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Backup Documents 02/24/2015 Item #16D4 16D4 COMMUNITY AND HUMAN SERIVCES INTEROFFICE MEMORANDUM TO: Board Minutes and Records FROM: Lisa N. Can, Grants Coordinator, HHVS DATE: February 24, 2015 RE: Older Americans Act Title III Contract between Area Agency on Aging for Southwest Florida, Inc and Collier County: OAA 203.15 Please find attached one (1) each fully executed documents that were approved by the BCC on the day listed below for recording in Minutes and Records. Feel free to contact me if you have any questions. BCC Approved on February 24, 2015: Item: 16.D. 4 Older Americans Act Contract FY15 Thank you for your assistance. January 2015 Contract#OAA 203.15 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. STANDARD CONTRACT 6 0 4 OLDER AMERICANS ACT TITLE III THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier County Board of County Commissioners (Contractor), and collectively referred to as the "Parties." The term Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient. WITNESSETH THAT: WHEREAS,the Agency has determined that it is in need of certain services as described herein; and WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such services as an independent Contractor of the Agency. NOW THEREFORE, in consideration of the services to be performed and payments to be made,together with the mutual covenants and conditions hereinafter set forth,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, exhibits and references incorporated,which constitute the contract document. 1.1 Agency Mission.Vision and Values Statement; The agency's mission: To help aging adults achieve greater independence through awareness of resources and access qualified service providers. The agency's vision: To be the recognized leader in supporting older adults and their families with access to trustworthy resources and services in their communities while empowering them to live with independence and dignity. The agency's values: We believe residents of Southwest Florida are entitled to: Comprehensive information about their choices of care;Timely access to resources and services; High standards of quality and performance; and Personal and professional accountability from all stakeholders. 2. Incorporation of Documents within the Contract The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Agency and/or Department handbooks, manuals or desk books and Master Contract number HM014,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 January 1,2015 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 December 31,2015. 4. Contract Amount The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $671,792.00 ($346,722.00 In-Home Services), or the rate schedule, 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 s. 287.058(1)(g), F.S.,the Agency may renew the contract for a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon satisfactory performance evaluations by the Agency and the availability of funds. 1 January 2015 Contract#1A6Oj 54 6. Official Payee and Representatives(Names,Addresses,and Telephone Numbers): The Contractor name, as shown on page 1 of this Collier County Housing,Human and Veteran Services a. contract, and mailing address of the official payee to 3339 E Tamiami Trail, Building H whom the payment shall be made is: Naples, FL 34112 Kimberly Grant, Director b The name of the contact person and street address where Collier County Housing, Human and Veteran financial and administrative records are maintained is: Services 3339 E Tamiami Trail,Building H Naples,FL 34112 The name, address,and telephone number of the Kimberly Grant, Director c. Collier County Housing, Human and Veteran representative of the Contractor responsible for Services administration of the program under this contract is: 3339 E Tamiami Trail,Building H Naples, FL 34112 (239)252-2273 The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc. d' Requests for Payment and Receipt and Expenditure 15201 North Cleveland Avenue, Suite 1100 forms are to be mailed is: North Fort Myers, FL 33903 Fiscal Director e. The name,address,and telephone number of the Area Agency on Aging for Southwest Florida,Inc. Contract Manager for this contract is: 15201 North Cleveland Avenue, Suite 1100 North Fort Myers, FL 33903 Upon change of representatives(names,addresses,telephone numbers)by either party,notice shall be provided in writing to the other party and the notification attached to the originals of this contract. 7. All Terms and Conditions Included: This contract and its Attachments, I, III, VII, VIII, IX, X, XI and 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 THEREOF, the Parties hereto have caused this contract to be executed by their undersigned officials as duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR COUNTY COMMISSIONERS SOUTHWEST FLORIDA,INC. SIGNED BY: V An t SIGNED BY: �%'`��t'U/Wlu NAME: Stephen Y. Carnell NAME: MARIANNE G. LORINI TITLE: Public Services Administrator TITLE: PRESIDENT/CEO DATE: \ \Zl ( 201C DATE: I) glib Federal Tax ID: 59-6000558 to form and legality Approved as Fiscal Year Ending Date: 9/30 2 istant Co Attorney G4► 6D4 January 2015 Contract# A 203.15 INDEX OF ATTACHMENTS ATTACHMENT I STATEMENT OF WORK 4 ATTACHMENT III FEDERAL RESOURCES AWARD 16 ATTACHMENT VII BUDGET AND RATE SUMMARY 17 ATTACHMENT VIII INVOICE SCHEDULE 19 ATTACHMENT IX REQUEST FOR PAYMENT-106A 20 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT-1 O5as 21 ATTACHMENT XI RECEIPTS AND EXPENDITURE REPORT-105AE 22 3 CA January 2015 Contract#OAA 203.15 ATTACHMENT I AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. 1 STATEMENT OF WORK 1 6 4 OLDER AMERICANS ACT PROGRAM TITLE III SECTION I: SERVICES TO BE PROVIDED 1.1 DEFINITIONS OF TERMS AND ACRONYMS 1.1.1 CONTRACT ACRONYMS Area Agency on Aging(AAA) Activities of Daily Living(ADL) Alliance of Information&Referral Systems(AIRS) Assessed Priority Consumer List(APCL) Adult Protective Services(APS) Client Information and Registration Tracking System(CIRTS) Chronic Disease Self-Management Education(CDSME) Chronic Disease Self-Management Program(CDSMP) Evidence-Based Disease Prevention and Health and Promotion(EBDPHP) Information and Referral(I&R) Instrumental Activities of Daily Living(IADL) Older Americans Act(OAA) Planning and Service Area(PSA) 1.1.2 PROGRAM SPECIFIC TERMS Area Plan: A plan developed by the AAA outlining a comprehensive and coordinated service delivery system in its PSA in accordance with Section 306 (42 U.S.C. 3026)of the OAA and Department instructions. Area Plan Update: A revision to the area plan wherein the AAA enters OAA specific data in CIRTS. An update may also include other revisions to the area plan as instructed by the Department or Agency. Child: An individual who is not more than 18 years of age or an individual with disability. Family Caregiver: An adult family member, or another individual, who is an informal provider of in-home and community care to an older individual. Frail: When an older individual is unable to perform at least two ADLs without substantial human assistance, including verbal reminding,physical cueing or supervision;or due to cognitive or other mental impairment,requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to another individual. Grandparent: A grandparent or step-grandparent of a child,or a relative of a child by blood,marriage or adoption and who lives with the child; is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the child, such as legal custody or guardianship,or is raising the child informally. 4 �9 January 2015 Contract#OAA 203.15 1.2 GENERAL DESCRIPTION 1 6 D 4 1.2.1 General Statement The OAA Program is a federal program initiative that provides assistance to older persons and caregivers and is the only federal supportive services program directed solely toward improving the lives of older people. The program provides a framework for a partnership among the different levels of government and the public and private sectors with a common objective, improving the quality of life for all older individuals by helping them to remain independent and productive. The primary purpose of the OAA program is to foster the development and implementation of comprehensive and coordinated systems to serve older individuals. The OAA program uses these systems to assist older individuals to attain and maintain maximum independence and dignity in a home environment and allows for the capability of self-care with appropriate supportive services. 1.2.2 Authority The relevant authority references governing the OAA program are: (1) Older Americans Act of 1965, as amended; (2) Rule 58A-1, Florida Administrative Code; and (3) Section 430.101, Florida Statutes. 1.2.3 Scope of Service The Contractor is responsible for the programmatic, fiscal, and operational management of the Title II1B, Title IIIC1, Title IIIC2, and Title IIIE programs of the OAA within its designated PSA. The scope of service includes planning, coordinating and assessing the needs of older persons, and assuring the availability and quality of services. The services shall be provided in a manner consistent with and described in both the current Contractor's Request for Proposal and the Agency's Area Plan Update, and the current Department of Elder Affairs Programs and Services Handbook. 1.2.4 Major Program Goals The major goals of the OAA program are to improve the quality of life for older individuals, preserve their independence and prevent or delay more costly institutional care. These goals are achieved through the implementation of a comprehensive and coordinated service system that provides a continuum of service alternatives that meet the diverse needs of elders and their caregivers. 1.3 INDIVIDUALS TO BE SERVED 1.3.1 OAA Title HI,General Consumers shall not be dually enrolled in an OAA program and a Medicaid capitated long-term care program,with the exception of consumers in need of OAA Legal Assistance services. 1.3.2 OAA Title IIIB, Supportive Services Eligibility for OAA Title IIIB, Supportive Services, are as follows: (1) Individuals must be age 60 or older; and (2) Information and Referral/Assistance services are provided to individuals regardless of age. 1.3.3 OAA Titles IIIC1 and IIIC2,Nutrition Services,General General factors that should be considered in establishing priority for Nutrition Services, both Cl and C2, include those older persons who meet the following: (1) Cannot afford to eat adequately; (2) Lack the skills or knowledge to select and prepare nourishing and well-balanced meals; (3) Have limited mobility which may impair their capacity to shop and cook for themselves; or (4) Have a disabling illness or physical condition requiring nutritional support or have been screened at a high nutritional risk. 5 January 2015 Contract#OAA 203.15 1.3.3.1 OAA Title IIIC1,Congregate Nutrition Services 1 6 D 4 In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I, Paragraph 1.3.3, individuals must be mobile, not homebound and physically, mentally and medically able to attend a congregate nutrition program. Individuals eligible to receive congregate meals include the following: (1) Individuals age 60 or older;and (2) Any spouse(regardless of age)who attends the dining center with his/her eligible spouse; (3) Persons with a disability, regardless of age, who reside in a housing facility occupied primarily by older individuals where congregate nutrition services are provided; (4) Disabled persons who reside at home with and accompany an eligible person to the dining center; and (5) Volunteers, regardless of age, who provide essential services on a regular basis during meal hours. 1.3.3.2 OAA Title IIIC2,Home Delivered Nutrition Services In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I, Paragraph 1.3.3, individuals must be homebound and physically, mentally or medically unable to attend a congregate nutrition program. Individuals eligible to receive home delivered meals include the following: (1) Individuals age 60 or older who are homebound by reason of illness, disability or isolation; (2) The spouse of a homebound eligible individual,regardless of age,if the provision of the collateral meal supports maintaining the person at home; (3) Individuals with disabilities, regardless of age, who reside at home with eligible individuals and are dependent on them for care; and (4) Persons at nutritional risk who have physical, emotional or behavioral conditions, which would make their presence at the congregate site inappropriate; and persons at nutritional risk who are socially or otherwise isolated and unable to attend a congregate nutrition site. 1.3.4 OAA Title HIE,Caregiver Support Services Eligibility for OAA Title IIIE, Caregiver Support Services, are as follows: (1) Family caregivers of individuals age 60 or older; (2) Grandparents(age 55 or older)or older individuals(age 55 or older)who are relative caregivers; (3) Priority will be given to family caregivers who provide care for individuals with Alzheimer's disease and related disorders with neurological and organic brain dysfunction and for grandparents or older individuals who are relative caregivers who provide care for children with severe disabilities; and (4) For respite and supplemental services, a family caregiver must be providing care for an older individual who meets the definition of the term"frail"in OAA, Section 102 Paragraph 22. 1.3.5 Targeted Groups Preference shall be given to those with the greatest economic and social need, with particular attention to low- income older individuals, including those that are low-income minorities, have limited English proficiency, and older individuals residing in rural areas. SECTION II—MANNER OF SERVICE PROVISION 2.1 SERVICE TASKS In order to achieve the goals of the OAA program,the Contractor shall ensure the following tasks are performed: (1) Client eligibility determination; (2) Targeting and screening of service delivery for new clients; (3) Delivery of services to eligible clients; (4) Use of volunteers to expand the provision of available services; (5) Development of Partnerships and Collaborations; (6) Monitoring the performance of its subcontractors; (7) Information and Referral/Assistance Access Services(Elder Helplines); and (8) Grievance and Complaint Procedures. 6 0 1 6 0 4 January 2015 Contract#OAA 203.15 2.1.1 Client Eligibility Determination The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a client is based on meeting the requirements described in this ATTACHMENT I, Section 1.3. 2.1.2 Targeting and Screening of Service Delivery for New Clients The Contractor shall develop and implement policies and procedures consistent with OAA targeting and screening criteria. 2.1.3 Delivery of Services to Eligible Clients The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of elders and their caregivers. The Contractor shall ensure the performance and report performance of the following services in accordance with the current Department of Elder Affairs Programs and Services Handbook. The services funded pursuant to this contract are in accordance with the OAA,Title III, sections 321,331,336, 361,and 373 as follows: (1) Section 321, Title IIIB Supportive Services; (2) Section 331, Title IIIC1 Congregate Nutrition Services; (3) Section 336,Title IIIC2 Home Delivered Nutrition Services; and (4) Section 373,Title IIIE Caregiver Support Services 2.1.3.1 Supportive Services(HIB Program) Supportive services include a variety of community-based and home-delivered services that support the quality of life for older individuals by helping them remain independent and productive. Services include the following: (1) ADRC Access; (17) Recreation; (2) Adult Day Care/Adult Day Health Care; (18) Emergency Alert Response; (3) Caregiver Training/Support; (19) Escort; (4) Case Aid/Case Management; (20) Health Support; (5) Chore Services; (21) Home Health Aid; (6) Companionship; (22) Homemaker; (7) Counseling(Gerontological and Mental Health); (23) Housing Improvement; (8) Education/Training; (24) Information; (8) Legal Assistance; (25) Intake; (9) Material Aid; (26) Interpreter/Translating; (10) Occupational Therapy; (27) Referral/Assistance; (11) Outreach; (28) Respite Services; (12) Personal Care; (29) Screening/Assessment; (13) Physical Therapy; (30) Speech Therapy; (14) Shopping Assistance; (31) Telephone Reassurance; and (15) Skilled Nursing; (32) Transportation (16) Specialized Medical Equipment, Services, and Supplies 2.1.3.2 Congregate Nutrition Services (IIIC1 Program) Nutrition services are provided in congregate settings and are designed to reduce hunger and food insecurity, promote socialization and the health and well-being of older individuals by assisting them to gain access to nutrition and other disease prevention and health promotion services. Services include the following: (1) Congregate meals; (2) Congregate meals screening; (3) Nutrition education and nutrition counseling; and (4) Outreach. 7 0 January 2015 Contract#OAA 203.15 1604 2.1.3.3 Home Delivered Nutrition Services(HIC2 Program) In-home nutrition services are provided to reduce hunger and food insecurity; promote socialization and the health and well-being of older individuals by assisting such individuals to gain access to nutrition and other disease prevention and health promotion services. Services include the following: (1) Home delivered meals; ((2) Nutrition education and counseling; and 3) Outreach. 2.1.3.4 Caregiver Support Services(HIE Program) The following services are intended to provide direct help to caregivers, assist in the areas of health, nutrition and financial literacy and assist caregivers in making decisions and problem solving related to their caregiving roles and responsibilities: (1) Adult Day Care/Adult Day Health Care; (7) Intake; (2) Caregiver Training/Support; (8) Outreach; (3) Counseling(Gerontological and Mental Health); (9) Referral/Assistance; (4) Education/Training; (10) Respite Services; (5) Financial Risk Reduction(Assessment and (11) Screening/Assessment; and Maintenance); (12) Transportation. (6) Information; 2.1.3.5 Caregiver Support Supplemental Services(HIES Program) At least 10 percent,but no more than 20 percent,of the total Title IIIE funds shall be used to provide supplemental support services. The following services are provided to complement the care provided by caregivers: (1) Chore Services; (2) Housing Improvement; (3) Legal Assistance; (4) Material Aid; and (5) Specialized Medical Equipment, Services and Supplies. 2.1.3.6 Caregiver Support Grandparent Services (HIEG Program) At least 5 percent,but no more than 10 percent,of the total Title IIIE funds shall be used to provide support services to grandparents and older individuals who are relative caregivers. Services for grandparents or older individuals who are relative caregivers designed to help meet their caregiving obligations include the following: (1) Caregiver Training/Support; (7) Outreach; (2) Child Day Care; (8) Referral/Assistance; (3) Counseling(Gerontological and Mental Health); (9) Screening/Assessment; (4) Education/Training; (10) Sitter; and (5) Information; (11) Transportation (6) Legal Assistance; 2.1.4 Use of Volunteers to Expand the Provision of Available Services 2.1.4.1 The Contractor shall ensure the use of trained volunteers in providing direct services delivered to older individuals and individuals with disabilities needing such services. If possible, the Contractor shall work in coordination with organizations that have experience in providing training, placement, and stipends for volunteers or participants (such as organizations carrying out federal service programs administered by the Corporation for National and Community Service), in community service settings. 8 160 Li January 2015 Contract#OAA 203.15 2.1.4.2 The Contractor shall submit a quarterly report of volunteer activities and services electronically on the internet in a format provided by the Agency and/or the Department's Office of Volunteer and Community Services. The quarterly report schedule is as follows: Report Period Report Due Dates January 1 -March 31 April 15, 2015 April 1-June 30 July 15, 2015 July 1- September 30 October 15, 2015 October 1 -December 31 January 15, 2016 2.1.5 Use of Subcontractors If this contract involves the use of a subcontractor or third party, then the Contractor shall not delay the implementation of its agreement with the subcontractor. If any circumstances occur that may result in a delay for a period of 60 days or more of the initiation of the subcontract or in the performance of the subcontractor, the Contractor shall notify the Contract Manager and the Agency's Chief Financial Officer in writing of such delay. 2.1.5.1 The Contractor shall not permit a subcontractor to perform services related to this agreement without having a binding subcontractor agreement executed. In accordance with section 23.1 of the Master Contract,the Agency will not be responsible or liable for any obligations or claims resulting from such action. 2.1.5.2 The Contractor shall submit a copy of all subcontracts to the Contract Manager within thirty days of the subcontract being executed. 2.1.5.3 Monitoring the Performance of Subcontractors The Contractor shall monitor at least once per year each of its subcontractors, subrecipients, vendors, and/or consultants paid from funds provided under this contracts. The Contractor shall perform fiscal, administrative and programmatic monitoring to ensure contractual compliance, fiscal accountability, programmatic performance and compliance with applicable state and federal laws and regulations. The Contractor shall monitor to ensure that time schedules are met, the budget and scope of work are accomplished within the specified time periods and other performance goals stated in this contract are achieved. 2.1.5.4 The contractor shall document, and provide upon request, evidence of partnerships created formally through Memorandums of Agreement or Understanding or informally through emails and phone calls. Contractor will be required to keep track of partnerships in the Monthly Programmatic Report. Each month the Contractor should review and provide updates as necessary. 2.1.6 Subcontractor Outreach Reporting Requirements The Contractor shall document its oversight of subcontractor performance of outreach activities, by establishing a uniform reporting format that includes the following: number and type of provider events or activities; date and location; total number of participants at each event or activity; individual service needs identified; and referral sources or information provided. The Contractor shall require subcontractors to use this format for reporting on outreach activities at least semi-annually. 2.1.7 Grievance and Complaint Procedures 2.1.7.1 Grievance Procedures The Contractor shall comply with and ensure subcontractor compliance with the Minimum Guidelines for Recipient Grievance Procedures, Appendix D, Department of Elder Affairs Programs and Services Handbook, to address complaints regarding the termination, suspension or reduction of services, as required for receipt of funds. 9 1604 January 2015 Contract#OAA 203.15 2.1.7.2 Complaint Procedures The Contractor shall develop and implement complaint procedures and ensure that subcontractors develop and implement complaint procedures to process and resolve client dissatisfaction with services. Complaint procedures shall address the quality and timeliness of services, provider and direct service worker complaints, or any other advice related to complaints other than termination, suspension or reduction in services that require the grievance process as described in Appendix D,Department of Elder Affairs Programs and Services Handbook. The complaint procedures shall include notification to all clients of the complaint procedure and include tracking the date, nature of complaint and the determination of each complaint. 2.2 SERVICE TIMES The Contractor shall ensure the provision of the services listed in the contract during normal business hours unless other times are more appropriate to meet the performance requirements of the contract, and it shall monitor its subcontractors to ensure they are available to provide services during hours responsive to client needs and during those times which best meet the needs of the relevant service community. 2.3 DELIVERABLES 2.3.1 Programmatic Operations/Administration The Contractor shall ensure the provision of services outlined in Section 2.3.2 in accordance with Department of Elder Affairs Programs and Services Handbook through its review of reports outlined in Section 2.4 of this agreement at least as follows: A.) monthly review of subcontractors' surplus/deficit reports, and CIRTS data accuracy reports; B.) annual review of service cost reports; and C.)at least annually and as needed to correlate with applicable contract amendments area plan update for OAA service units, recording of manual units of service portions of the OAA Annual Report. 2.3.2 Service Unit The Contractor shall ensure the provision of the services described in the contract in accordance with the current Department of Elder Affairs Programs and Services Handbook and the services tasks described in Section 2.1. The chart below lists the services allowed and the units of measurement. Units of service will be paid pursuant to the rate established in the 2015 Area Plan as updated in ATTACHMENT VII and approved by the Agency. Services Unit of Service Adult Day Care/Adult Day Health Care Interpreter/Translating Legal Caregiver Training/Support Assistance Medication Case Aid/Case Management Management Child Day Care Mental Health Counseling/Screening Chore Services Nutrition Counseling Companionship Occupational Therapy Congregate Meals Screening Personal Care Counseling Services Physical Therapy Escort Recreation Hour Financial Risk Reduction Services Respite Services Health Support Screening/Assessment Home Health Aide Sitter Homemaker Skilled Nursing Services Housing Improvement Speech Therapy Intake Emergency Alert Response Day 10 January 2015 Contract#OAA 13.6 0 4 Education/Training Information Material Aid Nutrition Education Episode Outreach Referral/Assistance Specialized Medical Equipment, Services and Supplies Telephone Reassurance Escort Shopping Assistance One-Way Trip Transportation Congregate and Home Delivered Meals Meal 2.4 REPORTS The Contractor shall respond to additional routine and/or special requests for information and reports required by the Agency in a timely manner as determined by the Contract Manager.The Contractor shall establish due dates for any subcontractors that permit the Contractor to meet the Agency's reporting requirements. 2.4.1 Client Information and Registration Tracking System (CIRTS)Reports The Contractor shall input OAA specific data into CIRTS to ensure CIRTS data accuracy. The contractor shall use CIRTS generated reports which include the following: (1) Client Reports; (2) Monitoring Reports; (3) Services Reports; (4) Miscellaneous Reports; (5) Fiscal Reports; (6) Aging Resource Center Reports; and (7) Outcome Measurement Reports. 2.4.2 Service Costs Reports The Contractor shall require subcontractors to submit to the Agency annual service cost reports, which reflect actual costs of providing each service by program. This report provides information for planning and negotiating unit rates and is due February 15, 2016. 2.4.3 Surplus/Deficit Report The Contractor will submit a consolidated surplus/deficit report in a format provided by the Agency to the Contract Manager by the 18th of each month. This report is for all agreements and/or contracts between the Contractor and the Agency. The report shall include the following: (1) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the Agency will be resolved; (2) Recommendations to transfer funds to resolve surplus/deficit spending; 2.5 RECORDS AND DOCUMENTATION The Contractor will ensure the collection and maintenance of client and service information on a monthly basis from the CIRTS or any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. 2.5.1 Each Contractor and subcontractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. The routine backing up of all data and software is required to recover from losses or outages of the computer system. Data and software essential to the continued operation of contractor functions must be backed up. The security controls over the backup resources shall be as stringent as the protection required of the primary resources. It is recommended that a copy of the backed up data be stored in a secure, offsite location. 11 C 1( 1 6 0 4 January 2015 Contract#OAA 203.15 2.5.1.1 The Contractor shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement in its contracts and/or agreements with subcontractors. These policies and procedures shall be made available to the Agency upon request. 2.6 PERFORMANCE SPECIFICATIONS 2.6.1 Outcomes (1) The Contractor shall ensure services provided under this contract are in accordance with the current DOEA Programs and Services Handbook. (2) The Contractor shall timely submit to the Agency all reports described in ATTACHMENT I,Paragraph 2.4 REPORTS. (3) The Contractor shall timely submit to the Agency all information described in ATTACHMENT I, Paragraph 2.5 RECORDS AND DOCUMENTATION. 2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS 2.7.1 Matching,Level of Effort,and Earmarking Requirements The Contractor shall provide match of at least 1 0 percent of the federal funds received. The Contractor's match will be made in the form of cash,general revenue administrative funds and/or in-kind resources. The Contractor will assure, through a provision in subcontracts, a match requirement of at least 10 percent of the cost for services funded through this contract. The subcontractor's match will be made in the form of cash and/or in-kind resources. The Contractor shall report match by title each month. At the end of the contract period, the Contractor must properly match OAA funds that require a match. 2.7.2 Consumer Contributions Consumer contributions are to be used under the following terms: (1) The Contractor assures compliance with Section 315 of the OAA as amended in 2006, in regard to consumer contributions; (2) Voluntary contributions are not to be used for cost sharing or matching; (3) Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and (4) Voluntary contributions are to be used only to expand services. 2.7.3 Use of Service Dollars and Management of the Assessed Priority Consumer List The Contractor is expected to spend all federal, state and other funds provided by the Agency for the purpose specified in the contract. The Contractor must manage the service dollars in such a manner so as to avoid having a wait list and a surplus of funds at the end of the contract period, for each program managed by the Contractor. If the Agency determines that the Contractor is not spending service funds accordingly, the Agency may transfer funds to other Contractors during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under state and federal law. 2.7.4 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget and Rate Summary, ATTACHMENT VII to this contract. Any changes in the amounts of federal or general revenue funds identified on the Budget Summary form require a contract amendment. 2.7.5 Title III Funds The Contractor assures compliance with Section 306 of the OAA, as amended in 2006, that funds received under Title III will not be used to pay any part of a cost(including an administrative cost) incurred by the Contractor to maintain a contractual or commercial relationship that is not carried out to implement Title III. 2.8 AGENCY RESPONSIBILITIES 2.8.1 Program Guidance and Technical Assistance The Agency will provide to the Contractor guidance and technical assistance as needed to ensure the successful fulfillment of the contract by the Contractor. 12 !!r. January 2015 Contract#OAA 203 1��5 6 0 4 2.8.2 Contract Monitoring The Agency will review and evaluate the performance of the Contractor under the terms of this contract. Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or an on- site visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and deliverables. The Agency may use, but is not limited to, one or more of the following methods for monitoring: (1) Desk reviews and analytical reviews; (2) Scheduled, unscheduled and follow-up on-site visits; (3) Client visits; (4) Review of independent auditor's reports; (5) Review of third-party documents and/or evaluation; (6) Review of progress reports; (7) Review of customer satisfaction surveys; (8) Agreed-upon procedures review by an external auditor or consultant; (9) Limited-scope reviews; and (10) Other procedures as deemed necessary. SECTION III: METHOD OF PAYMENT 3.1 General Statement of Method of Payment The method of payment for this contract includes advances, cost reimbursement for administration costs, and fixed rate for services. The Contractor shall ensure that the fixed rates for services include only those costs that are in accordance with all applicable state and federal statutes and regulations and are based on audited historical costs in instances where an independent audit is required. The Contractor shall consolidate all requests for payment from subcontractors and expenditure reports that support requests for payment and shall submit to the Agency on forms 106A (ATTACHMENT IX), 105as (ATTACHMENT X),and 105AE(ATTACHMENT XI). 3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget and Rate Summary, ATTACHMENT VII to this contract. Any changes in the total amounts of the funds identified on the Budget Summary form require a contract amendment. 3.2 Advance Payments The Contractor may request up to two months of advances at the start of the contract period, if available, to cover program administrative and service costs. The payment of an advance will be contingent upon the sufficiency and amount of funds released to the Agency by the State of Florida("budget release"). The Contractor shall provide the Contract Manager documentation justifying the need for an advance and describing how the funds will be distributed. 3.2.1 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient budget is available,the Agency will issue approved advance payments after January 1,2015. 3.2.2 All advance payments made to the Contractor shall be returned to the Agency as follows: one—tenth of the advance payment received shall be reported as an advance recoupment on each request for payment, starting with report number five, in accordance with the Invoice Schedule,ATTACHMENT VIII to this contract. 3.2.3 Interest earned on advances must be identified separately by source of funds, state or federal. Contractors shall maintain advances of federal funds in FDIC interest bearing accounts unless otherwise exception is made in accordance with 45 CFR 74.22(k). Earned interest must be returned to the Agency at the end of each quarter of the contract period. 13 January 2015 Contract#OAA 2 3.1 , 4 3.3 Invoice Submittal and Requests for Payment All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA forms 106A (ATTACHMENT IX), 105as (ATTACHMENT X), and 105AE (ATTACHMENT XI). The Contractor shall include with its request for payment documentation of services provided,the units of services provided, and the rates for the services provided in conformance with the requirements as described in the deliverables and service tasks. 3.3.1 Remedies for Nonconforming Services The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely, completely and commensurate with required standards of quality. Such goods and/or services will only be delivered to eligible program participants. 3.3.1.1 If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed under this contract. In addition, any nonconforming goods(including home delivered meals)and/or services not meeting such standards will not be reimbursed under this contract.The Contractor's signature on the request for payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor shall solely bear the costs associated with preparing or providing nonconforming goods and/or services.The Agency requires immediate notice of any significant and/or systemic infractions that compromise the quality, security or continuity of services to clients. 3.3.2 Financial Consequences Contractor shall ensure the provision of services to the projected number of clients in accordance with the 2014 RFP as updated and within the contract amount. The Contractor shall ensure expenditure of 100% of the contract amount budgeted for services to clients at the unit rates established in the RFP. In the event the Contractor has a surplus of 1% or more at the end of the of the grant term, the Agency will reallocate an amount equal to 1% reverted carry forward amount in the next contract term to other area agencies found to be serving clients to the fullest extent of their allocated budgets. If, or to the extent, there is any conflict between this paragraph and paragraphs 39.1 and 39.2 of the Master Contract, this paragraph shall have precedence. 3.3.3 All payment requests shall be based on the submission of actual monthly expenditure reports beginning with the first month of the contract. The schedule for submission of advance requests(when available)and invoices is ATTACHMENT VIII to this contract. 3.3.4 Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in ATTACHMENT VII,Budget and Rate Summary. 3.3.5 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and approval by the Agency of all financial and programmatic reports due from the Contractor and any adjustments thereto, including any disallowance not resolved as outlined in Section 25 of the Master Contract. 3.3.6 Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided between January 1, 2015 and December 31, 2015, must be submitted to the Agency's Contract Manager no later than December 31, 2015. 3.4 Consequences for Noncompliance Contractor shall ensure 100% of the deliverables identified in SECTION II — MANNER OF SERVICE PROVISION are performed pursuant to contract requirements, and as described in Section 2.3.1 are identified as major deliverables in this contract. 3.4.1 If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to correctly, completely, or adequately perform these major deliverables,the Contractor will have 10 days to submit a Corrective Action Plan("CAP")to the Contract Manager that addresses the deficiencies and states how the 14 January 2015 Contract#OAA 20315 6 0 4 �T ,9 deficiencies will be remedied within a time period approved by the Contract Manager. The Agency 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 Agency will also assess a Financial Consequence for failure to timely submit a CAP. 3.4.2 In the event Contractor fails to correct an identified deficiency within the approved time period specified in the CAP,the Agency shall deduct, from the payment for the invoice of the following month, 1%of the monthly amount billed for each day the deficiency is not corrected. The Agency 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. 3.4.3 If Contractor fails to timely submit a CAP plan, the Agency shall deduct 1% of the monthly amount billed for each day the CAP is overdue, beginning the 11th 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. 3.4.4 If, or to the extent, there is any conflict between subsections 3.4 — 3.4.4 and paragraphs 39.1 and 39.2 of the Master Contract, subsections 3.4—3.4.4 shall have precedence. 3.5 Dates for Final Request for Payment The Contractor shall submit the final request for payment to the Agency no later than February 15,2016. 3.6 Documentation for Payment The Contractor shall maintain documentation to support payment requests that shall be available to the Agency or authorized individuals, such as Department of Financial Services,upon request. 3.6.1 The Contractor must enter all required data per the Department's CIRTS Policy Guidelines for clients and services in the CIRTS database. The data must be entered into the CIRTS before they submit their request for payment and expenditure reports to the Agency. The Agency shall establish time frames to assure compliance with due dates for the requests for payment and expenditure reports. 3.6.2 The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is accurate.This report must be submitted to the Agency with the monthly request for payment and expenditure report and must be reviewed by the Agency before the request for payment and expenditure reports can be approved by the Agency. 15 rte._ °, January 2015 Contract#OAA 2031 6 0 4 ATTACHMENT III 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: COLLIER COUNTY PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Older Americans Act Title IIIB— CA/CM/SCAS $ 23,574.00 Transportation $ 31,000.00 U.S. Health and Human Services 93.044 $ 54,574.00 Support Services $ 346,722.00* Total IIIB OAA Title IIIC1 —Congregate Meals $ 255,419.00 Meals Screening Nutrition Counseling U.S. Health and Human Services 93.045 Nutrition Education Outreach Total IIIC1 $ 255,419.00 OAA Title III C2—Home Delivered Meals $ 243,081.00 Meals Nutrition Education U.S. Health and Human Services 93.045 Screening TotalIIIC2 $ 243,081.00 Older Americans Act Title III E CA/CM & Services(Title III E) 93.052 $ 89,116.00 Supplement Services(Title III ES) U.S. Health and Human Services $ 17,761.00 Grandparent Services(Title III EG) $ 11,841.00 Total HIE $ 118,718.00 TOTAL FEDERAL AWARD $ 671,792.00 *In Home Services $346,722.00 In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on Aging for Southwest Florida,Inc. COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: FEDERAL FUNDS: 2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-122—Cost Principles)* 2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-110—Administrative Requirements)OMB Circular A-133—Audit Requirements COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE Section 215.97, Fla. Stat. Chapter 69I-5,Fla. Admin. Code 16 0 4 January 2 3 2015 Contract#OA . ATTACHMENT VII Budget and Rate Summary OLDER AMERICANS ACT BUDGET SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY 1. Title III B Support Services $ 54,574.00* 2. Title III Cl Congregate Meals $ 255,419.00 3. Title III C2 Home Delivered Meals $ 243,081.00 4. Title III E Services $ 118,718.00 TOTAL $ 671,792.00 *In Home Services$346,722.00 In Home Services are funds to serve Collier County clients. The Vendors are paid directly by the Area Agency on Aging for Southwest Florida,Inc. 17 0 January 2015 Contract#OAA 203.15 1 6 0 4 ATTACHMENT VII Budget and Rate Summary OLDER AMERICANS ACT RATE SUMMARY CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY IIIB, IIIE, IIIES & IIIEG Services Total Cost Reimbursement Rate IIIB Case Management $ 55.00 $ 49.50 Screening/Assessment $ 55.00 $ 49.50 Transportation 100% Cost 90% of Cost Services Total Cost Reimbursement Rate IIIE,IIIES and IIIEG IIIE- Respite In-Home $ 21.66 $ 19.50 Respite In-Facility $ 12.00 $ 10.80 Direct Pay Respite $ 16.66 $ 15.00 Adult Day Care $ 12.00 $ 10.80 Screening/Assessment $ 55.00 $ 49.50 IIIES- Specialized Medical Equipment, Service& 100% Cost 90%of Cost Supplies IIIEG-Child Day Care $ 16.67 $ 15.00 Screening/Assessment $ 55.00 $ 49.50 C-1 & C-2 COLLIER COUNTY Services Total Cost Reimbursement Rate C1 Congregate Meals $ 9.88 $ 8.90 Nutrition Counseling $58.88 $53.00 Nutrition Education $ 1.80 $ 1.62 Outreach $4.80 per person $4.32 per person C2 Home Delivered Meals $ 9.77 $ 8.80 Nutrition Counseling $58.88 $53.00 Nutrition Education $ 1.80 $ 1.62 Nutrition Screening $55.00 $49.50 Outreach $4.80 per person $4.32 per person 18 Cq January 2015 Contract#OAA 20115i D 4 16 41 ATTACHMENT VIII INVOICE SCHEDULE ADVANCE BASIS CONTRACT Submit to Agency Report Number Based On On This Date 1 January Advance* January 1 2 February Advance* January 1 3 January Expenditure Report February 9 *See Note#4* 4 February Expenditure Report March 9 5 March Expenditure Report April 9 6 April Expenditure Report May 9 7 May Expenditure Report June 9 8 June Expenditure Report July 9 9 July Expenditure Report August 9 10 August Expenditure Report September 9 11 September Expenditure Report October 9 12 October Expenditure Report November 9 13 November Expenditure Report December 9 14 December Expenditure Report January 9 15 Final Expenditure and Request for Payment February 15 16 Closeout Report March 1 Legend: * Advance based on projected cash need. Note# 1: Report#1 for Advance Basis Agreements cannot be submitted to the Agency prior to January 1 or until the agreement with the Agency has been executed. Note #2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance amount, on each of the reports, repaying advances issued the first two months of the agreement.The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT IX). Note# 3: Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the Agency, payment is to accompany the report. Note#4: ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 9th falls on a Saturday, then the report will be due by the 8th by 12:00 p.m. AND IF the 9th falls on a Sunday, the report will be due by the 10th by 12:00 p.m. Actual submission of the vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report which is verified and paid by CIRTS data only. 19 January 2015 Contract#OAA 203.15 613 4 d 1 ATTACHMENT IX REQUEST FOR PAYMENT REQUEST FOR PAYMENT OLDER AMERICANS ACT PROVIDER NAME,ADDRESS,PHONE AND FED ID NUMBER TYPE OF REPORT: THIS REQUEST PERIOD: _.. Advance ......Report# ,...... _.._ _..._ ....... _..... Reimbursement_. . Contract #. • __... • __.... _.... _..... _.Contract Period: __.... • _.._ _.. .........PSA: _....... __ CERTIFICATION: I hereby certify to the best of my knowledge that this request conforms with the terms and the purposes set forth in the above contract Prepared By: Date: Approved By: Date: PART A: a (1) t (2) (3) (4) r (5) _...(B) A.. (7) I BUDGET SUMMARY III8 IIIC1 IIIC2 IIIE TOTAL I.Approved Contract Amount 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ' 2. Previous Funds • '. RECEIVED for Contract period.... . .. .... ..0.00 ...0.00 _.._ .0.00 _.. ... 0.00 0.00 0.00 _....._ 0.00 • 3.Contract Balance .0.00 ....0.00 0.00. .. .. ....0.00 0.00 0.00 0.00 (Line 1 minus line 2) 4.Previous Funds REQUESTED and Not Received. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.Contract Balance . .....0.00 0.00. .0.00 _.... 0.00 0.00 _.. .0.00 0.00 (Line 3 minus line 4) PART B: FUNDS REQUESTED _.. _.. _. _....... 1.1st-2nd Months _....... _.... _..... _...... Request Only 0.00... 0.00 0.00 0.00 _... 0.00 0.00 ......0.00 2.Net Expenditures _.. _..... _.. For Month 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.Total 0.00 _...... ... ... 0.00 0.00 0.00 0.00 _...... 0.00 .......0.00 PART C: NET FUNDS REQUESTED:......... _._._. _... _...... _. _ _.... 1.Less:Over-Advance 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.Contract Funds are Hereby Requested For 0.00 .0.00 0.00 0.00 0.00 0.00 0.00 List of Services/Units/Rates provided-See attached report. DOEA FORM 106A revised 9/14 • 20 {3 January 2015 Contract#OAA 201156 D 4 ATTACHMENT X RECEIPTS AND EXPENDITURE REPORT OLDER AMERICAN ACT PROVIDER NAME,ADDRESS, PHONE#AND FEID# PROGRAM FUNDING SOURCE: THIS REPORT PERIOD FROM: TO: IIIB IIIC1 CONTRACT PERIOD: 111C2 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. Federal Funds $0.00 $0.00 $0.00 0/0 2. State Funds $0.00 $0.00 $0.00 % 3. Program Income-Non Match $0.00 $0.00 $0.00 % 4. Local Cash Match $0.00 $0.00 $0.00 0/0 5. SUBTOTAL:CASH RECEIPTS $0.00 $0.00 $0.00 6. Local In-Kind Match $0.00 $0.00 '' $0.00 7.TOTAL RECEIPTS $0.00 $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 1. Meals/Meal Agreements $0.00 $0.00 $0.00 % 2. Service/Subcontractor $0.00 $0.00 $0.00 0/0 3. Other $0.00 $0.00 $0.00 0/0 4. Indirect Cost $0.00 $0.00 $0.00 5.TOTAL EXPENDITURES $0.00 $0.00 $0.00 PART C:OTHER EXPENDITURES (For Tracking Purposes only) 1. Match a.Other and In-Kind $0.00 $0.00 $0.00 % b.Local Match $0.00 $0.00 $0.00 0/0 2. NSIP Cash Received $0.00 $0.00 $0.00 ok 3. Program Income $0.00 $0.00 $0.00 4.TOTAL OTHER $0.00 $0.00 $0.00 PART D: INTEREST 1. Eamed on Advances $0.00 2. Return on Advances $0.00 3. Other Eamed $0.00 DOPA FORM 105as revised 9/23/2014 21 Cg) I January 2015 Contract#OAA 03. . . ATTAC RECEIPTS AND EXPENDITURE REPORT OLDER AMERICAN ACT PROVIDER NAME,ADDRESS,PHONE#AND FEID# Program Funding Source: THIS REPORT PERIOD FROM: TO: CONTRACT Title III E PERIOD: 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: PARTA:BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4.Percent of Budget For This Report Year to Date Approved Budget • 1.Federal Funds $0.00 $0.00 $0.00 % • 2.State Funds $0.00 $0.00 $0.00 % 3.Program Income $0.00 $0.00 $0.00 % 4.Local Cash Match $0.00 $0.00 $0.00 % • 5.SUBTOTAL:CASH RECEIPTS $0.00 $0.00 $0.00 % 6.Local In-Kind Match $0.00 $0.00 $0.00 % 7.TOTAL RECEIPTS $0.00 $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 • A:Direct Services 1.Personnel $0.00 $0.00 $0.00 % 2.Travel $0.00 $0.00 $0.00 % 3.Building Space $0.00 $0.00 $0.00 % 4.Communication/Utilities $0.00 $0.00 $0.00 % 5.Printing/Supplies $0.00 $0.00 $0.00 % 6.Equipment $0.00 $0.00 $0.00 % 7.Other $0.00 $0.00 $0.00 % B:Agreement Services 8.Senices Subcontracted $0.00 $0.00 $0.00 9.TOTAL EXPENDITURES $0.00 $0.00 $0.00 % 10. DEDUCTIONS a.Total Local Match $0.00 $0.00 $0.00 % b.Program Income Used $0.00 $0.00 $0.00 % c.TOTAL DEDUCTIONS $0.00 $0.00 $0.00 % 11.NETEXPENDITURES $0.00 $0.00 $0.00 PART C:EXPENDITURES ANALYSIS 2.Units of Services Year to Date 3.Number of People Served Year to Date A.Expenditures by Services Year to Date: 1.Information $0.00 $0.00 0.00 2.Assistance $0.00 $0.00 0.00 3.Counseling $0.00 $0.00 000 4.Respite $0.00 $0.00 0_00 5.Supplemental Services $0.00 $0.00 000 6.TOTAL $0.00 Part B Line 11,column 3 should be equal to this total. PART D:GRANDPARENT SERVICES(reported by Federal Fiscal Year) FFY $ FFY $ FFY $ Match$ Match$ Match$ 22 v c! 16D 4 Attestation Statement Agreement/Contract Number OAA 203.15 Amendment Number n/a 1, Stephen Y. Carnell ,attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida Public Services Administrator (Signature of Recipient/Contractor name) The only exception to this statement would be for changes in page formatting,due to the differences in electronic data processing media,which has no affect on the agreement/contract content. aff Nsk jj 41 Signatu�'e of Rec. lent/Contractor representative Date Approved as to form and legality ______a_usi Assistant Coun ttomeY \ 1604 VERIFICATION OF EMERGENCY PREPAREDNESS PLAN Contract# OAA 203.15 I, Stephen Y Carnell certify that Collier County Government (Name of authorized contractor representative) (Name of contractor) has a current and properly maintained Emergency Preparedness Plan. Assurance is given that the plan will be made available to the Area Agency on Aging for Southwest Florida, Inc. upon request. lig ff) 1110 11‘ v 7//f Signature of au orized contractor representative Public Services Administrator Title /2_1120(5 Date Collier County Government Company Approved as to form and legality Assistant Cou Attorney op October 2008 �� I DEPARTMENT OF. 1604 4 BACKGROUND SCREENING ELDER' AFFAIRS Affidavit of Compliance - Employer STATE OF FLORIDA AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. ➢ The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, Long-Term Care Ombudsman Program, Serving Health Insurance Needs of Elders Program, Service Providers, Diversion Providers, 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. ➢ 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 area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities;and volunteers." §430.0402(1)(b), Fla.Stat. ATTESTATION: As the duly authorized representative of Collier County Community and Human Services Employer Name located at 3339 Tamiami Trail E Room 211 Naples FL 34112 , Street Address City State ZIP code I, Kimberley Grant, Director of Community and Human Services do hereby affirm under penalty of perjury Name of Representative that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regarding level 2 background screening. I( 1 -- Signature of Representative Date STATE OF FLORIDA, COUNTY OF Collier Sworn to (or affirmed) and subscribed before me this qday of iarvorii , 20 15 , by i K I Mbe,y 1 '' 4 CiICLIif (Name of Representative)who is personally known to me or produced / as roof of identification. ,.i :;'' °v PRISCIU A DORIA MY COMMISSION#EE 876607 ��.�, i°y'�- ., x EXPIRES:May 20,2017 Print Ty ,:,,1 i41am114160444*kPlici ' fio ry Public Notary Public DOEA Form 235,Affidavit of Compliance-Employer,Effective April 2012 Section 435.05(3),F.S. Form available at: http://elderaffairs.state.fl.us/english/backgroundscreening.php 1 6 0 4 STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST Program/Facility Name: Collier County Community and Human County: AAA/Contractor Services Collier AAA of Southwest Florida Address: Completed By: 3339 Tamiami Trail E,Room 211 Lisa N. Carr City,State,Zip Code: Date: Telephone: 239-252-2339 Naples,FL 34122 January 8,2015 PART I:READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided: Collier County Community and Human Services is situated over a 2,300 square mile area. Collier County Community and Human Services provides in-home care,facility adult day care,case management and nutrition services to frail,elderly residents of Collier County. 2. POPULATION OF AREA SERVED. Source of data: Total# %White %Black %Hispanic %Other %Female 341,015 96.4% 2.7% 7.0% .9% 53.8% 3. STAFF CURRENTLY EMPLOYED. Effective date: Total# %White %Black %Hispanic %Other %Female %Disabled 7 50% 20% 20% 10% 90% 0% 4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date: Total# %White %Black %Hispanic %Other %Female %Disabled %Over 40 381 64% 9% 33% 22% 64% n/a 100% 5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE. Total# %White %Black %Hispanic %Other %Female %Disabled 5 100% 40% 0 PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. 6. Is an Assurance of Compliance on file with DOEA? If N/A or NO,explain. N/A YES NO ❑ ® ❑ 7. Compare the staff composition to the population. Is staff representative of the population? If N/A or NO,explain. N/A YES NO C ® ❑ 8. Compare the client composition to the population. Are race and sex characteristics representative of the population? If N/A or NO,explain. N/A YES NO ❑ ® ❑ 9. Are eligibility requirements for services applied to clients and applicants without regard to race,color, national origin,sex,age,religion or disability? If N/A or NO,explain. N/A YES NO ❑ ® C 10. Are all benefits,services and facilities available to applicants and participants in an equally effective manner regardless of race, sex,color, age,national origin,religion or disability? If N/A or NO,explain. N/A YES NO ❑ ® ❑ 11. For in-patient services, are room assignments made without regard to race, color,national origin or disability? If N/A or NO,explain. N/A YES NO ® n ❑ 12. Is the program/facility accessible to non-English speaking clients? If N/A or NO, explain. N/A YES NO ❑ ® n 13. Are employees, applicants and participants informed of their protection against discrimination? If YES, N/A YES NO 1 how? Verbal 111Written® Poster® If N/A or NO,explain. 1 6U4 ® ❑ 14. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. N/A NUMBER 15. Is the program/facility physically accessible to mobility, hearing, and sight-impaired individuals? If N/A or NO,explain. N/A YES NO ® ❑ PART III:THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. 16. Has a self-evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? If NO,explain. YES NO ❑ C 17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If NO, explain. YES NO n 18. Has a person been designated to coordinate Section 504 compliance activities? If NO,explain. YES NO ❑ ❑ 19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination on the basis of disability? If NO, explain. YES NO ❑ ❑ 20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? If NO,explain. YES NO Fl PART IV:FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF$50,000.00 OR MORE. 21. Do you have a written affirmative action plan? If NO,explain. YES NO DOEA USE ONLY Reviewed By In Compliance: YES n NO* ❑ Program Office *Notice of Corrective Action Sent / / Date Telephone Response Due / / On-Site ❑ Desk Review ❑ Response Received / / Revised August 2010,Page 2 of 2 2 1 6 D4 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 and sex. 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 and disability. 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 and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. 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 80. This is usually a standard part of the contract language for DOEA 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. 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,45 CFR 80.3 (b)(6). 9. 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 (b)(2). 10. 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). 11. 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). 12. 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 staff. 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). 13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a 3 '7 complaint of discriminationElder Affairs or the U.S. Depart nt of S. The with either the Florida Department of 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,45 CFR 80.6(d). 14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, 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, e.g., settled, no reasonable cause found,failure to conciliate, failure to cooperate,under review, etc. 15. The program/facility must be physically accessible to disabled 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, 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. 16. 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. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. b. Modify policies and practices that do not meet Section 504 requirements. c. Take remedial steps to eliminate any discrimination that has been identified. d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.),45 CFR 84.6. 17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7(b). 18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7(a). 19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication,45 CFR 84.8 (a). 20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services,45 CFR 84.52 (d). 21. Programs/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 60 and Title VI of the Civil Rights Act of 1964, as amended. DOEA Form 101-B,Revised August 2010 4 L It,"r11\11YLli1V 1 V C , 1 604 ELDER; AFFAIRS 2014 Florida County Profiles STATE OF FLORIDA : Collier Grandparents (60+) Total 60+Living With Own 3,659 Pcs �Il`atior1 b `A eC to ' Grandchildren (Under Age 18) � �° Grandparent Responsible for All Ages 341,015 100.0% Own Grandchildren 751 Under 60 224,649 65.9% (Under Age 18) 60+ 116,366 Grandparent Not Responsible 27 65+ 92,803 27.2/2%° for Own Grandchildren 2,913 70+ 67,616 19.8% 75+ 43,669 12.8% (Under Age 18) 80+ 25,513 7,5% 60+ Not Living With Own 111,676 85+ 11,541 3.4% Grandchildren (Under Age 18) Population by Race (60+) Skilled Nursing Facility Utilization White 112,198 96.4% SNF Beds 908 Non-White 4,168 3.6% Community Beds 755 Black 3,092 2.7% Sheltered Beds 153 Other Minorities 1,076 0.9% Veterans Administration Beds 0 Other Beds 0 `.,SQa}p,Ulatidiiiyil ttiiite /,(60+) z 4x, SNFs With Beds 13 Total Hispanic 8,153 7.0% Community Beds 10 White 7,807 6.7% Sheltered Beds 3 Non-White 346 0.3% Veterans Administration Beds 0 Total Non-Hispanic 108,213 93.0% Other Beds 0 Total Minorities' 11,975 10.3% SNFs With Community Beds 10 byGender(60+) Community Bed Days 275,575 Population Community Patient Days 245,142 Population 60+ 116,366 34.1% Medicaid Patient Days 116,713 1 Male 53,811 46.2% Occupancy Rate 89.0% Female 62,555 53.8% Percent Medicaid 47.6% Financial Status(60+, % 60+)_ Adult Day Care Below Poverty Guideline 8,119 7.0% Facilities 1 Capacity 41 Below 125%of Poverty 11,174 9.6% Guideline Adult Family Care Homes Minorities Below Poverty 2,292 2.0% Guideline Homes 4 Minorities Below 125%of Beds 17 3,157 2.7% Poverty Guideline Home Health Agencies Medically Underserved (65+) Agencies 34 Total Medically Underserved 23,317 Medicaid Certified Agencies 2 Medically Underserved Medicare Certified Agencies 10 Populations-Living in Areas 23,317 Defined as Having Medically Underserved Populations Homemaker& Companion Service Medically Underserved Areas- Companies Living in Medically Underserved 0 Companies 24 Areas Living Situation (60+) ' - Ambulatory Surgical Centers Living Alone 21,803 Facilities 14 Male 6,540 Operating Rooms 32 Female 15,263 Recovery Beds 74 Vl:l.11\14•11.1V 1 VI' ELDER 1604 2014 Florida County Profiles AFFAIRS STATE OF FLORIDA Collier (Continued) Rural Designation Registered Voters Rural (Yes/No) NO Registered to Vote in 178,913 Florida-All Ages Assisted Living Facilities Registered to Vote in 90,101 Total Beds 1,334 Florida-Age 60+ OSS Beds2 6 Percent of Population Registered 50.4% to Vote in Florida-Age 60+ Non-OSS Beds 1,328 Total Facilities 19 Households With Cost Burden Above Facilities With ECC License3 8 30% and Income Below 50% Area Facilities With LMH License' 1 Median Income (65+) (2010) Facilities With LNS Licenses 8 Elder Households 49,733 Hospitals Percent of All Households 10.6% Hospitals 5 Median Household Income (All Ages) Hospitals With Skilled Nursing Units 0 2008-2012 $56,104 Hospital Beds 980 Skilled Nursing Unit Beds 0 Medicaid & Medicare Eligibility Medical Professionals Medicaid Eligible -All Ages 42,841 Medical Doctors Medicaid Eligible -60+ 5,391 Dual Eligible-All Ages 6,138 Licensed 831 Dual Eligible -60+ 4,611 Limited License 21 Critical Need Area License 8 Veterans Restricted 0 Total 25,135 Medical Faculty Certificate 0 Age 45-64 6,722 Public Heath Certificate 0 Age 65-84 15,182 Specialties Age 85+ 3,231 Licensed Podiatric Physicians 31 Licensed Osteopathic Physicians 82 Disability Status (60+) Licensed Chiropractic Physicians 103 With One Type of Disability' 13,246 Registered Nurses Hearing 11,930 Licensed Registered Nurses 3,350 Vision 4,405 Cognitive 6,308 Driver's License Ambulatory 15,896 Drivers With Florida Driver's 262,597 Self-Care 4,295 License-All Ages Independent Living 10,153 Drivers With Florida Driver's 104,344 With Two or More Disabilities 13,203 License-Age 60+ - With No Disabilities 91,584 Percent of Drivers With Florida 39.7% Probable Alzheimer's Cases' 12,467 Driver's License-Age 60+ Food Stamps (60+) English Proficiency(60+) Participants (60+) 3,667 Potentially Eligible 11,174 With Limited English Proficiency 6,138 Food Stamp Participation Rate (60+) 32.8% L/l:t'(ll\liYll:LVl Vl"1 1 1604 ELDER 2014 Florida County Profiles AFFAIRS' STATE 4F FLORIDA • Collier (Continued) Cost of Living Useful Websites Annual Expenses' County Chronic Disease Profile(Collier) Single Elders Florida Housing Data Clearinghouse(Collier) Owner without Mortgage $25,104 Behavioral Risk Factors(BRFSS) (Collier) Renter, one bedroom $29,364 Owner with Mortgage $37,920 Elder Couple Owner without Mortgage $37,572 Renter, one bedroom $41,832 Owner with Mortgage $50,388 Note:Wider Opportunities for Women Elder Economic Security Standard TM Index(Elder Index)measures how much income retired older adults require to meet their basic needs—without public or private assistance.The Elder Index measures basic expenses for elders age 65+living in the community,not in institutions. MGVI]1\1 lYtlil\1 VI'i ELDER; 1 6 D4 2014 Florida County Profiles AFFAIRS !STATE OF FLORIDA i 1 Total Minorities= (60+ Population)—(White Non-Hispanic 60+) 2 OSS beds: Optional State Supplementation beds 3 ECC License: Extended Congregate Care License 4 LMH License: Limited Mental Health License 5 LNS License: Limited Nursing Services License 6 With One Type of Disability:65+people who have only one type of disability 7 Probable Alzheimer's Cases=(65-74 Population x 0.0334)+ (75-84 Population x 0.1760)+(85+ Population x 0.4480) $Annual expenses include: housing, including utilities,taxes, insurance;food;transportation; health care, based on good health; and miscellaneous. Sources • Population:Florida Population by County,Age,Race,Ethnicity and Gender provided by Florida Legislature,Office of Economic and Demographic Research • Financial Status&Living Situation:Department of Elder Affairs calculations based on Florida Population data and 2007-2011 American Community Survey • Medically Underserved Population(Data as of 7/18/2014):Florida Department of Health and U.S.Department of Health and Human Services • Grandparents:Department of Elder Affairs calculations based on Florida Population data and 2007-2011 American Community Survey,Special Tabulation on Aging • Skilled Nursing Facility Utilization,Adult Day Care,Adult Family Care Home,Ambulatory Surgical Centers,Assisted Living Facilities,Home Health Agencies,Homemakers&Companion Service Companies,Hospitals:Florida Agency for Health Care Administration • Rural Designation:Based on the definition of Rural Designation by Rural Economic Development Initiative • Medical Professionals:Florida Department of Health • Driver's License:Florida Department of Highway Safety&Motor Vehicles • Food Stamps:Florida Department of Children and Families • Registered Voters(Data as of 1/31/2014):Florida Department of State • Households with Cost Burden Above 30%and income below 50%Area Median Income:The Shimberg Center for Housing Studies • Median Household Incomes:U.S.Census Bureau:State and County QuickFacts • Medicaid&Medicare Eligibility and Medicaid Eligibility:Florida Agency for Health Care Administration • Veterans Demographics:Florida Department of Veterans'Affairs • Disability Status:Department of Elder Affairs calculations based on Florida Population data and 2009-2011 American Community Survey Data • Probable Alzheimer's Cases:Department of Elder Affairs calculations based on Florida Population data and Alzheimer's by Age in 2014 Alzheimer's Disease Facts and Figures report at http://www.alz.org/documents_custom/facts 2014/alz If florida.pdf?tvpe=interior map&facts=undefined&facts=facts • English Proficiency:Department of Elder Affairs calculations based on Florida Population data and 2007-2011 American Community Survey,Special Tabulation on Aging • Cost of Living(Data as of 7/18/2014):Wider Opportunities for Women Elder Economic Security StandardTM Index(Elder Index) at htto://www.basiceconomicsecurity.or2/E1/