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3rd Modification 09/16/2015 V • f ORIGINAL MODIFICATION NUMBER[3] OF AGREEMENT BETWEEN THE FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY LOW INCOME HOME ENERGY ASSISTANCE PROGRAM AND COUNTY OF MONROE CFDA Number.93.568 Agreement Number:15EA-OF-11-54-01-019 FEDERALLY-FUNDED SITBGRANT AGREEMENT THIS MODIFICATION Number[3)is entered into by the State of Florida,Department of Economic Opportunity,with headquarters in Tallahassee,.Florida,hereinafter referred to as "DEO,"and COUNTY OF MONROE,hereinafter referred to as"Recipient" (each individually a"Party"and collectively"the Parties"). WHEREAS,Section(4) of the Agreement provides that modification of the Agreement shall be in writing executed by the Parties thereto;and WHEREAS,DEO and Recipient have entered into the Agreement,pursuant to which DEO has provided an Agreement of Two Hundred Two Thousand Eight Hundred Eighty Dollars and Zero Cents ($202,880.00) to Recipient;and WHEREAS,the Parties seek to modify the Agreement language to reflect changes in programmatic policies and state laws;and WHEREAS,FY 2014 carryover funds are available to increase the amount of funding granted to Recipient. NOW,THEREFORE,in consideration of the mutual promises of the Parties contained herein,the Parties agree as follows: 1. Paragraph(17)(c),ATTACHMENTS AND EXHIBITS,is hereby modified to read as follows: (c) This Modification has the following modified attachments and exhibits (check all that are applicable): ® Exhibit 1 -Audit Requirements 11 Exhibit 1-A—Funding Sources • ® Exhibit 2—Audit Compliance Certification ❑ Exhibit 3—Federal Requirements ❑ Attachment A-Scope of Work ❑ Attachment B-Program Statutes and Regulations ❑ Attachment C-Reports • Attachment D-Property Management and Procurement 0 Attachment E-Statement of Assurances ❑ Attachment F-Warranties and Representations .0 Attachment G-Certification Regarding Debarment 4 ❑ Attachment H—Trafficking Victims Protection Act of 2000 ►;1 Attachment I-Recipient Information Page 1 —. _......._ _._� • Attachment J-Budget Summary,Workplan and Deliverables ►1 Attachment K—Budget Detail ►1 Attachment L—Multi-County Fund Distribution 0 Attachment M-Justification of Advance Payment 2. Paragraph(18)(a),FUNDING/CONSIDERATION,is hereby modified to read as follows: (a)This is a cost-reimbursement agreement. Recipient shall be reimbursed for costs incurred in the satisfactory performance of work hereunder in an amount not to exceed Two Hundred Twelve Thousand Five Hundred Ninety Eight Dollars and Zero Cents($212,598.00),subject to the availability of funds and appropriate budget authority. Until DEO provides further notice to Recipient's contact person identified in Attachment I,however,Recipient is only authorized to incur costs in an amount not to exceed Two Hundred Twelve Thousand Five Hundred Ninety Eight Dollars and Zero Cents ($212,598.00). Upon receipt of written notice from DEO authorizing additional costs to be incurred,changes to the costs Recipient may incur must be accomplished using the Informal Modification process identified in Attachment B. The terms of this Agreement shall be considered to have been modified to allow Recipient to incur additional costs upon Recipient's receipt of the written notice from DEO. This revised agreement amount includes: 1. $202,880.00 Current LIHEAP Allocation(FY 2015) 2. $9,718.00 Base Increase/Carryover(FY 2015 and FY 2014) 3. $212,598.00 Total Modified LIHEAP Allocation 3. Attachment A,Section A.,Payment and Deliverables,is hereby modified to read as follows: Recipient shall be reimbursed monthly for expenditures reported on its Monthly Financial Status Report as described in Attachment C,Reports.Reimbursement shall be made on a monthly basis for the Deliverable accepted by DEO as having been successfully completed. (1) 'Deliverable"is defined as: a. Certification that Recipient operated during its regular business hours as identified in Attachment F,Warranties and Representations. (2) The Deliverable shall be reported monthly on Recipient's Monthly Financial Status Report as described in Attachment C,Reports. (3) Successful completion of the Deliverable shall be determined by receipt by DEO of Recipient's Monthly Financial Status Report containing the certification required in Subparagraph A.(1)a. above. 4. Attachment A,Section C,Definitions,Paragraph(6)c.,is hereby modified to read as follows: c. May be used to pre-pay home energy usage. Page 2 5. Attachment A,Section E,Client Services and Benefits,Paragraph(10),is hereby modified to read as follows: (10) Calculation of income eligibility: a. Use the past 30 days earnings for all occupants of the household annualized,or the Applicant's most current economic situation. b. Reference the current year Sources of Allowable Income to determine what is and is not considered as allowable income. c. Total household income cannot exceed the 150%poverty level. e. If the Applicant claims that there is no household income,a self-certification is allowable. f. For.Applicants receiving Supplemental Nutrition Assistance Program(SNAP) or Supplemental Security Income(SSI),program qualification approvals or notifications may be used to document household size and income. 6. Attachment A,Section F,Client Records,is hereby modified to read as follows: Recipient will maintain information in a file for each LIHEAP Client that includes at least the following information: (1)Client's name,address,sex,and age,and customer name on utility account(if not the Client); (2)Names,ages,and current identification documentation(no more than one year expired) of all household members; (3)Social Security Numbers and documentation of such numbers for all household members or the citation to the applicable exemption; (4)Signed Notice Regarding Collection of Social Security Numbers; (5)Income amount and method of verification for all household members; (6)Income documentation to support eligibility; (7)Signed statement of self-declaration of income,if applicable; (8)Signed statement of how basic living expenses,such as food,shelter,and transportation are being provided if the total household income is less than 50%of the current Federal Poverty Guidelines and no one in the household is receiving SNAP assistance; (9)Copies of approval or denial letters,including appeal procedures,provided to the Client; (10)Documentation of disability income or physician's statement if preference or additional benefit provided due to a disability; (11)Documentation of Client's obligation to pay the energy bill for the residence in which Client resides; (12)Signed Authorization for Release of General and/or Confidential Information for LIHEAP Data,or notation that the Client did not sign the waiver; (13)Utility Account Number; (14) If LIHEAP prevented disconnection or restored an energy disruption;and _._ Page 3 (15)A signed I IHEAP application with signatures of the Applicant,Recipient's representative,and supervisory staff. [REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK] _..._ Page 4 . ,, D ORIGINAL STATE OF FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY FEDERALLY FUNDED SUBGRANT AGREEMENT MODIFICATION SIGNATURE PAGE IN WITNESS WHEREOF,the Parties have duly executed and delivered this Modification as of the date set forth below. RECIPIENT STATE OF FLORIDA DEPARTMENT OF ECONOMIC OPPORTUNITY COUNTY OF MONROE (Type Legal N e of Recipient) 1 C ):s t A.t..6 2._)4 L.i x,D . i five_....ill a dt, By: By`/= :d� Lt� 2�_/r!• Ack cKG- Q �4 llA(d5�'P. oP� William B.Killingsworth,Director N .� • (Type Name and Title Here) Division of Community Developments w F. cp Date: 9) t col r C7 LC Date: `o / !� o rrl rrl 1 '11 o c: Approved as to form and legal 3 rn Federal Identification Number sufficiency,subject only to full and _G7 = proper execution by the Parties. - N 073876757 T' -.1 �� DUNS*Number Office of the General C el Dep ent of Ecpno 'c pportunity 15EA-OF-11-54-01-019 Agreement Number i J(� By: 1 ` Approv Date: M OE COU A F O"�EY P OVED PEDRO J 1 P SIGNED BY: mr-\ ® ASSlS t., UNTY AT1 EY 15 fir_ ate NAME: DANNY KOLHAGE e 5 E�U,"t,>_ I TITLE: MAYOR ��auw,ARK �' 4-.riL •• i�ra. g DATE: /0 o� //1.S "`yyam� -*" • •EP ` RK FY 2015 LIHEAP AGREEMENT EXHIBIT 1 - AUDIT REQUIREMENTS The administration of resources awarded by DEO to the recipient may be subject to audits and/or monitoring by DEO as described in this section. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133 and Section 215.97,F.S.,as revised(see"AUDITS"below),monitoring procedures may include,but not be limited to,on-site visits by DEO staff,limited scope audits as defined by OMB Circular A-133,as revised,and/or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by DEO. In the event DEO determines that a limited scope audit of the recipient is appropriate,the recipient agrees to comply with any additional instructions provided by DEO staff to the recipient regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations,or audits deemed necessary by the Chief Financial Officer(CFO)or Auditor GeneraL AUDITS PART I: FEDERALLY FUNDED This part is applicable if the recipient is a State or local government or a non-profit organization as defined in OMB Circular A-133,as revised. 1. In the event that the recipient expends$300,000($500,000 for fiscal years ending after December 31,2003) or more in Federal awards in its fiscal year, the recipient must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. Exhibit 1 to this agreement indicates Federal resources awarded through DEO by this agreement. In determining the Federal awards expended in its fiscal year, the recipient shall consider all sources of Federal awards, including Federal resources received from DEO. The determination of amounts of Federal awards expended should be in accordance with the guidelines established by OMB Circular A-133,as revised. An audit of the recipient conducted by the Auditor General in accordance with the provisions of OMB Circular A-133,as revised,will meet the requirements of this part. 2. In connection with the audit requirements addressed in Part I,paragraph 1, the recipient shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133,as revised. 3. If the recipient expends less than $300,000 ($500,000 for fiscal years ending after December 31,2003)in Federal awards in its fiscal year,an audit conducted in accordance with the provisions of OMB Circular A- 133, as revised,is not required. In the event that the recipient expends less than $300,000 ($500,000 for fiscal years ending after December 31,2003)in Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133,as revised,the cost of the audit must be paid from non-Federal resources(i.e.,the cost of such an audit must be paid from the recipient resources obtained from other than Federal entities). 4. Title 2 CFR part 200, entitled Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards, also known as the Super Circular, supersedes and consolidates the requirements of OMB Circulars A-21, A-87, A 110, A-122, A-89, A-102 and A-133 and is effective for Federal awards or increments of awards issued on or after December 26,2014. Please refer to title 2 CFR part 200 for revised definitions,reporting requirements and auditing thresholds referenced in this Attachment and Agreement accordingly. ........................_.._... Page 6 Part II: STATE FUNDED This part is applicable if the recipient is a non-state entity as defined by Section 215.97(2),Florida Statutes. 1. In the event that the recipient expends a total amount of state financial assistance equal to or in excess of $500,000 in any fiscal year of such recipient(for fiscal years ending September 30,2004 or thereafter),the recipient must have a State single or project-specific audit for such fiscal year in accordance with Section 215.97, F.S.; applicable rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),Rules of the Auditor General. Exhibit 1 to this agreement indicates state financial assistance awarded through DEO by this agreement. In determining the state financial assistance expended in its fiscal year, the recipient shall consider all sources of state financial assistance, including state financial assistance received from DEO, other state agencies,and other non-state entities. State financial assistance does not include Federal direct or pass- through awards and resources received by a non-state entity for Federal program matching requirements. 2. In connection with the audit requirements addressed in Part II,paragraph 1,the recipient 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 Chapters 10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General. 3. If the recipient expends less than $500,000 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 recipient expends less than$500,000 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of section 215.97,F.S.,the cost of the audit must be paid from the non-state entity's resources(i.e.,the cost of such an audit must be paid from the recipient's resources obtained from other than State entities). 4. Additional information regarding the Florida Single Audit Act can be found at: http://www.myflorida.com/audgen/p ges/flsaa.htm PART III: OTHER AUDIT REQUIREMENTS (NOTE:This part would be used to specify any additional audit requirements imposed e the State awarding entity that are solely a matter of that State awarding entity's policy (i.e., the audit as not required by Federal or State laws and is not in conflict with otberFederal or State audit requirements). Pursuant to Section 215.97(8),Florida Statutes,State agencies may conduct or arrange for audits of state financial assistance that are in addition to audits conducted in accvrdance with Section 215.97,Florida Statutes. In such an event,the State awarding agency must arrange fort ending the full cost ofsuch additional audits.) PART IV: REPORT SUBMISSION 1. 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-133,as revised,by or on behalf of the recipient directly to each of the following at the address indicated: A. DEO at each of the following addresses: • Electronic copies(preferred): Audit@deolnyflorida.com or Paper(hard copy): Department Economic Opportunity -- Page 7 _....... MSC# 130,Caldwell Buildin• 107 East Madison Street Tallahassee,FL 32399-4126 B. The Federal Audit Clearinghouse designated in OMB Circular A-133,as revised(the number of copies required by Sections .320 (d)(1)and(2),O.MB Circular A-133,as revised,should be submitted to the Federal Audit Clearinghouse)at the following address: Federal Audit Clearinghouse Bureau of the Census 1201 East 10th Street Jeffersonville,IN 47132 • C. Other Federal agencies and pass-through entities in accordance with Sections .320 (e)and(f),OMB Circular A-133,as revised. 2. Pursuant to Section .320 (f), OMB Circular A-133, as revised, the recipient shall submit a copy of the reporting package described in Section.320(c),OMB Circular A-133,as revised and any management letter issued by the auditor,to DEO at each of the following addresses: Electronic copies (preferred): Audit@deo.myflorida.com or Paper(hard copy): Department Economic Opportunity MSC#130,Caldwell Building 107 East Madison Street Tallahassee,FL 32399-4126 3. Copies of financial reporting packages required by Part II of this agreement shall be submitted by or on behalf of the recipient directly to each of the following: A. DEO at each of the following addresses: Electronic copies(preferred): Audit@deo.mvflorida.com or Paper(hard copy): Department Economic Opportunity MSC# 130,Caldwell Building 107 East Madison Street Tallahassee,FL 32399-4126 B. The Auditor General's Office at the following address: Auditor General Local Government Audits/342 Claude Pepper Building,Room 401 111 West Madison Street Tallahassee,FL 32399-1450 Email Address: flaudgen Iocalgovt@aud.state.fl.us 4. Copies of reports or the management letter required by Part III of this agreement shall be submitted by or on behalf of the recipient directly to: —.... — Page 8 A. DEO at each of the following addresses: N jA 5. Any reports, management letter, or other information requited to be submitted to DEO pursuant to this agreement shall be submitted timely in accordance with OMB Circular A-133,Florida Statutes,and Chapters 10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations),Rules of the Auditor General,as applicable. 6. Recipients,when submitting financial reporting packages to DEO for audits done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (non-profit and for-profit organizations),Rules of the Auditor General,should indicate the date that the reporting package was delivered to the recipient in correspondence accompanying the reporting package. PART V: RECORD RETENTION 1. The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of five (5) years from the date the audit report is issued, or five (5) state fiscal years after all reporting requirements are satisfied and final payments have been received,whichever period is longer,and shall allow DEO,or its designee,CFO,or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to DEO,or its designee,CFO,or Auditor General upon request for a period of five(5)years from the date the audit report is issued,unless extended in writing by DEO.In addition,if any litigation,claim,negotiation,audit,or other action involving the records has been started prior to the expiration of the controlling period as identified above,the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the controlling period as identified above,whichever is longer. _..__........._....._ Page 9 FY 2015 LIHEAP AGREEMENT EXHIBIT 1-A FUNDING SOURCES FEDERAL RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: NOTE:If the resources awarded to the recipient represent more than one Federal program,provide the same information shown below for each Federal program and show total Federal resources awarded If inapplicable,delete the table below and type `N/A': Federal Awarding Agency: U.S.Department of Health and Human Services Pass-Through Entity: Florida Department of Economic Opportunity Federal Award Identification Number: G-12B2FLCOSR Federal Award Date: January 21,2015 Total Federal Award to Pass-Through Entity: $69,338,313 Catalog of Federal Domestic Assistance Title: Low-Income Home Energy Assistance Program Catalog of Federal Domestic Assistance Number: 93-568 Recipient's DUNS-Registered Name: COUNTY OF MONROE Recipient's DUNS Number: 073876757 Federal Funds Obligated to Recipient $212,598.00 Project Description: Home energy assistance to low income households This is not a research and development award see 2 C RK1200 7 fu nsriise) Indirect Cost Rate: - See Exhibit 3 of FY 2015 Subgrant Agreement COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: NOTE:If the resources awarded to the recipient represent more than one Federal program, list applicable compliance requirements for each Federal program in the same manner as shown below. If inapplicabk,delete the table below and type `N/A': Federal Program: 1. Recipient shall use the LIHEAP funds to provide energy payment assistance to eligible consumers with low income. These funds will be expended in accordance with all attachments to this Agreement, applicable OMB Circulars,and the FY 2015 LIHEAP State Plan. 2. Recipient shall comply with applicable OMB Circulars and eligibility requirements as set forth in the U.S. Department of Health and Human Services regulations codified in Title 45 of the Code of Federal Regulations,Part 96—Block Grants,and Tide 31 of the Code of Federal Regulations,Part 205—Cash Management Improvement Act of 1990. NOTE:Instead of listing the specific compliance requirements as shown above, the State awarding agency may elect to use language that requires the recipient to comply with the requirements of applicable provisions of specific laws,riles,regulations,etc. For example, for Federal Program 1, the language may state that the recipient must comp/y with a specific law(s), rule(s), or regulation(s) that pertains to how the awarded resources must be used or how eligibiliy determinations are to be made. The State awarding agency,if practical,may want to attach a copy of the rpecjc law,rule,or regulation referred to. Page 10 _ �_ STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: NONE MATCHING RESOURCES FOR FEDERAL PROGRAMS: NO1 b:If the resources awarded to the recipient for matching represent more than one Federal program,provide the same information shown below for each Federal program and show total State resources awarded for matching. Federal Program:NA SUBJECT TO SECTION 215.97,FLORIDA STATUTES: NO 1 b:If the resources awarded to the recipient represent more than one State project,provide the same information shown below for each State project and show total state financial assistance awarded that is subject to Section 215.97,Florida Statutes. State Project NA COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 1. NONE NOTE: List applicable compliance requirements in the same manner as illustrated above for Federal resources. For matching resources provided by DEO for Federal programs, the requirements might be similar to the requirements for the applicable Federal program.. Also,to the extent that dderent requirements pertain to afferent amounts of the non Federal resources,there may be more than one grouping(i.e., 1,2,3,etc.)listed under this category. NOTE: Title 2 CFR§200.331 and section 215.97(5),Florida Statutes,require that the information about Federal Programs and State Projects included in Exhibit 1 be provided to the Recipient. • Page 11 FY 2015 LIHEAP AGREEMENT EXHIBIT 2 np 1e Audit Compliance Certification irib-f— Rot, ,, ,5 47ne..) Email a copy of this form within 60 days of the end of each,fiscal year in which this grant was open to audit rr deo.myi1orida:com. Grantee: FEIN: Grantee's Fiscal Year: Contact's Name: Contact's Phone: Contact's Email: 1. Did Grantee expend state financial assistance,during its fiscal year, 'at it received under any agreement(e.g.,contract,grant,memorandum of agreement,mem• andum of understanding, economic incentive award agreement,etc.)between the Recipient .nd the Department of Economic Opportunity(DEO)? ❑Yes El No If the above answer is yes,answer the following before proce,• •g to item 2. Did Grantee expend$500,000 or more of state financial as : tance(from DEO and all other sources of state financial assistance combined) during its fiscal y-. 0 Yes ❑No If yes,the Recipient certifies that it will timely co :ply with all applicable state single,or project-specific audit requirements of section 21 .97,Florida Statutes,and the applicable rules of the Department of Financial Services and t • Auditor General. 2. Did the Recipient expend federal awards d g its fiscal year that it received under any agreement (e.g.,contract,grant,memorandum of agre- ent,memorandum of understanding,economic incentive award agreement, etc.) between the Reap• t and DEO? ❑Yes El No If the above answer is yes,also answer 0.e following before proceeding to execution of this certification: Did the Recipient expend$750,010 or more in federal awards (from DEO and all other sources of federal awards combined) d : :its fiscal year? 0 Yes ❑No If yes,the Recipient ce • •s that it will timely comply with all applicable single or program- specific audit requirem- is of title 2 CFR part 200,subpart F,as revised. By signing below,I ce fy,on behalf of the Recipient,that the above representations for items 1 and 2 are true and c i.rect. Signature o `uthorized Representative Date Printed Name of Authorized Representative Tide of Authorized Representative -- _ Page 12 FY2015 LIHEAP AGREEMENT MODIFIED ATTACHMENT I RECIPIENT INFORMATION FEDERAL FISCAL YEAR: 2015 AGREEMENT PERIOD: 4/1/2015 THRU MARCH 31,2016 Instructions: Complete the blanks highlighted in yellow. For item III,put an"X"in whichever highlighted box applies to your agency. I. RECIPIENT: COUNTY OF MONROE AGREEMENT#: 15EA-OF-11-54-01-019 II. Agreement Amount: $212,598.00 Total Direct Client Assistance: i III. RECIPIENT CATEGORY: ENon-Profit pLocal Government EState Agency IV. COUNTY(IES)TO BE SERVED WITH THESE FUNDS: MONROE V. GENERAL ADMINISTRATIVE INFORMATION a. Recipient County Location: MONROE COUNTY b. Executive Director or Chief Administrator: SHERYL GRAHAM Address: 1100 SIMONTON STREET SUITE 2-257 City: KEY WEST ,FL Zipcode: 33040 Telephone: 305-292-4510 Fax: 305-295-4359 Cell: Email: qraham-sheryk monroecounty-fl.gov Mailing address if different from above Mailing Address: City: ,FL Zipcodc: c. Chief Elected Official for Local Governments or President/Chair of the Board for Nonprofits: Name: DANNY KOLHAGE Tide: COUNTY MAYOR Address*: 530 WHITEHEAD ST,SUITE 102 City: KEY WEST ,FL Zipcode: 33040 Telephone: 305-292-3440 Fax: Email: *Enter home or business address,telephone numbers and email other than the Recipient's d. Official to Receive State Warrant: Name: AMY HEAVILIN Title: DEPUTY CLERK Address: 500 WHITEHEAD ST City: KEY WEST ,FL Zipcodc: 33040 e. Recipient Contacts 1. Program: Name: SHERYL GRAHAM Tide: SR.DIRECTOR SOCIAL SERVICES Address: 1100 SIMONTON ST,SUITE 2-257 City: KEY WEST ,FL Zipcode: 33040 Telephone: 305-292-4510 Fax: 305-295-4359 Cell: Email: qraham-shervk monroecounty-fl.qov 2. Fiscal: Name: KIM W.WEAN Title: COMPLIANCE MANAGER Address: 1100 SIMONTON ST,SUITE 1-190 City: KEY WEST ,FL Zipcode: 33040 Telephone: 305-292-4588 Fax: 305-295-4379 Cell: Email: wilkes-kimamonroecounty-fl.gov f. Person(s)authorized to sign reports: Name: SHERYL GRAHAM Tide: SR.DIRECTOR SOCIAL SERVICES Name: KIM W.WEAN Title: COMPLIANCE MANAGER Name: Tide: g. Recipient's FEID Number: 59-6000749 h. Recipient's DUNS Number: 73876757 V. RECIPIENT FISCAL YEAR: October 1,2014 thru September 30,2015 Paste 1-3 FY2015 LIHEAP AGREEMENT MODIFIED ATTACHMENT J BUDGET SUMMARY,WORBPLAN AND DELIVERABLES FOR DEO USE ONLY RECIPIENT: COUNTY OF MONROE Mod No: Reviewed By: AGREEMENT: 15EA-0E-11-54-01-019 Date Reviewed: SECTION I::BUDGET SUMMARY A. B. C. D. TOTAL LIHEAP FUNDS ONLY Last Approved Adjustments to AMENDED Budget Approved Budget BUDGET Amount Increase/(Decrease) B+C 1.111E:1P FUNDS 202,880.00 9,718.00 212,598.00 ADMINISTRATIVE EXPENSES (Cell 2D cannot exceed 8.5%of Cell 1D*) Maximum Administrative Expenses: $18,070.83 2 Salaries incl Fringe,Rent,Utilities,Travel,Other 17,243.00 R(t) 17,243.00 OUTREACH EXPENSES (Cell3D cannot exceed Cell ID minus Cell 2D times.15) Maximum Outreach Expenses: I $29,303.25 3 Salaries incl Fringe,Rent,Utilities,Travel,Other 2 ,845.00 0.00 27,845.00 DIRECT CLIENT ASSISTANCE Home Energy Assistansce 4 Cel4D must be at kart 25%of Cell 1D 75,000.00 0.00 75,000.00 Minimum Home Energy:I $53,149.50 5 Crisis Assistance 76,950.00 9,718.00 86,668.00 Weather Related/Supply Shortage/Disaster 6 Ce116D must be at kart 2%i of Cell 1 D 5,842.00 0.00 5,842.00 Minimum Weather Related: $4,251.96 Subtotal Direct Client Assistance 7 157,792.00 9,718.00 167,510.00 (Line 4+Line 5+Line 6) 10 GRAND TOTALS 202,880.00 9,718.00 212,598.00 SECTION II:WOR KPL AN AND DELIVERABLES Last Approved Amended Amended Estimated Estimated Cost Per Type of Assistance Estimated Number Estimated of Households Number of Households Household** Expenditures*** Summer Home Energy 125 125 300.00 37,500.00 Winter Home Energy 125 125 300.00 37,500.00 Summer Crisis 135 175 215.00 37,625.00 Winter Crisis 135 196 250.22 49,043.12 Weather Related/Supply Shortage 20 20 292.11) 5,842.00 TOTAL I 0 __. 641 1.116L I 167,510.12 *If less than 8.5%of Line 1 is budgeted for Administrative Expenses,the maximum allowed for Outreach Expenses may be increased. The total.\dministratn I:y o,,.j la i It, total Outreach Expenses may not exceed the sum of the original maximum allowed for these items. Total of Line 2 plus Line 3 may not exceed: $47,374.08 Amount budgeted Line 2+Line 3= $45,088.00 **Estimated Cost per Household must be based on the agency's historic average cost. ***Estimated Expenditues given in the Workplan must agree with the corresponding values on Lines 4-7. • FY 2015 LIHEAP AGREEMENT ' MODIFIED ATTACHMENT K ADMINISTRATIVE AND OUTREACH EXPENSE BUDGET DETAIL(Lines 2-3) Recipient: COUNTY OF MONROE Agreement#: 15EA-OF-11-54-01-019 • Instrndio,,s On the form below,enter the detail of the figures listed on the Brrdgel Sunmmp. If more.+pace is needed,ropy this form ropy this form to another tab and name the new tabs"Budget Detail 1"."Budget Detail2",etc. • Line Expenditure Detail • Item LII-IEAP FUNDS Number (Round all line items to dollars. Do not use cents and decimals in totals.Totals must agree with Attachment)) 2 .ADMINISTRATIVE EXPENSES: salary:Sr.Director .: 6,720.00 5%LIHEAP,15%CCE,20%MCT,4%C1,4%C2,32%GENERAL REVENUE,20%WAR 104•HRS X$64.62/HR LOADED WITH FRINGE • • salary:Compliance Manager 4,204.00 5%LIHEAP,40%CCE,5%MCT,5%ADI,5%CCDA,5%Cl,5%C2,30%GENERAL REVENUE 104 HRS X$40.42/HR LOADED WITH FRINGE • MISC- 5,319.00 1)PHONE,POSTAGE,FREIGHT- S319.00 2)PRINTING AND BINDING SUPPLIES- S500.00 3)OFFICE SUPPLIES S500.00 4)OPERATING SUPPLIES S500.00 5)RENTAL/COPIER S1,000.00 6)MAINTENANCE AGREEMENT $2,500.00 (annual fee for maintaining internal data client tracking system) • TRAVEL: 2 persons to the Annual FACA training conference(airfare,meals,per diem) 1,000.00 TOTAL ADMINISTRATIVE EXPENSES 17,243.00 3 OUTREACH EXPENSES • salary:FULL TIME CASE MANAGER(INTAKE,ELIGIBILITY) 9,391.00 • 15%LIHEAP, 85%GENERAL REVENUE 312 HRS X$30.10/HR LOADED WITH FRINGE salary:STAFF ASSISTANTS(TWO INTAKE,ELIGIBILITY) $8253.00 x 2 employees 16,507.00 20%LIHEAP, 80%GENERAL REVENUE 416 HRS X S19.84/HR LOADED WITH FRINGE TRAVEL:1000 MILES X S.445/PER MILE(estimated local mileage) 445.00 TRAVEL: 1 person to the Annual FACA training conference(airfare,meals,per diem) 1,000.00 Other(consumable office supplies such as:postage for mail outs,equipment) 502.00 TOTAL OUTREACH EXPENSES • - 27,845.00 • ' DIRECT CLIENT ASSISTANCE: • 4 HOME ENERGY • • - - _ • • • 75.600.00• s • CRISIS 86,668.00 • • • • G. WEATHER . 5,842.00 . • • pi)) /s FY 2015 LIHEAP AGREEMENT MODIFIED ATTACHMENT L MULTI-COUNTY FUND DISTRIBUTION Recipient: COUNTY OF MONROE Agreement#: 15EA-OF-11-54-01-019 Number of Counties to be Served with this agreement: If the Recipient will serve more than one county with this agreement,complete the form below. Describe how you will equitably allocate LIHEAP resources to each of the counties you serve. This plan must be in part based on the 150%poverty population of each county. Instructions: Enter appropriate data only in the cells below that are highlighted in yellow. Percentages will automatically populate when the total direct client assistance amount and all three columns for each county are filled in. Poverty Population Data Souce: Provide the U.S.Census data source for the 150%of poverty population used including the year of the data. If any other data or factors are used in allocating the funds,describe and give the source. not applicable only serving one county with this funding Data Source and Description: TOTAL DIRECT %OF AGENCY'S COUNTY'S% CLIENT DIRECT CLIENT COUNTY 150%POVERTY OF POVERTY ASSISTANCE* ASSISTANCE POPULATION*` POPULATION IN $167,510.00 DOLLARS SERVICE AREA COUNTY ALLOCATED TO ALLOCATION THIS COUNTY MONROE 100% 167,510.00 100.0% :•� � , � , ���� #VALUEI #VALUE! P . #VALUE! ;y #VALUE! .t #VALUE! #VALUE! I #VALUE! . .- #VALUE! #VALUE! Total Budgeted Direct 100 100% #VALUE! 100.0% Client Assistance* *Allocation must be equal to Attachment J,Line 7.