Backup Documents 12/10-11/2013 Item #16D 9ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENTI- n Q
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SI L7
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Once
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.
Complete routing lines #1 through #2 as appropriate for additional signatures, dates, and/or information needed. Nthe document is already complete with the
exception of the Chairman's signaturr, draw a line through rocuitinglimos #1 through #2complete the checklist, and forward to the Attorney Office.
Route to Add s (List in rmiting order)
Office
Initials
Date
1. Lisa Carr
HHVS
21C
1/6/14
2. Jennifer B. White, ACA
County Attorney Office
Office located in HHVS
Department
�a.P�
,
��i,1 k4
3. BCC Office
Board of County
Commissioners
4. Minutes and Records
Clerk of Court's Office
Number of Original
3
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who c/prepared the Executive Summary. Primary contact informoon is needed in the event one of the
addressees above, may need to contact staff for additional or missies information.
Name of Primary Staff
Lisa Carr "s
.Phone Number
252-2339
Contact / Department
appropriate.
es
Applicable)
Agenda Date Item was
12/10/13
Agenda Item Number
16D9
Approved by the BCC
Does the document need to be sent to another agency for additional signatures? If yes,
Type of Document
Standard Contract Amendment for OAA
Number of Original
3
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 Attome .
to be recorded
All handwritten strike -through and revisions have been initialed by the County Attorney's
-Ver
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
Applicable)
1.
Does the document require the chairman's original signature?
2.
Does the document need to be sent to another agency for additional signatures? If yes,
Ovide 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 Attome .
4.
All handwritten strike -through and revisions have been initialed by the County Attorney's
-Ver
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
ides'
tJ
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
Yes
should be provided to the County Auomey 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 12/10/13 and all changes made duringRit
the meeting have been incorporated in the attached document. The County
Attorne 's Office has reviewed the ch if a Ikable.
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 th
Chairman's signature.
ores Kadlec-Roussey, Chief Financial Officer
Area Agency on Aging for Southwest Florida, Inc.
d/b/a Senior Choices of Southwest Florida
15201 N. Cleveland Ave., Suite 1100
North Fort Myers, Florida 33903
(239) 652-6900
Please send documents to the above address. Thank you!
MW
0otifity, of oilier
CLERK OF THE'CIR UIT COURT
Dwight E. Brock COLLIER CO Y CO RTHOUSE
U�,
Clerk of Courts 3315 TAMIAMI TRL E STE 102, P.O. BOX 413044
NAPLES, FLORIDA �'r
� ;NAPLES, FLORIDA
34112-5324 34101-3044
January 21, 2014
Area Agency on Aging for Southwest Florida, Inc.
Attn: Delores Kadlec-Roussey, Chief Financial Officer
d/b/a Senior Choices of Southwest Florida
15201 N. Cleveland Ave.
Suite 1100
North Fort Myers, Florida 33903
Re: Older Americans Act Program Title III
OAA #203.13.005
1609
Clerk of Courts
Accountant
Auditor
Custodian of County Funds
Transmitted herewith are three (3) originals of the above referenced documents, as
adopted by the Collier County Board of County Commissioners of Collier County,
Florida on Tuesday, December 10, 2013, during Regular Session.
Very truly yours,
DWIGHT E. BROCK, CLERK
Martha Vergara, Depu erk
Enclosure
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk�collierclerk.com
HO USING HUMAN AND VETERIAN SERI VCES
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Lisa N. Carr, Grants Coordinator, HHVS
DATE: February 28, 2014
RE: Senior Choices OAA 203.14 Contract, Amendments OAA 20313.004 and 005
Senior Choices HCE Amendment 203.12.007
Please find attached one (1) each fully executed document that was 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.
February 11, 2014 Item 16.D.5:
Older American Act Program Title III —OAA 203.14
December 10, 2013 Item 16.D.7:
OAA Amendment 203.13.004
December 10, 2013 Item 16.D.9:
OAA Amendment 203.13.005
December 10, 2013:
HCE 203.12.007 and OAA 203.005
Thank you for your assistance.
A,�,endment 005
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT
OLDER AMERICANS ACT PROGRAM TITLE III
Collier County Board of Commissioners
16U 94
OAA 203.13.005
This AMENDMENT, entered into on November 4, 2013 by and between the Area Agency on Aging for
Southwest Florida, Inc.. hereinafter referred to as the "Agency," and Collier County Board of County
Commissioners, hereinafter referred to as the "Contractor," wllectivelystatedasthe "Parties'whicharnendscontract
OAA 203.1.3
RECITALS:
WHEREAS, on February 5, 2013, the parties entered into the Standard Contract for the Older
American's Act Program Title III for social services to be provided to Collier County's frail and elderly
seniors (hereinafter referred to as "Contract"); and
WHEREAS, on April 1.1, 2013, the parties entered into a First Amendment to the Contract; and
WHEREAS, on August 8, 2013, the parties entered into a Second Amendment to the Contract; and
WHEREAS, on July 22, 2013, the parties entered into a Third Amendment to the Contract; and
WHEREAS, on October 3, 2013, the parties entered into a Fourth Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on December 31, 201.3;
and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to
the Agenda from the Florida Department of Elder Affairs;
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, 2014 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, 2014.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level
specified in the agreement.
Amendment 005
1b0 g
OAA 203.13.005
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
Contractor: Commissio ers
SIGNED BY:
NAME: Tom Henning
Chairman
TITLE:
DATE: December 10, 2013
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
,718ST: Ciera
DWIGHT EJOIR
By:
Attest as to Chairman's
signature only.
2
Area Agency on Aging for Southwest
Florida, Inc
SIGNED BY:
NAME: Ronald Lucchino, PhD
TITLE: Board President
DATE: ' A/
Approved as to form and legality
Assistant Coun ttorney
160
Attestation Statement
Agreement/Contract Number: OAA 203.13
Amendment Number: 005
Tom Henning
Chairman
I, , 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.
December 10, 2013
Signature of Recipient/Contra
* 13 C1C;'lark
Attest as to ChaTF
irman's
t.Jgtlsture 001
Date
Approved as to form and legality
Assistant County orney
02