Backup Documents 07/12/2016 Item #16D 3 COMMUNITY AND HUMAN SERI VCES 1603
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grants Coordinator, CHS
DATE: July 13, 2016
RE: Agreements between Area Agency on Aging for Southwest Florida, Inc and
Collier County
Please find attached a fully executed document that was 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 July 12,2016,Item 16D3, 16D4, 16D5 and 16D6
Thank you for your assistance.
Amendment 002 July 2015 to June 2016 ADI 203.15.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. Ura"
Asa
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of County Commissioners ("Contractor"), amends agreement ADI 203.15.
The purpose of this amendment is to amend 4. Contract Amount, increase the allocation by$4,600.00, and revise
ATTACHMENT III and ATTACHMENT VIII,ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
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$282,050.00, 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.
This amendment shall be effective April 21, 2016. All provisions in the agreement and any attachments thereto in conflict
with this amendment shall be and are hereby changed to conform with this amendment
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.
SIGNED BY: NO ip,� 0/ SIGNED BY:
�i/152.4^-(1.—
NAME: STEPHEN Y. CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: May 26, 2016 DATE: 6//6//4,
Federal Tax ID: 59-6000-558
Fiscal Year Ending Date: 09/30
Approved as to form and legality
Assistant County Attorney 0.)
1
Amendment 002 July 2015 to June 2016 ADI 203.15.002
1603
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
$0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheimer's Disease Initiative General Revenue/TSTF-Collier 65004 $ 282,050.00
TOTAL AWARD $ 282,050.00
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
2
C
Amendment 002 July 2015 to June 2016 ADI 203.15.002
16133
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL BUDGET SUMMARY
for
Collier County Board of County Commissioners,
Collier
ALLOCATION TOTAL $ 282,050
3
Revised August 2007
6 0 3
1603
Attestation Statement
Agreement/Contract Number ADI 203.15
Amendment Number 002
I, 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 and
Public Services Department Head
(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.
'4) May 26, 2016
Signat e of Recipient/Contractor representative
Date
Revised August 2007