration Tracking System (CIRTS). This date shall not be changed. 21. 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 horn' 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. 17 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 cider'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 EFMAP 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 «olio 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. 17.1ntake Worker — Person who accepts the EHEAP application and required documentation and may bave 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 [lie 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. 'fire 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. 18 April I, 2021 — September 2023 B. GENERAL DESCRIPTION 1. General Statement EHEAP 203.21 The Emergency Honie 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.; h. 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 I 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 be 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 1, Section H: 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. z April 1, 2021 — September 2023 4. Major Program Goals EHEAP 203.21 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 Cliarges 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; (S) 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. P April 1, 2021 -- September 2023 C. CLIENTS TO BE SERVED 1. General Description EHEAP 203,21 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; e. 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 1,C,3,d, below, or be determined categorically eligible to receive EHEAP 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 L Legally reside in the State of Florida. 3. Client Determination Contractor shall begin taking applications for EHEAP 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 oft -ace, 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 X1V), 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. 21 April I, 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; IL Ensure elders receive no more than one approved crisis assistance benefit during the cooling season, April I September 30, and one approved crisis assistance benefit during the heating season, October I — March 3 I. 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 (H)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. 11. MANNER OF SERVICE PROVISION A. SERVICE TASKS In order to achieve the goals of EHEAP, the Contractor shall ensure the following tasks are performed. 22 April 1, 2021— September 2023 EHEAP 203.21 1. Ensure that all eligible elders meet the requirements of Section I.C.2, of this contract; 2 Ensure that all energy assistance payments made to home energy vendors comply with the requirements of Section ILA,14A, 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: n. 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 snider which the elder may reapply; h. Information or documentation needed for the elder to reapply; L The name, address, and phone number applicable to the appeal process; and j. Number of days the elder has to file the appeal, 0. 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 (10) working days of receipt of the written Notice of Denial and Appeal. a. Upon receipt of a validly Fled 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; 23 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 EF-IEAP 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#071113-1-1-SWCBS, littp:Heldci-affairs.state.n.us/doca/iioticeslJtily 13/L1I-IEAP%20Notice%20rc%2OSocial%20Securit %20 Numbers?%20Final.)dfl. 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 EHEAP 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: O. 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 at) existing, MOU with the Weat herizatio n 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 24 April 1, 2021 — September 2023 EHEAP 203.21 benefits in the last eighteen (18) months and who are homeowners are referred to a WAP 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, RHEAP 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 elders 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; (11)The Contractor's commitment to make payment to the ]tome energy vendor within forty-five (45) days of the date of crisis resolution; (12)Assurance from the hone 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 (Iitt ://cld]erafrairs.state.fl.us/dOea/noticies/se t1S/Authorization for Release client0*20waiver 8%2020%2U15.pdI) for EHEAP Data from each eligible elder and ensure the signed releases are available for inspection by the home energy vendor; 25 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: (lttt )://suiibiz.orQ/sent,ch.html) and the vendor's name must be checked on Excluded Parties List System (EPLS) (littps://wwNv.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 HHHAP services and other non-EHEAP energy assistance resources in the service area, the Contractor may lituit crisis benefits to less than those stated in Section 1.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 (Avww.dnb.com) and maintaining an active and current profile in the System for Award Management (SAM) (ht#ps://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 service provider performs any service required under this contract and is paid for providing specific services without a direct pass -through of federal funds. RM April 1, 2021 — September 2023 EHEAP 203.21 'File 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. It. 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-ri-ce telephone number, and normal business hours in available forms of media (i.e. newspapers, radio, television, website, publications, etc.) 27 April 1, 2021 — September 2023 D. DELIVERABLES 1. Deliverables EHEAP 203.21 i. Certification that the Contractor must operate during its regular business hours, as identified in Section II.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 LA.18. 2. Source Doeumentation 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 cornnurnity resources for energy assistance; a summary of funds expended per county for the reporting month using the EHEAP Cost Reimbursement Summary form (ATTACHMENT XXI); and the certification required in Section 11, D.1, 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. (I)Ifthe 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). h. The elder's name, address, sex, and age; c. Names, ages and current identification documentation (no more than one year expired) of all lousehold 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 9071113-1-I- S WCBS, litt)://cl(leraffiirs.st,ite.fl.tis/doeaitiotices/Jul 13/LIHF-AP°n20Notice°,u2Ot-o%20Sooiat °020 Seo unity%20Num bers`%620Fi nal . i)d O-, 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 fitly 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 meteMampering and returned checks; and other charges that are not energy -related and are not required for cooling/heating the household. 28 April I, 2021 --- September 2023 EHEAP 203.21 (2) Use of the most current utility bill(s), which provides the vendor's narne 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 Vlll). lc. 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; in, 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 loosing; 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 ina. 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 91" 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 fiends 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 liours, the liourly wage, and the estimated salary to be paid by EHEAP. 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 mast be supported by the submitted cost allocation plan. c. EHEAP 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 EFIEAP administratively. For each individual on the list, the Contractor must 29 April I, 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. 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 [I -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. L Monthly Client Service Report For the term of this agreement, each month the Contractor shall provide the E14EAAP Contract Manager, on the 9111 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 9"' of each month along with the county's monthly billing. The EHEAP Outreach Activity Report shall consist of the following: (I)Date; (2)County: (3)Location Address (4)Description of Activity; and (5)Narne and Position of Staff It. 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 the 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 surphrs/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 30 April I, 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--06/30/2l 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 S 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. n. 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 31 April 1, 2021 — September 2023 EHEAP 203.21 performance of this contract. e. 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 SFYIFFY 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 XVH). 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 911of each month for the preceding month, the following information will be entered on ATTACHMENT XII, Request for Payment, under Part D: Service Information 0) The total number of individuals served with crisis assistance for the reporting month; (ji) 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 minimtan 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. .t. Contractor shall ensure that each city within their service area rt'eceives a minimum level of crisis services monthly, as delineated in Section I.A.18.; V. EHEAP funded staff shall make themselves available in all underserved counties as needed, to ensure 32 April 1, 2021 — September 2023 that the minitnum level of service is met; and EHEAP 203.21 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. S. Develop adequate procedures to ensure E14EAP 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 finds 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 an([ 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; e. 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; 33 April 1, 2021 — September 2023 EHEAP 203.21 It. Policies regarding the detection and prevention of fraud and abuse of program funds. At a minimum, the policy Nvill 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. Custody of assets Record keeping Authorization 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. 1r. 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"; in. 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; 34 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 hoine-hound elders for completion of the program application or eligibility determination when other assistance is not available, that at a minimum, includes: L Designation of appropriate staff to conduct Imome visits; ii. Applicant and staff safety and security precautions; W. Confidentiality; iv, Means to collect required documentation; v. Safeguarding Applicant informationl 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 flocs 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 XTI). 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. 2 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. 35 April I, 2021 -- September 2023 Ill. METHOD OF PAYMENT A, PAYMENT METHOD USED EHEAP 203.21 The Method of Payment for this contract is a combi nation of cost reimbursement and advance payments, subject to the availability of finds and Contractor performance. The Agency will pay the Contractor upon satisfactory completion of the Tasks/Deliverables, as specified in Section 11, Manner of Service Provision, and in accordance with other terns and conditions of this contract. L 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 front 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 1511' 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 Contactor or the Agency finds that the budgeted amount of Weather Rclated/Supply Shortage emergency assistance funds is not sufficient to meet the emergency, Contactor 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 15, if no emergency has been declared, the Agency will release the funds and Contactor shal I al locate these funds to the crisis category of the program. 36 April 1, 2021 — September 2023 c. Indirect Cost Rate EHEAP 203,21 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 fi-om the Agency. The Contractor shall submit to the Agency documentation to support full distribution of advance finds with report number 5, due to the Agency on the 911 of the 51' month upon execution of contract, in accordance with the Invoice Report Schedule, (ATTACHMENT XII1), to this contract. h. All advance funds requested for the Contractor must be ftrliy 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 oil 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 X11I 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 out the invoice. The form and substance of each invoice submitted by Contractor shall be as follows; 37 April I, 2021 — September 2023 EHEAP 203.21 1. 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; e. The number of individuals referred to other community resources for energy assistance during the reporting month; Z 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. 2 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 shal l 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, * 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 fiends. 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 38 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 perforated pursuant to contract requirements, and as described in Section II,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 I I`r' 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 4vithin the approved time period specified in the CAP, the Agency shall deduct, from the payment for the invoice of the following month, ] %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, sighed 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 ( I ) Administrative, (2) Outreach, and (3) Crisis Assistance. C. Enfoi•centent L 1n 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; h. The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual fiends have been misappropriated; C. The Contractor has committed multiple or repeated violations of legal and regulatory requirements or Agency and/or Department standards; 39 April I, 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; C. 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 OFATTACHMENT 40 April 1, 2021 — September 2023 ATTACHMENT I1 FINANCIAL AND COMPLIANCE AUDIT EHEAP 203.21 `file 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 a n d/o r 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 1: 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 Pall 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. F i n a n c i a l a n d C o m p l i a n c e A u d i t A T T A C H M E N T 11, 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 1, paragraph 1, the Contractor shall ftilfill 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 CPR 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 organ ization'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 arnount 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 41 April I, 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. A T T A C H M E N T 11, 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 If, 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 fnanciai 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 frilly disclosed in the audit report with reference to file Agency contract involved. If not otherwise disclosed as required by Rule 691-5.003, 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 contact 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 Pail 200 and required by Pail I of this Financial Compliance Audit Attachment, shall be submitted, when required by 2 CFR § 200,512 by or on behalf of (lie Contractor directly to each of the following: Federal Audit Clearinghouse Bureau of the Census 1201 East 10"' 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: Aren Agency on Aging for Southwest Florida, Inc. Attn: Richard Cocchieri, Fiscal Director 2830 Winkler Ave, Suite 112 Fort Myers, FL 33916 42 April I, 2021 — September 2023 EHEAP 203.21 Additionally, copies of financial reporting packages required by PART It 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, orother 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, shouid indicate the date that the reporting package was delivered to the Contractor in correspondence accompanying the reporting package. PART IV: RECORD RETENT10N 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. 43 April 1, 2021 — September 2023 EHEAP 203,21 ATTACHMENT II -EXHIBIT 1 PART I; AUDIT RELATIONSHIP DETERMINATION Contractors who receive state or fcderal 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 (lie audit requirements if the audit threshold requirements set forth in Part I and/or Part 11 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 CPR 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 691-5006, 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 wi(b 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 CPR § 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 44 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. Deparlment 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 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 45 April 1, 2021 — September 2023 FUNDING SUMMARY EHEAP 203.21 ATTACHMENT H—EXHIBIT 2 lnte: Title 2 CFR, as revised, and Section 215.97, F.S., require that the information about Federal Programs and State Projects included in ATTACHMENT H—EXHIBIT 1, 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 CONc1cT OF THR FOLLOWING! RANT AWARD (FAIN#): 2002FLLIEA FEDERAL AWARD DATE: 10/01/2019 DUNS NUMBER: 076997790 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Emergency Home Energy Assistance for the Elderly Progratn United States Department of Health and 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: [ATCHING RESOURCES FOR FEDERAL PROGRAMS PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL STATE AWARD FATE VINAlNC:IAL ANNISTA[NCE SUBJEU I I U NEC 1 lU[N Lln.V /, 14.N. I PROGRAM TITLE I FUNDING SOURCE I CSFA I AMOUNT AL 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 UP A. B. April 1, 2021 — September 2023 ATTACHMENT III CERTIFICATIONS AND ASSURANCES EHEAP 203.21 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. DebRi-ment and.5usRensionCertification' CFR Pail 95 and: Part 751 C. Nondiscrimination & E qual Qj)UQLjunitv Assurance, 45 CFR Part :I D. Certification Regarding Public Entity Cl-hues, Section 287,133, F.S. E. Association af Commun6jX OiXalliZILlions for Reform Now (ACORN) Funding Restrictions Assurance (Pub, L. 111-1171 F. Scrutinized Comoardes Lists n, .o Boycott of Israel Certification. Section G. Certification Regarding Data Integrity C.om lianee for Contracts. Grants. Loans. and Coonerative Anreements H. Verification of Emoloynrent Status Certification I. Records and Documentation J. Certification Regrading in5pecl'on of Public Records 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 ova criminal offense in connection withobtaining, attemptingto 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 certiPrcation; 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. 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 47 Apri 1 1, 2021 — September 2023 EHEAP 203.21 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 ofeither 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 orpursuant 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 suhjected 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 Slates 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 1— 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 DOER 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. 48 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 convieted of Public Entity Crime as defined in Section 287.I33, F.S„ nor placed on the Convieted 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 C O M M U N I T Y 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. III-H7). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L. 111417 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 I. 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 property. 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, soilware, 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 some 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. 49 April I, 2021 —September 2023 H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION EHEAP 203.21 As a condition of contracting with the Agency, Contractor certifies the use of (lie U.S. Departnreiht of Homeland Sec►u•ily's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment dirties 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 ellgibilily of all new employees hired by file Subcontractor during (lie 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 Circutar A-110). 1. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all colrtact 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 fire 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 Depatime rt and state agencies or sub divisions defined in section 768.28(2), F.S. 2. Section 119.01(3), F.S., states if public fiords 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 (Aron Agency on Aging for Southwest Florida, hie.) are public records. Section 119.07, F.S, states that every person who has custody of such a public record shall pernilt the record to be inspected and copied by any person desiring to do so, under reasonable clrcumstances. Additionally, I certify this organization does--X_does not— provide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by file 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 sigtrjhg-KeeToxv, Contractor certifies t]I representations ou idd' in parts A through J above are true and correct. j �� 3339 Tatniami Tail C, Suite 211 aniel R Rodrigt , tt ervice Department Hen( Street Address Collier County Board of County Commissioners Naples, FL 34112 Contractor Date I City, State, Lip code 50 April 1, 2021 — September 2023 ATTACHMENT IV ASSURANCES —NON -CONSTRUCTION PROGRAMS EHEAP 203.21 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 bave 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 fi-om using their positions for a purpose that constitutes or presents the appearance or, personal or organizational conflict of interest or personal gain. 4 Will initiate and complete the work within the applicable time frame alter receipt of approval of the awarding agency. a 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 VI11 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 0) 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 asaresultof Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases. 51 April I, 2021 — September 2023 EHEAP 203.21 8 Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §§ 1501-1508 and §§ 7324-7328), which limlt the political activities of employees whose principal employment activities are funded in whole or In part with federal funds. St 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 !-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 111e 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 (1 G 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 assuringcompliance 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 (1 G U.S.C. § 469a- I et seq.). 14. Will comply with P.L. 93-348 regarding the protection of 11lnla11 subjects Involved In mscarch, 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. 1 & Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. § 4901 et seq.), which prohibits tlic 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. I& Will comply with all applicable requirements of all other federal laws, executive orders, regulations, and policies governingthis nr02r•anl. SIGNATURE OF AUTHORIZED CERT.IFI'ANG,0FEICIAL, Daniel R Rodriguez IPublic Service Department Head APPLICANT ORGANIZATION i)ATE SUBMITTED Collier County Board of County Coin inissioners =Count nitality 52 e April I, 2021 — September 2023 EHEAP 203.21 ATTACHMENT V FI.nR1nA 11PPARTMRNTOP G_IMIRM AFFATRC CIVII, RiC:HTN CnMP111ANCE CHECKLIST Prog arnlFacility Name County AAA/Contractor Address Completed By City, State, Zip Code Date Telephone PART 1: 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: For questions 2-5 please indicate the follow 2. Population of area served 3. Staff currently employed 4. Clients currently enrolled/registered S. Advisory/GovermingBoard it'applicable ing: Total# % White 0/0% Black Hispanic CIO Other % Female CIO Disabled D�O Overdo Source of data; Effective Effective date: PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO, EXPLAIN, G. Is an Assurance of Compliance on file with DOER? NIA YES NO ❑ ❑ ❑ 7. Compare the staff composition to the population. Is staff representative of the population? NIA YES NO ❑ ❑ ❑ 8. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national origin, sex, age, NIA YES NO religion or disability? ❑ ❑ ❑ 9. Are all benefits, services and facilities available to applicants and parlicipants in an equally effective manner regardless of NIA YES NO race, sex, color, age, national origin, religion or disability? ❑ ❑ ❑ 10, For in -patient services, are roost assignments made without regard to race, color, national origin or disability? NIA YES NO ❑ ❑ ❑ NIA YES NO 11. Is the prograin/facility program/facilityaccessible to non-English seakin clients? 1:1 El El NIA YES NO ❑ ❑ ❑ 12 Are employees, applicants and partici ants informed oftlteir protection against discrimination? IfYES, how? `Verbal El Nritten ❑ Poster 53 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 NIA NUMBER prograni/facility. 14. Is the progranrlfacilily physically accessible to mobility, hearing, and sight -impaired individuals? NIA YES NO ❑ ❑ ❑ PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRANIS 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 acid to make any necessary YES NO modifications? ❑ ❑ 16. Is there an established grievance procedure that incorporates due process in the resolution ofcomplaints? 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 ofnondiscrimination on the basis of YES NO disability? El 0 19. Are auxiliary aids available to ensure accessibility ofservices to hearing and sight -impaired individuals? YES NO ❑ ❑ PART IV: FOR PROGRAMS OR FACILITIES IVITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF S50,000.00 OR MORE. 20. Do you have a written affirmative action plan? If NO, explain. YES NO ❑ ❑ Reviewed by hI Compliance: YES Ll NO Program Office 'Notice of Correct iveA Action Sent Date Telephone Response Due On -Site Desk ReviewEl Response Received 54 April 1, 2021 —September 2023 EHEAP 203.21 INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECItLIST 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 thew 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 ofrecord 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 he 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. 445 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 he 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, 55 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 CPR § 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 set -vice 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 550,000.00 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. 56 April 1, 2021 — September 2023 111 Pu Im nt of ELDER AFFAIRS 6'I'>1T1, OF FLORIDA ATTACHMENT V11 BACKGROUNDSCREENING BACKGROUNDSCREENING Attestation of Compliance -Employer EHEAP 203.21 AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. Roil Desalirts Richard 1'rtu�out 9 The term "employee" 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 hits volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat. 9 A direct service provider is "a person 18 years of age orolder 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 located Employer Name Street Address City State ZIP code hereby affirm under penalty of Nance of Representative perjury that the above -named employer is in compliance with the provisions of Chapter 435 and sect ion430,0402, Florida Statutes, regarding level 2 background screening. Signature of Representative Dale DDEA Fornr 235. Attestation of Coinpliance - Employer, EJ(fective January 19, 1011 Section 433.05(3), F.S. Forut available at l�tty://eldernllairss�are jl.rls/etr�lish/backgrormdscreenrnQ.plrp 57 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. 58 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 & Outreach Expense Budget Detail ADD ADDITIONAL- Ll lit T21 S0.00 JR00 WOO $0.00 $0.00 SO.00 MOO S0,00 50.00 SOM $0.00 S0.00 S0.00 50.00 S0,00 S0,00 WOO tkdministradoal Subtotal $ - Outreach Subtotal S 'rotal $ 59 April 1, 2021 -September 2023 ATTACHMENT X1 EHEAP 203.21 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 Budg 1. Agreement Amount $0.00 $0.00 $0.00 #DIV101 2. Interest on Agreement Funds $0.00 $0.00 $0.00 0.00% 3. TOTAL AGREEMENT AMOUNT $0.00 $0.00 $0.00 #DIVIO! PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of Budget For This Report Year to Date Approved Budg 1. Administration $ - $0.00 $0.00 #DIV101 2. Outreach $ $0.00 $0.00 #DIV10I 3. Crisis Services $ $0.00 $0.00 #DIVIO! 4. Weather Related Services $ $0.00 $0.00 #DIV101 5. Weather Related Administration $ - $0.00 $0.00 0.00% G. TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIVI01 DOEA FORM 105p revised 12108 60 April 1, 2021 - September 2023 ATTACHMENT X1I EHEAP 203.21 REQUEST FOR PAYMENT REQUEST FOR PAYMENT EMERGENCY HOME ENERGY ASSISTANCE PROGRAM Contract# HPOiS CONTRACTOR NAME, ADDRESS, PHONE# and FEID4 TYPE OF REPORT: Request Period PSA # 8 Advanco Request Report# _ Contract # --- HP019 Reimbursement Request X Contract Pcrfod 10101119.09130120 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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 1, Approved Contract Amount 2. Previous Funds Reaclved for $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Contract Period 3. Centfact Balance (line 1 minus lira 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 S. Contract Balance (line 3 minus fine 4) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 PART B: CONTRACT FUNDS REQUEST 1. Anticipated Cash Needs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 {1st - 2nd month, Attach Justification) 2. Net ExpendAures For Month $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 (DOEA Form 105P, Part B, Line 6) 3, TOTAL $0.00 $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 Pali C. Line 1) PARTD: SERVICE INFORMATION Number of individuals (units) served with crisis energy assistance during the report month: 0 Number of individuals ineligible ordanled assistance during The report month. 0 Number of individuals served by referral to other community resources for energy during the report month. 0 Certification statement: Contractor hereby certifies tirat 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 FORfd 106P reused 4161V 61 April 1, 2021 September 2023 ATTACHMENT XIII EHEAP 203.21 INVOICE REPORT SCHEDULE Report Number Based Upon Date Due to the Agency I 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 2t 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 Eased 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 arnount, 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 9"' of each month. IF the 9" falls on a Saturday, then the report will be due by the 8"' by 12:00 p.m. AND IF the 91h falls on a Sunday, the report will be due by the 1011' 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 April I, 2021 — September 2023 ATTACHMENT XIV FLORIDA DEPARTMENTof ECONOMIC OPPORTUNITY EHFAP 203.21 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 $595460 8 $66,180 For each additional person in the household with more than 8 people, add: $ 6,720 *These figuresare based can the 2020 U.S. Department of Health and Human Services (HHS) poverty gtudelines published in the Federal Re 17, 2020. 63 April 1, 2021 - September 2023 ATTACHMENTXV LIHEAP PAYMENT MATRIX EHEAP 203.21 LOW-IIJCOME HOME EIJERGY ASSISTANCE PROGRAM PAYMENT MATRIX - FY 2020 HOME ENERGYBENEFJTS- ANO POVERTY LEVELS BY HOUSEHOLD SIZE AND INCOME HOUSEHOLD INCOME IN DOLLARS PER YEAR NUMBER OF 504d of Poverty Over 50% of Poverty At least 75 i but no Over100»S but no more Over 125% but no more PEOPLE IN or Less but Less than 75% more than 100% than 125% Poverty than 150% Poverty Poverty HOUSEHOLD At or Below Annual Income at Least but No Greater Than 1 56,3w0 56,381 S9,569 59,570 512,760 S12,761 S15,950 S15,951 S19,140 2 5E,620 58,621 512,929 S12,930 $17,240 S17,241 521,550 $21,551 S25,860 3 $10,860 S10,861 $16,289 516,290 521,720 521,721 S27,150 S27,151 $32,5°A d 513,100 513,101 $19,649 519,650 $26,200 S26,201 532,750 532,751 S39,300 S $15,340 515,341 523,009 S23,010 S30,6SO S30,681 538,350 S3S,351 546,020 6 S17,5S0 S17,581 $26,369 526,370 535,160 535,161 $43,950 $43,951 552,740 7 519,820 S19,821 529,729 S29,730 539,640 $39,641 'S49,550 $49,551 S59,460 8 S22,060 S22,061 533,089 $33,090 S44,120 544,121 555,150 $5S,151 566,1E0 9 S24,300 524,301 $36,449 536,450 $48,600 S48,601 S60,750 560,751 $72,900 10 $26,540 S26,541 $39,80 539,810 553,Ou0 $53,081 S66,350 S66,351 579,620 11 $28,780 $28,781 S43,169 S43,170 S57,560 557,561 571,950 S71,951 5,-6,340 12 $31,020 531,021 $46,529 546,530 562,M S62,041 $77,550 577,551 S93,060 13 533,260 $33,261 549,889 549,890 $66,520 S66,521 583,150 $83,151 >99,7E0 14 535,500 535,501 $53,249 $53,250 571,000 $71,001 $83,750 $88,751 5106,500 15 537,740 $37.741 556,609 S56,610 575,4&0 575,481 $94,350 $94,351 S113,220 16 539,9E0 539,981 $59,969 559,970 S79,960 $79,961 599,950 $99,951 $119,940 17 542,220 $42,221 $63,329 563,330 $S4,440 SE4,441 S105,550 5105,S51 -,126,660 18 $44,460 S44,461 $66,689 S66,690 585,920 S88,921 $111,150 S111,151 S133,380 19 546,700 S46,701 570,049 S70,050 593,4W $93,401 5116,750 S116,751 5140,100 20 548,940 548,941 $73,409 573,410 597,8-00 $97,881 SW,350 $122,351 S146,820 LMEAP HOME ENERGY BENEFIT' $350 to S6004 $300 to $550" 5250 to 55004, $200 to $450" ' These benefit kvets are effective July 1, 2020 ".v se f.p er are Ai:fd Lj%'0 the RAN V I DrW"VA I of MCO.fA ON �hoatunary :ktsnce x s��'eant!acceecttir+ckdes- € 0 010 r, $7S mM ,ov Stwkes (wal rcwrf C,udr-ints p'JlYfAN R t,w fedrrN9c9ito on Joaxvy 77,:dV €",-q..zkJ s7i is) SG.„•uA.• 5l40 64 April 1, 2021 - September 2023 ATTACHMENT XVI SOURCES OF INCOME LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIREAP)SOURCES OF INCOME EFFECTIVE July I, 2020 .UDED SOURCES OF INCOME udes total annual cash receipts before taxes from all sources) 1. Money wages and salaries before any deductions 2. Net receipts from non -fain employment (receipts from a person's own unincoiporated business, professional enterprise, or partnership, after deductions for business expenses) 3. Net receipts from fann self-employment (receipts from a farm which one open, tes as an owner, renter, or sharecropper, after deduetions for farm operating expenses) 4. REGULAR PAYMENTS FROM: Social Security tall road retirement Unemployment :oncpensation Strike benefits from onion fiindsWorker's compensation Veteran's payments 3uhlic Assistance or Temporary Assistance for Needy Families TANF), Supplemental Security Income, and non -federally funded Jeneral Assistance or General Relief money payments. BH BA P 203.21 SOURCES OF INCONIE 1. CAPITAL GAINS any Assets drawn down as withdrawals from a bank, orthe ale of property, a house, or a car. 2. Tax Refunds 3. Gills 4. Loans 5. Lump -sum inheritances 6. One -lime insurance payments 7. Foster Care Payments* 8. Compensation for injury 9. Combat zone pay to the military 10. Adoption Subsidies 11. Reverse Mortgage Payments 12. NON -CASH BENEFITS (a) Employer -paid or union paid portion of health insurance or other employee benefits (b) Food or housing received in lieu of wages (c) The value of food and fuel produced and consumed on farms. 5. Payments to foster children age 18 or older received through the I (d) The imputed value of rent from owner -occupied Independent Living Program non-fann or farm housing. 6. Training stipends 7. Alimony S. Child Support 9. Social Security Benefit Garnishes for Non -Payment of iehool Loans. (The total ancount of the Social Security Retirement )enefit including the garnished deduction must be used when :alculaling the applicant's income.) 10. Military family allotment or other regular support from a fancily member or someone not living in the household 11. Private pensions 12. Government employee pensions (including military retirement pay) 13, Regular insurance or annuity payments 14, Educational Assistance; 'rants, Fellowships, Assistantships, College or niversity Scholarships- Only count as income those funds 15. Dividends 16. Interest 17. Net rental income 18. Net royalties 19. Periodic receipts from estates or trusts 20. Net gambling or lottery winnings (e) Federal non -cash benefit programs such us Medicare, Medicaid, Food Stamps, school lunches, and housing assistance. 13. Supplemental Security Income (SSI) benefits cannot be garnished for any reason unless a recipient received an overpayment of benefits, he total amount of the SSI benefit minus the garnished eduction for recoupment must be used when calculatingthe mclicant's income. ersons whose cost of residence is paid through a fostercare residential program administered by the state cannot be anted as household members. 65 April I, 2021 — September 2023 EHEAP 203.2 t ATTACHMENT XVIII EHEAP APPLICATION AND ELIGIBILITY WORKSHEET Eltiergency Home Energy Assistance for the Elderly Prograin - Application section One: Applicant (Aged 60 and older) information Name:Ih'st,hl.Lss6 .:11na'uJf:--,rr_n C1i lr)ar.+=�n Date Stamp Dale of birth: Service address, City. Florida County: Zlp code: tntaie Yiorkkr S r-3.me FY,ore. Sex : 1 hta'e r t Fema's I Nurrtar of people rs tt'e houseloV Pwe Marital Slaws' t ; Married r' Partnered ; i Single t r Sepwe—d :1 6:vorced '-I Wdoues Ric* rIV&te L:Black-AfliwnAm-,,ean iFAsi3n 1:ft3LVeHvvi7aan+Pajf.:Ist3r4er I:Arre6can.ndianAask3Native tltghef Effirkiy f = Hispanvlatino T" Other I Prntary Language; :: Enphsh r 1 Span;sh i) Cher Does cent have tmileLo ability read.na, vFn:.n;, speak;rg, or understanding the Enplish briguage? ;-.Yes t r flo NrA Is tt•,e wens a veteran? r 1 Yes , ;No Was cent referred to the k-al Veterans Affairs off"? :1 Yes r i No 'MA Apn:rani s ncorrx type(s): AFplcant s montry ir,=.* amryunt Sectlan Two. Additional Household Mambets Information inoome tyros): Narr =: AV ESrf: Monthly v4orrz arrwrt. Name' I=me type,$): V11171,A¢e' SSN: !,!ontryiM1tom arrb.nt' Name lrloorAetyr? q Ags' SSN: `.lonthjr vtorrt am,74 t Nam+r: Inocnse typP;s): Ag- SSN Monthly:-eon-earrrmt: Nary.!- irsp;me ty;+ s) Age, SSN: Wnthyiromearro'nr Is th,-re a child S years of a¢a of younger in PR hour -NW t: Yes : ! No If Yes, select a': that 7 ! 0.2 ears old lil-5yeaisold Is there an rd victual Ydtn a d-"Oity in the househoii? is Yes t; No Is fie applicant a V 5. o:iXen or an at'sen Isvrfuhy adm;tled tot p-smlanent residence? i 1 Yes t 1 rta Is rrw_ applicant a horn w.ner? , s Yes (j No Does appf wnt the n gvsernment s ts;dued hoes r¢, such as Sec4on &? V Yes :1 No If yes. proMe the ow;plex name: If yes. does tea household feceve an energy subsdy? I ! Yes i i No Does applicant We n a student dwnl't6ry, adult family tare horse, or any A'ud of g€oup tv:ng facisty? s: Yes :1 No If yes. provide the f3c&ry name'. Section Foug: "eaUng and Cooling Information Hare you or any mercr_r of your household reoeved energy assistarce L9 0-t "nest season? t ! Yes :1 No If yes, piovde 0m name of Agency Type of Assistance'ICrisis rt Hom- Energy ; t VVeather.Re'3ted Data: 1%*nat is She primary Source or home heat;ra? (se>-:t one) i 1 E: ttr,:ily t_ NAural Gas I'Propane . t Wood'Coat : i Aefdlable Fuels Does household us: svpp m¢ntat heat-ng source?:' ElecUic-y ' J vk'a Coal r- N A Ala a3nd 5oriing urt type? t 1 Cent=a! A'C [ } 1'hndat�ASh'11L'C :1 Fans ! 1 Cthtr— spit=fy [x'cEud�ng evaporatsve cac'er) Section Five: Eneray Crisis Explanation Client At(esiattan and SIgnaturo The ofosmation provided on this ay,.`:at 7n, is to the test of eny kno>,saogg,true anJ complete. I understand hat prionry an;r*V4 ng ass+3tdri:e Yitg L° gls'en t0 t-,ose h3V54hptd€15'Ih lh0 tYJfe S1 Ih:Ome and greatest need, i e. those householos a tvhrh the el erTy, d sabred, rred�:ally needy. or ciddren pestle- I awl-ronxe the agenq to make bener: pymr--ras diredy to my energy suppler, I ass aware hat aflet I have pccvided all &e nlofmati; n requested to detefmrirt my 9gib:liy. fl l am applypw To, aEsis assistance, the aaen;y has 13 now$ to as upon my applicator with an e5g'te acton. I am also 3,14afe that if I am not approved ar denied s,,,thin the Gore a!!ats'ed, or ml 3Woved lot the correct amount, I have aright to appeal the de;l€{:^. {If you Sign Yrlth an -y.- Mro illtgej5es a!e requTed } IDa1c t ; Ht le cooing or heattq ensigy source has teen drscor>re;.ted U Un31�e to gel delivery of fuel, is out of K:e!. or is in danger of cut of fare! foe hearth Life-Tihms'en'' s g ( �' .16thar probe ins wilt lack of coo'rn¢ or heatnq in the home, such as needingto a a de os't repar r to equ, orient. or pay P P p interim 4n>£rgerfy mzasure to avoid funrer crisis. (Lire-nveVeningl 'i ftouFed that the energy Source for oC$. ng or rearing ;5 gem} to to disconneded. (Standard) iJ Rece;ved a nat.:a wr:aUng the energy source Nit is detrva;;enl or pelf due (5!Mddtdl— I I Has an energy sourco t't for tihi:h the due date has lapsed (Snridard) Att. Ci-1EhTS SHOULD SIGN THE VIA €YER, AUMORIZIRG IWE Rft Eb$E OF GEHERa L AND —OR CO!JFiDEUnAC WFOWA T€ON FOR 66 April 1, 2021 — September 2023 EHEAP 203.21 Enter encv Home Ener v Assistance for the EldeFIV Pro rain - E-li(libilit Worksheet 6TIFIFITITME pnr,Ua•.ze a=. house_ ,- 7 inoorne Sta,'e cxk lalCr 0", here 0,;w.r3 orr•,- S3kullt-a.s cr ,3z:e c31Gva'3i.ons in tms spy ^ Poverty GU10iltn46'fTittrre 0714 MOM 1. Add all gross ir.CY`.ihty earned anJ filer:: it, —,:-s` r•-r-, an,•. Ly ""V,Ad :Ie' vr.eafred Income from t);t past 30 1 `'-0�� .11'r..cF:Y `•:i'i 0 bays of all household ment•ers. f 3 + �5i9.Feq 3 e, 3aD 2. Am f-IW.:are Prahtium (5143.50). rr not rrluded z SSA amount. ill ===$)2,.•93 } to,&i O f 3 •f 3. Add htz+.are Pan 1), if applloa G�-. 446 [i d ... 5?,7J] 117'sli, 4. To 3r=; v3'28. rl'.0 dply tr.e rr,"!y 10!33 by 12 months. 11 7 % so3 i V9 b!G !) a ,_ .. 4rt) tail $22 WA Annvol Hn;sehnld inrrsme N�3t'ib 7N Rx rv^h a-, F..,r,,l nr.Ir,L rr,.r r.-nlrr "A [SlYbt t!•i 11'r:nY,f i5 fc.•. nt," i:,'=. ! f : C S II rH(1' i'ttiH.a' i,:•.[�'.j Gu'i_1,'.•i 1 e i.:lri'1f �3 f 4ll 11C3iegorira'_yE'•2b'= r::.)t]vs'!..cel-11411ntner„f !,:,rrl-.iF tc:ctlr'<)SrLtp •ac',a-[c',IrnfF,14.r. h,r.!},=,.:.SJ S'a'f'l'/.•iti Vh'L1t,t. l r•1 C- r,tlY.� jS C -rf tf !�t�:ll•I if - �•'sIJ._fC j:i.•1'Hjf 1'i •^. !..tf5 }i !� Section Seven: Ven doF, Benefit, and Veriftationt Information Enirpy Vendor /1 Other VoWyr ai G_n•.vs m.sk wJ, LII &T ,u.rid:r a,red)' N.-Ye H.rrr:: Pre WIS. eml avwa7.va.^e Co•, J: f Pavn �•'cc- Is'Lbr! er .4�, rtl^F IJJ ILKt, r:lr, t,-r: 0.,4' f1.l=e C3 t,11r=x1 _ _ tl.ls t!c r�ysc.a`_lts.±i-e,l L111GiP :ribs .aasis 1f I.a dvi-IT'tr. ilr'rfv It.Y.4, y t,14,1 _.,I M4v4 L)_c, 0 - :1 Yes titlo ,irfJ,.ae.y, a-d f[, n,n-,rrn! .-fi1:1f1 [I .: Ilc; wr Ca al.x}lW:1 r3 :. Pv.,tte Fan cr C-.,-trg C=tupurl If tY,t rf,'.n1UM is rr,p:e thin Corr y Pnsx,' [.; C,rcryf•rt 1 ., sf,.a lterr• v J't° the past due amount, dd t?e energy C..:, :: W-i_,e I, C yerldu vefify that tt.3 amount is required? i i Yes 1 l No • : NA £n/rfjy Ye_n6or f2 other Yendaf le? 1•r: r'. L'v 1. ra:1 n .af ; Nn>.� ti,rlt,-r= c•'t If Lra tr, r.' nvm arro,,^l d'.a to reso.4e the cris:i s more than the maa01um allowed, explain myj the bs'ar.:e of the 3mouns ilnru,l A,rofre rh.a_. ARuW Gua. - ilae wl be p3 4 d ippro f,d for EH EAP Gfls iS ass is[3R:e 4kuM1•� �n:� dt�r,r�'71rs-; :=iJlfrlkr: .: RtparLsav)14•y J,) U—n-jI IE•jJ!rl a-rJ Cw'.a:t Ptt Y,l .SIIex-P� 'i: Efrr:r;)cr._y I) ToW Enefgy wridorl `; (i) TOM Otnir Yendorl } IS tFj nawar On the Net b;e thm of Lie apphoanls? 12) Energy }vblldy S TO3l1 £f1EAP 1:9A11i1 add } -1 Yes E: fro If no, prov.Je narra on Lx IS) water, Sewer, Gafbage, } i1ri. eto. TOLL Enrgy Viodof (i) 6 T0011 omir Cindor (a) al Gid [ci )263) ham (I) f Section Eight- Weatherization Assistance Program (WAP) Referral If ttt applio3rd 3s a horreo'rmer, has he she reac ved rn7:e than thrce OREAP oa EHEAP tenelas in the last 13 months? _; Yes ,-, No i r1A If t*e answer to the p•!evious quesfon is 'yes-, was thO applicant ieferred to t','AP7 I ! Yes [-; No :-'NA If tit answer to the t3st quosfon is'ra-• exp+ain. )2eio'„aon 0 the Heat -,wets! rg Energy Crisis oo;uned yathn 1814S hours, ty the VT e':g tie asuan(s) (Se'60 all1h31 apply) t S Ap;-roval of ate' :atop t) EfiEAP benef,t p�tventad ds:onn"t-on Corrnitnient rrade to e:ndcr 1 ` EHEAP benef:l restored energy a'ready d:s:onnected i.) eeni3l of%,,^.p:':dYr^n, pgrdd.' add+L]nal informaN'.1 E 1 Yes, e)ienl waver I 1 een631 Of Api`Calcn, Y..+baio;t :; No. client relv,ed to sign YdOiec €1 %'ihnen referfal ar^d assistance to 3C\esa other Community re;oureas Cast Worker Signature Approval signature Cae- � £cr) cr't tiYrc StJ'er.'s'r f'r-, s N:n to %•l• r' fi•t',n rl-tr4' 1.rr a• 67 April 1, 2021 — September 2023 EHEAP 203,21 ATTACHMENT XIX EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS FH>a AP Annlication InstructionsSeetion One: Alllin cant (Age 60 and older) Information 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; ✓ The applicant's income type(s) and monthly income amount is recorded in this section, and ✓ If arty field is deterrninecl to be not applicable, conrplele 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: ✓ 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 anj,flelcl is cetermined to be nor 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: ✓ #'an),.field is cetermined to be not applicable, conyVele the fleld by entering NIA. Section Four: Heating and Cooling Information Complete Section Four by answering each question. Special note: ✓ If any field is determined to be rrol applicable, corrrplete tlre_field by ertter•ing NIrI. 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 energl crisis is non -life -threatening, provide crisis resolution within 48 hours. ✓ 1f 'aray field is cieternriraed to be riot applicable, complete the field by entering rYI4. 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 April 1, 2021 -- September 2023 EHEAP 203.21 Determination Complete Section Six by stapling the calculator tape in tite 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. ✓ Ifcveyfreld is delerrrrined lobe riot applicable, complete the field h.V entering VA. Complete Section Seven by completing in its entirety. Special notes: ✓ The minima n 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. ✓ 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; 69 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 -tip of services, including reasonable connection or reconnection fees, delivery fees, deposits, and other fees related to the start-up of service. ✓ ll'anp,Iield is determined to le not opplicohle, cwrrplete the field lij, enter`irrg N/,4. 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 be not applicable, complete the field by entering A11A. 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. ✓ lfarry, field is determined to he 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. 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—10101/2019 70 April 1, 2021 — September 2023 EHEAP 203.21 ATTACHMENT XX EHEAP CLIENT )FILE CONTENT CHECKLIST PROGRAM REQUIREMENTS MONITORED Yes Vo 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. Client rile contains documentation of Social Security numbers for all household members, or citation 6 the applicable exemption. 6. Client file contains signed notice regarding collection of social security number(s). The client file contains ofticint income documents for all household members and TANF, SSI, or NAP documentation, if categorically eligible. Ifincome is self -declared, is there a self -declaration form signed by each individual household "ember (18 years of age or older) lacking income verification or claitning zero income? The household's total gross income is calculated correctly and is at or below 150916 of the OMB icderal 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% ofthe current Federal Poverty Guidelines and no one in the household is receiving SNAP assistance. 1 Checked that elder does nut live in student dormitory, adult family care home, or any kind ofgroup rvtng facility. 2 Verified and documented household has not received LIHEAP Crisis Assistance during the satin heating or cooling season. 13. Documentation of Weatherization Assistance Program (WAP) referral, ifapplicable. 44 Copies of fuel bills, or other supporting documentation as proofofenergy crisis, for the residence in lv lich they reside. 15. Signed copy ofAuthoriznlion for Release ofGeneml and/or Confidential Information, 16. Only eligible components ofthc utility bill are paid to resolve the crisis. IZZ Only the mimmhmr necessary to resolve the crisis is paid. Ifa different amount is required by the htlity company, provide additional information oil the Eligibility Workshoel. Crisis energy benefit was reduced by unallownble charges, such as: water, server, garbage, and fire, M., if applicable. 19. Crisis energy benefit was reduced by energy subsidy, if applicable. D. 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 tioiking days ofeligibility detennination. 2, Appropriate benefit provided. 3 All required sections ofthe application are signed and dated by the elder, staff; and supervisorylpeer RIOR to payment. 4. Proofofpaymenttovendor. 5. Mee completed DOEA Form 211 in client file. INSTRUCTIONS: A check mark in the Yes column indicates the requirement has been mct. A check nark in the No column indicates the requirement has not been met or is questionable. Each " P1'o" mnrlt must be explained under "COMMENTS". SupervisorlPecr Signature Consumer Fite Monitoring Date DOER FORM 211 d11f2021 71 April 1, 2021 — September 2023 ATTACHMENT XXI BHEAP COST REIMBURSEMENT SUMMARY Contract # Report Period: EHEAP 203.21 Budget Category Description Numer of units Amount c 0 v a .. TOTAL ADMINISTRATION $0.00 u m O TOTAL OUTREACH $0.00 O 0 r m m 9 N N a fA .y U TOTAL. CRISIS ASSISTANCE $0.00 72 April 1, 2021 — September 2023 AAA Contract M Cost Allocation Plan PROGRAM:EIdERGENCY HOME ENERGY ASSISTANCE PROGRAM (EHEAP) EHEAP 203.21 ATTACHMENT XXII COST ALLOCATION PLAN 1Draibe your budgeting metlead to ensure :hat funds are available in both reasons, and to metre that this is a rAW-ee-mormh program. B.dwei,,4 Meelvddoyr AAA Val wVe t7oe t4ag oft counu w uwi�rnoq than one pro�ide.r wfth EHEiLP fu�, complete the tb= 15@10W, D�Lb& hoW YOU WW tqUttjbl�F agDCate EHEAPrescures to each of :lie cumties you �t in U�Apxe beh;%-,7u2 plan must be in pa�z based on Protiderheu,s c�u� data wurce for rhe 150% of poverty populamon Lued uxludmr tlut year of the 41atlff arr�oftmr dazR orfactors art used in alocazin: the finids, de�nbe and 0,* th*�rce 73 73 April 1, 2021 — September 2023 EHEAP 203.21 PSAe 0 ContnctM 0 DO EA Cost Analysis For Non -Competitively Procured Contracts In Excess Of Category H -A DDENDUM PROGRA3A:EMERGENCY NAME ENERGY ASSISTANCE PROGRAM [EMEAP) PSAAIIOCa:ion Sutnrzn3ry _ _ Ttru County Sub -totals Total Provider AllocationS - A = ?rr+iders markrtl with "red astrfisk" require a All other pmidars rrquire, aka minimums ma merandunt of understanding outlining pregram expectations and tot robs and e5pamibilities of both spencios. ` 1CIhe AAA sub cantracts with a provider for Ad minis trarion or Cutrracr furls, a tact anaF}�i: fomi farcach provider m required. Froviders wrto mquirc a ccst analysia arc mar.;rC veith a "green ar.arriSi,". s o - C a y - v ] to ] - 11 0 v ] tg ] tc ] 15 ] - t£ ] 1- t9 ] COST ANALYSIS ADDENDUM CERTiFECAMN {to he signed by AAA ED AND CFOF I aert that rho cast farhach ILne i Pm budder satelp y his been eva]uated a^d Ct;crmir red ra t�- a:lowabte, r�isonatl�, and necessary as rggai:etl by Soc =n 21.E_34i 5, Florida Szatuws_ CF6 Name ^igrxu m Date acu��e D.reC=r same Date 75 April 1, 2021 — September 2023 ATTACHMENT XXIII SERVICE RATE RIEPORT EHEAP 203.21 PROGRAM: EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PRORAM (EHEAP) Federally Funded From 04/01/2021 to 09/30/2023 Category SERVICE METHOD OF PAYMENT HIGH 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 relmbursement basis. 76 April 1, 2021 — September 2023 ATTACHMENT XXIV OUTREACH PLAN SURVEY PSA Click here to enter text. COUNTY(IES) Click here to enter text. AGENCY'S EHEAP COORDINATOR Click Isere to enter text. PHONE W/EXT. Click here to enter text. EMAIL Click here to enter test. EHEAP 203,21 1, ELDERLY OUTREACH Describe the efforts to increase the number and percentage of elderly households served. Click 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 hc-re 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: ❑ Use a locally developed brochure (send an electronic copy with your survey) ❑ Other, please describe Llick 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 77 April 1, 2021 — September 2023 EHEAP 203.21 ❑ Provide to Head Start Programs ❑ Other: 0d, 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 tent. 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 lwre to enter text. When do you advertise (check all that apply)? 78 April 1, 2021 — September 2023 EHEAP 203.21 ❑ 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? Clicl, here to enter text. In which language(s) are your ads place? (check all that apply) ❑ English ❑ Spanish ❑ Other (please list) Click here to eater text. Does your agency advertise In SHOPPERS? ❑ Yes ❑ No Name of Shopper Click mere to enter text. City/Location Click here to enter text, Name of Shopper Click here to enter text. City/Location Click ► c-re, to antor 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 hereto enter text, Does your agency advertise on RADIO? ❑ Yes ❑ No Station Call Letters Click here to eater text, City/Location Click here, to eater text, Station Call Letters Click here to enter text. City/Location Click her to enter text. 79 April I, 2021 — September 2023 EHEAP 203.21 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? ❑ 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 Isere to enter text, City/Location Click Isere to ellter 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 teat. 80 April I, 2021 — September 2023 EHEAP 203.21 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 toxt, Do you use the same press release each time? ❑ Yes ❑ No ❑ N/A ❑ Prepare announcements for public access television (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 Snot 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 eater 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 81 April 1, 2021 — September 2023 EHEAP 203.21 ❑ 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 dick here to E�ntF=r teaxt, 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): 82 April 1, 2021 — September 2023 EHEAP 203.21 ❑ 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 ❑ 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 walls -ins only a. Identlfv the Intake sites to be used dally (Mondav through Fri dav) 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 Mere 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 mere to enter text. 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Identifv the intake sites to be used reeulariv, 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 Mere to Dyes ONO to enter, to enter enter text. text. text, 83 April I, 2021 — September 2023 EHEAP 203.21 Click here to enter text. Click mere to enter text. Click here Click Here Click here to ❑Yes ❑No to eater to eater enter text. text, text. Click here to enter, text. Click here to enter text. Click here Ciicl; here Click mere to ❑Yes ONO to eater to enter enter text, text. text. Click Ileie to enter text, Click here to enter text. Click here Click litre 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 Mick Bare 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 ❑No to enter to enter enter text, text. tent. Click here to enter text, Click here to enter text. Click here Click here Click mere to ❑Yes ❑No to enter to enter enter text. text, text. Click hei'e 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. 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 Mere to enter text. Clirl< here to enter text. Click here Click here Click he€'e to ❑Yes ❑No to enter to enter enter tent. text, text. Click here to enter text. Click Mere to entertext. Click here Click Kure Click here to ❑Yes ❑No to enter to enter enter text, text. text. Click Mere to enter text. Click here to enter text. Click here Click here Click here to ❑Yes ❑ No to enter to enter enter toxt, text, text, Click Mere to enter text. Click, here to enter text. Click here Click home Click here to ❑Yes ❑No to enter to enter enter text. text. text, Click Mere to enter t(sNt, Click here to enter text. Click hers- Click here Click here to ❑Yes ❑ No 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. Cficl, here Mick here Click here to ❑Yes ❑No to enter to enter enter text. text, text. 84 April 1, 2021-- September 2023 EHEAP 203.21 Evening Hours Click here to eater text. Click here Click: here Click here to ❑Yes ❑ No to hitter to enter enter text, text. text. Saturday Hours Click here to enter text. Click hew Click here C'licl, here to OYes ❑No to enter to enter enter text. text. text. Other Click here to enter text. Click here Click lire Click here to ❑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. 6. 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; Mere 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 Ciick Click here to here to here to here to here to enter enter enter enter enter text. tent. text. teq. text. EHEAP Program Click here to enter text. Click Click Click Click Click Coordinator here to Isere to here to here to here to 85 April 1, 2021 September 2023 EHEAP 203.21 enter enter enter I enter- I eater text, text. text, text, text, 7. OUTREACH ASSESSMENT/EVALUATION Do you survey your applicants to assess the effectiveness of outreach efforts? ❑ Yes ❑ No Surveys are targeted at ❑ Elderly ❑ Handicapped/disabled ❑ Households with young children ❑ Non -English speaking households Surveys are not targeted ❑ Yes ❑ No Do you track numbers of applicants at each outreach site? ❑ Yes ❑ No Each time the site is used? ❑ For all visits combined? ❑ 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 onter text. Do you track the number of home visits? ❑ Yes ❑ No Do you track the reason for doing each home visit? ❑ Yes ❑ No What other way do you assess the effectiveness and success of your outreach efforts? Click Mere to enter text. 86 Revised Augus! 2007 Attestation Statement Agreement/Contract Number EHEAP 203,2I Amendment Number VA — I DANIEL R RODRIGUEZ , attest that na changes or revisions have been made to the (RCCltlicllt/coull•actol• represcillative) content of the above refereneed agreelucnt/contract or aIII enchuent between the Arca Agency on Aging for Southwest Florida and COLLIER COUNTY BOARD Or COUNTY COMMISSIONERS (Reelpicnt/Codirector name) I, The only exception to this statement would be for changes iu page formatting, due to tile differences in electronic data processing Media, which has no affect on the agreement/contract content. Signature of Recipient/Collh R tive Dafe Approved As to form and icgaiity Assistant Cuunty AI r+icy Revised August 2007