Loading...
Backup Documents 07/25/2023 Item #16D 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 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 Attomey Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Tracey Smith Community and Human TS 07/20/2023 Services 2. County Attorney Office—DDP County Attorney Office lJ(� p `Z 4I Z3 3. BCC Office Board of County Commissioners itI by/1 1 7/Z7/Z3 4. Minutes and Records Clerk of Court's Office q°1 7/Zilt3 /d•13 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 Tracey Smith, Grants Coordinator 252-1428 Contact/ Depas I.uient Agenda Date Item was 07/25/2023 Agenda Item Number 16.D.6 Approved by the BCC Type of Document THIRD AMENDMENT 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 N/A 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 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 Or the meeting have been incorporated in the attached document. The County 0 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 Chairman's signature. 16D6 ri CFAIN# B-20-UW-12-0014 Federal Award Date 109/22/2020; Federal Award Agency -IUD; CFDA Name (Community Development Block Grant-CV CFDA/CSFA# 14.218 Total Amount of I$1,170,800.39 Federal Funds Awarded $1,296,425.39 Subrecipient Name "Collier Health Services,Inc. dba Healthcare Network UEI# ;GPXBQKUGAJA5 FEIN 59-1741277 R&D NA Indirect Cost Rate NA Period of Performance p4/01/2021.-03/30/2023 09/30/2023 Fiscal Year End '03/31 Monitor End: p5/31/2023 12/30/2023 HIRD AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND [COLLIER HEALTH SERVICES,INC. d/b/a HEALTHCARE NETWORK CDBG-CV Healthcare Services I This AMENDMENT is made and entered into as of thisZ5I day of I 3\L' f 12023 by and between Collier County,a political subdivision of the State of Florida("COUNTY")and !d/b/a Healthcare Network;("SUBRECIPIENT"), a Florida Not for Profit Corporation,having its principal office at11454 Madison Ave,Immokalee,FL 34142!. 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 seq. and subject to 24 CFR Part 570; I WHEREAS, on [April 27, 20211, Agenda Item 16.D.3, the COUNTY entered into an Agreement with Collier Health Services, Inc. d/b/a Healthcare Networl to administer the "Community Development Block Grant (CDBG-CV) Case Management Healthcare Services Program, WHEREAS, on March 8, 2022, Agenda Item 16.D.11, the COUNTY entered into the First Amendment with Collier Health Services,Inc.dba Healthcare Network to further undertake ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-01[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents( Page I Gp' 1 6 D 6 the responsibilities of the Case Management Healthcare Services program by adding a technology component,reallocating the budget and revising payment deliverables. WHEREAS,on September 27,2022,Agenda Item 16.D.1,the COUNTY entered into the Second Amendment with Collier Health Services, Inc. d/b/a Healthcare Network to add a fourth project component for personal protective equipment and update the Exhibit C Quarterly Report requirements. WHEREAS,on February 16,2023,the County Manager signed the request for extension of the term of the agreement to July 30, 2023. WHEREAS, on May 23, 2023, Agenda Item 1 l.A., the COUNTY approved the use of Community Development Block Grant-CV to support the continuation of the Collier health Services, Inc. Community Health Workers to address health disparities within the community. WHEREAS,the parties wish to amend the Agreement by reallocating funds from current grant funded resources to support the staffing costs of the Community Health Workers to address mental health and substance abuse in low to moderate areas of the community which they are already serving.!; and NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein,the parties hereto agree to amend the Agreement as set forth below. WordsStruck Through are deleted;Words Underlined are added. PART 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 for medical and mental health/substance abuse services to serve the needs of our most vulnerable patients who have been diagnosed or are at risk for contracting COVID 19 communicable diseases during or after the pandemic in an effort to minimize disease severity and acute and/or chronic complications! 'Project Component One: Staffing—Salary costs ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-OI [23-SOC-01050j Case Management Healthcare Services for Low to Moderate Income Residents i { Page 2 C)Q 16D6 Project Component Two:Testing and Testing Supplied !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. ii 'k f't 1.1 GRANT AND SPECIAL CONDITIONS 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 ® Procurement Policy ® Uniform Relocation Act Policy ® Sexual Harassment Policy ❑ Section 3 Policy ® Section 504/ADA Policy ® Fraud,Waste,and Abuse Policy l:{ Limited English Proficiency Policy(LEP) El Violence Against Women Act(VAWA) Policy • LGBTQ Policy X X * 1.2 PROJECT DETAILS A. Project Description/Project Budget Description Federal Amount Project Component One: Staffing—Salary �,�0 costs $624,000.00 Project Component Two:tresting and ;$420,800.39 Testing Supplied Project Component Three: Technology i$31,625.00 including, but not limited to, laptops, software, subscriptions/member fees, cell phones and services,and/or equipment and supplies; 'COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-01[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents' Q Page 3 �+� 16D6 'Project Component Four: Personal 0,220,000.00 Protective Equipment(PPE)—Purchase, delivery and use of PPE including but not limited to masks,gloves, hand sanitizer and face shields Total Federal Funds: ;;$15-1-70,g00 39$1,296,425.39 1.2 PERIOD OF PERFORMANCE SUBRECIPIENT services shall begin on beginning March 1,2020 for all pre award costs and term of agreement shall begin April 1, 2021 and shall end on March 30, 2023 September 30,2023,unless terminated earlier,in accordance with provisions of Paragraph 3.9 Defaults, Remedies, and Termination. In accordance with 2 CFR 200 Subpart E-Cost Principles and Section 215.97(1)(d) Florida Statutes, the SUBRECIPIENT may expend funds authorized by this Agreement only for allowable costs resulting from obligations incurred during the specific Agreement period. If the SUBRECIPIENT complies with all requirements set forth herein, this Agreement shall terminate (March 30, 2023 September 30, 2023), whereupon all SUBRECIPIENT obligations for repayment of funds shall cease. Notwithstanding the foregoing, the COUNTY expressly reserves and does not waive its rights to recover any damages arising from or relating to the SUBRECIPIENT's breach of any of the Grant Documents,including but not limited to this Agreement and/or any attachments hereto which occurred in whole or in part before said termination. The County Manager or designee may extend the term of this Agreement for a period of up to 180 days after the end of the Agreement. Extensions must be authorized, in writing, by formal letter to the SUBRECIPIENT. 1.3 AGREEMENT AMOUNT The COUNTY agrees to make available HOUSS n ND EIGHT H rn D I~D DO r A n S A r�o CENTS ONE MILLION TWO HUNDRED NINETY SIX THOUSAND FOUR HUNDRED TWENTY FIVE DOLLARS AND 39 CENTS ($1,170,800.39 $1,296,425.39 for use by the SUBRECIPIENT, during the term of the Agreement(hereinafter, referred to as the"Funds"). [Signature Page to Follow] COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-0I[23-S0C-010501 Case Management Healthcare Services for Low to Moderate Income Residents i 0 Page 4 04 16D6 , IN WITNESS WHEREOF, the S1.1t3RICII'IEN'1' and the COUNTY, have each respectively,by authorized person or agent, hereunder set their hands and seals on the date first written above. A , rA'4°, . AS TO COUNTY: ;tt.R t{`!,I A ,° a , , CLERK BOAR!)OF COUNTY COMMISSIONERS OF ..' " " COLLIER COUNTY, I 1 ORIDA --., Attest as to :irrri tt"s;Deputy Clerk By: 6 - skgr t fa-/gin IRICK LOCAS RO,CHAIRPERSON Dated: / L7/?3 Date: U(-1 a S ) Zo Z 3 (SEAL) WITNESSES: AS TO SUBRECIPIEN'I': Witness#1 Signat re COLLIER HEALTH SERVICES.INC.d/b/a `iev5oUiT HEALTHCARE NETWORK )Aa r ( -�.___, -- Wit �I Printed N e By: ICAM RA . UFP, .HIEF CINANCiAL Witness#2y Signature Date: `(Q g 3 Witness'12 Printed Name at I �' [Please provide evidence of signing authority] App ved s to form I ity: 0 iib Derek D.Perry �ti`O Assistant County Attorney U®te: 3 v Z 4 i Z..0 2_3 kvil iRIIKALIIIS iRVKlA,INC.ifl9Ai;u1CARliNt:'1WWiK('t)-CV21{tl i?a-50C411051+l Cyst Mrosasew tlealdiee►c Services Far I na m Modem hoopoe Residnois i O • Nos G!• 1 6D6 i .0 EXHIBIT B COLLIER COUNTY COMMUNITY&HUMAN SERVICES SECTION I: REQUEST FOR PAYMENT SUBRECIPIENT Name: Collier Health Services,Inc. dba Healthcare Network SUBRECIPIENT Address: 1454 Madison Ave, Immokalee,FL 34142 Project Name: COVID Case Management Healthcare Services Project No: CD-CV21-01 Payment Request# Total Payment Minus Retainage Period of Availability:04/01/2021 through 03/30/2023 09/30/2023 Period for which the Agency has incurred the indebtedness through SECTION II: STATUS OF FUNDS Subrecipient CHS Approved 1. Grant Amount Awarded $ $ 2. Total Amount of Previous Requests $ $ 3.Amount of Today's Request(Net of Retainage, $ $ if applicable) 4. Current Grant Balance (Initial Grant Amount $ $ Award request) (includes Retainage) I certify that this request for payment has been made in accordance with the terms and conditions of the Agreement between the COUNTY and us as the SUBRECIPIENT. To the best of my knowledge and belief, all grant requirements have been followed. Signature Date Title Authorizing Grant Coordinator Authorizing Grant Accountant Supervisor(Approval required $15,000 and Division Director(Approval Required above) $15,000 and above) COLLIERHEALTHSERVICES,INC.HEALTHCARENETWORK CD-CV2l-0I[23-SOC-010501 Case Management Healthcare Services for Low to Moderate Income Residents I O 's Paget �+A V i II 1 1 6D 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: :Collier Health Services,Inc.dba Date: I 1 Healthcare Network f Project Title: ;COVID Case Management Healthcare IDIS#: :637 1 Services Program Contact: Telephone Number: Activity Reporting Period Report Due Date October Is'—December 31" January 10 January I5t—March 31 a April 10'h April 1•'—June 30th July 10'h July ls'—September 30'h October 101h REPORT FOR QUARTER ENDING:(check one that applies to the corresponding grant period): 1 2/3 1/;XXI 3/31/,xX 6/30/1XX1 9/30)XXI Please note: The HUD Program year begins;October I,2020�1-1September 30 20231.Each quarterly report must include cumulative data beginning from the start of the program year,October 1,2020,. 1. Please list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement and indicate your progress in meeting those goals since,October 1,2020. a, Outcome Goals:list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement Outcome I: At least 75%of staff time will be providing case management services. Outcome 2: At least 400 500 unduplicated lAtIG persons will be served.Must document that at least 51%of ersons served are low-to moderate income persons or households. Outcome 3: Delivery of a minimum of 6 outreach events. 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. Outcome 2: At least-1;000 500 LMC persons will be served. Outcome 3: Documentation 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 1,2020;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? i0l c. ...now receive a service or benefit that is no loner substandard? Total 0� 4. What funding sources did the SUBRECIPIENT apply for this period? Section 108 Loan Guarantee $ CDBG-CV Other Consolidated Plan Funds ! HOME $� Other Federal Funds $ ESG $ $� HOPWA $� $ Total Entitlement $; ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD•CV21-0I[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents J Page 7 CA0 16D6 I Funds I 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) :0: Total No.persons served under 18 1,0: (LMC) Quarter Total No.of Persons :0; Quarter Total No.of Persons :0: b. Total No,of Households served :0: Total No.of female head of household I0` (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) :Qi Total No.Persons served under 18 p: (LMC) YTD Total: I'd i YTD Total l b. Total No.Households served(LMH) i0i Total No,female head of household(LMH) I0 YTD Total ,0, . YTD Total ,Q 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 Lndicate 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 14vho fall into each category(the iota!should equal the total in question#6a presumed benefit category(the total should equal the or 6b): total in question#6a or 619: a Presumed Benefit Activities Only(LMC)QTR b Presumed Benefit Activities Only(LMC)YTD '0' Abused Children ELI r0' Abused Children ELI 04 Homeless ELI 101 Homeless Person ELI Person :0: Migrant Farm LI :0; Migrant Farm Workers LI Workers :0: Battered LI :0; Battered Spouses LI Spouses :0: Persons LI ;0; Persons w/HIV/AIDS LI w/HIV/AIDS :0: Elderly Persons LI or MOD :0: Elderly Persons LI or MOD 10� Illiterate Adults LI Id Illiterate Adults LI ,0, Severely LI 0, Severely Disabled Adults LI Disabled Adults :0: Quarter Total :0: 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 ll,(YTD)who fall into ',COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-01[23-SOC-0 1050] Case Management Healthcare Services for Low to Moderate Income Residents I Page 8 C+t)'0 16D (the total should equal the total in question#6): each income category(the total should equal the total in question 46): a ELI Extremely Low Income(0-30%) 0; b ELI Extremely Low ;0 Income(0-30%) LI Low Income(31-50%) ;0; LI Low Income ;0 MOD Moderate Income(51-80%) MOD Moderate Income ;0 (51-80%) NON-L/M Above Moderate Lrcome(>80%) 1,0; NON-L/M Above Moderate 1,0 income(>80%) Quarter Total 0; YTI)Total ;t 9, Is this project in a Low/Mod Area(LMA)? YES NO Was project completed this quarter? YES I NO I Ifyes,complete all of this section 9. Date project completed Block Group Census Tract Total Beneficiaries L°w °d Low/Mod Percentage Beneficiaries 0 ,0 ;0 1,0 ;0 Date LMA Narrative approved by CHS? What documentation supports project completion? (i.e., I Certificate of Completion or Certificate of Occupancy, 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!(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 co/watt should equal the total in should equal the total in question 6.) question 6.) a. RACE ETHNICITY h. RACE ETHNICITY /HISPANIC /HISPANIC White n t White 0 0 Black/African American i0 ' Black/African American Oi i0 Asian ri I Asian ;0 i0 American Indian/Alaska ;0 0 American Indian/Alaska Native Q Native _ :0'0' ' Native Hawaiian/Other Padle ',01, '0' Native Hawaiian/Other Pacific Islander I ' Islander Black/African American&White fl 0' Black/African American& :0,1 '0; White American Indian/Alaska Native& ,Q I0: American Indian/Alaska ;0, :0', Native&Black/African Black/African American American Other Multi-racial 0 '0' Other Multi-racial 101 ]01 �A �A A A Name: Signature: Title: I Your typed name here represents your electronic signature ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CI)-CV2 1-01 123-SOC-010501 Case Management Healthcare Services for Low to Moderate Income Residents I 0 Page 9 r+t's. 3 16D6 FAIN# ]B-20-UW-12-0016, Federal Award Date :09/22/2020 Federal Award Agency IHUD CFDA Name iCommunity Development Block Grant-CV CFDA/CSFA# 14.218 Total Amount of 1$1,170,800.39 Federal Funds Awarded $1,296,425.39 Subrecipient Name iCollier Health Services,Inc. dba Healthcare Network UEI# ;GPXBQKU6AJA5 FEIN 59-1741277 R&D NA Indirect Cost Rate NA Period of Performance iO4/01/2021-03/30/2023 09/30/2023 Fiscal Year End '03/31 Monitor End: 05/31/2023 12/30/2023 (THIRD AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND !COLLIER HEALTH SERVICES,INC. d/b/a HEALTHCARE NETWORK CDBG-CV Healthcare Services I This AMENDMENT is made and entered into as of thisZ5I day of I L 12023 by and between Collier County,a political subdivision of the State of Florida("COUNTTY") and !d/b/a Healthcare Network;("SUBRECIPIENT"), a Florida Not for Profit Corporation,having its principal office atI1454 Madison Ave,lmmokalee,FL 34142!. RECITALS WHEREAS, Ithe 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 seq. and subject to 24 CFR Part 570; WHEREAS, on April 27, 20211, Agenda Item 16.D.3, the COUNTY entered into an Agreement with Collier Health Services, Inc. d/b/a Healthcare Networl to administer the Community Development Block Grant (CDBG-CV) Case Management Healthcare Services Program, WHEREAS, on March 8, 2022, Agenda Item 16,D.11, the COUNTY entered into the First Amendment with Collier Health Services,Inc. dba Healthcare Network to further undertake ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV2I-01[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents I �� Page 1 r+ � D 6 the responsibilities of the Case Management Healthcare Services program by adding a technology component,reallocating the budget and revising payment deliverables. WHEREAS,on September 27,2022,Agenda Item 16.D.1,the COUNTY entered into the Second Amendment with Collier Health Services, Inc. d/b/a Healthcare Network to add a fourth project component for personal protective equipment and update the Exhibit C Quarterly Report requirements. WHEREAS,on February 16,2023, the County Manager signed the request for extension of the term of the agreement to July 30, 2023. WHEREAS, on May 23, 2023, Agenda Item 11.A., the COUNTY approved the use of Community Development Block Grant-CV to support the continuation of the Collier Health Services, Inc. Community Health Workers to address health disparities within the community. WHEREAS,the parties wish to amend the Agreement by reallocating funds from current grant funded resources to support the staffing costs of the Community Health Workers to address mental health and substance abuse in low to moderate areas of the community which they are already serving."; and 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,S ick-Through are deleted;Words Underlined are added. X X PART 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 for medical and mental health/substance abuse services to serve the needs of our most vulnerable patients who have been diagnosed or are at risk for contracting COVID 19 communicable diseases during or after the pandemic in an effort to minimize disease severity and acute and/or chronic complications! 'Project Component One: Staffing—Salary costs ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CDCV21-01[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents Page 2 cps Project Component Two:Testing and Testing Supplied !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 sanitize!'and face shields. I 1.1 GRANT AND SPECIAL CONDITIONS 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 ® Procurement Policy Uniform Relocation Act Policy ® Sexual Harassment Policy ® 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 $198,375.00 costs $624,000.00 Project Component Two: Testing and ;$420,80039 Testing Supplied Project Component Three: lifechnology ;$31,625.00 including, but not limited to, laptops, software, subscriptions/member fees, cell phones and services,and/or equipment and supplied COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-01 [23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents I O Page 3 v I 16D6 { 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: $l,l70,800 $1,296,425.39 1.2 PERIOD OF PERFORMANCE SUBRECIPIENT services shall begin on beginning March 1,2020 for all pre award costs and term of agreement shall begin April 1, 2021 and shall end on March 30, 2023 September 30,2023,unless terminated earlier,in accordance with provisions of Paragraph 3.9 Defaults, Remedies, and Termination. In accordance with 2 CFR 200 Subpart E-Cost Principles and Section 215.97(1)(d) Florida Statutes, the SUBRECIPIENT may expend funds authorized by this Agreement only for allowable costs resulting from obligations incurred during the specific Agreement period. If the SUBRECIPIENT complies with all requirements set forth herein, this Agreement shall terminate (March 30, 2023 September 30, 2023), whereupon all SUBRECIPIENT obligations for repayment of funds shall cease. Notwithstanding the foregoing, the COUNTY expressly reserves and does not waive its rights to recover any damages arising from or relating to the SUBRECIPIENT's breach of any of the Grant Documents,including but not limited to this Agreement and/or any attachments hereto which occurred in whole or in part before said termination. The County Manager or designee may extend the term of this Agreement for a period of up to 180 days after the end of the Agreement. Extensions must be authorized, in writing, by formal letter to the SUBRECIPIENT. 1.3 AGREEMENT AMOUNT The COUNTY agrees to make available THOUSAND EIGHT HUNDRED DOLLARS AND 39 CENTS ONE MILLION TWO HUNDRED NINETY SIX THOUSAND FOUR HUNDRED TWENTY FIVE DOLLARS AND 39 CENTS ($1,170,800.39 $1,296,425.39 for use by the SUBRECIPIENT, during the term of the Agreement(hereinafter, referred to as the"Funds"). [Signature Page to Follow] ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CO-CV2I-01 123-SOC-01050] Case Management Healthcare Services Jor Low to Moderate Income Residents I O Page 4 ,s 1 6 D 6 " IN WITNESS WHEREOF, the SU13RFCII'IEN"1' 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: CRYSTAL K. K • Il.,CLERK BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA if �,. Attest as-t 's. �x jlepu y Clerk ay: Stgr .rf,�,.p . .. CRICK I.UCASTRO,CHAIRPF.RSO4, Dated. Y • •> I)ulc: 3-UL1 is 1 2-62 S '6`rl i, ; AL) WITNESSES: / — AS'1'O SUI3RECIPIEN'I': 1/�! 1 COLLIER HEALTH SERVICES,INC,dibla Witness#1 Signat`re HEALTHCARE NETWORK nal )otr( �ot,vi5©t)� �- -- Witn # PPrinted N e By: OM RA. OFF,1 EF FINANCIAL ei u, ii �� OFFICE[! Witness#2 Signature _ /� G{l;y�, �Q� roar I Date: iY c"77a.0 3 Witness#2 Printed Name "Please provide evidence of signing authority] A pro ed as o form legality: R\--1 Derek D.Perry �,Lro . Assistant County Attorney `° Date: Sv.-1 2 4 1 7,0 2_3 1C01.1.1[:RIlEALIIISKRYICC•S.INC.111 All li:AitrNUMMI; CD-Cv214112J•MIC-01151bI Can Maagetnant Healthcare San-ice:far Low to Madame Wont 1 1 C,�43 16D � EXHIBIT B COLLIER COUNTY COMMUNITY &HUMAN SERVICES SECTION I: REQUEST FOR PAYMENT SUBRECIPIENT Name: Collier Health Services,Inc. dba Healthcare Network SUBRECIPIENT Address: 1454 Madison Ave, Iminokalee,FL 34142 Project Name: COVED Case Management Healthcare Services Project No: CD-CV21-01 Payment Request# Total Payment Minus Retainage Period of Availability: 04/01/2021 through 03/30/2023 09/30/2023 Period for which the Agency has incurred the indebtedness through SECTION II: STATUS OF FUNDS Subrecipient CHS Approved 1. Grant Amount Awarded $ $ 2. Total Amount of Previous Requests $ $ 3.Amount of Today's Request(Net of Retainage, $ $ if applicable) 4. Current Grant Balance (Initial Grant Amount $ $ Award request) (includes Retainage) I certify that this request for payment has been made in accordance with the terms and conditions of the Agreement between the COUNTY and us as the SUBRECIPIENT. To the best of my knowledge and belief,all grant requirements have been followed. Signature Date Title Authorizing Grant Coordinator Authorizing Grant Accountant Supervisor(Approval required $15,000 and Division Director(Approval Required above) $15,000 and above) COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV2I-01[23-SOC-010501 Case Management Healthcare Services for Low to Moderate Income Residents I O Page 6 �l I 1 6D 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: :Collier Health Services,Inc.dba Date: Healthcare Network Project Title: ;COVID Case Management Healthcare IDIS#: 1,637 Services Program Contact: Telephone Number: Activity Reporting Period Report Due Date October 1"—December 31" January 10th January 15'—March 313E April 10th April 151—June 30'h July 10'h July I"—September 30'11 October 10'h REPORT FOR QUARTER ENDING:(check one that applies to the corresponding grant period): 12/31/1XX4 3/3 l/1XX1 6/304XX1 9/304X) Please note: The HUD Program year begins;October I,2020I--1September 30?2024 Each quarterly report must include cumulative data beginning from the start of the program year October 1,2020,. 1. Please list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement and indicate your progress in meeting those goals since October 1,2020. 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 43000 500 unduplicated ING persons will be served.Must document that at least 51%of ersons served are low-to moderate income persons or households. Outcome 3: Delivery of a minimum of 6 outreach events. 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. Outcome 2: At least-1,980 500 CIE persons will be served. Outcome 3: Documentation 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 1,2020;;of the persons assisted,how many... Answer ONLY for Public Facilities&Infrastructure Activities a03 Matrix Codes a. ...now have new access(continuing)to this service or benefit? 01 b. ...now have improved access to this service or benefit? 01 c. ...now receive a service or benefit that is no Ion er substandard? 0 Total ,0, 4. What funding sources did the SUBRECIPIENT apply for this period? Section 108 Loan Guarantee $f 1 CDBG-CV $f Other Consolidated Plan Funds $s I HOME $I Other Federal Funds $i ESG St' HOPWA $i Total Entitlement $ ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD•CV21-01[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents I 0 i Page 7 1 I I Funds I 5, What is the total number of UNDUPLICATED Persons(LMC)or Households(LMH)served this QUARTER, if applicable? Answer question 5a or Sb;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) ;0; Total No.persons served under 18 ;0; (LMC) Quarter Total No.of Persons ;0; Quarter Total No.of Persons ;0 b. Total No,of Households served ;0; Total No.of female head of household 10 (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) 1VI Total No.Persons served under 18 !l a (LMC) YTD Total: 10 YTD Total "�p' b. Total No.Households served(LMH) 101 Total No.female head of household(LMH) Hu YTD Total ,0, YTD Total ;0, 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 I Soho fall into each category(the total should equal the total in question 116a 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 ;Of Abused Children ELI ,0, Homeless ELI , , Homeless Person ELI Person 1.0: Migrant Farm LI ;0; Migrant Farm Workers LI Workers 0; Battered LI :0', Battered Spouses LI Spouses 0; Persons LI ;0; Persons w/HIV/AIDS LI w/HIV/AIDS 0; Elderly Persons LI or MOD :0: Elderly Persons LI or MOD '0' Illiterate Adults LI 101 Illiterate Adults LI i0� Severely LI �0; Severely Disabled Adults LI Disabled Adults 0; Quarter Total 10; 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 II,(YTD)who fall into COLLIERHEAL'fHSERVICES,INC.HEALTHCARENETWORI: CD-CV2I-0I[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents 1 O Page 8 Gps 1 6 D 6 (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%) 0; b ELI Extremely Low ;0 Income(0-30%) LI Low Income(31-50%) )3: LI Low Income ;0 MOD Moderate Income(51-80%) V MOD Moderate Income ;0 (51-80%) NON-L/M Above Moderate Income(>80%) :0: NON-L/M Above Moderate ;0 Income(>80%) Quarter Total 10; YTD Total ;0 9, Is this project in a Low/Mod Area(LMA)? YES NO I Was project completed this quarter? YES I NO I Ifyes,complete all of this section 9, Date project completed I Low/Mod Block Group Census Tract Total Beneficiaries Beneficiaries Low/Mod Percentage ICI to to 'IP 1 Date LMA Narrative approved by CHS? What documentation supports project completion? (i.e., I Certificate of Completion or Certificate of Occupancy, 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 !(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 White 0 0 Black/African American it3� i Black/African American ;01 101 Asian 101 i Asian ;01 i0 0 American Indian/Alaska ,0 0 American Indian/Alaska Native Native 0' 1,0 Native Hawaiian/Other Pacific ',0', ;0 Native Hawaiian/Other Pacific Islander Islander Black/African American&White '0 �X Black/African American& ;0, :0; White ;0 American Indian/Alaska Native& 'O I0� American Indian/Alaska ;0, Native&Black/African Black/African American American Other Multi-racial 0' '0' Other Multi-racial 101 id !o ilai R ,a, Name: I I Signature: Title: I 1 Your typed name here represents your electronic signature ;COLLIER HEALTH SERVICES,INC,HEALTHCARE NETWORK CD-CV21-0I[23-SOC-01050j Case Management Healthcare Services for Low to Moderate Income Residents I 0 Page 9 C,' 16D6 FAIN# IB-20-UW-12-0016 Federal Award Date 1/09/22/2020; Federal Award Agency -IUD; CFDA Name iCommunity Development Block Grant-CV CFDA/CSFA# 14.218 Total Amount of ;$1,170,800.39 Federal Funds Awarded $1,296,425.39 Subrecipient Name ',Collier Health Services,Inc. dba Healthcare Network UEI# JGPXBQKU6AJA5 FEIN 59-1741277 R&D NA Indirect Cost Rate NA Period of Performance iO4/01/2021-03/30/2023 09/30/2023 Fiscal Year End '03/31 Monitor End: 'p5/31/2023 12/30/2023 I'HIRD AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY AND /COLLIER HEALTH SERVICES,INC. d/b/a HEALTHCARE NETWORK CDBG-CV Healthcare Services This AMENDMENT is made and entered into as of this R51 day of I Uv Ll 12023 by and between Collier County, a political subdivision of the State of Florida("COUNTY")and 1d/b/a Healthcare Network;("SUBRECIPIENT"), a Florida Not for Profit Corporation,having its principal office atf1454 Madison Ave,Immokalee,FL 34142!. 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 seq. and subject to 24 CFR Part 570; WHEREAS, on 'April 27, 20211, Agenda Item 16.D.3, the COUNTY entered into an Agreement with Collier Health Services, Inc. d/b/a Healthcare Networld to administer the community Development Block Grant (CDBG-CV) Case Management Healthcare Services Program, WHEREAS, on March 8, 2022, Agenda Item 16.D.11, the COUNTY entered into the First Amendment with Collier Health Services,Inc.dba Healthcare Network to further undertake ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV2I-8I[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents �� Page 1 16D6 the responsibilities of the Case Management Healthcare Services program by adding a technology component,reallocating the budget and revising payment deliverables. WHEREAS,on September 27,2022,Agenda Item 16.D.1,the COUNTY entered into the Second Amendment with Collier Health Services, Inc. d/b/a Healthcare Network to add a fourth project component for personal protective equipment and update the Exhibit C Quarterly Report requirements. WHEREAS,on February 16,2023,the County Manager signed the request for extension of the term of the agreement to July 30, 2023. WHEREAS, on May 23, 2023, Agenda Item 11.A., the COUNTY approved the use of Community Development Block Grant-CV to support the continuation of the Collier health Services, Inc. Community Health Workers to address health disparities within the community. WHEREAS,the parties wish to amend the Agreement by reallocating funds from current grant funded resources to support the staffing costs of the Community Health Workers to address mental health and substance abuse in low to moderate areas of the community which they are already serving 1; and 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 Struckhe ough are deleted;Words Underlined are added. 'if X X jj PART 1 i 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 Service Description of Project/Outcome: "Collier Health Services, Inc. will provide a case management/care navigation program for medical and mental health/substance abuse services to serve the needs of our most vulnerable patients who have been diagnosed or are at risk for contracting COVID 19 communicable diseases during or after the pandemic in an effort to minimize disease severity and acute and/or chronic complications! "Project Component One: Staffing—Salary costs COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-01[23-SOO-010501 Case Management Healthcare Services for Low to Moderate Income Residents Page 2 rs. 1 RD6 Project Component Two:Testing and Testing Supplied 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 sanitizes and face shields. I ie k 4r 1.1 GRANT AND SPECIAL CONDITIONS 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 ® Procurement Policy Uniform Relocation Act Policy ® Sexual Harassment Policy n Section 3 Policy ® Section 504/ADA Policy ® Fraud,Waste,and Abuse Policy ® Limited English Proficiency Policy(LEP) ri Violence Against Women Act(VAWA) Policy • LGBTQ Policy X X * I 1.2 PROJECT DETAILS A. Project Description/Project Budget Description Federal Amount Project Component One: Staffing—Salary P198,375.00 costs' $624,000.00 Project Component Two:lT'esting and '$420,800.39 Testing Supplied Project Component Three: [Technology 1$31,625.00 including, but not limited to, laptops, software, subscriptions/member fees, cell phones and services,and/or equipment and supplied ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV2I-01 [23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents i O Page 3 1 6D (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: 470,800:39$1,296,425.39 x x i 1.2 PERIOD OF PERFORMANCE SUBRECIPIENT services shall begin on beginning March 1,2020 for all pre award costs and term of agreement shall begin April 1, 2021 and shall end on March 30, 2023 September 30,2023,unless terminated earlier,in accordance with provisions of Paragraph 3.9 Defaults, Remedies, and Termination. In accordance with 2 CFR 200 Subpart E-Cost Principles and Section 215.97(1)(d) Florida Statutes, the SUBRECIPIENT may expend funds authorized by this Agreement only for allowable costs resulting from obligations incurred during the specific Agreement period. If the SUBRECIPIENT complies with all requirements set forth herein, this Agreement shall terminate (March 30, 2023 September 30, 2023), whereupon all SUBRECIPIENT obligations for repayment of funds shall cease. Notwithstanding the foregoing, the COUNTY expressly reserves and does not waive its rights to recover any damages arising from or relating to the SUBRECIPIENT's breach of any of the Grant Documents,including but not limited to this Agreement and/or any attachments hereto which occurred in whole or in part before said termination. The County Manager or designee may extend the term of this Agreement for a period of up to 180 days after the end of the Agreement. Extensions must be authorized, in writing, by formal letter to the SUBRECIPIENT, 1.3 AGREEMENT AMOUNT The COUNTY agrees to make available THOUS A T.TTl L IGHT H T?�D ED DO T A n C AND O C ATTS ONE MILLION TWO HUNDRED NINETY SIX THOUSAND FOUR HUNDRED TWENTY FIVE DOLLARS AND 39 CENTS ($1,170,800.39 $1,296,425.39 for use by the SUBRECIPIENT, during the term of the Agreement(hereinafter,referred to as the"Funds"). [Signature Page to Follow] COLLIER.HEALTH SERVICES,INC.HEALTHCARE NETWORK. CD-CV2l-01(23-SOC-010501 Case Management Healthcare Services for Low to Moderate Income Residents I O Page 4 +. 16D6 IN WITNESS WHEREOF, the SUHRE CLI'EEN'F 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: CRYS, ,5'►,l.;• : a CLERK BOARS)OF COUNTY COMMISSIONERS OF .} � ' . J� COLLIER COUNTY, FLORIDA i *" s Attest as r s, eputy Clerk • By: "signa' .re.bn y : , !RICK I OC:ASTRO,CHAIRPFRSOW Mit :; • - ` 3 •�:8�t;����`�" Date: 3 U L1 2 55 ) Z Q 2 3 (SEAL) WITNESSES: //��f/, J --- AS TO SLIBRECIPIENT: � Witness#t Signat.re COWER H(:ALTI•I SERVICES,INC.d/b/a HEALTHCARE NETWORK Ptot r( vvisou1 - Iiii—�''; Wit !11 Printed N e BY: d. tirtad,_: att-......-P4P,A CAMt RA . OFI', .HEt;I FINANCIAL UFF}CEI� fitness#2 Signature _ $,, �r : �C {' rc'k- � Date: � d— nness#2 Printed Namec [Please provide evidence of signing authority) A ed as o form a legality: ti0 De k D.Perry �\�60 Assistant County Attorney Date: J1(LJ1 ktix.lal:R IIEA1.11t51iRYICtES,INC_IniAM;l IICARIi Nl:IWORk 11I47VII41t 123-511C-010 591 Oar Meragc fie t tlealthere Services far Low to Moderate income Resigeks 1 G�0 1 6D EXHIBIT B COLLIER COUNTY COMMUNITY &HUMAN SERVICES SECTION I: REQUEST FOR PAYMENT SUBRECIPIENT Name: Collier Health Services,Inc. dba Healthcare Network SUBRECIPIENT Address: 1454 Madison Ave, Immokalee,FL 34142 Project Name: COVID Case Management Healthcare Services III Project No: CD-CV21-01 Payment Request# Total Payment Minus Retainage Period of Availability: 04/01/2021 through 03/30/2023 09/30/2023 Period for which the Agency has incurred the indebtedness through SECTION II: STATUS OF FUNDS Subrecipient CHS Approved 1. Grant Amount Awarded $ $ 2. Total Amount of Previous Requests $ $ 3.Amount of Today's Request(Net of Retainage, $ $ if applicable) 4. Current Grant Balance (Initial Grant Amount $ $ Award request) (includes Retainage) I certify that this request for payment has been made in accordance with the terms and conditions of the Agreement between the COUNTY and us as the SUBRECIPIENT. To the best of my knowledge and belief, all grant requirements have been followed, Signature Date Title Authorizing Grant Coordinator Authorizing Grant Accountant Supervisor(Approval required $15,000 and Division Director(Approval Required above) $15,000 and above) COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV2I-01[23-SOC-01050J Case Management Healthcare Services for Low to Moderate Income Residents I O Page 6 �+V�y 16D6 { 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: ;Collier Health Services,Inc.dba Date: 1 1 Healthcare Network 1 Project Title: ;COVID Case Management Healthcare IDIS it: 1,637 I Services 1 Program Contact: Telephone Number: Activity Reporting Period Report Due Date October l s'—December 3 I' January 10'h January 1s1—March 315t April 10th April 1"—June 30'h July loth July Is'—September 30th October 10'h REPORT FOR QUARTER ENDING:(check one that applies to the corresponding grant period): 12/314IXX! 3/314XX1 6/30,X) 9/30)X) Please note: The HUD Program year begins;October 1,202011-1September 30?20231.Each quarterly report must include cumulative data beginning front the start of the program year,October 1,202Q. 1. Please list the outcome goal(s)from your approved application and SUBRECIPIENT Agreement and indicate your progress in meeting those goals since;October 1,2020. 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 400 500 unduplicated I.MG persons will be served.Must document that at least 51%of ersons served are low-to moderate income pessons or households. Outcome 3: Delivery of a minimum of 6 outreach events. 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 Nvi II be hired specifically to focus on case management services and continuity of care.I Outcome 2: At least-4000 500 LMC persons will be served. Outcome 3: Documentation 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 111 If No,Explain: 3. Since;October 1,2020;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? b. ..now have improved access to this service or benefit? � c. ...now receive a service or benefit that is no longer substandard? Total 0� 4. What funding sources did the SUBRECIPIENT apply for this period? Section 108 Loan Guarantee $ 1 CDBG-CV $' ? Other Consolidated Plan Funds $ HOME $� Other Federal Funds $ ! ESG $f $: HOPWA $ Total Entitlement $: ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV2l-0I [23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents O Page 7 r+Qs V i 16D6 I Funds I I 5. What is the total number of UNDUPLICATED Persons(LMC)or Households(LMH)served this QUARTER, if applicable? Answer question 5a or Sb;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) ;0: Total No.persons served under 18 1,0 (LMC) Quarter Total No.of Persons ;0; Quarter Total No.of Persons 0 b. Total No,of Households served ;0; Total No.of female head of household 1Q (LMH) 6. What is the total number of UNDUPLICATED clients served since iOctober 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 ;0; j (LMC) YTD Total: '0{ YTD Total '0' b. Total No.Households served(LMI-I) IdTotal No.female head of household(LMH) CIO YTD Total AYTD Total ;U 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 i►vho 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 6h): a Presumed Benefit Activities Only(LMC)QTR b Presumed Benefit Activities Only(LMC)YTD �04 Abused Children ELI i�i' Abused Children ELI ,0, Homeless ELI 0 Homeless Person ELI Person 0; Migrant Farm LI ',0; Migrant Farm Workers LI Workers 0; Battered LI 1,0; Battered Spouses LI Spouses 0; Persons LI ;a Persons w/HIV/AIDS LI w/HIV/AIDS p; Elderly Persons LI or MOD 1,0; Elderly Persons LI or MOD 101 Illiterate Adults LI '0' Illiterate Adults LI In p Severely LI �0; Severely Disabled Adults LI Disabled Adults 0; Quarter Total ;0; 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 II,(YTD)who fall into ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-01[23-SOC-01050] Case Management Healthcare Services for Low to Moderate Income Residents Page 8 r+p0 V 1 6D6j (the total should equal the total in question 46): each income category(the total should equal the total in question 46): a ELI Extremely Low Income(0-30%) U; b ELI Extremely Low ;0 Income(0-30%) LI Low Income(31-50%) ;0, LI Low Income 1,0 MOD Moderate Income(51-80%) ;0 MOD Moderate Income ;0 (51-80%) NON-L/M Above Moderate Income(>80%) ;0, NON-L/M Above Moderate ;0, Income(>80%) Quarter Total ;0; YTI)Total ;1# 9, Is this project in a Low/Mod Area(LMA)? YES NO Was project completed this quarter? YES I NO I If yes,complete oil of this section 9. Date project completed Block Group Census Tract Total Beneficiaries Low/Mod Low/Mod Percentage Beneficiaries 0 ;0 1,0 1,0 ;0 Date LMA Narrative approved by CHS? What documentation supports project completion? (i.e., 1 Certificate of Completion or Certificate of Occupancy, 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 t I(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 w n I'd White ;0I 0 Black/African American 0 C Black/African American PI idl Asian i i �0 Asian 01 101 American Indian/Alaska Native 'A IA American Indian/Alaska p ,A Native '0 10 Native Hawaiian/Other Pacific ;0; ;0, Native Hawaiian/Other Pacific Islander Islander 'p' '0 Black/African American& ,0, ;0, Black/African American&White White American Indian/Alaska Native& '0' I0� American Indian/Alaska 0, M Native&Black/African Black/African American American Other Multi-racial 10� i0� Other Multi-racial Id 101 Name: I 1 Signature: Title: I Your typed name here represents your electronic signature ;COLLIER HEALTH SERVICES,INC.HEALTHCARE NETWORK CD-CV21-01[23-SOC-01050I Case Management Healthcare Services for Low to Moderate Income Residents0 Page 9 c 1