Agenda 06/11/2024 Item #16D 4 (After-the-fact Contract Amendments Five and Six between the Area Agency on Aging for Southwest Florida, Inc and Collier County Services for Seniors Emergency Home Energy Assistance Program)06/11/2024
EXECUTIVE SUMMARY
Recommendation to approve after-the-fact contract Amendments Five and Six between the Area Agency on
Aging for Southwest Florida Inc., and Collier County Services for Seniors Emergency Home Energy
Assistance Program FY23 funds to replace Attachment IX-Budget Summary and recognize additional
funding in the total amount of $1,662.15; and authorize the necessary Budget Amendment. (Human Services
Grant Fund 1837)
OBJECTIVE: To provide home energy assistance aid to elders in the event of a home energy heating or cooling
emergency; and support the Quality of Place focus area of the Collier County Strategic Plan by supporting access to
health, wellness, and human services.
CONSIDERATIONS: The Community and Human Services (CHS) Division’s Services for Seniors program has
been providing support to Collier County’s frail and elderly citizens for over thirty (30) years through various grant
programs. The grants are funded by the Florida Department of Elder Affairs (DOEA) through the Area Agency on
Aging of Southwest Florida, Inc. (AAASWFL). These grant-funded services enable clients to remain in their homes
and live with independence and dignity.
Collier County, as the Lead Agency, manages the spending authority for the Emergency Home Energy Assistance
Program (EHEAP). As the Lead Agency, there is no provision for the County to not accept these funds as this grant
is part of the acceptance of the Agency’s Older American Act funds.
EHEAP provides crisis assistance to eligible low-income households experiencing a heating or cooling emergency
with at least one household member aged sixty (60) years or older. The program allows for payments to utility
companies and fuel suppliers; the payment of deposits, late fees, disconnect and reconnection fees with Florida
Power and Light (FPL) and Lee County Electric Cooperative (LCEC); as well as the repair or replacement of
existing heating or cooling equipment.
On June 22, 2021 (Agenda Item #16.D.10), the Board of County Commissioners (Board) approved the current
service agreement, EHEAP 203.21, in the amount of $96,708.79.
On July 13, 2021 (Agenda Item #16.D.2), the First Amendment, EHEAP 203.21.01, was approved by the Board to
replace Attachment I, the EHEAP Activity Report, and Attachment XVII, the EHEAP Application and Eligibility
Worksheet.
On April 25, 2023 (Agenda Item #16.D.6), the Board approved the Second Amendment, EHEAP 203.21.02, to
authorize additional FY22 funding in the amount of $100,000.
On July 25, 2023 (Agenda Item #16.D.3), the Board approved the Third Amendment, EHEAP 203.21.03, to reduce
the FY22 budget by $81,823.89, authorize additional funding for FY23 in the amount of $100,000, and revise the
contract expiration date from September 30, 2023 to June 30, 2024 to coincide with the State Fiscal Year. The
Third Amendment became effective July 1, 2023, and is currently set to expire on June 30, 2024.
On August 8, 2023 (Agenda Item #16.D.2), the Board approved the Fourth Amendment, EHEAP 203.21.04, to
replace Attachment XIII-Invoice Report Schedule, Attachment XIV-Income Guidelines, Attachment XV- Payment
Matrix, and XVII- EHEAP Application., effective July 1, 2023.
The proposed Fifth Amendment, EHEAP 203.21.05, will update Attachment IX-Budget Summary and will move
$13,000 from the EHEAP Outreach line item to the EHEAP Crisis Assistance line item in FY23 funding.
The proposed Sixth Amendment EHEAP 203.21.06 will update and replace Attachment IX-Budget Summary and
will add $1,662.15 from Weather Crisis to the EHEAP Crisis Assistance line item in FY23 funding.
16.D.4
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06/11/2024
These Amendments are being presented for Board ratification “After-the-Fact” because Collier County received the
Amendments on May 2, 2024 and May 8, 2024. Pursuant to CMA #5330, Resolution 2018 -202, and attached
County Manager memo, the County Manager authorized the Public Services Department Head to sign the
amendment.
FISCAL IMPACT: A Budget Amendment is needed to recognize additional grant funding in the amount of
$1,662.15 in Human Services Grant Fund (1837), Project 33756. A Budget Amendment to move $13,000 between
budget line items will be done administratively. There is no match required for this grant program.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this item.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for Board
approval. -CJS
RECOMMENDATION: To approve after-the-fact contract Amendments Five and Six between the Area Agency
on Aging for Southwest Florida Inc., and Collier County Services for Seniors Emergency Home Energy Assistance
Program FY23 funds to replace Attachment IX-Budget Summary and recognize additional funding in the total
amount of $1,662.15; and authorize the necessary Budget Amendment.
Prepared By: Joshua Thomas, Grants Coordinator I, Community & Human Services Division
ATTACHMENT(S)
1. {linked} EHEAP 203.21 -Exec (PDF)
2. EHEAP 203.21.001 exec (PDF)
3. EHEAP 203.21.02 exec (PDF)
4. EHEAP 203.21.03 exec (PDF)
5. EHEAP 203.21.04 - exec (PDF)
6. Resolution 2018-202 (PDF)
7. County Manager Designation Aging Grants Cluster (PDF)
8. EHEAP 203.21.05 and 203.21.06 (PDF)
16.D.4
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06/11/2024
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.4
Doc ID: 28847
Item Summary: Recommendation to approve after-the-fact contract Amendments Five and Six between the Area
Agency on Aging for Southwest Florida Inc., and Collier County Services for Seniors Emergency Home Energy
Assistance Program FY23 funds to replace Attachment IX-Budget Summary and recognize additional funding in
the total amount of $1,662.15; and authorize the necessary Budget Amendment. (Human Services Grant Fund
1837)
Meeting Date: 06/11/2024
Prepared by:
Title: Operations Analyst – Community & Human Services
Name: Joshua Thomas
05/16/2024 4:55 PM
Submitted by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
05/16/2024 4:55 PM
Approved By:
Review:
Community & Human Services Tami Bailey PSD Reviewer Completed 05/16/2024 5:00 PM
Community & Human Services Donald Luciano PSD Reviewer Completed 05/17/2024 9:51 AM
Community & Human Services Kristi Sonntag CHS Review Completed 05/17/2024 4:57 PM
Operations & Veteran Services Jeff Weir OVS Director Review Completed 05/20/2024 10:35 AM
Community & Human Services Darrick Gartley PSD Reviewer Completed 05/21/2024 3:46 PM
Public Services Department Todd Henry Level 1 Department Review Completed 05/22/2024 2:21 PM
County Attorney's Office Carly Sanseverino Level 2 Attorney Review Completed 05/22/2024 4:12 PM
Public Services Department Geoffrey Willig PSD Department Head Review Skipped 05/30/2024 10:42 AM
Grants Erica Robinson Level 2 Grants Review Completed 05/30/2024 2:58 PM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 05/30/2024 3:09 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 05/31/2024 8:04 AM
Grants Therese Stanley OMB Reviewer Completed 06/01/2024 4:16 PM
Corporate Compliance and Continuous Improvement Megan Gaillard Additional Reviewer Completed
06/01/2024 5:56 PM
Office of Management and Budget Blanca Aquino Luque OMB Reviewer Completed 06/03/2024 11:10 AM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 06/03/2024 6:15 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 06/11/2024 9:00 AM
16.D.4
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16.D.4.bPacket Pg. 1524Attachment: EHEAP 203.21.001 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.bPacket Pg. 1525Attachment: EHEAP 203.21.001 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.bPacket Pg. 1526Attachment: EHEAP 203.21.001 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.bPacket Pg. 1527Attachment: EHEAP 203.21.001 exec (28847 : FY23 EHEAP Amendments 5 and 6)
1
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
WHEREAS, the purpose of this Amendment is to authorize Fiscal Year 2022 funding.
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 amended pages 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 EHEAP 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.
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
SIGNED BY:
NAME: _________________________________
TITLE: _________________________________
CONTRACTOR: &2//,(5 COUNTY
BOARD OF COUNTY COMMISSIONERS
SIGNED BY:
NAME:
TITLE:
DATE: DATE:
(+($3$SULO±6HSWHPEHU
Tanya R. Williams
Public Services Dept. Head
As Designee of the County Manager,
pursuant to Resolution No. 2018-202.
Approved as to Form and Legality:
_________________________________
Derek D. Perry
Assistant County Attorney
Appppppppppppppppppppppppprpppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppooovooooooooooooooooooooooooooooooooooooooooooooooooooooooooed as to Form ananaaaannnnnaanaaaaannnnnnnanaaaaanannnnnnaanaaaaanannnnnaaannnnnaaannnananaaaaaaaaaaanaanaaaannaaaaannnaannnd Legality:
_______________________________________________________________
Derek D. Perry
Assistant County Attorney
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WilliamsTan
ya
Digitally signed by
WilliamsTanya
Date: 2023.03.24
16:38:42 -04'00'
03.24.2023
Maricela Morado
President and CEO
03.29.23
Maricela
Morado
Digitally signed by
Maricela Morado
Date: 2023.03.29
12:00:03 -04'00'
16.D.4.c
Packet Pg. 1528 Attachment: EHEAP 203.21.02 exec (28847 : FY23 EHEAP Amendments 5 and 6)
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency)
and &ROOLHU County Board of County Commissioners (Contractor), collectively referred to as the "Parties." The
term Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS, the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Agency.
NOW THEREFORE, in consideration of the services to be performed; and payments to be made, together with the
mutual covenants and conditions set forth herein, the Parties agree as follows:
Purpose of Contract:
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments, forms and exhibits, which constitute the contract document.
Incorporation of Documents within the Contract:
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department
handbooks, manuals and/or desk books, as an integral part of the contract, except to the extent that the contract
explicitly provides to the contrary. In the event of conflict in language among any of the documents referenced above,
the specific provisions and requirements of the contract document(s) shall prevail over inconsistent provisions in the
proposal(s) or other general materials not specific to this contract document and identified attachments.
Term of Contract:
This contract shall begin at twelve (12:00) AM., Eastern Standard Time April 1, 2021 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 (11:59) P.M., Eastern
Standard Time September 30, 2023.
Contract Amount:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $ subject to the availability of funds. Any costs or services paid for under any other contract
or from any other source are not eligible for payment under this contract.
Renewals:
By mutual agreement of the Parties, in accordance with Section 287.058(l)(g), Florida Statutes (F.S.), the Agency may
renew the contract for a period not to exceed three years, or the term of the original contract, whichever is longer. The
renewal price, or method for determining a renewal price, is set price, is set forth in the bid, proposal, or reply. No
other costs for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original
contract and contingent upon satisfactory performance evaluations by the Agency and the availability of funds.
Compliance with Federal Law:
6.1 If this contract contains federal funds this section shall apply.
6.1.1 The Contractor shall comply with the provisions of 45 Code of Federal Regulations (CFR) 75 and/or 45 CFR
Part 92, 2 CFR Part 200 and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all
applicable standards, orders, or regulations issued under Section 306 of the Clean Air Act as amended (42
United States Code (U.S.C.) 7401, et seq.), Section 508 of the Federal Water Pollution Control Act as
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16.D.4.c
Packet Pg. 1529 Attachment: EHEAP 203.21.02 exec (28847 : FY23 EHEAP Amendments 5 and 6)
':'6/%4&91*3&
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16.D.4.c
Packet Pg. 1530 Attachment: EHEAP 203.21.02 exec (28847 : FY23 EHEAP Amendments 5 and 6)
)<)81'6$&7,9(WKURXJK
BUDGET SUMMARY (2022-2023)
EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM
Award
Total Administrative Budget $
Total Outreach Budget $
Crisis Assistance $
Total $
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16.D.4.c
Packet Pg. 1531 Attachment: EHEAP 203.21.02 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.dPacket Pg. 1532Attachment: EHEAP 203.21.03 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.dPacket Pg. 1533Attachment: EHEAP 203.21.03 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.dPacket Pg. 1534Attachment: EHEAP 203.21.03 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.dPacket Pg. 1535Attachment: EHEAP 203.21.03 exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.dPacket Pg. 1536Attachment: EHEAP 203.21.03 exec (28847 : FY23 EHEAP Amendments 5 and 6)
April 2021 - June 2024
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
WHEREAS, the purpose of this Amendment is to replace Attachments XIII, XIV, XV, and XVII.
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:
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.
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC.
SIGNED BY:
NAME:___________________________________
TITLE:
DATE: __________________________________
CONTRACTOR: COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
SIGNED BY:
NAME:___________________________________
TITLE:
DATE: __________________________________
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
EHEAP 203.21.04
Tanya R. Williams
Public Services Dept. Head
As designee of the County Manager,
pursuant to Resolution No. 2018-202.
Maricela Morado
President and CEO
Approved as to Form and Legality:
_________________________________
Derek D. Perry
Assistant County Attorney
CAO
16.D.4.e
Packet Pg. 1537 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
ATTACHMENT XIII
INVOICE REPORT SCHEDULE
Report Number Based Upon
1 April Advance Request*
2 May Advance Request*
3 April Expenditure Report
4 May Expenditure Report
5 June Expenditure Report
6 July Expenditure Report
7 August Expenditure Report
8 September Expenditure Report
9 October Expenditure Report
10 November Expenditure Report
11 December Expenditure Report
12 January Expenditure Report
13 February Expenditure Report
14 March Expenditure Report
15 April Expenditure Report
16 May Expenditure Report
17 June Expenditure Report
18 July Expenditure Report
19 August Expenditure Report
20 September Expenditure Report
21 October Expenditure Report
22 November Expenditure Report
23 December Expenditure Report
24 January Expenditure Report
25 February Expenditure Report
26 March Expenditure Report
27 April Expenditure Report
28 May Expenditure Report
29 June Expenditure Report
30 July Expenditure Report
31 August Expenditure Report
32
33
34
35
36
37
38
39
40
41
42
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
Final Close Out Report
Date Due
Upon Execution of Contract
Upon Execution of Contract
May 9, 2021
June 9, 2021
July 9, 2021
August 9, 2021
September 9, 2021
October 9, 2021
November 9, 2021
December 9, 2021
January 9, 2022
February 9, 2022
March 9, 2022
April 9, 2022
May 9, 2022
June 9, 2022
July 9, 2022
August 9, 2022
September 9, 2022
October 9, 2022
November 9, 2022
December 9, 2022
January 9, 2023
February 9, 2023
March 9, 2023
April 9, 2023
May 9, 2023
June 9, 2023
July 9, 2023
August 9, 2023
September 9, 2023
October 9, 2023
November 9, 2023
December 9, 2023
January 9, 2024
February 9, 2024
March 9, 2024
April 9, 2024
May 9, 2024
June 9, 2024
July 9, 2024
July 15, 2024
*Advance based on projected cash need.
Note 1
Advance basis invoices, cannot be submitted to the Department of Financial Services (DFS) prior to April 1 or until the contract with the
Department has been executed and uploaded to DFS Florida Accountability Contract Tracking System (FACTS). Actual submission of
all vouchers to DFS is dependent on the accuracy of the Receipts and Expenditure Report.
Note 2
Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance amount, on each of the reports, repaying advances
issued for the first one or two months of the agreement. The adjustment shall be recorded in Part C, 1 of the report (Attachment XII).Note
3
Submission of invoices may or may not generate a payment request. If final invoice reflects funds due back to the Department, payment
is to accompany the final close-out invoice.
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16.D.4.e
Packet Pg. 1538 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
ATTACHMENT XIV
POVERTY INCOME GUIDELINES
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP)
POVERTY INCOME GUIDELINES*
EFFECTIVE JULY 1, 2023
PEOPLE IN THE HOUSEHOLD 60% SMI
1 $27,735
2 $36,269
3 $44,803
4 $53,337
5 $61,870
6 $70,404
7 $72,004
8 $73,605
Please refer to the Federal Poverty Guidelines (FPG) Benefits Matrix for income ranges for
households with 9-or-more individuals.
*These figures are based on the 2022 U.S. Department of Health and Human Services (HHS) poverty
guidelines published in the Federal Register on January 19, 2023.
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16.D.4.e
Packet Pg. 1539 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
ATTACHMENT XV
LIHEAP PAYMENT MATRIX
ATTACHMENT 'A'
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM PAYMENT MATRIX - Updated FY 2023/2024
HOME ENERGY BENEFITS1 AND POVERTY LEVELS Max Income
Value Column† BY HOUSEHOLD INCOME AND SIZE
Number of People
in Household
50% or Less
of Max Income Value
>50%-70%
of Max Income Value
>70%-85%
of Max Income Value
>85%-100%
of Max Income Value
1 $ 13,868 $ 13,869 $ 19,415 $ 19,416 $ 23,575 $ 23,576 $ 27,735 State Median Income (SMI) 2 $ 18,135 $ 18,136 $ 25,388 $ 25,389 $ 30,829 $ 30,830 $ 36,269
3 $ 22,402 $ 22,403 $ 31,362 $ 31,363 $ 38,083 $ 38,084 $ 44,803
4 $ 26,669 $ 26,670 $ 37,336 $ 37,337 $ 45,336 $ 45,337 $ 53,337
5 $ 30,935 $ 30,936 $ 43,309 $ 43,310 $ 52,590 $ 52,591 $ 61,870
6 $ 35,202 $ 35,203 $ 49,283 $ 49,284 $ 59,843 $ 59,844 $ 70,404
7 $ 36,002 $ 36,003 $ 50,403 $ 50,404 $ 61,203 $ 61,204 $ 72,004
8 $ 36,803 $ 36,804 $ 51,524 $ 51,525 $ 62,564 $ 62,565 $ 73,605
Number of People
in Household 75% of FPG or Less At least 75% but no more than
100% FPG
Over 100% but no more than
125% FPG
Over 125% but no more than 150%
FPG
9 $ 41,774 $ 41,775 $ 55,700 $ 55,701 $ 69,625 $ 69,626 $ 83,550 Federal Poverty Guidelines (FPG) 10 $ 45,629 $ 45,630 $ 60,840 $ 60,841 $ 76,050 $ 76,051 $ 91,260
11 $ 49,484 $ 49,485 $ 65,980 $ 65,981 $ 82,475 $ 82,476 $ 98,970
12 $ 53,339 $ 53,340 $ 71,120 $ 71,121 $ 88,900 $ 88,901 $ 106,680
13 $ 57,194 $ 57,195 $ 76,260 $ 76,261 $ 95,325 $ 95,326 $ 114,390
14 $ 61,049 $ 61,050 $ 81,400 $ 81,401 $ 101,750 $ 101,751 $ 122,100
15 $ 64,904 $ 64,905 $ 86,540 $ 86,541 $ 108,175 $ 108,176 $ 129,810
16 $ 68,759 $ 68,760 $ 91,680 $ 91,681 $ 114,600 $ 114,601 $ 137,520
17 $ 72,614 $ 72,615 $ 96,820 $ 96,821 $ 121,025 $ 121,026 $ 145,230
18 $ 76,469 $ 76,470 $ 101,960 $ 101,961 $ 127,450 $ 127,451 $ 152,940
19 $ 80,324 $ 80,325 $ 107,100 $ 107,101 $ 133,875 $ 133,876 $ 160,650
20 $ 84,179 $ 84,180 $ 112,240 $ 112,241 $ 140,300 $ 140,301 $ 168,360
LIHEAP
HOME ENERGY
BENEFIT1
$1,000 (up to $1,350)
(Base $1,000 plus one each of additional
assistance below** )
$750 (up to $1,100)
(Base $750 plus one each of additional assistance
below** )
$550 (up to $900)
(Base $550 plus one each of additional assistance
below** )
$400 (up to $750)
(Base $400 plus one each of additional assistance
below** )
**Additional Assistance if applicant household includes any of the following: 1 These benefit levels are effective July 1, 2023.
(1) Elderly (Senior 60 and over)$100
Figures are based on the FY 2023 U.S. Department of
Health and Human Services (HHS) Guidelines published
in the Federal Register on January 19, 2023.
(2) Disabled $100
(3) Child age 5 or younger: $150
† Maximum Income Values
are the greater of 60% SMI
(family size 1-8) or 150% FPL
(family size 9-20).
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16.D.4.e
Packet Pg. 1540 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
ATTACHMENT XVII
EHEAP APPLICATION AND ELIGIBILITY WORKSHEET
Emergency Home Energy Assistance for the Elderly Program - Application
0BSection One: Applicant (Aged 60 and older) Information
Name: (First, M, Last) ☐EHEAP ☐ Heating Season ☐ Cooling Season
Date of birth: Age: SSN:
Service address: City: Date Stamp
Florida County: Zip Code: Phone: Intake worker’s name:
Gender: ☐ Male ☐ Female Number of people in the household:
Marital Status: ☐ Married ☐ Partnered ☐ Single ☐ Separated ☐ Divorced ☐ Widowed Phone:
Race: ☐ White ☐ Black/African American ☐ Asian ☐ Native Hawaiian/Pacific Islander ☐ American Indian/Alaska Native ☐ Other
Ethnicity: ☐ Hispanic/Latino ☐ Other Primary Language: ☐ English ☐ Spanish ☐ Other
_____________________Does client have limited ability reading, writing, speaking, or understanding the English language? ☐ Yes ☐ No
Is the client a veteran? ☐ Yes ☐ No Was client referred to the local Veteran’s Affairs office? ☐ Yes ☐ No ☐
N/A
Applicant’s income type(s): Applicant’s monthly income amount:
1BSection Two: Additional Household Members Information
Name: Income type(s):
Age: SSN: Monthly income amount:
Name: Income type(s):
Age: SSN: Monthly income amount:
Name: Income type(s):
Age: SSN: Monthly income amount:
Name: Income type(s):
Age: SSN: Monthly income amount:
2BSection Three: Household Characteristics
Is there a child 5 years of age or younger in the household? ☐ Yes ☐ No
If Yes, select all that applies: ☐ 0-2 years old ☐ 3-5 years old
Is there an individual with a disability in the household? ☐ Yes ☐ No
Is the applicant a U.S. citizen or an alien lawfully admitted for permanent residence? ☐ Yes ☐ No
Is the applicant a homeowner? ☐ Yes ☐ No
Does applicant live in government subsidized housing, such as Section 8? ☐ Yes ☐ No
If yes, provide the complex name:
________________________________________________________________________________
If yes, does the household receive an energy subsidy? ☐ Yes ☐ No
Does applicant live in a student dormitory, adult family care home, or any kind of group living facility? ☐ Yes ☐ No
If yes, provide the facility name: ________________________________________________________________________
3BSection Four: Heating and Cooling Information
Have you or any member of your household received energy assistance in the current season? ☐ Yes ☐ No
If yes, provide the name of Agency:
_______________________________________________________________________________
Type of Assistance: ☐ Crisis ☐ Home Energy ☐ Weather-Related Date: ________________________________What is the primary source of home heating? (select one) ☐ Electricity ☐ Natural Gas ☐ Propane ☐ Wood/Coal ☐ Refillable
Fuels
Does household use supplemental heating source? ☐ Electricity ☐ Wood/Coal ☐ N/A
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16.D.4.e
Packet Pg. 1541 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
Air conditioning unit type? ☐ Central A/C ☐ Window/Wall A/C ☐ Fans ☐ Other – specify (including evaporative cooler)
______________________
4BSection Five: Energy Crisis
Explanation
5BClient Attestation and Signature
☐Home cooling or heating energy source has been
disconnected. (Life-Threatening)
The information provided on this application, is to the best of my knowledge,
true and complete. I understand that priority in providing assistance will be
given to those households with the lowest income and greatest need, i.e.
those households in which the elderly, disabled, medically needy, or children
reside. I authorize the agency to make benefit payments directly to my
energy supplier. I am aware that after I have provided all the information
requested to determine my eligibility, if I am applying for crisis assistance, the
agency has 18 hours to act upon my application with an eligible action. I am
also aware that if I am not approved or denied within the time allowed, or not
approved for the correct amount, I have a right to appeal the decision. (If you
sign with an “X” two witnesses are required.)
Client Signature:______________________________________________________
Date:__________________________________________________________
☐Unable to get delivery of fuel, is out of fuel, or is
in danger of being out of fuel for heating. (Life-
Threatening)
☐Other problems with lack of cooling or heating in
the home, such as needing to pay a deposit, repair
of equipment, or interim emergency measure to
avoid further crisis. (Life-Threatening)
☐Notified that the energy source for cooling or
heating is going to be disconnected. (Standard)
☐Received a notice indicating the energy source
bill is delinquent or past due. (Standard)
☐Has an energy source bill for which the due date
has lapsed. (Standard)
ALL CLIENTS SHOULD SIGN THE WAIVER, AUTHORIZING THE RELEASE OF GENERAL AND/OR CONFIDENTIAL INFORMATION FOR LIHEAP/EHEAP FEDERAL REPORTING.
*Your Social Security Number (SSN) is confidential under law. We may not collect your SSN unless we explain the reason for collecting your SSN in
writing and provide the applicable statutory authority for doing so. Certain provisions of Chapter 430, Florida Statutes, read with Section 119.071(5),
Florida Statutes, specifically authorize the Department of Elder Affairs (DOEA) and its designated staff/employees to collect SSNs when authorized by
law or when collection of SSNs is imperative to the performance of DOEA's statutorily assigned duties. The Department is collecting your social
security number as part of its responsibility to provide Emergency Home Energy Assistance.
DOEA Form 114 – 07/01/2023
Emergency Home Energy Assistance for the Elderly Program - Eligibility Worksheet
6BSection Six: Income Eligibility Determination
Annualize all
household income.
Staple calculator tape
here showing income
calculations or write
calculations in this
space.
State Median Income (SMI) Guidelines
effective 07/01/2023.
1.Add all gross
monthly earned
and unearned
income from the
past 30 days of all
household
members.
Select the annual income limit by household size:
100% of Max Income Value (MIV) 50% of MIV
☐1..........$27,735 $ 13,868
☐2..........$36,269 $ 18,135
☐3..........$44,803 $ 22,402
☐4..........$53,337 $ 26,669
☐5..........$61,870 $ 30,935
☐6..........$70,404 $ 35,202
☐7..........$72,004 $ 36,002
☐8..........$73,605 $ 36,803
(Please refer to the Federal Poverty Guidelines (FPG) Benefits Matrix for income
ranges for households with 9-or-more individuals.)
2.Add Medicare
Premium
($148.50), if not
included in SSA
amount.
3.Add Medicare Part
D, if applicable.
4.To annualize,
multiply the
monthly total by 12
months.
Annual Household
Income
$_________________
_____________
☐Categorically
Eligible
If the total annual household income is less than 50% of the current State Median Income for household size (using chart
above), and no one in the household is receiving SNAP assistance, the applicant must provide a signed statement of how
basic living expenses (i.e., food, shelter and transportation) are provided for the household.
7BSection Seven: Vendor, Benefit, and Verification Information
Energy Vendor #1
Name:
Other Vendor #1
Name:
Contact made with LIHEAP provider to verify previous crisis assistance.
Contact Person: ____________________
CAO
16.D.4.e
Packet Pg. 1542 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
Account Number: Account/Vo
ucher
Number:
Date: Date of contact: _______________________
Has the applicant received LIHEAP crisis assistance during the current season?
☐Yes ☐ NoMinimum Amount
Due:________________
Amount
Due:_____________________
_____
Verification and
Commitment
Contact Person:
_____________________
Date:________________
______________
☐
Blanket
☐
Portable
Fan
☐Space
Heater
☐
Window
A/C
☐Repair Existing
Heating or Cooling
Equipment
☐Emergency
Shelter
☐Other
_______________
____
If the minimum amount due is more than the past due amount, did the
energy vendor verify that this amount is required?
☐Yes ☐No ☐N/AEnergy Vendor #2
Name:
Other Vendor #2
Name:
Account Number:
Account/Vo
ucher
Number:
Date:
If the minimum amount due to resolve the crisis is more than the
maximum allowed, explain how the balance of the amount due will be paid
if approved for EHEAP crisis assistance.
__________________________________________________________________
________________________________________________
Minimum Amount
Due:________________
Amount
Due:_____________________
______Verification and
Commitment
Contact Person:
_____________________
Date:________________
______________
☐
Blanket
☐
Portable
Fan
☐Space
Heater
☐
Window
A/C
☐Repair Existing
Heating or Cooling
Equipment
☐Emergency
Shelter
☐Other
_______________
____
(1) Total Energy
Vendors $ (4)Total Other
Vendors $
Is the name on the fuel bill that of the applicants?
☐Yes ☐No
If no, provide name on bill:
___________________________
(2)Energy Subsidy $ Total EHEAP
Benefit
Add
Total Energy
Vendor (4) &
Total Other
Vendor (4)
$
(3)Water, Sewer,
Garbage, Fire,
etc.
$
(4)Deduct (2&3)
from (1)$
8BSection Eight: Weatherization Assistance Program (WAP) Referral
If the applicant is a homeowner, has he/she received more than three LIHEAP or EHEAP benefits in the last 18 months?
☐Yes ☐ No ☐ N/A
If the answer to the previous question is “yes”, was the applicant referred to WAP? ☐ Yes ☐ No ☐ N/A
If the answer to the last question is “no”,
explain:___________________________________________________________________
9BSection Nine: Resolution of Crisis
Resolution of the Heating/Cooling Energy Crisis occurred within 18/48 hours, by the following eligible action(s): (Select all that apply)
☐Approval of application ☐EHEAP benefit prevented disconnection
☐Commitment made to vendor ☐EHEAP benefit restored energy already disconnected
☐Denial of Application, pending
additional information
☐Yes, client signed waiver
☐Denial of Application, ineligible ☐No, client refused to sign waiver
☐Written referral and assistance to access other community resources
Case Worker Signature 11BApproval Signature
I have determined the eligibility of the
applicant. I am not the applicant, nor am I a
friend, relative, or employee of the applicant.
The application and eligibility determination must be reviewed for errors and appropriate file
documentation prior to making payment. I have reviewed and approved this application for
crisis assistance.
Case Worker’s Name: Supervisor/Peer’s Name:
Case Worker’s Signature: Supervisor/Peer’s Signature:
Date: Date:
Agency Name: Agency Name:
DOEA Form 114 – 07/01/2023
CAO
16.D.4.e
Packet Pg. 1543 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
Emergency Home Energy Assistance for the Elderly Program –Spanish Application Form
Sección uno: Información del aplicante (60 años o más)
Sello o registro de la fecha
Nombre: (Nombre, segundo nombre, apellido) ☐EHEAP
☐Temporada caliente ☐Temporadafría
Fecha de nacimiento: Edad: Número Seg. Soc:
Dirección de servicio:
Ciudad: Condado: Código postal: Nombre del trabajador:
Teléfono:
Sexo: ☐ M ☐F Número de personas en el hogar: Teléfono:
Estado Civil: ☐ Casado/a ☐ Conviviente ☐ Soltero/a ☐ Separado/a ☐ Divorciado/a ☐ Viudo/a
Raza: ☐ Blanca ☐ Negra/Afro-americana ☐ Asiática ☐ Nativo de Hawái/Islas del Pacífico ☐ Indio americano/Nativo de Alaska ☐ Otro
Etnicidad: ☐ Hispano/Latino ☐ Otro Lengua materna: ☐ inglés ☐ español ☐ otro
¿El cliente tiene limitaciones para leer, escribir, entender o hablar el inglés? ☐ Sí ☐ No
¿El cliente es veterano? ☐ Sí ☐ No ¿El cliente ha sido derivado a la Oficina de Asuntos del Veterano? ☐ Sí ☐ No ☐ N/A
Tipo(s) de ingreso(s) del solicitante: Ingreso mensual del solicitante:
Sección dos: Información sobre otros miembros en el hogar
Nombre: Tipo(s) de ingreso:
Edad: Número de SS: Cantidad de ingreso mensual:
Nombre: Tipo(s) de ingreso:
Edad: Número de SS: Cantidad de ingreso mensual:
Nombre: Tipo(s) de ingreso:
Edad: Número de SS: Cantidad de ingreso mensual:
Nombre: Tipo(s) de ingreso
Edad: Número de SS: Cantidad de ingreso mensual:
Sección tres: Características de los miembros del hogar
¿Hay un niño menor de 5 años en el hogar? ☐ Sí ☐ No
De ser afirmativo, seleccione las que apliquen: ☐ 0-2 años de edad ☐ 3-5 años de edad
¿Existe alguna persona con discapacidades en el hogar? ☐ Sí ☐ No
¿El solicitante es ciudadano estadounidense o extranjero con una residencia permanente? ☐ Sí ☐ No
¿El solicitante es dueño de la vivienda? ☐ Sí ☐ No
¿El solicitante vive en una vivienda subsidiada por el gobierno, tal como Section 8? ☐ Sí ☐ No
Si es afirmativo, provea el nombre del complejo
habitacional:
Si
¿El solicitante vive en una residencia universitaria, hogar de cuidado familiar para adultos, o cualquier otro tipo de instalación compartida? ☐ Sí
☐No
Si es afirmativo, provea el nombre de la instalación:
Sección cuatro: Información sobre aire acondicionado y calefacción
¿Ha recibido usted o algún miembro de su hogar ayuda con los servicios de electricidad en la temporada actual? ☐ Sí ☐ No
Si es afirmativo, provea el nombre de la agencia:
¿Cuál es la fuente principal de calefacción doméstica? (seleccione una) ☐ Electricidad ☐ Gas natural ☐ Gas propano
☐Madera/carbón ☐ Combustibles rellenables
¿El hogar utiliza una fuente de calefacción suplementaria? ☐ Electricidad ☐ Madera/carbón ☐ N/A
CAO
16.D.4.e
Packet Pg. 1544 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
Tipo de aire acondicionado ☐ A/C Central ☐ A/C de ventana/pared ☐ Ventiladores ☐ Otros – especifique (tales como aire
acondicionado portátil)
Sección cinco: Explicación de la crisis de energía Certificación y firma del cliente
☐Se ha cortado la fuente de energía de la calefacción o del aire
acondicionado en el hogar. (Pone en peligro la vida)
La información proporcionada en esta solicitud es a mi leal saber y
entender completa y verdadera. Tengo entendido que se dará prioridad de
brindar asistencia a los hogares con ingresos más bajos y con mayor
necesidad, p.ej. aquellos hogares en los que residen personas mayores,
discapacitados o niños con necesidades médicas. Autorizo a la agencia
realizar los pagos de prestaciones directamente a mi proveedor de energía.
Si estoy solicitando asistencia de crisis de energía, soy consciente que
después de haber proporcionado toda la información solicitada para
determinar mi admisibilidad, la agencia tiene 18 horas para tomar las
medidas necesarias y adecuadas en cuanto a mi solicitud. Asimismo, tengo
conocimiento que, si no me aprueban o deniegan dentro del plazo
establecido, o si no se me aprueba por la cantidad correcta, tengo derecho
a apelar la decisión. (Si firma con una "X", se exige que haya dos testigos).
Firma del cliente:
Fecha:
☐No se puede obtener el suministro de combustible, se ha
quedado sin combustible o corre el riesgo de quedarse sin
combustible para la calefacción. (Pone en peligro la vida)
☐Otros problemas relacionados con la falta de aire acondicionado o
calefacción en el hogar, tales como la necesidad de pagar una garantía,
reparación de equipos o una medida de emergencia provisional para
evitar futuras crisis. (Amenaza la vida)
☐Se le notificó que se va a desconectar la fuente de energía para el
aire acondicionado o calefacción. (Estándar)
☐Recibió una notificación indicando que la factura de electricidad está
atrasada o vencida. (Estándar)
☐Tiene una factura de electricidad cuya fecha de vencimiento ha
caducado. (Estándar)
TODOS LOS CLIENTES DEBEN FIRMAR LA EXENCIÓN, AUTORIZANDO LA DIVULGACIÓN DE INFORMACIÓN GENERAL Y/O CONFIDENCIAL
PARA EL INFORME FEDERAL DE LIHEAP/EHEAP
*Su número de seguro social (SSN) es confidencial en virtud de la ley. No podemos recolectar su SSN a menos que le
expliquemos por escrito la razón y le proporcionemos la autoridad legal correspondiente para hacerlo. Ciertas
disposiciones del Capítulo 430, artículo 119.071 (5) de las Leyes de Florida, autorizan específicamente al Departamento
del Adulto Mayor (DOEA) y a su personal/empleados autorizados recolectar los SSN cuando lo autorice la ley o cuando
la recolección del SSN sea imperativa para el desempeño de las funciones asignadas por ley del DOEA. El Departamento
recolecta su número de seguro social como parte de su responsabilidad de proporcionar asistencia de emergencia
energética en el hogar.
Hoja de admisibilidad del Programa de Asistencia de Emergencia Energética en el Hogar para Adultos Mayores
Sección seis: Determinación de la admisibilidad de ingresos
Anualice todos los ingresos del hogar Escriba los cálculos en este espacio o engrape
la cinta de papel de la calculadora aquí en
donde se muestren los cálculos de sus
ingresos,
Guía del ingreso promedio del estado a partir del
01/07/2023
1. Sume todos los ingresos brutos
mensuales ganados y aquellos
ingresos no salariales de los últimos
30 días de todos los
Seleccione el límite de ingresos anuales según el
tamaño de la unidad familiar:
150% máximo del valor de ingresos (MVI) 50% de MVI
☐1………$27,735 $13,868
☐2………$36,269 $18,135
☐3………$44,803 $22,402
☐4………$53,337 $26,669
☐5………$61,870 $30,935
☐6………$70,404 $35,202
☐7………$72,004 $36,002
☐8………$73,605 $36,803
(Consulte la estructura de los índices federales de
pobreza (FPG) para conocer los rangos de ingresos
para hogares con 9 o más personas).
2.Agregue la prima de Medicare ($
148.50), si no está incluida en el monto
de los beneficios del
3. Agregue la Parte D de Medicare, si es
necesario.
4. Para anualizar, multiplique el total
mensual por 12 meses.
Ingreso anual del hogar
$
☐Categóricamente
admisible
Si el total ingreso anual del hogar es menor que el 50% de las guías actuales de ingreso promedio para el tamaño de la
unidad familiar (usando el cuadro anterior), y ninguna persona en el hogar recibe asistencia de SNAP, el solicitante debe
proporcionar un documento firmado de cómo se proporcionan los gastos básicos diarios tales como comida, vivienda y
transporte en el hogar.
Sección siete: Proveedor, renta y verificación de la información
Proveedor de energía #1
Nombre:
Otro proveedor #1
Nombre:
Contacto realizado con el proveedor
de LIHEAP para verificar la previa
asistencia de crisis de energía.
Persona de contacto: Número de cuenta:
Número de cuenta/
comprobante: Fecha:
CAO
16.D.4.e
Packet Pg. 1545 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
Importe mínimo adeudado:
_
Cantidad adeudada: Fecha de contacto:
¿El solicitante ha recibido
asistencia de crisis de energía de
LIHEAP durante la temporada
actual? ☐ Sí ☐ No
Verificación y obligaciones Persona de
contacto:
Fecha:
☐Mantas ☐ Reparación de equipos de
☐Ventilador portátil calefacción o aire acondicionado existentes
☐ Calefactor ☐Refugio de emergencia
☐A/C de ventanas ☐Otros:
Si el importe mínimo adeudado
es mayor que la cantidad
adeudada anterior, ¿el
proveedor de energía verificó
que se requiera ese monto?
☐Sí ☐ No ☐N/A Proveedor de energía #2
Nombre:
Otro proveedor #2
Nombre:
Número de cuenta:
Número de cuenta/
comprobante Fecha: Si el importe mínimo adeudado
para solucionar la crisis es
mayor que el máximo
permitido, explique cómo se
pagará el saldo del monto
adeudado si es aprobado para
la asistencia de crisis de
EHEAP.
Importe mínimo adeudado: Cantidad adeudada:
Verificación y obligaciones Persona de
contacto:
Fecha:
☐Mantas ☐Reparación de equipos de
calefacción o aire acondicionado
☐Ventilador portátil existentes
☐ Calefactor ☐Refugio de emergencia
☐A/C de ventanas ☐Otros:
(1) Total del proveedor/es de energía $ (4)Total de otros proveedores $ ¿El nombre que figura
en la factura de
combustible es el del
solicitante?
☐Sí ☐ No
Si es no, provea el nombre
de la persona que figura
en la factura:
(2)Subsidio de energía $
Renta total de EHEAP Sume el
total del proveedor de energía (4) y
el total de otros
proveedores (4)
$
(3) Agua, alcantarillado, basura,
fuego, etc. $
(4)Deducible (2&3) de (1) $
Sección ocho: Referencia del Programa de Asistencia para Climatización (WAP)
Si el solicitante es propietario de la vivienda, ¿ha recibido más de tres beneficios de LIHEAP o EHEAP en los últimos 18 meses?
☐Sí ☐ No ☐ N/A
Si la respuesta a la pregunta anterior es “Sí”, ¿el solicitante obtuvo una referencia de WAP? ☐ Sí ☐ No ☐ N/A
Si la respuesta a la última pregunta es "No", explique:
Sección nueve: Solución de la crisis
La solución de la crisis de calefacción o aire acondicionado se produjo dentro de las 18/48 horas, mediante las siguientes acciones adecuadas:
(Seleccione todas las que correspondan)
☐Aprobación de la aplicación ☐Los beneficios de EHEAP evitó la desconexión
☐Compromiso hecho con el proveedor ☐Los beneficios de EHEAP restauró la energía cortada
☐Aplicación denegada, información adicional pendiente ☐Sí, el cliente firmó la exención
☐Aplicación denegada, no cumple con los requisitos ☐No, el cliente se negó a firmar la exención
☐Obtuvo una referencia por escrito y ayuda para acceder a otros servicios de la comunidad
CAO
16.D.4.e
Packet Pg. 1546 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
Firma del encargado/a del caso Firma de aprobación
He determinado la admisibilidad del solicitante. No soy el solicitante, ni su amigo,
pariente o empleado del solicitante.
La determinación de la aplicación y de admisibilidad deben revisarse para
detectar errores, y la documentación adecuada debe estar en archivo
antes de realizar el pago. He revisado y aprobado esta solicitud de
asistencia de crisis de energía.
Nombre del encargado/a del caso: Nombre del supervisor:
Firma del encargado/a del caso: Firma del supervisor:
Fecha: Fecha:
Nombre de la agencia: Nombre de la agencia:
CAO
16.D.4.e
Packet Pg. 1547 Attachment: EHEAP 203.21.04 - exec (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.f
Packet Pg. 1548 Attachment: Resolution 2018-202 (28847 : FY23 EHEAP Amendments 5 and 6)
16.D.4.f
Packet Pg. 1549 Attachment: Resolution 2018-202 (28847 : FY23 EHEAP Amendments 5 and 6)
c,t["rao vLnW
ffice of Management & Budget
TO: Amy Patterson - County Manager
CC: Tanya \Mlliams - Department Head
Public Services Department
FROM: Therese Stanley
Manager - OMB Grants Compliance
DATE: April24,2024
RE County Manager Designation to Execute Grant Applications and Contract Documents
outlined in RESO 2018-202 for the Cluster of Aging Grants.
On November 13,2018, Resolution 2018-202 superseding 96-268 and 10-122was approved by
the Board to allow the County Manager or designee to execute grant program documents
including applications, contracts and amendments for the cluster of aging programs.
Federal and State funding is received on an annual basis through the Older Americans Act and
Department of Elder Affairs administered by the Area Agency on Aging for Southwest Florida
(AAA). This action is necessary to expedite execution so that funding shifted between grant
programs to meet client needs is available timely to order to maintain program standards of
service. All executed documents are presented to the Board after-the-fact and coordinated with
the OMB Grants Compliance Office as required pursuant the CMA 5330 Grants Coordination
Policy.
This letter serves to designate Tanya \Mlliams, Public Services Department Head, as the
Authorizing Official to fulfill these responsibilities.
32€g Tamiami Trail East, Suite 201 . Naptes, Florida 34112.5746 . 239-2S2f973 . FA.X 239.252{828
Approved by County Manager:
a\})4
{lzslzoz4 ta"o
0-,r''?*tu^
Ciunty {gkrager
16.D.4.g
Packet Pg. 1550 Attachment: County Manager Designation Aging Grants Cluster (28847 : FY23 EHEAP Amendments 5 and 6)
Wil202l - Jltne 2024 EHEAP 203.21.06
AMENDMENT SIX
BETWEEN
f,MERGENCY HOME ENERGY ASSISTANCE PROGRAM
AND
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
This Amendment, entered into between Emergency Home Energy Assistance Program and Area Agency on
Aging for Southwest Florida, Inc. (Contractor), hereby amends conhact ELIE AP 203.21.
WHEREAS, the purpose of this Amendment is to increase funding from Weather Crisis to EHEAP Crisis by $ I,662.14.
NOW THEREFORL, in consideration ofthe mutual covenants and obligations set forth herein, the receipt
and sufficiency of which are hereby acknowledged, the Parties agree to the following:
1. Attachment lX, Budget Summary, is hereby replaced.
All provisions in the conhact 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 pedormed at the level specified in the
contract.
This Amendment and all its attachments are hereby made part ofthe contract
IN WITNESS THEREOF, the Parties have caused this two (2) page Amendment to be executed by their officials as duly
authorized, and agree to abide by the terms, conditions, and provisions of Contract EHEAP 203.21, as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
l'ederal Ta-\ tD: 59-6000558
Fiscal Year Ending Datc: 09/30
DUNS: 076997790
COLLIER COUNTY BOARD OF COUNTY
COMMISSK)NERS
AREA AGENCY ON AGING FOR SOUTITWEST
FLORIDA, INC.
SISIGNED:
NAME: Tanya R. WilliamsNAME: Maricela Morado
TITI,E; President and CEO TITLE: Public Services Department Head
As Designee ofthe County Manger Pursuant to
DATil ^e."r.-ro, zu 16. zuzDATE:
Page 1 of 2 @
16.D.4.h
Packet Pg. 1551 Attachment: EHEAP 203.21.05 and 203.21.06 (28847 : FY23 EHEAP Amendments 5 and 6)
April 2021- June 2024 EHEAP 203.21.06
BUDGET SUMMARY FY 23 (July 1,2023 - June 303024)
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM F'OR THE ELDERLY
PSA:8
COLNTY:COl.t.UiR
TOTAL ADMINISTRATION BUDGET $ 8,s00.00
TOTAL OUTREACH BUDGI]'f $ 2,s00.00
TOTAL CRISIS ASSISTANCE $ 90,662.1s
TOTAL s 101,662.15
Page 2 ol 2 @
16.D.4.h
Packet Pg. 1552 Attachment: EHEAP 203.21.05 and 203.21.06 (28847 : FY23 EHEAP Amendments 5 and 6)
pttl202l - June 2024 EHEAP 203.21.05
AMEI{DMENT FtllE
BETWEEN
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
AND
AREA AGENCY ON AGING FOR SOUTIIWEST FLORIDA,INC
This Amendment, entered into between Emergency Home Energy Assistance Program and Area Agency on
Aging for Southwest Florid4 Inc. (Contractor), hereby amends conlract EHEAP 202.21.
WHEREAS, the purpose of this Amendment is to transfer funding from title EHEAP Outreach to EIIEAP
Crisis by $ 13,000.00
NOW THER-EFORE, 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:
All provisions in the contract and any attachments tiereto 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 ofthe contract.
IN WITNESS TIIEREOF, the Parties have caused this two (2) page Amendment to be executed by their officials as
duly authorized, and agree to abide by the terms, conditions and provisions of Contract EHEAP 202.21, as amended.
This Amendment is effective on the last date the Amendment has been signed by both Parties.
Federai Tax II): 59-6000558
Fiscal Ye6r Erding Date: 09/30
AREA AGENCY ON AGING FOR SOUTITWEST
FLORIDA, INC.
COLLIER COUNTY BOARD OF
COIry+{COMMISSIONERS
SIGNED:
NAME: Maricela Morado NAME: Tanya R. Williams
TITLE: President/CEO TITLE: Public Services Department Head
As Designee ofthe County Manager Pursuant to
DATE:DATE, Kesolutron 2u t a-tul
Dl.r'l'lS: 076997790
1. Attachment IX, Budget Summary, is hereby replaced.
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16.D.4.h
Packet Pg. 1553 Attachment: EHEAP 203.21.05 and 203.21.06 (28847 : FY23 EHEAP Amendments 5 and 6)
April 2021 - September 2023
TOTAL ADMINISTRATION BUDGET
TOTAL OtlTREACH BTIDGET
TOTAL CRISIS ASSISTANCE
TOTAL
BUDGET SUMMARY FY 23 (luly 1,2023 - Iune 30,2024
$ 8,s00.00
EHEAP 203.21.05
EMERGENCY HOME ENERCY ASSISTANCE PROGRAM FOR THE ELDERLY PROGRAM
PSA:8
COLNTY:COLLIER
$ 2,500.00
$ 89,000.00
$ 100,000.00
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Packet Pg. 1554 Attachment: EHEAP 203.21.05 and 203.21.06 (28847 : FY23 EHEAP Amendments 5 and 6)