Backup Documents 05/28/2019 Item #16D6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 0 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human *K, 05.28.19
Services
2. County Attorney Office County Attorney Office
O. S j 3 t'N
3. BCC Office Board of County
Commissioners .c-,5A/ \yq
4. Minutes and Records Clerk of Court's Office
k)6. GAbD It
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klop CHS Phone Number 252-2901
Contact/ Department
Agenda Date Item was 05.28.19 Agenda Item Number 16D6
Approved by the BCC
Type of Document MOU ALPI Number of Original 3
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? Q K
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the WK
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's WK
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 05.28.19 and all changes made during WK
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the WK
BCC,all changes directed by the BCC have been made,and the document is ready for the (�
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1606
MEMORANDUM
Date: May 31, 2019
To: Wendy Klopf, Grant Coordinator
Community & Human Services
From: Ann Jennejohn, Sr. Deputy Clerk
Minutes & Records Department
Re: Memorandum of Understanding between Collier County
and Agricultural and Labor Program, Inc.,
Attached you will find two original copies of the document referenced above,
(Item #16D6) approved by the Board of County Commissioners May 28, 2019.
The Board's Minutes and Records Department has held the third original memorandum
for the records of the Collier County Board of County Commissioners.
If you have any questions or if I can be of further assistance, please feel free to
contact me at 252-8406.
Thank you.
Attachment (2)
1606
MEMORANDUM OF UNDERSTANDING
Low Income Home Energy Assistance Program
The purpose of this Agreement is to document the mutually beneficial relationship between the Emergency Home
Energy Assistance Program (EHEAP) provider, Collier County Board of County Commissioners
(LIHEAP/EHEAP) provider for Collier County,and the Agricultural and Labor Program,Inc.
This Agreement is designed to encourage coordination efforts on behalf of consumers who are eligible for EHEAP
or LIHEAP assistance. This Agreement starts on October 1,2018 through September 30,2023 or will be updated
if one of the above contracted parties change. All parties agree to the following terms and conditions:
1. Develop a positive relationship that encourages coordination and focuses on providing needed services to
consumers in county in which they were residing at the time the home energy costs were incurred.
2. Coordinate services to prevent the duplication of benefits to consumers.
3. Make efforts to increase the quality of services provided to elderly participants.
4. Make referrals as necessary between agencies to ensure that crisis assistance is provided to consumers
with the highest home energy needs and the lowest household income where there are insufficient funds.
When funds are not available or are insufficient to meet the emergency home energy needs of a consumer,
each agency agrees to accept an application for crisis benefits from consumers who may have initiated
services with the other agency. The application must be properly completed. The consumer will provide
all required eligibility documents.
5. Share information concerning training and staff development conducted on a local,state and national level.
6. Invite each other to participate on planning meetings designed to enhance the delivery of services to
consumers facing home energy crisis situations.
7. Plan and coordinate advertising, or hosting of events, when possible, that will make the community,
especially low-income rural areas, aware of the availability of funds.
8. Coordinate services between programs for potential consumers living in the service area, between the
Department of Community Affairs' Weatherization Assistance Program,LIHEAP&EHEAP.
9. Implement a plan that permits an immediate response on requests for verification that a household has not
received EHEAP or LI HEAP crisis benefits.
I hereby agree to the terms described above and will work to ensure that all involved staff members understand
and comply with these conditions:
I hereby agree to comply with the above regulations:
1606
RECIPIENT VENDOR
COLLIER COUNTY BOARD OF AGRICULTURAL AND LABOR
COUNTY COMMISSIONERS PROGRAM,INC.
3299 Tamiami Trail E 300 Lynchburg Rd
Naples FL34112 Lake Alfred, FL 33850
Federal ID Number: 59-6000558 Federal ID Number:59-1634148
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA
CRYSTAL K::&WEL, CLERK -
By: I2111)1
__
b ` O 'e-- ' WIL �AM L. M ` EL,JR, !AIRMAN
�.. `# 14•.9EP a ,C�gLERK Mr
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Date: NAy 2-4i ; Zv‘CI
Dated: M -3 ( 1 '2019 By: it 1
AR ENE DOBISON/CEO
(SEAL) MUM
Date: MUM 1. 2.0 t I
Approved as to form and legality:
(N-e.o
By: ------
•
Jennifer A. Belpedio + •I ,�p`_.
Assistant County Attorney A`
Date: 1'YLLs i Zo iq
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