10/21/1998 t
Rate Agreement US -951
ALUANCE FOR AGING, INC
1998 -1999 STANDARD USDA o o t
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THIS RATE AGREEMENT is entered into between the Aillience for . , Inc., hereinafter c r9iirrea to the
"Alliance ", and Monroe County Board of Commissioners, hereinafter referred to as the "p " C )
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THE PARTIES AGREE:
I. Provider Responsibilities:
A. Upon receipt of a prior authorization for services from Alliance staff, to provide the following services:
The purchase of United States produced agricultural and other food commodities for use in nutrition
projects operating under approved Title III contracts for nutrition services with the provider. Prior
authorization for these services will be provided by the Alliance for Aging or its designee.
B. To provide services which meet departmental standards as defined in the Department of Elder Affairs
Client Services Manual.
C. Federal Laws and Regulations
1. The provider shall comply with the provisions of 45 CFR, Part 74, and /or 45 CFR, Part 92, and
other regulations, if applicable.
2. The provider shall comply with the provisions of the U.S. Department of Labor, Occupational Safety
and Health Administration (OSHA) code, 29 CFR, Part 1910.1030.
3. The provider shall comply with all applicable standards, orders, or regulations issued under Section
306 of the Clean Air Act, as amended (42 U.S.C. 1857(h) et seq.), Section 508 of the Clean Water
Act, as amended (33 U.S.C. 1368 et seq.), Executive Order 11738, and Environmental Protection
Agency regulations (40 CFR Part 15). The provider shall report any violations of the above to the
Alliance.
4. The provider must, prior to rate agreement execution, complete the Certification Regarding Lobbying
form, ATTACHMENT I. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required,
it may be obtained from the contract manager. All disclosure forms as required by the Certification
Regarding Lobbying form must be completed and returned to the contract manager no more than
ten (10) days after contract execution.
5. The provider must prior to contract execution, complete the Debarment, Suspension, Ineligibility and
Voluntary Exclusion form, ATTACHMENT II.
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D. Civil Rights Certification
The provider gives this assurance in consideration of and for the purpose of obtaining federal grants,
loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal
financial assistance to programs or activities receiving or benefitting from federal financial assistance.
The provider agrees to complete the Civil Rights Compliance Questionnaire, DOEA Forms 101 A and B,
if services are provided to clients and if fifteen (15) or more persons are employed.
The provider assures it will comply with:
1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq., which prohibits
discrimination on the basis of race, color, or national origin in programs and activities receiving or
benefitting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits
discrimination on the basis of handicap in programs and activities receiving or benefitting from
federal financial assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which
prohibits discrimination on the basis of sex in education programs and activities receiving or
benefitting from federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits
discrimination on the basis of age in programs or activities receiving or benefitting from federal
financial assistance.
5. Section 654 of the Omnibus Budget Reconciliation Act of 1981, as amended, 42 U.S.C. 9849,
which prohibits discrimination on the basis of race, creed, color, national origin, sex, handicap,
political affiliation or beliefs in programs and activities receiving or benefitting from federal financial
assistance.
6. The Americans with Disabilities Act of 1990, 42 USC 12101, et. seq., which prohibits
discrimination against, and provides equal opportunities for individuals with disabilities, in
employment, public services, and public accommodations.
7. All regulations, guidelines, and standards as are now or may be lawfully adopted under the above
statutes.
8. The provider shall establish procedures to handle complaints of discrimination involving services or
benefits through this rate agreement. The provider shall advise clients, employees, and participants
of the right to file a complaint, the right to appeal a denial or exclusion from the services or benefits
from this rate agreement, and their right to a fair hearing. Complaints of discrimination involving
services or benefits through this rate agreement may also be filed with the Secretary of the
Department of Elder Affairs or the appropriate federal or state agency.
9. The provider further assures all contractors, subcontractors, sub - grantees, or others with whom it
arranges to provide services will comply with the above laws and regulations.
E. Requirements of Chapter 287.058, Florida Statutes
1. To submit bills for fees or other compensation for services or expenses in sufficient detail for a
proper pre -audit and post- audit.
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2. To submit bills for any travel expenses in accordance with section 112.061, Florida Statutes.
3. To provide units of deliverables, including reports, findings, and drafts as specified in this rate
agreement.
4. To allow public access to all documents, papers, letters, or other materials subject to the provisions
of Chapter 119, Florida Statutes, and made or received by the provider in conjunction with this rate
agreement.
F. Withholdings and Other Benefits
The provider is responsible for Social Security and Income Tax withholdings.
G. Indemnification
If the provider is a state or local governmental entity, pursuant to subsection 768.28(18) Florida
Statutes, the provisions of this section do not apply.
1. Provider agrees it will indemnify, defend, and hold harmless the Alliance and all of the Alliance's
officers, agents, and employees from any claim, loss, damage, cost, charge, or expense arising out
of any acts, actions, neglect or omission by the provider, its agents, employees, or subcontractors
during the performance of the rate agreement, whether direct or indirect, and whether to any person
or property to which the Alliance or said parties may be subject, except neither provider nor any of
its subcontractors will be liable under this section for damages arising out of injury or damage to
persons or property directly caused or resulting from the sole negligence of the Alliance or any of
its officers, agents, or employees.
2. Provider's obligation to indemnify, defend, and pay for the defense or, at the Alliance's option, to
participate and associate with the Alliance in the defense and trial of any claim and any related
settlement negotiations, shall be triggered by the Alliance's notice of claim for indemnification to
provider. Provider's inability to evaluate liability or its evaluation of liability shall not excuse
provider's duty to defend and indemnify the Alliance, upon notice by the Alliance. Notice shall be
given by registered or certified mail, return receipt requested. Only an adjudication or judgment after
the highest appeal is exhausted specifically finding the Alliance solely negligent shall excuse
performance of this provision by providers. Provider shall pay all costs and fees related to this
obligation and its enforcement by the Alliance. The Alliance's failure to notify provider of a claim
shall not release provider of the above duty to defend.
H. Insurance and Bonding
1. To provide adequate liability insurance coverage on a comprehensive basis and to hold such liability
insurance at all times during the existence of this rate agreement. The provider accepts full
responsibility for identifying and determining the type(s) and extent of liability insurance necessary
to provide reasonable financial protections for the provider and the clients to be served under this
rate agreement. Upon execution of this rate agreement, the provider shall furnish the Alliance
written verification supporting both the determination and existence of such insurance coverage.
Such coverage may be provided by a self- insurance program established and operating under the
laws of the State of Florida. The Alliance reserves the right to require additional insurance where
appropriate.
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2. To furnish an insurance bond from a responsible commercial insurance company covering all officers,
directors, employees and agents of the provider authorized to handle funds received or disbursed
under this rate agreement in an amount commensurate with the funds handled, the degree of risk
as determined by the insurance company and consistent with good business practices.
3. If the provider is a state agency or subdivision as defined by section 768.28, Florida Statutes, the
provider shall furnish the Alliance, upon request, written verification of liability protection in
accordance with section 768.28, Florida Statutes. Nothing herein shall be construed to extend any
party's liability beyond that provided in section 768.28, Florida Statutes (See also Indemnification
Clause).
I. Abuse, Neglect and Exploitation Reporting
In compliance with Chapter 415, F.S., an employee of the provider who knows, or has reasonable cause
to suspect, that a child, aged person or disabled adult is or has been abused, neglected, or exploited,
shall immediately report such knowledge or suspicion to the State of Florida's central abuse registry and
tracking system on the single statewide toll -free telephone number (1- 800- 96ABUSE).
J. Transportation Disadvantaged
If clients are to be transported under this rate agreement, the provider will comply with the provisions
of Chapter 427, Florida Statutes, and Rule Chapter 41 -2, Florida Administrative Code.
K. Purchasing
Procurement of Products or Materials with Recycled Content
Any products or materials which are the subject of, or are required to carry out this rate agreement shall
be procured in accordance with the provisions of Sections 403.7065 and 287.045, Florida Statutes.
L. Sponsorship
As required in Section 286.25, Florida Statutes, if the provider is a non - governmental organization which
sponsors a program financed wholly or in part by state funds, including any funds obtained through this
rate agreement, it shall in publicizing, advertising or describing the sponsorship of the program, state:
"Sponsored by Monroe Count Board of Commissioners, the State of Florida, Department of Elder Affairs
and the Alliance for Aging, Inc ". If the sponsorship reference is in written material the words "State of
Florida, Department of Elder Affairs and the Alliance for Aging, Inc." shall appear in the same size letters
and type as the name of the organization.
M. Use Of Funds For Lobbying Prohibited
To comply with the provisions of section 216.347, Florida Statutes, which prohibit the expenditure of
contract funds for the purpose of lobbying the Legislature, a judicial branch or a state agency.
N. Employment
If the provider is a non - governmental organization, it is expressly understood and agreed the provider will
not knowingly employ unauthorized alien workers. Such employment constitutes a violation of the
employment provisions as determined pursuant to section 274A(e) of the Immigration Nationality Act
(INA), 8 U.S.C. s.1324 a (e)( "section 274A(e)"). Violation of the employment provisions as determined
pursuant to section 274A(e) shall be grounds for unilateral cancellation of this contract.
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0. Audits and Records
1. To maintain books, records, and documents (including electronic storage media) in accordance with
generally accepted accounting procedures and practices which sufficiently and properly reflect all
revenues and expenditures of funds provided by the Alliance under this rate agreement.
2. To assure these records shall be subject at all reasonable times to inspection, review, audit, copy,
or removal from premises by state personnel and other personnel duly authorized by the Alliance,
as well as by federal personnel, if applicable.
3. To maintain and file with the Alliance such progress, fiscal and inventory and other reports as the
Alliance may require within the period of this rate agreement. Such reporting requirements must be
reasonable given the scope and purpose of this rate agreement.
4. To submit management, program, and client identifiable data, as specified in the Department
of Elder Affairs Client Services Manual. To assure program specific data is recorded and
submitted in accordance with Department of Elder Affairs information system instructions.
5. To provide a financial and compliance audit to the Alliance as specified in ATTACHMENT III and to
ensure all related party transactions are disclosed to the auditor.
6. To include these aforementioned audit and record keeping requirements in all approved subcontracts
and assignments.
7. This rate agreement contains federal funds. The Catalog of Federal Domestic Assistance (CFDA)
number is 10.570.
8. This rate agreement is funded from a grants and aids appropriation.
P. Retention of Records
1. To retain all client records, financial records, supporting documents, statistical records, and any
other documents (including electronic storage media) pertinent to this rate agreement for a period
of five (5) years after termination of this rate agreement, or if an audit has been initiated and audit
findings have not been resolved at the end of five (5) years, the records shall be retained until
resolution of the audit findings.
2. Persons duly authorized by the Alliance and federal auditors, pursuant to 45 CFR, Part 92.42(e)(1)
and (2), shall have full access to and the right to examine or duplicate any of said records and
documents during said retention period or as long as records are retained, whichever is later.
Q. Monitoring and Incident Reporting
1. To provide progress reports, including data reporting requirements as specified by the Alliance.
These reports will be used for monitoring progress or performance of the contractual services as
specified in the Department of Elder Affairs Client Services manual.
2. The Alliance will perform the required administrative monitoring of service providers in accordance
with the department's unit rate contract monitoring checklist.
3. To permit persons duly authorized by the Alliance to inspect any records, papers, documents,
facilities, goods and services of the provider which are relevant to this rate agreement, and /or
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interview any clients and employees of the provider to be assured of satisfactory performance of
the terms and conditions of this rate agreement. Following such inspection the Alliance will deliver
to the provider a list of its concerns with regard to the manner in which said goods or services are
being provided. The provider will rectify all noted deficiencies provided by the Alliance within the
time set forth by the Alliance, or provide the Alliance with a reasonable and acceptable justification
for the provider's failure to correct the noted shortcomings. The Alliance shall determine whether
such failure is reasonable and acceptable. The provider's failure to correct or justify within a
reasonable time as specified by the Alliance may result in the withholding of payments, being
deemed in breach or default, or termination of this rate agreement.
4. The provider will inform the Alliance within 24 hours of conditions that could impair continued
service delivery. Reportable conditions may include:
• proposed client terminations
• provider financial concerns /difficulties
• service documentation problems
• contract non - compliance
• service quality and consumer complaint trends.
The provider will present the Alliance with a brief summary of the problem(s) and proposed
corrective action plans and time frames for implementation.
R. Safeguarding Information
Except as provided for Alliance auditing and monitoring purposes, not to use or disclose any information
concerning a recipient of services under this rate agreement for any purpose except upon written consent
of the recipient, or the recipient's authorized representative.
S. Assignments and Subcontracts
1. All assignments or subcontracts shall be subject to the conditions of this rate agreement and to any
conditions of approval the Alliance shall deem necessary.
2. All assignments or subcontracts shall not be deemed in any event or in any manner to obligate the
Alliance beyond the total dollar amount agreed upon in this rate agreement.
T. Final Request for Payment
1. To submit the final request for payment to the Alliance no more than 30 days after the rate
agreement ends or is terminated; if the provider fails to do so, all right to payment is forfeited, and
the Alliance will not honor any requests submitted after the aforesaid time period. Any payment due
under the terms and conditions of this rate agreement may be withheld until all reports due from the
provider, and necessary adjustments thereto, have been approved by the Alliance.
2. A final receipt and expenditure report as a closeout report will be forwarded to the Alliance within
forty -five (45) days after the rate agreement ends or is terminated. All monies which have been paid
to the provider which have not been used to retire outstanding obligations of the rate agreement
being closed out must be refunded to the Alliance along with the final receipt and expenditure
report.
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. U. Return of Funds
1. To return to the Alliance any overpayments due to unearned funds or funds disallowed pursuant to
the terms of this rate agreement that were disbursed to the provider by the Alliance.
a. The provider shall return any overpayment to the Alliance within forty (40) calendar days after
either discovery by the provider, or notification by the Alliance, of the overpayment.
b. In the event the provider or its independent auditor discovers an overpayment has been made,
the provider shall repay said overpayment within forty (40) calendar days without prior
notification from the Alliance. In the event the Alliance first discovers an overpayment has
been made, the Alliance will notify the provider by letter of such a finding.
2. Should repayment not be made in a timely manner, the Alliance will charge interest of one (1)
percent per month compounded on the outstanding balance forty (40) calendar days after the date
of notification or discovery.
II. Alliance Responsibilities:
A. Contract Amount
To make payments for services identified in Section I.A. of this rate agreement at the rates stipulated
below, in an amount not to exceed $ N/A , subject to the availability of funds. The Alliance's
performance and obligation to pay under this rate agreement is contingent upon an annual appropriation
by the Legislature. The costs of services paid under any other contract or rate agreement are not eligible
for reimbursement under this rate agreement.
SERVICE RATE
ELIGIBLE CONGREGATE AND $0.5607 per meal
HOME DELIVERED MEALS
B. Schedule of Payments
To make payment on a monthly basis and in accordance with the procedures and requirements for
payment outlined in Section III, Paragraph C, Method of Payment.
C. Contract Payment
Unless otherwise stated in the rate agreement between the Alliance and the provider, payments made
by the Alliance to the provider must be within seven (7) working days after receipt by the Alliance of full
or partial payments from the Department of Elder Affairs in accordance with section 287.0585, Florida
Statutes. Failure to pay within seven (7) working days will result in a penalty charged against the
Alliance and paid to the provider in the amount of one -half of one (1) percent of the amount due, per day
from the expiration of the period allowed herein for payment. Such penalty shall be in addition to actual
payments owed and shall not exceed fifteen (15) percent of the outstanding balance due.
D. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of Banking and Finance. The duties
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of this individual include acting as an advocate for vendors who may be experiencing problems in
obtaining timely payment(s) from a state agency. The Vendor Ombudsman may be contacted at (850)
488 -2924 or by calling the State Comptroller's Hotline, 1- 800 - 848 -3792.
III. Provider and Alliance Mutual Responsibilities:
A. Effective Date
1. This rate agreement shall begin on October 1, 1998 or the date this rate agreement has been signed
by both parties, whichever is later.
2. This rate agreement shall end on September 30, 2000.
B. Method of Payment
1. The Alliance shall make payment to the provider for provision of services at the rate stated below:
Services to be Unit of Unit Max.
Provided Service Rate Units
Eligible Congregate 1 unit = $0.5607 N/A
and Home Delivered 1 meal
Meals
2. All requests for reimbursement shall be submitted on DOEA Form 117, Request for Reimbursement,
USDA Cash -ln -Lieu of Commodities. DOEA Form 118, PSA /Provider Monthly Meals Report must
be submitted with the request for reimbursement. DOEA Form 119, USDA Commodities,
Supplemental Report, must be submitted with the request for reimbursement when the provider
utilizes USDA commodities. Duplication or replication of the forms via data processing equipment
is permissible but replication must include all data elements in the same format as included on the
departmental forms. The due date for the request for reimbursement and report(s) shall be no later
than the 10th day of the month following the month being reported.
3. Any payment due by the Alliance under the terms of this rate agreement may be withheld pending
the receipt and approval by the Alliance of all financial and programmatic reports due from the
provider and any adjustments thereto.
4. In the event that the final reimbursement rate established by the United States Department of
Agriculture (USDA) is greater or less than the rate in Section 11I, C.1., then this rate agreement shall
be appropriately adjusted and the final rate shall be effective for the entire rate agreement period.
5. This rate agreement is for services provided during the 1999 Federal Fiscal year beginning October
1, 1998 through September 30, 1999. The additional twelve months (October 1, 1999 through
September 30, 2000) are to allow rates to be adjusted for the twelve month service period. Rate
adjustments will be based on the final reimbursement rate established by the USDA. This rate
agreement shall automatically terminate after the final rate for the federal fiscal year has been
established and the release of final payments are authorized by the Alliance.
6. The provider agrees to submit financial reports in accordance with the Department of Elder Affairs
Client Services Manual.
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C. Termination
1. Termination at Will
This rate agreement may be terminated by either party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
2. Termination Because of Lack of Funds
In the event funds to finance this rate agreement become unavailable, the Alliance may terminate
the rate agreement upon no less than twenty -four (24) hours notice in writing to the provider. Said
notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery. The Alliance shall be the final authority as to the availability of funds.
3. Termination for Breach
Unless the provider's breach is waived by the Alliance in writing, the Alliance may, by written notice
to the provider, terminate this rate 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. If applicable, the Alliance may employ the default provisions in Chapter 60A- 1.006(3),
Florida Administrative Code. Waiver of breach of any provisions of this rate agreement shall not be
deemed to be a waiver of any other breach and shall not be construed to be a modification of the
terms of this rate agreement. The provisions herein do not limit the Alliance's right to remedies at
law or to damages.
D. Suspension:
1. Reasonable Cause
The Alliance may, for reasonable cause, temporarily suspend the use of funds by a provider pending
corrective action, or pending a decision of terminating the rate agreement. Reasonable cause is such
cause as would compel a reasonable person to suspend the use of funds pursuant to this rate
agreement; it includes, but is not limited to, the provider's failure to permit inspection of records,
provide reports, rectify deficiencies noted by the Alliance within the time specified by the Alliance,
use funds as agreed in this rate agreement, or such other cause as might constitute breach of any
of the terms of this rate agreement.
2. The Alliance may prohibit the provider from receiving further payments and may prohibit the provider
from incurring additional obligations of funds. The suspension may apply to any part, or to all of the
provider's obligations.
3. To suspend operations of the provider, the Alliance will notify the provider in writing by certified mail
of: the action taken; the reason(s) for such action; and the conditions of the suspension. The
notification will also indicate: corrective actions necessary to remove the suspension; the provider's
right to an administrative hearing; and, the appropriate time period to request an administrative
hearing before the effective date of the suspension (unless provider actions warrant an immediate
suspension).
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E. Notice and Contact
1. The name, address and telephone number of the contract manager for the Alliance for this rate
agreement is:
John L. Stokesberry, Executive Director
9500 South Dadeland Boulevard, Suite 400
Miami, Florida 33156
(305) 670 -6502 SC 455 -6502
2. The name, address and telephone number of the representative of the provider responsible for
administration of the program under this rate agreement is:
Louis LaTorre, Executive Director
Wing 111 - 5100 College Road
Key West, FL 33040
(305) 292 -4573
3. In the event different representatives are designated by either party after execution of this rate
agreement, notice of the name and address of the new representative will be rendered in writing to
the other party and said notification attached to originals of this rate agreement.
F. Payment of Authorized Services
This rate agreement does not obligate the Alliance to pay the provider unless services which were prior
authorized by the Alliance have been rendered.
G. Renegotiation or Modification
1. Modifications of provisions of this rate agreement shall only be valid when they have been reduced
to writing and duly signed. The parties agree to renegotiate this rate agreement if federal and /or
state revisions of any applicable laws or regulations make changes in this rate agreement necessary.
2. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price level
increases and changes in the rate of payment when these have been established through the
appropriations process and subsequently identified in the Alliance's operating budget.
H. Special Provisions
1. State Laws and Regulations
The provider agrees to comply with applicable parts of the Florida Statutes, Rule 58A -1, Florida
Administrative Code and the Department of Elder Affairs Client Services Manual.
The Alliance and provider agree to provide the services and implement the provisions of this rate
agreement in accordance with the Federal, State and Local laws, rules, regulations and policies that
pertain to USDA cash payments and Older American's Act.
2. Non - expendable Property
The purchase of non - expendable property with USDA funds is unallowable.
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3. Copyright Clause
Where activities supported by this rate agreement produce original writing, sound recordings,
pictorial reproductions, drawings or other graphic representation and works of any similar nature,
the Alliance has the right to use, duplicate and disclose such materials in whole or part, in any
manner, for any purpose whatsoever and to have others acting on behalf of the Alliance do so.
If the materials so developed are subject to copyright, trademark or patent, then legal title and every
right, interest, claim or demand of any kind in and to any patent, trademark, copyright, or application
for the same, will vest in the State of Florida, Department of State, for the exclusive use and benefit
of the state. Pursuant to Section 286.021, Florida Statutes (1987), no person, firm or corporation,
including parties to this rate agreement, shall be entitled to use the copyright, patent or trademark
without the prior written consent of the Department of State.
4. Grievance and Appeal Procedures
In accordance with ATTACHMENT IV, Minimum Guide lines for Recipient Grievance Procedures, the
provider will have procedures for handling complaints from persons who complain that service has
been denied, terminated or reduced improperly.
5. Investigation of Allegations
Any report that implies criminal intent on the part of this provider or any service provider agency and
referred to the state attorney must be sent to the Alliance. The provider must investigate allegations
regarding falsification of client information, service records, payment requests, and other related
information.
I. Name, Mailing, and Street Address of Payee
1. The name (provider name as shown on page 1 of this rate agreement) and mailing address of the
official payee to whom the payment shall be made:
Monroe County Board of Commissioners
Wing III - 5100 College Road
Key West, FL 33040
2. The name of the contact person, street address and telephone number where financial and
administrative records are maintained:
Louis LaTorre
Wing III - 5100 College Road
Key West, FL 33040
(305) 292 -4573
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IN WITNESS THEREOF, the parties hereto have caused this 19 page rate agreement to be executed by
their undersigned officials as duly authorized.
ALLIANCE FOR AGING, INC FOR
PROVIDER: MONROE COUNTY BOARD DADE AND MONROE COUNTIES
OF COMMISSIONERS
BOARD PRESIDENT OR
AUTHORIZED DESIGNEE
SIGNED SIGNER
BY: -- BY: \ C t==XINC N a acV+o
1\J
NAME: —i/1 1--a/60 NAME: WILLIS N. MURRAY
TITLE: ( v - 1F. TITLE: PRESIDENT
DATE: /P/2-//F V DATE: \ 2 / 0-)3 q
FEDERAL ID NUMBER: 59- 6000749
PROV ER FISCAL ENDING DATE: 9/30
�}+
A AP Nn . PROVED AS TO FORM
dC�
AITEST: DANNY L. KOLHAGE `_i�II11/
CLERK
R•: RT "'"
BY
DATE •
D Y CL � d�
12
• ATTACHMENT I
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE
AGREEMENT
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 an 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 the awarding of any federal grant, the making 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 sub - recipients 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 and not more
th. • $100,000 for each such failure.
z 1612.1142-
Signature Date
e704 c 10nticryl • 1Iauf0 US -951
Name of Authorized Individual '` ~ Application or Contract Number
M.nro• C. nt B.ard of C•mmis
Win. III - 100 Ile .e Road
Ke West FL 33040 Iro
rt .,..
Name and Address of Organizatio
APPROVED AS TO FORM
AND L At SUFFICIE / `•
DOEA 103 (SEAL) A..A. 1 //' ,
ATTEST :DANNY L KOU-IAGE CLE ?K UZA NE • T! N
611 a�! •• \ . DATE ,
DEPT CLE: e
13
•
• ATTACHMENT II
•
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS /SUBCONTRACTS
This certification is required by the regulation implementing Executive Order 12549, Debarment and
Suspension, signed February; 18, 1986. The guidelines were published in the May 29, 1987 Federal
Register (52 Fed. Reg., pages 20360 - 20369).
(1) The prospective provider certifies, by signing this certification, that neither he nor his principals
is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in contracting with the Department of Elder Affairs by any federal
department or agency.
(2) Where the prospective provider is unable to certify to any of the statements in this
certification, such prospective provider shall attach an explanation to this certification.
i
-%- \ l'-74
1�1Z) l i
Si ur < F�
(sE I )
, t �` k - ATTEST: DAN., t 1. ; .�LHAc C,l
Date
aCk LOhciaY1 . dl,
Name and Title of Authorize Individual
Monroe County Board of Commissioners
Organization APPROVED SUFI F•
Name of Or
g AND LE • L SUFFICI,l
DOEA Form 112A By - 174p NE A, 9 .7
October 1993 DATE
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CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS /SUBCONTRACTS
1. Each provider whose contract equals or exceeds $25,000 in federal monies must sign this
debarment certification prior to contract execution. Independent auditors who audit federal
programs regardless of the dollar amount are required to sign a debarment certification form.
Neither the Department of Elder Affairs nor its contract providers can contract with providers
if they are debarred or suspended by the federal government.
2. This certification is a material representation of fact upon which reliance is placed when this
contract is entered into. If it is later determined that the signed knowingly rendered an
erroneous certification, the Federal Government may pursue available remedies, including
suspension and /or debarment.
3. The provider shall provide immediate written notice to the contract manager at any time the
provider learns that its certification was erroneous when submitted or has become erroneous
by reason of changed circumstances.
4. The terms "debarred," "suspended," "ineligible," "person," "principal," and "voluntarily
excluded," as used in this certification, have the meanings set out in the Definitions and
Coverage sections of rules implementing Executive Order 12549 and 45 CFR (Code of Federal
Regulations), Part 76. You may contact the contract manager for assistance in obtaining a
copy of those regulations.
5. The provider further agrees by submitting this certification that, it shall not knowingly enter
into any subcontract with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this contract unless authorized by the Federal
Government.
6. The provider further agrees by submitting this certification that it will require each
subcontractor of this contract whose payment will equal or exceed $25,000 in federal monies,
to submit a signed copy of this certification with each contract.
7. The Alliance for Aging, Inc. and its contract providers may rely upon a certification of a
provider that is not debarred, suspended, ineligible, or voluntarily exclude from
contracting /subcontracting unless it knows that the certification is erroneous.
DOEA Form 112B
October 1993
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•
ATTACHMENT III
FINANCIAL AND COMPLIANCE AUDITS
This attachment is applicable, if the provider or grantee hereinafter referred to as provider, is any local government entity, nonprofit
' organization, or for - profit organization.
PART I: SINGLE AUDIT
This part is applicable if the provider is a local government entity or nonprofit organization and receives a total of $25,000 or more from
the Alliance during its fiscal year. The provider has "received" funds when it has obtained cash from the Alliance or when it has incurred
expenses which will be reimbursed by the Alliance.
The provider agrees to have an annual financial and compliance audit performed by independent auditors in accordance with the current
Government Auditing Standards ( "Yellow Book ") issued by the Comptroller General of the United States. Local governments shall comply
with Office of Manaaement and Budget (OMB) Circular A -128, Audits of State and Local Governments. Nonprofit providers receiving
federal funds passed through the Alliance shall comply with the audit requirements contained in OMB Circular A -133 , Audits of
Institutions of Higher Learning and Other Nonprofit Institutions, except as modified herein. Such audits shall cover the entire organization
for the organization's fiscal year, not to exceed 12 months. The scope of the audit performed shall include the financial audit requirements
of the "Yellow Book ", and must include reports on internal control and compliance. The audit report shall include a schedule of financial
assistance that discloses each state contract by number. An audit performed by the Auditor General shall satisfy the requirements of this
attachment.
Compliance findings related to contracts with the Alliance shall be based on the contract requirements, including any rules, regulations,
or statutes referenced in the contract. Where applicable, the audit report shall include a computation showing whether or not matching
requirements were met. All questioned costs and liabilities due to the Alliance shall be calculated and fully disclosed in the audit report
with reference to the Alliance contract involved. These requirements do not expand the scope of the audit as prescribed by the "Yellow
Book ".
If the provider has received any funds from a grants and aids appropriation, the provider will also submit a compliance reports(s) in
accordance with the rules of the Auditor General, chapter 10.600, and indicate on the schedule of financial assistance which contracts
are funded from state grants and aids appropriations.
Copies of the financial and compliance audit report, management letter, and all other correspondence, if any, related to audits performed
by independent auditors, other than the Auditor General, shall be submitted within 180 days after the end of the provider's fiscal year,
unless otherwise required by Florida Statutes, to the following:
A. Contract Manager for the Alliance: (Please submit 2 Copies)
John L. Stokesberry
9500 South Dadeland Boulevard, Suite 400
Miami, Florida 33156
B. Submit to this address only those reports prepared in accordance with OMB Circular A -133:
Federal Audit Clearinghouse
U.S. Bureau of the Census
Jeffersonville, Indiana 47132
C. Submit to this address only those reports prepared in accordance with the rules of the Auditor General, chapter 10.600:
Jim Dwyer
Office of the Auditor General
P.O. Box 1735
Tallahassee, Florida 32302
The provider shall ensure that audit working papers are made available to the Alliance, or its designee, upon request for a period of five
years from the date the audit report is issued, unless extended in writing by the Alliance.
DOEA -104A 9/30/92
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PART 1I : GRANTS AND AIDS AUDIT /ATTESTATION
This part is applicable if the provider is awarded funds from a grants and aid appropriation, and is either (1) a local government
entity or nonprofit organization receiving a total of less than $25,000 from the Alliance during its fiscal year or (2) a for - profit
organization receiving any amount from the Alliance. The provider has "received" funds when it has obtained cash from the Alliance
or when it has incurred expenses which will be reimbursed by the Alliance.
If the amount received from grants and aids appropriation awards exceeds $100,000, the provider agrees to have an audit
performed by an independent certified public accountant and submit a compliance report(s) in accordance with the rules of the
Auditor General, chapter 10.600. The audit report shall include a schedule of financial assistance that discloses each state contract
by number and indicates which contracts are funded from state grants and aids appropriations.
Compliance findings related to contracts with the Alliance shall be based on the contract requirements, including any rules,
regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation showing whether
or not matching requirements were met. All questioned costs and liabilities due to the Alliance shall be calculated and fully
disclosed in the audit report with reference to the Alliance contract involved.
If the amount received from grants and aids appropriation awards exceeds $25,000, but does not exceed $100,000, the provider
may have an audit as described above or have a statement prepared by an independent certified public accountant which attests
that the provider has complied with the provisions of all contracts funded by a grants and aids appropriation.
If the amount received from grants and aids appropriation awards does not exceed $25,000, the provider will have the head of the
entity or organization attest, under penalties of perjury, that the organization has complied with the provisions of all contracts
funded by a grants and aids appropriation.
Copies of the audit report and all other correspondence, if any, related to audits performed by the independent auditor, or the
attestation statement, shall be submitted within 180 days after the provider's fiscal year end to the following:
A. Contract Manager for the Alliance: (Please Submit 2 Copies)
John L. Stokesberry
9500 South Dadeland Boulevard, Suite 400
Miami, Florida 33156
B. Jim Dwyer
Office of the Auditor General
P.O. Box 1735
Tallahassee, Florida 32302
The provider shall ensure that audit working papers are made available to the Alliance, or its designee, upon request for a period
of five years from the date the audit report is issued, unless extended in writing by the Alliance.
PART III: NO AUDIT REQUIREMENT
This part is applicable if the provider is not awarded funds from a grants and aids appropriation, and is either (1) a local government
entity or nonprofit organization receiving a total of less than $25,000 from the Alliance during its fiscal year or (2) a for - profit
organization receiving any amount from the Alliance. The provider has "received" funds when it has obtained cash from the Alliance
or when it has incurred expenses which will be reimbursed by the Alliance.
The provider has no audit or attestation statement required by this attachment.
DOEA -1048
9/30/92
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ATTACHMENT IV
MINIMUM GUIDELINES FOR RECIPIENT GRIEVANCE PROCEDURES
APPLICABLE TO ALL ACTIONS DEEMED TERMINATIONS, SUSPENSIONS, OR REDUCTIONS IN SERVICE; TRANSFERS OR
DISCHARGES; AND ADVERSE DETERMINATIONS RELATING TO SCREENING OR ANNUAL REVIEW.
NOTICE OF DECISION OF ACTON TO BE TAKEN AND EXPLANATION OF THE GRIEVANCE PROCEDURE FOR REVIEWING
THAT DECISION
• Notice of decision and an explanation of the grievance procedure must be mailed no less than 30 calendar* days prior
to the date action will be taken. Prior notice is not applicable where the health or safety of the individual is endangered
if action is not taken immediately; however, notice must be made as soon thereafter as practicable.
• The Notice must contain:
a statement of what action is intended to be taken;
the reasons for the intended action;
the specific law, rule, regulation, or change of law that requires the action;
an explanation of the individual's right to a grievance review if requested in writing and delivered within 14
calendar* days of the Notice postmark (assistance in writing, submitting and delivering the request must be
offered and available to the individual), the individual's right, after a grievance review, for further appeal, the
right to seek redress through the courts if applicable;
an explanation of the circumstances under which current benefits, if any, are continued if a grievance review
is requested, and until a final decision is made to discontinue services; and
a statement that the individual may represent herself or use legal counsel, a relative, a friend, or other qualified
representative in the requested review proceedings.
• All records of the above activities must be preserved and remain confidential.
GRIEVANCE REVIEW PROCEDURE UPON TIMELY RECEIPT OF A. WRITTEN REQUEST FOR REVIEW
• Within 7 calendar* days of the receipt of a request for review, the provider must acknowledge receipt of the request
by a written statement delivered to the requester. This statement must also provide notice of:
the time and place scheduled for the review;
the designation of one or more impartial reviewers who have not been involved in the decision at issue;
the opportunity to examine, at a reasonable time before the review, the individual's own case
record, and to a copy of such case record at no cost to the individual;
the opportunity to informally present argument, evidence, or witnesses without undue interference
at a reasonable time before or during the review;
a contact person for any accommodations required under the Americans with Disabilities Act;
assistance, if needed, in order to attend the review; and
the stopping of the intended action until all appeals are exhausted.
• All grievance reviews must be conducted at a reasonable time, date and place by one or more impartial reviewers who
have not been directly involved in the initial determination of the action in question.
• The reviewer(s) must provide written notification to the requester within 7 calendar* days after the grievance review
of:
the decision, stating the reasons therefore in detail;
the effect the decision has on current benefits, if favorable, or the circumstances regarding continuation of
current benefits until all appeals are exhausted;
the individual's right to appeal an adverse decision to the Area Agency on Aging by written request within 7
calendar* days;
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the availability of assistance in writing, submitting and delivering the appeal to the appropriate agency;
the opportunity to be represented by herself or by legal counsel, a relative, a friend or other qualified
sl
representative.
PROCEDURE FOR APPEALS OF A GRIEVANCE REVIEW DECISION UPON TIMELY RECEIPT OF A WRITTEN APPEAL TO THE
AREA AGENCY ON AGING
• Within 7 calendar* days of the receipt of a notice of appeal of a grievance review decision, the AAA must acknowledge
receipt of the notice of appeal by a written statement delivered to the appellant. This statement must also provide
notice of:
the time and place scheduled for the appeal;
the designation of one or more impartial AAA officials who have not been involved in the
decision at issue;
the opportunity to examine at a reasonable time before the appeal the individual's own case record
to date, and to a copy of such case record at no cost to the individual;
the opportunity to informally present argument, evidence, or witnesses without undue interference
during the appeal;
assistance, if needed, in order to attend the appeal; and
the stopping of the intended action until all appeals are exhausted.
• All appeals of grievance reviews must be conducted at a reasonable time, date and place by one or more impartial AAA
officials who have not been directly involved in the initial determination of the action in question.
• The designated AAA official(s) must provide written notification to the requester within 7 calendar* days after
considering the grievance review appeal of:
the decision, stating the reasons therefore in detail;
the effect the decision has on current benefits, if favorable, or the circumstances regarding
continuation of current benefits until all appeals are exhausted;
the individual's right to appeal, if applicable; and
the availability of assistance in requesting a fair hearing, including a notice regarding accommodations as required
by the ADA.
Except for Medicaid Waiver actions, the decision of the AAA shall be the final decision. For Medicaid Waiver
actions, the written notification must also provide notice of the individual's right to appeal an adverse decision
to the Agency on Health Care Administration (AHCA) for a fair hearing procedure (Medicaid Waiver actions only).
• All records of the above activities must be preserved and remain confidential.
• In computing any period of time prescribed or allowed by these guidelines, the last day of the period so computed shall
be included unless it is a Saturday, Sunday, or legal holiday, in which event the period shall run until the end of the next
day which is neither a Saturday, Sunday, or legal holiday.
NOTE: ALSO SEE 42 C.F.R. 431.200 -.246 and AHCA Rules 59G- 1.0101851, (98) and (99), F.A.C., "Fair Hearings,"
"Grievance," and "Grievance Procedure."
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