Backup Documents 09/22/2015 Item #16D 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 160 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Peggy Hager Community& Human4J
Services (CHS) Division J
e/ -2/45
2. County Attorney Office County Attorney Office CI�J�' �c1\ -)-\\5
3. BCC Office Board of County
Commissioners V/0, 'J `\\ZzkVs
4. Minutes and Records Clerk of Court's Office
TA) 1 I MI 1, s S'
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 Gino Santabarbara,CHS Phone Number 252-2399
Contact/ Department
Agenda Date Item was September 22,2015 i Agenda Item Number 16D6
Approved by the BCC _
Type of Document Amendment#2 to Youth Haven Number of Original 3
Attached Subrecipient Agreement-Safe and Secure Documents Attached
Home for Collier Youth Phase II&III _
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not A plicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman' original si ature? SA-4,N.... n a C Tkci S
2. Does the document need to be sent to anothe y for additional signatures'? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be GS
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the GS
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 GS
signature and initials are required.
7. In most cases(some contracts are an exception),the original cument and this routing slip
should be provided to the County Attorney Office at the time a item is input into SIRE. ,414(''
f�I i
Some documents are time sensitive and require forwarding to Tallahassee within a certain j
time frame or the BCC's actions are nullified. Be aware o our deadlines!
8. The document was approved by the BCC on 09/22/15 and all changes made GSI .
during the meeting have been incorporated in the attached document. The County pt
Attorney's Office has reviewed the changes, if applicable
9. Initials of attorney verifying that the attached document is the version approved by the - . 9
BCC, all changes directed by the BCC have been made,and the document is ready for the - s?•I
� 40
Chairman's signature. ' 1
1:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1 .60 . 6
MEMORANDUM
Date: September 25, 2015
To: Gino Santabarbara, Grant Coordinator
Public Services Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: 2nd Amendment to Youth Haven's Subrecipient Agreement
"Safe and Secure Home for Collier Youth Phase II and III
Attached are two (2) originals of each item referenced above, (Item #16D6) approved
by the Board of County Commissioners on Tuesday, September 22, 2015.
The Minutes and Record's Department has kept an original copy of the agreement as
part of the Board's Official Record.
If you have any questions, please feel free to call me at 252-7240.
Thank you.
Attachment
1606
Grant# B-14-UC-12-0016
B-13-UC-12-0016
B-i 2-UC-12-0016
B-11-UC-12-0016
CFDA/CSFA# 14.218
Subrecipient—Youth Haven,Inc.
DUNS #-077283349
AGREEMENT# CD14-12
FEID #-23-7065187
IDIS # - 481
Fiscal Year End: 6/30
Monitor End: 04/2021
SECOND AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
YOUTH HAVEN, INC.
SAFE AND SECURE HOME FOR COLLIER YOUTH PHASE II & III
This Amendment is entered into this,2€ day of .56'preiy6F, .2015, by and between
Youth Haven, Inc., a private not-for-profit corporation existing under the laws of the State of
Florida, herein after referred to as SUBRECIPIENT and Collier County, Florida, hereinafter to
be referred to as "COUNTY,"collectively stated as the "Parties."
RECITALS
WHEREAS, on November 18th 2014, the COUNTY entered into an Agreement for
awarding Community Development Block Grant Program funds to be used for Safe and Secure
Home for Collier Youth Phase II & III Project (hereinafter referred to as the "Agreement");
and
WHEREAS, the Parties desire to amend the Agreement to clarify milestones deadlines in
order to achieve a National Objective in accordance with 24 CFR 570.208.
NOW, THEREFORE, in consideration of foregoing Recitals, and other good and
valuable consideration, the receipt and sufficiency of which is hereby mutually acknowledged,
the Parties agree to amend the Agreement as follows:
Words Str'uel Throtgh are deleted; Words Underlined are added
x x
[15-GRC-00425/1204665/1] Youth Haven Inc.
CDBG CD I4-12—Second Amendment
Safe and Secure Home for Collier Youth Phase II&Ill Page 1 of 8
160 6
PART I
SCOPE OF WORK
1.2 PROJECT DETAILS
A. Project Description
Improvements Federal Funds
Project Component 1: Security lighting, including concrete poles, $89,750
fixtures and wiring.
Project Component 2: Security fence at lake and security gate with $35,000
cipher lock at driveway.
Project Component 3: Security camera system including data $92,500
storage equipment.
Project Component 4: Installation of Security window, counter and $28,500
code renovations to the interior of Janet's Cottage.
Project Component 5: Landscaping—Install landscaping buffer at $20,000
South property fence.
Project Component 6: Installation of fiber-optic data cable and $46,350
network equipment. $104,100
Project Component 7: Design and Permitting $25,600
Project Component 8: Installation of new plumbing fixtures and 2" $38,750
water line at Jay's&Janette's Cottages.
Project Component 9: Installation of sidewalks within the campus $44,800
area.
. ..•- . • .. • : P .. . • $57,750
parking areas.
$479,000
X X *
E. Payment Deliverables
(i 5-GRC-0O425/1204665/I] Youth Haven Inc.
CDBG CD 1 4-12—Second Amendment
Safe and Secure Home for Collier Youth Phase 11&I❑ Page 2 of 8
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The Following Table Details the Payment Deliverables
Project Component Six: Submission of supporting documents must be Submission
Installation of fiber-optic data provided as backup as evidenced by properly of monthly
cable and network equipment. completed invoices, timesheets, payroll registers, invoices- See
banking documents, vehicle logs, and any additional Exhibit B
documents as needed.
Final 10% ($4,635) ($10,410.00) released upon the
delivery and completion of installed fiber-optic data
cable and network equipment and any
documentation of a minimum of the required
supporting proof of payment documents.
Project Component Seven: Submission of supporting documents must be Submission
Design and Permitting provided as backup as evidenced by properly of monthly
completed invoices, timesheets, payroll registers, invoices- See
banking documents, vehicle logs, and any additional Exhibit B
documents as needed.
Final 10% ($2,650) released upon documentation of
a minimum of all necessary permits, drawing and
fees associated with the completion of the project
Project Component Eight: Submission of supporting documents must be Submission
Installation of new plumbing provided as backup as evidenced by properly of monthly
fixtures and 2" water line at Jays completed invoices, timesheets, payroll registers, invoices- See
&Janette's Cottages. banking documents, vehicle logs,and any additional Exhibit B
documents as needed.
Final 10% ($3,875) released upon the delivery and
completion of the installation of new plumbing
fixtures and 2" water lines at Jay's Janette's
Cottages and documentation.
Project Component Nine: Submission of supporting documents must be Submission
Installation of sidewalks within provided as backup as evidenced by properly of monthly
the campus area. completed invoices, timesheets, payroll registers, invoices- See
banking documents, vehicle logs, and any additional Exhibit B
documents as needed.
Final 10% ($4,480) released upon the delivery and
completion of the installation of new sidewalks
within the campus area.
Project Component Ten: _.: • • .... . • Submission
-
:. •• . - . provided as backup as evidenced by properly of monthly
and parking areas. completed invoices, timesheets, payroll registers, invoices Sec
.. -- . _• , _ _ . , . ... -•. Exhibit B
[15-GRC-00425/1204665/1] Youth Haven Inc.
C[)BG CD 14-12—Second Amendment
Safe and Secure Home for Collier Youth Phase 11&In Page 3 of 8
1 606
Final 10% ($5,775) released upon the delivery,
Final 10% retainage released Supporting proof of payment documents, including a End of
upon completion of the project Certification of Completion must be provided as Project
and proof of individuals served, backup including final beneficiary information for
all individuals and households served.
1.4 AGREEMENT AMOUNT
The COUNTY agrees to make available FOUR HUNDRED SEVENTY NINE THOUSAND
DOLLARS and 00/100 ($479,000)for the use by the SUBRECIPIENT for SAFE AND
SECURE HOME FOR COLLIER YOUTH PHASE II & III PROJECT during the Term of
the Agreement (hereinafter, the aforestated amount including, without limitation, any additional
amounts included thereto as a result of a subsequent amendment(s) to the Agreement, shall be
referred to as the"Funds").
The SUBRECIPIENT project budget shall be as follows:
Line Item Description CDBG
Funds
Project Component#1- Security lighting, including concrete poles, $ 89,750
fixtures and wiring.
Project Component#2- Security fence at lake and security gate $ 35,000
with cipher lock at driveway..
Project Component#3- Security camera system including data $ 92,500
storage equipment.
Project Component#4- Installation of Security window, counter $ 28,500
and code renovations to the interior of Janette's Cottage.
Project Component#5- Landscaping-Install landscaping buffer at $ 20,000
South property fence.
Project Component#6-Installation of fiber-optic data cable and $-450
network equipment. $104,100
Project Component#7- Design and Permitting $ 25,600
Project Component#8- Installation of new plumbing fixtures and $ 38,750
2" water line at Jays &Janette's Cottages.
Project Component#9- Installation of sidewalks within the campus $ 44,800
area.
' . . . .. ! . - - . :. ... • . - $ 57,750
parking areas.
TOTAL $479,000
x
115-GRC-00425/1204665/11 Youth Haven Inc.
CDBG CD14-12—Second Amendment
Safe and Secure Home for Collier Youth Phase 11&111 Page 4 of 8
,
NT
the
IN WITNESS WHEREOF, the
agent,entUh r�eunderEset then>ahands and seals on the date
have each,
respectively, by an authorized persong
first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
COLLIER
O FLORIDA
WIGHT E. BROCK;CLERK '
11:4
By: �A-
Attest
as t Chairma n Glerk TIM NANCE,CHAIRMAN
signature only: YOUTH HAVEN, INC.
Dated:,, 6il-1r11� 1 !�' By: !' � 'fir YJ L J^
(SEAL) BRENDA O'CONNOR,PRESIDE/I' k ..'
YOUTH HAVEN INC.
Approved as to form and legality:
Jenniedio l
Assistant County Attorney 0 ���`
[15-GRC-00425/1204665/11 Youth Haven Inc.
CDBG CD14-12—Second Amendment
Safe and Secure Home for Collier Youth Phase II&III Page 5 of 8
�i'J
rl C.7
EXHIBIT "D"
QUARTERLY PERFORMANCE REPORT DATA
GENERAL
Grantee is required to submit to HUD, through the Integrated Disbursement and Information
System ("IDIS") Performance Reports. The County reports information on a quarterly basis. To
facilitate in the preparation of such reports, Subrecipient shall submit the information contained
herein within ten(10) days of the end of each calendar quarter.
QUARTERLY PROGRESS REPORT
Sub-recipients: Please fill in the following shaded areas of the report
Agency Name: Youth I avet2� TLC Date: _
•
Project Title:
ae nd, eeur Home fQT Goliielcttt>a:P:hase.Zl&uI
Alternate
Program Contact: Stephanle J111X Llggc E eciative hecto Contact
Telephone Number.
"REPORT FOR QUARTER ENDING:(check one that applies to the
corresponding grant period): 0
12(31/14 ❑3/31/15 .. ;:_'L70BI30i15 - 1:19/30/15
L7
Please take note; Each quarterly report needs to include cumulative data beginning from the start of the agreement date.
Please.list the outcome go.al(s)from your:approved application 8.sub-recipient agreement and indlcate your. irogress to meeting
1. those goals since the beginning of the agreement.
A.Outcome Goals: list the outcome goal(s)from.your approved application&sub-recipient agreement.
Outcome 1 s . •
-
Outcom;e 2 All landscaping completed by January X01¢ K
Outcome Provide#ora lien the propert in the amount of tCDE 3 a Istance
Otatcomle 00 ° expended by Deuembelr J-I 20�
Outcome S All upgrades must be fully completed and:begin.serving beneficiaries byiviarch 41,lUlb
(15-GRC-00425112046651l] Youth Haven Inc.
CDBG CD 14-12—Second Amendment
Safe and Secure Home for Collier Youth Phase I1&In Page 6 of 8
1 ''-; r'
1Y''
k .-.)Li t
.,
B.Goat Progress: Indicate the progress to date in meeting each outcome goal.
..,.:;.,,;:,.,_:;,,,,.::„.;:::::,:,..„...:,:_::,,I.;;;.:
Outcome 1:
Is this project still in compliance sch
ce with the original project edule?If mn.2.m
ore than behind schedule,must submit a new •
2. timeline for approval.
❑ `'. ❑
Yes No
If no,explain:
3. Since October 28,2014,of the persons assisted,how many....
a. ...now have new access(continuing)to this service or benefit? =`0
b. ...now has improved access to this service or benefit? ',,:;0
c. ...now receive a service or benefit that is no longer substandard? .
TOTAL: 0
4. What funding sources are applied for this period!program year?
Section 108 Loan Guarantee •$• V HOPWA
Other Consolidated Plan Funds
CDBG
$ .': $'.
Other Federal Funds ESG
$ $
State!Local Funds HOME
Total
$ Entitlement $
Total Other Funds - Funds -
[I5 GRC-0042511204665/11 Youth Haven Inc.
CDBG CD 14-12—Second Amendment
Safe and Secure Home for Collier Youth Phase H&[II Page 7 of 8
1.60 6
5. What is the total number of UNDUPLICATED clients served this quarter,If applicable?
a. Total No.of adult females served: 0,. Total No.of females served under 18: 0
b. Total No.of adult males served: 0 Total No.of males served under 18: 0
TOTAL: 0 TOTAL: 0
c. Total No.of families served: 0 Total No.of female head of household: . 0 .
6. What is the total number of UNDUPLICATED clients served since October,if applicable?
a. Total number of adult females served: 0' Total number of females served under 18: 0
b. Total number of adult males served: of • Total number of males served under 18: ' 0
TOTAL: 0 TOTAL: 0
C. Total No.of families served: 0. Total No.of female head of household: 0
Complete EITHER question#7 OR#8.Complete question#7 if your program only serves clients in one or more of the listed HUD Presumed
Benefit categories. Complete question#6 if any client in your program does not fall Into a Presumed Benefit category.
DO NOT COMPLETE BOTH QUESTION 7 AND 8.
7. PRESUMED BENEFICIARY DATA: r 8. OTHER BENEFICIARY DATA:INCOME RANGE
Indicate the total number of UNDUPLICATFD
persons served since October 1 who fall into Indicate the total number of.LLL'IQ.UELIC XED persons
each presumed benefit category (the total served since October 1 who fall into each income
should equal the total in question#6): category(the total should equal the total in question#6):
Report as: Report as:
0 Abused Children 0 Extremely low Income(0-30%)
0 Homeless Person A. Low Income(31-50%)
0 Battered Spouses 0 `Moderate Income(51-80%)
0 Persons w/HN/AIDS 0 i,Above Moderate Income(>80%)
O ';•Elderly Persons
0 Veterans
0 , S Chronically/Mentally ill
• 0 Physically Disabled Adults
0 2 Other-Youth
TOTAL: 0 TOTAL: 0
9. Racial&Ethnic Data: (if applicable)
Please indicate how many UNDUPLICATED clients served since October fall into each race category. In addition
to each race category, please indicate how many persons in each race category consider themselves Hispanic
(Total Race column should equal the total cell).
RACE ETHNICITY
White of whom,how many are Hispanic?
Black/African American 0,+ ' 0 of whom,how many are Hispanic?
Asian p. 0 of whom,how many are Hispanic?
American Indian/Alaska Native 0 0 -';of whom,how many are Hispanic?
Native Hawaiian/Other Pacific Islander O'; 0 of whom,how many are Hispanic?
American Indian/Alaskan Native&White 01 0. of whom,how many are Hispanic?
Black/African American&White p,° 0 of whom,how many are Hispanic'?
Am.Indian/Alaska Native&Black/African Am 0 i .0 ,';of whom,how many are Hispanic?
Other Multi-racial 0- 0 of whom,how many are Hispanic?
Other 0:: : 0 of whom,how many are Hispanic?
TOTAL: 0 0 TOTAL HISPANIC
Name: Signature:
Your typed name here represents your electronic
Title: signature
(I5-GRC-00425/1204665/1] Youth Haven Inc.
CD13G CD 14-12—Second Amendment
Safe and Secure Home for Collier Youth Phase II&III Page 8 of 8