Backup Documents 02/28/2023 Item #16D6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 6
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. Loretta Blanco Community and Human 02/28/2023
Services
2. County Attorney Office 3/ 123
RTT ,
3. BCC Office Board of County
Commissioners tt,/1p(d 3(z/z 3
4. Minutes and Records Clerk of Court's Office 44"
!//,;7
2-
3
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 Loretta Blanco Phone Number 252-2675
Contact/ Department
Agenda Date Item was 02/28/2023 Agenda Item Number 16.D.6
Approved by the BCC
Type of Document SF425 Federal Financial Report-Close Out Number of Original 1 original of each item
Attached HCN Termination letter Documents Attached
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? LB
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 LB
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 LB
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 LB
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 02/28/2023 and all changes made during LB 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 LB 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
1606
Federal Financial Report OMB Number:4040-0014
(Follow form Instructions) Expiration Date:02/28/2025
1.Federal Agency and Organizational Element to Which Report is Submitted 2.Federal Grant or Other Identifying Number Assigned by Federal
Agency(To report multiple grants,use FFR Attachment)
CDC Office of Financial Resources
NU58DP007038
3.Recipient Organization(Name and complete address including Zip code)
Recipient Organization Name: Collier County Board of County Commissioners
Street1: 3299 Tamiami Trl E Ste 202
Street2:
City: Naples County: Collier
State: FL: Florida Province:
Country: USA: UNITED STATES ZIP/Postal Code: 34112-5746
4a.UEI 4b.EIN 5.Recipient Account Number or Identifying Number
(To report multiple grants,use FFR Attachment)
JWKJKYRPLLU6 596000558
NU58DP007038
6.Report Type 7.Basis of Accounting 8.Project/Grant Period 9.Reporting Period End Date
Quarterly ❑ Cash From: To: 08/30/2023
El Semi-Annual Accrual 08/31/2021 08/30/2024
0 Annual
®Final
10.Transactions Cumulative
(Use lines a-c for single or multiple grant reporting)
Federal Cash(To report multiple grants,also use FFR attachment):
a.Cash Receipts 0.00
b.Cash Disbursements 0.00
c.Cash on Hand(line a minus b) 0.00
(Use lines d-o for single grant reporting)
Federal Expenditures and Unobligated Balance:
d.Total Federal funds authorized 0.00
e.Federal share of expenditures 0.00
f.Federal share of unliquidated obligations 0.00
g.Total Federal share(sum of lines e and f) 0.00
h.Unobligated balance of Federal Funds(lined minus g) 0.00
Recipient Share:
i.Total recipient share required 0.00
j.Recipient share of expenditures 0.00
k.Remaining recipient share to be provided(line i minus j) 0.00
Program Income:
I.Total Federal program income earned 0.00
m.Program Income expended in accordance with the deduction alternative 0.00
n.Program Income expended in accordance with the addition alternative 0.00
o.Unexpended program income(line I minus line m and line n) 0.00
16D6
11.Indirect Expense
a.Type b.Rate c.Period From Period To d.Base e.Amount f.Federal Share
Charged
g.Totals:
12.Remarks:Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:
Add Attachment Delete Attachment View Attachment
13.Certification: By signing this report,I certify to the best of my knowledge and belief that the report is true,complete,and accurate,and the
expenditures,disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award.
am aware that any false,fictitious,or fraudulent information,or the omission of any material fact,may subject me to criminal,civil or
administrative penalties for fraud,false statements,false claims or otherwise.(U.S.Code Title 18,Section 1001 and Title 31,Sections 3729-3730
and 3801-3812).
a.Name and Title of Authorized Certifying Official
Prefix: Mr First Name: Rick Middle Name:
Last Name: Locastro Suffix:
Title: Chairman
b.Signature of Authorized Certifying Official c.Telephone(Area code,number and extension)
239-252-8601
('''.......24 .,............
d.Email Address e.Date Report Submitted 14.Agency use only:
Rick.LoCastro@colliercountyfl.gov 02/28/2023
h ' i.: ..I GT
Standard Form 425
tRY: I'k1'.K.KD Z L,CLERK
.t,, j'
,
7 Aktt p Chairman's
sy;
Ap roved as too formignature andonl legality
J,S1
Assistant County Attorney
0
(4
� 6D6
Colter County
Public Services Department
Community & Human Services Division
February 14, 2023
Jamie Ulmer
1454 Madison Avenue West
Immokalee, FL 34142
Re: CDC21-01 Community Health Workers for COVID Response and Resilient Communities (CCR)
program
Dear Mr. Ulmer:
We are notifying you that on February 14, 2023, the Board of Collier County Commissioners voted
unanimously to return the Center for Disease Control (CDC) CCR grant back to the CDC effective
immediately.
As per the following section in your agreement: Part III TERMS AND CONDITIONS, Section 3.9 DEFAULTS,
REMEDIES, AND TERMINATION:
In accordance with 2 CPR 200.340, this Agreement may be terminated for convenience by either
the COUNTY or SUBRECIPIENT, in whole or in part, by setting forth, in writing, the reasons for
such termination, the effective date, and, in the case of partial terminations, the portion to be
terminated. However, if in the case of a partial termination,the COUNTY determines that the
remaining poltion of the award will not accomplish the purpose for which the award was made,
the COUNTY may terminate the award in its entirety.This Agreement may also be terminated if
the award no longer effectuates the program goals or COUNTY priorities.
At this time, Collier County's Commissioners have determined that the CDC CCR grant no longer
effectuates the County's priorities and is therefore terminating this agreement, effective immediately.
Although the CDC CCR grant is being terminated,the County will be reimbursing Healthcare Network for
all expenditures through February 14, 2023. To date, we have received $222,064.10 in pay requests, of
which $142,092.46 has been disbursed. Presently there is$79,971.64 in pay requests that are under
review.
Community&Human Services Division•3339 Tamiami Trail East,Suite 211•Naples,Florida 34112-5361
239-252-CARE(2273)•239-252-CAFE(2233)•239-252-4230(RSVP)•wrww.colliergov.net/humanservices
16Ub
Please submit all pay requests for work thru February 14, 2023 in Neighborly by March 14, 2023 for any
services related to this program that Health Care Network plans to request reimbursement. Nothing
past February 14, 2023 will be reimbursed.
Collier County's Community and Human Service Division wants to thank Health Care Network for their
partnership and ongoing efforts to serve the residents of Collier County.
If you have any questions, please call (239)269-3907 or email at Kristi.Sonntag@colliercountyfl.gov
Respectfully,
Rick LoCastro
Chairman
3299 Tamiami Trail East
Suite 303
Naples, Florida 34112
t�•
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1606
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Loretta Blanco Community and Human /.6 03/15/2023
Services
2. a4ereiM County Attorney Office l
/�C•y�1 j I1 7423
3. BCC Office Board of County �CJ
Commissioners Rt. , Trip/( 3117/23
4. Minutes and Records Clerk of Court's Office r�/�'„ w c ( 67
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 Loretta Blanco Phone Number 252-2675
Contact/ Depai lment
Agenda Date Item was 02/28/2023 Agenda Item Number 16.D.6
Approved by the BCC
Type of Document SF425 Federal Financial Report-Corrected Number of Original 1 original of each item
Attached Close-Out Form Documents Attached
HCN Termination letter
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? LB
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 LB
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 LB
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 LB
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 02/28/2023 and all changes made during LB 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 LB 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
160 6
Federal Financial Report OMB Number:4040-0014
(Follow form Instructions) Expiration Date:02/28/2025
1.Federal Agency and Organizational Element to Which Report is Submitted 2.Federal Grant or Other Identifying Number Assigned by Federal
Agency(To report multiple grants,use FFR Attachment)
CDC Office of Financial Resources
NU58DP007038
3.Recipient Organization(Name and complete address including Zip code)
Recipient Organization Name: Collier County Board of County Commissioners
Streetl: 3299 Tamiami Trl E Ste 202
Street2:
City: Naples County: Collier
State: FL: Florida Province:
Country: USA: UNITED STATES ZIP/Postal Code: 34112-5746
4a.UEI 4b.EIN 5.Recipient Account Number or Identifying Number
JWKJKYRPLLU6 596000558 (To report multiple grants,use FFR Attachment)
NU58CP007038
6.Report Type 7.Basis of Accounting 8.Project/Grant Period 9.Reporting Period End Date
Quarterly ID Cash From: To: 08/30/2023
Semi-Annual Accrual 08/31/2021 08/30/2024
Annual
®Final
10.Transactions Cumulative
(Use lines a-c for single or multiple grant reporting)
Federal Cash(To report multiple grants,also use FFR attachment):
a.Cash Receipts o.00
b.Cash Disbursements
0.00
c.Cash on Hand(line a minus b) 0.00
(Use lines d-o for single grant reporting)
Federal Expenditures and Unobligated Balance:
d.Total Federal funds authorized 843,488.00
e.Federal share of expenditures o 00
f.Federal share of unliquidated obligations 0.0 0
g.Total Federal share(sum of lines e and f) 0.00
h.Unobligated balance of Federal Funds(line d minus g) 843,488.00
Recipient Share:
i.Total recipient share required 0.00
j.Recipient share of expenditures 0.00
k.Remaining recipient share to be provided(line i minus j) 0.00
Program Income:
I.Total Federal program income earned o.0o
m.Program Income expended in accordance with the deduction alternative o.00
n.Program Income expended in accordance with the addition alternative 0.00
o.Unexpended program income(line I minus line m and line n) 0.00
1 60 6 .,
11.Indirect Expense
a.Type b.Rate c.Period From Period To d.Base e.Amount f.Federal Share
Charged
g.Totals:
12.Remarks:Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:
Add Attachment Delete Attachment View Attachment
13.Certification: By signing this report,I certify to the best of my knowledge and belief that the report is true,complete,and accurate,and the
expenditures,disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award.I
am aware that any false,fictitious,or fraudulent information,or the omission of any material fact,may subject me to criminal,civil or
administrative penalties for fraud,false statements,false claims or otherwise.(U.S.Code Title 18,Section 1001 and Title 31,Sections 3729-3730
and 3801-3812).
a.Name and Title of Authorized Certifying Official
Prefix: Mr First Name: Rick Middle Name:
Last Name: LoCastro Suffix:
Title: Chairman
b.Signature of Authorized fficial c.Telephone(Area code,number and extension)
239-252-8601
d.Email Address e.Date Report Submitted 14.Agency use only:
Rick.LoCastro@colliercountyfl.gov 02/28/2023
Standard Form 425
ATTEST
CRYSTAL K.KINZEL,CL>✓
BY: ..
A Attest mas tnoCoaairmliyatny's
signature ,, ��- cnty Attorney
sstsi�,,tf r� tk! ,
0
0"
1606
TANGIBLE PERSONAL PROPERTY REPORT OMB Number:4040-0018
B Expiration Date: 11/30/2024
Final Report SF-428-
Federal Grant or Other Identifying Number Assigned by Federal Agency(Block 2 on SF-428).
NU58DP007038
1. Report(Select all that apply)
❑ a. Federally-owned Property(List on Supplemental Sheet SF-428S or recipient equivalent and complete Section 2a below)
❑ b.Acquired Equipment with acquisition cost of$5,000 or more for which the awarding agency has reserved the right to
transfer title(List on Supplemental Sheet SF-428S or recipient equivalent and complete Section 2b below).
❑ c. Residual Unused Supplies with total aggregate fair market value exceeding$5,000 not needed for any other Federally
sponsored programs or projects(Complete Section 2c below).
• d. None of the above
2.Complete relevant section(s) For Agency Use Only,
2a, Federally-owned Property(Select one or more). Agency response to requested disposition of 1 ederally owned properly
❑ (i)Request transfer to Award ❑(i).Recipientrequestapprovetl ❑denied
❑(n)Dispose in accordance with attached instructions
❑ (ii)Request Federal Agency disposition instructions Agency response to requested disposition of acquired equipment
❑ (iii)Other(Provide detail in Block 3 or attach request) ❑(t)Recipientrequestepproved ❑dented
2b,Acquired Equipment with current fair market value of ❑(Ii)Dispose in accordance with attached instructions
$5,000 or more; Authorized Awarding Agency Official
(Select one or more and attach Supplemental Sheet SF 428S
or recipient equivalent) Signature Date
❑ (i)Acknowledge equipment acquired under this federal
award will be retained for use as originally approved, Name.,; Phone
❑ (ii)Request Federal Agency disposition instructions, Title E Mail
Add Attachment Delete Attachment View Attachment
2c. Reportable Residual Unused Supplies
(i)❑Sale proceeds or ❑ Estimate of current fair market value $
(ii)Percentage of Federal participation
(iii)Federal share $
(iv)Selling and handling allowance $
(v)Amount remitted to the Federal Government $
3. Comments
Add Attachment Delete Attachment;I View Attachment .
FINAL REPORT ATTACHMENT TO SF-428 Agency Uss Qrtly
16D6
Cotter County
Public Services Department
Community & Human Services Division
February 14,2023
Jamie Ulmer
1454 Madison Avenue West
Immokalee, FL 34142
Re: CDC21-01 Community Health Workers for COVID Response and Resilient Communities(CCR)
program
Dear Mr. Ulmer:
We are notifying you that on February 14,2023,the Board of Collier County Commissioners voted
unanimously to return the Center for Disease Control(CDC)CCR grant back to the CDC effective
immediately.
As per the following section in your agreement: Part III TERMS AND CONDITIONS,Section 3.9 DEFAULTS,
REMEDIES,AND TERMINATION:
In accordance with 2 CPR 200.340,this Agreement may be terminated for convenience by either
the COUNTY or SUBRECIPIENT,in whole or in part, by setting forth,in writing,the reasons for
such termination,the effective date,and, in the case of partial terminations,the portion to be
terminated. However,if in the case of a partial termination,the COUNTY determines that the
remaining poltion of the award will not accomplish the purpose for which the award was made,
the COUNTY may terminate the award in its entirety.This Agreement may also be terminated if
the award no longer effectuates the program goals or COUNTY priorities.
At this time,Collier County's Commissioners have determined that the CDC CCR grant no longer
effectuates the County's priorities and is therefore terminating this agreement,effective immediately.
Although the CDC CCR grant is being terminated,the County will be reimbursing Healthcare Network for
all expenditures through February 14,2023. To date,we have received$222,064.10 in pay requests, of
which$142,092.46 has been disbursed. Presently there is$79,971.64 in pay requests that are under
review.
4
Community&Human Services Division•3339 Tamiami Trail East,Suite 211•Naples,Florida 34112-5361
239-252-CARE(2273)•239-252-CAFE(2233)•239-252-4230(RSVP)•w`vw.colliergov.net/humanservices
(��0
t6Ub
Please submit all pay requests for work thru February 14,2023 in Neighborly by March 14,2023 for any
services related to this program that Health Care Network plans to request reimbursement. Nothing
past February 14,2023 will be reimbursed.
Collier County's Community and Human Service Division wants to thank Health Care Network for their
partnership and ongoing efforts to serve the residents of Collier County.
If you have any questions, please call(239)269-3907 or email at Kristi.Sonntag@colliercountyfl.gov
Respectfully,
C /
Rick LoCastro
Chairman
3299 Tamiami Trail East
Suite 303
Naples, Florida 34112
Ap r vc as o fo and legality ATTEST
CRYSTAL K.KINZEL,CLERK
BY:
arL
Assistant County Attorney
as to Chairman's
Si9nature.only