Backup Documents 05/10/2022 Item #16D3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP i 3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routinglines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human w" 05/10/2022
Services
2. County Attorney's Office Derek Perry O C sf 2 S I 11311-
3. Minutes & Records Clerk of Court's Office Gt2e41
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/ Depar tment
Agenda Date Item was 05/10/2022 Agenda Item Number 16D3
Approved by the BCC C�('9 3)
Type of Document AAA/OAA Amendment 203.22.001 Number of Original 1
Attached Documents Attached
PO number or account NA
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? NA
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the NA
document or the fmal 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 05/10/2022 and all changes made
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made,and the document is ready for the t2
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
160 3
DocuSign Envelope ID:FC6B0280-1A35-473A-BA5B-3B5BFC80EA9C
January—December 2021 OAA 203.22.01
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT TITLE III
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency")
and Collier County Board of County Commissioners("Contractor"),amends agreement OAA 203.22.
The purpose of this amendment is to transfer funding in the amount of$2500 from IIIB TRS to IIIB and transfer
funding in the amount of$16,000.00 to Title IIIES from Title IIIE; revise ATTACHMENT II-EXHIBIT 2-
Funding Summary; and ATTACHMENT IX BUDGET SUMMARY.
All provisions in the contract any attachments thereto in conflict with this Amendment shall be and are hereby changed
to conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS WHEREOF, the Parties hereto have caused this amendment to be executed by their undersigned
officials as duly authorized,and agree to abide by the terms,conditions and provisions of OAA Contract or as amended.
This Amendment is effective on the last date the Amendment has been duly signed by both Parties.
COLLIER CO.BOARD OF CO. AREA AGENCY ON AGING FOR
C MM SS 0 ER ( SOUTHWEST FLORIDA,INC.
SIGNED SIGNED BY: E,.'M...--
nse
NAME: Tanya R Williams NAME:NORMA ADORNO
TITLE: Public Service Department Head TITLE:CEO
4/1/2022
DATE: "i /, /2022 DATE:
as designee of the County Manager,
pursuant to Resolution No. 2018-202.
Ap ved as to form and legality:
. i.4......4 .
J
Derek D. Perry /11
Assistant County Attorney ti
CA('
DocuSign Envelope ID:FC6B0280-1A35-473A-BA5B-3B5BFC80EA9C 1 6 0 3
January—December 2021 OAA 203.22.01
ATTACHMENT II -EXHIBIT 2-FUNDING SUMMARY
Note: Title 2 CFR§200331,as revised.and Section 215.97(5),F.S..require that the information about federal programs and StateProj ects be
p•ovided totheRecipient and gestated inTheFinancial And Compliance Audit Attachment II, Exhibit 1 provided to the recipient.
Information contained herein is a prediction oflundi ng antreesand related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title IlIB—
Transportation $ 5,796.26
Support Services U.S.Health and Human Services 93.044 $ 208,169.57
TotalIIIB $ 213,965.83
OAA Title IlIC t —Congregate Meals U.S. Health and Human Services 93.045 $ 552,670.89
Total HICI
OAA Title III C2—Home Delivered Meals U.S. Health and Human Services 93.045 $ 390,360.45
Total IIIC2
Older Americans Act Title III E
Services(Title III E) $ 144,002.44
Supplement Services(Title III ES) U.S. Health and Human Services 93.052 $ 30,143.23
Grandparent Services(Title III EG) $ 6,083.
TotalIHHE $ 180,229.07
Nutrition Services Incentive Program(NSIP) U.S. Health and Human Services 93.053 $ 51,728.59
TOTAL FEDERAL AWARD $1,388,954.83
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards/
OMB Circular A-133—Audits of States,Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
,STATE FINANCIAL ASSLSTANCE
Section 215.97&215.971,F.S.,Chapter 691-5,F.A.C., State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
2
-1(
160 3
DocuSign Envelope ID: FC6B0280-1A35-473A-BA5B-3B5BFC80EA9C
January—December 2021 OAA 203.22.01
ATTACHMENT
IX- BUDGET
SUMMARY
COLLIER COUNTY
1, Title III B Support Services $ 213,965.83
2. Title III CI Congregate Meals $ 552,670.89
3. Title III C2 Home Delivered Meals $ 390,360.45
4. Title III E Services $ 144,002.44
5. Title IIi ES Services $ 30,143.30
6. Title III EG Services $ 6,083.23
7. NSIP $ 51,728.59
TOTAL $1,388,954.83
3
DocuSign Envelope ID: FC6B0280-1A35-473A-BA5B-3B5BFC80EA9C I 0 3
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.22
Amendment Number .001
I,Tanya R Williams ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and •
Collier County Board of County Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
60 / /2022
Signatur of R cipient/Ia\t cto representative Date
as designee of the County Manager, pursuant to Resolution No. 2018-202.
Ap o ed as to form and le ality:
e D. Perry
Assistant County Attorney
/7_ 1/(6 Cl/
Revised August 2007
0