Title III Funds-FY 2003
Clelt Of lIIe
Circul Coun
Danny L. KoIhage
Clerk of the Circuit Court
Phone: (305) 292-3550
FAX: (305) 295-3663
e-mail: phancock@monroe-clerk.com
Memnrandum
TO: Louis Latorre, Director
Social Services Division
ATTN: Margaret Adkins
Nutrition Program
FROM: Pamela G. Hancod
Deputy Clerk .
DATE: September 27,2002
At the September 18, 2002, Board of County Commissioner's meeting the Board adopted
Resolution No. 359-2002 authorizing the submission ofa Grant Application to the Alliance for
Aging of Dade and Monroe Counties for the Year 1/1/03-12/31/03 for the Older American's Act
(OM) Grant Program to respond to the Request for Proposals from the Alliance for Aging for
the year 2003 Older American Act (OM) Grant funds and apply for moneys for the following
OM Programs: Title III C-1 (Congregate Meals), Title III C-2 (Home Delivered Meals), Title
III-B, In Home Services (Support Services/Homemaking), and Title III-E, In Home Services
(Respite Care Services). Also, authorization for the Mayor to sign the following documents,
which must be included in the grant application package: VI. Availability of Documents FoOD,
VII. Nutrition Assurances FoOD, VIll. Financial Statements Assurance Form, IX. Cost Sharing
Obligation Assurance Form, X. Contract Terms and Conditions Statement, XI. Statement of No
Involvement, and Match Commitment of Cash Donation Form (the Cash Donation Form will be
completed later as per your memo to me).
Enclosed is a certified copy of the subject Resolution and a duplicate original of each of
the above listed documents. Should you have any questions please do not hesitate to contact this
office.
Cc: County Administrator wlo documents
County Attorney
Finance
File ./
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APPENDIX III
OLDER AMERICANS ACT PROPOSAL
FOR
FISCAL YEAR 2003
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APPLlCANT:MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
DEPARTMENT OF SOCIAL SERVICES
Monroe County In-Home Service Program
And
Monroe County Nutrition Program
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1100 Simonton Street, First Floor, Room1-205
Key West, Florida 33040
305-292-4572
FUNDS REQUESTED:
Title III-B 00
Title III C-1 00
Title III C-2 00
Title III-E 00
CERTIFICATION BY AUTHORIZED AGENCY OFFICIAL:
I hereby certify that the contents of this document are true, accurate and complete
statements, I acknowledge that any intentional misrepresentation, omission, or falsification
may result in the immediate disqualification of this proposal for financial assistan
Failure to sign and date this cover page disqualifies the propo I from f, .
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Name: Charles "Sonny" McCoy
Signature:
Title: Mayor/Chairman
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VI.
AVAilABiliTY OF DOCUMENTS
(REQUIRED SUBMISSION - FATAL CRITERION)
The undersigned hereby gives assurance that the following documents are maintained in the
administrative office of the provider and are accessible for review by the Alliance, Indicate as
applicable:
YES N/A
L 1.
L 2.
x 3.
x 4.
L 5.
L 6,
x 7,
Current Board Roster
Articles of Incorporation
Corporate By-Laws
Advisory Council By-Laws and Membership Roster
Current Equipment Inventory
Bonding Verification
Staffing Plan
a, Position Descriptions
b, Pay Plan
c, Organizational Chart
8, Personnel Policies Manual
9, Fiscal and Administrative Policies Mnual
10, Operational Procedures Manual
11, Travel Policies
12, Affirmative Action Plan
13. Americans With Disabilities Act Assurance
14, Staff Development and Training Plan
15, Unusual Incident File
16. Service Subcontracts
17, Co-Pay and Contribution System
18, Civil Rights Compliance Documentation
19, Proof of General Liability Coverage
20, All Required Operational Licenses & Registrations
21, Copies of Nutrition Education Topics planned for the year
22. Copies of Approved Meals Plans
23, Complete and Up to Date Files on all Active Clients
L
L
L
L
x
L
x
L
L
L
L
L
L
L
L
L
CERTIFICATION BY AUTHORIZED AGENCY OFFICIAL:
Signature
I hereby certify t
upon request.
he documents identified above currently exist and are available for review
Charles "Son y" McCoy
Name of Authorized Individual
September 18, 2002
Date
Ma or/Chairman
Title of Authorized Individ I-
APPROVED AS TO FORM
AN AL SU lei N
VII,
NUTRITION ASSURANCES
(Submit only if Funded for Meals - Not a Fatal Criterion)
In accordance with Section 307(a)(13)(F) of the OAA which requires each nutrition project to be
established and administered with the advice of dietitians (or individuals with comparable
expertise), and Section 307(a)(13)(k) which requires compliance with applicable state or local
laws regarding safe and sanitary handling of food, equipment, and supplies used in the storage,
preparation, service, and delivery of meals to elderly nutrition program participants:
Lynne R. 0' Mara. Reaistered Dietary Technician
(Name of Nutrition Consultant)
will provide Nutrition Consultation for the nutrition project of
Monroe County (Nutrition Proaram)
(Name of Provider)
Lynne R. O'Mara
(Name of Nutrition Consultant)
is a registeredllicensed dietitian whose current registration number from the Commission on Dietetic
Registration is #723290. Dietetic Technician Reaistered and/or whose license number from the
Florida Department of Professional Regulation is or whose qualifications have been
approved by the area agency's nutrition consultant or the Department of Elder Affairs,
The Nutrition Consultant Agreement for Services and a current resume of the Nutrition Consultant will be
included in the application at the beginning of each bid cycle and updated when there is a staff change,
Monroe County (Nutrition Proaram)
(Name of Provider)
also assures meals provided through the project comply with the Dietary Guidelines for Americans and
provide to each parti ' ant a minimum of 33 and 1/3 percent of the daily recommended dietary
allowances if one I per day is provided; a minimum of 66 and 2/3 percent of the allowances if two
meals per day is ro ded; and 100 percent of the allowances if three meals per day is provided,
September 18, 2002
Date
Signature
Charles "Sonny" McCoy
Name of Authorized Representative
APPROVED AS TO FORM
AN~~
BY
<7Sl-ANw;~N
Mayor/Chai
Title
VIII.
FINANCIAL STATEMENTS ASSURANCE
(REQUIRED SUBMISSION - FATAL CRITERION)
Monroe County
(Name of Applicant Agency)
hereby gives assurance
that on
September 30.2001
(Date Package Mailed)
it submitted a complete
package of its audited financial statements and compliance reports
for the fiscal year ending 2001
to the Alliance for Aging for filing, review and comments as required
under Attachment III of its Master Agreement (Agreement No, PA 229)
IF A COpy OF THE MOST RECENT FINANCIAL STATEMENTS HAS NOT BEEN
SUBMITTED TO THE ALLIANCE, APPLICANT CERTIFIES THAT A COMPLETE SET WILL
BE PRESENTED PRIOR TO CONTRACT EXECUTION.
September 18, 2002
Date
Charles "Sonny" McCoy
Name of Authorized Representative
IX.
COST SHARING OBLIGATION ASSURANCE
(REQUIRED SUBMISSION - FATAL CRITERION)
Monroe County
(Name of Applicant Agency)
hereby certifies intent to
meet its cost sharing obligations for the federal funds sought under an Older Americans
Act sub-award grant for fiscal year 2003 by matching the funds received through one
of the following options:
LJ Cash Donation
LJ In-Kind Donation
r:&l Cash and In-Kind Donations
I hereby certify that the cash and/or in-kind donations committed for use under the
Older Americans Act sub-grant award requested are not included as match for any
other federally assisted program or contract and are not borne by the federal
government directly under any federal grant or contract.
September 18, 2002
Date
Charles "Sonny" McCoy
Name of Authorized Representative
Mayor/Chai
x. CONTRACT TERMS AND CONDITIONS STATEMENT
(REQUIRED SUBMISSION - FATAL CRITERION)
In the event Monroe County
(Name of Applicant Agency)
should be awarded a contract for the provision of services based on this Request for Proposals
for
Older Americans Act services,
Monroe County
(Name of Applicant Agency)
agrees to abide by the terms and conditions of the model contract, master agreement and their
respective attachments, including the billing and payment process,
September 18, 2002
Date
Charles "Sonny" McCoy
Name of Authorized Representative
XI.
STATEMENT OF NO INVOLVEMENT
(REQUIRED SUBMISSION - FATAL CRITERION)
I,
Charles Mc COy
, as an authorized representative
of
Monroe County
, certify that no member of this firm nor
any person having interest in this firm has been awarded a contract by the Alliance for Aging,
Inc.,
on a noncompetitive basis to:
(1) develop this Request for Proposals;
(2) perform a feasibility study concerning the scope of work contained in this RFP; or
(3) develop a program similar to what is contained in this RFP,
September 18, 2002
Date
Charles "Sonny" McCoy
Name of Authorized Representative