Agenda 12/08/2020 Item #16D 7 (After-the-Fact w/Area Agency on Aging for SW FL, Inc.)12/08/2020
EXECUTIVE SUMMARY
Recommendation to approve an “After-the-Fact” amendment and an attestation statement with
Area Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy Assistance
Program to amend and increase the combined energy crisis benefit assistance amount to $3,500 and
revise the attachments to conform to this amendment.
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 the grant programs. Some of these grants are funded by the Florida Department of Elder Affai rs
(DOEA) through the Area Agency on Aging of Southwest Florida, Inc. (AAASWFL). These grant -
funded 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).
EHEAP provides crisis assistance to eligible low-income households with at least 1 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, disconnect and reconnection fees with Florida Power and Light (FPL) &
Lee County Electric Cooperative (LCEC).
The current service agreement for EHEAP 203.20 was approved “After-the-Fact” at the Board of County
Commissioners (Board) on September 22, 2020 (Agenda Item #16D7). The contract has a term that is,
effective June 1, 2020 through September 30, 2021.
The proposed Amendment 1, is to replace attachments of the 2020 EHEAP Contract wherever stated
throughout the contract as well as:
1. Attachment I, Section I.B.3., Scope of Service, is hereby replaced;
The Contractor is responsible for the programmatic, fiscal, and operational management of
the EHEAP CARES Act. Eligible elders may receive multiple crisis assistance benefit(s),
that combined not to exceed $3,500 during the term of this agreement. Eligible, elders may
receive crisis assistance benefits during the period from June 1, 2020 to September 30, 2021.
2. Attachment I, Section I.C.3.h., is hereby replaced;
h. Ensure elders receive no more than the household crisis assistance cap of $3,500.
3. Attachment I, Section II.F.2., is hereby replaced; 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 Department. The maximum crisis
assistance cap for this contract is $3,500 per household.
4. Attachment VIII, EHEAP CARES Act Budget Summary, is hereby replaced;
16.D.7
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5. Attachment XV, EHEAP CARES Act Application and Eligibility Worksheet, is hereby
replaced;
6. Attachment XVI, EHEAP CARES Act Application Eligibility Instructions, is hereby replaced;
7. Attachment XVII, EHEAP CARES Act Client File Content Checklist, is hereby replaced;
This Item is being presented “After-the-Fact” because Collier County received the contract on November
11, 2020, from the grantor agency and is required to return it within thirty (30) days. This time frame
makes it challenging to process the document for the Board’s 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. Collier County, as the Lead
Agency, is responsible for responding to seniors’ needs and to manage the spending authority for the
Federal and State Funded Services for Seniors Programs.
FISCAL IMPACT: There is no Fiscal impact associated with this action, the funds reside in the Human
Services Grant Fund (707), Project 33719 (EHEAP).
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
RECOMMENDATION: To approve an “After-the-Fact” amendment and an attestation statement with
Area Agency on Aging for Southwest Florida, Inc. for the Emergency Home Energy Assistance Program
to amend and increase the combined energy crisis benefit assistance amount to $3,500 and amend the
attachments to conform to this amendment.
Prepared By: Wendy Klopf, Grant Coordinator, Community and Human Services Division
ATTACHMENT(S)
1. CARES EHEAP 203.20.001-Exec (PDF)
2. (Linked) CARES EHEAP 203.20 Executed (PDF)
3. Resolution 2018-202 (PDF)
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12/08/2020
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.7
Doc ID: 14223
Item Summary: Recommendation to approve an “After-the-Fact” amendment and an attestation
statement with Area Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy
Assistance Program to amend and increase the combined energy crisis benefit assistance amount to
$3,500 and revise the attachments to conform to this amendment.
Meeting Date: 12/08/2020
Prepared by:
Title: Operations Coordinator – Community & Human Services
Name: Wendy Klopf
11/17/2020 4:00 PM
Submitted by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
11/17/2020 4:00 PM
Approved By:
Review:
Community & Human Services Maggie Lopez Additional Reviewer Completed 11/17/2020 6:14 PM
Community & Human Services Kristi Sonntag CHS Review Completed 11/18/2020 3:28 PM
Community & Human Services Akiko Woods Additional Reviewer Completed 11/19/2020 8:52 AM
Operations & Veteran Services Kimberley Grant Level 1 Reviewer Completed 11/19/2020 10:48 AM
Public Services Department Todd Henry Level 1 Division Reviewer Completed 11/19/2020 3:49 PM
Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 11/19/2020 4:15 PM
Grants Erica Robinson Level 2 Grants Review Completed 11/23/2020 4:20 PM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 11/24/2020 9:18 AM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 11/24/2020 9:21 AM
Grants Therese Stanley Additional Reviewer Completed 11/24/2020 11:06 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 11/24/2020 1:49 PM
Budget and Management Office Ed Finn Additional Reviewer Completed 11/25/2020 12:22 PM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 11/25/2020 2:19 PM
Board of County Commissioners MaryJo Brock Meeting Pending 12/08/2020 9:00 AM
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16.D.7.a
Packet Pg. 2930 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2931 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2932 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2933 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2934 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2935 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2936 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2937 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
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Packet Pg. 2938 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
16.D.7.a
Packet Pg. 2939 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
16.D.7.a
Packet Pg. 2940 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
16.D.7.a
Packet Pg. 2941 Attachment: CARES EHEAP 203.20.001-Exec (14223 : CARES EHEAP Amendment 203.20.001)
16.D.7.c
Packet Pg. 2942 Attachment: Resolution 2018-202 (14223 : CARES EHEAP Amendment 203.20.001)
16.D.7.c
Packet Pg. 2943 Attachment: Resolution 2018-202 (14223 : CARES EHEAP Amendment 203.20.001)
(June 2020 — September 2021) CARES EHEAP 203.20
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
CARES EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier
Comity Board of County Commissioners (Contractor), collectively referred to as the "Parties." The term Contractor for this
purpose may designate a Vendor, Subgrantee, or Subrecipient.
WITNESSETH 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
services 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.
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks,
manuals and/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) A.M., Eastern Standard Time June 1, 2020 or on the date the contract has
been signed by the as party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) P.M., Eastern
Standard Time September 30, 2021.
The Agency agrees to pay fa• contracted services according to the terms and conditions of this contract in an amount not
to exceed $5G,406.20 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.
1•i• ,
By mutual agreement of the Patties, 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 forth in the bid, proposal, or reply. No other costs for
the renewal may be charged. Any renewal is subject to the same terns and conditions as the original contract and
contingent upon satisfactory performance evaluations by the Agency and the availability of funds*
G.1 If this contract contains federal funds this section shall apply.
6.1.1 The Contractor
shall
cotnply 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 11738, as amended, and, where applicable, OA
O�
V
(June 2020 — September 2021)
CARES EHEAP 203.20
Environmental Protection Agency regulations 2 CFR Part 1500, The Contractor shall report anyviolabons
of the above to the Agency.
6.1.3 Neither the Contractor nor any agent acting on behalf of the Contractor may use any federal funds 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 1[ 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.
6.2 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.
6.3 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 revoked 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.
6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR § 170.110(b), the Contractor shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 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 during
the contract term. Contractors meeting the terms and conditions of the E-Verify System are deemed to be in
compliance with this provision.
7.1 This contract is executed and entered into in the State of Florida, and shall be construed, per•for•med, 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 215.97, 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.
OHO
(June 2020 — September 2021)
CARES EHEAP 203.20
7.3.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in
ATTACHMENT I, to be received and accepted by the Agency Contract Manager prior to payment.
7.3.3 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 111. Method of Payment.
7.3.4 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 invoices
for any travel expenses in accordance with Section 112.061, 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, letters, or other public records as defined
in Section 119.011(12), 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.
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 funds 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 Iran Petroleum Energy Sector List, the Scrutinized Companies with Activities in Sudan List, or
the Scrutinized Companies that Boycott Israel List, or if the Contractor has been engaged in business operations
in Cuba or Syria or is engaged in a boycott of Israel.
S. Background 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 Department'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/or the Department as well as the Agency
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
http://cideraffairs.state.fl.us/Agency/backgroundscreening.nhn.
The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to
process and resolve client dissatisfaction with, or denial of, ser•vice(s) and to address complaints regarding the
termination, suspension or reduction of services, as required for receipt of funds. These procedures, at a minimurn, will
provide for notice of the grievance procedure and an opportunity for review of the Subcontractor's determination(s).
10.1 By execution of this contract, Contractor•
agrees to all provisions
of Chapter• 119,
F.S., and any other applicable
law, and shall:
10.1.1 Keep and maintain public records required by the Agency to perform the contracted services.
(June 2020 — September 2021)
CARES EHEAP 203.20
10.1.2 Upon 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.
10.1.3 Ensure 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.
10.1.4 Upon 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 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
I t9.07(1), F.S.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, 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.
2830 Winkler Ave, Suite112
Fort Myers, FL 33916
239-652-6900 or 866413-5337
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.
MOM
11.1 The Contactor 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 ensure 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 contact, at no additional cost to the
Agency.
(June 2020 — September 2021)
CARES EHEAP 203.20
11.3 upon 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.
11.4 The Contractor shall ensure that the records described in this section will be subject at all 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 for as long as records are tnaintained, 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.
11.7 Contractor agrees to comply with the Inspector General in any investigation, audit, inspection, review, or hearing
performed pursuant to Section 20.055, F.S. 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 Rights Comnliance:
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 contract.
12.3 The Contractor 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 contract contains federal fiords, 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
the 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 contract and denial of further assistance.
u r n r �� iSulilT:f:
The Contractor shall permit persons duly authorized by the Agency to inspect and copy any reca•ds, papers, documents,
facilities, goods, and services of the Contractor which are relevant to this contract, and to interview any clients,
employees, and Subcontractor employees of the Contractor to assure the 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
the 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 Agency's Contract
Manager.
(June 2020 — September 2021) CARES EHEAP 203,20
R. PrOVlslen of Services:
The Contractor shall provide services in the manner described in ATTACHMENT I.
rr i, •r tlri r i� 1
If the Contractor 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.
►• rr t•rr r�
The Contractor shall notify the Agency within ten (10) days of entering into a new contract with any ofthe 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.
The Contractor shall indemnify, save, defend, and hold harmless the Agency and its agents and employees fi•om 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 contract 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 of 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.
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18.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewals) and extensions) 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 full 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.
18.2 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.
r r
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.
(June 2020 — September 2021) CARES EHEAP 203,20
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),
21.1 The Contractor shall notify the Agency immediately but rro 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.
21.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of
a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number
(1400-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon the Contractor, its
Subcontractors, and their employees.
i c��II.Tt�iS�7�[dt{ i i
During the term of this contract, the Contractor shall immediately notify the Agency 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 Agency: (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., Middle District of Florida, Fort Myers, Florida);
and (4) the name, address, and telephone number of the bankruptcy attorney,
i r i r i r, ,. ridt171ti7i�
23.1 As required by Section 286.25, F.S., if the Contractor is anon -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 (Contractor's name)
and the Area Agency on Aging for Southwest Florida, Inc. and/or the State of Florida, Department of Elder Affairs."
If the sponsorship reference is in written material, the words "Area Agency on Aging for Southwest Florida, Inc.
and/or the State of Florida, Department of Elder Affairs" shall appear in at least the same size letters or type as
the name of the organization.
23.2 The Contractor shall not use the words "Area Agency on Aging for Southwest Florida, Inc. and/or the State of Florida,
Department of Elder Affairs" to indicate sponsorship of a program otherwise financed, unless specific written
authorization has been obtained by the Agency prior to such use.
24.1 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 assignment of the Contractor's obligations, the Contractor remains responsible for all work performed
and all expenses incurred in connection with this contract.
24.2 The State of Florida is, at all times, entitled to assign or transfer, in whole or part, its rights, duties, or obligations
under this contract to another governmental agency in the State of Florida upon giving prior written notice to the
Contractor.
24.3 This contract shall remain binding upon the successors in interest of the Contractor and the Agency.
25. Snbcontracts:
25.1 The Contractor• is responsible For all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the Contt•actor 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.
C90
(June 2020 — September 2021)
CARES EHEAP 203.20
25.2 The Contractor• shall promptly pay any Subcontractors upon receipt of payment from the Agency or other state
agency. Failure to snake 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.
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.
27. Payment:
Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in
ATTACHMENT I. The 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 contract specify otherwise. 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.
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 funds 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 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.
171 rim
i
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,
ijl� r u�7'Tdtfi�Il�aTiLiF3r73f11i7�itfi271t3Ri
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 flickr and YouTube. This
policy is available on the Department's website at: httn://elderaffairs.state.fl.us/Agency/financial.phhy,
(June 2020 — September 2021)
CARES EHEAP 203.20
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 nor accept gratuities, favors, or anything of monetary value from Contractors,
potential Contractors, or parties to Subcontracts. The Contractor's 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 appointment or placement in that position, or, if the individual is serving as an incumbent,
within thirty (30) calendar days of 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. Pnblic Rntity Crime:
Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendot• 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 under 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. Purchasine:
33.1 The Contracts• shall procure products and/o• services required to perform this contract in accordance with section
413.036, F.S.
33.1.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES THAT ARE THE
SUBJECT OF, OR REQUIRED TO CARRY OUT, THIS CONTRACT SHALL BE PURCHASED FROM
A NONPROFIT AGENCY FOR THE BLIND OR FOR THE SEVERELY HANDICAPPED THAT IS
QUALIFIED PURSUANT TO CHAPTER 413, FLORIDA STATUTES, IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET FORTH IN SECTION 413.036(1) AND (2). FLORIDA
STATUTES; AND FOR PURPOSES OF THIS CONTRACT THE PERSON, FIRM, OR OTHER
BUSINESS ENTITY CARRYING OUT THE PROVISIONS OF THIS CONTRACT SHALL BE
DEEMED TO BE SUBSTITUTED FOR THE STATE AGENCY INSOFAR AS DEALINGS WITH
SUCH QUALIFIED NONPROFIT AGENCY ARE CONCERNED.
33.1.2 Pursuant to sections 413.036(1) and (4), F.S., the Contractor shall not be required to procure a product or
service from RESPECT if: (a) the product or service is not available within a reasonable delivery time, (b)
the Contractor is required by law to procure the product or service from any agency of the state, or (c) the
Contractor determines that the performance specifications, price, or quality of the product or service is not
comparable to the Contractor's requirements.
33.1.3 This act shall have precedence over any law requiring state agency procurement of products or services
from any other nonprofit corporation unless such precedence is waived by the Agency in accordance with
its rules.
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(June 2020 —September 2021)
CARES EHEAP 203.20
33.1.4 Additional information about the designated nonprofit agency and the products it offers is available at
http://www,respectofflorida.org.
33.2 The Contractor shall procure any recycled products or materials which are the subject of, or are required to carry
out, this contract when the Department of Management Services determines that those products are available, in
accordance with the provisions of section 403.7065, F.S.
33.3 The Contractor shall procure products and/or services required to perform this contract in accordance with
section 946.515, F.S.
33.3.1 IT 1S EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES WHICH ARE THE
SUBJECT OF, OR REQUIRED TO CARRY OUT, THIS CONTRACT SHALL BE PURCHASED FROM
THE CORPORATION IDENTIFIED UNDER CHAPTER 946, F.S., IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET FORTH IN SECTION 946.515(2) AND (4), F.S.; AND FOR
PURPOSES OF THIS CONTRACT THE PERSON, FIRM, OR OTHER BUSINESS ENTITY CARRYING
OUT THE PROVISIONS OF THIS CONTRACT SHALL BE DEEMED TO BE SUBSTITUTED FOR
THIS AGENCY INSOFAR AS DEALINGS WITH SUCH CORPORATION ARE CONCERNED,
33.3.2 The corporation identified is Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE).
Additional information about PRIDE and the commodities or contractual services it offers is available at
https://pride-enterprises.org/.
If this contract 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 under this contract or in any way connected with
this contract, or if ownership of any discovery, invention, or copyrightable material was purchased in the course of or
as a result of work or services performed under this contract, the Contractor shall refer the 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 287.0571(5)(k), F.S., the only exceptions to this provision shall be those that are clearly expressed and
reasonably valued in this contract.
34.1 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to this Section 34.
34.2 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.
34.3 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, fully -paid, nonexclusive license for its use and the use of its Contractors, Subcontractors, or
Assignees of any resulting patented, copyrighted, or trademarked work products.
35.1 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 Contract Manager,
verification of an Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the
Agency of emergency provisions.
it
(June 2020 — September 2021)
CARES EHEAP 203.20
35.2 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall remain
responsible for performance raider this contract and must follow procedures to ensure continuity of operations
without interruption.
[cjaoLiR i1'TiT:7ifil
36.1 Equipment means: (a) tangible personal property (including information technology systems) having a usefid 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 $5,000.00 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].
36.2 Contractors 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-110) 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 Contractor shall promptly
investigate, fully document, and notify the Agency Contract Manager of any loss, damage, or theft ofequipment.
The Contractor shall provide the results of the investigation to the Agency Contract Manager,
36.3 The Contractor's property management standards for equipment (including replacement equipment), whether
acquired in whole or in 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 maintained that include a description of the equipment;
36.3.2 Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
36.3.3 Source of funding for the equipment, including the federal award 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.
OtlO
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(June 2020 — September 2021)
CARES EHEAP 203.20
36.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with
state funds with an acquisition cost over $5,000.00 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(a), as applicable], subject to the conditions of 2 CFR 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 finds 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-1.017, 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 Contract Manager. When
disposing of property or equipment the Contractor must submit a 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.).
36.6 The Agency Contract Manager will issue disposition instructions. If disposition instructions are not received
within one hundred twenty (120) 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 finds
through 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 (U.S.C.). 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 ITR 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.
The
PUR ] 000
Form is hereby
incorporated by reference and
available at:
http.mvflorida.con/apps/vbs/adoc/F7740
PUR]OOOdig
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 PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained
in the PUR 1000 Form shall take precedence.
'1 1 IdTa M.MMOTE -111.r Cm,.'rr'-
Any state funds 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 leas[ 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.
l2
(June 2020 —September 2021)
CARES EHEAP 203.20
l 1 ntimlInTi
Any dispute concerning performance of the contract shall be decided by the Agency Contract Manager, who shall reduce
the decision to writing and serve a copy on the Contractor.
If the Contractor fails to meet the minimum level of service or performance identified in this contract, the Agency shall
impose financial consequences as stated in ATTACHMENT I.
41. No Waiver of Sovereign Immunity:
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.
If any dispute arises out of this contract, the venue of such legal recourse shall be Lee County, Florida.
43, l;ntire Contrnct:
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.
WITMO
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.
��Y:S4:S>FTi71TItire] litx3�
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.
The Parties agree that the Agency's performance and obligation to pay under this contract are contingent upon an annual
appropriation by the Legislature.
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
No
1=0
or failure by
the Agency to exercise or enforce any of its rights under this conU•act 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.
The Contractor shall abide by all applicable current federal statutes, laws, rules, and regulations as well as applicable
current state statutes, Taws, 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 Contractor and subject the contract to immediate unilateral cancellation of
the contract at the discretion of the Agency.
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(June 2020 — September 2021)
CARES EHEAP 203.20
50. 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 I. 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 required documentation and reports due from the Contractor and
necessary adjustments thereto have been approved by the Agency.
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price
level increases and changes in the rate of payment when these have been established through the appropriations process
and subsequently identified in the Agency's operating budget.
r• i r i r � r
The Agency may, in its sole discretion, suspend any or all activities under 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) days, or any longer period agreed to by the
Contractor, the Agency shall either: (1) 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. Termination:
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 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 if the 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 60A4.006(3), F.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, after 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.
14
(June 2020 — September 2021) CARES EHEAP 203.20
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 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.
54.1 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. Non -electronic (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.
rMNO
The Agency may substitute any Agency employee to serve as the Agency Contact Manager.
REMAINDER OF THE PAGE INTENTIONALLYLEFT BLANK
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(June 2020 — Septontbcr 2021)
i ri
CARES EHEAP 203.20
The Contractor name, as shown on page I of this
Collier County Board of County Commissioners
3339 E Tamiami Trail, Building H
as
coutracl, and mailing address of the official payee to
Naples, FL 34112
whon the payment shall be made is:
The name of the contact person and sheet address
Kristi Sonnta& Director
Board of County Commissioners
b,
where fllmnCial and administrative records areCollieroCounty
/oCommunity and Human Services
maintained is:
3339 E Tamiami Trail, Building H
Nnikso FL 34112
Krisd Sonniag, Director
The name, address, and telephone number of the
Collier County Board of County Commissioners
c6
representative orthe Contractor responsible for
%Community and Human Services
adntlnisiration of the program under this contract is:
3339 C Tamiami Trail, Building H
Naples, FL 34112
239 252=2273
Area Agency on Aging for Southwest Florida, file.
The section and location within the Agency where
Fiscal Deparimon
d•
Requests for Payment and Receipt and Expenditure
forms are to be mailed is: 2 $ 30 to 11 Ni1t�Y q
&At %
Pmjrt L.33g1
MaricelaMorado,Director ofPiogeam&Planning
The name, address, and telephone number of the
Area Agency on Aging for Southwest Florida, file.
e'
Contract Mnnagcr for this contract is:
�100VCMINMI
'
24s3D Ls3Iu\IJ%UV
if
L. r. 239.652-69OU
47mm t=L�. 33 'to 112
Upon change of representatives (names, addresses, telephone mhmhers) by eft her party, notice shall be prnvided in
writing to the ulher party.
57. All Tm•ms and Cmulitimrs hhclutlerl;
'Phis contract and its Attachments I — XIX, including any exhibits referenced in said attachments, together with any
documents incorporated by reference, cocain all the terms and conditions agreed upon by the Parties. ']'here ore no
provisions, terns, conditions, or obligations other than those contained hercin, and this contract shall supersede all
previous communications, representations, or ngreements, either written or verbal, helween the Parties.
By signing this contract, time Parties agree that they have read and agree to the entire contract,
IN WITNESS WHEREOF, the Parties hereto have caused [his contract to be executed by their undersigned officials as
duly autho ]zed.
CUNTRAC'fU12: COLLIER COUNTY BOARD
OF COUNTY y141S' ONEliS
SIGNED BY; A WWI
NAME: SPAa'ZC2l `f Cot ne u
TITLC: 0�r hlTic�sr'rueee\�LN�Amet\4 VW4
DATE: �ILLo�
Federal Tax ID; 59.6000558
FiscalYear EndingDmc: U'I/3U
Duns: 076997790
AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, INC.
S[GNED BY; �—
NAME: NORMA ADORNO
TITLE: COO. INTERIM CEO
Approved as to Porn andl
egality
Assl. rat County A
16
�I y r7
(June 2020 — September 2021)
CARES EHEAP 203.20
INDEX OF ATTACHMENTS
ATTACHMENTI......................................:........................................................................................................................10
STATEMENTOF WORK................................................................................................................................................. 18
ATTACHMENTII.............................................................................................................................................................38
FINANCIAL AND COMPLIANCE AUDIT ........ .................... ................................ .........................................I................ 38
ATTACHMENTIII............................................................................................................................................................44
CERTIFICATIONS AND ASSURANCES......................................................................................................................... 44
ATTACHMENTIV............................................................................................................................................................49
ASSURANCES -NON -CONSTRUCTION PROGRAMS, ........................... 4 .............................. 49
ATTACHMENTV..............................................................................................................................................................52
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST................................152
ATTACHMENTVI............................................................................................................................................................57
CONTRACTOR'S STATE CONTRACT LIST................................................................................................................... 57
ATTACHMENTVII...........................................................................................................................................................58
BACKGROUND SCREENING,,,,., .......................................................... 58
ATTACHMENTVIII.........................................................................................................................................................59
EHEAP CARES ACT BUDGET SUMMARY ................................................................................................................... 59
ATTACHMENTIX............................................................................................................................................................60
EHEAP CARES ACT ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL... 1., 1*0 144 "1 "1 Ill 41, 04, Ill "1 1160
ATTACHMENTX.............................................................................................................................................................. 61
RECEIPTS AND EXPENDITURE REPORT................................................................................................................... 61
ATTACHMENTXI............................................................................................................................................................62
REQUEST FOR PAYMENT............................................................................................................................................ 62
ATTACHMENTXII...........................................................................................................................................................63
EHEAP CARES ACT INVOICE REPORT SCHEDULE ............................................. ....................... I............................ 63
ATTACHMENTXIII.........................................................................................................................................................64
POVERT17INCOME GUIDELINES................................................................................................................................ 64
ATTACHMENTXIV......................................................................................................................................................... 65
EHEAP CARES ACT SOURCES OF INCOME.............................................................................................................. 65
ATTACHMENTXV...........................................................................................................................................................66
EHEAP CARES ACT APPLICATIONAND ELIGIBILITY WORKSHEET.................................................................4... 66
ATTACHMENTXVI......................................................................................................................................................... 68
EHEAP CARES ACT APPLICATIONAND ELIGIBILITY INSTRUCTIONS................................................................. 68
ATTACHMENTXVII........................................................................................................................................................71
EHEAP CARES ACT CLIENT FILE CONTENT CHECKLIST....................................................................................... 71
ATTACHMENTXVIII......................................................................................................................................................72
EHEAP CARES ACT COST REIMBURSEMENT SUMMARY........................................................................................ 72
ATTACHMENTXIX.........................................................................................................................................................73
SERVICE RATE REPORT............................................................................................................................. a................. 73
OdJ
17
(June 2020 — September 2021) CARES EHEAP 203.20
ATTACHMENT
STATEMENT OF WORK
EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM
CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY (CARES) ACT
I. SERVICES TO BE PROVIDED
A. DEFINITION OF TERMS
1. Eighteen (18) hour rule —The timeframe within which all applications for life -threatening crisis assistance
shall be acted upon, with an eligible action to mediate the crisis being taken and documented in the client file
within eighteen (18) hours of the application date stamp.
2. Forty-eight (48) hour rule — The timeframe within which all applications for standard crisis assistance shall
be acted upon, with an eligible action to mediate the crisis being taken and documented in the client file within
forty-eight (48) hours of the application date stamp.
3. Caseworker —Person who is responsible for determining program eligibility by completing the Emergency
Home Energy Assistance for the Elderly Program Coronavirus Aid, Relief, And Economic Security (CARES) Act
(EHEAP CARES Act) Eligibility Worksheets (ATTACHMENT XV and XVI) and awarding crisis benefits.
4. 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.
5. Client Application Date -The date the 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.
6. Crisis - A home cooling or heating crisis exists when an elder has no access to, or is in danger of losing access
to, needed home energy.
7. Crisis Assistance — Assistance provided to an elder who has no access to, or is in danger of losing access to,
needed home energy.
8. 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 EHEAP CARES Act 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 or forty-eight (18/48) hour rule was met.
b. Vendors must be paid within forty-five (45) days of the date of resolution.
9. 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 18/48-hour rule for crisis resolution
begins when the application is date stamped.
10. Disability —A disabling condition that causes an elder to be determined eligible to receive Supplement Security
Income (SSI) or Social Security Disability Income (SSDI) from the Social Security Administration.
11. Elder — An individual aged sixty (60) years or older.
12. 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;
(June 2020 — September 2021) CARES EHEAP 203.20
c.
Denial of an
elder 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 CARES
Act funding is not available or the elder is ineligible.
13. Energy Subsidy - Utility costs paid directly or indirectly to the elder who lives in government —subsidized
housing.
14. Household —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.
15. Household Member — Persons in a household who share a common kitchen or bath and purchase residential
energy in common.
16. Intake Worker — Person who accepts the EHEAP CARES Act application and required documentation and
may have the responsibility to determine eligibility or award crisis benefits.
17. Minimum Level of Service — Service to a minimum of one household per month.
18. Crisis Assistance Benefit— Payment of heating/cooling energy bill; the purchase of a heating/cooling device;
and/or the repair of a heating/cooling device.
19. 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 frail
elder individuals.
20. Provider —The entity that has entered into a contract, subcontract, or Memorandum of Understanding (MOU)
to provide services under EHEAP CARES Act. For the purposes of this contract, the terms "Provider" and
"Contractor" may be used interchangeably.
21. Reasonable Promptness - Within fifteen (15) working days of receiving the client's completed application.
22. Request for Payment— Submission of actual monthly expenditures for reimbursement.
23. Service Unit —one individual (elder) served.
24. 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.
25. 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 to alleviate the
possibility of fraud. This date shall not be changed. Signatures must be in ink. Rubber-stamped signatures will
not be accepted.
26. 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) Coronavirus Aid, Relief, and
Economic Security (CARES) Act 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. The primary purpose of the EHEAP CARES
Act program is to prevent, prepare for, and respond to coronavirus; including assisting low-income households
with at least one member aged sixty (60) or older experiencing a heating or cooling emergency.
(June 2020 — September 2021) CARES EHEAP 203.20
2. Authority
The relevant federal and state authorities governing EHEAP CARES Act are:
a. Low Income Home Energy Assistance Act of 1981 (Title XXVI of the Omnibus Budget Reconciliation Act
of 1981, P.L. 97-35), as amended;
b. CARES Act;
c. 42 United States Code (U.S.C.) § 8621 et seq.;
d. 45 Code of Federal Regulations (CFR) Part 96, Subpart H (§§ 96.80-96.89);
e. Section 409.508, Florida Statutes (F.S.) and Rule 73C-26.021(3), Florida Administrative Code (F.A.C.);
f. Rule Chapter 73C-26, F.A.C.;
g. State of Florida LIHEAP Policies and Procedures Manual; and
h. LIHEAP State Plan,
3. Scope of Service
The Contractor is responsible For the programmatic, fiscal, and operational management of EHEAP CARES
Act. Eligible elders may receive multiple crisis assistance benefit(s), that combined not to exceed $2,000.00
during the term of this agreement. Eligible, elders may receive crisis assistance benefits during the period from
June 1, 2020 to September 30, 2021. The services provided under this contract shall be in a manner consistent
with and described in ATTACHMENT 1, Section 1I: Manner of Service Provision. Contractor, in collaboration
with its EHEAP CARES Act program partners, shall ensure the following service tasks are completed:
(1) Consumer Ouh•each;
(2) Program Partners and Stakeholders Coordination;
(3) Elder's Benefit Eligibility Determination; and
(4) Benefit Disbursement.
4. Major Program Goals
EHEAP CARES Act 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 Summer and Winter
Crisis seasons are waived until the CARES Act funding is fully expended.
a. Standard Crisis
A standard hone 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 has been notified that the energy source for cooling or heating is going to be disconnected;
(2) The elder has received a notice indicating the energy source is delinquent or past due; and/or
(3) The elder has an energy bill for which the due date has lapsed;
b. Life -Threatening Crisis
A life -threatening home cooling or heating crisis exists if one of the following conditions is present:
(1) The elder's home cooling or heating energy source has been disconnected;
(2) The elder is unable to get delivery of fuel for heating, is out of fuel for heating, or is in danger of being
out of fuel for heating; or
(3) The elder has other problems with lack of cooling or heating in the home, such as needing to pay a
deposit, needing a repair of heating or cooling equipment, or needing an interim emergency measure to
avoid further crisis.
(June 2020 — September 2021)
CARES EHEAP 203.20
C. CLIENTS TO BE SERVED
1. General Description
EHEAP CARES Act provides for direct client services to elders in low-income households experiencing a home
energy heating or cooling emergency. A household receiving EHEAP CARES Act 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 CARES Act service area (Planning and Service Area) at the time the home energy
costs were incurred;
c. Complete and return an EHEAP CARES Act application with all required information and verification to
Contractor, while funds remain available;
d. Provide a fuel bill or other documentation 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 (I50%) of the Officeof
Management and Budget (OMB) federal poverty level for the size of the household, in accordance with
Section I.C.3.d. of this contract;
f. 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;
h. Not be a student living in a dormitory; and
i. Legally reside in the State of Florida.
3. Client Determination
Contractor shall begin taking applications For EHEAP CARES Act services upon execution of this contract and
continue taking applications until the contract expires or funds are exhausted. Contractor will not accept
applications when funds are exhausted for a particular time period. Contractor shall:
a. Provide assistance to elders in completing Department -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 funds;
c. Treat homeowners and those who rent equitably under this contract;
d. Calculate the income eligty 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 the current year EHEAP
CARES Act Sources of Income (ATTACHMENT XIV) to determine what is considered allowable income.
Contractor shall proceed as follows:
(1) Total household income cannot exceed one hundred fifty percent (150%) of the current federal
Poverty Income Guidelines (ATTACHMENT XIII);
i. Stimulus payments from the federal government in relation to the Coronavirus Disease will not be
considered income and will not be considered in determining a household's Federal Poverty
Level (150% or below).
ii. Any type of unemployment payments will not be counted as income.
(June 2020 — September 2021)
CARES EHEAP 203.20
(2) Obtain a self -declaration from household members aged eighteen (18) years or older claiming zero
income. Self -declarations must be completed and signed by the household member who is claiming
zero income.
i. Zero income can be determined with proof of client employment termination or self -declaration.
ii. Zero income can be determined at the time of application and projected forward (cun•ent economic
status), instead of using the past 30 days. If applicable, clients should note the reason for zero
income related to COVID 19.
. Although not counted as income for eligibility purposes, excluded income sources may be used to
determine how a household is meeting its expenses.
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:
(1) 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 the utility bill
must be subtracted from the allowable EHEAP CARES Act 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 income 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 or
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 the household crisis assistance cap of $2,000.00.
(1) Elders may apply for and receive multiple crisis assistance benefit;
(2) Crisis assistance benefit may consist of payment of more than one energy obligation in the following
allowable categories for a household to resolve a single crisis:
(i) Utility payments for heating/cooling bill assistance for electric, gas, propane, wood, coal, or
refillable fuels;
(ii) Temporary emergency shelter (if needed due to energy -related crisis);
(iii) Payment to landlords (when utility costs are included in rent);
(iv) Repairs or replacements to heating/cooling units (as long as the amount is within the benefit
limits and the work is done by a licensed contractor);
(v) Deposits to connect or restore energy;
(vi) Late fees, disconnect fees, and reconnect fees;
(vii) Charges from a previous account held by the applicant that is now closed;
(vIII) Blankets and fans;
(ix) 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 CARES Act funding.
22
(June 2020 — September 2021)
CARES EHEAP 203.20
Example: In a case where taxes for other services are commingled with taxes for home energy
services, proceed with paying the taxes portion of the bill;
(x) 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;
(xi) Pre -pay home energy usage:
a. 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.
b. The benefit amount for pre -paid account shall be for one month's energy usage and may
include other allowable costs;
(xii) The purchase or repair of fans, blankets, air conditioners, and/or portable heaters in addition to
heating/cooling bill assistance; and
(xiii) 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.
(3) Water, sewer, garbage, and fire, etc. charges may not be paid;
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 CARES Act, Contractor shall ensure the fallowing tasks are performed:
I. 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 II.A.14.d. of this agreement;
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 or forty-eight (18/48)
hours of the application date stamp, and document in the client file that the crisis was resolved within eighteen
or forty-eight (18/48) hours;
4. Provide all elders approved for EHEAP CARES Act funding witha written Notice of Approval and Appeal on
agency letterhead within fifteen (IS) 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;
c. The next date when the elder will be eligible to apply for further assistance; and
d. Contractor's appeal process.
e. Signature, date and contact information of agency's authorized representative.
5. Provide all elders whose EHEAP CARES Act applications were denied with a written Notice of Denial and
Appeal on agency letterhead 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;
23
(June 2020 — September 2021)
CARES EHEAP 203.20
c. Type of benefit sought;
d. Reason(s) for denial;
e. Statement on Contractor's benefit limits, if applicable;
f. Contractor's appeal process;
g. Explanation of circumstances under which the elder may reapply;
It. 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.
k. Signature, date and contact information of agency's authorized representative.
6. Maintain consumer appeal procedures that provide an opportunity for a fair adminisb•ative 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 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.
8. Post appeal provisions in a prominent place and in plain view at all locations where EHEAP CARES Act
applications are received;
9. Ensure all ineligible applicants and applicants denied crisis assistance, when EHEAP CARES Act fiords 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 CARES Act benefits. Post in a conspicuous place at all locations where EHEAP CARES Act
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.";
11. Compare LIHEAP CARES Act records and EHEAP CARES Act records for households with elderly members
to avoid exceeding the household crisis benefit cap 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 #071113-1-I-SWCBS, http://elderaffairs.state.fl.us/ Agency
notices/Julvl3/LIHEAP%20Notice%20re%20Social%20Security%20Numb ers%20Final.1)df). The Notice
Regarding Collection of Social Security Numbers shall be signed by the elder and retained in the client file;
(June 2020 — September 2021)
CARES EHEAP 203.20
13. Consumer Outreach
Ensure that households in all counties within the service area wishing to benefit fiom 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 CARES Act. 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 CARES Act program, especially those serving seniors;
b. Encouraging EHEAP CARES Act program participation through local television and radio programs, and
placing announcements of the EHEAP CARES Act 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 making presentations about EHEAP CARES Act in response
to requests by local congregational centers serving elderly or disabled persons; and
e. Providing information concerning the local weatherization program to all persons who request it (including
organizations that provide outreach activities).
14. Program Partners and Stakeholder Coordination
Contractor 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 LIHEAP contractors in their respective service areas to prevent exceeding
the household crisis assistance cap to elders;
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 whichelders
who have received more than three EHEAP or 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 LIHEAP contractors. Each MOU
shall ensure coordination of services, 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 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 EHEAP
requirements and guidelines;
d. Developing agreements with home energy vendors that benefit elders. Contractor shall maintain copies of
all vendor agreements. All current EHEAP agreements between Contractor and home energy vendors are
valid under the EHEAP CARES Act contract. 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;
25 O1'O
(June 2020 — September 2021)
CARES EHEAP 203.20
(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 amount necessary to
resolve the crisis situation;
(11) Contractor's commitment to make payment to the home energy vendor within foil y-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 the home energy vendor 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 data to DEO;
(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(Inttp://sunbiz.org/searcln.html). The business name on the vendor agreement must
match the legal business name on the State of Florida Sunbiz website; and
15. Comply with the Federal Financial Accountability and Transparency Act (FFATA) by securing a Dun and
Bradstreet Numbering System (DUNS) number (www.drib .com) and maintaining an active and current profile
in the System for Award Management (SAM) (www.sam.gov).
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:
(June 2020 — September 2021)
CARES EHEAP 203.20
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. 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;
(3) The total number of individuals sewed by referral to other community resources for energy assistance
during the reporting month; and
(4) The total amount of funding expended for crisis assistance per county for the reporting month.
c. Entities providing any service required under this contract must canply 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.gov).
d. Entities must maintain current written agreements in the following formats with service providers:
(1) 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.
Contractor shall submit a copy of all MOUs to the Agency's Contract Manager within thirty (30) days
of the contract execution date; and an EHEAP CARES Act 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 Contract Manager within thirty (30) days of the contract
execution date.
e. 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.
£ 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.
g. Subcontractor shall not be permitted to perform services related to this contract without an executed
subcontract and an approved Provider Cost Analysis or Mn" verifying that subcontractor's staff is paid
from non-federal resources or is compensated for such activities by EHEAP CARES Act. 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.
h. Contractor shall document the subcontractor's progress in performing its work under this contract in the
quarterly report.
(June 2020 — September 2021)
CARES EHEAP 203.20
i. For each subcontractor, Contractor shall provide a written statement to the Agency regarding whether that
subcontractor is a minority vendor, as defined in Section 288.703, F.S.
j. If this contract 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 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 Planning and 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 majeure.
3. Contractor shall publish its service delivery location, toll -free telephone number, and normal business hours 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 hours, as identified in Section ILC.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.17.
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 EHEAP CARES Act
Receipts and Expenditure Report (ATTACHMENT XI) and EHEAP CARES Act 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 funds expended per county for the reporting month using the EHEAP
CARES Act Cost Reimbursement Summary form (ATTACHMENT XIX); and the certification required in
Section III, E.2.
3. Records and Documentation
Contractor will maintain a separate record (paper and CIRTS) for each EHEAP CARES Act applicant that
includes the following, as applicable:
a. The EHEAP CARES Act Application and Eligibility Worksheet (ATTACHMENT XV) 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 CARES Act Application and Eligibility Worksheet Instructions (ATTACHMENT XVI) issued
by the Agency.
(1) If Contractor approves an application, one elderly member of the household must be registered in
CIRTS using the EHEAP CARES Act Application and Eligibility Worksheet (ATTACHMENT XV);
or
(2) If Contractor denies an application, the elder must be registered in CIRTS using the EHEAP CARES
Act Application and Eligibility Worksheet (ATTACHMENT XV).
(June 2020 — September 2021)
CARES EHEAP 203.20
b. The cider's name, address, sex, and age;
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 #071113-1-I-
S WCB S,_
http://elderaffairs,state.fl.us/Agency/notices/July 13/LIHEAP%2ONotice%20re%20Social%2OSecurity%2
ON umbers%20Final.ndf);
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 beingprovided
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 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 coolingtheating
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 amount(s) due is required. If an elder's utility bill,
cutoff notice, 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 CARES Act Application and Eligibility Worksheet (ATTACHMENT XV).
k. Signed Authorization for Release of General and/or Confidential Information for LIHEAP/EHEAP Federal
Reporting a• 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 EHEAP CARES Act prevented a disconnection or restored an energy disruption;
p. Documentation of coordination with LIHEAP providers to avoid exceeding the individual crisis cap for
households with elderly residents;
q. Proof of payment made to vendors;
r. Documentation of calculation of benefits For elders living in subsidized housing; and
s. Completed EHEAP CARES Act Client File Content Checklist (ATTACHMENT XXII).
29
(June 2020 — September 2021) CARES EHEAP 203.20
E. PERFORMANCE SPECIFICATIONS
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 EHEAP CARES Act Request for Payment (ATTACHMENT
XI) as delineated in Section II.E. Le. of this contract.
b. Administrative and Outreach Expense Budget Detail
Contactor shall submit to the Agency's EHEAP Contract Manager the EHEAP CARES Act Administrative
and Outreach Expense Budget Detail (ATTACHMENT IX). The EHEAP CARES Act Administrative and
Outreach Expense Budget Detail shall clearly delineate planned expenditures for funds retained by the
Contractor and funds subcontracted. The EHEAP CARES Act Administrative and Outreach Expense Budget
Detail shall include all Contractor positions, by title, to be paid with these funds and shall detail the
estimated number of hours, the hourly wage, and the estimated salary to be paid by EHEAP CARES Act
Funding sources, estimated hours, and hourly wage shall be identified for the balance of salary where
EHEAP CARES Act funds are used to pay less than one hundred percent (100%) of the salary.
c. 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 Agency Cost Analysis
for Non -Competitively Procured Contacts In Excess of Category II.
(1) The Contractor shall submit a completed Cost Analysis which shall reflect Administrative, Otutreach,
and Crisis Service allocations as delineated on the EHEAP CARES Act Budget Summary
(ATTACHMENT VIII) 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
and approved by the Agency prior to any change.
d. Monthly Reports
(1) 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 181 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 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;
e. For the term of this contract, each month Contractor shall provide to the Agency, by the 9ih of each month
fa• the preceding month, the following information will be entered on ATTACHMENT XI, Request for
Payment, under Part D: Service 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 reportingmonth;
(3) The total number of individuals served by referral to other community resources for energy assistance
during the reporting month; and
(4) The total amount of funding expended for crisis assistance per county for the reporting month.
(June 2020 —September 2021)
CARES EHEAP 203.20
f. EHEAP CARES Act Quarterly Reports
The quarterly EHEAP CARES Act Summary Report shall be submitted based on the following schedule:
REPORT
REPORTING PERIOD
DATE DUE TO AGENCY
1
05/01/20 — 06/30/20
July 09, 2020
2
07/01/20-09/30/20
October 09, 2020
3
10/01//20 — 12/31/20
January 09, 2021
4
01/01/21—03/31/21
April 09, 2021
5
04/01/21—06/30/21
July 09, 2021
6
07/01/21—09/30/21
October 09, 2021
(I) The Conhractor shall ensure timely and accurate CIRTS data entry of EHEAP CARES Act activity and
submit to the Agency's EHEAP Contract Manager the service report entitled "EHEAP Summary" from
CIRTS. The report shall reflect the use of EHEAP CARES Act in each county in the PSA and shall be
inclusive of all elders applying for crisis energy assistance during the reporting month or period. The
EHEAP Summary Report parameters for the program year shall be:
(i) PSA;
(ii) All Providers;
(iii) All Locations;
(iv) Start Date (first date of reporting period); and
(v) End Date (last date of reporting period).
g. Program Effectiveness Reports
Contractor agrees to provide to the Agency any additional service reports requested by the Agency
concerning the effectiveness ofthe program and shall include any statistics and information that the Agency
may require. The reportingperiod 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 well 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 the 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 CARES Act applications in accordance with the EHEAP
CARES Act Client File Content Checklist (ATTACHMENT XVII).
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.
31 Otla
(June 2020 — September 2021)
CARES EHEAP 203.20
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 CARES Act client files in accordance with the EHEAP CARES Act Client File
Content Checklist, (ATTACHMENT XVII).
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.
F. CONTRACTOR RESPONSIBILITES
1. Make vendor 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 assistance cap
for this contract is $2,000.00 per household.
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 CARES Act crisis services to households with elders in every county within the service area.
a. Contractor shall ensure that each county within their service area receives a minimum level of crisis services
monthly, as delineated in Section I.A.17.;
b. EHEAP CARES Act funded staff shall make themselves available in all underserved counties as needed,
to ensure that the minimum level of service is met; and
c. Contractor shall provide oversight to ensure that the minimum level of service is provided monthly in each
county 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 Inoue energy needs and the lowest household income,
which will be determined by taking into account both the energy burden and 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 funds, all funds incorrectly paid on behalf of elders that cannot be
collected fi•om the elder.
8. Develop adequate procedures to ensure EHEAP CARES Act funds are appropriately budgeted 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 CARES Act administrative award to Contractor or Subcontractor are paid from non-federal sources.
10. Develop adequate procedures to address the use of EHEAP CARES Act funds 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.
(June 2020 — September 2021)
CARES EHEAP 203.20
12. Ensure providers and appropriate staff participate in training opportunities scheduled by the Agency to cover
EHEAP CARES Act 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 CARES Act. 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 LIHEAP Policies and Procedures Manual;
b. An MOU or Subcontract with EHEAP CARES Act providers;
c. An MOU with all service area LIHEAP CARES Act 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 CARES Act funds are appropriately budgeted and expended
in all counties within Contractor's service area;
]r. Policies regarding the detection and prevention of fraud and abuse of program funds;
i. Policies that address serving family members and employees;
j. Policies and procedures to secure applicant Social Security Numbers in order to protect applicants'
identities;
Ic. Procedures for computer system backup and recovery;
1. Procedures for referral or access assistance to the "Lifeline Program";
m. 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 EHEAP CARES Act;
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 funds 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 CARES
Act funding is not available or they do not qualify;
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
(June 2020 — September 2021)
CARES EHEAP 203.20
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 the 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 the 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 CARES Act in Florida.
a. This contract 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 contract and any incorporated reference contained herein, this
contract shall have precedence.
III. METHOD Or PAYMENT
A. PAYMENT METHOD USED
The Method of Payment for this contract is cost reimbursement, 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 11, Manner of Service Provision, and in accordance with other terms and conditions of this
contract.
1. Cost Reimbursement
The Contractor agrees to distribute fiords as detailed in the EHEAP CARES Act Budget Summary (ATTACHMENT
IX) attached to this contract. Any change in allocation of categorical or total amounts of funds identified on the
EHEAP CARES Act 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 Vlll. All Cost
Reimbursement EHEAP CARES Act Requests for Payment must include the actual EHEAP CARES Act
Receipts and Expenditure Reports beginning with the first month of this executed contract.
a. Budget Summary
Contractor agrees to implement the distribution of funds as detailed in the EHEAP CARES Act Budget
Swnmary (ATTACHMENT VIII). 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 CARES Act,
above and beyond the budgeted amount, is prohibited. Administrative costs that exceed the contracted
EHEAP CARES Act 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.
(June 2020 — September 2021)
CARES EHEAP 203.20
(2) Outreach Expense
Outreach expenses are those costs incurred in delivering EHEAP CARES Act 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. Outreach expense shall not include senior management expense,
except when outreach and intake involving direct contact with elders occurs. Documentation to support
this exception shall be maintained by Contractor and available upon request.
c. 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 the Agency (in compliance with 2
C.F.R, Part 200), or a de minimis indirect cost rate as defined in 2 C.F.R. § 200.414(f). Subrecipient shall
maintain its current Indirect Cost Rate Proposal and make the proposal available upon request. If
Subrecipient chooses to use the de minimis 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
Advance payments will not be issued for this project.
B. The final request for payment is due to the Agency no later than October ] 5, 2021.
C. 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 EHEAP CARES Act Service Rate Report (ATTACHMENT XIX);
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 the EHEAP CARES Act
Receipts and Expenditure Report (ATTACHMENT X), EHEAP CARES Act Request for Payment
(ATTACHMENT XI), and EHEAP CARES Act Cost Reimbursement Summary (ATTACHMENT XVIII);
4. Contractor shall include required supporting documentation as delineated in Section III.E. with the cost
reimbursement portion of the invoice.
D. PAYMENT WITHHOLDING
Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and approval
by the Agency of all financial and prograunmatic reports due horn the Contractor• and any adjustments thereto,
including any disallowance not resolved.
E. SUPPORTING DOCUMENTATION REQUIREMENTS
For• the reporting month, Contractor• shall include the following with Request for• Payment:
1. The number of individuals served that include:
a. The number of individuals served with crisis assistance during the reporting month;
b. The number of individuals ineligible or denied assistance during the reporting month;
c. The number of individuals referred to other community resources for energy assistance during the reporting
month;
35
(June 2020 — September 2021)
CARES EHEAP 203.20
2.
Certification that
Contractor
operated during its
normal business hours during the reporting month;
3.
The total amount
of funding
expended for crisis
assistance per county for the reporting period; and
F. FINANCIAL CONSEQUENCES
Failure to meet the deliverables described in this contract may result in a financial consequence and may result in
the redistribution of funding. Contractor shall ensure the provision of services and the successful completion of
deliverables as set forth in this contract.
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.
3. 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 non-federal funds.
G. 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.
I. 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 infractionthat compromises Contractor's ability to
provide participant services, to achieve programmatic performance, or to provide sound financial management
of the program.
H, CONSEQUENCES FOR NON-COMPLIANCE
Contractor shall ensure that one hundred percent (] 00%) of the deliverables identified in this contract are performed
pursuant to contract requirements. The deliverables described in Section II.D, are identified as major deliverables
in this contract.
I. 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
a Financial Consequence for Non -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 Contractor 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 1 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 event that 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 funds 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, 1% of the monthly value of
the administrative funds in the contract for each day the Contractor fails to timely submit a CAP.
36
(June 2020 — September 2021) CARES EHEAP 203.20
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 a Agency approved budget modification process.
2. For the purpose of transferring funds, the following are considered budget categories: (1) Administration, (2)
Outreach, and (3) Crisis Assistance.
END Or ATTACHMENT
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Agency to the Contractor may be subject to audits and/or monitoring by the
Agency, as described in this section,
MONITORING
[n addition to reviews of audits conducted in accordance with 2 CFR Part 200 (formerly OMB Circular A-133 as revised),
and Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits
by the Agency 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. In the event the
Agency determines that a limited scope audit of the Contractor is appropriate, the Contractor agrees to comply with any
additional instructions provided by the Agency 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 Chief Financial
Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the Contractor is a State or local government or anon -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 and
Compliance Audit Attachment, Exhibit 2 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 200. 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 Agency 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 contract
with the Agency in effect during the audit period. Financial repotting 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.
GQ,O
38
(June 2020 — September 2021)
CARES EHEAP 203.20
PART II: STATE FUNDED
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 $750I00 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, Financial
Compliance Audit Attachment, Exhibit 2 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 non -state
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 II, 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 from 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 691- 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 directly to each of the following:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10"' 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.
O
(June 2020 —September 2021) CARES EHEAP 203.20
The Contractor shall submit a copy of any management letter issued by the auditor directly to the Area Agency on Aging for
Southwest Florida, Inc. at the following address:
Area Agency on Aging for Southwest Florida, Inc.
Attn: Chad Tripp, CFO
2830 Winkler Ave., Suite 112
Fort Myers, FL 33916
Additionally, copies of financial reporting packages required by this contract's Financial Compliance Audit Attachment,
Part 11, shall be submitted by or on behalf of the Contractor directly to 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: Chad Tripp, CFO
2830 Winkler Ave., Suite 112
Fort Myers, FL 33916
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letters, or other information required to be submitted to the Agency pursuant to this contract 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 ]0.550 (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 contract for a period of
six (6) years fi•om 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.
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMENT II -EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the can requirements of 2 CFR Pact 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. Contractors 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 CPR § 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 chanter schools are exempt. Exempt organizations must
comply with all compliance requirements set forth within the contract or award document.
NOTE: If a Contn•actor 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-5.006, 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. Conhactors 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 § 200.4t6 - § 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, ides, and regulations
41 ONO
(June 2020 — September 2021)
CARES EHEAP 203.20
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. Conhactors who receive state financial assistance and who are determined to be a
recipiendsub-recipient must comply with the following fiscal laws, rules, and regulations:
Sections 215.97 & 215.971, F,S.
Chapter 691-5, F.A.C.
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules, and regulations
42
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMENT II -EXHIBIT 2
FUNDING SUMMARY (2020-2021)
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 1, 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 THISCONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD (FAIN#): 17EA-OF-13-00-16-003
FEDERAL AWARD DATE:
DUNS NUMBER: 0769977§0
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Emergency Home Energy Assistance
for the Elderly Program —
Coronavirus Aid, Relief, And
Economic Security (CARES) Act
United States Department of Health and
Hunan Services
93.568
Collier $ 56,406.20
TOTAL FEDERAL AWARD
$ 56,406.20
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 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 CONSISTOF
THE FOLLOWING:
MATCHING RESOURCES h'OR FEDERAL PROGRAMS
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
TOTAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FiNANCiAI. ASSISTANCF,
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
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMENT III
CERTIFICATIONS AND ASSURANCES
AGENCY will not award this contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES.
In performance of this contract, Contractor provides the following certifications and assurances:
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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 contract 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 atall
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.
(June 2020 — September 2021) CARES EHEAP 203.20
B. CERTII ICATION 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 tenon scrmn onand 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 1-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
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 his 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 Department of Health and Hunan 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.
(June 2020 — September 2021)
CARES EHEAP 203.20
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 Pail 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
from participation in, be denied the benefits of, or be otherwise subjected to discrimination raider 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 includingjob 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 carry out the WIA Title I — financially assisted program or activity.
Contractor understands that AGENCY 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 AGENCY immediately upon any change of
circumstances regarding this status.
E. ASSOCIATION OF COMMUNITY 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.
(June 2020 — September 2021)
CARES EHEAP 203.20
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.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS,
GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
I. The Contractor and any Subcontractors of services under this contract have financial management systems capable
of providing certain information, including: (I) 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 finds 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 chip 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 fiom 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 service 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 certes 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 services 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/conh•acts 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 contract imposed by
Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A -I 10),
(June 2020 — September 2021)
CARES EHEAP 203.20
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.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of Section 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 Agency and state agencies or subdivisions defined in section 768.28(2), F.S.
2. Section 119.01(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 entity which 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 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 subconh•act agreements (if
applicable).
By signing below, Contractor certifies that the representations outlined in pacts A through J above are true and correct.
Approved
Street Address
Corot �1�
Cityq Mate, Zip code
as to form and legality
48 Ass ant County At 'ncy
O
U
(June 2020 — September 2021)
CARES EHEAP 203.20
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.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE 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 fiotn 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 C.F.R. 900, Subpart F),
6. Will comply with all federal statutes 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) Sections523 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) Title Vill 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.
(June 2020 — September 2021) CARES EHEAP 203.20
T Will comply, or has already complied, with the requirements of Titles 11 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.
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.
Il. 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 ManagementAct
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.
7
50
(June 2020 — September 2021)
CARES EHEAP 203.20
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations, and policies
governing this program.
SI CER IP]'INC OFFICIAL
TITLE
MTUREAUTHORIZED
" " Se
lc r euNA 1-"
APPLICANIC ORGA ` ATIOON
DATE UBMITTED
�tll�r�L v� C uCI VJMV ll�SIOYIerS
11O 20ZO
Approved as to form and legality
AsWant and County Att ncy
51
(June 2020 — September 2021) CARES EHEAP 203,20
ATTACHMENT V
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name
County
AAA/Contractor
Address
Completed By
City, State, Zip Code
Date
Telephone
PART L• READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORNIATION, WHICH WILL HELP YOU COMPLETE THIS
FORMo
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
i
For questions 2-5
2. Population of to
3. Staff currently t
4. Clients cm•rentt
5. Adrisory/Govei
please indicate the following:
White
Black
Hispanic
Other
Female
Disabled
Over 40
ea served
mplayed
enrolled/registered
ning Board if applicable
Source of data:
Effective date:
Effective date:
PART II: USE A SEP
(June 2020 — September 2021) CARES EHEAP 203,20
13. Give the number and current status of any discrimination complaints regarding services or employment filed N/A NUMBER
against the program/facility. ❑
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
NO, EXPLAIN,
15. Has as a self -evaluation been conducted to identify any barriers to serving disabled individuals and to make any YES NO
necessary modifications? ❑ ❑
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
El
NO
F1
19.Are
auxiliary aids available to ensure accessibility of services to hearing and sight -impaired individuals?
YES
NO
❑
❑
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF S50,000.00 OR
20. Do you have a written affirmative action plan? If NO, explain.
MORE.
YES
NO
❑
❑
Reviewed
by
In Compliance: YES
❑NO*
❑
Program Office
*Notice of Corrective Action Sent
Date
Telephone
Response Due
On -Site ❑ Desk Review ❑
Response Received
(June 2020 — September 2021) CARES EHEAP 203.20
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. htclude the source of your population statistics. ("Other" races include
Asian/Pacific Islanders and American Indian/Alaskan 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.
5. 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 AGENCY 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 through site record analysis of persons who applied but were denied services or employment. 45 CFR § 80.3(a) and 45 CFR
§ 80.I.
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
(June 2020 — September 2021)
CARES EHEAP 203.20
12a 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).
13. 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 Agency and/or Department 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.
14. Report number of discrimination conplaints 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.).
15. 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, resh•oom facilities, water fountains, and information and admissions offices should be
accessible. Door widths and traffic areas of administrative 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.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct aself-
evaluation to identify any accessibility barriers. Self -evaluation is a four -step process:
a. Evaluate, with the assistance of disabled individual(s)/organization(s), current practices and policies 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 polocies
and practices; and
d. Maintain self -evaluation on file, including a list of the interested persons consulted, a description of areas
examined, any any problems identified, and a description of any modifications made and of any remedial steps
taken 34 CFR § 84.6. (This checklist may be used to satisfy this requirement if these four steps have been
followed).
17. Programs or facilities that employ 15 or more persons shall adopt grievance procedures that incorporate appropriate due
process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited
by Part 84 of Title 45, CFR45 CFR § 84.7(b).
18. Programs or facilities that employ 15 or more persons shall designate at least one person to coordinate its efforts to
comply with Part 84 of Title 45, CFR. 45 CFR § 84.7(a).
19. 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).
(June 2020 — September 2021)
CARES EHEAP 203.20
20. Programs/facilities that employ 15 or more persons must 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 in 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).
21. 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 60 and
Title VI of the Civil Rights Act of 1964, as amended.
o
w
F
a
o
o F
a0.
w
a
i
n
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMENT VII
BACKGROUNDSCREENING
BACKGROUND SCREENING
ELDER AFFAIRS
.roviI:M I1.rnmt.i. �. Affidavit of Compliance =Employer
AUTHORITY:
This form is
required annually of all employers to
comply with the attestation
requirements
set forth in
section 436.06(3), Florida Statutes.
Y 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 (and Disability) Resource Centers, Lead Agencies,
and Service Providers that contract directly or indirectly with the Department of Elder Affairs (DO EA), and
any other person or entity which hires employees or has volunteers in service who meet the definition
of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat.
Y 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
located
Street
Employer Name
State Z1Pcode
I, do hereby affirm under penalty of perjury
Name o(Representative
that the above named employer is in compliance with the provisions of Chapter 43S and section
430.0402, Florida Statutes, regarding level 2 background screening.
Signature of Representative Date
STATEOFFLORIDA,COUNTYOF
Sworn to (or affirmed) and subscribed before me this day of 20J by
of Representative) who Is personally known
proof ofidentification.
Print,Type, or5tampCommissioned Name of Notary Public Notary Public
OOFA Form 235, Affidavit of Compliance - Employer, Effective September 21, 2017 Section 435.0513i, F.S.
Formavallablea[: htto•//elderatfalrs state.0 us/en¢Ilzh/bacWtroundscreenlnR.php
58 \ J
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMENT VIII
EHEAP CARES ACT BUDGET SUMMARY
AGENCY: AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA9 INC.
TOTAL ADMINISTRATIVE BUDGET
Collier
TOTAL OUTREACH BUDGET
Collier
CRISIS ASSISTANCE
Collier
TOTAL
Collier
Projected minimum number of Individuals to be served Crisis Energy
Assistance
CARES Act
Total Award
$ 4,656.31
$ 7,770.10
$ 43,979.79
$ 56,406.20
Collier = 154
"Eligible households may be provided with more than one benefit, totaling no more than $2,000.00. The
minimum number of individuals to be served crisis energy assistance may reflect duplicated consumers if a
consumer receives multiple benefits.
(June 2020 — September 2021) CARES EHEAP 203.20
ATTACHMENT IX
EHEAP CARES ACT ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL
PSA CONTRACT #
Emergency Home Energy Assistance Program CARES Act
Administrative &Outreach Expense Budget Detail
Item
DetailLine
EHpenditUFe
Cost
$0,00
$0400
$0000
$0.00
$0,00
$0000
$0000
so.00
$0400
$0,00
$0000
$0.00
$0000
$0,00
$0000
$0,00
$0000
so.00
$0000
$0.00
$0.00
$0000
$0000
_ $0000
Total
SO.UO
Administration Subtotal S -
Outreach Subtotal S
Total S -
(June 2020 - September 2021)
CARES EHEAP 203.20
ATTACHMENT X
RECEIPTS AND EXPENDITURE REPORT
CARES ACT
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
I
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source:
Contract#
EHEAP
Contract Period
CARES ACT
(Emergency Home Energy
Report Period
Assistance for the Elderly Program)
Report #
Invoice #
PSA
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
in the contract. To the best of my knowledge,
all CIRTS is accurate and correct.
Prepared by: Date:
Approved by:
Date
PART A: BUDGETED INCOME/ RECEIPTS
1. 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
%
2. Interest on Agreement Funds
$0.00
$0.00
$0,00
%
3. TOTAL AGREEMENT AMOUNT
$0.00
$0.00
$0.00
%
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
$0.00
%
2. Outreach
$0.00
$0.00
$0,00
%
3. Crisis Services
$0.00
$0.00
$0.00
%
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
%
AGENCY FORM 105pca
(June 2020 - September 2021)
CARES EHEAP 203,20
ATTACHMENT XI
REQUEST FOR PAYMENT
_ REQUEST FOR PAYMENT
-- CARES ACT
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
CONTRACTOR NAME, ADDRESS, PHONE# and FEID#
TYPE OF REPORT:
Contract#
Contract Period _
Advance Request
Request Period
Report#
Reimbursement Request
Invoice # -
PSA
CERTIFICATION: I hereby certify that this 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:
PART A: BUDGET SUMMARY
ADMINISTRATION
OUTREACH
CRISIS
TOTAL
SERVICES
SERVICES
SERVICES
1. Approved Contract Amount
$0.00
$0.00
$0.00
$0.00
2. Previous Funds Received for
$0.00 -
$0.00
$0.00
$0.00
Contract Period
3. Contract Balance (line 1 minus line 2)
$0.00
$0.00
$0.00
$0.00
4. Previous Funds Requested and Not
$0.00
$0.00
$0.00
$0.00
Received for Contract Period
5. Contract Balance (line 3 minus line 4)
$0.00
$0.00
$0.00
$0.00
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Needs
$0.00
$0.00
$0.00
(1 at- 2nd month, Attach Justification)
2. Net Expenditures For Month
$0.W
$0.00
$0.00
_
_ $0.()0
_
(AGENCY Form 105PCA, Part B, Line fi)
_
3. TOTAL
$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
2. TOTAL FUNDS REQUESTED
$0.00
$0.00
50.00
_
_ _ $_0.00
(Part B. Line 3 minus Part C. Line 1)
PART D SERVICE INFORMATION '
Number of Individuals served with crisis assistance during the report month:
Number of Individuals ineligible or denied assistance during the report month:
Number of individuals served by referal to other community resources for energy assistance during the report month:
Certification statement: Contractor hereby certifies that It has been open and operating during Its normal business hairs for the reporting month, as
described In the Statement of Work section, of the EHEAP contract.
H"cwur xvnm yea 62 OI'J
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMENT XII
EHEM- CARES ACT INVOICE REPORT SCHEDULE
Report Number
Based Upon
Date Due to the Agency
1
June Invoice
July 09, 2020
2
July Invoice
August 09, 2020
3
August Invoice
September 09, 2020
4
September Invoice
October 09, 2020
5
October Invoice
November 09, 2020
6
November Invoice
December 09, 2020
7
December Invoice
January 09, 2021
8
January hrvoice
February 09, 2021
9
February Invoice
March 09, 2021
I O
March Invoice
April 09, 2021
I 1
April Invoice
May 09, 2021
12
May Invoice
June 09, 2021
13
June Invoice
July 09, 2021
14
July Invoice
August 09, 2021
15
August Invoice
September 09, 2021
16
September Invoice
October 09, 2021
17
Final Request for Payment
October 15, 2021
Note 1 Advance payments will not be issued with the project.
Note 2 Submission of invoices may or may not generate a payment request. If final invoice
reflects funds due back to the Agency, payment is to accompany the final invoice
report.
Note 3 ALL Expenditure Reports are due by 12:00 p.m. on the 9th of each month. IF the 9`h
falls on a Saturday, then the report will be due by the 8th by 12:00 P.M. AND [F the
9th falls on a Sunday, the report will be due by the 1 Oth by 12:00 p.m. Actual submis-
sion 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.
(June 2020 — September 2021)
CARES EHEAP 203.20
ATTACHMI N"C lIII
FLORIDA DEPARTMEN"f f
ECONOMIC OPPORTUNITY
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP)
POVERTY INCOME GUIDELINES*
EFFECTIVE JULY I, 2020
PEOPLE IN THE HOUSEHOLD
150%
1
$19,140
2
$255860
3
$32,580
4
$3%300
5
$46,020
6
$52,740
7
$5%460
8
$66,180
For each additional person in the household
with more than 8 people, add,
$ 6,720
*These
figures are
based on the
2020 U.S. Department of Health
and Human
Services (HHS)
povectp
guidelines
published in
the Federal Register on January
17,
2020.
(June 2020 - September 2021) CARES EHEAP 203.20
ATTACHMENT XIV
EHEAP CARES ACT SOURCES OF INCOME
EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY- CARES ACT
FY 2020/2021 SOURCES OF INCOME
EFFECTIVE June 1, 2020
SOURCES OPINCOhIE
1. h4oncy wages and salaries before vny deductions
2. NM receipts from non -farm emplo}ment (receipts from a
person's own unincorporated business, professional
enterprise, or partnership, after deductions for business
expenses)
3. Net receipts Erom farm self-employment (receipts from a
farm which one operates as an owner, renter, or
sharecropper, after deductions for farm operating
expenses)
4. REGULAR Pr\YMEN'fS FROM:
Social Security
Railroad retirement
Strike benefits from union funds
Worker's compensation
Veteran's payments
Public Assistance or'remporary Assistance for Needy Families
(I'ANF), Supplemental Security Income, and non -federally funded
General Assistance or General Relief money payments.
5. Payments to foster children age 18 or older received through the
Independent Living Program
'!mining stipends
r\limany
Child Support
Social Security Benefit Garnishes for Nan -Payment of
School Loans. (rhe total amount of the Social Security Retirement
benefit including the garnished deduction must be used when
calculating the applicant's income.)
10. Military family allotment or other regular support from
a Camay member or someone not living in the
household
71. Private pensions
72. Government employee pensions (including military
retirement pay)
EXCLUDED
SOURCES OF INCOME
]. CAPI'IS\L GAINS
Any Assets drawn down as withdrawals from a bank, the sale
of property, a house or a car.
2. Tax Refunds
3. Gifts
4. Loans
5. Lump -sum inheritances
6. One-time insurance payments
7. Foster Care Payments*
8. Compensation for injury
9. Combat zone pay to the military
10. Adoption Subsidies
17. Reverse Mortgage Payments
12. NON -CASH BENEFITS
(a) Employer -paid or union paid portion of health
insurance or other employee benefits
(b) Ibod or housing received in lieu of wages
(c) The value of Food and fuel produced and
consumed on farms.
(d) The imputed value of rent from owner -occupied
non -farm or farm housing.
(e) hederal non -cash benefit pro}rcams such as Medicare,
Medicaid, Ibod Stamps, school lunches, and housing
assistance.
13. Supplemental Security Income (SSI) benefits cannot be
garnished for any reason unless a recipient received an
overpayment of benefits.
The total amount of the SSI benefit minus the garnished
deduction for recoupment must be used when calculating
the applicant's income.
14.
3. Regular insurance or annuity payments
1
74. Educational Assistance:
Grants, Fellowships, rlssismntships, College or 15.
University Scholarships - Only count as income those hinds
specifically allotted for living expenses
15. Dividends
16. Interest
17. Net rental income
78. Net royalties
19. Periodic receipts from estates or trusts
20. Net eambline or lottery winnings
*Persons whose cost of residence is paid through a foster
rnre or residential program administered by the state
gy notbe counted as household members.
Stimulus payments from the federal government in
relation to the Coronavinrs Disease will not be
considered income and will not be considered in
determining a houselnold's Federal Poverty Level
(150% or below).
Arty type of unemployment payments will not be
conned as income.
(i1
(June 2020 —September 2021)
CARES EHEAP 203,20
ATTACHMENT XV
EHEAP CARES ACT APPLICATION AND ELIGIBILITY NYORKSHEET
Section One: Applicant (Aged 60 and older) Information
Name: (Fist, In, Lost) ❑ EI(EAP CARES Act
Date Stansp
Daleofbirth:SSN:
Service address:
City:
Florida County:
ZIP Code:
intake worker's narne:
Phone:
Sex: 0Male ❑Female
Number of people in the household:
Phone:
Marital Status: D Marred ❑ Partnered ❑ Single ❑ Separated ❑ Divorced ❑ Widowed
Race: D While 0 BIaeWAfrican American 0 Asian 0 Native Hawaiian/Pacific Islander 0 American Indian/Alaska Native 0 Other
Etlinicily: D Hispanic/Lalino D Other
I Primary Language: 0 English D Spanish D Other
Does client have limited ability reading, writing, speaking, or understanding die English language? 0 Yes 0 No
Is the client a veteran? 0 Yes 0 No
Was client referred to the local Veteran's Affairs office? 0 Yes 0 No ❑ N/A
Applicant's income type(s): Applicant's monthly income autumn:
ISOPMAM11 Additional Household
Name Income type(s):
Age:
SSN:
Alonthly income arnounc
Namo.
Income type(s):
Age:
SSN:
Monthly income amount:
Name:
Income type(s):
Age:
SSN:
Monthly intone amount:
Name:
Income type(s):
Age: I
SSN:
Monthly income amount:
Name:
Income type(s):
Age: SSN: Monthly income amount:
SoctionThrea: Household Characteristics
Is there a child 5 years of age oryounger in the household? ❑ Yes O No
If Yes, select all that applies: 0 0-2 years old ❑ 3-5 years old
Is there an individual with a disability in the household? ❑ Yes 0 No
Is the applicant a U.S. citizen or or alien IawNlly admitted for pemuanent residence? O Yes D No
Is the applicant a homeowner! 0 Yes 0 No
Does applicant live in government subsidized housing, such as Section 8211 Yes 0No
If yes, provide the complex name:
If yest does the household receive an enertry subsidy? 0 Yu 0 No
Does applicant live in a student dormitory, adult family care home, or any kind ofgrmtp living facility? Dyes D No
If yes, provide the facility name:
Section Four: Heating and Cooling Information
Have you or any member ofyour household received energy assistance in the current season? DYes ONO
If yes, provide the name of Agency:
Type of Assistance: ❑Crisis ❑Hone Energy ❑Weather -Related Dale:
What is the primary source ofhome heating? (select one) 0Electricity ElNatural Gas ❑Propane 0 Wood/Coal ❑ Refillable Fuels
Does household use supplemental heating source? D Electricity ❑ Wood/Coal ❑ N/A
Air conditioning unit type? 0 Central A/C ORlndow/Wal[A/C
❑Fans ❑Other— specify(including evaporative cooler)
Section Five: Energy Crisis
Client Attestation and Signature
The information provided on this application, is to the best of illy knowledge, Inie
❑ Home cooling or healing energy source has been
and complete. I understand [lint priority in providing assistance will be given to
disconnected. (Life-7Lrealening/18-hoer)
those households with [he lowest income and greatest need, i.e. those households in
which the elderly,disabled, medically needy, or children reside. (authorize the
❑ Unable to get delivery of fuel, is out of fuel, or is in
danger of being out of fuel for healing.(Life-Arearening118-
agency to make benefit payments directly to my energy supplier. lam aware that
after I have provided all the information requested to determine lily eligibility, if I
n applying for crisis assistance, the agency has 18]loan to act upon my application
❑ Other problems with lack of cooling or heating in the
home, such as needing to pay a deposit, repair of equipment,
with an eligible action. Ism also aware that if l am not approved or denied within
r interim emergency measure to avoid further crisis.
the time allowed, or not approved for the correct amount, I have a right to appeal the
(Li%-Threalening/18-Lour)
decision. (If you sign with an"X" two witnesses are required.)
❑ Notified that the energy source for cooling or heating is
going to be disconnected. (StandarA'48 hour)
Client
Signature:
❑ Received a notice indicating the energy source bill is
r
delinquent or past due. (SlandarA'I8-hour)
Date:
❑ Has an en erq source bill for which (he due date has
lapsed. (Sean W48-hour)
LI CI-EA..'110 LDSIGA THE IPAIIER.1 T O IZ\'GT ERELEAS'E OF( ENRRALAND/OR CONFIDENTIAL INFORMATION I.IIIEAP/
ENEIPFEDBRA/-RfiPORThYO.
66
(June 2020 - September 2021)
CARES EHEAP 203.20
Emergency Home Energy
Assistance for the Elderly Program CARES Act - Eligibility Worksheet
Annualize all household income.
Staple calculator tape here showing
Poverty Guidelines effective 0710112020.
income calculations or write calculations
in This
1. Add all gross monthly earned and
Select the annual Income limit by household size:
unearned income from the past 30
space.
150%of Poverty 50%of PoveM
days of all household members.
❑ I .......... $19,140 $ 61380
2. Add Medicare Premium ($135.50),
❑ 2..........$25,860 $ 8,620
if not Included In SSA amount.
❑ 3..........$32,580 $10,860
3. Add Medicare Part D, if applicable.
❑ 4..........$39,300 $13, 100
❑ 5..........$46,020 $15,340
4. To annualize, multiply the monthly
total by 12 months.
❑ 6..........$52,740 $17,580
❑ 7..........$59,460 $196820
Annual Household Income
❑ 8.......... $66,180 $22,060
$
(Add $6,720 for each additional member of family unit
with more than 8 members.)
If the total annual household Income is less than 50% of the current Federal Poverty Guidelines for household size (using chad above), and no one in
the household Is receli SNAP assistance, the
applicant must provide a signed statement of haw basic living expenses (i.e., food, shelter and
transportation) are provided for the household.
Section Seven: Vendor, Benefit,
and Verification Information
Eneri Vendor #1
Other Vendor #1 Contact made with LI HEAP pruvlder to vedfy
Name:
Name: previous crisis assistance.
Contact Person:
AcccunWoucher
Account Number:
Number: Date: Dale of contact:
Has the applicant received LIHEAP crisis
assistance under the CARES Act Contract?
Minimum Amount Due:
Amount Due'
❑ Yes 0 No
Verification and Commitment
❑ Blanket ❑ Repair Existing Heading
❑ Portable Fan or Cooling Equipment
If the minimum amount due is more than
Contact Person:
❑ Space Heater 0 Emergency Shelter
the past due amount, did the energy
Date:
❑Window A/C D Other
vendor verify that this amount is required?
❑ Yes ❑ No ❑ NIA
Enerov Vendor#2
Omer Vendor#2
Nam
Name:
AccounWoucher
Account Number:
Number:
Date:
If the minimum amount due to resolve the
crisis is more than the maximum allowed
Minimum Amount Due:
Amount Due:
($2,000), explain how the balance of the
amount due will be paid if approved for
Verification and Commitment
❑ Blanket ❑ Repair Existing Heating
EHEAP crisis assistance.
❑ Portable Fan or Cooling Equipment
Contact Person:
❑ Space Heater 0 Emergency Shelter
Date:
❑Window AIC D Other
(1) Total Energy Vendors $
(4) Total Other Vendors $ Is the name on the fuel bill that
of the applicants?
(2) Energy Subsidy $
Total EHEAP Benefit
Add ❑ Yes ❑ No
(3) Water, Sewer, Garbage, $
$ If no, provide name on bill:
Flro, etc.
Total Energy Vendor (4)
(d) Deducl(283) from it)
S Total Other Vendor (4)
Section Elghti Weatherization
Assistance Program (WAP) Referral
lithe applicant is a homeowner, has he/she received more than three LIHEAP or EHEAP benefits In the last 18 months?
If the answer to the previous question is *yes", was the applicant referred to WAP? 0 Yes ❑ No ❑ NIA
If the answer to the last question Is'no', explain:
Section Nine: Resolution of Crisis
Resolution of the Energy Crisis occurred within 18/48 hours, by the following eligible action(s): (Select all that apply)
❑ Approval of application
❑ EHEAP CARES Act benefit prevented disconnection
❑ Commitment made to vendor
❑ EHEAP CARES Act benefit restored energy already
disconnected
❑ Denial of Application, pending additional information
❑ Yes, client signed waiver
❑ Denial of Application, ineligible
❑ No, client refused to sign waiver
❑ Written referral and assistance to access other community resources
Case Worker Signature
Approval Signature
I have determined the eligibility of file applicant.
I am not the
The application and eligibility determination must be reviewed tat once arld
applicant, not am I a friend, relative, or employe
cant.
err'WrIlate file documeutallon prior to making paymeril. I have reviewed
and approved this am0lication for crisis assistance.
Case Workers Name:
Supervisor/Peers Name:
Case Workers Signature:
Supervisor/Peels Blinders:
Date:
Data:
Agency Name:
Agency Name:
C`a
ncewcr re,m 114-0e10ia020
67
(June 2020 — September 2021) CARES EHEAP 203,20
ATTACHMENT XVI
EHEAP CARES ACT APPLICATION AND ELIGIBILITY INSTRUCTIONS
@3 @11 LOR11511REFEV1061003M
Section One: Aoalicant Loge ti0 and older, Information
Complete Section One in its entirety.
Special notes:
✓ The Winter and Summer Seasons are waived under the CARES Act.
✓ 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.
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 numbers) 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 CARES Act 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.
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: Energy 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 note:
✓ If any field is determined to be not applicable, complete the field by entering N/A.
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 CARES Act federal reporting. CIRTS will require you to
verify that either the waiver has been signed or that the client has refused to sign.
O
68
V�
(June 2020 — September 2021)
CARES EHEAP 203,20
Figuns i •u e• a i. •i
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.
✓ Specific to CARES Act, the following is not counted as income when determining income
eligibility for the household:
o Stimulus payments from the federal government in relation to the Coronavirus
Disease; and
o Any type of unemployment payments will not be counted as income.
✓ 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:
✓ Eligible elders may receive multiple crisis assistance benefit(s), that combined not to exceed
$2,000,00,
✓ 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 CARES Act benefit. The energy subsidy is deducted from home energy vendor
payments only.
✓ It is allowable to make several crisis benefit payments for a household to resolve a single crisis
and/or one or more benefits from EHEAP CARES Act funding. 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 crisis assistance cap of
$2,000,
✓ 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.
✓ Allowable utility categories for heating/cooling bill assistance include the following:
• Electricity;
• Natural Gas;
• Propane;
• Wood/Coal; and
• Refillable fuels;
✓ Crisis benefits may also be used for the following:
• Pre -pay energy;
• Purchase of blankets, portable fans, space heaters, and window air conditioners; O�'D
69
(June 2020 - September 2021) CARES EHEAP 203.20
Repair of an existing heating/cooling unit;
Deposits to connect or restore energy;
Late fees and disconnect and reconnect fees;
Charges from a previous account held by the elder that is now closed;
Payment to landlord when utility costs are included in the elder's rent; and
Temporary emergency shelter, if due to energy related crisis.
✓ WAtpr sAwpr nnrhnnp nnri fire pfr MAV hir)T ha nniA With PPPAP r.APFQ Ant fnnrlc I I
the amounts for these charges.
✓ Chases incurred due to illegal activities, such as a worthless check or meter tampering, MAY
NOT be paid with EHEAP CARES Act funds.
✓ If any field is determined to be not applicable, complete the field by entering N/A.
Complete Section Eight in its entirety.
Special notes:
✓ When determining the number of LIHEAP or EHEAP CARES Act 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 18/48 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 Sianature
To complete this section, the individual who completes the EHEAP CARES Act 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 CARES Act 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 CARES Act benefit awarded are correct.
(June 2020 — September 2021) CARES EHEAP 203,20
ATTACHMENT XVII
EHEAP CARES ACT CLIENT FILE CONTENT CHECKLIST
ELDER'S NAME
PSA#
AGENCY
APPROVAL
DENIAL
NAME OF WORKER
APPLICATION DATE
CRISIS RESOLUTION DATE
CHECK DATE
PROGRAM REQUIREMENTS \10NITORED
Yes
No
N/A
COMMENTS
I. 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.
5 Client file contains documentation of Social Security numbers for all household members, or citation
to the applicable exemption.
6. Client Ole contains signed notice regarding collection of social security number(s).
7. The client file contains official income documents for all household members.
8 If income is self -declared, is there a self -declaration form signed by each individual household
member (18 years of age or older) lacking income verification or claiming zero income?
9 The household's total gross income is calculated correctly and is at or below 150%of the OMB
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.
IL Checked that elder does not live in student dormitory, adult family care home, or any kind of group
living facility.
12 Verified and documented household has not received combined LIHEAP and CHEAP CARES Act
Crisis Assistance exceeding the crisis assistance cap of$2,000.00.
13, Documentation of Weatherization Assistance Program (WAP) referral, ifapplicable.
14 Copies of fuel bills, orother supporting documentation as proof of energy crisis, for the residence in
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.
17 Only the minimum necessary to resolve the crisis is paid. If a different amount is required by the
utility company, provide additional information on the Eligibility Worksheet.
18 Crisis energy benefit was reduced by unallowable charges, such as: water, sewer, garbage, fire, etc., if
applicable.
19. Crisis energy benefit was reduced by energy subsidy, if applicable.
20. Energy crisis resolved within 18/48 hours by an eligible action.
21 Written notice of approval or denial for services that includes appeal procedures is issued within 15
working days of eligibility determination.
22. Appropriate benefit provided, at or below the EHEAP CARES Act crisis assistance cap of$2,000.00.
23 All required sections of the application are signed and dated by the elder, staff, and supervisory/peer
PRIOR to payment.
24. Proof of payment to vendor.
25. Place completed AGENCY Form 211 (05101/2020) in client file.
INSTRUCTIONS: A check mark in the ]'es column indicates the requirement hfls been met. A check mark in the no column indicates the requirement has
not been met or is questionable. Each "No" mflrk must he explained under "COMMENTS",
Snperrisor/Peer Signnture
AGaNCY FORxf 311 OSNI/2030
Consumer Rilc Monitm•ing Datc
(June 2020 —September 2021) CARES EHEAP 203.20
ATTACHMENT XVIII
EHEAP CARES ACT COST REIMBURSEMENT SUMMARY
Contract #
Report Period:
Budget
Category
Description
Numer of units
Amount
O
—
'c
Is
Q
TOTAL ADMINISTRATION $0.00
0
_ _-
TOTAL OUTREACH $0.00
=O
TOTAL CRISIS ASSISTANCE $0.00
uvdaied as/oi/zozo
(June 2020 — September 2021) CARES EHEAP 203,20
ATTACHMENT XIX
SERVICE RATE REPORT
PROGRAM: EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM CARES ACT
Federally Funded
From 05/01/2020 to 09/30/2021
CATEGORY
METHOD
HIGH
UNIT
SERVICE
OF
REIMBURSEMENT
PAYMENT
RATE
TYPE
Administration
ADMINISTRATIVE COSTS*
Cost Reimbursement
Cost Reimbursement
EPISODE
Outreach
OUTREACH COSTS*
Cost Reimbursement
Cost Reimbursement
EPISODE
Crisis Assistance
CRISIS ENERGY ASSISTANCE BENEFITS*
Cost Reimbursement
Cost Reimbursement
EPISODE
*As stipulated in contract, these services are provided on a cost reimbursement basis.
OYJ
73
Revised August 2007
Attestation Statement
Agreement/Contt•act Number CARES EHEAP 203.20
Amendment Number NA
1, STEPHEN Y CARNELL ,attest that no changes m• 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.
I/
Signature o Recipient/ ontracto• representative Date
Revised August 2007
Approved as to forni and legality
As. •slant County urney
��,✓ ` ,gyp'
a\G\
CAO