12/11/2013 ContractAMY REAVILIN, .CPA
CLERK OF CIRCUIT COURT &COMPTROLLER
MONnoe couxrr, FLORIDA
DATE: December 23, 2013
TO: Sheryl Graham, Director
Social Services
ATTN. • Kim Wilkes
Sr. Grants Coordinator
FROM. • Vitia Fernandez, D.
At the November 20, 2013, Board of Cou4y Commissioner's meeting the Board granted approval and
authorized execution of Item C3 AWaKce for Aging, Inc. Standard Contract, Older Americans Act
(OAA) Contract AA -1429 between the Alliance for Aging, Inc. (AAA) and the Monroe County Board
of County Commissioners (Social Services /In home and nutrition programs) for the current contract
period of 1/1/14 to 12/31/14.
Enclosed are six (6) duplicate originals executed on behalf of Monroe County, for your handling.
Please be sure to return two fully executed duplicate originals as soon as possible. Should you have any
questions, please feel free to contact me.
cc: County Attorney (w /o documents)
Finance
File
500 Whitehead Street Suite 101, PO Box 1980, Key West, FL 33040 Phone: 305 - 295 -3130 Fax: 305- 295 -3663
3117 Overseas Highway, Marathon, FL 33050 Phone: 305 -289 -6027 Fax: 305 - 289 -6025
88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852 -7145 Fax: 305 - 852 -7146
F�.,�7kyEg� OEGRU
OAA Contract AA -1429
ALLIANCE FOR AGING, INC.
STANDARD CONTRACT
OLDER AMERICANS ACT PROGRAM TITLE III
THIS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter referred to as the "AAA," and Monroe
County Social Services. hereinafter referred to as the "Contractor ", and collectively referred to as the "Parties." The term
contractor for this purpose may designate a vendor, subgrantee or subrecipient, the status to be further identified in
ATTACHMENT III, Exhibit -2 as necessary.
WITNESSETH THAT:
WHEREAS, the AAA has established through the Area Plan on Aging that it is in need of certain services as described herein;
and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such services
as an independent contractor of the AAA.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the mutual
covenants and conditions hereinafter set forth, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this
contract including all attachments and exhibits, which constitute the contract document.
1.1 Definitions
DOEA means the Florida Department of Elder Affairs.
AAA means the Alliance for Aging, Inc.
PSA means the Planning and Service Area corresponding to Miami -Dade and Monroe Counties.
2. Incorporation of Documents within the Contract
The contract incorporates by reference the AAA's 2012 OAA RFP, including any addenda; the Contractor's
application in response to the 2012 OAA RFP; and the 2013 DOEA Programs and Services Handbook. In the event of
conflict in language among any of the documents referenced above, the order of preference shall be as follows:
(a) This contract, including all attachments and exhibits;
(b) The 2012 OAA RFP;
(c) DOEA's 2013 Program and Services Handbook; and
(d) The Contractor's application(s) submitted in response to the RFP.
3. Term of Contract
This contract shall begin on January 1, 2014 or on the date on which the contract has been signed by the last party
required to sign it, whichever is later. It shall end at midnight, local time in Miami, Florida, on December 31, 2014,
unless renewed or extended as provided herein
4. Contract Amount
The AAA agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $ 431,557.01 subject to the availability of funds. Any costs or services paid for under any other
contract or from any other source are not eligible for payment under this contract.
5. Renewals
By mutual agreement of the parties, the AAA may renew the contract for five additional one year renewal periods.
Any renewal is subject to the same terms and conditions as the original contract and contingent upon satisfactory
performance evaluations by the AAA and the availability of funds. This contract may be extended upon mutual
agreement for one extension period not to exceed six months.
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6. Compliance with Federal Law
6.1. If this contract contains federal funds the following shall apply:
OAA Contract AA -1429
6.1.1 The Contractor shall comply with the provisions of 45 CFR 74 and/or 45 CFR 92, and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all applicable
standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42 U.S.C. 7401, et seq.), s. 508
of the Federal Water Pollution Control Act as amended (33 U.S.C. 1251, et seq.), Executive Order 11738, as
amended, and where applicable Environmental Protection Agency regulations 40 CFR 30. The contractor shall report
any violations of the above to the AAA.
6.1.3 The Contractor, or agent acting for the Contractor, may not use any federal funds received in connection with this
contract to influence legislation or appropriations pending before the Congress or any State legislature. If this
contract contains federal funding in excess of $100,000.00, the contractor must, prior to contract execution, complete
the Certification Regarding Lobbying form, ATTACHMENT II. All disclosure forms as required by the
Certification Regarding Lobbying form must be completed and returned to the Contract Manager, prior to payment
under this contract.
6.1.4 In accordance with Appendix A to 2 CFR 215, the contractor shall comply with Executive Order 11246, Equal
Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of
Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
6.1.5 If this contract contains federal funds and provides services to children up to age 18, the contractor shall comply with
the Pro - Children Act of 1994 (20 U.S.C. 6081).
6.1.6 A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards shall not
be made to parties listed on the government -wide Excluded Parties List System, in accordance with the OMB
guidelines at 2 CFR 180 that implement Executive Orders 12549 and 12689, "Debarment and Suspension." The
Excluded Parties List System contains the names of parties debarred, suspended, or otherwise excluded by agencies,
as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The
Contractor shall comply with these provisions before doing business or entering into subcontracts receiving federal
funds pursuant to this contract. The Contractor shall complete and sign ATTACHMENT V prior to the execution of
this contract.
6.2 The Contractor shall not employ an unauthorized alien. The AAA shall consider the employment of unauthorized
aliens a violation of the Immigration and Nationality Act (8 U.S.C. 1324 a) and the Immigration Reform and Control
Act of 1986 (8 U.S.C. 1101). Such violation shall be cause for unilateral cancellation of this contract by the AAA.
6.3 If the Contractor is a non - profit provider and is subject to Internal Revenue Service (IRS) tax exempt organization
reporting requirements (filing a Form 990 or Form 990 -N) and has its tax exempt status revoked for failing to comply
with the filing requirements of the 2006 Pension Protection Act or for any other reason, the Contractor must notify
the AAA in writing within thirty (30) days of receiving the IRS notice of revocation.
6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR Part 170.110(b), the Contractor shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 170.
6.6 To comply with Presidential Executive Order 12989 and State of Florida Executive Order Number 11 -116,
Contractor agrees to utilize the U.S. Department of Homeland Security's E -verify system to verify the
employment of all new employees hired by Contractor during the contract term. Contractor shall include in
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related subcontracts a requirement that subcontractors performing work or providing services pursuant to
the state contract utilize the E -verify system to verify employment of all new employees hired by the
subcontractor during the contract term. Contractors meeting the terms and conditions of the E -Verify System
are deemed to be in compliance with this provision.
7. Compliance with State Law
7.1 This contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in
all respects in accordance with the Florida law, including Florida provisions for conflict of laws.
7.2 The Contractor shall comply with the requirements of s. 287.058, F.S. as amended.
7.2.1 The Contractor shall provide units of deliverables, including various client services, and in some instances may
include reports, findings, and drafts, as specified in this contract, which the Contract Manager must receive and
accept in writing prior to payment.
7.2.2 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail for a
proper pre -audit and post- audit.
7.2.3 If itemized payment for travel expenses is permitted in this contract, the contractor will submit bills for any travel
expenses in accordance with s. 112.061, F.S., or at such lower rates as may be provided in this contract.
7.2.4 The Contractor shall allow public access to all documents, papers, letters, or other public records as defined in
subsection 119.011(12), F.S., made or received by the contractor in conjunction with this contract except for those
records which are made confidential or exempt by law. The Contractor's refusal to comply with this provision shall
constitute an immediate breach of contract for which the AAA may unilaterally terminate the contract.
7.3 If clients are to be transported under this contract, the Contractor shall comply with the provisions of Chapter 427,
F.S., and Rule 41 -2, F. A. C.
7.4 Subcontractors who are on the discriminatory vendor list may not transact business with any public entity, in
accordance with the provisions of s. 287.134, F.S.
7.5 The Contractor will comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
7.6 In accordance with s. 287.135 F.S., any contractor on the Scrutinized Companies with Activities in Sudan List or the
Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (Lists), created pursuant to s.
215.473 F.S., is ineligible to enter into or renew a contract funded through a DOEA contract for goods or services of
$1 million or more. The Alliance may terminate this contract if the Contractor is found to have submitted a false
certification of its status on the Lists or has been placed on the Lists. Further, the Contractor is subject to civil
penalties, attorney's fees and costs and any costs for investigations that led to the finding of false certification. If this
contract contains $1 million or more, the Contractor shall complete and sign ATTACHMENT L, Certification
Regarding Scrutinized Companies Lists, prior to the execution of this contract.
8. Background Screening
The Contractor shall ensure that, prior to providing services, all persons having access to vulnerable elders and
children, their living area, funds or personal property, or protected health information pertaining to such individuals,
shall pass a Level II criminal background screening in accordance with the requirements of s. 430.0402 and ch. 435,
F.S., as amended. These provisions shall apply to employees, subcontractors, consultants, direct service providers and
volunteers. Consequently, any commitment for employment, purchase of services, or volunteer program participation
shall be contingent upon the passing of a Level II background check. The background screening shall include
employment history checks as provided in s. 435.03(1), F.S., and both local and national criminal record checks
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coordinated through law enforcement agencies.
OAA Contract AA -1429
8.1 For purposes of this section, the term "direct service provider" means a person 18 years of age or older who, pursuant
to a program to provide services to the elderly, has direct, face -to -face contact with a client while providing services
to the client or has access to the client's living areas or to the client's funds or personal property. This term includes
coordinators, managers, and supervisors of residential facilities and volunteers.
9. Grievance Procedures
The Contractor shall develop and implement, and ensure that its subcontractors have established grievance procedures
to process and resolve client dissatisfaction with or denial of service(s), and address complaints regarding the
termination, suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum,
should provide for notice of the grievance procedure and an opportunity for review of the subcontractor's
determination(s).
10. Audits, Inspections. Investigations. Public Records and Retention
10.1 The Contractor shall establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of funds
provided by the AAA under this contract. Contractor shall adequately safeguard all such assets and assure they are
used solely for the purposes authorized under this contract. Whenever appropriate, financial information should be
related to performance and unit cost data.
10.2 The Contractor shall retain all client records, financial records, supporting documents, statistical records, and any
other documents (including electronic storage media) pertinent to this contract for a period of six (6) years after
completion of the contract or longer when required by law. In the event an audit is required by this contract,
records shall be retained for a minimum period of six (6) years after the audit report is issued or until resolution
of any audit findings or litigation based on the terms of this contract, at no additional cost to the AAA.
10.3 Upon demand, at no additional cost to the AAA, the Contractor will facilitate the duplication and transfer of any
records or documents during the required retention period in Paragraph 10.2.
10.4 The Contractor shall assure that the records described in Paragraph 10 shall be subject at all reasonable times to
inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the AAA.
10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the AAA, DOEA and
Federal auditors, pursuant to 45 CFR 92.36(i)(10), shall be allowed full access to and the right to examine any of the
Contractor's contracts and related records and documents pertinent to this specific contract, regardless of the form in
which kept.
10.6 The Contractor shall provide a financial and compliance audit to the AAA as specified in this contract and in
ATTACHMENT III and to ensure that all related party transactions are disclosed to the auditor.
10.7 The Contractor shall comply and cooperate immediately with any inspections, reviews, investigations, or audits
deemed necessary by the office of the DOEA's Inspector General pursuant to s. 20.055, F.S.
11. Nondiscrimination -Civil Rights Compliance
11.1 The Contractor shall execute assurances in ATTACHMENT VI that it will not discriminate against any person in the
provision of services or benefits under this contract or in employment because of age, race, religion, color, disability,
national origin, marital status or sex in compliance with state and federal law and regulations. The Contractor further
assures that all contractors, subcontractors, subgrantees, or others with whom it arranges to provide services or
benefits in connection with any of its programs and activities are not discriminating against clients or employees
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OAA Contract AA -1429
because of age, race, religion, color, disability, national origin, marital status or sex.
11.2 During the term of this contract, the Contractor shall complete and retain on file a timely, complete and accurate Civil
Rights Compliance Checklist (ATTACHMENT B).
113 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures will include notifying clients, employees, and
participants of the right to file a complaint with the appropriate federal or state entity.
11.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from federal
financial assistance, and are binding upon the Contractor, its successors, transferees, and assignees for the period
during which such assistance is provided. The Contractor further assures that all subcontractors, vendors, or others
with whom it arranges to provide services or benefits to participants or employees in connection with any of its
programs and activities are not discriminating against those participants or employees in violation of the above
statutes, regulations, guidelines, and standards. In the event of failure to comply, the Contractor understands that the
AAA may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, including but not limited to, termination of and denial of further
assistance.
12. Provision of Services
The Contractor shall provide services in the manner described in ATTACHMENT I.
13. Monitoring by the AAA
The Contractor shall permit persons duly authorized by the AAA to inspect and copy any records, papers, documents,
facilities, goods and services of the Contractor which are relevant to this contract, and to interview any clients,
employees and subcontractor employees of the Contractor to assure the AAA of the satisfactory performance of the
terms and conditions of this contract. Following such review, the AAA will deliver to the Contractor a written report
of its findings and request for development, by the Contractor, a corrective action plan where appropriate. The
Contractor hereby agrees to timely correct all deficiencies identified in the corrective action plan.
14. Coordinated Monitoring with Other Agencies
If the Contractor receives funding from one or more of the State of Florida human service agencies, in addition to
AAA funding, then a joint monitoring visit including such other agencies may be scheduled. For the purposes of this
contract, and pursuant to s. 287.0575, F.S. as amended, Florida's human service agencies shall include the
Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities, the
Department of Veterans Affairs, and the Department of Elder Affairs. Upon notification and the subsequent
scheduling of such a visit by the designated agency's lead administrative coordinator, the Contractor shall comply
and cooperate with all monitors, inspectors, and/or investigators.
15. Indemnification
The Contractor shall indemnify, save, defend, and hold harmless the AAA and its agents and employees from any and
all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the
execution of this agreement or performance of the services provided for herein. It is understood and agreed that the
Contractor is not required to indemnify the AAA for claims, demands, actions or causes of action arising solely out of
the AAA's negligence.
15.1 Except to the extent permitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
executed between the AAA and state agencies or subdivisions defined in s. 768.28(2), F.S.
16. Insurance and Bonding
16.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this contract
and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or subdivision as
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defined by subsection 768.28(2), F.S., the Contractor accepts full responsibility for identifying and determining the
type(s) and extent of liability insurance necessary to provide reasonable financial protections for the Contractor and
the clients to be served under this contract. The limits of coverage under each policy maintained by the Contractor do
not limit the Contractor's liability and obligations under this contract. The Contractor shall ensure that the AAA has
copy of the most current written verification of insurance coverage throughout the term of this contract. Such
coverage may be provided by a self - insurance program established and operating under the laws of the State of
Florida. The AAA reserves the right to require additional insurance as specified in this contract.
16.2 Throughout the term of this agreement, the Contractor shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Contractor authorized to
handle funds received or disbursed under all agreements and/or contracts incorporating this contract by reference in
an amount commensurate with the funds handled, the degree of risk as determined by the insurance company and
consistent with good business practices.
17. Confidentiality of Information
The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal law or regulations except with the written consent of a person legally
authorized to give that consent or when authorized by law.
18. Health Insurance Portability and Accountability Act
Where applicable, the Contractor shall comply with the Health Insurance Portability and Accountability Act (42 USC
1320d.), as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
19. Incident Reporting
19.1 The Contractor shall notify the AAA immediately, but no later than forty-eight (48) hours from the Contractor's
awareness or discovery of conditions that may materially affect the Contractor or subcontractor's ability to perform
the services required to be performed under this contract. Such notice shall be made orally to the Contract Manager
(by telephone) with an email to immediately follow.
19.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a
child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number
(1- 800- 96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Contractor and
its employees.
20. New Contract(s) Reporting
The Contractor shall notify the AAA within ten (10) days of entering into a new contract with any of the four (4) state
human service agencies other than DOEA. The notification shall include the following information: (1) contracting
state agency; (2) contract name and number; (3) contract start and end dates; (4) contract amount; (5) contract
description and commodity or service; and (6) Contract Manager name and number. In complying with this provision,
and pursuant to s. 287.0575, F.S. as amended, the Contractor shall complete and provide the information in
ATTACHMENT D.
21. Bankruptcy Notification
If, at any time during the term of this contract, the Contractor, its assignees, subcontractors or affiliates files a claim
for bankruptcy, the Contractor must immediately notify the AAA. Within ten (10) days after notification, the
Contractor must also provide the following information to the AAA: (1) the date of filing of the bankruptcy petition;
(2) the case number; (3) the court name and the division in which the petition was filed (e. g., Northern District of
Florida, Tallahassee Division); and, (4) the name, address, and telephone number of the bankruptcy attorney.
22. Sponsorship and Publici
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22.1 As required by s. 286.25, F.S., if the Contractor is a non - governmental organization which sponsors a program
financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in publicizing,
advertising, or describing the sponsorship of the program, state: "Sponsored by (Contractor's name), 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 "Alliance for Aging, Inc." shall appear in at
least the same size letters or type as the name of the organization.
22.2 The Contractor shall not use the words "The State of Florida Department of Elder Affairs" or "Alliance for Aging,
Inc." to indicate sponsorship of a program otherwise financed, unless specific authorization has been obtained by the
AAA prior to use.
23. Assignments
23.1 The Contractor shall not assign the rights and responsibilities under this Contract without the prior written approval
of the AAA, which shall not be unreasonably withheld. Any sublicense, assignment, or transfer otherwise occurring
without prior written approval of the AAA will constitute a material breach of the contract.
23.2 The AAA shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations under
this contract to another agency upon giving prior written notice to the Contractor. In the event the AAA approves
transfer of the Contractor's obligations, the Contractor remains responsible for all work performed and all expenses
incurred in connection with the contract.
23.3 This contract shall remain binding upon the successors in interest of either the Contractor or the AAA.
24. Subcontracts
24.1 The Contractor is responsible for all work performed pursuant to this contract and the service provider application in
response to the 2012 OAA RFP, whether actually furnished by the Contractor or its subcontractors. Any subcontracts
shall be evidenced by a written document and subject to any conditions of approval the AAA deems necessary. The
Contractor further agrees that the AAA shall not be liable to the subcontractor in any way or for any reason. The
Contractor, at its expense, shall defend the AAA against any such claims.
24.2 The Contractor shall promptly pay any subcontractors upon receipt of payment from the AAA or other sponsoring
agency. Failure to make payments to any subcontractor in accordance with s. 287.0585, F.S., unless otherwise stated
in the contract between the Contractor and subcontractor, will result in a penalty as provided by statute.
25. Independent Capacity of Contractor
It is the intent and understanding of the Parties that the Contractor, or any of its subcontractors, are independent
contractors and are not employees of the AAA and shall not hold themselves out as employees or agents of the AAA
without specific authorization from the AAA. It is the further intent and understanding of the Parties that the AAA
does not control the employment practices of the Contractor and shall not be liable for any wage and hour,
employment discrimination, or other labor and employment claims against the Contractor or its subcontractors. All
deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds
and all necessary insurance for the Contractor shall be the sole responsibility of the Contractor.
26. Payment
Payments will be made to the Contractor pursuant to s. 215.422, F.S., as services are rendered and invoiced by the
Contractor. The AAA's Contract Manager will have final approval of the invoice for payment, and will approve the
invoice for payment only if the Contractor has met all terms and conditions of the contract, unless the bid
specifications, purchase order, or this contract specify otherwise. The approved invoice will be submitted to the
AAA's fiscal section for budgetary approval and processing. Disputes arising over invoicing and payments will be
resolved in accordance with the provisions of s. 215.422 F.S.
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27. Return of Funds
The Contractor will return to the AAA any overpayments due to unearned funds or funds disallowed and any interest
attributable to such funds pursuant to the terms and conditions of this contract that were disbursed to the Contractor
by the AAA. In the event that the Contractor or its independent auditor discovers that an overpayment has been
made, the Contractor shall repay said overpayment immediately without prior notification from the AAA. In the
event that the AAA first discovers an overpayment has been made, the Contract Manager, on behalf of the AAA, will
notify the Contractor by letter of such findings. Should repayment not be made forthwith, the Contractor will be
charged at the lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after AAA notification or
Contractor discovery.
28. Data Integrity and Safeguarding Information
The Contractor and its subcontractors shall insure an appropriate level of data security for the information the
Contractor is collecting or using in the performance of this contract. An appropriate level of security includes
approving and tracking all contractor employees that request system or information access and ensuring that user
access has been removed from all terminated employees. The Contractor, among other requirements, must anticipate
and prepare for the loss of information processing capabilities. All data and software must be routinely backed up to
insure recovery from losses or outages of the computer system. The security over the backed -up data is to be as
stringent as the protection required of the primary systems. The Contractor must maintain written procedures for
computer system back up and recovery. The Contractor shall complete and sign ATTACHMENT IV prior to the
execution of this contract.
29. Computer Use and Social Media Policy
The DOEA has implemented a new Social Media Policy, in addition to its Computer Use
Policy, which applies to all employees, contracted employees, consultants, OPS and volunteers, including all
personnel affiliated with third parties, such as, but not limited to, Area Agencies on Aging and vendors. Any entity
that uses the DOEA's computer resource systems must comply with the DOEA's policy regarding social media. Social
Media includes, but is not limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video
sharing, social networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and
YouTube (ATTACHMENT E).
30. Conflict of Interest
The Contractor shall establish safeguards to prohibit employees, board members, management and subcontractors
from using their positions for a purpose that constitutes or presents the appearance of personal or organizational
conflict of interest or personal gain. No employee, officer or agent of the Contractor or subcontractor shall participate
in selection, or in the award of an agreement supported by State or Federal funds if a conflict of interest, real or
apparent, would be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member of
his/her immediate family; (c) his or her partner, or; (d) an organization which employs, or is about to employ, any of
the above, has a financial or other interest in the firm selected for award. The Contractor or any subcontractor's
officers, employees or agents will neither solicit nor accept gratuities, favors or anything of monetary value from
contractors, potential contractors, or parties to subcontracts. The Contractor's board members and management must
disclose to the AAA any relationship which may be, or may be perceived to be, a conflict of interest within thirty (30)
calendar days of an individual's original appointment or placement in that position, or if the individual is serving as
an incumbent, within thirty (30) calendar days of the commencement of this contract. The Contractor's employees
and subcontractors must make the same disclosures described above to the Contractor's board of directors.
Compliance with this provision will be monitored.
31. Public Entity Crime
Pursuant to s. 287.133, F.S., the following restrictions are placed on the ability of persons convicted of public entity
crimes to transact business with the AAA. A person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any
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goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the
construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real
property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant
under a contract with any public entity; and may not transact business with any public entity in excess of the
threshold amount provided in s. 287.017, F.S., for CATEGORY TWO for a period of 36 months following the date of
being placed on the convicted vendor list.
32. Blank
33. Patents, Copyrights, Royalties
If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed,
produced or for which ownership was purchased in the course of or as a result of work or services performed under
this contract, the Contractor shall refer the discovery, invention or material to the AAA to be referred to the
Department of State. Any and all patent rights or copyrights accruing under this contract are hereby reserved to the
State of Florida in accordance with Chapter 286, F.S. Pursuant to s. 287.0571 (5) (k) 1 and 2 as amended, the only
exceptions to this provision shall be those that are clearly expressed and reasonably valued in the contract.
33.1 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to Paragraph 33.
33.2 If this contract is awarded solely with federal funding, the terms and conditions are governed by 2 CFR
215.36
34. Emergency Preparedness and Continuity of Operations
34.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety or welfare, the Contractor shall, within
thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification of an
emergency preparedness plan (Continuity of Operations Plan.) In the event of an emergency, the Contractor shall
notify the AAA of emergency provisions.
34.2 In the event, a situation results in a cessation of services by a subcontractor, the Contractor will retain responsibility
for performance under this contract and must follow procedures to ensure continuity of operations without
interruption.
35. PUR 1000 Form
State of Florida, Department of Management Services PUR 1000 Form is hereby incorporated by reference. In the
event of any conflict between the PUR 1000 Form and any terms or conditions of this contract the terms or conditions
of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in the
PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained in the PUR
1000 Form shall take precedence.
36. Use of State Funds to Purchase or Improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds
provided for at least 5 years from the date of purchase or the completion of the improvements or as further required
by law.
37. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager, who shall reduce the
'RIVE
decision to writing and serve a copy on the Contractor.
OAA Contract AA -1429
38. Financial Consequences of Non - Performance
If the Contractor fails to meet the minimum level of service or performance identified in this agreement, or that is
customary for the industry, then the AAA may apply financial consequences commensurate with the deficiency.
Financial consequences may include but are not limited to contract suspension, refusing payment, withholding
payments until deficiency is cured, tendering only partial payments, and/or cancellation of contract and reacquiring
services from an alternate source.
38.1 The Contractor shall not be charged with financial consequences, when a failure to perform arises out of causes that
were the responsibility of the AAA.
39. No Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
40. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Miami -Dade County, Florida.
41. Entire Contract
This contract contains all the terms and conditions agreed upon by the parties. No oral agreements or representations
shall be valid or binding upon the AAA or the Contractor unless expressly contained herein or by a written
amendment to this contract signed by both Parties.
42. Force Maieure
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party experiencing the force majeure condition provides immediate written notification to the other party
and takes all reasonable efforts to cure the condition.
43. Severability Clause
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
44. Condition Precedent to Contract: Appropriations
The Parties agree that the AAA's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
45. Addition/Deletion
The Parties agree that, notwithstanding the terms of the procurement documents and actions leading to this contract,
the AAA reserves the right to add or to delete any of the services required under this contract when deemed to be in
the best interest of the elder population targeted by the Area Plan and reduced to a written amendment signed by both
Parties. The Parties shall negotiate compensation for any additional services added.
46. Waiver
The delay or failure by the AAA to exercise or enforce any of its rights under this contract shall not constitute or be
deemed a waiver of the AAA's right thereafter to enforce those rights, nor shall any single or partial exercise of any
such right preclude any other or further exercise thereof or the exercise of any other right.
47. Compliance
The Contractor shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable
current State statutes, laws, rules and regulations. The Parties agree that failure of the Contractor to abide by these
laws shall be deemed an event of default of the Contractor, and subject the contract to immediate, unilateral
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cancellation of the contract at the discretion of the AAA.
OAA Contract AA -1429
48. Final Invoice
The Contractor shall submit the final invoice for payment to the AAA as specified in Paragraph 3.3.4. (date for final
request for payment) of ATTACHMENT I. If the Contractor fails to submit final request for payment by the
deadline, then all rights to payment may be forfeited and the AAA may not honor any requests submitted after the
aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from
the Contractor and necessary adjustments thereto have been approved by the AAA.
49. Renegotiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. 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 reflected in the AAA's contract with DOEA pursuant to which the AAA administers
funding under this contract.
50. Termination
50.1 This contract may be terminated by either party without cause upon no less than thirty (30) calendar days notice in
writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be delivered by
U.S. Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the
Contract Manager or the representative of the Contractor responsible for administration of the contract.
50.2 In the event funds for payment pursuant to this contract become unavailable, the AAA may terminate this contract
upon no less than twenty -four (24) hours notice in writing to the Contractor. Said notice shall be delivered by U.S.
Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to the
Contract Manager or the representative of the Contractor responsible for administration of the contract. The AAA
will be the final authority as to the availability and adequacy of funds. In the event of termination of this contract, the
Contractor will be compensated for any work satisfactorily completed prior to the date of termination.
50.3 This contract may be terminated for cause by the AAA upon no less than twenty -four (24) hours notice in writing to
the Contractor. Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other
breach and shall not be construed to be a modification of the terms and conditions of this contract. The provisions
herein do not limit the AAA's or the Contractor's rights to remedies at law or in equity.
50.4 Failure to have performed any contractual obligations with the AAA in a manner satisfactory to the AAA will be a
sufficient cause for termination. To be terminated as a contractor under this provision, the Contractor must have (1)
previously failed to satisfactorily perform in a contract with the AAA, been notified by the AAA of the unsatisfactory
performance and failed to correct the unsatisfactory performance to the satisfaction of the AAA; or (2) had a contract
terminated by the AAA for cause.
51. Electronic Records and Signature
The AAA authorizes, but does not require, the Contractor to create and retain electronic records and to use
electronic signatures to conduct transactions necessary to carry out the terms of this Contract. A contractor that
creates and retains electronic records and uses electronic signatures to conduct transactions shall comply
with the requirements contained in the Uniform Electronic Transaction Act, s. 668.50, Fla. Stat. All electronic
records must be fully auditable; are subject to Florida's Public Records Law, ch. 119, Fla. Stat.; must comply
with section 28, Data Integrity and Safeguarding Information; must maintain all confidentiality, as applicable;
and must be retained and maintained by the Contractor to the same extent as non - electronic records are
retained and maintained as required by this Contract.
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OAA Contract AA -1429
51.1 The AAA's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the AAA. The Contractor is authorized to conduct electronic transactions with the
AAA only upon further written consent by the AAA.
51.2 Upon request by the AAA, the Contractor shall provide the AAA or DOEA with non - electronic (paper) copies of
records. Non - electronic (paper) copies provided to the AAA of any document that was originally in
electronic form with an electronic signature must indicate the person and the person's capacity who
electronically signed the document on any non - electronic copy of the document.
52. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
a.
The Contractor name, as shown on page 1 of this
contract, and mailing address of the official payee to
ft'6%rOG C Gv.b 5 j�}.ri�
I I 0o Sl r"1� 2��'�' a — 25 7
whom the payment shall be made is:
33vy�o
IGI M 4EAFi GO' • Gv s
The name of the contact person and street address
b.
where financial and administrative records are
(1 dO �`��Itt-N 4C
maintained is:
% W 4 f -
The name, address, and telephone number of the
(` � L
smv{l ) S/ 11 l • �QCCTDQ.►
C.
representative of the Contractor responsible for
I I M sivvU j to" 5'`'Mjr 9 —ZL57?
administration of the program under this contract is:
I<< Wes+ Flca.10R• 6
d.
The section and location within the AAA where
Associate Vice President Finance
Requests for Payment and Receipt and Expenditure
760 NW 107th Avenue, Suite214
forms are to be mailed is:
Miami, Florida 33172 -3155
Contract Manager
e.
The name, address, and telephone number of the
Contract Manager for the AAA for this contract is:
Alliance for Aging, Inc.
760 NW 107th Avenue, Suite 214
Miami, Florida 33172 -3155
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
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OAA Contract AA -1429
ATTACHMENT
ATTACHMENT DESCRIPTION
PAGE
ATTACHMENT I
STATEMENT OF WORK
15 -29
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING
31
ATTACHMENT III
FINANCIAL COMPLIANCE AUDIT ATTACHMENT
33 -35
ATTACHMENT III
EXHIBIT 1
FEDERAL RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT
37
ATTACHMENT III
EXHIBIT 2
AUDIT REPLATIONSHIP DETERMINATION
39
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
41
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS /SUBCONTRACTS
43
ATTACHMENT VI
ASSURANCES — NON- CONSTRUCTION PROGRAMS
45 -46
ATTACHMENT VII
CONTRACT BUDGET SUMMARY BY SERVICE AND TITLE
47
ATTACHMENT VIII
OLDER AMERICANS ACT CONTRACT REPORT CALENDAR
49
ATTACHMENT IX
REQUEST FOR PAYMENT
51
ATTACHMENT X,
EXHIBIT 2
RECEIPTS AND EXPENDITURES, TITLE IIIB, IIIC1, AND IIIC2
53
ATTACHMENT X,
EXHIBIT 3
RECEIPTS AND EXPENDITURES, TITLE IIIE
55
ATTACHMENT A
DEPARTMENT OF ELDER AFFAIRS' PROGRAMS & SERVICES
HANDBOOK (ON ALLIANCE FOR AGING, INC. INTERNET SITE)
57
ATTACHMENT B
DEPARTMENT OF ELDER AFFAIRS' CIVIL RIGHTS COMPLIANCE
CHECKLIST AND INSTRUCTIONS
59 -64
ATTACHMENT D
PROVIDER'S STATE CONTRACTS LIST
65
ATTACHMENT E
DEPARTMENT'S COMPUTER USE POLICY AND ITS SOCIAL MEDIA
POLICY, PROVIDED ON CD INSTRUCTIONS
67
ATTACHMENT F
INTENTIONALLY OMITTED.
ATTACHMENT G
BACKGROUND SCREENING — AFFIDAVIT OF COMPLIANCE
69
ATTACHMENT H
VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
71
ATTACHMENT I
INTENTIONALLY OMITTED.
ATTACHMENT J
BUSINESS ASSOCIATE AGREEMENT
73 -79
ATTACHMENT K
ADRC POLICY AND PROCEDURES FOR OUTSOURCED FUNCTIONS
81 -87
ATTACHMENT L
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LIST
89
INDEX TO CONTRACT ATTACHMENTS
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OAA Contract AA -1429
ATTACHMENT I
ALLIANCE FOR AGING, INC.
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE III
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 CONTRACT ACRONYMS
ADL — Activities of Daily Living
APS — Adult Protective Services
AIRS — Alliance of Information & Referral Systems
ADA — Americans with Disabilities Act
AAA — Area Agency on Aging (Previous setting, it means Alliance for Aging, Inc.)
APCL — Assessed Priority Consumer List
CIRTS — Client Information and Registration Tracking System
DOEA — Department of Elder Affairs (The Department)
FLAIRS — Florida Alliance of Information and Referral Services
I &R— Information and Referral
IADL — Instrumental Activities of Daily Living
MOA — Memorandum of Agreement
MOU — Memorandum of Understanding
OAA —Older Americans Act
PSAs — Planning and Service Areas
WebDB — Web based Database System
1.1.2 PROGRAM SPECIFIC TERMS
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and coordinated service delivery
system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Act
and DOEA instructions.
Area Plan Update: A revision to the area plan wherein the area agency on aging enters OAA specific data in the
Client Information and Registration Tracking System ( CIRTS). An update may also include other revisions to the
area plan as instructed by the DOEA.
Child: An individual who is not more than 18 years of age or an individual with disability.
Family Caregiver: An adult family member, or another individual, who is an informal provider of in -home and
community care to an older individual.
Frail: When an older individual is unable to perform at least two activities of daily living (ADLs) without
substantial human assistance, including verbal reminding, physical cueing or supervision; or due to cognitive or
other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a
serious health or safety hazard to the individual or to another individual.
Grandparent: A grandparent or step - grandparent of a child, or a relative of a child by blood, marriage or adoption
and who lives with the child; is the primary caregiver of the child because the biological or adoptive parents are
unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the child, such as
legal custody or guardianship, or is raising the child informally.
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OAA Contract AA -1429
53. All Terms and Conditions Included
This contract and its Attachments, I through X, A, B, D, E, F, G, H, J, K, L and any exhibits referenced in said
attachments, together with any documents incorporated by reference, contain all the terms and conditions agreed upon
by the Parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this
contract shall supersede all previous communications, representations or agreements, either written or verbal between
the Parties.
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused this 13 page contract, to be executed by their undersigned officials
as duly authorized.
Monroe County Social Services.
SIGNED BY. t
y X61hdge
NAME:
A Mayor Pro - Tem
TITLE:
DATE i a • A 4. 901 '!i
ALLIANCE FOR AGING, INC.
SIGNED BY
NAME: MAX B. ROTHMAN, JD, LL.M.
TITLE: PRESIDENT �ANND CEO
�
DATE: N 6 o ) �)'
DEC 26 2013
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OAA Contract AA -1429
1.2 ALLIANCE FOR AGING, INC. MISSION STATEMENT
The Alliance for Aging Inc.'s mission is to promote and advocate for the optimal quality of life for older adults and
their families.
1.3 GENERAL DESCRIPTION
1.3.1 General Statement
The OAA Program is a federal program initiative that provides assistance to older persons and caregivers and is the
only federal supportive services program directed solely toward improving the lives of older people. The program
provides a framework for a partnership among the different levels of government and the public and private sectors
with a common objective, improving the quality of life for all older individuals by helping them to remain
independent and productive. The primary purpose of the OAA program is to foster the development and
implementation of comprehensive and coordinated systems to serve older individuals. The OAA program uses
these systems to assist older individuals to attain and maintain maximum independence and dignity in a home
environment and allows for the capability of self -care with appropriate supportive services.
1.3.2 Authority
The relevant references authority governing the OAA program are:
(1) Older Americans Act of 2006, as amended;
(2) Rule 58A -1, Florida Administrative Code; and
(3) Section 430.101, Florida Statutes.
1.3.2.1 Incorporation of Reference Memoranda
In accordance with the AAA's Contract with DOEA, the following Florida Department of Financial Services, Chief
Financial Officer Memoranda, are provided for informational purposes and incorporated by reference:
(1) CFO Memo No. 02: Release date, August 20,2010;
(2) CFO Memo No. 03: Release date, June 29,2010; and
(3) CFO Memo No. 06: Release date, June 30, 2010.
1.3.3 Scope of Service
The Contractor is responsible for providing the services as required by this contract and as described in the
Contractor's application(s) submitted in response to the 2012 OAA RFP. The services shall be provided in a manner
consistent with and described in the current Department of Elder Affairs Programs and Services Handbook.
1.3.4 Major Program Goals
The major goals of the OAA program are to improve the quality of life for older individuals, preserve their
independence and prevent or delay more costly institutional care. These goals are achieved through the
implementation of a comprehensive and coordinated service system that provides a continuum of service alternatives
that meet the diverse needs of elders and their caregivers.
1.3.5 Leadership and Advocacy
As a designated Focal Point, a provider is encouraged to provide coordination of services for older individuals. The
Provider must also provide community leadership on aging issues and serve as the advocate and focal point for the
elderly within the community in cooperation with agencies, organizations and individuals participating in activities
funded by the Alliance. Advocacy should include initiating positive changes in public or private policies and
attitudes towards older persons, taking action to improve, modify, or eliminate situations which adversely impact on
lives of older persons, or expressing support for older persons and their interests. Advocacy activities may be
broadly supportive of the general interests of older persons or may involve specific activities on behalf of
individuals."
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OAA Contract AA -1429
1.4 INDIVIDUALS TO BE SERVED
1.4.1 Eligibility (Title III Programs)
1.4.1.1 OAA Title III, General
Consumers shall not be dually enrolled in an OAA program and a Medicaid capitated long -term care program.
1.4.1.2 OAA Title IIIB, Supportive Services
Eligibility for OAA Title IIIB, Supportive Services, are as follows:
(1) Individuals age 60 or older; and
(2) Information and Referral/Assistance services are provided to individuals regardless of age.
1.4.1.3 OAA Titles IIIC1 and C2, Nutrition Services, General
General factors that should be considered in establishing priority for Nutrition Services, both CI and C2, include
those older persons who:
(1) Cannot afford to eat adequately;
(2) Lack the skills or knowledge to select and prepare nourishing and well - balanced meals;
(3) Have limited mobility which may impair their capacity to shop and cook for themselves; or
(4) Have a disabling illness or physical condition requiring nutritional support or have been screened at a high
nutritional risk.
1.4.1.3.1 OAA Title IIIC1, Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I,
Paragraph 1.4.1.3 individuals must be mobile, not homebound and physically, mentally and medically able to
attend a congregate nutrition program. Individuals eligible to receive congregate meals include:
(1) Individuals age 60 or older; and
(2) Any spouse (regardless of age) who attends the dining center with his/her eligible spouse;
(3) Persons with a disability, regardless of age, who reside in a housing facility occupied primarily by older
individuals where congregate nutrition services are provided;
(4) Disabled persons who reside at home with and accompany an eligible person to the dining center; and
(5) Volunteers, regardless of age, who provide essential services on a regular basis during meal hours.
1.4.1.3.2 OAA Title HIC2, Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in ATTACHMENT I,
Paragraph 1.4.1.3, individuals must be homebound and physically, mentally or medically unable to attend a
congregate nutrition program. Individuals eligible to receive home delivered meals include the following:
(1) Individuals age 60 or older who are homebound by reason of illness, disability or isolation;
(2) The spouse of a homebound eligible individual, regardless of age, if the provision of the collateral meal
supports maintaining the person at home;
(3) Individuals with disabilities, regardless of age, who reside at home with eligible individuals and are dependent
on them for care; and
(4) Persons at nutritional risk who have physical, emotional or behavioral conditions, which would make their
presence at the congregate site inappropriate; and persons at nutritional risk who are socially or otherwise
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isolated and unable to attend a congregate nutrition site.
OAA Contract AA -1429
1.4.1.4 OAA Title IIIE, Caregiver Support Services
Eligibility for OAA Title IIIE, Caregiver Support Services, are as follows:
(1) Family caregivers of individuals age 60 or older;
(2) Grandparents (age 55 or older) or older individuals (age 55 or older) who are relative caregivers;
(3) Priority will be given to family caregivers who provide care for individuals with Alzheimer's disease and
related disorders with neurological and organic brain dysfunction and for grandparents or older individuals
who are relative caregivers who provide care for children with severe disabilities; and
(4) For respite and supplemental services, a family caregiver must be providing care for an older individual who
meets the definition of the term "frail" in OAA, Section 102 Paragraph 22.
1.4.2 Targeted Groups
Preference shall be given to those with the greatest economic and social needs, with particular attention to low -
income older individuals, including those that are low- income minorities, have limited English proficiency, and
older individuals residing in rural areas.
SECTION II — MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the OAA program, the Contractor shall ensure the following tasks are performed:
(1) Client eligibility determination;
(2) Targeting and screening of service delivery for new clients;
(3) Delivery of services to eligible clients;
(4) Use of volunteers to expand the provision of available services;
(5) Monitoring the performance of its subcontractors; and
(6) Information and Referral/Assistance Access Services (Elder Helplines).
2.1.1 Client Eligibility Determination as listed in ATTACHMENT I, Paragraph 1.4.
2.1.2 Targeting and Screening of Service Delivery for New Clients
The Contractor shall develop and implement policies and procedures consistent with OAA targeting and screening
criteria.
2.1.3 Delivery of Services to Eligible Clients
The Contractor shall provide a continuum of services that meets the diverse needs of elders and their caregivers. The
Contractor shall perform and report performance of the following services in accordance with ATTACHMENT A.
The services funded pursuant to this contract are in accordance with the OAA, Title III, sections 321, 331, 336, and
373 as follows:
(1) Section 321, Title IIIB Supportive Services;
(2) Section 331, Title IIIC1 Congregate Nutrition Services;
(3) Section 336, Title IIIC2 Home Delivered Nutrition Services; and
Section 373, Title IIIE Caregiver Support Services.
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OAA Contract AA -1429
2.1.3.1 Supportive Services
Supportive services include a variety of community-based and home - delivered services that support the quality of
life for older individuals by helping them remain independent and productive. Services include the following:
(1) Adult Day Care /Adult Day Health Care; (10) Emergency Alert Response;
(2) Caregiver Training/Support;
(3) Chore Services;
(4) Companionship;
(5) Counseling (Gerontological and Mental
Health);
(6)
Education/Training;
(7)
Legal Assistance;
(8)
Material Aid;
(9) Recreation;
(11)
Escort;
(12)
Homemaker;
(13)
Housing Improvement;
(14)
Personal Care;
(15) Shopping Assistance;
(16) Specialized Medical Equipment, Services, and
Supplies;
(17) Respite Services;
(18) Screening/Assessment;
(19) Transportation.
2.1.3.2 Congregate Nutrition Services
Nutrition services are provided in congregate settings and are designed to reduce hunger and food insecurity,
promote socialization and the health and well being of older individuals by assisting them to gain access to nutrition
and other disease prevention and health promotion services. Services include the following:
(1) Congregate meals;
(2) Congregate meals screening;
(3) Nutrition education and nutrition counseling.
2.1.3.3 Home Delivered Nutrition Services
In -home nutrition services are provided to reduce hunger and food insecurity; promote socialization and the health
and well being of older individuals by assisting such individuals to gain access to nutrition and other disease
prevention and health promotion services. Services include the following:
(1) Home delivered meals;
(2) Nutrition education and counseling.
2.1.3.4 Caregiver Support Services (IIIE Program)
The following services are intended to provide direct help to caregivers, assist in the areas of health, nutrition and
financial literacy and assist caregivers in making decisions and problem solving related to their caregiving roles and
responsibilities:
(1) Adult Day Care;
(2) Caregiver Training/Support;
(3) Counseling (Gerontological and Mental Health);
(4) Education/Training;
(5) Respite Services;
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(6) Screening/Assessment;
OAA Contract AA -1429
2.1.3.5 Caregiver Support Supplemental Services (IIIES Program): At least 10 percent, but no more than 20 percent,
of the total Title IIIE funds shall be used to provide supplemental support services. The following services are
provided to complement the care provided by caregivers:
(1) Chore Services;
(2) Housing Improvement;
(3) Material Aid; and
(4) Specialized Medical Equipment, Services and Supplies.
2.1.3.6 Caregiver Support Grandparent Services (IIIEG Program): At least 5 percent, but no more than 10 percent, of
the total Title IIIE funds shall be used to provide support services to grandparents and older individuals who are
relative caregivers. Services for grandparents or older individuals who are relative caregivers designed to help meet
their caregiving obligations include the following:
(1) Caregiver Training/Support;
(2) Sitter.
2.1.4 Use of Volunteers to Expand the Provision of Available Services
2.1.4.1 Use of Volunteers to Expand the Provision of Available Services
The Contractor shall make use of trained volunteers in providing direct services delivered to older individuals and
individuals with disabilities needing such services. If possible, the Contractor shall work in coordination with
organizations that have experience in providing training, placement, and stipends for volunteers or participants
(such as organizations carrying out Federal service programs administered by the Corporation for National and
Community Service), in community service settings.
2.1.4.2 The Contractor shall submit a quarterly report of volunteer activities and services electronically on the
internet in a format provided by the Department's Office of Volunteer and Community Services. The
quarterly report schedule is as follows:
Report Period
Report Due Date
January 1 - March 31
April 30, 2013
April 1- June 30
July 30, 2013
July 1- September 30
October 31, 2013
October 1 - December 31
January 31, 2014
2.1.5 Monitoring the Performance of Subcontractors
The Contractor shall conduct at least one monitoring per year of each subcontractor. The Contractor shall perform
fiscal, administrative and programmatic monitoring of each subcontractors to ensure contractual compliance, fiscal
accountability, programmatic performance, and compliance with applicable state and federal laws and regulations.
2.1.7 Subcontractor Outreach Reporting Requirements
The Contractor shall document its performance of outreach activities, by submitting a uniform reporting format
provided by the Alliance that includes the following: number and type of provider events or activities; date and
location; total number of participants at each event or activity; individual service needs identified; and referral
sources or information provided. The Contractor shall complete and submit this report on outreach activities at least
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OAA Contract AA -1429
semi - annually.
2.2 SERVICE LOCATION AND EQUIPMENT
2.2.1 Service Times
The Contractor shall ensure the provision of the services listed in the contract during normal business hours unless
other times are more appropriate to meet the performance requirements of the contract, and it shall monitor its
subcontractors to ensure they are available to provide services during hours responsive to client needs and during
those times which best meet the needs of the relevant service community.
2.3 Equipment
2.3.1 Equipment means: (a) an article of nonexpendable, tangible personal property having a useful life of more than one
year and an acquisition cost which equals or exceeds the lesser of the capitalization level established by the
organization for the financial statement purposes, or $5,000.00 [for federal funds], or (b); nonexpendable, tangible
personal property of a nonconsumable nature with an acquisition cost of $1,000.00 or more per unit, and expected
useful life of at least one year, and hardback bound books not circulated to students or the general public, with a
value or cost of $250.00 or more [for state funds].
2.3.2 Contractors and subcontractors who are Institutions of Higher Education, Hospitals, and Other Non - Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A -110) that include: (a) a property list with all the elements
identified in the circular; and, (b) a procedure for conducting a physical inventory of equipment at least once every
two years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of the equipment; and
(d) maintenance procedures to keep the equipment in good condition. The property records must be maintained on
file and shall be provided to the AAA upon request. The Contractor shall promptly investigate, fully document and
notify the Contract Manager of any loss, damage, or theft of equipment. The contractor shall provide the results of
the investigation to the Contract Manager.
2.3.3 The Contractor's property management standards for equipment acquired with Federal funds and federally -owned
equipment shall include accurately maintained equipment records with the following information:
(1) A description of the equipment;
(2) Manufacturer's serial number, model number, Federal stock number, national stock number, or other
identification number;
(3) Source of the equipment, including the award number;
(4) Whether title vests in the contractor or the Federal Government;
(5) Acquisition date (or date received, if the equipment was furnished by the Federal Government) and cost;
(6) Information from which one can calculate the percentage of Federal participation in the cost of the equipment
(not applicable to equipment furnished by the Federal Government);
(7) Location and condition of the equipment and the date the information was reported;
(8) Unit acquisition cost; and
(9) Ultimate disposition data, including date of disposal and sales price or the method used to determine current
fair market value where a contractor compensates the Federal awarding agency for its share.
2.3.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with
state funds with an acquisition cost over $1,000.00 that is specifically identified in the Unit Cost report or in the
Provider Application and is part of the cost of carrying out the activities and functions of the grant awards and Title
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(ownership) will vest in the Contractor, subject to the conditions of 2 CFR Part 215 Administrative Requirements
(formerly OMB Circular A -110), Subpart C, Paragraph 34. Equipment purchased under these thresholds is
considered supplies and is not subject to property standards. Equipment purchased with funds identified in the
budget attachments to agreements covered by this contract, or identified in the sub - agreements with sub - contractors
(not included in a cost methodology), is subject to the conditions of Chapter 273, F. S. and 60A- 1.0017, F. A. C. or
Title 45 CFR Part 74.
2.3.5 The Contractor shall not dispose of any equipment or materials provided by the AAA, or purchased with funds
provided through this contract without first obtaining the approval of the AAA's Contract Manager. When
disposing of property or equipment the Contractor must submit a written request for disposition instructions to the
respective Contract Manager. The request should include a brief description of the property, purchase price,
funding source, percentage of state or federal participation, acquisition date and condition of the property. The
request should also indicate the Contractor's proposed disposition (i.e., transfer or donation to another agency that
administers federal programs, offer the items for sale, destroy the items, etc.).
2.3.6 The AAA's Contract Manager will issue disposition instructions. If disposition instructions are not received within
120 days of the written request for disposition, the Contractor is authorized to proceed as directed in 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A -110).
2.3.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract. Real property purchases from Older Americans Act funds are
subject to the provisions of Title 42, Chapter 35, Subchapter III, Part A., Sec. 3030b United States Code (USC).
2.3.8 Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and tested prior to
disposal to ensure no confidential information remains.
2.3.9 Information technology resources (ITR) may not be purchased with funds provided under this Contract absent
approval by AAA. Any approved purchase of ITR by the Contractor must comply with DOEA's ITR procedures
and standards including completion of an ITR worksheet for any computer related item costing $1,000 or more.
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2.4 DELIVERABLES
2.4.1 Service Unit
The contractor shall provide the services described in the contract in accordance with the 2011 DOEA Program
and Services Handbook..
2.5 REPORTS
The Contractor is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the AAA. The Contractor must establish due dates for any subcontractors
that permit the Contractor to meet the AAA's reporting requirements.
2.5.1 Blank
2.5.2 Client Information and Registration Tracking System ( CIRTS) Reports
The contractor is required to use CIRTS reports in the web based CIRTS database system to ensure data
accuracy. The report categories include the following:
(1) Client reports (assessments, care plans, enrollments);
(2) Monitoring reports;
(3) Services reports;
(4) Outcome measures reports.
2.5.3 Service Costs Reports
The Contractors shall submit to the AAA semi - annual service cost reports, which reflect actual costs of providing
each service by program.
2.5.4 Surplus/Deficit Report
By the end of the first month of this contract, the Contractor will submit a monthly expenditure plan by service to
the AAA's program manager.
The Contractor will submit a consolidated surplus /deficit report in a format provided by the AAA to the AAA's
Contract Manager with the monthly request for payments according to the calendar on attachment VIII. This report
is for all agreements and/or contracts between the Contractor and the AAA. The report shall include the following:
(1) The contractor's current status regarding surplus /deficit;
(2) The Contractor's detailed plan on how the surplus /deficit spending exceeding the threshold specified by the
AAA will be resolved;
(3) Number of clients currently on Assessed Priority Consumer List (APCL) that receive a priority ranking score
of 4 or 5; and
(4) Number of clients currently on the APCL designated as Imminent Risk.
(5) Number of contacts including telephone calls, walk -ins, emails or faxes as related to outsourced ADRC
functions, including one- to-one outreach contacts when consumers are provided with information, referral or
assistance for themselves or others. They do not include public education activities. This is not an unduplicated
count.
(6) A detailed report describing any budget variances and plans to address them in the coming months.
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2.5.5 Surplus Recapture.
In accordance with its surplus /deficit management policies, in order to maximize available funding and minimize
the time that potential clients must wait for services, the AAA in its sole discretion can reduce funding awards if the
Contractor is not spending according to monthly plans and is projected to incur a surplus at the end of the year.
2.5.6 Blank
2.5.7 Blank
2.5.8 Background Screening Affidavit of Compliance
To demonstrate compliance with section 8 of the Standard Contract, the Contractor shall submit ATTACHMENT
G, Background Screening Affidavit of Compliance annually, by January 15th.
2.6 RECORDS AND DOCUMENTATION
The Contractor will ensure the accurate collection and maintenance of client and service information on a monthly
basis from the CIRTS or any such system designated by the AAA. Maintenance includes valid exports and backups
of all data and systems according to AAA standards.
2.6.1 Each Contractor and subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The Contractor shall maintain written policies and procedures for computer
system backup and recovery and shall have the same requirement in its contracts and/or agreements with
subcontractors. These policies and procedures shall be made available to the AAA upon request.
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outcomes
(1) The Contractor shall maintain a record of all reports described in ATTACHMENT I, Paragraph 2.5
REPORTS.
(2) The Contractor shall timely submit to the AAA all information described in ATTACHMENT I, Paragraph
2.6 RECORDS AND DOCUMENTATION.
(3) The Contractor shall ensure services in this contract are in accordance with ATTACHMENT A.
2.7.2 The performance of the Contractor in providing the services described in this contract shall be measured by the
current Area Plan strategies for the following criteria:
(1) Percent of most frail elders who remain at home or in the community instead of going into a nursing home;
(2) Percent of Adult Protective Services (APS) referrals who are in need of immediate services to prevent further
harm who are served within 72 hours;
(3) Percent of elders assessed with high or moderate risk environments who improved their environment score;
(4) Percent of new service recipients with high -risk nutrition scores whose nutritional status improved;
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(7) Percent of family and family- assisted caregivers who self -report they are very likely to provide care;
(8) Percent of caregivers whose ability to continue to provide care is maintained or improved after one year of
service intervention (as determined by the caregiver and the assessor);
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(9) Percent of customers who are at imminent risk of nursing home placement who are served with community
based services; and
(10) Any other outcome measures as listed in the Provider's Service Application in response to the 2012 OAA RFP.
2.7.3 Monitoring and Evaluation Methodology
The AAA will review and evaluate the performance of the Contractor under the terms of this contract. Monitoring
shall be conducted through direct contact with the Contractor through telephone, in writing, and/or an on -site visit.
The AAA's determination of acceptable performance shall be conclusive. The Contractor agrees to cooperate with
the AAA in monitoring the progress of completion of the service tasks and deliverables.
2.7.4 Remedies - Nonconforming Services
The Contractor shall ensure that all participants served under this agreement are eligible for the program, and that all
monthly and/or quarterly performance reports and financial records are maintained for each reporting period and
submitted as stipulated in 2.5, 2.5.3- 2.5.4, 2.6 through 2.7.2.
Any nonconforming program services, performance reports or financial records not meeting the requirements of this
Contract shall not be eligible for reimbursement under this program. The costs associated with enrolling, training,
reporting and/or managing the program shall be borne solely by the Contractor. The AAA requires immediate
notice of any significant and/or systemic infractions that compromise the Contractor's ability to provide participant
services, to achieve programmatic performance or to provide sound financial management of the program.
2.8 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.8.1 Matching, Level of Effort, and Earmarking Requirements
The Contractor will fulfill a match requirement of at least 10 percent of the cost for all services funded through this
contract (i.e. 90 cents of grant funds must be matched with 10 cents from the Contractor.) The subcontractor's
match will be made in the form of cash and/or in -kind resources. The Contractor shall report match by title each
month. At the end of the contract period, the Contractor must properly match all OAA funds.
2.8.2 Consumer Contributions
Consumer contributions are to be used under the following terms:
(1) The Contractor assures compliance with Section 315 of the Older Americans Act as amended in 2006, in
regard to consumer contributions;
(2) Voluntary contributions are not to be used for cost sharing or matching;
(3) Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and
(4) Voluntary contributions are to be used only to expand services.
2.8.3 Use of Service Dollars
The Contractor is expected to spend all federal, state and other funds provided by the AAA for the purpose specified
in the contract. The Contractor must manage the service dollars in such a manner so as to avoid having a wait list
and a surplus of funds at the end of the contract period, for each program managed by the Contractor. If the AAA
determines that the Contractor is not spending service funds accordingly, the AAA may transfer funds to other
contractors during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under
state and federal law.
2.8.4 The Contractor agrees to distribute funds as detailed in the Budget Summary, ATTACHMENT VII to this
contract. Any changes in the amounts of federal or general revenue funds identified on the Budget Summary form
require a contract amendment.
2.8.5 Title III Funds
The Contractor assures compliance with Section 306 of the Older Americans Act, as amended in 2006, that funds
received under Title III will not be used to pay any part of a cost (including an administrative cost) incurred by the
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Contractor to maintain a contractual or commercial relationship that is not carried out to implement Title III.
2.9 AAA RESPONSIBILITIES
2.9.1 Program Guidance and Technical Assistance
The AAA will provide to the Contractor guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Contractor.
2.9.2 Program/Contract Monitoring
The AAA will review and evaluate the performance of the Contractor under the terms of this contract.
Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or an
on -site visit. The AAA's determination of acceptable performance shall be conclusive. The Contractor agrees
to cooperate with the AAA in monitoring the progress of completion of the service tasks and deliverables. The
AAA may use, but is not limited to, one or more of the following methods for monitoring:
(1) Desk reviews and analytical reviews;
(2) Scheduled, unscheduled and follow -up on -site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third -party documents and/or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed -upon procedures review by an external auditor or consultant;
(9) Limited -scope reviews; and
(10) Other procedures as deemed necessary.
2.9.3 Contract Monitoring
The AAA shall, at its own discretion, conduct monitoring concerning any aspect of the contractor's
performance of this contract.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, and fixed rate for services. The Contractor shall ensure
fixed rates for services include only those costs that are in accordance with all applicable state and federal statutes
and regulations and are based on audited historical costs in instances where an independent audit is required. The
Contractor shall consolidate all requests for payment from subcontractors and expenditure reports that support
requests for payment and shall submit to the AAA on forms 106A (ATTACHMENT IX), 105AA
(ATTACHMENT X, EXHIBIT 1), 105AS (ATTACHMENT X, EXHIBIT 2), and 105AE (ATTACHMENT X,
EXHIBIT 3).
3.1.1 The Contractor agrees to implement the distribution of funds as detailed in ATTACHMENT VII, Budget
Summary. An amendment is required to change any amount, unit cost, or number of units by service.
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3.2 Advance Payments
3.2.1 The Contractor may request up to two months of advances at the start of the contract period, if available, to cover
program service costs. The payment of an advance will be contingent upon the sufficiency and amount of funds
released to the AAA by the State of Florida ( "budget release "). The Contractor shall provide the AAA's Contract
Manager documentation justifying the need for an advance and describing how the funds will be distributed.
3.2.2 The Contractor's requests for advance require the approval of the AAA's Contract Manager. If sufficient budget is
available, the AAA will issue approved advance payments after January 1, 2013.
3.2.3 Requests for the first through the twelfth months shall be based on the submission of actual monthly expenditure
reports beginning with the first month of the contract. The schedule for submission of advance requests, if available
is shown on ATTACHMENT VIII of this contract.
3.2.4 All advanced payments made to the Contractor shall be recouped in accordance with the Reporting Schedule,
ATTACHMENT VIII of this contract.
3.2.5 Interest earned on advances must be identified separately by source of funds, state or federal. Contractors shall
maintain advances of federal funds in interest bearing accounts unless otherwise excepted in accordance with 45
CFR 74.22(k). Earned interest must be returned to the AAA at the end of each quarter.
3.3 Invoice Submittal and Requests for Payment
All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA
forms 106A (ATTACHMENT IX) , 105AA (ATTACHMENT X- EXHIBIT 1), 105AS (ATTACHMENT X-
EXHIBIT 2), and 105AE (ATTACHMENT X- EXHIBIT 3).
3.3.1 The Contractor shall submit all payment requests based on the submission of the Contractor's actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance requests
(when available) and invoices is ATTACHMENT VIII to this contract.
3.3.2 Any payment due by the AAA under the terms of this contract may be withheld pending the receipt and approval of
all financial and programmatic reports due from the Contractor and any adjustments thereto.
3.3.3 The AAA will authorize payment only for allowable expenditures, which are in accordance with the limits specified
in ATTACHMENT VII, Budget Summary. Any changes in the amounts of federal or general revenue funds
identified on the Budget Summary form require a contract amendment.
3.3.3.1 Monthly review of the Receipt and Expenditure Report and the Request for Payment Form by the Alliance
will focus on:
(1) Line item comparison of year -to -date expenditures with the budget to monitor rate of
expenditures;
(2) Allowable total reimbursement, on a service by service level, does not exceed
budgeted/contractual amount (No unilateral modified spending authority.);
(3) Validation of service units reported against CIRTS.
Validation of service units reported against the Area Plan on Aging, fiscal module contract data housed in CIRTS.
3.3.4 Date for Final Request for Payment
The Contractor shall submit the final request for payment to the AAA no later than February 15, 2015.
3.4 Documentation for Payment
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The Contractor shall maintain documentation to support payment requests that shall be available to the AAA or
authorized individuals, such as Department of Financial Services, upon request.
3.4.1 The Contractor must enter all required data following DOEA's CIRTS Policy Guidelines for clients and services in
the CIRTS database. Data must be entered into CIRTS before the Contractors submit their request for payment and
expenditure reports.
3.4.2 The Contractor shall run monthly CIRTS reports and verify that client and service data in CIRTS is accurate. This
report must be submitted to the AAA with the monthly request for payment and expenditure report and must be
reviewed by the AAA before the Contractor's request can be approved by the AAA.
3.5.1 Remedies for Nonconforming Services
The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely,
completely and commensurate with required standards of quality. Such goods and/or services will only be delivered
to eligible program participants.
If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services not
meeting such standards will not be reimbursed under this contract. The Contractor's signature on the request for
payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor shall
solely bear the costs associated with preparing or providing nonconforming goods and/or services. The Alliance
requires immediate notice of any significant and/or systemic infractions that compromise the quality, security or
continuity of services to clients
3.5.2 Financial Consequences
The Contractor shall ensure the provision of services to the projected number of clients in accordance with
the Service Provider Application and within the contract amount. The Contractor shall ensure expenditure
of 100% of the contract amount budgeted for services to clients at the unit rates established in this
contract. On a service -by- service basis, in the event the Contractor has a surplus of 1 % or more at the end
of the contract term, the Alliance will reallocate this surplus to other provider agencies in accordance with
its policies. If, or to the extent, there is any conflict between this paragraph and paragraphs 38 and 38.1 of
the standard contract, this paragraph shall have precedence.
3.5.3 Consequences for Noncompliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.3.3 Scope of Services are performed
pursuant to contract requirements, as described in Sections and subsections 2.3., 2.4, 2.5, 2.6 and 2.7 which are
hereby identified as major deliverables on this contract.
If at any time the Contractor is notified by the Alliance's Contract Manager that it has failed to correctly,
completely, or adequately perform these major deliverables, the Contractor will have 10 days to submit a Corrective
Action Plan ( "CAP ") to the Contract Manager that addresses the deficiencies and states how the deficiencies will be
remedied within a time period approved by the Contract Manager. The Alliance shall assess a Financial
Consequence for Non - Compliance on the Contractor for each deficiency identified in the CAP which is not
corrected pursuant to the CAP. The Alliance may also assess a Financial Consequence for failure to timely submit a
CAP.
In the event Contractor fails to correct an identified deficiency within the approved time period specified in the
CAP, the Alliance shall deduct, from the payment for the invoice of the following month for each day the deficiency
is not corrected, I% of the monthly value of the portion of the reimbursement that is identified as "Management and
General Costs" and "Facilities and Maintenance Costs" in the Contractor's unit rate methodology contained in the
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Service Provider Application or, in the case of a for - profit provider that did not submit a unit rate methodology, this
amount shall be 15 percent of the unit rate. The Alliance may also deduct, from the payment for the invoice of the
following month, 1% of the monthly value of the portion of the unit rate described above for each day the
Contractor fails to timely submit a CAP.
If, or to the extent, there is any conflict between this paragraph and paragraphs 38 and 38.1 of the standard contract,
this paragraph shall have precedence.
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ATTACHMENT II
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress, an
officer or employee of congress, an employee of a member of congress, or an officer or employee of the state legislator,
in connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress,
or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance
with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all sub -
awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and cooperative agreements) and
that all sub - contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by
section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty
of not less than $10,000.00 and not more than $100,000.00 for each such failure.
A�24,2 'I Zo /Jo V 20 1 3
oor
Signature Date
S In eA� i I C-4rainam (�I C�,o�o� �R I �Fa 9
Name of Aut orized Individual- — Application or Agreement Number
me
�MON — '
Na SHERYL G H gar�zation
The Historic Gato Cigar Factory
1100 Simonton St., Suite 2 -257
Key West, Florida 33040
DOEA Form 103
(Revised Nov 2002)
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ATTACHMENT III
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Department of Elder Affairs or the Alliance for Aging, Inc. to the provider
may be subject to audits and/or monitoring by the Department of Elder Affairs or the Alliance for Aging, Inc., as described in
this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A -133, as revised, and Section 215.97, F.S., (see
"AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the department of staff, limited
scope audits as defined by OMB Circular A- 133, as revised, and/or other procedures. By entering into this agreement, the
provider agrees to comply and cooperate with any monitoring procedures /processes deemed appropriate by the Department of
Elder Affairs or the Alliance for Aging, Inc. In the event the Department of Elder Affairs or the Alliance for Aging, Inc.
determines that a limited scope audit of the provider is appropriate, the provider agrees to comply with any additional
instructions provided by the Department of Elder Affairs or the Alliance for Aging, Inc. to the provider regarding such audit.
The provider 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 provider is a State or local government or a non - profit organization as defined in OMB Circular
A -133, as revised.
In the event that the provider expends $500,000 or more in Federal awards during its fiscal year, the provider 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 the Department of Elder Affairs or the Alliance for Aging,
Inc. by this agreement. In determining the Federal awards expended in its fiscal year, the provider shall consider all sources of
Federal awards, including Federal resources received from the Department of Elder Affairs or the Alliance for Aging, Inc.
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 provider conducted by the Auditor General in accordance with the provisions of
OMB Circular A -133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the requirements relative
to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised.
If the provider expends less than $500,000 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 provider expends less than $500,000 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 audit must be paid from
provider resources obtained from other than Federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs or the Alliance for Aging, Inc. shall be based
on the agreement's requirements, including any rules, regulations, or statutes referenced in the agreement. The financial
statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned
costs and liabilities due to the Department of Elder Affairs or the Alliance for Aging, Inc. shall be fully disclosed in the audit
report with reference to the Department of Elder Affairs or the Alliance for Aging, Inc. agreement involved. If not otherwise
disclosed as required by Section .310(b)(2) of OMB Circular A -133, as revised, the schedule of expenditures of Federal
awards shall identify expenditures by agreement number for each agreement with the Department of Elder Affairs or the
Alliance for Aging Inc. in effect during the audit period. Financial reporting packages required under this part must be
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submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider's fiscal year
end.
PART II: STATE FUNDED
This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes
In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000 in any
fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider must have a State single
or project - specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; 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 I to this agreement indicates state financial assistance awarded
through the Department of Elder Affairs or the Alliance for Aging, Inc. by this agreement. In determining the state financial
assistance expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state
financial assistance received from the Department of Elder Affairs or the Alliance for Aging, Inc., other state agencies, and
other nonstate entities. State financial assistance does not include Federal direct or pass - through awards and resources
received by a nonstate entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1; the provider shall ensure that the audit complies
with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as
defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for -
profit organizations), Rules of the Auditor General.
If the provider 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 provider 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, Florida Statutes, the cost of the audit must be paid from
the nonstate entity's resources (i.e., the cost of such an audit must be paid from the provider resources obtained from other
than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs or the Alliance for Aging Inc. shall be based
on the agreement's requirements, including any applicable rules, regulations, or statutes. The financial statements shall
disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities
due to the Department of Elder Affairs or the Alliance for Aging, Inc. shall be fully disclosed in the audit report with
reference to the Department of Elder Affairs or the Alliance for Aging Inc. agreement involved. If not otherwise disclosed as
required by Rule 691 - 5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance shall identify
expenditures by agreement number for each agreement with the Department of Elder Affairs or the Alliance for Aging, Inc. in
effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after
delivery of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities.
Non - profit or for - profit organizations are required to be submitted within 45 days after delivery of the audit report, but no
later than 9 months after the provider's fiscal year end. Notwithstanding the applicability of this portion, the Department of
Elder Affairs or the Alliance for Aging, Inc. retains all right and obligation to monitor and oversee the performance of this
agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and required by
PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A -133, as revised, by or on
behalf of the provider directly to each of the following:
The Alliance for Aging, Inc.:
Alliance for Aging, Inc.
Attn: Carlos Lahitte
760 NW 107 Avenue, Suite 214
Miami, FL 33172 -3155
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The Federal Audit Clearinghouse designated in OMB Circular A -133, as revised (the number of copies required by Sections
.320 (d)(1) and (2), OMB 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 10` Street
Jeffersonville, IN 47132
Other Federal agencies and pass - through entities in accordance with Sections .320 (e) and (f), OMB Circular A -133, as
revised.
Pursuant to Sections .320(f), OMB Circular A -133, as revised, the provider 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 the
Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Carlos Lahitte
760 NW 107 Avenue, Suite 214
Miami, FL 33172 -3155
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on behalf of
the provider directl to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Carlos Lahitte
760 NW 107` Avenue, Suite 214
Miami, FL 33172 -3155
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399 -1450
Any reports, management letter, or other information required to be submitted to the Department of Elder Affairs 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.
Providers, when submitting financial reporting packages to the Department of Elder Affairs for audits done in
accordance with OMB Circular A -133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -
profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered
to the provider in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six
years from the date the audit report is issued, and shall allow the Alliance for Aging, Inc. or its designee, the CFO or Auditor
General access to such records upon request. The provider shall ensure that audit working papers are made available to the
Alliance for Aging, Inc. , or its designee, CFO, or Auditor General upon request for a period of six years from the date the
audit report is issued, unless extended in writing by the Alliance for Aging, Inc..
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ATTACHMENT III
EXHIBIT 1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Older Americans Act Administration
U.S. Health and Human Services
93.044
$27,655.38
Title IIIB — Support Services
Older Americans Act Administration
U.S. Health and Human Services
93.045
$132,499.03
Title IRC1—Congregate Meals
Older Americans Act Administration
U.S. Health and Human Services
93.045
$213,581.48
Title III C2 — Home Delivered Meals
Older Americans Act Administration
U.S. Health and Human Services
93.052
$57,821.12
Title //I E — Caregiver Support Services
$431,557.01
TOTAL FEDERAL AWARD
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ATTACHMENT III
EXHIBIT 2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A -133, as revised,
and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state financial
assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 are met.
Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A -133, as revised, and/or
Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to be recipients or
subrecipients of Federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance
requirements.
In accordance with Sec. 210 of OMB Circular A -133 and/or Rule 691 - 5.006, FAC, provider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A -133 and/or Section 215.97, F.S.
X Recipient/subrecipient subject to OMB Circular A -133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and has been approved by the
department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I- .006(2), FAC [state financial assistance] and
Section .400 OMB Circular A -133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state
matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and
regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A -87)*
OMB Circular A -102 — Administrative Requirements
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON - PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non - Profit Organizations (Formerly OMB Circular A -122 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 — Administrative Requirements)
Requirements)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A -21 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 — Administrative Requirements)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular A-
133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
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ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the contractor named in the contract or agreement to which this form is an
attachment, hereby certifies that:
(1) The contractor and any sub - contractors of services under this contract have financial management systems capable of
providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each
grant- funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of
funds for all agreement supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The
inability to process information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly.
(2) Management Information Systems used by the contractor, sub - contractor(s), or any outside entity on which the contractor
is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of
processing data accurately, including year -date dependent data. For those systems identified to be non - compliant,
contractor(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the
undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of
these products offered by the contractor (represented by the undersigned) and purchased by the State will be verified for
accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the
hardware or software programs from operating properly, the contractor agrees to immediately make required corrections to
restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the State,
and without interruption to the ongoing business of the state, time being of the essence.
(4) The contractor and any sub - contractor(s) of services under this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data
integrity compliance issues.
The contractor shall require that the language of this certification be included in all subagreements, subgrants, and
other agreements and that all sub - contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars
A -102 and 2 CFR Part 215 (formerly OMB Circular A -110).
awn ,ia� Se es lI 100 Smart j 330Vo
Name ddress of Cbntractor
D `e +n r Zo 2013
Sign r Title Date
Sh en, l (bra -ham
Name of AiAhorized Signer
(Revised June 2008)
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ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective contractor certifies, by signing this certification, neither it nor its principals are presently
debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation
in this transaction by any federal department or agency.
(2) Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective
participant shall attach an explanation to this certification.
Zo IJo ✓ Zo 1 3
Signature Date
O
Title A enc / &nviees Department
g Y �
(Certification signature should be same as Contract signature.) The Historic Gato Cigar Factory
Instructions for Certification 1100 Simonton St., Suite 2 -257
Key West, Florida 33040
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person,"
"primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out in the sections
of rules implementing Executive Order 12549. (2 CFR 180.5- 180.1020, as supplemented by 2 CFR 376.10-
376.995). You may contact the Contract Manager for assistance in obtaining a copy of those regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties entered into
this transaction. If it is later determined that the contractor knowingly rendered an erroneous certification, in
addition to other remedies available to the federal government, the department may pursue available remedies,
including suspension and/or debarment.
3. The contractor will provide immediate written notice to the Contract Manager if at any time the contractor learns that
its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The
contractor may decide the method and frequency by which it determines the eligibility of its principals. Each
participant to a lower tier covered transaction may, but is not required to, check the Excluded Parties List System
(EPLS).
4. The contractor will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
- Lower Tier Covered Transaction' in all its lower tier covered transactions and in all solicitations for lower tier
covered transactions.
5. The contractor agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized
by the federal government.
6. If the contractor knowingly enters into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the
federal government, the department may pursue available remedies, including suspension, and/or debarment.
7. The contractor may rely upon a certification of a prospective participant in a lower tier covered transaction that it is
not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the
certification is erroneous.
(Revised June 200
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ATTACHMENT VI
ASSURANCES —NON- CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348- 0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR C;VMFLEIEDruRM Iv I 11 Vrrll;L, qJr iviAuvAkyJ&Jvrr.l.i fu.unULVai,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If
such is the case, you will be notified.
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds
sufficient to pay the non - Federal share of project cost) to ensure proper planning, management, and completion of the project described
in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of
personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. C Ci4728 -4763) relating to prescribed standards for merit
systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights
Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. E 1 1681-1683, and 1685- 1686), which prohibits discrimination on the basis of sex; (c)
Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. L_ 794), which prohibits discrimination on the basis of handicaps;
(d) the Age Discrimination Act of 1975, as amended (42 U.S.C. L' 1 6101 - 6107), which prohibits discrimination on the basis of age; (e)
the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse;
(f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 -616), as
amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) ❑ Ci 523 and 527 of the Public Health Service
Act of 1912 (42 U.S.C.:111 290 dd -3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records;
(h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. ; , 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or
financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance
is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970 (P.L. 91 -646) which provide for fair and equitable treatment of persons displaced or whose property is
acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for
project purposes regardless of Federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C..: 1501 -1508 and 7324 - 7328), which limit the political
activities of employees whose principal employment activities are funded in whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. 276a to 276a -7), the Copeland Act (40 U.S.C.
276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333), regarding labor
standards for federally assisted construction subagreements.
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OAA Contract AA -1429
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973
(P.L. 93 -234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if
the total cost of insurable construction and acquisition is $10,000.00 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality
control measures under the National Environmental Policy Act of 1969 (P.L. 91 -190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (16 U.S.C. ❑ 1- 1451 et seq.); (f) conformity of Federal actions to State
(Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. ❑ ;7401 et seq.); (g)
protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93 -523); and (h)
protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93 -205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. [ I C 1721 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended
(16 U.S.C. 11470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act
of 1974 (16 U.S.C. ❑ 469a -1 et seq.).
14. Will comply with P.L. 93 -348 regarding the protection of human subjects involved in research, development, and related activities
supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 -544, as amended, 7 U.S.C. 11112131 et seq.) pertaining to the
care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 1i 1 " -4801 et seq.), which prohibits the use of lead- based
paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996
and OMB Circular No. A -133, Audits of States, Local Governments, and Non - Profit Organizations.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
SR. 1�tRec -�ro(�.
APPLICANT ORGANIZATION
CNTY
DATE SUBMITTED
�MO NR OE
SIodal Services Department
20 No v 2-
SHEPYL GRAHAM
1100 Simonton St., Suite 2 -257
Key West, Florida 33040
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OAA Contract AA -1429
CONTRACT BUDGET SUMMARY BY SERVICE AND TITLE
CIRTS SUMMARY FOR THE AGENCY
ATTACHMENT VII
Service to be Provided
Service
Unit Rate
Maximum
Units of
Service
Maximum
Dollars
Chore 1116
$22.00
291
$6,422.38
Homemaker /Personal Care IIIB
$22.00
370
$8,141.00
Screening & Assessment 11113
$25.00
24
$607.00
Congregate Meals C1
$9.25
13,947
$129,011.03
Congregate Meals Screening C1
$20.00
96
$1,925.00
Nutrition Counseling C1
$47.50
19
$926.00
Nutrition Education C1
$0.20
3,185
$637.00
Home Delivered Meals Frozen C2
$6.00
32,828
$196,971.60
Home Delivered Meals Hot C2
$6.00
1,817
$10,906.88
Nutrition Counseling C2
$47.50
4
$190.00
Nutrition Education C2
$0.20
1,810
$362.00
Screening & Assessment C2
$25.00
206
$5,151.00
Chore IIIE
$22.00
55
$1,213.98
In Home Respite IIIE
$20.00
998
$19,974.00
Respite in Facility HIE
$10.50
3,389
$35,589.14
Screening & Assessment HIE
$25.00
41
$1,044.00
Material Aid (ITN)
$1.00
10,435
$10,435.00
L Education/ (ITN)
$82.00
25
$2,050.00
Total Contract
$431,557.01
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ATTACHMENT VIII
OLDER AMERICANS ACT CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Submit to AAA
Report Number
Based On
On This Date
I
January Advance*
January 1
2
February Advance*
January 1
3
January Expenditure Report
February 5
4
February Expenditure Report
March 5
5
March Expenditure Report
April 5
6
April Expenditure Report
May 5
7
May Expenditure Report
June 5
8
June Expenditure Report
July 5
9 **
July Expenditure Report**
August 5
10 **
August Expenditure Report**
September 5
11
September Expenditure Report
October 5
12
October Expenditure Report
November 5
13
November Expenditure Report
December 5
14
December Expenditure Report
January 5
15
Final Expenditure and Request for Payment
February 15
16
Close Out Report
February 28
Legend: * Advance based on projected cash need.
** Recoupment of advance due with this report.
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Department of
Financial Services (DFS) prior to January 1 or until the agreement with the AAA has been
executed and a copy sent to DFS. Actual submission of the vouchers to DFS is dependent
on the accuracy of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the AAA by the
submission date of report #9. The adjustment shall be recorded in Part C, 1 of the report
(ATTACHMENT IX).
Note #3: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the AAA payment is to accompany the report.
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ATTACHMENT IX
REQUEST FOR PAYMENT
OLDER AMERICANS ACT
PROVIDER NAME, ADDRESS, PHONE AND FED ID NUMBER TYPE OF REPORT: THIS REQUEST PERIOD:
Report #
Advance
Agreement #
Reimbursement
Agreement Period:
PSA :
CERTIFICATION: I hereby certify to the best of my knowledge that this request conforms with the terms and the purposes set forth in the above agreement.
Prepared By: pate: APpro\ed By: Date:
PART A:
(
(
(
( _
( _
(
BUDGET SUMMARY
ADMIN.
III B
lllcl
IIIC2
Title IIIE
TOTAL
1. Approved
Agreement Amount.
_ 0.00
0.00
0.00
0.00
_ 0.00
0.0
2. Pre%4ous Funds
RECEIVED for
Agreement period.
_ 0.00
0.00
0.00
0.00
0.00
0.00
3. Agreement Balance
0.00
0.00
0.00
0.00
_. _ 0.00
0.00
4. PreHous Funds
REQUESTED and
Not Received.
0.00
0.00
0.00
0.00
0.00
0.00
5. Agreement Balance
0.00
0.00
0.00
_ 0.00
_ 0.00
0.00
PART B:
FUNDS REQUESTED
1. tst-2nd Months
__
Request Only
0.00
0.00
0.00
0.00
0.00
0.00
2. Net Expenditures
For Month
0.00
0.00
0.00
0.00
0.00
0.00
3. Additional
Cash Needs (Attach Doc.)
0.00
0.00
0.00
0.00
_ 0.00
0.00
4. Total
0.00
0.00
0.00
0.00
0.00
0.00
PART C:
NET FUNDS REQUESTED:
1. Less: Over- Adwence
0.00
0.00
0.00
0.00
0.00
0.00
2. Agreement Funds are
Hereby Requested For
0.00
0.00
0.00
0.00
0.00
0.00
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ATTACHMENT X
EXHIBIT -2
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source:
THIS REPORT PERIOD
FROM: TO:
IIIB IIIC1
CONTRACT
IIIC2
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that this report is complete and all outlays
herein are for purposes set forth
in the contract.
Prepared by : Date :
Approved by :
Date
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Federal Funds
$0.00
$0.00
$0.00
2. State Funds
$0.00
$0.00
$0.00
%
3. Program Income
$0.00
$0.00
$0.00
%
4. Local Cash Match (CCE, HCE and Other)
$0.00
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
%
6. Local In -Kind Match
$0.00
$0.00
$0.00
%
7. TOTAL RECEIPTS
$0.00
$0.00
$0.00
%
PART B : EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Meals / Meal Agreements
$0.00
$0.00
$0.00
%
2. Service Subcontractor
$0.00
$0.00
$0.00
%
3. Other
$0.00
$0.00
$0.00
%
4. Indirect Cost
$0.00
$0.00
$0.00
%
5. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
%
PART C: OTHER EWENDITURES
(For Tracking Purposes only)
1. Match
a. Other and In -Kind
$0.00
$0.00
$0.00
%
b. Local Match
$0.00
$0.00
$0.00
%
2. USDA Cash Received
$0.00
$0.00
$0.00
%
3. TOTAL OTHER
$0.00
$0.00
$0.00
%
PART D: OTHER REVENUE AND EXPENDITURES
2. Addition Cost Alternative Program Income
3. Interest
1. Program Income (PI)
a. Approved Budget $
a. Earned on GR Advances $
a. OAA Unbudgeted PI Receipts YTD
b. Received YTD $
b. Return of GR Advance $
c. Expenditures $
c. Other Earned $
DOEA FORM 105as revised 11/09
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OAA Contract AA -1429
ATTACHMENT X
EXHIBIT 3
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source :
THIS REPORT PERIOD
FROM:
TO:
CONTRACT
Title III E
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date :
Appro%ed by :
- Date:
PART A : BUDGETED INCOME/ RECEIPTS
1. Appro%ed
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approxed Budget
1. Federal Funds
$0.00
$0.00
$0.00
2. State Funds
$0.00
$0.00
$0.00
3. Program Income
$0.00
$0.00
$0.00
4. Local Cash Match
$0.00
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
8. Local In -Kind Match
$0.00
$0.00
$0.00
%
7. TOTAL RECEIPTS
$0.00
$0.00
$0.00
PART B : EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
A: Direct Services
1. Personnel
$0.00
$0.00
$0.00
%
2. Travel
$0.00
$0.00
$0.00
%
3. Building Space
$0.00
$0.00
$0.00
%
4. Communication / Utilities
$0.00
$0.00
$0.00
%
5. Printing / Supplies
$0.00
$0.00
$0.00
%
8. Equipment
$0.00
$0.00
$0.00
%
7. Other
$0.00
$0.00
$0.00
%
B : Agreement Services
8. Services Subcontracted
$0.00
$0.00
$0.00
%
9. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
%
10. DEDUCTIONS
a. Total Local Match
$0.00
$0.00
$0.00
b. Program Income Used
$0.00
$0.00
$0.00
%
c. TOTAL DEDUCTIONS
$0.00
$0.00
$0.00
%
11. NET EXPENDITURES
$0.00
$0.00
$0.00
%
PART C : EXPENDITURES ANALYSIS
2. Units of Services Year to Date
3. Number of People Served
Year to Date
A. Expenditures by Services Year to Date:
1. Information ..................... $0.00
........................
$0.00
..........................944
2. Assistance ..................... 50.00
........................
$0.00
..........................A.44
3. Counseling ..................... $4 44
........................
$4 44
..........................A.44
4. Respite ......................... $4.44
........................
$4.44
..........................94A
5. Supplemental Seruces...... 50.00
........................
$0.00
..........................
4 44
8. TOTAL .......................... $444
Part B Line 11, column 3 should be equal to this total.
PART D : GRANDPARENT SERVICES (reported by Federal
Fiscal Year)
FFY $ FFY
$
FFY
$
Match $
Match $
Match $
DOEA FORM 105AE revised 12/08
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ATTACHMENT A
Department of Elder Affairs Programs & Services Handbook,
Available at the Alliance for Aging Internet site under, "Downloads ".
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OAA Contract AA -1429
ATTACHMENT B
war. &nra AC CI r%C0 ACCA10C
CIVIL RIGHTS COMPLIANCE CHECKLIST
Program /Facility Name - MKrpGCo-Vx�' �% ►W
County - MonrolU
I AAA/Contractor
Address 1100 !3 IItib0%V 1 %'C.t 4e - l9 0
Completed By 14tA W. w eak
F ty, State, Zip Code ��- R . 330(tp
Date I1
1$ 13
Telephone 292'�{
PART L
READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH
WILL HELP YOU IN THE COMPLETION OF THIS FORM.
1. Briefly describe the geographic area served by the program /facility and the type of service provided:
• �,/ arc. OAS IdeL
_
2. POPULATION OF AREA SERVED. Source of data �1oMtn�oa4 4� CA rp Alo lva QQ
t % White TZ % Black 6.� % His ni % Other_Z % Femal —OF' I `en'..&
3. STAFF CURRENTLY EMPLOYED. Effective date:
Total #20 I % White 7 O % Black Zq % Hispanic 1 % Other : Q % Female % Disabled
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date:
Total #— % VAth te % Black % Hisp�� tic % Other-(( % F .az % Di�ab % Over o0
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total #5 1 % White JM % Black O 1 % Hispanic O % Other Q 1 % Femalez I % Disabled O
PART II. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. NA YES NO
6. Is an Assurance of Compliance on file with DOEA? If NA or NO, explain. ❑ K ❑
7. Compare the staff composition to the population. Is staff representative of the population?
If NA or NO, explain.
8. Compare the client composition to the population. Are race and sex characteristics representative
of the Population? If NA or NO, explain.
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NA YES NO
❑9❑
NA YES NO
❑ K ❑
NA YES NO
❑ ❑ NE
9. Are eligibility requirements for services applied to clients and applicants without regard to
race, color, national origin, sex, age, religion or disability? If NA or NO, explain.
OAA Contract AA -1429
10. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of
race, sex, color, age, national origin, religion or disability? If NA or NO, explain.
NA YES NO
❑ rz ❑
11. For in- patient services, are room assignments made without regard to race, color, national origin or disability? If NA or
NO, explain.
NA YES NO
❑ TA ❑
12. Is the program /facility accessible to non - English speaking clients? If NA or NO, explain.
es
13. Are employees, applicants and participants informed of their protection against discrimination?
If yes, how? Verbal Z Written CK Poster ❑ If NA or NO, explain.
14. Give the number and current status of any discrimination complaints regarding services or
employment filed against the program /facility.
Q
15. Is the program /facility physically accessible to mobility, hearing, and sight- impaired individuals? If NA or
NO, explain.
NA YES NO
❑ E9 ❑
PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES
16. Has a self - evaluation been conducted to identify any barriers to serving disabled individuals, and to make any
necessary modifications? If NO, explain. 5
17. Is there and established grievance procedure that incorporates due process in the resolution of
complaints? If NO, explain.
YES NO
TA ❑
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OAA Contract AA -1429
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES NO
YEW ❑
19. Do recruitment and notification materials advise applicants, employees and participants of
nondiscrimination on the basis of disability? If NO, explain.
�l es
20. Are auxiliary aids available to assure accessibility of services to hearing and sight impaired
individuals? If NO, explain.
YES NO
❑
❑ ❑
PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES No
X❑
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OAA Contract AA -1429
AAA USE ONLY
Reviewed By
In Compliance: YES 13 NO' o
Program Office
'Notice of Corrective Action Sent
Date
Telephone
Response Due
On -Site 0 Desk Review 13
Response Received
DOEA Form 101 -A, Revised May 2008 Page 2 of 2
57
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OAA Contract AA -1429
ATTACHMENT B
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
Describe the geographic service area such as a district, county, city or other locality. If the program/facility
serves a specific target population such as adolescents, describe the target population. Also, define the type of
service provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city, county or other regional area. Population
statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. ( "Other" races include
Asian/Pacific Islanders and American Indian/Alaskan Natives.)
Enter the total number of full -time staff and their percent by race, sex and disability. Include the effective date of
your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and
list their percent by race, sex and disability. Include the date that enrollment was counted.
Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for DOEA recipients and their sub - grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in
the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever
action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are
sanctioned to serve target populations such as elderly or disabled persons, 45 CFR
80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a)
and 45 CFR 80.1 (b) (2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin,
religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied
uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting
rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR
80.3 (b).
11. For in- patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants, including those persons who
may not speak English. In geographic areas where a significant population of non - English speaking people live,
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OAA Contract AA -1429
program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy
or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in
the provision of services, 45 CFR 80.3 (a).
13. Programs /facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries or any other interested parties. This should include information on their right to file a
complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS.
The information may be supplied verbally or in writing to every individual, or may be supplied through the use of
an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color,
creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement,
termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and
address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g.,
settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc.
15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby,
public telephone, restroom facilities, water fountains, information and admissions offices should be accessible.
Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and
serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or
raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a
self - evaluation to identify any accessibility barriers. Self - evaluation is a four step process:
❑ With the assistance of a disabled individual /organization, evaluate current practices and policies which do not
comply with Section 504.
❑ Modify policies and practices that do not meet Section 504 requirements.
❑ Take remedial steps to eliminate any discrimination that has been identified.
❑ Maintain self - evaluation on file. (This checklist may be used to satisfy this requirement if these four steps
have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any
action prohibited by Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads, and other appropriate written communication, 45 CFR 84.8 (a).
20. Programs /facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with
impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to,
interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be
used to provide equally effective services, (45 CFR 84.52 (d).
21. Programs /facilities with 50 or more employees and $50,000 in federal contracts must develop, implement and
maintain a written affirmative action compliance program in accordance with Executive Order 11246.41 CFR 60
and Title VI of the Civil Rights Act of 1964, as amended.
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OAA Contract AA -1429
ATTACHN1ENT D
Provider's State Contracts List
REPORT PERIOD: FROM
TO
PROVIDER INORMATIOf!
Name: Phone A:
Address: Emad:
FEW Contact:
Contract
Contrmct
Contract *I
Contr..t/Pgr.-M—M
State
S
End j
Date
p 0escriptlon of
urpose/Types
Contract
Pho
9
i
to
1
12 ;
—
13.
_
_
14
16
17
18
(_.
19
I ¢
L 20
Ttkal,
SIGNATURE. DATE:
TITLE'
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�O A 4 ��
OAA Contract AA -1429
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ATTACHMENT E
Department's Computer Use Policy and its Social Media Policy
Available at the Alliance for Aging Internet site under, "Downloads"
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ATTACHMENT G
DEPARTMENT
ELDER
AFFAIRS
"AT/ Of' ftAl AM
BACKGROUND SCREENING
Affidavit of Compliance - Employer
AUTHORITY: This form Is required annually of all arnployers to comply with the attestation
requirements set forth In section 435.0513). Fioirids Statutes.
The term "employer" means any person or entity required by law to conduct background screening,
including but not limited to, Area Agencies on Aging, Aging Resource Centers, Aging and Disability
Resource Centers, Lead Agencies, Long -Term Care Ombudsman Program, Serving health Insurance Needs
of Elden Program, Service Providers, Deversion Providers, and any other person or entity which hires
employees or has volunteers in service who meet the defini don of a direct service provider. .see §
435.02, 430.0402, Fla. Stat;
`r A direct service provider Is "a person IS years of age or older who, pursuant to a program to provide
services to the elderly, has direct, face -to -face contact with a client while providing services to the client
and has access to the client's living area, funds, personal property, or personal identification information
as defined in s. 817568. The term includes coordinators, managers, and supervisors of residential
facilities, and volunteers.' S 430.0402(3)(b), Fla- Stat_
ATTESTATION
As the duty authorized representative of
&npfdW Name
located at
Street Address City State ZIP code
l•
Name of Represerttat>fve do hereby affirm under penalty of perjury
that the above named employer Is In compliance with the provisions of Chapter 435 and section
430.0402, Florida Statutes, regarding level 2 background screening.
Signature of Representative
STATE OF FLORIDA, COUNiTY OF
Date
Sworn to (or affirrtted) and subscribed before me this day of . 20____, by
(Name of Representative) who Is personally known
to me or produced
rriM.. Type, w Stamp Commbaaned Name of Notary Public Notary Public
as proof of identification,
rJ0fA form 235, Air-davit of Cer"ok ee - Empbyer, Efrttrive April 2012 Section 435.05(31, f S.
Firm "A"ble 1W ritto l Od A Mim J141011 uVef)'"MtAetker x nds_r0 nine An
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ATTACHMENT H
Verification of Employment Status Certification
As a condition of contracting with the Alliance for Aging, Inc., 0 OCIa- ' �S,
hereby referred to as contractor, certifies the use of the U.S. Department of Homelan I Security's E- verify system to
verify the employment eligibility of all new employees hired by Contractor during the contract term to perform
employment duties pursuant to this Agreement and (b) that any subcontracts include an express requirement that
subcontractors performing work or providing services pursuant to this Agreement utilize the E -verify system to verify
the employment eligibility of all new employees hired by the subcontractor during the contract term.
2 No v' 2-013
si4� Date
(Same as contract signature)
SR . lbi Re C-kp -)
Title 1'
COUNN
oT MONROE
comp" rvlces Department
SHERy'L GRAPIA3V
The Historic C to Ug r Factory
1100 Simonton St., Suite 2 -257
Key West, Florida 33040
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OAA Contract AA -1429
ATTACHMENT J
Alliance for Aging, Inc.
Business Associate Agreement
This Business Associate ApleeTe t is dated, by the Alliance for Aging, Inc ( "Covered Entity ") and
Morro
( "Business Associate "), a not Florida corporation.
1.0 Background
1.1 Covered Entity has entered into one or more contracts or agreements with Business Associate that involves
the use of Protected Health Information (PHI).
1.2 Covered Entity, recognizes the requirements of the Health Insurance Portability and Accountability Act of 1996
( HIPAA) and has indicated its intent to comply in the County's Policies and Procedures.
1.3 HIPAA regulations establish specific conditions on when and how covered entities may share information with
contractors who perform functions for the Covered Entity.
1.4 HIPAA requires the Covered Entity and the Business Associate to enter into a contract or agreement containing
specific requirements to protect the confidentiality and security of patients' PHI, as set forth in, but not limited to
the Code of Federal Regulations (C.F.R.), specifically 45 C.F.R. §§ 164.502(e), 164.504(e), 164.308(b), and
164.314(a- b)(2010) (as may apply) and contained in this agreement.
1.5 The Health Information Technology for Economic and Clinical Health Act (2009), the American Recovery and
Reinvestment Act (2009) and Part I — Improved Privacy Provisions and Security provisions located at 42 United
States Code (U.S.C.) §§ 17931 and 17934 (2010) require business associates of covered entities to comply with
the HIPAA Security Rule, as set forth in, but not limited to 45 C.F.R. §§ 164.308, 164.310, 164.312, and 164.316
(2009) and such sections shall apply to a business associate of a covered entity in the same manner that such
sections apply to the covered entity.
The parties therefore agree as follows:
2.0 Definitions. For purposes of this agreement, the following definitions apply:
2.1 Access. The ability or the means necessary to read, write, modify, or
communicate data/information or otherwise use any system resource.
2.2 Administrative Safeguards. The administrative actions, and policies and
procedures, to manage the selection, development, implementation, and
maintenance of security measures to protect electronic Protected Health
Information (ePHI) and to manage the conduct of the covered entity's workforce
in relation to the protection of that information.
2.3 ARRA The American Recovery and Reinvestment Act (2009)
2.4 Authentication. The corroboration that a person is the one claimed.
2.5 Availability. The property that data or information is accessible and useable upon demand by an authorized
person.
2.6 Breach. The unauthorized acquisition, access, use, or disclosure of PHI which
compromises the security or privacy of such information.
2.7 Compromises the Security. Posing a significant risk of financial, reputational,
or other harm to individuals.
2.8 Confidentiality. The property that data or information is not made available or
disclosed to unauthorized persons or processes.
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OAA Contract AA -1429
2.9 Electronic Protected Health Information.(ePHI) Health information as specified in 45 CFR §160.103(1)(i) or
(1)(ii), limited to the information created or received by Business Associate from or on behalf of Covered Entity.
2.10 HITECH. The Health Information Technology for Economic and Clinical Health
Act (2009)
2.11 Information System. An interconnected set of information resources under the
same direct management control that shares common functionality. A system
normally includes hardware, software, information, data, applications,
communications, and people.
2.12 Integrity. The property that data or information have not been altered or
destroyed in an unauthorized manner.
2.13 Malicious software. Software, for example, a virus, designed to damage or
disrupts a system.
2.14 Part I. Part I — Improved Privacy Provisions and Security provisions located at
42 United States Code (U.S.0 §§ 17931 and 17934 (2010).
2.15 Password. Confidential authentication information composed of a string of
characters.
2.16 Physical Safeguards. The physical measures, policies, and procedures to
protect a covered entity's electronic information systems and related buildings
and equipment, from natural and environmental hazards, and unauthorized
intrusion.
2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health
Information at 45 CFR Part 160 and Part 164, subparts A and E.
2.18 Protected Health Information. (PHI) Health information as defined in 45 CFR
§160.103, limited to the information created or received by Business Associate
from or on behalf of Covered Entity.
2.19 Required By Law. Has the same meaning as the term "required by law" in
45 CFR § 164.103.
2.20 Secretary. The Secretary of the Department of Health and Human Services or
his or her designee.
2.21 Security incident. The attempted or successful unauthorized access, use,
disclosure, modification, or destruction of information or interference with system
operations in an information system.
2.22 Security or Security measures. All of the administrative, physical, and technical
safeguards in an information system.
2.23 Security Rule. The Security Standards for the protection of Electronic Protected
Health Information at 45 CFR part 164, subpart C, and amendments thereto.
2.24 Technical Safeguards. The technology and the policy and procedures for its
use that protect electronic protected health information and control access to it.
2.25 Unsecured PHI. Protected health information that is not secured through the use
of technology or methodologyspecified by the Secretary in guidance issued
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under 42 U.S.C. section 17932(h)(2).
OAA Contract AA -1429
2.26 All other terms used, but not otherwise defined, in this Agreement shall have the
same meaning as those terms in the Privacy Rule.
3.0. Obligations and Activities of Business Associate.
3.1 Business Associate agrees to not use or disclose PHI other than as permitted or
required by this agreement or as Required by Law.
3.2 Business Associate agrees to:
(a) Implement policies and procedures to prevent, detect, contain and
correct Security violations in accordance with 45 CFR § 164.306;
(b) Prevent use or disclosure of the PHI other than as provided for by this
Agreement or as required by law;
(c) Reasonably and appropriately protect the confidentiality, integrity, and
availability of the ePHI that the Business Associate creates, receives,
maintains, or transmits on behalf of the Covered Entity; and
(d) Comply with the Security Rule requirements including the Administrative
Safeguards, Physical Safeguards, Technical Safeguards, and policies
and procedures and documentation requirements set forth in 45 CFR §§
164.308, 164.310, 164.312, and 164.316.
3.3 Business Associate agrees to mitigate, to the extent practicable, any harmful
effect that is known to Business Associate of a use or disclosure of PHI by
Business Associate in violation of the requirements of this Agreement.
3.4 Business Associate agrees to promptly report to Covered Entity any use or
disclosure of the PHI not provided for by this Agreement of which it becomes
aware. This includes any requests for inspection, copying or amendment of such
information and including any security incident involving PHI.
3.5 Business Associate agrees to notify Covered Entity without unreasonable delay
of any security breach pertaining to:
(a) Identification of any individual whose unsecured PHI has been, or is
reasonably believed by the
Business Associate to have been, accessed, acquired, or disclosed during such security breach; and
(b) All information required for the Notice to the Secretary of HHS of Breach
of Unsecured Protected Health Information.
3.6 Business Associate agrees to ensure that any agent, including a subcontractor,
to whom it provides PHI received from, or created or received by Business
Associate on behalf of Covered Entity, agrees to the same restrictions and
conditions that apply through this Agreement to Business Associate with respect
to such information.
3.7 If Business Associate has PHI in a Designated Record Set:
(a) Business Associate agrees to provide access, at the request of Covered
Entity during regular business hours, to PHI in a Designated Record Set,
to Covered Entity or, as directed by Covered Entity, to an individual in
order to meet the requirements under 45 CFR §164.524; and
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OAA Contract AA -1429
(b) Business Associate agrees to make any amendment(s) to PHI in a
Designated Record Set that the Covered Entity directs or agrees to
pursuant to 45 CFR § 164.526 at the request of Covered Entity or an
Individual within 10 business days of receiving the request.
3.8 Business Associate agrees to make internal practices, books, and records,
including policies and procedures and PHI, relating to the use and disclosure of
PHI received from, or created or received by Business Associate on behalf of
Covered Entity, available to the Covered Entity or to the Secretary upon request
of either for purposes of determining Covered Entity's compliance with the Privacy Rule.
3.9 Business Associate agrees to document such disclosures of PHI and information
related to such disclosures as would be required for Covered Entity to respond
to a request by an individual for an accounting of disclosures of PHI in
accordance with 45 CFR § 164.528.
3.10 Business Associate agrees to provide to Covered Entity or an individual, upon request,
information collected in accordance with Paragraphs h and i above, to permit Covered Entity
to respond to a request by an Individual for an accounting of disclosures of PHI in accordance
with 45 CFR § 164.528 and ARRA § 13404.
3.11 Business Associate specifically agrees to use security measures that reasonably
and appropriately protect the confidentiality, integrity, and availability of PHI in
electronic or any other form, that it creates, receives, maintains, or transmits on
behalf of the Covered Entity.
3.12 Business Associate agrees to implement security measures to secure passwords
used to access ePHI that it accesses, maintains, or transmits as part of this
Agreement from malicious software and other man -made and natural
vulnerabilities to assure the availability, integrity, and confidentiality of such
information.
3.13 Business Associate agrees to implement security measures to safeguard ePHI
that it accesses, maintains, or transmits as part of this agreement from malicious
software and other man -made and natural vulnerabilities to assure the
availability, integrity, and confidentiality of such information.
3.14 Business Associate agrees to comply with:
(a) ARRA § 13404 (Application of Knowledge Elements Associated with
Contracts);
(b) ARRA § 13405 (Restrictions on Certain Disclosures and Sales of Health
Information); and
(c) ARRA § 13406 (Conditions on Certain Contacts as Part of Health Care
Operations).
4.0 Permitted Uses and Disclosures by Business Associate. Except as
otherwise limited in this Agreement or any related agreement, Business
Associate may use or disclose PHI to perform functions, activities, or services
for, or on behalf of, Covered Entity as specified in any and all contracts with
Covered Entity provided that such use or disclosure would not violate the Privacy
Rule if done by Covered Entity or the minimum necessary policies and
procedures of the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except as otherwise limited in this agreement or any related agreement,
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Business Associate may use PHI for the proper management and administration
of the Business Associate or to carry out the legal responsibilities of the Business
Associate.
5.2 Except as otherwise limited in this agreement or any related agreement,
Business Associate may disclose PHI for the proper management and
administration of the Business Associate, provided that disclosures are Required
By Law, or Business Associate obtains reasonable assurances from the person
to whom the information is disclosed that it will remain confidential and used or
further disclosed only as Required By Law or for the purpose for which it was
disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information has
been breached.
5.3 Business Associate may use PHI to provide data aggregation services to
Covered Entity as permitted by 45 CFR §164.504(e)(2)(i)(B),only when
specifically authorized by Covered Entity.
5.4 Business Associate may use PHI to report violations of law to appropriate
Federal and State authorities, consistent with 45 CFR §164.5020)(1).
6.0 Obligations of Covered Entity.
6.1 Covered Entity shall notify Business Associate of any limitation(s) in its notice of
privacy practices of Covered Entity in accordance with 45 CFR § 164.520, to the
extent that such limitation may affect Business Associate's use or disclosure of
PHI, by providing a copy of the most current Notice of Privacy Practices (NPP)
to Business Associate as Attachment I to this Agreement. Future Notices and /or
modifications to the NPP shall be posted on Covered Entity's website at
www.allianceforaging.org
6.2 Covered Entity shall notify Business Associate of any restriction to the use or
disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR
§ 164.522, to the extent that such restriction may affect Business Associate's
use or disclosure of PHI.
7.0 Permissible Requests by Covered Entity. Except for data aggregation or
management and administrative activities of Business Associate, Covered Entity
shall not request Business Associate to use or disclose PHI in any manner that
would not be permissible under the Privacy Rule if done by Covered Entity.
8.0 Effective Date and Termination.
8.1 The Parties hereby agree that this agreement amends, restates and replaces any
other Business Associate Agreement currently in effect between Covered Entity
and Business Associate and that the provisions of this agreement shall be
effective as follows:
(a) These Business Associate Agreement provisions, with the exception of
the electronic security provisions and the provisions mandated by
ARRA, HITECH and Part I shall be effective upon the later of April 14,
2003, or the effective date of the earliest contract entered into between
Business Associate and Covered Entity that involves the use of PHI;
(b) The electronic security provisions hereof shall be effective the later of
April 21, 2005 or the effective date of the earliest contract entered into
between Business Associate and Covered Entity that involves the use of
PHI; and
(c) Provisions hereof mandated by ARRA, HITECH and /or Part I shall be
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effective the later of February 17, 2010 or the effective date of the
earliest contract entered into between covered entity and business
associate that involves the use of PHI or ePHI.
8.2 Termination for Cause. Upon Covered Entity's knowledge of a material breach
by Business Associate, Covered Entity shall either:
(a) Provide an opportunity for Business Associate to cure the breach or end
the violation and terminate this agreement if Business Associate does
not cure the breach or end the violation within the time specified by
Covered Entity;
(b) Immediately terminate this agreement if Business Associate has
breached a material term of this Agreement and cure is not possible; or
(c) If neither termination nor cure is feasible, Covered Entity shall report the
violation to the Secretary.
8.3 Effect of Termination. Except as provided in subparagraph (b) of this section,
upon termination of this agreement, for any reason, Business Associate shall
return all PHI and ePHI received from Covered Entity, or created or received by
Business Associate on behalf of Covered Entity.
(a) This provision shall apply to PHI and ePHI that is in the possession of
subcontractors or agents of Business Associate. Business Associate
shall retain no copies of the PHI and ePHI.
(b) In the event that Business Associate or Covered Entity determines that
returning the PHI or ePHI is infeasible, notification of the conditions that
make return of PHI or ePHI infeasible shall be provided to the other
party. Business Associate shall extend the protections of this Agreement
to such retained PHI and ePHI and limit further uses and disclosures of
such retained PHI and ePHI, for a minimum of six years and so long as
Business Associate maintains such PHI and ePHI, but no less than six
(6) years after the termination of this agreement.
9.0 Regulatory References. A reference in this agreement to a section in the
Privacy Rule or Security Rule means the section then in effect or as may be
amended in the future.
10.0 Amendment. The Parties agree to take such action as is necessary to amend
this agreement from time to time as is necessary for Covered Entity to comply
with the requirements of the Privacy Rule, the Security Rule and the Health
Insurance Portability and Accountability Act of 1996, Pub. L. No. 104 -191.
11.0 Survival. Any term, condition, covenant or obligation which requires
performance by either party hereto subsequent to the termination of this
agreement shall remain enforceable against such party subsequent to such
termination.
12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit
Covered Entity to comply with the Privacy Rule and Security Rule.
13.0 Incorporation by reference. Any future new requirement(s), changes or
deletion(s) enacted in federal law which create new or different obligations with
respect to HIPAA privacy and /or security, shall be automatically incorporated by
reference to this Business Associate Agreement on the respective effective
date(s).
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14.0 Notices. All notices and communications required, necessary or desired to be
given pursuant to this agreement, including a change of address for purposes of
such notices and communications, shall be in writing and delivered personally to
the other party or sent by express 24 -hour guaranteed courier or delivery service,
or by certified mail of the United States Postal Service, postage prepaid and
return receipt requested, addressed to the other party as follows (or to such other
place as any party may by notice to the others specify):
To Covered Entity: Alliance for Aging, Inc.
Attention: Max B. Rothman, JD, LL.M.
760 NW 107th Avenue, Suite 214
Miami, Florida 33172 -3155
To Business Associate:
Any such notice shall be deemed delivered upon actual receipt. If any notice cannot be delivered or delivery thereof is refused,
delivery will be deemed to have occurred on the date such delivery was attempted.
15.0 Governing Law. The laws of the State of Florida, without giving effect to
principles of conflict of laws, govern all matters arising under this agreement.
16.0 Severability. If any provision in this agreement is unenforceable to any extent,
the remainder of this agreement, or application of that provision to any persons
or circumstances other than those as to which it is held unenforceable, will not
be affected by that unenforceability and will be enforceable to the fullest extent
permitted by law.
17.0 Successors. Any successor to Business Associate (whether by direct or indirect
or by purchase, merger, consolidation, or otherwise) is required to assume
Business Associate's obligations under this agreement and agree to perform
them in the same manner and to the same extent that Business Associate would
have been required to if that succession had not taken place. This assumption
by the successor of the Business Associate's obligations shall be by written
agreement satisfactory to Covered Entity.
18.0 Entire Agreement. This agreement constitutes the entire agreement of the
parties relating to the subject matter of this agreement and supersedes all other
oral or written agreements or policies relating thereto, except that this agreement
does not limit the amendment of this agreement in accordance with section 10.0
of this agreement.
Covered Entity:
r� By: Date: l
(signature)
Business Associate: eX I C
By: Vf Date: ZO /J V 2'013
(signature)
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ATTACHMENT K
Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
AGING AND DISABILITY RESOURCE CENTER (ADRC) — OUTSOURCED FUNCTIONS
I. If applicable, the provider agrees to the following:
A. Perform ADRC outsourced functions in accordance with the Alliance's policies and procedures.
i. Policies and Procedures for Outsourced Function- Screening
ii. Policies and Procedures for Outsourced Function -Triage
iii. Policies and Procedures for Activation from Waitlist- Client Services
iv. Policies and Procedures for Termination from Waitlist- Client Services
B. Maintain wait lists in CIRTS in accordance with DOEA requirements.
C. Report number of client contacts to the Aging and Disability Resource Center.
D. Adhere to prioritization policy as set forth by DOEA on a monthly basis. Reference DOEA Notice of
Instruction: Assessed Priority Consumer List#:062906- 1- 1 -OVCS as applicable.
E. Ensure the agency's Disaster Plan reflects ADRC Outsourced Functions, annually or as needed to
incorporate ADRC outsourced functions.
F. Ensure against conflicts of interest and inappropriate self - referrals by referring consumers in need
of options counseling or long -term care services beyond the provider's scope of services to the
Aging and Disability Resource Center.
G. Ensure that services provided are in the clients' best interest, are the most cost effective, of high
quality, and are responsive and appropriate to the assessed needs.
The Assessed Priority Consumer List (APCL) is maintained when services funded by the department are not
available. Contracted providers of registered services for Alzheimer's Disease Initiative (ADI) and Older
American's Act (OAA) maintain waiting lists in the CIRTS database for registered services when funding is not
available.
Registered Services for the above listed programs are as follows: Adult Day Care (ADC), Adult Day Health Care
(ADHC), Chore (CHO), Escort (ESC), Home Delivered Meals (HDM), Home Health Aide (HHA), Homemaker
(HMK), Model Day Care (MDC), Personal Care (PECA), Facility-Based Respite (RESF), In -Home Respite
(RESP).
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Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for
Outsourced function - Screening
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that a comprehensive list of clients in need of services is maintained in CIRTS by appropriate
funding source and that the ADRC is thereby able to effectively gauge the level of elder service need in
Miami -Dade and Monroe Counties.
Policy: To obtain necessary information from clients in order to assist in determining level of need and eligibility
for DOEA funded services
Procedure:
1. ADRC Contracted Providers will collect information from callers and conduct a 701A assessment.
Alternatively, if a 701 B assessment already exists or is provided from another source (i.e. CARES) the
information from the 701 B can be utilized.
2. Based on the information provided via the 701A(B) assessment, the ADRC Contracted Provider will
make a determination as to the services that the caller is in need of receiving .
3. The ADRC Contracted Provider will determine the appropriate funding source(s) that provides the
needed services.
4. If the caller is in need of a service(s) that is not provided by the ADRC Contracted Provider, the ADRC
Contracted Provider will refer caller to the ADRC Elder Helpline utilizing the ADRC Referral Form
and /or to an ADRC Contracted Provider that provides the needed service.
5. The caller will be provided with general information regarding the ADRC as well as the ADRC Elder
Helpline contact number.
6. The caller will be informed of the services and funding sources that they are being placed on the wait
list for in CIRTS.
7. ADRC Contracted Provider will create a client record in CIRTS (if there is no existing record) and enter
the services needed for the caller by funding source and service. [if there is an existing record in
CIRTS, the appropriate fields will be updated].
8. If the ADRC Contracted Provider determines that the caller may qualify for more than one funding
source, ADRC Contracted Provider is encouraged to enter the appropriate information under multiple
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funding sources. [If there is an existing client record in CIRTS, the client record in CIRTS will be
updated with appropriate information].
9. ADRC Contracted Provider will inform caller that they will receive a follow -up call (or home visit in case
of active client) to check on their status based on DOEA Wait List Reassessment Standards and
encourage caller to contact the ADRC Elder Helpline with any questions.
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Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for
Outsourced function - Triage
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that clients in need of DOEA funded services receive services based on the highest level of
need, first, as funding becomes available.
Policy: To assist clients in obtaining DOEA funded services as funding becomes available, based on level of
need as determined by a CIRTS priority score.
Procedure:
1. ADRC Contracted Provider will conduct periodic follow -up calls (or home visit in case of active client) to
check on client status based on DOEA Wait List Reassessment Standards.
2. Based on the information provided via the 701A(B) assessment, the ADRC Contracted Provider will
update the client information in CIRTS specifically as it pertains to level of need for services by funding
source.
3. The ADRC Contracted Provider will ensure that the CIRTS prioritization score is accurately maintained,
according to DOEA Standards.
4. If the caller is in need of a service(s) that is not provided by the ADRC Contracted Provider, the ADRC
Contracted Provider will refer caller to the ADRC Elder Helpline utilizing the ADRC Referral Form and /or to
an ADRC Contracted Provider that provides the needed service.
5. The caller will be informed of the services and funding sources that they remain on the wait list for and /or
have been removed from the wait list for.
6. ADRC Contracted Provider will advise client of any change in their CIRTS priority score based on the
updated information.
7. ADRC Contracted Provider will remind client of the ADRC Elder Help Line contact number and to contact
the ADRC Elder Help Line with any questions or concerns.
8. As funding becomes available, ADRC Contracted Provider will run CIRTS Prioritization Report and
activate clients according to DOEA Standards (refer to ADRC Client Activation Policies and Procedures).
The Contracted Provider will apply targeting criteria, as appropriate, to prioritized clients to ensure
activations meet programmatic requirements.
Alliance for Aging, Inc.
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Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for
Activation From Wait List — Clients/Services
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that elders in need of DOEA funded services in Miami -Dade and Monroe Counties and on the
CIRTS wait list begin to receive services as funding becomes available.
Policy: ADRC will work with ADRC Contracted Providers to ensure that clients waiting for DOEA funded
services begin to receive those services as funding becomes available.
Procedure:
1. ADRC Contracted Provider will activate clients on CIRTS wait list based on DOEA prioritization polices
and funding availability.
2. ADRC Contracted Provider will update CIRTS status by funding source and service for any services being
activated for the client using appropriate CIRTS codes.
3. Client may be left on wait list of a different funding source than the one being activated if ADRC
Contracted Provider determines that it is appropriate.
4. Client may also be left on wait list in CIRTS if they are being activated by the ADRC Contracted Provider
under a temporary non -DOEA funding source and ADRC Contracted Provider determines that the clients'
need will persist after the temporary funding source is exhausted.
5. ADRC Contracted Provider will inform the client of any services /funding source that they are being
activated for as well as those services and funding sources that they will continue to be wait listed for.
6. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have any questions
or concerns regarding the status of any of their services.
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Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for
Termination From Wait List — Clients /Services
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that the comprehensive list of clients in need of services in CIRTS is appropriately maintained
by funding source and that the ADRC is thereby able to effectively gauge the current level of elder
service need in Miami -Dade and Monroe Counties.
Policy: ADRC will maintain an accurate and current list of clients in need of elder services in Miami -Dade and
Monroe Counties with the assistance of the ADRC Contracted Providers.
Procedure:
1. ADRC Contracted Provider will re- screen clients which the ADRC Contracted Provider initially placed on
the CIRTS wait list for services based on DOEA Reassessment Standards.
2. The re- screening may be in the form of a phone screening or a home visit depending on the clients status
(i.e. active /pending)
3. ADRC Contracted Provider will determine if the client is no longer in need (or eligible) for any of the
services they were wait - listed for.
4. ADRC Contracted Provider will terminate the client from the wait list (entirely or by specific service) using
the appropriate CIRTS termination code for any services or funding source for which the client is
determined to no longer be eligible for or no longer in need of.
5. ADRC Contracted Provider will inform the client of any services /funding source that they are being
removed from the wait list for.
6. ADRC Contracted Provider will inform client of their ability to be re -added to the wait list if their level of
need should change.
7. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have any questions
or concerns regarding their wait list status.
8. Reference DOEA Notice of Instruction: Assessed Priority Consumer List#:062906- 1- 1 -OVCS as applicable.
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Aging and Disability Resource Center
Monthly Client Data Report Instructions
NOTE: All Service Providers are required to submit the Client Data Report on a monthly basis at the
same time that they submit the Surplus Deficit Report and related expenditure plan to the Contract
Manager.
Total # of Personal Contacts (Calls. Walk -ins. Mail. E -mails or Faxes): This is a count of all contacts during the
reporting period from individuals seeking information, referral or assistance for themselves or others received by the
ADRC, satellite office, any outsourced entity, or, to the extent possible, all access points with which the ADRC has
an agreement. Contacts include telephone calls, walk -ins, mail, a -mails or faxes for the entire planning and service
area. These are communications related to ADRC functions, including ADRC - related one -to -one outreach contacts
when consumers are provided with information, referral or assistance for themselves or others. They do not include
ADRC public education activities. Administrative and personal contacts are excluded. This number is not an
unduplicated count. Documentation for the total count by type of contact and source receiving the contact must be
maintained by the ADRC.
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ATTACHMENT L
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
The undersigned, an authorized representative of the Contractor named in the contract or agreement to which this
form is an attachment, hereby certifies that:
(1) The Contractor understands that pursuant to s. 287.135 F.S., any company at the time of bidding or submitting
a proposal for a new contract or renewal of an existing contract, that is on the "Scrutinized Companies with
Activities in Sudan List" or the "Scrutinized Companies with Activities in the Iran Petroleum Sector List
(collectively, "the Lists ") is ineligible for, and may not bid on, submit a proposal for, or enter into or renew a
contract pursuant to which funding is provided by the Department of Elder Affairs (Department) for goods or
services of $1 million or more.
(2) The Contractor understands that, pursuant to s. 287.135 F.S., any company that submits a false certification is
subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of false
certification.
(3) The Contractor understands that the contract to which this form is an attachment may be terminated by the
AAA if the Contractor submits a false certification or has been placed on the Lists.
This certification, required by Florida law, 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.
" ,j)
Signature Ja4ze==
(Same as contract signature)
SR . ])i2
Title
CAUM 0MONROE
Cow Xwkes Department
SHERYL GIMHAM
The Historic Gato Cigar Factory
1100 Simonton St., Suite 2 -257
Key West, Florida 33040
20 NoV 2013
Date
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