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Backup Documents 09/25-26/2012 Item #16D 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SlIb 0 3 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper.Attach to original document.Original documents should be hand delivered to the Board Office.The completed routing slip and original documents are to be forwarded to the Board Office only after the Board has taken action on the item.) ROUTING SLIP Complete routing lines#1 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#6). Route to Addressee(s) Office Initials Date (List in routing order) 1.Colleen Greene Emily Pep in County Attorney Q 91,91U/i0Z 2. 3. 4. 5. Ian Mitchell, Executive Manager Board of County Commissioners to the BCC y �(Z�e/�2 6. Minutes and Records Clerk of Court's Office T`r` q42- 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 Sue Filson,need 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 Marilyn Matthes Phone Number 593-3511 Contact Agenda Date Item was September 25,2012 Agenda Item Number # 16.d.3 Approved by the BCC Type of Document Grant Agreement Number of Original • 2 of Grant Attached 3 Partnership Agreements between Access Documents Attached Agreement Florida and East Naples,Estates Branch, • 3 Partnership and Immokalee Branch Libraries Agreements INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Original document has been signed/initialed for legal sufficiency. (All documents to be MM 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. Is the Chairman's original signature required? MM 3. All handwritten strike-throughs and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board. 4. The Chairman's signature line date has been entered as the date of BCC approval of the MM document or the final negotiated contract date,whichever is applicable. 5. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's MM signature and initials are required. 6. In most cases(some contracts are an exception),the original document and this routing slip MM should be provided to Ian Mithchell 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! (Postmark before Oct. 1 required.) 7. The document was approved by the BCC on_September 25,2012_(enter date)and all MM Mik is nw changes made during the meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. for line' I:Forms/County Forms/BCC Forms/Original Documents Routing Slip,Revised 6-15-2011 16O3x MEMORANDUM Date: September 27, 2012 To: Marilyn Matthes, Director Collier County Public Library From: Martha Vergara, Deputy Clerk Minutes & Records Department Re: State Aide for Library Services & Technology Act Grant Attached are two (2) originals of the agreement referenced above, (Item #16D3) approved by the Board of County Commissioners on Tuesday, September 25, 2012. Please forward a fully executed original to the Minutes and Record's Department for where it will be kept as part of the Board's Official Records. If you have any questions, please contact me at 252-7240. Thank you Attachment it [1 _ 131 _ , PROJECT NUMBER 12-LSTA-D-01 Florida Department of State,Division of Library and Information Serviees • • LIBRARY SERVICES AND TECHNOLOGY ACT GRANT AGREEMENT • AGREEMENT executed and entered into . • BETWEEN the State of Florida,Department of State,Division of Library and Information Services,hereinafter referred to as the DIVISION,and the • SUBGRANTEE: Collier County Board of County Commissioners for and on behalf of Collier County Public Library the PROJECT: Collier Connects the GRANT AMOUNT: Twenty-seven thousand one hundred fifty-four dollars ($27,154) released in four equal advance payments.as,determined by the Division. The funds must be expended on or before September 30,2013. Unless there is a change of address,any notice required by this agreement shall be delivered to the Division of Library and Information Services,500 South Bronough Street,Tallahassee,Florida ' 32399-0250,for the State,and to the Collier County Public Library,2385 Orange Blossom Drive, Naples,FL,34109-8840,for the SUBGRANTEE. In the event of a change of address it is the obligation of the moving partyto notify the other party in writing of the change of address. The DIVISION,as administrator of federal funds authorized under Section 257.12,Florida Statutes,wishes to provide a grant of federal funds. Federal funds are provided through the Library Services and Technology Act under Florida's long range plan approved by the Institute of Museum and Library Services. The SUBGRANTEE agrees to meet all state requirements and requirements of the Library Services and Technology Act,hereinafter referred to as LSTA. • The SUBGRANTEE has made application and has met all eligibility requirements for receipt of a Library Services and Technology Act Grant. By reference,the application and any approved revisions'are hereby made a part of this agreement The parties agree as follows: L The SUBGRANTEE agrees to: a. Administer all fiords granted to it by the DIVISION to carry out the project as described in the project proposal and revisions submitted to and approved by the DIVISION. .b. Piovide the DIVISION with statistical,narrative,.financial and other evaluative reports as requested. • LSTA Grant AgeaoatK Effective 4/142012 Page 1 of 8 Chap er 1B-2A11(2xd).Florida Administrative Code _ _ H. 16fl 3 c. Retain and make available to the DIVISION,upon request,all financial and programmatic records,supporting documents,statistical records,and other records for the project. d. Retain all records for a period of five years from the date of submission of the final project report. If any litigation,claim,negotiation,audit or other action involving the records has been started before the expiration of the five year period,the records shall be retained until completion of the action and resolution of all issues which arise from it,or until the end of the regular five year period,whichever is later. e. Establish and maintain a proper accounting system in accordance with generally accepted accounting procedures. To use and maintain adequate{seal authority,control,and accounting procedures that will ensure proper disbursement 4 and accounting for, federal project funds. f. Perform all acts in connection with this agreement in strict conformity with all applicable State and Federal laws and regulations. g. Pay out'all project funds on or before the project ending date. h. Expend all grant funds received under this Agreement solely for the purposes of the project. To repay to the DIVISION any and all funds not expended for the purposes of the project i. Not use any grant funds for lobbying the legislature,the judicial branch,or any state agency. j. Invest temporarily surplus funds and return the interest earned on such investments to the • State quarterly. k Maintain bills-for services or expenses in detail sufficient.for proper preaudit and postaudit. I. Maintain any travel expenses in accordance to the provisions of Section 112.061,Florida Statutes. m. That to the best of the SUBGRAN TEE'S'knowledge and belief that the SUBGRANTEE, and its principals: 1. Are not presently excluded or disqualified(debarment,suspension and other responsibility matters); 2. Have not been convicted within the preceding three years of any of the offenses listed in 45 CFR 1185.800(a)or had a civil judgment rendered against the applicant or its principals for one of those offenses within that time period; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity(Federal,State,or local)with commission of any of the offenses listed in 45 CFR 1185.800(a);and 4. Have not had one or more public transactions(Federal,State,•or local)terminated within the preceding three years for cause or default Page 2 of 8 LSTA Gnat Agreement,Effective 4/10/2012 ampler 18-2.011(2Xd)Florida Administrative Code 3_ _ That the SUBGRANTEE,and its principals will comply with 45 CFR Part 1185 Subpart C(Responsibilities of Participants Regarding Transactions)and will require similar compliance with Subpart C by persons at the next lower tier with whom the primary tier 'participant enters into covered transactions. • n. Provide or continue to provide a drug-free workplace by complying with the requirements in Subpart B of 45 CFR Part 1186. This includes:making a good faith effort,on a continuing basis,to maintain a drug-free workplace;publishing a drug-free workplace statement establishing a free awareness �8 program for its employees;taking actions concerning employees who are convicted of violating drug statutes in the workplace;and identifying(either with this application,upon award,or in documents kept on file in the SUBGRANTEE'S office)all known workplaces under the award. o. The SUBGRANTEE hereby certifies that it is cognizant of the prohibition of conflicts of interest described in Sections 112.311 through 112.326,Florida Statutes,and affirms that it will not enter into or maintain a business or other relationship with any employee of the Department of State that would violate those provisions. The SUBGRANTEE further agrees to seek authorization from the General Counsel for the Department of State prior to entering into any business or other relationship with a Department of State employee to avoid a potential violation of those statutes. p: As required by Section 1352,Title 31 of the United States Code,and implemented for persons entering into a grantor cooperative agreement over$100,000,the SUBGRANTEE certifies to the best of his or her knowledge and belief that: 1. No Federal appropriated fiords 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 agency,a Member of Congress,an officer or employee of Congress, or'an`employee of a Member of Congress in connection with the awarding of a Federal contract;the making of a Federal°grant,the making of a Federal loan,the entering into of a cooperative agreement,or the extension,continuation,renewal, amendment,or modification of a Federal contract,grant,loan,or cooperative • agreement 2. If any funds other than appropriated Federal funds have been paid or will be paid to any person(other than a regularly employed officer or employee of the applicant)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 request,complete, and submit Standard Form LLL,"Disclosure of Lobbying Activities,"in accordance with its instructions. • 3. The SUBGRANTEE shall include the language of this certification in Part q in the award documents for all subawards at all tiers(including subcontracts,subgrants,and contracts under grants,Ibans,and cooperative agreements)and that all subrecipients shall certify and disclose accordingly. ; q: That to the best of the SUBGRANTEE'S knowledge and belief that the SUBGRANTEE i�not delinquent in the repayment of any Federal debt. . 4. Page 3 of 8 LSTA Gant Agreement,Main 4 1W2012 asepwer 18- .011(2)(d),Florida Administrative Code 6 3 3 • r. As required by the Civil Rights Act of 1964,the Rehabilitation Act of 1973,the Education Amendments of 1972,and the Age Discrimination in Employment Act of 1975,as implemented at 45 CFR Part 1180.44,the SUBORANTEE certifies that the SUBGRANTEE will comply with the following nondiscrimination sues and their implementing regulations: 1. Title VI of the Civil Rights Act of 1964,as amended(42 USC§2000 et seq.),which provides that no person in the United States shall,on the grounds of race,color,or national origin,be excluded from participation in,be denied the benefits og or otherwise be subject to discrimination under any program or activity receiving Federal financial assistance; 2. Section 504 of the Rehabilitation Act of 1973,as amended(29 USC §701 et seq.), which prohibits discrimination on the basis of disability in Federally-assisted programs; 3. Title lX of the Education Amendments of 1972,as amended(20 USC §§ 1681-83, 1685-86),which prohibits discrimination on the basis of sex in education programs and activities receiving Federal financial assistance; 4. The Age Discrimination in Employment Act of 1975,as amended(42 USC § 6101 et seq.),which prohibits discrimination on the basis of age in Federally-assisted programs; The SUBGRANTEE shall insert similar provisions listed in Part r in all subcontracts for services required by this agreement. s. In the event that the SUBGRANTEE expends$500,000 or more in Federal awards in its fiscal year,the SUBGRANTEE must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133,as revised. In determining the Federal awards expended in its fiscal year,the SUBGRANTEE shall consider all sources of Federal awards,including Federal resources received from the Department of State. 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 SUBGRANTEE conducted by the Auditor General in accordance with the provisions. 0MB Circular A-133,as revised,will meet the requirements of this part. In.connection with the audit requirements addressed in Part s.,paragraph 1,the SUBGRANTEE shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133,as revised. If the SUBGRANTEE expends less than$500,000 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 SUBGRANTEE expends less than$500,000 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 an audit must be paid from SUBGRANTEE resources obtained from other than Federal entities). Page 4 of 8 LSTA Grant Aireament.Effective 4/012012 Chapter 1B-2.011(2)(d),Florida Adm'iuhtrr<tvs Code 1, 16 n .1 a • 311 t II Copies of reporting packages for audits conducted in accordance with OMB Circular A- 133,as revised,and required by this agreement shall be submitted,when required by • - Section.320(d),OMB Circular A-133,as revised,by or on behalf of the SUBGRANTEE directly to each of the following: 1. The Department of State at the following address: Office of Inspector General Florida Department of State It A.Gray Building,Room 114A 500 S.Bronough Street • Tallahassee,Florida 32399-0250 2. 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 3. Other Federal agencies and pass-through entities in accordance with Sections 320(e) and(f),OMB Circular A-133,as revised. • IL The DIVISION agrees to: a. Provide a grant in accordance with the terms of this agreement in the amount and frequency as stated above in consideration for the SUBGRAN IEE's performance hereinunder,and contingent upon funding by the Institute of Museum and Library Services. The State of Florida's performance and obligation to pay under this agreement is contingent upon an annual appropriation by the Legislature. In the event that the state or federal funds on which this agreement is dependent are withdrawn,this agreement is terminated and the state has no further liability to the SUBGRANTEE beyond that already incurred by the termination date. In the event of a state revenue shortfall,the total grant may be reduced accordingly. • b. Provide professional advice and assistance to the SUBGRANTEE as needed,in implementing and evaluating the project. c. Review the project during the grant period to ensure that adequate progress is being made toward achieving the project objectives. M. The SUBGRANTEE and the DIVISION mutually agree that a. This instrument embodies the entire agreement of the parties. There are no provisions, terms;conditions,or obligations other than those contained herein;and this agreement shall supersede all previous communications,representations,or agreements,either verbal or written,between the parties. No amendment shall be effective unless reduced in writing and signed by the parties. Page 5 of 8. 1.UTA Glint Agrmoek Motive 4/10/2012 Chaplet 18-2.011(2xd).Florida Adadoimitive Cods • 1b CI 3 b. This agreement is executed and entered into in the State of Florida,and shall be construed,performed,and enforced in all respects in accordance with the laws and rules of the State of Florida. Each party shall perform its obligations hereunder in accordance with the terms and conditions of this agreement. If any matter arising out of this Agreement becomes the subject of litigation,venue shall be in Leon County. c. If any term or provision of the agreement is found to be illegal and unenforceable,the remainder of the agreement shall remain in full force and effect and such term or • provision shall be deemed stricken. d. No delay or omission to exercise any right,power or remedy accruing to either party upon breach or default by either party under this Agreement shall impair any such right, power or remedy of either party,nor shall such delay or omission be construed as a waiver of any such breach or default,or any similar breach or default • e. This agreement shall be terminated by the DIVISION because of failure of the SUBGRANTEE to•fulfill its obligations under the agreement in a timely and satisfactory , manner unless the SUBGRANTEE demonstrates good cause as to why it cannot fulfill its obligations. Satisfaction of obligations by the SUBGRANTEE shall be determined by the DIVISION based on the terms and conditions imposed on the SUBGRANTEE in this agreement and compliance with the program guidelines. The DIVISION shall provide SUBGRANTEE a written notice of default letter. SUBGRANTEE shall have 15 Wender days to cure the default If the default is not cured by the SUBGRANT'EE within the stated period,the DIVISION shall terminate this agreement,unless the SUBGRANTEE demonstrates good cause as to why it cannot cure the default within the prescribed time period. For purposes of this agreement,"good cause"is defined as circumstances beyond the SUBGRANTEE's control. hi the event of termination of this agreement,tlx SUBGRANTEE will be compensated for any work satisfactorily completed prior to the notification of termination,if equitable. f. The DIVISION shall unilaterally cancel this y agreement in the event that the SUBGRANTEE refuses to allow public access to all documents or other materials made or received in regard to this agreement that are subject to the provisions of Chapter 119, Florida Statutes. SUBGRANTEE agrees to immediately contact the DIVISION for • assistance in the event that it receives a public records request related to this agreement or the grant that it awards. g. The DIVISION shall not be liable to pay attorney fees,interest,late charges and service fees,or cost of collection related to the grant h. The DIVISION shall not assume any liability for the acts,omissions to act or negligence of the SUBGRANTEE,its agents,servants or employees;nor shall the SUBGRANTEE exclude liability for its own acts,omissions to act or negligence to the DIVISION. In addition,the SUBGRANTEE hereby agrees to be responsible for any injury or property damage resulting from any activities conducted by the SUBGRANTEE. • Page 6of5 ISTA Gnat Apama;Effective 4/IW2012 Chester 1B-2.011t2)(d).Monde Administrative Cods • 1 6 3 i. The SUBGRANTEE,other than a SUBGRANTEE which is the State or agency or subdivision of the State,agrees to indemnify and-hold the DIVISION harmless from and against any and all claims or demands for damages of any nature,including but not limited to personal injury,death,or damage to property,arising out of any activities performed under this agreement and shall investigate all claims at its own expense. j.. The SUBGRANTEE shall be responsible for all work performed and all expenses incurred in connection with the Project. The SUBGRANTEE may subcontract as necessary to perform the services set forth in this agreement,including entering into subcontracts with vendors for services and commodities,PROVIDED THAT such subcontract has been approved by the DIVISION prior to its execution,and PROVIDED THAT it is understood by the SUBGRANTEE that the DIVISION shall not be liable to the subcontractor for any expenses or liabilities incurred under the subcontract and that the SUBGRANTEE shall be solely liable to the subcontractor for all expenses and liabilities incurred under the subcontract. The SUBGRANTEE shall include the s copyright provision in paragraph(o.)of this agreement in all of its subcontracts. k Neither the State nor any agency or subdivision of the State waives any defense of sovereign immunity,or increases the limits of its liability,by entering into this contractual relationship. 1. The SUBGRANTEE,its officers,agents,and.employees,in performance of this agreement,shall act in the capacity of an independent contractor and not as an officer, employee or agent of the DIVISION. Under this agreement,SUBGRANTEE is not entitled to accrue any benefits of state employment,including retirement benefits,and any other rights or privileges connected with employment in the State Career•Service. SUBGRANTEE agrees to take such steps as may be necessary to ensure that each . subcontractor of the SUBGRANTEE will be deemed to be an independent contractor and will not be considered or permitted to be an agent,servant,joint venturer,or partner of the DIVISION. m. The SUBGRANTEE shall not assign, sublicense or otherwise transfer its rights,duties,or obligations under this agreement without prior written consent of the DIVISION,which consent shall not be unreasonably withheld. The agreement transferee must demonstrate compliance with the requirements of the program. If the Department approves a transfer of the SUBGRANTEE's obligations,the SUBGRANTEE remains responsible for all work.perfomned and all expenses incurred in connection with the agreement. In the event the Legislature transfers the rights,duties,and obligations of the DIVISION to another government entity,pursuant to section 20.06,Florida Statutes,or otherwise,the rights, duties,and obligations under this agreement shall also be transferred to the successor government entity as if it were an original party to this agreement. n. This agreement shall bind the successors,assigns and legal representatives of the SUBGRANTEE and of any legal entity that succeeds to the obligations of the DIVISION. Page 7 of 8 LS IrA Omit Apeanait.Motive 4/1W2012 rupee-Is-2.011(2Xd),Florida Adraiaisosifve code 6 0 3 _ _ .. • o. When publications,films,or similar materials are developed,directly or indirectly from a ' program,project,or activity supported with grant funds,SUBGRANTEE(and any of its subcontractors,if applicable)shall grant the Department of State an irrevocable,royalty- free,non-transferable;non-exclusive right and license to reproduce or otherwise use,to make derivative works from,and to display and distribute any copyrighted material developed under this Agreement for any state goveanmentel purpose. The SUBGRANTEE also grants the federal awarding agency a royalty-free,nonexclusive, and irrevocable license to reproduce,publish or otherwise use;and to authorize others to use,for federal government purposes: (a)The copyright in any work developed under a grant,subgiant,or contract under a grant or subgrant;and(b)any rights of copyright to which the grantee,subgrantee,or a contractor purchases ownership with grant support. The SUBGRANTEE shall include the foregoing paragraph in all of its subcontracts. p: No costs incurred before the date of this agreement shall be eligible as project expenditures. No costs incurred after the completion date or other termination of the Agreement shall be eligible as project expenditures unless specifically authorized by the DIVISION. q. If the SUBGRANTEE is in noncompliance with any terms)of this grant agreement or any other grant agreement with the Division of Library and Information Services,the • Division of Historical Resources or the Division of Cultural Affairs,the Division may withhold grant payments until the SUBGRANTEE domes into compliance. Violation of a grant program requirement,including but not limited to failure to submit grant reports and other grant documents;submission of incomplete grant reports or other grant documents; or violation of other grant agreement requirements;shall constitute a basis for the Division to place the SUBGRANTEE in noncompliance status with the Department of State. • IV.the term of this agreement will commence on the date of execution of the agreement. THE SUBGRANTEE THE DIVISION BOARD OF COUNTY COMMISSIONERS, COLL ;FLOR A By: Judith A.Ring,Director Fred Coyj,e;.Chairman Division of Library and Information Services ATT Department of State,State of Florida -' '. • • OW tThIT E.Bl OCK dleik -_-4 .��if el that Witness ' ti •as a° outrider' A 'rant Coo ttorney Witness Page 8 of 8 • 1603 MEMORANDUM Date: September 27, 2012 To: Marilyn Matthes, Director Collier County Public Library From: Martha Vergara, Deputy Clerk Minutes & Records Department Re: Collier County ACCESS Florida Community Partner Network Agreement—w/ Immokalee Library, Golden Gate Library and the East Naples Library Attached are one (1) original agreement for each referenced above, (Item #16D3) approved by the Board of County Commissioners on Tuesday, September 25, 2012. Please forward a fully executed original to the Minutes and Record's Department for where it will be kept as part of the Board's Official Records. If you have any questions, please contact me at 252-7240. Thank you Attachment !àACCESS 16 3 Florida cbLLicx cowry ACCESS Florida Community Partner Network Agreement Immokalee Branch Library.located at, 417 1st Street Immokalee Fl 34142, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS' Florida services are Supplemental Nutrition Assistance Program (SNAP), Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current dient population Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. "`Yes ❑ No This is requested of partners with access to My ACCESS Account-Partner View. Our telephone and fax number may also be induded with this advertisement. .4 Yes ❑ No Phone Number:23?-657- 2-(n.2 Fax Number:2_39-4'051- ' I Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is: Choose one: Self-Service Site ❑Assisted Service Site* Service Type 1-I0r *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our Organization's Site(s): Provide informational handouts Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center- 1-866-762-2237 X Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents Provide an explanation of the application process * ❑ Provide assistance to customers to complete/submit their application and For provide requested information* XProvide assistance to customers with "My ACCESS Account"* I ❑ Provide case status information and outstanding information needed to determine eligibility.* Automated Community Connection to Economic Self-Sufficiency 1 16fl3 3 COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all daims,suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable, subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1. above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA) policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.myflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant, the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant, the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). E. Brochures,ACCESS Materials and Signage 2 160 3 Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and induding civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE). This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system • Partners are expected to monitor their employees to ensure all guidelines set forth in this 3 16D 3 II agreement are followed. • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. 4 1603 DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1) the use or disclosure of confidential case file information, induding information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or Bass room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), induding timely notifying applicants of the eligibility decision, the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. 5 16F1 3 1 MUTUAL AGREEMENT Start Date and End Date ❑ This agreement shall begin on 11/ 1 ) 1). or on the date on which it is signed by the last party required to sign it, whichever is latest. 0 This agreement shall end at midnight, local time in , Florida, on © This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1)previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: (wrrtie mrriak1l'2. bra nci1 2-00,r), 407 IYr 5t 1 rvlm0lcck FL 34(Li. 237- C57- 381 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan_connell @dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an as needed" basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 1603 SIGNATURES Signature of Community Agency W• %- c- 1 Z Executive or Designee — - Date Printed Name of the Executive or --CQy °J •CS- 1 Z Designee Date Signature of DCF Regional Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch — Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA * W. S' v By C, Fred Coyle, Chairman ATTESTS' '... DWIGHT E. BRC"CK;.Clerk BY. 114. ♦ M & te rt � iiroved p as to.form and legal sufficiency: • sistant Co$ ty Attor ey • 7 1603 Additional information needed Community Partner Contact Name: _ra rya tAi1`t►awe 5 Contact Phone Number(and extension, if applicable): 7-3cl - 593-351 I Contact E-Mail Address: ±'NItIIQWt - Goli tr-(lb Alternate Contact Name: 511 V ic\ lJe Y\--f Alternate Contact Phone(and extension, if applicable): 9 _ 657-2412- Alternate Contact E-Mail Address: 3 4 ckeOcolL;e,r - (,d,Ori Fax Number: 2-3`7- (p57-' O Website(if applicable): W 1 /( � W W. Co tk i t r o,/ t f3^ Days of Week Open: Mirk 't- j-r'wl r 9-4 Hours of Operation: 8 3ACCESS 1613 3 Florida Co«/EL co,),iry ACCESS Florida Community Partner Network Agreement East Naples Library. located at, 8787 Tamiami Trail E Naples Fl 34113, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS' Florida services are Supplemental Nutrition Assistance Program(SNAP), Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current dient population Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. ` Yes ❑ No This is requested of partners with access to My ACCESS Account—Partner View. Our telephone and fax number may also be induded with this advertisement. )4Yes ❑ No Phone Number:2 7-715-5592 Fax Number.t.ui- la Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is: Choose one: XSelf-Service Site ❑Assisted Service Site* Service Type L-1 b°A-4Y *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our Organization's Site(s): J"' Provide informational handouts XProvide paper applications as requested by customers* Provide access to telephone to call DCF Customer Call Center- 1-866-762-2237 >C. Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents Provide an explanation of the application process* • Provide assistance to customers to complete/submit their application and /or provide requested information* Provide assistance to customers with "My ACCESS Account"* Li Provide case status information and outstanding information needed to determine eligibility.* ' Automated Community Connection to Economic Self-Sufficiency 1 161) 3 COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all daims, suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable, subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1. above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a daim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA) policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.mvflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant, the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant, the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). E. Brochures, ACCESS Materials and Signage 2 1 6 0 3 te Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and including civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE). This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system • Partners are expected to monitor their employees to ensure all guidelines set forth in this 3 ei 'D 3 agreement are followed. • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner.organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. 4 160 3 , DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1) the use or disclosure of confidential case file information, induding information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or class room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), induding timely notifying applicants of the eligibility decision, the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. 5 160 3 MUTUAL AGREEMENT Start Date and End Date ❑ This agreement shall begin on i// I I Z- or on the date on which it is signed by the last party required to sign it, whichever is latest. ❑ This agreement shall end at midnight, local time in , Florida, on © This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1)previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: Col I t e C C ntrit, tjckp1r:, bra.rta\ ahickcy 8757 t ooWiram\ "Tra c X10. p(es rL 39L13 23 = "715- 55`f 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan_connell @dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an "as needed" basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 lED 3 SIGNATURES Signature of Community Agency L. - �— I Z Executive or Designee - Date Printed Name of the Executive or ���i— V V , C�1/(_� J - ? S'- I Z Designee -.-. Date Signature of DCF Regional Director, Circuit Administrator or Date Designee Printed Name of the Regional _Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By: tA) (' v Fred Coyle, Chairman 0',2 ATTEST:. ". .. DWIGHT E.F3R0CK`Clerk •E3y: • ■w a ffel t Iri. 1 **WI s f4rrn and s 1eyal icienc 9 Y• ssthutto ey 7 160 3i4 Additional information needed Community Partner Contact Name: Dr-vi sz M c-MA�on Contact Phone Number(and extension, if applicable): z39_ 2_52-751-12._ Contact E-Mail Address: eivAc_-wt4onA•c_d(iEr-Itle,crno Alternate Contact Name: Vaifi �'CDo� Alternate Contact Phone(and extension, if applicable): '13°Ia 5 , Alternate Contact E-Mail Address: P aeohscc'j'®co‘1fler fib fifes Fax Number: n 1,ty Website (if applicable): rNww•C-al l l`e•r9ov.vt�rtloriNty Days of Week Open: Tk Hours of Operation: o - 8 tt ESS ! 16D 31 Florida co J4-074-- Gou:.irf ACCESS Florida Community Partner Network Agreement Estates Branch Library. located at, 1266 Golden Gate Blvd W Naples Fl 34120, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS' Florida services are Supplemental Nutrition Assistance Program(SNAP), Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current client population 01) Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. ® Yes ❑ No This is requested of partners with access to My ACCESS Account-Partner View. Our telephone and fax number may also be included with this advertisement. al Yes ❑ No Phone Number: 23J- 4SS- 8VW Fax Number: Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is: Choose one: Self-Service Site ❑Assisted Service Site* Service Type L-'ISAA A *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our Organization's Site(s): A Provide informational handouts X Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center- 1-866-762-2237 X Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents X Provide an explanation of the application process* ❑ Provide assistance to customers to complete/submit their application and /or provide requested information* Provide assistance to customers with "My ACCESS Account"* ❑ Provide case status information and outstanding information needed to determine eligibility.* ' Automated Community Connection to Economic Self-Sufficiency 1 161] 3 1 COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all claims, suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable, subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1. above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA) policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.myflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant, the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant, the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). 2 i60 3 E. Brochures,ACCESS Materials and Signage Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and induding civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE). This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system 3 1603 3 • Partners are expected to monitor their employees to ensure all guidelines set forth in this agreement are followed. • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. 4 I 160 3 DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1)the use or disclosure of confidential case file information, induding information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or lass room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), including timely notifying applicants of the eligibility decision, the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. 5 1603 MUTUAL AGREEMENT Start Date and End Date rLi This agreement shall begin on III I 112 or on the date on which it is signed by the last party required to sign it, whichever is latest. ❑ This agreement shall end at midnight, local time in , Florida, on © This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1)previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: C111 ler C.oijtty c4i 1 i r Ary 2.4* Gc t 31 d , w N o4 I e 1 FL 3i-11 2f) 23 - 5 -808 R • 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan_connell @dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an"as needed" basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 160 3 SIGNATURES • r i1 Signature of Community Agency ;'` -i ` Z Executive or Designee Date Printed Name of the Executive or F - D W . Cp-((,E 9 • 2 S— I Z Designee Date Signature of DCF Regional Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA . w, �'lv By. a -v Fred Coyle, Chairman ATTEST:` •• • 1 DWIGHT E. BROCK, CJerk By ,' ' e , r • _.. Atfierai ICO-.'fs ORor4i ana legal sufficiency: Assistant Co ty Attorr( y 7 i6fl 1 6 1:1 3 Additional information needed Community Partner Contact Name: 'Ja vi a C i Contact Phone Number(and extension, if applicable): 237 - 2.52 L)r1, Contact E-Mail Address: � ®coLj t``ri v.rl Alternate Contact Name: Alternate Contact Phone(and extension, if applicable): 237 - I/55-X g8 Alternate Contact E-Mail Address: k,�CocScSQCD��)tr " �l,�O 01 Fax Number: Website(if applicable): Days of Week Open: Hours of Operation: id - r_ 8 160 3 MEMORANDUM Date: September 27, 2012 ( Marilyn Matthes, Director Collier County Public Library 066)11‘) ' Frnm, Martha Vergara, Deputy Clerk Minutes & Records Department 1 Re: State Aide for Library Services & Technology Act Grant Attached are two (2) originals of the agreement referenced above, (Item #16D3) approved by the Board of County Commissioners on Tuesday, September 25, 2012. Please forward a fully executed original to the Minutes and Record's Department for where it will be kept as part of the Board's Official Records. If you have any questions, please contact me at 252-7240. Thank you • .w/ \\j Attachment i v: j� ; 6 0 3 A' . FLORIDA DEPARTMENT OfSTATE RICK SCOTT KEN DETZNER Governor Secretary of State October 1, 2012 Marilyn Matthes, Director Collier County Public Library 2385 Orange Blossom Drive Naples, Florida 34109-8840 Subject: Executed Project Agreement Project: 12-LSTA-D-01, Collier Connects Dear Ms. Matthes: Please find enclosed one executed original copy of the project agreement for the project noted above for your files. Our office is keeping the other copy as part of the official files for the project. Please include the project identification number in any future correspondence with our office regarding this project. If you have questions or need assistance please contact Dorothy Frank at dorothy.frank @dos.myflorida.com or 850.245.6631. Sincerely, '14---D Oegi, Marian A. Deeney -) Library Program Administrator MD/fl Enclosure ,„....-Alks ---01 DIVISION OF LIBRARY AND INFORMATION SERVICES R. A. Gray Building • 500 South Bronough Street • Tallahassee, Florida 32399-0250 Telephone: 850.245.6600 • Facsimile: 850.245.6282 • http://info.florida.gov ----.1liks VIVA FLORIDA 500. Commemorating 5O0 years of Florida history www.fla500.com VIVA FLORIDA 500. 160 3 PROJECT NUMBER 12-LSTA-D-01 Florida Department of State,Division of Library and Information Services LIBRARY SERVICES AND TECHNOLOGY ACT GRANT AGREEMENT AGREEMENT executed and entered into a� - - �1 t BETWEEN the State of Florida, Department of State, Division of Library and Information Services, hereinafter referred to as the DIVISION, and the SUBGRANTEE: Collier County Board of County Commissioners for and on behalf of Collier County Public Library the PROJECT: Collier Connects the GRANT AMOUNT: Twenty-seven thousand one hundred fifty-four dollars ($27,154) released in four equal advance payments as determined by the Division. The funds must be expended on or before September 30, 2013. Unless there is a change of address, any notice required by this agreement shall be delivered to the Division of Library and Information Services, 500 South Bronough Street, Tallahassee, Florida 32399-0250, for the State, and to the Collier County Public Library, 2385 Orange Blossom Drive, Naples, FL, 34109-8840, for the SUBGRANTEE. In the event of a change of address it is the obligation of the moving party to notify the other party in writing of the change of address. The DIVISION, as administrator of federal funds authorized under Section 257.12,Florida Statutes, wishes to provide a grant of federal funds. Federal funds are provided through the Library Services and Technology Act under Florida's long range plan approved by the Institute of Museum and Library Services. The SUBGRANTEE agrees to meet all state requirements and requirements of the Library Services and Technology Act, hereinafter referred to as LSTA. The SUBGRANTEE has made application and has met all eligibility requirements for receipt of a Library Services and Technology Act Grant. By reference,the application and any approved revisions are hereby made a part of this agreement. The parties agree as follows: I. The SUBGRANTEE agrees to: a. Administer all funds granted to it by the DIVISION to carry out the project as described in the project proposal and revisions submitted to and approved by the DIVISION. b. Provide the DIVISION with statistical, narrative, financial and other evaluative reports as requested. Page 1 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code 1613 3 c. Retain and make available to the DIVISION, upon request, all financial and programmatic records, supporting documents, statistical records, and other records for the project. d. Retain all records for a period of five years from the date of submission of the final project report. If any litigation, claim, negotiation, audit or other action involving the records has been started before the expiration of the five year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five year period, whichever is later. e. Establish and maintain a proper accounting system in accordance with generally accepted accounting procedures. To use and maintain adequate fiscal authority, control, and accounting procedures that will ensure proper disbursement of, and accounting for, federal project funds. f. Perform all acts in connection with this agreement in strict conformity with all applicable State and Federal laws and regulations. g. Pay out all project funds on or before the project ending date. h. Expend all grant funds received under this Agreement solely for the purposes of the project. To repay to the DIVISION any and all funds not expended for the purposes of the project. i. Not use any grant funds for lobbying the legislature, the judicial branch, or any state agency. j. Invest temporarily surplus funds and return the interest earned on such investments to the State quarterly. k. Maintain bills for services or expenses in detail sufficient for proper preaudit and postaudit. 1. Maintain any travel expenses in accordance to the provisions of Section 112.061,Florida Statutes. m. That to the best of the SUBGRANTEE'S knowledge and belief that the SUBGRANTEE, and its principals: 1. Are not presently excluded or disqualified (debarment, suspension and other responsibility matters); 2. Have not been convicted within the preceding three years of any of the offenses listed in 45 CFR 1185.800(a) or had a civil judgment rendered against the applicant or its principals for one of those offenses within that time period; 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses listed in 45 CFR 1185.800(a); and 4. Have not had one or more public transactions (Federal, State, or local)terminated within the preceding three years for cause or default. Page 2 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code 160 3 That the SUBGRANTEE, and its principals will comply with 45 CFR Part 1185 Subpart C (Responsibilities of Participants Regarding Transactions) and will require similar compliance with Subpart C by persons at the next lower tier with whom the primary tier participant enters into covered transactions. n. Provide or continue to provide a drug-free workplace by complying with the requirements in Subpart B of 45 CFR Part 1186. This includes: making a good faith effort, on a continuing basis,to maintain a drug-free workplace; publishing a drug-free workplace statement; establishing a drug-free awareness program for its employees; taking actions concerning employees who are convicted of violating drug statutes in the workplace; and identifying (either with this application, upon award, or in documents kept on file in the SUBGRANTEE'S office) all known workplaces under the award. o. The SUBGRANTEE hereby certifies that it is cognizant of the prohibition of conflicts of interest described in Sections 112.311 through 112.326,Florida Statutes, and affirms that it will not enter into or maintain a business or other relationship with any employee of the Department of State that would violate those provisions. The SUBGRANTEE further agrees to seek authorization from the General Counsel for the Department of State prior to entering into any business or other relationship with a Department of State employee to avoid a potential violation of those statutes. p. As required by Section 1352, Title 31 of the United States Code, and implemented for persons entering into a grant or cooperative agreement over$100,000,the SUBGRANTEE 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 agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of a Federal contract, the making of a Federal grant,the making of a Federal loan,the entering into of a cooperative agreement, or the extension, continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than appropriated Federal funds have been paid or will be paid to any person (other than a regularly employed officer or employee of the applicant) 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 request, complete, and submit Standard Form LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. 3. The SUBGRANTEE shall include the language of this certification in Part q in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. q. That to the best of the SUBGRANTEE'S knowledge and belief that the SUBGRANTEE is not delinquent in the repayment of any Federal debt. Page 3 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code 160 3 r. As required by the Civil Rights Act of 1964,the Rehabilitation Act of 1973, the Education Amendments of 1972, and the Age Discrimination in Employment Act of 1975, as implemented at 45 CFR Part 1180.44,the SUBGRANTEE certifies that the SUBGRANTEE will comply with the following nondiscrimination statutes and their implementing regulations: 1. Title VI of the Civil Rights Act of 1964, as amended (42 USC § 2000 et seq.), which provides that no person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or otherwise be subject to discrimination under any program or activity receiving Federal financial assistance; 2. Section 504 of the Rehabilitation Act of 1973, as amended (29 USC § 701 et seq.), which prohibits discrimination on the basis of disability in Federally-assisted programs; 3. Title IX of the Education Amendments of 1972, as amended(20 USC §§ 1681-83, 1685-86), which prohibits discrimination on the basis of sex in education programs and activities receiving Federal financial assistance; 4. The Age Discrimination in Employment Act of 1975, as amended (42 USC § 6101 et seq.), which prohibits discrimination on the basis of age in Federally-assisted programs; The SUBGRANTEE shall insert similar provisions listed in Part r in all subcontracts for services required by this agreement. s. In the event that the SUBGRANTEE expends $500,000 or more in Federal awards in its fiscal year, the SUBGRANTEE must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. In determining the Federal awards expended in its fiscal year, the SUBGRANTEE shall consider all sources of Federal awards, including Federal resources received from the Department of State. 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 SUBGRANTEE conducted by the Auditor General in accordance with the provisions OMB Circular A-133, as revised, will meet the requirements of this part. In connection with the audit requirements addressed in Part s., paragraph 1, the SUBGRANTEE shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised. If the SUBGRANTEE expends less than $500,000 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 SUBGRANTEE expends less than $500,000 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 an audit must be paid from SUBGRANTEE resources obtained from other than Federal entities). Page 4 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code 1603 71. Copies of reporting packages for audits conducted in accordance with OMB Circular A- 133, as revised, and required by this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the SUBGRANTEE directly to each of the following: 1. The Department of State at the following address: Office of Inspector General Florida Department of State R. A. Gray Building, Room 114A 500 S. Bronough Street Tallahassee, Florida 32399-0250 2. 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 3. Other Federal agencies and pass-through entities in accordance with Sections 320 (e) and (f), OMB Circular A-133, as revised. II. The DIVISION agrees to: a. Provide a grant in accordance with the terms of this agreement in the amount and frequency as stated above in consideration for the SUBGRANTEE's performance hereinunder, and contingent upon funding by the Institute of Museum and Library Services. The State of Florida's performance and obligation to pay under this agreement is contingent upon an annual appropriation by the Legislature. In the event that the state or federal funds on which this agreement is dependent are withdrawn, this agreement is terminated and the state has no further liability to the SUBGRANTEE beyond that already incurred by the termination date. In the event of a state revenue shortfall,the total grant may be reduced accordingly. b. Provide professional advice and assistance to the SUBGRANTEE as needed, in implementing and evaluating the project. c. Review the project during the grant period to ensure that adequate progress is being made toward achieving the project objectives. III. The SUBGRANTEE and the DIVISION mutually agree that: a. This instrument embodies the entire agreement of the parties. There are no provisions, terms, conditions, or obligations other than those contained herein; and this agreement shall supersede all previous communications, representations, or agreements, either verbal or written, between the parties. No amendment shall be effective unless reduced in writing and signed by the parties. Page 5 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code 160 3 b. This agreement is executed and entered into in the State of Florida, and shall be construed, performed, and enforced in all respects in accordance with the laws and rules of the State of Florida. Each party shall perform its obligations hereunder in accordance with the terms and conditions of this agreement. If any matter arising out of this Agreement becomes the subject of litigation, venue shall be in Leon County. c. If any term or provision of the agreement is found to be illegal and unenforceable, the remainder of the agreement shall remain in full force and effect and such term or provision shall be deemed stricken. d. No delay or omission to exercise any right,power or remedy accruing to either party upon breach or default by either party under this Agreement shall impair any such right, power or remedy of either party; nor shall such delay or omission be construed as a waiver of any such breach or default, or any similar breach or default. e. This agreement shall be terminated by the DIVISION because of failure of the SUBGRANTEE to fulfill its obligations under the agreement in a timely and satisfactory manner unless the SUBGRANTEE demonstrates good cause as to why it cannot fulfill its obligations. Satisfaction of obligations by the SUBGRANTEE shall be determined by the DIVISION based on the terms and conditions imposed on the SUBGRANTEE in this agreement and compliance with the program guidelines. The DIVISION shall provide SUBGRANTEE a written notice of default letter. SUBGRANTEE shall have 15 calendar days to cure the default. If the default is not cured by the SUBGRANTEE within the stated period,the DIVISION shall terminate this agreement, unless the SUBGRANTEE demonstrates good cause as to why it cannot cure the default within the prescribed time period. For purposes of this agreement, "good cause" is defined as circumstances beyond the SUBGRANTEE's control. In the event of termination of this agreement, the SUBGRANTEE will be compensated for any work satisfactorily completed prior to the notification of termination, if equitable. f. The DIVISION shall unilaterally cancel this agreement in the event that the SUBGRANTEE refuses to allow public access to all documents or other materials made or received in regard to this agreement that are subject to the provisions of Chapter 119, Florida Statutes. SUBGRANTEE agrees to immediately contact the DIVISION for assistance in the event that it receives a public records request related to this agreement or the grant that it awards. g. The DIVISION shall not be liable to pay attorney fees, interest, late charges and service fees, or cost of collection related to the grant. h. The DIVISION shall not assume any liability for the acts, omissions to act or negligence of the SUBGRANTEE, its agents, servants or employees; nor shall the SUBGRANTEE exclude liability for its own acts, omissions to act or negligence to the DIVISION. In addition, the SUBGRANTEE hereby agrees to be responsible for any injury or property damage resulting from any activities conducted by the SUBGRANTEE. Page 6 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code 160 3 i. The SUBGRANTEE, other than a SUBGRANTEE which is the State or agency or subdivision of the State, agrees to indemnify and hold the DIVISION harmless from and against any and all claims or demands for damages of any nature, including but not limited to personal injury, death, or damage to property, arising out of any activities performed under this agreement and shall investigate all claims at its own expense. j. The SUBGRANTEE shall be responsible for all work performed and all expenses incurred in connection with the Project. The SUBGRANTEE may subcontract as necessary to perform the services set forth in this agreement, including entering into subcontracts with vendors for services and commodities, PROVIDED THAT such subcontract has been approved by the DIVISION prior to its execution, and PROVIDED THAT it is understood by the SUBGRANTEE that the DIVISION shall not be liable to the subcontractor for any expenses or liabilities incurred under the subcontract and that the SUBGRANTEE shall be solely liable to the subcontractor for all expenses and liabilities incurred under the subcontract. The SUBGRANTEE shall include the copyright provision in paragraph (o.) of this agreement in all of its subcontracts. k. Neither the State nor any agency or subdivision of the State waives any defense of sovereign immunity, or increases the limits of its liability, by entering into this contractual relationship. 1. The SUBGRANTEE, its officers, agents, and employees, in performance of this agreement, shall act in the capacity of an independent contractor and not as an officer, employee or agent of the DIVISION. Under this agreement, SUBGRANTEE is not entitled to accrue any benefits of state employment, including retirement benefits, and any other rights or privileges connected with employment in the State Career Service. SUBGRANTEE agrees to take such steps as may be necessary to ensure that each subcontractor of the SUBGRANTEE will be deemed to be an independent contractor and will not be considered or permitted to be an agent, servant,joint venturer, or partner of the DIVISION. m. The SUBGRANTEE shall not assign, sublicense or otherwise transfer its rights, duties, or obligations under this agreement without prior written consent of the DIVISION, which consent shall not be unreasonably withheld. The agreement transferee must demonstrate compliance with the requirements of the program. If the Department approves a transfer of the SUBGRANTEE's obligations,the SUBGRANTEE remains responsible for all work performed and all expenses incurred in connection with the agreement. In the event the Legislature transfers the rights, duties, and obligations of the DIVISION to another government entity pursuant to section 20.06,Florida Statutes, or otherwise, the rights, duties, and obligations under this agreement shall also be transferred to the successor government entity as if it were an original party to this agreement. n. This agreement shall bind the successors, assigns and legal representatives of the SUBGRANTEE and of any legal entity that succeeds to the obligations of the DIVISION. Page 7 of 8 LSTA Grant Agreement,Effective 4/10/2012 Chapter 1B-2.011(2)(d),Florida Administrative Code i ____ __ _ 160 3 . . • o. When publications,films,or similar materials are developed,directly or indirectly from a program,project,or activity supported with grant funds,SUBGRANTEE(and any of its subcontractors,if applicable)shall grant the Department of State an irrevocable,royalty- free,non-transferable;non-exclusive right and license to reproduce or otherwise use,to make derivative works from,and to display and distribute any copyrighted material developed under this Agreement for any state governmental purpose. The SUBGRANTEE also grants the federal awarding agency a royalty-free,nonexclusive, and irrevocable license to reproduce,publish or otherwise use,and to authorize others to use,for federal government purposes: (a)The copyright in any work developed under a grant,subgrant,or contract under a grant or subgrant;and(b)any rights of copyright to which the grantee,subgrantee,or a contractor purchases ownership with grant support. The SUBGRANTEE shall include the foregoing paragraph in all of its subcontracts. • ` p: No costs incurred before the date of this agreement shall be eligible as project expenditures. No costs incurred after the completion date or other termination of the Agreement shall be eligible as project expenditures unless specifically authorized by the DIVISION. q. If the SUBGRANTEE is in noncompliance with any term(s)of this grant agreement or any other grant agreement with the Division of Library and Information Services,the • Division of Historical Resources or the Division of Cultural Affairs,the Division may withhold grant payments until the SUBGRANTEE domes into compliance. Violation of a grant program requirement,including but not limited to failure to submit grant reports and other grant documents;submission of incomplete grant reports or other grant documents;or violation of other grant agreement requirements;shall constitute a basis for the Division to place the SUBGRANTEE in noncompliance status with the Department • of State. % IV.The term of this agreement will commence on the date of execution of the agreement. THE SUBGRANTEE THE DIVISION BOARD OF COUNTY COMMISSIONERS, COIL FLOR A a w,m, By; ( ,,,Judi A:.Ring, hector Fred CayJerChairman Div lion of Library and Information Services z Department of State,State of Florida ATTEST:, r•, DWIGHT E.BROCK,(tlec ThaV"(A____ it i' ; Witness Ap; - ' as o rril'- d ': s uffteren ,A 1°.' _ � ' A Assistant Count (• ttorney Witness• t ^� Page 8 of 8 fACCESS 1613 3 Florida Co COU:l7 ACCESS Florida Community Partner Network Agreement Estates Branch Library. located at, 1266 Golden Gate Blvd W Naples Fl 34120, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS' Florida services are Supplemental Nutrition Assistance Program(SNAP), Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current dient population W Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. ® Yes ❑ No This is requested of partners with access to My ACCESS Account-Partner View. Our telephone and fax number may also be included with this advertisement. l Yes ❑ No Phone Number: 2-3'J ASS- 8-015-e- Fax Number: 4oN✓A.r� f Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is: Choose one: XSelf-Service Site ❑Assisted Service Site* Service Type Li Q,Z,A-R *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our Organization's Site(s): ›, Provide informational handouts X Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center- 1-866-762-2237 M. Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents X. Provide an explanation of the application process* ❑ Provide assistance to customers to complete/submit their application and /or provide requested information* Provide assistance to customers with "My ACCESS Account"* ❑ Provide case status information and outstanding information needed to determine eligibility.* 1 Automated Community Connection to Economic Self-Sufficiency 1 1613 3 COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all claims, suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable, subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1. above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA) policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.mvflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant, the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant, the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). 2 1603 E. Brochures, ACCESS Materials and Signage Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1) the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and including civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE). This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system 3 160 3 • Partners are expected to monitor their employees to ensure all guidelines set forth in this • agreement are followed. • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. 4 16fl3 DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2) Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or class room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), including timely notifying applicants of the eligibility decision, the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. 5 160 3 MUTUAL AGREEMENT Start Date and End Date l This agreement shall begin on 1 1' 1 1 2 or on the date on which it is signed by the last party required to sign it, whichever is latest. ❑ This agreement shall end at midnight, local time in , Florida, on 1 This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1) previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: CO if y C C l l ter CaJnty E.5,,-ecit i 2.(;',6, �OiG tY G,A+t 61 vel 1P1 1\j 61 It's , FL 3/11 '2-0 237 - 455-3082 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan_connell @dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an"as needed" basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 160 3 SIGNATURES Signature of Community Agency Executive or Designee Date Printed Name of the Executive or QED V i . Coif Le • 2 S- 12_ Designee Date �,, )131/14V/2--- Signature of DCF Regional _ Director, Circuit Administrator frith&46.111111111111411# inistrat or or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA �. ,lv By: Fred Coyle, Chairman ATTEST DWIGHT E BROCK, Clerk AtteftPlilY 16040 4), By •i.$4 Cl stc}Roren.at d legal sufficiency_ Assistant Co ty Attor y 7 1603 Additional information needed Community Partner Contact Name: V1cf Ck?A.1Ie.k Contact Phone Number(and extension, if applicable): Z3 7_ L yLl Contact E-Mail Address: dch0.(bc lc Bceil i t i cif-A Alternate Contact Name: Alternate Contact Phone(and extension, if applicable): 2,31 - q55-,"6g,c? Alternate Contact E-Mail Address: I&,lrcocsc Fax Number: Website (if applicable): t ,INW.C,0L1I�5L'V. irftlii , Days of Week Open: Hours of Operation: - (;` 8 1603 , SIGNATURES Signature of Community Agency `-- '} Executive or Designee Date Printed Name of the Executive or W Co' 'ZS- I Z Designee Date • Signature of DCF Regional Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By" 71 ., Fred Coyle,Chairman ATTEST:' ' DWIGHT E BROcK,,Clerk aBsy. *��f�� immature proved as to.form and legal sufficiency: • • • sistant Co J ty Attor'ey 7 fAcuss 160 3 Florida C'011-162 co=,vey ACCESS Florida Community Partner Network Agreement East Naples Library. located at, 8787 Tamiami Trail E Naples Fl 34113, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS' Florida services are Supplemental Nutrition Assistance Program(SNAP), Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current dient population Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. ` Yes ❑ No This is requested of partners with access to My ACCESS Account—Partner View. Our telephone and fax number may also be included with this advertisement. ,Yes ❑ No Phone Number:237-•77S-5D1 Fax Number l t Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is: Choose one: rc Xpelf-Sery ice Site ❑Assisted Service Site* Service Type *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our Organization's Site(s): SProvide informational handouts Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center- 1-866-762-2237 Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents Provide an explanation of the application process* ❑ Provide assistance to customers to complete/submit their application and /or provide requested information* Provide assistance to customers with "My ACCESS Account"* ❑ Provide case status information and outstanding information needed to determine eligibility.* ' Automated Community Connection to Economic Self-Sufficiency 1 160 3 COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all daims,suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable, subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1. above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA) policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.myflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant, the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant, the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). E. Brochures, ACCESS Materials and Signage 2 1603 . Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and including civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE). This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system • Partners are expected to monitor their employees to ensure all guidelines set forth in this 3 1603 , agreement are followed. • • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. 4 16034 DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2) Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or class room training that address(1)ACCESS Program overview, (2)the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), including timely notifying applicants of the eligibility decision, the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. 5 16D 3 MUTUAL AGREEMENT Start Date and End Date ❑ This agreement shall begin on id / I '2- or on the date on which it is signed by the last party required to sign it, whichever is latest. ❑ This agreement shall end at midnight, local time in , Florida, on ❑x This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1) previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: Col I i' r Cou vi'y Ijd„p1 r�s brn-ick, �b cos; 87,1'7 oorn rcti;nnl Ira`�I C- NI s 31-i113 23 .7`15-- 55c1 A:.'l,11Ti.41111.iff.L.;.Y it ]!. 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan_connell@dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an"as needed" basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 i6D3 SIGNATURES Signature of Community Agency Executive or Designee Date Printed Name of the Executive or .-ED VV . CoyLE J - Z r- i Z- Designee Date Signature of DCF Regional LI ■414 �61 C77 1O//17 //2_ / Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By: Fred Coyle,Chairman 2 ATTEST DWIGHT E BROCK Clerk By- '„ ,�. A+ li ,e t er ht 411010 1�8�s frl rti and legal s iciency: 4 • -ssistant Crunty Atto ley 7 1603 .4 , Additional information needed Community Partner Contact Name: L° M fr , I✓,J�.l�L G u+J'l1 Contact Phone Number(and extension, if applicable): 2,39- 251_.7 5i-17 Contact E-Mail Address: V C-W a,lo Y1[,c_ott! T-_J i ;,c 1'0 Alternate Contact Name: . 6t0-1-, Alternate Contact Phone(and extension, if applicable): II " a3gasa �5 Alternate Contact E-Mail Address: P eo e (9cc\\'des hb.d;t Fax Number: '241*7\ 1 � Website(if applicable): t `� itteMile ca - Days of Week Open: Hours of Operation: o - 8 16O3 SIGNATURES Signature of Community Agency Executive or Designee - Date Printed Name of the Executive or Et V V , CDY t_L 2 S— I Z Designee Date Signature of DCF Regional Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA k./1 By Fred Coyle, Chairman ATTEST,,: DWIGHT E. B,ROCK, OJerk By` la; 2 , ,t,, . c r�{ ' -tcrorili aria legal sufficiency: Assistant Co ty Attor y 7 fACCESS 1613 3 Florida aLL,c,. Cowl/ ACCESS Florida Community Partner Network Agreement Immokalee Branch Library. located at, 417 1St Street Immokalee Fl 34142, agrees to serve as an access point for applicants and recipients of ACCESS Florida services. For purposes of this agreement ACCESS' Florida services are Supplemental Nutrition Assistance Program(SNAP), Temporary Cash Assistance, Refugee Assistance, and Medicaid programs administered by the Department of Children and Families. As a member of the ACCESS Florida Community Network our organization will be available to: ❑ Serve our current client population Serve the general public in our community. Our name and street address information as listed above may be advertised as an ACCESS Florida Community Network site and listed on the ACCESS Florida public Internet web page at http://www.dcf.state.fl.us/programs/access/ Partner agrees to be advertised on the ACCESS Community Network site. )titYes ❑ No This is requested of partners with access to My ACCESS Account-Partner View. Our telephone and fax number may also be included with this advertisement. ,l Yes ❑ No Phone Number: 237-657- 2:-"6.8"2-. Fax Number: .37-47E5'7-(-190 t Community Partners will provide all services under this Agreement without charge to the customer, display ACCESS signage, required informational posters and ACCESS brochures to support customer education and support and will notify the Department of any established partner site closures. The access level of our organization is: Choose one: Self-Service Site ❑Assisted Service Site* Service Type b��'� *At a minimum, provides services annotated with asterisk(*) below to be considered for access to Partner View. Services offered at Our Organization's Site(s): XProvide informational handouts • Provide paper applications as requested by customers* ❑ Provide access to telephone to call DCF Customer Call Center- 1-866-762-2237 • Provide computer to apply for assistance on-line* ❑ Provide printer for ACCESS documents ❑ Provide fax machine to fax application and other documents to DCF ❑ Provide copy machine to copy application related documents • Provide an explanation of the application process * ❑ Provide assistance to customers to complete/submit their application and /or provide requested information* Provide assistance to customers with "My ACCESS Account"* 9 ❑ Provide case status information and outstanding information needed to determine eligibility.* ' Automated Community Connection to Economic Self-Sufficiency 1 16D 3 COMMUNITY PARTNER ASSURANCES A. Indemnification 1. Community Partner agrees to be liable for and indemnify, defend, and hold harmless the Department and its officers, agents, and employees from all claims, suits,judgments, awards of money damages, attorneys fees, and court costs, arising out of any act, neglect, or omission by Community Partner, its agents, employees, and if applicable, subcontractors during the performance of this agreement, including subsequent amendments thereof. 2. Community Partner's inability to evaluate its liability or its evaluation of liability shall not excuse Community Partner's duty to comply with subparagraph A.1. above, within 7 days after notice by Department to Community Partner by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding Community Partner not liable shall excuse Community Partner's compliance with subparagraph A.1. Community Partner shall pay all costs and fees, including attorneys fees related to obligations and their enforcement against Community Partner by Department. Department's failure to notify Community Partner of a claim, suit, or judgment, award of money damages, attorney's fees, or court costs shall not release Community Partner from the requirements of subparagraphs A.1. or A.2. Community Partner shall not be liable for the sole act, negligence, or omission of Department. 3. If Community Partner is an agency or subdivision of the State, its obligation to indemnify, defend and hold harmless the department shall be to the extent permitted by law and without waiving the limits of sovereign immunity. B. Civil Rights Compliance The Community Partner shall ensure that all civil rights requirements are met. All applicants and recipients are granted civil rights in accordance with Federal laws and US Department of Agriculture, Food and Nutrition Services(USDA) policy that services will be provided without discrimination on the basis of race, color, national origin, age, sex, disability, political beliefs or religion. The nondiscrimination poster, "And Justice for All", is posted on the ACCESS Florida internet page at http://www.myflorida.com/accessflorida/. If this web page is not accessible to customers, the"And Justice for All "poster shall be posted in a lobby area for customers to read. C. Confidentiality of Customer Information Community Partner will only use confidential customer case file information to assist the applicant, the recipient, or Department or their respective duly authorized representatives, with the completion of the application process for ACCESS Florida benefits or services, conducting an investigation into performance of this agreement or the administration of ACCESS Florida programs. Community Partner will only disclose confidential customer case file information to the applicant, the recipient, or Department, or their respective duly authorized representatives only for those purposes set forth in this section. If Community Partner has questions or concerns about safeguarding of confidential case file information or an intended use or disclosure of such information, Community Partner must contact the appropriate local DCF office Contact Person, or their designee. Community Partner agrees not to implement an intended use or disclosure unless approved by DCF. Community Partner agrees to notify the appropriate local DCF contact person within 48 hours of the receipt of verbal or written requests for case file information. No information obtained from a customer's records may be shared with individuals or organizations. All such requests should be referred to DCF for review and action. Community Partner will only access confidential customer case file information if they are an approved Assisted Service Site, have completed all required security training and have been given a consent form from the customer allowing access to information that is dated within 90 days of the access to information. D. Health Insurance Portability and Accountability Act Where applicable, community partners agree to comply with the Health Insurance Portability and Accountability Act(42 U. S. C. 1320d.)as well as all regulations promulgated hereunder(45 CFR Parts 160, 162, and 164). E. Brochures, ACCESS Materials and Signage 2 16133 Community Partner shall ensure that customers are aware that they are an ACCESS Partner by displaying an ACCESS Sign in their store front window or other appropriate area as agreed upon between the Department and the Community Partner. Brochures, paper applications and other informational ACCESS materials shall be made available to customers. F. Training The Community Partner shall participate in on-line training as provided by the Department in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2)Civil Rights requirements; and (3)for those partners using the My ACCESS Account-Partner view, Department's annual Security Awareness training. Additionally, the Community Partner will participate in either the on-line training modules or other training sessions provided by the Department that address(1)ACCESS Program overview, (2) the My ACCESS Account Status training. The Community Partner agrees to on-site monitoring as established by the Department. G. Information Security Obligations The Partner shall be held responsible for information security, especially involving the access, transport or storing of sensitive and confidential information. Fulfillment of security responsibilities shall be mandatory and violations may be cause for action, up to and including civil penalties or criminal penalties under chapters 119, 812, 815, 817, 839, or 877, Florida Statutes, or similar laws. H. Client Risk Prevention and Incident Reporting The Community Partner must 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 of 1-800-962-2873(1-800-96ABUSE). This requirement is binding upon Community Partner and its officers, agents, and employees, as required by chapters 39 and 415, Florida Statutes. I. Publicity Provider and its employees, agents, and representatives will not, without prior DCF written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service provided by the Partner has been approved or endorsed by the State, or refer to the existence of this Agreement in press releases, advertising or materials distributed to the Partner's prospective customers. ADDITIONAL ASSURANCES FOR PARTNERS UTILIZING THE PARTNER VIEW SYSTEM The My ACCESS Account—Partner View is a system that allows limited access to customer information to certain personnel who are actively assisting customers with their ACCESS Florida program activity. Partners with access to this system shall perform the following: • Assist customers in completing the web application as requested. Partners that assist the customer completing screens on the web application shall have the customer submit the electronic application themselves unless the Community Partner is acting as the authorized representative and has all required documentation verifying their designation as the authorized representative. • Assist customers to understand what verifications are outstanding and necessary in order for Department to determine eligibility for the Medicaid, Supplemental Nutrition Assistance Program (SNAP)and/or Temporary Cash Assistance programs. • Assist customers with verifying case status and eligibility information through opening their account on MyAccount • Assist customers with understanding the availability of public assistance benefits and services administered by Department • Notify Department if Partner has case information in its possession, custody, or control concerning a customer that is inconsistent with Department's information. • Follow Department policies regarding obtaining information not available on the Partner View system • Partners are expected to monitor their employees to ensure all guidelines set forth in this 3 1603 agreement are followed. • Prior to viewing customer case file information, a Partner using this system will obtain a standalone written consent or authorization from the applicant or recipient authorizing Department to share confidential public assistance case file information related to eligibility determination with the Community Partner organization. The consent or authorization shall comply with Department policies and must be retained and available to Department or its designated representatives, as necessary, during normal business hours for review and comparison against inquiries made on the ACCESS system for a period of three years from the date such consent or authorization is received from the applicant, recipient, or authorized household representative. Failure to have valid consent forms may result in the Partner loosing access to customer information. Community Partners must complete and submit all designated security forms for each individual allowed access to confidential customer case file information as required by Department. Community Partner must notify Department's liaison of termination of any Community Partner employees that have or had access to confidential customer case file information. 4 16 3 DEPARTMENT ASSURANCES A. Training Department will offer training to Community Partner in the following areas: (1)the use or disclosure of confidential case file information, including information governed by the Health Insurance Portability and Accountability Act of 1996 and its implementing federal regulations; (2) Civil Rights requirements; and (3)for those partners using the Partner View system, Department's annual Security Awareness training. Additionally, the Department offers on-line or class room training that address(1)ACCESS Program overview, (2) the My ACCESS Account Status training. B. Supplies and Materials Department will supply and replenish ACCESS signage, paper applications and public assistance programs literature as needed at no cost to Community Partner. Community Partner must notify Department of the need for additional literature in a timely manner based on its local demand levels. C. Eligibility Determination Department will complete the eligibility determination process on completed applications received from Community Partner site(s), including timely notifying applicants of the eligibility decision, the availability of hearing rights, and how fair hearings may be requested. D. For Partner using the My ACCESS Account Partner View System Department will provide limited access to confidential customer case file information. This access will be granted solely to assist the Community Partner in their limited role of assisting with the administration of ACCESS Florida services. The department will monitor Community Partner's compliance with the terms and conditions of customer consent or authorization relating to information concerning applicant and recipient households and assistance groups. Monitoring will occur using on-site visits, computerized surveillance, desk reviews and by other means deemed necessary by Department. 5 16D 3 MUTUAL AGREEMENT Start Date and End Date ❑ This agreement shall begin on /I 1 1 ) 17. or on the date on which it is signed by the last party required to sign it, whichever is latest. ❑ This agreement shall end at midnight, local time in , Florida, on 0 This agreement will remain in effect unless terminated by either party with proper notice. Termination 1. This agreement can be terminated by either party without cause upon no less than 30 calendar days notice in writing to the other party, unless an earlier time is mutually agreed upon in writing. 2. This agreement may be terminated for Community Partner's non-performance upon no less than 24 hours notice in writing by Department. Department may exercise the provisions of Rule 60A- 1.006(3), Florida Administrative Code, if this agreement is terminated for nonperformance. Waiver of any breach of this agreement shall not be deemed a waiver of any other breach and shall not be construed to be a modification of this agreement. Department may exercise all other rights and remedies at law or in equity to redress a breach of this agreement 3. Community Partner's failure to perform any obligation required by this agreement in a manner satisfactory to Department will be sufficient cause to terminate this agreement. To be terminated as a partner under this subparagraph, Community Partner must have: (1) previously failed to satisfactorily perform in a contract with Department, been notified by Department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to Department's satisfaction; or(2) had a contract terminated by Department for cause. The contact person, or their designee, shall be responsible for informing the appropriate local Department of Children and Families office of performance concerns of which the Community Partner becomes aware in the performance of its duties and responsibilities, and be responsible for providing in a timely manner the appropriate local Department of Children and Families office with original or copies of documentation required by this agreement, and for being available to Department for consultation and assistance, as requested by Department or as agreed by Community Partner, during Community Partner's normal business hours and days of operation. 1.Community Partner's name, as shown on page 1, mailing address, telephone number and e-mail address is: J1�� CA(1N_r Cvvyrty INNYIyckAI 11 pIL ArA 1-10 re,(-y' 1117 i't S-i- 1 yvi vY oka ,FL- 31{0-12, �- ( 57-"j33-Z. 2. The name, address, telephone number and e-mail address of Department of Children and Families ACCESS Program contact person is: Ian Connell Community Partner Liaison 2295 Victoria Ave Fort Myers Fl 33901 239-344-0874 Fax 239-344-0801 lan_connell@dcf.state.fl.us Department's contact person will be available to assist Community Partner in its performance of this agreement on an "as needed" basis during Department's normal business hours and days of operation. All contact with Department by the Community Partner must be through Department's local contact person. 6 1603 ' SIGNATURES Signature of Community Agency tA)• 2C- Executive or Designee Date Printed Name of the Executive or W ° CDY L -CS - ( Z Designee Date Signature of DCF Regional 4 �1IIPII1■ /131 (P /I 2 Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By S ,V Fred Coyle, Chairman \ ATTEST DWIGHT E. BROCK,.Clerk By. ® ♦ • &4a/ssei proved as to form and legal sufficiency: ' a • sistant Co ty Attor'ey 7 16113 Additional information needed Community Partner Contact Name: — "o`vtr. tit✓,I(t a..m 5 Contact Phone Number(and extension, if applicable): _ 9 �. 3-3_ t1 Contact E-Mail Address: _ vv Rio_wts r�)I;'t*_.r ni Alternate Contact Name: J S��Vta\ Alternate Contact Phone(and extension, if applicable): -3_31 _ 6 5 7-2 ?g2 Alternate Contact E-Mail Address: sr �e colt,e.c - /.67,0c1 Fax Number: Website(if applicable): Days of Week Open: p� i Hours of Operation: M1.1- 1 l � )7/W1F- 8 1603 . , SIGNATURES Signature of Community Agency W. Executive or Designee Date Printed Name of the Executive or VV . CoyLE 9 - 2C- I z Designee Date Signature of DCF Regional Director, Circuit Administrator or Date Designee Printed Name of the Regional Kimberly Kutch Director, Circuit Administrator or Circuit 20 Community Development Administrator Designee BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA By: ( .). -\'v Fred Coyle,Chairman 1 01.2"� ATTEST , DWUGHT"Ett /nBROCK:Clerk ':; G �JC ::f Imo, y: AtteStentYWeattle*Or t. IAPPA s'fd'f- ft and legal s iciency: Y ssistant Cirunty Atto fey 7