Backup Documents 02/28/2017 Item #16D 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 D
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office In'tials Date
1. Priscilla Doria Community & Human Services f,J ,31.)7// 7
2. County Attorney Office 0_211--)
3. BCC Office Board of County Commissioners -2Azqv--1,
4. Minutes and Record Clerk of Court's Office rM 2l�(�� 3�
I`�I �m
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Priscilla Doria, Grant Coordinator Phone Number 239-252-5312
Contact/ Department Community and Human Services
Agenda Date Item was February 28,2017 Agenda Item Number 16.D.2
Approved by the BCC
Type of Document Second Amendment to Community Number of Original 3
Attached Assisted and Supportive Living,Inc. Documents Attached
PO number or account
number if document is I P
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (I•'tial) Applicable)
1. Does the document require the chairman's original signature? 51` * Q !
2. Does the document need to be sent to another agency for additional signatures? If yes, ,' NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be ��
signed by the Chairman,with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N /4 NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the I Q
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. Aip(
Some documents are time sensitive and require forwarding to Tallahassee within a certain V
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on above date and all changes made during n
the meeting have been incorporated in the attached document. The County (UII,� ¢
Attorney's Office has reviewed the changes,if applicable. cr. lay
9. Initials of attorney verifying that the attached document is the version approved by the _ ,t V
BCC,all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature. (tt
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
160 2
MEMORANDUM
Date: March 2, 2017
To: Priscilla Doria, Grants Coordinator
Community & Human Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Second Amendment to Community Assisted & Supportive Living,
Inc.
Community Assisted & Supported Living, Inc.
dba Renaissance Manor
Attached are two (2) originals of the document referenced above, (Item #16D2)
approved by the Board of County Commissioners on Tuesday, February 2, 2017.
The Board's Minutes and Records Department has kept one of the three original
documents as part of the Board's Official Records.
If you have questions, please feel free to call me at 252-7240.
Thank you
Attachment
160 2
Grant - SHIP FY 2014-2015/2015-2016
Activity: - Rental Acquisition
SPONSOR: - Community Assisted and
Supported Living D.B.A. Renaissance
Manor, Inc.
DUNS #- 940621519
CSFA#- 52.901
SECOND AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
AND
COMMUNITY ASSISTED AND SUPPORTED LIVING
D.B.A. RENAISSANCE MANOR, INC.
THIS AGREEMENT is made and entered into this c day of �2 J,rgQ r ,
2017, by and between Collier County, a political subdivision of the State of Flofida,
("COUNTY" or Grantee") having its principal address as 3339 E. Tamiami Trail, Suite 211,
Naples FL 34112, and Community Assisted and Supported Living D.B.A. Renaissance
Manor, Inc., a private not-for-profit corporation existing under the laws of the State of Florida,
having its principal office 1693 Main Street, Suite A, Sarasota, FL 34236 ("SPONSOR").
WHEREAS, on June 28, 2016, Item 16D17, the County entered into an Agreement with
Sponsor to acquire two properties with State Housing Initiatives Partnership Program (SHIP)
funds;
WHEREAS, on October 25, 2016, Item 16D2, the Agreement was amended to increase
the project funding and the Sponsor was incorrectly referred to as "Subrecipient";
WHEREAS, the Parties desire to further amend the Agreement approved on October 25,
2016, Item 16D3 to remove aiy reference to "Subrecipient" as stated in First Amendment and
replace it with"Sponsor" in order to conform to original approved agreement.
WHEREAS, the Parties desire to replace Exhibit E, Quarterly Progress Report.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the Parties as follows:
Words Struckough are deleted; Words Underlined are added
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V. AGREEMENT AMOUNT
It is expressly agreed and understood that the total amount to be disbursed by the
COUNTY for the use by the SUBRECIPIENT SPONSOR during the term of the
Agreement shall not exceed. SIX HUNDRED THOUSAND DOLLARS ($600,000)
The budget identified for the Project shall be as follows
Line Item Description SHIP Funds
Project Component One: Acquisition of two rental $600,000
properties. (Maximum is $300,000 per property.)
TOTAL $600,000
* *
**Remainder of this page left blank intentionally**
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EXHIBIT "E"
Status Report for the Quarter Ending: Submittal Date:
Project Name: Project Number:
• k . • .. • •. •
Contact Person:
Telephone: Fax: E mail:
. . . . IP .
•
Number of units under rehab this period
Number of units completed this period
Number of units completed to date
Amount of funds expended this period
Amount of funds expended to date
New Contracts executed this period
Name of Contractor Address Amount of Contract
Client Income Category Income Amount
•
What events/actions are scheduled for the next month?
Identify any issues that may cause delay in meeting scheduled expenditure deadline dates.
Date
Signature
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16 D 2
EXHIBIT "E"
QUARTERLY PROGRESS REPORT
Complete form for preceding quarter and submit to County by the 1"of the following quarterly month.
Quarter Year: Circle One: 1st 2nd 3rd 4th Period Ending:
Grant: Project Name:
SPONSOR:
Please identify any actions taken or completed during this quarter period for the following stages;
Stage PROPERTY ACQUISITION
1:
Stage PROPERTY STANDARDS/
2: REHABILITATION
Stage TENANT ELIGIBILITY
3:
What events/actions are scheduled for the next month/quarter?
Identify any issues that may cause delay in meeting scheduled expenditure deadline date or program
requirements by end of agreement.
Signature Date
Print Name Title
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IN WITNESS WHEREOF,the SPONSOR and the COUNTY, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date first written above.
ATTEST:
DWIGHT E. BROCK, CLERK BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA
By;
Deptrcy laClerkfirman
tincf Ior
I ......-- „VaTilato
Dated: Gill I ) 2b 17
(SEAL)
Attest as to Chairman's
signature only. Community Assisted and Supported Living,Inc.
D.B.A. Renaissance Manor
By: //
.* **. • J • S crt-k- lerjC•2..0.
J. ScoiEll
Approved as to form and legality:
i,C__,LA
Senn r A. Belpedik
Assistant County Atto ey
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