10/19/2016 ContractAMY REAVILIN, CPA
CLERK OF CIRCUIT COURT &COMPTROLLER
MONROE COUNTY, FLORIDA
DATE: November 1, 2016
TO: Sheryl Graham, Director
FROM: Cheryl Robertson Executive Aide to the Clerk of Court & Comptroller Of,
At the October 19, 2016 Board of County Commissioner's meeting the Board granted approval and
authorized execution of the item C27 Approval of Ratification of Nutrition Services Incentive
Program (NSIP) Contract US -1651 between the Alliance for Aging, Inc., and Monroe County
BOCC/Monroe County Social Services for the contract year 2015 -2016 (10101115 - services end on
12/31/16; contract ends on 02/15/2017) in the amount of $42,766.48.
Enclosed are three (3) duplicate originals of the above mentioned for your handling. Should you have
any questions, please feel free to contact me.
cc: County Attorney
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
E) ORIGINAL Contract No. US -1651
October 2015 — December 2016
FLORIDA DEPARTMENT OF ELDER AFFAIRS
CONTRACT
NUTRITION SERVICES INCENTIVE PROGRAM
THIS CONTRACT is entered into between the Alliance for Aging, Inc. hereinafter referred to as the "Alliance ", and
Monroe County Social Services (Contractor), and collectively referred to as the "Parties."
WITNESSETH THAT:
WHEREAS, the Alliance has determined 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 Alliance.
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. PurFose 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, forms, exhibits and references incorporated, which constitute the contract document.
2. Incorporation of Documents within the ontra
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks,
manuals, as an integral part of the contract, except to the extent that the contract explicitly provides to the contrary. In
the event of conflict in language among any of the documents referenced above, the specific provisions and
requirements of the contract document(s) shall prevail over inconsistent provisions in the proposal(s) or other general
materials not specific to this contract document and identified attachments.
3. Term of Contract
This contract shall begin on October 1, 2015 and shall end on September 30, 2016.
Delivery of services shall end on September 30, 2016. This contract shall end on December 31, 2016. See Attachment
I, Section III.
4. Contract Amount
The Alliance agrees to pay for contracted services according to the terms and conditions of this contract in an amount
not to exceed $27,245.93 or the rate schedule, 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
The contract may be renewed on a yearly basis for no more than two additional years. Such renewals shall be contingent
upon satisfactory performance evaluations as determined by the Alliance and the availability of funds. Any renewal of
a contract shall be subject to mutual agreement, confirmed in writing, and subject to the same terms and conditions set
forth in the initial contract. The renewal price, or method for determining a renewal price, is set forth in the bid, proposal,
or reply. No other costs for the renewal may be charged.
In the event that a subsequent agreement may not be executed prior to the July 1 S` start date, the Alliance may, at its
discretion, extend this Agreement upon written notice for up to 90 days to ensure continuity of service. Services
provided under this extension will be paid for out of the succeeding agreement amount.
October, 2015 — December 2016
Contract No. US -1651
6, Official Payee and Renre entative (Names. Addresses. and TeleRhone Numbers):
7. All Terms and Conditions Included: o ? I n
This contract and its Attachments, I, 111, VII, and H and any exhibits referenced in said attach4pts, togaher r ' h
any documents incorporated by reference, contain all the terms and conditions agreed upon bR4 Partim' TKe e are
no provisions, terms, conditions, or obligations other than those contained herein, and this songvt shall4iperMe all
previous communications, representations or agreements, either written or verbal between c � .:s
x . n•
c- F yn
IN WITNESS THEREOF, the Parties hereto have caused this contract, to be executed by their tindersigne off`aals as ,3
duly authorized. Q•
Contractor: MONROE OUNTY SOCIAL
SE
SIGNED BY:
el
7 � �/
NAME: ROMAN GASTESI
ALLIANCE FOR AGING, INC.
SIGNED BY:
NAME Max B. Rothman, JD, LL.
TITLE: COUNTY ADMINISTRATOR
DATE: 9/21/2015
Mk 17 5 � � / ✓N' .
TITLE: President and CEO
DATE: SEP 2 4 2015
- T - �h
SIGNED BY:
NAME: DANNY KOL
TITLE: MAYOR
DATE: /a / /'
The Contractor name, as shown on page 1 of this
Sheryl Graham, Senior Director
a.
contract, and mailing address of the official payee to
Monroe County Social Services
whom the payment shall be made is:
1100 Simonton Street, 2 " Floor
Key West, FL 33040
Kim Wilkes Wean, Compliance Manager
b.
The name of the contact person and street address where
1100 Simonton Street, 2 "d Floor
financial and administrative records are maintained is:
Key West, FL 33040,
Sheryl Graham, Senior Director
C.
The name, address, and telephone number of the
Monroe County Social Services
representative of the Contractor responsible for
P p
1100 Simonton Street, 2 " Floor
administration of the program under this contract is:
Key West, FL
33040
d
The section and location within the Alliance where
Laurie Semo, CFO
The Alliance for Aging, Inc.
Requests for Payment and Receipt and Expenditure
760 NW 107` Avenue, Suite 214, 2 nd Floor
forms are to be mailed is:
Miami, FL 33172
Dianne Duke
e.
The name, address, and telephone number of the
760 NW 107` Avenue, Suite 214, 2 n Floor
Contract Manager for this contract is:
Miami, FL 32172
(305) 670 -6500
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.
7. All Terms and Conditions Included: o ? I n
This contract and its Attachments, I, 111, VII, and H and any exhibits referenced in said attach4pts, togaher r ' h
any documents incorporated by reference, contain all the terms and conditions agreed upon bR4 Partim' TKe e are
no provisions, terms, conditions, or obligations other than those contained herein, and this songvt shall4iperMe all
previous communications, representations or agreements, either written or verbal between c � .:s
x . n•
c- F yn
IN WITNESS THEREOF, the Parties hereto have caused this contract, to be executed by their tindersigne off`aals as ,3
duly authorized. Q•
Contractor: MONROE OUNTY SOCIAL
SE
SIGNED BY:
el
7 � �/
NAME: ROMAN GASTESI
ALLIANCE FOR AGING, INC.
SIGNED BY:
NAME Max B. Rothman, JD, LL.
TITLE: COUNTY ADMINISTRATOR
DATE: 9/21/2015
Mk 17 5 � � / ✓N' .
TITLE: President and CEO
DATE: SEP 2 4 2015
- T - �h
SIGNED BY:
NAME: DANNY KOL
TITLE: MAYOR
DATE: /a / /'
October 2015 — December 2016
INDEX TO ATTACHMENTS
Contract No. US -1651
3
October 2015 — December 2016
Contract No. US -1651
STATEMENT OF WORK
THE ALLIANCE FOR AGING, INC.
NUTRITION SERVICES INCENTIVE PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1 GENERAL DESCRIPTION
ATTACHMENT
1.1.1 General Statement
The NSIP is intended to provide incentives for the effective delivery of nutritious meals to older individuals.
NSIP allows programs to increase the number and/or the quality of meals served. NSIP is a cash allotment
or commodity program that supplements funding or food used in meals served under the OAA. Florida has
opted for cash payments in lieu of donated foods.
1.1.2 Authority
The relevant authority governing NSIP are:
(1) Older Americans Act of 2006, as amended, Section 311 (42 U.S.C. § 3030a)
(2) 42 U.S.C. 303a, 42 U.S.C. 604
(3) Section 430.101, Florida Statutes
(4) Catalog of Federal Domestic Assistance (CFDA) 93.05
1.1.3 Scope of Service
The Contractor is responsible for the programmatic, fiscal and operational management of the NSIP,
involving oversight of the nutrition service operations of its subcontracted providers. The program services
provided under this contract shall be provided in a manner consistent with and described in the Contractor's
current area plan update, which is incorporated by reference, and the current DOEA Program and Services
Handbook, which is also incorporated by reference.
1.2.3.1 In fulfilling the terms of this agreement, the Contractor's scope of services shall consist of completion of
the following service tasks: (1) Client Eligibility Determination; (2) Program Eligibility Compliance; (3)
Program Coordination and Oversight; (4) Ensuring Compliance with Prescribed Nutrition Requirements;
(5) Ensuring Compliance with Prescribed Food Origin Requirements; (6) Compliance with Program
Reporting and Records Management Requirements; and (7) Monitoring the Performance of Subcontractors.
1.2.3.2 The Contractor shall use the NSIP funding under this contract to supplement funding for food used in meals
served under the OAA.
1.2.4 Term of Provision of Services
The term of this contract for the delivery of services shall be as referenced in Paragraph 3 of this contract.
However, for the purpose of settling upon the appropriate meal reimbursement rate, as provided by USDA,
the contract shall remain open until December 31, 2016. Notwithstanding this three (3) month
reconciliation period, this contract makes no provisions for the payment of any services provided beyond
September 30, 2016.
1.2.5 Major Program Goals
The major goals of the NSIP program are as follows:
M
October 2015 — December 2016
Contract No. US -1651
(1) To supplement funding for food used in meals served by OAA Nutrition Program Providers; and
(2) Provide incentives for the effective delivery of nutritious meals to older individuals.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 Congregate Meals
Client eligibility for congregate meals is as follows:
(1) Individuals age 60 or older;
(2) Spouses (regardless of age) attending the dining center with their eligible spouse;
(3) Persons with a disability, regardless of age, residing in a housing facility occupied primarily by older
individuals where congregate nutrition services are provided;
(4) Persons with disabilities residing at home with and accompanying an eligible person to the dining
center; and
(5) Volunteers, regardless of age, providing essential services on a regular basis during meal hours
1.3.2 Home Delivered Meals
Client eligibility for congregate meals is as follows:
(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 homebound eligible individual at home;
(3) Individuals with a disability, regardless of age, residing at home with eligible individuals and are
dependent on them for care;
(4) Persons at nutritional risk having physical, emotional or behavioral conditions, which would make their
presence at the congregate site inappropriate; and
(5) Persons at nutritional risk who are socially or otherwise isolated and unable to attend a congregate
nutrition site.
1.3.3 Restrictions
Meals served to an elderly individual funded in whole or in part under the Medicaid Waiver, Home Care
for the Elderly or Community Care for the Elderly Programs or other means tested programs may not be
included in the NSIP count.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
2.1.1 Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become
a client is based on meeting the requirements described in this ATTACHMENT I, Section 11 2.1.2.
2.1.2 Program Eligibility Requirements
Entities must meet the following criteria in order to be eligible for program participation:
(1) An agency that has received a grant under the OAA Title III (OAA section 311(42 U.S.C.3030a)); and
5
October 2015 — December 2016
Contract No. US -1651
(2) A nutrition service provider that serves meals and is under the jurisdiction, control, management and
audit authority of the Area Agency on Aging and the Department of Elder Affairs.
2.1.3 Oversight of Provider's Nutrition Service Operations
The Contractor shall oversee the nutrition service operations of the provider to ensure that the requirements
of ATTACHMENT I are met, as well as any other applicable regulations and policies prescribed by the
Department of Health and Human Services, USDA, state and local health departments or any other agency
designated to inspect meal quality for the State.
2.1.4 Prescribed Nutritional Requirements
The Contractor shall ensure that each meal provided under this NSIP contract meets the following criteria:
(1) Comply with the current Dietary Guidelines for Americans, published by the Secretaries of the
Department of Health and Human Services and the Department of Agriculture; and
(2) Provide a minimum of 33 1/3 percent of the dietary reference intakes /adequate intakes for an age 70+
female as established by the Food and Nutrition Board of the National Academy of Sciences.
2.1.5 Food Origin and Commodities Requirements
Consistent with existing requirements of the Nutrition Services Incentive program, the Contractor and its
service providers may use NSIP cash to purchase foods of U.S. origin for their nutrition projects under Title
III of the OAA. NSIP funds must be used to expand meal services to older adults.
2.1.6 Compliance with Program Reporting and Records Management Requirements
(1) The Contractor shall ensure that all program reporting requirements evidencing service delivery are
timely met. The Contractor must establish interim report submittal due dates for its providers or
Subcontractors to permit the Contractor to meet the Department's reporting deadlines.
(2) In addition to any special reports that may be requested by the Department, the Contractor shall comply
with the reporting and records management requirements as referenced in this ATTACHMENT
II, sections 2.4 through 2.5.1.
2.1.7 Use of Subcontractors
If this contract involves the use of a Subcontractor or third party, then the Contractor shall not delay the
implementation of its agreement with the Subcontractor. If any circumstances occur that may result in a
delay for a period of 60 days or more of the initiation of the Subcontract or in the performance of the
Subcontractor, the Contractor shall notify the Contract Manager and the Alliance's Chief Financial
Officer in writing of such delay.
The Contractor shall not permit a Subcontractor to perform services related to this agreement without
having a binding Subcontractor agreement executed. The Alliance will not be responsible or liable
for any obligations or claims resulting from such action.
2.1.8 Monitoring the Performance of Subcontractors
The Contractor shall monitor at least once per year each of its Subcontractors, Subrecipients, Vendors
and/or Consultants paid from funds provided under this contract. The Contractor shall perform fiscal,
administrative and programmatic monitoring to ensure contractual compliance, fiscal accountability,
programmatic performance and compliance with applicable state and federal laws and regulations. The
Contractor shall monitor to ensure that time schedules are met the budget and scope of work are
accomplished within the specified time periods
achieved.
and other performance goals stated in this contract are
31
October 2015 — December 2016
2.2 SERVICE TIMES
2.2.1 Service Times
Contract No. US -1651
The Contractor shall ensure the services listed in this contract are available at times appropriate to meet
client service needs, at a minimum, during normal business hours. Normal business hours are defined as
Monday through Friday, 8:00am to 5:OOpm.
2.3 DELIVERABLES
2.3.1 Service Unit
The Contractor shall ensure the provision of the services described in the contract in accordance with the
current Department of Elder Affairs Programs and Services Handbook and the service tasks described in
ATTACHMENT I, SECTION II Part 2.1. The chart below lists the type of services allowed and
the unit of measurement:
Service Unit of Service
Congregate Meals Meal
Home Delivered Meals Meal
7
October 2105 to December 2016
2.4 REPORTS
Contract # US 1651
The Contractor shall respond to additional routine and /or special requests for information and reports required by
the Alliance in a timely manner as determined by the Contract Manager. The Contractor shall establish due
dates for any Subcontractors that permit the Contractor to meet the Alliance's reporting requirements.
2.4.1 Client Information and Registration Tracking System (CIRTS) Reports
The Contractor shall input NSIP specific data into CIRTS to ensure CIRTS data accuracy. The Contractor
shall use CIRTS generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports;
(4) Miscellaneous Reports;
(5) Fiscal Reports;
(6) Aging and Disability Resource Center Reports; and
(7) Outcome Measurement Reports.
2.5 RECORDS AND DOCUMENTATION
The Contractor shall ensure the collection and maintenance of client and service information on a monthly basis
from the CIRTS or any such system designated by the Department. Maintenance includes valid exports and backups of
all data and systems according to Department standards.
2.5.1 Each Contractor and Subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to
recover from losses or outages of the computer system. Data and software essential to the continued
operation of Contractor functions must be backed up. The security controls over the backup resources
shall be as stringent as the protection required of the primary resources. It is recommended that a copy of
the backed up data be stored in a secure, offsite location. 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 will be made
available to the Alliance upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
The Contractor shall ensure services provided under this contract are in accordance with the current DOEA
Programs and Services Handbook.
The Contractor shall timely submit to the Alliance all reports and information described in
ATTACHMENT I, SECTION 11 2.4 and 2.5.
2.7 ALLIANCE RESPONSIBILITIES
2.7.1 Program Guidance and Technical Assistance
The Alliance will provide the Contractor with guidance and technical assistance as needed to ensure the
successful fulfillment of the contract by the Contractor.
2.7.2 Contract Monitoring
The Alliance will review and evaluate the performance of the Contractor under the terms of this contract.
October 2105 to December 2016 Contract # US 1651
Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or an
on -site visit. The Alliance's determination of acceptable performance shall be conclusive. The
Contractor agrees to cooperate with the Alliance in monitoring the progress of completion of the service tasks
and deliverables. The Alliance 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.
SECTION III: METHOD OF PAYMENT
3.1 GENERAL STATEMENT OF METHOD OF PAYMENT
This is a fixed rate contract. The Alliance shall make payment to the Contractor for provision of services up to a
maximum number of units of service and at the prospective rate stated below:
Service to be Provided
Unit of Service
Unit Rate
Maximum
un
Eligible Congregate and
l unit = 1 meal
$.72
37,842
Home Delivered Meals
The prospective rate is based on the estimated OAA grant award.
3.2 REQUESTS FOR PAYMENT
3.2.1 Date for Final Request for Payment
(1) The final request for payment is due to the Alliance no later than October 15, 2016 This contract is for services
provided during the 2014 Federal Fiscal Year beginning October 1. 2015 through September 30. ZM;
however, the contract is in effect through December 31, 2016 The additional three months (October 1. ZM
through December 31. 20161 are to allow rates to be adjusted for the service period. This contract shall
automatically terminate after the final rate for the federal fiscal year has been established and the release of
final payments are authorized by the Alliance.
(2) In the event that the final reimbursement rate is greater or less than the rate in ATTACHMENT I, Section 3.1,
then this contract shall be appropriately adjusted upon notice from the Contract Manager.
(3) In the event of a conflict between this paragraph and any other provision in the contract, this section shall
supersede.
3.2.2 Documentation for Payment
The Contractor shall submit all requests for reimbursement in accordance with (ATTACHMENT I) All
requests for reimbursement must include the following:
(1) The Contractor shall submit the request for reimbursement on DOEA Form 117NSIP, NSIP Request
for Reimbursement, (ATTACHMENT VII);
(2) The Contractor shall submit a CIRTS report with DOEA Form 117NSIP as supporting documentation
9
October 2105 to December 2016 Contract # US 1651
for the total number of meals reported. The CIRTS report must match the number of meals reported on
DOEA Form 117NSIP;
(3) The due date for the request for reimbursement and report(s) is no .later than the 191JLday of the month
following the month being reported, except for the final request for reimbursement, which is due no
later than October 15. 2016 The Recipient must submit the final request for payment to the Alliance no
more than 15 days after the contract ends or is terminated; if the Recipient fails to do so, all right to
payment is forfeited, and the Alliance will not honor any requests submitted after the aforesaid
time period. Any payment due under the terms of this contract may be withheld until all reports due
from the Recipient, and necessary adjustments thereto, have been approved by the Alliance.
(4) Additional Reporting Requirements: If the Alliance has sanctioned the recipient, while the sanctions are
in effect the recipient shall provide to the Alliance, on a monthly basis, the recipient's financial
statements that reflect the current, un- audited revenues and expenditures and the recipient's cash
position as well as any other documentation that may be requested by the Alliance.
(5) If the recipient is required to prepare a corrective action plan, supporting documentation as requested by
the Alliance shall be provided.
3.2.2.1 The Contractor shall maintain documentation to support payment requests that shall be available to the
Alliance or authorized individuals, such as the Alliance of Financial Services, upon request.
3.2.2.2 Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and
approval by the Alliance of complete and accurate financial and programmatic reports due from the Contractor
and any adjustments thereto, including any disallowance not resolved or pending resolution.
3.2.2.3 The Contractor must enter all required data per (ATTACHMENT I). The data must be entered into the
CIRTS before the Subcontractors submit their request for payment and expenditure reports to the
Contractor. The Contractor shall establish time frames to assure compliance with due dates for the
submission of requests for payment and expenditure reports to the Alliance.
3.2.2.4 The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is
accurate. This report must be submitted to the Contractor with the monthly request for payment and
expenditure report and must be reviewed by the Contractor before the Subcontractor's request for payment
and expenditure reports can be approved by the Contractor.
3.2.3 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 shall only be
delivered to eligible program participants.
3.2.3.1 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.
3.2.4 Consequence for Noncompliance/ Financial Consequences
The Contractor shall ensure 100% of the deliverables identified in ATTACHMENT I are
performed pursuant to contract requirements. The Service Tasks identified in Section 2.1 are
Major Deliverables in this contract.
3.2.4.1 If at any time the Contractor is notified by the Alliance's Contract Manager that it has
failed to correctly, completely, or adequately perform the Major Deliverables, the Contractor
will have 10 days to issue a Corrective Action Plan ( "CAP ") to the Contract Manager or
delegee that addresses the deficiencies and states how the deficiencies will be remedied
within the specified time period. The Alliance shall assess a Financial Consequence of 1%
10
October 2105 to December 2016 Contract # US 1651
of the monthly value of the contract for Non - Compliance on the Contractor for each
Deficiency identified in the CAP which is not corrected pursuant to the CAP. The
Alliance will also assess a Financial Consequence for failure to timely submit a CAP.
3.2.4.2 In the event the Contractor fails to correct an identified deficiency within the timeline
specified in the CAP, the Alliance shall deduct, from the payment for the invoice of the
following month, 1% of the monthly value of the contract for each day the deficiency is not
corrected.
11
October 2105 to December 2016
Contract # US 1651
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
Nutrition Services Incentive Program
FGTF
93.053
$27,245.93
TOTAL FEDERAL AWARD
$27,245.93
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirement for Federal Awards.
STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MAT(`uiN(_ IDVQ"ITDi! UC inn UU"UDAi nnnrrnArac
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT
AL STATE AWARD
fIAlh V11NANUTAL ASS1NTA1NUE SUBjECrj TU Sec. 215.97, F.S.
PROGRAM TITLE I FUNDING SOURCE CSFA I AMOUNT
AL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
N/A
12
October 2105 to December 2016
Contract # US 1651
ATTACHMENT III
EXHIBIT 1
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 69I- 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 - 5.006(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 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
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 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
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 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
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
13
October 2015 — December 2016
Contract # US 1651
ATTACHMENT VII
REQUEST FOR REIMBURSEMENT
Nutrition Services Incentive Program
PROVIDER NAME, ADDRESS, PHONE# and FEID#
TYPE OF REPORT:
THIS REQUEST PERIOD:
Payment Request:
From To
Regular Final
Report #
Contract Period To
Contract #
PSA #
CERTIFICATION: I hereby certify that to the best of my ImovAedge the Information In this report Is accurate and complete and that all outlays reported herein were for purposes
set forth in the contract documents.
Prepared by: Date: Approved by: Date
PART A: REIMBURSEMENT COMPUTATION
YEAR TO DATE
CURRENT MONTH
CONGREGATE
HOME DELIVERED
CONGREGATE
HOME DELIVERED
1. Number of Meals Served
0
0
0
0
2. Line 1 Times $ .72 cams per Meal
$0.00
$0.00
$0.00
$0.00
Year To Date Total Meals 0
Current Month Total Meals 0
Year To Date Total Reimbursed $0.00
Total Reimbursement Requested $0.00
PART B: CONTRACT SUMMARY
1. Approved Contract Amount
$0.00.
2. Previous Reimbursements Requested
$0,00
3. Contract Balance
$0.00
4. Amount to be Reimbursed - This Report
$0.00
5. Contract Balance
$0.00
DOEP. Fotm 11 ] ,)sip r-SeU 7/14
14
October 2015 — December 2016
Contract # US 1651
ATTACHMENT H
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 with 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
to the Department 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
Department 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.
S —
Signature
(Same as contract signature)
COUNTY ADMINISTRATOR
Title
4 k t �1? 0
S
Date
SEP 2 2 2015
MONROE COUNTY BOCC/ SOCIAL SERVICES
Company Name
C�
15