Backup Documents 05/22/2012 Item #16D 7ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI1 b D 7
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 #1 through #4, complete the checklist, and forward to Ian Mitchell (line #5).
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
1. Louise Pelletier
HHVS
Agenda Item Number
16 D 7
2. Jennifer White
County Attorney Office
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5 da t
3.Ian Mitchell, Executive Manager
Board of County Commissioners
Number of
6
Attached
4. Minutes & Records
Clerk of Courts — Im
123 tZ
Chairman needed on each copy
and Attestation Statement
Chairman and Clerk to the Board and possibly State Officials.)
2.
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
Contact
Louise Pelletier / Housing, Human and
Veteran Services
Phone Number
252 -2696
Please call or e-mail
for pie k u
Agenda Date Item was
May 22, 2012
Agenda Item Number
16 D 7
Approved by the BCC
Original document has been signed/ initialed for legal sufficiency. (All documents to be
LP
Type of Document
Amendment to two (2) contract agreements
Number of
6
Attached
an original signature from the
Documents Attached
Chairman needed on each copy
and Attestation Statement
INSTRUCTIONS & CHECKLIST
I: 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 Attorney's
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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
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document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
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signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
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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 05/22/12 (enter date) and all changes
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made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
MEMORANDUM
Date: May 23, 2012
To: Louise Pelletier, Case Management
Housing, Human &Veteran Services
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Contract #OAA 203.12.001 Amendment 1 & Attestation
Statement with the Area Agency on Aging of SWFL, Inc.
Contract #CCE 203.11.002 Amendment 2 & Attestation
Statement with the Area Agency on Aging of SWFL, Inc.
Attached are three (3) original copies of the two documents referenced above,
(Item #16D7) approved by Board of County Commissioners on May 22, 2012.
After forwarding for signature and subsequent return, please send one executed
original copy of each agreement 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 x 3)
Date: June 19, 2012
To: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
From: Louise Pelletier, Case Management Supervisor
Housing, Human & Veteran Services
Re: Area Agency on Aging of SW FL for
Amendment OAA 203.12.001
Amendment CCE 203.11.002
Enclosed are the originals of the signed documents referenced above being forwarded to
the Minutes and Records Department for the Board's Official Record.
If you have any questions, please contact me at 239 - 252 -269.
Thank you.
F-iunian and
Veteran, servives
3391 Fast Tamhwu tral - Heahh Ruddtnq • Naples, FL 34117
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20V 16 0 7
Amendment 001 OAA 203.12.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT
OLDER AMERICANS ACT PROGRAM TITLE III
I nel "r941nTMMT45V =-
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida, Inc., hereinafter
referred to as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as
the "Contractor," amends contract OAA 203.12,
The purpose of this Amendment is to clarify intake services are for processing EHEAP applications on page 36,
ATTACHMENT V11 Rate Summary.
This amendment shall be effective April 16, 2012.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are
hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed
at the level specified in the agreement.
This Amendment and all of its attachments, 4 pages, are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by
their officials there unto duly authorized.
SIGNATURE PAGE TO FOLLOW
SIGNATURE PAGE TO
FOLLOW
REMAINDER OF PAGE INTENTIALLY
LEFT BLANK
1
Amendment 001
Contractor:
SIGNED BY:
Collier County Board of County
Commissioners h
NAME: Fred W. Coyle
TITLE: Chairman
DATE: May 22, 2012
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 09/30
ATTEST
r
L.
--
.. Y�tLERK
Approval as to form and legal sufficiency
Jennife B. White
Assistant County Attorney
2
. 26.1fll
Area on Aging for Southwest Florida, Inc
SIGNED BY: IZA,2-,
NAME: Leigh Anna Nowak
TITLE: Board President
DATE: May 22, 2012
Amendment 001
OAA 209.600?" 7
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
3
Amendment 001 OAA162.Q 7
OLDER AMERICANS ACT
RATE SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
IIIB & IIIE
Services Total Cost Reimbursement Rate
IIIB
Case Aide
$27.78
$25.00
Case Management
$50.00
$45.00
*Intake -EHEAP Only
$27.78
$25.00
Screen in Assessment
$50.00
$45.00
Transportation
100% Cost
90% of Cost
*Intake Units used for only
EHEAP
$50.00
$45.00
11110
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
C1
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
$4.32 per person
10�
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
4
Attestation Statement
Agreement /Contract Number OAA 203.12.001
Amendment Number
1, Fred W. Coyle , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida dba as Senior Choices of Southwest Florida and
Collier County Board of Commissioners
(Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
Signature of Recipient/Contractor re
Fred W. Coyle, Chairman
ATTEST:
Dwight E. Brock, Clerk
i it, C ' 4
W Fyn
05/22/2012
tative Date
&?0-, '
Approval as to form legal Sufficiency:
County Attorney
Amendment 002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
STANDARD CONTRACT
COMMUNITY CARE FOR THE ELDERLY PROGRAM
Collier County Board of Commissioners
CCE 203.11.002
1607
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida. Inc.. hereinafter
referred to as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as
the "Recipient," amends contract CCE 203.11.
The purpose of this Amendment is to: transfer $53,000 from Case Management to CCE Spending Authority;
and (2) revise Attachment VII, Budget Summary.
This amendment shall be effective on April 16, 2012.
All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are
hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed
at the level specified in the agreement.
This Amendment and all of its attachments, 3 pages, are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by
their officials there unto duly authorized.
SIGNATURE PAGE TO
FOLLOW
REMAINDER OF PAGE INTENTIALLY
LEFT BLANK
1
Amendment 002
Contractor:
SIGNED BY
Collier County Board of County
NAME: Fred W. Coyle
TITLE: Chairman
DATE: May 22, 2012
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 09/30
ATTEST
DWIGHT E. BROCK
t�='9t'
CLERK
q0t ° ' W
Approval as to form and legal sufficiency
-�vl'�
Jennifer
Assistant County Attorney
2
CCE 203.11.002
Area on Aging for Southwest Florida, Inc
SIGNED BY:
NAME: Leigh Anna Nowak
TITLE: Board President
DATE: May 22, 2012
Amendment 002
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
for
Collier County Board of Commissions
Collier County
1. CCE Spending Authority $496,717.00
Case Management, Case Aide,
2. $65,000.00
Intake Allocations
3. Lead Agency Operating Dollars $95,950.00
Total $657,667.00
RATE SUMMARY
for
Collier County Board of Commissioners
Collier County
CCE 203.11.002
6 u 7
0%
ATTACHMENT VII
Collier County
Total Rate
Reimbursement Rate
Case Management
$50.00
$45.00
Case Aid
$27.78
$25.00
Chore
$20.00
$18.00
Companion
$20.00
$18.00
EARS
$0.83
$0.75
EARS Plus
$1.11
$1.00
Enhanced Chore
$30.00
$27.00
Facility Respite (24 hours)
$138.90
$125.00
Homemaking
$20.00
$18.00
Personal Care
$22.22
$20.00
Respite -In Home
$20.00
$18.00
Skilled Nursing
$38.89
$35.00
Adult Day Care
$10.00
$9.00
Spec. Medical Equipment
100% Cost
90% cost
3
• i ,
Attestation Statement
Agreement /Contract Number CCE 203.11
Amendment Number f[Z
1, Fred Coyle , attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida, Inc. and
Collier Countv Board of Commissioners.
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has,;no affect on the agreement /contract content.
7/26/2012
Fred W. Coyle, Chairman Date
Signature of Recipient /Contractor reprelnta&
AAA Contract Manager to initial and date indicating signatures /initials appropriate on all documents; ready
for AAA designee signature
initial date
Revised November 2610 —*ncv&d a3 tcptrt1 cc 1ftgtilUi'(C!r$fi