Backup Documents 07/13/2021 Item #16D 4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 p 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 County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human
Services
2. Minutes & Records Clerk of Court's Office c—re/
1
2 / (I
T
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 07/13/2021 Agenda Item Number 16D4
Approved by the BCC
Type of Document Amendment HCV21 203.21.001 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 final 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_07/13/21 and all changes made during WK is
the meeting have been incorporated in the attached document. The County tption for
Attorney's Office has reviewed the changes,if applicable. line.
9. Initials of attorney verifying that the attached document is the version approved by the WK is not
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
1604
February 2021 —September 2022 HCV21 203.21.001
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC.
CORONAVIRUS CONSOLIDATED APPROPRIATIONS ACT PROGRAM
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 HCV21 203.21.
The purpose of this amendment is to add or update contract language and invoice forms;increase allocation funding by amending
4. Contract Amount; and increase allocations by$64,733.40.
NOW THEREFORE,in consideration of the mutual covenants and obligations set forth herein,the receipt and sufficiency
of which are hereby acknowledged.the Parties agree to the following:
1. Attachment I. Section I.B.1.. General Statement, is hereby replaced.
1. General Statement
The primary purpose of the Coronavirus Consolidated Appropriations Act Program is to prevent, prepare for, and
respond to coronavirus by providing nutrition services to older individuals and their caregivers. Additional funds have
been awarded to provide credible information about COVID-19 vaccines, identify people who may need help getting
a COVID-19 vaccination. help with scheduling appointments. and arranging accessible transportation to COVID-
19 vaccination sites,reminding the person of their second vaccination appointment.and providing respite for caregivers
to get their COVID-19 vaccination.
2. Attachment I. Section I.B.2..Authority. is hereby replaced.
2. Authority
All applicable federal laws, regulations. action transmittals. program instructions. review guides and similar
documentation related to the following:
a. Catalog of Federal Domestic Assistance Nos. 93.044 and 93.045:
b. Older Americans Act of 1965.as amended 2020:
c. Consolidated Appropriations Act, 2021. P.L. 116-260:
d. Expanding Access to COVID-19 Vaccines via the Aging Network, P.L. 116-260 and P.L. 116-131 and 42 U.S.
Code Sec. 241:
e. 42 U.S.C. 247d:
f. 42 U.S.C. § 303 and§ 604:
g. Rule 58A-1. Florida Administrative Code(F.A.C.):
h. Section 430.101, Florida Statutes (F.S.):and
i. DOEA Programs and Services Handbook,which is hereby incorporated by reference,to include any subsequent
revisions thereof.
1
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February 2021 —September 2022 HCV21 203.21.001
3. Attachment I. Section I.B.4., Major Program Goals. is hereby replaced.
4. Major Program Goals
The major goals of the Coronavirus Consolidated Appropriations Act Program are to prevent, prepare for, and
respond to coronavirus by providing nutrition services to older individuals and their caregivers. Additional funds have
been added to provide information about the COVID-19 vaccinations, identify people needing a vaccination,
scheduling appointments for their vaccinations, and arranging transportation and respite as needed.
4. Attachment I. Section 1.C.2.c. Expanding COVID-19 Vaccinations via the Aging Network. is hereby added.
c. Expanding COVID-19 Vaccinations via the Aging Network
These funds are for the Contractor to serve older adults and their caregivers within their Planning and Service Area.
5. Attachment I. Section II.D.1., Delivery of Services to Eligible Clients. is hereby replaced.
1. Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of elders and their
caregivers. Documentation of service delivery must include a report consisting of the following: number of clients
served, number of service units provided by service. and rate per service unit with calculations that equal the total
invoice amount. The Contractor shall ensure the performance and reporting of the following types of services, in
accordance with the current Agency's current Department-approved Area Plan. the current DOEA Programs and
Services Handbook. and Section II.A.
a. Coronavirus Consolidated Appropriations Act Nutrition Services under Title III-C of the Older
Americans Act
Nutrition services are designed to reduce hunger and food insecurity and to promote socialization and the health and
well-being of older individuals through access to nutrition and other disease prevention and health promotion
services. Services include the following:
i. Congregate meals:
ii. Congregate meals screening:
iii. Home delivered meals:
iv. Nutrition education and nutrition counseling:
v. Outreach:
vi. Screening and Assessment:
vii.Shopping Assistance: and
viii.Telephone Reassurance.
b. Expanding Access to COVID-19 Vaccines via the Aging Network
i. Education(Individual and Group):
ii. Information:
iii. Outreach:
iv. Respite(In-home and Facility-based):
v. Telephone Reassurance—COVID-19: and
vi. Transportation.
2
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February 21 -- September 2022 HCV21 203.21.001
6. Attachment II—Exhibit 2, Funding Summary, is hereby replaced.
7. Attachment IX,Budget and Rate Summary, is hereby replaced.
8. Attachment Xl,Request for Payment,is hereby replaced.
9. Attachment XII, Receipts and Expenditure Report, is hereby added.
10. Attachment X111,Cost Reimbursement Seminary, is hereby added.
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$296,475.47 subject to the availability of'funds. Any costs or services paid for under any other contract or
from any other source arc not eligible for payment under this contract,
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 arc still in effect and are to he performed at the level specified in the
contract.
This Amendment and all its allaehmenls are hereby made part al'the eanlntcl.
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 contract as amended. This
Amendment is effective upon having been duly signed by both Parties.
Contractor: COLLIER COUNT B AREA AGENCY ON AGING FOR
OF COUN MISS • SOUTHWEST FLORIDA,INC,
SIGNED R SIGNED BY:
NAME: NAME.: NORMA ADORNO
TITLE:FUBLIC SERVICE DEPARTMENT HEAD TITLE: CEO
Federal Tax ID: 59-6000558
Fiscal Ycar Ending Date: 09/30
Duns: 076997790
Approved as to form and legality
30. sislunt County At cy
3
1604
(February 2021 —September 2022) HCV21 210,211,212,217.21.001
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY(2021)
Nntet Title 2 CFR, as revised,and Section 215.97,F.S.,require that the information about Federal Programs and Stale
Projects included in Attachment II,Exhibit 1, be provided to the recipient. Information contained herein is a prediction of
finding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF TILE FOLLOWING:
COLLIER COUNTY
GRANT AWARD(FAIN#): 2101FLHDC5 I FEDERAL AWARD DATE; 1/27/2021
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Coronavirus Consolidated Appropriations
Act t r Nutrition Services under U.S.Health and Human Services 93.045 $296,E175.'17
Title ill-C oftlie Older Americans Act
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 APP!,ICABLE 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
4
16D4
HCV2 1210,21 1,212,217.21.001
(February 202I —September 2022)
ATTACHMENT IX
BUDGET AND RATE SUMMARY
COVID CARES ACT
COLLIER COUNTY
1, Title Ill C Congregate Meals/HDM $ 231,742.07
2. Expanding Access to COVID-19 Vaccines Fund $ 64,733.40
TOTAL. $ 296,745.47
5
1 604
11CV21 210,21 1,212,217.21.001
(February 2021 September 2022)
ATTACIIMENT IX
BUDGET AND RATE SUMMARY
COLLIER COUNTY
C-
SERVICE RT.IMRURSF,MENT UNIT TYPE
UNIT RATE
C -- CONGREGATE MEALS $11.72 MEALS
HOME DELIVERED MEALS $ 8.07 MEALS
NUTRITION EDUCATION $ 1.59 PARTICIPANTS
CONGREGATE MEAT.SCREENING $28.00 HOUR
OUTREACH $4,32 PER PERSON EPISODE
SCREENING & ASSESSMENT _ $48.76 HOUR
SHOPPING ASSISTANCE— COVID 19 $34.12 ONE-WAY TRIP
TELEPHONE REASSURANCE—COVID $13.40 EPISODE
INFORMATION-COVA $13.40 EPISODE
OUTREACH—COVA $ 4.32 EPISODE
RESPITE IN-FACILITY—COVA $11.44 HOUR
RESPITE IN-IIOME--COVA $25.02 HOUR
TELEPHONE REASSURANC COVA $14.89 EPISODE
*As stipulated in the contract,these services are provided on a cost reimbursement basis.
6
6 0 4
I IC V 2 1210,21 1,212,217.21.001
(February 2021 —September 2022)
A'l"I'ACIIMENT XI
RECEIPTS AN!) EXPENDITURE REPORT
EXPANDING ACCESS TO COVID-19 VACCINES FUND
PROVIDER!P1.1E,ADDRESS, PH' NENANDFEIOP PROGRAM FUNOIM.; 03r7acl
0
0
r.,orUact P 1w.
0 COFICNA'l.+..}3G NEOL-? TE6 AR=ACC=SIATIC"+t:a ACT
0 R?p1 PO Da
0 T1l a Hi
0 Rar.ot''rnoc N
0 PIA
0
0
CERTI-I : I Vse hestofmykrunle0geand belief Iri Tlsrer_r:IscoTF1eteandal cut xys here-nareTcrFt.rF,cseeEEt'7r1
I Me C01U3;l. TC the test DI n.rt tnetNeese,al CRTC,'d 1:411/t6 3Ci1 YrT6�.
P:Epxed by: Cate: ApFtvwa by: Gate:
PART A:8JOGETE0 I4COME!RECEIPTS 1.,';Fpmed 2.Mba Recs1 4s ? To:31!tee R 4.FVCErt of
Etrig_t For Th's RRF<ri Year Ia Dale Af'pra.c,1 euagel
I.Feae aI FI rds 50.03 b).CO i0 CO N'IV,01
2.TOTAL RECEIPT!) 55.03 50.00 50 0] =PJl]!
?ART E:CuJt-ITRAOTED EcPE'4OITJREO Appoweo 2.EIC eri:ar:, 3.EW.rtltIr c 3.Perc rtc!
E.R1get For Ths Reran Year 1a Dale A ,-arei Db I
I. E.r,s.raes 50.03 50.to 5+".,U3 "CAW!
IX
2.TOTAL E?rF£11f,E,{.� 5003 ,?].CO <,0) #06. ]!
PART C:PROGRAM IN:ONE
1.Prcsram I1ron1e 513.E0
PART D:INTEREST
1.Ea rs4 c'AAYarCEs $0.00
2.Refined or A.dalces $0.00
cosiFOi'.%'MC (
7
1604
HCV2I 210,21 1,212,217.21.001
(February 2021 —September 2022)
ATTACHMENT X[[
RECEIPTS APIO EXPENDITURE REPORT
EXPANDING ACCESS TO COVID•I3 VACCINES FUND
PROVIDER NA►VE.ADCRECS. PHONE.AND FEED? PROGRAM FUNOINSSOURCE: .4n'J3.t?
O
0 CUnir3Ct PE*ot:
i EXPANDIASACGE:?T6 COVrD-15VAC,:VE:p.m)
0 Rep:tt Pend
The III
} 9ep:02Inv01ce P
1,SA
C
C
C ERTIF;CATION: I certry:o Ihe sit Of my ArQAleagf:ant DE IEt T31 IMS reporl :comp e e 3n3 31 outlays Weir 3"e for CUroose3 set fora
Ti 7.i C6173Ct.
Premed by: D3:e: A.7pr.r'_dby Da:e'
PART A:BLJOCETEO It'33OPJE.'RECEIPTS I.Ap:r .ea =.ActJal RECE pte 3.Iola R alp:6 :.Peroert or
Edoaet FOf MIS Repc••t Year to Date A:p:oea Eadyit
I.Federal Funds S:.CO S3.C4 SOX RDIV:C!
2.TOTAL RECEIPTc S?.C•3 S.0.c3 S0.0t• RDIV.CI
PART 0:CONTRACTED EXPENCITURES 1.Approved 2.E SIraIUres 3.Etcrdlturas :.PerCert of
Sutge: Po Tn's Re?or. Y23r10 Date Ag r qed&'.ilget
t. EXFen1eE 5:CO 5.11.20 5O.00 ItDIV.C!
2 TOTAL EXPENSES 5229 59.C3 50.O1i RDIV:C!
PART C:PROGRAM INCOME
1.Prog•am Ircorie S0.0C•
coeAF Rs.1'.C521CV
8
1 604
11CV21 210,211,212,217.21.001
(February 2021 September 2022)
A I I ACHMENT XIII
COST REIMBURSEMENT SUMMARY
EXPANDING ACCESS 10 COV'ID-19 VACCINES FUND
F G A C:rtra:t
C:rlra..l Pence.
KaoCf:c.ery n
ReF�crt'r.vo-ca p
uuevf:
Cealoarry pa-eaHptlen HufMsr et unite Amount
!L�
TOTAL EXPENSES 7a.C`7,
nnFA FORM C RF-hAC.\'
9
1604
Revised August 2007
Attestation Statement
Agreement/Contract Number: WCV203.21
Amendment Number: .001
1,pallid 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 he for changes in page formatting,due to the differences in
electronic data processing media,which has no affect on the agreement/contract content.
-----Z-—)-----0 a---7
I
' i 3 Signature of Rceipicni/Cont",,_ _Z/‘""'-
w Date
Approved as to form and legality
Ass'. ant County Attor (Q 1"1
Revised August 2007
i i