Backup Documents 06/24/2014 Item #16D17 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 D 17
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. Lisa Can HHVS It 6/18/2014
2. Jennifer B. Belpedio, ACA Office located in HHVS )"a$ �,�5''
County Attorney Office Department
3. BCC Office Board of County
CommissionersL�"�
4. Minutes and Records Clerk of Court's Office
b.19.RAI eAk,
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 Lisa Can Phone Number 252-2339
Contact/ Department
Agenda Date Item was 6/24/2014 Agenda Item Number 16.D.17
Approved by the BCC
Type of Document Amendments w/Attestation Statements- Number of Original 3 originals cc
Attached Area Agency on Aging for Southwest Documents Attached V.-sak ,
Florida,Inc.
PO number or account t/ ( - -v \\ t st
number if document is e_x44N
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? LNC
2. Does the document need to be sent to another agency for additional signatures? If yes, LNC
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
signed by the Chairman,with the exception of most letters,must be reviewed and signed LNC
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's LNC 1/.
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 LN C
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 LNC
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip LNC
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 6/24/2014 tenter date)and all changes LNC
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the / LNC
BCC,all changes directed by the BCC have been made,and the document is ready fo r the •
Chairman's signature. �.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
INSTRUCTIONS & CHECKLIST #2 16 D 17
Please send the original Chairman signed documents to additional agency for signature:
Kathy Gronberg, Fiscal Specialist III
Senior Choices of Southwest Florida, Inc.
15201 N Cleveland Ave Ste 1100
North Fort Myers, FL 33903
239-652-6900 Ext. 251
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16017
MEMORANDUM
Date: June 27, 2014
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Teresa.Cannon, Deputy Clerk
Minutes & Records Department
Re: Amendments and Attestation Statement with the Area Agency on
Aging for SWFL, Inc. for the Alzheimer's Disease Initiative
Program (ADI 203.13.008), Community Care for the Elderly
Program (CCE 203.13.009) and Home Care for the Elderly
Program (HCE 203.13.010)
Attached for further processing are three (3) original copies of the each amendment
document referenced above, (Item #16D17) approved by the Board of County
Commissioners June 24, 2014.
After the representative for Senior Choices has signed the documents, please return
one of the original copies to the Minutes & Records Department for the Board's
Official Record.
If you have any questions please call me at 252-8411.
Thank you
16017
HOUSING HUMAN AND VETERIAN SERIVCES
INTEROFFICE MEMORANDUM ;
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grants Coordinator, HHVS
DATE: August 7, 2014
RE: Area Agency on Aging for Southwest Florida, Inc: Federal and State Contract
#HM203.14, Amendments CCE 203.13.009, CCE 203.13.010, ADI 203.13.008,
ADI 203.13.009 and HCE 203.13.010
Please find attached one (1) each fully executed document that was approved by the BCC for
recording in Minutes and Records. Feel free to contact me if you have any questions.
Thank you for your assistance.
1. 7
Amendment 008 ADI 203.13.008
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida, Inc. hereinafter
referred to as the"Agency," and Collier County Board of County Commissioners, hereinafter referred to as the
"Contractor,"collectively stated as the"Parties" which amends contract ADI 203.12.
This amendment shall be effective July 1, 2014.
RECITALS:
WHEREAS, on August 9, 2012, the parties entered into the Standard Contract for social services to be
provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract"); and
WHEREAS, on July 1, 2012, the parties entered into a First Amendment to the Contract; and
WHEREAS, on April 1 l, 2013, the parties entered into a Second Amendment to the Contract; and
WHEREAS, on June 6, 2013, the parties entered into a Third Amendment to the Contract; and
WHEREAS, on July 1, 2013, the parties entered into a Fourth Amendment to the Contract; and
WHEREAS, on August 8, 2013, the parties entered into a Fifth Amendment to the Contract; and
WHEREAS, on April 10, 2014, the parties entered into a Sixth Amendment to the Contract; and
WHEREAS, still pending execution, the parties entered into a Seventh Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2014;
and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agency from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to August 30, 2014 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
I. The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2014.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level
specified in the agreement.
SIGNATURE PAGE TO FOLLOW
1
Amendment 008
ADI203 .OII8 0 17
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Collier County Board of County Area Agency on Aging for Southwest Florida,
Contractor: Co 1 missioners Inc.
SIGNED
SIGNED : i� �� BY: {'
NAME: Tom Henning NAME: Ronald Lucchino, PhD
TITLE: Chairman TITLE: Board President
DATE: June 24, 2014 DATE: 7/2//if
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
Approved as to form and legality
'T SRO Clowk
• , Cam+ '•"�
.-'•- _ ASSistantCounty. orncy
1p\
Attest as to Chairman's
signature only: 4
2
16017
Attestation Statement
Agreement/Contract Number: ADI 203.12
Amendment Number 008
I, Tom Henning ,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 dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(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.•
CAS------ /
6/24/2014
'gnature of Recipien /Contra■ •r representative Date
Approved as to form and legal it.
N t
.. _ -- Assistant County A cY �
est as-to Chairman's '�
signature only
0
16017
Amendment 009 CCE 203.13.009
• AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida, Inc. hereinafter
referred to as the "Agency,"and Collier County Board of County Commissioners, hereinafter referred to as the
"Contractor,"collectively stated as the"Parties"which amends contract CCE 203.12.
This amendment shall be effective July 1, 2014.
RECITALS:
WHEREAS, on August 9, 2012, the parties entered into the Standard Contract for social services to be
provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract"); and
WHEREAS, on July 1, 2012, the parties entered into a First Amendment to the Contract; and
WHEREAS, on July 1, 2012, the parties entered into a Second Amendment to the Contract; and
WI-HEREAS, on April 11, 2013, the parties entered into a Third Amendment to the Contract; and
WHEREAS, on June 6, 2013, the parties entered into a Fourth Amendment to the Contract; and
WHEREAS, on July 1, 2013. the parties entered into a Fifth Amendment to the Contract; and
WHEREAS, on August 8, 2013, the parties entered into a Sixth Amendment to the Contract; and
WHEREAS, still pending execution, the parties entered into a Seventh Amendment to the Contract; and
WHEREAS, still pending execution, the parties entered into an Eighth Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2014;
and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agency from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to August 30, 2014 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
1. The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2014.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level
specified in the agreement.
SIGNATURE I'AGE TO FOLLOW
1
C�
16017
Amendment 009 CCE 203.13.009
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Collier County Board of County Area Agency on Aging for Southwest Florida,
Contractor: Commissioi rs Inc.
/ I
SIGNED
SIGNED BY: n` BY:
NAME: Tom Henning NAME: Ronald Lucchino,PhD
TITLE: Chairman TITLE: Board President
DATE: June 24, 2014 DATE: 7/ IJI/
Federal Tax ID: 59-60005 88
Fiscal Year Ending Date: 09/30
P;s 4 n- ; Approved as to form and legality
T E, 4R0 , Clork
�� _. .. ,..... Assistant County orn„
Attest as•to Chairman's ' c:•\`
signature only.
2
16017
r '
Attestation Statement
Agreement/Contract Number: CCE 203.12
Amendment Number 009
I, Tom Henning ,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 dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(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.
6/24/2014
Signatur of Rec ent/Contracto epresentative Date
Approved as to form and legality
i s T E. 3R0 efork •
Assistant County At ey
„or
Attest as to Chairman's `off
signature only. tee
•
16D17
Amendment 010 HCE 203.13.010
r
r
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida, Inc. hereinafter
referred to as the "Agency,"and Collier County Board of County Commissioners, hereinafter referred to as the
"Contractor,"collectively stated as the"Parties"which amends contract CCE 203.12.
This amendment shall be effective July 1, 2014.
RECITALS:
WHEREAS, on June 30, 2012, the parties entered into the Standard Contract for social services to be
provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract"); and
WHEREAS, on July 1, 2012, the parties entered into a First Amendment to the Contract; and
WHEREAS, on October 16, 2012, the parties entered into a Second Amendment to the Contract; and
WHEREAS, on April 11, 2013, the parties entered into a Third Amendment to the Contract; and
WHEREAS, on June 6, 2013, the parties entered into a Fourth Amendment to the Contract; and
WI'IEREAS, on July 1, 2013, the parties entered into a Fifth Amendment to the Contract; and
WHEREAS, on August 8, 2013, the parties entered into a Sixth Amendment to the Contract; and
WHEREAS, on November 1, 2013, the parties entered into a Seventh Amendment to the Contract; and
WHEREAS, still pending execution, the parties entered into an Eighth Amendment to the Contract; and
WHEREAS, still pending execution, the parties entered into a Ninth Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2014;
and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agency from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to August 30, 2014 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
1. The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2014.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level
specified in the agreement.
SIGNATURE PAGE TO FOLLOW
1
0
16017
Amendment 010 HCE 203.13.010
4
' IN WITNESS WHEREOF. the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Collier County Board of County Area Agency on Aging for Southwest Florida,
Contractor: Commission. s Inc.
/ SIGNE.
SIGNED It
jiki
BY: . % �.�. �;–
NAME: Tom Henning NAME: Ronald Lucchino, PhD
TITLE: Chairman TITLE: Board President
DATE: June 24, 2014 DATE: r �"/
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
1 r -� Approved as to Inn and legality c,, .
De
�'' -�`�— Assistant C of I m ttorney 097
eo
Attest as to Chairman's (.,2
signlah'ure only.
2
0
. •16017
Attestation Statement
Agreement/Contract Number: HCE 203.12
Amendment Number 010
I, Tom Henning ,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 dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(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 m 'ia,which has no affect on the agreement/contract content.
/
�_, i 6/24/2014
Signature of Recipient/Contrac I iresentative Date
Approved as t< to and legality
5 - rt��yj �/r �w �/
i'-r• ..• ,, is : 00K, rl'6Y q'r.n, NV
lb, t.-.1 Assi tant ( ourny A ney \��
f:t`A;Af as to Chairman's
0