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Backup Documents 09/29/2009 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING st6 D 5 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original documents are to be forwarded to the Board Office only after the Board has taken action on the item.) ROUTING SLIP Complete routing lines # I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the exce tion of the Chairman's si ature, draw a line throu h routin lines # I throua #4, com lete the checklist, and fi)rward to Sue Filson line #5 . Route to Addressee(s) Initials Date (List in routin order 1. Terri Daniels Housing and Human Services 11/2/09 2. Donna Fiala, Chairman Board of County Commissioners PRIMARY CONTACT INFORMATION (The primary contact is the holder of the original document pending BeC approval. Normally the primary contact is the person'who created/prepared the executive summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing information. All original documents needing the BCe Chairman's signature arc to be delivered to the Bee office only after the BCe has acted to approve the 3. 4. 5. Ian Mitchell, Executive Manager Board of County Commissioners 6. Minutes and Records Clerk of Court's Office item.) Name of Primary Staff Terri Daniels Phone Number 252-2689 Contact Agenda Date Item was September 29,2009 Agenda Item Number 16D5 Approved by the BCC Type of Document Amendments to State Agreements Number of Original 1<! . '~), Attached Documents Attached ' .J 1. INSTRUCTIONS & CHECKLIST Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is a ro riate. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman, with the exception of most letters, must be reviewed and signed by the Office of the County Attorney. This includes signature pages from ordinances, resolutions, etc. signed by the County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully executed by all parties except the BCC Chairman and Clerk to the Board and ossibl' State Officials. All handwritten strike-through and revisions have been initialed by the County Attorney's Office and all other arties exce t the BCC Chairman and the Clerk to the Board The Chairman's signature line date has been entered as the date ofBCe approval of the document or the final ne otiated contract date whichever is a Iicable. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's si ature and initials are re uired. In most cases (some contracts are an exception), the original document and this routing slip should be provided to Sue Filson in the Bee office within 24 hours of BCe approvaL Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCe's actions are nullified. Be aware of our deadlines! The document was approved by the BeC on 9/29/09 (enter date) and all changes made during the meeting have been incorporated in the attached document. The Count Attorne 's Office has reviewed the chan es, if a Iicable. Yes (Initial 2. 3. 4. 5. 6. I~ \../ I: Forms/ County Forms/ BCC Forms! Original Documents Routing Slip WWS Onginal 9.03.04, Revised 1.26.05. Revised 2.24.05 MEMORANDUM Date: November 4, 2009 To: Terri Daniels, Grants Supervisor Human Services Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Amendment to Agreement #CCE 203.09 with the Area Agency on Aging for state funded grant programs Attached are your three (3) original amendment documents, referenced above (Agenda Item #16D5), approved by the Board of County Commissioners on Tuesday, September 29, 2009. After further processing we request that an original be returned to our office for the Board's Official Records. If you should have any questions, please call 252-8406. Thank you. Attachments (3) 1605 16D5 Amendment #001 Contract CCE 203.09 STANDARD CONTRACT AREA AGENCY ON AGING Collier County Board of Commissioners This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc., hereinafter referred to as the "agency", and Collier County Board of Commissioners. hereinafter referred to as the "recipient", amends agreement #CCE 203.09. The purpose of this amendment is to; (1) amend paragraph 3.2.4 of Attachment I; and (2) revise and replace Attachment IX, Invoice Schedule. 1. Paragraph 3.2.4 of Attachment I, is hereby amended to read: 3.2.4 All advance payment made to the recipient shall be returned to the Agency by the submission date of report #12 in accordance with the Invoice Schedule, as shown on Attachment IX to this contract. 2. Attachment IX, Invoice Schedule is hereby replaced with the revised Attachment IX, Invoice Schedule and attached hereto. All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the agreement. This amendment and all of its attachments are hereby made a part of this agreement. IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there unto duly authorized. COLLIER COUNTY HOUSING AND HUMAN SERVICES BY: ,\0 c ' (1'.: , \.. " ..,. (, ATTEST;~"". ",. ". .,' DWIGI;a' E,,~~9f:~~Cl~t:~ ::; j' ......~.: '1~1' ,'".~.. . BOARD OF q;JVNTY COMMISSIONERS COLLIER c6u.NTY, FLORIDA ' I ! By: ?.De Attett~., . .t...tW4~.I.i \ Approved as to form and legal sufficiency 0~~ Assistant County Attorney " 'f, " , t(.~., By: DONNA FIALA, CHAIRMAN Date: September 29, 2009 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA By: NAOMI MANNING, BOARD PRESIDENT FEDERAL ID NUMBER: 59-60000558 FISCAL YEAR-END DATE: 9/30 Date: September 29, 2009 1 1605 Amendment #001 Contract CCE 203.09 ATTACHMENT IX COMMUNITY CARE FOR THE ELDERLY (CCE) INVOICE SCHEDULE Report Submit to AAA Number Based On On this Date 1 July Advance* July 1 2 August Advance* July 1 3 July Expenditure August 10 4 August Expenditure September 10 5 September Expenditure October 10 6 October Expenditure November 10 7 November Expenditure December 10 8 December Expenditure January 10 9 January Expenditure February 10 10 February Expenditure March 10 11 March Expenditure April 10 12 April Expenditure May 10 13 May Expenditure June 10 14 June Expenditure July 10 15 Final Expenditure and Closeout Report July 25 Legend: * Advance based on projected cash need. Note #1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging prior to July 1 or until the contract with the agency has been executed and a copy sent to DFS. Actual submission of the vouchers to AAA is dependent on the accuracy of the expenditure report. All advance payments made to the recipient shall be returned to the Agency by the submission date of report #12. The adjustment shall be recorded in Part C, 1 of the report (Attachment X) Submission of expenditure reports mayor may not generate a payment request. If final expenditure report reflects funds due back to the Agency, payment is to accompany the report. Note #2: Note #3: Revised August 2009 - Form 1 2 1605 Attestation Statement Agreement/Contract Number CCE 203.09 Amendment Number 0 I I, Donna Fiala. Chairman (Recipien t/Con tractor/ representative) , attest that no changes or revisions have been made to the content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida, Inc. and Collier County Board of Commissioners (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data prqcessing media, which has no affect on the agreement/contract content. I Ii , I ' ~ / ,/ . .(.,,....~.".., ~ ~" r ~ ,f ../1- / J~, /,' " ,,' Signature of Recipient/Contractor representative September 29. 2009 Date DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready for DOEA Secretary/designee signature. initial date Approved as to form and legal suffi~iency " [~!JfPJL- Ass~., J.rf.'~-vf.m~ A~b,rney ! ::'~.:'.:' .::; ~.~, \T~''''''P: (.,,:. "'\1 1[:;:)L'. ",#,' - DWIGH~~..a~QOtsi. Ci~~ ~'< .' 8, Attnt' .~ . <- '19ft~tW't OIl, if Item # .\l.t b'5 ~~~;da g1f1~ Date I \,. "'~ Rec'd ..ll.....L..U' J kS Deputy Clerk '''~''-'''--_._,...",_.......--"..~,.,.."..._-"..., July 2009 Report Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Legend: * 16D5 CCE 203.09 ATTACHMENT IX COMMUNITY CARE FOR THE ELDERLY INVOICE SCHEDULE Based On July Advance. August Advance. July Expenditure August Expenditure September Expenditure October Expenditure November Expenditure December Expenditure January Expenditure February Expenditure March Expenditure April Expenditure May Expenditure June Expenditure Final Expenditure and Closeout Report Submit to AM On This QatEl July 1 July 1 August 10 September 10 October 10 November 10 December 10 January 10 February 10 March 10 April 10 May 10 June 10 July 10 July 25 Advance based on projected cash need. Note #1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging prior to July 1 or until the contract with the department has been executed and a copy sent to DFS. Actual submission ofthe vouchers to AM is dependent on the accuracy of the expenditure report. Note #2: Report numbers 13 and 14 shall reflect an adjustment of one half of the total advance amount, on each of the two reports respectively, repaying advances for the first two months of the contract. The adjustment shall be recorded in Part C, 1 of the report (Attachment X). Note #3: Submission of expenditure reports mayor may not generate a payment request. Ifflnal expenditure report reflects funds due back to the department, payment is to accompany the report. 39 16D5 MEMORANDUM Date: November 4, 2009 To: Terri Daniels, Grants Supervisor Human Services Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Amendment to Agreement #HCE 203.09 with the Area Agency on Aging for state funded grant programs Attached are your three (3) original amendment documents, referenced above (Agenda Item #16D5), approved by the Board of County Commissioners on Tuesday, September 29, 2009. After further processing we request that an original be returned to our office for the Board's Official Records. If you should have any questions, please call 252-8406. Thank you. Attachments (3) "-'<"'---"-"""~--'-'--'--'-_~__"~'_r '" Amendment #00 I Contract HCE 203.09 16D5 STANDARD CONTRACT AREA AGENCY ON AGING Collier County Board ofComm;ss;oners This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc., hereinafter referred to as the "agency", and C~~er ~o~ntv Board of Commissioners. hereinafter referred to as the "recipient", amends agreement #It' 20 .0 . The purpose of this amendment is to; (1) amend paragraph 3.2.4 of Attachment I; and (2) revise and replace Attachment VII, Invoice Schedule. 1. Paragraph 3.2.4 of Attachment I, is hereby amended to read: 3.2.4 All advance payment made to the recipient shall be returned to the Agency by the submission date of report #12 in accordance with the Invoice Schedule, as shown on Attachment VII to this contract. 2. Attachment VII, Invoice Schedule is hereby replaced with the revised Attachment VII, Invoice Schedule and attached hereto. All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the agreement. This amendment and all of its attachments are hereby made a part of this agreement. IN WIlNESS WHEREOF, the parties hereto have caused this ~ page amendment to be executed by their officials there ooto duly authorized. > ,. l~' 1 +TjsT: ,~,~~ 0'", 1:>wto't~ ['Bl{b~~lr~ '. ..... . .,."') . A . gly: - ,~., . "/",,, ", "I~ .:.,f '..}t t. COLLIER COUNTY HOUSING AND HUMAN SERVICES BY: BOARD O~. NTY COMM~SS ONERS COLLIER C TY, FLORIDA 0' B' ~~& Y,-- - DONNA FIALA, CHAIRMAN Date: September 29. 2009 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA By: - NAOMI MANNING, BOARD PRESIDENT Date: September 29.2009 FEDERAL ID NUMBER: 59-60000558 FISCAL YEAR-END DATE: 9/30 Amendment #00 I Report Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Legend: * Note #1: Note #2: Note #3: Revised August 2009 Contract HCE 203.09 16 D 5 A TT ACHMENT VIII HOME CARE FOR THE ELDERLY INVOICE SCHEDULE Based On July Advance* August Advance'" July Expenditure August Expenditure September Expenditure October Expenditure November Expenditure December Expenditure January Expenditure February Expenditure March Expenditure April Expenditure May Expenditure June Expenditure Final Expenditure and Closeout Report Submit to Agency On This Date July 1 July 1 August 20 September 20 October 20 November 20 December 20 January 20 February 20 March 20 April 20 May 20 June 20 July 20 July 25 Advance based on projected cash need. Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging prior to July 1 or until the agreement with the agency has been executed and a copy sent to agency. Actual submission of the vouchers to the agency is dependent on the accuracy of the expenditure report. All advance payments made to the recipient shall be returned to the agency by the submission date of report #12. The adjustment shall be recorded in Part C, 1, of the report (Attachment IX). Submission of expenditure reports mayor may not generate a payment request. If final expenditure report reflects funds due back to the agency, payment is to accompany the report. 2 16D5 Agreement/Contract Number HCE 203.09 Amendment Number 01 I, Donna Fiala. Chairman (Recipient/Contractor/representative) , attest that no changes or revisions have been made to the content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida, Inc. and CoUier County Board of Commissioners __ __' (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in g media, which has no affect on the agreement contract content. .d~ September 29. 2009 Date Signature of Recipient/Contractor representative DOEA Contract Mantlger to initial and date indicating signatures/initials appropriate on all documents; ready for DOEA Secretary/designee signature. mitial date Approved as to form and legal sufficiency -C11~~ Assistant County Attorney . ,'\ \"101 ATTEST: :\' DWIO't~~:.-. By: Item # \ li \)S' Agenda fl....Jt1...M Date ~l Date ll, ?.-.Aa Rec'd LJJ.. , ttr Deputy Clerk f' tI' . ~~~ ~ l", .. . ~ .~. "':ti1 w eM '"- . . ,"IDr ~t....);. . 16D5 MEMORANDUM Date: November 4,2009 To: Terri Daniels, Grants Supervisor Human Services Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Amendment to Agreement #ADI 203.09 with the Area Agency on Aging for state funded grant programs Attached are your three (3) original amendment documents, referenced above (Agenda Item #16D5), approved by the Board of County Commissioners on Tuesday, September 29, 2009. After further processing we request that an original be returned to our office for the Board's Official Records. If you should have any questions, please call 252-8406. Thank you. Attachments (3) """'--_.._-".~-_._---- 16D5 Amendment #001 Contract AD! 203.09 STANDARD CONTRACT AREA AGENCY ON AGING Collier County Board of Commissioners This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida, Inc., hereinafter referred to as the "agency", and Collier County Board of Commissioners. hereinafter referred to as the "recipient", amends agreement #ADI 203.09. The purpose of this amendment is to; (1) amend paragraph 3.2.4 of Attachment I; and (2) revise and replace Attachment VII, Invoice Schedule. 1. Paragraph 3.2.4 of Attachment I, is hereby amended to read: 3.2.4 All advance payment made to the recipient shall be returned to the Agency by the submission date ofreport #12 in accordance with the Invoice Schedule, as shown on Attachment VII to this contract. 2. Attachment VII, Invoice Schedule is hereby replaced with the revised Attachment VII, Invoice Schedule and attached hereto. All provisions in the agreement and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the agreement. This amendment and all of its attachments are hereby made a part of this agreement. IN WITNESS WHEREOF, the parties hereto have caused this 2. page amendment to be executed by their officials there unto duly authorized. COLLIER COUNTY HOUSING AND HUMAN SERVICES BY: ATTEST:"'F DW~~,~ E'.,~~, Clerk . " .") " BYffu.u.::R~:'<'~' (. ~'lif' ,,1, ' ',f ,,'+~\', .' " " , 01'. ~ (lift. II,} Apprciyed as ta.f9rJh'and legal sufrid~rtdy , C-~~ Assistant County Attorney BOARD OF C~o/NTY COMMISSIONERS COLLIER Ce> TY, FLORIDA / J f, I I \ .., ~ " By:'l'('>'''}''~('' ," . DONNA FIALA, CHAIRMAN Date: September 29, 2009 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA By: NAOMI MANNING, BOARD PRESIDENT FEDERAL ID NUMBER: 59-60000558 FISCAL YEAR-END DATE: 9/30 Date: September 29. 2009 16D ~ Amendment #00 I Contract AD! 203.09 ATTACHMENT VI] ALZHEIMER'S DISEASE INITIATIVE (ADI) INVOICE SCHEDULE Report Submit to AAA Number Based On On this Date 1 July Advance* July 1 2 August Advance* July 1 3 July Expenditure August 10 4 August Expenditure September 10 5 September Expenditure October 10 6 October Expenditure November 10 7 November Expenditure December 10 8 December Expenditure January 10 9 January Expenditure February 10 10 February Expenditure March 10 11 March Expenditure April 10 12 April Expenditure May 10 13 May Expenditure June 10 14 June Expenditure July 10 15 Final Expenditure and Closeout Report July 25 Legend: * Advance based on projected cash need. Note #1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging prior to July 1 or until the contract with the agency has been executed and a copy sent to DFS. Actual submission of the vouchers to AAA is dependent on the accuracy of the expenditure report. All advance payments made to the recipient shall be returned to the Agency by the submission date of report #12. The adjustment shall be recorded in Part C, 1 of the report (Attachment XI) Submission of expenditure reports mayor may not generate a payment request. If final expenditure report reflects funds due back to the Agency, payment is to accompany the report. Note #2: Note #3: Revised August 2009 - Form 1 2 16D5 Attestation Statement Agreement/Contract Number ADI 203.09 Amendment Number 01 I, Donna Fiala. Chairman (Recipien t/Con tractor/ representative) , attest that no changes or revisions have been made to the content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida, lnc, and Collier County Board of Commissioners (Recipient/Contractor name) The only exception to this statement would be for changes in page formatting, due to the differences in electronic data processin~ media, which has no affect on the agreement/contract content. / I J ( L;.I ~ , 'j /\ 1 ,t-", r ' '.~ ( Signature of Recipierit/Contractor representative September 29.2009 Date DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all documents; ready for DOEA Secretary/designee signature, initial date Approved as to form and legal sufficiency ~em# 1lt'b Agenda tr- ~tt-oq Date - (~i0J- Assistant County Attorney . .'~' ~,~:'! \ t'.21l1 K oep'~ii),-t\er\<. . :~".t~1J ~!.r, ~<\\ " ..' . .. . ~ l' p.' ATTEST~ (",',," ~.~.~~~~ ' ~<;..' OWIGHTEl BROCK;CIeik' ey;CtLJ ~,,'6r - ~n ol' ", .', , ..;\ ......,........- 'A'.'... . ': .........