Backup Documents 09/28/2010 Item #16D 9ORIGINAL
AC OMPPA NY ALL ORIGINAL CHECKLIST
OCUMENT SENT TO
16,09
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 mid 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 # I through #4 as appropriate for additional signatures, dates. and/or information needed. If the document is already complete with the
exception of the Chairman's signature, draw a line through routine lines # 1 through 94. eomolew the checklist and forward m Inn Mitchell nines 851
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
I.
_
(Initial)
Applicable)
2.
September 28, 2010
Agenda Item Number
16 D -09
3.
signed by the Chairman, with the exception of most letters. must be reviewed and signed
/
f
4.
Contract Amendment
Number of Original
9
5. Ian Mitchell, Executive Manager
Board of County Commissioners
Documents Attached
Id
6. Minutes and Records
Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BUC approvat. Nonnally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of die addressees above, including Ian Mitchell, need to contact stair for additional or missing
information. All original documents needing the BC'( C'haninan s signature are to he delivered to the BCC oflicc oulp after the BCC has acted to approve the
item.)
Name of Primary Staff
Nick Green, I4FIVS
Phone Number
252 -2376
Contact
Grants Coordinator
(Initial)
Applicable)
Agenda Date Item was
September 28, 2010
Agenda Item Number
16 D -09
Approved by the BCC
signed by the Chairman, with the exception of most letters. must be reviewed and signed
/
f
Type of Document
Contract Amendment
Number of Original
9
Attached
resolutions, etc. signed by the Comity Attorneys Office and signature pages from
Documents Attached
INSTRUCTIONS & CHECKLIST
L Forms/ County Forms/ BCC forms / Original Documents Routing Slip w WS Original 9.0304, 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)
I.
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
/
f
by the Office of the County Attorney. l his includes signature pages from ordinances,
%-
resolutions, etc. signed by the Comity Attorneys 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 possibl � State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
n/a
Office and all other parties exec t 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 Ian Mitchell in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on 09/28/10 and all changes made during
the meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes, if applicable.
L Forms/ County Forms/ BCC forms / Original Documents Routing Slip w WS Original 9.0304, Revised 1 26 05. Revised 2 24 05
MEMORANDUM
Date: October 14, 2010
To: Nick Green, Grants Coordinator
Human & Human Services
From: Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re: Contract Amendment #1 "Collier County Hunger and
Homeless Coalition"
Attached is one original and one certified copy as referenced
above (Item #16D9) approved by the Board of County Commissioners
on September 28, 2010.
The Minutes and Record's Department will hold the second original
document in the Board's Official Records.
If you have any questions please call me at 252 -8411.
Thank you.
Attachment (2)
1609
EXHIBIT A -1 Contract Amendment # 1
"Collier County Hunger and Homeless Coalition"
This Amendment, dated ��� �� 2 -0 2010 to the referenced Agreement shall
be by and between the parties to the original Agreement, Collier County Hunger and Homeless Coalition
(hereafter referred to as "Sub - Recipient') and Collier County, a political subdivision of the State of
Florida, (to be referred to as "County ").
Statement of Understanding
Re: State of Florida Homeless Assistance Challenge Grant #HFZ03
In order to continue the services provided for in the original Agreement document referenced above and
later adjusted by a Zero Dollar Contract Change Notification dated March 5, 2010, the Sub- Recipient
agrees to amend the above referenced Agreement as follows:
Note: Numbers strueli thFaugh have been deleted; numbers underlined have been added
AMENDMENT TO:
C. BUDGET: Challenge Grant funding for $32,000
Line Item: Challenge Grant Funds
HMIS Equipment & Software:
Computers, Printers
and Peripherals $ 700
HMIS operational Costs
Office supplies, classroom
materials, printing, $ 100
HMIS Rental (Space) $ 2,000
Personnel: $ 24,000
Salary, benefits, mileage
Training (includes travel) $ 5,000
Technical Services $ 200
Website Maintenance
Total Budget: $ 32,000
Exhibit A -1 Contract Amendment Grant # HFZ03
Collier County Hunger and Homeless Coalition
.r;
Budget after Zero Contract Change Notification of March 5, 2010 and Current Amendment:
Original Line Item
Original Bud et
New Budget
HMIS Equipment and
$700.00
$2,000.0 $0.00
Software:
Computers, Printers and
Peripherals
HMIS operational costs; office
$100.00
$1,000.0 $1,272.82
supplies, classroom
materials, printing
HMIS rental (space)
$2,000.00
$0,90 iffl.31
Personnel: salary, benefits,
$24,000.00
mileage
$25.691.87
Training (includes travel)
$5,000.00
$4,800.00
Technical Services, website
_
$200.00
$200.00 (satne} 175.00
maintenance
TOTAL BUDGET
$32,000.00
$32,000.00 (same)
All other terms and conditions of the agreement shall remain in force.
IN WITNESS WHEREOF, the Sub - Recipient and the Owner have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date(s) indicated below.
Acc%�*hFw 0 - - -day of EPw / , 2010.
First Witness:
Signature
!1(CV-00(rPV\ C�tCL�I� �JGrC� tiVL %`
Printed Name and Title
Seep ss:
Signature n
Printed Name and Title
BOARD OF COUNTY COMMISSIONERS
OF COLLIER COUNTY, FLORIDA
l�7r r ti
FRED W. COYLE, CHAIRMAN
Collier County Hunger and Homeless Coalition
By:
Debra ahr
Chief Executive Officer
Approval for form and legal sufficiency:
JetKifer B. White
Assistant County Attorney Fitem
Exhibit A -] Contract Amendment Grant # IIFZ03
Collier County Hunger and Homeless Coalition
Agenda
Date
Date C) (4 (Q
Recd
eputy Clerk