Backup Documents 04/13/2021 Item #16D6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 0 6
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 Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human Irk 4 13i ` f
Services _ ` �1�
2. Minutes & Records Clerk of Court's Office /I y ` ' l;/b
'f
3.
4.
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 252-2901
Contact/ Department
Agenda Date Item was 04/13/2021 Agenda Item Number 16D6
Approved by the BCC •
Type of Document Amendment OAA 203.20.007 Number of Original 1
Attached Documents Attached
PO number or account NA
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? WK
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
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 NA
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 NA
▪ document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NA
signature and initials are required.
' 7. In most cases(some contracts are an exception),the original document and this routing slip NA
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 04/13/2021 and all changes made during WK
the 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 WK
BCC,all changes directed by the BCC have been made,and the document is ready for the
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
1 60 6
January—December 2020 OAA 203.20.007
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
OLDER AMERICANS ACT TITLE III
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 OAA 203.20
Tile purpose of this amendment is to confirm the final contract allocation by amending 4. Contract Amount to
reflect the 2020 Contract Year;and revise ATTACHMENT IX BUDGET AND RATE SUMMARY
4 Contract Amount:
The Agency paid for contracted services according to the terms and conditions of this contract in an amount of
$817,324.84 funds to Collier County Board ol'County Commissioners during the 2020 OAA Contract Year.
Collier Cty
OAA Total Not
Contract Paid Spent
I Title Ill B Support Services $184,969.65 184,953.65 $16.00
2 Title III C1 Congregate Meals''* $638,262.88 123347.82 $514,915.06
Title III C2 Home Delivered
3 Meals** $285,493.28 115141.14 $170,352.14
4 Title iII E Services $184,057.85 130,050.28 $54,007.57
5 NSIP $52,147.74 53,1E7.68 ($1,019.94)
6 COVID-19 C1'Y* $85,890.16 85,887.15 $3.01
7 CDVID-19 C2*# $124,779,10 124,777.12 $1.98
TOTAL $1,555,600.66 $817,324.84 1$738,275.82
•
All provisions in the contract and any attachments thereto in conflict with this Amendment shall be and arc 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 OAA contract as amended.
Contractor: CO1,i,IER Cot1NTY BOARD AREA AGENCY ON ACING FOR
OF COUNTY COMM1' 'IONER,S SOUTHWEST FLORIDA,INC.
SIGNED BY: ""'' SIGNED BY: -
NAME: TAMES C FRENCH NAME: NORf'1A ADORN°
TITLE:PUBLIC SERVICE DEPARTMENT HEAD TITLE: CEO 1
DATE: 03/ 08 /2021 DATE: 3-W- 202 t
Approved as to torn and legality
%-Ck)\--2 5t2?)' ‘\
Assistant County Min.
1 606
January—December 2020 OAA 203.20.007
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
ATTACHMENT IX
BUDGET AND RATE SUMMARY
OLDER AMERICANS ACT BUDGET SUMMARY
COLLIER COUNTY
$ 817,324.84
TOTAL $ 817,324.84
2
16D6
Revised August 2007
Attestation Statement
Agreement/Contract Number OAA 203.20
Amendment Number .007
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 COUNTY 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.
03/ /2021
Signature lrf Recipient/Contractor representative Date
Approved as to form and legality
Assistant County Auk cy 31 g yeA
Revised August 2007