Backup Documents 05/26/2009 Item #16D 3
1603
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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 bl.: hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Offtce 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
exceotion of the Chairman's signature, draw a line through routin!! lines # I through #4, complete the checklist, and forward to Sue Filson (line #51.
Route to Addressee( s) Office Initials Date
(List in routing order)
1. Debbi Maxon Housing and Human Services ~ 5/26/09
2, Donna Fiala, Chairman Board of County Commissioners
3.
4.
5. Sue Filson, Executive Manager Board of County Commissioners
6. Minutes and Records Clerk of Court' s Office
PRIMARY CONT ACT INFORMATION
(The primary contact is the holder of the original document pending BCe approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needcd 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 Bee Chairman's signature arc to be delivered to the BCe ollice only after thc Bee has acted to approve the
item.)
Name of Primary Staff Debbi Maxon Phone Number 252-2695
Contact Case Manager I I
Agenda Date Item was May 26, 2009 Agenda Item Number 1'OU15--' 1f.J 03
Approved by the BCC
Type of Document CCE Contract Amendment N umber of Original 3
Attached Documents Attached
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 ofBCC approval of the
document or the final neaotiated contract date whichever is a licable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si 'nature 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 BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require fornrarding 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 BCC on 5/26/09 (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)
N/A (Not
A licable)
2.
3.
4.
5.
6.
~
~
I/n
~
n..
~
1: Forms! County Forms! BeC Forms! Original Documcnts Routing Slip WWS Original 9.03.04. Revised 1.2605. Revised 2.2405
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MEMORANDUM
Date:
May 29, 2009
To:
Debbie Maxon,
Human & Health Services
From:
Ann J ennej ohn, Deputy Clerk
Minutes and Records Department
Re:
Contract #CCE 203.08 Amendment between Collier
County and the Area Agency on Aging of Southwest
Florida, Inc., reflecting additional grant funding for the
Community Care for the Elderly (CCE) Program
Enclosed are three (3) original amendment documents, referenced above
(Agenda Item #16D3) approved by the Board of County Commissioners on
Tuesday, May 26, 2009.
After further processine: please forward a fullv executed orie:inal to the
Minutes and Records Department for the Board's Records.
If you should have any questions, you may contact me at 252-8406.
Thank you.
Enclosures (3)
1-b-B-3
Amendment #001
Contract CCE 203.08
STANDARD CONTRACT
AREA AGENCY ON AGING
Collier County Services for Seniors
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florid8., Inc.,
hereinafter referred to as the "agency", and Collier County Services for Seniors. hereinafter
referred to as the "recipient", amends agreement #CCE 203,08.
The purpose of this amendment is to;
I. adjust the contract amount by the following, effective April I 0, 2009:
A: increase the lead agency funds by $3,490.00
B: increase spending authority funds by $19,775.00, and
2. revise the Budget Summary, Attachment III.
All provisions in the agreement and any attachments thereto in conflict with this amendment
shall be and are hereby changed to confonn 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 ~ page amendment to be executed
by their officials there unto duly authorized.
ATTEST: (. "':'/"..
DWIGHT ,8:' BROCK; ct~~k
BY:=~'t
.t"I~. .t!\' .'
Approved as to form and
legal sufficiency:
r~~
Assistant County Attorney
COLLIER COUNTY HOUSING
AND HUMAN SERVICES
By:
BOARD OF UNTY CO~MI SIONERS
COLLIER TY, FLORID
~~
FIALA, CHAIRMAN
Date: May 26. 2009
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INe.
SIGNED BY:
NAME: John Koehler
TITLE: Immediate Past Board President
DATE: April 10. 2009
FEDERAL ID NUMBER: 59-6000558
FISCAL YEAR-END DATE 9/30
Amendment #00 I
Contract CCE 203.08
A TT ACHMENT III
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Servcies For Seniors
1. CCE Spending Authority
Lead Agency Services - CM,
CA, Intake
Lead Agency Operations
$459,044.00
2.
$113,000.00
3.
$100,949.00
Total
$672,993.00
2
1:trlt3
;J
16D 3
Attestation Statement
Agreement/Contract Number: CCE 203.08
Amendment Number: 001
I, Donna Fiala, Chairman, 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 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 d processing media, which has no affect on the agreement/contract content.
d-~
Ma 26 2009
Date
Signature of Recipient/Contractor representative
~m~~
Assistant County Attorney
:",. til
ATTEST:-.''- ." "". ',"-
DWIGHT BROCK, Clerk' ~
By:
Attall,. tot u
,t~ .,.,
L.
DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all
documents; ready for DOEA Secretary/designee signature
Initial date
Revised August 2007
fOIT3
Amendment #00 I
Contract CCE 203.08
STANDARD CONTRACT
AREA AGENCY ON AGING
Collier County Services for Seniors
This AMENDMENT, entered into by the Area Agency on Aging for Southwest Florida. Inc.,
hereinafter referred to as the "agency", and Collier County Services for Seniors. hereinafter
referred to as the "recipient", amends agreement #CCE 203.08.
The purpose of this amendment is to;
1. adjust the contract amount by the following, effective April 1 0, 2009:
A: increase the lead agency funds by $3,490.00
B: increase spending authority funds by $19,775.00, and
2. revise the Budget Summary, Attachment III.
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 ~ page amendment to be executed
by their officials there unto duly authorized.
ATTEST: .., . t."
DWIGl{T E:' B.R0Cl(, Clerk
By:
COLLIER COUNTY HOUSING
AND HUMAN SERVICES
By:
BOARD OE UNTY CO:lM SIONERS
COLLIER TY, FLORID _
By: ~. ~
DONNf\. FIALA, CHAIRMAN
Date: May 26,2009
Approved as to form and
legal sufficiency:
r~m~
Assistant County Adorney
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INe.
SIGNED B~~~r'"~
NAME: John Koehler
TITLE: Immediate Past Board President
DATE: April 10, 2009
FEDERAL ID NUMBER: 59-6000558
FISCAL YEAR-END DATE 9/30
1
_,_._..,..".,.__..,,~,._.,_,.,____ '._-"-'~"'''_W___''
toD3
Amendment #00 I
Contract CCE 203.08
A TT ACHMENT III
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Servcies For Seniors
1.
CCE Spending Authority
Lead Agency Services - CM,
CA, Intake
Lead Agency Operations
$459,044.00
2.
$113,000.00
3.
$100,949.00
Total
$672,993.00
2
Attestation Statement
Agreement/Contract Number: CCE 203.08
Amendment Number: ..Q!!!
I, Donna Fiala, Chairman, 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 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 d a processing media, which has no affect on the agreement/contract content.
f
d~.
Ma 26 2009
Date
Recipient/Contractor representative
1Jt~yVJ~
Assistant County Aftorney
A TTES1=
DWIGHT B~OCK, Clerk <
By: ~ 1J!:iJ: 0. ( .
At'-'~t n.. . . a . . .
.1~..,'.'
DOEA Contract Manager to initial and date indicating signatures/initials appropriate on all
documents; ready for DOE A Secretary/designee signature
Initial date
Revised August 2007
1603