Agenda 12/13/2016 Item #16D19 16.D.19
12/13/2016
EXECUTIVE SUMMARY
Recommendation to approve an after-the-fact Amendment and Attestation Statement with the
Area Agency on Aging for Southwest Florida, Inc. to extend the grant period through February 28,
2017 for the Older Americans Act Programs. (No Fiscal Impact).
OBJECTIVE: To provide uninterrupted support services to Collier County Services for Seniors' frail,
elderly clients.
CONSIDERATIONS: The Older Americans Act (OAA) Programs are federal program initiatives
that provide assistance to older persons and caregivers and are the only federally funded support service
programs directed solely toward improving the lives of older people. These funds are received by Collier
County through the Florida Department of Elder Affairs, and administered by the Area Agency on Aging
for Southwest Florida,Inc.
The current Standard Contract for the OAA Programs was approved by the Board on February 23, 2016
(Agenda item 16D5) and has an expiration date of December 31, 2016. Historically, during the month of
November, the County's Services for Seniors Program receives an amendment extending the expiration
date for the upcoming grant cycle. The amendment received this year extends the existing grant
agreement through February 28, 2017 or until a new agreement is executed, whichever comes first.
This item is being presented after-the-fact because Collier County received the contract extension on
November 17, 2016 from the grantor agency and is required to return it within 30 days. This time frame
makes it impossible to process the document for the Board's consideration. Pursuant to CMA 5330 and
Resolution No. 2010-122, the County Manager authorized Steve Camell, Public Services Department
Head, to sign the agreement. This amendment is being presented for Board ratification. Collier County, as
the Lead Agency, is responsible to respond to seniors' needs and to manage the spending authority for the
Federal and State funded Services for Seniors programs.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
item.
FISCAL IMPACT: Funding from the Department of Elder Affairs via the Area Agency on Aging under
the 2016 grant award is available in Human Services Grant Fund 707, Projects 33443 (3B), 33446 (3E),
33444 (C1), 33445 (C2). There is no fiscal impact associated with this action.
LEGAL CONSIDERATIONS: The underlying Agreement expressly contemplates an extension by
mutual assent of the parties. This item has been reviewed by the County Attorney, is approved for
legality, and requires majority vote for approval. -JAB
RECOMMENDATION: That the Board of County Commissions approves the after-the-fact Standard
Contract extension and Attestation Statement with Area Agency on Aging for Southwest Florida, Inc. for
Services for Seniors.
Prepared by: Lisa N. Can, Grants Coordinator, Community and Human Services
ATTACHMENT(S)
1. OAA 203.16.006 Extension (PDF)
2. OAA 203.16.005 Amendment (PDF)
Packet Pg. 1613
16D.19
12/13/2016
3.OAA 203.16.004 Amendment (PDF)
4. OAA 203.16.003 Amendment (PDF)
5. OAA 203.16.002 Amendment (PDF)
6. OAA 203.16.001 Amendment (PDF)
7. OAA 203.16 Contract Executed (PDF)
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16D.19
12/13/2016
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.19
Item Summary: Recommendation to approve an after-the-fact Amendment and Attestation
Statement with the Area Agency on Aging for Southwest Florida, Inc. to extend the grant period through
February 28, 2017 for the Older Americans Act Programs. (No Fiscal Impact).
Meeting Date: 12/13/2016
Prepared by:
Title: Grants Coordinator—Community&Human Services
Name: Lisa Can
11/18/2016 5:09 PM
Submitted by:
Title: Division Director-Cmnty&Human Svc—Public Services Department
Name: Kimberley Grant
11/18/2016 5:09 PM
Approved By:
Review:
Community&Human Services Kristi Sonntag Additional Reviewer Completed 11/21/2016 12:15 PM
Community&Human Services Dora Carrillo Additional Reviewer Completed 11/21/2016 1:19 PM
Public Services Department Hailey Margarita Alonso Level 1 Division Reviewer Completed 11/21/2016 1:44 PM
Public Services Department Amanda O.Townsend Additional Reviewer Completed 11/21/2016 4:27 PM
Community&Human Services Maggie Lopez Additional Reviewer Completed 11/21/2016 5:01 PM
Public Services Department Cynthia Kemner Additional Reviewer Completed 11/23/2016 9:24 AM
Grants Erica Robinson Level 2 Grants Review Completed 11/23/2016 10:29 AM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 11/23/2016 3:42 PM
Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 11/27/2016 11:26 AM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 11/28/2016 9:47 AM
County Attorney's Office Scott Teach Level 3 County Attorney's Office Review Completed 11/29/2016 8:34 AM
Budget and Management Office Ed Finn Additional Reviewer Completed 11/30/2016 11:56 AM
Grants Therese Stanley Additional Reviewer Completed 12/05/2016 1:38 PM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 12/06/2016 1:01 PM
Board of County Commissioners MaryJo Brock Meeting Pending 12/13/2016 9:00 AM
Packet Pg.1615
Amendment 06 OAA 203.16.006 16.D.19.a
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT PROGRAM TITLE III
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) and amends contract OAA 202.16.
The purpose of this amendment is to (1) extend this contract for 60 days or until a new 2017 OAA 202.17 contract
executed,whichever comes first.
This amendment shall be effective on January 1, 2017
RECITALS: N
WHEREAS, on February 2, 2016, 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 >-
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WHEREAS, on February 12, 2016, the parties entered into a First Amendment to the Contract; and
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WHEREAS, on June 16, 2016 the parties entered into a Second Amendment to the Contract; and
WHEREAS, on October 27, 2016,the Agency has processed a Third Amendment to the Contract, and
WHEREAS, on October 27, 2016,the Agency has processed a Fourth Amendment to the Contract, and
WHEREAS, on November 2, 2016,the Agency has processed a Fifth Amendment to the Contract, which has c
not been executed; and
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WHEREAS, Section 3 of the Contract provides that the agreement is to expire on December 31, 2016; and o
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WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
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Agency from the Florida Department of Elder Affairs;
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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 February 28, 2017 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 February 28,2017.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level specified is
the agreement.
SIGNATURE PAGE TO FOLLOW
1
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Amendment 06 OAA 203.16.006 16.D.19:a I
L. .JITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there unt
duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.
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SIGNED BY: --4) CO� 41'• ' SIGNED BY:
NAME: STEVE Y, CARNELL NAME: MARIAN-NE G LORINI
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TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
cuDATE:November ( ,201$ DATE: cc
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30 w
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Approved as to form and legality
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16.D.19.a'
Revised August 2007
Attestation Statement
Agreement/Contract Number: OAA 203.16
Amendment Number 006
I, Steve Y Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
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content of the above referenced agreement/contract or amendment between the Area Agency on Aging for .y
Southwest Florida and a;
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Public Services Department Head m
(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. p
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• i' (/ • November 18 , 2016
tnair of Recipient/Contractor representative Date 9^
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Approved as to form and legality
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Assistant County Attorney
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Revised August 2007
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.Amendment .005 OAA 203.16.005 16.D.19.b
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
.-. OLDER AMERICANS ACT PROGRAM TITLE III
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) and amends contract OAA 203.16.
The purpose of this amendment is decrease allocations for Collier County by$19,500 from OA3B Transportation,revise#4
Contract Amount and revise ATTACHMENT III and ATTACHMENT VII.
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4. Contract Amount
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The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount w
not to exceed $1,006,838.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for
payment under any other contract or from any other source are not eligible for payment under this contract.
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All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby O
changed to conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified
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in the contract c
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This Amendment and all its attachments are hereby made part of the contract.
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IN WITNESS THEREOF, the Parties hereto have caused this 4 page amendment, to be executed by their
undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this OAA
contract as amended. This Amendment is effective on the last date the Amendment has been signed by both cc
Parties.
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COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST o
Contractor: COUNTY COMMISSIONERS FLORIDA,INC.
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SIGNED BY: I . '.t� SIGNED BY:
NAME: STEVE Y. CARNELL NAME: MARIANNE G LORINII
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: November /0 , 2016 DATE:
Federal Tax ID: 59-60005 88
Fiscal Year Ending Date: 09/30
Approved as to form and legality
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Assistant County Attorney 0.5"`(."
Packet Pg. 1619
16.D.19.b'
Amendment.005 OAA 203.16.005
ATTACHMENT III
FUNDING SUMMARY
Note: Title 2 CFR§200331,as revised,and Section 215.97(5),Florida Statutes,require that the information about federalro rams
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and State Proj ects be provi ded to the Recipient and a-e stated in The Financial And Compliance Audit Attachment And Exhibit 1.
Financial And Compliance Audit Attachment,Exhibit 2-Funding Summary Provides Information Regarding the Funding Sources
Applicable to this contract,contained lerein,isapredictioncflimdingsourcesand related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD (FAIN#): 16AAFLT3SS, 16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC
DUNS NUMBER :076997790 FEDERAL AWARD DATE: OCTOBER 20,2015
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT .°
Older Americans Act Title IIIB —
CA/CM/SCAS $ 23,574.0 w
Transportation U.S. Health and Human Services 93.044 $ 0.0 co
Support Services $ 316,722.0 >-
Total IIIB $ 340,296.0 <
OAA Title IIIC1 —Congregate Meals $ 293,000.0 0
Meals
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Screening U.S. Health and Human Services 93.045 N
Nutrition Education
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Outreach :-.
Total IIIC1
OAA Title III C2—Home Delivered $ 293,000.0 E
Meals $ 250,832.0 <
Meals
Nutrition Education U.S. Health and Human Services 93.045
Screening o
Outreach $ 250,832.0 .
Total IIIC2 0
Older Americans Act Title III E
CA/CM & Services (Title III E) $ 97,755.0
Supplement Services (Title III ES) U.S. Health and Human Services 93.052 $ 18,335.0
Grandparent Services (Title III EG) $ 6,620.0 V.
Total IIIE $ 122,710.0 Q
TOTAL FEDERAL AWARD
$1,006,838.0
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
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Packet Pg 1620
Amendment.005 OAA 203.16.005 16.D.19.b
FEDERAL FUNDS:
2 CFR Part 200Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards/
OMB Circular A-133—Audits of States, Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS: _
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STATE FINAN . AL ASSISTANCE $1
Section 215.97,F.S.,Chapter 69I-5,FL Admin Code,Reference Guide for State Expenditures,Other fiscal requirements set forth in w
program laws,rules and regulations. co
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Amendment .005 OAA 203.16.005 16.D.19.b
ATTACHMENT VII
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS °
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COLLIER COUNTY
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1. Title III B Support Services $ 340,296.00
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2. Title III Cl Congregate Meals $ 293,000.00
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3. Title III C2 Home Delivered Meals $ 250,832.00 v
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4. Title III E Services $ 122,710.00
TOTAL $ 1,006,838.00
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Packet Pg. 1622
16.D.19.b
Revised August 2007
Attestation Statement
Agreement/Contract Number: OAA 203.16
Amendment Number 005
I, Steve Y Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
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content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Department Head t'
(Recipient/Contractor name) >-
The only exception to this statement would be for changes in page formatting,due to the differences in QO
electronic data processing media,which has no affect on the agreement/contract content. ..
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J November I'D 2016
Signature of ecipient/ retractor representative Date E
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Approved as to form and legality
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Assistant County Attorney
Revised August 2007
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Packet Pg. 1623
Amendment.004 OAA 203.16.004 16.D.19.c
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AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT PROGRAM TITLE III
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) and amends contract OAA 203.16.
The purpose of this amendment is increase allocations for Collier County by$2,000 for Cl,revise#4 Contract Amount and
revise ATTACHMENT III and ATTACHMENT VII.
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4. Contract Amount LL
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $1,026,338.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for 0
payment under any other contract or from any other source are not eligible for payment under this contract.
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All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby 9�-.
changed to conform to 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 contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF, the Parties hereto have caused this 4 page amendment, to be executed by their
undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this OAA
contract as amended. This Amendment is effective on the last date the Amendment has been signed by both 0
Parties. »-•
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Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA,INC.
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SIGNED BY: . 4 ' � ✓ SIGNED BY: 2ID ✓Le. ..'�/ /j/2( t
NAME: STEVE Y. CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DA 1 h: October j1, 2Ol6 DA 1'h: /à/ 7//j„
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30 Approved as to form and Legality
Assistant County Anon
Packet Pg. 1624
Amendment.004 OAA 203,16.004 16.D.19.c
ATTACHMENT HI
FUNDING SUMMARY
Note: Title 2 CFR§200331,as revised,and Section 215 97(5),Florida Statutes,require that the information about federal programs
and State Proj ects be provided to the Recipient and are stated in The Financial And Compliance Audit Attachment And Exhibit 1.
Financial And Compliance Audit Attachment, Exhibit 2-Funding Summary Provides Information Regarding theFunding Sources
Applicable tothis contract,contained llrein,is aprediction of finding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD (FAIN#): 16AAFLT3SS, 16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC 2
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DUNS NUMBER: 076997790 FEDERAL AWARD DATE: OCTOBER 20,2015
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT w
Older Americans Act Title IIIB— co
CA/CM/SCAS $ 23,574.0
Transportation U.S. Health and Human Services 93.044 $ 19,500.0 Q
Support Services $ 316,722.0
Total IIIB $ 359,796.0 ••
OAA Title IIIC1 —Congregate Meals $ 293,000.0 N
Meals c
Sening U.S. Health and Human Services 93.045
ition Education
Outreach
Total IIIC1 4
$ 293,000.0
OAA Title III C2—Home Delivered
Meals $ 250,832.0
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Meals
Nutrition Education U.S. Health and Human Services 93.045
Screening o
Outreach $ 250,832.0 c
Total IIIC2 E
Older Americans Act Title III E
CA/CM& Services (Title III E) 93.052 $ 97,755.0 w
Supplement Services (Title III ES) U.S. Health and Human Services $ 18,335.0 Q
Grandparent Services (Title III EG) $ 6,620.0
Total IIIE $ 122,710.0
TOTAL FEDERAL AWARD $1,026,338.0
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
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Packet,Pg. 1625
Amendment.004 16.D.19.c;
OAA 203.16.004
FEDERAL FUNDS:
2 CFR Part 200Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards/
OMB Circular A-133—Audits of States,Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OI
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97,F.S.,Chapter 69I-5,FL Admin Code,Reference Guide for State Expenditures,Other fiscal requirements set forth in c
program laws,rules and regulations.
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16.D.19.c
Amendment.003
ATTACHMENT VII
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
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1. Title III B Support Services $ 359,796.00
2. Title III Cl Congregate Meals $ 293,000.00
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3. Title III C2 Home Delivered Meals $ 250,832.00 >-
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4. Title III E Services $ 122,710.00
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TOTAL $1,026,338.00
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Packet Pg. 1627
16.D.19.c
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Revised August 2007
Attestation Statement
Agreement/Contract Number: OAA 203.16
Amendment Number 004
I, Steve Y Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative) o
0
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) u
The only exception to this statement would be for changes in page formatting,due to the differences in
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electronic data processing media,which has no affect on the agreement/contract content.
October (5, 2016
Signature o Kecip t/Uontractor r-presentative Date
Approved as to form and legality
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Assistant County Atttime
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Revised August 2007
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Packet Pg. 1628
Amendment.003 OAA 203.16.003 16.D.19.d
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT PROGRAM TITLE III
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) and amends contract OAA 203.16.
The purpose of this amendment is increase allocations for Collier County by$6,000 carry-forward money, decrease
allocations by$11,000(-$11,500 transportation and+$500 OA3EG), revise#4 Contract Amount and revise 'o
ATTACHMENT III by showing the FAIN#'s for the Grant Award and the DUNS Number for the county as well as the x
new allocation, and ATTACHMENT VII and change language in ATTACHMENT I,MANNER OF SERVICE W
PROVISION, D Deliverables,2. Reports, a.Programmatic Operations/Administrative-(2)Annual review of service cost
reports; Service Cost Reports.
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4. Contract Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount c
not to exceed $1,024,338.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for
payment under any other contract or from any other source are not eligible for payment under this contract. a
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ATTACHMENT I "'
MANNER OF SERVICE PROVISION
D. Deliverables
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2. Reports
a. Programmatic Operations/Administration- The Contractor shall ensure the provision of services, as Q
outlined in this contract, are in accordance with the Agency and/or the Department of Elder Affairs o
Programs and Services Handbook through its review of reports as outlined below:
(1) Monthly review of subcontractors' surplus/deficit reports,and CIRTS data accuracy reports; °1
(2) Annual review of service cost reports: The Contractor shall respond to additional routine or specie
requests for information and reports required by the Agency in a timely manner as determined by th
Contract Manager. The Contractor shall establish reporting due dates for Subcontractors that permit th
Contractor to meet the Agency's reporting requirements.
Service Cost Reports
a.The Agency shall require the Contractor to submit Annual Service Cost Reports, which reflect actual
costs of providing each service by program. Service Cost Reports for all contracts are due by
February 15,2017 for the prior calendar year.
b.Unit Cost Methodology worksheets must be submitted by August 1 of each year, if a rate increase is
being requested for any contract in the next calendar year.
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Packet Pg. 1629
Amendment .003 OAA 203.16.003
16.D.19.d
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby
changed to conform to 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 contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF, the Parties hereto have caused this 5 page amendment, to be executed by their
undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this OAA a
contract as amended. This Amendment is effective on the last date the Amendment has been signed by both
Parties. u1
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Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMIVIISSIONERS FLORIDA,INC.
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SIGNED BY: Brio( b• C;)(-/#
SIGNED BY: (,.Qfj,( t.A,%L
NAME: S LEVE Y. CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO 0
DATE: October 16, 2016 DAIE: /d �7//4, O
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Federal Tax ID: 59-6000588 QQ
Fiscal Year Ending Date: 09/30 QD
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Approved as to form and legality Q
Assistant County A racy
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t5�'nt
Packet Pg. 1630
Amendment.003 OAA 203.16.003 16.D.19.d
ATTACHMENT III
FUNDING SUMMARY
Note: Title 2 CFR§200331,as revised,and Section 215.97(5),Florida Statutes,require that the information about federal programs
and State Projects be provided to the Recipient and are stated in The Financial And Compliance Audit Attachment And Exhibit 1.
Financial And Compliance Audit Attachment,Exhibit 2-Funding Summary Provides Information Regardingthe Funding Sources
Applicable tothis contract,contained lrein,isapredictionof€tndings3urcesand related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD (FAIN#): 16AAFLT3SS,16AAFLT3CM, 16AAFLT3HD, 16AAFLT3PH, 16AAFLT3FC
DUNS NUMBER: 076997790 FEDERAL AWARD DATE: OCTOBER 20,2015
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT x
Older Americans Act Title IIIB —
CA/CM/SCAS $ 23,574.0
Transportation U.S. Health and Human Services 93.044 $ 19,500.0 Q
Support Services $ 316,722.0
Total IIIB $ 359,796.0 ••
OAA Title IIIC1 —Congregate Meals $ 291,000.0
Meals
S�eening U.S. Health and Human Services 93.045
ition Education
Outreach
Total IIIC1 G
$ 291,000.0
OAA Title III C2 —Home Delivered
Meals $ 250,832.0 T-
Meals o
Nutrition Education U.S. Health and Human Services 93.045 Q
Screening p
Outreach $ 250,832.0 c
Total IIIC2
Older Americans Act Title III E
CA/CM& Services (Title III E) 93.052 $ 97,755.0
Supplement Services (Title III ES) U.S. Health and Human Services $ 18,335.0 e
Grandparent Services (Title III EG) $ 6,620.0
Total IIIE $ 122,710.0
TOTAL FEDERAL AWARD $1,024,338.0
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
3
Packet Pg 1631
Amendment .003 OAA 203.16.003 16.D.19.d
•
FEDERAL FUNDS:
2 CFR Part 200Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards/
OMB Circular A-133—Audits of States, Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO'11- l.RECIPIENT PURSUANT TO 1'HlS CONTRACT CONSIST OI
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
asaLyaNANsaad.AsaSTANCE,
Section 215.97,F.S.,Chapter 69I-5,FL Admin Code,Reference Guide for State Expenditures,Other fiscal requirements set forth in o
program laws,rules and regulations.
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Packet Pg. 1632
Amendment.003OAA: 16.1119.d
00-444
ATTACHMENT VII
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
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COLLIER COUNTY
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1. Title III B Support Services $ 359,796.00 >-
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2. Title III Cl Congregate Meals $ 291,000.00
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3. Title III C2 Home Delivered Meals $ 250,832.00
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4. Title III E Services $ 122,710.00
TOTAL $1,024,338.00
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Packet Pg. 1633
16D.19.d
Revised August 2007
Attestation Statement
Agreement/Contract Number: OAA 203.16
Amendment Number 003
I, Steve Y Carvell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
.N
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and x
w
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 O
electronic data processing media,which has no affect on the agreement/contract content.
1 v: October , 2016
✓
Signature of Ke pient/Uontractor representative l)ate
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Approved as to form and legality
m
Assistant County A rncy ,71
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Revised August 2007
(F.in)
Packet Pg. 1634
• 16.D.19.e:"
OAA.002 203.16.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT PROGRAM TITLE III
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) and amends contract OAA 203.16.
The purpose of this amendment is increase allocations by $6,147 for Collier County; change reimbursement percentage o c
OA3B Transportation; revise#4 Contract Amount and revise ATTACHMENT III and ATTACHMENT VII.
U
4. Contract Amount w
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not t
exceed$1,029,338.00 or the rate schedule, subject to the availability of funds. Any costs or services paid for payment unde
any other contract or from any other source are not eligible for payment under this contract.
O
This amendment shall be effective on May 18,2016. 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.
lrovisions not in conflict with this amendment are still in effect and are to be performed at the level specified is
L. agreement.
This amendment and all of its attachments are hereby made a part of this agreement. Q
IN WITNESS WHEREOF, the parties hereto have caused this 4 page amendment to be executed by their officials there unt c
duly authorized. NQ
0
COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
Contractor:
COUNTY COMMISSIONERS FLORIDA,INC.
,tp Q
SIGNED BY: 40t wP SIGNED BY:
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: June 10,2016 DATE: ‘,/L/)�
feral Tax ID: 59-6000588
al Year Ending Date: 09/30
1 Approved as to form and legality
Assistant County AttorneyIt ,.Fto
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- - Packet Pg. 1635
16D.19.e`
Amendment.002 OAA 203.16.002
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title IIIB–
CA/CM/SCAS $ 23,574.00
Transportation U.S. Health and Human Services 93.044 $ 31,000.00
Support Services $ 316,722.00
Total IIIB $ 371,296.00 c
0
$ 285,000.00 '_
OAA Title IIIC1 –Congregate Meals d
Meals w
ScreeningU.S. Health and Human Services 93.045 `-
Nutrition Education >-
Outreach Q
TotalIIICI $ 285,000.0( 0
OAA Title III C2–Home Delivered o
Meals $ 250,832.0(
Meals 5
Nutrition Education U.S. Health and Human Services 93.045 co—.
Screening
Outreach $ 250,832.0( E
Total IIIC2 N
Older Americans Act Title III E o
CA/CM& Services (Title III E) 93.052 $ 97,755.0( to
Supplement Services (Title III ES) U.S. Health and Human Services $ 18,335.0( o
Grandparent Services (Title III EG) $ 6,120.0( N
Total IIIE $ 122,210.01
TOTAL FEDERAL AWARD $1,029,338.0( c
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P.
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT g
TO THIS CONTRACT ARE AS FOLLOWS: Q
FEDERAL FUNDS:
2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-122—Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-110—Administrative Requirements)
OMB Circular A-133—Audit Requirements
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97,Fla. Stat.
2
Packet Pg. 1636
16.D.19,e
Amendment.002 CAA 203.16.002
ATTACHMENT VII
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
1. Title III B Support Services $ 371,296.00 'y
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2. Title III Cl Congregate Meals $ 285,000.00
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3. Title III C2 Home Delivered Meals $ 250,832.00 >-
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4. Title III E Services $ 122,210.00
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TOTAL $1,029,338.00
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Packet Pg. 1637
160 19.e
Amendment.002 OAA 203.16.002
ATTACHMENT VII
OLDER AMERICANS ACT RATE SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
IIIB
Services Total Cost Reimbursement Rate
Adult Day Care 12.83 11.55 0
Case Aide 33.89 30.50 c
Case Management 60.00 54.00 x
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Chore 23.33 21.00
Chore (Enhanced) 30.33 27.30
Companionship 23.33 21.00 Q
Emergency Alert Response 1.31 1.18 8
0
Escort 21.67 19.50 ••
Homemaker 21.50 19.35 v
Housing Improvement 100% Cost 90% of Cost c
Material Aid 100% Cost 90% of Cost E
Personal Care 25.67 23.10
Respite In-Facility 12.83 11.55
Respite In-Home 25.67 23.10 E
Screening and Assessment 60.00 54.00 0
Shopping Assistance 21.00 18.90 0.
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Skilled Nursing Services 42.00 37.80 �;
Specialized Medical Equipment, Services, and 100% Cost 90% of Cost co
Supplies
Transportation 100% Cost 100% of Cost 0
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Packet Pg. 1638
16D.19.e
Revised August 2007
Attestation Statement
Agreement/Contract Number: OAA 203.16
Amendment Number 002
I, Stephen Y Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative) '(7)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and m
Public Services Department Head u.
(Recipient/Contractor name)
O
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. c
,
--. ti' $ 1` June 10, 2016
75
Signature of Recip nt/Contractor representative Date
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Approved as to form and legality
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Assistant County Attorney` GOA
Revised August 2007
Packet Pg. 1639
Amendment .001 OAA 2 16.D.19.f
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT PROGRAM TITLE III
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) and amends contract OAA 203.16.
The purpose of this amendment is remove some sections that do not pertain to this contract regarding subcontracts/vendo
and revise ATTACHMENT VII Rate Summary by adding additional services to OA3ES. ch
1. Under H MANNER OF SERVICE PROVISION: A. Service Tasks: 4. Monitoring the Performance of i
Subcontracts: W
Item b. Subcontractor Outreach Reporting Requirements should be deleted as it does not apply to vendors;
e_
2. Under H MANNER OF SERVICE PROVISION: A. Service Tasks: 5. Grievance and Complial <
Procedures: 0
Item b. Legal Provider Grievance Procedures should be deleted as it does not apply to vendors; ••
3. Under II MANNER OF SERVICE PROVISION: B. Staffing Requirements: 3. Subcontractors—Use (
Subcontractors: d. "The Contractor shall require subcontractors to enter....." should be deleted as it does not app c
to vendors;
4. Under H MANNER OF SERVICE PROVISION: B. Staffing Requirements: 3. Subcontractors—Use
Subcontractors: e. "The Contractor shall require subcontractors to run monthly CIRTS....." should be deleted as <
does not apply to vendors;
5. Under II MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: a. Programmat
Operations/Administration should be deleted as it does not apply to vendors. N
6. Under II MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: c. Surplus/Deficit Repor O
(1) A list of all subcontractors and their current status regarding surplus/deficit; should be deleted as it does not app
to vendors;
7. Under H MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: c. Surplus/Deficit Repor
(5)Number of clients currently on APCL that receive a priority ranking score of 4 or 5; should be deleted as it does n
apply to vendors;
8. Under II MANNER OF SERVICE PROVISION: D. Deliverables: 2. Reports: c. Surplus/Deficit Repor
(6) Number of clients currently on the APCL designated as Imminent Risk; should be deleted as it does not apply
vendors;
9. Revise ATTACHMENT VII Rate Summary by adding Material Aid, Chore, and Enhanced Chore to the service
listed under OA3ES.
1
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Packet Pg. 1640
Amendment.001 OAA 2 16.D.19.f
COLLIER COUNTY
IIIE,HIES,&IIIEG
rte.
Services Total Cost Reimbursement Rate
IIIE— Adult Day Care _ $ 12.83 $ 11.55
Direct Pay Respite $ 16.67 $ 15.00
Respite In-Facility $ 12.83 $ 11.55
Respite In-Home $25.67 $23.10
Screening&Assessment $ 60.00 $ 54.00
IIIES— Chore $ 23.33 $ 21.00
Enhanced Chore $ 30.33 $ 27.30
Specialized Medical Equipment, Service& 100%Cost 90%of Cost
Supplies
Material Aid 100% Cost 90% of Cost
IIIEG- Child Day Care $ 16.67 $ 15.00
Screening/Assessment $ 60.00 $ 54.00
a)
This amendment shall be effective on January 31, 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. >-
u_
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified i
the agreement. o
This amendment and all of its attachments are hereby made a part of this agreement.
Sd
1 ITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there unt c
duty authorized.
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Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST cc
COUNTY COMMISSIONERS FLORIDA,INC. o
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SIGNED BY: To'' v , , SIGNED BY: y .Gtit w�- /� C�.�L<3;.L O
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NAME: Stephen Y. Carnell NAME: MARIANNE G LORINI
TITLE: Public Services Department Head TITLE: PRESIDENT/CEO
DATE: February 5, 2016 DATE: 02/1.2//4
Federal Tax ID: 59-60005 88
Fiscal Year Ending Date: 09/30
Approved as to form and legali+.
2 istant Co ttorn! 2 J 3 I)Co
Packet Pg. 1641
16.D.19.f
Re'ised August 2007
Attestation Statement
Agreement/Contract Number: OAA 203.16
Amendment Number 001
I, Stephen Y Carvell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
O
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
W
Public Services Department Head Co
(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. 0
4
7„,/' February 5, 2016 9s-�
Signa o Rebfpient/Contractor representative Date
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Approrced as to form and legality o
Assistant County Atto t'7.•
Revised August 2007
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Packet Pg. 1642
-(l.'anuary 2016—December 2016 OAA 20 16.D.19.g
I
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA,INC. CONTRACT
OLDER AMERICANS ACT TITLE III
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency)
and Collier County Board of County Commissioners (Contractor), and collectively referred to as the"Parties." The
term Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient.
WITNESSETH THAT:
WHEREAS,the Agency has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform
such services as an independent Contractor of the Agency.
NOW THEREFORE,in consideration of the services to be performed and payments to be made,together with the
mutual covenants and conditions hereinafter set forth,the Parties agree as follows:
1. purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this
contract including all attachments, forms, exhibits and references incorporated, which constitute the contract >-
document.
0
2. Jncorporation of Documents within the Contract c
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Agency
and or Department handbooks, manuals or desk books and Master Contract number HM014, as an integral
part of the contract, except to the extent that the contract explicitly provides to the contrary. In the event of
conflict in language among any of the documents referenced above, the specific provisions and
requirements of the contract document(s)shall prevail over inconsistent provisions in the proposal(s)or other
general materials not specific to this contract document and identified attachments. u
Lu
3. Term of Contract
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time January 1, 2016 or on the date the
contract has been signed by the last party required to sign it,whichever is later. It shall end at eleven fifty-nine
(11:59)P.M., Eastern Standard Time December 31,2016.
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4. Cpntract Amount Q
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed 51.021191.00, 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.
V
5. Renewals
By mutual agreement of the Parties, in accordance with s. 287.058(1)(g), F.S., the Agency may renew the
contract for a period not to exceed three years, or the term of the original contract, whichever is longer. The
renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other
costs for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original
contract and contingent upon satisfactory performance evaluations by the Agency and the availability of
funds.
1
Packet Pg. 1643
,� 16.D.19.g
January 2016—December 2016 OAA 203.lo
6. Official Payee and Representatives(Names,Addresses,and Telephone Numbers):
The Contractor name,as shown on page 1 of this Collier County Board of County Commissioners
3339 E Tamiami Trail, Building H
a. contract,and mailing address of the official payee to Naples,FL 34112
whom the payment shall be made is:
Kimberley Grant, Director
The name of the contact person and street address where Collier County Board of County Commissioners
b. financial and administrative records are maintained is: %Community and Human Services
3339 E Tamiami Trail,Building H
Naples,FL 34112
The name, address,and telephone number of the Kimberley Grant, Director
C. Collier County Board of County Commissioners
representative of the Contractor responsible for %Community and Human Services
administration of the program under this contract is: 3339 E Tamiami Trail,Building H
Naples, FL 34112
(7391 257-7.273
The section and location within the Agency where Area Agency on Aging for Southwest Florida, Inc.
d. Requests for Payment and Receipt and Expenditure 15201 North Cleveland Avenue, Suite 1100
forms are to be mailed is: North Fort Myers, FL 33903
Tammy Rhoades,Vice President of Finance
e. The name, address,and telephone number of the Area Agency on Aging for Southwest Florida,Inc. LL
Contract Manager for this contract is: 15201 North Cleveland Avenue, Suite 1100
North Fort Myers,FL 33903 0
(239)652-6900 ••
Upon change of representatives(names, addresses,telephone numbers)by either party,notice shall be provided in N
writing to the other party and the notification attached to the originals of this contract.
a)
y
7. All Terms and Conditions Included:
This contract and its Attachments, I, II, III, IV, VII, VIII, IX, & X and any exhibits referenced in said u,
attachments, together with any documents incorporated by reference, contain all the terms and conditions
agreed upon by the Parties. There are no provisions,terms,conditions,or obligations other than those contained
herein, and this contract shall supersede all previous communications, representations or agreements, either
written or verbal between the Parties. U
By signing this contract,the Parties agree that they have read and agree to the entire contract.
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IN WITNESS THEREOF, the Parties hereto have caused this contract to be executed by their undersigned
officials as duly authorized. 0
CONTRACTOR: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR a'
COUNTY CO SIONERS SOUTHWEST FLORIDA,INC.
SIGNED BY: � �, - C. C ' SIGNED BY:
U t/
NAME: Stephen Y,Carnell NAME: MARIANNE G LORINI
TITLE: Public Services Department Head TITLE: PRESIDENT/CEO
DATE: January 8. 2016 DATE: 02/aliCo
Federal Tax ID: 59-6000588 Approved as to form and legality
Fiscal Year Ending Date: 9/30 CA
2
Assistant County Attorney
k yl\l Co
Packet Pg. 1644
16.D.19.g
January 2016—December 2016 OAA 203.1
61i
ATTACHMENT I
STATEMENT OF WORK 4
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING--Certification for Contracts Grants, Loans and Cooperative
Agreements 19
ATTACHMENT III
FEDERAL RESOURCES A WARD 20
ATTACHMENT IV
Certification Regarding Debarment, Suspension. Ineligibility and Voluntary Exclusion Contracts/
Subcontracts21
0
ATTACHMENT VII o
BUDGET AND RATE SUMMARY 22 a
ATTACHMENT VIII w
INVOICE SCHEDULE 25 co
ATTACHMENT IX uu..
REQUEST FOR PAYMENT-106A 26 1
ATTACHMENT X o
RECEIPTS AND EXPENDITURE REPORT—Exhibit 1-1O5as-IIIB 27 0
ATTACHMENT X 0
csi
RECEIPTS AND EXPENDITURE REPORT—Exhibit 2-105as-IIIC] 28
ATTACHMENT X cs
RECEIPTS AND EXPENDITURE REPORT—Exhibit 3-105as-IIIC2 29 d
fTACHMENT X w
RECEIPTS AND EXPENDITURE REPORT—Exhibit 4-105as-IIIE 30 15
ATTACHMENT X y
RECEIPTS AND EXPENDITURE REPORT—Exhibit 5-HIB Unit Cost Report 31
ATTACHMENT X to
RECEIPTS AND EXPENDITURE REPORT—Exhibit 6—IIIC1 Unit Cost Report .............................. 32 M
ATTACHMENT X 0N
RECEIPTS AND EXPENDITURE REPORT—Exhibit 7—IIIC2 Unit Cost Report 33 Q
ATTACHMENT X 0
RECEIPTS AND EXPENDITURE REPORT—Exhibit 8—IIIE Unit Cost Report 34 a
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Packet Pg. 1645
'January 2016—December 2016 ()AA 20 16.D.19.g
ATTACHMENT I
STATEMENT OF WORK
I. SERVICES TO BE PROVIDED
A. Definitions of Terms
1. Contract Acronyms
Area Agency on Aging(AAA)
Activities of Daily Living(ADL)
Alliance of Information&Referral Systems(AIRS)
Assessed Priority Consumer List(APCL)
Adult Protective Services(APS)
Client Information and Registration Tracking System(CIRTS)
Information and Referral(I&R)
Instrumental Activities of Daily Living(IADL)
National Council on Aging(NCOA)
Older Americans Act(OAA) >-
Planning and Service Area(PSA)
2. Program Specific Terms p
Area Plan: A plan developed by the AAA outlining a comprehensive and coordinated service delivery o
system in its PSA in accordance with Section 306 (42 U.S.C. 3026) of the OAA and Agency N
instructions.
Area Plan Update: A revision to the Area Plan wherein the AAA enters OAA specific data in CIRTS.
An update may also include other revisions to the Area Plan as instructed by the Agency.
Child: An individual who is not more than eighteen(18)years of age or an individual with disability.
Criteria: A standard which the Administration on Aging/Administration for Community Living set c
for the Title III D Program. AoA/ACL's standard criterion consists of three tiers: Minimal Criteria, o
Intermediate Criteria, and Highest Level Criteria.
Family Caregiver: An adult family member, or another individual,who is an informal provider of in- N
home and community care to an older individual.
0
Frail: When an older individual is unable to perform at least two ADLs without substantial human
assistance, including verbal reminding, physical cueing or supervision; or due to cognitive or other
mental impairment, requires substantial supervision because the individual behaves in a manner that
poses a serious health or safety hazard to the individual or to another individual.
Grandparent: A grandparent or step-grandparent of a child, or a relative of a child by blood,marriage
or adoption and who lives with the child; is the primary caregiver of the child because the biological or
adoptive parents are unable or unwilling to serve as the primary caregiver of the child; and has a legal
relationship to the child, such as legal custody or guardianship, or is raising the child informally.
4
Packet Pg. 1646
January 2016—December 2016 OAA 2 16.D.19.g
B. General Description
1. General Statement
The OAA Program is a federal program initiative that provides assistance to older persons and
caregivers and is the only federal supportive services program directed solely toward improving the
lives of older people. The OAA Program provides a framework for a partnership among the different
levels of government and the public and private sectors with a common objective, improving the quality of
life for all older individuals by helping them to remain independent and productive. The primary
purpose of the OAA Program is to foster the development and implementation of comprehensive and
coordinated systems to serve older individuals. The OAA Program uses these systems to assist older
individuals to attain and maintain maximum independence and dignity in a home environment and
allows for the capability of self-care with appropriate supportive services.
2. Authority
All applicable federal laws, regulations, action transmittals, program instructions, review guides and
similar documentation related to the following:
0
Catalog of Federal Domestic Assistance No.93.043,93.044, 93.045, and 93.052
Older Americans Act of 1965, as amended;
Rule 58A-1, Florida Administrative Code(FAC); and w
co
Section 430.101,Florida Statutes(F.S.).
>-
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3. Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of the OAA o
Title IIIB, Title IIIC1, Title IIIC2, and Title IIIE Programs within its designated PSA. This Scope of c
Service includes planning, coordinating and assessing the needs of older persons, and assuring the q.
availability and quality of services. The services shall be provided in a manner consistent with, and `..
described in, both the current Agency's Area Plan Update and the current Florida Department of Elder a
Affairs Programs and Services Handbook. z
4. Major Program Goals
The major goals of the OAA Program are to improve the quality of life for older individuals,preserve
their independence and prevent or delay more costly institutional care. These goals are achieved
through the implementation of a comprehensive and coordinated service system that provides a v
continuum of service alternatives that meet the diverse needs of elders and their caregivers.
M
C. Clients to be Served QN
1. General Statement o
Preference shall be given to those with the greatest economic and social need,with particular attention c
to low-income older individuals, including those that are low-income minorities,have limited English a'
proficiency, and older individuals residing in rural areas. c
a. OAA Title III,General
Consumers shall not be dually enrolled in an OAA Program and a Medicaid capitated Long-Term
Care Program,with the exception of consumers in need of OAA Legal Assistance services and
OAA Congregate Nutrition Services, including transportation to and from congregate meal sites.
b. OAA Title HIB,Supportive Services
(1) Individuals must be age sixty(60)or older; and
(2) Information and Referral/Assistance services are provided to individuals regardless of age.
5 CAO
Packet Pg. 1647
January 2016—December 2016 OAA 2 16.D.19.g
c. OAA Titles IHC1 and IIIC2,Nutrition Services,General
General factors that shall be considered in establishing priority for nutrition services, include those
older persons who meet the following:
(1) Cannot afford to eat adequately;
(2) Lack the skills or knowledge to select and prepare nourishing and well-balanced meals;
(3) Have limited mobility which may impair their capacity to shop and cook for themselves; or
(4) Have a disabling illness or physical condition requiring nutritional support or have been
screened at a high nutritional risk.
d. OAA Title IIIC1,Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in Section
I.C.1.c, above, individuals must be mobile, not homebound, and physically, mentally, and medically
able to attend a congregate nutrition program. Individuals eligible to receive congregate meals
include the following:
y
(1) Individuals age sixty(60)or older;
(2) Any spouse(regardless of age)who attends the dining center with his/her eligible spouse;
0
(3) Persons with a disability, regardless of age, who reside in a housing facility occupied
primarily by older individuals where congregate nutrition services are provided; u-
(4) Disabled persons who reside at home with and accompany an eligible person to the dining
center; and 0
(5) Volunteers,regardless of age,who provide essential services on a regular basis during meal
hours.
e. OAA Title IIIC2,Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements as listed in Section
I.C.1.c, individuals must be homebound and physically, mentally, or medically unable to attend a w
congregate nutrition program. Individuals eligible to receive home delivered meals include the
following:
v I
(1) Individuals age sixty (60) or older who are homebound by reason of illness, disability or co
isolation; M;
0
(2) The spouse of a homebound eligible individual, regardless of age, if the provision of the
collateral meal supports maintaining the person at home;
(3) Individuals with disabilities,regardless of age, who reside at home with eligible individuals
and are dependent on them for care;and
(4) Persons at nutritional risk who have physical, emotional or behavioral conditions, which 2
would make their presence at the congregate site inappropriate; and persons at nutritional
risk who are socially or otherwise isolated and unable to attend a congregate nutrition site.
f. OAA Title HIE,Caregiver Support Services
Eligibility for OAA Title HIE, Caregiver Support Services, are as follows:
(1) Family caregivers of individuals age sixty(60)or older;
(2) Grandparents [age fifty five (55) or older] or older individuals [age fifty five (55) or older]
who are relative caregivers;
(3) Priority will be given to family caregivers who provide care for individuals with Alzheimer's
disease and related disorders with neurological and organic brain dysfunction and for
6
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grandparents or older individuals who are relative caregivers who provide care for children
with severe disabilities; and
(4) For respite and supplemental services,a family caregiver must be providing care for an older
individual who meets the definition of the term"frail"as defined in this contract, I.A.2.
II. MANNER OF SERVICE PROVISION
A. Service Tasks
In order to achieve the goals and objectives of the OAA Program,the Contractor shall ensure the following
Service Tasks are performed at the level specified in this contract.
1. Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to
become a client is based on meeting the requirements described in this Contract.
2. Targeting and Screening of Service Delivery for New Clients
The Contractor shall develop and implement policies and procedures consistent with OAA targeting
and screening criteria. w
3. Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of Lt
elders and their caregivers. The Contractor shall ensure the performance and report performance of the
following services are in accordance with the current Florida Department of Elder Affairs Programs 0
and Services Handbook. The services funded pursuant to this contract are in accordance with the OAA,
Title HI, Sections 321, 331,336, and 373 as follows: N
Section 321, Title IIIB Supportive Services; o
Section 331,Title IIIC1 Congregate Nutrition Services;
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Section 336,Title IIIC2 Home Delivered Nutrition Services; Lu
Section 373,Title ME Caregiver Support Services; andcu
a. Supportive Services (MR Program) - Supportive services include a variety of community-based o
and home-delivered services that support the quality of life for older individuals by helping them o
remain independent and productive. Services include the following: c.6
(1) Adult Day Care/Adult Day Health Care; (17) Recreation;
(2) Caregiver Training/Support; (18) Emergency Alert Response;
(3) Case Aid/Case Management; (19) Escort; 0
(4) Chore Services; (20) Health Support;
(5) Companionship; (21) Home Health Aid;
(6) Counseling (Gerontological and Mental Health); (22) Homemaker;
(7) Education/Training; (23) Housing Improvement;
(8) Legal Assistance; (24) Information;
(9) Material Aid; (25) Intake;
(10 Occupational Therapy; (26) Interpreter/Translating;
(11 Outreach; (27) Referral/Assistance;
(12 Personal Care; (28) Respite Services;
(13 Physical Therapy; (29) Screening/Assessment;
(14 Shopping Assistance; (30) Speech Therapy;
(15 Skilled Nursing; (31) Telephone Reassurance; and
(16 Specialized Medical Equipment, Services, &Supplies (32) Transportation
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b. Congregate Nutrition Services(IIIC1 Program)
Nutrition Services are provided in congregate settings and are designed to reduce hunger and food
insecurity, promote socialization and the health and well-being of older individuals by assisting
them to gain access to nutrition and other disease prevention and health promotion services.
Services include the following:
(1) Congregate meals
(2) Congregate meals screening;
(3) Nutrition education and nutrition counseling; and
(4) Outreach.
c. Home Delivered Nutrition Services(IIIC2 Program)
In-home nutrition services are provided to reduce hunger and food insecurity;promote socialization
and the health and well-being of older individuals by assisting such individuals to gain access to c
nutrition and other disease prevention and health promotion services. Services include the .y°
following:
(1) Home delivered meals; W
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(2) Nutrition education and counseling;
(3) Outreach; and W
(4) Screening/Assessment. o
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d. Caregiver Support Services (HIE Program)
The following services are intended to provide direct help to caregivers,assist in the areas of health, .a
nutrition and financial literacy, and assist caregivers in making decisions and problem solving d
related to their caregiving roles and responsibilities:
(1) Adult Day Care/Adult Day Health Care;
(2) Caregiver Training/Support;
(3) Counseling(Gerontological and Mental Health);
(4) Education/Training;
(5) Financial Risk Reduction (Assessment and Maintenance); N
(6) Information;
(7) Intake; 0
(8) Outreach; E
(9) Powerful Tools for Caregivers;
(10) Referral/Assistance; w
(11) Respite Services;
(12) Screening/Assessment;
(13) Stress-Busting Program for Family Caregivers; and Transportation
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(i) Caregiver Support Supplemental Services(111LS Program)
At least ten (10) percent, but no more than twenty (20) percent, of the total Title IIIF
funds shall be used to provide supplemental support services. The following services are
provided to complement the care provided by caregivers:
(1) Chore Services;
(2) Housing Improvement;
(3) Legal Assistance;
(4) Material Aid; and
(5) Specialized Medical Equipment, Services and Supplies.
(ii) Caregiver Support Grandparent Services(IIIEG Program)
At least five(5)percent, but no more than ten (10) percent, of the total Title HIE funds
shall be used to provide support services to grandparents and older individuals who are
relative caregivers. Services for grandparents or older individuals who are relative
caregivers designed to help meet their caregiving obligations include the following:
(1) Caregiver Training/Support;
(2) Child Day Care; Li-
(3) Counseling(Gerontological and Mental Health);
(4) Education/training; p
(5) Legal Assistance;
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(6) Outreach;
(7) Referral/Assistance; a.)
(8) Screening/Assessment;
(9) Sitter; and
(10) Transportation. x
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4. Monitoring the Performance of its Subcontractors
a. The Contractor shall monitor at least once per year each of its subcontractors, o
subrecipients, vendors, and/or consultants paid from funds provided under this o
contract. The Contractor shall perform fiscal, administrative and programmatic
monitoring to ensure contractual compliance, fiscal accountability, programmatic
performance and compliance with applicable state and federal laws and regulations.
The Contractor shall monitor to ensure that time schedules are met, the budget and
scope of work are accomplished within the specified time periods and other 0
performance goals stated in this contract are achieved.
b. Subcontractor Outreach Reporting Requirements—The Contractor shall document
its oversight of subcontractor performance of outreach activities, by establishing a
uniform reporting format that includes the following: number and type of provider
events or activities; date and location; total number of participants at each event or
activity; individual service needs identified; and referral sources or information
provided. The Contractor shall require subcontractors to use this format for reporting
on outreach activities at least semi-annually.
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5. Grievance and Complaint Procedures
Grievance Procedures
The Contractor shall comply with and ensure subcontractor compliance with the Minimum Guidelines
for Recipient Grievance Procedures,Appendix D,Department of Elder Affairs Programs and Services
Handbook, to address complaints regarding the termination, suspension or reduction of services, as
required for receipt of funds.
a. Complaint Procedures
The Contractor shall develop and implement complaint procedures and ensure that subcontractors
develop and implement complaint procedures to process and resolve client dissatisfaction with
services. Complaint procedures shall address the quality and timeliness of services, provider and
direct service worker complaints, or any other advice related to complaints other than termination,
suspension or reduction in services that require the grievance process as described in Appendix D,
Department of Elder Affairs Programs and Services Handbook. The complaint procedures shall 2
include notification to all clients of the complaint procedure and include tracking the date, nature
of complaint, and the determination of each complaint.
a)
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b. Legal Provider Grievance Procedures
The Contracts shall ensure that legal providers have an internal grievance procedure that addresses u.
both denial of service and complaints by clients about manner or quality of legal
assistance. Grievance policies that comport with requirements of the Legal Services Corporation O
are sufficient to meet this standard.At a minimum,the procedure must provide applicants with:
(1) Adequate notice of the grievance procedures;
(2) Information on how to file a grievance or complaint, and; a)
(3) An opportunity for review of the complaint by the Legal Provider's Executive Director or
the Executive Director's designee. u.
(4) The Contractor may not serve in an appellate capacity or otherwise interfere in the grievance
review process for legal providers. However,the Contractor may request that legal providers
maintain a file of complaints and statements of disposition of complaints,with redacted client
identifying information, for examination by the Contractor during monitoring.
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B. Staffing Requirements `V
1. Staffing Levels—The Contractor shall dedicate the staff necessary as required to meet the obligations
of the contract. O"
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2. Professional Qualifications—The Contractor shall ensure that the staff responsible for performing this
contract have the qualifications as specified in the DOEA Programs and Services Handbook.
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Unit of
Services Service
.-o Adult Day Care/Adult Day Health Care Home Health Aide
Caregiver Training/Support Homemaker
Case Aid/Case Management Housing Improvement Hour
Child Day Care Legal Assistance
Chore Services Nutrition Counseling
Companionship Skilled Nursing Services
Congregate Meals Screening
Emergency Alert Response Day
Specialized Medical Equipment, Services and Material Aid
Supplies Episode
Escort One-Way
Shopping Assistance Trip
Transportation
Congregate and Home Delivered Meals Meal
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2. Reports
The Contractor shall respond to additional routine and/or special requests for information and reports LL
required by the Agency in a timely manner as specified by the Agency. The Contractor shall .Q
establish due dates for any subcontractors that permit the Contractor to meet the Agency's reporting o
requirements.
a. Programmatic Operations/Administration- The Contractor shall ensure the provision of
services, as outlined in this contract, are in accordance with the Agency and/or the Department of
Elder Affairs Programs and Services Handbook through its review of reports as outlined below:
a)
(1) Monthly review of subcontractors' surplus/deficit reports,and CIRTS data accuracy reports; 11.1
(2) Annual review of service cost reports;
b. Client Information and Registration Tracking System (CIRTS) Reports- Contractor shall input
OAA-specific data into CIRTS to ensure CIRTS data accuracy. Contractor shall use CIRTS-
generated reports which include the following:
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(1) Client Reports;
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(2) Monitoring Reports;
(3) Services Reports; as
(4) Miscellaneous Reports;
(5) Fiscal Reports;
(6) Aging Resource Center Reports; and
(7) Outcome Measurement Reports.
c. Surplus/Deficit Report - The Contractor shall submit a Consolidated Surplus/Deficit Report, in a
format provided by the Agency to the Contract Manager, by the 18th of each month. This
Consolidated Surplus/Deficit Report is for all agreements and/or contracts between the
Contractor and the Agency and must include the following:
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(1) A list of all subcontractors and their current status regarding surplus/deficit;
(2) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold
specified by the Agency will be resolved;
(3) Recommendations to transfer funds to resolve surplus/deficit spending;
(4) Input from the Contractor's Board of Directors on resolution of spending issues, if applicable;
(5) Number of clients currently on APCL that receive a priority ranking score of 4 or 5; and
(6) Number of clients currently on the APCL designated as Imminent Risk.
(7) Information provided in the Monthly Programmatic Report must match CIRTS data and the
Request for Payment.
(8) The Contractor shall review program documentation to ensure documentation is complete and
adequately supports the information reported on the Monthly Programmatic Report prior to
submitting a Request for Payment. The Contractor will attest to the review in the "comments"
section of the Monthly Programmatic Report, and provide relevant information regarding the
documentation as needed. c
d. Program Highlights - The Contractor shall submit Program Highlights referencing specific events
that occurred in FFY 2015 by August 30, 2016. The Contractor shall provide a new success story, w
quote, testimonial, or human-interest vignette. The highlights shall be written for a general ca
audience,with no acronyms or technical terms.For all agencies or organizations that are referenced in
the highlight, the Contractor shall provide a brief description of their mission or role. The active u_
tense shall be consistently used in the highlight narrative, in order to identify the specific individual or
entity that performed the activity described in the highlight. The Contractor shall review and edit 0
Program Highlights for clarity, readability, relevance, specificity, human interest, and grammar, o0
prior to submitting them to the Agency. N
e. Invoices - The Contractor shall submit complete and accurate monthly invoices as referenced in
Section III,Method of Payment.
3. Records and Documentation
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a. The Contractor shall maintain documentation to support Requests for Payment that shall be
available to the Agency or authorized individuals, such as Department of Financial Services, upon c�
request. co
b. CIRTS Data and Maintenance `"
The Contractor shall ensure collection and maintenance of client and service information on a
monthly basis from CIRTS or any such system designated by the Agency. Maintenance
includes valid exports and backups of all data and systems according to Agency standards.
c. Data Integrity and Back up Procedures
Each Contractor shall anticipate and prepare for the loss of information processing capabilities. The Q
routine backing up of all data and software is required to recover from losses or outages of the
computer system. Data and software essential to the continued operation of contractor functions
must be backed up. The security controls over the backup resources shall be as stringent as the
protection required of the primary resources. It is recommended that a copy of the backed up data
be stored in a secure, offsite location.
d. Policies and Procedures for Records and Documentation
The Contractor shall maintain written policies and procedures for computer system backup and
recovery and shall have the same requirement of its subcontractors. These policies and procedures
shall be made available to the Agency upon request.
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January 2016—December 2016 OAA 203 16.D.19.g
E. Performance Specifications
1. Outcomes and Outputs(Performance Measures)—At a minimum,the Contractor must:
a. The Contractor shall ensure the provision of the services described in this contract are in accordance
with the current Florida Department of Elder Affairs Programs and Services Handbook and the
Service Tasks described in Section ILA.
b. The Contractor shall timely submit to the Agency all documentation and reports described in
ATTACHMENT I, Section II.D.
c. The Contractor shall develop and document strategies in the Agency's Area Plan to support the
Department's standard of performance achievement (as referenced on the Department website
http://floridafiscalportal.state.fl.us/PDFDoc.aspx?ID=9126) including increases for the following:
y
(1) Percent of most frail elders who remain at home or in the community instead of going into a x
nursing home; w
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(2) Percent of APS referrals who are in need of immediate services to prevent further harm who
are served within 72 hours;
(3) Percentage of active clients eating two or more meals per day;
(4) Percent of new service recipients whose ADL assessment score has been maintained or 9
improved;
(5) Percent of new service recipients whose IADL assessment score has been maintained or
improved; d
(6) After service intervention, the percentage of caregivers who self-report being very confident
about their ability to continue to provide care; and
(7) Percent of customers who are at imminent risk of nursing home placement who are served with
community based services.
d. The Contractor's performance of these measures will be reviewed and documented in the U
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Agency's Annual Programmatic Monitoring Reports.
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2. Monitoring and Evaluation Methodology
The Agency will review and evaluate the performance of the Contractor under the terms of this p
contract. Monitoring shall be conducted through direct contact with the Contractor through telephone,
in writing, or an on-site visit. The Agency's determination of acceptable performance shall be a:
conclusive. The Contractor agrees to cooperate with the Agency in monitoring the progress of 2
completion of the service tasks and deliverables. The Agency may use, but is not limited to, one
or more of the following methods for monitoring:
a. Desk reviews and analytical reviews;
b. Scheduled, unscheduled, and follow-up on-site visits;
c. Client visits;
d. Review of independent auditor's reports;
e. Review of third-party documents and/or evaluation;
f. Review of progress reports;
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g. Review of customer satisfaction surveys;
h. Agreed-upon procedures review by an external auditor or consultant;
i. Limited-scope reviews; and
j. Other procedures as deemed necessary.
3. Performance Definitions
"Work day" shall mean a provider's staff member's eight (8) hour work period, unless specifically
noted otherwise"Day" shall mean a calendar day, unless specifically noted otherwise.
F. Contractor Responsibilities
1. Contractor Unique Activities
All service tasks and deliverables pursuant to this contract are solely and exclusively the responsibility
of the Contractor, and for which, by execution of the contract, the Contractor agrees to be held o
accountable; and v,
2. Coordination with Other Providers and/or Entities
Notwithstanding that services for which the Contractor is held accountable involve coordination with ca
other entities in performing the requirements of the contract; the failure of other entities does not
alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to w
perform pursuant to this contract. 0
G. Agency Responsibilities
1. Agency Obligations - The Agency will provide technical support to assist the Contractor in meeting -a
the requirements of this contract. °'
2. Agency Determinations - The Agency reserves the exclusive right to make certain determinations u,
in the tasks and approaches. The absence of the Agency setting forth a specific reservation of rights
does not mean that all other areas of the contract are subject to mutual agreement. c°
III.METHOD OF PAYMENT v
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A. Payment Method Used - The Method of Payment for this contract is a combination of fixed-fee/unit rate,
cost reimbursement,and advance payments,subject to the availability of funds and Contractor performance.
The Agency will pay the Contractor upon satisfactory completion of the Tasks/Deliverables, as p
specified in Section II, Manner of Service Provision, and in accordance with other terms and conditions of
the contract. E
1. Fixed Fee/Unit Rate — Payments for Fixed Fee/Unit Rate shall not exceed amounts established in .U�.
ATTACHMENT VII Budget and Rate Summary. Q
2. Cost Reimbursement —The Contractor agrees to distribute funds as detailed in contract and the
Budget and Rate Summary, ATTACHMENT VII, to this contract. Any changes in the total
amounts of the funds identified on the Budget Summary form require a contract amendment.
Payment may be authorized only for allowable expenditures, which are in accordance with the
limits specified in ATTACHMENT VII. All Cost Reimbursement Requests for Payment must
include the actual Expenditure Reports beginning with the first month of the contract.
15
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January 2016—December 2016 OAA 203 16.D.19.g
B. Advance Payments - The Contractor may request up to two (2) months of advances at the start of the
contract period to cover program administrative and service costs. The payment of an advance will be
contingent upon the sufficiency and the amount of funds released to the Department of the State of Florida
("budget release"). The Contractor's requests for advance require the approval of the Agency's
Contract Manager. The Contractor shall provide the Agency Contract Manager documentation justifying
the need for an advance and describing how the funds will be distributed. If sufficient budget is available,
the Agency will issue approved advanced payments after January 1st of the contract year.
1. Any advanced payments the Contractor requested for subcontractors must be distributed within seven
days of receipt of payment from the Agency. The Contractor shall submit to the Agency
documentation to support full distribution of advanced funds with report number 5, due to the
Agency on March 15, 2016, in accordance with the Invoice Schedule, ATTACHMENT VIII to this
contract.
2. All advance payments made to the Contractor shall be reimbursed to the Agency as follows: one—tenth
of the advance payment received shall be reported as an advance recoupment on each Request for
Payment, starting with report number five, in accordance with the Invoice Schedule,ATTACHMENT
VIII to this contract.
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3. Interest earned on advances must be identified separately by source of funds, state or federal.
Contractors shall maintain advances of federal funds in FDIC interest bearing accounts unless otherwise u-
exception is made in accordance with 45 CFR 74.22(k). Earned interest must be returned to the
Agency at the end of each quarter of the contract period. 0
C. Final Invoice Instructions-The Contractor shall submit the final Request for Payment to the Agency no N
later than February 15,2017.
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D. Method of Invoice Payment _
Payment shall be made upon the Contractor's presentation of an invoice subsequent to the acceptance and w
approval by the Agency of the deliverables shown on the invoice. The form and substance of each
invoice submitted by the Contractor shall be as follows:
1. Have a Remittance Address — this must correspond exactly to the "Remit To" address provided to c.>
MFMP during registration;
2. Request payment for services as established in ATTACHMENT VII Budget and Rate Summary of
the contract; o
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3. The Contractor shall consolidate all Request for Payment from subcontractors and Expenditure Reports
that support requests for payment and shall submit to the Agency using forms Request for
Payments (ATTACHMENT IX), Receipt and Expenditure Reports (ATTACHMENT X
Exhibits 1-8)
4. The Contractor shall include with its fixed fee/unit rate portion of the invoice, the units of services
provided based on rates as established in ATTACHMENT VII Budget and Rate Summary of the
contract, number of clients, and the rates for the services provided in conformance with the requirements
as described in the deliverables and service tasks; and
5. All Requests for Payment shall be based on the submission of actual monthly Expenditure Reports
beginning with the first month of the contract. The schedule for submission of advance requests (when
available)and invoices is Invoice Schedule,ATTACHMENT VIII.
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E. Financial Consequences
1. Contractor shall ensure 100%of the deliverables identified in SECTION II—MANNER OF SERVICE
PROVISION are performed pursuant to contract requirements, and as described in Section II.D. are
identified as major deliverables in this contract.
2. If at any time the Contractor is notified by the Agency Contract Manager that it has failed to correctly,
completely,or adequately perform these major deliverables,the Contractor will have 10 days to submit
a Corrective Action Plan ("CAP") to the Agency Contract Manager that addresses the deficiencies
and states how the deficiencies will be remedied within a time period approved by the Agency
Contract Manager. The Agency shall assess a Financial Consequence for Non-Compliance on the
Contractor for each deficiency identified in the CAP which is not corrected pursuant to the CAP. The
Agency will also assess a Financial Consequence for failure to timely submit a CAP.
3. In the event Contractor fails to correct an identified deficiency within the approved time period
specified in the CAP, the Agency shall deduct, from the payment for the invoice of the following a;
month, 1% of the monthly value of the administrative funds in the contract for each day the deficiency w
is not corrected. The Agency shall also deduct, from the payment for the invoice of the following r
month, 1%of the monthly value of the administrative funds in the contract for each day the Contractor }
fails to timely submit a CAP. u_
4. If Contractor fails to timely submit a CAP, the Agency shall deduct 1% of the monthly value of the 9
administrative funds in the contract for each day the CAP is overdue, beginning the 11th day after
notification by the Agency Contract Manager of the deficiency. The deduction will be made from the
payment for the invoice of the following month.
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5. Remedies for Nonconforming Services
The Contractor shall ensure that all goods and/or services provided under this contract are delivered
timely, completely and commensurate with required standards of quality. Such goods and/or services
will only be delivered to eligible program participants.
6. If the Contractor fails to meet the prescribed quality standards for services, such services will not be
reimbursed under this contract. In addition, any nonconforming goods (including home delivered
meals) and/or services not meeting such standards will not be reimbursed under this contract. The N
Contractor's signature on the Request for Payment Form certifies maintenance of supporting
documentation and acknowledgement that the Contractor shall solely bear the costs associated with
preparing or providing nonconforming goods and/or services. The Agency requires immediate {
notice of any significant and/or systemic infractions that compromise the quality,security or continuity
of services to clients.
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If, or to the extent,there is any conflict between Section D, 1-6 above, and paragraphs 39.1 and 39.2
of the Master Contract, this section shall take precedence.
IV.SPECIAL PROVISIONS
A. Final Budget and Funding Revision Requests - Final requests for budget revisions or adjustments to
contract funds based on expenditures for provided services must be submitted to the Agency
Contract Manager in writing no later than December 31,2016; email requests are considered acceptable.
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B. Contractor's Financial Obligations
1. Matching,Level of Effort,and Earmarking Requirements
The Contractor's match will be made in the form of cash, general revenue administrative funds, and/or
in-kind resources. The Contractor will assure,through a provision in subcontracts,a match requirement
of at least 10 percent of the cost for services funded through this contract. The subcontractor's match
will be made in the form of cash and/or in-kind resources. The Contractor shall report match by title
each month. At the end of the contract period, the Contractor must properly match OAA funds that
require a match.
2. Consumer Contributions
Consumer contributions are to be used under the following terms:
a. The Contractor assures compliance with Section 315 of the OAA as amended in 2006, in regard to
consumer contributions;
b. Voluntary contributions are not to be used for cost sharing or matching;
c. Accumulated voluntary contributions are to be used prior to requesting federal reimbursement;and
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d. Voluntary contributions are to be used only to expand services. >
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3. Use of Service Dollars and Management of the Assessed Priority Consumer List
The Contractor is expected to spend all federal, state, and other funds provided by the Agency for
the purpose specified in the contract. The Contractor must manage the service dollars in such a manner
so as to avoid having a wait list and a surplus of funds at the end of the contract period,for each program
managed by the Contractor. If the Agency determines that the Contractor is not spending service -o
funds accordingly, the Agency may transfer funds to other AAAs during the contract period and/or
adjust subsequent funding allocations accordingly,as allowable under state and federal law.
4. The Contractor agrees to distribute funds as detailed in this contract and ATTACHMENT VII.Any
115
change in the funds identified in ATTACHMENT VII require a contract amendment. t°
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5. Title III Funds v
The Contractor assures compliance with Section 306 of the OAA, as amended in 2006, that funds
received under Title III will not be used to pay any part of a cost (including an administrative cost)
incurred by the Contractor to maintain a contractual or commercial relationship that is not carried out `N'
to implement Title III. Q
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January 2016—December 2016 OAA 203.16
ATTACHMENT H
CERTIFICATION REGARDING LOBBYING
Certification for Contracts,Grants,Loans and Cooperative Agreements
The undersigned certifies,to the best of his or her knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person for
influencing or attempting to influence an officer or an employee of any Agency, a member of Congress, an officer
or employee of Congress, or an employee of a member of Congress in the connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal
contract, grant, loan or cooperative agreement. _
0
(2) If any funds other than Federal appropriated funds have been paid or will be paid,to any person for influencing or 2
attempting to influence an officer or an employee of any Agency,a member of Congress, an officer or employee of x
Congress, or an employee of a member of Congress in the connection with this Federal contract, grant, loan or w
CID
cooperative agreement,the undersigned shall complete and submit Standard Form-LLL, Disclosure Form to Report
Lobbying, in accordance with its instructions.
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(3) The undersigned shall require that the language of this certification be included in the award documents for all sub-
awards at all tiers(including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements) ••
ep
and that all sub-recipients shall certify and disclose accordingly. cp
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This certification is a material representation of fact upon which reliance was placed when this transaction was made or -t,=
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by °'
§1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of 3—,
not less than $10,000 and not more than $100,000 for each such failure. i,.,
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`1n �'_ L .,..e . January 8,2016 0o
Signature Date
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Stephen Y.Carrell OAA 203.16 N
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Name of Authorized Individual Contract/Agreement
Number ..
Collier County Government aa)
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Name of the Organization u
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3339 Tamiami Trail E., Suite 211,Naples,FL 34112 Q
Address of Organization
Approved as to form and legality
Assistant County Attorney c '3
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January 2016—December 2016 OAA 203.16 16.D.19.g
ATTACHMENT III
FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title IIIB—
CA/CM/SCAS $ 23,574.(
Transportation U.S. Health and Human Services 93.044 $ 31,000.(
Support Services $ 316,722.(
Total IIIB $ 371,296.(
$ 278,853.0 c
OAA Title IIIC1 —Congregate Meals
Meals a)
Screening U.S. Health and Human Services 93.045
Nutrition Education
Outreach LL
Total IIIC1 $ 278,853J
0
OAA Title III C2—Home Delivered
0
Meals $ 250,832.1 4
N
Meals
Nutrition Education U.S. Health and Human Services 93.045 a
Bening
breach $ 250,832.1 3
Total IIIC2
Older Americans Act Title III E ccs
CA/CM & Services (Title III E) $ 97,755.1 0
Supplement Services (Title III ES) U.S. Health and Human Services 93.052 $ 18,335.1
Grandparent Services (Title III EG) $ 6,120.(
Total IIIE $ 122,210.1
TOTAL FEDERAL AWARD $1,023,191.1
J.d
a
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-122—Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-110—Administrative
Requirements)OMB Circular A-133—Audit Requirements
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL
ASSISTANCE Section 215.97,
'la. Stat.
,hapter 691-5,Fla.Admin.Code
20 C,�o
Packet Pg. 1661
16.D.19.g',
January 2016—December 2016 OAA 203.16
ATTACHMENT IV
Certification Regarding Debarment, Suspension,Ineligibility and Voluntary Exclusion
Contracts/Subcontracts
This certification is required by the regulations implementing Executive Order 12549,Debarment and Suspension,signed
February 18, 1986. The guidelines were published in the May 29, 1987 Federal Register (52 Fed. Reg., pages 20360-
20369). (2 CFR 180.5-180.1020, as supplemented by 2 CFR 376.10-376.995).
Instructions
1. Each provider whose contract/subcontract contains federal monies or state matching funds must sign this certification
prior to execution of each contract/subcontract. Additionally, providers who audit federal programs must also sign,
regardless of the contract amount. Florida Department of Elder Affairs (DOEA)and/or Agency cannot contract with
these types of providers if they are debarred or suspended by the federal government. c
y
2. This certification is a material representation of fact upon which reliance is placed when this contract/subcontract is
entered into. If it is later determined that the signer knowingly rendered an erroneous certification, the Federal
Government may pursue available remedies, including suspension and/or debarment.
3. The provider shall provide immediate written notice to the Agency Contract Manager at any time the provider learns >-
that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
0
4. The terms "debarred", "suspended", "ineligible", "person", "principal", and "voluntarily excluded", as used in this c
certification, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive
Order 12549. You may contact the Agency Contract Manager for assistance in obtaining a copy of those regulations.
5. The provider agrees by submitting this certification that, it shall not knowingly enter into any subcontract with a °J
person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this
contract/subcontract unless authorized by the Federal Government. w
6. The provider further agrees by submitting this certification that it will require each subcontractor of this w
contract/subcontract,whose payment will consist of federal monies,to submit a signed copy of this certification.
U
7. The Agency may rely upon a certification of a provider that it is not debarred, suspended, ineligible, or voluntarily
excluded from contracting/subcontracting unless it knows that the certification is erroneous. c
8. This signed certification must be kept in the Agency Contract Manager's file and provided to Agency
Contract Administration. Subcontractor's certifications must be kept at the contractor's business location. 0
a>
CERTIFICATION
(I) The prospective provider certifies, by signing this certification, that neither it nor its principals is presently
debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in
this contract/subcontract by any federal department or Agency.
(2) Where the prospective provider is unable to certify to any of the statements in this certification, such prospective
provider shall attach an explanation to this certification.
(3) By initialing Agency Contract Manager confirms that prospective provider has not been listed in the EPLS
database < Verification Date 12-31-15
jiiitcfty January 8, 2016
Signature (must be same as contract signature) Date
Approved as to form and legality
Title and Organization County of Collier r
21 Assistant County Attorney a�;�
Packet Pg. 1662
January 2016—December 2016 OAA 203.16 16.1119.9
ATTACHMENT VII
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
1. Title III B Support Services $ 371,296.00
2. Title III Cl Congregate Meals $ 278,853.00
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3. Title III C2 Home Delivered Meals $ 250,832.00 '7)
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4. Title III E Services $ 122,210.00 w
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TOTAL $1,023,191.00
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22
Packet Pg. 1663
January 2016-December 2016 OAA 203.16 16.D.19.g
ATTACHMENT VII
OLDER AMERICANS ACT RATE SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
IIIB
Services Total Cost Reimbursement Rate
Adult Day Care 12.83 11.55
Case Aide 33.89 30.50
Case Management 60.00 54.00
Chore 23.33 21.00 c
Chore (Enhanced) 30.33 27.30 _
Companionship 23.33 21.00 w
Emergency Alert Response 1.31 1.18 to
Escort 21.67 19.50 >-
Homemaker 21.50 19.35 I i
Housing Improvement 100% Cost 90% of Cost
Material Aid 100% Cost 90% of Cost •
Personal Care 25.67 23.10 to
Respite In-Facility 12.83 11.55
Respite In-Home 25.67 23.10 a
Screening and Assessment 60.00 54.00 ;-.
Shopping Assistance 21.00 18.90
w
Skilled Nursing Services 42.00 37.80 t
Specialized Medical Equipment, Services, and 100% Cost 90% of Cost cow
Supplies
Transportation 100% Cost 90% of Cost v
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COLLIER COUNTY
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IIIE, HIES, & MEGE
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Services Total Cost Reimbursement Rate Q
IIIE- Adult Day Care $ 12.83 $ 11.55
Direct Pay Respite $ 16.67 $ 15.00 1
Respite In-Facility $ 12.83 $ 11.55
Respite In-Home $ 25.67 $ 23.10
Screening & Assessment $ 60.00 $ 54.00
IIIES- Specialized Medical Equipment, Service & 100% Cost 90% of Cost I
Supplies
MEG- Child Day Care $ 16.67 $ 15.00
Screening/Assessment $ 60.00 $ 54.00 -
23
C40)
Packet Pg: 1664
January 2016—December 2016 OAA 203.16 16.D.19.g
COLLIER COUNTY
C-1 & C-2
Services Total Cost Reimbursement Rate
Cl
Congregate Meals $ 9.88 $ 8.90
Nutrition Education $ 1.80 $ 1.62
Congregate Meal Screening $31.12 $28.00
Outreach $4.80 per person $4.32 per person
C2
Home Delivered Meals $ 9.77 $ 8.80
Nutrition Education $ 1.80 $ 1.62
Screening & Assessment $60.00 $54.00
Outreach $4.80 per person $4.32 per person
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24 !C
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Packet Pg. 1665
i
January 2016—December 2016 OAA 203.16 16.D.19.g
ATTACHMENT VIII
INVOICE SCHEDULE
Report Number Based On Submit to Agency
On This Date
1 January Advance* January 1
2 February Advance* January 1
3 January Expenditure Report February 9 *See Note#4*
4 February Expenditure Report March 9
5 March Expenditure Report April 9
6 April Expenditure Report May 9
7 May Expenditure Report June 9
8 June Expenditure Report July 9
9 July Expenditure Report August 9
10 August Expenditure Report September 9 c
11 September Expenditure Report October 9 I
12 October Expenditure Report November 9 cr
13 November Expenditure Report December 9 tu
x
14 December Expenditure Report January 9 to
,-
15 Final Expenditure and Request for Payment February 15 >-
1 6
16 Closeout Report March 1
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Legend: * Advance based on projected cash need.
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0
Note# 1: Report#1 for Advance Basis Agreements cannot be submitted to the Agency prior to N
January 1 or until the agreement with the Agency has been executed. -o
a)
Note#2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the agree- w
ment. The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT IX). 5
L
Note 3: Submission of expenditure reports may or may not generate a payment request. If final c°
# .
to
expenditure report reflects funds due back to the Agency,payment is to accompany the
report. o
Note#4: ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 9th falls
on a Saturday, then the report will be due by the 8th by 12:00 p.m. AND IF the 9th falls
on a Sunday, the report will be due by the 10th by 12:00 p.m. Actual submission of the a
vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report ?
which is verified and paid by CIRTS data only. w
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25
0
Packet Pg. 1666
•
16D.19.g
Jknuary 2016-December 2016 OAA 203.16
ATTACHMENT IX
REQUEST FOR PAYMENT
OLDER AMERICANS ACT
Provider Name,Address and Phone#: Type of Report: This Report Period:
From: To:
Report#
Advance Contract#
Contract Period:
Reimbursement 01/01/16-12/31/16
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared By: Date: Approved By: Date: o
N
PART A: ' (1) (2) ' (3) (4) (5) cu
BUDGET SUMMARY III B IIIC1 IIIC2 IIIE TOTAL W
(D
1.Approved >-
Contract Amount. $0.00 $0.00 $0.00 $0.00 $( Q
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2. Previous Funds
RECEIVED for
Contract period $0.00 $0.00 $0.00 $0.00 $(
3. Contract Balance $0.00 $0.00 $0.00 $0.00 $( 3
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4. .vious Funds
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REQUESTED and
Not Received. $0.00 $0.00 $0.00 $0.00 $(
5. Contract Balance $0.00 $0.00 $0.00 $0.00 $( (?
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PART B:
0
FUNDS REQUESTED (NI
1.
1. Net Expenditures 0
For Month $0.00 $0.00 $0.00 $0.00 $1
a)
v
PART C: ra
NET FUNDS REQUESTED:
1. Less Advance Payment
Hereby Requested For $0.00 $0.00 $0.00 $0.00 $i
2. Contract Funds are
Hereby Requested For $0.00 $0.00 $0.00 $0.00
26
Packet Pg. 1667
,
16.D.19.g',
January 2016-December 2016 OAA 203.16
ATTACHMENT X-Exhibit 1
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
Provider Name,Address and Phone#: Program Funding Source : This Report Period:
From: To:
Title III Report#
B Contract#
Contract Period:
01/01/16-12/31/16
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: Approved by: Date:
PART A: BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts ' (5) S.
O
Budget For This Report Year to Date Approved Budget '5
y I
1. Federal Funds $0.00 $0.00 $0.00 0.00% W 1
2. State Funds $0.00 $0.00 $0.00 0.00% m 1
3. Other, In-Kind& Local Match $0.00 $0.00 $0.00 0.00% >-
4. Program Income $0.00 $0.00 $0.00 0.00% u_
1
5.TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% 0
0
0
PART B : EXPENDITURES 1.Approved 2. Expenditures 3. Expenditures 4. Percent of
Budget For This Report Year to Date Approved Budget m
a)
1.All IIIB Services $0.00 $0.00 $0.00 0.00%
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2.TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00%
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PART C : OTHER EXPENDITURES U
(For Tracking Purposes only) 0
7-
1.
1. Match re;
0
a. Other and In-Kind $0.00 $0.00 $0.00 0.00% N
b. Local Match $0.00 $0.00 $0.00 0.00%
0
2. Program Income $0.00 $0.00 $0.00 0.00% c
as
3.TOTAL OTHER $0.00 $0.00 $0.00 0.00% E
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27
Packet Pg. 1668
1
16.D.19.g
-January 2016-December 2016 OAA 203.16
ATTACHMENT X-Exhibit 2
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
Provider Name,Address and Phone#: Program Funding Source : This Report Period:
From: To:
Title III Report#
Cl Contract# ,
Contract Period:
01/01/16-12/31/16
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: Approved by : Date :
c
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PART A: BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts ' (5) .-
Budget For This Report Year to Date Approved Budget a)
K
W
1. Federal Funds $0.00 $0.00 $0.00 0.00% cm
2. State Funds $0.00 $0.00 $0.00 0.00% >-
3.
3. Other, In-Kind&Local Match $0.00 $0.00 $0.00 0.00% Q
4. Program Income $0.00 $0.00 $0.00 0.00% Q
0
5.TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% ..
0
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PART B : EXPENDITURES 1.Approved 2. Expenditures 3. Expenditures 4. Percent of -0
m
Budget For This Report Year to Date Approved Budget c
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X
i.All IIIC1 Services $0.00 $0.00 $0.00 0.00% W
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2.TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00% o
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PART C: OTHER EXPENDITURES r
(For Tracking Purposes only) riN
1. Match e(
a. Other and In-Kind $0.00 $0.00 $0.00 0.00% Q
b. Local Match $0.00 $0.00 $0.00 0.00% 0
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2. Program Income $0.00 $0.00 $0.00 0.00% a)
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3. TOTAL OTHER $0.00 $0.00 $0.00 0.00% a
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28
Packet Pg. 1669
1
16.D.19.g
January 2016-December 2016 OAA 203.16
ATTACHMENT X-Exhibit 3
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT , �
Provider Name, Address and Phone#: Program Funding Source : This Report Period:
From: To:
Title III Report#
C2 Contract#
Contract Period:
01/01/16-12/31/16
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date: Approved by : Date:
O
PART A: BUDGETED INCOME/RECEIPTS 1. Approved 2.Actual Receipts 3.Total Receipts ' (5) .0-
Budget For This Report Year to Date Approved Budget ar
K
W
1. Federal Funds $0.00 $0.00 $0.00 0.00% c0
2. State Funds $0.00 $0.00 $0.00 0.00%
3. Other, In-Kind& Local Match $0.00 $0.00 $0.00 0.00% u-
4. Program Income $0.00 $0.00 $0.00 0.00% Q
0
5.TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% c
0
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PART B : EXPENDITURES 1. Approved 2. Expenditures 3. Expenditures 4. Percent of d
Budget For This Report Year to Date Approved Budget 0.--
1.All II1C1 Services $0.00 $0.00 $0.00 0.00% W
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2. TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00% 0-
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PART C : OTHER EXPENDITURES co
(For Tracking Purposes only) M
0
1. Match N
a. Other and In-Kind $0.00 $0.00 $0.00 0.00% 1
b. Local Match $0.00 $0.00 $0.00 0.00% 0
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2. Program Income $0.00 $0.00 $0.00 0.00% a)
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3. TOTAL OTHER $0.00 $0.00 $0.00 0.00% vs
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29
Co
Packet Pg. 1670
16.D.19.g
January 2016-December 2016 OAA 203.1
i. ATTACHMENT X-Exhibit 4
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
Provider Name, Address and Phone#: Program Funding Source : This Report Period:
From: To:
Title III Report#
E Contract#
Contract Period:
01/01/16-12/31/16
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by: Date: Approved by : Date
C
0
PART A: BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts ` (5)
Budget For This Report Year to Date Approved Budget a;
x
W
1. Federal Funds $0.00 $0.00 $0.00 0.00% co
2. State Funds $0.00 $0.00 $0.00 0.00% >-
3.
3. Other, In-Kind & Local Match $0.00 $0.00 $0.00 0.00% u_
4. Program Income $0.00 $0.00 $0.00 0.00% 1
0
5.TOTAL RECEIPTS $0.00 $0.00 $0.00 0.00% o
0
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PART B : EXPENDITURES 1.Approved 2. Expenditures 3. Expenditures 4. Percent of -a
a)
Budget For This Report Year to Date Approved Budget 3
c.)
a)
i.All IIIE Services $0.00 $0.00 $0.00 0.00% x
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2.TOTAL EXPENDITURES $0.00 $0.00 $0.00 0.00% 5
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PART C: OTHER EXPENDITURES v-to
(For Tracking Purposes only) c
1. Match N
a. Other and In-Kind $0.00 $0.00 $0.00 0.00% 1
b. Local Match $0.00 $0.00 $0.00 0.00% 0
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2. Program Income $0.00 $0.00 $0.00 0.00% a)
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3.TOTAL OTHER $0.00 $0.00 $0.00 0.00% w?
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30
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Packet Pg. 1671
16.D.19.g
January 2016-December 2016 OAA 203.10
Provider Name: ATTACHMENT X -Exhibit 5 This Report Period:
Unit Cost Report From: To:
Older Americans Act Report# --�
IIIB Contract#
Contract Period:
01/01/16 - 12/31/16
Units this Total Earned this
Unit Rate Services Retro's Month Units this YTD Units Rate Period Earned YTD
Request
ADC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
CA 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
CHO 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
ECHO 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 ' c
0
CM 0.00 0.00, 0.00 0.00 $0.00 $0.00 $0.00 I V)
COMP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 x
EAR 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 w
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ESC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 >-
HMK 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 <
HN 0.00 0.00 0.00 0.00 (5) $0.00 $0.00 O
P E CA 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 0
RESP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 N
SA 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 Is
SCAS 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 a--
*z ` 43: :Cost Reimb Services s V:% #
HOIM 0.00 0.00 0.00 0.00 Varies $0.00 $0.00
Ils
MATE 0.00 0.00 0.00 0.00 Varies $0.00 $0.00 y
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SCSM 0.00 0,00 0.00 0.00 Varies $0.00 $0.00 o
TRS 0.00 0.00 0.00 0.00 Varies $0.00 $0.00 `r°
Tota I 0.00 0.00 $0.00 $0.00 N
1 0
Please include the following CIRTS reports:
For all unit rate services: a)
E
Monthly and YTD Service Units with Unduplicated Client Counts r-
Please be sure that the YTD units tie out to this report. w
For cost reimbursement services:
Services Reported by Program and Service Report
Run from 01/01/16 through the current month end.
Please be sure that all YTD dollars are equal to or less than the YTD amounts on this report.
i. .. _... _ 1_. . .,.3
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31
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Packet Pg. 1672
i
' 16.D.19.g
r January 2016-December 2016 OAA 203.16
Provider Name: ATTACHMENT X -Exhibit 6 This Report Period:
Unit Cost Report From: To:
Older Americans Act Report #
lltC1 Contract #
Contract Period:
01/01/16- 12/31/16
Units this Total Earned this
Unit Rate Services Retro's Month Units this YTD Units Rate Period Earned YTD
Request
CNTL 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
NTED 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
NTSC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
NUCOI 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
OTR 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 0
Total 0.00 0.00 $0.00 $0.00 .)
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Please include the following CIRTS report:
M
0
N
Monthly and YTD Service Units with Unduplicated Client Counts Q
Please be sure that the YTD units tie out to this report. Q
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32
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Packet Pg. 1673
r, 1 16.D.19.g
January 2016-December 2016 OAA 203.1
Provider Name: ATTACHMENT X -Exhibit 7 This Report Period:
Unit Cost Report From: To:
Older Americans Act Report #
IIIC2 Contract#
Contract Period:
01/01/16- 12/31/16
Units this TORI Earned this
Unit Rate Services Retro's Month Units this YTD Units Rate Period Earned YTD
Request
HDM 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
NTED 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
NUCOI 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
OTR 0.00 0.00 0.00 0,00 $0.00 $0.00 $0.00 ,
SCAS 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 c
0
Total 0.00 0.00 $0.00 $0.00 : 'Di
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Please include the following CIRTS report:
M
0
04
Monthly and YTD Service Units with Unduplicated Client Counts
Please be sure that the YTD units tie out to this report. e
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33
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Packet Pg. 1674
H J 16.D19.g
,January 2016-December 2016 OAA 203.16
Provider Name: ATTACHMENT X -Exhibit 8 This Report Period:
Unit Cost Report From: To:
-
Older Americans Act Report#
IIIE Contract#
Contract Period:
01/01/16- 12/31/16
Units this Total Earned this
Unit Rate Services-ME Retro's Month Units this YTD Units Rate Period Earned YTD
Request
ADC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
DPRESP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
RESF 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
RESP 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00
0
SCAS 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 .c
Unit Rate Services-IIIEG ' 1x
CTSG 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.200 w
co
DCC 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 >.
u_
DPSIT 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 <
SCAS 0.00 0.00 0.00 0.00 (5) $0.00 $0.00 0
Cost Reimb Servs-IIIES .. .... . c
HOIM 0.00 0.00 0.00 0.00 Varies $0.00 0.00 N
MATE 0.00 0.00 0.00 0.00 Varies $0.00 0.00 0
1 -
".SM 0.00 0.00 0.00 0.00 Varies $0.00 0.00I E
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0.00 $0.00 $0.00 x
€
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€ CV
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Please include the following CIRTS reports: o
w
For all unit rate services: E
Monthly and YTD Service Units with Unduplicated Client Counts
Please be sure that the YTD units tie out to this report. cti
For cost reimbursement services:
Services Reported by Program and Service Report
Run from 01/01/16 through the current month end.
Please be sure that all YTD dollars are equal to or less than the YTD amounts on this report.
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34
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Packet Pg. 1675
16.D.19.g
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Revised August 2007
Attestation Statement
Agreement/Contract Number: OAA 203.16
Amendment Number n/a
I, Stephen Y Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative) 2
.N
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and W
co
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 0
electronic data processing media,which has no affect on the agreement/contract content.
^
N•14 t January 8, 2016
Signature o ecipient/ tractor representati e- Date
a
v
Ng
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0
C
d
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w
w
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1
Revised August 2007
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Packet Pg. 1676