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Backup Document 02/22/2022 Item #16D 8 I o 8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#I 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 02/22/22 Services 2. Minutes & Records Clerk of Court's Office a/ pea.is 3a rk 3. 4. PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Wendy Klopf/CHS Phone Number 252-2901 Contact/ Department Agenda Date Item was 02/22/2022 Agenda Item Number 16D8 Approved by the BCC Type of Document AAA/EHEAP ARP Agreement 203.22 Number of Original 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_02/22/22 and all changes made during WK the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the WK BCC, all changes directed by the BCC have been made,and the document is ready for the Chairman's signature. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 FLORIDA DEPARTMENT OF ELDER AFFAIRS STANDARD CONTRACT THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida,Inc.(Agency)and the Collier County Board of County Commissioners.(Contractor),collectively referred to as the"Parties."The term Contractor for this purpose may designate a Vendor, Subgrantee,or Subrecipient. WITNESSETH THAT: WHEREAS,the Agency has determined that it is in need of certain services as described herein; and WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform suchservices as an independent Contractor of the Agency. NOW THEREFORE,in consideration of the services to be performed and payments to be made,together with the . mutual covenants and conditions set forth herein,the Parties agree as follows: 1. Purpose of Contract: The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract including all attachments,forms,and exhibits which constitute the contract document. 2. Incorporation of Documents within the Contract: The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Agency handbooks, manuals and/or desk books, as an integral part of the contract,except to the extent that the contract explicitly provides to the contrary. In the event of conflict in language among any of the documents referenced above, the specific provisions and requirements of the contract document(s)shall prevail over inconsistent provisions in the proposal(s)or other general materials not specific to this contract document and identified attachments. 3. Term of Contract; This contract shall begin at twelve(12:00)A.M.,Eastern Standard Time November 1,2021 or on the date the contract has been signed by the last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59)P.M., Eastern Standard Time September 30,2022. 4. Contract Amount: The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amountnot to exceed$96,800.00,subject to the availability of funds.Any costs or services paid for under any other contractor from any other source are not eligible for payment under this contract. 5. Renewals: By mutual agreement of the Parties,in accordance with Section 287.058(1)(g),Florida Statutes(F.S.),the Agencymay renew the contract for a period not to exceed three years, or the term of the original contract,whichever is longer.The renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costsfor the renewal may be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon satisfactory performance evaluations by the Agency and the availability of funds. 6. Compliance with Federal Law: 6.1 If this contract contains federal funds this section shall apply. 6.1.1 The Contractor shall comply with the provisions of 45 Code of Federal Regulations (CFR)Part 75 and/or 45 CFR Part 92,2 CFR Part 200,and other applicable regulations. 6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all applicable standards,orders,or regulations issued under Section 306 of the Clean Air Act as amended(42 United States Code (U.S.C.) § 7401, et seq.), Section 508 of the Federal Water Pollution Control Act as amended (33 U.S.C. § 1251, et seq.), Executive Order 11738, as amended, and, where applicable, Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations of the above to the Agency. 6.1.3 Neither the Contractor nor any agent acting on behalf of the Contractor may use any federal funds received in connection with this contract to influence legislation or appropriations pending before Congress or any state legislature. The Contractor must complete all disclosure forms as required, specifically the Page 1 of 73 CN° 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 Certification and Assurances Attachment,which must be completed and returned to the Contract Manager prior to the execution of this contract. 6.1.4 In accordance with Appendix II to 2 CFR Part 200, the Contractor shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulations 41 CFR Part 60 and in Department of Health and Human Services regulations 45 CFR Part 92, if applicable. 6.1.5 A contract award with an amount expected to equal or exceed$25,000.00 and certain other contract awards will not be made to parties listed on the government-wide Excluded Parties List System,in accordance with the Office of Management and Budget (OMB) guidelines at 2 CFR Part 180 that implement Executive Orders 12549 and 12689, "Debarment and Suspension." The Excluded Parties List System contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract. 6.2 The Contractor shall not employ an unauthorized alien. The Agency will consider the employment of unauthorized aliens a violation of the Immigration and Nationality Act(8 U.S.C. § 1324a)and the Immigration Reform and Control Act of 1986 (8 U.S.C. § 1101). Such violation will be cause for unilateral cancellation of this contract by the Agency. 6.3 If the Contractor is a non-profit provider and is subject to Internal Revenue Service(IRS)tax exempt organization reporting requirements (filing a Form 990 or Form 990-N), and has its tax exempt status revoked for failing to comply with the filing requirements of the Pension Protection Act of 2006 or for any other reason,the Contractor must notify the Agency in writing within thirty(30)days of receiving the IRS notice of revocation. 6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons. 6.5 Unless exempt under 2 CFR § 170.110(b), the Contractor shall comply with the reporting requirements of the Transparency Act as expressed in 2 CFR Part 170. 6.6 To comply with Presidential Executive Order 12989,as amended,and State of Florida Executive Order Number 11-116, Contractor agrees to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all new employees hired by Contractor during the contract term.Contractor shall include in related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the state contract utilize the E-verify system to verify employment of all new employees hired by the Subcontractorduring the contract term. Contractors meeting the terms and conditions of the E-Verify System are deemed to bein compliance with this provision. 7. Compliance with State Law; 7.1 This contract is executed and entered into in the State of Florida,and shall be construed,performed,and enforced in all respects in accordance with Florida law, including Florida provisions for conflict of laws. 7.2 If this contract contains state financial assistance funds,the Contractor shall comply with Section 215.97, F.S., and Section 215.971, F.S., and expenditures must be in compliance with laws, rules, and regulations including, but not limited to,the Reference Guide for State Expenditures. 7.3 The Contractor shall comply with the requirements of Section 287.058,F.S.,as amended. 7.3.1 The Contractor shall perform all tasks contained in Attachment I. 7.3.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in Attachment I,to be received and accepted by the AGENCY Contract Manager prior to payment. 7.3.3 The Contractor shall comply with the criteria and final date by which such criteria must be met for completion of this contract as specified in Attachment I, Section III.Method of Payment. 7.3.4 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail for a proper pre-audit and post-audit. Page 2 of 73 CAO 160 b November 2021-September 2022 EHEAP ARPA 203.22 7.3.5 If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit invoices for any travel expenses in accordance with Section 112.061,F.S.,or at such lower rates as may be provided in this contract. 7.3.6 The Contractor shall allow public access to all documents,papers,letters,or other public records as defined in Section 119.011(12), F.S., made or received by the Contractor in conjunction with this contract except for those records which are made confidential or exempt by law. The Contractor's refusal to comply with this provision will constitute an immediate breach of contract for which the Agency may unilaterally terminate this contract. 7.4 If clients are to be transported under this contract, the Contractor shall comply with the provisions of Chapter 427,F.S.,and Rule Chapter 41-2,Florida Administrative Code(F.A.C). 7.5 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in accordance with the provisions of Section 287.134,F.S. 7.6 The Contractor shall comply with the provisions of Section 11.062,F.S.,and Section 216.347,F.S.,which prohibit the expenditure of contract funds for the purpose of lobbying the legislature,judicial branch or a state agency. 7.7 The Agency may, at its option, terminate the Contract if the Contractor is found to have submitted a false certification as provided under Section 287.135(5), F.S., has been placed on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List,the Scrutinized Companies with Activities in Sudan List,or the Scrutinized Companies that Boycott Israel List,or if the Contractor has been engaged in business operations in Cuba or Syria or is engaged in a boycott of Israel. 8. Background Screening: The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435, F.S., as amended, are met regarding background screening for all persons who meet the definition of a direct service provider and who are not exempt from the Agency's level 2 background screening pursuant to Sections 430.0402(2)-(3),F.S. The Contractormust also comply with any applicable rules promulgated by the Agency and the Agency for Health CareAdministration regarding implementation of Section 430.0402 and Chapter 435, F.S. To demonstrate compliance withthis provision, Contractor shall submit the Background Screening Affidavit of Compliance (Screening Form) to the Agency within thirty (30) days of execution of this contract. Should the Agency have a completed Screening Form on file for the Contractor,a new Screening Form will be required every twelve(12)months. 8.1 Further information concerning the procedures for background screening may be found at https://elderaffairs.org/about-us/background-screening/ 9. Grievance Procedures: The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to process and resolve client dissatisfaction with, or denial of, service(s) and to address complaints regarding the termination,suspension or reduction of services,as required for receipt of funds. These procedures,at a minimum,will provide for notice of the grievance procedure and an opportunity for review of the Subcontractor's determination(s). 10. Public Records and Retention: 10.1 By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any other applicable law,and shall: 10.1.1 Keep and maintain public records required by the Agency to perform the contracted services. 10.1.2 Upon request from the Agency's custodian of public records,provide the Agency a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that doesnot exceed the cost provided in Chapter 119,F.S.,or as otherwise provided by law. 10.1.3 Ensure that public records that are exempt, or confidential and exempt, from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the Agency. 10.1.4 Upon completion of the contract, the Contractor will either transfer, at no cost to the Agency, all public records in possession of the Contractor to the Agency or will keep and maintain public records requiredby the Agency. If the Contractor transfers all public records to the Agency upon completion of thecontract, Contractor shall destroy any duplicate public records that are exempt,or confidential and exempt, Page 3 of 73 CA4 November 2021 -September 2022 EHEAP PP203.22 from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records.All records stored electronically must be provided to the Agency in a format that is compatiblewith the information technology systems of the Agency. 10.2 The Agency may unilaterally cancel this contract,notwithstanding any other provisions of this contract,for refusal by the Contractor to comply with Section 10 of this contract by not allowing public access to all documents,papers, letters, or other material made or received by the Contractor in conjunction with this contract, unless the records are exempt, or confidential and exempt, from Section 24(a) of Article I of the State Constitution and Section 119.07(1),F.S. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES,TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Public Records Coordinator Area Agency on Aging for Southwest Florida,Inc. 2830 Winkler Ave, Suite 112 Fort Myers,FL 33916 239-652-6900 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 records in their possessionto the Agency and destroy any duplicate public records that are exempt, or confidential and exempt, from public records disclosure requirements.All records stored electronically shall be provided to the Agency in aformat that is compatible with the information technology systems of the Agency. 11. Audits.Inspections.Investigations: 11.1 The Contractor shall establish and maintain books,records,and documents(including electronic storage media) sufficient to reflect all assets, obligations, unobligated balances, income, interest, and expenditures of funds provided by the Agency under this contract. Contractor shall adequately safeguard all such assets and ensurethat they are used solely for the purposes authorized under this contract.Whenever appropriate,financial information should be related to performance and unit cost data. 11.2 The Contractor shall retain and maintain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media)pertinent to this contract for a period of six (6)years after completion of the contract, or longer when required by law. In the event an audit is required by this contract,records shall be retained for a minimum period of six(6)years after the audit report is issued or until resolution of any audit findings or litigation based on the terms of this contract,at no additional cost to the Agency. 11.3 Upon demand, at no additional cost to the Agency, the Contractor shall facilitate the duplication and transferof any records or documents during the required retention period. 11.4 The Contractor shall ensure that the records described in this section will be subject at all reasonable times to inspection,review, copying, or audit by federal, state,or other personnel duly authorized by the Agency. 11.5 At all reasonable times for as long as records are maintained,persons duly authorized by the Agency and federal auditors, pursuant to 45 CFR Part 75, shall be allowed full access to and the right to examine any of the Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the form in which kept. 11.6 The Contractor shall provide a Financial and Compliance Audit to the Agency as specified in this contract and ensure that all related third-party transactions are disclosed to the auditor. 11.7 Contractor agrees to comply with the Inspector General in any investigation,audit,inspection,review,or hearing performed pursuant to Section 20.055, F.S. Contractor further agrees that it shall include in related subcontracts a requirement that subcontractors performing work or providing services pursuant to this contract agree to Page4of73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 cooperate with the Inspector General in any investigation, audit, inspection, review, or hearing pursuant to Section 20.055(5), F.S. By execution of this contract the Contractor understands and will comply with this subsection. 11.8 In accordance with Executive Order 20-44 which requires executive agencies to submit a list of entities named in statute with which a state agency must form a sole-source,public-private agreement or an entity that,through contract or other agreement with the state,annually receives 50%or more of their budget from the State or from a combination of State and Federal funds.Any Contractor that meets one or both of the criteria listed must submit an annual report, including the most recent IRS Form 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 must include total compensation including salary,bonuses,cashed-in leave,cash equivalents, severance pay,retirement benefits,deferred compensation,real-property gifts, and any other payout. 11.8.2 The Contractor shall inform the agency of any changes in total executive compensation between the annual reports as those changes occur. 11.8.3 All compensation reports must indicate what percent of compensation comes directly from the State or Federal allocations to the contracted entity. 12. Jvondiscrimination-Civil Rights Compliance: 12.1 The Contractor shall execute Assurances as stated in the Assurances-Non-Construction Programs Attachment that it will not discriminate against any person in the provision of services or benefits under this contract or in employment because of age, race,religion,color, disability,national origin,marital status, or sex in compliance with state and federal law and regulations. The Contractor further assures that all Contractors, Subcontractors, Sub-grantees, or others with whom it arranges to provide services or benefits in connection with any of its programs and activities are not discriminating against clients or employees because of age,race,religion, color, disability,national origin,marital status,or sex. 12.2 During the term of this contract,the Contractor shall complete and retain on file a timely,complete,and accurate Civil Rights Compliance Checklist,attached to this contract. 12.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving services or benefits through this contract. These procedures shall include notifying clients, employees, and participants of the right to file a complaint with the appropriate federal or state entity. 12.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from federal financial assistance,and are binding upon the Contractor,its successors,transferees,and assignees for the period during which such assistance is provided. The Contractor further assures that all Subcontractors,Vendors, or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the any statutes, regulations, guidelines, and standards. In the event of failure to comply, the Contractor understands that the Agency may,at its discretion,seek a court order requiring compliance with the terms ofthis assurance or seek other appropriate judicial or administrative relief including, but not limited to, terminationof the contract and denial of further assistance. 13. Monitoring by the Agency: The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records,papers,documents, facilities, goods, and services of the Contractor which are relevant to this contract, and to interview any clients, employees,and Subcontractor employees of the Contractor to assure the Department of the satisfactory performance of the terms and conditions of this contract. Following such review,the Agency will provide a writtenreport of its findings to the Contractor and,where appropriate,the Contractor shall develop a Corrective Action Plan(CAP). The Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determinedby the Agency's Contract Manager. 14. Provision of Services: The Contractor shall provide services in the manner described in Attachment I. Page 5 of 73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 15. Coordinated Monitoring with Other Agencies; If the Contractor receives funding from one or more State of Florida human service agencies,in addition to the Agency, then a joint monitoring visit including such other agencies may be scheduled. For the purposes of this contract, and pursuant to Section 287.0575, F.S., as amended, Florida's human service agencies shall include the Agency, the Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities, and the Department of Veterans' Affairs. Upon notification and the subsequent scheduling of such a visitby the designated agency's lead administrative coordinator, the Contractor shall comply and cooperate with all monitors, inspectors, and/or investigators. 16. New Contract(s)Reporting: The Contractor shall notify the Agency within ten(10)days of entering into a new contract with any of the remaining four(4) state human service agencies.The notification shall include the following information:(1)contracting state agency and the applicable office or program issuing the contract; (2) contract name and number; (3) contract start and end dates; (4) contract amount; (5) contract description and commodity or service; and (6) Contract Manager name andcontact information.In complying with this provision,and pursuant to Section 287.0575,F.S.,as amended,the Contractor shall complete the Contractor's State Contracts List attached to this contract. 17. Indemnification: The Contractor shall indemnify, save, defend, and hold harmless the Agency and its agents and employees from any and all claims, demands, actions, and causes of action of whatever nature or character arising out of, or by reason of, the execution of this contract or performance of the services provided for herein. It is understood and agreed that the Contractor is not required to indemnify the Agency for claims, demands, actions, or causes of action arising solely out of the negligence of the Agency. 17.1 Except to the extent permitted by Section 768.28,F.S., or other Florida law,this Section 17 is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in Section 768.28(2),F.S. 18. Insurance and Bonding: 18.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this contract and any renewal(s) and extension(s) of it. By execution of this contract,unless it is a state agency or subdivision as defined by Section 768.28(2),F.S.,the Contractor accepts full responsibility for identifying and determining the type(s) and extent of liability insurance coverage necessary to provide reasonable financial protections for the Contractor and the clients to be served under this contract. The limits of coverage under each policy maintained by the Contractor do not limit the Contractor's liability and obligations under this contract. The Contractor shall ensure that the Agency has the most current written verification of insurance coverage throughout the term of this contract. Such coverage may be provided by a self-insurance program established and operating under the laws of the State of Florida.The Agency reserves the right to require additional insurance as specified in this contract. 18.2 Throughout the term of this contract, the Contractor shall maintain an insurance bond from a responsible commercial insurance company covering all officers, directors, employees, and agents of the Contractor authorized to handle funds received or disbursed under all agreements and/or contracts incorporating this contract by reference in an amount commensurate with the funds handled, the degree of risk as determined by the insurance company, and consistent with good business practices. 19. Confidentiality of Information; The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 20. jlealth Insurance Portability and Accountability Act: Where applicable,the Contractor shall comply with the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as well as all regulations promulgated thereunder(45 CFR Parts 160, 162,and 164). 21. jncident Reporting: 21.1 The Contractor shall notify the Agency immediately but no later than forty-eight(48)hours from the Contractor's awareness or discovery of conditions that may materially affect the Contractor's or Subcontractor's Page 6of73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ability to perform the services required to be performed under this contract. Such notice shall be made orally to the Agency's Contract Manager(by telephone)with an email to immediately follow. 21.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse,neglect,or exploitation of a child, aged person,or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96ABUSE). As required by Chapters 39 and 415,F.S.,this provision is binding upon the Contractor, its Subcontractors,and their employees. 22. Bankruptcy Notification: During the term of this contract, the Contractor shall immediately notify the Agency if the Contractor, its assignees, Subcontractors,or affiliates file a claim for bankruptcy.Within ten(10)days after notification,the Contractor must also provide the following information to the Agency: (1)the date of filing of the bankruptcy petition; (2)the casenumber; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida, Tallahassee Division);and(4)the name, address, and telephone number of the bankruptcy attorney. 23. Sponsorship and Publicity: 23.1 As required by Section 286.25, F.S., if the Contractor is a non-governmental organization which sponsors a program financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by (Contractor's name)and the State of Florida,Department of Elder Affairs." If the sponsorship reference is in written material, the words"State of Florida,Department of Elder Affairs"shall appear in at least the same size letters or type as the name of the organization. 23.2 The Contractor shall not use the words "State of Florida, Department of Elder Affairs"to indicate sponsorship of a program otherwise financed, unless specific written authorization has been obtained by the Agency priorto such use. 24. Assignments: 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, or transfer otherwise occurring without prior written approval of the Agency shall constitute a material breach of the contract. In the event the State of Florida approves assignment of the Contractor's obligations,the Contractor remains responsible for all work performed and all expenses incurred in connection with this contract. 24.2 The State of Florida is,at all times,entitled to assign or transfer,in whole or part,its rights,duties,or obligations under this contract to another governmental agency in the State of Florida upon giving prior written notice to the Contractor. 24.3 This contract shall remain binding upon the successors in interest of the Contractor 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 furnished by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a written document and subject to any conditions of approval the Agency deems necessary.The Contractor further agrees that the Agency will not be liable to the Subcontractor in any way or for any reason. The Contractor, at its expense,shall defend the Agency against any such claims. 25.2 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the Agency or other state agency. Failure to make payments to any Subcontractor in accordance with Section 287.0585, F.S., unless otherwise stated in the contract between the Contractor and Subcontractor, will result in a penalty as provided by statute. 26. Independent Capacity of Contractor: It is the intent and understanding of the Parties that the Contractor and any of its Subcontractors are independent Contractors and are not employees of the Agency, and that they shall not hold themselves out as employees or agents of the Agency without prior specific authorization from the Agency. It is the further intent and understanding of the Parties that the Agency does not control the employment practices of the Contractor and will not be liable for any wage and hour, employment discrimination, or other labor and employment claims against the Page 7 of 73 CAO November 2021 -September 2022 EHEAP ARPA 203.22 Contractor or its Subcontractors. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds, and all necessary insurance for the Contractor are the sole responsibility of the Contractor. 27. payment: Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in Attachment I. The AGENCY Contract Manager will have final approval of the Contractor's invoice submitted for paymentand will approve the invoice for payment only if the Contractor has met all terms and conditions of the contract, unlessthe bid specifications,purchase order,or this contract specify otherwise. The approved invoice will be submitted to theAgency's finance section for budgetary approval and processing. Disputes arising over invoicing and payments will be resolved in accordance with the provisions of Section 215.422,F.S. A Vendor Ombudsman has been established within the Florida Department of Financial Services and may be contacted at 800-342-2762. 28. Return of Funds: The Contractor shall return to the Agency any overpayments due to unearned funds or funds disallowed,and any interest attributable to such funds pursuant to the terms and conditions of this contract,that were disbursed to the Contractor by the Agency.In the event that the Contractor or its independent auditor discovers that an overpaymenthas been made,the Contractor shall repay said overpayment immediately without prior notification from the Agency. In the event that the Agency first discovers an overpayment has been made, the AGENCY Contract Manager will notify the Contractor in writing of such findings. Should repayment not be made forthwith,the Contractorshall be charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03,F.S.,after Agency notification or Contractor discovery. 29. Data Integrity and Safeguarding Information: The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities.All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system.The security over the backed-up data is to be as stringent as the protection required of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for Agreements,Grants,Loans,and Cooperative Agreements prior to the execution of this contract. 30. Social Media and Personal Cell Phone use: 30.1 Inappropriate use of social media and personal cell phones may pose risks to AGENCY's confidential and proprietaryinformation and may jeopardize compliance with legal obligations.By signing this contract,Contractor agrees tothe following social media and personal cell phone use requirements. 30.2 Social Media Defined. The term Social Media and /or personal cellular communication includes, but is not limited to, social networking websites, blogs, podcasts, discussion forums, RSS feeds, video sharing, SMS (including Direct Messages (DMs), iMessages, text messages, etc.); social networks like Instagram, TikTok, Snapchat,Google Hangouts, WhatsApp, Signal,Facebook, Pinterest, and Twitter; and content sharing networks such as Flickr and YouTube. This includes the transmission of social media through any cellular or online transmission via any electronic,interne,intranet,or other wireless communication. 30.3 Application to any direct or incidental AGENCY or other state business. This contract applies to any AGENCY orother state business conducted on any of the Contractor's,Subcontractor's,or their employees'social media accounts or through personal cellular communication. 30.4 Application to AGENCY and Contractors Equipment.This contract applies regardless of whether the social media is accessed using AGENCY's IT facilities and equipment or equipment belonging to Contractor, Subcontractor, or their respective employees. Equipment includes, but is not limited to, personal computers, cellular phones,personal digital assistants,smart watches,or smart tablets. 30.5 Florida Government in the Sunshine, Florida Public Records Law, and HIPAA. Contractor acknowledges that any AGENCY or other state business conducted by social media or through personal cellular communication issubject to Florida's Government in the Sunshine Law, Florida's Public Records Law (Chapter 119, Florida Page 8 of 73 CAO November 2021 -September 2022 EHE P R 203.22 Statutes),and the Health Insurance Portability and Accountability Act(HIPAA). Compliance with these laws and other applicable laws are further detailed in the contract. 30.6 Prohibited or Restricted Postings. Contractors may not take or post photos or videos of, or include names or identifying information, about any of AGENCY's clients.Any social media posts which include photos,videos, or names of volunteers, staff, or other affiliates of AGENCY may only be posted with the permission of those individuals. Any such posts related to volunteer service at AGENCY may only include individuals over the age of 18. 30.7 Assist AGENCY with Communications. Contactors may be asked periodically to assist in distributing certain AGENCY communications through their social media outlets.Any such requests should be posted in adherence to the social media requirements herein and the other provisions of this contract. 31. Conflict of Interest; The Contractor shall establish safeguards to prohibit employees,board members,management,and Subcontractors from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain. No employee, officer, or agent of the Contractor or Subcontractor shall participate in the selection or in the award of a contract supported by state or federal funds if a conflict of interest,real or apparent,would be involved. Such a conflict would arise when:(a)the employee,officer or agent;(b)any member of his/her immediate family;(c)his or her partner;or(d)an organization which employs,or is about to employ,any of the above individuals, has a financial or other interest in the firm being selected for award. The Contractor's or Subcontractor's officers, employees,or agents will neither solicit nor accept gratuities,favors, or anything of monetary value from Contractors, potential Contractors, or parties to Subcontracts. The Contractor's board members and management must disclose to the Agency any relationship which may be,or may be perceived to be,a conflict of interest within thirty(30)calendar days of an individual's original appointment or placement in that position,or,if the individual is serving as anincumbent, within thirty(30)calendar days of the commencement of this contract.The Contractor's employees and Subcontractors must make the same disclosures described above to the Contractor's board of directors.Compliance with this provision will be monitored. 32. Public Entity Crime; Pursuant to Section 287.133,F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity;may not submit a bid,proposal,or reply on a contract with a public entity for the construction or repair of a public building or public work;may not submit bids,proposals,or replies on leases of real property to a public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, F.S., for CATEGORY TWO for a period of thirty six(36)months following the date of being placed on the Convicted Vendor List. 33. Purchasing: 33.1 The Contractor shall procure products and/or services required to perform this contract in accordance 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 TO CARRY OUT,THIS CONTRACT SHALL BE PURCHASED FROM A NONPROFIT AGENCY FOR THE BLIND OR FOR THE SEVERELY HANDICAPPED THAT IS QUALIFIED PURSUANT TO CHAPTER 413,FLORIDA STATUTES,IN THE SAME MANNER AND UNDER THE SAME PROCEDURES SET FORTH IN SECTION 413.036(1) AND (2), FLORIDA STATUTES; AND FOR PURPOSES OF THIS CONTRACT THE PERSON, FIRM, OR OTHER BUSINESS ENTITY CARRYING OUT THE PROVISIONS OF THIS CONTRACT SHALL BE DEEMED TO BE SUBSTITUTED FOR THE STATE AGENCY INSOFAR AS DEALINGS WITH SUCH QUALIFIED NONPROFIT AGENCY ARE CONCERNED. 33.1.2 Pursuant to sections 413.036(1)and(4), F.S.,the Contractor shall not be required to procure a product or service from RESPECT if: (a)the product or service is not available within a reasonable delivery time,(b) the Contractor is required by law to procure the product or service from any agency of the state, or(c)the Contractor determines that the performance specifications,price,or quality of the product or service is not comparable to the Contractor's requirements. Page 9 of 73 CAO 16Q 8 November 2021-September 2022 EHEAP ARPA 203.22 33.1.3 This act shall have precedence over any law requiring state agency procurement of products or services from any other nonprofit corporation unless such precedence is waived by the Agency in accordance with its rules. 33.1.4 Additional information about the designated nonprofit agency and the products it offers is available at http://www.respectofflorida.org. 33.2 The Contractor shall procure any recycled products or materials which are the subject of,or are required to carry out,this contract when the Department of Management Services determines that those products are available,in accordance with the provisions of section 403.7065,F.S. 33.3 The Contractor shall procure products and/or services required to perform this contract in accordance with section 946.515,F.S. 33.3.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES WHICH ARE THE SUBJECT OF,OR REQUIRED TO CARRY OUT,THIS CONTRACT SHALL BE PURCHASED FROM THE CORPORATION IDENTIFIED UNDER CHAPTER 946, F.S., IN THE SAME MANNER AND UNDER THE SAME PROCEDURES SET FORTH IN SECTION 946.515(2) AND(4),F.S,; AND FOR PURPOSES OF THIS CONTRACT THE PERSON,FIRM,OR OTTER BUSINESS ENTITY CARRYING OUT THE PROVISIONS OF THIS CONTRACT SHALL BE DEEMED TO BE SUBSTITUTED FOR THIS AGENCY INSOFAR AS DEALINGS WITH SUCH CORPORATION ARE CONCERNED. 33.3.2 The corporation identified is Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE). Additional information about PRIDE and the commodities or contractual services it offers is available at https://pride-enterprises.org/. 33.4 The Agency shall provide a Certified Minority Business Subcontractor Expenditure (CMBE) Report summarizing the participation of certified suppliers for the current reporting period and project to date.The CMBE Report shall include the names, addresses, and dollar amount of each certified participant, and a copy must be forwarded to the Agency, Division of Financial Administration,and must accompany each invoice submitted to the Agency. The Office of Supplier Diversity (850-487-0915) will assist in furnishing names ofqualified minorities. The Agency's Minority Coordinator (850-414-2153) will assist with questions and answers. The CMBE Report is attached to this contract. 34. Patents.Copyrights.Royalties: If this contract is awarded state funding and if any discovery, invention, or copyrightable material is developed or produced in the course of or as a result of work or services performed under this contract or in any way connected with this contract, or if ownership of any discovery, invention, or copyrightable material was purchased in the course of or as a result of work or services performed under this contract, the Contractor shall refer the discovery, invention, or copyrightable material to the Agency to be referred to the Department of State. Any and all patent rights or copyrights accruing under this contract are hereby reserved to the State of Florida in accordance with Chapter 286,F.S.Pursuant to Section 287.0571(5)(k), F.S., the only exceptions to this provision shall be those that are clearly expressedand 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 pursuant to this 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 Contractor or one of its Subcontractors is a university and a member of the State University System of Florida,then Section 1004.23, F.S.,shall apply,but the Agency shall retain a perpetual,fully-paid, nonexclusive license for its use and the use of its Contractors, Subcontractors,or Assignees of any resulting patented,copyrighted,or trademarked work products. Page 10 of 73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 35. Emergency Preparedness and Continuity of Operations: 35.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the administration and coordination of services necessary for client health, safety, or welfare,the Contractor shall, within thirty (30) calendar days of the execution of this contract, submit to the AGENCY Contract Manager, verification of an Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the Department of emergency provisions. 35.2 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall remain responsible for performance under this contract and must follow procedures to ensure continuity of operations without interruption. 36. Equipment: 36.1 Equipment means:(a)tangible personal property(including information technology systems)having a useful life of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization level established by the organization for the financial statement purposes, or$5,000.00 [for federal funds -2 CFR § 200.33 and 45 CFR§75.2,as applicable],or(b);nonexpendable,tangible personal property of a non-consumable nature with an acquisition cost of$5,000.00 or more per unit, and expected useful life of at least one(1) year; and hardback bound books not circulated to students or the general public, with a value or cost of$250.00 or more [for state funds]. 36.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations shall have written property management standards in compliance with 2 CFR Part 200 Administrative Requirements (formerly OMB Circular A-110) that include: (a) a property list with all the elements identified in the circular;(b)a procedure for conducting a physical inventory of equipment at least once every two (2) years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of the equipment;and(d)maintenance procedures to keep the equipment in good condition.The property records must be maintained on file and shall be provided to the Agency upon request. The Contractor shall promptly investigate, fully document, and notify the AGENCY Contract Manager of any loss, damage, or theft of equipment.The Contractor shall provide the results of the investigation to the AGENCY Contract Manager. 36.3 The Contractor's property management standards for equipment (including replacement equipment), whether acquired in whole or in part with federal funds and federally-owned equipment shall, at a minimum, meet the following requirements and shall include accurately maintained equipment records with the following information: 36.3.1 Property records must be maintained that include a description of the equipment; 36.3.2 Manufacturer's serial number, model number, federal stock number, national stock number, or other identification number; 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 date(or date received,if the equipment was furnished by the federal government); 36.3.6 Information from which one can calculate the percentage of federal participation in the cost of the equipment(not applicable to equipment furnished by the federal government); 36.3.7 Location,use and condition of the equipment and the date the information was reported; 36.3.8 Unit acquisition cost;and 36.3.9 Ultimate disposition data, including date of disposal and sales price or the method used to determine current fair market value where a Contractor compensates the federal awarding agency for its share. 36.3.10 A physical inventory must be taken,and the results reconciled with the property records at least once every two(2)years. 36.3.11 A control system must be developed to ensure adequate safeguards to prevent loss, damage,or theft of the property. Any loss,damage, or theft must be investigated.45 CFR§75.320(d)(3). 36.3.12 Adequate maintenance procedures must be developed to keep the property in good condition. Page 11 of 73 CAO November 2021 -September 2022 IE6 ARPA 2822 36.3.13 If the Contractor is authorized or required to sell the equipment,proper sales procedures must be established to ensure the highest possible return. 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 part of the cost of carrying out the activities and functions of the grant awards and title(ownership) will vest in the Contractor [for federal funds see 2 CFR § 200.313(a) and 45 CFR § 75.320(a), as applicable], subject to the conditions of 2 CFR Part 200 and/or 45 CFR Part 75. Equipment purchased under these thresholds is considered supplies and is not subject to property standards. Equipment purchased with funds identified in the budget attachments to agreements covered by this contract or identified in the sub-agreements with Subcontractors (not included in a cost methodology), is subject to the conditions of Chapter 273,F.S.,rule 60A-1.017,F.A.C., and 2 CFR Part 200 and/or 45 CFR Part 75. 36.5 The Contractor shall not dispose of any equipment or materials provided by the Agency or purchased with funds provided through this contract without first obtaining the approval of the AGENCY Contract Manager. When disposing of property or equipment the Contractor must submit a written request for disposition instructions to the Agency's Contract Manager. The request should include a brief description of the property, purchase price, funding source, and percentage of state or federal participation, acquisition date and condition of the property. The request should also indicate the Contractor's proposed disposition of the property(i.e., transfer ordonation to another agency that administers federal programs,offer of the items for sale,destroy the items,etc.). 36.6 The AGENCY Contract Manager will issue disposition instructions. If disposition instructions are not received within one hundred twenty (120) days of the written request for disposition, the Contractor is authorized to proceed as directed in 2 CFR§200.313 or 45 CFR§75.320,as applicable. 36.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but excludes movable machinery and equipment. Real property may not be purchased with state or federal funds through agreements covered under this contract without the prior approval of the Agency. Real property purchases from Older Americans Act funds are subject to the provisions of Title 42, Chapter 35, Subchapter III, Part A., Section 3030b United States Code(U.S.C.).Real property purchases from state funds can only be made through fixed capital outlay grants and aids appropriations and therefore are subject to the provisions of Section 216.348,F.S. 36.8 Any permanent storage devices(e.g.:hard drives,removable storage media)must be reformatted and tested prior to disposal to ensure no confidential information remains. 36.9 The Contractor must adhere to the Agency's procedures and standards when purchasing Information Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR worksheet is required for any computer related item costing$1,000.00 or more,including data processing hardware,software, services, supplies, maintenance, training, personnel, and facilities. The completed ITR worksheet shall be maintained in the LAN administrator's file and must be provided to the Agency upon request.The Contractor has the responsibility to require any Subcontractors to comply with the Agency's ITRprocedures. 37. FUR 1000 Form: The PUR 1000 Form is hereby incorporated by reference and available at: ht�pt ://dms,myfl orida.com/purchasing In the event of any conflict between the PUR 1000 Form and any terms or conditions of this contract, the terms or conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in the PUR 1000 Form are required by any section of the Florida Statutes,the terms or conditions contained in the PUR 1000 Form shall take precedence. 38. Use of State Funds to Purchase or Improve Real Property: Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or political subdivision granting to the state a security interest in the property at least to the amount of state funds provided for at least five(5)years from the date of purchase or the completion of the improvements or as further required by law. Page 12 of 73 CA0 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 39. Dispute Resolution: Any dispute concerning performance of the contract shall be decided by the AGENCY Contract Manager, who shall reducethe decision to writing and serve a copy on the Contractor. 40. Financial Consequences: If the Contractor fails to meet the minimum level of service or performance identified in this contract,the Agency shall impose financial consequences as stated in Attachment I. 41. No Waiver of Sovereign Immunity: Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which sovereign immunity may be applicable. 42. Venue: If any dispute arises out of this contract,the venue of such legal recourse shall be Leon County,Florida. 43. Entire Contract: This contract contains all the terms and conditions agreed upon by the Parties.No oral agreements or representations shall be valid or binding upon the Agency or the Contractor unless expressly contained herein or by a written amendment to this contract signed by both Parties. 44. Force Majeure: The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control, provided the party experiencing the force majeure condition provides immediate written notification to the other party and takes all reasonable efforts to cure the condition. 45. Severability Clause; The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable, the other provisions are severable to that void provision and shall remain in full force and effect. 46. Condition Precedent to Contract Appropriations: The Parties agree that the Agency's performance and obligation to pay under this contract are contingent upon an annual appropriation by the Legislature. 47. Addition/Deletion: The Parties agree that the Agency reserves the right to add or to delete any of the services required under this contract when deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties. The Parties shall negotiate compensation for any additional services added. 48. Waiver: The delay or failure by the Agency to exercise or enforce any of its rights under this contract will not constitute orbe deemed a waiver of the Agency's right thereafter to enforce those rights,nor will any single or partial exercise of any such right preclude any other or further exercise thereof or the exercise of any other right. 49. Compliance: The Contractor shall abide by all applicable current federal statutes, laws,rules, and regulations as well as applicable current state statutes,laws,rules and regulations. The Parties agree that failure of the Contractor to abide by these laws shall be deemed an event of default of the Contractor and subject the contract to immediate unilateral cancellation of the contract at the discretion of the Agency. 50. Final Invoice: The Contractor shall submit the final invoice for payment to the Agency no later than thirty(30)days after the contract ending date unless otherwise specified in Attachment I. If the Contractor fails to do so, all right to payment isforfeited and the Agency shall not honor any requests submitted after the aforesaid time period.Any payment dueunder the terms of this contract shall be withheld until all required documentation and reports due from the Contractorand necessary adjustments thereto have been approved by the Agency. Page 13 of 73 C A0 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 51. Renegotiations of Modifications; Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently identified in the Agency's operating budget. 52. Suspension of Work: The Agency may, in its sole discretion, suspend any or all activities under the contract or purchase order, at any time, when in the interest of the State to do so.The Agency shall provide the Contractor written notice outlining the particulars of suspension.Examples of the reason for suspension include,but are not limited to,budgetary constraints,declaration of emergency, or other such circumstances. After receiving a suspension notice, the Contractorshall comply with the notice and shall not accept any purchase orders. Within ninety (90) days, or any longer period agreed to by the Contractor, the Agency shall either: (1) issue a notice authorizing resumption of work, at which time activity shall resume, or (2) terminate the contract or purchase order. Suspension of work shall not entitle the Contractor to any additional compensation. 53. Termination: 53.1 Termination for Convenience. The Agency,by written notice to the Contractor,may terminate this contractin whole or in part when the Agency determines in its sole discretion that it is in the State's interest to do so.The Contractor shall not furnish any product after it receives the notice of termination,except as necessary to complete the continued portion of this contract, if any. The Contractor shall not be entitled to recover any cancellation charges or lost profits. 53.2 Termination for Cause.The Agency may terminate this contract if the Contractor fails to:(1)deliver the product within the time specified in the contract or any extension, (2) maintain adequate progress, thusendangering performance of the contract, (3) honor any term of the contract, or (4) abide by any statutory, regulatory, or licensing requirement. Rule 60A-1.006(3), F.A.C., governs the procedure and consequences of default. The Contractor shall continue work on any work not terminated. Except for defaults of Subcontractors at any tier,the Contractor shall not be liable for any excess costs if the failure to perform the contract arises from events completely beyond the control,and without the fault or negligence,of the Contractor. If the failure to perform is caused by the default of a Subcontractor at any tier,and if the cause of the default is completely beyondthe control of both the Contractor and the Subcontractor, and without the fault or negligence of either,the Contractor shall not be liable for any excess costs for failure to perform,unless the subcontracted products were obtainable from other sources in sufficient time for the Contractor to meet the required delivery schedule. If,aftertermination,it is determined that the Contractor was not in default,or that the default was excusable,the rights and obligations of the Parties shall be the same as if the termination had been issued for the convenience of the Agency.The rights and remedies of the Agency in this clause are in addition to any other rights and remedies provided by law or under the contract. 54. Electronic Records and Signature: The Agency authorizes,but does not require,the Contractor to create and retain electronic records and to use electronic signatures to conduct transactions necessary to carry out the terms of this contract.A Contractor that createsand retains electronic records and uses electronic signatures to conduct transactions shall comply with the requirementscontained in the Uniform Electronic Transaction Act,Section 668.50,F.S.All electronic records must be fully auditable;are subject to Florida's Public Records Law, Chapter 119, F.S.; must comply with contract Section 29, Data Integrity and Safeguarding Information;must maintain all confidentiality,as applicable;and must be retained and maintained by the Contractor to the same extent as non-electronic records are retained and maintained as required by this contract. 54.1 The Agency's authorization pursuant to this section does not authorize electronic transactions between the Contractor and the Agency. The Contractor is authorized to conduct electronic transactions with the Agency only upon further written consent by the Agency. 54.2 Upon request by the Agency, the Contractor shall provide the Agency with non-electronic (paper) copies of records. Non-electronic (paper) copies provided to the Department of any document that was originally in Page 14 of 73 C Ap 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 electronic form with an electronic signature must identify the person and the person's capacity who electronically signed the document on any non-electronic copy of the document. 55. Contract Manager: The Agency may substitute any Agency employee to serve as the AGENCY Contract Manager. REMAINDER OF THE PAGE INTENTIONALLY LEFT BLANK Page 15 of 73 CAO 160 8 November 2021-Septemhar 2022 CHEAP ARPA 203.22 56.Official Payee and Representatives(Names.Addresses.and Telephone Numbers): Collier County Board of County Commissioners The Contractor name,as shown on page I of this 3339 F.Tantiami Trail,Building I i a. contract,and mailing address of the official payee to Naples,FI.341 12 whom the payment shall be made is: Kristi Sonntag,Director The name of the contact person and street address Collier County Board of County Commissioners b. where financial and administrative records arc Community and Human Services maintained is: 3339 E Tamiami Trail,Building H Napltu FL 34112 Norma Adorno,Chief Executive Officer, The name,address,and telephone number of the 2830 Winkler Ave.,Suite 112 c, representative of the Contractor responsible for Mort Myers,FL 33916 administration of the program under this contract is: 239-652-6900 Area Agency on Aging for Southwest Florida, The section and location within the Agency where Inc. d. Requests for Payment and Receipt and Expenditure 2830 Winkler Ave.,Suite 112 forms are to be mailed is: Fort Myers,FL 33916 Richard Cocchieri The name,address,and telephone number of the Area Agency on Aging for Southwest Florida,Inc. e. Contract Manager for this contract is: 2830 Winkler Ave.,Suite 112 Fort Myers,FL 33916 (239)652-6900 x58279 Upon change of representatives(names,addresses,telephone numbers)by either party,notice shall be provided in writing to the other party. 57. All Terms and Condittnntincluded; This contract and its Attachments I—XXI, including any exhibits referenced in said attachments, together with any documents incorporated by reference, contain all the terms and conditions agreed upon by the Parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications,representations,or agreements,either written or verbal,between the Parties. By signing this contract,the Parties agree that they have read and agree to the entire contract. IN WITNESS WHEREOF,the Parties hereto have caused this contract to he executed by thcirundersigned officials as duly authorized. CONTRACTO •COLLIER CO '' ' OAItD OF .AREA AGENCY ON AGING FOR COUNTY MiISSIONI; SOUTHWEST FLORIDA,INC SIGNAT /, SIGNAT[lltb. .- x f NAME DA 'IE R DRI tl NAME NORMA ADORNO TITLE NT i IEAD TITLE President/CEO DATE otl )4g-,1/707 DATE t 2—k--Approved 2�2.2... Federal Tax ID:59-6000558 Duns:076997790 as to form and legality .-3 1 -- 13 - Assistant County Attorney Page 16 of 73 C.40 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 INDEX OF ATTACHMENTS ATTACHMENT I 18 STATEMENT OF WORK 18 ATTACHMENT II 37 FINANCIAL AND COMPLIANCE AUDIT 3 7 ATTACHMENT III 43 CERTIFICATIONS AND ASSURANCES 43 ATTACHMENT IV 48 ASSURANCES-NON-CONSTRUCTION PROGRAMS 48 ATTACHMENT V 50 FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST 50 ATTACHMENT VI 54 CONTRACTOR'S STATE CONTRACT LIST 54 ATTACHMENT VIII 56 CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES(CMBE FORM) 56 ATTACHMENT IX 58 EHEAP ARP ACT BUDGET SUMMARY 58 ATTACHMENT X 59 EHEAP ARP ACT ADMINISTRATIVE AND OUTREACH EXPENSE B UDGET DETAIL 59 ATTACHMENT XI 60 RECEIPTS AND EXPENDITURE REPORT 60 ATTACHMENT XII 61 REQUEST FOR PAYMENT 61 ATTACHMENT XIII 62 EHEAP ARP ACT INVOICE REPORT SCHEDULE 62 ATTACHMENT XIV 63 STATE MEDIAN INCOME GUIDELINES 63 ATTACHMENT XV 64 EHEAP ARP ACT SOURCES OF INCOME 64 ATTACHMENT XVI 65 EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM-APPLICATION 65 ATTACHMENT XVII 68 EHEAP ARP ACT APPLICATION INSTRUCTIONS 68 ATTACHMENT XVIII 71 EHEAP ARP ACT CLIENT FILE CONTENT CHECKLIST 71 ATTACHMENT XIX 72 EHEAP ARP ACT RECIPIENT INFORMATION 72 ATTACHMENT XX 73 SERVICE RATE REPORT 73 Page 17 of 73 cA0 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT I STATEMENT OF WORK EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM AMERICAN RESCUE PLAN(ARP)ACT OF 2021 SUPPLEMENTAL GRANT I. SERVICES TO BE PROVIDED A. DEFINITION OF TERMS 1. Eighteen (18) hour rule—The timeframe within which all applications for life-threatening crisis assistance shall be acted upon, with an eligible action to mediate the crisis being taken and documented in the client file within eighteen(18)hours of the application date stamp. 2. Forty-eight(48) hour rule—The timeframe within which all applications for standard crisis assistance shall be acted upon,with an eligible action to mediate the crisis being taken and documented in the client file within forty-eight(48)hours of the application date stamp. 3. Caseworker—Person who is responsible for determining program eligibility by completing the Emergency Home Energy Assistance for the Elderly Program American Rescue Plan Act of 2021 Supplemental Grant (EHEAP ARP)Eligibility Worksheet(Attachment XVI)and awarding crisis benefits. 4. Caseworker Signature Date — The date that the client's completed application is processed, eligibility determined,and the crisis resolved. This date shall not be changed. Signatures must be in ink. Rubber-stamped signatures will not be accepted. 5. Categorically Eligible—Applicants will be considered eligible to receive EHEAP services,regardless if their household in is exceeding 150% of the State Median Income Guideline, if any member of their household is receiving Temporary Assistance for Needy Families (TANF), Supplemental Social Security (SSI), or Supplemental Nutrition Assistance Program(SNAP)benefits. 6. Client Application Date-The date the application is completed(whether by self or with assistance)and signed by the elder.This date shall not be changed. Signatures must be in ink. Rubber-stamped signatures will not be accepted.If an elder cannot write their signature on the application,or any other required document,and must sign with an"X,"two witnesses are required. 7. Crisis-A home cooling or heating crisis exists when an elder has no access to,or is in danger of losing access to,needed home energy. 8. Crisis Assistance—Assistance provided to an elder who has no access to, or is in danger of losing access to, needed home energy. 9. Date of Resolution—The date that a documented commitment to pay was made to the utility vendor to resolve the energy crisis. This date is used as the EHEAP ARP Act Client Enrollment date in the Agency's Client Information and Registration Tracking System(CIRTS). This date shall not be changed. a. The amount of time elapsed between the Date Stamp and the Date of Resolution shall determine whether or not the eighteen or forty-eight(18/48)hour rule was met. b. Vendors must be paid within forty-five(45)days of the date of resolution. 10. Date Stamp—The date the application and all required documentation is presented in acceptable form to intake staff. An inked stamp must be used,and the date shall not be changed. The 18/48-hour rule for crisis resolution begins when the application is date stamped. 11. Disability—A disabling condition that causes an elder to be determined eligible to receive Supplement Security Income(SSI)or Social Security Disability Income(SSDI)from the Social Security Administration. 12. Elder—An individual aged sixty(60)years or older. 13. Eligible Action — An action taken by the caseworker to mediate an elder's energy crisis. Eligible actions include: a. Approval of an elder's application; b. Denial of an elder's application pending further information; Page 18 of 73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 C. Denial of an elder's application because the elder is deemed ineligible; d. Contact with a utility vendor to halt utility disconnection or interruption in services;or e. Written referral to and providing the elder with assistance contacting another agency if EHEAP ARP Act funding is not available or the elder is ineligible. 14. Energy Subsidy - Utility costs paid directly or indirectly to the elder who lives in government—subsidized housing. 15. Household—Any individual or group of individuals who are living together as one economic unit for whom residential energy is customarily purchased in common or who make undesignated payments for energy in the form of rent. 16. Household Member—Persons in a household who share a common kitchen or bath and purchase residential energy in common. 17. Intake Worker—Person who accepts the EHEAP ARP Act application and required documentation and may have the responsibility to determine eligibility or award crisis benefits. 18. Minimum Level of Service—Service to a minimum of one household per month. 19. Crisis Assistance Benefit—Payment of heating/cooling energy bill;the purchase of a heating/cooling device; and/or the repair of a heating/cooling device. 20. Priority for Assistance—Households with the highest home energy needs and lowest household income,which will be determined by taking into account both the energy burden and the unique situation of such households with members of vulnerable populations,including very young children, individuals with disabilities, and frail elder individuals. 21. Provider—The entity that has entered into a contract, subcontract, or Memorandum of Understanding(MOU) to provide services under EHEAP ARP Act. For the purposes of this contract, the terms "Provider" and "Contractor"may be used interchangeably. 22. Reasonable Promptness-Within fifteen(15)working days of receiving the client's completed application. 23. Request for Payment—Submission of actual monthly expenditures for reimbursement. 24. Service Unit—One individual(elder)served. 25. Social Security Number—The number on an elder's Social Security card or the number provided by an award or determination letter from an entity,such as a government agency,that has already verified the social security number. 26. Supervisory/Peer Review Date — The date that a supervisor or peer reviewed the application and documentation and signed the application indicating vendor payment can be made. The intent of the supervisor/peer review is to avoid errors in eligibility determination and payment amounts and to alleviate the possibility of fraud.This date shall not be changed. Signatures must be in ink. Rubber-stamped signatures will not be accepted. 27. Verification Date—The date the caseworker verified previous Low-Income Home Energy Assistance Program (LIHEAP) crisis benefits with the LIHEAP provider or the minimum amount necessary to resolve the crisis with the utility company. This date shall not be changed. B. GENERAL DESCRIPTION 1. General Statement The Emergency Home Energy Assistance for the Elderly Program(EHEAP)American Rescue Plan(ARP)Act of 2021 Supplemental Grant serves the mission of the Agency by providing home energy assistance aid toelders in the event of a home energy heating or cooling emergency. The primary purpose of the EHEAP ARPAct program is to prevent,prepare for,and respond to coronavirus;including assisting low-income householdswith at least one member aged sixty(60)or older experiencing a heating or cooling emergency. Page 19 of 73 C1 Ap 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 2. Authority The relevant federal and state authorities governing EHEAP ARP Act are: a. Low Income Home Energy Assistance Act of 1981 (Title XXVI of the Omnibus Budget Reconciliation Act of 1981,P.L. 97-35), as amended; b. ARP Act of 2021; c. 42 United States Code(U.S.C.) § 8621 et seq.; d. 45 Code of Federal Regulations(CFR)Part 96, Subpart H(§§ 96.80-96.89); e. Section 409.508,Florida Statutes(F.S.)and Rule 73C-26.021(3),Florida Administrative Code(F.A.C.); f. Rule Chapter 73C-26,F.A.C.; g. State of Florida LIHEAP Policies and Procedures Manual; and h. LIHEAP State Plan. 3. Scope of Service The Contractor is responsible for the programmatic, fiscal, and operational management of EHEAP ARP Act. Eligible elders may receive multiple crisis assistance benefit(s),that combined not to exceed$5,000.00 during the term of this agreement. Eligible, elders may receive crisis assistance benefits during the period from November 1, 2021 to September 30,2022. a. The services provided under this contract shall be in a manner consistent with and described in Attachment I, Section II: Manner of Service Provision. Contractor, in collaboration with its EHEAP ARP Act program partners,shall ensure the following service tasks are completed: (1) Consumer Outreach; (2) Program Partners and Stakeholders Coordination; (3) Elder's Benefit Eligibility Determination;and (4) Benefit Disbursement. 4. Major Program Goals EHEAP ARP Act is designed to provide crisis assistance to eligible low-income households with at least one individual aged sixty(60)or older experiencing a heating or cooling emergency.The Summer and Winter Crisis seasons are waived until the ARP Act funding is fully expended. a. Standard Crisis A standard home cooling or heating crisis exists when an elder has no access to, or is in danger of losing access to,needed home energy because one or more of the following conditions is present: (1) The elder has been notified that the energy source for cooling or heating is going to be disconnected; (2) The elder has received a notice indicating the energy source is delinquent or past due;and/or (3) The elder has an energy bill for which the due date has lapsed; b. Life-Threatening Crisis A life-threatening home cooling or heating crisis exists if one of the following conditions is present: (1) The elder's home cooling or heating energy source has been disconnected; (2) The elder is unable to get delivery of fuel for heating,is out of fuel for heating,or is in danger of being out of fuel for heating;or (3) The elder has other problems with lack of cooling or heating in the home, such as needing to pay a deposit,needing a repair of heating or cooling equipment,or needing an interim emergency measure to avoid further crisis. Page 20 of 73 C Cop 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 C. CLIENTS TO BE SERVED 1. General Description EHEAP ARP Act provides for direct client services to elders in low-income households experiencing a home energy heating or cooling emergency. A household with 1-8 individuals receiving EHEAP ARP Act services may not have an income above sixty percent(60%)of the State Median Income and for households with 9-or- more individuals incomes,please refer to the Federal Poverty Guidelines(FPG)Benefits Matrix, as published by the United States Department of Health and Human Services, unless the household is determined categorically eligible. 2. Client Eligibility To be eligible for services under this contract,and to receive assistance,an elder must: a. Be aged sixty(60)or older; b. Reside in the EHEAP ARP Act service area(Planning and Service Area)at the time the home energy costs were incurred; c. Complete and return an EHEAP ARP Act application with all required information and verification to Contractor,while funds remain available; d. Provide a fuel bill or other documentation evidencing an energy emergency and an obligation to pay for home energy costs for the home in which they live; e. Possess a total gross household income of not more than sixty percent(60%)of the Office of Management and Budget(OMB) state median income level for the size of the household with 1-8 individuals and for households with 9-or-more individuals incomes, please refer to the FPG Benefits Matrix, in accordance with Section I.C.3.d.,or be determined categorically eligible to receive EHEAP benefits; f. Be experiencing one or more verifiable home cooling or heating crises; g. Not be a resident of a group living facility or a home where the cost of residency is at least partially paid (or subsidized)through a foster care or residential program administered by the state; h. Not be a student living in a dormitory; and i. Legally reside in the State of Florida. 3. Client Determination Contractor shall begin taking applications for EHEAP ARP Act services upon execution of this contract and continue taking applications until the contract expires or funds are exhausted. Contractor will not accept applications when funds are exhausted for a particular time period.Contractor shall: a. Provide assistance to elders in completing Agency-provided applications for assistance and determining eligibility; b. Ensure that no one is excluded from program participation on the grounds of race, color, national origin, sex,or age,and ensure that such persons shall not be subjected to discrimination under any activity funded in whole or in part with these funds; c. Treat homeowners and those who rent equitably under this contract; d. Calculate the income eligibility of the elder by using the past thirty(30)days earnings for all occupants of the household annualized or the elder's current economic situation and reference the current year EHEAP ARP Act Sources of Income (Attachment XV) to determine what is considered allowable income. Contractor shall proceed as follows: (1) Total household income with 1-8 individuals cannot exceed sixty percent (60%) of the current State Median Income Guidelines(Attachment XIV)and for households with 9-or-more individuals income, please refer to the FPG Benefits Matrix,unless the household is determined categorically eligible; i. Stimulus payments from the federal government in relation to the Coronavirus Disease will not be considered income and will not be considered in determining a household's State Median Income (60%or below). Page 21 of 73 CSC 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ii. Any type of unemployment. (2) Obtain a self-declaration from household members aged eighteen(18)years or older claiming zero income. Self-declarations must be completed and signed by the household member who is claiming zero income. i. Zero income can be determined with proof of client employment termination or self-declaration. ii. Zero income can be determined at the time of application and projected forward(current economic status), instead of using the past 30 days. If applicable, clients should note the reason for zero income related to COVID19. iii. Although not counted as income for eligibility purposes, excluded income sources may be used to determine how a household is meeting its expenses. e. Determine if all or part of the elder's utility costs are paid directly (utility reimbursement) or indirectly (utility allowance)by the government if the elder lives in government-subsidized housing.Contractor shall proceed as follows: (1) If total home heating or cooling costs are included in the rent and the elder has no obligation to pay any portion of the costs,then the elder is not eligible for assistance; and (2) If there is a Florida Section 8(Housing Choice Voucher Program)or a Public Housing Authority(PHA) Program energy subsidy available to the elder during the period covered by the utility bill, then the elder is only eligible for partial assistance.The energy subsidy for the period covered by the utility bill must be subtracted from the allowable EHEAP ARP Act benefit calculated for the household. f. Use program qualification approvals or notifications from TANF, SSI, or SNAP to document household size and income of elders,or to determine and document categorical eligibility to receive EHEAP benefits. The benefit level to be provided to elders receiving TANF,SSI,and SNAP shall be the same as that provided to other qualified elders; g. Obtain a signed statement of maintenance from the elder explaining how basic living expenses(i.e.,food, shelter,and transportation are being provided)if the total household income is less than fifty percent(50%) of the current State Median Income Guidelines and no one in the household is receiving SNAP; h. Ensure elders receive no more than the household crisis assistance cap of$5,000.00. (1) Elders may apply for and receive multiple crisis assistance benefit; (1) Water,sewer,garbage,and fire,etc. charges may not be paid; (2) Crisis assistance benefit may consist of payment of more than one energy obligation in the following allowable categories for a household to resolve a single crisis: (i) Utility payments for heating/cooling bill assistance for electric, gas, propane, wood, coal, or refillable fuels; (i) Temporary emergency shelter(if needed due to energy-related crisis); (ii) Payment to landlords(when utility costs are included in rent); (iii) Repairs or replacements to heating/cooling units (as long as the amount is within the benefit limits and the work is done by a licensed contractor); (iv) Deposits to connect or restore energy; (v) Late fees,disconnect fees,and reconnect fees; (vi) Charges from a previous account held by the applicant that is now closed; (vii) Taxes and fees associated with the client's utility bill towards the energy portion. In some cases,where the utility vendor combines all the other fees and taxes,which also includes non-home energy services,such taxes and fees can be paid with EHEAP ARP Act funding. Example:In a case where taxes for other services are commingled with taxes for home energy services,proceed with paying the taxes portion of the bill; Page 22 of 73 C AQ 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 (viii) Other allowable payments are those related to the start-up of services, including reasonable connection or reconnection fees, delivery fees, deposits, and other fees related to the start-up of service; (ix) Pre-pay home energy usage: a. The elder is within seven days of using the remaining balance of the pre-purchased energy source, the elder's power is currently disconnected/shut off, or the elder needs a deposit. b. The benefit amount for pre-paid account shall be for one month's energy usage and may include other allowable costs; (x) The purchase or repair of fans, blankets, air conditioners, and/or portable heaters in addition to heating/cooling bill assistance;and (xi) Crisis situations which may involve a heater or air conditioner that is powered by both gas and electricity, in which case both energy obligations are eligible for a crisis benefit. (xii) Payment to landlord when utility costs are included in the elder's rent is allowable;and (xiii) Payment for temporary emergency shelter is allowable if due to energy related crisis i. In no case shall the Contractor be required to incur costs in excess of the full contract amount to provide services to the clients. II. MANNER OF SERVICE PROVISION A. SERVICE TASKS In order to achieve the goals of EHEAP ARP Act,Contractor shall ensure the following tasks are performed: 1. Ensure that all eligible elders meet the requirements of Section I.C.2.of this contract; 2. Ensure that all energy assistance payments made to home energy vendors comply with the requirements of Section II.A.14.d. of this agreement; 3. Implement appropriate program management and operational controls to ensure all applications for crisis assistance are acted upon with an eligible action to mediate the crisis within eighteen or forty-eight (18/48) hours of the application date stamp,and document in the client file that the crisis was resolved within eighteen or forty-eight(18/48)hours; 4. Provide all elders approved for EHEAP ARP Act funding with a written Notice of Approval and Appeal on agency letterhead within fifteen (15) working days of crisis resolution. The written Notice of Approval and Appeal shall include: a. Type and amount of assistance; b. Name of the home energy vendor to be paid on elder's behalf; c. The next date when the elder will be eligible to apply for further assistance; and d. Contractor's appeal process. e. Signature,date,and contact information of agency's authorized representative. 5. Provide all elders whose EHEAP ARP Act applications were denied with a written Notice of Denial and Appeal on agency letterhead within fifteen(15)working days of receiving the elder's application.The written Notice of Denial and Appeal shall contain: a. Name of the elder; b. Date of application; c. Type of benefit sought; d. Reason(s)for denial; Page 23 of 73 ,4Q 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 e. Statement on Contractor's benefit limits,if applicable; f. Contractor's appeal process; g. Explanation of circumstances under which the elder may reapply; h. Information or documentation needed for the elder to reapply; i. The name,address,and phone number applicable to the appeal process; and j. Number of days the elder has to file the appeal. k. Signature,date and contact information of agency's authorized representative. 6. Maintain consumer appeal procedures that provide an opportunity for a fair administrative hearing to elders whose applications for assistance are denied or whose applications are not acted upon with reasonable promptness; 7. Provide an opportunity for elders to file a written appeal or complaint with Contractor's Program Supervisor within ten(10)working days of receipt of the written Notice of Denial and Appeal. a. Upon receipt of a validly filed appeal or complaint, Contractor must respond in writing within ten (10) working days; b. Elders may appeal Contractor's first response by filing its objections to the response with Contractor's Director,Executive Director, or Board Chair,as applicable,within five(5)working days of receipt of the first response; and c. Upon receipt of a validly filed objection to the first response,Contractor must respond in writing within ten (10)working days, and the response must clearly state the final outcome of the appeal,that the decision is final,and if applicable,the circumstances under which the elder may reapply for services. 8. Post appeal provisions in a prominent place and in plain view at all locations where EHEAP ARP Act applications are received; 9. Ensure all ineligible applicants and applicants denied crisis assistance, when EHEAP ARP Act funds are not available or are insufficient to meet their emergency home energy needs,are referred to and assisted in securing help through other community resources; 10. Ensure no consumer fees are charged to,nor donations accepted from, an elder as a prerequisite for receiving EHEAP ARP Act benefits.Post in a conspicuous place at all locations where EHEAP ARP Act applications are received the following notice: "No money,cash, or checks will be requested or received from customers inthe EHEAP office.If an employee asks for money,report this to the agency executive director or Agency head."; 11. Compare LIHEAP ARP Act records and EHEAP ARP Act records for households with elderly members to avoid exceeding the household crisis benefit cap and maintain documentation sufficient to ensure compliance with this requirement; 12. Maintain a written policy and implement procedures to protect and secure elder applicants' information and social security numbers in order to protect their identities from theft or fraud. This policy shall address the handling of both paper and electronic records and files. Contractor shall, in collecting elders' social security numbers, use the Notice Regarding Collection of Social Security Numbers, which is incorporated into this contract by reference, (Notice of Instruction #071113-1-I-SWCBS, http://elderaffairs.state.fl.us/doea/notices/July 13/LIHEAP%20Notice%20re%20Social%20S ecurity%20Numb ers%20Final.pdf). The Notice Regarding Collection of Social Security Numbers shall be signed by the elder and retained in the client file; 13. Consumer Outreach Ensure that households in all counties within the service area wishing to benefit from the program have the opportunity to do so. Contractor shall undertake consumer outreach initiatives in all counties within the service area designed to inform potentially eligible households about EHEAP ARP Act. Outreach efforts must focus on elderly households with disabled individuals, young children, and where the highest percentage of the household income is required to pay for their home energy. Specific outreach initiatives shall include,but are not limited to: Page 24 of 73 040 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 a. Informing all service area local agencies,non-profits,and similar organizations that are in regular contact with the low-income population about the EHEAP ARP Act program, especially those serving seniors; b. Encouraging EHEAP ARP Act program participation through local television and radio programs, and placing announcements of the EHEAP ARP Act program in media community calendars; c. Developing and implementing a written procedure for making home visits to households with homebound elderly persons in order to assist with the completion of the program application when other assistance is not available; d. Making visits to provide information and/or making presentations about EHEAP ARP Act in response to requests by local congregational centers serving elderly or disabled persons; and e. Providing information concerning the local weatherization program to all persons who request it(including organizations that provide outreach activities). f. Maintaining an EHEAP Outreach Activity Report to demonstrate to the Agency that outreach efforts to inform potentially eligible households about EHEAP are conducted to target households in all counties. 14. Program Partners and Stakeholder Coordination Contractor shall coordinate services with other program partners and stakeholders to prevent the duplication of services,facilitate referrals,and improve the efficiency of services for consumers.Coordination activities shall include,but not be limited to: a. Communicating with the DEO LIHEAP contractors in their respective service areas to prevent exceeding the household crisis assistance cap to elders; b. Developing a new,or continuing an existing,MOU with the Weatherization Assistance Program(WAP)in the service area. The MOU shall detail cooperative efforts and describe the actions that will be taken by both parties to ensure coordination and referrals. The MOU shall be reviewed and renewed at least every five years. Contractor,in coordination with the local WAP agency,shall develop a system by which elders who have received more than three EHEAP or LIHEAP benefits in the last eighteen(18)months and who are homeowners are referred to a WAP provider. Contractor shall maintain copies of all MOUs; c. Establishing a new, or continuing an existing, MOU with service area LIHEAP contractors. Each MOU shall ensure coordination of services, avoid duplication of assistance, and increase the quality of services provided to elders. The MOU shall direct LIHEAP providers to refer elders aged sixty (60) or older to EHEAP providers for energy assistance. The MOU shall be reviewed and renewed at least every five(5) years.Contractor shall maintain copies of all MOUs.MOUs with local LIHEAP agencies shall be updated if the contracting parties change. The MOUs must be applicable to Contractor's current EHEAP requirements and guidelines; d. Developing agreements with home energy vendors that benefit elders. Contractor shall maintain copies of all vendor agreements. All current EHEAP agreements between Contractor and home energy vendors are valid under the EHEAP ARP Act contract. All agreements between Contractor and home energy vendors shall contain the following conditions: (1) The beginning and ending date of the Vendor Agreement; (2) The Contractor's representative(s) authorized to resolve a crisis situation and make a payment commitment on behalf of an elder; (3) The home energy vendor's representative(s)authorized to resolve a crisis; (4) A description of how energy payments will be made directly to the home energy vendor on behalf of the EHEAP eligible customer; (5) Assurance from the home energy vendor that no household receiving EHEAP assistance will be treated adversely because of such assistance under applicable provisions of state law or public regulatory requirements; (6) Assurance that the home energy vendor will not discriminate,either in the cost of goods supplied or the services provided,against the eligible household on whose behalf payments are made; Page 25 of 73 C AO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 (7) A statement that only energy-related elements of a utility bill are to be paid.Water,sewer,garbage,and fire, etc. charges are not covered as part of the utility bill of the household. However, EHEAP does allow an exception with water that is used for air conditioning,i.e.an evaporated cooler; (8) A statement that Contractor may not pay for charges that result from illegal activities such as a worthless check or meter tampering, and that the home energy vendor is aware that those charges are the responsibility of the elder; (9) Assurance from the home energy vendor that when the benefit amount to the elder does not pay for the complete charges owed by an elder,the elder is responsible for the remaining amount owed; (10) Details on how the home energy vendor will assist Contractor in verifying the elder's account information and, in the case of crisis assistance, make timely commitments to resolve the crisis. A process should be in place to verify the current amount owed and the minimum amount necessary to resolve the crisis situation; (11) Contractor's commitment to make payment to the home energy vendor within forty-five (45) days of the date of crisis resolution; (12) Assurance from the home energy vendor that when EHEAP payments made to the vendor cannot be applied to the elder's account,the funds will be returned to Contractor or,with Contractor's approval, applied to another eligible customer's account; (13) Assurance that the Contractor shall collect a signed Authorization for Release of General and/or Confidential Information for EHEAP Data from each eligible elder and ensure the signed releases are available for inspection by the home energy vendor; (14) Assurance that the home energy vendor is aware that as long as signed Authorization for Release of General and/or Confidential Information for EHEAP Data are collected and available,the home energy vendor will provide the requested customer data to DEO; (15) The agreement will be reviewed by both parties at least every five(5)years; (16) The agreement must be signed by a representative of both Contractor and the vendor who has authority to bind the entity and enter into such commitments; and (17) The home energy vendor, with the exception of municipal providers, must be in "active" status with the State of Florida(http://sunbiz.org/search.html). The business name on the vendor agreement must match the legal business name on the State of Florida Sunbiz website;and 15. Comply with the Federal Financial Accountability and Transparency Act (FFATA) by securing a Dun and Bradstreet Numbering System(DUNS)number(www.dnb.com)and maintaining an active and current profile in the System for Award Management(SAM)(www.sam.gov). B. STAFFING REQUIREMENTS 1. Use of Subcontractors If an entity other than the Contractor provides any service required under this contract, the Contractor shall ensure the following requirements are met: a. Eligible entities that provide outreach, perform intake, make eligibility determinations, or process benefit payments must be one of the following: (1) A Local City Government; (2) A Local County Government; (3) A Community-Based Organization; (4) A Faith-Based Organization;or (5) A State Community Services Agency. b. For the term of this contract, each month Subcontractor shall provide to Contractor the following information: Page 26 of 73 Cl 16L1 8 November 2021 -September 2022 EHEAP ARPA 203.22 (1) The total number of individuals served with crisis assistance for the reporting month; (2) The total number of individuals ineligible or denied assistance during the reporting month; (3) The total number of individuals served by referral to other community resources for energy assistance during the reporting month;and (4) The total amount of funding expended for crisis assistance per county for the reporting month. c. Entities providing any service required under this contract must comply with the FFATA. This includes securing a DUNS number(www.dnb.com)and maintaining an active and current profile in the System for Award Management(SAM)(www.sam.gov). d. Entities must maintain current written agreements in the following formats with service providers: (1) A MOU shall be executed by both parties if a service provider performs any service required under this contract and is paid for providing specific services without a direct pass-through of federal funds.The MOU shall clearly state program expectations and the role and responsibilities of each entity. Contractor shall submit a copy of all MOUs to the Agency's Contract Manager within thirty(30)days of the contract execution date;and (2) An EHEAP ARP Act subcontract shall be executed by both parties if a service provider performs any service required under this contract and is awarded a direct pass-through of federal funds to operate the program and provide program services. Contractor shall submit a copy of all subcontracts to the Agency's Contract Manager within thirty(30)days of the contract execution date. e. Eligible entities must provide the service provider commensurate compensation for the delivery of administrative and outreach activities and for the delivery of crisis benefits. Commensurate compensation of administration and outreach activities shall include cost-reimbursement of actual expenses or a negotiated rate for specific activities. f. If any of the work required under this contract is subcontracted, Contractor shall include in the subcontract that the subcontractor is bound by the terms of this contract, is bound by all applicable state and federal laws and regulations and shall hold the Agency and Contractor harmless against all claims of any nature arising out of the subcontractor's performance of work under this contract to the extent allowed and required by law. g. Subcontractor shall not be permitted to perform services related to this contract without an executed subcontract and an approved Provider Cost Analysis or MOU verifying that subcontractor's staff is paid from non-federal resources or is compensated for such activities by EHEAP ARP Act. In accordance with Sections 25-26 of the Standard Contract,the Agency shall not be responsible or liable for any obligations or claims resulting from any subcontract. h. Contractor shall document the subcontractor's progress in performing its work under this contract in the quarterly report. i. For each subcontractor,Contractor shall provide a written statement to the Agency regarding whether that subcontractor is a minority vendor,as defined in Section 288.703,F.S. j. If this contract involves the use of a subcontractor or third party, then Contractor shall not delay the implementation of its agreement with the subcontractor. If any circumstances occur that may result in a delay of the initiation of the subcontract or in the performance of the subcontractor for a period of sixty (60)days or more,Contractor shall notify the Agency's Contract Manager and the Agency's ChiefFinancial Officer in writing of such delay. C. SERVICE DELIVERY 1. Service Delivery Location Contractor shall ensure that the services provided under this contract are available to residents within each county in the Planning and Service Area(PSA)by in-person service,telephone,and/or other electronic means. 2. Service Times Contractor shall provide the services listed in this contract during normal business hours.Normal business hours are defined as Monday through Friday,8:00 a.m.to 5:00 p.m.local time,excluding holidays and force majeure. Page 27 of 73 qO 16o 6 November 2021 -September 2022 EHEAP ARPA 203.22 3. Contractor shall publish its service delivery location,toll-free telephone number,and normal business hours in available forms of media(i.e. newspapers,radio,television,website,publications,etc.). D. DELIVERABLES 1. Deliverables a. Certification that Contractor must operate during its regular business hours,as identified in Section II.C.2. of this contract. b. Contractor shall provide the minimum level of service per month in each county served, as defined in Section I.A.17. 2. Source Documentation The deliverables shall be reported monthly on Contractor's monthly financial status reports. Successful completion of the deliverables shall be determined by the Agency's receipt of Contractor's EHEAP ARP Act Receipts and Expenditure Report(Attachment XI)and EHEAP ARP Act Request for Payment(AttachmentXll) containing the number of individuals served with crisis assistance; number of individuals ineligible or denied assistance; number of applicants served by referral to other community resources for energy assistance;a summary of funds expended per county for the reporting month using the EHEAP ARP Act Cost Reimbursement Summary form(Attachment XIX); and the certification required in Section III,E.2. 3. Records and Documentation Contractor will maintain a separate record(paper and CIRTS)for each EHEAP ARP Act applicant that includes the following, as applicable: a. The EHEAP ARP Act Application and Eligibility Worksheet(Attachment XVI)completed and signed by Contractor and the elder. The application must be approved by a supervisor or peer prior to payment remittance. Contractor is responsible for using the most recent application, eligibility worksheet, and EHEAP ARP Act Application and Eligibility Worksheet Instructions (Attachment XVII) issued by the Agency. (1) If Contractor approves an application, one elderly member of the household must be registered in CIRTS using the EHEAP ARP Act Application and Eligibility Worksheet(Attachment XVI);or (2) If Contractor denies an application,the elder must be registered in CIRTS using the EHEAP ARP Act Application and Eligibility Worksheet(Attachment XVI). b. The elder's name, address,sex,and age; c. Names, ages and current identification documentation (no more than one year expired) of all household members; d. Social Security numbers and documentation of those numbers for all household members,or the citation to the applicable exemption; e. Signed notice regarding the collection of Social Security numbers (Notice of Instruction #071113-1-I- SWCBS, http://elderaffairs.state.tl.us/doea/notices/July 13/LIHEAP%20Notice%20re%20Social%20Security%20N umbers%20Final.pdf); f. Income amount and method of verification for all household members; g. Income documentation to support eligibility that is representative of the elder's current economic situation; h. Statement of self-declaration of income, if applicable; i. A signed statement of how basic living expenses(i.e.,food,shelter,and transportation)are being provided if the total household income is less than fifty percent(50%)of the current State Median Income Guidelines and no one in the household is receiving SNAP assistance; j. Documentation of the elder's obligation(s)to pay an energy bill for the residence in which they live; (1) The elder's utility bill must include detail to identify unallowable categories of assistance resulting from charges for water, sewer, garbage, and fire, etc.; charges resulting from meter-tampering and Page 28 of 73 C1A A0 November 2021 -September 2022 ;AAA A 2082 returned checks;and other charges that are not energy-related and are not required for cooling/heating the household. (2) Use of the most current utility bill(s)which provides the vendor's name and address,account holder's name and physical address, account number, and amount(s) due is required. If an elder's utility bill, cutoff notice, door-hanger notice, or similar documentation does not include all of this information, Contractor must document the verified missing information by writing the information on the utility bill and on the EHEAP ARP Act Application and Eligibility Worksheet(Attachment XVI). k. Signed Authorization for Release of General and/or Confidential Information for LIHEAP/EHEAP Federal Reporting or a statement on the application which states that the elder refused to sign the waiver; I. Copies of approval or denial letters, including those related to the initial application and all appeals,which are provided to the elder; m. If preference is given due to a disability, documentation of such disability that includes disability income or a physician's statement; n. Documentation of referrals to LIHEAP and WAP; o. Notation if EHEAP ARP Act prevented a disconnection or restored an energy disruption; p. Documentation of coordination with LIHEAP providers to avoid exceeding the individual crisis cap for households with elderly residents; q. Proof of payment made to vendors; r. Documentation of calculation of benefits for elders living in subsidized housing; s. Documented calculation of crisis benefits for elders whose energy bill includes unallowable charges;and t. Completed EHEAP ARP Act Client File Content Checklist(Attachment XXIII). E. PERFORMANCE SPECIFICATIONS 1. Reports Contractor is responsible for responding in a timely fashion to additional routine and/or special requests for information and reports required by the Agency.Contractor must establish due dates for any subcontractor'sreport that permits Contractor to meet the Agency's reporting requirements. a. Contractor shall report monthly on Contractor's EHEAP ARP Act Request for Payment(Attachment XII) as delineated in Section II.E.1.e. of this contract. b. Administrative and Outreach Expense Budget Detail Contractor shall submit to the Agency's EHEAP Contract Manager the EHEAP ARP Act Administrative and Outreach Expense Budget Detail (Attachment X). The EHEAP ARP Act Administrative and Outreach Expense Budget Detail shall clearly delineate planned expenditures for funds retained by theContractor and funds subcontracted. The EHEAP ARP Act Administrative and Outreach Expense Budget Detail shall include all Contractor positions,by title,to be paid with these funds and shall detail the estimated number of hours, the hourly wage, and the estimated salary to be paid by EHEAP ARP Act Funding sources, estimated hours,and hourly wage shall be identified for the balance of salary where EHEAP ARP Act funds are used to pay less than one hundred percent(100%)of the salary. c. Provider Cost Analysis State of Florida Chief Financial Officer Memorandum No. 02 (released October 3, 2012), requires Contractor to provide assistance to the Agency's Contract Manager in completing the DOEA Cost Analysis for Non-Competitively Procured Contracts In Excess of Category II. (1) The Contractor shall submit a completed Cost Analysis which shall reflect Administrative, Outreach, and Crisis Service allocations as delineated on the EHEAP ARP Act Budget Summary (Attachment IX) and must be sufficient to explain the expenditures' allowability, allocability, and reasonableness. The Cost Analysis shall be submitted and approved by the Agency prior to execution of this contract. All subsequent amendments that affect the budget shall also be submitted and approved by the Agency prior to any change. Page 29 of 73 c40 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 d. Monthly Client Service Report For the term of this contract,each month,Contractor shall provide to the Agency,by the 15th of each month for the preceding month,the following information: (1) The total number of households served per county; (2) The total amount of funding expended for crisis assistance per county; (3) The total number of households served by referral to other community resources for energy assistance; and (4) The total number of households ineligible or denied crisis assistance. e. EHEAP Outreach Activity Report Contractor shall ensure the use of outreach efforts that will inform potentially eligible households about EHEAP. The EHEAP Outreach Activity Report is due on the 15th day following the end of each quarter and shall consist of the following: (1) Date; (2) County; (3) Location Address; (4) Description of Activity;and (5) Name and Position of Staff. f. Program Effectiveness Reports Contractor agrees to provide to the Agency any additional service reports requested by the Agency concerning the effectiveness of the program and shall include any statistics and information that the Agency may require.The reporting period shall begin with the effective date of this contract in a formatand according to a schedule provided by the Agency for each report. 2. Monitoring and Evaluation Methodology Contractor shall monitor its performance under this contract,as well as that of its subcontractors,subrecipients and consultants who are paid from funds provided under this contract, to ensure that the scope of work is accomplished within the specified time periods and budgets set and that other performance goals stated in this contract are achieved. Such review shall be made for each function or activity set forth in this contract and reported in the quarterly report. a. Contractor shall review completed EHEAP ARP Act applications in accordance with the EHEAP ARP Act Client File Content Checklist(Attachment XXIII). b. The Agency shall, at its own discretion, conduct investigations concerning any aspect of Contractor's performance of this contract. c. The Agency shall conduct a full onsite review of Contractor at least once during each three-year period. Contractor shall allow the Agency to carry out monitoring, evaluation, and technical assistance, and shall ensure the cooperation of its employees,and of any subcontractors with whom Contractor contracts to carry out program activities. d. The Agency shall conduct desk review activities throughout the year to monitor contractual program requirements. e. The Agency shall conduct EHEAP intake site visits. f. In conjunction with onsite monitoring visits and desk review activities,the Agency shall review a sample of completed EHEAP ARP Act client files in accordance with the EHEAP ARP Act Client File Content Checklist,(Attachment XXIII). g. The Agency shall conduct follow-up reviews including prompt return visits to Contractors that fail to meet the goals,standards,and requirements established by the state and federal funding agency. F. CONTRACTOR RESPONSIBILITES 1. Make vendor payments directly to fuel and/or home energy providers on behalf of eligible elders. Page 30 of 73 e40 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 2. Determine the correct amount of each crisis benefit based on the minimum necessary amount needed to resolve the crisis,but not more than the item limits or total limit set by the Agency. 3. Encourage households to seek assistance prior to incurring non-energy penalties such as disconnect/reconnect fees,additional deposits,interest,or late payments. 4. Provide EHEAP ARP Act crisis services to households with elders in every county within the service area. a. The Contractor shall provide oversight to ensure that each county within their service area receives the minimum level of crisis services monthly,as delineated in Section I.A.17;and b. EHEAP ARP Act funded staff shall make themselves available in all underserved counties as needed,to ensure that the minimum level of service is met. 5. Make crisis benefit payments to vendors on behalf of approved elders within forty-five(45)days of the date of crisis resolution. 6. Make payments on behalf of those elders with the highest home energy needs and the lowest household income, which will be determined by taking into account both the energy burden and the unique situation of households that result from having members of a vulnerable population, including very young children, the disabled and frail elders. 7. Refund to the Agency, with non-federal funds, all funds incorrectly paid on behalf of elders that cannot be collected from the elder. 8. Develop adequate procedures to ensure EHEAP ARP Act funds are appropriately budgeted and expended in all counties within Contractor's service area. Procedures should include referral to other community agencies when funds budgeted for a particular time period are exhausted and elders are subsequently denied. 9. Develop monitoring and oversight procedures to ensure that administrative costs that exceed the contracted EHEAP ARP Act administrative award to Contractor or Subcontractor are paid from non-federal sources. 10. Develop adequate procedures to address the use of EHEAP ARP Act funds for elders who are on oxygen support or a"Lifeline Program"and must have power. 11. Develop a written policy regarding the use of funds for repairing or replacing heating or cooling equipment. The procedures must address the conditions under which an elder is eligible for such funds and what constitutes an emergency related to lack of heating or cooling. 12. Ensure providers and appropriate staff participate in training opportunities scheduled by the Agency to cover EHEAP ARP Act policies and procedures. 13. Ensure the provision of training for all providers and staff members assigned responsibilities within the program. 14. Maintain an EHEAP Policies and Procedures Manual to serve as a local resource for program administration, training, and reference. The EHEAP Policies and Procedures Manual shall be distributed to all subcontractors that provide any service under EHEAP ARP Act. The EHEAP Policies and Procedures Manual shall be reviewed during,and in accordance with,the Agency's EHEAP contract monitoring schedule,and shall include the following: a. The State of Florida LIHEAP Policies and Procedures Manual; b. An MOU or Subcontract with EHEAP ARP Act providers; c. An MOU with all service area LIHEAP ARP Act providers; d. An MOU with all service area WAP providers; e. Contractor's cost allocation methodology; f. Written policies and procedures to ensure that all energy assistance payments made to home energy vendors comply with the requirements of the Vendor Agreement; g. Adequate procedures to ensure that EHEAP ARP Act funds are appropriately budgeted and expended in all counties within Contractor's service area; h. Policies regarding the detection and prevention of fraud and abuse of program funds; Page 31 of 73 e 60 8 November 2021 -September 2022 EHEAP ARPA 203.22 i. Policies that address serving family members and employees; j. Policies and procedures to secure applicant Social Security Numbers in order to protect applicants' identities; k. Procedures for computer system backup and recovery; I. Procedures for referral or access assistance to the"Lifeline Program"; m. A policy outlining the criteria to determine if a household has a"home energy crisis" and the information and/or documentation required to verify the crisis; n. Policies and procedures for determining the eligibility of elders applying for EHEAP ARP Act; o. Policies which encourage households to seek assistance prior to incurring non-energy penalties such as disconnect/reconnect fees,additional deposits,interest,or late payments; p. Procedures referring elderly homeowners who have received more than three energy benefits (EHEAP or LIHEAP)in the last eighteen(18)months to the WAP provider; q. A policy concerning the use of funds for the purchase or repair of heating or cooling equipment; r. Policies and procedures which detail allowable timeframes for elders to submit required documentation, if missing at the time of application; s. A resource guide, or the utilization of the Information and Referral database (ReferNET),to access other energy assistance resources available at the local level to provide referrals to elders when EHEAP ARP Act funding is not available,or they do not qualify; t. Consumer appeal procedures that provide an opportunity for a fair administrative hearing at the provider level to elders whose applications for assistance are denied,or whose applications are not acted upon with reasonable promptness;and u. Policies and procedures for conducting home visits to home-bound elders for completion of the program application or eligibility determination when other assistance is not available. 15. Notwithstanding that tasks for which the Contractor is held accountable involve coordination with other entities in performing this contract,the failure of other entities does not alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform pursuant to this contract. G. AGENCY RESPONSIBILITIES 1. The Agency may provide technical support and assistance to the Contractor within the resources of the Agency to assist the Contractor in meeting the requirements of this contract.The support and assistance,orlack thereof, shall not relieve the Contractor from full performance of contract requirements. 2. The Agency will provide to Contractor the State of Florida LIHEAP Policies and Procedures Manual.TheState of Florida LIHEAP Policies and Procedures Manual will provide information and procedures needed to administer EHEAP ARP Act in Florida. a. This contract excludes all provisions of the State of Florida LIHEAP Policies and Procedures Manual in reference to LIHEAP Regular Home Energy Annual Benefits. b. To the extent any conflict arises between this contract and any incorporated reference contained herein,this contract shall have precedence. III.METHOD OF PAYMENT A. PAYMENT METHOD USED The Method of Payment for this contract is cost reimbursement,subject to the availability of funds and Contractor performance. The Agency will pay the Contractor upon satisfactory completion of the Tasks/Deliverables, as specified in Section II, Manner of Service Provision, and in accordance with other terms and conditions of this contract. Page 32 of 73 e40 November 2021 -September 2022 AEOIA 20322 1. Cost Reimbursement The Contractor agrees to distribute funds as detailed in the EHEAP ARP Act Budget Summary (Attachment IX)attached to this contract.Any change in allocation of categorical or total amounts of funds identified on the EHEAP ARP Act Budget Summary form require a contract amendment.Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in Attachment IX. All Cost Reimbursement EHEAP ARP Act Requests for Payment must include the actual EHEAP ARP Act Receipts and Expenditure Reports beginning with the first month of this contract. a. Budget Summary Contractor agrees to implement the distribution of funds as detailed in the EHEAP ARP Act Budget Summary(Attachment IX). An amendment is required to change category allocations or the total amount of this contract. (1) Administrative Expense Administrative expenses include costs for general administration and coordination of the program, including direct and indirect costs.This includes the salaries,fringe benefits(i.e.insurance,retirement, etc.),rent,utilities,travel,etc.associated with financial and administrative management of the program. The use of other federal funds to supplement the administrative operations of EHEAP ARP Act,above and beyond the budgeted amount,is prohibited.Administrative costs that exceed the contracted EHEAP ARP Act administrative award to Contractor or subcontractor must be paid from non-federal sources. Contractors must have adequate procedures for monitoring and oversight to ensure compliance. (2) Outreach Expense Outreach expenses are those costs incurred in delivering EHEAP ARP Act services that are not purely administrative in nature. This may include staff and subcontractor expenses such as salaries, fringe benefits (i.e. insurance, retirement, etc.), rent, utilities, travel, etc. for those employees performing outreach and intake. Outreach expense shall not include senior management expense, except when outreach and intake involving direct contact with elders occurs. Documentation to support this exception shall be maintained by Contractor and available upon request. c. Indirect Cost Rate Per 2 C.F.R. § 200.331(a)(4), Subrecipients of federal awards are required to have an approved, federally recognized indirect cost rate negotiated between the Subrecipient and the Federal Government. If no such rate exists,then the Subrecipient shall have either a rate negotiated with the Agency(in compliance with 2 C.F.R. Part 200), or a de minimis indirect cost rate as defined in 2 C.F.R. §200.414(f). Subrecipientshall maintain its current Indirect Cost Rate Proposal and make the proposal available upon request. If Subrecipient chooses to use the de minimis rate, Subrecipient shall make sure it is entitled to use that rate and include a statement to that effect. Subrecipient is not obligated to establish an indirect cost rate if Subrecipient does not charge an indirect cost rate. 2. Advance Payments Advance payments will not be issued for this project. B. The final request for payment is due to the Agency no later than October 30,2022. C. METHOD OF INVOICE PAYMENT Payment shall be made upon Contractor's presentation of an invoice subsequent to the acceptance and approval by the Department of the deliverables on the invoice. The form and substance of each invoice submitted by Contractor shall be as follows: 1. Have Remittance Address that corresponds exactly to the "Remit To" address provided to My Florida MarketPlace(MFMP)during registration; 2. Request payment for services as established in the EHEAP ARP Act Service Rate Report(Attachment XXI); 3. Contractor shall consolidate all Requests for Payment from subcontractors and Receipts and Expenditure Reports that support requests for payment and shall submit them to the Agency using the EHEAP ARP Act Page 33 of 73 410 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 Receipts and Expenditure Report(Attachment XI),EHEAP ARP Act Request for Payment(Attachment XII), and EHEAP ARP Act Cost Reimbursement Summary(Attachment XIX); 4. Contractor shall include required supporting documentation as delineated in Section III.E. with the cost reimbursement portion of the invoice. D. PAYMENT WITHHOLDING Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and approval by the Department of all financial and programmatic reports due from the Contractor and any adjustmentsthereto, including any disallowance not resolved. E. SUPPORTING DOCUMENTATION REQUIREMENTS For the reporting month,Contractor shall include the following with Request for Payment: 1. The number of individuals served that include: a. The number of individuals served with crisis assistance during the reporting month; b. The number of individuals ineligible or denied assistance during the reporting month; c. The number of individuals referred to other community resources for energy assistance during the reporting month; 2. Certification that Contractor operated during its normal business hours during the reporting month; 3. The total amount of funding expended for crisis assistance per county for the reporting period;and 4. The Certified Minority Business Subcontract Expenditure Form (CMBE Form) (Attachment VIII), if applicable. F. FINANCIAL CONSEQUENCES Failure to meet the deliverables described in this contract may result in a financial consequence and may result in the redistribution of funding. Contractor shall ensure the provision of services and the successful completion of deliverables as set forth in this contract. 1. The Agency shall not reimburse any expenditures associated with Deliverables not accepted by the Agency as successfully completed; however, this does not preclude Contractor from receiving payment for such expenditures upon successful completion of the deliverable. 2. If Contractor fails to be open and available for services according to its regular business hours as identified in Section II.C.2. of this contract, excluding weekends or state and federal holidays, Contractor shall pay to the Agency financial consequences for such failure,unless the Agency waives such failure in writing basedupon its determination that the failure was due to factors beyond the control of Contractor. 3. Contractor's failure to operate according to its regular business hours shall result in an assessment of a financial consequence in the amount of$10.00 per day. 4. Any amounts due from financial consequences shall be paid by Contractor out of non-federal funds. G. REMEDIES-NONCONFORMING SERVICES Contractor shall ensure that all participants served under this contract are eligible for the program and that all monthly and/or quarterly performance reports and financial records are maintained for each reporting period and submitted as stipulated in this contract. 1. Any nonconforming program service, performance report, or financial record not meeting the aforementioned requirements is not eligible for reimbursement under this program. Contractor shall solely bear the costs associated with enrolling, training, reporting and/or managing the program. Contractor shall give immediate notice to the Department of any significant and/or systemic infraction that compromises Contractor's ability to provide participant services,to achieve programmatic performance,or to provide sound financial management of the program. Page 34 of 73 e 9'p November 2021 -September 2022 Etta 203.0 H. CONSEQUENCES FOR NON-COMPLIANCE Contractor shall ensure that one hundred percent(100%)of the deliverables identified in this contract are performed pursuant to contract requirements. The deliverables described in Section II.D. are identified as major deliverables in this contract. 1. If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to correctly, completely,or adequately perform these major deliverables,the Contractor will have ten(10)days to submit a Corrective Action Plan (CAP) to the Contract Manager that addresses the deficiencies and states how the deficiencies will be remedied within a time period approved by the Contract Manager.The Agency shall assess a Financial Consequence for Non-Compliance on the Contractor for each deficiency identified in the CAP which is not corrected pursuant to the CAP.The Agency will also assess a Financial Consequence for failure to timely submit a CAP. If Contractor fails to timely submit a CAP,the Agency shall deduct 1%of the monthly value of the administrative funds in the contract for each day the CAP is overdue,beginning the 1la, day after notification by the Contract Manager of the deficiency. The deduction will be made from the payment for the invoice of the following month. 2. In the event that Contractor fails to correct an identified deficiency within the approved time period specified in the CAP, the Agency shall deduct, from the payment for the invoice of the following month, 1% of the monthly value of the administrative funds in the contract for each day the deficiency is not corrected. The Agency may also deduct,from the payment for the invoice of the following month, 1%of the monthly value of the administrative funds in the contract for each day the Contractor fails to timely submit a CAP. IV. SPECIAL PROVISIONS A. The following is incorporated by reference: 1. State of Florida LIHEAP Policies and Procedures Manual. B. Modifications The Agency shall not be obligated to reimburse Contractor for expenditures in excess of the funded amount ofthis contract unless and until the Department officially approves such expenditures by executing a writtenmodification to the original contract,signed by both parties. 1. Contractor must use a Agency approved budget modification process. 2. For the purpose of transferring funds, the following are considered budget categories: (1)Administration, (2) Outreach,and(3)Crisis Assistance. C. Enforcement 1. In accordance with Section 430.04, F.S., the Agency shall rescind designation of an area agency on aging or take intermediate measures against the Contractor, including corrective action, unannounced special monitoring, temporary assumption of operation of one or more programs by the Agency, placement on probationary status, imposing a moratorium on Contractor action, imposing financial penalties for nonperformance, or other administrative action pursuant to Chapter 120, F.S., if the Agency finds that anyof the following have occurred: a. An intentional or negligent act of the Contractor has materially affected the health, welfare, or safety of clients,or substantially and negatively affected the operation of an aging services program; b. The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual funds have been misappropriated; c. The Contractor has committed multiple or repeated violations of legal and regulatory requirements or Agency standards; d. The Contractor has failed to continue the provision or expansion of services after the declaration of a state of emergency; Page 35 of 73 Q/0 November 2021 -September 2022 EHE P RF 203.2Z e. The Contractor has exceeded its authority or otherwise failed to adhere to the terms of this contract with the Agency, or has exceeded its authority or otherwise failed to adhere to the provisions specifically provided by statute or rule adopted by the Agency; f. The Contractor has failed to properly determine client eligibility as defined by the Agency or efficiently manage program budgets;or g. The Contractor has failed to implement and maintain a Agency-approved client grievance resolution procedure. 2. In making any determination under this provision,the Agency may rely upon findings of another state or federal agency or other regulatory body.Any claims for damages for breach of contract are exempt from administrative proceedings and shall be brought before the appropriate entity in the venue of Leon County, Florida. In the event the Agency initiates action to rescind an area agency on aging designation,the Agency shall follow the procedures set forth in 42 U.S.C. §3025(b). END OF ATTACHMENT Page 36 of 73 C, 0 1 • 0 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT II FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Agency to the Contractor may be subject to audits and/or monitoring by the Agency, as described in this section. MONITORING In addition to reviews of audits conducted in accordance with 2 CFR Part 200(formerly OMB Circular A-133 as revised), and Section 215.97, F.S., (see"AUDITS"below), monitoring procedures may include,but not be limited to, on-site visits by the Agency staff, limited scope audits and/or other procedures. By entering into this contract, the Contractor agreesto comply and cooperate with any monitoring procedures/processes deemed appropriate by the Agency. In the event the Agency determines that a limited scope audit of the Contractor is appropriate, the Contractor agrees to comply withany additional instructions provided by the Agency to the Contractor regarding such audit. The Contractor further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer(CFO)or Auditor General. AUDITS PART I: FEDERALLY FUNDED This part is applicable if the Contractor is a State or local government or a non-profit organization as defined in 2 CFR Part 200, Subpart A. In the event that the Contractor expends $750,000.00 or more in federal awards during its fiscal year,the Contractor must have a single or program-specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial and Compliance Audit Attachment, Exhibit 2 indicates federal resources awarded through the Agency by this contract. In determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards, including federal resources received from the Agency. The determination of amounts of Federal awards expended should be in accordance with 2 CFR Part 200.An audit of the Contractor conducted by the Auditor General in accordancewith the provisions of 2 CFR Part 200 will meet the requirements of this part. In connection with the audit requirements addressed in Part I, paragraph 1, the Contractor shall fulfill the requirements relative to auditee responsibilities as provided in 2 CFR§200.508. If the Contractor expends less than$750,000.00 in federal awards in its fiscal year, an audit conducted in accordance with the provisions of 2 CFR Part 200 is not required. In the event that the Contractor expends less than$750,000.00 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200,the cost of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from Contractor resources obtained from other than federal entities.) An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to contracts with the Agency shall be based on the contract's requirements,including anyrules, regulations, or statutes referenced in the contract. The financial statements shall disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Agency contract involved. If not otherwise disclosed as required by 2 CFR § 200.510, the schedule of expenditures of federal awards shall identify expenditures by contract number for each contract with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the Contractor's fiscalyear end. PART II: STATE FUNDED Page 37 of 73 ��o 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 This part is applicable if the Contractor is a non-state entity as defined by Section 215.97(2),F.S. In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of$750,000.00 in any fiscal year of such Contractor,the Contractor must have a State single or project-specific audit for such fiscal year in accordance with Section 215.97, F.S.; applicable rules of the Department of Financial Services; and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. Financial Compliance Audit Attachment,Exhibit 2 indicates state financial assistance awarded through the Agency by this contract. In determining the state financial assistance expended in its fiscal year, the Contractor shall consider all sources of state financial assistance, including state financial assistance received from the Agency,other state agencies,and other non-state entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a non- state entity for Federal program matching requirements. In connection with the audit requirements addressed in Part II, paragraph 1, the Contractor shall ensure that the audit complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as defined by Section 215.97(2), F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),Rules of the Auditor General. If the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year, an audit conducted in accordance with the provisions of Section 215.97,F.S., is not required. In the event that the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97,F.S.,the cost of the audit must be paid from the non-state entity's resources(i.e.,the cost of such an audit must be paid from the Contractor resources obtained from other than State entities). An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to contracts with the Agency shall be based on the contract's requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable contract. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Agency contract involved. If not otherwise disclosed as required by Rule 69I- 5.003, F.A.C., the schedule of expenditures of state financial assistance shall identify expenditures by contract number for each contract with the Agency in effect during the audit period. For local governmental entities, financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report,but no later than 12 months after the Contractor's fiscal year end. For non-profit or for-profit organizations,financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 9 months afterthe Contractor's fiscal year end.Notwithstanding the applicability of this portion,the Agency retains all right and obligation to monitor and oversee the performance of this contract as outlined throughout this document and pursuant to law. PART III: REPORT SUBMISSION Copies of financial reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of this Financial Compliance Audit Attachment,shall be submitted,when required by 2 CFR§200.512 by or on behalf of the Contractor directly to each of the following: Federal Audit Clearinghouse Bureau of the Census 1201 East 10th Street Jeffersonville,IN 47132 Pursuant to 2 CFR§200.512,all other Federal agencies,pass-through entities and others interested in a reporting package and data collection form must obtain it by accessing the Federal Audit Clearinghouse. The Contractor shall submit a copy of any management letter issued by the auditor directly to the Agency. Page 38 of 73 C�� 160 8 November 2021-September 2022 EHEAP ARPA 203.22 Florida Department of Elder Affairs Attn: Audit Repository 4040 Esplanade Way,Suite 235S Tallahassee,Florida 32399-7000 Additionally, copies of financial reporting packages required by this contract's Financial Compliance Audit Attachment, Part II, shall be submitted by or on behalf of the Contractor directly to each of the following: The Agency at the following address: Florida Department of Elder Affairs Attn: Audit Repository 4040 Esplanade Way,Suite 235S Tallahassee,Florida 32399-7000 The Auditor General's Office at the following address: State of Florida Auditor General Claude Pepper Building,Room 574 111 West Madison Street Tallahassee,Florida 32399-1450 Any reports,management letters,or other information required to be submitted to the Agency pursuant to this contractshall be submitted timely in accordance with 2 CFR Part 200, F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),Rules of the Auditor General, as applicable. Contractors,when submitting financial reporting packages to the Agency for audits done in accordance with 2 CFR Part200 or Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to the Contractor in correspondence accompanying the reporting package. PART IV: RECORD RETENTION The Contractor shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of six(6)years from the date the audit report is issued,and shall allow the Agency or its designee,the CFO,or Auditor General access to such records upon request.The Contractor shall ensure that audit working papers are made available to the Agency or its designee, CFO, or Auditor General upon request for a period of six(6)years from the date the audit report is issued, unless extended in writing by the Agency. Page 39 of 73 e 441O November 2021 -September 2022 EHEAP ADA 20382 ATTACHMENT II-EXHIBIT 1 PART I: AUDIT RELATIONSHIP DETERMINATION Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200 and/or Section 215.97,F.S. Contractors who are determined to be recipients or sub-recipients of federal awards and/or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 are met.Contractors who have been determined to be vendors are not subject to the audit requirements of 2 CFR§200.38 and/or Section 215.97,F.S.Regardless of whether the audit requirements are met, Contractors who have been determined to be recipients or sub-recipients of Federal awards and/or state financial assistance must comply with applicable programmatic and fiscal compliance requirements. In accordance with 2 CFR Part 200 and/or Rule 69I-5.006,F.A.C.,Contractor has been determined to be: Vendor not subject to 2 CFR§200.38 and/or Section 215.97,F.S. Recipient/sub-recipient subject to 2 CFR§§200.86 and 200.93 and/or Section 215.97,F.S. Exempt organization not subject to 2 CFR Part 200 and/or Section 215.97, F.S. For Federal awards, for-profit organizations are exempt; for state financial assistance projects, public universities, community colleges, district school boards, branches of state (Florida) government, and charter schools are exempt. Exempt organizations must comply with all compliance requirements set forth within the contract or award document. NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and/or state financial assistance,and has been approved by the Agency to subcontract,they must comply with Section 215.97(7), F.S.,and Rule 69I-5.006, F.A.C. [state financial assistance] and/or 2 CFR§ 200.330 [federal awards]. PART II: FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal awards,state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a sub- recipient must comply with the following fiscal laws,rules,and regulations: STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW: 2 CFR§200.416- §200.417—Special Considerations for States,Local Governments,and Indian Tribes* 2 CFR§200.201 —Administrative Requirements** 2 CFR§200 Subpart F—Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules,and regulations NON-PROFIT ORGANIZATIONS MUST FOLLOW: 2 CFR§200.400- §200.411 —Cost Principles* 2 CFR§200.100—Administrative Requirements 2 CFR§200 Subpart F—Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules,and regulations EDUCATIONAL INSTITUTIONS(EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW: 2 CFR§200.418—§200.419—Special Considerations for Institutions of Higher Education* 2 CFR§200.100—Administrative Requirements 2 CFR,§200 Subpart F—Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules,and regulations *Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in 2 CFR §200.400(5)(c). Page 40 of 73 CA AO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 **For funding passed through U.S.Health and Human Services,45 CFR Part 75;for funding passed through U.S. Department of Education,34 CFR Part 80. STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a recipient/sub-recipient must comply with the following fiscal laws,rules,and regulations: Sections 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 Page 41 of 73 A 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT II-EXHIBIT 2 FUNDING SUMMARY(2021-2022) Note: Title 2 CFR,as revised,and Section 215.97,F.S.,require that the information about Federal Programs and State Projects included in Attachment II,Exhibit 1,be provided to the recipient.Information contained herein is a prediction of funding sources and related amounts based on the contract budget. 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: GRANT AWARD(FAIN#): 2102FLE5C6 FEDERAL AWARD DATE: March 11,2021 DUNS NUMBER: 966140837 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Emergency Home Energy Assistance for the United States Department of Elderly Program—American Rescue Plan Health and Human Services 93.568 $96,800.00 (ARP)Act of 2021 Supplemental Grant TOTAL FEDERAL AWARD $96,800.00 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: FF,I)ERAL FUNDS: 2 CFR Part 200—Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards. OMB Circular A-133—Audits of States,Local Governments,and Non-Profit Organizations 2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: MATCHING RESOURCES FOR FEDERAL PROGRAMS PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL STATE AWARD STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S. PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT TOTAL AWARD COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: ,STATE FINANCIAL ASSISTANCE Sections 215.97&215.971,F.S.,Chapter 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 Page 42 of 73 40 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT III CERTIFICATIONS AND ASSURANCES AGENCY will not award this contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. Inperformance of this contract, Contractor provides the following certifications and assurances: A. Debarment and Suspension Certification(29 CFR Part 95 and 45 CFR Part 75) B. Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 93) C. Nondiscrimination& Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80) D. Certification Regarding Public Entity Crimes.section 287.133.F.S, E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance (Pub. L. 111-117) F. Scrutinized Companies Lists and No Boycott of Israel Certification.section 287.135.F.S, G. Certification Regarding Data Integrity Compliance for Contracts. Agreements. Grants. Loans. and Cooperative Agreements H. Verjfication of Employment Status Certification I. Records and Documentation J. Certification Regarding Inspection of Public Records A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS—PRIMARY COVERED TRANSACTION. The undersigned Contractor certifies,to the best of its knowledge and belief,that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal Agency or agency; 2. Have not within a three-year period preceding this contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local)with commission of any of the offenses enumerated in paragraph A.2. of this certification;and/or 4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local)terminated for cause of default. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients and contractors shall provide this certification accordingly. B. CERTIFICATION REGARDING LOBBYING—CERTIFICATION FOR CONTRACTS, GRANTS,LOANS, AND COOPERATIVE AGREEMENTS. The undersigned Contractor certifies,to the best of its knowledge and belief,that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan, Page 43 of 73 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 the entering into of any cooperative agreement, and the extension, continuation,renewal, amendment, or modification of any Federal contract,grant, loan,or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report Lobbying,"in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this contract imposed by 31 U.S.C. § 1352.Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure. C. NON-DISCRIMINATION&EQUAL OPPORTUNITY ASSURANCE(29 CFR PART 37 AND 45 CFR PART 80).-As a condition of the Contract,Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: 1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color,religion, sex,national origin, age,disability, political affiliation,or belief,and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I-financially assisted program or activity. 2. Title VI of the Civil Rights Act of 1964(Pub.L. 88-352),as amended,and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 80),to the end that,in accordance with Title VI of that Act and the Regulation,no person in the United States shall,on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84),to the end that, in accordance with Section 504 of that Act and the Regulation,no otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 91),to the end that,in accordance with the Act and the Regulation,no person in the United States shall,on the basis of age,be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. Title IX of the Education Amendments of 1972(Pub.L. 92-318),as amended,and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 86),to the end that, in accordance with Title IX and the Regulation,no person in the United States shall, on the basis of sex,be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990 (Pub. L. 101-336),which prohibits discrimination in all employment practices including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions,and privileges of employment.It applies to recruitment,advertising,tenure,layoff,leave,fringe benefits, and all other employment-related activities. 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above.This assurance applies to Contractor's operation of the WIA Title I—financially assisted program or activity,and to all contracts Contractor makes to carry out the WIA Title I—financially assisted program or activity. Page 44 of 73 (1 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 Contractor understands that AGENCY and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S. Contractor hereby certifies that neither it,nor any person or affiliate of Contractor,has been convicted of a Public Entity Crime as defined in section 287.133,F.S.,nor placed on the convicted vendor list. Contractor understands and agrees that it is required to inform AGENCY immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE(Pub.L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub.L. 111-117 are available under the conditions provided by Pub.L. 111-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers(including subcontracts,sub-grants and contracts under grants,loans and cooperative agreements)and that all sub- recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION,SECTION 287.135,F.S. In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized Companies that Boycott Israel List and that it is not engaged in a boycott of Israel. If this contract is in the amount of$1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it is not engaged in business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S.,the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penaltiesand attorney fees and costs,including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification,Contractor shall attach an explanation to this contract. G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS,LOANS,AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing certain information,including:(1)accurate,current,and complete disclosure of the financialresults of each grant-funded project or program in accordance with the prescribed reporting requirements; (2)the source and application of funds for all contract supported activities;and(3)the comparison of outlays with budgeted amounts for each award.The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported,transmitted,or calculated have been assessed and verified Page 45 of 73 rip 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 to be capable of processing data accurately, including year-date dependent data.For those systems identified to be non-compliant,Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware,software,firmware,microcode,or imbedded chip technology, the undersigned warrants that these products are capable of processing year-date dependent data accurately. All versions of these products offered by the Contractor(represented by the undersigned)and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly,the Contractor agrees to immediately make required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state,time being of the essence. 5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies arising from data integrity compliance issues. H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION As a condition of contracting with the Agency, Contractor certifies the use of the U.S.Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express requirement that Subcontractors performing work or providing services pursuant to this contract utilize the E-verify system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract term. The Contractor shall require that the language of this certification be included in all sub-agreements,sub-grants,and other agreements/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this contract imposed by Circulars A-102 and 2 CFR Part 200 and 215(formerly OMB Circular A-110). I. RECORDS AND DOCUMENTATION The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any andall contract related records and documentation.The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency.Maintenance includes valid exports and backups of all data and systems according to Agency standards. J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS 1. In addition to the requirements of Section 10 of the Standard Contract,sections 119.0701(3)and(4)F.S.,and any other applicable law,if a civil action is commenced as contemplated by section 119.0701(4),F.S.,and the Agency is named in the civil action,Contractor agrees to indemnify and hold harmless the Agency for any costs incurred bythe Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119,F.S.,concerning this contract or services performed thereunder. a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Agency and state agencies or subdivisions defined in section 768.28(2),F.S. 2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership contributions for any person,corporation,foundation,trust,association,group,or other organization,all the financial, business, and membership records of such an entity which pertain to the public agency (Florida Department of Elder Affairs)are public records. Section 119.07,F.S,states that every person who has custody of such a public record shall permit the record to be inspected and copied by any person desiring to do so,under reasonable circumstances. Page 46 of 73 �40 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 Additionally,I certify this organization does does not provide for institutional memberships. 111 Contractor's signature below attests that records pertaining to the dues or membership application by the Agency areavailable for inspection if applicable,as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct. 3339 TAMIAMI TRAIL E Signature an itl o .ze epresentative Street Address DANIEL R RODRI Z-PUBL VICE DEPARTMENT HEAD COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS NAPLES.FL 34112 Contractor 01/ LJ /2022 Date City,State,Zip code Approved as to form and legality Assistant County Attorney Page 47 of 73 C-70 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT IV ASSURANCES— NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five(45) minutes per response, including time for reviewing instructions,searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden,to the Office of Management and Budget. Paperwork Reduction Project(0348-0043), Washington,DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency.Further,certain federal awarding agencies may require applicants to certify to additional assurances.If such is the case,you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost)to ensure proper planning,management,and completion of the project described in this application. 2. Will give the awarding agency,the Comptroller General of the United States,and if appropriate,the state,through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes,or presents the appearance of,personal or organizational conflict of interest or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§ 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration(5 C.F.R. 900, Subpart F). 6. Will comply with all federal statutes relating to nondiscrimination.These include but are not limited to:(a)Title VI of the Civil Rights Act of 1964(P.L.88-352)which prohibits discrimination on the basis of race,color or national origin; (b)Title IX of the Education Amendments of 1972, as amended(20 U.S.C. §§ 1681-1683 and §§ 1685-1686), which prohibits discrimination on the basis of sex;(c) Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C. §794),which prohibits discrimination on the basis of handicaps; (d)the Age Discrimination Act of 1975,as amended (42 U.S.C.§§6101-6107),which prohibits discrimination on the basis of age;(e)the Drug Abuse Office and Treatment Act of 1972(P.L.92-255),as amended,relating to nondiscrimination on the basis of drug abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 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)Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended,relating to nondiscrimination in the sale,rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s)which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases. Page 48 of 73 Cio £ 60 8 November 2021 -September 2022 EHEAP ARPA 203.22 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §§ 1501-1508 and §§ 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis-Bacon Act(40 U.S.C. §§ 276a to 276a-7), the Copeland Act(40 U.S.C. §276c and 18 U.S.C. §874)and the Contract Work Hours and Safety Standards Act(40 U.S.C. §§327- 333),regarding labor standards for federally assisted construction sub-contracts. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order(EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. § 1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. § 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974,as amended(P.L. 93-523);and(h)protection of endangered species under the Endangered Species Act of 1973,as amended(P.L.93-205). 12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. § 1721 et seq.)related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. § 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974(16 U.S.C. §469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. § 2131 et seq.) pertaining to the care,handling,and treatment of warm blooded animals held for research,teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C. §4801 et seq.),which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. 18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations, and policies governing this program. S GNATURE OF ED TIFYIN ICIAL TITLE 1)ANIFT.R RODRKIT PUBLIC SERVICE DEPARTMENT HEAD APPLICANT ORG 'IZATION DATE SUBMITTED COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS of I4q7m7 Approved as to form and legality ► b-aa Page 49 of 73 Assistant County Attorney 110 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT V FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST Program/Facility Name County AAA/Contractor Address Completed By City,State,Zip Code Date Telephone PART I:READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: Total# % % `For questions 2-5 please indicate the following: White Black Hispanic Other Female Disabled Over 40 2.Population of area served Source of data: 3.Staff currently employed Effective date: 4.Clients currently enrolled/registered Effective date: 5. Advisory/Governing Board if applicable PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO,EXPLAIN. 6. Is an Assurance of Compliance on file with DOEA? N/A YES NO ❑ ❑ ❑ 7. Compare the staff composition to the population. Is staff representative of the population? N/A YES NO ❑ ❑ ❑ S. Are eligibility requirements for services applied to clients and applicants without regard to race,color,national N/❑A Y❑ES NO❑ origin,sex,age,religion,or disability? 9. Are all benefits,services and facilities available to applicants and participants in an equally effective manner N/A YES NO regardless of race,sex,color,age,national origin,religion,or disability? ❑ ❑ ❑ 10. For in-patient services,are room assignments made without regard to race,color,national origin or disability? N/A YES NO ❑ ❑ ❑ 11. Is the program/facility accessible to non-English speaking clients? N/A YES NO ❑ ❑ ❑ 12.Are employees,applicants and participants informed of their protection against discrimination?If YES,how? N/A YES NO Verbal 0 Written 0 Poster❑ 0 0 0 Page 50 of 73 not '70 1 '0 8 November 2021 -September 2022 EHEAP ARPA 203.22 13.Give the number and current status of any discrimination complaints regarding services or employment filed N/A NUMBER against the program/facility. ❑ 14. Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? N/A YES NO ❑ ❑ ❑ PART III:THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES.IF NO, EXPLAIN. 15.Has as a self-evaluation been conducted to identify any barriers to serving disabled individuals and to make any YES NO necessary modifications? ❑ 16. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO ❑ ❑ 17. Has a person been designated to coordinate Section 504 compliance activities? YES NO ❑ ❑ 18.Do recruitment and notification materials advise applicants,employees,and participants of nondiscrimination on YES NO the basis of disability? ❑ 19.Are auxiliary aids available to ensure accessibility of services to hearing and sight-impaired individuals? YES NO ❑ ❑ PART IV:FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF$50,000.00 OR MORE. 20. Do you have a written affirmative action plan? If NO,explain. YES NO ❑ ❑ DOEA USE ONLY Reviewed ❑ In Compliance: YES El NO* ❑ Program Office *Notice of Corrective Action Sent / / Date Telephone Response Due / /_ On-Site Desk Review Response Received / / Page 51 of 73 -T W d November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT V INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 1. Describe the geographic service area such as a district, county, city, or other locality. If the program/facility serves a specific target population such as adolescents,describe the target population. Also,define the type of service provided. 2. Enter the percent of the population served by race,sex,disability,and over the age of 40. The population served includes persons in the geographical area for which services are provided such as a city,county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3. Enter the total number of full-time staff and their percent by race, sex, disability, and over the age of 40. Include the effective date of your summary. 4. Enter the total number of clients who are enrolled,registered or currently served by the program or facility,and list their percent by race, sex,disability,and over the age of 40. Include the date that enrollment was counted. a. Where there is a significant variation between the race,sex,or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons. 5. Enter the total number of advisory board members and their percent by race, sex, disability, and over the age of 40. If there is no advisory or governing board,leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR Part 80. This is usually a standard part of the contract language for DOEA Recipients and their Sub-grantees. 45 CFR§ 80.4(a). 7. Is the race,sex,and national origin of the staff reflective of the general population? For example,if 10%of the population is Hispanic,is there a comparable percentage of Hispanic staff? 8. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment?Evidence of such may be indicated in staff and client representation(Questions 3 and 4)and also through on-site record analysis of persons who applied but were denied services or employment. 45 CFR§ 80.3(a)and 45 CFR § 80.1. 9. Participants or clients must be provided services such as medical,nursing, and dental care, laboratory services,physical and recreational therapies, counseling, and social services without regard to race, sex, color, national origin, religion, age, or disability. Courtesy titles, appointment scheduling, and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age, or disability. Entrances, waiting rooms, reception areas,restrooms,and other facilities must also be equally available to all clients. 45 CFR§ 80.3(b). 10. For in-patient services,residents must be assigned to rooms,wards,etc.,without regard to race,color,national origin,or disability.Also,residents must not be asked whether they are willing to share accommodations with persons of a different race,color,national origin,or disability. 45 CFR§ 80.3(a). 11. The program/facility and all services must be accessible to participants and applicants,including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services. 45 CFR § 80.3(a). 12. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries, or any other interested parties. 45 CFR § 80.6(d). This should include information on their right to file a complaint of discrimination with either the Agency or the U.S.Department of Health and Human Services. The information may be supplied verbally or in writing to every individual or may be supplied through the useof an equal opportunity policy poster displayed in a public area of the facility. Page 52 of 73 �40 16 0 8 November 2021 -September 2022 EHEAP ARPA 203.22 13. Report number of discrimination complaints filed against the program/facility. Indicate the basis(e.g.race,color,creed, sex, age,national origin, disability, and/or retaliation)and the issues involved(e.g. services or employment,placement, termination, etc.).Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local,state,or federal agency with whom the complaint has been filed. Indicate the current status of the complaint (e.g. settled,no reasonable cause found,failure to conciliate,failure to cooperate,under review,etc.). 14. The program/facility must be physically accessible to mobility, hearing, and sight-impaired individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches,ramps, and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, and information and admissions offices should be accessible. Door widths and traffic areas of administrative offices,cafeterias,restrooms,recreation areas,counters,and serving lines should be observed for accessibility. Elevators should be observed for door width and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired individuals. 15. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self- evaluation to identify any accessibility barriers. Self-evaluation is a four-step process: a. Evaluate, with the assistance of disabled individual(s)/organization(s), current policies and practices that do not or may not comply with Section 504; b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate the effects of any discrimination that resulted from adherence to these policies and practices;and d. Maintain self-evaluation on file,including a list of the interested persons consulted,a description of areas examined, and any problems identified, and a description of any modifications made and of any remedial steps taken 45 CFR § 84.6. (This checklist may be used to satisfy this requirement if these four steps have been followed). 16. Programs or facilities that employ 15 or more persons shall adopt grievance procedures that incorporate appropriate due process standards and that provide for the prompt and equitable resolution of complaints alleging any action prohibited by Part 84 of Title 45,CFR45 CFR§ 84.7(b). 17. Programs or facilities that employ 15 or more persons shall designate at least one person to coordinate its efforts to comply with Part 84 of Title 45,CFR. 45 CFR§ 84.7(a). 18. Programs or facilities that employ 15 or more persons shall take appropriate initial and continuing steps to notify participants, beneficiaries, applicants, and employees that the program/facility does not discriminate on the basis of handicap in violation of Section 504 and Part 84 of Title 45, CFR. Methods of initial and continuing notification may include the posting of notices, publication in newspapers and magazines, placement of notices in publications of the programs or facilities, and distribution of memoranda or other written communications. 45 CFR§ 84.8(a). 19. Programs or facilities that employ 15 or more persons shall provide appropriate auxiliary aids to persons with impaired sensory, manual, or speaking skills where necessary to afford such persons an equal opportunity to benefit from the service in question. Auxiliary aids may include,but are not limited to,brailed and taped materials,interpreters,and other aids for persons with impaired hearing or vision. 45 CFR§ 84.52(d). 20. Programs 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 accordance with Executive Order 11246,41 CFR Part 60 and Title VI of the Civil Rights Act of 1964,as amended. Page 53 of 73 C�Q t6D 8 N N (+) 0 N Q d Q u 1 ' 1 .. 1 1 1 1 I ' , 1 1 1 . 1 1 1 1 1 1 na W .-. R 3 _ 4-1 o Lio E o Q . . . .. Aft +Fr L if- +Fr i{T ifs �Pr -EA- tR if} if4 V1- fPr rya V o H a) O w CL o F- s a to 01 L to C..I = U E U t .. F R . Z 1:� C a7 0-0 I-4 oVy v o H w O H c >. [.H _a rj Z ` 0 Z O ) a a 0 U � to a) a) H K .. RI Cm a o ro W G d• 0 a w 0 H ✓ tC) 13 R Z ✓ cE cl a, )- J a o aL, a ro r E w a c 43 43 cn U o s at N CD N ' L.'CV ` " +:r F N r iii vg C 4,2 y C U O Cl) ,-1 1-4 en V' Lo to I� Co 01 O .-I NI Ind' LA to II co 11 O N N N le a) N 0 O z CAO 60 t� November 2021 -September 2022 EHEAP ARPA 203.22 BACKGROUND SCREENING Ron DeSantis DCrart]Yara9L of ELDER AFFAIRS Richard Prudom STATE OF FLOIUDA 1€(retwry BACKGROUNDSCREENING Attestation of Compliance-Employer AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3),Florida Statutes. > The term"employer"means any person or entity required by law to conduct background screenings, including but not limited to, Area Agencies on Aging/Aging and Disability Resource Centers, Lead Agencies, and Service Providers that contract directly or indirectly with the Department of Elder Affairs (DOEA), and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider.See§§435.02,430.0402,Fla.Stat. ➢ A direct service provider is"a person 18 years of age or older who,pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities and volunteers."§430.0402(1)(b),Fla.Stat. ATTESTATION: As the duly authorized representative of COT TIER COT ROARI) OF CC)TTNTY CY)MMTSSTONF.RS Employer Name located at 33 39 TAMTAMT TRAIT,F. NAPLES,FT, 34112 Street Address City State ZIP code I, DANIEL R RODRIGUEZ do hereby affirm under penalty of Name of Representative perjury that the above-named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regard'ng level 2 background screening. 01!- 2027 Signature of Rep sentative Date DOEA Form 235,Attestation of Compliance-Employer,Effective January 19,2021 Section 435.05(3), F.S.Form available at:htrps: 'i'iderctflirs.arg'wp.content7ploads.'doeaform-35-attestation-uf-compliance enrploy'er.1'df Approved as to form and legality I-13—aa Page 55 of 73 Assistant County Attorney CAO November 2021 -September 2022 EHE P A PA 203.2 ATTACHMENT VIII CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES(CMBE FORM) CMBE FORM MUST ACCOMPANY INVOICES SUBMITTED TO DOEA CONTRACTOR NAME: DOEA CONTRACT NUMBER: *REPORTING PERIOD-FROM: TO: *(DATE RANGE OF RENDERED SERVICES,MUST MATCH INVOICE SUBMITTED TO DOEA) DOEA CONTRACT MANAGER: REPORT ALL EXPENDITURES MADE TO CERTIFIED MINORITY BUSINESS(SUBCONTRACTORS). CONTACT DOEA CMBE COORDINATOR FOR ANY QUESTIONS, AT 850-414-2153. SUBCONTRACTOR NAME SUBCONTRACTOR'S CMBE EXPENDITURES FEID DOEA USE ONLY--REPORTING ENTITY(DIVISION,OFFICE,ETC) SEND COMPLETED FORMS VIA INTEROFFICE MAIL TO:JUSTIN TAYLOR CMBE COORDINATOR,CONTRACT ADMINISTRATION&PURCHASING,TALLAHASSEE,FLORIDA 32399-7000. If unsure if subcontractor is a certified minority supplier,click on the hyperlink below. Enter the name of the supplier,click "search". Only Certified Minority Business Entities will be displayed. Page 56 of 73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 haps://osd.dms.myflorida.com/directories INSTRUCTIONS (A) ENTER THE COMPANY NAME AS IT APPEARS ON YOUR DOEA CONTRACT. (B) ENTER THE DOEA CONTRACT NUMBER. (C) ENTER THE SERVICE PERIOD MATCHING THE CURRENT INVOICE'S SERVICE PERIOD. (D) ENTER ALL CERTIFIED MINORITY BUSINESS EXPENDITURES FOR THE TIME PERIOD COVERED BY THE INVOICE: 1. ENTER CERTIFIED MINORITY BUSINESS NAME. 2. ENTER THE CERTIFIED MINORITY BUSINESS FEID NUMBER. 3. ENTER THE CERTIFIED MINORITY BUSINESS CMBE NUMBER. 4. ENTER THE AMOUNT EXPENDED WITH THE CERTIFIED MINORITY BUSINESS FOR THE TIME PERIOD COVERED BY THE INVOICE. (E) MBE FORM MUST ACCOMPANY INVOICE PACKAGE SUBMITTED TO DOEA FINANCIAL ADMINISTRATION FOR PROCESSING. (F) FINANCIAL ADMINISTRATION WILL FORWARD ALL COMPLETED CMBE FORMS TO CONTRACT ADMINISTRATION&PURCHASING OFFICE. Page 57 of 73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 EHEAP ARP ACT BUDGET SUMMARY EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM COLLIER COUNTY HPP21 Total Award TOTAL ADMINISTRATIVE BUDGET $8,300.00 TOTAL OUTREACH BUDGET $13,500.00 CRISIS ASSISTANCE $75,000.00 TOTAL $96,800.00 *Eligible households may be provided with more than one benefit,totaling no more than$5,000.00.The minimum number of individuals to be served crisis energy assistance may reflect duplicated consumers if a consumer receives multiple benefits. Page 58 of 73 0, 10 160 November 2021 -September 2022 EHEAP ARPA 203.22 EHEAP ARP ACT ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL PSA CONTRACT # Emergency Home Energy Assistance Program - ARP 2O21 2022 Administrative & Outreach Expense Budget Detail ADD ADDITIONAL LINES AS NEEDED Budget Quantity/ Line kern Expenditure Detail His L.nirCast Total Cost f � - Tot71._... .__ _ _ SO.00, Administration Subtotal $ - Outreach Subtotal. $ - Total $ - Page 59 of 73 C40 160 6 November 2021 -September 2022 EHEAP ARPA 203.22 RECEIPTS AND EXPENDITURE REPORT EMERGENCY HOME ENERGY ASSISTANCE PROGRAM AMERICAN RESCUE PLAN FUNDING PROVIDER NAME,ADDRESS. PHONE AND FEIDO Program Funding Source: Contract 0 Contract Period EH EAP-American Rescue Plan f Emergency Home Energy Report Period Assistance for the Elderly Program) Report N Invoice N PSA CERTIFICATION: I Certify to the best of my knowledge and belief that this repeat is complete and all outlays herein are for purposes set forth in the contract. Prepared by: Oath: Approved by: Date PART A:BUDGETED INCOME/RECEIPTS 1.Approved 2 Actual Rocopts 3.Total Receipts 4.Portent of Budget For This Report Year to Date Approved Budget 1..Agreement Amount $0.00 $0.00 VIM 'it 2.TOTAL AGREEMENT AMOUNT $0.00 $O 00. $0.00 . ..._._14. PART B:EXPENDITURES I.Approved 2.F.xpenditores 3.Expenditures 4.Percent of Budget For This Report Year to Date Approved Budget 1..Administration $0.00 $0.00 $0.00 2.Outreach $0.00 $0.00 $0.00 3..Crisis Services $0.00 $0.00 $0.00 % 4.Weather Related Services $0.00 $0.00 $0.00 % 5..TOTAL EXPENDITURES $0.00 $0.00 $0.00 DOEA FORM 105PARP Page 60 of 73 edel 0 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT XII REQUEST FOR PAYMENT E MERGEN CY HOME ENERGY ASSISTANCE PROGRAM'. AMERICAN' RESCUE PLAN FUNDING CONTRACTOR NAME„ADDRESS.PHGNE#a nrf :FEmc+k TYPE OF REPORT: Contract lc----- Contract Pe Report Period_ Reimbursement Request---- Report*_____ involce s P-SA CERT;FICAT:OU: 1herebycertlythatthlstequaittothebaitofmyknowledgetobecompaideandCcwrectandccnfor swiththetermsoftheabovecontract Prepared W:_ —_ 'Date:_ _ Approved by: ------- Date:_--_-- PART A: BUDGETSLN3MAR^f' A MIN 4TRATYJN OUTREACH CRISIS WEATHER TOTAL SER'+1 CES SERVICES SER' C.E$ RELATED 1..Appnaved Contract Amount SO 00 3€+..00 SO„CO 40.00 3+7.).00 2 PreVoua Fund►Re,::eivedfor SO 00 i0.0+3 #1.+h7 30.00 SO 00 Contract Period 3.Contract Balance:,rr 1 rnnus:'i+n2', WOO Sale 1000 $01 $0-00 4.Previous Fundi Requested and Not 0,00 Ui.G+ 30J.kr #i+.[* 0_00 Received for Contact Ferrol 5.Contract Balance:^,nc 3 rna+ nc 4: 30.00 SO_t $0.€U $0.00 WOO b PART& CONTRACT FUNDS!REQUEST 1-leitExpendilutes For Month ${+Sir $0.05 't0J.+0 S€+.0O3 4o,00 3DOEA Form 105P,Part B,Line 51 2 TOTAL 10.00 10.03 $0.00 5+.€0 10..00 PART C: NET FUNDS RE{UE STED 1.TOTAL iFiUNDS REQUESTED 10.00 $0,0 „00 10,03 3raAe PART D: SER'V:CE 3NFDIAT'rON arum berof indiv'I uaii leneolwhn WI;saitisiancerlut ngthe raportmonth: Number of lndrvidual i rei}guile or den lea aia:itarce Our mg the report month: Ram of indlvlduals iar 4by retaral to otter cortemuMt/resources TOT energy al)il'tan,e during the repottrrlanth: CertTicat5n iist3 rr,ent: Contractor hsreDy certnea that It has IX.'311 opa It and opera trigauring is normal Du i nisi h*uis for tne reportng:month,as described In the Statente nt of Work se cton.of the E HEAP contract aDOZA ro ii i U3PAR a Page 61 of 73 C4 16I 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT XIII EHEAP ARP ACT INVOICE REPORT SCHEDULE Report Number Based Upon Date Due to the Agency 1 November Invoice December 9, 2021 2 December Invoice January 9, 2022 3 January Invoice February 9, 2022 4 February Invoice March 9, 2022 5 March Invoice April 9, 2022 6 April Invoice May 9, 2022 7 May Invoice June 9, 2022 8 June Invoice July 9, 2022 9 July Invoice August 9, 2022 10 August Invoice September 9, 2022 11 September Invoice October 9, 2022 12 Final Request for Payment October 15, 2022 Note 1 Advance payments will not be issued with the project. Note 2 Submission of invoices may or may not generate a payment request. If final invoice reflects funds due back to the Agency, payment is to accompany the final invoice. Page 62 of 73 CAD 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT XIV STATE MEDIAN INCOME GUIDELINES LOW INCOME HOME ENERGY ASSISTANCE PROGRAM(LIHEAP) STATE MEDIAN INCOME GUIDELINES* EFFECTIVE OCTOBER 1,2021 PEOPLE IN THE HOUSEHOLD 60% SMI 1 $25,296 2 $33,079 3 $40,863 4 $48,646 5 $56,430 6 $64,213 7 $65,672 8 $67,132 Please refer to the Federal Poverty Guidelines (FPG) Benefits Matrix for income ranges for households with 9-or-more individuals. *These figures are based on the 2022 U.S.Department of Health and Human Services (HHS) poverty guidelines published in the Federal Register on February 1,2021. Page 63 of 73 C4 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT XV EHEAP ARP ACT SOURCES OF INCOME EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY-ARP ACT FY 2021/2022 SOURCES OF INCOME EFFECTIVE June 1,2020 INCLUDED EXCLUDED SOURCES OF INCOME SOURCES OF INCOME (Includes total annual cash receipts before taxes from all sources) 1. Money wages and salaries before any deductions 1.CAPITAL GAINS Any Assets drawn down as withdrawals from a bank,the sale 2. Net receipts from non-farm employment(receipts from a of property,a house or a car. person's own unincorporated business,professional 2. Tax Refunds enterprise,or partnership,after deductions for business 3. Gifts expenses) 4. Loans 5. Lump-sum inheritances 3. Net receipts from farm self-employment(receipts from a 6. One-time insurance payments farm which one operates as an owner,renter,or 7. Foster Care Payments* sharecropper,after deductions for farm operating 8. Compensation for injury expenses) 9. Combat zone pay to the military 10.Adoption Subsidies 4. REGULAR PAYMENTS FROM: 11.Reverse Mortgage Payments Social Security 12. NON-CASH BENEFITS Railroad retirement (a) Employer-paid or union paid portion of health Strike benefits from union funds insurance or other employee benefits Worker's compensation Veteran's payments (b) Food or housing received in lieu of wages Public Assistance or Temporary Assistance for Needy Families (TANF),Supplemental Security Income,and non-federally funded (c) The value of food and fuel produced and General Assistance or General Relief money payments. consumed on farms. 5. Payments to foster children age 18 or older received through the (d) The imputed value of rent from owner-occupied Independent Living Program non-farm or farm housing. 6. Training stipends (e) Federal non-cash benefit programs such as Medicare, 7. Alimony Medicaid,Food Stamps,school lunches,and housing 8. Child Support assistance. 9. Social Security Benefit Garnishes for Non-Payment of 13. Supplemental Security Income(SSI)benefits cannot be School Loans.(The total amount of the Social Security Retirement garnished for any reason unless a recipient received an benefit including the garnished deduction must be used when overpayment of benefits. calculating the applicant's income.) The total amount of the SSI benefit minus the garnished deduction for recoupment must be used when calculating 10. Military family allotment or other regular support from the applicant's income. a family member or someone not living in the household *Persons whose cost of residence is paid through a foster care or residential program administered by the state 11. Private pensions cannot be counted as household members. 12. Government employee pensions(including military 14. Stimulus payments from the federal government in retirement pay) relation to the Coronavirus Disease will not be considered income and will not be considered in 13. Regular insurance or annuity payments determining a household's State Median Income 14. Educational Assistance: Level(150%or below). Grants,Fellowships,Assistantships,College or 15. Any type of unemployment payments will not be University Scholarships-Only count as income those funds counted as income. specifically allotted for living expenses 15. Dividends 16. Interest 17. Net rental income 18. Net royalties 19. Periodic receipts from estates or trusts 20. Net gambling or lottery winnings Page 64 of 73 eA 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 ATTACHMENT XVI EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM-APPLICATION Section One: Applicant(Aged 60 and older) Information Name:(First, M, Last) ❑EHEAP 0 Heating Season ❑Cooling Season 1 ❑EHEAP ARP Date of birth: Age: SSN: 1 Service address: City: Date Stamp Florida County: Zip Code: Phone: Intake worker's name: Gender: ❑Male❑Female 0 Other Number of people in the household: Marital Status: 0 Married 0 Partnered ❑Single ❑Separated ❑Divorced ❑Widowed Phone: Race:❑White ❑Black/African American ❑Asian ❑Native Hawaiian/Pacific Islander 0 American Indian/Alaska Native ❑Other Ethnicity: 0 Hispanic/Latino ❑Other Primary Language:0 English ❑Spanish ❑Other Does client have limited ability reading,writing,speaking,or understanding the English language? ❑Yes ❑No Is the client a veteran? ❑Yes ❑No Was client referred to the local Veteran's Affairs office? ❑Yes 0 No ❑N/A Applicant's income type(s): Applicant's monthly income amount: Section Two: Additional Household Members Information Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Section Three: Household Characteristics Is there a child 5 years of age or younger in the household? 0 Yes ❑No If Yes,select all that applies: 0 0-2 years old 0 3-5 years old Is there an individual with a disability in the household? ❑Yes 0 No Is the applicant a U.S.citizen or an alien lawfully admitted for permanent residence? ❑Yes ❑No Is the applicant a homeowner?❑Yes ❑No Does applicant live in government subsidized housing,such as Section 8? ❑Yes ❑No If yes,provide the complex name: If yes,does the household receive an energy subsidy?❑Yes ❑No Does applicant live in a student dormitory,adult family care home,or any kind of group living facility? ❑Yes 0 No If yes,provide the facility name: Section Four: Heating and Cooling Information Have you or any member of your household received energy assistance in the current season? ❑Yes ❑No If yes,provide the name of Agency: Type of Assistance: ❑Crisis 0 Home Energy ❑Weather-Related Date: What is the primary source of home heating?(select one) 0 Electricity ❑Natural Gas ❑Propane ❑Wood/Coal ❑Refillable Fuels Does household use supplemental heating source?❑Electricity ❑Wood/Coal ❑N/A Air conditioning unit type?❑Central A/C ❑Window/Wall A/C ❑Fans 0 Other—specify(including evaporative cooler) Section Five: Energy Crisis Explanation Client Attestation and Signature Page 65 of 73 CAO 16D 8 November 2021 -September 2022 EHEAP ARPA 203.22 0 Home cooling or heating energy source has been The information provided on this application,is to the best of my knowledge,true and disconnected. (Life-Threatening) complete.I understand that priority in providing assistance will be given to those households with the lowest income and greatest need,i.e.those households in which the ❑Unable to get delivery of fuel,is out of fuel,or elderly,disabled,medically needy,or children reside.I authorize the agency to make is in danger of being out of fuel for heating.(Life- benefit payments directly to my energy supplier.I am aware that after I have provided all Threatening) the information requested to determine my eligibility,if I am applying for crisis assistance, 0 Other problems with lack of cooling or heating the agency has 18 hours to act upon my application with an eligible action. I am also in the home,such as needing to pay a deposit, aware that if I am not approved or denied within the time allowed,or not approved for the repair of equipment,or interim emergency measure correct amount,I have a right to appeal the decision.(If you sign with an"X"two to avoid further crisis. witnesses are required.) (Life-Threatening) 0 Notified that the energy source for cooling or heating is going to be disconnected.(Standard) Client Signature: 0 Received a notice indicating the energy source Date: bill is delinquent or past due.(Standard) 0 Has an energy source bill for which the due date has lapsed.(Standard) II LL CLIENTS SHOULD SIGN THE WAIVER.AUTHORIZING THE RELEASE OF GENERAL AND/OR CONFIDENTIAL,INFORMATION FOR LIHEAP/EHEAP FEDERAL REPORTING. *Your Social Security Number(SSN)is confidential under law.We may not collect your SSN unless we explain the reason for collecting your SSN in writing and provide the applicable statutory authority for doing so.Certain provisions of Chapter 430,Florida Statutes,read with Section 119.071(5),Florida Statutes,specifically authorize the Department of Elder Affairs(DOEA)and its designated staff/employees to collect SSNs when authorized by law or when collection of SSNs is imperative to the performance of DOEA's statutorily assigned duties.The Agency is collecting your social security number as part of its responsibility to provide Emergency Home Energy Assistance. DOEA Form 114—10/7/2021 Emergency Home Energy Assistance for the Elderly Program-Eligibility Worksheet Section Six: income Eligibility Determination Staple calculator tans State Median Income(SMI)Guidelines Annualize all household income. here showing iroome effective 10/1/2021. calculations or write calculations in this Select the annual income limit by household size: 1. Add all gross monthly earned and space. 100%of Max Income Value(MIV) 50%of MIV unearned income from the past 30 ❑ 1 $25,296 $ 12,648 days of all household members. ❑ 2 $33,079 $ 16,540 ❑ 3 $40,863 $20,431 2. Add Medicare Premium($148.50), ❑ 4 $48,646 $24,323 if not included in SSA amount. ❑ 5 $56,430 $28,215 3. Add Medicare Part D,if applicable. ❑ 6 $64,213 $32,106 ❑ 7 $65,672 $32,836 4. To annualize,multiply the monthly ❑ 8 $67,132 $33,566 total by 12 months. Annual Household Income (Please refer to the Federal Poverty Guidelines(FPG)Benefits Matrix for income ranges for households with 9-or-more $ individuals.) If the total annual household income is less than 50%of the current State Median Income for household size(using chart above), ❑Categorically Eligible and no one in the household is receiving SNAP assistance,the applicant must provide a signed statement of how basic living expenses(i.e.,food,shelter and transportation)are provided for the household. Section Seven: Vendor, Benefit,aid Verification Information Energy Vendor#1 Other Vendor#1 Contact made with LIHEAP provider to Name: Name: verify previous crisis assistance. Contact Person: Account Number: Account/Voucher Date: Date of contact: Number: Has the applicant received LIHEAP crisis assistance during the current season? Minimum Amount Due: Amount Due: ❑Yes 0 No Page 66 of 73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 0 Repair Existing ❑ Blanket Heating or Cooling Verification and Commitment ❑ portable Fan Equipment Contact Person: If the minimum amount due is more than Date: 0 Space Heater 0 Emergency Shelter the past due amount,did the energy vendor ❑ Window A/C ❑ Other verify that this amount is required? ❑ Yes ❑No ❑N/A Energy Vendor#2 Other Vendor#2 Name: Name: Account/Voucher Account Number: Number: Date: If the minimum amount due to resolve the Minimum Amount Due: Amount Due: crisis is more than the maximum allowed, explain how the balance of the amount due ❑Repair Existing will be paid if approved for EHEAP crisis ❑Blanket Heating or Cooling Verification and Commitment assistance. ❑portable Fan Equipment Contact Person: 0 Space Heater 0 Emergency Shelter Date: ❑ Window A/C 0 Other (1)Total Energy Vendors $ (4)Total Other Vendors $ Is the name on the fuel bill that of the (2)Energy Subsidy $ applicants? Total EHEAP Benefit ❑ yes 0 No (3)Water,Sewer, Add Garbage,Fire,etc. $ Total Energy Vendor(4)& $ If no,provide name on bill: Total Other Vendor(4) (4)Deduct(2&3)from(1) $ Section Eight: Weatherization Assistance Program(WAP) Referral If the applicant is a homeowner,has he/she received more than three LIHEAP or EHEAP benefits in the last 18 months? ❑Yes ❑No 0 N/A If the answer to the previous question is"yes",was the applicant referred to WAP? ❑Yes ❑No 0 N/A If the answer to the last question is"no" explain: Section Nine: Resolution of Crisis Resolution of the Heating/Cooling Energy Crisis occurred within 18/48 hours,by the following eligible action(s):(Select all that apply) ❑Approval of application ❑EHEAP benefit prevented disconnection 0 Commitment made to vendor ❑EHEAP benefit restored energy already disconnected ❑Denial of Application,pending additional information ❑Yes,client signed waiver ❑Denial of Application,ineligible ❑No,client refused to sign waiver ❑Written referral and assistance to access other community resources Case Worker Signature Approval Signature l have determined the eligibility of the applicant.I am not the The application and eligibility determination must be reviewed tier errors and applicant.nor am I a friend,relative,or employee of the appropriate file documentation prior to making payment. I have reviewed applicant, and approved this application for crisis assistance. Case Worker's Name: Supervisor/Peer's Name: Case Worker's Signature: Supervisor/Peer's Signature: Date: Date: Agency Name: Agency Name: DOEA Form 114-10/7/2021 Page 67 of 73 CA0 November 2021 -September 2022 EHEA,ARPA 203.22 ATTACHMENT XVII EHEAP ARP ACT APPLICATION INSTRUCTIONS Section One: Applicant(Age 60 and older)Information Complete Section One in its entirety. Special notes: ✓ The Winter and Summer Seasons are waived under the ARP Act. ✓ The Date Stamp is the official application date; ✓ The Intake Worker(with name and phone number recorded) is the person who accepts the application and required documentation; ✓ The applicant's income type(s)and monthly income amount is recorded in this section, and ✓ fl any,field is determined to be not applicable, complete the field by entering A%4, Section Two: Additional Household Members Information Complete Section Two by listing additional household members and providing the information requested. Special notes: ✓ At a minimum,the name(s), age(s),and Social Security number(s)of each additional household member is required; ✓ You will be attaching a calculator tape of the household's income calculations in the section provided on the EHEAP ARP Act Eligibility Worksheet; and ✓ .If any field is determined to he not applicable. complete the field by entering. -A. Section Three: Household Characteristics Complete Section Three by answering each"Yes"or"No"question and providing additional information if applicable. Special note: ✓ be field is determined to he not applicable, complete the,field by entering.N'A. Section Four: Heating and Cooling Information Complete Section Four by answering each question. Special note: ✓ If any field is determined to be not applicable, complete the,field by entering Air).. Section Five: Energy Crisis Explanation Section Five is completed by choosing the best possible explanation for the applicant's crisis and obtaining their signature and date of signature. Special note: ✓ ifana-field is determined to be not applicable, complete the field by entering N'A. Client Attestation and Signature The applicant should read the attestation statement. If the applicant is unable to read the attestation statement,the intake worker should read it to them before they sign and date the application. At this point,the intake worker should have the applicant sign the waiver authorizing the release of general and/or confidential information for LIHEAP/EHEAP ARP Act federal reporting. CIRTS will require you to verify that either the waiver has been signed or that the client has refused to sign. Page 68 of 73 CAO November 2021 -September 2022 EIA6ARPA 203B EHEAP ARP Act Eligibility Worksheet Instructions Section Six: Income Eligibility Determination Complete Section Six by stapling the calculator tape in the space provided,entering the annual income, and checking the appropriate number of individuals in the household to determine the household annual income limit. Special notes: ✓ If the applicant is over-income and received TANF, SSI, or SNAP, check the categorical eligibility box and include the appropriate documentation in client file. ✓ Adjacent to the annual income limit by household size is the fifty percent(50%) of poverty amount by household size. If the annual household income is below the amount for the household size,AND the household does not receive SNAP,the applicant must provide a written statement of how basic living expenses are provided for the household. ✓ Specific to ARP Act, the following is not counted as income when determining income eligibility for the household: o Stimulus payments from the federal government in relation to the Coronavirus Disease ; and o Any type of unemployment payments will not be counted as income. ✓ If any field is determined to be not applicable, complete the field by entering Section Seven: Vendor.Benefit.and Verification Information Complete Section Seven by completing in its entirety. Special notes: ✓ Eligible elders may receive multiple crisis assistance benefit(s),that combined not to exceed$5,000.00. ✓ The minimum amount due is the amount provided to you during the verification process with the home energy vendor. ✓ For those applicants receiving an energy subsidy,the minimum amount due will be reduced by the energy subsidy amount listed on the applicant's public housing lease to determine the total EHEAP ARP Act benefit. The energy subsidy is deducted from home energy vendor payments only. ✓ It is allowable to make several crisis benefit payments for a household to resolve a single crisis and/or one or more benefits from EHEAP ARP Act funding. This may include the purchase of blankets,portable fans, space heaters,and/or repair of existing heating/cooling equipment, in addition to energy bill assistance,that combined does not exceed the crisis assistance cap of$5,000. ✓ Crisis situations that involve a heater or air conditioner that is powered by both gas and electricity are eligible for a crisis benefit payment to both home energy vendors. ✓ Allowable utility categories for heating/cooling bill assistance include the following: • Electricity; • Natural Gas; • Propane; • Wood/Coal;and • Refillable fuels; V Crisis benefits may also be used for the following: • Pre-pay energy; • Purchase of blankets, portable fans, space heaters, and window air conditioners; • Repair of an existing heating/cooling unit; • Deposits to connect or restore energy; • Late fees and disconnect and reconnect fees; Page 69 of 73 CAO 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 • Charges from a previous account held by the elder that is now closed; • Payment to landlord when utility costs are included in the elder's rent;and ■ Temporary emergency shelter,if due to energy related crisis. ✓ Water,sewer, garbage,and fire,etc.MAY NOT be paid with EHEAP ARP Act funds.Utility bills that include charges that are not directly related to cooling and heating will be reduced by the amounts for these charges. ✓ Charges incurred due to illegal activities,such as a worthless check or meter tampering,MAY NOT be paid with EHEAP ARP Act funds. ✓ .If any field is determined to he not applicable, complete the field by entering.VA. Section Eight: Weatherization Assistance Program(WAP)Referral Complete Section Eight in its entirety. Special notes: ✓ When determining the number of LIHEAP or EHEAP ARP Act crisis benefits the applicant has had,you will include the current application in the count,provided the application is approved.Refer back to Section Seven,to the information obtained from the LIHEAP provider. ✓ If any field is determined to he not applicable. complete the,field by entering MA. Section Nine: Resolution of Crisis Complete Section Nine by selecting all that applies to this applicant and application for services. Special notes: ✓ The left-hand selections indicate that the application has been acted upon within the 18/48 hour requirement. ✓ If the selection is made to deny the application pending additional information from the client,the 18/48 hours has been met and does not repeat itself when the client returns with the pending information. You have already met the requirement. ✓ If any field is determined to be not applicable, complete the field by entering.147/1. Case Worker Signature To complete this section,the individual who completes the EHEAP ARP Act Eligibility Worksheet,determines income eligibility, and provides the commitment to the utility vendor must sign and complete the requested information. Special note: ✓ If you are the applicant, or a friend,relative,or employee of the applicant,you cannot determine the eligibility or award EHEAP ARP Act benefits.This application must be processed by someone who is not the applicant or a friend,relative,or employee of the applicant. Approval SiEnatjtrr To complete this section,the signer is attesting that he/she has reviewed the application for completeness,determined that all required documentation is included,and verified that the annual household income calculation and EHEAP ARP Act benefit awarded are correct. Page 70 of 73 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 EHEAP ARP ACT CLIENT FILE CONTENT CHECKLIST ELDER'S NAME PSA# AGENCY APPROVAL DENIAL NAME OF WORKER APPLICATION DATE CRISIS RESOLUTION DATE C ECK DATE PROGRAM REQUIREMENTS MONITORED Yes No N/A COMMENTS 1. Individual client file for the elder includes consumer's name,address,sex,and age. 2. Household contains a member 60 or older. 3. The household is in the Florida county covered by the contract. 4. All household members are listed and their name,age,DOB,and income(s)are included. 5 Client file contains documentation of Social Security numbers for all household members,or citation to the applicable exemption. 6. Client file contains signed notice regarding collection of social security number(s). The client file contains official income documents for all household members and TANF,SSI,or 7. SNAP documentation,if categorically eligible. 8 If income is self-declared,is there a self-declaration form signed by each individual household member(18 years of age or older)lacking income verification or claiming zero income? The household's total gross income with 1-8 individuals incomes is calculated correctly and is at or 9. below 60%of the State Median Income and for households with 9-or-more individuals,please refer to the Federal Poverty Guidelines Benefits Matrix,or the household is determined categorically eligible Statement of how basic living expenses(i.e.,food,shelter and transportation)are being provided if 10. total household income is less than 50%of the current Federal Poverty Guidelines and no one in the household is receiving SNAP assistance. 11 Checked that elder does not live in student dormitory,adult family care home,or any kind of group living facility. 12 Verified and documented household has not received LIHEAP Crisis Assistance during the same heating or cooling season. 13. Documentation of Weatherization Assistance Program(WAP)referral,if applicable. 14 Copies of fuel bills,or other supporting documentation as proof of energy crisis,for the residence in which they reside. 15. Signed copy of Authorization for Release of General and/or Confidential Information. 16. Only eligible components of the utility bill are paid to resolve the crisis. 17. Only the minimum necessary to resolve the crisis is paid.If a different amount is required by the utility company,provide additional information on the Eligibility Worksheet. 18 Crisis energy benefit was reduced by unallowable charges,such as:water,sewer,garbage,and fire, etc.,if applicable. 19. Crisis energy benefit was reduced by energy subsidy,if applicable. 20. Energy crisis resolved within 18 or 48 hours by an eligible action. 21 Written notice of approval or denial for services that includes appeal procedures is issued within 15 working days of eligibility determination. 22. Appropriate benefit provided. 23 All required sections of the application are signed and dated by the elder,staff,and supervisory/peer PRIOR to payment. 24. Proof of payment to vendor. 25. Place completed DOEA Form 211 in client file. INSTRUCTIONS: A check mark in the Yes column indicates the requirement has been met.A check mark in the No column indicates the requirement has not been met or is questionable. Each"No"mark must be explained under"COMMENTS". Supervisor/Peer Signature Consumer File Monitoring Date DOEA FORM 211 11/1/2021 Page 71 of 73 CA0 160 8 November 2021 -September 2022 EHEAP ARPA 203.22 EHEAP ARP ACT RECIPIENT INFORMATION EHEAP APR Act RECIPIENT INFORMATION FEDERAL YEAR: 2021/2022 CONTRACT PERIOD: November 1,2021 to September 30,2022 I. PLANNING&SERVICE AREA: II. CONTRACT NUMBER: CONTRACT AMOUNT: III. COUNTIES TO BE SERVED: IV.GENERAL ADMINISTRATIVE INFORMATION a. Recipient: Recipient Address: Telephone: Fax: Websit e: b. Executive Director or Chief Administrator: Telephone: Email Address.: c. President/Chairman of the Board: Name: Ad dress: Telephone: Fax: Email Address: d. Program Contacts: Name: Title: Telephone: Email Address: Name: Title: Telephone: Email Address: e. Fiscal Contacts: Name: Title: Telephone: Email Address: Name: -It le: Telephone: Email Address: f. Person(s)authorized to sign reports and/or contracts: g. Agency's FEID Number: Agency's DUNS# h. AUDIT DUE DATE; Audit(s)are due bythe end of the Ninth month following the end of the.agency's fiscal year. Recipient Fiscal Year: thru Audit Due to DOEA: lhOx{td 9/E1/2tr21. Page 72 of 73 AO 16D 8 November 2021 -September 2022 EHEAP ARPA 203.22 SERVICE RATE REPORT 3PROGRAM: EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM-ARP ACT Federally Funded From l 1/01/2021 to 09/30/2022 • CATEGORY METHOD UNIT SERVICE OF REIMBURSEMENT TYPE PAYMENT RATE Administration ADMINISTRATIVE COSTS* . Cost Reimbursement Cost Reimbursement EPISODE Outreach OUTREACH COSTS* Cost Reimbursement Cost Reimbursement EPISODE Crisis Assistance CRISIS ENERGY ASSISTANCE BENEFITS* Cost Reimbursement Cost Reimbursement EPISODE *As stipulated in contract,these services are provided on a cost reimbursement basis. Page 73 of 73 CAO 160 8 Attestation Statement Agreement/Contract Number EHEAP ARPA 203.22 Amendment Number 0 I, flANTFT R R(1TIRMTTF7 ,attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agr ment/ ract or amendment between the Area Agency on Aging for Sout st orida and r / • (Recipient Con ractor m The only exception to is statement would be for changes in page formatting,due to the differences in electronic data processing media,which has no effect on the agreement/contract content. COLLIER COUNTY BOARD OF COMMISSIONERS 01/4C6022 Signature of Recipient/Contractor representative Date Approved as to form and legality Assistant County Attorney Revised August 2007 C'4Q