Backup Documents 01/26/2016 Item #16D 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 p
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. Michelle Rubbo CHS e- daDht,
2. Jennifer A. Belpedio County Attorney Office %CA I \' QV
3. BCC Office Board of County �
Commissioners ('t /6/ t\-Z1\
4. Minutes and Records Clerk of Court's Office 'NO
°k) \?SG fiV
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Phone Number
Contact/ Department Lisa Oien 252-6141
ease call for pick up
Agenda Date Item was 1/26/2016 Agenda Item Number
Approved by the BCC -k&rB- 14 16 4
Type of Document Third Amendment to Agreement in Number of Original 3 Amendment
Attached triplicate Documents Attached documents
(between Collier County and Youth Haven)
PO number or account
number if document is to be A1/4„
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 signatur AMPED SIGNATURE IS n/a
2. Does the document need to be sent to another agency for additiona signatures? If yes, no
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 yes
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 yes 6„,(0°'"''
document or the final negotiated contract date whichever is applicable. "i � ''
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's yes
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
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 1/26/2016 and all changes made yes •
during the meeting have been incorporated in the attached document. The County < .000
Attorney's Office has reviewed the changes, if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the '' ,
BCC, all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature. - 1 •
, l/' / r C
,
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
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MEMORANDUM
Date: February 1, 2016
To: Lisa Oien, Grant Coordinator
Community & Human Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Amendment #3 to Agreement between Collier County and
Youth Haven, Inc.
Attached are one (1) original amendment to the agreement referenced above, (Item
#16D6) approved by the Board of County Commissioners on Tuesday, January 26,
2016.
An original has been kept by the Minutes and Records Department as part of the
Board's Official Records.
One (1) Original was forwarded to Joyce Zirkle at Youth Haven, Inc.
If you have any questions, please feel free to contact me at 252-7240.
Thank you.
Attachment
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County of Collier
CLERK OF THE CIRCUS' COURT
COLLIER COUNTY CQ.1JRTHO\JSE
3315 TAMIAMI TRL E STE 102 Dwight E. Brock- Clerk;,{pf Circuit Court
P.O. BOX 413044
NAPLES,FL 34112-5324 NAPLES,FL 34101-3044
Clerk of Courts • Comptroller • Auditor • Custodian of County Funds
February 1, 2016
Youth Haven
Attn: Joyce Zirkle, CGMA
5867 Whitaker Road
Naples, Florida 33112
Re: Third Amendment to Agreement between Collier County and
Youth Haven, Inc.
(Safe and Secure Home for Collier Youth Phase II & III)
Transmitted herewith is one (1) original agreement of the above referenced
document for your records per request, as adopted by the Collier County Board of
County Commissioners of Collier County, Florida on Tuesday, January 26,
2016, during Regular Session.
Very truly yours,
DWIGHT E. BROCK, CLERK
Martha Vergara, Deputy Cl rk
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email-CollierClerk@collierclerk.com
16Db
Grant#B-14-UC-12-0016
B-13-UC-12-0016
B-12-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
THIRD AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
YOUTH HAVEN,INC.
SAFE AND SECURE HOME FOR COLLIER YOUTH PHASE II & III
th
This Amendment is entered into this %Up day of &vi V016, by and between
Youth Haven, Inc., a private not-for-profit corporation exi g undee 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");
WHEREAS, on June 9, 2015 the Parties amended the Agreement to clarify the duration
of the records retention period;
WHEREAS, on September 22, 2015 the Parties amended the Agreement to clarify
milestone deadlines in order to achieve a National Objective in accordance with 24 CFR 570.208;
WHEREAS, the Parties desire to amend the agreement to combine related budget
activities and clarify a specific term used in the agreement;
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 Struckough are deleted; Words Underlined are added
[15-GRC-00425/1204665/1] Youth Haven Inc.
CDBG CD14-12—Third Amendment
Safe and Secure Home for Collier Youth Phase II&III Page 1 of 9
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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. Security fence at lake and security gate with $256,800
cipher lock at driveway. Installation of security window, counter
and code renovations to the interior of Janette's Cottage.
Landscaping—Install landscaping buffer at South property fence.
Installation of new plumbing fixtures and 2"water line at Jay's and
Janette's Cottages. Installation of sidewalks within the campus
area. Including associated activities and fees needed to complete
the tasks.
..•_. - : : - • • . --. • _ - • • $357000
Project Component 32: Security camera system including data X2-500
storage equipment. Installation of fiber-optic data cable and $196,600
network equipment. Including associated activities and fees
needed to complete the tasks.
' .• .. - . : . -= • • . -- , _z. . .,•. $28,500
• _. .. - . _.,•. . . - .• . .,•. _. . _ .. _ . $20;000
South p per,-„f nc,
' .� .,.. ._ .. .. .. •. . _ . . 404400
network e n♦
Project Component,73:Design and Permitting $25,600
• z'- -z- .. _ . • . . . •: •. _ : • : " $3845.0
,
[15-GRC-00425/120466511] Youth Haven Inc.
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Safe and Secure Home for Collier Youth Phase II&III Page 2 of 9
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_ . -- _ .: • .. . .• . •.. . . .. ..
$479,000
* * *
E. Payment Deliverables
The Following Table Details the Payment Deliverables
Payment Deliverable Payment Supporting Documentation Submission
Schedule _
Project Component One: Security Submission of supporting documents must be Submission
lighting, including concrete poles, provided as backup as evidenced by properly of monthly
fixtures and wiring. Security completed invoices,banking documents or canceled invoices- See
fence at lake and security gate check as evidence of proof of payment, Al A or Exhibit B
with cipher lock at driveway. similar documents timesheets, payroll registers;
Installation of security window, .. • .. . . . .. •.. .. - . , .••- _ ,
counter and code renovations to and any additional documents as needed.
the interior of Janette's Cottage.
Landscaping—Install landscaping t°. ! , !.!! . ._ • •- . _ '
buffer at South property fence. . : -. _ •. • .. _. . .. ' .. ..
Installation of new plumbing - •. __. •-- . . .._. . . • . .
fixtures and 2" water line at Jays • _. .', _. _ . ..
& Janette's Cottages. Installation
of sidewalks within the campus
area. Including associated
activities and fees needed to
complete the tasks.
. .... .- • bion
fence at lake and sccurity gate . . •. .. ..- . . . •._ -_. . . .. efmen* y
• - • - - - , •-•- -- .. . _• , invoiees—dee
.. • .- . -t• - - - . . . • Exhibit B
Project Component ThreeTwo: Submission of supporting documents must be Submission
Security camera system including provided as backup as evidenced by properly of monthly
data storage equipment. completed invoices, timesheets, payroll registers, invoices- See
Installation of fiber-optic data :. •- -• , _ _ :_ , banking Exhibit B
cable and network equipment. documents or cancelled check as evidence of proof
Including associated activities of payment, AlA or similar document and any
and fees needed to complete the additional documents as needed.
[15-GRC-00425/1204665/11 Youth Haven Inc.
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Safe and Secure Home for Collier Youth Phase II&III Page 3 of 9
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tasks.
Project Component Four: _. . • .._. --- -• . men
•
. . - - - •• :: , .._ . . - - .._ of monthly
•
•
. . .._ -•. . •. . • -• - , ••- •-- , •• - - - , invoices See
the interior of Janette's Cottage. .. •. _ .... . •• . . . . . Exhibit B
,o , -
,
Project—Compone t Five: .. . • . ..- ••_ •--• - • • t •- Submission
-• •. -• • •: • : • . -. • provided as backup as evidenced by properly of monthly
• ... ... - -- • -•-- •..• •-- , .. , iffveiees—See
. •--- ... , - - , ... . €xhi B
_ 10 III
Project Component Six: . . . • ... •: ..-. _ ._ Submission
•- .. .. .. . . - -. .._ of monthly
eahle-and-rietwork-equipmeat, -• •
. _ .. • - -- , = -_ , .. - , invoiees--wee
. •• . --- - , •- • , • .'y-add ional € iit-B
documents edea
10 III
.
payment-documents. _ •.
Project Component SevenThree: Submission of supporting documents must be Submission
Design and Permitting provided as backup as evidenced by properly of monthly
completed invoices, • _ • _ , :. • •: , invoices- See
•• •.: •• • , • ••- - _ ,and any additional Exhibit B
documents as needed.
Project Component Eight: -. -•• ... •. .._. _ . ,_ Submission
- • of
fixtures and 2" water lino at Jays --.•• . . _. __ ,. •.. . - • _ inv�ce e
&r., ette's Co .., : .._.. _ . . , . . .. Exhibit B
[15-GRC-00425/1204665/1] Youth Haven Inc.
CDBG CD14-12—Third Amendment
Safe and Secure Home for Collier Youth Phase II&III Page 4 of 9
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••: ,0, • . •:
fixtures and 2" water lines at Jay's Janette's
Project Component Nine: . .. . ... .._. _ . ._ sukais&kan
' • . . •._. . .._ . . . _ •._• _. . .._ of monthly
•
-- • ' . • - , • - • - , .. . - • , invoices---See
. , . - , • • • .--• •- • Eithibit-B
I0
Final 10% retainage released Supporting proof of project completion paywiefit End of
upon completion of the project desuments5 including a Certification of Completion Project
and proof of individuals served. or proof of final inspection from County inspector
must be provided as 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, $
fixtures and wiring. Security fence at lake and security gate with 89 0$256,800
cipher lock at driveway. Installation of Security window,counter
and code renovations to the interior of Janette's Cottage.
Landscaping—Install landscaping buffer at South property fence.
Installation of new plumbing fixtures and 2" water line at Jays&
Janette's Cottages. Installation of sidewalks within the campus
area. Including associated activities and fees needed to complete
the tasks.
.. _ .. ' _ .. , . .. $ 35,000
[15-GRC-00425/1204665/1] Youth Haven Inc.
CDBG CD14-12—Third Amendment
Safe and Secure Home for Collier Youth Phase II&III Page 5 of 9
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Project Component#32- Security camera system including data $
storage equipment. Installation of fiber-optic data cable and 92,500$196,600
network equipment. Including associated activities and fees needed
to complete the tasks.
•-- .. • .. . • . _ -• , -. - $ 28,500
_•- • .. . . . • . . . . _ .. - . $ 20,000
S terty f
vvuuit, r ,
Project Component ft6 Installation of fiber optic data cable and X0400
net er-IE:quipment,
Project Component#73-Design and Permitting $ 25,600
.. : • . . •. . _ . - $ 38,750
.. • • . • . . •- . .. $ 44,800
area7
TOTAL $479,000
*
IN WITNESS WHEREOF, the SUBRECIPIENT and the County, have each,
respectively, by an authorized person or agent, hereunder set their hands and seals on the date
first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
DWIGHT E.,: :OCK,CLERK COLLIER CO Y,FLORID
r Ali
By.
DeputyC =rk DONNA FI LA CHAIRMAN
4 2 YOUTH HAVEN, INC.
Date,
Al'p• 2,q0
Attest as—.
.+ BtZ I c •Y: V'7 )i:)
signature only. BRENDA O'CONNOR,PRESIDENTf
YOUTH HAVEN INC.
Approved as to form and legality: 4
ait
Jennifer . di
Belp eo �7"
�
Assistant County Attorney C4k
[15-GRC-00425/1204665/1] Youth Haven Inc.
CDBG CD14-12—Third Amendment
Safe and Secure Home for Collier Youth Phase II&III Page 6 of 9
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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 Haven, Inc. Date:
Project Title: Safe and Secure Home for Collier Youth Phase II &III
Alternate
Program Contact: Stephanie Jinx Liggett, Executive Director Contact:
Telephone Number:
*REPORT FOR QUARTER ENDING:(check one that applies to the
corresponding grant period): 0 12/31/14 03/3144-5 006/30/15 0 0/30/15 0
Please take note: Each quarterly report needs to include cumulative data beginning from the start of the agreement date.
Please list the outcome goal(s)from your approved application&sub-recipient agreement and indicate your progress in 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: All landscaping completed by January February 2016
Outcome 2: Provide for a lien the property in the amount of CDBG assistance
Outcome 3: 50% expended* by December 31, 2015
Outcome 4: All upgrades must be fully completed and begin serving beneficiaries by March 31, 2016
*expenses incurred
[15-GRC-00425/1204665/1] Youth Haven Inc.
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Safe and Secure Home for Collier Youth Phase II&III Page 7 of 9
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B.Goal Progress: Indicate the progress to date in meeting each outcome goal.
Outcome 1:
Is this project still in compliance with the original project schedule?If more than 2 months behind schedule,must submit a new
2. timeline for approval.
❑ El
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? 0
TOTAL: 0
4. What funding sources are applied for this period I program year?
$ $
Section 108 Loan Guarantee - HOPWA -
$ $
Other Consolidated Plan Funds - CDBG -
$ $
Other Federal Funds - ESG -
$ $
State/Local Funds - HOME -
Total
$ Entitlement $
Total Other Funds - Funds -
[15-GRC-00425/1204665/1] Youth Haven Inc.
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Safe and Secure Home for Collier Youth Phase II&III Page 8 of 9
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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: 0 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#8 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 8. OTHER BENEFICIARY DATA INCOME RANGE
Indicate the total number of UNDUPLICATED Indicate the total number of UNDUPLICATED persons
persons served since October 1 who fall into served since October 1 who fall into each income
each presumed benefit category (the total category(the total should equal the total in question#6):
should equal the total in question#6):
Report as: Report as:
O Abused Children 0 Extremely low Income(0-30%)
O Homeless Person 0 Low Income(31-50%)
O Battered Spouses 0 Moderate Income(51-80%)
O Persons w/HIV/AIDS 0 Above Moderate Income(>80%)
O Elderly Persons
O Veterans
O Chronically/Mentally ill
O Physically Disabled Adults
O Other-Youth
TOTAL: 0 TOTAL: 0
9. Racial&Ethnic Data: I(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 0 0 ;of whom, how many are Hispanic?
American Indian/Alaska Native 0 0 ;of whom,how many are Hispanic?
Native Hawaiian/Other Pacific Islander 0 0 ;of whom, how many are Hispanic?
American Indian/Alaskan Native&White 0 0 ;of whom, how many are Hispanic?
Black/African American&White 0 0 ;of whom,how many are Hispanic?
Am. Indian/Alaska Native&Black/African Am. 0 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
[15-GRC-00425/1204665/11 Youth Haven Inc.
CDBG CD14-12—Third Amendment
Safe and Secure Home for Collier Youth Phase II&III Page 9 of 9