The URL can be used to link to this page

Agenda 03/09/2021 Item #16D 4 (Emergency home Energy Assistance Program)16.D.4 03/09/2021 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 decrease funding in the amount of $45,000 and authorize the supporting Budget Amendment. (Net Fiscal Impact ($45,000)) 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. These grants are funded by the Florida Department of Elder Affairs (DOEA) through the Area Agency on Aging of Southwest Florida, Inc. (AAASWFL). These grant fund services enable clients to remain in their homes and live with independence and dignity. The Collier County Services for Seniors (CCSS) 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 a least one individual aged sixty (60) or older experiencing a heating or cooling emergency. The program allows for payments to utility companies; fuel suppliers; for the repair or replacement of existing heating or cooling equipment; for the payment of deposits, late fees, disconnect, and reconnection fees with Florida Power and Light (FPL) & Lee County Electric Cooperative (LCEC). Centro -Campesino Farmworker Center, Inc. will provide additional Weatherization Services for clients who require additional EHEAP assistance who have received more than three (3) benefits in the last eighteen (18) months. The current service agreement for EHEAP 203.19 was approved "after -the -fact" at the Board of County Commissioners (Board) meeting on November 12, 2019 (Agenda Item #16D4). Amendment 1, EHEAP 203.19.001 was approved "after -the -fact" at the Board meeting on April 28, 2020 (Agenda Item #16D5) to correct the county's Federal Tax ID (FIE) number on the Agreement. Amendment 2, EHEAP 203.19.002 was approved "after -the -fact" at the Board meeting on October 27, 2020 (Agenda Item #16D7) to extend the contract term to March 30, 2021 and increase services and funding. The Proposed Amendment 3, EHEAP 203.19.003, is to decrease the allocation by $45,000, revise Attachment II -Exhibit 2 and Attachment IX Annual Budget Summary and detail. The grantor customarily reallocates the distribution of funds between the seven (7) counties that make up the Public Service Area administered by AAASWFL to distribute funding where the priority of need is greater. The following table provides a detailed breakdown of funding: Program Component I Project I Current Revised Required Budget Packet Pg. 789 16.D.4 03/09/2021 Number Budget Emergency Home Energy I 33651 I $96,548.22 Assistance Program-EHEAP Budget I Adjustment $51,548.22 1 $45,000 This item is being presented "after -the -fact" because Collier County received the Amendment contract on February 10, 2021, from the grantor agency and is required to return it within thirty (30) days. This time frame makes it impossible to process the document for the Board's consideration. Pursuant to CMA #5330 and Resolution No. 2018-202, the County Manager authorized the Public Services Department Head to sign the Amendment. This Amendment is being presented for Board ratification. Collier County, as the Lead Agency, is responsible for responding to seniors' needs and managing the spending authority for the Federal and State Funded Services for Seniors Programs. FISCAL IMPACT: A Budget Amendment in the amount of ($45,000) is required to decrease the grant award to $51,548.22 in the Human Services Grant Fund (707), Project 33651. GROWTH MANAGEMENT: There is no Growth Management impact from this recommendation. LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote for Board action. - JAB RECOMMENDATIONS: To approve an "After -the -Fact" amendment and an attestation statement with Area Agency on Aging for Southwest Florida, Inc., for the Emergency Home Energy Assistance Program to decrease funding in the amount of $45,000 and authorize the supporting Budget Amendment. (Net Fiscal Impact ($-45,000)) Prepared By: Wendy Klopf, Grant Coordinator, Community and Human Services Division ATTACHMENT(S) 1. EHEAP 203.19.003-Exec (PDF) 2. EHEAP 203.19.002-Exec (PDF) 3. EHEAP 203.19.001 Exec (PDF) 4. (Linked) EHEAP 203.19 Executed (PDF) 5. Resolution 2018-202 (PDF) Packet Pg. 790 16. D.4 03/09/2021 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.4 Doe ID: 15071 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 decrease funding in the amount of $45,000 and authorize the supporting Budget Amendment. Meeting Date: 03/09/2021 Prepared by: Title: Operations Coordinator — Community & Human Services Name: Wendy Klopf 02/18/2021 10:58 AM Submitted by: Title: Manager - Federal/State Grants Operation — Community & Human Services Name: Kristi Sonntag 02/18/2021 10:58 AM Approved By: Review: Community & Human Services Kristi Sonntag CHS Review Community & Human Services Maggie Lopez Additional Reviewer Operations & Veteran Services Kimberley Grant Additional Reviewer Public Services Department Todd Henry Public Services Deapartment Public Services Department James C French PSD Dept Head Review Grants Erica Robinson Level 2 Grants Review County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Office of Management and Budget Laura Wells Level 3 OMB Gatekeeper Review Grants Therese Stanley Additional Reviewer Budget and Management Office Ed Finn Additional Reviewer County Manager's Office Dan Rodriguez Level 4 County Manager Review Board of County Commissioners MaryJo Brock Meeting Pending Completed 02/18/2021 1:31 PM Completed 02/18/2021 2:01 PM Completed 02/18/2021 3:14 PM Completed 02/18/2021 3:52 PM Completed 02/19/2021 10:36 AM Completed 02/23/2021 9:56 AM Completed 02/23/2021 1:39 PM Completed 02/24/2021 9:51 AM Completed 02/24/2021 11:26 AM Completed 02/26/2021 9:49 AM Completed 03/02/2021 4:21 PM Completed 03/02/2021 4:37 PM 03/09/2021 9:00 AM Packet Pg. 791 16.D.4.a October 2019 — March 2021 EHEAP 203,19.003 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. EMERGENCY HOME ENERGY ASSISTANCE PROGRAM COLLIF,R C0I1NTV BOAI11) OF COUNTY COMMISSIONERS THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc, (Agency) and Collier County Board of County Commissioners (Contractor), amends agreement, EHEAP 203.19. The purpose of this amendment is to decrease allocation limding by amending 4. Contract Amount; decrease allocations by $45,000.00; revise ATTACHMENT It,—EXI1lBIT 2 and ATTACHMENT IX ANNUAL BUDGET SUMMARY AND DETAIi,. 4. Contract Amount: The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $51,548,22 subject to the availability of fiends. Any costs or services paid for under any other contract or from any other source are not eligible for payment under this contract. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to this Amendment. Al I ]provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract. This Amendment and all its attachments are hereby made part of the contract. IN WITNESS THEREOF, the Parties hereto have caused this amendment, to be executed by their undersigned officials as duly authorized; and agree to abide by the terms, conditions and provisions of this EHEAP contract as amended. This Amendment is effective on February 2, 2021 after it has been signed by both Parties. IN WITNESS WHEREOF, the Parties hereto have causal this contract to be executed by their undersigned officials as duly authorized. CONTRACTOR: COLLIER COUNTY BOARD OF COUNT-Y- OM MISSIONER SIGNED NAME:3otr,cft� C.Frern 'l r T1Tl.E: DATE: 2 t 1 IT2� Federal Tax ID: 59-6000558 Fiscal Year handing Date: 09/30 Duns: 076997790 AREA AGENCY ON AGING FOR SOUTHWESTFLORIDA, INC. SIGNED BY: NAMF: NORMA ADORNO TITLE: CEO DATE: 2 —19— 2b2 l Approved as to torn and legality Asslant County Aut 0 LO v ar x w M 0 0 ai r M 0 N d Q w x w c m E z U 2 r Q Packet Pg. 792 16.D.4.a October 2019 — March 2021 EHEAP 203,19.003 ATTACHMENT H—EXIIIBIT 2 FUNDING SUMMARY Note: Title 2 CFR, as revised, and Section 215.97, F.S., require (lint the information about Federal Programs and State Projects included in ATTACHMENT H—EXIIIBIT I, be provided to the recipient. Intbrniation contained herein is a prediction of funding sources and related amounts based on the contract budget. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOI,LOWING: .RANT AWARD (FAIN#): 17EA-OF-13-00-16-003 FEDERAL. AWARD DATE: April 1, 2019 )UNS NUMBER: 076997790 'ROC RAM TITLE FUNDING SOURCE; CFDA AMOUNT Emergency Home Energy Assistance United States Department of Health for the Elderly Program and I luman Scrviccs 93.568 FHEAP Collier 93.568 S 51.548.22 TOTAL FEDERAL AWARD I S 51.548.22 COMPLIANCE REQUIREMENTS APPLICABLE TO TH E FEDERAL RESOURCES AWARDED W PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: FEDERAL FUNDS: LO 2 CFR Part 200 — Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. OMB Circular A-133 — Audits of States, Local Govemments. and Non -Profit Organizations fit 2 STATE RESOURCES AWARDED TO THE RECIPIENTPURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: MATCHING RESOURCES FOR FEDERAL PROGRAMS PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL STATE AWARD STATE FINANCIAL ASSISTANCE SUBJECT 1'0 SECTION 215.97, F.S. PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT TOTAL AWARD COMPLIANCE RFQLJ I RF.MENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO TIIIS CONTRACT AREAS FOLLOWS: STATE. FINANCIAL ASSISTANCE Sections 215.97 & 215.971, F.S., Chapter 691-5, F.A.C, State Projects Compliance Supplement Reference Uulde for State Expenditures Other fiscal requirements set forth in program laws, ruleS, and rcbulation; 2 Packet Pg. 793 16.D.4.a October 2019 -- March 2021 FHF.AP 203,19.003 ATTACHMENT IX ANNUAL B01)(XI' SUiMMARY ANI) DETAIL EMERGENCY HOME ENERGY ASSISTANCE PROGRAM for Collier County Board of County Commissioners Collier EIIEAP ADMINISTRATION BUDGET S M 5,121.82 R ai EHEAP OUTREACH BUDGET S 7,468.60 ai 0 EHEAP CRISIS ASSISTANCE. S 38,957.80 N TOTAL S c 51,548.22 Projected minimum number of individuals to be served c Energy Assistance* 9 Q a *Eligible households may be provided with multiple henefits totnling thirty-five hundred dollars. The minimum w number of consumers may reflect duplicated cansumer:s if a consumer receives multiple benefits until the end of this w contract, March 31, 2021. 0 3 a� x W M O O O r M O N d Q W 2 W r Q Packet Pg. 794 16.D.4.a Revised August 2007 Attestation Statement Agreement/Contract Number EHEAP 203.19 Amendment Number .04 1, JAMES C FRENCH attest that no changes or revisions have been made to the {Recipient/Contrmtor rcprescnlalirc) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and COLLIER COUNTY BOARD OF COMMISSIONERS. (Reel pient/Contractor name) The only exception to this statement would he for changes in page formatting, due to the differences in electronic data processing media, which has no affect on the agreement/contract content, rc of RecipientlContractor representative Date ApiVOWd aR to form anti legality A , alit County Atto l Revised August 2007 Packet Pg. 795 16. D.4.b October 2019-March 2021 CHEAP 203.19.002 AREA AGENCY ON AGING FOR SOUTiiWEST FLORIDA, INC. I- MERGENCY HOME ENERGY ASSISTANCE PitOGRAM This Amendment, entered into between the Area Agency on Aging for Southwest Florida, inc, (Agency) and Collier County Hoard of County Commissioners (Contractor), hereby amends contract FHHAP 203.19. WHEREAS, Section 51. of the Standard Contract States "Modifications of the provisions of this contract shall be effective October 1, 2020, WHEREAS, pursuant to Chapter 287.057(12), Florida Statutes, the Department is hereby exercising its option to extend the current contract for a period not to exceed 6 months. WHEREAS, the purpose of this Amendment is to extend the contract term, increase services and I'unding, and replace attachments of the 2019 hHEAI1 Contract, The Contract ending date of September 30, 2020 will be replaced with March 31, 2021, wherever stetted throughout the contract, The previous total contract amount of $73,218.87 is hereby increased by S23,329.35. The total contract arnount is hereby amended to read $96,548.22 wherever stated throughout the contract. NOW THEREFORE, in consideration of the mutual covenants and obligations set lbrth herein, the receipt and sufficiency of which are hereby acknowledged, the Parties agree to the following: 56. Otlicial Payee and Representatives (Nantes, Addresses, and Telephone Numbers): Updated information for the Agency. The section and location within the Agency where d. Requests for Payment and Receipt and Expenditure forms are to bu mailed is: The name, address, and telephone number of the e. Contract Manager for this contract is: I. Attachment i1, Financial and Compliance Audit Area Agency oil Aging for Southwest Florida, inc. Fiscal Department 2830 Winkler Ave., Suite 112 Fort Myers, F'I , 33916 Maricela Morado, Director of Program & Planning Area Agency on Aging for Southwest Florida, Inc. 2830 Winkler Ave., Suite 112 Fort Myers, Ft, 33916 239-652-6900 The Contractor shall submit a copy of any management letter issued by the auditor, to the Arca Agency on Aging for Southwest Florida, 1ne,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 Additionnlly, topics of financial reporting packages required by PART ]1 of this contract's Financial and Compliance Audit Attachment shall he submitted by or on bohalf 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: Child Tripp, (-- O 2830 Winkler Ave., Suite 112 Fort Myers, 1+1, 33916 0 LO Packet Pg. 796 16. D.4.b October 2019-March 2021 2. Attachment 1, Scope of Work, is hereby replaced; 3. Attachment II Exhibit 2, Funding Summary, is hereby replaced; 4. Attachment IX, Budget Summary, is hereby replaced; 5. Attachment Xllt, F,l II AP Invoice Report Schedule, is hereby replaced; 0. Attachment XIV, Poverty Income Ouidelines, is hereby replaced; 7. Attachment XVI, EHEAP Sources of Income, is hereby replaced; 8. Attachment XVIII, CHEAP Application and Eligihility Worksheet, is hercby replaced; EHEAP 203,19.002 9. Attachment XIX, EI[EAP Application and Eli gihiIity Worksheet Instructions, is here by replaced; and 10. Attachment XX, FHFAP Client File Content Checklist, is hereby replaced. All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to this Amendment. All provisions not in conflict with this Amendment are still in effect and are to he performed at the level specified in (fie contract. This Amendment and all its attachments are hereby made part of the contract. IN W[TNF,SS 'I'HERkOF, the Parties have caused this Amendment to be executed by their officials as duly authorized, and agree to abide by the terms, conditions and provisions of Contract as amended. This Amendment is effective October 1, 2020. CONTRACTOR: C'OLLIPH COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST COUNTY COMMISSIONERS FLORIDA, INC. NAME: STEPHEN Y CARNELL TITLE:PUBLIC SERVICE DEPARTMENT HEAD DATE: (b /'6? how Federal Tax II): 59-6000558 Fiscal Year Ending Date: 09/30 DUNS 076997790 _ SIGNED BY: NAME: NORMA ADORNO TITLE: INTERIM CEO/PRESIDENT & COO DATE: 10 t 2,— ZU 2,1) Approved as to form and. legality —r---� •ount Alto> > Asstst t C y y � Packet Pg. 797 16. D.4.b October 2019-March 2021 EHEAP 203.19,002 ATTACHMENT I STATEMENT OF WORK EMERCFNCY HOME i+.NERCY ASSISTANCE FOR THE ELDERLY PROGRAM SERVICES TO BE PROVIDED A. DEFiNITION OFTERMS 1. Eighteen (18) hour role The timeframe within which all applications lot• life -threatening crisis assistance shall be acted upon, Nvith an eligible action to mediate the crisis being taken and documented in the client file within eighteen (1 S) hours of the application date stamp. o 0 2. Forty-eight (48) hour rule -- The timeframe within which all applications for standard crisis assistance shall rn be acted upon, with an eligible action to mediate the crisis being taken and documented in the client file within r c forty-eight (48) hours of lllc application date slanlp. N 3. Caseworker — Person who is responsible for determining program eligibility by completing; the Emergency � Home Energy Assistance for the Elderly Program (F.HF.AP) Eligibility Worksheet (Attachment XVI) and E awarding crisis benefits. c 4. Caseworker Signature Date — The date that the client's completed application is processed, eligibility m E deternined, and the crisis resolved. This date shall not be changed. Signatures must he in ink. Rubber-stamped a- signatures will not be accepted. w 5. Client Application Date -The date file application is completed (whether by self or with assistance) and signed w by the elder. This date shall not be changed. Signatures must be in ink. Rubber -stumped 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. 0 u� 6. Crisis - A home cooling or heating crisis exists when an elder has no access to, or is in danger of losing access V to, needed home energy. W x 7. Crisis Assistance — Assistance provided to an elder who has no access to, or is in danger of losing access to, w c� needed home energy. c 8. Date of Resolution — The date that a documented commitment to pay was made to the utility vendor to resolve ai r the energy crisis. This date is used as the EHEAP Client Enrollment date in the Department's Client Information N and Registration Tracking System (CIRTS). This date shall not be changed. a a. The amount of time elapsed between the Date Stantp and the Date of Resolution shall determine whether w 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. Dote 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 1)isahility Income (SSDI) from the Social Security Administration. 11. Eider 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 i nCl UdC: H. Approval ofan elder's application; b. Denial of an elder's application pending ftnther information; c. Denial of an elder's application because the elder is deemed ineligible; Packet Pg. 798 1 ti.D.4.b October 2019-March 2021 EHEAP 203.19.002 d. Contact with a utility vendor to halt utility disconnection or interruption in services; or e. Written referral to and providing the older with assistance contacting another agency if EHEAP 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 application and required documentation and may have the responsibility to determine eligibility or award crisis benefits. 17, Minimum Level of Scrviec — Service to a minimum of one household per month. 18. Crisis Assistance Benoit — Payment of heating/cooling energy bill; the purchase of a heating/cooling device; and/or the repair of a heating/cooling device. 19. Priorlty for Assistance Households with the highest home energy needs and lowest household income, which will be determined by taking into necount hoth 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. Pruvider -- The entity that has entered into a contract, subcontract, or Memorandum of Understanding (MOU) i to provide services under EHEAP. 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 cxpcuditures 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. VeriCcation Date The date the caseworker verified previous Low -Income Home Energy Assistance Program (L1HE.AP) crisis benefits with the LIHEAP provider or the minimum amount ncccssary 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 (EI 1EAP) 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 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. Packet Pg. 799 16. D.4.b October 2019-March 2021 2. Authority EHEAP 203,19.002 The relevant federal and state authorities gover7iing EHEAP are: a. Low Income Home Energy Assistance Act of 1981 ('Title X X V I of the Omnibus Budget Reconciliation Act of 1981, Y.L. 97-35), as amended; b. 42 United States Code (U.S.C.) § 8621 et seq.; c. 45 Code of Federal Regulations (CPR) Part 96, Subpart 11 (§§ 96.80-96.89); if. See( iuu 409.508, Florida Statutes (F.S.) and Rule 73C-26.021(3), Florida Administrative Code (RA.C.); e. Rule Chapter 73C-26, RA.C.; f. State of Florida LII IEAP Policies and Procedures Manual; and g. I.IHEAP Statc flan. 3. Scope of Service The Contractor is responsible for the programmatic, fiscal, and operational management of EHEAP. Eligible elders may receive multiple crisis assistance benefit(s), that combined not to exceed $3,500,00 during thcterm of this agreement. Eligible, elders may receive crisis assistance benefits during the period from October 1, 2019 to March 31, 202I. a. The services provided under this contract shall be in a manner consistent with and described in Attachment f, Section 11: Manner of Service Provision. Contractor, in collaboration with its El ]GAP program partners, shall ensure the following service tasks are completed: (1) Consumer Outreach; (2) Program Partners and Stakeholders Coordination; (3) Elder's Benefit h;ligibility Determination; and (4) Benefit Disbursement. 4. Major Program Goals HHHAP is designed to provide crisis assistance to eligible low-income households with at Icast one individual aged sixty (60) or older experiencing a heating or cooling emergency. The Summer and Winter Crisis seasons are waived until the funding is fully expended. a. Standard Crisis A standard home 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 ol'lhe lollowing 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 healing, or is in danger of being out of fuel for heating; Or (3) The elder has other problems with lack of cooling or healing 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. r, 0 LO Packet Pg. 800 16. D.4.b October 2019-March 2021 C. CLIENTS'TO BE SERVED 1. General Description EHEAP 203,19.002 EHEAP provider, for direct client services to elders in low -Income households experiencing a llomc energy heating or cooling emergency, A household receiving EHEAP services ►nay not have an income above one hundred fifty percent (150%) of the poverty level, as published by the United States iepartment ofHealthand Human Services. 2. Client Eligibility To be eligible tar services under this contract, and to receive assistance, an elder must: a. Be aged sixty (60) or older; b. Reside in the EI IEAP service area (Planning and Service Area) at the time the home energy costs were incurred; C. Complete and return an N,HKAP 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; c. Possess a total gross household income of not more than one hundred fifty percent (1500/n) of the Office of Management and Budget (OMB) federal poverty level for the size of the household, in accordance with Section I.C.3.d. ol'this contract; f. He experiencing one or more verifiable home cooling or heating crises; _ w g. Not he 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; o 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 services upon execution ol'this contract and continue taking applications until the contract expires or finds are exhausted. Contractor will not accept applications when fiords are exhausted for a pnilicular 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 prograin 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 lunded in whole or in part with these funds; c. Treat homeowners and those who rent equitably under this contract; d. Calculate the income eligibility of the elder by using the past thirty (30) drys earnings for all necupants of the household annualized or the elder's current economic situation and reference the current year EHEAP Sources of Income (Attachment XVI) to determine what is considered allowable income, Contractor shall proceed as follows: (1) 'Total household income cannot exceed one hundred fifty percent (150%) of the current federal Poverty Income Guidelines (Altachinent X1V); i. Stimulus payments from tiie federal government in relation to the Coronavirus Disease will not be considered income and will not he considered in determining a household's Federal Poverty Level (150%or below). ii. Any type of unemployment payments will not be counted as income. Packet Pg. 801 October 2019-March 2021 EHEAP 203.19.002 (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 (current economic status), instead of using the past 30 days. If applicable, clients should note the reason for zero income related to COVID19. iii. 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 benefit calculated for the household. f. Use program qualification approvals or notifications to document household size. and income of elders w 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 c poverty level for the size of the household. The benefit level to be provided to elders receiving SNAP or u� SSI shall be the same as that provided to other qualified elders; g, Obtain a signed statement of maintenance from the elder explaining )low 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 $3,500.00. (1) Elders may apply for and receive multiple crisis assistance benefit. (2) Water, sewer, garbage, and fire, etc. charges may not be paid. (3) 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: (1) Utility payments for heating/cooling bill assistance for electric, gas, propane, wood, coal, or refillable fuels; (if) 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; (v1) 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; Packet Pg. 802 October 2019-March 2021 EHEAP 203.19.002 (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 funding. 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-upof service; (A) 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. L In no case shall the Contractor be required to incur costs in excess of the full contract amount to provide services to the clients. T ti IT. MANNER OF SERVICE PROVISION ,0 A. SERVICE TASKS In order to achieve the goals of EHEAP, Contractor shall ensure the following tasks are performed: m x w 1. Ensure that all eligible elders meet the requirements of Section I.C.2. of this contract; 2. Ensure that all energy assistance payments made to home energy vendors comply with the requirements of Section 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 funding with a written Notice of Approval and Appeal on contractor 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; e. 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 contractor's authorized representative. Packet Pg. 803 1 ti.D.4.b October 2019-March 2021 EH}. -',AP 203,19,002 5. Provide all elders whose EHEAP applications were denied with a written Notice of Denial and Appeal on contractor 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; 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; h. Information or documentation needed for the elder to reapply; i. The name, address, and phone number applicable to the appeal process; and J. Number of days the elder has to file the appeal. k. Signature, date and contact information of contractor's authorized representative. 6, Maintain consumer appeal procedures that provide an opportunity for a fair administrative hearing to elders whose applications for assistance are denied or whose applications are not acted upon with reasonable promptness; 7. Provide an opportunity for elders to file a written appeal or complaint with Contractor's Program Supervisor within ten (10) working days of receipt of the written Notice of Denial and Appeal. e u� a. Upon receipt of a validly filed appeal or complaint, Contractor must respond in writing within ten (10) 77 working days; x b. Elders may appeal Contractor's first response by filing its objections to the response with Contractor's N Director, Executive Director, or Board Chair, as applicable, within five (5) working days of receipt of the c first response; and a; c. Upon receipt of a validly filed objection to the first response, Contractor must respond in writing within ten c (10) working days, and the response must clearly state the final outcome of the appeal, that the decision is N final, and if applicable, the circumstances under which the elder may reapply for services. Q 8. Post appeal provisions in a prominent place and in plain view at all locations where EHEAP applications are received; 9. Ensure all ineligible applicants and applicants denied crisis assistance, when EHEAP funds are not available or are insufficient to meet their emergency home energy needs, are referred to and assisted in securing help through other community resources; 10. Ensure no consumer fees are charged to, nor donations accepted from, an elder as a prerequisite for receiving EHEAP benefits. Post in a conspicuous place at all locations where EHEAP applications are received the following notice: "No money, cash, or checks will be requested or received from customers in the EHEAP office. If an employee asks for money, report this to the agency executive director or department head." It. Compare LII-IEAP records and EHEAP records for households with elderly members to avoid exceeding the household crisis benefit cap and maintain documentation sufficient to ensure compliance with this requirement; Packet Pg. 804 October 2019-March 2021 E1-1f;AP 203.19,002 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://eideraffairs state fl ut/doea/notices/July 13/LIHEAP%20Notiee%20re%20Social%20Security%20Numb ers%20Final.odf). The Notice Regarding Collection of Social Security Numbers shall be signed by the elder and retained in the client file; 13. Consumer Outreach Ensure that households in all counties within the service area wishing to benefit from the program have the opportunity to do so. Contractor shall undertake consumer outreach initiatives in all counties within the service area designed to inform potentially eligible households about EHEAP. Outreach efforts must focus on elderly households with disabled individuals, young children, and where the highest percentage of the household income is required to pay for their home energy. Specific outreach initiatives shall include, but are not limited to: a. Informing all service area local agencies, non -profits, and similar organizations that are in regular contact with the low-income population about the EHEAP program, especially those serving seniors; b. Encouraging EHEAP program participation through local television and radio programs, and placing announcements of the EHEAP program in media community calendars; c. Developing and implementing a written procedure for making home visits to households with homebound r elderly persons in order to assist with the completion of the program application when other assistance is c not available; d. Making visits to provide information and/or making presentations about EHEAP in response to requests by local congregational centers serving elderly or disabled persons; w e. Providing information concerning the local weatherization program to all persons who request it (including c organizations that provide outreach activities); e E Updating the AAA's digital footprint to reflect current eligibility requirements and benefits available o� M through EHEAP; and N g. Developing and implementing an EHEAP education campaign in conjunction with the provision of other a Q services. w 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; IE Packet Pg. 805 October 201.9-March 2021 EHEAP 203,19,002 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 contract. All agreements between Contractor and liome 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 representatives) authorized to resolve a crisis; (4) A description of ]low 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 w 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 tire 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 forty-five (45) days of the date of crisis resolution; (12) Assurance from the home energy vendor that when EHEAP payments made to the vendor cannot be applied to the elder's account, the funds will be returned to Contractor or, with Contractor's approval, applied to another eligible customer's account; (13) Assurance that the Contractor shall collect a signed Authorization for Release of General andlor 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; Packet Pg. 806 16. D.4.b October 2019-March 2021 EHEAP 203.19.002 (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 nlunicipat providers, must he in "active" status with the State of Florida (http:(isunbiz.oru/seat-h.httiil). The business name on the vendor agreement must match the legal business name on the State of Florida Sunbiz websitc; and 15. Comply with [lie Fcderal Financial Accountability and 'Transparency Act (FF'ATA) by securing a Dun and Bradstreet Numbering System (DLINS) number (www.dnb.coni) and maintaining an active and current profile in the Systein fbr Award Management (SAM) (www.sam.gov). B. STAFFING REQUIRF:MER'TS 1. Use of Subcontractor's If an entity other than the Contractor provides any service required under this contract, the Contractor shall ensure the following requirements are mct: a. Eligible entities that provide outreach, perform intake, make eligibility determinations, or process benefit payments inust be one of the following: (1) A I.ocal City Government; w (2) A t.ocal County Government; (3) A Community -Based Organization; r, c LO (4) A Vaith-Based Organization; or (5) A Stale Community Services Agency. ar x b. For the terin 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) Tltc 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. c. Entities providing any service required under this contract must comply with the FFATA. This includes securing a DUNS nuurber and maintaining an active and current profile in the System for Award Management (SAM) (�s►��v.sr►m.goy). d. Entities mast maintain current written agreements in the following formats with service providers: (1) A MOIJ shall be executed by both parties if service provider perfonns any servicc 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 tlrc contract execution date; and (2) An EHEAP suhcontract 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. 12 Packet Pg. 807 16. D.4.b October 2019-March 2021 EHEAP 203.19.002 c. Eligible entities must provide the service provider commensurate compensation for the delivery of administrative and outreach activities and for the delivery of crisis benctits. Commensurate compensation of administration and outreach activities shall include cost -reimbursement of actual expenses or a negotiated rate for specific activities. f. 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 MOU verifying that subcontractor's staff is paid from non-federal resources or is compensated for such activities by I HFA P. In accordance with Sections 25-26 of the Standard Contract, the Agency shall not be responsible or liable lbr any obligations or claims resulting /rain any subcontract. h. Contractor shall document the subcontractor's progress in performing its work under this contract in the quarterly report. 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 0 In 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 o Officer in writing of such delay. x C. tit?RViCE DELIVERY I. Service Delivei;y 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 Contactor 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 1'oree rnRjcurc. 3. Contractor shall publish its service delivery location, toll -free telephone number, and normal business hours in available forms ol'medin (i.e. newspapers, radio, television, vvebsite, publications, etc.). D. DELIVERABLES 1. Deliverables a. Certification that Contractor must operate during its regular business 11OUI-S, as identified in Section ii.C.2. ol'this contract. b. Contractor shall provide the minimtttn level of service per month in each coUnly served, as defined in Section I.A.17. 13 Packet Pg. 808 October 2019-March 2021 2. Source Documentation EHEAP 203,19.002 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 Receipts and Expenditure Report (Attachment XI) and EHEAP 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 Cost Reimbursement Summary form (Attachment XXI); and the certification required in Section [11, E.2. 3. Records and Documentation Contractor will maintain a separate record (paper and CIRTS) for each EHEAP applicant that includes the following, as applicable: a. The EHEAP Application and Eligibility Worksheet (Attachment XVIII) completed and signed by Contractor and the elder. The application must be approved by a supervisor or peer prior to payment remittance. Contractor is responsible for using the most recent application, eligibility worksheet, and EHEAP Application and Eligibility Worksheet Instructions (Attachment XIX) issued by the Agency. (1) If Contractor approves an application, one elderly member of the household must be registered inIL a CIRTS using the EHEAP Application and Eligibility Worksheet (Attachment XVIIi); or w (2) If Contractor denies an application, the elder must be registered in CIRTS using the EHEAP w Application and Eligibility Worksheet (Attachment XVIII), r b. The elder's name, address, sex, and age; 0 u� c. Names, ages and current identification documentation (no more than one year expired) of all household members; m d. Social Security numbers and documentation of those numbers for all household members, or the citation to w the applicable exemption; N e. Signed notice regarding the collection of Social Security numbers (Notice of Instruction 4071113-1-I- SWCBS,_ http://eideraffairs.state.fl.us/doea/notices/July13/LIHEAP%20Notice%20re%20Social%20Sectirit, %� 20N um bets%20FipA1.pdf); 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 tine residence in which they live; (1) The elder's utility bill must include detail to identify unallowable categories of assistance resulting from charges for water, sewer, garbage, and fire, etc.; charges resulting from meter -tampering and returned checks; and other charges that are not energy -related and are not required for cooling/heating the household. (2) Use of the most current utility bill(s) which provides the vendor's name and address, account holder's name and physical address, account number, and atnount(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 Application and Eligibility Worksheet (Attachment XVIII). 14 Packet Pg. 809 16. D.4.b October 2019-March 2021 EHEAP 203,19.002 k. Signed Authorization for Rclose of General and/or Confidential Infortnalion for LII IEAPIEIIEAP Federal Reporting or a statement on the application which states that the elder refused to sign the waiver; I. 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'rcfcrrals to LIHEAP and WAP; o, Notation if EHEAP prevontcd a disconnection or restored an energy disruption; p. Documentation of coordination with L1HF.AP 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. C'omplcted I-;HHAP CHcnt File Content Cliecklist (Attachment XX). 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 c report that permits Contractor to meet the Agency's reporting requirements. a. Contractor shall report monthly on Contractor's EHEAP Request for Payment (Attachment XI1) as deli nested in Section II.E.I .e. ol'this contract. V b. Administrativeand Outrench Expense Budget Detail Contractor shall submit to the Agency's EHEAP Contract Manager the EIIEAP Administrative and Outreach Expense Budget Detail (Attachment X). The EHEAP Administrative and Outreach Expense Budget Detail shall clearly delineate planned expenditures for funds retained by the Contractor and funds subcontracted. The EHEAP 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 Funding sources, estimated hours, and hourly wage shall he identified for the balance of salary where FHFAP funds are used to pay less thanone hundred percent (100%) ofthe salary, c. Provider Cost Analysis State of Florida Chief Financial Officer Memorandum No. 02 (released October 3, 2012), roquires Agency to provide assistance to the Contractor's Contract Manager in completing the DOER Cost Analysis (br Non -Competitively Procured Contracts In h.xcess of Category 11, (1) The Contractor shall submit a completed Cost Analysis which shall reflect Administrative, Outreach, and Crisis Service allocations as delineated on the El IEAP Budget Summary (Attachment IX) and must be sufficient to explain the expenditures' allnwahility, 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 he submitted and approved by the Agency prior to any change. 15 Packet Pg. 810 1 ti.D.4.b October 2019-March 2021 d. EHEAP Quarterly Report EHEAP 203.19.002 The quarterly EHEAP Summary Report shall be submitted based on the following schedule: REPORT REPORTING PERIOD DATE DUE TO AGENCY 1 10/01/19 — 12/31/19 January 15, 2020 2 01 /01 /20 — 03/31 /20 April 15, 2020 3 04/01/20--06/30/20 July 15,2020 4 07/01/20 — 09/30/20 October 15, 2020 5 10/01/20 — 12/31/20 January 15, 2021 6 01/01/21—03/31121 April 15, 2021 (1) The Contractor shall ensure timely and accurate CIRTS data entry of EHEAP activity and submit to the Agency's EHEAP Conti -act Manager the service report entitled "EHEAP Summary" from CIRTS. The E report shall reflect the use of EHEAP in each contractor county in the PSA and shall be inclusive of all E elders applying for crisis energy assistance during the reporting month or period. The EHEAP Summary a Report parameters for the program year shall be: < LU W PSA; _ (ii) All Providers; w (iii) All Locations; (iv) Start Date (first date of reporting period); and (v) End Date (last date of reporting period). e. For the term of this contract, each month Contractor shah provide to the Agency, by the 9°i of cacti month for the preceding month, 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 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. f. Program Effectiveness Reports Contractor agrees to provide to the Agency any additional service reports requested by the Agency concerning the effectiveness of the program and shall include any statistics and information that the Agency may require. The reporting period shall begin with the effective date ofthis 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. Stich review shall be rnade for each function or activity set forth in this contract and reported in the quarterly report. 16 Packet Pg. 811 October 2019-March 2021 EHEAP 203,19,002 a. Contractor shall review completed EHEAP applications in accordance with the EHEAP Client Bile Content Checklist (Attachment XX). b. The Agency shall, at its own discretion, conduct investigations concerning ally aspect of Contractor's performance of this contract. e. The Agency shall conduct a full onsite review of Confracbr at least once during each three-year period. Contractor shall allow the Agency to cnity out monitoring, evaluation, and technical assistance, and shall ensure the cooperation of its employees, and of any subcontractors with whom Contractor contracts to carry out program activities. d, The Agency shall conduct desk review activities throughout the year to monitor contractual program requirements. e. The Agency shall conduct EHEAP intake site visits. f. In conjunction with onsite monitoring visits and desk review activities, the Agency shall review it sample of completed EHEAP client files in accordance with the E14BAP Client File Content Checklist, (Attachment XX)• g. The Agency shall conduct follow-up reviews including prompt return visits to Contractors that fail to meet the goals, standards, and requirements established by the state and federal funding agency. J+, CONTRACTOR RESPONSIBILITIES I. Make vendor payments directly to file] and/or home energy providers on behalf of eligible elders. Z. Determine file correct arnotaut of each crisis benefit based on the minimum necessary amount needed to resolve r the crisis, but not more than the item limits or total limit set by the Agency. Tile maximum crisis assistance cap o for this contract is $3,500.00 per household. 'n 3. Encourage households to seek assistance prior to incurring non -energy penalties such as disconnect/reconnect fees, additional deposits, interest, or late payments. w 4. Provide EHEAP crisis services to households with eiders in every county within the service area. c a. Contractor shall ensure that each countywithin their service area receives a minin;uni level of crisis services monthly, as delineated in Section I.A.17.c EHEAP fiinded staff shall make themselves available in all underservod counties as needed, to ensure that the minimum level of service is met; and b. 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. G. Make payments on behalfof those elders with the highest home energy needs and tite 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 frall elders. 7. Refi:nd to the Agency, with non-federal funds, all funds incorrectly paid on behalf of elders that cannot be collected from the elder. S. Develop adequate procedures to ensure EHEAP funds are appropriately budgeted and expended in alleotunties 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 procoduros to ensure that administrative costs that exceed the contracted EHEAP administrative award to Contractor or Subcontractor are paid from non-federal sources. 17 Packet Pg. 812 October 2019-March 2021. EHEAP 203.19.002 10. Develop adequate procedures to address the use of EHEAP 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. 12. Ensure providers and appropriate staff participate in training opportunities scheduled by the Agency to cover EHEAP policies and procedures. 13. Ensure the provision of training for all providers and staff members assigned responsibilities within the program. 14. Maintain an EHEAP Policies and Procedures Manual to serve as a local resource for program administration, training, and reference. The EHEAP Policies and Procedures Manual shall be distributed to all subcontractors that provide any service under EHEAP. The EHEAP Policies and Procedures Manual shall be reviewed during, and in accordance with, the Agency's EHEAP contract monitoring schedule, and shall include the following: a. The State of Florida LIHEAP Policies and Procedures Manual; b. An MOU or Subcontract with EHEAP providers; Q c. An MOU with all service area LIHEAP providers; a a d. An MOU with all service area WAP providers; W _ w e. Contractor's cost allocation methodology; r f. Written policies and procedures to ensure that all energy assistance payments made to home energy vendors ti comply with the requirements of the Vendor Agreement; g. Adequate procedures to ensure that EHEAP fiends are appropriately budgeted and expended in all counties within Contractor's service area; w h. Policies regarding the detection and prevention of fraud and abuse of program funds; c i. Policies that address serving family members and employees; r' j. Policies and procedures to secure applicant Social Security Numbers in order to protect applicants' N identities; a Ic. Procedures for computer system backup and recovery; Q w x Procedures for referral or access assistance to the "Lifeline Program"; U.1 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 EUIEAP; 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; 18 Packet Pg. 813 October 2019-Match 2021 EHEAP 203.19.002 s. A resource guide, or the utilization of the Information and Referral database (ReferNET), to access other energy assistance resources available at the local level to provide referrals to elders when EHEAP funding is not available or they do not qualify; t, Consumer appeal procedures that provide an opportunity for a fair administrative hearing at the provider level to elders whose applications for assistance are denied, or whose applications are not acted upon with reasonable promptness; and u. Policies and procedures for conducting home visits to home -bound elders for completion of the program application or eligibility determination when other assistance is not available. 15. Notwithstanding that tasks for which the Contractor is held accountable involve coordination with other entities in performing this contract, the failure of other entities does not alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform pursuant to this contract. G. AGENCY RESPONSIBILITIES 1. The Agency may provide technical support and assistance to 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 frill performance of contract requirements. 2. The Agency will provide to Contractor the State of Florida LIHEAP Policies and Procedures Manual. The State of Florida LIHEAP Policies and Procedures Manual will provide information and procedures needed to administer EHEAP in Florida. a. This contract excludes all provisions of the State of Florida LTHEAP Policies and Procedures Manual in w reference to LIHEAP Regular Home Energy Annual Benefits. r b. To the extent any conflict arises between this contract and any incorporated reference contained herein, this contract shall have precedence. III. METHOD OF PAYMENT A. PAYMENT METHOD USED The Method of Payment for this contact is cost reimbursement, subject to the availability of funds and Contractor performance. The Agency will pay the Contactor upon satisfactory completion of the Tasks/Deliverables, as specified in Section It, Manner of Service Provision, and in accordance with other terms and conditions of this contract. 1. Cost Reimbursement The Contractor agrees to distribute funds as detailed in the EHEAP Budget Summary (Attachment IX) attached to this contract. Any change in allocation of categorical or total amounts of fiords identified on the EHEAP Budget Summary form require a contact amendment. Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in Attachment iX. All Cost Reimbursement EHEAP Requests for Payment must include the actual EHEAP Receipts and Expenditure Reports beginning with the first month of this contract. a. Budget Summary Contractor agrees to implement the distribution of funds as detailed in the EHEAP Budget Summary (Attachment iX). An amendment is required to change category allocations or the total amount of this contract. 19 Packet Pg. 814 October 2019-March 2021 (1) Administrative Expense EHEAP 203.19.002 Administrative expenses include costs for general administration and coordination of the program, including direct and indirect costs. This includes the salaries, fringe benefits (i.e. insurance, retirement, etc.), rent, utilities, travel, etc. associated with financial and administrative management of the program. The use of other federal funds to supplement the administrative operations of EHEAP, above and beyond the budgeted amount, is prohibited. Administrative costs that exceed the contracted EHEAP administrative award to Contractor or subcontractor must be paid from non-federal sources. Contractors must have adequate procedures for monitoring and oversight to ensure compliance. (2) Outreach Expense Outreach expenses are those costs incurred in delivering EHEAP services that are not purely administrative in nature. This may include staff and subcontractor expenses such as salaries, fringe benefits (i.e. insurance, retirement, etc.), rent, utilities, travel, etc. for those employees performing outreach and intake. 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 Q recognized indirect cost rate negotiated between the Subrecipient and the Federal Government. If no such a rate exists, then the Subrecipient shall have either a rate negotiated with the Agency (in compliance with 2 w C.F.R. Part 200), or a de minimis indirect cost rate as defined in 2 C.F.R. § 200.414(f). Subrecipient shall = w 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 ti 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. v 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 April 15, 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; 1. 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 Service Rate Report (Attachment XXIiI); 3. Contractor shall consolidate all Requests for Payment from subcontractors and Receipts and Expenditure Reports that support requests for payment and shall submit them to the Agency using the EHEAP Receipts and Expenditure Report (Attachment XI), EHEAP Request for Payment (Attachment XII), and EHEAP Cost Reimbursement Summary (Attachment XXI); 4. Contractor shall include required supporting documentation as delineated in Section fI.E. with the cost rehnbursement 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 programmatic reports due from the Contractor and any adjustments thereto, including any disallowance not resolved. 20 Packet Pg. 815 October 2019-March 2021 E I f CAP 203,19.002 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; 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 firom 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 w 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. N 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. 1. Any nonconforming program service, performance report, or financial record not meeting the aforementioned requirements is not eligible for reimbursement under this program. Contractor shall solely bear the costs associated with enrolling, training, reporting and/or managing the program. Contractor shall give immediate notice to the Agency of any significant and/or systemic 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 (100%) of the deliverables identified in this contract are performed pursuant to contract requirements. The deliverables described in Section 11.13, are identified as major deliverables in this contract. 21 Packet Pg. 816 October 2019-March 2021 CHEAP 203.19.002 1. If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to correctly, completely, or adequately perform these major deliverables, the Contractor will have ten (10) days to submit a Corrective Action Plan (CAP) to the Contract Manager that addresses the deficiencies and states how the deficiencies will be remedied within a time period approved by the Contract Manager. The Agency shall assess 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 I F" 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, l% 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, I % of the monthly value of the administrative funds in the contract for each day the Contractor fails to timely submit a CAP. 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 W 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. w END OFAT7ACHMENT 22 Packet Pg. 817 16. D.4.b October 2019-March 2021 ATTACHMENT H-EXHIBIT2 FUNDING SUMMARY (2019-2021) MKIWAll xtea jy,Qjg,; Title 2 CFR, as revised, and Section 215.97, F.S., require that the information about Federal Programs and State Projects included in Attachment 11, 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. FEDERAI. RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO'I'HISCONTRACT CONSIST OF THE FOLLOWING: GRANT AWARD (FAIN#): 17EA-01-IJ-00-16-003 FLsUERAL AWARD DATE: April 2019 DUNS NUMBER: 076997790 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Emergency Home Energy Assistance for the Elderly Program United States Department of Health and 1-ioman Services 93.568 -93.568 EHEAP Collier- - $ 96,548.22 'TOTAL FEDERAL AWARD $ 96,548.22 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: FEDERAL FUNDS:LO 2 CFR Part 200 -- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. OMB Cil'eUlar A-133 — Audits of States, Local Governments, and Non -Profit Organizations 0 2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSISTOF THE FOLLOWING: MATCHING RESOURCES FOR FEDERAI, PROGRAMS PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL STATE AWARD C'VA TL` VIM A XTt-IF A { A C`CICTA Md-V QVn iri r"I"Tn crr-irmN '7 1 c 07 i' C PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT TOTAL AWARD -_ COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL AS�15 AN .E 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 23 Packet Pg. 818 16. D.4.b October 2019-March 2021 ATTACHMENT IX BUDGET SUMMARY EMERGENCY HOME; ENERGY ASSISTANCE PROGRAM for Collier County Board of County Commissioners EHEAP 203.19.002 Collier EHEAP ADMINISTRATION BUDGET S 8,421.82 EHEAP OUTREACH BUDGET $ 13,468.60 EHEAP CRISIS ASSISTANCE. S 74,657.80 TOTAL S 96,548.22 Projected minimum number of individuals to be served Energy Assistance* 269 *Eligible households may be provided with one benefit per season tip to six hundred dollars per benefit. The minimum number of consumers may reflect duplicated consumers if a consumer receives a benefit in both seasons. r Q Page 24 of 34 Packet Pg. 819 October 2049-Itiarch 2021 ATTACHMENT XIII LHEAP INVOICE REPORT SCHEDULE EHEAP 203.19.002 Report Number Based Upon Date Due to the Agency 1 October Advance* Upon receipt of executed contract 2 November Advance* Upon receipt of executed contract 3 October invoice November 09, 2019 4 November Invoice December 09, 2019 5 December Invoice January 09, 2020 F January Invoice February 09, 2020 7 February Invoice March 09, 2020 8 March Invoice April 09, 2020 9 April Invoice May 09, 2020 10 May Invoice June 09, 2020 11 June Invoice July 09, 2020 12 July Invoice August 09, 2020 13 August Invoice September 09, 2020 14 September Invoice October 09, 2020 15 October Invoice November 09, 2020 16 November Invoice December 09, 2020 17 December Invoice January 09, 2021 18 January Invoice February 09, 2021 19 February Invoice March 09, 2021 20 March Invoice April 09, 2021 21 Final Request for Payment April 15, 2021 * Advance based on projected cash need. Note # l: Report # t and #2 for advance basis invoices, cannot be submitted to the Agency prior to October 1 or until the agreement with the Agency has been executed and a copy sent to the Agency. Actual submission of the vouchers to the Agency is dependent on the accuracy of the Receipts and Expenditure Report. Note #2: Report numbers 5 through 14 shall reflect an adjustment of one -tenth of the total advance amount, on each of the reports, repaying advances issued the fist one or two months of tine agreement. The adjustment shall be recorded in Part C. 1 of the report (ATTACHMENT XIl). Note # 3: Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the Agency, payment is to accompany the final report. Note 44: ALL Expenditure Reports are due by 12:00 p.m. on the 90, of each month. IF the 9"' falls on a Saturday, then the report will be due by the 8°i by 12:00 p.m. AND IF the 91 falls on a Sunday, the report will be due by the 10" by 12:00 p.m. Actual submission of the vouchers to Dept. of Elder Affairs is dependent oil the accuracy of the expenditure report, which is verified and paid by CIRTS data only. Page 25 of 34 Packet Pg. 820 16. D.4.b October 2019-March 2021 ATTACHMENT XIV POVERTY INCOME. GUIDELINES EHEAP 203,19.002 LOW INCOME HOME ENERGY ASSISTANCE. PROGRAM (LIHFAP) POVERTY INCOME GUIDELINES* EFFECTIVE, JULY 1, 2020 PEOPLE IN THE HOUSEHOLD 1 150% $19,140 2 $25,860 3 $32,580 4 $39,300 5 G ---- -- -7_$59,460 $46,020 $52J40 8 $GG,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 f-iutnan Services (HI IS) poverty guidelines published in the Fedowl Register on January 17, 2020. 0 LO Page 26 of 34 Packet Pg. 821 October 2019-March 2021 ATTACHMENT XVI EHEAP SOURCES OF INCOME L{ILAP 203,19,002 EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY FY 2020/2021 SOURCES OF INCOME EFFECTIVE June 1, 2020 INCLUDED SOURCES OF INCOME EXCLUDED (Includes total annual casl) receipts before taxes from all sources SOURCES OF INCOME 1. Money wages and salaries befi)re any deductions 1. CAPITAL GAINS Any Assets drawn down as withdrawals from a bank, the sake 2. Net receipts from non -farm employment (receipts from a of property, a house or a car. person's own unincorporated business, professional 2. Tax Refunds enterprise, or partnership, after deductions for business 3. Gifts eltpcnscs.) 4. IS)ans 5. Lump -sum inheritances 3. Net receipts from farm self-employment (remaipts fron) a G. One-time insurance Payments farm which one operates as an owner, renter, or 7. Foster Care Paymenrs'r sharecropper, after deductions for farm operating 8. Compensation for injury expenses) 9. Combat zone pay to the military 10. Adoption Subsidies 4. RI-iGULAR PAYMEXIS FROXI: 11. Reverse !Mortgage Payments Social Security 12. NON-CAS[i BEN11FITS Railroad retirement (a) 1'smployer-paid or union paid portion of health Strike benefits from union finds insurance or other employee benefits Worker's compensation Veteran's payments (b) Food or housing received in lieu of wages Public Assistance or Tmilporaty Assistance for Needy Families (I'ANF), Supplemental Security Income, and non -federally funded (c) 11)e value of food and fuel produced and General Assistance or General Relief money payments. consumed on farms. 5. Payments to foster children age 18 or older received through the (d) The imputed value of rent from owner -occupied Independent Jiving Program non -fare or hnn housing. G. Training stipends (c) Federal non -cash benefit programs such as 4fedicare, 7. Alimony Medicaid, Food Stamps, school lunches, and housing S. Child Support assistance. 9. Social Security Benefit Garnishes for Non -Payment of 13. Supplemental Security Income (SSI) benefits cannot be School Loans. (1'Ime total amount of the Social Security Retirement garnished for any reason unless a recipient received an benefit including the garnished deduction must be used when overpayment of benefits. calculating the applicant's income.) '[lie totat amount of the SSI benefit minus the garnished deduction for recoupment must be used when calculating 10. klil'ttary family allotment or other regular supportfron) the applicant's income. a family member or someone not living in the household 41)ersons whose cost of residence is paid through a foster care or residential program administered by the state 11. Private pensions cannot be counted as household members. 12. Government employee pensions (inchtdingmilitary 14. Stimulus payments from the federal government in retirement pay) relation to the Coronavirus Disease will not be considered income and will not be considered in 13. Regular insurance or annuity payments determining a household's Federal Poverty Level 14. Educational Assistance: 1501/o or below . Grants, Fellowships, Assistantships, College or 15. Any type of unemployment payments -,tiill not be University Scholarships - Only count as income those funds counted as income. specifically allotted for living expenses 15, Dividends 16. Interest 17. Net rental income 18. Net royalties 19. Periodic receipts from estates or trusts 20. Nut gambling or lotte , winnings i^9 0 0 nD 7 CV) O N r C tv E C tv E Q IL a W 2 W ti CD to U tv K W N O CD r th 0 N IL Q W 2 W C tv E z t� to a Page 27 of 34 Packet Pg. 822 16. D.4.b October 2019-March 2021 ATTACIIMENT XV1II EHEAP APPLICATION AND ELIGIBILITY WORKSHEET EHEAP 203.19.002 [=i tt,l'goncy Holtie, Energy A siManco for the Eldorly ProCUrcittt CARES Act -- Application Name: (First, M, Last) El C rioi5 ,�s,%iStE- ncr) Date of birth: Age: SSN: Service address: Date Stamp City: Florida County: ZIP Code: Intake worker's name: Sex: ❑ Male ❑ Female Number of people in the household: Phone: Marital Status: ❑ Married ❑ Partnered El Single ❑ Separated ❑ Divorced D Widowed Phone: Race: ❑ White EI Black/African American ❑ Asian 177 Native Hawaiian/Pacific Islander ❑ American Indian/Alaska Native ❑ Other Ethnicity: ❑ Hispanic/Latino ❑ Other Primary Language: ❑ English []Spanish ❑Other Does client have limited ability reading, writing, speaking, or understanding the English language? ❑ Yes ❑ No Is the client a veteran? C7 Yes U No Was client referred to the local Veteran's Affairs office? ❑ Yes D No 0 N/A Applicant's income type(s): Applicant's monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: u Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Name: Income type(s): Age: SSN: Monthly income amount: Section Th • .ree • Is there a child 5 years of age or younger in the household? ❑ Yes 171 No If Yes, select all that applies: ❑ 0-2 years old ❑ 3-5 years old Is there an individual with a disability in the household? ❑ Yes ❑ No Is the applicant a U.S. citizen or an alien lawfully admitted for permanent residence? ❑ Yes n No Is the applicant a homeowner? ❑ Yes ❑ No Does applicant live in government subsidized housing, such as Section 8? ❑ Yes ❑ No If yes, provide the complex name: If yes, does the household receive an energy subsidy? ❑ Yes ❑ No Does applicant live In a student dormitory, adult family care home, or any kind of group living facility? D Yes 0 No If yes, provide the facility name: Four -section . and Coolino Information Have you or any member of your household received energy assistance in the current season? ❑ Yes C7 No If yes, provide the name of Agency: _ Type of Assistance: ❑ Crisis ❑ Home Energy ❑ Weather -Related Date: 28 0 LO Packet Pg. 823 October 2019-March 2021 EHEAP 203,19.002 What is the primary source of home heating? (select one) t I Electricity ❑ Natural Gas L1 Propane ❑ Wood/Coal n Refillable Fuels Does household use supplemental heating source? U Electricity ❑ WoodiCoal ❑ NIA Air conditioning unit type? ❑ Central A/C L Window/Wall AIC ❑ Fans CI Other — specify (including evaporative cooler) ❑ Home cooling or heating energy source has been disconnected. (Life-Threafening/18-hour) Ll Unable to get delivery of fuel, is out of fuel, or is in danger of being out of fuel for heating. (Life -Threaleninglf8-hour) ❑ Other problems with lack of cooling or healing in the home, such as needing to pay a deposit, repair of equipment, or interim emergency measure to avoid further crisis. (Life-Threateningll8-hour) ❑ Notified that the energy source for cooling or heating is going to be disconnected. (StandefU148-hour) I I Received a notice indicating the energy source billis dell nquenl or past due. (SlandarrU484iour) The information provided on this application, is to the best of my knowledge, true and complete. I understand that priority in providing assistance will be given to those households with the lowest income and greatest need, i.e. those households in which the elderly, disabled, medically needy, or children reside. I authorize the agency to make benefit payments directly to my energy supplier. I am aware that after I have provided all the information requested to determine my eligibility, if I am applying for crisis assistance, the agency has 18 hours to act upon my application with an eligible action. I am also aware that if I am not approved or denied within the time allowed, or not approved for the correct amount, I have a right to appeal the decision. (If you sign with an 'X" two wilnesses are required.) Client Signature: U Has an energy source bill for which the due date has lapsed. (Standa0148-hour) ❑at@: DC1EAFan 114-0151C112NO-Revised 29 Packet Pg. 824 16. D.4.b October 2019-March 2021 EHEAP 203.19.002 7111o.rgellcy Home,' (=i1(-, tjy A ssi:--tanGe for tho Elderly Program CARES Pict M- Application •h six: Income Eligibillity tr - Annualize all household income. : t.;13if' {; 31c{rl;,[cu tarpe Izerc shrfvruui incolfre. Poverty Guidelines effective 71112020, — ,aloe. is!i. ns cu t•.fit i;aicu!a!ior.s in ihis 1. Add all gross monthly earned and ;t,,� ;L Select the annual income limit by household unearned income from the past 30 size: days of all household members. 150% of Poverty 50°% of poverty 2. Add Medicare Premium ($144.60), if ❑ ..........$25.860 not included in SSA amount. 1712 ..........$25,860 S 8,620 8,620 Li 3.......... $32,580 $10.860 3. Add Medicare Part D, if applicable. ❑ 4.......... $39,300 $13,100 4. To annualize, multiply the monthly ❑ 5.......... $46,020 $15,340 total by 12 months. D 6...... ....$52,740 $17,580 Annual Household Income ❑ 7..........$59,460 $19,820 ❑ 8.......... $66,180 $22,060 $ (Add $6,720 for each additional member of _I family unit with more than 8 members.) If the total annual household Income is less than 60% of the current Federal Poverty Guidelines for household size (using chart above), and no one in the household is receiving SNAP assistance, the applicant must provide a signed statement of how basic living expenses (I.e., food, shelter and transportation) are provided for the household. • •• • • IQ Energy Vendor #1 Other Vendor #1 Contact made with LIHEAP provider to Name: Name: verify previous crisis assistance. Contact Person: AccounWoucher Dale of contact: Account Number: Number: Date: Has the applicant received CARES Act EHEAP or LIHEAP crisis assistance? L1 Yes © No Minimum Amount Due: Amount Due: If yes, provide total amount & Date(s) Verification and Commitment ❑ Blanket ❑ Repair Existing Heating or Portable Fan Cooling Equipment If the minimum amount due is more Contact Person: ❑ Space Heater ❑ Emergency Shelter than the past due amount, did the Date: ❑ Window A/C U Other energy vendor verify that this amount is required? L3 Yes 17 No ❑ N/A Enotgv Vendor #2 Other Vendor #2 Name: Name: AccounVVoucher Account Number: Number: Date: If the minimum amount due to resolve the crisis is more than the maximum allowed ($3,500), explain how the Minimum Amount Due: Amount Due: balance of the amount due will be paid if approved for EHEAP crisis Verification and Commitment 0 Blanket ❑ Repair Existing Heating or assistance. C Cooling Equipment ❑ Portable Fan g -- - Contact Person: ❑ Space Healer ❑ Emergency Shelter Date: O Window A/C ❑ Other (1 ) Total Energy Vendors $ (4) Total Other Vendors S Is the name on the fuel bill that of the (2) Energy Subsidy $ Total EHEAP Benefit applicants? ❑ Yes 0 No $ 13) Water, Sewer, Garbage, Add $ If no, provide name on Fire, etc. — Total Energy Vendor (4) & Total Other Vendor (4) bill: (4) Deduct (2&3) from (1) $ .,Siactlion Eight• •. If the applicant is a homeowner, has he/she received more than three LIHEAP or EHEAP benefits in the last 18 months? El Yes El No 0 N/A If the answer to the previous question is "yes", was the applicant referred to WAP? 0 Yes 0 No 0 N/A y W Q Packet Pg. 825 16. D.4.b October 2019-March 2021 EHEAP 203.19.002 If the answer to the last question is "no", explain: Section Nine: Retollutlon of Crisis Resolution of the Heating/Cooling Energy Crisis occurred within 18148 hours, by the following eligible action(s): (Select all that apply) El Approval of application 0 EHEAP benefit prevented disconnection ❑ Commitment made to vendor ❑ EHEAP benefit restored energy already disconnected L7 Denial of Application, pending additional information ❑ Yes, client signed waiver ❑ Denial of Application, ineligible ❑ No, client refused to sign waiver L1 Written referral and assistance to access other community resources Worker Signature ApprovalCase I have determined the i . .. nor am I a friend. relative, or employee. of the applicant. The application and eligibi for efrors documentation reviewed a Case Worker's Name: Supervisor/Peer's Name: Case Worker's Signature: Supervisor/Peer's Signature: Date: Date: Agency Name: Agency Name: DOFA Form 114—0610172D20-Revised 31 M O O CD r M O N c N E C d E Q d Q W W r O 1O Packet Pg. 826 16. D.4.b October 2019-March 2021 EHEAP 203.19.002 ATTACHMENT XIX EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS Section One: Annlicant Mae 60 and old2[1113fgrmation Complete Section One in its entirety. Special notes: ✓ The Winter and Summer Seasons are waived. ✓ 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 carry hoh-i is determined to he riot appficable, cooipfctr, thn, field by enterio.q NIA. Section Two: Additional Household Mea3bers Information Complete Section Two by listing additional household members and providing the information requested. Special notes: ✓ At a minimum, the name(s), age(s), and Social Security number(s) of each additional household W member is required; ✓ You will be attaching a calculator tape of the household's income calculations in the section o provided on the EHEAP Eligibility Worksheet; and f If F;my flad is tfetcrminec:t to be, not complete tho ficicl by onforiog NIA. � Section Three: Household Characteristics Complete Section Three by answering each "Yes" or "No" question and providing additional information if applicable. Special note: V. ff ,:.my hold is deft-,nmine(d to be not aj)pficahl;, complutt; tlrc, hold by entering NIA. Section Four: jgating and Cooling Information Complete Section Four by answering each question. Special note: ,� !f Dirty fii>!d is eic�fc=rtrtitrc;d to !Je nc�t af:pfic,;thlt;, corrtpletc: tfrc.fir�lCt fry ettterirrg NSA. Section Five: Energy Cuais 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 zany tight is dofetmink-ma to be not ofy,) fc abtc, comr.Netcr fho ficki by entoring N/A. Client Attestglign and Signature The applicant should read the attestation statement. If the applicant is unable to read the attestation statement, the intake worker should read it to them before they sign and date the application. 32 Packet Pg. 827 16. D.4.b October 2019-March 2021 EHEAP 203,19.002 At this point, the intake worker should have the applicant sign the waiver authorizing the release of general and/or confidential information for LIHEAP/EHEAP federal reporting. CIRTS will require you to verify that either the waiver has been signed or that the client has refused to sign. 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 EHEAP, 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. !t <�riy tied! rs rl�,tcarrr►irrerf tr, l�n rac�t ,:r/�pdir:rrl�te, r:�n7r�l�tr.� the tif�tc! !1y c�ntc�rir�rl NI�1. Section Seven: Vendor. Benefit. and Vef"figalion 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 $3,500.00. ✓ 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 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 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 $3,500, ✓ 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; 33 0 LO Packet Pg. 828 16. D.4.b October 2019-March 2021 EHEAP 203.19.002 ■ Purchase of blankets, portable fans, space heaters, and window air conditioners; ■ 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. d Water, sewer, garbage, and fire, etc. MAY NOT be paid with EHEAP funds, Utility bills that include charges that are not directly related to cooling and heating will be reduced by the amounts for these charges. f Charges incurred due to illegal activities, such as a worthless check or meter tampering, MAY NOT be paid with EHEAP funds. ;l"wY hold rs de"I w?inc!f to hn /n.-)j ml.)Jjlkt�nhlb, cou),Welc Mo lialai by anlenng NIA Section Elaht; Weatherization Assistance Program (WAP) Referral Complete Section Eight in its entirety. Special notes: ✓ When determining the number of LIHEAP or EHEAP crisis benefits the applicant has had, you w 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. c If atty fiolrl is deterrniood to ho not ot)piicoblo, cnmplute 1ho ! is ki by c,-W cineg N/A. Section Nine: Resolution of Crisis Complete Section Nine by selecting all that applies to this applicant and application for services. Special notes: f 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. ✓ 0 aoy hoki is <!eloi rtritcc.rt is be not croplir,abio, rot)tpleto Me field by oWeling NIA, Case Worker StgLlaturg To complete this section, the individual who completes the EHEAP Eligibility Worksheet, determines income eligibility, and provides the commitment to the utility vendor must sign and complete the requested information Special note: ✓ If you are the applicant, or a friend, relative, or employee of the applicant, you cannot determine the eligibility or award EHEAP benefits. This application must be processed by someone who is not the applicant or a friend, relative, or employee of the applicant. To complete this section, the signer is attesting that he/she has reviewed the application for completeness, determined that all required documentation is included, and verified that the annual household income calculation and EHEAP benefit awarded are correct. 34 Packet Pg. 829 16. D.4.b October 2019-March 2021 EHEAP 203.19.002 ATTAC"MENT XX EHEAP CARES ACT CLIENT FILE CONTENT CIIECI(LIST ELDER'S NAME AGENCY APPROVAL. DENIAL NAME OF WORKER APPLICATION DATE CRISIS RESOLUTION DATE CHECK DATE PROGRAM REQUIIlEXIEN`I'S MONITORED Yes \o NIA COb1;1lEN'TS i Individual client file thr the cider includes consumer's name, address, sec, and age. 2 I lotrsehnld contains a memhcr(4) or older. 3. The household is in the Florida county covered by the coorract. 4. AR huusehuld members tar I isted and llr:ir mute, age. DOB, and incomc(s) are included. 5 Client file contains doeutricmation of Socin1 5ccurity numbers fur all huusehuld morubers, or citation to lice applicable exemption. G. Client file contains signed notice regarding collection of social security numbers) 7. The client file contains official income documents forall household members. S. It' income is self-dechtred, is there at self -declaration form signed by each individual household member (i B vears orage or older) lacking income verification or claiming zeroincortrd7 y '1 he houschold's total gross income is calculot<d correctly and is at or below 15o"!o of the omn Federal Poverty l.evcl for the household sire. 10. Statement of how basic living expmscs (ix,, f uod, shelter and wi nspurtmion) are being Provided if total huusehuld incunic is less than 50% ofthe current Federal Poverty Guidelines and tin one in the houschold is rxciving SNAP assistance. i I Cl!ecked that elder does tint live in student dormitory, adult rami;y care hor,or tiny kind of group living facility, 12 Verified and dncmncntcd Iwuschold tints out received combined LIHEAP Ind EHEAP Crisis Assistance exceeding the crisis assistance cap or$3,500VU. 13. Uoctimenimion of 1Veatherizntinn Assistance Progmm (WAP) rofcrral, ifapplictibic. 1.1 Copies aI'll tel bills, or ollter suppoiIing doe untenlalion as proofofonergy crisis, for the rest dencc in which they reside. 15. Signed copy of Authorization for Release of 0eneral andtor Cunlidential hlfounation. 16. Oaly eligible components ofthe utility hill are paid to rsolve the crisis. 17 Only the minimum necessary to resnlve the crisis is paid. If a different amount is required by the udldy c-utnpuny, previdc additional information on the Fligibility Wnrkshect. 1 R. Cri sis energy benefit was roduecd by unullmwble charges, such as: water, server, garbage, fire, etc., if appl icabla. 19. Crisis energy henetit was reduced by energy subsidy, ifapplicuble. 20. Energy erisis resolved within 1210 hours by an oligibleaction 21 Written notitx of appruval ut dcuial for services that includes appeal procedures is issued within 15 working days ofeingihilny determination. 22 Appropriate benefit provided, at or beloiv tha EHEAP crisis assistance cap of$3 50o_00. 23 All required sections of the applicalion tyre signed turd dated by Ow elder, staff, and supervisorylpeer PRIOR to payinenl. 24. Proof or payment to veaattor. 25. Place completed DOER Form 211 (0610112020) it client file. INSI'RU(MoNS: A check nuirk in the W culumn indicates the requirement has been ntet. A check mark in the ltiiu vulumn indicates the requirement has not been ntct or is questionable. P,acb "No" marl: must he explained under "COhiAIBN't S". Supervisor/Peer. 5lgnature Consumer Nile Nionitoring !late OOCA FORS 211 W)1, 2020 35 Packet Pg. 830 Revised August 2007 Attestation Statement Agreement/Contract Number EIJEAP 203.19 Amendment Number _.002 I, STEPHCN Y CARNrLL. , attest that no changes or revisions have been made to the (Recipient/Cnowactor representative) content of the above referenced Agreementlemnlrart or amendment between the Area Agency on Aging for Southwest Florida and COLLIER COUNTY BOARD OF COMMISSIONERS, (ItecipientlConfracter name) The only exception to this statement would be for changes in page forrnnttiug, clue to the differences in electronic data processing media, which has no affect on the agreement/contract content. Signature of ReeWent/Contrachfrepresentative Approved as to form and legality — 1(—�-2 — or__ A. ntunt County At or ey l o Ifo la0.10 Revised August 2007 OW Zoeo Date Packet Pg. 831 16.D.4.c July 2019 to June 2020 El -IF -AP 203.19.001 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. EMERGENCY HOME ENERGY ASSISTANCE PROGRAM COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ("Agency") and Collier County Board of County Commissioners ("Contractor"), amends agreement EHEAP 203.19, The purpose of this amendment is to correct Collier County's Federal Tax ID below the signature area of the Contract. The Federal Tax ID below the signature area of the Contract should read as follows: Federal Tax ID: 59-6000558 Fiscal Year Ending Date: 09/30 DUNS: 076997790 All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to conform to this Amendment. 0 All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract. u This Amendment and all its attachments are hereby made part of the contract, w IN WITNESS WHEREOF, the Parties hereto have caused this amendment to be executed by their undersigned officials c as duly authorized. CONTRACTOR: COLLIER COUNTY AREA AGENCY ON AGING FOR BOARD OF C T COMMIS O RS SOUTHWEST FLORIDA, INC. SIGNED BY: SIGNED BY: NAME: S"I'El'HEN Y CARNELL NAME: MARIANNE G LORINI TITLE: PUBLIC SERVICES DEPARTMENT HEAD TITLE: PRESIDENT //CEO DATE: 021..)'/)/2020 DATE: c /`, 120 Federal Tax ID: 59-6000558 Fiscal Year Ending Date: 09/30 Duns: 076997790 Approved as to form end Iebaliiy A—oslutanl County A -Robley r� Packet Pg. 832 16.D.4.c Revised August 2007 Attestation Statement Agree►►►ent/Contract Number EHEAP 203,I9 Amendment Number.Al I, STEPHEN Y CARNELL , attest that no changes or revisions have been 111ade to tile (Recipient/Contractor representatve) content of the above referenced agreement/contract or sines dinent between the Area Agency on Aging for Southwest Florida and COLLIER COUNTY BOARD Or COMMISSIONERS. (ReciilicIlWoniractor name) The only exception to this statement would be for changes h► page fornlatth►g, clue to the differences in electronic data processing Media, which has no affect an the agreement/contract content. Signature Revised August 2007 LIM ractor representative 02/28/2020 Date Approved as to form atut legality � a R� stunt Coutlty Att rl 'y M O O O M 0 N r C d E c m E Q tL Q w 2 u.t 0 U d K W O O Os cM O N IL a w x! w .. I E M U c� Q { p 7 Packet Pg. 833 Im 16. D.4.f RESOLUTION NO. 2018- 2 0 2 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, REPEALING AND SUPERSEDING RESOLUTION NO. 96-268 and 10-122 AND AUTHORIZING THE COUNTY MANAGER OR HIS/HER DESIGNEE TO EXECUTE CERTAIN STANDARD SOCIALISENIOR SERVICES GRANT APPLICATIONS AND CONTRACT DOCUMENTS INCLUDING AMENDMENTS IN COMPLIANCE WITH CMA #5330, GRANT COORDINATION. WHEREAS, the Board of County Commissioners (Board) has the authority to apply for and receive social/senior services grants including the Older American's Act Program (OAA), Community Care for the Elderly Program (CCE), Alzheimer's Disease Initiative Program (ADI), Medicaid Waiver Agreement, the Home Care for the Elderly program (HCE), and USDA Nutritional Supplement Incentive Program, and Emergency Home Energy Assistance Program (EHEAP); and WHEREAS, in order for Collier County's social/senior services grant documents to be submitted in a timely fashion, the Board adopted Resolution No. 96-268 and 10-122 authorizing the County Manager or his/her designee to execute the required standard grant documents; and WHEREAS, Collier County CMA 95330, Grant Coordination, provides authorization for the County Manager or his/her designee to execute certain grant documents and return to the Board of County Commissioners for after -the -fact approval; and WHEREAS, the Board wishes to delegate signature authorization to the County Manager or his/her designee for the above -referenced social/senior services grant programs and as it relates to grant applications, standard contract documents, and major and minor amendments provided that said submissions and contracts require no additional Collier County matching funds. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that the County Manager or his/her designee is hereby authorized to execute grant applications, standard contract documents, and "IN Packet Pg. 834 16. D.4.f amendments in compliance with CMA H5330, Grant Coordination, for the Older American's Act Program (OAA), Community Care for the Elderly Program (CCE), Alzheimer's Disease .Initiative Program (ADI), Medicaid Waiver Agreement, the Horne Care for the Elderly program (HCE), and USDA Nutritional Supplement Incentive Program, Emergency Home Energy Assistance Program (EHEAP) provided said -submissions and contracts require no additional Collier County matching funds. BE IT FURTHER RESOLVED that this Resolution repeals and supersedes Resolution No. 96-268 and No.10-122. THIS RESOLUTION ADOPTED after motion, second, and majority vote favoring same this j-1 day of J . , -y , 2018. ATTEST: CRYSTAL K. KiNZEL CLERK :s s By: By: 'A eSt 85 tp (;€t�PK%gTY CLERK signature only, Approval for form and legality: 3ennl r A. Belpedio Assistant County Attorney tiO 2 ti 0 LO Packet Pg. 835 October 2019 — September 2020 1H1AP 203.19 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. EMERGENCY HOME ENERGY ASSISTANCE PROGRAM COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, hie. (Agency) and Collier County Board of County Commissioners (Contractor), collectively referred to as the "Parties." The term Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient. 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. 2 Incorporation of Documents within the Contract: The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks, manuals or desk books, as an integral part of the contract, except to the extent that the contract explicitly provides to the contrary. In the event of conflict in language among any of the documents referenced above, the specific provisions and requirements of tile contract document(s) shall prevail over inconsistent provisions in the proposal(s) or other general materials not specific to this contract document and identified attachments, 3 Term of Contract: This contract shall begin at twelve (12:00) AM., Eastern Standard Time October 1, 2019 or on the date the contract has been signed by the last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) .P.M.., Eastern Standard Time September 30, 2020. 4 Contract Amount: The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $73,218,87 subJect to the availability of finrds. Any costs or services paid for under any other contract or from any other source are not eligible for payment under this contract. S. Renewals: By mutual agreement of the Parties, in accordance with Section 287.058(1)(g), Florida Statutes (F.S.), the Agency may renew the contract for a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or method for determining a renewal price, is set price, is set forth in the bid, proposal, or reply. No other costs .for the renewal may be charged. Any October 2019 — September 2020 EHEAP 203.19 renewal is subject to the same terms and conditions as the original contract and contingent upon satisfactory performance evaluations by the Agency and the availability of funds. 6. Complianee with Federal Law: 6.1 If this contract contains federal funds this section shall apply. 6.1.1 The Contractor shall comply with the provisions of 45 Code of Federal Regulations (CFR) 75 and/or 45 CFR Part 92, 2 CFR Part 200 and other applicable regulations. 6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all applicable standards, orders, or regulations issued under Section 306 of the Clean Air Act as amended (42 United States Code (U.S.C.) 7401, et sect.), Section 508 of the Federal Water Pollution Control Act as amended (33 U.S.C. 1251, et seq.), Executive Order 11,738, as amended, and where applicable Environmental Protection Agency regulations 2 CFR Part 1500, The Contractor shall report any violations of the above to the Agency. 6.13 Neither the Contractor nor any agent acting on behalf of the Contractor, may not use any federal fluids 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. 61.4 In accordance with Appendix II to 2 CFR Part 200, the Contractor shall comply with Executive Order 11246, Equal Employment Opportunity, as amended by Executive Order 1.1375 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 art 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 I2689, "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 finds 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 Ini.rnigration and Nationality Act (8 U.S.C. 1324a) and the Immigration Reform and Control Act of 1986 (8 U.S.C. 1101). Such violation will be cause for unilateral cancellation of this contract by the Agency. 63 If the Contractor is a non-profit provider and is subject to Internal Revenue Service (IRS) tax exempt organization reporting requirements (filing a Form 990 or Form 990-N) and has its tax-exempt status revolted for failing to comply with the filing requirements of the Pension Protection. Act of 2006 or for any other reason, the Contractor must notify the Agency in writing within thirty (30) days of receiving the IRS notice of revocation. 2 October 2019 -- September 2020 EHEAP 203.19 64 The Contractor shall comply with Title 2 CFR Pail 175 regarding Trafficking in Persons. 65 Unless exempt under 2 CFR fart 170,110(b), the Contractor shall comply with the reporting requirements of tile Transparency Act as expressed in 2 CFR Part 170. 66 To comply with Presidential Executive Order 12989, as amended, and State of Florida Executive Order Number 1 I-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. Compliance with State Law 7.1 This contract is executed and entered into .in the ,State of Florida, and shall be construed, performed, and enforced in all respects in accordance with Florida law, including Florida provisions for conflict of laws, 7.2 If this contract contains state financial assistance funds, the Contractor shall comply with Section 21.5,97, 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 1. 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 Area Agency contract manager prior to payment. 733 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 1, Section III. Method of Payment. 73.4 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail for a proper pre -audit and post -audit. 7.3.5If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit bills for any travel expenses in accordance with Section H 2.061, 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 41-2,1~lorida 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. L October 2019 — September 2020 EHEAP 203.19 7.6 The Contractor shall comply with the provisions of Section 11.062, F,S,, and Section 216,347, F.S., which prohibit the expenditure of Contract 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 Section List, the Scrutinized Companies with Activities in Sudan .List, or the Scrutinized Companies that .Boycott Israel list, or if the contractor had been engaged in business operations in Cuba or Syria or is engaged in a boycott of Israel. 8. Backaround Screenina: The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435, F.S., as amended, are rnet regarding background screening for all persons who meet the definition of a direct service provider and who are not exempt from the Agency's level 2 background screening pursuant to Sections 430.0402(2)-(3), F.S. The Contractor must also comply with any applicable rules promulgated by the Agency and the Department for Health Care Administration regarding implementation of Section 430,0402 and Chapter 435, F.S. To demonstrate compliance with this provision, Contractor shall submit the Background Screening Affidavit of Compliance (Screening Form) to the Agency within thirty (30) days of execution of this contract. Should the Agency have a completed Screening Form on file for the Contractor, a new Screening Form will be required every twelve (12) months. 8.1 Further information concerning the procedures :For background screening may be found at htt�.{IclderaEFaia•s.state.l`I.us/doea/back rcnt��dscreenin . >h �. 9. Grievance Procedures: The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to process and resolve client dissatisfaction with, or denial of. service(s) and address complaints regarding the termination, suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum, will provide for notice of the grievance procedure and an opportunity for review of the Subcontractor's determination(s). 10. Public Records and Retention: 1.0.1By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any other applicable law, and shall: 10.1.4Keep and maintain public records required by the Agency to perform the contracted services. 1.01.2Upon request from tine 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. 10.1.3Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the Agency. 10.1.4Upon completion of the contract, the Contractor wi I 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 D October 2019 --- September 2020 EHAP 203.19 Agency upon completion of the contract, Contractor shall destroy any duplicate public records that are exen.ipt 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. 1.0.2 The Agency may unilaterally cancel this contract, notwithstanding any other provisions of this contract, for refusal by the Contractor to comply with Section 10 of this contract by not allowing public access to all documents, papers, letters, or other material made or received by the Contractor in conjunction with this contract, unless the records are exempt or confidential and exempt from Section 24(a) of Article I of the State Constitution and Section 119.07(.1), F.S. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 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. 15201 N Cleveland Ave., Suite 1100 North Fort Myers, FL 33903 239-652-6900 or 866-413-5337 10.3 Upon termination of this contract, whether for convenience or for cause as detailed in section 53 of this contract, the Contractor and Subcontractors shall, at no cost to the Agency, transfer all public records in their possession to the Agency and destroy any duplicate public records that are exempt, or confidential and exempt, fi,om 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. 11.Audits Inspections, Invcsti ations: 11.1 The Contractor shall establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of -funds provided by the Agency under this contract. Contractor shall adequately safeguard all such assets and assure that they are used solely for the purposes authorized under this contract. Whenever appropriate, financial information should be related to performance and unit cost data. 11.2 The Contractor shall retain and maintain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this contract for a period of six (6) years after completion of the contract, or longer when required by law. In the event an audit is required by this contract, records shall be retained for a minimum period of six. (6) years after the audit report is issued or until resolution of any audit findings or litigation based on the terms of this contract, at no additional cost to the Agency. 11.3Upon demand, at no additional cost to the Agency, the Contractor shall facilitate the duplication and transfer of any records or documents during the required retention period. IIAThe Contractor shall ensure that the records described in this section will be subject at all October 2019 — September 2020 EHEAP 203.19 reasonable times to inspection, review, copying, or audit by federal, state, or other personnel duly authorized by the Agency. 11.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Agency and federal auditors, pursuant to 45 CFR Part 75, shall be allowed full access to and the right to examine any of the Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the forth in which kept. 11.6 The Conti -actor 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. 1.1.7Contractor agrees to comply with the Inspector General in any investigation, audit, inspection, review, or hearing performed pursuant to Section 20,055, Florida ,Statutes. Contractor further agrees that it shall include in related subcontracts a requirement that subcontractors performing work or providing services pursuant to this contract agree to cooperate with the Inspector General in any investigation, audit, inspection, review, or hearing pursuant to Section 20.055(5), F.S. By execution of this contract, the Contractor understands and will comply with this subsection. 12.Non discrimination -Civil Ri lnts Com liance- 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. 1.2.3 `IThe 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 funds, these assurances are a condition of continued receipt of or benefit from federal financial assistance, and are binding upon the Contractor, its successors, transferees, and assignees for the period during which such assistance is provided. The Contractor further assures that all Subcontractors, Vendors, or others with whom it arranges to provide services or benefits to participants or employees in connection with. any of its programs and activities are not discriminating against those participants or employees in violation of any statutes, regulations, guidelines, and standards. In the event of failure to comply, the Contractor understands that the Agency may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief including, but not Iimited to, termination of the contract and denial of further assistance. 13.Monitoring by the Agency: The Contractor shall permit persons duly authorized by the Agency to inspect and copy any records, papers, documents, facilities, goods, and services of the Contractor, which are relevant to this contract, and to interview any clients, employees, and Subcontractor employees of the Contractor to assure the October 2019 --- September 2020 EHEAP 203.19 Agency of the satisfactory performance of the terms and conditions of this contract. Following such review, the Agency will provide a written report of its findings to the Contractor and, where appropriate, the Contractor shall develop a Corrective Action Plan (CAP). 'fire Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determined by the Contract Manager. 14. Provision of Services: The Contractor shall provide services in the manner described in ATTACHMENT I. 14 Coordinated Monitoring with Other Agencies: 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. 16L New Contract(s) Repnrtin: The Contractor shall notify the. Agency within ten (10) days of entering into a new contract with any of the remaining four (4) state human service agencies. The notification shall include the following; information.: (1) contracting state agency and the applicable office or program issuing the contract; (2) contract name and number; (3) contract start and end dates; (4) contract amount; (5) contract description and commodity or service; and (6) Contract Manager name and contact information. In complying with this provision, and pursuant to Section 287.0575, F.S., as amended, the Contractor shall complete the Contractor's State Contracts List attached to this contract. 17. Indemnification: The Contractor shall indemnify, save, defend, and hold harmless the Agency and its agents and employees 6•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 agreement or performance of the services provided for herein. It is understood and agreed that the Contractor is .not required to indemnify the Agency for claims, demands, actions, or causes of action arising solely out of the negligence 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. 18 Insurance and Bonding; 181 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or subdivision as defined by Section 768.28(2), F.S., the Contractor accepts fill 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. 0 October 2019 --- September 2020 EHEAP 203,19 182 Throughout the term of this contract, the Contractor shall maintain an insurance bond from a responsible commercial insurance company covering all officers, directors, employees, and agents of the Contractor authorized to handle funds received or disbursed under all agreements and/or .contracts incorporating this contract by reference in an amount commensurate with the funds handled, the degree of risk as determined by the insurance company, and consistent with good business practices. 19 Confidentiality _of_Information: The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent or when authorized by law. 2t1. Health InsurancePortability and Accountability Act: Where applicable, the Contractor shall comply with the Health Insurance Portability and Accountability Act (42 USC § 1320d.), as well as all regulations promulgated thereunder (45 CFR Parts 1.60, 162, and 164). 21. Incident Reportinp, 211 The Contractor shall notify the Agency immediately but no later than forty-eight (48) hours from the Contractor's awareness or discovery of conditions that may materially affect the Contractor's or Subcontractor's ability to perform the services required to be performed under this contract. Such notice shall be made orally to the Agency's Contract Manager (by telephone) with an email to immediately follow. 212 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number (1-800-96ABUSE), As required by Chapters 39 and 415, F.S., this provision is binding upon the Contractor, its Subcontractors, and their employees. 22` Bankruptcy Notification: During the term of this contract, the Contractor shall immediately notify the Area Agency on Aging for Southwest Florida, Inc. if the Contractor, its assignees, Subcontractors, or affiliates file a claim for bankruptcy. Within ten (1.0) days after notification; the Contractor must also provide the following information to the Area Agency on Aging for Southwest .Florida, Inc.: (1) the date of fling of the bankruptcy petition; (2) the case number; (3) the court name and the division in which the petition was filed (e.g., M District ofFl.orida, Tallahassee Division); and (4) the name, address, and telephone number of the bankruptcy attorney. 2 L Snonsorsbiv and Publici 231 As required by Section 286,25, F.S., if the Contractor is a non -governmental organization which sponsors a program .financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by (Contractors name) and the State of Florida, :Department of Elder Affairs and/or the Area Agency on Aging for Southwest Florida, Inc.." If the sponsorship reference is in written material, the words "State of Florida, Department of Elder Affairs and/or the Area Agency on Aging for Southwest Florida, Tnc." shall appear in at least the sauce size letters or type as the name of the organization, 8 GID October 2019 -- September 2020 EHEAP 203.19 232 The Contractor shall not use the words "State of Florida, Department ofEldcr Affairs and the Area Agency on Aging for Southwest Florida, Inc." to indicate sponsorship of a program otherwise financed, unless specific authorization has been obtained by the Agency prior to such use. 24 Assignments: 241 The Contractor shall not assign the rights and responsibilities under this contract without the prior written approval of the Agency. Any sublicense, assignment, or transfer otherwise occurring without prior written approval of the Agency shall constitute a material breach of the contract. In the event the State of Florida approves transfer of the Contractor's obligations, the Contractor remains responsible for all work performed and all expenses incurred in connection with this contract. 242 This contract shall remain binding upon the successors in interest of the Contractor and the Agency. 24 Subcontracts: 251 The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract, whether actually furnished by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a written document and subject to any conditions of approval the Agency deems necessary. The Contactor further agrees that the Agency will not be liable to the Subcontractor in any way or for any reason. The Contractor, at its expense, shall defend the Agency against any such claims. 252 The Contractor shalt promptly pay any Subcontractors upon receipt of payment from the Agency or other state agency. failure to male payments to any ,Subcontractor in accordance with Section 287.0585, F.S., unless otherwise stated in the contract between the Contractor and Subcontractor, will result in a penalty as provided by statute. 26� .Indet)endent Capacity of Contractor: It is the intent and understanding of the Parties that the Contractor and any of its Subcontractors are independent Contractors and are not employees of the Agency, and that they shall not hold themselves out as employees or agents of the Agency without prior specific authorization from the Agency. It is the further intent and understanding of the Parties that the Agency does not control the employment practices of the Contractor and wil I not be liable for any wage and hour, employment discrimination, or other labor and employment claims against the Contractor or its Subcontractors. All deductions for social security, withholding taxes. income taxes, contributions to unemployment compensation funds, and all necessary insurance for the Contractor are the sole responsibility of the Contractor. V. Payment; Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in ATTACHMENT I. The Area Agency Contract Manager will have final approval of the Contractor's invoice submitted for payment and will approve the invoice for payment only if the Contractor has met all terms and conditions of the contract, unless the bid specifications, purchase order, or this 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 [lie provisions of Section 215.422, ES, A Vendor Ombudsman has been established within the Florida Department of financial Services and may be contacted at 800-342-2762. 9 �a� October 2019 — September 2020 28. Return of Funds: EHEAP 203,19 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 Area Agency Contract Manager will notify the Contractor in writing of such findings. Should repayment not be made forthwith, the Contractor shall be charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03, F.S., after Agency notification or Contractor discovery. 29 Data Integrity and Safeguarding Information: The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that request system or information access and ensuring that user access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of the computer system. The security over the backed -up data is to be as stringent as the protection required of the primary systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract. Al Computer Use and Social Media Policy: The Department has implemented a Social Media Policy, in addition to its Computer Use Policy, which applies to all employees, contracted employees, consultants, Other Personal Services (OPS) employees and volunteers, including all personnel affiliated with third parties, such as, but not limited to, contractors and subcontractors. Any entity that uses the Department's computer resource systems mast comply with the Department's policy regarding social media. Social Media includes, but is not limited to, blogs, podcasts, discussion forums, Wik.is, RS5 feeds, video sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as fliclu and YouTube. This policy is available on the Department's website at: http://eidei-aftair_s.state.rl.tis/doca/fnincial.plip. 31.. Conflict of Interest: The Contractor shall establish safeguards to prohibit employees, board members, management, and Subcontractors from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain. No employee, officer, or agent of the Contractor or Subcontractor shall participate in the selection, or in the award of a contract supported by state or federal funds if a conflict of interest, real or apparent, would be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member of his/her immediate family; (c) his or her partner; or (d) an organization which employs, or is about to employ, any of the above individuals, has a financial or other interest in the firm being selected for award. The Contractor's or Subcontractor's officers, employees, or agents will neither solicit nor accept gratuities, favors, or anything of monetary value from Contractors, potential Contractors, or parties to Subcontracts. The Contractors board members and management must disclose to the Agency any relationship which may be', or may be perceived to be, a conflict of interest within thirty (30) calendar days of an individual's original 10 October 2019 -- September 2020 EHEAP 203.19 appointment, or, placement in that position, or if the individual is serving as an incumbent, within. thirty (30) calendar days 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. M Public Entity Crime: Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply oil 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. M Purehasin$4: 31t The Contractor may purchase articles which are the subject of, or are required to carry out, this contract from Prison Rehabilitative Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, F.S., in the same manner and under the procedures set forth in Sections 946.515(2) and (4), F,S. For purposes of this contract, the Contractor shall be deemed to be substituted for the Agency insofar as dealings with PRIDE. This clause is not applicable to Subcontractors unless otherwise required by law. An abbreviated list of products/services available from PRIDE may be obtained by contacting .PRIDE (800) 643-8459, M The Contractor may procure any recycled products or materials which are the subject of or are required to carry out this contract in accordance with the provisions of Section 403.7065, F.S. M The Contractor may purchase articles that are the subject of, or required to carry out, this contract from a nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, F.S., in the same manner and under the same procedures set forth ill Sections 413.036(1) and (2), F.S. For purposes of this contract, the Contractor shall be deemed to be substituted for the Agency insofar as dealings with such qualified nonprofit agency are concerned. Additional information about the designated nonprofit agency and the products it offers is available at http://Nvww.resRectoffioi,ida.,.oi,c). This clause is not applicable to Subcontractors unless otherwise required by law. M Patents Copyri2hts, Royalties: 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 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)(lo, F.S., the only exceptions to this provision shall be those that are clearly expressed and reasonably valued in this contract. 3�l 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, 11 October 2019 -- September 2020 EHEAP 203.19 342 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR 200.315 or 45 CFR 75.322, as applicable. 343 Notwithstanding the foregoing provisions, if the Contractor or one of its Subcontractors is a university and a member of the State University System of Florida, then Section 1004.23, .F.S., shall apply, but the Agency shall retain a perpetual, 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 Einerj4enn Preparedness and Continuity of Operations: M1 If the tasks to be performer{ pursuant to this contract include the physical care and control of clients, or the administration and coordination of services necessary for client health, safety, or welfare, the Contractor shall, within thirty (30) calendar days of the execution of this contract, submit to the Agency's Contract Manager verification of an Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the Agency of emergency provisions. 352 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall remain responsible for performance under this contract and must follow procedures to ensure continuity of operations without interruption. 36 Eguipment- 361 Equipment means: (a) tangible personal property (including information technology systems) having a useful life of more than one year and a per -unit acquisition cost which equals or exceeds the lesser of the capitalization level established by the organization for the financial statement purposes, or $5,000.00 [for federal funds--2 CFR 2.00.33 and 45 CFR 75.2, as applicable], or (b); nonexpendable, tangible personal property of a non-consurnable nature with an acquisition cost of $1,000.00 or more per unit, and expected useful life of at least one (1) year; and hardback bound books not circulated to students or the general public, with a value or cost of $250.00 or more [for state funds]. 362 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's Contract Manager of any loss, damage, or theft of equipment. The Contractor shall provide the results of the investigation to the Agency's Contract Manager, 36.3 The Contractor's property management standards for equipment (including replacement equipment), whether acquired in whole or part with federal funds and federally -owned equipment shall, at a minimum, meet the following requirements and shall include accurately maintained equipment records with the following information: 36.3.1 Property records must be 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; 12 October 2019 — September 2020 EHEAP 203.19 36.3.3 Source of funding for the equipment, including the federal award number identification number; 36.3.4 Whether title vests in the Contractor or the federal government; 36.3.5 Acquisition date (or date received, if the equipment was furnished by the federal govermnent); 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 niust be developed to ensure adequate safeguards to prevent loss, darnage, 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 he developed to keep the property in good condition. 36.3,13 If the Contractor is authorized or required to sell the equipment, proper sales procedures must be established to ensure the highest possible return. 36.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with state funds with an acquisition cost over $1,000,00 is part of the cost of carrying out the activities and functions of the grant awards and title (ownership) will vest in the Contractor [for federal funds see 2 CPR § 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, P.S., rule 60A-1.001 7, F. A. C., and 2 CFR fart 200 and/or 45 CFR Part 75. 36.5 The Contractor shall not dispose of any equipment or materials provided by the Agency, or purchased with funds provided through this contract without first obtaining the approval of the Agency's Contract Manager. When disposing of property or equipment the Contractor must subunit 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.). 13 October 2019 — September 2020 EHEAP 203.19 36.6 The Agency's 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 lane[ improvements), buildings, structures and appurtenances thereto, but excludes movable machinery and equipment. Real property may not be purchased with state or federal funds 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 111, Part A., Section 3030b United States Code (USC). Real property purchases frorn 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 1TR worksheet is required for any computer related item costing $1,000.00 or more, including data processing hardware, software, set -vices, 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. 37.PUR 1000 Form: The PUR 1000 Form is hereby incorporated by reference and available at: [ ttl)_l1w-wtiv.»ivflcrrida wcoi1l/,rp psLybs/idgc -7740 PUR 1000 1n the event of any conflict between the PUR 1.000 Form, and any terms or conditions ofthis contract; the terms or conditions of this contract shall take precedence over the PUR1000 Form. However, if the conflicting terms or conditions in the PUR1000 Form are required by any section of the Florida Statutes, the terms or conditions contained in the PUR 1000 Form shall take precedence. 38. Use of State Funds to Purchase or 1inproye Real Property. Any state fiends provided for the purchase of or improvements to real property are contingent upon the Contractor or political subdivision granting to the state a security interest in the property at least to the amount of state funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. 39. Dispute Resolution: Any dispute concerning performance of the contract slrall be decided by the Agency's Contract Manager, who shall reduce the decision to writing and serve a copy on the Contractor. 40. Financial Consequences: If the Contractor fails to rneet the minimum level of service or performance identified in this contract, the Agency will impose financial consequences as stated in ATTACHMENT 1. 14 October 2019 — September 2020 41. No Waiver of Sovereign Lninunity: EHEAP 203.19 Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which sovereign immunity may be applicable. 42. Venue: If any dispute arises out of this contract, the venue of such legal recourse shall be Lee County, Florida. 43.Entire Contract: This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or representations shall be valid or binding upon the Agency or the Contractor unless expressly contained herein or by a written amendment to this contract signed by both Patties, 44.Force Maieure: The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control, provided the party experiencing the force majeure condition provides immediate written notification to the other party and takes all reasonable efforts to cure the condition. 45. Severability Clause: The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable, the other provisions are severable to that void provision and shall remain in full force and effect. 46. Condition Precedent to Contract Appropriations: The Parties agree that the Agency's performance and obligation to pay under this contract are contingent upon an annual appropriation by the Legislature. 47. Additiort/Deletion: The Parties agree that the Agency reserves the right to add or to delete any of the services required under this contract when deemed to be. in the State of Florida's best interest and reduced to a written amendment signed by both Parties. The Parties shall negotiate compensation for any additional services added. 48. Waiver: The delay or failure by the Agency to exercise or enforce any of its rights under this contract will not constitute or be deerned a waiver of the Agency's right thereafter to enforce those rights, nor will any single or partial exercise of any such right preclude any other or further exercise thereof or the exercise of any other right. 49. Compliance: The Contractor shall abide by all applicable current federal statutes, laws, rules; and regulations as well as applicable current state statutes, laws, rules and regulations. The Parties agree that failure of the Contractor to abide by these laws shall be deemed an event of default of the Contractor and subject the contract to immediate unilateral cancellation of the contract at the discretion of the Agency. 5Q. Final .invoice: The Contractor shall submit the final invoice for payment to the Agency .no later than thirty (30) days after the contract ending date unless otherwise specified in ATTACHMENT L If the Contractor fails to do so, all right to payment is forfeited and the Agency shall not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract shall be withheld until all 15 M October 2019 -- September 2020 EHEAP 203.19 required documentation and reports due from the Contractor and necessary adjustments thereto have been approved by the Agency. 51. Renegotiations of Modifications: Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly signed by both parties. 52.Suspensionof Work: 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) teri.ninate the contract or purchase order. Suspension of work shall not entitle the Contractor to any additional compensation. 53.Termination: 53A Termination for Convenience. The Agency, by written notice to the Contractor, may terminate this contract in whole or in pail when the Agency determines in its sole discretion that it is in the States 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 60A-1.006(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. 54.Electronic Records and Signature: The Agency authorizes, but does not require, the Contractor to create and retain electronic records and to use electronic signatures to conduct transactions necessary to carry out the terms of this contract. A Contractor that creates and retains electronic records and uses electronic signatures to conduct 16 October 2019 -- September 2020 EHEAP 203.19 transactions shall comply with the requirements contained in the Uniform Electronic Transaction Act, Section 669.50, F,S, All electronic records must be fully auditable; are subject to Florida's Public Records Law, Chapter 11.9, 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:I 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. 55, Contract Mansur: The Agency may substitute any Agency employee to serve as the Area Agency's Contract Manager. REMAINDER OF THEPAGE INTENTIONALLY LEFT BLANK 17 October 2019 — September 2020 EHEAP 203.19 56. Official Payee and Re resentatives(Names, Addresses, and Telephone Numbers), The Contractor name, as shown on page 1 of Collier County Board of County Commissioners a. this contract, and mailing address of the 3339 E Tamiami Trail, Building H Naples, FL 34112 official payee to whom. the payment shall be made is: The name of the contact person and street Kristi Sonntag, Director Collier County Board of County Commissioners b. address where financial and administrative %Community and Human Services records are maintained is: 3339 E Tamiami Trail, Building H Naples, FL 34112 The name, address, and telephone number of Kristi Sonntag, Director c. the representative of the Contractor Collier County Board of County Commissioners %Community and Human Services responsible for administration of the program l p g 3339 E Tamiami Trail, Building H under this contract is: Naples, FL 34112 (239)252-2273 The section and location within the Agency Area Agency on Aging for Southwest Florida, Inc. d. where Requests for Payment and Receipt and Fiscal Department Expenditure forms are to be mailed is: 15201 North Cleveland Avenue, Suite 1100 North Fort Myers, FL 33903 The name, address, and telephone number Vacant, Director of Program & Planning e. of the Contract Manager for this contract Area Agency on Aging for Southwest Florida, Inc. 1520I North Cleveland Avenue, Suite 1100 North is: Fort Myers, FL 33903 239-652-6900 Upon change of representatives (names, addresses, and telephone numbers) by either party, notice shall be provided in writing to the other party. 57. All Terms and Conditions Included: This contract and its ATTACHMENTS I -XXIII including any exhibits referenced in said attachments, together with any documents incorporated by reference, contain all the terms and conditions agreed upon by the Parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications, representations or agreements, either written or verbal between the Parties. By signing this contract, the Parties agree that they have read and agree to the entire contract. IN WITNESS, THEREOF, the Parties hereto have caused this contract to be executed by their undersigned officials as duly authorized. CONTRACTOR, COLLIER COUNTY BOARD OF COUNTY CMMSTONER SIGNED BY: NAME: STEPHEN Y CARNELL TITLE: Public Services -Department Head DATE: (j r-- Federal Tax ID: 59-6000598 Fiscal Year Ending Date: 09/30 DUNS: 076997790 AREA AGENCY ON AGING FOR SOUTHWEST FLOWDA, INC. SIGNED BY:� NAME: MA.RIANNE G LORINI TITLE: PRESIDENT/CEO DATE: / 0 i $ 9 Approved as to form and legality 1$ sistant County A •ney7 October 2019 --- September 2020 INDEX OF ATTACHMENTS EHEAP 203.19 ATTACHMENT STATEMENTOF WORK........................................................................................................................ 20 ATTACHMENT 11 FINANCIAL AND COMPLIANCE AUDIT............................................................................................ 45 ATTACHMENTIII CERTIFICATIONSAND ASSURANCES..............................................................................................51. ATTACHMENT TV ASSURANCES -NON -CONSTRUCTION PROGRAMS ......................................................................56 ATTACHMENT V FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST.- 58 ATTACHMENT VIT BACKGROUNDSCREENING................................................................................................................62 ATTACHMENT IX BUDGETSUMMARY ............ ................... .................................................................................... ........... 63 ATTACHMENT X EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAILL................................64 ATTACHMENT XI RECEIPTS AND EXPENDITURE REPORT...........................................................................................65 ATTACHMENT XII REQUESTFOR PAYMEN`1........ ..............................................................................................................66 ATTACIIMENT XIII INVOICEREPORT SCHEDULE.............................................................................................................67 ATTACHMENT XIV POVERTYINCOME GUIDELINES........................................................................................................68 ATTACHMENT XV LIFTEAPPAYMENT MATRIX ................................................................................................................69 ATTACHMENT XVT SOURCESOF INCOME...........................................................................................................................70 ATTACHMENT XVIT OUTREACHPLAN SURVEY ........ ....... ........................... ................;....,................. ................................. 71 ATTACHMENT XVIII EHEAP APPLICATION AND ELIGIBILITY WORKSI IEET................................................................91 ATTACHMENT XTX EIJEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS...........................................................83 ATTACHMENT XX EHEAP CLIENT FILE CONTENT CHECKLIST................................................................................... 86 ATTACHMENT XXI EHEAP COST REIMBURSEMENT SUMMARY...................................................................................87 ATTACHMENT XX.II. COSTALLOCATION PLAN...................................................................................................................88 ATTACHMENT XX.II1 SERVICERATE REPOR'.I'.......................................................................................................................91 19 �a G October 2019 — September 2020 ATTACHMENT I STATEMENT OF WORK I. SERVICES TO BE PROVIDED A. DEFINITION OF TERMS EHEAP 203.19 1. 18 hours -- The timeframe within which all applications for crisis assistance shall be acted upon, with an eligible action to mediate the crisis within eighteen (18) hours of the application date stamp and documenting in the client file the eligible action taken. 2. Caseworker — Person who is responsible for determining program eligibility by completing the Emergency Horne Energy Assistance for the Elderly Program (EHEAP) Eligibility Worksheet (ATTACHMENT XVII1) and awarding crisis benefits. 3. Caseworker Signature Date -- The date that the client's completed application is processed, eligibility determined, and the crisis resolved. This date shall not be changed. Signatures must be in ink. Rubber-stamped signatures will not be accepted. 4. Client Application Date — The date that the client's completed application is completed (whether by self or with assistance) and signed by the elder. This date shall not be changed. Signatures trust be in ink. Rubber-stamped signatures will not be accepted. If an elder cannot write their signature on the application, or any other required docurnent, and must sign with an "X." two witnesses are required. 5. Crisis — A home cooling or heating crisis exists when an elder has no access to, or is in immediate danger of losing access to, needed home energy. S. Crisis Assistance — Assistance provided to an elder who has no access to, or is in danger of losing access to, needed home energy. 7. Date of Resolution — The date that a documented commitment to pay was made to the utility vendor to resolve the energy crisis. This date is used as the EHEAP 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 bemeen the Date Stamp and the Date of Resolution shall determine whether or not the eighteen (18) hour rule was met. b. Vendors must be paid within forty -hive (45) days of the date of resolution. 8. Date Stamp — The date the application and all required documentation is presented in acceptable form to intake staff. An inked stamp must be used, and the date shall not be changed. The 18-hour hour rule for crisis resolution begins when the application is date stamped. 9. Disability --- A disabling condition that causes an elder to be determined eligible to receive Supplement Security Income (SST) or Social Security Disability Income (SSDI) from the Social Security Administration. 20 UNO October 2019 — September 2020 EHEAP 203.19 10.Elder — An individual aged sixty (60) years or older. 1.1, Eligible Action — An action taken by the caseworker to mediate an elder's energy crisis. Eligible actions include: a. Approval of an elder's application; b. Denial of an elder's application pending further information; c. Denial of an elder's application because the elder is deemed ineligible; d. Contact with a utility vendor to halt utility disconnection or interruption in services; or e. Written referral to and providing the elder with assistance contacting another agency if EHEAP funding is not available or the elder is ineligible. 12. Energy Subsidy — Utility costs paid directly or indirectly to the elder who lives in government - subsidized housing. 13. 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. 14.Housebold Member —Persons in ahousehold who share a common kitchen or bath and purchase residential energy in common. 15.Intake Worker — Person who accepts the EHEAP application and required documentation and may have the responsibility to determine eligibility or award crisis benefits. 16.Mininrum Level of Service — Service to a minimum of one household per month. 17.0-isis Assistance Benefit — Payment of a heating/cooling energy bill; the pure.lrase of heating/cooling device; and/or the repair of a heating/cooling device. 18.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. 19.Provider — The entity that has entered into a contract, subcontract, or Memorandum of Understanding (MOU) to provide services under EHEAP. For the purposes of this contract, the terms "Provider" and "Conti -actor" may be used interchangeably. 20.Reasosiable Promptness —Within fifteen (15) working days of receiving the client's completed application. 24.Request for Payment — Submission of actual monthly expenditures for reimbursement. 22.Service Unit — One individual (elder) sewed. 23. Social Security Number —'.l he number on an elder's Social Security card or the number provided by an award or determination letter from an entity, such as a government agency, that has already verified the social security number. 24. Supervisory/Peer Review Date — The date that a supervisor or peer reviewed the application and documentation and signed the application indicating vendor payment can be made. The intent of the supervisor/peer review is to avoid errors in eligibility determination and payment amounts and 21 0 October 2019 — September 2020 EHEAP 203.19 to alleviate the possibility of fraud. This date small not be changed. Signatures must be in ink. Rubber-stamped signatures will not be accepted. 25. Verification Date - The date the caseworker verified previous Low -Income Hoarse 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 En-iergency Home Energy Assistance for the Elderly Program (EHEAP) serves the mission of the Agency by providing home energy assistance aid to elders in the event of a home energy heating or cooling emergency. EHEAP is designed to assist lo,,v-income households with at least one member aged sixty (60) or older experiencing a heating or cooling emergency 2. Authority The relevant federal and state authorities governing EIIEAP are: a. Low Income Home Energy Assistance Act of 1981; (Title XXVI of the Omnibus Budget Reconciliation Act of 1.981, P.L. 97-35), as amended.; b. 42 United States Code (U. S. C.) § 8621 et seq.; c. 45 Code of Federal Regulations (CFR) Part 96, Subpart II (§§ 96.80-96.89); d. Section 409.508, Florida Statutes (F.S.) and Rule 73C-26.021 (3), Florida Administrative Code (F. A. C.); e. Rule Chapter 73C-26, R A. C.; L State of Florida LIHEAP Policies and Procedures Manual; and g. LIHEAP State Plan. 3. Scope of Service The Contractor is responsible for the programmatic, fiscal, and operational management of EHEAP. Eligible elders may receive one crisis assistance benefit per heating or cooling season, not to exceed $600.00 each. If eligible, elders may receive one summer crisis assistance benefit during the period frarn April I to September 30, and one winter crisis assistance benefit during the period of October I to March 31, each year. An elder's eligibility for crisis benefits is not related to EHEAP contract periods. Weather-Related/Supply Shortage funds can be provided in addition to crisis benefits when authorized by the Florida Department of Economic Opportunity (DEO). In the event of a weather - related event or supply shortage, the President of the United States, Governor of the State of Florida, or Executive Director of DEO may declare a weather- related crisis and release additional funds to assist affected households. When benefits are distributed for a weather-related/supply shortage emergency, the Contractor shall comply with directives provided by the DOEA as to the allowable expenditures of these funds. a. The services provided under this contract shall be in a manner consistent with and described in ATTACHMENT I, Section 11: Manner of Service Provision. Contractor, in collaboration with its EHEAP program partners, shall ensure the following service tasks are completed: 22 0�0 October 2019 -- September 2020 EHEAP 203.19 (1) Consumer Outreach; (2) Program .Partners and Stakeholders Coordination; (3)1 lder's Benefit Eligibility Determination; and (4) Benefit Disbursement. 4. Major Program Goals EHEAP is designed to provide crisis assistance to eligible low-income households with at least one individual aged sixty (60) or olden experiencing a heating or cooling emergency. The program allows for payments to utility companies and/or fuel suppliers; for the purchase of blankets, portable heaters, fans, and/or air conditioners; for the repair or replacement of existing heating or cooling equipment; for the payment of deposits, late fees, disconnect and reconnection fees; for the provision of temporary emergency shelter; or to resolve other heating and cooling emergencies. The program also provides eligible elders with weather-related/supply shortage emergency benefits when authorized by DEO. a. Crisis Assistance A standard home cooling or heating crisis exists when an elder has no access to, or is in danger of losing access to, needed home energy because one or more of the following conditions is present: (1)The elder's home cooling or heating energy source has been cut off; (2) The elder has been notified Chat the elder's home cooling or heating energy source will soon be cut off, (3) The elder has an energy bill or notice for which the due date has lapsed; (4) The elder has received a notice indicating the household's energy bill is delinquent or past du e; (5) The elder is unable to get delivery of heating fuel, is out of heating fuel, or is in danger of being out of heating fuel; or (6)The elder has other problems with lack of cooling or heating in the home, such as needing to pay a deposit, needing a repair or purchase of heating or cooling equipment; or needing interim emergency measures to avoid further crisis. b. Allowable Categories for Crisis Assistance are: (1) Electric; (2) Gas; (3) Profane; (4) Wood/coal; (5)Refillab.le fuels; and (f)Pre-pay home energy usage. (i) The elder is within seven days of using the remaining balance of the pre -purchased energy source, the elder's power is currently disconnected/shut off, or the elder needs a deposit. 23 October 2019 --- September 2020 EHEAP 20119 (ii) The LIHEAP Payment (ATTACHMENT XV) shall be used to determine the benefit amount. C. CLIENTS TO BE SERVED I. General Description EHEAP provides for direct client services to elders in low-income households experiencing a home energy heating or cooling emergency. A household receiving EHEAP services may not have an income above one hundred fifty percent (150%) of the poverty level, as published by the United States Department ofH.ealt.h and Human Services. 2. Client Eligibility To be eligible for services under this contract, and to receive assistance, an elder nxust: a. Be aged sixty (60) or older; b. Reside in the EHEAP service area (Planning and Service Area) at the time the home energy costs were incurred; c. Complete and return an EHEAP application with all required information and verification to contractor, while funds remain available; d. Provide a fuel bill or other documentation evidencing an energy emergency and an obligation to pay for home energy costs for the horne in which they live; e. Possess a total gross household income of not more than one hundred fifty percent (150%) of the Office of Management and Budget (OMB) federal poverty level for the size of the household. In accordance with Section I.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; Ii. 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 services upon execution of this contract and continue taking applications until the contract expires or funds are exhausted. Contractor shall not accept applications when funds are exhausted for a particular time period. Contractor shall: a. Provide assistance to elders in completing Agency -provided applications for assistance and determining eligibility; 6. Ensure that no one is excluded from program participation on the grounds of race, color, national origin, sex, or age; and ensure that such persons shall not be subjected to discrimination under any activity funded in whole or in part with these finds; c. Treat homeowners and those who rent equitably under this contract; d. Calculate the income eligibility of the elder by using the past thirty (30) days earnings for all occupants of the household annualized or the elder's current economic situation and reference 24 October 2019 — September 2020 EHEAP 203.19 the current Sources of Income (ATTACHMENT XVI) to determine what is considered allowable income. Contractor shall proceed as follows; (I)Total household income cannot exceed one hundred fifty percent (150%) of the current federal Poverty Income Guidelines (ATTACHMENT XIV); and (2) Obtain a written 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. e. Determine if all or part of the elders utility costs are paid directly (utility reimbursement) or indirectly (utility allowance) by the government if the elder lives in government -subsidized housing. Contractor shall proceed as follows: (I)If total home heating or cooling costs are included in the rent and the elder has no obligation to pay any portion of the costs, then the elder is not eligible for assistance; and (2)If there is a .Florida Section 8 (Housing Choice Voucher Program) or a Public Housing Authority (PHA) Program energy subsidy available to the elder during the period covered by the utility bill, then the elder is only eligible. for partial assistance. The energy subsidy for the period covered by the utility bill must be subtracted from the allowable EHEAP benefit calculated for the household. f. Use program qualification approvals or notifications to document household size and income of elders receiving Supplemental Nutrition Assistance Program (SNAP) or SSI. Elders shall meet program income eligibility guidelines and possess a total gross household 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 one approved crisis assistance benefit during the cooling season, April I — September 30, and one approved crisis assistance benefit during the heating season, October l — March 31. The Contractor shall proceed as follows: (I) Crisis assistance benefit may consist of payment of more than one energy obligation, per heating and cooling season, for a household to resolve a single crisis, thus allowing for: (i) The purchase or repair of fans, blankets, air conditioners, and/or portable heaters in addition to heating/cooling bill assistance, that combined does not exceed the maximum crisis benefit of $600; and (R)Crisis situations which may involve a heater or air eonditioner that is powered by both gas and electricity, in which case both energy obligations are eligible for a crisis benefit payment that combined does not exceed the maximum crisis benefit of $600. (2) Water, sewer, and garbage, and fire, etc, charges may not be paid. (3)Repair or replacement of a heating/cooling unit is allowable within the maximum limit of 25 October 2019 — September 2020 EHEAP 203.19 $600, provided any required installation or repair work is completed by a licensed contractor; (4) Deposits to connect or restore energy are allowable, not to exceed the maximum limit of $600; (5) Late fees, disconnect fees, and reconnect fees are allowable, not to exceed the maximum limit of $600; (6) Charges from a previous account held by the elder that is now closed are allowable, not to exceed the maximum limit of $600; (7) Payment to landlord when utility costs are included in the elder's rent is allowable, not to exceed the maximum limit of $600; and (8) Payment for temporary emergency shelter is allowable, if due to energy -related crisis, not to exceed the maximum limit of $600. I In no case shall the Contractor be required to incur costs in excess of the full contract amount to provide services to the clients. 11. MANNER OF SERVICE PROVISION A. SERVICE TASKS In order to achieve the goals of EHEAP, Contractor shall ensure the following tasks are performed: 1. Ensure that all eligible elders meet the requirements of Section I.C.2. of this contract; 2 Ensure that all energy assistance payments made to home energy vendors comply with the requirements of Section '11.A.14.d. of this contract; 3. Implement appropriate program management and operational controls to ensiire all applications for crisis assistance are acted upon with an eligible action to mediate the crisis within eighteen (18) hours of the application date stamp, and document in the client file that the crisis was resolved within eighteen (18) hours. 4 Provide all elders approved for EHEAP funding with a written Notice of Approval and Appeal within fifteen (15) working days of crisis resolution. The written Notice of Approval and Appeal shall include: a. Type and amount of assistance; b. Name of the home energy vendor to be paid on elder's behalf; c. The next date when the elder will be eligible to apply for further assistance; and d. Contractor's appeal process. 5. Provide all elders whose EHEAP applications were denied with a written Notice of Denial and Appeal within :Fifteen (15) working days of receiving the elder's application. The written Notice of Denial and Appeal shall contain: a. Name of the elder; b. Date of application; c. Type of benefit sought; d. Reason(s) for denial; 26 October 2019 — September 2020 EHEAP 203.19 e. Statement on Contractor's benefit limits, if applicable; f. Contractor's appeal process; g. Explanation of circumstances under which the elder may reapply; h. Information or documentation needed for the elder to reapply; i. 'file narne, address, and phone number applicable to the appeal process; and ,j. Number of days the elder has to file the appeal. 6. Maintain consumer appeal procedures that provide an opportunity for a fair administrative hearing to elders whose applications for assistance are denied or whose applications are not acted upon with reasonable promptness; 7. Provide an opportunity for elders to file a written appeal or complaint with the Contractor's Program Supervisor within ten (10) working days of receipt of the written Notice of Denial and Appeal. a. Upon receipt of a validly .tiled 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 are received; 9. 9. Ensure all ineligible applicants and applicants denied crisis assistance, when EHEAP funds are not available or are insufficient to meet their emergency home energy needs, are referred to and assisted in securing help through other community resources; 10. Ensure no consumer fees are charged to, nor donations accepted from, an elder as a prerequisite for receiving EHEAP benefits. Post in a conspicuous place at all locations where EHEAP applications are received the following notice: "No money, cash, or checks will be requested or received frorn customers in the EHEAP office. If an employee asks for money, report this to the agency executive director or Agency head." It. Compare LI.HEAP records and EHEAP records for households with elderly members to avoid duplicate crisis assistance payment during the same eligibility period and maintain documentation sufficient to ensure compliance with this requirement; 12. Maintain a written policy and implement procedures to protect and secure elder applicants' information and social security numbers in order to protect their identities from theft; or fraud. This policy shall address the handling of both paper and electronic records and files. Contractor shall, in collecting elders' social security numbers, use the Notice Regarding Collection of Social Security Numbers, which is incorporated into this contract by reference, (Notice of Instruction#071 1.13-1-I-SWCBS, littl)://(-[(Iei,affair,s.state.fl.us/doca/noticesf"Jtilv I 3/LIHL:AI'%2.{)Notice`20re�/`20Sc:rcial"/"20Seeurit %20.Number:s%20l-inal.l)d D.. The Notice Regarding Collection of Social Security Numbers shal I be signed by the elder and .retained in the client file; 27 October 2019 — September 2020 13, Consumer Outreach EHEAP 203.19 Ensure that households in all counties within the service area wishing to benefit froth the program have the opportunity to do so. Contractor shall undertake consumer outreach initiatives in all counties within the service area designed to inform potentially eligible households about EHEAP. Outreach efforts must focus on elderly households with disabled individuals, young children, and where the highest percentage of the household income is required to pay for their home energy. Specific outreach initiatives shall include, but are not limited to: a. Informing all service area local agencies, non -profits, and similar organizations that are in regular contact with the low-income population about the EHEAP program, especially those serving seniors; b. Encouraging EHEAP program participation through local television and .radio programs, and placing announcements of the EHEAP program in media community calendars; c. Developing and implementing a written procedure for malting 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. Malting visits to provide information, and/or malting presentations about EIIEAP in response to requests by local congregational centers serving elderly or disabled persons; e. Providing information concerning the local weatherization program to all persons who request it (including organizations that provide outreach activities); and f. Completing the EHEAP Outreach Plan Survey (ATTACHMENT XVII) to demonstrate to the Agency that outreach efforts to inform potentially eligible households about EHEAP shall be grade to target households in all counties. The EHEAP Outreach Plan Survey is required to be submitted by Contractor to the Contract manager within thirty (30) days of the contract execution date. 14. Program Partners and Stakeholder Coordination Coordinate shall coordinate services with other program partners and stakeholders to prevent the duplication of services, facilitate referrals, and improve the efficiency of services for consumers. Coordination activities shall include, but not be limited to: a. Communicating with the DEO LII-I.EAP contractors in their respective service areas to prevent the duplication of benefits to elders. Additionally, Contractor shall review LJ14EAP and EHEAP records for households with elderly members to ensure duplicate crisis assistance payments are not received during the same heating or cooling season; b. Developing a new, or continuing an existing, MOU with the Weatherization Assistance Program (WAP) in the service area. The MOU shall detail cooperative efforts and describe the actions that will be taken by both parties to ensure coordination and referrals. The MOU shall be reviewed and renewed at least every five years. Contractor, .in coordination with the local WAP agency, shall develop a system by which elders who have received more than three EHEAP and LIF-IEAP benefits in the last eighteen (18) months and who are homeowners are referred to a WAP provider. Contractor shall maintain copies,of all MOUs; c. Establishing a new, or continuing an existing, MOU with service area LIIIEAP contractors. Each MOU shall ensure coordination of services, to avoid duplication of assistance, and increase the quality of services provided to elders. The MOU shall direct LIIIEAP providers to refer elders aged sixty (fit}) 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 28 October 2019 — September 2020 EHEAP 203.19 of all MOUs. MOUs with local LIHEAP agencies shall be updated if the contracting parties change. The MOUs must be applicable to Contractor's current Elm -AP program requirements and guidelines; d. Developing agreements with home energy vendors that benefit elders. Contractor shall maintain copies of all vendor agreements. All agreements between Contractor and home energy vendors shall contain the following conditions: (1)The beginning and ending date of the Vendor Agreement; (2)The Contractor's representative(s) authorized to resolve a crisis situation and malce a payment commitment on behalf of an elder ; (3)The home energy vendor's representative(s) authorized to resolve a crisis; (4)A description of how energy payments will be made directly to the home energy vendor on behalf of the EHEAP eligible customer; (5)Assurance from the home energy vendor that no household receiving EHEAP assistance will be treated adversely because of such assistance under applicable provisions of state law or public regulatory requirements; (6)Assurance that the home energy vendor will not discriminate, either in the cost of goods supplied or the services provided, against the eligible household on whose behalf payments are made; (7)A statement that only energy -related elements of a utility bill are to be paid. Water, sewer, garbage, and fire, etc. charges are not covered as part of the utility bill of the household. However, EHEAP does allow an exception with water that is used for air conditioning, i.e. an evaporated cooler; (8)A statement that Contractor may not pay for charges that result from illegal activities such as a worthless check or meter tampering, and that the home energy vendor is aware that those charges are the responsibility of the elder; (9)Assurance from the home energy vendor that when the benefit amount to the elder does not pay for the complete charges owed by an elder, the elder is responsible for the remaining amount owed; (10) Details on how the home energy vendor will assist Contractor in verifying the elder's account information and, in the case of crisis assistance, make timely commitments to resolve the crisis. A process should be in place to verify the current amount owed and the minimum amount necessary to resolve the crisis situation; (11) Contractor's commitment to make payment to the home energy vendor within forty- pve (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 cligible elder and ensure the signed releases are available .for inspection by the horne energy vendor; (14) Assurance that home energy vendors is aware that as long as signed .Authorization for Release of General and/or Confidential Information for EHEAP Data are collected and available, the home energy vendor will provide the requested customer date to DEO; 29 ("M t October 2019 — September 2020 EHEAP 203.19 (15) The agreement will be reviewed by both parties at least every five (5) years; (16) The agreement must be signed by a representative of both Contractor and the vendor who has authority to bind the entity and enter into such commitments; and (.17) The home energy vendor, with the exception of municipal providers, must be in "active" status with the State of Florida: (httjl.-//siiiibiz.org/.sLeireli.litLn) and the vendor's name must be checked on Excluded Parties List System (EPLS) (https://w�,,w.e ls.aov . The business name on the vendor agreement must match the legal business name on the State of Florida website. 1S Comply with the Federal Financial Accountability and Transparency Act (FFATA) by securing a Dun and Bradstreet. Numbering System (DUNS) number (www.(inb.com) and maintaining an active and current profile in the System for Award Management (SAM) (www.sam.gov); and 1CA Based on local need for EHEAP services and other non-El1EAP energ37 assistance resources in the service area, Contractor may limit crisis benefits to less than those stated in Section 1.C.3.h. Policy changes concerning the amount of crisis benefits available to elders require Agency approval and require notification of the change be sent to current and potential elders. B, STAFFING REQUIREMENTS 1. Use of Subcontractors If an entity other than the Contractor provides any service required under this contract, the Contractor shall ensure the following requirements are met: a. Eligible entities that provide outreach, perform intake, make eligibility determinations, or process benefit payments must be one of the following: (1) A Local City Government; (2) A Local County Government; (3) A Community -Based Organization; (4) A Faith -fused Organization; or (5) A State -Community Services Agency. b. Entities providing any administrative function under this contract shall provide to Contractor a list of all individuals performing administrative functions for the EHEAP. The list must include Subcontractor's employees, agents and representatives setving EHEAP administratively. For each individual on the list, Subcontractor must also provide the individual's EHEAP administrative duties and fiinction(s). Additionally, Subcontractor must provide total salary and benefit amounts for each individual on the list, specifying all funding sources from which that person is paid and the corresponding amounts of that pay charged to each funding source. c. For the term of this contract, each month Subcontractor shall provide to Contractor the following information: (1) The total number of individuals served with crisis assistance for the reporting month; (2) The total number of individuals ineligible or denied assistance during the reporting month; 30 October 2019 — September 2020 EHEAP 203.19 (3) The total number of individuals served by referral to other community resources for energy assistance during the reporting month; (4) The total amount of funding expended for crisis assistance per county for the reporting month; and (5) An EIIEAP Outreach Activity Report to demonstrate that outreach efforts to inform potentially eligible households about EHEAP are conducted to target households in all counties. d, Entities providing any service required under this,contract must comply with the FFATA. This includes securing a DUNS number (v%7ww.dnb.corn) and maintaining an active and current profile in the System for Award Management (SAM) (ww!ww.sann.gov). e. 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. The Contractor shall submit a copy of all MOUs to the Agency's Contract Manager within thirty (30) days of the contract execution date; and (2) An (:;HEAP 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. f. Eligible entities must provide the service provider commensurate compensation for the delivery of administrative and outreach activities and for the delivery of crisis benefits. Commensurate compensation of administration and outreach activities shall include cast -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 (lie extent allowed and required by law. h. Subcontractor shall not be permitted to perform services related to this contract without an executed subcontract and an approved Provider Cost Analysis or MOU verifying that subcontractor's staff is paid from non-federal resources or is compensated for such activities by EHEAP. In accordance with Sections 25-26 of the Standard Contract, the Agency shall not be responsible or liable for any obligations or claims resulting from any subcontract. L Contractor shall document the subcontractor's progress in perforrnin ; its work under this contract in the quarterly report. j. 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., Iz. 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 31 October 2019 — September 2020 EHEAP 203.19 subcontractor for a period of sixty (60) days or more, Contractor shall notify the Agency's Contract Manager and the Agency's Chief Financial Officer in writing of such delay. C. SERVICE DELIVERY 1. Service Delivery Location Contractor shall ensure that the services provided under this contract are available to residents within each county in the Service Area (PSA) by in -person service, telephone, and/or other electronic means. 2. Service Times Contractor shall provide the services listed in this contract during normal business hours, Normal business lioUr;S are defined as Monday through Friday, 8:00 a.m. to 5:00 p.rn, 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 II.C.2 of this contract. b. Contractor shall provide the minimum level of service per month in each county served, as defined in Section I.A.16. 2, Source Documentation The deliverables shall be reported monthly on Contractor's monthly financial status reports. Successful completion of the deliverables shall be determined by the Agency's receipt of Contractor's Receipts and Expenditure Report (ATTACHMENT XI) and Request for Payment (ATTACHMENT XII) containing the number of individuals served with crisis assistance; number of individuals ineligible or denied assistance; number of applicants served by referral to other community resources for energy assistance; a summary of fiinds expended per county for the reporting month using the EHEAP Cost Reimbursement Summary form (ATTACHMENT XXI); and the certification required in Section 1.1, D.I. 3. Records and Documentation Contractor will maintain a separate record (paper and CIRTS) for each EI-IEAP applicant that includes the following as applicable: a. The EHEAP Application and Eligibility Worksheet, (ATTACHMENT XVIII), completed and signed by Contractor and the elder. The application must be approved by a supervisor or peer prior to payment remittance. Contractor is responsible for using the most recent application, eligibility worksheet, and EHEAP Application and Eligibility Worksheet Instructions (ATTACHMENT XIX), issued by the Agency. (I)lf Contractor approves an application, one elderly member of the household must be registered in CIRTS using the ] HEAP Application and Eligibility Worksheet (ATTACHMENT XVIII); or (2) If Contractor denies an application, the elder must be registered in CIRTS using the EHEAP Application and Eligibility Worksheet (ATTACHMENT XVIII). b. The elder' s .narne, address, sex, and age; 32 October 2019 — September 2020 EHEAP 203.19 c. Names, ages and current identification documentation (no more than one year expired) of all household members; d. Social Security numbers and documentation of those numbers for all household members or the citation to the applicable cxemption; e. Signed notice regarding the collection of Social Security numbers (Notice of Instruction f#071 l 13-1=1-SWCBS, httLJ/clderaffairs.state.fl.us/cloca/noticesf.ltilyli/L1Ii.EAP`/n20Noticc`/o20i-e'/o2OSocial %20 4ecuritvT%20Numbegs%20Tinal,pdt , f. Income amount and method of verification for all household rnernbers; g. Income documentation to support eligibility that is representative of the elder's current economic situation; h. Statement of self -declaration of income, if applicable; i. A signed statement of how basic living expenses (i.e., food, shelter, and transportation) are being provided if the total household income is less than fitly percent (50%) of the current Federal Poverty Guidelines and no one in the household is receiving SNAP assistance; j. Documentation of the elder's obligation(s) to pay an energy bill for the residence in which they live; (1) The elder's utility bill must include detail to identify unallowable categories of assistance resulting from charges for water, sewer, garbage, and fare, etc.; charges resulting from meter -tampering and returned checks; and other charges that are not energy -related and are not required for cooling/heating the household, (2) Use of the most current utility bill(s) which provides the vendor's name and address, account holder's name and physical address, account number, and amount(s) due is required. If an elder's utility bill, cutoff notice, or door -hanger notice or similar documentation does not include all of this information., Contractor must document the verified missing information by writing the information on the utility bill and on the EHEAP Application and Eligibility Worksheet (ATTACHMENT VIIII). k. Signed Authorization for Release of General and/or Confidential Information for LIHEAP/ EIIEAP federal Reporting or a statement on the application which states that the elder refused to sign the waiver; 1. Copies of approval or denial letters, including those related to the initial application and all appeals, which are provided to the elder; m. If preference is given due to a disability, documentation of such disability that includes disability income or a physician's statement; n. Documentation of referrals to LIHEAP and WAP; o. Notation if ElIEAP prevented a disconnection or restored an energy disruption; p. Documentation of coordination with LIHEAP providers to avoid duplication of crisis services for households with elderly residents; c1. Proof of payment made to vendors; j% Documented of calculation of crisis benefits for elders living in subsidized housing; and s. Completed EHEAP Client Tile Content Checklist, (ATTACHMENT XX). 33 { f�t7j October 2019 — September 2020 E. PERFORMANCE SPECIFICATIONS EHEAP 203.19 1. Reports Contractor is responsible for responding in a timely fashion to additional .routine and/or special requests for information and reports required by the Agency. Contractor must establish due dates For any subcontractor's report that permits Contractor to meet the Agency's reporting requirements. a. Contractor shall report monthly on Contractors Request for Payment, (ATTACHMENT XII) as delineated in Section I1..F_,.1.i. of this contract. b. Administrative and Outreach Expense Budget Detail Contractor shall submit by the 9th of the month to the Agency's EHEAP Contract Manager the EHEAP Administrative and Outreach Expense Budget Detail (ATTACHMENT X). The Administrative and Outreach Expense Budget Detail shall clearly delineate planned expenditures for funds retained by the Contractor and funds subcontracted. The Administrative and Outreach Expense Budget Detail shall include all Contractor positions, by title, to be paid with these Rinds and shall detail the estimated number of hours, the hourly wage, and the estimated salary to be paid by EHEAP. Funding sources, estimated hours, and hourly wake shall be identified for the balance of salary where EHEAP finds are used to pay less than one hundred percent (100%) of the salary. Percentages must be supported by the submitted cost allocation plan. c. Cost Allocation Plan The Contractor shall submit to the Agency's EHEAP Contract Manager the EAHEAP Cost Allocation Plan (ATTACHMENT XXII). The Cost Allocation Plan shall provide budgeting methodology, allocation distribution, and the data source(s) used. d. Provider Cost Analysis State of Florida Chief Financial Officer Memorandum No. 02 (released October 3, 2012), requires Contractor to provide assistance to the Agency's Contract Manager in completing the DOER Cost Analysis for Non -Competitively Procured Contracts in Excess of Category 11- Addendum to the EHEAP Cost Allocation Plan (ATTACHMENT XXII). (1) The Contractor shall submit a completed Cost Analysis, which shall reflect Administrative, Outreach, and Crisis Service allocations as delineated on the Budget Summary (ATTACHMENT IX) and must be sufficient to explain the expenditures' allowability, allocability, and reasonableness. The Cost Analysis shall be submitted and approved by the Agency prior to execution of this contract. All subsequent amendments that affect the budget shall also be submitted to and approved by the Agency prior to any change. c. .Monthly Reports (.1) EHEAP Outreach Activity Report Tile Contractor shall ensure the use of outreach efforts that will inform potentially eligible households about EHEAP to the Agency Contract Manager or its designee by the 9"' of each month along with the county's monthly billing. The EHEAP Outreach Activity Report shall consist of the following: (i) Date; (U) County: 34 October 2019 — September 2020 EHEAP 203.19 (iii) Location Address (iv) Description of Activity; and (v) Name and Position of Staff (2) Surplus/Deficit Report —Lead Agency Spending Report The Contractor shall submit a Consolidated Surplus/Deficit Report, Lead Agency Spending Report, in a format provided by the Agency, to the Agency Contract Manager by the 18th of each month. This Consolidated Surplus/Deficit Report is for all agreements and contracts between the Contractor and the Agency and must include the following: (i) A list of all contracts and their current status regarding surplus/deficit; (ii) The Contractor's detailed plan on how the surplus/deficit spending exceeding the threshold specified by the Agency will be resolved; (iii) Recommendations to transfer funds within the PSA to resolve surplus/deficit spending; and (iv) Input from the Agency's Board of Directors on resolution of spending issues, if applicable; f. Quarterly Reports EfIEAP Summary Report Contractor shall ensure timely and accurate CIRTS data entry of EHEAP activity and submit to the Agency's EHEAP Conti -act Manager or designee the service report entitled, "EHEAP SUMMARY," from CIRTS. The report shall reflect the use of EHEAP in your county(s) in the PSA and shall be inclusive of all elders applying for crisis energy assistance during the reporting quarter. The CIRTS EHEAP Summary Report shall be submitted based on the following schedule: REPORT REPORTING PERIOD SEASON DATE DUE TO AGENCY 1 10/01/19 — 12/31/19 Heating Season January 09, 2020 2 01 /01 /20 — 03/31 /20 Heating Season April 09, 2020 3 04/01/20 — 06/30/20 Cooling Season July 09, 2020 4 07/01/20 — 09/30/20 Cooling Season October 09, 2020 The EHEAP Summary Report parameters for the program year shall be: (i) PSA; (ii) All Providers; (iii) Your Location; (iv) EHEAP; (v) All Cities; 35 October 2019 — September 2020 EHEAP 203.19 (vi) Poverty Line $12,140; (vii) Each Additional Household Members $4,320; and (viii) Current Reporting Period. g. Program Effectiveness Reports The Contractor agrees to provide the Agency any additional service reports requested by the Agency concerning the effectiveness of the program and shall include any statistics and information that the Agency may require. The reporting period shall begin with the effective date of this contract in a format and according to a schedule provided by the Agency for each report. 2. Monitoring and Evaluation Methodology Contractor shall monitor its performance under this contract as swell as that of its subcontractors, subrecipients and consultants who are paid from funds provided under this contract to ensure that the scope of work is accomplished within specified time periods and budgets set and that other performance goals stated in this contract are achieved. Such review shall be made for each function or activity set forth in this contract and reported in the quarterly report. a. Contractor shall review completed EHEAP applications in accordance with the EHEAP Client File Content Checklist (ATTACHMENT XX). b. The Agency shall, at its own discretion, conduct investigations concerning any aspect of Contractor's performance of this contract. c. The Agency shall conduct a full onsite review of Contractor at Least once during each three-year period. Contractor shall allow the Agency to carry out monitoring, evaluation, and technical assistance, and shall ensure the cooperation of its employees, and of any subcontractors with whom Contractor contracts to carry out program activities. d. The Agency shall conduct desk review activities throughout the year to monitor contractual program requirements. e. The Agency shall conduct EHEAP intake site visits. f. In conjunction with onsite monitoring visits and desk review activities, the Agency shall review a sample of completed EHEAP client files in accordance with the EHEAP Client File Content Checklist, (ATTACHMENT XX). g. The Agency shall conduct follow-up reviews including prompt return visits to Contractors that fail to meet the goals, standards, and requirements established by the state and federal funding agency. 3. Program Highlights The Contractor shall submit Program Highlights referencing specific events that occurred in SFYIFFY 2018-2019 by August 30, 2019. The Contractor shall provide a new success story, quote, testimonial, or human -interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms. For all agencies or organizations that are referenced in the highlight, the Contractor shall provide a brief description of their mission or role. The active tense shall be consistently used in the highlight narrative, to identify the specific individual or entity that performed the activity described in the highlight. 36 October 2019 — September 2020 4. Outreach Ilan Survey EHEAP 203.19 Contractor shall submit to the EHEAP Contract Manager the EHEAP Outreach Plan Survey (ATTACHMENT XVII). The purpose of the Outreach Plan Survey is to delineate all activities and efforts for the program year. The EHEAP Outreach Plan Survey is due within thirty (30) days of the contract execution date, S. Within three months of execution of this contract, Contractor shall provide the Agency a list of all individuals performing any administrative functions for the EHEAP. The list must include Contractor's employees, agents, and representatives, as well as all employees, agents, or representatives of subcontractor(s) or sub-subcontractor(s) serving EHEAP administratively. For each individual on the list, Contractor must also provide the individual's EHEAP administrative duties and function(s). Additionally, Subrecipient must provide total salary and benefit amounts for each individual on the list, specifying all funding sources fi•om which that person is paid and the corresponding amounts of that pay charged to each funding source. 6. For the term of this contract, each month Contractor shall provide to the Agency, by the 91, of each month for the preceding month, the following information will be entered on ATTACHMENT XII, Request for Payment, under Part D: Service Information (i) The total number of individuals served with crisis assistance for the reporting month; (ii) The total number of individuals ineligible or denied assistance during the reporting month; (iii) The total number of individuals served by referral to other community resources for energy assistance during the reporting month; and (iv) The total amount of funding expended for crisis assistance per county for the reporting month. F, CONTRACTOR RESPONSIBILITES I. Make 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 benefit for this contract period is $600.00 per household per season. 3. Encourage households to seek assistance prior to incurring non -energy penalties such as disconnect/reconnect fees, additional deposits, interest or late payments. 4. Provide EII.EAP crisis services to households with elders in every city within the service area. a. Contractor shall ensure that each city within their service area receives a minimum level of crisis services monthly, as delineated in Section I.A.1G.; b. EI:IEAP 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 city in Contractor's service area, S. Make crisis benefit payments to vendors on behalf of approved elders within forty-five (45) days of the date of crisis resolution. 6. Mahe payments on behalf of those elders with the highest home energy needs and the lowest household income, which will be determined by taking into account both the energy burden and 37 c:�c� October 2019 — September 2020 EHEAP 20119 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 fiends, all funds incorrectly paid on behalf of elders that cannot be collected from the elder. 8. Develop adequate procedures to ensure EHEAP funds are appropriately budgeted and expended to permit payment of energy assistance benefits in both the heating and cooling seasons, ensure that this is a twelve- month program, and ensure that :Funding is available to and expended in, all counties within Contractor's service area. Procedures should include referral to other cornmunity agencies when funds budgeted for a particular time period are exhausted and elders are subsequently denied. 9. Develop monitoring and oversight procedures to ensure that administrative costs that exceed the contracted EHEAP administrative award to Contractor or Subcontractor are paid fi•om non-federal sources. IIO.Develop adequate procedures to address the use of EHEAP finds for elders who are on oxygen support or a "Lifeline Program" and must have power. 11. Develop a written policy regarding the use of funds for repairing or replacing heating or cooling equipment, The procedures must address the conditions under which an elder is eligible for such funds and what constitutes an emergency related to lack of heating or cooling. 12, Ensure providers and appropriate staff participate in training opportunities scheduled by the Agency to cover EHEAP policies and procedures. B 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 prograrn administration, training, and reference, The EHEAP Policies and Procedures Manual shall be distributed to all subcontractors that provide any service under EHEAP. The EHEAP Policies and Procedures Manual shall be reviewed during, and in accordance with, the Agency's EHEAP contract monitoring schedule, and shall include the following - a. The State of Florida LIHEAP Policies and Procedures Manual; b. An MOU or Subcontract with EHEAP providers; e. An MOU with all service area L.iHEAP providers; d. An MOU with all service area WAP providers; e. Contractor's cost allocation methodology; C Written policies and procedures to ensure that all energy assistance payments made to home energy vendors comply with the requirements of the Vendor Agreement; g. Adequate procedures to ensure that EHEAP funds are appropriately budgeted and expended to sufficiently allow for energy assistance benefits in both the heating and cooling seasons, ensure that this is a twelve- month program, and to ensure that funding is available to, and expended in, all counties within Contractor's service area; Ii. Policies regarding the detection and prevention of fraud and abuse of program funds; i. Policies that address serving family members and employees; 38 October 2019 — September 2020 EHEAP 203.19 j. Policies and procedures to secure applicant Social Security Numbers, in order to protect applicants' identities; k. Procedures for computer system backup and recovery; 1. Procedures for referral or access assistance to the "Lifeline Program"; in. A policy outlining the criteria to determine if a household has a "home energy crisis" and the information and/or documentation required to verify the crisis; n. Policies and procedures for determining the eligibility of elders applying for EHEAP; 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 tiniefrarnes 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 ciders when EHEAP Funding is not available or they do .not qualify; or contacting; the Area Agency's Elder Help Line for resources. t. Consumer appeal procedures that provide an opportunity for a fair administrative hearing at the provider level to elders whose applications for assistance are denied, or whose applications are not acted upon with reasonable promptness; and u. Policies and procedures for conducting home visits to home -bound elders for completion of the program application or eligibility determination when other assistance is not available. L1i Notwithstanding that tasks for which the Contractor is held accountable involve coordination with other entities in performing this contract, the failure of other entities does not alleviate the Contractor from any accountability for tasks or services that the Contractor is obligated to perform pursuant to this contract. G. AGENCY RESPONSIBILITIES 1. The Agency may provide technical support and assistance to Contractor within the resources of the Agency to assist the Contractor in meeting the requirements of this contract. The support and assistance, or lack thereof, shall. not relieve Contractor from full performance of contract requirements. Z The Agency will provide to Contractor the State of Florida LIHEAP Policies and Procedures Manual. The State of Florida LIHEAP Policies and Procedures Manual will provide information and procedures needed to administer EHEAP in Florida. a. This contract excludes all provisions of the State offlorida LIHEAP Policies and Procedures Manual in reference to LII-IEAP Regular Home Energy Annual Benefits. la. To the extent any conflict arises between this contract and any incorporated reference contained herein, this contract shall have precedence. 39 October 2019 — September 2020 111. METHOD OF PAYMENT A. PAYMENT METHOD USED EHEAP 203.19 The Method of Payment for this contract is a combination of cost reimbursement and advance payments, subject to the availability of funds and Contractor performance. The Agency will pay the Contractor upon satisfactory completion of the Tasks/Deliverables, as specified in Section II, Manner of Service Provision, and in accordance with other terms and conditions of this contract. I Cost Reimbursement The Contractor agrees to distribute funds as detailed in the Budget Summary (ATTACHMENT IX), attached to this contract. Any change in allocation of categorical or total amounts of funds identified on the Budget Summary form require a contract amendment. Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in ATTACHMENT IX. All Cost Reimbursement Requests for Payment must include the actual Receipts and Expenditure Reports beginning with the first month of this contract. a. Budget Summary Contractor agrees to implement the distribution of funds as detailed in the Budget Summary (ATTACHMENT 1X). An amendment is required to change category allocations or the total amount of this contract. (1) Administrative Expense Administrative expenses include costs for general administration and coordination of the program, including direct and indirect costs. This includes the salaries, fringe benefits (i.e. insurance, retirement, etc.), rent, utilities, travel, etc. associated with financial and administrative management of the program. The use of other federal funds to supplement the administrative operations of EHEAP, above and beyond the budgeted amount, is prohibited. Administrative costs that exceed the contracted EHEAP administrative award to Contractor or subcontractor must be paid from non-federal Sources. Contractors must have adequate procedures for monitoring and oversight to ensure. compliance. (2) Outreach Expense Outreach expenses are those costs incurred in delivering EHEAP services that are not purely administrative in nature. This may include staff and subcontractor expenses such as salaries, fringe benefits (Le. insurance, retirement, etc.), rent, utilities, travel, etc. for those employees performing outreach and intake; and any subcontractor expenses. Outreach expense shall not include senior management expense, unless outreach and intake involving direct contact with elders occurs. Documentation to support this exception shall be maintained by Contractor and available upon request. b. Weather/Related Supply Shortage Weather Related/Supply Shortage funds are a set -aside for emergency assistance. These funds must be held in this budget line item category until December 15'�' of the program year, for use in response to a possible disaster. These funds shall only be used during state or federal emergencies declared officially by the President of the United States, the Governor ofthe State of Florida, or the Executive Director of DEO. In the event of an emergency being officially declared, if Contractor or the Agency finds that the budgeted amount of Weather 40 October 2019 — September 2020 E11EAP 203.19 Related/Supply Shortage emergency assistance funds is not sufficient to meet the emergency, Contractor may, with the Agency's written authorization, draw on other contract categories up to fifty percent (50%) of the total contract budget. When funds are distributed for a weather- related/supply shortage emergency, the Agency will provide binding directives as to the allowable expenditures of the funds. After Decembet• 15, if no emergency has been declared, the Agency will release the funds and Contractor shall allocate these funds to the crisis category of the program. c. .ludirect Cost Rate Per 2 C.F.R.§ 200.331(a)(4), Subrecipients of federal awards are required to have an approved, federally recognized indirect cost rate, negotiated between the Subrecipient and the Federal Government, If no such rate exists, then the Subrecipient shall have either a rate negotiated with DOEA (in compliance with 2 C.F.R.Tart 200), or a de minimal indirect cost rate as defined in 2 C.F.R.. § 200.414(f). Subrecipient shall maintain its current Indirect Cost Rate Proposal and make the proposal available upon request. If Subrecipient chooses to use the de minimal rate, Subrecipient shall make sure it is entitled to use that rate and include a statement to that effect. Subrecipient is not obligated to establish an indirect cost rate if Subrecipient does not charge an indirect cost rate. 2 Advance Payments Contractor may request up to two (2) months of advances at the start of the contract period to cover program administration, outreach, and service costs. The payment of an advance will be contingent upon the sufficiency and amount of funds released to the Agency by the State of Florida ("budget release"). Contractor's requests for advance payments require the written approval of the Agency's Contract Manager. For the first month's advance request, Contractor shall provide the Agency's Contract Manager documentation,justifying the need for an advance and describing how the funds will be distributed. If sufficient budget is available, and the Agency's Contract Manager, in his or her sole discretion, has determined that there is a ,justified need for an advance, the Agency will issue approved advance payments after October 1, 2019. a. Any advance payment the Contractor requests for subcontractors must be distributed within seven days of receipt of payment frorn the Agency. The Contractor shall submit to the Agency documentation to support full distribution of advance funds with report number 5, due to the Agency on January 9, 2020, in accordance with the Invoice Report Schedule, (ATTACHMENT XIIY), to this contract. h. All advance funds requested for the Contractor must be fully expended no later than December 15, 2019. Any amount of advance payments not fully recouped on the Request for Payment starting with Receipts and Expenditure Report number 5, due to the Agency on January 9, 2020, in accordance with the Invoice Report Schedule, (ATTACHMENT XIIi), attached to this contract. c. .All advance payments made to the Contractor shall be reimbursed to the Agency as follows: one -tenth of the advance payment received shall be reported as an advance recoupment on each Request for Payment, starting with Receipts and Expenditure Report number 5, in accordance with the Invoice Report Schedule, (ATTACHMENT XIII), attached to this contract. d. .Interest earned on advances must be identified separately by source of funds, state or- federal. Contractor shall maintain advances of federal funds in FDIC interest bearing accounts, unless an exception is made in accordance with 45 CFR fart 75. Interest earned in excess of 41 October 2019 — September 2020 EHEAP 203.19 $250 per year on Federal cash balances shall be returned to the Agency at the end of each quarter of the contract period. B. All payment requests shall be based on actual monthly expenditures beginning with the first month of this contract. The schedule for submission of advance requests and requests for payment is in ATTACHMENT XIII. to this contract. C. The final request for payment is due to the Agency no later than October 15, 2020. D, METHOD OF INVOICE PAYMENT Payment shall be made upon Contractor's presentation of an invoice subsequent to the acceptance and approval by the Agency of the deliverables on the invoice. The form and substance of each invoice submitted by Contractor shall be as follows: ]. Il.ave Remittance Address that corresponds exactly to the "Remit To" address provided to My Florida MarlcetPlace (MFMP) during registration; 2 Request payment for services as established in the Service Rate Report (ATTACHMENT XXIII); 36 Contractor shall consolidate all Requests for Payment from subcontractors and Receipts and Expenditure Reports that support requests for payment and shall submit them to the Agency using; Receipts and Expenditure Report (ATTACHMENT XI), Request for Payment (ATTACHMENT XII), and Cost Reimbursement Summary (ATTACHMENT XXI); 4. Contractor shall include requiring supporting documentation as delineated in Section III. F. with the cost reimbursement portion of the invoice. E. PAYMENT WITHHOLDING Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and approval by the Department of all financial and programmatic reports due from the Contractor and any adjustments thereto, including any disallowance not resolved. F. SUPPORTING DOCUMENTATION REQUIREMENTS For the reporting month, Contractor shall include the following with Request for Payment: 1. 'File number of individuals served, that include: a, The number of individuals served with crisis assistance during the reporting month; D. The number of individuals ineligible or denied assistance daring the reporting month; c. The number of individuals referred to other community resources for energy assistance during the reporting month; 2. Certification that Contractor operated during its .normal business hours during; the reporting month; and a The total amount of funding expended for crisis assistance per county for the reporting period; G. FINANCIAL CONSEQUENCES Failure to meet the deliverables described in this contract may result in a financial consequence and may result in the redistribution of funding. Contractor shall ensure the provision of services and the successful completion of deliverables as set forth in this contract. 42 October 2019 — September 2020 EHEAP 203.19 1. The Agency shall not reimburse any expenditures associated with Deliverables not accepted by the Agency as successfully completed; however, this does not preclude Contractor from receiving; payment for such expenditures upon successful completion of the deliverable. 2 If Contractor fails to be open and available for services according to its regular business hours as identified in Section II.C.2 of this contract, excluding weekends or state and federal holidays, Contractor shall pay to the Agency financial consequences for such failure, unless the Agency waives such failure in writing based upon its determination that the failure was due to factors beyond the control of Contractor. * Contractor's failure to operate according to its regular business hours shall result in an assessment of a financial consequence in the amount of $10.00 per day. * Any amounts due from financial consequences shall be paid by Contractor out of non-federal funds. H. REMEDIES -NONCONFORMING SERVICES Contractor shall ensure that all participants served under this contract are eligible for the program and that all monthly and/or quarterly performance reports and financial records are maintained for each reporting period and submitted as stipulated in this contract. t 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. Contactor shall give immediate notice to the Agency of any significant and/or systemic infraction that compromises Contractor's ability to provide participant services, to achieve programmatic performance, or to provide sound financial management of the program. 1, CONSEQUENCES FOR NON-COMPLIANCE, Contractor shall ensure one hundred percent (100%) of the deliverables identified in this contract are performed pursuant to contract requirements, and as described in Section ILD, are identified as major deliverables in this contract. 1. If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to correctly, completely, or adequately perform these major deliverables, the Contractor will have ten (10) days to submit a Corrective Action Plan (CAI') 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 forNon-Compliance on the Contractor for each deficiency identified in the CAI' which is not corrected pursuant to the CAI'. 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 I lth 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. 43 EHEAP 203.19 October 2019 — September 2020 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 appaoves such expenditues by executing a written modification to the original contract. signed by both parties. 1. Contractor must use an Agency approved budget modification process. 2 .For the purpose of transferring funds, the following are considered budget categories (1) Administrative, (2) Outreach, and (3) Crisis Assistance, END OF A TTA.CHMENT 44 October 2019 T September 2020 FINANCIAL AND COMPLIANCE AUDIT EHEAP 203.19 ATTACHMENT II The administration of resources awarded by the Agency to the Contractor may be subject to audits and/or monitoring by the Area Agency on Aging for Southwest Florida as described in this section, MONITORING In addition to reviews of audits conducted in accordance with 2 CFR Part 200 (formerly OMB Circular A-133 as revised), and Section 215.97, KS., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the Agency and/or Department staff, limited scope audits and/or other procedures. By entering into this contract, the Contractor agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Agency and/or Department. In the event the Agency a n d/ o r D c p a r t m e n t determines that a limited scope audit of the Contractor is appropriate, the Contractor agrees to comply with any additional instructions provided by the Agency and/or Department to the Contractor regarding such audit. The Contractor further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Agency's Director of Program and Planning. AUDITS PART I: FEDERALLY FUNDED This part is applicable if the Contractor is a State or local government or a non-profit organization as defined in 2 CFR Part 200, Subpart A. In the event that the Contractor expends $750,000.00 or more in federal awards during its fiscal year, the Contractor must have a single or program -specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial a n d C o m p l i a n c e A u d i t A T T A C H M E N T 11, EXHIBIT 2 to this agreement indicates federal resources awarded through the Agency by this contract. In determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards, including federal resources received from the Agency. The determination of amounts of Federal awards expended should be in accordance with 2 CFR Part. An audit of the Contractor conducted by the Auditor General in accordance with the provisions of 2 CFR Part 200 will meet the requirements of this part. In connection with the audit requirements addressed in Part I, paragraph 1, the Contractor shall fulfill the requirements relative to auditee responsibilities as provided in 2 CFR §200.508, If the Contractor expends less than $750,000.00 in federal awards in its fiscal year, an audit conducted in accordance with the provisions of 2 CFR Part 200 is not required. In the event that the Contractor expends less than $750,000.00 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200, the cost of the audit must be paid from non-federal resources (Le., 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 covet, 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 Hint for each applicable contract. All questioned costs and liabilities due to the Agency shall be fully disclosed in the audit report with reference to the Area Agency on Aging for Southwest Florida, Inc. contract involved. If not otherwise disclosed as required by 2 CFR § 200.510, the schedule of expenditures of federal awards shall identify expenditures by contract number for each agreement with the Agency in effect during the audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the Contractor's fiscal year end. 45 PART IIe STATE FWkDED 2020 EHEAP 203.19 This part is applicable if the Contractor is a non -state entity as defined by Section 215.97(2), F.S. In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of $750,000.00 in any fiscal year of such Contractor, the Contractor must have a State single or project -specific audit for such fiscal year in accordance with Section 215.97, F.S.; applicable rules of the Department of Financial Services; and Chapter 10.550 (local governmental entities) or 10,650 (nonprofit and for -profit organizations), Rules of the Auditor General. ATTACHMENT 11, EXHIBIT 2 to this agreement indicates state financial assistance awarded through the Agency by this contract. In determining the state financial assistance expended in its fiscal year, the Contractor shall consider all sources of state financial assistance, including state financial assistance received from the Agency, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass -through awards and resources received by a non -state entity for Federal program matching requirements. In connection with the audit requirements addressed in Part 11, 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 21597, 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 69I-5,003, F.A.C., the schedule of expenditures of state financial assistance shall identify expenditures by contract number for each contract with the Agency in effect during the audit period. For local governmental entities, financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the Contractor's fiscal year end. For non-profit or for -profit organizations, financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 9 months after the Contractor's fiscal year end. Notwithstanding the applicability of this portion, the Agency retains all right and obligation to monitor and oversee the performance of this contract as outlined throughout this document and pursuant to law. PART III: REPORT SUBMISSION Copies of financial reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of this Financial Compliance Audit Attachment, shall be submitted, when required by 2 CFR § 200.512 by or on behalf of the Contractor direct] to each of the following: Federal Audit Clearinghouse Bureau of the Census 1201 East 101h Street Jeffersonville, IN 47132 Pursuant to 2 CFR §200.512, all other Federal agencies, pass -through entities and others interested in a reporting package and data collection form must obtain it by accessing the Federal Audit Clearinghouse. 46 October 2019 --- September 2020 EHEAP 203,19 The Contractor shall submit a copy of any management letter issued by the auditor, to the Area Agency on Aging for Southwest Florida, Inc.at the following address: Area Agency on Aging for Southwest Florida, Inc. Attn: Ken Carr, CFO 15201 N Cleveland Ave., Suite 1100 North Fort Myers, FL 33903 Additionally, copies of financial reporting packages required by PART II of this contract's Financial and Compliance Audit Attachment shall be submitted by or on behalf of the Contractor directlyto each of the following: The Area Agency on Aging for Southwest Florida, lnc,at the following address: Area Agency on Aging for Southwest Florida, Inc. Attn: Ken Carr, CFO 15201 N Cleveland Ave., Suite 1100 North Fort Myers, FL 33903 The Auditor General's Office at the following address: State of Florida Auditor General Claude Pepper Building, Room 574 111 West Madison Street Tallahassee, Florida 32399-1450 Any reports, management letters, or other information required to be submitted to the Agency pursuant to this agreement shall be submitted timely in accordance with 2 CFR Part 200, F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General, as applicable. Contractors, when submitting financial reporting packages to the Agency for audits done in accordance with 2 CFR Part 200 or Chapter 10.550 (local governmental entities) or 10,650 (nonprofit and for -profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to the Contractor in correspondence accompanying the reporting package. PART IV: RECORD RIJTENTION The Contractor shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six (6) years from the date the audit report is issued, and shall allow the Agency or its designee, the CFO or Auditor General Access to such records upon request. The Contractor shall ensure that audit working papers are made available to the Agency or its designee, CFO, or Auditor General upon request for a period of six (6) years from the date the audit report is issued, unless extended in writing by the Agency. 47 October 2019 — September 2020 EHEAP 203,19 ATTACHMENT II -EXHIBIT I PART I: AUDIT RELATIONSHIP DETERMINATION Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200 and/or Section 215.97, F.S. Contractors who are determined to be recipients or sub -recipients of federal awards and/or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part 11 of Exhibit 1 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 691-5.006, F.A.C., Contractor has been determined to be: Vendor not subject to 2 CFR § 200.38 and/or Section 215.97, F.S. X Recipient/sub-recipient subject to 2 CFR §§ 200.86 and 200.93 and/or Section 215,97, F.S. Exempt organization not subject to 2 CFR Part 200 and/or Section 215.97, F.S. For Federal awards, for -profit organizations are exempt; for state financial assistance projects, public universities, community colleges, district school boards, branches of state (Florida) government, and charter schools are exempt. Exempt organizations must comply with all compliance requirements set forth within the contract or award document. NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and /or state financial assistance, and has been approved by the Agency to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-5006, F.A.C. [state financial assistance] and/or 2 CFR § 200.330[federal awards]. PART II: FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a sub - recipient must comply with the following fiscal laws, rules, and regulations: STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW: 2 CFR § 200.416 - §200.417 ---- Special Considerations for States, Local Governments, and Indian Tribes* 2 CFR § 200.201 -- Administrative Requirements** 2 CFR § 200 Subpart F — Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules, and regulations NON-PROFIT ORGANIZATIONS MUST FOLLOW: 2 CFR § 200.400 - §200.411 — Cost Principles* 2 CFR § 200.100 — Administrative Requirements 2 CFR § 200 Subpart F --- Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW: 2 CFR § 200.418 — §200.419 --- Special Considerations for Institutions of Higher Education* 2 CFR § 200.100 — Administrative Requirements 2 CFR § 200 Subpart F — Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules, and regulations 48 October 2019 — September 2020 EHEAP 203.19 *Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in 2 CFR § 200.400(5)(c). **For funding passed through U.S. Health and Human Services, 45 CFR Part 75; for funding passed through U.S. Department of Education, 34 CFR Part 80. STATE FINANCIAL ASSISTANCE, Contractors who receive state financial assistance and who are determined to be a recipient/sub-recipient must comply with the following fiscal laws, rules, and regulations: Section 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 49 4sj`� October 2019 — September 2020 FUNDING SUMMARY EHEAP 203.19 ATTACHMENT II —EXHIBIT 2 DIote: Title 2 CFR, as revised, and Section 215,97, F.S., require that the information about Federal Programs and State Projects included in ATTACHMENT II —EXHIBIT I, be provided to the recipient. Information contained herein is a prediction of funding sources and related amounts based on the contract budget. 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: GRANT AWARD (FAIN#): 17EA-OF-13-00-16-003 FEDERAL AWARD DATE: April 1, 2019 DUNS NUMBER: 076997790 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT Emergency Home Energy Assistance for the Elderly Program United States Department of Health and Human Services 93.568 EHEAP Collier 93.568 $ 73 218.87 TOTAL FEDERAL AWARD $ 73 218•87 COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: FEDF,RAL 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 CONSIST OF THE FOLLOWING: MAWd-H I-- niR.Q IrrRCV-q FOR FRTIF.RAI. PROGRAMS 11 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL STATE AWARD c. A mr, i i'M • MerT AT A OCTC-P A NT!"'1; CTT-n TIP I- ' 'rfA Cl; I TTl11V 7.1 S Q7 F .0 i1C11111'll1%!1111\ lf1LA"1 XI Al A ••u PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT TOTAL AWARD COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: 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 50 October 2019 — September 2020 CERTIFICATIONS AND ASSURANCES EHEAP 203.19 ATTACHMENT III DOEA will not award this contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In performance of this contract, Contractor provides the following certifications and assurances: a. Debarment and Sus!' ign Certification ' CFR Part 25-and 45 CFR Part 751 c. NondiscriWination &Equal OUllortunity1 9 CFR Part 37and R Part ; e. 1 I J of Commullity.-Organizations1 1 Now (ACORN) Funding ons Assurance' f. Scrutinized Cornl2aniification.2 7 1 : 1 { ►''s ! ' 1 � s I, 1111MJ7M=r1TW4 11 FMMK m T Tm 111' 11 1 I 1 1.1 1 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 at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub - recipients and contractors shall provide this certification accordingly. 51 October 2019 — September 2020 EHIAP 203.19 13. CERTIFICATION REGARDING LOBBYING — CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS The undersigned Contractor certifies, to the best of its knowledge and belief, that: No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form -- LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub - recipients and contractors shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this contract was made or entered into. Submission of this certification is a prerequisite for making or entering into this contract imposed by 31 U,S.C. § 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. C. NON-DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART 80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: I. Section 188 of the Workforce Investment Act of 1998 (WLA), (Pub. L. 105-220), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I -financially assisted program or activity. 2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department and/or Agency. 3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with Section 504 of that Act, and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely by reason of 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 Agency of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Agency. 5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded 52 October 2019 — September 2020 EHEAP 203.19 from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Agency. 6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits and all other employment -related activities. 7. Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to Contractor's operation of the WIA Title I — financially assisted program or activity; and to all contracts, Contractor makes to carry out the WIA Title I --- financially assisted program or activity. Contractor understands that the Agency and/or DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub - recipients and contractors shall provide this assurance accordingly. D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S. Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime as defined in Section 287,133, F.S., nor placed on the Convicted Vendor List. Contractor understands and agrees that it is required to inform Area Agency and DOEA immediately upon any change of circumstances regarding this status. E. ASSOCIATION OF C O M M U N I T Y ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING RESTRICTIONS ASSURANCE (Pub. L. 111-117). As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. It 1-117. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients and contractors shall provide this assurance accordingly. F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTION 287.135, F.S. In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized Companies that Boycott Israel List and that it is not engaged in a boycott of Israel. If this contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S., Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it is not engaged in business operations in Cuba or Syria. Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the Agency terminating this contract and the submission of a false certification may subject Contractor to civil penalties and attorney fees and costs, including any costs for investigations that led to the finding of false certification. If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to this contract. 53 October 2019 — September 2020 EHEAP 203.19 G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS 1. The Contractor and any Subcontractors of services under this contract have financial management systems capable of providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant -funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all contract supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. 2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which the Contractor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Contractors will take immediate action to assure data integrity. 3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded clop technology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of these products offered by the Contractor (represented by the undersigned) and purchased by the state will be verified for accuracy and integrity of data prior to transfer. 4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the Contractor agrees to immediately make required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of the essence. 5. The Contractor and any Subcontractors of set -vices 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 certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this contract, and that any subcontracts include an express requirement that Subcontractors performing work or providing 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/contracts and that all Subcontractors shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this contract was made or entered into, Submission of this certification is a prerequisite for malting or entering into this transaction imposed by Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A -I 10). I. RECORDS AND DOCUMENTATION The Contractor agrees to matte available to Agency staff and/or any party designated by the Agency any and all contract related records and documentation. The Contractor shall ensure the collection and maintenance of all program related information and documentation on any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. 54 October 2019 — September 2020 EHEAP 203.19 J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS I. In addition to the requirements of Sections 10 of the Standard Contract sections 119.0701(3) and (4) F.S., and any other applicable law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the Agency is named in the civil action, Contractor agrees to indemnify and hold harmless the Agency for any costs incurred by the Agency, and any attorneys' fees assessed or awarded against the Agency from a Public Records Request made pursuant to Chapter 119, F.S., concerning this contract or services performed thereunder. a. Notwithstanding Section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed between the Department and state agencies or sub divisions defined in section 768.28(2), F.S. 2. Section 119.01(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 X does not provide for institutional memberships. Contractor's signature below attests that records pertaining to the dues or membership application by the Agency are available for inspection if applicable, as stated above. By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if applicable). By signing below, Contractor certifies the'representations outlined in parts A through J above are true and correct. %, l STEPHEN Y CA KNELL 3339 TAMIAMI TRAIL E, SUITE 212 (Signature and Title of Authorized Representative) (Street Address) COLLIER COUNTY BOARD OF COMMISSIONERS NAPLES, FL 34112 (Contractor) l 0 ) S-/ A (Date) (City, State, ZIP code) 55 064" October 2019 — September 2020 EHEAP 203.19 ATTACHMENT IV ASSURANCES---NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (D348-0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MA1NAGEM>JNT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2 Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of, personal or organizational conflict of interest or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§ 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6 Will comply with all federal statues relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-1683, and §§ 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.§ 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91- 616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§ 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. § 3601 ct seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles 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. 56 October 2019 — September 2020 EHEAP 203.19 Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §§ 1501-1508 and §§ 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds. 9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §§ 276a to 276a-7), the Copeland Act (40 U.S.C. § 276c and 18 U.S.C. § 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§ 327- 333), regarding labor standards for federally assisted construction sub -contracts. 10 Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000,00 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 1 1738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. § 1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U,S.C. § 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205). 12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. § 1721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. § 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. § 469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. § 2131 et seq) pertaining to the care, handling, and treatment of warm-blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. § 4801 et seq.), which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and 2 CFR Part 200. I& Will comply with all applicable requirements of all other federal laws, executive orders, regulations, and policies governing this program. SI F AUTHORIZED / TIFYING OFFICIAL TITLE STEPHEN Y CAAELL PUBLIC SERVICES -DEPARTMENT HEAD APPLICANT ORGANIZATION COUNTY BOARD OF COMMISSIONERS DATE SUBMITTED q Approved as to form and legality Lop �� As ' �tant County Atto ��,� C, 1e `� 1 October 2019 -- September 2020 ffiMaWNT V FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST Program/Facility Name County AAA/Contractor Address Completed By City, State, Zip Code Bate Telephone PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS FORM, 1. Briefly describe the geographic area served by the program/facility and the type of service provided: For questions 2-5 please indicate the foil 2. Population of area served 3. Staff currently employed 4. Clients currently enrol I ed/registered 5. Advisory/Governing Board if applicable owing: Total # White Black Hispanic Other Female Disabled Over RFD Source of data: Effective datel Effective date: PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF NIA or NO, EXPLAIN. 6. Is an Assurance of Compliance on file with DOEA? NIA YES NO 7. Compare the staff composition to the population. Is staff representative of the population? 8. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national origin, sex, age, religion or disability? 9. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of race, sex, color, age, national origin, religion or disability? 10. For in -patient services, are room assignments made without regard to race, color, national origin or disability? 11. Is the programlfacility accessible to non-English speaking clients? 12 Are emplo ees, applicants and participants informed of their protection against discrimination? If YES, how? Verbal Written❑ Poster❑ 58 NIA YES NO ❑ ❑ ❑ NIA YES NO ❑ ❑ ❑ NIA YES NO ❑ ❑ ❑ NIA YES NO ❑ ❑ ❑ N/A YES NO N/A YES NO ❑ ❑ ❑ October 2019 — September 2020 EHEAP 203.19 13. Give the number and current status of any discrimination complaints regarding services or employment filed NIA 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 YES NO the basis of disability? ❑ ❑ 19. Are auxiliary aids available to ensure accessibility of services to hearing and sight -impaired individuals? YES NO PART IV, FOR PROGRAMS OR FACILITIES WITII 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE, 20. Do you have awritten affirmative action plan? If NO, explain. YES NO i Reviewed by In Compliance: YLS LJ NO* Program Office *Notice of Corrective Action Sent Date Telephone Response Due On -Site Desk Review Response Received 59 October 2019 — September 2020 EHEAP 203,19 ATTACHMENT V INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST 1, Describe the geographic service area such as a district, county, city, or other locality. If the program/facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided, 2. Enter the percent of the population served by race, sex, disability, and over the age of 40. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American 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. S. Enter the total number of advisory board members and their percent by race, sex, disability, and over the age of 40, If there is no advisory or governing board, leave this section blank. 6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR Part 80. This is usually a standard part of the contract language for DOER Recipients and their Sub -grantees. 45 CFR § 80.4(a). 7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 8, Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record analysis of persons who applied but were denied services or employment. 45 CFR § 80.3 (a) and 45 CFR § 90.1, 9. Participants or clients must be provided services such as medical, nursing, and dental care, laboratory services, physical and recreational therapies, counseling, and social services without regard to race, sex, color, national origin, religion, age, or disability. Courtesy titles, appointment scheduling, and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age, or disability. Entrances, waiting rooms, reception areas, restrooms, and other facilities must also be equally available to all clients. 45 CFR § 80.3(b). 10. For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin, or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race, color, national origin, or disability. 45 CFR § 80.3(a). 11. The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non-English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services. 45 CFR § 80.3(a), 60 October 2019 — September 2020 EHEAP 203.19 12. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries, or any other interested parties. 45 CFR § 80.6(d)This should include information on their right to file a complaint of discrimination with either the Area Agency on Aging for Southwest Florida, Inc. and/or the Florida Department of Elder Affairs or the U.S. Department of Health and Human Services. The information may be supplied verbally or in writing to every individual or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility. 13. Report number of discrimination complaints filed against the program/facility. Indicate the basis, (c.g., race, color, creed, sex, age, national origin, disability, and/or retaliation) and the issues involved, (e.g., services or employment, placement, termination, etc.). Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state, or federal agency with whom the complaint has been filed. Indicate the current status of the complaint ( e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc.). 14. The program/facility must be physically accessible to mobility, hearing, and sight -impaired individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps, and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, and information and admissions offices should be accessible. Door widths and traffic areas of 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. 15. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self - evaluation to identify any accessibility barriers. Self -evaluation is a four -step process: a. Evaluate, with the assistance of disabled individuals(s)/organization(s), current policies and practices that do not or may not comply with Section 504; b. Modify policies and practices that do not rneet Section 504 requirements. c. Take remedial steps to eliminate the effects of any discrimination that resulted from adherence to these policies and practices; and d. Maintain self -evaluation on file, including a list of the interested persons consulted, a description of areas examined, and any problems identified, and a description of any modifications made and of any remedial steps taken 45 CFR § 84.6. (This checklist may be used to satisfy this requirement if these four steps have been followed.). 16. Programs or facilities that employ 15 or more persons shall adopt grievance procedures that incorporate appropriate due process standards that provide for the prompt and equitable resolution of complaints alleging any action prohibited by Part 84 of Title 45, CFR § 84.7(b). 17. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Part 84 of Title 45 CFR § 84.7(a). 18. Programs or facilities that employ 15 or more persons shall take appropriate initial and continuing steps to notify participants, beneficiaries, applicants, and employees that the program/facility does not discriminate on the basis of handicap in violation of Section 504 and Part 84 of Title 45, CFR. Methods of initial and continuing notification may include the posting of notices, publication in newspapers and magazines, placement of notices in publications of the programs or facilities, and distribution of memoranda or other written communications. 45 CFR § 84.8(a). 19. Programs/facilities that employ 15 or more persons shall provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary to afford such persons an equal opportunity to benefit from the service question. Auxiliary aids may include, but are not limited to, brailed and taped materials, interpreters and other aids for persons with impaired hearing or vision. 45 CFR § 84.52(d). 20. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement, and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR Part 60 and Title VI of the Civil Rights Act of 1964, as amended. 61. October 2019 -- September 2020 ATTACHMENT VII BACKGROUND SCREENING EHEAP 203.19 'i ut_rntrr�l It>�- crE� t E BACKGROUND SCREENING ELDER; !AFFAIRS; Affidavit of Compliance - Employer sTATE OF FLORIDA AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes. ➢ The term "employer" means any person or entity required by law to conduct background screening, including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability Resource Centers, Lead Agencies, t.ong-Term Care Ombudsman Program, Serving Health insurance Needs of Elders Program, Service Providers, Diversion Providers, and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider, See 0 435,02, 430,0402, Fla. Stat. ➢ A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client's living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilitiies; and volunteers." § 430.0402(i)(b), Fla. Stat. ATTESTATION: As the duly authorized representative of Employer Name located at StreetAddress City State ZIP code I, do hereby affirm under penalty of perjury f Jame of lwpresentative that the above named employer is in compliance with the provisions of Chapter 435 and section 430,0402, Florida statutes, regarding level background screening. Signature of Representative STATE OF FLORIDA, COUNTY OF Date Sworn to (or affirmed) and subscribed before me this day of 20_, by (Name of Representative) who is personally known to me or produced Print,Type, or Stamp OomrrfsslonedName ,oiNotary Public Notary public as proof of identification. DOEA Form 235, A(Rdavlt of CDmptiarxe - CmPIoyer, Effective April 2012 Sacdon 435.05(3), F5. Form avOabie at: ht iillrl<icF aflalrs.s�.vf,:,€Ltis/e>�;€idiLa }dun :r:reeaiir ' 62 October 2019 — September 2020 EHEAP 203.19 ATTACHMENT IX ANNUAL BUDGET SUMMARY AND DETAIL EMERGENCY HOME ENERGY ASSISTANCE PROGRAM for Collier County Board of County Commissioners Collier EHEAP ADMINISTRATION BUDGET $ 6,110.19 EHEAP OUTREACH BUDGET $ 10,295.01 EHEAP CRISIS ASSISTANCE $ 56,813.67 TOTAL $ 73,218.87 Projected minimum number of individuals to be served Energy Assistance* 204 *Eligible households may be provided with one benefit per season up to six hundred dollars per benefit. The minimum number of consumers may reflect duplicated consumers if a consumer receives a benefit in both seasons. 63 October 2019 - September 2020 EHEAP 203.19 ATTACHMENT X EHEAP ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL w Ink CONTRACT # Emergency Home Energy Assistance Program Administrative & Outreach Expense Budget Detail AIDD . . SO.00 SUO SUM __....... _-__.------_--- S0.00 SOM - _ SU.00 S0.00 00 S0.00 S0.00 SU.00 -- S0.00 50,00 'I'ar<ti �O.DD Ad:inh-tistradon Subtotal $ Outreach Subtotal $ - 'I owl October 2019 - September 2020 EHEAP 203.19 ATTACHMENT XI RECEIPTS AND EXPENDITURE REPORT EMERGENCY HOME ENERGY ASSISTANCE PROGRAM PROVIDER NAME, ADDRESS, PHONE# AND FEID# Program Funding Source: THIS REPORT PERIOD FROM: EHEAP CONTRACT (Emergency Home Energy PERIOD: 10/01119-09130120 Assistance for the Elderly Program) CONTRACT # HP019 REPORT # PSA# 8 CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth To the best of my knowledge, all CIRTS is acccurate and correct. Prepared by : Date : Approved by : Date PART A: BUDGETED 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 #DIV10I 2. Interest on Agreement Funds $0,00 $0.00 $0.00 0.00% 3. TOTAL AGREEMENT AMOUNT $0.00 $0.00 $0.00 #DIV10! 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 4DIV1O! 2. Outreach $ $0.00 KOO #DIVIO! 3, Crisis Services $ $0.00 $0.00 #DIV101 4. Weather Related Services $ - $0.00 $0.00 #DIWOI 5. Weather Related Administration $ - $0.00 $0.00 0.OG% 6, TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIIN01 DOEA FORM 105p revised 12/08 October 2019 - September 2020 EHEAP 203.19 ATTACHMENT XII REQUEST FOR PAYMENT REQUEST FOR PAYMENT EMERGENCY HOME ENERGY ASSISTANCE PROGRAM Contract # -HP019 CONTRACTOR NAME, ADDRESS, PHONE=# and FEID# TYPE OF REPORT: Request Period - PSA # AdvanceRequest Report# Contract # - HP019 Reimbursement Request X Contract Period_10101119-09130120 CERTIFICATION: I hereby cenify that!his request to_ the best of yry knowledge to be comptete and correct and conforms with the terms of the. above contract. _ To the best of my knowledge, ail CIRTS Is accurate and ogrrect. - Prepared by: Date: Approved by: Date; ADMINISTRATION PARS A: BUDGET SUMMARY ADMINISTRATION OUTREACH CRISIS _ WEATHER WEATHER TOTAL ' SERVICES SERVICES SERVICES RELATED RELATED $0 00 $0.Do -- $0.00 $0,00 $0.00 $0.00 1. Approved Contract Amount -- 2, Previous Funds Received for $0.00 $6,60 $0.00 $6,06 $0.04 $0,00 Contraet Period ... . . a. Contract Balance pine 1 minus line 2) ............. .......... ___- ----. , ....... SO 00 ............. ...., ,- 50.04 .. ..._... $0.00 ..0 - $0.04 ---- ...,.,. $0 00 _ .. - $0 00 ...... ........ 4. Previous Funds Requested and Not $0.00 $0,04 $0.00 $0.00 _ _ $0.00 $0.00 Received for Contract Period 5. Contract Balance (line 3 minus line 4) $0,00 $D 00 $0,60 $0.00 $0.00 SO PD PARTS: CONTRACT FUNDS REQUEST 1. Anticipated Cash Needs $0.00 $0.00 $0,00 $0,00 $0.00 $0.00 (1st - 2nd month, Attach dustificatlonl - -- 2, Net Expenditures For Month $0.00 $0.00 $0.00 $0.06 $0.00 $0,00 (DOEA Form 106P, Part B, Line 6) 3, TOTAL $0.00 .. . _ $0.00 S6.00 ..._ ... $0.00 _ _...,. .....,. $0.00..... __$0.04.,.......... PART C; NET FUNDS REQUESTED 1. Less Advance Applied $0.00 $6.00 $0.00 $0.00 $0.00 $0.00 2: TOTAL FUNDS REQUESTED. - _. .., .....,. .$0.66 $0.00.............. ...$0.00 --_ ---$6.06... ............... $0.00-........ __- $0.Ot1,....,....,.., (Part H, L€rm 3 minus Part G, Line 1) PART D: SERV€CE INFORMATION Number of individuals {units} served with crisis energy assistance during the report month: 0 .,. Number of individuals ineligible Dr denied assistance during the report manta. _ 0 Number of Individuals served by referra€ to other community resources for energy during the report month. _ 0 Certification statement: Contractor hereby certifies that it has been open and operating during Its normal business hours for the reporting month, as described In the Statement of Work section, of the EHEAP contract, DOEA FORM H_1SP redsed 410147 66 October 2019 — September 2020 INVOICE REPORT SCHEDULE Report Number Based Upon 1 October Advance* 2 November Advance* 3 October Invoice 4 November Invoice 5 December Invoice 6 January Invoice 7 February Invoice 8 March Invoice 9 April Invoice 10 May Invoice I I June Invoice 12 July Invoice 13 August Invoice 14 September Invoice 15 Final Request for Payment * Advance based on projected cash need. EHEAP 203.19 ATTACHMENT XIII Date Due to the Department Upon receipt of executed contract. Upon receipt of executed contract. November 09, 2019 December 09, 2019 January 09, 2020 February 09, 2020 March 09, 2020 April 09, 2020 May 09, 2020 June 09, 2020 July 09, 2020 August 09, 2020 September 09, 2020 October 09, 2020 October 15, 2020 Note # 1: Report #1 and 92 for advance basis invoices, cannot be submitted to the Agency prior to October I or until the agreement with the Agency has been executed and a copy sent to the Agency. Actual submission of the vouchers to the Agency is dependent on the accuracy of the Receipts and Expenditure Report. Note #2: Report numbers 5 through 14 shall reflect an adjustment of one -tenth of the total advance amount, on each of the reports, repaying advances issued the first one or two months of the agreement. The adjustment shall be recorded in Part C. I of the report (ATTACHMENT XH). Note # 3: Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the Agency, payment is to accompany the report. Note #4: ALL Expenditure Reports are due by 12:00 p.m. on the 9" of each month. IF the 9th falls on a Saturday, then the report will be due by the 81h by 12:00 p.m. AND IF the 9th falls on a Sunday, the report will be due by the loth by 12:00 p.m. Actual submission of the vouchers to Dept. of Elder Affairs is dependent on the accuracy of the expenditure report which is verified and paid by CIRTS data only. r 67 Ci October 2019 — September 2020 EHEAP 203.19 ATTACHMENT XJV LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) POVERTY INCOME GUIDELINES' EFFECTIVE OCTOBER 1, 2019 PEOPLE IN THE HOUSEHOLD 150% 1 $183735 2 $25,365 3 $31,995 4 $38,625 5 $45,255 6 $513885 7 $581515 8 $65,145 For each additional person in the household with more than 8 people, add: $ 6,630 1. *These figures are based on the 2019 U.S. Department of Health and Human Services (HHS) poverty guidelines published in the I ederulRegisler on February 1, 2019. 68 October 20 19 - September 2020 LIHEAP PAYMENT MATRIX EHEAP 203.19 ATTACHMENT XV LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM PAYMENT MATRIX -.FY 2019/2020 HHS POVERTY LEVELS BY HOUSEHOLD SIZE AND INCOME HOUSEHOLD INCOME IN DOLLARS PER YEAR NUMBER OF 50% of Poverty or Over 50% of Poverty At least 75% but no more than 100% Over 100% but no more Over 125% but no more than 150% PEOPLE IN Less but Less than 75% PovertyPOVetty than 125% poverty HOUSEHOLD At or Below Annual Income at Least but No Greater Than 1 $ 6,245 $ 6,246 $ 9,367 $ 9,368 $12,490 $12,491 $15,613 $15,614 $18,735 2 $ 8,455 $ 8,456 $12,682 $12,683 $16,910 $16,911 $21,138 $21,139 $25,365 3 $10,665 $10,666 $15,997 $15,998 $21,330 $21,331 $26,663 $26,664 $31,995 4 $12,875 $12,876 $19,312 $19,313 $25,750 $25,751 $32,188 $32,189 $38,625 5 $15,085 $15,086 $22,627 $22,629 $30,170 $30,171 $37,713 $37,714 $45,255 6 $17,295 $17,296 $25,942 $25,943 $34,590 $34,591 $43,238 $43,239 $51,885 7 $19,505 $19,506 $29,257 $29,258 $39,010 $39,011 $48,763 $48,764 $58,515 8 $21,715 $21,716 $32,572 $32,572 $43,430 $43,431 $54,288 $54,289 $65,145 9 $23,925 $23,926 $35,887 $35,888 $47,850 $47,851 $59,813 $59,814 $71,775 10 $26,135 $26,136 $39,202 $39,203 $52,270 $52,271 $65,338 $65,339 $79,405 11 $28,345 $28,346 $42,517 $42,518 $56,690 $56,691 $70,863 $70,864 $85,035 12 $30,555 $30,556 $45,832 $45,833 $61,110 $61,111 $76,388 $76,389 $91,665 13 $32,765 $32,766 $49,147 349,148 $65,530 $65,531 $81,913 $81,914 $98,295 14 $34,975 $34,976 $52,462 $52,463 $69,950 $69,951 $87,438 $87,439 $104,925 15 $37,185 $37,186 $55,777 $55,778 $74,370 374,371 $92,963 $92,964 $111,555 16 $39,395 $39,396 $59,092 $59,093 $78,790 $78,791 $98,488 $98,489 $118,185 17 $41,605 $41,606 $62,407 $62,408 $83,210 $83,211 $104,013 $104,014 $124,815 18 $43,815 $43,816 $65,722 $65,723 $87,630 $87,631 $109,538 $109,539 $131,445 19 $46,025 $46,026 $69,037 $69,038 $92,050 $92,051 $115,063 $115,064 $138,075 20 $48,235 $48,236 372,352 $72,353 $96,470 $96,471 $120,588 $120,589 $144,705 LIHEAP HOME ENERGY BENEFIT' $300 to $475** $250 to $425** $200 to $375** •"Additional Ass[stnnce if applicant household incltides: l) Elderly $50 2) Disabled $50 3) Applicant with child age 5 or younger: $75 These benefit levels are effective October 1, 2019 These figures are based upon the 2019 U.S, Department of Health and Human Services (HHS) Poverty Guidelines published in the Federal Register on February 1, 2019 69 October 2019 — September 2020 SOURCES 'OE L COAME EHEAP 203.19 ATTACHMENT XVI LOW, il* C M HOA r=:NE:RG i` SSISTA2 CE1'ltOGRAM (LITTEAP) FFr'FECTn-E OOTOSE}i'1, Zia,') iI TGI�t� t =L r-D SOTURCE-5 OF WCOME, doU1ai::10ES or- INCOME 4123clude-- total are ual cash se.caiDu befotc t:n---cs f'xo= an re:'. J. hrotae-rums m-,A mbidts, befcEr T,, dediactiaa. ?, x3e sect pt #a ®ux u=-fmn tmp3icL�-pts �yc:is,s�'s •�x�,n v�dcrpaxa�tcd ki�.xGiu.e�s:,,.pxsfxr..aisrl enrerpri..e, axx prxtnenwe, after dedsz*faus FRr butinea: expeua:es`i �+. Iti'rt xec�.i�s#5 ==r_lt§i fxrix ;cl%-ircpirsFnro-u# q`.r�lp�s. � -;,,., R .f ann whida:aue: ptza#e a: a commr_r, aenter, a-r a�rop er_, a.itax de?=,E-,,m Fn=- carat optradagg e�ea;e.5 �nx•i: �.a�nu:iF iu� °?rv„d - .t a rir cssv-gar; '�.ue:mplo,:�mtn3 =rsri�sesa3�:u �txi.. L�rseFs�:s £cui iwian fixed t: '�Cryr�cc", c�:ixx�rra.snricn llubl cA.kmmaa os $aa Need. Fx=Wac. �ji sue, ��xpp7e eut?1 5 vu�it Eue-amrr, •ae;: G-cnv--d .4"�S3 3im nce ,ar > rrlh F -U?m is pa,,-txaeaa#t. S. my=eam, to :cs:ter ri filsrr; ago I8 a_ o3drz ed s21--la tee Lade ae deA t Tsx-ux is_o�== 6. `rs:ti,aing :ripen& E. AamanT d, 'ClimUci Suppyut ccszl SevaZkT Senmfit Ca tsi:'rs forI7a safvae r CIE $aal-Lonam. (r- a tatnl mmaunr C'tt4* $06;x 5ectw:tr yeti e -T-ft beicFcilicludimg.:.rl^ m;:i::is}Y.ed iletl:uz�mm must bt sis ^t1srn •r.lclvd. i-ig rppiii�mi 5 issc;o t.) MA, AlEh-=y mar=l. j .:i?'•araaeu: or der xqp-lin a1pporz frzm a'fua:xi7;ul-sbex or:omemne uc lirixg% TI-it 4e=,--hold I'l. Fli are Pe ioac 1,3. Gt-er=-neQT',—Fls✓fea peuazcux• iln'4LLa g m2i'arT retirc�uueut pig. 3. '' aci7ac iusututice -ru u tc pa, aaeu� .4.. E-rmnji u:ri ...z3sra�ec: �ra�.:, Fe:L�arx-;,lip•,, t�r.yiserur:Lipc, �.c,31 ar a3 �L. r3Lvt r=r�--n n Only coics3C-D rohfftxuL- UY 2i P"Itrl for lii is l t cts es I.-;) - Dividends 16- b tt "t 7, hetzt 3ntr3 ;>:arr.t IR_ _i`.et 3vopjdt::� I P, Ft1i0&2 xt.�:ipt. & ,i eli, �te. Or trU=D p.• Wet MEJ3_iva sir 10arCT 2,77 A1 —,e-n d-mwax: d-=-n n • V, �Lrv*s.+;lr. &=l a: o7an:-, nr #ir :ate of proper, N. hh .rase, or T. '�rx 1�e:�;vsrtw 4. i_ra: 5. Lump -,um ilaar i �a & Oae-tjneiwnwanoepy.; raeuts. Fo T,-r �.,Zsre 7 mTm e=-0' _ s e vptm saes x "LL9LU; c+. Comb i acne p.,;1. U�, the x litaxy 1 . Adnpt<, n .rsrilssidiet 1,?. I•UL"�+I•I-G si'3I� EE,I:TJ✓Z'Z' �i� *-r-�nr'•3rei-p,l~� ac zvaeti5 paid psuvcs.�. of �S1tL auzu::a:•ce ac a-.:ae: e�mpi,��ee iit�fi.�;, 1i1 Fc., ' ae �mmmingx,:c jre4inUeltil ofncs cs- fc! T4t of €aed ar..'i fiat pmdw:fd aid comuwarl -ckm h2mi. ` Niue Of rrst.trra e�c�ax acr,sie> nou-,Eu= ox faxm'.imomuk & ;e; 'Fedexml non zasa iseale;bt pD w--=en .u-_-h a.=- 3.lezt ram, 1Secieud Faactt ..eec1 lx�ucl:;sd L1u i asxs�:nce. 13. 5c�ppta rim#sl k��.uriF I�e�rle (*'W lines fa#* crts cs'he V sui bed. fox ;pis' stmca iu i=_.s x ue6prye Lencei erl ran eveil3:ipie= of lbeaxr.fim. 'rAe tat-.] -=o;wt of die =SI bentril niblur doe khed dtel:w--L,or ffo>eik-elAting i%e xpplies �.t - s orrr. Paranuw ciiaosr cxX^st of reaidewM i5 P7.ia :gis is z fa,m,r ca:.r ax xr*:ix9ei tint p=F-=i _ lY is:texed k+r the. scar be Ekut,! hold memubex5- 70 October 2019 -- September 2020 OUTREACH PLAN SURVEY PSA Click he)•e U.) enter trr,A. COUNTY(IES) Click here to enter text. AGENCY'S EHEAP COORDINATOR Click here to es -tor text. PHONE W/EXT. Click here to enter ti?,.J. EMAIL Clicls here to enta r te.A, EHEAP 203.19 ATTACHMENT XVH 1. ELDERLY OUTREACH Describe the efforts to increase the number and percentage of elderly households served. C:lic't here to entrr text. 2. INTEGRATION OF OTHER LOCAL AGENCIES IN OUTREACH Describe what local coordination efforts support outreach activities. Identify agencies, utilities, charities, and others incorporated in these efforts and the activities 'included. Clicl: h -re -to antes• t kxt. 3. ADVERTISING, PROMOTIONAL, MEDIA, AND OTHER PRINT OUTREACH EFFORTS a, Brochures -please select all of the options you currently use in your program from the list below: ❑ Use a locally developed brochure (send an electronic copy with your survey) ❑ Other, please describe Click hose to renter text. How will the brochures be distributed/used (check all that apply): ❑ Display at County courthouse/office building ❑ Provide to Senior Citizen Centers in county ❑ Provide to meal sites in county ❑ Provide to "Meals on Wheels" for distribution ❑ Provide to local utility companies and heating fuel providers ❑ To cooperating local agencies (such as Salvation Army) ❑ Grocery stores or similar businesses ❑ Provide to churches ❑ Provide to hospitals ❑ provide to day care facilities ❑ Provide to local libraries ❑ Laundromats ❑ Provide to banks 0 Provide to clinics October 2019 — September 2020 EHEAP 203.19 ❑ Provide to Head Start Programs ❑ Other: C:lidl hei,,a to enter text. b. POSTERS Please select all of the options you currently use in your program from the list below: ❑ Use locally developed poster (sand a copy with your survey) ❑ Don't use posters How does your agency distribute or use program posters (check all that apply): ❑ Display at County courthouse/office building ❑ Provide to Senior Citizen Centers in county ❑ Provide to meal sites in county ❑ Provide to grocery stores ❑ Provide to iaundromats ❑ Provide to churches ❑ Provide to hospitals ❑ Provide to day care facilities ❑ Provide to local libraries ❑ Provide to other businesses ❑ Provide to clinks ❑ Provide to Head Start Programs ❑ Provide to banks ❑ Other: Click here to enter test. c. PAID ADVERTISING Does your agency use paid advertising to promote the program? ❑ Yes ❑ No (if you answered No — go to Section D) Total Budget for advertising (per fiscal year) $ C lick here to enter t.axt. Does you agency advertise in NEWSPAPERS? ❑ Yes ❑ No Name of Paper Click here to enNi, text, Name of Paper Click here to inter text, Name of Paper Oick here to enter text. City/Location Click "here tr, enter text, City/Location Ciici.: hiN,e to enter text. City/Location Click here to renter text, Frequency or # of times ads are placed per cooling season: Uidhere t{_} enter Text. Frequency or # of times ads are placed per heating season: Clidi here. to enter taxt, When do you advertise (check all that apply)? 72 i October 2019 — September 2020 EHEAP 203.19 ❑ April ❑ October ❑ May ❑ November ❑ June ❑ December ❑ July ❑ January 12 August ❑ February El September ❑ March Do you use the same ad for all newspaper advertising? ❑ Yes ❑ No If not, how many different ads do you place? Cli, lk here to ent; r text. In which language(s) are your ads place? (check all that apply) ❑ English ❑ Spanish ❑ Other (please list) Click here to enter Does your agency advertise In SHOPPERS? ❑ Yes ❑ No Name of Shopper Clicl: l)e�•e to cnter'te;:t. City/Location Click h ,re to enter text. Name of Shopper City/Location Clici, Dare tcs ar�ter text, Frequency or # of times ads are placed per cooling season: Clid• here to enter text, Frequency or # of times ads are placed per heating season: C.licl< Mere to enterrext, When do you advertise (check all that apply) ❑ April ❑ October ❑ May ❑ November ❑ June ❑ December ❑ July ❑ January ❑ August ❑ February ❑ September ❑ March Do you use the same ad for all shopper advertising? ❑ Yes ❑ No If not, how many different ads do you place? C'lid, here to enter text. In which language(s) are your ads place? (check all that apply) ❑ English ❑ Spanish ❑ Other (please list) Click hera to enter try:,t. Does your agency advertise on RADIO? ❑ Yes ❑ No Station Call Letters C:Ikdl: liera to enter text. City/Location Clic k h ra to enter text, Station Call Letters 0,:I, hart} to enter text. City/Location Click here to enter text. October 2019 -- September 2020 EHEAP 203.19 Frequency or # of times ads are placed per cooling season: Oick hQre to enter text. Frequency or # of tirnes ads are placed per heating season: Click hone to eater tf xt. When do you advertise (check all that apply) ❑ April ❑ October ❑ May ❑ November ❑ June ❑ December ❑ July ❑ January ❑ August ❑ February ❑ September ❑ March Do you use the same ad for all radio advertising? ❑ Yes ❑ No If not, how many different ads do you place? C,lir;k hero to crrter' text, In which language(s) are your ads place? (check all that apply) ❑ English ❑ Spanish ❑ other (please list) Click here to enter text, Does your agency advertise on TELEVISION? ❑ Yes ❑ No Station Call Letters Ciick Mere to enter text. City/Location Click hereto er}ter text. Cable Operator Click Mere. tics rater tw-xf, City/Location �iicl; i7er°e tct enter is t Frequency or # of times ads are placed per cooling season: Click here to anter text. Frequency or # of times ads are placed per heating season: Click h xe to eater text, When do you advertise (check all that apply) ❑ April ❑ October ❑ May ❑ November ❑ June ❑ December ❑ July ❑ January ❑ August ❑ February ❑ September ❑ March Do you use the same ad for all television advertising? ❑ Yes ❑ No If not, how many different ads do you place? Ciicl: itt e to errt:r text, In which language(s) are your ads place? (check all that apply) ❑ English ❑ Spanish ❑ Other (please list) £ lis is 13c-rr: t:, encr �e, t. OTHER PAID AVERTISING (Please Describe): Click here t.a enter- tty, t, 74 Y October 2019 -- September 2020 FHEAP 203,19 d, FREE MEDIA PROMOTION/COVERAGE Please check all the appropriate selections related to how your agency utilizes free media promotion/coverage: ❑ Issue Press Releases to local/area media Are press releases sent out more than one time per year? ❑ Yes ❑ No If yes, how often? Click hes-e to enter text. Do you use the same press release each time? ❑ Yes ❑ No ❑ N/A ❑ Prepare announcements for public access television (cable) ❑ Prepare public service announcements (PSAs) ❑ Arrange for on air radio or television interviews ❑ Post information on a County or Agency website ❑ Post information or link to other local websites ❑ Our agency does not take part in any Free Media Promotion Are any of these materials translated? ❑ Yes ❑ No ❑ Spanish ❑ Other non-English languages Web activities: ❑ Post information on a County or Agency website ❑ Post information or link to other local websites e, DIRECT PROMOTIONAL ACTIVITIES Please select all of the appropriate selections related to how your agency completes Direct Promotional Activities: ❑ Direct mail — Anticipated size of mailing(s) Click her,,: to enter taxi. (number of pieces sent) ❑ Telephone promotion {not application taking) ❑ Displays/at stores, malls, etc, ❑ Displays/booths at events (check all that apply): ❑ Home Show ❑ Job Fair ❑ Meal Sites ❑ Health Fairs ❑ Other (please list): Click hers to enter text, Who will you target with your direct promotional activities (check all that apply)? ❑ Aging/Seniors/Elderly ❑ Disabled ❑ High Energy Users ❑ Families with children ❑ Last year's applicants ❑ Homebound ❑ Last year's home visit applicants 75 October 2019 -- September 2020 EHEAP 203.19 ❑ Churches ❑ Head Start ❑ Specific Vendors ❑ Subsidized -housing residents ❑ Other (List) HOME VISITS Does your agency perform home visits? ❑ Yes ❑ No (if no, skip to Section 6, Special Outreach Efforts) Number of home visits conducted last year Click here to en;.=r texi, Number of home visits expected this year Click mare to enter text. Do early applications reduce the number of home visits? ❑ Yes ❑ No Check the criteria used to determine when home visits will be done (check all that apply): ❑ Age ❑ Disability ❑ Transportation difficulties (no car, can't drive, etc.) ❑ Applicant's work schedule ❑ Small children in household ❑ Language barrier/availability of translator ❑ Other (please list): Click hem to enter text. 4, SPECIAL OUTREACH EFFORTS Please check each of the Target/Special Needs populations you are carrying out special efforts to reach from the list below: ❑ The working poor (check all activities that apply): ❑ Evening office hours Saturday morning office hours ❑ Saturday afternoon office hours ❑ Promote at churches ❑ Special phone/mail application efforts ❑ After hours home visits ❑ Promote at specific employers ❑ Other (please list): ❑ Households with young children: ❑ Provide materials to day care facilities ❑ Take applications at day care facilities ❑ Promote at churches ❑ Handouts to school children ❑ Materials for Pediatricians and clinics ❑ Other (please list): 76 October 2019 — September 2020 EHEAP 203.19 ❑ Non -English speaking population, etc.: ❑ Promote through Hispanic groups ❑ Provide brochures/posters in other languages to hospitals and clinics ❑ Promote through religious organizations ❑ Identify local interpreters to use ❑ Have signage at office in multiple languages ❑ Use pre-recorded messages in different languages ❑ Set application site at gatherings and events where minority groups congregate and interpreters are available 5. INTAKE SITES AND TIMES Please select the statement that best fits your application process: ❑ Take applications primarily through appointments ❑ Take applications by appointment and work in walk-ins ❑ Take applications by appointment and have day(s) for doing walk-ins ❑ Take applications primarily through walk-ins and reserve appointments for special needs or problem cases, ❑ Take applications from walk-ins only A _ Idontifv the int;dca sites to he used daliv Wondav through Fridavl Name of Site Area/County(s) Served Hours Also LIHEAP provider? Click hire to enter text, Oick here to entertext. Click here to entertext. ❑Yes ❑No Crick hi the to enter toxt. Click here to inter teat. Click here to enter text, Dyes ❑No Click hei w to enter tt: t. Click here to enter text. Click here to ente.f text. Dyes ❑No Click h:.re to enter text. Click here to enter t(s.3t. Click here to enter text. Dyes ❑No Chck hare. to enter text. Click here to enter text. Grid: het-6 to enter teat. ❑Yes ❑ No C?iCi. here to enter teyt. Click here to enter to t. Click here to en -ter text. ❑Yes ❑ No Click hero to ether fc¢'x.t. Click 11�'re to entertext. Click h;?re to entertext. ❑Yes [I No chef hers to €hritertaxt, Click here to entertext, U=d< 11to entertext. Dyes ❑No Crick here: to tinter text, 0i:k. here to cuter text. C.Eck herb to enter text. Dyes El No �. n ,t> to entef Click h_re to Crick here to enter t� xk. r . E..:ig�1<, ee's. to enter text. ❑Yes El No Click I er to entert xt, Click I :r=v to entertr::t. Click here to entertext. ❑Yes El No CIlCI 11£:t'0 to enter tex"t. Click I' el'. tL'6 enter tc;it< Click heree, to anter te,xt,❑Yes El No Click hers to enter text. Clicl, here to €ant(?r text, Click here to enter text. ❑Yes El No Click hiL re to cmt r text. Click here to enter text, Click here. K) enter text. ❑Yes El No Ckck, here to enter text. to enter ie;;t, Crick here to enter text. ❑Yes El No h. Irip. ntify the intake sites to be used reeulariv, as In once a week, twice a month, etc. Name of Site Area/County(s) Served Day(s) of Frequency Hours Also LIHEAP Week (time/??) provider? Click here ire (.liter text. Click here to enter text. Clitk hr:re Click here Clicl< here to ❑Yes []No to enter to enter entertext. text, t-ext, 77 ( October 2019 — September 2020 EHEAP 203.19 C'licl: here to enter text, Click here: to enter text, Click here Clicl here Click here to []Yes ❑No to e€rater to e rite enter text. text. text, Cl cl< here to enter text, Click here to enter text, Click here Click here Click here to ❑Yes ❑No to e€liar to entour entwrtext. text, text. Cl=cl< here to enter tex+. Click hare to anter text. Chc'l, here Click here Click hc-r-a to ❑Yes ❑No to M; ,ter to enter enter text, t pxt, t$}:t. Click here to enter text. 06 here to inter text. Ciicl; here Click here Click here to ❑Yes ❑No to enter to enter enter text. text. text, Click itar� t-- enter text' C'hcl, hz re to enter text, 01M, here (:lick here Clicl, here to ❑Yes ❑No to enter to enter enter text. text. text, Click to ent': r text. Chc(_ her-. to ,?nt;: r text. Cfic3; here Click here Click here to ❑Yes ❑No to o n'.er to t'mtor Ili?r i£'xf. text, text. chrl: 11-�21e to en;te'( te7e. C k:k hens, to'3ntor text, C tk hero.. Click horc, dick herc- to ❑Yes ❑No to eater to enter enter ti :xt< t4.xt' text, c. identify other sites to be used. Name of Site Area/County(s) Served Day(s) of Frequency Hours Also LIHEAP Week (time/??) provider? Click hel e to enter text. Clicl•_ here to enter text. Click h re (:lick here Click here to ❑Yes ❑No to enter to enter en;»r text. text, text, Click here to enter text, Clic1, here to enter text, Click here Click hero i_]iCi: here to ❑Yes ❑No to enter to eater e111'e€'t4?XT. text, te'xL Click 1'€e! e to sister ti xt. Click here to ellt.cl' tc- t. Click hire Click here: Click h,wre to ❑Yes ❑No to 01115!" to enter or:r-r text, taxtr text. Click here to enter text. Oick here to enter tc-yt. Click here Click hire Click here to ❑Yes ❑No to enter to anter enter text, tttxt. text. Click to enter text. Click here to enter tcxL %licL I.iere Click here Click here to ❑Yes ❑No to 9ri'te r to e ntsr enter tf--Xt, text, teXL d, planned extended or flexible application times. Area/County(s) Served Day(s) of Frequency Hours Also LIHEAP Week (time/??) provider? Evening Hours Click hr-1•e to ernter text. Clic1, herE Click her;: Clack here to []Yes ❑No to eilter to enter enter text, text, text. 78 October 2019 — September 2020 EHEAP 203.19 Evening Hours Click here to enter text. lick hole Click hers Oick here to Eyes ❑Na to enter, to enter enta.r t:eA text, text, Saturday Hours Click here to enter text. C1ir.l- h,,5re Click here Click here to ❑Yes ❑No t'.) troter to entc1, snter text. text, text, Other Click h�>re'to enter text, Click hexe Click here Click here to ❑Yes ❑No to Er•rtc.r to enter enter text. text, text. e. Days Offices are Closed Check all holidays the agency is closed: ❑ Columbus Day ❑ Veterans Day ❑ Thanksgiving ❑ Friday after Thanksgiving ❑ Christmas Eve ❑ Christmas Day ❑ New Year's Eve ❑ New Years Day ❑ Martin Luther King, Jr,'s Birthday ❑ President's Day ❑ Good Friday ❑ Memorial Day ❑ independence Day ❑ Labor Day ❑ Other (Please List) ❑ Click here to enter test. ❑ Click hE:re to enter text, ❑ CI Iz.I< Mere to enter 2e t, 6. SENIOR STAFF WORK SCHEDULES Plp;; p nrovide the regular weekly office hours for the followine: Title Name Mon Tue Wed Thurs Fri Executive Director Click, her: to enter text. Click Click. Click ckck Click Were to here to here to here to here to erne; enter enter enbt .,r enter text, to ;t, text, tr,-.?Ct:, text, Chief Financial Officer Clict,; here to enter text, Click ChclS C:lici� Click Click; here. to herr- to here to here to here t'n rnter enter Enact" entc-1, ent,?r text, text. te<<t. text., text. EHEAP Program Click here to antert,2=xt, Click Clicks Click; Oink Click Coordinator herw to hers to here to here to hero to 79L.' October 2019 --- September 2020 EHEAP 203.19 € nteI enter en,er enter entor I text. tex I ti_}t. text, text, 7. OUTREACH ASSESSMENT/EVALUATION Do you survey your applicants to assess the effectiveness of outreach efforts? ❑ Yes ❑ No Surveys are targeted at ❑ Elderly ❑ Handicapped/disabled Households with young children ❑ Non -English speaking households Surveys are not targeted ❑ Yes ❑ No Do you track numbers of applicants at each outreach site? ❑ Yes ❑ No Each time the site is used? ❑ For all visits combined? ❑ Do you compare types of outreach sites? ❑ Yes ❑ No What is the most effective type of outreach site? (For example: senior center, library, town hall, fire station, housing facility, etc.) Oi6,, hei3 ? to enter tr'xt, Do you track the number of home visits? ❑ Yes ❑ No Do you track the reason for doing each home visit? ❑ Yes ❑ No What other way do you assess the effectiveness and success of your outreach efforts? C.licit h�r� tr3 e; rf�€ tr xt, 80 (- �� October 2019 — Sept=4� Q EHEAP 203.19 APPLICATION AND ELIGIBILITY WORKSHEET ATTACHMENT XVIII rNmeruenry Hom.i- tilerg -.,-ImAnce fr4ir 44m, 04eHy On v As gram - Appilicalluo Rpm — lid NIR"I HAM, lrhtmw.rsws o,ie S'Ex U Wj-t� 1-1 e Wt10-,j,4: F112.V0. IJ 'wril( ME61 13 spin Wkfli, 4.1 AW IJ hdik"Norm M Eii IA pilh C.1 �P.111 011,L, 17.1- —0111 F le isp miss A 40=01 r! V%A Fit us %u(w1,vMokm 1-1 Nut 171 W4 ncu luane am emu umume qpqy� Qvwy JVQ) Hunt Fo , A5 7 1K SSN: OUR 101,10S win -un %I lw lo"W"OW J Rh p M "Itcflirl akiM ifvyy "Mm!t-313 !$ 11W Own 044"M hep in fps"M" usymm"s, viah iss Sginve AV 1; VIR r. N,') -LI N — ------ '1 the rlok..nl ,,,r+qry U, Njw,,� huniv-3,7 f,-k.r! c"11(.1 F.1 01,10'riit'. I-114;Mfi lj;1tCp,-cr tw7jlseind RTM., ST (al life n ymm mm" v ni,4:jr� eiii 4u�iiruvu; Luizii 10 pow bow H AM "M J 1,fct) V ft, -!y k, P 1.i 6ov s?x-i i1r uni'litnT {D wav v ii—p*lsil s-lu.r 4N<,4j1i r-T VC n Mom not *,i{v*ffjk, i-WIVII, ((;f Diii 01 11,i�r,1109 I10,q f U10"'M 81 - — Q ') `1) October 2019 — September 2020 EHEAP 203.19 rmrpm ofme:)" A.Y%g1-s;1:tMea ftr 1ho El dow tv ptLl)worn -FliffivAl IIVWCOM111004: 9. M.111 III... q L�l ttL 91L�l It I 9� JiTC;71 A I C'Y.0 t;-.Vs at -A 11ratischoM B�Arjs 7 A00 :�,$nfiz:.wv ' FV1,-, (s:-.)�, -ml 00, IR00104 rl L�,'A 0100T r. ... .... A 7o iiimaa,%;,,p, Is L- M11IWPI4 khaf t,?. I Z III ur,9—, 5� 15 1 fi IN-." SFI (01r Ill, —F1 "P3M, U1 Okuhf L ... .... ... . .. . fv� Ad arufzj tweWbA A nIik:ti, rA II.. t.5 _� I lww i& i fl- k k vJ � !4I.W. 4 kSI a A L k, 11 "Ci i Iljs i:A (0 1. 11 t4h -�4 Olt ii[SAt£rlria mw I er I n& N) 3 �a 6. i r!) I Ir flee, 1f A. 'M W hkt I WO I., U. owvlrOk �1. 1i 0ijLAP."1qAkt-,.Sr ""te Auc N11,ILLf, H;r jw� 410A IVA ire, e,,r, I". MIMI C'.1 MIA N-w tht- md--r-g- lhr,,r t,,,t �;wmhitqj VxtA-;, I I.Alil Glttw To"] C111-07i V;,mlm5 s M Ina (-,Lqio %,, nA Dirt of Un- auldca"IS7 121 L-qq IiLi40), 11 PFCOULz mirrin or hi:I , G r*,Q*j -7 rho (-u— viwj�y Wnlk-1 14.,'I 41 Milint Jfi:31 �vsn ji} L I M 1;MX.M. jum; gagriljmal —knirm. MY!& r1pZ) T.D�IIWA 1v VVA F T C1 yeas C Nu mm€ Ipt-e c5pgNn. j.)j 10 h 1, 1 V0 i nj A4141 k- LI-11 —Atv 1r I— i5mv,,jW-1 o-,,E ow" a K"(F9, ))I' i"ilk"y Ue0 illq (<.,Cl V11-a k� I fto Pf ;41(,(i N i . 41L�11 ........ . . . ..... p . .. ft.rA . 82 October 2019 — September 2020 EHEAP 203.19 ATTACHMENT XIX EHEAP APPLICATION AND ELIGIBILITY INSTRUCTIONS Department of Elder Affairs Emergency Home Energy Assistance for the Elderly Program (EHEAP) InstructionsEHEAP Applicatnol]- Section One: Annlicant (Age 60 and older) Information Complete Section One in its entirety, Special notes: ✓ The ©ate Stamp is the official application date; ✓ The Intake Worker (with name and phone number recorded) is the person who accepts the application and required documentation; ✓ The applicant's income type(s) and monthly income amount is recorded in this section, and ✓ if any field is determined to be not applicable, complete the field by entering N/A. Section Two: Additional Household Members Informpfilrgr1 Complete Section Two by listing additional household members and providing the information requested. Special notes: ✓ At a minimum, the name(s), age(s), and Social Security number(s) of each additional household member is required; ✓ You will be attaching a calculator tape of the household's income calculations in the section provided on the EHEAP Eligibility Worksheet; and ✓ if any field is determined to be not applicable, complete the field by entering N/A. 5e0on Three: Househgld Characteristics Complete Section Three by answering each "Yes" or "fro" question and providing additional information if applicable. Special note: ✓ if any field is determined to be not applicable, complete the field by entering N/A. Section Eourw Heating and Coglong-Information Complete Section Four by answering each question. Special note: ✓ 1f any field is determined to be not applicable, complete the field by entering N/A. Section Five: Energy Crisis ExnlaLIation Section Five is completed by choosing the best possible explanation for the applicant's crisis and obtaining their signature and date of signature. Special notes: ✓ All life -threatening crisis explanations must be acted upon, with an eligible action to mediate the crisis within eighteen (18) hours of the application date stamp. ✓ All standard crisis explanations must be acted upon, with an eligible action to mediate the crisis within forty-eight (48) hours of the application date stamp. ✓ If any field is determined to be not applicable, complete the field by entering N/A. 83 �,x} October 2019— September 2020 EHEAP 203.19 Client Attestation and Signature The applicant should read the attestation statement. If the applicant is unable to read the attestation statement, the intake worker should read it to them before they sign and date the application. At this point, the intake worker should have the applicant sign the waiver authorizing the release of general and/or confidential information for LIHEAP/EHEAP federal reporting. CIRTS will require you to verify that either the waiver has been signed or that the client has refused to sign. EHEAP Eligibility W rk he t Insiructions Section Six: Income Eligibility DeterL13ijnatoon Complete Section Six by stapling the calculator tape in the space provided, entering the annual income, and checking the appropriate number of individuals in the household to determine the household annual income limit. Special notes: ✓ Adjacent to the annual income limit by household size is the fifty percent (50%) of poverty amount by household size. If the annual household income is below the amount for the household size, AND the household does not receive SNAP, the applicant must provide a written statement of how basic living expenses are provided for the household. ✓ if any field is determined to be not applicable, complete the field by entering N/A. Section Seven: YeLidar. Benefit, andif' i n Information Complete Section Seven by completing in its entirety. Special notes; ✓ The minimum amount due is the amount provided to you during the verification process with the home energy vendor. ✓ For those applicants receiving an energy subsidy, the minimum amount due will be reduced by the energy subsidy amount listed on the applicant's public housing lease to determine the total EHEAP benefit. The energy subsidy is deducted from home energy vendor payments only. ✓ Water, sewer, garbage, and fire, etc. MAY NOT be paid with EHEAP funds. Utility bills that include charges that are not directly related to cooling and heating will be reduced by the amounts for these charges. ✓ It is allowable to make several crisis benefit payments for a household to resolve a single crisis. This may include the purchase of blankets, portable fans, space heaters, and/or repair of existing heating/cooling equipment, in addition to energy bill assistance, that combined does not exceed the maximum crisis benefit of $600. ✓ Crisis situations that involve a heater or air conditioner that is powered by both gas and electricity are eligible for a crisis benefit payment to both home energy vendors, that combined does not exceed the maximum crisis benefit of $600. ✓ Allowable utility categories for heating/cooling bill assistance include the following: :�. Utility payments for heating/cooling bill assistance for electric, gas, propane, wood, coal, or refillable fuels; b. Temporary emergency shelter (if needed due to energy -related crisis); e. Payment to landlords (when utility costs are included in rent); a. Repairs or replacements to heating/cooling units (as long as the amount is within the benefit limits and work is done by a licensed contractor); 84 �� October 2019 -- Septexber 2020 EHEAP 203.19 e. Deposits to connect or restore energy; f. Late fees, disconnect fees, and reconnect fees; g. Charges from a previous account held by the applicant that is now closed; t,. Blankets and fans, ►. Taxes and fees associated with the client's utility bill towards the energy portion. In some cases, where the utility vendor combines all the other fees and taxes, which also includes non -home energy services, such taxes and fees can be paid with EHEAP funding. Example: In a case where heating and cooling taxes are commingled with other service taxes, proceed with paying the taxes portion of the bill. j. Other allowable payments are those related to the start-up of services, including reasonable connection or reconnection fees, delivery fees, deposits, and other fees related to the start-up of service. ✓ If any field is determined to be not applicable, complete the field by entering N/A, Section Eight: i Program -Referral Complete Section Eight in its entirety. Special notes: ✓ When determining the number of LIHEAP or EHEAP crisis benefits the applicant has had, you will include the current application in the count, provided the application is approved. Refer back to Section Seven, to the information obtained from the LIHEAP provider. ✓ If any field is determined to be not applicable, complete the field by entering N/A. Section N' i C i Complete Section Nine by selecting all that applies to this applicant and application for services. Special notes: ✓ The left-hand selections indicate that the application has been acted upon within the eighteen (18) hour / forty-eight (48) hour requirement. ✓ If the selection is made to deny the application pending additional information from the client, the 18148 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 Wor�gr Signature To complete this section, the individual who completes the EHEAP Eligibility Worksheet, determines income eligibility, and provides the commitment to the utility vendor must sign and complete the requested information. Special note: ✓ If you are the applicant, or a friend, relative, or employee of the applicant, you cannot determine the eligibility or award EHEAP benefits. This application must be processed by someone who is not the applicant or a friend, relative, or employee of the applicant. To complete this section, the signer is attesting that he/she has reviewed the application for completeness, determined that all required documentation is included, and verified that the annual household income calculation and EHEAP benefit awarded are correct. Instructions for DOEA Form 114---10/l/2019 85 October 2019 -- September- 2020 EHEAP 203.19 ATTACHMENT XX Tr MER E.NC !' HOME. ENERGY ARRIWANCF FOR THE ELDERLY CLIENT' FILE CONTENT CHECKLIST ELDER'S NAME — - - PSA# - AGENCY APPROVAL DENIAL NAME OF WORKER APPLICATION DATE. CRISIS RESOLUTION DATE CHECK DATE PROGRAM RF.QUIRFMENTS MONITORED 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. Client file contains documentation of Social Security numbers for all household members, or citation 5 to the applicable exemption. 6. Client file contains signed notice regarding collection of social security number(s). 7. The client file contains official income documents for all household members. If income is self -declared, is there a self -declaration form signed by each individual household 8 member (18 years of age or older) lacking income verification or claiming zero income? The household's total grass income is calculated correctly and is at or below 150% of the OMB 9 Federal Poverty [,evel for the household size. Statement of how basic living expenses (i.e., food, shelter and transportation) are being provided if 10. total household income is less than 50% of the current Federal Poverty Guidelines and no one in the household is receiving SNAP assistance. Checked that elder does not live in student dormitory, adult family care home, Or any kind of group ] 1 living facility. Verified and documented household has not received LIIIEAP Crisis Assistance during the, same 12 healing or cooling season. 13. Documentation of Weatherization Assistance Program (WAP) referral, if applicable. Copies of fuel bills, or other supporting documentation as proof of energy crisis, for the residence in 14 which they reside. 15, Signed copy of Authorization for Release of General and/or Confidential Information. 16. Only eligible components of the utility bill are paid to resolve the crisis. Only the minimum necessary to resolve the crisis is paid. If a different amount is required by the 17 utility company, provide additional information on the Eligibility Workshect. Crisis energy benefit was reduced by unallowable charges, such as: water, sewer, garbage, fire, etc., if 18 applicable. 19. Crisis energy benefit was reduced by energy subsidy, if applicable. 20. Energy crisis resolved within 18 hours by an eligible action. Written notice of approval or denial for services that includes appeal procedures is issued within 15 21 working days of eligibility detemiination. 22. Appropriate benefit provided, at or below $600.00. All required sections of the application are signed and dated by the elder, staff, and supervisory/peer 23 PRIOR to payment. 24, Proof of payment to vendor. 25. Place completed DOEA Form 211 (1010112019) in client file. INSTRUCTIONS: A clicck mark in the Yes column indicates (lie requirement has been met. A check mark in the No column indicates the requirement has not been met or is questionahle. Each "No" ninrit must be explainer) under" COMMENTS", Supervisor/Peer Signature Consumer File Monitoring Date DOGA FORM 211 I010112019 p Q6 October 2019— September 2020 u EHEAP COST REIMBURSEMENT SUMMARY Contract # Report Period; EHEAP 203.19 ATTACHMENT XXI TOTAL ADMINISTRATION $0.00 87° �) W M, I1M R P L' a [Y N y Sda C Ip V C N � C � r' 'J T .p li O d a � u a y e tl U � o p o n W � 6 'p r ryQry d W 00 F �4 OI 00 A � DO a kl � y � O AN G. N RC a v u J C N tl O N r N Yiapinold I{>I 1Af1 9 u UGIleilsluIwP11 11111111111111 11111111111111 91111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 11111111111111111111 IIIIIII��II�IIIIIIII \ \ \ s \! c ©!•�\�:::$!$la.r :} 'td{!LC\§ �yi��y\ ) � ) \ 4 \ F ( f ! 7 } ] ! t �k a mi }� !k }} �} (\ §k »S .! §7 ! ) d1 k \ + ! ®t § § 2 §) { 3 2 o a M. /V\ October 2019 — September 2020 SERVICE RATE REPORT EHEAP 203.19 ATTACHMENT XXIII PROGRAM: EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PRORAM (EHEAP) Federally Funded From 10/01/2019 to 09/30/2020 Category SERVICE METHOD OF HIGH REIMBURSEMEN UNIT PAYMENT T RATE TYPE Administration ADMINISTRATIVE Cost Reimbursement Cast Reimbursement EPISODE COSTS* Outreach OUTREACH COSTS* Cost Reimbursement Cost Reimbursement EPISODE Crisis CRISIS ENERGY Cost Reimbursement Cost Reimbursement EPISODE Assistance ASSISTANCE BENEFITS* *As stipulated in contract, these services are provided on a cost reimbursement basis. 91 Revised August 2007 Attestation Statement Agreement/Contract Number, EHEAP 203.19 Amendment Number I, Stephen Y Carnell , attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency ou 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. Sigs tare 4 Recipient/ rtraetor represent hive Date Revised August 2007 A:4Q proved as to fort" an legality nt County Altar 3c �1 �1 \Q ( 5b