Backup Documents 05/09/2023 Item #16D 5 16D 5
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 GWK, 05/09/2023
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/ Depai Invent
Agenda Date Item was 05/09/2023 Agenda Item Number 16D5
Approved by the BCC
Type of Document AAA/ENHCE 203.23.001 Amendment 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 05/09/2023 and all changes made during WK
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
6D 5
(November 2022—August 2023) ENHCE 203.23.01
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
ENHANCED HOME CARE FOR THE ELDERLY
WHEREAS, the purpose of this Amendment is to amend section 3.Term of Contract,which will shorten the term of the contract and
make the final invoice due on September 3rd 2023,and to add CSFA grant number.
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:
3. Term of Contract:
This contract shall begin at twelve(12:00)A.M.,Eastern Standard Time November 1,2022 or on the date the contract has been
signed by the last party required to sign it,whichever is later. It shall end at eleven fifty-nine(I I:59)P.M.,Eastern Standard
Time September 30,2023.
Updated pages 23 through 26-Table 2 and 3 attached. Updated page 33 -CSFA number attached.
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.
CONTRACT I '; IER . . !DUTY AREA AGENCY ON AGING FOR
BOARD OF a� I4 CO11 acnatMi0y SOUTHWEST 949RID , C_
Date:2023.04.06
SIGNED BY:
ya 16:27:38-04'00' SIGNED BY: 1 fJ/ t i f f
NAME: Tanya R Williams NAME: Maricela Morado
TITLE: Public Service Department Head TITLE: ChiefExecutive Officer/President
DATE: 04.06.2023 DATE: r` /. 0 7. g 3
As designee of the County Manager, pursuant to
Resolution No. 2018-202.
App ed as to Form a d Legality:
Derek D. Perry
Assistant County Attorney
osg
16D 5
(November 2022—August 2023) ENHCE 203.23.01
a. Maintain written policies and procedures for computer system backup and recovery and shall have the same
requirement of subcontractors. These policies and procedures shall be made available to AAASWFL upon
request.
21. Agree to cooperate with AAASWFL in monitoring the progress of completion of the service tasks and
deliverables.
22. The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of functionally
impaired elders and their caregivers. The Contractor shall ensure that performance and reporting of the
following services are in accordance with the current DOEA Handbook,and Section II.A.1.-2. Of this contract.
Documentation of service delivery must include but is not limited to the following: number of clients served,
number of service units provided by service, and rate per service unit with calculations that equal the total
invoice amount.The services include the following categories:
23. The Contractor agrees to comply with the following responsibilities when AAASWFL,Department or Agency
data is utilized:
a. Comply with the Department of Health and Human Services Privacy Regulations in the CFR, Title 45,
Sections 160 and 164, regarding disclosure of protected health information as specified in Attachment II,
Business Associate Agreement.
b. Ensure all services provided under this Contract will be performed within the borders of the United States
and its territories and protectorates. State-owned Data (data collected or created for or provided by
AAASWFL,Department and/or Agency)will be processed and stored in data centers that are located only
in the forty-eight(48) contiguous United States. The Contractor shall ensure that call centers, Information
Technology (IT) help desks or any other type of customer support provided directly under this Contract,
shall be located only in the forty-eight(48)contiguous United States.
c. To not subcontract,assign,or transfer any work identified under this Contract,without prior written consent
of the Agency. Changes to approved subcontracts and/or subcontractors require approval in writing by
AAASWFL prior to the effective date of any subcontract.
d. Ensure its employees,subcontractors and agents shall provide immediate notice to AAASWFL in the event
it becomes aware of any security breach and any unauthorized transmission or loss of any or all of the data
collected or created for or provided by AAASWFL,Department and/or Agency.
e. Conform to current and updated publications of the principles, standards, and guidelines of the Federal
Information Processing Standards (FIPS), the National Institute of Standards and Technology (NIST)
publications,including but not limited to Cybersecurity-Framework and NIST.SP.800-53.
C. Deliverables Section
The Contractor shall submit monthly deliverables for review and approval to AAASWFL in accordance with Table
1, Deliverable Requirements, and Table 2,Deliverable Schedule,below:
91. TABLE 1—DELIVERABLE REQUIREMENTS
Deliverable Supporting Documentation Due Dat
Signed consent forms from each Completed and signed
participant in the enhanced HCE Attachment IX in PDF files or The third(3rd)calendar day o
1 program that acknowledges the other electronic format files with each month
program's limited scope and duration legally binding attestation from
of services. the HCE participant.
Report providing the aggregate
number of participants enrolled into Excel spreadsheet showing per rd)
the enhanced HCE program,their The third(3 calendar day o
2 person information on each month.
demographics (e.g., age,sex,race, Attachment XII.
ethnicity,AHCA region), and their
health insurance carrier.
C�0
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16D 5
(November 2022—August 2023) ENHCE 203.23.01
Report documenting all home
modifications and Enhanced HCE Excel spreadsheet showing per The third(31d)calendar day of
3 services rendered,their costs, and person information on each month
dates of service per person served and Attachment XIII
Provider Name.
Consolidated Surplus/Deficit Report Completed and signed report in ,i,
4 in accordance with the requirements PDF file or other electronic The twelfth(12 )calendar
listed in Attachment I, Section I, Sub- format file day of each month.
Section F, Item 13.
701B assessment data that will be
5 used by the Agency to quantify the Assessment results in electronic As requested by the Agency
impact of services on participant and format.
caregiver conditions
Program Highlights referencing a new PDF completed in accordance
6 success story,quote,testimonial, or with Attachment I, Section 1, September 15,2023
human-interest vignette that occurred Sub-Section F, Item 15.
in preceding SFY/FFY.
TABLE 2—DELIVERABLE SCHEDULE
Source Documentation/Reporting Due Date
• November Demographic Information
• November Services Information
December 3,2022
• November Informed Consents
• Invoice for November Services
• November Surplus/Deficit Report December 12,2022
• December Demographic Information
• December Services Information January 3, 2023
• December Informed Consents
• Invoice for December Services
• December Surplus/Deficit Report January 12, 2023
• January Demographic Information
• January Services Information
February 3,2023
• January Informed Consents
• Invoice for January Services
• Quarterly Survey Results(November, December,January) February 8,2023
• January Surplus/Deficit Report February 12,2023
• February Demographic Information
• February Services Information March 3,2023
• February Informed Consents
• Invoice for February Services
• February Surplus/Deficit Report March 12,2023
• March Demographic Information
• March Services Information April 3,2023
• March Informed Consents
• Invoice for March Services
• March Surplus/Deficit Report April 12,2023
• April Demographic Information
• April Services Information May 3, 2023
• April Informed Consents
• Invoice for April Services
• Quarterly Survey Results(February,March,April) May 8, 2023
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16D 5
(November 2022—August 2023) ENHCE 203.23.01
• April Surplus/Deficit Report May 12,2023
• May Demographic Information
• May Services Information June 3 2023
• May Informed Consents
• Invoice for May Services
• May Surplus/Deficit Report June 12,2023
• June Demographic Information
• June Services Information
July 3,2023
• June Informed Consents
• Invoice for June Services
• June Surplus/Deficit Report July 12,2023
• July Demographic Information
• July Services Information
August 3,2023
• July Informed Consents
• Invoice for July Services
• Quarterly Survey Results(May,June,July) August 8,2023
• July Surplus/Deficit Report August 12,2023
• August Demographic Information
• August Services Information
September 3,2023
• August Informed Consents
• Invoice for August Services
• August Surplus/Deficit Report September 12,2023
• Program Highlights September 15,2023
III.METHOD OF PAYMENT
A. Payment Methods Used
The method of payment for this contract is cost reimbursement based on monthly invoicing from the Contractor to
the Agency, subject to the availability of funds and Contractor performance. The Agency will pay the Contractor
upon satisfactory completion of the Tasks/Deliverables, and in accordance with other terms and conditions of this
contract.
B. Monthly Payments
The Contractor shall submit all invoices to AAASWFL for preliminary approval within fifteen(15) calendar days
of completion and approval of deliverables(s). The Agency will pay the invoiced amount for services completed
each month and after all deliverables are submitted and approved.
TABLE 3
PAYMENT SCHEDULE
# State Fiscal Year Number
Deliverable/Service Description Unit Cost
- SFY of Units
ciQ,O
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16D 5
(November 2022—August 2023) ENHCE 203.23.01
Year 1 Operations
(December 1, 2022—June 30, 2023)
The Vendor shall provide proactive, client-
directed,time-limited home modifications, Per Monthly
Invoiced Amount for
1 SFY 2022/2023 self-management support, and caregiver 7
support in accordance with the terms in this Services Delivered
Contract. The required reports are the
supporting documentation the Agency will
use to verify the completion of services.
Year 2 Operations
(July 1, 2023—August 30,2023)
The Vendor shall provide proactive,client-
Per Monthly
directed,time-limited home modifications, Invoiced Amount for
2 SFY 2023/2024 self-management support, and caregiver 2
support in accordance with the terms in this Services Delivered
Contract. The required reports are the
supporting documentation the Agency will
use to verify the completion of services.
C. Method of Invoice Payment
All requests for payment shall all be submitted using Attachment XIV.Payment may be authorized for all allowable
expenditures to complete the tasks identified in and required by this Contract.
Any payment due under the terms of this contract may be withheld pending the receipt and approval by AAASWFL
of all deliverables due from the Contractor and any adjustments thereto, including any disallowance not resolved.
Payment shall be made upon the Contractor presentation of an invoice subsequent to the acceptance and approval
by AAASWFL of the deliverables shown on the invoice. The form and substance of each invoice packet submitted
by the Contractor shall be as follows:
1. Have a Remittance Address that corresponds exactly to the "Remit To" address provided to
MyFloridaMarketPlace(MFMP)during registration.
2. Request payment monthly for the services provided in conformance with the requirements as described in the
current DOEA Handbook and in accordance with the Payment Schedule in Table 3 above, at the rates
established in Attachment 1 Section II.A.1 and II.A.2. Documentation of service delivery must include a report
consisting of the following:name of each client served,all home modifications and services provided with their
cost and dates of service, with calculations that equal the total invoice amount (Attachment XIII).
Reimbursement amounts for administrative costs must be reflected on the Cost Reimbursement Summary form
(Attachment XVI) and include only items contained on the Contractor's Cost Analysis form. Any requested
changes to the approved budget subsequent to the execution of the contract must be submitted to AAASWFL
for written approval. Any change to the total contract amount requires a formal contract amendment.
3. The Contractor shall consolidate all subcontractors'Requests for Payment and Receipt and Expenditure Reports
that support Requests for Payment and shall submit the consolidated information to AAASWFL using the
Request for Payment (Attachment XIV), Receipt and Expenditure Report (Attachment XV), and Cost
Reimbursement Summary (Attachment XVI) forms for services and administrative expenses, which must
include itemized expenditure categories.
4. All Requests for Payment shall be based on the submission of monthly Receipt and Expenditure Reports
beginning with the first month of this contract.
5. The Contractor shall submit monthly invoices to AAASWFL for review and processing for payment.
C.
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16D 5
(November 2022—August 2023) ENHCE 203.23.01
ATTACHMENT II
EXHIBIT 2
FUNDING SUMMARY(2022-2023)
Note: Title 2 CFR, as revised, and Section 215.97,F.S., require that the information about Federal Programs and State
Projects included in Attachment II,Exhibit 1,be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): FEDERAL AWARD DATE:
DUNS NUMBER:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200—Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133—Audits of States,Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
ARP Enhanced FMAP Medical Care Trust Fund 65.001 $334,665.56
TOTAL AWARD $334,665.56
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97&215.971,F.S., Chapter 69I-5,F.A.C., State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
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