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
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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
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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.
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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,
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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
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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.
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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
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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
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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
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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.
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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.
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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.
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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.
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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.
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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
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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
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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
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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
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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;
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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.
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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.
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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).
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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;
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(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;
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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:
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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;
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(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:
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(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.
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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
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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.
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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.
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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;
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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.
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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
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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.
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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;
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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
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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
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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.
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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.
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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).
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**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
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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
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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,
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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.
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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
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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.
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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
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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.
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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
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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
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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
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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.
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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
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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
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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
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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,
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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
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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 $0.00
DOEA FORM 105PARP
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November 2021 -September 2022 EHEAP ARPA 203.22
ATTACHMENT XII
REQUEST FOR PAYMENT
E MERGEN CY HOME ENERGY ASSISTANCE PROGRAM'.
AMERICAN' RESCUE PLAN FUNDING
CONTRACTOR NAME„ADDRESS.PHGNE#a nrf :FEmc+k TYPE OF REPORT: Contract lc-----
Contract Pe
Report Period_
Reimbursement Request---- Report*_____
involce s
P-SA
CERT;FICAT:OU: 1herebycertlythatthlstequaittothebaitofmyknowledgetobecompaideandCcwrectandccnfor swiththetermsoftheabovecontract
Prepared W:_ —_ 'Date:_ _ Approved by: ------- Date:_--_--
PART A: BUDGETSLN3MAR^f' A MIN 4TRATYJN OUTREACH CRISIS WEATHER TOTAL
SER'+1 CES SERVICES SER' C.E$ 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
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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
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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.
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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
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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
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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
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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
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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.
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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;
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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.
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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
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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.
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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.
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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