Agenda 11/12/2019 Item #16D 4 (After-the-Fact Contract w/Agency on Aging for SW FL, Inc. for the Emergency Home Energy Assistance Program)11/12/2019
EXECUTIVE SUMMARY
Recommendation to approve an “after-the-fact” contract and an attestation statement with Area
Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy Assistance Program
and authorize a Budget Amendment to ensure continuous funding for FY19/20. (Net Fiscal Impact
$73,218.87)
OBJECTIVE: To provide home energy assistance aid to elders in the event of a home energy heating or
cooling emergency.
CONSIDERATIONS: The Community and Human Services (CHS) Division’s Services for Seniors
program has been providing support to Collier County’s frail and elderly citizens for over thirty (30) years
through various grant programs. Some of these grants are funded by the Florida Department of Elder
Affairs (DOEA) through the Area Agency on Aging of Southwest Florida, Inc. (Agency). These grant
fund services enable clients to remain in their homes and live with independence and dignity.
The Collier County Services for Seniors Program is responsible for responding to seniors’ needs and
managing the spending authority for the Federal and State Funded Services for Seniors Programs. Collier
County, as the Lead Agency, manages the spending authority for the Emergency Home Energy
Assistance Program (EHEAP). As the Lead Agency there is no provision for the County to not accept
these funds as this grant is part of the acceptance of the Agency’s Older American Act funds.
This Item is being presented “after-the-fact” because Collier County received the contract on September
30, 2019, from the grantor agency and is required to return it within thirty (30) days. This time frame
makes it impossible to process the document for the Board of County Commissioners (Board)
consideration. Pursuant to CMA# 5330 and Resolution No. 2018-202, the County Manager authorized the
Public Services Department Head to sign the agreement. This Agreement is being presented for Board
ratification.
The total grant award of $73,218.87 will be used to fund the program beginning October 1, 2019 and
ending September 30, 2020. EHEAP provides crisis assistance to eligible low-income households with at
least one individual aged sixty (60) or older experiencing a heating or cooling emergency. The program
allows for payments to utility companies; fuel suppliers; for the repair or replacement of existing heating
or cooling equipment; for the payment of deposits, late fees, and disconnect and reconnection fees with
Florida Power and Light (FPL) & Lee County Electric Cooperative (LCEC). Centro-Campesino
Farmworker Center, Inc. will provide additional Weatherization Services for clients who require
additional EHEAP assistance who have received more than three (3) benefits in the last eighteen (18)
months.
The following table provides a detailed breakdown of the award:
EHEAP BUDGET
EHEAP ADMINISTRATION $ 6,110.19
EHEAP OUTREACH BUDGET $10,295.01
EHEAP CRISIS ASSISTANCE $56,813.67
TOTAL $73,218.87
FISCAL IMPACT: Funding from the Department of Elder Affairs via the Area Agency on Aging in the
amount of $73,218.87 will reside in the Human Services Grant Fund (707), Project 33651.
16.D.4
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11/12/2019
GROWTH MANAGEMENT: There is no Growth Management impact from this recommendation.
LEGAL CONSIDERATIONS: This Item is approved for form and legality and requires a majority vote
for Board action. - JAB
RECOMMENDATIONS: To approve an after-the-fact contract and an attestation statement with Area
Agency on Aging for Southwest Florida, Inc. for the Emergency Home Energy Assistance Program and
authorize a Budget Amendment to ensure continuous funding for FY19/20. (Net Fiscal Impact
$73,218.87)
Prepared By: Wendy Klopf, Grant Coordinator, Community and Human Services Division
ATTACHMENT(S)
1. [Linked] EHEAP 203.19 Executed (PDF)
2. Resolution 2018-202 (PDF)
16.D.4
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11/12/2019
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.4
Doc ID: 10480
Item Summary: Recommendation to approve an “after-the-fact” contract and an attestation
statement with Area Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy
Assistance Program and authorize a Budget Amendment to ensure continuous funding for FY19/20. (Net
Fiscal Impact $73,218.87)
Meeting Date: 11/12/2019
Prepared by:
Title: Operations Coordinator – Community & Human Services
Name: Wendy Klopf
10/15/2019 8:54 AM
Submitted by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
10/15/2019 8:54 AM
Approved By:
Review:
Community & Human Services Kristi Sonntag CHS Review Completed 10/17/2019 12:10 PM
Community & Human Services Akiko Woods Additional Reviewer Completed 10/18/2019 11:29 AM
Community & Human Services Maggie Lopez Additional Reviewer Completed 10/22/2019 5:44 PM
Public Services Department Kimberley Grant Level 1 Reviewer Completed 10/23/2019 1:29 PM
Public Services Department Todd Henry Level 1 Division Reviewer Completed 10/23/2019 1:41 PM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 10/24/2019 2:27 PM
Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 10/24/2019 4:42 PM
Grants Erica Robinson Level 2 Grants Review Completed 10/25/2019 2:09 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 10/25/2019 2:38 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 10/28/2019 12:27 PM
Budget and Management Office Ed Finn Additional Reviewer Completed 10/29/2019 9:42 AM
Grants Therese Stanley Additional Reviewer Completed 11/01/2019 12:58 PM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 11/03/2019 10:10 PM
Board of County Commissioners MaryJo Brock Meeting Pending 11/12/2019 9:00 AM
16.D.4
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16.D.4.b
Packet Pg. 1514 Attachment: Resolution 2018-202 (10480 : EHEAP Contract 203.19)
16.D.4.b
Packet Pg. 1515 Attachment: Resolution 2018-202 (10480 : EHEAP Contract 203.19)
October 2019 — September 2020
EHEAP 203.19
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Joe. (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.
WITNF..SSETH THAT:
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 set -vices 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 set forth herein, 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) AM., Eastern Standard Time October 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 September 30, 2020.
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 $73,218.87 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)(g), 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
price, is set forth in the bid, proposal, or reply. No other costs for the renewal may be charged. Any
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October 2019 — September 2020 EHEAP 203.19
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 t 1738,
as amended, and where applicable Environmental Protection Agency regulations 2 CFR Part
1500, The Contractor shall report any violations of the above to the Agency.
6.13 Neither the Contractor nor any agent acting on behalf of the Contractor, may not use any
federal finds received in connection with this contract to influence legislation or
appropriations pending before 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 1I 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 Office of Management and Budget (OMB) guidelines at
2 CFR Part 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.
62 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.
63 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 revolted 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 of revocation.
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EHEAP 203.19
6.4 Tire Contractor shall comply with Title 2 CFR Pail 175 regarding Trafficking in Persons.
65 Unless exempt under 2 CFR Part 170.110(b), the Contractor shall comply with the reporting
requirements of the Transparency Act as expressed in 2 CPR 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 daring the contract term.
Contractors meeting the terms and conditions of the E -Verify System are deemed to be in
compliance with this provision.
7. Coin Ill ianccwithState 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
21597, 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.
73.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as
specified in ATTACHMENT I to be received and accepted by the Area Agency contract
manager prior to payment.
7.33 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,
73.4 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 112.06 1, 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, tetters, or other public
records as defined in Section 119.011(72), 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.
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October 2019 — September 2020 EHEAP 203.19
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 finds 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 ban Petroleum Energy Section List, the Scrutinized Companies
with Activities in Sudan .List, or the Scrutinized Companies that Boycott Israel list, or if the
contractor had been engaged in business operations in Cuba or Syria or is engaged in a boycott of
Israel.
8. Backeround Screening:
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 Sections 430.0402(2)-(3), F.S. The Contractor must also comply with any applicable rules
promulgated by the Agency and the Department for Health Care Administration regarding
implementation of Section 430.0402 and Chapter 435, F.S. To demonstrate compliance with this
provision, Contractor shall submit the Background Screening Affidavit of Compliance (Screening
Form) to the Agency within 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
lithr//clderaffairs.state fl us/doca/backgroundscreenina.Iprn•
9. Grievance Procedures:
The Contactor 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. Publie Records and Retention:
1.0.1By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any
other applicable law, and shall:
1O.1.11(eep and maintain public records required by the Agency to perform the contracted services.
1O.1.2tJpon 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.
1O.1.3Ensure 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 the Agency.
1OJAUpon completion of the contract, the Contractor will either transfer, at no cost to the Agency,
all public records in possession of the Contractor to the Agency, or will keep and maintain
public records required by the Agency. If the Contractor transfers all public records to the
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October 2019 — September 2020
EHEAP 203.19
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 THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF
CHAPTER 11.9, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE
PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE 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 or 866-413-5337
10.3 Upon termination of this contract, whether for convenience or for cause as detailed in section 53 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.
1LAudits, Inspections, Investil?ations:
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 that 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 law. 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.
IL3Upon 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.
IIAThe Contractor shall ensure that the records described in this section will be subject at all
October 2019 — September 2020 EHEAP 203.19
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 f'o• as long as records are maintained, persons duly authorized by the
Agency and federal auditors, pursuant to 45 CFR Part 75, shall 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 to the Agency as specified in this
contract and ensure that all related third -party transactions are disclosed to the auditor.
11,7Contractor 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 Rieirts Compliance:
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 contact.
12.3The Contactor shall establish procedures pursuant to federal law to handle complaints of
discrimination involving services or benefits through this contract, These procedures shall include
notifying clients, employees, and participants of the right to file a complaint with the appropriate
federal or state entity.
12.4 If this contact contains federal finds, 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 any 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 the contact 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 Contactor, which are relevant to this contract,
and to interview any clients, employees, and Subcontractor employees of the Contractor to assure the
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October 2019 — September 2020 EHEAP 203.19
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 (lie 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 Contract Manager.
14. Provision of Services:
The Contractor shall provide services in the manner described in ATTACHMENT I.
15. Coordinated Monitoring with Other Agencies:
If the Cont actor receives funding from one or more State of Florida human service agencies, in addition
to the Agency, then a joint monitoring visit including such other agencies may be scheduled. For the
purposes of this contract, and pursuant to Section 287.0575, F.S., as amended, Florida's human service
agencies shall include the Agency, the Department of Children and Families, the Department of Health,
the Agency for Persons with Disabilities, and the Department of Veterans' Affairs. Upon notification and
the subsequent scheduling of such a visit by the designated agency's lead administrative coordinator, the
Contractor shall comply and cooperate with all monitors, inspectors, and/or investigators.
16. New Contract(s) Reporting:
The Contractor shall notify the Agency within lien (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; and (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 attached to this contract.
17. Indemnification:
The Contractor shall indemnify, save, defend, and hold harmless the Agency and its agents and employees
from any and all claims, demands, actions, and causes of action of whatever nature or character arising
out of, or by reason of the execution of this agreement 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 o f the Agency.
17.1 ,Except to the extent permitted by Section 768.28, F.S., or other Florida law, this Section 17 is not
applicable to contracts executed between the Agency and state agencies or subdivisions defined in
Section 768.28(2), F.S.
18 Insurance and Bonding:
181 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 fall
responsibility for identifying and determining the type(s) and extent of liability insurance coverage
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.
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EHEAP 203,19
182 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.
19 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.
2R Health 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).
21. Incident Reporting:
21J 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 Contractor's
or Subcontractor's 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,
212 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or
exploitation of it 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, its Subcontractors, and their employees.
22. 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., M District of Florida,'fallahassee Division); and (4) the name, address, and telephone number
of the bankruptcy attorney.
23. Snonsorsbip and Publiei
231 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 (Contractors name) and the State of Florida, Department of Elder Affairs
and/or the Area Agency on Aging for Southwest Florida, Inc.." If the sponsorship reference is in
written material, the words "State of Florida, Department of Elder Affairs and/or the Area Agency
on Aging for Southwest Florida, inc." shall appear in at least the same size letters or type as the
name of the organization.
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EHEAP 203.19
232 The Contractor shall not use the words "State of Florida, Department of Elder Affairs and the Area
Agency on Aging for Southwest Florida, Inc." to indicate sponsorship of a program otherwise
financed, unless specific authorization has been obtained by the Agency prior to such use.
24 Assignments:
241 The Contractor shall not assign the rights and responsibilities under this contract without the prior
written approval of the Agency. Any sublicense, assignment, or transfer otherwise occurring
without prior written approval of the Agency shall constitute a material breach of the contract. In
the event 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.
242 This contract shall remain binding upon the successors in interest of the Contractor and the
Agency.
25. Subcontracts:
251 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.
252 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the Agency
or other state agency. Failure to male 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.
26. 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 that they shall not hold themselves
out as employees or agents of the Agency without prior 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.
V. Payment:
Payments shall be made to the Contractor for all completed and approved deliverables (units of service)
as defined in ATTACHMENT 1. The Area Agency 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 contact specify otlierwise. The approved invoice will be submitted to the Agency's finance
section for budgetary approval and processing. Disputes arising over invoicing and payments 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.
9
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October 2019 — September 2020 EHEAP 203.19
28 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 fiords 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 Area Agency 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.
29 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.
AA Computer Use and Social Media Policy:
The Department has implemented a Social Media Policy, in addition to its Computer Use Policy, which
applies to all employees, contracted employees, consultants, Other Personal Services (OPS) employees
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, Wikis, RSS feeds, video sharing, social networks like MySpace, Facebook
and Twitter, as well as content sharing networks such as flicla• and YouTube. This policy is available on
the Department's website at: http://eidei-affairs state.fl.us/doea/financial.plip.
31. 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 individuals,
has a financial or other interest in the firm being selected for award. The Contractor's or Subcontractor's
officers, employees, or agents will neither solicit not, accept gratuities, favors, or anything of monetary
value from Contractors, potential Contractors, or parties to Subcontracts. The Contractors 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
10
October 2019 — September 2020 EHEAP 203.19
appointment, or, placement in that position,, or if the individual is serving as an incumbent, within thirty
(30) calendar days or 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.
32. 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 wider a 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.
33 Purchasing:
Alt 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
Sections 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.
332 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.
333 The Contractor may purchase articles that are the subject of, or required to carry 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 Sections
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 h�,./wwwsespactoffioridaLoi� This clause is not applicable to Subcontractors unless
otherwise required by law.
3'6 Patents, Copyrights, Royalties:
ffthis contact is awarded state 'funding and if any discovery, invention, or copyrightable material is
developed or produced in the course of or as a result of work or services performed raider this contract
or in any way connected with this contract, or if ownership of any discovery, invention, or
copyrightable 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 287.057l(5)(k), F.S., the only exceptions to
this provision shall be those that are clearly expressed and reasonably valued in this contract.
311 If the primary purpose of this contract is the creation of intellectual property, the State ofFlorida
shall retain an unencumbered right to use such property, notwithstanding any agreement made
Pursuant to this Section 34.
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October 2019 — September 2020 EHEAP 203.19
342 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.
343 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, fhlly-paid, nonexclusive license for its use
and the use of its Contractors, Subcontractors, or Assignees of any resulting patented,
copyrighted, or trademarked work products.
35 Emergency Preparedness and Continuity of Operations:
M1 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.
352 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall
remain responsible for performance under this contract and must follow procedures to ensure
continuity of operations without interruption.
36 Equipment
361 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].
362 Contractus 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-1 10) 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 Contactor 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 Contact
Manager.
353 The Contractor's property management standards for equipment (including replacement
equipment), whether acquired in whole or part with federal funds and federally -owned equipment
shall, at a minimum, meet the following requirements and shall include accurately maintained
equipment records with the following information:
36.3.1 Property records must be mairrtained that include a desceiption of the equipment;
36.3.2 Manufacturer's serial number, model number, federal stock number, national stock
number, or other identification number;
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October 2019 — September 2020 EHEAP 203.19
36.3.3 Source of funding for the equipment, including the federal award number identification
number;
36.3.4 Whether title vests in the Contractor or the federal government;
36.3.5 Acquisition date (or date received, if the equipment was furnished by the federal
government);
36.3.6 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);
36.3.7 Location, use and condition of the equipment and the date the information was
reported;
36.3.8 Unit acquisition cost; and
36.3.9 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.
36.3.10 A physical inventory must be taken, and the results reconciled with the property
records at least once every two (2) years.
36.3.11 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.
45 CFR § 75.320(d)(3).
36.3.12 Adequate maintenance procedures must be developed to keep the property in good
condition.
36.3.13 If the Contractor is authorized or required to sell the equipment, proper sales
procedures must be established to ensure the highest possible return.
36.4 Equipment purchased with federal fiords 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(x), as applicable], subject to the
conditions of 2 CPR Part 200 and/or 45 CFR part 75. Equipment purchased under these thresholds
is considered supplies and is not subject to property standards. 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., rule 60A-1.001 7, F. A. C., and 2 CFR Part 200 and/or 45 CFR Part 75.
36.5 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
it 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 of the property (i.e., transfer or donation to another
agency that administers federal programs, offer of the items for sale, destroy the items, etc.).
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EHEAP 203.19
36.6 The Agency's Contract Manager will issue disposition instructions. If disposition instructions are
not received within one hundred twenty (1.20) 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.
36.7 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 thorough 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 III, Part A., Section 3030b United States Code (USC). 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.
36.8 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.
36.9 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 fFR 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.
37.PUR 1000 Form:
The PUR 1000 Foran is hereby incorporated by reference and available at:
http_!/w_yw_.mvflorida cpm/;ap lsh bsladoc,T-7740 PUR I000.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 PUR1000 Form. However, if the
conflicting terms or conditions in the PUR1000 Form are required by any section of the Florida Statutes,
the terms or conditions contained in the PUR1000 Form shall take precedence.
38. Use of State Funds to Purchase or Improve Real Property:
Any state fiords 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.
39. 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.
40. Financial Consenuences:
If the Contractor faits to meet the minimum level of service or performance identified in this contract, the
Agency will impose financial consequences as stated in ATTACHMENT I.
14
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41. No Waiver of Sovereign Immunity:
EHEAP 203.19
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.
42. Venuc:
If any dispute arises out of this contract, the venue of such legal recourse shall be Lee County, Florida.
43.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.
44. Force Maieure:
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.
45. 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.
46. Condition Precedent to Contract Appropriations:
The Parties agree that the Agency's performance and obligation to pay under this contract are contingent
upon an annual appropriation by the Legislature.
47. 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.
48. 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.
49. 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 Contactor and subject the
contract to immediate unilateral cancellation of the contract at the discretion of the Agency.
SII. Final Invoice:
The Contractor shall submit the final invoice for payment to the Agency no later than thirty (30) days
after the contract ending date unless otherwise specified in ATTACHMENT L If the Contractor fails to
do so, all right to payment is forfeited and the Agency shall not honor any requests submitted after the
aforesaid time period. Any payment due under the terms of this contract shall be withheld until all
15
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EHEAP 203.19
required documentation and reports due from the Contractor and necessary adjustments thereto have been
approved by the Agency.
51. 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.
52.Susuension of Worts;:
The Agency may in its sole discretion, suspend any or all activities tinder the contract or purchase order,
at any time, when in the interest 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) clays,, or any longer period agreed to by the Contractor, the Agency shall either (I)
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.
53. Termin ation:
53.1 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.
53.2 Termination for Cause. The Agency may terminate this contract ifthe 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), P.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, atter 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.
54.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
16
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October 2019 — September 2020 EHEAP 203.19
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 contract 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.
541 The Agency's authorization pursuant to this section does not authorize electronic transactions
between the Contractor and the Agency. The Contractor is authorized to conduct electronic
transactions with the Agency only upon further written consent by the Agency.
54.2 Upon request by the Agency, the Contractor shall provide the Agency with non -electronic (paper)
copies of records. Nonelectronic (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.
55. Contract Manager:
The Agency may substitute any Agency employee to serve as the Area Agency's Contract Manager.
REMAINDER OF THEPAGE INTENTIONALLY LEFT BLANK
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EHEAP 203.19
56. Official Payee and Representatives(Names, Addresses, and Telephone Numbers):
57. All Terms and Conditions Included:
This contract and its ATTACHMENTS I -XXIII 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, THEREOF, the Parties hereto have caused this contract to be executed by their undersigned
officials as duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD
OF COUNTY C M SIONER
SIGNED BY: V, �IZI
NAME: STEPHEN Y CARNELL
TITLE: Public Services -Department Head
DATE: "1
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
DUNS: 076997790
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA,
SIGNED BY: Tu -
NAME: MARIANNE G LORINI
TITLE: PRESIDENT/CEO
DATE: /a I P bf
Approved as to form and legality
18
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The Contractor name, as shown on page I of
Collier County Board of County Commissioners
a.
this contract, and mailing address of the
3339 E Tamiami Trail, Building H
Naples, FL 34112
official payee to whom the payment shall be
made is:
The name of the contact person and street
Kristi Sonntag, Director
Collier County Board of County Commissioners
b.
address where financial and administrative
%Community and Human Services
records are maintained is:
3339 E Tamiami Trail, Building H
Naples, FL 34112
The natne, address, and telephone number of
Kristi Sonmag, Director
C.
the representative of the Contractor
CollierCountyBoard of County Commissioners
/oCommunity and Human Services
responsible for administration of the ro am
P p gr
3339 E Tamiami Trail, Building H
under this contract is:
Naples, FL 34112
(239)252-2273
The section and location within the Agency
Area Agency on Aging for Southwest Florida, Inc.
d.
where Requests for Payment and Receipt and
Fiscal Department
Expenditure forms are to be mailed is:
15201 North Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
The name, address, and telephone number
Vacant, Director of Program & Planning
e.
of the Contract Manager for this contract
Area Agency on Aging for Southwest Florida, Inc.
15201 North Cleveland Avenue, Suite 1100 North
is:
Fort Myers, FL 33903
239-652-6900
Upon change of representatives (names, addresses, and telephone numbers) by either party, notice shall be
provided in writing to the other party.
57. All Terms and Conditions Included:
This contract and its ATTACHMENTS I -XXIII 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, THEREOF, the Parties hereto have caused this contract to be executed by their undersigned
officials as duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD
OF COUNTY C M SIONER
SIGNED BY: V, �IZI
NAME: STEPHEN Y CARNELL
TITLE: Public Services -Department Head
DATE: "1
Federal Tax ID: 59-6000588
Fiscal Year Ending Date: 09/30
DUNS: 076997790
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA,
SIGNED BY: Tu -
NAME: MARIANNE G LORINI
TITLE: PRESIDENT/CEO
DATE: /a I P bf
Approved as to form and legality
18
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October 2019 — September 2020
INDEX OF ATTACHMENTS
EHEAP 203.19
ATTACHMENT
.........
STATEMENTOF WORK........................................................................................................................
20
A'17TACHMENT 11
FINANCIAL AND COMPLIANCE AUDIT............................................................................................45
ATTACHMENTIII
CERTIFICATIONSAND ASSURANCES..............................................................................................51
ATTACHMENT IV
ASSURANCES -NON -CONSTRUCTION PROGRAMS......................................................................56
ATTACHMENT V
FLORIDA DEPARTMENT" OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST....
58
ATTACHMENT VII
BACKGROUNDSCREENING................................................................................................................62
ATTACHMENT IX
BUDGETSUMMARY .................................... ............ ....... .......................................... ................. ............
63
ATTACHMF.,NT X
EHEAP ADMINISTRATIVE.; AND OUTREACH EXPENSE BUDGET DETAIL................................64
ATTACHMENT XI
RECEIPTS AND EXPENDITURE REPORT...........................................................................................65
ATTACHMENT XII
REQUESTFOR PAYMF,N`I'.....................................................................................................................66
ATTACHMENT XIII
INVOICEREPORT SCHEDULE .............................................................................................................67
ATTACHMENT XIV
POVERTYINCOME GUIDELINES.. ................................ .....................................................................
68
ATTACHMENT XV
LTHEAP PAYMENT MATRIX....................................................69
........................................ .
ATTACHMENT XVI
SOURCESOF INCOME...................................................................................................
ATTACHMENT XVII
OUTREACHPLAN SURVEY..........................................................:...............................
ATTACHMENT XVIII
EHEAP APPLICATION AND ELIGIBILITY WORKSHEET.. ......................................
ATTACHMENT XIX
EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS ...................................
ATTACHMENT XX
EHEAP CLIENT FILE CONTENT CHECKLIST .......................................................1111
ATTACHMENT XXT
EHEAP COST REIMBURSEMENT' SUMMARY ............. ............... ............... ................. ..............
1111
ATTACHMENT XXII
COSTALLOCATION PLAN......................................................................................11..................11..
ATTACHMENT XXIII
SERVICERATE REPOR'I'......................................................................................11...11.....................
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October 2019 — September 2020
ATTACHMENT
STATEMENT OF WORK
I. SERVICES TO BE PROVIDED
A. DEFINITION OF TERMS
EHEAP 203.19
1. 18 hours — The timeframe within which all applications for crisis assistance shall be acted upon,
with an eligible action to mediate the crisis within eighteen (18) hours of the application date
stamp and documenting in the client file the eligible action taken.
2. Caseworker —,Person who is responsible for determining program eligibility by completing the
Emergency Home Energy Assistance for the Elderly Program (EIIEAP) Eligibility Worksheet
(ATTACHMENT XVIII) and awarding crisis benefits,
3. Caseworker Signature Date — The date that the client's completed application is processed,
eligibility determined, and the crisis resolved. This date shall not be changed. Signatures must be
in ink. Rubber-stamped signatures will not be accepted.
4. Client Application Date — The date that the client's completed application is completed (whether
by self or with assistance) and signed by the elder. This date shall not be changed. Signatures
must be in ink. Rubber-stamped signatures will not be accepted. If an elder cannot write their
signature on the application, or any other required document, and must sign with an "X." two
witnesses are required.
5. Crisis — A home cooling or heating crisis exists when an elder has no access to, or is in immediate
danger of losing access to, needed home energy.
6. Crisis Assistance — Assistance provided to an elder who has no access to, or is in danger of losing
access to, needed home energy.
7. Date of Resolution — The date that a documented commitment to pay was made to the utility
vendor to resolve the energy crisis. This date is used as the F,HEAP Client Enrollment date in the
Department's Client Information and Registration Tracking System (CIRTS). This date shall not
be changed.
a. The amount of time elapsed between the Date Stamp and the Date of Resolution shall
determine whether or not the eighteen (18) hour rule was met.
b. Vendors must be paid within forty-five (45) days of the date of resolution.
S. Date Stamp — The date the application and all required documentation is presented in acceptable
form to intake staff. An inked stamp must be used, and the date shall not be changed. The 18 -hour
hour rule for crisis resolution begins when the application is date stamped.
9. Disability — A disabling condition that causes an elder to be determined eligible to receive
Supplement Security Income (SSI) or Social Security Disability Income (SSDT) from the Social
Security Administration.
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October 2019 — September 2020 EHEAP 203.19
10.Elder—An individual aged sixty (60) years or older.
11. Eligible Action —An action taken by the caseworker to mediate an elder's energy crisis. Eligible
actions include:
a. Approval of an elder's application;
b. Denial of an elder's application pending further information;
c. Denial of an elder's application because the elder is deemed ineligible;
d. Contact with a utility vendor to halt utility disconnection or interruption in services; or
e. Written referral to and providing the elder with assistance contacting another agency if
EHEAP funding is not available or the elder is ineligible.
12. Energy Subsidy — Utility costs paid directly or indirectly to the elder who lives in government -
subsidized housing.
13.Houseltold —Any individual or group of individuals who are living together as one economic unit
for whom residential energy is customarily purchased in common or who make undesignated
payments for energy in the form of rent.
14.Houschold Member—Persons in a household who share a common kitchen or bath and purchase
residential energy in common.
15.Intake Worker — Person who accepts the ENEAP application and required documentation and
may have the responsibility to determine eligibility or award crisis benefits.
16.Mininrum Level of Service — Service to a minimum of one household per month.
17.0-isis Assistance Benefit — Payment of a heating/cooling energy bill, the purchase of
heating/cooling device; and/or the repair of a heating/cooling device.
1S.Priority for Assistance — Households with the highest home energy needs and lowest household
income, which will be determined by taking into account both the energy burden and the unique
situation of such households with members of vulnerable populations, including very young
children, individuals with disabilities, and fi•ail elder individuals.
1.9.Provider — The entity that has entered into a contract, subcontract, or Memorandum of
Understanding (MOU) to provide services under EHEAP. For the purposes of this contract, the
terms "Provider" and "Contractor" may be used interchangeably.
20.Reasonable Promptness —Within fifteen (15) working days of receiving the client's completed
application.
21.Request for Payment — Submission of actual monthly expenditures for reimbursement.
22.Service Unit — One individual (elder) served.
23. Social Security Number —The number on an elder's Social Security card or the number provided
by an award or determination letter from an entity, such as a government agency, that has already
verified the social security number.
24.Supervisory/Peer Review Date—The date that a supervisor or peer reviewed the application and
documentation and signed the application indicating vendor payment can be made. The intent of
the supervisor/peer review is to avoid errors in eligibility determination and payment amounts and
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October 2019 — September 2020
EHEAP 203.19
to alleviate the possibility of fraud. This date shall not be changed. Signatures must be in ink.
Rubber-stamped signatures will not be accepted.
25. Verification Date - The date the caseworker verified previous Low -Income Home Energy
Assistance Program (LIHEAP) crisis benefits with the LIHEAP provider or the minimum amount
necessary to resolve the crisis with the utility company. This date shall not be changed.
B. GENERAL DESCRIPTION
1. General Statement
The Emergency Home Energy Assistance for the Elderly Program (EHEAP) serves the mission
of the Agency by providing home energy assistance aid to elders in the event of a home energy
heating or cooling emergency. EHEAP is designed to assist low-income households with at least
one member aged sixty (60) or older experiencing a heating or cooling emergency
2. Authority
The relevant federal and state authorities governing EIIEAP are:
a. Low Income Home Energy Assistance Act of 1981; (Title XXVI of the Omnibus Budget
Reconciliation Act off.981, P.L. 97-35), as amended.;
b. 42 United States Code (U. S. C.) § 8621 et seq.;
c. 45 Code of Federal Regulations (CFR) Part 96, Subpart I -I (§§ 96.80-96.89);
d. Section 409.508, Florida Statutes (F.S.) and Rule 73C-26.021 (3), Florida Administrative Code
(F. A. C.);
e. Rule Chapter 73C-26, F. A. C.;
L State of Florida LIHEAP Policies and Procedures Manual; and
g. LIHEAP State Plan.
3. Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of
EHEAP. Eligible elders may receive one crisis assistance benefit per heating or cooling season,
not to exceed $600.00 each. If eligible, elders may receive one summer crisis assistance benefit
during the period from April 1 to September 30, and one winter crisis assistance benefit during the
period of October I to March 31, each year. An elder's eligibility for crisis benefits is not related
to EHEAP contract periods.
Weather-Related/Supply Shortage funds can be provided in addition to crisis benefits when
authorized by (lie Florida Department of Economic Opportunity (DEO). In the event of a weather-
related event or supply shortage, the President of the United States, Governor of the State of
Florida, or Executive Director of DEO may declare a weather- related crisis and release additional
funds to assist affected households. When benefits are distributed for a weather-related/supply
shortage emergency, the Contractor shall comply with directives provided by the DOEA as to the
allowable expenditures of these funds.
a. The services provided under this contract shall be in a manner consistent with and described
in ATTACHMENT I, Section II: Manner of Service Provision. Contractor, in
collaboration with its EHEAP program partners, shall ensure the following service tasks are
completed:
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October 2019 — September 2020 EHEAP 203.19
(I) Consumer Outreach;
(2) Program Partners and Stakeholders Coordination;
(3) Elder's Benefit Eligibility Determination; and
(4) Benefit Disbursement.
4. Major Program Goals
EHEAP is designed to provide crisis assistance to eligible low-income households with at least
one individual aged sixty (60) or older experiencing a heating or cooling emergency. The program
allows for payments to utility companies and/or fuel suppliers; for the purchase of blankets,
portable heaters, fans, and/or air conditioners; for the repair or replacement of existing heating or
cooling equipment; for the payment of deposits, late fees, disconnect and reconnection fees; for
the provision of temporary emergency shelter; or to resolve other heating and cooling
emergencies. The program also provides eligible elders with weather-related/supply shortage
emergency benefits when authorized by DEO.
a. Crisis Assistance
A standard ]ionic cooling or heating crisis exists when an elder has no access to, or is in danger
of losing access to, needed home energy because one or more of the following conditions is
present:
(1) The elder's home cooling or heating energy source has been cut off;
(2) The elder has been notified that the elder's home cooling or heating energy source will
soon be cut off;
(3) Tile elder has an energy bill or notice for which the due date has lapsed;
(4) The elder has received a notice indicating the household's energy bill is delinquent or past
due;
(5) The elder is unable to get delivery of heating fuel, is out of heating fuel, or is in danger of
being out of heating Eitel; or
(6) The elder has other problems with lack of cooling or heating in the home, such as needing
to pay a deposit, needing a repair or purchase of heating or cooling equipment, or needing
interim emergency measures to avoid 'further crisis.
b. Allowable Categories for Crisis Assistance are:
(1) Electric;
(2) Gas;
(3)Propane;
(4) Wood/coal;
(5) Refillable fuels; and
(6)Pre-Pay home energy usage.
(i) The elder is within seven days of using the remaining balance of the pre -purchased
energy source, the elder's power is currently disconnected/shut off, or the elder
needs a deposit.
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October 2019 — September 2020 EHEAP 203.19
(ii) The LIHEAP Payment (ATTACHMENT XV) shall be used to determine the
benefit amount.
C. CLIENTS TO BE SERVED
I. General Description
EHEAP provides for direct client services to elders in low-income households experiencing a
home energy heating or cooling emergency. A household receiving EHEAP services may not have
an income above one hundred fifty percent (150%) of the poverty level, as published by the United
States Department of Health and Human Services.
2. Client Eligibility
To be eligible for services under this contract, and to receive assistance, an elder must:
a. Be aged sixty (60) or older;
b. Reside in the EHEAP service area (Planning and Service Area) at the time the home energy
costs were incurred;
c. Complete and return an EHEAP application with all required information and verification to
contractor, while funds remain available;
d. Provide a fuel bill or other docmnentation evidencing an energy emergency and an
obligation to pay for home energy costs for the home in which they live;
e. Possess a total gross household income of not more than one hundred fifty percent (150%) of
the Office of Management and Budget (OMB) federal poverty level for the size of the
household. In accordance with Section I.C3.d. of this contract;
I. Be experiencing one or more verifiable home cooling or heating crises.
g. Not be a resident of a group living facility or a home where the cost of residency is at least
partially paid (or subsidized) through a foster care or residential program administered by the
state;
Ii. Not be a student living in a dormitory; and
i. Legally reside in the State of Florida.
3. ClientDeterminatimt
Contractor shall begin taking applications for EHEAP services upon execution of this contract
and continue taking applications until the contract expires or finds are exhausted. Contractor shall
not accept applications when funds are exhausted for a particular time period. Contractor shall:
a. Provide assistance to elders in completing Agency -provided applications for assistance and
determining eligibility;
b. Ensure that no one is excluded from program participation on the grounds of race, color,
national origin, sex, or age, and ensure that such persons shall not be subjected to
discrimination under any activity funded in whole or in part with these finds;
c. Treat homeowners and those who rent equitably under this contract;
it. Calculate the income eligibility of the elder by using the past thirty (30) days earnings for all
occupants of the household annualized or the elder's current economic situation and reference
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October 2019 — September 2020 EHEAP 203.19
the current Sources of income (ATTACHMENT XVI) to determine what is considered
allowable income. Contractor shall proceed as follows;
(1)Total household income cannot exceed one hundred fifty percent (1.50%) of the current
federal Poverty Income Guidelines (ATTACHMENT XIV); and
(2) Obtain a written self -declaration from household members aged eighteen (18) years of-
older
rolder claiming zero income. Self'declarations must be completed and signed by the
household member who is claiming zero income.
e. Determine if all or part of the elder's utility costs are paid directly (utility reimbursement) or
indirectly (utility allowance) by the government if the elder lives in government -subsidized
housing. Contractor shall proceed as follows:
(I)If total home heating or cooling costs are included in the rent and the elder has no
obligation to pay any portion of the costs, then the elder is not eligible for assistance; and
(2)If there is a Florida Section 8 (Housing Choice Voucher Program) or a Public Housing
Authority (PHA) Program energy subsidy available to the elder during the period covered
by the utility bill, then the elder is only eligible for partial assistance. The energy subsidy
for the period covered by (lie utility bill must be subtracted from the allowable EHEAP
benefit calculated for the household,
f. Use program qualification approvals or notifications to document household size and income
of elders receiving Supplemental Nutrition Assistance Program (SNAP) or SSI. Elders shall
meet program income eligibility guidelines and possess a total gross household intone of not
more than 150% of the OMB federal poverty level for the size of the household. The benefit
level to be provided to elders receiving SNAP o• SSI, shall be the same as that provided to
other qualified elders;
g. Obtain a signed statement of maintenance from the elder explaining how basic living expenses,
(i.e., food, shelter, and transportation are being provided) if the total household income is less
than fifty percent (50%) of the current federal poverty guidelines and no one in the household
is receiving SNAP;
h. Ensure elders receive no more than one approved crisis assistance benefit during the cooling
season, April I — September 30, and one approved crisis assistance benefit during the heating
season, October I — March 31. The Contractor shall proceed as follows:
(1) Crisis assistance benefit may consist of payment of more than one energy obligation, per
heating and cooling season, for a household to resolve a single crisis, thus allowing for:
(i) The purchase or repair of fans, blankets, air conditioners, and/or portable heaters in
addition to heating/cooling bill assistance, that combined does not exceed the
maximum crisis benefit of $600; and
(H)Crisis situations which may involve a heater or air conditioner that is powered by both
gas and electricity, in which case both energy obligations are eligible for a crisis
benefit payment that combined does not exceed the maxinnun crisis benefit of $600.
(2) Water, sewer, and garbage, and fire, etc, charges may not be paid.
(3)Repair or replacement of a heating/cooling unit is allowable within the maximum limit of
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October 2019 — September 2020 EHEAP 203.19
$600, provided any required installation or repair work is completed by a licensed
contractor;
(4) Deposits to connect or restore energy are allowable, not to exceed the maximum limit of
$600;
(5) Late fees, disconnect fees, and reconnect fees are allowable, not to exceed the maximum
limit of $600;
(6) Charges 'from a previous account held by the elder that is now closed are allowable, not
to exceed the maximum limit of $600;
(7) Payment to landlord when utility costs are included in the elder's rent is allowable, not to
exceed the maximum limit of $600; and
(8) Payment for temporary emergency shelter is allowable, if due to energy-related crisis,
not to exceed the maximum limit of $600.
i. In no case shall the Contractor be required to incur costs in excess of the full contract
amount to provide services to the clients.
II. MANNER OF SERVICE PROVISION
A. SERVICE TASKS
In order to achieve the goals of EHEAP, Contractor shall ensure the following tasks are performed:
1. Ensure that all eligible elders meet the requirements of Section I.C.2. of this contract;
2 Ensure that all energy assistance payments made to home energy vendors comply with the
requirements of Section 11.A.14.d. of this contract;
3. Implement appropriate program management and operational controls to ensure all applications
for crisis assistance are acted upon with an eligible action to mediate the crisis within eighteen
(18) hours of the application date stamp, and document in the client file that the crisis was resolved
within eighteen (18) hours.
4. Provide all elders approved for EHEAP funding with a written Notice of Approval and Appeal
within fifteen (15) working days of crisis resolution. The written Notice of Approval and Appeal
shall include:
a. Type and amount of assistance;
b. Name of the home energy vendor to be paid on elder's behalf;
e. The next date when the elder will be eligible to apply for further assistance; and
d. Contractor's appeal process.
5. Provide all elders whose EHEAP applications were denied with a written Notice of Denial and
Appeal within fifteen (15) working days of receiving the elder's application. The written Notice
of Denial and Appeal shall contain:
a. Name of the elder;
b. Date of application;
c. Type of benefit sought;
d. Reason(s) for denial;
26
October 2019 — September 2020 EHEAP 203.19
e. Statement on Contractor's benefit limits, if applicable;
f. Contractor's appeal process;
g. Explanation of circumstances under which the elder may reapply;
h. Information or documentation needed for the elder to reapply;
i. The name, address, and phone number applicable to the appeal process; and
j. Number of days the elder has to file the appeal.
6. Maintain consumer appeal procedures that provide an opportunity for a fair administrative hearing
to elders whose applications for assistance are denied or whose applications are not acted upon
with reasonable promptness;
7. Provide an opportunity for elders to file a written appeal or complaint with the Contractor's
Program Supervisor within ten (10) working days of receipt of the written Notice of Denial and
Appeal.
a. Upon receipt of a validly filed appeal or complaint, Contractor must respond in writing
within ten (10) working days;
b. Elders may appeal Contractor's first response by filing its objections to the response with
Contractor's Director, 'Executive Director, or Board Chair, as applicable, within five (5)
working days of receipt of the first response; and
c. Upon receipt of a validly filed objection to the first response, Contractor must respond in
writing within ten (10) working days, and the response must clearly state the final outcome
of the appeal, that the decision is final, and if applicable, the circumstances under which the
elder may reapply for services,
S. Post appeal provisions in a prominent place and in plain view at all locations where EFIEAP are
received;
9. 9. Ensure all ineligible applicants and applicants denied crisis assistance, when EHEAP funds are
not available or are insufficient to meet their emergency home energy needs, are referred to and
assisted in securing help through other community resources;
10. Ensure no consumer fees are charged to, nor donations accepted from, an elder as a prerequisite
for receiving EHEAP benefits. Post in a conspicuous place at all locations where EHEAP
applications are received the following notice: "No money, cash, or checks will be requested or
received from customers in the EHEAP office. If an employee asks for money, report this to the
agency executive director or Agency head."
.It. Compare LIHEAP records and EHEAP records for households with elderly members to avoid
duplicate crisis assistance payment during the same eligibility period and maintain documentation
sufficient to ensure compliance with this requirement;
12. Maintain a written policy and implement procedures to protect and secure elder applicants'
information and social security numbers in order to protect their identities from theft or fraud.
This policy shall address the handling of both paper and electronic records and files. Contractor
shall, in collecting elders' social security numbers, use the Notice Regarding Collection of Social
Security Numbers, which is incorporated into this contract by reference, (Notice of
Instruction#071 1 13-1-I-SWCB S,
http://el(lerafrairs state f7 us/doea/noticess/Jtih,l3/LIHEAI'%2ONotice%20re%20Social%20Seeurit
y%20Numbcrs%20PinaLpd[). The Notice Regarding Collection of Social Security Numbers shall
be signed by the elder and retained in the client file;
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October 2019 — September 2020
13. Consumer Outreach
EHEAP 203.19
Ensure that households in all counties within the service area wishing to benefit from the program
have the opportunity to do so. Contractor shall undertake consumer outreach initiatives in all
counties within the service area designed to inform potentially eligible households about EHEAP.
Outreach efforts must focus on elderly households with disabled individuals, young children, and
where the highest percentage of the household income is required to pay for their home energy.
Specific outreach initiatives shall include, but are not limited to:
a. Informing all service area local agencies, non -profits, and similar organizations that are in
regular contact with the low-income population about the EHEAP program, especially those
serving seniors;
b. Encouraging EHEAP program participation through local television and radio programs, and
placing announcements of the EHEAP program in media community calendars;
c. Developing and implementing a written procedure for making home visits to households with
homebound elderly persons in order to assist with the completion of the program application
when other assistance is not available;
d. Making visits to provide information, and/or malting presentations about EHEAP in response
to requests by local congregational centers serving elderly or disabled persons;
e. Providing information concerning the local weatherization program to all persons who request
it (including organizations that provide outreach activities); and
f. Completing the EHEAP Outreach Plan Survey (ATTACHMENT XVII) to demonstrate to the
Agency that outreach efforts to inform potentially eligible households about EHEAP shall be
rnade to target households in all counties. The EHEAP Outreach Plan Survey is required to
be submitted by Contractor to the Contract manager within thirty (30) days of the contract
execution date.
14. Program Partners and Stakeholder Coordination
Coordinate shall coordinate services with other program partners and stakeholders to prevent the
duplication of services, facilitate referrals, and improve the efficiency of services for
consumers. Coordination activities shall include, but not be limited to:
a. Communicating with the DEO LIIIEAP contractors in their respective service areas to prevent
the duplication of benefits to elders. Additionally, Contractor shall review LIHEAP and
EHEAP records for households with elderly members to ensure duplicate crisis assistance
payments are not received during the same heating or cooling season;
b. Developing a new, or continuing an existing, MOU with the Weatherization Assistance
Program (WAP) in the service area. The MOU shall detail cooperative efforts and describe
the actions that will be taken by both parties to ensure coordination and referrals. The MOU
shall be reviewed and renewed at least every five years. Contractor, in coordination with the
local WAP agency, shall develop a system by which elders who have received more than three
EI-IEAP and LIHEAP benefits in the last eighteen (18) months and who are homeowners are
referred to a WAP provider. Contractor shall maintain copies,of all MOUS;
c. Establishing a new, or continuing an existing, MOU with service area LIIIEAP contractors.
Each MOU shall ensure coordination of services, to avoid duplication of assistance, and
increase the quality of services provided to elders. The MOU shall direct LIHEAP providers
to refer elders aged sixty (60) or older to EHEAP providers for energy assistance. The MOU
shall be reviewed and renewed at least every five (5) years. Contractor shall maintain copies
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October 2019 — September 2020 EHEAP 203.19
of all MOUS. MOUS with local LIHEAP agencies shall be updated if the contracting parties
change. The MOUS must be applicable to Contractor's current EIIEAP program requirements
and guidelines;
d. Developing agreements with home energy vendors that benefit elders. Contractor shall
maintain copies of all vendor agreements. All agreements between Contractor and home
energy vendors shall contain the following conditions:
(1)The beginning and ending date of the Vendor Agreement;
(2)The Contractor's representative(s) authorized to resolve a crisis situation and make a
payment commitment on behalf of an elder;
(3)The home energy vendor's representative(s) authorized to resolve a crisis;
(4)A description of how energy payments will be made directly to the home energy vendor
on behalf of the EHEAP eligible customer;
(5)Assurance from the home energy vendor that no household receiving EHEAP assistance
will be treated adversely because of such assistance under applicable provisions of state
law or public regulatory requirements;
(6)Assurance that the home energy vendor will not discriminate, either in the cost of goods
supplied or the services provided, against the eligible household on whose behalf payments
are made;
(7)A statement that only energy-related elements of a utility bill are to be paid. Water, sewer,
garbage, and fire, etc. charges are not covered as part of the utility bill of the household.
However, EHEAP does allow an exception with water that is used for air conditioning, i.e.
an evaporated cooler;
(8)A statement that Contractor may not pay for charges that result from illegal activities such
as a worthless check or meter tampering, and that the home energy vendor is aware that
those charges are the responsibility of the elder;
(9)Assurance from the home energy vendor that when the benefit amount to the elder does
not pay for the complete charges owed by an elder, the elder is responsible for the
remaining amount owed;
(10) Details on how the home energy vendor will assist Contractor in verifying the elder's
account information and, in the case of crisis assistance, make timely commitments to
resolve the crisis. A process should be in place to verify the current amount owed and the
minimum annount necessary to resolve the crisis situation;
(11) Contractor's commitment to make payment to the home energy vendor• within forty-
five (45) days of the date of crisis resolution;
(12) Assurance from the home energy vendor that when EHEAP payments made to the
vendor cannot be applied to the elder's account, the funds will be returned to Contractor
or, with Contractor's approval, applied to another eligible customer's account,;
(13) Assurance that the Contractor shall collect a signed Authorization for Release of
General and/or Confidential Information for EHEAP Data from each eligible elder and
ensure the signed releases are available for inspection by the home energy vendor;
(14) Assurance that home energy vendors is aware that as long as signed Authorization for
Release of General and/or Confidential Information for EHEAP Data are collected and
available, the home energy vendor will provide the requested customer date to DEO;
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October 2019 — September 2020 EHEAP 203.19
(15) The agreement will be reviewed by both parties at least every five (5) years;
(16) The agreement must be signed by a representative of both Contractor and the vendor
who has authority to bind the entity and enter into such commitments; and
(.17) The home energy vendor, with the exception of municipal providers, must be in
"active" status with the State of Florida: (http://sunbiz.org/search.html) and the vendor's
name must be checked on Excluded Parties List System (EPLS) (haps://vvww.epls.eov .
The business name on the vendor agreement must match the legal business name on the
State of Florida website.
15. Comply with the Federal Financial Accountability and Transparency Act (FFATA) by securing a
Dun and Bradstreet. Numbering System (DUNS) number (www.dnb.com) and maintaining an
active and current profile in the System for Award Management (SAM) (www.sam.gov); and
166 Based on local need for EHEAP services and other non-EHEAP energy assistance resources in
the service area, Contractor may limit crisis benefits to less than those stated in Section I.C.3.h.
Policy changes concerning the amount of crisis benefits available to elders require Agency
approval and require notification of the change be sent to current and potential elders.
B. STAFFING REQUIREMENTS
1. Use of Subcontractors
If an entity other than the Contractor provides any service required under this contract, the
Contractor shall ensure the following requirements are met:
a. Eligible entities that provide outreach, perform intake, make eligibility determinations, or
process benefit payments must be one of the following:
(1) A Local City Government;
(2) A Local County Government;
(3) A Community -Based Organization;
(4) A Faith -Based Organization; or
(5) A State -Community Services Agency.
b. Entities providing any administrative function under this contract shall provide to Contractor
a list of all individuals performing administrative functions for the EHEAP. The list must
include Subcontractor's employees, agents and representatives serving EHEAP
administratively. For each individual on the list, Subcontractor must also provide the
individual's EHEAP administrative duties and fimction(s). Additionally, Subcontractor must
provide total salary and benefit amounts for each individual on the list, specifying all funding
sources from which that person is paid and the corresponding amounts of that pay charged to
each funding source.
c. For the term of this contract, each month Subcontractor shall provide to Contractor the
following information:
(1) The total number of individuals served with crisis assistance for the reporting month;
(2) The total number of individuals ineligible or denied assistance during the reporting month;
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October 2019 — September 2020 EHEAP 203.19
(3) The total number of individuals served by referral to other community resources for energy
assistance during the reporting month;
(4) The total amount of funding expended for crisis assistance per county for the reporting
month; and
(5) An EHEAP Outreach Activity Report to demonstrate that outreach efforts to inform
potentially eligible households about EHEAP are conducted to target households in all
counties,
d. Entities providing any service required under this contract must comply with the FFATA. This
includes securing a DUNS number (www.dnb.com) and maintaining an active and current
profile in the System for Award Management (SAM) (www.sam.tToy).
e. Entities must maintain current written agreements in the following formats with service
providers:
(I)A MOU shall be executed by both parties if a service provider performs any service
required under this contract and is paid for providing specific services without a direct
pass-through of federal funds. The MOU shall clearly state program expectations and the
role and responsibilities of each entity. The Contractor shall submit a copy of all MOUS
to the Agency's Contract Manager within thirty (30) days of the contract execution date;
and
(2) An EHEAP subcontract shall be executed by both parties if a service provider performs
any service required under this contract and is awarded a direct pass-through of federal
funds to operate the program and provide program services. Contractor shall submit a copy
of all subcontracts to the Agency's ContraetManager within thirty (30) days of the contract
execution date.
f. 'Eligible entities must provide the service provider commensurate compensation for the delivery
of administrative and outreach activities and for the delivery of crisis benefits. Commensurate
compensation of administration and outreach activities shall include cost -reimbursement of
actual expenses or a negotiated rate for specific activities.
g. If any of the work required under this contract is subcontracted, Contractor shall include in the
subcontract that the subcontractor is bound by the terms of this contract, is bound by all
applicable state and federal laws and regulations, and shall hold the Agency and Contractor
harmless against all claims of any nature arising out of the subcontractor's performance of
work under this contract to the extent allowed and required by law.
It. Subcontractor shall not be permitted to perform services related to this contract without an
executed subcontract and an approved Provider Cost Analysis or MOU verifying that
subcontractor's staff is paid from non-federal resources or is compensated for such activities
by EHEAP. In accordance with Sections 25-26 of the Standard Contract, the Agency shall not
be responsible or liable for any obligations or claims resulting from any subcontract.
i. Contractor shall document the subcontractor's progress in performing its work under this
contract in the quarterly report.
j. For each subcontractor, Contactor shall provide a written statement to the Agency regarding
whether that subcontractor is a minority vendor, as defined in Section 288.703, F.S.,
k. If this contact involves the use of a subcontractor or third party, then Contractor shall not
delay the implementation of its agreement with the subcontractor. If any circumstances occur
that may result in a delay of the initiation of the subcontract or in the performance of the
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6Io
October 2019 — September 2020 EHEAP 203.19
subcontractor for a period of sixty (60) days or more, Contractor shall notify the Agency's
Contract Manager and the Agency's Chief Financial Officer in writing of such delay.
C. SERVICE DELIVERY
1. Service Delivery Location
Contractor shall ensure that the services provided under this contract are available to residents
within each county in the Service Area (PSA) by in-person service, telephone, and/or other
electronic means.
2. Service Times
Contractor shall provide the services listed in this contract during normal business hours. Normal
business hours are defined as Monday through Friday, 8:00 a.m. to 5:00 p,m, local time, excluding
holidays, and force maleure.
3. Contractor shall publish its service delivery location, toll-free telephone number, and normal
business homy in available forms of media (i.e, newspapers, radio, television, website, publications,
etc.)
D. DELIVERABLES
1. Deliverables
a. Certification that Contractor must operate during its regular business homy, as identified in
Section II.C.2 of this contract.
b. Contractor shall provide the minimum level of service per month in each county served, as
defined in :Section I.A.16.
2. Source Documentation
The deliverables shall be reported monthly on Contractor's monthly financial status reports.
Successful completion of the deliverables shall be determined by the Agency's receipt of
Contractor's Receipts and Expenditure Report (ATTACHMENT XI) and Request for Payment
(ATTACHMENT XII) containing the number of individuals served with crisis assistance;
number of individuals ineligible or denied assistance; number of applicants served by referral to
other community resources for energy assistance; a summary of fiords expended per county for
the reporting month using the EHEAP Cost Reimbursement Summary form (ATTACHMENT
XXT); and the certification required in Section II, W.
3. Records and Documentation
Contractor will maintain a separate record (paper and CIRTS) for each EHEAP applicant that
includes the following as applicable:
a. The EHEAP Application and Eligibility Worksheet, (ATTACHMENT XVIII), completed
and signed by Contractor and the elder. The application must be approved by a supervisor or
peer prior to payment remittance. Contractor is responsible for using the most recent
application, eligibility worksheet, and EHEAP Application and Eligibility Worksheet
Instructions (ATTACHMENT XIX), issued by the Agency.
(1)If Contractor approves an application, one elderly member of the household must be
registered in CARTS using the EHEAP Application and Eligibility Worksheet
(ATTACHMENT XVIII); or
(2) If Contractor denies an application, the elder must be registered in CIRTS using the
EHEAP Application and Eligibility Worksheet (ATTACHMENT XVIII).
b. The elder' s name, address, sex, and age;
32
October 2019 — September 2020 EHEAP 203.19
c. Names, ages and current identification documentation (no more than one year expired) of all
household members;
d. Social Security numbers and documentation of those numbers for all household members or
the citation to the applicable exemption;
e. Signed notice regarding the collection of Social Security numbers (Notice of Instruction
#07 1 1 1 3-1-1-S W CBS,
f. Income amount and method of verification for all household members;
g. ,Income documentation to support eligibility that is representative of the elder's current
economic situation;
h. Statement of self -declaration of income, if applicable;
i. A signed statement of how basic living expenses (i.e., food, shelter, and transportation) are
being provided if the total household income is less than fitly percent (50%) of the current
Federal Poverty Guidelines and no one in the household is receiving SNAP assistance;
j. Documentation of the elder's obligation(s) to pay an energy bill for the residence in which
they live;
(1) The elder's utility bill must include detail to identify unallowable categories of
assistance resulting from charges for water, sewer, garbage, and fire, etc.; charges
resulting from meter -tampering and returned checks; and other charges that are not
energy-related and are not required for cooling/heating the household,
(2) Use of the most current utility bill(s) which provides the vendor's name and address,
account holder's name and physical address, account number, and amourt(s) due is
required. If an elder's utility bill, cutoff notice, or door -hanger notice or similar
documentation does not include all of this information, Contractor must document the
verified missing information by writing the information on the utility bill and on the
EHEAP Application and Eligibility Worksheet (ATTACHMENT VIII).
k. Signed Authorization for Release of General and/or Confidential Information for LIHEAP/
EFIEAP Federal Reporting or a statement on the application which states that the elder
refused to sign the waiver;
1. Copies of approval or denial letters, including those related to the initial application and all
appeals, which are provided to the elder;
m. If preference is given due to a disability, documentation of such disability that includes
disability income or a physician's statement;
n. Documentation of referrals to LIHEAP and WAP;
o. Notation if EIIEAP prevented a disconnection or restored an energy disruption;
p. Documentation of coordination with IAHEAP providers to avoid duplication of crisis
services for households with elderly residents;
q. Proof of payment made to vendors;
r. Documented of calculation of crisis benefits for elders living in subsidized housing; and
s. Completed EHEAP Client File Content Checklist, (ATTACHMENT XX).
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619
October 2019 — September 2020
E. PERFORMANCE SPECIFICATIONS
EHEAP 203.19
1. Reports
Contractor is responsible for responding in a timely fashion to additional routine and/or special
requests for information and reports required by the Agency. Contractor must establish due dates
for any subcontractor's report that permits Contractor to meet the Agency's reporting requirements.
a. Contractor shall report monthly on Contractor's Request for Payment, (ATTACHMENT
XII) as delineated in Section II.B.I.i, of this contract.
b. Administrative and Outreach Expense Budget Detail
Contractor shall submit by the 9th of the month to the Agency's EHEAP Contract Manager
the EHEAP Administrative and Outreach Expense Budget Detail (ATTACHMENT X). The
Administrative and Outreach Expense Budget Detail shall clearly delineate planned
expenditures for funds retained by the Contractor and funds subcontracted. The
Administrative and Outreach Expense Budget Detail shall include all Contractor positions,
by title, to be paid with these fiords and shall detail the estimated number of hours, the hourly
wage, and the estimated salary to be paid by EHEAP. Funding sources, estimated hours, and
hourly wage shall be identified for the balance of salary where EHEAP funds are used to pay
less than one hundred percent (100%) of the salary. Percentages must be supported by the
submitted cost allocation plan.
c. Cost Allocation Plan
The Contractor shall submit to the Agency's EHEAP Contract Manager the EHEAP Cost
Allocation Plan (ATTACHMENT XXII). The Cost Allocation Plan shall provide budgeting
methodology, allocation distribution, and the data source(s) used.
d. Provider Cost Analysis
State of Florida Chief Financial Officer Memorandum No. 02 (released October 3, 2012),
requires Contractor to provide assistance to the Agency's Contract Manager in completing the
DOEA Cost Analysis for Non -Competitively Procured Contracts in Excess of Category II -
Addendum to the EHEAP Cost Allocation Plan (ATTACHMENT XXII).
('1) The Contractor shall submit a completed Cost Analysis, which shall reflect
Administrative, Outreach, and Crisis Service allocations as delineated on the Budget
Summary (ATTACHMENT IX) and must be sufficient to explain the expenditures'
allowability, allocability, and reasonableness. The Cost Analysis shall be submitted and
approved by the Agency prior to execution of this contract. All subsequent amendments
that affect the budget shall also be submitted to and approved by the Agency prior to any
change.
e. .Monthly Reports
(I) EHEAP Outreach Activity Report
The Contractor shall ensure the use of outreach efforts that will inform potentially
eligible households about EHEAP to the Agency Contract Manager or its designee by
the 9°' of each month along with the county's monthly billing. The EHF.,AP Outreach
Activity Report shall consist of the following:
(i) Date;
(ii) County:
34
October 2019 — September 2020 EHEAP 203.19
(iii) Location Address
(iv) Description of Activity; and
(v) Name and Position of Staff
(2) Surplus/Deficit Report—Lead Agency Spending Report
The Contractor shall submit a Consolidated Surplus/Deficit Report, Lead Agency
Spending Report, in a format provided by the Agency, to the Agency Contract Manager
by the 18th of each month. This Consolidated Surplus/Deficit Report is for all
agreements and contracts between the Contractor and the Agency and must include the
following:
(i) A list of all contracts and their current status regarding surplus/deficit;
(ii) The Contractor's detailed plan on how the surplus/deficit spending exceeding the
threshold specified by the Agency will be resolved;
(iii) Recommendations to transfer funds within the PSA to resolve surplus/deficit
spending; and
(iv) Input from the Agency's Board of Directors on resolution of spending issues, if
applicable;
f. Quarterly Reports
EHEAP Summary Report
Contractor shall ensure timely and accurate CIRTS data entry of EHEAP activity and submit
to the Agency's EHEAP Contract Manager or designee the service report entitled, "EHEAP
SUMMARY," from CIRTS. The report shall reflect the use of EHEAP in your county(s) in
the PSA and shall be inclusive of all elders applying for crisis energy assistance during the
reporting quarter.
The CIRTS EHEAP Summary Report shall be submitted based on the following schedule:
REPORT
REPORTING PERIOD
SEASON
DATE DUE TO
AGENCY
1
10/01/19 — t2/31/19
Heating Season
January 09, 2020
2
01/01/20 — 03/31/20
Heating Season
April 09, 2020
3
04/01/20-06/30/20
Cooling Season
July 09, 2020
4
07/01/20 — 09/30/20
Cooling Season
October 09, 2020
The EHEAP Summary Report parameters for the program year shall be:
(i) PSA;
(ii) All Providers;
(iii) Your Location;
(iv) EHEAP;
(v) All Cities;
35
October 2019 — September 2020
EHEAP 203.19
(vi) Poverty Line $12,140;
(vii) Each Additional Household Members $4,320; and
(viii) Current Reporting Period.
g. Program Effectiveness Reports
The Contractor agrees to provide the Agency any additional service reports requested by the
Agency concerning the effectiveness of the program and shall include any statistics and
information that the Agency may require. The reporting period shall begin with the effective
date of this contract in a format and according to a schedule provided by the Agency for each
report.
2. Monitoring and Evaluation Methodology
Contractor shall monitor its performance under this contract as swell as that of its subcontractors,
subrecipients and consultants who are paid from funds provided under this contract to ensure that
the scope of work is accomplished within specified time periods and budgets set and that other
performance goals stated in this contract are achieved. Such review shall be made for each function
or activity set forth in this contract and reported in the quarterly report.
a. Contractor shall review completed EHEAP applications in accordance with the EHEAP Client
File Content Checklist (ATTACHMENT XX).
b. The Agency shall, at its own discretion, conduct investigations concerning any aspect of
Contractor's performance of this contract.
c. The Agency shall conduct a full onsite review of Contractor at least once during each three-year
period. Contractor shall allow the Agency to carry out monitoring, evaluation, and technical
assistance, and shall ensure the cooperation of its employees, and of any subcontractors with
whom Contractor contracts to carry out program activities.
d. The Agency shall conduct desk review activities throughout the year to monitor contractual
program requirements.
e. The Agency shall conduct EHEAP intake site visits.
f. In conjunction with onsite monitoring visits and desk review activities, the Agency shall review
a sample of completed EHEAP client files in accordance with the EHEAP Client File Content
Checklist, (ATTACHMENT XX).
g. The Agency shall conduct follow-up reviews including prompt return visits to Contractors that
fail to meet the goals, standards, and requirements established by the state and federal funding
agency.
3. Program Highlights
The Contractor shall submit Program Highlights referencing specific events that occurred in
SFY/FFY 2018-2019 by August 30, 2019. The Contractor shall provide a new success story, quote,
testimonial, or human -interest vignette, The highlights shall be written for a general audience, with
no acronyms or technical terms. For all agencies or organizations that are referenced in the
highlight, the Contractor shall provide a brief description of their mission or role. The active tense
shall be consistently used in the highlight narrative, to identify the specific individual or entity that
performed the activity described in the highlight.
36
October 2019 — September 2020
4. Outreach Plan Survey
EIIEAP 203.19
Contractor shall submit to the EHEAP Contract Manager the EHEAP Outreach Plan Survey
(ATTACHMENT XVII). The purpose of the Outreach Plan Survey is to delineate all activities
and efforts for the program year. The EHEAP Outreach Plan Survey is due within thirty (30) days
of the contract execution date.
5. Within three months of execution of this contract, Contractor shall provide the Agency a list of
all individuals performing any administrative functions for the EHEAP. The list must include
Contractor's employees, agents, and representatives, as well as all employees, agents, or
representatives of subcontractor(s) or sub-subcontractor(s) serving EHEAP administratively. For
each individual on the list, Contractor must also provide the individual's EHEAP administrative
duties and function(s). Additionally, Subrecipient must provide total salary and benefit amounts
for each individual on the list, specifying all funding sources from which that person is paid and
the corresponding amounts of that pay charged to each funding source.
6. For the term of this contract, each month Contractor shall provide to the Agency, by the 901 of each
month for the preceding month, the following information will be entered on ATTACHMENT
XII, Request for Payment, under Part D: Service Information
(i) The total number of individuals served with crisis assistance for the reporting month;
(ii) The total number of individuals ineligible or denied assistance during the reporting
month;
(iii) The total number of individuals served by referral to other community
resources for energy assistance during the reporting month; and
(iv) The total amount of funding expended for crisis assistance per county for the
reporting month.
F. CONTRACTOR RESPONSIBILITES
I. Make vends» • payments directly to fuel and/or home energy providers on behalf of eligible elders.
2. Determine the correct amount of each crisis benefit based on the minimum necessary amount
needed to resolve the crisis, but not more than the item limits or total limit set by the Agency. The
maximum crisis benefit for this contract period is $600.00 per household per season.
3. Encourage households to seek assistance prior to incurring non -energy penalties such as
disconnect/reconnect fees, additional deposits, interest or late payments.
4. Provide EHEAP crisis services to households with elders in every city within the service area.
a. Contractor shall ensure that each city within their service area receives a minimum level of
crisis services monthly, as delineated in Section T.A.16.;
b. EI3EAP funded staff shall make themselves available in all underserved counties as needed,
to ensure that the minimum level of servicers met; and
c. Contractor shall provide oversight to ensure that the minimum level of service is provided
monthly in each city in Contractor's service area.
5. Make crisis benefit payments to vendors on behalf of approved elders within forty-five (45) days
of the date of crisis resolution.
6. Make payments on behalf of those elders with the highest home energy needs and the lowest
household income, which will be determined by taking into account both the energy burden and
37
October 2019 — September 2020 EHEAP 203.19
the unique situation of households that result from having members of a vulnerable population,
including very young children, the disabled, and frail elders.
7. Refund to the Agency, with non-federal Rinds, all funds incorrectly paid on behalf of elders that
cannot be collected from the elder.
8. Develop adequate procedures to ensure EIIEAP funds are appropriately budgeted and expended
to permit payment of energy assistance benefits in both the heating and cooling seasons, ensure
that this is a twelve- month program, and ensure that funding is available to and expended in, all
counties within Contractor's service area. Procedures should include referral to other community
agencies when funds budgeted for a particular time period are exhausted and elders are
subsequently denied.
9. Develop monitoring and oversight procedures to ensure that administrative costs that exceed the
contracted EHEAP administrative award to Contractor or Subcontractor are paid from non-federal
sources.
IO.Develop adequate procedures to address the use of EILEAP finds for elders who are on oxygen
support or a "Lifeline Program" and must have power.
11. Develop a written policy regarding the use of funds for repairing or replacing heating or cooling
equipment. The procedures must address the conditions under which an elder is eligible for such
funds and what constitutes an emergency related to lack of heating or cooling.
12. Ensure providers and appropriate staff participate in training opportunities scheduled by the
Agency to cover EHEAP policies and procedures.
13 Ensure the provision of training for all providers and staff members assigned responsibilities
within the program.
14 Maintain an EHEAP Policies and Procedures Manual to serve as a local resource for program
administration, training, and reference. The EHEAP Policies and Procedures Manual shall be
distributed to all subcontractors that provide any service under EHEAP. The EHEAP Policies and
Procedures Manual shall be reviewed during, and in accordance with, the Agency's EHEAP
contract monitoring schedule, and shall include the following:
a. The State of Florida LIIIEAP Policies and Procedures Manual;
b. An MOU or Subcontract with EIIEAP providers;
c. An MOU with all service area L IHEAP providers;
d. An MOU with all service area WAP providers;
e. Contractor's cost allocation methodology;
f. Written policies and procedures to ensure that all energy assistance payments made to home
energy vendors comply with the requirements of the Vendor Agreement;
g. Adequate procedures to ensure that EHEAP funds are appropriately budgeted and expended
to sufficiently allow for energy assistance benefits in both the heating and cooling seasons,
ensure that this is a twelve- month program, and to ensure that funding is available to, and
expended in, all counties within Contractor's service area;
Ii. Policies regarding the detection and prevention of fraud and abuse of program funds;
i. Policies that address serving family members and employees;
38
October 2019 — September 2020 EHEAP 203.19
j. Policies and procedures to secure applicant Social Security Numbers, in order to protect
applicants' identities;
k. Procedures for computer system backup and recovery;
1. Procedures for referral or access assistance to the "Lifeline Program';
in, A policy outlining the criteria to determine if a household has a "home energy crisis" and the
information and/or documentation required to verify the crisis;
n. Policies and procedures for determining the eligibility of elders applying for F.,HEAP;
o. Policies which encourage households to seek assistance prior to incurring non -energy
penalties such as disconnect/reconnect fees, additional deposits, interest, or late payments;
p. Procedures referring elderly homeowners who have received more than three energy benefits
(EHEAP or LIHEAP) in the last eighteen (18) months to the WAP provider;
q. A policy concerning the use of fonds for the purchase or repair of heating or cooling
equipment;
r. Policies and procedures which detail allowable timeframes for elders to submit required
documentation, if missing at the time of application;
s. A resource guide, or the utilization of the Information and Referral database (ReferNET), to
access other energy assistance resources available at the local level to provide referrals to
elders when EHEAP Funding is not available or they do not qualify; or contacting the Area
Agency's Elder Help Line for resources.
t. Consumer appeal procedures that provide an opportunity for a fair administrative hearing at
the provider level to elders whose applications for assistance are denied, or whose applications
are not acted upon with reasonable promptness; and
u. Policies and procedures for conducting home visits to home -bound elders for completion of
the program application or eligibility determination when other assistance is not available.
15 Notwithstanding that tasks for which the Contractor is held accountable involve coordination with
other entities in performing this contract, the failure of other entities does not alleviate the
Contractor from any accountability for tasks or services that the Contractor is obligated to perform
pursuant to this contract.
G. AGENCY RESPONSIBILITIES
1. The Agency may provide technical support and assistance to Contractor within the resources of
the Agency to assist the Contractor in meeting the requirements of this contract. The support and
assistance, or lack thereof, shall not relieve Contractor from full performance of contract
requirements.
2 The Agency will provide to Contractor the State of Florida LIHEAP Policies and Procedures
Manual. The State of Florida LIHEAP Policies and Procedures Manual will provide information
and procedures needed to administer EHEAP in Florida.
a. This contact excludes all provisions of the State of Florida LIHEAP Policies and Procedures
Manual in reference to LIHEAP Regular Home Energy Annual Benefits.
b. To the extent any conflict arises between this contact and any incorporated reference
contained herein, this contract shall have precedence.
39
October 2019 — September 2020
III. METHOD OF PAYMENT
A. PAYMENT METHOD USED
EHEAP 203.19
The Method of Payment for this contract is a combination of 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, Manner
of Service Provision, and in accordance with other terms and conditions of this contract.
L Cost Reimbursement
The Contractor agrees to distribute funds as detailed in the Budget Summary (ATTACHMENT
IX), attached to this contract. Any change in allocation of categorical or total amounts of funds
identified on the Budget Summary form require a contract amendment. ,Payment may be
authorized only for allowable expenditures, which are in accordance with the limits specified in
ATTACHMENT IX. All Cost Reimbursement Requests for ,Payment must include the actual
Receipts and Expenditure Reports beginning with the first month of this contract.
a. Budget Summary
Contractor agrees to implement the distribution of funds as detailed in the Budget Summary
(ATTACHMENT IX). An amendment is required to change category allocations or the total
amount of this contract.
(1) Administrative Expense
Administrative expenses include costs for general administration and coordination of the
program, including direct and indirect costs. This includes the salaries, fringe benefits (i.e.
insurance, retirement, etc.), rent, utilities, travel, etc, associated with financial and
administrative management of the program. The use of other federal funds to supplement
the administrative operations of EHEAP, above and beyond the budgeted amount, is
prohibited. Administrative costs that exceed the contracted EHEAP administrative award
to Contractor or subcontractor must be paid from non-federal sources. Contractors must
have adequate procedures for monitoring and oversight to ensure compliance.
(2) Outreach Expense
Outreach expenses are those costs incurred in delivering EHEAP services that are not
purely administrative in nature. This may include staff and subcontractor expenses such as
salaries, fringe benefits (i.e. insurance, retirement, etc.), rent, utilities, travel, etc. for those
employees performing outreach and intake, and any subcontractor expenses. Outreach
expense shall not include senior management expense, unless outreach and intake involving
direct contact with elders occurs. Documentation to support this exception shall be
maintained by Contractor and available upon request.
b. Weather/Related Supply Shortage
Weather Related/Supply Shortage funds are a set-aside for emergency assistance. These funds
must be held in this budget line item category until December 15°i of the program year, for use
in response to a possible disaster. These funds shall only be used during state or federal
emergencies declared officially by the President of the United States, the Governor of the State
of Florida, or the Executive Director of DEO. In the event of an emergency being officially
declared, if Contractor or the Agency finds that the budgeted amount of Weather
40
October 2019 — September 2020 EHEAP 203.19
Related/Supply Shortage emergency assistance funds is not sufficient to meet the emergency,
Contractor may, with the Agency's written authorization, draw on other contract categories up
to fifty percent (50%) of the total contract budget. When funds are distributed for a weather-
related/supply shortage emergency, the Agency will provide binding directives as to the
allowable expenditures of the funds. After December T5, if no emergency has been declared,
the Agency will release the funds and Contractor shall allocate these finds to the crisis category
of the program.
e. Indirect Cost Rate
Per 2 C.F.R.§ 200.331(a)(4), Subrecipients of federal awards are required to have an approved,
federally recognized indirect cost rate, negotiated between the Subrecipient and the Federal
Government. If no such rate exists, then the Subrecipient shall have either a rate negotiated
with DOEA (in compliance with 2 C.F.R.Tart 200), or a de minimal indirect cost rate as
defined in 2 C.F.R. § 200.4140. Subrecipient shall maintain its current Indirect Cost Rate
Proposal and make the proposal available upon request. If Subrecipient chooses to use the de
minimal rate, Subrecipient shall make sure it is entitled to use that rate and include a statement
to that effect. Subrecipient is not obligated to establish an indirect cost rate if Subrecipient
does not charge an indirect cost rate.
2 Advance Payments
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 ofFlorida
("budget release"). Contractor's requests for advance payments require the written approval of the
Agency's Contract Manager. For the first month's advance request, Contractor shall provide the
Agency's Contract Manager documentation justifying the need for an advance and describing how
the funds will be distributed. If sufficient budget is available, and the Agency's ContaetManager,
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 October 1, 2019.
a. Any advance payment the Contractor requests for subcontractors must be distributed within
seven days of receipt of payment from the Agency. The Contractor shall submit to the Agency
documentation to support full distribution of advance funds with report number 5, due to the
Agency on January 9, 2020, in accordance with the Invoice Report Schedule,
(ATTACHMENT XIII), to this contract.
b. All advance fluids requested for the Contractor must be fully expended no later than December
15, 2019. Any amount of advance payments not fully recouped on the Request for Payment
starting with Receipts and Expenditure Report number 5, due to the Agency on January 9,
2020, in accordance with the Invoice Report Schedule, (ATTACHMENT XHI), attached to
this contract.
e. 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 Receipts and Expenditure Repoli number 5, in
accordance with the Invoice Report Schedule, (ATTACHMENT XIII), attached to this
contract.
d. Interest earned on advances must be identified separately by source of fluids, state or federal.
Contractor shall maintain advances of federal fluids in FDIC interest bearing accounts, unless
an exception is made in accordance with 45 CFR Part 75. Interest earned in excess of
41
October 2019 — September 2020
EHEAP 203.19
$250 per year on Federal cash balances shall be returned to the Agency at the end of each
quarter of the contract period.
B. All payment requests shall be based oil actual monthly expenditures beginning with the first month
of this contract. The schedule for submission of advance requests and requests for payment is in
ATTACHMENT XIII to this contract.
C. The final request for payment is due to the Agency no later than October 15, 2020.
D. METHOD OF INVOICE PAYMENT
Payment shall be made upon Contractor's presentation of an invoice subsequent to the acceptance and
approval by the Agency of the deliverables on the invoice. The form and substance of each invoice
submitted by Contractor shall be as follows:
I. Have Remittance Address that corresponds exactly to the "Remit To" address provided to My
Florida Marketplace (MFMP) during registration;
2 Request payment for services as established in the Service Rate Report (ATTACHMENT
XXIII);
3 Contractor shall consolidate all Requests for Payment from subcontractors and Receipts and
Expenditure Reports that support requests for payment and shall submit them to the Agency using
Receipts and Expenditure Report (ATTACHMENT XI), Request for Payment
(ATTACHMENT XII), and Cost Reimbursement Summary (ATTACHMENT XXI);
4. Contractor shall include requiring supporting documentation as delineated in Section III. F. with
the cost reimbursement portion of the invoice.
E. PAYMENT WITHHOLDING
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt
and approval by the Department of all financial and programmatic reports due from the Contractor
and any adjustments thereto, including any disallowance not resolved.
F. SUPPORTING DOCUMENTATION REQUIREMENTS
For the reporting month, Contractor shall include the following with Request for Payment:
L 'file number of individuals served, that include:
a. The number of individuals served with crisis assistance during the reporting month;
Ii. The number of individuals ineligible or denied assistance during the reporting month;
e. The number of individuals referred to other community resources for energy assistance
during the reporting month;
2 Certification that Contractor operated during its normal business hours during the reporting month;
and
a The total amount of funding expended for crisis assistance per county for the reporting period;
G. FINANCIAL CONSEQUENCES
Failure to meet the deliverables described in this contract may result in a financial consequence and
may result in the redistribution of fimding. Contractor shall ensure the provision of services and the
successibl completion of deliverables as set forth in this contract.
42
October 2019 — September 2020 EHEAP 203.19
1 The Agency shall not reimburse any expenditures associated with Deliverables not accepted by
the Agency as successfully completed; however, this does not preclude Contractor :from receiving
payment for such expenditures upon successful completion of the deliverable.
2 If Contractor fails to be open and available for services according to its regular business hours as
identified in Section II.C.2 of this contract, excluding weekends or state and federal holidays,
Contractor shall pay to the Agency financial consequences for such failure, unless the Agency
waives such failure in writing based upon its determination that the failure was due to factors
beyond the control of Contractor.
* Contractor's failure to operate according to its regular business hours shall result in an assessment
of a financial consequence in the amount of $10.00 per day.
4 Any amounts due from financial consequences shall be paid by Contractor out of nonfederal funds.
H. REMEDIES -NONCONFORMING SERVICES
Contractor shall ensure that all participants served under this contract are eligible for the program and
that all monthly and/or quarterly performance reports and financial records are maintained for each
reporting period and submitted as stipulated in this contract.
1 Any nonconforming program service, performance report, or financial record not meeting the
aforementioned requirements is not eligible for reimbursement under this program. Contractor
shall solely bear the costs associated with enrolling, training, reporting and/or managing the
program. Contractor shall give immediate notice to the Agency of any significant and/or systemic
infraction that compromises Contractor's ability to provide participant services, to achieve
programmatic performance, or to provide sound financial management of the program.
1, CONSEQUENCES FOR NON-COMPLIANCE
Contractor shall ensure one hundred percent (100%) of the deliverables identified in this contract
are performed pursuant to contract requirements, and as described in Section II.D. are identified as
major deliverables in this contract.
1. If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to
correctly, completely, or adequately perform these major deliverables, the Contractor will have
ten (10) days to submit a Corrective Action Plan (CAP) to the Contract Manager that addresses
the deficiencies and states how the deficiencies will be remedied within a time period approved
by the Contract Manager. The Agency shall assess aFinancial Consequence forNon-Compliance
on the Contractor 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. if Contactor fails to timely submit a CAP, the Agency shall deduct 1% of the monthly
value of the administrative funds in the contract for each day the CAP is overdue, beginning the
I I" day after notification by the Contract Manager of the deficiency. The deduction will be made
from the payment for the invoice of the following month.
2 In the eventthat Contractor fails to correct an identified deficiency within the approved time period
specified in the CAP, the Agency shall deduct, from the payment for the invoice of the following
month, 1% of the monthly value of the administrative finds in the contract for each day the
deficiency is not corrected. The Agency may also deduct, from the payment for the invoice of
the following month, t% of the monthly value of the administrative funds in the contract for
each day the Contractor fails to timely submit a CAP.
43
October 2019 — September 2020 EIIEAP 203.19
IV. SPECIAL PROVISIONS
A. The following is incorporated by reference:
1. State of Florida LIHEAP Policies and Procedures Manual,
B. Modifications
The Agency shall not be obligated to reimburse Contractor for expenditures in excess of the funded
amount of this contract unless and until the Agency officially approves such expenditures by
executing a written modification to the original contract. signed by both parties.
1. Contractor must use an Agency approved budget modification process.
2 For the purpose of transferring funds, the following are considered budget categories
(1) Administrative, (2) Outreach, and (3) Crisis Assistance.
END OF ATTACHMENT
44
October 2019 — September 2020
FINANCIAL AND COMPLIANCE AUDIT
EHEAP 203.19
ATTACHMENT II
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 as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with 2 CFR Pail 200 (formerly OMB Circular A-133 as revised),
and Section 215.97, KS., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits
by the Agency and/or Department staff, limited scope audits 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
and/or Department. In the event the Agency and/or Department determines that a limited scope audit of the
Contractor is appropriate, the Contractor agrees to comply with any additional instructions provided by the Agency
and/or Department 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 Agency's Director of Program and Planning.
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
a n d C o m p l i a n c e A u d i t A T T A C H M E N T 11, EXHIBIT 2 to this agreement 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. 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 agreement with the Agency in effect daring 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.
45
PART IIe STATE F1�DED 2020
EHEAP 203.19
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 Chapter 10.550
(local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.
ATTACHMENT 11, EXHIBIT 2 to this agreement 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 nonstate 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 I1, 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 audit must be
paid fiom 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
69I-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. For local governmental entities, 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 non-profit or for-profit organizations, financial reporting
packages required under this part must 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 financial 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 submitted, when required by 2 CFR § 200.512 by or on behalf
of the Contractor directIV to each of the following:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 101i Street
Jeffersonville, IN 47132
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.
46
r::
October 2019 — September 2020 EHEAP 203.19
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: Ken Carr, CFO
15201 N Cleveland Ave., Suite 1100
North Fort Myers, FL 33903
Additionally, copies of financial reporting packages required by PART II of this contract's Financial and Compliance
Audit Attachment shall be submitted by or on behalf of the Contractor directlyto 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: Ken Carr, 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 Sheet
Tallahassee, Florida 32399-1450
Any reports, management letters, or other information required to be submitted to the Agency pursuant to this agreement shall
be submitted timely in accordance with 2 CFR Part 200, F.S., and Chapter 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 Chapter 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 agreement 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.
47
October 2019 — September 2020
EHEAP 203.19
ATTACHMENT H -EXHIBIT 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 I are met. Contactors 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.
NOTE: 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 69I-5006, F.A.C. [state
financial assistance] and/or 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
48
October 2019 — September 2020
EHEAP 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 recipienUsub-recipient must comply with the following fiscal laws, rules, and regulations:
Section 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
49
October 2019 — September 2020
FUNDING SUMMARY
EHEAP 203.19
ATTACHMENT II—EXHIBIT 2
Note: Title 2 CFR, as revised, and Section 215.97, F.S., require that the information about Federal Programs
and State Projects included in ATTACHMENT II—EXHIBIT I, be provided to the recipient. Information
contained herein is a prediction of funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CO NTR A ('T (-nNSiST (1F THE F(N.i.OWING-
GRANT AWARD (FAIN#): 17EA-OF-13-00-16-003 FEDERAL AWARD DATE: April 1, 2019
DUNS NUMBER: 076997790
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Emergency Home Energy Assistance
for the Elderly Program
United States Department of Health
and Human Services
93.568
EHEAP
Collier
93.568
$ 73 218.87
TOTAL FEDERAL AWARD
$ 73 218.87
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Pail 200 — Uniform 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:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
ANN1N 1 A1NCL
JISl,11V 1N Z13.7/. P.J.
I PROGRAM TITLE I FUNDING SOURCE I CSFA I AMOUNT
AL A
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE.
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
50
October 2019 — September 2020
CERTIFICATIONS AND ASSURANCES
EHEAP 203.19
ATTACHMENT III
DOEA will not award this contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In
performance of this contract, Contactor provides the following certifications and assurances:
a. Debarment and Susnension Certification R Part 95 andL Part 75)
1 1 I Regarding1 I ' CFR Part ' 45 [ Part '
c. Nondiscriminaflon & Filual1 1 1 9 CFR Part 37 and 45 CFR' : 1
/. Certification Regarding"llic EntJU Crimes. Section
e. Assoceation of Coin m u njL� Organizations for Reform Now (ACORN) Fundi n i! Restrictions Assu ran ce (Pub.
L Scrutinized Companies Lists and No Boycott of Israel Certification Section 287.135. F.S.
OFIR11 M, 11 k"+ !In=P711111 \ 1111 rMlITO r1WQ 11 F MIMN =1IT = 1 110•
1
111 I 1 1'1 1
' 1 1 IT11,11111K411, 1011
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:
1. 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 contact 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, falsification 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 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 certification accordingly.
51
October 2019 — September 2020
EHEAP 203.19
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
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 at all
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 CFR 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 -financially 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
Department and/or 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 Ns 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 Agency 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
52
October 2019 — September 2020
EHEAP 203.19
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.
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 cant' 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 Area Agency and DOEA immediately upon any change
of circumstances regarding this status.
E. ASSOCIATION OF C O M M U N I T Y 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 engaged 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 is not
engaged in 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.
53
October 2019 — September 2020 EHEAP 203.19
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS,
GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
1. The Contractor and any Subcontractors of set -vices under this contract have financial management systems
capable of providing certain 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
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 clup technology,
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 immediately make
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 set -vice delivery to continue in case of an emergency, including emergencies
arising from data integrity compliance issues.
H. 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 set -vices 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 transaction imposed by
Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A -I 10).
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.
54
October 2019 — September 2020 EHEAP 203.19
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of Sections 10 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 Department and state agencies or sub divisions defined in section 768.28(2), F.S.
2. Section 119.0 1(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 entitywhich 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 X 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 signinygg below, Contractor certifies the epresentations outlined in parts A through J above are true and correct.
STEPHEN Y'CARNELL 3339 TAMIAMI TRAIL E. SUITE 212
(Signature and Title of Authorized Representative)
COLLIER COUNTY BOARD OF COMMISSIONERS
(Contractor) 1 O I 5-1 A (Date)
55
(Street Address)
NAPLES FL 34112
(City, State, ZIP code)
0�1
October 2019 — September 2020 EHEAP 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.
PIN ARF. nn NOT RFTYMN VOIiR C'OMPI NTFn FORM TO TAF. OFFiC'F, 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 CY R. 900, Subpart F).
6 Will comply with all federal statues 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) Sections 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) Titte 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 0) 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 in purchases.
56
October 2019 — September 2020 EHEAP 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 (EO) 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.
SIF AUTHORIZED TIFYING OFFICIAL TITLE
n �
STEPHEN Y CAJ&ELL UBLIC SERVICES -DEPARTMENT HEAD
APPLICANT ORGANIZATION DATESUBMITTED
COLLIER COUNTY BOARD OF COMMISSIONERS I C' I "�-I Iq
Approved as to form and legality
q `x.40
As ' Stant County Attu a q '\ N
�,O
October 2019 — September 2020 X"i1'APC9WNT V
Ri "DTnA IIRPADTMRNT (ITi RI ]IRR AFFAIR. ("MI. RT(_FIT.0 (YIMPI.IANCF. CHF.CK1JST
Program/Facility Name
County
AAA/Contractor
Address
Completed By
City, State, Zip Code
Date
Telephone
PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of set -vice provided:
For questions 2-5 please indicate the foll
2. Population of area served
Total %
owing: White Black Hispanic I Other
Female Disabled Over 40
Source of data:
NO
❑
3. Staff currently employed
4. Clients currently enrolled/registered
Effective date:
5. Advisory/Governing Board if applicable
PART II: 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 DOER?
N/A
El
YES
NO
❑
7. Compare the staff composition to the population. Is staff representative of the population?
N/A
El
YES
NO
❑
8. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national
origin, sex, age, religion or disability?
N/A
El
YES
El
NO
1:19.
Are all benefits, services and facilities available to applicants and participants in an equally effective manner
regardless of race, sex, color, age, national origin, religion or disability?
N/A
E]❑
YES
NO
E]10.
For in-patient services, are room assignments made without regard to race, color, national origin or disability?
N/A
11
YES
NO
❑
11. Is the program/facility accessible to non-English speaking clients?
N/A
1:1❑
YES
NO
❑
12 Are emplo ees, applicants and participants informed of their protection against discrimination? If YES, how?
Verbal Written❑ Poster❑
N/A
El
YES
El
NO
El
58
n
C��
October 2019 — September 2020 EHEAP 203.19
59
1
Reviewed by
13. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility.
N/A
❑
NUMBER
Date
Telephone Response Due
On-Sit,0 Desk Review
Response Received
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
EXPLAIN.
15, Has as a self-evaluation been conducted to identify any barriers to serving disabled individuals and to make any YES
necessary modifications? ❑
NO,
NO
❑
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
the basis of disability?
YES
❑
NO
❑
19. Are auxiliary aids available to ensure accessibility of services to hearing and sight -impaired individuals?
YES
❑
NO
❑
PART IV: FOR PROGRAMS OR FACILITIES WITII 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $5D,000.00 OR MORE.
20. Do you have a written affirmative action plan? HNO, explain. YES
❑
NO
❑
59
1
Reviewed by
In Compliance: YES LJ NO* LJ
Program Office
*Notice of Corrective Action Sent
Date
Telephone Response Due
On-Sit,0 Desk Review
Response Received
59
October 2019 — September 2020 EHEAP 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, sex, disability, and over the age of 40. 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 IndiardAlaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex, disability, and over the age of 40. 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, disability, and over the age of 40. Include the date that enrollment was counted.
a, 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.
S. Enter the total number of advisory board members and their percent by race, sex, disability, and over the age of
40. 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 Part 80. This is usually a standard part of
the contract language for 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. 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 set -vices or employment. 45 CFR § 80.3 (a)
and 45 CFR § 80.1.
9. 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).
10. 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).
11. 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
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).
60
October 2019 — September 2020 EHEAP 203.19
12. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries, or any other interested parties. 45 CFR § 80.6(d)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 the Florida Department of Elder Affairs or the U.S. Department of Health and Human Services. 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.
13. Report number of discrimination complaints filed against the program/facility. Indicate the basis, (e.g,, race, color,
creed, sex, age, national origin, disability, and/or retaliation) and 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 of the complaint ( e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate,
under review, etc.).
14. The program/facility must be physically accessible to mobility, hearing, and sight -impaired 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, and information and admissions
offices should be accessible. Door widths and traffic areas of adnimishative 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.
15. 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. Evaluate, with the assistance of disabled individuals(s)/organization(s), current policies and practices that do not
or may not comply with Section 504;
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate the effects of any discrimination that resulted from adherence to these policies
and practices; and
d. Maintain self-evaluation on file, including a list of the interested persons consulted, a description of areas
examined, and any problems identified, and a description of any modifications made and of any remedial steps
taken 45 CFR § 84.6. (This checklist may be used to satisfy this requirement if these four steps have been
followed.).
16. Programs or facilities that employ 15 or more persons shall adopt grievance procedures that incorporate appropriate
due process standards that provide for the prompt and equitable resolution of complaints alleging any action
prohibited by Part 84 of Title 45, CFR § 84.7(b).
17. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Part 84 of Title 45 CFR § 84.7(a).
18. Programs or facilities that employ 15 or more persons shall take appropriate initial and continuing steps to notify
participants, beneficiaries, applicants, and employees that the program/facility does not discriminate on the basis of
handicap in violation of Section 504 and Part 84 of Title 45, CFR. Methods of initial and continuing notification
may include the posting of notices, publication in newspapers and magazines, placement of notices in publications
of the programs or facilities, and distribution of memoranda or other written communications. 45 CFR § 84.8(a).
19. Programs/facilities that employ 15 or more persons shall provide appropriate auxiliary aids to persons with impaired
sensory, manual or speaking skills where necessary to afford such persons an equal opportunity to benefit from the
service question. Auxiliary aids may include, but are not limited to, brailed and taped materials, interpreters and other
aids for persons with impaired hearing or vision. 45 CFR § 84.52(d).
20. 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 Part
60 and Title VI of the Civil Rights Act of 1964, as amended.
61
October 2019 — September 2020
utas —rat->ni cit 1
l
I
`ELDER;
AFFSTATE AIRS
EHEAP 203.19
ATTACHMENT VII
BACKGROUND SCREENING
BACKGROUND SCREENING
Affidavit of Compliance - Employer
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 §4
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
SVeetAddress City. State ZIP code
I, 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 background screening.
Signature of Representative
STATE OF FLORIDA, COUNTY OF
Sworn to (or affirmed) and subscribed before me this _ day of
to me or produced
Pdnq Type or Stamp ('nmmisslPned Namn.ol Notary Public
20_, by
(Name of Representative) who is personally known
Notary Public
as proof of identification.
DOEA Form 235, ArfidaNt of Compllaxe - Employor. Eff cU a April 2012 Section 435.05(3), RS
Form available at: btb9rmlde,,Ha,L�t" fl =/e,erfILb�' imndw'ee111rs{ l
62
October 2019 — September 2020 EHEAP 203.19
ATTACHMENT IX
ANNUAL BUDGET SUMMARY AND DETAIL
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
for
Collier County Board of County Commissioners
Collier
EHEAP ADMINISTRATION BUDGET $ 6,110.19
EHEAP OUTREACH BUDGET
$ 10,295.01
EHEAP CRISIS ASSISTANCE
$ 56,813.67
TOTAL
$ 73,218.87
Projected minimum number of individuals to be sewed
Energy Assistance*
204
*Eligible households may be provided with one benefit per season up to six hundred dollars per benefit. The
minimum number of consumers may reflect duplicated consumers if a consumer receives a benefit in both
seasons.
63
October 2019 — September 2020
EREAP 203.19
ATTACHMENT X
EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL
PSA CONTRACT #
Emerqency Home Enerqy Assistance Program
Administrative & Outreach Expense Budget Detai
WIN
MENMUE
50.00
$0.00
SO.00
50.00
S(to()
S0.00
50.00
50.00
S0.00
50.00
50.00
S().00
$(),00
r ----------
SO.00
50.00
SO.00
S0,00
SO.00
5t 00
sT) (TO
S0.00
S0,00
$0,00
Administration Subtotal $
-
Outreach Subtotal $
Totul $ -
64
October 2019 - September 2020
EHEAP 203.19
ATTACHMENT X1
RECEIPTS AND EXPENDITURE REPORT
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source:
THIS REPORT PERIOD
FROM:
EHEAP
CONTRACT
(Emergency Home Energy
PERIOD: 10/01119.09130/20
Assistance for the Elderly Program)
CONTRACT # HP019
REPORT#
PSA# 8
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
To the best of my knowledge, all CIRTS is acccurate and correct.
Prepared by : Date : Approved by : Date:
PART A: BUDGETED INCOMEI RECEIPTS
I. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Agreement Amount
$0.00
$0.00
$0.00
#DIV/01
2. Interest on Agreement Funds
$0.00
$0.00
$0.00
0.00%
3. TOTAL AGREEMENT AMOUNT
$0.00
$0.00
$0.00
#DIV/0i
PART B : EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Administration
$ -
$0.00
$0.00
#DIV/01
2. Outreach
$ -
$0.00
$0.00
#DIV/01
3. Crisis Services
$ -
$0.00
$0.00
#DIV101
4. Weather Related Services
$ -
$0,00
$0.00
#DIV/01
5. Weather Related Administration
$ -
$0.00
$0.00
0.00%
6. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
#DIV/01
DOEA FORM 105p revised 12/08
65 a'
C�_
October 2019 - September 2020
EHEAP 203.19
ATTACHMENT XII
REQUEST FOR PAYMENT
REQUEST FOR PAYMENT
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
Contract# HP019
CONTRACTOR NAME, ADDRESS, PHONE# and FEIO#
TYPE OF REPORT :
Request Period
_
PSA# a _.. _...
Advance Request
Report#
Contract #_HP019
Reimbursement Request X
Contract Period _ 10101119-05130120
CERTIFICATION: I hereby certify thattrus request to the best of my knowledge to be complete and correct and conforms with the terms of the above contract. .
To the best of my knowledge, all CIRTS Is accurate and correct
Prepared by: Date: Approved by: Date;
ADMINISTRATION
PART A: BUDGET SUMMARY
ADMINISTRATION
OUTREACH
CRISIS
WEATHER
WEATHER
TOTAL,,,,
'
SERVICES
CERVICES
SERVICES
RELATED
RELATED
$D.06
$0.00
_ $0.00
$0.00
$0.00
$0.00
1. Approved Contract Amount
2. Previous Funds Received for
$0.00
$0.00
$0.00
$0.00
$0.00.
$0.00
Contract Period
3. Contract Balance pine t minus line 2)
$0.00
$0.00
_ $0.00
E0.00
$D o0 _
moo
4. Previous Funds Requested and Not
$D.00
$0,00
$0.00
$0.00
$0.00
$0.00
Received for Contract Perlotl
5 Contract Balance (Ilne 3 minus line 4)
$0.00,
$0.00
_ $0.00
$0.00
$0.00_ _
$0.00
PART S: CONTRACT FUNDS REQUEST
1. Anticipated Cash Needs
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
(1st- 2nd month, Attach Justification)
2, Net Expenditures For Month
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00,
(DOEA Form 106P, Part B, Line 6)
3. TOTAL _
_. $0.00
$0.00
$0.00
$0.00
$0.00..
$0.00
PART C: NET FUNDS REQUESTED
1. Less Advance Applied
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
2, TOTAL FUNDS REQUESTED
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
(Part B, Line 3 minus Pad C, Line 1)
PART D: SERVICE INFORMATION
Number of Individuals Junks) sewed with crisis energy assistance during the report month _ 0 _
Number of Individuals ineligible or denied assistance during the report month. 0
Number of Individuals served by referral to other community resources for energy during the report month. 0 _
Certification statement: Contractor hereby certifies that It has been open and operating during els normal business hours for the reporting month, as _.
described in the Statement of Work section, of the SHEAF contract. _
DOEA FORM 106P _..._ _..- .... _.....
-
redsed 410117 -
66
October 2019 — September 2020
INVOICE REPORT SCHEDULE
Report Number Based Upon
I October Advance*
2 November Advance*
3
October Invoice
4
November Invoice
5
December Invoice
6
January Invoice
7
February Invoice
8
March Invoice
9
April Invoice
10
May Invoice
11
June Invoice
12
July Invoice
13
August Invoice
14
September Invoice
15
Final Request for Payment
* Advance based on projected cash need.
EIIEAP 203.19
ATTACHMENT XIII
Date Due to the Department
Upon receipt of executed contract.
Upon receipt of executed contract.
November 09, 2019
December 09, 2019
January 09, 2020
February 09, 2020
March 09, 2020
April 09, 2020
May 09, 2020
June 09, 2020
July 09, 2020
August 09, 2020
September 09, 2020
October 09, 2020
October 15, 2020
Note # 1: Report 41 and #2 for advance basis invoices, cannot be submitted to the Agency prior to
October I or until the agreement with the Agency has been executed and a copy sent to the
Agency. Actual submission of the vouchers to the Agency is dependent on the accuracy of
the Receipts and Expenditure Report.
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 one or two months of the
agreement. The adjustment shall be recorded in Part C. I of the report (ATTACHMENT XII).
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 9" of each month. IF the 9t' falls on
a Saturday, then the report will be due by the 8" by 12:00 p.m. AND IF the 9"' falls on a
Sunday, the report will be due by the 10t" 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.
Q67 c>
October 2019 — September 2020
DE'4)
FLORIDA DEPARTMENTof
ECONOMIC OPPORTUNITY
EHEAP 203.19
ATTACHMENT XIV
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP)
POVERTY INCOME GUIDELINES*
EFFECTIVE OCTOBER 1, 2019
PEOPLE IN THE HOUSEHOLD
150%
1
$18,735
2
$25,365
3
$31,995
4
$38,625
5
$45,255
6
$51,885
7
$58,515
8
$65,145
For each additional person in the household
with more than 8 people, add:
$ 6,630
*These figures are based on the 2019 U.S. Department of Health and Human Services (HHS) poverty
guidelines published in the Federal Register on February 1, 2019.
68
October 2019 - September 2020
LIHEAP PAYMENT MATRIX
EHEAP 203.19
ATTACHMENT XV
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM PAYMENT MATRIX - FY 2019/2020
1) Elderly
$50
1) Disabled
HHS
POVERTY LEVELS
$75
BY
HOUSEHOLD SIZE AND INCOME
HOUSEHOLD INCOME IN DOLLARS PER YEAR
NUMBER OF
50% of
Over 50%
of Poverty
At least
75% but no
Over 100% but
no more
Ovex 125%
but no
150%
PEOPLE IN
Poverty or
but Less
than 75%
more than 100%
than 125%
Poverty
more than
Less
PovertyPovex
HOUSEHOLD
At or Below
Annual Income at Least but No Greater Than
1
$ 6,245
$ 6,246
$ 9,367
$ 9,368
$12,490
$12,491
$15,613
$15,614
$18,735
2
$ 8,455
$ 8,456
$12,682
$12,683
$16,910
$16,911
$21,138
$21,139
$25,365
3
$10,665
$10,666
$15,997
$15,998
$21,330
$21,331
$26,663
$26,664
$31,995
4
$12,875
$12,876
$19,312
$19,313
$25,750
$25,751
$32,188
$32,189
$38,625
5
$15,085
$15,086
$22,627
$22,628
$30,170
$30,171
$37,713
$37,714
$45,255
6
$17,295
$17,296
$25,942
$25,943
$34,590
$34,591
$43,238
$43,239
$51,885
7
$19,505
$19,506
$29,257
$29,258
$39,010
$39,011
$48,763
$48,764
$58,515
8
$21,715
$21,716
$32,572
$32,572
$43,430
$43,431
$54,288
$54,289
$65,145
9
$23,925
$23,926
$35,887
$35,888
$47,850
$47,851
$59,813
$59,814
$71,775
10
$26,135
$26,136
$39,202
$39,203
$52,270
$52,271
$65,338
$65,339
$78,405
11
$28,345
$28,346
$42,517
$42,518
$56,690
$56,691
$70,863
$70,864
$85,035
12
$30,555
$30,556
$45,832
$45,833
$61,110
$61,111
$76,388
$76,389
$91,665
13
$32,765
$32,766
$49,147
$49,148
$65,530
$65,531
$81,913
$81,914
$98,295
14
$34,975
$34,976
$52,462
$52,463
$69,950
$69,951
$87,438
$87,439
$104,925
15
$37,185
$37,186
$55,777
$55,778
$74,370
$74,371
$92,963
$92,964
$111,555
16
$39,395
$39,396
$59,092
$59,093
$78,790
$78,791
$98,488
$98,489
$118,185
17
$41,605
$41,606
$62,407
$62,408
$83,210
$83,211
$104,013
$104,014
$124,815
18
$43,815
$43,816
$65,722
$65,723
$87,630
$87,631
$109,538
$109,539
$131,445
19
$46,025
$46,026
$69,037
$69,038
$92,050
$92,051
$115,063
$115,064
$138,075
20
$48,235
$48,236
$72,352
$72,353
$96,470
1 $96,471
$120,588
$120,589
$144,705
FLIHEAP HOME
ENERGY BENEFIT' $300 to $475** $250 to $425** $200 to $375**
"-Additional Assistance if applicant household includes:
1) Elderly
$50
1) Disabled
$50
3) Applicant with child age 5 or younger:
$75
69
These benefit levels are effective October 1, 2019
These figures are based upon the 2019 U.S, Department
of Health and Human Services I HHS) Poverty Guidelines
published in the Federal Register on
February 1, 2019
October 2019 — September 2020
SOURCES OF LN,CO h,IE
EHEAP 203.19
ATTACHMENT XVI
70 ->'\
LOW II'CO,SLE HOME ENE:R'GV ASSISTANCZ PROGRAM (LSHE.AP)
FY 2D'19 j'?t72fl- SOURCES OF Rti COME
EFFECTI: TE OCTOBER 1, 21719
ING111LINED
=LUDED
SOT MCEI OF INCOME,
SOURCES OF INCONCE
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70 ->'\
October 2019 — September 2020
OUTREACH PLAN SURVEY
PSA Click here to enter text.
COUNTY(IES) Click here to enter tent.
AGENCY'S EHEAP COORDINATOR Click here to enfct text.
PHONE W/EXT. Click here to enter taxi.
EMAIL Cllclr here to entzr text.
EHEAP 203.19
ATTACHMENT XVII
1. ELDERLY OUTREACH
Describe the efforts to increase the number and percentage of elderly households served.
Click here to enter text.
2. INTEGRATION OF OTHER LOCAL AGENCIES IN OUTREACH
Describe what local coordination efforts support outreach activities. Identify agencies, utilities, charities, and
others incorporated in these efforts and the activities included.
Click h" re to entertett.
3. ADVERTISING, PROMOTIONAL, MEDIA, AND OTHER PRINT OUTREACH EFFORTS
a. Brochures — please select all of the options you currently use in your program from the list below:
❑ Use a locally developed brochure (send an electronic copy with your survey)
❑ Other, please describe Click here to enter tent.
How will the brochures be distributed/used (check all that apply):
❑ Display at County courthouse/office building
❑ Provide to Senior Citizen Centers in county
❑ Provide to meal sites in county
❑ Provide to "Meals on Wheels" for distribution
❑ Provide to local utility companies and heating fuel providers
❑ To cooperating local agencies (such as Salvation Army)
❑ Grocery stores or similar businesses
❑ Provide to churches
❑ Provide to hospitals
❑ Provide to day care facilities
❑ Provide to local libraries
❑ Laundrornats
❑ Provide to banks
❑ Provide to clinics
71
October 2019 — September 2020 EHEAP 203.19
❑ Provide to Head Start Programs
❑ Other: Click hers to enter text.
b. POSTERS
Please select all of the options you currently use in your program from the list below:
❑ Use locally developed poster (send a copy with your survey)
❑ Don't use posters
How does your agency distribute or use program posters (check all that apply):
❑ Display at County courthouse/office building
❑ Provide to Senior Citizen Centers in county
❑ Provide to meal sites in county
❑ Provide to grocery stores
❑ Provide to laundromats
❑ Provide to churches
❑ Provide to hospitals
❑ Provide to day care facilities
❑ Provide to local libraries
❑ Provide to other businesses
❑ Provide to clinics
❑ Provide to Head Start Programs
❑ Provide to banks
❑ Other: Click here to enter text.
c. PAIDADVERTISING
Does your agency use paid advertising to promote the program?
❑ Yes
❑ No (if you answered No — go to Section D)
Total Budget for advertising (per fiscal year) $ Click here to enter text.
Does you agency advertise in NEWSPAPERS? ❑ Yes ❑ No
Name of Paper Click here to enter text. City/Location Click hereto enter text,
Name of Paper Click here, to enter text. City/Location Click here to enter text.
Name of Paper Click here to enter text City/Location Click here to enter text.
Frequency or # of times ads are placed per cooling season: Click here to enter text.
Frequency or # of times ads are placed per heating season: Click here to enter text.
When do you advertise (check all that apply)?
72
October 2019 — September 2020
EHEAP 203,19
❑ April
❑ October
❑ May
❑ November
❑ June
❑ December
❑ July
❑ January
❑ August
❑ February
❑ September
❑ March
Do you use the same ad for all newspaper advertising? ❑ Yes ❑ No
If not, how many different ads do you place? Crich hereto enter_ r text.
In which language(s) are your ads place? (check all that apply)
❑ English
❑ Spanish
❑ Other (please list) Crick here to ante+text,
Does your agency advertise in SHOPPERS? ❑ Yes ❑ No
Name of Shopper Cl Ick here to c nte.r te::t. City/Location Click hare to enter text,
Name of Shopper Clicic hare eo enter text. City/Location Click here to entar text,
Frequency or # of times ads are placed per cooling season: Glick here to enter text.
Frequency or # of times ads are placed per heating season: Click hereto enter text,
When do you advertise (check all that apply)
❑ April ❑ October
❑ May ❑ November
❑ June ❑ December
❑ July ❑ January
❑ August ❑ February
❑ September ❑ March
Do you use the same ad for all shopper advertising? ❑ Yes ❑ No
If not, how many different ads do you place? Clk1, here to enter text.
In which language(s) are your ads place? (check all that apply)
❑ English
❑ Spanish
❑ Other (please list) Click here eo enter text.
Does your agency advertise on RADIO? ❑ Yes ❑ No
Station Call Letters Click Isere to enter text. City/Location Click here to enter text,
Station Call Letters Click hereto enter text. City/Location Click here to enter-Cext.
73
October 2019 — September 2020
EHEAP 203.19
Frequency or # of times ads are placed per cooling season: Click here to enter text.
Frequency or # of times ads are placed per heating season: Click here to er�te.r text.
When do you advertise (check all that apply)
❑ April ❑ October
❑ May ❑ November
❑ June ❑ December
❑ July ❑ January
❑ August ❑ February
❑ September ❑ March
Do you use the same ad for all radio advertising? ❑ Yes ❑ No
If not, how many different ads do you place? Click here to enter text.
In which language(s) are your ads place? (check all that apply)
❑ English
❑ Spanish
❑ Other (please list) Click here to enter text.
Does your agency advertise on TELEVISION? ❑ Yes ❑ No
Station Call Letters Clld< Dere to enter faxt. City/Location Click hereto enter text.
Cable Operator Click hers to enter text, City/Location Click here to entertext.
Frequency or # of times ads are placed per cooling season: Click here to enter text.
Frequency or # of times ads are placed per heating season: Click here to enter text.
When do you advertise (check all that apply)
❑ April
❑
October
❑ May
❑
November
❑ June
❑
December
❑ July
❑
January
❑ August
❑
February
❑ September
❑
March
Do you use the same ad for all television advertising? ❑ Yes ❑ No
If not, how many different ads do you place? Click herd to enter text.
In which language(s) are your ads place? (check all that apply)
❑ English
❑ Spanish
❑ Other (please list) C,liei� hire t� anter text.
OTHER PAID AVERTISING (Please Describe): Click hers to entar tcmt,
74
October 2019 — September 2020
FHEAP 203.19
d. FREE MEDIA PROMOTION/COVERAGE
Please check all the appropriate selections related to how your agency utilizes free media
promotion/coverage:
❑ Issue Press Releases to local/area media
Are press releases sent out more than one time per year? ❑ Yes ❑ No
If yes, how often? Click lie re to enter text.
Do you use the same press release each time? ❑ Yes ❑ No ❑ N/A
❑ Prepare announcements for public access television (cable)
❑ Prepare public service announcements (PSAs)
❑ Arrange for on air radio or television interviews
❑ Post information on a County or Agency website
❑ Post information or link to other local websites
❑ Our agency does not take part in any Free Media Promotion
Are any of these materials translated? ❑ Yes ❑ No
❑ Spanish ❑ Other non-English languages
Web activities:
❑ Post information on a County or Agency website
❑ Post information or link to other local websites
e. DIRECT PROMOTIONAL ACTIVITIES
Please select all of the appropriate selections related to how your agency completes Direct Promotional
Activities:
❑ Direct mail — Anticipated size of mailings) Click hexa to enter text. (number of pieces sent)
❑ Telephone promotion (not application taking)
❑ Displays/at stores, malls, etc.
❑ Displays/booths at events (check all that apply):
❑ Home Show
❑ lob Fair
❑ Meal Sites
❑ Health Fairs
❑ Other (please list): Click hereto enter text,
Who will you target with your direct promotional activities (check all that apply)?
❑ Aging/Seniors/Elderly
❑ Disabled
❑ High Energy Users
❑ Families with children
❑ Last year's applicants
❑ Homebound
❑ Last year's home visit applicants
75 (`0
October 2019 — September 2020 EHEAP 203.19
❑ Churches
❑ Head Start
❑ Specific Vendors
❑ Subsidized -housing residents
❑ Other (List)
f, HOME VISITS
Does your agency perform home visits? ❑ Yes ❑ No (if no, skip to Section 6, Special Outreach
Efforts)
Number of home visits conducted last year Click hc-re to enter text,
Number of home visits expected this year Click here to cntertext ,
Do early applications reduce the number of home visits? ❑ Yes ❑ No
Check the criteria used to determine when home visits will be done (check all that apply):
❑ Age
❑ Disability
❑ Transportation difficulties (no car, can't drive, etc.)
❑ Applicant's work schedule
❑ Small children in household
❑ Language barrier/availability of translator
❑ Other (please list): Click hereto enter texi.
4, SPECIAL OUTREACH EFFORTS
Please check each of the Target/Special Needs populations you are carrying out special efforts to reach from the
list below:
❑ The working poor (check all activities that apply):
❑ Evening office hours
❑ Saturday morning office hours
❑ Saturday afternoon office hours
❑ Promote at churches
❑ Special phone/mail application efforts
❑ After hours home visits
❑ Promote at specific employers
❑ Other (please list):
❑ Households with young children:
❑ Provide materials to day care facilities
❑ Take applications at day care facilities
❑ Promote at churches
❑ Handouts to school children
❑ Materials for Pediatricians and clinics
❑ Other (please list):
76
October 2019 — September 2020 EIiEAP 203.19
❑ Non-English speaking population, etc.:
❑ Promote through Hispanic groups
❑ Provide brochures/posters in other languages to hospitals and clinics
❑ Promote through religious organizations
❑ Identify local interpreters to use
❑ Have signage at office in multiple languages
❑ Use pre-recorded messages in different languages
❑ Set application site at gatherings and events where minority groups congregate and interpreters
are available
5. INTAKE SITES AND TIMES
Please select the statement that best fits your application process:
❑ Take applications primarily through appointments
❑ Take applications by appointment and work in walk-ins
❑ Take applications by appointment and have day(s) for doing walk-ins
❑ Take applications primarily through walk-ins and reserve appointments for special needs or problem
cases,
❑ Take applications from walk-ins only
IA.+Ih,+I,. int.4. aitac to IN. umd daily IMnndav thrnunh Fridav)
Name of Site
Area/County(s) Served
Hours
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h. Identifv the intake sites to be used reeulariv, as In once a week, twice a month, etc.
Name of Site
Area/County(s) Served
Day(s) of iFrequency
Hours
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Week
(time/??)
provider?
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77 C�
\fix
October 2019 — September 2020
EHEAP 203.19
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c. Identify other sites to be used.
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Area/County(s) Served
Day(s) of
Frequency
Hours
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d. Planned extended or flexible application times.
78
Area/County(s) Served
Day(s) of
Frequency
Hours
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Week
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I
provider?
Evening Hours
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text,
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78
October 2019 — September 2020
EHEAP 203.19
Evening Hours
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Thanksgiving
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enter text.
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New Years Day
Saturday Hours
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e. Days Offices are Closed
Check all holidays the agency is closed:
❑
Columbus Day
❑
Veterans Day
❑
Thanksgiving
❑
Friday after Thanksgiving
❑
Christmas Eve
❑
Christmas Day
❑
New Year's Eve
❑
New Years Day
❑
Martin Luther King, 1r: s Birthday
❑
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text,
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6, SENIOR STAFF WORK SCHEDULES
Plm<a nrrndrle the recuUr WOokiv office hours for the followine:
Title
Name
Mon
Toe
Wed
Thurs
Fri
Executive Director
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Chief Financial Officer
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EHEAP Program
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Coordinator
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79
October 2019 — September 2020
EHEAP 203.19
7. OUTREACH ASSESSMENT/EVALUATION
Do you survey your applicants to assess the effectiveness of outreach efforts? ❑ Yes ❑ No
Surveys are targeted at
❑ Elderly
❑ Handicapped/disabled
❑ Households with young children
❑ Non-English speaking households
Surveys are not targeted ❑ Yes ❑ No
Do you track numbers of applicants at each outreach site? ❑ Yes ❑ No
Each time the site is used? ❑ For all visits combined? ❑
Do you compare types of outreach sites? ❑ Yes ❑ No
What is the most effective type of outreach site? (For example: senior center, library, town hall, fire
station, housing facility, etc.) Click hereto eniertext,
Do you track the number of home visits? ❑ Yes ❑ No
Do you track the reason for doing each home visit? ❑ Yes ❑ No
What other way do you assess the effectiveness and success of your outreach efforts? Click here to ester text.
80 >'`
enter
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text.
text.
text,
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7. OUTREACH ASSESSMENT/EVALUATION
Do you survey your applicants to assess the effectiveness of outreach efforts? ❑ Yes ❑ No
Surveys are targeted at
❑ Elderly
❑ Handicapped/disabled
❑ Households with young children
❑ Non-English speaking households
Surveys are not targeted ❑ Yes ❑ No
Do you track numbers of applicants at each outreach site? ❑ Yes ❑ No
Each time the site is used? ❑ For all visits combined? ❑
Do you compare types of outreach sites? ❑ Yes ❑ No
What is the most effective type of outreach site? (For example: senior center, library, town hall, fire
station, housing facility, etc.) Click hereto eniertext,
Do you track the number of home visits? ❑ Yes ❑ No
Do you track the reason for doing each home visit? ❑ Yes ❑ No
What other way do you assess the effectiveness and success of your outreach efforts? Click here to ester text.
80 >'`
October 2019 — Se p tem'P &lN �OZ� EHEAP 203.19
APPLICATION AND ELIGIBILITY WORKSHEET ATTACHMENT XVIII
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October 2019 — September 2020
FHFAP 203.19
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82
October 2019 — September 2020
EHEAP 203.19
ATTACHMENT XIX
EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS
Department of Elder Affairs
Emergency Home Energy Assistance for the Elderly Program (EHEAP)
EHEAP Application Instructions
Section One: Applicant (Age 60 and older) Information
Complete Section One in its entirety.
Special notes:
✓ The Date Stamp is the official application date;
✓ The Intake Worker (with name and phone number recorded) is the person who accepts the
application and required documentation;
✓ The applicant's income type(s) and monthly income amount is recorded in this section, and
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Two: Additional Household Members Information
Complete Section Two by listing additional household members and providing the information requested.
Special notes:
✓ At a minimum, the name(s), age(s), and Social Security number(s) of each additional household
member is required;
✓ You will be attaching a calculator tape of the household's income calculations in the section
provided on the EHEAP Eligibility Worksheet; and
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Three: Household Characteristics
Complete Section Three by answering each "Yes" or "No" question and providing additional information if applicable.
Special note:
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Four• Heatina and Cooling Information
Complete Section Four by answering each question.
Special note:
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Five: Enerav Crisis Explanation
Section Five is completed by choosing the best possible explanation for the applicant's crisis and obtaining their
signature and date of signature.
Special notes:
✓ All life-threatening crisis explanations must be acted upon, with an eligible action to mediate the
crisis within eighteen (18) hours of the application date stamp.
✓ All standard crisis explanations must be acted upon, with an eligible action to mediate the crisis
within forty-eight (48) hours of the application date stamp.
✓ If any field is determined to be not applicable, complete the field by entering N/A.
83 �:`^
October 2019— September 2020
EHEAP 203.19
Client Attestation and Signature
The applicant should read the attestation statement. If the applicant is unable to read the attestation
statement, the intake worker should read it to them before they sign and date the application.
At this point, the intake worker should have the applicant sign the waiver authorizing the release of general
and/or confidential information for LIHEAP/EHEAP federal reporting. CIRTS will require you to verify that either
the waiver has been signed or that the client has refused to sign.
EHEAP Eliaibility Worksheet Instructions
Section Six: Income Eligibility Determination
Complete Section Six by stapling the calculator tape in the space provided, entering the annual income, and
checking the appropriate number of individuals in the household to determine the household annual income limit.
Special notes:
✓ Adjacent to the annual income limit by household size is the fifty percent (50%) of poverty
amount by household size. If the annual household income is below the amount for the
household size, AND the household does not receive SNAP, the applicant must provide a
written statement of how basic living expenses are provided for the household.
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Seven: Vendor Benefit and Verification Information
Complete Section Seven by completing in its entirety.
Special notes:
✓ The minimum amount due is the amount provided to you during the verification process with the
home energy vendor.
✓ For those applicants receiving an energy subsidy, the minimum amount due will be reduced by
the energy subsidy amount listed on the applicant's public housing lease to determine the total
EHEAP benefit. The energy subsidy is deducted from home energy vendor payments only.
✓ Water, sewer, garbage, and fire, etc. MAY NOT be paid with EHEAP funds. Utility bills that
include charges that are not directly related to cooling and heating will be reduced by the
amounts for these charges.
✓ It is allowable to make several crisis benefit payments for a household to resolve a single crisis.
This may include the purchase of blankets, portable fans, space heaters, and/or repair of
existing heating/cooling equipment, in addition to energy bill assistance, that combined does not
exceed the maximum crisis benefit of $600.
✓ Crisis situations that involve a heater or air conditioner that is powered by both gas and
electricity are eligible for a crisis benefit payment to both home energy vendors, that combined
does not exceed the maximum crisis benefit of $600.
✓ Allowable utility categories for heating/cooling bill assistance include the following:
a. Utility payments for heating/cooling bill assistance for electric, gas, propane, wood, coal,
or refillable fuels;
b. Temporary emergency shelter (if needed due to energy-related crisis);
c. Payment to landlords (when utility costs are included in rent);
d. Repairs or replacements to heating/cooling units (as long as the amount is within the
benefit limits and work is done by a licensed contractor);
84 �t
October 2019 — Sept ber 2 2 EHEAP 203.19
e. repos s4o connect or restore energy;
f. Late fees, disconnect fees, and reconnect fees;
g. Charges from a previous account held by the applicant that is now closed;
i,. Blankets and fans,
1. Taxes and fees associated with the client's utility bill towards the energy portion. In some
cases, where the utility vendor combines all the other fees and taxes, which also includes
non -home energy services, such taxes and fees can be paid with EHEAP funding.
Example: In a case where heating and cooling taxes are commingled with other service
taxes, proceed with paying the taxes portion of the bill.
j. Other allowable payments are those related to the start-up of services, including
reasonable connection or reconnection fees, delivery fees, deposits, and other fees
related to the start-up of service.
✓ If any field is determined to be not applicable, complete the field by entering N/A.
ii.F=11,12211
Complete Section Eight in its entirety.
Special notes:
✓ When determining the number of LIHEAP or EHEAP crisis benefits the applicant has had, you
will include the current application in the count, provided the application is approved. Refer back
to Section Seven, to the information obtained from the LIHEAP provider.
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Section Nine: Resolution of Crisis
Complete Section Nine by selecting all that applies to this applicant and application for services.
Special notes:
✓ The left-hand selections indicate that the application has been acted upon within the
eighteen (18) hour/ forty-eight (48) hour requirement.
✓ If the selection is made to deny the application pending additional information from the client,
the 18/48 hours has been met and does not repeat itself when the client returns with the
pending information. You have already met the requirement.
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Case Worker Signature
To complete this section, the individual who completes the EHEAP Eligibility Worksheet, determines income
eligibility, and provides the commitment to the utility vendor must sign and complete the requested information.
Special note:
✓ If you are the applicant, or a friend, relative, or employee of the applicant, you cannot determine
the eligibility or award EHEAP benefits. This application must be processed by someone who is
not the applicant or a friend, relative, or employee of the applicant.
To complete this section, the signer is attesting that he/she has reviewed the application for completeness,
determined that all required documentation is included, and verified that the annual household income
calculation and EHEAP benefit awarded are correct.
Instructions for DOEA Form 114-10/1/2019
85
October 2019 — September 2020
EMERC-_1:NCY HOMF FNrrRf-v
EHEAP 203.19
ATTACHMENT XX
A B.cLCTAN CR FOR TAF F.i.PIERLY CLIENT FILE CONTENT CHECKLIST
ELDER'S NAMEv
PSA#
AGENCY
APPROVAL_.
DENIAL_
NAME OF WORKER '-
APPLICATION DATE :
CRISIS RESOLUTION DATE
CHECK DATE
PROGRAM REQUIREMENTS MONITORED
Yes
No
N/A
COMMENTS
1. Individual client file for the elder includes consumer's name, address, sex, and age.
2. Household contains a member 60 or older.
3. The household is in the Florida county covered by the contract.
4. All household members are listed and their name, age, DOB, and income(s) are included.
Client file contains documentation of Social Security numbers for all household members, or citation
5
to the applicable exemption.
6. Client file contains signed notice regarding collection of social security number(s).
7. The client file contains official income documents for all household members.
If income is self -declared, is there a self -declaration form signed by each individual household
8
member (18 years of age or older) lacking income verification or claiming zero income?
The household's total gross income is calculated correctly and is at or below 150% of die OMB
9
Federal Poverty Level for the household size.
Statement of how basic living expenses (i.e., food, shelter and transportation) are being provided if
10. total household income is less than 50% of the current Federal Poverty Guidelines and no one in the
household is receiving SNAP assistance.
Checked that elder does not live in student dormitory, adult family care home, or any kind of group
11
living facility.
Verified and documented household has not received LIFIEAP Crisis Assistance during the same
12
heating or cooling season.
13. Documentation of Weatherization Assistance Program (WAP) referral, if applicable.
Copies of fuel bills, or other supporting documentation as proof of energy crisis, for the residence in
14
which they reside.
15. Signed copy of Authorization for Release of General and/or Confidential Information.
16. Only eligible components of the utility bill are paid to resolve the crisis.
Only the minimum necessary to resolve the crisis is paid. If a different amount is required by the
17
utility company, provide additional information on the Eligibility Worksheet.
Crisis energy bereft was reduced by unallowable charges, such as: water, sewer, garbage, fire, etc., if
18
applicable.
19. Crisis energy benefit was reduced by energy subsidy, if applicable.
20. Energy crisis resolved within 18 hours by an eligible action.
Written notice of approval or denial for services that includes appeal procedures is issued within 15
21
working days of eligibility determination.
22, Appropriate benefit provided, at or below $600.00.
All required sections of the application are signed and dated by the elder, staff, and supervisory/peer
23
PRIOR to payment.
24. Proof of payment to vendor.
25. Place completed COLA Form 211 (10/01/2019) in client file.
INSTRUCTIONS: A check mark in the Yes eolonn indicates the requirement has been met. A check non it the No column Indicates the requil mucw has
not been met oris questionable. Each "No" stark must be explained under "COMMENTS".
Supervisor/Peer Signature Consumer File Monitoring Date
DOEA FORM 21110RA/2619 <
86
October 2019— September 2020
EHEAP COST REIMBURSEMENT SUMMARY
Contract #
Report Period:
EHEAP 203.19
ATTACHMENT XXI
TOTAL ADMINISTRATION $0.00
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October 2019 — September 2020
SERVICE RATE REPORT
EHEAP 203.19
ATTACHMENT XXIII
PROGRAM: EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PRORAM (EHEAP)
Federally Funded
From 10/01/2019 to 09/30/2020
HIGH
Category
SERVICE
METHOD OF
REIMBURSEMEN
UNIT
PAYMENT
T RATE
TYPE
Administration
ADMINISTRATIVE
Cost Reimbursement
Cost Reimbursement
EPISODE
COSTS*
Outreach
OUTREACH COSTS*
Cost Reimbursement
Cost Reimbursement
EPISODE
Crisis
CRISIS ENERGY
Cost Reimbursement
Cost Reimbursement
EPISODE
Assistance
ASSISTANCE BENEFITS*
*As stipulated in contract, these services are provided on a cost reimbursement basis.
91
Revised August 2007
Attestation Statement
Agreement/Contract Number: EHEAP 203.19
Amendment Number
I, 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 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.
Approved as to fomi an Iegulity
01
A"IstlantCountyAliot c \�
01
Revised August 2007