12/20/2006 Lower/Middle/Upper Keys
GI... aiDe
Gircal Glun
Danny L. Kolhage
Office (305) 292-3550 Fax (305) 295-3653
1\IIenwrandum
To:
Debbie Barsell, Director
Community Services Division
Attn:
Sandy Molina
Isabel C. DeSantis, . t1 )
Deputy Clerk ~
From:
Date:
Wednesday, January 03, 2007
At the BOCC meeting on December 20, 2006, the Board granted approval and
authorized execution of the following:
Memorandum of Agreement between Monroe County and Emergency Home
Energy Assistance for the Elderly Program (EHEAEP)/ Alliance for Aging, Inc_, and
Low-Income Energy Assistance Program (LIHEAP)/Monroe County BOCC and approval
ofEHEAEP Intake Center Referral Agreements for the three intake centers throughout
Monroe County - Lower/MiddlelUpper Keys_
Enclosed please find are four (4) sets of each document executed by Monroe
County for your handling. Please be sure that the sets marked Monroe County Clerk's
Office Orieina! and Monroe County Finance Deuartment's Orieina! are returned
to this office as quickly as possible. Should yoU have any questions, please do not
hesitate to contact me.
cc: Finance, w/o doc.
County Attorney
File V
M-"",...If'''"'''''
,"I':'!.':,. ',:;';"".., ~ ,:;,;,~f
EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM (EHEAEP)
INTAKE CENTER REFERRAL AGREEMENT
This Referrai Agreement between the Alliance for Aaina. Inc., the Area Agency on Aging (AAA) for
Planning and Service Area (PSA) 11 and Monrop r.ounty r.omrimn; ty Support> Services/Lower Keys
the Intake Center, shall begin on the date the agreement has been signed by both parties, whichever is
later. This referral agreement is in effect for a period of time that is equal to the Intake Center's voluntary
enrollment period in the EHEAEP program. One purpose of this agreement is to promote the
development of a coordinated service delivery system to meet the energy needs of the aged. Another
purpose of this agreement is to enable eligible elderly participants to access the EHEAEP program in a
convenient manner by going to the intake center nearest to their place of residence. Both parties agree
to and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabled adults.
C. To require the parties of this Agreement to provide technical assistance and consultation to each
other on matters pertaining to EHEAEP benefits' and share appropriate information so
duplication may not occur.
D. To establish an effective working relationship between the Intake Center responsible for the
initial assessment and verification of need, and the AAA that is responsible for management
and oversight of the EHEAEP program.
II. Under this Agreement, the Intake Center agrees to the following:
A. To accept referrals at large from any elderly individuals in the community experiencing an
energy emergency crisis and in need of assistance.
B. To provide quality service(s) to the EHEAEP applicant.
C. To obtain all documentation required under EHEAEP guidelines in order to establish that an
energy crisis exists and that the applicant meets all pertinent eligibility requirements.
D. To maintain the EHEAEP applicant's confidentiality according to 42 CFR 431.301.
E. To forward all information obtained and any required documentation to the EHEAEP
Coordinator at the Alliance for Aging Elder Helpline for case approval and processing.
G. To adhere to the requirements and the policies and procedures outlined in the EHEAEP
manual.
III. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To oversee the processing of all requests for assistance on behaif of eligible elderly individuals.
B. To provide technical assistance and training to Service Providers.
C. To complete a new referral agreement signed by all parties as appropriate.
IV. Termination
In the event this agreement is terminated, the Intake Center agrees to submit, at the time notice of intent
to terminate is delivered, a pian which identifies procedures to ensure services to consumers will not be
interrupted or suspended by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with proof
of delivery.
B. Termination for Breach
Uniess a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this 2 page agreement to be executed by their undersigned
officials as duly authorized.
Area Ag;9CY on A~
-Jf'k,) ~-
~f2-Le{lfe-' fi'/T~ tV
print name
~~ tl~AJ0{&(j 1100
:z./ ~./~ 7
Intak~)(}~
j
signature
;11art'o !J1'&:.enrla~~/ ~I/or-
print name
lille
litle
Simonton Street, Key West, FL
33040
date
10l.- ::1.0- oGo
dale
,SoAL, . . tJ-IAGECl.EFl~ ~.)
ArrtJ';o.~W~
6'1" - _ "','1 /
~
~
.....
~
-~
"":"\
~
...
.....-
'"1
c:;
:D
-
(..,)
...,
:JS:
(..,)
.,
;-J
,-'n
'c:'
o
-0
o
Date
-
(..,)
2
r:,1(i}:~~:,t\~,~~
EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM (EHEAEP)
INTAKE CENTER REFERRAL AGREEMENT
This Referral Agreement between the Alliance for Aqinq, Inc., the Area Agency on Aging (AAA) for
Pianning and Service Area (PSA) 11 and Monroe County Commllni ty SlIpport Send peR IMi ddl e Keys
the Intake Center, shall begin on the date the agreement has been signed by both parties, whichever is
later. This referral agreement is in effect for a period of time that is equal to the Intake Center's voluntary
enroilment period in the EHEAEP program. One purpose of this agreement is to promote the
development of a coordinated seNice delivery system to meet the energy needs of the aged. Another
purpose of this agreement is to enable eligible elderly participants to access the EHEAEP program in a
convenient manner by going to the intake center nearest to their place of residence. Both parties agree
to and wiil treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabled adults.
C. To require the parties of this Agreement to provide technical assistance and consultation to each
other on matters pertaining to EHEAEP benefits and share appropriate information so
duplication may not occur.
D. To establish an effective working relationship between the Intake Center responsible for the
initial assessment and verification of need, and the AAA that is responsible for management
and oversight of the EHEAEP program.
II. Under this Agreement, the Intake Center agrees to the following:
A. To accept referrals at large from any elderly individuals in the community experiencing an
energy emergency crisis and in need of assistance.
B. To provide quality seNice(s) to the EHEAEP applicant.
C. To obtain ail documentation required under EHEAEP guidelines in order to establish that an
energy crisis exists and that the applicant meets all pertinent eligibility requirements.
D. To maintain the EHEAEP applicant's confidentia lity according to 42 CFR 431.301.
E. To forward ail information obtained and any required documentation to the EHEAEP
Coordinator at the Ailiance for Aging Elder Helpline for case approval and processing.
G. To adhere to the requirements and the policies and procedures outlined in the EHEAEP
manual.
III. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To oversee the processing of all requests for assistance on behalf of eligible elderly individuals.
B. To provide technical assistance and training to SeNice Providers.
C. To complete a new referral agreement signed by ail parties as appropriate.
I
IV. Termination
In the event this agreement is terminated, the Intake Center agrees to submit, at the time notice of intent
to terminate is delivered, a plan which identifies procedures to ensure services to consumers will not be
interrupted or suspended by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with proof
of delivery.
B. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this 2 page agreement to be executed by their undersigned
officials as duly authorized.
Intake Center ~
~4 <l
signature
~A-J~
~a.-n'o D"&..e."np""o" ~yor
print name
print name
~tJ(~~fJB3
?-)~JtJ7
tille
title
4QO h1rn ~~rp.pt(Orp.~n). M~r~thona FL
/~-;/o ~O(,
date
date
\ '. ....~. "J~'ECU:R~ .
I " .... lW
~.. (I.,
3:
o 0
:z: );>
::On?;
0,"'''.-
P'1 A-<
no r"
o()'
c::::.--;:::~
MONROE COUNTY ATTORN~~ S.
~V~A~T~~~
~ON.
Dale COUJJ' WJ)J',f
/ 7
2
33050
"'"
=
=
-'
...,
,...,
CD
-.../:
".::J
w
...,
c)
-0
::I:
ca
:'~
rq
"
o
;;0
CJ
to)
M....,"'" If"- "" "
....':L>'::lJ.l.4i<o;.."'" .l,"-.v~..."'d
EMERGENCY HOME ENERGY ASSISTANCE FOR THE ELDERLY PROGRAM (EHEAEP)
INTAKE CENTER REFERRAL AGREEMENT
This Referral Agreement between the Alliance for AClinCl. Inc., the Area Agency on Aging (AAA) for
Planning and Service Area (PSA) 11 andMnnrnp r.nllnry r.nmmllni ty Support Services/Upper Key'i
the Intake Center, shall begin on the date the agreement has been signed by both parties, whichever is
later. This referral agreement is in effect for a period of time that is equal to the Intake Center's voluntary
enrollment period in the EHEAEP program. One purpose of this agreement is to promote the
development of a coordinated service delivery system to meet the energy needs of the aged. Another
purpose of this agreement is to enable eligible elderly participants to access the EHEAEP program in a
convenient manner by going to the intake center nearest to their place of residence. Both parties agree
to and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabled adults.
C. To require the parties of this Agreement to provide technical assistance and consultation to each
other on matters pertaining to EHEAEP benefits' and share appropriate information so
duplication may not occur.
D. To establish an effective working relationship between the Intake Center responsible for the
initial assessment and verification of need, and the AAA that is responsible for management
and oversight of the EHEAEP program.
II. Under this Agreement, the Intake Center agrees to the following:
A. To accept referrals at large from any elderly individuals in the community experiencing an
energy emergency crisis and in need of assistance.
B. To provide quality service(s) to the EHEAEP applicant.
C. To obtain all documentation required under EHEAEP guidelines in order to establish that an
energy crisis exists and that the applicant meets all pertinent eligibility requirements.
D. To maintain the EHEAEP applicant's confidentiality according to 42 CFR 431.301.
E. To forward all information obtained and any required documentation to the EHEAEP
Coordinator at the Alliance for Aging Elder Helpline for case approval and processing.
G. To adhere to the requirements and the policies and procedures outlined in the EHEAEP
manual.
III. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To oversee the processing of all requests for assistance on behalf of eligible elderly individuals.
B. To provide technical assistance and training to Service Providers.
C. To complete a new referral agreement signed by all parties as appropriate.
IV. Term ination
In the event this agreement is terminated, the Intake Center agrees to submit, at the time notice of intent
to terminate is delivered, a plan which identifies procedures to ensure services to consumers will not be
interrupted or suspended by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with proof
of delivery.
B. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this 2 page agreement to be executed by their undersigned
officials as duly authorized.
S; kLe,ve..
Intake Center
. 1?J4,~4~n >
signature
print name
;11 o-I'I'Q D" Ge",na.ro, A~'IoY-
/
print name
..:IAJret2/Jj f teSt be 101 Y C ecJ
date
2-/ v/o ]
title
88820 Overseas Highwav (Gulf). Plantation Key, FL
33070
title
liiI-~O-OG.
date
.....
:3: c:::> .."
<:) c:::> ;.::
<:> .....
% }:> ..., ;.."
::0 Z ...., 0
oo?\: CD
fT1 r- -.,~ .."
::X' c::>
c-;. {- to) 0'0
!:::)G~,,_
~?C t~: ..., ':'0
:x ,"'1
-oC;'..,. CJ
:< :-'1:-.,.: ttJ 0
,- :;:'~
-" :;)
r rn CJ
J> to)
l~:~~ .
t."'"": "-~. L . .., \.-1' ~.'O-::; "LEnK
~:I;.,nU~
c.. 'J,';;lEi4
MONROE COUNTY ATTORNEY
~OV~gM:
c;7VSU~.4HUTTON
Date C~N%AT~EY
.~ !f
2