Backup Documents 09/09/2025 Item #16D 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 09/09/2025 BCC MTG
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. David R. Schwartz Community and Human DS 09/5/25
Services
2. Minutes and Records Clerk of Court's Office DS
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 Phone Number 239-252-4899
Contact/ Department
Agenda Date Item was 9.9.25 Agenda Item Number 16.D.6
Approved by the BCC
Type of Document Number of Original 1
Attached (oh frc.c/. - HPb ZS Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK DS
2. Does the document need to be sent to another agency for additional signatures? If yes, DS
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 DS
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 DS
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 DS
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 DS
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip Ds
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 N/A is not
the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the 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.
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FLORIDA DEPARTMENT OF ELDER AFFAIRS
STANDARD CONTRACT
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida,Inc. (AAASWFL)and
Collier County Board of County Commissioners(Contractor),collectively referred to as the"Parties."
WITNESSETH THAT:
WHEREAS,the AAASWFL has determined that it is in need of certain services as described herein for the Emergency
Home Energy Assistance for the Elderly Program; and
WHEREAS,the EI-IEAP Program is funded with Federal funds;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 AAASWFL.
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:
1. 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.
2. Incorporation of Documents within the Contract:
The contract will incorporate attachments,proposal(s),state plan(s),grant agreements,relevant AAASWFL 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.
3. Term of Contract:
This contract shall begin at twelve (12:00)A.M., Eastern Standard Time July 1, 2025, 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.
4. Contract Amount:
The AAASWFL agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed$104,400.00,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.
5. Renewals:
By mutual agreement of the Parties, in accordance with Section 287.058(1)(g), Florida Statutes(F.S.), the AAASWFL
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 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 AAASWFL and the availability of funds.
6. 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) Part 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
amended (33 U.S.C. § 1251, et seq.), Executive Order 11738, as amended, and, where applicable,
Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations
of the above to the AAASWFL.
6.1.3 Neither the Contractor nor any agent acting on behalf of the Contractor may use any federal funds received
in connection with this contract to influence legislation or appropriations pending before Congress or any
state legislature. The Contractor must complete all disclosure forms as required, specifically the
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Certification and Assurances Attachment,which must be completed and returned to the Contract Manager
prior to the execution of this contract.
6.1.4 In accordance with Appendix Il to 2 CFR Part 200, the Contractor shall comply with Department of Labor
regulations 41 CFR Part 60 and in Department of Health and Human Services regulations 45 CFR Part 92,
if applicable.
6.1.5 A contract award with an amount expected to equal or exceed$25,000.00 and certain other contract awards
will not be made to parties listed on the government-wide Excluded Parties List System,in accordance with
the Office of Management and Budget (OMB) guidelines at 2 CFR Part 180 that implement Executive
Orders 12549 and 12689, "Debarment and Suspension." The Excluded Parties List System contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared
ineligible under statutory or regulatory authority other than Executive Order 12549, The Contractor shall
comply with these provisions before doing business or entering into subcontracts receiving federal funds
pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances
Attachment prior to the execution of this contract.
6.2 The Contractor shall not employ an unauthorized alien. The AAASWFL will consider the employment of
unauthorized aliens a violation of the immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. § 1101). Such violation will be cause for unilateral cancellation of
this contract by the AAASWFL.
6.3 If the Contractor is a non-profit provider and is subject to Internal Revenue Service(IRS)tax exempt organization
reporting requirements (filing a Form 990 or Form 990-N), and has its tax exempt status revoked for failing to
comply with the filing requirements of the Pension Protection Act of 2006 or for any other reason,the Contractor
must notify the AAASWFL in writing within thirty(30)days of receiving the IRS notice of revocation.
6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR 170.110(b), the Contractor shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR Part 170.
6.6 To comply with Presidential Executive Order 12989,as amended, and State of Florida Executive Order Number
1 1-1 16,and section 448.095(5)F.S.,Contractor agrees to utilize the U.S. Department of Homeland Security's E-
verify system to verify the employment of all new employees hired by Contractor during the contract term.
Contractor shall include in related subcontracts a requirement that Subcontractors performing work or providing
services pursuant to the state contract utilize the E-verify system to verify employment of all new employees
hired by the Subcontractor during the contract term. Contractors shall require any subcontractors to provide an
affidavit stating it does not employ any unauthorized aliens and has no subcontractors that employ unauthorized
aliens. Contractors shall retain any affidavits from subcontractors through the term of this contract.
7. Compliance with State Law:
7.1 This contract is executed and entered into in the State of Florida,and shall be construed,performed,and enforced
in all respects in accordance with Florida law, including Florida provisions for conflict of laws.
7.2 If this contract contains state financial assistance funds, the Contractor shall comply with Section 215.97, F.S.,
and Section 215.971, F.S., and expenditures must be in compliance with applicable laws,rules, and regulations
including,but not limited to, the Department of Financial Services Reference Guide for State Expenditures.
7.3 The Contractor shall comply with the requirements of Section 287.058,F.S.,as amended.
7.3.1 The Contractor shall perform all tasks contained in Attachment I.
7.3.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in
Attachment I,to be received and accepted by the AAASWFL Contract Manager prior to payment.
7.3.3 The Contractor shall comply with the criteria and final date by which such criteria must be met for
completion of this contract as specified in Attachment I, Section III. Method of Payment.
7.3.4 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre-audit and post-audit.
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7.3.5 If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit invoices
for any travel expenses in accordance with Section 112.061, F.S.,or at such lower rates as may be provided
in this contract.
7.4 If clients are to be transported under this contract,the Contractor shall comply with the provisions of Chapter 427,
F.S.,and Rule Chapter 41-2, Florida Administrative Code(F.A.C).
7.5 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in
accordance with the provisions of Section 287.134, F.S.
7.6 The Contractor shall comply with the provisions of Section 11.062,F.S.,and Section 216.347, F.S.,which prohibit
the expenditure of contract funds for the purpose of lobbying the legislature,judicial branch or a state agency.
7.7 The AAASWFL may, at its option, terminate the Contract if the Contractor is found to have submitted a false
certification as provided under Section 287.135(5), F.S., has been placed on the Scrutinized Companies with
Activities in the Iran Petroleum Energy Sector List,the Scrutinized Companies with Activities in Sudan List,or
the Scrutinized Companies that Boycott Israel List,or if the Contractor has been engaged in business operations
in Cuba or Syria or is engaged in a boycott of Israel.
7.8 The nongovernmental entity Contractor shall comply with the requirements of section 787.06(13), Florida
Statutes, and provide the AAASWFL the required affidavit, or complete and return the applicable portions of
Form PUR 2024 as described in ATTACHMENT III,whenever this Contract is executed,renewed,or extended.
8. Background Screening:
The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435,F.S.,as they may be amended,
are met regarding background screening for all employees,volunteers,and persons seeking employment who are"direct
service providers"as that term is defined in Section 430.0402(1)(b)and who are not exempted from Level 2 background
screening by Section 430.0402(2).The Contractor and its direct service providers,must also comply with any applicable
rules promulgated by the AAASWFL and the Agency for Health Care Administration regarding implementation of
Section 430.0402 and Chapter 435,F.S. Contractor shall submit the Background Screening Attestation of Compliance-
Employer(Screening Form)to the AAASWFL within thirty(30)days of execution of this contract and annually,through
the term of this contract pursuant to section 435.05(3) F.S. The Contractor shall also maintain copies of the new
screening forms for its direct service providers as required herein. The Contractor hereby agrees to correct all
background screening deficiencies identified by the AAASWFL's Contract Manager within thirty (30) days upon
notification.
8.1 Further information concerning the procedures for background screening may be found at
httns://elderaffaius.org/about-us/background-screening
8.2 The Contractor shall submit for each employee having access to the Clearinghouse program or the background
screening information obtained from the program, an executed Attestation of Compliance — Background Screening
Program User form to the AAASWFL within sixty(60)days of execution of this contract for each background screening
program user and annually thereafter,within forty-five(45)days of the contract anniversary date.
9. Grievance Procedures:
The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to
process and resolve client dissatisfaction with, or denial of, service(s) and to address complaints regarding the
termination,suspension or reduction of services,as required for receipt of funds. These procedures,at a minimum,will
provide for notice of the grievance procedure and an opportunity for review of the Subcontractor's determination(s).
10. Public Records and Retention:
The AAASWFL may unilaterally cancel this contract, notwithstanding any other provisions of this contract, for
refusal by the Contractor to allow public access to all documents,papers, letters,or other material made or received
by the Contractor in conjunction with this contract,unless the records are exempt,or confidential and exempt,from
Section 24(a)of Article I of the State Constitution and Section 119.071, F.S.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, FLORIDA STATUTES,TO THE CONTRACTOR'S DUTY TO
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PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT
THE CUSTODIAN OF PUBLIC RECORDS AT:
Fiscal@AAASWFL.org
AAASWFL.org
Area Agency on Aging for Southwest Florida, Inc.
2830 Winkler Ave.,Suite 112
Fort Myers, FL 33916
239-652-6900
10.1 By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any other applicable
law,and shall:
10.1.1 Keep and maintain public records required by the AAASWFL to perform the contracted services.
10.1.2 Upon request from the AAASWFL's custodian of public records, provide the AAASWFL a copy of the
requested records or allow the records to be inspected or copied within a reasonable time at no cost to the
AAASWFL.
10.1.3 Ensure that public records that are exempt, or confidential and exempt, from public records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and
following completion of the contract if the Contractor does not transfer the records to the AAASWFL.
10.1.4 Upon completion of the contract,the Contractor will either transfer,at no cost to the AAASWFL,all public
records in possession of the Contractor to the AAASWFL or will keep and maintain public records required
by the AAASWFL. If the Contractor transfers all public records to the AAASWFL upon completion of the
contract,Contractor shall destroy any duplicate public records that are exempt,or confidential and exempt,
from public records disclosure requirements. If the Contractor keeps and maintains public records upon
completion of the contract, the Contractor shall meet all applicable requirements for retaining public
records.All records stored electronically must be provided to the AAASWFL in a format that is compatible
with the information technology systems of the AAASWFL.
10.2 Upon termination of this contract, whether for convenience or for cause as detailed in section 53 of this contract,
the Contractor and Subcontractors shall,at no cost to the AAASWFL,transfer all public records in their possession
to the AAASWFL and destroy any duplicate public records that are exempt, or confidential and exempt, from
public records disclosure requirements. All records stored electronically shall be provided to the AAASWFL in a
format that is compatible with the information technology systems of the AAASWFL.
11. Audits,Inspections,investigations:
11.1 The Contractor shall establish and maintain books, records,and documents(including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest, and expenditures of funds
provided by the AAASWFL under this contract. Contractor shall adequately safeguard all such assets and ensure
that they are used solely for the purposes authorized under this contract. Whenever appropriate, financial
information should be related to performance and unit cost data.
11.2 The Contractor shall retain and maintain all client records, financial records, supporting documents, statistical
records, and any other documents (including electronic storage media) pertinent to this contract for a period of
six(6)years after completion of the contract, or longer when required by law. In the event an audit is required
by this contract,records shall be retained for a minimum period of six(6)years after the audit report is issued or
until resolution of any audit findings or litigation based on the terms of this contract, at no additional cost to the
AAASWFL.
11.3 Upon demand,at no additional cost to the AAASWFL,the Contractor shall facilitate the duplication and transfer
of any records or documents during the required retention period.
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11.4 The Contractor shall ensure that the records described in this section will be subject at all reasonable times to
inspection,review,copying, or audit by federal, state,or other personnel duly authorized by the AAASWFL.
11.5 At all reasonable times for as long as records arc maintained, persons duly authorized by the AAASWFL and
federal auditors, pursuant to 45 CFR Part 75,shall be allowed full access to and the right to examine any of the
Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the
form in which kept.
11.6 The Contractor shall provide a Financial and Compliance Audit to the AAASWFL as specified in this contract
and ensure that all related third-party transactions are disclosed to the auditor.
11.7 Contractor agrees to comply with the inspector General in any investigation,audit,inspection,review,or hearing
performed pursuant to Section 20.055, F.S. Contractor further agrees that it shall include in related subcontracts
a requirement that subcontractors performing work or providing services pursuant to this contract agree to
cooperate with the Inspector General in any investigation, audit, inspection, review, or hearing pursuant to
Section 20.055(5), F.S. By execution of this contract the Contractor understands and will comply with this
subsection.
11.8 In accordance with Executive Order 20-44 which requires executive agencies to submit a list of entities named
in statute with which a state agency must form a sole-source,public-private agreement or an entity that,through
contract or other agreement with the state,annually receives 50%or more of their budget from the State or from
a combination of State and Federal funds.Any Contractor that meets one or both of the criteria listed must submit
an annual report, including the most recent IRS Form 990, detailing the total compensation for the entities'
executive leadership teams within thirty(30)days of execution of this contract.
11.8.1 The report must include total compensation including salary,bonuses,cashed-in leave,cash equivalents,
severance pay,retirement benefits,deferred compensation, real-property gifts,and any other payout.
11.8.2 The Contractor shall inform the agency of any changes in total executive compensation between the
annual reports as those changes occur.
11.8.3 All compensation reports must indicate what percent of compensation comes directly from the State or
Federal allocations to the contracted entity.
12. Nondiscrimination-Civil Rights Compliance:
12.1 The Contractor shall execute Assurances as stated in the Assurances-Non-Construction Programs Attachment that
it will not discriminate against any person in the provision of services or benefits under this contract or in
employment because of age, race, religion,color,disability, national origin, marital status, or sex in compliance
with state and federal law and regulations. The Contractor further assures that all Contractors, Subcontractors,
Sub-grantees, or others with whom it arranges to provide services or benefits in connection with any of its
programs and activities arc not discriminating against clients or employees because of age, race, religion, color,
disability,national origin, marital status,or sex.
12.2 During the term of this contract,the Contractor shall complete and retain on file a timely,complete,and accurate
Civil Rights Compliance Checklist,attached to this contract.
12.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures shall include notifying clients, employees, and
participants of the right to file a complaint with the appropriate federal or state entity.
12.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance,and are binding upon the Contractor,its successors,transferees,and assignees for the
period during which such assistance is provided. The Contractor further assures that all Subcontractors,Vendors,
or others with whom it arranges to provide services or benefits to participants or employees in connection with
any of its programs and activities arc not discriminating against those participants or employees in violation of
the any statutes, regulations, guidelines, and standards. In the event of failure to comply, the Contractor
understands that the AAASWFL may,at its discretion,seek a court order requiring compliance with the terms of
this assurance or seek other appropriate judicial or administrative relief including,but not limited to,termination
of the contract and denial of further assistance.
13. Monitoring by the AAASWFL:
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The Contractor shall permit persons duly authorized by the AAASWFL to inspect and copy any records, papers,
documents, facilities, goods, and services of the Contractor which are relevant to this contract, and to interview any
clients, employees, and Subcontractor employees of the Contractor to assure the AAASWFL of the satisfactory
performance of the terms and conditions of this contract. Following such review,the AAASWFL will provide a written
report of its findings to the Contractor and, where appropriate, the Contractor shall develop a Corrective Action Plan
(CAP). The Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determined
by the AAASWFL's Contract Manager.
14. Provision of Services:
The Contractor shall provide services in the manner described in Attachment 1.
15. Coordinated Monitoring with Other Agencies:
If the Contractor receives funding from one or more State of Florida human service agencies, in addition to the
AAASWFL, then a joint monitoring visit including such other agencies may be scheduled. For the purposes of this
contract, and pursuant to Section 287.0575, F.S., as amended, Florida's human service agencies shall include the
AAASWFL,the Department of Children and Families(DCF),the Department of Health(DOH),the Agency for Persons
with Disabilities (APD), and the Department of Veterans' Affairs (DVA). Upon notification and the subsequent
scheduling of such a visit by the designated agency's lead administrative coordinator,the Contractor shall comply and
cooperate with all monitors,inspectors,and/or investigators.
16. Other Contract(s)Reporting:
Pursuant to Section 287.0575, F.S., as amended, the Contractor shall complete the Contractor's State Contracts List
attached to this contract.The Contractor shall notify the AAASWFL within ten(10)days of entering into a new contract
with any of the four (4) state human service agencies, to include DCF, DOH, APD or DVA . The notification shall
include the following information:(1)contracting state agency and the applicable office or program issuing the contract;
(2) contract name and number; (3) contract start and end dates; (4) contract amount; (5) contract description and
commodity or service;and(6)Contract Manager name and contact information.
17. Indemnification:
The Contractor shall be fully liable for, and fully indemnify, defend, and hold harmless the State of Florida, the
AAASWFL and its officers, agents and employees from and against any and all suits, claims, damages, losses, and
expenses, including attorney's fees, arising out of or resulting from any acts, actions, breaches neglect or omissions,
including personal injury and/or damage to property, related to execution of'this contract, any subcontracts or the
performance of services caused in whole or part by the Contractor. it is understood and agreed that the Contractor is not
required to indemnify the AAASWFL for claims, demands, actions, or causes of action arising solely out of the
negligence of the AAASWFL.
17.1 Except to the extent permitted by Section 768.28, F.S.,or other Florida law,this Section 17 is not applicable to
contracts executed between the AAASWFL and state agencies or subdivisions defined in Section 768.28(2),F.S.
18. Insurance and Bonding:
18.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewal(s) and extension(s)of it. By execution of this contract, unless it is a state agency or
subdivision as defined by Section 768.28(2), F.S., the Contractor accepts full responsibility for identifying and
determining the type(s) and extent of liability insurance coverage necessary to provide reasonable financial
protections for the Contractor and the clients to be served under this contract. The limits of coverage under each
policy maintained by the Contractor do not limit the Contractor's liability and obligations under this contract.
The Contractor shall ensure that the AAASWFL has the most current written verification of insurance coverage
throughout the term of this contract. Such coverage may be provided by a self-insurance program established
and operating under the laws of the State of Florida. The AAASWFL reserves the right to require additional
insurance as specified in this contract.
18.2 Throughout the term of this contract, the Contractor shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees, and agents of the Contractor
authorized to handle funds received or disbursed under all agreements and/or contracts incorporating this contract
by reference in an amount commensurate with the funds handled, the degree of risk as determined by the
insurance company,and consistent with good business practices.
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19. Confidentiality of Information:
The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized
to give that consent or when authorized by law.
20. Health Insurance Portability and Accountability Act:
Where applicable, the Contractor shall comply with the Health insurance Portability and Accountability Act of 1996,
Public Law 104-191,as well as all regulations promulgated thereunder(45 CFR Parts 160, 162,and 164).
21. Incident Reporting:
21.1 The Contractor shall notify the AAASWFL immediately, but no later than forty-eight (48) hours from the
Contractor's awareness or discovery of conditions that may materially affect the Contractor's or Subcontractor's
ability to perform the services required to be performed under this contract. Such notice shall be made to the
AAASWFL's Contract Manager in the most efficient manner with an email or other writing to immediately
follow.
21.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse,neglect,or exploitation of
a child, aged person,or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number
(1-800-96ABUSE). As required by Chapters 39 and 415, F.S.,this provision is binding upon the Contractor, its
Subcontractors,and their employees.
22. Bankruptcy Notification:
During the term of this contract,the Contractor shall immediately notify the AAASWFL if the Contractor,its assignees,
Subcontractors, or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Contractor must
also provide the following information to the AAASWFL: (1) the date of filing of the bankruptcy petition; (2) the case
number; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida,
Tallahassee Division);and(4) the name,address,and telephone number of the bankruptcy attorney.
23. Sponsorship and Publicity:
23.1 As required by Section 286.25, F.S., if the Contractor is a non-governmental organization which sponsors a
program financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in
publicizing,advertising,or describing the sponsorship of the program, state: "Sponsored by(Contractor's name),
Area Agency on Aging for Southwest Florida, Inc.,and the State of Florida,Department of Elder Affairs." If the
sponsorship reference is in written material, the words "Area Agency on Aging for Southwest Florida, inc., and
State of Florida, Department of Elder Affairs"shall appear in at least the same size letters or type as the name of
the organization.
23.2 The Contractor shall not use the words"Area Agency on Aging for Southwest Florida, Inc. and State of Florida,
Department of Elder Affairs" to indicate sponsorship of a program otherwise financed, unless specific written
authorization has been obtained by the AAASWFL prior to such use.
24. Assignments:
24.1 The Contractor shall not assign the rights and responsibilities under this contract without the prior written
approval of the AAASWFL. Any sublicense,assignment, or transfer otherwise occurring without prior written
approval of the AAASWFL shall constitute a material breach of the contract. In the event the State of Florida
approves assignment of the Contractor's obligations,the Contractor remains responsible for all work performed
and all expenses incurred in connection with this contract.
24.2 The State of Florida is,at all times,entitled to assign or transfer,in whole or part,its rights,duties,or obligations
under this contract to another governmental agency in the State of Florida upon giving prior written notice to the
Contractor.
24.3 This contract shall remain binding upon the successors in interest of the Contractor and the AAASWFL.
25. Subcontracts:
25.1 The Contractor is responsible for any and all work performed and for any and all commodities produced pursuant
to this contract, whether actually furnished by the Contractor or its Subcontractors. Any subcontracts shall be
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evidenced by a written document and subject to any conditions of approval the AAASWFL deems necessary.
The Contractor further agrees that the AAASWFL will not be liable to the Subcontractor in any way or for any
reason. The Contractor,at its expense,shall defend the AAASWFL against any such claims.
25.2 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the AAASWFL or other
state agency. Failure to make payments to any Subcontractor in accordance with Section 287.0585,F.S.,unless
otherwise stated in the contract between the Contractor and Subcontractor, will result in a penalty as provided
by statute.
26. Independent Capacity of Contractor:
It is the intent and understanding of the Parties that the Contractor and any of its Subcontractors are independent
Contractors and are not employees of the AAASWFL, and that they shall not hold themselves out as employees or
agents of the AAASWFL without prior specific authorization from the AAASWFL. It is the further intent and
understanding of the Parties that the AAASWFL does not control the employment practices of the Contractor and will
not be liable for any wage and hour, employment discrimination, or other labor and employment claims against the
Contractor or its Subcontractors. All deductions for social security,withholding taxes, income taxes, contributions to
unemployment compensation funds, and all necessary insurance for the Contractor are the sole responsibility of the
Contractor.
27. Payment:
Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in
Attachment I. The AAASWFL Contract Manager will have final approval of the Contractor's invoice submitted for
payment and will approve the invoice for payment only if the Contractor has met all terms and conditions of the contract,
unless the bid specifications,purchase order,or this contract specify otherwise. The approved invoice will be submitted
to the AAASWFL's finance section for budgetary approval and processing. Disputes arising over invoicing and
payments will be resolved in accordance with the provisions of Section 215.422,F.S. A Vendor Ombudsman has been
established within the Florida Department of Financial Services and may be contacted at 800-342-2762.
28. Return of Funds:
The Contractor shall return to the AAASWFL any overpayments due to unearned funds or funds disallowed, and any
interest attributable to such funds pursuant to the terms and conditions of this contract, that were disbursed to the
Contractor by the AAASWFL.In the event that the Contractor or its independent auditor discovers that an overpayment
has been made, the Contractor shall repay said overpayment immediately without prior notification from the
AAASWFL. In the event that the AAASWFL first discovers an overpayment has been made,the AAASWFL Contract
Manager will notify the Contractor in writing of such findings. Should repayment not be made forthwith,the Contractor
shall be charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03,F.S.,after AAASWFL
notification or Contractor discovery.
29. Data Security,Recovery,and Damages for Non-Performance:
29.1 Data Security. The Contractor and all Contractor Representatives shall comply with Rule Chapter 60GG-2,Florida
Administrative Code(F.A.C.),which contains information technology(IT)procedures;and requires adherence to
the AAASWFL's security policies in performance of this Contract. The Contractor shall provide immediate notice
to the AAASWFL's information Security Manager(ISM), within the Office of Information Technology, 1) in the
event it becomes aware of any security breach or any unauthorized transmission or loss of any or all of the data
collected,created for,or provided by the AAASWFL(State Data);and 2)of any allegation or suspected violation
of Rule Chapter 60GG-2,F.A.C.Except as required by law or legal process,and,with respect to the AAASWFL's
information, after notice to the AAASWFL, the Contractor shall not divulge to third parties any Confidential
Information obtained by the Contractor in the course of performing Contract work according to applicable rules,
including,but not limited to, Rule Chapter 60GG-2, F.A.C. "Confidential Information"means information in the
possession or under the control of the state of Florida(State)or the Contractor that is exempt from public disclosure
pursuant to chapter 119, F.S., or to any other applicable provision of State or federal law that serves to exempt
information from public disclosure. This includes,but is not limited to,the security procedures,business operations
information, or commercial proprietary information. The Contract will not be required to keep confidential any
information that is publicly available through no fault of the Contractor, material that the Contractor developed
independently without relying on the State's Confidential Information,or information that is otherwise obtainable
under State law as a public record. If State Data will reside in the Contractor's system,the Contractor will conduct
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at the Contractor's expense, an annual network penetration test or security audit of the
Contractor's system(s)on which State Data resides and will share the results with the State upon request to.
29.2 Data Protection. No State Data will be transmitted, processed, or stored outside of the United States of America
regardless of method,except as required by law. Access to the AAASWFL's State Data will only be available to
staff approved and authorized by the AAASWFL that have a legitimate business need. Access to State Data does
not include remote support sessions for devices that might contain the State Data; however, during the remote
support session the Contractor must escort the remote support access and maintain visibility of the support
personnel's actions. Requests for remote access to the AAASWFL's systems will be submitted to the AAASWFL's
Help Desk. Remote connections are subject to detailed monitoring via two-way log reviews and the use of other
tools. When remote access is no longer needed, the AAASWFL must be promptly notified, and access will be
promptly removed.
29.3 Breach and Negligence. The Contractor agrees to protect, indemnify, defend, and hold harmless the
AAASWFL from and against any and all costs,claims,demands,damages,losses,and liabilities arising from
or in any way related to the Contractor's breach of this Section or the negligent acts or omissions of the
Contractor related to this section.
29.4 Ownership of State Data. The AAASWFL's State Data will be made available to the AAASWFL upon its request,
in the form and format reasonably requested by the AAASWFL. Title to all of the AAASWFL's State Data will
remain property of the AAASWFL and/or become property of the AAASWFL upon receipt and acceptance.
Notwithstanding the foregoing, for purposes of this Section,any fields used for authentication for services shall be
excluded from the definition of State Data for security purposes. The Contractor shall not possess or assert any
lien or other right against or to any State Data in any circumstances.
30. Social Media and Personal Cell Phone use:
30.1 Inappropriate use of social media and personal cell phones may pose risks to AAASWFL's confidential and
proprietary information and may jeopardize compliance with legal obligations.By signing this contract,Contractor
agrees to the following social media and personal cell phone use requirements.
30.2 Social Media Defined. The term Social Media and /or personal cellular communication includes, but is not
limited to, social networking websites, blogs, podcasts, discussion forums, RSS feeds, video sharing, SMS
(including Direct Messages (DMs), iMessages, text messages, etc.); social networks like Instagram, TikTok,
Snapchat,Google Hangouts,WhatsApp,Signal,Facebook,Pinterest,and Twitter or their successors;and content
sharing networks such as Flickr and YouTube. This includes the transmission of social media through any cellular
or online transmission via any electronic, intranet, intranet,or other wireless communication.
30.3 Application to any direct or incidental AAASWFL or other state business. This contract applies to any
AAASWFL or other state business conducted on any of the Contractor's, Subcontractor's, or their employees'
social media accounts or through personal cellular communication.
30.4 Application to AAASWFL and Contractors Equipment.This contract applies regardless of whether the social
media is accessed using AAASWFL's IT facilities and equipment or equipment belonging to Contractor,
Subcontractor, or their respective employees. Equipment includes, but is not limited to, personal computers,
cellular phones,personal digital assistants,smart watches,or smart tablets.
30.5 Florida Government in the Sunshine, Florida Public Records Law, and HIPAA. Contractor acknowledges
that any AAASWFL or other state business conducted by social media or through personal cellular
communication is subject to Florida's Government in the Sunshine Law, Florida's Public Records Law(Chapter
119, Florida Statutes), and the Health Insurance Portability and Accountability Act (HIPAA). Compliance with
these laws and other applicable laws are further detailed in the contract.
30.6 Prohibited or Restricted Postings. Any social media posts which include photos, videos, or names of clients,
volunteers, staff, or other affiliates of AAASWFL may only be posted when authorized by law and when any
required HIPAA authorizations and any other consents or authorizations required pursuant to federal or state law
are on file with the contractor's records.
30.7 Assist AAASWFL,with Communications.Contractors may be asked periodically to assist in distributing certain
AAASWFL communications through their social media outlets.Any such requests should be posted in adherence
to the social media requirements herein and the other provisions of this contract.
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31. Conflict of Interest:
The Contractor shall establish safeguards to prohibit employees,board members,management,and Subcontractors from
using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of
interest or personal gain. No employee, officer, or agent of the Contractor or Subcontractor shall participate in the
selection or in the award of a contract supported by state or federal funds if a conflict of interest,real or apparent,might
be involved. Such a conflict would arise when:(a)the employee,officer or agent;(b)any member of his/her immediate
family;(c)his or her partner;or(d)an organization which employs,or is about to employ,any of the above individuals,
has a financial or other interest in the firm being selected for award. The Contractor's or Subcontractor's officers,
employees,or agents will neither solicit nor accept gratuities, favors,or anything of monetary value from Contractors,
potential Contractors, or parties to Subcontracts. The Contractor's board members and management must disclose to
the AAASWFL any relationship which may be, or may be perceived to be, a conflict of interest within thirty (30)
calendar days of an individual's original appointment or placement in that position,or,if the individual is serving as an
incumbent, within thirty (30) calendar days of the commencement of this contract. The Contractor's employees and
Subcontractors must make the same disclosures described above to the Contractor's board of directors. Compliance
with this provision will be monitored.
32. Public Entity Crime:
Pursuant to Section 287.133, F.S.,a person or affiliate who has been placed on the Convicted Vendor List following a
conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or
services to a public entity;may not submit a bid,proposal,or reply on a contract with a public entity for the construction
or repair of a public building or public work; may not submit bids, proposals,or replies on leases of real property to a
public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a
contract with any public entity;and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017, F.S., for CATEGORY TWO for a period of thirty six (36)months following the date of
being placed on the Convicted Vendor List.
33. Purchasing:
33.1 The Contractor shall procure products and/or services required to perform this contract in accordance with section
413.036, F.S. and the state contract with the Central Non-Profit Agency for the Blind or Other Severely
Handicapped(RESPECT):
33.1.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES THAT ARE THE
SUBJECT OF,OR REQUIRED TO CARRY OUT,THIS CONTRACT SHALL BE PURCHASED FROM
A NONPROFIT AGENCY FOR THE BLIND OR FOR THE SEVERELY HANDICAPPED THAT IS
QUALIFIED PURSUANT TO CHAPTER 413,FLORIDA STATUTES,IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET FORTH IN SECTION 413.036(1) AND (2), FLORIDA
STATUTES; AND FOR PURPOSES OF THIS CONTRACT THE PERSON, FIRM, OR OTHER
BUSINESS ENTITY CARRYING OUT THE PROVISIONS OF THIS CONTRACT SHALL BE
DEEMED TO BE SUBSTITUTED FOR THE STATE AGENCY INSOFAR AS DEALINGS WITH
SUCH QUALIFIED NONPROFIT AGENCY ARE CONCERNED.
33.1.2 Pursuant to sections 413.036(1) and (4), F.S., the Contractor shall not be required to procure a product or
service from RESPECT if: (a)the product or service is not available within a reasonable delivery time,(b)
the Contractor is required by law to procure the product or service from any agency of the state,or(c)the
Contractor determines that the performance specifications,price,or quality of the product or service is not
comparable to the Contractor's requirements.
33.1.3 This act shall have precedence over any law requiring state agency procurement of products or services
from any other nonprofit corporation unless such precedence is waived by the AAASWFL in accordance
with its rules.
33.1.4 Additional information about the designated nonprofit agency and the products it offers is available at
http://www.respectofflorida.org.
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33.2 The Contractor shall procure any recycled products or materials which arc the subject of,or are required to carry
out,this contract when the Department of Management Services determines that those products are available, in
accordance with the provisions of section 403.7065,F.S.
33.3 The Contractor shall procure products and/or services required to perform this contract in accordance with
section 946.515, F.S.
33.3.1 iT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES WHiCH ARE THE
SUBJECT OF,OR REQUIRED TO CARRY OUT,THIS CONTRACT SHALL BE PURCHASED FROM
THE CORPORATION IDENTIFIED UNDER CHAPTER 946, F.S., IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET FORTH IN SECTION 946.515(2) AND (4), F.S.; AND FOR
PURPOSES OF THIS CONTRACT THE PERSON,FIRM,OR OTHER BUSINESS ENTITY CARRYING
OUT THE PROVISIONS OF THIS CONTRACT SHALL BE DEEMED TO BE SUBSTITUTED FOR
THIS AGENCY INSOFAR AS DEALINGS WITH SUCH CORPORATION ARE CONCERNED.
33.3.2 The Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE) is under contract with the
Department of Management Services(DMS). Additional information about PRIDE and the commodities or
contractual services it offers is available at https://pride-enterprises.org/.
33.4 The Contractor shall provide a Certified Minority Business Subcontractor Expenditure (CMBE) Report
summarizing the participation of certified suppliers for the current reporting period and project to date. The
CMBE Report shall include the names, addresses, and dollar amount of each certified participant, and a copy
must be forwarded to the AAASWFL, Division of Financial Administration, and must accompany each invoice
submitted to the AAASWFL. The Office of Supplier Diversity(850-487-0915)will assist in furnishing names of
qualified minorities. The Department's Minority Coordinator (850-414-2153) will assist with questions and
answers. The CMBE Report is attached to this contract.
34. Patents,Copyrights,Royalties:
If this contract is awarded state funding and if any discovery, invention, or copyrightable material is developed or
produced in the course of or as a result of work or services performed under this contract or in any way connected with
this contract, or if ownership of any discovery, invention,or copyrightable material was purchased in the course of or
as a result of work or services performed under this contract, the Contractor shall refer the discovery, invention, or
copyrightable material to the AAASWFL to be referred to the Department of State. Any and all patent rights or
copyrights accruing under this contract are hereby reserved to the State of Florida in accordance with Chapter 286, F.S.
Pursuant to Section 287.0571(5)(k), F.S., the only exceptions to this provision shall be those that are clearly expressed
and reasonably valued in this contract.
34.1 If the primary purpose of this contract is the creation of intellectual property,the State of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to this Section 34.
34.2 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR 200.315 or
45 CFR 75.322,as applicable.
34.3 Notwithstanding the foregoing provisions, if the Contractor or one of its Subcontractors is a university and a
member of the State University System of Florida, then Section 1004.23, F.S.,shall apply, but the AAASWFL
shall retain a perpetual, fully-paid,nonexclusive license for its use and the use of its Contractors,Subcontractors,
or Assignees of any resulting patented, copyrighted,or trademarked work products.
35. Emergency Preparedness and Continuity of Operations:
35.1 if the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety, or welfare, the Contractor shall,
within thirty(30) calendar days of the execution of this contract, submit to the AAASWFL Contract Manager,
verification of an Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the
AAASWFL of emergency provisions immediately,or as soon as practicable.
35.2 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall remain
responsible for performance under this contract and must follow procedures to ensure continuity of operations
without interruption.
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36. Equipment:
36.1 Equipment means: (a)tangible personal property(including information technology systems)having a useful life
of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization level
established by the organization for the financial statement purposes, or$10,000.00[for federal funds-2 CFR
200.33 and 45 CFR 75.2,as applicable],or(b);nonexpendable,tangible personal property of a non-consumable
nature with an acquisition cost of$10,000.00 or more per unit, and expected useful life of at least one(1)year;
and hardback bound books not circulated to students or the general public, with a value or cost of$250.00 or
more[for state funds].
36.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 200
Administrative Requirements (formerly OMB Circular A-110) that include: (a) a property list with all the
elements identified in the circular;(b)a procedure for conducting a physical inventory of equipment at least once
every two(2) years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of the
equipment;and(d)maintenance procedures to keep the equipment in good condition.The property records must
be maintained on file and shall be provided to the AAASWFL upon request. The Contractor shall promptly
investigate, fully document, and notify the AAASWFL Contract Manager of any loss, damage, or theft of
equipment.The Contractor shall provide the results of the investigation to the AAASWFL Contract Manager.
36.3 The Contractor's property management standards for equipment (including replacement equipment), whether
acquired in whole or in part with federal funds and federally-owned equipment shall, at a minimum, meet the
following requirements and shall include accurately maintained equipment records with the following
information:
36.3.1 Property records must be maintained that include a description of the equipment;
36.3.2 Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
36.3.3 Source of funding for the equipment,including the federal award identification number;
36.3.4 Whether title vests in the Contractor or the federal government;
36.3.5 Acquisition date(or date received,if the equipment was furnished by the federal government);
36.3.6 Information from which one can calculate the percentage of federal participation in the cost of the
equipment(not applicable to equipment furnished by the federal government);
36.3.7 Location,use and condition of the equipment and the date the information was reported;
36.3.8 Unit acquisition cost;and
36.3.9 Ultimate disposition data, including date of disposal and sales price or the method used to determine
current fair market value where a Contractor compensates the federal awarding agency for its share.
36.3.10 A physical inventory must be taken,and the results reconciled with the property records at least once
every two(2)years.
36.3.11 A control system must be developed to ensure adequate safeguards to prevent loss,damage,or theft of
the property. Any loss,damage,or theft must be investigated.45 CFR 75.320(d)(3).
36.3.12 Adequate maintenance procedures must be developed to keep the property in good condition.
36.3.13 If the Contractor is authorized or required to sell the equipment,proper sales procedures must be
established to ensure the highest possible return.
36.4 Equipment purchased with federal funds with an acquisition cost of $10,000.00 or less,and equipment purchased
with state funds with an acquisition cost less than $10,000.00 is part of the cost of carrying out the activities and
functions of the grant awards and title (ownership) will vest in the Contractor [for federal funds see 2 CFR
200.313(a)and 45 CFR 75.320(a),as applicable],subject to the conditions of 2 CFR Part 200 and/or 45 CFR Part
75. Equipment purchased under these thresholds is considered supplies and is not subject to property standards.
Equipment purchased with funds identified in the budget attachments to agreements covered by this contract or
identified in the sub-agreements with Subcontractors (not included in a cost methodology), is subject to the
conditions of Chapter 273,F.S.,rule 60A-1.017,F. A.C.,and 2 CFR Part 200 and/or 45 CFR Part 75.
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36.5 The Contractor shall not dispose of any equipment or materials provided by the AAASWFL or purchased with
funds provided through this contract without first obtaining the approval of the AAASWFL Contract Manager.
When disposing of property or equipment the Contractor must submit a written request for disposition instructions
to the AAASWFL's Contract Manager. The request should include a brief description of the property, purchase
price, funding source, and percentage of state or federal participation, acquisition elate and condition of the
property. The request should also indicate the Contractor's proposed disposition of the property(i.e.,transfer or
donation to another agency that administers federal programs,offer of the items for sale,destroy the items,etc.).
36.6 The AAASWFL Contact Manager will issue disposition instructions. If disposition instructions are not received
within one hundred twenty (120) days of the written request for disposition, the Contractor is authorized to
proceed as directed in 2 CFR 200.313 or 45 CFR 75.320, as applicable.
36.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract without the prior approval of the AAASWFL. Real property
purchases from Older Americans Act funds are subject to the provisions of Title 42,Chapter 35, Subchapter III,
Part A.,Section 3030b United States Code(U.S.C.). Real property purchases from state funds can only be made
through fixed capital outlay grants and aids appropriations and therefore are subject to the provisions of Section
216.348, F.S.
36.8 Any permanent storage devices(e.g.: hard drives,removable storage media)must be reformatted and tested prior
to disposal to ensure no confidential information remains.
36.9 The Contractor must adhere to the AAASWFL's procedures and standards when purchasing Information
Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR
worksheet is required for any computer related item costing S1,000.00 or more, including data processing
hardware, software, services, supplies, maintenance, training, personnel, and facilities. The completed ITR
worksheet shall be maintained in the LAN administrator's file and must be provided to the AAASWFL upon
request.The Contractor has the responsibility to require any Subcontractors to comply with the AAASWFL's ITR
procedures.
37. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
http://dms.myflorida.com/purchasing
In the event of any conflict between the PUR 1000 Form and any terms or conditions of this contract, the terms or
conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes,the terms or conditions contained
in the PUR 1000 Form shall take precedence.
38. Use of State Funds to Purchase or Improve Real Property:
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds provided
for at least five(5)years from the date of purchase or the completion of the improvements or as further required by law.
39. Dispute Resolution:
Any dispute concerning performance of the contract shall be decided by the AAASWFL Contract Manager,who shall
reduce the decision to writing and serve a copy on the Contractor.
40. Financial Consequences:
If the Contractor fails to meet the minimum level of service or performance identified in this contract, the AAASWFL
shall impose financial consequences as stated in Attachment I.
41. No Waiver of Sovereign Immunity:
Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
42. Venue:
If any dispute arises out of this contract,the venue of such legal recourse shall be Lee County,Florida.
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43. Entire Contract:
This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or representations
shall be valid or binding upon the AAASWFL or the Contractor unless expressly contained herein or by a written
amendment to this contract signed by both Parties. •
44. Force Majeure:
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party experiencing the force majeure condition provides immediate written notification to the other party
and takes all reasonable efforts to cure the condition.
45. Severability Clause:
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
46. Condition Precedent to Contract Appropriations:
The Parties agree that the AAASWFL's performance and obligation to pay under this contract are contingent upon an
annual appropriation by the Legislature and the award federal funds to the State for this Contract.
47. Addition/Deletion:
The Parties agree that the AAASWFL reserves the right to add or to delete any of the services required under this
contract when deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both
Parties. The Parties shall negotiate compensation for any additional services added.
48. Waiver:
The delay or failure by the AAASWFL to exercise or enforce any of its rights under this contract will not constitute or
be deemed a waiver of the AAASWFL's right thereafter to enforce those rights, nor will any single or partial exercise
of any such right preclude any other or further exercise thereof or the exercise of any other right.
49. Compliance:
The Contractor shall abide by all applicable current federal statutes, laws, rules, and regulations as well as applicable
current state statutes,laws,rules and regulations. The Parties agree that failure of the Contractor to abide by these laws
shall be deemed an event of default of the Contractor and subject the contract to immediate unilateral cancellation of
the contract at the discretion of the AAASWFL.
50. Final Invoice:
The Contractor shall submit the final invoice for payment to the AAASWFL no later than thirty (30) days after the
contract ending date unless otherwise specified in Attachment 1. If the Contractor fails to do so,all right to payment is
forfeited and the AAASWFL shall not honor any requests submitted after the aforesaid time period. Any payment due
under the terms of this contract shall be withheld until all required documentation and reports due from the Contractor
and necessary adjustments thereto have been approved by the AAASWFL.
51. Amendment or Modification:
Amendment or modification of the provisions of this Contract shall be valid only when they have been reduced to
writing and duly signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively
to reflect price level increases and changes in the rate of payment when these have been established through the
appropriations process and subsequently identified in the AAASWFL's operating budget.
52. Suspension of Work:
The AAASWFL may, in its sole discretion, suspend any or all activities under the contract or purchase order, at any
time, when in the interest of the State to do so. The AAASWFL shall provide the Contractor written notice outlining
the particulars of suspension. Examples of the reason for suspension include, but are not limited to, budgetary
constraints,declaration of emergency,or other such circumstances. After receiving a suspension notice,the Contractor
shall comply with the notice and shall not accept any purchase orders. Within ninety (90) days, or any longer period
agreed to by the Contractor, the AAASWFL shall either: (1) issue a notice authorizing resumption of work, at which
time activity shall resume, or (2) terminate the contract or purchase order. Suspension of work shall not entitle the
Contractor to any additional compensation.
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53. Termination:
53.1 Termination for Convenience. The AAASWFL,by written notice to the Contractor,may terminate this contract
in whole or in part when the AAASWFL determines in its sole discretion that it is in the State's interest to do so.
The Contractor shall not furnish any product after it receives the notice of termination, except as necessary to
complete the continued portion of this contract, if any. The Contractor shall not be entitled to recover any
cancellation charges or lost profits.
53.2 Termination for Cause. The AAASWFL may terminate this contract if the Contractor fails to: (1) deliver the
product within the time specified in the contract or any extension, (2) maintain adequate progress, thus
endangering performance of the contract, (3) honor any term of the contract, or (4) abide by any statutory,
regulatory,or licensing requirement. The Contractor shall continue work on any work not terminated. Except for
defaults of Subcontractors at any tier, the Contractor shall not be liable for any excess costs if the failure to
perform the contract arises from events completely beyond the control,and without the fault or negligence,of the
Contractor. If the failure to perform is caused by the default of a Subcontractor at any tier,and if the cause of the
default is completely beyond the control of both the Contractor and the Subcontractor, and without the fault or
negligence of either, the Contractor shall not be liable for any excess costs for failure to perform, unless the
subcontracted products were obtainable from other sources in sufficient time for the Contractor to meet the
required delivery schedule. If, after termination, it is determined that the Contractor was not in default, or that
the default was excusable,the rights and obligations of the Parties shall be the same as if the termination had been
issued for the convenience of the AAASWFL. The rights and remedies of the AAASWFL in this clause arc in
addition to any other rights and remedies provided by law or wider the contract.
54. Electronic Records and Signature:
The AAASWFL authorizes, but does not require, the Contractor to create and retain electronic records and to use
electronic signatures to conduct transactions necessary to carry out the terms of this contract. A Contractor that creates
and retains electronic records and uses electronic signatures to conduct transactions shall comply with the requirements
contained in the Uniform Electronic Transaction Act, Section 668.50, F.S. All electronic records must be fully
auditable;are subject to Florida's Public Records Law, Chapter 119, F.S.; must comply with contract Section 29, Data
integrity and Safeguarding Information; must maintain all confidentiality, as applicable; and must be retained and
maintained by the Contractor to the same extent as non-electronic records are retained and maintained as required by
this contract.
54.1 The AAASWFL's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the AAASWFL. The Contractor is authorized to conduct electronic transactions with the
AAASWFL only upon further written consent by the AAASWFL.
54.2 Upon request by the AAASWFL,the Contractor shall provide the AAASWFL with non-electronic(paper)copies
of records. Non-electronic (paper) copies provided to the AAASWFL of any document that was originally in
electronic form with an electronic signature must identify the person and the person's capacity who electronically
signed the document on any non-electronic copy of the document.
55. Contract Manager:
The AAASWFL may substitute any AAASWFL employee to serve as the AAASWFL Contract Manager.
56. Antitrust Assignment:
The Contractor, the AAASWFL, and the State of Florida recognize that in actual economic practice, overcharges
resulting from antitrust violations are in fact usually borne by the State of Florida. Therefore, the Contractor hereby
assigns to the State of Florida any and all claims for such overcharges as to goods, materials, or services purchased in
connection with the Contract.
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57.Official Payee and Representatives(Names.Addresses,and Telephone Numbers):
The Contractor name,as shown on page 1 of this contract, Collier County Board of County Commissioners
a. and mailing address of the official payee to whom the 3339 E. Tamiami Trail, Building H
payment shall be made is: Naples,FL 34112
Kristi Sonntag,Director
b. The name of the contact person and street address where Collier County Board of County Commissioners
financial and administrative records arc maintained is: Community and Human Service
3339 E.Tamiami Trail,Building H
Naples,FL 34112
The name,address,and telephone number of the Kristi Sonntag,Director
c. representative of the Contractor responsible for Collier County Board of County Commissioners
administration of the program under this contract is: Community and Human Service
3339 E.Tamiami Trail,Building H
Naples,FL 34112
The section and location within the AAASWFL where
d. Requests for Payment and Receipt and Expenditure forms Fiscal(a>AAASWFL.org
are to be mailed is:
Nga Cotter,CPA for Fiscal
e. The name,address,and telephone number of the Contract (Nga.Cotter@AAASWFL.org)
Manager for this contract is: Sarah Gualco for Program
(Sarah.Gualco@AAAS W FL.org)
2830 Winkler Ave.,Suite 112
Fort Myers, FL 33916
After the execution of this Contract, the party making any changes in representatives(names,addresses, telephone
numbers)must notify the other party in writing of such change and such changes shall not require a formal amendment
to the Contract.
58. All Terms and Conditions Included:
This contract and its Attachments I —XXIII, including any exhibits referenced in said attachments,together with any
documents incorporated by reference, contain all the terms and conditions agreed upon by the Parties. There are no
provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all
previous communications,representations,or agreements,either written or verbal,between the Parties.
By signing this contract,the Parties agree that they have read and agree to the entire contract.
IN WITNESS WHEREOF,the Parties hereto have caused this eighty-two(82)page contract to be executed by their
undersigned officials as duly authorized.
CONTRACTOR: AREA AGENCY ON AGING FOR
COLLIER COUNTY BOARD OF COUNTY SOUTHWEST FLORIDA,INC.
COMMISSIONERS
SIGNED BY: SIGNED BY:
aYbigkONAME: krri er-san NAME:Maricela Morado
TITLE: 0)1 t►� 4 er" TITLE:President and CEO
DATE: —j j�'' J DATE: 07.31.25
Federal Tax ID:59-6000558 Approved as to form and legal sufficiency,subject only to full
DUNS: 076997790 and proper execution by the Parties.
Approved as to form and legality
Page 16 of 82 Assistant County Attorney �AO
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INDEX OF ATTACHMENTS
ATTACHMENT I 18
STATEMENT OF WORK 18
ATTACHMENT II 39
FINANCIAL AND COMPLIANCE AUDIT 39
EXHIBIT I 42
EXHIBIT 2 44
ATTACHMENT III 45
CERTIFICATIONS AND ASSURANCES 45
ATTACHMENT IV 50
ASSURANCES—NON-CONSTRUCTION PROGRAMS 50
ATTACHMENT V 52
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST 52 •
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 54 •
ATTACHMENT VI 56
CONTRACTOR'S STATE CONTRACT LIST 56
ATTACHMENT VII 57
BACKGROUND SCREENING 57
ATTACHMENT VIII 58
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES(CMBE FORM) 58
ATTACHMENT IX 60
AAASWFL TOTAL COMPENSATION PAID TO NON-PROFIT PERSONNEL USING STATE FUNDS 61
ATTACHMENT X 62
BUDGET SUMMARY 62
ATTACHMENT XI 63
EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL 63
ATTACHMENT XII 64
RECEIPTS AND EXPENDITURE REPORT 64
ATTACHMENT XIII 65
REQUEST FOR PAYMENT 65
ATTACHMENT XIV 66
INVOICE REPORT SCHEDULE 66
ATTACHMENT XV 67
EHEAP APPLICATION AND ELIGIBILITY WORKSHEET 67
ATTACHMENT XVI 69
NOTICE REGARDING COLLECTION OF SOCIAL SECURITY NUMBERS EMERGENCY HOME ENERGY ASSISTANCE FOR
THE ELDERLY PROGRAM 69
ATTACHMENT XVII 71
NOTICE REGARDING AUTHORIZATION FOR RELEASE OF GENERAL AND/OR CONFIDENTIAL INFORMATION FOR
LIHEAP/EHEAP FEDERAL REPORTING 71
ATTACHMENT XVIII 73
EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS 73
ATTACHMENT XIX 76
EHEAP CLIENT FILE CONTENT CHECKLIST 76
ATTACHMENT XX 77
EHEAP COST REIMBURSEMENT SUMMARY 77
ATTACHMENT XXI 78
COST ALLOCATION PLAN 78
ATTACHMENT XXII 81
RECIPENT INFORMATION 81
ATTACHMENT XXIII 82
SERVICE RATE REPORT 82
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ATTACHMENT I
STATEMENT OF WORK
L SERVICES TO BE PROVIDED
A. DEFINITION OF TERMS
1. Eighteen (18) hour rule —The timeframe within which all applications for life-threatening crisis assistance
shall be acted upon, with an eligible action to mediate the crisis being taken and documented in the client file
within eighteen(18)hours of the application date stamp.
2. Forty-eight (48) hour rule—The timeframe within which all applications for standard crisis assistance shall
be acted upon,with an eligible action to mediate the crisis being taken and documented in the client file within
forty-eight(48)hours of the application date stamp.
3. Caseworker — Person who is responsible for determining program eligibility by completing the Emergency
Home Energy Assistance for the Elderly Program (EHEAP) Eligibility Worksheet (Attachment XV) and for
awarding crisis benefits.
4. Caseworker Signature Date — The date that the client's completed application is processed, eligibility
determined,and the crisis resolved. This date shall not be changed. Signatures must be in ink. Rubber-stamped
signatures will not be accepted.
5. Categorically Eligible—Applicants will be considered eligible to receive EHEAP services,regardless if their
household income is exceeding 150% of the Federal Poverty Guideline, if any member of their household is
receiving Temporary Assistance for Needy Families (TANF), Supplemental Social Security (SSI), or
Supplemental Nutrition Assistance Program(SNAP) benefits.
6. Client Application Date - The date of the application receipt is the date that the application was submitted
online by an applicant, or the date that an application was received by paper, phone, email or in-person. An
electronic signature is considered an original signature. If a hard-copy application is completed without a
signature, the case worker will reach out to the applicant to receive verbal confirmation and note the date and
time verbal confirmation was obtained.
7. Crisis -A home cooling or heating crisis exists when an elder has no access to,or is in danger of losing access
to, needed home energy.
8. Crisis Assistance—Assistance provided to an elder who has no access to, or is in danger of losing access to,
needed home energy.Contractor must refer to the current LIHEAP Policies and Procedures Manual for current
Crisis Assistance guidelines.
9. Date of Resolution —The date that a documented commitment to pay was made to the utility vendor to
resolve the energy crisis. This date is used as the EHEAP Client Enrollment date in the DOEA's Enterprise
Client Information and Registration Tracking System(eCIRTS). This date shall not be changed.
a, The amount of time elapsed between the Date Stamp and the Date of Resolution shall determine if the 18
or 48-hour rule was met.
b. Vendors must be paid within forty-five(45)days of the date of resolution.
10. Date Stamp—The date the application and all required documentation is presented in acceptable form to intake
staff. An inked stamp must be used, and the date shall not be changed. The 18 or 48-hour rule for crisis
resolution begins when the application is date-stamped.
11. Disability—A disabling condition that causes an elder to be determined eligible to receive Supplement Security
Income(SSI)or Social Security Disability Income(SSDI) from the Social Security Administration.
12. Elder—An individual aged sixty(60)years or older.
13. Eligible Action —An action taken by the caseworker to mediate an elder's energy crisis. All applications for
Crisis Assistance must be acted upon by Contractor, with an Eligible Action taken to mediate the crisis within
18 hours of the Application Receipt. Eligible actions include:
a. Approval of an elder's application and contact with utility vendor or other action to resolve the crisis,
such as providing non-utility services like blankets or fans.
b. Review of application and indicate that applicant needs to provide more information;
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c. Denial of an elder's application pending further information;
d. Denial of an elder's application because the elder is deemed ineligible;
c. Contact with a utility vendor to halt utility disconnection or interruption in services;or
f. Written referral to,and providing the elder with assistance to contact,another agency if EHEAP funding is
not available or the elder is ineligible.
14. Energy Subsidy - Utility costs paid directly or indirectly to the elder who lives in government—subsidized
housing.
15. Household—Any individual or group of individuals who are living together as one economic unit for whom
residential energy is customarily purchased in common or who make undesignated payments for energy in the
form of rent.
16. Household Member— Persons in a household who share a common kitchen or bath and purchase residential
energy in common.
17. Intake Worker—Person who accepts the EHEAP application and required documentation and may have the
responsibility to determine eligibility or award crisis benefits.
18. Minimum Level of Service—Service to a minimum of one household per month.
19. Crisis Assistance Benefit—Payment of heating/cooling energy bill.
20. Priority for Assistance—Households with the highest home energy needs and lowest household income,which
will be determined by taking into account both the energy burden and the unique situation of such households
with members of vulnerable populations, including very young children, individuals with disabilities, and frail
elder individuals.
21. Program Year-October la'-September 30'h
22. Provider—The entity that has entered into a contract,subcontract,or Memorandum of Understanding(MOU)
to provide services under EHEAP.For the purposes of this contract,the terms"Provider"and"Contractor"may
be used interchangeably.
23. Qualified Alien-This is defined in Personal Responsibility and Work Opportunity Reconciliation(PRWORA)
Act §431, 8 U.S.C. §1641 (1996) (commonly known as the "Welfare Reform Act"), as: legal permanent
residents, refugees, asylees, individuals paroled into the United States for a period of at least one year,
individuals whose deportation has been withheld,individuals granted conditional entry,and certain individuals
who are victim of domestic abuse.Qualified aliens are eligible to receive assistance and services under EHEAP
as long as they meet other EHEAP requirements.
24. Reasonable Promptness-Within fifteen(15)working days of receiving the client's completed application.
25. Request for Payment—Submission of actual monthly expenditures for reimbursement.
26. Service Unit—One individual(elder)served.
27. Social Security Number—The number on an elder's Social Security card or the number provided by an award
or determination letter from an entity,such as a government agency,that has already verified the social security
number.
28. Supervisory/Peer Review Date — The date that a supervisor or peer reviewed the application and
documentation and signed the application indicating vendor payment can be made. The intent of the
supervisor/peer review is to avoid errors in eligibility determination and payment amounts and to alleviate the
possibility of fraud. This date shall not be changed. Signatures must be in ink. Rubber-stamped signatures will
not be accepted.
29. Verification Date—The date the caseworker verified previous Low-Income Home Energy Assistance Program
(LIHEAP)crisis benefits with the LIHEAP provider or verified the minimum amount necessary to resolve the
crisis with the utility company. This date shall not be changed.
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B. GENERAL DESCRIPTION
1. General Statement
The Emergency Home Energy Assistance for the Elderly Program (EHEAP) serves the mission of the
AAASWFL by providing home energy assistance aid to elders in the event of a home energy heating or cooling
emergency. EHEAP is designed to assist low-income households with at least one member aged sixty(60)or
older experiencing a heating or cooling emergency.
2. Authority
The relevant federal and state authorities governing EHEAP are:
a. Low Income Home Energy Assistance Act of 1981 (Title XXVI of the Omnibus Budget Reconciliation Act
of 1981, P.L. 97-35),as amended;
b. 42 United States Code(U.S.C.)§ 8621 et seq.;
c. 45 Code of Federal Regulations(CFR)Part 96,Subpart H(§§96.80-96.89);
d. Section 409.508,Florida Statutes(F.S.)and Rule 73C-26.021(3),Florida Administrative Code(F.A.C.);
e. Rule Chapter 73C-26,F.A.C.;
f. State of Florida LIHEAP Policies and Procedures Manual,as amended;and
g. LIHEAP State Plan.
3. Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of EHEAP Eligible
elders may receive multiple crisis benefits per program year,not to exceed$2,000.00.
Weather-Related/Supply Shortage funds can be provided in addition to crisis benefits when authorized by the
Florida Commerce In the event of a weather-related event or supply shortage,the President of the United States,
Governor of the State of Florida, or Secretary of Florida Commerce may declare a weather-related crisis and
release additional funds to assist affected households. When benefits are distributed for a weather-
related/supply shortage emergency, the Contractor shall comply with directives provided by the Florida
Department of Elder Affairs(Department or DOEA)as to the allowable expenditures of these funds.
a. The services provided under this contract shall be in a manner consistent with and described in Attachment
I, Section II. Manner of Service Provision. The Contractor, in collaboration with its El-LEAP program
partners,shall ensure the following service tasks are completed:
(1) Consumer Outreach;
(2) Program Partners and Stakeholders Coordination;
(3) Elder's Benefit Eligibility Determination;and
(4) Benefit Disbursement.
4. Major Program Goals
EHEAP is designed to provide crisis assistance to eligible low-income households with at least one individual
aged sixty(60)or older experiencing a heating or cooling emergency.
a. Standard Crisis
A standard home cooling or heating crisis exists when an elder has no access to,or is in danger of losing
access to, needed home energy because one or more of the following conditions is present:
(1) The elder has been notified that the energy source for cooling or heating is going to be disconnected;
(2) The elder has received a notice indicating the energy source is delinquent or past due;and/or
(3) The elder has an energy bill for which the due date has lapsed;
b. Life-Threatening Crisis
A life-threatening home cooling or heating crisis exists if one of the following conditions is present:
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(1) The elder's home cooling or heating energy source has been disconnected;
(2) The elder is unable to get delivery of fuel for heating, is out of fuel for heating,or is in danger of being
out of fuel for heating; or
(3) The elder has other problems with lack of cooling or heating in the home, such as needing to pay a
deposit,needing a repair of heating or cooling equipment,or needing an interim emergency measure to
avoid further crisis.
c. Crisis Assistance
Allowable categories for crisis assistance are:
(1) Utility payments for heating/cooling bill assistance for electric, gas, propane,wood, coal, or refillable
fuels;
(2) Temporary emergency shelter(if needed due to energy-related crisis);
(3) Payment to landlords(when utility costs are included in rent);
(4) Deposits to connect or restore energy;
(5) Late fees,disconnect fees,and reconnect fees;
(6) Charges from a previous account held by the applicant that is now closed;
(7) Blankets and fans;
(8) Taxes and fees associated with the client's utility bill towards the energy portion.In some cases,where
the utility vendor combines all the other fees and taxes,which also includes non-home energy services,
such taxes and fees can be paid with EHEAP funding.
Example: in a case where taxes for other services are commingled with taxes for home energy services,
proceed with paying the taxes portion of the bill.
(9) Other allowable payments are those related to the start-up of services,including reasonable connection
or reconnection fees,delivery fees,deposits,and other fees related to the start-up of service.
C. CLIENTS TO BE SERVED
1. General Description
EHEAP provides for direct client services to elders in low-income households experiencing a home energy
heating or cooling emergency. A household receiving EHEAP services may not have an income above sixty
percent (60%) of the current Florida State Median Income guideline for households of I-to-8 members, nor
exceed one hundred filly percent (150%) of the Federal poverty level guideline for households of 9 members
or more,as published by the United States Department of Health and Human Services, unless the household is
determined categorically eligible.
2. Client Eligibility
To be eligible for services under this contract,and to receive assistance,an elder must:
a. Be aged sixty(60)or older;
b. Reside in the EHEAP service area (Planning and Service Area) at the time the home energy costs were
incurred;
c. Complete and return an EHEAP application with all required information and verification to the Contractor,
while funds remain available;
d. Provide a fuel bill or other documentation evidencing an energy emergency and an obligation to pay for
home energy costs for the home in which they live;
e. Possess a total gross household income of not more than sixty percent (60%) of the current Florida State
Median Income guideline for households of 1-to-8 members, nor exceed one hundred and fifty percent
(150%) of the Federal Poverty Level guideline for households of 9 members or more, in accordance with
Section I.C.3.d. below, or be determined categorically eligible to receive EHEAP benefits;
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f. Be experiencing one or more verifiable home cooling or heating crises;
g. Not be a resident of a group living facility or a home where the cost of residency is at least partially paid
(or subsidized) through a foster care or residential program administered by the state;
h. Not be a student living in a dormitory;and
i. To Be eligible for El lEAP, the applicant must be a citizen of the United States,a permanent legal resident, •
or a qualified alien who Is eligible for federal benefits,
j. If anyone in the household is receiving Supplemental Security Income (SSI), SNAP, TANF, or a means-
tested veterans' program, the household is considered to have met legal resident status and no further
documentation is required.
3. Client Determination
The Contractor shall begin taking applications for EHEAP services upon execution of this contract and continue
taking applications until the contract expires or funds are exhausted. The Contractor shall not accept
applications when funds are exhausted for a particular time period. The Contractor shall:
a. Provide assistance to elders in completing-provided applications for assistance and determining eligibility;
b. Ensure that no one is excluded from program participation on the grounds of race, color, national origin,
sex,or age,and ensure that such persons shall not be subjected to discrimination under any activity funded
in whole or in part with these funds;
c. Treat homeowners and those who rent equitably under this contract;
d. Calculate the income eligibility of the elder by using the past thirty(30)days earnings for all occupants of
the household annualized or the elder's current economic situation and reference the current year Sources
of Income that can be found in the LIHEAP policies and Procedures Manual to determine what is considered
allowable income. The Contractor shall proceed as follows:
(1) Total household income cannot exceed sixty percent (60%) of the current Florida State Median
Income guideline for households of I-to-8 members, nor exceed one hundred filly percent(I50%)of
the current Federal Poverty Level Guidelines for households of 9 members or more(disseminated by
the AAASWFL to the Contractors via email)unless the household is determined categorically eligible;
and
(2) Obtain a written self-declaration from any household members aged eighteen (18) years or older
claiming zero income. The self-declarations must be completed and signed by the household member
who is claiming zero income.
(3) All sources of included and excluded income can be found in the LIHEAP Policies and Procedures
Manual.
e. Determine if all or part of the elder's utility costs are paid directly (utility reimbursement) or indirectly
(utility allowance)by the government if the elder lives in government-subsidized housing. The Contractor
shall proceed as follows:
(1) If total home heating or cooling costs are included in the rent and the elder has no obligation to pay any
portion of the costs,then the elder is not eligible for assistance;and
(2) If there is a Florida Section 8(Housing Choice Voucher Program)or a Public Housing Authority(PHA)
Program energy subsidy available to the elder during the period covered by the utility bill, then the
elder is only eligible for partial assistance. The energy subsidy for the period covered by the utility bill
must be subtracted from the allowable EHEAP benefit calculated for the household.
f. For applicants or any members of their household receiving Supplemental Nutrition Assistant Program
(SNAP) or Supplemental Security Income (SSI), or Temporary Assistance for Needy Families (TANF)
program will not be subject to income eligibility as these clients will be considered as categorically eligible
or automatically qualified.
g. Ensure elders have not exceeded the maximum amount of crisis assistance during the program year The
Contractor shall proceed as follows:
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(1) Crisis assistance benefits may consist of payments of more than one energy obligation, for a household
to resolve a single crisis, thus allowing for:
(I) The purchase or repair of fans, blankets, and/or portable heaters in addition to heating/cooling bill
assistance, that combined does not exceed the maximum crisis;and
(ii) Crisis situations which may involve a heater or air conditioner that is powered by both gas and
electricity, in which case both energy obligations are eligible for a crisis benefit payment that
combined does not exceed the maximum crisis benefit.
(2) Water,sewer,garbage,and fire,etc.charges may not be paid;
(3) Deposits to connect or restore energy are allowable;
(4) Late fees,disconnect fees,and reconnect fees are allowable;
(5) Charges from a previous account held by the elder that is now closed are allowable;
(6) Payment to landlord when utility costs are included in the elder's rent is allowable;and
(7) Payment for temporary emergency shelter is allowable if due to an energy-related crisis.
i. In no case shall the Contractor be required to incur costs in excess of the full contract amount to provide
services to the clients.
II. MANNER OF SERVICE PROVISION
A. SERVICE TASKS
In order to achieve the goals of EHEAP,the Contractor shall ensure the following tasks are performed:
1. Ensure that all eligible elders meet the requirements of Section I.C.2.above;
2. Ensure that all energy assistance payments made to home energy vendors comply with the requirements of
Section II.A.14.d. below;
3. Implement appropriate program management and operational controls to ensure actions are taken to resolve a
home energy emergency within 18 hours of application approval for crisis benefits when the consumer is in a
life-threatening situation. For non-life-threatening situations,one or more Eligible Actions must be undertaken
to resolve the home energy emergency within 48 hours of application approval with standard crisis assistance
and document the Client File with which Eligible Action was used.
4. Provide all elders approved for EHEAP funding with a written Notice of Approval and Appeal within fifteen
(15)working days of crisis resolution. The written Notice of Approval and Appeal shall include:
a. Type and amount of assistance;
b. Name of the home energy vendor to be paid on elder's behalf;
c. Contractor's appeal process.
5. Provide all elders whose EHEAP applications were denied with a written Notice of Denial and Appeal within
fifteen (15) working days of receiving the elder's application. The written Notice of Denial and Appeal shall
contain:
a. Name of the elder;
b. Date of application;
c. Type of benefit sought;
d. Reason(s)for denial;
e. Statement on Contractor's benefit limits, if applicable;
f. Contractor's appeal process;
g. Explanation of circumstances under which the elder may reapply;
h. Information or documentation needed for the elder to reapply;
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i. The name,address,and phone number applicable to the appeal process;and
j. Number of days the elder has to file the appeal.
6. Maintain consumer appeal procedures that provide an opportunity for a fair administrative hearing to elders
whose applications for assistance arc denied or whose applications arc not acted upon with reasonable
promptness;
7. Provide an opportunity for elders to file a written appeal or complaint with the Contractor's Program Supervisor
within ten(10)working days of receipt of the written Notice of Denial and Appeal.
a. Upon receipt of a validly filed appeal or complaint,the Contractor must respond in writing within ten (10)
working days;
b. Elders may appeal the Contractor's first response by filing objections to the response with the Contractor's
Director, Executive Director, or Board Chair,as applicable, within five (5) working days of receipt of the
first response;and
c. Upon receipt of a validly filed objection to the first response,the Contractor must respond in writing within
ten(10)working days, and the response must clearly state the final outcome of the appeal,that the decision
is final,and if applicable,the circumstances under which the elder may reapply for services.
8. Post appeal provisions in a prominent place and in plain view at all locations where EHEAP applications are
received;
9. Ensure all ineligible applicants and applicants denied crisis assistance,when EHEAP funds arc not available or
are insufficient to meet their emergency home energy needs,arc referred to and assisted in securing help through
other community resources;
10. Ensure no consumer fees are charged to,nor donations accepted from, an elder as a prerequisite for receiving
EHEAP benefits. The Contractor shall post the following notice in a conspicuous place at all locations where
EHEAP applications arc received: "No money,cash,or checks will be requested or received from customers in
the EHEAP office. if an employee asks for money, report this to the agency executive director or AAASWFL
head.";
11. Compare LIHEAP records and EHEAP records for households with elderly members to avoid duplicate crisis
assistance payment during the same eligibility period and maintain documentation sufficient to ensure
compliance with this requirement;
12. Maintain a written policy and implement procedures to protect and secure elder applicants' information and
social security numbers in order to protect their identities from theft or fraud. This policy shall address the
handling of both paper and electronic records and files. The Contractor shall,in collecting elders'social security
numbers, use the Notice Regarding Collection of Social Security Numbers (Attachment XVi). The Notice
Regarding Collection of Social Security Numbers shall be signed by the elder and retained in the client file;
13. Perform consumer outreach to ensure that households in all counties within the service area wishing to benefit
from the program have the opportunity to do so. The Contractor shall undertake consumer outreach initiatives
in all counties within the service area designed to inform potentially eligible households about EHEAP.
Outreach efforts must focus on elderly households with disabled individuals, young children, and where the
highest percentage of the household income is required to pay for their home energy. Specific outreach
initiatives shall include,but are not limited to,the following:
a. informing all service area local agencies, non-profits, and similar organizations that are in regular contact
with the low-income population about the EHEAP program, especially those serving seniors;
b. Encouraging EHEAP program participation through local television and radio programs, and placing
announcements of the EHEAP program in media community calendars;
c. Developing and implementing a written procedure for making home visits to households with homebound
elderly persons in order to assist with the completion of the program application when other assistance is
not available;
d. Making visits to provide information and/or making presentations about EHEAP in response to requests by
local congregational centers serving elderly or disabled persons;
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e. Providing information concerning the local weatherization program to all persons who request it(including
organizations that provide outreach activities); and
f. Maintaining an EHEAP Outreach Activity Report to demonstrate to the AAASWFL that outreach efforts
to inform potentially eligible households about EHEAP are conducted to target households in all counties.
14. Coordinate services with other program partners and stakeholders to prevent the duplication of services,
facilitate referrals,and improve the efficiency of services for consumers. Coordination activities shall include,
but not be limited to,the following:
a. Communicating with Florida Commerce LIHEAP contractors in their respective service areas to prevent
the duplication of benefits to elders.Additionally,the Contractor shall review LIHEAP and EHEAP records
for households with elderly members to ensure that duplicate crisis assistance payments arc not received
during the same Program Year.
b. Developing a new, or continuing an existing, Memorandum of Understanding (MOU) with the
Weatherization Assistance Program (WAP) in the service area. The MOU shall detail cooperative efforts
and describe the actions that will be taken by both parties to ensure coordination and referrals.Contractor,
in coordination with the local WAP agency, shall develop a system by which elders who have received
more than three EHEAP and LIHEAP benefits in the last eighteen(18) months and who are homeowners
are referred to a WAP provider. The MOU shall be reviewed and renewed at least every three years. The
Contractor shall maintain copies of all MOUs. MOUs with local WAP agencies shall be updated if the
contracting parties change. The MOUs must be applicable to Contractor's current EHEAP program
requirements and guidelines;
c. Establishing a new, or continuing an existing, MOU with service area LIHEAP contractors. Each MOU
shall ensure coordination of services to avoid duplication of assistance and increase the quality of services
provided to elders. The MOU shall direct LIHEAP providers to refer elders aged sixty (60) or older to
EHEAP providers for energy assistance.The MOU shall be reviewed and renewed each program year.The
Contractor shall maintain copies of all MOUs. MOUs with local LIHEAP agencies shall be updated if the
contracting parties change. The MOUs must be applicable to Contractor's current EHEAP program
requirements and guidelines;
d. Developing agreements with home energy vendors that benefit elders.The Contractor shall maintain copies
of all vendor agreements. All agreements between the Contractor and home energy vendors shall contain
the following conditions:
(1) The beginning and ending date of the Vendor Agreement;
(2) The Contractor's representative(s) authorized to resolve a crisis situation and make a payment
commitment on behalf of an elder;
(3) The home energy vendor's representative(s)authorized to resolve a crisis;
(4) A description of how energy payments will be made directly to the home energy vendor on behalf of
the EHEAP eligible customer;
(5) Assurance from the home energy vendor that no household receiving EHEAP assistance will be treated
adversely because of such assistance under applicable provisions of state law or public regulatory
requirements;
(6) Assurance that the home energy vendor will not discriminate,either in the cost of goods supplied or the
services provided,against the eligible household on whose behalf payments are made;
(7) A statement that only energy-related elements of a utility bill are to be paid. Water,sewer,garbage,and
fire, etc. charges are not covered as part of the utility bill of the household. However, EHEAP does
allow an exception with water that is used for air conditioning,i.e.an evaporated cooler;
(8) A statement that the Contractor may not pay for charges that result from illegal activities such as a
worthless check or meter tampering,and that the home energy vendor is aware that those charges are
the responsibility of the elder;
(9) Assurance from the home energy vendor that when the benefit amount to the elder does not pay for the
complete charges owed by an elder,the elder is responsible for the remaining amount owed;
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(10) Details on how the home energy vendor will assist the Contractor in verifying the elder's account
information and, in the case of crisis assistance, make timely commitments to resolve the crisis. A
process should be in place to verify the current amount owed and the minimum amount necessary to
resolve the crisis situation;
(11) Contractor's commitment to make payment to the home energy vendor within forty-five (45) days of
the date of crisis resolution;
(12) Assurance from the home energy vendor that when EHEAP payments made to the vendor cannot be
applied to the elder's account, the funds will be returned to the Contractor or, with the Contractor's
approval,be applied to another eligible customer's account;
(13) Assurance that the Contractor shall collect a signed Authorization for Release of General and/or
Confidential Information(Attachment XVII) for EHEAP Data from each eligible elder and ensure the
signed releases arc available for inspection by the home energy vendor;
(14) Assurance that the home energy vendor is aware that as long as signed Authorization for Release of
General and/or Confidential Information for EHEAP Data are collected and available,the home energy
vendor will provide the requested customer data to Florida Commerce.
(15) The agreement will be reviewed by both parties at least every five(5)years;
(16) The agreement must be signed by a representative of both the Contractor and the vendor who has
authority to bind the entity and enter into such commitments; and
(17) The home energy vendor, with the exception of municipal providers, must be in "active" status with
the State of Florida(http://sunbiz.org/search.html)and the vendor's name must be checked on Excluded
Parties List System(EPLS)(www.sam.gov). The business name on the vendor agreement must match
the legal business name on the State of Florida website.
15. Comply with the Federal Financial Accountability and Transparency Act(FFATA)by securing a Unique Entity
Identifier(UE1)number(www.sam.gov)and maintaining an active and current profile in the System for Award
Management(SAM) (www.sam.gov); and
16. Policy changes concerning the amount of crisis benefits available to elders require AAASWFL approval and
require notification of the change be sent to current and potential elders.
B. STAFFING REQUIREMENTS
1. Use of Subcontractors
If an entity other than the Contractor provides any service required under this contract,the Contractor shall
ensure the following requirements arc met:
a. Eligible entities that provide outreach, perform intake, make eligibility determinations,or process benefit
payments must be one of the following:
(1) A Local City Government;
(2) A Local County Government;
(3) A Community-Based Organization;
(4) A Faith-Based Organization;or
(5) A State Community Services Agency.
b. For the term of this contract, each month the Subcontractor shall provide to the Contractor the following
information:
(1) The total number of individuals served with crisis assistance for the reporting month;
(2) The total number of individuals ineligible or denied assistance during the reporting month;
(3) The total number of individuals served by referral to other community resources for energy assistance
during the reporting month;
(4) The total amount of funding expended for crisis assistance per county for the reporting month;and
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(5) An EHEAP Outreach Activity Report to demonstrate that outreach efforts to inform potentially eligible
households about EHEAP are conducted to target households in all counties.
c. Entities providing any service required under this contract must comply with the FFATA. This includes
securing a UEI number (Unique Entity Identifier) and maintaining an active and current profile in the
System for Award Management(SAM)(www.sam.gov).
C. SERVICE DELIVERY
1. Service Delivery Location
The Contractor shall ensure that the services provided under this contract are available to residents within each
county in the Planning and Service Area(PSA)by in-person service,telephone,and/or other electronic means.
2. Service Times
The Contractor shall provide the services listed in this contract during normal business hours.Normal business
hours are defined as Monday through Friday, 8:00 a.m. to 5:00 p.m. local time, excluding state-observed
holidays and force majeure.
3. The Contractor shall publish its service delivery location,toll-free telephone number,and normal business hours
in available forms of media(i.e.newspapers,radio, television,website,publications,etc.).
D. DELIVERABLES
1. Deliverables
a. Certification that the Contractor must operate during its regular business hours, as identified in Section
1LC.2.of this contract.
b. The Contractor shall provide the minimum level of service per month in each county served, as defined in
Section I.A.18.
2. Source Documentation
The deliverables shall be reported monthly on Contractor's monthly financial status reports. Successful
completion of the deliverables shall be determined by the AAASWFL's receipt of Contractor's Receipts and
Expenditure Report (Attachment Xii) and Request for Payment (Attachment XIII) containing the number of
individuals served with crisis assistance; number of individuals ineligible or denied assistance; number of
applicants served by referral to other community resources for energy assistance;a summary of funds expended
per county for the reporting month using the EHEAP Cost Reimbursement Summary form(Attachment XX);
and the certification required in Section II. D.1.
3. Records and Documentation
The Contractor will maintain a separate record(paper and eCIRTS)for each EHEAP applicant that includes the
following,as applicable:
a. The EHEAP Application and Eligibility Worksheet(Attachment XV)completed and signed by Contractor
and the elder. The application must be approved by a supervisor or peer prior to payment remittance.
Contractor is responsible for using the most recent application, eligibility worksheet, and EHEAP
Application and Eligibility Worksheet Instructions(Attachment XVIII) issued by the AAASWFL.
(1) If Contractor approves an application, one elderly member of the household must be registered in
eCIRTS using the EHEAP Application and Eligibility Worksheet(Attachment XV);or
(2) if Contractor denies an application, the elder must be registered in eCIRTS using the EHEAP
Application and Eligibility Worksheet(Attachment XV).
b. The elder's name,address,sex,and age;
c. Names, ages, and current identification documentation (no more than one year expired) of all household
members;
d. Social Security numbers and documentation of those numbers for all household members,or the citation to
the applicable exemption;
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e. Signed notice regarding the collection of Social Security numbers(Attachment XVI)
f. Income amount and method of verification for all household members;
g. Income documentation to support eligibility that is representative of the elder's current economic situation;
h. Statement of self-declaration of income,if applicable;
i. A signed statement of how basic living expenses(i.e., food,shelter,and transportation)are being provided
if the total household income is less than fifty percent(50%)of the current Federal Poverty Guidelines and
no one in the household is receiving SNAP assistance;
j. Documentation of the elder's obligation(s)to pay an energy bill for the residence in which they live;
(1) The elder's utility bill must include detail to identify unallowable categories of assistance resulting
from charges for water, sewer, garbage, and fire, etc.; charges resulting from meter-tampering and
returned checks; and other charges that are not energy-related and are not required for cooling/heating
the household.
(2) Use of the most current utility bill(s)which provides the vendor's name and address, account holder's
name and physical address, account number, and amount(s) due is required. If an elder's utility bill,
cutoff notice, door-hanger notice, or similar documentation does not include all of this information,
Contractor must document the verified missing information by writing the information on the utility
bill and on the EHEAP Application and Eligibility Worksheet(Attachment XV).
k. Signed Authorization for Release of General and/or Confidential Information for LIHEAP/EHEAP Federal
Reporting or a statement on the application which states that the elder refused to sign the waiver;
1. Copies of approval or denial letters,including those related to the initial application,and all appeals,which
are provided to the elder;
m. if preference is given due to a disability,documentation of such disability that includes disability income
or a physician's statement;
n. Documentation of referrals to LIHEAP and WAP;
o. Notation if EHEAP prevented a disconnection or restored an energy disruption;
p. Documentation of coordination with LIHEAP providers to avoid duplication of crisis services for
households with elderly residents;
q. Proof of payment made to vendors;
r. Documented calculation of crisis benefits for elders living in subsidized housing;
s. Documented calculation of crisis benefits for elders whose energy bill includes unallowable charges;and
t. Completed EHEAP Client File Content Checklist(Attachment XIX).
E. PERFORMANCE SPECIFICATIONS
1. Reports
Contractor is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the AAASWFL.Contractor must establish due dates for any subcontractor's
report that permits Contractor to meet the AAASWFL's reporting requirements.
a. Contractor shall report monthly on Contractor's Request for Payment (Attachment XIII) as delineated in
Section II.E.l.f. of this contract.
b. Administrative and Outreach Expense Budget Detail
Contractor shall submit to the AAASWFL's EHEAP Contract Manager the EHEAP Administrative and
Outreach Expense Budget Detail (Attachment XI). The Administrative and Outreach Expense Budget
Detail shall clearly delineate planned expenditures for funds retained by the Contractor and funds
subcontracted. The Administrative and Outreach Expense Budget Detail shall include all Contractor
positions, by title, to be paid with these funds and shall detail the estimated number of hours, the hourly
wage, and the estimated salary to be paid by EIIEAP. Funding sources, estimated hours, and hourly wage
shall be identified for the balance of salary where EHEAP funds are used to pay less than one hundred
percent(100%)of the salary. Percentages must be supported by the submitted cost allocation plan.
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c. Cost Allocation Plan
The Contractor shall submit to the AAASWFL's EHEAP Contract Manager the EHEAP Cost Allocation
Plan (Attachment XXI). The Cost Allocation Plan shall provide budgeting methodology, allocation
distribution,and the data source(s)used.
d. Cost Analysis
State of Florida Chief Financial Officer Memorandum No. 02 (released October 3, 2012), requires
Contractor to provide assistance to the AAASWFL's Contract Manager in completing the AAASWFL Cost
Analysis For Non-Competitively Procured Contracts In Excess of Category II-Addendum to the EHEAP
Cost Allocation Plan(Attachment XXI).
(1) The Contractor shall submit a completed Cost Analysis which shall reflect Administrative, Outreach,
and Crisis Service allocations as delineated on the Budget Summary (Attachment X) and must be
sufficient to explain the expenditures'allowability,allocability,and reasonableness.The Cost Analysis
shall be submitted to and approved by the AAASWFL prior to execution of this contract.All subsequent
amendments that affect the budget shall also require a completed Cost Analysis be submitted and
approved by the AAASWFL prior to any change.
e. EHEAP Administrative Costs Report
Within the first quarter of this contract,Contractor shall provide the EHEAP Contract Manager a list of all
individuals performing any administrative functions for EHEAP. The list must include Contractor's
employees, agents, and representatives; as well as, all employees, agents, or representatives of
subcontractors, serving EHEAP administratively. For each individual on the list, Contractor must also
provide the individual's EHEAP administrative duties and functions. Additionally, Contractor must
provide total salary and benefit amounts for each individual on the list,specifying all funding sources from
which that person is paid,and the corresponding amounts of that pay charged to each funding source.
f. Program Effectiveness Reports
The Contractor agrees to provide to the AAASWFL any additional service reports requested by the
AAASWFL concerning the effectiveness of the program and shall include any statistics and information
that the AAASWFL may require.The reporting period shall begin with the effective date of this contract in
a format and according to a schedule provided by the AAASWFL for each report.
2. Monitoring and Evaluation Methodology
The Contractor shall monitor its performance under this contract, as well as that of its subcontractors, and
consultants who are paid from funds provided under this contract, to ensure that the scope of work is
accomplished within the specified time periods and budgets set and that other performance goals stated in this
contract are achieved. Such review shall be made for each function or activity set forth in this contract and
reported in the monthly client service report.
a. Contractor shall review completed EHEAP applications in accordance with the EHEAP Client File Content
Checklist(Attachment XIX).
b. The AAASWFL shall, at its own discretion,conduct investigations concerning any aspect of Contractor's
performance of this contract.
c. The AAASWFL shall conduct a full onsite review of the Contractor at least once during each three-year
period. Contractor shall allow the AAASWFL to carry out monitoring,evaluation,and technical assistance,
and shall ensure the cooperation of its employees.
d. The AAASWFL shall conduct desk review activities throughout the year to monitor contractual program
requirements.
e. The AAASWFL shall conduct EHEAP intake site visits.
f. in conjunction with onsite monitoring visits and desk review activities, the AAASWFL shall review a
sample of completed EHEAP client files in accordance with the EHEAP Client File Content Checklist
(Attachment XIX).
g. The AAASWFL shall conduct follow-up reviews including prompt return visits to Contractors that fail to
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meet the goals,standards, and requirements established by the state and federal funding agency.
F. CONTRACTOR RESPONSIBILITES
1. Make vendor payments directly to fuel and/or home energy providers on behalf of eligible elders.
2. Determine the correct amount of each crisis benefit based on the minimum necessary amount needed to resolve
the crisis,but not more than the item limits or total limit set by the DOEA.
3. Encourage households to seek assistance prior to incurring non-energy penalties such as disconnect/reconnect
fees, additional deposits, interest,or late payments.
4. Provide EHEAP crisis services to households with elders in every county within the contracted service area.
a. The Contractor shall provide oversight to ensure that each county within their service area receives the
minimum level of crisis services monthly,as delineated in Section 1.A.17.; and
b. EHEAP funded staff shall make themselves available in all underserved counties within the contracted
service area as needed,to ensure that the minimum level of service is met.
5. Make crisis benefit payments to vendors on behalf of approved elders within forty-five(45)days of the date of
crisis resolution.
6. Make payments on behalf of those elders with the highest home energy needs and the lowest household income,
which will be determined by taking into account both the energy burden and the unique situation of households
that result from having members of a vulnerable population, including very young children, the disabled, and
frail elders.
7. Refund to the AAASWFL,with non-federal funds,all funds incorrectly paid on behalf of elders that cannot be
collected from the elder.
8. Develop adequate procedures to ensure EHEAP funds are appropriately budgeted and expended to permit
payment of energy assistance benefits during the program year , ensure that this is a twelve-month program,
and ensure that funding is available to, and expended in, all counties within the Contractor's service area.
Procedures should include referral to other community agencies when funds budgeted for a particular time
period are exhausted and elders are subsequently denied.
9. Develop monitoring and oversight procedures to ensure that administrative costs that exceed the contracted
EHEAP administrative award to the Contractor or Subcontractor are paid from non-federal sources.
10. Develop adequate procedures to address the use of EHEAP funds for elders who are on oxygen support or a
"Lifeline Program"and must have power.
11. Ensure providers and appropriate staff participate in training opportunities to cover EHEAP policies and
procedures.
12. Ensure the provision of training for all providers and staff members assigned responsibilities within the program.
13. Maintain an EHEAP Policies and Procedures Manual to serve as a local resource for program administration,
training, and reference. The EHEAP Policies and Procedures Manual shall be distributed to all subcontractors
that provide any service under EHEAP.The EHEAP Policies and Procedures Manual shall be reviewed during,
and in accordance with, the AAASWFL's EHEAP contract monitoring schedule, and shall include the
following:
a. The State of Florida LIHEAP Policies and Procedures Manual;
b. An MOU or Subcontract with El-lEAP providers;
c. An MOU with all service area LIHEAP providers;
d. An MOU with all service area WAP providers;
e. Contractor's cost allocation methodology;
f. Written policies and procedures to ensure that all energy assistance payments made to home energy vendors
comply with the requirements of the Vendor Agreement, as stated in Section i1. A, d.,of this Attachment;
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g. Adequate procedures to ensure that EHEAP funds arc appropriately budgeted and expended to sufficiently
allow for energy assistance benefits during the program year ensure that this is a twelve-month program,
and to ensure that funding is available to,and expended in all counties within the Contractor's service area;
h. Policies regarding the detection and prevention of fraud and abuse of program funds. At a minimum the
policy will address initiatives reflective of the detection and prevention of internal and external collusion,
conspiracy,and complacency.
i. These policies will incorporate internal controls that provides for safeguarding assets,proper recording
of transactions,efficient and effective accomplishment of goals and objectives,and compliance of rules
and other governance through the segregation of duties.
ii. The concept of segregation of duties is to separate the following responsibilities in each business
process.
(1.)Custody of assets
(2.)Record keeping
(3.)Authorization
(4,)Reconciliation
iii. When duties cannot be segregated, compensating controls should be considered. Compensating
controls can be preventative, detective, or monitoring controls that are executed by an independent,
supervisory-level employee who does not have custody, record-keeping, authorization, or
reconciliation responsibilities for the process.
i. Policies that address serving friends, family members, and employees, that includes senior management
oversight and approval of:
i. Application and eligibility determination;and
ii. Benefit determination and award.
j. Policies and procedures to secure applicant Social Security Numbers in order to protect applicants'
identities,that at a minimum, include:
i. Storage of active and archived paper client files.
ii. Access to, use of, storage, and disposal of client database printouts and reports containing client
information.
iii. Transporting applicant information and client files from one location to another.
iv. Authorization to access both paper and electronic files.
v. Retention conditions and means of disposal of archived client information and files.
k. Procedures for data integrity;
i. The AAAs will ensure all providers maintain written procedures for computer system backup and
recovery.
ii. All data and software shall be routinely backed up to ensure recovery from losses or outages of the
computer system.
iii. The security over the backed-up data is to be as stringent as the protection required of the primary
system.
iv. An appropriate level of security includes approving and tracking all provider employees that request
system or information access and ensuring that user access has been removed from all terminated
employees.
v. Contractor shall not use confidential information exchanged under this Agreement for any purpose not
specifically authorized by this Agreement.The Parties agree that confidential information will be used
only to the extent necessary to assist in its valid administrative needs and shall be disclosed only for
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those purposes defined in this Agreement to those persons who have a valid need for access to this
information
vi. Contractor shall store all confidential information in a place physically and electronically secure from
access, review, or retrieval by unauthorized persons through physical, magnetic, media, or electronic
means.
vii. Contractor shall ensure: 1)that confidential information received under this Agreement is not stored on
any portable storage media or peripheral devices(e.g., laptops, thumb drives, hard drives,etc.) unless
the devices are encrypted; 2) that security policies and protocols which require active authentication
and password credentialing are in place; and 3) that the amount of data stored on such devices is
restricted and the length of time data is stored on such devices is limited to the minimum amount of
time necessary to carry out the official duties and responsibilities requiring such storage.
viii.Contractor shall take precautions to ensure that only authorized employees, contractors, other
authorized users or utilities(only to the extent needed to assist with eligibility determination),who have
a recognized need to know are given access to systems containing the confidential information
exchanged under this Agreement
ix. Contractor shall instruct all personnel with access to the confidential information regarding the
confidential nature of the information,the requirements of this Agreement,and the sanctions specified
in Florida law,as well as 20 CFR Part 603,against unauthorized disclosure of information covered by
this Agreement. By signing this Agreement,Contractor acknowledges that all personnel having access
to the information disclosed under this Agreement have been instructed in accordance with this
provision and that they shall be held responsible for ensuring that their employees,contractors and other
authorized users comply with the safeguards of 20 CFR 603.
x. Contractor shall destroy all confidential information exchanged under this Agreement in their
possession or in their employees', agents', or subcontractors' possession when the information is no
longer needed for the specific purpose authorized in this Agreement,pursuant to the requirements of
20 CFR 603.9(b)(1)(vi). Contractor shall destroy any duplicate, copy, or other replication of
confidential information received under this Agreement in a manner which will prevent reconstruction,
duplication,access,and inappropriate use or release of the information
I. Procedures for referral or access assistance to the"Lifeline Program";
in. A policy outlining the criteria to determine if a household has a "home energy crisis" and the information
and/or documentation required to verify the crisis, as outlined in Section I. B. 4 a. Standard Crisis,and b.
Life-Threatening Crisis,of this Attachment;
n. Policies and procedures for determining the eligibility of elders applying for EHEAP,as outlined in Section
I.C.2.Client Eligibility,and 3.Eligibility Determination;
o. Policies which encourage households to seek assistance prior to incurring non-energy penalties such as
disconnect/reconnect fees,additional deposits,interest,or late payments;
p. Procedures referring elderly homeowners who have received more than three energy benefits(EHEAP or
LIHEAP) in the last eighteen(18)months to the WAP provider;
q. Policies and procedures which detail allowable timeframes for elders to submit required documentation, if
missing at the time of application;
r. A resource guide, or the utilization of the Information and Referral system in eCIRTS (to access other
energy assistance resources available at the local level to provide referrals to elders when EHEAP funding
is not available or they do not qualify;
s. Consumer appeal procedures that provide an opportunity for a fair administrative hearing at the provider
level to elders whose applications for assistance are denied,or whose applications are not acted upon with
reasonable promptness;and
t. Policies and procedures for conducting home visits to home-bound elders for completion of the program
application or eligibility determination when other assistance is not available,that at a minimum,includes:
i. Designation of appropriate staff to conduct home visits;
ii. Applicant and staff safety and security precautions;
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iii. Confidentiality;
iv. Means to collect required documentation;
V. Safeguarding Applicant information and documentation during transport;and
vi. Training and technical assistance.
14. Notwithstanding that tasks for which the Contractor is held accountable involve coordination with other entities
in performing this contract,the failure of other entities does not alleviate the Contractor from any accountability
for tasks or services that the Contractor is obligated to perform pursuant to this contract.
15. Ensure timely and accurate eCIRTS data entry of EIIEAP activity is completed prior to submitting Request for
Payment(Attachment XiII).
16. Policies and procedures for completing client applications. These may be completed directly in eCIRTS with
electronic signatures and all required documentation uploaded or completed with paper, hard copies that are
maintained in a secure location.
a. If required documentation is uploaded to eCIRTS, it must be in a readable and auditable format.
b. if required documentation is completed with paper,hard copies, it must be made available to the AAASWFL
for inspection or monitoring upon request.Additionally,the Contractor is responsible for ensuring all client
application information is entered in eCIRTS for reporting purposes. This does not require the Contractor
to ensure all required documentation, such as the Client File Checklist, is uploaded to eCIRTS but
maintained locally.
17. Contractor shall adhere to the following operational requirements:
a. Have its main administrative office(s)open for business, with the entrance door open to the public,and at
least one employee on site Monday through Friday during the hours of 8:00 AM and 5:00 PM, excluding
state-observed holidays.
b. Provide a 30-day advanced notice of permanent relocation of main or satellite offices.
c. Provide a 3-day advanced notice of planned temporary office closures.
d. Provide notice as soon as possible in the event of unplanned or emergency disruption to office operations.
e. Develop,maintain,and annually update a comprehensive Business Continuity and Disaster Recovery Plan
that ensures the continuation of essential program operations and services in the event of disruption,
disaster, or other emergencies. This plan must include contingencies for operating from an alternative
location, data backup procedures, communication protocols, and strategies to minimize service
interruptions. Upon request,the Contractor shall provide a copy of the plan to Commerce and demonstrate
readiness to implement the plan when necessary.
G. AAASWFL RESPONSIBILITIES
1. The AAASWFL may provide technical support and assistance to the Contractor within the resources of the
AAASWFL to assist the Contractor in meeting the requirements of this contract.The AAASWFL's support and
assistance,or lack thereof,shall not relieve the Contractor from full performance of contract requirements.
2. The AAASWFL will email the Contractor with any updates to attachments to this contract, and any
programmatic updates (such as the income guidelines and benefits matrix) as they are updated by the Florida
Department of Commerce.
3. The AAASWFL will provide to the Contractor the State of Florida LIHEAP Policies and Procedures Manual.
The State of Florida LIHEAP Policies and Procedures Manual will provide information and procedures needed
to administer EHEAP in Florida.
a. This contract excludes all provisions of the State of Florida LIHEAP Policies and Procedures Manual in
reference to LII-IEAP Regular Home Energy Annual Benefits.
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II1.METHOD OF PAYMENT
A. PAYMENT METHOD USED
The method of payment for this contract is a combination of cost reimbursement and advance payments,subject to
the availability of funds and Contractor performance. The AAASWFL will pay the Contractor upon satisfactory
completion of the Tasks/Deliverables, as specified in Section II., Manner of Service Provision,and in accordance
with other terms and conditions of this contract.
1. Cost Reimbursement
The Contractor agrees to distribute funds as detailed in the Budget Summary (Attachment X) attached to this
contract. Any change in allocation of categorical or total amounts of funds identified on the Budget Summary
form require a contract amendment. Payment may be authorized only for allowable expenditures,which are in
accordance with the limits specified in Attachment X. All Cost Reimbursement Requests for Payment must
include the actual Receipts and Expenditure Reports beginning with the first month of this contract.
•
a. Budget Summary
Contractor agrees to implement the distribution of funds as detailed in the Budget Summary (Attachment
X). An amendment is required to change category allocations or the total amount of this contract.
i. Administrative Expense
Administrative expenses include costs for general administration and coordination of the program,
including direct and indirect costs.This includes the salaries,fringe benefits(i.e. insurance,retirement,
etc.),rent,utilities,travel,etc.associated with financial and administrative management of the program.
The use of other federal funds to supplement the administrative operations of EHEAP, above and
beyond the budgeted amount, is prohibited. Administrative costs that exceed the contracted EHEAP
administrative award to the Contractor or subcontractor must be paid from non-federal sources.
Contractors must have adequate procedures for monitoring and oversight to ensure compliance.
ii. Outreach Expense
Outreach expenses are those costs incurred in delivering EHEAP services that are not purely
• administrative in nature. This may include staff and subcontractor expenses such as salaries, fringe
benefits (i.e. insurance, retirement, etc.), rent, utilities, travel, etc. for those employees performing
outreach and intake. Outreach expenses shall not include senior management expense, except when
outreach and intake involving direct contact with elders occurs. Documentation to support this
exception shall be maintained by the Contractor and available upon request.
(3)Administrative and Outreach funds should not be spent at a faster rate than Direct Client Assistance
funds.
b. Weather/Related Supply Shortage
Weather Related/Supply Shortage funds are a set-aside for emergency assistance. These funds must be held
in this budget line item category until December 15'''of the program year,for use in response to a possible
disaster. These funds shall only be used during state or federal emergencies declared officially by the
President of the United States,the Governor of the State of Florida,or the Secretary of Florida Commerce.
in the event of an emergency being officially declared, if the Contractor or the AAASWFL finds that the
budgeted amount of Weather Related/Supply Shortage emergency assistance funds is not sufficient to meet
• the emergency, the Contractor may, with the AAASWFL's written authorization, draw on other contract
categories up to fifty percent(50%)of the total contract budget. When funds are distributed for a weather-
related/supply shortage emergency, the AAASWFL will provide binding directives as to the allowable
expenditures of the funds. After December 15'h, if no emergency has been declared, the AAASWFL will
release the funds and the Contractor shall allocate these funds to the crisis category of the program.
c. Indirect Cost Rate
Pursuant to 2 CFR 200.331(a)(4),Contractors of federal awards are required to have an approved,federally
recognized indirect cost rate negotiated between the Contractor and the Federal Government. if no such
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rate exists,then the Contractor shall have either a rate negotiated with the AAASWFL(in compliance with
2 CFR Part 200), or a de minimis indirect cost rate as defined in 2 CFR 200.414(f). Contractor shall
maintain its current Indirect Cost Rate Proposal and make the proposal available upon request. If Contractor
chooses to use the de minimis rate, Contractor shall make sure it is entitled to use that rate and include a
statement to that effect. Contractor is not obligated to establish an indirect cost rate if Contractor does not
charge an indirect cost rate.
B. All payment requests shall be based on actual monthly expenditures beginning with the first month of this contract.
The schedule for submission of requests for payment is in Attachment XiII to this contract.
C. The final close-out request for payment is due to the AAASWFL no later than June 30',2026
D. METHOD OF INVOICE PAYMENT
Payment shall be made upon Contractor's presentation of an invoice subsequent to the acceptance and approval by
the Department of the deliverables on the invoice. The form and substance of each invoice submitted by Contractor
shall be as follows:
1. Have Remittance Address that corresponds exactly to the "Remit To" address provided to My Florida
MarketPlace(MFMP)during registration;
2. Request payment for services as established in the Service Rate Report(Attachment XXIII);
3. Contractor shall consolidate all Requests for Payment from subcontractors and Receipts and Expenditure
Reports that support requests for payment and shall submit them to the AAASWFL using the Receipts and
Expenditure Report (Attachment XII), Request for Payment (Attachment XIII), and Cost Reimbursement
Summary(Attachment XX);
4. Contractor shall include required supporting documentation as delineated in Section III.F. with the cost
reimbursement portion of the invoice.
E. PAYMENT WITHIIOLDING
Any payment due by the AAASWFL under the terms of this contract may be withheld pending the receipt and
approval by the Department of all financial and programmatic reports due from the Contractor and any adjustments
thereto, including any disallowance not resolved.
F. SUPPORTING DOCUMENTATION REQUIREMENTS
For the reporting month,Contractor shall include the following with Request for Payment:
1. The number of individuals served,that include:
a. The number of individuals served with crisis assistance during the reporting month;
b. The number of individuals ineligible or denied assistance during the reporting month;
c. The number of individuals referred to other community resources for energy assistance during the reporting
month;
2. Certification that Contractor operated during its normal business hours during the reporting month;
3. The total amount of funding expended for crisis assistance per county for the reporting period;and
4. The Certified Minority Business Subcontract Expenditure Form(CMBE Form),Attachment VIII, if applicable.
G. FINANCIAL CONSEQUENCES
Failure to meet the deliverables described in this contract may result in a financial consequence and may result in
the redistribution of funding. Contractor shall ensure the provision of services and the successful completion of
deliverables as set forth in this contract.
1. The AAASWFL shall not reimburse any expenditures associated with deliverables not accepted by the
AAASWFL as successfully completed;however,this does not preclude Contractor from receiving payment for
such expenditures upon successful completion of the deliverable.
2. If Contractor fails to be open and available for services according to its regular business hours as identified in
Section II.C.2. of this contract,excluding weekends or state and federal holidays,Contractor shall pay to the
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AAASWFL financial consequences for such failure,unless the AAASWFL waives such failure in writing
based upon its determination that the failure was due to factors beyond the control of Contractor.
3. Contractor's failure to operate according to its regular business hours shall result in an assessment of a financial
consequence in the amount of$10.00 per day.
4. Any amounts due from financial consequences shall be paid by Contractor out of non-federal funds.
H. REMEDIES-NONCONFORMING SERVICES
Contractor shall ensure that all participants served under this contract are eligible for the program and that all
monthly performance reports and financial records are maintained for each reporting period and submitted as
stipulated in this contract.
1. Any nonconforming program service,performance report, or financial record not meeting the aforementioned
requirements is not eligible for reimbursement under this program. Contractor shall solely bear the costs
•
associated with enrolling, training, reporting and/or managing the program. Contractor shall give immediate
notice to the AAASWFL of any significant and/or systemic infraction that compromises Contractor's ability to
provide participant services,to achieve programmatic performance,or to provide sound financial management
of the program.
I. CONSEQUENCES FOR NON-COMPLIANCE
Contractor shall ensure that one hundred percent(100%)of the deliverables identified in this contract are performed
pursuant to contract requirements. The deliverables described in Section 11.D. arc identified as major deliverables
in this contract.
1. If at any time the Contractor is notified by the AAASWFL's Contract Manager that it has failed to correctly,
completely,or adequately perform these major deliverables,the Contractor will have ten(10)days to submit a
Corrective Action Plan (CAP) to the Contract Manager that addresses the deficiencies and states how the
deficiencies will be remedied within a time period approved by the Contract Manager. The AAASWFL shall
assess a Financial Consequence for Non-Compliance on the Contractor for each deficiency identified in the
CAP which is not corrected pursuant to the CAP. The AAASWFL will also assess a Financial Consequence
for failure to timely submit a CAP. If Contractor fails to timely submit a CAP,the AAASWFL shall deduct 1%
of the monthly value of the administrative funds in the contract for each day the CAP is overdue,beginning the
11°i day after notification by the Contract Manager of the deficiency. The deduction will be made from the
payment for the invoice of the following month.
2. In the event that Contractor fails to correct an identified deficiency within the approved time period specified
in the CAP, the AAASWFL shall deduct, from the payment for the invoice of the following month, 1%of the
monthly value of the administrative funds in the contract for each day the deficiency is not corrected. The
AAASWFL may also deduct, from the payment for the invoice of the following month, 1% of the monthly
value of the administrative funds in the contract for each day the Contractor fails to timely submit a CAP.
IV.SPECIAL PROVISIONS
A. The following is incorporated by reference:
1. State of Florida LIHEAP Policies and Procedures Manual.
B. Modifications
The AAASWFL shall not be obligated to reimburse Contractor for expenditures in excess of the funded amount of
ibis contract unless and until the AAASWFL officially approves such expenditures by executing a written
modification to the original contract,signed by both parties.
1. Contractor must use a AAASWFL approved budget modification process.
• 2. For the purpose of transferring funds, the following are considered budget categories: (1) Administration, (2)
Outreach,and(3)Crisis Assistance.
C. Enforcement
1. In accordance with Section 430.04, F.S., the AAASWFL shall rescind designation of an EHEAP Provider or
take intermediate measures against the Contractor, including corrective action, unannounced special
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monitoring, temporary assumption of operation of one or more programs by the AAASWFL, placement on
probationary status, imposing a moratorium on Contractor action, imposing financial penalties for
nonperformance,or other administrative action pursuant to Chapter 120,F.S.,if the AAASWFL finds that any
of the following have occurred:
a. An intentional or negligent act of the Contractor has materially affected the health, welfare, or safety of
clients,or substantially and negatively affected the operation of an aging services program;
b. The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual funds
have been misappropriated;
c. The Contractor has committed multiple or repeated violations of legal and regulatory requirements or
AAASWFL standards;
d. The Contractor has failed to continue the provision or expansion of services after the declaration of a state
of emergency;
e. The Contractor has exceeded its authority or otherwise failed to adhere to the terms of this contract with
the AAASWFL, or has exceeded its authority or otherwise failed to adhere to the provisions specifically
provided by statute or rule adopted by the AAASWFL;
f. The Contractor has failed to properly determine client eligibility as defined by the AAASWFL or efficiently
manage program budgets;or
g. The Contractor has failed to implement and maintain a AAASWFL-approved client grievance resolution
procedure.
2. In making any determination under this provision, the AAASWFL may rely upon findings of another state or
federal agency or other regulatory body. Any claims for damages for breach of contract are exempt from
administrative proceedings and shall be brought before the appropriate entity in the venue of Lee County,
Florida.In the event the AAASWFL initiates action to rescind an EHEAP Provider designation,the AAASWFL
shall follow the procedures set forth in 42 U.S.C. § 3025(b).
END OF ATTACHMENT
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ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the AAASWFL to the Contractor may be subject to audits and/or monitoring
by the AAASWFL,as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with 2 CFR Part 200(formerly OMB Circular A-133 as revised),
and section 215.97, F.S., (see"AUDITS"below), monitoring procedures may include, but not be limited to, on-site visits
by the AAASWFL staff, limited scope audits and/or other procedures. By entering into this contract,the Contractor agrees
to comply and cooperate with any monitoring procedures/processes deemed appropriate by the AAASWFL. In the event
the AAASWFL determines that a limited scope audit of the Contractor is appropriate,the Contractor agrees to comply with
any additional instructions provided by the AAASWFL to the Contractor regarding such audit. The Contractor further
agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief
Financial Officer(CFO)or Auditor General.
AUDITS
PART 1: FEDERALLY FUNDED
This part is applicable if the Contractor is a State or local government or a non-profit organization as defined in 2 CFR Part
200,Subpart A.
In the event that the Contractor expends$1,00,000.00 or more in federal awards during its fiscal year,the Contractor must
have a single or program-specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial and
Compliance Audit Attachment, Exhibit 2 indicates federal resources awarded through the AAASWFL by this contract. In
determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards,
including federal resources received from the AAASWFL. The determination of amounts of'Federal awards expended
should be in accordance with 2 CFR Part 200. An audit of the Contractor conducted by the Auditor General in accordance
with the provisions of 2 CFR Part 200 will meet the requirements of this pail.
In connection with the audit requirements addressed in Part I, paragraph 1, the Contractor shall fulfill the requirements
relative to auditee responsibilities as provided in 2 CFR 200.508.
If the Contractor expends less than$1,000,000.00 in federal awards in its fiscal year,an audit conducted in accordance with
the provisions of 2 CFR Part 200 is not required. In the event that the Contractor expends less than$1,000,000.00 in federal
awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200,the cost
of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from Contractor resources
obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to contracts with the AAASWFL shall be based on the contract's requirements,including any
rules,regulations,or statutes referenced in the contract.The financial statements shall disclose whether or not the matching
requirement was met for each applicable contract. All questioned costs and liabilities due to the AAASWFL shall be fully
disclosed in the audit report with reference to the AAASWFL contract involved. If not otherwise disclosed as required by
2 CFR 200.510, the schedule of expenditures of federal awards shall identify expenditures by contract number for each
contract with the AAASWFL in effect during the audit period. Financial reporting packages required under this part must
be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the Contractor's fiscal
year end.
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PART II:STATE FUNDED
This part is applicable if the Contractor is a non-state entity as defined by section 215.97(2),F.S.
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of$750,000.00 in
any fiscal year of such Contractor, the Contractor must have a State single or project-specific audit for such fiscal year in
accordance with section 215.97, F.S.;applicable rules of the Department of Financial Services; and Chapter 10.550(Local
Governmental Entity Audits)or 10.650(Florida Single Audit Act Audits Nonprofit and For-Profit Organizations),Rules of
the Auditor General. Financial Compliance Audit Attachment,Exhibit 2 indicates state financial assistance awarded through
the AAASWFL by this contract. In determining the state financial assistance expended in its fiscal year, the Contractor
shall consider all sources of state financial assistance, including state financial assistance received from the AAASWFL,
other state agencies,and other non-state entities. State financial assistance does not include Federal direct or pass-through
awards and resources received by a non-state entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part Il, paragraph 1, the Contractor shall ensure that the audit
complies with the requirements of section 215.97(8), F.S. This includes submission of a financial reporting package as
defined by section 215.97(2), F.S., and Chapter 10.550, (local governmental entities) or 10.650 (nonprofit and for-profit
organizations),Rules of the Auditor General.
If the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year, an audit conducted in
accordance with the provisions of section 215.97, F.S., is not required. in the event that the Contractor expends less than
$750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the
provisions of section 215.97,F.S., the cost of the audit must be paid from the non-state entity's resources(i.e., the cost of
such an audit must be paid from the Contractor resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to contracts with the AAASWFL shall be based on the contract's requirements, including any
applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement
was met for each applicable contract. All questioned costs and liabilities due to the AAASWFL shall be fully disclosed in
the audit report with reference to the AAASWFL contract involved. If not otherwise disclosed as required by Rule 69I-
5.003, F.A.C.,the schedule of expenditures of state financial assistance shall identify expenditures by contract number for
each contract with the AAASWFL in effect during the audit period. For local governmental entities, financial reporting
packages required under this part must be submitted within 45 days after delivery of the audit report,but no later than 12
months after the Contractor's fiscal year end. For non-profit or for-profit organizations, financial reporting packages
required under this part must be submitted within 45 days after delivery of the audit report,but no later than 9 months after
the Contractor's fiscal year end. Notwithstanding the applicability of this portion, the AAASWFL retains all right and
obligation to monitor and oversee the performance of this contract as outlined throughout this document and pursuant to
law.
PART III: REPORT SUBMISSION
Copies of financial reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of
this Financial Compliance Audit Attachment, shall be submitted,when required by 2 CFR 200.512 by or on behalf of the
Contractor directly to each of the following:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
Pursuant to 2 CFR 200.512,all other Federal agencies,pass-through entities and others interested in a reporting package
and data collection form must obtain it by accessing the Federal Audit Clearinghouse.
The Contractor shall submit a copy of any management letter issued by the auditor directly to the AAASWFL.
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Area Agency on Aging for Southwest Florida,Inc.
Attn: Nga Cotter,CPA
Director of Finance
2830 Winkler Avenue,Suite 112
Fort Myers, FL 33916
Additionally,copies of financial reporting packages required by this contract's Financial Compliance Audit Attachment,
Part I1,shall be submitted by or on behalf of the Contractor directly to each of the following:
The AAASWFL at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Nga Cotter,CPA
Director of Finance
2830 Winkler Avenue,Suite 112
Fort Myers, FL 33916
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building,Room 574
111 West Madison Street
Tallahassee,Florida 32399-1450
Any reports,management letters,or other information required to be submitted to the AAASWFL pursuant to this contract
shall be submitted timely in accordance with 2 CFR Part 200, and Florida Statutes Chapter 10.550 (local governmental
entities)or 10.650(nonprofit and for-profit organizations), Rules of the Auditor General,as applicable.
Contractors,when submitting financial reporting packages to the AAASWFL for audits done in accordance with 2 CFR Part
200 or Florida Statutes Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),
Rules of the Auditor General, should indicate the date that the reporting package was delivered to the Contractor in
correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of
six (6)years from the date the audit report is issued, and shall allow the AAASWFL or its designee, the CFO, or Auditor
General access to such records upon request. The Contractor shall ensure that audit working papers are made available to
the AAASWFL or its designee, CFO,or Auditor General upon request for a period of six (6)years from the date the audit
report is issued,unless extended in writing by the AAASWFL.
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ATTACHMENT II
EXHIBIT 1
PART I:AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200
and/or section 215.97,F.S. Contractors who are determined to be recipients or sub-recipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I
and/or Part 11 of Exhibit 1 are met. Contractors who have been determined to be vendors are not subject to the audit
requirements of 2 CFR 200.38 and/or section 215.97,F.S. Regardless of whether the audit requirements are met,
Contractors who have been determined to be recipients or sub-recipients of Federal awards and/or state financial
assistance must comply with applicable programmatic and fiscal compliance requirements.
In accordance with 2 CFR Part 200 and/or Rule 691-5.006,F.A.C.,Contractor has been determined to be:
Vendor not subject to 2 CFR 200.38 and/or section 215.97, F.S.
X Recipient/sub-recipient subject to 2 CFR 200.86 and 200.93 and/or section 215.97,F.S.
_Exempt organization not subject to 2 CFR Part 200 and/or section 215.97, F.S. For Federal awards, for-profit
organizations are exempt; for state financial assistance projects, public universities, community colleges, district
school boards,branches of state (Florida)government,and charter schools are exempt. Exempt organizations must
comply with all compliance requirements set forth within the contract or award document.
NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and/or state financial assistance,and has been
approved by the AAASWFL to subcontract, they must comply with section 215.97(7), F.S., and Rule 69I-5.006, F.A.C.
[state financial assistance]and/or 2 CFR 200.330[federal awards].
PART 11: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal
awards,state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a sub-
recipient must comply with the following fiscal laws,rules,and regulations:
STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR 200.416-200.417—Special Considerations for States,Local Governments,and Indian Tribes*
2 CFR 200.201 —Administrative Requirements**
2 CFR 200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations.
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR 200.400-200.411—Cost Principles*
2 CFR 200.100—Administrative Requirements
2 CFR 200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations.
EDUCATIONAL INSTITUTIONS(EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT)
MUST FOLLOW:
2 CFR 200.418—200.419—Special Considerations for Institutions of Higher Education*
2 CFR 200.100—Administrative Requirements
2 CFR 200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations.
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in 2 CFR
200.400(5)(c).
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**For funding passed through U.S. Health and Human an Services,45 CFR Part 75.
STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a
recipient/sub-recipient must comply with the following fiscal laws,rules,and regulations:
Sections 215.97&215.971,F.S.
Chapter 691-5,F.A.C.
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations.
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ATTACHMENT II
EXHIBIT 2
FUNDING SUMMARY (2025-2026)
Note: Title 2 CFR, as revised,and section 215.97, F.S.,require that the information about Federal Programs and State
Projects included in Attachment II, Exhibit 1,be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUAN'17I'O'l'IIIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): G-2502FLLIEA FEDERAL AWARD DATE: July 1,2025
UEI NUMBER: RHZNJDNFJAL3
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Emergency Home Energy Assistance United States Department of Health and 93.568 $104,400.00
for the Elderlogram Human Services _
TOTAL FEDERAL AWARD $104,400.00
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200—Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133—Audits of States, Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO TIIE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215,97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
TOTAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT"f0 THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97&215.971,F.S.,Chapter 691-5, F.A.C.,State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations.
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ATTACHMENT III
CERTIFICATIONS AND ASSURANCES
AAASWFL will not award this contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In
performance of this contract,Contractor provides the following certifications and assurances:
A. Debarment and Suspension Certification(29 CFR Part 95 and 45 CFR Part 75)
B. Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 93)
C. Nondiscrimination& Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes,section 287.133, F.S.
E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance
(Pub. L. 111-1171
F. Scrutinized Companies Lists and No Boycott of Israel Certification,section 287.135,F.S.
G. Certification Regarding Data Integrity Compliance for Contracts, Agreements, Grants, Loans, and
Cooperative Agreements
H. Verification of Employment Status Certification
I. Records and Documentation
J. Certification Regarding Inspection of Public Records
K. Form PUR 2024
A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS—PRIMARY COVERED TRANSACTION.
The undersigned Contractor certifies,to the best of its knowledge and belief,that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by a Federal AAASWFL or agency;
2. Have not within a three-year period preceding this contract been convicted or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing
a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements,or receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or
local)with commission of any of the offenses enumerated in paragraph A.2. of this certification;and/or
4. Have not within a three-year period preceding this application/proposal had one or more public transactions
(Federal, State,or local) terminated for cause of default.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall provide this certification accordingly.
B. CERTIFICATION REGARDING LOBBYING—CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS.
The undersigned Contractor certifies,to the best of its knowledge and belief,that:
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No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in
connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,
the entering into of any cooperative agreement,and the extension,continuation,renewal,amendment, or modification
of any Federal contract,grant, loan,or cooperative agreement.
if any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative
agreement, the undersigned shall also complete and submit Standard Fonn — LLL, "Disclosure Form to Report
Lobbying,"in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this contract was made or
entered into. Submission of this certification is a prerequisite for making or entering into this contract imposed by 31
U.S.C.§ 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than$100,000 for each such failure.
C. NON-DISCRIMINATION&EQUAL OPPORTUNITY ASSURANCE(29 CFR PART 37 AND 45 CFR PART
80).-As a condition of the Contract,Contractor assures that it will comply fully with the nondiscrimination and equal
opportunity provisions of the following laws:
1. Section 188 of the Workforce investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination
against all individuals in the United States on the basis of race,color,religion,sex, national origin,age,disability,
political affiliation,or belief',and against beneficiaries on the basis of either citizenship/status as a lawfully admitted
immigrant authorized to work in the United States or participation in any WIA Title I-financially assisted program
or activity.
2. Title VI of the Civil Rights Act of 1964(Pub.L.88-352),as amended,and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services(45 CFR Part 80),to the end that,in accordance
with Title VI of that Act and the Regulation,no person in the United States shall,on the ground of race,color, or
national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity for which the Applicant receives Federal financial assistance from the
AAASWFL.
3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 84), to the end that, in
accordance with Section 504 of that Act and the Regulation,no otherwise qualified handicapped individual in the
United States shall, solely by reason of his handicap,be excluded from participation in, be denied the benefits of,
or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial
assistance from the AAASWFL.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services(45 CFR Pail 91),to the end that,in accordance
with the Act and the Regulation,no person in the United States shall,on the basis of age,be denied the benefits of,
be excluded from participation in, or be subjected to discrimination under any program or activity for which the
Applicant receives Federal financial assistance from the AAASWFL.
5. Title IX of the Education Amendments of 1972(Pub.L. 92-318),as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 86), to the end that, in
accordance with Title IX and the Regulation,no person in the United States shall,on the basis of sex, be excluded
from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education
program or activity for which the Applicant receives Federal financial assistance from the AAASWFL.
6. The American with Disabilities Act of 1990(Pub. L. 101-336),which prohibits discrimination in all employment
practices including job application procedures,hiring,firing,advancement,compensation,training,and other terms,
conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe
benefits,and all other employment-related activities.
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7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws
listed above. This assurance applies to Contractor's operation of the WIA Title I—financially assisted program or
activity,and to all contracts Contractor makes to carry out the WIA Title I—financially assisted program or activity.
Contractor understands that AAASWFL and the United States have the right to seek judicial enforcement of the
assurance.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall provide this assurance accordingly.
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S.
Contractor hereby certifies that neither it,nor any person or affiliate of Contractor,has been convicted of a Public Entity
Crime as defined in section 287.133, F.S.,nor placed on the convicted vendor list.
Contractor understands and agrees that it is required to inform AAASWFL immediately upon any change of
circumstances regarding this status.
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RESTRICTIONS ASSURANCE(Pub. L. 111-117).
As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions
pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511 (Pub.
L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that
appropriations made under Pub. L. 1 1 1-1 17 are available under the conditions provided by Pub. L. 1 1 1-1 17.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers(including subcontracts,sub-grants and contracts under grants,loans and cooperative agreements)and that all sub-
recipients and contractors shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION,SECTION
287.135, F.S.
In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized
Companies that Boycott Israel List and that it is not engaged in a boycott of Israel.
If this contract is in the amount of'Sl million or more, in accordance with the requirements of section 287.135, F.S.,
Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the
Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it is not engaged in business
operations in Cuba or Syria.
Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the
AAASWFL terminating this contract and the submission of a false certification may subject Contractor to civil penalties
and attorney fees and costs,including any costs for investigations that led to the finding of false certification.
If Contractor is unable to certify any of the statements in this certification,Contractor shall attach an explanation to this
contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS,AGREEMENTS,
GRANTS, LOANS,AND COOPERATIVE AGREEMENTS
1. The Contractor and any Subcontractors of services under this contract have financial management systems capable
of providing certain information,including:(1)accurate,current,and complete disclosure of the financial results of
each grant-funded project or program in accordance with the prescribed reporting requirements; (2)the source and
application of funds for all contract supported activities; and (3)the comparison of outlays with budgeted amounts
for each award. The inability to process information in accordance with these requirements could result in a return
of grant funds that have not been accounted for properly.
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2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the
Contractor is dependent for data that is to be reported,transmitted,or calculated have been assessed and verified to
be capable of processing data accurately, including year-date dependent data. For those systems identified to be
non-compliant,Contractors will take immediate action to assure data integrity.
3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chip technology,
the undersigned warrants that these products are capable of processing year-date dependent data accurately. All
versions of these products offered by the Contractor(represented by the undersigned) and purchased by the state
will be verified for accuracy and integrity of data prior to transfer.
4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that
impede the hardware or software programs from operating properly, the Contractor agrees to immediately make
required corrections to restore hardware and software programs to the same level of functionality as warranted
herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the
essence.
5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies
arising from data integrity compliance issues.
H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the AAASWFL, Contractor certifies the use of the U.S. Department of Homeland
Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the
contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express
requirement that Subcontractors performing work or providing services pursuant to this contract utilize the E-verify
system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract
term.
The Contractor shall require that the language of this certification be included in all sub-agreements, sub-grants, and
other agreements/contracts and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this contract was made or
entered into. Submission of this certification is a prerequisite for making or entering into this contract imposed by
Circulars A-102 and 2 CFR Part 200 and 215(formerly OMB Circular A-110).
I. RECORDS AND DOCUMENTATION
The Contractor agrees to make available to AAASWFL staff and/or any party designated by the AAASWFL any and all
contract related records and documentation. The Contractor shall ensure the collection and maintenance of all program
related information and documentation on any such system designated by the AAASWFL. Maintenance includes valid
exports and backups of all data and systems according to AAASWFL standards.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of Section 10 of the Standard Contract,sections 119.0701(3)and(4)F.S.,and any other
applicable law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the AAASWFL is
named in the civil action,Contractor agrees to indemnify and hold harmless the AAASWFL for any costs incurred by
the AAASWFL and any attorneys' fees assessed or awarded against the AAASWFL from a Public Records Request
made pursuant to Chapter 119,F.S.,concerning this contract or services performed thereunder.
a. Notwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed
between the AAASWFL and state agencies or subdivisions defined in section 768.28(2),F.S.
2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership
contributions for any person,corporation,foundation, trust,association,group,or other organization,all the financial,
business, and membership records of such an entity which pertain to the public agency (Florida Department of
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Elder Affairs)are public records.Section 119.07,F.S,states that every person who has custody of such a public record
shall permit the record to be inspected and copied by any person desiring to do so,under reasonable circumstances.
K. FORM PUR 2024
Contractor must complete and return to the AAASWFL the applicable portions of Form PUR 2024 attached in the link
below.
hltps://www.dms.myflorida.com/business operations/stateJurchasing/state agency resources/state_purchasingjpur
forms
Part A: Use of Coercion for Labor and Services. Whenever executing, renewing, or extending this Contract, the
Contractor must complete and return Part A, attesting that it does not use coercion for labor or services as defined in
section 787.06,F.S.
Part B: Provision of Commodities Produced by Forced Labor. If applicable, a member of the Contractor's senior
management must complete and return Part B.
By signing below, the Contractor agrees to include all relevant certification and assurance provisions(A—K) in any related
subcontract agreements, as applicable; the Contractor certifies that the representations set forth in Sections A through K
above are true and correct; and the Contractor attests that, if applicable, records related to the payment of dues or
membership contributions by the AAASWFL will be made available for inspection, as stated above.
Arvq..er 3339 E.Tamiami Trail,Building H
Signatutdand Title of Authorized Represe tative J Street Address
Collier County Board of County Commissioners
Community and Human Service Naples,FL 34112
Contractor Date'( /2( City,State,Zip code
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ATTACHMENT IV
ASSURANCES—NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average forty-five(45) minutes per response, including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden,to the Office of Management and Budget. Paperwork Reduction Project(0348-0043),
Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET,SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please
contact the awarding agency. Further,certain federal awarding agencies may require applicants to certify to
additional assurances.If such is the case,you will be notified.
I. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non-federal share of project cost)to ensure proper planning,management,and
completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States,and if appropriate,the state,through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the
award; and will establish a proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes,or presents the
appearance of,personal or organizational conflict of interest or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§ 4728-4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of
OPM's Standards for a Merit System of Personnel Administration(5 CFR 900, Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a)Title VI of
the Civil Rights Act of 1964(P.L.88-352)which prohibits discrimination on the basis of race,color or national origin;
(b)Title IX of the Education Amendments of 1972, as amended(20 U.S.C. §§ 1681-1683 and §§ 1685-1686), which
prohibits discrimination on the basis of sex;(c)Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C.
§794),which prohibits discrimination on the basis of handicaps; (d)the Age Discrimination Act of 1975,as amended
(42 U.S.C.§§6101-6107),which prohibits discrimination on the basis of age;(e)the Drug Abuse Office and Treatment
Act of 1972(P.L.92-255),as amended,relating to nondiscrimination on the basis of drug abuse;(f)the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism;(g)Sections523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§ 290 dd-3 and 290 ee 3), as amended,relating to confidentiality of alcohol and drug
abuse patient records;(h)Title VIiI of the Civil Rights Act of 1968(42 U.S.C. §3601 et seq.),as amended,relating to
nondiscrimination in the sale,rental or financing of housing; (i)any other nondiscrimination provisions in the specific
statute(s) under which application for federal assistance is being made; and (j) the requirements of any other
nondiscrimination statute(s)which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and iII of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements
apply to all interests in real property acquired for project purposes regardless of federal participation in purchases.
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8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §§ 1501-1508 and §§ 7324-7328), which
limit the political activities of employees whose principal employment activities are funded in whole or in part with
federal funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. §§ 276a to 276a-7), the Copeland
Act(40 U.S.C. §276c and 18 U.S.C. §874)and the Contract Work Hours and Safety Standards Act(40 U.S.C. §§327-
333), regarding labor standards for federally assisted construction sub-contracts.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (42 U.S.C. §4012a)which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or
more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (42 U.S.C. §§ 4321 et
seq.) and Executive Order(EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of
wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e)
assurance of project consistency with the approved State management program developed under the Coastal Zone
Management Act of 1972 (16 U.S.C. § 1451 et seq.); (f) conformity of federal actions to State (Clear Air)
Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended(42 U.S.C. § 7401 et seq.); (g)
protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (42
U.S.C. §300F et seq.);and(h)protection of endangered species under the Endangered Species Act of 1973,as amended
(16 U.S.C. §§ 1531-1544).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. § 1271 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended, and the Archaeological and Historic Preservation Act of 1974 (54 U.S.C. §§ 300101-307108), and
EO 11593 (identification and protection of historic properties).
14. Will comply with the National Research Act of 1974(P.L. 93-348)regarding the protection of human subjects involved
in research,development,and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966(7 U.S.C. §2131 et seq.)pertaining to the care,handling,
and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. § 4831(b)), which prohibits the use of
lead-based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and 2 CFR Part 200.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations, and policies
governing this program.
SIGN URE OF AUT ORIZED CERTIFYING OFFICIAL TITLE
etiut
APPLICANT GANIZATION DATE SUBMITTED
Collier County Board of County Commissioners
Community and Human Service _y/g r n�
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ATTACHMENT V
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name County AAA/Contractor
Address Completed By
City,State,Zip Code Date Telephone
PART I:READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH\'ILL HELP YOU COMPLETE
THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
% % % %
For questions 2-5 please indicate the following: total IF \Vhite Black Hispanic Other Female Disabled Over 40
2.Population of area served Source of data:
3.Staff currently employed Effective date:
4.Clients currently enrolled/registered Effective date:
5. Advisory/Governing Board if applicable
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO,EXPLAIN.
6. Is an Assurance of Compliance on file with AAASWFL? N/A YES NO
❑ ❑ ❑
7. Compare the staff composition to the population. Is staff representative of the population? N❑ l❑S ❑
8. Are eligibility requirements for services applied to clients and applicants without regard to race,color,national Ne. V'S Nam(
origin,sex,age,religion,or disability? LJ
9. Are all benefits,services and facilities available to applicants and participants in an equally effective manner N/A YES NO
regardless of race,sex,color,age,national origin,religion,or disability? ❑
❑ ❑
10. For in-patient services,are room assignments made without regard to race,color,national origin or disability? N/A YES NO
❑ ❑ ❑
11. Is the program/facility accessible to non-English speaking clients? N/A YES NO
❑ ❑ ❑
12.Are emiloyccs,applicants and_participants informed of their protection against discrimination? If YES,how? N/A YES NO
Verbal n Written❑Poster L ❑ 0 0
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N/A NUMBER
13.Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility. ❑
14. Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? N/A YES NO
❑ ❑ ❑
PART III:TILE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EiIPLOYEES. IF NO,
EXPLAIN.
15.Has as a self-evaluation been conducted to identify any barriers to serving disabled individuals and to make any YES NO
necessary modifications? ❑ ❑
16. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO
❑ ❑
17. Has a person been designated to coordinate Section 504 compliance activities? YES NO
❑ ❑
18.Do recruitment and notification materials advise applicants,employees,and participants of nondiscrimination on YES NO
the basis of disability? ❑ ❑
19.Are auxiliary aids available to ensure accessibility of services to hearing and sight-impaired individuals? YES NO
❑ ❑
PART Is':FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF S50,000.00 OR MORE.
20. Do you have a written affirmative action plan? If NO,explain. YES NO
❑ ❑
Reviewed by In Compliance: YES ❑ NO* 0
Program Office *Notice of Corrective Action Sent / /
Date Telephone Response Due / /
On-Site ❑ Desk Review ❑ Response Received / /
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ATTACHMENT V
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district, county, city, or other locality. If the program/facility serves a
specific target population such as adolescents,describe the target population. Also,define the type of service provided.
2. Enter the percent of the population served by race,sex,disability,and over the age of 40. The population served includes
persons in the geographical area for which services are provided such as a city,county or other regional area. Population
statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. ("Other" races include
Asian/Pacific Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex, disability, and over the age of 40. Include the
effective date of your summary.
4. Enter the total number of clients who are enrolled,registered or currently served by the program or facility,and list their
percent by race,sex,disability,and over the age of 40. Include the date that enrollment was counted.
a. Where there is a significant variation between the race,sex,or ethnic composition of the clients and their availability
in the population, the program/facility has the responsibility to determine the reasons for such variation and take
whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when
programs are sanctioned to serve target populations such as elderly or disabled persons.
5. Enter the total number of advisory board members and their percent by race, sex,disability, and over the age of 40. If
there is no advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR Part 80. This is usually a standard part of the
contract language for AAASWFL Recipients and their Sub-grantees. 45 CFR 80.4(a).
7. Is the race,sex,and national origin of the staff reflective of the general population? For example,if 10%of the population
is Hispanic,is there a comparable percentage of Hispanic staff?
8. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation(Questions 3 and 4)and also through
on-site record analysis of persons who applied but were denied services or employment. 45 CFR 80.3(a) and 45 CFR
80.1.
9. Participants or clients must be provided services such as medical, nursing,and dental care, laboratory services,physical
and recreational therapies, counseling, and social services without regard to race, sex, color, national origin, religion,
age, or disability. Courtesy titles, appointment scheduling, and accuracy of record keeping must be applied uniformly
and without regard to race, sex, color, national origin, religion, age, or disability. Entrances, waiting rooms, reception
areas,restrooms,and other facilities must also be equally available to all clients. 45 CFR 80.3(b).
10. For in-patient services,residents must be assigned to rooms,wards,etc.,without regard to race,color,national origin,or
disability. Also,residents must not be asked whether they are willing to share accommodations with persons of a different
race,color,national origin,or disability. 45 CFR 80.3(a).
11. The program/facility and all services must be accessible to participants and applicants,including those persons who may
not speak English. in geographic areas where a significant population of non-English speaking people live, program
accessibility may include the employment of bilingual stag. In other areas, it is sufficient to have a policy or plan for
service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision
of services. 45 CFR 80.3(a).
12. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries, or any other interested parties. 45 CFR 80.6(d). This should include information on their
right to file a complaint of discrimination with either the AAASWFL or the U.S. Department of Health and Human
Services. The information may be supplied verbally or in writing to every individual or may be supplied through the use
of an equal opportunity policy poster displayed in a public area of the facility.
13. Report number of discrimination complaints filed against the program/facility. Indicate the basis(e.g. race,color,creed,
sex,age,national origin,disability,and/or retaliation)and the issues involved(e.g.services or employment,placement,
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termination,etc.). Indicate the civil rights law or policy alleged to have been violated along with the name and address
of the local,state,or federal agency with whom the complaint has been filed. Indicate the current status of the complaint
(e.g.settled,no reasonable cause found, failure to conciliate, failure to cooperate,under review,etc.).
14. The program/facility must be physically accessible to mobility, hearing, and sight-impaired individuals. Physical
accessibility includes designated parking areas,curb cuts or level approaches,ramps, and adequate widths to entrances.
The lobby, public telephone, restroom facilities, water fountains, and information and admissions offices should be
accessible. Door widths and traffic areas of administrative offices,cafeterias,restrooms,recreation areas,counters,and
serving lines should be observed for accessibility. Elevators should be observed for door width and Braille or raised
numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an
appropriate height for mobility impaired individuals.
15. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self-
evaluation to identify any accessibility barriers. Self-evaluation is a four-step process:
a. Evaluate, with the assistance of disabled individual(s)/organization(s), current policies and practices that do not or
may not comply with Section 504;
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate the effects of any discrimination that resulted from adherence to these policies and
practices;and
d. Maintain self-evaluation on file,including a list of the interested persons consulted,a description of areas examined,
and any problems identified,and a description of any modifications made and of any remedial steps taken 45 CFR
84.6.(This checklist may be used to satisfy this requirement if these four steps have been followed).
16. Programs or facilities that employ 15 or more persons shall adopt grievance procedures that incorporate appropriate due
process standards and that provide for the prompt and equitable resolution of complaints alleging any action prohibited
by Part 84 of Title 45,CFR45 CF 84.7(b).
17. Programs or facilities that employ 15 or more persons shall designate at least one person to coordinate its efforts to
comply with Part 84 of Title 45,CFR. 45 CFR 84.7(a).
18. Programs or facilities that employ 15 or more persons shall take appropriate initial and continuing steps to notify
participants, beneficiaries, applicants, and employees that the program/facility does not discriminate on the basis of
handicap in violation of Section 504 and Part 84 of Title 45, CFR. Methods of initial and continuing notification may
include the posting of notices, publication in newspapers and magazines, placement of notices in publications of the
programs or facilities,and distribution of memoranda or other written communications. 45 CFR 84.8(a).
19. Programs or facilities that employ 15 or more persons shall provide appropriate auxiliary aids to persons with impaired
sensory, manual, or speaking skills where necessary to afford such persons an equal opportunity to benefit from the
service in question. Auxiliary aids may include,but are not limited to,brailed and taped materials,interpreters,and other
aids for persons with impaired hearing or vision. 45 CFR 84.52(d).
20. Programs or facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement, and
maintain a written affirmative action compliance program in accordance with Executive Order 11246,41 CFR Part 60
and Title VI of the Civil Rights Act of 1964,as amended.
Page 54 of 82 CAO
16D6
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CAO
16D6
(July 2025—June 2026) I-1P025
ATTACHMENT VII
BACKGROUND SCREENING
ATTESTATION OF COMPLIANCE-EMPLOYER
AUTHORITY: ALL EMPLOYERS are required to annually submit this form attesting to compliance with the
provisions of chapter 435 and section 430.0402 of the Florida Statutes.
The term "employer" means any person or entity required by law to conduct background screenings, including but not
limited to, Area Agencies on Aging/Aging and Disability Resource Centers, Lead Agencies, and Service Providers that
contract directly or indirectly with the Department of Elder Affairs(Department),and any other person or entity which hires
employees or has volunteers in service who meet the definition of a direct service provider. See§§435.02&430.0402,Fla.
Stat.(2023)
A direct service provider is a person 18 years of age or older who,pursuant to a program to provide services to the elderly,
has direct,face-to-face contact with a client while providing services to the client and has access to the client's living areas,
funds,personal property,or personal identification information as defined in s. 817.568. The term also includes,but is not
limited to,the administrator or a similarly titled person who is responsible for the day-to-day operations of the provider;the
financial officer or similarly titled person who is responsible for the financial operations of the provider; coordinators,
managers, and supervisors of residential facilities; volunteers; and any other person seeking employment with a provider
who is expected to,or whose responsibilities may require him or her to,provide personal care or services directly to clients
or have access to client funds,financial matters,legal matters,personal property,or living areas.§430.0402(1)(b),Fla.Stat.
(2023).
ATTESTATION
As the duly authorized representative of: Collier County Board of County Commissioners
(Name of Employer)
Located at 3339 E.Tamiami Trail, Building H Naples FL 34112
Street address City State Zip Code
tinder penalty of perjury, I, AifYI ?a-Norsm
y (Name of Representative)
hereby swear or affirm that the above-named employer is in compliance with the provisions of chapter
435 and section 430.0402 of the Florida Statutes,regarding level 2 background screening.
iktP44/M 77T���
Signatui of Representative Date
4,ASUT!.Form 233.Attestation of Compliance-Employer.Mettler October 2023.F.S.
Form available nt: Jurns:oelderulluirs.vretaban-rmbackerumtd-screcninetixkuround-sercenin,:-rlcarinithouxtrainin¢-accessine-the-ckarinelwttsd.
Page 57 of 82 CAa
16D6
(July 2025—June 2026) HP025
ATTACHMENT VIII
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES(CMBE FORM)
CMBE FORM MUST ACCOMPANY INVOICES SUBMITTED TO AAASWFL
CONTRACTOR NAME:
AAASWFL CONTRACT NUMBER:
*REPORTING PERIOD-FROM: TO:
*(DATE RANGE OF RENDERED SERVICES, MUST MATCH INVOICE SUBMITTED TO
AAASWFL) AAASWFL CONTRACT MANAGER:
REPORT ALL EXPENDITURES MADE TO CERTIFIED MINORITY BUSINESS(SUBCONTRACTORS).
CONTACT AAASWFL CMBE COORDINATOR FOR ANY QUESTIONS, AT 850-414-2153.
SUBCONTRACTOR NAME SUBCONTRACTOR'S CMBE EXPENDITURES
FEID
DOEA USE ONLY--REPORTING ENTITY(DIVISION,OFFICE,ETC)
SEND COMPLETED FORMS VIA INTEROFFICE MAIL TO:JUSTIN TAYLOR
CMBE COORDINATOR,CONTRACT ADMINISTRATION&PURCHASING,TALLAHASSEE,FLORIDA 32399-7000.
If unsure if subcontractor is a certified minority supplier,click on the hyperlink below. Enter the name of the supplier,click
"search". Only Certified Minority Business Entities will be displayed.
Page 58 of 82 GAO
16D6
(July 2025—June 2026) 1 IP025
baps://osd.dms.myflorida.com/directories
INSTRUCTIONS
(A) ENTER THE COMPANY NAME AS IT APPEARS ON YOUR AAASWFL CONTRACT.
(B) ENTER THE AAASWFL CONTRACT NUMBER.
(C) ENTER THE SERVICE PERIOD MATCHING THE CURRENT INVOICE'S SERVICE PERIOD.
(D) ENTER ALL CERTIFIED MINORITY BUSINESS EXPENDITURES FOR THE TIME PERIOD COVERED BY
THE INVOICE:
1. ENTER CERTIFIED MINORITY BUSINESS NAME.
2. ENTER THE CERTIFIED MINORITY BUSINESS FEID NUMBER.
3. ENTER THE CERTIFIED MINORITY BUSINESS CMBE NUMBER.
4. ENTER THE AMOUNT EXPENDED WITH THE CERTIFIED MINORITY BUSINESS FOR THE TIME
PERIOD COVERED BY THE INVOICE.
(E) MBE FORM MUST ACCOMPANY INVOICE PACKAGE SUBMITTED TO AAASWFL
FINANCIAL ADMINISTRATION FOR PROCESSING.
(F) FINANCIAL ADMINISTRATION WILL FORWARD ALL COMPLETED CMBE FORMS TO CONTRACT
ADMINISTRATION&PURCHASING OFFICE.
Pagc 59 of 82
16D6
ATTACHMENT IX
EXIHBIT I
Form instructions for Total Compensation Paid to Non-Profit Personnel Using State Funds
CONTRACT DOCUMENTATION REQUIREMENTS
Section 216.1366,F.S.,amended in 2023,establishes new documentation requirements for any contract for services executed
amended,or extended on or alter July 1,2023,with non-profit organizations as defined in s.215.97(2)(m),F.S.The contract must
require the contractor to provide documentation that indicates the amount of state funds:
• Allocated to be used during the full term of the contract for renumeration to any member of the board of directors or an officer
of the contractor.
• Allocated under each payment by the public agency to be used for renumeration of any member of the board of directors or an
officer of the contractor.The documentation must indicate the amounts and recipients of the renumeration.
Such information must be included in the contract tracking system maintained pursuant to s.215.985 F.S.,and must be posted on
the contractor's website if the contractor maintains a wcbsite.
• As used in this subsection,the term:
o "Officer"means a Chief Executive Officer(CEO),Chief Financial Officer(CFO),Chief Operating Officer(COO),or any
other position performing an equivalent function.
o "Renumeration"means all compensation earned by or awarded to personnel,whether paid of accrued,regardless of
contingency,including bonuses,accrued paid time off,severance payments,incentive payments,contributions to a retirement plan,
or in-kind payments,reimbursements,or allowances for moving expenses,vehicles and other transportation,telephone services,
medical services,housing,and meals.
o "State funds"means funds paid from the General Revenue Fund or any state trust fund,funds allocated by the Federal
Government and distributed by the state,or funds appropriated by the state for distribution through any grant program. The term
does not include funds used for the state Medicaid program.
The attached form will be used to document the compensation to non-profits using state funds.
This memorandum does not supersede the requirements outlined in Chief Financial Officer Memorandum No. I.
if you have any questions,please call the Bureau of Auditing at(850)413-5512.
FLORIDA ACCOUNTABILITY CONTRACT TRACKING SYSTEM(FACTS)REQUIREMENTS
Section(s.)215.985,Florida Statues(F.S.),amended in 2023,requires that each contract for which a state entity makes a payment
pursuant to a contract executed,amended,or extended on or after July 1,2023,the state entity shall post any documents submitted
pursuant to s.216.1366 F.S.,which indicates the use of state funds as remuneration under the contract or a specified payment
associated with the contract on the contract tracking system.
1. Are you a nonprofit organization as described in the in s.215.97(2)(m)?
No
Yes
If yes,move on to question 2. If no,this form is not applicable to you.
2. Are any of the Officers,as described above,or any member of the Board of Director paid with state funds under this
contract?
No
Yes
If yes,please complete the AAASWFL Total Compensation Paid to Non-Profit Personnel Using State Funds
attachment for each Individual this applies to.
if no,Please fill in the identifying information and certification statement on the attachment below.
Name:
Title:
Date:
CAO
16D6
ATTACHMENT IX
DOEA Total Compensation Paid to Non-Profit Personnel Using State Funds
Name:
Title:
Agency Agreement/Contract #
Total Contract Amount
Contract Term:
Line Item Budget Category Total Amount Paid Amount Paid from State Funds
Salaries
Fringe Benefits
Bonuses
Accrued Paid Time Off
Severance Payments
Retirement Contributions
In-Kind Payments
Incentive Payments
Reimbursements/Allowances
Moving Expenses
Transportation Costs
Telephone Services
Medical Services Costs
Housing Costs
Meals
CERTIFICATION: I certify that the amounts listed above arc true and accurate and in accordance with the
approved budget.
Name:
Signature:
Title:
---
Date:
16D6
(July 2025—June 2026) HP025
ATTACHMENT•
ANNUAL BUDGET SUMMARY
EMERGENCY HOME ENERGY ASSISTANCE
FOR THE ELDERLY PROGRAM
•
Funding Collier County
Administrative $8,842
Outreach $14,334
Crisis Assistance $79,112
Weather Related/Supply $2,112
Shortage Crisis**
Total $104,400
**Protected minimum 263
number of Individuals to
be served Crisis Energy
Assistance
**Eligible households may be provided with multiple benefits per program year,totaling no more than
$2,000.00.The minimum number of individuals to be served crisis energy assistance may reflect duplicated
consumers if a consumer receives multiple benefits.
**Weather Related/Supply Shortage funds are a set-aside for emergency assistance. These funds must be held
in this budget line item category until December 15th of the program year,for use in response to a possible
disaster.
* Award amount to be spent July 1,2025 to June 30,2026, Please note this date may be extended by the
Florida Department of Commerce and will be communicated via email.
Page 62 of 82 CAO
16uti
(July 2025--,tune 2026) 1-IP025
ATTACHMENT XI
EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL
PSA CONTRACT #
Emergency Home Energy Assistance Program
Administrative & Outreach Expense Budget Detail
ADD ADDITIONAL LINES AS NEEDED
Budget Quantity/
Line Item Expenditure Detail I Irs Unit Cost Total Cost
$0.00
$0.00
_ S0.00
S0.00
S0.00
S0,00
S0.00
S0.00
S0.00_
S0.00 I'I
$0.00
S0.00
$0.00
S0.00
S0.00
S0.00
S0.00
$0.00
$0.00
$0.00
$0.00
S0.00
$0.00
$0.00
Total ( $0.00
Administration Subtotal $ -
Outreach Subtotal $ -
Q
Total $ -
Page 63 of 82 CAO
(July 2025-June 2026) IIP025
ATTACHMENT XII
RECEIPTS AND EXPENDITURE REPORT
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
PROVIDER NAME,ADDRESS, PHONE#AND FEID# Program Funding Source: THIS REPORT PERIOD
FROM: TO:
EHEAP CONTRACT
(Emergency Home Energy PERIOD:
Assistance for the Elderly Program) CONTRACT#
REPORT#
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract
Prepared by: _Date: Approved by: Date:
PART A:BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4 Percent of
Budget For This Report Year to Date Approved Budget
1.Agreement Amount S0.00 $0.00 $0.00 %
2.Interest on Agreement Funds S0.00 S0.00 $0.00 . _
3.TOTAL AGREEMENT AMOUNT S0.00 $0.00 $0.00 %
PART B EXPENDITURES 1.Approved 2 Expenditures 3.Expenditures 4 Percent of
Budget For This Report Year to Date Approved Budget
I.Administration S0.00 S0.00 SO.00 °:°
2.Outreach S0.00 $0.00 S0.00
3.Crisis Services $0.00 $0.00 $0.00 %
4.Weather Related Services $0.00 $0.00 $0.00 %
5.Weather Related Administration $0.00 S0.00 $0.00
6.TOTAL EXPENDITURES $0.00 $0.00 50.00 %
DOEA FORM 105p revised'12/08
Page 64 of 82
16D6
(July 2025-June 2026) HP025
ATTACHMENT XIII
REQUEST FOR PAYMENT
REQUEST FOR PAYMENT
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
CONTRACTOR NAME,ADDRESS,PHONE#and FEID# TYPE OF REPORT: Contract#
Contract Period
Advance Request,._ Request Period
Report If
Reimbursement Request Invoice#
PSA
CERTIFICATION: I hereby certify that this request to the best of my knowledge to be complete and correct and conforms with the terms of the above contract.
Prepared by: - Date: Approved by: Date:
ADMINISTRATION
PART A: BUDGET SUMMARY ADMINISTRATION OUTREACH CRISIS WEATHER WEATHER TOTAL
SERVICES SERVICES SERVICES RELATED RELATED
1.Approved Contract Amount $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2.Previous Funds Received for $0.00 S0.00 $0.00 $0.00 $0.00 $0.00
Contract Period
3.Contract Balance(line 1 minus line 2) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
4.Previous Funds Requested and Not $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Received for Contract Period
5.Contract Balance(line 3 minus line 4) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
PART B: CONTRACT FUNDS REQUEST
1.Anticipated Cash Needs S0.00 $0.00 $0.00 $0.00 $0.00 $0.00
(1st-2nd month,Attach Justification)
2.Net Expenditures For Month S0.00 50.00 $0.00 $0.00 $0.00 $0.00
(DOEA Form 105P,Part B,Line 6)
3.TOTAL $0.00 50.00 $0.00 $0.00 $0.00 $0.00
PART C: NET FUNDS REQUESTED
1.Less Advance Applied $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2.TOTAL FUNDS REQUESTED $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
(Pert B.Line 3 minus Port C,Line 1)
PART D: SERVICE INFORMATION
Number of Individuals served with crisis assistance during the report month:
Number of Individuals Ineligible or denied assistance during the report month:
Number of Individuals served by referral to other community resources for energy assistance during the report month:
Certification statement: Contractor hereby certifies that It has been open and operating during Its normal business hours for the reporting month,as
described In the Statement of Work section,of the EHEAP contract.
DOEA FORM 106P
revised 4/6/17
1 f''f`t Page 65 of 82
16D6
(July 2025—June 2026) I-IP025
ATTACHMENT XIV
INVOICE REPORT SCHEDULE
Invoice Number Based Upon Date Due to the AAASWFL
1-HP025JUL July Expenditure Repot August 10,2025
2-HP025AUG August Expenditure Report September 10,2025
3-HP025SEP September Expenditure Report October 10,2025
4-HP025OCT October Expenditure Report November 10,2025
5-HP025NOV November Expenditure Report December 10,2025
6-HP025DEC December Expenditure Report January 10,2026
7-HP025JAN January Expenditure Report February 10,2026
8-HP025FEIi February Expenditure Report March 10,2026
9-HP025MAR March Expenditure Report April 10,2026
10-HP025APR April Expenditure Report May 10,2026
11- HP025MAY May Expenditure Report June 10, 2026
12-HP025FIN Final Close Out Report June 15,2026
Submission of invoices may or may not generate a payment
Note 1: request. If final invoice reflects funds due back to the AAASWFL,
payment is to accompany the final close-out invoice.
Page 66 of 82 tl,At )
16D6
(July 2025--June 2026) HP025
ATTACHMENT XV
EHEAP APPLICATION AND ELIGIBILITY WORKSHEET
Fnlerprnry Home Energy Assistance for the klderiy Program-Application
Section One: Applkant(Aged 60 and older)Information
N3-0 r oz.4 c.l: ireAp •MY.n3 it)t:f. 6),}V:4344f.
Data Mt-r1 I Age 9.N
UrYk a33le3s C t) Dale Stamp
ttoosa Cowl I Zp Cob.. I Prot ,•:are*costs^1-r
G1n0tr MYe Pea lNar:tr or oe0r 4 n tit nO.ri•M:
Marta:Stasis, until OarTereo Ln;Y .eO3r3tec :.04O40 w3:30J ..... .__ :I.1e
nrf With e3:1.A ra A•1e1e3n Altar NV/ela*3'drPa:meupriser A1•e'C)^"313••A'alt3N37,1 Ones
COY.1. nspavcuao Mir Perin engwgs en;it :pavin Otter
Dots 4-eel ha.e ten 1+3at lay aata'S Arttng.1:0119 D v504s:a•Yng the e icy seiliguJge' Yet No
It tie Otte?a/ett•31' Yea NO 11Y3C C Ytt n'e'reo b trie°Ca,Ve:1'31.1 Arran"CC? Yet NO NA
AfC1'3•ft NOM.tyr+'t) AC:ICa'tt rc1tYt)n:Ortea11ou1t
'13'^R. In:o.'r,()Deist-
I
IAge ..N I VCr71 yleopre 3nou•t
u^t 14:Ore tet4(3)
IAge ..N I Worthy WOO?!Jrf-u':
'11-4 11:0,'e):e(t)'
IAge ,,;t MC•?):•.:•re 311033•3
41-4. $130"1 101(3 1
Age .N I.': cr)
Section lhree: Household Characteristic
it dare a cn•d 1)earl a'ape Cr):a'.;er 1'14 nauter,'d' Yes NO
N Yet.tetCI at air alp IS C-2)ten O.l )3)11r10'0
II tier!31 Ad 10331•t1 3113D41 1?e nOu$11)131 Yet NC
Is:At a;-:Cc3n13 U.S.C:2e1 Or 313141 LI4'u as-ett3 tee te'r13•e';rel'4e1441 Yet NC
It Vt.3Cctdart a note:•sift' Yet Nt
Den amicart.Y1 1 gDltTTert ls4t3Ct3 r:TA r2.1a01 31 1.111:C1 I' Y11 NO
esti pro,de!1!cCnelet ewe. ..
tt)ti.Otts ib4 rYaten:'d rattle!3•clergy HAM)? Yet No
Does a;yicae• 44 l aitulMt Don'tOr0 31u1 tar".Care rani or 31)1•I Or t rtut .•I'.l: :1 Yet NO
)er pp,343Mt3I)naTe .. - ____- _. -
Section Four: Healing and Cooling Intorntatio
elm)CU 01 a•)nt'nteror)04.1Io lercO te{CNtd tiara)3UnN<e to tit Oant•t teas:,l ret 40
:t)tt .r.1 3e rife nr t Cr Agent)
Type e'A SOW:e: Cte'1 MO"1e fr'ery) w13Crer•Re3:t0 03CC
was:II Int VVrlary Hunt or Volt rierrg'(1e'4:I0rt; [IICVIC ty Natural G31 0t30rt w5:0'C33t ftt•'aD-e rue
Croat h041440/1 Ott supClare l:3t 1e3:•.J eturcf• f e:NC) wCOO C*4i VA
Ar CO,a'Deng taut Ope CtrCf3 A C iv-wODI Wa'AC fait O!ner-spe:•t;sou:•3 e.3;:'•:.a
i - n ti.. t g
M0'1e CO:'190'rues:lg.r4'g)t:uftt bat C411 Ire .':nl-)'c•:.01107$3s3'C3"C"Ii IO"!13I1:f rr)1rcer 3;R
OIKY'e_a3 l'e•T.'N•t:1/pI tat 3^4 cr..p.ate u^3enter-I V13:tail)Ir.pr:.'ar 33J13J"Ct*III
91.H+:O RCfe 1113340.343S a lit Ott Wig n:0"..3.3 graaait ref:,I e.I.34
C'I:e C)9tt delWry O*'ON. "I V nrt 01 n 1 nOUIIPCMMt month VIe NOen) Ot301to•Ted:al)'reedy Cr cr'4rei res de 1
di';et c'teng out o'Sailor hea:ng leaf- autioece Ire);.racy to mate Delete par t1:s Orec:>)t0?)1r4r9y suop:er
rnrea.Mn91 I an aAare 11031 3.tr 1 n3.e pro:2+0 31 ow 0-•C r-)ter te:J*I 10 tD C4'efr'I1R
Orret;tt:4kmt wu+�3:a orcOOing orMxn3n T)el 3 fry.OIar'3pp)119br:rat ate throe.the aver:)Ali t3 ncw►t.
Lie no-e,turn at reealg so pay a depc4't reps y c' act(4 c•,Ty styes:on AIT 3n a 4 DM KIIOI I aM also aAare tit)!f 1 3 1 rat
1Ourprell,Of rn:!'11 t•7Hgert)ntasir'e t0 ar0d 3ppreta of 001'03 AIller T1 t Te 3n0A1O,Cr r)1 ap11O.11•or V1e CC<rer,
raiser ens* (l a r rl e'Y g, 3n t Cu• 1 na.e a opt ro acC43 tie Otul10" Cn)Ou for tin li'A•to)
A hilts art rapurto
tic:•e3 7131 ere t1H2)t0u"Cf^Or CO:n;or
halt•;It;Mn)to De d4co•1e:3ed.(Z11131'1
fete.e3 a 900u'TOCatrg 34 tiers)13'.l tt t CIMi.'3^aa't 111114
II III r welt or rapt due (:brJa d+
1.13 ar e14r;)pace DI toe anon Ina d i dila Dy•l
lu111;440 IYa airo1
Y cif COtia.MR)NRter I+•`+'tl t D0r'1alrla war as ws''.1/'VP 3ot4Cl)ar.C..N uiets Ae apsn tit mew toe cd4Ctrrg you-Y.4 r WON
3rcl ponce 4•atee awn()()au)w1 ttr w i^9 so Genii ton s:Xi<r Crap a)3.fro :U,d3 Jw rp :COT3 WTI:COT I It 0711 S:nTm 7.atv1
p(4<31:J)3+-01.t:f 01e D,Salnn.Cf D344 A.•an rDCrr-A 17411 OttrrattAl Car YrcAD)tes 13 OCtict Syla Ale^atrxrad 0)W tf*11r1 cores*:n
d t.'1.1 4 rwaC.t to 7e Necc"ATre Cf U^.FA'p t:navt)atti7ttd 021s Tht:currie"t Is cotton's leis eons seMy utter ii peter te
ree crto'ry b{roAle elwyenc)NY"e Call';)Awttar+ae
Page 67 of 82 CAO
6 D 6
(July 2025—June 2026) 111'025
Enteritency Ii.7nte fnettty Assistance for the Elder! Pro ram•Eli ibilit Worksheet
Section tier: Income Eligibility Determination
Ants)It at r.:v1en:-Ir.uc^1e ,' r,-t'tt'ore it:e.-) State alitan Income(PM Otlaesner
.:•it:itoa!:.:•s Mice w07A1f2o3i.
I A03 al ffab1 tr0'T)tamer 310 • •.1,1:t Coact Irei1'1.1 Imam 17!r)tousero4tee -.
Yr.anf0 locore'run V*past l: 1CC0l WU&tar*Vx4 tWol SO'.UMtV
03)1 Ctat noattKtr O'17 ff{ ...Sb Set 115254
AJJ Veerare Penton ISM 0: 2 POOCC I:OOCO
e rot r V.Mer0 Remote: 7 (17 an 1S4.7C0
I
A03 Mel:ay Dan D.If atir'CJJI.. a SSO tI3 ;..^a of i
t .fdd211 134117
I TDallualte rot(•)tn.nO'T.) t MI S t :)
141XDy 12moor 7 $'i•atl S:a:CS
Annual no,usfr 00 nMCme a ..(!tilt St]Sea
1cteM*?Neon M fMMeV Dover)Utr•.3T1,e1 if Ali
betels Mate h,r m.:m ra yet rA'ro.eewrs*ter
hor-^i:te roroys t
r re tea rnn 1'tsernorrxre a trst:r,!:..(et*Chien`JY!Vetlar Oxon.brnaiseraa 1,Ye(LAN
G/egorWgEgot muttaacsq ram rerier(uwr+ro:Re.'rySiAPaWv.ror.rre Wort out(Y;fir!a1{7e0
a'.te,we d roa tank:no))romrser.t e,taua Note Yi0 rrt(M»tnt ate IrNON h_/Ire macros
Section Seven. Vendor.Benefit,and Verification Information •
PRO VonOor/( Wet YMr00r a I Corsi makf am CARP retv,rer 13 WV')
Nre. fir,. Ife.'Out tfII a4Ytaret
Cory Perrin
Savant renter. LV 11Accou rstre I Car Cite crania
rot nit ar9r3J rewe0:fr ? net
%e mV'1 AO'dtt Cur ArW7 Cueaassli x outg ie caw:. r]GY+
Yer N0
ver%a:tin aryl Cam:Wren D.1110. Par CoSt19 mn:r.
Nob°.rr Cf COotn9 evcrnri
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Case Worker Signature Approval Signature
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a pitare v ant a Semi Mabee.ce exportdfr amebae emmoonatnd be approved droeID ItimUMIISMS
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Page 68 of 82
16D6
(July 2025—June 2026) HP025
ATTACHMENT XVI
NOTICE REGARDING COLLECTION OF SOCIAL SECURITY NUMBERS EMERGENCY HOME ENERGY
ASSISTANCE FOR THE ELDERLY PROGRAM
FLORIDACOMMERCE
Notice of Collection of Social Security Numbers
•
The following disclosure is being made pursuant to section 119.071(5), Florida Statutes.
Social security numbers of applicants and household members are requested because this
information is crucial for the performance of the duties and responsibilities prescribed by law under
the Low-Income Household Energy Assistance Program. This information is not required by state or
federal law; however, social security numbers are necessary to determine eligibility for program
services and specifically for the following purposes:
1. To verify an applicant's identity
2. To verify household size •
3. To verify household income
A social security number collected pursuant to this notice, can only be used by the Florida
Department of Commerce and (Sub-Recipient)for the purposes specified
above.
Nondisclosure except under limited circumstances.
Social security numbers will not be disclosed to other entities unless required or authorized by Florida law.
Section 119.071(5), Florida Statutes, allows disclosure of a person's social security number under the
following specific, limited circumstances:
• If disclosure is expressly required by Federal or Florida law or is necessary for the subrecipient or
governmental entity to perform its duties and responsibilities
• If the individual expressly consents to disclosure in writing
• if disclosure is made to prevent and combat terrorism pursuant to the U.S.Patriot Act of 2001 or Presidential
Executive Order 13224 (blocking property and prohibiting business transactions with persons who
commit,threaten to commit,or support terrorism)
• (For a subrecipient employee and dependents),if disclosure is necessary to administer the person's health
benefits or pension plan funds,or
• If disclosure is for the purpose of the administration of the Uniform Commercial Code by the office of the
Secretary of State
• If disclosure is requested by a commercial entity for permissible uses under the federal Driver's Privacy
Protection Act of 1994, the federal Fair Credit Reporting Act, or the federal Financial Services
Modernization Act of 1999(for example, to verify the accuracy of personal information provided by the
individual to the commercial entity;use by an insurer in connection with claims investigation or anti-fraud
activities; for use in connection with a credit transaction).
CAO
Page 69 of 82
1 6 D 6
(July 2025—June 2026) I-1P025
Acknowledgment of Receipt of Notice
I confirm that I have been provided a copy of this Notice regarding the collection of my social security
number and the social security numbers of all household occupants as part of the application process for
the Florida Low-Income I-Iousehold Energy Assistance Program.
Signature of Applicant Signature of Subrecipient Staff
Page 70 of 82 CAO
1 6 D 6
(July 2025—June 2026) HP025
ATTACHMENT XVII
NOTICE REGARDING AUTHORIZATION FOR RELEASE OF GENERAL AND/OR CONFIDENTIAL
INFORMATION FOR LIHEAP/EHEAP FEDERAL REPORTING
,FLORIDA
COMMERCE
LIHEAP Authorization for Release of Information Form
Authorization for Release of General and/or Confidential Information
For LIHEAP/EHEAP Federal Reporting
The Florida Department of Commerce's (FloridaCommerce) Low-Income Household
Energy Assistance Program(LIHEAP) Program Office is requesting that you authorize
your utility service provider to disclose the following information to the LIHEAP office to
which you are applying for assistance:
• Your utility account status and history,such as payment history,past due amounts,
deposits,current shut-off due dates or disconnection,current life support status,payment
arrangements,and history of energy assistance payments.
• Your total annual energy usage and charges for up to twelve months.
The Florida LIHEAP office and its contractors will use this information to develop
LIHEAP program performance measures and meet Federal reporting requirements.
Please note that:
• You have a right to receive a copy of this form.
• You are not required to authorize your utility service provider to disclose your customer data.
• Your decision not to authorize the disclosure will not affect your utility services or any
LIHEAP assistance you may be eligible for.
• Your utility service provider may not disclose your customer data unless you authorize the
disclosure to the LIHEAP office, Florida Commerce,or as otherwise permitted or required by
laws or regulations.
• Your utility service provider will have no control over the data disclosed pursuant to this
consent and will not be responsible for monitoring or taking any steps to ensure that the Florida
LIHEAP office maintains the confidentiality of the data or uses the data as authorized by you.
• The Florida LIHEAP office will not disclose any private applicant information except for the
purpose of administering public assistance as defined by State and Federal laws and regulations
and developing LIHEAP program performance measures.
ACCOUNT HOLDER(CUSTOMER NAME):
SERVICE ADDRESS FOR UTILITY:
NAME OF UTILITY SERVICE PROVIDER:
UTILITY ACCOUNT NUMBER:
PHONE NUMBER FOR UTILITY ACCOUNT:
Page 71 of 82 (:AO
1 6 D 6
(July 2025—June 2026) 11P025
SECTION A:APPLICANT READS AND COMPLETES THIS SECTION ONLY IF HE/SHE iS THEACCOUNTHOLDER
I hereby authorize the above-named utility and this agency to disclose pertinent information regarding
my account to agencies that may provide me financial assistance, including the Florida LIHEAP
Office. I understand that the purpose of this disclosure is solely for federal reporting purposes and
does not determine my eligibility for assistance. I further understand that some of the information the
above-named utility may provide to this agency may be considered confidential. I also understand that
the above-named utility does not and will not have control over any account information provided to
agencies pursuant to this Authorization, and I will hold the utility harmless for any claim related to
the account information provided. All information is accurate to the best of my knowledge.The
agency may verify information contained in the payment assistance application, including the utility
account for which I am seeking assistance.
ACCOUNT HOLDER'S SIGNATURE: DATE:
SECTION B:APPLICANT READS AND COMPLETES THIS SECTION ONLY IF HE/SHE IS NOT THE ACCOUNT HOLDER
As applicant for payment assistance for the above-named utility account, I hereby confirm, under
penalty of perjury, that I am an Authorized Representative on behalf of the Account Holder, and I
have authority to initiate this assistance application on his/her behalf. This may be confirmed at the
agency's discretion,by contacting the Account Holder. I,and the Account Holder,understand that the
purpose of this disclosure is solely for federal reporting purposes and does not determine my
eligibility. I further understand that some of the information the above-named utility may provide to
this agency may be considered confidential. I also understand that the above-named utility does not
and will not have control over any account information provided to agencies pursuant to this
Authorization,and I will hold the utility harmless for any claim related to the account infonnation
provided. All information is accurate to the best of my knowledge. The agency may verify
information contained in the payment assistance application, including the utility account for which I
am seeking assistance.
APPLICANT'S NAME(NOT ACCOUNT HOLDER):
APPLICANT'S PHONE NUMBER:
SECTION C:FOR AGENCY USE ONLY
Agency must maintain this form in the Applicant's file and make it available to the utility vendor of
record upon request, for accounting and auditing purposes.
AGENCY NAME:
PHONE:
AGENCY CASEWORKER'S NAME:
AGENCY CASEWORKER'S SIGNATURE: DATE:
Page 72 of 82
16D6
(July 2025—June 2026) 1-IP025
ATTACHMENT XVIII
EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS
EHEAP Application Instructions
Section One: Applicant(Age 60 and older)Information
Complete Section One in its entirety.
Special notes:
✓ The Date Stamp is the official application date;
✓ The Intake Worker(with name and phone number recorded)is the person who accepts the application and
required documentation;
✓ The applicant's income type(s)and monthly income amount is recorded in this section,and
✓ If any field is determined to be not applicable,complete the field by entering N/A.
Section Two:Additional Household Members Information
Complete Section Two by listing additional household members and providing the information requested.
Special notes: •
✓ At a minimum,the name(s),age(s),and Social Security number(s)of each additional household member
is required;
✓ You will be attaching a calculator tape of the household's income calculations in the section provided on
the EHEAP Eligibility Worksheet;and
✓ 1f any field is determined to be not applicable, complete the field by entering N/A.
Section Three: Household Characteristics
Complete Section Three by answering each"Yes"or"No"question and providing additional information if applicable.
Special note:
✓ if anyfteld is determined to be not applicable, complete the,field by entering N/A.
Section Four:Heating and Cooling Information
Complete Section Four by answering each question.
Special note:
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Five: Energy Crisis Explanation
Section Five is completed by choosing the best possible explanation for the applicant's crisis and obtaining their signature
and date of signature.
Special note:
✓ If energy crisis is life-threatening,provide crisis resolution within 18 hours.
✓ If energy crisis is non-life-threatening,provide crisis resolution within 48 hours.
✓ If any,field is determined to be not applicable, complete the field by entering N/A.
Client Attestation and Signature
The applicant should read the attestation statement. If the applicant is unable to read the attestation statement,the intake
worker should read it to them before they sign and date the application.
At this point,the intake worker should have the applicant sign the waiver authorizing the release of general and/or
confidential information for LIHEAP/El-IEAP federal reporting. eCiRTS will require you to verify that either the waiver
has been signed or that the client has refused to sign.
EHEAP Eligibility Worksheet Instructions
Page 73 of 82 CAC)
16D6
(July 2025—June 2026) I1P025
Section Six: Income Eligibility Determination
Complete Section Six by stapling the calculator tape in the space provided,entering the annual income,and checking the
appropriate number of individuals in the household to determine the household annual income limit.
Special notes:
✓ If the applicant is over-income and received TANF,SSI,or SNAP,check the categorical eligibility box
and include the appropriate documentation in client file.
✓ Adjacent to the annual income limit by household size is the fifty percent(50%)of poverty amount by
household size. If the annual household income is below the amount for the household size,AND the
household does not receive SNAP,the applicant must provide a written statement of how basic living
expenses are provided for the household.
✓ Ifany,feld is determined to be not applicable, complete the field by entering N/A.
Section Seven:Vendor,Benefit,and Verification Information
Complete Section Seven by completing in its entirety.
Special notes:
✓ The minimum amount due is the amount provided to you during the verification process with the home
energy vendor.
✓ For those applicants receiving an energy subsidy,the minimum amount due will be reduced by the energy
subsidy amount listed on the applicant's public housing lease to determine the total EHEAP benefit. The
energy subsidy is deducted from home energy vendor payments only.
✓ Water,sewer,garbage,and fire,etc. MAY NOT be paid with EHEAP funds. Utility bills that include
charges that arc not directly related to cooling and heating will be reduced by the amounts for these
charges.
✓ Charges incurred due to illegal activities,such as a worthless check or meter tampering, MAY NOT be
paid with EHEAP funds.
V it is allowable to make several crisis benefit payments for a household to resolve a single crisis.This may
include the purchase of blankets,portable fans, space heaters,and/or repair of existing heating/cooling
equipment, in addition to energy bill assistance.
✓ Crisis situations that involve a heateror air conditioner that is powered by both gas and electricity arc
eligible for a crisis benefit payment to both home energy vendors.
✓ Allowable utility categories for heating/cooling bill assistance include the following:
• Utility payments for heating/cooling bill assistance for electric,gas,propane,wood,coal,or
refillable fuels;
• Temporary emergency shelter(if needed due to energy-related crisis);
• Payment to landlords(when utility costs are included in rent);
• Repairs or replacements to heating/cooling units(as long as the amount is within the benefit
limits and work is done by a licensed contractor);
• Deposits to connect or restore energy;
• Late fees,disconnect fees,and reconnect fees;
• Charges from a previous account held by the applicant that is now closed;
• Blankets and fans;
• Taxes and fees associated with the client's utility bill towards the energy portion. In some cases,
where the utility vendor combines all the other fees and taxes,which also includes non-home
energy services,such taxes and fees can be paid with EHEAP funding. Example: In a case where
heating and cooling taxes are commingled with other service taxes,proceed with paying the taxes
portion of the bill.
Page 74 of 82 CAO
16D6
(July 2025—June 2026) FHP025
■ Other allowable payments arc those related to the start-up of services, including reasonable
connection or reconnection fees,delivery fees,deposits,and other fees related to the start-up of
service.
✓ flatly field is determined to be not applicable, complete the,field by entering N/A.
Section Eight:Weatherization Assistance Program(WAP)Referral
Complete Section Eight in its entirety.
Special notes:
✓ When determining the number of LIHEAP or EHEAP crisis benefits the applicant has had, you will
include the current application in the count,provided the application is approved. Refer back to Section
Seven,to the information obtained from the LIHEAP provider.
✓ If any field i.s determined to be not applicable, complete the field by entering N/A.
Section Nine: Resolution of Crisis
Complete Section Nine by selecting all that applies to this applicant and application for services.
Special notes:
✓ The left-hand selections indicate that the application has been acted upon within the 18-hour or 48-hour
requirement.
✓ lithe selection is made to deny the application pending additional information from the client,the 18-
hour or 48-hour requirement has been met and does not repeat itself when the client returns with the
pending information. You have already met the requirement.
✓ If any field is determined to be not applicable, complete the fi eld by entering N/A.
Case Worker Signature
To complete this section,the individual who completes the EHEAP Eligibility Worksheet,determines income eligibility,
and provides the commitment to the utility vendor must sign and complete the requested information.
Special note:
✓ If you are the applicant,or a friend,relative,or employee of the applicant,you cannot determine the
eligibility or award EHEAP benefits. This application must be processed by someone who is not the
applicant or a friend,relative,or employee of the applicant.
Approval Signature
To complete this section,the signer is attesting that he/she has reviewed the application for completeness,determined that
all required documentation is included,and verified that the annual household income calculation and EHEAP benefit
awarded are correct.
Instructions for AAASWFL Form 114—10/01/2019
Page 75 of 82 cAO
16D6
(July 2025-June 2026) I.1P025
ATTACHMENT XIX
EHEAP CLIENT FILE CONTENT CHECKLIST
ELDER'S NAME PSAI) AGENCY APPROVAL
DENIAL
NAME OF WORKER APPLICATION DATE CRISIS RESOLUTION DATE CHECK DATE
PROGRAM REQUIREMENTS MONITORED Yes No N/A COMMENTS
1. Individual client file for the elder includes consumer's name,address,sex,and age.
2. Household contains a member 60 or older.
3. The household is in the Florida county covered by the contract.
4. All household members arc listed and their name,age,DOB,and income(s)arc included.
5 Client tile contains documentation of Social Security numbers for all household members,or citation
to the applicable exemption.
6. Client file contains signed notice regarding collection of social security number(s).
? The client file contains official income documents for all household members and TAMP,SSI,or
SNAP documentation,ilcategorically eligible.
8 If income is self-declared,is there a self-declaration form signed by each individual household
member(18 years of age or older claiming zero income?
The household's total gross income with 1-8 individuals'incomes is calculated correctly and is at or
9 below 60%of the State Median Income.For households with 9-or-more individuals,please refer to
the Federal Poverty Level Guidelines Benefit Matrix,or the household is determined categorically
eligible.
Statement of how basic living expenses(i.e.,food,shelter and transportation)arc being provided if
10. total household income is less than 50%of the current Federal Poverty Guidelines and no one in the
household is receiving SNAP assistance.
I I Checked that cider does not live in student dormitory,adult family care home,or any kind of group
living facility.
12 Verified and documented household has not received LIHEAP Crisis Assistance during the same
heating or cooling season.
13. Documentation of\\'eatherization Assistance Program(\VAP)referral,if applicable.
14 Copies of fuel bills,or other supporting documentation as proof of energy crisis,for the residence in
which they reside.
15. Signed copy of Authorization for Release of General and/or Confidential Information.
16. Only eligible components of the utility bill arc paid to resolve the crisis.
17 Only the minimum necessay to resolve the crisis is paid. If a different amount is required by the
utility company,provide additional information on the Eligibility Worksheet.
18 Crisis energy benefit was reduced by unallowable charges,such as:water,sewer,garbage,and fire,
etc.,if applicable.
19. Crisis energy benefit was reduced by energy subsidy,if applicable.
20. Energy crisis resolved within 18 or 48 hours by an eligible action.
21 Written notice of approval or denial for services that includes appeal procedures is issued within 15
working days of eligibility determination.
22. Appropriate benefit provided.
23 All required sections of the application arc signed and dated by the elder,staff,and supervisory/peer
PRIOR to payment.
24. Proof of payment to vendor.
25. Place completed AAASIVFL Form 211 in client file.
INSTRUCTIONS: A check mark in the Yes column Indicates the requirement has been tort.A check mark in the No column indicates the requirement has
not been met or is questionable. Each"No"mark must he explained under"COMMENTS".
Supervisor/Peer Signature Consenter File Monitoring Date
Page 76 of 82 c4O
16D6
(July 2025—June 2026) I IP025
ATTACHMENT XX
EIIEAP COST REItMBURSEMENT SUMMARY
Contract#
Report Period:
Budget
Category Description Nurner of units Amount
0
V
TOTAL ADMINISTRATION $0.00
.c
u
u
O
TOTAL OUTREACH $0.00
F
O
}
c,
N
TOTAL CRISIS ASSISTANCE $0.00
Page 77 of 82 C,1Q
1 6 D 6
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CAO
1 6 D 6
ATTACHMENT XXII
RECIPENT INFORMATION
EHEAP
RECIPIENT INFORMATION
FEDERAL YEAR: 2024
1. PLANNING&SERVICE AREA: I
II. CONTRACT NUMBER: CONTRACT AMOUNT: I
I11, COUNTIES TO BE SERVED:
IV.GENERAL ADMINISTRATIVE INFORMATION
a. Recipient:
Recibiert Acdress:
Telephone:
Fa.4:
We mite:
b. Eaetutire Director or Chief Administrator:
Telephone:
Email Adc•ess:
c. President/Chairman o1 the Board: frame: I
Adc &s:
Telephone:
Fa.r:
Email Adc•ess:
O. Program Contacts:
Name:
Title:
Telephone:
Email Adc-:ss:
Name:
Title:
Telephone:
Email Ade-ess:
e. Fiscal Contacts:
Name:
Title:
Telephone:
Email Adcess:
Name:
Title:
Telephone:
Email Adc•ess:
f. Person's]authorised to sign reports and/or contracts:
g. Agency's FEID Number: I ( Agency's DUNS P I
N. AUDfT DUE DATE: Audit1S1 are die ts•the ere of the Ninth.mcrtn tolcoins,We end oldie agen1•s'iza.year
Reciaiert Fiscal Year: thru I
Audit Due to DO EA: t.ran■drry;aa
Page 81 of 82
16D6
ATTACHMENT XXIII
SERVICE RATE REPORT
PROGRAM: EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM
fI Federally Funded From 07/01/2025 to 06/30/2026
CATEGORY METHOD HIGH UNIT TYPE
SERVICE OF REIMBURSEMENT
PAYMENT RATE
Ammonization ADMINISTRATIVE COSTS* Cost Cost Reimbursement EPISODE
Reimbursement
Cst
Outreach OUTREACH COSTS* ReimbursementCost Reimbursement EPISODE
Crisis CRISIS ENERGY ASSISTANCE Cost
Assistance BENEFITS* Reimbursement Cost Reimbursement EPISODE
*As stipulated in contract,these sclvices are provided on a cost reimbursement basis.
Page 82 of 82