Backup Documents 09/10/2019 Item #16D 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 3
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 Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf CHS WK 09.10.19
2. Minutes and Records Clerk of Court's Office fio($j
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 Klopf Phone Number 239.252.2901
Contact/ Department
Agenda Date Item was September 10,2019 Agenda Item Number 16D3
Approved by the BCC
Type of Document OAA Amendment 203.19.003 & .004 Number of Original 2 originals
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? NA
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 •
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 NA
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 NA
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 09/10/19 and all changes made 7./ -"' N/A is not
during the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the 7/j /' N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
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
16D3
Amendment .003 OAA 203.19.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT TITLE III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of County Commissioners. ("Contractor"), amends agreement OAA 203.19.
The purpose of this amendment is to amend Contract Amount,Collier County: increase allocations for OA3C1 by
$48,816.86;for 0A3C2 by$12,687.75;for OA3E and OA3ES by$32,186.17; and forNSIP decrease allocations by$525.69;
and revise ATTACHMENT II-EXHIBIT 2-Funding Summary and revise ATTACHMENT IX BUDGET AND RATE
SUMMARY.
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$1,328,364.09 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.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to 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
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF,the Parties hereto have caused this amendment,to be executed by their undersigned officials as
duly authorized; and agree to abide by the terms, conditions and provisions of this OAA contract as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY CO kS IS IONERS SOUTHWEST FLORIDA,INC.
SIGNED BY: • ' `77./ SIGNED BY:
NAME: STEPHEN Y CARNELL NAME: MARIANNE G LORINI
TITLE:PUBLIC SERVICE DEPARTMENT HEAD TITLE: PRESIDENT/CEO
DATE: b/ 09 DATE: ?//// 9
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 12/31 Approved as to tornm and legality
ALJ e
1 Assistant County Aft y \\c
1b03
Amendment .003 OAA 203.19.003
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2CFR§200331,asrevised,and Section 21597(5),Florida Statutes,require that the information about federal programs
and StateProjectsbelrovidedtotheRecipientand are stated inTheFinancial And Compliance Audit Attachment And Exhibit 1.
Financial And Compliance Audit Attachment,Exhibit 2-Funding Summary Provides Information Regarding theFunding Sources
Applicable to this contract,contained herein,isapredictioncfiimdingmurcesand 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 IIIB— $ 10,010.00
Transportation U.S. Health and Human Services 93.044 $ 380,753.00
Support Services $ 390,763.00
Total IIIB
OAA Title IIIC1 —Congregate Meals U.S. Health and Human Services 93.045 $ 387,933.86
Total IIIC1
OAA Title III C2—Home Delivered U.S.Health and Human Services 93.045 $ 310,477.75
Total IIIC2
Older Americans Act Title III E $ 115,704.02
Services (Title III E) 93.052
Supplement Services (Title III ES) U.S. Health and Human Services $ 70,603.15
Grandparent Services (Title III EG) $ 6,145.00
Total IIIE $ 192,452.17
NSIP U.S.Health and Human Services 93.053 $ 46,737.31
TOTAL FEDERAL AWARD $1,328,364.09
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 TO THE 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 ASSISTANCE
Section 215.97,F.S.,Chapter 69I-5,FL Admin Code,Reference Guide for State Expenditures,Other fiscal requirements set forth in
program laws,rules and regulations.
2
S
16133
Amendment .003 OAA 203.19.003
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 $ 387,933.86
3. Title III C2 Home Delivered Meals $ 310,477.75
4. Title III E Services $ 192,452.17
5. NSIP $ 46,737.31
TOTAL $ 1,328,364.09
3
0
16D3
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.19
Amendment Number .003
I,Stephen Y Camel ,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.
,111 eri C_PYO
Signature of Recipient/Contractor representative ate
Approved as to form and legality
Assts ant County Att C
� �
(1)-
Revised August 2007
16D3
Amendment .004 OAA 203.19.004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT TITLE III
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and
Collier County Board of County Commissioners. ("Contractor"), amends agreement OAA 203.19.
The purpose of this amendment is to move funding from OA3EG to OA3E. The total Contract Amount for Collier County
will remain the same. Funding allocations for OA3E will be increased by$2,000.00; and allocations for OA3EG will be
decreased by$2,000.00;revise ATTACHMENT II-EXHIBIT 2-Funding Summary; and ATTACHMENT IX BUDGET
AND RATE SUMMARY will not change.
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$1,328,364.09 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.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to 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
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF, the Parties hereto have caused this amendment,to be executed by their undersigned officials as
duly authorized; and agree to abide by the terms, conditions and provisions of this OAA contract as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY 0 ' MISSIONERS7 ' SOUTHWEST FLORIDA,INC.
BY: � s\ f'� O� G
SIGNED SIGNED BY: zt;d
NAME: CA
NAME: MARIANNE G LORINI
TITLE: ' f e� ( TITLE: PRESIDENT/CEO
DATE: (Q.-S-r
1KPI DATE:
7/3 4111
Federal Tax ID: 59-60005 88
Fiscal Year Ending Date: 12/31 •
Approved as to form and kgaltty
1 Assistant County At 'My , 0
0
1b03
Amendment .004 OAA 203.19.004
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title 2CFR§200331,asrevised,and Section 21597(5),Florida Statutes,require thattheinformation about federal programs
and StateProjects be Fovided to the Reci pient and are stated in TheFi nancial And Compliance Audit Attachment And Exhibit 1.
Financial And Compliance Audit Attachment, Exhibit 2-Funding Summary Provides Information Regarding the Funding Sources
Applicable to this contract,contained herein,is a prediction oflundings urcesand 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 IIIB — $ 10,010.00
Transportation U.S. Health and Human Services 93.044 $ 380,753.00
Support Services $ 390,763.00
Total MB
OAA Title IIIC1 —Congregate Meals U.S. Health and Human Services 93.045 $ 387,933.86
Total IIIC1
OAA Title III C2—Home Delivered U.S. Health and Human Services 93.045 $ 310,477.75
Total IIIC2
Older Americans Act Title III E $ 117,704.02
Services (Title III E) 93.052 70,603.15
Supplement Services(Title III ES) U.S. Health and Human Services $
Grandparent Services (Title III EG) $ 4,145.00
Total HIE $ 192,452.17
NSIP U.S. Health and Human Services 93.053 $ 46,737.31
TOTAL FEDERAL AWARD $1,328,364.09
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 TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
$TATE FINANCIAL ASSISTANCE
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.
2
CAO
1603
Amendment .004 OAA 203.19.004
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 $ 387,933.86
3. Title III C2 Home Delivered Meals $ 310,477.75
4. Title III E Services $ 192,452.17
5. NSIP $ 46,737.31
TOTAL $ 1,328,364.09
3
Revised August 2007 16 D 3
Attestation Statement
Agreement/Contract Number_OAA 203.19.
Amendment Number .004
I,Stephen Y Carrell ,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 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.
1' , 0-7(z.r/i
Signature o Recipient/Contractor representative
Date
\pproved as to form and legality
A. A A.
Assistant County Alt R ey
122_\‘°1
Revised August 2007