Backup Documents 05/14/2013 Item #16D13ORIGINAL DOCUMENTS CHECKLIST & ROUTING S P
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 3
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA U
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the Comity 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. Ifthe 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 Addressees (List in routing order)
Office
Initials
Date
1. Barbetta Hutchinson
HHVS
Zif
5/16/13
2. Jennifer B. White, ACA
County Attorney Office
Office located in HHVS
Department
Agenda Item Number
16D13
3. BCC Office
Board of County
Commissioners
NO
4. Minutes and Records
Clerk of Court's Office
Number of Original
1 five page document
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who crcated/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
Lisa Carr
Phone Number
252 -2339
Contact / Department
apmoDriate.
(Initial)
Applicable)
Agenda Date Item was
5/14/13
Agenda Item Number
16D13
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
NO
Type of Document
Amendment
Number of Original
1 five page document
Attached
Original document has been signed/initialed for legal sufficiency. (All documents to be
Documents Attached
PO number or account
signed by the Chairman, with the exception of most letters, must be reviewed and signed
YES
number if document is
by the Office of the County Attorney.
to be recorded
All handwritten strike - through and revisions have been initialed by the County Attorney's
YES
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
apmoDriate.
(Initial)
Applicable)
1.
Does the document require the chairman's original signature?
NO
2.
Does the document need to be sent to another agency for additional signatures? If yes,
NO
provide the Contact Information (Name; Agency; Address; Phone) on an attached sheet.
3.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
YES
by the Office of the County Attorney.
4.
All handwritten strike - through and revisions have been initialed by the County Attorney's
YES
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
N/A
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
N/A
signature and initials are required.
7.
In most cases (some contracts are an exception), the original document and this routing slip
YES
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8.
The document was approved by the BCC on 5/14/13 (enter date) and all changes
YES
made during the meeting have been incorporated in the attached document. The
County Attorne 's Office has reviewed the changes, if applicable.
9.
Initials of attorney verifying that the attached document is the version approved by the
YES
BCC, all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature.
ATTACHMENT 003
16013
NSIP 203.13.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
DBA SENIOR CHOICES OF SOUTHWEST FLORIDA
NUTRITION SERVICES INCENTIVE PROGRAM
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of
Southwest Florida ( "Agency ") and Collier County Board of County commissioners, ( "Contractor "), amends contract
NSIP 203.13.
The purpose of this amendment is to decrease the contract amount by $1,689.00 and decrease the level of services
accordingly. This amendment changes total contract funding from $35,146.00 to $33,457.00.
Additionally, this amendment (1) revises section 4 of the Standard contract, (2) revises ATTACHMENT I, SECTION
III METHOD OF PAYMENT; AND (3) revises ATTACHMENT III Exhibit 1.
The purpose of this amendment is to amend the following contract sections (Paragraphs and Attachments).
STANDARD CONTRACT:
(1) Revises section 4.
CONTRACT ATTACHMENTS:
(1) Revise ATTACHMENT I, SECTION III METHOD OF PAYMENT; and
(2) Revise ATTACHMENT III Exhibit 1.
Line denotes completion of above summary
4. Contract Amount
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $33,457.00, 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.
CONTRACT ATTACHMENTS:
(1) ATTACHMENT I, SECTION III METHOD OF PAYMENT is hereby replaced with the revised Attachment and
attached hereto.
(2) ATTACHMENT III Exhibit 1 is hereby replaced with the revised Attachment and attached hereto.
This amendment shall be effective on April 11, 2013. All provisions in the agreement and any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
ATTACHMENT 003 16012313.003
IN WITNESS WHEREOF, the Parties hereto have caused this 4 page amendment to be executed by their officials there
unto duly authorized.
Contractor: COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY:
NAME: Stephen Y. Carnell
TITLE: Interim Public Services Administrator
DATE: April 18, 20, 2013
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 9/30
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC. DBA SENIOR CHOICES OF
SOUTHWEST FLORIDA
r �
SIGNED BY: — Cr' B"
NAME: RONALD LUCCHINO, PhD
TITLE: BOARD PRESIDENT
DATE: 6 " �-- /3
2
ATTACHMENT 002
1 4q0 379, X58.13.002
ATTACHMENT I
SECTION III: METHOD OF PAYMENT
3.1 GENERAL STATEMENT OF METHOD OF PAYMENT
This is a fixed rate contract. The Agency shall make payment to the Contractor for provision of services up to a
maximum number of units of service and at the prospective rate stated below:
Service to be Provided
Unit of Service
Unit Rate
Eligible Congregate and
Home Delivered Meals
1 unit= 1 meal
$.72
The prospective rate is based on the estimated OAA grant award.
COLLIER
Service to be Provided
Unit of
Service
Unit Rate
Maximum
Units
Allocation
Eligible Congregate and
Home Delivered Meals
1 unit=
$0.72
46,468
$ 33,457
(Under OAA and ARRA)
1 meal
3
ATTACHMENT III
9
ATTACHMENT 002
16013
NSIP 357, 358.13.002
EXHIBIT 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Nutrition Services Incentive Program
Older Americans Act
93.053
$33,457.00
TOTAL FEDERAL AWARD
$33,457.00
TOTAL FEDERAL AWARD
$33,457.00
COLLIER
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Nutrition Services Incentive Program
Older Americans Act
93.053
$33,457.00
TOTAL FEDERAL AWARD
$33,457.00
16D13
Attestation Statement
Agreement /Contract Number NSIP 203.13
Amendment Number 003
I, Stephen Y. Carnell , attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(Signature of 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.
Signature of Recipibnt /Contractor representative
Stephen Y. Carnell, Interim Administrator
Collier County Public Services Division
13
Date
MR