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Item C17 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 9-1$-201 3 Division:_County Administrator Bulk Item: Yes X_ No _ Department: Social Services/In-Home Services Staff Contact Person/Phone#: Sheryl Grah } 4510 t 3 ry AGENDA ITEM WORDING: Approval of Amendment 001 to the Alzheimer's Disease Initiative (ADI)Contract KZ-1397 between the Alliance for Aging,Inc. (Area Agency on Aging)and the Monroe County Board of County Commissioners(Social Services/In-Home Services)for fiscal year 7/1113 to 6/30/14. ITEM BACKGROUND: Approval of the Amendment 001 to ADI Contract #KZ-1397 will increase the amount under contract by$13,277.00 for a total allocation of$70,023.00 PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to ADI Contract #KZ1397 on 6-19-13. CONTRACT/AGREEMENT CHANGES: increasing contract KZ-1397 by$13,277.00 for the total of$70,023.00. Original Contract amount$56,746.00. STAFF RECOMMENDATIONS: Approval TOTAL COST: $70,023.00 INDIRECT COST: _-0-_BUDGETED: Yes X No COST TO COUNTY: $0 tNo Cash Match Required) SOURCE OF FUNDS: Grants REVENUE PRODUCING: Yes No_ AMOUNT PER MONTH 134.00_ Year 1 608.00 APPROVED BY: County A X OMB/Purchasing X Risk Management DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# Revised 1/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Alliance for Aging, Inc. Contract#Amend. 001 to ADI Contract#KZ- 1397 Effective Date: July 1,2013 Expiration Date: June 30,2014 Contract Purpose/Description: Approval of Amendment 001 to the Alzheimer°s Disease Initiative(ADI) Contract#KZ-1397 to increase the amount under contract by$13,277.00 for a total allocation of$70,023.00 Contract Manager: Sheryl Graham 4510 Social Services/Stop 1 (Name) (Ext.) (Department/Stop#) 3 For BOCC meeting on 9/18/2013 � Agenda Deadline: 9/3/2013 CONTRACT COSTS Total Dollar Value of Contract: $70,023.00 Current Year Portion: $ Budgeted?Yes X No 0 Account Codes: _125_-6153613_ - Grant:$70,023.00(Fiscal Year) County Match: $0(No Cash Match required) ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: {Not included in dollar value above e .Maintenance,utilities,janitorial,salaries,etc CONTRACT RENEW Changes _ Date Out ate In Needed _ iewe Division Director { /t-/ Yes❑ No Risk Management � � Yes❑ No t, O.M.B./Purchasing —1 Yes 0 No t. �1 County Attorney Yes 0 No Comments: OMB Form Revised 2/27/01 MCP#2 Amendment 001 CONTRACT KZ 1397 Page 1 THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter referred to as the"Alliance", and Monroe County Board of Commissioners,Social Services/In-Home Services.. The purpose of this amendment is increase the amount allocated under contract by $13,277.00 for a total allocation of$70,023.00. The increase is for Respite services. METHOD OF PAYMENT: All>provisions in the contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with 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 are hereby amended to conform with this amendment. This amendment and all its attachments are hereby made a part of the contract. This amendment and all its attachments are hereby made a part of the contract. IN WITNESS WHEREOF, the parties hereto have caused this 1-page amendment to be executed by their undersigned officials as duly authorized. PROVIDER: Monroe County Board of ALLIANCE FOR AGING, INC. Commissioners,Social Services/In-Home Services.. SIGNED BY: SIGNED BY: George Neugent Max B. Rothman, JD, LL.M. NAME: NAME: Mayor President& CEO TITLE: TITLE: 9-18-2013 DATE: DATE: MON CO NTY ATT4 OVE AS TC?F ASS #STAN ' l!l11U111�iL u. L CONTRACT KZ-13 7 ' Page 1 ACZHEIMERSI DISEASE INITIATIVE CONTRACT 2013-2014 THIS AGREEMENT is entered into between the Alliance for Aging, Inc.,hereinafter referred to as the "Alliance" and"Monroe County Board of Commissioners.", hereinafter referred to as the "provider." THIS CONTRACT IS SUBJECT TO FURTHER MODIFICATION IN ORDER TO INCORPORATE CERTAIN PASS-THROUGH LANGUAGE REQUIRED BY THE STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS. ALL SUBSEQUENT MODIFICATIONS WILL BE MADE THROUGH AMENDMENTS TO THIS CONTRACT. Attachment I, II, III, IV V, VI, VII, VIII, IX, X, XI XII, XIII, XIV,XV and XVI are integral to this Agreement i, Provider Agrees: A. ` Services to be Provided: 1. The provider's service provider application for state fiscal year 2013 and any revisions thereto approved by the Alliance and located in the contract manager's file, are incorporated by reference in this contract between the Alliance and the provider, and prescribe the services to be rendered by the provider. 2. Consumers may not be enrolled in a Department of Elder Affairs'state general revenue funded program, including ADI, who are also enrolled in a Medicaid capitated long-term care health plan or program. These programs include the Frail Elder Program operated by United Health Care, the Channeling Program operated by Miami Jewish Home and Hospital for the Aged, the long Term Care Community Diversion Program and the Program of All Inclusive Care for the Elderly(PACE) program scheduled to begin operation in the Miami-Dade County area. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the provider's service provider application for state fiscal year 2013 and the 2011 Department of Elder Affairs Home and Community Based Services Handbook . In the event the handbook is revised, such revision will automatically be incorporated into the contract and the provider will be given a copy of the revisions. If. The Alliance Agrees: A. Contract Amount: To pay for services in an amount not to exceed $56,746, subject to the availability of funds. Obligation to Pay:'- The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the legislature. B. Source of Funds: 1 � r CONTRACT KZ•1397 Page 2 The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the provider pursuant to this contract are in the state grants and aids appropriations. Ill. Provider and Alliance Mutually Agree: A. Effective Date: 1. This contract shalt begin on July 1, 2013 or on the date the contract has been signed by both parties, whichever is later. 2. Delivery of services shall end on June 30, 2014. IN WITNESS WHEREOF,the parties hereto have caused this agreement to be executed by their undersigned officials as duly authorized. PROVIDER: Monroe County Board of ALLIANCE FOR AGING, INC. Commissioners. SIGNED BY: - L <'�: i� IGNED BY: NAME: fR2 ae, NAME: Max B. Rothman, , ALLM. TITLE: -1p Q-- TITLE: President&'CEO DATE: T i`� 2•►3 DATE: JUN 2 S 2013 (SEAL) p EY A1"9E69" 1Y KE11 Litt,CLERK pip E ©UED NN B Or- CLERK ISTANT CO Ty ATT RN C� .�.13 2 Y { r CONTRACT KZ-1397 Page 3 ATTACHMENT ALZHEIMER'S DISEASE INITIATIVE PROGRAM 1. STATEMENT OF PURPOSE The Alzheimer's Disease Initiative(ADI) Program is focused on caring for persons 18 +with memory disorders. 11. SERVICES TO BE PROVIDED A. Services: 1. The provider's service provider application for state fiscal year 2012 and any revisions thereto approved by the Alliance and located in the contract manager's file, are incorporated by reference in this contract between the Alliance and the provider, and prescribe the services to be rendered by the provider. 2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue funded program, including ADI, who are also enrolled in a Medicaid capitated long-term care health plan or program. These programs include the Frail Elder Program operated by United Health Care, the Channeling Program' operated by Miami Jewish Horne and Hospital for the Aged, the Long Term Care Community Diversion Program operating in Planning and'Service Areas 7 and 9 and any other areas that may participate in the Long Term Care Diversion Program through expansion and the Program of All Inclusive Care for the Elderly(PACE)program scheduled to begin operation in the Miami-Dade County area. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the provider's service provider application for state fiscal year 2013 and the 2011 Department of Elder Affairs Home and Community Based Services Handbook . In the event the handbook is revised, such revision will automatically be incorporated into the contract and the provider will be given a copy of the revisions. Ill. METHOD OF PAYMENT 3 CONTRACT KZ-1 97 Page t A. The method of payment in this contract is based on a fixed rate reimbursement for approved services. The provider must ensure fixed rates include only those costs that are in accordance with all applicable state and federal statutes and regulations and are based on audited historical costs in instances where an independent audit is required. All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA farms 1 6Z and 105Z. Duplication or replication of both forms via data processing equipment is permissible, provided all data elements are in the same format as included on departmental forms. B. Invoices must be submitted no later than 90 days after the end of the month on which the expense was incurred, except that invoices can not be submitted after close out report date(usually July 15th.) Invoices submitted late will not paid. Exceptions to this rule are at the discretion of the Alliance, on a case by case basis; such exceptions must be requested prior to the expiration of the invoicing deadline. In making a determination of the exception the Alliance will consider whether the disruption to the billing cycle was beyond the control of the provider, the frequency with which such exceptions are requested by the provider, and whether the Alliance can request reimbursement at a late date from DOEA. C. The provider shall maintain documentation to support payment requests which shall be available to the Comptroller, the Department of Elder Affairs, or the Alliance upon request. D. The provider shall maintain documentation to support payment requests which shall be available to the Alliance, the Department of Elder Affairs or the Comptroller upon request. E. The provider may request a monthly advance for service costs for each of the first two months of the contract period, based on anticipated cash needs.` Detailed documentation justifying cash needs for advances must be submitted with the signed contract, approved by the Alliance, and maintained in the contract manager's file.' All payment requests for the third through the twelfth months shall be based on the submission of monthly actual expenditure reports beginning with the first month of the contract. The schedule for submission of advance requests is ATTACHMENT 11 to this contract. Reconciliation and recouping of advances made under this contract are to be completed by March and April. All advance payments are subject to the availability of funds. F. Advance funds may be temporarily invested by the provider in an insured interest bearing account. All interest earned on contract fund advances must be returned to the Alliance within thirty(30)days of the end of the first quarter of the contract period. G. The Alliance shall make payment to the provider for provision of services up to a maximum number of units of service and at the rate(s) stated belowL Maximum Maximum Service to be Provided Service Unit Rate Units of Dollars Service In Home Respite $24.03 2,361 $56,746 4 CONTRACT KZ-1397 � Page 5 t H. Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and approval by the Alliance of complete and accurate financial and programmatic;reports due from the provider and any adjustments thereto, including any disallowance not resolved. IV. SPECIAL PROVISIONS A. State Laws and Regulations: The provider agrees to comply with applicable parts of Rule 58D-1, Florida Administrative Code promulgated for administration of Sections 430.501 through 430504, Florida Statutes, and the 2011 Department of Elder Affairs Client Home and Community Based Services Handbook. B. Assessment and Prioritization for Service Delivery for New Consumers: The following are the criteria to prioritize new consumers for service delivery. It is not the intent of the Department of Elder Affairs to remove existing clients from any program in order to serve new clients being assessed and prioritized for service delivery. 1. Priority Criteria for Service Delivery: a. individuals in nursing homes under Medicaid who could be transferred to the community; b. individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community; c. individuals in nursing homes which are closing and can be discharged to the community; or d. individuals whose mental or physical health condition has deteriorated to the degree self care is not possible, there is no capable caregiver and institutional placement will occur within 72 hours. 2. Priority Criteria for Other Assessed Individuals: The assessment and provision of services should always consider the most cost effective means of service delivery. Functional impairment shall be determined through the department's consumer assessment form administered to each applicant. The most frail individuals not prioritized in groups one, two or three above, regardless of referral source, will receive services to the extent funding is available. C. Co-payment Collections: 1. The provider will establish annual co-payment goals. The Alliance also has the option to withhold a portion of the provider's Request for Payment if goals are not met according to the Department of Elder Affairs' co-payment guidelines. 5 r a CONTRACT KZ-1 97 j Page 6 ' 9 2. ,Co-payments include only the amounts assessed consumers or the amounts consumers opt to contribute in lieu of an assessed co-payment. The contribution must be equal to or greater than the assessed co-payment. D. Evaluation,Statistics and Report The provider agrees to respond to requests for evaluation information and statistical data concerning its consumers based on information requirements of the Memory Disorder Clinics and Brain Sank. The provider will ensure Model Clay Care Centers supported by this contract develop innovative therapies and interventions which can be shared with other Alzheimer's Disease Initiative health and social'services personnel via training. Model Day Care Centers supported by this contract must report to the provider all training activities provided to health care and social service personnel and caregivers, as well as serve as a natural laboratory for service related applied research by Memory Disorder Clinics. An annual Model Day Care Center Training Report, ATTACHMENT IV, is due by July 5, 2013. E. Collaboration with Memory Disorder Clinics. Memory Disorder Clinics are required to provide four hours of in-service training to all respite and model day care centers in their designated service areas. The provider agrees to collaborate with Memory Disorder Clinics to assist in this effort. F. Service Cost Reports. The provider will submit semi-annual service cost reports which reflect actual costs of providing each service by program. This report provides information for planning and negotiating unit rates. G. Reporting: The provider need to provide the Alliance with an expenditure plan by July 15 or two weeks after contract has been signed, a monthly update due on the 21 of each following month. The expenditure plan and updates must fallow the format provided by the Alliance. 6 �.J CONTRACT KZ-1397 Page 7 ATTACHMENT 11 ALZHEIMER'S DISEASE INITIATIVE PROGRAM CONTRACT REPORT CALENDAR Report Submit Number to the Alliance on This Me I July Advance ............................................................... July 1 2 August Advance * ........................................................... July 1 3 July Expenditure Report .................................................... August 10 4 August Expenditure Report ................................................ September 10 5 September Expenditure Report ........................................... October 10 6 October Expenditure Report ............................................... November 10 7 November Expenditure Report ............................................ December 10 8 December Expenditure Report ............................................ January 10 9 January Expenditure Report/............................................... February 10 10 February Expenditure Report/July Advance Reconciliation March 10 11 March Expenditure Report/August Advance Reconciliation April 10 12 April Expenditure Report .................................................... May 10 13 May Expenditure Report .................................................... June 10 14 June Expenditure Report.................................................... July 10 16 Final Expenditure and Closeout Report ................................. July 20 Legend: Advance based on projected cash need. Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the Alliance, payment is to accompany the report. Note # 1: Report#1 for Advance Basis Contracts cannot be submitted to the Alliance prior to July 1 or until the contract with the Alliance has been executed. Actual submission of the vouchers to the Department of Elder Affairs is dependent on the accuracy of the expenditure report. 7 r CONTRACT K2.1397 Page 8 ATTACHMENT ill ANNUAL MODEL DAY CARE CENTER TRAINING REPORT Model Day Care Center Name. Printed Name of Person Signature of Person Date Executed Completing Report Completing Report The purpose of each model day care program must be to provide service delivery to persons suffering from Alzheimr's disease or a related memory disorder and training for health care and social service personnel in the care of persons having Alzheimer's disease or related memory disorders. This report documents the required training for the State Fiscal Year July 1 st through June 30th. Number Number Total Actual Training Event(s) Health Care Social People Professiona Services Trained Is Trained Personne I ` Trained Training Title: Dates Training Summary: 8 CONTRACT KZ-1397 � Page 9 , ATTACHMENT IV 1. Under this Contract,the provider agrees to the following: A. Perform ARC outsourced functions in accordance with policies and procedures developed by the Alliance for Aging. Refer to the following attachments: i. Attachment V; Policies and Procedures for Outsourced Function-Screening ii. Attachment VI: Policies and Procedures for Outsourced Function-Triage iii. Attachment VII: Policies and Procedures for Activation from aitlt- Client Services iv. Attachment Vlll; Policies and Procedures for Termination from Waitlist- Client Services B. Maintain wait lists in CIRTS in accordance with DOER requirements. C. Report number of client contacts to the Aging Resource Center. D. Adhere to prioritization policy as set forth by the Department of Elder Affairs. E. Update the agency Disaster Plan to incorporate ARC outourced functions. F. Ensure against conflicts of interest and inappropriate self-referrals by referring consumers in need of options counseling or long-term care services beyond the provider's scope of services to the Aging Resource Center, G. Ensure that services provided are in the clients' best interest, are the most cost effective, of high quality, and are responsive and appropriate to the assessed needs.' The Assessed Priority Consumer List(APCL) is maintained when services funded by the department are not available. Contracted providers of registered services for Alzheimer's Disease Initiative(ADI), Older American's Act(OAA), and Contracted Services(CS) maintain waiting lists in the C1RTS database for registered services when funding is not available. Note. OAA3E is an exempt funding source for ARC Wait List purposes. For services provided through OAA3E, no CIRTS client data entry is required. Registered Services for the above listed programs are as follows:'Adult Day Care(ADC), Adult Day Health Care (ADHC), Chore (CHO), Escort(ESC), Home Health Aide(HHA), Homemaker(HMK), Model Day Care (MDC), Personal Care (PECA), Facility-Based`Respite(RESF), In-Home Respite (RESP). 9 t CONTRACT KZ-1397 0 Page 10 Attachment V AGING &'DISABILITY RESOURCE CENTER(ADRC)—OUTSOURCED FUNCTIONS 11. If applicable, the provider agrees to the following: A. Perform ADRC outsourced functions in accordance with the Alliance's policies and procedures. i. Policies and Procedures for Outsourced Function-Screening ii. Policies and Procedures for Outsourced Function-Triage iii. Policies and Procedures for Activation from Waitlist- Client Services iv. Policies and Procedures for Termination from Waitlist- Client Services B. Maintain wait lists in CIRTS in accordance with DOEA requirements. C. Report number of client contacts to the Aging Resource Center. D. Adhere to prioritization policy as set forth by DOER on a monthly basis. Reference ©OEA Programs and Services Handbook. E. Ensure the agency's Disaster Plan reflects ADRC Outsourced Functions, annually or as needed to incorporate ADRC outsourced functions. F. Ensure against conflicts of interest and inappropriate self-referrals by referring consumers in need of options counseling or long-term care services beyond the provider's scope of services to the Aging and Disability Resource Center. G. Ensure that services provided are in the clients' best interest, are the most cost effective, of high quality, and are responsive and appropriate to the assessed needs. 4 The Assessed Priority Consumer List(APCL)is maintained when services funded by the department are not available. Contracted providers of registered services for Alzheimer's Disease Initiative (ADI) and Older American's Act(OAA) maintain waiting lists in the CIRTS database for registered services when funding is not available. Registered Services for the above listed programs are as follows: Adult Day Care(ADC), Adult Day Health Care(ADHC), Chore (CHO), Escort (ESC), Home Delivered Meals (HDM), Home Health Aide (HHA), Homemaker(HMK), Model Day Care (MDC), Personal Care (PECA), Facility-Based Respite(RESF), In-Home Respite (RESP). 10 ' CONTRACT Z-1397 Page 11 Alliance for Aging, Inc, Aging and Disability Resource Center/Elder Helpline Policy and Procedure for Outsourced function - Screening Creation Rafe: March 5, 2008 Revision Cate. May 2012 Review Date May 2011 Objective: To ensure that a comprehensive list of clients in need of services is maintained in CIRTS by appropriate funding source and that the ADRC is thereby able to effectively gauge the level of elder service need in Miami-Dade and Monroe'Counties. Policy: To obtain necessary information from clients in order to assist in determining level of need and eligibility for DOER funded services Procedure. 1. "ADRC Contracted Providers will collect information from callers and conduct a 701A assessment. Alternatively, if a 701 B assessment already exists or is provided from another source(i.e. CARES) the information from the,701 B can be utilized. 2. Based on the information provided via the 701A(B)assessment, the ADRC Contracted Provider will make a determination as to the services that the caller is in need of receiving . 3. The ARC Contracted Provider will determine the appropriate funding source(s)that provides the needed services. 4. If the caller is in need of a service(s)that is not provided by the ADRC Contracted Provider, the ARC Contracted Provider will refer caller to the ADRC Elder Helpline utilizing the ADRC Referral Form and/or to an ADRC Contracted Provider that provides the needed service. 5. The caller will be provided with general information regarding the ADRC as well as the ADRC Elder Helpline contact number. 6. The caller will be informed of the services and funding sources that they are being placed on the wait list for in CIRTS. 7. ADRC Contracted Provider will create a client record in CIRTS(if there is no existing record)and enter the services needed for the caller by funding source and service. [If there is an existing record in CIRTS, the appropriate fields will be updated]. 8. If the ADRC Contracted Provider determines that the caller may qualify for more than one funding source, ADRC Contracted Provider is encouraged to enter the appropriate information under multiple funding sources. [If there is an existing client record in CIRTS, the client record in CIRTS will be updated with appropriate information]. 9. ADRC Contracted Provider will inform caller that they will receive a follow-up call (or home visit in case of active client)to check on their status based on DOEA Wait List Reassessment Standards and encourage caller to contact the ADRC Elder Helpline with any questions. 11 CONTRACT KZ-1397 Page 12 Alliance for Aging, Inc, Aging and Disability Resource Center/Elder Helpline Policy and Procedure for Outsourced function •Triage Creation bate: March 5, 2008 Revision Date May 2012 Review Hate: May 2011 Objective: To ensure that clients in need of DOEA funded services receive services based on the highest level of need, first, as funding becomes available. Policy; To assist clients in obtaining DOEA funded;services as funding becomes available, based on level of need as determined by a CIRTS priority score. Procedure: 1. ADRC Contracted Provider will conduct periodic follow-up calls(or home visit in case of active client) to check on client status based on DOEA Wait list Reassessment Standards. 2. Based on the information provided via the 701A(B)assessment, the ADRC Contracted Provider will update the client information in CIRTS specifically as it pertains to lever of need for services by funding source. 3. The ADRC Contracted Provider will ensure that the CIRTS prioritization score is accurately maintained, according to DOEA Standards. 4. If the caller is in need of a service(s)that is not provided by the ADRC Contracted Provider, the ADRC Contracted Provider will refer caller to the ADRC Elder Helpline utilizing the ADRC Referral Form and/or to an ADRC Contracted Provider that provides the deeded service. 5. The caller will be informed of the services and funding sources that they remain on the wait list for and/or have been removed from the wait list for. 6. ADRC Contracted Provider will advise client of any change in their CIRTS priority score based on the updated information. 7. ADRC Contracted Provider will remind client of the ADRC Elder Help line contact number and to contact the ADRC Elder Help line with any questions or concerns. 8. As funding becomes available, ADRC Contracted Provider will run CIRTS Prioritization Report and activate clients according to DOER Standards(refer to ADRC Client Activation Policies and Procedures). The Contracted Provider will apply targeting criteria, as appropriate, to prioritized clients to ensure activations meet programmatic requirements. 12 t CONTRACT KZ-1397 Page 13 Alliance for Aging, Inc. Aging and Disability Resource Center/Elder Helpline Policy and Procedure for Activation From Wait List— Clients/Services Creation Date: March 5, 2008 Revision Date: May 2012 Review Date: May 2011 Objective: To ensure that elders in need of DOEA funded services in Miami-Dade and Monroe Counties and on the CIRTS wait list begin to receive services as funding becomes available. Policy: ADRC will work with ADRC Contracted Providers to ensure that clients waiting for DOEA funded services begin to receive those services as funding becomes available. Procedure:, 1. ADRC Contracted Provider will activate clients on CIRTS wait list based on DOEA prioritization polices and funding availability. 2. ADRC Contracted Provider will update CIRTS status by funding source and service for any services being activated for the client using appropriate CIRTS codes. 3. Client may be left on wait list of a different funding source than the one being activated if ADRC Contracted Provider determines that it is appropriate. 4. Client may also be left on wait list in CIRTS if they are being activated by the ADRC Contracted Provider under a temporary non-DOER funding source and ADRC Contracted Provider determines that the clients'need will persist after the temporary funding source is exhausted. 5. ADRC Contracted Provider will inform the client of any services/funding source that they are being activated for as well as those services and funding sources that they will continue to be wait listed for. 6. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have any questions or concerns regarding the status of any of their services. 13 CONTRACT KZ-197 Page 14 Alliance for Aging, Inc. Aging and Disability Resource Center/Elder Helpline Policy and Procedure for Termination From Wait List—Clients/Services Creation Date; March 5, 2008 Revision date; May 2012 Review Date: May 2011 Objective: To ensure that the comprehensive list of clients in need of services in CIRTS is appropriately maintained by funding source and that the ADRC is thereby able to effectively gauge the current level of elder service need in Miami-Dade and Monroe Counties. Policy: ADRC will maintain an accurate and current list of clients in need of elder services in Miami- Dade and Monroe Counties with the assistance of the ADRC Contracted Providers. Procedure. 1. ADRC Contracted Provider will re-screen clients which the ADRC Contracted Provider initially placed on the CIRTS wait list for services based on DOEA Reassessment Standards. 2. The re-screening may be in the form of a phone screening or a home visit depending on the clients status(i.e. active/pending) 3. ADRC Contracted Provider will determine if the client is no longer in need (or eligible)for any of the services they were wait-listed for. 4. ADRC Contracted Provider will terminate the client from the wait list(entirely or by specific service) using the appropriate CIRTS termination code for any services or funding source for which the client is determined to no longer be eligible for or no longer in need of.` 5. ADRC Contracted Provider will inform the client of any services/funding source that they are being removed from the wait list for. 6. ADRC Contracted Provider will inform client of their ability to be re-added to the wait list if their level of need should change. 7. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have any questions or concerns regarding their wait list status. 8. Reference DOEA Programs and Services Handbook as applicable. 14 CONTRACT KZ-1397 Page 15 ATTACHMENT IX CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS,GRANTS, LOANS AND AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief,that: (1)No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress, an officer or employee of congress,an employee of a member of congress, or an officer or employee of the state legislator, in connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2)If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any;agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL,"Disclosure Form to Report Lobbying,"in accordance with its instructions. (3)The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers(including subcontracts,sub-grants, and contracts under grants,loans and cooperative agreements)and that all subproviders shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000.00 and not more than $100,000.00 for each such failure. (SEAS.) AMA�Y Signature x eat" fAA p(L K7 - 3 9'7 Name of Authorized divid al Application or Agreement Number () C...C--- Name and Address of Org6Aization C NTY y MflN OV AS DUEA Farm 103(RevLved Nov 2{02) PF.ty� ANC`GOUt .Y Date, --- 15 t i `• • . s' .' , it off $t • • •s • a •. • . a - �a its of • a • , • . -. '• r • ! CONTRACT KZ-1397 Pa a 17 9 expenditures by agreement number for each agreement with the Alliance of Elder Affairs in effect during the audit period.Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider's fiscal year end. As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance Audit Report. PART II:STATE FUNDED This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2),Florida Statutes. In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000.00 in any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider trust have a State single or project-specific audit for such fiscal year in accordance with Section 215.97,Florida Statutes; applicable rules of the Alliance of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial assistance awarded through the Alliance of Eider Affairs by this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state financial assistance received from the Alliance of Elder Affairs, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in Part II, paragraph 1, the provider shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10650 (nonprofit and for-profit organizations), Rules of the Auditor General. If the provider expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending September 30,2004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, Florida;Statutes, is not required. In the event that the provider expends less than $500,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes,the cost of the audit must be paid from the nonstate entity's resources (i.e.,the cast of such an audit must be paid from the provider resources obtained from other than State entities). An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Alliance of Elder Affairs shall be based on the agreement's requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement.All questioned costs and liabilities due to the Alliance of Elder Affairs shall be fully disclosed in the audit report with reference to the Alliance of Elder Affairs agreement involved. If not otherwise disclosed as required by Rule 691-5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the Alliance of Elder Affairs in effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after 17 ♦ 1 CONTRACT KZ-1397 Page 19 the provider's fiscal year end. Notwithstanding the applicability of this portion, the Alliance of Elder Affairs retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law. As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance Audit Report, PART III: REPORT SUBMISSION Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I of this agreement shall be submitted,when required by Section .320 (d), OMB Circular A-1 3, as revised:,by or on behalf of the provider directl to each of the following: The Alliance for Aging, Inc. at the following address: Alliance for Aging,Inc.Attn: Carlos Lahitte 760 NW 107 th Ave,Suite 214 Miami,FL 33172 18 CONTRACT KZ-1397 Page 19 ATTACHMENT X EX MIT 2 PART I:AUDIT RELATIONSHIP DETERMINATION Providers who receive state or federal resources may or may not be subject to the audit requirements of C} B Circular A-133, as revised, and/or Section 215.97, Fla. Stat Providers who are determined to be providers or subproviders of federal awards and/or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-133, as revised, and/or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to be providers or subproviders of Federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance requirements. In accordance with Sec.210 of OMB Circular A-133 and/or Rule 691-5.006,FAC,provider has been determined to be: Vendor or exempt entity and not subject to OMB CircularA-133 and/or Section 215.97,F.S. X Provider/subprovider subject to OMB Circular A-133 and/or Section 215.97,F.S. NOTE: If a provider is determined to be a provider/subprovider of federal and or state financial assistance and has been approved by the Alliance to subcontract,they must comply with Section 215.97(7),F.S.,and Rule 691- .006(2),FAC[state financial assistance]and Section_.400 OMB Circular A-133[federal awards]. PART II:FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state matching funds on Federal awards and who are determined to be a subprovider, must comply with the following fiscal laws,rules and regulations: STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW: 2 CFR Part 225 Cost Principles for State,Local and Indian Tribal Governments(Fonnerly OMB Circular A-87)* OMB Circular A-102—Administrative Requirements OMB Circular A 133—Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations NON-PROFIT ORGANIZATIONS MUST FOLLOW- 2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-122-Cost Principles)* 2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-110-Administrative Requirements) Requirements) OMB Circular A-133-Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations EDUCATIONAL INSTITUTIONS{EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT}MUST FOLLOW: 19 ' CONTRACT KZ-1397 Page 20 2 CER Part 220 Cost Principles for Educational Institutions OMB(Formerly Circular A-21-Cast Principles)* 2 C R Part 215 Administrative Requirements(Formerly OMB Circular A-I 10-Administrative Requirements) OMB Circular A-133—Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations 'Some Federal programs may be exempted from compliance with the Cast Principles Circulars as noted in the OMB Circular A-133 Compliance Supplement,Appendix 1. STATE FINANCIAL ASSISTANCE, Providers who receive state financial assistance and who are determined to be a providerlsubprovider,must comply with the following fiscal laws,rules and regulations: Section 215.97,Fla.Stat. Chapter 691-5,Fla.Admin.Cade State Projects Compliance Supplement Reference Guide for State Expenditures Other fiscal requirements set forth in program laws,rules and regulations 20 r CONTRACT KZ-1397 Page 21 ATTACHMENT XI CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned, an authorized representative of the provider named in the contract or agreement to which this form is an attachment,hereby certifies that: (1)The provider and any sub-providers of services under this contract have financial management systems capable of providing certain information,including: (1)accurate,current,and complete disclosure of the financial results of each grant- funded project or program in accordance with the prescribed reporting requirements; (2)the source and application of funds for all agreement supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. (2)Management Information Systems used by the provider,sub-provider(s),or any outside entity on which the provider is dependent for data that is to be reported, transmitted or calculated,have been assessed and verified to be capable of processing data accurately, including year-date dependent data. For those systems identified to be non-compliant, provider(s)will take immediate action to assure data integrity. (3)If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the undersigned warrants that these products are capable of processing year-date dependent data accurately. All versions of these products offered by the provider(represented by the undersigned) and purchased by the State will be verified for accuracy and integrity of data prior to transfer. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the provider agrees to immediately make required corrections to restore hardware and software programs to the same lever of functionality as warranted herein, at no charge to the State, and without interruption to the ongoing business of the state,time being of the essence. (4) The provider and any sub-providers) of services under this contract warrant their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity compliance issues. The provider shall require that the language of this certification be included in all subagreements, subgrants, and other agreements and that all sub-providers shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A-102 and 2 CFR Part 215(formerly OMB Circular A-110). Name and Address f Provider 40 Signature „a Title D 1 .IM1" 1POPELEODU.M R EY 4TY Name of uthorized igner (Revised June 2008) ATT MY K!. 11 Its,CLERK n # s t0 CONTRACT KZ-1397 Paige 22 ATTACHMENT XII CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS C� (1)The prospective provider certifies,by signing this certification,neither it nor its principals are presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from participation in this transaction by any federal Alliance or agency. (2)Where the prospective provider is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this certification. (SEAL) C A,T 'AMY H viUN,Cl.OR `� Zy` � �, ,nji. F> \..+ ti Signature •— nAC. ate K , A0 lAkO Title Agency/Organi U AS (Certification signature should be same as Contract signature.) Instructions for Certification 3 Cate t.The terms "covered transaction," „debarred," "suspended," "ineligible," "lower tier covered transaction," "person," "primary covered transaction,"and"voluntarily excluded,"as used herein.,have the meanings set out in the sections of rules implementing Executive Order 12549. (2 CFR 180.5- 180.1020, as supplemented by 2 CFR 376.10-376.995). You may contact the Contract Manager for assistance in obtaining a copy of those regulations. 2.This certification is a material representation of facts upon which reliance was placed when the parties entered into this transaction. If it is later determined that the provider knowingly rendered an erroneous certification,in addition to other remedies available to the federal government,the Alliance may pursue available remedies, including suspension and/or debarment, 3.The provider will provide immediate written notice to the Contract Manager if at any time the provider learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The provider may decide the method and frequency by which it determines the eligibility of its principals. Each participant to a lower tier covered transaction may,but is not required to,check the Excluded Parties List System (EPLS). 4.The provider will include a "Certification Regarding Debarment, Suspension, ineligibility and Voluntary Exclusion- Lower Tier Covered Transaction"in all its lower tier covered transactions and in all solicitations for lower tier covered transactions. 5.The provider agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,suspended,determined ineligible or voluntarily excluded from participation, unless otherwise authorized by the federal government. 6.1f the provider knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible,or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government,the Alliance may pursue available remedies, including suspension,and/or debarment. 7.The provider may rely upon a certification of a prospective participant hi a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction,unless it knows that the certification is erroneous. (Revised June 20M) 22 -. { . Y CONTRACT,KZ-1 7 Page 2 ATTACHMENT XIII ASSURANCES—NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing an(Y reviewing the collection of information. Send comments regarding the burden estimate or any other a ect of this collection of information, including suggestions for redu' this burden, to the {office of Management and Budget. Paperwork Deduction Project(0348-00431 WasKin t„ on,DC 20503. PLEASE Imo}NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Nate: Certain of these assurances may not be applicable to your project or program If you have questions please contact the awarding agency.Further,certain Federal awarding agencies may require applicants to certify to additional assurances.If such is the case,you will be notified. I.Has the legal authority to apply for Federal assistance,and the institutional,managerial and financial capability (including funds sufficient to pay the non-Federal share of project cost)to ensure proper planning,management,and completion of the project described in this application. 2. ill give the awarding agency,the Comptroller General of the United States,and if appropriate,the State, through any authorized representative,access to and the right to examine all records,books,papers,or documents related to the award;and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3.Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest,or personal gain. 4.Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5.Will comply with the Intergovernmental Personnel Act of 1970(42 U.S.C..4728-4763)relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration(5 C.F.R.900,Subpart F). 6.Will comply with all Federal statutes relating to nondiscrimination.These include but are not limited to.(a)Title VI of the Civil Rights Act of 1964(P.L 88-352)which prohibits discrimination on the basis of race,color or national origin;(b)Title IX of the Education Amendments of 1972,as amended(20 U.S.C.. 1681-1683,and 1685- 1686) which prohibits discrimination on the basis of sex;(c)Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S. .194),which prohibits discrimination on the basis of handicaps;(d)the Age Discrimination Act of 1975,as amended(42 U.S.C..6101- 107),which prohibits discrimination on the basis of age;(e)the Drug Abuse Office and Treatment Act of 1972(P.L.92-255),as amended,relating to nondiscrimination on the basis of drug abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment and Rehabilitation Act of 1970 (P.L.91-616),as amended,relating to nondiscrimination on the basis of alcohol abuse or alcoholism;(g).523 and 527 of the Public Health Service Act of 1912(42 U.S.C.,290 dd-3 and 290 ee 3),as amended,relating to confidentiality of alcohol and drug abuse patient records;(h)Title VIII of the Civil Rights Act of 1968(42 U.S.C..3601 et seq.),as amended,relating to nondiscrimination in the sale,rental or financing of housing;(i)any other nondiscrimination provisions in the specific statute(s)under which application for Federal assistance is being made;and(j)the requirements of any other nondiscrimination statute(s)which may apply to the application. 7.Will comply,or has already complied,with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970(P.L.91-646)which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 3.Will comply,as applicable,with the provisions of the Hatch Act(5 U.S.C..1501-1508 and 7324-7328),which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal 23 TRACT KZ-1 97 Pag tj e a 24 9 9. ill comply,as applicable,with the provisions of the Mavis-Bacon Act(40 U. .C..276a to 276a•7),the Copeland Act(40 U.S.C.276c and 18 U.S.C.874)and the Contract Work Hours and Safety Standards Act(40 U.S.C.327- 33), regarding labor standards for federally assisted construction subagree ents. 10.Will comply,if applicable,with flood insurance purchase requirements of Section 102(a)of the Flood Disaster Protection Act of 1 (P.L.93-234)which requires providers in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is$10,000.00 or more. 11. ill comply with environmental standards which may be prescribed pursuant to the following:(a)institution of environmental quality control measures under the National Environmental Policy Act of 1969(P.L.91-190)and Executive Order(EO)11514;(b)notification of violating facilities pursuant to EO 11738,(c)protection of wetlands pursuant to EO 11990;(d)evaluation of flood hazards in floodplains in accordance with EO 11988;(e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972(16'U.S.C. 1451 et seq.); (f)conformity of Federal actions to State(Clear Air) Implementation Plans under Section 176(c)of the Clear Air Act of 1955,as amended(42 U.S.C.1401 et seq.); (g)protection of underground sources of drinking water under the Safe Drinking Water Act of 1974,as amended,(P.L.93-52 ) and(h)protection of endangered species under the Endangered Species Act of 1973,as amended,(P.L.93-205) 12 Will comply with the Wild and Scenic Rivers Act of 1968 components of the national wild and scenic rivers system(16 U.S.C..1721 et seq.)related to protecting components or potential 13.Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966,as amended(16 U.S.C.A70),EO 11393(identification and protection of historic properties),and the Archaeological and Historic Preservation Act of 1974(16 U.S.C..469a-1'et seq.). 14. ill comply with P.L.93-348 regarding the protection of human subjects involved in research,development, and related activities supported by this award of assistance. 15.Will comply with the Laboratory Animal Welfare Act of 1966(P.L.89-544,as amended,7 U.S.C..2131 et seq.) pertaining to the care,handling,and treatment of warm blooded animals held for research,teaching,or other activities supported by this award of assistance. 16.Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C..4801 et seq.),which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. 17.Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No.A-133,Audits of States,Local Governments,and Non-Profit Organizations. 1 .Will comply with all applicable requirements of all other Federal laws,executive orders,regulations and policies governing this program. SIGNATURE OF AUTHORIZED CERTIPYNG OFFICIAL Z1TL.H r � -4 AI'I'LICaNTOxc:aNlzaTION DATE SUMMED Ma ©v t�� (S5A.) A AIM HEA LIN,CLERK ASS1STAW CO24 ATT Date Y CONTRACT KZ 1397 Page 25 A l l ACHtl`3EN i XI Y STATE OF FLORIDA ALLIANCE OF ELDER AFFAERS CIVIL BIGHTS CONVLLANCE CHECKLIST Program/Facility Naive � �„� Co CoeProvider �c.. Address Ijr.Q & � l .t Completed By Kty,State,Zip Code 1J 1: . , ; C 0 late Telephon Z' z PART L READ THE ATTAcHYD mmuc oNS FOR ILLUSTRATIVE n4oilmATION WHICH WILL HELP YOU iN THE COMPLETION OF THIS FORM. 1. Briefly describe the geographic area served by the program/facility and the type of service provided; Yd :Cite_ Z POPULATION OF AREASERVED.7Smm of data: V.A„ `I�lt►��t ��*y �tit/��1 [a1'�. r �. Total# %White %Black °/Oilil : %�.7t[ler %l 'Ia. � 1 3. AFF CURRENTLY EMPLOYED.Effective date Total# %White %Black %Hispanic %Other °I°Female °l°Disabled MA 0 o sa 4. CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date: a Total# %White 0/ Black I %Hispanic %other %Female %Disabled °t°Over 4{1 ra Iota00 5. ADVISORY OR GOVERNNG BOARD,IF APPLICABLE. Toy # %White %Black %Hispariic %Other %Female %Di&*ed 0 0 1 0 o I ca to 4 PART IL USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE 6. Is an Assurance of Compliance on file with the Alliance? If NA or NO explain NA 'E NO 7. Compare the staff composition to the population.Is staff representative of the population?If NA or NO,explain. NA( N0 8. Compare the client composition to the population.Are race and sex characteristics representative of the Population?If NA or NO,explain. NA Es o 25 an NT R p+�r-.-sue 4 37Page 26 9. Are eligibility requirements for services applied to clients and a licants without regar o race,color,nanonal origin,sex,age,re pion or disabilitV f it NA Or NU, ex lain. NA ES O 10. Are all benefits,services and facilities available to applicants and participants in an equally effective manner regardless of race,sex,color,age,national origin,religion or disability?If NA or NO,explain. NA YES NO A 11. For in-patient services are room assignments made without regard to race,color,national origin or disability?If NA or 9( ,explain. (2�iYEs NO 12. Is the program/facility accessible to non-English speaking clients?If NA or NO,explain. N YE `NO 13. Are ernployees�applicants axd_participants informed of their prtIf NA or Nam, discrimination. It yes,how. Verbal w--Written G-'"Poster explain. C 14. Give the number and current status of anv discrimination complaints regarding services or employment filed against the program/facility. Zk-yLD 26 a 15. Is the pro am/facility physically accessible to mobility,hearing,and sight-impaired individuals? If NA or�,explain. NA<DO PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES YES NO 16. Has a self-evaluation been conducted to identify any barriers to serving;disabled individuals,and to make any necessary modifications?If No,explain. Lidu 17. Is there anti established grievance procedure that incorporates due process in the resolution of complaints?If NO,explain. YES NO 18. Has a person been designated to coordinate Section 504 compliance activities?If YES O NO,explain. 19. Do recruitment and notification materials advise applicants,em lovees and participants of nondiscrimination on the basis of disability?If I0,'expla n. 20. Are auxiliary aids available to assure accessibility of services to hearing and sight impaired individuals?If NO,explain. 27 CONTRACT KZ-1397 Page 28 C!❑ YES NO PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF$50,000 OR MORE. /"� 21. Do you have a written affirmative action plan?If NO,explain. `/ ID DfOEA USE ONLY Reviewed By incompliance: YES o NO* o Program Office *Notice of Corrective Action Sent / 1 Date Telephone Response Due l / On-Site n Desk Review n Response Received DOEA Form 101-A,Revised May 2008 Page 2 of 2 28 CONTRACT KZ-1397 Page 29 Al ri T.tp1 AlY INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST l.Describe the geographic;service area such as a district,county,city or other locality.If the program/facility serves a specific target population such as adolescents,describe the target population.Also,define the type of service provided. 2.Enter the percent of the population served by race and sex The population served includes persons in the geographical area for which services are provided such as a city,county or other regional area. Population statistics can be obtained from local chambers of commerce,libraries,or any publication from the 1980Census containing Florida population statistics.Include the source of your population statistics.("Other"races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3.Enter the total number of full-time staff and their percent by race,sex and disability.Include the effective date of your summary. 4.Enter the total number of clients who are enrolled,registered or currently served by the program or facility,and list their percent by race,sex and disability.Include the date that enrollment was counted. 5.Enter the total number of advisory board members and their percent by race,sex,and disability.If there is no advisory or governing board,'leave this section blank. 6.Each provider of federal financial,assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80.This is usually a standard part of the contract language for DOEA providers and their sub-grantees,45 CFR 80.4(a) 7Is the race,sex,and national origin of the staff reflective of the general population?For example,if 10%of the population is Hispanic,is there a comparable percentage of Hispanic staff? 8Where there is a significant variation between the race,sex or ethnic composition of the clients and their availability in the population,the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination.Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons,45 CFR 80. (b)(6). 9.Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment?Evidence of such may be indicated in staff'and client representation (Questions 3 and 4)and also through on-site record analysis of persons who applied but were denied services oremployment,45 CFR 80 (a)and45CFR80.I(b)(2). I O.Participants or clients must be provided services such as medical,nursing and dental care, laboratory services,physical and recreational therapies,counseling and social services without 29 CONTRACT KZ 1397 Page 30 regard to race,sex,color,national origin,religion,age or disability.Courtesy titles,appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex,color,national origin,religion,age or disability.Entrances,waiting rooms,reception areas, restrooms and other facilities must also be equally available to all clients,45 CFR 80.3(b). I I.For in-patient services,residents must be assigned to rooms,wards,etc.,without regard to race, color,national origin or disability. ,residents must not be asked whether they are willing to share accommodations with persons of a different race,color,national origin,or disability,45'CFR 80.3(a). 12.The program/facility and all services must be accessible to participants and applicants,including those persons who may not speak English.In geographic areas where a significant population of non-English speaking people live,program accessibility may include the employment of bilingual staff.In other areas,it is sufficient to have a policy or plan for service,such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services,45 CFR 80.3(a); I3.Prograrns/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants,beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Alliance of Elder Affairs or the U.S.Alliance of HHS.The information may be supplied verbally or in writing to every individual,or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility,45 CFR 80.6 (d). 14.Report number of discrimination complaints filed against the program/facility. Indicate the basis,e.g., race,color,creed,sex,age,national origin,disability,'retaliation;the issues involved,e.g.,services or employment,placement, termination,etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g.,settled,no reasonable cause found,failure to conciliate,failure to cooperate,under review,etc, 15.The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas,curb cuts or level approaches, ramps and adequate widths to entrances.The lobby,public telephone,restroom facilities,water fountains,information and admissions offices should be accessible. Door widths and traffic areas of administrative offices,cafeterias, restrooms,recreation areas,counters and serving Iines should be observed for accessibility. Elevators should be observed for door width,and Braille or raised numbers. Switches and controls for light,heat, ventilation, fire alarms,and other essentials should be installed at an appropriate height for mobility impaired individuals. 15.Section 504 of the Rehabilitation Act of 1973 requires that a provider of federal financial assistance conduct a self-evaluation to identify any accessibility barriers. Self-evaluation is a four step process: -With the assistance of a disabled individual/organization,evaluate current practices and policies which do not comply with Section 504. •Modify policies and practices that do not meet Section 504 requirements. •Take remedial steps to eliminate any discrimination that has been identified. •Maintain self-evaluation on file. (This checklist may be used to satisfy this 30 s , CONTRACT KZ 1397 � Page 31 requirement if these four steps have been followed.), 45 CFR 84.6. 17.Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7(b). 18Progras or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7(a). 19.Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material,notices for hearings,newspaper ads, and other appropriate written communication,45 CFR 84.8 (a). 20.Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include,but are not limited to,interpreters for hearing impaired individuals,taped or Braille materials, or any alternative resources that can be used to provide equally effective services, (45 CFR 8452 (d). 21.Programs/facilities with 50 or:more employees and$50,000 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive{order 11246.41 CFR 60 and Title VI of the Civil Rights Act of 1964,as amended. 31 CONTRACT KZ 1397 Page 32 ATTACHMENT XV Verification of Employment Status Certification As a condition of contracting with the Alliance for Aging, Inc., Monroe County Board of Commissioners, hereby referred to as contractor, certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this Agreement and(b)that any subcontracts include an express requirement that subcontractors performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term. r �� aQt3 Signature ,� cZ, + D -- (Same as contract s4nature) R-- kNI t3 a. Title �- (SEAL) ATr9 AMY.HEA IUN,CLERK go BY, Company Name CIEPL -Y CLERK MONK COUNTY ATT Y AP R E AS TO F PEd A COUNTY ATT RN Date l -. 01P. 32 CONTRACT KZ 1397 Page 33 ATTACHMENT XVI Alliance for Aging, Inc. Business Associate Agreement This Business Associate Agreement is dated , by the Alliance for Aging, Inc("Covered Entity")and aunfb ("Business Associate"), a not-for- profit Florida corporation. 1.0 Background. 1.1 Covered Entity has entered into one or more contracts or agreements with Business Associate that involves the use of Protected Health Information(PHI). 1.2 Covered Entity, recognizes the requirements of the Health Insurance Portability and Accountability Act of 1996(HIPAA)and has indicated its intent to comply in the County's Policies and Procedures. 1.3 HIPAA regulations establish speck conditions on when and how covered entities may share information with contractors who perform functions for the Covered Entity. 1.4 HIPAA requires the Covered Entity and the Business Associate to enter into a contract or agreement containing specific requirements to protect the confidentiality and security of patients'PHI, as set forth in, but not limited to the Code of Federal Regulations(C.F.R.), specifically 45 C.F.R.§§ 164.502(e), 164.504(e), 164.308(b), and 164.314(a-b)(2010)(as may apply)and contained in this agreement. 1.5 The Health Information Technology for Economic and Clinical Health Act(2009), the American Recovery and Reinvestment Act(2009)and Part I—Improved Privacy Provisions and Security provisions located at 42 United States Code(U.S.C.)§§ 17931 and 17934(2010)require business associates of covered entities to comply with the HIPAA Security Rule, as set forth in, but not limited to 45 C.F.R. §§ 164. 08, 164.310, 164.312,and 164.316(2009)and such sections shall apply to a business associate of a covered entity in the same manner that such sections apply to the covered entity. The parties therefore agree as follows; 2.0 Definitions. For purposes of this agreement, the following definitions apply: 2.1 Access. The ability or the means necessary to read, write, modify,or communicate data/information or otherwise use any system resource. 2.2 Administrative Safeguards. The administrative actions, and policies and procedures, to manage the selection,development, implementation, and maintenance of security measures to protect electronic Protected Health Information(ePHI)and to manage the conduct of the covered entity's workforce in relation to the protection of that information. 2.3 ARRA. The American Recovery and Reinvestment Act(2009) 2.4 Authentication. The corroboration that a person is the one claimed. 2.5 Availability. The property that data or information is accessible and useable upon demand by an authorized person. 33 CONTRACT KZ 1397 Page 34 2.6 Breach. The unauthorized acquisition, access, use, or disclosure of PHI which compromises the security or privacy of such information. 2.7 Compromises the Security. Posing a significant risk of financial, reputational,or other harm to individuals. 2.8 Confidentiality. The property that data or information is not made available or disclosed to unauthorized persons or processes. 2.9 Electronic Protected Health Information.(ePHI) Health information as specified in 45 CFR§160.103(1)(i)or(1)(ii), limited to the information created or received by Business Associate from or on behalf of Covered Entity. 2.10 HITECH.The Health Information Technology for Economic and Clinical Health Act(2009) 2.11 information System. An interconnected set of information resources under the same direct management control that shares common functionality. A system normally includes hardware, software, information,data, applications, communications,and people. 2.12` Integrity. The property that data or information have not been altered or destroyed in an unauthorized manner. 2.13 Malicious software. Software,for example, a virus, designed to damage or disrupts a system. 2.14 Part 1. Part I—Improved`Privacy Provisions and Security provisions located at 42 United States Code(U.S.C.)§§ 17931 and 17934(2010). 2.15 Password. Confidential authentication information composed of a string of characters. 2.16 Physical Safeguards. The physical measures, policies, and procedures to protect a covered entity's electronic information systems and related buildings and equipment,from natural and environmental hazards, and unauthorized intrusion. 2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164, subparts A and E. 2.18 Protected Health Information.(PHI)'Health information as defined in 45 CFR §160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity. 2.19 Required By Law. Has the same meaning as the term"required by law"in 45 CFR§ 164.103. 2.20 Secretary. The Secretary of the Department of Health and Human Services or his or her designee. 2.21 Security incident.The attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system. 2.22 Security or Security measures.All of the administrative, physical,and technical safeguards in an information system. 2.23 Security Rule. The Security Standards for the protection of Electronic Protected Health Information at 45 CFR part 164, subpart C, and amendments thereto. 2.24 Technical Safeguards. The technology and the policy and procedures for its use that protect electronic protected health information and control access to it. 34 , { CONTRACT KZ' 1397 Page 35 • 2.25 Unsecured PHI; Protected health information that is not secured through the use of technology or methodology specified by the Secretary in guidance issued under 42 U.S.C. section 17932(h)(2), 2.26 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in the Privacy Rule. 3.0. Obligations and Activities of Business Associate. 3.1 Business Associate agrees to not use or disclose PHI other than as permitted or required by this agreement or as Required by Law. 3.2 Business Associate agrees to: (a) Implement policies and procedures to prevent, detect, contain and correct Security violations in accordance with 45 CFR§ 164.306; (b) Prevent use or disclosure of the PHI other than as provided for by this Agreement or as required by law; (c) Reasonably and appropriately protect the confidentiality, integrity, and availability of the ePHI that the Business Associate creates, receives, maintains,or transmits on behalf of the Covered Entity;and (d) Comply with the Security Rule requirements including the Administrative Safeguards, Physical Safeguards,Technical Safeguards,and policies and procedures and documentation requirements set forth in 45 CFR§§ 164.308, 164.310, 164.312, and 164.316. 3.3 Business Associate agrees to mitigate,to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this Agreement. 3.4 Business Associate agrees to promptly report to Covered Entity any use or disclosure of the PHI not provided for by this Agreement of which it becomes aware.This includes any requests for inspection, copying or amendment of such information and including any security incident'involving PHI. 3.5 Business Associate agrees to notify Covered Entity without unreasonable delay of any security breach pertaining to (a) Identification of any individual whose unsecured PHI has been,or is reasonably believed by the Business Associate to have been, accessed, acquired,or disclosed during such security breach;and (b) All information required for the Notice to the Secretary of HHS of Breach of Unsecured Protected Health Information. 3.6 Business Associate agrees to ensure that any agent, including a subcontractor,to whom it provides PHI received from, or created or received by Business Associate on behalf of Covered Entity, agrees to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information. 3.7 If Business Associate has PHI in a Designated Record Set: (a) Business Associate agrees to provide access,at the request of Covered Entity during regular business hours, to PHI in a Designated Record Set, to Covered Entity or, as directed by Covered Entity;to an individual in order to meet the requirements under 45 CFR§164.524; and 35 a . CONTRACT KZ 1397 Page 36 (b) Business Associate agrees to make any amendment(s)to PHI in a Designated Record Set that the Covered Entity directs or agrees to pursuant to 45 CFR§ 164.526 at the request of Covered Entity or an Individual within 10 business days of receiving the request. 3.8 Business Associate agrees to make internal practices, books,and records, including policies and procedures and PHI,relating to the use and disclosure of PHI received from, or created or received by Business Associate on behalf of Covered Entity, available to the Covered Entity or to the Secretary upon request of either for purposes of determining Covered Entity's;compliance with the Privacy Rule. 3.9 Business Associate agrees to document such disclosures of PHI and information related to such disclosures as would be required for Covered Entity to respond to a'request by an individual for an accounting of disclosures of PHI in accordance with 45 CFR§ 164.528. 3.10 Business Associate agrees to provide to Covered Entity or an individual, upon request, information collected in accordance with Paragraphs h and i above, to permit Covered Entity to respond to a request by an individual for:an accounting of disclosures of PHI in accordance with 45 CFR§ 164.528 and ARRA,;§ 13404. 3.11 Business Associate specifically agrees to use security measures that reasonably and appropriately protect the confidentiality, integrity,and availability of PHI in electronic or any other form, that it creates, receives, maintains,or transmits on behalf of the Covered Entity. 3.12 Business Associate agrees to implement security measures to secure passwords used to access ePHI that it accesses, maintains,or transmits as.part of this Agreement from malicious software and other roan-made and natural vulnerabilities to assure the availability, integrity,and confidentiality of such information. 3.13 Business Associate agrees to implement security measures to safeguard ePHI that it accesses,maintains,or transmits as part of this agreement from malicious software and other man-made and natural vulnerabilities to assure the availability, integrity, and confidentiality of such information. 3.14 Business Associate agrees to comply with: (a) ARRA§ 13404(Application of Knowledge Elements Associated with Contracts); (b) ARRA§ 13405(Restrictions on Certain Disclosures and Sales of Health Information);and (c) ARRA§ 13406(Conditions on Certain Contacts as Part of Health Care Operations). 4.0 Permitted Uses and Disclosures by Business Associate. Except as otherwise limited in this Agreement or any related agreement, Business Associate may use or disclose PHI to perform functions,activities, or services for, or on behalf of, Covered Entity as specified in any and all contracts with Covered Entity provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity. 5.0 Specific Use and Disclosure Provisions. 5.1 Except as otherwise limited in this agreement or any related agreement, Business Associate may use PHI for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate. 5.2 Except as otherwise limited in this agreement or any related agreement, Business Associate may disclose PHI for the proper management and administration of the Business Associate, provided that disclosures are Required By Law, or Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as Required By Law or for the purpose for which it was disclosed to the person, and the 36 ' CONTRACT KZ 1397 Page 37 person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached. 5.3 Business Associate may use PHI to provide data aggregation services to Covered Entity as permitted by 45 CFR§164.504(e)(2)(i)(B),only when specifically authorized by Covered Entity. 5.4 Business Associate may use PHI to report violations of law to appropriate Federal and State authorities,consistent with 45 CFR 164.5 20)(1): 6.0 Obligations of Covered Entity. 6.1 Covered Entity shall notify Business Associate of any limitation(s)in its notice of privacy practices of Covered Entity in accordance with 45 CFR§ 164.520, to the extent that such limitation may affect Business Associate's use or disclosure of PHI, by providing a copy of the most current Notice of Privacy Practices(NPP)to Business Associate as Attachment I to this Agreement. Future Notices and/or modifications to the NPP shall be posted on Covered Entity's website at www.allianceforaginQ oro. 6.2 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR§ 164.522,to the extent that such restriction may affect Business Associate's use or disclosure of PHI. 7.0 Permissible Requests by Covered Entity. Except for data aggregation or management and administrative activities of Business Associate,Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by Covered Entity. 8.0 Effective Date and Termination. 8.1 The Parties hereby agree that this agreement amends, restates and replaces any other Business Associate Agreement currently in effect between Covered Entity and Business Associate and that the provisions of this agreement shall be effective as follows: (a) These Business Associate Agreement provisions,with the exception of the electronic security provisions and the provisions mandated by ARRA,HITECH and Part I shall be effective upon the later of April 14, 2003,or the effective date of the earliest contract entered into between Business Associate and Covered Entity that involves the use of PHI; (b) The electronic security provisions hereof shall be effective the later of April 21, 2005 or the effective date of the earliest contract entered into between Business Associate and Covered Entity that involves the use of PHI;and (c) Provisions hereof mandated by<ARRA, HITECH and/or Part I shall be effective the later of February 17, 2010 or the effective date of the earliest contract entered into between covered entity and business associate that involves the use of PHI or ePH1. 8.2 Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity shall either: (a) Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this agreement if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity; (b) Immediately terminate this agreement if Business Associate has breached a material term of this Agreement and cure is not possible;or (c) If neither termination nor cure is feasible,Covered Entity shall report the violation to the Secretary. 37 CONTRACT KZ 1397 Page 38 83 Effect of Termination. Except as provided in subparagraph(b)of this section, upon termination of this agreement,for any reason, Business Associate shall return all PHI and ePHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. (a) This prevision shall apply to PHI and ePHI that is in;the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the PHI and ePHI. (b) In the event that Business Associate or Covered Entity determines that returning the PHI or ePHI is infeasible, notification of the conditions that make return of PHI or ePHI infeasible shall be provided to the other party. Business Associate shall extend the protections of this Agreement to such retained PHI and ePHI and limit further uses and disclosures of such retained PHI and ePHI,fora minimum of six years and so long as Business Associate maintains such PHI and ePHI, but no less than six(6)yearn after the termination of this agreement. 9.0 Regulatory References. A reference in this agreement to a section in the Privacy Rule or Security Rule means the section then in effect or as may be amended in the future. 10.0 Amendment. The Parties agree to take such action as is necessary to amend this agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule,the Security Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No.'`104-191. 11.0 Survival. Any term,condition,covenant or obligation which requires performance by either party hereto subsequent to the termination of this agreement shall remain enforceable against such party subsequent to such termination. 12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit Covered Entity to comply with the Privacy Rule and Security Rule. 13.0 Incorporation by reference. Any future new requirement(s),changes or deletion(s) enacted in federal law which create new or different obligations with respect to HIPAA privacy and/or security,shall be automatically incorporated by reference to this Business Associate Agreement on the respective effective date(s). 14.0 Notices. All notices and communications required, necessary or desired to be given pursuant to this agreement,including a change of address for purposes of such notices and communications, shall be in writing and delivered personally to the other party or sent by express 24-hour guaranteed courier or delivery service,or by certified mail of the United States Postal Service, postage prepaid and return receipt requested, addressed to the other party as follows(or to such other place as any party may by notice to the others specify): To Covered Entity: Alliance for Aging, Inc. Attention: Max Rothman 760 NW 107 Avenue Miami, Florida 33172 To Business Associate: ' aVLrQ'r. Any such notice shall be deemed delivered upon actual receipt. If any notice cannot be delivered or delivery thereof is refused, delivery will be deemed to have occurred on the date such delivery was attempted. 15.0 Governing Law. The laws of the State of Florida, without giving effect to principles of conflict of laws,'govern all matters arising under this agreement. 38 ' CONTRACT KZ 1397 Page 39 16.0 Severabitity. If any provision in this agreement is unenforceable to any extent, the remainder of this agreement,or application of that provision to any persons or circumstances other than those as to which it is held unenforceable,will not be affected by that unenforceability and will be enforceable to the fullest extent permitted by law. " -17.0 Successors. Any successor to Business Associate(whether by direct or indirect or by purchase,merger,consolidation,or otherwise)is required to assume Business Associate's obligations under this agreement and agree to perform them in the same manner and to the same extent that Business Associate would have been required to if that succession had not taken place. This assumption by the successor of the Business Associate's obligations shall be by written agreement satisfactory to Covered Entity. 18.0 Entire Agreement. This agreement constitutes the entire agreement of the parties relating to the subject matter of this agreement and supersedes all other oral or written agreements or policies relating thereto, except that this agreement does not limit the amendment of this agreement in accordance with section 10.0 of this agreement. Covered Entity: By; Date: " (signature)— Business Associate: sw tie, By: = � t tl �-�' t Date. 11 z.13 (signature) pj►r�Lsn-t'.. c2._ (SEAL) HEA, IM,CLERK B 4 -- " C1F:ll':CLERK MON p�T A f PE�RO J.ME t�0 / As• S 31 l 3 l� 3 13 39