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Backup Documents 11/08/2022 Item #16D 5 Q5 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#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. Wendy Klopf Community and Human Irk 11/08/2022 Services 2. Minutes & Records Clerk of Court's Office 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 11/08/22 Agenda Item Number 16D5 Approved by the BCC Type of Document AAA/OAA AMENDMENT 203.22.003 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 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 11/08/2022 and all changes made during WK N/A is not the meeting have been incorporated in the attached document. The County an option for Attorney's Office has reviewed the changes,if applicable. this line. 9. Initials of attorney verifying that the attached document is the version approved by the WK N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the an option for Chairman's signature. this line. 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 A6 it 5 January -December 2022 OAA 203.22.03 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. OLDER AMERICANS ACT WHEREAS,the purpose of this Amendment is to increase funding by$940,104.70 and replace Attachment IX NOW THEREFORE,in consideration of the mutual covenants and obligations set forth herein,the receipt and sufficiency of which are hereby acknowledged,the Parties agree to the following: 4. Contract Amount: The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed$2,329,059.53,subject to the availability of funds. Any costs or services paid for under any other contract or from any other source are not eligible for payment under this contract. All provisions in the contract and 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 THEREOF, the Parties hereto have caused this amendment, to be executed by their officials as duly authorized; and agree to abide by the terms, conditions and provisions of this amendment as amended. This Amendment is effective on the last date the Amendment has been signed by both Parties. IN WITNESS WHEREOF,the Parties hereto have caused this contract to be executed by their undersigned officials as duly authorized. CONTRACTOR: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR OF COUNTY COMMISSIONERS SOUTHWEST F WiAiamsTanya , 517 T a SIGNED BY: SIGNED BY: NAME: Tanya R Williams NAME: Maricela Morado TITLE: Public Services Department Head 11TLE: Interim Chief Executive Officer/President DATE: 10/25/2022 DATE: /G• a?b. clo as designee of the County Manager, pursuant to Resolution No. 2018-202. ved as to Form And Legality: A : '),eXI 6. /,,W //Derek D_ Perry Assistant County Attorney 1 1605 ATTACHMENT IX- BUDGET SUMMARY COLLIER COUNTY 1. Title III B Support Services $ 495,000.00 2. Title III CI Congregate Meals $ 600,000.00 3. Title III C2 Home Delivered Meals $ 905,230.94 4. Title III E Services $ 240,000.00 5. Title III ES Services $ 31,000.00 6. Title III EG Services $ 6,100.00 7. NSIP $ 51,728.59 TOTAL $ 2,329,059.53 2 16 © 5 Revised August 2007 Attestation Statement Agreement/Contract Number OAA 203.22 Amendment Number 3 I, Tarwa R Williamc ,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. W I I I I a m sTa n ya Digitally signed by WilliamsTanya Date:2022.10.25 15:31:38-04'00' 10/25/2022 Signature of Recipient/Contractor representative Date as designee of the County Manager, pursuant to Resolution No. 2018-202. Approved as to Form,and Legality: �"L Derek D. Perry Assistant County Attorney Revised August 2007 3