Backup Documents 09/27/2022 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 b Q 1
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Tracey Smith Community and Human TS
Services
2. County Attorney Office—DDP County Attorney Office
.JJe I010IZZ
3. BCC Office Board of County
Commissioners G/p► 0 fs/ i6I6[ZZ
4. Minutes and Records Clerk of Court's Office F ( (��1 n� r �, -
PRIMARY CONTACT INFORMATION r I I (J 1 0(
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 Tracey Smith, Grants Coordinator 252-1428
Contact/ Depth tinent
Agenda Date Item was 09/27/2022 Agenda Item Number 1(1.p•
Approved by the BCC
Type of Document AMENDMENT #2 BETWEEN COLLIER Number of Original 3
Attached COUNTY AND COLLIER HEALTH Documents Attached
SERVICES INC.
PO number or account
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
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
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 Yes
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 N/A
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
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 TS
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
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 0
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on above date 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 .n O
Chairman's signature. v
16 9 .
MEMORANDUM
Date: October 8, 2022
To: Tracey Smith, Grants Coordinator
Housing & Human Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Amendment #2 between Collier County and
Collier Health Services, Inc.
Attached, are two original copies of the agreement amendment referenced above,
(Item #16D1) approved by the Board of County Commissioners September 27, 2022.
The third original agreement amendment will be held in the Minutes and Records
Department for the Board's Official Record.
If you have any questions, please contact me at 252-8406.
Thank you.
Attachments (2)
16QI
FAIN# B-20-UW-12-0016
Federal Award Date 09/22/2020
Federal Award Agency HUD
CFDA Name Community
Development Block
Grant-CV
CFDA/CSFA# 14.218
Total Amount of $1,170,800.39
Federal Funds Awarded
Subrecipient Name Collier Health
Services,Inc. dba
Healthcare Network
UEI# GPXBQKU6AJA5
FEIN 59-1741277
R&D NA
Indirect Cost Rate NA
Period of Performance 04/01/2021-03/30/2023
Fiscal Year End 03/31
Monitor End: 05/31/2023
SECOND AMENDMENT TO
AGREEMENT BETWEEN COLLIER COUNTY
AND
COLLIER HEALTH SERVICES,INC. dba HEALTHCARE NETWORK
CDBG-CV Healthcare Services
This AMENDMENT is made and entered into as of this 2? day of pte.,04er 2022,
by and between Collier County, a political subdivision of the State of Florida ("COUNTY") and
Collier Health Services, Inc. dba Healthcare Network ("SUBRECIPIENT"), a private non-profit
organization having its principal office at 1454 Madison Ave,Immokalee,FL 34142 existing under
the laws of the State of Florida.
RECITALS
WHEREAS, the COUNTY has entered into an Agreement with the United States
Department of Housing and Urban Development (HUD) for a grant for the execution and
implementation of a Community Development Block Grant(CDBG) Program in certain areas of
Collier County, pursuant to Title I of the Housing and Community Development Act of 1974 (as
amended), codified as 42 USC 5301 et. Se. and subject to 24 CFR Part 570 ; and
WHEREAS, on April 27, 2021, Agenda Item 16.D.3, the COUNTY entered into an
Agreement with Collier Health Services, Inc. dba Healthcare Network. to administer the
Community Development Block Grant (CDBG-CV) COVID Case Management Healthcare
Services Program; and
COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK [22-SOC-00940]
CD-CV21-01 Words.tricl ei are deletions;
Case Management Healthcare Services for Low to Moderate Income Residents words underlined are additions.
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16B1
WHEREAS, the parties wish to amend the Agreement and the attached Exhibit C,
incorporated herein by reference, to include the language as stated below.
NOW, THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereto agree to amend the Agreement as set forth below.
Words Struckough are deleted; Words Underlined are added.
PART 1
SCOPE OF WORK
The SUBRECIPIENT shall, in a satisfactory and proper manner and consistent with any standards
required as a condition of providing CDBG assistance as provided herein and, as determined by
Collier County Community and Human Services (CHS) Division, perform the tasks necessary to
conduct the program as follows:
Project Name: COVID Case Management Healthcare Services
Description of Project/Outcome: Collier Health Services, Inc. will provide a case
management/care navigation program to serve the needs of our most vulnerable patients
who have been diagnosed or are at risk for contracting COVID-19 in an effort to
minimize disease severity and acute and/or chronic complications.
Project Component One: Staffing—Salary costs
Project Component Two: Testing and Testing Supplies
Project Component Three: Technology including, but not limited to, laptops, software,
subscriptions/member fees, cell phones and services, and/or equipment and supplies.
Project Component Four: Personal Protective Equipment (PPE) — Costs associated with
purchase, freight, delivery and use of PPE including but not limited to masks, gloves, hand
sanitizer and face shields.
1.1 GRANT AND SPECIAL CONDITIONS
A. Within sixty (60) calendar days of the execution of this Agreement, the
SUBRECIPIENT must deliver to CHS for approval, a detailed project schedule for the
completion of the project.
COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK [22-SOC-00940]
CD-CV21-01 Words,ti are deletions;
Case Management Healthcare Services for Low to Moderate Income Residents
Page 2 words underlined are additions. O
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16D. 1
B. The following resolutions and policies must be submitted within sixty (60)days of this
Agreement:
® Affirmative Fair Housing Policy
® Affirmative Action/Equal Opportunity Policy
® Conflict of Interest Policy(COI)and related COI Forms
Z Procurement Policy
® Uniform Relocation Act Policy
® Sexual Harassment Policy
E Section 3 Policy
® Section 504/ADA Policy
® Fraud, Waste, and Abuse Policy
® Limited English Proficiency Policy(LEP)
® Violence Against Women Act(VAWA) Policy
® LGBTQ Policy
1.2 PROJECT DETAILS
A. Project Description/Project Budget
Description Federal Amount
Project Component One: Staffing—Salary
costs $498,375.00
Project Component Two: Testing and $220,800.39
Testing Supplies $420,800.39
Project Component Three: Technology $51,625.00
including, but not limited to, laptops, $31,625.00
software, subscriptions/member fees, cell
phones and services, and/or equipment and
supplies
Project Component Four: Personal $220,000.00
Protective Equipment(PPE)—Purchase,
delivery and use of PPE including but not
limited to masks, gloves, hand sanitizer
and face shields
Total Federal Funds: $1,170,800.39
COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK [22-SOC-00940]
CD-CV2I-OI Words btiidc.crr are deletions;
Case Management Healthcare Services for Low to Moderate Income Residents
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C. Payment Deliverables
Payment Deliverable Payment Supporting Submission Schedule
Documentation
Project Component One: Submission of supporting Submission of monthly
Staffing—Salary costs documents must be provided invoices no later than the 20th
as backup, as evidenced by day of the following month.
Exhibit B, signed and dated
timesheets,check stubs,
payroll registers,bank
statements/cancelled checks
and any other additional
documentation as requested.
10%retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
Objective
Project Component Two: Submission of supporting Submission of monthly
Testing and Testing Supplies documents must be provided invoices no later than the 20th
as backup, as evidenced by day of the following month.
receipts,invoices,credit card
statements, bank statements
and any other additional
documentation as requested.
10%retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
objective.
Project Component Three: Submission of supporting Submission of monthly
Technology including but not documents must be provided invoices no later than the 20th
limited to laptops, software, as backup, as evidenced by day of the following month.
subscriptions/member fees, Exhibit B,receipts, invoices,
cell phones and services, credit card statements,bank
and/or equipment and statements,cancelled checks
supplies and any other additional
documentation as requested.
10%retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
objective.
COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK [22-SOC-00940]
CD-CV2I-OI Words sit are deletions;
Case Management Healthcare Services for Low to Moderate Income Residents words underlined are additions.
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Payment Deliverable Payment Supporting Submission Schedule
Documentation
Project Component 4: Submission of supporting Submission of monthly
Personal Protective documents must be provided invoices no later than the 20th
Equipment(PPE)—Purchase, as backup, as evidenced by day of the following month.
delivery and use of PPE receipts and/or invoices,
including but not limited to credit card statements(if
masks, gloves,hand sanitizer applicable),bank statements
and face shields or cancelled checks and any
other additional
documentation as requested.
10%retainage will be held
from each pay request until
final monitoring clearance and
achievement of the national
objective.
* * *
3.14 PROGRAM GENERATED INCOME
Purchase of Equipment: Equipment under the SUBRECIPIENT'S control that was acquired or
improved, in whole or in part, with CDBG-CV funds shall be used to meet one of the CDBG-CV
National Objectives, pursuant to 24 CFR 570.208, during the continued use period, as referenced
in section 3.14 (Grant Closeout Procedures) of this Agreement. If the SUBRECIPIENT sells,
transfers, disposes of, or otherwise fails to continue to use the CDBG-CV-assisted equipment in a
manner that meets a CDBG-CV National Objective,the SUBRECIPIENT shall pay the COUNTY
an amount equal to the current fair market value of the equipment, less the percentage of non-
CDBG-CV funds used to acquire the equipment.
Equipment no longer needed by the SUBRECIPIENT for CDBG-CV eligible activities under
this Agreement shall be: (a) transferred to the COUNTY for use elsewhere in the CDBG-CV
program, or(b)retained by the SUBRECIPIENT after compensating the COUNTY an amount
equal to the current fair market value of the equipment, less the percentage of non-CDBG-CV
funds used to acquire the equipment.
* *
[Signature Page and Attached Exhibit C to Follow]
COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK [22-SOC-00940]
CD-CV21-01 Words ,Lii k�.raredeletions;
Case Management Healthcare Services for Low to Moderate Income Residents words underlined are additions.
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IN WITNESS WHEREOF, the SUBRECIPIENT and the COUNTY, have each
respectively, by authorized person or agent, hereunder set their hands and seals on the date first
written above.
ATTEST: AS TO COUNTY:
Mon
CRYSTAp :KIN Z CLERK BOARD OF CO I.TY COMMISSIONERS OF
A. • , ,, , .� COLLIER CO ► . ' D A
.-U . • roe. , i
'_ , ).. :�ty Clerk � 0.4i6k �
Attest as Col ., i By:
WIL/ AM L. MCDANIEL, JR.,
Dated: Sitley41Vitta— CHAIRPERSON
(SEAL) Date: See - 21I Z62'2-
WITNESSES: AS TO SUBRECIPIENT:
'tness#1 Signat COLLIER HEALTH SERVICES, INC.dba
HEALTHCARE NETWORK
•
Witness L....:rliiil�i t , e ��r��/ ,
/''ilik°/� By. /1 `
i �i � TAMI RAZNOFF, CHI INANCIAL
;*%;.r_. OFFICER
/ • C( Date: 77:9-//- 0(9"--
Witness#2 Printed Name
[Please provide evidence of signing authority]
Ap ved as to form and ality:
•
�
Derek D. Perry 19
�
Assistant County Attorney 4\`b\
Date: OCT C I 2,o22
Attachments: Exhibit C - Quarterly Performance Report Data
COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK [22-SOC-00940]
CD-CV2I-01 Words al„,k,.,are deletions;
Case Management Healthcare Services for Low to Moderate Income Residents words underlined are additions.
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EXHIBIT C
QUARTERLY PERFORMANCE REPORT DATA
The COUNTY is required to submit Performance Reports to HUD through the Integrated Disbursement
and Information System(IDIS).The COUNTY reports information on a quarterly basis.To facilitate in the
preparation of such reports,SUBRECIPIENT shall submit the information contained herein within ten(10)
days of the end of each calendar quarter. At COUNTY's discretion, SUBRECIPIENT may be required to
enter the information collected on this exhibit into an online grant management system.
Subrecipient Name: ECollier Health Services,Inc.dba Date:
Healthcare Network
Project Title: ICOVID Case Management Healthcare IDIS#: 1637
Services
Program Contact: Telephone Number: I
Activity Reporting Period Report Due Date
October 1st—December 31' January 10th
January 1st—March 31 st April 10th
April 1"—June 30th July 10th
July 1"—September 30th October 10th
REPORT FOR QUARTER ENDING:(check one that applies to the corresponding grant period):
12/31/XX[ 3/31/XX[ 6/30/XX[ 9/30/XX[
Please note: The HUD Program year begins[October 1,20201—[September 30,20231.Each quarterly report must include
cumulative data beginning from the start of the program year[October 1,20201.
1. Please list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement and indicate your
progress in meeting those goals since[October 1,20201.
a. Outcome Goals:list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement
Outcome 1: [At least 75%of staff time will be providing case management services.[
Outcome 2: !At least 40439 500 unduplicated LMC persons will be served.Must document that at least 51%of
persons served are low-to moderate income persons or households.
Outcome 3: [
b. Goal Progress: Indicate the progress to date in meeting each outcome goal.
Outcome 1: One Manager of Case Management,4-Three Case Managers,One Community Social Worker will be
hired specifically to focus on case management services and continuity of care. [
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words underlined are additions. 0
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Outcome 2: fAt least 1,000 500 LMC persons will be served.
Outcome 3: fDocumentation will be kept of the low to moderate income persons served on a quarterly basis.
2. Is this project still in compliance with the original project schedule: Yes No ❑
If No,Explain:
3. Since October 1,20201;of the persons assisted,how many...
Answer ONLY for Public Facilities&Infrastructure Activities *03 Matrix Codes
a. ...now have new access(continuing)to this service or benefit? 0
b. ...now have improved access to this service or benefit? 0
c. ...now receive a service or benefit that is no longer substandard? 0
Total 101
4. What funding sources did the SUBRECIPIENT apply for this period?
Section 108 Loan Guarantee $1 CDBG-CV $
Other Consolidated Plan Funds $1 HOME $
Other Federal Funds $f ESG $�
$I HOPWA $1 I
$� Total Entitlement $1
Funds
5. What is the total number of UNDUPLICATED Persons(LMC)or Households(LMH)served this QUARTER,if
applicable? Answer question 5a or 5b;NOT both
For LMC activities: people,race/ethnicity,and income data are reported by persons.
For LMH activities: households,race/ethnicity,and income level are reported by households,regardless
the number of persons in the household.
a. Total No.Persons/Adults served(LMC) Total No.persons served under 18 01
(LMC)
Quarter Total No.of Persons 01 Quarter Total No.of Persons 101
[22-SOC-00940]
Words strickcn are deletions;
words underlined are additions.
16D 1
b. Total No.of Households served Total No.of female head of household
(LMH)
6. What is the total number of UNDUPLICATED clients served since[October 11,if applicable?
Answer question 6a or 6b,NOT both
For LMC activities: race/ethnicity and income data are reported by persons.
a. Total No. Persons/Adults served(LMC) 101 Total No.Persons served under 18 101
(LMC)
YTD Total: [t YTD Total fd
b. Total No. Households served(LMH) 101 Total No.female head of household(LMH)
YTD Total YTD Total 101
Complete EITHER question 7 or 8,NOT both
Complete question 7a and 7b if your program only serves clients in one or more of the listed HUD Presumed
Benefit categories.
7. PRESUMED BENEFICIARY DATA ONLY: PRESUMED BENEFICIARY DATA ONLY
(LMC)Quarter (LMC)YTD
Indicate the total number of UNDUPLICATED persons Indicate the total number of UNDUPLICATED
served this quarter who fall into each presumed benefit persons served since'October 1 who fall into each
category(the total should equal the total in question#6a presumed benefit category (the total should equal the
or 6b): total in question#6a or 6b):
a Presumed Benefit Activities Only(LMC)QTR b Presumed Benefit Activities Only(LMC)YTD
01 Abused Children ELI 01 Abused Children ELI
01 Homeless ELI Homeless Person ELI
Person
101 Migrant Farm LI 01 Migrant Farm Workers LI
Workers
101 Battered LI 0 Battered Spouses LI
Spouses
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words underlined are additions.
1 6 D 1
Persons LI FOI Persons w/HIV/AIDS LI
w/HIV/AIDS
fd Elderly Persons LI or MOD 10 Elderly Persons LI or
MOD
(d Illiterate Adults LI 101 Illiterate Adults LI
Severely LI Id Severely Disabled Adults LI
Disabled Adults
101 Quarter Total 101 YTD Total
8. Complete question 8a and 8b if any client in your program does not fall into a Presumed Benefit category.
Other Beneficiary Data: Income Range Other Beneficiary Data: Income Range
Indicate the total number of UNDUPLICATED persons Indicate the total number of UNDUPLICATED
served this Quarter who fall into each income category persons served since'October 11,(YTD)who fall into
(the total should equal the total in question#6): each income category(the total should equal the total
in question#6):
a ELI Extremely Low Income(0-30%) d b ELI Extremely Low 0
Income(0-30%)
LI Low Income(31-50%) [d LI Low Income 0
MOD Moderate Income(51-80%) fd MOD Moderate Income 0
(51-80%)
NON-L/M Above Moderate Income(>80%) NON-L/M Above Moderate 101
Income(>80%)
Quarter Total 101 YTD Total 101
9. Is this project in a Low/Mod Area(LMA)? YES NO
Was project completed this quarter? YES NO [ If yes,complete all of this section 9.
Date project completed
Low/Mod
Block Group Census Tract Total Beneficiaries Beneficiaries Low/Mod Percentage
0 b [0 0 10
Date LMA Narrative approved by CHS?
What documentation supports project completion? (i.e..
Certificate of Completion or Certificate of Occupancy,
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words underlined are additions. 0
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etc.)
10. Racial&Ethnic Data(if applicable)
Please indicate how many UNDUPLICATED Please indicate how many UNDUPLICATED clients
clients served this Quarter fall into each race served since October 1 k(YTD)fall into each race category.
category.In addition to each race category,please In addition to each race category please indicate how many
indicate how many persons in each race category persons in each race category consider themselves
consider themselves Hispanic.(Total Race column Hispanic. (Total Race column should equal the total in
should equal the total in question 6.) question 6.)
a. RACE ETHNICITY b. RACE ETHNICITY
/HISPANIC
/HISPANIC
White 101 101 White 10 0
Black/African American 01 101 Black/African American 101 [�
Asian Asian 101
American Indian/Alaska Native American Indian/Alaska
Native
Native Hawaiian/Other Pacific Islander 0 Native Hawaiian/Other Pacific 0
Islander
Black/African American&White Black/African American&
White
American Indian/Alaska Native& American Indian/Alaska
Black/African American Native&Black/African
American
Other Multi-racial Other Multi-racial
01 01
Name:
Signature:
Title:
Your typed name here represents your electronic signature
[22-SOC-00940]
Words btii,lltir are deletions;
words underlined are additions. 0