Backup Documents 09/14/2010 Item #16D11ORIGINAL DOCUMENTS CHECKLIST & ROUTING SL4 b D 1
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
exeention of the Chairman's signature, draw a line through routing lines #I 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, Human and Veteran
Services
(Initial)
9/17/10
2.
September 1� 2009
Agenda Item Number
16DI I
3.
by the Office of the County Attorney. This includes signature pages from ordinances,
4. Ian Mitchell, Executive Manager
Board of County Commissioners
Number of Original
3
5. Minutes and Records
Clerk of Court's Office
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 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 13CC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Terri Daniels
Phone Number
252 -2689
Contact
appropriate.
(Initial)
Applicable)
Agenda Date Item was
September 1� 2009
Agenda Item Number
16DI I
Approved by the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
NSIP Amendment #1 203.10
Number of Original
3
Attached
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Documents Attached
INSTRUCTIONS & CHECKLIST
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1: Forms/ County Forms/ BCC Forms / Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
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 or 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 (some 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.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC (enter date) and all changes
made during the meeting have been incoated in the attached document. The
�echanges,
County Attorney's Office has reviewed t if applicable.
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1: Forms/ County Forms/ BCC Forms / Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16011
MEMORANDUM
Date: September 23, 2010
To: Terri Daniels, Grants Supervisor
Human Services Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: NSIP Amendment #1
Attached, please find one (3) original as referenced above (Agenda
Item #16D11), approved by the Board of County Commissioners on
Tuesday, September 14, 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 #001
16011
Contract NSIP 203.10
STANDARD CONTRACT
AREA AGENCY ON AGING
Collier County Housing, Human and Veteran Services
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc.,
hereinafter referred to as the "agency ", and Collier County Housing Human and Veteran
Services, hereinafter referred to as the "recipient ", amends agreement #NSIP 203.10.
The purpose of this amendment is to:
1. Decrease the NSIP allocation by $6,346.60 and
2. ATTACHMENT II1, Exhibit -1 is hereby replaced with the revised ATTACHMENT III,
Exhibit -1 and attached hereto.
This amendment shall be effective August 12, 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:V �s
Deputy Clerk
�ttNt a !a pw t �
i�pi+aEw'� alAt a
Approved as to form and
legal sufficiency
Assistan Cou-f);1 tto ey^
Federal Tax ID: 59- 6000558
Fiscal Year Ending 9/30
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Fred W. Coyne,, Chhairniay�
Date: LVIV
SepterfibJ 14, 2010
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA
M
Date:
Leigh Anna Nowak, Board President
Amendment #001
16011
Contract NSIP 203.10
ATTACHMENT III
EXHIBIT -1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS AGREEMENT CONSIST OF THE FOLLOWING:
COLLIER COUNTY
PROGRAM TITLE
FUNDING
CFDA
AMOUNT
SOURCE
Nutrition Services Incentive
Older Americans Act
93.053
$37,157.40
Program
TOTAL FEDERAL AWARD
$37,157.40
16 ®11
Attestation Statement
Agreement/Contract Number NSIP 203.09
Amendment Number I
I, Fred W. Coyle. Chairman 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.
r ,a
Signature of Recipient /Contractor representative
Approved as to form and
legal sufficiency
Assistant ounty Attorney
September 14, 2010
Date
ATTEST:
DWIGHT E. BROCK, CLERK
�.., r _
Revised April 2010 DBF'utYCtat
Attw •t to £hairwaa j
09ftiture " ,