Backup Documents 02/28/2012 Item #16D 5ORIGINAL DOCUMENTS CHECKLIST & ROUTING S1I16 D 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
ROUTING SLIP
Complete routing lines #I through #4 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 #I through #4, complete the checklist, and forward to Ian Mitchell (line 45).
Route to Addressee(s)
(List in routing order
Office
Initials
Date
1. Jennifer B. White, ACA
Office of the County Attorney
3l �, N
2.Ian Mitchell, Executive Manager
Board of County Commissioners
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for pick u
3. Minutes & Records
Clerk of Courts
Agenda Item Number
16 D 5
Approved by the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Contract — PLEASE RETURN
Number of
3
Attached
ORIGINALS TO LOUISE PELLETIER
Documents Attached
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Ian Mitchell needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.
Name of Primary Staff
Louise Pelletier / Housing, Human and
Phone Number
252 -2696
Contact
Veteran Services
(Initial)
Please call or e-mail
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
LP
for pick u
Agenda Date Item was
February 28, 2012
Agenda Item Number
16 D 5
Approved by the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Contract — PLEASE RETURN
Number of
3
Attached
ORIGINALS TO LOUISE PELLETIER
Documents Attached
FOR ROUTING TO AGENCY
INSTRUCTIONS & CHECKLIST
l: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark'N /A'in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate
(Initial)
Applicable)
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
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signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from contracts,
agreements, etc. that have been fully executed by all parties except the BCC Chairman and
Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorneys
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Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
LP
document or the final negotiated contract date whichever is applicable.
4.
'Sign herd'tabs are placed on the appropriate pages indicating where the Chairman's
LP
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
LP
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
6.
The document was approved by the BCC on 12/13/11 (enter date) and all changes
LP
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
l: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
1605
MEMORANDUM
Date: April 10, 2012
To: Louise Pelletier, Case Management
Housing, Human &Veteran Services
From: Ann Jennej ohn, Deputy Clerk
Minutes & Records Department
Re: Contract #OAA 203.12 with Assurances and Certifications
between Collier County and Area Agency on Aging of SWFL Inc.,
d /b /a Senior Choices of SWFL for the FY12 Older Americans Act
Program Title III
Attached are three (3) original copies of the document referenced above,
(Item #16D5) approved by Board of County Commissioners February 28, 2012.
After forwarding for signature and further processing please return a complete
executed copy to the Minutes and Records Department for the Board's Official Record.
If you have any questions, please contact me at 252 -8406.
Thank you.
Attachments (3)
DATE:
TO:
FROM:
CC:
RE:
Co per CouHty
Public Services Division
Housing, Human & Veteran Services
Memorandum
April 10, 2012
Ian Mitchell
1605 '1
Kim Grant, Interim Director of Housing, Human, and Veteran Services
Jennifer B. White, Assistant County Attorney
Assurances and Certifications - Area Agency on Aging for Southwest Florida,
Inc.
In accordance with the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of
Southwest Florida Standard Contract Older Americans Act Program Title III the attached exhibits
are being provided to you as reassurance that Housing, Human, and Veteran Services department
will be complying with all the requirements and certifications as stated on Contract # OAA 203.12.
Assurances
Page
Document
Clarification
Certification regarding lobbying certification for contracts,
25
grants, bans and agreements
To the best ofmy knowledge and beliefall statements are true
SAP program is the financial management system and meets the
Certification regarding data integrity compliance for agreements,
requirements ofthe contractor. The county is the contractor and there
31
R rts, and cooperative agreements
_ _..._.____.
are no sub - contractors (para. 1).
CIRTS (DOER) program is the management information system and
Certification regarding data integrity compliance for agreements,
meets the requirements. The county is the contractor and there are no
31
grants, bans and cooperative agreements _
sub- contractors (para. 2).
Certification regarding data integrity compliance for agreements,
To the best of my knowledge and beliefthat Collier County IT Dept
31
grants, loans and cooperative agreements _ _...__._
ensures the rovision of tecbnology and its operation (para.3). V
HHVS will comply with data integrity compliance (see attached
Certification regarding data integrity compliance for agreements,
County Disaster Plan & Housing, Human, and Veteran Departments
31
grants, loans and cooperative agreements
(HHVS) Emergency Plan (para. 4).
Certification regarding debarment, suspension, ineligibility and
32
voluntary exclusion for lower tier covered transactions
_ _. _
To the best ofmy knowledge and beliefall statements_are true
HHVS staffwill comply with all requirements and all the assurances
34
Assurances -non-, construction programs
that are applicable.
49
Cert ification regarding scrutinized companies lists
HHVS understands and will comply with all purchasng requirements
HHVS understands and will comply with E- verify system for
50
Verification ofemployment status certification
employment
HHVS is in compliance with Collier County emergency plan and
HHVS dept emergency plan (see attached). The emergency plan has
51
Verification ofemergency preparedness plan
_ _ .-
been made available to Area Agent on Aging.
HHVS verges that no changes/revision will be made to
52 1
Attestation statement 1
contracts/agreements
Kim Grant, Interim Director of Housing, Human, d Veteran Services
HOUSing,
Human and
Veteran ,Services
of Collier County
3339 Tamiami Trail East, Suite 211 • Naples, FL 34112 -5361
239 - 252 -CARE (2273) - 239 252 -HOME (4663) • 239 -252 -CAFE (2233) • 239 - 252 -RSVP (7787) - 239 - 252 -VETS (8387) • www .colliergov.netthumanservices
January 2012 Contract #OAA 203.12
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. dba 1605
Senior Choices of Southwest Florida 1
STANDARD CONTRACT
OLDER AMERICANS ACT PROGRAM TITLE III
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc., d /b /a Senior
Choices of Southwest Florida ( "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, the status to be further identified in ATTACHMENT III, Exhibit -2 as necessary.
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 and exhibits, which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), area plan(s), grant agreements, relevant Agency and
or Department handbooks, manuals or desk books, 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.
3. Term of Contract
This contract shall begin on January 1, 2012 or on the date on which the contract has been signed by the last
parry required to sign it, whichever is later. It shall end at midnight, local time in North Fort Myers, Florida,
on December 31, 2012.
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 $614,964.00, 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.
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 fiends.
6. Compliance with Federal Law
6.1 If this contract contains federal funds this section shall apply.
6.1.1 The Contractor shall comply with the provisions of 45 CFR 74 and /or 45 CFR 92, and other applicable
regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all
applicable standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42 U.S.C.
7401, et seq.), s. 508 of the Federal Water Pollution Control Act as amended (33 U.S.C. 1251, et seq.),
Executive Order 11738, as amended, and where applicable Environmental Protection Agency regulations 40
CFR 30. The Contractor shall report any violations of the above to the Agency.
January 2012
Contract #OAA 203.12
1605
6.1.3 The Contractor, or agent acting for the Contractor, may not use any federal funds received in connection with
this contract to influence legislation or appropriations pending before the Congress or any state legislature. If
this contract contains federal funding in excess of $100,000.00, the Contractor must, prior to contract
execution, complete the Certification Regarding Lobbying form, ATTACHMENT II. All disclosure forms
as required by the Certification Regarding Lobbying form must be completed and returned to the Contract
Manager prior to payment under this contract.
6.1.4 In accordance with Appendix A to 2 CFR 215, the Contractor shall comply with Executive Order 11246,
Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in
Agency of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
6.1.5 If this contract contains federal funds and provides services to children up to age 18, the Contractor shall
comply with the Pro - Children Act of 1994 (20 U.S.C. 6081).
6.1.6 A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards
will not be made to parties listed on the government -wide Excluded Parties List System, in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 and 12689, "Debarment and
Suspension." The Excluded Parties List System contains the names of parties debarred, suspended, or
otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority
other than Executive Order 12549. The Contractor shall comply with these provisions before doing business
or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor shall complete
and sign ATTACHMENT V prior to the execution of this contract.
6.2 The Contractor shall not employ an unauthorized alien. The Agency will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.C. 1324a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. 1101). Such violation will be cause for unilateral cancellation of
this contract by the Agency.
6.3 If the Contractor is a non - profit provider and is subject to Internal Revenue Service (IRS) tax exempt
organization reporting requirements (filing a Form 990 or Form 990 -N) and has its tax exempt status revoked
for failing to comply with the filing requirements of the 2006 Pension Protection Act or for any other reason,
the Contractor must notify the Agency in writing within thirty (30) days of receiving the IRS notice of
revocation.
6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR Part 170.110(b), the Contractor shall comply with the reporting requirements of
the Transparency Act as expressed in 2 CFR 170.
6.6 To comply with Presidential Executive Order 12989 and State of Florida Executive Order Number 11 -116,
Contractor agrees to utilize the U.S. Agency of Homeland Security's E- verify system to verify the
employment of all new employees hired by Contractor during the contract term. Contractor shall include in
related subcontracts a requirement that subcontractors performing work or providing services pursuant to the
state contract utilize the E- verify system to verify employment of all new employees hired by the
subcontractor during the contract term. Contractors meeting the terms and conditions of the E- Verify System
are deemed to be in compliance with this provision.
7. Compliance with State Law
7.1 This contract is executed and entered into in the State of Florida, and shall be construed, performed and
enforced in all respects in accordance with the Florida law, including Florida provisions for conflict of laws.
7.2 The Contractor shall comply with requirements of s. 287.058, F.S. as amended.
7.2.1 The Contractor shall provide units of deliverables, including various client services, and in some instances
may include reports, findings, and drafts, as specified in this contract, which the Contract Manager must
receive and accept in writing prior to payment in accordance with s. 215.971, F.S. (1) and (2).
7.2.2 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre -audit and post- audit.
7.2.3 If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit bills for any
travel expenses in accordance with s. 112.061, F.S., or at such lower rates as may be provided in this contract.
7.2.4 The Contractor shall allow public access to all documents, papers, letters, or other public records as defined
in subsection 119.011(12), F.S., made or received by the Contractor in conjunction with this contract except
for those records which are made confidential or exempt by law. The Contractor's refusal to comply with
January 2012
16U�
Contract #OAA 203.12
this provision will constitute an immediate breach of contract for which the Agency may unilaterally
terminate the contract.
7.3 If clients are to be transported under this contract, the Contractor shall comply with the provisions of Chapter
427, F.S., and Rule 41 -2, F. A. C.
7.4 Subcontractors who are on the discriminatory vendor list may not transact business with any public entity, in
accordance with the provisions of s. 287.134, F.S.
7.5 The Contractor shall comply with the provisions of s. 11.062, F.S., and s.. 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
7.6 In accordance with s. 287.135 F.S., any contractor on the Scrutinized Companies with Activities in Sudan
List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (Lists), created
pursuant to s. 215.473 F.S., is ineligible to enter into or renew a contract with the Agency for goods or
services of $1 million or more. Pursuant to s. 287.135 F.S., the Agency may terminate this contract if the
Contractor is found to have submitted a false certification of its status on the Lists or has been placed on the
Lists. Further, the Contractor is subject to civil penalties, attorney's fees and costs and any costs for
investigations that led to the finding of false certification. If this contract contains $1 million or more, the
Contractor shall complete and sign ATTACHMENT H, Certification Regarding Scrutinized Companies
Lists, prior to the execution of this contract.
8. Backgoround Screening
The Contractor shall ensure that, prior to providing services, all persons having access to vulnerable elders
and children, their living area, funds or personal property, or protected health information pertaining to such
individuals, will pass a Level 11 criminal background screening in accordance with the requirements of s.
430.0402 and ch. 435, F.S., as amended. These provisions apply to employees, subcontractors, consultants,
direct service providers and volunteers. Consequently, any commitment for employment, purchase of
services, or volunteer program participation will be contingent upon the passing of a Level 11 background
check. The background screening will include employment history checks as provided in s. 435.03(1), F.S.,
and both local and national criminal record checks coordinated through law enforcement agencies.
8.1 For purposes of this section, the term "direct service provider" means a person 18 years of age or older who,
pursuant to a program to provide services to the elderly, has direct, face -to -face contact with a client while
providing services to the client or has access to the client's living areas or to the client's funds or personal
property. This term includes coordinators, managers, and supervisors of residential facilities and volunteers.
9. Grievance Procedures
The Contractor shall develop, implement, and ensure that its subcontractors have established grievance
procedures to process and resolve client dissatisfaction with or denial of service(s), and address complaints
regarding the termination, suspension or reduction of services, as required for receipt of funds. These
procedures, at a minimum, will provide for notice of the grievance procedure and an opportunity for review
of the subcontractor's determination(s).
10. Audits, Inspections, Investizations, Public Records and Retention
10.1 The Contractor shall establish and maintain books, records and documents (including electronic storage
media) sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of
funds provided by the Agency under this contract. Contractor shall adequately safeguard all such assets and
assure they are used solely for the purposes authorized under this contract. Whenever appropriate, financial
information should be related to performance and unit cost data.
10.2 The Contractor shall retain all client records, financial records, supporting documents, statistical records, and
any other documents (including electronic storage media) pertinent to this contract for a period of six (6)
years after completion of the contract or longer when required by law. In the event an audit is required by
this contract, records shall be retained for a minimum period of six (6) years after the audit report is issued or
until resolution of any audit findings or litigation based on the terms of this contract, at no additional cost to
the Agency.
10.3 Upon demand, at no additional cost to the Agency, the Contractor shall facilitate the duplication and transfer
of any records or documents during the required retention period in this section 10.2.
10.4 The Contractor shall assure that the records described in this section 10 will be subject at all reasonable times
to inspection, review, copying, or audit by federal, state, or other personnel duly authorized by the Agency.
10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Agency and
federal auditors, pursuant to 45 CFR 92.36(1)(10), will be allowed full access to and the right to examine any
of the Contractor's contracts and related records and documents pertinent to this specific contract, regardless
January 2012
- . — Vr
Contract #OAA .12 1&4
of the form in which kept.
16 Q
10.6 The Contractor shall provide a financial and compliance audit to the Agency as specified in this contract and
in ATTACHMENT III and ensure that all related third -party transactions are disclosed to the auditor.
10.7 The Contractor shall comply and cooperate immediately with any inspections, reviews, investigations, or
audits deemed necessary by the office of the Inspector General pursuant to s. 20.055, F.S.
11. Nondiscrimination -Civil Rights Compliance
11.1 The Contractor shall execute assurances in ATTACHMENT VI that it will not discriminate against any
person in the provision of services or benefits under this contract or in employment because of age, race,
religion, color, disability, national origin, marital status or sex in compliance with state and federal law and
regulations. The Contractor further assures that all contractors, subcontractors, subgrantees, or others with
whom it arranges to provide services or benefits in connection with any of its programs and activities are not
discriminating against clients or employees because of age, race, religion, color, disability, national origin,
marital status or sex.
11.2 During the term of this contract, the Contractor shall complete and retain on file a timely, complete and
accurate Civil Rights Compliance Checklist (ATTACHMENT B).
11.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination
involving services or benefits through this contract. These procedures will include notifying clients,
employees, and participants of the right to file a complaint with the appropriate federal or state entity.
11.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance, and are binding upon the Contractor, its successors, transferees, and assignees for
the period during which such assistance is provided. The Contractor further assures that all subcontractors,
vendors, or others with whom it arranges to provide services or benefits to participants or employees in
connection with any of its programs and activities are not discriminating against those participants or
employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to
comply, the Contractor understands that the Agency may, at its discretion, seek a court order requiring
compliance with the terms of this assurance or seek other appropriate judicial or administrative relief,
including but not limited to, termination of and denial of further assistance.
12. Provision of Services
The Contractor shall provide services in the manner described in ATTACHMENT I.
13. Monitoring by the Agency
The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records, papers,
documents, facilities, goods and services of the Contractor which are relevant to this contract, and to
interview any clients, employees and subcontractor employees of the Contractor to assure the Agency of the
satisfactory performance of the terms and conditions of this contract. Following such review, the Agency
will provide a written report of its findings to the Contractor, and where appropriate, the Contractor shall
develop a corrective action plan. The Contractor hereby agrees to correct all deficiencies identified in the
corrective action plan in a timely manner as determined by the Contract Manager.
14. Indemnification
The Contractor shall indemnify, save, defend, and hold harmless the Agency and its agents and employees
from any and all claims, demands, actions, causes of action of whatever nature or character, arising out of or
by reason of the execution of this agreement or performance of the services provided for herein. It is
understood and agreed that the Contractor is not required to indemnify the Agency for claims, demands,
actions or causes of action arising solely out of the Agency's negligence.
14.1 Except to the extent permitted by s. 768.28, F.S., or other Florida law, this section 15 is not applicable to
contracts executed between the Agency and state agencies or subdivisions defined in s. 768.28(2), F.S.
15. Insurance and Bonding
15.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or
subdivision as defined by subsection 768.28(2), F.S., the Contractor accepts full responsibility for identifying
and determining the type(s) and extent of liability insurance necessary to provide reasonable financial
protections for the Contractor and the clients to be served under this contract. The limits of coverage under
each policy maintained by the Contractor do not limit the Contractor's liability and obligations under this
contract. The Contractor shall ensure that the Agency has the most current written verification of insurance
coverage throughout the term of this contract. Such coverage may be provided by a self - insurance program
established and operating under the laws of the State of Florida. The Agency reserves the right to require
4
January 2012 Contract #OAA 203.12
additional insurance as specified in this contract. 1605
15.2 Throughout the term of this agreement, the Contractor shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Contractor
authorized to handle funds received or disbursed under all agreements and/or contracts incorporating this
contract by reference in an amount commensurate with the funds handled, the degree of risk as determined by
the insurance company and consistent with good business practices.
16. Confidentiality of Information
The Contractor shall not use or disclose any information concerning a recipient of services under this contract
for any purpose prohibited by state or federal law or regulations except with the written consent of a person
legally authorized to give that consent or when authorized by law.
17. Health Insurance Portability and Accountability Act
Where applicable, the Contractor shall comply with the Health Insurance Portability and Accountability Act
(42 USC 1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
18. Incident Reporting
18.1 The Contractor shall notify the Agency immediately but no later than forty-eight (48) hours from the
Contractor's awareness or discovery of conditions that may materially affect the Contractor or
subcontractor's ability to perform the services required to be performed under this contract. Such notice shall
be made orally to the Contract Manager (by telephone) with an email to immediately follow.
18.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation
of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone
number (1- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both
the Contractor and its employees.
19. New Contract(s) Reporting
The Vendor shall notify the Agency within ten (10) days of entering into a new contract with any of the
remaining four (4) state human service agencies. The notification shall include the following information: (1)
contracting state agency; (2) contract name and number; (3) contract start and end dates; (4) contract amount;
(5) contract description and commodity or service; and (6) Contract Manager name and number. In
complying with this provision, and pursuant to s. 287.0575, F.S. as amended, the Agency shall complete and
provide the information in ATTACHMENT D.
20. Bankruptcy Notification
During the term of this contract, the Contractor shall immediately notify the Agency if the Contractor, its
assignees, subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the
Contractor must also provide the following information to the Area Agency on Aging for Southwest Florida,
Inc.: (1) the date of filing of the bankruptcy petition; (2) the case number; (3) the court name and the division
in which the petition was filed (e.g., United States Bankruptcy Court Middle District of Florida, Fort Myers,
FL); and (4) the name, address, and telephone number of the bankruptcy attorney.
20. Sponsorship and Publicity
21.1 As required by s. 286.25, F.S., if the Contractor is a non - governmental organization which sponsors a
program financed wholly or in part by state funds, including any funds obtained through this contract, it shall,
in publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by Senior Choices
of Southwest Florida and the State of Florida, Department of Elder Affairs." If the sponsorship reference is
in written material, the words "Senior Choices of Southwest Florida and State of Florida, Department of
Elder Affairs" shall appear in at least the same size letters or type as the name of the organization.
21.2 The Contractor shall not use the words "Senior Choices of Southwest Florida and /or the State of Florida,
Department of Elder Affairs" to indicate sponsorship of a program otherwise financed, unless specific
authorization has been obtained by the Agency prior to use.
22. Assignments
22.1 The Contractor shall not assign the rights and responsibilities under this contract without the prior written
approval of the Agency, which shall not be unreasonably withheld. Any sublicense, assignment, or transfer
otherwise occurring without prior written approval of the Agency will constitute a material breach of the
contract.
22.2 Senior Choices of Southwest Florida is at all times entitled to assign or transfer, in whole or part, its rights,
duties, or obligations under this contract to another agency in the State of Florida, upon giving prior written
notice to the Contractor. In the event the Agency approves transfer of the Contractor's obligations, the
Contractor remains responsible for all work performed and all expenses incurred in connection with the
January 2012 In6t DA503.12
contract.
22.3 This contract shall remain binding upon the successors in interest of either the Contractor or the Agency.
23. Subcontracts
23.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to this
contract, whether actually furnished by the Contractor or its subcontractors. Any subcontracts shall be
evidenced by a written document and subject to any conditions of approval the Agency deems necessary.
The Contractor further agrees that the Agency will not be liable to the subcontractor in any way or for any
reason. The Contractor, at its expense, shall defend the Agency against any such claims.
23.2 The Contractor shall promptly pay any subcontractors upon receipt of payment from the Agency or other
state agency. Failure to make payments to any subcontractor in accordance with s. 287.0585, F.S., unless
otherwise stated in the contract between the Contractor and subcontractor, will result in a penalty as provided
by statute.
24. Independent Capacity of Contractor
It is the intent and understanding of the Parties that the Contractor, or any of its subcontractors, are
independent contractors and are not employees of the Agency and shall not hold themselves out as employees
or agents of the Agency without specific authorization from the Agency. It is the further intent and
understanding of the Parties that the Agency does not control the employment practices of the Contractor and
will not be liable for any wage and hour, employment discrimination, or other labor and employment claims
against the Contractor or its subcontractors. All deductions for social security, withholding taxes, income
taxes, contributions to unemployment compensation funds and all necessary insurance for the Contractor are
the sole responsibility of the Contractor.
25. Payment
Payments shall be made to the Contractor pursuant to s. 215.422, F.S., as services are rendered and invoiced
by the Contractor. The Contract Manager will have final approval of the invoice for payment, and will
approve the invoice for payment only if the Contractor has met all terms and conditions of the contract,
unless the bid specifications, purchase order, or this contract specify otherwise. The approved invoice will be
submitted to the Agency's finance section for budgetary approval and processing. Disputes arising over
invoicing and payments will be resolved in accordance with the provisions of s. 215.422 F.S. A Vendor
Ombudsman has been established within the Agency of Financial Services and may be contacted at (850)
413 -5665.
26. Return of Funds
The Contractor shall return to the Agency any overpayments due to unearned funds or funds disallowed and
any interest attributable to such funds pursuant to the terms and conditions of this contract that were
disbursed to the Contractor by the Agency. In the event that the Contractor or its independent auditor
discovers that an overpayment has been made, the Contractor shall repay said overpayment immediately
without prior notification from the Agency. In the event that the Agency first discovers an overpayment has
been made, the Contract Manager will notify the Contractor in writing of such findings. Should repayment
not be made forthwith, the Contractor shall be charged at the lawful rate of interest on the outstanding
balance pursuant to s. 55.03, F.S., after Agency notification or Contractor discovery.
27. Data Integrity and Safeguarding Information
The Contractor shall ensure an appropriate level of data security for the information the Contractor is
collecting or using in the performance of this contract. An appropriate level of security includes approving
and tracking all Contractor employees that request system or information access and ensuring that user access
has been removed from all terminated employees. The Contractor, among other requirements, must
anticipate and prepare for the loss of information processing capabilities. All data and software shall be
routinely backed up to ensure recovery from losses or outages of the computer system. The security over the
backed -up data is to be as stringent as the protection required of the primary systems. The Contractor shall
ensure all subcontractors maintain written procedures for computer system backup and recovery. The
Contractor shall complete and sign ATTACHMENT IV prior to the execution of this contract.
28. Computer Use and Social Media Policy
The Agency of Elder Affairs has implemented a new Social Media Policy, in addition to its Computer Use
Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all
personnel affiliated with third parties, such as, but not limited to, Area Agencies on Aging and vendors. Any
entity that uses the Agency's computer resource systems must comply with the Agency's policy regarding
social media. Social Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS
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1605 Contract #OAA 203.12
feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing
networks such as flickr and YouTube (ATTACHMENT E).
29. Conflict of Interest
The Contractor shall establish safeguards to prohibit employees, board members, management and
subcontractors from using their positions for a purpose that constitutes or presents the appearance of personal
or organizational conflict of interest or personal gain. No employee, officer or agent of the Contractor or
subcontractor shall participate in selection, or in the award of an agreement supported by state or federal
funds if a conflict of interest, real or apparent, would be involved. Such a conflict would arise when: (a) the
employee, officer or agent; (b) any member of his/her immediate family; (c) his or her partner; or (d) an
organization which employs, or is about to employ, any of the above, has a financial or other interest in the
firm selected for award. The Contractor or subcontractor's officers, employees or agents will neither solicit
nor accept gratuities, favors or anything of monetary value from contractors, potential contractors, or parties
to subcontracts. The Contractor's board members and management must disclose to the Agency any
relationship which may be, or may be perceived to be, a conflict of interest within thirty (30) calendar days of
an individual's original appointment or placement in that position, or if the individual is serving as an
incumbent, within thirty (30) calendar days of the commencement of this contract. The Contractor's
employees and subcontractors must make the same disclosures described above to the Contractor's board of
directors. Compliance with this provision will be monitored.
30. Public Entity Crime
Pursuant to s. 287.133, F.S., a person or affiliate who has been placed on the convicted vendor list following
a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any
goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity
for the construction or repair of a public building or public work; may not submit bids, proposals, or replies
on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity; and may not transact business with any
public entity in excess of the threshold amount provided in s. 287.017, F.S., for CATEGORY TWO for a
period of 36 months following the date of being placed on the convicted vendor list.
31. Purchasing
31.1 The Contractor may purchase articles which are the subject of or are required to carry out this contract from
Prison Rehabilitative Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, F.S.,
in the same manner and under the procedures set forth in subsections 946.515(2) and (4), F.S. For purposes
of this contract, the Contractor shall be deemed to be substituted for the Agency insofar as dealings with
PRIDE. This clause is not applicable to subcontractors unless otherwise required by law. An abbreviated list
of products /services available from PRIDE may be obtained by contacting PRIDE, (800) 643 -8459.
31.2 The Contractor may procure any recycled products or materials, which are the subject of or are required to
carry out this contract, in accordance with the provisions of s. 403.7065, F.S.
31.3 The Contractor may purchase articles that are the subject of, or required to carry out, this contract from a
nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413,
F.S., in the same manner and under the same procedures set forth in s. 413.036(1) and (2), F.S. For purposes
of this contract, the Contractor shall be deemed to be substituted for the Agency insofar as dealings with such
qualified nonprofit agency are concerned. Additional information about the designated nonprofit agency and
the products it offers is available at http: / /www.respectofflorida.org. This clause is not applicable to
subcontractors unless otherwise required by law.
32. Patents, Copyrights, Royalties
If this contract is awarded state funding and if any discovery, invention or copyrightable material is
developed, produced or for which ownership was purchased in the course of or as a result of work or services
performed under this contract, the Contractor shall refer the discovery, invention or material to the Agency to
be referred to the State of Florida. Any and all patent rights or copyrights accruing under this contract are
hereby reserved to the State of Florida in accordance with Chapter 286, F.S. Pursuant to s. 287.0571 (5) (k) 1
and 2 as amended, the only exceptions to this provision shall be those that are clearly expressed and
reasonably valued in the contract.
32.1 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain
an unencumbered right to use such property, notwithstanding any agreement made pursuant to this section 33.
32.2 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR 215.36.
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Contract #OAA 203.12
33. Emergency Preparedness and Continuity of Operations
33.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety or welfare, the Contractor shall,
within thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification
of an emergency preparedness plan. In the event of an emergency, the Contractor shall notify the Agency of
emergency provisions.
33.2 In the event a situation results in a cessation of services by a subcontractor, the Contractor shall retain
responsibility for performance under this contract and must follow procedures to ensure continuity of
operations without interruption.
34. PUR 1000 Form
The PUR 1000 Form is hereby incorporated by reference. In the event of any conflict between the PUR 1000
Form and any terms or conditions of this contract the terms or conditions of this contract shall take
precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in the PUR 1000 Form
are required by any section of the Florida Statutes, the terms or conditions contained in the PUR 1000 Form
shall take precedence.
35. Use of State Funds to Purchase or Improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon the
Contractor or political subdivision granting to the state a security interest in the property at least to the
amount of state funds provided for at least 5 years from the date of purchase or the completion of the
improvements or as further required by law.
36. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager, who shall
reduce the decision to writing and serve a copy on the Contractor.
37. Financial Consequences of Non - Performance
If the Contractor fails to meet the minimum level of service or performance identified in this agreement, or
that is customary for the industry, then the Agency must apply financial consequences commensurate with
the deficiency. Financial consequences may include, but are not limited to, contract suspension, refusing
payment, withholding payments until deficiency is cured, tendering only partial payments, and/or
cancellation of contract and reacquiring services from an alternate source.
37.1 The Contractor will not be charged with financial consequences, when a failure to perform arises out of
causes that were the responsibility of the Agency.
38. No Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to
which sovereign immunity may be applicable.
39. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Lee County, Florida.
40. Entire Contract
This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or
representations shall be valid or binding upon the Agency or the Contractor unless expressly contained herein
or by a written amendment to this contract signed by both Parties.
41. Force Maieure
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their
control, provided the party experiencing the force majeure condition provides immediate written notification
to the other party and takes all reasonable efforts to cure the condition.
42. Severability Clause
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or
unenforceable the other provisions are severable to that void provision and shall remain in full force and
effect.
43. Condition Precedent to Contract: Appropriations
The Parties agree that the Agency's performance and obligation to pay under this contract is contingent upon
an annual appropriation by the Legislature.
44. Addition/Deletion
The Parties agree that the Agency reserves the right to add or to delete any of the services required under this
contract when deemed to be in the State of Florida's best interest and reduced to a written amendment signed
by both Parties. The Parties shall negotiate compensation for any additional services added.
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January 2012
Contract #OAA 203.12
45. Waiver 1605
The delay or failure by the Agency to exercise or enforce any of its rights under this contract will not
constitute or be deemed a waiver of the Agency's right thereafter to enforce those rights, nor will any single
or partial exercise of any such right preclude any other or further exercise thereof or the exercise of any other
right.
46. Compliance
The Contractor shall abide by all applicable current federal statutes, laws, rules and regulations as well as
applicable current state statutes, laws, rules and regulations. The Parties agree that failure of the Contractor
to abide by these laws shall be deemed an event of default of the Contractor, and subject the contract to
immediate, unilateral cancellation of the contract at the discretion of the Agency.
47. Final Invoice
The Contractor shall submit the final invoice for payment to the Agency as specified in section 3.3.4. (date
for final request for payment) of ATTACHMENT I. If the Contractor fails to submit final request for
payment by the deadline, then all rights to payment may be forfeited and the Agency may not honor any
requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be
withheld until all reports due from the Contractor and necessary adjustments thereto have been approved by
the Agency.
48. Reneeotiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing
and duly signed by both parties. The rate of payment and the total dollar amount may be adjusted
retroactively to reflect price level increases and changes in the rate of payment when these have been
established through the appropriations process and subsequently identified in the Agency's operating budget.
49. Termination
49.1 This contract may be terminated by either party without cause upon no less than thirty (30) calendar days
notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall
be delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or
by hand delivery to the Contract Manager or the representative of the Contractor responsible for
administration of the contract.
49.2 In the event funds for payment pursuant to this contract become unavailable, the Agency may terminate this
contract upon no less than twenty -four (24) hours notice in writing to the Contractor. Said notice shall be
delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by
hand delivery to the Contract Manager or the representative of the Contractor responsible for administration
of the contract. The Agency will be the final authority as to the availability and adequacy of funds. In the
event of termination of this contract, the Contractor will be compensated for any work satisfactorily
completed prior to the date of termination.
49.3 This contract may be terminated for cause upon no less than twenty -four (24) hours notice in writing to the
Contractor. If applicable, the Agency may employ the default provisions in Rule 60A- 1.006(3), F.A.C.
Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other breach
and shall not be construed to be a modification of the terms and conditions of this contract. The provisions
herein do not limit the Agency's or the Contractor's rights to remedies at law or in equity.
50. Electronic Records and Signature
The Agency authorizes, but does not require, the Contractor to create and retain electronic records and to use
electronic signatures to conduct transactions necessary to carry out the terms of this Agreement. A contractor
that creates and retains electronic records and uses electronic signatures to conduct transactions shall comply
with the requirements contained in the Uniform Electronic Transaction Act, s. 668.50, Fla. Stat. All
electronic records must be fully auditable; are subject to Florida's Public Records Law, ch. 119, Fla. Stat.;
must comply with section 28, Data Integrity and Safeguarding Information; must maintain all confidentiality,
as applicable; and must be retained and maintained by the Contractor to the same extent as non - electronic
records are retained and maintained as required by this Agreement.
50.1 The Agency's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the Agency. The Contractor is authorized to conduct electronic transactions with the Agency
only upon further written consent by the Agency.
50.2 Upon request by the Agency, the Contractor shall provide the Agency with non - electronic (paper) copies of
records. Non - electronic (paper) copies provided to the Agency of any document that was originally in
electronic form with an electronic signature must indicate the person and the person's capacity who
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January 2012
51.
.44
electronically signed the document on any non - electronic copy of the document.
Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
9
e.
Contract #OAA 203.12
•1
The contractor name, as shown on page 1 of this
Collier County Housing, Human and Veteran Services
contract, and mailing address of the official
3339 E Tamiami Trail, Building H
payee to whom the payment shall be made is:
Naples, FL 34112
The name of the contact person and street
Kimberly Grant, Director
Collier County Housing, Human and Veteran Services
address where financial and administrative
3339 E Tamiami Trail, Building H
records are maintained is:
Naples, FL 34112
Kimberly Grant, Director
The name, address, and telephone number of the
Collier County Housing, Human and Veteran Services
representative of the contractor responsible for
3339 E Tamiami Trail, Building H
administration of the program under this contract
Naples, FL 34112
is:
(239) 252 -2273
Area Agency on Aging for Southwest Florida, Inc. dba
The section and location within the agency
Senior Choices of Southwest Florida
where Requests for Payment and Receipt and
15201 N Cleveland Avenue, Suite 1100
Expenditure forms are to be mailed is:
North Fort Myers, FL 33903
Leigh Wade Schield, Executive Director
The name, address, and telephone number of the
Area Agency on Aging for Southwest Florida, Inc. dba
Executive Director for the agency for this
Senior Choices of Southwest Florida
contract is:
15201 N. Cleveland Avenue, Suite. 1100
North Fort Myers, FL 33903
(239) 652 -6900
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
All Terms and Conditions Included
This contract and its ATTACHMENTS: I — XI, A, B, D, E, G, H and J and any exhibits referenced in said
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.
Signature Pages to Follow
10
January 2012 Contract #OAA 203.12
By signing this contract, the Parties agree that they have read and agree to the entire contract. 160 5
IN WITNESS THEREOF, the Parties hereto have caused this 52 page contract, to be executed by their
undersigned officials as duly authorized.
Agency:
Witnesses
A-
Signature i '/
pi A
Printed Na e
/v /-4
Signatu Erk
Printed Name
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 9/30
Contractor:
ATTEST:
Dwight E. Brock, Clerk of Court
lip.
SEAL
, 1
Approvedsf� fo¢ {ate legal sufficiency:
Jennifer B. ite
Assistant County Attorney
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,
INC., D /B /A SENIOR CHOICES OF SOUTHWEST
FLORIDA
SIGNED BY: 414--, A2,j ct,�--
NAME: LEIGH ANNA NOWAK
TITLE: PRESIDENT
DATE: ' I j-, ac t�—
11
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
By:
FRED W. COYLE, CHA N
January 2012
Contract #OAA 203.12
INDEX TO CONTRACT ATTACHMENTS 1605
ATTACHMENT
ATTACHMENT DESCRIPTION
PAGE
ATTACHMENT I
STATEMENT OF WORK
12
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING
25
ATTACHMENT III
FINANCIAL COMPLIANCE AUDIT ATTACHMENT
26
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
31
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
32
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS /SUBCONTRACTS
ATTACHMENT VI
ASSURANCES — NON - CONSTRUCTION PROGRAMS
33
ATTACHMENT VII
BUDGET and RATE SUMMARY
35
ATTACHMENT VIII
INVOICE SCHEDULE
37
ATTACHMENT IX
REQUEST FOR PAYMENT
38
ATTACHMENT X, EXHIBIT 2
RECEIPTS AND EXPENDITURES, TITLE IIIB, IIICI, AND IIIC2
39
ATTACHMENT X, EXHIBIT 3
RECEIPTS AND EXPENDITURES, TITLE IIIE
40
ATTACHMENT A
DEPARTMENT OF ELDER AFFAIRS' PROGRAMS & SERVICES
41
HANDBOOK (ON CD)
ATTACHMENT B
DEPARTMENT OF ELDER AFFAIRS' CIVIL RIGHTS COMPLIANCE
43
CHECKLIST AND INSTRUCTIONS
ATTACHMENT D
PROVIDER'S STATE CONTRACTS LIST
46
ATTACHMENT E
DEPARTMENT OF ELDER AFFAIRS' COMPUTER USE AND SOCIAL
47
MEDIA POLICY
ATTACHMENT G
BACKGROUND SCREENING AFFIDAVIT OF COMPLIANCE
48
ATTACHMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
49
ATTACHMENT J
VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
50
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January 2012 1605CAS#OAA 203.12
ATTACHMENT
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. dba
Senior Choices of Southwest Florida
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE III
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 CONTRACT ACRONYMS
AAA — Area Agency on Aging
ADL — Activities of Daily Living
AIRS — Alliance of Information & Referral Systems
APCL — Assessed Priority Consumer List
APS — Adult Protective Services
CIRTS — Client Information and Registration Tracking System
I &R — Information and Referral
IADL — Instrumental Activities of Daily Living
OAA — Older Americans Act
PSA — Planning and Service Area
1.1.2 PROGRAM SPECIFIC TERMS
Request for Proposal: A proposed 2010 -2012 plan developed by the Contractor outlining a comprehensive and
coordinated service delivery system approved by the Agency's Board of Directors.
Child: An individual who is not more than 18 years of age or an individual with disability.
Family Caregiver: An adult family member, or another individual, who is an informal provider of in -home
and community care to an older individual.
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.
1.2 Agency Mission, Vision and Values Statement
The agency's mission: To help aging adults achieve greater independence through awareness of resources and
access to qualified service providers. The agency's vision: To be the recognized leader in supporting older
adults and their families with access to trustworthy resources and services in their communities while
empowering them to live with independence and dignity. The agency's values: We believe residents of
Southwest Florida are entitled to: Comprehensive information about their choices of care; Timely access to
resources and services; High standards of quality and performance; and Personal and professional
accountability from all stakeholders.
1.2.1 Older Americans Act Program Mission Statement
The Older Americans Act (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 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.
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January 2012 Contract #.QkA 20
1.3 GENERAL DESCRIPTION
1605
.
1.3.1 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
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.
1.3.2 Authority
The relevant references authority governing the OAA program are:
1. Older Americans Act of 2006, as amended;
2. Rule 58A -1, Florida Administrative Code; and
3. Section 430.101, Florida Statutes.
1.3.2.1 Incorporation of Reference Memoranda
In accordance with Ch. 287 F.S., as amended, and Agency of Financial Services' Chief Financial Officer
Memoranda, the following memoranda are provided for informational purposes and incorporated by reference:
1. CFO Memo No. 02: Release date, August 20, 2010;
2. CFO Memo No. 03: Release date, June 29, 2010; and
3. CFO Memo No. 06: Release date, June 30, 2010.
1.3.3 Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of the Title IIIB, Title
IIIC1, Title IIIC2 and Title IIIE programs of the OAA within its designated PSA. The scope of service
includes planning, coordinating and assessing the needs of older persons, and assuring the availability and
quality of services. The services shall be provided in a manner consistent with and described in the current
Contractor's Request for Proposal, and the Agency's Area Plan Update, and the current Department of Elder
Affairs Programs and Services Handbook (ATTACHMENT A).
1.3.4 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 continuum of service
alternatives that meet the diverse needs of elders and their caregivers.
1.4 INDIVIDUALS TO BE SERVED
1.4.1 Eligibility (Title III Programs)
1.4.1.1 OAA Title III, General
Consumers shall not be dually enrolled in an OAA program and a Medicaid capitated long -term care program.
1.4.1.2 OAA Title HIB, Supportive Services
Eligibility for OAA Title IIIB, Supportive Services, are as follows:
1. Individuals must be age 60 or older; and
2. Information and Referral /Assistance services are provided to individuals regardless of age.
1.4.1.3 OAA Titles IIIC1 and C2, Nutrition Services, General
General factors that should be considered in establishing priority for Nutrition Services, both C1 and C2,
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.
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Ctr6 #115
�n /-
1.4.1.3.1 OAA Title IIIC1, Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I,
Paragraph 1.4.1.3, 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:
1. Individuals age 60 or older; and
2. Any spouse (regardless of age) who attends the dining center with his /her eligible spouse;
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;
4. Disabled persons who reside at home with and accompany an eligible person to the dining center; and
5. Volunteers, regardless of age, who provide essential services on a regular basis during meal hours.
1.4.1.3.2 OAA Title IIIC2, Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I,
Paragraph 1.4.1.3, individuals must be homebound and physically, mentally or medically unable to attend a
congregate nutrition program. Individuals eligible to receive home delivered meals include the following:
1. Individuals age 60 or older who are homebound by reason of illness, disability or isolation;
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 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.
1.4.1.4 OAA Title IIIE, Caregiver Support Services
Eligibility for OAA Title IIIE, Caregiver Support Services, are as follows:
1. Family caregivers of individuals age 60 or older;
2. Grandparents (age 55 or older) or older individuals (age 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 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" in OAA, Section 102 Paragraph 22.
1.4.2 Targeted Groups
Preference shall be given to those with the greatest economic and social need, with particular attention to low -
income older individuals, including those that are low- income minorities, have limited English proficiency, and
older individuals residing in rural areas.
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January 2012 Contract # A 203..124
SECTION 11— MANNER OF SERVICE PROVISION 1605
2.1 SERVICE TASKS
In order to achieve the goals of the OAA program, the Contractor shall ensure the following tasks are
performed:
1. Client eligibility determination;
2. Targeting and screening of service delivery for new clients;
3. Delivery of services to eligible clients;
4. Use of volunteers to expand the provision of available services;
5. Monitoring the performance of its subcontractors.
2.1.1 Client Eligibility Determination as listed in ATTACHMENT I, Paragraph 1.4.
2.1.2 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.
2.1.3 Delivery of Services to Eligible Clients
The Contractor shall provide a continuum of services that meets the diverse needs of elders and their caregivers.
The Contractor shall perform and report performance of the following services in accordance with
ATTACHMENT A. The services funded pursuant to this contract are in accordance with the OAA, Title III,
sections 321, 331, 336, and 373 as follows:
1. Section 321, Title II113 Supportive Services;
2. Section 331, Title IIIC1 Congregate Nutrition Services;
3. Section 336, Title IIIC2 Home Delivered Nutrition Services;
4. Section 373, Title IIIE Caregiver Support Services.
2.1.3.1 Supportive Services
Supportive services include a variety of community -based and home - delivered services that support the quality
of life for older individuals by helping them remain independent and productive. Services include the
following:
(1) Adult Day Care /Adult Day Health Care; (17) Homemaker;
(2) Caregiver Training /Support; (18) Housing Improvement;
(3) Case Aid/Case Management; (19) Information;
(4) Chore Services; (20) Intake;
(5) Companionship; (21) Interpreter /Translating;
(6) Counseling (Gerontological and Mental (22) Referral /Assistance;
Health);
(7) Education/Training; (23) Personal Care;
(8) Legal Assistance; (24) Physical Therapy;
(9) Material Aid; (25) Shopping Assistance;
(10) Occupational Therapy; (26) Skilled Nursing;
(11) Outreach; (27) Specialized Medical Equipment, Services,
and Supplies
(12) Recreation; (28) Respite Services;
16
January 2012 Cof6ou 5.12 (13) Emergency Alert Response; (29) Screening/Assessment;
(14) Escort; (30) Speech Therapy;
(15) Health Support; (31) Telephone Reassurance; and
(16) Home Health Aid; (32) Transportation
2.1.3.2 Congregate Nutrition Services
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.
2.1.3.3 Home Delivered Nutrition Services
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 nutrition and other
disease prevention and health promotion services. Services include the following:
1. Home delivered meals;
2. Nutrition education and counseling; and
3. Outreach.
2.1.3.4 Caregiver Support Services (IIIE Program)
The following services are intended to provide direct help to caregivers, assist in the areas of health, nutrition and
financial literacy and assist caregivers in making decisions and problem solving 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);
6. Information;
7. Intake;
8. Outreach;
9. Referral /Assistance;
10. Respite Services;
11. Screening/Assessment; and
12. Transportation.
17
January 2012 Contract #OAA 203.12
2.1.3.5 Caregiver Support Supplemental Services (IIIES Program): The following services are provided to
complement the care provided by caregivers:
1. Chore Services; 1605
2. Housing Improvement;
3. Legal Assistance;
4. Material Aid; and
5. Specialized Medical Equipment, Services and Supplies.
2.1.3.6 Caregiver Support Grandparent Services (IIIEG Program): Services for grandparents or older individuals
who are relative caregivers designed to help meet their caregiving obligations include the following:
1. Caregiver Training/Support;
7.
Outreach;
2. Child Day Care;
8.
Referral /Assistance;
3. Counseling (Gerontological and Mental Health);
9.
Screening/Assessment;
4. Education/Training;
10.
Sitter; and
5. Information;
11.
Transportation
6. Legal Assistance;
2.1.4 Use of Volunteers to Expand the Provision of Available Services
2.1.4.1 The Contractor shall make use of trained volunteers in providing direct services delivered to older individuals
and individuals with disabilities needing such services. If possible, the Contractor shall work in coordination
with organizations that have experience in providing training, placement, and stipends for volunteers or
participants (such as organizations carrying out federal service programs administered by the Corporation for
National and Community Service), in community service settings.
2.1.4.2 The Contractor shall submit a quarterly report of volunteer activities and services electronically in a format
provided by the Agency's. The quarterly report schedule is as follows:
Report Period Report Due Date
January 1 - March 31
April 1- June 30
July 1- September 30
October 1 - December 31
April 15, 2012
July 15, 2012
October 15, 2012
January 15, 2013
2.1.5 Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the Contractor shall not delay the
implementation of its agreement with the subcontractor. If any circumstances occur that may result in a delay for
a period of 60 days or more of the initiation of the subcontract or in the performance of the subcontractor, the
Contractor shall notify the Contract Manager in writing of such delay.
The Contractor shall not permit a subcontractor to perform services related to this agreement without having a
binding subcontractor agreement executed. In accordance with section 24.1 of the Standard Contract, the Agency
will not be responsible or liable for any obligations or claims resulting from such action.
2.1.6 Subcontractor Outreach Reporting Requirements
The Contractor shall document its oversight of subcontractor performance of outreach activities, by establishing a
18
January 2012
16 G5 1 k ontract #OAA 203.12
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.
2.2 SERVICE LOCATION AND EQUIPMENT
2.2.1 Service Times
The Contractor shall ensure the provision of the services listed in the contract during normal business hours unless
other times are more appropriate to meet the performance requirements of the contract, and it shall monitor its
subcontractors to ensure they are available to provide services during hours responsive to client needs and during
those times which best meet the needs of the relevant service community.
2.3 Equipment
2.3.1 Equipment means: (a) an article of nonexpendable, tangible personal property having a useful life of more than
one year and an acquisition cost which equals or exceeds the lesser of the capitalization level established by the
organization for the financial statement purposes, or $5,000.00 [for federal funds], or (b); nonexpendable, tangible
personal property of a nonconsumable nature with an acquisition cost of $1,000.00 or more per unit, and expected
useful life of at least one year; and hardback bound books not circulated to students or the general public, with a
value or cost of $250.00 or more [for state funds].
2.3.2 Contractors and subcontractors who are Institutions of Higher Education, Hospitals, and Other Non - Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A -110) that include: (a) a property list with all the elements
identified in 2 CFR Part 215; (b) a procedure for conducting a physical inventory of equipment at least once every
two years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of the equipment;
and (d) maintenance procedures to keep the equipment in good condition. The property records must be
maintained on file and shall be provided to the Agency upon request. The Contractor shall promptly investigate,
fully document and notify the Contract Manager of any loss, damage, or theft of equipment. The Contractor shall
provide the results of the investigation to the Contract Manager.
2.3.3 The Contractor's property management standards for equipment acquired with federal funds and federally owned
equipment shall include accurately maintained equipment records with the following information:
1. A description of the equipment;
2. Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
3. Source of the equipment, including the award number;
4. Whether title vests in the Contractor or the federal government;
5. Acquisition date (or date received, if the equipment was furnished by the federal government) and cost;
6. Information from which one can calculate the percentage of federal participation in the cost of the equipment
(not applicable to equipment furnished by the federal government);
7. Location and condition of the equipment and the date the information was reported;
8. Unit acquisition cost; and
9. Ultimate disposition data, including date of disposal and sales price or the method used to determine current
fair market value where a Contractor compensates the federal awarding agency for its share.
2.3.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with
state funds with an acquisition cost over $1,000.00 that is specifically identified in the area plan approved by the
Agency is part of the cost of carrying out the activities and functions of the grant awards and title (ownership) will
vest in the Contractor, subject to the conditions of 2 CFR Part 215 Administrative Requirements (formerly OMB
Circular A -110), Subpart C, paragraph 34. Equipment purchased under these thresholds is considered supplies and
is not subject to property standards. Equipment purchased with funds identified in the budget attachments to
agreements covered by this contract or identified in the sub - agreements with subcontractors (not included in a cost
19
January 2012
1605 Contract #OAA 203.12
methodology), is subject to the conditions of section 273, F. S. and 60A- 1.0017, F. A. C. or Title 45 CFR Part 74.
2.3.5 The Contractor shall not dispose of any equipment or materials provided by the Agency or purchased with funds
provided through this contract, without first obtaining the approval of the Contract Manager. When disposing of
property or equipment the Contractor must submit a written request for disposition instructions to the respective
Contract Manager. The request should include a brief description of the property, purchase price, funding source,
percentage of state or federal participation, acquisition date and condition of the property. The request should also
indicate the Contractor's proposed disposition (e.g., transfer or donation to another agency that administers federal
programs, offer the items for sale, destroy the items).
2.3.6 The Contract Manager will issue disposition instructions. If disposition instructions are not received within 120
days of the written request for disposition, the Contractor is authorized to proceed as directed in 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A -110).
2.3.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract without the prior approval of the Agency. Real property purchases
from OAA funds are subject to the provisions of Title 42, Chapter 35, Subchapter III, Part A., Sec. 3030b United
States Code. Real property purchases from state funds can only be made through fixed capital outlay grants and
aids appropriations and therefore are subject to the provisions of section 216.348, F. S.
2.3.8 Any permanent storage devices (e.g., hard drives and removable storage media) must be reformatted and tested
prior to disposal to ensure no confidential information remains.
2.3.9 The Contractor must adhere to the Agency's procedures and standards when purchasing Information Technology
Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR worksheet is
required for any computer related item costing $1,000.00 or more, including data processing hardware, software,
services, supplies, maintenance, training, personnel and facilities. The completed ITR worksheet shall be
maintained in the LAN administrator's file and must be provided to the Agency upon request. The Contractor has
the responsibility to require any subcontractors to comply with the Agency's ITR procedures.
2.4 DELIVERABLES
2.4.1 Service Unit
The Contractor shall provide the services described in the contract in accordance with ATTACHMENT A. The
chart below lists the services that can be performed and the unit of measurement.
dult Day Care /Adult Day Health Care
Interpreter /Translating
Caregiver Training/Support
Legal Assistance
Case Aid/Case Management
Medication Management
Child Day Care
Mental Health Counseling/Screening
Chore Services
Nutrition Counseling
Companionship
Occupational Therapy
Congregate Meals Screening
Personal Care
Counseling Services
Physical Therapy
Hour
Escort
Recreation
Financial Risk Reduction Services
Respite Services
Health Support
Screening/Assessment
Home Health Aide
Sitter
Homemaker
Skilled Nursing Services
Housing Improvement
Speech Therapy
Intake
Emergency Alert Response
Day
20
January 2012
IOU9
Contract #OAA 203.12
Education/Training
Episode
Information
Material Aid
Nutrition Education
Outreach
Referral /Assistance
Specialized Medical Equipment, Services and Supplies
Telephone Reassurance
Escort
One -Way Trip
Shopping Assistance
Transportation
Congregate and Home Delivered Meals
Meal
2.5 REPORTS
The Contractor is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the Agency. The Contractor must establish due dates for any subcontractors
that permit the Contractor to meet the Agency's reporting requirements.
2.5.1 Client Information and Registration Tracking System (CIRTS) Reports
The Contractor is required to use CIRTS reports in the web -based CIRTS database system to ensure data accuracy.
The report categories include the following:
Client Reports;
Monitoring Reports;
Services Reports;
Miscellaneous Reports;
Fiscal Reports; and
Outcome Measurement Reports.
2.5.2 Service Costs Reports
The Contractor shall require subcontractors to submit to the Contractor semi - annual service cost reports (August
15, 2012 and February 15, 2013), which reflect actual costs of providing each service by program. This report
provides information for planning and negotiating unit rates.
2.5.3 Variance Report
The Contractor will submit a consolidated variance report in a format provided by the Agency to the Contract
Manager by the 18th of each month. This report is for all agreements and /or contracts between the Contractor and
the Agency. The report shall include the following:
1. The Contractor's detailed plan on how the surplus /deficit spending exceeding the threshold specified by the
Agency will be resolved;
2. Recommendations to transfer funds to resolve surplus /deficit spending;
3. Number of clients currently on APCL that receive a priority ranking score of 4 or 5; and
4. Number of clients currently on the APCL designated as Imminent Risk.
2.5.4 OAA Annual Report
The completed manual units of service portions of the OAA Annual Report, if applicable, are due to the Contract
Manager on the date established by the Agency. The Agency will obtain the remaining report sections from the
CIRTS.
2.5.5 Background Screening Affidavit of Compliance
To demonstrate compliance with section 8 of the Standard Contract, the Contractor shall submit ATTACHMENT
G, Background Screening Affidavit of Compliance annually, by January 15`n
2.6 RECORDS AND DOCUMENTATION
The Contractor will ensure the collection and maintenance of client and service information on a monthly basis
from the CIRTS or any such system designated by the Agency. Maintenance includes valid exports and backups
21
January 2012 Contract #OAA 203.12
of all data and systems according to Agency standards. 16B5
2.6.1 Each Contractor and subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The Contractor shall maintain written policies and procedures for computer
system backup and recovery and shall have the same requirement in its contracts and/or agreements with
subcontractors. These policies and procedures shall be made available to the Agency upon request.
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outcomes
1. The Contractor shall timely submit to the Agency all reports described in ATTACHMENT I, Paragraph 2.5
REPORTS.
2. The Contractor shall timely submit to the Agency all information described in ATTACHMENT I,
Paragraph 2.6 RECORDS AND DOCUMENTATION.
3. The Contractor shall ensure services in this contract are in accordance with ATTACHMENT A.
2.7.2 The performance of the Contractor in providing the services described in this contract shall be measured by the
current Area Plan strategies for the following criteria:
Percent of most frail elders who remain at home or in the community instead of going into a nursing home;
2. Percent of APS referrals who are in need of immediate services to prevent further harm who are served within
72 hours;
3. Average monthly savings per consumer for home and community -based care versus nursing home care for
comparable client groups;
4. Percent of elders assessed with high or moderate risk environments who improved their environment score;
5. Percent of new service recipients with high -risk nutrition scores whose nutritional status improved;
6. Percent of new service recipients whose ADL assessment score has been maintained or improved;
7. Percent of new service recipients whose IADL assessment score has been maintained or improved;
8. Percent of family and family- assisted caregivers who self -report they are very likely to provide care;
9. Percent of caregivers whose ability to continue to provide care is maintained or improved after one year of
service intervention (as determined by the caregiver and the assessor); and
10. Percent of customers who are at imminent risk of nursing home placement who are served with community
based services.
2.7.3 Remedies - Nonconforming Services
The Contractor shall ensure that all participants served under this agreement are eligible for the program, and that
all monthly and /or quarterly performance reports and financial records are maintained for each reporting period
and submitted as stipulated in Paragraphs 1.4 - 1.4.2 and 2.1 - 2.1.6 and 2.5 - 2.5.8.
2.7.3.1 Any nonconforming program services, performance reports or financial records not meeting the aforementioned
requirements shall not be eligible for reimbursement under this program. The costs associated with enrolling,
training, reporting and/or managing the program shall be borne solely by the Contractor. The Agency requires
immediate notice of any significant and/or systemic infractions that compromise the Contractor's ability to provide
participant services, to achieve programmatic performance or to provide sound financial management of the
program.
2.8 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.8.1 Matching, Level of Effort, and Earmarking Requirements
The Contractor shall provide match of at least 10 percent of the federal funds received. The Contractor's match
will be made in the form of cash 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 all services funded through this contract.
22
January 2012
1605ontract #OAA 203.12
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 all OAA funds.
2.8.2 Consumer Contributions
Consumer contributions are to be used under the following terms:
1. The Contractor assures compliance with Section 315 of the OAA as amended in 2006, in regard to consumer
contributions;
2. Voluntary contributions are not to be used for cost sharing or matching;
3. Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and
4. Voluntary contributions are to be used only to expand services.
2.8.3 Use of Service Dollars
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 funds accordingly, the Agency may transfer
funds to other Contractors during the contract period and /or adjust subsequent funding allocations accordingly, as
allowable under state and federal law.
2.8.4 The Contractor agrees to distribute funds as detailed in the Budget Summary, ATTACHMENT VII to this
contract. Any changes in the amounts of federal identified on the Budget Summary form require a contract
amendment.
2.8.5 Title III Funds
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 incurred by the Contractor to maintain a contractual or
commercial relationship that is not carried out to implement Title III.
2.9 AGENCY RESPONSIBILITIES
2.9.1 Program Guidance and Technical Assistance
The Agency will provide to the Contractor guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Contractor.
2.9.2 Program /Contract Monitoring
The Agency will review and evaluate the performance of the Contractor under the terms of this 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 conclusive. The Contractor agrees to cooperate with the
Agency in monitoring the progress of 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:
1. Desk reviews and analytical reviews;
2. Scheduled, unscheduled and follow -up on -site visits;
3. Client visits;
4. Review of independent auditor's reports;
5. Review of third -party documents and /or evaluation;
6. Review of progress reports;
7. Review of customer satisfaction surveys;
8. Agreed =upon procedures review by an external auditor or consultant;
9. Limited -scope reviews; and
10. Other procedures as deemed necessary.
23
January 2012 Contract #OAAA 203.12
2.9.3 Contract Monitoring 1605
The Agency shall, at its own discretion, conduct monitoring concerning any aspect of the contractor's performance
of this contract.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances and fixed rate for services. The Contractor shall
ensure fixed rates for services include only those costs that are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an independent audit is
required. The Contractor shall consolidate all requests for payment from subcontractors and expenditure reports
that support requests for payment and shall submit to the Agency on forms 106A (ATTACHMENT IX), 105AA
(ATTACHMENT X, EXHIBIT 1), 105AS (ATTACHMENT X, EXHIBIT 2), and 105AE (ATTACHMENT
X, EXHIBIT 3).
3.1.1 The Contractor agrees to implement the distribution of funds as detailed in ATTACHMENT VII, Budget
Summary. An amendment is required to change the total amount of the contract.
3.2 Advance Payments
3.2.1 The Contractor may request up to two months of advances at the start of the contract period, if available, to cover
program administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the Agency by the State of Florida ( "budget release "). The Contractor shall provide
the Contract Manager documentation justifying the need for an advance and describing how the funds will be
distributed.
3.2.2 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient budget is
available, the Agency will issue approved advance payments after January 1, 2012.
3.2.3 All advance payments made to the Contractor shall be returned to the Agency as follows: one — twelfth of the
advance payment received shall be reported as an advance recoupment on each request for payment, starting with
report number three, in accordance with the Invoice Schedule, ATTACHMENT VIII to this contract.
3.2.4 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 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.
3.3 Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA
forms 106A (ATTACHMENT IX) , 105AS (ATTACHMENT X- EXHIBIT 2), and 105AE (ATTACHMENT
X- EXHIBIT 3).
3.3.1 The Contractor shall submit all payment requests based on the submission of the Contractor's actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance
requests (when available) and invoices is ATTACHMENT VIII to this contract.
3.3.2 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval of all financial and programmatic reports due from the Contractor and any adjustments thereto, including
any disallowance not resolved as outlined in Paragraph 26 of this contract.
3.3.3 The Agency will authorize payment only for allowable expenditures, which are in accordance with the limits
specified in ATTACHMENT VII, Budget Summary. Any changes in the amounts of federal or general revenue
funds identified on the Budget Summary form require a contract amendment.
3.3.4 Date for Final Request for Payment
The Contractor shall submit the final request for payment to the Agency no later than February 1, 2013.
3.4 Documentation for Payment
The Contractor shall maintain documentation to support payment requests, and the Contractor shall make such
documentation available to the Agency upon request.
3.4.1 The Contractor shall ensure all required data per the Department of Elder Affair's CIRTS Policy Guidelines for
clients and services is entered in the CIRTS database. The data entered into CIRTS must be submitted with their
request for payment and expenditure reports to the Agency.
3.4.2 The Contractor shall run monthly CIRTS reports and verify that client and service data in CIRTS is accurate.
24
January 2012 1605 Contract #OAA 203.12
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING CERTIFICATION
FOR CONTRACTS, GRANTS, LOANS AND 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 employee of any state or federal agency, a member of congress, an
officer or employee of congress, an employee of a member of congress, or an officer or employee of the state
legislator, in connection with the awarding 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.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of
congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form -LLL, 'Disclosure Form to Report Lobbying,"
in accordance with its instructions.
(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)
and that all sub - contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure.
luck February 28, 2012
Signature
Date
FRED W. COYLE, CHAIRMAN OAA 203.12
Name of Authorized Individual Application or Agreement Number
Board of County Commissioners
Collier County, Florida
3299 Tamiami Trail E., Suite 303
Naples FL 34112
Name and Address of Organization
Approved as to form and legal sufficiency:
Vv
Jennifer WWhite
Assistant County Attorney
DOEA Form 103 ;
(Revised Nov 2002) t
25 4
January 2012
FINANCIAL AND COMPLIANCE AUDIT
Contract #OAA 203.12
1605
ATTACHMENT III
The administration of resources awarded by Senior Choices of Southwest Florida to the provider may be subject to
audits and/or monitoring by the Agency, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A -133, as revised, and Section 215.97, F.S.,
(see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the Agency staff,
limited scope audits as defined by OMB Circular A -133, as revised, and/or other procedures. By entering into this
agreement, the provider agrees to comply and cooperate with any monitoring procedures /processes deemed appropriate by
Senior Choices of Southwest Florida. In the event the Agency determines that a limited scope audit of the provider is
appropriate, the provider agrees to comply with any additional instructions provided by the Agency to the provider
regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations,
or audits deemed necessary by the Chief Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non -profit organization as defined in OMB
Circular A -133, as revised.
In the event that the provider expends $500,000.00 or more in Federal awards during its fiscal year, the provider must
have a single or program- specific audit conducted in accordance with the provisions of OMB Circular A -133, as revised.
EXHIBIT 1 to this agreement indicates Federal resources awarded through the Department of Elder Affairs by this
agreement. In determining the Federal awards expended in its fiscal year, the provider shall consider all sources of
Federal awards, including Federal resources received from the Department of Elder Affairs. The determination of
amounts of Federal awards expended should be in accordance with the guidelines established by OMB Circular A -133, as
revised. An audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular
A -133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the requirements
relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised.
If the provider expends less than $500,000.00 in Federal awards in its fiscal year, an audit conducted in accordance with
the provisions of OMB Circular A -133, as revised, is not required. In the event that the provider expends less than
$500,000.00 in Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of
OMB Circular A -133, as revised, the cost of the audit must be paid from non - Federal resources (i.e., the cost of such audit
must be paid from provider resources obtained from other than Federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs shall be based on the agreement's
requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall
disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and
liabilities due to the Department of Elder Affairs shall be fully disclosed in the audit report with reference to the
Department of Elder Affairs agreement involved. If not otherwise disclosed as required by Section .310(b)(2) of OMB
Circular A -133, as revised, the schedule of expenditures of Federal awards shall identify expenditures by agreement
number for each agreement with the Department of Elder Affairs in effect during the audit period. Financial reporting
packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9
months after the end of the provider's fiscal year end.
26
January 2012
PART II: STATE FUNDED
16 005act #OAA 203.12
This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes.
In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000.00 in
any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider must have a State
single or project - specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of
the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -
profit organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial assistance
awarded through the Department of Elder Affairs by this agreement. In determining the state financial assistance
expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state financial
assistance received from the Department of Elder Affairs, other state agencies, and other nonstate entities. State financial
assistance does not include Federal direct or pass - through awards and resources received by a nonstate entity for Federal
program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1, the provider shall ensure that the audit
complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting
package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650
(nonprofit and for -profit organizations), Rules of the Auditor General.
If the provider expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending
September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, Florida
Statutes, is not required. In the event that the provider expends less than $500,000.00 in state financial assistance in its
fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the
cost of the audit must be paid from the nonstate entity's resources (i.e., the cost of such an audit must be paid from the
provider resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs shall be based on the agreement's
requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or
not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the
Department of Elder Affairs shall be fully disclosed in the audit report with reference to the Department of Elder Affairs
agreement involved. If not otherwise disclosed as required by Rule 69I- 5.003, Fla. Admin. Code, the schedule of
expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the
Department of Elder Affairs in effect during the audit period. Financial reporting packages required under this part must
be submitted within 45 days after delivery of the audit report, but no later than 12 months after the provider's fiscal year
end for local governmental entities. Non -profit or for - profit organizations are required to be submitted within 45 days
after delivery of the audit report, but no later than 9 months after the provider's fiscal year end. Notwithstanding the
applicability of this portion, the Department of Elder Affairs retains all right and obligation to monitor and oversee the
performance of this agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and required by
PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A -133, as revised, by or
on behalf of the provider directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of Southwest Florida at the following
address:
Area Agency on Aging for Southwest Florida, Inc. dha
Senior Choices of Southwest Florida
Attn: Leigh Wade Schield, Executive Director
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
27
January 2012
16 Oat #OAA 203.12
The Federal Audit Clearinghouse designated in OMB Circular A -133, as revised (the number of copies required by Sections
.320 (d)(1) and (2), OMB Circular A -133, as revised, should be submitted to the Federal Audit Clearinghouse), at the
following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
Other Federal agencies and pass - through entities in accordance with Sections .320 (e) and (f), OMB Circular A -133, as
revised. Pursuant to Sections .320(f), OMB Circular A -133, as revised, the provider shall submit a copy of the reporting
package described in Section .320(c), OMB Circular A -133, as revised, and any management letter issued by the auditor,
to the Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of Southwest Florida at the following
address:
Area Agency on Aging for Southwest Florida, Inc. dba
Senior Choices of Southwest Florida
Attn: Leigh Wade Schield, Executive Director
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on
behalf of the provider directly to each of the following:
The Area Agency on Aging for Southwest Florida, Inc. dba Senior Choices of Southwest Florida at the following address:
Area Agency on Aging for Southwest Florida, Inc. dba
Senior Choices of Southwest Florida
Attn: Leigh Wade Schield, Executive Director
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399 -1450
Any reports, management letter, or other information required to be submitted to Senior Choices of Southwest Florida
pursuant to this agreement shall be submitted timely in accordance with OMB Circular A -133, Florida Statutes, and
Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor
General, as applicable.
Providers, when submitting financial reporting packages to Senior Choices of Southwest Florida for audits done in
accordance with OMB Circular A -133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit
organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to the
provider in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six
years from the date the audit report is issued, and shall allow Senior Choices of Southwest Florida or its designee, the CFO
or Auditor General access to such records upon request. The provider shall ensure that audit working papers are made
available to Senior Choices of Southwest Florida, or its designee, CFO, or Auditor General upon request for a period of
six years from the date the audit report is issued, unless extended in writing by Senior Choices of Southwest Florida.
28
January 2012
1605 14
Contract #OAA 203.12
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
Older Americans Act Title I1113 -
CA/CM/SCAS/INSC
$ 20,000.00
Transportation
U.S. Health and Human Services
93.044
$ 65,000,00
Support Services
$ 85,000.00
Total IIIB
$275,000.00 **
OAA Title IIICI — Congregate Meals
U.S. Health and Human Services
93.045
$236,300.00
Spending Authority
OAA Title III C2 — Home Delivered Meals
U.S. Health and Human Services
93.045
$226,750.00
Older Americans Act Title III E —
$ 40,976.00
Supplement Services
U.S.
. Health and Human Services
93.052
18,079.00
Grandparent Services
$ 7,859.00
Total IIIE
$ 66,914.00
TOTAL FEDERAL AWARD
$614,964.00
** In Home Services $275,000.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by The Area Agency on Aging for
Southwest Florida, Inc. dba Senior Choices of Southwest Florida
29
January 2012
PART I: AUDIT RELATIONSHIP DETERMINATION
16U5 C"
Contract #OAA 203.12
ATTACHMENT III
EXHIBIT 2
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A -133, as
revised, and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state
financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit
1 are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A -133, as
revised, and/or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined
to be recipients or subrecipients of Federal awards and/or state financial assistance, must comply with applicable programmatic
and fiscal compliance requirements.
In accordance with Sec. 210 of OMB Circular A -133 and/or Rule 691 - 5.006, FAC, provider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A -133 and/or Section 215.97, F.S.
X Recipient/subrecipient subject to OMB Circular A -133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and has been approved by the
Department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I- .006(2), FAC [state financial assistance] and
Section _ .400 OMB Circular A -133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or
state matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws,
rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A -87)*
OMB Circular A -102 — Administrative Requirements
OMB Circular A -133 —Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON - PROFIT ORGANIZATIONS MUST FOLLOW:
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)
Requirements)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A -21 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 — Administrative Requirements)
OMB Circular A -133 —Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular A-
133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 691 -5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
30
1605 1 �1`11_
January 2012 Contract #OAA 203.12
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the contractor named in the contract or agreement to which this form is an
attachment, hereby certifies that:
(1) The contractor and any sub - contractors of services under this contract have financial management systems capable of
providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each
grant- funded project or program in accordance with the prescribed reporting requirements; (2) the source and application
of funds for all agreement supported activities; and (3) the comparison of outlays with budgeted amounts for each award.
The inability to process information in accordance with these requirements could result in a return of grant funds that
have not been accounted for properly.
(2) Management Information Systems used by the contractor, sub - contractor(s), or any outside entity on which the contractor
is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of
processing data accurately, including year -date dependent data. For those systems identified to be non- compliant,
contractor(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the
undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of
these products offered by the contractor (represented by the undersigned) and purchased by the State will be
verified for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that
impede the hardware or software programs from operating properly, the contractor agrees to immediately make required
corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge
to the State, and without interruption to the ongoing business of the state, time being of the essence.
(4) The contractor and any sub- contractor(s) of services under this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data
integrity compliance issues.
The contractor shall require that the language of this certification be included in all subagreements, subgrants, and other
agreements and that all sub - contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by
OMB Circulars A -102 and 2 CFR Part 215 (formerly OMB Circular A -110).
Board of County Commissioners, Collier County, Florida 3299 Tamiami Trail E., Suite 303, Naples FL 34112
W
Signature
CHAIRMAN
Title
FRED W. COYLE, CHAIRMAN
Name of Authorized Signer (Revised June' 008)
v t
1 4Q
-�i
Attat a
February 28, 2012
Date
Approved as to form and legal sufficiency:
Jennifer B. White, -Assistant County Attornelt�
31
Janua ry 2012 1605ontrjac'tq#0AA 203.12
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective contractor certifies, by signing this certification, neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any federal Department or agency.
(2) Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective
participant shall attach an explanation to this certification.
"*,� W.
Signature
FRED W. COYLE, CHAIRMAN
Title
Certification signature should be same as Contract signature.)
February 28, 2012 _
Date
Board of County Commissioners, Collier County
Agency /Organization
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person,"
"primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out in the sections of
rules implementing Executive Order 12549. (2 CFR 180.5- 180.1020, as supplemented by 2 CFR 376.10- 376.995).
You may contact the Contract Manager for assistance in obtaining a copy of those regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties entered into this
transaction. If it is later determined that the contractor knowingly rendered an erroneous certification, in addition
to other remedies available to the federal government, the Department may pursue available remedies, including
suspension and/or debarment.
3. The contractor will provide immediate written notice to the Contract Manager if at any time the contractor learns that its
certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The
contractor may decide the method and frequency by which it determines the eligibility of its principals. Each participant
to a lower tier covered transaction may, but is not required to, check the Excluded Parties List System (EPLS).
4. The contractor will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
- Lower Tier Covered Transaction" in all its lower tier covered transactions and in all solicitations for lower tier
covered transactions.
5. The contractor agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized by
the federal government.
6. If the contractor knowingly enters into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the
federal government, the Department may pursue available remedies, including suspension, and/or debarment.
7. The contractor may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not
debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the
certification is erroneb'us`11 e)14 dj.m2008)
Approved as to form and legal sufficiency:
ANIM
Jennifer . White, Assistant County Attorney �W
y 32
January 2012
1605 ontract #bAA 203.12
ASSURANCES —NON- CONSTRUCTION PROGRAMS
ATTACHMENT VI
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the
collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348- 0043),
Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If
such is the case, you will be notified.
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds
sufficient to pay the non - Federal share of project cost) to ensure proper planning, management, and completion of the project
described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C..4728 -4763) relating to prescribed standards for merit
systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil
Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C., 1681 -1683, and 1685- 1686), which prohibits discrimination on the basis of
sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C..794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101 - 6107), which prohibits discrimination on the basis
of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on the basis
of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L.
91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290 dd -3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient
records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the
sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for
Federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the
application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L. 91 -646) which provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of Federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501 -1508 and 7324 - 7328), which limit the political
activities of employees whose principal employment activities are funded in whole or in part with Federal funds.
33
January 2012
6 D 1"'
ontract #OAA 203.12
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S. C. 276a -7), the Copeland Act (40 U.S.C.
276c and 18 U.S.C., 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333), regarding labor standards for
federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act
of 1973 (P.L. 93 -234) which requires recipients in a special flood hazard area to participate in the program and to purchase
flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental
quality control measures under the National Environmental Policy Act of 1969 (P.L. 91 -190) and Executive Order (EO) 11514;
(b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of
flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C., 1451 et seq.); (f) conformity of
Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42
U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
amended, (P.L. 93 -523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L.
93 -205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C., 1721 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C..470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C..469a -1 et seq.).
14. Will comply with P.L. 93 -348 regarding the protection of human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 -544, as amended, 7 U.S.C..2131 et seq.) pertaining to the
care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.), which prohibits the use of lead- based
paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments
of 1996 and OMB Circular No. A -133, Audits of States, Local Governments, and Non -Profit Organizations.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this
program
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
lukW.
FRED W. COYLE, CHAIRMAN
APPLICANT ORGANIZATION
DATE SUBMITTED
Collier County Board of County Commissioners
February 28, 2012
3299 Tamiami Trail E., Suite 303
Naples FL 34112
Approved as to form &
Jennifer B. White, Assil
N-11
DWIGHT E. nt
F
34
January 2012
16D5 s
Contract #OAA 203.12
ATTACHMENT VII
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
1. Title III B Support Services $85,000.00 **
2. Title III C1 Congregate Meals $236,300.00
3. Title III C2 Home Delivered Meals $226,750.00
4. Title III E Services $ 66,914.00
TOTAL: $614,964.00
** In Home Services $275,000.00
In Home Services are funds to serve Collier County Clients. The Vendors are paid directly by the Area Agency on
Aging for Southwest Florida, Inc., dba Senior Choices of Southwest Florida.
35
Janua ry 2012 1605 , Contract #OAA 203.12
OLDER AMERICANS ACT
RATE SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
IIIB &IIIE
Services Total Cost Reimbursement Rate
IUB
Case Aide
$27.78
$25.00
Case Management
$50.00
$45.00
Intake
$27.78
$25.00
Screening/Assessment
$50.00
$45.00
Transportation
100% Cost
90% of Cost
IIIE
Outreach
$58.89
$53.00
Respite-Day Care
$11.12
$10.00
Direct Pay Respite
Must include match
Up to $21.00
Direct Pay Facility Respite
Must include match
24 hours -- $125.00
Day Care -Sitter
$13.34
$12.00
Screening/Assessment-
$50.00
$45.00
Services
Cl
RATE SUMMARY
C -1 & C -2
Total Cost Reimbursement Rate
Congregate Meals
$ 9.84
$ 8.86
Nutrition Counseling
$58.89
$53.00
Nutrition Education
$ 1.80
$ 1.62
Nutrition Screening
$31.11
$28.00
Outreach
$4.80 per person
1 $4.32 per person
C2
Home Delivered Meals
$ 9.77
$ 8.79
Nutrition Counseling
$58.89
$53.00
Nutrition Education
$ 1.80
$ 1.62
Nutrition Screening
$50.00
$45.00
Outreach
$4.80 per person
$4.32 per person
36
January 2012
INVOICE SCHEDULE
ADVANCE BASIS CONTRACT
Report Number Based On
1
January Advance*
2
February Advance*
3
January Expenditure Report
4
February Expenditure Report
5
March Expenditure Report
6
April Expenditure Report
7
May Expenditure Report
8
June Expenditure Report
9
July Expenditure Report
10
August Expenditure Report
11
September Expenditure Report
12
October Expenditure Report
13
Report Advance Refund/Recoupment
14
November Expenditure Report
15
December Expenditure Report
16
Final Expenditure and Request for Payment
17
Closeout Report
Legend:
* Advance based on projected cash need.
16 D
Contract 50AA 203.12
ATTACHMENT VIII
Submit to State
On This Date
January 1
January 1
February 9 *See Note #4*
March 9
April 9
May 9
June 9
July 9
August 9
September 9
October 9
November 9
November 9
December 9
January 9
February 1
February 15
Note # 1: Report #I for Advance Basis Agreements cannot be submitted to the Agency prior to January 1 or
until the agreement with the Agency has been executed.
Note # 2: Report numbers 3 through 14 shall reflect an adjustment of one - twelfth of the total advance amount,
on each of the reports, repaying advances issued the first two months of the agreement. The
adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT IX).
Note #3: Submission of expenditure reports may or may not generate a payment request. If final expenditure
report reflects funds due back to the Agency, payment is to accompany the report.
Note #4: ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 9"' falls on a
Saturday, then the report will be due by the 8`h by 12:00 p.m. AND IF the 9"' falls on a Sunday, the
report will be due by the 10'h by 12:00 p.m. Actual submission of the vouchers to Dept. of Elder
Affairs is dependent on the accuracy of the expenditure report which is verified and paid by CIRTS
data only.
37
January 2012
1605 4-
Contract #OAA 203.12
ATTACHMENT IX
REQUEST FOR PAYMENT
OLDER AMERICANS ACT
PROVIDER NAME, ADDRESS, PHONE AND FED ID NUMBER
TYPE OF REPORT:
THI S REQUEST PERIOD:
Advance _
Report #
Reimbu cement
Agreement #
Agreement Period:
PSA :
CERTIFICATION: I hereby certify to the best of my knowledge that this request conforms with the terns and the purposes set forth in the above agreement.
Prepared By. Date _.. Approved By: _ Date:
PART A:
(1)
(2)
(3)
(4)
(�)
_ (6)__
BUDGET SUMMARY
Ill B
UICl
IHC2
Title IIIE
TOTAL
I. Approved
Agreement Amount.
0.00
0.00
0.00
0.00
0.00
0.00
2. Previous Funds
_
RECEIVED for
Agreement period
0.00
0.00
0.00
0.00
0.00
0.00
3. Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
4. Previous Funds
_
REQUESTED and
Not Received.
0.00
0.00
0.00
0.00
0.00
0.00
5. Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
PART B:
FUNDS REQUESTED
1. 1st -2nd Months
Request Only
0.00
0.00
0.00
0.00
0.00
0.00
2. Net Expenditures
For Month
0.00
0.00
0.00
0.00
0.00
0.00
3. Additional
Cash Needs (Attach Doc.)
0.00
0.00
0.00
0.00
0.00
0.00
4. Total
0.00
0.00
0.00
0.00
0.00
0.00
PART C:
NET FUNDS REQUESTED:
1. Less: Over- Advance
0.00
0.00
0.00
0.00
0.00
0.00
2. Agreement Funds are
_
Hereby Requested For
0.00
0.00
0.00
0.00
0.00
0.00
DOFAFORM106A revised 5 /10 _.. _.... ....... ....... _. _ _... ..
38
January 2012
16 05tract'#OAA 203.12
RECEIPTS AND EXPENDITURE REPORT OLDER AMERICAN ACT ATTACHMENT X
EXHIBIT 2
RECEIPTS AND EXPENDITURE REPORT OLDER _
AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source :
THIS REPORT PERIOD
FROM: TO:
BIB IIIC1
CONTRACT
IIIC2
PERIOD:
CONTRACT#
REPORT#
PSA#
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
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Federal Funds
$0.00
$0.00
$0.00
2. State Funds
$0.00
$0.00
$0.00
3. Program Income
$0.00
$0.00
$0.00
4. Local Cash Match (CCE, HCE and Other)
$0.00
$0.00
$0.00
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
6. Local In -Kind Match
$0.00
$0.00
$0.00
7. TOTAL RECEIPTS
$0.00
$0.00
$0.00
%
PART B : EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Meals / Meal Agreements
$0.00
$0.00
$0.00
%
2. Sermce Subcontractor
$0.00
$0.00
$0.00
%
3. Other
$0.00
$0.00
-- $0.00
4. Indirect Cost
$0.00
$0.00
$0.00
5. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
%
PART C: OTHER EXPENDITURES (For
Tracking Purposes only)
1. Match
a. Other and In -Kind
$0.00
$0.00
$0.00
b. Local Match
$0.00
$0.00
$0.00
2. USDA Cash Received
$0.00
$0.00
$0.00
3. TOTAL OTHER
$0.00
$0.00
$0.00
PART D: OTHER REVENUE AND EXPENDIIURES
2. Addition Cost Alternative Program Income 3.
Interest
I. Program Income (PI)
a. Approved Budget $
a. Earned on GR Advances $
a. OAA Unbudgeted PI Receipts YTD
b Received YTD ' °$
b. Return of GR Advance $
C. Expenditures $
a Other Earned $
39
January 2012
160,50ntract #OAA 203.12
ATTACHMENT X
EXHIBIT 3
_. .. ...RECEIPTS AND EXPENDITURE .REPORT
.... _
.OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source
THS REPORT PERIOD
FROM:
TO:
CONTRACT
Title HIE
PERIOD:
CONTRACT #
REPORT #
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
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Federal Funds
$0.00
$0.00
$0.00
1 State Funds
$0.00
$0.00
$0.00
3. Program Income
$0.00
$0.00
$0.00
_ %
4. Local Cash Match
$0.00
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
%
6. Local In -Kind Match
$0.00
$0.00
$0.00
T TOTAL RECEIPTS
$0.00
$0.00
$0.00
_
PART B : EXPENDITURES
I. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
A : Direct Services
1. Personnel
$0.00
$0.00
$0.00
2. Travel
$0.00
$0.00
$0.00
__%
3. Building Space
$0.00
$0.00
$0.00
4. Communication / Utilities
$0.00
$0.00
$0.00
S. Printing / Supplies
$0.00
$0.00
$0.00
6. Equipment
$0.00
$0.00
$0.00
%
7. Other
$0.00
$0.00
$0.00
B : Agreement Services
8. Services Subcontracted
$0.00
$0.00
$0.00
9. TOTAL EXPENDITURES
$0.00
$0.00
$000
10. DEDUCTIONS
a. Total Local Match
$0.00
$0.00
$0.00
% b. Program
Income Used -
$0.00 $000
$0.
0
% c.
TAL DEDUCTIONS
$0.00 $0.00 $0.00
11. NET EXPENDITURES
$0.00
$0.00
$0.00
PART C : EXPENDITURES ANALYSIS
2. Units of Services Year
to Date
3. Number of People Served Year to Date
A. Expenditures by Services Year to Date:
I. Information ..................... $0.00
.......................
$0,00
..........................
0.00
2. Assistance.. ................... $0,00
........................
$0.00
.............. I ....
.......
0_00
3. Counseling ..................... 000
.......................
0.00
..........................
0.00
4. Respite ......................... 0.00
........................
so .00
..........................
0_00
5. Supplemental Services..... $0.00
........................
0.00
...........................0.00
6. TOTAL .......................... $0.00
Part B Line 11, column 3 should be equal to this total.
PART D : GRANDPARENT SERVICES (reported by Federal Fiscal Year)
FFY $ FFY
$
FFY_
_$
Match $ _ _
Match $
Match $
DOEA FORM 105AE revised 12/08
40
January 2012
1 On05AA 203.12
Department of Elder Affairs Programs & Services Handbook, provided on CD.
Also, available at the Agency's Intranet site under, "Publications ".
41
ATTACHMENT A
January 2012
Contract OAA 203.12
1605
ATTACHMENT B
RTATF nF FT.n'PMA n1WPA12TX4FVT nF FT."FR A.FFATRR
CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name
County
AAA/Contractor
Address
Completed By
City, State, Zip Code
Date
Telephone
YAHr1: IiL'AU 1risA1.1AC:ril:U llVJ1KUl:1.IV1V�.irVx lLLUl I1ui 11VL' LV!'VKIV1A 11V1V Wrill:ri WILL riGLC YVU C:VmYLCl r. grill tVluvi.
1. Briefly describe the geographic area served by the program /facility and the type of service provided:
6. Is an Assurance of Compliance on file with DOEA? If N/A or NO, explain. N/A YES NO
❑ ❑ ❑
Revised August 2010, Page 1 of 2
42
7.
Compare the staff composition to the population. Is staff representative of the population?
If N/A or NO, explain.
N/A
❑
YES
❑
NO
❑
8.
Compare the client composition to the population. Are race and sex characteristics representative of the
population? If N/A or NO, explain.
N/A
❑
YES
❑
NO
❑
9.
Are eligibility requirements for services applied to clients and applicants without regard to race, color,
national origin, sex, age, religion or disability? If N/A or NO, explain.
N/A
❑
YES
❑
NO
❑
10.
Are all benefits, services and facilities available to applicants and participants in an equally effective
manner regardless of race, sex, color, age, national origin, religion or disability? If N/A or NO, explain
N/A
❑
YES
❑
NO
❑
11.
For in- patient services, are room assignments made without regard to race, color, national origin
or disability? If N/A or NO, explain.
N/A
❑
YES
❑
NO
❑
Revised August 2010, Page 1 of 2
42
January 2012
Contract OAA 203.12
1605
12. Is the program /facility accessible to non - English speaking clients? If N/A or NO, explain. N/A YES NO
❑ ❑ ❑
13. Are employees, applicants and participants informed of their protection against discrimination? If YES,
how? Verbal ❑ Written ❑ Poster ❑ If N/A or NO, explain.
N/A
❑
YES NO
❑ ❑
14. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program /facility.
N/A
NUMBER
15. Is the program /facility physically accessible to mobility, hearing, and sight- impaired individuals? If N/A or
NO, explain.
N/A
❑
YES NO
❑ ❑
PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15ORMORE EMPLOYEES,
16. Has a self - evaluation been conducted to identify any barriers to serving disabled individuals, and to make
any necessary modifications? If NO, explain.
YES
❑
NO
❑
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If
NO, explain.
YES
NO
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES
❑
NO
❑
19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination
on the basis of disability? If NO, explain.
YES
❑
NO
❑
20. Are auxiliary aids available to assure accessibility of services to hearing and sight - impaired individuals? If
NO, explain.
YES
❑
NO
❑
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES
❑
NO
❑
Reviewed By In Compliance: YES ❑ NO*
❑
Program Office "Notice of Corrective Action Sent
Date Telephone Response Due _/—/—
On -Site ❑ Desk Review ❑ Response Received _/_/_
Revised August 2010, Page 2 of 2
43
January 2012
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE` CHECKLIST
1605 1
Contract OAA 203.12
1. Describe the geographic service area such as a district, county, city or other locality. If the program /facility
serves a specific target population such as adolescents, describe the target population. Also, define the type of
service provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city, county or other regional area. Population
statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. ( "Other" races include
Asian/Pacific Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full -time staff and their percent by race, sex and disability. Include the effective date
of your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and
list their percent by race, sex and disability. Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted
in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part
of the contract language for DOEA recipients and their sub- grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff!
8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their
availability in the population, the program /facility has the responsibility to determine the reasons for such
variation and take whatever action may be necessary to correct any discrimination.. Some legitimate disparities
may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR
80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3
(a) and 45 CFR 80.1 (b) (2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies, counseling and social services without regard to race, sex, color, national
origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must
be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability.
Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all
clients, 45 CFR 80.3 (b).
11. For in- patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants, including those persons
who may not speak English. In geographic areas where a significant population of non - English speaking people
live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have
a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who
will assist in the provision of services, 45 CFR 80.3 (a).
44
January 2012
Contract OAA 203.12
1605
13. Programs /facilities must make information regarding the nondiscriminatory provisions of Title VI available to
their participants, beneficiaries or any other interested parties. This should include information on their right to
file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of
HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through
the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race,
color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment,
placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the
name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the
current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review,
etc.
15. The program /facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby,
public telephone, restroom facilities, water fountains, information and admissions offices should be accessible.
Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and
serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or
raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a
self - evaluation to identify any accessibility barriers. Self- evaluation is a four step process:
a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do
not comply with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self - evaluation on file. (This checklist may be used to satisfy this requirement if these four steps
have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging
any action prohibited by Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program /facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads, and other appropriate written communication, 45 CFR 84.8 (a).
20. Programs /facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with
impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited
to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can
be used to provide equally effective services, 45 CFR 84.52 (d).
21. Programs /facilities with 50 or more employees and 550,000.00 in federal contracts must develop, implement
and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41
CFR 60 and Title VI of the Civil Rights Act of 1964, as amended.
DOEA Form 101 -B, Revised August 2010
45
January 2012
(1)
t
Aknw
0
U
V)
CL
0
lk
I
,+ w w 10 � « 0 v% 4* w 0'A
G
46
165
Contract OAA 203.12
I
January 2012
16D5
Contract OAA 203.12
ATTACHMENT E
Department of Elder Affair's Computer Use Policy and its Social Media Policy, provided on CD
47
January 2012
6 05tract OAA 203.12
ATTACHMENT G
DEPARTMENT OF
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.06(3), Florida Statutes.
➢ The term "employer" means any person or entity required by law to conduct background screening,
including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability
Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Service Providers, Diversion
Providers, and any other person or entity which hires employees or has volunteers in service who meet
the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat.
A direct service provider is a person at least 18 years of age who, pursuant to a program to provide
services to the elderly, has direct face- to-face contact with a client while providing services, or has access
to the client's living area, funds, or personal property. A direct service provider also includes coordinators,
managers, and supervisors of residential facilities; and volunteers. §430.0402, Fla. Stat.
ATTESTATION:
As the duly authorized representative of
Employer Name
located at
StreetAddress City State Zipcode
I, do hereby affirm under penalty of perjury,
Name of Representative
that level 2 background screening has been conducted in compliance with the provisions of Chapter 435
and section 430.0402, Florida Statutes.
Signature of Representative
Date
STATE OF FLORIDA, COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of
to me or produced
20 , by
(Name of Representative) who is personally known
Print, Type, or Stamp Commissioned Name of Note ry Public Notary Public
as proof of identification.
DOEA Form 235, Affidavit of Compliance, Effective 9 -1 -11 Section 435.05(3),. F.S.
"Previous versions ofthis form will not be accepted" Form available at: htto: / /elderaffaim.st ate. fl. us/ enalish /`backxroundscreeninx.pho
48
January 2012 1605 Contract OAA 203.12
ATTACHMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
The undersigned, an authorized representative of the Contractor named in the contract or agreement to which this form is
an attachment, hereby certifies that:
(1) The Contractor understands that pursuant to s. 287.135 F.S., any company at the time of bidding or submitting a
proposal for a new contract or renewal of an existing contract, that is on the "Scrutinized Companies with Activities in
Sudan List" or the "Scrutinized Companies with Activities in the Iran Petroleum Sector List (collectively, "the Lists ")
is ineligible for, and may not bid on, submit a proposal for, or enter into or renew a contract with the Area Agency on
Aging for Southwest Florida, Inc. dba Senior Choices of Southwest Florida (Agency) for goods or services of $1
million or more.
(2) The Contractor understands that, pursuant to s. 287.135 F.S., any company that submits a false certification to the
Agency is subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of
false certification.
(3) The Contractor understands that the contract to which this form is an attachment may be terminated by the Agency if
the Contractor submits a false certification or has been placed on the Lists.
This certification, required by Florida law, is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction.
Imo- W.
February 28, 2012
Signature Date
(Same as contract signature)
Title: FRED W. COYLE, CHAIRMAN
Board of County Commissioners, Collier County, Florida
Company Name
}
?''
r s;
Approved as to form and legal sufficiency:
Jennifer B. hate
Aft`
at to
Assistant County Attorney
l ignstJi!" ! 481
49
}
?''
r s;
January 2012
1605
Verification of Employment Status Certification
Contract OAA 203.12
ATTACHMENT J
As a condition of contracting with the Area Agency Aging for Southwest Florida, Inc. dba Senior Choices of Southwest
Florida, hereby referred to as agency, Collier County Board of County Commissioners, hereby referred to as the
contractor, certifies the use of the U.S. Agency of Homeland Security's E- verify system to verify the employment
eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to
this Agreement and (b) that any subcontracts include an express requirement that subcontractors performing work or
providing services pursuant to this Agreement utilize the E- verify system to verify the employment eligibility of all new
employees hired by the subcontractor during the contract term.
.*_� W
Signature
(Same as contract signature)
FRED W. COYLE, CHAIRMAN
Title
Board of County Commissioners, Collier County, Florida
Company Name
Approved as to form and legal sufficiency:
Jenni . White
Assistant County Attorney _Z��
50
FebruM 28, 2012
Date
1605
January 2012 Contract OAA 203.12
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract # OAA 203.12
I, Fred W. Coyle , certify that Board of County Commissioners, Collier County, Florida
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that the plan will be
made available to the Area Agency on Aging for SW FL, Inc., d/b /a Senior Choices of Southwest Florida upon
request.
Signature of authorized contractoN4epresentative
Fred W. Coyle, Chairman
Title
February 28, 2012
Date
Approved as to form and legal sufficiency:
Jennifer . hite
Assistant County Attorney C
DOEA Contract Manager's Review
Initial Date
October 2008
51
7 77 -73 �� of ; rh.
January 2012
Attestation Statement
Agreement/Contract Number: OA/A��203.12
Amendment Number
16 G5 Contract OAA 203.12
I, FRED W. COYLE, CHAIRMAN, 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, Inc.,
d/b /a as Senior Choices of Southwest Florida and Board of County Commissioners, Collier County, Florida.
(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.
ILAk W. C111&
Signature of Recipient /Contractor re r entative
FRED W. COYLE, CHAIRMAN
Approved as to form and legal sufficiency:
Jennifeil. White lI_
Assistant County Attorney
52
February 28, 2012
Date
..