Backup Documents 03/09/2021 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 0
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community & Human l� 3tQlZI
Services
2. Minutes and Records Clerk of Courts Office 311 o`? - c:N5/B
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 Amendments for CCE,ADI&HCE Item Number of Original 3
Attached 16D5 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 s
meeting have been incorporated in the attached document. The County Attorney's o s!IOW
Office has reviewed the changes,if applicable. i `i) e
9. Initials of attorney verifying that the attached document is the version approved by the a,07 o ::;az4
BCC, all changes directed by the BCC have been made,and the document is ready for theca.
Chairman's signature. tie
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
160 5
July 2020—June 2021 ADI 203.20.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
ALZHIEIMER'S DISEASE INITIATIVE 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 Al)I 203.20.
'l'he purpose of this amendment is to increase allocation funding by amending 4.Contract Amount,Collier County: increase
allocations by$ 30,298.12; revise A'I"I'ACHMENT Ii-EXHIBIT 2-Funding Summary; and revise ATTACHMENT IX
BUDGET AND RATE SUMMARY.
4. Contract Amount;
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to
exceed$504,968.54 subject to the availability of funds. Any costs or services paid for under any other contract or from any
other source are not eligible for payment under this contract.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall he 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 arc 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 ADI contract as amended. This Amendment is
effective on January 20,2021 upon having been duly signed by both Parties.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON ACING FOR
OFCOUNTYCOM SS ERS SOUTHWFS'I' FLOlUDA,1NC:,
SIGNED BY: — SIGNED . OLASUA-VP SY:
NAME: JAMES C.FRENCH NAME: NORMA AL)ORN°
TITLE: PtURI.IC SERVICES DEPARTMENT HEAD TITLE: CEO 1
DATE: 02/ ill /2021 DATE: Z—ICI— 2 b2_ 1
Federal'Tax II): 59-600O 5R
Fiscal Year Ending Date:09/30
Duns: 076997790
Approved as to Patna and legality
Astir tint County n vcy '-\
1 CD„
16Q 5
July 2020—June 2021 ADI 203.20.002
ATTACHMENT II-EX H I BIT 2
FUNDING SUMMARY
Note:Title 2 CFR,as revised,and Section 215.97, F.S.,require that the information about Federal Programs and Slate
Projects included in Attachment II,Exhibit 1,be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SURRECIPI ENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAINti): I FEDERAL AWARD 1)A'I'E:
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO TILE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARP;AS FOLLOWS:
FEDERAL FUND%,;
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-Prolli Organizations
2. STATE RESOURCES AWARDED TO THE RECI PI ENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TIELE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWA RI)
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheitner's Disease Initiative-Collier General Revenue—TSTF 65.004 $ 504,968,54
TOTAL AWARD $ 504,968.54
COMPLIANCE REQUIREMENTS APPI,ICABI,k'I'O STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
ti7'ATE 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
July 2020—June 2021 AD!203.20.002
ATTACHMENT IX
ANNUAL BUDGET SUMMARY
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
for
Collier County Board of Count Commissioners
Collier
TOTAL; S 504,968.54
ALLOCATION TOTAL: S 504,968.54
3
160 5
Revised August 2007
Attestation Statement
Agreement/Contract Number AD1 203.20
Amendment Number.002
1, 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 hi
electronic data processing media,which has no affect an the agreement/contract content.
giiure of Recipient/Contractor representative Date
Approved us to form and legality
Ass tint County Ant ley
Revised August 2007
160 5
July 2020—June 2021 CCE 20120.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
COMMUNITY CARE FOR THE ELDERLY
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 CCE 203.20.
The purpose of this amendment is to increase allocation funding by amending 4. Contract Amount, increase allocations by
$ 84,9.13.05; revise ATTACHMENT II-EXHIBIT 2-Funding Summary; and revise ATTACHMENT VITT BUDGET
AND RATE SUMMARY.
4. Contract Amount;
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to
exceed$1,090,490.05 subject to the availability of funds. Any costs or services paid for under any other contract or from any
other source are not eligible for payment under this contract.
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and are hereby changed to
conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the contract.
This Amendment and all its attachments arc 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 CCE contract as amended. This Amendment is
effective on February 8,2021 upon having been duly signed by both Parties.
Contractor: COLLIER COUNTY BOARD AREA AGENCY ON AGING FOR
OF COUNTY COMMISSIONERS SOUTIIWEST FLORIDA,INC. ���� � �
SICNED SiGNGD BY� (�_ `^^" "'/,(,"`'
NAME: JAMES C FRENCH NAME: NORMA ADORNO
TITLE: PUBLIC SERVICE DEPARTMENT HEAD TITLE: CEO r 2 1
DATE: 021 112021 DATE: Z-l`t_ 2D
Federal Tax ii): 59-600055R
Fiscal Year Ending Date: 09/30
Duns: 076997 790
Approved as to form and legality
Ass .'tans County Attu
1 l-'�
160 5
July 2020—June 2021 CCE 203.20.001
ATTACHMENT II-EXHIBIT 2
FENDING 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 1, he 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 TIIE SUBRECIPIENT PURSUANT TO TIIIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): FEDERAL AWARD DATE:
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE. FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS;
2 CFR Part 200 [Jnifonn Administrative Requirements,Cost Principles, and Audit Requirements for Federal Awards.
OMB Circular A-133—Audits()I'States,focal Governments,and Non-Profit Organi,ations
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,R.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Community Care for the F.ldcrly-Collicr General Revenue 65.010 $1,000,990.05
TOTAL AWARD $1,000,990.05
COMPLIANCE REQUIREMENTS APPIJCAIBI.E TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97 1k 215.971,F.S.,Chapter 691-5,FA.C.,State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules, and regulations
160
July 2020—June 2021 CCE 203.20.001
ATTACHMENT VIII
ANNUAL BUDGET SUMMARY
COMMUNITY CARE FOR THE ELDERLY PROGRAM
for
Collier County Board of County Commissioners
Collier
ALLOCA'I'1m 'TOTAL $1,000,990.05
Total S1,000,990.05
3
1 6 D 5
Revlaed August 2007
Attestation Statement
Agreement/Contract Number CCE 203.20
Amendment Number .001
I, JAMES C FRENCH ,attest that no changes or revisions have been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area Agency on Aging for
Southwest Florida and
COLLIER COUNTY !BOARD OF COMMISSIONERS.
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the ngrccmenticontract content.
02/ /7 /2021
C
►gnature of Recipient/Contractor representative Date
Approved as to form and legality
Ass.tan!County AI n ey
Revised August 2007
1 l'
�. IS 0
July 2020—June 2021 HCE 203.20.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
HOME CARE FOR THE ELDERLY
COLLIER COUNTY BOARD OF COUNTY COMMMISSIONERS
TIIIS AMENDMENT is entered into between the Arca Agency on Aging for Southwest Florida,Inc.("Agency")and Collier
County Board of County Commissioners("Contractor"),amends agreement I ICE 203.20.
The purpose of this amendment is to increase allocation funding by amending 4.Contract Amount increase allocations by$
1,091.98;revise ATTACHMENT II-EXHIBIT 2-Funding Summary; and revise ATTACHMENT VIII BUDGET AND
RATE SUMMARY.
4. Contract Amount;
The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to
exceed S55,541.98 subject to the availability of funds. Any costs or services paid for under any othercontract 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 he executed by their undersigned officials as duly
authorized;and agree to abide by the terms,conditions and provisions of this HCE contract as amended. This Amendment is
effective on February 8,2021 upon having been duly signed by both Parties.
Contractor: COLLIER COUNTY BOA RI) AREA AGENCY ON AGING FOR
OFCOUNTtOM ISSIONERS SOUTHWEST FLORIDA,INC.
SIGNED BYG - SIGNED HY:
NAME: ��-- JAMESC. FRENCH NAME: NORMA At)t1RNO
TITLE:PUBLIC SERVICES IW..PARTMF.NT 11F.AD TITLE: CEO (J
DATE: 02/ j ! 1�021 DATE: ? -I -L-2U Li
Federal Tax iD: 59-6000558
Fiscal Year Finding Date: 9/30
Duns: 076997790 Approved as to term and legality
Ass . ant County ornoy
1
160 5
July 2020—June 2021 HCE 203.20.001
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Nate: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. FEI)ERRAI,RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FA IN#): FEDERAL AWARD DATE:
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICARI,I'TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDSt
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-Prolit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PIJRSLANT 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"I'O SECTION 215.97,F.S.
PROGRAM TITLE I FUNDING SOURCE CSFA AMOUNT
l lome Care for the Elderly-Collier General Revenue 65.001 S 55,541.98
TOTAL AWARD $ 55,541.98
COMPLIANCE REQUIREMENTS APPI.ICABI.E'I'O STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIA1. 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
160 5
July 2020--June 2021 HCE 203.20.001
ATTACHMENT VIII
ANNUAL BUDGET SUMMARY
HOME CARE FOR THE ELDERLY PROGRAM
for
Collier County Board of County Commissioners
Collier
Al.1.O('A'llON'IX)lAI. $ 55.541.98
Total $ 55,541.98
3
,
160 5
Revised August 2007
Attestation Statement
Agreement/Contract Number 110E 203.21
Amendment Number .001
1,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.
(RccipientiCnntractor 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.
tgnature of Recipient/Contractor representative Date
Approved as to form And►oi:tiity
Revised August 2007
Aistant Count
2411 ( A‘
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