Backup Documents 06/10/2025 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Parker Smith Community and Human PS 06/05/2025
Services
2. County Attorney Office County Attorney Office
5Aki/d 6/ibl Z5
3. BCC Office Board of County
Commissioners Ix b,b/SI 6/id/ z S
4. Minutes and Records Clerk of Courts Office ( ( O$M
i/0/1t1 ki 2u6
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 Parker Smith. Grants Coordinator I, Phone Number 239-252-6141
Contact/ Department Community and Human Services
Agenda Date Item was June 10, 2025 Agenda Item Number 16.D.1
Approved by the BCC
Type of Document Recommendation to authorize the Chairman Number of Original 1
Attached to sign Amendment Two to the Florida Documents Attached
Department of Elder Affairs(DOEA)
Agreement#XF305 to extend the period of
performance for the Golden Gate Senior
Center Expansion and Hardening
project. ...
PO number or account
number if document is N/A
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? PS
2. Does the document need to be sent to another agency for additional signatures? If yes, PS
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 PS
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 PS
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 PS
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's PS
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip PS
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 one and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County S4k'f'J an option for
Attorney's Office has reviewed the changes,if applicable. glib/2 S this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16 1
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC, all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
*** ONLY USE FOR AGREEMENTS***
Instructions
1) Return signed originals to:
Vanessa Collier
State and Federal Grants Manager
Collier County Government I Community and Human Services
3339 E. Tamiami Trail, Bldg. H, Suite 213
Naples, FL 34112
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
•
16D 1
XF305.A2
AMENDMENT TWO
BETWEEN
FLORIDA DEPARTMENT OF ELDER AFFAIRS
AND
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This Amendment,entered into between the Florida Department of Elder Affairs, (DOEA or Department)and Collier
County Board of County Commissioners(Contractor), hereby amends contract XF305.
WHEREAS the purpose of this Amendment is to amend contract language of Contract XF305.
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:
1. Standard Contract, Section 3, Term of Contract, is hereby replaced.
3. Term of Contract:
This contract shall begin at twelve(12:00) A.M., Eastern Standard Time July 1,2023, 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 June 30,2026.
All provisions in the contract and any attachments there to 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 have caused this one(1) page Amendment to be executed by their officials as
duly authorized, and agree to abide by the terms, conditions and provisions of Contract XF305 as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
COLLIER COUNTY BOARD OF COUNTY FLORIDA DEPARTMENT OF ELDER AFFAIRS
COMMISSIONERS
SIGNED:
SIGNED: ------ -- .
,.....„,e4e0".04--
Name: MICHELLE BRANHAM
Burt Saunders, Chairman
Title: SECRETARY
DATE: DATE: — — .�.—
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FEID: 596000 58
App as and legality ATT `. '' "g
!WA L
Iamb
Jeffrey • . i a w,County Attorney B '
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