Backup Documents 10/25/2016 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16D
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. Dawn Whelan Community and Human 61VF' 10/21/16
Services
2. County Attorney Office County Attorney Office p� ftt I2$1 1 c
3. BCC Office Board of County
Commissioners \(' / \ z.L\-c
4. Minutes and Records Clerk of Court's Office (Q(Ail
/6 3y 21.fet0
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 Dawn Whelan,Grant Coordinator, Phone Number 239-252-4230
Contact/ Department Community and Human Services
Agenda Date Item was October 25.2016 V Agenda Item Number 16D5
Approved by the BCC /
Type of Document Amendment Z Number of Original 2
Attached / Documents Attached
PO number or account
number if document is N/A
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? C 4-)A e 6 tiC DW
2. Does the document need to be sent to another agency for additional signatures? If yes, DW
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 1 DW
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 DW
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 DW
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 DW
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. (�(�fk
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 10/25/16 and all changes made during J -Qo'C a
the meeting have been incorporated in the attached document. The County ^a
Attorney's Office has reviewed the changes,if applicable. NJf )
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: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 160 5
1) There are 2 original Contracts. Please return one Chairman signed Amendment to:
Dawn Whelan
RSVP Project Director I Criminal Justice Grant Coordinator
Collier County Government I Community and Human Services
3339 E. Tamiami Trail, Bldg. H, Suite 211
Naples, FL 34112
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
160 5
MEMORANDUM
Date: October 28, 2016
To: Dawn Whelan, Grants Coordinator
Community & Human Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Amendment #3 to Agreement CJMHSA-001 Between Collier
County Board of County Commissioners and
David Lawrence Mental Health Center, Inc.
II
Attached are one (1) original of the document referenced above, (Item #16D5)
approved by the Board of County Commissioners on Tuesday, October 25, 2016.
The third original document has been held in our department for the
Board's Official Record.
If you have questions, please feel free to call me at 252-7240.
Thank you
Attachment
160 5
THIRD AMENDMENT TO AGREEMENT CJMHSA-001 BETWEEN
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
DAVID LAWRENCE MENTAL HEALTH CENTER, INC.
This Amendment, is entered into this day ofO , 2016,
by and between David Lawrence Mental Health Center, Inc. hereinafter referred to as
Subrecipient and Collier County, a political subdivision of the State of Florida, hereinafter
referred to as "COUNTY," collectively stated as the"Parties."
WHEREAS, on June 10, 2014, the County and Subrecipient entered into an agreement
for Subrecipient to provide "FIRST grant services" to Collier County residents (hereinafter
referred to as the "Agreement"); and
WHEREAS, on September 23, 2014, the Board of County Commissioners approved the
First Amendment to Agreement which added provisions for proper accountability over state
resources and a property clause for the purchase of tangible personal property; and
WHEREAS, on June 23, 2015, the Board of County Commsisioners approved the
Second Amendment to Agreement which revised the division name, added Board directed
Corrective Action language, removed and replaced Exhibits and added grantor required State
and Federal Laws, Rules and Regulations as Exhibit I; and
WHEREAS, the Parties desire to modify the Agreement to extend the contract term,
reduce the grant budget, adjust the match budget, and revise the staffing pattern.
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 modify the Agreement as follows:
1. Section 2 of the Agreement is amended as follows:
2. CONTRACT TERM
Services of the SUBRECIPIENT shall start on the 1st day of July, 2014 and end on the 3-1st day
ef-May, 30th day of June, 2017. The term of this Agreement and the provisions herein may be
extended by amendment to cover any additional time period
2. Exhibit C of the Agreement is amended as follows:
* * *
C-2.1.1. The following subcontract or sub-Subrecipient staff supported by this Contract
through David Lawrence Center:
FIRST team staff to include:
C-2.1.1.1.1 1.0 FTE Case Manager;
C-2.1.1.1.2 4g.063658 FTE Master's Level Mental Health Counselor; and
C-2.1.1.1.3 1,0.50 FTE Supportive Living, Employment and Life Skills Coach.
C-2.1.1.1.4 1.0 FTE Outreach Specialist
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� II
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C-2.1.1.1.5 .50 FTE Coordinator
C-2.1.1.1.6 .50 FTE Case Manager
3. Exhibit F, Method of Payment, is amended as follows:
F-3 Modifications to the "Budget and Scope" may only be made if approved in advance.
Budgeted fund shifts between budget categories and line items shall not be more than 10% and
does not signify a change in scope. Fund shifts that exceed 10% of budget category or line item
shall only be made with board approval.
Program
Period Activity Amount
Personnel $78 0
$66,497.07
Travel $6,408.00
Program Equipment $2,000.00
Year 1
Incidental $13,175.20
Expenses $8,808.53
Program $12,000.00
Evaluator
Personnel $79 83
$66,497.07
Travel $6,408.00
Program
Year 2 Incidental $23,475.20
Expenses $18,808.53
Program $12,000.00
Evaluator
Personnel $797740
8
$120,497.06
Travel $6,408.00
Program
Year 3 Incidental $30
Expenses $28,808.54
Program $12,000.00
Evaluator
CONTRACT TOTAL $367,140.80
2
CqO,
160 5
4. Exhibit F-7 is amended as follows:
The Subrecipient shall provide match funds in accordance with the schedule below:
Program Period Amount
Program Year 1
$110,688.74
Program Year 2 $110,688.74
Program Year 3 $110,688.74
MATCH TOTAL $332,066.22
SIGNATURE PAGE TO FOLLOW
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
3
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160 -
IN WITNESS WHEREOF, the Parties have executed this Amendment, on the date and year first
above written.
David Lawrence Mental Health Center, Inc.
By: di
Scott :urgess
Title: President/CEO
Date: September 28, 2016
COLLIER COUNTY
ATTEST:
DWIGHT E. BROCK, CLERKPAIN\clittL- °
By: Ofrrynar2
,•
,' � DONNA FIALA, CHAIRMAN
QEPU .114
Ahst as to Chairman's I Date a
signature only.
Approval for form and legality:
Jennifer A. Belpedio
Assistant County Attorney
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