Backup Documents 06/22/2021 Item #16D14 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 b D 1 4
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 Coun Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human tvk
Services
2. Minutes & Records Clerk of Court's Office
7i2-24 pen.
3. efeecC
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 06/22/2021 Agenda Item Number 16D14
Approved by the BCC
Type of Document Amendment OAA 203.21.002 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? NA
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_06/22/21 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
16U1if
January—December 2021 OAA 203.21.002
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 203.21.
The purpose of this amendment is to amend contract language of contract OAA 2021; add carry-forward allocations for
various Titles; amend 4. Contract Amount; 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$1,875,515.01 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
11. Audits,Inspections,Investigations Section 11.8 of the Standard Contract has hereby been added.
11.8 In accordance with Executive Order 20-44,which requires executive agencies to submit a list of entities named in
statute with which a state agency must form a sole-source, public-private agreement or an entity that,through
contract or other agreement with the state, annually receives 50%or more of their budget from the State or
from a combination of State and Federal funds. Any Contractor that meets one or both of the criteria listed
must submit an annual report, including the most recent IRS Form 990,detailing the total compensation for
the entities' executive leadership teams within thirty(30)days of execution of this contract.
11.8.1 The report must include total compensation including salary,bonuses, cashed-in leave, cash equivalents
severance pay,retirement benefits, deferred compensation,real-property gifts, and any other payout.
11.8.2 The Contractor shall inform the agency of any changes in total executive compensation between the
annual reports as those changes occur.
11.8.3 All compensation reports must indicate what percent of compensation comes directly from the State or
Federal allocations to the contracted entity
All provisions in the contract 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.
1
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January—December 2021 OAA 203.21.002
IN WITNESS WHIEREOF, 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 OAA Contract or as amended.
'Phis Amendment is effective on the last date the Amendment has been duly signed by both Parties.
CON'I'RAC It:C;OLLIER t.OU Y OF AREA AGENCY ON AGING FOR
COUNT OIliMIgSIONC SOUTHWEST FLORIDA,INC.
�- �. 0-.cl02-,.
SIGNED SIt�NPll BY:
NAME: DANIEL R RODRIG• Z NAME:NORMA ADORNO
TITLE: PUCLIC SERVICE DEPARTMENT 1IEAD TITLE:CFO
DATE: 06/as /2021 DATE: t-a- l hz 2 O 11
Federal Tax ID: 59-6000558
Fiscal Year Ending Date: 09/30
Duns: 076997790
Approved as to Ibrrm and legality
1C-k_Ac21.-
• tint County Annul 2 ,
Ctt `
;. ,
1 6D14
January—December 2021 OAA 203.21.002
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
Note: Title2CFR§§200331,asrevised,andSection21597(5),F.S.,requirethattheinformationaboutfederalprogramsandStateProjectsbe
1rovided tothe Recipient and are stated in The Financial And Compliance Audit Attachment II,Exhibit I provided to the recipient.
Information contained herein is a prediction ofuindingsourcesand related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
COLLIER COUNTY
GRANT AWARD (FAIN#): 2101FLOASS,2101 FLOACM,2101FLOAHD,2101FLOAPH,2101FLOAFC,2101FLOANS
DUNS NUMBER : 076997790 FEDERAL AWARD DATE: OCTOBER 22, 2020
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Older Americans Act Title IIIB—
Transportation $ 8,296.26
Support Services U.S. Health and Human Services 93.044 $ 304,927.88
Total IIIB $ 313,224.14
OAA Title IIIC 1 —Congregate Meals U.S. Health and Human Services 93.045 $ 751,744.89
Total HICI
OAA Title III C2—Home Delivered Meals U.S. Health and Human Services 93.045 $ 528,848.02
Total IIIC2
Older Americans Act Title III E
Services(Title III E) $ 174,742.74
Supplement Services(Title III ES) U.S. Health and Human Services 93.052 $ 49,143.40
Grandparent Services(Title III EG) $ 6,083.23
Total HIE $ 229,969.37
Nutrition Services Incentive Program (NSIP) U.S. Health and Human Services 93.053 $ 51,728.59
TOTAL FEDERAL AWARD $1,875,515.01
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200Uniform 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.
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
ESTATE FINANCIAL ASSISTANCE
Section 215.97&215.971,F.S., Chapter 69I-5,F.A.C.,State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
3
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January—December 2021 OAA 203.21.002
ATTACHMENT VIII
BUDGET AND RATE SUMMARY
OLDER AMERICANS ACT BUDGET SUMMARY
COLLIER COUNTY
1. Title III B Support Services $ 313,224.14
2. Title III CI Congregate Meals $ 751,744.89
3. Title III C2 Home Delivered Meals $ 528,848.02
4. Title III E Services $ 229,969.37
5. NSIP $ 51,728.59
TOTAL $1,875,515.01
1
4
Revised August 2007 16U14
Attestation Statement
Agreement/Contract Number OAA 203.21
Amendment Number .002
I,J)ANIEL R RODRIGUEZ ,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 fo changes in page formatting,due to the differences in
electronic data processing media,which ha affect on the agreement/contract content.
Signature of Recipient/ient/ nt e ative 'Date
g P P
Approved as to form and legality
Assistant County Attu ey c ` \\ \Z
Revised August 2007