Backup Documents 12/13/2022 Item #16D 3 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 12/13/2022
Services
2. Minutes & Records Clerk of Court's Office
(1-I3-aa y�yo
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 12/13/2022 Agenda Item Number 16D3
Approved by the BCC
Type of Document AAA/ADI-CCE AMENDMENT 203.22.01 Number of Original 2
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 12/13/2022 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.
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
July 2022 -June 2023 ADI 203.22.01
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
WHEREAS,the purpose of this Amendment is to increase funding by$307,985.60 and replace Attachment X:Annual Budget Summary
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$984,394.12 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 N ipned bY��� T� SOUTHWEST F 7 ''���i.. .
a oar:'�.,0.,9,,:os:o7 .4 s/• 1l.�1� l/�—t..
SIGNED BY: -oa'oo' SIGNED BY: .
NAME: Tanya R Williams NAME: Maricela Morado
ITI'LE: P„hlic Sersnc,s nepartment tread I'I'I'LE: Interim Chief Executive Officer/President
DATE: 10.19.2022 DATE: /0. o'I. gc;
As Designee of the County Manager,
Pursuant to Resolution No.2018-202.
A a�}ved as to Form ai Legality:
j)
A-77- .\
Derek D.Puny �%
Assistant County Attorney i
I
1
(July 2022-June 2023) ADI 203.22.01
ATTACHMENT X
ANNUAL BUDGET SUMMARY
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
for
Collier County Board of County Commissioners
Collier
TOTAL: S984,394.12
Revised August 2007
Attestation Statement
Agreement/Contract Number ADI 203.22
Amendment Number 1
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.
Digitally signed by
WilliamsTanya lliamsTanya
Date:2022.10.19 11:06:37
-04'00' 10.19.2022
Signature of Recipient/Contractor representative Date
As Designee of the County Manager,
Pursuant to Resolution No.2018-202.
A L oved as to Form,,and Legality:
7....„
Derek D.Perry
Assistant County Attorney
Revised August2007
July 2022-June 2023 CCE 203.22.01
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
COMMUNITY CARE FOR THE ELDERLY
WHEREAS,the purpose of this Amendment is to increase funding by$50,000 and to replace Attachment VIII
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$1,120,993.48,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 FL D
WilliamsTanya 11 �oaz'�,�o°:144 oro i J
SIGNED BY: SIGNED BY:
NAME: Tanya R Williams NAME: Maricela Morado
ITILE: Public Services Department Head ITILE: Interim Chief Executive Officer/President
DATE: 10.19.2022 DA f.b: /O.'/. 3 9'
As Designee of the County Manager,
Pursuant to Resolution No.2018-202.
Ap ed as to Form and Legality:
AI 6 il:- ' /
Derek D.Perry j'
Assistant County Attorney 6
i
(July 2022-June 2023) CCE 203.22.01
ATTACHMENT VIII
ANNUAL BUDGET SUMMARY
CCE
Collier County Board of County Commissioners
1. CCE Services Allocation $1,120,993.48
Total $1,120,993.48
Page 52 of 56
it
Revised August 2007
Attestation Statement
Agreement/Contract Number CCE 203.22
Amendment Number,1,��
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.
VI/iIIiamsTanya Qate:20 Digitally22.sign10.19 ed byWillia11:04:12msT-anya
-04'00' 10/19/2022
Signature of Recipient/Contractor representative Date
As Designee of the County Manager,
Pursuant to Resolution No.2018-202.
A7)'rved as to Formed Legality:
:
AI L,
,1_,i 7
Derek D. Perry
Assistant County Attorney
Revised August 2007