Agenda 10/12/2021 Item #16D4 (After-the-Fact Contract - AAA of SWFL)10/12/2021
EXECUTIVE SUMMARY
Recommendation to approve “After-the-Fact” contract Amendment, Attestation Statement, and
Budget Amendment with the Area Agency on Aging for Southwest Florida, Inc., Alzheimer’s
Disease Initiative grant program for the Collier County Services for Seniors to increase the
allocation, revise Attachment II Exhibit 2 Funding Summary and Attachment IX Budget and rate
Summary and the supporting Budget Amendment. ($171,440)
_____________________________________________________________________________________
OBJECTIVE: Provide uninterrupted support services to Collier County Services for Seniors’ (CCSS)
frail, elderly clients.
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 the Alzheimer’s Disease Initiative (ADI) grant program. This grant is funded by the Florida
Department of Elder Affairs (DOEA) through the Area Agency on Aging of Southwest Florida, Inc.
(AAA). This grant funds services to enable clients to remain in their homes and live with independence
and dignity.
The current service agreement for ADI estimated funding for 2021-2022 was approved by the Board of
County Commissioners (Board) on June 8, 2021 (Agenda Item #16D4) in order to have the budget in
place by July 1, 2021.
The fully executed contract 203.21 for ADI was approved “After-the-Fact” by the Board on September
14, 2021, Agenda Item #16D2, the contract has a one-year term, effective July 1, 2021 through June 30,
2022.
The proposed First Amendment, 203.21.001 will increase the allocation funding by $171,440, revise
Attachment II-Exhibit 2-Funding Summary; and revise Attachment IX Budget and Rate Summary.
This item is being presented “After-the-Fact” because Collier County received the amendment for
additional funding on August 24, 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’s consideration.
Pursuant to CMA# 5330 and Resolution No. 2018-202, the County Manager authorized the Public
Services Department Head to sign the agreement. This Amendment is being presented for Board
ratification. Collier County, as the Lead Agency, is responsible for responding to seniors’ needs and
managing the spending authority for the Federal and State Funded Services for Seniors programs.
CCSS is also responsible for the collection of client co-payments for the ADI Grants. ADI does not have
a co-pay requirement; therefore, Budget Amendment adjustments will be needed to the co-payment goals
used to support the programs.
The following table provides a detailed breakdown of the FY21-22 additional funding & copayment
budget:
Program Component Project Number Current Budget Revised Budget Increase/
Decrease
ADI 203.21 33749 $504,968.54 $676,408.54 $171,440
Total $504,968.54 $676,408.54 $171,440
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10/12/2021
Program Component Project Number Estimated Co-Pay
Budget
Revised Co-Pay
Budget
Increase/
Decrease
ADI Co-Payment
Budget YR21-22
33625 $17,486.55 $17,486.55 0
Total $17,486.55 $17,486.55 0
FISCAL IMPACT: Funding from the Department of Elder Affairs via the Area Agency on Aging under
the 2021 grant award is available in Human Services Grant Fund (707), Project 33749 (ADI). A Budget
Amendment is required to increase the funding within (ADI) Project 33749 by $171,440.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote
for Board action. - JAB
RECOMMENDATION: To approve an “After-the-Fact” contract Amendment, Attestation Statement,
and Budget Amendment with the Area Agency on Aging for Southwest Florida, Inc., Alzheimer’s
Disease Initiative grant program for the Collier County Services for Seniors to increase the allocation,
revise Attachment II Exhibit 2 Funding Summary and Attachment IX Budget and rate Summary and the
supporting Budget Amendment. ($171,440)
Prepared By: Wendy Klopf, Grants Coordinator, Community and Human Services Division
ATTACHMENT(S)
1. ADI 203.21.001 exec (PDF)
2. [Linked] ADI 203.21 Executed (PDF)
3. Resolution 2018-202 (PDF)
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10/12/2021
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.4
Doc ID: 19919
Item Summary: Recommendation to approve “After-the-Fact” contract Amendment, Attestation
Statement, and Budget Amendment with the Area Agency on Aging for Southwest Florida, Inc.,
Alzheimer’s Disease Initiative grant program for the Collier County Services for Seniors to increase the
allocation, revise Attachment II Exhibit 2 Funding Summary and Attachment IX Budget and rate
Summary and the supporting Budget Amendment.
Meeting Date: 10/12/2021
Prepared by:
Title: Operations Coordinator – Community & Human Services
Name: Wendy Klopf
09/03/2021 1:53 PM
Submitted by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
09/03/2021 1:53 PM
Approved By:
Review:
Community & Human Services Akiko Woods Additional Reviewer Completed 09/03/2021 3:24 PM
Community & Human Services Kristi Sonntag CHS Review Completed 09/14/2021 10:52 AM
Community & Human Services Maggie Lopez Additional Reviewer Completed 09/14/2021 11:21 AM
Community & Human Services Blanca Aquino Luque Additional Reviewer Completed 09/16/2021 4:05 PM
Operations & Veteran Services Kimberley Grant Additional Reviewer Completed 09/16/2021 5:04 PM
Public Services Department Todd Henry Public Services Department Completed 09/20/2021 2:19 PM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 09/20/2021 3:00 PM
Public Services Department Dan Rodriguez PSD Department Head Completed 09/20/2021 4:50 PM
Grants Erica Robinson Level 2 Grants Review Completed 09/23/2021 2:46 PM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 09/23/2021 4:39 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/28/2021 2:51 PM
Grants Therese Stanley Additional Reviewer Completed 09/29/2021 10:38 AM
Growth Management Operations Support Christopher Johnson Additional Reviewer Completed 09/30/2021 10:52 AM
County Manager's Office Sean Callahan Level 4 County Manager Review Completed 10/05/2021 8:27 AM
Board of County Commissioners Geoffrey Willig Meeting Pending 10/12/2021 9:00 AM
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(JULY 2021-JUNE 2022) ADI 203.21.00 I
AREA AG ENCY ON AGING FO R SOUTHWEST FLO RIDA, INC.
ALZHEI MER'S DISEASE INIATIVE PROG RAM STAN DARD CONTRACT
COLLIER COUNTY BOARD OF COUNTY CO MMISSIONERS
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 ADI 202.21.
The purpose of this amendment is to increase allocation funding by amending 4. Contract Amount, Collier County:
increase allocations by $171,440.00; revise ATTACHMENT II-EXHIBIT 2-Funding Summary; and revise AT TACHMENT IX BUDGET AN D RATE SUMMARY.
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 $676,408.54; subject to the availability offunds. Any costs or services paid for under any other contract
or from any other source are not eligible for payment under this contract.
All provisions in this contract and any attachments thereto in conflict with this Amendment shall be and are herebychanged 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 of its attachments are hereby made part of the contract.
IN 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 ADI contract as amended.
This Amendment is effective on the last date the Amendment has been duly signed by both Parties.
Contractor: COLLIER COUNTY BOARD OF COUNTY CO M SIONERS
SIGNED BY:
NAME:
TITLE: Public Service Depai1ment Head
DATE: 08/31/2021
Federal Tax ID; 59-6000558 Fiscal Year Ending Date: 09/30
AREA AGENCY ON AGIN G FOR SOUTHWEST FLO RIDA, INC.
SIGNED BY�4
NAME: Norma Adorno
TITLE: CEO
DATE:
Approved as tc :, · .. 11.-.! : ....�o_AA�� ,a,Assis CountyAt��. � cg \ 3 \
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Packet Pg. 969 Attachment: ADI 203.21.001 exec (19919 : AAA-ADI Amendment 203.21.001 Additional Funds)
16.D.4.aPacket Pg. 970Attachment: ADI 203.21.001 exec (19919 : AAA-ADI Amendment 203.21.001 Additional Funds)
16.D.4.aPacket Pg. 971Attachment: ADI 203.21.001 exec (19919 : AAA-ADI Amendment 203.21.001 Additional Funds)
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16.D.4.a
Packet Pg. 972 Attachment: ADI 203.21.001 exec (19919 : AAA-ADI Amendment 203.21.001 Additional Funds)
16.D.4.c
Packet Pg. 973 Attachment: Resolution 2018-202 (19919 : AAA-ADI Amendment 203.21.001 Additional Funds)
16.D.4.c
Packet Pg. 974 Attachment: Resolution 2018-202 (19919 : AAA-ADI Amendment 203.21.001 Additional Funds)
.Judy 2021- June 2022) AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. ADI 203.21
AL%HEIMEI2'S DISEASE INITIATIVE PROGRAM STANDARD CONTRACT
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS CONTRACT is point ell into between the Area Agency on Aging for Southwest Florida, tire. (Agency) and Collicr
County Board of Coun(y Commissioners (Contractor), collectively referred to as the "Parries." The term Contractor for
(his propose may chmignato a Vendor, Subgranlec, or Subrecipienl,
WITNESSETH THAT:
WHEREAS, the Agency has determined Ihtd It is in need of cat lain services as doscribed henin; and
WHEREAS, the Contractor has demonstrated that it has (he requlsi(e expertise and ability to faithfully perform such services
as an independent Contractor of (ho Agency.
NOW THEREFORE, in considendion of file services to be performed and payments to be made, together with the
nuaual covenants and conditions set forth hereln, file Parties agree as fellows:
1. Purpose of Contract:
The purpose of this contract is to providcservicos Ili accordance with the lei its and conditions specified iu this contract
including nil allachmonls, forms, and exhibits which constitute the contract document.
2. Incorporation of Documents within the Contract:
The contrscl 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 explicilly provides
to the contrary. In the event of conflict in hmguage among oily of the documents referenced above, the specilic
provisions and requhements of the contacl doeunnent(s) shall provnil over Inconsislon 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) A.M., Cashan Standard Time July 1, 2021 or on the date the contract ]airs
been signed by the lost party required Cosign it, whichever is later. It shall end at eleven frllynine (11:59) P.M., Hasten
Sfealnrd'I'imedauto 30, 2022.
J. Contract Amount:
'Ilia Agency agrees to pay for contracted services according to the tears and conditions of this contract in fill amount not
to exceed $504,968.54, subject to the availability of funds. Any costs or services paid for under any other contract or
from any other source are not eligible fa• payment tinder [fits contract.
5, Rcnewnls:
By mutual agreenenl of file Parties, in accordance with Section 287.058(1)(g), Florida Statutes (F.S.), file Agency fin ay
I enew the contract for a period not to exceed ince yems, or (he form of the original contract, whichever is longer, The
renewal price, or method for deendnIng a renewal 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
upoin setisfaclory performance evaluations by the Agency and the availability of funds.
6. Complimncewlfh Rede•al Low:
6.1 Willis contact contains federal funds this section shell apply.
6.1.1 Tito Contractor shall comply Willi the provisions of 45 Code of Federal Regulations (CPR) Part 75 and/or
45 CPR Part 92, 2 CFR Part 200, and other. applicable regtilallons.
6.1.2 If [his contract contains federal funds and is over $100,000.00, the Contractor shall comply Willi all
applicable standards, oilers, or regulations issued under Section 306 of the Clean Air Act as amended (42
United States Code (U.S.C.) § 7401, et seg.), Section 508 of the Federal Water Pollution Control Act as
amended (33 U.S.C. § 1251, at seg.), Executive Order 11738, as amended, and, where applicable,
Environmental Protection Agency regulations 2 CFR Par[ 1500. The Con(ractorshall report any violations
of the above to fine Agency.
6.1.3 Neither (he Contractor nor any agent acting on behalf of the Contractor play use any federal fonds received
in connection Willi 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
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Certification and Assurances Attachment, which must be completed and returned to the Contact Manager
prior to the execution of this contract.
6.1.4 In accoalanco with Appendix 11 to 2 CFR Vat 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 Dclarttnonl of Health and Human
Services regulations 45 CFR Part 92, if applicable.
6.1.5 A contract award with an mationl expected to equal or exceed F25,000.00 and certain other contract awards
will not be male to paties listed on the goverumeni-widofixchdeA Putties List System, in accodance will)
the Office of Management and Budget (OMB) guidelines at 2 CI+R part 180 that Implement Executive
Oilers 12549 and 12689, "Debarment and Suspension." The Excluded Parties List System contains the
names of parltes debarml, suspended, or otherwise excluded by agencies, as well as patties declared
ineligible under statutory or regulatory authority other than Executive Order 12549. The Contractor shall
comply with these provisions before doing business or enle•ing into subcontracts receiving federal funds
pursuant to [his contact. The Couiruclor shall complete and sign the Certifications and Assurances
Attachment prior to the execution of [his contract.
6.2 The Contractor shall not employ an unauthorized area. The Agency will consider the employnen of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. § 1101). Such violation will because for nnllatend cancellation of
this contact by the Agency.
6.3 Mile Contractor is a non-pro0l provider and is subject to Internal Revenue Service (IRS) tax exempt organizdion
reporting requirements (filing a Form 990 or Form 990-N), and has Its tax exempt status revoked for failing to
comply with the filingrequirommlits of the Pension Protection Act of2006 or for any other reason, the Contractor
must notify the Agency in writing within thirty (30) days oileceiving the IRS notice of revocalion.
6.4 The Contactor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR § 170.110(b), [he Contractor shall comply with the reporting requirennerns of the
Transpmency Act as expressed In 2 CFR Part 170,
6,6 To comply with Presidential Executive Order 12989, as amended, and Slate of Florida Executive Order Number
11-116, Contractor agrees to eilize the U.S. Department of Homeland Security's E-verily system to verify [he
employment of all new employees hired by Contractor during the contact tom. Contractor shot[ include in related
subcontracts a requirement that Subcontractors performing work or providing services pursuant to the stale
contact utilize the F verify system to verity employment of all new employees hired by the Subconlractorduring
the contract term. Contractors meeting the terms and conditions of the E-Verify System are deemed m bein
compliance with this provision.
7, Cmnnllnncewith Slate Lmv:
7,1 This contract is executed and entered into in the State of Florida, and shall be construed, performed, and enforced
in nil respects In accordance with Mal Ida law, including Florida provisions for conflict of Incas.
7.2 If this contract contains state financial assistance funds, the Contactor shall comply with Section 215.97, F.S.,
and Section 215.971, P.S., and expenditures must be in compliance with laws, rules, and regulations including,
but not limited to, the Reference Guide for State Expenditures.
7.3 The Contractor shall comply with the requirements of section 287.058, F.S., as annended.
7.3.1 The Contractor shall perform all tasks contained in Attachment 1.
7.3.2 The Contractor shall provide units of deliverables, including reports, findings, and drags, as specified in
Attachment 1, to be received and accepted by the Agency Contract Manager prior to payment,
7.3.3 The Contractor shall comply with tile clitoris and final date by which such clitoris must be met for
completion of this contract as specified in Attachment 1, Section 111. Melhod of Payment.
7.3.4 The Comment- shall submit bills for fees or other connpensation for services or expenses is sufficient dotatl
for a proper pre -audit and post -audit.
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7.3.5 If ileadmi paynlem for travel expenses is pennilled in this contract, ilia Contractor shall submit invoices
far ally travel expenses hn accordancewith Section 112.061, F.S., or' at srwh lower rates as may be provided
in this Contract.
7.3.6 The Contractor shall allow public access to all documents, papers, tellers, or other public records as defined
in Section 119.011(12), F.S, mnde or received by the Contractor in conjunction with (his contact except
for those records which are mado confidential or exempt by low. The Contractor's refusal to comply with
this provision will constihnle an Imnnedlale breach of contract for which the Agency may unilaterally
terminate tills counsel.
7A If clients are to be transported under (his contract, the Collimator shell comply with the provisions of Chapter
427, F.S., and Rule Chapter 41-2, Florida Adminis0rative Code (F.A.C).
7.5 Subcontractors who are on the Discriminatory Voidor List rally not transact business with any public entity, In
accordance with ilia provisions of Section 287.134, F.S.
7.6 Tho Contractor shall comply with Ilia pinvistonsol'Scclion 11.062, R.S, and Section 216.347, F.S., which prohibit
the expenditure of contact hods rot 'tho purpose of lobbying the legislature, judicial branch or a slate agency
7.7 The Agency may, at its option, toininme the Contract if the Contractor is found to have submitted a false
certification as provided under Section 287.135(5), F.S., lies been placed on the Scrutinized Companies with
Activities in Ilia Iran Petroleum Energy Sector List, the Scrutinized Companies with Activities in Sudan List, at
the Scrutinized Companies Ilim Boycott Israel List, or if the Contractor lies been engaged in business operations
in Cuba or Syria m• is engaged In a boycott of Israel.
Background Screening:
The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435, F,S., as amended, are mat
regarding background screening for all persons who meal the definition of a direct service provider and who are not
exempt from the Agency's level 2 background screening parsunat to Sections 430.0402(2)-(3), F.S. 'rho Contractor must
also comply with any applicable rules promulgated by the Agency and ilia Agency for Health Care Administration
regarding implementation of Section 430.0,102 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 Ilia Agency have it completed Screening Form on file for the
Contractor, a new Screening Form will be niquircd every twelve (12) months.
8.1 Further hifonnation concerning the procedures for background screening may be found at
11(p;//elduraB'nin sate Il uv/doen/ba�ku'oundscree nine nip.
9. Grievance Procedures:
The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to
process and resolve client dissatisfaction with, or denial of, soivice(s) and to address conptnints regarding tilt
termination, suspension or reduction of services, as required for receipt of funds. 'Phase procedures, at n mininnun, will
provide for notice of the grievance procedure and an opportunity for review of the Subcontractor's dclermination(s).
10, Public Records and Retention:
10.1 By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any other applicable
low, laid shall:
10.1.1 Keep and maintain public records required by (he 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 ilia requested
recoils or allow Ilia records la be inspected or copied within a reasonable tune at a cost that does not exceed
Ilia cost provided In Chapter 119, F.S., or as otherwise provided by Inv.
10.1.3 Ensure that public records that are exempt, in confidential and exempl, from public records disclosure
requirements are not disclosed except as authorized by low for file duration of the contract term sad
following completion of the contract if the Contractor does not transfer the records to the Agency.
MIA Upon completion of the contract, the Connector will either transfer, at no cost to ilia Agency, all public
ecords in possession of ilia Contractor to the Agency or will keep and maintain public records required by
the Agency. If (he Contractor transfers all public records to the Agency upon completion of the contract,
Counselor shall destroy any duplicate public records that are exempt, or confidential and exempt,
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front public records disclosure requhoments. Willa Conuncmr kooin and maintains public rCendS upon
completion of the contract, the Contractor shall meet all rill licable requirements fur retaining public
records. All records stored electronically must be provided to rho Agency in a fornal (list is compatible
with the information technology systems of the Agency.
10.2 The Agency cony unllatcrally canect this contract, notwithstanding any other provisions of [his contract, for rellrsal
by the Contractor to comply with Section 10 of this contract by not allowing public access to all documents,papom
letters, or other material node or reccived by the Contractor In conjunction with this conlmet, unless the records
are exonlpl, or confidential and exempt, front Section 24(a) of Article I of the Stale Constitution and Section
119.07(1), F.S.
IF THE CONTRACTOR HAS QUESTIONS REGARDING TJIE APPLICATION OF CHAPTER 119,
FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT, CONTAC1" 1'HE CUSTODIAN OR PUBLIC RECORDS AT:
Public Records Coordinator
Area Agency oil Aging for Southwest Florida, lite.
2830 Winkler Avenue, Suite 112
hart Myers, FL 33916
239-652-6900
10.3 Upon termination of this contract, whether for convenience or for cause as detailed in section 53 of this contract,
the Contractor and Subcontractors shall, at no cost to the Agency, transfer all public ]words It, theirpessesslell to
the Agency and destroy any duplicate public records that are exempt, or confidential and exempt, front public
records disciosma requirements. All records s(oed electronically shall be provided to the Agency in a forma( that
is compatible with [he information technology systems of [he Agency.
IL Audits, Llsoccllons. Llvcslianitons:
11.1 The Contractor shall establish and maintain books, records, and dOCnntella (including electronic storage media)
sufficient to rellec( all assets, obligations, unobligated balances, Income, interes(, and expenditures of fonds
provide(lbythe Agencyun(lorihiscmnrtnct, Connitc(orshall adequately safeguard all such assets and ensure that
they are used solely for the purposes authorized under (his contract, Whenever appropriate, financial information
should he related to performance and unit cost data.
11.2 The Contractor shall retain and maintain all client records, financial recoils, supporting documents, statistical
records, and any other documents (including electronic storage media) pcilblent to this contract for a period of
six (6) years after completion of the contract, or longer when required by law. fur the event an audit is required
by this contract, records shalt be retained for it minimmn period of six (6) yeas a0cr file audit report is Issued of
until resakrtion of any audit findings or litigation based on ilia terms of this contract, at no additional cost to the
Agency.
11.3 Upon demand, at no additional cost in tiro Agency, the Contractor shalt facilitate the duplication and transfer of
any records or documents during the required retention period.
11.4 The Contractor shall ensure that the recoils described in this section will be subject at all reasonable lines to
inspection, review, copying, at audit by federal, state, or edict porso nol duly authorized by the Agency.
11.5 Mall reasonable (lines for as long its records ale nlahlbdoed, persons (duly authorized by the Agency and federal
auditors, pursuant to 45 CPR Part 75, shell be allowed full access to and the right to examine any of Ills
Contractor''$ contl'ac(s slid misled records and documents perlhlcnl to lilts specific counsel, reganlless of Ilia
form in which kept.
11.6 The Contractor shall provide a Financial slid Compliance Audit to the Agency as specified in this contract and
onsne that all related Third -party transactions me disclosed to the auditor.
I I.7 Contractors agrees to comply will' the Inspector General in any investigation, audit, inspection, review, or hearing
performed pesuanl to Section 20.055, F.S. contractor further agrees that 11 shall Include in related subcontracts
it requirement that subcontractors performing work or providing services pursuant in [his contract agree to
cooperale with the Inspector General in any investigation, audit, inspection, review, or hearing pursuant to
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Section 20.055(5), F.S. By execution of this contract the Contractor understands and will comply with this
subsection.
11.8 In acconlance with Executive Order 20-44 which requires executive agencies to submit a list ofentities named
In staluto with which a slide agency must Jet In a sole -source, public -private agreement or an cntify Ihal, through
contract or other agreement with the slate, annually receives 50%or more of their budget from the Stale or from
a conrhination of Slate Ind Federal fonds. Any Contractor that nice(& one or both of the In listed must submit
an annual report, Including file most recent IRS Porn 990, detailing the total compensation for the entities'
executive leadership teams within thirty (30) days of execution of this contract,
11.8.1 The report lutist include total compensation rneludingsalflry,bemuses, ollshed-ill leave, cash equivmens,
severance pay, relrennent benefits, deferred compensation, I ad-ja oper1y gifts, and any other payout.
11.8.2 The Contractor shall inform the agency of ally changes in total executive compensation between the
annual repots as those changes occur.
11.8.3 All compensation reports roast indicate what percent of coin pensattell comes directly from the Slate or
Federal allocations to the contracted entity.
12. Noudisciiminalioin-Civil Rimhis Conmiimncei
121 The Contraclorshnll execute Assurances as stated in the Assurances-Non-Cons(mrctiou Programs A(lachnnenllhat itwDI
not discriminate ugelnst any person in ilia provision of services or henefils under this conlracl is in employment
because of ago, race, religion, color, disability, national oigin, marital status, or a" in compliance with slate and
federal law rand regulations. The Contractor further assures that till Contractors, Subcontractors, Sub -grantees, or
others will) whom It arranges to provide services or benefits in connection with ally of its programs and activities
are not discriminating against clients m employees because of age, race, religion, color, disability, national origin,
marital status, or sex.
12.2 During the term of this contract, Una Contactor shall complete and retain on file a timely, complete, and accurate
Civil Rights Compliance Checklist, attached to [his contract.
12.3 The Codiactor shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or betiefils through this contract 'these procedures shall Inchade notifying clients, employeas, and
parlicipants of the right to fnle a complaint with the appropriate federal or stale entity.
12.4 If This contract contains federal funds, these assurances sit a condItloll of continued receipt of or benefit from
federal financial asslatarce, and arc binding upon the Contractor, Its successors, transferees, and assignees for the
period duringwhich such assistance is provided. 'the Contractor Ruche• assures (lint all Subcontractors, Vendors,
of others with when it arranges to provide services or hencfrls to pe(icipats or employees in connection will)
any of its programs and activities are not discriminating ngninst those participants e• employees in violation of
the any simnies, regulations, guidelines, and standards. in the event of failure to comply, the Contractor
understands that the Agency rally, at its discretion, seek a coud order requiring compliance with the terms of this
assurance or seek other appropriate judicial or administrative relief including, bill not limited to, ten ninallon of
the contract and denial of further assistance•
13. Monitoring by the Aeomv:
The ContmctO• shall permit persons duly authorised by the Agency to inspect and copy tiny records, papers, documents,
facilities, goods, and services of the Contractor which are relevant to this contact, slid 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. Pollo wing such review, the Agency will provide a written relxnt of its 0ndings to
the Contractor and, where approprinlo, the Contractor shall develop it Corrective Action Plan (CAP). The Contractor
hereby agrees to correct all deficiencies identified in the CAP in a timely manner its detenninedby the Agency's Contract
Manager.
14. Provision of Services:
The Contractor shall provide services in the manner described in Attachment I.
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15. Com•dhmted Mmiitm•Ing with Olhm•Agendes;
ADI203.21
If the Contraelor receives funding li'om one or more Slate of Millie hlanml service agencies, in addition to the Agency,
then a joint monitoring visit Including such other agencies may be scheduled. For the purposes of (his contract, and
pursuant to Section 287.0575, P.S., as amended, Florida's human service agencies shall include The Agency, the
Department of Children and Families, the Department of liemhh, the Agency for Persons Willi Disabilities, and the
Department of Veterans' Affairs, Upon notification and the subsequent scheduling of such a visit by the designated
agency's lead administrative coordinator, the Conh'aetor shall comply and coopoale with all monilaa,inspecuirs, and/or
invosliga(ors.
16. New Conh•nct(a)licoo•flne;
The Contractor shell notify, the Agency within ton (10) days of entering into a new conhaat with any of Iho romainbng four
(4) slate human service agenctes.'1'he notification shall Inctudo Iho following inlorlainion: (1) contracting stale agency
mid the applicable office or program Issuhig the cattraci; (2) conh•act name and number; (3) coit(rttct start and end dales;
(4) contract amount; (5) contract description and commodity or service; and (0) Contract Manager name and contact
informallon. In complying with (his provision, and plasuant to Section 287.0575, P.S., as amended, (he Contractor shall
complete the Contractor's State Contracts List attached to this contract.
J7. Indemnification:
'fhe Contractor shall indemnify, save, defend, and hold hanWesx the Agency and its agents and employees front any
and all o[ninrs, demands, actions, and causes of action ofwhetever nabn'e or chaacto• arising out of, or by reason of,
the execution of this contract or performance of the services provided for herein, It is understood and agreed that the
Contractor is not required to indemnity the Agency for claims, dennands, act Ions, of causes of act ton arising solely onl
of the negligence of the Agency.
17.1 L'xcopl to the extent permilled by Section 768.28, P.S., or other Florida law, (his Section 17 is not applicable to
contracts executed between the Agency and stale agencies or subdivisions defined in Section 768.28(2), V.S.
18. ❑nsmraneeand Buntline:
18,1 idle Contractor shall provide continuous adequate liability insurance coverage during the existence of this
conk act and any renewal(s) laid exlension(s) of it, By execution of this contrncl, unless it is a state agency or
subdivision as defined by Section 768.28(2), 17.S„ the Contractor accepts fill[ responsibility for identifying and
determining the (ype(x) and extent of liability insurance coverage necessary to provide reasonable financial
protections fen the Contractor and the clients to be served under ibis 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 Conhaclor shall ensure that the Agency has the most current writlon verification of insurance coverage
throughout Ilse term of this contact Such coverage may, be provided by a self-insurance program established
and operating miler the Imes of the Stale of florkla. The Agency reserves the right to require additional insurance
as speclfiol in this contract.
18.2 Throughout the term of this collrael, the Connector shall maintain all insurance bond tom a responsible
commercial insurance company covering all officers, directors, employers, and agents of the Contraelor
authorized to handle funds received or disbursed under ell agi e i nonts and/or contracts incorpo'sting this contract
by reference in an amount commensurate with the fonds handled, the degree of risk as determined by the
insurance company, and consistent with good business practices.
19. Confidentiality oflinfa•nnallon:
'Due Contractor shall not use or disclose any informn(ion concerning a raclpienl of services under (his contract for any
purpose prohibited by stale or federal Inv or regulations oxecpt with the written consent of n person legally authorised
to give that consent or when aulhurizcd by law.
20. II nlfin Insurance Po •lnbllity and Accountability Act:
Where applicable, the Contraelor shall comply Willi the health Insurance Portability and Accountability Act of 1996,
Public Law 104-191, as well as all regulations promulgated (hereunder (45 CPR Pals 160, 162, laid 164).
21. Incidar Renor(hng:
21.1 The Contractor shall notify the Agency humedialc[y but lie later (Ila"forty-eight(48) homy from the Contractor's
awareness or discovery of conditions that nary materially affect the Contractor's or Subcontractor's
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abjfly to perform the services required to be performed under this contract. Such 0olice shall be made omdly to
the Agency's Coah'act Manager (by lelephono) with till email to immediately follow.
21.2 The Contractor shall inunedialelyrepon knowledge or reasonablosuspicion of abuse, negleot, or exploitation of
a child, aged poison, or disabled Adult to the Florida Abuse I lot lfile on the statewide toll -five lelophone number
(1-800-9eABIJSB). As required by Chnptcra 39 and 415, F.S., this provision is binding upon the Contractor, its
Subcontractors, and their employees,
22. Baulnllntcv Notification:
During the term of Ibis contract, the Contractor shall immediately notify Ilia Agency if the Contractor, its assignees,
Subcontractors, or affiliates file a claim for bankruptcy. Within ten (10) days alter notification, the Contractor most also
is the following information to ilia Agency: (1) the date of filing of the bankruptcy petition; (2) Ilia case number;
(3) the court name and Ilia division In which the petition was filed (e.y, Northern District of Florida, Tallahassee
Division); sill (4)'tile name, address, and telephone number of the bankruptcy attorney,
23. Snonsorshinmtd Publicity:
23.1 As required by Section 286.25, F.S., if the Contractor is a nollrgoveiallontal organimilon which sponsors a
is agram financed wholly or In part by state Wads, including any funds obtained through this contract, it shall, ill
publicizing, advertising, or describing the sponsorship of tiro program, stale; "Sponsored by (Contractor's name)
slid the Stale of Florida, Department of Bider Affairs." if the sponsorship reference is in written material,lhe
words "State of Florida, Department of Bider Affairs" shall appear in at least the scone size lellcrs or• type "stile
name of the organization.
23.2 'file Contractor shall not use the words "Area Agency on Aging for Southwest Florida, Inc. anti/or Stale of
Not Department of Elder Affairs" to indicate sponsorship of a program otherwise financed, unloss specific
written authorirnrion has been obtained! by the Agency prior to such use.
24. Assienments:
24.1 The Contractor shall not assign the rights and responsibilities under this contract without the prior written
approval of the Agency. Any sublicense, assignment, ea' b'ansfelotherwise Occurring without prior written
approval of Ills Agency shall constitute a material br'Cach of tits cost, act. fit the emit tile State of Florida
approves assipmoont ofthe Contractor's obligations, the Contractor remains responsible for ail workperfanned
and all expenses incurred in connection with this contract.
24.2 The Slate of Florida is, at till times, entitled to assignor transfer, in whole or part, its rights, duties, orobligations
under This contract to another goverlunemai agency in the State of Florida upon giving prior wrilel notice to tho
Contractor.
24.3 This contract shall remain binding upon Iho ancecssms in interest ordle Contraclm' and the Agency.
25. Subcontracts:
25.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually (initialled by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a
written document and subject to ally conditions of approval the Agency deems necessary.'llic Contractor further
agrees (hat the Agency will not be liable to the Subcontractor in any way in, for any reason. The Contractor, at
Its expense, shall defend the Agency against ally such claims.
25.2 The Contractor shall promptly pay tiny Subcontractors upon receipt of Ixlymcnl from the Agency or other slate
Agency. Failure to (oaks payments to cry Subcontractor in accordance with Section 287.0585, F.S., unless
otherwisc staled in the contract between the Contractor and Subcontractor, will result in it penalty as provided
by statute.
26. ludalended Cmmcily of Contractor
If is the intent and understanding of Ilia Parties (lint the Contractor and any of its Subcontractor are Independent
Conu'nctors And are not employees of the Agency, and the they shall nor hold themselves out as employees or agents
of Ilia Agency without prior specific authorization from Ilia Agency. It is the felher intent and understanding of the
Parties that the Agency does not control the enlployaram practices of tho Contractor and will not be liable for any wage
and hour, employment discrimination, or other labor And employment claims agninsl file
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Contractor or its Subcontractors. All deductions for social sociality, .withholding taxes, income laxes, contributions to
unennploynionl coopenselion funds, old all necessary Insurance for Ito Contrnctor are the sole responsibility of the
Connector.
27. Payment:
Payments shall be panic to the Contraclor for all completed and approved deliverables (units of service) as defined in
Attachment 1. The AGENCY Contract Manager will have final approval of lire Contractor's invoice submillod for
payment and will approve Ilia invoice fa• payment only If Contraclor lips met nll iepns 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 will) the provisions of Section 215.422, F.S. A Vendor Ombudsman has beeneetablished
within the Florida Department of Financial Services and play be contacted m 800-342.2702,
28. Return of Funds:
The Contractor still[[ return to the Agency any overpayments clue to unearned funds 01, funds disallowed, and any interest
attributable to such funds pumunnl to the terms and conditions of this contract, that were disbursed to the Contractor by
(he Agency, In the event that the Contractor or its Independent auditor discovers that an overpayment hasbeen made, the
Contractor shall repay said overpayment immediately, without prior notification from (he Agency. In file event that the
Agency first discovers an overpayment lilts been made, the AGENCY Contract Manager will notify, the Contractor in
writing of such findings. Should repnymenl not be nm(le forthwith, the Contractor shall be charged at thelawfd jute of
iula'esl on (he outstanding balance puooml to Section 55.03, F.S., nfer Agotcy notification or Contractor discovery.
29. Data Integrity and Safeeuo•dtae IDfor•natioa:
The Contraclor shall ensure an appropriate level of data security for the information the Contractor is collectngor rising
In the performance of this contract. An appropriate level of security includes approving and (racking all Contractor
employees that request system or information access slid ensuringthnl user access has been removed front all laminated
employees. The Contractor, among other requilCmeuts, nos[ anticipate and prepare for the loss of information
processing capabilities. All data and sofwarc shall he routinely backed up to ensure recovery from losses or pillages of
the computer system. Thesecutrity, over the backed -up data is to be as stringent as theplo(ection required of the primary
systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and
recovery. The Contractor shall complete slid sign the Certification Regarding Data Integrity Compliance for
Agreements, Grants, Loans, and Cooperative Agreements prior to ilia execution of this contract.
30. Computer Use and Social Melia Policy:
The Agency has Implemented a Social Melia Policy, in addition to its Computer Use Policy, which applies to all
employees, contracted employees, consultants, Other Pelsonnl Services (OPS) employees and volunteers, including all
personnel affiliated with third parties, such as, but not limited to, conuaeto:s and subcontractors. Any entity that uses
the Agency's computer resource systems must comply with the Agency's policy regarding social media. Social Media
includes, but is not limited to, blogs, po dents, discussion fprums, Willis, RSS feeds, video sharing, social networks like
MySpaee, Faccbook still T wittor, as well as content sharing networks such as flicks, and Youlfube. This policy is
available on the Agency's webste at; titter!/elderaffnis elate Il t s/Aocn/Onanciml.php.
31. Conflict of Interest:
The Contractor shall establish safeguards to prohibit enployees, board members, management, and Subennuaclom from
using Ihcir positions for a purpose [hill 00nslltnes or presents the appearance of personal or organizational conflict of
Interest or persomd gain. No employee, officer, or agent of the Contractor or Subcontractor shall Inulicipate in the
select loll or is the awnrd of a contract supported by slate or federal funds if a conflict of IinelList, real Or apparent, would
be involved. Such a conflict would arise when: (n) the employee, officer or agent; (b) any member of his/her immediate
family; (c) his or her per or (d) all orgalliealion 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.'rhe Contractor's Or Subcontractor's offices,
ennployem, or agents will neither solicit nor accept gratuities, favors, or anything of monetary value front Contractor,
potential Coral actors, or parties 10 Subcontracts, ']'lie ConmPetot''s bear (I mrember's and nmnageln rid must disclose to Ills
Agency ally relationship which play be, or may be perceived to be, a conf let of hit crest within thirty (30) calendar days
of all Ipill vidual's original appol remelt of placement in (lull Posit 1011, or, If the indl vi(hlal Is aavhag as all Incumbent,
wl tam thirty (30) calendar days of Ilie co111111ellmlleat of Iilis conh'act. 'I lie Coat Inotar's employees and
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Suleordmolors rams( make Ito same disclosures described above to Ile Contractor's board of directors, Compliance
with this provision will be mordlored.
32. Public Entity Crhnnct
Pursuant to Section 287,133, F.S., a person or al'liliate who lies been placed on the Convicted Vendor List following a
conviction for a public entity crime may not submit a bid, proposal, or reply oil a contract to provide any goods or
services to a public ontity; 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, o• replies on lenses of real property to a
public entity; rely not be awal'ded or pelforal Work its a contractor, Supplier, Subcono'actor, or Consultant under a
contract with any public entity; and may not transact buldness with any public entity in excess of the threshold annual
provided in Section 287.017, ISS., for CATEGORY TWO for a period of thirty six (36) months following the date of
being placed on the Convicted Vendor List.
33, purchasing:
33.1 The Contractor shall procure products and/or services required to perform this contract in ac(en]anco with section
413.036, F.S.
33.1.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES THAT ARE THE
SUBJECT OF, OR REQUIRED I'D CARRY OUT, THIS CONTRACT SHALL BE PURCHASED FROM
A NONPROFIT AGENCY FOR THE BLIND OR FOR THE SEVERELY I IANDICAPPED THAT IS
QUALIFBR AND
UNDER'THE SAME PROCEDURES SUF FOR 'ill IN SECTION IDA S413.036(1) AND 2,FLORIDA
S'rATUTFS; AND FOR PURPOSES OF THIS CONTRACT THE PERSON, FIRM, Olt 0T1113R
BUSINESS ENTITY CARRYING OUT THE PROVISIONS OF THIS CONTRACT' SHALL BE
DEEMED TO BE SUBSTITUTED FOR THE STATE AGENCY INSOFAR AS DEALINGS WITH
SUCI I QUALIFIED NONPROFIT AGENCY ARE CONCL'ItNED.
33.1.2 Pursuant to sections 413.036(1) and (4), F,S., the Contractor shut] lint be required to procure a product or
service from RESPECT if; (a) the Imodool or service is not available within a reasonable delivery Ihno, (b)
the Contractor is required by law to procure (lie product or service Bum any agency of the stale, or (c) the
Contractor determines that the performance specifications, price, or quality of the producl or service is not
comparable to the Conh'acuies requiuonenis.
33.1.3 This act shall have precedence over any Inv requiring stale agency procurement of products or services
front ally Other nonprofit corporation unless such precedence is waived by the Agency in aceordanoe with
its rules.
33.1.4 Additional information about the designated nonproRl agency and the products It offers is available at
hltp://www. respeclofiloi(la.org.
33.2 Tine Conirnclashall procure any recycled precincts or materials which are the subject of, or are required to nary
out, this contract when the Department of Maageleeat Services determines that those praducts arc available, in
accerdaee with the provisions of section 403,7065, F.S.
33.3 The Contractor shall procure products and/or services required to perform (his contract in accordance will)
section 946.515, F.S.
33.3.1 1'I' IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES WHICH ARE THE
sUB1ECr OF, Olt REQUIRED TO CARRY OUT, THIS CONTRACT SHALL BE PURCI IASF.D FROM
THE CORPORATION IDENTIFIED UNDER CHAPTER 946, F.S., IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET PORTII IN SECTION 946.515(2) AND (4), F.S.; AND FOR
PURPOSES OF TI IIS CONTRACT" THE PERSON, FIRM, Olt 0'1'f1LR BUSINESS ENTITY CARRYING
OUT THE PROVISIONS OF THIS CONTRACT SHALL BE llL'EMED TO BE SUBSTITUTED FOR
THIS AGENCY INSOFAR AS DEALINGS WITII SUCI I CORPORATION ARE CONCERNED.
33.3.2 Tile corporation IdenliBal is Prison Rehabilitative Industries and Divosified Enterprises, Inc. (PRIDE).
Additional information about PRIDE and the c0000dillos or contractual services it offers is available at
hlgns://pride-cnto•prises.orp/. O
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33.4 The Contractor shall provide a Certified Minority Business Subcontractor expendi(nre (CMBR) Repoli
summarizing the participation of certified suppller:s for the current sporting period and projecl Ip dato. The CMBE
Report shall include lice annual, addresses, end dollar amount of each certified participant, and a copy must be
forwarded to the Agency, Division of Financial Administration, and runs( accompany each invoice submitted to
the Agency. The Office 01' Supplier Divosby (850-487-0915) will resist in furnishing nonms of qualified
nnbilo-hics. The Agency's Minority Coordinator (850-414-2153) will assist with questions and answers. The
CMBR Report is attached to this contract.
34. Patents, Convr•iehts, Revalues:
If this contract is awarded state funding unit if any discovery, invention, or eopyrigirinble material is developed or
In oduced In Ore course of or as a result of work or services performed under this contract or in any way connecledl with
this contract, or if ownership of any discovery, invention, or copyrightable, material was purchased in the course of or
its a result of work or services performed under this contract, the Contractor shall refer the discovery, invention, or
copyriglaable nmterial to the Agency to be referred to the Doparanenl of State. Any and all patent rights or copyrights
accruing under (his contract are hereby reserved to the Stoic 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.
34.1 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 pursuont to (his Section 34.
34.2 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.
34.3 Notwithstanding the foregoing provisions, if the Conrnctor of one of Its Subcontractors is a university and it
member of the Slnle University System of Florida, then Section 1004.23, F•S., shall apply, bill the Agency shall
retain it perpetual, fully -paid, nonexclusive license for its use told the use of Its Contractors, Subcontraclors,or
Assignees of oily resulting relented, copyrighted, or Trademarked work products.
35. Emergency Preparedness and Continuity of0noathave
35.1 If the tusks to be performed pursuant to this contract include (lie physical care and control of climes, or the
administration and coordination of services necessary far client health, safety, or welfare, the Contractor shall,
within thirty (30) calendar days of the execution of this contract, submit to the AGENCY Contract Manager,
verification of oil emergency Preparedness Plan. In the even( of an ernergeoy, the Contractor shall notify the
Agency of emergency provisions.
35.2 In the evenl a situation results in a emotion of services by a Subcontractor, the Contractor shall remain
responsible for porformance under this contract and must follow procedures to ensure conlinnily of operations
Without interruption.
36. Eaninment:
36.1 Equipment means: (a) tangible persmml properly (inciading information technology systems) havinga eseNl life
of more Iran one yearand a pe,unil acquisition cost which equals or exceeds the lesser ofthe capitalizallon level
established by the organkation for the financial statement purposes, or $5,000.00 [for federal funds - 2 CFR §
200.33 and 45 CPR § 75.2, as applicabto], or (b); nonexpeadidl e, langibhe personal property are non -consumable
nature with an acquisition cost of $5,000.00 or name per unit, mud expected useful life of al least one (1) year;
and hardback bound books not circulated to students or the general public, with a vnduc or coil of$250.00 or
aloe [for state funds].
36.2 ConO•actor:c and Subcontractors who are Institutions of Higher Education, Hosphals, and Other Non -Profit
Organizations shall have wril(en property rnamgennent standards to connpliance with 2 CFR Part 200
Adminislrmive Requirements (fanncry OMB Circular A-110) that include: (EQ a property list with aft gee
elements identified inthe circular; (b) a procedure for conducting n physical inventory Of equipmenl ill least once
every live (2) years; (c) a control system to insure adequate safeguards to prevent loss, damage, Or (hell of floc
equipment; and (d) malatonance procedures to keep the equipment in good condition. The property records gust
be maintained on file and shall be provided Ia the Agency upon request. ']lie Contractor shall promptly
investigate, filly document, and notify the AGENCY Cerntlaei Manager of any loss, drnnago, or thefl of
equipmenl: file Contractor shall provide the msulls of the investigation to the AGENCY Contmcl Manager.
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36.3 The Contractor's properly mmnagenlent Matricide for equipment (including replacement equipment), whether
acquired in whole or in par( with federal funds and federally -owned equipment shall, at it ardidn um, nleel (he
following requirements rind shall include accurately nlahuained equppnenl records will) the following
information:
36.3.1 Properlyrecords runs( bemalnti fined that includoatlescripton of the equipment;
36.3.2 Mamfacturces serial number, model number, federal stock number, national stock number, or other
Identification munber;
36.3.3 Source of funding for the equipment, including the federal award Identification number;
36.3.4 Whether title vests in the Contractor or the federal government;
36.3.5 Acquisition due (or data received, if the equipment was furnished by the federal government);
36.3.6 Information ficnl which one can calculate the percentage of federal prulkipallon in the CDs( of the
equipment (no( applicable to equipment furnished by the federal government);
36.3,7 Location, use mid condition of the equipment and the dale the information was reported;
36.3.8 Unit acquisition cost; still
36.3.9 M innate disposition data, Including date of disposal slid sales price or the method used to determine
current fair ntarkel value where a Contractor compensates the federal awarding agency for its share.
36.3.10 A physical inventory must be taken, and the results reconciled with the property rocords at least orae
every two (2) years.
36.3.11 A control system must be developed to ensure adequate safeguods to prevent loss, damage, or Ilion of
Ilse properly. Any loss, damage, or then must be investigated. 45 CPI( § 75.320((I)(3).
36.3.12 Adequate rnalolenance procedures must be developed to keep the property in good condition.
36.3.13 If the Contractor is aulhortrcd or required to sell the equipment, proper sales procedures must be
established to unsure the highest possible return.
36.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with
state funds with an acquisition cost over $5,000.00 is pint 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 CPR § 200313(a)
and 45 CFR § 75320(a), as applicable), subject to the conditions of 2 CPR Part 200 and/or 45 CPR Pori 75.
Equipment purchased tinder those thresholds is considered supplies and is not subject to property standards.
Equipment purchased with funds identified ;n the budget attachments to agreements covered by this contract or
identified in the sub-agrocmonts with Subcontractors (not included in a cost methodology), is subject Io the
conditions of Chnpler 273, P.S., rule 60A-1.017, 11. A. C., and 2 CPR Part 200 and/ar 45 CFR fort 75,
36.5 The Contractor shall not dispose of tiny equipment or materials provided by the Agency or purchased with funds
provided through this contract wilhout first obtaining the approval of the AGENCY Contract Manger. When
disposing of properly or equipment the Contractor must subsoil a written request for disposition instructions to
the Agency's Contract Manager. The request should include a brief description of (he property, purchase price,
funding source, and percentage of slate or federal participation, acquisition date and conditionof the property.
The request should also indicate (he Contractor's proposed disposition of the property (Le,, transfer or donation
to another agency flat ninlinislera federal programs, offll of the items for sale, destroy the items, etc.).
36.6 The AGENCY Contract Manager will issue disposition instructions. If dispositun 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 CPR § 200.313 or 45 CFR § 75.320, as applicable.
36.7 Reap property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property rally not be purchased will) slate or federal funds
through agreements covered tinder this contract withotit tile prior approval of the Agency. Reap property
purchases from Older Americans Act funds are subject to the provisions ofTite 42, Chapter 35, Subchapter In,
Part A, Section 30306 United Stales Code (U.S.C.). Reap property parehaaea non state funds am only be sonde
through fixed capital outlay grants and aids appropriations slid therofine use subject to the provisions of section
216.348, P.S. O
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36.8 Any permanent storage devices (e.g.: hard drives, removableslornge media) must be reformatted and Tooled prlor
to disposal to ensure no confidential Information remains.
36.9 'Ilto Contactor nmst adhere to the Agency's procedures and standards when purchasing Information Technology
Resournes (ITR) as part of any agreemenl(s) incorporating this contract by reference. An ITR wortsheel is
required for any computer relnied item costing $1,000.00 or Pore, including (lain processing hardware, software,
services, supplies, maintenance, training, personnel, and facdhies. The completed In workshcct shall be
maintained in the LAN administrator's file said must be provided io llne Agency upon requesi.'rlio Contracts• hits
(he responsibility to require any Subcontractors le comply with the Agency's ITR procedures.
37. PUR 1000 Form:
The PUR 1000 Form Is hereby incorporated by reference and available at:
htiv.//ww mXflorido.com/npns/vbVadncM7740 PUM000.ndf
In the even of any connlcl between Ito PUR 1000 Form and any Isms or conditions of (his contract, the terms or
conditions of this contract shall take precedence over the PUR 1000 Point. However, if the conRicling terms or
conditions in the PUR 1000 Fornn ore required by any section of the Florida Statutes, the Terms m conditions contained
!n the PUR 1000 Form shall lake precedence.
38. Use of State Funds to Purchase or Lunrove Rea] Property:
Any slate funds provided f'or the purchase of s• innprevsncnls to real property arc contingent upon fire Contractor at,
political subdivision granfing to the since securily interest in the properly al least to the amount of state finds provided
fore( least five (5) yeas from the dnicof purchaseor the completion of the improvements or as further required by law,
39. Uismde Resolution:
Any dispute concerning performance of the contract shall be decided by the AGENCY Contract Manager, who shall
reducelhe decision to writing and serve a copy on the Connector.
40. Financial Cmrsemsnces:
If lino Conti ac it fails in meet the minimum level of service or performance ideall0ed in this conract, the Agency shall
impose financial consequences as stated in Attachment I.
41, No Waver of Save cien Inunnnliv:
Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
42. Venue:
Iraq dispute miser out oi'(h!s contract, the venue of such legal recoorseshall be Lee Couoy, Florida.
43. Entire Conhecb
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 tiro Contractor unless expressly contained herein or by a written amendment
to this contract signed by both parties.
44. Fare Me leure:
'file Parties will nol be liable for any delays or fullures In performance due to circumstonecs beyond [hell, control,
provided the party experiencing (he force nnnjene condition provides lnunedinlo written notification to the other party
and Inkes all reasonable efforts to cure the condition.
45. Scverabliifv Couse;
The Parties agree that Ira Pond of compsenl jurisdiction deems any term or condition herein void or unenforceable,
the otter provisions are sevemble to Ito void provision and shall rennin In Rill force and effect.
46. CmuROon Precslenl to Contract Apm•oorlatiots;
The Parties agree that the Agency's performance and obligation in pay under this contract are contingent upon till annual
appropriation by the Legislature.
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July 2021- June 2022)
47, AddillonlDeletion:
ADI203.21
The Parties agree dun the Agency reserves the right to add or to delete any of f is services required under this contract
when deoned to be in the State of Florida's best interest and minced to a written amendment signed by both Parties.
The Parties $ball negotiate conpellsatlon for tiny additional services added.
48. Waiver:
The delay or failure by the Agency to exercise or enforce tiny 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 tiny single or partial exercise of any
such right preclude any other or further exercise thereof or file exercise of any office right.
49, Compliance:
The Contractor shell abide by all applicable current federal statutes, laws, rules, and regulations as well as applicable
concnt state statutes, laws, rules and regulations. The Parties agree that failure of the Contractor to abide by these laws
still[[ be deemed an event of default of the Contractor and subject the conh'act to immediate umllateral cancellation of
the contract at the discretion of the Agency.
50. Fine[Invoice:
The Conlraclor shall submit the final invoice for payment to the Agency no Inter then thirty (30) days after the contract
ending date unless otherwise specified in Attachment 1, If the Contactor fails to do so, all right to paymonl is forfeited
and the Agency shall not honor any requests submitted after the aforesaid time period. Any paynwnt due under the terms
of this contract shelf be withheld until all required documentation and reports due from the Contractor and necessary
adjustments thereto have been approved by the Agency,
51, Remtodations ofModificatiohls:
Modifications of file provisions of this contract shall be valid only when (hey have been reduced to writing and duly
signed by both parties.'1'he rate of payment and the total dollsamount may be adjusted re(rwelively to reflect price
level Increases and changes in the rate of payn a ll when III= have been established through the appropriations process
and subsequently identified in (fie Agency's operating budget.
52. Suspension of Work:
The Agency may, in its sole discretion, suspend any or all activillos under the contract o• purchase order, at any time,
when f l tine interest of the Slate to do so. The Agency shall provide lire Contractor written notice outlining the ptu1iodais
of suspension. Bxanlples of the reason for suspension include, but are not tinted to, budgetary constraints, declaration
of emergency, or other such circumstances. After receiving a suspension notice, Ile Contractor shell comply with the
notice and shall not accept any purchase ceders. Within ninety (90) days, or tiny longer period agreed to by the
Contractor, the Agency shall tither: (1) Issue a notice authorizing resunhpton of work, at which time activity shall
resume, or (2) terminate the contract or purchase order. Suspension of work shell not entitle the Contractor to any
additional compensation.
53. Termination:
53.1 Termhlation for Convenience. The Agency, by written notice to the Contractor, cony temlinatc tills contract fn
whole or in pail when the Agency de(erminos in its sole discretion that it is In the Slates Interest to do so. The
Contractor shall not furnish any product alter it roecivos the nolico of ha rniontion, except as necessary a complete
the confined portion of this contrac(, if any. The Contractor shall not be entitled to recovor any cancellation
charges or lest profits.
53.2 Terminal for Cnnse.Thc Agency may leralinae this contract if the Contractor fails to:(() deliver the product
within the time specified in the conlrocl or' nay extension, (2) nnnintain adequate progress, (husendangering
pal fo rmnnce of the contract, (3) honor any torn of the contend, or (4) nblde by any statutory, regulatory, or
licensing requirement. Rule 6OA-1.006(3), F.A.C., govems the procedure and consequeees of default. The
Contractor shell continue work on any work no( lerminatel. Fxecpl for defaults of Submilractom at any tier, the
Contractor shall not be liable for any excess costs if the failure to perform the contract arises O'onevents
completely beyond the control, and without the fault or negligence, of lie Contractor. If the failure to perform is
unused by the defnufl ore Subcontractor at any tier, and Mile cause of the defitull is completely bcyoullho control
of bout the Conlractor and the Subconracto, and without the fail]( or negligence of either, the
eft
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13 of 63
duly 2021- .Jane 2022) AD1203.21
Contractor shall not be Itablo for any excess costs for hdhire to perfo'nn, unless (tie subcontracted products were
obtainable front other sources in suf0oiotl limo for the Contractor to meet the required delivery schedule, If,after
termination, it is determined Iha( the Contractor was not in default, o' that the default was oxcusable, Ilia rights
and obligations of (he Parties shall be (he sane as if Ilia termination tied been issued for the convenience of Ilia
Agency. The rights and remedies of fire Agency In this clauso are in addition to any other rights and remedies
provided by low or under the contract.
$4. Electronic Records mr<I Signature:
The Agency authorizes, but does not inquire, Ilia Contractor to create and retain electronic records and (o use electonic
signatures to conduct Iransactions necessary to carry out Ilia loans of [his contract. A Contractor (lint crcateannd retains
eleclrotio records nnA uses electronic signatures to conduct transactions shill comply with the requirenncntscolairred in
the Uniform Lriceironic Transacllon Act, Section 668.50, R.S. All electronic moods most be fully lard liable; are subject
to Florida's Public Recoils Law, Chapter 119, P.S.; must comply with contract Section 29, Dalalntegrity and
Safeguarding Information; nest maintain all confidentiality, as applicable; and must be retained and maintained by the
Conlracter to the same extent as non -electronic records are minined End nlaintalned as required by this contract,
54.1 The Agency's authorization pursuant to Ibis secllon does not authorize electronic transactions between the
Contractor and Ilia Agency. The Contractor is authorized to conduct cleco unit transactions with Ilia Agency only
upon further written consent by the Agency.
54.2 Upon request by the Agency, the Contractor shall provide file Agency with non -electronic (papor) copies of
recorcis.Non-clectronic(pnpur) copies provided tothe Agency of tiny docunton(thal was originally inelectronic
form with an elcoh 011ie signature rims( identify the person and the poison's capacity wha electronicnllysigned the
document on any non -electronic copy of the dacarneal.
55. Contract Mmmger:
'I'he Agency arty snbstitutc any Agency eng)loyee to serve as Ito ACPNCY Contra[ Managot
REMAINDER OF THE PACEIN'I'ENITONALLY LEFT RLANIC
C Qv
14 of 63
July 2021 - June 2022) ADI 203.21
56. Official Payee and Reoresentntives (Names, Addresses, and Telcnhono Numbers):
The Contractor name, as shown on page I of this
Collier County Board oTCounty Connnissionors
3329 E Ta ail Building li
n.
contract, and mailillg address of the official payee to
leaian
Naples , , FLL 34112
whom Ito Iwynrcnt shell be ]]rude is:
The name of the contact person and street oddness
Kristi Solmlag, Director
1,
where financial and administrative records are
Collier County Bond of County Comnilssionerx
maintained is:
3329 E Tamiami Trail Building H
Naples, FL 34112
239-252-2273
The name, address, and telcpbone number of Ilw
Kristi Sunning, Director
Collier County Board ofCouniy Commissioners
c,
representative of the Conlraclor responsible for
3329 F. TaleTrail Building FI
ndministrnllon of the program kinder this cmdract Is:
Naples, FL 34112
239-252-2273
Area Agency on Aging for Southwest Florida, Inc.
The section and localion within the Agency where
2830 Winkler Ave., Suite 112
d,
Requests for Payment and Receipt and Bxpeaditure
Fort Myers, FL 33916
fomns me to be moiled is:
239-652-6922
Richard Cocchieri, Director of Pinance
The name, address, and (clephone numbo. of Ile
2830 Winkler Ave, Suite 112
Contract Malinger for this conluct is:
Fort Myers, FL 33916
239-652-6922
Upon change of representatives (names, addressee, telephone numbers) by either party, notice shall be providedin
writing to the other party.
57. All Terms and Conditions Included:
This contract and its Attachments I - XVII, including any exhibits referenced to said attachments, together will) any
documents incorporated by reference, contain till the terms kind conditions agreed upon by the I'arlies. There are no
provisions, Ions, conditions, or obligations other then those contained herein, and this contract shall supersede till
previous communications, representations, or agreements, either written or verbal, between the Parties.
By signing this contract, the Parties agree (till( they have read and agree to the entire contracl.
IN WITNESS WHEREOF, the Parties hereto have canned this sixty-three (63) page contract to be executed by their
undersigned omcinls as duly authorized.
CONTRACTOR: COLLIER AREA AGENCY ON AGING FOR
COUNTY BOA 'COUNTY SOUTHWEST FLORIDA, INC.
COMM[S 1 ILR9
SIONBD BY: SICiNBD BY\`-// (J"CJl3�
NAME:: Daniel R Ro uez NAME: Norma Adorno
'TITLE: Public Service Department Head 'TITLE:
DATE: 08/ I..3/2021 DATE:
CEO
August 18, 2021
Approved as to form and legality
-� rederal'1'm ID: 59-6000558 �\ ��y CO
15 of 63 errant County Allorney
O
July 2021 • Jiwc 2022) ADI 203.21
INDEX OF ATTACHMENTS
A'TI'ACHMENT I ................................... 17
S%A7L'MEN'I'OF IVORK... ....................................................................................................................... .................... .... 17
]MACHMsNT 11...................... ..................I..........31
I+INANCU L AND COMPLIANCE AUD17 ............................_...................................,..................................................... 31
ATTACHMENTIII............................................................................................................................................I...............37
CRIUMIC117TONS AND ASSURANCES ......................................................................................................................... 37
ATTACHMENTIV............................................................................................................................................................42
ASSURANCES—NON-CONSTR UCTION PROGRAMS.................................................................................................. 42
A'I'1'ACHMENT V............................... .... .... ...................... ...... ..... ......................... ........................... .................. I............ 1.44
FLORIDA DEPARTMENT OF ELDER APPAIRS CIVIL RI6'IITIS COMIUANCE CHYCKLIST.................................
44
ATTACHMENTVI............................................................................................................................................................49
CONTRAC.'TOIYS STATE CONTRA CT LIS1....................................................................................................................
49
ATTACHMENTVIII..............................................................................................................................I.........................51
CERTIFIED A41N0121TYDUSINFSSSUECONTRAC'1'01i F.XPENDPf'URES (CAME FORM) ......................................
51
A'Tl'ACHMEN'Y IX...........................................................................................................................................1................53
INVOICERRPORT SCHEDULF......................................................................................................................................53
ATTACHMENTX...................................... ........ ........... —,.... ............................. ,........ .... ...................................................
54
ANNUAL BUDGET SUMMARY ........................... .................................................... ...... .................. ............ I... I...............
54
ATTACHMENTXI............................................................................................................................................................
55
REQUEST FOR PAYMEN7....................... .......................................................................................................................
55
ATTACHMENTXII............................... ............. ..... ........... .... ............................................................... ...................
...... ...56
RECEIPT AND FXPENDIT'URE RL'PORT......................................................................................................................
56
ATTACHMENTXIII.........................................................................................................................................................
57
ANNUAL MODEL DAYCARE CENTER 77AINING REPORT......................................................................................57
ATTACHMENTXI V............................................... ............................ ............. ......... .... ..... ......... ..... I ........................
I ...... . 58
COSTREINIIIURSFAIF.NTSiIMMAR]'........................ ............................. ......... ............................................. .............
....5E
ATTACHMENTXV...........................................................................................................................................................
59
SERVICER/17P REPORT................................................................................................................................................
59
ATTACHMENTXVI.........................................................................................................................................................
60
S11.VER ALERT PROTOCOLS ................ .......................................... ... ........ ..................... ..................... I .... ...................
.. 60
ATTACIMENTXVII........................................................................................................................................................
62
AGING AND DISARILITYRESOURCE CENTER (ADRC) SILMR ALERT.SERVICES REF'L%RRAL FORM ................
62
16 of 63
;July 2021- Juno 2022) ADI 203.21
ATTACHMENT I
STA'ITMENT OF WORK
ALMEIMER'S DISEASE INMATIVE PROGRAM
1. SCRVICESTO RE PROVIDED
A. DefhdtionsofTer•ms
Acronyms
Alzheimer's Disease (AD)
Alzbeinner's Disease Initiative (ADI)
Activities of Daily Living (ADL)
Area Agency on Aging (AAA)
Assessed Priority Consumer List (APCL)
Adult Protective Services (APS)
Client Information and Registration Tracking System (CIR'1'S)
Community Care for Disabled Adults (CODA)
Corrective Action Plan (CAP)
Dementia Care & Care Initiative (DCCI)
Department of Elder Affairs (DORA or Department)
Florida Administrative Code (F.A.C.)
Florida Statutes (F•SJ
I long Caro for Disabled Adults (I ICDA)
Instrumental Activities of Daily Living (IADL)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
Summary of Programs and Services (SOPS)
United Slates Code (U.S.C.)
2. Program -Specific Terms
Area Pinar: A plan developed by the Contractor outlining a compiclonsive and coordinated service delivery
system in the respective Planing and Service Area, In accoxla im with Section 306 of the Older Americans
Act (42 U.S.C. § 3026), as amended, and Agency Instructions, The Alto Plan includes performance memories
and unit rates per service offered per county.
Area Plan Update: A rcvlsion to Zile Area Plan wheroin the Connector cigars ADI-specific data into the
CIR'I'S. An update may, also include other revisions to the Area Plan as instructed by the Agency.
Department of Elder Affairs Handbook: An official document of DORA. The DOEA Handbook includes
program petioles, procedures, and standards applicable to agencies which are recipiaus/providors of DOEA
funded programs. An annual update is provided through a Notice of Instruclion (NOI).
Functional Assessment: A comprehensive, systoantic, slid multidimensional review of it person's ability to
romain independent and in the least restrictive living arrangement.
Memory Disorder Clhde (MDC): Research oriented programs crenated pulstnmu to Suctions 430.502(I) and
(2), R.S., to provide diagnostic and referral services, conduct basic and service -elated multidisciplinary
research, gild develop training materials and edmadional oppertanitios for try slid professional caregivers of
individuals wilt AD.
Notice of Instruction (NOI): 711e Department's established method to communicate, to the Contractor the
reflairement to perform a task or nativity. NOIs are located on (lie Departmetu's "bade at
hgtp://eldenf0rirsslote.fl.os/Aoeahnols. php.
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17 of 63 CY
;.July 2021-.tow 2022) AD1203.21
Proviso: Language used in it general appropriations bill to quality or restrict the way in which a specific
appropriation is to be expended.
Program Highlights: Success sim'i", quotes, testimonials, or vignettes that arc used in the
Deporlment's Summary of programs and Services (SOPS) to include information [lint helps tell the story of
how programs and services help elders, fllmlIles, unit caregivers.
Specialized Day Care: Licensed Speclatimd Alzheimer's Services Adult Day Core Centers, licensed in
accordance with Section 429.918, RS., tral are considered models because they provide specialized
Alzhcinim°s set vices for AD clients, I+Iuridaliexllhi'indm•gov provides xn up to dale listing of all Specialized
Alzheimer's Services Adult Day Care Centers,
Specialized AlAtehme's Se•vlem: Specialized Alzhehner's services, offered in day careceders include, but
are act limited to, those listed below:
1. Providing education and training fat thespecialized needs ofpersons with Alzheimer's disease or related
memory disorders and caregivers.
Pmvidingspecializedactivilicsihal piomole,ninininin,orenhaioetbe ADI Client'sphysical,cognitive,
social, spiritual, or emotional health.
Ill, Providing therapeutic, behavioral, health, safety, and sceurity interventions; clinical care, and support
services for the ADI client and caregiver.
Summary ofPrograns and Services (SOPS): A document produced by the Department and updated yearly
to provide Ilse public and the Legislature Willi Intel notion about programs and services for Florida's ciders.
D. GLrNGRALDLSCRIPTION
1. General Sinternent
The purpose ofthe ADl is to addtuss Ihespecinl needs of Individuals with AD, their families, and earegivois.
2. Alzltehner's Disease India live Program Mission Statement
The ADI program assists persons afflicted with AD and other forms of dementin to live as independently as
possible with support to family member and caregivers.
3. Authority
'llie relevant authority governing the ADI Program includes:
a. Role Chapter 58D-1, F,A.C.
It. Sections 430.501, 430.502, 430.503, and 430,504, F,S.; and
c. Cataloger Stale Financial Assistance (CSPA) Numbers 65004 and 65002.
4. Scope of Service
The Contractor is responsible for ilia programmatic, fiscal, and operational mmagement of the ADI Program.
The program services shot] be Provided in a niannar consistent with the Conu'actor's Area Plan, as updated,
and the current DOF,A handbook, which are incorporated by ivference. 'fhe Cortrsetor agrees to be board by
all subscqucnt amendments and revisions to the DOSA handbook, anti the Corurneer agrees m accept all such
amendments and revisions via a NO].
S MnJnr Program Goal
The major goal of Ilia ADI Program is to provide services to meet the needs ofoaregivers and individuals with
AD or other rotated disorders.
18 or63 GQ�0
:July 2021 - June 2022) ADf 203.21
C. Cllouts to bo Served
1. General Descrlplion
The AD) program addresses the special needs of individuals with AD or other related disorders laid Their
caregivers,
2. ClientItIlgibilty
Clients eligible to receive services under this contract muse
n. Be 18 years of age or older and have a diagnosis of AD or a related disorder', or be suspected of having
AD or a related disonler; or
p. If unrolled In Specialiced Alzlic nner's Services Adult Day Caro, be a parlicipant who has a documented
diagnosis of Alzhcinnor's disease or a dementia -related disorder (ADRD) from a licensed physician,
licensed physician assistant, or a licensed advanced registered nurse prnclitioner: and
c. Not be enrolled litany Medicaid capilated long -Term care program.
3. Targeted Groups
Priority for services under this contract will be given to those eligible persons assessed to be at risk of
placement in an institution.
d. Cllont Determination
'file Agency shall have Rnal nutho ily for the determination of client eligibility.
S Contract Limits
In no case shall the Contractor be required to !near costs more than the contract amount In providing services
to the clients.
6. Clients Served
This contract does not provide for direct services to clients other than intake, hdornlation and eferal services,
land screening.
IL MANNER OFSERVICR PROVISION
A. Service Tasha
To nchlove Iho goals of the ACT program, the Contractor shall perform, or ensure that its subcontractors perform,
file following tasks:
1. Client Eliglliltly Defervrhugion
The Conb•aclor shall ensure that applicant data is evaluated to determine eligibility, Migibility to become a
client Is based on meeting the requlminems described In Section I.C.2.
2. Assessment and Prioritization of Service Delivery for New Clients
The Contractor shall ensure the following criteria are used to. prioritize new clients is the sequence below for
service ticliveiy. ll is not tle inlont oflho Agency to nentovo oxisting clients from services to serve nev clients
being assessed and prioritized for service delivery,
a. Maniacal Risk individuals: Individuals in the community whose rental or physical health condition has
deteriorated to Ilse degree that self-rule Is nor possible, there Is no capable caregiver, and nureing lnenre
placement is likely whIlln a month or very likely within three (3) months.
b. Service priority for Individuals nor included above, regardless of referral source, will be dclomilned
through the Agency's functional assessment administered to erwh applicant, to the extent finding is
available. The Contractor shall ensure Ihat priority is given to nppiicanls at the higher levels of frailly and
risk of musing hone placement.
CAC)
19 of 63
)July 2021 - Juno 2022) ADI 203.21
3, Program Services
The Conh•ae[o• shall ensure the provision of program so, vices is consistent Willi the Con0•oe[or's current Area
Plan, as updated and approved by the Agency, and the current DOEA handbook.
4. •Posh Limi(s
The Contrnclor shall not perform any tasks related to the project other than those described in this contract
without the express written consent of (he Agency.
D. Ilse of subcodracto•s
If Inds conhact Involves the Ilse of a subconimctor, or third party, then the Contractor shall not delay the
implementation of Its agreement Willi file Subcontractor. If any chounis(ance occurs that may result in a delay far
a period of sixty (60) days or more of the initial ion of the subconbact or the performance of tho Subconlraclor, the
Contractor shall notify the Agency's Contrncl Monger and Ilse Agency's Chief Financial Officer to writing of
such delay, ']'lie Contractor shall not pewit a Subcontractor to perform services related to this contract without
having a binding Subcontractor agreement executed. The Agency will not be responsible in liable for any
obligations or claims mulling from such action.
1. Copies of Subcontracts
'Pine Contractor shall submit a copy of all subcontracts to the AGENCY Contract Manager within thirty (30)
daysof the subconh act being executed.
2. Monitoring the Performance of Subcontractors
The Contractor shall monitor, at least once per fiscal year, each of Its subcontractors, subrocipill vendors,
and/or conaullants paid from funds provided under [his contract. The Contractor shall perform fiscal,
administrative, and µogrammatic mentioning to ensure contractual compliance, fiscal accountability.
programmnalic performance, and compliance Willi applicable state and federal lows and reguhatlons. The
Contractor shall monitor to ensure (hat the budget is met, Ilse scope of work is accomplished within the
specified time periods, and other performance goals slated in (his contract are achieved.
3. Copies ofSubcontracto• Montloring Reports
The Contracloe shall forward a copy of all subconliaotor Monifoftng Reports to the AGI3NCY Contract
Manage'within thirty (30) days of the report being Issued to the Subcontractors, Subreclpicn(s, Vendors,
and/or Cellaml(anla.
C, Shifting Requirements
1, Shafting Levels
The Contractor shall assign its own adntinlstrnlive and supporl soffas necessary to nreel the obligations of
this contract and shall ensure tile( subcontractors dedicate adequate staff acconlingly.
2• Professional Qualifications
The Contractor shall ensure that (he staff responsible for performing any dutios or$nrcthans within this contract
have the qualifications us specified in the current DORA I landbook.
3. Service Times
The Contractor shall enure the availability of tiro services listed in (his contract at limes appropriate, to elect
client service needs Including, at n minhnum, doing normal business hours, or as otherwise specific([ in
proviso or the Subcontractor's approved service provider application. Normal business hours are defined as
Monday through Friday, 5:00 a.m. to 5t00 p.m. local time.
ll, Service Locntimr red L+gnlpmert
L So•vice Delivery Location
Services will be provided as needed in locations determined by provider to best elect clients' immediate
needs,
a
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20 of 63
:3tdy 202I - 311110 2022) ADI 203.21
2. Changes [it Location
The Contractor shall notify (be Agency in writing a minimum of one wock prior to making changes do
location Illut will affect the Agency's ability to contact the Contractor by telephone or facshnile.
3. Equipment
Contractor shall be responsible for supplying, at its own expense, all equipment necessary for Its performance
under the contract including, bill not limited 10, computers, tcicphones, copiers, fox machines, maintenance, slid
office supplies,
E. Deliverables
The following section provides the specific quantifiable units of deliverables and source doenmrematdon required
to evidence Idle completion of (he tasks specified in this contract.
Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services addressing the diverse needs of
Individuals with AD and their caregivers. The Contractor shalt ensure performance and reporting of the
following services in accordance With the Contractor's current Agency -approved Aron Plan, the current DOEA
Handbook, which is incorporated by reforenee, and Section II.A. of (]its con(mol. Decumenlation of service
delivery must include a repel consisting of the following: number of clients served, number of seiviceunits
provided by service, slid fate per service not With MICnINIICOS that equal the total invoice amount. The
conlinuttm of services provided under this contract include those ideinified by the following service categories:
is. Respite and Other Services
(1) CaregiverTminingfSupport.
(2) Case Aide.
(3) Case Management.
(4) Counseling(Geronlological).
(5) Counseling(Menlal Health/Screming).
(6) Educntio /Tiadning.
(7) Bntegency Home Delivered Shelf Meals
(9) Home Delivered Meals
(9) 1lonremaker
(10) Housing Improvement
(11) Intake.
(12) Material Aid
(13) Model Day Care.
(14) Personal Cairo
(15) Respite(Facllity-Bused).
(10) Respile(In-Homc).
(17) Rupile(In-Pacdlity, Specialized Alzheimer's services)
(18) Specialized Medical Equipment, Services, and Supplies; and
(19) Transportation.
(20) Shopping Assistance —COVID-19
(21) 'Telephone Reassurance —COVID — 19
Memory Disorder Clinics (MDCS)
'fie Contractor shau maintain coordination with Iho MDCs, the Alzheime's Disease and RelatedDiseders
Rcsomeh Brain Bank (Brain Bank), and all other components of the ADI, as Well as Silver Aler(,dn the
designated PSA. MDCs are required to provide annual in :service training to all respile, in-facillly Postpile,
Find model day coo center staff In their desiggated service areas, and to plan and develop sovdce-rodated
research projects with model day care center and respite providers. The Contractor shell respond to
requests for statistical data concerningils consumers, lined on Information requirements of (he MDCsand
the Brain Bank, and assist the MDCs in carrying out Silver Alerl protocol activities (Attachment XVI)to
Include return of the Aging and Disability Resource Center (ADRC) Silver Alert Services Referral Form
(Attachment XVII) to the referring MDC Wilhin fourteen (14) days of receipt.
21. of 63
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ADI 203.21
C. Model Day Cave Programs
The Contractor shall ensure Model Day Care Centers supported by this contract develop innovative
therapies and interventions which can be shared with other ADI health and social services personnel and
camidve:s via training. Model Day Care Centres supported by this contract must report to the Contractor
all training activities provided to health care and social service personnel and caregives, as well as serve
as natural laboratories for research.
2. Services find Units of Sevice
The Contractor shall ensure lied the pmvislon of services described in this contract is in accordance wlth the
current DOEA Handbook still the service tasks described in Section Ii.A. The Service Rate Report (Altechmen
XV) lists the services that can be performed, the highest reiinbesenenl unit rule, the method of payment, end
the service unit type, Units of service will be paid pursuant to file rate established in the Area Plait is updated,
as shown in the Service Rate Report, and approved by the Agency.
3. Administrative Responsibilities
'rhe Contractor shall provide management find oversight of ADI Illogical operations in accordance with the
current DORA handbook and the Agency -approved Contractor's Area Plan and Cos( Analysis. Management
and oversight of ADI progrnot operations include the Collowing:
a. Developing 0 Compcitive solicitation process for allocation of ADI fonds, including appeal procedures for
handling disputes involving Lend Agency.
h. Prepat'ingand revising the Area Plan update.
e. Designatingappropriade and capable Lend Agencies and establishing vendor agmentenls at the AAA level,
when applicable for Lead Agency and ADI services according to manuals, rules, and agmeuent procedures
of AGENCY,
d. Providing technical assistance to Load Agencies and vendors to ensure provision of quality services.
e. Monitoring and evaluating lead Agencies, subcontractors, and vendors for programmatic and fiscal
compliance.
f. Appropriately submitting payments to subcontractors.
g. Arranging in-service training for Lead Agencies al least annually.
it. Establishing procedures for handling recipient complaints concerning such adverse actions as service
termination, suspension, or reduction.
L Ensuringeanptiance with Client information and Registration 97acking System(CIRTS) regulations.
J. Monitoring performance objective achievements in accordance with largels set by the Agency.
It. Cooduclingeliern satisfactionsurveys to evaluate and improve service delivery.
I. Participating in at least one Dementia Care and Cure Initiative (DCCI) task force within the Contractor's
service area; and
tin, bnntodintely notifying the Agency's Emergency Coordinating Officer of any changes to nines and
contact Information made to the Conireclor's local Rntergcney Coordinating Offioer.
R. Rellorts
The Contractor shall respond to additional routine or special requests forinformation and reports required by the
Agency in a timely manner, as determined by the AGENCY Contract Manager. ']'be Contractor shall establish
reporlingdue dates for Subcontractors that permit the Contractor to meet the Agency's reporting requirements.
1. Area Plan Update and All Revisions Thereto
The Contractor is required to submit an annual Area Plan option, wherein the Contractor enters ADI-speoific
data do the CIR'rS. The Collimator may also be required to submit revisions to Ito Aron Plait as instructed by
the Agency,
2, CIIi'1'S RCpUr1Y
'ilia Contractor shall input ADI-specific data Into CIR'rS. To ensure CIRTS data accuracy, the Connector shall
use ClIVI'S-generated reports which include ilia following:
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a. Client Reports.
It. Monitoring Reports.
c. Services Reports.
d. Miscellaneoars Reports.
e. fiscal Reports.
f. Aging and Disabi lily Resource Center Reports.
g. Outcome Measurement Reports.
3. Almost Service Cost lieports
The Contractor shalt require subcontractors to submil Annual Service Cost Reports, which reflect actual costs of
providingeach service by program. This Annual Service Cost Report provides information for planning and
negotiating unit rates.
Lead Agency Spending Report
'Ilia Contractorshall submit a Lead Agency Spending Report, in a Ramat provided by the Agency, to the Agency
Contract Manager by the (18th) day of each month. This Lead Agency Report is for all agreements and contracts
between the Contractor and the Agency and nmst include the following:
a. A list of all subcontractors and their stators regarding surplus/defleil.
h. The Contractor's detailed plan on how the surplus/defrch spending exceeding the Threshold specified by the
Agency will be resolved; and
c. Recommendations to Transfer funds to resolve surpins/dolic t spending. Input front the Contractor's Board of
Directors on resolution of spending Issues, If applicable,
Program Highlights
The Contactor shall submit Program Highlights referencingspecifac events that occurred in SPY/FFY
2020-2021 by August 30, 2021.'ilie Contractor shall provide a new success story, conic, tostimonial, or hunian-
Interest vignette. The highlights shall bo written for a general audience, Willi no acronyms or technical terms. For
all agencies or organizations that are referenced in the highlight, the Contractor shall provide it brief
description of their mission or role. The active tense shall be consistently used in the highlight narralivo, to
identify the specific Individual or entlty That performed the activity described in the highlight. The
Contractor shall review and edit Program Highlights for clarity, readability, relevance, specificity, human
Interest, and grmnoar prior to submitting them to the Agency.
G. Records and Documentation
1. Regnexfs fur Pnpmmrt
The Contractor shall mainlaln documentation to support Requosts for Payment Ilia[ shot] be available In the
Agency or authorized individuals, such as the Department of Financial Services, upon request.
2. CIRTS Data and Maintenance
'fire Contractor shall ensure, monthly, collection and maintenance of client and service infomalion in CIRTS
or any such system dosignated by the Agency. Maintenance includes accurate and current data, and valid
exports and backups of all data and systems according to Agency standards.
3. CIRTS Address Validation
The Contractor shall work with the Agency to ensure client address are concoct in CIRTS for disaster
preparedness efforts. At least normally, and Ilse frequently as needed, the Agency will provide dlreclion on
how to validate CIRTS addresses to ensure these can be mapped, ilia Contractor will receive a list of
unnmiched addressed that cannot be mopped and the Contractor will Ira responsible fur working wlth the Lead
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Agencies to correct oddmsses and send it list to the Agency Willi confirmed addresses. The Agency will use
this information to update nnyn, client mslers, and unmatched mddresses to disseminate In the LenA Agencies.
4. Data Integrity and Bach up Procedures
Bach Contractor shall anticipate and prcpmo for the loss of information lion processing capabilities. The routine
backing up of all data and software is required to recover front losses or oulages of tho computer syslenn. Data
and software essential to the continued operation of Contractor functions must be backed tip.'1'he security
controls over the backup resources shall be its stringent as the protection required of the primary resources. A
copy of Ibe backed -up data shall be stored in a secure, offshe location.
S. Policies and Procedures for Records and Documentation
The Cunlmclor shall mainmin wriltcn polioios and procedums for computer syslen backup mill recovery and
shall have the stone requirement of its snbconh'actors.'I'hese policies and procedures shall be made available
to the Agency upon request.
H. Pei-fommiice Speciftcnttons
1. Outcomes and Ontputs (Performmlee Measures) .
The Contractor must:
a. Hostile the prioritization of clients and provision of services to clients in accordance Willi Section ILA.
above,
It. Unsure tine provision of the services described in this contract are in accordance with the current DOHA
Ilandbook and Seddon II.D. above.
e. Timely and accurately submit to the Agency all mquired documentation and mports described in Section
U.S. above; and
d, Timely (i.e. in accordance With the Annual Budget Sununauy) sill occamlely subnil the Request for
Payment, the Receipt and Expenditure Report, and the Annual Model Day Care Center Training Report,
and supporting documentation to the Agenoy.
2. Annual Programmatic Monitoring Report
Tire Contraotor's performance of the measures in Section ILIA. I., above, will be roviewed mid documented In
the Agency's Annual Progranunmic Monitoring Repot.
3, Monitoring and Rrmluatfon Methodology
The Agency will review still evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through dine contact with the Contractor via telephone, in writing, and/or on -
site visil(s). Tile Agency's determination ofaccephable performm¢c shell be conclusive. The Conhactor agrees
to cooperate with the Agency in monitoring the progress of completion of the service tasks and deliverables.
The Agency may use, but Is not limited to, one or more of the following methods for monitoring:
n. Desk reviews and analytical reviews.
b. Scheduled, unscheduled, and follow-up on-silevisits.
c, Client visits.
d. Review of lndeponderuinlilm•'s reporls.
c. Review of third -party documents and/or evaluation.
f. Review of progress reports.
g. Review of customer satisfaction surveys.
h. Agroid-upon procedures review by mrexternal auditoror consultant.
I. Linniled-scope reviews.
J. Other procedures as decmod necessary.
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1, Conlrnetor Accounlnhility
All service tasks and deliverables pursuant to (his contract tare solely and exclusively fhe responsibility of the
Contractor and are (asks and deliverables for which, by execulion of (his contract, the Contractor agrees to be
held accountable.
2. Coordination with Other Providers and/or Entities
Notwithstanding (list services for which (he Contractor is held accountable involve coorlinalion will) other
entities in performing ilia requirements of this contract, the failure of other entities does not alleviate the
Contractor from any accountability far tasks or Services that (la Conh'a0tor Is obligated to pel'fenn pursuant to
this contract.
J. Agency Responsibilities
1. Agency Obligations
'Ilia Agency may, within Its resources, provide technical support and assistance to the Contractor to assist ilia
Contractor in meeting file requiironenls of this contract. The Agency's support and assistanco, or Inokthereof,
shall not relieve the Contractor from full performance of contract requirements.
2. Agency Determinations
The Agency reserves the exclusive right to make certain determinations (n the tasks and approaches used to
perform tasks. The absence of the Agency selling forth a specific reservation of righis does not mean that all
other areas of the contmel are subject to mutual agrconnnt.
111. METHOD OF PAYMENT
A. Payment Methods Used
The method of Imyment for this contract is a combination of fixed Re/unit rate, cost roimbuaomed, and advance
payments, subject to (lie availability of funds and Contractor performance, The Agency will pay Ilia Contractor upon
safisfactory oonipletion of (he Tasks/Deliverables, as specified in Section II., Manner of Service Provision, andin
accordance with other terms and conditions oftlds contract.
1, Fixed ReelUnit Rate
Payments for Fixed Pee/Unll Rnteshall not exceed amounts oslablished in the Service Rate Report,
2. Cost Reimbursement
Payment may be authorized only for allowable expenditures which are in accordance with ilia services
specified in the Service Rate Ropoit. All Cost Reimbursement Requests for Payment mast inclulethe Receipt
and Expenditure Report, as well as the Cost Reimbursement Summary Porm, beginning with (he fiisl month
of this contract. Reimbursement amounts for administrative costs must be l•eflecfod on the Cost Reimbursement
Summary Form and Include only items contained on the Contractor's Cost Analysis Penn.
Advance Payments
'fhe Contr utor may request up to Iwo (2) months of advances a( the start of the contract Period to cover progrton
administrative and sevice costs. The payment of an advance will be contingent upon (lie sufficiency and amount
offends released to fhe Agency by the State of Floridn (budget relcase).'I'he Contractor's requests Fur advance
payments require the written approval of IheAgency's Contract Manager. For the first monlh's advance nattiest,
the Contactor shall provide to ilia Agency's Comm( Manager documentation justifying the need for an
advance and describing how the funds will be distributed. If the Contractor is requesting two
(2) months of udvanees, documentation must be provided reflecting the cash needs of the Conlrnetor within the
Initial Iwo (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.'1'11e Cnllrae(Or must also
describe how the funds will be distributed for the Rnsl and second month. If sufflcient budget is available, and
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Ilia Agency's Contract Manager, in his or her sole discretion, has delermicd [hat there is,juslifled need hbr an
advance, the Agency will issue approved advance payments a0cr July Isl of the contract your.
a. Any advance payntants Ilia Conimclor requests for subcontractors must be distributed within seven(7)days
of receipt of payment from the Agency. The Contractor shall submit to Ilia Agency documentation to
support full dish'ibullon of advanced funds with Report Number 5, (file to the Deparintent on October 10,
2021, in accordance with the Invoice Report Schedule (Attachment IX).
B. All advance payments retained by file Contractor mind be fully expended no later than September 30, 2021.
Any portion of advance payments not expendecl mind be recouped on tiro Request for Payment (Attachment
XI), Repel'1 Number 5, due to the Department on October 10, 2021, in accordance with the Invoice Repot
Schedule (Allachment IX).
c. All advance payments made to the Contractor shall be reimbursed to file Agency its follows: At least one —
tenth of the advance payment recelved shall be reported as na advance recoupnwnl on itself Bequest for
Payment (Allachmmnt XI), starting with Report Number 5, in accordance with the Invoice Report Schedule
(Altachment IX).
B. Pending Distribution
The Contractor agrees to distribute funds as detailed in the Area Plan nimble and the Annual Budget Similarly.
Any changes in the total iuounls of the funds identified on Ibe Budge Summary form require a contract
amendment.
C. Method of Invoice Payment
Payment shall be made upon the Contr'nclor's presentation of an invoice after file acceptance and approval by the
Agency of die deliverables shown on the invoice. no fe•m and substance of each invoice submilted by the
Contractor shall be as follows:
1. Have a Remittance Address that corresponds exactly to the "Retail To" address provided to
MyFloridaMarkelPlrco (MI+MP) during registration.
2. Request payment on a monthly basis for Ilia units of servicos established in tire Contractor's approved Area
Plan, provided in ennfornnace with the requirements as described in the curmnl DOBA I leuibook, at the rates
established in the Sevice Rate Report of this contract. Documentation of service delivery must include a report
consisting of file following: number of elicnts served, number of service units provided by service, andiato per
service unit will) calculations that equal the total invoice amount. Reimbursement amounts for administrative
costs must be roflocted on the Cost Ideimbm:semenl Sununaey Porm and include only items contained on the
Contractor's Cost Analysis Form. Any requested changes to the approved budget after the execution of this
contract nmsl be submitted to the AGBNCY Contract Manager for written approval. Any change to the total
contract anlouml requires a contract amendment.
3. The Contractor shall consolidate all Subcontractor. Requests I'or payment and Receipt kind 6xpendilur'c
Reports Ihsl support Requests for Payment and shall submit to Ilia Agency using fhe attached Request for
Pnymenl form, Receipt and fixpendituro Report, and Cold Rcbnbursement Summary for services and
administrative expenses, which must include ilcndznd expenditure categories; and
4. All Requests for Payment shall be based on the submission of monthly Receipt and Bxpendilurc Repels
beginning with the find month of this coulracl.'rhe schedule for submission of advance requests (when
available) and invoices is listed in the Invoice Schedule.
1). Payntartwldhholdhtg
Any payment due by the Department trader the lens of this contract jury be withheld pending the recelpt and
approval by the Agency of all financial and programmatic reports due 14om the Contractor slid may adjustments
thcrelo, including any disallowances.
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E. Pilot Invoice Instructions
The Contractor shall submit (he final Request for Payment to Ilia Agency no later than duly 25, 2022.
F. CIRTS Daft Entries for Subcontractors
The Connuctormusl require Subcontractors to enteral l required datafm•clicnis and services inlbe CIRTS database
per the current DOP.A handbook and the CIRTS User Manmd — Aging Provider Network users (located in
Docuntcnls on the CIRTS Enterprise Applicalion Services). Subcommo ot's must enter Mils (Into into the CIRTS
pilot to submitting their Requests for Payment and lieceipl and P,apcnditure Reports to the Contractor. The
Cortroc(or shall establish deadlines facompleting CIRTS deli entry and ensure compliance with duc dntas fo tlic
Requests for Payment and Receipl and Expenditure Reports that Connector must submit to lire Agency.
G. Subcontractors' Mofidy CIRTS Reports
The Contractor muss repnire Subcontractors to run monthly CIRTS reports and to verify that client slid service
(Into in (lie CIRTS is accurate. 'flits report must be submitted to the Contractor with the monthly Request for
Payment and Receipt and Expenditure Repot mid must be reviewed by the Conlrnclor before the Subconn'actor's
Rognest for Payment and Receipt and Expendi(uro Reports can be approved by the Contractor,
H. Corrective Acilmn Plan
1. Connector shall ensure one hundred percent (100%) of the deliverables identified in Section II.P..13 of this
contract are performed pursuant to contract requirements,
2. If a( any lime the Contractor is notified! by the AGL'NCY Contract Manager that it has felled to correctly,
completely, or adequately perform contract deliverables identified in Section ILP..1-3 of this contract, the
Contractor will have (on (10) days to submit a Corrective Action Plan (CAP) to the AGENCY Contract
Manage' (ha( addresses the deficiencies and slates how the deficiencies will be remedied within a time period
approved by the AOFNCY Contract Manager. The Agency shall assess it Financial Consequence for Non -
Compliance on (he Contactor as refocnced below in Section 111.1. of this contract for each deficiency
identified in the CAP which is no( corrected pursuant to the CAP. The Agency will also assess a Financial
Consequence fa' failure to timely submit a CAP. -
3. If IOc Contractor fails to correct an identified deficiency within file approved fine period specified in the CAP,
the Agency shall deduct the percentage established below in Section Ill.). of tills contract front the payment for
the invoice of the following month.
4. If the Contractor fails to timely submit a CAP, the Agency shall deduct (he percentage established below in
Section III.L ofthis contract for each day the CAP is overdec.'fhe deduction will be made from (he payment for
the invoice of the following month.
h FinnncfN Consequences
The Agency will withhold or reduce payment If the Contractor falls to perform ilia doliveables to Idle satisfaction
of the Agency According to the requirements referenced in Section H.E. of this contract.'rile following financial
consequences will be imposed if the deliverables stated do not must in part or in whole the performance criteria
as outlined in Section ILL. of this contract.
1. Delivery of scivfoes to eligible clients as referenced in Section II.A.I-3. and Section H.F.I. of this contract —
Failure to comply with established assessment and prlorltimtion criteria, as evidenced by CIRTS reports, will
result in a 2%reduction of payment per business day. Thereduction of paynnenl will begin on the frost business
shay following the Age ey's notification to the Contractor !bat the identified deficiency was not cured or
satisfactorily addressed in accordance with the Agency -approved CAP, referenced fit Section 111.11.
2, Administrative responsibilities as referenced in Section I1.E.3. of Ibis contract -- Failure to perform
nonagennon and oversight ofADI Program operations will result in a 2%reduction of psynneu per business
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clay. The reduction of payment will begin the Nsl business day following file Agency's notification to the
Contractor that the identified deficiency was not cared or satisfactorily addressed in accordance with the
Agency -approved CAP, referenced in Scclion II I.H.
3• 'Timely submission or a CAP— Failure to limely submit a CAP within tell (10) business days lifter notification
of a deficiency by the AGENCY Contract Manager will rcsull in a 2%reducldmn of payment per business day
the CAP Is not received.'Hle reduction of payment will begin the first business day following lite Agency's
notification to file Contractor that lice Identified deficiency was not cured or satisfactorily addressed in
necozionce with the Agency approved CAP, referenced in Section III.H•
4. Exceptions nrny be granted solely, In writing, by the AGENCY contract ninnnger.
IV. SPEClALPROVISIONS
A. Fhnd Budget and Funding Revislon Requests
Final requests for budget revisions or adjustments to contract finds based on expenditures for provided services
must bo submilled to (he AGENCY Contract Manager in writing no Inter Ihto June 30, 2022. Emit] requests are
considered neceplable.
11. Contractor's Finnacial GbligNions
1. Use of Service Dollars and Management of the Assessed Priority Consumer List
The Conhactor is expected to spend all funds provided by the Agency for the purpose specified in this contract.
For each program managed by the Contractor, lite Contractor must manage the service dollars in such a ntannor
to avoid having it wail list and a surplus of funds in the end of the contract period. If Ibe Agency determines
(lint the Contractor is not spending service funds accordingly, the Agency may it funds to other AAAs
doing the contract period and/or adjust subsequent funding allocations accordingly, as allowable trader state
and federal law.
2. Cost Sharing and Ca -payments
Personal to 430.204(g), the dollar amount far co -payments associated with any Alzbedmer's Disease titillative
programs must be calculated by applying the current federal poverty guidelines published by file U.S.
Department of Health and Human Services.
a. No co-paymonts will be assessed on it client whose laconic is at, or below, the federal povoty level
(PPL) as established each year by the U.S, Department of Health and Human Services.
b, No client rally have their services terminated for inability to pay their assessed co -payment, The
Conhaclor, in conjunction with provider agencies, must establish procedures to remedy financial
hardships associated with co -payments and ensure there is no interruption in service(s) for inability to
pay. if a client's co -payment Is ruduced or waived entirely, a written explanation for file change "mist
be placed in the client file.
C. Remedies fm•Nonconfmnthrg Services
1. 11m Connector shot] ensure that all goods and/or services provided undo this connect are delivered thmely,
completely, and commensurate with required standards of quality. Such goods condor services will only be
delivered to eligible prngram pmlicipanis.
2. If the Contractor falls to meet the prescribed qualily shntdards forsevices, such services will not be reimbursed
under this contract, in addition, any nonconforntinggoods and/or services not nneolingsuch standards will not
be reimbursed under Ibis contract. 'file Contractor's signature on the Request for Payment For"' mllifies
maintonanec of suppoling docannentalion and acknowledgement don the Contractor shall solely bear the costs
associated with prelaring or providing nonconforming goods and/or services. 'Phu Agency requires
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immediate notice of any significant and/or systemic infractions that compronriso file quality, security, or
conff slily of services to clients.
1). Incident deporting
The Contractor shall notify the Agency immediately bill no later than forty-eight (48) hours front the Contractor's
awarelloss or discovery of changes that may materially affect the Contrnclo' of any Subcontractor's ability to
perform the services required to be performed under this contract and in authorizing proviso. Such noliceshall be
made orally to the AGENCY Contract Manager (by telephone) with an email to Immediately follow, which shall
Include the Contractor's plan for provision of services authorized in proviso.
L. Investigation of Criminal Allegnflons
Any report that implies criminal Intent et the port of the Contractor or tiny Subwnlraciors laid referred to a
governmental or investigatory agency must be seal to the Agency. If the Contractor has reason to believe That iho
allegations will Ito referred to the Sale Ana'ney, a Inv onforcemeni agency, fhe United Slates Allorney's office, a] -
other governmental agency, the Coaractor shall notify the Inspector General at [lie Agency Immediately. A copy
of all documents, reports, notes, or other written material concerning the investigation, whother in the possession of
the Contractor or Subcontractors, most be still to the Depm•irent's Inspector General with a sta nney of the
investigation and allegations.
F. Volunteers
If applicable, the Contractor shall ensure the use of trained volunteers In providing direct services delivered to older
Individuals and individuals with disablikes flooding such services. If possible, the Contractor shall work in
coordination with organizations that have experience in providing training, placement, and stipends for volunteers
or participants (such as organizations carrying out federal service progrnuns administered by file Corporation fa•
National and Community Service).
G. Enforcement
1. In accordance with Section 430.04, F.S., life Agency may, without taking any intermediate measures flvnileble
to it against the Contactor, rescind fhe Contractor's designation as an AAA, If life Agency finds that any of the
following have aceui ml:
n, An intentional or negligent act of the Contractor lilts materially, affected the health, welfare, or safely of
clients, or substantially and negatively affected the operation of services covered pursuant to this contract.
b, The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual finds
have been misappropriated.
c, The Contractor ties committed nudliple or repeated violations of legal and regulatory raquiloRMIs,
regardless of whether such Imes or regulations are onfoced by file Agency, at tile Contractor has committed
multiple or repeated violations of Agency standards.
d. 'fhe Contractor has failed to continue (lie provision or expansion of services after the declaration are state
of emergency.
o, ';'Ire Contractor has failed to adhere to [lie terns of flits contract.
f. The Contractor has failed to properly deiennine client eligibility as defined by the Agency or efficiently
manage program budgets; or
g. The Contractor has failed to implement laid maintain a Agency -approved client grievance resolution
procelurs.
If the Agency finds (lint any acis listed in scefion MG, I.e. g. above have eecnrred, in accordance with Section
430.04, FS, the Agency may, in Its sole diserotim, lake intermediate measures affadrust file Contractor,
Including corrective action, unannounced special nronita'ing, lefnporuy assumption ofihe operation of ono or
more wnlrnefunl seviaes, phiMllenl of the Contactor at probationary slatrs, imposing a moratortunn on
Contractor notion, imposing financial penalties for nonporfornnerce, or other administrative action porsumn to
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3, In making any dolerninalion underthis provision,llic Agency may, rely upon findings of another slate or federal
agency, or other regulatory body. Any cinins for damages for breach of contract arc exempt fron ndninisumive
proceedings and shall be brought before the appropriate entity in the venue of Loon County, Florida, hi the
event the Agency initiates action to rescind an AAA designation, the Agency shall follow the procedures set
forth in 42 U. S. C. § 3025(b).
ENOOFA27ACHMENr
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A'1"I'ACIIMENT If
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Agency to the Contractor may be subject to audits and/or monitoring by
the Agency, as described in this section. '
MONITORING
In addition to reviews of audits conducted in accordance with 2 CPR Part 200 (fonooly OMB Circular A-133 as revised),
and Section 215.97, P.S., (sec "AUDITS" below), monitoring procedures only include, but not be limited to, on -site visits
by the Agency staff, flinherl scope audits and/or other procedures. By enledng into this contract, the Contractor agrees to
comply end cooperate with ally 111011hu ing procedures/processes domed appropriate by the Agency, III the event the
Agency determines that a limited scope audit of Ilia Contractor is appropririe, the Contractor agrees to comply with any
additional instructions provided by the Agency to the Contractor regarding such audit. 'file Contractor farther agrees to
comply and cooperate with any Inspections, reviews, invesiigrlions, or audits deemed necessary by [he Chief Financial
Officer (CPO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the Contractor is a Stole ar local government or a non-profit oganiallon as defined in 2 CPR Pad
200, Subpar(A.
In the event thin 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 whit ilia provisions of 2 CPR Part 200. Financial said
Compliance Audit Attachment, Exhibit 2 indicates federal resources nwilided through the Agency by (his contract. III
determining (he federal awards expended in ila fiscal year, the Conhmctor shall consider all sources of Pedernl awsnis,
Including federal resources received front the Agency. The determination of announns of Federal awards expended should
be in accordance with 2 CPR Par[ 200. An audit of the Contractor conducted by the Auditor General in accordance with the
provisions of 2 CPR Pat 200 will meet the requirements of this part.
fit connection with the audit requirements addressed in Par( I, paragraph I, the Contractor shall fulfill the requirenhenns
relaliva to auditce responsibilities as provided in 2 CPR § 200,508.
If the Conlrnclor expends less than $750,000.00 in federal awards in its fiscal year, an audit conducted in accordance with
the provisions of 2 Ch'R Part 200 is not required. In the event that the Contactor expends less then $750,000.00 in Want
awards in its fiscal year and elects to have an audit conducted in accodance with the provisions of 2 CPR Palt 200, nice cost
of the and!( must be paid font non-fedeal resources (i.e., the cost of such audit must be paid from Contractor rexourew
obtained from What than federal olities.)
An audit conducted in accordance with this part shall carer the entire organization for the organization's fiscal year.
Compliance findings related to contracts with tho Agency shall be based on the conh•net's requirements, including any rules,
regulations, or stalules referenced In the contract. The financial statements shall disclose whether or not the matching
requirement was act for each applicable contract. All gncxtioned costs and liabilities due to Oc Agency doll be filly
disclosed in the audit report with reference to fhe Agency contract involved. Mutt otherwise disclosed as required by 2 CPR
§ 200.510, the schedule of expenditures of federal awards shall identify expenditures by contract number for each contract
with the Agency in effect during the audit periol. Financial reporting packages required under this part must be submitted
within (he earlier of30 days after n:celpi of the audit report o• 9 months alter the end of the Contractor's ilscnI year end.
PART Il: STATE FUNDED
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This pail is applicable if the Coun'actor is a non -stale entity as defned by Section 215.97(2), F.S.
in ilia event that ilia Contractor expends a total amount of state fnaceial assistance equal to or in excess of $750,000.00 in
any fiscal year of such Contractor, Ile Contractor must have a Stntc single or project -specific audit for such fiscal year in
accordance with Section 215.97, F.S.; applicable rates of the Deparhneul of Financial Services; and Chapter 10.550 (local
governmental entities) or 10.650 (nonprofit and fo�pmfit organizations), Rides of the Auditor Oenerl. Financial
Compliance Audi( Attachment, Rxhibil 2 indicates state financial assistance awarded through the Agency by this contract.
In determining the slate financial assistance expended in its fiscal year, the Contractor shall ccaudder• all sources of state
financial assistance, Including state financial assistance mcoived f'onn ilia Agency, other stale agonciess, and other non -state
en(Illes. Slate financial assistance does not include Federal direct or pass -through av a xis and resources received by anon -
state entity for Federal prognun matching requiremems.
In connection with the audit requireneu(s addressed in Par( II, paragraph I, (he Contractor shall ensure that the audit
cumplies with Ibc mgnimniens of Section 215.97(8), F.S. This Includes submission of a financial reporing package as
defined by Section 215.97(2), F.S., and Chapter 10,550 (local governmental entities) of 10.650 (nonprofit and for -profit
organizations), Rules of (he Auditor General.
If ilia Contractor expends less than $750,000,00 in state financial assistance in its fiscal year, an audit wnduciecl in
accordance with file provisions of Section 215.97, F.S., is not required. In the event that the Contractor expends loss Ihnn
$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 fain file non -state entity's resources (ire., (he cast of
such an audit must he paid from tire Contractor resources obtained fron other tall State entities).
An audit conducted in accordance with (his purl shall cover the entire organization for ilia organimlion's fiscal your.
Compliance findings related to contracts with (he Agency shall be based on the contract's requirements, including any
applicable rules, regulations, or statutes. The financial statements shall disclose whether or no( 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 raper( with reference to ilia Agency contract involved. If not othetwiso disclosed as required by Rule 691- 5.003,
P.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 loco] governmental entities, financial reporting packagos
required under this part mast be submitted within 45 days after delivery of ilia audit report, but no later than 12 nnonllns after
the Coniractn°s fiscal year end. Vol non-profit or for -profit organizations, financial reporting packages required under (his
part most be submitted within 45 days after delivery of ilia audit report, bill no later (hall 9 months afler the Contractor's
rascal year end. Notwithstanding Ilia applicability of this portion, ilia Agency retains all right and obligal lone nnouitor and
oversee the performance of this wn(n ict as outlined throughout (his document and pursuant to law.
PART III; REPORT SU13MISSION
Copies of financial reporting packages for audits conducted in accondance with 2 CFR Part 200 and required by Pat I of
(]its Financial Compliance Audit Altmimaenl, shall be submitted, when required by 2 CFR § 200.512 by or on behalf of the
Contractor directly to each of the following:
Federal Audit Clearinghouse
Banana of the Census
1201 East l0a' Street
Joffe'so villa, IN 47132
Pursuant to 2 CFR § 200.512, all other Pederal agencies, pass -through entities and olhos interested in a reporting package
and data collection form nmsl obtain it by accessing the Federal Audit Clearinghouse.
'file Conlr'aclor• shall submit a copy of any management letter issued by the audi(or directly to the Agency.
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Area Agency on Aging far Soulhw lit Florida, lite.
Richard Cocclderl, Director of Finance
2530 Wielder Ave, Suite 112
Fort Myers, FL 33916
Additionally, copies of financial reporling packages required by this contract's Financial Compliance Audit AMohntenl,
Per( 11, shall be submitted by or on behalf of the Confinclordircufly to each of the following;
The Agency al the following addess:
Area Agency on Aging 1'nr Southwest Florida, lite.
Richard Cocchferi, Director of Finance
2530 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
III West Madison Street
Tallahassee, Florida 32399-14.50
Any reports, management tellers, or other inforniallon required to be submitted to the Agency purulent to this contract shot
be submitted timely in accordance with 2 CFR Pat 200, P.S., and Chapter 10.550 (local governmental entities) or 10.650
(no nterefll still for -profit m'ganbsitlons), Rules of the Auditor General, as applicable.
Contractors, when submilthlg financial reporting packages to the Agency for audits done in uccordance with 2 CFR P411200
or Chapter 10.550 (local govemntemul entities) or 10.650 (nonprofit and for-profrl organizations), Rates of (110 Auditor
General, should indicate the date (het the reporting package wns delivered to the Conh'actor in correspondence
aowiiiporyingthc reporting package.
PART IV: RECORD RETENTION
The Contractor shot[ retain sufficient records demotsimting its compliance with the loans of (his contract for a period of
six (6) years front tine date the audit report is issued, and shall allow the Agency or its designee, the CPO, or Auditor General
access to such records upon i equest. The Contractor shell ensure that audit working Impels are made available to the Agency
or its designee, CPO, or AuditsGeneral upon request for a period of six (6) years treat the date the audit report is issued,
unless extended in writing by the Agency.
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A'I •ACUMEN' H-PARIBIT I
PART1: AUDITRELATIONSIIIPDEfIPIiNI1NATION
Contractors who receive slate or federal resources may or nifty act be subject to the audit requirements oft CPR Part 200
and/or Section 215.97, P.S. Conlrxctols wino flrc deterndneA lobe recipients or sub-recipiwlls of federal awards and/or
state Financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I
and/or Part It of Exhibit I nit met. Contractors who have been determined to be vendors are not subject to the audit
requiroments of 2 CPR § 200.38 andtlm• 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 Pederal mvads and/or stale financial
assistance omS( connply with applicable programmatic and fiscal compliance requirwneu(s.
In accedancewith 2 CFR Part 200 and/or Rule 691-5.006, F.A.C, Contractor has been determined to be:
_Vendor not subject to 2 CPR § 200.38 and/or Section 215 97, P.S.
Recipient/sub-recipient subject to 2 CFR §§ 200.86 and 200,93 mid/or Section 215.97, F.S,
,exempt organization not subject to 2 CFR Parl 200 and/or Section 215,97, F.S. For Federal awards, for -profit
orgnnivations are exompt; for state financial assistance projects, public universities, conunnnily colleges, district
school boards, branches of stale (Florida) government, and chnrter schools are exempt. Exennp( o ganivations inns(
comply with all conrpliauco requirements set forth within the contract orawad document.
NOTE; If a Contractor is deieradned to boa rooipicn(/sub-recipient of federal and/or sloe financial assistance, and has been
approved by the Agency to subcontract, they must comply with Section 215.97(7), F.S., slid Rule 691-5.006, F.A.C. [state
financial assismnee] and/or 2 CFR § 200.330 [federal mvards].
PARTH; FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR S'rATE MATCHING FUNDS ON FEDERAL AWARDS. Connectors who receive Pedeal
awards, state maintenance ofefforl funds, or stale matching funds on Federal awards and who are deterndncd to be a sub-
recipiem must comply with the following frswll laws, rules, and roguhnions:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR § 200.416 - § 200,417 —Special Considealions for Slates, Local Governments, and Indian •tribes*
2 CFR § 200.201 — Adnlinls0'ative Requli enlcrlts**
2 CFR § 200 Subpar(F—Audil Requirements
Reference Guide for State Bxpendhuros
Other fiscal requirements set forth in program laws, tide%, and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLO W t
2 C17R § 200,400 - § 200.411 — Cost Principles*
2 CFR § 200.100 — Adminisiralive RequiremealS
2 CFR § 200 Subpai I F — Audit Requirements
Reference Guido for Slate Expenditures
Other fiscal requirements net forth in program Imvs, tides, and regulations
EDUCATIONAI, INSTITUTIONS (EVEN IF A PART OF A STA97i OR LOCAL GOVERNMENT)
MUST FOLLOW:
2 CFR § 200.418 —§ 200,419 — Special Considerations for Instilutions ol'Higher Education*
2 CPR § 200.100 — Administrative Requiemcnts
2 CFR § 200 Subpart F —Audi( Requirements
Reference Guido for State Expenditures
Other fiscal miuiremens set forth in progl'am Imes, rides, and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Choular::s as noted in 2 CFR
§200A00(5)(c).
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**Por fundingpasscd through U.S, Health and I Itnnnn Services, 45 CPR Part 75; for funding passed through U.S.
Deparlmenl of Lducallon, 34 CPR Part 80.
STATIC' FINANCIAL ASSISTANCE. Conlraclors who receive slate financial assistance and who are determined to be a
recipient/sub-reeipleu must comply with the following fiscal laws, rules, and rcgulalions:
Sections 215.97 & 215.971, P.S.
Chapter 691-5, F.A.C,
Stale Projects Compliance Supplement
Rofcronce Gulde for State Expenditures
Other fiscal requirements set forth in program laws, I'tlles, and regulations
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ATTACHMENT II -EXHIBIT 2
FUNDING SUMMARY (20214022)
NotE TItle 2 CFR, as revised, and Section 215,97, F.S., require that (Ile info'mmion about Federal Programs and Stale
Projects included in Attachment 11, Exhibit I, be provided to the recipient, Information contained heroin is a prediction of
fundingsourees and related amounts based on Iheconh'nct budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING;
GRANT AWARD (FAIN#): FEDERAL AWARD DATE:
DUNSNUMBBR;
PROGRAMTITLE
FUNDING SOURCE
CFDA
I AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE IIEQUIRBMENTS APPLICABLE TO TIfE PEDERALRESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CPR Part 200—Uniform Administrative Requirements, Cost Principles, and Audit Requi mnents for Federal Awards.
OMB Circular A-I33 —Audits of States, Local Governments, and Non -Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97, F.S.
PROGRAMTI'I'LE
FUNDINGSOURCE
CSFA
AMOUNT
Alzheimer's Disease Initiative
General Revenue
65.004
$504,968.54
TO'TALAWARD,
$504,968.54
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97 & 215.971, P.S., Chapter 091-5, P.A.C., Slate ]'rejects Compliance Supplement
Rofarence Guide for State Expenditures
Olhor fiscal m1uironlent5 set forth in program Jam, odes, and regulations
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ATI'ACHMP:NT III
CHIMI+ICATIONS AND ASSURANCES
AGENCY will not award Ibis contract unless Contractor complotes this CERTIFICATIONS AND ASSURANCES.
Inperl'orncnce of this contract, Conlroclo• provides the following cortifications and assurancos:
A, Debarment and Suspension Certification (29 CFR Part 95 and 45 CPR Pa•I 75)
B. Certificaton Reeo•dina Lobbvbne (29 CPR Po•t 93 and 45 CIER Pm{ 93)
C. Nondiscrimination@ Equal Opportunity Assurance(29 CFRPar(37 and 45 CFRNu•180)
1). Certification Reaerdine Public ErdRy Cranes, section 287.133. P.S.
E. Association r f Conl nunity Ounnizations for Reform Nov (ACORN) Fundhna Restrictions Assurance
(Poll. L. 111-117)
F. Scrutinized Conuandes Lists and No Boycott of Israel Certification section 287 135. P.S.
G. Certification Re.a•dlim Dula hicitri(v Conn lin nee for Contracts Atreenneuls Grant& Lonx and
Cooperative Agreentenls
H. Verification of EmoloVntclll Stales Certifien tier
1. Records and Documetarllml
J. Certification Rcurding bnsnestlol ofPuldle Records
A. CERTIFICATION REGARDING DEBARMEM', SUSPENSION, AND OTHER RESPONSI331LITY
MATTERS —PRIMARY COVERED TRANSACTION,
The undersigned Contractor certifies, to the best of its knowledge and belief', that it and its principals;
I. 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 IN cc -year period preceding Ibis contract been convicted al Imd m civiijudgment rendered against
them for commission of fraud or a criminal offense in connection Willi obtaining, al(empling to obtain, or perfuming
a public (Fe(leral, Slate, of local) transaction oncontract under a public i n lsacllon; violation of Federal or Stale
nnflhast statules or connnission of embezzlement, theft, forgery, bribery, fhisificntion or destvetion of records,
making filsc stalenluns, of receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by it government entity (Federal, State, or
local) with oonunlssion of ally of the offenses enumerated In panigraph A.2. of this cardficalion; and/or
4. Have not within a three-year period preceding this appiicallon/proposal and one or more public transactions
(Federal, Stale, or local) te•ini imed for cause of default,
The undersigned shall require that langunge ofIli is cortification be included in the documents for all subcontracts at all
tiers (including subcontracts, sub -grants, and contracts under grants, loans, and coopo'ative agreements) and that all
sub -recipients and eonhaclom shall provide (his certification accordingly.
B. CERTIFICATION REGARDING LOBBYING— CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS.
The undersigned Contractor certifies, to the best ol'its knowledge and belief, that
No Federal appropriated fonds 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 Willi thcavarding of any Federal contract, Iho nlakingofally Federal grant, the makingoftiny Federal loan,
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the entering into orally cooperative agreement, and the extension, confinualion, renewal, amendment, or modifhcallon
orally Fade)at contract, grant, loan, or cooperative agroomen(.
truly funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence all officer or employee orally agency, it Member of Congross, till officer or employee of
Congross, or employee of a Member of Congress in connection with a Federal mail net, grant, loan, or cooperative
agroonteut, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report
Lobbying," in accordmnco with its instructions.
Tim undemigned shall require (lint language of this Certification be included lit the duounlents I'm' all subcont'aels at all
tiers (including subcontracts, sub -grants, and contracts initialgrants, loans, and cooperative agreements) and that nit
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
enlered into. Submission of this certification is a prerequishe for making or entering!ilia this contract imposed by 31
U.S.C. if 1352, Anype son who fails to filo lho required certificalion shall ba subject to it civil penally of not less than
$10,000 and not meta than $100,000 for each such failure.
C. NON- DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART
80). - As it condition of the Contract, Contractor assures Ihal It will comply fully with ilia nondiscrindnallon and equal
oppor(unily provisions of ilia following Imes;
I. Section 189 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination
against all individuals In file United Sudes on Ilia basis of race, color, religion, sex, nalk n d origin, ago, disability,
political affiliation, or belief, and against beneficiaries on the basis of either citizomlilplsuuus as a lawfully ndnnitted
Immigrant authorized to work In the United Slates or pivaicipation in any WIA Ti11e 1-financially Assisted program
or activity.
2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88.352), as amended, and all requirements imposed by or pursuant
to the Regulation of the Deportment of Ha llh and ]-Inman Services (45 CPI! Pail 80), to the end that, in nocordance
with Tille VI of flint Act and (he Regulation, no person In Ilia United Slates shell, on (he ground of race, color, or
national origin, be excluded from participation in, be dulled the bohcfrts of, or be otherwise subjected to
dlsodin nation undo'tiny program or activity for which tho Applico t receives Federal financial assistance from the
Agency.
3. Section 504 of ilia Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all ruluirenhenis imposed by or
pursuant to ilia Regulation of Ilia Department of Renith and Human Services (45 CFR Pail 84), to the end flint, !u
accordance with Section 504 of That Act slid the Regulation, no otherwise qualified handicapped individual in the
United States shell, solely by reason of his handiest), be excluded from participation in, be denied ilia benefits of,
or be subjected to discrimination under tiny pr'oganh or activity for which the Applicant receives Federal financial
assistance front the Department.
4. The Age Discrimination Act of 1975 (Pub. 1— 94-135), as amended, and till requirements imposed by or pursuant to
the Regulation of the Department of Health and ]lumen Services (45 CFR Part 91), to the end (hat, in accordanoe
with Ilia Act and the Regulation, ao person in the United States shall, oil ilia basis of age, be denied (he benefits of,
be excluded from pniticipallon in, or be subjected to discrimination under any program o• activity for which ilia
Applicant receives Federal financial assistance front (he Department.
5. Title IX of the Education Amendments ar t972 (Pub. L. 92-318), as amended, and all requirements imposed by or
pursuant to (he Regulation of the Department of Health mid Human Services (45 CFR Pail 86), to the end that, in
accordance with Title IX and the Regulalion, no planet, In ilia United Slates shall, on the basis of sex, be excluded
from palicipaiun in, be duhied [lie benefits of, or be otherwise subjected to discrimination under any education
program or activity for which the Applicant receives Federal financial assistance front Ilia Department.
6. file Anwi icon with Dinabililles Act of 1990 (Pub. L. 101-330), 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 rocrui(onem, alveaiising, tenure, layoff, leave, Ilinge beneEls,
and at I other employment -rotated activities.
7. Contractor also assures that it will comply with 29 CPR Pao 37 and all other regulations implomneniing the laws
listed above.'17ds assurance applies to Contractor's operation of the W IA Title I — financially assisted progran m'
activity, and to all connects Contractor makes to carry out Ilia WIA Title I — financially assistul program or Activity.
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ADI 203.21
Contractor undcrslands that DORA and the United States have the rigid to seek judicial enforcement of ilia
assurance.
The undersigned shall acquire [lint language of this assurance be included in the documents for all subcontracts at nil
tiers (Including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and tile( fill
sub -recipients and contractors shall provide this assurance accordingly.
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S.
Contractor hereby ceriiRes that neither it, nor flay person or affiliate of Contractor, has been convicted of a Public rhaily
Crime as doftned in section 287.133, p,S., nor placed on the convicted vendor list.
Contractor understands and agrees that it Is required to inform AGENCY immediately upon any change of
circumstances regmxling This slnhts.
R. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RRS3'RIC'TIONS ASSURANCE (Pub. L. 111-117).
Asa condition of uric Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining
to ACORN and its subsidimies per the Consolidated Approprinliana Act, 2010, Division E, Section 511 (Pub.
L. 1I1-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that
appropriations nla(le under Pub. L. 1 I 1-117 aiv available tnlder the conditions provided by Pub, L. 1 I 1-117.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
ties (including snbconh•acls, sub -grants and contracts under grads, loans and coopendive agreements) and that all sub -
recipients and contractors shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS AND NO ROYCO'I'r OF ISRAEL CERTIFICATION, SECTION
287.135, F.S.
In accordance with section 287.135, I'.S., Coldlectm• hereby cer(i0es that it has not been placed on the Scrutinized
Companies that Boycott [at act List and that it Is not engaged in a boycott of Israel.
If this contract Is ill the amount of $1 million or more, in accodace with the ivquirenlents of section 287.135, F.S.,
Contractor herby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the
Scrutinized Companies with Activities in the Iron Petroleum Energy Sector Usi and (he( it is not engaged in business
operations in Cuba or Syria.
Contractor understands Elio( pursuant to section 287,135, F.S, the submission of a false certification may result in the
Agency teiminatingthis contract and the submission ors, false ccrtilicarion nay subject Contractor locivil penaltiacrnd
attorney fees and costs, including any costs for investigations that led to the finding of raise certification.
if Contractor is unable to certify any of the statements in this cis 1111cmion, Contractor shall attach all explanalon to
this contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS,
GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
I, The Contractor and any Subcontractors ofservices under this contract have financial mnnngenent systems capable
of providing certain information, including: (1) accurate, current, and complete disclosure of Iho f inanciahrestdls of
each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the source and
appilcation of funds for all contract supported activities; and (1) the comparison ofoullays with budgeted amounts
fur each awa d. The inability to process infon ration in accordance with IIIM requirements could result In a return
of grant funds that have not been accounted ro- properly,
2. Management Information Systems used by the Contractor, Subconli actors, or any outside entity on which the
Contractor is dependcn( fordo s Thal is to be reported, transmitted, or calculated have been assessed land verified
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to be capable orprocossing data accurately, hicluding year -date dependent dam. For II'Me systems identified to be
nun -compliant, Contractors will take immediate notion to assure (Into integrity.
3. If this contract includes the provision ofhardwnrc, sofware, firmware, microcode, or Imbedded chip technology,
the undersigned warrants that these products are capable of processing yen -date dependent data accurately. All
versions of these products offered by the Contractor (leprasenled by the undersigned) and purchased by the state
will be verified for acomacy, and Integrity ordain prior to transfer.
4, it, the event of any decrease in functionality related to lime and data related codes and hnlemnal subroutines Ilnl
impede the hardware a• sonware programs front operating properly, the Contractor agrees to inunedialely make
requicd correction% to restore hardware and sollware programs Io the same love] of functionality as warranted
herein, at no charge to IIle state, and without interruption to the ongoing business of the stale, thine being of the
essence.
5. The Contractor and any Subcontractors of services under This enntracl warlanl flint their policies and procedures
include it disaster plan to provide for service delivery to continue Ill case ofan emergency, including emergencies
arising from (lain integrity compliance issues.
H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of conlracting with the Agency, Contractor certi fits the use of the U.S. Department of Homeland
Securitys E-verify system to verify the onnploymea eligibility of till new employees Idled by Contractor during the
enniract term to perform employment duties pursuant to this contract, and that flay subconlincls Include an express
I equirement (lint Subcontractors performing work or providing services pursuant to [Ills contract utilize the B-verify
system to verify the employment eligibility of all new employees ]iirer) by the Subcontractor during the enilre contract
lerm.
The Contractor shall require that (he language of Ills certification be included in all sub -agreements, sub -guards, and
other agr'co immus/contracts and that all Subcontractors sludl certify congrllamce accorclingly.
This certification is a material representation of fact upon which reliance was placed when (his contract was made or
entered into, Submission ofthis certification is a prerequisite for making or entering into this contract imposed by
Ctroulars A-102 and 2 CFR Part200 and 215 (formerly OMB Chcula A-110).
h RECORDS AND DOCUMENTATION
The Contactor agrees to make available to Agency staff and/or any party designated by the Agency luny nndall
contract rented records and documentation. The Contractor shot[ ensure the collection and maintenance of all
program related Information and documentation oil any such system designated by the Agency. Maintenance
Includes valid exports mill backups of all data and systems awcoding to Agency standards.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1• In addition to file requirements of Section 10 oflite Standard Central, sections 119.0701(3) and F.S., and any other
applicable low, if a civil action is commenced as contemplated by section 119.070 ] (4), F.S., and the Agency is ranted
in the civil action, Contractor agrees to indemnify and hold hot niloss the Agency for any costs incurred by Iho Agency
and any al(m•ncys' fees assessed or awarded against the Agency foil a Public Records Request made pursuant to
Chapter 119, F.S., concerning (his contract or services performed Ihetcuuder.
a, Notwi(hs(anding section 119,0701, F.S., or other Florida law, this section is not applicable to contracts executed
bolwcen the Agency and state agencies to subdivisions defined in section 765.28(2), F.S.
2• Section 119,01(3), F.S.; stales if public funds are expended by an agency in payment of due% le, membeallip
contributions for• any person, corporation, foundation, (rust, association, group, or other organization, all the financial,
business, and membership records of such an entl y which pertain to the public agency (Florida Department of
FIc er Affairs) are public retells. Scot ton 119.07,1.S, states that every pe:snn who has oustody of such a public recorcl
shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances.
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Additionally, I certify thisorganizatimt does y_dow not_Providelor Institutional memberships.
Contraclor's signature below nttcsls thnt records pertaining to the dues or membership appllcndon by the Agency arcavailable
for inspection if applicable, as slated above.
By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if
applicable).
By signing below, Contractor certifies that the representations mnlined in parrs A through J above uretrueend correct.
i
3339 Tamiami Trail E Suite 211
SI namand
d'"He of I •le •esmrtative
1laniel R Rodri u
Street Address
Collier Colinty Board of Commissioners
Naples. FL 34112
Contractor
Dnto
City, Stale, Zip code
APPmved a to fo to and Icgaliiy
Ass �AIP
/7
G
41 of CO
;July 202t - dune 2022)
ATTACHMENT1V
ASSURANCIS—NONCONSTRUCI'ION PROGRAMS
AD1203.21
Public reporting burden for [his collection of information is estimated to average forty-five (45) ndnules par response,
including time for reviewing Instructions, scorching existing data sources, gathering and maintaining the data needed and
completing slid reviewing the collection of Infori n lloa. Send comments regarling the burden wihna[e of any other aspect
of this collection of infurnalion, Including suggesllons fe, reducing this burden, to the Office of Management and Budget.
Paperwork Reduoifon Project (0348.0043), Washington, DC 20503•
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET, SEND I'r,rwr11E ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or progr anti. If you have questions please
contact the awarding Agency. Furlhor, certain federal evading agencies may require applicants to earthy to
nddilimanl nastu'nnces. If such Is the case, you will be notified.
1. lifts (lie legal aut wity to apply for federal assistance, and the Insdualonal, 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. WIII give Isle awarding agency, (he Comptroller General of the United States, and ifopproprfato, the slue, through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the
awand; and will establish a proper accounting system in accordance with gelncnilly accepted accounting silada'ds of
agency directives.
3. WIII establish safeguards to prohibit employees froin using their positions for a purpose Met constitutes, or presents the
appearance of, personal or organtzafional canniet of interest or personal gain.
4. Will initiate and complete (lie work within the applicable lime frameaRer receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§ 1728-4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified fit Appendix A of
OPM's Standards for a Merit System of Personnel Administration (5 C.P•R. 900, Subpar( P).
6. Will comply with all federal stables relating to nondiscrimination.'1'hese include but are not ]finite([ 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)'fille IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-1083 and §§ 1685-1686), which
prohibits disc, imfnalion on the basis of sex; (e) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.
if 794), which prohibits discrindnatton on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.C. §§ 6101-0107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Tieattlnou
Act of 1972 (P.L. 92-255), as amended, relating to nondisci inminatiol collie basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevenlfon, 9Teahnent and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on f he basis of alcohol abuse or alcoholism; (g) Sections523 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)Tito Vill of the Civil Rights Act of 1968 (42 U.S.C. § 3601 et seq.), as amended, relating to
nondiscrimination fn the sale, rental or ftno icing of housing; (p) tiny other nondiscrimination provisions in the specific
staitiie(s) under which application for federal assistance is being made; and 0) the requirements of any other
nondiscriminaton sfalue(s) which may apply to the aplAcnlion.
7, Will comply, or has already complied, with the requirements of"I'ilicv 11 and III of the uniform Relacaton Assistance
and Real Properly Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of federal at federally assisicd programs.'I'hese requironleuts
apply to all inleresls in real property acquired for project purposes regardless of federal participation in purchases.
9
42 of fi3 C'
July 2021 - Jane 2022) ADI 203.21
8. Will comply, as applicable, with (he provisions of the Hutch Act (5 U.S.C. §§ 1501.1508 and §§ 7324-7328), which
Ihntt the political activities of eurployees whose principal employment activities are funded in whole or in part with
federal funds.
9. Will comply, as applicable, with the provisions of the Davis -Satan Act (40 U.S.C, §§ 276a to 276a-7), the Copeland
Act (40 U.S.C. § 276e anti 18 U.S.C. § 874) and the Contract Work Horns land Safely Standards Act (40 U.S.C. §§ 327-
333), regarding labor standards lot, federally assisted construction sub-c n(racts.
10. WIII comply, if applicable, with food Insurance purchase ioquiromcn(s of Section 102(n) of (he Flood Disaster
Protection Act of 1973 (P.L, 93-234) which requires recipients in a special Cloud hazard area to paiticipate in llre
program and to purchase food insurance If the total cost of hlsurable conshuc(ion and acquisition is $10,000.00 or
more.
11. WIII comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures undo (bo National Environmental Policy Act of 1969 (P.L. 91.190) and
Exceldive Orlor (PO) 11514; (b) notification of violating facilities pursuant to EO 11738; (a) protection of wetlands
pursuant (o BO 11990; (d) evaluation of food hazards in foodpialns in accordance with PO 11988; (a) assurance of
project consistency with file approved State management poginm developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. § 14.51 of seq.); (i) conformity of federal actions to Stole (Clear Air) Implementation Plans under
Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. § 7401 at seq.); (g) protection of underground
sources ofthinking water under the Safe Drinking Wolei 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 Sconce Rivers Act of 1968 (16 U.S.C. § 1721 at seq.) related to In components
or potent InI components of the national wild and seen to rivals system,
13. Will assist ilia awaudiOR agency in assuring compliance with Section 106 of the National I fistorie Prese'val!on Act of
1966, as amended (16 U.S.C. § 470), EO 11593 (identification and proleclion of historic properties), and the
Archaeological anti Historic Preservation Act of 1974 (16 U.S.C. § 469a-I at seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and mialetl
activities supported by (his award ofassisianco.
IS, Will comply with (he Laben(ory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. § 2131 at seq.)
pertaining to the care, handling, and hea(ment of warns blooded animals held for research, leaching, or other nclivilies
supported by this award of amisfance.
16. Will comply will) the Lood-Based Point Poisoning Prevention Act (42 U.S.C. § 4801 of seq.), which prohibits the use
of Icad- based pain( in construction or rehabilitation of residence structures,
17, Will cause to be performed the required financial and compliance audits in accordance with the Single Audi( Act
Anleminonts of 1996 end 2 CFR Part 200.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations, raid policies
governing this program.
8IGNA'rnRli01+ADI'Ibtii'LC ilt l'IaYING0 '1'I1'LR
Daniel R Rodr'i ue — Public Service De ar[ment Head
APPLICAN'I'ORGANIZANION DA3'C SUIIaIi'1"1'IA
Collier County Board of Commissioners 081 /2021
Approved as se form and legality n
v
43 of 63 Assisuilef County Allbanuakr-
;dilly 2021- Jmno 2022) ADI 203.21
ATTACHMENTV
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
PrograndPnclIhy Name
County
AAA/Contractor
Address
Comploted By
City, S(nle, Zip Code
Date
'Telephone
PART i; READ THE ATTACHED INS'fRucnoN5 FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU
COMPLRTH.'I'll IS FORM.
I, 111 lefly describe the geographic area served by the program/fhcility and the type ofam vice provided:
For questions 2.5 please indicate the for
2. 1'gadpasn of Iron screed
3. Stnrf arrcntly emph,yal
t. Cllmas stiocmly cnrelred/rcgiatercd
IS, AdVismy/Gsvernhng ❑oAM If Appacahlc
owing;
'Iblal fl
%
NMltu
-A
Rlack
Ilba% ale
%
Other
%
Pana10
%
Disabled
%
I Over40
so'c"'C Cf dAlpl
Ili; nVC IIpIC:
Rffectivc dins:
PARTII: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or
NO, EXPLAIN,
6,
is no Aasurnase ofCompliame on rile with DOER?
NIA NO
ElY❑
7.
Compare the staff composition to the population. Isshaffu'eprcunbdiveofthepopalation?
NO
El
El
a.
Are eligibility repliromenls farscavices applied to ellenis and nppliceals wilhool reganl to Ines, color, nndunal
NO
origin, sex, age, religion, or disability?
El
❑S
❑
9,
Are all benefits, services mad fneilitles available to applicants and pro kipams in an equally affective manner
N/A
YES
NO
regardless of race, sex, color, age, national origin, religion, or disability?
❑
❑
❑
10. per hi-pnici l services, are room ossigmncnis made without regmxl to race, color, national origin or disability?
N/A
YES
NO
❑
❑
❑
,W of 03
Jn ly 2021 - Juno 2a22>
ADI 203.21
11. Is the program/facilily accessible to non-Rnglish speaking clients?
N/A
VHS
NO
❑
❑
❑
12.Arc em rlevees, applicants and Participants infornrod of their protcaliun age ills( discrimination? 1fYRS, hmw
N/A
YES
NO
Vcrbnl Wrillen ❑ Poster ❑
❑
❑
❑
13, Give the numberand current slates of say (liscrimilialion complaints reprdhlgsmvices or employment filed
ap asl the prograndlhellity.
N/ANUMDLIk
❑
14. is the progmnRaaility physically accessible to mobility, hearing and sight -Impaired individuals)
N/A YES NO
PART IM T)IE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACIL ITI RS WITH lS OR MOUE
EMPLOYERS. IF NO, EXPLAIN.
IS.Hns as a self-evahlmion been conducted to idwlify any ban'iu's to serving disnbled individuals and to make nay
necessary n alificallons7
YES
❑
NO
16. Is therean established gdevanoe pmmdum Far incmlwnlass due prows in the resolmion ofcompiaints?
VHS
❑
NO
❑
17. Hxsa person bwu designated to coordinate Scclion 504 canplimtwacliviRcs4
YES
❑
NO
❑
18. Do recruilment and notification naeorials advise applicants,employees, and Participants ofnondiscriminaLion on
Ilia basis of dlsabllky?
YES
❑
NO
19.Aro mtaillary nkls available to ensnrc acceseNilityofscrvlwsto luarhrg and sight -impaired individnnls7
YES
❑
NO
❑
45 of 63
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O
dnly?��1 4,1'I���I O1121'ItOOIiAMSOR EACILITIRSWITH 50 OR MORE EMPLOYEES AND RiiDIiRALCON7'ItACI5OR D1203.21
$50,000.00 OR MORE.
20. Do you Iwo a written af0nualive ncfion phml If NO, cxplaln.
5'ES NO
❑ ❑
Bevicived by
In Coloplianco: YES NO -
Program Office
'Notico ofColrcofivc Action Sont / /
Dale Telephone
Response Duo / /
On-Slle Desk Review
Rosponso Rcccived / /
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4G of 03
Judy 2021 - June 2022)
ATTACHMENT V
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHCCKLIST
ADI 203.21
1. Describe the geographic service area such as a district, county, city, or other locality. If the pmgrun/lhcility solves it
specific target population such as adolescents, describe the target population. Also, define the type of service provided.
2, Enter Ilia percent ofthc population served by race,sex,disability, still over the age of 40. The population served includes
poisons in Ilia geographical area for which services aro provided such as a city, county or other regional nice. Populldioll
statistics can be obtained rival load ch(nnbers of conunerce, libraries, or any publication front the 1930 Census
conhdning Floride population stallinics. Include the source of your population statistics. ("Other" faces include
Asiat/Pacifie Inlanders and American Indian/Alaskan Natives.)
3• Enter the total number of full -thee staff and their pax:enl by race, sex, disability, and over the age of 40. Include Ilia
effective date of your summary.
4. Eater the total number of eliets who ere enrolled, registered or currently served by the progran or facility, and list their
percent by race, sex, disability, and over the age of 40, Include the (late that enrollment was counted.
it, Whiso there is a significant variation between the race, sex, or eihniccontposition of the olicnts and their availability
in the population, the program/fncilily has the responsibility to determine the reasons for such variation slid take
whatever notion truly be necessary 10 correct any discrimination. Scale legitimate disparities may exist when
programs are sanctioned to serve tagel populations such as elderly or disabled persons.
5, Enter Ilia total number of advisory board nronibers and their percent by race, sex, disability, and over the age of 40, If
there is no advisory at 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
conpliance with all nondis dininaloy provisions as required in 45 CFR Pat 80. This is usually it standard part of ilia
calracl hulguago Its DDEA Recipients and their Sub -grantees. 45 CPR § 80.4(u).
7. Is the race, sex, and national origin of the staff reflective orlhe general populalion7 For example, if 10%of the population
Is Hispanic, is there a comparable percentage of Hispanic staff?
8. Do eligibility requirements unlawfltlly exclude persons in protected groups front the prevision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through
on -rile record analysis of persons who applied but ware laded services or anploymenh 45 CFR § 80,3(a) and 45 CFR
§ 80.I.
9, Participants or cllants must be provided services such as medical, nursing, and denial care, laboratory services, physical
slid recreational therapies, counseling, and social services without regard to race, sex, color, national origin, religion,
age, or disabllily. Courtesy lilies, appointment scheduling, and accuracy of recoil keeping mull be applied uniformly
and withoul rognrd to recq sex, color, national origin, religion, age, or disability. 111111•ances, wailing ronms, reception
areas, restrooms, and other facilities trust also be equally available to all clients. 45 CFR § 80.3(b).
10. For in -patient services, residents nn(st be assigned to founts, wards, etc., without regard to race, color, national origin, or
disability. Also, residents must not be asked whether they are willing Io share acconnmodatios with persons of a different
race, color, national origin, at disability. 45 CPR § 80.3(a).
IL The progran✓facility, mid all services must be accessible to participants still applicants, includingthose persons who limy
not speak English. In geographic areas whore a significant population of non-English speaking people live, prognull
accessibility may include the employment of bilingual staff. In other areas, II Is sUfficieal to have a policy air' plan fair
service, such as a current list ofnamos and telephone nunnbers of bilingual Individuals who will assist in the provision of
services. 45 CFR § 80.3(a).
12. Prograns/facilitics must make Information regarding the nondiscriminatory provisions of Title VI available to their
participants, benefuiarics, or any other interested parties, 45 CFR § 80.6(d). This should include Information on that) -
right to file a complaint of discrimination with either the Agency or the U,S. Dcparloat oflieallh and Henan Services.
'file information may be supplied verbally or in writinglo every individual or may be supplied through the useoran equal
opportunity policy poster displayed in n public area of the facility,
13. Report number of discrimination complaints filed against the program/facility. Indicatcihe basis (e.g. race, octal', weed,
sex, age, national origin, disability, and/or retaliation) and ilia issues involved (o,g. services or ompdoynlenl, placement,
a
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47 of 63
July 2021 - June 2022)
ADI 203.21
leiminallon, etc). Indicate the civil rights law or policy alleged to have [wen violated! along with the name and address
of the local, state, or federal agency Willi whom the complaint has been filed. Indicate the current status of the conlphdrit
(e.g. settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc.).
14. The progrem/facility midst be physically accessible to mobility, hearing, and sight -impaired individuals. Physical
accessibility includes designated parkingareas, curb cots or level npproachos, romps, and adequate widths to enhances.
The lobby, public telephone, restroona Mcililies, water Fountains, and information and admissions offices should be
accessible. Door widths and trarfic areas of a minislr'alive offices, cafelel'las, rLstroonts, recreation areas, colonels, and
serving !has should be observed for accessibility. Elevators should be observed for done width and Braille or raised
numbers. Switches and controls for light, heat, ventilation, lire alarms, laid other essentials should In installed at all
appropriate belght for mobility impaired individuals.
15, Section 504 of the Rehabilitation Act of 1973 requires that a recipient of fedend financial assistance conduct a self -
evaluation to identify any accessibility barriers. Self -evaluation is a fourstep process:
a. Rvalunle, will ille ns.sistancc of (lisnbled irldividulal(a)/ol'ganizatporl(s), carront policies and practices that do not or
may not comply with Section 504;
b. Modify politic and practices flint do not meet Section 504 requirements.
c. Take remedial steps to eliminate the effects of any discrimination Ihal resulted train adherence to these policies slid
practices; and
d. Maintain soli evaluation on file, Including lisp 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 (lint employ 15 or more persons shall adopt grievance procedures that incorporate appropriate (lite
proums standards and that provide for the prompt and equitable resolution of cnnlplaints alleging ally net tell prohibited
by Puri 84 of Title 45, CFR45 CFR § 84.7(b).
17. Programs or facilities that employ 15 or more persons shall designate at least one pond to coordinate its efforts to
comply with Pal 84 of Title 45, CPR, 45 CFR § 84.7(o).
Is. Programs or facilities that employ 15 or more persons shell take appropriate initial and continuing steps to nolI6,
participants, beneficiaries, applicants, and employees that the pregranlfeciihy does not discriminate on the basis of
handicap in violation of Section 504 aml Fat 84 oP'fitle 45, CI°R. Methods of initial and continuing notification any
include Ilse posting of notices, publication in newspapers and magazines, placencl of notices in publications of the
programs of facilities, and distribution of memoranda or other written communications. 45 CFR § 84.8(x).
19. Programs or facilities that employ 15 or more persons shall In appropriate auxillary "ids to portions with impaired
sensory, manual, or speaking skills where necessary to afford such persons an equal opportunity to benefu from the
service in question. Anxppiary olds may include, bur are not flailed to, bralled and taped materials, interpreters, and other
aids for persons with impaired hearing or vision. 45 CPR § 84.52(d),
20. Programs or facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement, and
maintain a written affirmative action compliance program in acconlance with Bxeeulive Order 11246, 41 CFR Part 60
and'111le VI of the Civil Rhgina Act of 1964, as amended.
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48 of 63
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n.r.,o en, or
ELDER AFFAIRS
s•I'MB OP FLORIDA •-
BACKGROUND SCREENING
BACKGRO U NDSCIME+N ING
Alleslnlion or CompBnnec-gngrioyer
AUTHOAITY: This form is regni. ed annually of all employers to comply with file a/leslntlon
regndrmuonts set forth bisection 435.05(3), Florida Slnhdes,
AOI203,21
Ron Mantis
Carvrnar
Rlchnrd Pruden,
Srrrslmp
i The lerm'bmployer" menns any person or entity required by Inv to conduct background screenings,
including but not Rallied to, Area Agencies on Aging/Aging and Disability Resource Ccalcrs, Land
Agencies, and Service Providers that contract dircclly or indircclly with 0o Deparlment of Bider
Affairs (DOBA), and any other person aentity which hires employees or has volunteers In service
who erect Iho definition ofn direct service provider. Sce §§ 435.02, 430.0402, Fla. Slat.
A direct service provider is"n person IS years ofngcaroldel m•Iro, pursuant lonprogmni loprovido
smvims to like elderly, hits direct, foe-lo-love coninet ssith a client while providing services to tite
client eel has access to the diwlfs living aroa, rands, personal property, or personal identification
information its defined in s. 917.568. The Tenn includes coordinators, managers, and supervisors of
residential facilities and volunteers." § 430.0402(I)(b), Fla.Slal.
A9'mi'ATION:
As (tic rely authorized representative of
located lit
save/ ddd ees• City Sole ZIP vale
i, Ao Iwreby nflirm unror penally of
Name aflicprasenlnlive
perjury (lint the above -named employer is in conspolmlce with the provisions ofChapler 435 and section 430.0402, Florida
Statutes, rrgmvling level 2 background screening,
.Signature gfRal"vaennalive
DOEA Fornr 235, Aaesfallmn gfCwapllailee - ErrrploYeA Ij/%clira Jmercny 19. 2021 Section
d35.05(3),
FS. Form available at: ailn'/&kkelft. sla,j u&enadah/Lackgr l l enlru
50 a 63
July 2021 - dune 2022)
ATTACHMENT VIII
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDYFURES (CMBE FORM)
CMBR b'ORMi4lUS1'ACCOA91'ANI'INVOIC'GS 5'UUMI]TED TO DOEA
CONTRACTORNAME
IIOEA CONTRACT NUMBER:
*REPORTING PERIOD -FROM: TO;
*(DATE RANGE OF RENDERED SERVICES, MUST MATCH INVOICE SUBMITTED TO DOEA)
DOEA CONTRACT MANAGER
ADI203.21
RXPOWF ALL EXPXNDITURXS MADE TO CER711FIED MINORITY BUSINESS (SUBCONTRACTORS).
CONIACTDOGA CAME COORDINATOR I%OHANYOUP8970N5A'I'850-d14-2IS3.
CMBE
S FEN)
DOEA USE ONLY -- REPORTING ENTITY (DIVISION, OFFICE, E'I'C)
SEND COMPLETED FORMS VIA INTEROFFICE MAILTO:,I USTIN TAYLOR -
CMBE COORDINATOR, CONTRACT ADMINISTI ATION R PURCHASING, TALLAHASSEE, FLORIDA 32399-
7000,
51 M63
July 2021- Juno 2022)
ABI 203.21
If unsure ifsubwnlrnetor is at cerlified minorily sups lor, click on the hWlei'IInk below Rntor the mane of the supplies click
"scamhll, Only Certified Minovily Blisinoss Entities will be dispinycd
(11(Ixc//osd dms ntyfloridn comldirectories
INSTRUCTIONS
(A) ENTER 771E COMPANY NAME. AS IT APPEARS ON YOUR DORA CONTRACT.
(B) ENI'E1k'1'IiFsDOBACON7'RACTNIIMBEIL.
(C) ENTER'f1-IRSERVICE PFRIODMATCHINGI'l 1E CURRENT INVOICB'S SERVICE PERIOD.
(D) ENTER ALL CEWNFIED MINORITY BUSINESS BXPENDITURES FOR THE TIME PERIOD COVERED BY
THE INVOICE:
I. ENTER CPHNIFIF.D MINORITY BUSINESS NAME.
2. FNTBR'I'1 IE CERTIFIED MINORITY BUSINESS FEID NUMBER.
3. ENTBRTI IECERTIFIED MINORITY BUSINESS CMBF NUMBER.
d. ENTERTIIB AMOUNT BXPL'NDL'DWITH THE CELSI'B'im MINORITY BUSINESS FORTLIETIME
PERIOD COVERED BY TI IE INVOICE.
(E) MBE FORM MUST ACCOMPANY INVOICE PACKAGE SUBMITTED TO DOBA FINANCIAL
ADMINISTRATION FOR PROCESSING.
(11) FINANCIAL ADMINISTRATION WILL FORWARD ALL COMPIFTED CMBE FORMS TO CONTRACT
ADMINISTRATION &. PIIRCI WING OFFICE
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ADI 203.21
ATTACHMENT IX
INVOICE REPORT SCHEDULE
ATZHEIMER'S DISEASE INI'rlXl'IV E
Report Number
IJased On Submil to State on This Date
I
July Advance* July
2
August Advancc+ July1
3
July Expenditure Repot August 10
4
August Expandiftau Repot September 10
5
September Expenditure Repoli October 10
6
October Expenditure r, client November 10 '
7
November Expenditure Repot December 10
g
December Expeadilura Report January 10
9
January Expenditure Repot February 10
10
February Rxpenditue Report March 10
II
March Expenditure Report April 10
12
April Expenditure Report May 10
13
May Expenditure Repxf June 10
14
June Expenditure Repat1 July 10
IS
Final Request for Pay tell[ July25
Legend:
° Advance based on projected cash need.
Note N I;
Report III for Advance Basis Contracts cannot be submitted to the Agency prior
to ,July I or until the conbacl with the Agency has been executed and a copy sent
to DFS. Actual submission of the vouchers to DFS Is dependent on the accurl
of the expenditure report.
Note# 2:
All advance paymenls made to the Contactor shall be rotunred to the Agency as
follows: one — lenlh of the advance payment received shall be reported as an
advance recoupment on curb request Pon payment, starting with report number five
(S).'file adjtell ment still][ be recorded in Part C, Utie I of file report (Attachment
XI).
Note 0 3:
Submission of expenditure repm1s may rr any not gena•nlo n paymen roplcsl. Ire
final expendimrc report reflects rends duc back Io the Agency, payment is to
accompany [be repot.
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ATTACHMENT X
ANNUAL EIIDGET SUMMARY
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
for
Calllar Comity flomrl of County Commission's
Collier
TOTAL: $504,968.54
AM 203.21
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54 of 63
July 2021- Julle 2022)
ATTACHMENTM
REQUEST IFOR PAYMENT
ALZHEIMEIZS DISEASE INITIATIVE PROGRAM
ADr 203.21
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55 of 63
:July 2021 - June 2022)
A'I"1'ACDMENT XII
11ECHIPT AND EXPENDITUItE REPOW ALZIDUME118
DISEASE INITIATIVE PROGIIAM
ADI203.21
PROVIDER NAME, ADDRESS, PHONE If and FFID/
CONTRACTU
PROGRAM FUNDI NG :
CONTRACT PERIOD
RESPITE
REPORT PERIOD
PROJECTS
REPORT II
SPECIALIZED DAY CARE
PSA
CERTIFICATION : I codify to the beat of my knov2ed9
1 and belief that the report Is complete oru correct and all oulleys
herein are for purposes set forth M
the contract.
Prepared by Date:
_ Annwvod by:
PART A! BUDGETED INCOME/ RECEIPTS
1. Approved
Budged
2. Actual Receipts
For This Report
3. Tara l RecelDl¢
Yeardo Gale
4. Percent of
Approved Budget
1, Stale Funds
$0.00
$0.00
$0.00
11DIV/DI
2. Program Income
3. Local Cash Match
$0.00
KOS
$0.00
$0.00
$0.00
$0.00
I/DIV/DI
0DIV/01
4. SUBTOTAL: CASH RECEIPTS
0. Local In -Kind Match
8, TOTAL RECEIPTS
$O.OD
$0.00
$0.00
6DIV/01
PART 8 : EXPENDITURES
1. Approved
Budget
2. Expenditures
For Thls Report
3. Expenditures
Yee(to Deb
4. Percent of
Approved Budget
1. Administrative Services
$0.00
$0.00
$0.00
ODIV/01
2. Servica Subconlractor(s)
$0.00
$0.00
$0.00
WIV/01
3. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
/IDIV/01
PART C : OTHER REVENUE AND EXPENDITURES
I. Interest:
III, Advance Recouped
1. Program Income (PI)
1. A011 PI Collected YTD $
1. Earned on OR Advance $
2, Return of OR Advance $
$
(Includes co-paymenla collected) 3. Other Earned $
PART D : CO -PAYMENTS CURRENT MONTI4 YEAR-TO-DATE
1. Total of Co -payments assessed $ $
2. Total of Co -payments collected $ $
(For Tracking Purposes only)
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56 of 63
July 2021- June 2022)
ATTACIIMC' NT XIII
ANNUAL MODEL DAY CARP CENTER TRAINING
REPORT AL'LHLIMER'S DISPASC INITIATIVE PROGRAM
Model Day Core Conter Name:
Print name of person completing roporl
Signature of person completing report
F=P w
ADI 203.21
The purposo of Ilia model day calm program must be to provide service delivery to persons suffering from Atzheimer's
disease or a related memory disorder and training for health care and social service personnel in the care of persons having
Alzhoinret"s disease or related memory disorders. This report documents Ihu required training far the State Fisenl Year Ady
I at through June 301h.
Actual Training Events
Number Hcallh
Care
Professionals
Trained
Number Social
Services
Personnel
77ainod
Total People
Trained
Training Tillo:
Date:
Truiningsununtty:
57 of 63
Judy 2021 -.fNNo 2022)
ADI 203.21
AITACDMMI' XI V
COST RRIMilUR88MCNT SUMMARY
aeaon Omoloe�
DUEaot
Number al
Colepary pwcAPWn
unlla
Servko Deb
AmoeM
r
k
TOTAL ADMINISTRATION S0.0(
N
W
TOTAL EXPENSES $0.0(
Y
C
58 of 63
July 2021 - Juno 2022)
ATTACHMENT XV
SERVICE RATE REPORT
ADI 203.21
SERVICE
REIMBURSEMENT
UNITRATE
METIIOD OF
PAYMENT
UNITTYPI;
CASRAIDR
_
$33.88
Fixed Fee/Unit Enlo
HOURS
CASE MANAOL+MEM'
$60.00
Fixed Poo/Unit lint,
HOURS
RESPITE IN -FACILITY
$12.23
Fixed Fee/Unfit Rale
HOURS
RESPITEIN-HOML
525.02
Pixed Pon/Unit Me
HOURS
SHOPPING ASSISTANCE -COVID-19
$34.12
Fixed Pee/Unit Rate
ONE-WAY
TRII'
SPECIALIZED MEDICAL EQUIPMENT SERVICES,
AND SUPPLIES
Cm(Relmbarsemont
EPISODES
TRI,EPI TONS REASSURANCE• COVID-19
$13AO
Fixed Fee/Unit Irate
EPISODES
TRANSPORTATION
Cos( R,1n1tA0Sement
ONE
TRIP ONE-WAY
59 of 63
July 2021 - June 2022) ADf 203.21
ATTACHMENT XVI
DEPARTMENT OPELDER ArFA1RS
SILVER ALERT PROTOCOLS
I, Designated Momory Disorder Clinic (MDC) staff shall subscribe to the Department of Slider Affairs SilverAlort Llslsery
by entering their emall address all hlip://lids.elderaffairs.nrg/lislmanager/Iislinfo/xilveralerL By subscribing loreceive
Silver Alert notifications, M DCs are nulonmiical ly nol if ied via email whenever a Silver Alerl is issued,
2. Whennodficnlion of a Silver Alai is received by the MDC,ench Clinic Coordinolm• or designee reviews the
Information to de(ermine:
a) The county the endangered person is missing from, and
b) 'file Jaw enforcement agency Ilia( is reporting file Silver Alert. (Tile MDC that provides services In the county of
the reporting law enforcement agency is responsible for following up on all Silver Alerts in (tint county.)
3. The MDC or designee contacts the reputing law enforcement agency to obtain Ilia caregiver/contacl person's name,
phone number and address to enable the MDC coordinator or designee to follow up and assist ilia family with
information and resources. 'Ilia MDC Coordinator or designee completes the upper portion of the referral form
(Attachment XVII) includingthecnregivcr/conlncl person information.
Wit is determined that Iha endangered person resides in mmtiwr county, then the MDC coordinator or designee will
contact the MDC serving the county of residence and send the referral form within one to three (I-3) business days.
4.'11ne MDC Coordinator or designee in the county of residence will control the caregivel/contaci person In a timely
mannor [upon receipt of contact Information from Imv enforceniem o• within three (3) business days.] Tads activity is
reported unde number 6, "phone information/support/counseling," on ilia MDC Quarterly Report form (Attachment
IX).
(Note: If the endangered person has been recovered at ilia time of this contact, the MDC Coordinator will proceed will)
steps I and 2 as indicated below under "Upon Recovery of Endangered person.")
Upon Recovery of Endangered Person
The MDC shall contact the caregiver•/conhlet person:
I. MDC Coordinator or designee shall assess the situation and provide Alzbeimer's disease/dementia information and
referrals as needed. The MDC Coordinator or designee shall offer to make a referral to Ilia Aging and Disability
Resource Canter (ADRC).
2. If ilia cnregiverlcontact person consents to the ADRC referral, then the MDC Coordinator or designee shall send tine
Silver Alert Services Referral Porn (Attachment XVII) to the ADRC serving Ilia county of residence and inform the
emegiver/contacl fiction that a representative from the ADRC will contact thenr.'fhis activity shall be reported under
nunnber 4, "Rcforrals," ono the MDC Quarterly Report forin (Attachnncnt IX).
If the MDC makes n referral to the ADRC:
I. ADRC Inilinies contact with Ilia canigive•.
2. ADRC provides info in dion regnrAing community aesources and makes iel'crmis as appropriate for carogiver and
endangered person. The ADRC any also, screen ilia endangered person for services.
3. Within fourteen (14) business days, the ADRC completes Ilia Silver Alert Services Referral I+ornn and sends a copy
bock to the MDC noting all services and referrals provided and/or arranged. y
C
4. 11nc MDC retains ilia Silver Alert Services Referral Form.
6a of 63
;.luly 2021 -3nne 2022)
Compilation of Dma
Each MDC will it Silver Alerls in the designated scrvloe areas to ensure that follow-up has been completed and
disposition noted otter the endangered person is returned home.
ADI 203.21
A cony of Silver Alcri Referral Form rceadless of outcome shnll be entailed to file DOEA Contract Manager al
mwnorvAisorda•dinlrU�i clAarnffnirs.are
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61 or63
J03. 2021 -.hntc 2022) ADI 203.21
ATTACHMENT XVII
1)1)PAR'I'MI?N'1' OF ELDER AFFAIRS
AGING AND DISABILITY RESOURCE CENTER (ADRC) SILVI:12 ALERT SERVICES REFERRAL FORM
Date of Referml Received:
Referring MDC:
MDC Conlact Name;
MDC Phone;
ADRC;
ADRC Contact Pelson:
ADRC Phone:
Connly:
Notes/Comment:
Endangered Person Name:
Address:
City:
State:
7.ip Code:
Age:
DOB:
Lives with Camgivor:
Yes / No
Lives Moos:
Yes / No
Caregiver Name:
Relationship:
Mile:
Alternate Mono:
Services/Referrals Provided by ADRC:
62 of 63
;lacy 2021-June 2022) ADI 203.21
I. ADRC inifiates contact with the cmcgiver.
2. ADRC provides ini'ammlion regarding community resources and makes referrals as appropriate for caregiver and
endangered person. The ADRC may also screen the endangered person for services.
3. Within fourteen (14) business days, the ADRC completes the ADRC Silver Alert Services Referral Form and sends a
copy back to the MDC noting all services and referrals provided and/or arranged.
,1 17ne MDC retains the Silver Alert Services Referral Norm.
Compilation ofDnhn
Each MDC will (rack Silver Alerts in the designatal service areas to ensure that follow-up has been completed and
disposition noted after the eadangeretl person is returned home.
No modMcallons are to be male to this fo •in unless autborlred by DOLMA.
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Revised August 2007
Attestation Statement
Agreement/Conh•act Number AD] 203.21
Amendment Number
t Daniel R Rodrienez , attest that no changes or revisions bays, been made to the
(Recipient/Contractor representative)
content of tine above referenced agreement/contract or amendment between the Area Agency on Aging for
southwest Florida and
Collier County Board of County Connnissioners
(Recipient/Contractm, name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement/contract content.
g
Signatureo lenient/ ar asirlitative Date
Approved as to form and legality
La A C
Assistant Cotmly Alto
Revised August 2007
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