Backup Documents 03/12/2019 Item #16D 6 coifler County 1606
Public Services Division
Community&Human Services
Memorandum
To: Clerks Recording
CC:
From: Wendy Klopf, Grant Coordinator, Services for Seniors
Date: 03.12.19
Subject: Executed Agreement with Area Agency on Aging of SWFIa (AAA)
CHS is providing executed Agreement from Area Agency on Aging of SWFIa (AAA) that was approved on
the Consent Agenda on 03.12.19
• 1606-0AA 203.19
Enclosed are the copies for Minutes and Records since they did not require the BCC signature due to
Resolution 2010-122, designating the Public Service Administrator authority to sign the amendments.
Let me know if you need anything.
Thanks
Wendy Klopf
Grant Coordinator-Services for Seniors
252-2901
Collier County
6
January—December 2019 OAA 203.19 1 0 6
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
STANDARD CONTRACT
OLDER AMERICANS ACT
DRS CONTRACT is entered into between Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier
County Board of County Commissioners (Contractor), collectively referred to as the "Parties." The term Contractor for
this purpose may designate a Vendor, Subgrantee or Subrecipient.
WTTNESSETHTHAT:
WHEREAS,the Agency has determined that it is in need of certain services as described herein; and WHEREAS,
the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such services as an
independent Contractor of the Agency.
NOW THEREFORE,in consideration of the services to be performed and payments to be made,together with the
mutual covenants and conditions hereinafter set forth,the Parties agree as follows:
1. Purpose of Contract:
The purpose of this Contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments,forms and exhibits,which constitute the contract document.
2. Incorporation of Documents within the Contract:
The contract will incorporate attachments,proposal(s),state plan(s),grant agreements,relevant Department handbooks,
manuals or desk books, as an integral part of the contract, except to the extent that the contract explicitly provides to
the contrary. In the event of conflict in language among any of the documents referenced above,the specific provisions
and requirements of the contract document(s) shall prevail over inconsistent provisions in the proposal(s) or other
general materials not specific to this contract document and identified attachments.
3. Term of Contract:
This contract shall begin at twelve(12:00)A.M.,Eastern Standard Time January 1,2019 or on the date the contract
has been signed by the last party required to sign it,whichever is later. It shall end at eleven fifty-nine (11:59)P.M.,
Eastern Standard Time December 31,2019.
4. Contract Amount:
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not
to exceed$1,235,199.00 subject to the availability of funds. Any costs or services paid for under any other contract or
from any other source are not eligible for payment under this contract.
5. Renewals`
By mutual agreement of the Parties, in accordance with Section 287.058(1)(8), Florida Statutes (F.S.), the Agency
may renew the contract for a period not to exceed three years,or the term of the original contract,whichever is longer.
The renewal price,or method for determining a renewal price, is set forth in the bid,proposal,or reply.No other costs
for the renewal may be charged.Any renewal is subject to the same terms and conditions as the original contract and
contingent upon satisfactory performance evaluations by the Agency and the availability of funds.
6. Compliance with Federal Law:
6.1 If this contract contains federal funds this section shall apply.
6.1.1 The Contractor shall comply with the provisions of 45 Code of Federal Regulations (CFR) 75 and/or 45
CFR Part 92,2 CFR Part 200 and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all
applicable standards,orders,or regulations issued under Section 306 of the Clean Air Act as amended (42
United States Code (U.S.C.) 7401, et seq.), Section 508 of the Federal Water Pollution Control Act as
amended (33 U.S.C. 1251, et seq.), Executive Order 11738, as amended, and where applicable
Environmental Protection Agency regulations 2 CFR Part 1500.The Contractor shall report anyviolations
of the above to the Agency.
•
1 ',
1606
January—December 2019 OAA 203.19
6.1.3 The Contractor, or agent acting for the Contractor,may not use any federal funds received in connection
with this contract to influence legislation or appropriations pending before the Congress or any state
legislature. The Contractor must complete all disclosure forms as required, specifically the Certification
and Assurances Attachment,which must be completed and returned to the Contract Manager prior to the
execution of this contract.
6.1.4 In accordance with Appendix II to 2 CFR Part 200, the Contractor shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as
supplemented in Department of Labor regulations 41 CFR Part 60 and in Department of Health and Human
Services regulations 45 CFR Part 92, if applicable.
6.1.5 A contract award with an amount expected to equal or exceed$25,000.00 and certain other contract awards
will not be made to parties listed on the government-wide Excluded Parties List System,in accordance with
the OMB gnidelines at 2 CFR 180 that implement Executive Orders 12549 and 12689, "Debarment and
Suspension." The Excluded Parties List System contains the names of parties debarred, suspended, or
otherwise excluded by agencies,as well as parties declared ineligible under statutory or regulatory authority
other than Executive Order 12549. The Contractor shall comply with these provisions before doing
business or entering into subcontracts receiving federal funds pursuant to this contract. The Contractor
shall complete and sign the Certifications and Assurances Attachment prior to the execution of this contract.
6.2 The Contractor shall not employ an unauthorized alien. The Agency will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act(8 U.S.C. 1324a) and the Immigration
Reform and Control Act of 1986(8 U.S.C. 1101). Such violation will be cause for unilateral cancellation of this
contract by the Agency.
6.3 If the Contractor is a non-profit provider and is subject to Internal Revenue Service(IRS)tax exempt organization
reporting requirements (filing a Form 990 or Form 990-N)and has its tax exempt status revoked for failing to
comply with the filing requirements of the Pension Protection Act of 2006 or for any other reason,the Contractor
must notify the Agency in writing within thirty(30)days of receiving the IRS notice ofrevocation.
6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR §170.110(b), the Contractor shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR Part 170.
6.6 To comply with Presidential Executive Order 12989,as amended,and State of Florida Executive Order Number
11-116, Contractor agrees to utilize the U.S. Department of Homeland Security's E-verify system to verify the
employment of all new employees hired by Contractor during the contract term. Contractor shall include in
related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the
state contract utilize the E-verify system to verify employment of all new employees hired by the Subcontractor
during the contract term. Contractors meeting the terms and conditions of the E-Verify System are deemed to be
in compliance with this provision.
7. Compliance with State Law;
7.1 This contract is executed and entered into in the State of Florida,and shall be construed,performed and enforced
in all respects in accordance with Florida law,including Florida provisions for conflict of laws.
7.2 If this contract contains state financial assistance funds,the Contractor shall comply with Section 215.97,F.S.,
and Section 215.971,F.S.,and expenditures must be in compliance with laws,rules,and regulations, including,
but not limited to,the Reference Guide for State Expenditures.
7.3 The Contractor shall comply with the requirements of Section 287.058,F.S.as amended.
7.3.1 The Contractor shall perform all tasks contained in Attachment I.
7.3.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in
Attachment I,to be received and accepted by the contract manager prior to payment.
7.3.3 The Contractor shall comply with the criteria and final date by which such criteria must be met for
completion of this contract as specified in Attachment I, Section III.Method of Payment.
2
1606
January—December 2019 OAA 203.19
7.3.4 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre-audit and post-audit.
7.3.5 If itemized payment for travel expenses is permitted in this contract,the Contractor shall submit bills for
any travel expenses in accordance with Section 112.061,F.S.,or at such lower rates as may be provided in
this contract.
7.3.6 The Contractor shall allow public access to all documents,papers,letters,or other public records as defined
in subsection 119.011(12),F.S.,made or received by the Contractor in conjunction with this contract except
for those records which are made confidential or exempt by law. The Contractor's refusal to comply with
this provision will constitute an immediate breach of contract for which the Agency may unilaterally
terminate this contract,
7.4 If clients are to be transported under this contract,the Contractor shall comply with the provisions of Chapter
427,F.S.,and Rule Chapter 41-2,Florida Administrative Code(F.A.C).
7.5 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity,in
accordance with the provisions of Section 287,134,F.S.
7.6 The Contractor shall comply with the provisions of Section 11.062,F.S.,and Section 216.347,F.S.,which prohibit
the expenditure of contract funds for the purpose of lobbying the legislature,judicial branch or a state agency.
7.7 The Agency may,at its option,terminate the Contract if the Contractor is found to have submitted a false
certification as provided under section 287,135(5),F.S.,has been placed on the Scrutinized Companies with
Activities in the Iran Petroleum Energy Sector List,the Scrutinized Companies with Activities in Sudan List,or
the Scrutinized Companies that Boycott Israel List,or if the Contractor has been engaged in business operations
in Cuba or Syria or is engaged in a boycott of Israel.
8. Radigraundeening:_
The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435, F.S., as amended, are met
regarding background screening for all persons who meet the definition of a direct service provider and who are not
exempt from the Agency's level 2 background screening pursuant to Section 430.0402(2)-(3), F.S. The Contractor
must also comply with any applicable rules promulgated by the Agency and the Agency for Health Care
Administration regarding implementation of Section 430.0402 and Chapter 435,F.S. To demonstrate compliance with
this provision, Contractor shall submit to the Agency,the Background Screening Affidavit of Compliance(Screening
Form) upon thirty (30) days of execution of this contract. Should the Agency have a completed Screening Form on
file for the Contractor,a new Screening Form will be required every twelve(12)months.
8.1 Further information concerning the procedures for background screening may be found at
http://elderaffairs.state.fl.us/doea/backgroundscreening.php.
9. Grievance Procedures;
The Contractor shall develop, implement,and ensure that its Subcontractors have established grievance procedures to
process and resolve client dissatisfaction with or denial of service(s),and address complaints regarding the termination,
suspension or reduction of services, as required for receipt of funds.These procedures,at a minimum,will provide for
notice of the grievance procedure and an opportunity for review of the Subcontractor's determination(s).
10. Public Records and Retention;
10.1 By execution of this contract,Contractor agrees to all provisions of Chapter 119,F.S., and any other applicable
law,and shall:
10.1.1 Keep and maintain public records required by the Agency to perform the contracted services.
10.1.2 Upon request from the Agency's custodian of public records,provide the Agency a copy of the requested
records or allow the records to be inspected or copied within a reasonable time at a cost that does not
exceed the cost provided in Chapter 119,F.S.,or as otherwise provided by law.
3
1 6 D 6
January—December 2019 OAA 203.19
10.1.3 Ensure that public records that are exempt, or confidential and exempt, from public records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and
following completion of the contract if the Contractor does not transfer the records to theAgency.
10.1.4 Upon completion of the contract, the Contractor will either transfer, at no cost to the Agency, all public
records in possession of the Contractor, or will keep and maintain public records required by the Agency.
If the Contractor transfers all public records to the Agency upon completion of the contract, Contractor
shall destroy any duplicate public records that are exempt,or confidential and exempt,from public records
disclosure requirements. If the Contractor keeps and maintains public records upon completion of the
contract, the Contractor shall meet all applicable requirements for retaining public records. All records
stored electronically must be provided to the Agency in a format that is compatible with the information
technology systems of the Agency.
10,2 The Agency may unilaterally cancel this contract, notwithstanding any other provisions of this contract, for
refusal by the Contractor to comply with Section 10 of this contract by not allowing public access to all documents,
papers, letters, or other material made or received by the Contractor in conjunction with this contract,unless the
records are exempt, or confidential and exempt, from Section 24(a) of Article I of the State Constitution and
Section 119.07(1),F.S.
IF TILE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119,FLORIDA STATUTES,TO THE CONT'RACTOR'S DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT
TH; CUSTODIAN OF PUBLIC RECORDS AT:
Public Records Coordinator
Area Agency on Aging for Southwest Florida,Inc.
15201 N Cleveland Ave.,Suite 1100
North Fort Myers,FL 33903
239-652-6900
11. Audits.Inspections.Investigations:
11.1 The Contractor shall establish and maintain books,records and documents(including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of funds
provided by the Agency under this contract. Contractor shall adequately safeguard all such assets and assure
they are used solely for the purposes authorized under this contract. Whenever appropriate,financial information
should be related to performance and unit cost data.
11.2 The Contractor shall retain and maintain all client records, financial records, supporting documents, statistical
records, and any other documents(including electronic storage media)pertinent to this contract for a period of
six(6)years after completion of the contract or longer when required by Iaw.In the event an audit is required
by this contract,records shall be retained for a minimum period of six(6)years after the audit report is issued or
until resolution of any audit findings or litigation based on the terms of this contract,at no additional cost to the
Agency.
11.3 Upon demand,at no additional cost to the Agency,the Contractor shall facilitate the duplication and transfer of
any records or documents during the required retention period.
11.4 The Contractor shall assure that the records described in this section will be subject at all reasonable times to
inspection,review,copying,or audit by federal,state,or other personnel duly authorized by the Agency.
11.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Agency and
federal auditors, pursuant to 45 CFR Part 75,will be allowed full access to and the right to examine any of the
Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the
form in which kept.
11.6 The Contractor shall provide a Financial and Compliance Audit Attachment to the Agency as specified in this
contract and ensure that all related third-party transactions are disclosed to the auditor.
4
1606
January—December 2019 OAA 203.19
11.7 Contractor agrees to comply with the Inspector General in any investigation,audit,inspection,review,or hearing
performed pursuant to Section 20.055,Florida Statutes. Contractor further agrees that it shall include in related
subcontracts a requirement that subcontractors performing work or providing services pursuant to this contract
agree to cooperate with the Inspector General in any investigation,audit,inspection,review,or hearing pursuant
to Section 20,055(5), F.S.By execution of this contract the Contractor understands and will comply with this
subsection.
12. Nondiscrimination-Civil Rights Com lip iance:
12.1 The Contractor shall execute Assurances as stated in the Assurances-Non-Construction Programs Attachment that
it will not discriminate against any person in the provision of services or benefits under this contract or in
employment because of age, race,religion, color,disability, national origin, marital status or sex in compliance
with state and federal law and regulations. The Contractor further assures that all Contractors, Subcontractors,
Sub-grantees, or others with whom it arranges to provide services or benefits in connection with any of its
programs and activities are not discriminating against clients or employees because of age,race,religion, color,
disability,national origin,marital status or sex.
12.2 During the term of this contract,the Contractor shall complete and retain on file a timely,complete and accurate
Civil Rights Compliance Checklist,attached to this contract.
12.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures will include notifying clients, employees, and
participants of the right to file a complaint with the appropriate federal or state entity.
12.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance,and are binding upon the Contractor,its successors,transferees,and assignees for the
period during which such assistance is provided. The Contractor further assures that all Subcontractors,Vendors,
or others with whom it arranges to provide services or benefits to participants or employees in connection with
any of its programs and activities are not discriminating against those participants or employees in violation of
the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the Contractor
understands that the Agency may,at its discretion,seek a court order requiring compliance with the terms of this
assurance or seek other appropriate judicial or administrative relief,including but not limited to,termination of
and denial of further assistance.
13. Monitoring by the Agency:
The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records, papers, •
documents, facilities, goods, and services of the Contractor which are relevant to this contract, and to interview any
clients, employees, and Subcontractor employees of the Contractor to assure the Agency of the satisfactory
performance of the terms and conditions of this contract. Following such review,the Agency will provide a written
report of its findings to the Contractor, and where appropriate,the Contractor shall develop a Corrective Action Plan
(CAP). The Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determined
by the Agency's Contract Manager.
14. Provision of Services:
The Contractor shall provide services in the manner described in Attachment I.
15. indemnification:
The Contractor shall indemnify,save, defend, and hold harmless the Agency and its agents and employees from any
and all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the
execution of this contract or performance of the services provided for herein. It is understood and agreed that the
Contractor is not required to indemnify the Agency for claims, demands, actions or causes of action arising solely out
of the negligence of the Agency.
15.1 Except to the extent permitted by Section 768.28,F.S.,or other Florida law,this section 16 is not applicable to
contracts executed between the Agency and state agencies or subdivisions defined in Section 768.28(2),F.S.
•
5 ___
1606
January—Decetnber 2019 OAA 203.19
16. Insurance and Bonding:,
16.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or
subdivision as defined by Section 768.28(2), F.S.,the Contractor accepts full responsibility for identifying and
determining the type(s) and extent of liability insurance necessary to provide reasonable financial protections
for the Contractor and the clients to be served under this contract. The limits of coverage under each policy
maintained by the Contractor do not limit the Contractor's liability and obligations under this contract. The
Contractor shall ensure that the Agency has the most current written verification of insurance coverage
throughout the term of this contract. Such coverage may be provided by a self-insurance program established
and operating under the laws of the State of Florida. The Agency reserves the right to require additional
insurance as specified in this contract.
16.2 Throughout the term of this contract, the Contractor shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Contractor
authorized to handle funds received or disbursed under all agreements and/or contracts incorporating this
contract by reference in an amount commensurate with the funds handled,the degree of risk as determined by
the insurance company and consistent with good business practices.
17. Confidentiality of Information;
The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized
to give that consent or when authorized by law.
18. 1ealth Insurance Portability and Accountability Act;
Where applicable,the Contractor shall comply with the Health Insurance Portability and Accountability Act(42 USC
1320d.),as well as all regulations promulgated thereunder(45 CFR Parts 160, 162,and 164).
19. Incident Reporting:
19.1 The Contractor shall notify the Agency immediately but no later than forty-eight (48) hours from the
Contractor's awareness or discovery of conditions that may materially affect the Contractors or Subcontractors
ability to perform the services required to be performed under this contract. Such notice shall be made orally to
the Agency's Contract Manager(by telephone)with an email to immediately follow.
19.2 The Contractor shall 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
(1-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon the Contractor,
Subcontractors,and their employees.
20. New Contract(s)Reporting:
The Contractor shall notify the Agency within ten(10) days of entering into a new contract with any of the remaining
four (4) state human service agencies. The notification shall include the following information: (1)contracting state
agency and the applicable office or program issuing the contract; (2)contract name and number; (3)contract start and
end dates; (4) contract amount; (5) contract description and commodity or service; (6) Contract Manager name and
contact information. In complying with this provision, and pursuant to Section 287.0575, F.S., as amended, the
Contractor shall complete the Contractor's State Contracts List(request copy from Area Agency).
21. Bankruptcy Notification:
During the term of this contract, the Contractor shall immediately notify the Area Agency on Aging for Southwest
Florida, Inc. if the Contractor, its assignees, Subcontractors or affiliates file a claim for bankruptcy. Within ten (10)
days after notification,the Contractor must also provide the following information to the Area Agency on Aging for
Southwest Florida,Inc.; (1)the date of filing of the bankruptcy petition;(2)the case number;(3)the court name and the
division in which the petition was filed (e.g., Middle District of Florida, Fort Myers Division); and (4) the name,
address,and telephone number of the bankruptcy attorney.
6
•
• 1606
January—December 2019 OAA 203.19
22. Sponsorship and Publicity:
22.1 As required by Section 286.25, F.S., if the Contractor is a non-governmental organization which sponsors a
program financed wholly or in part by state funds, including any funds obtained through this contract, it shall,
in publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by (Contractor's
name) and the Area Agency on Aging for Southwest Florida, Inc. and/or State of Florida, Department of Elder
Affairs." If the sponsorship reference is in written material, the words "Area Agency on Aging for Southwest
Florida,Inc.and/or State of Florida,Department of Elder Affairs"shall appear in at least the same size letters or
type as the name of the organization.
22.2 The Contractor shall not use the words"Area Agency on Aging for Southwest Florida,Inc.and/or State of Florida,
Department of Elder Affairs" to indicate sponsorship of a program otherwise financed, unless specific
authorization has been obtained by the Agency prior to use.
23. Assignments;
23.1 The Contractor shall not assign the rights and responsibilities under this contract without the prior written
approval of the Agency, which shall not be unreasonably withheld. Any sublicense, assignment, or transfer
otherwise occurring without prior written approval of the Agency will constitute a material breach of the
contract.
23.2 The Area Agency and/or the State of Florida is, at all times, entitled to assign or transfer, in whole or part, its
rights, duties,or obligations under this contract to another governmental agency in the State of Florida, upon
giving prior written notice to the Contractor. In the event the Area Agency and/or the State of Florida approves
transfer of the Contractor's obligations, the Contractor remains responsible for all work performed and all
expenses incurred in connection with this contract.
233 This contract shall remain binding upon the successors in interest of either the Contractor or the Agency. •
24. Subcontracts;
24.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a
written document and subject to any conditions of approval the Agency deems necessary. The Contractor
further agrees that the Agency will not be liable to the Subcontractor in any way or for any reason. The
Contractor,at its expense,shall defend the Agency against any such claims.
24.2 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the Agency or other state
agency. Failure to make payments to any Subcontractor in accordance with Section 287.0585, F.S., unless •
otherwise stated in the contract between the Contractor and Subcontractor,will result in a penalty as provided
by statute.
25. Independent Capacity of Contractor:
It is the intent and understanding of the Parties that the Contractor, and any of its Subcontractors, are independent
Contractors and are not employees of the Agency and shall not hold themselves out as employees or agents of the
Agency without specific authorization from the Agency. It is the further intent and understanding of the Parties that the
Agency does not control the employment practices of the Contractor and will not be liable for any wage and hour,
employment discrimination, or other labor and employment claims against the Contractor or its Subcontractors. All
deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds
and all necessary insurance for the Contractor are the sole responsibility of the Contractor.
26. Payment;
Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in
Attachment I. The Contract Manager will have final approval of the Contractor's invoice submitted for payment, and
will approve the invoice for payment only if the Contractor has met all terms and conditions of the contract,unless the
bid specifications, purchase order, or this contract specify otherwise. The approved invoice will be submitted to the
Agency's finance section for budgetary approval and processing. Disputes arising over invoicing and payments
7
16D6
January—December 2019 OAA 203.19
will be resolved in accordance with the provisions of Section 215.422,F.S. A Vendor Ombudsman has been established
within the Florida Department of Financial Services and may be contacted at 800-342-2762.
27. Return of Funds:
The Contractor shall return to the Agency any overpayments due to unearned funds or funds disallowed and any
interest attributable to such funds pursuant to the terms and conditions of this contract that were disbursed to the
Contractor by the Agency. In the event that the Contractor or its independent auditor discovers that an overpayment has
been made, the Contractor shall repay said overpayment immediately without prior notification from the Agency. In
the event that the Agency first discovers an overpayment has been made, the Contract Manager will notify the
Contractor in writing of such findings. Should repayment not be made forthwith,the Contractor shall be charged at the
lawful rate of interest on the outstanding balance pursuant to Section 55.03, F.S., after Agency notification or
Contractor discovery.
28. Data Integrity and Safeguarding Information:
The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using
in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor
employees that request system or information access and ensuring that user access has been removed from all terminated
employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information
processing capabilities.All data and software shall be routinely backed up to ensure recovery from losses or outages
of the computer system. The security over the backed-up data is to be as stringent as the protection required of the
primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system
backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance
for Agreements,Grants,Loans,and Cooperative Agreements prior to the execution of this contract.
29. Computer Use and Social Media Policy:
The Florida Department ofElder Affairs has implemented a Social Media Policy,in addition to its Computer Use Policy,
which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel
affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the
Department's computer resource systems must comply with the Department's policy regarding social media. Social
Media includes, but is not limited to blogs, podcasts, discussion forums, Wilds, RSS feeds, video sharing, social
networks like MySpace,Facebook and Twitter, as well as content sharing networks such as flickr and YouTube.This
policy is available on the Department's website at:http://eldera.ffairs.state.fl.us/doea/financial.php.
30. Conflict of Interest:
The Contractor shall establish safeguards to prohibit employees,board members,management and Subcontractors from
using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of
interest or personal gain. No employee, officer or agent of the Contractor or Subcontractor shall participate in the
selection,or in the award of a contract supported by state or federal funds if a conflict of interest,real or apparent,would
be involved. Such a conflict would arise when: (a)the employee,officer or agent;(b)any member of his/her immediate
family; (c) his or her partner; or(d) an organization which employs, or is about to employ, any of the above, has a
financial or other interest in the firm selected for award. The Contractor or Subcontractor's officers, employees or
agents will neither solicit nor accept gratuities, favors or anything of monetary value from Contractors, potential
Contractors, or parties to Subcontracts: The Contractor's board members and management must disclose to the
Agency any relationship which may be, or may be perceived to be, a conflict of interest within thirty (30) calendar
days of an individual's original appointment or placement in that position,or if the individual is serving as an incumbent,
within thirty(30)calendar days of the commencement of this contract. The Contractor's employees and Subcontractors
must make the same disclosures described above to the Contractor's board of directors. Compliance with this provision
will be monitored.
31. Public Entity Crime:
Pursuant to Section 287.133,F.S.,a person or affiliate who has been placed on the Convicted Vendor List following a
conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or
services to a public entity;may not submit a bid,proposal,or reply on a contract with a public entity for the construction
or repair of a public building or public work;may not submit bids,proposals,or replies on leases of real property to a
public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a 8 ,`
1606
January—December 2019 OAA 203.19
contract with any public entity; and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017,F.S.,for CATEGORY TWO for a period of thirty six(36)months following the date of
being placed on the Convicted Vendor List.
32. Purchasing:
32.1 The Contractor may purchase articles which are the subject of or are required to carry out this contract from
Prison Rehabilitative Industries and Diversified Enterprises,Inc., (PRIDE)identified under Chapter 946,F.S.,
in the same manner and under the procedures set forth in subsections 946.515(2)and (4),F.S. For purposes of
this contract,the Contractor shall be deemed to be substituted for the Agency insofar as dealings with PRIDE.
This clause is not applicable to Subcontractors unless otherwise required by law. An abbreviated list of
products/services available from PRIDE may be obtained by contacting PRIDE,800-643-8459.
32.2 The Contractor may procure any recycled products or materials,which are the subject of or are required to carry
out this contract,in accordance with the provisions of Section 403.7065,F.S.
32.3 The Contractor may purchase articles that are the subject of, or required to early out, this contract from a
nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413,F.S.,
in the same manner and under the same procedures set forth in Section 413.036(1)and(2),F.S. For purposes of
this contract, the Contractor shall be deemed to be substituted for the Agency insofar as dealings with such
qualified nonprofit agency are concerned. Additional information about the designated nonprofit agency and
the products it offers is available at http://www.respectofflorida.org. This clause is not applicable to
Subcontractors unless otherwise required by law.
33. Patents.Copyrights.Royalties:
If this contract is awarded state funding and if any discovery,invention or copyrightable material is developed,produced
or for which ownership was purchased in the course of or as a result of work or services performed under this contract,
the Contractor shall refer the discovery,invention or material to the Agency to be referred to the Department of State.
Any and all patent rights or copyrights accruing under this contract are hereby reserved to the State of Florida in
accordance with Chapter 286,F.S.Pursuant to Section 287.0571(5)(k),as amended,the only exceptions to this provision
shall be those that are clearly expressed and reasonably valued in this contract
33.1 If the primary purpose of this contract is the creation of intellectual property,the State of Florida shall retain an
unencumbered right to use such property,notwithstanding any agreement made pursuant to this Section 34.
33.2 If this contract is awarded solely federal funding,the terms and conditions are governed by 2 CFR§200.315 or
45 CFR§75,322,as applicable.
33.3 Notwithstanding the foregoing provisions, if the Contractor or one of its Subcontractors is a university and a
member of the State University System of Florida, then Section 1004.23, F.S., shall apply, but the Agency
shall retain a perpetual,fully-paid,nonexclusive license for its use and the use of its Contractors,Subcontractors
or Assignees of any resulting patented,copyrighted or trademarked work products.
34. emergency Preparedness and Continuity of Operations:
34.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health,safety or welfare, the Contractor shall,
within thirty (30) calendar days of the execution of this contract, submit to the Agency's Contract Manager,
verification of an Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the
Agency of emergency provisions.
34.2 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall retain
responsibility for performance under this contract and must follow procedures to ensure continuity of operations
without interruption.
•
9
16D6
January—December 2019 OAA 203.19
35. Equipment:
35.1 Equipment means:(a)tangible personal property(including information technology systems)having a useful life
of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization level
established by the organization for the financial statement purposes,or$5,000.00 [for federal funds-2 CFR
§200.33 and 45 CFR§75.2,as applicable],or(b);nonexpendable,tangible personal property of a non-
consumable nature with an acquisition cost of$1,000.00 or more per unit,and expected useful life of at least one
(1) year; and hardback bound books not circulated to students or the general public, with a value or cost of
$250.00 or more[for state funds].
35.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 200
Administrative Requirements (formerly OMB Circular A-110) that include: (a) a property list with all the
elements identified in the circular;(b)a procedure for conducting a physical inventory of equipment at least once
every two (2) years; (c)a control system to insure adequate safeguards to prevent loss, damage,or theft of the
equipment; and(d)maintenance procedures to keep the equipment in good condition.The property records must
be maintained on file and shall be provided to the Agency upon request. The Contractor shall promptly
investigate, fully document and notify the Agency's Contract Manager of any loss, damage, or theft of
equipment. The Contractor shall provide the results of the investigation to the Agency's ContractManager.
35.3 The Contractor's property management standards for equipment(including replacement equipment), whether
acquired in whole or in part with federal funds and federally-owned equipment shall, as a minimum, meet the
following requirements and to include accurately maintained equipment records with the following information:
35.3.1 Property records must be maintained that include a description of the equipment;
35.3.2 Manufacturer's serial number, model number,federal stock number,national stock number,or other
identification number;
35.3.3 Source of funding for the equipment,including the federal award identification number;
35.3.4 Whether title vests in the Contractor or the federal government;
35.3.5 Acquisition date(or date received,if the equipment was furnished by the federal government)andcost;
35.3.6 Information from which one can calculate the percentage of federal participation in the cost of the
equipment(not applicable to equipment furnished by the federal government);
35.3.7 Location,use and condition of the equipment and the date the information was reported;
35.3.8 Unit acquisition cost;and
35.3.9 Ultimate disposition data,including date of disposal and sales price or the method used to determine
current fair market value where a Contractor compensates the federal awarding agency for its share.
35.3.10 A physical inventory must be taken and the results reconciled with the property records at leastonce
every two(2)years.
35.3.11 A control system must be developed to ensure adequate safeguards to prevent loss,damage,or theft of
the property.Any loss,damage, or theft must be investigated.
35.3.12 Adequate maintenance procedures must be developed to keep the property in good condition.
35.3.13 If the Contractor is authorized or required to sell the equipment,proper sales procedures must be
established to ensure the highest possible return.
35.4 Equipment purchased with federal funds with an acquisition cost over$5,000.00 and equipment purchased with
state funds with an acquisition cost over$1,000.00 is part of the cost of carrying out the activities and functions
of the grant awards and Title (ownership)will vest in the Contractor [for federal funds see 2 CFR§200.313(a)
and 45 CFR §75.320(a), as applicable], subject to the conditions of 2 CFR Part 200 and/or 45 CFR Part 75.
Equipment purchased under these thresholds is considered supplies and is not subject to property standards.
10
1686
January—December 2019 OAA 203.19
Equipment purchased with funds identified in the budget attachments to agreements covered by this contract,or
identified in the sub-agreements with Subcontractors (not included in a cost methodology), is subject to the
conditions of Chapter 273,F. S.and 60A-1.017,F.A. C. and 2 CFR Part 200 and/or 45 CFR Part 75,
•
35.5 The Contractor shall not dispose of any equipment or materials provided by the.Agency, or purchased with
funds provided through this contract without first obtaining the approval of the Agency's Contract Manager. •
When disposing of property or equipment the Contractor must submit a written request for disposition
instructions to the Agency's Contract Manager. The request should include a brief description of the property, •
purchase price, funding source, and percentage of state or federal participation, acquisition date and condition
of the property.The request should also indicate the Contractor's proposed disposition(i.e.,transfer or donation
to another agency that administers federal programs,offer the items for sale,destroy the items,etc.).
35.6 The Agency's Contract Manager will issue disposition instructions. If disposition instructions are not received
within one hundred twenty (120) days of the written request for disposition, the Contractor is authorized to
proceed as directed in 2 CFR§200.313 or 45 CFR§75.320,as applicable.
35.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract without the prior approval of the Agency. Real property
purchases from Older Americans Act funds are subject to the provisions of Title 42, Chapter 35,Subchapter Ill,
Part A., Section 3030b U.S.C.Real property purchases from state funds can only be made through fixed capital
outlay grants and aids appropriations and therefore are subject to the provisions of Section 216.348,F.S.
35.8 Any permanent storage devices(e.g.:hard drives,removable storage media)must be reformatted and tested prior
to disposal to ensure no confidential information remains.
35.9 The Contractor must adhere to the Agency's procedures and standards when purchasing Information
Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR
worksheet is required for any computer related item costing $1,000.00 or more, including data processing
hardware, software, services, supplies, maintenance, training, personnel and facilities. The completed 1I'R
worksheet shall be maintained in the LAN administrator's file and must be provided to the Agency upon
request. The Contractor has the responsibility to require any Subcontractors to comply with the Agency's ITR
procedures.
36. NIR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
http://www.myflorida.com/apps/vbs/adoc/F7740 PURI 000.pdf
In the event of any conflict between the PUR 1000 Form and any terms or conditions of this contract the terms or
conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes,the terms or conditions contained
in the PUR 1000 Form shall take precedence.
37. Use of State Funds to Purchase or Improve Real Property:
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds provided
for at least five(5)years from the date of purchase or the completion of the improvements or as further required by law.
•
11
1606
January—December 2019 OAA 203,19
38. Dispute Resolution:
Any dispute concerning performance of the contract shall be decided by the Agency's Contract Manager, who shall
reduce the decision to writing and serve a copy on the Contractor,
39. Financial Consequences:
If the Contractor fails to meet the minimum level of service or performance identified in this contract,the Agency will
impose financial consequences as stated in Attachment I.
40. No Waiver of Sovereign Immunity;
Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
41. Venue:
If any dispute arises out of this contract,the venue of such legal recourse shall be Lee County, Florida.
42. Entire Contract:
This contract contains all the terms and conditions agreed upon by the Parties,No oral agreements or representations
shall be valid or binding upon the Agency or the Contractor unless expressly contained herein or by a written
amendment to this contract signed by both Parties.
43. Force Majeure:
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party experiencing the force majeure condition provides immediate written notification to the other party
and takes all reasonable efforts to cure the condition.
44. Severability Clause:
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable the
other provisions are severable to that void provision and shall remain in full force and effect,
45. Condition Precedent to Contract Appropriations:
The Parties agree that the Agency's performance and obligation to pay under this contract is contingent upon an
annual appropriation by the Legislature.
46. Addition/Deletion:
The Parties agree that the Agency reserves the right to add or to delete any of the services required under this contract
when deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties.
The Parties shall negotiate compensation for any additional services added.
47. Waiver;
The delay or failure by the Agency to exercise or enforce any of its rights under this contract will not constitute or be
deemed a waiver of the Agency's right thereafter to enforce those rights, nor will any single or partial exercise of any
such right preclude any other or further exercise thereof or the exercise of any other right.
48. Compliance:
The Contractor shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable
current state statutes,laws,rules and regulations. The Parties agree that failure of the Contractor to abide by these laws
shall be deemed an event of default of the Contractor, and subject the contract to immediate, unilateral cancellation of
the contract at the discretion of the Agency.
49. Final Invoice;
The Contractor shall submit the final invoice for payment to the Agency no later than thirty (30) days upon the
contract ending date unless otherwise specified in Attachment I. If the Contractor fails to do so, all right to payment is
forfeited and the Agency may not honor any requests submitted after the aforesaid time period. Any payment due
under the terms of this contract may be withheld until all required documentation and reports due from the Contractor
and necessary adjustments thereto have been approved by the Agency.
12
1606
January—December 2019 OAA 203.19
50. renegotiations of Modifications:
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price
level increases and changes in the rate of payment when these have been established through the appropriations process
and subsequently identified in the Agency's operating budget.
51. Suspension of Work:
The Agency may in its sole discretion suspend any or all activities under the contract or purchase order, at any time,
when iu the best interests of the State to do so. The Agency shall provide the Contractor written notice outlining the
particulars of suspension.Examples of the reason for suspension include,but are not limited to,budgetary constraints,
declaration of emergency, or other such circumstances. After receiving a suspension notice, the Contractor shall
comply with the notice and shall not accept any purchase orders. Within ninety(90)days, or any longer period agreed
to by the Contractor,the Agency shall either(1)issue a notice authorizing resumption of work,at which time activity
shall resume, or (2) terminate the contract or purchase order. Suspension of work shall not entitle the Contractor to
any additional compensation.
52. Termination:
52.1 Termination for Convenience. The Agency,by written notice to the Contractor,may terminate this contract in
whole or in part when the Agency determines in its sole discretion that it is in the State's interest to do so. The
Contractor shall not furnish any product after it receives the notice of termination, except as necessary to
complete the continued portion of this contract, if any. The Contractor shall not be entitled to recover any
cancellation charges or lost profits.
52.2 Termination for Cause. The Agency may terminate this contract if the Contractor fails to (1) deliver the
product within the time specified in the contract or any extension, (2) maintain adequate progress, thus
endangering performance of the contract, (3) honor any term of the contract, or (4) abide by any statutory,
regulatory, or licensing requirement. Rule 60A-1.006(3), F.A.C., governs the procedure and consequences of
default. The Contractor shall continue work on any work not terminated. Except for defaults of Subcontractors
at any tier,the Contractor shall not be liable for any excess costs if the failure to perform the contract arises from
events completely beyond the control, and without the fault or negligence, of the Contractor. If the failure to
perform is caused by the default of a Subcontractor at any tier,and if the cause of the default is completely beyond
the control of both the Contractor and the Subcontractor, and without the fault or negligence of either, the
Contractor shall not be liable for any excess costs for failure to perform,unless the subcontracted products were
obtainable from other sources in sufficient time for the Contractor to meet the required delivery schedule. If,after
termination, it is determined that the Contractor was not in default, or that the default was excusable,the rights
and obligations of the Parties shall be the same as if the termination had been issued for the convenience of the
Agency. The rights and remedies of the Agency in this clause are in addition to any other rights and remedies
provided by law or under the contract.
52.3 Upon termination of this contract,the Contractor and Subcontractors shall,at no cost to the Agency,transfer all
public records in their possession to the Agency and destroy any duplicate public records that are exempt, or
confidential and exempt,from public records disclosure requirements. All records stored electronically shall be
provided to the Agency in a format that is compatible with the information technology systems of the Agency.
53. electronic Records and Signature;
The Agency authorizes, but does not require, the Contractor to create and retain electronic records and to use
electronic signatures to conduct transactions necessary to carry out the terms of this contract.A Contractor that creates
and retains electronic records and uses electronic signatures to conduct transactions shall comply with the requirements
contained in the Uniform Electronic Transaction Act, Section 668.50, F.S. All electronic records must be fully
auditable;are subject to Florida's Public Records Law,Chapter 119,F.S.;must comply with Section 29,Data Integrity
and Safeguarding Information;must maintain all confidentiality,as applicable;and must be retained and maintained by
the Contractor to the same extent as non-electronic records are retained and maintained as required by this contract.
13
1606
Januaiy—December 2019 OAA 203.19
53.1 The Agency's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the Agency. The Contractor is authorized to couduct electronic transactions with the Agency
only upon further written consent by the Agency.
53.2 Upon request by the Agency, the Contractor shall provide the Agency with non-electronic (paper) copies of
records. Non-electronic (paper) copies provided to the Agency of any document that was originally in
electronic form with an electronic signature must identify the person and the person's capacity who electronically
signed the document on any non-electronic copy of the document.
54. Contract Manager;
The Agency may substitute any Agency employee to serve as the ContractManager.
REMAINDER OF TUE TE PA OE INTENTIONALLY LEFT BLANK
•
14
1606
January—December 2019 OAA 203.19
55. Official Payee and Representatives (Names.Addresses,and Telephgne Numbers):
Collier County Board of County Commissioners
The Contractor name, as shown on page 1 of this
3339 E Tamiami Trail,Building H
a. contract, and mailing address of the official payee to Naples, FL 34112
whom the payment shall be made is:
Kristi Sonntag,Director
The name of the contact person and street address Collier County Board of County Commissioners
b. where financial and administrative records are %Community and Human Services
maintained is: 3339 B Tamiami Trail, Suite 211
Naples,FL 34112
Kristi Sonntag,Director
The name,address,and telephone number of the Collier County Board of County Commissioners
C. representative of the Contractor responsible for %Community and Human Services
administration of the program under this contract is: 3339 E Tamiami Trail, Suite 211
Naples,FL 34112
(239)252-2273
d The section and location within the Agency where Area Agency on Aging for Southwest Florida,Inc.
Requests for Payment and Receipt and Expenditure 15201 North Cleveland Avenue,Suite 1100
forms are to be mailed is: North Fort Myers,FL 33903
Becky MacKenzie,Director of Program&Planning
e. The name,address,and telephone number of the Area Agency on Aging for Southwest Florida,Inc.
Contract Manager for this contract is: 15201 North Cleveland Avenue,Suite 1100
North Fort Myers,FL 33903
(239)652-6900
Upon change of representatives(names,addresses,telephone numbers)by either party,notice shall be provided in
writing to the other party.
56. All Terms and Conditions Included:
This contract and its Attachments, I—XVII including any exhibits referenced in said attachments, together with any
documents incorporated by reference, contain all the terms and conditions agreed upon by the Parties. There are no
provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all
previous communications,representations or agreements,either written or verbal between the Parties.
By signing this contract,the Parties agree that they have read and agree to the entire contract.
IN WITNESS WHEREOF,the Parties hereto have caused this contract to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY COMMISSIONERS SOUTHWEST FLORIDA,INC.
'11
SIGNED BY: SIGNED BY: Ni"
NAME: Stephen Y Carrell NAME: G LORNI
TITLE: Public Service Department Head TITLE: PRESIDENT/CEO
DATE: i 1' l 1 DATE: O./
f t legality
Federal Tax ID: 59-600005$$ Approved as to form and leg Y
Fiscal Year Ending Date: 09/30
Duns: 076997790 \��__,-
s,6tant County
15
1606
January–December 2019 OAA 203.19
INDEX OF ATTACHMENTS
ATTACHMENT I 17
STATEMENT OF WORK
ATTACHMENT IL 35
FINANCIAL AND COMPLIANCE AUDIT
ATTACHMENT III 41
CERTIFICATIONS AND ASSURANCES
ATTACHMENT IV 46
ASSURANCES—NON-CONSTRUCTION PROGRAMS
ATTACHMENT V 48
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
ATTACHMENT VII 52
BACKGROUND SCREENING
ATTACHMENT IX 53
BUDGET AND RATE SUMMARY
ATTACHMENT X 57
INVOICE SCHEDULE
ATTACHMENT XI 58
REQUEST FOR PAYMENT
ATTACHMENT XII—Exhibit 1 59
RECEIPTS AND EXPENDITURE REPORT(NB)
ATTACHMENT XII—Exhibit 2 60
RECEIPTS AND EXPENDITURE REPORT(NC])
ATTACHMENT XII—Exhibit 3 61
RECEIPTS AND EXPENDITURE REPORT(IIIC2)
ATTACHMENT XII Exhibit 4 62
RECEIPTS AND EXPENDITURE REPORT(IIIE)
ATTACHMENT XII—Exhibit 5 63
RECEIPTS AND EXPENDITURE REPORT(NSIP)
ATTACHMENT XVI 64
OAA ANNUAL VOLUNTEER ACTIVITY REPORT SPECIFICATIONS
ATTACHMENT XVII 66
OAA ANNUAL VOLUNTEER EER ACTIVITYREPORT
16
1606
January—December 2019 OAA 203.19
ATTACHMENT I
STATEMENT OF WORK
I. SERVICES TO BE PROVIDE])
A. Definitions of Terms
I. Contract Acronyms
Area Agency on Aging(AAA)
Activities of Daily Living(ADL)
Administration on Aging(AoA)
Administration on Community Living(ACL)
Alliance of Information&Referral Systems(AIRS)
Assessed Priority Consumer List(APCL)
Adult Protective Services(APS)
Client Information and Registration Tracking System(CIRTS)
Chronic Disease Self-Management Education(CDSME)
Chronic Disease Self-Management Program(CDSMP)
Dietary Reference Intake(DRI)
Evidence-Based Disease Prevention and Health Promotion(EBDPHP)
Florida Department of Business and Professional Regulations(DBPR)
Florida Department of Elder Affairs(DOEA or Department)
Florida Department of Health(DOH)
Information and Referral(I&R)
Instrumental Activities of Daily Living(IADL)
National Council on Aging(NCOA)
Nutrition Services Incentive Program(NSIP)
Older Americans Act(OAA)
Planning and Service Area(PSA)
State of Florida(State)
Statewide Medicaid Managed Care Long-Term Care(SMMC LTC)
United States Department of Agriculture(USDA)
United States Department of Health and Human Services(USDHHS)
2. Program Specific Terms
Adult Child with a Disability: A child who is age 18 or older and is financially dependent on an older
individual who is a parent of the child and has a disability.
Area Plan: A plan developed by the AAA outlining a comprehensive and coordinated service delivery system
in its PSA in accordance with Section 306 of the OAA [42 United States Code(U.S.C.) § 3026] and Agency
instructions.
Area Plan Update:A revision to the Area Plan wherein the AAA enters OAA specific data in CIRTS.An
update may also include other revisions to the Area Plan as instructed by the Agency.
17
1606
January—December 2019 OAA 203,19
Child:An individual who is not more than eighteen(18)years of age or an individual with a disability.
Criteria: A standard which the Administration on Aging(AoA)/Administration for Community Living(ACL)
set for the Title IIID Program. AoA/ACL's standard criterion consists of three tiers: Minimal Criteria,
Intermediate Criteria,and Highest-Level Criteria.
Family Caregiver: An adult family member, or another individual, who is an informal provider of in-home
and community care to an older individual.
Frail: When an older individual is (1) determined to be is unable to perform at least two activities of daily
living without substantial human assistance, including verbal reminding,physical cueing,or supervision or(2)
unable to perform at least three such activities without such assistance;or,(3)due to a cognitive or other mental
impairment, requires substantial supervision because the individual be-haves in a manner that poses a serious
health or safety hazard to the individual or to another individual,
Grandparent: A grandparent or step-grandparent of a child, or a relative of a child by blood, marriage or
adoption, who: (1) lives with the child, (2) is the primary caregiver of the child because the biological or
adoptive parents are unable or unwilling to serve as the primary caregiver of the child, and (3) has a legal
relationship to the child,such as legal custody or guardianship, or is raising the child informally.
Living Healthy: Also known as CDSMP for the State of Florida.
B. General Description
1. General Statement
The primary purpose of the OAA Program is to foster the development and implementation of comprehensive
and coordinated systems to serve older individuals.These systems assist older individuals to attain and maintain
maximum independence with supportive services.
The NSIP provides incentives for the effective delivery of nutritious meals to older individuals. NSIP allows
programs to increase the number and/or the quality of meals served. NSIP is a cash allotment or commodity
program that supplements funding or food used in meals served under the OAA, Florida has opted for cash
payments in lieu of donated foods.
2. Authority
All applicable federal Iaws, regulations, action transmittals, program instructions, review guides and similar
documentation related to the following:
a. Catalog of Federal Domestic Assistance Nos. 93.043, 93.044,93.045,93.052,and 93.053;
b. Older Americans Act of 1965, as amended 2016;
c. Section 311 of the Older Americans Act of 1965,as amended 2016(42 U.S.C. §3030a);
d.42 U.S.C. § 303 and§ 604;
e. Rule 58A-1,Florida Administrative Code(F.A.C.);
f. Section 430.101,Florida Statutes(F.S.); and
g. DOEA Programs and Services Handbook,which is hereby incorporated by reference,to include any
subsequent revisions thereof,
3. Scope of Service
The Contractor is responsible for the programmatic,fiscal,and operational management of the OAA Title IIIB,
Title HIC1, Title IIIC2, and Title HIE Programs and NSIP, within its designated service area. The program
services shall be provided in a manner consistent with the Agency's current Area Plan,as updated and hereby
incorporated by reference, and the current DOEA Programs and Services Handbook. The Contractor shall use
the NSIP funding to supplement funding for food used in meals served by OAA Nutrition Program Providers.
18
1606
.January—December 2019 OAA 203.19
4. Major Program Goals
The major goals of the OAA Program are to improve older individuals' quality of life, preserve their
independence,and prevent or delay their need for costlier institutional care.These goals are achieved through
the implementation of a comprehensive and coordinated service system that provides a continuum of service
alternatives and effective delivery of nutritious meals that meet the diverse needs of elders and their caregivers.
C. Clients to be Served
1. General Description
The OAA Program gives preference to older individuals with greatest economic need and older individuals
with greatest social need (with particular attention to Iow-income older individuals, including low-income
minority older individuals,older individuals with limited English proficiency,and older individuals residing in
rural areas),
2. Client Eligibility
a. OAA Title III
Consumers shall not be dually enrolled in an OAA Program and a Medicaid capitated Long-Term Care
Program, except consumers in need of OAA Legal Assistance services and OAA Congregate Nutrition
Services,including transportation to and from congregate meal sites.
b. NSIP
Meals served to an elderly individual, funded in whole or in part under the SMMC LTC, (Statewide
Medicaid Managed Care Long-Term Care). Home Care for the Elderly, Community Care for the Elderly
Programs,or other means tested programs may not be included in the NSIP count.OAA-funded congregate
meals provided to SMMC LTC clients may be included inthe NSIP count.
c. OAA Title hUB,Supportive Services
1. Individuals must be age sixty(60)or older;and
ii, I&R(Information and Referral)/Assistance services are provided to individuals regardless of age.
d. OAA Titles IIICI and IIIC2,Nutrition Services,General
General factors that shall be considered in establishing priority for the receipt of nutrition services include
those older persons who:
i. Cannot afford to eat adequately;
ii. Lack the skills or knowledge to select and prepare nourishing and well-balanced meals;
iii. Have limited mobility which may impair their capacity to shop and cook for themselves;
iv. Have a disabling illness or physical condition requiring nutritional support;or
v. Have been screened at a high nutritional risk.
e. OAA Title mCi,Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in Section I.C.2.d.above,
individuals must be mobile, not homebound, and physically, mentally, and medically able to attend a
congregate nutrition program.Individuals eligible to receive congregate meals include the following:
i. Individuals age sixty(60)or older;
ii. Any spouse(regardless of age)who attends the dining center with his/her eligible spouse;
iii. Persons with a disability,regardless of age,who reside in a housing facility occupied primarily by older
individuals where congregate nutrition services are provided;
iv. Disabled persons who reside at home with and accompany an eligible person to the dining center;and
v. Volunteers,regardless of age,who provide essential services on a regular basis during meal hours.
19
1606
January—December 2019 OAA 203.19
£ OAA Title IIIC2,Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements as listed in Section I.C.2.d.,
individuals must be homebound and physically, mentally, or medically unable to attend a congregate
nutrition program. Individuals eligible to receive home delivered meals include the following:
i. Individuals age sixty(60) or older who are homebound because of illness, disability,or isolation;
ii. The spouse of a homebound eligible individual,regardless of age,if the provision of the collateral meal
supports maintaining the person at home;
iii. Individuals with disabilities,regardless of age, who reside at home with eligible individuals and are
dependent on them for care;and
iv. Persons at nutritional risk who have physical,emotional,or behavioral conditions which would make
their presence at congregate nutrition sites inappropriate;and
v. Persons at nutritional risk who are socially or otherwise isolated and unable to attend a congregate
nutrition site.
g. OAA Title TTTE, Caregiver Support Services
Eligibility for OAA Title IIIE, Caregiver Support Services, is as follows:
i. Eligible individuals include:
(1) Family caregivers of individuals age sixty(60) or older;and
(2) Grandparents [age fifty-five(55)or older] or older individuals [age fifty-five(55)or older]who
are relative caregivers.
ii. For respite and supplemental services,a family caregiver must be providing care for an older individual
who meets the definition of the term"frail"as defined above.
iii. Priority will be given to family caregivers who provide care for individuals with Alzheimer's disease
and related disorders with neurological and organic brain dysfinction and to grandparents or older
individuals who are relative caregivers who provide care for children with severe disabilities.
IL MANNER OF SERVICE PROVISION
A. Service Tasks
To achieve the goals of the OAA Program,the Contractor shall ensure performance of the following tasks:
I. Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility.Eligibility to become a
client is based on meeting the requirements described in Section I.C.2.
2. Targeting and Screening New Clients for Service Delivery
The Contractor shall develop and implement policies and procedures consistent with OAA targeting and
screening criteria for new clients.
3. Program Services
The Contractor shall ensure the provision of program services is consistent with the Agency's current Area
Plan, as updated and approved by the Department, and the current DOEA Programs and Services Handbook.
20
1606
January—December 2019 OAA 203.19
4. Program Eligibility Requirements
a. Eligibility Criteria
To be eligible for program participation, an entity must:
i. Be an agency that has received a grant under OAA Title III [OAA section 311(42 U.S.C. § 3030a)];
and
ii. Partner with a nutrition service provider that serves meals and is under the jurisdiction, control,
management,and audit authority of the Area Agency on Aging and the Florida Department of Elder
Affairs.
a.Provider's Nutrition Service Operations
The Contractor shall ensure that the nutrition service operations of the provider meet the requirements of
this contract, as well as any other applicable regulations and policies prescribed by the current DOEA
Programs and Services Handbook, USDHHS, USDA, DOH and local health departments,DBPR, or any
other agency designated to inspect meal quality for the State.
c. Prescribed Nutritional Requirements
The Contractor shall ensure that each meal provided under this contract meets the following criteria:
i. Complies with the current Dietary Guidelines for Americans,published by the Secretaries of the
USDHHS and USDA;and
ii. Provides a minimum of thirty-three and a third percent (33 1/3%) of the dietary reference
intakes/adequate intakes for a female age seventy(70)or older as established by the Food and Nutrition
Board of the National Academy of Sciences.
d. Food Origin and Commodities Requirements
Consistent with existing requirements of the NSIP,the Contractor and its service providers may use NSIP
cash to purchase foods of U.S. origin for their nutrition projects under Title III of the OAA. NSIP funds
must be used to expand meal services to older adults.
B. Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the Contractor shall not delay the
implementation of its agreement with the Subcontractor.If any circumstance occurs that may result in a delay for a
period of sixty(60) days or more of the initiation of the subcontract or the performance of the Subcontractor, the
Contractor shall notify the Area Agency Contract Manager and/or the Agency's Chief Financial Officer in writing
of such delay.The Contractor shall not permit a Subcontractor to perform services related to this contract without
having a binding Subcontractor agreement executed. The Agency will not be responsible or liable for any
obligations or claims resulting from such action.
1. Copies of Subcontracts
The Contractor shall submit copies of all subcontracts to the Agency Contract Manager within thirty (30)days
of execution of each subcontract agreement.
2. Monitoring the Performance of Subcontractors
The Contractor shall monitor,at least once per year, each of its subcontractors,sub-recipients,vendors, and/or
consultants paid from funds provided under this contract. The Contractor shall perform fiscal, administrative,
and programmatic monitoring to ensure contractual compliance, fiscal accountability, programmatic
performance, and compliance with applicable state and federal laws and regulations. The Contractor shall
monitor its subcontractors to ensure that the budget and scope of work are accomplished within the specified
time periods,and that all performance goals stated in this contract are achieved.
a. The Contractor shall enter all required data per the Agency's and Department's CIRTS Policy Guidelines
for clients and services into the CIRTS database. The data must be entered into the CIRTS database
before the Contractor submits their Request for Payment and Receipts and Expenditure Reports to the
21
1606 .
January-December 2019 OAA 203.19
Agency.The Agency shall establish time frames to ensure compliance with due dates for the Requests for
Payment and Receipts Expenditure Reports to the Agency.
b. The Contractor shall run monthly CIRTS reports and to verify that the client and service data in the
CIRTS database is accurate. This report must be submitted to the Agency with the monthly Request for
Payment and Receipts and Expenditure Report.
c. The Agency shall require Contractors to report on outreach activities at least semi-annually using a
uniform reporting format established by the Agency. Contractor reports must include the total number of
outreach events or activities performed as well as the following information for each event or activity:
date, location, type of event or activity,total number of participants, individual service needs identified,
and referral sources or information provided to participants,
C. Staffing Requirements
1. Staffing Levels
The Contractor shall assign its own administrative and support staff as needed to perform the tasks,
responsibilities, and duties under this contract and ensure that subcontractors dedicate adequate staff
accordingly.
2. Professional Qualifications
The Contractor shall ensure that the staff responsible for performing any duties or functions within this contract
have the qualifications specified in the DOEA Programs and Services Handbook.
3. Service Times
The Contractor shall ensure the availability of services listed in this contract at times appropriate to meet client
service needs,including,at a minimum, during normal business hours.Normal business hours are defined as
Monday through Friday, 8:00 a.m.to 5:00 p.m. local time.
D. Deliverables
The following section provides the specific quantifiable units of deliverables and the source documentation required
to evidence the completion of the tasks specified in this contract. The Contractor must submit all required
documentation in the time and manner specified for the minimum performance levels to be met.Each deliverable
must be accepted in writing by the Agency Contract Manager based on the requirements for each deliverable
before the Contractor submits an invoice requesting payment.
1. Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of elders and
their caregivers. Documentation of service delivery must include a report consisting of the following: number
of clients served, number of service units provided by service, and rate per service unit with calculations that
equal the total invoice amount. The Contractor shall ensure the performance and reporting of the following
types of services, in accordance with the Agency's current Area Plan, the current DOEA Programs and
Services Handbook,and Section II.A.
a. Supportive Services(IIIB Program)
Supportive services include a variety of community-based and home-delivered services that support older
individuals' quality of life by helping them remain independent and productive. Services include the
following:
i. Adult Day Care/Adult Day Health vi. Counseling(Gerontological and
Care; Mental Health);
ii. Caregiver Training/Support; • vii. Education/Training;
iii. Case Aid/Case Management; viii. Legal Assistance;
iv. Chore Services; ix. Material Aid;
v. Companionship; x. Occupational Therapy;
2.2
1606
January—December 2019 OAA 203.19
xi. Outreach; xxii. Homemaker;
xii, Personal Care; xxiii. Housing Improvement;
xiii. Physical Therapy; xxiv. Information;
xiv. Shopping Assistance; xxv. Intake;
xv. Skilled Nursing; xxvi. Interpreter/Translating;
xvi. Specialized Medical Equipment, xxvii. Referral/Assistance;
Services,and Supplies; xxviii.Respite Services; I}
xvii. Recreation; xxix. Screening/Assessment;
xviii. Emergency Alert Response; xxx, Speech Therapy;
xix. Escort; xxxi. Telephone Reassurance;and
xx. Health Support; xxxii. Transportation.
xxi. Home Health Aid;
a. Congregate Nutrition Services(IIICI Program)
Nutrition services are provided in congregate settings and are designed to reduce hunger and food insecurity
and to promote socialization and the health and well-being of older individuals through access to nutrition
and other disease prevention and health promotion services.Services include the following:
i. Congregate meals;
ii. Congregate meals screening;
iii. Nutrition education and nutrition counseling;and
iv. Outreach,
b. Home Delivered Nutrition Services(I11C2 Program)
In-home nutrition services are provided to reduce hunger and food insecurity; promote socialization and
the health and well-being of older individuals by assisting such individuals to gain access to nutrition and
other disease prevention and health promotion services. Services include the following:
i, Home delivered meals;
ii. Nutrition education and counseling;
iii. Outreach;and
iv. Screening/Assessment.
c. Disease Prevention and Health Promotion Services(Title HID Program)
Evidence-Based Disease Prevention and Health Promotion (EBDPHP) services have been demonstrated
through evaluation to be effective for improving health and wellbeing or reducing disease,disability,and/or
injury among older adults. The ACL defines EBDPHP services as meeting highest-level criteria. Only
services that meet the highest-level criteria are allowable under the HID Program.EBDPHP services must
be delivered per the requirements of the program and ensure program fidelity. EBDPHP services include
the following:
i. A Matter of Balance; iv. Arthritis Foundation Tai Chi Program
ii. Active Living Every Day; (Tai Chi for Arthritis);
Arthritis Foundation Exercise Program; v. Arthritis Self Management Program;
23
1606
January—December 2019 OAA 20119
vi. Brief Intervention&Treatment for xix. Physical Fitness;
Elders(BRITE); xx. Powerful Tools for Caregivers;
vii. Chronic Disease Self-Management xxi. Program to Encourage Active
Program; Rewarding Lives for Seniors
viii. Chronic Pain Self-Management (PEARLS);
Program; xxii. Programa de Manejo Personal de la
ix. Diabetes Empowerment Education Artritis;
Program(DEEP); xxiii. Programa de Manejo Personal de la
x. Diabetes Self-Management Program; Diabetes;
xi. Disease Information; xxiv. Stepping On;
xii. Enhance Fitness; xxv. Stay Active and Independent for Life
xiii. Enhance Wellness; (SAIL);
xiv. Fit and Stron xxvi. Tai Chi/Tai Ji Quan Moving for Better
Stone Balance(Highest-Level);
xv. Healthy Eating Every Day; xxvii. Tomando Control de su Salud;
xvi. Healthy Ideas; xxviii.Un Asunto de Equilibrio; and
xvii. Healthy Moves for Aging Well; xxix. Walls with Ease.
xviii. HomeMeds;
e. Caregiver Support Services(11LE Program)
The following services are intended to provide direct aid to caregivers in the areas of health,nutrition,and
financial literacy, and to assist them with decision-making and problem-solving related to their caregiving
roles and responsibilities:
i. Adult Day Care/Adult Day Health viii. Outreach;
Care; ix. Powerful Tools for Caregivers;
ii. Caregiver Training/Support; x. Referral/Assistance;
iii. Counseling(Gerontological and , Respite Services;
Mental Health);
iv. Education/Training; xii. Screening/Assessment;
xiii. Stress-Busting Program for Family
v. Financial Risk Reduction
Caregivers;and
(Assessment and Maintenance);
vi. Information; xiv. Transportation.
vii. Intake;
24
1606
January—December 2019 OAA 203.19
(1) Caregiver Support Supplemental Services(HIES Program)
At least ten percent(10%),but no more than twenty percent(20%),of the total Title THE funds
shall be used to provide supplemental support services. The following services are provided to
complement the care provided by caregivers:
(a) Chore Services;
(b) Housing Improvement;
(c) Legal Assistance;
(d) Material Aid;and
(e) Specialized Medical Equipment, Services and Supplies. •
(2) Caregiver Support Grandparent Services(MEG Program)
At least five percent(5%),but no more than ten percent(10%),of the total Title IRE funds shall be
used to provide support services to grandparents and older individuals who are relative caregivers.
Services for grandparents or older individuals who are relative caregivers that are designed to help
them meet their caregiving obligations include the following:
(a) Caregiver Training/Support;
(b) Child Day Care;
(c) Counseling(Gerontological and Mental Health);
(d) Education/training;
(e) Legal Assistance;
(f) Outreach;
(g) Referral/Assistance; •
(h) Screening/Assessment;
(i) Sitter; and
(j) Transportation.
2. Provision of Services
The Agency and/or Contractor shall ensure the provision of the services described in this contract are in
accordance with the current DOEA Programs and Services Handbook, the Agency's Department-approved
Area Plan,and the tasks described in Section ILA.
I.. Complaint Procedures
The Agency and/or Contractor shall develop and implement complaint procedures and ensure that
subcontractors develop and implement complaint procedures to process and resolve client
dissatisfaction with services. Complaint procedures shall address the quality and timeliness of
services, provider and direct service worker complaints, and all other issues except the termination,
suspension, or reduction of services, which shall be addressed through the grievance process as
described in Appendix D of the DOEA Programs and Services Handbook.Complaint procedures shall
include notification to all clients of the complaint procedure and include tracking the date,nature, and
disposition of each complaint.
E. Reports
The Contractor shall respond to additional,routine,or special requests for information and reports required by the
Agency in a timely manner as determined by the Agency Contract Manager. The Contractor shall establish
reporting deadlines and due dates for subcontractors that permit the Contractor to review and validate the data and
25
1606
January—December 2019 OAA 203.19
meet the Agency's reporting requirements.
1. OAA Annual Volunteer Activity Report
The Contractor shall submit an OAA Annual Volunteer Activity Report electronically, to Area Agency
Programs Department at the following email address: Program s@ a a a s w fl.or g, per the report
specifications provided in Attachment XVI. The Annual Volunteer Activity Report must be completed and
submitted to the Agency by January 10,2019. The form is Attachment XVII.
2. CIRTS Reports
a. Contractor shall input OAA-specific and NSIP-specific data into CIRTS. To ensure CIRTS data accuracy,
the Contractor shall use CIRTS-generated reports which include the following:
i. Client Reports;
ii, Monitoring Reports;
iii. Services Reports;
iv. Miscellaneous Reports;
v. Fiscal Reports;and
vi. Outcome Measurement Reports.
b. CIRTS Data Entries for Contractors
The Agency must require Contractors to enter all required data for clients and services in the CIRTS
database per the DOEA Programs and Services Handbook and the CIRTS User Manual---Aging Provider
Network users (located in Documents on the CIRTS Enterprise Application Services). Contractors must
enter this data into the CIRTS database prior to submitting their Requests for Payment and Receipts and
Expenditure Reports to the Agency.The Agency shall establish deadlines for completing CIRTS data entry
to ensure compliance with due dates for the Requests for Payment and Receipts and Expenditure Reports
that Contractor must submit to the Agency.
3. Annual Service Cost Reports
The Agency shall require Contractors to annually submit to the Agency service cost reports,which reflect actual
costs of providing each service.This Annual Service Cost Report will be due by February 15,of each year. The
report will include actual costs for performing all services during the preceding calendar year. Supporting
documentation must accompany the report which will include General Ledger,Trial Balance and/or Statement
of Revenue and Expenditures along with a narrative explanation and justification of rate differences,
Any multi-year contracts entered into with service providers on or after the effective date of this contract shall
contain a provision requiring the contract's parties to re-evaluate the contract's reimbursement rates on an
annual basis, The Contractor may annually renegotiate rates based on factors including but not limited to a
review of sustainability,the respective consumer price index, or current market conditions. However, it is the
intent of the Department and/or Agency that the quality of services provided to current program recipients not
be reduced. Unit Cost Methodology worksheets, along with supporting documentation and narrative
explanation,must be submitted by August 1 of each year,if a rate increase is being requested.
4. Surplus/Deficit Report
The Contractor shall submit a Consolidated Surplus/Deficit Report, Lead Spending Report, in a format
provided by the Agency, to the Agency's Contract Manager by the 18th of each month. This Consolidated
Surplus/Deficit Report is for all agreements and/or contracts between the Contractor and the Agency and must
include the following:
a. A list of all subcontractors and their status regarding surplus/deficit;
b. The Contractor's detailed plan on how the surplus/deficit spending which exceeds the threshold specified
by the Agency will be resolved;
26
16D6
January—December 2019 OAA 203.19
c. The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the
Agency will be resolved.
d. Recommendations to transfer funds to resolve surplus/deficit spending;
e. Input from the Contractor's Board of Directors on resolution of spending issues,if applicable;
5. OAA National Aging Program Information System(NAPIS)Report
Data required for the OAA NAPIS Report that is not recorded in CIRTS will be provided to the Agency
Contract Manager in the format and on the date established by the Agency.
6. Program Highlight Narratives
The Contractor shall submit brief written narratives to the Agency for publication in the Program Highlight
sections of the Agency's Summary of Programs and Services, which is hereby incorporated by reference,to
include any subsequent revisions thereof. The narratives shall reference specific events that have occurred
since the last submission of Program Highlight narratives, including new success stories,quotes,testimonials,
or human-interest vignettes. The narratives shall be written for a general audience, with no acronyms or
technical terms. For all agencies or organizations that are referenced in the narratives, the Contractor shall
provide a brief description of their mission or role.The active tense shall be consistently used in the narratives
to identify the specific individuals or entities that performed the activities described in the narratives. The
Contractor shall review and edit narratives for clarity, readability, relevance, specificity,human interest, and
grammar prior to submitting them to the Agency.
7. Congregate Meal Site and Food Service Vendor Verification Report
The Agency shall conduct monthly reviews of the PSA's congregate meal site information to verify the
accuracy of the information on file. Congregate meal site information includes, but may not be limited to,the
address of the meal site,meal service time,name of caterer/vendor,and days of meal service.Any changes to
congregate meal site information must be submitted to the Agency Contract Manager. Any changes to this
information that the Contractor is made aware of prior to the Contractor's monthly report submission shall be
communicated to the Agency Contract Manager within 48 hours of the change (or in advance as appropriate).
The Agency will complete a comprehensive annual verification by June 1st of each year.
F. Records and Documentation
1. The Contractor agrees to make available to Agency staff and any party designated by the Agency all contract
related records and documentation.The Contractor shall ensure the collection and maintenance of all program
related information and documentation on any system designated by the Agency. Maintenance includes valid
exports and backups of all data and systems according to Agency standards. Data must be usable and must be
maintained in a format that is readable to the Agency.
2. CIRTS Data and Maintenance
The Contractor shall ensure monthly collection and maintenance of client and service information in CIRTS or
any other system designated by the Agency. Maintenance includes ensuring that all data is accurate and
current and performing valid exports and backups of all data and systems according to Agency standards.
3. Policies and Procedures for Records and Documentation
The Contractor shall maintain written policies and procedures for computer system backup and recovery and
shall have the same requirement of its subcontractors.These policies and procedures shall be made available to
the Agency upon request.
27
16D6
January--December 2019 OAA 203.19
G. Performance Specifications
1. Outcomes and Outputs(Performance Measures)
At a minimum,the Contractor shall:
a. Ensure the provision of the services described in this contract are in accordance with the DOEA Programs
and Services Handbook,the current Agency's Depatlment-approved Area Plan,and Section ILA..
b. Timely and accurately submit to the Agency all documentation and reports described in Attachment I,
Section II.E.
c. Timely and accurately,per Attachment X,submit to the Agency Attachments XI—XVII(whichever
reports pertain to the Contractor's specific contract).
d. Develop and document strategies to support the Agency's standard of peiformance achievement,
including increases in the following:
i. Percentage of most frail elders who remain at home or in the community instead of going into a nursing
home;
ii. Percentage of APS referrals who need immediate services to prevent further harm who are served within
seventy-two(72)hours;
iii. Percentage of active clients eating two or more meals per day;
iv. Percentage of new service recipients whose ADL assessment score has been maintained or improved;
v. Percentage of new service recipients whose IADL assessment score has been maintained orimproved;
vi. Percentage of caregivers who, after service intervention, self-report being very confident about their
ability to continue to provide care;and
vii. Percentage of customers who are at imminent risk of nursing home placement who are served with
community-based services.
2. The Contractor's performance of the measures in G.1, above,will he reviewed and documented in the
Agency's Annual Programmatic Monitoring Reports.
3. Monitoring and Evaluation Methodology
The Agency will review and evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Contractor via telephone, in writing, or an on-
site visit. The primary, secondary, or signatory of the contract must be available for any on-site programmatic
monitoring visit. The Agency reserves the right to conduct an on-site visit unannounced by persons duly
authorized by the Agency. The Agency's determination of acceptable peiformance shall be conclusive. The
Contractor agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks
and deliverables. The Agency may use, but is not limited to, one or more of the following methods for
monitoring:
a. Desk reviews and analytical reviews;
b. Scheduled,unscheduled,and follow-up on-site visits;
c. Client visits;
d. Review of independent auditor's reports;
e. Review of third-party documents and/or evaluation;
f. Review of progress reports;
g. Review of customer satisfaction surveys;
28
1606
January—December 2019 OAA 203.19
h. Agreed-upon procedures review by an external auditor or consultant;
1. Limited-scope reviews; and
j. Other procedures as deemed necessary by the Agency.
4. Performance Definitions
"Work day" shall mean a provider's staff member's eight (8) hour work period, unless specifically noted
otherwise. "Day"shall mean a calendar day,unless specifically noted otherwise.
H. Contractor Responsibilities
1. Contractor Unique Activities
All tasks listed above in Section II.are solely and exclusively the responsibility of the Contractor and are tasks
for which,by execution of this contract,the Contractor agrees to be held accountable.
2. Coordination with Other Providers and/or Entities
Notwithstanding that services for which the Contractor is held accountable involve coordination with other
entities in performing the requirements of this contract, the failure of other providers or entities does not
alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform
pursuant to this contract.
I. Agency Responsibilities
1. Agency Obligations
The Agency may, within its resources, provide technical support and/or assistance to the Contractor to
assist the Contractor in meeting the requirements of this contract. The Agency's support and assistance, or
lack thereof,shall not relieve the Contractor from full performance of contract requirements.
2. Agency Determinations
The Agency reserves the exclusive right to make certain determinations in the tasks performed by the
Contractor and the approaches used by the Contractor to perform those tasks. The absence of the Agency
setting forth a specific reservation of rights does not mean that all other areas of the contract are subject to
mutual agreement.
IlL&METHOD OF PAYMENT
A. Payment Method Used
The method of payment for this contract is a combination of Fixed-Fee/Unit Rate, Cost Reimbursement, and
Advance Payments subject to the availability of funds and Contractor performance. The Agency will pay the
Contractor upon satisfactory completion of the Tasks/Deliverables,as specified in Section II.D.,and in accordance
with all other terms and conditions of this contract.
B. Unit of Service
1. Fixed Fee/Unit Rate
Contractor must meet the minimum level of performance stated in the contract to receive payment. Payments
for Fixed Fee/Unit Rates shall not exceed amounts established in Attachment IX.
2. Fixed Rates for NSIP Program
Payments for NSIP Fixed rate shall not exceed the unit rate of service identified below:
Service to be Provided Unit of Service Unit Rate
Eligible Congregate and Home Delivered Meals 1 unit= 1 meal $.72
29
1606
January—December 2019 OAA 203.19
COLLIER
Service to be Provided Unit of Service Unit Rate Maximum Units Allocation
Eligible Congregate and 1 unit= 1 meal $.72 65,643 $47,263
Home Delivered Meals
3. Cost Reimbursement
Payment shall only be authorized for allowable expenditures,per the limits specified in the Budget Summary
(Attachment LX). All cost reimbursement Requests for Payment must include the actual Receipts and
Expenditure Reports, beginning with the first month of the contract. The Contractor must meet the minimum
level of performance stated in the contract to receive payment.
The Contractor agrees to distribnte funds as detailed in the Agency's Area Plan Update and the Budget
Summary (Attachment IX).Any change in the total amounts of the funds identified on the Budget Summary
form requires a contract amendment.
C. Advance Payments
The Contractor may request up to two (2)months of advances at the start of the contract period to cover program
administration,outreach,and service costs.The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the Agency by the State of Florida (budget release), The Contractor's requests for
advance payments require the written approval of the Agency Contract Manager.The Contractor shall provide the
Agency Contract Manager documentation justifying the need for an advance and describing how the funds will be
distributed. Documentation should reflect the cash needs of the Contractor within the initial two (2) months and
should be supported through a cash-flow analysis or other information appropriate to demonstrate the Contractor's
financial need for the advance.If sufficient budget is available,and the Agency's Contract Manager, in his or her
sole discretion, has determined that there is a justified need for an advance, the Agency will issue approved
advance payments after January 1st of the contract year.Advance payments will not be issued forNSIP.
1. Any advance payments the Contractor requests for subcontractors must be distributed within seven(7)days of
receipt of payment from the Agency.The Contractor shall submit to the Agency documentation to support full
distribution of advanced funds with Request for Payment, report number 5, due to the Agency
on April 09,2019,in accordance with Invoice Schedule(Attachment X).
2. All advance payments retained by the Contractor must be fully expended no Iater than March 31, 2019. Any
portion of advanced payments not expended must be recouped on the Request for Payment, report number 5,
due to the Agency on April 09,2019, in accordance with the Invoice Schedule(AttachmentX).
3. All advance payments made to the Contractor shall be reimbursed to the Agency as follows: one—tenth of the
advance payment received shall be reported as an advance recoupment on each Request for Payment, starting
with report number 5,in accordance with the Invoice Schedule(Attachment X).
4. Interest earned on advances must be identified separately by source of funds(state or federal).Contractors shall
maintain advanced payments of federal funds in FDIC interest bearing accounts unless an exception is made in
accordance with 45 CFR§75.3 05.Earned interest must be returned to the Agency at the end of each quarter of
the contract period.
D. Invoice Instructions
Payment shall be made upon the Contractor's presentation of an invoice subsequent to the acceptance by the
Agency of the deliverables shown on the invoice. The form and substance of each invoice submitted by the
Contractor shall be as follows:
1. The invoice shall include a"Remit to"address that corresponds exactly to the remittance address identified in
the MyFloridaMarketPlace(MFMP)registration.
2. The monthly invoice shall include the units of services established in the Agency's Department-approved
30
1606
January—December 2019 OAA 203.19
Area Plan, per the requirements in the DOEA Programs and Services Handbook, at the rates established in
Attachment IX, Service Rate Report. Documentation of service delivery shall include a report consisting of
the following: number of clients served,number of service units provided by service,and rate per service unit,
with calculations that equal the total invoice amount, Any change to the Agency's Department-approved
budget after the execution of this contract shall require approval from the Agency's Contract Manager prior to
being made.Any change to the total contract amount requires a contract amendment.
3. The Contractor shall consolidate requests for payment from subcontractors and receipts and expenditure reports
that support the requests for payment and shall submit to the Agency Requests for Payment(Attachment XI),
and Receipt and Expenditure Reports(Attachment XII-XVI according to Contractor's contract).
4. The Contractor shall include with the Fixed Fee/Unit Rate portion of its invoice the units of services provided
based on rates established in Attachment IX,number of clients, and the rates for the services provided per the
requirements described in the deliverables and service tasks. The Contractor shall clearly state the provider
name,the report month,and the invoice number on the invoice.
5. All Requests for Payment shall be based on the submission of actual monthly Receipts and Expenditure Reports •
beginning with the first month of the contract. The schedule for submission of advanced payment requests
(when available)and invoices can be found in the Invoice Schedule(Attachment X).
6. Final contract invoices must be submitted to the Agency no later than February 15,2020.
•
E. Payment Withholding
Any payment due by the Agency under the terms of this contract may be withheld pending receipt and approval by
the Agency of all financial and programmatic reports due from the Contractor and any adjustments thereto,
including any disallowance not resolved. ••
F. Corrective Action Plan
1. Contractor shall ensure 100% of the deliverables identified in Section II.D.are performed pursuant to contract
requirements.
2. If at any time the Contractor is notified by the Agency Contract Manager that it has failed to correctly,
completely,or adequately perform contract deliverables identified in Section II.D.,the Contractor will have ten
(10) days to submit a Corrective Action Plan (CAP) to the Agency Contract Manager that addresses the
deficiencies and states how the deficiencies will be remedied within a time period approved by the Agency
Contract Manager.The Agency shall assess a financial consequence for non-compliance on the Contractor as
referenced in Section III.G. for each deficiency identified in the CAP which is not corrected pursuant to the
CAP.The Agency will also assess a financial consequence for failure to timely submit a CAP to the Agency.
3. If the Contractor fails to correct an identified deficiency within the Agency-approved period specified in the
CAP,the Agency shall deduct the percentage established in Section III.G,from the payment for the invoice of
the following month.
4. If the Contractor fails to timely submit a CAP to the Agency, the Agency shall deduct the percentage
established in Section IILG. for each day the CAP is overdue. The deduction will be made from the payment
for the invoice of the following month.
G. Financial Consequences
The Agency will withhold or reduce payment if the Contractor fails to perform the deliverables to the satisfaction
of the Agency according to the requirements referenced in Section II.D. The following financial consequences
will be imposed if the deliverables stated do not meet in part or in whole the performance criteria as outlined in
Section ll.D.t:
1. Delivery of services to eligible clients as referenced in Section II.A.2. and Section II.D.1. of this contract—
Failure to comply with established assessment and prioritization criteria,as evidenced by CIRTS reports,will
result in a 2%reduction of payment per business day.The reduction of payment will begin on the first business
31
1606
January--December 2019 OAA 203.19
day following the Agency's notification to the Contractor that the identified deficiency was not cured or
satisfactorily addressed in accordance with the Agency-approved CAP.
2. Services and units of services as referenced in Section IT.D.2. of this contract—Failure to provide services in
accordance with the current DOEA Programs and Services Handbook, the service tasks described in Section
ILA.,and Attachment XV,or failure to submit required documentation will result in a 2%reduction of payment
per business day. The reduction of payment will begin the first business day following the Agency's
notification to the Contractor that the identified deficiency is not cured or satisfactorily addressed in accordance
with the Agency-approved CAP.
3. Administrative duties as referenced in Section IT.D.3. of this contract—Failure to perform management and
oversight of program operations will result in a 2%reduction of payment per business day. The reduction of
payment will begin the first business day following the Agency's notification to the Contractor that the
identified deficiency was not cured or satisfactorily addressed in accordance with the Agency approved
CAP.
4. Timely submission of a CAP—Failure to timely submit a CAP within ten(10)business days afternotification
of a deficiency by the Agency Contract Manager will result in a 2%reduction of payment per business day
the CAP is not received.The reduction of payment will begin with the subsequent invoice received from the
Contractor and shall be prorated for each day the CAP was late following the due date specified by the
Agency and shall remain in effect until the contractor complies with the submission requirement.
5. Exceptions may be granted solely,in writing,by the Agency Contract Manager.
IV SPECIAL PROVISIONS
A. Final Budget and Funding Revision Requests
Final requests for budget revisions or adjustments to contract funds based on expenditures for provided services
must be submitted to the Agency Contract Manager in writing no later than December 31, 2019; email requests
are considered acceptable.
B. Contractor's Financial Obligations
1. Matching,Level of Effort,and Earmarking Requirements
The Contractor will assure a match requirement of at least ten percent(l0%) of the cost for services funded
through this contract. The Contractor's and/or subcontractor match will be made in the form of cash and/or
in-kind resources. The Contractor shall report match funds by title each month. At the end of the contract
period,the Contractor must properly match OAA funds that require a match.
2. Consumer Contributions
Consumer contributions are to be used under the following terms:
a. The Contractor assures compliance with Section 315 of the OAA,as amended in 2006,regarding consumer
contributions;
b. Voluntary contributions are not to be used for cost sharing or matching;
c. Voluntary contributions are to be used only to expand services;and
d. Accumulated voluntary contributions are to be used prior to requesting federal reimbursement.
3. Use of Service Dollars and Management of the Assessed Priority Consumer List
The Contractor is expected to spend all federal,state, and other funds provided by the Agency for the purpose
specified in this contract. For each program managed by the Contractor, the Contractor must manage the
service dollars in such a manner as to avoid having a wait list and a surplus of funds at the end of the contract
period. If the Agency determines that the Contractor is not spending service funds accordingly, the Agency
may transfer funds to other Lead Agencies during the contract period and/or adjust subsequent funding
allocations as allowable under state and federal law.
32 `°`
16Q6
January—December 2019 OAA 203.19
4. Title III Funds
The Contractor assures compliance with Section 306 of the OAA,as amended in 2006,and will not use funds
received under Title III to pay any part of a cost(including an administrative cost) incurred by the Contractor
to maintain a contractual or commercial relationship that is not carried out to implement Title M.
C. Remedies for Nonconforming Services
1. The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely,
completely, and commensurate with required standards of quality. Such goods and/or services will only be
delivered to eligible program participants.
2. If the Contractor fails to meet the prescribed quality standards for services,such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services
not meeting such standards will not be reimbursed under this contract. The Contractor's signature on the
Request for Payment Form certifies maintenance of supporting documentation and acknowledgement that the
Contractor shall solely bear the costs associated with preparing or providing nonconforming goods and/or
services. The Agency requires immediate notice of any significant and/or systemic infractions that
compromise the quality,security,or continuity of services to clients.
D. Incident Reporting
The Contractor shall notify the Agency immediately but no later than forty-eight(48)hours from the Contractors
awareness or discovery of changes that may materially affect the Contractor or any subcontractor's ability to
perform the services required to be performed under this contract. Such notice shall be made orally to the Agency
Contract Manager (by telephone) with an email to immediately follow, including the Contractor's plan for
provision of services required by contract. This plan must detail the Contractor's anticipated plan for ensuring a
continuity in services for each client impacted by and for the duration of the incident.Following submission of the
plan, the Contractor's is expected to provide the Agency updates in a frequency determined by the Agency as
appropriate until the incident is resolved.
E. Volunteers
The Contractor shall ensure the use of trained volunteers in providing direct care services delivered to older
individuals and those individuals with disabilities needing such services. If possible,the Contractor shall work in
coordination with organizations that have experience in providing training,placement, and stipends for volunteers
or participants (such as organizations carrying out federal service programs administered by the Corporation for
National and Community Service).
F. Enforcement
1. In accordance with Section 430.04, F.S., the Agency/and or Department shall rescind designation of a lead
agency or take intermediate measures against the Contractor, including corrective action, unannounced
special monitoring,temporary assumption of operation of one or more programs by the Agency,placement on
probationary status, imposing a moratorium on Contractor action, imposing financial penalties for
nonperformance, or other administrative action pursuant to Chapter 120, F.S., if the Agency and/or
Department finds that any of the following have occurred:
a. An intentional or negligent act of the Contractor has materially affected the health,welfare,or safety of
clients,or substantially and negatively affected the operation of an aging services program.
b. The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual funds
have been misappropriated.
c. The Contractor has committed multiple or repeated violations of legal and regulatory requirements or
Agency and/or Department standards.
d. The Contractor has failed to continue the provision or expansion of services after the declaration of a state
of emergency.
33
1606
January—December 2019 OAA 203.19
e. The Contractor has exceeded its authority or otherwise failed to adhere to the terms of this contract with
the Agency and/or Department or has exceeded its authority or otherwise failed to adhere to the
provisions specifically provided by statute or rule adopted by the Agency.
f. The Contractor has failed to properly determine client eligibility as defined by the Agency or efficiently
manage program budgets.
g. The Contractor has failed to implement and maintain an Agency-approved client grievance resolution
procedure.
2. In making any determination under this provision the Agency may rely upon findings of another state or
federal agency, or other regulatory body. Any claims for damages for breach of contract are exempt from
administrative proceedings and shall be brought before the appropriate entity in the venue of Lee County,
Florida. In the event the Agency initiates action to rescind a lead agency designation,the Agency shall follow
the procedures set forth in 42 U.S.C.§3025(b). •
•
G. Investigation of Criminal Allegations •
Any report that implies criminal intent on the part of the Contractor or any subcontractors and referred to a
governmental or investigatory agency must be sent to the Agency. If the Contractor has reason to believe that the
allegations will be referred to the State Attorney,a law enforcement agency,the United States Attorney's office,or
governmental agency, the Contractor shall notify the Area Agency and/or Inspector General at the Department
immediately. A copy of all documents, reports, notes, or other written material concerning the investigation,
whether in the possession of the Contractor or subcontractors, must be sent to the Area Agency's and/or
Department's Inspector General with a summary of the investigation and allegations. •
•
REMAINDER OF PAGE.INTENTIONALLY LEFT BLANK
•
•
34
16o6
January—December 2019 OAA 203.19
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Agency to the Contractor may be subject to audits and/or monitoring by
the Area Agency on Aging for Southwest Florida,Inc.,as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with 2 CFR Part 200 (formerly OMB Circular A-133 as revised),
and Section 215.97,F.S., (see"AUDITS"below),monitoring procedures may include, but not be limited to, on-site visits
by the Agency staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By
entering into this contract,the Contractor agrees to comply and cooperate with any monitoring procedures/processes deemed
appropriate by the Agency.In the event the Agency determines that a limited scope audit of the Contractor is appropriate,
the Contractor agrees to comply with any additional instructions provided by the Agency to the Contractor regarding such
audit. The Contractor further agrees to comply and cooperate with any inspections, reviews, investigations, or audits
deemed necessary by the Chief Financial Officer(CFO)or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the Contractor is a State or local government or a non-profit organization as defined in 2 CFR Part
200, Subpart A.
In the event that the Contractor expends$750,000.00 or more in federal awards during its fiscal year,the Contractor must
have a single or program-specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial
Compliance Audit Attachment, Exhibit 2 indicates federal resources awarded through the Agency by this contract. In
determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards,
including federal resources received from the Agency. The determination of amounts of Federal awards expended should
be in accordance with 2 CFR Part 200. An audit of the Contractor conducted by the Auditor General in accordance with
the provisions of 2 CFR Part 200 will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the Contractor shall fulfill the requirements
relative to auditee responsibilities as provided in 2 CFR§200.508.
If the Contractor expends less than$750,000.00 in federal awards in its fiscal year,an audit conducted in accordance with
the provisions of 2 CFR Part 200 is not required. In the event that the Contractor expends less than$750,000.00 in federal
awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200 the cost.
of the audit must be paid from non-federal resources(i.e., the cost of such audit must be paid from Contractor resources
obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to contracts with the Agency shall be based on the contract's requirements, including any
rules,regulations,or statutes referenced in the contract.The financial statements shall disclose whether or not the matching
requirement was met for each applicable contract. All questioned costs and liabilities due to the Agency shall be fully
disclosed in the audit report with reference to the Area Agency on Aging for Southwest Florida,Inc. contract involved. If
not otherwise disclosed as required by 2 CFR §200.510 the schedule of expenditures of federal awards shall identify
expenditures by contract number for each contract with the Agency in effect during the audit period.Financial reporting
packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9
• months after the end of the Contractor's fiscal year end.
35
1606
•January—December 2019 OAA 20119
PART If: STATE FUNDED
This part is applicable if the Contractor is a non-state entity as defined by Section 215.97(2),F.S.
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of$750,000.00 in
any fiscal year of such Contractor,the Contractor must have a State single or project-specific audit for such fiscal year in
accordance with Section 215.97,F.S.;applicable rules of the Department of Financial Services; and Chapters 10.550(local
governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. Financial
Compliance Audit Attachment,Exhibit 2 indicates state financial assistance awarded through the Agency by this contract.
In determining the state financial assistance expended in its fiscal year, the Contractor shall consider all sources of state
financial assistance, including state financial assistance received from the Agency, other state agencies, and other non-
state entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a
non-state entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1, the Contractor shall ensure that the audit
complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as
defined by Section 215.97(2), F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations),Rules of the Auditor General.
If the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year, an audit conducted in
accordance with the provisions of Section 215.97,F.S.,is not required.In the event that the Contractor expends less than
$750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the
provisions of Section 215.97, F.S.,the cost of the audit must be paid from the non-state entity's resources(i.e.,the cost of
such an andit must be paid from the Contractor resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to contracts with the Agency shall be based on the contract's requirements, including any
applicable rules,regulations, or statutes. The financial statements shall disclose whether or not the matching requirement
was met for each applicable contract. All questioned costs and liabilities due to the Agency shall be fully disclosed in the
audit report with reference to the Agency contract involved. If not otherwise disclosed as required by Rule 691- 5.003,
F.A.C., the schedule of expenditures of state financial assistance shall identify expenditures by contract number for each
contract with the Agency in effect during the audit period. Financial reporting packages required under this part must be
submitted within 45 days after delivery of the audit report, but no later than 12 months after the Contractor's fiscal year
end for local governmental entities.Non-profit or for-profit organizations are required to be submitted within 45 days after
delivery of the audit report, but no later than 9 months after the Contractor's fiscal year end. Notwithstanding the
applicability of this portion, the Agency retains all right and obligation to monitor and oversee the performance of this
contract as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of this Financial
Compliance Audit Attachment, shall be snbmitted, when required by 2 CFR §200.512 by or on behalf of the Contractor
directly to each of the following:
The Area Agency on Aging for Southwest Florida,Inc. at the following address:
Area Agency on Aging for Southwest Florida,Inc.
Attn: Tammy Rhoades,CFO
15201 N Cleveland Ave.,Suite 1100
North Fort Myers,FL 33903
36
1606
January—December 2019 OAA 203.19
For fiscal year 2013 and earlier to the Federal Audit Clearinghouse designated in 2 CFR§200.36 at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville,IN 47132
For fiscal year 2014 and later,pursuant to 2 CFR§200.512,the reporting package and the data collection form must be
submitted electronically to the Federal Audit Clearinghouse.
Pursuant to 2 CFR §200.512,all other Federal agencies,pass-through entities and others interested in a reporting package
and data collection form must obtain it by accessing the Federal Audit Clearinghouse.
The Contractor shall submit a copy of any management letter issued by the auditor,to the Area Agency on Aging for
Southwest Florida,Inc.at the following address:
Area Agency on Aging for Southwest Florida,Inc.
Attn: Tammy Rhoades, CFO
15201 N Cleveland Ave.,Suite 1100
North Fort Myers,FL 33903
Additionally, copies of financial reporting packages required by this contract's Financial Compliance Audit Attachment,
Part II shall be submitted by or on behalf of the Contractor directly to each of the following:
The Area Agency on Aging for Southwest Florida,Inc. at the following address:
Area Agency on Aging for Southwest Florida,Inc.
Attn:Tammy Rhoades,CFO
15201 N Cleveland Ave.,Suite 1100
North Fort Myers,FL 33903
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building,Room 574
111 West Madison Street
Tallahassee,Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Agency pursuant to this contract
shall be submitted timely in accordance with 2 CFR Part 200, Florida Statutes, and Chapters 10.550 (local governmental
entities)or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General,as applicable.
Contractors,when submitting financial reporting packages to the Agency for audits done in accordance with 2 CFR Part 200
or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor
General, should indicate the date that the reporting package was delivered to the Contractor in correspondence
accompanying the reporting package.
PART IV:RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of
six (6) years from the date the audit report is issued, and shall allow the Agency or its designee, the CFO or Auditor
General access to such records upon request. The Contractor shall ensure that audit working papers are made available to
the Agency or its designee, CFO, or Auditor General upon request for a period of six (6) years from the date the audit
report is issued,unless extended in writing by the Agency.
37
1606
January—December 2019 OAA 203.19
ATTACHMENT II EXIIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200
and/or Section 215.97,F.S.Contractors who are determined to be recipients or sub-recipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I
and/or Part II of Exhibit 1 are met. Contractors who have been determined to be vendors are not subject to the audit
requirements of 2 CFR§200.38,and/or Section 215.97,F.S.Regardless of whether the audit requirements are met,
Contractors who have been determined to be recipients or sub-recipients of Federal awards and/or state financial
assistance must comply with applicable programmatic and fiscal compliance requirements.
In accordance with 2 CFR Part 200 and/or Rule 69I-5.006,F.A.C., Contractor has been determined to be:
Vendor not subject to 2 CFR §200.38 and/or Section 215.97,F.S.
X Recipient/sub-recipient subject to 2 CFR§200.86 and §200.93 and/or Section 215.97,F.S.
Exempt organization not subject to 2 CFR Part 200 and/or Section 215.97, F.S. For Federal awards, for-profit
organizations are exempt; for state financial assistance projects, public universities, community colleges, district
school boards,branches of state(Florida) government, and charter schools are exempt. Exempt organizations must
comply with all compliance requirements set forth within the contract or award document.
NO FE: If a Contractor is determined to be a recipient/sub-recipient of federal and or state financial assistance and has been
approved by the Agency to subcontract,they must comply with Section 215.97(7),F.S.,and Rule 691-5.006, F.A.C. [state
financial assistance] and 2 CFR§200.330[federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal
awards,state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a sub-
recipient must comply with the following fiscal laws,rules and regulations:
STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR§200.416-§200.417—Special Considerations for States,Local Governments and Indian Tribes*
2 CFR§200.201—Administrative Requirements**
2 CFR§200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR§200.400- §200.411—Cost Principles*
2 CFR§200.100—Administrative Requirements
2 CFR§200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
EDUCATIONAL INSTITUTIONS(EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT)
MUST FOLLOW:
2 CFR§200.418—§200.419—Special Considerations for Institutions of Higher Education*
2 CFR§200.100—Administrative Requirements
2 CFR§200 Subpart F—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
38
16D6
January—December 2019 OAA 203.19
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in 2 CFR
§200.400(5)(c).
**For funding passed through U.S. Health and Human Services,45 CFR Part 75; for funding passed through U.S.
Department of Education,34 CFR Part 80.
STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a
recipient/sub-recipient must comply with the following fiscal laws,rules and regulations:
Sections 215.97&215.971,F.S.
Chapter 69I-5,F.A.C.
State Projects Compliance Supplement
Reference Guide for State Expenditures •
Other fiscal requirements set forth in program laws,rules and regulations
39
1686
January—December 2019 OAA 203,19
ATTACHMENT 11-EDIT 2
FUNDING SUMMARY
Note: Title2 CFR§200331,asrevised,and Section 215.97(5),Florida Statutes,require that the information about federal programs and
StateProjects bep•ovided totheRecipient and are stated in The Financial And Compliance Audit Attachment And Exhibit 1.Financial And
Compliance Audit Attachment, Exhibit 2-Funding Summary ProvidesInformation RegardingtheFunding Sources Applicable tothiscontract,
contained herein,isapredictionoft ndingsauces and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD(FAIN#): 19AAFLT3SS, 19AAFLT3CM,19AAFLT3HD, 19AAFLT3PH,19AAFLT3FC,
19AAFLNSIP
DUNS NUMBER:076997790 FEDERAL AWARD DATE: OCTOBER 20,2018
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title 11113 —
Transportation $ 10,010.00
Support Services U.S. Health and human Services 93.044 $ 3$0,753.00
Total 111B $ 390,763.00
OAA Title 1TTC1 —Congregate Meals U.S. Health and Human Services 93.045 $ 339,117.00
Total IIIC1
OAA Title Ill C2—Home Delivered U.S. Health and Human Services 93.045 $ 297,790.00
Total 111C2
Older Americans Act Title III E
Services (Title III E) 93.052 $ 139,834,00
Supplement Services (Title III ES) U.S.Health and Human Services $ 14,287.00
Grandparent Services (Title III EG) $ 6,145.00
Total INF, $ 160,266.00
NSIP U.S. Health and Human Services 93.053 $ 47,263.00 I
TOTAL FEDERAL AWARD $1,235,199.00
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards/
OMB Circular A-133—Audits of States,Local Governments,and Non-Profit Organizations
2. STATE RESOURCES AWARDED TOTEM RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSJSTANCE
Section 215.97,F,S.,Chapter 691-5,FL Admin Code,Reference Guide for State Expenditures,Other fiscal requirements set forth in
program laws,rules and regulations.
40
1606
January—December 2019 OAA 203.19
ATTACHMENT III
CERTIFICATIONS AND ASSURANCES
Agency will not award this Contract unless Contractor completes this CERFI ICATIONS AND ASSURANCES.In
performance of this contract,Contractor provides the following certifications and assurances:
A. debarment and Suspension Certification(29 CFR Part 95 and 45 CFR Part75)
B. Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 93)
C. Nondiscrimination &Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes.section 287.133.F.S.
E. AsoOation of Community Organizations for Reform Now (ACORN)Funding Restrictions Assurance
(Pub.L. 111-117)
F. Scrutinized Companies Lists and No Boycott of Israel Certification.section 287.135.F.S.
G. Certification Regarding Data Integrity Compliance for Contracts.Agreements.Grants.Loans,and
Cooperative Agreements
H. Verification of Employment Status Certification
L records and Documentation
J. Certification Regarding Inspection of Public Records
A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS--PRIMARY COVERED TRANSACTION.
The undersigned Contractor certifies,to the best of its knowledge and belief,that it and its principals:
L Are not presently debarred,suspended,proposed for debarment,declared ineligible, or voluntarily excluded from
covered transactions by a Federal department or agency;
2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing
a public(Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsificatiou or destruction of records,
making false statements,or receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity(Federal, State,or
local)with commission of any of the offenses enumerated in paragraph A.2. of this certification;and/or
4. Have not within a three-year period preceding this application/proposal had one or more public transactions
(Federal, State, or local)terminated for cause of default.
The undersigned shall require that language of this certification be included in the documents for all subcontracts atall
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall provide this certification accordingly.
B. CERTIFICATION REGARDING LOBBYING—CERTIFICATION FOR CONTRACTS,GRANTS,LOANS,
AND COOPERATIVE AGREEMENTS.
The undersigned Contractor certifies,to the best of its knowledge and belief,that:
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 Congress or an employee of a Member of Congress in
41
1606
January—December 2019 OAA 203.19
connection with the awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,
the entering into of any cooperative agreement, and the extension,continuation,renewal, amendment, or modification
of any Federal contract,grant, loan,or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid 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 employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative
agreement, the undersigned shall also complete and submit Standard Form — LLL, "Disclosure Form to Report
Lobbying,"in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts atall
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this Contract was made or
entered into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31
U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than$100,000 for each such failure.
C. NON-DISCRIMINATION&EQUAL OPPORTUNITY ASSURANCE(29 CYR PART 37 AND 45 CFR PART
80). -As a condition of the Contract,Contractor assures that it will comply fully with the nondiscrimination and equal
opportunity provisions of the following laws:
1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220),which prohibits discrimination
against all individuals in the United States on the basis of race,color,religion, sex, national origin, age,disability,
political affiliation,or belief,and against beneficiaries on the basis of either citizenship/status as a lawfully admitted
immigrant authorized to work in the United States or participation in any WIA Title I-fmancially assisted program
or activity.
2. Title VI of the Civil Rights Act of 1964(Pub.L. 88-352),as amended,and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services(45 CFR Part 80),to the end that,in accordance
with Title VI of that Act and the Regulation, no person in the United States shall,on the ground of race, color, or
national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity for which the Applicant receives Federal financial assistance from the
Agency.
3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84),to the end that,in
accordance with Section 504 of that Act and the Regulation,no otherwise qualified handicapped individual in the
United States shall, solely by reason of his handicap,be excluded from participation in,be denied the benefits of,
or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial
assistance from the Agency.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services(45 CFR Part 91),to the end that,in accordance
with the Act and the Regulation,no person in the United States shall,on the basis of age,be denied the benefits of,
be excluded from participation in, or be subjected to discrimination under any program or activity for which the
Applicant receives Federal financial assistance from the Agency.
5. Title IX of the Education Amendments of 1972(Pub.L. 92-318),as amended,and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 86),to the end that, in
accordance with Title IX and the Regulation,no person in the United States shall,on the basis of sex,be excluded
from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education
program or activity for which the Applicant receives Federal financial assistance from the Agency.
6. The American with Disabilities Act of 1990(Pub. L. 101-336),which prohibits discrimination in all employment
practices, including job application procedures, hiring, firing, advancement, compensation, training, and other
terms,conditions,and privileges of employment. It applies to recruitment,advertising,tenure,layoff, leave,fringe
benefits,and all other employment-related activities.
42 4_
j
1606
January—December 2019 OAA 203.19
7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws
listed above.This assurance applies to Contractor's operation of the WIA Title I—financially assisted program or
activity,and to all contracts Contractor makes to carry out the WIA Title I—financially assisted program or activity.
Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial
enforcement of the assurance.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall provide this assurance accordingly.
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S.
Contractor hereby certifies that neither it,nor any person or affiliate of Contractor,has been convicted of a Public Entity
Crime as defined in section 287.133,F.S.,nor placed on the convicted vendor list.
Contractor understands and agrees that it is required to inform Agency immediately upon any change of
circumstances regarding this status.
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW(ACORN)FUNDING
RESTRICTIONS ASSURANCE(Pub.L.111-117).
As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions
pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act,2010,Division E,Section 511 (Pub.
L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that
appropriations made under Pub.L. 111-117 are available under the conditions provided by Pub.L. 111-117.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers(including subcontracts,sub-grants and contracts under grants,loans and cooperative agreements)and that all sub-
recipients and contractors shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION,SECTION
287.135,F.S.
In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized
Companies that Boycott Israel List and that it is not participating in a boycott of Israel.
if this Contract is in the amount of$1 million or more, in accordance with the requirements of section 287.135,F.S.,
Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the
Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business
operations in Cuba or Syria.
Contractor understands that pursuant to section 287.135,F.S.,the submission of a false certification may result in the
Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and
attorney fees and costs,including any costs for investigations that led to the finding of false certification.
If Contractor is unable to certify any of the statements in this certification,Contractor shall attach an explanation to
this Contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS,AGREEMENTS,
GRANTS,LOANS,AND COOPERATIVE AGREEMENTS
1. The Contractor and any Subcontractors of services under this contract have financial management systems
capable of providingcertain information,including: (1)accurate, current,and complete disclosure of the financial
results of each grant-funded project or program in accordance with the prescribed reporting requirements;(2)the
source and application of funds for all contract supported activities;and(3)the comparison of outlays with
43
1606
January—December 2019 OAA 203.19
budgeted amounts for each award.The inability to process information in accordance with these requirements
could result in a return of grant funds that have not been accounted for properly.
2. Management Information Systems used by the Contractor,Subcontractors, or any outside entity on which the
Contractor is dependent for data that is to be reported,transmitted,or calculated have been assessed and verified
to be capable of processing data accurately, including year-date dependent data.For those systems identified to be
non-compliant,Contractors will take immediate action to assure data integrity.
3. If this contract includes the provision of hardware,software,firmware,microcode,or imbedded chiptechnology,
the undersigned warrants that these products are capable of processing year-date dependent data accurately.All
versions of these products offered by the Contractor(represented by the undersigned)and purchased by the state
will be verified for accuracy and integrity of data prior to transfer.
4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that
impede the hardware or software programs from operating properly,the Contractor agrees to immediatelymake
required corrections to restore hardware and software programs to the same level of functionality as warranted
herein,at no charge to the state,and without interruption to the ongoing business of the state,time being of the
essence.
5. The Contractor and any Subcontractors of services under this contract warrant that their policies and procedures
include a disaster plan to provide for service delivery to continue in case of an emergency,including emergencies
arising from data integrity compliance issues.
II.VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Agency,Contractor certifies the use of the U.S.Department of Homeland
Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the
contract term to perform employment duties pursuant to this contract,and that any subcontracts include an express
requirement that Subcontractors performing work or providing services pursuant to this Contract utilize the E-verify
system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract
term.
The Contractor shall require that the language of this certification be included in all sub-agreements,sub-grants,and
other agreements/contracts and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this Contract was made or
entered into.Submission of this certification is a prerequisite for making or entering into this Contract imposed by
Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A-110).
I. RECORDS AND DOCUMENTATION
The Contractor agrees to make available to Agency staff and/or any party designated by the Agency any and all
contract related records and documentation.The Contractor shall ensure the collection and maintenance of all program
related information and documentation on any such system designated by the Agency.Maintenance includes valid
exports and backups of all data and systems according to Agency standards.
J.CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of sections 10.1 and 10.2 of the Standard Contract,sections 119.0701(3)and (4)F.S.,
and any other applicable law, if a civil action is commenced as contemplated by section 119.0701(4),F.S., and the
Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs
incurred by the Agency and any attorneys' fees assessed or awarded against the Agency from a Public Records
Request made pursuant to Chapter 119,F.S.,concerning this contract or services performed thereunder.
a. Notwithstanding section 119.0701,F.S.,or other Florida law,this section is not applicable to contracts executed
between the Agency and state agencies or subdivisions defined in section 768.28(2),F,S.
44
. 1 6 D6
January—December 2019 OAA 203.19
2. Section 119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership
contributions for any person, corporation,foundation,trust,association, group, or other organization,all the financial,
business, and membership records of such an entity which pertain to the public agency (Area Agency on Aging
for Southwest Florida,Inc.)are public records. Section 119.07,F.S,states that every person who has custody of such
a public record shall permit the record to be inspected and copied by any person desiring to do so, under reasonable
circumstances. ��//
Additionally,I certify this organization does I1 does not provide for institutional memberships.
Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are
available for inspection if applicable,as stated above.
By execution of this contract,Contractor must include these provisions(A-J) in all related subcontract agreements(if
applicable).
By signing below,Contractor certifies that the representations outlined in parts A through J above are true and correct.
3339 Tamiami Trail E Suite 211
Signature and Title of Authorized Representative Street Address •
Stephen Y Cornell,Public Services Department Head
Collier County Board of County Commissioners Naples,FL 34112
Contractor Date 1/uh y City,State,Zip code
Approved as to form and legality
t/v
As.'stint County A try y
%\‘0\\`I
•
1
45
1606
January—December 2019 OAA 203.19
ATTACHMENT IV
ASSURANCES--NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average forty-five(45)minutes per response, including time
for reviewing instructions,searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden,to the Office of Management and Budget. Paperwork Reduction Project(0348-0043),
Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET,SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program.If you have questions please
contact the awarding agency.Further,certain federal awarding agencies may require applicants to certify to
additional assurances.If such is the case,you will be notified.
1. Has the legal authority to apply for federal assistance,and the institutional,managerial and financial capability
(including funds sufficient to pay the non-federal share of project cost)to ensure proper planning,management, and
completion of the project described in this application.
2. Will give the awarding agency,the Comptroller General of the United States,and if appropriate,the state,through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the
award; and will establish a proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest,or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970(42 U.S.C. §4728-4763)relating to prescribed standards
for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's
Standards for a Merit System of Personnel Administration(5 C.F.R.900,SubpartF).
6. Will comply with all federal statutes relating to nondiscrimination.These include but are not limited to: (a)Title VI of
the Civil Rights Act of 1964(P.L.88-352)which prohibits discrimination on the basis of race,color or national origin;
(b)Title IX of the Education Amendments of 1972,as amended(20 U.S.C. §1681-1683,and 1685-1686),which
prohibits discrimination on the basis of sex;(c) Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C.
§794),which prohibits discrimination on the basis of handicaps;(d)the Age Discrimination Act of 1975,as amended
(42 U.S.C. §6101-6107),which prohibits discrimination on the basis of age;(e)the Drug Abuse Office and Treatment
Act of 1972(P.L.92-255),as amended,relating to nondiscrimination on the basis of drug abuse;(f)the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism;(g)§523 and 527 of the Public Health Service
Act of 1912 (42 U.S.C. §290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse
patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to
nondiscrimination in the sale,rental or financing of housing; (i)any other nondiscrimination provisions in the specific
statute(s) under which application for federal assistance is being made; and (j) the requirements of any other
nondiscrimination statute(s)which may apply to the application.
7. Will comply, or has already complied,with the requirements of Titles II and III of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements
apply to all interests in real property acquired for project purposes regardless of federal participation inpurchases.
46
1606
January—December 2019 OAA 203.19
8. Will comply, as applicable, with the provisions of the Hatch Act(5 U.S.C. §1501-1508 and 7324-7328), which limit
the political activities of employees whose principal employment activities are funded in whole or in part with federal
funds.
9. Will comply,as applicable,with the provisions of the Davis-Bacon Act(40 U.S.C. §276a to 276a-7),the Copeland Act
(40 U.S,C. 276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act(40 U.S.C. §327-333),
regarding labor standards for federally assisted construction sub-contracts.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or
more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order(EU) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the Coastal Zone Management Act
of 1972 (16 U.S.C. §1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under
Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h)protection
of endangered species under the Endangered Species Act of 1973,as amended, (P.L.93-205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974(16 U.S.C. §469a-1 et seq.).
14. Will comply with P.L.93-348 regarding the protection of human subjects involved in research,development,and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §2131 et seq.)
pertaining to the care,handling, and treatment of warm blooded animals held for research,teaching, or other activities
supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C. §4801 et seq.),which prohibits the use of
lead-based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and 2 CFR Part 200.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies
governing this program.
SIGNA3URE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
Public Service Department Head
Stephen Y Carvell
APPLICANT ORGANIZATION DATE SUBMITTED l Collier County Board of County Commissioners /1‘
I
Approved as to form and legality
47
assistant County .310.y
1606
January—December 2019 OAA 203A9
ATTACHMENT V
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name County AAA/Contractor
Address Completed By
City,State,Zip Code Date Telephone
PART I:READ THE ATTACHED INSTRUCTIONS FOIL ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE
THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
For questions 2-5please
% % % % %
Total#
indicate the following: White BIack Hispanic Other Female Disabled Over 40
2.Population of area served Source of data:
3.Staff currently employed Effective date:
4.Clients currently enrolled/registered Effective date:
I S.Advisory/GoverningBoard if applicable
PART It USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO EXPLAIN.
6. Is an Assurance of Compliance on file with DOBA? N/A YES NO
❑ ❑ ❑
7. Compare the staff composition to the population. Is staff representative of the population? N/A YES NO
❑ ❑ ❑
8. Are eligibility requirements for services applied to clients and applicants without regard to race,color,national N/A YES NO
origin,sex,age,religion or disability? ❑ ❑ ❑
9, Are all benefits,services and facilities available to applicants and participants in an equally effective manner N/A YES NO
regardless of race,sex,color,age,national origin,religion or disability? D D ❑
10. For in-patient services,are room assignments made without regard to race,color,national origin or disability? N/A YES NO
❑ ❑ ❑
11. Is the program/facility accessible to non-English speaking clients? N/A YES NO
❑ ❑ ❑
12.Are employees,applicants and participants informed of their protection against discrimination? If YES,how? N/A YES NO
Verbal D Written D Poster❑ ❑ ❑ ❑
48
1606
January—December 2019 OAA 203.19
13. Give the number and current status of any discrimination complaints regarding services or employment filed N/A NUMBER
against the program/facility. [l
14.Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? N/A YES NO
❑ ❑ ❑
PART III:THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES.IF NO
EXPLAIN.
15.Has as a self-evaluation been conducted to identify any barriers to serving disabled individuals,and to make any YES NO
necessary modifications? ❑ ❑
16. Is there an established grievance procedure that incorporates due process in the resolution of complaints? YES NO
❑ ❑
17. Has a person been designated to coordinate Section 504 compliance activities? YES NO
❑ ❑
18.Do recruitment and notification materials advise applicants,employees and participants of nondiscrimination on YES NO
the basis of disability?
❑ ❑
19.Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? YES NO
❑ ❑
PART lY:FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF$50,000.00 OR MORE.
20. Do you have a written affirmative action plan? IfNO,explain. YES NO
❑ ❑
DOEA USE ONLY
Reviewed by In Compliance: YESn� NO*
Program Office *Notice of Corrective Ac`fion Sent ❑/ /„
Date Telephone Response Due / /
On-Site ❑ Desk Review ❑ Response Received / /_._._,
49
1606
January--December 2019 OAA 203.19
ATTACHMENT V
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district,county, city or other locality. If the program/facility serves
a specific target population such as adolescents, describe the target population. Also, define the type of service
provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city,county or other regional area. Population statistics
can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing
Florida population statistics.Include the source of your population statistics. ("Other"races include Asian/Pacific
Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of
your summary.
4. Enter the total number of clients who are enrolled,registered or currently served by the program or facility,and list
their percent by race,sex and disability.Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board,leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for Area Agency and/or DOEA Recipients and their Sub-grantees,45 CFR 80.4(a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
8. Where there is a significant variation between the race,sex or ethnic composition of the clients and their availability
in the population,the program/facility has the responsibility to determine the reasons for such variation and take
whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when
programs are sanctioned to serve target populations such as elderly or disabled persons,45 CFR 80.3 (h)(6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on-site record analysis of persons who applied but were denied services or employment,45 CFR 80.3 (a)
and 45 CFR 80.1 (b)(2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies,counseling and social services without regard to race,sex,color,national origin,
religion,age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied
uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting
rooms,reception areas,restrooms and other facilities must also be equally available to all clients,45 CFR 80.3 (b).
11. For in-patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race,color,national origin,or disability,45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants,including those persons who
may not speak English. In geographic areas where a significant population of non-English speaking people live,
program accessibility may include the employment of bilingual staff. In other areas,it is sufficient to have a policy
50
1606
January-December 2019 OAA 203.19
or plan for service,such as a current list of names and telephone numbers of bilingual individuals who will assist
in the provision of services,45 CFR 80.3 (a).
13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries or any other interested parties. This should include information on their right to file a
complaint of discrimination with either the Area Agency on Aging for Southwest Florida, Inc. and/or Florida
Department of Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in
writing to every individual,or may be supplied through the use of an equal opportunity policy poster displayed in
a public area of the facility,45 CFR 80.6(d).
14. Report number of discrimination complaints filed against the program/facility.Indicate the basis, e.g.,race, color,
creed,sex,age,national origin,disability,retaliation; the issues involved,e.g.,services or employment,placement,
termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and
address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status,
e.g.,settled,no reasonable cause found,failure to conciliate,failure to cooperate,under review,etc.
15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas,curb cuts or level approaches,ramps and adequate widths to entrances. The lobby,public
telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door
widths and traffic areas of administrative offices,cafeterias, restrooms, recreation areas, counters and serving lines
should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers.
Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an
appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self-
evaluation to identify any accessibility barriers. Self-evaluation is a four step process:
a. With the assistance of a disabled individual/organization,evaluate current practices and policies which do not
comply with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have
been followed.),45 CFR 84.6.
17, Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate
due process standards and provide for the prompt and equitable resolution of complaints alleging any action
prohibited by Section 504.45 CFR 84.7(b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7(a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads, and other appropriate written communication,45 CFR 84.8(a).
20, Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired
sensory, manual or speaking skills where necessary. Auxiliary aids may include,but are not limited to, interpreters
for hearing impaired individuals,taped or Braille materials,or any alternative resources that can be used to provide
equally effective services,45 CFR 84.52(d).
21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and
maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60
and Title VI of the Civil Rights Act of 1964, as amended.
51
1606
January—December 2019 OAA 203.19
ATTACHMENT VII
BACKGROUND SCREENING
DEPART1,MEr1T OF
BACKGROUND SCREENING
ELDER
AFFAIRS Affidavit of Compliance - Employer
STATE bF P1T110A
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.05(3), Florida Statutes.
The term "employer" means any person or entity required by law to conduct background screening,
including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability
Resource Centers,Lead Agencies,Long-Term Care Ombudsman Program,Serving Health Insurance Needs
of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires
employees or has volunteers in service who meet the definition of a direct service provider. See §§
435.02,430.0402,Fla.Stat.
A direct service provider is"a person 18 years of age or older who, pursuant to a program to provide
services to the elderly,has direct,face-to-face contact with a client while providing services to the client
and has access to the client's living area,funds,personal property,or personal Identification information
as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential
facilities;and volunteers." §430.0402(1)(b),Fla.Stat.
ATTESTATION:
As the duly authorized representative of
Employer Name
located at
Street Address City State ZIP code
1, do hereby affirm under penalty of perjury
Name of Representative
that the above named employer Is in compliance with the provisions of Chapter 435 and section
430.0402,Florida Statutes,regarding level 2 background screening,
Signature of Representative Date
STATE OF FLORIDA,COUNTY OF
Sworn to (or affirmed) and subscribed before me this day of , 20 , by
(Name of Representative)who Is personally known
to me or produced as proof of Identification.
Pdnt,Type,or Stamp Commissioned Name of Notary Public Notary Public
DOEA Form 235,Affidavit of Compliance-Employer,Effective April 2012 Section 435,05(3),F.S.
Form available at:littnl/eideraffairsstate.fl.ustenallshlbackgroundscreening.oho
52
1606
January—December 2019 OAA 203.19
ATTACHMENT IX
BUDGET AND RATE SUMMARY
OLDER AMERICANS ACT BUDGET SUMMARY
CONTRACTOR: COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
1, Title III B Support Services $ 390,763.00
2. Title III Cl Congregate Meals $ 339,117.00
3. Title ITT C2 Home Delivered Meals $ 297,790.00
4. Title III E Services $ 160,266.00
5. NSIP $ 47,263.00
TOTAL S 1,235,199.00
53
1606
January—December 2019 OAA 203.19
ATTACHMENT IX
BUDGET AND RATE SUMMARY
COLLIER COUNTY
[IIB
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE
ADULT DAYCARE $11.55 Fixed Fee/Unit Rate HOURS
CASE AIDE $30.50 Fixed Fee/Unit Rate HOURS
CASE MANAGEMENT $54.00 Fixed Fee/Unit Rate HOURS
CHORE $21.34 Fixed Fee/Unit Rate HOURS
CHORE(ENHANCED) $35.00 Fixed Fee/Unit Rate HOURS
COMPANIONSHIP $21.00 Fixed Fee/Unit Rate HOURS
EMERGENCY ALERT RESPONSE $ 1.53 Fixed Fee/Unit Rate DAYS
ESCORT $19.50 Fixed Fee/Unit Rate TRIPS
HOMEMAKER $19.50 Fixed Fee/Unit Rate HOURS
HOUSING IMPROVEMENT Cost Reimbursement 90%of Cost EPISODE
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE
PERSONAL CARE $23.21 Fixed Fee/Unit Rate HOURS
RESPITE IN-FACILITY $11.55 Fixed Fee/Unit Rate . HOURS
REPITE IN-HOME $23.27 Fixed Fee/Unit Rate HOURS
SCREENING AND ASSESSMENT $54.16 Fixed Fee/Unit Rate HOURS
SHOPPING ASSISTANCE $18.90
SKILLED NURSING SERVICES $38.02 Fixed Fee/Unit Rate HOURS
SPECIALIZED MEDICAL EQUIPMENT,
SERVICES,AND SUPPLIES Cost Reimbursement 90%of Cost EPISODE
TRANSPORTATION Cost Reimbursement 100%of Cost TRIPS
54 �'
16D6
January—December 2019 OAA 203.19
ATTACHMENT IX
BUDGET AND RATE SUMMARY
COLLIER COUNTY
IIIE,IIIES, &MEG
SERVICE REIMBURSEMENT METHOD OF UNIT
UNIT RATE PAYMENT TYPE
IIIE ADULT DAYCARE $11.55 Fixed Fee/Unit Rate HOURS
DIRECT PAY RESPI1•E $15.00 Fixed Fee/Unit Rate HOURS
RESPITE IN-FACILITY $11.55 Fixed Fee/Unit Rate HOURS
RESPITE IN-HOME $23.27 Fixed Fee/Unit Rate HOURS
SCREENING&ASSESSMENT $54.00 Fixed Fee/Unit Rate HOURS
HIES--CHORE $21.00 Fixed Fee/Unit Rate HOURS
ENHANCED CHORE $27.30 Fixed Fee/Unit Rate DAYS
Specialized Medical Equipment, Cost Reimbursement 90%of Cost EPISODE
Service & Supplies
MATERIAL AID Cost Reimbursement 90%of Cost EPISODE
HMG-CHILD DAY CARE $15.00 Fixed Fee/Unit Rate HOURS
SCREENING AND ASSESSMENT $54.00 Fixed Fee/Unit Rate HOURS
55
1606
January—December 2019 OAA 203.19
ATTACHMENT IX
BUDGET AND RATE SUMMARY
C-1 & C-2
COLLIER COUNTY
C-1 & C-2
SERVICE REIMM
BURSEENT
UNIT RATE
CI -- CONGREGATE MEALS $10.07
NUTRITION EDUCATION $ 1.62
CONGREGATE MEAL SCREENINIG $28.00
OUTREACH $4.32 PER PERSON
SERVICE REIIVB3URSEMENT
UNIT RATE
C2 -- HOME DELIVERED MEALS $ 8.87
NUTRITION EDUCATION $ 1.62
SCREENING&ASSESSMENT $54.00
OUTREACH $4.32 PER PERSON
56
1606
January—December 2019 OAA 203.19
ATTACHMENT X
INVOICE SCHEDULE
Submit to Agency
Report Number Based On
On This Date
1 January Advance* January 1
2 February Advance* January 1
3 January Expenditure Report February 9 *See Note#4*
4 February Expenditure Report March 9
5 March Expenditure Report April 9
6 April Expenditure Report May 9
7 May Expenditure Report June 9
8 June Expenditure Report July 9
9 July Expenditure Report August 9
10 August Expenditure Report September 9
11 September Expenditure Report October 9
12 October Expenditure Report November 9
13 November Expenditure Report December 9
14 December Expenditure Report January 9
15 Final Expenditure and Request for Payment February 15
Legend: *Advance based on projected cash need.
Note# 1: Report#1 for Advance Basis Agreements cannot be submitted to the Agency prior to
January 1 or until the agreement with the Agency has been executed.
Note#2: Report numbers 5 through 14 shall reflect an adjustment of one-tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the agree-
ment. The adjustment shall be recorded in Part C, 1 of the report(ATTACHMENT XI).
Note#3: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the Agency,payment is to accompany the
report.
Note#4: ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 9th falls
on a Saturday,then the report will be due by the gtn by 12:00 p.m. AND IF the 9th falls
on a Sunday,the report will be due by the 10th by 12:00 p.m. Actual submission of the
vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report
which is verified and paid by CIRTS data only.
57
. 1606
January-December 2019 OAA 203.19
ATTACHMENT XI
REQUEST FOR PAYMENT
TYPE OF REPORT:
PROVIDER NAME,ADDRESS,PHONE A FED ID NUMBER Contract P
Advance
Contract Period:
Reimbursement Report Period
Report*
PSA
Invoice
CERTIFICATION:I hereby certify to the best of my knowledge that tNs request conforms with the terms and the purposes set forth In the above contract.
Prepared By. Date: Approved By. Date:
PART A: (1) (2) (3) (4) (5) (S) (7) (8)
BUDGET SUMMARY ADMIN. IIIB 11101 IIIC2 IIID IIIE NSIP TOTAL
t•Approved
Contract Amount 0.00 0.00 0,06 0.00 0.00 0.02 0.00 a00
2,Previous Funds
RECEIVED for
Contract period 0,00 0.00 0.00 0.00 0.00 0.00 0,00 0,00
3.Contract Balance 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00
(tine 1 minus Ile 2)
4.Previous Funds
REQUESTER and
Not Received. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00
5.Contract Balance 0,00 0.00 0.00 0.00 0,00 0.00 0.00 0.00
(tine 3 minus line 4)
PART B:
FUNDS REQUESTED
1,1.02nd Months
Request Only 0,00 0.00 0,00 0.00 0.00 0.00 0.0D 0.00
2,Net Expenditures
For Month 0.00 0.00 0,00 0.00 . 0,00 0.00 0.00 0.00
3,Total 0.00 0.00 0,00 0,00 0.00 0.00 0.00 0.00
PART C: .
NET FUNDS RE0UEsTED:
•
1.Less:over-Advance 0.00 0.00 0.00 0.00 0.00 0.08 0.00 0,00
•
•
2.Contract Funds are
Hereby Requested 0.00 0.00 0.00 0,00 0.05 0.00 0.00 0.00
•
•
List of Services 1 Units 1 Rates provided-See attached report.
ODEA blue Only
ODEA FORA 106A revised 10119/18
1
58
. 1 606
January-December 2019 OAA 203.19
ATTACHMENT XII
EXHIBIT 1
RECEIPTS AND EXPENDITURE REPORT
PROVIDER NAME,ADDRESS,PHONE#AND FEID# PROGRAM FUNDING SOURCE: Contract#
Title III Contract Period:
I11B ReportPeriod
PSA Report#
Invoice#
CERTIFICATION:I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
In the contract.
Prepared by: Date: Approved by: Date:
PART A:BUDGE I ED INCOME/RECEIPTS 1.Approved Budget 2.Actual Receipts 3.Total Receipts 4.Percent of
For This Report Year to Date Approved Budget
1.Federal Funds $0.00 $0.00 $0.00 #DIV/DI
2.State Funds $0.00 $0.00 $0.00 #DIV/0l
3.Program Income-Non Match $0,00 $0.00 $0.00 #DIV/01
4.Local Cash Match $0.00 $0.00 $0.00 #DIV/0l
5.SUBTOTAL:CASH RECEIPTS $0.00 $0.00 $0.00 #DIV/01
6.Local In-Kind Match $0.00 $0.00 $0.00 #DIV/0I
7.TOTAL RECEIPTS $0.00 $0.00 $0.00 #D1V/01
PART B:EXPENDITURES 1.Approved Budget 2.Expenditures 3.Expenditures .4.Percent of
For This Report Year to Date Approved Budget
1.AAA Direct Services $0.00 $0.00 $0.00 #DIV/01
2.Subcontractor $0.00 $0.00 $0.00 , #DIV/01
3. IIIB SetAsIde $0.00 $0.00 $0,00 #DIV/0I
4.IIIB Set Aside DRR(Disaster Recovery Reserve) $0.00 $0.00 $0.00 #DIV/0!
5.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/Ol
PART C:OTHER EXPENDITURES 1,Approved Budget 2.Expenditures 3.Expenditures ,4.Percent of
(For Tracking Purposes only) For This Report Year to Date r Approved Budget
1.Match
a.Other and In-Kind $0.00 $0.00 $0.00 r #DIV/Ol
b.Local Match $0.00 $0.00 $0.00 #DIV(01
r
2.Program Income $0.00 $0.00 $0.00 #DIV/01
3.TOTAL OTHER $0.00 $0.00 $0.00 #DIV/01
•1
PART D:INTEREST
1.Earned on Advances $0.00
2.Return on Advances $0.00
3,Other Earned $0.00
DOFA FORM 105as-IIIB revised 10/15/18
59
1606
January-December 2019 OAA 203.19
ATTACHMENT XII
EXHIBIT 2
RECEIPTS AND EXPENDITURE REPORT
PROVIDER NAME,ADDRESS, PHONE#AND FEID# PROGRAM FUNDING SOURCE: Contract#
Title III Contract Period:
Cl Report Period
PSA Report#
Invoice#
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by: Date: Approved by: Date:
PART A:BUDGETED INCOME/RECEIPTS 1.Approved Budget 2.Actual Receipts 3.Total Receipts 4.Percent of
For This Report Year to Date Approved Budget
1,Federal Funds $0,00 $0,00 $0,00 #DIV/01
2.State Funds $0.00 $0.00 $0.00 #DIV/01
3.Program Income-Non Match $0.00 $0.00 $0.00 #DIV/01
4.Local Cash Match $0.00 $0.00 $0.00 #DlV/ol
5.SUBTOTAL:CASH RECEIPTS $0.00 $0.00 $0.00 #DIV/0!
6.Local In-Kind Match $0.00 $0.00 $0.00 #DIV/01
7.TOTAL RECEIPTS $0.00 $0.00 $0.00 #DIV/01
PART B:EXPENDITURES 1.Approved Budget 2.Expenditures 3.Expenditures 4.Percent of
For This Report Year to Date Approved Budget
1.Subcontractor $0.00 $0,00 $0.00 #DIV/01
2.Cl Set Aside DRR(Disaster Recovery Reserve) $0.00 $0.00 $0.00 #DIV/Ol
3.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV/01
PART C:OTHER EXPENDITURES 1.Approved Budget 2.Expenditures 3.Expenditures 4,Percent of
(For Tracking Purposes only) For This Report Year to Date Approved Budget
r
1.Match
a.Other and In-Kind $0.00 $0.00 $0.00 #DIV/01
b.Local Match $0.00 $0.00 $0.00 r #DIV/01
2.Program Income $0.00 $0.00 $0.00 #DIV/01
3.TOTAL OTHER $0.00 $0,00 $0.00 #DI V/01
PART D:INTEREST
1.Earned on Advances $0.00
2.Return on Advances $0.00
3.Other Earned $0.00
DOCA FORM 105as-C1 revised 1W19/2018
60
1606
January-December 2019 OAA 203.19
•
ATTACHMENT XII
EXHIBIT 3
RECEIPTS AND EXPENDITURE REPORT
PROVIDER NAME,ADDRESS, PHONE#AND FEID# PROGRAM FUNDING SOURCE: Contract#
Title III Contract Period:
C2 Report Period
PSA Report#
Invoice#
CERTIFICATION:(certify to the best of my knowledge and belief that this report is complete and at outlays herein are for purposes set forth
in the contract
Prepared by: Date: Approved by: Date:
PART A:BUDGE t ED INCOME/RECEIPTS 1.Approved Budget 2.Actual Receipts 3.Total Receipts 4.Percent of
For This Report Year to Date Approved Budget
1.Federal Funds $0.00 $0.00 $0.00 #D!V/di
2.State Funds $0.00 $0.00 $0.00 #DIVIOI
3.Program Income--Non Match $0.00 $0.00 $0,00 #DIVIbl
4.Local Cash Match $0.00 $0.00 $0.00 #DIV/0l
5.SUBTOTAL:CASH RECEIPTS $0.00 $0.00 $0.00 #DIVIOI
6.Local In-Kind Match $0.00 $0.00 $0.00 #DIV/0l
7.TOTAL RECEIPTS $0.00 $0.00 $0.00 #DIV/0I
PART B:EXPENDITURES 1.Approved Budget 2.Expenditures 3.Expenditures 4.Percent of
For This Report Year to Date Approved Budget
1.Subcontractor $0.00 $0.00 $0.00 #DIV/Ol
2.C2 Set Aside DRR(Disaster Recovery Reserve) $0,00 $0.00 $0.00 #DIV/OI
3.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIVIOI
PART C:OTHER EXPENDITURES 1.Approved Budget 2.Expenditures 3.Expenditures 4.Percent of
(For Tracking Purposes only) For This Report Year to Dater Approved Budget
1. Match
r
a.Other and In-Kind $0.00 $0.00 $0.00 #DIV/OI
L Local Match $0.00 $0.00 $0.00 #DIV/01
r
2.Program Income $0.00 $0.00 $0.00 #DIVI01
3.TOTAL OTHER $0.00 $0.00 $0.00 #DIV/Ol
PART D:INTEREST
1.Earned on Advances $0.00
2.Return on Advances $0.00
3,Other Earned $0.00
A FORM 105as-02 revised 10/19/19
61
. 1 606
January-December 2019 OAA 203.19 •
ATTACHMENT XII
EXHIBIT 4
RECEIPTS AND EXPENDITURE REPORT
PROVIDER NAME,ADDRESS,PHONE#AND FEID# PROGRAM FUNDING SOURCE: Contract# •
Title III ContractPeriod:
I IIE Report Period
PSA Report#
Ii
Invoice#
CERTIFICATION:I certify to the best of my knowledge and belief that this report Is complete and all outlays herein are for purposes set forth
In the contract.
Prepared by: Date: Approved by: Date:
PART A:BUDGETED INCOME/RECEIPTS 1.Approved Budget 2.Actual Receipts 3.Total Receipts 4.Percent of
For This Report Year to Date Approved Budget
1,Federal Funds $0.00 $0.00 $0.00 #DIV/Ol
2.State Funds $0.00 $0.00 $0,00 #DIV/0l
3.Program Income-Non Match $0.00 $0.00 $0.00 #DIV/0l
4.Local Cash Match $0.00 $0.00 $0.00 #DIV/OI
5.SUBTOTAL:CASH RECEIPTS $0.00 $0.00 $0.00 #DIV/O!
6.Local In-Kind Match $0.00 $0.00 $0.00 #DIV/01
7.TOTAL RECEIPTS $0.00 50.00 $0.00 #DIV/OI
PART B:EXPENDITURES 1.Approved Budget 2.Expenditures 3.Expenditures 4.Percent of
For This Report Year to Date Approved Budget
1,AAA Direct Services $0.00 $0.00 $0.00 #DIV/01
2.Sub-Contracted Services $0.00 $0.00 $0.00 #DIV/OI
3.TOTAL EXPENDITURES $0.00 $0,00 $0,00 #DIV/0t
PART C:OTHER EXPENDITURES 1,Approved Budget 2.Expenditures 3.Expenditures 4.Percent of
(For Tracking Purposes only) For This Report Year to Date Approved Budget
1.Match
a.Other and In-Kind $0,00 50.00 $0.00 #D1V/O1
b.Local Match $0.00 $0.00 $0,00 #01VIOl
2.Program Income $0.00 $0.00 $0.00 #DIV/OI
3.TOTAL OTHER $0.00 $0.00 $0.00 #DIV/ol
PART D:EXPENDITURES ANALYSIS
1.Expenditures by Services Year to Date: 2.Units of Services Year to Date 3.Number of People Served Year to Date
1.information $0.00 ........................0 0
2.Assistance.................. $0.00 0 0 .
3.Counseling ..-. $0.00 ........................2 0
4.Respite... 50,00 0 ..........................0
5.Supplemental Services $0.00 0 0
6.TOTAL $0.00
Pad B Une 3,column 3 should be equal to this total.
PART E:GRANDPARENT SERVICES(reported by Federal Fiscal Year)
FFY $ FFY $ FFY $
Match$ Match$ Match$
PART F:INTEREST
1.Earned on Advances $0.00
2.Returned on Advances $0.00
3.Other Earned $0,00 -.
boEA FORM I DSas-IIrE revised 10/19118
62
•
1606
January—December 2019 OAA 203.19
ATTACHMENT XII
EXHIBIT 5
RECIEPTS AND EXPENDITURE REPORT
PROVIDER NAME,ADDRESS,PHONE#AND FEID# PROGRAM FUNDING SOURCE: Contract#
Title III Contract Period:
NSIP Report Period
PSA Report#
Invoice#
CERTIFICATION: I certify to the best of my knowledge and belief that this report Is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by: Date: Approved by: Date:
PART A:EXPENDITURE COMPUTATION YEAR TO DATE CURRENT MONTH
CONGREGATE HOME DELIVERED CONGREGATE HOME DELIVERED
1.Number of Meals Served 0 0 0 0
2.Line 1 Times$.72 cents per Meal $0.00 $0.00 $0.00 $0.00
Year To Date Total Meals 0 Current MonthTotal Meals 0
Year To Date TotalExpenditures $0.00 Total CurrentExpenditures $0.00
PART 0:CONTRACT SUMMARY
1.Approved Contract Amount $0.00
2.Actual Expenditures for this Report $0,00
3.Total Expenditures Year to Date $0.00
4.Contract Balance $0.00
DOEA FORM 106as-NSIP revised 10/19/18
63
1606
January December 2019 OAA 203.19
ATTACHMENT XVI
OAA ANNUAL VOLUNTEER ACTIVI'T'Y REPORT SPECIFICATIONS
I. Categories&Definitions
Direct Volunteers: Volunteers who have person-to-person contact with clients (e.g. I&R specialists, SHINE counselors, and
individuals providing respite and companionship).
Indirect Volunteers: Volunteers who coordinate,manage, or participate in specific services,programs,or activities that assist paid
staff in planning, implementing, and evaluating the goals and objectives of an organization (e.g. speaker's bureau volunteer, data
entry,board members,etc.).
Episodic Volunteers; Volunteers who participate in a specific, one-time event for a limited time, regardless of direct or indirect
volunteers.
NOTE: A volunteer can only be counted once. Select the category (direct, indirect, or episodic) that best describes the individual •
volunteer and his/her volunteer work.
Unduplicated direct or indirect volunteers:Number of volunteers who perform service activities.
IL Survey Questions
i. User input:Email address
i. User input:Survey questions
1. Number of unduplicated direct service volunteers.
1. Number of unduplicated indirect service volunteers.
2. Number of episodic volunteers engaged during the contract year.
3. Total number of direct volunteer hours served.
4. Total number of indirect volunteer hours served.
5. Total number of episodic volunteer hours served.
6. Number of clients served by volunteers.
7. Number of volunteers age 60 or older.
8. Number of volunteers under age 60.
III.Service Categories
Groupings for reporting the number of volunteers providing services during the data collection period(January 1 —December
31).If there are no activities during the year,enter zero.
Adult Day Care: Non-residential facility specializing in providing activities for elderly individuals or individuals with disabilities.
Operates ten to twelve(10—12)hours per day and provides meals,social or recreational outings,and general supervision.
Advisory Council/Board Membership: Group of experts and leaders in an industry who share knowledge, contacts, and leadership
skills to benefit an organization; comprised of people who have no material interests in the organization other than their directorship
and who are responsible for a fiduciary role within the organization.
AmeriCorps: Network of national service programs that engage members and community volunteers in intensive service to meet
needs in education,public health,and the environment.This service produces volunteers who will provide direct services to clients.
AmeriCorps Vista: VISTA members commit to serve full-time for a year at a nonprofit organization or local government agency,
working to fight illiteracy, improve health services, create businesses, strengthen community groups, and much more. This service
produces volunteers who will provide direct services to clients.
Clerical/Administration: Complex work tasks performed under direction in support of one or more persons serving in an
administrative or professional capacity;completion of routine administrative tasks directly related to the work of supervisor(s).
Companionship Programs: Programs that help elders to help other elders with their daily lives. Tasks may include grocery
shopping,household chores,going out to lunch,or simply visiting the elders to keep them company.
i , I
t I
64 , , I
1606
January---December 2019 OAA 203.19
Congregate Meals: Meal service in a group setting to individuals who cannot prepare or obtain nutritionally
adequate meals themselves.Meals assist individuals to maintain a nutritious diet.
Consumer Education/Counseling: Enhances the capacity of mature consumers to navigate the increasingly
complex marketplace. Consumer education programs provide significant benefits, including identification of
market information, compliant and consumer redress procedures, and understanding of a technology-based
consumer environment.
Disaster Preparation/Recovery: Services provided in coordination with American Red Cross,FEMA, and
local task forces in response or in preparation of a disaster.
Education: Community outreach program of an academic institution that offers educational and cultural programs
specifically designed to foster and support lifelong learning.
Foster Grandparents: Provides a way for volunteers age 55 and older to stay active by serving children and
youth in their communities,through tutoring and mentoring.
Fundraising:Any service directly related to the solicitation of contributions for a committee,program,or organization.
Health Promotion: Programs specifically for older adults in the areas of health education, physical activity,
coordinated screening,and mental health.
Home Delivered Meals: Meal service delivered to the homes to individuals who cannot prepare or obtain
nutritionally adequate meals for themselves.Meals assist individuals to maintain a nutritious diet.
Homemaker Programs: Programs provide in-home services to elders at-risk of premature placement in a
nursing home. Clients must be 60 years of age or older.
Home Repair:Home improvement,remodeling,or handyman work,including small odd jobs,and routine tasks.
Information and Referral: One-to-one services directing elders to appropriate programs and resources based
on elders'needs and specialized knowledge of aging services within the community.
Intergenerational: Activities or programs that increase cooperation, interaction, or exchange between any two or more
generations.
Legal Assistance: Legal services to elders age 60 and older that deal with issues such as property taxes,
mobile home, and other landlord tenant issues, advance directives, Medicaid eligibility, Social Security
denial,and state and local welfare benefit denials.
RSVP: Retired Senior Volunteer Program includes a network for individuals age 55 and older who use their
skills and talents in volunteer activities such as home repairs,tutoring and mentoring,and assisting victims of
natural disasters.
Recreation: Programs for older adults including health education, physical activity, and coordinated
screening for physical and mental health.
RELIEF: Respite for Elders Living in Everyday Families offers respite services to caregivers of frail elders and
those with Alzheimer's disease and related dementia.
Respite:Service that provides a temporary break for a family member from daily caregiving responsibilities.
Senior Companions:Volunteers provide services to elders at risk of institutionalization due to chronic illness,
disability,or isolation.Services may include transportation to medical appointments,shopping assistance,meal
preparation,companionship,and advocacy,as well as respite for caregivers.
Senior Fraud Abuse Prevention Programs: Safety education and prevention strategies for elder abuse,
Medicare fraud and abuse,and identity theft,and programs on home safety.
SHINE: Serving Health Insurance Needs of Elders provides educational materials and free,unbiased
insurance counseling to Florida elders,caregivers,and family members.
Special Events:Time-limited events.
Speakers' Bureau:Service that provides the right professional speaker for every type of event.
Telephone Reassurance: Scheduled telephone calls to check on homebound elders, which may include a
friendly visit from law enforcement or volunteers.
Transportation: Service provided for older adults and individuals with disabilities including lift-equipped
vehicles for wheelchair transport and medical transportation for appointments,dialysis,and chemotherapy.
•
65
1606
January—December 2019 OAA 203.19
„„
Area Agency on Aging
FOR SOUTHWEST FLORIDA
ATTACHMENT XVII
2019 Annual Volunteer Report
1st 2nd 3rd 4th
Category
Quarter Quarter Quarter Quarter
Number of unduplicated direct service volunteers
Number of unduplicated indirect service volunteers
Number of episodic volunteers engaged this quarter
Total number of direct volunteer hours served
Total number of indirect volunteer hours served
Total number of episodic volunteer hours served
Number of clients served by volunteers
Number of volunteers 60 or older
Adult Daycare
A non-residential facility specializing in providing activities for
elderly and/or handicapped individuals. Operate 10 - 12
hours per day and provide meals,social/recreational outings,
and general supervision.
Advisory Council/Board Membership
A group of assorted experts and leaders in a particular
industry that share knowledge, contacts, and leadership skills
for the betterment of a growing organization. Is comprised of
people who have no material interests in the organization
other than their directorship and are responsible for fiduciary
role within the organization.
AmeriCorps
A network of national service programs that engage
members and community volunteers in intensive service to
meet critical needs in education, public health, and the
AmeriCorps Vista
VISTA members commit to serve full-time for a year at a
nonprofit organization or local government agency, working
to fight illiteracy, improve health services, create businesses,
strengthen community groups,and much more.
66
1606
January—December 2019 OAA 203.19
Clerical/Administration
Under direction, performs complex clerical and
administrative work tasks in support of one or more persons
serving in an administrative or professional capacity;
completes routine administrative tasks directly related to
the work of their supervisor(s); and performs other related
work as required.
Companionship Programs
A program, that helps senior citizens find persons to help
them with their daily lives. Tasks may include grocery
shopping, household chores, going out to lunch, or simply
visiting the senior's house orALF to keep them company.
Congregate Meals
An individually designed service which provides meals to
waiver participants who cannot prepare or obtain
nutritionally adequate meals for themselves, or when the
provision of such meals will decrease the need for more costly
supports to provide in-home meal preparation. These meals
will assist the waiver participant to maintain a nutritious diet.
ConsumerEducation/Counseling
Highlights the role of consumer education in enhancing the
capacity of mature consumers to navigate the increasingly
complex marketplace. Consumer education programs can
provide significant benefits, including identification of
market information, complaint and consumer redress
procedures, and understanding a more technology-based
consumer environment.
Disaster Preparation/Recovery
Services in coordination with American Red Cross, FEMA,
& local task forces, in response or in preparation of a
disaster.
Education
A community outreach program of an academic institution
that offers educational and cultural programs specifically
designed to foster and support lifelong learning.
67
1606
January—December 2019 OAA 203.19
Fundraising
Performs any service directly related to the solicitation
of contributions for a committee, program or
organization.
Health Promotion
Programs specifically for older adults in the areas of health
education, physical activity, coordinated screening and
mental health.
Home Delivered Meals
(e.g. Meals on Wheels); an individually designed service
which provides meals to waiver participants who cannot
prepare or obtain nutritionally adequate meals for
themselves, or when the provision of such meals will
decrease the need for more costly supports to provide in-
home meal preparation.
Homemaker Programs
The program provides in-home services to senior citizens.
Services are available to eligible clients who are at-risk of
premature placement in a nursing home due to a
medical, emotional or psychological impairment. Clients
of the homemaker program must be 60 years of age or
older and homebound.
Home Repair
Home improvement,remolding or handyman work.Small
or odd jobs;and routine tasks.
Information&Referral
Provides in-depth information and referral services
directing seniors to appropriate programs and resources
based on specialized knowledge of aging services and
seniors'needs within their community.
Intergenerational
Activities or programs that increase cooperation, interaction
or exchange between any two or more generations.
68
1606
January—December 2019 OAA 203.19
Legal Assistance
Offers free civil legal services to senior citizens age 60 and older
with no income eligibility requirements. The issues that are
dealt with may include: property tax problems, mobile home
and other landlord tenant issues, advance directives and
Medicaid eligibility, help with social security denial, and help
with state and local welfare benefit denials.
Recreation
Programs specifically for older adults in the areas of health
education,physical activity, coordinated screening and mental
health.
RELIEF
Respite for Elders Living in Everyday Families- Offers respite
services to caregivers of frail elders and those with Alzheimer's
disease and related dementia,
Respite
Provides a temporary break for a family member from daily
care-giving responsibilities.
Senior Companion
Volunteers provide services to elders at risk of
institutionalization due to chronic illness, disability or isolation.
Services include such things as transportation to medical
appointments, shopping assistance, meal preparation,
companionship and advocacy,as well as respite for caregivers.
Senior Prevention/Fraud/Abuse Programs
Elder abuse prevention, Medicare fraud and abuse, identity
theft, safety education and prevention strategies including
programs on home safety etc.
SHINE
Provides educational materials and free, unbiased insurance
counseling to Florida elders,caregivers and family members.
69
1606
January—December 2019 OAA 203.19
Special Events/Time Limited
Speaker's Bureau(list topics below)
A service that provides the right professional speaker for every
type of event.
Telephone Reassurance
Scheduled telephone calls to check on homebound seniors who
may include a friendly visit via law enforcement or volunteers.
Transportation
Programs specifically for older adults in the areas of public
transportation and specialized transportation for disabled
individuals may include lift-equipped vehicles for wheelchair
transport and medical transportation for appointments,
dialysis,and chemotherapy.
70
1606
DEPARTMENT OI
BACKGROUND SCREENING
ELDER •
AFFAIRS Affidavit of Compliance - Employer
STATE OF FLORIDA
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435,05(3), Florida Statutes.
> The term "employer" means any person or entity required by law to conduct background screening,
including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability
Resource Centers, Lead Agencies, Long-Term Care Ombudsman Program, Serving Health Insurance Needs
of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires
employees or has volunteers in service who meet the definition of a direct service provider. See §§
435.02,430.0402, Fla.Stat.
> A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide
services to the elderly, has direct,face-to-face contact with a client while providing services to the client
and has access to the client's living area, funds, personal property, or personal identification information
as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential
facilities;and volunteers," §430.0402(1)(b), Fla.Stat.
ATTESTATION:
As the duly authorized representative of Collier County Board of County Commissioners
Employer Name
located at 3339 Tamiami Trail E#211 Naples FL 34112 ,
Street Address City State ZIP code
I, Stephen Y Carnell do hereby affirm under penalty of perjury
Name of Representative
that the above named employer is in compliance with the provisions of Chapter 435 and section
430.0402, Florida Statutes,regarding level 2 background screening.
Signature of Reative
Date
I
STATE OF FLORIDA, COUNTY OF CG i 1 e •
�r
Sworn to (or affirmed) and subscribed before me this I ,4h day of LkU , 20 ICj' , by
K4v'N� c 'k (Name of Representative)who i personally known
to me or produced as proof of identification.
frs' Notary Public State of Florida
Wendy Ktopf i, .11110 _
aa • my Commission FF 968391
Fri ,Tj atarlfplfianiyiissigimatiameofNot. Public Notary Public
Approve• is to form a 11 Itity
DOEA Form 235,Affidavit of Compliance-Employer,Effective April2012 e,tion 435{ F.•
Form available at:http://elderaffairs.state.fl.us/english/backgroundscreening.phpA t1rr ant County Attornllb
l,`� Y
1 6D6
VERIFICATION OF EMERGENCY PREPAREDNESS PLAN
Contract#203.19
I, Stephen Y Carnell certify that Collier County Board of CountyCommissioners
(Name of authorized contractor representative) (Name of contracto
has a current and properly maintained Emergency Preparedness Plan. Assurance is given that
the pian will be made available to the Department of Elder Affairs(DOEA) upon request.
Signature of authorized contractor representative
Public Service Department Head
Title
I I ) �I
Date
Approved as to form and legality
Wit ,
DOEA Contract Manager's Review ASEtt8 t,'!1!COtattly Atu'b 015
October 2008
•
C)
1606
Revised August 2007
Attestation Statement
Agreement/Contract Number 203.19
Amendment Number NA
1,Stephen Y Carnell ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
Collier County Board of County 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.
C*Xj—iatk I I 11 ilei
g
Si nature of Recipient/Contractor representative
p Datd
Approved as to form and legality
Assistant County A(Lucy
Revised August 2007