Backup Documents 09/28/2021 Item #16D 4 1 60
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routinglines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human IY° , 09/28/2021
Services
2. Minutes & Records Clerk of Court's Office
3.
4.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf/CHS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 09/28/2021 Agenda Item Number 16D4
Approved by the BCC
Type of Document Amendment-OAA 203.21.003 Number of Original 1
Attached Documents Attached
PO number or account NA
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? NA
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the NA
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NA
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on_09/28/2021 and all changes made WK
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the WK
BCC,all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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January-December 2021 OAA 203.21,003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
OLDER AMERICANS ACT TITLE III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc.("Agency")
and Collier County Board of County Commissioners("Contractor"),amends agreement OAA 203.21.
WHEREAS,the purpose of this Amendment is to replace Attachment VIII.
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:
1, Attachment VIII —Budget and Rate Summary,is hereby replaced.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed
to conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the
contract.
This Amendment and all its attachments are hereby made part of the contract,
1N WITNESS WHEREOF, the Parties hereto have caused this amendment to be executed by their undersigned
officials as duly authorized,and agree to abide by the terms,conditions and provisions of OAA Contract or as amended.
This Amendment is effective on the last date the Amendment has been duly signed by both Parties.
CONTRACTO , OLLIER AREA AGENCY ON AGING FOR
BOARD OF UNT COM SOUTHWEST FLORIDA,INC,
SIGNED BY: SIGNED BY:
NAME: Daniel R Rodriguez NAME:NORMA ADORNO
TITLE:_Public Service Department Head_ TITLE:CEO
DATE: 09/02/2021 DATE: Rv — a-0a---I
•
Federal Tax ID: 59-6000558
Approved as to form and legality
Asslstgnt County Attor► `
(V3
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Janua!y—December 2021 OAA 203.21.003
ATTACHMENT VIII
•
BUDGET AND RATE SUMMARY
COLLIER
IIIB
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE
CASE MANAGEMENT $54.00 Fixed Fee/Unit Rate HOURS
CHORE $22.29 Fixed Fee/Unit Rate HOURS
EMERGENCY ALERT RESPONSE $ 1.35 Fixed Fee/Unit Rate DAYS
HOMEMAKER $25.44 Fixed Fee/Unit Rate HOURS
HOUSING IMPROVEMENT Cost Reimbursement 90%of Cost EPISODE
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE
PERSONAL CARE $25.44 Fixed Fee/Unit Rate HOURS •
RECREATION MATERIALS •
(EMERGENCIES ONLY) Cost Reimbursement 100%of Cost EPISODE •
RESPITE IN-HOME S25.44 Fixed Fee/Unit Rate HOURS
SI-TOPPING ASSISTANCE—COVID-I9 $34.12 Fixed Fee/Unit Rate ONE-WAY TRIPS
SKILLED NURSING SERVICES $41.55 _ Fixed Fee/Unit Rate HOURS
SPECIALIZED MEDICAL
•
EQUIPMENT, SERVICES,AND Cost Reimbursement 90%of Cost EPISODE
•
TELEPHONE REASSURANCE—COVID-I9 $13.40 Fixed Fee/Unit Rate EPISODE
TRANSPORTATION Cost Reimbursement 100%of Cost TRIPS •
•
•
•
•
•
ova
2
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January—December 2021 OAA 203.21.003
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
COLLIER COUNTY
IIIE,IIIES,& MEG
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE •
HIE-- ADULT DAY CARE $12.76 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS •
(EMERGENCIES ONLY) Cost Reimbursement 100%of Cost EPISODE •
RESPITE IN-HOME $25.44 Fixed Fee/Unit Rate HOURS
RESPITE IN-FACILITY $11.05 Fixed Fee/Unit Rate HOURS •
SCREENING&ASSESSMENT $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE—COVID-19 $34.12 Fixed Fee/Unit Rate ONE-WAY
•
TELEPHONE REASSURANCE—COVID-19 $13.40 Fixed Fee/Unit Rate EPISODE
IIIES--CHORE $22.29 Fixed Fee/Unit Rate HOURS
Specialized Medical Equipment, Cost Reimbursement 90%of Cost EPISODE
Service&Supplies
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE •
IIIEG--CHILD DAY CARE $15.00 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS
•
(EMERGENCIES ONLY) Cost Reimbursement 100%of Cost EPISODE
SCREENING AND ASSESSMENT $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE--COVID-19 $34.12 Fixed Fee/Unit Rate ONE-WAY •
TELEPHONE REASSURANCE—COVID-I9 $13.40 Fixed Fee/Unit Rate EPISODE
•
•
•
•
QN13
3
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January—December 2021 OAA 203.21.003
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
C-1 & C-2
COLLIER COUNTY
SERVICE REIMBURSEMENT UNIT TYPE
UNIT RATE
Cl -- CONGREGATE MEALS $11.72 MEALS
HOME DELIVERED MEALS $8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
CONGREGATE MEAL SCREENING $28.00 HOUR
CONGREGATE MEALS FOR MANAGED $11.72 MEALS
LONG TERM CLIENTS
OUTREACH $4.32 PER PERSON EPISODE
SHOPPING ASSISTANCE—COVID-19 $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE—COVID-19 $13.40 EPISODE
SERVICE REIMBURSEMENT
UNIT RATE UNIT TYPE
C2 -- HOME DELIVERED MEALS $ 8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
SCREENING &ASSESSMENT $48.76 HOUR
OUTREACH $4.32 PER PERSON EPISODE
SHOPPING ASSISTANCE—COVID-I9 $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE—cOVID-19 $13.40 EPISODE
4
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Revised August 2007
Attestation Statement
Agreement/Contract Number ()AA 2tY1 21
Amendment Number .003
I, Daniel R Rodriguez ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of County Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for chnnges in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
Sigt att a of Recipient on c r e sentative " Date
Approved as to form and legality
%CLA
Assistant County Att ey
Revised August 2007
•
or