Backup Documents 09/10/2013 Item #16D 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI� 6 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Lisa Can HHVS It 9/12/13
2. Jennifer B. White, ACA Office located in HHVS c->C0 13 13
County Attorney Office Department
3. BCC Office Board of County Q14 by
Commissioners p fl/57- 9113)i3
4. Minutes and Records Clerk of Court's Office
913 (3t2'39
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 Lisa Carr Phone Number 252-2339
Contact/ Department
Agenda Date Item was 9/10/13 Agenda Item Number 16D1
Approved by the BCC
Type of Document CCE Agreement,HCE Agreement&ADI Number of Original 3 copies of each for a
Attached Agreements Documents Attached total of 9 originals
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? YES V
2. Does the document need to be sent to another agency for additional signatures? If yes, NO
V
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 ^j '
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 YES V.
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 YES
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. c4lf✓'
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 9/10/13 (enter date)and all changes
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the ��
BCC,all changes directed by the BCC have been made, and the document is ready for the �0'
Chairman's signature.
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 IM
MEMORANDUM
Date: September 16, 2013
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: July 2012 — June 2014
CCE 203.12.005
HCE 203.12.005
ADI 203.12.004
Attached are three set (3 sets) of each original agreement referenced above (Item
#16D1) approved by the Board of County Commissioners on Tuesday, September 10,
2013.
Please forward for additional signatures and return a fully executed original
back to the Minutes and Records Department to be kept as part of the
Board's Official Records.
If you have any questions, please call me at 252-7240.
Thank you
Attachments
160 1
HOUSING HUMAN AND VETERIAN SERIVCES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grant Coordinator, HHVS
DATE: November 6, 2013
RE: Senior Choices Amendments
Please find attached seven (7) fully executed amendments that were approved by the BCC on the
days listed below for recording in Minutes and Records. Feel free to contact me if you have any
questions.
September 10, 2013 Item 16.D.1:
Community Care for the Elderly-CCE 203.12.005
Home Care for the Elderly—HCE 203.12.005
Alzheimer's Disease Initiative—ADI 203.12.004
September 24, 2013 Item 16.D.10:
Older Americans Act Program- OAA 203.13.002
September 24, 2013 Item 16.D.11:
Community Care for the Elderly-CCE 203.12.006
Home Care for the Elderly—HCE 203.12.006
Alzheimer's Disease Initiative—ADI 203.12.005
Thank you for your assistance.
Amend ment 005 July 2012–June 2014 CCE 203.12.005
‘ , 1 1
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
1 6 0
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida, Inc. dba
Senior Choices of Southwest Florida, hereinafter referred to as the "Agency,"and Collier County Board
of County Commissioners, hereinafter referred to as the "Recipient,"amends contract CCE 203.12—
July 2012-June 2014.
The purpose of this amendment is to add an additional paragraph to Item#4. Contract Amount to read as
follows: The Agency agrees to pay for contracted services according to the terms and conditions of this
contract in an amount not to exceed $717,202.00 for year two, 2013 –2014, 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; revise ATTACHMENT III Exhibit- 1 and ATTACHMENT VIII,
and add Home Delivered Meals.
This amendment shall be effective July 1, 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,three pages, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Collier County Board of County Area Agency on Aging for Southwest
Recipient: missioners Florida,Inc., dba Senior Choices of
Southwest Florida
I
SIGNED BY: L SIGNED BY: / dr
V -
NAME: Georgia A. Hiller, Esq. NAME: Ronald Lucchino, PhD
TITLE: Chairwoman TITLE: Board President
DATE: September 10, 2013 /�
DATE:
Federal Tax-ID: 59-6000588
Fisca''et digg fate: 09/30 Approved as to form and legality
e-Ns , CUB RA
y. Y !T � , Assistant County Attorney
1- ,:.. C)•r o airman's
re onl
su�natu .y
160 11
Amendment 005 July 2012—June 2014 CCE 203.12.005
ATTACHMENT III
EXHIBIT—1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Community Care for the Elderly Program General Revenue-Collier 65010 $ 717,202.00
TOTAL AWARD $ 717,202.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
2 0 9
Amendment 005 July 2012 —June 2014 CCE 203.12.005
A± 613 TACHMENT VIII
11
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
for
Collier County Board of Commissioners
Collier County
1. CCE Spending Authority $612,202.00
2. Case Management and 105,000.00
Case Aide
Total $717,202.00
RATE SUMMARY
for
Collier County Board of Commissioners
Collier County
Collier County Total Unit Cost Reimbursement Rate-90%
Case Management $55.56 $50.00
Case Aide $30.00 $27.00
Adult Day Care $12.22 $11.00
Chore $22.22 $20.00
Enhanced Chore $28.89 $26.00
Companion $22.22 $20.00
Skilled Nursing $40.00 $36.00
EARS $ 1.24 $ 1.12
Homemaking $21.11 $19.00
Personal Care $24.44 $22.00
Respite-In Home $24.44 $22.00
Home Delivered Meals $7.78 $7.00
Specialized Medical Equipment,
Services&Supplies $Cost Reimbursement $90%Cost Reimbursement
Transportation $Cost Reimbursement $90%Cost Reimbursement
3 •
160 1 1
Attestation Statement
Agreement/Contract Number: CCE 203.12
Amendment Number 005
I, Georgia A.Hiller.Esq. ,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 dala processing media,which has no affect on the agreement/contract content.
1
a
i /;
9/10/2013
Signatu of Recipient/Contractor representative Date
Approved as to form and legality
OWI HT E. OdK, Clark It()`
i
Asst County Attorney
Sy: l. ��;.«ter, ��
A fe t asta rrnares / 0.
signature only.
`�y
160 i
HOUSING HUMAN AND VETERIAN SERI VCES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grant Coordinator, HHVS
DATE: November 6, 2013
RE: Senior Choices Amendments
Please find attached seven (7) fully executed amendments that were approved by the BCC on the
days listed below for recording in Minutes and Records. Feel free to contact me if you have any
questions.
September 10, 2013 Item 16.D.1:
Community Care for the Elderly-CCE 203.12.005
Home Care for the Elderly—HCE 203.12.005
Alzheimer's Disease Initiative—ADI 203.12.004
September 24, 2013 Item 16.D.10:
Older Americans Act Program- OAA 203.13.002
September 24, 2013 Item 16.D.11:
Community Care for the Elderly-CCE 203.12.006
Home Care for the Elderly — HCE 203.12.006
Alzheimer's Disease Initiative—ADI 203.12.005
Thank you for your assistance.
Amendment 005 July 2012 —June 2014 HCE 203.12.005
160 1 `4
• AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida, Inc. dba
Senior Choices of Southwest Florida, hereinafter referred to as the "Agency,"and Collier County Board
of County Commissioners, hereinafter referred to as the "Recipient,"amends contract HCE 203.12
July 2012-June 2014.
The purpose of this amendment is to add an additional paragraph to Item#4. Contract Amount to read as
follows: The Agency agrees to pay for contracted services according to the terms and conditions of this
contract in an amount not to exceed $35,875 for year two, 2013 —2014, 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; and revise ATTACHMENT III Exhibit- 1 and ATTACHMENT
VIII.
This amendment shall be effective July 1, 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,three pages, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Hier County Board of County Area Agency on Aging for Southwest
Contractor: om Florida, Inc., dba Senior Choices of
ni ior�ers Southwest Florida
SIGNED
SIGNED BY: BY:
NAME: Georgia A. Hiller, Esq. NAME: Ronald Lucchino, PhD
TITLE: Chairwoman TITLE: Board President
DATE: September 10, 2013 DATE:
( 6I 7/ 3
Federal Tax ID: 59-600058y �
Fiscal Year Ending Ll�a es." lM• 4.4//i,�;
Approved as to form and legality
ATT5ST.r!:
D i GH . BROCK, Ier 1, .., LA\ �r ,
Assistant County�1 1 ►_ A rn
eY
By:
Attest as to£, �Irma.'acv-- i
signature only.
Amendment 005 July 2012 —June 2014 HCE 203.12.005
160 1
ATTACHMENT III
EXHIBIT—I
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Home Care for the Elderly Program General Revenue 65001 $35,875.00
TOTAL AWARD $35,875.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
2
Amendment 005 July 2012—June 2014 HCE 203.12.005
16D 1
ATTACHMENT VIII
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of Commissioners
HCE Case Management $ 2,768.00
HCE Basic Subsidies 14— 18 HCE Clients 22,896.00
HCE Special Subsidies 10,211.00
Total $35,875.00
HOME CARE FOR THE ELDERLY PROGRAM
RATE SUMMARY
Collier County
SERVICES REIMBURSEMENT RATE
Payments to the Lead Agency Collier
Case Management(CMV) $55.56
Case Aide(CAV) $30.00
Homemaker(HMKV) $21.11
Personal Care(PECV) $24.44
Respite (RESV) $24.44
Specialized Medical Equipment,
Services and Supplies (SCSV) Total Cost
Background Screening(OTHBKV) Total Cost
Payments to the Caregiver
Respite(RESP) Total Cost
Specialized Medical Equipment,
Services and Supplies (SCSM) Total Cost
Transportation(TRS) Total Cost
3
0
160 1
Attestation Statement
Agreement/Contract Number: HCE 203.12
Amendment Number 005
I, Georgia A. Hiller.Esq. ,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
la
ta,pro •ssing media,which has no affect on the agreement/contract content.
' Ldi
9/10/2013
Signature R ipient/Contractor representative Date
ATITI8X' Approved as to form and legality
DWIGHT E. BR* * , toff
--\.\,,C\..-3))_,,e Attest as to Chairman fix.
`v Assistant County%-.
rney
signature oniy�
S
160 1
HOUSING HUMAN AND VETERIAN SERIVCES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grant Coordinator, HHVS
DATE: November 6, 2013
RE: Senior Choices Amendments
Please find attached seven (7) fully executed amendments that were approved by the BCC on the
days listed below for recording in Minutes and Records. Feel free to contact me if you have any
questions.
September 10, 2013 Item 16.D.1:
Community Care for the Elderly-CCE 203.12.005
Home Care for the Elderly—HCE 203.12.005
Alzheimer's Disease Initiative—ADI 203.12.004
September 24, 2013 Item 16.D.10:
Older Americans Act Program- OAA 203.13.002
September 24, 2013 Item 16.D.11:
Community Care for the Elderly-CCE 203.12.006
Home Care for the Elderly— HCE 203.12.006
Alzheimer's Disease Initiative—ADI 203.12.005
Thank you for your assistance.
Amendment 004 July 2012–June 2014 ADI 203.12.004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. 16 0 1
dba SENIOR CHOICES OF SOUTHWEST FLORIDA
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT,entered into between the Area Agency on Aging for Southwest Florida, Inc. dba
Senior Choices of Southwest Florida, hereinafter referred to as the "Agency," and Collier County Board
of County Commissioners, hereinafter referred to as the "Recipient,"amends contract ADI 203.12—July
2012-June 2014.
The purpose of this amendment is to add an additional paragraph to Item#4. Contract Amount to read as
follows: The Agency agrees to pay for contracted services according to the terms and conditions of this
contract in an amount not to exceed $104,961 for year two, 2013 –2014, 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; and revise ATTACHMENT III Exhibit- 1 and.ATTACHMENT
VIII.
This amendment shall be effective July 1, 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, three pages, is hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Collier County Board of County Area Agency on Aging for Southwest
Contractor: Conxissiners Florida, Inc., dba Senior Choices of
Southwest Florida
SIGNED-
SIGNED BY: BY:
NAME: Georgia A. Hiller, Esq. NAME: Ronald Lucchino, PhD
TITLE: Chairwoman TITLE: Board President
DATE: September 10, 2013 DATE:
/ U13 /0
Federal Tax ID: 59-6000588
Fiscal Year Ending D ' /3c{I'.•`
's�� Approved as to form and legality
ATTEST; 71
D IGHT L..BR r :A : %C.l 1`Z <-
!�► Assistant Count 1 tto y
By: -.-.� s !1 1 �
Attest as to pea's` , `
signature only,
Amendment 004 July 2012 —June 2014 ADI 203.12.004
160 1
ATTACHMENT III
EXHIBIT—1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheimer's Disease Initiative General Revenue/TSTF 65004 $104,961.00
TOTAL AWARD $104,961.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
2
0
Amendment 004 July 2012 —June 2014 ADI 203.12.004
1613 1
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
for
Collier County Board of County Commissioners
1. Respite $103,611.00
2. Case Management and Case Aide Allocation 1,350.00
3. Total $104,961.00
RATE SUMMARY
for
Collier County Board of County Commissioners
SERVICES UNIT RATE
Case Management $55.56
Case Aide $30.00
In-Home Respite $24.44
Respite Facility $12.22
Specialized Medical Equipment,
Services and Supplies 100% Reimbursement
3
CP
160 1
Attestation Statement
Agreement/Contract Number: ADI 203.12
Amendment Number 004
I, Georgia A. Hiller.Esq. ,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.
9/10/2013
Signature of Reci /Contractor representative Date
i; �R� . Approved as to form and legality
p f4T-E. B: A . ^^
f , `�
�E , assistant Co
ty Attorney
Attest as to Cl a iai
slgnaiti only
0