Backup Documents 05/25/2010 Item #16D 9ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP1 6 D 9
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 throw h routing lines #1 through #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s)
List in routing order)
Office
Initials
Date
1. Terri Daniels
Housing and Human Services
Dept.
Agenda Item Number
6/9/2010
2. Ian Mitchell, Manager BCC
Board of County Commissioners
��9�2v10
3. Minutes and Records
Clerk of Court's Office
Number of Original
3
4.
Amend #4
Documents Attached
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created /prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Ian Mitchell, 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 oliice only after the BCC has acted to approve the
item.
Name of Primary Staff
Contact
Terri Daniels
Phone Number
252 -2689
Agenda Date Item was
May 25, 2010
Agenda Item Number
16D9
Approved by the BCC
Original document has been signed/initialed for legal sufficiency. (All documents to be
Type of Document
Home Care for the Elderly HCE 203.09
Number of Original
3
Attached
Amend #4
Documents Attached
INSTRUCTIONS & CHECKLIST
C Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, devised 224 -05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applica ble
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
document m the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
5.
In most cases (sonic contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours of BCC approval.
�j
Some documents are time sensitive and require forwarding to Tallahassee within a certain
41
time frame or the BCC's actions are nullified. Bea are 9 _ or deadlines!
6.
The document was approved by the BCC on enter date) and all changes
made during the meeting have been incorpora ed in the attached document. The
r6
County Attorney's Office has reviewed the changes, if applicable.
C Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, devised 224 -05
16D 9
MEMORANDUM
Date: June 9, 2010
To: Terri Daniels, Grants Supervisor
Human Services Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Contract: Reports for Choose Life License Plate
Funds
(Reports for 2005, 2006, 2007, 2008, and 2009)
Attached, please find three originals as referenced above (Agenda
Item #16D9), approved by the Board of County Commissioners on
Tuesday, May 25, 2010.
Please return a fully executed copy once all signatures
have been obtained for the Board's permanent records.
If you should have any questions, please call 252 -7240.
Thank you.
Amendment 4004
160 9
Contract HCE 203.09
STANDARD CONTRACT
AREA AGENCY ON AGING
Collier County Board of County Commissioners
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc.,
hereinafter referred to as the "agency ", and Collier County Board of County Commissioners,
hereinafter referred to as the "recipient ", amends agreement #HCE 203.09.
The purpose of this amendment is to: (1) Amend Paragraph 3.2.4 of Attachment I, and (2)
revise and replace Attachment VIII, Home Care for the Elderly Invoice Report Schedule.
(1) Paragraph 3.2.4 of the Standard Contract is amended to read:
3.2.4 All advance payments made to the contractor shall be returned to the agency as
follows: one third by report number 13, one -third by report number 14, and one-
third by report 15, in accordance with the invoice schedule as shown on Attachment
VIII to this contract.
(2) Attachment VIII, Home Care for the Elderly Invoice Report Schedule is hereby
replaced with the revised Attachment VIII, Home Care for the Elderly Report Schedule
and attached hereto.
This amendment shall be effective May 6, 2010.
All provisions in the agreement and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed
by their officials there unto duly authorized.
ATTEST:
DWIGHT E BROCK, Clerk
By:
Deputy Clerk
Mat u `�o pK
Approved as to form and
legal nnsnnuf^^f^^c i ency
l
Assistant County Attorney
Federal Tax ID: 59- 6000558
Fiscal Year Ending: 09/30
BOARD OF COUNTY COMMISSIONERS
COLLIE�, C UNTY, FLORIDA
By. �kt_#k w. C
FRED COYLE, CHAIRMAN
Date: Mav 25 2010
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA
By:
NAOMI E. MANNING, BOARD PRESIDENT
Date:
Amendment #004
HOME CARE FOR THE ELDERLY
INVOICE SCHEDULE
Report Number Based On
1
July Advance*
2
August Advance*
3
September Advance*
4
July Expenditure
5
August Expenditure
6
September Expenditure
7
October Expenditure
B
November Expenditure
9
December Expenditure
10
January Expenditure
11
February Expenditure
12
March Expenditure
13
April Expenditure
14
May Expenditure
15
16
Legend:
Note #1:
Note #2
Note #3
June Expenditure
Final Expenditure and Closeout Report
Advance based on projected cash need.
160
Contract HCE 203.09
ATTACHMENT VIII
On This Date
July 1
July 1
July 1
August 20
September 20
October 20
November 20
December 20
January 20
February 20
March 20
April 20
May 20
June 20
July 20
July 25
Report #1 for Advance Basis Contracts cannot be submitted to the Department of
Financial Services (DFS) prior to July 1 or until the agreement with the department
has been executed and a copy sent to DFS. Actual submission of the vouchers to DFS
is dependent on the accuracy of the expenditure report.
Report numbers 13, 14 and 15 shall reflect an adjustment of one third of the total
advance amount, on each of the three reports respectively, repaying advances for
the first three months of the contract. The adjustment shall be recorded in Part C, 1
of the report (Attachment X).
Submission of expenditure reports may or may not generate a payment request. If
final expenditure report reflects funds due back to the department, payment is to
accompany the report.
2
ne
160 9
VI IM HNIENI S
RE( '.P:IPTS AND EXPENDI'fFRISS
WAIF C',4RE FOR 'I [IF. I- IA)F1, .A PRM.RAII
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I�:ISG Management-
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r, ONl f1JC'X__ -
bask
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NE E" )I, TP
CERTIFICATION: 1 certify to the best of my knowledge and
bchet (hat the report
is comploto and i orrecl
end all outlays herein
are for purposes
,,It Earth In the contlarL
Pr*pared BY: __ -- Date:____APProvca
By
_ Date'
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160 9
Attestation Statement
Agreement/Contract Number HCE 203.09
Amendment Number 4
I, Fred Coyle attest that no changes or revisions have been made to
(Recipient/Contractor representative)
the content of the above referenced agreement/contract or amendment between the Area Agency on
Aging for Southwest Florida, Inc. and
Collier County Board of Commissioners
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement/contract content.
Fred Coyle, Chairman
Signature of Recipient/Contractor representative
Approved as to form and
legal sufficiency
CbCwCV
Assistant County Attorney
Revised April 2010
May 25, 2010
Date
Af TEST;
[)WIGHT E. 13Rn K, Cleric
Attest u to fM f
01"VA " fA °r -N