Backup Documents 03/09/2021 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routinglines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community & Human 3}c1'a
Services �.l.J��--��
2. Minutes and Records Clerk of Courts Office
piur
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf/CHS Phone Number
Contact/ Department 252-2901
Agenda Date Item was 3/9/2021
Approved by the BCC
Type of Document EHEAP Amendment Item 16D4 Number of Original 1
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? N/A Stamp OK if
Original is
NOT required
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's WK N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's N/A
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 3/9/21 and all changes made during the WK
meeting have been incorporated in the attached document. The County Attorney's
Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made,and the document is ready for the J�`.9-k
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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October 2019—March 2021 EHEAP 203.19,003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
COLLIER COUNTY HOARD 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 landing by amending 4. Contract Amount; decrease
allocations by$45,000.00; revise ATTACHMENT II—EXHIBIT 2 and ATTACHMENT IX ANNUAL BUDGET
SUMMARY AND DETAIL.
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 fiords. Any costs or services paid for under any
other contract or from any other source are not eligible for payment under this contract.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby
changed to conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF,the Parties hereto have caused this amendment,to be executed by their undersigned officials
as duly authorized;and agree to abide by the terms,conditions and provisions of this 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 caused this contract to be executed by their undersigned officials
as duly authorized.
CONTRACTOR: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUN -Y OM MISSIONER SOUTHWEST FLORIDA,INC.
U
SIGNED B ``'"`� SIGNED BY: tik.Ot
NAME: 3Qn,e . C,Frerdr NAME: NORMA ADORNO
TITLE:c ,5e*-utae. 41Dnd TITLE: CEO
2/ 1 I f ?.ZI DATE: 2 -l.q- 2b2
Federal Tax ID:59-6000558
Fiscal Year Ending Date:09/30 Approved us to form and legality
Duns: 076997790 C
1 As nt County Attar • fit
! t
tr,
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October 2019—March 2021 EHEAP 203.19.003
ATTACHMENT II—EXHIBIT 2
FUNDING SUMMARY
Note: Title 2 CFR,as revised,and Section 215.97,F.S.,require that the information about Federal Programs and State
Projects included in ATTACHMENT II—EXHIBIT I,be provided to the recipient.Information contained herein is a
prediction of funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS 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 United States Department of Health
for the Elderly Program and Human Services 93.568
EHEAP Collier 93.568 $ 51,548.22
TOTAL FEDERAL AWARD $ 51,548.22
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200—Uniform Administrative Requirements, Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133—Audits of States,Local Governments, and Non-Profit Organizations
2 STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST
OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
TOTAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
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
2
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October 2019—March 2021 EHEAP 203.19.003
ATTACHMENT IX
ANNUAL BUDGET SUMMARY AND DETAIL
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
for
Collier County Board of County Commissioners
Collier
EHEAP ADMINISTRATION BUDGET $ 5,121.82
EHEAP OUTREACH BUDGET $ 7,468.60
EHEAP CRISIS ASSISTANCE $ 38,957.80
TOTAL $ 51,548.22
Projected minimum number of individuals to be served
Energy Assistance* 9
*Eligible households may be provided with multiple benefits totaling thirty-five hundred dollars. The minimum
number of consumers may reflect duplicated consumers if a consumer receives multiple benefits until the end of this
contract,March 31,2021.
3
c)/
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Revised August 2007
Attestation Statement
Agreement/Contract Number EHEAP 203.19
Amendment Number.QQj
I,JAMES C FRENCH ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
COLLIER COUNTY BOARD OF COMMISSIONERS.
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
Z —/ 7—�/
ignature of Recipient/Contractor representative Date
Approved as to form and legality
As ' ant County Attu
Revised August 2007