Backup Documents 12/14/2021 Item #16D2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 U 2
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human vok 12/14/2021
Services
2. Minutes & Records Clerk of Court's Office
3.
4.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf/CHS Phone Number 252-2901
Contact/ Depaitinent
Agenda Date Item was 12/14/2021 Agenda Item Number 16D2
Approved by the BCC
Type of Document Amendment-OAA 203.21.004& .005 Number of Original 2
Attached Documents Attached
PO number or account NA
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? NA
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the NA
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NA
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on_12/14/2021 and all changes made WK
during the meeting have been incorporated in the attached document. The County an opti«•
`
Attorney's Office has reviewed the changes,if applicable. this line
9. Initials of attorney verifying that the attached document is the version approved by the WK N/A is .
BCC,all changes directed by the BCC have been made,and the document is ready for the an opti.
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16U
January-December 2021 OAA 203.21,004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT'I'ITI,1? III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, inc, ("Agency")
and Collier County Board of County Commissioners("Contractor"), amends agreement OAA 203.21,
The purpose of this amendment is to amend contract language of contract OAA 2021; increase funding in the amount of
$70,741.69 to Older Americans Act Title IIIB;amend 4. Contract Amount; revise ATTACHMENT Il-EXHIBIT 2-
Funding Summary; and revise ATTACHMENT ViiI BUDGET AND 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
noun exceed S1,946,256.70 subject to the availability of funds, Any costs or services paid for under any other
contract or from any other source are not eligible for payment under this contract
All provisions in the contract any attachments thereto in conflict with this Amendment shall be and arc hereby changed •
to conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the
contract.
•
This Amendment and all its attachments are hereby made part of the contract,
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 OAA Contract or as amended.
This Amendment is effective on the last date the Amendment has hcen duly signed by both Parties.
CONTRACTOR: C ,i,iER COUNTY RD OF AREA AGENCY ON AGING FOR
COUNTY CO ISSIONER • SOUTHWEST FLORIDA, INC,
SIGNED BY: SI GNED BY: s "--"0-CN
NAME:/��• , RLIc1rt u� NAME: NORMA ADORNO
TITLE:PLA_Ol'e Sc'a vtl r' N\ev l k-60 TITLE:CEO
DATE: (Q I c97 raGu1a DATE: 6c)_ - 1021.
Federal Tax iD: 59-6000558
Fiscal Year Ending Date:09/30
Duns: 076997790
Approved as to form and legality
tent County Attor
C�0
•
16Q2r
January—December 2021 OAA 203.21.004
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR§200331,as revised,and Section 21597(5),F.S.,require that the information about federal programs and StateProjects be
provided tothe Recipient and are stated in The Financial And Compliance Audit Attachment II,Exhibit 1 provided to the recipient.
Information contained herein is a prediction cffinding murces and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD (FAIN#): 2101FLOASS,2101 FLOACM,2101FLOAHD,2101FLOAPH,2101FLOAFC,2101FLOANS
DUNS NUMBER : 076997790 FEDERAL AWARD DATE: OCTOBER 22, 2020
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title IIIB
Transportation $ 8,296.26
Support Services U.S. Health and Human Services 93.044 $ 375,669.57
Total IIIB $ 383,965.83
OAA Title IIIC1 —Congregate Meals U.S. Health and Human Services 93.045 S 751,744.89
Total IIIC1
OAA Title III C2—Home Delivered Meals U.S. Health and Human Services 93.045 $ 528,848.02
Total IIIC2
Older Americans Act Title III E
Services (Title III E) $ 174,742.74
Supplement Services (Title III ES) U.S. Health and Human Services 93.052 $ 49,143.40
Grandparent Services (Title III EG) $ 6,083.23
Total HIE $ 229,969.37
Nutrition Services Incentive Program(NSIP) U.S. Health and Human Services 93.053 $ 51,728.59
TOTAL FEDERAL AWARD $1,946,256.70
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200Uniform Administrative Requirements,Cost Principles, and Audit Requirements for Federal Awards/
OMB Circular A-133—Audits of States, Local Governments, and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97&215.971, F.S., Chapter 69I-5,F.A.C.,State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
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i 6 D 2
January—December 2021 OAA 203.21.004
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
OLDER AMERICANS ACT BUDGET SUMMARY
COLLIER COUNTY
1. Title III B Support Services $ 383,965.83
2. Title III Cl Congregate Meals $ 751,744.89
3. Title III C2 Home Delivered Meals $ 528,848.02
4. Title III E Services $ 229,969.37
5. NSIP $ 51,728.59
TOTAL $1,946,256.70
3 ed10
Revised August 2007 16 D 2
Attestation Statement
Agreement/Contract Number OAA 203.21
Amendment Number .0Q4
I,Daniel R Rodriguez ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of County Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
10/ 7/2021
Signature of Recipient/Con re re tive Date
Approved as to form and legality
Ass .5(s
nt County y Attorn
IDIAS\a\
Revised August 2007
C90
16Q
January-December 2021 OAA 203.21.005
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida,Inc.("Agency")and Collier
County Board of County Commissioners ("Contractor"),amends agreement OAA 203.21.
The purpose of this amendment is to revise ATTACHMENT VIII'BUDGET AND RATE SUMMARY.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the
contract.
This Amendment and all its attachments are hereby made part of the contract.
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 OAA Contract or as amended.This Amendment is
effective on the last date the Amendment has been duly signed by both Parties.
CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING
BOARD OF COUNTY COMMISSIONERS FOR SOUTHWEST FLORIDA,INC.
SIGNED B\"'� i ��/� • SIGNED BX:
-Z-TIAMAAA-al e(4-1174(9
NAME: Daniel R Rodriguez
NAME: Norma Adorno
President/CEO
TITLE: ,hl• Spryiep 17epatlu]ent Heart TITLE:
DATE: 11/15/202 i
DATE: �l—l 6 - 2-0
Federal Tax iD: 59-6000558
Fiscal Year Ending Date: 12/21
Approved as to form and legality
Assistant County Attomay1`t IQL Z1
t 0
;sue
161] :
January—December 2021 OAA 203.21.005
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
COLLIER COUNTY
C-1& C-2
SERVICE UNIT UNIT TYPE
UNIT RATE
Cl -- CONGREGATE MEALS $11.72 MEALS
HOME DELIVERED MEALS $8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
CONGREGATE MEAL SCREENING $28.00 HOUR
CONGREGATE MEALS FOR MANAGED $11.72 MEALS
LONG TERM CLIENTS
OUTREACH $4.32 PER PERSON EPISODE
SHOPPING ASSISTANCE—COVID-19 $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE—COVID-19 $13.40 EPISODE
SERVICE REIMBURSEMENT UNIT TYPE
UNIT RATE
C2 -- HOME DELIVERED MEALS $ 8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
SCREENING&ASSESSMENT $48.76 HOUR
OUTREACH $4.32 PER PERSON EPISODE
SHOPPING ASSISTANCE—COVID-19 $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE—COVID-19 $13.40 EPISODE
'G
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January—December 2021 OAA 203.21.005
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
COLLIER COUNTY
IIrn
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE
CASE MANAGEMENT $54.00 Fixed Fee/Unit Rate HOURS
CHORE $22.29 Fixed Fee/Unit Rate HOURS
EMERGENCY ALERT RESPONSE $ 1.35 Fixed Fee/Unit Rate DAYS
HOMEMAKER $25.44 Fixed Fee/Unit Rate HOURS
HOUSING IMPROVEMENT Cost Reimbursement 90%of Cost EPISODE
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE
PERSONAL CARE $25.44 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS
(EMERGENCIES ONLY) Cost Reimbursement 100%of Cost EPISODE
RESPITE IN-HOME $25.44 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE—COVID-19 $34.12 Fixed Fee/Unit Rate ONE-WAY TRIPS
SKILLED NURSING SERVICES $41.55 Fixed Fee/Unit Rate HOURS
SPECIALIZED MEDICAL
EQUIPMENT, SERVICES,AND Cost Reimbursement 90%of Cost EPISODE
TELEPHONE REASSURANCE—COVID-19 $13.40 Fixed Fee/Unit Rate EPISODE
TRANSPORTATION Cost Reimbursement 100%of Cost TRIPS
2 ;
16.D z
January—December 2021 OAA 203,21.005
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
COLLIER COUNTY
IIIE,IDLE,&IIIEG
REIMBURSEMENT METHOD OF UNIT
SERVICE UNIT RATE PAYMENT TYPE
IRE-- ADULT DAY CARE $13.50 Fixed Fee/Unit Rate HOURS
(effective until 9/30/21)
ADULT DAY CARE $108,00 Fixed Fee/Unit Rate DAYS
(effective beginning 10/t/21)
RECREATION MATERIALS Cost Reimbursement 100%of Cost EPISODE
(EMERGENCIES ONLY)
RESPITE IN-HOME $25.44 Fixed Fee/Unit Rate HOURS
RESPITE IN-FACILITY $11.05 Fixed Fee/Unit Rate HOURS
SCREENING&ASSESSMENT $55,17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE—COV1D-19 $34.12 Fixed Fee/Unit Rate ONE-WAY
TELEPHONE REASSURANCE—COVID-19 $13.40 Fixed Fee/Unit Rate EPISODE
IIIES--CHORE $22.29 Fixed Fee/Unit Rate HOURS
Specialized Medical Equipment, Cost Reimbursement 90%of Cost EPISODE
Service&Supplies
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE
IIIEG--CHILD DAY CARE $15.00 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS
(EMERGENCIES ONLY) Cost Reimbursement 100%of Cost EPISODE
SCREENING AND ASSESSMENT $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE--COVID-19 $34.12 Fixed Fee/Unit Rate ONE-WAY
TELEPHONE REASSURANCE—COVID-19 $13.40 Fixed Fee/Unit Rate EPISODE
0
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4
1 6 D 2
January—December 2021 OAA 203.21.005
Revised August 2007
Attestation Statement
Agreement/Contract Number:CAA 203.21
Amendment Number 005
I, Daniel R Rodriguez ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and
Collier County Board of County Commissioners .
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in electronic data processing
media,which has no effect on the agrecment/contract content.
..----- i
7. /
r 11//=(202I
r a t re o rp t we a e
Approved as to'' form and legalit.,
Assi nt Count 1y Attor y
0
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