Backup Documents 10/26/2021 Item #16D 1 1 60 1
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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 10/26/2021
Services
2. Minutes & Records Clerk of Court's Office
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 10/26/21 Agenda Item Number 16D1
Approved by the BCC
Type of Document Amendment-CARES EHEAP 203.20.002 Number of Original l
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_10/26/21 and all changes made during WK • is not
the meeting have been incorporated in the attached document. The County :option 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 o p r,' "-,_+r
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
160 I
(JUNE 2021 —SEPTEMBER 2021) CARES EHEAP 203.20.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
EMERGENCY HOME ENERGY ASSISTANCE 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 CARES El LEAP 203.20.
The purpose of this amendment is to deduct$23,445.44 from the CARES EHEAP Crisis Assistance funding
from Collier County Hoard of County Commissioners, revise ATTACHMENT II-EXHIBIT 2-FUNDING
SUMMARY; revise ATTACHMENT IX—ANNUAL BUDGET AND RATE SUMMARY.
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 of its attachments are hereby made part of the contract,
IN WITNESS WHEREOF,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 the contract as
amended. This Amendment is cflbctive on the last date the Amendment has been duly signed by both Parties. •
Contractor:
COLLIER COUNTY.DOARD OF COUNTY AREA AGENCY ON AGING FOR SOUTHWEST
COMMISSIONEE tS FLORIDA, INC.
SIGNED B , SIGNED tIY:
‘-4-4)\-A-6-1 CIA14
NAME: NAME: Norma Adorno
TITLE: Public Service DepatitnenLHead TITLE: CEO
DATE: 09/4 /202I DATE: �-'0 �3"-" Od-)I
Federal Tax ID;59-6000558
Fiscal Year Ending Date; 09/30 Approved as to form and legality
Assistant County Attorn
160 1
(JUNE 2021—SEPTEMBER 2021) CARES EHEAP 203.20.002
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
EMERGENCY HOME ENERGY ASSISTANCE 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 CARES EHEAP 203.20.
The purpose of this amendment is to deduct$23,445.44 from the CARES EHEAP Crisis Assistance funding
from Collier County Board of County Commissioners,revise ATTACHMENT II-EXHIBIT 2-FUNDING
SUMMARY; revise ATTACHMENT IX—ANNUAL BUDGET AND RATE SUMMARY.
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 of its attachments are hereby made part of the contract.
IN WITNESS WHEREOF,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 the contract as
amended. This Amendment is effective on the last date the Amendment has been duly signed by both Parties.
Contractor:
COLLIER COUNTY.JOARD OF COUNTY AREA AGENCY ON AGING FOR SOUTHWEST
COMMISSIONED FLORIDA, INC.
SIGNED B . SIGNED BY:
NAME: NAME:
TITLE: Public Service Department Head TITLE:
DATE: 09/.. /2021 DATE:
Federal Tax ID; 59-6000558
Fiscal Year Ending Date: 09/30 Approved as to form and legality
Assistant County Attorn
1•
i 60 Y
(JUNE 2021—SEPTEMBER 2021) CARES EHEAP 203.20.002
ATTACHMENT II-EXHIBIT 2
FUNDING SUMMARY
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
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.
I. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
GRANT AWARD(FAIN#): 2002FLLIEA FEDERAL AWARD DATE: 10/01/2019
DUNS NUMBER: 076997790
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
Emergency Home Energy Assistance United States Department of Health and
for the Elderly Program Human Services 93.568
CARES EHEAP Collier County 93.568 $32,960.76
TOTAL FEDERAL AWARD $32,960.76
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
°Ls/I
1 60 1
(JUNE 2021—SEPTEMBER 2021) CARES EHEAP 203.20.002
ATTACHMENT IX
ANNUAL BUDGET SUMMARY AND DETAIL
EMERGENCY HOME ENERGY ASSISTANCE PROGRAM
for
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
EHEAP ADMINISTRATION BUDGET $ 4,656.31
EHEAP OUTREACH BUDGET $ 7,770.10
EHEAP CRISIS ASSISTANCE $20,534.35
TOTAL $32,960.76
Projected minimum number of individuals to be served
Energy Assistance* 26
*Program expenditures may not exceed the spending authority as provided in the Budget Summary. As program funds are
released,written notification of additional spending authority will be provided to Contractors.
**Eligible households may be provided with one benefit per season. The minimum number of consumers may reflect duplicated
consumers if a consumer receives a benefit in both seasons.
***Weather Related/Supply Shortage funds are a set-aside for emergency assistance.These funds must be held in this
budget line item category until December 15th of the program year,for use in response to a possible disaster.
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(JUNE 2021—SEPTEMBER 2021) CARES EHEAP 203.20.002
Attestation Statement
Agreement/Contract Number: CARES EHEAP 203.20
Amendment Number: 002
1, Daniel 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, Inc. 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 n effect on the agreement/contract content.
7-------"'s, ------
09/ /2021
Signature of ecipie o ac resentattve Date
Approved as to form and legality
AsII-ant County Attorn4S—