Backup Document 06/28/2022 Item #16D 2 I602 -
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 arc to he forwarded to the(minty Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must he received in the County Attorney Office no later
than Mondry preceding the Board meeting.
**NEW** ROUTING SLIP
Complete muting lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#l 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 ° KK. 06/28/2022
Services
2. County Attorney's Office Derek Percy
0 or
3. Minutes& Records Clerk of Court's Office lig 2.4
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 06/28/22 Agenda Item Number 16D2
Approved by the BCC
Type of Document AAA/OAA Amendment 203.22.002 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)
I. 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 arc 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 06/28/2022 and all changes made WK
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 WK
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature. ,,,
L 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
I6D •
DocuSign Envelope ID:DlAA2484-CD1F-4622-9EBE-BA9A383A81B1
Ja^ ^^ nnoo n i. ,gnoo r OAA 203.22.02
DocuSign Envelope ID:296ACA84-2AC7-4EBB-A5FG-BE1G711E625A
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT TITLE III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida,Inc.
("Agency")and Collier County Board of County Commissioners("Contractor"),amends agreement OAA 203.21.
The purpose of this amendment is to add service HDM to 1IIE,and replace Budget and Rate 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
COMMI SIB RR SOUTHWEST FLORIDA,INC.
,—DoeuSlgn•d by7
SIGNED SIGNED BY: � QYtKb
t-5C1BM9FE5C3495...
NAME: Tanya Williams NAME:NORMA ADORNO
TITLE: Public Service Department Head TITLE:CEO
5/18/2022
DATE: 05/I fI/2022 DATE:
as designee of the County Manager,
pursuant to Resolution No. 2018-202.
Ap0_
• ed as to Forme Legality:
II , ,
i W' D. Perry \ / F
Assistant County Attorney 6/16/202
2
cep
Page 1 of 4
I
i602
OAA 203.22.02
DocuSign Envelope ID:296ACA84-2AC7-4EBB-A5F6-BE16711E625A
ATTACHMENT XV BUDGET
AND RATE SUMMARY
COLLIER COUNTY
IIIB
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE
CASE MANAGEMENT $54.00 Fixed Fee/Unit Rate HOURS
CHORE $22.29 Fixed Fee/Unit Rate HOURS
EMERGENCY ALERT RESPONSE $ 1.35 Fixed Fee/Unit Rate DAYS
HOMEMAKER $25.44 Fixed Fee/Unit Rate HOURS
HOUSING IMPROVEMENT Cost Reimbursement 90%of Cost EPISODE
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE
PERSONAL CARE $25.44 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS
(EMERGENCIES ONLY) Cost Reimbursement 100%of Cost EPISODE
RESPITE IN-HOME $25.44 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE—COVID-19 $34.12 Fixed Fee/Unit Rate ONE-WAY TRIPS
SKILLED NURSING SERVICES $41.55 Fixed Fee/Unit Rate HOURS
SPECIALIZED MEDICAL
EQUIPMENT, SERVICES,AND Cost Reimbursement 90%of Cost EPISODE
TELEPHONE REASSURANCE—COVID-19 $13.40 Fixed Fee/Unit Rate EPISODE
TRANSPORTATION Cost Reimbursement 100%of Cost TRIPS
040
Page 2 of 4
1602
on,) OM 203.22.02
DocuSign Envelope ID:296ACA84-2AC7-4EBB-A5F6-BE16711E625A
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
COLLIER COUNTY
C-1 &C-2
SERVICE REIMBURSEMENT UNIT TYPE
UNIT RATE
Cl -- CONGREGATE MEALS $11.72 MEALS
HOME DELIVERED MEALS $ 8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
CONGREGATE MEAL SCREENING $28.00 HOUR
CONGREGATE MEALS FOR MANAGED $11.72 MEALS
LONG TERM CLIENTS
OUTREACH $4.32 PER PERSON EPISODE
SI-TOPPING ASSISTANCE-COVID-19 $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE--COVID-19 $13.40 EPISODE
SERVICE REIMBURSEMENT
UNIT RATE UNIT TYPE
C2 -- HOME DELIVERED MEALS $ 8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
SCREENING &ASSESSMENT $48.76 HOUR
OUTREACH $4.32 PER PERSON EPISODE
SHOPPING ASSISTANCE-COVID-19 $34.12 ONE-WAY TRIPS
TELEPHONE REASSURANCE-COVID-19 $13.40 EPISODE
0.0
Page 3 of 4
1 6 D 2
OAA 203.22.02
DocuSign Envelope ID:296ACA84-2AC7-4EBB-A5F6-BE16711E625A
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
COLLIER COUNTY
IIIE, HIES,&IHEG
REIMBURSEMENT METHOD OF UNIT
SERVICE UNIT RATE PAYMENT TYPE
IIIE --ADULT DAY CARE $108.00 Fixed Fee/Unit Rate DAYS
HOME DELIVERED MEALS $ 8.07 Fixed Fee/Unit Rate MEALS
RECREATION MATERIALS Cost Reimbursement 100%of Cost EPISODE
(EMERGENCIES ONLY)
RESPITE IN-HOME $25.44 Fixed Fee/Unit Rate HOURS
RESPITE IN-FACILITY $11.05 Fixed Fee/Unit Rate HOURS
SCREENING&ASSESSMENT $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE—COVID-19 $34.12 Fixed Fee/Unit Rate ONE-WAY
TELEPHONE REASSURANCE COVID-19 $13.40 Fixed Fee/Unit Rate EPISODE
IIIES--CHORE $22.29 Fixed Fee/Unit Rate HOURS
Specialized Medical Equipment, Cost Reimbursement 90%of Cost EPISODE
Service& Supplies
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE
IIIEG--CHILD DAY CARE $15.00 Fixed Fee/Unit Rate HOURS
RECREATION MATERIALS
(EMERGENCIES ONLY) Cost Reimbursement 100%of Cost EPISODE
SCREENING AND ASSESSMENT $55.17 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE COVID-I9 $34.12 Fixed Fee/Unit Rate ONE-WAY
TELEPHONE REASSURANCE—COVID-19 $13.40 Fixed Fee/Unit Rate EPISODE
Page 4 of 4
1602
DocuSign Envelope ID:296ACA84-2AC7-4EBB-A5F6-BE16711E625A
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.22
Amendment Number 2
t, 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 Count,v 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.
C05/ /2022
Signature of Recipient ontractor representative Date
pru cd . to d c ,ality
Assistant County Attornuy
Revised August 2007
co